Migraine Briefs

Raising awareness among clinicians that many of the potential variables contributing to the presence of migraine are modifiable (eg, psychological problems and lifestyle behaviors) might intensify resources dedicated to assessing and impacting these factors in order to potentially prevent the frequency and severity of migraine. This according to a recent study that aimed to identify the modifiable and non-modifiable variables that are associated with, and might moderate, the presence of migraine in the general population. Using a nationally representative cross-sectional survey, researchers evaluated responses from individuals aged 15 years and older (n=22,842). There was a secondary analysis of data from the second wave of a health interview survey conducted from 2014 to 2015. They found:

• The 1-year prevalence of migraine was 8%.
• The final multivariate model (Wald χ²=693.00, df=15) retained depression severity, chronic anxiety, exercising several times a month or week, and alcohol use as predictors of migraine (odds ratios=2.1–3.5 for positive associations, odds ratios=0.4–0.9 for negative associations).

Roy R, Sánchez-Rodriguez E, Galán S, et al. Factors associated with migraine in the general population of Spain: Results from the European Health Survey 2014. Pain Med. 2019;20(3):555-563. doi:10.1093/pm/pny093.

Raising awareness among clinicians that many of the potential variables contributing to the presence of migraine are modifiable (eg, psychological problems and lifestyle behaviors) might intensify resources dedicated to assessing and impacting these factors in order to potentially prevent the frequency and severity of migraine. This according to a recent study that aimed to identify the modifiable and non-modifiable variables that are associated with, and might moderate, the presence of migraine in the general population. Using a nationally representative cross-sectional survey, researchers evaluated responses from individuals aged 15 years and older (n=22,842). There was a secondary analysis of data from the second wave of a health interview survey conducted from 2014 to 2015. They found:

• The 1-year prevalence of migraine was 8%.
• The final multivariate model (Wald χ²=693.00, df=15) retained depression severity, chronic anxiety, exercising several times a month or week, and alcohol use as predictors of migraine (odds ratios=2.1–3.5 for positive associations, odds ratios=0.4–0.9 for negative associations).

Roy R, Sánchez-Rodriguez E, Galán S, et al. Factors associated with migraine in the general population of Spain: Results from the European Health Survey 2014. Pain Med. 2019;20(3):555-563. doi:10.1093/pm/pny093.

Raising awareness among clinicians that many of the potential variables contributing to the presence of migraine are modifiable (eg, psychological problems and lifestyle behaviors) might intensify resources dedicated to assessing and impacting these factors in order to potentially prevent the frequency and severity of migraine. This according to a recent study that aimed to identify the modifiable and non-modifiable variables that are associated with, and might moderate, the presence of migraine in the general population. Using a nationally representative cross-sectional survey, researchers evaluated responses from individuals aged 15 years and older (n=22,842). There was a secondary analysis of data from the second wave of a health interview survey conducted from 2014 to 2015. They found:

• The 1-year prevalence of migraine was 8%.
• The final multivariate model (Wald χ²=693.00, df=15) retained depression severity, chronic anxiety, exercising several times a month or week, and alcohol use as predictors of migraine (odds ratios=2.1–3.5 for positive associations, odds ratios=0.4–0.9 for negative associations).

Roy R, Sánchez-Rodriguez E, Galán S, et al. Factors associated with migraine in the general population of Spain: Results from the European Health Survey 2014. Pain Med. 2019;20(3):555-563. doi:10.1093/pm/pny093.

Non-persistence to prophylactic treatment was frequent among migraine patients, a recent study found. Furthermore, opioid use was common in migraine patients and the risk of gastrointestinal-related adverse events and opioid abuse increased with long-term use of opioids. These results suggest a need for more effective prophylactic migraine treatments. This study used the IBM MarketScan databases from 2005 through 2014 to evaluate migraine patients initiating prophylactic medication. In total, 147,832 patients were analyzed. Outcome measures included persistence with prophylactic migraine medications throughout 2 to 5 years. Acute medication use and gastrointestinal-related adverse events and opioid abuse following opioid use were evaluated. Researchers found:

• Non-persistence was observed in 90% of patients; 39% switched, 30% restarted, and 31% discontinued treatment.
• Throughout the follow-up, 59.9% of patients received triptans, 66.6% non-steroidal anti-inflammatory drugs, 77.4% opioids, and 2.6% ergotamines.
• Among opioid users, 16.6% experienced nausea/vomiting, 12.2% had constipation, and 10.4% had diarrhea.
• Opioid abuse was reported in <1% of opioid users.
• Gastrointestinal-related adverse events increased with increasing number of days’ supply of opioids.

Bonafede M, Wilson K, Xue F. Long-term treatment patterns of prophylactic and acute migraine medications and incidence of opioid-related adverse events in patients with migraine. [Published online ahead of print February 28, 2019]. Cephalalgia. doi:10.1177%2F0333102419835465.

Non-persistence to prophylactic treatment was frequent among migraine patients, a recent study found. Furthermore, opioid use was common in migraine patients and the risk of gastrointestinal-related adverse events and opioid abuse increased with long-term use of opioids. These results suggest a need for more effective prophylactic migraine treatments. This study used the IBM MarketScan databases from 2005 through 2014 to evaluate migraine patients initiating prophylactic medication. In total, 147,832 patients were analyzed. Outcome measures included persistence with prophylactic migraine medications throughout 2 to 5 years. Acute medication use and gastrointestinal-related adverse events and opioid abuse following opioid use were evaluated. Researchers found:

• Non-persistence was observed in 90% of patients; 39% switched, 30% restarted, and 31% discontinued treatment.
• Throughout the follow-up, 59.9% of patients received triptans, 66.6% non-steroidal anti-inflammatory drugs, 77.4% opioids, and 2.6% ergotamines.
• Among opioid users, 16.6% experienced nausea/vomiting, 12.2% had constipation, and 10.4% had diarrhea.
• Opioid abuse was reported in <1% of opioid users.
• Gastrointestinal-related adverse events increased with increasing number of days’ supply of opioids.

Bonafede M, Wilson K, Xue F. Long-term treatment patterns of prophylactic and acute migraine medications and incidence of opioid-related adverse events in patients with migraine. [Published online ahead of print February 28, 2019]. Cephalalgia. doi:10.1177%2F0333102419835465.

Non-persistence to prophylactic treatment was frequent among migraine patients, a recent study found. Furthermore, opioid use was common in migraine patients and the risk of gastrointestinal-related adverse events and opioid abuse increased with long-term use of opioids. These results suggest a need for more effective prophylactic migraine treatments. This study used the IBM MarketScan databases from 2005 through 2014 to evaluate migraine patients initiating prophylactic medication. In total, 147,832 patients were analyzed. Outcome measures included persistence with prophylactic migraine medications throughout 2 to 5 years. Acute medication use and gastrointestinal-related adverse events and opioid abuse following opioid use were evaluated. Researchers found:

• Non-persistence was observed in 90% of patients; 39% switched, 30% restarted, and 31% discontinued treatment.
• Throughout the follow-up, 59.9% of patients received triptans, 66.6% non-steroidal anti-inflammatory drugs, 77.4% opioids, and 2.6% ergotamines.
• Among opioid users, 16.6% experienced nausea/vomiting, 12.2% had constipation, and 10.4% had diarrhea.
• Opioid abuse was reported in <1% of opioid users.
• Gastrointestinal-related adverse events increased with increasing number of days’ supply of opioids.

Bonafede M, Wilson K, Xue F. Long-term treatment patterns of prophylactic and acute migraine medications and incidence of opioid-related adverse events in patients with migraine. [Published online ahead of print February 28, 2019]. Cephalalgia. doi:10.1177%2F0333102419835465.

Migraine is associated with aberrant connections from the somatosensory cortex to the frontal lobe, according to a recent study. The frequency-specific increases in connectivity in terms of strength, path length, and clustering coefficients support the notion that migraineurs have elevated cortical networks. Twenty-two migraineurs in the interictal phase and 22 sex- and age-matched healthy volunteers were studied using a whole-head magnetoencephalography (MEG) system. Researchers found:

• The brain network patterns revealed that the patients with migraine exhibited remarkably increased functional connectivity in the high-frequency (250–1000 Hz) band between the sensory cortex and the frontal lobe.
• The results of quantitative analysis of graph theory showed that the patients had:

1. an increased degree of connectivity in the theta (4–8 Hz), beta (13–30 Hz) and gamma (30–80 Hz) bands;
2. an increased connectivity strength in the beta (13–30 Hz) and gamma (30–80 Hz) bands;
3. an increased path length in the beta (13–30 Hz), gamma (30–80 Hz) and ripple (80–250 Hz) bands; and
4. an increased clustering coefficient in the theta (4–8 Hz), beta (13–30 Hz) and gamma (30–80 Hz) bands.

Ren J, Xiang J, Chen Y, li F, Wu T, Shi J. Abnormal functional connectivity under somatosensory stimulation in migraine: A multi-frequency magnetoencephalography study. J Headache Pain. 2019;20(1):3. doi:10.1186/s10194-019-0958-3.

Migraine is associated with aberrant connections from the somatosensory cortex to the frontal lobe, according to a recent study. The frequency-specific increases in connectivity in terms of strength, path length, and clustering coefficients support the notion that migraineurs have elevated cortical networks. Twenty-two migraineurs in the interictal phase and 22 sex- and age-matched healthy volunteers were studied using a whole-head magnetoencephalography (MEG) system. Researchers found:

• The brain network patterns revealed that the patients with migraine exhibited remarkably increased functional connectivity in the high-frequency (250–1000 Hz) band between the sensory cortex and the frontal lobe.
• The results of quantitative analysis of graph theory showed that the patients had:

1. an increased degree of connectivity in the theta (4–8 Hz), beta (13–30 Hz) and gamma (30–80 Hz) bands;
2. an increased connectivity strength in the beta (13–30 Hz) and gamma (30–80 Hz) bands;
3. an increased path length in the beta (13–30 Hz), gamma (30–80 Hz) and ripple (80–250 Hz) bands; and
4. an increased clustering coefficient in the theta (4–8 Hz), beta (13–30 Hz) and gamma (30–80 Hz) bands.

Ren J, Xiang J, Chen Y, li F, Wu T, Shi J. Abnormal functional connectivity under somatosensory stimulation in migraine: A multi-frequency magnetoencephalography study. J Headache Pain. 2019;20(1):3. doi:10.1186/s10194-019-0958-3.

Migraine is associated with aberrant connections from the somatosensory cortex to the frontal lobe, according to a recent study. The frequency-specific increases in connectivity in terms of strength, path length, and clustering coefficients support the notion that migraineurs have elevated cortical networks. Twenty-two migraineurs in the interictal phase and 22 sex- and age-matched healthy volunteers were studied using a whole-head magnetoencephalography (MEG) system. Researchers found:

• The brain network patterns revealed that the patients with migraine exhibited remarkably increased functional connectivity in the high-frequency (250–1000 Hz) band between the sensory cortex and the frontal lobe.
• The results of quantitative analysis of graph theory showed that the patients had:

1. an increased degree of connectivity in the theta (4–8 Hz), beta (13–30 Hz) and gamma (30–80 Hz) bands;
2. an increased connectivity strength in the beta (13–30 Hz) and gamma (30–80 Hz) bands;
3. an increased path length in the beta (13–30 Hz), gamma (30–80 Hz) and ripple (80–250 Hz) bands; and
4. an increased clustering coefficient in the theta (4–8 Hz), beta (13–30 Hz) and gamma (30–80 Hz) bands.

Ren J, Xiang J, Chen Y, li F, Wu T, Shi J. Abnormal functional connectivity under somatosensory stimulation in migraine: A multi-frequency magnetoencephalography study. J Headache Pain. 2019;20(1):3. doi:10.1186/s10194-019-0958-3.

Migraine is more frequent in patients with subclinical hypothyroidism in respect to controls, according to a recent study. Using a case-control strategy, 151 consecutive subclinical hypothyroidism patients (mean age 48.36 ± 15.86 years) and 150 controls (mean age 50.86 ± 9.19 years) were recruited. In all subjects, migraine characteristics were collected through a direct interview. Clinical and biochemical parameters (thyroid-stimulating hormone, free triiodothyronine, free thyroxine, and anti-thyroid antibodies) were compared between subclinical hypothyroidism patients in comorbidity with migraine and subclinical hypothyroidism patients without migraine. Researchers found:

• The prevalence of lifetime migraine was significantly higher in subclinical hypothyroidism patients in comparison with controls (46% vs 13%; OR 5.80).
• Both migraine without and with aura were significantly higher in subclinical hypothyroidism patients than controls.
• Thyroid hormones and concentrations of antibodies did not differ between subclinical hypothyroidism patients with and without migraine.
• Interestingly, a comorbidity for autoimmune diseases was observed in subclinical hypothyroidism patients with migraine in respect to those without migraine.

Rubino E, Rainero I, Garino F, et al. Subclinical hypothyroidism is associated with migraine: A case-control study. Cephalalgia. 2019;39(1):15–20. doi:10.1177/0333102418769917.

Migraine is more frequent in patients with subclinical hypothyroidism in respect to controls, according to a recent study. Using a case-control strategy, 151 consecutive subclinical hypothyroidism patients (mean age 48.36 ± 15.86 years) and 150 controls (mean age 50.86 ± 9.19 years) were recruited. In all subjects, migraine characteristics were collected through a direct interview. Clinical and biochemical parameters (thyroid-stimulating hormone, free triiodothyronine, free thyroxine, and anti-thyroid antibodies) were compared between subclinical hypothyroidism patients in comorbidity with migraine and subclinical hypothyroidism patients without migraine. Researchers found:

• The prevalence of lifetime migraine was significantly higher in subclinical hypothyroidism patients in comparison with controls (46% vs 13%; OR 5.80).
• Both migraine without and with aura were significantly higher in subclinical hypothyroidism patients than controls.
• Thyroid hormones and concentrations of antibodies did not differ between subclinical hypothyroidism patients with and without migraine.
• Interestingly, a comorbidity for autoimmune diseases was observed in subclinical hypothyroidism patients with migraine in respect to those without migraine.

Rubino E, Rainero I, Garino F, et al. Subclinical hypothyroidism is associated with migraine: A case-control study. Cephalalgia. 2019;39(1):15–20. doi:10.1177/0333102418769917.

Migraine is more frequent in patients with subclinical hypothyroidism in respect to controls, according to a recent study. Using a case-control strategy, 151 consecutive subclinical hypothyroidism patients (mean age 48.36 ± 15.86 years) and 150 controls (mean age 50.86 ± 9.19 years) were recruited. In all subjects, migraine characteristics were collected through a direct interview. Clinical and biochemical parameters (thyroid-stimulating hormone, free triiodothyronine, free thyroxine, and anti-thyroid antibodies) were compared between subclinical hypothyroidism patients in comorbidity with migraine and subclinical hypothyroidism patients without migraine. Researchers found:

• The prevalence of lifetime migraine was significantly higher in subclinical hypothyroidism patients in comparison with controls (46% vs 13%; OR 5.80).
• Both migraine without and with aura were significantly higher in subclinical hypothyroidism patients than controls.
• Thyroid hormones and concentrations of antibodies did not differ between subclinical hypothyroidism patients with and without migraine.
• Interestingly, a comorbidity for autoimmune diseases was observed in subclinical hypothyroidism patients with migraine in respect to those without migraine.

Rubino E, Rainero I, Garino F, et al. Subclinical hypothyroidism is associated with migraine: A case-control study. Cephalalgia. 2019;39(1):15–20. doi:10.1177/0333102418769917.

Demographics and migraine diagnosis in the pediatric population are associated with evidence-based medicine and opioid/barbiturates. This according to a recent study that aimed to evaluate providers’ use and predictors of evidence-based medicine or opioid/barbiturate as first-line acute treatment for children’s initial presentation of acute migraine or primary headache. Primary care, therefore, provides an opportunity to target provider interventions to enhance effective pediatric headache treatment. This retrospective, observational study utilized patient (children aged 6–17) and provider/encounter characteristics extracted from the patient’s electronic health record from 2008 to 2014 during an initial encounter for migraine or primary headache. Researchers found:

• In all, 38,926 patients (56.7% female, mean age=12.1) and 1617 providers were evaluated.
• Only 17.7% of patients were diagnosed with migraine; 16.1% received evidence-based medicine.
• Older children (OR=1.07), females (OR=1.14), and those diagnosed with migraine (OR=4.71) were more likely to receive evidence-based medicine.
• Among prescriptions, 15.8% were for opioids/barbiturates.
• Older children (OR=1.14) and those cared for in the emergency department/urgent care (OR=2.02) were at increased risk.

Seng EK, Gelfand AA, Nicholson RA. Assessing evidence-based medicine and opioid/barbiturate as first-line acute treatment of pediatric migraine and primary headache: A retrospective observational study of health systems data. [Published online ahead of print February 20, 2019]. Cephalalgia. doi:10.1177%2F0333102419833080.

Demographics and migraine diagnosis in the pediatric population are associated with evidence-based medicine and opioid/barbiturates. This according to a recent study that aimed to evaluate providers’ use and predictors of evidence-based medicine or opioid/barbiturate as first-line acute treatment for children’s initial presentation of acute migraine or primary headache. Primary care, therefore, provides an opportunity to target provider interventions to enhance effective pediatric headache treatment. This retrospective, observational study utilized patient (children aged 6–17) and provider/encounter characteristics extracted from the patient’s electronic health record from 2008 to 2014 during an initial encounter for migraine or primary headache. Researchers found:

• In all, 38,926 patients (56.7% female, mean age=12.1) and 1617 providers were evaluated.
• Only 17.7% of patients were diagnosed with migraine; 16.1% received evidence-based medicine.
• Older children (OR=1.07), females (OR=1.14), and those diagnosed with migraine (OR=4.71) were more likely to receive evidence-based medicine.
• Among prescriptions, 15.8% were for opioids/barbiturates.
• Older children (OR=1.14) and those cared for in the emergency department/urgent care (OR=2.02) were at increased risk.

Seng EK, Gelfand AA, Nicholson RA. Assessing evidence-based medicine and opioid/barbiturate as first-line acute treatment of pediatric migraine and primary headache: A retrospective observational study of health systems data. [Published online ahead of print February 20, 2019]. Cephalalgia. doi:10.1177%2F0333102419833080.

Demographics and migraine diagnosis in the pediatric population are associated with evidence-based medicine and opioid/barbiturates. This according to a recent study that aimed to evaluate providers’ use and predictors of evidence-based medicine or opioid/barbiturate as first-line acute treatment for children’s initial presentation of acute migraine or primary headache. Primary care, therefore, provides an opportunity to target provider interventions to enhance effective pediatric headache treatment. This retrospective, observational study utilized patient (children aged 6–17) and provider/encounter characteristics extracted from the patient’s electronic health record from 2008 to 2014 during an initial encounter for migraine or primary headache. Researchers found:

• In all, 38,926 patients (56.7% female, mean age=12.1) and 1617 providers were evaluated.
• Only 17.7% of patients were diagnosed with migraine; 16.1% received evidence-based medicine.
• Older children (OR=1.07), females (OR=1.14), and those diagnosed with migraine (OR=4.71) were more likely to receive evidence-based medicine.
• Among prescriptions, 15.8% were for opioids/barbiturates.
• Older children (OR=1.14) and those cared for in the emergency department/urgent care (OR=2.02) were at increased risk.

Seng EK, Gelfand AA, Nicholson RA. Assessing evidence-based medicine and opioid/barbiturate as first-line acute treatment of pediatric migraine and primary headache: A retrospective observational study of health systems data. [Published online ahead of print February 20, 2019]. Cephalalgia. doi:10.1177%2F0333102419833080.

Parental migraine is associated with offspring migraine, with a stronger association for maternal migraine, according to a recent study. Therefore, this may indicate maternal-specific transmission. Researchers utilized data from the HUNT Study, a large, population-based cohort study. Using a cross-sectional design, the sample consisted of 13,731 parents and 8970 offspring. Logistic regression was used to calculate odds ratios with 95% confidence intervals for active migraine and non-migrainous headache in offspring, given active maternal or paternal headache. They found:

• There was a significant association between maternal migraine and offspring migraine (odds ratio 2.76).

• A weaker association was found between paternal migraine and offspring migraine (odds ratio 1.67).

• For non-migrainous headache, there was a significant association between mothers and offspring (odds ratio 1.25), but not between fathers and offspring.

Børte S, Zwart J-A, Stendland SØ, Hagen K, Winsvold BS. Parental migraine in relation to migraine in offspring: Family linkage analyses from the HUNT Study. [Published online ahead of print February 2, 2019]. Cephalalgia. doi:10.1177%2F0333102419828989.

Parental migraine is associated with offspring migraine, with a stronger association for maternal migraine, according to a recent study. Therefore, this may indicate maternal-specific transmission. Researchers utilized data from the HUNT Study, a large, population-based cohort study. Using a cross-sectional design, the sample consisted of 13,731 parents and 8970 offspring. Logistic regression was used to calculate odds ratios with 95% confidence intervals for active migraine and non-migrainous headache in offspring, given active maternal or paternal headache. They found:

• There was a significant association between maternal migraine and offspring migraine (odds ratio 2.76).

• A weaker association was found between paternal migraine and offspring migraine (odds ratio 1.67).

• For non-migrainous headache, there was a significant association between mothers and offspring (odds ratio 1.25), but not between fathers and offspring.

Børte S, Zwart J-A, Stendland SØ, Hagen K, Winsvold BS. Parental migraine in relation to migraine in offspring: Family linkage analyses from the HUNT Study. [Published online ahead of print February 2, 2019]. Cephalalgia. doi:10.1177%2F0333102419828989.

Parental migraine is associated with offspring migraine, with a stronger association for maternal migraine, according to a recent study. Therefore, this may indicate maternal-specific transmission. Researchers utilized data from the HUNT Study, a large, population-based cohort study. Using a cross-sectional design, the sample consisted of 13,731 parents and 8970 offspring. Logistic regression was used to calculate odds ratios with 95% confidence intervals for active migraine and non-migrainous headache in offspring, given active maternal or paternal headache. They found:

• There was a significant association between maternal migraine and offspring migraine (odds ratio 2.76).

• A weaker association was found between paternal migraine and offspring migraine (odds ratio 1.67).

• For non-migrainous headache, there was a significant association between mothers and offspring (odds ratio 1.25), but not between fathers and offspring.

Børte S, Zwart J-A, Stendland SØ, Hagen K, Winsvold BS. Parental migraine in relation to migraine in offspring: Family linkage analyses from the HUNT Study. [Published online ahead of print February 2, 2019]. Cephalalgia. doi:10.1177%2F0333102419828989.

Migraine sufferers exhibited impaired conditioned pain modulation of the nociceptive blink reflex, suggesting a deficiency in inhibition of trigeminal nociception, which may contribute to the development of migraine headaches. This according to a recent study that aimed to assess conditioned pain modulation efficiency in persons with and without migraine headaches. Twenty-three adults with and 32 without a history of migraine headaches participated in the study. Four electrocutaneous stimulations of the supraorbital branch of the left trigeminal nerve were delivered at 150% of an individually determined pain threshold. Conditioned pain modulation was assessed by applying a noxious counterstimulus (forearm ischemia) and delivering 4 more electrocutaneous stimulations. After each stimulation, pain and the nociceptive blink reflex were assessed. Researchers found:

• Participants with and without migraine headaches had similar baseline pain responsivity, without significant differences in pain report or nociceptive blink reflexes.

• Pain report was inhibited by conditioned pain modulation in both the migraine and control groups.

• However, unlike non-migraine controls, participants with migraines did not exhibit an inhibition of nociceptive blink reflexes during the ischemia task.

Williams AE, Miller MM, Bartley EJ, McCabe KM, Kerr KL, Rhudy JL. Impairment of inhibition of trigeminal nociception via conditioned pain modulation in persons with migraine headaches. [Published online ahead of print January 25, 2019]. Pain Med. doi:10.1093/pm/pny305.

Migraine sufferers exhibited impaired conditioned pain modulation of the nociceptive blink reflex, suggesting a deficiency in inhibition of trigeminal nociception, which may contribute to the development of migraine headaches. This according to a recent study that aimed to assess conditioned pain modulation efficiency in persons with and without migraine headaches. Twenty-three adults with and 32 without a history of migraine headaches participated in the study. Four electrocutaneous stimulations of the supraorbital branch of the left trigeminal nerve were delivered at 150% of an individually determined pain threshold. Conditioned pain modulation was assessed by applying a noxious counterstimulus (forearm ischemia) and delivering 4 more electrocutaneous stimulations. After each stimulation, pain and the nociceptive blink reflex were assessed. Researchers found:

• Participants with and without migraine headaches had similar baseline pain responsivity, without significant differences in pain report or nociceptive blink reflexes.

• Pain report was inhibited by conditioned pain modulation in both the migraine and control groups.

• However, unlike non-migraine controls, participants with migraines did not exhibit an inhibition of nociceptive blink reflexes during the ischemia task.

Williams AE, Miller MM, Bartley EJ, McCabe KM, Kerr KL, Rhudy JL. Impairment of inhibition of trigeminal nociception via conditioned pain modulation in persons with migraine headaches. [Published online ahead of print January 25, 2019]. Pain Med. doi:10.1093/pm/pny305.

Migraine sufferers exhibited impaired conditioned pain modulation of the nociceptive blink reflex, suggesting a deficiency in inhibition of trigeminal nociception, which may contribute to the development of migraine headaches. This according to a recent study that aimed to assess conditioned pain modulation efficiency in persons with and without migraine headaches. Twenty-three adults with and 32 without a history of migraine headaches participated in the study. Four electrocutaneous stimulations of the supraorbital branch of the left trigeminal nerve were delivered at 150% of an individually determined pain threshold. Conditioned pain modulation was assessed by applying a noxious counterstimulus (forearm ischemia) and delivering 4 more electrocutaneous stimulations. After each stimulation, pain and the nociceptive blink reflex were assessed. Researchers found:

• Participants with and without migraine headaches had similar baseline pain responsivity, without significant differences in pain report or nociceptive blink reflexes.

• Pain report was inhibited by conditioned pain modulation in both the migraine and control groups.

• However, unlike non-migraine controls, participants with migraines did not exhibit an inhibition of nociceptive blink reflexes during the ischemia task.

Williams AE, Miller MM, Bartley EJ, McCabe KM, Kerr KL, Rhudy JL. Impairment of inhibition of trigeminal nociception via conditioned pain modulation in persons with migraine headaches. [Published online ahead of print January 25, 2019]. Pain Med. doi:10.1093/pm/pny305.

Vestibular migraine (VM) typically affects women in their 40s with a personal and family history of migraine, according to a recent study. Typical ictal symptoms were triggered as well as spontaneous vertigo (associated with photophobia and phonophobia), nausea, aural symptoms, and headache. In addition, interictal vestibular symptoms, comorbid psychiatric disorders, and non‐specific interictal neuro‐otologic findings were common. Researchers evaluated a retrospective chart review of 491 patients seen from August 2014 until March 2018 at a tertiary neurology referral center for vestibular disorders to identify patients fulfilling the 2012 VM criteria. There were 131 patients (105 women) identified; mean age of VM onset was 44.3 (±13.7) years. They found:

• Preceding the onset of vestibular symptoms, most had migraine (57.3%) and motion sickness (61.1%).

• It was common to have a family history of migraine (50.8%) and episodic vestibular symptoms (28.1%).

• Common ictal symptoms were triggered (visually induced and head‐motion) and spontaneous vertigo, accompanied by photophobia and phonophobia (118/131 [90.1%] patients), nausea (105/131 [80.2%] patients), aural symptoms (79/131 [60.3%] patients), and headache (65/131 [49.6%] patients).

• Interictally, many experienced visually induced (116/131 [88.6%] patients), head‐motion (86/131 [65.6%] patients), and persistent (67/131 [51.1%] patients) dizziness.

Beh SC, Masrour S, Smith SV, Friedman DI. The spectrum of vestibular migraine: Clinical features, triggers, and examination findings. [Published online ahead of print February 8, 2019]. Headache. doi:10.1111/head.13484.

Vestibular migraine (VM) typically affects women in their 40s with a personal and family history of migraine, according to a recent study. Typical ictal symptoms were triggered as well as spontaneous vertigo (associated with photophobia and phonophobia), nausea, aural symptoms, and headache. In addition, interictal vestibular symptoms, comorbid psychiatric disorders, and non‐specific interictal neuro‐otologic findings were common. Researchers evaluated a retrospective chart review of 491 patients seen from August 2014 until March 2018 at a tertiary neurology referral center for vestibular disorders to identify patients fulfilling the 2012 VM criteria. There were 131 patients (105 women) identified; mean age of VM onset was 44.3 (±13.7) years. They found:

• Preceding the onset of vestibular symptoms, most had migraine (57.3%) and motion sickness (61.1%).

• It was common to have a family history of migraine (50.8%) and episodic vestibular symptoms (28.1%).

• Common ictal symptoms were triggered (visually induced and head‐motion) and spontaneous vertigo, accompanied by photophobia and phonophobia (118/131 [90.1%] patients), nausea (105/131 [80.2%] patients), aural symptoms (79/131 [60.3%] patients), and headache (65/131 [49.6%] patients).

• Interictally, many experienced visually induced (116/131 [88.6%] patients), head‐motion (86/131 [65.6%] patients), and persistent (67/131 [51.1%] patients) dizziness.

Beh SC, Masrour S, Smith SV, Friedman DI. The spectrum of vestibular migraine: Clinical features, triggers, and examination findings. [Published online ahead of print February 8, 2019]. Headache. doi:10.1111/head.13484.

Vestibular migraine (VM) typically affects women in their 40s with a personal and family history of migraine, according to a recent study. Typical ictal symptoms were triggered as well as spontaneous vertigo (associated with photophobia and phonophobia), nausea, aural symptoms, and headache. In addition, interictal vestibular symptoms, comorbid psychiatric disorders, and non‐specific interictal neuro‐otologic findings were common. Researchers evaluated a retrospective chart review of 491 patients seen from August 2014 until March 2018 at a tertiary neurology referral center for vestibular disorders to identify patients fulfilling the 2012 VM criteria. There were 131 patients (105 women) identified; mean age of VM onset was 44.3 (±13.7) years. They found:

• Preceding the onset of vestibular symptoms, most had migraine (57.3%) and motion sickness (61.1%).

• It was common to have a family history of migraine (50.8%) and episodic vestibular symptoms (28.1%).

• Common ictal symptoms were triggered (visually induced and head‐motion) and spontaneous vertigo, accompanied by photophobia and phonophobia (118/131 [90.1%] patients), nausea (105/131 [80.2%] patients), aural symptoms (79/131 [60.3%] patients), and headache (65/131 [49.6%] patients).

• Interictally, many experienced visually induced (116/131 [88.6%] patients), head‐motion (86/131 [65.6%] patients), and persistent (67/131 [51.1%] patients) dizziness.

Beh SC, Masrour S, Smith SV, Friedman DI. The spectrum of vestibular migraine: Clinical features, triggers, and examination findings. [Published online ahead of print February 8, 2019]. Headache. doi:10.1111/head.13484.

In a population of obese adults in the United States, migraineurs showed greater total health care utilization and expenses than non-migraineurs, a recent study found. Therefore, treatment plans that address risk factors associated with migraine and comorbidities may help reduce the utilization of health care services and costs. This 7-year retrospective study used longitudinal panel data from 2006 to 2013 from the Household Component of the Medical Expenditure Panel Survey to identify obese adults reporting migraines. Outcomes compared in migraineurs versus non-migraineurs were as follows: annualized per-person medical care, prescription drug, and total health expenses. Researchers found:

• In 23,596 obese adults, 4.7% reported migraine (n=1025) approximating 3 million civilian non-institutionalized individuals in the United States.
• Logistic regression showed that the following sociodemographic characteristics increased migraine risk: age (18–45 years), females, white race, poor perceived health status, and greater Charlson comorbidity index.
• Migraineurs showed $1401, $813, and $2213 greater annual medical, prescription drug, and total health expenses than non-migraineurs, respectively.
• After adjustment, total health expenses increased by 31.6% in migraineurs versus non-migraineurs.

Wu J, Davis-Ajami ML, Lu ZK. Impact of migraine on health care utilization and expenses in obese adults: A US population-based study. [Published online ahead of print December 31, 2018]. Clinicoecon Outcomes Res. doi:10.2147/CEOR.S189699.

In a population of obese adults in the United States, migraineurs showed greater total health care utilization and expenses than non-migraineurs, a recent study found. Therefore, treatment plans that address risk factors associated with migraine and comorbidities may help reduce the utilization of health care services and costs. This 7-year retrospective study used longitudinal panel data from 2006 to 2013 from the Household Component of the Medical Expenditure Panel Survey to identify obese adults reporting migraines. Outcomes compared in migraineurs versus non-migraineurs were as follows: annualized per-person medical care, prescription drug, and total health expenses. Researchers found:

• In 23,596 obese adults, 4.7% reported migraine (n=1025) approximating 3 million civilian non-institutionalized individuals in the United States.
• Logistic regression showed that the following sociodemographic characteristics increased migraine risk: age (18–45 years), females, white race, poor perceived health status, and greater Charlson comorbidity index.
• Migraineurs showed $1401, $813, and $2213 greater annual medical, prescription drug, and total health expenses than non-migraineurs, respectively.
• After adjustment, total health expenses increased by 31.6% in migraineurs versus non-migraineurs.

Wu J, Davis-Ajami ML, Lu ZK. Impact of migraine on health care utilization and expenses in obese adults: A US population-based study. [Published online ahead of print December 31, 2018]. Clinicoecon Outcomes Res. doi:10.2147/CEOR.S189699.

In a population of obese adults in the United States, migraineurs showed greater total health care utilization and expenses than non-migraineurs, a recent study found. Therefore, treatment plans that address risk factors associated with migraine and comorbidities may help reduce the utilization of health care services and costs. This 7-year retrospective study used longitudinal panel data from 2006 to 2013 from the Household Component of the Medical Expenditure Panel Survey to identify obese adults reporting migraines. Outcomes compared in migraineurs versus non-migraineurs were as follows: annualized per-person medical care, prescription drug, and total health expenses. Researchers found:

• In 23,596 obese adults, 4.7% reported migraine (n=1025) approximating 3 million civilian non-institutionalized individuals in the United States.
• Logistic regression showed that the following sociodemographic characteristics increased migraine risk: age (18–45 years), females, white race, poor perceived health status, and greater Charlson comorbidity index.
• Migraineurs showed $1401, $813, and $2213 greater annual medical, prescription drug, and total health expenses than non-migraineurs, respectively.
• After adjustment, total health expenses increased by 31.6% in migraineurs versus non-migraineurs.

Wu J, Davis-Ajami ML, Lu ZK. Impact of migraine on health care utilization and expenses in obese adults: A US population-based study. [Published online ahead of print December 31, 2018]. Clinicoecon Outcomes Res. doi:10.2147/CEOR.S189699.

Optimism and pessimism are associated with migraine and migraine‐related disability. This according to a recent study that found that people with migraine were less optimistic and more pessimistic than controls and endorsed higher levels of anxious and depressive symptoms. The sample population was selected through a stratified, multi‐stage area probability sample of households. A validated questionnaire eliciting data on demographics, headache features, migraine‐related disability, depression (PHQ‐9), anxiety (GAD‐7), optimism, and pessimism was administered to people with migraine and headache‐free control participants via trained interviewers. The odds for having migraine/no headache diagnosis were calculated by binary logistic regression, and ordinal regression was performed to check associations between migraine‐related disability and optimism. Researchers found:

• Out of 600 individuals, 302 met inclusion criteria and were included (140 controls [with no history of headache disorders] and 162 people meeting criteria for migraine [29 with chronic migraine, that is, ≥15 headache days/month]).
• Pessimism and anxiety were predictors of meeting criteria for migraine, while optimism was inversely associated with migraine‐related disability.

Peres MFP, Belitardo A, Mercante JP, et al. Optimism, pessimism, and migraine: A cross‐sectional, population‐based study. [Published online ahead of print January 19, 2019]. Headache. doi:10.1111/head.13471.

Optimism and pessimism are associated with migraine and migraine‐related disability. This according to a recent study that found that people with migraine were less optimistic and more pessimistic than controls and endorsed higher levels of anxious and depressive symptoms. The sample population was selected through a stratified, multi‐stage area probability sample of households. A validated questionnaire eliciting data on demographics, headache features, migraine‐related disability, depression (PHQ‐9), anxiety (GAD‐7), optimism, and pessimism was administered to people with migraine and headache‐free control participants via trained interviewers. The odds for having migraine/no headache diagnosis were calculated by binary logistic regression, and ordinal regression was performed to check associations between migraine‐related disability and optimism. Researchers found:

• Out of 600 individuals, 302 met inclusion criteria and were included (140 controls [with no history of headache disorders] and 162 people meeting criteria for migraine [29 with chronic migraine, that is, ≥15 headache days/month]).
• Pessimism and anxiety were predictors of meeting criteria for migraine, while optimism was inversely associated with migraine‐related disability.

Peres MFP, Belitardo A, Mercante JP, et al. Optimism, pessimism, and migraine: A cross‐sectional, population‐based study. [Published online ahead of print January 19, 2019]. Headache. doi:10.1111/head.13471.

Optimism and pessimism are associated with migraine and migraine‐related disability. This according to a recent study that found that people with migraine were less optimistic and more pessimistic than controls and endorsed higher levels of anxious and depressive symptoms. The sample population was selected through a stratified, multi‐stage area probability sample of households. A validated questionnaire eliciting data on demographics, headache features, migraine‐related disability, depression (PHQ‐9), anxiety (GAD‐7), optimism, and pessimism was administered to people with migraine and headache‐free control participants via trained interviewers. The odds for having migraine/no headache diagnosis were calculated by binary logistic regression, and ordinal regression was performed to check associations between migraine‐related disability and optimism. Researchers found:

• Out of 600 individuals, 302 met inclusion criteria and were included (140 controls [with no history of headache disorders] and 162 people meeting criteria for migraine [29 with chronic migraine, that is, ≥15 headache days/month]).
• Pessimism and anxiety were predictors of meeting criteria for migraine, while optimism was inversely associated with migraine‐related disability.

Peres MFP, Belitardo A, Mercante JP, et al. Optimism, pessimism, and migraine: A cross‐sectional, population‐based study. [Published online ahead of print January 19, 2019]. Headache. doi:10.1111/head.13471.