Light Holiday Reading: 3 Migraine Studies

December 5, 2018

New research provides insights into migraine with visual aura, cognitive behavioral therapy, and the genetic basis of pediatric migraine.

The highlights of three new studies in migraine research include: individuals who experience migraine with visual aura may have an increased risk of atrial fibrillation and possibly stroke; cognitive behavioral therapy (CBT) for insomnia holds promise for reducing headache frequency among those with chronic migraine; and a large-scale genetic study has found common gene variants associated with migraines in African-American children.

Migraine with aura appears to increase the risk of atrial fibrillation, which may potentially lead to ischemic strokes. A longitudinal, community-based cohort study included 11,939 participants who were assessed for headache. They were without prior atrial fibrillation or stroke. Some 426 participants reported migraines with visual aura, 1090 migraine without visual aura, 1018 non-migraine headache, and 9405 no headache. Over a 20-year follow-up period, incident atrial fibrillation was noted in 232 (15%) of 1516 with migraine and 1623 (17%) of 9405 without headache. After adjustment for multiple confounders, migraine with visual aura was associated with increased risk of atrial fibrillation compared with no headache (Hazard Ratio 1.30) as well as when compared with migraine without visual aura (Hazard Ratio 1.39).

“Our research suggests that atrial fibrillation may play a role in stroke in those with migraine with visual aura,” said lead author Souvik Sen, MD, MS, MPH, of the University of South Carolina in Columbia, SC. “It is important to note that people with migraine with aura may be at a higher risk of atrial fibrillation due to problems with the autonomic nervous system, which helps control the heart and blood vessels. More research is needed to determine if people with migraine with visual aura should be screened for atrial fibrillation.”

Source: Sen S, Androulakis XM, Duda V, et al. Migraine with visual aura a risk factor for incident atrial fibrillation: A cohort study. Neurology. 2018 Nov 14. [Epub ahead of print]

A small but growing body of literature suggests that patients with migraine as well as comorbid conditions such as insomnia respond well to behavioral interventions, including CBT, and that targeting comorbidities may improve migraine itself. Analyses of 2 randomized trials comparing CBT for insomnia to a sham control intervention were used to quantify the effects of a brief course of treatment on headache frequency. Monthly headache frequency of the treatment group decreased by 6.2 days more than the control group, supporting an interpretation that there is a 97.5% chance that the treatment intervention is at least 2.7 days better than the control intervention.

“Given the high comorbidity between insomnia and chronic migraine, this study endeavored to apply Bayesian statistical analyses to quantify the most likely outcome for an adult with chronic migraine who receives a brief course of CBT for insomnia to reduce headache. CBT for insomnia thus may offer promise as an adjunctive chronic migraine intervention within medical practice settings via individual, group, or electronic administration, pending larger studies of its efficacy within chronic migraine,” stated the researchers, led by Todd A. Smitherman PhD, of the Department of Psychology, Migraine and Behavioral Health Laboratory, University of Mississippi, Oxford, MS.

Source: Smitherman TA, Kuka AJ, Calhoun AH, et al. Cognitive-Behavioral Therapy for Insomnia to Reduce Chronic Migraine: A Sequential Bayesian Analysis. Headache. 2018;58:1052-1059.

The first large-scale genetic study of its kind may lead to the development of precision medicine strategies for migraine. A genome-wide association study of 380 African-American children and 2129 ancestry-matched controls set out to identify variants associated with migraine. The study also included an independent cohort of 233 African-American patients and 4038 non-migraine control subjects. A novel genetic susceptibility locus on chromosome 5, specifically 5q.33.1, predisposed African-American children to migraine, but not the controls. Further analysis of the risk locus on chromosome 5 implicated two genes, NMUR2 and GLRA1, both involved in signaling pathways in the central nervous system.

“Scientists already know that migraines may run in families, and other researchers have discovered multiple genetic links to migraine in European adults,” said lead author Hakon Hakonarson, MD, PhD, director of the Center for Applied Genomics at Children’s Hospital of Philadelphia. “This work provides new insights into the genetic basis of childhood migraine. Our hope is that follow-up research on these signaling pathways may eventually lead to targeted migraine treatments for African-American children.”

Source: Chang X, et al. Common variants at 5q33.1 in Europeans predispose to migraine in African-American children. Journal of Medical Genetics. Sept. 28, 2018.