16th European Headache Congress

Professor

Chair

Post-Traumatic Headache

Invited speaker

Invited lecture

Headache phenotypes in post-traumatic headache

Post-Traumatic Headache: Insights from Research Imaging and Sensory Testing

The idiopathic intracranial hypertension prospective cohort study: evaluation of prognostic factors and outcomes

Idiopathic intracranial hypertension

Secondary headaches

Abstract text (incl. figure legends and references) Question There is limited longitudinal data evaluating visual and headache outcomes in Idiopathic intracranial hypertension (IIH). We aimed to evaluate the long-term outcomes in a large prospective real-world cohort of patients with IIH and prognostic factors. Methods A longitudinal clinical examination dataset was analysed from the prospectively collected IIH:Life database 2012-2021. Data included demographics and disease status. Visual outcomes included visual acuity (LogMAR), perimetric mean deviation (MD) (Humphrey 24–2 central threshold) and papilloedema (optical coherence tomography (OCT) imaging measurements). Headache frequency (days per month) and the headache impact test-6 questionnaire (HIT-6) were noted. We analysed the key variables for prognostic outcomes of vision and headache, focusing on the medically treated cohort. Results 490 had a confirmed diagnosis of IIH. 98% were female with a mean body mass index (BMI) of 38 kg/m2. Those with the highest OCT RNFL had the worst visual outcomes, but there was a delay of over 12 months before the visual field and OCT measurements revealed this decline. In the medically managed cohort (n=426) visual outcomes were good. Regression analyses showed change in BMI and disease duration had the most influence on vision. Those who were managed medically and had active IIH (n=281) there was a high headache burden and risk of high headache frequency was found to be associated with a personal migraine history and daily headache at diagnosis. There was a low relapse rate of 3.7%, which was associated with weight gain. Conclusions Those with the most elevation of their RNFL had worse long-term visual outcomes which only became apparent in longer term follow-up after 12 months. In a medically managed cohort of people with IIH disease duration and change in BMI were the key factors in influencing visual outcomes. The headache burden was high, and targeted therapy remained an unmet clinical need.

Abstract lecture

Dysregulation of multiple metabolic pathways related to amino acid and lipid metabolism in idiopathic intracranial hypertension: A non-targeted case control and longitudinal metabolomic study.

Basic science, animal models in headache research

Abstract text (incl. figure legends and references) Idiopathic intracranial hypertension (IIH) is a disease characterised by raised intracranial pressure (ICP) and occurs predominantly in women with obesity; however the underlying molecular pathogenesis is not fully understood. We have applied untargeted metabolomic analysis using ultra high performance liquid chromatography-mass spectrometry to characterise the cerebrospinal fluid (CSF) and serum metabolite profiles in IIH compared to control subjects and to probe underlying disease mechanisms. CSF and serum were collected from IIH patients (n=66) with active disease (lumbar puncture pressure &gt;25 cmCSF and Frisén papilloedema grade ≥1) at baseline and again at 12 months following therapeutic weight loss. Analogous samples were collected at baseline from gender and body mass index matched healthy controls with obesity (n=20). We identified two annotated metabolite features in CSF; (1) formylpyruvate and (2) maleylpyruvate and/or fumarylpyruvate isomers, which were present at lower concentrations in IIH compared to control subjects and returned to relative values of control subjects following weight loss. These metabolites showed the opposite trend in serum. Several amino acid and fatty acid metabolic pathways were repeatedly perturbed in serum. Arginine metabolism and arginine biosynthesis pathways were also altered in CSF and serum in relation to IIH symptoms and remission. Lipid classes related to obesity were observed as biologically important in serum supporting the link between obesity and lipid metabolism in IIH. These results support IIH being a systemic metabolic disease, not merely a pathology of the central nervous system and optic nerve. The perturbed pathways were also associated with disease clinical features and normalised over 12 months in line with disease remission. Perturbation of these metabolic pathways provides initial understanding of disease dysregulation in IIH and require further mechanistic evaluation.

Prof.

Real-world evidence of galcanezumab for migraine treatment in Japan: A retrospective analysis

CGRP inhibitors in the clinic

Abstract text (incl. figure legends and references) Question: Galcanezumab is the first anti-calcitonin gene-related peptide monoclonal antibody approved in Japan. How are the efficacy and safety of galcanezumab in patients with migraine in a real-world setting in Japan? Methods: We retrospectively analyzed patients with migraine who received three doses of galcanezumab between August 2021 and February 2022 at the Keio University Hospital. We assessed changes in monthly migraine days (MMD), responder rate (RR), and migraine-associated and premonitory symptoms. We also investigated injection site reactions and adverse events. Results: Fifty-two patients received three doses of galcanezumab during the study period. Compared to baseline, the MMDs decreased by 5.9 days (95% confidence interval, 4.2–7.7) at 3 months. The 50% RR was 61.5% at 3 months. A total of 64.9%, 50.0%, and 63.9% of patients showed improvement in the severity of photophobia, phonophobia, and nausea/vomiting, respectively. Premonitory symptoms persisted in 62.5% of patients. Moreover, injection site reaction was the most common adverse event (34.6%). Conclusion: This study revealed the efficacy and safety of galcanezumab for migraineurs in Japan. Galcanezumab also improved migraine-associated symptoms. However, despite a reduction in headaches, premonitory symptoms persisted in &gt;50% of the patients at 3 months, possibly due to a peripheral action of anti-calcitonin gene-related peptide monoclonal antibodies.

SciSe 6
New insights in posttraumatic headache and idiopathic intracranial hypertension

Appointment

Chair

Programme

SciSe 6New insights in posttraumatic headache and idiopathic intracranial hypertension

Appointment

Chair

Programme

SciSe 6
New insights in posttraumatic headache and idiopathic intracranial hypertension