Headache & Migraine

Key clinical point: Calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) were more effective than onabotulinumtoxinA in patients with chronic migraine (CM), even in those who were difficult-to-treat (DTT) and did not respond to ≥3 preventive treatments.

Major finding: At 6 months, CGRP mAb vs onabotulinumtoxinA significantly reduced monthly migraine days (−13.0 vs −8.7 days/month; P < .001) in overall populations, with a similar reduction observed in those who were DTT (−13.0 vs −9.1 days/month; P < .001). Both treatments were well tolerated, with no treatment discontinuation being observed because of adverse events.

Study details: This multicenter, real-world study included 316 and 333 patients with CM who received ≥1 dose of CGRP mAb and onabotulinumtoxinA, respectively, and of whom 544 were DTT and had failed to respond ≥3 preventive treatments.

Disclosures: This study was funded by Taiwan National Science and Technology Council and others. Three authors declared receiving research grants, personal fees as advisors or speakers, or honoraria as speakers from various sources.

Source: Wang Y-F, Yang F-C, Chen L-A, et al. Comparative effectiveness and tolerability of calcitonin gene-related peptide (CGRP) monoclonal antibodies and onabotulinumtoxinA in chronic migraine: A multicenter, real-world study in Taiwan. Eur J Neurol. 2024 :e16372 (Jun 5). doi: 10.1111/ene.16372 Source

Key clinical point: Calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) were more effective than onabotulinumtoxinA in patients with chronic migraine (CM), even in those who were difficult-to-treat (DTT) and did not respond to ≥3 preventive treatments.

Major finding: At 6 months, CGRP mAb vs onabotulinumtoxinA significantly reduced monthly migraine days (−13.0 vs −8.7 days/month; P < .001) in overall populations, with a similar reduction observed in those who were DTT (−13.0 vs −9.1 days/month; P < .001). Both treatments were well tolerated, with no treatment discontinuation being observed because of adverse events.

Study details: This multicenter, real-world study included 316 and 333 patients with CM who received ≥1 dose of CGRP mAb and onabotulinumtoxinA, respectively, and of whom 544 were DTT and had failed to respond ≥3 preventive treatments.

Disclosures: This study was funded by Taiwan National Science and Technology Council and others. Three authors declared receiving research grants, personal fees as advisors or speakers, or honoraria as speakers from various sources.

Source: Wang Y-F, Yang F-C, Chen L-A, et al. Comparative effectiveness and tolerability of calcitonin gene-related peptide (CGRP) monoclonal antibodies and onabotulinumtoxinA in chronic migraine: A multicenter, real-world study in Taiwan. Eur J Neurol. 2024 :e16372 (Jun 5). doi: 10.1111/ene.16372 Source

Key clinical point: Calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) were more effective than onabotulinumtoxinA in patients with chronic migraine (CM), even in those who were difficult-to-treat (DTT) and did not respond to ≥3 preventive treatments.

Major finding: At 6 months, CGRP mAb vs onabotulinumtoxinA significantly reduced monthly migraine days (−13.0 vs −8.7 days/month; P < .001) in overall populations, with a similar reduction observed in those who were DTT (−13.0 vs −9.1 days/month; P < .001). Both treatments were well tolerated, with no treatment discontinuation being observed because of adverse events.

Study details: This multicenter, real-world study included 316 and 333 patients with CM who received ≥1 dose of CGRP mAb and onabotulinumtoxinA, respectively, and of whom 544 were DTT and had failed to respond ≥3 preventive treatments.

Disclosures: This study was funded by Taiwan National Science and Technology Council and others. Three authors declared receiving research grants, personal fees as advisors or speakers, or honoraria as speakers from various sources.

Source: Wang Y-F, Yang F-C, Chen L-A, et al. Comparative effectiveness and tolerability of calcitonin gene-related peptide (CGRP) monoclonal antibodies and onabotulinumtoxinA in chronic migraine: A multicenter, real-world study in Taiwan. Eur J Neurol. 2024 :e16372 (Jun 5). doi: 10.1111/ene.16372 Source

Key clinical point: Patients with migraine who switched one or multiple times among available anti-calcitonin gene-related peptide (CGRP) monoclonal antibody (mAb) treatments showed lower treatment response and higher disease burden than those who adhered to one anti-CGRP mAb treatment.

Major finding: Overall, 73.1% patients did not switch their anti-CGRP mAb, while 20.6% switched once, 5.4% switched twice, and 0.9% switched three or more times. The ≥50% response rate for monthly migraine days was 64.7% in patients who did not switch among anti-CGRP mAb, but it worsened in those who switched once (50.7%) or twice (25.0%) during their last treatment cycle.

Study details: This real-world retrospective study used data from the Neuro TransData registry and included 655 patients with migraine who received at least one anti-CGRP mAb.

Disclosures: The authors did not disclose any source of funding. The authors declared no competing interests.

Source: Hong JB, Israel-Willner H, Peikert A, et al, and the NTD Study Group. Therapeutic patterns and migraine disease burden in switchers of CGRP-targeted monoclonal antibodies — insights from the German NeuroTransData registry. J Headache Pain. 2024;25:90 (Jun 3). doi: 10.1186/s10194-024-01790-7 Source

Key clinical point: Patients with migraine who switched one or multiple times among available anti-calcitonin gene-related peptide (CGRP) monoclonal antibody (mAb) treatments showed lower treatment response and higher disease burden than those who adhered to one anti-CGRP mAb treatment.

Major finding: Overall, 73.1% patients did not switch their anti-CGRP mAb, while 20.6% switched once, 5.4% switched twice, and 0.9% switched three or more times. The ≥50% response rate for monthly migraine days was 64.7% in patients who did not switch among anti-CGRP mAb, but it worsened in those who switched once (50.7%) or twice (25.0%) during their last treatment cycle.

Study details: This real-world retrospective study used data from the Neuro TransData registry and included 655 patients with migraine who received at least one anti-CGRP mAb.

Disclosures: The authors did not disclose any source of funding. The authors declared no competing interests.

Source: Hong JB, Israel-Willner H, Peikert A, et al, and the NTD Study Group. Therapeutic patterns and migraine disease burden in switchers of CGRP-targeted monoclonal antibodies — insights from the German NeuroTransData registry. J Headache Pain. 2024;25:90 (Jun 3). doi: 10.1186/s10194-024-01790-7 Source

Key clinical point: Patients with migraine who switched one or multiple times among available anti-calcitonin gene-related peptide (CGRP) monoclonal antibody (mAb) treatments showed lower treatment response and higher disease burden than those who adhered to one anti-CGRP mAb treatment.

Major finding: Overall, 73.1% patients did not switch their anti-CGRP mAb, while 20.6% switched once, 5.4% switched twice, and 0.9% switched three or more times. The ≥50% response rate for monthly migraine days was 64.7% in patients who did not switch among anti-CGRP mAb, but it worsened in those who switched once (50.7%) or twice (25.0%) during their last treatment cycle.

Study details: This real-world retrospective study used data from the Neuro TransData registry and included 655 patients with migraine who received at least one anti-CGRP mAb.

Disclosures: The authors did not disclose any source of funding. The authors declared no competing interests.

Source: Hong JB, Israel-Willner H, Peikert A, et al, and the NTD Study Group. Therapeutic patterns and migraine disease burden in switchers of CGRP-targeted monoclonal antibodies — insights from the German NeuroTransData registry. J Headache Pain. 2024;25:90 (Jun 3). doi: 10.1186/s10194-024-01790-7 Source

Key clinical point: A meta-analysis of real-world studies provided strong evidence that erenumab was effective and safe in patients with migraine.

Major finding: At 3 months, erenumab significantly reduced monthly migraine days (mean difference [MD] −7.18 days), monthly headache days (MD −6.89 days), headache impact test-6 scores (MD −6.97), medication days (MD −6.22 days), acute monthly intake (MD −15.75), and pain intensity (MD −1.71), and the results were consistent at 6 and 12 months. The proportion change difference of any adverse event was 0.34 and 0.43 at 6 and 12 months, respectively, with constipation being the most common adverse event (0.19 and 0.20 at 6 and 12 months, respectively).

Study details: Findings are from a meta-analysis of 53 real-world studies including 6509 patients with migraine who were treated with erenumab.

Disclosures: This study was funded by the University of Castilla – La Mancha, Spain. The authors declared no conflicts of interest.

Source: Fernández-Bravo-Rodrigo J, Cavero-Redondo I, Lucerón-Lucas-Torres M, et al. Real-world effectiveness and safety of erenumab for the treatment of migraine: A systematic review and meta-analysis. Eur J Pharmacol. 2024;975:176702 (May 31). doi: 10.1016/j.ejphar.2024.17670 Source

Key clinical point: A meta-analysis of real-world studies provided strong evidence that erenumab was effective and safe in patients with migraine.

Major finding: At 3 months, erenumab significantly reduced monthly migraine days (mean difference [MD] −7.18 days), monthly headache days (MD −6.89 days), headache impact test-6 scores (MD −6.97), medication days (MD −6.22 days), acute monthly intake (MD −15.75), and pain intensity (MD −1.71), and the results were consistent at 6 and 12 months. The proportion change difference of any adverse event was 0.34 and 0.43 at 6 and 12 months, respectively, with constipation being the most common adverse event (0.19 and 0.20 at 6 and 12 months, respectively).

Study details: Findings are from a meta-analysis of 53 real-world studies including 6509 patients with migraine who were treated with erenumab.

Disclosures: This study was funded by the University of Castilla – La Mancha, Spain. The authors declared no conflicts of interest.

Source: Fernández-Bravo-Rodrigo J, Cavero-Redondo I, Lucerón-Lucas-Torres M, et al. Real-world effectiveness and safety of erenumab for the treatment of migraine: A systematic review and meta-analysis. Eur J Pharmacol. 2024;975:176702 (May 31). doi: 10.1016/j.ejphar.2024.17670 Source

Key clinical point: A meta-analysis of real-world studies provided strong evidence that erenumab was effective and safe in patients with migraine.

Major finding: At 3 months, erenumab significantly reduced monthly migraine days (mean difference [MD] −7.18 days), monthly headache days (MD −6.89 days), headache impact test-6 scores (MD −6.97), medication days (MD −6.22 days), acute monthly intake (MD −15.75), and pain intensity (MD −1.71), and the results were consistent at 6 and 12 months. The proportion change difference of any adverse event was 0.34 and 0.43 at 6 and 12 months, respectively, with constipation being the most common adverse event (0.19 and 0.20 at 6 and 12 months, respectively).

Study details: Findings are from a meta-analysis of 53 real-world studies including 6509 patients with migraine who were treated with erenumab.

Disclosures: This study was funded by the University of Castilla – La Mancha, Spain. The authors declared no conflicts of interest.

Source: Fernández-Bravo-Rodrigo J, Cavero-Redondo I, Lucerón-Lucas-Torres M, et al. Real-world effectiveness and safety of erenumab for the treatment of migraine: A systematic review and meta-analysis. Eur J Pharmacol. 2024;975:176702 (May 31). doi: 10.1016/j.ejphar.2024.17670 Source

Key clinical point: Migraine, migraine with aura (MA), and migraine without aura (MO) were not associated with a higher risk for atrial fibrillation (AF), with migraine and its subtypes serving as a protective factor for AF in individuals age ≥ 55 years with migraine.

Major finding: No significant association was found between migraine (adjusted hazard ratio [aHR] 0.76; 95% CI 0.48-1.18), MA (aHR 1.00; 95% CI 0.59-1.70), or MO (aHR 0.50; 95% CI 0.23-1.06) and the risk for AF. However, among patients age ≥ 55 years, the risk for AF was significantly lower in those with migraine (aHR 0.53; 95% CI 0.39-0.73), MA (aHR 0.58; 95% CI 0.38-0.87), or MO (aHR 0.48; 95% CI 0.30-0.78) than in those without headache.

Study details: This prospective, population-based 9-year follow-up study included 39,340 individuals (age ≥ 20 years) without AF who answered the headache questionnaire during the Trøndelag Health Study; of these, 1524 (3.8%) developed AF.

Disclosures: This study did not receive any specific funding from any sources. The authors declared no conflicts of interest.

Source: Giri S, Tronvik E, Dalen H, et al. Migraine and risk of atrial fibrillation: A 9-year follow-up based on the Trøndelag Health Study. Cephalalgia. 2024 (May 29). doi: 10.1177/03331024241254517 Source

Key clinical point: Migraine, migraine with aura (MA), and migraine without aura (MO) were not associated with a higher risk for atrial fibrillation (AF), with migraine and its subtypes serving as a protective factor for AF in individuals age ≥ 55 years with migraine.

Major finding: No significant association was found between migraine (adjusted hazard ratio [aHR] 0.76; 95% CI 0.48-1.18), MA (aHR 1.00; 95% CI 0.59-1.70), or MO (aHR 0.50; 95% CI 0.23-1.06) and the risk for AF. However, among patients age ≥ 55 years, the risk for AF was significantly lower in those with migraine (aHR 0.53; 95% CI 0.39-0.73), MA (aHR 0.58; 95% CI 0.38-0.87), or MO (aHR 0.48; 95% CI 0.30-0.78) than in those without headache.

Study details: This prospective, population-based 9-year follow-up study included 39,340 individuals (age ≥ 20 years) without AF who answered the headache questionnaire during the Trøndelag Health Study; of these, 1524 (3.8%) developed AF.

Disclosures: This study did not receive any specific funding from any sources. The authors declared no conflicts of interest.

Source: Giri S, Tronvik E, Dalen H, et al. Migraine and risk of atrial fibrillation: A 9-year follow-up based on the Trøndelag Health Study. Cephalalgia. 2024 (May 29). doi: 10.1177/03331024241254517 Source

Key clinical point: Migraine, migraine with aura (MA), and migraine without aura (MO) were not associated with a higher risk for atrial fibrillation (AF), with migraine and its subtypes serving as a protective factor for AF in individuals age ≥ 55 years with migraine.

Major finding: No significant association was found between migraine (adjusted hazard ratio [aHR] 0.76; 95% CI 0.48-1.18), MA (aHR 1.00; 95% CI 0.59-1.70), or MO (aHR 0.50; 95% CI 0.23-1.06) and the risk for AF. However, among patients age ≥ 55 years, the risk for AF was significantly lower in those with migraine (aHR 0.53; 95% CI 0.39-0.73), MA (aHR 0.58; 95% CI 0.38-0.87), or MO (aHR 0.48; 95% CI 0.30-0.78) than in those without headache.

Study details: This prospective, population-based 9-year follow-up study included 39,340 individuals (age ≥ 20 years) without AF who answered the headache questionnaire during the Trøndelag Health Study; of these, 1524 (3.8%) developed AF.

Disclosures: This study did not receive any specific funding from any sources. The authors declared no conflicts of interest.

Source: Giri S, Tronvik E, Dalen H, et al. Migraine and risk of atrial fibrillation: A 9-year follow-up based on the Trøndelag Health Study. Cephalalgia. 2024 (May 29). doi: 10.1177/03331024241254517 Source

Key clinical point: Anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) were well tolerated and effective in treating high-frequency episodic or chronic migraine, with factors such as unilateral pain, fewer migraine days, and lower disability associated with good and excellent responses to anti-CGRP mAb treatment.

Major finding: At 6 months, 56.5% and 26.7% patients receiving anti-CGRP mAb showed good and excellent responses (≥50% vs ≥75% reduction in monthly headache days), respectively. The presence of unilateral pain, fewer monthly migraine days, and a low Migraine Disability Assessment Score were independent predictors of good (area under the curve [AUC] 0.648; 95% CI 0.616-0.680) and excellent (AUC 0.691; 95% CI 0.651-0.731) responses to anti-CGRP mAb treatment.

Study details: This prospective multicenter real-world study included 4963 patients with high-frequency episodic or chronic migraine who received anti-CGRP mAb treatment with a 6-month follow-up.

Disclosures: This study did not receive specific funding from any sources. Several authors declared receiving speaker honoraria, travel grants, or honoraria from or having other ties with various sources.

Source: Caronna E, Gallardo VJ, Egeo G, et al, for the EUREkA study group. Redefining migraine prevention: Early treatment with anti-CGRP monoclonal antibodies enhances response in the real world. J Neurol Neurosurg Psychiatry. 2024 (May 22). doi: 10.1136/jnnp-2023-333295 Source

Key clinical point: Anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) were well tolerated and effective in treating high-frequency episodic or chronic migraine, with factors such as unilateral pain, fewer migraine days, and lower disability associated with good and excellent responses to anti-CGRP mAb treatment.

Major finding: At 6 months, 56.5% and 26.7% patients receiving anti-CGRP mAb showed good and excellent responses (≥50% vs ≥75% reduction in monthly headache days), respectively. The presence of unilateral pain, fewer monthly migraine days, and a low Migraine Disability Assessment Score were independent predictors of good (area under the curve [AUC] 0.648; 95% CI 0.616-0.680) and excellent (AUC 0.691; 95% CI 0.651-0.731) responses to anti-CGRP mAb treatment.

Study details: This prospective multicenter real-world study included 4963 patients with high-frequency episodic or chronic migraine who received anti-CGRP mAb treatment with a 6-month follow-up.

Disclosures: This study did not receive specific funding from any sources. Several authors declared receiving speaker honoraria, travel grants, or honoraria from or having other ties with various sources.

Source: Caronna E, Gallardo VJ, Egeo G, et al, for the EUREkA study group. Redefining migraine prevention: Early treatment with anti-CGRP monoclonal antibodies enhances response in the real world. J Neurol Neurosurg Psychiatry. 2024 (May 22). doi: 10.1136/jnnp-2023-333295 Source

Key clinical point: Anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) were well tolerated and effective in treating high-frequency episodic or chronic migraine, with factors such as unilateral pain, fewer migraine days, and lower disability associated with good and excellent responses to anti-CGRP mAb treatment.

Major finding: At 6 months, 56.5% and 26.7% patients receiving anti-CGRP mAb showed good and excellent responses (≥50% vs ≥75% reduction in monthly headache days), respectively. The presence of unilateral pain, fewer monthly migraine days, and a low Migraine Disability Assessment Score were independent predictors of good (area under the curve [AUC] 0.648; 95% CI 0.616-0.680) and excellent (AUC 0.691; 95% CI 0.651-0.731) responses to anti-CGRP mAb treatment.

Study details: This prospective multicenter real-world study included 4963 patients with high-frequency episodic or chronic migraine who received anti-CGRP mAb treatment with a 6-month follow-up.

Disclosures: This study did not receive specific funding from any sources. Several authors declared receiving speaker honoraria, travel grants, or honoraria from or having other ties with various sources.

Source: Caronna E, Gallardo VJ, Egeo G, et al, for the EUREkA study group. Redefining migraine prevention: Early treatment with anti-CGRP monoclonal antibodies enhances response in the real world. J Neurol Neurosurg Psychiatry. 2024 (May 22). doi: 10.1136/jnnp-2023-333295 Source

Key clinical point: A high proportion of patients with episodic migraine (EM) who achieved an initial response to atogepant showed a sustained response with continued treatment.

Major finding: In the ADVANCE trial, over 70% of participants who achieved an initial ≥50% response with atogepant during the first month sustained their response over 12 weeks. Similarly, in the long-term safety (LTS) trial, 84.7% of those who achieved an initial ≥50% response with atogepant during the first 12 weeks sustained their response through weeks 24-48.

Study details: Findings are from a post hoc analysis of the ADVANCE trial (n = 659) and open-label LTS trial (n = 521) that included patients with EM who were randomly assigned to receive atogepant or placebo once daily for 12 weeks and atogepant or standard care once daily for 52 weeks, respectively.

Disclosures: The study was funded by AbbVie. Some authors declared being full-time employees of or holding stocks in AbbVie or having other ties with various sources.

Source: Lipton RB, Nahas SJ, Pozo-Rosich P, et al. Sustained response to atogepant in episodic migraine: Post hoc analyses of a 12-week randomized trial and a 52-week long-term safety trial. J Headache Pain. 2024;25:83 (May 21). doi: 10.1186/s10194-024-01783-6 Source

Key clinical point: A high proportion of patients with episodic migraine (EM) who achieved an initial response to atogepant showed a sustained response with continued treatment.

Major finding: In the ADVANCE trial, over 70% of participants who achieved an initial ≥50% response with atogepant during the first month sustained their response over 12 weeks. Similarly, in the long-term safety (LTS) trial, 84.7% of those who achieved an initial ≥50% response with atogepant during the first 12 weeks sustained their response through weeks 24-48.

Study details: Findings are from a post hoc analysis of the ADVANCE trial (n = 659) and open-label LTS trial (n = 521) that included patients with EM who were randomly assigned to receive atogepant or placebo once daily for 12 weeks and atogepant or standard care once daily for 52 weeks, respectively.

Disclosures: The study was funded by AbbVie. Some authors declared being full-time employees of or holding stocks in AbbVie or having other ties with various sources.

Source: Lipton RB, Nahas SJ, Pozo-Rosich P, et al. Sustained response to atogepant in episodic migraine: Post hoc analyses of a 12-week randomized trial and a 52-week long-term safety trial. J Headache Pain. 2024;25:83 (May 21). doi: 10.1186/s10194-024-01783-6 Source

Key clinical point: A high proportion of patients with episodic migraine (EM) who achieved an initial response to atogepant showed a sustained response with continued treatment.

Major finding: In the ADVANCE trial, over 70% of participants who achieved an initial ≥50% response with atogepant during the first month sustained their response over 12 weeks. Similarly, in the long-term safety (LTS) trial, 84.7% of those who achieved an initial ≥50% response with atogepant during the first 12 weeks sustained their response through weeks 24-48.

Study details: Findings are from a post hoc analysis of the ADVANCE trial (n = 659) and open-label LTS trial (n = 521) that included patients with EM who were randomly assigned to receive atogepant or placebo once daily for 12 weeks and atogepant or standard care once daily for 52 weeks, respectively.

Disclosures: The study was funded by AbbVie. Some authors declared being full-time employees of or holding stocks in AbbVie or having other ties with various sources.

Source: Lipton RB, Nahas SJ, Pozo-Rosich P, et al. Sustained response to atogepant in episodic migraine: Post hoc analyses of a 12-week randomized trial and a 52-week long-term safety trial. J Headache Pain. 2024;25:83 (May 21). doi: 10.1186/s10194-024-01783-6 Source

Key clinical point: Long-term treatment with oral rimegepant, taken as needed (PRN) or every other day (EOD) plus PRN on nonscheduled days, reduced the need for analgesics or antiemetics in adults with migraine.

Major finding: The proportion of participants who stopped using analgesics or antiemetics after the pre-treatment observation period increased during weeks 1-4 (36.9%), 5-8 (52.6%), and 9-12 (56.5%) following rimegepant treatment in both PRN and PRN plus EOD cohorts.

Study details: This post hoc analysis of an open-label study included 1800 adults with migraine who received rimegepant PRN (n = 1514) or EOD plus PRN (n = 286) for 3 months according to the frequency of attacks, and of whom 80.1% used analgesics or antiemetics during the 30-day pre-treatment observation period.

Disclosures: This study was funded by Biohaven (acquired by Pfizer in October 2022). Terence Fullerton and Glenn Pixton declared being full-time employees of and holding stocks or options in Pfizer, and Glenn Pixton also declared holding stocks in Abbvie.

Source: Fullerton T, Pixton G. Long-term use of rimegepant 75 mg for the acute treatment of migraine is associated with a reduction in the utilization of select analgesics and antiemetics. J Pain Res. 2024;17:1751-1760 (May 2). doi: 10.2147/JPR.S456006 Source

Key clinical point: Long-term treatment with oral rimegepant, taken as needed (PRN) or every other day (EOD) plus PRN on nonscheduled days, reduced the need for analgesics or antiemetics in adults with migraine.

Major finding: The proportion of participants who stopped using analgesics or antiemetics after the pre-treatment observation period increased during weeks 1-4 (36.9%), 5-8 (52.6%), and 9-12 (56.5%) following rimegepant treatment in both PRN and PRN plus EOD cohorts.

Study details: This post hoc analysis of an open-label study included 1800 adults with migraine who received rimegepant PRN (n = 1514) or EOD plus PRN (n = 286) for 3 months according to the frequency of attacks, and of whom 80.1% used analgesics or antiemetics during the 30-day pre-treatment observation period.

Disclosures: This study was funded by Biohaven (acquired by Pfizer in October 2022). Terence Fullerton and Glenn Pixton declared being full-time employees of and holding stocks or options in Pfizer, and Glenn Pixton also declared holding stocks in Abbvie.

Source: Fullerton T, Pixton G. Long-term use of rimegepant 75 mg for the acute treatment of migraine is associated with a reduction in the utilization of select analgesics and antiemetics. J Pain Res. 2024;17:1751-1760 (May 2). doi: 10.2147/JPR.S456006 Source

Key clinical point: Long-term treatment with oral rimegepant, taken as needed (PRN) or every other day (EOD) plus PRN on nonscheduled days, reduced the need for analgesics or antiemetics in adults with migraine.

Major finding: The proportion of participants who stopped using analgesics or antiemetics after the pre-treatment observation period increased during weeks 1-4 (36.9%), 5-8 (52.6%), and 9-12 (56.5%) following rimegepant treatment in both PRN and PRN plus EOD cohorts.

Study details: This post hoc analysis of an open-label study included 1800 adults with migraine who received rimegepant PRN (n = 1514) or EOD plus PRN (n = 286) for 3 months according to the frequency of attacks, and of whom 80.1% used analgesics or antiemetics during the 30-day pre-treatment observation period.

Disclosures: This study was funded by Biohaven (acquired by Pfizer in October 2022). Terence Fullerton and Glenn Pixton declared being full-time employees of and holding stocks or options in Pfizer, and Glenn Pixton also declared holding stocks in Abbvie.

Source: Fullerton T, Pixton G. Long-term use of rimegepant 75 mg for the acute treatment of migraine is associated with a reduction in the utilization of select analgesics and antiemetics. J Pain Res. 2024;17:1751-1760 (May 2). doi: 10.2147/JPR.S456006 Source

Key clinical point: Adherence to an ideal healthy lifestyle and improvement in cardiovascular health (CVH) scores were associated with a significantly lower risk for new-onset migraine.

Major finding: Compared with participants in the poor category of healthy lifestyle index, those in the ideal (adjusted hazard ratio [aHR] 0.81; P < .001) or intermediate (aHR 0.91; P = .035) category had a significantly reduced risk for new-onset migraine. Similarly, participants with high CVH scores had a significantly lower risk for new-onset migraine than those with low CVH scores (aHR 0.73; P = .011).

Study details: This study evaluated the association between healthy lifestyle scores, CVH scores, and migraine in 332,895 participants without migraine (age 37-73 years) from the UK Biobank.

Disclosures: This study was funded by the Interdisciplinary Innovative Talents Foundation of Renmin Hospital at Wuhan University, China, Research on Degree and Graduate Education Teaching Reform at Wuhan University, and others. The authors declared no conflicts of interest.

Source: Lei Y, Zhang L, Shan Z, et al. Poor healthy lifestyle and life's essential 8 are associated with higher risk of new-onset migraine: A prospective cohort study. J Headache Pain. 2024;25:82 (May 17). doi: s10194-024-01785-4 Source

Key clinical point: Adherence to an ideal healthy lifestyle and improvement in cardiovascular health (CVH) scores were associated with a significantly lower risk for new-onset migraine.

Major finding: Compared with participants in the poor category of healthy lifestyle index, those in the ideal (adjusted hazard ratio [aHR] 0.81; P < .001) or intermediate (aHR 0.91; P = .035) category had a significantly reduced risk for new-onset migraine. Similarly, participants with high CVH scores had a significantly lower risk for new-onset migraine than those with low CVH scores (aHR 0.73; P = .011).

Study details: This study evaluated the association between healthy lifestyle scores, CVH scores, and migraine in 332,895 participants without migraine (age 37-73 years) from the UK Biobank.

Disclosures: This study was funded by the Interdisciplinary Innovative Talents Foundation of Renmin Hospital at Wuhan University, China, Research on Degree and Graduate Education Teaching Reform at Wuhan University, and others. The authors declared no conflicts of interest.

Source: Lei Y, Zhang L, Shan Z, et al. Poor healthy lifestyle and life's essential 8 are associated with higher risk of new-onset migraine: A prospective cohort study. J Headache Pain. 2024;25:82 (May 17). doi: s10194-024-01785-4 Source

Key clinical point: Adherence to an ideal healthy lifestyle and improvement in cardiovascular health (CVH) scores were associated with a significantly lower risk for new-onset migraine.

Major finding: Compared with participants in the poor category of healthy lifestyle index, those in the ideal (adjusted hazard ratio [aHR] 0.81; P < .001) or intermediate (aHR 0.91; P = .035) category had a significantly reduced risk for new-onset migraine. Similarly, participants with high CVH scores had a significantly lower risk for new-onset migraine than those with low CVH scores (aHR 0.73; P = .011).

Study details: This study evaluated the association between healthy lifestyle scores, CVH scores, and migraine in 332,895 participants without migraine (age 37-73 years) from the UK Biobank.

Disclosures: This study was funded by the Interdisciplinary Innovative Talents Foundation of Renmin Hospital at Wuhan University, China, Research on Degree and Graduate Education Teaching Reform at Wuhan University, and others. The authors declared no conflicts of interest.

Source: Lei Y, Zhang L, Shan Z, et al. Poor healthy lifestyle and life's essential 8 are associated with higher risk of new-onset migraine: A prospective cohort study. J Headache Pain. 2024;25:82 (May 17). doi: s10194-024-01785-4 Source

Key clinical point: Eptinezumab demonstrated favorable efficacy and tolerability in patients with episodic or chronic migraine resistant to conventional preventive treatments, but its efficacy was compromised in those resistant to calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb).

Major finding: After 3 months of eptinezumab treatment, patients with migraine experienced a reduction in monthly headache days (MHD; −4 days), monthly migraine days (−3 days), and acute medication days (−2 days; P < .001 for all). The 30% responder rates decreased with increase in the number of prior CGRP mAb therapies (none 78.6%; one 45.0%; two 32.1%; three 23.5%; P = .010). Overall, 10.4% of patients reported mild side effects.

Study details: This retrospective real-world analysis included 79 patients with episodic or chronic migraine, of whom 14 had never received anti-CGRP mAb and 65 received anti-CGRP mAb without sufficient effectiveness and with intolerability.

Disclosures: Open access for this study was funded by Projekt DEAL. Some authors declared receiving honoraria, personal fees, travel fees, scientific support, or financial support from or having other ties with various sources.

Source: Scheffler A, Wenzel P, Bendig M, et al. Effectiveness and tolerability of eptinezumab in treating patients with migraine resistant to conventional preventive medications and CGRP (receptor) antibodies: A multicentre retrospective real-world analysis from Germany. J Headache Pain. 2024;25:79 (May 16). doi: 10.1186/s10194-024-01788-1 Source

Key clinical point: Eptinezumab demonstrated favorable efficacy and tolerability in patients with episodic or chronic migraine resistant to conventional preventive treatments, but its efficacy was compromised in those resistant to calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb).

Major finding: After 3 months of eptinezumab treatment, patients with migraine experienced a reduction in monthly headache days (MHD; −4 days), monthly migraine days (−3 days), and acute medication days (−2 days; P < .001 for all). The 30% responder rates decreased with increase in the number of prior CGRP mAb therapies (none 78.6%; one 45.0%; two 32.1%; three 23.5%; P = .010). Overall, 10.4% of patients reported mild side effects.

Study details: This retrospective real-world analysis included 79 patients with episodic or chronic migraine, of whom 14 had never received anti-CGRP mAb and 65 received anti-CGRP mAb without sufficient effectiveness and with intolerability.

Disclosures: Open access for this study was funded by Projekt DEAL. Some authors declared receiving honoraria, personal fees, travel fees, scientific support, or financial support from or having other ties with various sources.

Source: Scheffler A, Wenzel P, Bendig M, et al. Effectiveness and tolerability of eptinezumab in treating patients with migraine resistant to conventional preventive medications and CGRP (receptor) antibodies: A multicentre retrospective real-world analysis from Germany. J Headache Pain. 2024;25:79 (May 16). doi: 10.1186/s10194-024-01788-1 Source

Key clinical point: Eptinezumab demonstrated favorable efficacy and tolerability in patients with episodic or chronic migraine resistant to conventional preventive treatments, but its efficacy was compromised in those resistant to calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb).

Major finding: After 3 months of eptinezumab treatment, patients with migraine experienced a reduction in monthly headache days (MHD; −4 days), monthly migraine days (−3 days), and acute medication days (−2 days; P < .001 for all). The 30% responder rates decreased with increase in the number of prior CGRP mAb therapies (none 78.6%; one 45.0%; two 32.1%; three 23.5%; P = .010). Overall, 10.4% of patients reported mild side effects.

Study details: This retrospective real-world analysis included 79 patients with episodic or chronic migraine, of whom 14 had never received anti-CGRP mAb and 65 received anti-CGRP mAb without sufficient effectiveness and with intolerability.

Disclosures: Open access for this study was funded by Projekt DEAL. Some authors declared receiving honoraria, personal fees, travel fees, scientific support, or financial support from or having other ties with various sources.

Source: Scheffler A, Wenzel P, Bendig M, et al. Effectiveness and tolerability of eptinezumab in treating patients with migraine resistant to conventional preventive medications and CGRP (receptor) antibodies: A multicentre retrospective real-world analysis from Germany. J Headache Pain. 2024;25:79 (May 16). doi: 10.1186/s10194-024-01788-1 Source

SAN DIEGO — Cognitive impairment, or “brain fog,” is a well-known effect of active migraines, but evidence is mounting that it is also common during interictal periods.

In fact, these effects may appear in the prodromal phase and carry through the headache and into the post-headache period, according to Richard Lipton, MD, who spoke about cognition and migraine at the annual meeting of the American Headache Society.

Lipton_Richard_NY_web2.JPG

He pointed out existing evidence that migraine patients have cognitive impairment relative to the general population even during the interictal period. Such studies suggest that migraine, especially with aura, could be a risk factor for later dementia.

One important limitation of studies that compare people with migraines with controls is that a range of factors could explain an association between lower cognitive function and migraines, including socioeconomic factors, education, severe headaches requiring specialty care, and comorbidities, among others. Acute and preventative treatments could also affect cognition.

However, longitudinal studies of cognitive function in individual patients have been sparse. Questions remain, like whether cognitive performance differs between the headache period and the interictal period, as well as similar questions about the premonitory and post-drome phases. “And then there’s a long-term question: Do people with migraine show more interictal or ictal decline in cognitive performance relative to migraine-free controls?” said Dr. Lipton, professor of neurology at Albert Einstein College of Medicine in the Bronx, New York.

He showed evidence from a retrospective study by Lundbeck conducted at four sites that asked patients with chronic migraine about bothersome symptoms both before and after treatment. More than three-fourths (77.7%) rated “difficulty concentrating or thinking clearly” as a bothersome symptom.

Following treatment, 5.0% said their cognitive issues had completely improved, 32.0% that they were “very much” improved, 26.0% moderately improved, 23.0% slightly improved, and 14.0% not at all improved.

“I am not saying this is a rigorous study, but I am saying that it illustrates two points that are important for us today: One is that brain fog is very common in a subspecialty care sample of headache patients like the ones many of us treat, and it also suggests that there’s hope that treatment can improve cognitive impairment as migraine gets better,” said Dr. Lipton.

Cognition has received less attention than other migraine symptoms, and treatment can be a two-edged sword: “There’s some evidence that some treatments can reduce cognitive impairment, and obvious evidence that some treatments, topiramate and tricyclics, can induce cognitive impairment,” said Dr. Lipton.

Studies that compare cognition within the same patient at different time periods can get around some of the limitations of comparisons between populations, but face their own challenges. “Single shot” cognitive measures may not be reliably repeatable and differences seen on “good” versus “bad” days or proximity to recent headaches.

The solution, Dr. Lipton believes, is intensive repeated measures that avoid the practice effect, in which a participant improves at a test due to repetition.

He summarized a study that was presented later in the day at a poster session, which used smartphones or other devices to test 19 participants five times per day, over 5 days, in natural environments. Devices gathered both subjective and objective assessments of cognition, along with information on mood, stress, and status and fluctuations in pain, and have the potential to go further by measuring things like physical exertion, heart rate, pollution levels, and other variables.

“It clearly improves the reliability and the validity of cognitive assessment and makes it possible to link cognition to the stage of the headache cycle,” said Dr. Lipton.

The researchers found worse cognitive performance during the headache phase as compared with the interictal phase. “Objective cognitive performance measurably declines during the headache phase, and the next step is to fully control for acute medications that people may take during the headache phase,” said Dr. Lipton.

He expressed hope that improved measurements can improve outcomes, if it’s possible to identify therapies that don’t impact cognition. “We think it’s very likely that certain classes of acute and preventive medications may not cause cognitive impairment, and there is a strong hope that they may actually reduce the cognitive burden of disease and potentially even reduce cognitive decline. Those are areas that I’m very excited to explore in the future,” said Dr. Lipton.

The results emphasize the need to treat patients early, according to Nada Hindiyeh, MD, who attended the session and was asked for comment. “Generally, patients are going to come to you with episodic migraines. When migraines start to increase in frequency and severity, that means all of these other symptoms are going to come along with it and be increased in frequency and severity, so it’s important to recognize this early so you can get patients on the right treatments and preventives to really prevent these episodes from happening and prevent that cognitive decline,” said Dr. Hindiyeh, director of headache neurology at Metrodora Institute, West Valley City, Utah.

Dr. Lipton has financial relationships with Aeon, AbbVie/Allergan, Amgen, Biohaven, Dr. Reddy’s Laboratories, electroCore, Eli Lilly, GlaxoSmithKline, Lundbeck, Merck, Novartis, Pfizer, Teva, Axon, CoolTech, and Manistee. Dr. Hindiyeh has no relevant financial disclosures.

SAN DIEGO — Cognitive impairment, or “brain fog,” is a well-known effect of active migraines, but evidence is mounting that it is also common during interictal periods.

In fact, these effects may appear in the prodromal phase and carry through the headache and into the post-headache period, according to Richard Lipton, MD, who spoke about cognition and migraine at the annual meeting of the American Headache Society.

Lipton_Richard_NY_web2.JPG

He pointed out existing evidence that migraine patients have cognitive impairment relative to the general population even during the interictal period. Such studies suggest that migraine, especially with aura, could be a risk factor for later dementia.

One important limitation of studies that compare people with migraines with controls is that a range of factors could explain an association between lower cognitive function and migraines, including socioeconomic factors, education, severe headaches requiring specialty care, and comorbidities, among others. Acute and preventative treatments could also affect cognition.

However, longitudinal studies of cognitive function in individual patients have been sparse. Questions remain, like whether cognitive performance differs between the headache period and the interictal period, as well as similar questions about the premonitory and post-drome phases. “And then there’s a long-term question: Do people with migraine show more interictal or ictal decline in cognitive performance relative to migraine-free controls?” said Dr. Lipton, professor of neurology at Albert Einstein College of Medicine in the Bronx, New York.

He showed evidence from a retrospective study by Lundbeck conducted at four sites that asked patients with chronic migraine about bothersome symptoms both before and after treatment. More than three-fourths (77.7%) rated “difficulty concentrating or thinking clearly” as a bothersome symptom.

Following treatment, 5.0% said their cognitive issues had completely improved, 32.0% that they were “very much” improved, 26.0% moderately improved, 23.0% slightly improved, and 14.0% not at all improved.

“I am not saying this is a rigorous study, but I am saying that it illustrates two points that are important for us today: One is that brain fog is very common in a subspecialty care sample of headache patients like the ones many of us treat, and it also suggests that there’s hope that treatment can improve cognitive impairment as migraine gets better,” said Dr. Lipton.

Cognition has received less attention than other migraine symptoms, and treatment can be a two-edged sword: “There’s some evidence that some treatments can reduce cognitive impairment, and obvious evidence that some treatments, topiramate and tricyclics, can induce cognitive impairment,” said Dr. Lipton.

Studies that compare cognition within the same patient at different time periods can get around some of the limitations of comparisons between populations, but face their own challenges. “Single shot” cognitive measures may not be reliably repeatable and differences seen on “good” versus “bad” days or proximity to recent headaches.

The solution, Dr. Lipton believes, is intensive repeated measures that avoid the practice effect, in which a participant improves at a test due to repetition.

He summarized a study that was presented later in the day at a poster session, which used smartphones or other devices to test 19 participants five times per day, over 5 days, in natural environments. Devices gathered both subjective and objective assessments of cognition, along with information on mood, stress, and status and fluctuations in pain, and have the potential to go further by measuring things like physical exertion, heart rate, pollution levels, and other variables.

“It clearly improves the reliability and the validity of cognitive assessment and makes it possible to link cognition to the stage of the headache cycle,” said Dr. Lipton.

The researchers found worse cognitive performance during the headache phase as compared with the interictal phase. “Objective cognitive performance measurably declines during the headache phase, and the next step is to fully control for acute medications that people may take during the headache phase,” said Dr. Lipton.

He expressed hope that improved measurements can improve outcomes, if it’s possible to identify therapies that don’t impact cognition. “We think it’s very likely that certain classes of acute and preventive medications may not cause cognitive impairment, and there is a strong hope that they may actually reduce the cognitive burden of disease and potentially even reduce cognitive decline. Those are areas that I’m very excited to explore in the future,” said Dr. Lipton.

The results emphasize the need to treat patients early, according to Nada Hindiyeh, MD, who attended the session and was asked for comment. “Generally, patients are going to come to you with episodic migraines. When migraines start to increase in frequency and severity, that means all of these other symptoms are going to come along with it and be increased in frequency and severity, so it’s important to recognize this early so you can get patients on the right treatments and preventives to really prevent these episodes from happening and prevent that cognitive decline,” said Dr. Hindiyeh, director of headache neurology at Metrodora Institute, West Valley City, Utah.

Dr. Lipton has financial relationships with Aeon, AbbVie/Allergan, Amgen, Biohaven, Dr. Reddy’s Laboratories, electroCore, Eli Lilly, GlaxoSmithKline, Lundbeck, Merck, Novartis, Pfizer, Teva, Axon, CoolTech, and Manistee. Dr. Hindiyeh has no relevant financial disclosures.

SAN DIEGO — Cognitive impairment, or “brain fog,” is a well-known effect of active migraines, but evidence is mounting that it is also common during interictal periods.

In fact, these effects may appear in the prodromal phase and carry through the headache and into the post-headache period, according to Richard Lipton, MD, who spoke about cognition and migraine at the annual meeting of the American Headache Society.

Lipton_Richard_NY_web2.JPG

He pointed out existing evidence that migraine patients have cognitive impairment relative to the general population even during the interictal period. Such studies suggest that migraine, especially with aura, could be a risk factor for later dementia.

One important limitation of studies that compare people with migraines with controls is that a range of factors could explain an association between lower cognitive function and migraines, including socioeconomic factors, education, severe headaches requiring specialty care, and comorbidities, among others. Acute and preventative treatments could also affect cognition.

However, longitudinal studies of cognitive function in individual patients have been sparse. Questions remain, like whether cognitive performance differs between the headache period and the interictal period, as well as similar questions about the premonitory and post-drome phases. “And then there’s a long-term question: Do people with migraine show more interictal or ictal decline in cognitive performance relative to migraine-free controls?” said Dr. Lipton, professor of neurology at Albert Einstein College of Medicine in the Bronx, New York.

He showed evidence from a retrospective study by Lundbeck conducted at four sites that asked patients with chronic migraine about bothersome symptoms both before and after treatment. More than three-fourths (77.7%) rated “difficulty concentrating or thinking clearly” as a bothersome symptom.

Following treatment, 5.0% said their cognitive issues had completely improved, 32.0% that they were “very much” improved, 26.0% moderately improved, 23.0% slightly improved, and 14.0% not at all improved.

“I am not saying this is a rigorous study, but I am saying that it illustrates two points that are important for us today: One is that brain fog is very common in a subspecialty care sample of headache patients like the ones many of us treat, and it also suggests that there’s hope that treatment can improve cognitive impairment as migraine gets better,” said Dr. Lipton.

Cognition has received less attention than other migraine symptoms, and treatment can be a two-edged sword: “There’s some evidence that some treatments can reduce cognitive impairment, and obvious evidence that some treatments, topiramate and tricyclics, can induce cognitive impairment,” said Dr. Lipton.

Studies that compare cognition within the same patient at different time periods can get around some of the limitations of comparisons between populations, but face their own challenges. “Single shot” cognitive measures may not be reliably repeatable and differences seen on “good” versus “bad” days or proximity to recent headaches.

The solution, Dr. Lipton believes, is intensive repeated measures that avoid the practice effect, in which a participant improves at a test due to repetition.

He summarized a study that was presented later in the day at a poster session, which used smartphones or other devices to test 19 participants five times per day, over 5 days, in natural environments. Devices gathered both subjective and objective assessments of cognition, along with information on mood, stress, and status and fluctuations in pain, and have the potential to go further by measuring things like physical exertion, heart rate, pollution levels, and other variables.

“It clearly improves the reliability and the validity of cognitive assessment and makes it possible to link cognition to the stage of the headache cycle,” said Dr. Lipton.

The researchers found worse cognitive performance during the headache phase as compared with the interictal phase. “Objective cognitive performance measurably declines during the headache phase, and the next step is to fully control for acute medications that people may take during the headache phase,” said Dr. Lipton.

He expressed hope that improved measurements can improve outcomes, if it’s possible to identify therapies that don’t impact cognition. “We think it’s very likely that certain classes of acute and preventive medications may not cause cognitive impairment, and there is a strong hope that they may actually reduce the cognitive burden of disease and potentially even reduce cognitive decline. Those are areas that I’m very excited to explore in the future,” said Dr. Lipton.

The results emphasize the need to treat patients early, according to Nada Hindiyeh, MD, who attended the session and was asked for comment. “Generally, patients are going to come to you with episodic migraines. When migraines start to increase in frequency and severity, that means all of these other symptoms are going to come along with it and be increased in frequency and severity, so it’s important to recognize this early so you can get patients on the right treatments and preventives to really prevent these episodes from happening and prevent that cognitive decline,” said Dr. Hindiyeh, director of headache neurology at Metrodora Institute, West Valley City, Utah.

Dr. Lipton has financial relationships with Aeon, AbbVie/Allergan, Amgen, Biohaven, Dr. Reddy’s Laboratories, electroCore, Eli Lilly, GlaxoSmithKline, Lundbeck, Merck, Novartis, Pfizer, Teva, Axon, CoolTech, and Manistee. Dr. Hindiyeh has no relevant financial disclosures.