Migraine ICYMI

Key clinical point: Maternal migraine diagnosis is associated with a higher risk for several childhood cancers in offspring.

Major finding: A significant positive association was observed between maternal migraine and the risk for non-Hodgkin lymphoma (odds ratio [OR] 1.70; 95% CI 1.01-2.86), central nervous system tumors (OR 1.31; 95% CI 1.02-1.68; particularly glioma: OR 1.64; 95% CI 1.12-2.40), neuroblastoma (OR 1.75; 95% CI 1.00-3.08), and osteosarcoma (OR 2.60; 95% CI 1.18-5.76).

Study details: This study included children age < 20 years with cancers (cases) and birth year- and sex-matched (25:1) children without cancers (control individuals).

Disclosures: This study was supported by the US National Institutes of Health. The authors declared no conflicts of interest.

Source: Orimoloye HT et al. Maternal migraine and risk of pediatric cancers. Pediatr Blood Cancer. 2023 (Apr 26). doi: 10.1002/pbc.30385

Key clinical point: Maternal migraine diagnosis is associated with a higher risk for several childhood cancers in offspring.

Major finding: A significant positive association was observed between maternal migraine and the risk for non-Hodgkin lymphoma (odds ratio [OR] 1.70; 95% CI 1.01-2.86), central nervous system tumors (OR 1.31; 95% CI 1.02-1.68; particularly glioma: OR 1.64; 95% CI 1.12-2.40), neuroblastoma (OR 1.75; 95% CI 1.00-3.08), and osteosarcoma (OR 2.60; 95% CI 1.18-5.76).

Study details: This study included children age < 20 years with cancers (cases) and birth year- and sex-matched (25:1) children without cancers (control individuals).

Disclosures: This study was supported by the US National Institutes of Health. The authors declared no conflicts of interest.

Source: Orimoloye HT et al. Maternal migraine and risk of pediatric cancers. Pediatr Blood Cancer. 2023 (Apr 26). doi: 10.1002/pbc.30385

Key clinical point: Maternal migraine diagnosis is associated with a higher risk for several childhood cancers in offspring.

Major finding: A significant positive association was observed between maternal migraine and the risk for non-Hodgkin lymphoma (odds ratio [OR] 1.70; 95% CI 1.01-2.86), central nervous system tumors (OR 1.31; 95% CI 1.02-1.68; particularly glioma: OR 1.64; 95% CI 1.12-2.40), neuroblastoma (OR 1.75; 95% CI 1.00-3.08), and osteosarcoma (OR 2.60; 95% CI 1.18-5.76).

Study details: This study included children age < 20 years with cancers (cases) and birth year- and sex-matched (25:1) children without cancers (control individuals).

Disclosures: This study was supported by the US National Institutes of Health. The authors declared no conflicts of interest.

Source: Orimoloye HT et al. Maternal migraine and risk of pediatric cancers. Pediatr Blood Cancer. 2023 (Apr 26). doi: 10.1002/pbc.30385

Key clinical point: This meta-analysis demonstrated a significant bidirectional association between psoriasis and migraine, with greater severity of psoriasis being associated with an increasingly higher risk of developing migraine.

Major finding: Presence vs absence of psoriasis was associated with 1.69-fold higher odds of prevalent migraine (pooled odds ratio [OR] 1.69; 95% CI 1.26-2.28), with the risk for incident migraine being significantly higher in patients with mild (incidence rate ratio [IRR] 1.37; 95% CI 1.30-1.44) and severe (IRR 1.55; 95% CI 1.29-1.86) psoriasis and psoriatic arthritis (IRR 1.92; 95% CI 1.65-2.23). Moreover, presence vs absence of migraine was associated with 1.88-fold higher odds of prevalent psoriasis (OR 1.88; 95% CI 1.32-3.67).

Study details: Findings are from a systematic review and meta-analysis of 10 studies including 6,745,968 participants.

Disclosures: This study did not declare the funding source. The authors declared no conflicts of interest.

Source: Huang IH et al. Bidirectional associations between psoriasis and migraine: A systematic review and meta-analysis. J Dtsch Dermatol Ges. 2023;21(5):493-502 (Apr 17). doi: 10.1111/ddg.14994

Key clinical point: This meta-analysis demonstrated a significant bidirectional association between psoriasis and migraine, with greater severity of psoriasis being associated with an increasingly higher risk of developing migraine.

Major finding: Presence vs absence of psoriasis was associated with 1.69-fold higher odds of prevalent migraine (pooled odds ratio [OR] 1.69; 95% CI 1.26-2.28), with the risk for incident migraine being significantly higher in patients with mild (incidence rate ratio [IRR] 1.37; 95% CI 1.30-1.44) and severe (IRR 1.55; 95% CI 1.29-1.86) psoriasis and psoriatic arthritis (IRR 1.92; 95% CI 1.65-2.23). Moreover, presence vs absence of migraine was associated with 1.88-fold higher odds of prevalent psoriasis (OR 1.88; 95% CI 1.32-3.67).

Study details: Findings are from a systematic review and meta-analysis of 10 studies including 6,745,968 participants.

Disclosures: This study did not declare the funding source. The authors declared no conflicts of interest.

Source: Huang IH et al. Bidirectional associations between psoriasis and migraine: A systematic review and meta-analysis. J Dtsch Dermatol Ges. 2023;21(5):493-502 (Apr 17). doi: 10.1111/ddg.14994

Key clinical point: This meta-analysis demonstrated a significant bidirectional association between psoriasis and migraine, with greater severity of psoriasis being associated with an increasingly higher risk of developing migraine.

Major finding: Presence vs absence of psoriasis was associated with 1.69-fold higher odds of prevalent migraine (pooled odds ratio [OR] 1.69; 95% CI 1.26-2.28), with the risk for incident migraine being significantly higher in patients with mild (incidence rate ratio [IRR] 1.37; 95% CI 1.30-1.44) and severe (IRR 1.55; 95% CI 1.29-1.86) psoriasis and psoriatic arthritis (IRR 1.92; 95% CI 1.65-2.23). Moreover, presence vs absence of migraine was associated with 1.88-fold higher odds of prevalent psoriasis (OR 1.88; 95% CI 1.32-3.67).

Study details: Findings are from a systematic review and meta-analysis of 10 studies including 6,745,968 participants.

Disclosures: This study did not declare the funding source. The authors declared no conflicts of interest.

Source: Huang IH et al. Bidirectional associations between psoriasis and migraine: A systematic review and meta-analysis. J Dtsch Dermatol Ges. 2023;21(5):493-502 (Apr 17). doi: 10.1111/ddg.14994

Key clinical point: Cross-sectional study confirms a significant association of migraine history with the severity of vasomotor symptoms (VMS) and hypertension in midlife women, potentially helping to identify those at risk for severe menopause symptoms.

Major finding: The likelihood of severe or very severe vs no hot flashes (adjusted odds ratio [aOR] 1.34; P = .007) and risk for hypertension (aOR 1.31; P = .002) were significantly higher among women with vs without a history of migraine.

Study details: Findings are from a cross-sectional study including 5708 women aged between 45 and 60 years, of whom 23.7% had a history of migraine.

Disclosures: This study was partially supported by a grant from the National Institute on Aging. Dr. Kling and Dr. Kapoor declared serving as consultants for various sources.

Source: Faubion SS et al. Association of migraine and vasomotor symptoms. Mayo Clin Proc. 2023;98(5):701-712 (May 1). doi: 10.1016/j.mayocp.2023.01.010.

Key clinical point: Cross-sectional study confirms a significant association of migraine history with the severity of vasomotor symptoms (VMS) and hypertension in midlife women, potentially helping to identify those at risk for severe menopause symptoms.

Major finding: The likelihood of severe or very severe vs no hot flashes (adjusted odds ratio [aOR] 1.34; P = .007) and risk for hypertension (aOR 1.31; P = .002) were significantly higher among women with vs without a history of migraine.

Study details: Findings are from a cross-sectional study including 5708 women aged between 45 and 60 years, of whom 23.7% had a history of migraine.

Disclosures: This study was partially supported by a grant from the National Institute on Aging. Dr. Kling and Dr. Kapoor declared serving as consultants for various sources.

Source: Faubion SS et al. Association of migraine and vasomotor symptoms. Mayo Clin Proc. 2023;98(5):701-712 (May 1). doi: 10.1016/j.mayocp.2023.01.010.

Key clinical point: Cross-sectional study confirms a significant association of migraine history with the severity of vasomotor symptoms (VMS) and hypertension in midlife women, potentially helping to identify those at risk for severe menopause symptoms.

Major finding: The likelihood of severe or very severe vs no hot flashes (adjusted odds ratio [aOR] 1.34; P = .007) and risk for hypertension (aOR 1.31; P = .002) were significantly higher among women with vs without a history of migraine.

Study details: Findings are from a cross-sectional study including 5708 women aged between 45 and 60 years, of whom 23.7% had a history of migraine.

Disclosures: This study was partially supported by a grant from the National Institute on Aging. Dr. Kling and Dr. Kapoor declared serving as consultants for various sources.

Source: Faubion SS et al. Association of migraine and vasomotor symptoms. Mayo Clin Proc. 2023;98(5):701-712 (May 1). doi: 10.1016/j.mayocp.2023.01.010.

Key clinical point: Patients with migraine who recovered from COVID-19 showed an increase in the frequency of headache attacks, level of anxiety, and use of antimigraine drugs.

Major finding: Among patients with migraine, those with vs without a history of COVID-19 showed a significant increase in the frequency of headache attacks (P = .01), level of anxiety (P = .002), and use of antimigraine drugs (P = .04) after recovering from COVID-19, with no significant difference being observed in the headache intensity (P = .51) and the dynamics of the Beck Depression scale score (P = .09).

Study details: Findings are from a retrospective study including 133 patients aged 18-55 years with chronic and episodic migraine and with (n = 95) or without (n = 38) a history of COVID-19.

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

Source: Hrytsenko O et al. The impact of the COVID-19 pandemic on patients with migraine. SAGE Open Med. 2023 (Apr 28). doi: 10.1177/20503121231170726

Key clinical point: Patients with migraine who recovered from COVID-19 showed an increase in the frequency of headache attacks, level of anxiety, and use of antimigraine drugs.

Major finding: Among patients with migraine, those with vs without a history of COVID-19 showed a significant increase in the frequency of headache attacks (P = .01), level of anxiety (P = .002), and use of antimigraine drugs (P = .04) after recovering from COVID-19, with no significant difference being observed in the headache intensity (P = .51) and the dynamics of the Beck Depression scale score (P = .09).

Study details: Findings are from a retrospective study including 133 patients aged 18-55 years with chronic and episodic migraine and with (n = 95) or without (n = 38) a history of COVID-19.

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

Source: Hrytsenko O et al. The impact of the COVID-19 pandemic on patients with migraine. SAGE Open Med. 2023 (Apr 28). doi: 10.1177/20503121231170726

Key clinical point: Patients with migraine who recovered from COVID-19 showed an increase in the frequency of headache attacks, level of anxiety, and use of antimigraine drugs.

Major finding: Among patients with migraine, those with vs without a history of COVID-19 showed a significant increase in the frequency of headache attacks (P = .01), level of anxiety (P = .002), and use of antimigraine drugs (P = .04) after recovering from COVID-19, with no significant difference being observed in the headache intensity (P = .51) and the dynamics of the Beck Depression scale score (P = .09).

Study details: Findings are from a retrospective study including 133 patients aged 18-55 years with chronic and episodic migraine and with (n = 95) or without (n = 38) a history of COVID-19.

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

Source: Hrytsenko O et al. The impact of the COVID-19 pandemic on patients with migraine. SAGE Open Med. 2023 (Apr 28). doi: 10.1177/20503121231170726

Key clinical point: The alpha-calcitonin gene-related peptide (CGRP) level was significantly elevated in patients with chronic migraine (CM) vs control individuals, which eventually normalized after treatment with CGRP monoclonal antibodies (mAb) and correlated with clinical response.

Major finding: The significantly higher alpha-CGRP levels in patients with CM vs control individuals (P = .004) normalized at 2 weeks (median 40.4 pg/mL; 95% CI 35.6-48.1 pg/mL) and 3 months (median 40.9 pg/mL; 95% CI 36.3-45.9 pg/mL) post-treatment with a CGRP mAb. A significant correlation was observed between decrease in monthly migraine days at the third month and absolute decrease in alpha-CGRP content at the same time-point (P = .02).

Study details: The data come from an observational study including 103 patients with CM who initiated treatment with CGRP mAb and 78 matched control individuals.

Disclosures: This study was supported by the Instituto de Salud Carlos III, IDIVAL Spain, and Lilly grant. J Pascual and V González-Quintanilla declared receiving advisory or speaker honoraria from various sources, including Lilly. Other authors declared no conflicts of interest.

Source: Gárate G et al. Serum alpha and beta-CGRP levels in chronic migraine patients before and after monoclonal antibodies against CGRP or its receptor. Ann Neurol. 2023 (Apr 11). doi: 10.1002/ana.26658

Key clinical point: The alpha-calcitonin gene-related peptide (CGRP) level was significantly elevated in patients with chronic migraine (CM) vs control individuals, which eventually normalized after treatment with CGRP monoclonal antibodies (mAb) and correlated with clinical response.

Major finding: The significantly higher alpha-CGRP levels in patients with CM vs control individuals (P = .004) normalized at 2 weeks (median 40.4 pg/mL; 95% CI 35.6-48.1 pg/mL) and 3 months (median 40.9 pg/mL; 95% CI 36.3-45.9 pg/mL) post-treatment with a CGRP mAb. A significant correlation was observed between decrease in monthly migraine days at the third month and absolute decrease in alpha-CGRP content at the same time-point (P = .02).

Study details: The data come from an observational study including 103 patients with CM who initiated treatment with CGRP mAb and 78 matched control individuals.

Disclosures: This study was supported by the Instituto de Salud Carlos III, IDIVAL Spain, and Lilly grant. J Pascual and V González-Quintanilla declared receiving advisory or speaker honoraria from various sources, including Lilly. Other authors declared no conflicts of interest.

Source: Gárate G et al. Serum alpha and beta-CGRP levels in chronic migraine patients before and after monoclonal antibodies against CGRP or its receptor. Ann Neurol. 2023 (Apr 11). doi: 10.1002/ana.26658

Key clinical point: The alpha-calcitonin gene-related peptide (CGRP) level was significantly elevated in patients with chronic migraine (CM) vs control individuals, which eventually normalized after treatment with CGRP monoclonal antibodies (mAb) and correlated with clinical response.

Major finding: The significantly higher alpha-CGRP levels in patients with CM vs control individuals (P = .004) normalized at 2 weeks (median 40.4 pg/mL; 95% CI 35.6-48.1 pg/mL) and 3 months (median 40.9 pg/mL; 95% CI 36.3-45.9 pg/mL) post-treatment with a CGRP mAb. A significant correlation was observed between decrease in monthly migraine days at the third month and absolute decrease in alpha-CGRP content at the same time-point (P = .02).

Study details: The data come from an observational study including 103 patients with CM who initiated treatment with CGRP mAb and 78 matched control individuals.

Disclosures: This study was supported by the Instituto de Salud Carlos III, IDIVAL Spain, and Lilly grant. J Pascual and V González-Quintanilla declared receiving advisory or speaker honoraria from various sources, including Lilly. Other authors declared no conflicts of interest.

Source: Gárate G et al. Serum alpha and beta-CGRP levels in chronic migraine patients before and after monoclonal antibodies against CGRP or its receptor. Ann Neurol. 2023 (Apr 11). doi: 10.1002/ana.26658

Key clinical point: Switching calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) may benefit patients with episodic migraine (EM) or chronic migraine (CM) who had failed to respond to the first CGRP-mAb or experienced a loss of efficacy over time.

Major finding: Overall, 71.9% of patients responded to the first CGRP-mAb, 42.3% of those who did not respond or experienced a loss of efficacy over time to the first CGRP-mAb responded to the second CGRP-mAb, and 28.6% of patients who received the third CGRP-mAb showed a response.

Study details: Findings are from a retrospective, real-world case series including 171 patients with EM or CM who received one (n = 137), two (n = 27), or all three(n = 7) CGRP-mAb as migraine preventive therapy.

Disclosures: This study received no specific funding from any source. Some authors declared receiving personal fees, unrestricted grants, honoraria, or travel grants from various sources.

Source: Kaltseis K et al. Monoclonal antibodies against CGRP (R): Non-responders and switchers: Real world data from an Austrian case series. BMC Neurol. 2023;23(1):174 (Apr 28). doi: 10.1186/s12883-023-03203-9

Key clinical point: Switching calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) may benefit patients with episodic migraine (EM) or chronic migraine (CM) who had failed to respond to the first CGRP-mAb or experienced a loss of efficacy over time.

Major finding: Overall, 71.9% of patients responded to the first CGRP-mAb, 42.3% of those who did not respond or experienced a loss of efficacy over time to the first CGRP-mAb responded to the second CGRP-mAb, and 28.6% of patients who received the third CGRP-mAb showed a response.

Study details: Findings are from a retrospective, real-world case series including 171 patients with EM or CM who received one (n = 137), two (n = 27), or all three(n = 7) CGRP-mAb as migraine preventive therapy.

Disclosures: This study received no specific funding from any source. Some authors declared receiving personal fees, unrestricted grants, honoraria, or travel grants from various sources.

Source: Kaltseis K et al. Monoclonal antibodies against CGRP (R): Non-responders and switchers: Real world data from an Austrian case series. BMC Neurol. 2023;23(1):174 (Apr 28). doi: 10.1186/s12883-023-03203-9

Key clinical point: Switching calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) may benefit patients with episodic migraine (EM) or chronic migraine (CM) who had failed to respond to the first CGRP-mAb or experienced a loss of efficacy over time.

Major finding: Overall, 71.9% of patients responded to the first CGRP-mAb, 42.3% of those who did not respond or experienced a loss of efficacy over time to the first CGRP-mAb responded to the second CGRP-mAb, and 28.6% of patients who received the third CGRP-mAb showed a response.

Study details: Findings are from a retrospective, real-world case series including 171 patients with EM or CM who received one (n = 137), two (n = 27), or all three(n = 7) CGRP-mAb as migraine preventive therapy.

Disclosures: This study received no specific funding from any source. Some authors declared receiving personal fees, unrestricted grants, honoraria, or travel grants from various sources.

Source: Kaltseis K et al. Monoclonal antibodies against CGRP (R): Non-responders and switchers: Real world data from an Austrian case series. BMC Neurol. 2023;23(1):174 (Apr 28). doi: 10.1186/s12883-023-03203-9

Key clinical point: A higher proportion of patients with episodic migraine (EM), chronic migraine (CM), or treatment-resistant migraine receiving galcanezumab vs placebo achieved a ≥50% response within the first 3 months of treatment, which was sustained for 4-6 months.

Major finding: Galcanezumab vs placebo was associated with higher odds of clinical response in patients with EM (120 mg galcanezumab: odds ratio [OR] 2.7) and CM (120 mg galcanezumab: OR 19.4; all P < .001), with a higher proportion of galcanezumab- vs placebo-treated patients maintaining ≥50% response for 3-6 months of the double-blind treatment period (P < .001).

Study details: This post hoc analysis included 3348 patients with EM (EVOLVE-1 and EVOLVE-2 trials), CM (REGAIN trial), or EM or CM with 2-4 prior treatment failures (CONQUER trial) who received galcanezumab or placebo.

Disclosures: This study was funded by Eli Lilly and Company or one of its subsidiaries, Indianapolis, IN, USA. Three authors declared being employees of Eli Lilly. SJ Tepper declared ties with various sources, including Eli Lilly.

Source: Tepper SJ et al. Sustained response of galcanezumab in migraine prevention: Patient-level data from a post hoc analysis in patients with episodic or chronic migraine. Headache. 2023 (May 3). doi: 10.1111/head.14494

Key clinical point: A higher proportion of patients with episodic migraine (EM), chronic migraine (CM), or treatment-resistant migraine receiving galcanezumab vs placebo achieved a ≥50% response within the first 3 months of treatment, which was sustained for 4-6 months.

Major finding: Galcanezumab vs placebo was associated with higher odds of clinical response in patients with EM (120 mg galcanezumab: odds ratio [OR] 2.7) and CM (120 mg galcanezumab: OR 19.4; all P < .001), with a higher proportion of galcanezumab- vs placebo-treated patients maintaining ≥50% response for 3-6 months of the double-blind treatment period (P < .001).

Study details: This post hoc analysis included 3348 patients with EM (EVOLVE-1 and EVOLVE-2 trials), CM (REGAIN trial), or EM or CM with 2-4 prior treatment failures (CONQUER trial) who received galcanezumab or placebo.

Disclosures: This study was funded by Eli Lilly and Company or one of its subsidiaries, Indianapolis, IN, USA. Three authors declared being employees of Eli Lilly. SJ Tepper declared ties with various sources, including Eli Lilly.

Source: Tepper SJ et al. Sustained response of galcanezumab in migraine prevention: Patient-level data from a post hoc analysis in patients with episodic or chronic migraine. Headache. 2023 (May 3). doi: 10.1111/head.14494

Key clinical point: A higher proportion of patients with episodic migraine (EM), chronic migraine (CM), or treatment-resistant migraine receiving galcanezumab vs placebo achieved a ≥50% response within the first 3 months of treatment, which was sustained for 4-6 months.

Major finding: Galcanezumab vs placebo was associated with higher odds of clinical response in patients with EM (120 mg galcanezumab: odds ratio [OR] 2.7) and CM (120 mg galcanezumab: OR 19.4; all P < .001), with a higher proportion of galcanezumab- vs placebo-treated patients maintaining ≥50% response for 3-6 months of the double-blind treatment period (P < .001).

Study details: This post hoc analysis included 3348 patients with EM (EVOLVE-1 and EVOLVE-2 trials), CM (REGAIN trial), or EM or CM with 2-4 prior treatment failures (CONQUER trial) who received galcanezumab or placebo.

Disclosures: This study was funded by Eli Lilly and Company or one of its subsidiaries, Indianapolis, IN, USA. Three authors declared being employees of Eli Lilly. SJ Tepper declared ties with various sources, including Eli Lilly.

Source: Tepper SJ et al. Sustained response of galcanezumab in migraine prevention: Patient-level data from a post hoc analysis in patients with episodic or chronic migraine. Headache. 2023 (May 3). doi: 10.1111/head.14494

Key clinical point: Eptinezumab led to significantly greater reductions in monthly migraine days (MMD) in patients with migraine who previously failed multiple migraine preventive treatments.

Major finding: Reduction in monthly migraine days over 1-12 weeks was significantly higher with 100 mg eptinezumab (−4.8 days) and 300 mg eptinezumab (−5.3 days) vs placebo (−2.1 days; both P < .0001), with reductions sustained or improved over 13-24 weeks and the odds of achieving ≥50% and ≥75% reduction in MMD favoring eptinezumab over placebo (P < .05).

Study details: This subgroup analysis of the DELIVER trial included 299, 293, and 298 patients with migraine and multiple unsuccessful treatments who were randomly assigned to receive 100 mg eptinezumab, 300 mg eptinezumab, and placebo, respectively.

Disclosures: This study was funded by H. Lundbeck A/S. Some authors declared receiving personal fees or honoraria or serving as consultants or on advisory board for various sources. The other authors declared being full-time employees of H. Lundbeck A/S or one of its subsidiary companies.

Source: Ashina M et al. Efficacy and safety of eptinezumab for migraine prevention in patients with prior preventive treatment failures: Subgroup analysis of the randomized, placebo-controlled DELIVER study. Cephalalgia. 2023 (Apr 26). doi: 10.1177/03331024231170807

Key clinical point: Eptinezumab led to significantly greater reductions in monthly migraine days (MMD) in patients with migraine who previously failed multiple migraine preventive treatments.

Major finding: Reduction in monthly migraine days over 1-12 weeks was significantly higher with 100 mg eptinezumab (−4.8 days) and 300 mg eptinezumab (−5.3 days) vs placebo (−2.1 days; both P < .0001), with reductions sustained or improved over 13-24 weeks and the odds of achieving ≥50% and ≥75% reduction in MMD favoring eptinezumab over placebo (P < .05).

Study details: This subgroup analysis of the DELIVER trial included 299, 293, and 298 patients with migraine and multiple unsuccessful treatments who were randomly assigned to receive 100 mg eptinezumab, 300 mg eptinezumab, and placebo, respectively.

Disclosures: This study was funded by H. Lundbeck A/S. Some authors declared receiving personal fees or honoraria or serving as consultants or on advisory board for various sources. The other authors declared being full-time employees of H. Lundbeck A/S or one of its subsidiary companies.

Source: Ashina M et al. Efficacy and safety of eptinezumab for migraine prevention in patients with prior preventive treatment failures: Subgroup analysis of the randomized, placebo-controlled DELIVER study. Cephalalgia. 2023 (Apr 26). doi: 10.1177/03331024231170807

Key clinical point: Eptinezumab led to significantly greater reductions in monthly migraine days (MMD) in patients with migraine who previously failed multiple migraine preventive treatments.

Major finding: Reduction in monthly migraine days over 1-12 weeks was significantly higher with 100 mg eptinezumab (−4.8 days) and 300 mg eptinezumab (−5.3 days) vs placebo (−2.1 days; both P < .0001), with reductions sustained or improved over 13-24 weeks and the odds of achieving ≥50% and ≥75% reduction in MMD favoring eptinezumab over placebo (P < .05).

Study details: This subgroup analysis of the DELIVER trial included 299, 293, and 298 patients with migraine and multiple unsuccessful treatments who were randomly assigned to receive 100 mg eptinezumab, 300 mg eptinezumab, and placebo, respectively.

Disclosures: This study was funded by H. Lundbeck A/S. Some authors declared receiving personal fees or honoraria or serving as consultants or on advisory board for various sources. The other authors declared being full-time employees of H. Lundbeck A/S or one of its subsidiary companies.

Source: Ashina M et al. Efficacy and safety of eptinezumab for migraine prevention in patients with prior preventive treatment failures: Subgroup analysis of the randomized, placebo-controlled DELIVER study. Cephalalgia. 2023 (Apr 26). doi: 10.1177/03331024231170807

Key clinical point: Half of the patients with high-frequency episodic migraine (HFEM) or chronic migraine (CM) who did not respond to anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) at 12 weeks were indeed late responders, suggesting the need for extension of treatment duration beyond 12 months.

Major finding: At 12 weeks, 34.4% were nonresponders, of which 55.1% showed response between 13 and 24 weeks and were classified as late responders. Compared with responders, late responders had a higher body mass index (P = .024), more frequent prior treatment failures (P = .017), and psychiatric comorbidities (P = .041).

Study details: This was a prospective, real-life study including 771 patients with HFEM or CM who received anti-CGRP mAb for ≥24 weeks.

Disclosures: This study was partially supported by the Italian Ministry of Health, IRCCS San Raffaele Roma, and Fondazione Italiana Cefalee. Some authors declared receiving travel grants or honoraria for advisory board participations or serving on speaker panels or clinical investigation studies for various sources.

Source: Barbanti P et al for the Italian Migraine Registry study group. Late response to anti-CGRP monoclonal antibodies in migraine: A multicenter, prospective, observational study. Neurology. 2023 (Apr 18). doi: 10.1212/WNL.0000000000207292

Key clinical point: Half of the patients with high-frequency episodic migraine (HFEM) or chronic migraine (CM) who did not respond to anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) at 12 weeks were indeed late responders, suggesting the need for extension of treatment duration beyond 12 months.

Major finding: At 12 weeks, 34.4% were nonresponders, of which 55.1% showed response between 13 and 24 weeks and were classified as late responders. Compared with responders, late responders had a higher body mass index (P = .024), more frequent prior treatment failures (P = .017), and psychiatric comorbidities (P = .041).

Study details: This was a prospective, real-life study including 771 patients with HFEM or CM who received anti-CGRP mAb for ≥24 weeks.

Disclosures: This study was partially supported by the Italian Ministry of Health, IRCCS San Raffaele Roma, and Fondazione Italiana Cefalee. Some authors declared receiving travel grants or honoraria for advisory board participations or serving on speaker panels or clinical investigation studies for various sources.

Source: Barbanti P et al for the Italian Migraine Registry study group. Late response to anti-CGRP monoclonal antibodies in migraine: A multicenter, prospective, observational study. Neurology. 2023 (Apr 18). doi: 10.1212/WNL.0000000000207292

Key clinical point: Half of the patients with high-frequency episodic migraine (HFEM) or chronic migraine (CM) who did not respond to anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAb) at 12 weeks were indeed late responders, suggesting the need for extension of treatment duration beyond 12 months.

Major finding: At 12 weeks, 34.4% were nonresponders, of which 55.1% showed response between 13 and 24 weeks and were classified as late responders. Compared with responders, late responders had a higher body mass index (P = .024), more frequent prior treatment failures (P = .017), and psychiatric comorbidities (P = .041).

Study details: This was a prospective, real-life study including 771 patients with HFEM or CM who received anti-CGRP mAb for ≥24 weeks.

Disclosures: This study was partially supported by the Italian Ministry of Health, IRCCS San Raffaele Roma, and Fondazione Italiana Cefalee. Some authors declared receiving travel grants or honoraria for advisory board participations or serving on speaker panels or clinical investigation studies for various sources.

Source: Barbanti P et al for the Italian Migraine Registry study group. Late response to anti-CGRP monoclonal antibodies in migraine: A multicenter, prospective, observational study. Neurology. 2023 (Apr 18). doi: 10.1212/WNL.0000000000207292

The theme of this month's round-up is women's health, specifically as it relates to migraine. Three recent studies have highlighted the connection between estrogen and migraine, in terms of the potential increase in risk for certain conditions, such as gestational hypertension and endometriosis, and the use of potential therapies, such as calcitonin gene-related peptide (CGRP) antagonist medications to treat menstrual migraine.

Although most practitioners know that there is a deep connection between vascular risk and migraine, most are unfamiliar with the specific interplay between these two conditions. Antihypertensive medications are common preventive treatments for migraine, and migraine itself has been associated with an increased risk for specific vascular issues in pregnancy, most notably venous sinus thrombosis. Crowe and colleagues specifically looked at whether women with migraine experience a higher risk for hypertensive disorders of pregnancy.

This was a UK-based prospective cohort study using a large longitudinal database called the Clinical Practice Research Datalink. Over 1 million live-born or stillborn deliveries were analyzed from 1993 through 2020. The data were linked to diagnosis and prescription codes for migraine that were filled or documented before 20 weeks of gestation and compared with diagnosis codes for hypertensive disorders that occurred from week 20 through the pregnancy and delivery. Regression models were then used to estimate risk ratios and CI. Only single pregnancies were counted because multiple pregnancies already are associated with a higher risk for most other vascular conditions.

Any history of migraine prior to pregnancy was associated with an increased risk for gestational hypertension, eclampsia, and preeclampsia (relative risk 1.17). The greatest risk was higher frequency. Migraine that persisted into the first trimester led to a relative risk of 1.84. The use of migraine medications, especially vasoconstrictive-type medications, was also associated with a higher risk compared with women without migraine.

Women with migraine frequently present before family planning to discuss the potential risks and options of migraine treatment during pregnancy. In addition to discussing the most appropriate preventive and acute medications, it would be appropriate also to discuss any potential red flag symptoms that may occur during pregnancy. This discussion should include hypertensive disorders of pregnancy as per this study.

Since the advent of CGRP antagonist treatments for migraine, many practitioners and patients have been curious to know whether specific features of migraine are better treated with this class of medication. There are now both acute and preventive CGRP antagonists, both as small molecule agents and monoclonal antibodies (mAb). Menstrual migraines specifically can be a more difficult-to-treat subtype, and often when other triggers are negated, hormonal fluctuation can still be a significant problem for many patients. Verhagen and colleagues set out to determine whether CGRP mAb are more or less effective for menstrually associated migraine.

This analysis was post hoc, using data from a single-arm study investigating the efficacy of two of the CGRP mAb medications: erenumab and fremanezumab. Patients were included if they had a history of migraine with > 8 monthly migraine days and at least one antihypertensive or antiepileptic preventive treatment for migraine had previously failed. Any other prophylactic medications were tapered before starting this trial; patients were given a validated electronic diary, and adherence to this diary had to be > 80%. Women were also excluded if they did not have regular menses (for instance, if they were on continuous hormonal contraception) or they were postmenopausal. Logistic regression was used to compare the preventive effect of these medications on perimenstrual and non-perimenstrual migraine attacks.

A total of 45 women were included in this observation. The relative reduction in total monthly migraine days was 31.4%; 28% were noted during and around menses, 32% were during other times of the menstrual cycle. Sensitivity analysis showed no significant difference between these two periods of time, and the ratio remained statistically similar as well.

It appears that the relative reduction in monthly migraine days did not fluctuate when the patient was treated with a CGRP antagonist mAb. Although other classes of preventive medication, specifically onabotulinumtoxinA (Botox), may affect menstrually associated migraine less potently, it appears that the CGRP antagonist class may be just as effective regardless of the underlying migraine trigger. It would definitely be worth considering a CGRP antagonist trial, or the addition of a CGRP mAb, if menstrual migraine remains significant despite otherwise effective preventive treatment.

Migraine is strongly affected by fluctuations in estrogen, and women with endometriosis often experience headaches associated with their severe attacks. Pasquini and colleagues specifically looked to see if the headache associated with endometriosis could be better diagnosed. Specifically, were these women experiencing migraine or another headache disorder?

This was a consecutive case-control series of 131 women admitted to a specialty endometriosis clinic. They were given a validated headache questionnaire that was reviewed by a neurologist to determine a diagnosis of migraine vs a diagnosis of another headache disorder. The case group included women with a history of endometriosis who were previously diagnosed with migraine, while the control group consisted of women with endometriosis only who did not have a history of headache.

Diagnosis of migraine was made in 53.4% of all patients: 18.6% of those experienced pure menstrual migraine (defined as migraine only occurring perimenstrually), 46% had some menstrually associated migraine symptoms, and 36% had purely non-menstrual migraine. Painful periods and dysuria were more frequent in patients with endometriosis and migraine compared with those without migraine. Other menstrually related conditions, including the duration of endometriosis, the phenotype of endometriosis, the presence of other systemic comorbidities, or heavy menstrual bleeding did not seem to differ significantly between the migraine and non-migraine groups.

Women of reproductive age consistently are seen most often for migraine and other headache conditions. Much of this is related to menstrual migraine and the effect that hormonal fluctuation has on migraine frequency and severity. Most practitioners work closely with their patient's gynecologist to determine which hormonal treatments and migraine treatments are most appropriate and safe for each individual situation. This study in particular sheds light on the particular phenotypes of headache pain and the specific headache diagnosis that most women with endometriosis experience.

The theme of this month's round-up is women's health, specifically as it relates to migraine. Three recent studies have highlighted the connection between estrogen and migraine, in terms of the potential increase in risk for certain conditions, such as gestational hypertension and endometriosis, and the use of potential therapies, such as calcitonin gene-related peptide (CGRP) antagonist medications to treat menstrual migraine.

Although most practitioners know that there is a deep connection between vascular risk and migraine, most are unfamiliar with the specific interplay between these two conditions. Antihypertensive medications are common preventive treatments for migraine, and migraine itself has been associated with an increased risk for specific vascular issues in pregnancy, most notably venous sinus thrombosis. Crowe and colleagues specifically looked at whether women with migraine experience a higher risk for hypertensive disorders of pregnancy.

This was a UK-based prospective cohort study using a large longitudinal database called the Clinical Practice Research Datalink. Over 1 million live-born or stillborn deliveries were analyzed from 1993 through 2020. The data were linked to diagnosis and prescription codes for migraine that were filled or documented before 20 weeks of gestation and compared with diagnosis codes for hypertensive disorders that occurred from week 20 through the pregnancy and delivery. Regression models were then used to estimate risk ratios and CI. Only single pregnancies were counted because multiple pregnancies already are associated with a higher risk for most other vascular conditions.

Any history of migraine prior to pregnancy was associated with an increased risk for gestational hypertension, eclampsia, and preeclampsia (relative risk 1.17). The greatest risk was higher frequency. Migraine that persisted into the first trimester led to a relative risk of 1.84. The use of migraine medications, especially vasoconstrictive-type medications, was also associated with a higher risk compared with women without migraine.

Women with migraine frequently present before family planning to discuss the potential risks and options of migraine treatment during pregnancy. In addition to discussing the most appropriate preventive and acute medications, it would be appropriate also to discuss any potential red flag symptoms that may occur during pregnancy. This discussion should include hypertensive disorders of pregnancy as per this study.

Since the advent of CGRP antagonist treatments for migraine, many practitioners and patients have been curious to know whether specific features of migraine are better treated with this class of medication. There are now both acute and preventive CGRP antagonists, both as small molecule agents and monoclonal antibodies (mAb). Menstrual migraines specifically can be a more difficult-to-treat subtype, and often when other triggers are negated, hormonal fluctuation can still be a significant problem for many patients. Verhagen and colleagues set out to determine whether CGRP mAb are more or less effective for menstrually associated migraine.

This analysis was post hoc, using data from a single-arm study investigating the efficacy of two of the CGRP mAb medications: erenumab and fremanezumab. Patients were included if they had a history of migraine with > 8 monthly migraine days and at least one antihypertensive or antiepileptic preventive treatment for migraine had previously failed. Any other prophylactic medications were tapered before starting this trial; patients were given a validated electronic diary, and adherence to this diary had to be > 80%. Women were also excluded if they did not have regular menses (for instance, if they were on continuous hormonal contraception) or they were postmenopausal. Logistic regression was used to compare the preventive effect of these medications on perimenstrual and non-perimenstrual migraine attacks.

A total of 45 women were included in this observation. The relative reduction in total monthly migraine days was 31.4%; 28% were noted during and around menses, 32% were during other times of the menstrual cycle. Sensitivity analysis showed no significant difference between these two periods of time, and the ratio remained statistically similar as well.

It appears that the relative reduction in monthly migraine days did not fluctuate when the patient was treated with a CGRP antagonist mAb. Although other classes of preventive medication, specifically onabotulinumtoxinA (Botox), may affect menstrually associated migraine less potently, it appears that the CGRP antagonist class may be just as effective regardless of the underlying migraine trigger. It would definitely be worth considering a CGRP antagonist trial, or the addition of a CGRP mAb, if menstrual migraine remains significant despite otherwise effective preventive treatment.

Migraine is strongly affected by fluctuations in estrogen, and women with endometriosis often experience headaches associated with their severe attacks. Pasquini and colleagues specifically looked to see if the headache associated with endometriosis could be better diagnosed. Specifically, were these women experiencing migraine or another headache disorder?

This was a consecutive case-control series of 131 women admitted to a specialty endometriosis clinic. They were given a validated headache questionnaire that was reviewed by a neurologist to determine a diagnosis of migraine vs a diagnosis of another headache disorder. The case group included women with a history of endometriosis who were previously diagnosed with migraine, while the control group consisted of women with endometriosis only who did not have a history of headache.

Diagnosis of migraine was made in 53.4% of all patients: 18.6% of those experienced pure menstrual migraine (defined as migraine only occurring perimenstrually), 46% had some menstrually associated migraine symptoms, and 36% had purely non-menstrual migraine. Painful periods and dysuria were more frequent in patients with endometriosis and migraine compared with those without migraine. Other menstrually related conditions, including the duration of endometriosis, the phenotype of endometriosis, the presence of other systemic comorbidities, or heavy menstrual bleeding did not seem to differ significantly between the migraine and non-migraine groups.

Women of reproductive age consistently are seen most often for migraine and other headache conditions. Much of this is related to menstrual migraine and the effect that hormonal fluctuation has on migraine frequency and severity. Most practitioners work closely with their patient's gynecologist to determine which hormonal treatments and migraine treatments are most appropriate and safe for each individual situation. This study in particular sheds light on the particular phenotypes of headache pain and the specific headache diagnosis that most women with endometriosis experience.

The theme of this month's round-up is women's health, specifically as it relates to migraine. Three recent studies have highlighted the connection between estrogen and migraine, in terms of the potential increase in risk for certain conditions, such as gestational hypertension and endometriosis, and the use of potential therapies, such as calcitonin gene-related peptide (CGRP) antagonist medications to treat menstrual migraine.

Although most practitioners know that there is a deep connection between vascular risk and migraine, most are unfamiliar with the specific interplay between these two conditions. Antihypertensive medications are common preventive treatments for migraine, and migraine itself has been associated with an increased risk for specific vascular issues in pregnancy, most notably venous sinus thrombosis. Crowe and colleagues specifically looked at whether women with migraine experience a higher risk for hypertensive disorders of pregnancy.

This was a UK-based prospective cohort study using a large longitudinal database called the Clinical Practice Research Datalink. Over 1 million live-born or stillborn deliveries were analyzed from 1993 through 2020. The data were linked to diagnosis and prescription codes for migraine that were filled or documented before 20 weeks of gestation and compared with diagnosis codes for hypertensive disorders that occurred from week 20 through the pregnancy and delivery. Regression models were then used to estimate risk ratios and CI. Only single pregnancies were counted because multiple pregnancies already are associated with a higher risk for most other vascular conditions.

Any history of migraine prior to pregnancy was associated with an increased risk for gestational hypertension, eclampsia, and preeclampsia (relative risk 1.17). The greatest risk was higher frequency. Migraine that persisted into the first trimester led to a relative risk of 1.84. The use of migraine medications, especially vasoconstrictive-type medications, was also associated with a higher risk compared with women without migraine.

Women with migraine frequently present before family planning to discuss the potential risks and options of migraine treatment during pregnancy. In addition to discussing the most appropriate preventive and acute medications, it would be appropriate also to discuss any potential red flag symptoms that may occur during pregnancy. This discussion should include hypertensive disorders of pregnancy as per this study.

Since the advent of CGRP antagonist treatments for migraine, many practitioners and patients have been curious to know whether specific features of migraine are better treated with this class of medication. There are now both acute and preventive CGRP antagonists, both as small molecule agents and monoclonal antibodies (mAb). Menstrual migraines specifically can be a more difficult-to-treat subtype, and often when other triggers are negated, hormonal fluctuation can still be a significant problem for many patients. Verhagen and colleagues set out to determine whether CGRP mAb are more or less effective for menstrually associated migraine.

This analysis was post hoc, using data from a single-arm study investigating the efficacy of two of the CGRP mAb medications: erenumab and fremanezumab. Patients were included if they had a history of migraine with > 8 monthly migraine days and at least one antihypertensive or antiepileptic preventive treatment for migraine had previously failed. Any other prophylactic medications were tapered before starting this trial; patients were given a validated electronic diary, and adherence to this diary had to be > 80%. Women were also excluded if they did not have regular menses (for instance, if they were on continuous hormonal contraception) or they were postmenopausal. Logistic regression was used to compare the preventive effect of these medications on perimenstrual and non-perimenstrual migraine attacks.

A total of 45 women were included in this observation. The relative reduction in total monthly migraine days was 31.4%; 28% were noted during and around menses, 32% were during other times of the menstrual cycle. Sensitivity analysis showed no significant difference between these two periods of time, and the ratio remained statistically similar as well.

It appears that the relative reduction in monthly migraine days did not fluctuate when the patient was treated with a CGRP antagonist mAb. Although other classes of preventive medication, specifically onabotulinumtoxinA (Botox), may affect menstrually associated migraine less potently, it appears that the CGRP antagonist class may be just as effective regardless of the underlying migraine trigger. It would definitely be worth considering a CGRP antagonist trial, or the addition of a CGRP mAb, if menstrual migraine remains significant despite otherwise effective preventive treatment.

Migraine is strongly affected by fluctuations in estrogen, and women with endometriosis often experience headaches associated with their severe attacks. Pasquini and colleagues specifically looked to see if the headache associated with endometriosis could be better diagnosed. Specifically, were these women experiencing migraine or another headache disorder?

This was a consecutive case-control series of 131 women admitted to a specialty endometriosis clinic. They were given a validated headache questionnaire that was reviewed by a neurologist to determine a diagnosis of migraine vs a diagnosis of another headache disorder. The case group included women with a history of endometriosis who were previously diagnosed with migraine, while the control group consisted of women with endometriosis only who did not have a history of headache.

Diagnosis of migraine was made in 53.4% of all patients: 18.6% of those experienced pure menstrual migraine (defined as migraine only occurring perimenstrually), 46% had some menstrually associated migraine symptoms, and 36% had purely non-menstrual migraine. Painful periods and dysuria were more frequent in patients with endometriosis and migraine compared with those without migraine. Other menstrually related conditions, including the duration of endometriosis, the phenotype of endometriosis, the presence of other systemic comorbidities, or heavy menstrual bleeding did not seem to differ significantly between the migraine and non-migraine groups.

Women of reproductive age consistently are seen most often for migraine and other headache conditions. Much of this is related to menstrual migraine and the effect that hormonal fluctuation has on migraine frequency and severity. Most practitioners work closely with their patient's gynecologist to determine which hormonal treatments and migraine treatments are most appropriate and safe for each individual situation. This study in particular sheds light on the particular phenotypes of headache pain and the specific headache diagnosis that most women with endometriosis experience.