AHS 2019: More Guidance on New Migraine Agents and Triggers

Damian McNamara

July 08, 2019

Unlike last year, when the focus of the American Headache Society (AHS) Annual Meeting 2018 was on the approval and promise of multiple calcitonin gene-related peptide (CGRP) antibodies to treat migraine, this year's meeting in Philadelphia will highlight research on practical clinical experience with these agents, including trials evaluating their use in certain patient subpopulations.

The agents in this class "remain the greatest cause of excitement in the field, even a year after they were introduced," Andrew C. Charles, MD, chair of the Scientific Committee for the AHS Annual Meeting 2019 and neurologist at the University of California, Los Angeles, Medical Center, told Medscape Medical News.

"There will also be long-term data and subgroup analyses from trials of the CGRP antibodies," he added. "Now we're really in this phase of being able to evaluate real-world data and how we incorporate these exciting new therapies into clinical practice."

And it's not just the antibodies. The meeting will feature phase 3 studies on the development CGRP small molecule therapeutics.

"The small molecule approach, compared to the antibodies, will be very interesting," Charles said.

"It's a new twist on the same theme. There are now multiple agents in the pipeline with the same target, potentially with different indications and maybe with different efficacies," he said.

Environmental, Dietary Triggers

Another major theme of the meeting is how environmental factors may influence migraine. One plenary session will highlight the plausibility of migraine as a disturbance of metabolic function; another will address how eating behavior influences brain function and is influenced by brain function.

"There is also a fascinating late-breaking session where the speakers propose that intake of riboflavin — either dietary intake or as supplements — is related to the risk of migraine," Charles said. "That one is quite provocative and goes along with the theme of environmental factors."

Other noteworthy research includes epidemiology studies addressing the continued use of opioids in a migraine patient.

"There has always been attention to this topic, but at this meeting there will be a very interesting abstract about the unfortunately large percentage of migraine patients that are being prescribed opioids and whether or not this is a gateway into opioid dependence," he said.

Charles also highlighted research by Amy Gelfand, MD, on adult migraine and an association with infantile colic. "Her data support a rather radical notion that colic may in fact be a first manifestation of migraine," Charles said.

A session entitled Wellness for the Headache Provider is new to the meeting this year. Evidence supporting physician wellness, including techniques for mindfulness-based stress reduction, will be presented.

Charles said the wellness data presented at the meeting will be more rigorous than many of those reported in the public domain. "There has been very, very little attempt to quantify it and present data that support one approach vs another," he said.

This is related to another main theme of the annual meeting: incorporation of popular nonpharmacologic approaches to general wellness and "seeing if these are things we can apply to migraine," Charles said.

Novel neuromodulation devices and their potential use in headache disorders, for example, will be other nonpharmacologic therapies presented at the meeting.

In addition, "there is some really good evidence that migraine is being dealt with primarily in primary care settings and still underdiagnosed," Charles said. "So another theme of the meeting is how to improve understanding and management of all kinds of headache disorders in the primary care setting.

"The overwhelming majority of what we are talking about is migraine, but certainly there is some other very important evidence being presented," including data on new therapies presented at the Industry Submitted Abstracts session.

"Recently, one of the antibodies was approved for treatment of cluster headache, and the first approval for this disorder in a long, long time. That is something that will also be discussed at the meeting, as well as new ideas about cluster headaches and how they relate to other headache disorders," Charles said.

TBI From an Athlete's Perspective

The opening session of the meeting will include a keynote speaker — an athlete who experienced traumatic brain injury and subsequently experienced headache. "That will be a nice personal and relatable topic," Charles said.

The remainder of the opening session will feature speakers and updates from the Jefferson Headache Center, located not far from the Philadelphia Convention Center. "It's been one of the leading headache centers in the country for decades," he added.

The schedule/program agenda and more information on the AHS 2019 Annual Meeting are available online.

Charles is a consultant for Alder, Amgen, Biohaven, Eli Lilly, and eNeura.

American Headache Society (AHS) Annual Meeting 2019.

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