News

Migraine is responsible for approximately 86 million lost workdays in the UK each year due to absenteeism and reduced effectiveness at work (presenteeism), according to a new report produced by the Work Foundation and funded by Novartis. The publication, Society’s Headache: The socioeconomic impact of migraine, concludes that this lost productivity costs the UK economy nearly £8.8 …

Significantly more migraine patients were free of pain and the most bothersome migraine symptoms, two hours after taking the oral CGRP inhibitor, ubrogepant 50mg, than those treated with placebo. These were the key findings reported by investigators taking part in the Phase 3, ACHIEVE II trial. Patients in the lower dose, ubrogepant 25mg group were …

Erenumab significantly reduces migraine frequency in patients with episodic migraine who have not responded to other preventive treatments, according to the LIBERTY study.  At the end of 12 weeks, patients taking erenumab had nearly three-fold higher odds of having their migraine days reduced by at least 50% (weeks 9-12: 30.3% with erenumab, 13.7% with placebo, …

An anti receptor activity-modifying protein 1 (RAMP 1) antibody is now available for scientists investigating the role of calcitonin gene-related peptide (CGRP) in migraine. Validated by Dr Debbie Hay (member of the CGRP Forum Editorial Advisory Board) and colleagues, the antibody corresponds to a region within the human RAMP C-terminal protein sequence. Dr Hay comments: …

Progress in the fundamental understanding of migraine is leading to novel, mechanism-based and disease-specific treatments, according to a new expert review. The World Health Organization ranks migraine as the third most prevalent medical condition and the second most disabling neurological disorder in the world.  However, despite the availability of evidence-based guidelines, the management of migraine …

An updated meta-analysis, including over 1 million subjects followed up for up to 26 years, concludes that migraine is associated with a higher long-term risk of cardiovascular and cerebrovascular events, an effect that is due to an increased risk of stroke (both ischaemic and haemorrhagic) and myocardial infarction (MI). After analysing a total of 16 …

An analysis of data from the Women’s Health Study reports that adolescents with endometriosis are more likely to experience migraines than young women without endometriosis.1 The cross-sectional study, conducted within the ongoing longitudinal cohort of the Women’s Health Study: From Adolescence to Adulthood,2 compared adolescents surgically diagnosed with endometriosis with a control group of adolescents …

In the USA, severe headache and migraine remain important public health problems that are more common and burdensome for women, particularly women of childbearing age, and other historically disadvantaged segments of the population. These are the conclusions of a systematic review of the most current publicly available summary statistics from the US National Health Interview …

Mathematical modelling of value-based pricing (VBP) concludes that, compared with supportive care, preventive treatment of migraine with erenumab is likely to result in lower direct and indirect costs, and incremental quality adjusted life years (QALYs). The model compared erenumab to no preventive treatment in episodic and chronic migraine patients who had failed at least one …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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%) …

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 …

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 …

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 …

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 …

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: …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …