Migraine Briefs

Key clinical point: Shift workers are more likely to develop migraines and headaches than day workers.

Major finding: Shift workers had a 72% and 25% higher risk of developing migraine and unspecified headache, respectively, compared with day workers.

Study details: A longitudinal study included 2,952 individuals for the analyses of shift work and headache and 2,272 individuals for the analyses of shift work and migraine from the Danish PRISME cohort.

Disclosures: The study was funded by NordForsk, Nordic Program on Health and Welfare. The original PRISME study was supported by the Danish Working Environment Research Fund. The authors declared no conflicts of interest.

Citation: Appel AM et al. Int Arch Occup Environ Health. 2020 Jan 11. doi: 10.1007/s00420-019-01512-6.

Key clinical point: Shift workers are more likely to develop migraines and headaches than day workers.

Major finding: Shift workers had a 72% and 25% higher risk of developing migraine and unspecified headache, respectively, compared with day workers.

Study details: A longitudinal study included 2,952 individuals for the analyses of shift work and headache and 2,272 individuals for the analyses of shift work and migraine from the Danish PRISME cohort.

Disclosures: The study was funded by NordForsk, Nordic Program on Health and Welfare. The original PRISME study was supported by the Danish Working Environment Research Fund. The authors declared no conflicts of interest.

Citation: Appel AM et al. Int Arch Occup Environ Health. 2020 Jan 11. doi: 10.1007/s00420-019-01512-6.

Key clinical point: Shift workers are more likely to develop migraines and headaches than day workers.

Major finding: Shift workers had a 72% and 25% higher risk of developing migraine and unspecified headache, respectively, compared with day workers.

Study details: A longitudinal study included 2,952 individuals for the analyses of shift work and headache and 2,272 individuals for the analyses of shift work and migraine from the Danish PRISME cohort.

Disclosures: The study was funded by NordForsk, Nordic Program on Health and Welfare. The original PRISME study was supported by the Danish Working Environment Research Fund. The authors declared no conflicts of interest.

Citation: Appel AM et al. Int Arch Occup Environ Health. 2020 Jan 11. doi: 10.1007/s00420-019-01512-6.

Key clinical point: About one-quarter of pediatric patients with headache have joint hypermobility.

Major finding: Among children with headache and joint hypermobility, 80% had severe headache disability.

Study details: A prospective, single-center study of 76 children with headache.

Disclosures: The study was not supported by funding, and the investigators had no disclosures.

Citation: Sahjwani D et al. CNS 2019, Abstract 101.

Key clinical point: About one-quarter of pediatric patients with headache have joint hypermobility.

Major finding: Among children with headache and joint hypermobility, 80% had severe headache disability.

Study details: A prospective, single-center study of 76 children with headache.

Disclosures: The study was not supported by funding, and the investigators had no disclosures.

Citation: Sahjwani D et al. CNS 2019, Abstract 101.

Key clinical point: About one-quarter of pediatric patients with headache have joint hypermobility.

Major finding: Among children with headache and joint hypermobility, 80% had severe headache disability.

Study details: A prospective, single-center study of 76 children with headache.

Disclosures: The study was not supported by funding, and the investigators had no disclosures.

Citation: Sahjwani D et al. CNS 2019, Abstract 101.

Key clinical point: New daily persistent headache may be relatively common among children presenting to headache clinics.

Major finding: Girls with new daily persistent headache report symptoms such as photophobia, phonophobia, and nausea significantly more frequently than boys do.

Study details: An observational study of 454 pediatric patients with new daily persistent headache.

Disclosures: The study was not supported by funding, and the investigators had no disclosures.

Citation: Pierce E et al. CNS 2019, Abstract 100.

Key clinical point: New daily persistent headache may be relatively common among children presenting to headache clinics.

Major finding: Girls with new daily persistent headache report symptoms such as photophobia, phonophobia, and nausea significantly more frequently than boys do.

Study details: An observational study of 454 pediatric patients with new daily persistent headache.

Disclosures: The study was not supported by funding, and the investigators had no disclosures.

Citation: Pierce E et al. CNS 2019, Abstract 100.

Key clinical point: New daily persistent headache may be relatively common among children presenting to headache clinics.

Major finding: Girls with new daily persistent headache report symptoms such as photophobia, phonophobia, and nausea significantly more frequently than boys do.

Study details: An observational study of 454 pediatric patients with new daily persistent headache.

Disclosures: The study was not supported by funding, and the investigators had no disclosures.

Citation: Pierce E et al. CNS 2019, Abstract 100.

Key clinical point: Ubrogepant, an oral calcitonin gene–related peptide (CGRP)–receptor antagonist, may relieve patients’ migraine pain and their most bothersome associated symptom, such as photophobia, phonophobia, or nausea, at 2 hours after acute treatment.

Major finding: At 2 hours, pain freedom was reported by 101 of 464 participants in the ubrogepant 50-mg group (21.8%), 90 of 435 in the ubrogepant 25-mg group (20.7%), and 65 of 456 in the placebo group (14.3%).

Study details: ACHIEVE II was a randomized, double-blind, placebo-controlled, single-attack clinical trial that included more than 1,300 adults with migraine.

Disclosures: The trial was sponsored by Allergan, the company developing the drug. Several authors are Allergan employees. Dr. Lipton is a consultant, advisory board member, or has received honoraria from Allergan and other companies.

Citation: Lipton RB et al. JAMA. 2019;322(19):1887-98. doi: 10.1001/jama.2019.16711.

Key clinical point: Ubrogepant, an oral calcitonin gene–related peptide (CGRP)–receptor antagonist, may relieve patients’ migraine pain and their most bothersome associated symptom, such as photophobia, phonophobia, or nausea, at 2 hours after acute treatment.

Major finding: At 2 hours, pain freedom was reported by 101 of 464 participants in the ubrogepant 50-mg group (21.8%), 90 of 435 in the ubrogepant 25-mg group (20.7%), and 65 of 456 in the placebo group (14.3%).

Study details: ACHIEVE II was a randomized, double-blind, placebo-controlled, single-attack clinical trial that included more than 1,300 adults with migraine.

Disclosures: The trial was sponsored by Allergan, the company developing the drug. Several authors are Allergan employees. Dr. Lipton is a consultant, advisory board member, or has received honoraria from Allergan and other companies.

Citation: Lipton RB et al. JAMA. 2019;322(19):1887-98. doi: 10.1001/jama.2019.16711.

Key clinical point: Ubrogepant, an oral calcitonin gene–related peptide (CGRP)–receptor antagonist, may relieve patients’ migraine pain and their most bothersome associated symptom, such as photophobia, phonophobia, or nausea, at 2 hours after acute treatment.

Major finding: At 2 hours, pain freedom was reported by 101 of 464 participants in the ubrogepant 50-mg group (21.8%), 90 of 435 in the ubrogepant 25-mg group (20.7%), and 65 of 456 in the placebo group (14.3%).

Study details: ACHIEVE II was a randomized, double-blind, placebo-controlled, single-attack clinical trial that included more than 1,300 adults with migraine.

Disclosures: The trial was sponsored by Allergan, the company developing the drug. Several authors are Allergan employees. Dr. Lipton is a consultant, advisory board member, or has received honoraria from Allergan and other companies.

Citation: Lipton RB et al. JAMA. 2019;322(19):1887-98. doi: 10.1001/jama.2019.16711.

Key clinical point: Headache is a significant concern after pediatric hemispherectomy.

Major finding: Of 22 children who underwent hemispherectomy, 19 (86.4%) had headaches after the surgery.

Study details: A retrospective chart review and follow-up questionnaires that were administered to 22 children with hemispherectomy.

Citation: Pandit I et al. CNS 2019. Abstract 99.

Key clinical point: Headache is a significant concern after pediatric hemispherectomy.

Major finding: Of 22 children who underwent hemispherectomy, 19 (86.4%) had headaches after the surgery.

Study details: A retrospective chart review and follow-up questionnaires that were administered to 22 children with hemispherectomy.

Citation: Pandit I et al. CNS 2019. Abstract 99.

Key clinical point: Headache is a significant concern after pediatric hemispherectomy.

Major finding: Of 22 children who underwent hemispherectomy, 19 (86.4%) had headaches after the surgery.

Study details: A retrospective chart review and follow-up questionnaires that were administered to 22 children with hemispherectomy.

Citation: Pandit I et al. CNS 2019. Abstract 99.

The Food and Drug Administration has approved ubrogepant (Ubrelvy, Allergan) for the acute treatment of migraine with or without aura in adults.

Olivier Le Moal/Getty Images

Ubrogepant is the first drug in the class of oral calcitonin gene–related peptide receptor antagonists approved for the acute treatment of migraine. It is approved in two dose strengths (50 mg and 100 mg).

The drug is not indicated, however, for the preventive treatment of migraine.

“Migraine is an often disabling condition that affects an estimated 37 million people in the U.S.,” Billy Dunn, MD, acting director of the office of neuroscience in the FDA’s Center for Drug Evaluation and Research, said in an FDA news release.

Ubrogepant represents “an important new option for the acute treatment of migraine in adults, as it is the first drug in its class approved for this indication. The FDA is pleased to approve a novel treatment for patients suffering from migraine and will continue to work with stakeholders to promote the development of new safe and effective migraine therapies,” added Dr. Dunn.

The safety and efficacy of ubrogepant for the acute treatment of migraine was demonstrated in two randomized, double-blind, placebo-controlled trials (ACHIEVE I and ACHIEVE II). In total, 1,439 adults with a history of migraine, with and without aura, received ubrogepant to treat an ongoing migraine.

“Both 50-mg and 100-mg dose strengths demonstrated significantly greater rates of pain freedom and freedom from the most bothersome migraine-associated symptom at 2 hours, compared with placebo,” Allergan said in a news release announcing approval.

The most common side effects reported by patients in the clinical trials were nausea, tiredness, and dry mouth. Ubrogepant is contraindicated for coadministration with strong CYP3A4 inhibitors.

The company expects to have ubrogepant available in the first quarter of 2020.

A version of this story originally appeared on Medscape.com.

The Food and Drug Administration has approved ubrogepant (Ubrelvy, Allergan) for the acute treatment of migraine with or without aura in adults.

Olivier Le Moal/Getty Images

Ubrogepant is the first drug in the class of oral calcitonin gene–related peptide receptor antagonists approved for the acute treatment of migraine. It is approved in two dose strengths (50 mg and 100 mg).

The drug is not indicated, however, for the preventive treatment of migraine.

“Migraine is an often disabling condition that affects an estimated 37 million people in the U.S.,” Billy Dunn, MD, acting director of the office of neuroscience in the FDA’s Center for Drug Evaluation and Research, said in an FDA news release.

Ubrogepant represents “an important new option for the acute treatment of migraine in adults, as it is the first drug in its class approved for this indication. The FDA is pleased to approve a novel treatment for patients suffering from migraine and will continue to work with stakeholders to promote the development of new safe and effective migraine therapies,” added Dr. Dunn.

The safety and efficacy of ubrogepant for the acute treatment of migraine was demonstrated in two randomized, double-blind, placebo-controlled trials (ACHIEVE I and ACHIEVE II). In total, 1,439 adults with a history of migraine, with and without aura, received ubrogepant to treat an ongoing migraine.

“Both 50-mg and 100-mg dose strengths demonstrated significantly greater rates of pain freedom and freedom from the most bothersome migraine-associated symptom at 2 hours, compared with placebo,” Allergan said in a news release announcing approval.

The most common side effects reported by patients in the clinical trials were nausea, tiredness, and dry mouth. Ubrogepant is contraindicated for coadministration with strong CYP3A4 inhibitors.

The company expects to have ubrogepant available in the first quarter of 2020.

A version of this story originally appeared on Medscape.com.

The Food and Drug Administration has approved ubrogepant (Ubrelvy, Allergan) for the acute treatment of migraine with or without aura in adults.

Olivier Le Moal/Getty Images

Ubrogepant is the first drug in the class of oral calcitonin gene–related peptide receptor antagonists approved for the acute treatment of migraine. It is approved in two dose strengths (50 mg and 100 mg).

The drug is not indicated, however, for the preventive treatment of migraine.

“Migraine is an often disabling condition that affects an estimated 37 million people in the U.S.,” Billy Dunn, MD, acting director of the office of neuroscience in the FDA’s Center for Drug Evaluation and Research, said in an FDA news release.

Ubrogepant represents “an important new option for the acute treatment of migraine in adults, as it is the first drug in its class approved for this indication. The FDA is pleased to approve a novel treatment for patients suffering from migraine and will continue to work with stakeholders to promote the development of new safe and effective migraine therapies,” added Dr. Dunn.

The safety and efficacy of ubrogepant for the acute treatment of migraine was demonstrated in two randomized, double-blind, placebo-controlled trials (ACHIEVE I and ACHIEVE II). In total, 1,439 adults with a history of migraine, with and without aura, received ubrogepant to treat an ongoing migraine.

“Both 50-mg and 100-mg dose strengths demonstrated significantly greater rates of pain freedom and freedom from the most bothersome migraine-associated symptom at 2 hours, compared with placebo,” Allergan said in a news release announcing approval.

The most common side effects reported by patients in the clinical trials were nausea, tiredness, and dry mouth. Ubrogepant is contraindicated for coadministration with strong CYP3A4 inhibitors.

The company expects to have ubrogepant available in the first quarter of 2020.

A version of this story originally appeared on Medscape.com.

Key clinical point: The 12-week injection cycle of Onabotulinumtoxin A (OnabotA) may need to be reconsidered.

Major finding: The study of 98 patients and 471 treatment cycles found that 43 patients experienced one or more wearing-off-effect (WOE) events (worsening headaches and neck pain). Of those patients, 24 reported 1 WOE event and 19 patients reported 2 or more WOEs. Almost 32% of patients used abortive therapy to manage their WOEs.

Study details: This was a retrospective review of patients with worsening headache variables and neck pain who received OnabotA for their chronic migraine in treatment cycles.

Disclosures: Dr. Khan received honorarium for Depomed, Inc. and Promius Pharma while conducting the study.

Citation: Khan FA, et al. Headache. 2019 Nov 22. doi: 10.1111/head.13713. [Epub ahead of print].

Key clinical point: The 12-week injection cycle of Onabotulinumtoxin A (OnabotA) may need to be reconsidered.

Major finding: The study of 98 patients and 471 treatment cycles found that 43 patients experienced one or more wearing-off-effect (WOE) events (worsening headaches and neck pain). Of those patients, 24 reported 1 WOE event and 19 patients reported 2 or more WOEs. Almost 32% of patients used abortive therapy to manage their WOEs.

Study details: This was a retrospective review of patients with worsening headache variables and neck pain who received OnabotA for their chronic migraine in treatment cycles.

Disclosures: Dr. Khan received honorarium for Depomed, Inc. and Promius Pharma while conducting the study.

Citation: Khan FA, et al. Headache. 2019 Nov 22. doi: 10.1111/head.13713. [Epub ahead of print].

Key clinical point: The 12-week injection cycle of Onabotulinumtoxin A (OnabotA) may need to be reconsidered.

Major finding: The study of 98 patients and 471 treatment cycles found that 43 patients experienced one or more wearing-off-effect (WOE) events (worsening headaches and neck pain). Of those patients, 24 reported 1 WOE event and 19 patients reported 2 or more WOEs. Almost 32% of patients used abortive therapy to manage their WOEs.

Study details: This was a retrospective review of patients with worsening headache variables and neck pain who received OnabotA for their chronic migraine in treatment cycles.

Disclosures: Dr. Khan received honorarium for Depomed, Inc. and Promius Pharma while conducting the study.

Citation: Khan FA, et al. Headache. 2019 Nov 22. doi: 10.1111/head.13713. [Epub ahead of print].

Key clinical point: Onabotulinumtoxin A (OnabotA) may decrease migraine days by 50% or more.

Major finding: Of 112 patients with chronic migraine (100 female), 96 responded positively to OnabotA, resulting in decreased migraine days by at least 50%. Having a dependent personality trait was linked to treatment nonresponse.

Study details: This was a case-control observational study of chronic migraine patients that received two or more treatment cycles of OnabotA.

Disclosures: None.

Citation: Gonzalez-Martinez A, et al. Headache. 2019 Nov 6. doi: 10.1111/head.13693. [Epub ahead of print].

Key clinical point: Onabotulinumtoxin A (OnabotA) may decrease migraine days by 50% or more.

Major finding: Of 112 patients with chronic migraine (100 female), 96 responded positively to OnabotA, resulting in decreased migraine days by at least 50%. Having a dependent personality trait was linked to treatment nonresponse.

Study details: This was a case-control observational study of chronic migraine patients that received two or more treatment cycles of OnabotA.

Disclosures: None.

Citation: Gonzalez-Martinez A, et al. Headache. 2019 Nov 6. doi: 10.1111/head.13693. [Epub ahead of print].

Key clinical point: Onabotulinumtoxin A (OnabotA) may decrease migraine days by 50% or more.

Major finding: Of 112 patients with chronic migraine (100 female), 96 responded positively to OnabotA, resulting in decreased migraine days by at least 50%. Having a dependent personality trait was linked to treatment nonresponse.

Study details: This was a case-control observational study of chronic migraine patients that received two or more treatment cycles of OnabotA.

Disclosures: None.

Citation: Gonzalez-Martinez A, et al. Headache. 2019 Nov 6. doi: 10.1111/head.13693. [Epub ahead of print].

Key clinical point: Vitamin D supplementation may decrease the frequency, severity, and duration of migraines.

Major finding: Significantly lower 25 (OH)-vitamin D levels were found in patients with migraine, compared with healthy controls. Migraine patients with low vitamin D levels had a higher incidence of aura, phonophobia/photophobia, autonomic manifestations, allodynia, and medication resistance.

Study details: This was a case-control study of 40 patients with migraine, compared with 40 healthy control patients. Patient history was taken including headache characteristics, MIGSEV, and HIT-6 scores. Each patient’s serum 25 (OH)-vitamin D level was measured.

Disclosures: None.

Citation: Hussein M, et al. J Pain Res. 2019 Aug 20;12:2529-36. doi: 10.2147/JPR.S216314. eCollection 2019.

Key clinical point: Vitamin D supplementation may decrease the frequency, severity, and duration of migraines.

Major finding: Significantly lower 25 (OH)-vitamin D levels were found in patients with migraine, compared with healthy controls. Migraine patients with low vitamin D levels had a higher incidence of aura, phonophobia/photophobia, autonomic manifestations, allodynia, and medication resistance.

Study details: This was a case-control study of 40 patients with migraine, compared with 40 healthy control patients. Patient history was taken including headache characteristics, MIGSEV, and HIT-6 scores. Each patient’s serum 25 (OH)-vitamin D level was measured.

Disclosures: None.

Citation: Hussein M, et al. J Pain Res. 2019 Aug 20;12:2529-36. doi: 10.2147/JPR.S216314. eCollection 2019.

Key clinical point: Vitamin D supplementation may decrease the frequency, severity, and duration of migraines.

Major finding: Significantly lower 25 (OH)-vitamin D levels were found in patients with migraine, compared with healthy controls. Migraine patients with low vitamin D levels had a higher incidence of aura, phonophobia/photophobia, autonomic manifestations, allodynia, and medication resistance.

Study details: This was a case-control study of 40 patients with migraine, compared with 40 healthy control patients. Patient history was taken including headache characteristics, MIGSEV, and HIT-6 scores. Each patient’s serum 25 (OH)-vitamin D level was measured.

Disclosures: None.

Citation: Hussein M, et al. J Pain Res. 2019 Aug 20;12:2529-36. doi: 10.2147/JPR.S216314. eCollection 2019.

Episodic visual snow was tied to migraine attacks in a case series of three adults who denied any visual snow outside of the migraines, based on data collected at an outpatient headache center.

Visual snow, a condition in which patients experience visual distortion of tiny, flickering dots resembling analog television static, is often a comorbid condition in migraine patients with and without aura. However, “to our knowledge, this is the first report of patients with an episodic form of visual snow strictly occurring with migraine attacks,” wrote Julius Hodak, MD, of the University of Bern (Switzerland) and colleagues.

In a research letter published in JAMA Neurology, the investigators described 3 adults with histories of migraine but no aura who presented to a tertiary headache center between January 2016 and December 2017, in addition to 1,934 adults with migraine but no visual snow. The three patients initially presented with headaches, and neurologic and MRI results were normal.

Two patients experienced black and white episodic visual snow and one experienced black and yellow visual snow. In one patient, visual snow occurred for less than 2 minutes before and during a migraine attack. The other two patients experienced visual snow during the entire migraine attack.

Based on these patients, the researchers proposed distinguishing episodic visual snow from the distinct disorder of visual snow syndrome, in which patients experience continuous visual snow and other visual symptoms.

In addition, the cases were notable because of the lack of aura in the patients, the researchers wrote.

“In clinical practice, a detailed history in patients reporting visual flickering is therefore necessary to differentiate aura from [episodic visual snow],” they added, because an aura diagnosis would affect patient guidance on contraception use or the timing of triptans.

Dr. Hodak had no financial conflicts to disclose. The study was supported by Deutsche Migräne-und Kopfschmerzgesellschaft, Eye on Vision Foundation, and Baasch-Medicus Foundation.

SOURCE: Hodak J et al. JAMA Neurol. 2019 Nov 25. doi: 10.1001/jamaneurol.2019.4050.

Episodic visual snow was tied to migraine attacks in a case series of three adults who denied any visual snow outside of the migraines, based on data collected at an outpatient headache center.

Visual snow, a condition in which patients experience visual distortion of tiny, flickering dots resembling analog television static, is often a comorbid condition in migraine patients with and without aura. However, “to our knowledge, this is the first report of patients with an episodic form of visual snow strictly occurring with migraine attacks,” wrote Julius Hodak, MD, of the University of Bern (Switzerland) and colleagues.

In a research letter published in JAMA Neurology, the investigators described 3 adults with histories of migraine but no aura who presented to a tertiary headache center between January 2016 and December 2017, in addition to 1,934 adults with migraine but no visual snow. The three patients initially presented with headaches, and neurologic and MRI results were normal.

Two patients experienced black and white episodic visual snow and one experienced black and yellow visual snow. In one patient, visual snow occurred for less than 2 minutes before and during a migraine attack. The other two patients experienced visual snow during the entire migraine attack.

Based on these patients, the researchers proposed distinguishing episodic visual snow from the distinct disorder of visual snow syndrome, in which patients experience continuous visual snow and other visual symptoms.

In addition, the cases were notable because of the lack of aura in the patients, the researchers wrote.

“In clinical practice, a detailed history in patients reporting visual flickering is therefore necessary to differentiate aura from [episodic visual snow],” they added, because an aura diagnosis would affect patient guidance on contraception use or the timing of triptans.

Dr. Hodak had no financial conflicts to disclose. The study was supported by Deutsche Migräne-und Kopfschmerzgesellschaft, Eye on Vision Foundation, and Baasch-Medicus Foundation.

SOURCE: Hodak J et al. JAMA Neurol. 2019 Nov 25. doi: 10.1001/jamaneurol.2019.4050.

Episodic visual snow was tied to migraine attacks in a case series of three adults who denied any visual snow outside of the migraines, based on data collected at an outpatient headache center.

Visual snow, a condition in which patients experience visual distortion of tiny, flickering dots resembling analog television static, is often a comorbid condition in migraine patients with and without aura. However, “to our knowledge, this is the first report of patients with an episodic form of visual snow strictly occurring with migraine attacks,” wrote Julius Hodak, MD, of the University of Bern (Switzerland) and colleagues.

In a research letter published in JAMA Neurology, the investigators described 3 adults with histories of migraine but no aura who presented to a tertiary headache center between January 2016 and December 2017, in addition to 1,934 adults with migraine but no visual snow. The three patients initially presented with headaches, and neurologic and MRI results were normal.

Two patients experienced black and white episodic visual snow and one experienced black and yellow visual snow. In one patient, visual snow occurred for less than 2 minutes before and during a migraine attack. The other two patients experienced visual snow during the entire migraine attack.

Based on these patients, the researchers proposed distinguishing episodic visual snow from the distinct disorder of visual snow syndrome, in which patients experience continuous visual snow and other visual symptoms.

In addition, the cases were notable because of the lack of aura in the patients, the researchers wrote.

“In clinical practice, a detailed history in patients reporting visual flickering is therefore necessary to differentiate aura from [episodic visual snow],” they added, because an aura diagnosis would affect patient guidance on contraception use or the timing of triptans.

Dr. Hodak had no financial conflicts to disclose. The study was supported by Deutsche Migräne-und Kopfschmerzgesellschaft, Eye on Vision Foundation, and Baasch-Medicus Foundation.

SOURCE: Hodak J et al. JAMA Neurol. 2019 Nov 25. doi: 10.1001/jamaneurol.2019.4050.