Welcome to the WCN 2023 Interactive Program

Background and Aims:

We looked into the frequency of headache caused by excessive pharmaceutical use. The extensive headache awareness campaign in Itoigawa City was thereafter a success. Through these encounters, it was discovered that the doctor could not accurately identify the headaches since not enough time was spent asking the patient about their symptoms. In addition, many respondents said they would avoid going to the doctor because they were unhappy with the diagnosis and course of action. Therefore we noticed the need for AI-based headache diagnostics and developed the AI model. AI diagnostic models can accurately diagnose headaches with only a medical questionnaire sheet, thereby reducing interview time by a doctor, avoiding misdiagnosis, and potentially simulating the experience of a visit to a specialist at any time from the comfort of one's home.

Methods:

We developed an AI-based diagnostic model from a retrospective investigation of 6058 patients (4240 training and 1818 test dataset) diagnosed by a headache specialist. The ground truth was the diagnosis by the headache specialist.

Results:

About the AI-based headache diagnosis model, the dataset included about 80% of the patients who had migraine, 13% tension-type headaches, 1% trigeminal autonomic cephalalgias, 1% other primary headaches, and 5% secondary headaches. The mean age was approximately 35 years, and 66% were women. The model’s micro-average accuracy, sensitivity (recall), specificity, and precision for the test dataset were 90.78%, 89.76%, 89.21%, 94.23%, respectively.

Conclusions:

The AI-based headache diagnosis model based on the experience of awareness raising and epidemiological survey will solve the unmet need in clinical headache practice.

Background and Aims:

Migraine-related stigma may increase the disease’s overall burden. We evaluated stigmatizing attitudes toward people with migraine.

Methods:

OVERCOME (US), a population-based web survey conducted in a representative sample of US adults (2018–2020), queried 11,997 randomly selected individuals without migraine about attitudes towards people with migraine (11 questions using a 5-point Likert scale, ’never’/‘rarely’=NO, ’sometimes’/‘often’/‘very often’=YES).

Results:

Mean age was 47.4 (SD 17.3) years; 51.1% were female. Relationships to a person with migraine were: family/friends only (45.2%), co-workers only (4.2%), multiple people (6.5%), and none (44.1%). All questions prompted ‘yes’ responses by ≥24.2% of respondents, with highest responses for: migraine is easily treatable (45.1%), people with migraine try to hide their migraine from others (42.7%), and people have migraine as a result of their own unhealthy behavior (36.9%).

Seven of the eleven stigmatizing attitudes assessed were significantly more commonly endorsed by males than females (Figure), including that people with migraine exaggerate their migraine burden (33.2%(m) vs 28.7%(f), p<0.001) and that people with migraine make things difficult at work (31.3%(m) vs 26.0%(f), p<0.001). Females more frequently believed that those with migraine try to hide the condition (41.5%(m) vs 43.9%(f), p=0.007).

Conclusions:

In this survey of people without migraine, 45.1% believed that migraine is easily treatable and 36.9% believed that it is due to a person’s own unhealthy behavior. Male respondents more often believed those with migraine exaggerate their burden and make things difficult at work, while female respondents more often believed those with migraine try to hide their condition.

Background and Aims:

Major depressive disorder (MDD) is a prevalent comorbidity associated with migraine and is a negative predictor of migraine treatment response. UNITE aimed to evaluate the efficacy and safety of fremanezumab, a monoclonal antibody that selectively targets the calcitonin gene-related peptide (CGRP) pathway, in adults with migraine and MDD.

Methods:

In this double-blind, parallel-group, Phase 4 study (NCT04041284), adults diagnosed with migraine, and history of MDD with active symptoms of depression, were randomized 1:1 to monthly fremanezumab (225 mg) or placebo for 12 weeks. Patients in the 12-week open-label extension (OLE) received quarterly fremanezumab (675 mg). The primary endpoint was mean change in average number of monthly migraine days (MMD) from baseline to Week 12. Secondary efficacy endpoints included the proportion of patients achieving ≥50% reduction in MMD.

Results:

Among the 353 randomized patients (mean age, 42.9 years; 88% women), 330 completed the double-blind period (DBP) (fremanezumab, n=164/175; placebo, n= 166/178). Mean change from baseline in MMD was –5.1 and –2.9 for fremanezumab and placebo, respectively (P<0.0001; Figure 1). At Week 12, 40% of patients receiving fremanezumab achieved ≥50% reduction in MMD, with an average of 33% (fremanezumab) versus 13% (placebo) during the DBP (P<0.0001; Figure 2). Adverse events (mostly injection site reactions) were reported in 40% of patients receiving fremanezumab and 27% of patients receiving placebo. These results were maintained throughout the OLE.

Conclusions:

In adults with migraine and MDD, fremanezumab significantly reduced MMD over 12 weeks, with a sustained reduction over the longer-term, and was well tolerated. Acknowledgements: funded by Teva Pharmaceuticals.

Background and Aims:

Fibromyalgia is a chronic pain syndrome characterized by widespread musculoskeletal pain and affective problems. Current evidence shows that some patients also present significant brain alterations during the processing of signals that come from the body, especially in negative affective situations. Recent clinical studies have shown that neuromodulation using non-invasive stimulation can alleviate pain in these patients; however, the neurophysiological mechanisms involved are still unknown. The aim of this study is to examine whether tDCS could affect brain processing of affective pictures in fibromyalgia.

Methods:

In this study, 18 women with fibromyalgia aged between 38 and 73 years were randomly assigned to either an active tDCS group or a sham group. Active treatment consisted of a 20-minute tDCS session of 1.5 mA of current applied at the left motor cortex. Participants were presented to images of facial expressions of anger, pain, happiness, and neutrality twice, before and after the stimulation. Before and after application, EEG event-related potentials (ERP) were recorded during the image presentations.

Results:

Greater amplitudes were observed after tDCS compared to baseline in response to expressions of pain and anger; while reduced amplitudes were evoked in response to happiness.

Conclusions:

tDCS stimulation can modulate the neural activity related to processing of visual affective expressions. It might constitute a tool with some potential to revert dysfunctional neural changes related to the chronic pain condition and help alleviate fibromyalgia symptoms.

Background and Aims:

Chronic low back pain can be disabling. When it is added to fibromyalgia, it can be even more disrupting to quality of life or even personal plans for life. To cope with the sabotaging pain, resilience to pain is an important characteristics that keeps the individual going. This study investigated the factors determining the pain resilience in patients whose back pain is associated with fibromyalgia.

Methods:

Only individuals who concurrently have diagnoses of fibromyalgia and low back pain were invited to participate. In addition to filling out the Pain Resilience Scale, semi-structured, in-depth interviews were conducted to explore the experience of living with both pains and the coping strategy adopted.

Results:

Nine patients (3 male and 6 female; aged 27 to 58) were interviewed. The answers on the Pain Resilience Scale had a mean of 19.44 (sd=8.78). Thematic analysis discovered two major themes related to the experience of pain: a.) shift of self-identification, and b.) changes in body image. Three themes were found regarding the coping of pain: a.) purpose of life, b.) acceptance of diagnoses, and c.) disengagement from aversive stimuli. Major differentiation between participants with high and low pain resilience lies in the strategy adopted to disengage from aversive stimuli.

Conclusions:

The theme of pain experience might have similarities, but the strategy of coping can be a determining factor impacting the pain resilience in individuals with both pains. Different approaches adopted to disengage from aversive stimuli are found to differentiate between individuals with high and low resilience to pain.

Background and Aims:

The Canadian Headache Society (CHS) produced a Guideline for Migraine Prophylaxis of Episodic Migraine in 2012. There are new trials such as onabotulinum toxin, CGRP biologics and oral therapy, and other trials of previously reviewed treatments. Therefore, we are updating the guidelines for episodic and chronic migraine incorporating these changes.

Methods:

We performed an updated search covering timeline since initial search of previous publication (January 2008) until present for migraine preventive medications. We reviewed studies in abstract form in Covidence and are in process of selecting studies in full text form for inclusion into the guideline update. We will identify studies of previously selected medications and new medications, including calcitonin gene related peptide modulators not previously available for migraine prevention. We will evaluate the efficacy and safety of these medications in episodic and chronic migraine. The outcomes of interest will include migraine/headache day reduction, fifty percent responder rate and rate of adverse events. We will undertake a network meta-analysis using methodologically appropriate studies to compare the efficacy of these treatments/medications and see if there is any advantage in terms of efficacy and safety. We will organize a Delphi consensus process to arrive at our recommendations based on the updated literature search and network meta-analysis looking at comparative efficacy.

Results:

Pending ongoing data analysis.

Conclusions:

We will present the updated guideline recommendations.

Background and Aims:

There have been no trials directly comparing the efficacy of different calcitonin gene-related peptide (CGRP) antagonists in migraine prevention. We report results from the first head-to-head study of two CGRP antagonists, galcanezumab (monoclonal antibody) versus rimegepant (gepant), in the prevention of episodic migraine.

Methods:

In this 3-month, double-blind, double-dummy study, participants were randomized (1:1) to subcutaneous (SC) galcanezumab 120 mg/month (after 240 mg loading dose) and placebo oral disintegrating tablet (ODT) every other day (q.o.d.) or to rimegepant 75 mg ODT q.o.d. and SC placebo/month. Primary endpoint was the proportion of participants with ≥50% reduction in monthly migraine headache days (MHD/month) from baseline across 3 months. Key secondary endpoints were overall mean change from baseline in: MHD/month across 3 months and at Month 3, 2, and 1, MHD/month with acute migraine medication use, Migraine-Specific Quality of Life Questionnaire Role Function-Restrictive domain score at Month 3; ≥75% and 100% reduction from baseline in MHD/month across 3 months.

Results:

Of 580 randomized participants (galcanezumab: 287, rimegepant: 293; mean age: 42 years), 83% were female and 81% Caucasian. Galcanezumab was not superior to rimegepant in achieving ≥50% reduction from baseline in MHD/month (62% versus 61% respectively; P=0.70). Given the prespecified multiple testing procedure, key secondary endpoints cannot be considered statistically significant. Overall, treatment-emergent adverse events were reported by 21% of participants with no significant differences between treatment groups.

Conclusions:

Galcanezumab did not achieve its primary endpoint over rimegepant. The efficacy and safety profile observed in galcanezumab-treated participants were consistent with previous studies. ClinicalTrials.gov–NCT05127486.