Migraine ICYMI

Key clinical point: Migraine history was associated with poor sleep quality in premenopausal women, but not in perimenopausal women.

Major finding: A significant association was observed between migraine history and poor sleep quality in premenopausal women (odds ratio [OR] 1.4; 95% CI 1.01-2.04; P  =  .044) but not in perimenopausal women (OR 1.14; 95% CI 0.80-1.64; P  =  .46).

Study details: The data come from a cross-sectional analysis of 2067 women (premenopausal n = 962; perimenopausal n = 1105) from the Data Registry on the Experiences of Aging, Menopause, and Sexuality, of which 594 (28.7%) had a migraine history.

Disclosures: This study did not receive any funding. Some authors declared being consultants for or receiving past funding, consulting fees, grant support, or honoraria from various organizations.

Source: Faubion SS et al. Migraine and sleep quality: Does the association change in midlife women? Menopause. 2023 (Jan 31). Doi: 10.1097/GME.0000000000002149

Key clinical point: Migraine history was associated with poor sleep quality in premenopausal women, but not in perimenopausal women.

Major finding: A significant association was observed between migraine history and poor sleep quality in premenopausal women (odds ratio [OR] 1.4; 95% CI 1.01-2.04; P  =  .044) but not in perimenopausal women (OR 1.14; 95% CI 0.80-1.64; P  =  .46).

Study details: The data come from a cross-sectional analysis of 2067 women (premenopausal n = 962; perimenopausal n = 1105) from the Data Registry on the Experiences of Aging, Menopause, and Sexuality, of which 594 (28.7%) had a migraine history.

Disclosures: This study did not receive any funding. Some authors declared being consultants for or receiving past funding, consulting fees, grant support, or honoraria from various organizations.

Source: Faubion SS et al. Migraine and sleep quality: Does the association change in midlife women? Menopause. 2023 (Jan 31). Doi: 10.1097/GME.0000000000002149

Key clinical point: Migraine history was associated with poor sleep quality in premenopausal women, but not in perimenopausal women.

Major finding: A significant association was observed between migraine history and poor sleep quality in premenopausal women (odds ratio [OR] 1.4; 95% CI 1.01-2.04; P  =  .044) but not in perimenopausal women (OR 1.14; 95% CI 0.80-1.64; P  =  .46).

Study details: The data come from a cross-sectional analysis of 2067 women (premenopausal n = 962; perimenopausal n = 1105) from the Data Registry on the Experiences of Aging, Menopause, and Sexuality, of which 594 (28.7%) had a migraine history.

Disclosures: This study did not receive any funding. Some authors declared being consultants for or receiving past funding, consulting fees, grant support, or honoraria from various organizations.

Source: Faubion SS et al. Migraine and sleep quality: Does the association change in midlife women? Menopause. 2023 (Jan 31). Doi: 10.1097/GME.0000000000002149

Key clinical point: Migraine may be associated with an increased risk for any stroke and ischemic stroke in middle-aged and elderly populations.

Major finding: Findings suggested an association between migraine and risk for any stroke (adjusted hazard ratio [aHR] 1.44; P  =  .076) and ischemic stroke (aHR 1.50; P  =  .067), but without statistical significance.

Study details: This ongoing prospective population-based cohort study included 6925 stroke-free participants, of which 1030 participants had a lifetime history of migraine and 195 participants developed incident stroke.

Disclosures: This study received funding from Erasmus Medical Center, Erasmus University, Netherlands, and other sources. AMVD Brink declared receiving support from the Dutch Research Council and research grants or consulting fees from AbbVie/Allergan and other sources.

Source: Acarsoy C et al. Migraine and the risk of stroke in a middle-aged and elderly population: A prospective cohort study. Cephalalgia. 2023;43(1):3331024221132008 (Jan 9). Doi: 10.1177/03331024221132008

Key clinical point: Migraine may be associated with an increased risk for any stroke and ischemic stroke in middle-aged and elderly populations.

Major finding: Findings suggested an association between migraine and risk for any stroke (adjusted hazard ratio [aHR] 1.44; P  =  .076) and ischemic stroke (aHR 1.50; P  =  .067), but without statistical significance.

Study details: This ongoing prospective population-based cohort study included 6925 stroke-free participants, of which 1030 participants had a lifetime history of migraine and 195 participants developed incident stroke.

Disclosures: This study received funding from Erasmus Medical Center, Erasmus University, Netherlands, and other sources. AMVD Brink declared receiving support from the Dutch Research Council and research grants or consulting fees from AbbVie/Allergan and other sources.

Source: Acarsoy C et al. Migraine and the risk of stroke in a middle-aged and elderly population: A prospective cohort study. Cephalalgia. 2023;43(1):3331024221132008 (Jan 9). Doi: 10.1177/03331024221132008

Key clinical point: Migraine may be associated with an increased risk for any stroke and ischemic stroke in middle-aged and elderly populations.

Major finding: Findings suggested an association between migraine and risk for any stroke (adjusted hazard ratio [aHR] 1.44; P  =  .076) and ischemic stroke (aHR 1.50; P  =  .067), but without statistical significance.

Study details: This ongoing prospective population-based cohort study included 6925 stroke-free participants, of which 1030 participants had a lifetime history of migraine and 195 participants developed incident stroke.

Disclosures: This study received funding from Erasmus Medical Center, Erasmus University, Netherlands, and other sources. AMVD Brink declared receiving support from the Dutch Research Council and research grants or consulting fees from AbbVie/Allergan and other sources.

Source: Acarsoy C et al. Migraine and the risk of stroke in a middle-aged and elderly population: A prospective cohort study. Cephalalgia. 2023;43(1):3331024221132008 (Jan 9). Doi: 10.1177/03331024221132008

Key clinical point: Acupuncture showed a similar preventive treatment effect to fremanezumab in patients with episodic migraine; however, acupuncture was associated with lower adverse event rates.

Major finding: Compared with acupuncture, monthly and single-dose fremanezumab showed similar decrease in monthly migraine days (P  =  .473 and P  =  .214, respectively) and 50% responder rate (P  =  .17 and P  =  .109, respectively).  The adverse event risk was lower with acupuncture (25%) vs monthly and single-dose fremanezumab (both 66%).

Study details: This study evaluated 302 patients with episodic migraine from an acupuncture trial (acupuncture n = 145; sham acupuncture n = 81; waiting-list control n = 76) and 875 patients with episodic migraine from the fremanezumab trial (monthly fremanezumab n = 290; single-dose fremanezumab n = 291; placebo n = 294).

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

Source: Zheng H et al. Matching adjusted indirect comparison of acupuncture versus fremanezumab in the preventive treatment of episodic migraine. Curr Med Res Opin. 2023 (Feb 8). Doi: 10.1080/03007995.2023.2174746

Key clinical point: Acupuncture showed a similar preventive treatment effect to fremanezumab in patients with episodic migraine; however, acupuncture was associated with lower adverse event rates.

Major finding: Compared with acupuncture, monthly and single-dose fremanezumab showed similar decrease in monthly migraine days (P  =  .473 and P  =  .214, respectively) and 50% responder rate (P  =  .17 and P  =  .109, respectively).  The adverse event risk was lower with acupuncture (25%) vs monthly and single-dose fremanezumab (both 66%).

Study details: This study evaluated 302 patients with episodic migraine from an acupuncture trial (acupuncture n = 145; sham acupuncture n = 81; waiting-list control n = 76) and 875 patients with episodic migraine from the fremanezumab trial (monthly fremanezumab n = 290; single-dose fremanezumab n = 291; placebo n = 294).

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

Source: Zheng H et al. Matching adjusted indirect comparison of acupuncture versus fremanezumab in the preventive treatment of episodic migraine. Curr Med Res Opin. 2023 (Feb 8). Doi: 10.1080/03007995.2023.2174746

Key clinical point: Acupuncture showed a similar preventive treatment effect to fremanezumab in patients with episodic migraine; however, acupuncture was associated with lower adverse event rates.

Major finding: Compared with acupuncture, monthly and single-dose fremanezumab showed similar decrease in monthly migraine days (P  =  .473 and P  =  .214, respectively) and 50% responder rate (P  =  .17 and P  =  .109, respectively).  The adverse event risk was lower with acupuncture (25%) vs monthly and single-dose fremanezumab (both 66%).

Study details: This study evaluated 302 patients with episodic migraine from an acupuncture trial (acupuncture n = 145; sham acupuncture n = 81; waiting-list control n = 76) and 875 patients with episodic migraine from the fremanezumab trial (monthly fremanezumab n = 290; single-dose fremanezumab n = 291; placebo n = 294).

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

Source: Zheng H et al. Matching adjusted indirect comparison of acupuncture versus fremanezumab in the preventive treatment of episodic migraine. Curr Med Res Opin. 2023 (Feb 8). Doi: 10.1080/03007995.2023.2174746

Key clinical point: Patients with difficult-to-treat chronic migraine and insufficient treatment response after the first 2 cycles of onabotulinumtoxinA showed improvements in migraine-related outcomes after switching to anti-calcitonin gene-related peptide monoclonal antibodies (anti-CGRP mAbs).

Major finding: At 9 months, a higher proportion of patients achieved a ≥50% response rate (65.0% vs 22.4%) and reported a greater reduction in monthly headache days (change from baseline −12.0 vs −5.0 days) with anti-CGRP mAbs vs onabotulinumtoxinA treatment. No serious adverse events were reported. Treatment discontinuation due to adverse events was reported by 2 patients.

Study details: This retrospective analysis included 78 patients with difficult-to-treat chronic migraine with or without medication overuse and ≥2 migraine preventive treatment failures who discontinued onabotulinumtoxinA and switched to anti-CGRP mAbs.

Disclosures: This study did not receive any specific funding. Three authors declared receiving personal fees or grants or serving on a scientific advisory board and as a founding scientist for various sources.

Source: Iannone LF et al. Switching onabotulinumtoxinA to monoclonal anti-CGRP antibodies in drug-resistant chronic migraine. CNS Drugs. 2023;37(2):189-202 (Jan 19).  Doi: 10.1007/s40263-022-00983-5

Key clinical point: Patients with difficult-to-treat chronic migraine and insufficient treatment response after the first 2 cycles of onabotulinumtoxinA showed improvements in migraine-related outcomes after switching to anti-calcitonin gene-related peptide monoclonal antibodies (anti-CGRP mAbs).

Major finding: At 9 months, a higher proportion of patients achieved a ≥50% response rate (65.0% vs 22.4%) and reported a greater reduction in monthly headache days (change from baseline −12.0 vs −5.0 days) with anti-CGRP mAbs vs onabotulinumtoxinA treatment. No serious adverse events were reported. Treatment discontinuation due to adverse events was reported by 2 patients.

Study details: This retrospective analysis included 78 patients with difficult-to-treat chronic migraine with or without medication overuse and ≥2 migraine preventive treatment failures who discontinued onabotulinumtoxinA and switched to anti-CGRP mAbs.

Disclosures: This study did not receive any specific funding. Three authors declared receiving personal fees or grants or serving on a scientific advisory board and as a founding scientist for various sources.

Source: Iannone LF et al. Switching onabotulinumtoxinA to monoclonal anti-CGRP antibodies in drug-resistant chronic migraine. CNS Drugs. 2023;37(2):189-202 (Jan 19).  Doi: 10.1007/s40263-022-00983-5

Key clinical point: Patients with difficult-to-treat chronic migraine and insufficient treatment response after the first 2 cycles of onabotulinumtoxinA showed improvements in migraine-related outcomes after switching to anti-calcitonin gene-related peptide monoclonal antibodies (anti-CGRP mAbs).

Major finding: At 9 months, a higher proportion of patients achieved a ≥50% response rate (65.0% vs 22.4%) and reported a greater reduction in monthly headache days (change from baseline −12.0 vs −5.0 days) with anti-CGRP mAbs vs onabotulinumtoxinA treatment. No serious adverse events were reported. Treatment discontinuation due to adverse events was reported by 2 patients.

Study details: This retrospective analysis included 78 patients with difficult-to-treat chronic migraine with or without medication overuse and ≥2 migraine preventive treatment failures who discontinued onabotulinumtoxinA and switched to anti-CGRP mAbs.

Disclosures: This study did not receive any specific funding. Three authors declared receiving personal fees or grants or serving on a scientific advisory board and as a founding scientist for various sources.

Source: Iannone LF et al. Switching onabotulinumtoxinA to monoclonal anti-CGRP antibodies in drug-resistant chronic migraine. CNS Drugs. 2023;37(2):189-202 (Jan 19).  Doi: 10.1007/s40263-022-00983-5

Key clinical point: Eptinezumab vs placebo demonstrated early, sustained, and clinically meaningful improvements in patient-reported outcomes in patients with chronic migraine and medication-overuse headache.

Major finding: Higher proportions of patients receiving 100/300 mg eptinezumab vs placebo showed ≥6-point reduction in the 6-item Headache Impact Test total score (46.0%/57.1% vs 31.7%) at week 4 and improvements in Patient Global Impression of Change scores (58.5%/67.4% vs 35.8%) and patient-identified most bothersome symptom (57.1%/64.6% vs 29.9%) at week 12, which was sustained until week 24.

Study details: This post hoc analysis of the phase 3 PROMISE-2 trial included a subgroup of 431 patients with chronic migraine and medication-overuse headache who were randomly assigned to receive ≤2 doses of eptinezumab (100/300 mg) or placebo.

Disclosures: The trial was funded by Lundbeck Seattle BioPharmaceuticals, Inc. Three authors declared being current or former employees of Lundbeck or its subsidiaries or a company contracted by H Lundbeck A/S. Several authors reported ties with various sources, including Lundbeck.

Source: Starling AJ et al. Eptinezumab improved patient-reported outcomes in patients with migraine and medication-overuse headache: Subgroup analysis of the randomized PROMISE-2 trial. Headache. 2023 (Jan 12). Doi: 10.1111/head.14434

Key clinical point: Eptinezumab vs placebo demonstrated early, sustained, and clinically meaningful improvements in patient-reported outcomes in patients with chronic migraine and medication-overuse headache.

Major finding: Higher proportions of patients receiving 100/300 mg eptinezumab vs placebo showed ≥6-point reduction in the 6-item Headache Impact Test total score (46.0%/57.1% vs 31.7%) at week 4 and improvements in Patient Global Impression of Change scores (58.5%/67.4% vs 35.8%) and patient-identified most bothersome symptom (57.1%/64.6% vs 29.9%) at week 12, which was sustained until week 24.

Study details: This post hoc analysis of the phase 3 PROMISE-2 trial included a subgroup of 431 patients with chronic migraine and medication-overuse headache who were randomly assigned to receive ≤2 doses of eptinezumab (100/300 mg) or placebo.

Disclosures: The trial was funded by Lundbeck Seattle BioPharmaceuticals, Inc. Three authors declared being current or former employees of Lundbeck or its subsidiaries or a company contracted by H Lundbeck A/S. Several authors reported ties with various sources, including Lundbeck.

Source: Starling AJ et al. Eptinezumab improved patient-reported outcomes in patients with migraine and medication-overuse headache: Subgroup analysis of the randomized PROMISE-2 trial. Headache. 2023 (Jan 12). Doi: 10.1111/head.14434

Key clinical point: Eptinezumab vs placebo demonstrated early, sustained, and clinically meaningful improvements in patient-reported outcomes in patients with chronic migraine and medication-overuse headache.

Major finding: Higher proportions of patients receiving 100/300 mg eptinezumab vs placebo showed ≥6-point reduction in the 6-item Headache Impact Test total score (46.0%/57.1% vs 31.7%) at week 4 and improvements in Patient Global Impression of Change scores (58.5%/67.4% vs 35.8%) and patient-identified most bothersome symptom (57.1%/64.6% vs 29.9%) at week 12, which was sustained until week 24.

Study details: This post hoc analysis of the phase 3 PROMISE-2 trial included a subgroup of 431 patients with chronic migraine and medication-overuse headache who were randomly assigned to receive ≤2 doses of eptinezumab (100/300 mg) or placebo.

Disclosures: The trial was funded by Lundbeck Seattle BioPharmaceuticals, Inc. Three authors declared being current or former employees of Lundbeck or its subsidiaries or a company contracted by H Lundbeck A/S. Several authors reported ties with various sources, including Lundbeck.

Source: Starling AJ et al. Eptinezumab improved patient-reported outcomes in patients with migraine and medication-overuse headache: Subgroup analysis of the randomized PROMISE-2 trial. Headache. 2023 (Jan 12). Doi: 10.1111/head.14434

Key clinical point: Galcanezumab significantly improved migraine-related outcomes in patients with high-frequency episodic migraine (HFEM) or chronic migraine, with a large proportion of patients experiencing improvements in photophobia mostly within the first month of treatment.

Major finding: Galcanezumab significantly improved headache days, migraine days, analgesics consumption, Migraine Disability Assessment scores, and Headache Impact Test-6 scores at 3 and 6 months (all P < .0001). Overall, 68.1% of patients experienced a significant improvement in ictal photophobia, of which 56.3% of patients reported an improvement within the first month of treatment.

Study details: This retrospective observational study included 47 patients with HFEM or chronic migraine and ≥3 previous prophylactic treatment failures who experienced moderate-to-severe photophobia during migraine attacks and received galcanezumab.

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

Source: Schiano di Cola F et al. Photophobia and migraine outcome during treatment with galcanezumab. Front Neurol. 2023;13:1088036 (Jan 18). Doi: 10.3389/fneur.2022.1088036

Key clinical point: Galcanezumab significantly improved migraine-related outcomes in patients with high-frequency episodic migraine (HFEM) or chronic migraine, with a large proportion of patients experiencing improvements in photophobia mostly within the first month of treatment.

Major finding: Galcanezumab significantly improved headache days, migraine days, analgesics consumption, Migraine Disability Assessment scores, and Headache Impact Test-6 scores at 3 and 6 months (all P < .0001). Overall, 68.1% of patients experienced a significant improvement in ictal photophobia, of which 56.3% of patients reported an improvement within the first month of treatment.

Study details: This retrospective observational study included 47 patients with HFEM or chronic migraine and ≥3 previous prophylactic treatment failures who experienced moderate-to-severe photophobia during migraine attacks and received galcanezumab.

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

Source: Schiano di Cola F et al. Photophobia and migraine outcome during treatment with galcanezumab. Front Neurol. 2023;13:1088036 (Jan 18). Doi: 10.3389/fneur.2022.1088036

Key clinical point: Galcanezumab significantly improved migraine-related outcomes in patients with high-frequency episodic migraine (HFEM) or chronic migraine, with a large proportion of patients experiencing improvements in photophobia mostly within the first month of treatment.

Major finding: Galcanezumab significantly improved headache days, migraine days, analgesics consumption, Migraine Disability Assessment scores, and Headache Impact Test-6 scores at 3 and 6 months (all P < .0001). Overall, 68.1% of patients experienced a significant improvement in ictal photophobia, of which 56.3% of patients reported an improvement within the first month of treatment.

Study details: This retrospective observational study included 47 patients with HFEM or chronic migraine and ≥3 previous prophylactic treatment failures who experienced moderate-to-severe photophobia during migraine attacks and received galcanezumab.

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

Source: Schiano di Cola F et al. Photophobia and migraine outcome during treatment with galcanezumab. Front Neurol. 2023;13:1088036 (Jan 18). Doi: 10.3389/fneur.2022.1088036

Key clinical point: Rimegepant was effective for the acute treatment of migraine in patients who responded inadequately to 1 or ≥2 triptans and in current triptan users.

Major finding: Rimegepant was more effective than placebo at 2 hours postdose in providing freedom from pain and the most bothersome symptom (MBS) in patients with an inadequate response to 1 (both P < .001) and ≥2 (P  =  .013 and P < .001, respectively) triptans and in current triptan users (both P < .001). Among triptan-naive patients, rimegepant vs placebo significantly improved pain freedom (P  =  .007) but not MBS (P  =  .06).

Study details: This was a post hoc analysis of three phase 3 randomized controlled trials including 3507 patients with migraine who had (35.2%) or did not have (64.8%) inadequate response to triptans and who received rimegepant (n = 1749) or placebo (n = 1758).

Disclosures: This study was funded by Biohaven Pharmaceuticals, Inc. Six authors declared being employees of or holding stocks in Biohaven. Some authors declared ties with various sources.

Source: Lipton RB et al. Efficacy of rimegepant for the acute treatment of migraine based on triptan treatment experience: Pooled results from three phase 3 randomized clinical trials. Cephalalgia. 2023;43(2):3331024221141686 (Feb 5). Doi: 10.1177/03331024221141686

Key clinical point: Rimegepant was effective for the acute treatment of migraine in patients who responded inadequately to 1 or ≥2 triptans and in current triptan users.

Major finding: Rimegepant was more effective than placebo at 2 hours postdose in providing freedom from pain and the most bothersome symptom (MBS) in patients with an inadequate response to 1 (both P < .001) and ≥2 (P  =  .013 and P < .001, respectively) triptans and in current triptan users (both P < .001). Among triptan-naive patients, rimegepant vs placebo significantly improved pain freedom (P  =  .007) but not MBS (P  =  .06).

Study details: This was a post hoc analysis of three phase 3 randomized controlled trials including 3507 patients with migraine who had (35.2%) or did not have (64.8%) inadequate response to triptans and who received rimegepant (n = 1749) or placebo (n = 1758).

Disclosures: This study was funded by Biohaven Pharmaceuticals, Inc. Six authors declared being employees of or holding stocks in Biohaven. Some authors declared ties with various sources.

Source: Lipton RB et al. Efficacy of rimegepant for the acute treatment of migraine based on triptan treatment experience: Pooled results from three phase 3 randomized clinical trials. Cephalalgia. 2023;43(2):3331024221141686 (Feb 5). Doi: 10.1177/03331024221141686

Key clinical point: Rimegepant was effective for the acute treatment of migraine in patients who responded inadequately to 1 or ≥2 triptans and in current triptan users.

Major finding: Rimegepant was more effective than placebo at 2 hours postdose in providing freedom from pain and the most bothersome symptom (MBS) in patients with an inadequate response to 1 (both P < .001) and ≥2 (P  =  .013 and P < .001, respectively) triptans and in current triptan users (both P < .001). Among triptan-naive patients, rimegepant vs placebo significantly improved pain freedom (P  =  .007) but not MBS (P  =  .06).

Study details: This was a post hoc analysis of three phase 3 randomized controlled trials including 3507 patients with migraine who had (35.2%) or did not have (64.8%) inadequate response to triptans and who received rimegepant (n = 1749) or placebo (n = 1758).

Disclosures: This study was funded by Biohaven Pharmaceuticals, Inc. Six authors declared being employees of or holding stocks in Biohaven. Some authors declared ties with various sources.

Source: Lipton RB et al. Efficacy of rimegepant for the acute treatment of migraine based on triptan treatment experience: Pooled results from three phase 3 randomized clinical trials. Cephalalgia. 2023;43(2):3331024221141686 (Feb 5). Doi: 10.1177/03331024221141686

Key clinical point: A dose of 60 mg atogepant once daily was safe and well tolerated and demonstrated early efficacy sustained over 1 year in patients with episodic migraine.

Major finding: Treatment-emergent adverse events (TEAE), mostly mild or moderate, occurred in 67.0% vs 78.6% of patients receiving atogepant vs oral standard care, respectively. Serious TEAE occurred in 4.4% of atogepant-treated patients; however, treatment discontinuation due to adverse events (<6%) and lack of efficacy (<1%) was rare. Overall, 60.4% and 84.2% of patients reported ≥50% reduction in monthly migraine days during weeks 1-4 and 49-52 of atogepant treatment, respectively.

Study details: This open-label phase 3 trial included 744 patients with migraine with or without aura who were randomly assigned to receive 60 mg atogepant or oral standard care migraine preventive medication.

Disclosures: This study was sponsored by Allergan/AbbVie. Five authors declared being current or former employees of or holding stocks in AbbVie. Several authors declared serving as a consultants, speakers, scientific advisors,  or primary investigators for AbbVie and other sources.

Source: Ashina M et al. Once-daily oral atogepant for the long-term preventive treatment of migraine: Findings from a multicenter, randomized, open-label, phase 3 trial. Headache. 2023;63:79-88 (Jan 18). Doi: 10.1111/head.14439

Key clinical point: A dose of 60 mg atogepant once daily was safe and well tolerated and demonstrated early efficacy sustained over 1 year in patients with episodic migraine.

Major finding: Treatment-emergent adverse events (TEAE), mostly mild or moderate, occurred in 67.0% vs 78.6% of patients receiving atogepant vs oral standard care, respectively. Serious TEAE occurred in 4.4% of atogepant-treated patients; however, treatment discontinuation due to adverse events (<6%) and lack of efficacy (<1%) was rare. Overall, 60.4% and 84.2% of patients reported ≥50% reduction in monthly migraine days during weeks 1-4 and 49-52 of atogepant treatment, respectively.

Study details: This open-label phase 3 trial included 744 patients with migraine with or without aura who were randomly assigned to receive 60 mg atogepant or oral standard care migraine preventive medication.

Disclosures: This study was sponsored by Allergan/AbbVie. Five authors declared being current or former employees of or holding stocks in AbbVie. Several authors declared serving as a consultants, speakers, scientific advisors,  or primary investigators for AbbVie and other sources.

Source: Ashina M et al. Once-daily oral atogepant for the long-term preventive treatment of migraine: Findings from a multicenter, randomized, open-label, phase 3 trial. Headache. 2023;63:79-88 (Jan 18). Doi: 10.1111/head.14439

Key clinical point: A dose of 60 mg atogepant once daily was safe and well tolerated and demonstrated early efficacy sustained over 1 year in patients with episodic migraine.

Major finding: Treatment-emergent adverse events (TEAE), mostly mild or moderate, occurred in 67.0% vs 78.6% of patients receiving atogepant vs oral standard care, respectively. Serious TEAE occurred in 4.4% of atogepant-treated patients; however, treatment discontinuation due to adverse events (<6%) and lack of efficacy (<1%) was rare. Overall, 60.4% and 84.2% of patients reported ≥50% reduction in monthly migraine days during weeks 1-4 and 49-52 of atogepant treatment, respectively.

Study details: This open-label phase 3 trial included 744 patients with migraine with or without aura who were randomly assigned to receive 60 mg atogepant or oral standard care migraine preventive medication.

Disclosures: This study was sponsored by Allergan/AbbVie. Five authors declared being current or former employees of or holding stocks in AbbVie. Several authors declared serving as a consultants, speakers, scientific advisors,  or primary investigators for AbbVie and other sources.

Source: Ashina M et al. Once-daily oral atogepant for the long-term preventive treatment of migraine: Findings from a multicenter, randomized, open-label, phase 3 trial. Headache. 2023;63:79-88 (Jan 18). Doi: 10.1111/head.14439

Key clinical point: Prepregnancy migraine history was associated with a higher risk for adverse pregnancy outcomes, including preterm delivery, preeclampsia, and gestational hypertension.

Major finding: Participants with vs without a history of prepregnancy migraine were at a 17% increased risk for preterm delivery (adjusted relative risk [aRR] 1.17; 95% CI 1.05-1.30), 28% higher risk for gestational hypertension (aRR 1.28; 95% CI 1.11-1.48), and 40% greater risk for preeclampsia (aRR 1.40; 95% CI 1.19-1.65).

Study details: This prospective cohort study evaluated 30,555 incident pregnancies in 19,694 participants, of which 11.3% of participants reported a history of physician-diagnosed migraine with or without aura.

Disclosures: This study was supported by the US National Institutes of Health (NIH). Six authors declared receiving support from NIH unrelated to this study and reported ties with various sources.

Source: Purdue-Smithe AC et al. Prepregnancy migraine, migraine phenotype, and risk of adverse pregnancy outcomes. Neurology. 2023 (Jan 19). Doi: 10.1212/WNL.0000000000206831

Key clinical point: Prepregnancy migraine history was associated with a higher risk for adverse pregnancy outcomes, including preterm delivery, preeclampsia, and gestational hypertension.

Major finding: Participants with vs without a history of prepregnancy migraine were at a 17% increased risk for preterm delivery (adjusted relative risk [aRR] 1.17; 95% CI 1.05-1.30), 28% higher risk for gestational hypertension (aRR 1.28; 95% CI 1.11-1.48), and 40% greater risk for preeclampsia (aRR 1.40; 95% CI 1.19-1.65).

Study details: This prospective cohort study evaluated 30,555 incident pregnancies in 19,694 participants, of which 11.3% of participants reported a history of physician-diagnosed migraine with or without aura.

Disclosures: This study was supported by the US National Institutes of Health (NIH). Six authors declared receiving support from NIH unrelated to this study and reported ties with various sources.

Source: Purdue-Smithe AC et al. Prepregnancy migraine, migraine phenotype, and risk of adverse pregnancy outcomes. Neurology. 2023 (Jan 19). Doi: 10.1212/WNL.0000000000206831

Key clinical point: Prepregnancy migraine history was associated with a higher risk for adverse pregnancy outcomes, including preterm delivery, preeclampsia, and gestational hypertension.

Major finding: Participants with vs without a history of prepregnancy migraine were at a 17% increased risk for preterm delivery (adjusted relative risk [aRR] 1.17; 95% CI 1.05-1.30), 28% higher risk for gestational hypertension (aRR 1.28; 95% CI 1.11-1.48), and 40% greater risk for preeclampsia (aRR 1.40; 95% CI 1.19-1.65).

Study details: This prospective cohort study evaluated 30,555 incident pregnancies in 19,694 participants, of which 11.3% of participants reported a history of physician-diagnosed migraine with or without aura.

Disclosures: This study was supported by the US National Institutes of Health (NIH). Six authors declared receiving support from NIH unrelated to this study and reported ties with various sources.

Source: Purdue-Smithe AC et al. Prepregnancy migraine, migraine phenotype, and risk of adverse pregnancy outcomes. Neurology. 2023 (Jan 19). Doi: 10.1212/WNL.0000000000206831

Key clinical point: Use of remote electrical neuromodulation (REN) every other day is a safe and effective preventive treatment for migraine.

Major finding: REN was superior to placebo in reducing the mean number of migraine days per month (P < .001), moderate or severe headache days per month (P = .005), percentage of patients achieving ≥50% reduction in headache days (P = .015), and days of acute medication intake (P = .001). No device-related serious adverse events were reported in either REN or placebo group.

Study details: Findings are from a prospective, randomized, double-blind trial including 179 patients with migraine who were randomly assigned to receive REN (n = 95) or placebo stimulation (n = 84) every other day.

Disclosures: This study was funded by Theranica Bio-Electronics. Some authors declared receiving research, support, or educational grants, royalties, or honoraria from or serving as a consultant, on a speaker bureau, or on an advisory board for various sources, including Theranica.

Source: Tepper SJ et al. Remote electrical neuromodulation for migraine prevention: A double-blind, randomized, placebo-controlled clinical trial. Headache. 2023 (Jan 27). Doi: 10.1111/head.14469

Key clinical point: Use of remote electrical neuromodulation (REN) every other day is a safe and effective preventive treatment for migraine.

Major finding: REN was superior to placebo in reducing the mean number of migraine days per month (P < .001), moderate or severe headache days per month (P = .005), percentage of patients achieving ≥50% reduction in headache days (P = .015), and days of acute medication intake (P = .001). No device-related serious adverse events were reported in either REN or placebo group.

Study details: Findings are from a prospective, randomized, double-blind trial including 179 patients with migraine who were randomly assigned to receive REN (n = 95) or placebo stimulation (n = 84) every other day.

Disclosures: This study was funded by Theranica Bio-Electronics. Some authors declared receiving research, support, or educational grants, royalties, or honoraria from or serving as a consultant, on a speaker bureau, or on an advisory board for various sources, including Theranica.

Source: Tepper SJ et al. Remote electrical neuromodulation for migraine prevention: A double-blind, randomized, placebo-controlled clinical trial. Headache. 2023 (Jan 27). Doi: 10.1111/head.14469

Key clinical point: Use of remote electrical neuromodulation (REN) every other day is a safe and effective preventive treatment for migraine.

Major finding: REN was superior to placebo in reducing the mean number of migraine days per month (P < .001), moderate or severe headache days per month (P = .005), percentage of patients achieving ≥50% reduction in headache days (P = .015), and days of acute medication intake (P = .001). No device-related serious adverse events were reported in either REN or placebo group.

Study details: Findings are from a prospective, randomized, double-blind trial including 179 patients with migraine who were randomly assigned to receive REN (n = 95) or placebo stimulation (n = 84) every other day.

Disclosures: This study was funded by Theranica Bio-Electronics. Some authors declared receiving research, support, or educational grants, royalties, or honoraria from or serving as a consultant, on a speaker bureau, or on an advisory board for various sources, including Theranica.

Source: Tepper SJ et al. Remote electrical neuromodulation for migraine prevention: A double-blind, randomized, placebo-controlled clinical trial. Headache. 2023 (Jan 27). Doi: 10.1111/head.14469