Tag Archives: #headache

NEJM: Trial of A Monoclonal Antibody to PACAP for Migraine Prevention

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PainRelief.com Interview with:
Professor Messoud Ashina, MD, PhD, DMSc
Department of Neurology and Danish Headache Center
Glostrup Hospital
University of Copenhagen, Glostrup
Copenhagen, Denmark

PainRelief.com: What is the background for this study?

Background and Main Findings: Current migraine treatments targeting CGRP aren’t fully effective for everyone. PACAP is another key molecule implicated in migraine and can trigger migraine attacks. Lu AG09222, an antibody that blocks PACAP, has shown promise in reducing migraine days in a phase 2a trial.

Effects Duration: 4 weeks.

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Stanford Study Finds Migraine Patients Treated with OnabotA tend to Elect Extended Treatment

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PainRelief.com Interview with:
Leon S. Moskatel, MD
Clinical Assistant Professor
Division of Headache, Department of Neurology
Stanford University
Palo Alto, CA

PainRelief.com: What is the background for this study?

Response: OnabotulinumtoxinA (onabotA) is one of the most effective and well-tolerated treatments for chronic migraine, which the FDA approved for the prevention of chronic migraine in 2010.

OnabotA for chronic migraine is usually administered according to the PREEMPT protocol every 12 weeks for at least 3 treatments. Previous studies examining the long-term use of onabotA have been limited by either relatively short duration or small sample size. At the Stanford Headache Center, we were able to query our electronic medical records and create a prescription database to examine long-term persistence to onabotA over 11 years, between 2011-2021.

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UCLA Study Finds Distinctive Vascular Eye Changes During Migraines

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PainRelief.com Interview with:
Katherine Podraza MD, PhD
Headache medicine specialist at Hartford HealthCare Headache Center
Assistant Professor of Neurology
University of Connecticut School of Medicine

PainRelief.com: What is the background for this study?

Response: We know migraine is a complex and disabling neurovascular neurological disorder that has to do with the dysfunction of cortical networks in the brain. The eye given its direct connections to the brain through neuronal and vascular supply may also show changes related to migraine.

We studied changes in blood vessel structure and perfusion in the eye during migraine attacks using a non-invasive imaging technology called OCTA (Optical Coherence Tomography Angiography). As part of the study, patients with migraine (both with and without aura) were scanned both during an attack as well as between migraine attacks. In addition, we scanned healthy controls for comparison.

Our goal with the interictal scan (scans done when patients are not having an attack) was to find out if we can find imaging biomarkers for migraine. Our second goal was to use OCTA to find out if there are any changes in perfusion during a migraine attack. This could lead to a better understanding of the pathophysiology of migraine.

For the analysis, we specifically focused on two important regions in the retina, the fovea which processes our highest acuity vision and the parafovea which is the surrounding area and provides additional visual processing support. The fovea has the largest density of cone photoreceptors and also includes the foveal avascular zone which is devoid of blood vessels.

The parafovea surrounds the foveal region and is an area that has the thickest layer of retinal ganglion cells which transmit inputs from photoreceptors to various regions of the brain via the optic nerve. This region, given the complex interaction of neuronal cells and vascular inputs, was a perfect location to investigate migraine mechanisms.

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New Migraine Headaches Linked to Increased Motor Vehicle Crashes in Older Adults

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PainRelief.com Interview with:
Carolyn DiGuiseppi, MD, MPH, PhD
Professor of Epidemiology
Colorado School of Public Health
University of Colorado Denver
Aurora, CO 80045

PainRelief.com: What is the background for this study?

Response: Migraine headache is a leading cause of disability worldwide and affects many older adults in the US and globally.

Some of the symptoms of an acute migraine, like fatigue, impaired concentration, headache, or dizziness, could affect older adults’ ability to drive safely.  In fact, past research has suggested that people with migraine are at higher risk of having injuries resulting from motor vehicle crashes (compared to people without this diagnosis). We wanted to learn whether the risk of crashes depends on whether people have had a migraine diagnosis for some time or have been recently diagnosed, and whether being treated with migraine medications affects the risk of crashes.

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Some Headaches May Really Stem From Neck Muscles

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PainRelief.com Interview with:
Nico Sollmann, M.D., Ph.D.
Resident in the Department of Diagnostic and Interventional Radiology
University Hospital Ulm, and the
Department of Diagnostic and Interventional Neuroradiology
University Hospital Rechts der Isar in Munich, Germany

PainRelief.com: What is the background for this study?

Response: Neck pain is very common among patients with primary headache disorders, such as tension-type headache or migraine. However, neck pain is mostly neglected during diagnosis as well as for treatment concepts in patients with such headache disorders. 

Our study revealed alterations of the trapezius muscles in subjects with tension-type headache and subjects with tension-type headache plus migraine attacks by using quantitative magnetic resonance imaging. We suggest that those changes (i.e., increase of T2 values of the trapezius muscles) may be related to subtle edematous changes within the musculature, which might stem from inflammation. .

PainRelief.com: What are the main findings?

Response: Given that we also found significant associations between those muscular changes and the number of days a subject suffered from headache over the 30 days prior to imaging as well as neck pain, our study may provide objective evidence for the interrelationship between the neck area and the brain in headache disorders

PainRelief.com: What should readers take away from your report?

Response: Primary headache disorders may be linked to neck pain, and quantitative magnetic resonance imaging may help to visualize and objectify changes of neck musculature that might be related to subjectively perceived pain. Involvement of neck muscles in primary headache disorders may relate to subtle inflammatory alterations in muscle tissue.

PainRelief.com: What recommendations do you have for future research as a result of this study?

Response: The application of quantitative magnetic resonance imaging can objectively detect changes of the trapezius muscles in subjects suffering from headache disorders, thus providing a quantitative biomarker. Such a biomarker has not yet been available, and it could be used to phenotype patients, monitor the disease status, as well as treatment effects.

In a planned randomized controlled trial, we would like to combine quantitative magnetic resonance imaging (for diagnostics) with peripheral magnetic stimulation (for treatment) to provide a comprehensive framework combining a novel treatment approach with therapy monitoring. Such a trial could help to elucidate effects of peripheral magnetic stimulation by an objective method that is targeting the neck musculature in headache disorders, thus providing the possibility to potentially relieve muscular pain and headache.

No disclosures. The study has been published as an open-access article in the meantime for more detailed information. (https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-023-01626-w)

Citation:

  1. RSNA 2023 abstract: https://press.rsna.org/pressrelease/2023_resources/2475/abstract.pdf
  2. Sollmann N, Schandelmaier P, Weidlich D, Stelter J, Joseph GB, Börner C, Schramm S, Beer M, Zimmer C, Landgraf MN, Heinen F, Karampinos DC, Baum T, Bonfert MV. Headache frequency and neck pain are associated with trapezius muscle T2 in tension-type headache among young adults. J Headache Pain. 2023 Jul 12;24(1):84. doi: 10.1186/s10194-023-01626-w. PMID: 37438700; PMCID: PMC10337094.

https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-023-01626-w

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Headache: Clinical Trial Finds Oral Atogepant Reduced Monthly Migraine Days

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Dr. Trugman

PainRelief.com Interview with:

Joel M. Trugman, MD
Associate Vice President
Neuroscience Development
AbbVie

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Migraine is a disabling chronic disease characterized by recurrent headache attacks and associated symptoms, including nausea, phonophobia, or sensitivity to sound, and photophobia, or sensitivity to light.

The ADVANCE clinical trial is a phase 3, randomized, double-blind, placebo-controlled trial and examined the safety and efficacy of atogepant, an oral, small-molecule calcitonin gene-related peptide receptor antagonist in patients with episodic migraine. The primary efficacy endpoint was the change from baseline in mean monthly migraine days (MMD) across the 12-week treatment period. This analysis that was recently published examined the efficacy of atogepant using 4 levels of mean monthly migraine day (MMD) responder rates. 

This analysis found that all doses of atogepant significantly increased the proportion of participants who achieved a ≥25%, ≥50%, ≥75% and 100% reduction in mean monthly migraine days over 12 weeks of treatment.

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Study Reports on Adolescent Headaches During Covid Restrictions

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PainRelief.com Interview with:
Dr Ayşe Nur Özdag Acarli
Ermenek State Hospital, Karaman, Turkey

PainRelief.com:  What is the background for this study? 

Response: Headache is the most common neurological problem in children and adolescents. Various factors can contribute to headache such as school, sleep, physical activity, electronic devices, mental health problems and socioeconomic conditions.

For young people, the COVID-19 pandemic has had a striking change on every aspect of life such as school closure, online education from home, fewer academic pressures, more self care at home. Early studies, examined shorter-term effects of the pandemic, reported a reduction on the prevalence of headache and chronic pain in adolescents during COVID-19, which was attributed to less school-related stress. However, in my personal clinical experience, young patients suffered more frequent and severe headaches during the pandemic, especially after the first year of the pandemic. However, literature has been lacking in the long term effects of the pandemic on headache in adolescents.

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Large Study of Painful Cluster Headaches Has Revealing Findings

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PainRelief.com Interview with:
Mark J. Burish, MD, PhD.
Assistant Professor
Vivian L. Smith Department of Neurosurgery
Director, Will Erwin Headache Research Center
McGovern Medical School at UTHealth Houston

Dr. Mark Burish – Neurosurgery
Photo by Dwight C. Andrews/The University of Texas Medical School at Houston Office of Communications

PainRelief.com:  What is the background for this study?  Would you describe cluster headaches?

Response: Cluster headache is a disease associated with excruciating attacks of one-sided pain around the eye – patients regularly say it is more painful than childbirth, kidney stones, or gunshot wounds.  The attacks last between 15 minutes and 3 hours and can occur up to 8 times per day.  During an attack, patients will often have changes around the eye (such as a watery or bloodshot or droopy eye) changes in the nose (like congestion and a runny nose), and a restless feeling like they can’t sit still.  It is called “cluster” headache because, for most patient, the headaches occur every day for several weeks then go away for the rest of the year, only to come back the following year.  This is called “episodic” cluster headache, though there is another version called “chronic” cluster headache in which the headaches occur at least 9 months a year.

Cluster headache is found in about 1 in 1000 patients.  Because it is uncommon, there have not been a lot of large international studies investigating basic questions like the age that these headaches start and the differences from patient to patient.  There is a great need to understand more about this disorder at every level.  So two researchers from the University of West Georgia (Larry Schor and Stuart Pearson) performed a large epidemiology study on cluster headache because very few have been done.  They created an online questionnaire and advertised it internationally.  They ended up obtaining the largest study in terms of participants and the most international study ever performed (at least to our knowledge).  They then asked for help analyzing it from several physicians (including myself) and statisticians.  I felt very fortunate that they reached out to me and I really enjoyed working on this project because I think it gives us a lot of insights into cluster headache.

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Infused VYEPTI Provided Pain Relief When Initiated During a Migraine Attack

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PainRelief.com Interview with:
Roger Cady, MD
VP Neurology
Lundbeck Pharmaceutical
La Jolla Research Center
San Diego, CA 92121

PainRelief.com:  What is the background for this study? 

Response: The RELIEF study evaluated how preventive migraine candidates may benefit from a VYEPTI infusion during an active migraine attack when administered within 1 to 6 hours of a moderate to severe migraine attack. VYEPTI is the first and only intravenous (IV) infusion approved for the preventive treatment of migraine in adults.

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