Neck pain does not necessarily indicate cervical musculoskeletal dysfunction when present with migraine, according to a study published in Headache. Researchers conducted a crosssectional, single-blinded study among 124 patients with migraine—106 and 18 of whom had episodic and chronic migraine, respectively—32 healthy controls, and 21 people with idiopathic neck pain. Participants were assessed using a set of measures for cervical movement range and accuracy, segmental joint dysfunction, and neuromuscular and sensorimotor function. Two distinct clusters of cervical musculoskeletal function were identified: neck function similar to healthy controls (108 individuals) and neck dysfunction similar to patients with neck pain disorders (69 individuals). Among patients with migraine, 76—including 62 with and 14 without neck pain—were clustered as having normal cervical musculoskeletal function, whereas 48 with neck pain had cervical dysfunction comparable to a neck disorder. There was no association observed between musculoskeletal dysfunction and pain hypersensitivity or symptoms during testing.

Oral Atogepant Effective for Reducing Number of Migraine Days

Once-daily oral atogepant effectively reduced the number of migraine days during 12 weeks, according to a study published in The New England Journal of Medicine. Investigators conducted a phase III trial of adults with 4-14 migraine days per month, randomly assigning patients to receive once-daily oral atogepant at 10 mg (214 patients), 30 mg (223 patients), or 60 mg (222 patients) or placebo (214 patients) for 12 weeks. Changes from baseline in the mean number of migraine days per month at 12 weeks were −3.7 days with atogepant 10 mg, −3.9 days with atogepant 30 mg, −4.2 days with atogepant 60 mg, and −2.5 days with placebo. The mean differences from placebo in the change from baseline were −1.2 days with atogepant 10 mg, −1.4 days with atogepant 30 mg, and −1.7 days with atogepant 60 mg. Results favored atogepant over placebo for the secondary endpoints except for the Activity Impairment in MigraineDiary Performance of Daily Activities score and Physical Impairment score for the 10-mg dose. Constipation, at rates of 6.9% to 7.7% across atogepant doses, and nausea, at rates of 4.4% to 6.1% across atogepant doses, were the most common adverse events. “Longer and larger trials are needed to determine the effect and safety of atogepant for migraine prevention,” the authors wrote.

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