Migraine ICYMI

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

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

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

Disclosures: None.

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

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

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

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

Disclosures: None.

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

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

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

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

Disclosures: None.

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

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

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

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

Disclosures: None.

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

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

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

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

Disclosures: None.

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

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

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

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

Disclosures: None.

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

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

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

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

Disclosures: None.

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

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

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

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

Disclosures: None.

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

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

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

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

Disclosures: None.

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

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

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

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

Disclosures: The study received partial funding from Merck.

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

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

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

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

Disclosures: The study received partial funding from Merck.

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

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

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

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

Disclosures: The study received partial funding from Merck.

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

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

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

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

Disclosures: The authors reported having no conflicts of interest.

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

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

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

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

Disclosures: The authors reported having no conflicts of interest.

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

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

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

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

Disclosures: The authors reported having no conflicts of interest.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

CHARLOTTE, N.C. – New daily persistent headache (NDPH) is relatively common among pediatric patients presenting to a headache clinic, according to research presented at the 48th national meeting of the Child Neurology Society. Most children with NDPH fulfill criteria for its migraine subtype, and one-third of pediatric patients with NDPH have comorbid medication overuse headache (MOH).

NDPH is defined as a daily, unremitting headache that lasts for at least 3 months. “Not many studies on NDPH focus on pediatrics,” said Emily Pierce, from Children’s National Medical Center in Washington. NDPH “is considered to be one of the most intractable headaches in children. Children are able to tell that they’ve had this different type of headache because there’s some kind of onset that is very memorable.”

Ms. Pierce and colleagues conducted an observational study to describe the characteristics of NDPH in pediatric patients who presented to a headache program at a tertiary referral center. The researchers included pediatric patients who visited the headache clinic at Children’s National Medical Center between 2016 and 2018 in their analysis. All patients were enrolled in patient registry that had been approved by an independent review board. Ms. Pierce and colleagues queried the registry for NDPH and reviewed these records to examine participants’ clinical presentations.

The investigators identified 3,260 patient encounters during the study period. Of these encounters, 454 patients (13.9%) were identified as having NDPH. Patients with NDPH were predominantly female (78%) and white (72%). The median age of the sample was 14.8 years.

The frontal head region was the most common location of headache pain, which often had a throbbing quality and was associated with photophobia, phonophobia, nausea, and decreased activity. The median pain intensity was 6 of 10. Approximately 72% of patients had tried abortive medication, and 56% of patients had failed at least one abortive medication. Excedrin, ibuprofen, and acetaminophen were among the common failed abortive medications.

Furthermore, 36% of patients were diagnosed with MOH. The most commonly overused medication was ibuprofen. MOH “is also considered to be intractable for patients with NDPH,” said Ms. Pierce. “Typically, if the patient stops overusing that medication, they’ll find relief from their headaches. However, with our NDPH patients, when they stop overusing that medication, they still are having headaches associated with NDPH.”

The data indicated “a strong difference between our male and female patients,” said Ms. Pierce. Female patients reported significantly more instances of photophobia, phonophobia, nausea, and dizziness than did male patients. Overall, 78% of participants had a diagnosis of an additional comorbidity, such as head trauma (18%), anxiety (14%), depression (8%), or other (37%).

Observational studies of pediatric NDPH offer “a better way for our providers to diagnose these patients, and also to better understand them and help them figure out a treatment that may work,” said Ms. Pierce. In future research, she and her colleagues intend to examine blood work and potential genetic associations in pediatric patients with NDPH.

The study was not supported by funding, and the investigators had no disclosures.

[email protected]

SOURCE: Pierce E et al. CNS 2019, Abstract 100.

CHARLOTTE, N.C. – New daily persistent headache (NDPH) is relatively common among pediatric patients presenting to a headache clinic, according to research presented at the 48th national meeting of the Child Neurology Society. Most children with NDPH fulfill criteria for its migraine subtype, and one-third of pediatric patients with NDPH have comorbid medication overuse headache (MOH).

NDPH is defined as a daily, unremitting headache that lasts for at least 3 months. “Not many studies on NDPH focus on pediatrics,” said Emily Pierce, from Children’s National Medical Center in Washington. NDPH “is considered to be one of the most intractable headaches in children. Children are able to tell that they’ve had this different type of headache because there’s some kind of onset that is very memorable.”

Ms. Pierce and colleagues conducted an observational study to describe the characteristics of NDPH in pediatric patients who presented to a headache program at a tertiary referral center. The researchers included pediatric patients who visited the headache clinic at Children’s National Medical Center between 2016 and 2018 in their analysis. All patients were enrolled in patient registry that had been approved by an independent review board. Ms. Pierce and colleagues queried the registry for NDPH and reviewed these records to examine participants’ clinical presentations.

The investigators identified 3,260 patient encounters during the study period. Of these encounters, 454 patients (13.9%) were identified as having NDPH. Patients with NDPH were predominantly female (78%) and white (72%). The median age of the sample was 14.8 years.

The frontal head region was the most common location of headache pain, which often had a throbbing quality and was associated with photophobia, phonophobia, nausea, and decreased activity. The median pain intensity was 6 of 10. Approximately 72% of patients had tried abortive medication, and 56% of patients had failed at least one abortive medication. Excedrin, ibuprofen, and acetaminophen were among the common failed abortive medications.

Furthermore, 36% of patients were diagnosed with MOH. The most commonly overused medication was ibuprofen. MOH “is also considered to be intractable for patients with NDPH,” said Ms. Pierce. “Typically, if the patient stops overusing that medication, they’ll find relief from their headaches. However, with our NDPH patients, when they stop overusing that medication, they still are having headaches associated with NDPH.”

The data indicated “a strong difference between our male and female patients,” said Ms. Pierce. Female patients reported significantly more instances of photophobia, phonophobia, nausea, and dizziness than did male patients. Overall, 78% of participants had a diagnosis of an additional comorbidity, such as head trauma (18%), anxiety (14%), depression (8%), or other (37%).

Observational studies of pediatric NDPH offer “a better way for our providers to diagnose these patients, and also to better understand them and help them figure out a treatment that may work,” said Ms. Pierce. In future research, she and her colleagues intend to examine blood work and potential genetic associations in pediatric patients with NDPH.

The study was not supported by funding, and the investigators had no disclosures.

[email protected]

SOURCE: Pierce E et al. CNS 2019, Abstract 100.

CHARLOTTE, N.C. – New daily persistent headache (NDPH) is relatively common among pediatric patients presenting to a headache clinic, according to research presented at the 48th national meeting of the Child Neurology Society. Most children with NDPH fulfill criteria for its migraine subtype, and one-third of pediatric patients with NDPH have comorbid medication overuse headache (MOH).

NDPH is defined as a daily, unremitting headache that lasts for at least 3 months. “Not many studies on NDPH focus on pediatrics,” said Emily Pierce, from Children’s National Medical Center in Washington. NDPH “is considered to be one of the most intractable headaches in children. Children are able to tell that they’ve had this different type of headache because there’s some kind of onset that is very memorable.”

Ms. Pierce and colleagues conducted an observational study to describe the characteristics of NDPH in pediatric patients who presented to a headache program at a tertiary referral center. The researchers included pediatric patients who visited the headache clinic at Children’s National Medical Center between 2016 and 2018 in their analysis. All patients were enrolled in patient registry that had been approved by an independent review board. Ms. Pierce and colleagues queried the registry for NDPH and reviewed these records to examine participants’ clinical presentations.

The investigators identified 3,260 patient encounters during the study period. Of these encounters, 454 patients (13.9%) were identified as having NDPH. Patients with NDPH were predominantly female (78%) and white (72%). The median age of the sample was 14.8 years.

The frontal head region was the most common location of headache pain, which often had a throbbing quality and was associated with photophobia, phonophobia, nausea, and decreased activity. The median pain intensity was 6 of 10. Approximately 72% of patients had tried abortive medication, and 56% of patients had failed at least one abortive medication. Excedrin, ibuprofen, and acetaminophen were among the common failed abortive medications.

Furthermore, 36% of patients were diagnosed with MOH. The most commonly overused medication was ibuprofen. MOH “is also considered to be intractable for patients with NDPH,” said Ms. Pierce. “Typically, if the patient stops overusing that medication, they’ll find relief from their headaches. However, with our NDPH patients, when they stop overusing that medication, they still are having headaches associated with NDPH.”

The data indicated “a strong difference between our male and female patients,” said Ms. Pierce. Female patients reported significantly more instances of photophobia, phonophobia, nausea, and dizziness than did male patients. Overall, 78% of participants had a diagnosis of an additional comorbidity, such as head trauma (18%), anxiety (14%), depression (8%), or other (37%).

Observational studies of pediatric NDPH offer “a better way for our providers to diagnose these patients, and also to better understand them and help them figure out a treatment that may work,” said Ms. Pierce. In future research, she and her colleagues intend to examine blood work and potential genetic associations in pediatric patients with NDPH.

The study was not supported by funding, and the investigators had no disclosures.

[email protected]

SOURCE: Pierce E et al. CNS 2019, Abstract 100.

CHARLOTTE, N.C. – A significant proportion of children who present to headache clinics have joint hypermobility, according to data presented at the 48th national meeting of the Child Neurology Society. Furthermore, patients with joint hypermobility have a high rate of headache disability, while patients without joint hypermobility have less headache disability, according to Dhwani Sahjwani, MD, a resident at Inova Fairfax Hospital in Falls Church, Va., and colleagues.

While conducting research in the headache clinic at Children’s National Hospital in Washington, D.C., Dr. Sahjwani saw several children with joint hypermobility and a diagnosis of a disorder such as Ehlers-Danlos syndrome. She and her colleagues began analyzing patients to evaluate the potential association between joint hypermobility and headache disability in children. The investigators included pediatric patients examined in the headache clinic at Children’s National Medical Center between October 2018 and January 2019 in their study. All headache clinic patients were enrolled in a patient registry that had been approved by an independent review board.

Dr. Sahjwani and colleagues measured patients’ headache disability with the Headache Impact Test–6 (HIT-6) questionnaire. Scores of 60 or greater on this questionnaire indicate severe headache disability. The researchers assessed joint hypermobility using the Beighton scoring system. In this system, scores greater than 4 indicate joint hypermobility.

Dr. Sahjwani’s group scored 76 patients using the Beighton system and HIT-6 questionnaire. Participants’ median age was 13.7 years. Approximately 26% of patients had Beighton scores that indicated joint hypermobility. About 65% of the patients with joint hypermobility had a diagnosis of migraine without aura. In addition, 80% of patients with joint hypermobility had severe headache disability, according to the HIT-6 disability criteria. The average pain intensity in patients with hypermobile joints was 6.1 out of 10. Among participants without significant joint hypermobility, 90% had mild headache disability.

Patients with joint hypermobility and increased tissue elasticity “tend to have a lower threshold for pain, in general, in all parts of their bodies,” said Dr. Sahjwani. Greater headache severity might be expected in this population, “because they have more pain if they have hypermobile joints or tissue.”

Headache treatments for this population are based solely on the type of headache that each patient has. Patients with joint hypermobility and migraine, for example, are candidates for rescue medication and long-term prophylactic medications. “I don’t think the joint hypermobility is going to change how you manage their headaches,” said Dr. Sahjwani.

The study results suggest that, when children present with severely debilitating headaches, a neurologist should consider examining them for joint hypermobility “to see if they have another diagnosis, such as Ehlers-Danlos syndrome ... that has to be managed in addition to their headaches,” Dr. Sahjwani concluded.

The study was not supported by funding. The authors did not report any disclosures.

[email protected]

SOURCE: Sahjwani D et al. CNS 2019, Abstract 101.

CHARLOTTE, N.C. – A significant proportion of children who present to headache clinics have joint hypermobility, according to data presented at the 48th national meeting of the Child Neurology Society. Furthermore, patients with joint hypermobility have a high rate of headache disability, while patients without joint hypermobility have less headache disability, according to Dhwani Sahjwani, MD, a resident at Inova Fairfax Hospital in Falls Church, Va., and colleagues.

While conducting research in the headache clinic at Children’s National Hospital in Washington, D.C., Dr. Sahjwani saw several children with joint hypermobility and a diagnosis of a disorder such as Ehlers-Danlos syndrome. She and her colleagues began analyzing patients to evaluate the potential association between joint hypermobility and headache disability in children. The investigators included pediatric patients examined in the headache clinic at Children’s National Medical Center between October 2018 and January 2019 in their study. All headache clinic patients were enrolled in a patient registry that had been approved by an independent review board.

Dr. Sahjwani and colleagues measured patients’ headache disability with the Headache Impact Test–6 (HIT-6) questionnaire. Scores of 60 or greater on this questionnaire indicate severe headache disability. The researchers assessed joint hypermobility using the Beighton scoring system. In this system, scores greater than 4 indicate joint hypermobility.

Dr. Sahjwani’s group scored 76 patients using the Beighton system and HIT-6 questionnaire. Participants’ median age was 13.7 years. Approximately 26% of patients had Beighton scores that indicated joint hypermobility. About 65% of the patients with joint hypermobility had a diagnosis of migraine without aura. In addition, 80% of patients with joint hypermobility had severe headache disability, according to the HIT-6 disability criteria. The average pain intensity in patients with hypermobile joints was 6.1 out of 10. Among participants without significant joint hypermobility, 90% had mild headache disability.

Patients with joint hypermobility and increased tissue elasticity “tend to have a lower threshold for pain, in general, in all parts of their bodies,” said Dr. Sahjwani. Greater headache severity might be expected in this population, “because they have more pain if they have hypermobile joints or tissue.”

Headache treatments for this population are based solely on the type of headache that each patient has. Patients with joint hypermobility and migraine, for example, are candidates for rescue medication and long-term prophylactic medications. “I don’t think the joint hypermobility is going to change how you manage their headaches,” said Dr. Sahjwani.

The study results suggest that, when children present with severely debilitating headaches, a neurologist should consider examining them for joint hypermobility “to see if they have another diagnosis, such as Ehlers-Danlos syndrome ... that has to be managed in addition to their headaches,” Dr. Sahjwani concluded.

The study was not supported by funding. The authors did not report any disclosures.

[email protected]

SOURCE: Sahjwani D et al. CNS 2019, Abstract 101.

CHARLOTTE, N.C. – A significant proportion of children who present to headache clinics have joint hypermobility, according to data presented at the 48th national meeting of the Child Neurology Society. Furthermore, patients with joint hypermobility have a high rate of headache disability, while patients without joint hypermobility have less headache disability, according to Dhwani Sahjwani, MD, a resident at Inova Fairfax Hospital in Falls Church, Va., and colleagues.

While conducting research in the headache clinic at Children’s National Hospital in Washington, D.C., Dr. Sahjwani saw several children with joint hypermobility and a diagnosis of a disorder such as Ehlers-Danlos syndrome. She and her colleagues began analyzing patients to evaluate the potential association between joint hypermobility and headache disability in children. The investigators included pediatric patients examined in the headache clinic at Children’s National Medical Center between October 2018 and January 2019 in their study. All headache clinic patients were enrolled in a patient registry that had been approved by an independent review board.

Dr. Sahjwani and colleagues measured patients’ headache disability with the Headache Impact Test–6 (HIT-6) questionnaire. Scores of 60 or greater on this questionnaire indicate severe headache disability. The researchers assessed joint hypermobility using the Beighton scoring system. In this system, scores greater than 4 indicate joint hypermobility.

Dr. Sahjwani’s group scored 76 patients using the Beighton system and HIT-6 questionnaire. Participants’ median age was 13.7 years. Approximately 26% of patients had Beighton scores that indicated joint hypermobility. About 65% of the patients with joint hypermobility had a diagnosis of migraine without aura. In addition, 80% of patients with joint hypermobility had severe headache disability, according to the HIT-6 disability criteria. The average pain intensity in patients with hypermobile joints was 6.1 out of 10. Among participants without significant joint hypermobility, 90% had mild headache disability.

Patients with joint hypermobility and increased tissue elasticity “tend to have a lower threshold for pain, in general, in all parts of their bodies,” said Dr. Sahjwani. Greater headache severity might be expected in this population, “because they have more pain if they have hypermobile joints or tissue.”

Headache treatments for this population are based solely on the type of headache that each patient has. Patients with joint hypermobility and migraine, for example, are candidates for rescue medication and long-term prophylactic medications. “I don’t think the joint hypermobility is going to change how you manage their headaches,” said Dr. Sahjwani.

The study results suggest that, when children present with severely debilitating headaches, a neurologist should consider examining them for joint hypermobility “to see if they have another diagnosis, such as Ehlers-Danlos syndrome ... that has to be managed in addition to their headaches,” Dr. Sahjwani concluded.

The study was not supported by funding. The authors did not report any disclosures.

[email protected]

SOURCE: Sahjwani D et al. CNS 2019, Abstract 101.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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