Migraine Briefs

Elevated vascular biomarkers were associated with migraine, a recent study found, particularly migraine with aura (MA), as well as with years of aura and number of aura attacks. Participants (300 women, 117 men) were aged 30–60 (mean 48) years, 155 MA, 128 migraine without aura (MO), and 134 were controls with no severe headaches. Plasma concentrations of fibrinogen, Factor II, D-dimer, high sensitivity C-reactive protein (hs-CRP), and von Willebrand factor antigen were compared between groups, also stratifying by sex. Researchers found:

• Fibrinogen and hs-CRP were elevated in migraineurs compared to controls.
• In logistic regression analyses, MO and MA had increased likelihood of elevated fibrinogen, and MA had increased likelihood of elevated Factor II and hs-CRP.
• Fibrinogen and Factor II were associated with MA in women but not men.
• In the migraine subgroup, the total number of years of aura, but not headache, predicted elevated hs-CRP, and the average number of aura, but not headache, attacks predicted all biomarkers but Factor II.

Migraine and vascular disease biomarkers: A population-based case-control study. Cephalalgia. 2018;38(3):511-518. doi:10.1177/0333102417698936.

Elevated vascular biomarkers were associated with migraine, a recent study found, particularly migraine with aura (MA), as well as with years of aura and number of aura attacks. Participants (300 women, 117 men) were aged 30–60 (mean 48) years, 155 MA, 128 migraine without aura (MO), and 134 were controls with no severe headaches. Plasma concentrations of fibrinogen, Factor II, D-dimer, high sensitivity C-reactive protein (hs-CRP), and von Willebrand factor antigen were compared between groups, also stratifying by sex. Researchers found:

• Fibrinogen and hs-CRP were elevated in migraineurs compared to controls.
• In logistic regression analyses, MO and MA had increased likelihood of elevated fibrinogen, and MA had increased likelihood of elevated Factor II and hs-CRP.
• Fibrinogen and Factor II were associated with MA in women but not men.
• In the migraine subgroup, the total number of years of aura, but not headache, predicted elevated hs-CRP, and the average number of aura, but not headache, attacks predicted all biomarkers but Factor II.

Migraine and vascular disease biomarkers: A population-based case-control study. Cephalalgia. 2018;38(3):511-518. doi:10.1177/0333102417698936.

Elevated vascular biomarkers were associated with migraine, a recent study found, particularly migraine with aura (MA), as well as with years of aura and number of aura attacks. Participants (300 women, 117 men) were aged 30–60 (mean 48) years, 155 MA, 128 migraine without aura (MO), and 134 were controls with no severe headaches. Plasma concentrations of fibrinogen, Factor II, D-dimer, high sensitivity C-reactive protein (hs-CRP), and von Willebrand factor antigen were compared between groups, also stratifying by sex. Researchers found:

• Fibrinogen and hs-CRP were elevated in migraineurs compared to controls.
• In logistic regression analyses, MO and MA had increased likelihood of elevated fibrinogen, and MA had increased likelihood of elevated Factor II and hs-CRP.
• Fibrinogen and Factor II were associated with MA in women but not men.
• In the migraine subgroup, the total number of years of aura, but not headache, predicted elevated hs-CRP, and the average number of aura, but not headache, attacks predicted all biomarkers but Factor II.

Migraine and vascular disease biomarkers: A population-based case-control study. Cephalalgia. 2018;38(3):511-518. doi:10.1177/0333102417698936.

Migraine headache was associated with an increased long-term risk of cardiovascular and cerebrovascular events, a recent study found. This effect was due to an increased risk of stroke (both ischemic and hemorrhagic) and myocardial infarction (MI). There was a moderate to severe degree of heterogeneity for the outcomes, which was partly explained by the presence of aura. A total of 16 cohort studies (18 study records) with 394,942 migraineurs and 757,465 non-migraineurs were analyzed. Researchers found:

• Migraine was associated with a higher risk of a major adverse cardiovascular and cerebrovascular event driven by a higher risk of stroke and MI.
• There was no difference in the risk of all-cause mortality, with a considerable degree of statistical heterogeneity between the studies.
• The presence of aura was an effect modifier for stroke and all-cause mortality.

Migraine and the risk of cardiovascular and cerebrovascular events: A meta-analysis of 16 cohort studies including 1,152,407 subjects. [Published online ahead of print March 27, 2018]. BMJ Open. doi:10.1136/bmjopen-2017-020498.

Migraine headache was associated with an increased long-term risk of cardiovascular and cerebrovascular events, a recent study found. This effect was due to an increased risk of stroke (both ischemic and hemorrhagic) and myocardial infarction (MI). There was a moderate to severe degree of heterogeneity for the outcomes, which was partly explained by the presence of aura. A total of 16 cohort studies (18 study records) with 394,942 migraineurs and 757,465 non-migraineurs were analyzed. Researchers found:

• Migraine was associated with a higher risk of a major adverse cardiovascular and cerebrovascular event driven by a higher risk of stroke and MI.
• There was no difference in the risk of all-cause mortality, with a considerable degree of statistical heterogeneity between the studies.
• The presence of aura was an effect modifier for stroke and all-cause mortality.

Migraine and the risk of cardiovascular and cerebrovascular events: A meta-analysis of 16 cohort studies including 1,152,407 subjects. [Published online ahead of print March 27, 2018]. BMJ Open. doi:10.1136/bmjopen-2017-020498.

Migraine headache was associated with an increased long-term risk of cardiovascular and cerebrovascular events, a recent study found. This effect was due to an increased risk of stroke (both ischemic and hemorrhagic) and myocardial infarction (MI). There was a moderate to severe degree of heterogeneity for the outcomes, which was partly explained by the presence of aura. A total of 16 cohort studies (18 study records) with 394,942 migraineurs and 757,465 non-migraineurs were analyzed. Researchers found:

• Migraine was associated with a higher risk of a major adverse cardiovascular and cerebrovascular event driven by a higher risk of stroke and MI.
• There was no difference in the risk of all-cause mortality, with a considerable degree of statistical heterogeneity between the studies.
• The presence of aura was an effect modifier for stroke and all-cause mortality.

Migraine and the risk of cardiovascular and cerebrovascular events: A meta-analysis of 16 cohort studies including 1,152,407 subjects. [Published online ahead of print March 27, 2018]. BMJ Open. doi:10.1136/bmjopen-2017-020498.

Migraine is a common comorbidity in patients with sarcoidosis, according to a recent study. As such, better recognition and targeted treatment of migraine has the potential to improve quality of life as part of a comprehensive care plan for those with sarcoidosis. The ID Migraine questionnaire was administered to a well-phenotyped observational cohort of patients with sarcoidosis (most of whom were seeking specialty care) and healthy controls. Predictors of migraine status were examined using univariate and multivariable logistic regression. Researchers found:

• Migraine was seen in 29% of 96 patients with sarcoidosis and 13% of 39 healthy controls.
• Among those with sarcoidosis, in univariate regression analysis only female sex was predictive of having migraine, and in a multivariable regression female sex remained significant.

There was no association between migraine and age, depression, dyspnea, immunosuppression use, or erythrocyte sedimentation rate.

Migraine is common in patients with sarcoidosis. [Published online ahead of print March 26, 2018]. Cephalalgia. doi:10.1177/0333102418768037.

Migraine is a common comorbidity in patients with sarcoidosis, according to a recent study. As such, better recognition and targeted treatment of migraine has the potential to improve quality of life as part of a comprehensive care plan for those with sarcoidosis. The ID Migraine questionnaire was administered to a well-phenotyped observational cohort of patients with sarcoidosis (most of whom were seeking specialty care) and healthy controls. Predictors of migraine status were examined using univariate and multivariable logistic regression. Researchers found:

• Migraine was seen in 29% of 96 patients with sarcoidosis and 13% of 39 healthy controls.
• Among those with sarcoidosis, in univariate regression analysis only female sex was predictive of having migraine, and in a multivariable regression female sex remained significant.

There was no association between migraine and age, depression, dyspnea, immunosuppression use, or erythrocyte sedimentation rate.

Migraine is common in patients with sarcoidosis. [Published online ahead of print March 26, 2018]. Cephalalgia. doi:10.1177/0333102418768037.

Migraine is a common comorbidity in patients with sarcoidosis, according to a recent study. As such, better recognition and targeted treatment of migraine has the potential to improve quality of life as part of a comprehensive care plan for those with sarcoidosis. The ID Migraine questionnaire was administered to a well-phenotyped observational cohort of patients with sarcoidosis (most of whom were seeking specialty care) and healthy controls. Predictors of migraine status were examined using univariate and multivariable logistic regression. Researchers found:

• Migraine was seen in 29% of 96 patients with sarcoidosis and 13% of 39 healthy controls.
• Among those with sarcoidosis, in univariate regression analysis only female sex was predictive of having migraine, and in a multivariable regression female sex remained significant.

There was no association between migraine and age, depression, dyspnea, immunosuppression use, or erythrocyte sedimentation rate.

Migraine is common in patients with sarcoidosis. [Published online ahead of print March 26, 2018]. Cephalalgia. doi:10.1177/0333102418768037.

Greater occipital nerve (GON) block seems to be an effective option for acute management of migraine headache, with promising reductions in pain scores, a recent study found. This retrospective cohort study was undertaken between January 2009 and August 2014 and included patients who underwent at least 1 GON block and attended at least 1 follow-up appointment. Change in the 11-point numeric pain rating scale (NPRS) was used to assess the response to GON block. A total of 562 patients met inclusion criteria; 423 were women (75%); mean age was 58.6 ± 16.7 years. Response was defined as “minimal” (less than 30% NPRS point reduction), “moderate” (31% to 50% NPRS point reduction), or “significant” ( greater than 50% NPRS point reduction). Researchers found:

• Of total patients, 459 (82%) rated their response to GON block as moderate or significant.
• No statistically significant relationship existed between previous treatment regimens and response to GON block.
• GON block was equally effective across the different age and sex groups.

Greater occipital nerve block for acute treatment of migraine headache: A large retrospective cohort study. J Am Board Fam Med. 2018;31(2):211-218. doi:10.3122/jabfm.2018.02.170188.

Greater occipital nerve (GON) block seems to be an effective option for acute management of migraine headache, with promising reductions in pain scores, a recent study found. This retrospective cohort study was undertaken between January 2009 and August 2014 and included patients who underwent at least 1 GON block and attended at least 1 follow-up appointment. Change in the 11-point numeric pain rating scale (NPRS) was used to assess the response to GON block. A total of 562 patients met inclusion criteria; 423 were women (75%); mean age was 58.6 ± 16.7 years. Response was defined as “minimal” (less than 30% NPRS point reduction), “moderate” (31% to 50% NPRS point reduction), or “significant” ( greater than 50% NPRS point reduction). Researchers found:

• Of total patients, 459 (82%) rated their response to GON block as moderate or significant.
• No statistically significant relationship existed between previous treatment regimens and response to GON block.
• GON block was equally effective across the different age and sex groups.

Greater occipital nerve block for acute treatment of migraine headache: A large retrospective cohort study. J Am Board Fam Med. 2018;31(2):211-218. doi:10.3122/jabfm.2018.02.170188.

Greater occipital nerve (GON) block seems to be an effective option for acute management of migraine headache, with promising reductions in pain scores, a recent study found. This retrospective cohort study was undertaken between January 2009 and August 2014 and included patients who underwent at least 1 GON block and attended at least 1 follow-up appointment. Change in the 11-point numeric pain rating scale (NPRS) was used to assess the response to GON block. A total of 562 patients met inclusion criteria; 423 were women (75%); mean age was 58.6 ± 16.7 years. Response was defined as “minimal” (less than 30% NPRS point reduction), “moderate” (31% to 50% NPRS point reduction), or “significant” ( greater than 50% NPRS point reduction). Researchers found:

• Of total patients, 459 (82%) rated their response to GON block as moderate or significant.
• No statistically significant relationship existed between previous treatment regimens and response to GON block.
• GON block was equally effective across the different age and sex groups.

Greater occipital nerve block for acute treatment of migraine headache: A large retrospective cohort study. J Am Board Fam Med. 2018;31(2):211-218. doi:10.3122/jabfm.2018.02.170188.

A recent study identifies early cerebral diffusion changes in children with tension-type and migraine-type headaches compared with controls. The hypothesized mechanisms of nociception in migraine-type and tension-type headaches may explain the findings as a precursor to structural changes seen in adult patients with chronic headache. Patients evaluated for tension-type or migraine-type headache without aura from May 2014 to July 2016 in a single center were retrospectively reviewed. Thirty-two patients with tension-type headache and 23 with migraine-type headache at an average of 4 months after diagnosis were enrolled. All patients underwent diffusion weighted imaging at 3T before the start of pharmacotherapy. Researchers found:

• There were no significant differences in regional brain volumes between the groups.
• Patients with tension-type and migraine-type headaches showed significantly increased apparent diffusion coefficient (ADC) in the hippocampus and brain stem compared with controls.
• Additionally, only patients with migraine-type headache showed significantly increased ADC in the thalamus and a trend toward increased ADC in the amygdala compared with controls.

Brain diffusion abnormalities in children with tension-type and migraine-type headaches. [Published online ahead of print March 15, 2018]. AJNR Am J Neuroradiol. doi:10.3174/ajnr.A5582.

A recent study identifies early cerebral diffusion changes in children with tension-type and migraine-type headaches compared with controls. The hypothesized mechanisms of nociception in migraine-type and tension-type headaches may explain the findings as a precursor to structural changes seen in adult patients with chronic headache. Patients evaluated for tension-type or migraine-type headache without aura from May 2014 to July 2016 in a single center were retrospectively reviewed. Thirty-two patients with tension-type headache and 23 with migraine-type headache at an average of 4 months after diagnosis were enrolled. All patients underwent diffusion weighted imaging at 3T before the start of pharmacotherapy. Researchers found:

• There were no significant differences in regional brain volumes between the groups.
• Patients with tension-type and migraine-type headaches showed significantly increased apparent diffusion coefficient (ADC) in the hippocampus and brain stem compared with controls.
• Additionally, only patients with migraine-type headache showed significantly increased ADC in the thalamus and a trend toward increased ADC in the amygdala compared with controls.

Brain diffusion abnormalities in children with tension-type and migraine-type headaches. [Published online ahead of print March 15, 2018]. AJNR Am J Neuroradiol. doi:10.3174/ajnr.A5582.

A recent study identifies early cerebral diffusion changes in children with tension-type and migraine-type headaches compared with controls. The hypothesized mechanisms of nociception in migraine-type and tension-type headaches may explain the findings as a precursor to structural changes seen in adult patients with chronic headache. Patients evaluated for tension-type or migraine-type headache without aura from May 2014 to July 2016 in a single center were retrospectively reviewed. Thirty-two patients with tension-type headache and 23 with migraine-type headache at an average of 4 months after diagnosis were enrolled. All patients underwent diffusion weighted imaging at 3T before the start of pharmacotherapy. Researchers found:

• There were no significant differences in regional brain volumes between the groups.
• Patients with tension-type and migraine-type headaches showed significantly increased apparent diffusion coefficient (ADC) in the hippocampus and brain stem compared with controls.
• Additionally, only patients with migraine-type headache showed significantly increased ADC in the thalamus and a trend toward increased ADC in the amygdala compared with controls.

Brain diffusion abnormalities in children with tension-type and migraine-type headaches. [Published online ahead of print March 15, 2018]. AJNR Am J Neuroradiol. doi:10.3174/ajnr.A5582.

Migraine disease has a higher prevalence in an otolaryngologic cohort than in the general population, according to a recent study, presenting with a high rate of sinonasal and otologic symptoms that may be due to or exacerbated by migraines. In a cross-sectional study utilizing the CHEER (Creating Healthcare Excellence through Education and Research) network, patients were recruited in 14 CHEER sites between June 2015 and March 2017. Those included were aged 18 years or older and had been seen for any concern that was not head and neck cancer. Patients with any history of brain abnormality or headaches that began within 2 weeks of a medical illness, trauma, or head injury were excluded. If they screened positive on the Migraine Assessment Tool (MAT+), the subjects also filled out questionnaires for sinonasal, otologic, and migraine-specific symptoms. Researchers found:

• Of 1458 patients screened, 235 (16.1%) screened positive for migraine (MAT+), which is higher than the general population (13%).
• The MAT+ group was significantly younger (47.2 vs 55.6 years of age) and predominantly women (80.0% vs 55.9%).

Patterns of migraine disease in otolaryngology: A CHEER network study. [Published online ahead of print March 20, 2018]. Otolaryngol Head Neck Surg. doi:10.1177/0194599818764387.

Migraine disease has a higher prevalence in an otolaryngologic cohort than in the general population, according to a recent study, presenting with a high rate of sinonasal and otologic symptoms that may be due to or exacerbated by migraines. In a cross-sectional study utilizing the CHEER (Creating Healthcare Excellence through Education and Research) network, patients were recruited in 14 CHEER sites between June 2015 and March 2017. Those included were aged 18 years or older and had been seen for any concern that was not head and neck cancer. Patients with any history of brain abnormality or headaches that began within 2 weeks of a medical illness, trauma, or head injury were excluded. If they screened positive on the Migraine Assessment Tool (MAT+), the subjects also filled out questionnaires for sinonasal, otologic, and migraine-specific symptoms. Researchers found:

• Of 1458 patients screened, 235 (16.1%) screened positive for migraine (MAT+), which is higher than the general population (13%).
• The MAT+ group was significantly younger (47.2 vs 55.6 years of age) and predominantly women (80.0% vs 55.9%).

Patterns of migraine disease in otolaryngology: A CHEER network study. [Published online ahead of print March 20, 2018]. Otolaryngol Head Neck Surg. doi:10.1177/0194599818764387.

Migraine disease has a higher prevalence in an otolaryngologic cohort than in the general population, according to a recent study, presenting with a high rate of sinonasal and otologic symptoms that may be due to or exacerbated by migraines. In a cross-sectional study utilizing the CHEER (Creating Healthcare Excellence through Education and Research) network, patients were recruited in 14 CHEER sites between June 2015 and March 2017. Those included were aged 18 years or older and had been seen for any concern that was not head and neck cancer. Patients with any history of brain abnormality or headaches that began within 2 weeks of a medical illness, trauma, or head injury were excluded. If they screened positive on the Migraine Assessment Tool (MAT+), the subjects also filled out questionnaires for sinonasal, otologic, and migraine-specific symptoms. Researchers found:

• Of 1458 patients screened, 235 (16.1%) screened positive for migraine (MAT+), which is higher than the general population (13%).
• The MAT+ group was significantly younger (47.2 vs 55.6 years of age) and predominantly women (80.0% vs 55.9%).

Patterns of migraine disease in otolaryngology: A CHEER network study. [Published online ahead of print March 20, 2018]. Otolaryngol Head Neck Surg. doi:10.1177/0194599818764387.

Both familial and common migraine may arise from dysfunction of discrete cell types within the neurovascular unit, and localization of the affected cell type(s) in an individual patient may provide insight into to their susceptibility to migraine, according to a recent study. The cell-type specific expression of both familial and common migraine-associated genes was determined bioinformatically using data from 2039 individual human brain cells across 2 published single-cell RNA sequencing datasets. Enrichment of migraine-associated genes was determined for each brain cell type. Researchers found:

• Analysis of single-brain cell RNA sequencing data from 5 major subtypes of cells in the human cortex (neurons, oligodendrocytes, astrocytes, microglia, and endothelial cells) indicates that greater than 40% of known migraine-associated genes are enriched in the expression profiles of a specific brain cell type.
• Further analysis of neuronal migraine-associated genes demonstrated that approximately 70% were significantly enriched in inhibitory neurons and 30% in excitatory neurons.

Localization of migraine susceptibility genes in human brain by single-cell RNA sequencing. [Published online ahead of print March 2, 2018]. Cephalalgia. doi:10.1177/0333102418762476.

Both familial and common migraine may arise from dysfunction of discrete cell types within the neurovascular unit, and localization of the affected cell type(s) in an individual patient may provide insight into to their susceptibility to migraine, according to a recent study. The cell-type specific expression of both familial and common migraine-associated genes was determined bioinformatically using data from 2039 individual human brain cells across 2 published single-cell RNA sequencing datasets. Enrichment of migraine-associated genes was determined for each brain cell type. Researchers found:

• Analysis of single-brain cell RNA sequencing data from 5 major subtypes of cells in the human cortex (neurons, oligodendrocytes, astrocytes, microglia, and endothelial cells) indicates that greater than 40% of known migraine-associated genes are enriched in the expression profiles of a specific brain cell type.
• Further analysis of neuronal migraine-associated genes demonstrated that approximately 70% were significantly enriched in inhibitory neurons and 30% in excitatory neurons.

Localization of migraine susceptibility genes in human brain by single-cell RNA sequencing. [Published online ahead of print March 2, 2018]. Cephalalgia. doi:10.1177/0333102418762476.

Both familial and common migraine may arise from dysfunction of discrete cell types within the neurovascular unit, and localization of the affected cell type(s) in an individual patient may provide insight into to their susceptibility to migraine, according to a recent study. The cell-type specific expression of both familial and common migraine-associated genes was determined bioinformatically using data from 2039 individual human brain cells across 2 published single-cell RNA sequencing datasets. Enrichment of migraine-associated genes was determined for each brain cell type. Researchers found:

• Analysis of single-brain cell RNA sequencing data from 5 major subtypes of cells in the human cortex (neurons, oligodendrocytes, astrocytes, microglia, and endothelial cells) indicates that greater than 40% of known migraine-associated genes are enriched in the expression profiles of a specific brain cell type.
• Further analysis of neuronal migraine-associated genes demonstrated that approximately 70% were significantly enriched in inhibitory neurons and 30% in excitatory neurons.

Localization of migraine susceptibility genes in human brain by single-cell RNA sequencing. [Published online ahead of print March 2, 2018]. Cephalalgia. doi:10.1177/0333102418762476.

Single pulse transcranial magnetic stimulation (sTMS) may be an effective, well-tolerated treatment option for migraine prevention, according to a recent study.  Researchers conducted the eNeura Spring TMS Post-Market Observational US Study of Migraine (ESPOUSE), a multicenter, prospective, open label, observational study. Of the total subjects (n=263), 229 completed a baseline diary, and 220 were found to be eligible based on the number of headache days. The treatment protocol consisted of preventive (4 pulses twice daily) and acute (3 pulses repeated up to 3 times for each attack) treatment. Researchers found:

• The device was assigned to 217 subjects (Safety Data Set) and 132 were included in the intention to treat Full Analysis Set.
• For the primary endpoint, there was a −2.75 ± 0.40 mean reduction of headache days from baseline compared to the performance goal (-0.63 days).
• There was a reduction of −2.93 (5.24) days of acute medication use, headache impact measured by HIT-6, −3.1 (6.4), and total headache days of any intensity −3.16 days (5.21) compared to the performance goal (−0.63 days).
• The most common adverse events were lightheadedness, tingling, and tinnitus; there were no serious adverse events.

A multicenter, prospective, single arm, open label, observational study of sTMS for migraine prevention (ESPOUSE study). [Published online ahead of print March 4, 2018]. Cephalalgia. doi:10.1177/0333102418762525.

Single pulse transcranial magnetic stimulation (sTMS) may be an effective, well-tolerated treatment option for migraine prevention, according to a recent study.  Researchers conducted the eNeura Spring TMS Post-Market Observational US Study of Migraine (ESPOUSE), a multicenter, prospective, open label, observational study. Of the total subjects (n=263), 229 completed a baseline diary, and 220 were found to be eligible based on the number of headache days. The treatment protocol consisted of preventive (4 pulses twice daily) and acute (3 pulses repeated up to 3 times for each attack) treatment. Researchers found:

• The device was assigned to 217 subjects (Safety Data Set) and 132 were included in the intention to treat Full Analysis Set.
• For the primary endpoint, there was a −2.75 ± 0.40 mean reduction of headache days from baseline compared to the performance goal (-0.63 days).
• There was a reduction of −2.93 (5.24) days of acute medication use, headache impact measured by HIT-6, −3.1 (6.4), and total headache days of any intensity −3.16 days (5.21) compared to the performance goal (−0.63 days).
• The most common adverse events were lightheadedness, tingling, and tinnitus; there were no serious adverse events.

A multicenter, prospective, single arm, open label, observational study of sTMS for migraine prevention (ESPOUSE study). [Published online ahead of print March 4, 2018]. Cephalalgia. doi:10.1177/0333102418762525.

Single pulse transcranial magnetic stimulation (sTMS) may be an effective, well-tolerated treatment option for migraine prevention, according to a recent study.  Researchers conducted the eNeura Spring TMS Post-Market Observational US Study of Migraine (ESPOUSE), a multicenter, prospective, open label, observational study. Of the total subjects (n=263), 229 completed a baseline diary, and 220 were found to be eligible based on the number of headache days. The treatment protocol consisted of preventive (4 pulses twice daily) and acute (3 pulses repeated up to 3 times for each attack) treatment. Researchers found:

• The device was assigned to 217 subjects (Safety Data Set) and 132 were included in the intention to treat Full Analysis Set.
• For the primary endpoint, there was a −2.75 ± 0.40 mean reduction of headache days from baseline compared to the performance goal (-0.63 days).
• There was a reduction of −2.93 (5.24) days of acute medication use, headache impact measured by HIT-6, −3.1 (6.4), and total headache days of any intensity −3.16 days (5.21) compared to the performance goal (−0.63 days).
• The most common adverse events were lightheadedness, tingling, and tinnitus; there were no serious adverse events.

A multicenter, prospective, single arm, open label, observational study of sTMS for migraine prevention (ESPOUSE study). [Published online ahead of print March 4, 2018]. Cephalalgia. doi:10.1177/0333102418762525.

Severe headache and migraine remain important public health problems that are more common and burdensome for women, particularly women of childbearing age, and other historically disadvantaged segments of the population, according to a recent study. Researchers searched for the most current publicly available summary statistics from the National Health Interview Survey (NHIS), the National Hospital Ambulatory Medical Care Survey (NHAMCS), and the National Ambulatory Medical Care Survey (NAMCS). They found:

• The prevalence and burden of self-reported migraine and severe headache in the US adult population is high, affecting roughly 1 out of every 6 Americans and 1 in 5 women over a 3-month period (15.3% overall, 9.7% of males, and 20.7% of females).
• The prevalence of migraine or severe headache in 2015 was highest in American Indians or Alaska Natives (18.4%) compared with whites, blacks, or Hispanics, with the lowest prevalence in Asians (11.3%).
• There is a higher burden of migraine in those aged 18-44 (17.9%), people who are unemployed (21.4%), those with family income less than $35,000 per year (19.9%), and the elderly and disabled (16.4%).

The prevalence and impact of migraine and severe headache in the United States: Figures and trends from government health studies. [Published online ahead of print March 12, 2018]. Headache. doi:10.1111/head.13281.

Severe headache and migraine remain important public health problems that are more common and burdensome for women, particularly women of childbearing age, and other historically disadvantaged segments of the population, according to a recent study. Researchers searched for the most current publicly available summary statistics from the National Health Interview Survey (NHIS), the National Hospital Ambulatory Medical Care Survey (NHAMCS), and the National Ambulatory Medical Care Survey (NAMCS). They found:

• The prevalence and burden of self-reported migraine and severe headache in the US adult population is high, affecting roughly 1 out of every 6 Americans and 1 in 5 women over a 3-month period (15.3% overall, 9.7% of males, and 20.7% of females).
• The prevalence of migraine or severe headache in 2015 was highest in American Indians or Alaska Natives (18.4%) compared with whites, blacks, or Hispanics, with the lowest prevalence in Asians (11.3%).
• There is a higher burden of migraine in those aged 18-44 (17.9%), people who are unemployed (21.4%), those with family income less than $35,000 per year (19.9%), and the elderly and disabled (16.4%).

The prevalence and impact of migraine and severe headache in the United States: Figures and trends from government health studies. [Published online ahead of print March 12, 2018]. Headache. doi:10.1111/head.13281.

Severe headache and migraine remain important public health problems that are more common and burdensome for women, particularly women of childbearing age, and other historically disadvantaged segments of the population, according to a recent study. Researchers searched for the most current publicly available summary statistics from the National Health Interview Survey (NHIS), the National Hospital Ambulatory Medical Care Survey (NHAMCS), and the National Ambulatory Medical Care Survey (NAMCS). They found:

• The prevalence and burden of self-reported migraine and severe headache in the US adult population is high, affecting roughly 1 out of every 6 Americans and 1 in 5 women over a 3-month period (15.3% overall, 9.7% of males, and 20.7% of females).
• The prevalence of migraine or severe headache in 2015 was highest in American Indians or Alaska Natives (18.4%) compared with whites, blacks, or Hispanics, with the lowest prevalence in Asians (11.3%).
• There is a higher burden of migraine in those aged 18-44 (17.9%), people who are unemployed (21.4%), those with family income less than $35,000 per year (19.9%), and the elderly and disabled (16.4%).

The prevalence and impact of migraine and severe headache in the United States: Figures and trends from government health studies. [Published online ahead of print March 12, 2018]. Headache. doi:10.1111/head.13281.

Assessment and treatment of sleep problems in pediatric patients with chronic headache is important, with several contextual and headache diagnostic factors influencing the severity of sleep disturbance, according to a recent retrospective chart review. Researchers evaluated 527 patients, aged 7-17 years, with a primary headache diagnosis of migraine (n=278), tension-type headache (TTH; n=157), and new daily persistent-headache (NDPH; n=92). Patients completed measures of disability, anxiety, and depression and their parents completed measures of sleep disturbance. They found:

• Sleep disturbance was greater in patients with TTH (10.34 ± 5.94) and NDPH (11.52 ± 6.40) than migraine (8.31 ± 5.89).
• Across patient groups, greater sleep disturbance was significantly associated with higher levels of functional disability, anxiety, and depression.
• Additionally, higher pain levels were significantly associated with greater sleep disturbance among TTH patients, with this association non-significant among the other headache groups.
• When simultaneously examining demographic, pain-related, and emotional distress factors, older age, higher levels of disability and depression, and NDPH diagnosis were all significant predictors of greater sleep disturbance.

Pediatric headache and sleep disturbance: A comparison of diagnostic groups. Headache. 2018;58(2):217-228. doi:10.1111/head.13207.

Assessment and treatment of sleep problems in pediatric patients with chronic headache is important, with several contextual and headache diagnostic factors influencing the severity of sleep disturbance, according to a recent retrospective chart review. Researchers evaluated 527 patients, aged 7-17 years, with a primary headache diagnosis of migraine (n=278), tension-type headache (TTH; n=157), and new daily persistent-headache (NDPH; n=92). Patients completed measures of disability, anxiety, and depression and their parents completed measures of sleep disturbance. They found:

• Sleep disturbance was greater in patients with TTH (10.34 ± 5.94) and NDPH (11.52 ± 6.40) than migraine (8.31 ± 5.89).
• Across patient groups, greater sleep disturbance was significantly associated with higher levels of functional disability, anxiety, and depression.
• Additionally, higher pain levels were significantly associated with greater sleep disturbance among TTH patients, with this association non-significant among the other headache groups.
• When simultaneously examining demographic, pain-related, and emotional distress factors, older age, higher levels of disability and depression, and NDPH diagnosis were all significant predictors of greater sleep disturbance.

Pediatric headache and sleep disturbance: A comparison of diagnostic groups. Headache. 2018;58(2):217-228. doi:10.1111/head.13207.

Assessment and treatment of sleep problems in pediatric patients with chronic headache is important, with several contextual and headache diagnostic factors influencing the severity of sleep disturbance, according to a recent retrospective chart review. Researchers evaluated 527 patients, aged 7-17 years, with a primary headache diagnosis of migraine (n=278), tension-type headache (TTH; n=157), and new daily persistent-headache (NDPH; n=92). Patients completed measures of disability, anxiety, and depression and their parents completed measures of sleep disturbance. They found:

• Sleep disturbance was greater in patients with TTH (10.34 ± 5.94) and NDPH (11.52 ± 6.40) than migraine (8.31 ± 5.89).
• Across patient groups, greater sleep disturbance was significantly associated with higher levels of functional disability, anxiety, and depression.
• Additionally, higher pain levels were significantly associated with greater sleep disturbance among TTH patients, with this association non-significant among the other headache groups.
• When simultaneously examining demographic, pain-related, and emotional distress factors, older age, higher levels of disability and depression, and NDPH diagnosis were all significant predictors of greater sleep disturbance.

Pediatric headache and sleep disturbance: A comparison of diagnostic groups. Headache. 2018;58(2):217-228. doi:10.1111/head.13207.