Even in individuals without psychiatric comorbidities, specific behavioraland psychological factors are associated with migraine, according to a study published in The Journal of Headache and Pain. Francesca Pistoia, MD, PhD, and colleagues investigated the relationship between psychological factors and migraine in individuals without psychiatric comorbidities. The analysis included women with episodic migraine (EM), women with chronic migraine (CM), and healthy controls. Patients with CM reported poorer sleep, more severe sleep disturbances, greater sleep medication use, higher daytime dysfunction, and more severe insomnia than controls. Compared with patients with CM, patients with EM had better sleep quality, fewer sleep disturbances, and less sleep medication use. However, patients with EM had more severe daytime dysfunction and insomnia versus controls. Patients with CM showed greater trait anxiety and higher general anxiety sensitivity than controls. A higher pain catastrophizing tendency, more severe feelings of helplessness, and more substantial ruminative thinking were seen in patients with CM than in patients with EM and healthy controls, while participants with EM showed higher scores in these dimensions than controls.
Monoclonal Antibodies for Migraine Prevention Increase Blood Pressure
Calcitonin gene-related peptide (CGRP) monoclonal antibodies increase blood pressure (BP) among patients taking the therapy for migraine prevention, according to findings published in Neurology. Gisela Terwindt, MD, PhD, and colleagues examined all patients with migraine who received erenumab and fremanezumab at a single headache center between January 2019 and January 2021, obtaining BP measurements from baseline (T0) through 12 months, with a 3-month interval (T1-T4). Both systolic and diastolic BP were higher at all time points (T1-T4) compared with T0 (P<0.001). The maximum estimated increase in mean systolic BP was 5.2 mmHg (95% CI, 3.1-7.5); the maximum estimated increase in mean diastolic BP was 3.5 mmHg (95% CI, 2.0- 4.9). For patients treated with erenumab (N=109), both systolic and diastolic BP were higher at all time points compared with T0 (all P<0.001); for fremanezumab (N=87), systolic but not diastolic BP was higher, compared with T0, at T1 (P=0.006) and T2 (P=0.004). “The majority of patients remained within the normal [BP] limits, but some patients required antihypertensive treatment,” Dr. Terwindt and colleagues wrote. “Physicians should be aware that people with migraine may be at risk [for developing] hypertension when treated with anti-CGRP (receptor) antibodies.”