Migraine Treatment Advances Spell Relief

Therapies on the rise. The AHS statement cited the monoclonal antibodies (mAbs) targeting calcitonin gene‐related peptide (CGRP)-erenumab, fremanezumab, galcanezumab, and eptinezumab-as the first mechanism‐based and disease‐specific class of preventive treatments for migraine since FDA approval of methysergide in 1962. The anti‐CGRP mAbs have demonstrated efficacy, safety, and tolerability for preventive treatment of episodic and chronic migraine and do not require dose titration.

Evidence- and expert-based guidance on monoclonal antibodies. A new European Headache Federation guideline offered recommendations for managing episodic and chronic migraine with the anti‐CGRP mAbs. Low to high quality evidence was found to support eptinezumab, erenumab, fremanezumab, and galcanezumab for episodic migraine, and there was medium to high quality evidence to support erenumab, fremanezumab, and galcanezumab for chronic migraine.

Pick your poison: botulinum toxin as migraine medicine. Botulinum toxin type A injections in the head and neck muscles were superior to placebo in reducing the frequency of chronic migraine headaches in a recent meta-analysis. There was a mean difference in the change of migraine frequency of −0.23 in favor of botulinum toxin over placebo after 3 months of therapy; the reduction in frequency was significant. Also seen in the botulinum toxin group: improvement in patients’ quality of life.

Probiotics in the mix. Supplementation with a 14-strain probiotic mixture could improve migraine headache in both chronic and episodic migraineurs. Episodic migraineurs who received probiotics in a randomized double-blind controlled trial saw significant reductions in mean frequency of attacks, severity, and abortive drug usage per week. Significantly reduced in chronic migraineurs were mean frequency of attacks, severity, duration of attacks, and number of abortive drugs taken per day.

Men are from Mars, women have worse migraine. Among patients with probable migraine in a recent population-based study, women experienced more severe symptoms than men and a higher impact of headache. Significantly higher among women were the prevalence of migraine and probable migraine, headache frequency per month, headache intensity, and Headache Impact Test‐6 score. The findings suggest that women with probable migraine need more intensive evaluation and treatment than men.

Migraineurs see glass as half empty. Optimism and pessimism, known to be related to several mental health and brain disorders, are also associated with migraine and migraine‐related disability. Persons with migraine in a cross‐sectional study were less optimistic and more pessimistic than controls and had higher levels of anxious and depressive symptoms. Pessimism and anxiety were predictors of meeting criteria for migraine. Optimism was inversely associated with migraine‐related disability.

Fear not patients’ pain avoidance. Patients with migraine may achieve improvement in headache frequency and disability without changes in avoidance or endurance behavior. In a recent study, neither avoidance nor endurance was related to headache intensity or frequency or to a diagnosis of episodic vs chronic migraine. Headache frequency, intensity, and pain-related disability were significantly improved 3 to 6 months after treatment while avoidance and endurance were unchanged.

Pain in the neck: migraine or musculoskeletal complaint? A meta-analysis examined whether neck pain in patients with migraine is a symptom or an indicator for associated cervical musculoskeletal impairment. Four of 20 test procedures distinguished between patients and controls: range of cervical motion, flexion-rotation, pressure pain thresholds, and forward head posture in a standing position. The presence of musculoskeletal impairments in patients with migraine was confirmed in 3 of the tests.