Headache最新文献

{"title":"Patient satisfaction with calcitonin gene-related peptide monoclonal antibodies in migraine: A multicenter prospective cohort study.","authors":"Alba López-Bravo, Ane Mínguez-Olaondo, Candela Nieves-Castellanos, Marta Ruibal-Salgado, Noemí Morollón Sánchez-Mateos, María Pilar Navarro-Pérez, Alicia Alpuente, Marta Torres-Ferrús, Jésica García-Ull, Ana Gago-Veiga, David García-Azorín, Alicia González-Martínez, Álvaro Sierra, Sonia Santos-Lasaosa","doi":"10.1111/head.14913","DOIUrl":"10.1111/head.14913","url":null,"abstract":"<p><strong>Background: </strong>Calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) are the first migraine-specific prophylactic medication. Clinical data regarding patient treatment satisfaction (TS) with CGRP mAbs are limited.</p><p><strong>Methods: </strong>A multicenter prospective cohort study was conducted in patients with ≥8 headache days/month who started treatment with erenumab, galcanezumab, or fremanezumab. Monthly migraine days (MMD), monthly headache days (MHD), Migraine Disability Assessment (MIDAS), and the six-item Headache Impact Test (HIT-6) scores were collected. Patients' satisfaction with treatment (effectiveness, convenience, side effects, and global satisfaction) was assessed by the Treatment Satisfaction Questionnaire for Medication, version 1.4 (TSQM-1.4©).</p><p><strong>Results: </strong>A total of 400 patients were included. The median (interquartile range [IQR]) TS scores were high (≥70%) across all domains of the TSQM-1.4 after 3 and 6 months of CGRP mAb therapy: 72.2 (50.0-83.3) and 83.3 (61.1-88.9) for effectiveness, 83.3 (72.2-100) and 83.3 (77.8-100) for convenience, and finally, a score of 78.6 (50.0-92.9) and 85.7 (71.4-92.9) for global satisfaction. The median (IQR) reduction in MHD and MMD was 10.0 (3.0-17.0; p < 0.001) and 8.0 (4.0-12.0; p < 0.001) days after 3 months of treatment, and 10.0 (3.0-17.0; p < 0.001) and 9.0 (5.0-17.0; p < 0.001) days after 6 months. The median (IQR) HIT-6 score decreased from 68.0 (65.0-72.0) to 60.0 (51.0-66.0; p < 0.001) at Month 3 and to 56.0 (48.0-64.0; p < 0.001) at Month 6. Finally, the median (IQR) MIDAS score decreased from 70 (40.0-120.0) to 24 (7.8-60.0; p < 0.001) and 17 (5.0-45.0; p < 0.001) at Months 3 and 6, respectively. The median change from baseline in MMD was significantly associated with effectiveness at 3 (β = -0.93, 95% CI -1.34 to -0.53; p < 0.001) and 6 months (β = -1.56, 95% CI -2.15 to -0.97; p < 0.001). Similarly, reductions in MMD were significantly associated with the global satisfaction dimension of the questionnaire (β = -0.82, 95% CI -1.27 to -0.37; p < 0.001) and (β = -1.80, 95% CI -2.42 to -1.18; p < 0.001).</p><p><strong>Conclusions: </strong>Most patients were satisfied with CGRP mAbs' effectiveness, tolerability, and convenience in a real-world setting. Interestingly, increasing TS was associated with meaningful reductions in frequency, impact, and disability caused by migraine.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"994-1004"},"PeriodicalIF":5.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tolosa-Hunt syndrome in children and adolescents: A systematic review.","authors":"H Shafeeq Ahmed, Purva Reddy Jayaram, Sukriti Khar","doi":"10.1111/head.14890","DOIUrl":"10.1111/head.14890","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This systematic review aims to consolidate and analyze the existing evidence on Tolosa-Hunt syndrome (THS) in the pediatric population, focusing on clinical features, diagnostic challenges, treatment outcomes, and prognosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Tolosa-Hunt syndrome is a rare headache disorder caused by idiopathic inflammation of the cavernous sinus, orbital apex, or orbit, resulting in neuro-ophthalmological manifestations. It is uniquely characterized by cranial nerve palsies and often responds well to steroids.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A comprehensive literature search was conducted using three databases along with the gray literature. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the review protocol was registered on International Prospective Register of Systematic Reviews (PROSPERO identifier: CRD42024576802). The review included case reports and case series published in multiple languages that documented pediatric or adolescent cases of THS. We excluded any cases that were irrelevant, had insufficient details, were unsure of the diagnosis, or were later re-diagnosed with another condition. Data on clinical presentations, imaging findings, treatment modalities, and outcomes were extracted and analyzed using Microsoft Excel 2021.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The initial literature search provided 325 articles of which 55 articles discussing 61 unique pediatric patients were included. The median (interquartile range [IQR]) age was 11 (8-15) years, with a female predominance (70% [43/61]). Common symptoms included unilateral headache (48% [29/61]), retro-orbital pain (56% [34/61]), and cranial nerve palsies, predominantly involving the oculomotor nerve (66% [40/61]). The median (IQR) duration of symptoms was 14.5 (5-35) days. Imaging often revealed contrast enhancement on magnetic resonance imaging with cavernous sinus/orbital apex lesions. Steroid therapy was the mainstay of treatment, with 91% (52/57) of patients receiving corticosteroids. High-dose steroids ranged from 500-1000 mg/day, with some cases requiring combined therapy (typically intravenous methylprednisolone followed by oral prednisolone) and subsequent tapering. A few patients (5% [3/61]) experienced spontaneous improvement without steroids. Recurrence was noted in 33% (20/61) of patients, often necessitating prolonged or repeated corticosteroid therapy, and some cases required additional immunosuppressive therapies (infliximab/adalimumab) for management. The median (IQR) time to symptom resolution was 14 (4.5-38.5) days, while the median (IQR) duration of follow-up was 730 (195-1095) days.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Tolosa-Hunt syndrome in children presents significant diagnostic and management challenges due to the complexity of symptoms and the rarity of the condition. Accurate diagnosis and prompt steroid therapy are crucial after ruling out other causes, althou","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1027-1040"},"PeriodicalIF":5.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Migraine and spontaneous coronary artery dissection: A retrospective case-control study.","authors":"Juleen C Lewis, Yulia Orlova, Gretchen E Tietjen, Chia-Chun Chiang, Andrea M Harriott","doi":"10.1111/head.14935","DOIUrl":"10.1111/head.14935","url":null,"abstract":"<p><strong>Objective: </strong>The objective was to determine if migraine is independently associated with a greater odds of spontaneous coronary artery dissection (SCAD) in a case-control study.</p><p><strong>Background: </strong>There is growing evidence that migraine is associated with SCAD, a non-atherosclerotic, non-traumatic cause of myocardial infarction. However, few studies have examined the independent association between migraine and SCAD.</p><p><strong>Methods: </strong>A total of 1295 SCAD cases and 1291 (1:1) age, sex, and race/ethnicity matched controls presenting to the Boston, Massachusetts area, using the International Classification of Diseases ninth revision and 10th revision codes from our Research Patient Data Registry, were identified between the years 1990 and 2022. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. For mediation, total effects, natural direct, and indirect effects were estimated using causal inference. Receiver operating characteristic (ROC) curves and area under the curve (AUC) was used to determine predictive power. Statistical significance was defined as p < 0.05.</p><p><strong>Results: </strong>Adjusting for age, sex, and race/ethnicity, the data demonstrated an almost two-fold increased odds of SCAD in patients with migraine (aOR 1.96, 95% CI 1.48-2.6; p < 0.001). There was no effect of aura phenotype on this association. Fibromuscular dysplasia (FMD) was found only in patients with SCAD (n = 133). After accounting for vascular risk factors, there was no longer an independent association between migraine and SCAD (aOR 0.90, 95% CI 0.63-1.29; p = 0.568). Using a model that adjusted for only demographic variables produced a ROC curve with the lowest predictive power (AUC 0.55) for SCAD, while the vascular risk factor-adjusted model had a higher predictive power (AUC 0.83). Hypertension appeared to mediate some of the effect of migraine on SCAD (proportion of effect mediated 0.70). FMD was highly associated with an increased risk of SCAD. There remained no independent association between SCAD and migraine when FMD was included in the model.</p><p><strong>Conclusions: </strong>The migraine-SCAD association can be partially attributed to the connection between migraine and vascular comorbidities including hypertension and FMD.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"933-943"},"PeriodicalIF":5.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12167654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic migraine disorders and the response to calcitonin gene-related peptide antagonist treatment.","authors":"Andrea M Kuczynski, William S Kingston","doi":"10.1111/head.14942","DOIUrl":"10.1111/head.14942","url":null,"abstract":"<p><p>Calcitonin gene-related peptide (CGRP) is a potent cerebral vasodilator and part of the trigeminal migraine cascade. Newer migraine therapies target CGRP signaling for both acute and preventative management of headache. In this series, we present two cases of genetic conditions, of which migraine is a key feature, responsive to CGRP antagonist therapy. A 31-year-old female with mitochondrial encephalopathy with lactic acidosis and stroke-like episodes and a phenotype of chronic migraine with visual aura, and a 62-year-old female with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy with a phenotype of chronic migraine and side-locked headache with cranial autonomic symptoms. Each experienced a significant reduction in the frequency of their migraine attacks with monoclonal antibody treatment against CGRP. In this case series, we add to the growing body of evidence that CGRP-blocking medications are safe and effective in some heritable neurological disorders in which vasomodulation is a common underlying pathology. To our knowledge, we present the first cases of galcanezumab use in an individual with mitochondrial encephalopathy with lactic acidosis and stroke-like episodes and eptinezumab in an individual with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1041-1043"},"PeriodicalIF":5.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12129244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex differences in pain, suicidal ideation, and suicide attempts in patients with migraine.","authors":"Ai Seon Kuan, Yen-Feng Wang, Shih-Pin Chen, Yi-Fang Chuang, Shuu-Jiun Wang","doi":"10.1111/head.14906","DOIUrl":"10.1111/head.14906","url":null,"abstract":"<p><strong>Objective: </strong>To examine sex-specific associations between non-cephalic pain and suicidal ideation and suicide attempts in patients with migraine, controlling for depression and other risk factors for suicide.</p><p><strong>Background: </strong>In patients with migraine, co-occurring pain conditions are common and are associated with worse physical and psychosocial function, but the association with suicide has not been determined.</p><p><strong>Methods: </strong>In this cross-sectional analysis, we included 10,690 patients with migraine who were consecutively recruited from headache clinics. All participants provided information on sociodemographic status, headache, Widespread Pain Index (WPI), suicidal ideation, and suicide attempts. Relative risks (RRs and 95% confidence intervals [CIs]) for factors associated with suicidal ideation and suicide attempts were calculated.</p><p><strong>Results: </strong>In this migraine cohort, more females reported non-cephalic pain than males (78.7% [6511/8271] vs. 66.7%, [1613/2419]; p < 0.001). The prevalences of suicidal ideation and suicide attempts were higher in female patients than male patients in those aged 20-59 years (p < 0.001), and the differences diminished after the age of 60 years. In female patients, a WPI ≥4 was associated with increased suicidal ideation and suicide attempts, and dysmenorrhea was associated with suicidal ideation (RR 1.27, 95% CI 1.12-1.43), while lower back pain was associated with both suicidal ideation (RR1.35, 95% CI 1.18-1.55) and suicide attempts (RR 1.48, 95% CI 1.19-1.84). In male patients, a WPI ≥2 was associated with increased suicidal ideation, and no individual pain site was associated with suicidal ideation or suicide attempts. In both sexes, there was a dose-response association between the number of pain sites and suicidal ideation and suicide attempts; and pain that had lasted for 2 years and extreme pain intensity were associated with suicide attempts.</p><p><strong>Conclusion: </strong>Non-cephalic pain was associated with suicidal ideation and suicide attempts, with observed differences in pain threshold and individual pain sites found between sexes. Patients with migraine and co-occurring pain conditions, chronic pain, or extreme pain are distinct subgroups of patients at risk of suicide who require sex-specific and integrated risk assessment by multidisciplinary teams.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"983-993"},"PeriodicalIF":5.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143033081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to reconsider the association between migraine and white matter hyperintensities?","authors":"Anders Hougaard","doi":"10.1111/head.14940","DOIUrl":"10.1111/head.14940","url":null,"abstract":"","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"903-904"},"PeriodicalIF":5.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143983075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcutaneous electrical nerve stimulation of the occipital nerves as treatment for chronic cluster headache.","authors":"Ida Stisen Fogh-Andersen, Anja Sofie Petersen, Rigmor Højland Jensen, Jens Christian Hedemann Sørensen, Kaare Meier","doi":"10.1111/head.14889","DOIUrl":"10.1111/head.14889","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Chronic cluster headache (CCH) is an excruciatingly painful condition that can be difficult to treat sufficiently with the available medical treatment options. The greater occipital nerves (GON) are of major interest in treating CCH, and various invasive treatment modalities, such as stimulating or blocking the nerves, have been applied. Because the terminal segment of the GON has a superficial course, the nerve is also accessible for non-invasive transcutaneous stimulation. Transcutaneous electrical nerve stimulation (TENS) has been suggested as a treatment for different chronic headaches, but evidence of the efficacy in patients with CCH is scarce. Additionally, no consensus exists on the optimal placement of the transcutaneous stimulation electrodes or the treatment usage pattern.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this explorative open-label clinical study, 36 patients with CCH were treated with TENS of the GON for 8-12 consecutive weeks between August 2021 and October 2023 as a separate part of the study protocol for a trial on stimulation of the GON (Clinicaltrials.gov identifier: NCT05023460). After a baseline period, TENS was used primarily as a preventive treatment, stimulating for 30 min twice daily at a minimum. The primary outcome was a change in attack frequency and safety with TENS treatment. Secondary outcomes were change in attack duration and pain intensity on the numeric rating scale, abortive treatments, and the Patient Global Impression of Change (PGIC) with TENS treatment. The change in attack frequency, duration, pain intensity, and use of abortive treatment was analyzed by comparing the baseline data with 4-weekly data from TENS treatment. The study aimed to systematically investigate the effect of TENS of the GON as a preventive treatment for CCH.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Weekly attack frequency decreased from a median of 15.7 (95% confidence interval [CI] 11.2-22.1) at baseline to 11.0 (95% CI 7.4-16.4) with TENS. In all, 13 of the 36 (36%) patients had a minimum 30% reduction in attack frequency. In the group of 30% responders, the number of weekly attacks decreased from 15.8 (95% CI 9.8-24.5) at baseline to 5.8 (95% CI 3.3-10.5) attacks with TENS. Five patients became entirely or nearly attack-free. For the entire cohort, attack duration and pain intensity were also significantly reduced with TENS. The use of oxygen was reduced by 42%, and triptan injections decreased by 55%. Overall, 15 (42%) patients reported a clinically important improvement with TENS treatment, rated on the PGIC scale. The 100 Hz stimulation programs were preferred over 10 Hz. No serious adverse events were registered.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Transcutaneous electrical nerve stimulation of the GON significantly reduced the frequency, intensity, and duration of weekly headache attacks in patients with severe CCH. Not all patients benefitted from TENS, but the treatment responders had a substantial imp","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"973-982"},"PeriodicalIF":5.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to \"Facial variant of epicrania fugax secondary to a cerebellopontine angle meningioma\".","authors":"","doi":"10.1111/head.14938","DOIUrl":"10.1111/head.14938","url":null,"abstract":"","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1050"},"PeriodicalIF":5.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of an educational website on headaches in schoolchildren: A cluster-randomized controlled trial.","authors":"Henrike Goldstein, Lisa-Marie Rau, Clarissa Humberg, Verena Bachhausen, Lorin Stahlschmidt, Julia Wager","doi":"10.1111/head.14923","DOIUrl":"10.1111/head.14923","url":null,"abstract":"<p><strong>Objective: </strong>In this cluster-randomized controlled trial, we developed an educational website on tension-type headache and migraine for children and adolescents and evaluated its effectiveness in a school setting.</p><p><strong>Background: </strong>Primary headaches are a widespread issue in children and adolescents, often persisting into adulthood and associated with considerable disabilities, costs, and reduced quality of life. Effective management of primary headaches may prevent chronicity and its associated consequences.</p><p><strong>Design: </strong>Guided by a workbook, N = 814 fifth and sixth grade students explored the website during class. Data were collected before the headache education and at three further assessments, each 4 weeks apart, between November 2021 and April 2022. Participants were randomly assigned by class to either the intervention group, which received the website-based educational intervention after the first data collection, or a control group, which accessed the website after the last data collection.</p><p><strong>Results: </strong>The intervention significantly increased children's headache-related knowledge (time × group interaction: β = 0.35, 95% confidence interval [CI] = [0.30; 0.41], p ≤ 0.001) and resulted in fewer passive pain coping strategies (time × group interaction: β = -0.06, 95% CI = [-0.12; 0.00], p = 0.044). However, the intervention did not significantly reduce the number of days with headaches, use of headache medication, or school absences due to headaches.</p><p><strong>Conclusion: </strong>While the website is an effective educational tool for imparting knowledge about headaches, even initiating small behavioral changes, it does not lead to substantial changes in behavior or headache characteristics. Educating children via this website may lay a solid foundation of knowledge, but the intervention should be expanded and supplemented with closer supervision to achieve more significant behavior changes and improved outcomes.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"961-972"},"PeriodicalIF":5.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12129248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of erenumab versus other migraine preventive medications on cardiovascular and cerebrovascular outcomes: A United States claims database-based observational cohort study.","authors":"David W Dodick, Stewart J Tepper, Jessica Ailani, Ani C Khodavirdi, Nico Pannacciulli, Alan Fu, Shia T Kent, Karminder Gill, Robert Urman, Sam S Oh","doi":"10.1111/head.14912","DOIUrl":"10.1111/head.14912","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the real-world risk of cardiovascular events among patients with migraine treated with erenumab and other migraine preventive medications.</p><p><strong>Background: </strong>Migraine preventive treatment with calcitonin gene-related peptide (CGRP) pathway inhibitors, such as erenumab and others, may theoretically result in cardiovascular effects due to a lack of compensatory vasodilation with CGRP pathway inhibition.</p><p><strong>Methods: </strong>In this retrospective observational cohort study, we estimated the unadjusted cumulative risk (CR) of new-onset hypertension, acute myocardial infarction (MI), or stroke among patients with migraine newly treated with erenumab, other anti-CGRP pathway monoclonal antibodies (mAbs), standard oral preventive medications, and onabotulinumtoxinA using data from the MarketScan® Commercial and Medicare Supplemental medical claims database. Comparative analyses to assess the relative risk (RR) of vascular events were gated on the comparability of treatment groups with respect to baseline demographics and clinical characteristics. Potential bias due to unmeasured confounding was evaluated via negative control outcome (NCO) analyses. Confounding based on measured covariates and differential informative censoring were addressed with inverse probability weights.</p><p><strong>Results: </strong>A total of 108,019 new users of migraine preventive medications were included. Unadjusted CR (95% confidence interval [CI]) of hypertension at 12 months of treatment was: erenumab, 9.34% (8.79-9.89%); other anti-CGRP pathway mAbs, 9.42% (8.92-9.92%); standard oral preventive medications, 9.09% (8.77-9.41%); and onabotulinumtoxinA, 9.10% (8.39-9.81%). NCO analyses identified minimal concerns related to unmeasured confounding in erenumab versus other mAbs and erenumab versus onabotulinumtoxinA comparisons. Adjusted RRs (95% CIs) of acute MI and stroke, respectively, at 36 months of treatment were 1.02 (0.45-1.59) and 0.90 (0.56-1.25) for erenumab versus other mAbs and 0.87 (0.19-1.55) and 0.97 (0.42-1.52) for erenumab versus onabotulinumtoxinA.</p><p><strong>Conclusions: </strong>In this analysis of the MarketScan medical claims database, we found no difference in the risk of vascular events in patients treated with erenumab versus other anti-CGRP pathway mAbs or onabotulinumtoxinA.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"919-932"},"PeriodicalIF":5.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12129247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}