Headache & Migraine

The Food and Drug Administration has approved lasmiditan (Reyvow) for acute treatment of migraines with and without auras in adults.

Wikimedia Commons/FitzColinGerald/ Creative Commons License

The agency’s Oct. 11 announcement said the approval is based on results from a pair of randomized, double-blind, placebo-controlled trials that included 3,177 adult patients with a history of migraine with and without aura. The percentage of patients whose pain and most bothersome migraine symptom (nausea, light sensitivity, or sound sensitivity) resolved after 2 hours was higher in patients receiving lasmiditan than in patients receiving placebo.

Lasmiditan is a serotonin 5-hydroxytryptamine_1F–receptor agonist, giving it a unique mechanism of action as compared with other migraine treatments.

The most common adverse events associated with lasmiditan include dizziness, fatigue, paresthesia, and sedation. There is a risk of driving impairment while taking the medication, and patients are advised not to operate or drive machinery for 8 hours after taking lasmiditan.

“Reyvow is a new option for the acute treatment of migraine, a painful condition that affects one in seven Americans. We know that the migraine community is keenly interested in additional treatment options, and we remain committed to continuing to work with stakeholders to promote the development of new therapies for the acute and preventive treatment of migraine,” said Nick Kozauer, MD, acting deputy director of the division of neurology products in the FDA’s Center for Drug Evaluation and Research.

Eli Lilly, the drug’s manufacturer, said in a news release that “the recommended controlled substance classification for Reyvow is currently under review by the Drug Enforcement Administration and is expected within 90 days of today’s FDA approval, after which Reyvow will be available to patients in retail pharmacies” in oral doses of 50 mg, 100 mg, and 200 mg.

[email protected]

The Food and Drug Administration has approved lasmiditan (Reyvow) for acute treatment of migraines with and without auras in adults.

Wikimedia Commons/FitzColinGerald/ Creative Commons License

The agency’s Oct. 11 announcement said the approval is based on results from a pair of randomized, double-blind, placebo-controlled trials that included 3,177 adult patients with a history of migraine with and without aura. The percentage of patients whose pain and most bothersome migraine symptom (nausea, light sensitivity, or sound sensitivity) resolved after 2 hours was higher in patients receiving lasmiditan than in patients receiving placebo.

Lasmiditan is a serotonin 5-hydroxytryptamine_1F–receptor agonist, giving it a unique mechanism of action as compared with other migraine treatments.

The most common adverse events associated with lasmiditan include dizziness, fatigue, paresthesia, and sedation. There is a risk of driving impairment while taking the medication, and patients are advised not to operate or drive machinery for 8 hours after taking lasmiditan.

“Reyvow is a new option for the acute treatment of migraine, a painful condition that affects one in seven Americans. We know that the migraine community is keenly interested in additional treatment options, and we remain committed to continuing to work with stakeholders to promote the development of new therapies for the acute and preventive treatment of migraine,” said Nick Kozauer, MD, acting deputy director of the division of neurology products in the FDA’s Center for Drug Evaluation and Research.

Eli Lilly, the drug’s manufacturer, said in a news release that “the recommended controlled substance classification for Reyvow is currently under review by the Drug Enforcement Administration and is expected within 90 days of today’s FDA approval, after which Reyvow will be available to patients in retail pharmacies” in oral doses of 50 mg, 100 mg, and 200 mg.

[email protected]

The Food and Drug Administration has approved lasmiditan (Reyvow) for acute treatment of migraines with and without auras in adults.

Wikimedia Commons/FitzColinGerald/ Creative Commons License

The agency’s Oct. 11 announcement said the approval is based on results from a pair of randomized, double-blind, placebo-controlled trials that included 3,177 adult patients with a history of migraine with and without aura. The percentage of patients whose pain and most bothersome migraine symptom (nausea, light sensitivity, or sound sensitivity) resolved after 2 hours was higher in patients receiving lasmiditan than in patients receiving placebo.

Lasmiditan is a serotonin 5-hydroxytryptamine_1F–receptor agonist, giving it a unique mechanism of action as compared with other migraine treatments.

The most common adverse events associated with lasmiditan include dizziness, fatigue, paresthesia, and sedation. There is a risk of driving impairment while taking the medication, and patients are advised not to operate or drive machinery for 8 hours after taking lasmiditan.

“Reyvow is a new option for the acute treatment of migraine, a painful condition that affects one in seven Americans. We know that the migraine community is keenly interested in additional treatment options, and we remain committed to continuing to work with stakeholders to promote the development of new therapies for the acute and preventive treatment of migraine,” said Nick Kozauer, MD, acting deputy director of the division of neurology products in the FDA’s Center for Drug Evaluation and Research.

Eli Lilly, the drug’s manufacturer, said in a news release that “the recommended controlled substance classification for Reyvow is currently under review by the Drug Enforcement Administration and is expected within 90 days of today’s FDA approval, after which Reyvow will be available to patients in retail pharmacies” in oral doses of 50 mg, 100 mg, and 200 mg.

[email protected]

IgG elimination diet combined with probiotics may be beneficial to migraine plus irritable bowel syndrome (IBS), a new study found. Researchers investigated the therapeutic potential of diet based on IgG elimination combined with probiotics on 60 patients with migraine plus IBS. IgG antibodies against 266 food varieties were detected by ELISA. Participants were randomized into 3 groups for treatment of IgG elimination diet or probiotics, or diet combined with probiotics. Among the findings:

• Improvement of migraine and gut symptom was achieved at a certain time point.
• Reduced over the counter (OTC) analgesics was seen in all groups.
• Use of triptans did not show significant difference.
• An increased serum serotonin level was seen in participants treated with elimination diet and elimination diet combined with probiotics.

Xie Y, et al. Effects of diet based on IgG elimination combined with probiotics on migraine plus irritable bowel syndrome. [Published online ahead of print August 21, 2019]. Pain Res Manag. doi: 10.1155/2019/7890461.

IgG elimination diet combined with probiotics may be beneficial to migraine plus irritable bowel syndrome (IBS), a new study found. Researchers investigated the therapeutic potential of diet based on IgG elimination combined with probiotics on 60 patients with migraine plus IBS. IgG antibodies against 266 food varieties were detected by ELISA. Participants were randomized into 3 groups for treatment of IgG elimination diet or probiotics, or diet combined with probiotics. Among the findings:

• Improvement of migraine and gut symptom was achieved at a certain time point.
• Reduced over the counter (OTC) analgesics was seen in all groups.
• Use of triptans did not show significant difference.
• An increased serum serotonin level was seen in participants treated with elimination diet and elimination diet combined with probiotics.

Xie Y, et al. Effects of diet based on IgG elimination combined with probiotics on migraine plus irritable bowel syndrome. [Published online ahead of print August 21, 2019]. Pain Res Manag. doi: 10.1155/2019/7890461.

IgG elimination diet combined with probiotics may be beneficial to migraine plus irritable bowel syndrome (IBS), a new study found. Researchers investigated the therapeutic potential of diet based on IgG elimination combined with probiotics on 60 patients with migraine plus IBS. IgG antibodies against 266 food varieties were detected by ELISA. Participants were randomized into 3 groups for treatment of IgG elimination diet or probiotics, or diet combined with probiotics. Among the findings:

• Improvement of migraine and gut symptom was achieved at a certain time point.
• Reduced over the counter (OTC) analgesics was seen in all groups.
• Use of triptans did not show significant difference.
• An increased serum serotonin level was seen in participants treated with elimination diet and elimination diet combined with probiotics.

Xie Y, et al. Effects of diet based on IgG elimination combined with probiotics on migraine plus irritable bowel syndrome. [Published online ahead of print August 21, 2019]. Pain Res Manag. doi: 10.1155/2019/7890461.

Excitatory non-invasive brain stimulation (NIBS) of the excitatory primary motor cortex (M1) is likely to reduce headache intensity and the frequency of headache attacks in patients with migraine, a new study found. Researchers quantitatively reviewed the efficacy of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) in randomized controlled trials (RTCs) in modifying headache intensity and frequency of headache attacks in patients with migraine. A random meta-analysis was performed to pool effect sizes of outcomes. Among the findings:

• Nine RCTs with 276 participants were included.
• Meta-analysis of excitatory M1 stimulation demonstrated significant effects on reducing headache intensity in patients with migraine.
• Meta-analysis of excitatory M1 stimulation showed significant effects on reducing frequency of headache attacks in patients with migraine.

Feng Y, et al. Effects of non-invasive brain stimulation on headache intensity and frequency of headache attacks in patients with migraine: A systematic review and meta-analysis. [Published online ahead of print September 18, 2019]. Headache. doi: 10.1111/head.13645.

Excitatory non-invasive brain stimulation (NIBS) of the excitatory primary motor cortex (M1) is likely to reduce headache intensity and the frequency of headache attacks in patients with migraine, a new study found. Researchers quantitatively reviewed the efficacy of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) in randomized controlled trials (RTCs) in modifying headache intensity and frequency of headache attacks in patients with migraine. A random meta-analysis was performed to pool effect sizes of outcomes. Among the findings:

• Nine RCTs with 276 participants were included.
• Meta-analysis of excitatory M1 stimulation demonstrated significant effects on reducing headache intensity in patients with migraine.
• Meta-analysis of excitatory M1 stimulation showed significant effects on reducing frequency of headache attacks in patients with migraine.

Feng Y, et al. Effects of non-invasive brain stimulation on headache intensity and frequency of headache attacks in patients with migraine: A systematic review and meta-analysis. [Published online ahead of print September 18, 2019]. Headache. doi: 10.1111/head.13645.

Excitatory non-invasive brain stimulation (NIBS) of the excitatory primary motor cortex (M1) is likely to reduce headache intensity and the frequency of headache attacks in patients with migraine, a new study found. Researchers quantitatively reviewed the efficacy of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) in randomized controlled trials (RTCs) in modifying headache intensity and frequency of headache attacks in patients with migraine. A random meta-analysis was performed to pool effect sizes of outcomes. Among the findings:

• Nine RCTs with 276 participants were included.
• Meta-analysis of excitatory M1 stimulation demonstrated significant effects on reducing headache intensity in patients with migraine.
• Meta-analysis of excitatory M1 stimulation showed significant effects on reducing frequency of headache attacks in patients with migraine.

Feng Y, et al. Effects of non-invasive brain stimulation on headache intensity and frequency of headache attacks in patients with migraine: A systematic review and meta-analysis. [Published online ahead of print September 18, 2019]. Headache. doi: 10.1111/head.13645.

Osmophobia is a specific clinical marker of migraine, but not tension-type headache, a new study found. Researchers conducted a prospective study on 193 patients suffering from migraine without aura, migraine with aura, episodic tension-type headache, or a combination of these. Each patient was asked to describe in detail osmophobia, when present, in the 4 headache attacks. Among the findings:

• 45.7% of migraine with aura attacks were associated with osmophobia.
• 67.2% of patients with migraine reported osmophobia in at least a quarter of the attacks.
• No tension-type headache attack was associated with osmophobia.

Terrin A, et al. A prospective study on osmophobia in migraine versus tension-type headache in a large series of attacks. [Published online ahead of print September 19, 2019]. Cephalalgia. doi: 10.1177/0333102419877661.

Osmophobia is a specific clinical marker of migraine, but not tension-type headache, a new study found. Researchers conducted a prospective study on 193 patients suffering from migraine without aura, migraine with aura, episodic tension-type headache, or a combination of these. Each patient was asked to describe in detail osmophobia, when present, in the 4 headache attacks. Among the findings:

• 45.7% of migraine with aura attacks were associated with osmophobia.
• 67.2% of patients with migraine reported osmophobia in at least a quarter of the attacks.
• No tension-type headache attack was associated with osmophobia.

Terrin A, et al. A prospective study on osmophobia in migraine versus tension-type headache in a large series of attacks. [Published online ahead of print September 19, 2019]. Cephalalgia. doi: 10.1177/0333102419877661.

Osmophobia is a specific clinical marker of migraine, but not tension-type headache, a new study found. Researchers conducted a prospective study on 193 patients suffering from migraine without aura, migraine with aura, episodic tension-type headache, or a combination of these. Each patient was asked to describe in detail osmophobia, when present, in the 4 headache attacks. Among the findings:

• 45.7% of migraine with aura attacks were associated with osmophobia.
• 67.2% of patients with migraine reported osmophobia in at least a quarter of the attacks.
• No tension-type headache attack was associated with osmophobia.

Terrin A, et al. A prospective study on osmophobia in migraine versus tension-type headache in a large series of attacks. [Published online ahead of print September 19, 2019]. Cephalalgia. doi: 10.1177/0333102419877661.

Noninvasive vagus nerve stimulation may reduce the intensity of vertigo and headache in patients with acute vestibular migraine attacks, according to a small, open-label study published online Sept. 25 in Neurology.

The retrospective, single-center study included data from 18 patients who had vestibular migraine and received acute treatment with a handheld stimulation device. The device used in the study, GammaCore, is approved for the treatment of migraine. There are no approved treatments for vestibular migraine.

“There’s a huge need for effective treatments for vestibular migraine attacks,” first author Shin C. Beh, MD, said in a news release. “People with vestibular migraine do not always have headaches, and when they do, they are often less severe than in typical migraine, so the pain-relieving drugs used for typical migraine often are not effective. People can take drugs that suppress the vertigo or the nausea, but those drugs cause drowsiness and make it hard for people to go about their usual activities.” Dr. Beh is an assistant professor of neurology and neurotherapeutics at University of Texas Southwestern Medical Center in Dallas.

The patients had an average age of about 46 years, and 16 were women. A total of 14 patients received treatment during an acute vestibular migraine attack, and 4 received treatment while they had bothersome interictal dizziness consistent with persistent perceptual postural dizziness.

After stimulation, vertigo improved in 13 of the 14 people with vestibular migraine attacks. In two of these patients, vertigo resolved completely, and five had at least a 50% improvement in vertigo symptoms. On a 0-10 scale, patients’ mean vertigo rating decreased from 5.2 before stimulation to 3.1 after stimulation.

Of five patients with vestibular migraine attacks who had headache, all experienced a reduction in headache pain. Mean headache severity decreased from 6 before stimulation to 2.4 after stimulation.

None of the four patients with interictal dizziness experienced a reduction in dizziness after stimulation.

Patients place the device against the neck to receive electrical stimulation, and patients received stimulation for 2 minutes on each side of the neck.

Participants reported a mild pulling sensation of the neck muscles during the stimulation but did not report pain or other side effects.

“Vestibular migraine is the most common neurologic cause of vertigo and can greatly interfere with a person’s daily life,” Dr. Beh said. “If these results can be confirmed with larger studies, not only could there finally be a treatment for vestibular migraine, such a treatment would also be easy to use.”

A randomized, double-blind, sham-controlled study is needed to further assess the use of noninvasive vagus nerve stimulation in treating vestibular migraine, the authors said.

The study had no targeted funding, and Dr. Beh had no relevant disclosures. Coauthor Deborah I. Friedman, MD, professor of neurology and neurotherapeutics and ophthalmology at UT Southwestern Medical Center, disclosed serving on advisory boards or speaking for pharmaceutical and medical device companies. Dr. Friedman is on the editorial advisory board of Neurology Reviews.

[email protected]

SOURCE: Beh SC et al. Neurology. 2019 Sep 25. doi: 10.1212/WNL.0000000000008388.

Noninvasive vagus nerve stimulation may reduce the intensity of vertigo and headache in patients with acute vestibular migraine attacks, according to a small, open-label study published online Sept. 25 in Neurology.

The retrospective, single-center study included data from 18 patients who had vestibular migraine and received acute treatment with a handheld stimulation device. The device used in the study, GammaCore, is approved for the treatment of migraine. There are no approved treatments for vestibular migraine.

“There’s a huge need for effective treatments for vestibular migraine attacks,” first author Shin C. Beh, MD, said in a news release. “People with vestibular migraine do not always have headaches, and when they do, they are often less severe than in typical migraine, so the pain-relieving drugs used for typical migraine often are not effective. People can take drugs that suppress the vertigo or the nausea, but those drugs cause drowsiness and make it hard for people to go about their usual activities.” Dr. Beh is an assistant professor of neurology and neurotherapeutics at University of Texas Southwestern Medical Center in Dallas.

The patients had an average age of about 46 years, and 16 were women. A total of 14 patients received treatment during an acute vestibular migraine attack, and 4 received treatment while they had bothersome interictal dizziness consistent with persistent perceptual postural dizziness.

After stimulation, vertigo improved in 13 of the 14 people with vestibular migraine attacks. In two of these patients, vertigo resolved completely, and five had at least a 50% improvement in vertigo symptoms. On a 0-10 scale, patients’ mean vertigo rating decreased from 5.2 before stimulation to 3.1 after stimulation.

Of five patients with vestibular migraine attacks who had headache, all experienced a reduction in headache pain. Mean headache severity decreased from 6 before stimulation to 2.4 after stimulation.

None of the four patients with interictal dizziness experienced a reduction in dizziness after stimulation.

Patients place the device against the neck to receive electrical stimulation, and patients received stimulation for 2 minutes on each side of the neck.

Participants reported a mild pulling sensation of the neck muscles during the stimulation but did not report pain or other side effects.

“Vestibular migraine is the most common neurologic cause of vertigo and can greatly interfere with a person’s daily life,” Dr. Beh said. “If these results can be confirmed with larger studies, not only could there finally be a treatment for vestibular migraine, such a treatment would also be easy to use.”

A randomized, double-blind, sham-controlled study is needed to further assess the use of noninvasive vagus nerve stimulation in treating vestibular migraine, the authors said.

The study had no targeted funding, and Dr. Beh had no relevant disclosures. Coauthor Deborah I. Friedman, MD, professor of neurology and neurotherapeutics and ophthalmology at UT Southwestern Medical Center, disclosed serving on advisory boards or speaking for pharmaceutical and medical device companies. Dr. Friedman is on the editorial advisory board of Neurology Reviews.

[email protected]

SOURCE: Beh SC et al. Neurology. 2019 Sep 25. doi: 10.1212/WNL.0000000000008388.

Noninvasive vagus nerve stimulation may reduce the intensity of vertigo and headache in patients with acute vestibular migraine attacks, according to a small, open-label study published online Sept. 25 in Neurology.

The retrospective, single-center study included data from 18 patients who had vestibular migraine and received acute treatment with a handheld stimulation device. The device used in the study, GammaCore, is approved for the treatment of migraine. There are no approved treatments for vestibular migraine.

“There’s a huge need for effective treatments for vestibular migraine attacks,” first author Shin C. Beh, MD, said in a news release. “People with vestibular migraine do not always have headaches, and when they do, they are often less severe than in typical migraine, so the pain-relieving drugs used for typical migraine often are not effective. People can take drugs that suppress the vertigo or the nausea, but those drugs cause drowsiness and make it hard for people to go about their usual activities.” Dr. Beh is an assistant professor of neurology and neurotherapeutics at University of Texas Southwestern Medical Center in Dallas.

The patients had an average age of about 46 years, and 16 were women. A total of 14 patients received treatment during an acute vestibular migraine attack, and 4 received treatment while they had bothersome interictal dizziness consistent with persistent perceptual postural dizziness.

After stimulation, vertigo improved in 13 of the 14 people with vestibular migraine attacks. In two of these patients, vertigo resolved completely, and five had at least a 50% improvement in vertigo symptoms. On a 0-10 scale, patients’ mean vertigo rating decreased from 5.2 before stimulation to 3.1 after stimulation.

Of five patients with vestibular migraine attacks who had headache, all experienced a reduction in headache pain. Mean headache severity decreased from 6 before stimulation to 2.4 after stimulation.

None of the four patients with interictal dizziness experienced a reduction in dizziness after stimulation.

Patients place the device against the neck to receive electrical stimulation, and patients received stimulation for 2 minutes on each side of the neck.

Participants reported a mild pulling sensation of the neck muscles during the stimulation but did not report pain or other side effects.

“Vestibular migraine is the most common neurologic cause of vertigo and can greatly interfere with a person’s daily life,” Dr. Beh said. “If these results can be confirmed with larger studies, not only could there finally be a treatment for vestibular migraine, such a treatment would also be easy to use.”

A randomized, double-blind, sham-controlled study is needed to further assess the use of noninvasive vagus nerve stimulation in treating vestibular migraine, the authors said.

The study had no targeted funding, and Dr. Beh had no relevant disclosures. Coauthor Deborah I. Friedman, MD, professor of neurology and neurotherapeutics and ophthalmology at UT Southwestern Medical Center, disclosed serving on advisory boards or speaking for pharmaceutical and medical device companies. Dr. Friedman is on the editorial advisory board of Neurology Reviews.

[email protected]

SOURCE: Beh SC et al. Neurology. 2019 Sep 25. doi: 10.1212/WNL.0000000000008388.

Unmet medical needs are of concern to patients who experience migraine treated with triptans and there may be an undertreatment with preventive therapies whose benefit is insufficient, a new study found. The study cohort consisted of participants with ≥4 triptan dose units per month, selected from the general population. Patients were stratified into: possible Low-Frequency Episodic Migraine (pLF-EM: 4-9 triptan dose units per month), possible High-Frequency Episodic Migraine (pHF-EM: 10-14 triptan dose units per month), and possible Chronic Migraine (pCM: 14 triptan dose units per month). Researchers found:

• Of 10,270,683 adults, 8 per 1000 were triptan users and of these, 38.2% were migraineurs with unmet medical needs.
• 72.3% of patients were affected by pLF-EM, 17.4% by pHF-EM, and 10.3% by pCM.
• 19.1% of patients used oral preventive drugs.
• Triptan use reduction was found in 22.3% of patients, decreasing with the intensification of need levels.

Piccinni C, Cevoli S, Martini N. A real-world study on unmet medical needs in triptan-treated migraine: prevalence, preventive therapies and triptan use modification from a large Italian population along two years. [Published online ahead of print June 27, 2019]. J Headache Pain. doi: 10.1186/s10194-019-1027-7.

Unmet medical needs are of concern to patients who experience migraine treated with triptans and there may be an undertreatment with preventive therapies whose benefit is insufficient, a new study found. The study cohort consisted of participants with ≥4 triptan dose units per month, selected from the general population. Patients were stratified into: possible Low-Frequency Episodic Migraine (pLF-EM: 4-9 triptan dose units per month), possible High-Frequency Episodic Migraine (pHF-EM: 10-14 triptan dose units per month), and possible Chronic Migraine (pCM: 14 triptan dose units per month). Researchers found:

• Of 10,270,683 adults, 8 per 1000 were triptan users and of these, 38.2% were migraineurs with unmet medical needs.
• 72.3% of patients were affected by pLF-EM, 17.4% by pHF-EM, and 10.3% by pCM.
• 19.1% of patients used oral preventive drugs.
• Triptan use reduction was found in 22.3% of patients, decreasing with the intensification of need levels.

Piccinni C, Cevoli S, Martini N. A real-world study on unmet medical needs in triptan-treated migraine: prevalence, preventive therapies and triptan use modification from a large Italian population along two years. [Published online ahead of print June 27, 2019]. J Headache Pain. doi: 10.1186/s10194-019-1027-7.

Unmet medical needs are of concern to patients who experience migraine treated with triptans and there may be an undertreatment with preventive therapies whose benefit is insufficient, a new study found. The study cohort consisted of participants with ≥4 triptan dose units per month, selected from the general population. Patients were stratified into: possible Low-Frequency Episodic Migraine (pLF-EM: 4-9 triptan dose units per month), possible High-Frequency Episodic Migraine (pHF-EM: 10-14 triptan dose units per month), and possible Chronic Migraine (pCM: 14 triptan dose units per month). Researchers found:

• Of 10,270,683 adults, 8 per 1000 were triptan users and of these, 38.2% were migraineurs with unmet medical needs.
• 72.3% of patients were affected by pLF-EM, 17.4% by pHF-EM, and 10.3% by pCM.
• 19.1% of patients used oral preventive drugs.
• Triptan use reduction was found in 22.3% of patients, decreasing with the intensification of need levels.

Piccinni C, Cevoli S, Martini N. A real-world study on unmet medical needs in triptan-treated migraine: prevalence, preventive therapies and triptan use modification from a large Italian population along two years. [Published online ahead of print June 27, 2019]. J Headache Pain. doi: 10.1186/s10194-019-1027-7.

Variables such as disability, depression, and lack of anger control are among the key factors associated with headache chronicity in patients who experience migraine, a new study found. The cross-sectional study included a target sample of 250 patients with acute or chronic migraine. All participants filled out questionnaires related to demographic characteristics, pain intensity, disability, depression, emotional intelligence, and anger. Researchers found:

• Patients with chronic migraine experienced higher levels of disability, depression, anger, and had lower levels of emotional intelligence vs patients with acute migraine.
• Variables that had a significant effect on headache chronicity were female gender, married status, lower level of education, headache duration, disability, depression, and anger.

Emadi F, Sharif F, Shaygan M, Sharifi N, Ashjazadeh N. Comparison of pain-related and psychological variables between acute and chronic migraine patients, and factors affecting headache chronicity. Int J Community Based Nurs Midwifery. 2019;7(3):192-200. doi: 10.30476/IJCBNM.2019.44994.

Variables such as disability, depression, and lack of anger control are among the key factors associated with headache chronicity in patients who experience migraine, a new study found. The cross-sectional study included a target sample of 250 patients with acute or chronic migraine. All participants filled out questionnaires related to demographic characteristics, pain intensity, disability, depression, emotional intelligence, and anger. Researchers found:

• Patients with chronic migraine experienced higher levels of disability, depression, anger, and had lower levels of emotional intelligence vs patients with acute migraine.
• Variables that had a significant effect on headache chronicity were female gender, married status, lower level of education, headache duration, disability, depression, and anger.

Emadi F, Sharif F, Shaygan M, Sharifi N, Ashjazadeh N. Comparison of pain-related and psychological variables between acute and chronic migraine patients, and factors affecting headache chronicity. Int J Community Based Nurs Midwifery. 2019;7(3):192-200. doi: 10.30476/IJCBNM.2019.44994.

Variables such as disability, depression, and lack of anger control are among the key factors associated with headache chronicity in patients who experience migraine, a new study found. The cross-sectional study included a target sample of 250 patients with acute or chronic migraine. All participants filled out questionnaires related to demographic characteristics, pain intensity, disability, depression, emotional intelligence, and anger. Researchers found:

• Patients with chronic migraine experienced higher levels of disability, depression, anger, and had lower levels of emotional intelligence vs patients with acute migraine.
• Variables that had a significant effect on headache chronicity were female gender, married status, lower level of education, headache duration, disability, depression, and anger.

Emadi F, Sharif F, Shaygan M, Sharifi N, Ashjazadeh N. Comparison of pain-related and psychological variables between acute and chronic migraine patients, and factors affecting headache chronicity. Int J Community Based Nurs Midwifery. 2019;7(3):192-200. doi: 10.30476/IJCBNM.2019.44994.

A very low-calorie ketogenic diet (VLCKD) has a preventive effect in overweight, episodic patients who experience migraine that appears within 1 month, a new study found. Researchers sought to determine the therapeutic effect of a very low-calorie diet in overweight, episodic patients who experience migraine during a weight-loss intervention in which participants alternated randomly between a VLCKD and a very low-calorie non-ketogenic diet (VLCnKD) each for 1 month. The primary outcomes measure was the reduction of migraine days each month compared to a 1-month pre-diet baseline. Among the findings:

• Thirty-five obese migraine sufferers were allocated blindly to 1-month successive VLCKD or VLCnKD in random order.
• During the VLCKD patients experienced ‒3.73 migraine days respect to VLCnKD.
• The 50% responder rate for migraine days was 74.28% during the VLCKD period and 8.57% during VLCnKD.
• Migraine attacks decreased by ‒3.02 during VLCKD respect to VLCnKD.

Di Lorenzo C, Pinto A, Lenca R, et al. A randomized double-blind, cross-over trial of very low-calorie diet in overweight migraine patients: A possible role for ketones? [Published online ahead of print July 28, 2019]. Nutrients. doi: 10.3390/nu11081742.

A very low-calorie ketogenic diet (VLCKD) has a preventive effect in overweight, episodic patients who experience migraine that appears within 1 month, a new study found. Researchers sought to determine the therapeutic effect of a very low-calorie diet in overweight, episodic patients who experience migraine during a weight-loss intervention in which participants alternated randomly between a VLCKD and a very low-calorie non-ketogenic diet (VLCnKD) each for 1 month. The primary outcomes measure was the reduction of migraine days each month compared to a 1-month pre-diet baseline. Among the findings:

• Thirty-five obese migraine sufferers were allocated blindly to 1-month successive VLCKD or VLCnKD in random order.
• During the VLCKD patients experienced ‒3.73 migraine days respect to VLCnKD.
• The 50% responder rate for migraine days was 74.28% during the VLCKD period and 8.57% during VLCnKD.
• Migraine attacks decreased by ‒3.02 during VLCKD respect to VLCnKD.

Di Lorenzo C, Pinto A, Lenca R, et al. A randomized double-blind, cross-over trial of very low-calorie diet in overweight migraine patients: A possible role for ketones? [Published online ahead of print July 28, 2019]. Nutrients. doi: 10.3390/nu11081742.

A very low-calorie ketogenic diet (VLCKD) has a preventive effect in overweight, episodic patients who experience migraine that appears within 1 month, a new study found. Researchers sought to determine the therapeutic effect of a very low-calorie diet in overweight, episodic patients who experience migraine during a weight-loss intervention in which participants alternated randomly between a VLCKD and a very low-calorie non-ketogenic diet (VLCnKD) each for 1 month. The primary outcomes measure was the reduction of migraine days each month compared to a 1-month pre-diet baseline. Among the findings:

• Thirty-five obese migraine sufferers were allocated blindly to 1-month successive VLCKD or VLCnKD in random order.
• During the VLCKD patients experienced ‒3.73 migraine days respect to VLCnKD.
• The 50% responder rate for migraine days was 74.28% during the VLCKD period and 8.57% during VLCnKD.
• Migraine attacks decreased by ‒3.02 during VLCKD respect to VLCnKD.

Di Lorenzo C, Pinto A, Lenca R, et al. A randomized double-blind, cross-over trial of very low-calorie diet in overweight migraine patients: A possible role for ketones? [Published online ahead of print July 28, 2019]. Nutrients. doi: 10.3390/nu11081742.

Postdural puncture headache in women who have undergone neuraxial anesthesia in childbirth may be associated with a small but significant increase in the risk of being diagnosed with intracranial subdural hematoma, research findings suggest.

A cohort study, published online in JAMA Neurology, looked at the incidence of intracranial subdural hematoma within 2 months of delivery in 22,130,815 women, using data from the U.S. Agency for Healthcare Research and Quality’s National Readmission Database.

The overall rate of postdural puncture headaches was 309 per 100,000 deliveries, and the overall incidence of subdural hematoma was 1.5 per 100,000 deliveries. Among the women with postdural puncture headache, however, the unadjusted rate of subdural hematoma was 147 per 100,000. After adjusting for confounding factors, women who experienced postdural puncture headache had a nearly 200-fold higher risk of subdural hematoma (odds ratio, 199; P  less than .001), representing an absolute risk increase of 130 per 100,000 deliveries.

“This was a small absolute increase because of the rarity of this outcome in this population,” wrote Dr. Albert R. Moore of the Royal Victoria Hospital at McGill University, Montreal, and coauthors. “However, this is an important and devastating outcome for a common exposure in young and usually healthy mothers.”

The authors noted that these findings confirmed other reports linking postdural puncture headache and intracranial subdural hematoma. The proposed mechanism connecting the two conditions was that decreased intracranial pressure from cerebrospinal fluid leakages leads to “sagging” of the brain and tension on the veins between the dura and arachnoid, which in turn could trigger a rupture and formation of a subdural hematoma.

Other risk factors for subdural hematoma included coagulopathy, arteriovenous malformation, and delayed blood patch. The investigators also found that obesity was associated with a lower risk of headache after postdural puncture, which might be the result of increased intracranial pressure providing resistance to the development of subdural hematoma.

There was a significant interaction between postdural puncture headache, severe preeclampsia, and chronic hypertension. In the absence of postdural puncture headache, severe preeclampsia and chronic hypertension were both independently associated with significant increases in the risk of subdural hematoma, Dr. Moore and associates noted.

In women who experienced postdural puncture headache, only chronic hypertension was significantly associated with subdural hematoma, they said.

The study was limited in being observational and at risk of misclassification. In addition, there was a risk of surveillance bias in that women with postdural puncture headaches might be more likely to receive brain imaging that would pick up minor subdural hematomas, the investigators said.

The study was supported by McGill University Health Center’s department of anesthesia. The authors reported no conflicts of interest.

SOURCE: Moore A et al. JAMA Neurol. 2019 Sep 16. doi: 10.1001/jamaneurol.2019.2995.

Postdural puncture headache in women who have undergone neuraxial anesthesia in childbirth may be associated with a small but significant increase in the risk of being diagnosed with intracranial subdural hematoma, research findings suggest.

A cohort study, published online in JAMA Neurology, looked at the incidence of intracranial subdural hematoma within 2 months of delivery in 22,130,815 women, using data from the U.S. Agency for Healthcare Research and Quality’s National Readmission Database.

The overall rate of postdural puncture headaches was 309 per 100,000 deliveries, and the overall incidence of subdural hematoma was 1.5 per 100,000 deliveries. Among the women with postdural puncture headache, however, the unadjusted rate of subdural hematoma was 147 per 100,000. After adjusting for confounding factors, women who experienced postdural puncture headache had a nearly 200-fold higher risk of subdural hematoma (odds ratio, 199; P  less than .001), representing an absolute risk increase of 130 per 100,000 deliveries.

“This was a small absolute increase because of the rarity of this outcome in this population,” wrote Dr. Albert R. Moore of the Royal Victoria Hospital at McGill University, Montreal, and coauthors. “However, this is an important and devastating outcome for a common exposure in young and usually healthy mothers.”

The authors noted that these findings confirmed other reports linking postdural puncture headache and intracranial subdural hematoma. The proposed mechanism connecting the two conditions was that decreased intracranial pressure from cerebrospinal fluid leakages leads to “sagging” of the brain and tension on the veins between the dura and arachnoid, which in turn could trigger a rupture and formation of a subdural hematoma.

Other risk factors for subdural hematoma included coagulopathy, arteriovenous malformation, and delayed blood patch. The investigators also found that obesity was associated with a lower risk of headache after postdural puncture, which might be the result of increased intracranial pressure providing resistance to the development of subdural hematoma.

There was a significant interaction between postdural puncture headache, severe preeclampsia, and chronic hypertension. In the absence of postdural puncture headache, severe preeclampsia and chronic hypertension were both independently associated with significant increases in the risk of subdural hematoma, Dr. Moore and associates noted.

In women who experienced postdural puncture headache, only chronic hypertension was significantly associated with subdural hematoma, they said.

The study was limited in being observational and at risk of misclassification. In addition, there was a risk of surveillance bias in that women with postdural puncture headaches might be more likely to receive brain imaging that would pick up minor subdural hematomas, the investigators said.

The study was supported by McGill University Health Center’s department of anesthesia. The authors reported no conflicts of interest.

SOURCE: Moore A et al. JAMA Neurol. 2019 Sep 16. doi: 10.1001/jamaneurol.2019.2995.

Postdural puncture headache in women who have undergone neuraxial anesthesia in childbirth may be associated with a small but significant increase in the risk of being diagnosed with intracranial subdural hematoma, research findings suggest.

A cohort study, published online in JAMA Neurology, looked at the incidence of intracranial subdural hematoma within 2 months of delivery in 22,130,815 women, using data from the U.S. Agency for Healthcare Research and Quality’s National Readmission Database.

The overall rate of postdural puncture headaches was 309 per 100,000 deliveries, and the overall incidence of subdural hematoma was 1.5 per 100,000 deliveries. Among the women with postdural puncture headache, however, the unadjusted rate of subdural hematoma was 147 per 100,000. After adjusting for confounding factors, women who experienced postdural puncture headache had a nearly 200-fold higher risk of subdural hematoma (odds ratio, 199; P  less than .001), representing an absolute risk increase of 130 per 100,000 deliveries.

“This was a small absolute increase because of the rarity of this outcome in this population,” wrote Dr. Albert R. Moore of the Royal Victoria Hospital at McGill University, Montreal, and coauthors. “However, this is an important and devastating outcome for a common exposure in young and usually healthy mothers.”

The authors noted that these findings confirmed other reports linking postdural puncture headache and intracranial subdural hematoma. The proposed mechanism connecting the two conditions was that decreased intracranial pressure from cerebrospinal fluid leakages leads to “sagging” of the brain and tension on the veins between the dura and arachnoid, which in turn could trigger a rupture and formation of a subdural hematoma.

Other risk factors for subdural hematoma included coagulopathy, arteriovenous malformation, and delayed blood patch. The investigators also found that obesity was associated with a lower risk of headache after postdural puncture, which might be the result of increased intracranial pressure providing resistance to the development of subdural hematoma.

There was a significant interaction between postdural puncture headache, severe preeclampsia, and chronic hypertension. In the absence of postdural puncture headache, severe preeclampsia and chronic hypertension were both independently associated with significant increases in the risk of subdural hematoma, Dr. Moore and associates noted.

In women who experienced postdural puncture headache, only chronic hypertension was significantly associated with subdural hematoma, they said.

The study was limited in being observational and at risk of misclassification. In addition, there was a risk of surveillance bias in that women with postdural puncture headaches might be more likely to receive brain imaging that would pick up minor subdural hematomas, the investigators said.

The study was supported by McGill University Health Center’s department of anesthesia. The authors reported no conflicts of interest.

SOURCE: Moore A et al. JAMA Neurol. 2019 Sep 16. doi: 10.1001/jamaneurol.2019.2995.

Migraines are associated with a significantly greater risk of Alzheimer’s disease and all forms of dementia except vascular dementia, according to research published online Sept. 4 in the International Journal of Geriatric Psychiatry.

In the Manitoba Study of Health and Aging, a population-based, prospective cohort study, 679 community-dwelling adults with a mean age of 75.9 years were followed for 5 years. Participants screened as cognitively intact at baseline had complete data on migraine history and all covariates at baseline and were assessed for cognitive outcomes 5 years later.

The study showed that a history of migraines was associated with a 2.97-fold greater likelihood of dementia, after adjustment for age, education, and a history of stroke, compared with individuals without a history of migraine. Individuals with Alzheimer’s disease were more than four times more likely to have a history of migraines (odds ratio 4.22).

However, researchers found no significant association between vascular dementia and a history of migraines, either before or after adjusting for confounders but particularly after incorporating a history of stroke into the model.

Lead investigator Suzanne L. Tyas, PhD, associate professor in the School of Public Health and Health Systems at the University of Waterloo, Ont., and coauthors suggested that the association between migraine and dementia was largely driven by the strong association between migraines and Alzheimer’s disease.

“This interpretation is supported by the weaker association for dementia than for Alzheimer’s disease, reflecting a dilution of the association with migraines across all types of dementia including vascular dementia, where a significant association was not found,” the researchers wrote.

The study population was 61.9% female, and no men reporting a history of migraine were diagnosed with dementia. While the study reflected a strong association between migraine and dementia in women, the researchers said they were unable to assess potential gender differences in this association.

Commenting on possible mechanisms behind the association, the authors wrote that there were overlaps underlying the biological mechanisms of migraine and dementia. Vascular risk factors such as diabetes, hypertension, heart attack, and stroke are associated with the development of dementia, and a relationship of these risk factors and migraine also has been seen.

“Many of the mechanisms involved in migraine neurophysiology, such as inflammation and reduced cerebral blood flow, are also underlying causes of dementia,” they wrote. “Repeated activation of these pathways in chronic migraineurs has been shown to cause permanent neurological and vascular damage.”

They also observed that the association could be influenced by genetic factors, as individuals with presenilin-1 mutations, which predispose them to Alzheimer’s disease, are more likely to experience migraines or recurrent headaches.

They suggested their findings could inform preventive strategies and treatments for Alzheimer’s disease, as well as interventions such as earlier screening for cognitive decline in individuals who experience migraines.

The study was funded by Manitoba Health and the National Health Research and Development Program of Health Canada. No conflicts of interest were declared.
 

SOURCE: Morton R et al. Int J Geriatr Psychiatry, 2019 Sep 4. doi: 10.1002/gps.5180.

Migraines are associated with a significantly greater risk of Alzheimer’s disease and all forms of dementia except vascular dementia, according to research published online Sept. 4 in the International Journal of Geriatric Psychiatry.

In the Manitoba Study of Health and Aging, a population-based, prospective cohort study, 679 community-dwelling adults with a mean age of 75.9 years were followed for 5 years. Participants screened as cognitively intact at baseline had complete data on migraine history and all covariates at baseline and were assessed for cognitive outcomes 5 years later.

The study showed that a history of migraines was associated with a 2.97-fold greater likelihood of dementia, after adjustment for age, education, and a history of stroke, compared with individuals without a history of migraine. Individuals with Alzheimer’s disease were more than four times more likely to have a history of migraines (odds ratio 4.22).

However, researchers found no significant association between vascular dementia and a history of migraines, either before or after adjusting for confounders but particularly after incorporating a history of stroke into the model.

Lead investigator Suzanne L. Tyas, PhD, associate professor in the School of Public Health and Health Systems at the University of Waterloo, Ont., and coauthors suggested that the association between migraine and dementia was largely driven by the strong association between migraines and Alzheimer’s disease.

“This interpretation is supported by the weaker association for dementia than for Alzheimer’s disease, reflecting a dilution of the association with migraines across all types of dementia including vascular dementia, where a significant association was not found,” the researchers wrote.

The study population was 61.9% female, and no men reporting a history of migraine were diagnosed with dementia. While the study reflected a strong association between migraine and dementia in women, the researchers said they were unable to assess potential gender differences in this association.

Commenting on possible mechanisms behind the association, the authors wrote that there were overlaps underlying the biological mechanisms of migraine and dementia. Vascular risk factors such as diabetes, hypertension, heart attack, and stroke are associated with the development of dementia, and a relationship of these risk factors and migraine also has been seen.

“Many of the mechanisms involved in migraine neurophysiology, such as inflammation and reduced cerebral blood flow, are also underlying causes of dementia,” they wrote. “Repeated activation of these pathways in chronic migraineurs has been shown to cause permanent neurological and vascular damage.”

They also observed that the association could be influenced by genetic factors, as individuals with presenilin-1 mutations, which predispose them to Alzheimer’s disease, are more likely to experience migraines or recurrent headaches.

They suggested their findings could inform preventive strategies and treatments for Alzheimer’s disease, as well as interventions such as earlier screening for cognitive decline in individuals who experience migraines.

The study was funded by Manitoba Health and the National Health Research and Development Program of Health Canada. No conflicts of interest were declared.
 

SOURCE: Morton R et al. Int J Geriatr Psychiatry, 2019 Sep 4. doi: 10.1002/gps.5180.

Migraines are associated with a significantly greater risk of Alzheimer’s disease and all forms of dementia except vascular dementia, according to research published online Sept. 4 in the International Journal of Geriatric Psychiatry.

In the Manitoba Study of Health and Aging, a population-based, prospective cohort study, 679 community-dwelling adults with a mean age of 75.9 years were followed for 5 years. Participants screened as cognitively intact at baseline had complete data on migraine history and all covariates at baseline and were assessed for cognitive outcomes 5 years later.

The study showed that a history of migraines was associated with a 2.97-fold greater likelihood of dementia, after adjustment for age, education, and a history of stroke, compared with individuals without a history of migraine. Individuals with Alzheimer’s disease were more than four times more likely to have a history of migraines (odds ratio 4.22).

However, researchers found no significant association between vascular dementia and a history of migraines, either before or after adjusting for confounders but particularly after incorporating a history of stroke into the model.

Lead investigator Suzanne L. Tyas, PhD, associate professor in the School of Public Health and Health Systems at the University of Waterloo, Ont., and coauthors suggested that the association between migraine and dementia was largely driven by the strong association between migraines and Alzheimer’s disease.

“This interpretation is supported by the weaker association for dementia than for Alzheimer’s disease, reflecting a dilution of the association with migraines across all types of dementia including vascular dementia, where a significant association was not found,” the researchers wrote.

The study population was 61.9% female, and no men reporting a history of migraine were diagnosed with dementia. While the study reflected a strong association between migraine and dementia in women, the researchers said they were unable to assess potential gender differences in this association.

Commenting on possible mechanisms behind the association, the authors wrote that there were overlaps underlying the biological mechanisms of migraine and dementia. Vascular risk factors such as diabetes, hypertension, heart attack, and stroke are associated with the development of dementia, and a relationship of these risk factors and migraine also has been seen.

“Many of the mechanisms involved in migraine neurophysiology, such as inflammation and reduced cerebral blood flow, are also underlying causes of dementia,” they wrote. “Repeated activation of these pathways in chronic migraineurs has been shown to cause permanent neurological and vascular damage.”

They also observed that the association could be influenced by genetic factors, as individuals with presenilin-1 mutations, which predispose them to Alzheimer’s disease, are more likely to experience migraines or recurrent headaches.

They suggested their findings could inform preventive strategies and treatments for Alzheimer’s disease, as well as interventions such as earlier screening for cognitive decline in individuals who experience migraines.

The study was funded by Manitoba Health and the National Health Research and Development Program of Health Canada. No conflicts of interest were declared.
 

SOURCE: Morton R et al. Int J Geriatr Psychiatry, 2019 Sep 4. doi: 10.1002/gps.5180.