How long should a woman wait before becoming pregnant again? According to the World Health Organization (WHO), it is advisable to wait at least 24 months between childbirth and a new pregnancy. But a study published in February of this year in The Lancet Regional Health — Americas, using data from more than 4.7 million live births in Brazil, suggests that this recommendation should be individualized, considering factors such as maternal obstetric history.

Researchers from the Federal University of Grande Dourados (UFGD), Oswaldo Cruz Foundation, São José do Rio Preto Medical School, Federal University of Bahia, and the London School of Hygiene and Tropical Medicine in the United Kingdom, used a birth cohort from the Center for Data Integration and Knowledge for Health, which combines data from the Ministry of Health’s Information System on Live Births (SINASC) and from a cohort of 100 million Brazilians. 

In total, the analysis included information on 3,804,152 women and 4,788,279 births. All participants had at least two consecutive live births.

Most interpregnancy intervals, ie, the difference between the previous childbirth and the subsequent conception, ranged from 23 to 58 months (39.1%). Extreme intervals of < 6 months and > 120 months occurred in 5.6% and 1.6% of cases, respectively.

Regarding adverse outcomes, the research indicated that, in the general population, small-for-gestational-age (SGA) babies were observed in 8.4% of subsequent births, while low birth weight (LBW) occurred in 5.9% and preterm birth in 7.5%.
 

Interpregnancy Interval and SGA Risk

The authors noted that the risk for subsequent adverse outcomes increased with extreme interpregnancy intervals, with SGA being the only exception. In this case, women who had an interval between the previous childbirth and the subsequent conception > 120 months had a lower risk for SGA.

According to João Guilherme Tedde, a medical student at UFGD and the first author of the study, similar patterns (extremely long interpregnancy intervals associated with a lower risk for subsequent SGA) have been described in the literature. In an interview with this news organization, he explained some hypotheses that could explain this phenomenon.

According to the researcher, the finding may reflect the distinct risk profile of mothers who wait a very long time to conceive again. “This group, composed of older women, likely has a higher prevalence of health problems, such as diabetes and obesity, which are known risk factors for having large-for-gestational-age (LGA) babies,” he said. He also highlighted the fact that the study showed that the risk for LGA also increased as the interval between pregnancies grew.

Another hypothesis suggested by the author is the possible occurrence of events between pregnancies, such as miscarriages or stillbirths. According to him, women who have experienced these events between two consecutive pregnancies may have falsely increased interpregnancy intervals, since miscarriages and stillbirths (which are considered conceptions) are not counted in SINASC.

“Thus, the lower occurrence of SGA in the group with very long intervals may reflect a competition of events between stillbirths or miscarriages and live SGAs,” he said.
 

Previous and Subsequent Adverse Events

The research also showed that the risks for subsequent SGA, LBW, and preterm birth were higher among women with a history of adverse events in previous pregnancies.

Furthermore, the authors noted that the previous occurrence of adverse outcomes seems to “have a more significant impact on the outcome of the current pregnancy than the interpregnancy interval.” 

“We found that, for women with the same interpregnancy interval (say < 6 months), but with different obstetric history (zero previous events vs one event), the absolute risk for subsequent adverse outcomes increased much more than when we change only the duration of the interval in a group with the same number of previous adverse events,” said Dr. Tedde.

There is still no convincing explanation for this fact, he said, since the cause-and-effect relationship between interpregnancy intervals and perinatal events is not clear. But the obstetrics literature generally shows that among the main risk factors for an adverse event is the previous occurrence of the same event. This effect could be related to living conditions and maternal habits, genetics, epigenetics, among others.

The researcher observed that this study is one of the largest in terms of sampling to investigate how maternal obstetric history can modulate the effect of interpregnancy interval on the risk for adverse outcomes in subsequent pregnancies.

The findings of the research published this year reinforce the importance of individualizing recommendations regarding interpregnancy intervals, considering factors such as maternal obstetric history. However, the author warns that it is still too early to point out the “best” interval for each situation.

“We need more studies that reproduce our findings and that expand the analyzed outcomes to also include those of interest to the mother, such as maternal mortality,” he concluded.

This story was translated from the Medscape Portuguese edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.

How long should a woman wait before becoming pregnant again? According to the World Health Organization (WHO), it is advisable to wait at least 24 months between childbirth and a new pregnancy. But a study published in February of this year in The Lancet Regional Health — Americas, using data from more than 4.7 million live births in Brazil, suggests that this recommendation should be individualized, considering factors such as maternal obstetric history.

Researchers from the Federal University of Grande Dourados (UFGD), Oswaldo Cruz Foundation, São José do Rio Preto Medical School, Federal University of Bahia, and the London School of Hygiene and Tropical Medicine in the United Kingdom, used a birth cohort from the Center for Data Integration and Knowledge for Health, which combines data from the Ministry of Health’s Information System on Live Births (SINASC) and from a cohort of 100 million Brazilians. 

In total, the analysis included information on 3,804,152 women and 4,788,279 births. All participants had at least two consecutive live births.

Most interpregnancy intervals, ie, the difference between the previous childbirth and the subsequent conception, ranged from 23 to 58 months (39.1%). Extreme intervals of < 6 months and > 120 months occurred in 5.6% and 1.6% of cases, respectively.

Regarding adverse outcomes, the research indicated that, in the general population, small-for-gestational-age (SGA) babies were observed in 8.4% of subsequent births, while low birth weight (LBW) occurred in 5.9% and preterm birth in 7.5%.
 

Interpregnancy Interval and SGA Risk

The authors noted that the risk for subsequent adverse outcomes increased with extreme interpregnancy intervals, with SGA being the only exception. In this case, women who had an interval between the previous childbirth and the subsequent conception > 120 months had a lower risk for SGA.

According to João Guilherme Tedde, a medical student at UFGD and the first author of the study, similar patterns (extremely long interpregnancy intervals associated with a lower risk for subsequent SGA) have been described in the literature. In an interview with this news organization, he explained some hypotheses that could explain this phenomenon.

According to the researcher, the finding may reflect the distinct risk profile of mothers who wait a very long time to conceive again. “This group, composed of older women, likely has a higher prevalence of health problems, such as diabetes and obesity, which are known risk factors for having large-for-gestational-age (LGA) babies,” he said. He also highlighted the fact that the study showed that the risk for LGA also increased as the interval between pregnancies grew.

Another hypothesis suggested by the author is the possible occurrence of events between pregnancies, such as miscarriages or stillbirths. According to him, women who have experienced these events between two consecutive pregnancies may have falsely increased interpregnancy intervals, since miscarriages and stillbirths (which are considered conceptions) are not counted in SINASC.

“Thus, the lower occurrence of SGA in the group with very long intervals may reflect a competition of events between stillbirths or miscarriages and live SGAs,” he said.
 

Previous and Subsequent Adverse Events

The research also showed that the risks for subsequent SGA, LBW, and preterm birth were higher among women with a history of adverse events in previous pregnancies.

Furthermore, the authors noted that the previous occurrence of adverse outcomes seems to “have a more significant impact on the outcome of the current pregnancy than the interpregnancy interval.” 

“We found that, for women with the same interpregnancy interval (say < 6 months), but with different obstetric history (zero previous events vs one event), the absolute risk for subsequent adverse outcomes increased much more than when we change only the duration of the interval in a group with the same number of previous adverse events,” said Dr. Tedde.

There is still no convincing explanation for this fact, he said, since the cause-and-effect relationship between interpregnancy intervals and perinatal events is not clear. But the obstetrics literature generally shows that among the main risk factors for an adverse event is the previous occurrence of the same event. This effect could be related to living conditions and maternal habits, genetics, epigenetics, among others.

The researcher observed that this study is one of the largest in terms of sampling to investigate how maternal obstetric history can modulate the effect of interpregnancy interval on the risk for adverse outcomes in subsequent pregnancies.

The findings of the research published this year reinforce the importance of individualizing recommendations regarding interpregnancy intervals, considering factors such as maternal obstetric history. However, the author warns that it is still too early to point out the “best” interval for each situation.

“We need more studies that reproduce our findings and that expand the analyzed outcomes to also include those of interest to the mother, such as maternal mortality,” he concluded.

This story was translated from the Medscape Portuguese edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.

How long should a woman wait before becoming pregnant again? According to the World Health Organization (WHO), it is advisable to wait at least 24 months between childbirth and a new pregnancy. But a study published in February of this year in The Lancet Regional Health — Americas, using data from more than 4.7 million live births in Brazil, suggests that this recommendation should be individualized, considering factors such as maternal obstetric history.

Researchers from the Federal University of Grande Dourados (UFGD), Oswaldo Cruz Foundation, São José do Rio Preto Medical School, Federal University of Bahia, and the London School of Hygiene and Tropical Medicine in the United Kingdom, used a birth cohort from the Center for Data Integration and Knowledge for Health, which combines data from the Ministry of Health’s Information System on Live Births (SINASC) and from a cohort of 100 million Brazilians. 

In total, the analysis included information on 3,804,152 women and 4,788,279 births. All participants had at least two consecutive live births.

Most interpregnancy intervals, ie, the difference between the previous childbirth and the subsequent conception, ranged from 23 to 58 months (39.1%). Extreme intervals of < 6 months and > 120 months occurred in 5.6% and 1.6% of cases, respectively.

Regarding adverse outcomes, the research indicated that, in the general population, small-for-gestational-age (SGA) babies were observed in 8.4% of subsequent births, while low birth weight (LBW) occurred in 5.9% and preterm birth in 7.5%.
 

Interpregnancy Interval and SGA Risk

The authors noted that the risk for subsequent adverse outcomes increased with extreme interpregnancy intervals, with SGA being the only exception. In this case, women who had an interval between the previous childbirth and the subsequent conception > 120 months had a lower risk for SGA.

According to João Guilherme Tedde, a medical student at UFGD and the first author of the study, similar patterns (extremely long interpregnancy intervals associated with a lower risk for subsequent SGA) have been described in the literature. In an interview with this news organization, he explained some hypotheses that could explain this phenomenon.

According to the researcher, the finding may reflect the distinct risk profile of mothers who wait a very long time to conceive again. “This group, composed of older women, likely has a higher prevalence of health problems, such as diabetes and obesity, which are known risk factors for having large-for-gestational-age (LGA) babies,” he said. He also highlighted the fact that the study showed that the risk for LGA also increased as the interval between pregnancies grew.

Another hypothesis suggested by the author is the possible occurrence of events between pregnancies, such as miscarriages or stillbirths. According to him, women who have experienced these events between two consecutive pregnancies may have falsely increased interpregnancy intervals, since miscarriages and stillbirths (which are considered conceptions) are not counted in SINASC.

“Thus, the lower occurrence of SGA in the group with very long intervals may reflect a competition of events between stillbirths or miscarriages and live SGAs,” he said.
 

Previous and Subsequent Adverse Events

The research also showed that the risks for subsequent SGA, LBW, and preterm birth were higher among women with a history of adverse events in previous pregnancies.

Furthermore, the authors noted that the previous occurrence of adverse outcomes seems to “have a more significant impact on the outcome of the current pregnancy than the interpregnancy interval.” 

“We found that, for women with the same interpregnancy interval (say < 6 months), but with different obstetric history (zero previous events vs one event), the absolute risk for subsequent adverse outcomes increased much more than when we change only the duration of the interval in a group with the same number of previous adverse events,” said Dr. Tedde.

There is still no convincing explanation for this fact, he said, since the cause-and-effect relationship between interpregnancy intervals and perinatal events is not clear. But the obstetrics literature generally shows that among the main risk factors for an adverse event is the previous occurrence of the same event. This effect could be related to living conditions and maternal habits, genetics, epigenetics, among others.

The researcher observed that this study is one of the largest in terms of sampling to investigate how maternal obstetric history can modulate the effect of interpregnancy interval on the risk for adverse outcomes in subsequent pregnancies.

The findings of the research published this year reinforce the importance of individualizing recommendations regarding interpregnancy intervals, considering factors such as maternal obstetric history. However, the author warns that it is still too early to point out the “best” interval for each situation.

“We need more studies that reproduce our findings and that expand the analyzed outcomes to also include those of interest to the mother, such as maternal mortality,” he concluded.

This story was translated from the Medscape Portuguese edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. A version of this article appeared on Medscape.com.

Key clinical point: Anti-calcitonin gene-related peptide monoclonal antibodies (anti-CGRP mAb) showed superior efficacy to botulinum toxin A (BoNT-A) in reducing the migraine burden in patients with chronic migraine (CM).

Major finding: Anti-CGRP mAbs vs BoNT-A led to significant reductions in mean Headache Impact Test-6 and Allodynia Symptoms Checklist-12 scores at 6 months (mean change −11.1 vs −3.2 points, P < .0001; and −5.2 vs −0.5 points, P = .0056, respectively) and 12 months (mean change −11.4 vs −3.6 points, P = .0042; and −6.0 vs −0.9 points, P = .0011, respectively).

Study details: This exploratory analysis of the real-world effectiveness of anti-CGRP mAb vs BoNT-A included 126 patients with CM who were treated with anti-CGRP mAb (n = 36) or BoNT-A (n = 90).

Disclosures: The study was supported by the Italian Ministry of Health. Some authors declared receiving funding, travel grants, honoraria, or personal fees for participation in advisory boards, speaker panels, and clinical investigation studies from various sources.

Source: Montisano DA, Giossi R, Canella M, et al. Reducing the impact of headache and allodynia score in chronic migraine: An exploratory analysis from the Real-world Effectiveness of Anti-CGRP Monoclonal Antibodies Compared to Onabotulinum Toxin A (RAMO) Study. Toxins. 2024;16(4):178. doi: 10.3390/toxins16040178 Source

Key clinical point: Anti-calcitonin gene-related peptide monoclonal antibodies (anti-CGRP mAb) showed superior efficacy to botulinum toxin A (BoNT-A) in reducing the migraine burden in patients with chronic migraine (CM).

Major finding: Anti-CGRP mAbs vs BoNT-A led to significant reductions in mean Headache Impact Test-6 and Allodynia Symptoms Checklist-12 scores at 6 months (mean change −11.1 vs −3.2 points, P < .0001; and −5.2 vs −0.5 points, P = .0056, respectively) and 12 months (mean change −11.4 vs −3.6 points, P = .0042; and −6.0 vs −0.9 points, P = .0011, respectively).

Study details: This exploratory analysis of the real-world effectiveness of anti-CGRP mAb vs BoNT-A included 126 patients with CM who were treated with anti-CGRP mAb (n = 36) or BoNT-A (n = 90).

Disclosures: The study was supported by the Italian Ministry of Health. Some authors declared receiving funding, travel grants, honoraria, or personal fees for participation in advisory boards, speaker panels, and clinical investigation studies from various sources.

Source: Montisano DA, Giossi R, Canella M, et al. Reducing the impact of headache and allodynia score in chronic migraine: An exploratory analysis from the Real-world Effectiveness of Anti-CGRP Monoclonal Antibodies Compared to Onabotulinum Toxin A (RAMO) Study. Toxins. 2024;16(4):178. doi: 10.3390/toxins16040178 Source

Key clinical point: Anti-calcitonin gene-related peptide monoclonal antibodies (anti-CGRP mAb) showed superior efficacy to botulinum toxin A (BoNT-A) in reducing the migraine burden in patients with chronic migraine (CM).

Major finding: Anti-CGRP mAbs vs BoNT-A led to significant reductions in mean Headache Impact Test-6 and Allodynia Symptoms Checklist-12 scores at 6 months (mean change −11.1 vs −3.2 points, P < .0001; and −5.2 vs −0.5 points, P = .0056, respectively) and 12 months (mean change −11.4 vs −3.6 points, P = .0042; and −6.0 vs −0.9 points, P = .0011, respectively).

Study details: This exploratory analysis of the real-world effectiveness of anti-CGRP mAb vs BoNT-A included 126 patients with CM who were treated with anti-CGRP mAb (n = 36) or BoNT-A (n = 90).

Disclosures: The study was supported by the Italian Ministry of Health. Some authors declared receiving funding, travel grants, honoraria, or personal fees for participation in advisory boards, speaker panels, and clinical investigation studies from various sources.

Source: Montisano DA, Giossi R, Canella M, et al. Reducing the impact of headache and allodynia score in chronic migraine: An exploratory analysis from the Real-world Effectiveness of Anti-CGRP Monoclonal Antibodies Compared to Onabotulinum Toxin A (RAMO) Study. Toxins. 2024;16(4):178. doi: 10.3390/toxins16040178 Source

Key clinical point: Contrary to common beliefs, neither anxiety nor depressive symptoms were associated with migraine-related outcomes in children and adolescents.

Major finding: Headache frequency and migraine-related disability had no significant association with anxiety (headache frequency P = .639; migraine-related disability P = .470) and depressive symptoms (headache frequency P = .209; migraine-related disability P = .796) at baseline. Similarly, no significant association was observed between longitudinal changes in anxiety and depressive symptoms and migraine-related outcomes.

Study details: Findings are from a prospective clinical cohort study including 123 children and adolescents with migraine who responded to a headache questionnaire and were assessed for anxiety and depressive symptoms.

Disclosures: This study was supported by the Program of Undergraduate Research Experience, University of Calgary, Canada, and others. Serena Laura Orr declared receiving royalties and research funding from various sources and serving on the editorial boards of Headache, Neurology, and the American Migraine Foundation. The other authors declared no conflicts of interest.

Source: Rizvi BA, Kuziek J, Cho LY, et al. Anxiety and depressive symptoms and migraine-related outcomes in children and adolescents. Headache. 2024 (Apr 6). doi: 10.1111/head.14701 Source

Key clinical point: Contrary to common beliefs, neither anxiety nor depressive symptoms were associated with migraine-related outcomes in children and adolescents.

Major finding: Headache frequency and migraine-related disability had no significant association with anxiety (headache frequency P = .639; migraine-related disability P = .470) and depressive symptoms (headache frequency P = .209; migraine-related disability P = .796) at baseline. Similarly, no significant association was observed between longitudinal changes in anxiety and depressive symptoms and migraine-related outcomes.

Study details: Findings are from a prospective clinical cohort study including 123 children and adolescents with migraine who responded to a headache questionnaire and were assessed for anxiety and depressive symptoms.

Disclosures: This study was supported by the Program of Undergraduate Research Experience, University of Calgary, Canada, and others. Serena Laura Orr declared receiving royalties and research funding from various sources and serving on the editorial boards of Headache, Neurology, and the American Migraine Foundation. The other authors declared no conflicts of interest.

Source: Rizvi BA, Kuziek J, Cho LY, et al. Anxiety and depressive symptoms and migraine-related outcomes in children and adolescents. Headache. 2024 (Apr 6). doi: 10.1111/head.14701 Source

Key clinical point: Contrary to common beliefs, neither anxiety nor depressive symptoms were associated with migraine-related outcomes in children and adolescents.

Major finding: Headache frequency and migraine-related disability had no significant association with anxiety (headache frequency P = .639; migraine-related disability P = .470) and depressive symptoms (headache frequency P = .209; migraine-related disability P = .796) at baseline. Similarly, no significant association was observed between longitudinal changes in anxiety and depressive symptoms and migraine-related outcomes.

Study details: Findings are from a prospective clinical cohort study including 123 children and adolescents with migraine who responded to a headache questionnaire and were assessed for anxiety and depressive symptoms.

Disclosures: This study was supported by the Program of Undergraduate Research Experience, University of Calgary, Canada, and others. Serena Laura Orr declared receiving royalties and research funding from various sources and serving on the editorial boards of Headache, Neurology, and the American Migraine Foundation. The other authors declared no conflicts of interest.

Source: Rizvi BA, Kuziek J, Cho LY, et al. Anxiety and depressive symptoms and migraine-related outcomes in children and adolescents. Headache. 2024 (Apr 6). doi: 10.1111/head.14701 Source

Key clinical point: Treatment with a combination of anti-calcitonin gene-related peptide (anti-CGRP) monoclonal antibodies (mAb) and onabotulinumtoxinA (onabot) was more effective than monotherapy with either anti-CGRP alone or onabot in reducing monthly migraine days (MMD) in patients with chronic migraine.

Major finding: Initiating therapy with either anti-CGRP mAbs or onabot significantly reduced the median MMD from 30 to 15 days, which further decreased to 8 days after initiating dual therapy with anti-CGRP mAb and onabot (both P < .0001). Overall, 68% of patients receiving dual therapy achieved 50% or greater reduction in MMD.

Study details: This real-world retrospective chart review included 423 patients with chronic migraine (age ≥ 18 years) who received monotherapy with either anti-CGRP mAb or onabot (n = 229) followed by dual therapy (concurrent treatment with anti-CGRP mAb and onabot; n = 194) for at least three consecutive months.

Disclosures: This study was funded by a Cleveland Clinic institutional grant. The authors declared no conflicts of interest.

Source: Salim A, Hennessy E, Sonneborn C, et al. Synergism of anti-CGRP monoclonal antibodies and onabotulinumtoxinA in the treatment of chronic migraine: A real-world retrospective chart review. CNS Drugs. 2024 (Apr 7). doi: 10.1007/s40263-024-01086-z  Source

Key clinical point: Treatment with a combination of anti-calcitonin gene-related peptide (anti-CGRP) monoclonal antibodies (mAb) and onabotulinumtoxinA (onabot) was more effective than monotherapy with either anti-CGRP alone or onabot in reducing monthly migraine days (MMD) in patients with chronic migraine.

Major finding: Initiating therapy with either anti-CGRP mAbs or onabot significantly reduced the median MMD from 30 to 15 days, which further decreased to 8 days after initiating dual therapy with anti-CGRP mAb and onabot (both P < .0001). Overall, 68% of patients receiving dual therapy achieved 50% or greater reduction in MMD.

Study details: This real-world retrospective chart review included 423 patients with chronic migraine (age ≥ 18 years) who received monotherapy with either anti-CGRP mAb or onabot (n = 229) followed by dual therapy (concurrent treatment with anti-CGRP mAb and onabot; n = 194) for at least three consecutive months.

Disclosures: This study was funded by a Cleveland Clinic institutional grant. The authors declared no conflicts of interest.

Source: Salim A, Hennessy E, Sonneborn C, et al. Synergism of anti-CGRP monoclonal antibodies and onabotulinumtoxinA in the treatment of chronic migraine: A real-world retrospective chart review. CNS Drugs. 2024 (Apr 7). doi: 10.1007/s40263-024-01086-z  Source

Key clinical point: Treatment with a combination of anti-calcitonin gene-related peptide (anti-CGRP) monoclonal antibodies (mAb) and onabotulinumtoxinA (onabot) was more effective than monotherapy with either anti-CGRP alone or onabot in reducing monthly migraine days (MMD) in patients with chronic migraine.

Major finding: Initiating therapy with either anti-CGRP mAbs or onabot significantly reduced the median MMD from 30 to 15 days, which further decreased to 8 days after initiating dual therapy with anti-CGRP mAb and onabot (both P < .0001). Overall, 68% of patients receiving dual therapy achieved 50% or greater reduction in MMD.

Study details: This real-world retrospective chart review included 423 patients with chronic migraine (age ≥ 18 years) who received monotherapy with either anti-CGRP mAb or onabot (n = 229) followed by dual therapy (concurrent treatment with anti-CGRP mAb and onabot; n = 194) for at least three consecutive months.

Disclosures: This study was funded by a Cleveland Clinic institutional grant. The authors declared no conflicts of interest.

Source: Salim A, Hennessy E, Sonneborn C, et al. Synergism of anti-CGRP monoclonal antibodies and onabotulinumtoxinA in the treatment of chronic migraine: A real-world retrospective chart review. CNS Drugs. 2024 (Apr 7). doi: 10.1007/s40263-024-01086-z  Source

Key clinical point: Higher body mass index (BMI) was positively associated with an increased risk for medication-overuse headache (MOH) in patients with migraine.

Major finding: Higher BMI was positively associated with a higher risk for MOH (adjusted odds ratio [aOR] 1.05; 95% CI 1.01-1.11; P = .031), with the risk being significantly higher in patients with migraine who had a BMI ≥ 28.0 kg/m² vs those with BMI of 18.5-23.9 kg/m² (aOR 1.81; 95% CI 1.04-3.17; P = .037).

Study details: This secondary analysis of the Survey of Fibromyalgia Comorbidity with Headache study included 2251 patients with migraine, of whom 195 (8.7%) had concomitant MOH.

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

Source: Liu H, Zhao H, Liu K, et al. Association between body mass index and medication-overuse headache among individuals with migraine: A cross-sectional study. Obes Facts. 2024 (Apr 3). doi: 10.1159/000538528 Source

Key clinical point: Higher body mass index (BMI) was positively associated with an increased risk for medication-overuse headache (MOH) in patients with migraine.

Major finding: Higher BMI was positively associated with a higher risk for MOH (adjusted odds ratio [aOR] 1.05; 95% CI 1.01-1.11; P = .031), with the risk being significantly higher in patients with migraine who had a BMI ≥ 28.0 kg/m² vs those with BMI of 18.5-23.9 kg/m² (aOR 1.81; 95% CI 1.04-3.17; P = .037).

Study details: This secondary analysis of the Survey of Fibromyalgia Comorbidity with Headache study included 2251 patients with migraine, of whom 195 (8.7%) had concomitant MOH.

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

Source: Liu H, Zhao H, Liu K, et al. Association between body mass index and medication-overuse headache among individuals with migraine: A cross-sectional study. Obes Facts. 2024 (Apr 3). doi: 10.1159/000538528 Source

Key clinical point: Higher body mass index (BMI) was positively associated with an increased risk for medication-overuse headache (MOH) in patients with migraine.

Major finding: Higher BMI was positively associated with a higher risk for MOH (adjusted odds ratio [aOR] 1.05; 95% CI 1.01-1.11; P = .031), with the risk being significantly higher in patients with migraine who had a BMI ≥ 28.0 kg/m² vs those with BMI of 18.5-23.9 kg/m² (aOR 1.81; 95% CI 1.04-3.17; P = .037).

Study details: This secondary analysis of the Survey of Fibromyalgia Comorbidity with Headache study included 2251 patients with migraine, of whom 195 (8.7%) had concomitant MOH.

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

Source: Liu H, Zhao H, Liu K, et al. Association between body mass index and medication-overuse headache among individuals with migraine: A cross-sectional study. Obes Facts. 2024 (Apr 3). doi: 10.1159/000538528 Source

Key clinical point: A higher dietary phytochemical index (DPI) score is associated with lower migraine frequency and improved migraine-related disability in patients with migraine.

Major finding: Patients with migraine in the third vs first tertile of the DPI showed a significant reduction in migraine frequency (incidence rate ratio 0.84; P_trend = .009) and an improvement in migraine-related disability (β −2.48; P_trend = .046). However, no significant association was seen between DPI and headache duration (P_trend = .439), headache severity (P_trend = .239), depression (P_trend = .480), anxiety (P_trend = .655), and stress (P_trend = .876).

Study details: This cross-sectional study evaluated the association between DPI and the clinical and psychological characteristics of migraine headaches in 262 patients with migraine (age 20-50 years).

Disclosures: This study was supported by the Isfahan University of Medical Sciences, Isfahan, Iran. The authors declared no conflicts of interest.

Source: Amani Tirani S, Balali A, Kazemi M, et al. The predictive role of the dietary phytochemical index in relation to the clinical and psychological traits of migraine headaches. Sci Rep. 2024;14:6886 (Mar 22). doi: 10.1038/s41598-024-57536-7 Source

Key clinical point: A higher dietary phytochemical index (DPI) score is associated with lower migraine frequency and improved migraine-related disability in patients with migraine.

Major finding: Patients with migraine in the third vs first tertile of the DPI showed a significant reduction in migraine frequency (incidence rate ratio 0.84; P_trend = .009) and an improvement in migraine-related disability (β −2.48; P_trend = .046). However, no significant association was seen between DPI and headache duration (P_trend = .439), headache severity (P_trend = .239), depression (P_trend = .480), anxiety (P_trend = .655), and stress (P_trend = .876).

Study details: This cross-sectional study evaluated the association between DPI and the clinical and psychological characteristics of migraine headaches in 262 patients with migraine (age 20-50 years).

Disclosures: This study was supported by the Isfahan University of Medical Sciences, Isfahan, Iran. The authors declared no conflicts of interest.

Source: Amani Tirani S, Balali A, Kazemi M, et al. The predictive role of the dietary phytochemical index in relation to the clinical and psychological traits of migraine headaches. Sci Rep. 2024;14:6886 (Mar 22). doi: 10.1038/s41598-024-57536-7 Source

Key clinical point: A higher dietary phytochemical index (DPI) score is associated with lower migraine frequency and improved migraine-related disability in patients with migraine.

Major finding: Patients with migraine in the third vs first tertile of the DPI showed a significant reduction in migraine frequency (incidence rate ratio 0.84; P_trend = .009) and an improvement in migraine-related disability (β −2.48; P_trend = .046). However, no significant association was seen between DPI and headache duration (P_trend = .439), headache severity (P_trend = .239), depression (P_trend = .480), anxiety (P_trend = .655), and stress (P_trend = .876).

Study details: This cross-sectional study evaluated the association between DPI and the clinical and psychological characteristics of migraine headaches in 262 patients with migraine (age 20-50 years).

Disclosures: This study was supported by the Isfahan University of Medical Sciences, Isfahan, Iran. The authors declared no conflicts of interest.

Source: Amani Tirani S, Balali A, Kazemi M, et al. The predictive role of the dietary phytochemical index in relation to the clinical and psychological traits of migraine headaches. Sci Rep. 2024;14:6886 (Mar 22). doi: 10.1038/s41598-024-57536-7 Source

Key clinical point: Atopic dermatitis (AD) is significantly associated with a higher risk for headache disorders or migraine.

Major finding: Patients with AD had a significantly higher risk for headache disorder (odds ratio [OR] 1.46; 95% CI 1.36-1.56) or migraine (OR 1.32; 95% CI 1.18-1.47; both P < .001). This finding was consistent across the different subgroup analyses.

Study details: The data come from a meta-analysis of 10 observational studies that evaluated the risk for headache disorders in 12,717,747 patients with AD, of which six studies evaluated migraine risk in 11,090,412 patients with AD.

Disclosures: This study was supported by the project of training talent for Zhejiang province young and middle-aged clinical traditional Chinese medicine experts and Hangzhou Municipal Health and Family Planning Commission Science and Technology Project, China. The authors declared no conflicts of interest.

Source: Yang W, Dai H, Xu X-F, et al. Association of atopic dermatitis and headache disorder: A systematic review and meta-analyses. Front Neurol. 2024;15:1383832. doi: 10.3389/fneur.2024.1383832 Source

Key clinical point: Atopic dermatitis (AD) is significantly associated with a higher risk for headache disorders or migraine.

Major finding: Patients with AD had a significantly higher risk for headache disorder (odds ratio [OR] 1.46; 95% CI 1.36-1.56) or migraine (OR 1.32; 95% CI 1.18-1.47; both P < .001). This finding was consistent across the different subgroup analyses.

Study details: The data come from a meta-analysis of 10 observational studies that evaluated the risk for headache disorders in 12,717,747 patients with AD, of which six studies evaluated migraine risk in 11,090,412 patients with AD.

Disclosures: This study was supported by the project of training talent for Zhejiang province young and middle-aged clinical traditional Chinese medicine experts and Hangzhou Municipal Health and Family Planning Commission Science and Technology Project, China. The authors declared no conflicts of interest.

Source: Yang W, Dai H, Xu X-F, et al. Association of atopic dermatitis and headache disorder: A systematic review and meta-analyses. Front Neurol. 2024;15:1383832. doi: 10.3389/fneur.2024.1383832 Source

Key clinical point: Atopic dermatitis (AD) is significantly associated with a higher risk for headache disorders or migraine.

Major finding: Patients with AD had a significantly higher risk for headache disorder (odds ratio [OR] 1.46; 95% CI 1.36-1.56) or migraine (OR 1.32; 95% CI 1.18-1.47; both P < .001). This finding was consistent across the different subgroup analyses.

Study details: The data come from a meta-analysis of 10 observational studies that evaluated the risk for headache disorders in 12,717,747 patients with AD, of which six studies evaluated migraine risk in 11,090,412 patients with AD.

Disclosures: This study was supported by the project of training talent for Zhejiang province young and middle-aged clinical traditional Chinese medicine experts and Hangzhou Municipal Health and Family Planning Commission Science and Technology Project, China. The authors declared no conflicts of interest.

Source: Yang W, Dai H, Xu X-F, et al. Association of atopic dermatitis and headache disorder: A systematic review and meta-analyses. Front Neurol. 2024;15:1383832. doi: 10.3389/fneur.2024.1383832 Source

Key clinical point: Patients with chronic kidney disease (CKD), particularly older adults and women, had a modestly reduced risk of developing migraine over a 16-year follow-up period.

Major finding: During the 16-year follow-up, patients with vs without CKD had an 11% lower risk for migraine (adjusted hazard ratio [aHR] 0.89; P = .006), with the risk being prominently lower among older adults (age ≥ 70 years; aHR 0.69; P < .001) and women (aHR 0.84; P = .006).

Study details: This nationwide, 16-year longitudinal follow-up study included 15,443 participants with CKD, of whom 349 (2.26%) had migraine, and 61,772 participants without CKD, of whom 1901 (3.08%) had migraine.

Disclosures: This study was supported by Bracco Imaging Korea and the National Research Foundation of Korea. The authors declared no conflicts of interest.

Source: Kwon MJ, Kim J-K, Kim M-J, et al. Associations between chronic kidney disease and migraine incidence: Findings from a Korean longitudinal big data study. J Pers Med. 2024;14(4):356 (Mar 28).  doi: 10.3390/jpm14040356 Source

Key clinical point: Patients with chronic kidney disease (CKD), particularly older adults and women, had a modestly reduced risk of developing migraine over a 16-year follow-up period.

Major finding: During the 16-year follow-up, patients with vs without CKD had an 11% lower risk for migraine (adjusted hazard ratio [aHR] 0.89; P = .006), with the risk being prominently lower among older adults (age ≥ 70 years; aHR 0.69; P < .001) and women (aHR 0.84; P = .006).

Study details: This nationwide, 16-year longitudinal follow-up study included 15,443 participants with CKD, of whom 349 (2.26%) had migraine, and 61,772 participants without CKD, of whom 1901 (3.08%) had migraine.

Disclosures: This study was supported by Bracco Imaging Korea and the National Research Foundation of Korea. The authors declared no conflicts of interest.

Source: Kwon MJ, Kim J-K, Kim M-J, et al. Associations between chronic kidney disease and migraine incidence: Findings from a Korean longitudinal big data study. J Pers Med. 2024;14(4):356 (Mar 28).  doi: 10.3390/jpm14040356 Source

Key clinical point: Patients with chronic kidney disease (CKD), particularly older adults and women, had a modestly reduced risk of developing migraine over a 16-year follow-up period.

Major finding: During the 16-year follow-up, patients with vs without CKD had an 11% lower risk for migraine (adjusted hazard ratio [aHR] 0.89; P = .006), with the risk being prominently lower among older adults (age ≥ 70 years; aHR 0.69; P < .001) and women (aHR 0.84; P = .006).

Study details: This nationwide, 16-year longitudinal follow-up study included 15,443 participants with CKD, of whom 349 (2.26%) had migraine, and 61,772 participants without CKD, of whom 1901 (3.08%) had migraine.

Disclosures: This study was supported by Bracco Imaging Korea and the National Research Foundation of Korea. The authors declared no conflicts of interest.

Source: Kwon MJ, Kim J-K, Kim M-J, et al. Associations between chronic kidney disease and migraine incidence: Findings from a Korean longitudinal big data study. J Pers Med. 2024;14(4):356 (Mar 28).  doi: 10.3390/jpm14040356 Source

Key clinical point: In patients with migraine, any oral prophylactic therapy significantly improved sleep quality, but anti-calcitonin gene-related peptide (anti-CGRP) monoclonal antibodies (mAb) had significantly better effects than other oral prophylactic therapies.

Major finding: The Pittsburgh Sleep Quality Index (PSQI) score significantly reduced from 6.84 at baseline to 5.581 at 3 months with any oral prophylactic therapy and from 8.913 at baseline to 6.491 at 3 months with anti-CGRP mAbs. Among oral therapies, calcium channel blockers (P = .042) and antidepressants (P = .049) showed higher efficacy in reducing PSQI scores.

Study details: This multicenter prospective study included 214 patients with migraine, with or without aura, who received any oral prophylactic therapy (n = 143) or anti-CGRP mAb (n = 71).

Disclosures: This study was partially supported by Fondazione Giorgini, Italy. Mauro Silvestrini declared receiving financial support from the Giorgini Foundation. The other authors declared no conflicts of interest.

Source: Viticchi G, Di Stefano V, Altamura C, et al. Effects of prophylactic drug therapies and anti-calcitonin peptide-related monoclonal antibodies on subjective sleep quality: An Italian multicenter study. Sleep Med. 2024;117:87-94 (Mar 17). doi: 10.1016/j.sleep.2024.03.026 Source

Key clinical point: In patients with migraine, any oral prophylactic therapy significantly improved sleep quality, but anti-calcitonin gene-related peptide (anti-CGRP) monoclonal antibodies (mAb) had significantly better effects than other oral prophylactic therapies.

Major finding: The Pittsburgh Sleep Quality Index (PSQI) score significantly reduced from 6.84 at baseline to 5.581 at 3 months with any oral prophylactic therapy and from 8.913 at baseline to 6.491 at 3 months with anti-CGRP mAbs. Among oral therapies, calcium channel blockers (P = .042) and antidepressants (P = .049) showed higher efficacy in reducing PSQI scores.

Study details: This multicenter prospective study included 214 patients with migraine, with or without aura, who received any oral prophylactic therapy (n = 143) or anti-CGRP mAb (n = 71).

Disclosures: This study was partially supported by Fondazione Giorgini, Italy. Mauro Silvestrini declared receiving financial support from the Giorgini Foundation. The other authors declared no conflicts of interest.

Source: Viticchi G, Di Stefano V, Altamura C, et al. Effects of prophylactic drug therapies and anti-calcitonin peptide-related monoclonal antibodies on subjective sleep quality: An Italian multicenter study. Sleep Med. 2024;117:87-94 (Mar 17). doi: 10.1016/j.sleep.2024.03.026 Source

Key clinical point: In patients with migraine, any oral prophylactic therapy significantly improved sleep quality, but anti-calcitonin gene-related peptide (anti-CGRP) monoclonal antibodies (mAb) had significantly better effects than other oral prophylactic therapies.

Major finding: The Pittsburgh Sleep Quality Index (PSQI) score significantly reduced from 6.84 at baseline to 5.581 at 3 months with any oral prophylactic therapy and from 8.913 at baseline to 6.491 at 3 months with anti-CGRP mAbs. Among oral therapies, calcium channel blockers (P = .042) and antidepressants (P = .049) showed higher efficacy in reducing PSQI scores.

Study details: This multicenter prospective study included 214 patients with migraine, with or without aura, who received any oral prophylactic therapy (n = 143) or anti-CGRP mAb (n = 71).

Disclosures: This study was partially supported by Fondazione Giorgini, Italy. Mauro Silvestrini declared receiving financial support from the Giorgini Foundation. The other authors declared no conflicts of interest.

Source: Viticchi G, Di Stefano V, Altamura C, et al. Effects of prophylactic drug therapies and anti-calcitonin peptide-related monoclonal antibodies on subjective sleep quality: An Italian multicenter study. Sleep Med. 2024;117:87-94 (Mar 17). doi: 10.1016/j.sleep.2024.03.026 Source

Key clinical point: Early initiation of erenumab demonstrated better long-term efficacy, tolerability, and patient adherence than non-specific oral migraine preventive medications (OMPM) in patients with episodic migraine (EM) and one or two previous preventive treatment failures.

Major finding: At month 12, significantly more patients in the erenumab vs OMPM group completed the initially assigned treatment and also achieved a ≥50% reduction in monthly migraine days (odds ratio 6.48; P < .001). A smaller proportion of patients in the erenumab group vs the OMPM group switched medications (2.2% vs 34.6%) and discontinued treatment due to adverse events (2.9% vs 23.3%).

Study details: Findings are from the APPRAISE trial that included 621 patients with EM (age ≥ 18 years) who had previously failed 1 or 2 preventive treatments and were randomly assigned to receive erenumab (n = 413) and OMPM (n = 208).

Disclosures: This study was funded by Novartis Pharma AG, Basel, Switzerland. Several authors declared themselves as employees of or holding stocks in Novartis, and the other authors declared ties with various sources, including Novartis.

Source: Pozo-Rosich P, Dolezil D, Paemeleire K, et al. Early use of erenumab vs nonspecific oral migraine preventives: The APPRAISE randomized clinical trial. JAMA Neurol. 2024 (Mar 25). doi: 10.1001/jamaneurol.2024.0368 Source

Key clinical point: Early initiation of erenumab demonstrated better long-term efficacy, tolerability, and patient adherence than non-specific oral migraine preventive medications (OMPM) in patients with episodic migraine (EM) and one or two previous preventive treatment failures.

Major finding: At month 12, significantly more patients in the erenumab vs OMPM group completed the initially assigned treatment and also achieved a ≥50% reduction in monthly migraine days (odds ratio 6.48; P < .001). A smaller proportion of patients in the erenumab group vs the OMPM group switched medications (2.2% vs 34.6%) and discontinued treatment due to adverse events (2.9% vs 23.3%).

Study details: Findings are from the APPRAISE trial that included 621 patients with EM (age ≥ 18 years) who had previously failed 1 or 2 preventive treatments and were randomly assigned to receive erenumab (n = 413) and OMPM (n = 208).

Disclosures: This study was funded by Novartis Pharma AG, Basel, Switzerland. Several authors declared themselves as employees of or holding stocks in Novartis, and the other authors declared ties with various sources, including Novartis.

Source: Pozo-Rosich P, Dolezil D, Paemeleire K, et al. Early use of erenumab vs nonspecific oral migraine preventives: The APPRAISE randomized clinical trial. JAMA Neurol. 2024 (Mar 25). doi: 10.1001/jamaneurol.2024.0368 Source

Key clinical point: Early initiation of erenumab demonstrated better long-term efficacy, tolerability, and patient adherence than non-specific oral migraine preventive medications (OMPM) in patients with episodic migraine (EM) and one or two previous preventive treatment failures.

Major finding: At month 12, significantly more patients in the erenumab vs OMPM group completed the initially assigned treatment and also achieved a ≥50% reduction in monthly migraine days (odds ratio 6.48; P < .001). A smaller proportion of patients in the erenumab group vs the OMPM group switched medications (2.2% vs 34.6%) and discontinued treatment due to adverse events (2.9% vs 23.3%).

Study details: Findings are from the APPRAISE trial that included 621 patients with EM (age ≥ 18 years) who had previously failed 1 or 2 preventive treatments and were randomly assigned to receive erenumab (n = 413) and OMPM (n = 208).

Disclosures: This study was funded by Novartis Pharma AG, Basel, Switzerland. Several authors declared themselves as employees of or holding stocks in Novartis, and the other authors declared ties with various sources, including Novartis.

Source: Pozo-Rosich P, Dolezil D, Paemeleire K, et al. Early use of erenumab vs nonspecific oral migraine preventives: The APPRAISE randomized clinical trial. JAMA Neurol. 2024 (Mar 25). doi: 10.1001/jamaneurol.2024.0368 Source