Migraine Briefs

Increased stroke risk in late life was observed in participants with late onset of migraine with aura (MA), as compared to participants with no headache in a recent ongoing, prospective, longitudinal, community‐based cohort study. Longer cumulative exposure to migraine with visual aura, however, was not associated with increased risk of ischemic stroke in late life. Participants were interviewed to ascertain migraine history at the third visit (1993–1995) and followed for ischemic stroke incidence over 20 years. Researchers performed a post hoc analysis to evaluate the association between the age of migraine onset and ischemic stroke. They found:

• There were 447 migraineurs with MA and 1128 migraineurs without aura (MO) identified among 11,592 black and white participants.
• There was an association between the age of MA onset at age ≥50 years (average duration=4.75 years) and ischemic stroke when compared to the no headache group (multivariable adjusted HR=2.17).
• MA onset at <50 years (average duration=28.17 years) was not associated with stroke (multivariable adjusted HR=1.31).
• MO was not associated with increased stroke regardless of the age of onset.

Androulakis XM, Sen S, Kodumuri N, et al. Migraine age of onset and association with ischemic stroke in late life: 20 years follow‐up in ARIC. [Published online ahead of print January 21, 2019]. Headache. doi:10.1111/head.13468.

Increased stroke risk in late life was observed in participants with late onset of migraine with aura (MA), as compared to participants with no headache in a recent ongoing, prospective, longitudinal, community‐based cohort study. Longer cumulative exposure to migraine with visual aura, however, was not associated with increased risk of ischemic stroke in late life. Participants were interviewed to ascertain migraine history at the third visit (1993–1995) and followed for ischemic stroke incidence over 20 years. Researchers performed a post hoc analysis to evaluate the association between the age of migraine onset and ischemic stroke. They found:

• There were 447 migraineurs with MA and 1128 migraineurs without aura (MO) identified among 11,592 black and white participants.
• There was an association between the age of MA onset at age ≥50 years (average duration=4.75 years) and ischemic stroke when compared to the no headache group (multivariable adjusted HR=2.17).
• MA onset at <50 years (average duration=28.17 years) was not associated with stroke (multivariable adjusted HR=1.31).
• MO was not associated with increased stroke regardless of the age of onset.

Androulakis XM, Sen S, Kodumuri N, et al. Migraine age of onset and association with ischemic stroke in late life: 20 years follow‐up in ARIC. [Published online ahead of print January 21, 2019]. Headache. doi:10.1111/head.13468.

Increased stroke risk in late life was observed in participants with late onset of migraine with aura (MA), as compared to participants with no headache in a recent ongoing, prospective, longitudinal, community‐based cohort study. Longer cumulative exposure to migraine with visual aura, however, was not associated with increased risk of ischemic stroke in late life. Participants were interviewed to ascertain migraine history at the third visit (1993–1995) and followed for ischemic stroke incidence over 20 years. Researchers performed a post hoc analysis to evaluate the association between the age of migraine onset and ischemic stroke. They found:

• There were 447 migraineurs with MA and 1128 migraineurs without aura (MO) identified among 11,592 black and white participants.
• There was an association between the age of MA onset at age ≥50 years (average duration=4.75 years) and ischemic stroke when compared to the no headache group (multivariable adjusted HR=2.17).
• MA onset at <50 years (average duration=28.17 years) was not associated with stroke (multivariable adjusted HR=1.31).
• MO was not associated with increased stroke regardless of the age of onset.

Androulakis XM, Sen S, Kodumuri N, et al. Migraine age of onset and association with ischemic stroke in late life: 20 years follow‐up in ARIC. [Published online ahead of print January 21, 2019]. Headache. doi:10.1111/head.13468.

One-hour treatment with external trigeminal nerve stimulation resulted in significant headache pain relief compared to sham stimulation and was well tolerated, according to a recent double-blind, randomized, sham-controlled study conducted across 3 headache centers in the United States. Adult patients who were experiencing an acute migraine attack, with or without aura, were recruited on site and randomly assigned 1:1 to receive either verum or sham external trigeminal nerve stimulation treatment for 1 hour. Pain intensity was scored using a visual analog scale. Researchers found:

• One hundred and six patients were randomized and included in the intention-to-treat analysis (verum: n=52; sham: n=54).
• The primary outcome measure was significantly more reduced in the verum group than in the sham group: −3.46 ± 2.32 vs −1.78 ± 1.89, or −59% vs −30%.
• With regards to migraine subgroups, there was a significant difference in pain reduction between verum and sham for “migraine without aura” attacks.
• For “migraine with aura” attacks, pain reduction was numerically greater for verum vs sham, but did not reach significance: mean visual analog scale reduction at 1 hour was −4.3 ± 1.8 for the verum group vs −2.6 ± 1.9 for the sham group.

Chou DE, Yugrakh MS, Winegarner D, Rowe V, Kuruvilla D, Schoenen. Acute migraine therapy with external trigeminal neurostimulation (ACME): A randomized controlled trial. [Published online ahead of print November 17, 2018]. Cephalalgia. doi:10.1177%2F0333102418811573.

One-hour treatment with external trigeminal nerve stimulation resulted in significant headache pain relief compared to sham stimulation and was well tolerated, according to a recent double-blind, randomized, sham-controlled study conducted across 3 headache centers in the United States. Adult patients who were experiencing an acute migraine attack, with or without aura, were recruited on site and randomly assigned 1:1 to receive either verum or sham external trigeminal nerve stimulation treatment for 1 hour. Pain intensity was scored using a visual analog scale. Researchers found:

• One hundred and six patients were randomized and included in the intention-to-treat analysis (verum: n=52; sham: n=54).
• The primary outcome measure was significantly more reduced in the verum group than in the sham group: −3.46 ± 2.32 vs −1.78 ± 1.89, or −59% vs −30%.
• With regards to migraine subgroups, there was a significant difference in pain reduction between verum and sham for “migraine without aura” attacks.
• For “migraine with aura” attacks, pain reduction was numerically greater for verum vs sham, but did not reach significance: mean visual analog scale reduction at 1 hour was −4.3 ± 1.8 for the verum group vs −2.6 ± 1.9 for the sham group.

Chou DE, Yugrakh MS, Winegarner D, Rowe V, Kuruvilla D, Schoenen. Acute migraine therapy with external trigeminal neurostimulation (ACME): A randomized controlled trial. [Published online ahead of print November 17, 2018]. Cephalalgia. doi:10.1177%2F0333102418811573.

One-hour treatment with external trigeminal nerve stimulation resulted in significant headache pain relief compared to sham stimulation and was well tolerated, according to a recent double-blind, randomized, sham-controlled study conducted across 3 headache centers in the United States. Adult patients who were experiencing an acute migraine attack, with or without aura, were recruited on site and randomly assigned 1:1 to receive either verum or sham external trigeminal nerve stimulation treatment for 1 hour. Pain intensity was scored using a visual analog scale. Researchers found:

• One hundred and six patients were randomized and included in the intention-to-treat analysis (verum: n=52; sham: n=54).
• The primary outcome measure was significantly more reduced in the verum group than in the sham group: −3.46 ± 2.32 vs −1.78 ± 1.89, or −59% vs −30%.
• With regards to migraine subgroups, there was a significant difference in pain reduction between verum and sham for “migraine without aura” attacks.
• For “migraine with aura” attacks, pain reduction was numerically greater for verum vs sham, but did not reach significance: mean visual analog scale reduction at 1 hour was −4.3 ± 1.8 for the verum group vs −2.6 ± 1.9 for the sham group.

Chou DE, Yugrakh MS, Winegarner D, Rowe V, Kuruvilla D, Schoenen. Acute migraine therapy with external trigeminal neurostimulation (ACME): A randomized controlled trial. [Published online ahead of print November 17, 2018]. Cephalalgia. doi:10.1177%2F0333102418811573.

Alcoholic beverages, especially red wine, are recognized as a migraine trigger factor by patients with migraine and have a substantial effect on alcohol consumption behavior, according to a recent study. Researchers conducted a cross‐sectional, web‐based, questionnaire study among 2197 patients with migraine from the well‐defined Leiden University MIgraine Neuro‐Analysis (LUMINA) study population. They assessed alcoholic beverage consumption and self‐reported trigger potential, reasons behind alcohol abstinence, and time between alcohol consumption and migraine attack onset. They found:

• Alcoholic beverages were reported as a trigger by 35.6% of participants with migraine.
• In addition, more than 25% of patients with migraine who had stopped consuming or never consumed alcoholic beverages did so because of presumed trigger effects.
• Wine, especially red wine (77.8% of participants), was recognized as the most common trigger among the alcoholic beverages.
• However, red wine consistently led to an attack in only 8.8% of participants.
• Time of onset was rapid (<3 hours) in one‐third of patients and almost 90% had an onset of less than 10 hours independent of beverage type.

Onderwater GLC, van Oosterhaut WPJ, Schoonman GG, Ferrari MD, Terwindt GM. Alcoholic beverages as trigger factor and the effect on alcohol consumption behavior in patients with migraine. [Published online ahead of print December 18, 2018]. Eur J Neurol. doi:10.1111/ene.13861.

Alcoholic beverages, especially red wine, are recognized as a migraine trigger factor by patients with migraine and have a substantial effect on alcohol consumption behavior, according to a recent study. Researchers conducted a cross‐sectional, web‐based, questionnaire study among 2197 patients with migraine from the well‐defined Leiden University MIgraine Neuro‐Analysis (LUMINA) study population. They assessed alcoholic beverage consumption and self‐reported trigger potential, reasons behind alcohol abstinence, and time between alcohol consumption and migraine attack onset. They found:

• Alcoholic beverages were reported as a trigger by 35.6% of participants with migraine.
• In addition, more than 25% of patients with migraine who had stopped consuming or never consumed alcoholic beverages did so because of presumed trigger effects.
• Wine, especially red wine (77.8% of participants), was recognized as the most common trigger among the alcoholic beverages.
• However, red wine consistently led to an attack in only 8.8% of participants.
• Time of onset was rapid (<3 hours) in one‐third of patients and almost 90% had an onset of less than 10 hours independent of beverage type.

Onderwater GLC, van Oosterhaut WPJ, Schoonman GG, Ferrari MD, Terwindt GM. Alcoholic beverages as trigger factor and the effect on alcohol consumption behavior in patients with migraine. [Published online ahead of print December 18, 2018]. Eur J Neurol. doi:10.1111/ene.13861.

Alcoholic beverages, especially red wine, are recognized as a migraine trigger factor by patients with migraine and have a substantial effect on alcohol consumption behavior, according to a recent study. Researchers conducted a cross‐sectional, web‐based, questionnaire study among 2197 patients with migraine from the well‐defined Leiden University MIgraine Neuro‐Analysis (LUMINA) study population. They assessed alcoholic beverage consumption and self‐reported trigger potential, reasons behind alcohol abstinence, and time between alcohol consumption and migraine attack onset. They found:

• Alcoholic beverages were reported as a trigger by 35.6% of participants with migraine.
• In addition, more than 25% of patients with migraine who had stopped consuming or never consumed alcoholic beverages did so because of presumed trigger effects.
• Wine, especially red wine (77.8% of participants), was recognized as the most common trigger among the alcoholic beverages.
• However, red wine consistently led to an attack in only 8.8% of participants.
• Time of onset was rapid (<3 hours) in one‐third of patients and almost 90% had an onset of less than 10 hours independent of beverage type.

Onderwater GLC, van Oosterhaut WPJ, Schoonman GG, Ferrari MD, Terwindt GM. Alcoholic beverages as trigger factor and the effect on alcohol consumption behavior in patients with migraine. [Published online ahead of print December 18, 2018]. Eur J Neurol. doi:10.1111/ene.13861.

Adolescents with migraine and healthy adolescents have similar inhibitory pain modulation capability despite having marked differences in pain sensitivity, according to a recent study. Although participants with a family history of migraine (Fam-His) were asymptomatic, they demonstrated alterations in pain processing, which may serve as markers for prediction of migraine development. In order to determine if inhibitory pain modulation occurs in youth as it does in adults, researchers performed a quantitative sensory testing investigation in adolescents with migraine (n=19). These patients were compared to healthy adolescents with (n=20) or without (n=29) Fam-His of migraine (eg, first degree relative with migraine). They found:

• In response to graded heat stimuli, Fam-His participants reported higher pain intensity ratings compared to migraine patients, who in turn, reported higher pain intensity ratings than the healthy controls.
• For heat- and pressure- conditioned pain modulation (CPM), there was no significant group difference in the magnitude of CPM responses.

Nahman-Averbuch H, Leon E, Hunter BM, et al. Increased pain sensitivity but normal pain modulation in adolescents with migraine. [Published online ahead of print January 7, 2019]. Pain. doi:10.1097/j.pain.0000000000001477.

Adolescents with migraine and healthy adolescents have similar inhibitory pain modulation capability despite having marked differences in pain sensitivity, according to a recent study. Although participants with a family history of migraine (Fam-His) were asymptomatic, they demonstrated alterations in pain processing, which may serve as markers for prediction of migraine development. In order to determine if inhibitory pain modulation occurs in youth as it does in adults, researchers performed a quantitative sensory testing investigation in adolescents with migraine (n=19). These patients were compared to healthy adolescents with (n=20) or without (n=29) Fam-His of migraine (eg, first degree relative with migraine). They found:

• In response to graded heat stimuli, Fam-His participants reported higher pain intensity ratings compared to migraine patients, who in turn, reported higher pain intensity ratings than the healthy controls.
• For heat- and pressure- conditioned pain modulation (CPM), there was no significant group difference in the magnitude of CPM responses.

Nahman-Averbuch H, Leon E, Hunter BM, et al. Increased pain sensitivity but normal pain modulation in adolescents with migraine. [Published online ahead of print January 7, 2019]. Pain. doi:10.1097/j.pain.0000000000001477.

Adolescents with migraine and healthy adolescents have similar inhibitory pain modulation capability despite having marked differences in pain sensitivity, according to a recent study. Although participants with a family history of migraine (Fam-His) were asymptomatic, they demonstrated alterations in pain processing, which may serve as markers for prediction of migraine development. In order to determine if inhibitory pain modulation occurs in youth as it does in adults, researchers performed a quantitative sensory testing investigation in adolescents with migraine (n=19). These patients were compared to healthy adolescents with (n=20) or without (n=29) Fam-His of migraine (eg, first degree relative with migraine). They found:

• In response to graded heat stimuli, Fam-His participants reported higher pain intensity ratings compared to migraine patients, who in turn, reported higher pain intensity ratings than the healthy controls.
• For heat- and pressure- conditioned pain modulation (CPM), there was no significant group difference in the magnitude of CPM responses.

Nahman-Averbuch H, Leon E, Hunter BM, et al. Increased pain sensitivity but normal pain modulation in adolescents with migraine. [Published online ahead of print January 7, 2019]. Pain. doi:10.1097/j.pain.0000000000001477.

In order to provide healthcare professionals with updated guidance in the use of novel preventive and acute treatments for migraine in adults, a recent position statement released by the American Headache Society updates prior recommendations and outlines the indications for initiating, continuing, combining, and switching preventive and acute treatments. Input was sought from health insurance providers, employers, pharmacy benefit service companies, device manufacturers, pharmaceutical and biotechnology companies, patients, and patient advocates. In addition, expert clinicians and researchers in the field of headache medicine from across North America and the European Union provided input and feedback.

The principles of pharmacologic preventive treatment of migraine with oral treatments have been as follows:

• Use evidence‐based treatments when possible and appropriate.
• Start with a low dose and titrate slowly; newer injectable treatments may work faster and may not need titration.
• Reach a therapeutic dose if possible.
• Allow for an adequate treatment trial duration.
• Establish expectations of therapeutic response and adverse events and maximize adherence.

The principles of acute treatment include:

• Use evidence‐based treatments when possible and appropriate.
• Treat early after the onset of a migraine attack.
• Choose a non-oral route of administration for selected patients.
• Account for tolerability and safety issues.
• Consider self‐administered rescue treatments.
• Avoid overuse of acute medications.

American Headache Society. The American Headache Society position statement on integrating new migraine treatments into clinical practice. [Published online ahead of print December 10, 2018]. Headache. doi:10.1111/head.13456.

In order to provide healthcare professionals with updated guidance in the use of novel preventive and acute treatments for migraine in adults, a recent position statement released by the American Headache Society updates prior recommendations and outlines the indications for initiating, continuing, combining, and switching preventive and acute treatments. Input was sought from health insurance providers, employers, pharmacy benefit service companies, device manufacturers, pharmaceutical and biotechnology companies, patients, and patient advocates. In addition, expert clinicians and researchers in the field of headache medicine from across North America and the European Union provided input and feedback.

The principles of pharmacologic preventive treatment of migraine with oral treatments have been as follows:

• Use evidence‐based treatments when possible and appropriate.
• Start with a low dose and titrate slowly; newer injectable treatments may work faster and may not need titration.
• Reach a therapeutic dose if possible.
• Allow for an adequate treatment trial duration.
• Establish expectations of therapeutic response and adverse events and maximize adherence.

The principles of acute treatment include:

• Use evidence‐based treatments when possible and appropriate.
• Treat early after the onset of a migraine attack.
• Choose a non-oral route of administration for selected patients.
• Account for tolerability and safety issues.
• Consider self‐administered rescue treatments.
• Avoid overuse of acute medications.

American Headache Society. The American Headache Society position statement on integrating new migraine treatments into clinical practice. [Published online ahead of print December 10, 2018]. Headache. doi:10.1111/head.13456.

In order to provide healthcare professionals with updated guidance in the use of novel preventive and acute treatments for migraine in adults, a recent position statement released by the American Headache Society updates prior recommendations and outlines the indications for initiating, continuing, combining, and switching preventive and acute treatments. Input was sought from health insurance providers, employers, pharmacy benefit service companies, device manufacturers, pharmaceutical and biotechnology companies, patients, and patient advocates. In addition, expert clinicians and researchers in the field of headache medicine from across North America and the European Union provided input and feedback.

The principles of pharmacologic preventive treatment of migraine with oral treatments have been as follows:

• Use evidence‐based treatments when possible and appropriate.
• Start with a low dose and titrate slowly; newer injectable treatments may work faster and may not need titration.
• Reach a therapeutic dose if possible.
• Allow for an adequate treatment trial duration.
• Establish expectations of therapeutic response and adverse events and maximize adherence.

The principles of acute treatment include:

• Use evidence‐based treatments when possible and appropriate.
• Treat early after the onset of a migraine attack.
• Choose a non-oral route of administration for selected patients.
• Account for tolerability and safety issues.
• Consider self‐administered rescue treatments.
• Avoid overuse of acute medications.

American Headache Society. The American Headache Society position statement on integrating new migraine treatments into clinical practice. [Published online ahead of print December 10, 2018]. Headache. doi:10.1111/head.13456.

Migraine with aura was associated with increased risk of incident atrial fibrillation (AF), according to a recent study, which may potentially lead to ischemic strokes. In the Atherosclerosis Risk in Communities (ARIC) study, participants were interviewed for migraine history from 1993 through 1995 and were followed for incident AF through 2013. AF was adjudicated using electrocardiograms (ECGs), discharge codes, and death certificates. Multivariable Cox proportional hazards models were used to study the relation between migraine and its subtypes with incident AF, compared with controls without headaches. Researchers found:

• Of 11,939 participants assessed for headache and without prior AF or stroke, 426 reported migraine with visual aura, 1090 migraine without visual aura, 1018 non-migraine headache, and 9405 no headache.
• Over a 20-year follow-up period, incident AF was noted in 232 (15%) of 1516 with migraine and 1623 (17%) of 9405 without headache.
• After adjustment for multiple confounders, migraine with visual aura was associated with increased risk of AF compared to no headache as well as when compared to migraine without visual aura.

Sen S, Androulakis XM, Duda V, et al. Migraine with visual aura is a risk factor for incident atrial fibrillation. A cohort study. [Published online ahead of print December 11, 2018]. Neurology. doi:10.1212/WNL.0000000000006650.

Migraine with aura was associated with increased risk of incident atrial fibrillation (AF), according to a recent study, which may potentially lead to ischemic strokes. In the Atherosclerosis Risk in Communities (ARIC) study, participants were interviewed for migraine history from 1993 through 1995 and were followed for incident AF through 2013. AF was adjudicated using electrocardiograms (ECGs), discharge codes, and death certificates. Multivariable Cox proportional hazards models were used to study the relation between migraine and its subtypes with incident AF, compared with controls without headaches. Researchers found:

• Of 11,939 participants assessed for headache and without prior AF or stroke, 426 reported migraine with visual aura, 1090 migraine without visual aura, 1018 non-migraine headache, and 9405 no headache.
• Over a 20-year follow-up period, incident AF was noted in 232 (15%) of 1516 with migraine and 1623 (17%) of 9405 without headache.
• After adjustment for multiple confounders, migraine with visual aura was associated with increased risk of AF compared to no headache as well as when compared to migraine without visual aura.

Sen S, Androulakis XM, Duda V, et al. Migraine with visual aura is a risk factor for incident atrial fibrillation. A cohort study. [Published online ahead of print December 11, 2018]. Neurology. doi:10.1212/WNL.0000000000006650.

Migraine with aura was associated with increased risk of incident atrial fibrillation (AF), according to a recent study, which may potentially lead to ischemic strokes. In the Atherosclerosis Risk in Communities (ARIC) study, participants were interviewed for migraine history from 1993 through 1995 and were followed for incident AF through 2013. AF was adjudicated using electrocardiograms (ECGs), discharge codes, and death certificates. Multivariable Cox proportional hazards models were used to study the relation between migraine and its subtypes with incident AF, compared with controls without headaches. Researchers found:

• Of 11,939 participants assessed for headache and without prior AF or stroke, 426 reported migraine with visual aura, 1090 migraine without visual aura, 1018 non-migraine headache, and 9405 no headache.
• Over a 20-year follow-up period, incident AF was noted in 232 (15%) of 1516 with migraine and 1623 (17%) of 9405 without headache.
• After adjustment for multiple confounders, migraine with visual aura was associated with increased risk of AF compared to no headache as well as when compared to migraine without visual aura.

Sen S, Androulakis XM, Duda V, et al. Migraine with visual aura is a risk factor for incident atrial fibrillation. A cohort study. [Published online ahead of print December 11, 2018]. Neurology. doi:10.1212/WNL.0000000000006650.

Women with active migraine have a lower risk of developing type 2 diabetes (T2D), according to a recent study, and a decrease in active migraine prevalence prior to diabetes diagnosis. Researchers used data from a prospective population-based study initiated in 1990 on a cohort of women born between 1925 and 1950. From eligible women in the study, researchers included those who completed a 2002 follow-up questionnaire with information available on migraine. They then excluded prevalent cases of T2D, leaving a final sample of women who were followed up between 2004 and 2014. All potential occurrences of T2D were identified through a drug reimbursement database. They found:

• From the 98,995 women in the study, 76,403 women completed the 2002 follow-up survey.
• Of these, 2156 were excluded because they had T2D, leaving 74,247 women.
• During 10 years of follow-up, 2372 incident T2D cases occurred.
• A lower risk of T2D was observed for women with active migraine compared with women with no migraine history (univariate hazard ratio, 0.80, multivariable-adjusted hazard ratio, 0.7).

Fagherazzi G, El Fatouhi D, Fournier A, et al. Associations between migraine and type 2 diabetes in women: Findings from the E3N Cohort Study. [Published online ahead of print December 17, 2018]. JAMA Neurology. doi:10.1001/jamaneurol.2018.3960.

Women with active migraine have a lower risk of developing type 2 diabetes (T2D), according to a recent study, and a decrease in active migraine prevalence prior to diabetes diagnosis. Researchers used data from a prospective population-based study initiated in 1990 on a cohort of women born between 1925 and 1950. From eligible women in the study, researchers included those who completed a 2002 follow-up questionnaire with information available on migraine. They then excluded prevalent cases of T2D, leaving a final sample of women who were followed up between 2004 and 2014. All potential occurrences of T2D were identified through a drug reimbursement database. They found:

• From the 98,995 women in the study, 76,403 women completed the 2002 follow-up survey.
• Of these, 2156 were excluded because they had T2D, leaving 74,247 women.
• During 10 years of follow-up, 2372 incident T2D cases occurred.
• A lower risk of T2D was observed for women with active migraine compared with women with no migraine history (univariate hazard ratio, 0.80, multivariable-adjusted hazard ratio, 0.7).

Fagherazzi G, El Fatouhi D, Fournier A, et al. Associations between migraine and type 2 diabetes in women: Findings from the E3N Cohort Study. [Published online ahead of print December 17, 2018]. JAMA Neurology. doi:10.1001/jamaneurol.2018.3960.

Women with active migraine have a lower risk of developing type 2 diabetes (T2D), according to a recent study, and a decrease in active migraine prevalence prior to diabetes diagnosis. Researchers used data from a prospective population-based study initiated in 1990 on a cohort of women born between 1925 and 1950. From eligible women in the study, researchers included those who completed a 2002 follow-up questionnaire with information available on migraine. They then excluded prevalent cases of T2D, leaving a final sample of women who were followed up between 2004 and 2014. All potential occurrences of T2D were identified through a drug reimbursement database. They found:

• From the 98,995 women in the study, 76,403 women completed the 2002 follow-up survey.
• Of these, 2156 were excluded because they had T2D, leaving 74,247 women.
• During 10 years of follow-up, 2372 incident T2D cases occurred.
• A lower risk of T2D was observed for women with active migraine compared with women with no migraine history (univariate hazard ratio, 0.80, multivariable-adjusted hazard ratio, 0.7).

Fagherazzi G, El Fatouhi D, Fournier A, et al. Associations between migraine and type 2 diabetes in women: Findings from the E3N Cohort Study. [Published online ahead of print December 17, 2018]. JAMA Neurology. doi:10.1001/jamaneurol.2018.3960.

Changes in speech occurred in almost half of individuals experiencing migraine attacks who were evaluated in a recent prospective, longitudinal, observational study. Participants provided speech samples 3 times per day using a speech elicitation tool included within a mobile app. Six complementary speech features that capture articulation and prosody were extracted from speech samples. Participants with migraine maintained a daily headache diary using the same app. A total of 56,767 speech samples were collected, including 43,102 from 15 individuals with migraine and 13,665 from matched healthy controls. They found:

• Significant group-level differences in speech features were identified between those with migraine and healthy controls and within the migraine group during the pre-attack vs attack vs interictal periods.
• Most consistently, speech changes occurred in the speaking rate, articulation rate and precision, and phonatory duration.
• Within-subject analysis revealed that 7 of 15 individuals with migraine showed significant change in at least 1 speech feature when comparing the migraine attack vs interictal phase and 4 showed similar changes when comparing the pre-attack vs interictal phases.

Schwedt TJ, Peplinski J, Garcia-Filion P, Berisha V. Altered speech with migraine attacks: A prospective, longitudinal study of episodic migraine without aura. [Published online ahead of print November 17, 2018]. Cephalalgia. doi:10.1177%2F0333102418815505.

Changes in speech occurred in almost half of individuals experiencing migraine attacks who were evaluated in a recent prospective, longitudinal, observational study. Participants provided speech samples 3 times per day using a speech elicitation tool included within a mobile app. Six complementary speech features that capture articulation and prosody were extracted from speech samples. Participants with migraine maintained a daily headache diary using the same app. A total of 56,767 speech samples were collected, including 43,102 from 15 individuals with migraine and 13,665 from matched healthy controls. They found:

• Significant group-level differences in speech features were identified between those with migraine and healthy controls and within the migraine group during the pre-attack vs attack vs interictal periods.
• Most consistently, speech changes occurred in the speaking rate, articulation rate and precision, and phonatory duration.
• Within-subject analysis revealed that 7 of 15 individuals with migraine showed significant change in at least 1 speech feature when comparing the migraine attack vs interictal phase and 4 showed similar changes when comparing the pre-attack vs interictal phases.

Schwedt TJ, Peplinski J, Garcia-Filion P, Berisha V. Altered speech with migraine attacks: A prospective, longitudinal study of episodic migraine without aura. [Published online ahead of print November 17, 2018]. Cephalalgia. doi:10.1177%2F0333102418815505.

Changes in speech occurred in almost half of individuals experiencing migraine attacks who were evaluated in a recent prospective, longitudinal, observational study. Participants provided speech samples 3 times per day using a speech elicitation tool included within a mobile app. Six complementary speech features that capture articulation and prosody were extracted from speech samples. Participants with migraine maintained a daily headache diary using the same app. A total of 56,767 speech samples were collected, including 43,102 from 15 individuals with migraine and 13,665 from matched healthy controls. They found:

• Significant group-level differences in speech features were identified between those with migraine and healthy controls and within the migraine group during the pre-attack vs attack vs interictal periods.
• Most consistently, speech changes occurred in the speaking rate, articulation rate and precision, and phonatory duration.
• Within-subject analysis revealed that 7 of 15 individuals with migraine showed significant change in at least 1 speech feature when comparing the migraine attack vs interictal phase and 4 showed similar changes when comparing the pre-attack vs interictal phases.

Schwedt TJ, Peplinski J, Garcia-Filion P, Berisha V. Altered speech with migraine attacks: A prospective, longitudinal study of episodic migraine without aura. [Published online ahead of print November 17, 2018]. Cephalalgia. doi:10.1177%2F0333102418815505.

While the majority of pregnant women with acute migraine received medications considered relatively safe in pregnancy, there was variation in treatment choice and sequence, a recent study found. Researchers conducted a retrospective chart review of medication administration for pregnant women who presented to an acute care setting with a migraine attack and received neurology consultation between 2009 and 2014. They identified 72 pregnant women with migraine who were treated with pain medications and found:

• Fifty-one percent (37/72) were in the third trimester of pregnancy, 39% (28/72) in the second trimester, and 10% (7/72) in the first trimester.
• Thirty-two percent (23/72) had not tried any acute medications at home before coming to the hospital, and 47% (34/72) presented in status migrainosus.
• Patients received treatment in the hospital for a median of 23 hours.
• Acetaminophen was the most frequent medicine administered first (53%, 38/72).
• Thirty-eight percent (27/72) received an intravenous (IV) fluid bolus, 24% received IV magnesium (17/72), and 6% (4/72) had peripheral nerve blocks performed.

Hamilton KT, Robbins MS. Migraine treatment in pregnant women presenting to acute care: A retrospective observational study. [Published online ahead of print November 7, 2018]. Headache. doi:10.1111/head.13434.

While the majority of pregnant women with acute migraine received medications considered relatively safe in pregnancy, there was variation in treatment choice and sequence, a recent study found. Researchers conducted a retrospective chart review of medication administration for pregnant women who presented to an acute care setting with a migraine attack and received neurology consultation between 2009 and 2014. They identified 72 pregnant women with migraine who were treated with pain medications and found:

• Fifty-one percent (37/72) were in the third trimester of pregnancy, 39% (28/72) in the second trimester, and 10% (7/72) in the first trimester.
• Thirty-two percent (23/72) had not tried any acute medications at home before coming to the hospital, and 47% (34/72) presented in status migrainosus.
• Patients received treatment in the hospital for a median of 23 hours.
• Acetaminophen was the most frequent medicine administered first (53%, 38/72).
• Thirty-eight percent (27/72) received an intravenous (IV) fluid bolus, 24% received IV magnesium (17/72), and 6% (4/72) had peripheral nerve blocks performed.

Hamilton KT, Robbins MS. Migraine treatment in pregnant women presenting to acute care: A retrospective observational study. [Published online ahead of print November 7, 2018]. Headache. doi:10.1111/head.13434.

While the majority of pregnant women with acute migraine received medications considered relatively safe in pregnancy, there was variation in treatment choice and sequence, a recent study found. Researchers conducted a retrospective chart review of medication administration for pregnant women who presented to an acute care setting with a migraine attack and received neurology consultation between 2009 and 2014. They identified 72 pregnant women with migraine who were treated with pain medications and found:

• Fifty-one percent (37/72) were in the third trimester of pregnancy, 39% (28/72) in the second trimester, and 10% (7/72) in the first trimester.
• Thirty-two percent (23/72) had not tried any acute medications at home before coming to the hospital, and 47% (34/72) presented in status migrainosus.
• Patients received treatment in the hospital for a median of 23 hours.
• Acetaminophen was the most frequent medicine administered first (53%, 38/72).
• Thirty-eight percent (27/72) received an intravenous (IV) fluid bolus, 24% received IV magnesium (17/72), and 6% (4/72) had peripheral nerve blocks performed.

Hamilton KT, Robbins MS. Migraine treatment in pregnant women presenting to acute care: A retrospective observational study. [Published online ahead of print November 7, 2018]. Headache. doi:10.1111/head.13434.

Chronic migraine (CM) patients have significantly greater cortical covariance compared to controls, according to a recent study. Cortical thickness in CM patients was predominantly accounted for by CM duration, posttraumatic stress disorder (PTSD), and poor sleep quality, while improved pain self‐efficacy buffered cortical thickness. Thirty CM cases (mean age 40 years; male‐to‐female 1:4) and 30 sex‐matched healthy controls (mean age 40 years) were enrolled. Participants completed self‐administered and standardized questionnaires assessing headache‐related clinical features and common psychological comorbidities. T1‐weighted brain images were acquired on a 3T MRI and a whole‐brain cortical thickness analysis was performed.

Researchers found:

• The whole brain cortical thickness analysis revealed no significant differences between CM patients and controls.
• However, significant associations between clinical features and cortical thickness were observed for the patients only.
• These associations included the right superior temporal sulcus (R² = 0.72) and the right insula (R²= 0.71) with distinct clinical variables (ie, longer history of CM, PTSD, sleep quality, pain self‐efficacy, and somatic symptoms).

Woldeamanuel YW, DeSouza DD, Sanjanwala BM, Cowan RP. Clinical features contributing to cortical thickness changes in chronic migraine–A pilot study. [Published online ahead of print November 23, 2018]. Headache. doi:10.1111/head.13452.

Chronic migraine (CM) patients have significantly greater cortical covariance compared to controls, according to a recent study. Cortical thickness in CM patients was predominantly accounted for by CM duration, posttraumatic stress disorder (PTSD), and poor sleep quality, while improved pain self‐efficacy buffered cortical thickness. Thirty CM cases (mean age 40 years; male‐to‐female 1:4) and 30 sex‐matched healthy controls (mean age 40 years) were enrolled. Participants completed self‐administered and standardized questionnaires assessing headache‐related clinical features and common psychological comorbidities. T1‐weighted brain images were acquired on a 3T MRI and a whole‐brain cortical thickness analysis was performed.

Researchers found:

• The whole brain cortical thickness analysis revealed no significant differences between CM patients and controls.
• However, significant associations between clinical features and cortical thickness were observed for the patients only.
• These associations included the right superior temporal sulcus (R² = 0.72) and the right insula (R²= 0.71) with distinct clinical variables (ie, longer history of CM, PTSD, sleep quality, pain self‐efficacy, and somatic symptoms).

Woldeamanuel YW, DeSouza DD, Sanjanwala BM, Cowan RP. Clinical features contributing to cortical thickness changes in chronic migraine–A pilot study. [Published online ahead of print November 23, 2018]. Headache. doi:10.1111/head.13452.

Chronic migraine (CM) patients have significantly greater cortical covariance compared to controls, according to a recent study. Cortical thickness in CM patients was predominantly accounted for by CM duration, posttraumatic stress disorder (PTSD), and poor sleep quality, while improved pain self‐efficacy buffered cortical thickness. Thirty CM cases (mean age 40 years; male‐to‐female 1:4) and 30 sex‐matched healthy controls (mean age 40 years) were enrolled. Participants completed self‐administered and standardized questionnaires assessing headache‐related clinical features and common psychological comorbidities. T1‐weighted brain images were acquired on a 3T MRI and a whole‐brain cortical thickness analysis was performed.

Researchers found:

• The whole brain cortical thickness analysis revealed no significant differences between CM patients and controls.
• However, significant associations between clinical features and cortical thickness were observed for the patients only.
• These associations included the right superior temporal sulcus (R² = 0.72) and the right insula (R²= 0.71) with distinct clinical variables (ie, longer history of CM, PTSD, sleep quality, pain self‐efficacy, and somatic symptoms).

Woldeamanuel YW, DeSouza DD, Sanjanwala BM, Cowan RP. Clinical features contributing to cortical thickness changes in chronic migraine–A pilot study. [Published online ahead of print November 23, 2018]. Headache. doi:10.1111/head.13452.