Migraine Frequency Research Articles

Severe obesity is associated with increased migraine severity and frequency: A retrospective cohort study

Migraine headaches and obesity are both prevalent disorders, resulting in a high socioeconomic burden. To better understand the relationship between obesity and migraine, the aim of this study was to investigate the association between migraine severity, metabolic syndrome and estrogen-associated variables.A retrospective analysis of adult patients with refractory migraine seen by our senior author (J.E.J.) was performed. Patient demographics and migraine characteristics, including migraine intensity, duration, and number of headaches per month were collected from medical records. Migraine headache index (MHI) was calculated by multiplying frequency, intensity and duration of headaches. Weight and height were used to calculate body mass index (BMI) and these were divided per Center for Disease Control (CDC) classifications. Univariate linear regression models were used to evaluate associations.Patients (n = 223) were predominantly female (78%) with a mean age of 44 years at presentation. Patients with a BMI higher than 40 (class 3 obesity) had a higher MHI (p = 0.01) and experienced a higher number of migraines per month (p = 0.007), compared to patients with a healthy BMI, respectively. Migraine frequency was found to be significantly higher in post-menopausal women compared to pre-menopausal women (p = 0.02). No other significant associations were found.This study found that severe obesity (BMI > 40) is associated with increased migraine severity and frequency. Post-menopausal patients are also found to have increased migraine frequency, which could be explained by the estrogen-withdrawal hypothesis. Future studies are needed to evaluate the outcomes of individuals with obesity after nerve deactivation surgery.

Effectiveness and Safety of Eptinezumab in Episodic and Chronic Migraine Headache in the UAE: A Retrospective Study.

Eptinezumab is a humanized IgG1 immunoglobulin monoclonal antibody administered intravenously as a preventative migraine treatment. Previously conducted randomized, double-blind, placebo-controlled trials exhibited significant reductions in monthly migraine frequency among adults experiencing episodic and chronic migraine. The present study seeks to expand upon the current findings and to evaluate eptinezumab's efficacy as a preventative treatment for chronic and episodic migraine patients in the United Arab Emirates. This study is intended to represent the first real-world evidence and will hopefully serve as a valuable complement to the existing literature on the subject. This was a retrospective exploratory study. The participants included within the study were adult (≥18years) patients diagnosed with either episodic or chronic migraine. Patients were categorized according to their history of previous preventative treatment failure. For the final assessment of treatment efficacy, we included only patients with a minimum of 6months of clinical follow-up data. Patients were assessed at baseline for their monthly migraine frequency and assessed again at months 3 and 6. The primary objective was to evaluate the efficacy of eptinezumab in reducing migraine frequency among chronic and episodic migraine patients. A total of 100 participants were identified, of whom 53 completed the study protocol at month 6. Of the total, 40 (75.47%) were female, 46 (86.79%) were Emirati locals, and 16 (30.19%) were pharmaceutically naïve, having never tried any prior preventative therapy. Additionally, 25 (47.17%) patients met the criteria for chronic migraine (CM), whereas the remaining 28 (52.83%) were diagnosed with episodic migraine (EM). The baseline monthly migraine frequency (MMD) was 12.23 (4.97) days across all participants, 15.56 (3.97) for CM patients, and 9.25 (3.76) for EM patients; by month 6, these frequencies reduced to 3.66 (4.21), 4.76 (5.32), and 2.68 (2.61), respectively. Overall, 58.49% of those enrolled experienced>75% reduction in MMD frequency by month 6. Patients enrolled in this trial experienced clinically significant reductions in MMD by month 6. Eptinezumab was well tolerated and with one AE of significance that led to discontinuation from the study.

Impairments to the multisensory integration brain regions during migraine chronification: correlation with the vestibular dysfunction.

Migraine is often combined with vestibular dysfunction, particularly in patients with chronic migraine (CM). However, the pathogenesis of migraine chronification leading to vestibular dysfunction is not fully understood. The current study investigated whether structural or functional impairments to the brain during migraine chronification could be associated with vestibular dysfunction development. The eligible participants underwent clinical assessment and magnetic resonance imaging (MRI) scans. Voxel-based morphometry (VBM) determined structural impairment by evaluating alterations in gray matter volume (GMV). Functional impairment was assessed by the mean amplitude of low-frequency fluctuation (mALFF). Furthermore, the resting-state functional connectivity (rsFC) of regions possessing impairment was examined with a seed-based approach. We also analyzed the correlations between altered neuroimaging features with clinical variables and performed multiple linear regression. Eighteen CM patients, 18 episodic migraine (EM) patients, and 18 healthy controls (HCs) were included in this study. A one-way ANOVA indicated the group differences in mALFF. These were located within right supramarginal gyrus (SMG), left angular gyrus (AG), middle frontal gyrus (MFG), left middle occipital gyrus (MOG), right rolandic operculum (Rol) and left superior parietal gyrus (SPG). During rsFC analysis, the CM group had more enhanced rsFC of left SPG with left MOG than the EM and HC groups. The EM group revealed enhanced rsFC of left SPG with left AG than the CM and HC groups. In multiple linear regression, after controlling for age, body mass index (BMI) and disease duration, the rsFC of left SPG with left MOG (β = 48.896, p = 0.021) was found to predict the total Dizziness Handicap Inventory (DHI) score with an explained variance of 25.1%. Moreover, the rsFC of left SPG with left MOG (β = 1.253, p = 0.003) and right SMG (β = -1.571, p = 0.049) were significant predictors of migraine frequency, accounting for a total explained variance of 73.8%. The functional impairments due to migraine chronification are primarily concentrated in the multisensory integration-related brain regions. Additionally, the rsFC of SPG with MOG can predict the frequency of migraine and the degree of vestibular dysfunction. Therefore, these neuroimaging features could be potential mechanisms and therapeutic targets for developing vestibular dysfunction in migraine.

Migraine, associated factors, and functional disability in medical students at a peruvian university during the COVID-19 pandemic: An analytical cross-sectional study

BackgroundIt is unknown whether the confinement caused by the coronavirus disease 2019 (COVID-19) pandemic may influence migraine triggers. This study aimed to determine the frequency of migraine and their associated factors in medical students at a Peruvian university. The characteristics of migraine episodes and degree of functional disability caused by migraine were also evaluated. MethodsAn analytical cross-sectional study was conducted on medical students of a Peruvian university. The suspected migraine was determined with the Migraine Screen Questionnaire. Sociodemographic, confounding, and COVID-19 pandemic–related variables were included as possible associated factors. Poisson regression models were used, and crude and adjusted prevalence ratios with 95% confidence intervals were estimated. ResultsThe participants comprised 327 students, and 30.3% (n = 99) had suspected migraine. Sex, clustered semesters, having family members with migraine and COVID-19 risk factors, and hours in front of the computer were associated with a higher probability of migraine. However, having more hours of sleep per day was associated with a lower probability. Moreover, most students with migraine had a severe functional disability (41.4%). ConclusionsThe high frequency of migraine in medical students could be due to COVID-19-related quarantine. Certain pandemic-related factors increase the probability of having migraine. A high level of disability should promote timely diagnosis and follow-up in affected students.

One-year changes in clinical and balance parameters in individuals of different subtypes of migraine

BackgroundMigraine has been associated with balance dysfunction, more pronounced in patients with aura and chronic migraine. Also, it has been suggested that balance deficits are progressive through the migraineurs lifetime. ObjectiveTo analyze the one-year progression of balance parameters and clinical parameters associated with balance in female patients with and without migraine. DesignProspective cohort study. MethodsThe participants were distributed in four groups: control (CG; n = 27) migraine with aura (MA; n = 25), migraine without aura (MwA; n = 26), and chronic migraine (CM; n = 27). They performed the Sensory Organization Test, Motor Control Test and Adaptation Test protocols of dynamic posturography tests. Questionnaires about fear of falls, dizziness disability, and kinesiophobia were administered. These assessments were performed twice: baseline and after 1-year (follow-up). No intervention was performed for balance improvement, and the participants maintained their usual migraine treatment prescribed. ResultsNone of the groups differed in balance tests between baseline and follow-up. We observed a reduction in migraine frequency in MA (−2.2 days, p = 0.01) and CM (−10.8 days, p < 0.001) groups, and in the migraine intensity (−2.3 points, p = 0.001) in CM group. Significant decreases in the scores of fear of falling, dizziness disability, and kinesiophobia were observed in the migraine groups (p < 0.05), but the differences did not exceed the minimal detectable change of the questionaries scores. ConclusionWomen with different migraine subtypes did not present balance changes in a one-year interval. The improvements in migraine's clinical features were not accompanied by improvements in balance parameters.

Balance alterations are associated with neck pain and neck muscle endurance in migraine

BackgroundMigraine patients may present with both cervical and balance dysfunctions. The neck plays an important role in balance by providing substantial proprioceptive input, which is integrated in the central nervous system and influences the balance control systems. Whether balance and neck dysfunctions are associated in patients with migraine is still to be explored. ObjectivesThis study aimed to assess the association between the sensory organization test of balance with neck pain features, cervical strength, endurance, and range of motion in patients with migraine. MethodsSixty-five patients with migraine underwent the sensory organization test assessed with the Equitest-Neurocom® device. Maximum voluntary isometric contraction, cervical flexion and extension range of motion, and cervical flexor and extensor endurance were assessed. In addition, the features of migraine and neck pain were collected. Patients were dichotomized according to cut-off scores of balance performance and the association between outcomes were explored. ResultsPatients with reduced balance performance presented a higher frequency of migraine (p = 0.035), a higher frequency of aura (p = 0.002), greater neck pain intensity (p = 0.013), and decreased endurance of cervical flexors (p = 0.010) and extensors (p < 0.0001). The total balance score was correlated with age (r = −0.33; p = 0.007), migraine frequency (r = −0.29; p = 0.021), neck pain intensity (r = −0.26; p = 0.038), and endurance of the cervical flexors (r = 0.39; p = 0.001) and extensors (r = 0.36; p = 0.001). Migraine frequency, neck pain intensity, and endurance of the cervical flexors can predict 21% of the sensory organization test variability. ConclusionNeck pain features and endurance of the cervical muscles are related to reduced balance performance in patients with migraine. These results shed light to a better understanding of balance alterations in migraine patients.

Migraine patients’ experiences with and expectations from physiotherapy

BackgroundNeck pain is prevalent in migraine and a common reason to receive physiotherapy. There is no information as to the type of modalities patients receive and whether these are perceived as effective and matching expectations. MethodsA survey was designed with closed and open-ended questions allowing for quantitative evaluation and qualitative insights into experiences and expectations. The survey was available online from June–November 2021 and was disseminated in the German migraine league (patient organization) and via social media. Open questions were summarized using qualitative content analysis. Differences between receiving and not receiving physiotherapy were analyzed through Chi2 or Fisher's Test. Categories within groups through Chi2-goodness-of-fit-test and multivariate logistic regression indicated perceived clinical improvement. Results149 (123 received physiotherapy) patients completed the questionnaire. Patients receiving physiotherapy had higher pain intensity (p < 0.001) and migraine frequency (p = 0.017). Most participants received 6 sessions or less (38%) (past 12 months) of manual therapy (82%) and soft-tissue techniques (61%). 63% perceived benefits after manual therapy, and 50% after soft-tissue techniques. Logistic regression revealed that ictal and interictal neck pain (OR: 9.12 and 6.41, respectively) and receiving manual therapy (OR: 5.52) are associated with improvement. Mat exercises and higher migraine frequency increased the odds for no improvement or worsening (OR: 0.25 and 0.65, respectively). Expectations included individualized and targeted treatment from a specialized physiotherapist (39%), easier access, more and longer sessions (28%), manual therapy (78%), soft-tissue techniques (72%) and education (26%). ConclusionsThis first study on migraine patients' views on physiotherapy can serve as insight for researchers for future studies and clinicians to improve future care.

Prevalence of migraine in systemic lupus erythematosus: A meta-analysis.

Systemic lupus erythematosus (SLE) is an autoimmune disorder with a wide range of clinical manifestations, including neurological issues in about 25%-75% of cases. Among the neurological involvement cases, most cases show migraine. However, the prevalence of migraine varied worldwide, and in some studies, a higher incidence of migraine in SLE cases was reported compared to healthy controls. In the present study, we adopted a meta-analysis approach to find out the prevalence of migraine in SLE patients worldwide and investigate whether migraine frequency is more prevalent in SLE patients than controls. Various literature databases such as Scopus, PubMed, Science Direct, and Google Scholar were screened for eligible studies. The last search was performed on January 21, 2023. Publication biases were accessed by Egger's regression analysis and funnel plots. Cochrane Q statistics and I2 values explored the presence or absence of heterogeneity. All statistical analysis of meta-analysis was performed in comprehensive meta-analysis software v3. Based on predefined inclusion and exclusion criteria, 17 reports comprising 2901 SLE patients and 575 healthy controls were considered in the present study. The meta-analysis revealed the prevalence of migraine to be 34.8%. Furthermore, migraine was more prevalent in SLE patients than healthy controls (OR: 1.964, p = 0.000, 95% CI = 1.512-2.550). Similar trends were also observed while considering another 10 independent reports those were not disclosed about the migraine diagnosis criteria (number of reports: 27, SLE: 3473, HC: 741, prevalence: 33.5%, SLE vs HC: OR = 2.107, p = 0.000, 95% CI = 1.672-2.655). Subgroup analysis demonstrated that SLE patients from South America had a higher prevalence of migraine (56.2%). About one-third of SLE patients experience migraine worldwide. The prevalence of migraine is more frequent in SLE patients than the healthy controls.

Comparing Migraine Headache Index versus Monthly Migraine Days after Headache Surgery: A Systematic Review and Meta-Analysis.

Nerve deactivation surgery for the treatment of migraine has evolved rapidly over the past 2 decades. Studies typically report changes in migraine frequency (attacks/month), attack duration, attack intensity, and their composite score-the Migraine Headache Index-as primary outcomes. However, the neurology literature predominantly reports migraine prophylaxis outcomes as change in monthly migraine days (MMD). The goal of this study was to foster common communication between plastic surgeons and neurologists by assessing the effect of nerve deactivation surgery on MMD and motivating future studies to include MMD in their reported outcomes. An updated literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The National Library of Medicine (PubMed), Scopus, and Embase were systematically searched for relevant articles. Data were extracted and analyzed from studies that met the inclusion criteria. A total of 19 studies were included. There was a significant overall reduction in MMDs [mean difference (MD), 14.11; 95% CI, 10.95 to 17.27; I 2 = 92%], total migraine attacks per month (MD, 8.65; 95% CI, 7.84 to 9.46; I 2 = 90%), Migraine Headache Index (MD, 76.59; 95% CI, 60.85 to 92.32; I 2 = 98%), migraine attack intensity (MD, 3.84; 95% CI, 3.35 to 4.33; I 2 = 98%), and migraine attack duration (MD, 11.80; 95% CI, 6.44 to 17.16; I 2 = 99%) at follow-up (range, 6 to 38 months). This study demonstrates the efficacy of nerve deactivation surgery on the outcomes used in both the plastic and reconstructive surgery and neurology literature.

The Positive and Negative Predictive Value of Targeted Diagnostic Botox Injection in Nerve Decompression Migraine Surgery.

Nerve decompression surgery is an effective treatment modality for patients who experience migraines. Botulinum toxin type A (Botox) injections have been traditionally used as a method to identify trigger sites; however, there is a paucity in data regarding its diagnostic efficacy. The goal of this study was to assess the diagnostic capacity of Botox in successfully identifying migraine trigger sites and predicting surgical success. A sensitivity analysis was performed on all patients receiving Botox for migraine trigger site localization followed by a surgical decompression of affected peripheral nerves. Positive and negative predictive values were calculated. A total of 40 patients met our inclusion criteria and underwent targeted diagnostic Botox injection followed by a peripheral nerve deactivation surgery with at least 3 months' follow-up. Patients with successful Botox injections (defined as at least 50% improvement in Migraine Headache Index scores after injection) had significantly higher average reduction in migraine intensity (56.7% versus 25.8%; P = 0.020), frequency (78.1% versus 46.8%; P = 0.018), and Migraine Headache Index (89.7% versus 49.2%; P = 0.016) postsurgical deactivation. Sensitivity analysis shows that the use of Botox injection as a diagnostic modality for migraine headaches has a sensitivity of 56.7% and a specificity of 80.0%. The positive predictive value is 89.5% and the negative predictive value is 38.1%. Diagnostic targeted Botox injections have a very high positive predictive value. It is therefore a useful diagnostic modality that can help identify migraine trigger sites and improve preoperative patient selection. Diagnostic, II.

Neck pain repercussions in migraine – The role of physiotherapy

IntroductionMigraine is a neurological and disabling disease whose peripheral manifestations can be addressed with physiotherapy. These manifestations can include pain and hypersensitivity to muscular and articular palpation in the neck and face region, a higher prevalence of myofascial trigger points, limitation in global cervical motion, especially in the upper segment (C1–C2), and forward head posture with worse muscular performance. Furthermore, patients with migraine can present cervical muscle weakness and greater co-activation of antagonists in maximum and submaximal tasks. In addition to musculoskeletal repercussions, these patients can also present balance impairment and a greater risk of falls, especially when chronicity of migraine frequency is present. The physiotherapist is a relevant player in the interdisciplinary team and can help these patients to control and manage their migraine attacks. PurposeThis position paper discusses the most relevant musculoskeletal repercussions of migraine in the craniocervical area under the perspective of sensitization and disease chronification, besides addressing physiotherapy as an important strategy for evaluating and treating these patients. ImplicationsPhysiotherapy as a non-pharmacological treatment option in migraine treatment may potentially reduce musculoskeletal impairments related to neck pain in this population. Disseminating knowledge about the different types of headaches and the diagnostic criteria can support physiotherapists who compose a specialized interdisciplinary team. Furthermore, it is important to acquire competencies in neck pain assessment and treatment approaches according to the current evidence.

Ultrasound-guided stellate ganglion block for the treatment of migraine in elderly patients: A retrospective and observational study.

This study aimed to assess the effectiveness and safety of ultrasound-guided stellate ganglion block (SGB) in the prophylactic treatment of migraine in the elderly. Treatment of migraine in the elderly is often difficult and troublesome due to multiple comorbidities, drug interactions, and adverse effects (AEs). SGB may be an effective treatment approach for migraine in the elderly as its clinical use is rarely limited by concomitant diseases and age-related physiological changes; however, no studies have evaluated the effectiveness of SGB in the treatment of migraine in the elderly population. This is a retrospective observational case series study. We retrospectively analyzed patients with migraine aged ≥65 years, who underwent ultrasound-guided SGB for headache management between January 2018 and November 2022. Pain intensity using the numerical rating scale (NRS, 0-10), number of days with headache per month, duration of headache, and the consumptions of acute medications were recorded before SGB treatment, and at 1, 2, and 3 months after the last SGB. Safety assessment included thorough documentation of serious and minor AEs related to SGB. Of 71 patients, 52 were analyzed in this study. After the final SGB, the NRS scores decreased significantly from a mean (± standard deviation [SD]) of 7.3 (1.2) at baseline to 3.3 (1.4), 3.1 (1.6), and 3.6 (1.6) at 1, 2, and 3 months, respectively (vs. baseline, p < 0.001). The mean (SD) number of headache days per month significantly reduced from 23.1 (5.5) to 10.9 (7.1) (p < 0.001), 12.7 (6.5) (p = 0.001), and 14.0 (6.8) days (p = 0.001) at the 1-, 2-, and 3-month follow-ups, respectively. The values of headache duration were also significantly lower at the 1-month (mean [SD] 12.5 [15.8] h, p = 0.001), 2-month (mean [SD] 11.3 [15.9] h, p = 0.001), and 3-month follow-ups (mean [SD] 14.3 [16.0] h, p = 0.001) compared to pre-treatment baseline (mean [SD] 22.7 [17.1] h). There were 33/52 (64%) patients experiencing at least a 50% reduction in acute medications consumption 3 months after the final SGB treatment. The overall AEs rate associated with ultrasound-guided SGB was 9.0% (26/290 SGBs). There were no serious AEs; all reported AEs were minor and transient. Stellate ganglion block treatment could reduce pain intensity, headache frequency, and duration of migraine, thereby reducing the need for adjunctive medications in elderly patients. Ultrasound-guided SGB might be a safe and effective intervention for the treatment of migraine in elderly patients.

Treatment with eptinezumab for migraine prevention in people with chronic migraine and medication-overuse headache: a plain language summary.

This is a summary of three articles describing preventive treatment of migraine in participants with a diagnosis of both chronic migraine and medication-overuse headache in a study called PROMISE-2 (PRevention Of Migraine via Intravenous ALD403 Safety and Efficacy-2). People living with chronic migraine and medication-overuse headache have one of the most disabling, costly, and difficult-to-treat headache disorders. After preventive migraine treatment with eptinezumab (trade name Vyepti), participants with chronic migraine and medication-overuse headache experienced fewer migraine days, a reduced severity of migraine attacks, and a reduced use of acute medication. More participants receiving eptinezumab treatment no longer met the definition of either chronic migraine or medication-overuse headache throughout the study when compared with those receiving placebo. Eptinezumab is beneficial for people who often use acute medication(s) due to frequent headache episodes or migraine attacks.

P.016 Impact of eptinezumab on patient-reported outcomes in patients with prior preventive treatment failures

Background: In DELIVER, eptinezumab reduced migraine frequency and was well tolerated in patients with migraine and prior preventive treatment failures. This analysis evaluated changes in patient-reported outcomes (PROs). Methods: DELIVER (NCT04418765; phase 3b double-blind study) randomized adults with migraine and 2-4 prior preventive treatment failures to eptinezumab or placebo every 12 weeks. The assessed PROs included EuroQol 5-Dimensions 5-Levels visual analogue scale (EQ-5D-5L VAS); 6-item Headache Impact Test (HIT-6), Patient Global Impression of Change (PGIC), most bothersome symptom (MBS), and Migraine-Specific Quality of Life Questionnaire (MSQ, v2.1). Results: Patients received eptinezumab 100mg (n=299), 300mg (n=294), or placebo (n=298). Mean changes from baseline to Wk12 in EQ-5D-5L VAS scores were 2.0 (100mg, P=0.0007) and 4.4 (300mg, P&lt;0.0001) versus -3.1 (placebo), and were maintained or further improved to Wk24 (2.0, 5.2, -2.8, respectively). Mean baseline HIT-6 total scores were ~66.4, with mean changes of -6.9 (100mg, P&lt;0.0001) and -8.5 (300mg, P&lt;0.0001) versus -3.1 (placebo) at Wk12 that were further improved through Wk24 (-8.9 and -9.9 vs -3.9). PGIC, MBS, and MSQ domain scores showed greater improvement for eptinezumab than placebo. Conclusions: In adults with migraine and prior preventive treatment failures, eptinezumab robustly improved health-related quality of life and migraine-related burden over 24 weeks versus placebo.

Migraine with and without aura in relation to the menstrual cycle and other hormonal milestones: A prospective cohort study.

Previous studies showed that the perimenstrual window is associated with an increased susceptibility to migraine attacks without aura, but had conflicting results regarding attacks with aura. We performed a longitudinal E-diary study among 526 premenopausal women with migraine. Differences in occurrence of perimenstrual migraine attacks between women with migraine with aura and without aura were assessed using a mixed effects logistic regression model. Additionally, participants completed a questionnaire about the influence of hormonal milestones on migraine frequency. Prevalence of menstrual migraine did not differ between women with migraine without aura and migraine with aura (59% versus 53%, p = 0.176). The increased risk of migraine attacks without aura during the perimenstrual window was similar for women with migraine without aura (OR[95%CI]:1.53 [1.44-1.62]) and those with migraine with aura (1.53 [1.44-1.62]). The perimenstrual window was not associated with increased risk of migraine aura attacks (1.08 [0.93-1.26], p = 0.314). Women with migraine with aura more often reported increased migraine frequency during pregnancy and breastfeeding compared to women with migraine without aura, but not during hormonal contraception use. Sex hormone levels seem to differently affect the trigeminovascular system (migraine headache) and the susceptibility to cortical spreading depolarization (aura). Exclusively migraine attacks without aura should be interpreted as perimenstrual attacks.

Bayesian joint modeling of patient-reported longitudinal data on frequency and duration of migraine

In this methodological study, we address the joint modeling of longitudinal data on the frequency and duration migraine attacks collected from patients in a clinical study in which patients were repeatedly asked at each hospital visit to report the number of days of migraine attacks they had in the last $30$ days and the corresponding average duration of attacks. In our motivating data set, the migraine frequency outcome is a count variable inflated at multiples of $5$ and $10$ days, whereas the migraine duration outcome is reported entirely in discrete hours, including $0$ for non-migraine days and inflated at multiples of $12$ hours. In our study, we propose a joint modeling approach that models each migraine outcome by a multiple inflated negative binomial model with random effects and assumes a bivariate normal distribution for the random effects. We estimate the model parameters under Bayesian inference. We examine the performance of the proposed joint model using a Monte Carlo simulation study and compare its performance with a separate modeling approach in which each longitudinal count outcome is modeled separately. Finally, we present the results of the analysis of migraine data.

Second-generation gepants in the treatment of migraine – a review of the findings of randomised controlled trials

Pharmacological treatment of migraine may be either acute (abortive) or preventive (prophylactic), though patients with frequent migraine attacks may require both. The aim of acute treatment is to treat attacks quickly and consistently, prevent recurrences, and restore patients to normal functioning. The goal of preventive migraine therapy is to reduce the frequency, duration, and severity of attacks. Calcitonin gene-related peptide (CGRP) is a neuropeptide which plays a critical role in migraine pathophysiology. The first CGRP antagonist studied in patients with migraine was olcegepant. Despite the fact that the efficacy of CGRP antagonists in the treatment of migraine has been demonstrated in clinical trials, further research on CGRP antagonists has been suspended due to safety concerns related to their toxic effects on the liver. In recent years, newgeneration gepants have been developed. The efficacy of rimegepant and ubrogepant as acute migraine medications, as well as atogepant and rimegepant as migraine preventives, has been confirmed in randomised placebo-controlled phase three studies. The most commonly reported treatment-related emergent adverse events of gepants include nausea and constipation. No cardiovascular or hepatic adverse events have emerged so far. CGRP antagonists do not exhibit vasoconstrictive proprieties. Gepants may be used in patients with cardiovascular diseases when triptans are contraindicated. The results of studies investigating the efficacy and tolerability of CGRP antagonists are promising and it is hoped that in the future they will broaden the range of abortive and prophylactic options for the management of migraine.

Balance disorders and migraine

BackgroundMigraine is associated with motion sensitivity symptoms such as kinetosis, vestibular symptoms and balance alterations. While focus is given to headache management, addressing these symptoms is often neglected, although they are related to additional migraine burden and increased disability. PurposeOur aim is to disseminate the current understanding of the motion sensitivity symptoms among patients with migraine, with focus on balance impairments. We discuss the susceptibility of migraine to motion sensitivity, its suggested mechanisms, the balance alterations during quiet standing, mobility tasks and reactions to external perturbations. The role of migraine subdiagnosis, implications for clinical practice and future perspectives are also acknowledged. ImplicationsBalance disorders are one of the signs reflecting a broader and complex spectrum of motion sensitivity, which are present even between attacks. Migraineurs are especially inherent to these symptoms probably due to brain hyperexcitability and to shared pathophysiological mechanisms.Patients, especially with aura and chronic migraine, exhibit balance instability during quiet standing under different surface and visual input conditions. Migraineurs demonstrated reduced limits of stability and lower performance on walk, transposing obstacles and sit to stand tasks. Only patients with aura present impairment of motor control reactions following external perturbations. Balance alterations are associated with falls and are influenced by aura, migraine frequency and psychosocial aspects, but not by vestibular symptoms or vestibular migraine diagnosis. There is a high demand for high quality of evidence regarding the assessment and care of motion sensitivity symptoms in migraineurs, considering approaches to manage not just the pain, but its associated symptoms.

Drug therapy of the acute migraine attack and prophylaxis ofmigraine

Migraine has a prevalence of 10 % in Germany, making it the most common neurological disorder. Migraine is a prevalent disorder not only for neurologist, it's an everyday topic for general physicians and internal medicine as well. Acute migraine attacks are treated with analgesics or triptans. In case of frequent migraine attacks, there is an indication for medicinal and non-pharmacological migraine prophylaxis. Medications include beta-blockers, flunarizine, anticonvulsants, amitriptyline or, in the case of chronic migraine, onabotulinumtoxinA. If these drugs are not effective, are not tolerated or contraindicated, monoclonal antibodies against calcitonin gene-related peptide (CGRP) or the CGRP receptor can be used.

SP25. The Association between Obesity and Migraine: Does This Exist?

PURPOSE: Migraine headaches are a chronic disease for millions worldwide. Metabolic syndrome including obesity and hypertension are hypothesized to be linked to an increased prevalence of migraine and to an increased migraine attack frequency. The aim of this study was to evaluate the association between obesity, menopausal status and migraine characteristics. METHODS: In this retrospective chart review, data from medical records between July 2013-July 2022 of patients who presented with migraine headache at the plastic and reconstructive surgery department at The Ohio State University were reviewed. Demographic data, body mass index (BMI) and blood pressure were recorded. Migraine headache characteristics were extracted and the migraine headache index (MHI) was calculated. The MHI was calculated by multiplying frequency, duration and intensity of migraine headaches. Univariate linear regression models were used to evaluate the associations between measures of migraine, metabolic syndrome and menopausal status. RESULTS: A total of 211 patients with migraine headaches were identified. Seventy-eight percent were female and 22% were male, with an average age of 44.6±12.8 years (average ± SD). Center for Disease Control and Prevention (CDC) classification of BMI was used. Higher MHI and number of headaches per month were significantly associated with class 3 obesity (BMI >40, p<0.01), but not with other BMI classes (p>0.05). Intensity and duration of headaches were not associated with BMI, respectively (p>0.05). Postmenopausal status was associated with a significantly lower number of migraines per month (p=0.02). Hypertension was not associated with migraine characteristics (p>0.05). CONCLUSION: A higher BMI is associated with increased MHI and frequency of migraines, but not with the intensity and duration of headaches experienced. Furthermore, number of headaches decreased after menopause. As fat mass increases in obesity, aromatase expression and consequently estrogen levels are also elevated, which impacts migraine headaches. Moreover, higher BMI may also impact compression neuropathy. These findings provide new insights into the association between obesity and migraine headaches. Future multicenter studies are needed to explore these associations in a larger group of patients.