Migraine Attacks Research Articles

Experimental and Clinical Investigation of Cytokines in Migraine: A Narrative Review.

The role of neuroinflammation in the pathophysiology of migraines is increasingly being recognized, and cytokines, which are important endogenous substances involved in immune and inflammatory responses, have also received attention. This review examines the current literature on neuroinflammation in the pathogenesis of migraine. Elevated TNF-α, IL-1β, and IL-6 levels have been identified in non-invasive mouse models with cortical spreading depolarization (CSD). Various mouse models to induce migraine attack-like symptoms also demonstrated elevated inflammatory cytokines and findings suggesting differences between episodic and chronic migraines and between males and females. While studies on human blood during migraine attacks have reported no change in TNF-α levels and often inconsistent results for IL-1β and IL-6 levels, serial analysis of cytokines in jugular venous blood during migraine attacks revealed consistently increased IL-1β, IL-6, and TNF-α. In a study on the interictal period, researchers reported higher levels of TNF-α and IL-6 compared to controls and no change regarding IL-1β levels. Saliva-based tests suggest that IL-1β might be useful in discriminating against migraine. Patients with migraine may benefit from a cytokine perspective on the pathogenesis of migraine, as there have been several encouraging reports suggesting new therapeutic avenues.

Social Media Listening and Digital Profiling Study of People With Headache and Migraine: Retrospective Infodemiology Study.

There is an unmet need for a better understanding and management of headache, particularly migraine, beyond specialist centers, which may be facilitated using digital technology. The objective of this study was to identify where, when, and how people with headache and migraine describe their symptoms and the nonpharmaceutical and medicinal treatments used as indicated on social media. Social media sources, including Twitter, web-based forums, blogs, YouTube, and review sites, were searched using a predefined search string related to headache and migraine. The real-time data from social media posts were collected retrospectively for a 1-year period from January 1, 2018, to December 31, 2018 (Japan), or a 2-year period from January 1, 2017, to December 31, 2018 (Germany and France). The data were analyzed after collection, using content analysis and audience profiling. A total of 3,509,828 social media posts related to headache and migraine were obtained from Japan in 1 year and 146,257 and 306,787 posts from Germany and France, respectively, in 2 years. Among social media sites, Twitter was the most used platform across these countries. Japanese sufferers used specific terminology, such as "tension headaches" or "cluster headaches" (36%), whereas French sufferers even mentioned specific migraine types, such as ocular (7%) and aura (2%). The most detailed posts on headache or migraine were from Germany. The French sufferers explicitly mentioned "headache or migraine attacks" in the "evening (41%) or morning (38%)," whereas Japanese mentioned "morning (48%) or night (27%)" and German sufferers mentioned "evening (22%) or night (41%)." The use of "generic terms" such as medicine, tablet, and pill were prevalent. The most discussed drugs were ibuprofen and naproxen combination (43%) in Japan; ibuprofen (29%) in Germany; and acetylsalicylic acid, paracetamol, and caffeine combination (75%) in France. The top 3 nonpharmaceutical treatments are hydration, caffeinated beverages, and relaxation methods. Of the sufferers, 44% were between 18 and 24 years of age. In this digital era, social media listening studies present an opportunity to provide unguided, self-reported, sufferers' perceptions in the real world. The generation of social media evidence requires appropriate methodology to translate data into scientific information and relevant medical insights. This social media listening study showed country-specific differences in headache and migraine symptoms experienced and in the times of the day and treatments used. Furthermore, this study highlighted the prevalence of social media usage by younger sufferers compared to that by older sufferers.

Targeting the intrinsically photosensitive retinal ganglion cell to reduce headache pain and light sensitivity in migraine: A randomized double-blind trial

Approximately 80% of patients with migraine report light sensitivity during attacks and almost half report that following headache, light sensitivity is the most bothersome symptom. Light wavelengths stimulating intrinsically photosensitive retinal ganglion cells (IPRGCs) exacerbate headache-associated light sensitivity; green light is most comfortable. We developed optical tints that block wavelengths exacerbating migraine pain and transmit wavelengths that are most comfortable. We studied patients with migraine to determine if spectacles with these tints ameliorate headache pain and light sensitivity.Randomized participants wore control lenses or lenses blocking light wavelengths that stimulate IPRGCs. Participants applied the lenses at migraine onset and recorded baseline, two- and four-hour headache pain on an 11-point scale. Primary endpoint was pain reduction at two hours following the first severe or very severe headache. Statistical tests used included mixed-effects model analysis, Mann-Whitney test, Cochran-Mantel-Haenszel test, Shapiro-Wilk test, Welch t-test.In 78 subjects, two- and four-hour pain reduction was not significantly different between groups. In post-hoc analyses of headaches with baseline pain scores ≥ 2, a mixed-effects model suggested that IPRGC lenses were associated with clinically and statistically significant reductions in two- and four-hour headache pain. In post-hoc analyses, fewer subjects wearing IPRGC lenses reported two-hour light sensitivity.Preliminary evidence suggests that optical tints engineered to reduce stimulation of IPRGCs may reduce migraine-associated pain and light sensitivity.Trial Registration: This study was registered at ClinicalTrials.gov (NCT04341298).

Metabolic markers of short and long-term exogenous DL-beta-hydroxybutyrate supplementation in episodic migraine patients: an exploratory analysis of a randomized-controlled-trial.

Background: Emerging findings propose that the pathophysiology of migraine may be associated with dysfunctional metabolic mechanisms. Recent findings suggest that migraine attacks are a response to the cerebral energy deficit, and ingestion of ketone bodies stabilizes the generation of a migraine attack. Based on these findings, ketone body supplementation is postulated as a prophylactic treatment approach to restore cerebral metabolism deficiency. Metabolic markers are unexplored after exogenous ketone body supplementation in episodic migraineurs. Therefore, the present single-arm uncontrolled explorative analysis evaluated blood ketone body and glucose concentration after short and long-term 6g exogenous DL-Mg-Ca-beta-hydroxybutyrate (DL-βHB) supplementation. Methods: The presented data are part of the MigraKet randomized-control cross-over clinical trial of 41 episodic migraineurs (Number NCT03132233). Patients were given a single dose of 6g DL-βHB. Ketone body and glucose blood concentration were assessed before intake, 20, and 40min after DL-βHB intake. Ketone body, glucose concentration and glycated hemoglobin values were evaluated after 12weeks of 18g DL-βHB ingestion (total dose), taken three times daily (6g/dose; 3x/day). Linear models explored the association between the ketone body and glucose levels. Results: Ketone body concentration increased within-group to a mean of 0.46 (0.30) mmol/L after 40min post- DL-βHB supplementation [estimate = 0.24mmol/L, CI = (0.20.0.27), p < 0.01]. This within-group increase of ketone body concentration did not change after repeated daily intake of DL-βHB supplementation over 12weeks [estimate = 0.00mmol/L, CI = (-0.03.0.04), p = 0.794]. DL-βHB intake significantly reduced blood glucose concentration within-group from a mean baseline of 4.91 (0.42) mmol/L to 4.75 (0.47) mmol/L 40min post-DL-βHB supplementation [estimate = -0.16mmol/L, CI = (-0.15, 0.03), p < 0.01]. Repeated DL-βHB supplementation for 12weeks showed no change within-group in acute ketone bodies concentration [estimate = 0.00mmol/L, CI = (-0.03.0.04), p = 0.794] and in the HbA1c value [estimate = 0.02, CI = (-0.07.0.11), p = 0.69]. Conclusion: A single dose of 6g DL-βHB significantly elevated blood ketone bodies and decreased blood glucose concentration within-group in episodic migraineurs. Long-term DL-βHB supplementation for 12weeks showed no effect within-group on acute ketone body concentration and had not impact on HbA1c. The elevation of the ketone body concentration was moderate, indicating that nutritional ketosis was not reached. Therefore, a dose higher than 6g of DL-βHB is required to reach the nutritional level of ketosis. ClinicalTrials.gov Identifier: NCT03132233.

Priority acute and preventive migraine treatment benefits: Results of the Migraine Clinical Outcome Assessment System (MiCOAS) qualitative study of people living with migraine.

There is renewed emphasis on including patients in determining, defining, and prioritizing outcomes for migraine treatment. To obtain insights directly from people living with migraine on their priorities for treatment. A total of 40 qualitative interviews were conducted as part of the Migraine Clinical Outcome Assessment System project, a United States Food and Drug Administration grant-funded program to develop a core set of patient-centered outcome measures for migraine clinical trials. Interviews included a structured exercise in which participants rank-ordered pre-defined lists of potential benefits for acute and preventive migraine therapy. The 40 study participants who reported being diagnosed with migraine by a clinician ranked the benefits and explained their rationale. Study participants consistently ranked either pain relief or absence of pain as their top priority for acute treatment. Relief/absence of other migraine symptoms and improved functioning were also prioritized. For preventive treatment, participants prioritized reductions in migraine frequency, symptom severity, and attack duration. Few differences were found between participants with episodic migraine and those with chronic migraine. However, participants with chronic migraine ranked "increased predictability of attacks" much higher than those with episodic migraine. Participants' rankings were influenced by prior expectations and experiences of migraine treatments, which caused many participants to deprioritize desired benefits as unrealistic. Participants also identified several additional priorities, including limited side-effects and reliable treatment efficacy in both acute and preventive treatments. The results showed the participants prioritized treatment benefits aligned with existing core clinical outcomes used in migraine research, but also valued benefits that are not typically assessed, such as predictability. Participants also deprioritized important benefits when they believed treatment was unlikely to deliver those outcomes.

Comprehensive Update and Review of Clinical and Imaging Features of SMART Syndrome.

Stroke-like migraine attacks after radiation therapy (SMART) syndrome is a delayed complication of cranial irradiation, with subacute onset of stroke-like symptoms including seizures, visual disturbance, speech impairment, unilateral hemianopsia, facial droop, and aphasia, often associated with migraine-type headache. The diagnostic criteria were initially proposed in 2006. However, the diagnosis of SMART syndrome is challenging because clinical symptoms and imaging features of SMART syndrome are indeterminate and overlap with tumor recurrence and other neurologic diseases, which may result in inappropriate clinical management and unnecessary invasive diagnostic procedures. Recently, various imaging features and treatment recommendations for SMART syndrome have been reported. Radiologists and clinicians should be familiar with updates on clinical and imaging features of this delayed radiation complication because recognition of this entity can facilitate proper clinical work-up and management. This review provides current updates and a comprehensive overview of the clinical and imaging features of SMART syndrome.

Can Serum Magnesium Level and Visual Evoked Potentials (P100) be a Predictive in Migraineurs?: Evidence Based Study.

Few dating back, the role of visual evoked potentials changes and reduced level of intracellular magnesium have appeared in migraine patients both throughout the attacks and in the interictal periods. Moreover, there is a lack of evidence regarding the correlation between magnesium levels and visual evoked potentials. To assess the changes in the levels of magnesium in migraineurs compared to a healthy control group is our prime intention. Also, to correlate serum magnesium levels with visual evoked potentials changes within the migraineurs is a secondary part of the study. After applying inclusion and exclusion criteria as per the study protocol, in total, 80 subjects were enrolled in the study. Of which 40 were migraineurs diagnosed as per the International Headache Society criteria for severe migraine headache. Rest of 40 was nonmigraineurs served as a control group of the study. All included patient was submitted to demographic profile, previous history of the disease and drug intake, thorough clinical investigation and baseline laboratory parameters. Apart from this, the measurement of visual evoked potentials changes (4th block) and magnesium levels were done as per our standard operating procedures. In migraineurs, serum total Mg level was considerably lower compared to the control group (1.79 ± 0.14 mg/dl versus 2.10 ± 0.17 mg/dl, P < 0.0001) and amplitude of P100 (P < 0.0001) was negatively correlated to reduced serum Mg level (P < 0.0001). As expected, both elevated visual evoked potential amplitude and reduced level of brain magnesium can be a demonstration of neuronal hyperexcitability of the optic pathways associated with a dropped threshold for migraine attacks.

Effects of rimegepant 75 mg daily on the pharmacokinetics of a combined oral contraceptive containing ethinyl estradiol and norgestimate in healthy female participants.

To assess the effect of single and multiple doses of rimegepant 75 mg dose on the pharmacokinetics of an oral contraceptive containing ethinyl estradiol (EE)/norgestimate (NGM) in healthy females of childbearing potential or non-menopausal females with tubal ligation. Females of childbearing age experience the highest prevalence of migraine and frequently inquire about the concomitant use of anti-migraine medications and contraceptives. Rimegepant, a calcitonin gene-related peptide receptor antagonist, demonstrated efficacy and safety for treating an acute migraine attack and preventing migraine. This open-label, single-center, phase 1, drug-drug interaction study explored the effects of rimegepant 75 mg daily dose on the pharmacokinetics of an oral contraceptive containing EE/NGM 0.035 mg/0.25 mg in healthy females of childbearing potential or non-menopausal females with tubal ligation. During cycles 1 and 2, participants received EE/NGM once daily for 21 days followed by placebo tablets with inactive ingredients for 7 days. Rimegepant was administered during only cycle 2 for 8 days, from days 12 through 19. The primary endpoint was the effect of single and multiple doses of rimegepant on the pharmacokinetics of EE and norelgestromin (NGMN), an active metabolite of NGM, at steady state, including area under the concentration-time curve for 1 dosing interval (AUC0-τ,ss ) and maximum observed concentration (Css[max] ). The study enrolled 25 participants, with pharmacokinetic data assessed for 20 participants. A single 75 mg dose of rimegepant co-administered with EE/NGM increased exposures of EE and NGMN by ≤16% (geometric mean ratio [GMR], 1.03; 90% confidence interval [CI], 1.01-1.06; and GMR, 1.16; 90% CI, 1.13-1.20, respectively). After 8 days of co-administering EE/NGM with rimegepant, EE pharmacokinetic parameters, AUC0-τ,ss and Css(max) , increased by 20% (GMR, 1.20; 90% CI, 1.16-1.25) and 34% (GMR, 1.34; 90% CI, 1.23-1.46), respectively, and NGMN pharmacokinetic parameters increased by 46% (GMR, 1.46; 90% CI, 1.39-1.52) and 40% (GMR, 1.40; 90% CI, 1.30-1.51), respectively. The study identified modest elevations in overall EE and NGMN exposures after multiple doses of rimegepant, but these elevations are unlikely to be clinically relevant in healthy females with migraine.

Optimization of migraine attacks relief

On December 24, 2022, in Moscow an interdisciplinary Council of Headache Experts, held under the auspice of the interregional public organization “Russian Society for the Study of Headache”, discussed the key problems of effective treatment of a migraine attack and the possibilities of a specific drug Kaporiza® (rizatriptan). Despite the development of strategies for the relief of migraine attacks and the effectiveness of triptans as first-line therapy, the choice of a specific drug in accordance with the individual clinical profile of the patient is difficult due to the existence of drugs in various forms (standard tablets, oral dispersible forms, injections, nasal sprays, rectal suppositories). Rizatriptan in the form of an orally dispersible tablet (ODT) has a number of advantages: high bioavailability, fast onset of action, and ease of use. Therefore, Kaporiza® (rizatriptan ODT) may be recommended as a priority therapy for all migraine patients who prefer the dispersible tablet form and who experience symptoms of nausea and vomiting, as well as for patients who have experience of poor efficacy and/or poor tolerability of other triptans. The Expert Council recommends to include rizatriptan ODT in the next edition of the clinical guidelines for the diagnosis and treatment of migraine as a first-line agent with Level A evidence.

Characterizing opioid use in a Dutch cohort with migraine.

There is lack of data on opioid (over)use for migraine in Europe. We performed a cross-sectional study in a large Dutch cohort using a web-based questionnaire to assess opioid use in individuals with migraine. Primary outcome was to assess opioid use for the treatment of migraine attacks. As secondary outcomes we specified use of opioids (duration of use, type of opioids, prescriber) and compared between persons with episodic migraine versus chronic migraine. Descriptive statistics, unpaired T-tests, Chi-square and Mann-Whitney U tests were used. In total n = 3712 patients participated, 13% ever used opioids for headache. In opioid users, 27% did this for >1 month, and 11% for >1 year, and 2% without prescription. The majority of prescribing physicians were general practitioners (46%), followed by neurologists (35%), other specialists (9%), or emergency room doctors (8%). Opioids were used as acute treatment in 63%, in 16% as preventive treatment, and in 21% for both indications. Chronic migraine patients reported more opioid use compared with episodic migraine (22% versus 12%, p < 0.001), with also more prolonged use (>1 month: 34% chronic migraine versus 24% episodic migraine, p < 0.003). Opioid use is more frequent and prolonged in chronic migraine patients. Further education for both doctors and migraine subjects and providing multimodal pain management strategies are needed to reduce opioid use in persons with migraine.

Efficacy of memantine compared with sodium valproate as prophylactic treatment for migraine: a controlled randomized pilot study

Aim: To compare the efficacy of memantine with that of valproate as a prophylactic treatment for episodic migraine within three months. The efficacy, safety, and response rate were evaluated. Methods: Prospective, randomized, double-blind, controlled clinical trial randomized participants were divided into two groups. The memantine group received memantine 10 mg twice daily, and the valproate group received valproate 500 mg twice daily. Results: Thirty-three patients participated in the study; 27 completed the treatment protocol, 14 in the memantine group, and 13 in the valproate group. The mean number of migraine attacks per month in the memantine group was 5.31 [standard deviation (SD) ± 1.54] initially and 0.93 (SD ± 1.49) at the end of treatment, noting a decrease of 4.21 (SD ± 1.76; P &lt; 0.001). In the valproate group, the mean number of migraine attacks per month was 5.35 (SD ± 1.11) initially and 0.77 (SD ± 1.16) at the end of treatment, with a difference of 4.5 (SD ± 1.39; P &lt; 0.001). All 27 patients had excellent response rates. Adverse effects were infrequent and mild in severity. Conclusions: A clinical trial compared the efficacy of memantine with that of valproate (first-line drug) as a prophylactic treatment. A significant reduction in attacks was noted in both drugs. Memantine could be a new preventive treatment option for migraine.

Prevalence of migraine in Iran: a systematic review and meta-analysis

BackgroundMigraine headaches affect all ages, from childhood to old age. Migraine attacks cause significant changes in the living conditions of the sick person, including a decrease in personal, social, and occupational performance. This study was conducted to determine the prevalence of migraine in Iran through a systematic review and meta-analysis.MethodIn this systematic review and meta-analysis study, the studies associated with the prevalence of migraine using the keywords: migraine, prevalence, and Iran its equivalents in international databases PubMed, Web of Science, Scopus, Science direct, and Iranian internal information databases, including SID and MagIran, was searched without limit until November 2022. Comprehensive Meta-Analysis software (Version 2) was used to analyze the data. Due to the high number of studies reviewed in this systematic review, the Begg and Mazumdar test was used at a significance level of 0.1, and the corresponding Funnel plot was used to check publication bias. Also, the I2 test was used to check the heterogeneity in this study.Results22 records were included in the final analysis. The prevalence of migraine in the general population of Iran was 15.1% (confidence interval 95%: 10.7–20.9), and in this population, the prevalence of migraine was higher in women than in men. The prevalence of migraine based on The International Classification of Headache Disorders (ICHD) 2 criteria was reportedly 16.4% (95% CI: 10.8–24.1), and with ICHD3 criteria, this value was reported as 17.1% (95% CI: 7.7–33.6). Based on a survey of 4571 children, the prevalence of migraine was reported to be 5.2% (95% CI: 1.3–18.7). Also, the prevalence of migraine in adolescents was calculated based on eight studies (n = 8820). Accordingly, 11.2% (95% CI: 5.8–20.4) of adolescents have migraines. Meanwhile, the prevalence of migraine in boys was 8.2% (95% CI: 4.8–13.7), and in girls was 8% (95% CI: 6.2–12.7).ConclusionAs a result, the prevalence of migraine in Iran, based on population-based studies, was reported as 15.1%. The result showed a higher prevalence of migraine in the general population than in children and adolescents. It was also found that the prevalence of migraine in women is higher than in men.

Patient Factors in the Dose Selection of Oral Sumatriptan for Acute Migraine: A Post Hoc Analysis of Two Randomized Controlled Studies.

Patients are seeking greater involvement in their healthcare. It therefore may be beneficial to provide guidance on initial oral sumatriptan dose selection for the treatment of acute migraine in nontraditional settings, such as telehealth and other remote forms of medical care. We sought to determine whether clinical or demographic factors are predictive of oral sumatriptan dose preference. This was a post hoc analysis of two clinical studies designed to determine preference for 25, 50, or 100mg oral sumatriptan. Patients were aged 18-65years with at least a 1year history of migraine and experienced, on average, between one and six severe or moderately severe migraine attacks per month, with or without aura. Predictive factors were demographic measures, medical history, and migraine characteristics. Possibly predictive factors were identified using three analyses: classification and regression tree analysis, marginal significance (P < 0.1) within a full-model logistic regression, and/or selection within a forward-selection procedure in a logistic regression. A reduced model containing the variables identified in the preliminary analyses was developed. Due to differences in study design, data were not combined. A dose preference was expressed by 167 patients in Study 1 and 222 patients in Study 2. Gender and medical history of urologic and/or psychological conditions in Study 1 and duration of migraine history, height, and medical history of endocrine or neurologic disease and headache severity in Study 2 were identified as possibly predictive. The predictive model showed low positive predictive value (PPV; 23.8%) and low sensitivity (21.7%) for Study 1. For Study 2, the model showed moderate PPV (60.0%) but low sensitivity (10.9%). No clinical or demographic characteristics alone or in combination were consistently or strongly associated with preference for oral sumatriptan dose level. The studies on which this paper is based were conducted before trial registration indexes were introduced.

Acetaldehyde via CGRP receptor and TRPA1 in Schwann cells mediates ethanol-evoked periorbital mechanical allodynia in mice: relevance for migraine

BackgroundIngestion of alcoholic beverages is a known trigger of migraine attacks. However, whether and how ethanol exerts its pro-migraine action remains poorly known. Ethanol stimulates the transient receptor potential vanilloid 1 (TRPV1) channel, and its dehydrogenized metabolite, acetaldehyde, is a known TRP ankyrin 1 (TRPA1) agonist.MethodsPeriorbital mechanical allodynia following systemic ethanol and acetaldehyde was investigated in mice after TRPA1 and TRPV1 pharmacological antagonism and global genetic deletion. Mice with selective silencing of the receptor activated modifying protein 1 (RAMP1), a component of the calcitonin gene-related peptide (CGRP) receptor, in Schwann cells or TRPA1 in dorsal root ganglion (DRG) neurons or Schwann cells, were used after systemic ethanol and acetaldehyde.ResultsWe show in mice that intragastric ethanol administration evokes a sustained periorbital mechanical allodynia that is attenuated by systemic or local alcohol dehydrogenase inhibition, and TRPA1, but not TRPV1, global deletion, thus indicating the implication of acetaldehyde. Systemic (intraperitoneal) acetaldehyde administration also evokes periorbital mechanical allodynia. Importantly, periorbital mechanical allodynia by both ethanol and acetaldehyde is abrogated by pretreatment with the CGRP receptor antagonist, olcegepant, and a selective silencing of RAMP1 in Schwann cells. Periorbital mechanical allodynia by ethanol and acetaldehyde is also attenuated by cyclic AMP, protein kinase A, and nitric oxide inhibition and pretreatment with an antioxidant. Moreover, selective genetic silencing of TRPA1 in Schwann cells or DRG neurons attenuated periorbital mechanical allodynia by ethanol or acetaldehyde.ConclusionsResults suggest that, in mice, periorbital mechanical allodynia, a response that mimics cutaneous allodynia reported during migraine attacks, is elicited by ethanol via the systemic production of acetaldehyde that, by releasing CGRP, engages the CGRP receptor in Schwann cells. The ensuing cascade of intracellular events results in a Schwann cell TRPA1-dependent oxidative stress generation that eventually targets neuronal TRPA1 to signal allodynia from the periorbital area.

Simultaneous Comparisons of 25 Acute Migraine Medications: A Big Data Analysis of 10 Million Patient Self-Reported Treatment Records From A Migraine Smartphone Application (S41.001)

Simultaneous Comparisons of 25 Acute Migraine Medications: A Big Data Analysis of 10 Million Patient Self-Reported Treatment Records From A Migraine Smartphone Application (S41.001)

Safety and Efficacy of Oral Calcitonin Gene-Related Peptide Receptor Antagonists for the Acute Treatment of Migraine in the Pediatric Population (P9-12.010)

<h3>Objective:</h3> To evaluate the safety and efficacy of gepants for the acute treatment of migraine in pediatric patients. <h3>Background:</h3> Calcitonin gene-related peptide (CGRP) has been found to be elevated during migraine attacks. Gepants are oral CGRP receptor antagonists, which have been shown to be effective for acute and preventive treat of migraine in adults. Generally, they are well tolerated with limited side effects. Currently, they are FDA approved in adults for migraine, however, there is limited data on their use in pediatrics. <h3>Design/Methods:</h3> Retrospective chart review of patients &lt; 18 years old who were prescribed a gepant (rimegepant or ubrogepant) for acute migraine treatment at a single institution from 1/1/2020 to 1/1/2023. Data was collected through chart review for all patients that used ≥ 1 dose of a gepant. Safety and tolerability were assessed through reported side effects, laboratory data and vital signs pre- and post-gepant use. The data was evaluated using descriptive statistics and compared using paired t-tests. <h3>Results:</h3> Thirteen patients were identified. Median (range) age was 16 years (13 to 17). There were 10 females and 3 males. Five (38%) had episodic migraine, 5 (38%) had chronic migraine and 3 (23%) had hemiplegic migraine. At baseline, median (range) headache days per month was 10 (0 to 30). Patients tried on median (range) 5 (1 to 8) acute medications before being prescribed a gepant. At the follow-up visit, 11 (85%) had reported any improvement or resolution of their migraine attack with use of a gepant. Zero patients reported side effects and there were no significant laboratory, height or weight changes seen after gepant use. <h3>Conclusions:</h3> The results indicate that gepants may be an effective acute treatment for migraine in pediatric patients. They appear to be safe and well-tolerated. However, larger prospective and randomized trials need to be conducted to confirm these results. <b>Disclosure:</b> Dr. Tourlas has stock in Axonics Modulation Technologies (AXNX). Dr. Tourlas has stock in Biote (BTMD). An immediate family member of Dr. Pavitt has received personal compensation for serving as an employee of Lundbeck.

Characterizing Prodrome (Premonitory Phase) in Migraine: Results From the PRODROME Trial Screening Period (S41.009)

Characterizing Prodrome (Premonitory Phase) in Migraine: Results From the PRODROME Trial Screening Period (S41.009)

Interim Analysis of Long-Term Safety and Tolerability Data of STS101 From the Phase 3 Open-Label ASCEND Study (P13-12.004)

Interim Analysis of Long-Term Safety and Tolerability Data of STS101 From the Phase 3 Open-Label ASCEND Study (P13-12.004)

Improvement in Patient-Reported Outcomes When Ubrogepant Is Administered During the Migraine Prodrome (Premonitory Phase): Results From the PRODROME Trial (P9-12.001)

Improvement in Patient-Reported Outcomes When Ubrogepant Is Administered During the Migraine Prodrome (Premonitory Phase): Results From the PRODROME Trial (P9-12.001)

Efficacy of Ubrogepant for the Treatment of Migraine Symptoms During the Prodrome (Premonitory Phase): Results From the PRODROME Trial (S47.002)

Efficacy of Ubrogepant for the Treatment of Migraine Symptoms During the Prodrome (Premonitory Phase): Results From the PRODROME Trial (S47.002)