Migraine Briefs

TOPLINE:

Habitual consumption of caffeine is not associated with frequency, duration, or intensity of episodic migraines, a new study showed. Investigators said the findings suggest caffeine restrictions in migraineurs may not be necessary.

METHODOLOGY:

• The secondary analysis of a prospective cohort study on sleep in adults with episodic migraine (with or without aura) included a group of 97 people (median age, 31 years; 82% White) with an average of 5.0 ± 3.6  days per month at baseline.
• Participants provided sociodemographic information, medical history, habitual caffeinated beverage consumption, alcohol intake, and lifestyle and psychosocial factors and completed the Center for Epidemiologic Studies- scale, the Perceived Stress Scale, and the Pittsburgh Sleep Quality Index.
• Additionally, they completed twice-daily electronic diaries for the subsequent 6 weeks, reporting headache activity and the use of medications to treat the headache.

TAKEAWAY:

• A total of 67% of participants reported one to two servings of caffeinated beverages per day, 12% reported three to four servings per day, and 21% reported no habitual caffeine consumption.
• After adjusting for age, sex, oral  use, and other confounders, mean headache frequency was similar among groups (7.1 days for no caffeine, 7.4 days for one to two servings, and 5.9 days for three to four servings).
• Similarly, adjusted mean headache duration did not differ across levels of caffeinated beverage intake (8.6 hours for no caffeine, 8.5 hours for one to two servings, and 8.8 hours for three to four servings).
• Adjusted mean headache intensity also did not differ among groups.

IN PRACTICE:

“Our findings do not support a recommendation for people with episodic migraine to avoid habitual caffeinated beverage intake,” the authors wrote. However, they noted that habitual caffeine intake may affect systems involved in pain modulation via adenosine signaling. «Therefore, it is possible that habitual caffeine use in those with migraine does not significantly alter adenosine signaling, but significant changes above or below usual consumption may serve as a trigger or contribute to lowering the threshold for an attack to occur along with other triggers,» they added.

SOURCE:

Suzanne M. Bertisch, MD, MPH, assistant professor of medicine, Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, was the senior and corresponding author of the study. It was published online in Headache.

LIMITATIONS:

Serving size was not standardized, and there was no information on the type of caffeinated beverage consumed or about other sources of caffeine. Moreover, the population consisted of relatively healthy participants with episodic migraine and generally low levels of habitual caffeinated beverage intake, which limited the statistical power to detect an association between migraine frequency, duration, and intensity with higher levels of caffeine intake.

DISCLOSURES:

The study was funded by the National Institute of Neurological Disorders and Stroke, the American Sleep Medicine Foundation, and the Harvard Catalyst/Harvard Clinical and Translational Science Center. Dr. Bertisch has done consulting work with Idorsia and ResMed. The other authors’ disclosures are listed in the original paper.

A version of this article appeared on Medscape.com.

TOPLINE:

Habitual consumption of caffeine is not associated with frequency, duration, or intensity of episodic migraines, a new study showed. Investigators said the findings suggest caffeine restrictions in migraineurs may not be necessary.

METHODOLOGY:

• The secondary analysis of a prospective cohort study on sleep in adults with episodic migraine (with or without aura) included a group of 97 people (median age, 31 years; 82% White) with an average of 5.0 ± 3.6  days per month at baseline.
• Participants provided sociodemographic information, medical history, habitual caffeinated beverage consumption, alcohol intake, and lifestyle and psychosocial factors and completed the Center for Epidemiologic Studies- scale, the Perceived Stress Scale, and the Pittsburgh Sleep Quality Index.
• Additionally, they completed twice-daily electronic diaries for the subsequent 6 weeks, reporting headache activity and the use of medications to treat the headache.

TAKEAWAY:

• A total of 67% of participants reported one to two servings of caffeinated beverages per day, 12% reported three to four servings per day, and 21% reported no habitual caffeine consumption.
• After adjusting for age, sex, oral  use, and other confounders, mean headache frequency was similar among groups (7.1 days for no caffeine, 7.4 days for one to two servings, and 5.9 days for three to four servings).
• Similarly, adjusted mean headache duration did not differ across levels of caffeinated beverage intake (8.6 hours for no caffeine, 8.5 hours for one to two servings, and 8.8 hours for three to four servings).
• Adjusted mean headache intensity also did not differ among groups.

IN PRACTICE:

“Our findings do not support a recommendation for people with episodic migraine to avoid habitual caffeinated beverage intake,” the authors wrote. However, they noted that habitual caffeine intake may affect systems involved in pain modulation via adenosine signaling. «Therefore, it is possible that habitual caffeine use in those with migraine does not significantly alter adenosine signaling, but significant changes above or below usual consumption may serve as a trigger or contribute to lowering the threshold for an attack to occur along with other triggers,» they added.

SOURCE:

Suzanne M. Bertisch, MD, MPH, assistant professor of medicine, Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, was the senior and corresponding author of the study. It was published online in Headache.

LIMITATIONS:

Serving size was not standardized, and there was no information on the type of caffeinated beverage consumed or about other sources of caffeine. Moreover, the population consisted of relatively healthy participants with episodic migraine and generally low levels of habitual caffeinated beverage intake, which limited the statistical power to detect an association between migraine frequency, duration, and intensity with higher levels of caffeine intake.

DISCLOSURES:

The study was funded by the National Institute of Neurological Disorders and Stroke, the American Sleep Medicine Foundation, and the Harvard Catalyst/Harvard Clinical and Translational Science Center. Dr. Bertisch has done consulting work with Idorsia and ResMed. The other authors’ disclosures are listed in the original paper.

A version of this article appeared on Medscape.com.

TOPLINE:

Habitual consumption of caffeine is not associated with frequency, duration, or intensity of episodic migraines, a new study showed. Investigators said the findings suggest caffeine restrictions in migraineurs may not be necessary.

METHODOLOGY:

• The secondary analysis of a prospective cohort study on sleep in adults with episodic migraine (with or without aura) included a group of 97 people (median age, 31 years; 82% White) with an average of 5.0 ± 3.6  days per month at baseline.
• Participants provided sociodemographic information, medical history, habitual caffeinated beverage consumption, alcohol intake, and lifestyle and psychosocial factors and completed the Center for Epidemiologic Studies- scale, the Perceived Stress Scale, and the Pittsburgh Sleep Quality Index.
• Additionally, they completed twice-daily electronic diaries for the subsequent 6 weeks, reporting headache activity and the use of medications to treat the headache.

TAKEAWAY:

• A total of 67% of participants reported one to two servings of caffeinated beverages per day, 12% reported three to four servings per day, and 21% reported no habitual caffeine consumption.
• After adjusting for age, sex, oral  use, and other confounders, mean headache frequency was similar among groups (7.1 days for no caffeine, 7.4 days for one to two servings, and 5.9 days for three to four servings).
• Similarly, adjusted mean headache duration did not differ across levels of caffeinated beverage intake (8.6 hours for no caffeine, 8.5 hours for one to two servings, and 8.8 hours for three to four servings).
• Adjusted mean headache intensity also did not differ among groups.

IN PRACTICE:

“Our findings do not support a recommendation for people with episodic migraine to avoid habitual caffeinated beverage intake,” the authors wrote. However, they noted that habitual caffeine intake may affect systems involved in pain modulation via adenosine signaling. «Therefore, it is possible that habitual caffeine use in those with migraine does not significantly alter adenosine signaling, but significant changes above or below usual consumption may serve as a trigger or contribute to lowering the threshold for an attack to occur along with other triggers,» they added.

SOURCE:

Suzanne M. Bertisch, MD, MPH, assistant professor of medicine, Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, was the senior and corresponding author of the study. It was published online in Headache.

LIMITATIONS:

Serving size was not standardized, and there was no information on the type of caffeinated beverage consumed or about other sources of caffeine. Moreover, the population consisted of relatively healthy participants with episodic migraine and generally low levels of habitual caffeinated beverage intake, which limited the statistical power to detect an association between migraine frequency, duration, and intensity with higher levels of caffeine intake.

DISCLOSURES:

The study was funded by the National Institute of Neurological Disorders and Stroke, the American Sleep Medicine Foundation, and the Harvard Catalyst/Harvard Clinical and Translational Science Center. Dr. Bertisch has done consulting work with Idorsia and ResMed. The other authors’ disclosures are listed in the original paper.

A version of this article appeared on Medscape.com.

Key clinical point: High dietary acid load was associated with higher odds of migraine. Restricting dietary acid load could therefore reduce the odds of migraine in susceptible patients.

Major finding: The risk for migraine was higher among individuals in highest vs. lowest tertile of dietary acid load measures, including potential renal acid load (odds ratio [OR], 7.208; 95% confidence interval [95% CI], 3.33-15.55), net endogenous acid production (OR, 4.10; 95% CI, 1.92-8.77) scores, and the protein/potassium ratio (OR, 4.12; 95% CI, 1.93-8.81; all P_trend less than .001).

Study details: Findings are from a case-control study of 1,096 participants including those with migraine (n=514) and healthy volunteers (n=582).

Disclosures: The study was supported by the Iranian Centre of Neurological Research, Neuroscience Institute. All authors declared no conflicts of interest.

Source: Mousavi M et al. Neurol Ther. 2021 Apr 24. doi: 10.1007/s40120-021-00247-2.

Key clinical point: High dietary acid load was associated with higher odds of migraine. Restricting dietary acid load could therefore reduce the odds of migraine in susceptible patients.

Major finding: The risk for migraine was higher among individuals in highest vs. lowest tertile of dietary acid load measures, including potential renal acid load (odds ratio [OR], 7.208; 95% confidence interval [95% CI], 3.33-15.55), net endogenous acid production (OR, 4.10; 95% CI, 1.92-8.77) scores, and the protein/potassium ratio (OR, 4.12; 95% CI, 1.93-8.81; all P_trend less than .001).

Study details: Findings are from a case-control study of 1,096 participants including those with migraine (n=514) and healthy volunteers (n=582).

Disclosures: The study was supported by the Iranian Centre of Neurological Research, Neuroscience Institute. All authors declared no conflicts of interest.

Source: Mousavi M et al. Neurol Ther. 2021 Apr 24. doi: 10.1007/s40120-021-00247-2.

Key clinical point: High dietary acid load was associated with higher odds of migraine. Restricting dietary acid load could therefore reduce the odds of migraine in susceptible patients.

Major finding: The risk for migraine was higher among individuals in highest vs. lowest tertile of dietary acid load measures, including potential renal acid load (odds ratio [OR], 7.208; 95% confidence interval [95% CI], 3.33-15.55), net endogenous acid production (OR, 4.10; 95% CI, 1.92-8.77) scores, and the protein/potassium ratio (OR, 4.12; 95% CI, 1.93-8.81; all P_trend less than .001).

Study details: Findings are from a case-control study of 1,096 participants including those with migraine (n=514) and healthy volunteers (n=582).

Disclosures: The study was supported by the Iranian Centre of Neurological Research, Neuroscience Institute. All authors declared no conflicts of interest.

Source: Mousavi M et al. Neurol Ther. 2021 Apr 24. doi: 10.1007/s40120-021-00247-2.

Key clinical point: Menopausal women with migraine are at a higher risk for incident hypertension.

Major finding: Migraine was associated with an increased risk for incident hypertension (hazard ratio_migraine, 1.29; 95% confidence interval, 1.24-1.35) in menopausal women.

Study details: Findings are from a longitudinal cohort study of 56,202 menopausal women free of hypertension or cardiovascular disease at the age of menopause who participated in the French E3N cohort.

Disclosures: The authors reported no targeted funding. CJ MacDonald and T Kurth received funding and/or honoraria from multiple sources. Other authors had no disclosures relevant to the manuscript.

Source: MacDonald CJ et al. Neurology. 2021 Apr 21. doi: 10.1212/WNL.0000000000011986.

Key clinical point: Menopausal women with migraine are at a higher risk for incident hypertension.

Major finding: Migraine was associated with an increased risk for incident hypertension (hazard ratio_migraine, 1.29; 95% confidence interval, 1.24-1.35) in menopausal women.

Study details: Findings are from a longitudinal cohort study of 56,202 menopausal women free of hypertension or cardiovascular disease at the age of menopause who participated in the French E3N cohort.

Disclosures: The authors reported no targeted funding. CJ MacDonald and T Kurth received funding and/or honoraria from multiple sources. Other authors had no disclosures relevant to the manuscript.

Source: MacDonald CJ et al. Neurology. 2021 Apr 21. doi: 10.1212/WNL.0000000000011986.

Key clinical point: Menopausal women with migraine are at a higher risk for incident hypertension.

Major finding: Migraine was associated with an increased risk for incident hypertension (hazard ratio_migraine, 1.29; 95% confidence interval, 1.24-1.35) in menopausal women.

Study details: Findings are from a longitudinal cohort study of 56,202 menopausal women free of hypertension or cardiovascular disease at the age of menopause who participated in the French E3N cohort.

Disclosures: The authors reported no targeted funding. CJ MacDonald and T Kurth received funding and/or honoraria from multiple sources. Other authors had no disclosures relevant to the manuscript.

Source: MacDonald CJ et al. Neurology. 2021 Apr 21. doi: 10.1212/WNL.0000000000011986.

Key clinical point: Galcanezumab effectively reduced monthly migraine headache days (MMHD) in patients with migraine who did not benefit from commonly prescribed preventive treatments.

Major finding: Patients treated with galcanezumab vs. placebo had a greater mean reduction in MMHD across months 1-3 (all P less than .01) and improved quality of life at month 3 (P less than .01). A greater proportion of patients treated with galcanezumab vs. placebo experienced 50% or more reduction in MMHD from baseline (all P less than .05).

Study details: Data come from a post hoc analysis of phase 3b CONQUER study which included patients with chronic or episodic migraine who were not benefited from 2-4 classes of migraine preventive treatments and were randomly allocated to receive placebo (n=230) or galcanezumab 120 mg/month (n=232).

Disclosures: This study was funded by Eli Lilly and Company. DK Kuruppu, Y Dong, and LY Medina declared being full-time employees of and/or minor stockholders of Eli Lilly and Company. J Tobin and AL Green reported receiving compensation from Eli Lilly and Company.

Source: Kuruppu DK et al. BMC Neurol. 2021 Apr 23. doi: 10.1186/s12883-021-02196-7.

Key clinical point: Galcanezumab effectively reduced monthly migraine headache days (MMHD) in patients with migraine who did not benefit from commonly prescribed preventive treatments.

Major finding: Patients treated with galcanezumab vs. placebo had a greater mean reduction in MMHD across months 1-3 (all P less than .01) and improved quality of life at month 3 (P less than .01). A greater proportion of patients treated with galcanezumab vs. placebo experienced 50% or more reduction in MMHD from baseline (all P less than .05).

Study details: Data come from a post hoc analysis of phase 3b CONQUER study which included patients with chronic or episodic migraine who were not benefited from 2-4 classes of migraine preventive treatments and were randomly allocated to receive placebo (n=230) or galcanezumab 120 mg/month (n=232).

Disclosures: This study was funded by Eli Lilly and Company. DK Kuruppu, Y Dong, and LY Medina declared being full-time employees of and/or minor stockholders of Eli Lilly and Company. J Tobin and AL Green reported receiving compensation from Eli Lilly and Company.

Source: Kuruppu DK et al. BMC Neurol. 2021 Apr 23. doi: 10.1186/s12883-021-02196-7.

Key clinical point: Galcanezumab effectively reduced monthly migraine headache days (MMHD) in patients with migraine who did not benefit from commonly prescribed preventive treatments.

Major finding: Patients treated with galcanezumab vs. placebo had a greater mean reduction in MMHD across months 1-3 (all P less than .01) and improved quality of life at month 3 (P less than .01). A greater proportion of patients treated with galcanezumab vs. placebo experienced 50% or more reduction in MMHD from baseline (all P less than .05).

Study details: Data come from a post hoc analysis of phase 3b CONQUER study which included patients with chronic or episodic migraine who were not benefited from 2-4 classes of migraine preventive treatments and were randomly allocated to receive placebo (n=230) or galcanezumab 120 mg/month (n=232).

Disclosures: This study was funded by Eli Lilly and Company. DK Kuruppu, Y Dong, and LY Medina declared being full-time employees of and/or minor stockholders of Eli Lilly and Company. J Tobin and AL Green reported receiving compensation from Eli Lilly and Company.

Source: Kuruppu DK et al. BMC Neurol. 2021 Apr 23. doi: 10.1186/s12883-021-02196-7.

Key clinical point: Medication-overuse headache (MOH) was associated with an increased risk for suicidal ideation and prior suicide attempt in patients with chronic migraine (CM).

Major finding: The presence of MOH increased the risks for suicidal ideation (odds ratio [OR], 1.75; P = .004) and prior suicide attempt (OR, 1.88; P = .024) in patients with CM.

Study details: Findings are from a cross-sectional study of 603 patients with CM with (n=320) or without (n=283) coexisting MOH.

Disclosures: The study was supported in part by the Taiwan Ministry of Science and Technology, Taipei Veterans General Hospital, and others. YF Wang and SJ Wang reported receiving honoraria and/or research grants from and serving on advisory boards for multiple sources. Three other authors had no disclosures.

Source: Wang YF et al. J Headache Pain. 2021 May 10. doi: 10.1186/s10194-021-01248-0.

Key clinical point: Medication-overuse headache (MOH) was associated with an increased risk for suicidal ideation and prior suicide attempt in patients with chronic migraine (CM).

Major finding: The presence of MOH increased the risks for suicidal ideation (odds ratio [OR], 1.75; P = .004) and prior suicide attempt (OR, 1.88; P = .024) in patients with CM.

Study details: Findings are from a cross-sectional study of 603 patients with CM with (n=320) or without (n=283) coexisting MOH.

Disclosures: The study was supported in part by the Taiwan Ministry of Science and Technology, Taipei Veterans General Hospital, and others. YF Wang and SJ Wang reported receiving honoraria and/or research grants from and serving on advisory boards for multiple sources. Three other authors had no disclosures.

Source: Wang YF et al. J Headache Pain. 2021 May 10. doi: 10.1186/s10194-021-01248-0.

Key clinical point: Medication-overuse headache (MOH) was associated with an increased risk for suicidal ideation and prior suicide attempt in patients with chronic migraine (CM).

Major finding: The presence of MOH increased the risks for suicidal ideation (odds ratio [OR], 1.75; P = .004) and prior suicide attempt (OR, 1.88; P = .024) in patients with CM.

Study details: Findings are from a cross-sectional study of 603 patients with CM with (n=320) or without (n=283) coexisting MOH.

Disclosures: The study was supported in part by the Taiwan Ministry of Science and Technology, Taipei Veterans General Hospital, and others. YF Wang and SJ Wang reported receiving honoraria and/or research grants from and serving on advisory boards for multiple sources. Three other authors had no disclosures.

Source: Wang YF et al. J Headache Pain. 2021 May 10. doi: 10.1186/s10194-021-01248-0.

Key clinical point: In a real-life cohort of patients with chronic migraine (CM) and high-frequency episodic migraine (HFEM), galcanezumab was safe, well tolerated, and seemed to be more effective compared with that in randomized control trials.

Major finding: After 6 months of therapy, galcanezumab reduced monthly migraine days by 8 days in patients with HFEM and monthly headache days by 13 days in patients with CM (both P less than .001). Overall, galcanezumab was well tolerated with no serious adverse events reported.

Study details: Data come from a real-life, prospective cohort study (GARLIT) of 163 patients with HFEM and CM treated with subcutaneous galcanezumab 120 mg monthly.

Disclosures: The study was funded by Campus Bio-Medico University. Lead author F Vernieri along with other authors reported receiving travel grants, honoraria, and/or grants from various pharma companies. N Brunelli, CM Costa, and M Albanese had nothing to disclose.

Source: Vernieri F et al. J Headache Pain. 2021 May 3. doi: 10.1186/s10194-021-01247-1.

Key clinical point: In a real-life cohort of patients with chronic migraine (CM) and high-frequency episodic migraine (HFEM), galcanezumab was safe, well tolerated, and seemed to be more effective compared with that in randomized control trials.

Major finding: After 6 months of therapy, galcanezumab reduced monthly migraine days by 8 days in patients with HFEM and monthly headache days by 13 days in patients with CM (both P less than .001). Overall, galcanezumab was well tolerated with no serious adverse events reported.

Study details: Data come from a real-life, prospective cohort study (GARLIT) of 163 patients with HFEM and CM treated with subcutaneous galcanezumab 120 mg monthly.

Disclosures: The study was funded by Campus Bio-Medico University. Lead author F Vernieri along with other authors reported receiving travel grants, honoraria, and/or grants from various pharma companies. N Brunelli, CM Costa, and M Albanese had nothing to disclose.

Source: Vernieri F et al. J Headache Pain. 2021 May 3. doi: 10.1186/s10194-021-01247-1.

Key clinical point: In a real-life cohort of patients with chronic migraine (CM) and high-frequency episodic migraine (HFEM), galcanezumab was safe, well tolerated, and seemed to be more effective compared with that in randomized control trials.

Major finding: After 6 months of therapy, galcanezumab reduced monthly migraine days by 8 days in patients with HFEM and monthly headache days by 13 days in patients with CM (both P less than .001). Overall, galcanezumab was well tolerated with no serious adverse events reported.

Study details: Data come from a real-life, prospective cohort study (GARLIT) of 163 patients with HFEM and CM treated with subcutaneous galcanezumab 120 mg monthly.

Disclosures: The study was funded by Campus Bio-Medico University. Lead author F Vernieri along with other authors reported receiving travel grants, honoraria, and/or grants from various pharma companies. N Brunelli, CM Costa, and M Albanese had nothing to disclose.

Source: Vernieri F et al. J Headache Pain. 2021 May 3. doi: 10.1186/s10194-021-01247-1.

Key clinical point: Fremanezumab was significantly more efficacious than placebo in reducing the average number of monthly headache days (MHDs) and monthly migraine days (MMDs) in patients with chronic migraine (CM) and comorbid moderate-to-severe depression.

Major finding: At week 12, the average number of MHDs of at least moderate severity was significantly reduced in fremanezumab quarterly (least-squares mean change [LSM], −5.3) and monthly (LSM, −5.5) dose regimens vs. placebo (LSM, −2.2; both P less than .001). Similarly, MMDs were significantly reduced with fremanezumab quarterly (LSM, −5.4; P = .002) and monthly (LSM, −5.5; P less than .001) dose regimens vs. placebo (LSM, −2.4).

Study details: Findings are from a post hoc analysis of phase 3 HALO trial that included 1,130 patients with CM randomly allocated to receive fremanezumab quarterly, fremanezumab monthly, or placebo.

Disclosures: The study was funded by Teva Pharmaceutical Industries Ltd. Some of the authors declared serving as consultant, advisory board member, and/or receiving research support and honoraria from multiple sources. Some of the authors declared being current/former employees of Teva Branded Pharmaceutical Products R&D, Inc. (USA).

Source: Lipton RB et al. Headache. 2021 Apr 23. doi: 10.1111/head.14097.

Key clinical point: Fremanezumab was significantly more efficacious than placebo in reducing the average number of monthly headache days (MHDs) and monthly migraine days (MMDs) in patients with chronic migraine (CM) and comorbid moderate-to-severe depression.

Major finding: At week 12, the average number of MHDs of at least moderate severity was significantly reduced in fremanezumab quarterly (least-squares mean change [LSM], −5.3) and monthly (LSM, −5.5) dose regimens vs. placebo (LSM, −2.2; both P less than .001). Similarly, MMDs were significantly reduced with fremanezumab quarterly (LSM, −5.4; P = .002) and monthly (LSM, −5.5; P less than .001) dose regimens vs. placebo (LSM, −2.4).

Study details: Findings are from a post hoc analysis of phase 3 HALO trial that included 1,130 patients with CM randomly allocated to receive fremanezumab quarterly, fremanezumab monthly, or placebo.

Disclosures: The study was funded by Teva Pharmaceutical Industries Ltd. Some of the authors declared serving as consultant, advisory board member, and/or receiving research support and honoraria from multiple sources. Some of the authors declared being current/former employees of Teva Branded Pharmaceutical Products R&D, Inc. (USA).

Source: Lipton RB et al. Headache. 2021 Apr 23. doi: 10.1111/head.14097.

Key clinical point: Fremanezumab was significantly more efficacious than placebo in reducing the average number of monthly headache days (MHDs) and monthly migraine days (MMDs) in patients with chronic migraine (CM) and comorbid moderate-to-severe depression.

Major finding: At week 12, the average number of MHDs of at least moderate severity was significantly reduced in fremanezumab quarterly (least-squares mean change [LSM], −5.3) and monthly (LSM, −5.5) dose regimens vs. placebo (LSM, −2.2; both P less than .001). Similarly, MMDs were significantly reduced with fremanezumab quarterly (LSM, −5.4; P = .002) and monthly (LSM, −5.5; P less than .001) dose regimens vs. placebo (LSM, −2.4).

Study details: Findings are from a post hoc analysis of phase 3 HALO trial that included 1,130 patients with CM randomly allocated to receive fremanezumab quarterly, fremanezumab monthly, or placebo.

Disclosures: The study was funded by Teva Pharmaceutical Industries Ltd. Some of the authors declared serving as consultant, advisory board member, and/or receiving research support and honoraria from multiple sources. Some of the authors declared being current/former employees of Teva Branded Pharmaceutical Products R&D, Inc. (USA).

Source: Lipton RB et al. Headache. 2021 Apr 23. doi: 10.1111/head.14097.

Key clinical point: Repeated active transcranial direct current stimulation (tDCS) for at least 4 weeks significantly reduced migraine pain intensity and resulted in a trend for reduction in the duration of a migraine episode.

Major finding: Patients treated with active vs. sham tDCS showed a significantly higher reduction of pain intensity (mean difference [MD], −1.44; P less than .01) and a trend for reduction in migraine duration (MD, −1.31; P = .14).

Study details: Findings are from a meta-analysis of 5 randomized controlled trials including 104 patients with migraine with/without aura and chronic migraine who received either active or sham tDCS.

Disclosures: No information on funding was available. The authors declared no conflicts of interest.

Source: Cai G et al. J Pain Res. 2021 Apr 27. doi: 10.2147/JPR.S295704.

Key clinical point: Repeated active transcranial direct current stimulation (tDCS) for at least 4 weeks significantly reduced migraine pain intensity and resulted in a trend for reduction in the duration of a migraine episode.

Major finding: Patients treated with active vs. sham tDCS showed a significantly higher reduction of pain intensity (mean difference [MD], −1.44; P less than .01) and a trend for reduction in migraine duration (MD, −1.31; P = .14).

Study details: Findings are from a meta-analysis of 5 randomized controlled trials including 104 patients with migraine with/without aura and chronic migraine who received either active or sham tDCS.

Disclosures: No information on funding was available. The authors declared no conflicts of interest.

Source: Cai G et al. J Pain Res. 2021 Apr 27. doi: 10.2147/JPR.S295704.

Key clinical point: Repeated active transcranial direct current stimulation (tDCS) for at least 4 weeks significantly reduced migraine pain intensity and resulted in a trend for reduction in the duration of a migraine episode.

Major finding: Patients treated with active vs. sham tDCS showed a significantly higher reduction of pain intensity (mean difference [MD], −1.44; P less than .01) and a trend for reduction in migraine duration (MD, −1.31; P = .14).

Study details: Findings are from a meta-analysis of 5 randomized controlled trials including 104 patients with migraine with/without aura and chronic migraine who received either active or sham tDCS.

Disclosures: No information on funding was available. The authors declared no conflicts of interest.

Source: Cai G et al. J Pain Res. 2021 Apr 27. doi: 10.2147/JPR.S295704.

Key clinical point: Erenumab demonstrated sustained efficacy and safety through 64 weeks in patients with episodic migraine (EM) with 2-4 prior preventive treatment failures.

Major finding: Overall, the proportion of patients achieving 50% or greater reduction in monthly migraine days increased from 30.4% at weeks 13-16 to 47.3% at weeks 37-40 and remained stable through weeks 61-64 (47.1%). Overall, 6.7% of patients experienced treatment-emergent serious adverse events and 1.7% discontinued treatment because of treatment-emergent adverse events.

Study details: Findings of the first year of the ongoing 3-year open-label extension phase of LIBERTY study that evaluated monthly erenumab 140 mg in 240 patients with EM who had 2-4 prior preventive treatment failures.

Disclosures: The study was funded by Novartis Pharma AG, Basel, Switzerland. Some of the authors reported receiving grants, professional fees, consulting fees, speaking/teaching fees, and/or honoraria from; being an employee of; and/or holding stocks in various pharmaceutical companies including Novartis.

Source: Goadsby PJ et al. Neurology. 2021 Apr 28. doi: 10.1212/WNL.0000000000012029.

Key clinical point: Erenumab demonstrated sustained efficacy and safety through 64 weeks in patients with episodic migraine (EM) with 2-4 prior preventive treatment failures.

Major finding: Overall, the proportion of patients achieving 50% or greater reduction in monthly migraine days increased from 30.4% at weeks 13-16 to 47.3% at weeks 37-40 and remained stable through weeks 61-64 (47.1%). Overall, 6.7% of patients experienced treatment-emergent serious adverse events and 1.7% discontinued treatment because of treatment-emergent adverse events.

Study details: Findings of the first year of the ongoing 3-year open-label extension phase of LIBERTY study that evaluated monthly erenumab 140 mg in 240 patients with EM who had 2-4 prior preventive treatment failures.

Disclosures: The study was funded by Novartis Pharma AG, Basel, Switzerland. Some of the authors reported receiving grants, professional fees, consulting fees, speaking/teaching fees, and/or honoraria from; being an employee of; and/or holding stocks in various pharmaceutical companies including Novartis.

Source: Goadsby PJ et al. Neurology. 2021 Apr 28. doi: 10.1212/WNL.0000000000012029.

Key clinical point: Erenumab demonstrated sustained efficacy and safety through 64 weeks in patients with episodic migraine (EM) with 2-4 prior preventive treatment failures.

Major finding: Overall, the proportion of patients achieving 50% or greater reduction in monthly migraine days increased from 30.4% at weeks 13-16 to 47.3% at weeks 37-40 and remained stable through weeks 61-64 (47.1%). Overall, 6.7% of patients experienced treatment-emergent serious adverse events and 1.7% discontinued treatment because of treatment-emergent adverse events.

Study details: Findings of the first year of the ongoing 3-year open-label extension phase of LIBERTY study that evaluated monthly erenumab 140 mg in 240 patients with EM who had 2-4 prior preventive treatment failures.

Disclosures: The study was funded by Novartis Pharma AG, Basel, Switzerland. Some of the authors reported receiving grants, professional fees, consulting fees, speaking/teaching fees, and/or honoraria from; being an employee of; and/or holding stocks in various pharmaceutical companies including Novartis.

Source: Goadsby PJ et al. Neurology. 2021 Apr 28. doi: 10.1212/WNL.0000000000012029.

Key clinical point: Calcitonin gene-related peptide (CGRP) monoclonal antibody was superior to botulinum toxin in reducing the frequency of acute analgesic intake in patients with chronic migraine (CM). Treatment-related serious adverse events (SAEs) were lower with CGRP monoclonal antibody.

Major finding: CGRP monoclonal antibody was superior to botulinum toxin in reducing the frequency of acute analgesics intake (weighted mean difference, −1.31; P = .02113). Treatment-related SAEs were lower with CGRP monoclonal antibody vs. botulinum toxin (relative risk, 0.505; P = .001).

Study details: Findings are from a meta-analysis of 10 studies including 6,325 patients, which performed indirect treatment comparison between CGRP monoclonal antibody and botulinum toxin for prophylactic treatment of CM.

Disclosures: No information on funding was available. The authors declared no conflicts of interest.

Source: Lu J et al. Front Pharmacol. 2021 May 3. doi: 10.3389/fphar.2021.631204.

Key clinical point: Calcitonin gene-related peptide (CGRP) monoclonal antibody was superior to botulinum toxin in reducing the frequency of acute analgesic intake in patients with chronic migraine (CM). Treatment-related serious adverse events (SAEs) were lower with CGRP monoclonal antibody.

Major finding: CGRP monoclonal antibody was superior to botulinum toxin in reducing the frequency of acute analgesics intake (weighted mean difference, −1.31; P = .02113). Treatment-related SAEs were lower with CGRP monoclonal antibody vs. botulinum toxin (relative risk, 0.505; P = .001).

Study details: Findings are from a meta-analysis of 10 studies including 6,325 patients, which performed indirect treatment comparison between CGRP monoclonal antibody and botulinum toxin for prophylactic treatment of CM.

Disclosures: No information on funding was available. The authors declared no conflicts of interest.

Source: Lu J et al. Front Pharmacol. 2021 May 3. doi: 10.3389/fphar.2021.631204.

Key clinical point: Calcitonin gene-related peptide (CGRP) monoclonal antibody was superior to botulinum toxin in reducing the frequency of acute analgesic intake in patients with chronic migraine (CM). Treatment-related serious adverse events (SAEs) were lower with CGRP monoclonal antibody.

Major finding: CGRP monoclonal antibody was superior to botulinum toxin in reducing the frequency of acute analgesics intake (weighted mean difference, −1.31; P = .02113). Treatment-related SAEs were lower with CGRP monoclonal antibody vs. botulinum toxin (relative risk, 0.505; P = .001).

Study details: Findings are from a meta-analysis of 10 studies including 6,325 patients, which performed indirect treatment comparison between CGRP monoclonal antibody and botulinum toxin for prophylactic treatment of CM.

Disclosures: No information on funding was available. The authors declared no conflicts of interest.

Source: Lu J et al. Front Pharmacol. 2021 May 3. doi: 10.3389/fphar.2021.631204.