Migraine Update: 5 New Insights

Acute migraine management gets green light. A proposed “traffic light” system may provide patients who have a migraine attack with a simple, easily recalled method for determining which drug to use based on the associated disability of the attack. In the system, green is an “I can still go” headache, yellow indicates an “I have to slow down” headache, and red signals an “I have to stop” headache. The goal is earlier, more effective treatment with a reduction in migraine‐associated disability.

Primary or nonprimary headache? Fulfilling International Headache criteria 3 (ICHD 3) criteria could help identify patients with primary headaches and those who will need advanced diagnostic strategies. Migraine and cervical myofascial pain were the most frequent etiologies for primary and nonprimary causes, respectively, in an ED study. Primary headache factors: fulfilling ICHD 3 criteria, history of migraine, and history of similar episodes. Nonprimary factors: immunosuppression and age ≥50 years.

Botox reduces migraine comorbidities. The Chronic Migraine OnabotulinuMtoxinA Prolonged Efficacy open-Label (COMPEL) study assessed the long-term safety and efficacy of onabotulinumtoxinA 155 U in adults with chronic migraine. The treatment not only reduced headache frequency but also resulted in a clinically meaningful reduction in depression and anxiety symptoms and improved associated symptoms of poor sleep quality and fatigue.

OnabotulinumtoxinA treatment response wears off. Patients with chronic migraine who receive onabotulinumtoxinA for prophylactic treatment may experience a wearing off of response during the first treatment cycle. However, a cohort longitudinal retrospective study has shown that increasing the dose in subsequent cycles could improve clinical response. Study authors called for more multicenter long-term studies to establish predictors and solutions.

Late-onset migraine with aura boosts stroke risk. In evaluating the association between cumulative exposure to migraine and incidence of ischemic stroke, investigators observed increased stroke risk in late life in patients with migraine with aura (MA) onset at age ≥ 50 years but not with onset at age < 50 years. Migraine without aura was not associated with increased stroke regardless of age of onset. The findings suggest that age of MA onset is important in assessment of stroke risk in older migraineurs.