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An update on behavioural treatments in migraine

The latest review of studies of behavioural interventions1 reports that relaxation techniques, especially progressive muscle relaxation, types of biofeedback and cognitive behavioural therapy are all effective prophylactic treatments for migraine. There are, however, inconsistencies and methodological limitations in the studies. The authors add that the combination of behavioural treatment and pharmacotherapy can lead to additive …

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Personalised nurse-led care reduces the impact on migraine on patients

A nursing intervention that includes individualised lifestyle advice can increase quality of life and self-efficacy in migraine patients.1 The study included 200 migraine patients (176 women and 24 men, mean age 40 years old), 162 of whom completed the study. All the patients were new referrals to a Canadian tertiary headache centre between January 2013 …

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Not all migraines with aura are the same

A prospective diary-based study concludes that there is high inter- and intra-patient variability in the experience of migraine with aura.   In the 72 patients who completed the study and recorded the characteristics of three consecutive auras (n = 216 auras): Most (56%) did not report a stereotyped aura on the three attacks with respect to visual …

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Migraine is undertreated in the United States, but study reveals no racial disparities

Migraine prophylaxis appears to be underused in the USA, and many patients with are not receiving evidence-based treatment for acute migraine. However, there no evidence that patients are disadvantaged because of their ethnicity.   These conclusions are based on analysis of data from the National Ambulatory Medical Care Survey. The aim of the study was …

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Fremanezumab add-on therapy is safe and effective

Fremanezumab is a safe and effective add-on treatment for migraine patients receiving concomitant treatment with other migraine preventive medications, according to a post hoc analysis.   The analysis used data from two randomised placebo-controlled studies investigating once-monthly subcutaneous injections of various dosing regimens of fremanezumab versus placebo in episodic and chronic migraine. The pooled sample …

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Symptoms of dizziness predominate in vestibular migraine

Chronic recurrent dizziness symptoms, rather than internal or external vertigo, were predominant in vestibular migraine patients treated in a neurology-headache clinic in Turkey. The study included 101 patients (mean age, 40.1±10.2 years; 86.1% women) with a confirmed diagnosis of vestibular migraine. All had been referred to the clinic from Otolaryngology after excluding peripheral causes of …

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Study highlights unmet needs of women with chronic migraine

Women with chronic migraine experience lack of understanding and support from both their families and doctors. This is the conclusion of a qualitative study of women attending a specialised headache clinic at a university hospital in Madrid, Spain. The 20 women included in the study were aged 18–65 (mean 38.65) years, and attended the clinic …

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‘Big data’ indicates surprising links between diseases

A novel classification of diseases based on environment and genetic influences has been created based on a study of insurance claims for over one third of the United States population. The researchers used the insurance claims to create a subset of 128,989 families (481,657 unique individuals). They then used these data to: Estimate the heritability …

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CLOCK gene variants interact with financial stress to increase migraine risk

People with a specific variation in the circadian CLOCK gene have more migraines under financial stress, according to a study presented during the European College of Neuropsychopharmacology (ECNP) congress in Paris. This is the first time that circadian rhythm genetics have been shown to have an effect on migraine. Speaking in Paris, lead investigator Dr …

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Inhibitory control interacts with pain catastrophising to predict migraine pain intensity in some women

The likelihood of greater migraine pain intensity can be predicted in overweight/obese women by presence of the combination of lower inhibitory control interacts and higher pain catastrophising. The study included 105 women who were overweight/obese (body mass index 35.1 ± 6.5 kg/m2). The women reported 5.3 ± 2.6 migraine attacks (8.3 ± 4.4 migraine days) over 28 days producing moderate pain …

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Allodynia reduces response to acute treatment of migraine

The presence of cutaneous allodynia is associated with a suboptimal response to all types of acute medical treatment for migraine, according to the American Migraine Prevalence and Prevention (AMPP) Study. The 2006 AMPP Study included 8233 people with migraine aged ≥18 years, who completed the Migraine Treatment Optimisation Questionnaire (mTOQ). Of these patients, 5236 (63.6%) …

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‘Following the pain’ means fewer onabotulinumtoxinA injections in chronic migraine

Targeting onabotulinumtoxinA injections to pericranial myofascial sites of pain simplifies the treatment protocol by reducing the number of injection sites required when treating chronic migraine. This is the conclusion of an observational, open-label, real-life cohort study including 63 consecutive patients fulfilling the diagnostic criteria for chronic migraine, and who were refractory to conventional treatments. The …

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Patient self-management strategies can improve some migraine symptoms

A meta-analysis concludes that non-pharmacological self-management interventions for migraine and tension-type headache are more effective than usual care in reducing pain intensity, mood and headache-related disability, but have no effect on headache frequency. The authors add that icognitive behavioural therapy (CBT), mindfulness and educational components, and delivery in groups may increase the effectiveness of self-management …

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OnabotulinumtoxinA reduces intensity of chronic migraine

A pooled analysis from the phase 3 PREEMPT clinical trial programme suggests that treatment with onabotulinumtoxinA results in clinically meaningful relief from headache intensity even in patients with chronic migraine who are non-responders based on analysis of headache frequency alone. The Phase 3 REsearch Evaluating Migraine Prophylaxis Therapy (PREEMPT) clinical trial programme was designed to …

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SMART: lifting the burden of headache in China

Work is now underway across the country in China to improve healthcare services for people with migraine. In 2008-2009 a nationwide survey revealed that one in 10 Chinese adults experienced migraine every year. Despite this major adverse impact on public health, the survey found that under-diagnosis and misdiagnosis were common: Only half (52.9%) of people …

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Eurolight reveals burden of migraine and other headache disorders in Lithuania

Headache disorders in Lithuania are associated with substantial ill health, unmet need for healthcare and high economic burden, according to Eurolight project1,2. The cross-sectional, structured, face-to-face interview study questoined 573 people (41.4% male, mean age 40.9 ± 13.8 years) of 1137 in the representative sample recruited from Kaunus city and the surrounded region. Gender-adjusted one-year prevalences were: …

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Restless legs syndrome may exacerbate migraine symptoms in children

Paediatric patients with migraine seem to experience worse symptoms if they also suffer from restless legs syndrome (RLS), according to an observational study from Turkey. The study included 65 consecutive patients diagnosed with migraine, 20 with TTH and 97 headache-free paediatric controls. The authors report that: RLS was significantly more common in children with migraine …

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Changes in grey matter brain regions may be involved in the pathology of migraine with aura

Significant alterations in the grey matter of the brain, associated with sensory discrimination of pain, multi-sensory integration and nociceptive information processing, may be involved in the pathological mechanism of migraine without aura. This is the conclusion of a study that used surface-based morphometry (SBM), voxel-based morphometry VBM and diffusion tensor imaging (DTI) analyses to detect …

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‘Following the pain’ with onabotulinumtoxin A is effective in chronic migraine

An observational, open-label, real-life, cohort study suggests that chronic migraine can be effectively treated with an onabotulinumtoxin A treatment schedule targeting pericranial myofascial sites of pain. The study included 63 consecutive patients treated at a specialist centre in France. All patients fulfilled the diagnostic criteria for chronic migraine, and were refractory to conventional treatments. The …

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Self-reported cognitive decline is frequent in people with migraine

In a study from South Korea,1 up to half of migraine patients reported cognitive decline, which was associated with depression and short sleep duration during weekdays. The study included 188 patients with migraine (age 38.1 ± 9.9 years). All patients scored within the normal range of the Korean-Mini Mental State Examination and the Korean-Montreal Cognitive …

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First meta-analysis finds topiramate no better than placebo in children

Topiramate seems to be no more effective than placebo in preventing migraines in children and is associated with more side effects, according to a meta-analysis.1 The meta-analysis included four randomised controlled trials with an aggregate of 465 patients aged <18 years (329 in the topiramate group, 136 in the placebo group). Compared with placebo, treatment …

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Further positive Phase 3 results announced for lasmiditan in acute migraine

Lasmiditan, an investigational, oral, first-in-class acute treatment for migraine, has met its primary endpoint in a second Phase 3 study, SPARTAN. Two hours following the first dose of lasmiditan, significantly more patients in all dosing groups were migraine pain-free: 28.6% for 50 mg (p=0.003), 31.4% for 100 mg (p < 0.001), 38.8% for 200 mg …

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Erenumab application accepted for review by the FDA

The US Food and Drug Administration (FDA) has accepted for review the Biologics License Application (BLA) for erenumab (Aimovig) for the prevention of migraine in patients experiencing four or more migraine days per month. If approved, Aimovig is expected to be the first-and-only monoclonal antibody targeting the calcitonin gene-related peptide (CGRP) receptor, specifically designed for …

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In chronic headache most risk factors for poor outcome can be modified

There are several potential predictors of poor prognosis and worse outcome of preventive treatment in people with chronic headache, but most of these risk factors are modifiable, according to a systematic review of published literature. Based on the authors’ analysis of 27 studies (17 prospective cohort studies and 10 randomised controlled trials) included in their …

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Study highlights link between melatonin, CGRP and nitric oxide

Exogenous melatonin appears to reduce inflammation by reducing calcitonin gene-related peptide (CGRP) level and inducible nitric oxide synthase (iNOS) activity in patients with migraine. This is the conclusion of a study comparing cultured peripheral blood mononuclear cells (PBMCs) isolated from 12 pure menstrual migraine patients and age- and sex-matched healthy controls. After treating the PBMCs …

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Migraine in low-income countries: time for action

Political action is needed to mitigate the economic burden and ill health associated with migraine and other headache disorders in low-income countries. This is the message of a study of migraine-related disability and other burdens in Ethiopia.1 In a cross-sectional survey using cluster-randomized sampling, the authors interviewed 2461 adults (aged 18-65 years old) in four …

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Duration and frequency of migraine attacks affect cognitive function

In a study from China, cognitive performance fell during migraine attacks, and the degree of cognitive dysfunction appeared to be related to the duration and frequency of a migraine attack. The cross-sectional study included 34 patients with migraine (6 males, 28 females; mean age 36 [20-55] years), 10 with aura and 24 without aura. Compared …

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Migraine is associated with symptoms of central sensitisation in children

Symptoms of central sensitisation are present in children with migraine. This is the conclusion of an observational cross-sectional study of children aged 8-15 years, treated for migraine at an Italian tertiary headache centre The study included 151 children with chronic migraine (n=47), migraine without aura (n=92) or migraine with aura (n=12). The authors used a …

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CGRP: its role beyond migraine pathology

Calcitonin gene-related peptide (CGRP) may act as a neuromodulator in some non-headache pain conditions, according to a systematic literature review. The literature search identified 375 citations, 50 of which contained relevant original human experimental studies and randomised controlled trials. In 13 out of 20 studies in somatic pain conditions, CGRP levels had a positive correlation …

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PROMISE 1: Eptinezumab phase 3 trial meets primary and key secondary endpoints in episodic migraine

Treatment with eptinezumab results in highly statistically significant reductions in monthly migraine days in patients with frequent episodic migraine, according to first results of the PROMISE 1 double-blind, randomised, placebo-controlled phase 3 study. On the primary endpoint of the mean change in monthly migraine days compared with baseline (mean 8.6 days) during Weeks 1-12, eptinezumab …

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EMA submission accepted for erenumab

The European Medicines Agency (EMA) has accepted the Marketing Authorisation Application for erenumab (AMG 334) for the prevention of migraine. Erenumab is a fully human anti-CGRP monoclonal antibody that binds selectively to the CGRP receptor. The regulatory submission to the EMA includes safety and efficacy data from four phase II and III clinical studies involving …

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Obesity significantly increases the risk of migraine

There seems to be a higher risk of migraine in people who are obese compared to people of normal weight, and being underweight may also marginally increase the risk of migraine. These are the findings of a meta-analysis of 12 studies including 288,981 individuals.1 Compared with people of normal BMI (18.5-24.9): In obese individuals (BMI …

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Migraine with tension-type headache and neck pain is a frequent presentation in specialist clinics

Migraine with co-existing tension-type headache and neck pain is common in patients who need specialist referral, according to a questionnaire and structured interview study conducted in a Danish tertiary headache clinic. The study included 148 patients with migraine and 100 age- and sex-matched healthy controls. Participants completed questionnaires on physical activity, psychological wellbeing, perceived stress …

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Offer treatment and prevention to children with suspected migraine without aura

Children with suspected migraine without aura should not be denied treatment if their symptoms do not meet the current International Classification of Headache Disorders diagnostic criteria (ICHD-3 beta). This is the conclusion of a retrospective study from Japan that included 54 patients with a clinical diagnosis of migraine with onset of repetitive headaches at age …

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Migraine risk in men is predicted by foetal growth restriction

Foetal growth restriction is associated with increased risk of migraine in adulthood among males but not among females, according to HUNT-3, the first population-based study to examine the effect of foetal growth restriction at birth on the later development of headache. HUNT 3 (Nord-Trøndelag Health Survey) was conducted in 2006-2008, and included all inhabitants aged …

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Multidisciplinary management optimises treatment of menstrual migraine

  Compared to treatment in a neurology clinic alone, multidisciplinary treatment in neurology-gynaecology clinic is more likely to result in effective treatment of menstrual migraine. This is the conclusion of a retrospective cohort study from a menstrual migraine clinic at a specialist centre in the Netherlands. The study included 88 women with menstrual migraine who …

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2017 American Academy of Neurology Annual Meeting: News with galcanezumab, fremanezumab

Preliminary data presented at this meeting suggest that certain patient characteristics (e.g., prior treatment failure or a history of migraine for >20 years) may be predictive of a better response to the calcitonin gene-related peptide (CGRP) antibody galcanezumab (previously known as LY2951742).1  If replicated and validated, such data could prove valuable in helping clinicians identify …

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2017 American Academy of Neurology Annual Meeting: Reduction in migraine days with single dose eptinezumab

In chronic migraine patients, a single infusion of eptinezumab (previously known as ALD403), a calcitonin gene-related peptide (CGRP) antibody, led to significant reduction in migraine days as measured by 75% responder rates.  Efficacy was maximal after 1 to 4 weeks and sustained for 12-weeks.1,2  These findings were reported by CGRP Forum Co-Editor Professor David Dodick. …

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2017 American Academy of Neurology Annual Meeting: Erenumab looks good in Phase 3 STRIVE and ARISE Trials

Erenumab (previously known as AMG 334), a calcitonin gene-related peptide (CGRP) receptor antibody, not only reduced monthly migraine days compared with placebo, but also showed no differences for serious or nonserious adverse events versus placebo groups in these two trials. According to CGRP Forum Co-Editor Professor Peter Goadsby, who presented results from the STRIVE trial1, …

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Does CGRP act as a neuromodulator in non-headache pain conditions?

As calcitonin gene-related peptide (CGRP) is widely distributed in nociceptive pathways in the peripheral and central nervous systems and its receptors are also expressed in pain pathways, some have suggested potential for the management of chronic pain. This systematic review evaluated the evidence for this. Recognition of the unmet, urgent need for new effective therapeutic …

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The trigeminovascular pathway, CGRP and CGRP receptors: where are we now?

Accumulating evidence highlights the relevance of calcitonin gene-related peptide (CGRP) and CGRP receptors expressed in the trigeminal ganglion in headache pathophysiology. This timely review overviews progress in understanding the complexity of the trigeminovascular pathway and its peptide transmitters. This information has been a driver for the development of novel anti-migraine therapies that inhibit either the …

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Galcanezumab: positive topline results in EVOLVE-1, EVOLVE-2 in episodic migraine, and REGAIN in chronic migraine

Galcanezumab (previously known as LY2951742), a calcitonin gene-related peptide (CGRP) antibody, met its primary endpoint in three Phase 3 studies (EVOLVE-1, EVOLVE-2 and REGAIN), with significant reductions in the number of monthly migraine headache days compared to placebo at both studied doses (120 mg and 240).  On the basis of these findings, the company is …

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Latest STRIVE data: Positive results for erenumab in episodic migraine

Early release of results from the STRIVE study (Study to evaluate the efficacy and safety of erenumab in migraine prevention) show that the study achieved its primary endpoint. Patients with episodic migraine treated with either 70 mg or 140 mg erenumab had significant reductions from baseline in monthly migraine days compared with placebo. Patients enrolled …

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Insomnia is common in both migraine and probable migraine

There is no significant difference in the prevalence of insomnia in patients with probable migraine compared to those with confirmed migraine. This is the conclusion of a study using data from the nation-wide, cross-sectional Korean Headache-Sleep Study, in which insomnia was diagnosed by a score of ≥15.5 on the Insomnia Severity Index (ISI) score. In …

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Mindfulness training may be effective after medication overuse in migraine

In patients with chronic migraine associated with medication overuse, mindfulness training may be as effective as medical prophylaxis in the year after acute medication withdrawal. This is the conclusion of a study including 44 patients (average age 44.5 years, average headache frequency/month 20.5, average monthly medication intake 18.4 pills). After withdrawal of medication in a …

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CGRP, PACAP38 and inherited migraine risk

Genetic factors do not contribute to susceptibility to migraine attacks induced by calcitonin gene-related peptide (CGRP) or pituitary adenylate cyclase-activating peptide-38 (PACAP38) This is the conclusion of four studies exploring factors that may be associated with the migraine response induced by these neuropeptides: Patients with a strong familial predisposition or a high number of migraine-associated …

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Non-invasive neuromodulation: evidence of efficacy is lacking

A review of studies concludes that there is currently very little controlled evidence to support the use of non-invasive neuromodulation devices in any headache condition, including migraine. The authors report that: The role of vagal nerve stimulation (nVNS) in the prophylactic treatment of cluster headache is supported only by open-label evidence and evidence is limited …

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Amitriptyline and topiramate fail in paediatric migraine

There are no significant differences in headache frequency or headache-related disability in childhood and adolescent migraine between amitriptyline, topiramate or placebo when given over 24 weeks. The active drugs are also associated with higher rates of adverse events. These are the conclusions of a randomised, double-blind, placebo-controlled trial that included 361 patients aged 8 to …

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CADASIL: a secondary cause of migraine with aura

CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) must be considered in the differential diagnosis of migraine with aura. This advice is based on a review of current literature. The authors report that: The presenting symptom of CADASIL is often migraine with aura, but clinical manifestations include migraine with and without aura, cognitive …

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Study reveals link between migraine and mood disorders in teenagers

Mood disorders in adolescence are associated with a greater likelihood of migraine, according to an analysis of data from the observational Canadian Community Health Survey (CCHS). The CCHS is a large, cross-sectional health survey sampling a nationally representative group of Canadians. This study analysed data from this observational study on all 61,375 participants aged 12-19 …

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