To kick off Migraine and Headache Awareness Month, the latest findings reported here may influence your approaches to diagnosis, treatment, and prevention and help you keep your patients informed.
Physicians and patients differ on flexible dosing, migraine risk rises with psoriasis, vestibular migraine diagnosis requires balancing act-these are some of the latest developments in migraine research. The American Migraine Foundation has designated June as Migraine and Headache Awareness Month 2019 to promote migraine recognition and treatment. The concise study summaries that follow describe recent findings that may influence your approaches to diagnosis, treatment, and prevention and help you keep your patients informed.
Physicians and patients differ on flexible dosing. The effect of having flexible dosing options on migraineurs’ acceptance of and adherence to a new migraine preventive therapy was evaluated. Physicians treating adult patients with migraine expected that having both monthly and quarterly options would increase the proportion of patients to receive the new medication. However, patients with migraine said they are more likely to fill the prescription and adhere to the new therapy when their preferred dosing regimen is available.
Migraine risk rises with psoriasis. Patients who have psoriasis may be at increased risk for migraine. In a national cohort study, migraines occurred significantly more frequently in patients with psoriasis than in controls, although after a stratification analysis the increased frequency occurred only in the group of middle-aged males. More studies are needed to show a definitive association.
Vestibular migraine diagnosis requires balancing act. Vestibular migraine, the most common neurological cause of vertigo in adults, can manifest with a variety of vestibular symptoms, including spontaneous vertigo, triggered vertigo, positional vertigo, and head-motion dizziness, according to a recent literature review. The keys to diagnosis are identifying a relationship between vestibular symptoms and migrainous features and being aware of the heterogeneity of manifestations. Treatments include rescue therapy, lifestyle modification, nonpharmacologic migraine preventives, and pharmacologic migraine prophylaxis.
Achieving peak botox benefit may require multiple treatments. A post hoc analysis of the Phase 3 Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) trials assessed time of onset of onabotulinumtoxinA after the first treatment in total and responder populations and consistency weekly through 5 treatment cycles. OnabotulinumtoxinA treatment resulted in significant reductions in headache and migraine days/week at week 1 that persisted after week 3. Combined with earlier reports, the findings suggest that achieving peak onabotulinumtoxinA benefit may require multiple treatments.
Novel drug classes could involve medication overuse headache. Acute treatment for migraine is likely to improve with 2 novel classes of drugs, 5-HT1F receptor agonists (lasmiditan) and small molecule calcitonin-gene related peptide (CGRP) receptor antagonists (gepants), according to the authors of a recent review. Decreased 5-hydroxytryptamine (5-HT, serotonin) levels, increased CGRP expression, and changes in 5-HT receptor expression may be involved in medication overuse headache (MOH), they noted, but their relationship with MOH has not yet been described because of the novelty of the drugs.
More neck pain in episodic migraine. In a study of potential factors associated with neck pain in episodic migraineurs, there were no significant differences in pain intensity, migraine disability, duration, or frequency of headache between those who had neck pain and those who did not. Also, lifestyle factors-smoking, alcohol, coffee, body mass index ≥23kg/m2, poor sleep, and time spent on TV and computers-were not associated with the presence of neck pain. However, neck tenderness and cephalic tenderness scores were higher in episodic migraineurs who had neck pain.
Headache treatment may ease depression and painful physical symptoms. Migraine with active headache among patients with major depressive disorder could predict other painful physical symptoms (PSS). In patients who had migraine with active headache, the intensities of other PSS-eg, head, back, chest, abdomen, general muscle, and limb pain-were significantly higher than in those who had migraine with inactive headache and those who did not have migraine, and the remission rate of depression was lower. Study authors suggested that prevention and treatment of headache might help decrease other PSS and improve the prognosis of depression.
Periodontitis linked to vascular inflammation with chronic migraine. In an investigation of the potential association of periodontitis with vascular systemic inflammation and complement activation in patients with chronic migraine, pentraxin 3 (PTX3), soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK), and other biomarkers were measured outside of migraine attacks. Circulating levels of PTX3 and sTWEAK were significantly higher in patients who had severe periodontitis than in those who had no periodontitis. The authors concluded that severe periodontitis is linked with vascular systemic inflammation in patients with chronic migraine.
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