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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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

  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 …

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 …

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. …

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, …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 % …

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 …

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 …

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 …

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, …

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 …

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 …