Migraine Briefs

Key clinical point: Patients with migraine were found to be at a higher risk for developing open angle glaucoma (OAG).

Major finding: Risk factors for OAG in patients with migraine were age, hyperlipidemia, and diabetes mellitus. There was 1.68-fold higher risk for OAG in migraine patients aged 49 years or less.

Study details: This was a retrospective matched-cohort study that included data from 17,283 patients with migraine, compared with 69,132 randomly selected patients. Migraine patients were followed for 10 years to determine if they would receive a diagnosis of OAG.

Disclosures: None.

Citation: Huang JY, et al. BMC Ophthalmol. 2019 Feb; doi: 10.1186/s12886-019-1062-9.

Key clinical point: Patients with migraine were found to be at a higher risk for developing open angle glaucoma (OAG).

Major finding: Risk factors for OAG in patients with migraine were age, hyperlipidemia, and diabetes mellitus. There was 1.68-fold higher risk for OAG in migraine patients aged 49 years or less.

Study details: This was a retrospective matched-cohort study that included data from 17,283 patients with migraine, compared with 69,132 randomly selected patients. Migraine patients were followed for 10 years to determine if they would receive a diagnosis of OAG.

Disclosures: None.

Citation: Huang JY, et al. BMC Ophthalmol. 2019 Feb; doi: 10.1186/s12886-019-1062-9.

Key clinical point: Patients with migraine were found to be at a higher risk for developing open angle glaucoma (OAG).

Major finding: Risk factors for OAG in patients with migraine were age, hyperlipidemia, and diabetes mellitus. There was 1.68-fold higher risk for OAG in migraine patients aged 49 years or less.

Study details: This was a retrospective matched-cohort study that included data from 17,283 patients with migraine, compared with 69,132 randomly selected patients. Migraine patients were followed for 10 years to determine if they would receive a diagnosis of OAG.

Disclosures: None.

Citation: Huang JY, et al. BMC Ophthalmol. 2019 Feb; doi: 10.1186/s12886-019-1062-9.

Key clinical point: Gender-related differences should be kept in mind when it comes to experiments and treatment approaches for migraine patients

Major finding: Female migraine patients were found to be more anxious, compared with male patients. They also had “more severe impairment in attentive processing of visual stimuli than their male counterparts,” noted the investigators.

Study details: Forty-six migraine patients without aura (23 females) and 46 age-matched healthy controls (23 females) were evaluated and analyzed using a three-stimulus oddball paradigm.

Disclosures: None.

Citation: Guo Y, et al. J Headache Pain. 2019;20(1):38. doi: 10.1186/s10194-019-0995-y.

Key clinical point: Gender-related differences should be kept in mind when it comes to experiments and treatment approaches for migraine patients

Major finding: Female migraine patients were found to be more anxious, compared with male patients. They also had “more severe impairment in attentive processing of visual stimuli than their male counterparts,” noted the investigators.

Study details: Forty-six migraine patients without aura (23 females) and 46 age-matched healthy controls (23 females) were evaluated and analyzed using a three-stimulus oddball paradigm.

Disclosures: None.

Citation: Guo Y, et al. J Headache Pain. 2019;20(1):38. doi: 10.1186/s10194-019-0995-y.

Key clinical point: Gender-related differences should be kept in mind when it comes to experiments and treatment approaches for migraine patients

Major finding: Female migraine patients were found to be more anxious, compared with male patients. They also had “more severe impairment in attentive processing of visual stimuli than their male counterparts,” noted the investigators.

Study details: Forty-six migraine patients without aura (23 females) and 46 age-matched healthy controls (23 females) were evaluated and analyzed using a three-stimulus oddball paradigm.

Disclosures: None.

Citation: Guo Y, et al. J Headache Pain. 2019;20(1):38. doi: 10.1186/s10194-019-0995-y.

Key clinical point: Migraine affects millions of patients in Europe. Yet, there aren’t enough specialists adhering to the national and international guidelines on migraines to treat those patients.

Major finding: Patients had seen general practitioners and neurologists for one year prior to seeing specialists. Fifty percent of those patients underwent unnecessary diagnostics and 34.2% had not been treated according to the recommended treatment guidelines.

Study details: Data was collected from 1,935 migraine patients between 2010 and 2018 visiting a headache clinic via standardized questionnaires regarding their prior history and treatment.

Disclosures: None.

Citation: Ziegeler C, et al. J Headache Pain. 2019;20(1):86. doi: 10.1186/s10194-019-1034-8.

Key clinical point: Migraine affects millions of patients in Europe. Yet, there aren’t enough specialists adhering to the national and international guidelines on migraines to treat those patients.

Major finding: Patients had seen general practitioners and neurologists for one year prior to seeing specialists. Fifty percent of those patients underwent unnecessary diagnostics and 34.2% had not been treated according to the recommended treatment guidelines.

Study details: Data was collected from 1,935 migraine patients between 2010 and 2018 visiting a headache clinic via standardized questionnaires regarding their prior history and treatment.

Disclosures: None.

Citation: Ziegeler C, et al. J Headache Pain. 2019;20(1):86. doi: 10.1186/s10194-019-1034-8.

Key clinical point: Migraine affects millions of patients in Europe. Yet, there aren’t enough specialists adhering to the national and international guidelines on migraines to treat those patients.

Major finding: Patients had seen general practitioners and neurologists for one year prior to seeing specialists. Fifty percent of those patients underwent unnecessary diagnostics and 34.2% had not been treated according to the recommended treatment guidelines.

Study details: Data was collected from 1,935 migraine patients between 2010 and 2018 visiting a headache clinic via standardized questionnaires regarding their prior history and treatment.

Disclosures: None.

Citation: Ziegeler C, et al. J Headache Pain. 2019;20(1):86. doi: 10.1186/s10194-019-1034-8.

Key clinical point: Follow-up consultations with migraine patients via telemedicine are effective and can increase physician productivity and patient convenience.

Major finding: Migraine disability assessment improved by an average of 24 points in the telemedicine patients and by 19 points in the control group.

Study details: A single-center, randomized study with 40 migraine patients.

Disclosures: The study received partial funding from Merck.

Citation: Friedman DI. Headache. 2019 June;59(S1):1-208, LBOR01

Key clinical point: Follow-up consultations with migraine patients via telemedicine are effective and can increase physician productivity and patient convenience.

Major finding: Migraine disability assessment improved by an average of 24 points in the telemedicine patients and by 19 points in the control group.

Study details: A single-center, randomized study with 40 migraine patients.

Disclosures: The study received partial funding from Merck.

Citation: Friedman DI. Headache. 2019 June;59(S1):1-208, LBOR01

Key clinical point: Follow-up consultations with migraine patients via telemedicine are effective and can increase physician productivity and patient convenience.

Major finding: Migraine disability assessment improved by an average of 24 points in the telemedicine patients and by 19 points in the control group.

Study details: A single-center, randomized study with 40 migraine patients.

Disclosures: The study received partial funding from Merck.

Citation: Friedman DI. Headache. 2019 June;59(S1):1-208, LBOR01

Key clinical point: Loudness discomfort levels and temporal auditory processing may help diagnosis patients with vestibular migraine (VM).

Major finding: VM patients experienced response latencies with longer frequencies and a lower noise tolerance, compared with patients without migraine. The statistically significant findings showed that “the frequency following response latencies were significantly longer in the patients with vestibular migraine than in the control group, suggesting altered pure tone temporal processing, which may also affect the processing of complex sounds,” noted the investigators. “The lower discomfort thresholds suggest the presence of mild hyperacusis, in concordance with other previous studies.”

Study details: Fifty-four women were split up into two groups: 29 women with VM and 25 healthy women without migraine.

Disclosures: The authors reported having no conflicts of interest.

Citation: Takeuti AA, et al. BMC Neurol. 2019 Jun 27;19(1):144. doi: 10.1186/s12883-019-1368-5.

Key clinical point: Loudness discomfort levels and temporal auditory processing may help diagnosis patients with vestibular migraine (VM).

Major finding: VM patients experienced response latencies with longer frequencies and a lower noise tolerance, compared with patients without migraine. The statistically significant findings showed that “the frequency following response latencies were significantly longer in the patients with vestibular migraine than in the control group, suggesting altered pure tone temporal processing, which may also affect the processing of complex sounds,” noted the investigators. “The lower discomfort thresholds suggest the presence of mild hyperacusis, in concordance with other previous studies.”

Study details: Fifty-four women were split up into two groups: 29 women with VM and 25 healthy women without migraine.

Disclosures: The authors reported having no conflicts of interest.

Citation: Takeuti AA, et al. BMC Neurol. 2019 Jun 27;19(1):144. doi: 10.1186/s12883-019-1368-5.

Key clinical point: Loudness discomfort levels and temporal auditory processing may help diagnosis patients with vestibular migraine (VM).

Major finding: VM patients experienced response latencies with longer frequencies and a lower noise tolerance, compared with patients without migraine. The statistically significant findings showed that “the frequency following response latencies were significantly longer in the patients with vestibular migraine than in the control group, suggesting altered pure tone temporal processing, which may also affect the processing of complex sounds,” noted the investigators. “The lower discomfort thresholds suggest the presence of mild hyperacusis, in concordance with other previous studies.”

Study details: Fifty-four women were split up into two groups: 29 women with VM and 25 healthy women without migraine.

Disclosures: The authors reported having no conflicts of interest.

Citation: Takeuti AA, et al. BMC Neurol. 2019 Jun 27;19(1):144. doi: 10.1186/s12883-019-1368-5.

Key clinical point: Patients that cycle through migraine preventive medications have a higher economic burden.

Major finding: Migraine patients cycling through more than two preventive migraine medications (PMMs) had an increased financial burden, compared with patients that received their initial medication class. “Mean all-cause total direct costs, including prescription costs, were significantly higher in PMM2 ($13,429) and PMM3 ($18,394) subgroups versus the persistent subgroup ($11,941),” noted the investigators

Study details: This was a retrospective observational study of 55,402 adult patients with migraine beginning their first PMM: antidepressants, antiepileptics, beta blockers, or neurotoxins. Patients had to have continuous medical and prescription enrollment for 12 months to be included in the study.

Disclosures: Eli Lilly and Company funded and designed the study. All study investigators reported being employees and stockholders of Eli Lily and Company.

Citation: Ford JH, et al. J Manag Care Spec Pharm. 2019 Jan;25(1):46-59. doi: 10.18553/jmcp.2018.18058.

Key clinical point: Patients that cycle through migraine preventive medications have a higher economic burden.

Major finding: Migraine patients cycling through more than two preventive migraine medications (PMMs) had an increased financial burden, compared with patients that received their initial medication class. “Mean all-cause total direct costs, including prescription costs, were significantly higher in PMM2 ($13,429) and PMM3 ($18,394) subgroups versus the persistent subgroup ($11,941),” noted the investigators

Study details: This was a retrospective observational study of 55,402 adult patients with migraine beginning their first PMM: antidepressants, antiepileptics, beta blockers, or neurotoxins. Patients had to have continuous medical and prescription enrollment for 12 months to be included in the study.

Disclosures: Eli Lilly and Company funded and designed the study. All study investigators reported being employees and stockholders of Eli Lily and Company.

Citation: Ford JH, et al. J Manag Care Spec Pharm. 2019 Jan;25(1):46-59. doi: 10.18553/jmcp.2018.18058.

Key clinical point: Patients that cycle through migraine preventive medications have a higher economic burden.

Major finding: Migraine patients cycling through more than two preventive migraine medications (PMMs) had an increased financial burden, compared with patients that received their initial medication class. “Mean all-cause total direct costs, including prescription costs, were significantly higher in PMM2 ($13,429) and PMM3 ($18,394) subgroups versus the persistent subgroup ($11,941),” noted the investigators

Study details: This was a retrospective observational study of 55,402 adult patients with migraine beginning their first PMM: antidepressants, antiepileptics, beta blockers, or neurotoxins. Patients had to have continuous medical and prescription enrollment for 12 months to be included in the study.

Disclosures: Eli Lilly and Company funded and designed the study. All study investigators reported being employees and stockholders of Eli Lily and Company.

Citation: Ford JH, et al. J Manag Care Spec Pharm. 2019 Jan;25(1):46-59. doi: 10.18553/jmcp.2018.18058.

No significant differences were demonstrated in the amount of coronary calcifications in patients with and without migraine, a new study found. Researchers evaluated if the increased cardiovascular (CV) risk in migraineurs is attributed to an increased coronary artery calcification (CAC). They found:

• The CAC score was assessed by computed tomography of the heart in 1,437 patients, of which 337 were migraineurs.
• All patients had a similar CV risk profile, so that the risk for CAC could be considered similar between migraineurs and non-migraineurs.
• There were no significant differences in the amount of CAC in patients with or without migraine.

Filippopulos FM, et al. Coronary artery calcification score in migraine patients. [Published online ahead of print October 1, 2019]. Sci Rep. doi: 10.1038/s41598-019-50660-9.

No significant differences were demonstrated in the amount of coronary calcifications in patients with and without migraine, a new study found. Researchers evaluated if the increased cardiovascular (CV) risk in migraineurs is attributed to an increased coronary artery calcification (CAC). They found:

• The CAC score was assessed by computed tomography of the heart in 1,437 patients, of which 337 were migraineurs.
• All patients had a similar CV risk profile, so that the risk for CAC could be considered similar between migraineurs and non-migraineurs.
• There were no significant differences in the amount of CAC in patients with or without migraine.

Filippopulos FM, et al. Coronary artery calcification score in migraine patients. [Published online ahead of print October 1, 2019]. Sci Rep. doi: 10.1038/s41598-019-50660-9.

No significant differences were demonstrated in the amount of coronary calcifications in patients with and without migraine, a new study found. Researchers evaluated if the increased cardiovascular (CV) risk in migraineurs is attributed to an increased coronary artery calcification (CAC). They found:

• The CAC score was assessed by computed tomography of the heart in 1,437 patients, of which 337 were migraineurs.
• All patients had a similar CV risk profile, so that the risk for CAC could be considered similar between migraineurs and non-migraineurs.
• There were no significant differences in the amount of CAC in patients with or without migraine.

Filippopulos FM, et al. Coronary artery calcification score in migraine patients. [Published online ahead of print October 1, 2019]. Sci Rep. doi: 10.1038/s41598-019-50660-9.

Patients with migraine who developed a migraine-like attack in response to nitroglycerin demonstrated stronger systemic cardiovascular (CV) responses compared to non-headache controls, a new study found. In 16 women with migraine without aura and 10 age- and gender-matched controls, intravenous nitroglycerin was administered. Researchers found:

• Nitroglycerin provoked a migraine-like attack in 81.2% of migraineurs but not in controls.
• Migraineurs who later developed a migraine-like attack showed different responses in all parameters vs controls.
• The decreases in cardiac output and stroke volume were more rapid and longer lasting, heart rate increased, mean arterial pressure and total peripheral resistance were higher and decreased after an initial increase.

van Oosterhout WPJ, et al. Abnormal cardiovascular response to nitroglycerin in migraine. [Published online ahead of print October 9, 2019]. Cephalalgia. doi: 10.1177/0333102419881657.

Patients with migraine who developed a migraine-like attack in response to nitroglycerin demonstrated stronger systemic cardiovascular (CV) responses compared to non-headache controls, a new study found. In 16 women with migraine without aura and 10 age- and gender-matched controls, intravenous nitroglycerin was administered. Researchers found:

• Nitroglycerin provoked a migraine-like attack in 81.2% of migraineurs but not in controls.
• Migraineurs who later developed a migraine-like attack showed different responses in all parameters vs controls.
• The decreases in cardiac output and stroke volume were more rapid and longer lasting, heart rate increased, mean arterial pressure and total peripheral resistance were higher and decreased after an initial increase.

van Oosterhout WPJ, et al. Abnormal cardiovascular response to nitroglycerin in migraine. [Published online ahead of print October 9, 2019]. Cephalalgia. doi: 10.1177/0333102419881657.

Patients with migraine who developed a migraine-like attack in response to nitroglycerin demonstrated stronger systemic cardiovascular (CV) responses compared to non-headache controls, a new study found. In 16 women with migraine without aura and 10 age- and gender-matched controls, intravenous nitroglycerin was administered. Researchers found:

• Nitroglycerin provoked a migraine-like attack in 81.2% of migraineurs but not in controls.
• Migraineurs who later developed a migraine-like attack showed different responses in all parameters vs controls.
• The decreases in cardiac output and stroke volume were more rapid and longer lasting, heart rate increased, mean arterial pressure and total peripheral resistance were higher and decreased after an initial increase.

van Oosterhout WPJ, et al. Abnormal cardiovascular response to nitroglycerin in migraine. [Published online ahead of print October 9, 2019]. Cephalalgia. doi: 10.1177/0333102419881657.

Poor awareness of migraine is common among patients in several countries, a new study found. The multicenter study was conducted in 12 headache centers in 7 countries with each center recruiting 100 or less patients referred for a first visit and diagnosed with migraine. Participants were given a structured clinical questionnaire-based interview about perceptions of the type of headache they suffer from, its cause, previous diagnoses, investigations, and treatments. Researchers found:

• Of the 1,161 patients who completed the study, 28% of participants were aware they suffer from migraine.
• 64% of participants called their migraine “headache,” less commonly used terms such as “cervical pain,” “tension headache,” and “sinusitis.”
• 8% of general practitioners and 35% of specialists consulted for migraine formulated the correct diagnosis.

Viana M, et al. Poor patient awareness and frequent misdiagnosis of migraine: findings from a large transcontinental cohort. [Published online ahead of print October 1, 2019]. Eur J Neurol. doi: 10.1111/ene.14098.

Poor awareness of migraine is common among patients in several countries, a new study found. The multicenter study was conducted in 12 headache centers in 7 countries with each center recruiting 100 or less patients referred for a first visit and diagnosed with migraine. Participants were given a structured clinical questionnaire-based interview about perceptions of the type of headache they suffer from, its cause, previous diagnoses, investigations, and treatments. Researchers found:

• Of the 1,161 patients who completed the study, 28% of participants were aware they suffer from migraine.
• 64% of participants called their migraine “headache,” less commonly used terms such as “cervical pain,” “tension headache,” and “sinusitis.”
• 8% of general practitioners and 35% of specialists consulted for migraine formulated the correct diagnosis.

Viana M, et al. Poor patient awareness and frequent misdiagnosis of migraine: findings from a large transcontinental cohort. [Published online ahead of print October 1, 2019]. Eur J Neurol. doi: 10.1111/ene.14098.

Poor awareness of migraine is common among patients in several countries, a new study found. The multicenter study was conducted in 12 headache centers in 7 countries with each center recruiting 100 or less patients referred for a first visit and diagnosed with migraine. Participants were given a structured clinical questionnaire-based interview about perceptions of the type of headache they suffer from, its cause, previous diagnoses, investigations, and treatments. Researchers found:

• Of the 1,161 patients who completed the study, 28% of participants were aware they suffer from migraine.
• 64% of participants called their migraine “headache,” less commonly used terms such as “cervical pain,” “tension headache,” and “sinusitis.”
• 8% of general practitioners and 35% of specialists consulted for migraine formulated the correct diagnosis.

Viana M, et al. Poor patient awareness and frequent misdiagnosis of migraine: findings from a large transcontinental cohort. [Published online ahead of print October 1, 2019]. Eur J Neurol. doi: 10.1111/ene.14098.

IgG elimination diet combined with probiotics may be beneficial to migraine plus irritable bowel syndrome (IBS), a new study found. Researchers investigated the therapeutic potential of diet based on IgG elimination combined with probiotics on 60 patients with migraine plus IBS. IgG antibodies against 266 food varieties were detected by ELISA. Participants were randomized into 3 groups for treatment of IgG elimination diet or probiotics, or diet combined with probiotics. Among the findings:

• Improvement of migraine and gut symptom was achieved at a certain time point.
• Reduced over the counter (OTC) analgesics was seen in all groups.
• Use of triptans did not show significant difference.
• An increased serum serotonin level was seen in participants treated with elimination diet and elimination diet combined with probiotics.

Xie Y, et al. Effects of diet based on IgG elimination combined with probiotics on migraine plus irritable bowel syndrome. [Published online ahead of print August 21, 2019]. Pain Res Manag. doi: 10.1155/2019/7890461.

IgG elimination diet combined with probiotics may be beneficial to migraine plus irritable bowel syndrome (IBS), a new study found. Researchers investigated the therapeutic potential of diet based on IgG elimination combined with probiotics on 60 patients with migraine plus IBS. IgG antibodies against 266 food varieties were detected by ELISA. Participants were randomized into 3 groups for treatment of IgG elimination diet or probiotics, or diet combined with probiotics. Among the findings:

• Improvement of migraine and gut symptom was achieved at a certain time point.
• Reduced over the counter (OTC) analgesics was seen in all groups.
• Use of triptans did not show significant difference.
• An increased serum serotonin level was seen in participants treated with elimination diet and elimination diet combined with probiotics.

Xie Y, et al. Effects of diet based on IgG elimination combined with probiotics on migraine plus irritable bowel syndrome. [Published online ahead of print August 21, 2019]. Pain Res Manag. doi: 10.1155/2019/7890461.

IgG elimination diet combined with probiotics may be beneficial to migraine plus irritable bowel syndrome (IBS), a new study found. Researchers investigated the therapeutic potential of diet based on IgG elimination combined with probiotics on 60 patients with migraine plus IBS. IgG antibodies against 266 food varieties were detected by ELISA. Participants were randomized into 3 groups for treatment of IgG elimination diet or probiotics, or diet combined with probiotics. Among the findings:

• Improvement of migraine and gut symptom was achieved at a certain time point.
• Reduced over the counter (OTC) analgesics was seen in all groups.
• Use of triptans did not show significant difference.
• An increased serum serotonin level was seen in participants treated with elimination diet and elimination diet combined with probiotics.

Xie Y, et al. Effects of diet based on IgG elimination combined with probiotics on migraine plus irritable bowel syndrome. [Published online ahead of print August 21, 2019]. Pain Res Manag. doi: 10.1155/2019/7890461.