With the 2016 theme Take a Closer Look. . .at Migraine, the American Headache Society was proud to host 850 attendees from around the world in such a lovely setting. Over four days and nights, the top experts in the field lead a series of lectures, seminars, symposia, and workshops designed to bring their colleagues up to speed on the latest developments in headache medicine.
It was taught by experts and aimed at professionals currently working in headache medicine, but patients can always find a few topics of interest on the agenda. With so much going in migraine research and treatment, this year is no exception. We’ve summarized some of the most fascinating science below.
A Headache for the Whole Family
It’s well known that chronic migraine (more than 15 days with migraine every month) can cause patients to miss work, school, and family events.1 But what about when the patient is also a parent — are children living at home affected? According to a new study,2 patients may not be the only ones feeling the burden of migraine.
Researchers compared the impact of chronic migraine with occasional migraine in more than 1400 pairs of parents with children between 13 and 21 years of age.2 Like their parents, the children of chronic migraine patients were more likely to miss school, family, and social events. But being absent more often wasn’t the only problem.
Compared with the children of patients with occasional headache, they were also2:
- More likely to have trouble focusing on schoolwork
- Less likely to receive help with schoolwork
- More likely to have symptoms of anxiety
More studies are needed to fully understand the findings,2 but it seems clear that migraine can affect the whole family. These initial results provide additional evidence for the urgent need to accurately diagnose and treat patients with migraine.
- Lipton RB, Bigal ME, Diamond M, et al. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology. 2007;68:343–349.
- Buse DC, Powers SW, Gelfand A, et al. Perspectives of adolescents on the burden of their parent’s migraine: results from the chronic migraine epidemiology and outcomes study. Headache. 2016. In press.
New App Challenges Current Thinking About Triggers
Technology is proving to be a useful tool in migraine. At last year’s meeting, researchers showed that telemedicine can save patients a lot of time and money on migraine care.1 They also demonstrated that, compared with a local doctor, a visit with a “virtual” specialist triples the chances of receiving expert-recommended treatments.2 Technology has also been used to help identify triggers and warn patients when attacks are about to occur.
This year, the techies are back with an app that may be able to help patients figure out how to reduce their chances of having an attack.3 Curelator Headache™, a new app that collects data about mood, stress, diet, and activity, surprised researchers by showing that some very well known triggers (i.e., alcohol, stress, travel, bright lights, odors) may actually “protect” against an attack. For example, someone with neck pain while traveling might get a massage or apply a heating pad. In such cases, rather than travel acting as a trigger, it leads to actions that offset the attack.
The research team, which believes that knowing which factors protect against attacks is just as useful as knowing which factors are likely to trigger attacks, sees great potential for empowering patients in the new iOS-only app.3 They acknowledge, however, that real improvements will depend on self-awareness: patients thinking about how their behavior can affect their condition. Ultimately, patients will have to try it and decide for themselves.
- Friedman DI, Rajan B, Seidmann A, Hawkins J. Telemedicine for migraine management: interim study results. Headache. 2015. In press.
- Markwell S, Smith TR, Nicholson RA, Dummitt BW, Yount BW, Stoneman JL. TeleMedicine improves migraine care quality: results of a pilot TeleHeadache program. Headache. 2015. In press.
- Donoghue S, Mian A, Albert M, Boucher G, Peris F. Identification of “protectors” — factors associated with reduced risk of migraine attacks: some surprising observations and interpretations. Headache. 2016. In press.
Smartphone Diary: Up to 40% of Migraine Attacks Go Untreated
One of the challenges of medical research is ensuring that information gathered from patients is accurate. Asking questions of patients, whether oral or written, is subject to their memory and bias. Another app, this one a diary for smartphones, may help solve the problem.
To improve the odds of getting a true picture of medication use, a new study in women with migraine and obesity used a smartphone diary that allowed participants to record which drug(s) they took in almost real-time.1 Perhaps the most surprising finding was that patients only treated about 60% of their attacks.
When they did use medication, about 80% used drugs like Advil® and Aleve®, 25% used Excedrin®, and only 28% used a triptan, which is a migraine-specific medication. . Many patients took more than one medication at a time, with the most common combination being a triptan with an Advil- or Aleve-type drug.
The smartphone diary, which uses cutting-edge technology to track patients in real-time, suggests that there is room for major improvement in the way women with obesity manage migraine. In future studies, researchers may use the diary app to help them to explain why.
- Pavlovic JM, Lipton RB, Thomas JG, et al. Smartphone-based ecological momentary assessment of acute headache medication use patterns in women with migraine and obesity. Headache. 2016. In press.
A Single Medication for Migraine Prevention and Treatment?
For many migraine patients, having a safe, effective acute medication that treats their attacks when they occur is all they need. For others, such as those with very severe or frequent attacks, a second medication may be taken every day to help prevent attacks – a preventive medication. Because the goals of acute and preventive migraine treatment are so different, no single drug has ever been able to do both jobs.
Now a new type of drug that may help to prevent attacks1 is showing promise in treating those that are already underway. (For the scientifically inclined, the drug — a calcitonin gene-related peptide (CGRP) antagonist — works on a chain of amino acids that dilates blood vessels and transmits pain signals.)
Here are the new findings being presented:
- In one study, migraine patients were given a monthly CGRP injection, and it reduced the number of migraine attacks within the first month2
- A second study focused on treating a single attack, and the CGRP drug was effective at eliminating pain at two hours after treatment3
- A third study, which measured “wellness” (i.e., ability to work/study normally, no difficulty concentrating, etc.) on days when patients were headache-free, found that the CGRP drug appeared to be effective — a first for a preventive drug4
In all three studies, side effects were minimal.2-4
Currently, there are many acute and preventive medications for treating migraine.5 The possibility of being able to replace them all with a single medication would simplify migraine treatment and, possibly, improve results for many patients. Experts in headache medicine are optimistic about CGRP drugs, and efforts to confirm these exciting results are already underway.
- Dodick DW, Goadsby PJ, Spierings EL, Scherer JC, Sweeney SP, Grayzel DS. Safety and efficacy of LY2951742, a monoclonal antibody to calcitonin gene-related peptide, for the prevention of migraine: a phase 2, randomised, double-blind, placebo-controlled study. Lancet Neurol. 2014;13:885–892.
- Oakes T, Zhang Q, Ferguson M, et al. Efficacy and safety of LY2951742 in a randomized, double-blind, placebo-controlled, dose-ranging study in patients with migraine. Headache. 2016. In press.
- Lipton RB, Voss T, Dodick DW, et al. A phase 2b randomized, double-blind, placebo-controlled trial of ubrogepant for acute treatment of a migraine attack. Headache. 2016. In press.
- VanderPluym J, Bigal M, Dodick DW. Effect of monoclonal calcitonin gene-related peptide antibody (TEV-48125) on wellness during headache-free days. Headache. 2016. In press.
- Silberstein SD, Holland S, Freitag F, Dodick DW, Argoff C, Ashman E. Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012;78:1337–1345.
Is Migraine Different for Men?
Migraine is the most common neurologic disorder in both men and women. But because it’s so much more common in women than in men, it’s often thought of as a women’s disease, even by headache specialists. That led a group of researchers to wonder if the belief affects how men with migraine are diagnosed and treated.
In a study involving nearly 17,000 migraine patients, researchers found that compared with women, men:
- Had fewer headache days per month
- Were less likely to:
- Be disabled by attacks
- Visit a medical professional
- Receive a migraine diagnosis
- Be prescribed medication
- Use medication to treat attacks
- Be extra-sensitive to touch, movement, and hot/cold temperatures
Clearly, there were marked differences in migraine based on gender, but do perceptions of those differences influence the quality of migraine care? These researchers suggest that by viewing migraine as a women’s disease, medical professionals may regularly and unwittingly limit men’s access to medical care.
- Scher AI, Wang S, Katsarava Z, et al. Epidemiology of migraine in men: results from the Chronic Migraine Epidemiology and Outcomes (CaMEO) study. Headache. 2016. In press.
Traumatic brain injury: the first five years
After a traumatic brain injury (TBI), many patients face daunting physical and mental problems. Even so, headache is the most frequently reported symptom. To try to understand the long-term impact of headache in TBI patients, researchers tracked a group of TBI patients for five years.1
This group of TBI patients were most likely to have migraine or probable migraine phenotype which is consistent with recent literature.1 Almost 40% had headache at the time of the injury and at three months afterwards. And after five years, 35% still had headaches. More than a third also reported experiencing several headaches per week five years after the TBI.1
Headache is often a persistent problem for TBI patients. As a result of this study, the need for long-term monitoring and treatment of headache conditions in individuals who have suffered a TBI is clear.
- Lucas S, Stacey A, Temkin N, Dikmen S, Bell KR, Hoffman J. Posttraumatic headache five years after traumatic brain injury. Headache. 2016. In press.