Migraine Briefs

A recent genome-wide association study (GWAS) provides new insights into the genetic basis of childhood migraine and allows for precision therapeutic development strategies targeting migraine patients of African-American ancestry. Researchers conducted a GWAS of 380 African-American children and 2129 ancestry-matched controls to identify variants associated with migraine. They then attempted to replicate their primary analysis in an independent cohort of 233 African-American patients and 4038 non-migraine control subjects. They found:

• Common variants at 5q33.1 are associated with migraine risk in African-American children.
• The association was validated in an independent study for an overall meta-analysis P-value of 3.81×10⁻¹⁰.
• eQTL (expression quantitative trait loci) analysis of the Genotype-Tissue Expression data also shows the genotypes of rs72793414 were strongly correlated with the mRNA expression levels of NMUR2 at 5q33.1.

Chang X, Pellegrino R, Garifallou, et al. Common variants at 5q33.1 predispose to migraine in African-American children. [Published online ahead of print September 28, 2018]. J Med Genet. doi:10.1136/jmedgenet-2018-105359.

A recent genome-wide association study (GWAS) provides new insights into the genetic basis of childhood migraine and allows for precision therapeutic development strategies targeting migraine patients of African-American ancestry. Researchers conducted a GWAS of 380 African-American children and 2129 ancestry-matched controls to identify variants associated with migraine. They then attempted to replicate their primary analysis in an independent cohort of 233 African-American patients and 4038 non-migraine control subjects. They found:

• Common variants at 5q33.1 are associated with migraine risk in African-American children.
• The association was validated in an independent study for an overall meta-analysis P-value of 3.81×10⁻¹⁰.
• eQTL (expression quantitative trait loci) analysis of the Genotype-Tissue Expression data also shows the genotypes of rs72793414 were strongly correlated with the mRNA expression levels of NMUR2 at 5q33.1.

Chang X, Pellegrino R, Garifallou, et al. Common variants at 5q33.1 predispose to migraine in African-American children. [Published online ahead of print September 28, 2018]. J Med Genet. doi:10.1136/jmedgenet-2018-105359.

A recent genome-wide association study (GWAS) provides new insights into the genetic basis of childhood migraine and allows for precision therapeutic development strategies targeting migraine patients of African-American ancestry. Researchers conducted a GWAS of 380 African-American children and 2129 ancestry-matched controls to identify variants associated with migraine. They then attempted to replicate their primary analysis in an independent cohort of 233 African-American patients and 4038 non-migraine control subjects. They found:

• Common variants at 5q33.1 are associated with migraine risk in African-American children.
• The association was validated in an independent study for an overall meta-analysis P-value of 3.81×10⁻¹⁰.
• eQTL (expression quantitative trait loci) analysis of the Genotype-Tissue Expression data also shows the genotypes of rs72793414 were strongly correlated with the mRNA expression levels of NMUR2 at 5q33.1.

Chang X, Pellegrino R, Garifallou, et al. Common variants at 5q33.1 predispose to migraine in African-American children. [Published online ahead of print September 28, 2018]. J Med Genet. doi:10.1136/jmedgenet-2018-105359.

The current diagnostic criteria for migraine outlined in the 3rd version of the International Classification of Headache Disorders (ICHD) are far more sensitive and specific than the clinical criteria proposed in 1962. This is according to a recent review that examines how the diagnostic criteria for migraine have evolved during the past 45 years and evaluates the strengths and weaknesses of the current diagnostic criteria promulgated by the ICHD. In future iterations, dividing episodic and chronic migraine into subtypes based on frequency (ie, low frequency vs high frequency; near-daily vs daily) potentially could assist in guiding clinical management. In addition, a better understanding of aura, vestibular migraine, migrainous infarction, and hemiplegic migraine likely will lead to more refined diagnostic criteria for those entities. As the pathophysiology of migraine is more fully elucidated and more sophisticated diagnostic technologies are developed (eg, the identification of biomarkers), the current diagnostic criteria for migraine will likely be further refined. Furthermore, the ICHD has allowed for more precise research study design in the field of headache medicine.

Tinsley A. Rothrock JF. What are we missing in the diagnostic criteria for migraine? Curr Pain Headache Rep. 2018;22:84. doi:10.1007/s11916-018-0733-1.

The current diagnostic criteria for migraine outlined in the 3rd version of the International Classification of Headache Disorders (ICHD) are far more sensitive and specific than the clinical criteria proposed in 1962. This is according to a recent review that examines how the diagnostic criteria for migraine have evolved during the past 45 years and evaluates the strengths and weaknesses of the current diagnostic criteria promulgated by the ICHD. In future iterations, dividing episodic and chronic migraine into subtypes based on frequency (ie, low frequency vs high frequency; near-daily vs daily) potentially could assist in guiding clinical management. In addition, a better understanding of aura, vestibular migraine, migrainous infarction, and hemiplegic migraine likely will lead to more refined diagnostic criteria for those entities. As the pathophysiology of migraine is more fully elucidated and more sophisticated diagnostic technologies are developed (eg, the identification of biomarkers), the current diagnostic criteria for migraine will likely be further refined. Furthermore, the ICHD has allowed for more precise research study design in the field of headache medicine.

Tinsley A. Rothrock JF. What are we missing in the diagnostic criteria for migraine? Curr Pain Headache Rep. 2018;22:84. doi:10.1007/s11916-018-0733-1.

The current diagnostic criteria for migraine outlined in the 3rd version of the International Classification of Headache Disorders (ICHD) are far more sensitive and specific than the clinical criteria proposed in 1962. This is according to a recent review that examines how the diagnostic criteria for migraine have evolved during the past 45 years and evaluates the strengths and weaknesses of the current diagnostic criteria promulgated by the ICHD. In future iterations, dividing episodic and chronic migraine into subtypes based on frequency (ie, low frequency vs high frequency; near-daily vs daily) potentially could assist in guiding clinical management. In addition, a better understanding of aura, vestibular migraine, migrainous infarction, and hemiplegic migraine likely will lead to more refined diagnostic criteria for those entities. As the pathophysiology of migraine is more fully elucidated and more sophisticated diagnostic technologies are developed (eg, the identification of biomarkers), the current diagnostic criteria for migraine will likely be further refined. Furthermore, the ICHD has allowed for more precise research study design in the field of headache medicine.

Tinsley A. Rothrock JF. What are we missing in the diagnostic criteria for migraine? Curr Pain Headache Rep. 2018;22:84. doi:10.1007/s11916-018-0733-1.

Recent findings support the use of multimodal magnetic resonance (MR) imaging to distinguish migraine with aura from stroke and the simultaneous use of these MR imaging sequences to improve understanding of perfusion changes during migraine with aura. Hemiplegic migraine is a common cause of acute brain attack in pediatrics. MR imaging sequences useful in differentiating hemiplegic migraine from other entities include arterial spin-labeling, susceptibility-weighted imaging (SWI), magnetic resonance angiography (MRA), and diffusion-weighted imaging (DWI). Researchers evaluated 12 pediatric patients with acute hemiplegic migraine or migraine with aura who underwent MR imaging within 12 hours of symptom onset. Quantitative and qualitative analyses were performed on arterial spin-labeling, and qualitative analysis, on SWI and MRA sequences. They found:

• All 12 patients had normal DWI and abnormal arterial spin-labeling findings.
• Furthermore, a more rapid transition from hypoperfusion to rebound hyperperfusion was observed in 3 patients compared with prior reports.

Cobb-Pitstick KM, Munjal N, Safier R, Cummings DD, Zuccoli G. Time course of cerebral perfusion changes in children with migraine with aura mimicking stroke. Am J Neuroradiol.

2018;39(9):1751-1755. doi:10.3174/ajnr.A5693.

Recent findings support the use of multimodal magnetic resonance (MR) imaging to distinguish migraine with aura from stroke and the simultaneous use of these MR imaging sequences to improve understanding of perfusion changes during migraine with aura. Hemiplegic migraine is a common cause of acute brain attack in pediatrics. MR imaging sequences useful in differentiating hemiplegic migraine from other entities include arterial spin-labeling, susceptibility-weighted imaging (SWI), magnetic resonance angiography (MRA), and diffusion-weighted imaging (DWI). Researchers evaluated 12 pediatric patients with acute hemiplegic migraine or migraine with aura who underwent MR imaging within 12 hours of symptom onset. Quantitative and qualitative analyses were performed on arterial spin-labeling, and qualitative analysis, on SWI and MRA sequences. They found:

• All 12 patients had normal DWI and abnormal arterial spin-labeling findings.
• Furthermore, a more rapid transition from hypoperfusion to rebound hyperperfusion was observed in 3 patients compared with prior reports.

Cobb-Pitstick KM, Munjal N, Safier R, Cummings DD, Zuccoli G. Time course of cerebral perfusion changes in children with migraine with aura mimicking stroke. Am J Neuroradiol.

2018;39(9):1751-1755. doi:10.3174/ajnr.A5693.

Recent findings support the use of multimodal magnetic resonance (MR) imaging to distinguish migraine with aura from stroke and the simultaneous use of these MR imaging sequences to improve understanding of perfusion changes during migraine with aura. Hemiplegic migraine is a common cause of acute brain attack in pediatrics. MR imaging sequences useful in differentiating hemiplegic migraine from other entities include arterial spin-labeling, susceptibility-weighted imaging (SWI), magnetic resonance angiography (MRA), and diffusion-weighted imaging (DWI). Researchers evaluated 12 pediatric patients with acute hemiplegic migraine or migraine with aura who underwent MR imaging within 12 hours of symptom onset. Quantitative and qualitative analyses were performed on arterial spin-labeling, and qualitative analysis, on SWI and MRA sequences. They found:

• All 12 patients had normal DWI and abnormal arterial spin-labeling findings.
• Furthermore, a more rapid transition from hypoperfusion to rebound hyperperfusion was observed in 3 patients compared with prior reports.

Cobb-Pitstick KM, Munjal N, Safier R, Cummings DD, Zuccoli G. Time course of cerebral perfusion changes in children with migraine with aura mimicking stroke. Am J Neuroradiol.

2018;39(9):1751-1755. doi:10.3174/ajnr.A5693.

Emergency department (ED) visits for migraine are burdensome to patients and to the larger healthcare system and society, a recent study found. Furthermore, a substantial number of headache specialists are dissatisfied with the care their patients receive in the ED. Researchers

surveyed members of the American Headache Society (AHS) Emergency Department/Refractory/Inpatient (EDRI) Section to understand their practice regarding patients who call their office to be seen urgently, and to understand their communication with local EDs. There were 96 eligible AHS members, 50 of whom responded to questionnaires either by email or in person (52%).They found:

• Of total respondents, 59% reported giving rescue treatment to their patients to manage acute attacks.
• 54% reported using standard protocols for outpatients not responding to usual acute treatments.
• In the event of a request for urgent care, 12% of specialists reported bringing patients into the office most or all of the time, and 20% reported sending patients to the ED some or most of the time for headache management.
• 60% reported that their ED has a protocol for migraine management.

Minen MT, Ortega E, Lipton RB, Cowan R. American Headache Society survey about urgent and emergency management of headache patients. [Published online ahead of print September 12, 2018]. Headache. doi:10.1111/head.13387.

Emergency department (ED) visits for migraine are burdensome to patients and to the larger healthcare system and society, a recent study found. Furthermore, a substantial number of headache specialists are dissatisfied with the care their patients receive in the ED. Researchers

surveyed members of the American Headache Society (AHS) Emergency Department/Refractory/Inpatient (EDRI) Section to understand their practice regarding patients who call their office to be seen urgently, and to understand their communication with local EDs. There were 96 eligible AHS members, 50 of whom responded to questionnaires either by email or in person (52%).They found:

• Of total respondents, 59% reported giving rescue treatment to their patients to manage acute attacks.
• 54% reported using standard protocols for outpatients not responding to usual acute treatments.
• In the event of a request for urgent care, 12% of specialists reported bringing patients into the office most or all of the time, and 20% reported sending patients to the ED some or most of the time for headache management.
• 60% reported that their ED has a protocol for migraine management.

Minen MT, Ortega E, Lipton RB, Cowan R. American Headache Society survey about urgent and emergency management of headache patients. [Published online ahead of print September 12, 2018]. Headache. doi:10.1111/head.13387.

Emergency department (ED) visits for migraine are burdensome to patients and to the larger healthcare system and society, a recent study found. Furthermore, a substantial number of headache specialists are dissatisfied with the care their patients receive in the ED. Researchers

surveyed members of the American Headache Society (AHS) Emergency Department/Refractory/Inpatient (EDRI) Section to understand their practice regarding patients who call their office to be seen urgently, and to understand their communication with local EDs. There were 96 eligible AHS members, 50 of whom responded to questionnaires either by email or in person (52%).They found:

• Of total respondents, 59% reported giving rescue treatment to their patients to manage acute attacks.
• 54% reported using standard protocols for outpatients not responding to usual acute treatments.
• In the event of a request for urgent care, 12% of specialists reported bringing patients into the office most or all of the time, and 20% reported sending patients to the ED some or most of the time for headache management.
• 60% reported that their ED has a protocol for migraine management.

Minen MT, Ortega E, Lipton RB, Cowan R. American Headache Society survey about urgent and emergency management of headache patients. [Published online ahead of print September 12, 2018]. Headache. doi:10.1111/head.13387.

Researchers discovered 10.7% prevalence of migraines and synergism between female gender and stress on risk of migraine in a recent study, suggesting health interventions targeting women under stress may be beneficial. This analysis was based on data from 42,282 persons aged ≥12 years who participated in a 2013–2014 community health survey. A multivariate log-binomial model was used to calculate adjusted prevalence ratios for migraines associated with individual and joint exposures of female gender and stress. Researchers used relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (S index) to measure additive interaction. They found:

• The adjusted prevalence ratios were 2.37 for female vs male, 1.63 for persons with high vs low levels of stress, and 3.38 for women with high stress vs men with low stress.
• The RERI estimate was 0.38, the AP estimate was 0.11, and the S index was 1.19.

Slatculescu AM, Chen Y. Synergism between female gender and high levels of daily stress associated with migraine headaches in Ontario, Canada. [Published online ahead of print August 28, 2018]. Neuroepidemiol. doi:10.1159/000492503.

Researchers discovered 10.7% prevalence of migraines and synergism between female gender and stress on risk of migraine in a recent study, suggesting health interventions targeting women under stress may be beneficial. This analysis was based on data from 42,282 persons aged ≥12 years who participated in a 2013–2014 community health survey. A multivariate log-binomial model was used to calculate adjusted prevalence ratios for migraines associated with individual and joint exposures of female gender and stress. Researchers used relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (S index) to measure additive interaction. They found:

• The adjusted prevalence ratios were 2.37 for female vs male, 1.63 for persons with high vs low levels of stress, and 3.38 for women with high stress vs men with low stress.
• The RERI estimate was 0.38, the AP estimate was 0.11, and the S index was 1.19.

Slatculescu AM, Chen Y. Synergism between female gender and high levels of daily stress associated with migraine headaches in Ontario, Canada. [Published online ahead of print August 28, 2018]. Neuroepidemiol. doi:10.1159/000492503.

Researchers discovered 10.7% prevalence of migraines and synergism between female gender and stress on risk of migraine in a recent study, suggesting health interventions targeting women under stress may be beneficial. This analysis was based on data from 42,282 persons aged ≥12 years who participated in a 2013–2014 community health survey. A multivariate log-binomial model was used to calculate adjusted prevalence ratios for migraines associated with individual and joint exposures of female gender and stress. Researchers used relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (S index) to measure additive interaction. They found:

• The adjusted prevalence ratios were 2.37 for female vs male, 1.63 for persons with high vs low levels of stress, and 3.38 for women with high stress vs men with low stress.
• The RERI estimate was 0.38, the AP estimate was 0.11, and the S index was 1.19.

Slatculescu AM, Chen Y. Synergism between female gender and high levels of daily stress associated with migraine headaches in Ontario, Canada. [Published online ahead of print August 28, 2018]. Neuroepidemiol. doi:10.1159/000492503.

A recent study found a 10.7% prevalence of migraines and synergism between female gender and stress on risk of migraine, suggesting health interventions targeting women under stress may be beneficial. Researchers used data from 42,282 persons aged ≥12 years who participated in a 2013–2014 community health survey. A multivariate log-binomial model was used to calculate adjusted prevalence ratios for migraines associated with individual and joint exposures of female gender and stress. They used relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (S index) to measure additive interaction. They found:

• The prevalence of migraines was 10.7%.
• The adjusted prevalence ratios were 2.37 for female vs male, 1.63 for persons with high vs low levels of stress, and 3.38 for women with high stress vs men with low stress.
• The RERI estimate was 0.38, the AP estimate was 0.11, and the S index was 1.19.

Slatculescu AM, Chen Y. Synergism between female gender and high levels of daily stress associated with migraine headaches in Ontario, Canada. [Published online ahead of print August 28, 2018]. Neuroepidemiol. doi:10.1159/000492503.

A recent study found a 10.7% prevalence of migraines and synergism between female gender and stress on risk of migraine, suggesting health interventions targeting women under stress may be beneficial. Researchers used data from 42,282 persons aged ≥12 years who participated in a 2013–2014 community health survey. A multivariate log-binomial model was used to calculate adjusted prevalence ratios for migraines associated with individual and joint exposures of female gender and stress. They used relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (S index) to measure additive interaction. They found:

• The prevalence of migraines was 10.7%.
• The adjusted prevalence ratios were 2.37 for female vs male, 1.63 for persons with high vs low levels of stress, and 3.38 for women with high stress vs men with low stress.
• The RERI estimate was 0.38, the AP estimate was 0.11, and the S index was 1.19.

Slatculescu AM, Chen Y. Synergism between female gender and high levels of daily stress associated with migraine headaches in Ontario, Canada. [Published online ahead of print August 28, 2018]. Neuroepidemiol. doi:10.1159/000492503.

A recent study found a 10.7% prevalence of migraines and synergism between female gender and stress on risk of migraine, suggesting health interventions targeting women under stress may be beneficial. Researchers used data from 42,282 persons aged ≥12 years who participated in a 2013–2014 community health survey. A multivariate log-binomial model was used to calculate adjusted prevalence ratios for migraines associated with individual and joint exposures of female gender and stress. They used relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (S index) to measure additive interaction. They found:

• The prevalence of migraines was 10.7%.
• The adjusted prevalence ratios were 2.37 for female vs male, 1.63 for persons with high vs low levels of stress, and 3.38 for women with high stress vs men with low stress.
• The RERI estimate was 0.38, the AP estimate was 0.11, and the S index was 1.19.

Slatculescu AM, Chen Y. Synergism between female gender and high levels of daily stress associated with migraine headaches in Ontario, Canada. [Published online ahead of print August 28, 2018]. Neuroepidemiol. doi:10.1159/000492503.

For patients with migraine in the emergency department (ED), the use of IV fluids, dopamine receptor antagonists (DRA), nonsteroidal anti-Inflammatory drugs, and corticosteroids increased whereas the use of narcotics and discharge prescriptions for narcotics decreased, according to a recent study. Researchers also found that the return rates for migraines decreased and they speculate that the increased use of non-narcotic medications contributed to this decrease. In this study, they examined a multi-hospital retrospective cohort consisting of consecutive ED patients from January 1, 1999, to September 31, 2014. They examined charts at the beginning and end of the time period and found:

• Of the 2,824,710 total visits, 8046 (0.28%) were for migraine.
• 290 charts (147 in 1999–2000 and 143 in 2014) were reviewed to determine migraine treatments.
• Of the 8046 migraine patients, 624 (8%) returned within 72 hours.
• The return rate decreased from 1999–2000 to 2014 from 12% to 4% (difference = 8%).

Ruzek M, Richman P, Eskin B, Allegra JR. ED treatment of migraine patients has changed. [Published online ahead of print August 20, 2018]. Am J Emerg Med. doi:10.1016/j.ajem.2018.08.051.

For patients with migraine in the emergency department (ED), the use of IV fluids, dopamine receptor antagonists (DRA), nonsteroidal anti-Inflammatory drugs, and corticosteroids increased whereas the use of narcotics and discharge prescriptions for narcotics decreased, according to a recent study. Researchers also found that the return rates for migraines decreased and they speculate that the increased use of non-narcotic medications contributed to this decrease. In this study, they examined a multi-hospital retrospective cohort consisting of consecutive ED patients from January 1, 1999, to September 31, 2014. They examined charts at the beginning and end of the time period and found:

• Of the 2,824,710 total visits, 8046 (0.28%) were for migraine.
• 290 charts (147 in 1999–2000 and 143 in 2014) were reviewed to determine migraine treatments.
• Of the 8046 migraine patients, 624 (8%) returned within 72 hours.
• The return rate decreased from 1999–2000 to 2014 from 12% to 4% (difference = 8%).

Ruzek M, Richman P, Eskin B, Allegra JR. ED treatment of migraine patients has changed. [Published online ahead of print August 20, 2018]. Am J Emerg Med. doi:10.1016/j.ajem.2018.08.051.

For patients with migraine in the emergency department (ED), the use of IV fluids, dopamine receptor antagonists (DRA), nonsteroidal anti-Inflammatory drugs, and corticosteroids increased whereas the use of narcotics and discharge prescriptions for narcotics decreased, according to a recent study. Researchers also found that the return rates for migraines decreased and they speculate that the increased use of non-narcotic medications contributed to this decrease. In this study, they examined a multi-hospital retrospective cohort consisting of consecutive ED patients from January 1, 1999, to September 31, 2014. They examined charts at the beginning and end of the time period and found:

• Of the 2,824,710 total visits, 8046 (0.28%) were for migraine.
• 290 charts (147 in 1999–2000 and 143 in 2014) were reviewed to determine migraine treatments.
• Of the 8046 migraine patients, 624 (8%) returned within 72 hours.
• The return rate decreased from 1999–2000 to 2014 from 12% to 4% (difference = 8%).

Ruzek M, Richman P, Eskin B, Allegra JR. ED treatment of migraine patients has changed. [Published online ahead of print August 20, 2018]. Am J Emerg Med. doi:10.1016/j.ajem.2018.08.051.

Symptoms of autonomic dysfunction were greatest among those with persistent posttraumatic headaches (PPTH) compared to migraine and healthy controls (HCs), a recent study found. In addition, among individuals with PPTH, number of lifetime traumatic brain injuries (TBIs) was associated with greater symptoms of autonomic dysfunction, while greater headache burden was associated with higher vasomotor domain autonomic dysfunction subscores, potentially indicating that PPTH patients with higher disease burden have an increased risk for having autonomic dysfunction. Individuals with PPTH (n=56) (87.5% of whom had a migraine/probable migraine phenotype), migraine (n=30), and HCs (n=36) were prospectively assessed in this cross‐sectional cohort study using the COMPASS‐31 questionnaire. Total COMPASS‐31 scores and individual domain scores were compared between subject groups. Researchers found:

• COMPASS‐31 mean total weighted score was 37.22 ± 15.44 in the PPTH group, 27.15 ± 14.37 in the migraine group, and 11.67 ± 8.98 for HCs.
• COMPASS‐31 mean weighted total scores were significantly higher in those with PPTH vs migraine, for PPTH vs HCs, and for migraine vs HCs.

Howard L, Dumkrieger G, Chong CD, Ross K, Berisha V, Schwedt TJ. Symptoms of autonomic dysfunction among those with persistent posttraumatic headache attributed to mild traumatic brain injury: A comparison to migraine and healthy controls. [Published online ahead of print August 29, 2018]. Headache. doi:10.1111/head.13396.

Symptoms of autonomic dysfunction were greatest among those with persistent posttraumatic headaches (PPTH) compared to migraine and healthy controls (HCs), a recent study found. In addition, among individuals with PPTH, number of lifetime traumatic brain injuries (TBIs) was associated with greater symptoms of autonomic dysfunction, while greater headache burden was associated with higher vasomotor domain autonomic dysfunction subscores, potentially indicating that PPTH patients with higher disease burden have an increased risk for having autonomic dysfunction. Individuals with PPTH (n=56) (87.5% of whom had a migraine/probable migraine phenotype), migraine (n=30), and HCs (n=36) were prospectively assessed in this cross‐sectional cohort study using the COMPASS‐31 questionnaire. Total COMPASS‐31 scores and individual domain scores were compared between subject groups. Researchers found:

• COMPASS‐31 mean total weighted score was 37.22 ± 15.44 in the PPTH group, 27.15 ± 14.37 in the migraine group, and 11.67 ± 8.98 for HCs.
• COMPASS‐31 mean weighted total scores were significantly higher in those with PPTH vs migraine, for PPTH vs HCs, and for migraine vs HCs.

Howard L, Dumkrieger G, Chong CD, Ross K, Berisha V, Schwedt TJ. Symptoms of autonomic dysfunction among those with persistent posttraumatic headache attributed to mild traumatic brain injury: A comparison to migraine and healthy controls. [Published online ahead of print August 29, 2018]. Headache. doi:10.1111/head.13396.

Symptoms of autonomic dysfunction were greatest among those with persistent posttraumatic headaches (PPTH) compared to migraine and healthy controls (HCs), a recent study found. In addition, among individuals with PPTH, number of lifetime traumatic brain injuries (TBIs) was associated with greater symptoms of autonomic dysfunction, while greater headache burden was associated with higher vasomotor domain autonomic dysfunction subscores, potentially indicating that PPTH patients with higher disease burden have an increased risk for having autonomic dysfunction. Individuals with PPTH (n=56) (87.5% of whom had a migraine/probable migraine phenotype), migraine (n=30), and HCs (n=36) were prospectively assessed in this cross‐sectional cohort study using the COMPASS‐31 questionnaire. Total COMPASS‐31 scores and individual domain scores were compared between subject groups. Researchers found:

• COMPASS‐31 mean total weighted score was 37.22 ± 15.44 in the PPTH group, 27.15 ± 14.37 in the migraine group, and 11.67 ± 8.98 for HCs.
• COMPASS‐31 mean weighted total scores were significantly higher in those with PPTH vs migraine, for PPTH vs HCs, and for migraine vs HCs.

Howard L, Dumkrieger G, Chong CD, Ross K, Berisha V, Schwedt TJ. Symptoms of autonomic dysfunction among those with persistent posttraumatic headache attributed to mild traumatic brain injury: A comparison to migraine and healthy controls. [Published online ahead of print August 29, 2018]. Headache. doi:10.1111/head.13396.

Migraine headaches occurred in 5 (3.1%) of 158 patients who underwent cerebral angiography, according to a recent observational cohort study that ascertained the frequency and type of headaches following catheter‐based cerebral angiography. Consecutive patients who underwent cerebral angiography through the transfemoral (or infrequently, radial) route were included. Each patient underwent a brief neurological assessment after the procedure and more detailed assessment was performed if any patient reported occurrence of a headache. The headaches were classified as migraine if the diagnostic criteria specified by International Headache Society were met. Headache severity was classified using a visual numeric rating scale and time to reach pain free status for 2 consecutive hours was ascertained. Researchers found:

• The median severity of migraine headaches was 10/10 and time to resolution of headaches was 120 minutes (range 60–360 minutes).
• Migraine headaches occurred in 4 (18.1%) of 22 patients with a history of migraine and 4 (23.5%) of 17 patients with regular migraine headaches (≥1 episodes per month).
• Headaches occurred in 6 (3.8%) patients who did not meet the criteria for migraine headaches.

Qureshi AI, Naseem N, Saleem MA, Potluri A, Raja F, Wallery SS. Migraine and non‐migraine headaches following diagnostic catheter‐based cerebral angiography. [Published online ahead of print August 16, 2018]. Headache. doi:10.1111/head.13377.

Migraine headaches occurred in 5 (3.1%) of 158 patients who underwent cerebral angiography, according to a recent observational cohort study that ascertained the frequency and type of headaches following catheter‐based cerebral angiography. Consecutive patients who underwent cerebral angiography through the transfemoral (or infrequently, radial) route were included. Each patient underwent a brief neurological assessment after the procedure and more detailed assessment was performed if any patient reported occurrence of a headache. The headaches were classified as migraine if the diagnostic criteria specified by International Headache Society were met. Headache severity was classified using a visual numeric rating scale and time to reach pain free status for 2 consecutive hours was ascertained. Researchers found:

• The median severity of migraine headaches was 10/10 and time to resolution of headaches was 120 minutes (range 60–360 minutes).
• Migraine headaches occurred in 4 (18.1%) of 22 patients with a history of migraine and 4 (23.5%) of 17 patients with regular migraine headaches (≥1 episodes per month).
• Headaches occurred in 6 (3.8%) patients who did not meet the criteria for migraine headaches.

Qureshi AI, Naseem N, Saleem MA, Potluri A, Raja F, Wallery SS. Migraine and non‐migraine headaches following diagnostic catheter‐based cerebral angiography. [Published online ahead of print August 16, 2018]. Headache. doi:10.1111/head.13377.

Migraine headaches occurred in 5 (3.1%) of 158 patients who underwent cerebral angiography, according to a recent observational cohort study that ascertained the frequency and type of headaches following catheter‐based cerebral angiography. Consecutive patients who underwent cerebral angiography through the transfemoral (or infrequently, radial) route were included. Each patient underwent a brief neurological assessment after the procedure and more detailed assessment was performed if any patient reported occurrence of a headache. The headaches were classified as migraine if the diagnostic criteria specified by International Headache Society were met. Headache severity was classified using a visual numeric rating scale and time to reach pain free status for 2 consecutive hours was ascertained. Researchers found:

• The median severity of migraine headaches was 10/10 and time to resolution of headaches was 120 minutes (range 60–360 minutes).
• Migraine headaches occurred in 4 (18.1%) of 22 patients with a history of migraine and 4 (23.5%) of 17 patients with regular migraine headaches (≥1 episodes per month).
• Headaches occurred in 6 (3.8%) patients who did not meet the criteria for migraine headaches.

Qureshi AI, Naseem N, Saleem MA, Potluri A, Raja F, Wallery SS. Migraine and non‐migraine headaches following diagnostic catheter‐based cerebral angiography. [Published online ahead of print August 16, 2018]. Headache. doi:10.1111/head.13377.

Children with chronic headache and migraine who are severely functionally impaired demonstrated linear improvement in pain‐specific patient‐reported outcomes over time, according to a recent study that aimed to evaluate the trajectory of recovery for children undergoing intensive interdisciplinary pain rehabilitation treatment (IIPT). A retrospective analysis was conducted of patient‐reported outcomes in a clinical database of 135 children (mean age 15.2 [SD=2.2] and 74% female) admitted to an IIPT program between the years 2008 and 2014. Available data across 5 separate time points (up to 1‐year post‐discharge) were reviewed. Researchers found:

• A statistically significant improvement was noted in pain‐specific measures of functioning, including daily functioning, emotional functioning, family functioning, and school absences over a 12‐month period.
• A more general measure of quality of life improved during the program, based upon child and parent reports, although these gains did not continue to improve post‐discharge.
• As expected, although children did not report a reduction in pain during rehabilitation, they did report a significant drop in perceived pain in the 12 months following discharge from the program.

Benore E, Webster EE, Wang L, Banez G. Longitudinal analysis of patient‐reported outcomes from an interdisciplinary pediatric pain rehabilitation program for children with chronic migraine and headache. [Published online ahead of print August 23, 2018]. Headache. doi:10.1111/head.13389.

Children with chronic headache and migraine who are severely functionally impaired demonstrated linear improvement in pain‐specific patient‐reported outcomes over time, according to a recent study that aimed to evaluate the trajectory of recovery for children undergoing intensive interdisciplinary pain rehabilitation treatment (IIPT). A retrospective analysis was conducted of patient‐reported outcomes in a clinical database of 135 children (mean age 15.2 [SD=2.2] and 74% female) admitted to an IIPT program between the years 2008 and 2014. Available data across 5 separate time points (up to 1‐year post‐discharge) were reviewed. Researchers found:

• A statistically significant improvement was noted in pain‐specific measures of functioning, including daily functioning, emotional functioning, family functioning, and school absences over a 12‐month period.
• A more general measure of quality of life improved during the program, based upon child and parent reports, although these gains did not continue to improve post‐discharge.
• As expected, although children did not report a reduction in pain during rehabilitation, they did report a significant drop in perceived pain in the 12 months following discharge from the program.

Benore E, Webster EE, Wang L, Banez G. Longitudinal analysis of patient‐reported outcomes from an interdisciplinary pediatric pain rehabilitation program for children with chronic migraine and headache. [Published online ahead of print August 23, 2018]. Headache. doi:10.1111/head.13389.

Children with chronic headache and migraine who are severely functionally impaired demonstrated linear improvement in pain‐specific patient‐reported outcomes over time, according to a recent study that aimed to evaluate the trajectory of recovery for children undergoing intensive interdisciplinary pain rehabilitation treatment (IIPT). A retrospective analysis was conducted of patient‐reported outcomes in a clinical database of 135 children (mean age 15.2 [SD=2.2] and 74% female) admitted to an IIPT program between the years 2008 and 2014. Available data across 5 separate time points (up to 1‐year post‐discharge) were reviewed. Researchers found:

• A statistically significant improvement was noted in pain‐specific measures of functioning, including daily functioning, emotional functioning, family functioning, and school absences over a 12‐month period.
• A more general measure of quality of life improved during the program, based upon child and parent reports, although these gains did not continue to improve post‐discharge.
• As expected, although children did not report a reduction in pain during rehabilitation, they did report a significant drop in perceived pain in the 12 months following discharge from the program.

Benore E, Webster EE, Wang L, Banez G. Longitudinal analysis of patient‐reported outcomes from an interdisciplinary pediatric pain rehabilitation program for children with chronic migraine and headache. [Published online ahead of print August 23, 2018]. Headache. doi:10.1111/head.13389.