Migraine Advances Highlighted at American Headache Society Annual Meeting

CONFERENCE REPORTER

Migraine is a featured topic at the American Headache Society 61st Annual Scientific Meeting, held July 11 to 14 in Philadelphia. Following are highlights of the scheduled migraine scientific presentations.

• “One-Year Incidence of Migraine in the US Population: Results from the Migraine in America Symptoms and Treatment (MAST) Study” was presented by Richard B. Lipton, MD, FAHS, the Edwin S. Lowe Professor and Vice Chair of Neurology, Professor of Epidemiology and Population Health, and Professor of Psychiatry and Behavioral Sciences at the Albert Einstein College of Medicine in New York.

In the MAST Study, a longitudinal, cross-sectional survey study of US adults with migraine, acute medication overuse (AMO) was present in 15% of respondents with migraine who currently took acute headache medication. Cutaneous allodynia was associated with AMO in men but not women.

Women in the MAST Study had more monthly headache days than men and were more likely to report migraine‐related disability and cutaneous allodynia. Although the lifetime consultation rate for headache was somewhat high, many persons with migraine symptoms reported never having received a diagnosis of migraine from a health care professional and acute prescription and preventive migraine treatments were underused.

The MAST Study showed significant associations between allodynia and headache frequency and intensity, anxiety or depression or both, symptom severity, and AMO.

• Michael J. Marmura, MD, FAHS, Assistant Professor of Neurology, Jefferson Headache Center, Thomas Jefferson University, Philadelphia, was to present “Incorporating Remote Electrical Neuromodulation (REN) into Usual Care Reduces Acute Migraine Medication Use.”

In a randomized, double‐blind, sham‐controlled, multicenter study, a remote REN device provided superior clinically meaningful relief of migraine pain and most bothersome symptoms compared with placebo. The pain relief and pain‐free superiority of the active treatment were sustained 48 hours post‐treatment. The authors concluded that REN offers a safe and effective nonpharmacological alternative for acute migraine treatment.

• “Non-invasive Vagus Nerve Stimulation for the Preventive Treatment of Episodic Migraine: The Multicenter, Double-blind, Randomized, Sham-controlled PREMIUM trial” was presented by Eric Liebler, BA, electroCore, Inc, Basking Ridge, NJ, and “Noninvasive Vagus Nerve Stimulation Inhibits Trigeminal Nociception in Two Episodic Migraine Models by Enhancing Descending Pain Modulation” was presented by Paul Durham, PhD, distinguished professor of biology and director of Missouri State University's Center for Biomedical and Life Sciences.

The efficacy, safety, and tolerability of noninvasive vagus nerve stimulation (nVNS) for the acute treatment of migraine was evaluated in a multicenter, double-blind, randomized, sham-controlled trial. The findings supported the abortive efficacy of nVNS as early as 30 minutes and up to 60 minutes after an attack and suggested effective pain relief, tolerability, and practicality for acute treatment of episodic migraine.

In a novel rodent model of episodic migraine, nVNS inhibited mechanical nociception and repressed expression of proteins associated with peripheral and central sensitization of trigeminal neurons.

• “The Relationship between Migraine and Risk of Cardiovascular Disease in Postmenopausal Women in the Observational Longitudinal Cohort of the Women's Health Initiative Study (WHI)” was presented by Jelena Pavlovic, MD, PhD, Assistant Professor of Neurology at the Albert Einstein College of Medicine/Montefiore Headache Center.

In a 2016 prospective cohort study among Nurses’ Health Study II participants, migraine was associated with an increased risk of major cardiovascular disease (CVD), myocardial infarction, stroke, and angina/coronary revascularization procedures. Migraine also was associated with a significantly increased risk of CVD mortality. Associations were similar across subgroups that included age, smoking status, hypertension, postmenopausal hormone therapy, and oral contraceptive use.

Dr Pavlovic was lead author of a 2017 study based on WHI data that demonstrated the safe use of hormone therapy in women who have migraine without increased risk of heart disease. “Since migraines affect one in every four women and women with migraines are often advised to avoid hormone therapy, these findings may have significant public health implications,” she said.

In a 2018 population-based cohort study, migraine was associated with increased risks of myocardial infarction, ischemic stroke, hemorrhagic stroke, venous thromboembolism, and atrial fibrillation or atrial flutter.

• Susan Hutchinson, MD, Orange County Migraine & Headache Center, Irvine, CA, presented “Results from the Chronic Migraine Epidemiology and Outcomes Study Demonstrate a High Level of Unmet Need for Migraine Treatment in People Who Discontinue Acute Prescription Migraine Medication.”

The Chronic Migraine Epidemiology and Outcomes (CaMEO) Study, a prospective web‐based survey study, was conducted to identify natural subgroups of persons with migraine based on profiles of comorbidities. An 8‐class model was based on 22 comorbidities: Class 1, Most Comorbidities; Class 2, Respiratory/Psychiatric; Class 3, Respiratory/Pain; Class 4, Respiratory; Class 5, Psychiatric; Class 6, Cardiovascular; Class 7, Pain; Class 8, Fewest Comorbidities.

Demographic and headache characteristics varied across classes. For example, Class 1 (Most Comorbidities) had a greater proportion of persons with severe disability and higher rates of allodynia, medication overuse, chronic migraine, and aura than Class 8 (Fewest Comorbidities).

The authors suggested that identifying natural subgroups may facilitate the development of personalized treatment.

References:

1. Global Leaders in Migraine Research to Convene at The American Headache Society 61st Annual Scientific Meeting [press release]. Mount Royal, NJ: American Headache Society. July 8, 2019. Accessed July 9, 2019.

2. Schwedt TJ, Alam A, Reed ML, et al. Factors associated with acute medication overuse in people with migraine: results from the 2017 migraine in America symptoms and treatment (MAST) study. J Headache Pain. 2018 May 24;19(1):38. doi: 10.1186/s10194-018-0865-z.

3. Lipton RB, Munjal S, Alam A, et al. Migraine in America Symptoms and Treatment (MAST) Study: baseline study methods, treatment patterns, and gender differences. Headache. 2018 Oct;58(9):1408-1426. doi: 10.1111/head.13407. Epub 2018 Oct 20.

4. Dodick DW, Reed ML, Fanning KM, et al. Predictors of allodynia in persons with migraine: results from the Migraine in America Symptoms and Treatment (MAST) study. Cephalalgia. 2019 Jun;39(7):873-882. doi: 10.1177/0333102418825346. Epub 2019 Feb 7.

5. Yarnitsky D, Dodick DW, Grosberg BM, et al. Remote electrical neuromodulation (REN) relieves acute migraine: a randomized, double-blind, placebo-controlled, multicenter trial. Headache. 2019 May 9. doi: 10.1111/head.13551. [Epub ahead of print]

6. Tassorelli C, Grazzi L, de Tommaso M, et al, for the PRESTO Study Group. Noninvasive vagus nerve stimulation as acute therapy for migraine: the randomized PRESTO study. Neurology. 2018 Jul 24;91(4):e364-e373. doi: 10.1212/WNL.0000000000005857. Epub 2018 Jun 15.

7. Hawkins JL, Cornelison LE, Blankenship BA, Durham PL. Vagus nerve stimulation inhibits trigeminal nociception in a rodent model of episodic migraine. Pain Rep. 2017 Oct 17;2(6):e628. doi: 10.1097/PR9.0000000000000628. eCollection 2017 Nov.

8. Kurth T, Winter AC, Eliassen AH, et al. Migraine and risk of cardiovascular disease in women: prospective cohort study. BMJ. 2016 May 31;353:i2610. doi: 10.1136/bmj.i2610.

9. The North American Menopause Society (NAMS). Hormone therapy may benefit migraine sufferers without increased risk of heart disease: new study reviews WHI data to demonstrate lack of association between migraines, cardiovascular disease and hormone therapy; opens door to increased use of hormones to treat migraines. ScienceDaily. ScienceDaily, 11 October 2017.

10. Adelborg K, Szépligeti SK, Holland-Bill L, et al. Migraine and risk of cardiovascular diseases: Danish population based matched cohort study. BMJ. 2018 Jan 31;360:k96. doi: 10.1136/bmj.k96.

11. Lipton RB, Fanning KM, Buse DC, et al. Identifying natural subgroups of migraine based on comorbidity and concomitant condition profiles: results of the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study. Headache. 2018;58:933-947. doi: 10.1111/head.13342. Epub 2018 Jul 19.