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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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Check for cognitive dysfunction in migraine patients, study recommends

Subtle signs of cognitive dysfunction are present in patients with migraine, according to an Italian study involving untreated patients with migraine without aura. The study compared 72 healthy controls with 72 consecutive migraine without aura patients referred to the outpatient headache clinic at the University of Naples. During an attack-free period, patients and controls were …

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Lower-dose vitamins do not reduce migraine with aura

Six months daily vitamin supplementation does not lower homocysteine levels or the occurrence of migraine in women with migraine with aura, according to a randomised, double-blind, placebo-controlled trial. The study included 300 White Australian women aged 18-60. The women had suffered migraine for over >5 years, had a current diagnosis of migraine with aura (>90 % …

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Giving up caffeine may improve migraine outcomes

People who stop consuming caffeine-containing drinks are likely to derive more benefit from triptan treatment for acute migraine, according to an uncontrolled prospective study from South Korea. The study included 108 migraine patients who reported daily consumption of caffeine-containing drinks, including coffee, tea, cola and energy drinks. The patients were instructed to discontinue their caffeine …

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Higher stroke risk for migraine patients after surgery

A hospital registry study reports that people with a history of migraine are at increased risk of perioperative ischaemic stroke and also have an increased 30-day hospital readmission rate. The prospective study included 124,558 surgical patients (mean age 52.6 years; 54.5% women) treated at Massachusetts General Hospital and two satellite campuses between January 2007 and …

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Risk of medication overuse headache is higher with non-specific migraine treatments

In patients with acute migraine, analgesics and opioids are associated with a higher risk of developing medication overuse headache compared with other, more specific treatments, according to an analysis of 29 studies. The analysis included studies of varying design that reported on medicine overuse headache according to the International Classification of Headache Disorders (ICHD). The …

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Anti-CGRP antibodies: effective and safe in migraine prophylaxis

Calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) are a safe and effective preventive treatment for episodic migraine. This is the conclusion of a meta-analysis of four randomised controlled trials including 1198 patients, identified by a systematic database search of studies published up to 2 April 2016. The pooled estimate showed that, when compared with placebo, …

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Global Burden of Disease 2015 ranks migraine in top 10 for disability

The latest report from the Global Burden of Disease Study, GBD 2015, shows that world-wide, migraine is in the top 10 causes of years lived with disability (YLDs), especially among those aged 45-64 years. Migraine also ranked within the top 6 causes of YLDs among younger individuals, including adolescents (aged 15 years or more). The …

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Systematic screening for metabolic syndrome in migraine with aura?

People with migraine have a higher incidence of cardiovascular disease, most notably, stroke. A contributing factor may be an increased propensity for the development of the metabolic syndrome, defined as a clustering of cardiovascular risk factors, specifically hypertension, insulin resistance, dyslipidaemia and central adiposity. The current study adds further evidence for this association, specifically in …

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