2024 HK data on migraine in women
10 Sep 2024
A recent cross-sectional study in Hong Kong provides insights into lifestyle factors associated with migraine in women.
The age-standardized prevalence of migraine is higher in women vs men (18.9 vs 9.8 percent). [Lancet Neurol 2018;17:954-976] In the current study, baseline data from the MECH-HK (Migraine Exposures and Cardiovascular Health in Hong Kong Chinese Women) cohort study were used to investigate the association between a combined lifestyle index (CLI) comprising 8 lifestyle factors (ie, smoking, physical activity, sleep, stress, fatigue, diet, body mass index [BMI], and alcohol consumption) and migraine in Chinese women. [J Headache Pain 2024;25:24]
Prevalence in HK women
A total of 3,510 Chinese women ≥30 years of age (mean age, 55.2 years) were identified for analysis after excluding those with non-migraine headaches and those with incomplete data on lifestyles, migraine or other covariates. Among these women, 357 (10.2 percent) had migraine based on criteria set out in the 3rd edition of the International Classification of Headache Disorders (ICHD-3). [J Headache Pain 2024;25:24]
Association with lifestyle factors
For each CLI component, a score of 0 (unhealthy) or 1 (healthy) was attributed, with a higher total score indicating a healthier lifestyle. After adjustment for age, marital status, living condition, education level, family income, employment status, menstrual age, menopause, hypertension, diabetes, hyperlipidaemia, myocardial infarction, stroke, and cancer, the odds ratios (ORs) for migraine in those with a CLI score of 4, 5, 6, and 7–8 vs 0–3 were 0.57 (95 percent confidence interval [CI], 0.43–0.75), 0.33 (95 percent CI, 0.24–0.46), 0.30 (95 percent CI, 0.21–0.44), and 0.25 (95 percent CI, 0.15–0.41), respectively (all p<0.001). [J Headache Pain 2024;25:24]
Analysis of each CLI component showed that migraine was significantly associated with sleep, stress, fatigue, and diet. ORs after adjustment for the above factors were 0.50 (95 percent CI, 0.38–0.65; p<0.001), 0.74 (95 percent CI, 0.58–0.95; p=0.019), 0.62 (95 percent CI, 0.48–0.81; p<0.001), and 0.65 (95 percent CI, 0.52–0.83; p<0.001), respectively. No significant association was found for smoking, physical activity, BMI, and alcohol consumption.
The CLI was also inversely associated with migraine attack frequency. Among the 357 women with migraine, average migraine attack frequency was 2.6 episodes per month (range, 0.9–3.2 episodes per month). Each point increase in CLI score was associated with a reduced frequency of migraine attacks (β=-0.55; 95 percent CI, -0.82 to -0.28; p<0.001), after adjustment for the above factors. [J Headache Pain 2024;25:24]
Previous studies: Migraine impairs QoL & mental health
Previous studies in Japan, Taiwan and South Korea showed that migraine is associated with moderate-to-severe disability, productivity loss, and impaired quality of life (QoL). [Curr Med Res Opin 2021;37:1945-1955; Cephalalgia 2012;33:171-181; J Clin Neurol 2012;8:204-211]
Anxiety is a common psychiatric comorbidity of migraine (mean prevalence, approximately 43 percent). [Front Neurol 2020;11:569405] A systematic review on psychiatric comorbidities of migraine showed increased risks of conditions such as depression, generalized anxiety disorder, and panic disorder. [J Headache Pain 2019;20:51]
Rimegepant improves QoL in migraine patients
A post hoc analysis of a study that evaluated rimegepant’s long-term safety and tolerability in migraine treatment demonstrated significant improvement in migraine-specific QoL among patients with 2–8 or 9–14 monthly migraine days (MMDs) treated with 52 weeks of as-needed rimegepant 75 mg QD (PRN groups; n=1,514), and those with 4–14 MMDs treated with 12 weeks of rimegepant 75 mg on a fixed every-other-day (QOD) schedule plus a PRN dose for migraine attacks on nonscheduled dosing days (QOD + PRN group; n=286). [Adv Ther 2021;38:5209-5220]
Along with MMD reductions of 0.47–2.94 days in the PRN groups and 3.31 days in the QOD + PRN group, migraine-specific QoL version 2.1 (MSQv2) scores significantly improved over time in all domains across all treatment groups (p<0.001). “The improvement was most pronounced in those with higher MMDs and those taking rimegepant QOD + PRN,” the researchers noted.
AHS 2024: CGRP-targeted therapies as 1L preventive treatment
In a 2024 position statement update, the American Headache Society (AHS) recommended that calcitonin gene–related peptide (CGRP)–targeting therapies, including rimegepant, should be considered as first-line options for migraine prevention, based on substantial evidence and extensive real-world clinical experience supporting their efficacy, tolerability and safety. [Headache 2024;64:333-341]
“Initiation of these therapies should not require prior trial and failure of other classes of migraine preventive treatment,” the AHS experts noted.