BackgroundAvailable instruments to quantify migraine-related disability, such as the Headache Impact Test (HIT-6) and Migraine Disability Assessment Test (MIDAS), have certain limitations (e.g., recall bias, overlooking interictal burden), and do not always facilitate patient-doctor communication. We developed a migraine scoring system, namely the European Migraine and Headache Alliance-Migraine Scoring System (EMHA-MSS) with the aim of improving patient communication with healthcare professionals.MethodsCross-sectional, descriptive, quantitative study conducted between June 2024 and March 2025. First, we used exhaustive diary registries from 319 Spanish-speaking patients for a pilot study (of whom n = 280 had complete HIT-6/MIDAS). Second, the EMHA-MSS was administered to a validation cohort of Spanish patients (N = 504). Third, we undertook cross-language analyses using a separate English-language dataset from English-speaking patients (N = 51). The pilot benchmarking analyses used an exploratory three-item version of the scale with different scoring, whereas the final psychometric analyses used the four-item EMHA-MSS.ResultsThe EMHA-MSS demonstrated unidimensional structure with excellent Confirmatory Factor Analysis fit (Comparative Fit Index = 1.000, Tucker-Lewis Index = 1.000, Root Mean Square Error of Approximation = 0.000, Standardized Root Mean Residual = 0.003). Acute treatment reliability was identified as the main factor driving reclassification between severity categories when comparing EMHA-MSS and HIT-6 or MIDAS (comparisons used an exploratory 3-item EMHA-MSS with different scoring in the pilot cohort). Our model provided an excellent fit, supported the expected factorial structure, and demonstrated that factor scores could be reliably calculated. The EMHA-MSS showed good to excellent test-retest reliability. Cross-language validity was demonstrated for the English version using configural and metric invariance, as well as partial scalar invariance.ConclusionThe EMHA-MSS highlighted the importance of treatment reliability, pain and attack intensity, and frequency in classifying patients with migraine and evaluating the severity of the disease. This novel scoring system could facilitate tailored management and monitoring of migraine over time, potentially improving alignment with patients' perceptions and enhancing the understanding between them and healthcare providers.
BackgroundVisual snow syndrome (VSS) is characterized by persistent visual disturbances and is considered to involve altered sensory integration and salience processing. Neuroimaging studies suggest aberrant attention and salience network integration, yet the real-time interaction between internal bodily signals and external sensory processing remains unclear.MethodsWe conducted a case-control electroencephalogram study in 18 VSS patients and 16 matched controls performing a visual oddball task with standard and deviant stimuli. Heartbeat-evoked potentials (HEP) were extracted as an index of cortical interoceptive processing and visual mismatch negativity (MMN) as a marker of exteroceptive prediction error. Trial-wise analyses and source localization assessed interoceptive-exteroceptive interactions.ResultsVSS participants exhibited altered HEP amplitudes relative to controls, together with reduced condition-dependent differentiation between standard and deviant trials. The relationship between HEP and MMN amplitudes was significantly moderated by group and associated with symptom intensity in VSS. Source analysis localized these effects to a left frontotemporal network.ConclusionsVSS is associated with altered interoceptive-exteroceptive interactions during visual perception, which may contribute to persistent visual symptoms.
AimTo evaluate the efficacy and safety of a fully self-administered, app-based biofeedback intervention for the prevention of episodic migraineMethodsThis open-label, randomized, waitlist-controlled multicenter trial included adults with episodic migraine assigned to 12 weeks of daily biofeedback or a waitlist control. The primary outcome was change in monthly migraine days (MMDs) from baseline to weeks 9-12. Secondary outcomes included migraine intensity, acute medication use, and migraine-specific quality of life (MSQ v2.1). Statistical analyses were performed according to the intention-to-treat principle by a statistician masked to treatment assignment.ResultsOf 1113 individuals screened, 279 participants (mean [SD] age, 41 [10] years; 92% women) were randomized to the intervention (n = 140) or waitlist control (n = 139). Baseline MMDs were 4.8 (2.4) and 4.6 (2.3) in the intervention and control groups, respectively. During weeks 9-12, the estimated reduction in MMDs was 0.9 days (95% CI, -1.4 to -0.5) in the intervention group and 0.0 days (95% CI, -0.5 to 0.4) in the control group (between-group difference, 0.9 days; 95% CI, 0.3 to 1.5; P = 0.002). Participants receiving biofeedback also showed greater improvements in MSQ v2.1 total scores (mean difference, 5.3 points; 95% CI, 2.1 to 8.6; P = 0.001). Nine device-related adverse events occurred, all with mild severity.ConclusionApp-based self-administered biofeedback was associated with a statistically significant reduction in migraine frequency and improved quality of life, with a favorable safety profile.
BackgroundMigraine is characterized by recurrent headaches and sensory hypersensitivities, with photophobia affecting up to 90% of patients during attacks. The mechanisms underlying ictal photophobia remain unclear, potentially involving altered excitability of the visual cortex, trigeminovascular sensitization, or cone-driven retinal pathways. Prior interictal studies have shown preserved macular cone opponent mechanisms, but ictal investigations are lacking.MethodsIn this prospective study, we simultaneously recorded Ganzfeld blue-red (B-R) and blue-yellow (B-Y) focal flash (8 Hz) macular cone electroretinogram (ERG) and the subsequent visual evoked potential (VEP) in 11 patients with migraine without aura during acute attacks and in 20 healthy volunteers. First (1F) and second (2F) harmonic amplitudes and phases were analyzed using discrete Fourier transformation and T2circ statistics. Responses were correlated with clinical variables, including photophobia severity (0-10 scale) during attacks, using Spearman's coefficient.ResultsFor B-Y stimuli, a selective reduction in ERG 1F amplitude was noted in patients (F = 4.19, p = 0.02), with preserved phases and no differences in other harmonics or VEP responses. A significant negative correlation was observed between the phase of the first harmonic of the VEP and the level of photophobia during the attack. No significant differences were observed in 1F or 2F ERG/VEP amplitudes or phases for B-R stimuli between patients with migraine and HVs.ConclusionsIctal macular cone-opponent pathways remain largely intact in migraine, with a specific S-cone amplitude attenuation suggesting an autonomic-mediated inference on blue-light hypersensitivity. The finding of a correlation of B-Y VEP phase with photophobia implies that this symptom may arise from subcortico-cortical integrations (e.g., thalamic-trigemino-cortical convergence) rather than focal retinal dysfunction.
AimChronic migraine with medication overuse (CMwMO) is a disabling phenotype of migraine with heterogenous responses to medication withdrawal and preventive treatments. We investigated whether baseline brain metabolic patterns reflect biological heterogeneity associated with 1-year clinical outcome in CMwMO.MethodsWe prospectively enrolled patients with CMwMO and healthy controls and obtained baseline headache profiles, psychological and dependence-related assessment as well as FDG-PET/MRI data. Patients received preventive treatments along with structured medication-withdrawal education. Poor outcome (n = 13) was defined as ongoing analgesic overuse together with <50% reduction in monthly headache days compared with baseline at one year follow-up. All other patients (n = 14) were classified as having a good outcome. Whole-brain metabolic comparisons, seed-based metabolic covariance analyses, and correlations with clinical variables were performed.ResultsAmong 27 patients with CMwMO, baseline headache frequency, disability, and medication use were similar between good and poor outcome groups, but the poor-outcome group was older, showed greater dependence severity, and had a longer duration of chronic headache. Compared with healthy controls (n = 17), only the poor-outcome group demonstrated hypermetabolism in the nucleus accumbens, thalamus, orbitofrontal cortex, and cerebellum. When compared to the good-outcome group, the poor-outcome group exhibited cerebellar hypermetabolism and stronger cerebellar metabolic covariance with the putamen and occipital cortex. Integrities of cerebellar-putamen metabolic coupling correlated with dependence severity, whereas cerebellar-occipital coupling correlated with duration of chronic headache and 1-year clinical outcomes.ConclusionsCMwMO appears to comprise biologically distinct subgroups with different baseline metabolic patterns. Treatment-refractory patients were characterized by metabolic alterations involving reinforcement and sensory prediction networks. Early identification of this subgroup may facilitate more individualized management targeting both headache burden and dependence-related behaviors.
Objective To examine whether plasma or serum pituitary adenylate cyclase-activating polypeptide (PACAP) levels differ between people with migraine and healthy controls (HCs), and to assess evidence for dynamic alterations during migraine attacks. Methods A systematic literature search was conducted in PubMed and Embase from inception to December 19, 2025. Eligible studies measured PACAP in plasma or serum of adult or pediatric participants with migraine and reported comparisons with HCs, and/or between ictal and interictal phases. Two reviewers independently screened articles, extracted data, and assessed risk of bias using the QUADAS-2 tool. Results Eleven studies met the inclusion criteria, comprising seven adult and four pediatric studies. Findings were inconsistent across studies, with some reporting higher PACAP-38 levels in participants with migraine, while others found no differences or even lower levels compared with HCs. Five studies compared ictal and interictal levels, but results were incongruent and lacked intraindividual measurements. Furthermore, all studies were judged to be at high overall risk of bias, primarily due to limitations in participant selection and index test methodology. Conclusions Current evidence on plasma or serum PACAP-38 levels in migraine is limited and inconsistent. The lack of intraindividual ictal-interictal comparisons and variability in study design and assays further weaken conclusions. Standardized, high-quality studies are essential to resolve existing uncertainties. Trial Registration The study protocol was prospectively registered in PROSPERO (CRD42024601373).
AimVisual Snow Syndrome (VSS) typically begins in early life with no significant diagnostic findings in the neurological and ophthalmological workups. Still, secondary forms of VSS have been reported. This study examines the diagnostic value of cerebrospinal fluid (CSF) analysis and the search for autoimmune encephalitis antibodies in patients with VSS.MethodsIn this retrospective case-control study, CSF samples from 36 VSS patients were analyzed and compared to a control group matched for age, sex, and migraine. In addition, serum and CSF antibodies associated with autoimmune encephalitis or paraneoplastic syndromes were analyzed in VSS patients. Cases with CSF abnormalities were further characterized.ResultsNo significant systematic differences in CSF cell count or protein levels were observed between VSS patients (n = 36) and controls (n = 31). CSF abnormalities in the VSS group included elevated cell counts (n = 4), elevated protein level (n = 1) and oligoclonal bands (n = 1). Autoantibodies associated with autoimmune encephalitis or paraneoplastic syndromes were not detected in either serum or CSF of VSS patients.ConclusionThis corresponds to grade 3b evidence (case-control study), suggesting that lumbar puncture and search for autoimmune encephalitis should not be routinely performed in patients presenting with typical VSS without red flags for additional comorbidities.
BackgroundHeadache disorders, particularly migraine, are among the leading causes of disability worldwide, with onset frequently occurring during childhood and adolescence. Despite their high prevalence and substantial functional impact, paediatric headache disorders remain under-recognised within health systems and under-represented in global policy frameworks.MethodsThis factsheet was developed to provide a comprehensive, developmentally informed overview of the global burden of headache disorders in children and adolescents. It synthesises evidence from population-based studies, systematic reviews, clinical cohorts, and Global Burden of Disease (GBD) 2023 estimates. Key domains include epidemiology, disability burden, functional and psychosocial impacts, risk factors and triggers, diagnostic and treatment gaps, and current management strategies, with particular attention to disparities across sociodemographic groups.ResultsAccording to GBD 2023 point-prevalence estimates, headache disorders increase markedly across development, from 10.71% among children aged 5-9 years to 42.64% among adolescents aged 15-19 years. Corresponding migraine prevalence estimates increase from 2.79% to 18.08%. GBD 2023 data also indicate that migraine is among the leading causes of years lived with disability from early life onwards.Migraine in children and adolescents is associated with substantial impairment in school attendance, academic performance, social participation, and quality of life. It is also frequently accompanied by psychiatric and somatic comorbidities. Access to timely diagnosis and evidence-based treatment remains highly inequitable, particularly in low- and middle-income countries. Emerging evidence suggests that adolescence may represent a critical window for intervention, with the potential to reduce progression to chronic migraine and long-term disability.ConclusionsMigraine and other headache disorders in children and adolescents constitute a major global public health challenge. This factsheet provides a comprehensive, evidence-based summary of their burden and highlights urgent priorities for policy integration, advocacy, and research. Early, equitable, and developmentally tailored care is essential to reduce lifelong disability and improve global brain health outcomes.
AimMigraine substantially affects daily functioning, yet its impact on unpaid domestic labor, an essential and sex-structured component of home life, remains poorly characterized. Domestic tasks require sustained physical and cognitive effort and may be sensitive to illness-related functional limitations, particularly in households were gendered expectations shape baseline role allocation.MethodsAs part of the SMILE project, 675 adults with migraine (544 females and 131 males) and 232 non-migraine controls (186 females and 46 males) completed a survey including demographics, MIDAS, DASS-21, and a ten-domain domestic labor module adapted from the Who Does What questionnaire. Participants rated the current division of each task and their preferred redistribution of responsibilities. Analyses were stratified by sex. Group differences were quantified using standardized mean differences (SMDs). Associations between MIDAS and chore scores were examined using Spearman correlations and multivariable linear regression adjusted for age and DASS-21 subscales.ResultsParticipants with migraine had substantial disability (median MIDAS 30 [IQR 15-64]; 65% severe), and a median of 10 headache days in the preceding three months [IQR 5-20]. Females with migraine reported greater partner involvement in several female-dominated tasks compared with controls, including cleaning after meals (mean 4.12 vs 3.47; SMD 0.32), laundry (3.16 vs 2.59; SMD 0.27), and general cleaning (3.59 vs 3.18; SMD 0.19). Males with migraine showed increased involvement in a different subset of chores, most notably trash disposal (3.42 vs 5.18; SMD 0.87). Females with migraine also expressed stronger preferences for increased partner involvement across multiple domains. Among males, MIDAS correlated with greater partner involvement (r up to 0.29), whereas among females, MIDAS showed weaker, more variable associations; regression models confirmed task-specific relationships.ConclusionMigraine is associated with distinct sex-specific patterns in the structure and desired redistribution of domestic labor. These findings highlight household functioning as an overlooked dimension of migraine-related disability and fit within the SMILE Resource-Role Strain framework.
AimHeadache is a common neurological complaint in emergency departments (EDs). However, potential sex-related differences in triage assessment, diagnostic evaluation, and management remain poorly understood. This study examined sex differences across the emergency care pathway among patients presenting with headache.MethodsWe conducted a cross-sectional observational study of adult patients presenting with headache to a large university hospital ED between 5 May 2023, and 5 May 2025. Sex differences were analyzed across key stages of emergency care, including Manchester Triage System (MTS) assignment, pain intensity, ED process times, diagnostic procedures, acute treatment, and final diagnoses. Multivariable logistic regression models were used to assess associations between sex and clinical management outcomes while adjusting for potential confounders. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated.ResultsAmong 95,150 ED presentations during the study period, 1825 adults (1.9%) presented with headache (61.9% women; mean age 48.5 ± 19.7 years). Women were more frequently assigned higher-urgency triage categories, whereas male sex was associated with lower odds of higher-urgency triage (aOR 0.79, 95% CI 0.62-0.99). Use of cranial CT and lumbar puncture did not differ by sex, while men had lower odds of cranial MRI (aOR 0.48, 95% CI 0.26-0.90). Men were more likely to be diagnosed with secondary headache due to serious pathology (aOR 1.54, 95% CI 1.08-2.19) and less likely with primary headache disorders (aOR 0.73, 95% CI 0.54-0.98). Women more often received repeated non-opioid analgesics (aOR 1.60, 95% CI 1.06-2.44) and antiemetics (aOR 1.69, 95% CI 1.16-2.45). No evidence of systematic sex-based delays in ED care delivery was observed.ConclusionSex differences in emergency headache care emerge early in the clinical pathway. Lower perceived urgency despite a higher likelihood of serious pathology among men suggests a potential mismatch between triage assessment and underlying clinical risk. These findings highlight the need to further evaluate sex-related factors in triage and diagnostic pathways for patients presenting to the ED with headache.
BackgroundPatients with migraine are frequently referred to physical therapy, particularly when neck pain is present or symptoms remain inadequately controlled with medical management. Cervical strengthening and stabilization exercises are commonly prescribed; however, the quality and consistency of supporting evidence remain unclear. This review evaluated the effectiveness and safety of cervical-focused exercise interventions for migraine.MethodsA systematic search of nine medical and rehabilitation databases identified studies evaluating cervical or upper-body strengthening and stabilization interventions in individuals aged ≥14 years with migraine diagnosed according to International Classification of Headache Disorders criteria. Eligible studies reported headache or disability outcomes. Methodological quality and risk of bias were assessed using the Downs and Black Checklist, CARE guidelines, and Cochrane Risk of Bias 2 tool. Random-effects meta-analyses were performed for headache frequency, headache intensity, and migraine-related disability.ResultsTwelve studies met inclusion criteria, including five randomized controlled trials, three observational studies, one case report, and three conference abstracts. Interventions varied in duration, supervision, and comparators. Meta-analysis demonstrated a moderate, statistically significant improvement in migraine-related disability (SMD=0.69; 95% CI, 0.19-1.18; I2=70.7%). Effects for headache frequency (SMD=0.61; 95% CI, -0.25-1.47; I2=73.7%) and headache intensity (SMD=0.41; 95% CI, -0.35-1.18; I2=74.1%) were not statistically significant. Observational studies reported within-group improvements.ConclusionsCervical strengthening and stabilization exercises may have potential for improving migraine-related disability; however, current evidence remains insufficient to establish clear benefit for migraine prevention outcomes. Findings are based on very low to low certainty evidence, limited by risk of bias and substantial heterogeneity. Future research should prioritize adequately powered, multicenter randomized controlled trials with rigorous methodology and standardized reporting to determine whether these interventions provide clinically meaningful benefit for individuals with migraine.Registration: Prospero IDCRD420251051356.
AimAlthough periaqueductal grey matter (PAG), assessed by transcranial sonography, has been proposed as a biomarker of migraine chronification, its longitudinal evolution remains unknown. This study aimed to evaluate whether changes in clinical diagnosis-from chronic migraine to episodic migraine (CM-EM) or from episodic migraine to chronic migraine (EM-CM)-were associated with modifications in PAG echogenicity.MethodsIn a prospective longitudinal cohort study we reanalysed a cohort of 115 participants (65 patients with migraine and 50 controls) previously assessed in a baseline study. The follow-up was performed three years after the initial evaluation, collecting demographic, clinical (migraine-related), and sonographic variables.ResultsNinety-four of the 115 participants were re-evaluated at the longitudinal follow-up. Patients who converted from episodic to chronic migraine (EM-CM, n = 3) showed a significantly larger PAG area (0.22 [0.16-0.23] cm2 vs. 0.13 [0.12-0.16] cm2; p = 0.043), a greater reduction in PAG echogenicity (-0.52 [-0.52 to -0.24] vs. -0.03 [-0.21 to 0.17]; p = 0.008), and higher heterogeneity (33.88 [31.85-36.72] vs. 26.67 [23.33-38.9]; p = 0.0344) at baseline compared with patients who remained episodic at the follow-up assessment (n = 18). Among patients with chronic migraine at baseline, no significant differences in PAG area, heterogeneity, or echogenicity intensity were observed between those who remained chronic and those who were classified as episodic migraine at follow-up.ConclusionPatients with chronic migraine who clinically improved (CM-EM) did not show relevant between-assessment differences in the previously described PAG alterations, suggesting the persistence of these alterations despite clinical improvement. In contrast, the small group of patients who underwent EM-CM transformation exhibited increased PAG heterogeneity and area at the follow-up assessment. Further studies with a larger sample size should be performed to confirm these results.
AIM:Migraine is highly heritable, yet no machine learning models for predicting treatment responses have incorporated genetic data. We aimed to develop machine learning models including both genetic and clinical information to predict treatment responses of migraine preventives and treatment retention of triptans. METHODS:This was a cross-sectional population-based machine learning analysis of the Trøndelag Health Studies and the national prescription registry. Clinical predictors included demographics, serum metabolic measures, comorbidities, mental health and lifestyle factors. Genetic predictors included 108 migraine risk loci. Preventive response was defined as ≥50% reduction in triptan dispensations after first preventive dispensation, and triptan retention as ≥3 dispensations. The dataset was split into training (70%), validation (10%) and test set (20%). A series of standard and causal machine learning architectures were trained and optimized on the training and validation set, and the best model was evaluated on the held-out test data. Shapley Additive exPlanation values identified key predictors. RESULTS:In total, 475 participants tried a preventive (amitriptyline, beta-blocker, candesartan or topiramate) and 565 a triptan (371 sumatriptan) during the project period. Using only clinical features, the best models achieved area under curve of 0.56-0.69 for the preventives, and 0.56 for triptans. When combining clinical and genetic data, the area under curve was unchanged or reduced in all cases except for amitriptyline (0.80) and sumatriptan (0.55). The most important predictors were hormone-related features, lipid levels and hemodynamic parameters. CONCLUSION:We developed models that predicted treatment responses to amitriptyline, beta-blockers, candesartan and topiramate with modest accuracy. Incorporating genetic data did not enhance performance, although the limited sample size and the uncertain accuracy of cohort definition and treatment response assessment prevent firm conclusions.
AimTo evaluate whether initiation of calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) was non-inferior to initiation of onabotulinumtoxinA with respect to the hazard of ischemic stroke or transient ischemic attack (IS + TIA) in a real-world cohort of adults with migraine.MethodsWe conducted a retrospective, active-comparator, new-user pharmacoepidemiology study using the NIH All of Us Research Program Registered Tier Dataset (v8). Adults with migraine initiating CGRP mAbs (erenumab, fremanezumab, galcanezumab, eptinezumab) were compared with initiators of onabotulinumtoxinA from January 2018 through September 2023. The primary outcome was IS + TIA occurring more than 90 days after treatment initiation. Inverse probability of treatment weighting (IPTW) with stabilized propensity scores was used to adjust for 23 baseline covariates. Non-inferiority was assessed on the hazard ratio (HR) scale using a prespecified margin of 1.5, with non-inferiority concluded if the upper bound of the 95% confidence interval (CI) was less than 1.5. Prespecified subgroup analyses included migraine with aura and without aura. Prespecified sensitivity analyses included a per-protocol analysis, a crossover-excluded analysis, and an IS-only analysis. Fracture was used as a negative control outcome.ResultsAmong 16,147 patients with migraine in the cohort, the primary comparison included 1,581 CGRP mAb initiators and 947 onabotulinumtoxinA initiators. IPTW achieved a good covariate balance for the primary comparison (maximum standardized mean difference 0.016). For the primary outcome, 14 IS + TIA events occurred among CGRP mAb initiators and 22 among onabotulinumtoxinA initiators. The hazard ratio for IS + TIA was 0.524 (95% CI 0.263-1.046), which met the prespecified statistical criterion for non-inferiority because the upper confidence bound was below 1.5; however, the estimate was imprecise because of the small number of events. In the migraine with aura subgroup, the estimate also met the non-inferiority criterion (HR 0.419, 95% CI 0.163-1.080), whereas the migraine without aura subgroup, per-protocol analysis, and major adverse cardiovascular events analysis were inconclusive for non-inferiority. For major adverse cardiovascular events the HR was 1.068 (95% CI 0.589-1.935). The fracture negative control was also not significantly different (HR, 1.175; 95% CI, 0.692-1.993; p = 0.551), arguing against systematic healthy-user confounding. A formal adjusted comparison with untreated patients was not feasible due to structural confounding inherent to the stepped-care treatment pathway.ConclusionsIn this real-world diverse cohort, initiation of CGRP mAbs met the prespecified statistical criterion for non-inferiority relative to onabotulinumtoxinA for the primary IS + TIA outcome. However, this finding was based on few events and wide CIs and should be interpreted cautiously as limited evidence against a large relative increase in incident IS + TIA risk, rather than as definitive evidence of equivalent safety, absence of modest harm, or a protective effect. Several secondary, subgroup, and supportive analyses remained inconclusive for non-inferiority. Larger adequately powered comparative safety studies are needed.
AimIn view of limited evidence-based acute treatments for spontaneous vertigo in vestibular migraine, this real-world cohort study assessed the effectiveness of rimegepant for acute vestibular migraine-related vertigo and factors associated with treatment response.MethodsClinical data were retrospectively collected from 86 patients with documented vestibular migraine treated with rimegepant 75 mg orally disintegrating tablets for acute attacks at a tertiary referral hospital between March and November 2025. Predictors of 2-h vertigo relief, defined as improvement from moderate or severe baseline vertigo to mild or no vertigo on an 11-point numeric rating scale, and 2-h numeric rating scale scores were analyzed using regression models accounting for within-patient clustering of attacks.ResultsAmong 86 patients, 192 of 252 treated vertigo episodes (76.2%) achieved vertigo relief. At 2 h after dosing, the mean change in vertigo numeric rating scale score was -4.44 (95% CI, -4.65 to -4.23). In adjusted models, age younger than 60 years (OR, 3.45 [95% CI, 1.15 to 10.31]; P = 0.027) and lower baseline numeric rating scale (OR per 1-point increase, 0.56 [95% CI, 0.36 to 0.86]; P = 0.008) were associated with higher odds of vertigo relief. Younger age, lower baseline numeric rating scale score, and better hearing (β, -1.14 [95% CI, -2.02 to -0.26]; P = 0.013) were also associated with lower 2-h numeric rating scale scores.ConclusionRimegepant was effective for vertigo episodes in patients with vestibular migraine, and treatment responsiveness was closely associated with age, baseline vertigo severity, and auditory function. These findings support the early initiation of rimegepant for acute treatment of vestibular migraine, rather than delaying treatment until vertigo exacerbation.
