Migraine Briefs

In a large-scale plasma metabolome analysis, metabolic profiling of plasma yielded alterations in high-density lipoprotein (HDL) metabolism in patients with migraine and decreased omega-3 fatty acids only in male migraineurs, a new study found. Researchers sought to identify a plasma metabolomic biomarker signature for migraine. Plasma samples from 8 Dutch cohorts (n=10,153: 2800 migraine patients and 7353 controls) were profiled on a H-NMR-based metabolomics platform to quantify 146 individual metabolites and 79 metabolite ratios. Metabolite measures associated with migraine were obtained after single-metabolite logistic regression combined with random-effects meta-analysis performed in a nonstratified and sex-stratified manner. Among the findings:

• Decreases in the level of apolipoprotein A1 and free cholesterol total lipid ratio present in small HDL subspecies were associated with migraine status.
• A decreased level of omega-3 fatty acids was associated with migraine in male participants only.
• Global test analysis supported that HDL traits were associated with migraine status.

Onderwater GLJ, Ligthart L, Bot M, et al. Large-scale metabolome analysis reveals alterations in HDL metabolism in migraine. [Published online ahead of print April 3, 2019]. Neurology. doi:10.1212/WNL.0000000000007313.

In a large-scale plasma metabolome analysis, metabolic profiling of plasma yielded alterations in high-density lipoprotein (HDL) metabolism in patients with migraine and decreased omega-3 fatty acids only in male migraineurs, a new study found. Researchers sought to identify a plasma metabolomic biomarker signature for migraine. Plasma samples from 8 Dutch cohorts (n=10,153: 2800 migraine patients and 7353 controls) were profiled on a H-NMR-based metabolomics platform to quantify 146 individual metabolites and 79 metabolite ratios. Metabolite measures associated with migraine were obtained after single-metabolite logistic regression combined with random-effects meta-analysis performed in a nonstratified and sex-stratified manner. Among the findings:

• Decreases in the level of apolipoprotein A1 and free cholesterol total lipid ratio present in small HDL subspecies were associated with migraine status.
• A decreased level of omega-3 fatty acids was associated with migraine in male participants only.
• Global test analysis supported that HDL traits were associated with migraine status.

Onderwater GLJ, Ligthart L, Bot M, et al. Large-scale metabolome analysis reveals alterations in HDL metabolism in migraine. [Published online ahead of print April 3, 2019]. Neurology. doi:10.1212/WNL.0000000000007313.

In a large-scale plasma metabolome analysis, metabolic profiling of plasma yielded alterations in high-density lipoprotein (HDL) metabolism in patients with migraine and decreased omega-3 fatty acids only in male migraineurs, a new study found. Researchers sought to identify a plasma metabolomic biomarker signature for migraine. Plasma samples from 8 Dutch cohorts (n=10,153: 2800 migraine patients and 7353 controls) were profiled on a H-NMR-based metabolomics platform to quantify 146 individual metabolites and 79 metabolite ratios. Metabolite measures associated with migraine were obtained after single-metabolite logistic regression combined with random-effects meta-analysis performed in a nonstratified and sex-stratified manner. Among the findings:

• Decreases in the level of apolipoprotein A1 and free cholesterol total lipid ratio present in small HDL subspecies were associated with migraine status.
• A decreased level of omega-3 fatty acids was associated with migraine in male participants only.
• Global test analysis supported that HDL traits were associated with migraine status.

Onderwater GLJ, Ligthart L, Bot M, et al. Large-scale metabolome analysis reveals alterations in HDL metabolism in migraine. [Published online ahead of print April 3, 2019]. Neurology. doi:10.1212/WNL.0000000000007313.

A recent systematic review and meta-analysis found that spinal manipulation may be an effective therapeutic technique to reduce migraine days and pain intensity. Researchers identified 6 randomized clinical trials (pooled n=677; range of n=42-218) eligible for meta-analysis and evaluated spinal manipulation and migraine-related outcomes through 2017. They found:

• Intervention duration ranged from 2 to 6 months; outcomes included measures of migraine days (primary), migraine pain/intensity, and migraine disability.
• Methodological quality varied across the studies.
• Spinal manipulation reduced migraine days with an overall small effect size, as well as migraine pain/intensity.

Rist PM, Hernandez A, Bernstein C, et al. The impact of spinal manipulation on migraine pain and disability: A systematic review and meta-analysis. Headache. 2019;59(4):532-542. doi:10.1111/head.13501.

A recent systematic review and meta-analysis found that spinal manipulation may be an effective therapeutic technique to reduce migraine days and pain intensity. Researchers identified 6 randomized clinical trials (pooled n=677; range of n=42-218) eligible for meta-analysis and evaluated spinal manipulation and migraine-related outcomes through 2017. They found:

• Intervention duration ranged from 2 to 6 months; outcomes included measures of migraine days (primary), migraine pain/intensity, and migraine disability.
• Methodological quality varied across the studies.
• Spinal manipulation reduced migraine days with an overall small effect size, as well as migraine pain/intensity.

Rist PM, Hernandez A, Bernstein C, et al. The impact of spinal manipulation on migraine pain and disability: A systematic review and meta-analysis. Headache. 2019;59(4):532-542. doi:10.1111/head.13501.

A recent systematic review and meta-analysis found that spinal manipulation may be an effective therapeutic technique to reduce migraine days and pain intensity. Researchers identified 6 randomized clinical trials (pooled n=677; range of n=42-218) eligible for meta-analysis and evaluated spinal manipulation and migraine-related outcomes through 2017. They found:

• Intervention duration ranged from 2 to 6 months; outcomes included measures of migraine days (primary), migraine pain/intensity, and migraine disability.
• Methodological quality varied across the studies.
• Spinal manipulation reduced migraine days with an overall small effect size, as well as migraine pain/intensity.

Rist PM, Hernandez A, Bernstein C, et al. The impact of spinal manipulation on migraine pain and disability: A systematic review and meta-analysis. Headache. 2019;59(4):532-542. doi:10.1111/head.13501.

In individuals with familial hemiplegic migraines (FHM), baseline and serial neuropsychological testing may help identify the potential progression and course of cognitive impairment associated with this condition. This according to a single-case study involving a male aged 24 years who recently endured an atypical, prolonged FHM episode. Researchers found:

• The patient’s overall neuropsychological functioning was intact with low average semantic fluency and processing speed.
• The patient also exhibited mild indication of executive dysfunction.

Trahan EM, Mercado JM. Familial hemiplegic migraines and baseline neuropsychological testing: A case report. [Published online ahead of print March 14, 2019]. Headache. doi:10.1111/head.13505.

In individuals with familial hemiplegic migraines (FHM), baseline and serial neuropsychological testing may help identify the potential progression and course of cognitive impairment associated with this condition. This according to a single-case study involving a male aged 24 years who recently endured an atypical, prolonged FHM episode. Researchers found:

• The patient’s overall neuropsychological functioning was intact with low average semantic fluency and processing speed.
• The patient also exhibited mild indication of executive dysfunction.

Trahan EM, Mercado JM. Familial hemiplegic migraines and baseline neuropsychological testing: A case report. [Published online ahead of print March 14, 2019]. Headache. doi:10.1111/head.13505.

In individuals with familial hemiplegic migraines (FHM), baseline and serial neuropsychological testing may help identify the potential progression and course of cognitive impairment associated with this condition. This according to a single-case study involving a male aged 24 years who recently endured an atypical, prolonged FHM episode. Researchers found:

• The patient’s overall neuropsychological functioning was intact with low average semantic fluency and processing speed.
• The patient also exhibited mild indication of executive dysfunction.

Trahan EM, Mercado JM. Familial hemiplegic migraines and baseline neuropsychological testing: A case report. [Published online ahead of print March 14, 2019]. Headache. doi:10.1111/head.13505.

In a study that analyzed Twitter data from 5 American Headache Society (AHS) conferences held from 2014 to 2016 using their respective hashtags, AHS conference discussions featured a small group of accounts creating the bulk of the content, with individual medical professionals and host organizations generating the largest shares of tweets and mentions while host organizations and other individuals produced the most impressions. Researchers gathered data on numbers of tweets, impressions, participants, and mentions during a 10-day period surrounding each conference, as well as samples of Twitter accounts participating. They found:

• 19,936 tweets were generated across the 5 conferences.
• 58% of tweets were created by the top 10 participating accounts in each conference, which were primarily individual medical professionals and host organizations.
• 75% of impressions generated across the 5 conferences came from the top 10 participants in each.
• An average of 331 accounts participated in each conference.
• #migraine usage during conferences showed a significant increase from baseline in number of tweets.

Callister MN, Robbins MS, Callister NR, Vargas BB. Tweeting the headache meetings: Cross-sectional analysis of Twitter activity surrounding American Headache Society conferences. [Published online ahead of print March 20, 2019]. Headache. doi:10.1111/head.13500.

In a study that analyzed Twitter data from 5 American Headache Society (AHS) conferences held from 2014 to 2016 using their respective hashtags, AHS conference discussions featured a small group of accounts creating the bulk of the content, with individual medical professionals and host organizations generating the largest shares of tweets and mentions while host organizations and other individuals produced the most impressions. Researchers gathered data on numbers of tweets, impressions, participants, and mentions during a 10-day period surrounding each conference, as well as samples of Twitter accounts participating. They found:

• 19,936 tweets were generated across the 5 conferences.
• 58% of tweets were created by the top 10 participating accounts in each conference, which were primarily individual medical professionals and host organizations.
• 75% of impressions generated across the 5 conferences came from the top 10 participants in each.
• An average of 331 accounts participated in each conference.
• #migraine usage during conferences showed a significant increase from baseline in number of tweets.

Callister MN, Robbins MS, Callister NR, Vargas BB. Tweeting the headache meetings: Cross-sectional analysis of Twitter activity surrounding American Headache Society conferences. [Published online ahead of print March 20, 2019]. Headache. doi:10.1111/head.13500.

In a study that analyzed Twitter data from 5 American Headache Society (AHS) conferences held from 2014 to 2016 using their respective hashtags, AHS conference discussions featured a small group of accounts creating the bulk of the content, with individual medical professionals and host organizations generating the largest shares of tweets and mentions while host organizations and other individuals produced the most impressions. Researchers gathered data on numbers of tweets, impressions, participants, and mentions during a 10-day period surrounding each conference, as well as samples of Twitter accounts participating. They found:

• 19,936 tweets were generated across the 5 conferences.
• 58% of tweets were created by the top 10 participating accounts in each conference, which were primarily individual medical professionals and host organizations.
• 75% of impressions generated across the 5 conferences came from the top 10 participants in each.
• An average of 331 accounts participated in each conference.
• #migraine usage during conferences showed a significant increase from baseline in number of tweets.

Callister MN, Robbins MS, Callister NR, Vargas BB. Tweeting the headache meetings: Cross-sectional analysis of Twitter activity surrounding American Headache Society conferences. [Published online ahead of print March 20, 2019]. Headache. doi:10.1111/head.13500.

The Migraine Specific Quality-of-Life Questionnaire Version 2.1 (MSQv2.1) electronic patient-reported outcome (ePRO) Role Function-Restrictive (RFR) domain has sufficient reliability, validity, responsiveness, and appropriate interpretation standards for use in episodic migraine (EM) and chronic migraine (CM) clinical trials to assess the functional impact of migraine, a new study suggests. The 7-item MSQv2.1 ePRO RFR measures the functional impact of migraine on relationships with family and friends, leisure time, work or daily activities, productivity, concentration, tiredness, and energy. Measurement properties of the RFR were assessed using data from 2 EM (CGAG [n=851] and CGAH [n=909]) and 1 CM (CGAI [n=1090]) phase 3 clinical trial. Researchers found:

• Cronbach’s alpha values for internal consistency reliability were 0.93, 0.92, and 0.92 for CGAG, CGAH, and CGAI, respectively.
• Test-retest reliability intra-class correlation coefficients were 0.82 and 0.84 for CGAG and CGAH, and 0.85 for CGAI in stable patients.
• Convergent validity was supported by moderate to strong correlations between the RFR and both the Migraine Disability Assessment (MIDAS) and the Patient Global Impression of Severity (PGI-S).

Speck RM, Shalhoub H, Wyrwich KW, et al. Psychometric validation of the role function restrictive domain of the Migraine Specific Quality-of-Life Questionnaire Version 2.1 electronic patient-reported outcome in patients with episodic and chronic migraine. [Published online ahead of print March 12, 2019]. Headache. doi:10.1111/head.13497.

The Migraine Specific Quality-of-Life Questionnaire Version 2.1 (MSQv2.1) electronic patient-reported outcome (ePRO) Role Function-Restrictive (RFR) domain has sufficient reliability, validity, responsiveness, and appropriate interpretation standards for use in episodic migraine (EM) and chronic migraine (CM) clinical trials to assess the functional impact of migraine, a new study suggests. The 7-item MSQv2.1 ePRO RFR measures the functional impact of migraine on relationships with family and friends, leisure time, work or daily activities, productivity, concentration, tiredness, and energy. Measurement properties of the RFR were assessed using data from 2 EM (CGAG [n=851] and CGAH [n=909]) and 1 CM (CGAI [n=1090]) phase 3 clinical trial. Researchers found:

• Cronbach’s alpha values for internal consistency reliability were 0.93, 0.92, and 0.92 for CGAG, CGAH, and CGAI, respectively.
• Test-retest reliability intra-class correlation coefficients were 0.82 and 0.84 for CGAG and CGAH, and 0.85 for CGAI in stable patients.
• Convergent validity was supported by moderate to strong correlations between the RFR and both the Migraine Disability Assessment (MIDAS) and the Patient Global Impression of Severity (PGI-S).

Speck RM, Shalhoub H, Wyrwich KW, et al. Psychometric validation of the role function restrictive domain of the Migraine Specific Quality-of-Life Questionnaire Version 2.1 electronic patient-reported outcome in patients with episodic and chronic migraine. [Published online ahead of print March 12, 2019]. Headache. doi:10.1111/head.13497.

The Migraine Specific Quality-of-Life Questionnaire Version 2.1 (MSQv2.1) electronic patient-reported outcome (ePRO) Role Function-Restrictive (RFR) domain has sufficient reliability, validity, responsiveness, and appropriate interpretation standards for use in episodic migraine (EM) and chronic migraine (CM) clinical trials to assess the functional impact of migraine, a new study suggests. The 7-item MSQv2.1 ePRO RFR measures the functional impact of migraine on relationships with family and friends, leisure time, work or daily activities, productivity, concentration, tiredness, and energy. Measurement properties of the RFR were assessed using data from 2 EM (CGAG [n=851] and CGAH [n=909]) and 1 CM (CGAI [n=1090]) phase 3 clinical trial. Researchers found:

• Cronbach’s alpha values for internal consistency reliability were 0.93, 0.92, and 0.92 for CGAG, CGAH, and CGAI, respectively.
• Test-retest reliability intra-class correlation coefficients were 0.82 and 0.84 for CGAG and CGAH, and 0.85 for CGAI in stable patients.
• Convergent validity was supported by moderate to strong correlations between the RFR and both the Migraine Disability Assessment (MIDAS) and the Patient Global Impression of Severity (PGI-S).

Speck RM, Shalhoub H, Wyrwich KW, et al. Psychometric validation of the role function restrictive domain of the Migraine Specific Quality-of-Life Questionnaire Version 2.1 electronic patient-reported outcome in patients with episodic and chronic migraine. [Published online ahead of print March 12, 2019]. Headache. doi:10.1111/head.13497.

In a recent observational study, the loss of habituation and lower threshold for occipital cortex excitability were demonstrated electrophysiologically in patients with visual snow syndrome (VS). While statistically significant loss of habituation was seen in both VS patients with or without migraine in the right eye, statistically significant loss of habituation in the left eye and decreased threshold of left occipital cortex excitability was seen in patients who had VS with migraine. Researchers investigated the role of neurophysiological assessments of the occipital cortex in VS patients with (VS_m) or without migraine (VS_wom) and in healthy control (HC). They found:

• Twenty-nine volunteers were recruited for the study; the VS_m (n=10), the VS_wom (n=7), and the HC group (n=12) did not differ demographically.
• Flickering and floaters were reported in all VS patients and flickering in the dark was the most distressing symptomology in both VS groups.
• Higher visual analogue scale (VAS) scores for palinopsia, photophobia, and concentration difficulty were more frequent in VS_m patients.
• In the post hoc analysis, the VS patients did not differ according to the presence of migraine from right or left eye stimulations.

Yildiz FG, Turkyilmaz U, Unal-Cevik I. The clinical characteristics and neurophysiological assessments of the occipital cortex in visual snow syndrome with or without migraine. [Published online ahead of print March 8, 2019]. Headache. doi:10.1111/head.13494.

In a recent observational study, the loss of habituation and lower threshold for occipital cortex excitability were demonstrated electrophysiologically in patients with visual snow syndrome (VS). While statistically significant loss of habituation was seen in both VS patients with or without migraine in the right eye, statistically significant loss of habituation in the left eye and decreased threshold of left occipital cortex excitability was seen in patients who had VS with migraine. Researchers investigated the role of neurophysiological assessments of the occipital cortex in VS patients with (VS_m) or without migraine (VS_wom) and in healthy control (HC). They found:

• Twenty-nine volunteers were recruited for the study; the VS_m (n=10), the VS_wom (n=7), and the HC group (n=12) did not differ demographically.
• Flickering and floaters were reported in all VS patients and flickering in the dark was the most distressing symptomology in both VS groups.
• Higher visual analogue scale (VAS) scores for palinopsia, photophobia, and concentration difficulty were more frequent in VS_m patients.
• In the post hoc analysis, the VS patients did not differ according to the presence of migraine from right or left eye stimulations.

Yildiz FG, Turkyilmaz U, Unal-Cevik I. The clinical characteristics and neurophysiological assessments of the occipital cortex in visual snow syndrome with or without migraine. [Published online ahead of print March 8, 2019]. Headache. doi:10.1111/head.13494.

In a recent observational study, the loss of habituation and lower threshold for occipital cortex excitability were demonstrated electrophysiologically in patients with visual snow syndrome (VS). While statistically significant loss of habituation was seen in both VS patients with or without migraine in the right eye, statistically significant loss of habituation in the left eye and decreased threshold of left occipital cortex excitability was seen in patients who had VS with migraine. Researchers investigated the role of neurophysiological assessments of the occipital cortex in VS patients with (VS_m) or without migraine (VS_wom) and in healthy control (HC). They found:

• Twenty-nine volunteers were recruited for the study; the VS_m (n=10), the VS_wom (n=7), and the HC group (n=12) did not differ demographically.
• Flickering and floaters were reported in all VS patients and flickering in the dark was the most distressing symptomology in both VS groups.
• Higher visual analogue scale (VAS) scores for palinopsia, photophobia, and concentration difficulty were more frequent in VS_m patients.
• In the post hoc analysis, the VS patients did not differ according to the presence of migraine from right or left eye stimulations.

Yildiz FG, Turkyilmaz U, Unal-Cevik I. The clinical characteristics and neurophysiological assessments of the occipital cortex in visual snow syndrome with or without migraine. [Published online ahead of print March 8, 2019]. Headache. doi:10.1111/head.13494.

Periventricular lesions (PVLs) play a key role in the differential diagnosis between migraine with aura (MA) and clinically isolated syndrome (CIS), particularly when there are greater than 3, according to a recent retrospective study. White matter hyperintensities (WMH) of 84 patients with MA and 79 patients with CIS were assessed using manual segmentation technique. Lesion probability maps (LPMs) and voxel-wise analysis of lesion distribution by diagnosis were obtained. Researchers also performed a logistic regression analysis based on lesion locations and volumes. They found:

• Compared to patients with MA, patients with CIS showed a significant overall higher T2 WMH mean number and volume (17.9 ± 16.9 vs 6.2 ± 11.9 and 3.1 ± 4.2 vs 0.3 ± 0.6 mL) and a significantly higher T2 WMH mean number in infratentorial, periventricular, and juxtacortical areas.
• LPMs identified the periventricular regions as the sites with the highest probability of detecting T2 WMH in patients with CIS.
• Voxel-wise analysis of lesion distribution by diagnosis revealed a statistically significant association exclusively between the diagnosis of CIS and the PVLs.

Lapucci C, Saitta L, Bommarito G, et al. How much do periventricular lesions assist in distinguishing migraine with aura from CIS? [Published online ahead of print March 8, 2019]. Neurology. doi:10.1212/WNL.0000000000007266.

Periventricular lesions (PVLs) play a key role in the differential diagnosis between migraine with aura (MA) and clinically isolated syndrome (CIS), particularly when there are greater than 3, according to a recent retrospective study. White matter hyperintensities (WMH) of 84 patients with MA and 79 patients with CIS were assessed using manual segmentation technique. Lesion probability maps (LPMs) and voxel-wise analysis of lesion distribution by diagnosis were obtained. Researchers also performed a logistic regression analysis based on lesion locations and volumes. They found:

• Compared to patients with MA, patients with CIS showed a significant overall higher T2 WMH mean number and volume (17.9 ± 16.9 vs 6.2 ± 11.9 and 3.1 ± 4.2 vs 0.3 ± 0.6 mL) and a significantly higher T2 WMH mean number in infratentorial, periventricular, and juxtacortical areas.
• LPMs identified the periventricular regions as the sites with the highest probability of detecting T2 WMH in patients with CIS.
• Voxel-wise analysis of lesion distribution by diagnosis revealed a statistically significant association exclusively between the diagnosis of CIS and the PVLs.

Lapucci C, Saitta L, Bommarito G, et al. How much do periventricular lesions assist in distinguishing migraine with aura from CIS? [Published online ahead of print March 8, 2019]. Neurology. doi:10.1212/WNL.0000000000007266.

Periventricular lesions (PVLs) play a key role in the differential diagnosis between migraine with aura (MA) and clinically isolated syndrome (CIS), particularly when there are greater than 3, according to a recent retrospective study. White matter hyperintensities (WMH) of 84 patients with MA and 79 patients with CIS were assessed using manual segmentation technique. Lesion probability maps (LPMs) and voxel-wise analysis of lesion distribution by diagnosis were obtained. Researchers also performed a logistic regression analysis based on lesion locations and volumes. They found:

• Compared to patients with MA, patients with CIS showed a significant overall higher T2 WMH mean number and volume (17.9 ± 16.9 vs 6.2 ± 11.9 and 3.1 ± 4.2 vs 0.3 ± 0.6 mL) and a significantly higher T2 WMH mean number in infratentorial, periventricular, and juxtacortical areas.
• LPMs identified the periventricular regions as the sites with the highest probability of detecting T2 WMH in patients with CIS.
• Voxel-wise analysis of lesion distribution by diagnosis revealed a statistically significant association exclusively between the diagnosis of CIS and the PVLs.

Lapucci C, Saitta L, Bommarito G, et al. How much do periventricular lesions assist in distinguishing migraine with aura from CIS? [Published online ahead of print March 8, 2019]. Neurology. doi:10.1212/WNL.0000000000007266.

Patients with migraine, in particular migraine with aura, were more likely to have elevated high sensitivity C-reactive protein (CRP), evident only among those with insomnia, according to a recent cross-sectional study. A total of 20,486 (63%) out of 32,591 individuals, aged 40 years and older, participated in the seventh wave of the Tromsø study conducted in 2015 and 2016, and had valid information on headache, insomnia, and high sensitivity CRP. Researchers found:

• A total of 6290 participants (30.7%) suffered from headache during the last year.
• Among these, 1736 (8.5%) fulfilled the criteria of migraine, 991 (4.8%) had migraine with aura, 746 (3.6%) migraine without aura (3.8%), and 4554 (22.2%) had non-migrainous headache.
• In the final multi-adjusted analysis, elevated high sensitivity CRP was associated with headache, migraine, and migraine with aura.
• No association was found between elevated high sensitivity CRP and migraine without aura or non-migrainous headache.
• The association between high sensitivity CRP and migraine was strongly dependent on insomnia status.
• Among individuals with insomnia, elevated high sensitivity CRP was associated with migraine, and migraine with aura, whereas no such relationship was found among those without insomnia.

Hagen K, Hopstock LA, Eggen AE, Mathiesen EB, Bilsen KB. Does insomnia modify the association between C-reactive protein and migraine? The Tromsø Study 2015–2016. [Published online ahead of print March 12, 2019]. Cephalalgia. doi:10.1177%2F0333102418825370.

Patients with migraine, in particular migraine with aura, were more likely to have elevated high sensitivity C-reactive protein (CRP), evident only among those with insomnia, according to a recent cross-sectional study. A total of 20,486 (63%) out of 32,591 individuals, aged 40 years and older, participated in the seventh wave of the Tromsø study conducted in 2015 and 2016, and had valid information on headache, insomnia, and high sensitivity CRP. Researchers found:

• A total of 6290 participants (30.7%) suffered from headache during the last year.
• Among these, 1736 (8.5%) fulfilled the criteria of migraine, 991 (4.8%) had migraine with aura, 746 (3.6%) migraine without aura (3.8%), and 4554 (22.2%) had non-migrainous headache.
• In the final multi-adjusted analysis, elevated high sensitivity CRP was associated with headache, migraine, and migraine with aura.
• No association was found between elevated high sensitivity CRP and migraine without aura or non-migrainous headache.
• The association between high sensitivity CRP and migraine was strongly dependent on insomnia status.
• Among individuals with insomnia, elevated high sensitivity CRP was associated with migraine, and migraine with aura, whereas no such relationship was found among those without insomnia.

Hagen K, Hopstock LA, Eggen AE, Mathiesen EB, Bilsen KB. Does insomnia modify the association between C-reactive protein and migraine? The Tromsø Study 2015–2016. [Published online ahead of print March 12, 2019]. Cephalalgia. doi:10.1177%2F0333102418825370.

Patients with migraine, in particular migraine with aura, were more likely to have elevated high sensitivity C-reactive protein (CRP), evident only among those with insomnia, according to a recent cross-sectional study. A total of 20,486 (63%) out of 32,591 individuals, aged 40 years and older, participated in the seventh wave of the Tromsø study conducted in 2015 and 2016, and had valid information on headache, insomnia, and high sensitivity CRP. Researchers found:

• A total of 6290 participants (30.7%) suffered from headache during the last year.
• Among these, 1736 (8.5%) fulfilled the criteria of migraine, 991 (4.8%) had migraine with aura, 746 (3.6%) migraine without aura (3.8%), and 4554 (22.2%) had non-migrainous headache.
• In the final multi-adjusted analysis, elevated high sensitivity CRP was associated with headache, migraine, and migraine with aura.
• No association was found between elevated high sensitivity CRP and migraine without aura or non-migrainous headache.
• The association between high sensitivity CRP and migraine was strongly dependent on insomnia status.
• Among individuals with insomnia, elevated high sensitivity CRP was associated with migraine, and migraine with aura, whereas no such relationship was found among those without insomnia.

Hagen K, Hopstock LA, Eggen AE, Mathiesen EB, Bilsen KB. Does insomnia modify the association between C-reactive protein and migraine? The Tromsø Study 2015–2016. [Published online ahead of print March 12, 2019]. Cephalalgia. doi:10.1177%2F0333102418825370.

Although results of a recent study are preliminary, spinal manipulation may be an effective therapeutic technique to reduce migraine days and pain/intensity. Literature databases were searched for clinical trials that evaluated spinal manipulation and migraine‐related outcomes through April 2017. Search terms included: migraine, spinal manipulation, manual therapy, chiropractic, and osteopathic. Meta‐analytic methods were employed to estimate the effect sizes (Hedges’ g) and heterogeneity (I²) for migraine days, pain, and disability. Researchers found:

• Six randomized clinical trials (RCTs) (pooled n=677; range of n=42‐218) were eligible for meta‐analysis.
• Intervention duration ranged from 2 to 6 months; outcomes included measures of migraine days (primary outcome), migraine pain/intensity, and migraine disability.
• Due to high levels of heterogeneity when all 6 studies were included in the meta‐analysis, the 1 RCT that was performed only among chronic migraineurs was excluded.
• Heterogeneity across the remaining studies was low.
• Spinal manipulation reduced migraine days with an overall small effect size (Hedges’ g=−0.35) as well as migraine pain/intensity.

Rist PM, Hernandez A, Bernstein, C, et al. The impact of spinal manipulation on migraine pain and disability: A systematic review and meta‐analysis. [Published online ahead of print March 14, 2019]. Headache. doi:10.1111/head.13501.

Although results of a recent study are preliminary, spinal manipulation may be an effective therapeutic technique to reduce migraine days and pain/intensity. Literature databases were searched for clinical trials that evaluated spinal manipulation and migraine‐related outcomes through April 2017. Search terms included: migraine, spinal manipulation, manual therapy, chiropractic, and osteopathic. Meta‐analytic methods were employed to estimate the effect sizes (Hedges’ g) and heterogeneity (I²) for migraine days, pain, and disability. Researchers found:

• Six randomized clinical trials (RCTs) (pooled n=677; range of n=42‐218) were eligible for meta‐analysis.
• Intervention duration ranged from 2 to 6 months; outcomes included measures of migraine days (primary outcome), migraine pain/intensity, and migraine disability.
• Due to high levels of heterogeneity when all 6 studies were included in the meta‐analysis, the 1 RCT that was performed only among chronic migraineurs was excluded.
• Heterogeneity across the remaining studies was low.
• Spinal manipulation reduced migraine days with an overall small effect size (Hedges’ g=−0.35) as well as migraine pain/intensity.

Rist PM, Hernandez A, Bernstein, C, et al. The impact of spinal manipulation on migraine pain and disability: A systematic review and meta‐analysis. [Published online ahead of print March 14, 2019]. Headache. doi:10.1111/head.13501.

Although results of a recent study are preliminary, spinal manipulation may be an effective therapeutic technique to reduce migraine days and pain/intensity. Literature databases were searched for clinical trials that evaluated spinal manipulation and migraine‐related outcomes through April 2017. Search terms included: migraine, spinal manipulation, manual therapy, chiropractic, and osteopathic. Meta‐analytic methods were employed to estimate the effect sizes (Hedges’ g) and heterogeneity (I²) for migraine days, pain, and disability. Researchers found:

• Six randomized clinical trials (RCTs) (pooled n=677; range of n=42‐218) were eligible for meta‐analysis.
• Intervention duration ranged from 2 to 6 months; outcomes included measures of migraine days (primary outcome), migraine pain/intensity, and migraine disability.
• Due to high levels of heterogeneity when all 6 studies were included in the meta‐analysis, the 1 RCT that was performed only among chronic migraineurs was excluded.
• Heterogeneity across the remaining studies was low.
• Spinal manipulation reduced migraine days with an overall small effect size (Hedges’ g=−0.35) as well as migraine pain/intensity.

Rist PM, Hernandez A, Bernstein, C, et al. The impact of spinal manipulation on migraine pain and disability: A systematic review and meta‐analysis. [Published online ahead of print March 14, 2019]. Headache. doi:10.1111/head.13501.

Persons with migraine show individual attack patterns and weekend migraine can be determined for a subgroup of participants, while others show accumulations of their attacks on other days of the week. This according to a recent analysis of migraine attacks collected online within the project Migraine Radar in respect to the distribution of migraine attacks throughout the week on a single‐participant level. Researchers recorded data using a web app as well as smartphone apps in order to collect data of 44,639 migraine attacks of 1085 participants who reported 7 or more attacks during a period of at least 90 days. They found:

• For 15.9% of the participants, the attacks were not distributed equally throughout the days of the week.
• Instead, participants show different individual patterns for the distribution of their migraine attacks.
• Furthermore, the modes of the individual distributions are not distributed equally throughout the week.
• Saturday seems to be the predominant day for migraine attacks for a greater proportion of participants (195 of 1085).

Drescher J, Wogenstein F, Gaul C, et al. Distribution of migraine attacks over the days of the week: Preliminary results from a web‐based questionnaire. [Published online ahead of print January 12, 2019]. Acta Neurol Scand. doi:10.1111/ane.13065.

Persons with migraine show individual attack patterns and weekend migraine can be determined for a subgroup of participants, while others show accumulations of their attacks on other days of the week. This according to a recent analysis of migraine attacks collected online within the project Migraine Radar in respect to the distribution of migraine attacks throughout the week on a single‐participant level. Researchers recorded data using a web app as well as smartphone apps in order to collect data of 44,639 migraine attacks of 1085 participants who reported 7 or more attacks during a period of at least 90 days. They found:

• For 15.9% of the participants, the attacks were not distributed equally throughout the days of the week.
• Instead, participants show different individual patterns for the distribution of their migraine attacks.
• Furthermore, the modes of the individual distributions are not distributed equally throughout the week.
• Saturday seems to be the predominant day for migraine attacks for a greater proportion of participants (195 of 1085).

Drescher J, Wogenstein F, Gaul C, et al. Distribution of migraine attacks over the days of the week: Preliminary results from a web‐based questionnaire. [Published online ahead of print January 12, 2019]. Acta Neurol Scand. doi:10.1111/ane.13065.

Persons with migraine show individual attack patterns and weekend migraine can be determined for a subgroup of participants, while others show accumulations of their attacks on other days of the week. This according to a recent analysis of migraine attacks collected online within the project Migraine Radar in respect to the distribution of migraine attacks throughout the week on a single‐participant level. Researchers recorded data using a web app as well as smartphone apps in order to collect data of 44,639 migraine attacks of 1085 participants who reported 7 or more attacks during a period of at least 90 days. They found:

• For 15.9% of the participants, the attacks were not distributed equally throughout the days of the week.
• Instead, participants show different individual patterns for the distribution of their migraine attacks.
• Furthermore, the modes of the individual distributions are not distributed equally throughout the week.
• Saturday seems to be the predominant day for migraine attacks for a greater proportion of participants (195 of 1085).

Drescher J, Wogenstein F, Gaul C, et al. Distribution of migraine attacks over the days of the week: Preliminary results from a web‐based questionnaire. [Published online ahead of print January 12, 2019]. Acta Neurol Scand. doi:10.1111/ane.13065.