Prevalence and impact of visual aura in migraine and probable migraine: a population study

Kim, Kyung Min; Kim, Byung-Kun; Lee, Wonwoo; Hwang, Heewon; Heo, Kyoung; Chu, Min Kyung

doi:10.1038/s41598-021-04250-3

Cited by 17 publications

(12 citation statements)

References 43 publications

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“…It is, therefore, possible that the self-reported migraine prevalence with aura does not reflect the prevalence of diagnosed migraine with aura. The prevalence of migraine with aura in the general population is 12.5% in Taiwan [ 39 ] and 29.4% in Korea [ 40 ]; however, in this study over 70% patients (Table 1 ) had reported migraine with aura at baseline. Second, the definition of a migraine day (Supplementary Table 1 ) in this study was different from the widely accepted definition that includes migraine-specific medication only.…”

Section: Discussionmentioning

confidence: 64%

A phase 3, randomised, placebo-controlled study of erenumab for the prevention of chronic migraine in patients from Asia: the DRAGON study

Kim

Wang

et al. 2022

J Headache Pain

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Abstact Background DRAGON was a phase 3, randomised, double-blind, placebo-controlled study which evaluated the efficacy and safety of erenumab in patients with chronic migraine (CM) from Asia not adequately represented in the global pivotal CM study. Methods DRAGON study was conducted across 9 Asian countries or regions including mainland China, India, the Republic of Korea, Malaysia, the Philippines, Singapore, Taiwan, Thailand, and Vietnam. Patients (N = 557) with CM (aged 18–65 years) were randomised (1:1) to receive once-monthly subcutaneous erenumab 70 mg or matching placebo for 12 weeks. The primary endpoint was the change in monthly migraine days (MMD) from baseline to the last 4 weeks of the 12-week double-blind treatment phase (DBTP). Secondary endpoints included achievement of ≥ 50% reduction in MMD, change in monthly acute headache medication days, modified migraine disability assessment (mMIDAS), and safety. Study was powered for the primary endpoint of change from baseline in MMD. Results At baseline, the mean (SD) age was 41.7 (± 10.9) years, and 81.5% (n = 454) patients were women. The mean migraine duration was 18.0 (± 11.6) years, and the mean MMD was 19.2 (± 5.4). 97.8% (n = 545) randomised patients completed the DBTP. Overall, demographics and baseline characteristics were balanced between the erenumab and placebo groups except for a slightly higher proportion of women in the placebo group. At Week 12, the adjusted mean change from baseline in MMD was − 8.2 days for erenumab and − 6.6 days for placebo, with a statistically significant difference for erenumab versus placebo (adjusted mean difference vs placebo: − 1.57 [95%CI: − 2.83, − 0.30]; P = 0.015). A greater proportion of patients treated with erenumab achieved ≥ 50% reduction in MMD versus placebo (47.0% vs 36.7%, P = 0.014). At Week 12, greater reductions in monthly acute headache medication days (− 5.34 vs − 4.66) and mMIDAS scores (− 14.67 vs − 12.93) were observed in patients treated with erenumab versus placebo. Safety and tolerability profile of erenumab was comparable to placebo, except the incidence of constipation (8.6% for erenumab vs 3.2% for placebo). Conclusion DRAGON study demonstrated the efficacy and safety of erenumab 70 mg in patients with CM from Asia. No new safety signals were observed during the DBTP compared with the previous trials. Trial registration NCT03867201

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Section: Discussionmentioning

confidence: 64%

A phase 3, randomised, placebo-controlled study of erenumab for the prevention of chronic migraine in patients from Asia: the DRAGON study

Kim

Wang

et al. 2022

J Headache Pain

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“…Firstly, we did not look in detail at the definition of a migraine day based on aura symptoms, but we do propose to include all days with (visual) aura symptoms lasting 5-60 minutes as migraine days (6). We solely took visual aura symptoms into account, since 98-99% of all migraine attacks with aura are accompanied by visual symptoms (20)(21)(22). Moreover, it is impossible to ask all possible aura symptomatology for each day as this is too time consuming, thus simplification of aura symptomatology for headache E-diaries is needed to lower the data entry burden for patients and thereby improve diary compliance (23).…”

Section: Effective Triptan Daysmentioning

confidence: 99%

Defining migraine days, based on longitudinal E-diary data

et al. 2023

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Background There is a need for standardization of the definition of a migraine day for clinical and research purposes. Methods We prospectively compared different definitions of a migraine day with E-diary data of n = 1494 patients with migraine. We used a baseline definition based on migraine characteristics with a duration of ≥4 hours OR triptan intake (independently from its effect) OR (visual) aura lasting 5–60 minutes. Results Of all migraine days defined by triptan intake only, 66.2% had a duration <4 hours. Adjusting the headache duration criterion to ≥30 minutes led to a decrease in days defined by triptan intake only and resulted in a 5.4% increase in total migraine days (equals 0.45 migraine day increase in monthly migraine days). These additional migraine days had a median duration of 2.5 hours. Conclusion We propose to define a migraine day as follows: 1) (a) headache duration ≥30 minutes; (b) matching ≥2 of four characteristics: unilateral, pulsating, moderate to severe pain, aggravation by or causing avoidance of routine physical activity; and (c) during headache ≥1 of the following: nausea and/or vomiting, photophobia and phonophobia or 2) (visual) aura duration 5–60 minutes or 3) a day with headache for which acute migraine-specific medication is used irrespective of its effect.

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“… 6 Visual auras are the most common type, reported to occur in 98% of cases of migraine with aura, although speech/motor and sensory symptoms can occur. 7 Auras generally occur prior to the onset of headache pain but may persist afterward. 6 One of the oldest accounts of migraine was described by Hippocrates, who wrote Most of the time he saw something shining before him like a light, usually in part of the right eye; at the end of a moment, a violent pain supervened in the right temple.…”

Section: Introductionmentioning

confidence: 99%

Role of Atogepant in the Treatment of Episodic Migraines: Clinical Perspectives and Considerations

Cohen¹,

Yuan²

2022

TCRM

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Advances in molecular biology and neuroscience have led to the discovery of calcitonin gene-related peptide (CGRP), a 37 amino-acid neuropeptide that plays a critical role in the pathogenesis of migraine. CGRP receptor antagonist, also known as gepant, is an oral medication that inhibits the CGRP-related nociceptive signaling pathway. To date, three gepants are approved by the FDA for migraine treatment. Atogepant is a 2nd-generation gepant that non-competitively antagonizes CGRP receptors inhibiting neurogenic inflammation and pain sensitization. With its long half-life and minimal cardiovascular or liver toxicity, it is the first in its class approved primarily for migraine prevention. This article will discuss the evidence, safety, and rationale of atogepant for use in clinical practice.

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Prevalence and impact of visual aura in migraine and probable migraine: a population study

Cited by 17 publications

References 43 publications

A phase 3, randomised, placebo-controlled study of erenumab for the prevention of chronic migraine in patients from Asia: the DRAGON study

A phase 3, randomised, placebo-controlled study of erenumab for the prevention of chronic migraine in patients from Asia: the DRAGON study

Defining migraine days, based on longitudinal E-diary data

Role of Atogepant in the Treatment of Episodic Migraines: Clinical Perspectives and Considerations

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