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Research suggesting that headache may predict the clinical evolution of COVID-19, along with recent findings about treating migraine headaches, made the condition this week's top trending clinical topic.
An observational study of more than 100 patients found that headache onset during the presymptomatic or symptomatic phase of COVID-19 may resemble tension-type or migraine headache. Headache itself was associated with a shorter symptomatic period (see Infographic below). Investigators suggest that patients who develop a headache during the asymptomatic or early symptomatic phase of COVID-19 may have a more localized inflammatory response, which indicates that their body may be better able to control and respond to the infection.
The study also found that patients with headache tended to be younger than those without (mean age, 50 years vs 63 years, respectively) and tended to be women (58.6% vs 29.4%). Approximately one third of the patients with COVID-19 who developed headaches had a history of migraine.
Migraine was the focus of many presentations at the recent American Headache Society (AHS) Annual Meeting 2020, held virtually this year. One of those presentations revealed results of a survey which showed that few patients with migraine receive optimal treatment (see Infographic below). Of the nearly 2200 patients with migraine, less than 33% with chronic migraine reported receiving an appropriate diagnosis. The survey also found that overuse of acute medication was common. Nearly 32% of patients with episodic migraine and 75% of patients with chronic migraine met the criteria for overuse.
Regarding medications used to treat migraine, calcitonin gene-related peptide monoclonal antibodies (CGRP-mAbs) were a popular subject at the AHS meeting. Results of a study of 369 patients with migraine taking one of three approved CGRP-mAbs found that adverse event rates were higher than those seen in preapproval clinical trials for the drugs. The findings also suggest that patients who don't respond to one of the CGRP-mAb treatments are likely to not respond again if they are switched to another.
Meanwhile, a retrospective chart review found that CGRP-mAbs are safe and effective in patients with chronic migraine who have only had a partial response to onabotulinumtoxinA (Botox) treatment. Investigators found that the drugs reduced the number of headache days and pain severity, with adverse event rates similar to those reported in previous trials.
Another promising migraine treatment covered during the 2020 AHS Annual Meeting was AXS-07, a combination of rizatriptan and the nonsteroidal anti-inflammatory drug meloxicam. It was found to be safe and well tolerated, and to provide better pain control than rizatriptan alone.
As researchers continue to explore its associations with COVID-19 and probe new treatment options for migraines, headache is likely to remain a popular topic, as it was this week.
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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Ryan Syrek. Trending Clinical Topic: Headache - Medscape - Jul 03, 2020.