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Eurolight study reveals poor medical care for people with migraine in Europe

In wealthy European countries, too few people with migraine consult physicians, and migraine-specific medications are used inadequately even among patients who do seek medical advice. These are the main conclusions of the Eurolight study, a cross-sectional, questionnaire-based survey that recorded migraine prevalence and frequency, and utilisation of medical services and acute and preventive medications in …

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PREMIUM trial does not support patent foramen ovale closure in migraine prevention

In the randomised PREMIUM trial, patent foramen ovale (PFO) closure to prevent migraine did not meet the primary endpoint of a > 50% reduction in migraine attacks, with or without aura, compared to sham control. PREMIUM is a double-blind study that randomised 230 patients with migraine to medical therapy with a sham procedure (right heart …

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Abdominal migraine: important, common and an under-recognised cause of recurrent pain in children

This useful article reviews published evidence and advises on diagnosis and treatment of abdominal migraine (see Table). The condition usually starts in childhood, though it may occur in adults. It may be associated with, or followed by, other forms of migraine, and it predicts adult migraine. Recommended pragmatic clinical definition of abdominal migraine Episodic central …

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Migraine is a strong marker of cardiovascular risk, Danish study concludes

Migraine appears to be an important risk factor for most cardiovascular diseases, according to the results of a nationwide, population-based study from Denmark.1 The study compared 51 032 patients with migraine and 510 320 people from the general population matched on age, sex, and calendar year. After 19 years of follow-up, migraine was positively associated with: Myocardial …

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ACHIEVE I: pivotal phase 3 clinical trial achieves key goal for ubrogepant

Allergan has announced that the ACHIEVE I study has met its co-primary endpoints, with both doses of the oral CGRP receptor antagonist ubrogepant being significantly more effective than placebo in treating a single migraine attack. ACHIEVE I is a multicentre, randomised, double-blind, placebo-controlled, parallel group study that randomised 1327 adults. Patients were treated for a …

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Phase 3 ARISE trial confirms efficacy and safety of erenumab 70 mg monthly in episodic migraine

Prophylaxis with erenumab 70 mg monthly significantly reduces migraine frequency and acute migraine-specific medication use in patients with episodic migraine. These are the outcomes of ARISE, a double-blind, placebo-controlled that randomised 577 adults with episodic migraine to either placebo or 70 mg erenumab monthly. On the primary endpoint of change in monthly migraine days from baseline to …

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LIBERTY: positive results for erenumab in episodic migraine patients not responding to multiple prior preventive treatments

Novartis reports that the phase IIIb LIBERTY study has met its primary endpoint, with significantly more patients taking erenumab experiencing at least a 50% reduction from baseline in their monthly migraine days compared with patients receiving placebo. Safety outcomes are consistent with previous erenumab studies. Full results of LIBERTY will be presented at a future …

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Opioid should not be first choice for acute migraine in the emergency department

Intravenous (IV) hydromorphone is substantially less effective than IV prochlorperazine for the treatment of acute migraine in the emergency department, according to a randomised controlled trial. The study was conducted in two emergency departments in New York City. Patients who not used an opioid within the previous month were randomised either to IV hydromorphone 1 …

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Study highlights safety of galcanezumab in patients with episodic migraine

Treatment-emergent adverse events are primarily mild to moderate with galcanezumab, according to results of a multicentre, double-blind, randomised phase 2b study in episodic migraine. The study included 410 patients with episodic migraine, who received 5 mg, 50 mg, 120 mg or 300 mg of galcanezumab or placebo subcutaneously once daily for 12 weeks. This was followed …

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Higher risk of physical and mental comorbidities for people with chronic migraine

Comorbidity is more frequent among people with chronic migraine compared to controls, especially among those living in areas of higher socioeconomic deprivation. These are the conclusions of an analysis of cross-sectional primary healthcare data from Scotland.1 The researchers examined data on the presence of chronic migraine, 31 other physical conditions and seven mental health conditions …

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PROMISE 2: single quarterly infusion of eptinezumab significantly reduces monthly migraine days in chronic migraine

Alder Biopharmaceuticals has announced that the pivotal phase 3 PROMISE 2 clinical trial in chronic migraine has met the primary endpoint and all key secondary endpoints for both doses of the CGRP inhibitor eptinezumab. On the primary endpoint of mean change from baseline in monthly migraine days over the 12-week, double-blind treatment period, a single …

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Phase 3 study shows that erenumab once monthly reduces the impact of episodic migraine

Erenumab administered subcutaneously at a monthly dose of 70 mg or 140 mg significantly reduced migraine frequency, the effects of migraines on daily activities, and the use of acute migraine-specific medication over six months. These are the outcomes of the STRIVE phase 3 trial, published in the New England Journal of Medicine.1 STRIVE randomly assigned …

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Fremanezumab cuts headache frequency in chronic migraine in phase 3 study

Prophylactic subcutaneous fremanezumab, given monthly or quarterly, significantly reduces the number of monthly headache days in patients with chronic migraine, according to a phase 3 trial published in the New England Journal of Medicine.1 The study included 1130 patients with chronic migraine (headache of any duration or severity on ≥15 days per month and migraine on …

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Patient satisfaction is higher with migraine-specific acute treatments

Using a migraine-specific medication (a triptan or ergot) as initial treatment for acute migraine is associated with the greatest patient satisfaction and the lowest migraine-related disability. This is the conclusion of a three-month diary study involving 337 patients (92.5% female, 84% with episodic migraine).1 Based on 29,722 recorded diary days: Patients took acute medication on …

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Adverse events are higher with triptans than with other acute migraine treatments

Any adverse event or a treatment-related adverse event is more likely with triptans than with placebo and non-triptan acute migraine treatments, according to a systematic literature review. The review included 141 randomised controlled trials evaluating oral treatments for acute migraine: Sumatriptan, eletriptan, rizatriptan, zolmitriptan and the combination of sumatriptan and naproxen were associated with a …

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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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