New drugs, treatments, studies and clinical guidelines, summarised in plain language with a link to the original source.
New drugsStudies
Weight loss with atogepant in the long-term treatment of migraine: An interim analysis of a safety endpoint from a 156-week, open-label, multicenter phase 3 extension study
This interim analysis of a phase 3 study evaluated 595 patients with episodic and chronic migraine in the USA and other centers who used 60 mg daily of atogepant. After 52 weeks, a mean weight reduction of 2.16 kg was observed, and 29.5% of participants achieved clinically significant weight loss (≥5%). For the patient, this suggests that preventive treatment with atogepant is not only safe in the long term but could also favor weight reduction, especially in people with a high body mass index.
This technical article from the University of Duisburg-Essen analyzes the management of medication-overuse headache (MOH) and prophylaxis in children. In adults with MOH, studies with erenumab (70/140 mg) and eptinezumab (100 mg) showed remissions of up to 69% and 40% respectively. For the pediatric population, a new study with fremanezumab is highlighted, which reduced episodic migraine days. These findings offer patients new effective therapeutic alternatives, such as monoclonal antibodies, compared to conventional treatments and the placebo effect.
Efficacy and safety of eptinezumab in adults with chronic migraine and medication-overuse headache who also received patient education: 24-week results from the RESOLUTION randomized trial
This phase 4 multinational clinical trial evaluated eptinezumab in 608 adults with chronic migraine and medication-overuse headache (MOH). After receiving education about MOH, patients treated with this monoclonal antibody showed sustained reductions in migraine frequency and days of acute medication use through week 24. The results indicate that the initial improvements in disease burden and quality of life are maintained after a second dose, resulting in many patients no longer meeting the diagnostic criteria for chronic migraine and MOH with a good safety profile.
Rimegepant for the acute treatment of migraine: a systematic review and meta-analysis
This meta-analysis of seven clinical trials evaluated the efficacy of 75 mg of rimegepant in 6,734 adults with migraine. The results show that 19.8% of patients achieved pain freedom at two hours, compared to 10.7% with placebo, and 14.2% maintained that relief for 24 hours. The drug proved to be safe and well-tolerated. For the patient, this confirms that rimegepant is an effective and safe option, especially useful if conventional treatments do not work or are contraindicated.
Systematic review and meta-analysis on the efficacy and safety of rimegepant for migraine
This meta-analysis of 5 studies with 5,565 participants evaluated the use of rimegepant for migraine. The results show that the drug is effective in achieving pain relief and eliminating the most bothersome symptom at 2 hours after treatment (RR=1.34 and 1.38 respectively). For the patient, rimegepant offers a safe and well-tolerated option without significant adverse effects compared to placebo, although the study warns that it failed to demonstrate statistical efficacy in preventing pain recurrence between 2 and 48 hours later.
Safety, tolerability, and efficacy of atogepant added to onabotulinumtoxinA for the preventive treatment of chronic migraine: a phase 3, multicenter, 24-week, open-label study
This phase 3 study evaluated adding 60 mg of daily atogepant to 75 adult patients with chronic migraine who were already receiving onabotulinumtoxinA. The results showed a reduction of 7.2 migraine days per month after 24 weeks, and 61.9% of participants managed to reduce their attacks by half. Although there were side effects such as constipation and nausea, the treatment was safe and well-tolerated. For the patient, this validates combining two different preventive therapies to achieve superior disease control.
Migraine management in children and adolescents: a systematic review of practice guidelines and recommendations
This systematic review analyzed 8 international clinical guidelines (such as AAN and NICE) published in the last decade regarding pediatric migraine. The results confirm the consensus on using paracetamol and ibuprofen as first-line treatment, and nasal sumatriptan or zolmitriptan as the second option. However, there is variability in doses and preventive treatments, with a lack of information identified regarding anti-CGRP drugs and neuromodulation. For the patient, this means that, while there are clear guidelines for rapid relief, prevention still needs to be better standardized.
How much aerobic exercise is needed to reduce migraine? A dose-response meta-analysis on pain intensity and frequency
This meta-analysis of 15 studies with 253 patients analyzed the impact of aerobic exercise on migraine. The results show that exercise significantly reduces both pain intensity and frequency. For a moderate effect, at least 200 total minutes of activity are required, reaching the maximum benefit between 900 and 950 cumulative minutes during the program. For the patient, this translates into a preliminary recommendation to perform 3 weekly sessions of 30 minutes for about 10 or 11 weeks to optimize improvement.
2025 Guideline Update for the Acute Treatment of Migraine in Adults in the Emergency Department: Evidence Evaluation of Parenteral Pharmacotherapies from the American Headache Society
This systematic review and meta-analysis from the American Headache Society updates the recommendations for the treatment of migraine in the emergency department for adults after evaluating 26 new clinical trials. It concludes that treatment with IV prochlorperazine and greater occipital nerve blocks should be offered as a priority due to their high efficacy. Conversely, the use of IV hydromorphone is strongly discouraged and IV paracetamol is questioned. For the patient, this ensures more effective management of acute pain through validated injectable therapies, avoiding ineffective drugs.
Comparative efficacy and safety of preventive treatments for vestibular migraine: a systematic review and network meta-analysis
This network meta-analysis analyzed 5 clinical trials with 419 patients to compare preventive drugs against vertigo in vestibular migraine. The results show that all evaluated treatments significantly reduced monthly attacks. Propranolol stood out with the largest theoretical reduction (-7.04 attacks/month), followed by valproic acid and venlafaxine. However, galcanezumab presented the best balance between efficacy, quality of evidence, and tolerability with no dropouts. For the patient, this validates classic and new options to decrease the frequency of vertigo and improve their quality of life.
The relationship between lifestyle behaviors and tension-type headache and migraine: a systematic review and meta-analysis
This systematic review and meta-analysis of 7 studies with 32,197 participants analyzed the impact of modifiable factors on migraine and tension-type headache. The results showed no significant associations between alcohol consumption, body mass index, smoking, or physical activity and the risk of suffering from these disorders. For a patient, this suggests that, according to current limited evidence, these specific habits might not be direct causes of the disease, although more high-quality research is required to confirm these findings.
Addressing unmet needs in migraine: effectiveness of fremanezumab in real-world conditions in PEARL study participants with at least three previous preventive treatment failures
This post-hoc analysis of the European PEARL study evaluated the effectiveness of fremanezumab in 398 patients with episodic and chronic migraine who had previously failed three or more preventive treatments. The results showed that 53.8% of participants achieved a reduction in their monthly migraine days of at least 50% during the first six months. For the patient, this confirms that the drug is a safe and effective option in real clinical practice, even when other traditional preventive treatments have not worked correctly.
Greater occipital nerve block for migraine treatment: an overview, systematic review, and meta-analysis
This meta-analysis and review of 16 clinical trials evaluated the efficacy of the greater occipital nerve block (GONB) in 930 patients. The results show that the use of local anesthetic reduces pain intensity in acute attacks after 30 minutes. In chronic migraine, weekly injections reduced pain and monthly migraine days by 4.46 days after one month. For the patient, this confirms that it is a safe and useful procedure for rapid relief, although evidence on long-term benefits or steroid use is still limited.
Early and sustained change in headache day frequency after eptinezumab treatment in adults with migraine in whom 2 to 4 prior preventive treatments failed: a post hoc analysis of the DELIVER randomized trial
This analysis of the DELIVER trial evaluated the use of intravenous eptinezumab in adults with migraine who did not respond to 2-4 prior preventives. The results show that 23% of patients reduced their headache days to fewer than 4 per month in the first 12 weeks, a figure that rose to 47% by the end of the study (weeks 61-72). Furthermore, 9% achieved zero days of pain after the last dose. For the patient, this represents a sustained improvement in pain intensity and disease burden, even in difficult-to-treat cases.
Acupuncture recommendations for migraine in headache treatment guidelines: a systematic review
This systematic review evaluated 25 global guidelines on the use of acupuncture for migraine. The results show that, although 40% recommend its use, the methodological quality is low and 77.8% lack details about the procedure. Only 4% of the guidelines offer high-quality recommendations. For the patient, this means that, although acupuncture is a recognized option, the lack of clear standards in current medical guidelines makes precise and uniform clinical application difficult.
Closing the gap between evidence and clinical practice for migraines: a systematic review (2019-2024)
This systematic review analyzed 169 randomized clinical trials on migraine published between 2019 and 2024 worldwide to evaluate their clinical usefulness. The results show that, although 50.9% exceed the average usefulness and 98.8% are patient-centered, less than 2% are considered of high usefulness. Serious deficiencies persist in data transparency (1.8%) and economic evaluations (0.6%). For the patient, this means that current research does not yet fully translate into practical, equitable, and accessible improvements for their daily treatment.
Migraine-related disability according to headache frequency subclassifications: a systematic review and meta-analysis
This systematic review and meta-analysis of 32 studies evaluated disability in patients with low-frequency episodic migraine (0-7 days per month), high-frequency (8-14 days), and chronic (15+ days). Results show that disability increases linearly with attack frequency. It highlights that between 42% and 44% of people with high-frequency migraine already present severe disability. For the patient, this validates that the need for intensive treatment should be based on both frequency and functional impact.
OnabotulinumtoxinA for the preventive treatment of episodic migraine: Results from the phase 3, multicenter, randomized, double-blind, placebo-controlled PRECLUDE trial
This phase 3 clinical trial conducted at multiple centers evaluated the efficacy of onabotulinumtoxinA in 775 adult patients with episodic migraine. The results showed that, although there was a reduction in monthly migraine days, there was no statistically significant difference between the 155 U or 195 U doses compared to placebo. Secondary objectives in reducing acute medication were also not met. For the patient, this confirms that Botox is not more effective than placebo in cases of episodic migraine, unlike its proven use in chronic migraine.
Adjunctive occipital nerve block for the emergency treatment of acute migraine: A randomized controlled trial
This randomized trial in adults evaluated the efficacy of adding a greater occipital nerve block (methylprednisolone and lidocaine) to standard intravenous triple therapy in the emergency department. Results showed that 95.2% of patients with the block achieved a 50% pain reduction within two hours, compared to 47.6% in the control group. At 30 days, patients reported fewer migraine days and more pain-free days. For the patient, this procedure offers rapid and lasting relief in cases of severe or refractory attacks.