Highlights from Headache and EHMTIC American Headache Society Scottsdale 2016 - THOMAS N. WARD MD PROFESSOR OF NEUROLOGY, EMERITUS GEISEL SCHOOL ...
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Highlights from Headache and EHMTIC
American Headache Society Scottsdale 2016
THOMAS N. WARD MD
PROFESSOR OF NEUROLOGY, EMERITUS
GEISEL SCHOOL OF MEDICINE AT DARTMOUTH
EDITOR-IN-CHIEF, HEADACHE: THE JOURNAL OF HEAD AND FACE PAIN
Disclosures
• I receive a stipend from the American Headache Society for services as Editor-in-Chief
of Headache; the journal of head and face pain.
• I am President and Treasurer of Dartmouth Region Medical Legal Consulting.
Learning objectives
• At the conclusion of this presentation participants will be able to…
• 1. Discuss the various features that are available to the readers of Headache
• 2. Be able to access the ahead of print materials in the journal from our on-line website
• 3. Be aware of some of the most interesting manuscripts in Headache from the past
year.
Editors of the Journal
• ROBERT E. RYAN, SR., MD Volume 1-4 1961-1965 (deceased)
• DONALD J. DALESSIO, MD Volume 5-14 1965-1975
• OTTO APPENZELLER, MD, PhD Volume 15-17 1975-1978
• LEE KUDROW, MD Volume 18-19 1978-1979
• DONALD J. DALESSIO, MD Volume 19-24 1979-1984
• JOHN G. EDMEADS, MD Volume 24-31 1984-1991
• J. KEITH CAMPBELL, MD Volume 32-41 1992-2001
• JOHN F. ROTHROCK, MD Volume 41-52 2001-2012
• THOMAS N. WARD, MD Volume 53-present 2013-
The Journal
• Can be accessed through the American Headache Society’s website.
• Current impact factor rose modestly to 2.961; we are ranked 63/192 among Clinical
Neurology journals.
• “The impact factor (IF) of an academic journal is a measure reflecting the average
number of citations to recent articles published in the journal. “
Thomson Reuters
A few words about Headache • Special features: • Our on-line version • Abstracts and Citations • Expert opinions • Headache toolboxes • Headache Rounds/Resident and Fellow section • Headache Currents
On-line version of the journal • Todd Schwedt, Editor • www.headachejournal.org • Podcasts • Early view • Virtual issues • Current issue highlights
Virtual issues: Virtual issues are collections of articles on a particular subject, published
in Headache: The Journal of Head and Face Pain. They are selected by a guest editor to provide a rapid overview
of the activity in a particular aspect of headache medicine. The virtual issues will be updated on a regular basis
by the editor, but will not be available as a paper publication.
• The following virtual issues are available:
• Mild Traumatic Brain Injury, Concussion, and Post-traumatic Headache,
• Orofacial Pain, Migraine Genetics, Idiopathic Intracranial Hypertension (IIH),
Neuroimaging, Migraine Research ,Sleep and Headache Disorders
• Occipital Nerve Block for Headache, Psychiatric Comorbidity and Migraine, Chronic
Migraine: Transformation and Reversion Factors
• Vestibular Migraine, Spontaneous Cerebrospinal Fluid (CSF) Leaks, Cefaliatria no Brasil |
Headache Medicine in Brazil
• Botulinum Toxin and Headache, Peripheral Nerve Blocks in Headache Treatment
• Evidence-Based Behavioral Interventions for Treatment of Headache, Obesity and
Headache
• Medication OveruseAbstracts and Citations • Abstracts and Citations Wade M. Cooper, Robert G. Kaniecki and Frederick R. Taylor • In each issue • Masterful survey of the headache literature with expert commentary and witty repartee • I recommend this feature highly
Expert opinion Randy Evans MD Series often with a guest expert(s) discussing a timely clinical topic and often-case based. From the April 2016 issue: Migraine and the Risk of Suicide. Aly Z, Rosen N, Evans R. pages 753-761.
Toolbox also available in Spanish • Deborah Tepper MD • Originally conceived by Dr. John F. Rothrock • Chronic Migraine • Prevention of Migraine • Onabotulinum A (Botox) • Pregnancy and Lactation - Migraine Management • Episodic Acute Migraine Treatment • New Daily Persistent Headache • Reversible Cerebral Vasoconstrictive Syndrome • CGRP-targeted therapy for migraine • Hemicrania continua • Many others, designed to be copied, given to patients (can also be ordered)
Patient Education Page • Sex and Headache • Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) for Acute Migraine Treatment • Opiate and Opioid (“Narcotic”) Therapy for Acute Migraine Headache • Occipital Nerve Blocks • Injectable Sumatriptan: Now Needle-Based or Needle-Free • Menstrual Migraine • Migraine Aura • Headache Prevention With Complementary and Alternative Medicine • Acute Migraine: Treating Early • Your Visit to the Doctor: Achieving a Satisfactory Result • Tool Box—Headache Web Sites • Migraine "Chronification": What You Can Do
• Compound Medications for Acute Migraine Treatment
• Patent Foramen Ovale (PFO) and Migraine
• Triptans, SSRIs/SNRIs and Serotonin Syndrome
• The Truth About Triggers
• What is Migraine?
• Topiramate (Topamax) for Migraine Prevention
• Oral Triptan Therapy
• Headache Diary
• Controlled Medication Agreement
• Monitoring Patients' Response to Acute Migraine Treatment: A Headache Attack
Report Form
• Opioid Therapy for Migraine
• Patient Information Regarding Subcutaneous* Self-Administration of
Dihydroergotamine
• Chronic Migraine: Medication Overuse HeadacheResidents and Fellows Section
• Includes Headache Rounds, Teaching Images in Headache, Education Research, Careers
in Headache Medicine, Opinions in Education Research, and Headache and the Arts.
• Drs. Morris Levin and Matthew Robbins
Headache Rounds based on the old feature in Headache recording case rounds at the
Faulkner Hospital with Dr. John Graham
• Peer-reviewed.
• Encourage medical students, residents and fellows to publish here.Headache Currents
• Previous editors David Dodick MD, Thomas Ward MD
• Current editor Stewart Tepper MD now at Dartmouth!!!
• From the July/August 2016 issue: Coeytaux RR, Befus D. Role of Acupuncture in the Treatment or
Prevention of Migraine, Tension-type Headache, or Chronic Headache Disorders.
• Ansari H, Ziad S. Drug-Drug Interactions in Headache Medicine.New feature
• Associate provider column
• Monthly feature provided by Lynda Krasenbaum APRN
• Content will evolve over time based on input from nurse practitioners, physician
assistants.
• Highlight content of interest to associate providers.Wolff Award 2016
• I should note that this year there was no Wolff Award given. To quote directly from the
journal’s website “The Harold G. Wolff Award is granted annually by the American
Headache Society for the best paper on headache, head or face pain and the nature of
pain itself. The recipient is invited to present the paper at the Society’s annual meeting,
which is then subsequently published in Headache. For more information on the Wolff
Award please visit www.AmericanHeadacheSociety.org.”
• There is a $10,000 award given as well.Member’s Choice Award
• This award is chosen from a list of 5 articles which I select (and those 5 cannot include
the Wolff Award nor articles which I have commissioned). The members are then
allowed to vote which results in the selection of their favorite article.
• The 2016 Member’s Choice Award: Buse DC, Serrano D, Reed ML, Kori SH, Cunanan CM,
Adams AM,Lipton RB. Adding Additional Acute medications to a Triptan Regimen for
Migraine and Observed Changes in Headache-Related Disability: Results from the
American Migraine Prevalence and Prevention (AMPP) Study. Headache 2015; 55(6):
825-839.Some highlights from the past year
• Pediatric collection:
• Hershey AD. Guest Editorial. Pediatric headache: Where We Are and Where We Are Going. Headache
2015; 55(10): 1356-1357.
• Gelfand A. Episodic Syndromes That May Be Associated With Migraine.: A.K.A. ‘the Childhood Periodic
Syndromes. Headache 2015; 55(10): 1358-1364.
• Kabbouche M. Management of Pediatric Headache in the Emergency Room and Infusion Center.
Headache 2015; 55(10): 1365-1370.
• Hickman C, Lewis KS, Little R, Rastogi RG, Yonker M. Prevention for Pediatric and Adolescent Migraine.
Headache 2015; 55(10): 1371-1381.
• Ernst MM, O’Brien HL, Powers SW. Cognitive-Behavioral Therapy: How Medical Providers Can Increase
Patient and Family Openness and Access to Evidence-Based Multimodal Therapy for Pediatric Migraine.
Headache 2015; 55(10): 1382-1396.
• Cobb-Pitstick KM, Hershey AD, O’Brien HL et al. Factors Influencing Migraine Recurrence After Infusion
and Inpatient Migraine Treatment in Children and Adolescents. Headache 2015; 55(10): 1397-1403.
• Law EFR, Beals-Erickson SE, Noel M, et al. Pilot Randomized Controlled Trial of Internet-Delivered
Cognitive-Behavioral Treatment for Pediatric Headache. Headache 2015; 55(10): 1410-1425.
• Kabbouche M. Pediatric Inpatient Headache Therapy: What is Available. Headache 2015; 55(1): 1426-
1429.Jason Roberts PhD Executive Editor, Headache
• Roberts J. Trial Registration, Transparency, and Selective Reporting: Let’s Get Clear
About What is Needed in Headache Medicine. Headache 2016; 56 (1): 3-7
• Rayhill M, Sharon R, Burch R, Loder E. Registration status and outcome reporting of
trials published in core headache medicine journals. Neurology. 2015 Nov
17;85(20):1789-94.
• Ward TN. Peer review: Toward improving the integrity of the process. Neurology 2015
Nov 17;85(20):1734-5
and
• Roberts J. Predatory journals: think before you submit. Headache 2016; 56(4): 618-621.Martin VT, Fanning KM, Serrano D et al. Asthma is a
risk factor for new onset chronic migraine: Results
from the American migraine prevalence and
prevention study. Headache 2016; 56(1): 118-131.
• Conclusions
• Asthma is associated with an increased risk of new onset CM 1 year later among
individuals with EM, with the highest risk being among those with the greatest number
of respiratory symptoms. The exact mechanisms underlying this association are
unknown, but could suggest mast cell degranulation, autonomic dysfunction, or shared
genetic or environmental factors.Yuan H, Silberstein SD. Vagus Nerve and Vagus Nerve
Stimulation, a Comprehensive Review, Part II.
Headache 2016; 56(2): 259-266.
• Abstract
• The development of vagus nerve stimulation (VNS) began in the 19th century. Although
it did not work well initially, it introduced the idea that led to many VNS-related animal
studies for seizure control. In the 1990s, with the success of several early clinical trials,
VNS was approved for the treatment of refractory epilepsy, and later for the refractory
depression. To date, several novel electrical stimulating devices are being developed.
New invasive devices are designed to automate the seizure control and for use in heart
failure. Non-invasive transcutaneous devices, which stimulate auricular VN or carotid
VN, are also undergoing clinical trials for treatment of epilepsy, pain, headache, and
others. Noninvasive VNS (nVNS) exhibits greater safety profiles and seems similarly
effective to their invasive counterpart. In this review, we discuss the history and
development of VNS, as well as recent progress in invasive and nVNS.• Tepper SJ. Editorial-Indomethacin. Headache 2016; 56(2): 421. (Headache Currents)
• Bordini EC, Bordini C, Woldeamanuel YW, Rapoport AM. Indomethacin Responsive
Headaches: Exhaustive Systematic Review With Pooled Analysis and Critical Appraisal of
81 Published Clinical Studies. Headache 2016; 56(2): 422-435. (Headache Currents)
• Lucas S. The Pharmacology of Indomethacin. Headache 2016; 56(2): 436-446.
(Headache Currents).Ward TN. RCVS and Headache. Headache 2016; 56(4) 617.
• Mawet J, Debette S, Bousser M-G, Ducros A. The Link Between Migraine, Reversible
Cerebral Vasoconstrictive Syndrome and Cervical Artery Dissection. Headache 2016;
56(4): 645-656.
• Ducros A, Wolff V. The Typical Thunderclap Headache of Reversible Cerebral
Vasoconstrictive Syndrome and its Various Triggers. Headache 2016; 56(4): 657-673.
• Wolff V, Ducros A. Reversible Cerebral Vasoconstrictive Syndrome Without Typical
Thunderclap Headache. Headache 2016; 56(4): 674-687.Peterlin B, Sacco S, Bernecker C, Scher AI. Adipocytokines
and Migraine: A Systematic Review. Headache 2016;
56(4): 622-644.
• Migraine is comorbid with obesity. Recent research suggests an association between
migraine and adipocytokines, proteins that are predominantly secreted from adipose tissue
and which participate in energy homeostasis and inflammatory processes.
• Conclusions
• While the existing data are suggestive that adipokines may be associated with migraine,
substantial study design differences and conflicting results limit definitive conclusions.
Future research utilizing carefully considered designs and methodology is warranted. In
particular careful and systematic characterization of pain states at the time of samples, as
well as systematic consideration of demographic (eg, age, sex) and other vital covariates (eg,
obesity status, lipids) are needed to determine if adipokines play a role in migraine
pathophysiology and if any adipokine represents a viable, novel migraine biomarker, or drug
target.Silberstein SD. The Management of Adults With Acute
Migraine in the Emergency Department. Guest Editorial.
Headache 2016; 56 (6): 907-908.
• Orr SL, Friedman BW, Christie S et al. Management of Adults With Acute Migraine in the
Emergency Department: The American Headache Society Evidence Assessment of
Parenteral Pharmacotherapies. Headache 2016; 56(6): 911-940.
• Recommendations
• Intravenous metoclopramide and prochlorperazine, and subcutaneous sumatriptan
should be offered to eligible adults who present to an ED with acute migraine (Should
offer—Level B). Dexamethasone should be offered to these patients to prevent
recurrence of headache (Should offer—Level B). Because of lack of evidence
demonstrating efficacy and concern about sub-acute or long-term sequelae, injectable
morphine and hydromorphone are best avoided as first-line therapy (May avoid–Level
C).Silberstein SD. The American Headache Society Cluster
Guidelines. Headache 2016; 6(7); 1091-1092
• Robbins MS, Starling AJ, Pringsheim TM et al. Treatment of Cluster Headache: The American Headache
Society Evidence-Based Guidelines. Headache 2016; 56(7): 1093-1106
• Results and Recommendations
• For acute treatment, sumatriptan subcutaneous, zolmitriptan nasal spray, and high flow oxygen remain
the treatments with a Level A recommendation. Since the 2010 review, a study of sphenopalatine
ganglion stimulation was added to the current guideline and has been administered a Level B
recommendation for acute treatment. For prophylactic therapy, previously there were no treatments
that were administered a Level A recommendation. For the current guidelines, suboccipital steroid
injections have emerged as the only treatment to receive a Level A recommendation with the addition
of a second Class I study. Other newly evaluated treatments since the 2010 guidelines have been given
a Level B recommendation (negative study: deep brain stimulation), a Level C recommendation
(positive study: warfarin; negative studies: cimetidine/chlorpheniramine, candesartan), or a Level U
recommendation (frovatriptan).
• Conclusions
• This AHS guideline can be utilized for understanding which therapies have superiority to placebo or
sham treatment in the management of CH. In clinical practice, these recommendations should be
considered in concert with other variables including safety, side effects, patient preferences, clinician
experience, cost, and the invasiveness of the intervention. Given the lack of Class I evidence and Level
A recommendations, particularly for a number of commonly used preventive therapies, further studies
are warranted to demonstrate safety and efficacy for established and emerging therapies.New (revived) feature: book reviews • Very occasional. • Professor Allan Purdy, President of the American Headache Society • The Heart’s Hard Turning: The Affairs of Men • John Farr Rothrock
EHMTIC 2016 Glasgow
• Lasmiditan, a selective 5-HT1F agonist without vasoconstrictive action. The Samurai
Phase 3 pivotal trial comparing lasmiditan 100mg, 200mg and placebo single dose for a
migraine attack (second dose permitted for rescue) looking a 2 hour pain free and 2
hour most bothersome associated symptom-free at 2 hours. 2,232 patients
randomized.>80% of enrolled subjects have multiple CV risk factors.
Lasmiditan Lasmiditan
HEADACHE PAIN RELIEF (ITT) Placebo
100mg 200mg
% of patients migraine headache pain
59.4% 59.5% 42.2%
relief at two hours
Odds Ratio (95% confidence interval) 2.4 (1.8 – 3.1) 2.5 (1.9 – 3.3)
p-value p < 0.001 p < 0.001• KEY SECONDARY ENDPOINT Lasmiditan 100mg Lasmiditan 200mg Placebo • % of patients MBS free at two hours 40.9% 40.7% 29.5% • • p-value p < 0.001 p < 0.001
TEAE • Mostly CNS-related lasmiditan 100mg lasmiditan 200mg placebo • Dizziness 11.9% 15.4% 3.1% Paresthesia 5.7% 7.6% 2.1% Somnolence 5.2% 5.3% 2.3% Fatigue 3.8% 3% 0.2% Vertigo 1% 0.3% 0 No serious adverse cv events
In summary
• Being the editor is a great job. You see many things.
• The good, the bad and the ugly.
• It is our journal, we depend on quality submissions especially from our membership.
• Please send us your best work, your colleagues will see it!
• Please submit your best work for the Wolff Award.
• Fellowship directors, please encourage your trainees to get published (the Resident and
Fellows Section is a great venue in which to accomplish that).
• Please send me your encouragement, criticisms, and suggestions.Thank you very much. • wardt1978@gmail.com The view from Lake Ward
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