Featured
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Review Article |
Insights from 25 years of onabotulinumtoxinA in migraine — mechanisms and management
OnabotulinumtoxinA was first linked to beneficial effects in migraine 25 years ago and has since become a widely used treatment for chronic migraine. In this Review, Pozo-Rosich and colleagues consider the impact that onabotulinumtoxinA has had on the management of chronic migraine and on the research field.
- Patricia Pozo-Rosich
- , Alicia Alpuente
- & Rami Burstein
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Review Article |
The 5-HT1F receptor as the target of ditans in migraine — from bench to bedside
Ditans are a recently developed drug class for the treatment of acute migraine. In this Review, the authors provide an overview of ditan development, from the initial rationale to the clinical studies that led to the recent FDA approval of the first ditan.
- Dimos D. Mitsikostas
- , Christian Waeber
- & Michael A. Moskowitz
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News & Views |
Zavegepant for the acute treatment of migraine: look before leaping
Results from a phase III trial have set zavegepant as the first intranasal gepant to be approved by the FDA for the acute treatment of migraine. The therapeutic benefits were modest, however, and more work is needed to address unmet treatment needs.
- Håkan Ashina
- & Peer Tfelt-Hansen
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Review Article |
Global epidemiology of migraine and its implications for public health and health policy
Here, Timothy Steiner and Lars Stovner discuss the progression of migraine epidemiology over the last seven decades and question the apparent increase in migraine prevalence over time.
- Timothy J. Steiner
- & Lars Jacob Stovner
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News & Views |
Identifying molecular targets in trigeminal nociception
A new paper published in Neuron presents an analysis of mRNA expression in human and mouse trigeminal ganglia at single-nucleus resolution. The resulting resource is thought-provoking and suggests new targets for pain therapies; however, the findings should be interpreted in the context of the available protein data and warrant functional verification.
- Lars Edvinsson
- , Jacob C. A. Edvinsson
- & Kristian A. Haanes
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Review Article |
Hormonal influences in migraine — interactions of oestrogen, oxytocin and CGRP
Reproductive hormones influence migraine in women but the basis of these effects is unknown. In this Review, the authors discuss what is known about sex hormones and their receptors in migraine-related areas of the CNS and the trigeminovascular pathway and propose a simple model to explain how hormones influence menstrual migraine.
- Diana N. Krause
- , Karin Warfvinge
- & Lars Edvinsson
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Review Article |
Headache in people with epilepsy
Headaches and epilepsy frequently co-exist in the same individual, but the pathophysiological mechanisms underlying this relationship are not yet clear. Here, the authors discuss the epidemiological and pathophysiological links between epilepsy and headache, and apply this knowledge to the clinical management of the two disorders.
- Prisca R. Bauer
- , Else A. Tolner
- & Josemir W. Sander
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Consensus Statement
| Open AccessDiagnosis and management of migraine in ten steps
In this Consensus Statement, which is endorsed by the European Headache Federation and the European Academy of Neurology, an expert panel provides recommendations for the diagnosis and management of migraine to support clinical decision-making by general practitioners, neurologists and headache specialists.
- Anna K. Eigenbrodt
- , Håkan Ashina
- & Messoud Ashina
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News & Views |
Potassium channel openers — novel triggers of aura and migraine
Results of two recent studies by Messoud Ashina and colleagues demonstrate that infusion of two different potassium channel openers can trigger migraine in humans; one of the compounds also triggered aura in patients diagnosed with migraine with aura. The findings highlight the importance of human experimental models in migraine research.
- Alan M. Rapoport
- & Richard B. Lipton
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Perspective |
The childhood migraine syndrome
Several childhood disorders, including infantile colic and cyclical vomiting syndrome, are thought to be related to migraine. In this Perspective, Gelfand and Abu-Arafeh present evidence for each of these disorders to be considered as part of a ‘childhood migraine syndrome’.
- Ishaq Abu-Arafeh
- & Amy A. Gelfand
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Research Highlight |
Crosstalk between prolactin and CGRP signalling contributes to migraine in females
- Sarah Lemprière
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News & Views |
Lessons from lockdown — behavioural interventions in migraine
A recent study reports an improvement in migraine symptoms during a COVID-19 lockdown in the Netherlands. The findings suggest that lifestyle changes can substantially alter the course of migraine, opening the door for greater use of behavioural interventions alongside existing pharmacological therapies.
- Licia Grazzi
- & Paul Rizzoli
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News & Views |
Making headway — a role for CGRP in post-traumatic headache
Although common, post-traumatic headache remains poorly understood and poorly treated. New data have implicated calcitonin gene-related peptide and the trigeminovascular system in this disorder, opening up new avenues for research into its pathophysiology and treatment.
- Dimos D. Mitsikostas
- & Michael A. Moskowitz
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News & Views |
Disentangling placebo effects in the treatment of migraine
A new meta-analysis of placebo-controlled trials of calcitonin gene-related peptide (CGRP) antibodies for migraine has shown that the direct biological effects of these treatments beyond the effects of placebo are modest, raising questions about how the ‘true value’ of these and other drugs are assessed.
- Elizabeth W. Loder
- & Brian McGeeney
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News & Views |
CGRP-targeted antibodies in difficult-to-treat migraine
A new study shows that the monoclonal antibody fremanezumab is effective for migraine prophylaxis, even in patients who have failed to respond to multiple preventive treatments. However, not all patients benefit from this treatment, and detailed investigation of non-responders could help to identify additional pharmacological targets and increase the number of responders.
- Tessa de Vries
- & Antoinette MaassenVanDenBrink
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Review Article |
The metabolic face of migraine — from pathophysiology to treatment
In this Review, the authors describe the evidence for abnormalities in energy metabolism and mitochondrial function in migraine, consider the potential mechanisms and highlight treatments that affect metabolism. They conclude that migraine is a conserved adaptive response that helps to restore brain energy homeostasis.
- Elena C. Gross
- , Marco Lisicki
- & Jean Schoenen
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News & Views |
Calcitonin gene-related peptide — beyond migraine prophylaxis
The benefits of targeting calcitonin gene-related peptide (CGRP) could go beyond migraine prevention, and three new studies report success with a new small-molecule CGRP receptor antagonist in acute migraine and with a monoclonal antibody in cluster headache.
- Jes Olesen
- & Messoud Ashina
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Comment |
Neuroinflammation — a common thread in neurological disorders
Inflammatory processes contribute to neurological disorders, and many therapeutic breakthroughs in neurological disease have been immune-targeted. The choice of neuroinflammation as the theme for the 5th European Academy of Neurology Congress in 2019 and of this Focus issue highlights its importance to neurologists across the discipline.
- Nils Erik Gilhus
- & Günther Deuschl
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Perspective |
Does inflammation have a role in migraine?
Migraine is one of the world’s most prevalent diseases, and approximately 2% of the general population experiences chronic migraine. Edvinsson and colleagues argue that inflammation could have an important role in migraine chronification, through a mechanism termed neurogenic neuroinflammation.
- Lars Edvinsson
- , Kristian Agmund Haanes
- & Karin Warfvinge
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In Brief |
Complete withdrawal more feasible and effective than restriction in medication-overuse headache
- Rebecca Kelsey
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In Brief |
Iron deposition in periaqueductal grey matter as a biomarker of chronic migraine
- Rebecca Kelsey
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News & Views |
CGRP antibodies for migraine prevention — new kids on the block
In the past few years, a number of new migraine treatments have emerged, including monoclonal antibodies against calcitonin gene-related peptide (CGRP) and the CGRP receptor. Now, a position statement from the American Headache Society offers guidance on the integration of these agents into clinical practice in the prevention of migraine.
- Hans-Christoph Diener
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Year in Review |
Getting closer to a cure for migraine
In the past few years the scientific community has witnessed a prodigious surge in research activity, publication of data and progress in understanding the mechanistic components of migraine. This renaissance is the result of efforts initiated decades ago that are finally being translated into benefits for individuals affected by this disease.
- Cristina Tassorelli
- & Roberto De Icco
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News & Views |
Sleep apnoea and poor sleep quality in patients with chronic migraine
Chronic migraine is a debilitating condition that arises from the worsening of episodic migraine. A large population-based questionnaire study showed that individuals with chronic migraine reported more sleep apnoea and worse sleep quality than individuals with episodic migraine. This finding provides important insights into the association between sleep disturbances and chronic migraine.
- Min Kyung Chu
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Review Article |
Biological insights from the premonitory symptoms of migraine
Premonitory symptoms of migraine can start hours to days before the onset of headache. In this Review, Karsan and Goadsby discuss the phenotypes of these premonitory symptoms and the insights that they provide into the neurobiology of migraine.
- Nazia Karsan
- & Peter J. Goadsby
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Research Highlight |
Erenumab succeeds in alleviating migraine where other treatments fail
- Charlotte Ridler
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Review Article |
Paediatric migraine: evidence-based management and future directions
Migraine is prevalent in the paediatric population and represents a major cause of disability. This Review outlines the epidemiology and natural history of paediatric migraine, discusses the recent landmark clinical trials of treatments for paediatric migraine and examines the best evidence-based interventions for this population in light of these new findings.
- Serena L. Orr
- , Marielle A. Kabbouche
- & Andrew D. Hershey
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Review Article |
CGRP as the target of new migraine therapies — successful translation from bench to clinic
Treatments that target calcitonin gene-related peptide (CGRP) and its receptor are proving effective for migraine treatment. In this Review, Edvinsson et al. trace the translation of CGRP biology into successful therapies and consider exactly where these drugs act.
- Lars Edvinsson
- , Kristian Agmund Haanes
- & Diana N. Krause
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Review Article |
Migrainomics — identifying brain and genetic markers of migraine
The causes of migraine remain unknown despite the high prevalence and societal burden of this disorder. Here, the authors highlight how advances in imaging and genetic studies of migraine provide insights into the underlying mechanisms of this disorder; furthermore, they discuss the potential for genetic and imaging biomarkers to improve our ability to prevent and treat migraine attacks.
- Dale R. Nyholt
- , David Borsook
- & Lyn R. Griffiths
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Review Article |
Human models of migraine — short-term pain for long-term gain
In the ongoing search for new and better migraine treatments, human models have a key role in the discovery of novel targets for antimigraine drugs. This Review summarizes existing experimental models of migraine in humans, and describes the development and use of these models in the identification of key molecular pathways, biomarkers and drug targets.
- Messoud Ashina
- , Jakob Møller Hansen
- & Jes Olesen
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News & Views |
CeAD and migraine — an association built on shifting sands
A growing body of evidence indicates that people with migraine have an increased risk of cervical artery dissection (CeAD). A new study in young patients with ischaemic stroke has identified a specific link between CeAD and migraine without aura.
- Caspar Grond-Ginsbach
- & Manja Kloss
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In Brief |
Migraine is associated with increased risk of perioperative ischaemic stroke
- Heather Wood
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Review Article |
New strategies for the treatment and prevention of primary headache disorders
The primary headache disorders are among the most common diseases worldwide. Nathaniel Schuster and Alan Rapoport discuss new and emerging preventive and acute treatments that have the potential to address unmet needs of patients with headache disorders, and to help treat and reduce headache-associated disability.
- Nathaniel M. Schuster
- & Alan M. Rapoport
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Review Article |
Medication-overuse headache: risk factors, pathophysiology and management
Medication-overuse headache (MOH) is a common disorder, but it remains under-recognized, and although several risk factors have been identified, the pathophysiology of the disorder is not completely understood. Here, Hans-Christoph Diener and colleagues review the epidemiology and pathophysiology of MOH, and suggest strategies for prevention and treatment.
- Hans-Christoph Diener
- , Dagny Holle
- & Charly Gaul
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News & Views |
Treasure hunt in a minefield — exploring migraine with GWAS
In a powerful display of international collaboration, a new genome-wide association study has mapped susceptibility loci for migraine on the basis of genetic data from 375,000 individuals. The study implicates several new loci in migraine — many of them suggestive of vascular pathophysiology — but the functional relevance of many now-detected risk alleles remains elusive.
- Cenk Ayata
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Review Article |
Chronic migraine: risk factors, mechanisms and treatment
About 2% of the general population and 8% of people with migraine have chronic migraine, defined as ≥15 headache days per month. The condition can be disabling and has a severe impact on quality of life, yet it receives little attention. This Review summarizes the current understanding of the risk factors and pathophysiological mechanisms of migraine chronification, and discusses strategies to prevent and treat the disorder.
- Arne May
- & Laura H. Schulte
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News & Views |
No more mistaken identities for botulinum neurotoxins
The American Academy of Neurology (AAN) has updated its guidelines on the use of botulinum neurotoxins in neurological disorders. The new guidelines provide individual recommendations for the four products that are commercially available in the USA; however, the clinical differences between the products are still not clear.
- Alberto Albanese
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News & Views |
Are migraine endophenotypes needed?
Classification of migraine into different endophenotypes could aid diagnosis and treatment, but requires detailed characterization of different phenotypes. A new study provides insight into the clinical features of migraine with unilateral cranial autonomic symptoms, but raises questions about the value of such classifications.
- Jes Olesen