Meeting a new attendance record, 1000 headache and migraine specialists are descending upon Boston this year for the American Headache Society (AHS) 2017 Annual Meeting June 8 through June 11.

With a high of 235 accepted abstracts on the latest research into treatment and disease epidemiology, which will be presented during scientific talks and 177 posters, the AHS scientific program committee chair said he's enthusiastic for this year's meeting — and for the field overall. In fact, he noted that the theme should be "hope" because of the proliferation of new therapeutic options.

"It's not just hope in a vague sort of way, it's very concrete. It's hope nearly delivered," Peter Goadsby, MD, PhD, professor of neurology at King's College London, United Kingdom, and the University of California, San Francisco, told Medscape Medical News.

Dr Peter Goadsby

During a pre-meeting webcast earlier today where he highlighted his picks for most groundbreaking data, Dr Goadsby noted that every study he mentioned was from a positive phase 3 trial. "We're entering a new era."

Some of the most important topics at the meeting fall under the umbrellas of pediatric migraine, care of veterans, and use of neuromodulation. In addition, Dr Goadsby said that the field has taken a definite step forward with the new class of treatment agents that block calcitonin gene-related peptides (CGRP).

"This has to be the most exciting thing to happen in the migraine space, without question. There's a serious biological underpinning going on," he said. These drugs "have a real effect on CGRP pathways — full stop, new paragraph."

Practice Changing

A slew of presentations on four new CGRP monoclonal antibodies will be given during various talks and the two poster sessions, which are scheduled for Friday and Saturday.

Although topline results were recently reported for phase 3 trials on the investigational agents fremanezumab (Teva) and galcanezumab (Eli Lilly and Co), researchers will be presenting more detailed findings during the AHS meeting, including at the Industry-Submitted Presentation session (not industry supported) scheduled for 8 am to 10 am on Saturday.

Other CGRP antibody research to be presented during that session include trials for eptinezumab (ALD403, Alder Biopharmaceuticals) and erenumab (AMG 334, Amgen and Novartis).

"These are types of things that patients will be asking clinicians about next Monday, figuratively speaking," said Dr Goadsby. He added that these aren't just hypotheticals but real data that will change practice.

"It's outrageous that we've never had a specific migraine preventative before, and it's about to happen," he said. "All of the CGRP studies have been positive. This works. It's just a matter of getting the horse to the end of the race."

Device Data

During the same Saturday morning session, talk will also turn to nonpharmacologic treatments, including multisensory neuromodulation and single-pulse transcranial magnetic stimulation for migraine.

The first will present results from a randomized trial on noninvasive caloric vestibular stimulation, through the use of a simple headset device, to prevent episodic migraine.

The latter will present findings from the open-label ESPOUSE trial for the prevention of migraines using a device that the US Food and Drug Administration approved in 2013 for treating migraine with aura.

"Not every patient is going to be excited about a new drug, but if I've got an option that's not a drug and is perfectly well tolerated, safe, and effective, that's something else," said Dr Goadsby. "That's the beauty of the field — that we've got evidence using an approach that I think will be welcomed by many patients. So the ESPOUSE study is quite important."

As for opioids, results will be presented during the Scientific Paper Presentation Session 2 from a randomized trial on prochlorperazine vs the opioid drug hydromorphone for acute migraine in emergency departments (EDs). According to a pre-meeting release, this study was halted early because the difference in effectiveness for prochlorperazine was so substantial.

Dr Goadsby noted in the same release that although hydromorphone is given for acute migraine during almost 25% of ED visits, it's well known that prescription opioids can lead to serious risk for addiction and overdose.

"This study is important in providing clear evidence that hydromorphone is significantly less effective…in achieving and maintaining headache relief," he said, adding that the findings support the AHS treatment guidelines for adults presenting to the ED.

"Physicians should first offer these patients intravenous prochlorperazine, metoclopramide, or subcutaneous sumatriptan, but not morphine or hydromorphone because of a lack of evidence for efficacy and concerns about side effects."

Patient Groups

During a session scheduled for the day before, at the Scientific Presentation Session 1, discussion will focus on younger patients, including a presentation on premonitory symptoms in pediatric migraine, such as tiredness and concentration impairment. A poster the same day will also examine the process of mapping pain in this vulnerable population.

Pediatric migraine "is a real biology. It's not just school avoidance or being a bit naughty. It's as biological as anything that happens to adults or as breaking a leg. It's just more difficult to understand," said Dr Goadsby.

Another group that will receive attention are veterans. A poster on Saturday will present findings on headache severity up to 11 years after the occurrence of a traumatic brain injury during deployment to the wars in Afghanistan or Iraq.

"The studies being presented…show that we're making real progress toward better treatment options for individuals with migraine and a deeper understanding of how the disease affects patient populations," said Dr Goadsby.

He added to Medscape Medical News that it's a great time to get into the field of migraine because there's just so much happening. "I want to tell younger folk: get on the train now because it's leaving the station. All of this is pretty exciting."

"At the Forefront"

There will also be several special talks and award presentations at the meeting, including Friday morning's Seymour Solomon Award Lecture on medication overuse headache, followed by presentation of the Lifetime Achievement Award, the Society's highest honor, to Dr Solomon himself.

At 93 years of age, Dr Solomon still sees patients 1 day a week and published a paper in January 2017. He is also a past president of the AHS, is a past chair of the American Council for Headache Education, and was director of the Montefiore Headache Unit in New York until he retired in 2009.

Other highlights include the following:

  • Thursday (June 8) afternoon: the Pan-American/Asian Symposium and a symposium in honor of Michael A Moskowitz, MD, on cortical spreading depression and aura;

  • Friday (June 9) afternoon/evening: a Plenary on translational research and the Harold G Wolff Award Lecture, with results from the American Migraine Prevalence and Prevention (AMPP) study on allodynia's link to initial and sustained response to treatment for acute migraine;

  • Saturday (June 10) afternoon: the John R Graham Lecture Award on "Understanding Migraine by the Company it Keeps;" and

  • Sunday (June 11) morning: a Plenary on lessons learned from recent clinical trials.

"It's true that migraine doesn't shorten life but it sort of ruins it," said Dr Goadsby, adding that these patients deserve treatments based on strong evidence.

He said that although there's never a good time to have a migraine, this is the best time for physicians and patients. "New treatments and a better understanding of the problem are needed, and the American Headache Society is right at the forefront of doing that."

Dr Goadsby's full webcast is available online with the password Boston.

Dr Goadsby is an investigator on trials assessing the CGRP erenumab.

Onsite Medscape Neurology coverage will begin June 8. Follow us on Twitter @MedscapeNeuro and @MedscapeDeb; the annual meeting Twitter feed will be using #AHS17BOS.


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