Migraine ICYMI

With increasing options for migraine therapy, the right choice for each patient might not be clear. And many individual patients could experience relief from any of the different choices, meaning that there is often more than one “right” answer when it comes to selecting a migraine treatment approach for each patient. Triptans and nonsteroidal anti-inflammatory drugs (NSAIDs), which have been around for decades, have shown consistent success in treating migraine episodes. Newer therapies could be safer for patients who have contraindications to triptans or NSAIDs, and these newer medications could be more effective for some patients, but we are still trying to fully understand which types of patients. Studies aimed at reaching conclusions regarding comparisons between triptans, calcitonin gene-related peptide inhibitors (CGRPi), and other treatments can help us determine which of the different categories of treatments are most effective for certain migraine populations (age or migraine subtype) or indications (acute vs preventive therapy).

A review published in 2023 in Aging and Disease described several markers of aging that are associated with migraine, including epigenetic aging and oxidative stress.² The review authors noted that markers of cellular senescence (ie, irreversible inhibition of cellular division) were increased in association with migraine. Additionally, endothelial progenitor cells, which reflect an increased ability for cell renewal, were decreased among migraine patients compared with the control group.

Telomeres, composed of nucleotides, are part of chromosome structures, serving to protect the molecular integrity of DNA. It has been established that shortened telomeres, often considered a reflection of aging and a marker of high potential for genetic and cellular damage, are a risk factor for physiologic changes that occur with the aging process. The 2024 Scientific Reports cross-sectional study included data from 6169 participants in the National Health and Nutrition Survey (NHANES) from 1999 to 2002.¹ The researchers used statistical analysis to determine whether there was an age-influenced telomere length in relation to migraine. They found that “telomere length was inversely associated with migraine risk in those aged 20-50 years, while no relationship was observed in those aged > 50 years.” The significance of this association among the younger group, but not among the older group, is not clear.

The limited research regarding the links between migraine and physiologic markers of aging has not untangled cause-and-effect distinctions. And while there is no evidence that preventing or treating migraine could slow down these pro-aging molecular processes, we do know that the distress of migraine episodes contributes to pain, anxiety, stress, depression, and sleep disruption. Given that we can’t change a patient’s hereditary predisposition to migraines, we can make an effort to alleviate the impact of migraine by using the tools that we have.

An article published in September 2024 in the BMJ described the results of a meta-analysis that included “137 randomized controlled trials with 89,445 participants allocated to 1 of 17 active interventions or placebo.”³ Treatments included NSAIDs, paracetamol, triptans, and CGRPi. The authors observed that triptans “had the best profiles and were more efficacious” than other treatment categories, including CGRPi. Interestingly, they observed that eletriptan and ibuprofen performed better for sustained pain freedom. Efficacy and sustained relief are crucial for patients with migraine, and for those who experience relief with simple over-the-counter ibuprofen, it makes sense to avoid making changes. But for those who are not getting the relief they need with established migraine therapies, trying the newer medications, such as CGRPi, could provide a solution. It is also important to keep in mind that triptans are contraindicated for some patients, such as those with a high-risk cardiovascular profile. Additionally, some patients may have contraindications to NSAIDs.

Prevention is another important aspect of migraine care. A September 2024 article in Headache: The Journal of Head and Face Pain used a retrospective cohort analysis of Patient-Reported Outcomes Measurement Information System (PROMIS) data, which included 1245 patients using a variety of migraine preventive therapies: antidepressants, antiseizure medications, beta-blockers, and CGRPi.⁴ The researchers reported that patients taking “CGRPi had a statistically significant reduction in pain T-scores (60.4 [standard deviation (SD) 7.4] to 58.4 [SD 8.2], p = 0.003), especially those who switched from other preventative medications to CGRPi.” This, along with the BMJ meta-analysis,³ helps in assessing relative benefits for treatments of acute migraine episodes and for migraine prevention. However, the efficacy of various types of therapy highlights the value of considering all options for each patient.

Individual patient characteristics, particularly contraindications, also play an important role in guiding therapeutic selection. And trial and error remain part of migraine treatment, given that there are no pretesting determinants that can predict treatment success for individual patients. We need to emphasize to patients that effective migraine therapy is obtainable and important — for comfort, quality of life, and possibly overall healthy aging.

References

1. Geng D, Liu H, Wang H, Wang H. Telomere length exhibits inverse association with migraine among Americans aged 20-50 years, without implications beyond age 50: a cross-sectional study. Sci Rep. 2024;14:22597. Source
2. Fila M, Pawlowska E, Szczepanska J, Blasiak J. Different aspects of aging in migraine. Aging Dis. 2023;14:6. Source
3. Karlsson WK, Ostinelli EG, Zhuang ZA, et al. Comparative effects of drug interventions for the acute management of migraine episodes in adults: Systematic review and network meta-analysis. BMJ. 2024;386:e080107. Source
4. Peasah SK, Soh YH, Huang Y, Nguyen J, Hanmer J, Good C. Patient reported outcomes and real-world use of calcitonin gene-related peptide medications in migraine. Headache. Published online September 30, 202 Source

With increasing options for migraine therapy, the right choice for each patient might not be clear. And many individual patients could experience relief from any of the different choices, meaning that there is often more than one “right” answer when it comes to selecting a migraine treatment approach for each patient. Triptans and nonsteroidal anti-inflammatory drugs (NSAIDs), which have been around for decades, have shown consistent success in treating migraine episodes. Newer therapies could be safer for patients who have contraindications to triptans or NSAIDs, and these newer medications could be more effective for some patients, but we are still trying to fully understand which types of patients. Studies aimed at reaching conclusions regarding comparisons between triptans, calcitonin gene-related peptide inhibitors (CGRPi), and other treatments can help us determine which of the different categories of treatments are most effective for certain migraine populations (age or migraine subtype) or indications (acute vs preventive therapy).

A review published in 2023 in Aging and Disease described several markers of aging that are associated with migraine, including epigenetic aging and oxidative stress.² The review authors noted that markers of cellular senescence (ie, irreversible inhibition of cellular division) were increased in association with migraine. Additionally, endothelial progenitor cells, which reflect an increased ability for cell renewal, were decreased among migraine patients compared with the control group.

Telomeres, composed of nucleotides, are part of chromosome structures, serving to protect the molecular integrity of DNA. It has been established that shortened telomeres, often considered a reflection of aging and a marker of high potential for genetic and cellular damage, are a risk factor for physiologic changes that occur with the aging process. The 2024 Scientific Reports cross-sectional study included data from 6169 participants in the National Health and Nutrition Survey (NHANES) from 1999 to 2002.¹ The researchers used statistical analysis to determine whether there was an age-influenced telomere length in relation to migraine. They found that “telomere length was inversely associated with migraine risk in those aged 20-50 years, while no relationship was observed in those aged > 50 years.” The significance of this association among the younger group, but not among the older group, is not clear.

The limited research regarding the links between migraine and physiologic markers of aging has not untangled cause-and-effect distinctions. And while there is no evidence that preventing or treating migraine could slow down these pro-aging molecular processes, we do know that the distress of migraine episodes contributes to pain, anxiety, stress, depression, and sleep disruption. Given that we can’t change a patient’s hereditary predisposition to migraines, we can make an effort to alleviate the impact of migraine by using the tools that we have.

An article published in September 2024 in the BMJ described the results of a meta-analysis that included “137 randomized controlled trials with 89,445 participants allocated to 1 of 17 active interventions or placebo.”³ Treatments included NSAIDs, paracetamol, triptans, and CGRPi. The authors observed that triptans “had the best profiles and were more efficacious” than other treatment categories, including CGRPi. Interestingly, they observed that eletriptan and ibuprofen performed better for sustained pain freedom. Efficacy and sustained relief are crucial for patients with migraine, and for those who experience relief with simple over-the-counter ibuprofen, it makes sense to avoid making changes. But for those who are not getting the relief they need with established migraine therapies, trying the newer medications, such as CGRPi, could provide a solution. It is also important to keep in mind that triptans are contraindicated for some patients, such as those with a high-risk cardiovascular profile. Additionally, some patients may have contraindications to NSAIDs.

Prevention is another important aspect of migraine care. A September 2024 article in Headache: The Journal of Head and Face Pain used a retrospective cohort analysis of Patient-Reported Outcomes Measurement Information System (PROMIS) data, which included 1245 patients using a variety of migraine preventive therapies: antidepressants, antiseizure medications, beta-blockers, and CGRPi.⁴ The researchers reported that patients taking “CGRPi had a statistically significant reduction in pain T-scores (60.4 [standard deviation (SD) 7.4] to 58.4 [SD 8.2], p = 0.003), especially those who switched from other preventative medications to CGRPi.” This, along with the BMJ meta-analysis,³ helps in assessing relative benefits for treatments of acute migraine episodes and for migraine prevention. However, the efficacy of various types of therapy highlights the value of considering all options for each patient.

Individual patient characteristics, particularly contraindications, also play an important role in guiding therapeutic selection. And trial and error remain part of migraine treatment, given that there are no pretesting determinants that can predict treatment success for individual patients. We need to emphasize to patients that effective migraine therapy is obtainable and important — for comfort, quality of life, and possibly overall healthy aging.

References

1. Geng D, Liu H, Wang H, Wang H. Telomere length exhibits inverse association with migraine among Americans aged 20-50 years, without implications beyond age 50: a cross-sectional study. Sci Rep. 2024;14:22597. Source
2. Fila M, Pawlowska E, Szczepanska J, Blasiak J. Different aspects of aging in migraine. Aging Dis. 2023;14:6. Source
3. Karlsson WK, Ostinelli EG, Zhuang ZA, et al. Comparative effects of drug interventions for the acute management of migraine episodes in adults: Systematic review and network meta-analysis. BMJ. 2024;386:e080107. Source
4. Peasah SK, Soh YH, Huang Y, Nguyen J, Hanmer J, Good C. Patient reported outcomes and real-world use of calcitonin gene-related peptide medications in migraine. Headache. Published online September 30, 202 Source

With increasing options for migraine therapy, the right choice for each patient might not be clear. And many individual patients could experience relief from any of the different choices, meaning that there is often more than one “right” answer when it comes to selecting a migraine treatment approach for each patient. Triptans and nonsteroidal anti-inflammatory drugs (NSAIDs), which have been around for decades, have shown consistent success in treating migraine episodes. Newer therapies could be safer for patients who have contraindications to triptans or NSAIDs, and these newer medications could be more effective for some patients, but we are still trying to fully understand which types of patients. Studies aimed at reaching conclusions regarding comparisons between triptans, calcitonin gene-related peptide inhibitors (CGRPi), and other treatments can help us determine which of the different categories of treatments are most effective for certain migraine populations (age or migraine subtype) or indications (acute vs preventive therapy).

A review published in 2023 in Aging and Disease described several markers of aging that are associated with migraine, including epigenetic aging and oxidative stress.² The review authors noted that markers of cellular senescence (ie, irreversible inhibition of cellular division) were increased in association with migraine. Additionally, endothelial progenitor cells, which reflect an increased ability for cell renewal, were decreased among migraine patients compared with the control group.

Telomeres, composed of nucleotides, are part of chromosome structures, serving to protect the molecular integrity of DNA. It has been established that shortened telomeres, often considered a reflection of aging and a marker of high potential for genetic and cellular damage, are a risk factor for physiologic changes that occur with the aging process. The 2024 Scientific Reports cross-sectional study included data from 6169 participants in the National Health and Nutrition Survey (NHANES) from 1999 to 2002.¹ The researchers used statistical analysis to determine whether there was an age-influenced telomere length in relation to migraine. They found that “telomere length was inversely associated with migraine risk in those aged 20-50 years, while no relationship was observed in those aged > 50 years.” The significance of this association among the younger group, but not among the older group, is not clear.

The limited research regarding the links between migraine and physiologic markers of aging has not untangled cause-and-effect distinctions. And while there is no evidence that preventing or treating migraine could slow down these pro-aging molecular processes, we do know that the distress of migraine episodes contributes to pain, anxiety, stress, depression, and sleep disruption. Given that we can’t change a patient’s hereditary predisposition to migraines, we can make an effort to alleviate the impact of migraine by using the tools that we have.

An article published in September 2024 in the BMJ described the results of a meta-analysis that included “137 randomized controlled trials with 89,445 participants allocated to 1 of 17 active interventions or placebo.”³ Treatments included NSAIDs, paracetamol, triptans, and CGRPi. The authors observed that triptans “had the best profiles and were more efficacious” than other treatment categories, including CGRPi. Interestingly, they observed that eletriptan and ibuprofen performed better for sustained pain freedom. Efficacy and sustained relief are crucial for patients with migraine, and for those who experience relief with simple over-the-counter ibuprofen, it makes sense to avoid making changes. But for those who are not getting the relief they need with established migraine therapies, trying the newer medications, such as CGRPi, could provide a solution. It is also important to keep in mind that triptans are contraindicated for some patients, such as those with a high-risk cardiovascular profile. Additionally, some patients may have contraindications to NSAIDs.

Prevention is another important aspect of migraine care. A September 2024 article in Headache: The Journal of Head and Face Pain used a retrospective cohort analysis of Patient-Reported Outcomes Measurement Information System (PROMIS) data, which included 1245 patients using a variety of migraine preventive therapies: antidepressants, antiseizure medications, beta-blockers, and CGRPi.⁴ The researchers reported that patients taking “CGRPi had a statistically significant reduction in pain T-scores (60.4 [standard deviation (SD) 7.4] to 58.4 [SD 8.2], p = 0.003), especially those who switched from other preventative medications to CGRPi.” This, along with the BMJ meta-analysis,³ helps in assessing relative benefits for treatments of acute migraine episodes and for migraine prevention. However, the efficacy of various types of therapy highlights the value of considering all options for each patient.

Individual patient characteristics, particularly contraindications, also play an important role in guiding therapeutic selection. And trial and error remain part of migraine treatment, given that there are no pretesting determinants that can predict treatment success for individual patients. We need to emphasize to patients that effective migraine therapy is obtainable and important — for comfort, quality of life, and possibly overall healthy aging.

References

1. Geng D, Liu H, Wang H, Wang H. Telomere length exhibits inverse association with migraine among Americans aged 20-50 years, without implications beyond age 50: a cross-sectional study. Sci Rep. 2024;14:22597. Source
2. Fila M, Pawlowska E, Szczepanska J, Blasiak J. Different aspects of aging in migraine. Aging Dis. 2023;14:6. Source
3. Karlsson WK, Ostinelli EG, Zhuang ZA, et al. Comparative effects of drug interventions for the acute management of migraine episodes in adults: Systematic review and network meta-analysis. BMJ. 2024;386:e080107. Source
4. Peasah SK, Soh YH, Huang Y, Nguyen J, Hanmer J, Good C. Patient reported outcomes and real-world use of calcitonin gene-related peptide medications in migraine. Headache. Published online September 30, 202 Source

Key clinical point: Diabetes may have a bidirectional association with migraine risk. Type 1 diabetes (T1D) reduced the risk for migraine, whereas migraine without aura increased the risk for diabetes.

Major findings: Diabetes did not significantly affect the overall risk for migraine (odds ratio [OR], 0.85; P = .13). However, individuals with T1D had a lower risk for migraine (OR, 0.48; P = .002) than those without diabetes. Conversely, migraine did not significantly increase the risk for diabetes (OR, 1.00, P = .99), but individuals with migraine without aura had a higher risk for diabetes (OR, 1.19; P = .03) than those without migraine.

Study details: This meta-analysis included eight cross-sectional studies (131,361 patients with diabetes and 1,005,604 patients with migraine) and four cohort studies (103,205 patients with diabetes and 32,197 patients with migraine).

Disclosure: The study was funded by the Ministry of Health & Welfare, Republic of Korea, and the National Research Foundation of Korea. One author is a junior editor at The Journal of Headache and Pain, and another serves on its board and has received grants from the Korea Health Industry Development Institute.

Source: Ha WS, Nguyen VK, Chu MK. Epidemiological linkage between migraine and diabetes mellitus: A systematic review and meta-analysis. J Headache Pain. 2024;25:158. Source

Key clinical point: Diabetes may have a bidirectional association with migraine risk. Type 1 diabetes (T1D) reduced the risk for migraine, whereas migraine without aura increased the risk for diabetes.

Major findings: Diabetes did not significantly affect the overall risk for migraine (odds ratio [OR], 0.85; P = .13). However, individuals with T1D had a lower risk for migraine (OR, 0.48; P = .002) than those without diabetes. Conversely, migraine did not significantly increase the risk for diabetes (OR, 1.00, P = .99), but individuals with migraine without aura had a higher risk for diabetes (OR, 1.19; P = .03) than those without migraine.

Study details: This meta-analysis included eight cross-sectional studies (131,361 patients with diabetes and 1,005,604 patients with migraine) and four cohort studies (103,205 patients with diabetes and 32,197 patients with migraine).

Disclosure: The study was funded by the Ministry of Health & Welfare, Republic of Korea, and the National Research Foundation of Korea. One author is a junior editor at The Journal of Headache and Pain, and another serves on its board and has received grants from the Korea Health Industry Development Institute.

Source: Ha WS, Nguyen VK, Chu MK. Epidemiological linkage between migraine and diabetes mellitus: A systematic review and meta-analysis. J Headache Pain. 2024;25:158. Source

Key clinical point: Diabetes may have a bidirectional association with migraine risk. Type 1 diabetes (T1D) reduced the risk for migraine, whereas migraine without aura increased the risk for diabetes.

Major findings: Diabetes did not significantly affect the overall risk for migraine (odds ratio [OR], 0.85; P = .13). However, individuals with T1D had a lower risk for migraine (OR, 0.48; P = .002) than those without diabetes. Conversely, migraine did not significantly increase the risk for diabetes (OR, 1.00, P = .99), but individuals with migraine without aura had a higher risk for diabetes (OR, 1.19; P = .03) than those without migraine.

Study details: This meta-analysis included eight cross-sectional studies (131,361 patients with diabetes and 1,005,604 patients with migraine) and four cohort studies (103,205 patients with diabetes and 32,197 patients with migraine).

Disclosure: The study was funded by the Ministry of Health & Welfare, Republic of Korea, and the National Research Foundation of Korea. One author is a junior editor at The Journal of Headache and Pain, and another serves on its board and has received grants from the Korea Health Industry Development Institute.

Source: Ha WS, Nguyen VK, Chu MK. Epidemiological linkage between migraine and diabetes mellitus: A systematic review and meta-analysis. J Headache Pain. 2024;25:158. Source

Key clinical point: Dihydroergotamine (DHE) nasal powder was well tolerated over the long term for the acute treatment of migraine.

Major findings: Treatment-emergent adverse events were reported in 48.5% of the participants, with nasal discomfort being the most common (11.3%). No deaths were reported. A serious adverse event related to treatment occurred in only one participant who did not disclose contraindications to DHE, and 4.4% of the participants discontinued the use of DHE. There were no new safety concerns.

Study details: The ASCEND trial involved 344 adults aged 18-65 years with a history of 4-12 migraine attacks per month for at least 1 year. Participants self-administered DHE (5.2 mg) as needed, with a maximum of 12 doses per month, for 1 year.

Disclosure: This study was funded by Satsuma Pharmaceuticals, Inc. Two authors declared being employees and stockholders of Satsuma, and others declared having ties with various sources, including Satsuma.

Sources: Tepper SJ, Albrecht D, Ailani J. Kirby L, Strom S, Rapoport AM. Long-term (12-Month) safety and tolerability of STS101 (dihydroergotamine nasal powder) in the acute treatment of migraine: Data from the phase 3 open-label ASCEND study. CNS Drugs. Published online October 7, 2024. Source

Key clinical point: Dihydroergotamine (DHE) nasal powder was well tolerated over the long term for the acute treatment of migraine.

Major findings: Treatment-emergent adverse events were reported in 48.5% of the participants, with nasal discomfort being the most common (11.3%). No deaths were reported. A serious adverse event related to treatment occurred in only one participant who did not disclose contraindications to DHE, and 4.4% of the participants discontinued the use of DHE. There were no new safety concerns.

Study details: The ASCEND trial involved 344 adults aged 18-65 years with a history of 4-12 migraine attacks per month for at least 1 year. Participants self-administered DHE (5.2 mg) as needed, with a maximum of 12 doses per month, for 1 year.

Disclosure: This study was funded by Satsuma Pharmaceuticals, Inc. Two authors declared being employees and stockholders of Satsuma, and others declared having ties with various sources, including Satsuma.

Sources: Tepper SJ, Albrecht D, Ailani J. Kirby L, Strom S, Rapoport AM. Long-term (12-Month) safety and tolerability of STS101 (dihydroergotamine nasal powder) in the acute treatment of migraine: Data from the phase 3 open-label ASCEND study. CNS Drugs. Published online October 7, 2024. Source

Key clinical point: Dihydroergotamine (DHE) nasal powder was well tolerated over the long term for the acute treatment of migraine.

Major findings: Treatment-emergent adverse events were reported in 48.5% of the participants, with nasal discomfort being the most common (11.3%). No deaths were reported. A serious adverse event related to treatment occurred in only one participant who did not disclose contraindications to DHE, and 4.4% of the participants discontinued the use of DHE. There were no new safety concerns.

Study details: The ASCEND trial involved 344 adults aged 18-65 years with a history of 4-12 migraine attacks per month for at least 1 year. Participants self-administered DHE (5.2 mg) as needed, with a maximum of 12 doses per month, for 1 year.

Disclosure: This study was funded by Satsuma Pharmaceuticals, Inc. Two authors declared being employees and stockholders of Satsuma, and others declared having ties with various sources, including Satsuma.

Sources: Tepper SJ, Albrecht D, Ailani J. Kirby L, Strom S, Rapoport AM. Long-term (12-Month) safety and tolerability of STS101 (dihydroergotamine nasal powder) in the acute treatment of migraine: Data from the phase 3 open-label ASCEND study. CNS Drugs. Published online October 7, 2024. Source

Key clinical point: Patients with migraine who received calcitonin gene-related peptide inhibitors (CGRPi) showed improved pain reduction compared with those on other preventative medications.

Major findings: Patients who received only CGRPi or switched to CGRPi had significant reductions in mean pain scores (−2.0 and −2.7, respectively; both P < .001), whereas those on other migraine-preventative medications did not. Patients adhering to CGRPi, including those who received only CGRPi (−3.1; P = .005) and those who switched from other medications to CGRPi (−3.7; P = .002), had significantly reduced pain scores; however, no reduction in pain scores was noted in patients not adhering to CGRPi.

Study details: This retrospective study analyzed Patient Reported Outcomes Measurement Information System data for adults with migraine over 12 months, including 1245 patients on other preventive medications (antiseizures, antidepressants, or beta-blockers), 148 receiving only CGRPi, and 112 switching to CGRPi.

Disclosure: The study did not receive any funding. The authors declared no conflicts of interest.

Source: Peasah SK, Soh YH, Huang Y, Nguyen J, Hanmer J, Good C. Patient reported outcomes and the real-world use of calcitonin gene–related peptide medications in migraine. Headache. Published online September 30, 2024. Source

Key clinical point: Patients with migraine who received calcitonin gene-related peptide inhibitors (CGRPi) showed improved pain reduction compared with those on other preventative medications.

Major findings: Patients who received only CGRPi or switched to CGRPi had significant reductions in mean pain scores (−2.0 and −2.7, respectively; both P < .001), whereas those on other migraine-preventative medications did not. Patients adhering to CGRPi, including those who received only CGRPi (−3.1; P = .005) and those who switched from other medications to CGRPi (−3.7; P = .002), had significantly reduced pain scores; however, no reduction in pain scores was noted in patients not adhering to CGRPi.

Study details: This retrospective study analyzed Patient Reported Outcomes Measurement Information System data for adults with migraine over 12 months, including 1245 patients on other preventive medications (antiseizures, antidepressants, or beta-blockers), 148 receiving only CGRPi, and 112 switching to CGRPi.

Disclosure: The study did not receive any funding. The authors declared no conflicts of interest.

Source: Peasah SK, Soh YH, Huang Y, Nguyen J, Hanmer J, Good C. Patient reported outcomes and the real-world use of calcitonin gene–related peptide medications in migraine. Headache. Published online September 30, 2024. Source

Key clinical point: Patients with migraine who received calcitonin gene-related peptide inhibitors (CGRPi) showed improved pain reduction compared with those on other preventative medications.

Major findings: Patients who received only CGRPi or switched to CGRPi had significant reductions in mean pain scores (−2.0 and −2.7, respectively; both P < .001), whereas those on other migraine-preventative medications did not. Patients adhering to CGRPi, including those who received only CGRPi (−3.1; P = .005) and those who switched from other medications to CGRPi (−3.7; P = .002), had significantly reduced pain scores; however, no reduction in pain scores was noted in patients not adhering to CGRPi.

Study details: This retrospective study analyzed Patient Reported Outcomes Measurement Information System data for adults with migraine over 12 months, including 1245 patients on other preventive medications (antiseizures, antidepressants, or beta-blockers), 148 receiving only CGRPi, and 112 switching to CGRPi.

Disclosure: The study did not receive any funding. The authors declared no conflicts of interest.

Source: Peasah SK, Soh YH, Huang Y, Nguyen J, Hanmer J, Good C. Patient reported outcomes and the real-world use of calcitonin gene–related peptide medications in migraine. Headache. Published online September 30, 2024. Source

Key clinical point: Ubrogepant showed real-world effectiveness for the acute treatment of migraine, with increased treatment satisfaction and a strong intention to continue using the medication.

Major findings: A high proportion of patients reported using ubrogepant for relief from migraine, with satisfaction rates of 75.8% at 2 hours, 83.4% at 4 hours, and 78.5% at 24 hours. Additionally, 85.1% were satisfied with their ability to think clearly and 83.8% were satisfied with returning to normal function. Overall, 90.7% participants intended to continue using ubrogepant and 87.4% reported switching to ubrogepant due to inadequate response to previous migraine treatments.

Study details: This observational cross-sectional study included 302 adults who had received ubrogepant for the acute treatment of migraine within the preceding 14 days; 120 participants reported taking 50 mg ubrogepant and 182 reported taking 100 mg ubrogepant.

Disclosure: The study was funded by AbbVie. Four authors declared being current or former employees of AbbVie and may hold stock in the company. Several authors reported having ties with various sources.

Source: Shewale AR, Poh W, Reed ML, et al. Ubrogepant users' real-world experience: Patients on ubrogepant, characteristics, and outcomes (UNIVERSE) study. Headache. Published online September 26, 2024. Source

Key clinical point: Ubrogepant showed real-world effectiveness for the acute treatment of migraine, with increased treatment satisfaction and a strong intention to continue using the medication.

Major findings: A high proportion of patients reported using ubrogepant for relief from migraine, with satisfaction rates of 75.8% at 2 hours, 83.4% at 4 hours, and 78.5% at 24 hours. Additionally, 85.1% were satisfied with their ability to think clearly and 83.8% were satisfied with returning to normal function. Overall, 90.7% participants intended to continue using ubrogepant and 87.4% reported switching to ubrogepant due to inadequate response to previous migraine treatments.

Study details: This observational cross-sectional study included 302 adults who had received ubrogepant for the acute treatment of migraine within the preceding 14 days; 120 participants reported taking 50 mg ubrogepant and 182 reported taking 100 mg ubrogepant.

Disclosure: The study was funded by AbbVie. Four authors declared being current or former employees of AbbVie and may hold stock in the company. Several authors reported having ties with various sources.

Source: Shewale AR, Poh W, Reed ML, et al. Ubrogepant users' real-world experience: Patients on ubrogepant, characteristics, and outcomes (UNIVERSE) study. Headache. Published online September 26, 2024. Source

Key clinical point: Ubrogepant showed real-world effectiveness for the acute treatment of migraine, with increased treatment satisfaction and a strong intention to continue using the medication.

Major findings: A high proportion of patients reported using ubrogepant for relief from migraine, with satisfaction rates of 75.8% at 2 hours, 83.4% at 4 hours, and 78.5% at 24 hours. Additionally, 85.1% were satisfied with their ability to think clearly and 83.8% were satisfied with returning to normal function. Overall, 90.7% participants intended to continue using ubrogepant and 87.4% reported switching to ubrogepant due to inadequate response to previous migraine treatments.

Study details: This observational cross-sectional study included 302 adults who had received ubrogepant for the acute treatment of migraine within the preceding 14 days; 120 participants reported taking 50 mg ubrogepant and 182 reported taking 100 mg ubrogepant.

Disclosure: The study was funded by AbbVie. Four authors declared being current or former employees of AbbVie and may hold stock in the company. Several authors reported having ties with various sources.

Source: Shewale AR, Poh W, Reed ML, et al. Ubrogepant users' real-world experience: Patients on ubrogepant, characteristics, and outcomes (UNIVERSE) study. Headache. Published online September 26, 2024. Source

Key clinical point: Patients with rheumatoid arthritis (RA) had a higher risk for migraine than those without RA, irrespective of the RA serologic status.

 Major findings: Patients with vs without RA had a 1.2-fold higher risk for migraine (adjusted hazard ratio (aHR), 1.21; 95% CI, 1.17-1.26). Both seropositive RA (aHR 1.20; 95% CI, 1.15-1.24) and seronegative RA (aHR, 1.26; 95% CI, 1.20-1.34) were associated with an increased risk for migraine. However, the risk was not significantly different between patients with seropositive RA and those with seronegative RA.

Study details: This longitudinal retrospective cohort study included 42,674 patients with RA (29,774 with seropositive RA and 12,900 with seronegative RA) and 213,370 age- and sex-matched control individuals without RA. Overall, 22,294 new migraine cases were reported during a mean follow-up of 4.4 years, following a 1-year lag period.

Disclosure: The study did not receive any funding. The authors declared no conflicts of interest.

Source: Kang S, Eun Y, Han K, et al. Heightened migraine risk in patients with rheumatoid arthritis: A national retrospective cohort study. Headache. Published online September 13, 2024. Source

Key clinical point: Patients with rheumatoid arthritis (RA) had a higher risk for migraine than those without RA, irrespective of the RA serologic status.

 Major findings: Patients with vs without RA had a 1.2-fold higher risk for migraine (adjusted hazard ratio (aHR), 1.21; 95% CI, 1.17-1.26). Both seropositive RA (aHR 1.20; 95% CI, 1.15-1.24) and seronegative RA (aHR, 1.26; 95% CI, 1.20-1.34) were associated with an increased risk for migraine. However, the risk was not significantly different between patients with seropositive RA and those with seronegative RA.

Study details: This longitudinal retrospective cohort study included 42,674 patients with RA (29,774 with seropositive RA and 12,900 with seronegative RA) and 213,370 age- and sex-matched control individuals without RA. Overall, 22,294 new migraine cases were reported during a mean follow-up of 4.4 years, following a 1-year lag period.

Disclosure: The study did not receive any funding. The authors declared no conflicts of interest.

Source: Kang S, Eun Y, Han K, et al. Heightened migraine risk in patients with rheumatoid arthritis: A national retrospective cohort study. Headache. Published online September 13, 2024. Source

Key clinical point: Patients with rheumatoid arthritis (RA) had a higher risk for migraine than those without RA, irrespective of the RA serologic status.

 Major findings: Patients with vs without RA had a 1.2-fold higher risk for migraine (adjusted hazard ratio (aHR), 1.21; 95% CI, 1.17-1.26). Both seropositive RA (aHR 1.20; 95% CI, 1.15-1.24) and seronegative RA (aHR, 1.26; 95% CI, 1.20-1.34) were associated with an increased risk for migraine. However, the risk was not significantly different between patients with seropositive RA and those with seronegative RA.

Study details: This longitudinal retrospective cohort study included 42,674 patients with RA (29,774 with seropositive RA and 12,900 with seronegative RA) and 213,370 age- and sex-matched control individuals without RA. Overall, 22,294 new migraine cases were reported during a mean follow-up of 4.4 years, following a 1-year lag period.

Disclosure: The study did not receive any funding. The authors declared no conflicts of interest.

Source: Kang S, Eun Y, Han K, et al. Heightened migraine risk in patients with rheumatoid arthritis: A national retrospective cohort study. Headache. Published online September 13, 2024. Source

Key clinical point: Patients with epilepsy showed no significant increase in the overall prevalence of migraine or non-migraine headaches, but those with epilepsy and migraine had an increased frequency of headaches.

Major findings: Compared with individuals without epilepsy, patients with epilepsy had no significant increase in the overall prevalence of migraine (odds ratio [OR], 0.95; P = .78) or non-migraine headaches (OR, 1.18; P = .17). However, among patients with migraine, those with epilepsy were more likely to experience highly frequent headaches than those without epilepsy (OR, 1.73; P = .024).

Study details: This population-based case-control study included 63,622 participants (age, ≥ 20 years); 364 had epilepsy, including 210 without headaches, 46 with migraine, and 108 with non-migraine headaches.

Disclosure: The study was funded by the Norwegian Research Council. The authors declared no conflicts of interest.

Source: Engstrand H, Revdal E, Argren MB, et al. Relationship between migraine and epilepsy in a large population-based cohort: The HUNT Study. Eur J Neurol. Published online September 27, 2024. Source

Key clinical point: Patients with epilepsy showed no significant increase in the overall prevalence of migraine or non-migraine headaches, but those with epilepsy and migraine had an increased frequency of headaches.

Major findings: Compared with individuals without epilepsy, patients with epilepsy had no significant increase in the overall prevalence of migraine (odds ratio [OR], 0.95; P = .78) or non-migraine headaches (OR, 1.18; P = .17). However, among patients with migraine, those with epilepsy were more likely to experience highly frequent headaches than those without epilepsy (OR, 1.73; P = .024).

Study details: This population-based case-control study included 63,622 participants (age, ≥ 20 years); 364 had epilepsy, including 210 without headaches, 46 with migraine, and 108 with non-migraine headaches.

Disclosure: The study was funded by the Norwegian Research Council. The authors declared no conflicts of interest.

Source: Engstrand H, Revdal E, Argren MB, et al. Relationship between migraine and epilepsy in a large population-based cohort: The HUNT Study. Eur J Neurol. Published online September 27, 2024. Source

Key clinical point: Patients with epilepsy showed no significant increase in the overall prevalence of migraine or non-migraine headaches, but those with epilepsy and migraine had an increased frequency of headaches.

Major findings: Compared with individuals without epilepsy, patients with epilepsy had no significant increase in the overall prevalence of migraine (odds ratio [OR], 0.95; P = .78) or non-migraine headaches (OR, 1.18; P = .17). However, among patients with migraine, those with epilepsy were more likely to experience highly frequent headaches than those without epilepsy (OR, 1.73; P = .024).

Study details: This population-based case-control study included 63,622 participants (age, ≥ 20 years); 364 had epilepsy, including 210 without headaches, 46 with migraine, and 108 with non-migraine headaches.

Disclosure: The study was funded by the Norwegian Research Council. The authors declared no conflicts of interest.

Source: Engstrand H, Revdal E, Argren MB, et al. Relationship between migraine and epilepsy in a large population-based cohort: The HUNT Study. Eur J Neurol. Published online September 27, 2024. Source

Key clinical point: Galcanezumab, a calcitonin gene-related peptide monoclonal antibody targeting the peripheral nervous system, led to early improvement in the severity of symptoms associated with central sensitization in patients with migraine.

Major findings: The Central Sensitization Inventory score significantly decreased from 36.0 at baseline to 29.7 at 3 months and 29.3 at 6 months after galcanezumab treatment (P < .001). The Allodynia Symptom Checklist score decreased from 5.55 at baseline to 4.09 at 3 months (P < .01) and 4.26 at 6 months (P < .01) with galcanezumab treatment.

Study details: This prospective real-world study included 86 patients with migraine (age, 20-65 years) who were treated with galcanezumab (240 mg administered initially, followed by 120 mg monthly) for 6 months.

Disclosure: This study was funded by the Ministry of Health, Labor and Welfare, Japan. Several authors reported having ties with various sources.

Source: Danno D, Imai N, Kitamura S, Ishizaki K, Kikui S, Takeshima T. Efficacy of galcanezumab in migraine central sensitization. Sci Rep. 2024; 14:21824. Source

Key clinical point: Galcanezumab, a calcitonin gene-related peptide monoclonal antibody targeting the peripheral nervous system, led to early improvement in the severity of symptoms associated with central sensitization in patients with migraine.

Major findings: The Central Sensitization Inventory score significantly decreased from 36.0 at baseline to 29.7 at 3 months and 29.3 at 6 months after galcanezumab treatment (P < .001). The Allodynia Symptom Checklist score decreased from 5.55 at baseline to 4.09 at 3 months (P < .01) and 4.26 at 6 months (P < .01) with galcanezumab treatment.

Study details: This prospective real-world study included 86 patients with migraine (age, 20-65 years) who were treated with galcanezumab (240 mg administered initially, followed by 120 mg monthly) for 6 months.

Disclosure: This study was funded by the Ministry of Health, Labor and Welfare, Japan. Several authors reported having ties with various sources.

Source: Danno D, Imai N, Kitamura S, Ishizaki K, Kikui S, Takeshima T. Efficacy of galcanezumab in migraine central sensitization. Sci Rep. 2024; 14:21824. Source

Key clinical point: Galcanezumab, a calcitonin gene-related peptide monoclonal antibody targeting the peripheral nervous system, led to early improvement in the severity of symptoms associated with central sensitization in patients with migraine.

Major findings: The Central Sensitization Inventory score significantly decreased from 36.0 at baseline to 29.7 at 3 months and 29.3 at 6 months after galcanezumab treatment (P < .001). The Allodynia Symptom Checklist score decreased from 5.55 at baseline to 4.09 at 3 months (P < .01) and 4.26 at 6 months (P < .01) with galcanezumab treatment.

Study details: This prospective real-world study included 86 patients with migraine (age, 20-65 years) who were treated with galcanezumab (240 mg administered initially, followed by 120 mg monthly) for 6 months.

Disclosure: This study was funded by the Ministry of Health, Labor and Welfare, Japan. Several authors reported having ties with various sources.

Source: Danno D, Imai N, Kitamura S, Ishizaki K, Kikui S, Takeshima T. Efficacy of galcanezumab in migraine central sensitization. Sci Rep. 2024; 14:21824. Source

Key clinical point: In American adults aged 20-50 years, a shorter telomere length was associated with an increased risk for migraine; however, no such association was found in adults older than 50 years.

 Major findings: In adults aged 20-50 years, a decrease in the ratio of telomeric repeats to single-copy genes was associated with an increased risk for migraine (odds ratio [OR], 1.48; P = .047). Those with the shortest telomeres were at a greater risk for migraine than those with the longest telomeres (OR, 1.35; P = .043). Such an association was not observed in adults older than 50 years.

Study details: This cross-sectional study analyzed data from the US National Health and Nutrition Examination Survey (1999-2002) on migraine and leukocyte telomere length in 6169 adults with or without migraine.

 Disclosure: The study was supported by the Natural Science Foundation of Hebei Province and the Central Government Guides Local Funds for Science and Technology Development. The authors declared no conflicts of interest.

Source: Geng D, Liu H, Wang H, et al. Telomere length exhibits inverse association with migraine among Americans aged 20–50 years, without implications beyond age 50: A cross-sectional study. Sci Rep. 2024;14:22597. Source

Key clinical point: In American adults aged 20-50 years, a shorter telomere length was associated with an increased risk for migraine; however, no such association was found in adults older than 50 years.

 Major findings: In adults aged 20-50 years, a decrease in the ratio of telomeric repeats to single-copy genes was associated with an increased risk for migraine (odds ratio [OR], 1.48; P = .047). Those with the shortest telomeres were at a greater risk for migraine than those with the longest telomeres (OR, 1.35; P = .043). Such an association was not observed in adults older than 50 years.

Study details: This cross-sectional study analyzed data from the US National Health and Nutrition Examination Survey (1999-2002) on migraine and leukocyte telomere length in 6169 adults with or without migraine.

 Disclosure: The study was supported by the Natural Science Foundation of Hebei Province and the Central Government Guides Local Funds for Science and Technology Development. The authors declared no conflicts of interest.

Source: Geng D, Liu H, Wang H, et al. Telomere length exhibits inverse association with migraine among Americans aged 20–50 years, without implications beyond age 50: A cross-sectional study. Sci Rep. 2024;14:22597. Source

Key clinical point: In American adults aged 20-50 years, a shorter telomere length was associated with an increased risk for migraine; however, no such association was found in adults older than 50 years.

 Major findings: In adults aged 20-50 years, a decrease in the ratio of telomeric repeats to single-copy genes was associated with an increased risk for migraine (odds ratio [OR], 1.48; P = .047). Those with the shortest telomeres were at a greater risk for migraine than those with the longest telomeres (OR, 1.35; P = .043). Such an association was not observed in adults older than 50 years.

Study details: This cross-sectional study analyzed data from the US National Health and Nutrition Examination Survey (1999-2002) on migraine and leukocyte telomere length in 6169 adults with or without migraine.

 Disclosure: The study was supported by the Natural Science Foundation of Hebei Province and the Central Government Guides Local Funds for Science and Technology Development. The authors declared no conflicts of interest.

Source: Geng D, Liu H, Wang H, et al. Telomere length exhibits inverse association with migraine among Americans aged 20–50 years, without implications beyond age 50: A cross-sectional study. Sci Rep. 2024;14:22597. Source

Key clinical point: Erenumab was effective in achieving and sustaining the remission of medication overuse headache (MOH) in adults with chronic migraine (CM) and nonopioid MOH, with adverse events reflecting the known safety profile of erenumab.

Major findings: At 6 months, 140 mg erenumab was significantly more effective than placebo in achieving increased MOH remission (odds ratio [OR], 2.01; P < .001) and sustained MOH remission (OR, 2.63; P < .001). The most common treatment-emergent adverse events in both erunumab groups were constipation (15.2%) and COVID-19 (13.9%); no new adverse events were reported.

Study details: This phase 4 randomized controlled trial included 584 adults with CM and MOH in the nonopioid-treated cohort who did not respond to one or more preventive treatments. Participants were randomly assigned to receive monthly injections of erenumab (70 mg or 140 mg) or placebo for 24 weeks.

Disclosures: This study was funded by Amgen. Some authors declared being employees or stockholders of Amgen, and others declared having ties with various sources, including Amgen.

Source: Tepper SJ, Dodick DW, Lanteri-Minet M, et al. Efficacy and safety of erenumab for nonopioid medication overuse headache in chronic migraine: A phase 4, randomized, placebo-controlled trial. JAMA Neurol. Published online September 16, 2024. Source

Key clinical point: Erenumab was effective in achieving and sustaining the remission of medication overuse headache (MOH) in adults with chronic migraine (CM) and nonopioid MOH, with adverse events reflecting the known safety profile of erenumab.

Major findings: At 6 months, 140 mg erenumab was significantly more effective than placebo in achieving increased MOH remission (odds ratio [OR], 2.01; P < .001) and sustained MOH remission (OR, 2.63; P < .001). The most common treatment-emergent adverse events in both erunumab groups were constipation (15.2%) and COVID-19 (13.9%); no new adverse events were reported.

Study details: This phase 4 randomized controlled trial included 584 adults with CM and MOH in the nonopioid-treated cohort who did not respond to one or more preventive treatments. Participants were randomly assigned to receive monthly injections of erenumab (70 mg or 140 mg) or placebo for 24 weeks.

Disclosures: This study was funded by Amgen. Some authors declared being employees or stockholders of Amgen, and others declared having ties with various sources, including Amgen.

Source: Tepper SJ, Dodick DW, Lanteri-Minet M, et al. Efficacy and safety of erenumab for nonopioid medication overuse headache in chronic migraine: A phase 4, randomized, placebo-controlled trial. JAMA Neurol. Published online September 16, 2024. Source

Key clinical point: Erenumab was effective in achieving and sustaining the remission of medication overuse headache (MOH) in adults with chronic migraine (CM) and nonopioid MOH, with adverse events reflecting the known safety profile of erenumab.

Major findings: At 6 months, 140 mg erenumab was significantly more effective than placebo in achieving increased MOH remission (odds ratio [OR], 2.01; P < .001) and sustained MOH remission (OR, 2.63; P < .001). The most common treatment-emergent adverse events in both erunumab groups were constipation (15.2%) and COVID-19 (13.9%); no new adverse events were reported.

Study details: This phase 4 randomized controlled trial included 584 adults with CM and MOH in the nonopioid-treated cohort who did not respond to one or more preventive treatments. Participants were randomly assigned to receive monthly injections of erenumab (70 mg or 140 mg) or placebo for 24 weeks.

Disclosures: This study was funded by Amgen. Some authors declared being employees or stockholders of Amgen, and others declared having ties with various sources, including Amgen.

Source: Tepper SJ, Dodick DW, Lanteri-Minet M, et al. Efficacy and safety of erenumab for nonopioid medication overuse headache in chronic migraine: A phase 4, randomized, placebo-controlled trial. JAMA Neurol. Published online September 16, 2024. Source