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Nummular Headache Linked to Range of Secondary Causes
A rare coin-shaped headache long viewed as a primary headache disorder frequently has underlying causes, according to new research, and clinicians should refer people who present with it for imaging.
First described in 2003, nummular or coin-shaped headache comprises an intermittent or constant pain limited to a rounded region between 1 and 6 cm in diameter. Classed as a primary headache by the International Classification of Headache Disorders (ICHD-3), it usually occurs in the parietal, or top rear, region of the head.
Now, a group of Spanish researchers has revised 20 years’ worth of cases, representing the largest series to date, and found a wide variety of causes, some of which, they say, had not been reported before in connection to this headache type.
For their research, published online in Headache, Antonio Sánchez-Soblechero, MD, and colleagues at the University Hospital Gregorio Marañón in Madrid, Spain, looked at clinical and imaging findings from 131 patients (67% women, median age at onset 52) seen from 2002 to 2022 at their center, seeking to identify any differences among primary and secondary or symptomatic coin-shaped headache cases. All patients underwent cranial MRI, CT, or both.
Altogether, 26% of the nummular headaches (n = 34) were found associated with trauma, vascular malformations, cranial bone disorders, neoplasia, arachnoid cysts, hypertension, aneurysm, or skin disorders including, in one case, a psoriasis plaque. Hypertension, aneurysm, and psoriasis were not previously described as causes of this headache, the authors said.
The definition of a nummular headache includes that secondary causes need to be excluded, according to the ICHD-3. The study authors proposed that “definite” secondary cases should meet ICHD-3 diagnostic criteria for nummular headache as well as for secondary headache, while “probable” cases meet all criteria for the former and all but one of the criteria for the latter. In their study, eight patients met the proposed criteria for “definite,” while the rest were deemed “probable” secondary cases.
Headache symptoms remained similar regardless of etiology, Sánchez-Soblechero and colleagues found, but coin-shaped headaches deemed to have secondary etiologies were significantly more likely to be associated with previous headache, remote head trauma, and longer symptom duration. The authors described treatments, including surgical interventions, for cases with secondary causes.
Preventive treatment was more effective in patients with determined causes for their headaches, Sánchez-Soblechero and colleagues found, with 72% seeing their monthly headache days halved, compared with just 30% of patients in whom a cause was not identified.
“The presence of any previous headache or remote head trauma may suggest a diagnosis of symptomatic nummular headache; however, as certain nummular headache might be an early symptom of intracranial mass lesions, neuroimaging is necessary. Finding the cause of nummular headache is essential to offer the most effective targeted treatment,” the investigators wrote in their analysis.
Primary Headache or Secondary?
In an interview, neurologist and headache specialist Nina Riggins, MD, PhD, of VA Palo Alto Health Care in California, praised the new findings as underscoring the importance of a thorough clinical approach.
“What this study shows is applicable to many primary headache disorders, whether migraine or cluster or nummular,” Riggins said. “Secondary headache can look like all of these headache types.”
Understanding what should be done to rule out secondary causes of headache is key for the correct diagnosis, she said. “In cases of coin-shaped headache, one should do a detailed neurological exam, consider imaging, check blood pressure, do blood work, and consider exams to exclude autoimmune psoriasis and other disorders as appropriate.”
Despite the inherent limits of its retrospective, single-center design, the study by Sánchez-Soblechero and colleagues is “extremely helpful in emphasizing that we should not dismiss [nummular headache] because it’s a little area of 1-6 centimeters,” Riggins said. “We absolutely have to make sure that we have ruled out secondary causes.” And while it would be useful to have evidence from prospective studies of nummular headache, “with such a rare headache, it’s hard. That’s why it’s so precious to have a study like this one, with 131 patients.”
Riggins acknowledged that the study emphasized the challenges of classifying and diagnosing nummular headache. The ICHD, last revised in 2018, “is a living, breathing document,” she said. “The idea is that as we learn more about headache disorders over time, this may mean changing some primary headaches to secondary, but we are clearly not there with this research: Most participants did not have a secondary cause for their coin-shaped headache.”
For now, Riggins said, “I think it’s best to keep classification straightforward for primary and secondary headache. It’s helpful for my day-to-day clinic life to have this neat division in place. But we do have to exclude secondary headache whenever possible in order to say that this is primary headache.”
Sánchez-Soblechero and coauthors disclosed no financial conflicts of interest related to their findings. Riggins disclosed consulting work for Gerson Lehrman Group, receiving research support from electroCore, Theranica, and Eli Lilly, and serving on advisory boards for Theranica, Teva Pharmaceuticals, Lundbeck, and Amneal Pharmaceuticals.
A version of this article appeared on Medscape.com.
A rare coin-shaped headache long viewed as a primary headache disorder frequently has underlying causes, according to new research, and clinicians should refer people who present with it for imaging.
First described in 2003, nummular or coin-shaped headache comprises an intermittent or constant pain limited to a rounded region between 1 and 6 cm in diameter. Classed as a primary headache by the International Classification of Headache Disorders (ICHD-3), it usually occurs in the parietal, or top rear, region of the head.
Now, a group of Spanish researchers has revised 20 years’ worth of cases, representing the largest series to date, and found a wide variety of causes, some of which, they say, had not been reported before in connection to this headache type.
For their research, published online in Headache, Antonio Sánchez-Soblechero, MD, and colleagues at the University Hospital Gregorio Marañón in Madrid, Spain, looked at clinical and imaging findings from 131 patients (67% women, median age at onset 52) seen from 2002 to 2022 at their center, seeking to identify any differences among primary and secondary or symptomatic coin-shaped headache cases. All patients underwent cranial MRI, CT, or both.
Altogether, 26% of the nummular headaches (n = 34) were found associated with trauma, vascular malformations, cranial bone disorders, neoplasia, arachnoid cysts, hypertension, aneurysm, or skin disorders including, in one case, a psoriasis plaque. Hypertension, aneurysm, and psoriasis were not previously described as causes of this headache, the authors said.
The definition of a nummular headache includes that secondary causes need to be excluded, according to the ICHD-3. The study authors proposed that “definite” secondary cases should meet ICHD-3 diagnostic criteria for nummular headache as well as for secondary headache, while “probable” cases meet all criteria for the former and all but one of the criteria for the latter. In their study, eight patients met the proposed criteria for “definite,” while the rest were deemed “probable” secondary cases.
Headache symptoms remained similar regardless of etiology, Sánchez-Soblechero and colleagues found, but coin-shaped headaches deemed to have secondary etiologies were significantly more likely to be associated with previous headache, remote head trauma, and longer symptom duration. The authors described treatments, including surgical interventions, for cases with secondary causes.
Preventive treatment was more effective in patients with determined causes for their headaches, Sánchez-Soblechero and colleagues found, with 72% seeing their monthly headache days halved, compared with just 30% of patients in whom a cause was not identified.
“The presence of any previous headache or remote head trauma may suggest a diagnosis of symptomatic nummular headache; however, as certain nummular headache might be an early symptom of intracranial mass lesions, neuroimaging is necessary. Finding the cause of nummular headache is essential to offer the most effective targeted treatment,” the investigators wrote in their analysis.
Primary Headache or Secondary?
In an interview, neurologist and headache specialist Nina Riggins, MD, PhD, of VA Palo Alto Health Care in California, praised the new findings as underscoring the importance of a thorough clinical approach.
“What this study shows is applicable to many primary headache disorders, whether migraine or cluster or nummular,” Riggins said. “Secondary headache can look like all of these headache types.”
Understanding what should be done to rule out secondary causes of headache is key for the correct diagnosis, she said. “In cases of coin-shaped headache, one should do a detailed neurological exam, consider imaging, check blood pressure, do blood work, and consider exams to exclude autoimmune psoriasis and other disorders as appropriate.”
Despite the inherent limits of its retrospective, single-center design, the study by Sánchez-Soblechero and colleagues is “extremely helpful in emphasizing that we should not dismiss [nummular headache] because it’s a little area of 1-6 centimeters,” Riggins said. “We absolutely have to make sure that we have ruled out secondary causes.” And while it would be useful to have evidence from prospective studies of nummular headache, “with such a rare headache, it’s hard. That’s why it’s so precious to have a study like this one, with 131 patients.”
Riggins acknowledged that the study emphasized the challenges of classifying and diagnosing nummular headache. The ICHD, last revised in 2018, “is a living, breathing document,” she said. “The idea is that as we learn more about headache disorders over time, this may mean changing some primary headaches to secondary, but we are clearly not there with this research: Most participants did not have a secondary cause for their coin-shaped headache.”
For now, Riggins said, “I think it’s best to keep classification straightforward for primary and secondary headache. It’s helpful for my day-to-day clinic life to have this neat division in place. But we do have to exclude secondary headache whenever possible in order to say that this is primary headache.”
Sánchez-Soblechero and coauthors disclosed no financial conflicts of interest related to their findings. Riggins disclosed consulting work for Gerson Lehrman Group, receiving research support from electroCore, Theranica, and Eli Lilly, and serving on advisory boards for Theranica, Teva Pharmaceuticals, Lundbeck, and Amneal Pharmaceuticals.
A version of this article appeared on Medscape.com.
A rare coin-shaped headache long viewed as a primary headache disorder frequently has underlying causes, according to new research, and clinicians should refer people who present with it for imaging.
First described in 2003, nummular or coin-shaped headache comprises an intermittent or constant pain limited to a rounded region between 1 and 6 cm in diameter. Classed as a primary headache by the International Classification of Headache Disorders (ICHD-3), it usually occurs in the parietal, or top rear, region of the head.
Now, a group of Spanish researchers has revised 20 years’ worth of cases, representing the largest series to date, and found a wide variety of causes, some of which, they say, had not been reported before in connection to this headache type.
For their research, published online in Headache, Antonio Sánchez-Soblechero, MD, and colleagues at the University Hospital Gregorio Marañón in Madrid, Spain, looked at clinical and imaging findings from 131 patients (67% women, median age at onset 52) seen from 2002 to 2022 at their center, seeking to identify any differences among primary and secondary or symptomatic coin-shaped headache cases. All patients underwent cranial MRI, CT, or both.
Altogether, 26% of the nummular headaches (n = 34) were found associated with trauma, vascular malformations, cranial bone disorders, neoplasia, arachnoid cysts, hypertension, aneurysm, or skin disorders including, in one case, a psoriasis plaque. Hypertension, aneurysm, and psoriasis were not previously described as causes of this headache, the authors said.
The definition of a nummular headache includes that secondary causes need to be excluded, according to the ICHD-3. The study authors proposed that “definite” secondary cases should meet ICHD-3 diagnostic criteria for nummular headache as well as for secondary headache, while “probable” cases meet all criteria for the former and all but one of the criteria for the latter. In their study, eight patients met the proposed criteria for “definite,” while the rest were deemed “probable” secondary cases.
Headache symptoms remained similar regardless of etiology, Sánchez-Soblechero and colleagues found, but coin-shaped headaches deemed to have secondary etiologies were significantly more likely to be associated with previous headache, remote head trauma, and longer symptom duration. The authors described treatments, including surgical interventions, for cases with secondary causes.
Preventive treatment was more effective in patients with determined causes for their headaches, Sánchez-Soblechero and colleagues found, with 72% seeing their monthly headache days halved, compared with just 30% of patients in whom a cause was not identified.
“The presence of any previous headache or remote head trauma may suggest a diagnosis of symptomatic nummular headache; however, as certain nummular headache might be an early symptom of intracranial mass lesions, neuroimaging is necessary. Finding the cause of nummular headache is essential to offer the most effective targeted treatment,” the investigators wrote in their analysis.
Primary Headache or Secondary?
In an interview, neurologist and headache specialist Nina Riggins, MD, PhD, of VA Palo Alto Health Care in California, praised the new findings as underscoring the importance of a thorough clinical approach.
“What this study shows is applicable to many primary headache disorders, whether migraine or cluster or nummular,” Riggins said. “Secondary headache can look like all of these headache types.”
Understanding what should be done to rule out secondary causes of headache is key for the correct diagnosis, she said. “In cases of coin-shaped headache, one should do a detailed neurological exam, consider imaging, check blood pressure, do blood work, and consider exams to exclude autoimmune psoriasis and other disorders as appropriate.”
Despite the inherent limits of its retrospective, single-center design, the study by Sánchez-Soblechero and colleagues is “extremely helpful in emphasizing that we should not dismiss [nummular headache] because it’s a little area of 1-6 centimeters,” Riggins said. “We absolutely have to make sure that we have ruled out secondary causes.” And while it would be useful to have evidence from prospective studies of nummular headache, “with such a rare headache, it’s hard. That’s why it’s so precious to have a study like this one, with 131 patients.”
Riggins acknowledged that the study emphasized the challenges of classifying and diagnosing nummular headache. The ICHD, last revised in 2018, “is a living, breathing document,” she said. “The idea is that as we learn more about headache disorders over time, this may mean changing some primary headaches to secondary, but we are clearly not there with this research: Most participants did not have a secondary cause for their coin-shaped headache.”
For now, Riggins said, “I think it’s best to keep classification straightforward for primary and secondary headache. It’s helpful for my day-to-day clinic life to have this neat division in place. But we do have to exclude secondary headache whenever possible in order to say that this is primary headache.”
Sánchez-Soblechero and coauthors disclosed no financial conflicts of interest related to their findings. Riggins disclosed consulting work for Gerson Lehrman Group, receiving research support from electroCore, Theranica, and Eli Lilly, and serving on advisory boards for Theranica, Teva Pharmaceuticals, Lundbeck, and Amneal Pharmaceuticals.
A version of this article appeared on Medscape.com.
FROM HEADACHE
Commentary: Health-Related Consequences of Migraine, December 2024
It is known that there are health-related consequences of migraine, as well as migraine-related comorbidities. Three recent studies examined the relationship between migraine and stroke, with nuanced results, suggesting that migraine does not necessarily increase stroke risk for all populations and may even be associated with a decreased risk for stroke for some patients. But it is clear that migraine is associated with an increased stroke risk for some specific populations, including during pregnancy.
Migraine is also known to have a negative impact on quality of life, affecting many different areas of well-being, including relationships, work productivity, and emotional health. Results from a recent study published in Cephalgia provided evidence that migraine can also increase the risk for occupational burnout.1
Yet, there’s some good news for migraine patients who have a genetic predisposition for migraine. Results of a recent study published in the Journal of Clinical Medicine showed that hereditary predisposition to migraine does not necessarily correlate with development of chronic migraine.2
An observational study, with results published in Cephalgia in November 2024, included 646 patients aged 18-54 years who were hospitalized with their first stroke.3 It showed no significant association between cerebral small-vessel disease and migraine with aura among the study population. Interestingly, migraine with aura is generally more closely linked with stroke risk than migraine without aura, so the results do not align with previously held beliefs about migraine and stroke risk.4
A larger study examined the relationship between migraine and cardiovascular risk scores.4 This cohort study included 140,915 Dutch adults with a mean age of 44 years. Results, published in JAMA Network Open in October 2024, revealed that the odds of having prevalent or incident migraine decreased with increasing cardiovascular risk score categories, especially for women. The authors suggested that having migraine could be associated with a healthier cardiovascular system and suggested several potential mechanisms for this inverse relationship, including alterations in the activity of calcitonin gene–related peptide activity, changes in nitric oxide effects, or cortical spreading depression in response to atherosclerosis.
Although the results of these studies, which were focused on young patients, are interesting and could provide a sense of relief for patients with migraine, the authors of the JAMA Network Open article acknowledged that these results should not be extrapolated to other populations.4 Specifically, they noted that it has been established in other studies that older patients with migraine have an increased cardiovascular risk.
The relationship between migraine and stroke risk is important for pregnant women. Results of a large analysis including 19,825,525 pregnant patients, with data obtained from 2016 to 2020, were published in November 2024 in the Journal of Women’s Health.5 The analysis revealed that a history of migraine substantially increases the risk for hemorrhagic or ischemic stroke during pregnancy. They reported that “acute ischemic stroke was most strongly associated with migraine with aura (odds ratio [OR], 23.26; 95% confidence interval [CI], 18.46-29.31), followed by migraine without aura (OR, 8.15; 95% CI, 4.79-13.88).” The authors advised that stroke risk should be addressed in pregnant women who have migraine or who have a migraine history, especially if they have migraine with aura.
It is well known that migraine risk has a hereditary component, but hereditary factors might not play a role in the time of onset of migraines. In a retrospective clinical genetic case-control study that included over 15,000 participants, researchers identified migraine polygenic risk scores using genome-wide association studies.2 The results were published in October 2024 in the Journal of Clinical Medicine. The study authors noted “a higher genetic risk was associated with earlier onset and increased risk for migraine well into adulthood, but not with chronification.” These results support the benefits of a diligent pursuit of effective migraine treatment, even for patients who might feel hopeless about achieving migraine control due to their own family history of migraine. As migraine therapies have evolved over the past decades, patients who had parents or other older family members with migraine may have a pessimistic outlook on the potential for effective treatment. However, newer therapies are far more effective than migraine treatments of the past, and patients should be informed and given encouragement that they can have a better prognosis and better migraine control than past generations.
The value of effective treatment cannot be underestimated. A study, with results published in Cephalgia in October 2024, included data from a subset of participants from the Negev Migraine Cohort, including 675 migraine patients and 232 control participants without migraine.1 The authors reported that migraine patients reported “significantly higher levels of occupational burnout, with a mean burnout score of 3.46 vs a mean of 2.82 among controls.” They also noted that migraine patients worked longer hours, with 40 hours of work weekly vs 36 for controls. The authors suggested accommodations for migraine patients, such as working from home or flexible scheduling. Although this could be beneficial, achieving migraine relief would be even better for patients, who could eventually be able to enjoy having a 36-hour work week rather than a 40-hour work week. Admittedly, this potential outcome is an overly literal interpretation of the research results, but it emphasizes the potential value of having “more time” in patients’ lives as a result of effective migraine relief.
References
1. Peles I, Sharvit S, Zlotnik Y, et al. Migraine and work — beyond absenteeism: Migraine severity and occupational burnout — a cohort study. Cephalalgia. October 18, 2024. Source
2. Chase BA, Frigerio R, Rubin S, et al. An integrative migraine polygenic risk score is associated with age at onset but not with chronification. J Clin Med. October 29, 2024. Source
3. Cloet F, Gueyraud G, Lerebours F, Munio M, Larrue V, Gollion C. Stroke due to small-vessel disease and migraine: a case-control study of a young adult with ischemic stroke population. Cephalalgia. 2024;44:1-8. Source
4. Al-Hassany L, MaassenVanDenBrink A, Kurth T. Cardiovascular risk scores and migraine status. JAMA Netw Open. October 22, 2024. Source
5. Reddy M, Vazquez S, Nolan B, et al. Migraine and its association with stroke in pregnancy: A national examination. J Womens Health. 2024;33:1476-1481. Source
It is known that there are health-related consequences of migraine, as well as migraine-related comorbidities. Three recent studies examined the relationship between migraine and stroke, with nuanced results, suggesting that migraine does not necessarily increase stroke risk for all populations and may even be associated with a decreased risk for stroke for some patients. But it is clear that migraine is associated with an increased stroke risk for some specific populations, including during pregnancy.
Migraine is also known to have a negative impact on quality of life, affecting many different areas of well-being, including relationships, work productivity, and emotional health. Results from a recent study published in Cephalgia provided evidence that migraine can also increase the risk for occupational burnout.1
Yet, there’s some good news for migraine patients who have a genetic predisposition for migraine. Results of a recent study published in the Journal of Clinical Medicine showed that hereditary predisposition to migraine does not necessarily correlate with development of chronic migraine.2
An observational study, with results published in Cephalgia in November 2024, included 646 patients aged 18-54 years who were hospitalized with their first stroke.3 It showed no significant association between cerebral small-vessel disease and migraine with aura among the study population. Interestingly, migraine with aura is generally more closely linked with stroke risk than migraine without aura, so the results do not align with previously held beliefs about migraine and stroke risk.4
A larger study examined the relationship between migraine and cardiovascular risk scores.4 This cohort study included 140,915 Dutch adults with a mean age of 44 years. Results, published in JAMA Network Open in October 2024, revealed that the odds of having prevalent or incident migraine decreased with increasing cardiovascular risk score categories, especially for women. The authors suggested that having migraine could be associated with a healthier cardiovascular system and suggested several potential mechanisms for this inverse relationship, including alterations in the activity of calcitonin gene–related peptide activity, changes in nitric oxide effects, or cortical spreading depression in response to atherosclerosis.
Although the results of these studies, which were focused on young patients, are interesting and could provide a sense of relief for patients with migraine, the authors of the JAMA Network Open article acknowledged that these results should not be extrapolated to other populations.4 Specifically, they noted that it has been established in other studies that older patients with migraine have an increased cardiovascular risk.
The relationship between migraine and stroke risk is important for pregnant women. Results of a large analysis including 19,825,525 pregnant patients, with data obtained from 2016 to 2020, were published in November 2024 in the Journal of Women’s Health.5 The analysis revealed that a history of migraine substantially increases the risk for hemorrhagic or ischemic stroke during pregnancy. They reported that “acute ischemic stroke was most strongly associated with migraine with aura (odds ratio [OR], 23.26; 95% confidence interval [CI], 18.46-29.31), followed by migraine without aura (OR, 8.15; 95% CI, 4.79-13.88).” The authors advised that stroke risk should be addressed in pregnant women who have migraine or who have a migraine history, especially if they have migraine with aura.
It is well known that migraine risk has a hereditary component, but hereditary factors might not play a role in the time of onset of migraines. In a retrospective clinical genetic case-control study that included over 15,000 participants, researchers identified migraine polygenic risk scores using genome-wide association studies.2 The results were published in October 2024 in the Journal of Clinical Medicine. The study authors noted “a higher genetic risk was associated with earlier onset and increased risk for migraine well into adulthood, but not with chronification.” These results support the benefits of a diligent pursuit of effective migraine treatment, even for patients who might feel hopeless about achieving migraine control due to their own family history of migraine. As migraine therapies have evolved over the past decades, patients who had parents or other older family members with migraine may have a pessimistic outlook on the potential for effective treatment. However, newer therapies are far more effective than migraine treatments of the past, and patients should be informed and given encouragement that they can have a better prognosis and better migraine control than past generations.
The value of effective treatment cannot be underestimated. A study, with results published in Cephalgia in October 2024, included data from a subset of participants from the Negev Migraine Cohort, including 675 migraine patients and 232 control participants without migraine.1 The authors reported that migraine patients reported “significantly higher levels of occupational burnout, with a mean burnout score of 3.46 vs a mean of 2.82 among controls.” They also noted that migraine patients worked longer hours, with 40 hours of work weekly vs 36 for controls. The authors suggested accommodations for migraine patients, such as working from home or flexible scheduling. Although this could be beneficial, achieving migraine relief would be even better for patients, who could eventually be able to enjoy having a 36-hour work week rather than a 40-hour work week. Admittedly, this potential outcome is an overly literal interpretation of the research results, but it emphasizes the potential value of having “more time” in patients’ lives as a result of effective migraine relief.
References
1. Peles I, Sharvit S, Zlotnik Y, et al. Migraine and work — beyond absenteeism: Migraine severity and occupational burnout — a cohort study. Cephalalgia. October 18, 2024. Source
2. Chase BA, Frigerio R, Rubin S, et al. An integrative migraine polygenic risk score is associated with age at onset but not with chronification. J Clin Med. October 29, 2024. Source
3. Cloet F, Gueyraud G, Lerebours F, Munio M, Larrue V, Gollion C. Stroke due to small-vessel disease and migraine: a case-control study of a young adult with ischemic stroke population. Cephalalgia. 2024;44:1-8. Source
4. Al-Hassany L, MaassenVanDenBrink A, Kurth T. Cardiovascular risk scores and migraine status. JAMA Netw Open. October 22, 2024. Source
5. Reddy M, Vazquez S, Nolan B, et al. Migraine and its association with stroke in pregnancy: A national examination. J Womens Health. 2024;33:1476-1481. Source
It is known that there are health-related consequences of migraine, as well as migraine-related comorbidities. Three recent studies examined the relationship between migraine and stroke, with nuanced results, suggesting that migraine does not necessarily increase stroke risk for all populations and may even be associated with a decreased risk for stroke for some patients. But it is clear that migraine is associated with an increased stroke risk for some specific populations, including during pregnancy.
Migraine is also known to have a negative impact on quality of life, affecting many different areas of well-being, including relationships, work productivity, and emotional health. Results from a recent study published in Cephalgia provided evidence that migraine can also increase the risk for occupational burnout.1
Yet, there’s some good news for migraine patients who have a genetic predisposition for migraine. Results of a recent study published in the Journal of Clinical Medicine showed that hereditary predisposition to migraine does not necessarily correlate with development of chronic migraine.2
An observational study, with results published in Cephalgia in November 2024, included 646 patients aged 18-54 years who were hospitalized with their first stroke.3 It showed no significant association between cerebral small-vessel disease and migraine with aura among the study population. Interestingly, migraine with aura is generally more closely linked with stroke risk than migraine without aura, so the results do not align with previously held beliefs about migraine and stroke risk.4
A larger study examined the relationship between migraine and cardiovascular risk scores.4 This cohort study included 140,915 Dutch adults with a mean age of 44 years. Results, published in JAMA Network Open in October 2024, revealed that the odds of having prevalent or incident migraine decreased with increasing cardiovascular risk score categories, especially for women. The authors suggested that having migraine could be associated with a healthier cardiovascular system and suggested several potential mechanisms for this inverse relationship, including alterations in the activity of calcitonin gene–related peptide activity, changes in nitric oxide effects, or cortical spreading depression in response to atherosclerosis.
Although the results of these studies, which were focused on young patients, are interesting and could provide a sense of relief for patients with migraine, the authors of the JAMA Network Open article acknowledged that these results should not be extrapolated to other populations.4 Specifically, they noted that it has been established in other studies that older patients with migraine have an increased cardiovascular risk.
The relationship between migraine and stroke risk is important for pregnant women. Results of a large analysis including 19,825,525 pregnant patients, with data obtained from 2016 to 2020, were published in November 2024 in the Journal of Women’s Health.5 The analysis revealed that a history of migraine substantially increases the risk for hemorrhagic or ischemic stroke during pregnancy. They reported that “acute ischemic stroke was most strongly associated with migraine with aura (odds ratio [OR], 23.26; 95% confidence interval [CI], 18.46-29.31), followed by migraine without aura (OR, 8.15; 95% CI, 4.79-13.88).” The authors advised that stroke risk should be addressed in pregnant women who have migraine or who have a migraine history, especially if they have migraine with aura.
It is well known that migraine risk has a hereditary component, but hereditary factors might not play a role in the time of onset of migraines. In a retrospective clinical genetic case-control study that included over 15,000 participants, researchers identified migraine polygenic risk scores using genome-wide association studies.2 The results were published in October 2024 in the Journal of Clinical Medicine. The study authors noted “a higher genetic risk was associated with earlier onset and increased risk for migraine well into adulthood, but not with chronification.” These results support the benefits of a diligent pursuit of effective migraine treatment, even for patients who might feel hopeless about achieving migraine control due to their own family history of migraine. As migraine therapies have evolved over the past decades, patients who had parents or other older family members with migraine may have a pessimistic outlook on the potential for effective treatment. However, newer therapies are far more effective than migraine treatments of the past, and patients should be informed and given encouragement that they can have a better prognosis and better migraine control than past generations.
The value of effective treatment cannot be underestimated. A study, with results published in Cephalgia in October 2024, included data from a subset of participants from the Negev Migraine Cohort, including 675 migraine patients and 232 control participants without migraine.1 The authors reported that migraine patients reported “significantly higher levels of occupational burnout, with a mean burnout score of 3.46 vs a mean of 2.82 among controls.” They also noted that migraine patients worked longer hours, with 40 hours of work weekly vs 36 for controls. The authors suggested accommodations for migraine patients, such as working from home or flexible scheduling. Although this could be beneficial, achieving migraine relief would be even better for patients, who could eventually be able to enjoy having a 36-hour work week rather than a 40-hour work week. Admittedly, this potential outcome is an overly literal interpretation of the research results, but it emphasizes the potential value of having “more time” in patients’ lives as a result of effective migraine relief.
References
1. Peles I, Sharvit S, Zlotnik Y, et al. Migraine and work — beyond absenteeism: Migraine severity and occupational burnout — a cohort study. Cephalalgia. October 18, 2024. Source
2. Chase BA, Frigerio R, Rubin S, et al. An integrative migraine polygenic risk score is associated with age at onset but not with chronification. J Clin Med. October 29, 2024. Source
3. Cloet F, Gueyraud G, Lerebours F, Munio M, Larrue V, Gollion C. Stroke due to small-vessel disease and migraine: a case-control study of a young adult with ischemic stroke population. Cephalalgia. 2024;44:1-8. Source
4. Al-Hassany L, MaassenVanDenBrink A, Kurth T. Cardiovascular risk scores and migraine status. JAMA Netw Open. October 22, 2024. Source
5. Reddy M, Vazquez S, Nolan B, et al. Migraine and its association with stroke in pregnancy: A national examination. J Womens Health. 2024;33:1476-1481. Source
Erenumab Outperforms Topiramate in Chronic Migraine Prevention
Key clinical point: Both erenumab and topiramate reduced migraine-induced disability; however, erenumab had a better safety profile for the prevention of chronic migraine.
Major findings: Migraine Disability Assessment (MIDAS) scores reduced after 3 months of treatment with both erenumab (15.17 at baseline to 5.79 at 3 months post-treatment) and topiramate (9.13 at baseline to 6.20 at 3 months post-treatment). A 50% reduction in the MIDAS score was achieved in patients receiving erenumab vs topiramate (≈79% vs 16%), with fewer discontinuations due to adverse events in patients receiving erenumab vs topiramate (3.8% vs 14.2%).
Study details: This retrospective cohort study included adults with a 12-month history of episodic or chronic migraine who received erenumab once monthly (dose, 70 mg/month; n = 52) or topiramate twice daily (dose, 50-100 mg/day; n = 56).
Disclosure: The study was funded by the Dubai Medical College for Girls. The authors declared no conflicts of interest.
Source: Nebrisi EE, Ruwayya ZSA, Alzayori DI, Alzayori RI, Chandran SB, Elshafei M. Efficacy and tolerability of erenumab and topiramate for prevention of chronic migraine: A retrospective cohort study. Medicina. Published online October 14, 2024. Source
Key clinical point: Both erenumab and topiramate reduced migraine-induced disability; however, erenumab had a better safety profile for the prevention of chronic migraine.
Major findings: Migraine Disability Assessment (MIDAS) scores reduced after 3 months of treatment with both erenumab (15.17 at baseline to 5.79 at 3 months post-treatment) and topiramate (9.13 at baseline to 6.20 at 3 months post-treatment). A 50% reduction in the MIDAS score was achieved in patients receiving erenumab vs topiramate (≈79% vs 16%), with fewer discontinuations due to adverse events in patients receiving erenumab vs topiramate (3.8% vs 14.2%).
Study details: This retrospective cohort study included adults with a 12-month history of episodic or chronic migraine who received erenumab once monthly (dose, 70 mg/month; n = 52) or topiramate twice daily (dose, 50-100 mg/day; n = 56).
Disclosure: The study was funded by the Dubai Medical College for Girls. The authors declared no conflicts of interest.
Source: Nebrisi EE, Ruwayya ZSA, Alzayori DI, Alzayori RI, Chandran SB, Elshafei M. Efficacy and tolerability of erenumab and topiramate for prevention of chronic migraine: A retrospective cohort study. Medicina. Published online October 14, 2024. Source
Key clinical point: Both erenumab and topiramate reduced migraine-induced disability; however, erenumab had a better safety profile for the prevention of chronic migraine.
Major findings: Migraine Disability Assessment (MIDAS) scores reduced after 3 months of treatment with both erenumab (15.17 at baseline to 5.79 at 3 months post-treatment) and topiramate (9.13 at baseline to 6.20 at 3 months post-treatment). A 50% reduction in the MIDAS score was achieved in patients receiving erenumab vs topiramate (≈79% vs 16%), with fewer discontinuations due to adverse events in patients receiving erenumab vs topiramate (3.8% vs 14.2%).
Study details: This retrospective cohort study included adults with a 12-month history of episodic or chronic migraine who received erenumab once monthly (dose, 70 mg/month; n = 52) or topiramate twice daily (dose, 50-100 mg/day; n = 56).
Disclosure: The study was funded by the Dubai Medical College for Girls. The authors declared no conflicts of interest.
Source: Nebrisi EE, Ruwayya ZSA, Alzayori DI, Alzayori RI, Chandran SB, Elshafei M. Efficacy and tolerability of erenumab and topiramate for prevention of chronic migraine: A retrospective cohort study. Medicina. Published online October 14, 2024. Source
Genetic Risk Linked to Earlier Migraine Onset but Not Chronification
Key clinical point: A higher polygenic risk score (PRS) was associated with an earlier migraine onset in both women and men; however, it was not associated with migraine chronification.
Major findings: A higher PRS was strongly associated with an earlier onset of migraine in both women (hazard ratios [HRs], 2.1 in DodoNA and 1.8 in GHI; P < .001 for both) and men (HRs, 2.5 in DodoNA; P < .001 and 1.6 in GHI; P = .027). However, PRS was not associated with migraine chronification (HR, 1.2; P = .424).
Study details: This retrospective clinical/genetic case-control study analyzed data from the DodoNA cohort (1653 individuals with migraine and 3460 control individuals without migraine) and the GHI cohort (2443 individuals with migraine and 8576 control individuals without migraine).
Disclosure: The study was funded by the Agency for Healthcare Research and Quality. Two authors declared having ties with various sources.
Source: Chase BA, Frigerio R, Rubin S, et al. An integrative migraine polygenic risk score is associated with age at onset but not with chronification. Published online October 29, 2024. Source
Key clinical point: A higher polygenic risk score (PRS) was associated with an earlier migraine onset in both women and men; however, it was not associated with migraine chronification.
Major findings: A higher PRS was strongly associated with an earlier onset of migraine in both women (hazard ratios [HRs], 2.1 in DodoNA and 1.8 in GHI; P < .001 for both) and men (HRs, 2.5 in DodoNA; P < .001 and 1.6 in GHI; P = .027). However, PRS was not associated with migraine chronification (HR, 1.2; P = .424).
Study details: This retrospective clinical/genetic case-control study analyzed data from the DodoNA cohort (1653 individuals with migraine and 3460 control individuals without migraine) and the GHI cohort (2443 individuals with migraine and 8576 control individuals without migraine).
Disclosure: The study was funded by the Agency for Healthcare Research and Quality. Two authors declared having ties with various sources.
Source: Chase BA, Frigerio R, Rubin S, et al. An integrative migraine polygenic risk score is associated with age at onset but not with chronification. Published online October 29, 2024. Source
Key clinical point: A higher polygenic risk score (PRS) was associated with an earlier migraine onset in both women and men; however, it was not associated with migraine chronification.
Major findings: A higher PRS was strongly associated with an earlier onset of migraine in both women (hazard ratios [HRs], 2.1 in DodoNA and 1.8 in GHI; P < .001 for both) and men (HRs, 2.5 in DodoNA; P < .001 and 1.6 in GHI; P = .027). However, PRS was not associated with migraine chronification (HR, 1.2; P = .424).
Study details: This retrospective clinical/genetic case-control study analyzed data from the DodoNA cohort (1653 individuals with migraine and 3460 control individuals without migraine) and the GHI cohort (2443 individuals with migraine and 8576 control individuals without migraine).
Disclosure: The study was funded by the Agency for Healthcare Research and Quality. Two authors declared having ties with various sources.
Source: Chase BA, Frigerio R, Rubin S, et al. An integrative migraine polygenic risk score is associated with age at onset but not with chronification. Published online October 29, 2024. Source
Atogepant Is Effective and Safe for Episodic Migraine Prevention
Key clinical point: Atogepant was an effective and safe treatment option for the prevention of episodic migraine.
Major findings: Atogepant (10 mg, 30 mg, and 60 mg) vs placebo led to a significant reduction in monthly migraine days (MMDs; P < .001, P < .001, and P = .0009, respectively), monthly headache days (all P < .001), acute medication use (all P < .001), as well as increase in the proportion of patients achieving a ≥50% reduction in MMDs (P = .007, P = .02, and P = .003, respectively). No significant difference was observed in serious adverse events between the atogepant and placebo groups.
Study details: This meta-analysis of six randomized controlled trials included 4569 patients with episodic migraine who were randomly assigned to receive atogepant (10 mg, 30 mg, or 60 mg) or placebo.
Disclosure: The study did not receive funding from any sources. The authors declared no conflicts of interest.
Source: Alrasheed AS, Almaqboul TM, Alshamrani RA, AlMohish NM, Alabdali MM. Safety and efficacy of atogepant for the preventive treatment of migraines in adults: A systematic review and meta-analysis. J Clin Med. Published online November 08, 2024. Source
Key clinical point: Atogepant was an effective and safe treatment option for the prevention of episodic migraine.
Major findings: Atogepant (10 mg, 30 mg, and 60 mg) vs placebo led to a significant reduction in monthly migraine days (MMDs; P < .001, P < .001, and P = .0009, respectively), monthly headache days (all P < .001), acute medication use (all P < .001), as well as increase in the proportion of patients achieving a ≥50% reduction in MMDs (P = .007, P = .02, and P = .003, respectively). No significant difference was observed in serious adverse events between the atogepant and placebo groups.
Study details: This meta-analysis of six randomized controlled trials included 4569 patients with episodic migraine who were randomly assigned to receive atogepant (10 mg, 30 mg, or 60 mg) or placebo.
Disclosure: The study did not receive funding from any sources. The authors declared no conflicts of interest.
Source: Alrasheed AS, Almaqboul TM, Alshamrani RA, AlMohish NM, Alabdali MM. Safety and efficacy of atogepant for the preventive treatment of migraines in adults: A systematic review and meta-analysis. J Clin Med. Published online November 08, 2024. Source
Key clinical point: Atogepant was an effective and safe treatment option for the prevention of episodic migraine.
Major findings: Atogepant (10 mg, 30 mg, and 60 mg) vs placebo led to a significant reduction in monthly migraine days (MMDs; P < .001, P < .001, and P = .0009, respectively), monthly headache days (all P < .001), acute medication use (all P < .001), as well as increase in the proportion of patients achieving a ≥50% reduction in MMDs (P = .007, P = .02, and P = .003, respectively). No significant difference was observed in serious adverse events between the atogepant and placebo groups.
Study details: This meta-analysis of six randomized controlled trials included 4569 patients with episodic migraine who were randomly assigned to receive atogepant (10 mg, 30 mg, or 60 mg) or placebo.
Disclosure: The study did not receive funding from any sources. The authors declared no conflicts of interest.
Source: Alrasheed AS, Almaqboul TM, Alshamrani RA, AlMohish NM, Alabdali MM. Safety and efficacy of atogepant for the preventive treatment of migraines in adults: A systematic review and meta-analysis. J Clin Med. Published online November 08, 2024. Source
Migraine With Aura Increases Stroke Risk in Pregnancy
Key clinical point: Pregnant women with migraine with aura had a significantly increased risk for both acute ischemic stroke and hemorrhagic stroke.
Major findings: Pregnant women with vs without migraine had a higher incidence of acute ischemic stroke (0.1% vs 0.0%) and hemorrhagic stroke (0.3% vs 0.1%). The risk for acute ischemic stroke was highest in those with aura (odds ratio [OR], 23.26; 95% CI, 18.46-29.31), followed by those without aura (OR, 8.15; 95% CI, 4.79-13.88) and those with unspecified migraine (OR, 5.43; 95% CI, 4.72-6.25).
Study details: This population-based study utilized the Healthcare Cost and Utilization Project's National Inpatient Sample database and involved 19,825,525 pregnant women, of whom 1.1% had migraine.
Disclosure: The study did not receive any funding. The authors declared no conflicts of interest.
Source: Reddy M, Vazquez S, Nolan B, et al. Migraine and its association with stroke in pregnancy: A national examination. J Womens Health. 2024;33:1476-1481. Source
Key clinical point: Pregnant women with migraine with aura had a significantly increased risk for both acute ischemic stroke and hemorrhagic stroke.
Major findings: Pregnant women with vs without migraine had a higher incidence of acute ischemic stroke (0.1% vs 0.0%) and hemorrhagic stroke (0.3% vs 0.1%). The risk for acute ischemic stroke was highest in those with aura (odds ratio [OR], 23.26; 95% CI, 18.46-29.31), followed by those without aura (OR, 8.15; 95% CI, 4.79-13.88) and those with unspecified migraine (OR, 5.43; 95% CI, 4.72-6.25).
Study details: This population-based study utilized the Healthcare Cost and Utilization Project's National Inpatient Sample database and involved 19,825,525 pregnant women, of whom 1.1% had migraine.
Disclosure: The study did not receive any funding. The authors declared no conflicts of interest.
Source: Reddy M, Vazquez S, Nolan B, et al. Migraine and its association with stroke in pregnancy: A national examination. J Womens Health. 2024;33:1476-1481. Source
Key clinical point: Pregnant women with migraine with aura had a significantly increased risk for both acute ischemic stroke and hemorrhagic stroke.
Major findings: Pregnant women with vs without migraine had a higher incidence of acute ischemic stroke (0.1% vs 0.0%) and hemorrhagic stroke (0.3% vs 0.1%). The risk for acute ischemic stroke was highest in those with aura (odds ratio [OR], 23.26; 95% CI, 18.46-29.31), followed by those without aura (OR, 8.15; 95% CI, 4.79-13.88) and those with unspecified migraine (OR, 5.43; 95% CI, 4.72-6.25).
Study details: This population-based study utilized the Healthcare Cost and Utilization Project's National Inpatient Sample database and involved 19,825,525 pregnant women, of whom 1.1% had migraine.
Disclosure: The study did not receive any funding. The authors declared no conflicts of interest.
Source: Reddy M, Vazquez S, Nolan B, et al. Migraine and its association with stroke in pregnancy: A national examination. J Womens Health. 2024;33:1476-1481. Source
Increased Cardiovascular Risk Scores Linked to Decreased Migraine Risk, Especially in Women
Key clinical point: Increased cardiovascular (CV) risk, as assessed by the Systematic Coronary Risk Evaluation 2 system, was associated with a lower risk for prevalent and incident migraine, notably in women.
Major findings: Compared with individuals with the lowest CV risk scores (< 1%), those with CV risk scores of 1% to < 2.5% had a higher risk for prevalent migraine (odds ratio [OR], 0.93; 95% CI, 0.90-0.96) and incident migraine (OR, 0.63; 95% CI, 0.57-0.69), whereas individuals with CV risk scores ≥ 10% had a lower risk for prevalent migraine (OR, 0.43; 95% CI, 0.39-0.48) and incident migraine (OR, 0.17; 95% CI, 0.10-0.27). The association between migraine and CV risk was stronger in women than in men within the same CV risk categories.
Study details: This ~13-year prospective population-based study involved 140,915 adults (58.5% women), with 25,915 having prevalent migraine and 2224 having incident migraine.
Disclosure: The study was supported by the Dutch Research Council and others. Two authors reported receiving research grants, advisory board fees, or speaking fees from various sources.
Source: Al-Hassany L, MaassenVanDenBrink A, Kurth T. Cardiovascular risk scores and migraine status. JAMA Netw Open. Published online October 22, 2024. Source
Key clinical point: Increased cardiovascular (CV) risk, as assessed by the Systematic Coronary Risk Evaluation 2 system, was associated with a lower risk for prevalent and incident migraine, notably in women.
Major findings: Compared with individuals with the lowest CV risk scores (< 1%), those with CV risk scores of 1% to < 2.5% had a higher risk for prevalent migraine (odds ratio [OR], 0.93; 95% CI, 0.90-0.96) and incident migraine (OR, 0.63; 95% CI, 0.57-0.69), whereas individuals with CV risk scores ≥ 10% had a lower risk for prevalent migraine (OR, 0.43; 95% CI, 0.39-0.48) and incident migraine (OR, 0.17; 95% CI, 0.10-0.27). The association between migraine and CV risk was stronger in women than in men within the same CV risk categories.
Study details: This ~13-year prospective population-based study involved 140,915 adults (58.5% women), with 25,915 having prevalent migraine and 2224 having incident migraine.
Disclosure: The study was supported by the Dutch Research Council and others. Two authors reported receiving research grants, advisory board fees, or speaking fees from various sources.
Source: Al-Hassany L, MaassenVanDenBrink A, Kurth T. Cardiovascular risk scores and migraine status. JAMA Netw Open. Published online October 22, 2024. Source
Key clinical point: Increased cardiovascular (CV) risk, as assessed by the Systematic Coronary Risk Evaluation 2 system, was associated with a lower risk for prevalent and incident migraine, notably in women.
Major findings: Compared with individuals with the lowest CV risk scores (< 1%), those with CV risk scores of 1% to < 2.5% had a higher risk for prevalent migraine (odds ratio [OR], 0.93; 95% CI, 0.90-0.96) and incident migraine (OR, 0.63; 95% CI, 0.57-0.69), whereas individuals with CV risk scores ≥ 10% had a lower risk for prevalent migraine (OR, 0.43; 95% CI, 0.39-0.48) and incident migraine (OR, 0.17; 95% CI, 0.10-0.27). The association between migraine and CV risk was stronger in women than in men within the same CV risk categories.
Study details: This ~13-year prospective population-based study involved 140,915 adults (58.5% women), with 25,915 having prevalent migraine and 2224 having incident migraine.
Disclosure: The study was supported by the Dutch Research Council and others. Two authors reported receiving research grants, advisory board fees, or speaking fees from various sources.
Source: Al-Hassany L, MaassenVanDenBrink A, Kurth T. Cardiovascular risk scores and migraine status. JAMA Netw Open. Published online October 22, 2024. Source
Eptinezumab Reduced Acute Headache Medication Use in Patients With Migraine
Key clinical point: In patients with migraine and those with prior treatment failure and medication overuse (MO), eptinezumab significantly reduced acute headache medication (AHM), with sustained reductions for up to 18 months.
Major findings: Eptinezumab significantly reduced AHM compared with placebo in patients with migraine and those with MO (P < .001 for all). These reductions in AHM were sustained through the 18-month treatment period, with continued reductions in the extension period.
Study details: This DELIVER trial post-hoc analysis of 890 patients, 49.2% had MO who failed 2-4 preventive treatments, among these 865 patients continued in the 48-week extension period.
Disclosure: This study was funded by H. Lundbeck A/S. Two authors reported receiving speaking fees from various sources. Five authors declared being full-time employees of H. Lundbeck A/S. Other authors declared multiple ties with various sources.
Source: Gryglas-Dworak A, Schim J, Ettrup A, et al. Long-term reductions in acute headache medication use after eptinezumab treatment in patients with migraine and prior preventive treatment failures: Post hoc analysis of the DELIVER randomized trial. Headache. Published online November 5, 2024. Source
Key clinical point: In patients with migraine and those with prior treatment failure and medication overuse (MO), eptinezumab significantly reduced acute headache medication (AHM), with sustained reductions for up to 18 months.
Major findings: Eptinezumab significantly reduced AHM compared with placebo in patients with migraine and those with MO (P < .001 for all). These reductions in AHM were sustained through the 18-month treatment period, with continued reductions in the extension period.
Study details: This DELIVER trial post-hoc analysis of 890 patients, 49.2% had MO who failed 2-4 preventive treatments, among these 865 patients continued in the 48-week extension period.
Disclosure: This study was funded by H. Lundbeck A/S. Two authors reported receiving speaking fees from various sources. Five authors declared being full-time employees of H. Lundbeck A/S. Other authors declared multiple ties with various sources.
Source: Gryglas-Dworak A, Schim J, Ettrup A, et al. Long-term reductions in acute headache medication use after eptinezumab treatment in patients with migraine and prior preventive treatment failures: Post hoc analysis of the DELIVER randomized trial. Headache. Published online November 5, 2024. Source
Key clinical point: In patients with migraine and those with prior treatment failure and medication overuse (MO), eptinezumab significantly reduced acute headache medication (AHM), with sustained reductions for up to 18 months.
Major findings: Eptinezumab significantly reduced AHM compared with placebo in patients with migraine and those with MO (P < .001 for all). These reductions in AHM were sustained through the 18-month treatment period, with continued reductions in the extension period.
Study details: This DELIVER trial post-hoc analysis of 890 patients, 49.2% had MO who failed 2-4 preventive treatments, among these 865 patients continued in the 48-week extension period.
Disclosure: This study was funded by H. Lundbeck A/S. Two authors reported receiving speaking fees from various sources. Five authors declared being full-time employees of H. Lundbeck A/S. Other authors declared multiple ties with various sources.
Source: Gryglas-Dworak A, Schim J, Ettrup A, et al. Long-term reductions in acute headache medication use after eptinezumab treatment in patients with migraine and prior preventive treatment failures: Post hoc analysis of the DELIVER randomized trial. Headache. Published online November 5, 2024. Source
Occupational Burnout Linked to Migraine Severity
Key clinical point: Patients with migraine, particularly those with severe symptoms, were at a higher risk for occupational burnout than those without migraine.
Major findings: Patients with vs without migraine experienced increased occupational burnout (mean burnout score, 3.46 vs 2.82), had higher rates of depression (mean Depression, Anxiety and Stress Scale–21 score, 0.864 vs 0.664), worked longer hours (median weekly hours, 40.0 vs 36.0), and preferred remote work (20.3% vs 10.3%). Migraine severity, as measured by the Migraine Disability Assessment, was significantly associated with increased occupational burnout (P < .001).
Study details: This observational cohort study included 675 patients with migraine and 232 patients without migraine, matched according to age, gender, and primary clinic.
Disclosure: The study was funded by Teva Pharmaceuticals. Gal Ifergane received consulting fees and honoraria from various sources, including Teva Pharmaceuticals, and others declared no conflicts of interest.
Source: Peles I, Sharvit S, Zlotnik Y, et al. Migraine and work — beyond absenteeism: Migraine severity and occupational burnout — A cohort study. Cephalalgia. Published online October 18, 2024. Source
Key clinical point: Patients with migraine, particularly those with severe symptoms, were at a higher risk for occupational burnout than those without migraine.
Major findings: Patients with vs without migraine experienced increased occupational burnout (mean burnout score, 3.46 vs 2.82), had higher rates of depression (mean Depression, Anxiety and Stress Scale–21 score, 0.864 vs 0.664), worked longer hours (median weekly hours, 40.0 vs 36.0), and preferred remote work (20.3% vs 10.3%). Migraine severity, as measured by the Migraine Disability Assessment, was significantly associated with increased occupational burnout (P < .001).
Study details: This observational cohort study included 675 patients with migraine and 232 patients without migraine, matched according to age, gender, and primary clinic.
Disclosure: The study was funded by Teva Pharmaceuticals. Gal Ifergane received consulting fees and honoraria from various sources, including Teva Pharmaceuticals, and others declared no conflicts of interest.
Source: Peles I, Sharvit S, Zlotnik Y, et al. Migraine and work — beyond absenteeism: Migraine severity and occupational burnout — A cohort study. Cephalalgia. Published online October 18, 2024. Source
Key clinical point: Patients with migraine, particularly those with severe symptoms, were at a higher risk for occupational burnout than those without migraine.
Major findings: Patients with vs without migraine experienced increased occupational burnout (mean burnout score, 3.46 vs 2.82), had higher rates of depression (mean Depression, Anxiety and Stress Scale–21 score, 0.864 vs 0.664), worked longer hours (median weekly hours, 40.0 vs 36.0), and preferred remote work (20.3% vs 10.3%). Migraine severity, as measured by the Migraine Disability Assessment, was significantly associated with increased occupational burnout (P < .001).
Study details: This observational cohort study included 675 patients with migraine and 232 patients without migraine, matched according to age, gender, and primary clinic.
Disclosure: The study was funded by Teva Pharmaceuticals. Gal Ifergane received consulting fees and honoraria from various sources, including Teva Pharmaceuticals, and others declared no conflicts of interest.
Source: Peles I, Sharvit S, Zlotnik Y, et al. Migraine and work — beyond absenteeism: Migraine severity and occupational burnout — A cohort study. Cephalalgia. Published online October 18, 2024. Source
Migraine Not Associated With Cerebral Small-Vessel Disease in Patients With Stroke
Key clinical point: Migraine, including migraine with aura (MWA) and migraine without aura (MWoA), was not a significant factor for stroke caused by cerebral small-vessel disease (CSVD) in adult patients hospitalized with first-ever ischemic stroke.
Major findings: Patients with migraine (P = .003), those with MWA (P = .02), and those with MWoA (P = .04) were found to have a significantly lower prevalence of CSVD lesions than those without migraine. There was no significant association between CSVD lesions of any grade and migraine (P = .34), MWA (P = .60), and MWoA (P = .51).
Study details: This retrospective case-control study included 646 patients who were hospitalized for their first-ever ischemic stroke, of whom 225 (34.82%) had migraine. Among those with migraine, 115 (17.8%) had MWA and 110 (17.02%) had MWoA.
Disclosure: This study received no specific funding. One author declared receiving speaker fees from various pharmaceutical companies.
Source: Cloet F, Gueyraud G, Lerebours F, Munio M, Larrue V, Gollion C. Stroke due to small-vessel disease and migraine: A case-control study of a young adult with ischemic stroke population. Cephalalgia. 2024;44:1-8. Source
Key clinical point: Migraine, including migraine with aura (MWA) and migraine without aura (MWoA), was not a significant factor for stroke caused by cerebral small-vessel disease (CSVD) in adult patients hospitalized with first-ever ischemic stroke.
Major findings: Patients with migraine (P = .003), those with MWA (P = .02), and those with MWoA (P = .04) were found to have a significantly lower prevalence of CSVD lesions than those without migraine. There was no significant association between CSVD lesions of any grade and migraine (P = .34), MWA (P = .60), and MWoA (P = .51).
Study details: This retrospective case-control study included 646 patients who were hospitalized for their first-ever ischemic stroke, of whom 225 (34.82%) had migraine. Among those with migraine, 115 (17.8%) had MWA and 110 (17.02%) had MWoA.
Disclosure: This study received no specific funding. One author declared receiving speaker fees from various pharmaceutical companies.
Source: Cloet F, Gueyraud G, Lerebours F, Munio M, Larrue V, Gollion C. Stroke due to small-vessel disease and migraine: A case-control study of a young adult with ischemic stroke population. Cephalalgia. 2024;44:1-8. Source
Key clinical point: Migraine, including migraine with aura (MWA) and migraine without aura (MWoA), was not a significant factor for stroke caused by cerebral small-vessel disease (CSVD) in adult patients hospitalized with first-ever ischemic stroke.
Major findings: Patients with migraine (P = .003), those with MWA (P = .02), and those with MWoA (P = .04) were found to have a significantly lower prevalence of CSVD lesions than those without migraine. There was no significant association between CSVD lesions of any grade and migraine (P = .34), MWA (P = .60), and MWoA (P = .51).
Study details: This retrospective case-control study included 646 patients who were hospitalized for their first-ever ischemic stroke, of whom 225 (34.82%) had migraine. Among those with migraine, 115 (17.8%) had MWA and 110 (17.02%) had MWoA.
Disclosure: This study received no specific funding. One author declared receiving speaker fees from various pharmaceutical companies.
Source: Cloet F, Gueyraud G, Lerebours F, Munio M, Larrue V, Gollion C. Stroke due to small-vessel disease and migraine: A case-control study of a young adult with ischemic stroke population. Cephalalgia. 2024;44:1-8. Source