Safety of Triptans in Treating Migraines in Pregnant Women: A Target Trial Emulation.

Objective: To evaluate the safety of triptans in pregnant women with migraine.

Patients And Methods: We emulated a randomized clinical trial that hypothetically assigned patients to triptans or no triptan treatments. Data were retrieved from a multistate US-based health system from 2000 to 2022 on pregnant women with a diagnosis of migraine.

AAN Position: Opioids.

This position statement serves to establish the American Academy of Neurology (AAN)'s stance on neurology care team's needs for safe prescribing of opioids and research for nonopioid pain alternatives so that the AAN can continue to advocate effectively for its members. While considerable improvements have been made in prescribing practices to address patient pain, opioids remain the most misused prescription medication in the United States. Neurology care teams often care for patients with chronic, complex conditions that include pain disorders such as migraine, peripheral neuropathy, traumatic brain injury, multiple sclerosis, and low back pain and are the 14th most frequent group to prescribe opioids.

Benefit-risk assessment based on number needed to treat and number needed to harm: Atogepant vs. calcitonin gene-related peptide monoclonal antibodies.

Background: To evaluate the benefit-risk assessment of atogepant and calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) vs. placebo based on the number needed to treat (NNT) and the number needed to harm (NNH) in a blended episodic migraine and chronic migraine (EM + CM) population.

Methods: The NNT was calculated based on achievement of a ≥ 50% reduction in mean monthly migraine days (MMDs) from baseline across 12 weeks.

Safety of Triptans in Patients Who Have or Are at High Risk for Cardiovascular Disease: A Target Trial Emulation.

Objective: To evaluate the safety of triptans in migraine patients with cardiovascular disease or elevated cardiovascular risk.

Patients And Methods: We retrieved data from a multistate US-based health system (January 2000 to August 2022) on adults with migraine and confirmed cardiovascular/cerebrovascular disease, or at least two cardiovascular risk factors. We compared the effect of triptans to nontriptan treatments on major adverse cardiovascular events (MACE) and its components at 60 days of starting treatments.

Diversity, Equity, and Inclusion in Headache Care and Research.

This article reviews the disparities faced by individuals who experience headache disorders and discusses potential solutions to deliver equitable care. Disparities exist in the diagnosis and treatment of headache disorders with regard to race, ethnicity, sex, gender, sexual orientation, geography, and socioeconomic status. Furthermore, research in the realm of headache disparities is inadequate, and the clinical trial representation of patients from underserved communities is poor.

Comparative efficacy, quality of life, safety, and tolerability of atogepant and rimegepant in migraine prevention: A matching-adjusted indirect comparison analysis.

Background: Comparative evaluations of preventive migraine treatments can help inform clinical decision making for managing migraine in clinical practice.

Methods: An anchored matching-adjusted indirect comparison analysis was conducted using pooled participant-level data from two phase 3 atogepant trials (ADVANCE and PROGRESS) and one phase 2/3 rimegepant trial (BHV3000-305) to evaluate the relative efficacy and safety/tolerability of atogepant and rimegepant as preventive migraine treatments. Participants receiving atogepant 60 mg once daily, rimegepant orally disintegrating tablet 75 mg once every other day, and placebo were included.

Harassment in the headache field: a global web-based cross-sectional survey.

Background: Matters of workplace harassment are an important issue. This issue needs to be recognized and studied to prevent occurrences. These important sensitive areas of effective workplace management are increasingly gaining more interest.

Temporal analysis of remote electric neuromodulation for the prevention of migraine.

To evaluate the onset, magnitude and persistence of efficacy of remote electrical neuromodulation (REN) compared with placebo for the preventive treatment of migraine. Analysis was conducted on data from a prospective, double-blind, placebo-controlled clinical trial, which assessed the efficacy of REN for the prevention of migraine. The number of monthly migraine days (MMD) per group was calculated in 2-week intervals and compared between the groups.

A qualitative evidence synthesis of patient perspectives on migraine treatment features and outcomes.

Objectives: We aimed to identify migraine treatment features preferred by patients and treatment outcomes most valued by patients.

Background: The values and preferences of people living with migraine are critical for both the choice of acute therapy and management approach of migraine.

Methods: We conducted a qualitative evidence synthesis.

Acute Treatment of Headache (Focus on Migraine).

Acute treatments for migraine and cluster headache are necessary to abort attacks, relieve pain and associated symptoms, and restore an individual's ability to function. Acute headache treatments consist of a variety of medication and nonmedication options. In this article, we discuss the approach to acute treatment of migraine and cluster headache.

Post hoc analysis of clinical trial data and pharmacokinetic data to assess wearing-off of erenumab within monthly treatment cycle.

Background: Treatment wearing-off has been reported for calcitonin gene-related peptide-pathway monoclonal antibodies, including erenumab, specifically in the last week of the monthly dosing cycle.

Objective: We sought to determine the consistency of erenumab effect throughout the monthly treatment cycle.

Methods: In this post hoc analysis of four pivotal double-blind, randomized controlled studies of erenumab in episodic and chronic migraine, we assessed wearing-off based on change in weekly migraine days at week 4 versus average over weeks 1-3 in each monthly dosing cycle.

Post-COVID Headache: A Literature Review.

Purpose Of Review: Post-COVID headache may be unique in presentation and mechanism, often presenting as a new phenotype in patients with a history of a primary headache disorder or resulting in a new headache syndrome in those without history of headache. This review presents a description of the literature published focused on post-COVID headache. Additionally, we discuss potential mechanisms and considerations for treatment of post-COVID headache.

Perceived barriers to career progression in the headache field: A global web-based cross-sectional survey.

Background: It is well recognized that underrepresented and minoritized groups do not have the same career opportunities. However, there are limited data on the range and specifics of potential barriers that withhold people in headache medicine and science from reaching their full potential. Moreover, people from different geographical regions often perceive different challenges.

Functionality, satisfaction, and global impression of change with ubrogepant for the acute treatment of migraine in triptan insufficient responders: a post hoc analysis of the ACHIEVE I and ACHIEVE II randomized trials.

Background: Triptans are the first-line option for the acute treatment of migraine attacks; however, triptans are contraindicated in people with certain underlying cardiovascular risk factors and are associated with inadequate efficacy or poor tolerability in some individuals. Ubrogepant is an oral calcitonin gene-related peptide receptor antagonist approved for the acute treatment of migraine.

Methods: This post hoc analysis of the phase 3 ACHIEVE trials examined the impact of ubrogepant on the Functional Disability Scale (FDS), satisfaction with medication, and Patient Global Impression of Change (PGIC) in participants who were self-reported triptan insufficient responders (TIRs), defined as those who are unable to take triptans due to contraindications, tolerability issues, or insufficient efficacy.

Narrative review of neuroimaging in migraine with aura.

Objective: To improve the understanding of the role and utility of various neuroimaging modalities (clinical and research) for the evaluation of migraine aura (MA) and hemiplegic migraine during the ictal and interictal phases.

Background: MA is defined by reversible neurologic symptoms and is considered a manifestation of a primary condition. As such, most patients with MA do not require imaging.