Today in Migraine Science

Hair Loss and CGRP Migraine Drugs: What the Evidence Shows The reports are consistent across both the antibodies and the gepants, the shedding is usually mild and reverses after stopping, and the true rate is still unknown.

Most acute migraine trials recruit people who still have options. This new phase 4 trial enrolled 570 adults who had already failed at least two triptans, mostly because the triptans did not work. Rimegepant pulled ahead of placebo at one hour for pain relief and two hours for the most bothersome symptom, with gaps above 30 percentage points still open at 48 hours. Exploratory endpoints, uncorrected p values, Pfizer-run.

How Long Do People Stay on Anti-CGRP Migraine Drugs? What 53 Real-World Studies Show About three in four were still on treatment at a year. Most who stopped did so in the first six months, and the reason was lack of effect rather than side effects.

Not about treating migraine, but about the gel cap in your freezer. America's animal poison control center pulled 45 dogs that had chewed into polyacrylamide hydrogel migraine caps, eye masks or cooling wraps, and found seizures, tremors and vomiting. Of the 21 followed to an outcome, 14 died or were put down. The gel contained acrylamide, a neurotoxin, far above expected residual levels.

CGRP does more than carry migraine pain, and this new review maps what else it does in bone and joints. In animals it drives bone formation and helps fractures knit, while blocking it leaves healing worse. What that means for someone on a CGRP antibody who breaks a bone is unknown, because the human evidence is short-term biomarker work with nothing at all on fracture healing.

Migraine runs about three to one in women and the usual explanation stops at hormones. This new review in Science works through what the past decade has turned up since sex became a required variable in funded research: separate pathways that start, amplify and settle pain in each sex, involving hormones but also immune cells talking to nerves, the gut microbiome, and the brain's own pain-damping circuits.

This new review pooled 53 real-world studies on how long people stay on CGRP antibodies and gepants: 93 percent at three months, 84 percent at six, 76 percent at a year. Of 1,242 recorded stops, 64 percent were because it was not working well enough and only 15 percent because of side effects.

This new analysis of 370 people on rimegepant found half had at least one week with their weekly migraine days cut by half or more inside two weeks, and half reached a reduction that then held by week three. A useful anchor against the usual advice to give a preventive two or three months, though these are medians.

This new study read 446 comments left on an Instagram reel and a Facebook post asking how migraine care had changed over twelve years. People credited the CGRP drugs and specialist clinics, but said delayed diagnosis, access, reimbursement and stigma had not moved. They defined success as regaining participation and predictability, not fewer migraine days.

This new questionnaire study of 606 students and staff at a German university found a 3.8 percent lifetime rate of headache associated with sexual activity, against the 1 to 1.6 percent usually quoted. A third described something resembling aura. Migraine was not associated with it, but primary exercise headache was, four times over.

A migraine drug with a mechanism unlike anything approved has entered phase 3 TriGemX Bio, previously Kallyope, announced on October 1 that it raised 94 million dollars and started phase 3 trials of elismetrep, an oral TRPM8 channel blocker. Every migraine-specific drug on the market works through serotonin receptors or CGRP, so this is a genuinely different target. Results are not expected until mid-2027, and the evidence so far is a phase 2b trial.

Six free migraine tools are now live A printable appointment summary, a 3-question screening test, a chronic migraine threshold calculator, a medication overuse checker, a preventive response calculator and a caffeine tally. All free, no sign-up.

This new network meta-analysis pooled 25 trials and 22,100 people to compare over-the-counter painkillers against lasmiditan, ubrogepant and rimegepant. Acetaminophen with aspirin and caffeine came out on top for pain relief at two hours and for light and sound sensitivity, with ibuprofen just behind. Every author works for Haleon, which sells both Excedrin and Advil.

This new review gathered 24 studies of repetitive transcranial magnetic stimulation for migraine prevention. High-frequency stimulation over the motor cortex or left prefrontal cortex looked most promising, but the authors are blunt that the studies differ so much in design and outcome that no reliable conclusion can be drawn yet.

CGRP Migraine Drugs and Women's Health: Periods, Pregnancy, Breastfeeding, and Birth Control A new review in Headache gathered the 16 studies that exist across menstrual migraine, pregnancy, breastfeeding and hormonal contraception, and the post works through how little of it covers the antibodies.

This new analysis of 6,267 adults using a migraine tracking app found the expected penalty for short sleep and a much larger one for long sleep. Six hours or less went with about 11 percent more headache days, while ten hours or more went with 27 percent more headache days and 66 percent higher disability. Perceived stress accounted for roughly half of the short-sleep link.

This new review pulled together the 16 studies that exist on CGRP drugs across menstrual migraine, pregnancy, breastfeeding and hormonal contraception. Gepants reach breast milk at 0.04 to 0.19 percent of the maternal dose, well under the usual cut-off, but there is no human milk data at all for the antibodies, and not one study has looked at interaction with hormonal contraception.

This new review weighed the hair loss reports that keep coming up among people on CGRP drugs, and found a consistent pattern across both the antibodies and the gepants: non-scarring, usually reversible, starting weeks to months in. Because it rests on spontaneous reporting, it cannot say how often this happens or that the drugs caused it.

This new analysis followed 741 people on rimegepant for prevention through 12 blinded weeks and then a year of open-label treatment. The blinded gap over placebo was slim, quality of life improving 18.6 points against 15.0. By the end of the open year everyone had improved a great deal, including the former placebo group, who caught up completely.

This new study tested 34 people with vestibular migraine, 31 with migraine alone and 32 with neither. Both migraine groups did worse than controls on attention and working memory, and neither did worse than the other, so the cognitive deficit a recent meta-analysis framed as characteristic of vestibular migraine is not specific to it.

This new study of 48 people with genetically confirmed mitochondrial disease found 48 percent had migraine in the past year against about 9 percent in the general population, with epilepsy and higher resting blood lactate each tracking independently with it.

This new study built a model to predict tomorrow's migraine out of what 53,065 people had logged in the Nerivio app, and when it called an attack coming it was right 91 percent of the time. Most of that signal came from the recent past: the last 30 days of headache severity carried 56 percent of it, while warning symptoms the day before added only 11 percent. Precision alone does not say how many attacks it missed, and the study was run by the company that makes the device.

This new survey of 847 people with migraine in Lithuania found 41 percent keeping a headache diary, with digital use falling away as age went up. The uncomfortable part is at the other end: 13 percent said their doctor had never looked at the diary, and another 14 percent said their doctor did not know they kept one.

This new review asked whether the newer dissolving occluder devices beat the permanent metal ones for closing a hole in the heart, across three studies and 481 people, two of those cohorts made up entirely of migraine patients. Neither device came out ahead, but nobody was followed long enough for the device to actually dissolve.

Cannabis for Migraine: What Randomized Trials Show Only five double-blind randomized trials exist across migraine and headache. Vaporized THC plus CBD beat placebo for acute attacks on moderate-certainty evidence, CBD on its own did nothing, and the post works through why THC trials are so hard to blind.

This new study put wrist sensors on 27 people through 96 migraine attacks and trained machine learning models to see an attack coming. Models trained on a person's own data reached about 82 percent accuracy, but models trained on everybody else and applied to a new person beat chance in only a third of them. The signal is real but personal.

This new study followed 113 people in Romania starting a CGRP antibody. By six months the episodic group had gone from a median of 10 monthly migraine days to 2 and the chronic group from 25 headache days to 6, and seven in ten of the chronic group no longer met the criteria for chronic migraine. Four in five were still on treatment at a year.

This new study gave five weekly stellate ganglion blocks to 42 people with chronic migraine that had failed everything else, and reports median monthly headache days falling from 29 to 6 at six months. Only 14 percent halved their pain intensity, so attacks got rarer rather than milder. No control group and no blinding.

This new trial gave 44 children and teenagers with migraine either omega-3 or coconut oil for 12 weeks. The blood work did exactly what it should, with omega-3 levels up and the omega-6 to omega-3 ratio down. The symptoms did nothing: no difference against placebo in pain, disability or psychological distress.

Experts from 11 countries put together this new review of migraine triggers worldwide. The top of the list is the same everywhere, stress and menstruation and disrupted sleep, but below that it splits: Ramadan and Yom Kippur fasting, barometric pressure in East Asia, the Lodos winds in Türkiye, the Arctic midnight sun, and watermelon in Brazil.

This new pooled analysis of two Italian clinics followed 78 people on atogepant, most with chronic migraine that had already failed other preventives, and found median monthly migraine days dropping from 13 to 4, with 74 percent halving their days. The quarter who had medication-overuse headache responded in the same proportion as everyone else, so the overuse did not blunt the drug.

Options for preventing migraine in pregnancy are thin, and this new series from a London obstetric medicine clinic describes what one team does: of 73 pregnant women with migraine, 61 were started on low-dose aspirin, and most of those on aspirin alone reported improvement. A description of practice rather than a test of it, with no comparison group.

This new study ran the full vestibular test battery on 193 people with definite vestibular migraine and found the results scattered: head impulse testing normal in two thirds, caloric testing abnormal in 41 percent, and none of the tests predicting any of the others. No single test catches vestibular migraine, and a normal result does not rule it out.

This new review walks through what is being tried beyond CGRP. PACAP antibodies look the most promising for people the CGRP drugs have not helped, though the human evidence is thin. It is also blunt about the failures: orexin, nitric oxide synthase and the cyclic nucleotide pathways all had good mechanistic arguments and no clinical results.

This new study followed 108 people whose headaches began after a concussion, none of whom had ever had aura, and found about a third developing aura symptoms within 60 days of the injury. In mice, head injury made the brain wave behind aura far easier to set off, and Botox in the scalp did nothing to stop that wave but completely blocked the pain it produced.

This new trial gave 20 healthy volunteers a single large dose of fremanezumab into a vein and then sampled their spinal fluid, finding the drug there within a day, still there at 30 days, and CGRP bound up where it had been undetectable in controls. The amounts are tiny, 0.06 percent of blood levels at day one rising to 0.36 percent by day 30.

This new review found only five double-blind randomized trials of cannabinoids across low back pain and headache. For acute migraine, vaporized THC plus CBD beat placebo at two hours on moderate-certainty evidence, while CBD on its own did nothing. Anything containing THC announces itself, so people could probably tell which arm they were in.

This new cohort of 54 people who had migraine trigger-site surgery in Taiwan reports 87 percent cutting their headache days by at least half, with each extra year of waiting before the operation coming to 0.34 more headache days a month afterwards. No control group, and everyone was selected for surgery by the surgeons reporting the result.

This new analysis of every reimbursed triptan prescription in France from 2014 to 2025 found packages dispensed up 17.5 percent while the number of people taking them barely moved, so the same population is getting through more: 4.25 packages a year each, rising to 5.11.

This new study matched 347 women with breast hypertrophy against 340 without, adjusting for BMI, mood and demographics, and found chronic migraine 40 percent more common in the hypertrophy group, with roughly double the neck pain and cervical radiculopathy and half again the sleep apnea. Only the women with neck pain were actually more likely to get reduction surgery.

This new study followed 858 pregnant patients with recurrent headaches and found 64 percent had migraine, peaking in the second trimester. Preterm delivery, severe preeclampsia, abruption and stillbirth taken together came out no different from matched patients with no headache disorder, 25.4 percent against 21.1 percent.

This new analysis went back through three phase 3 atogepant trials to ask how fast daily function picks up. From week one, people on atogepant were between 1.6 and 7.6 times more likely to report no limitation at all in a given week. Run by the drug's maker on data collected to answer other questions.

This new audit of 667 children at one headache clinic found far fewer reporting no response to treatment during lockdown than before it, 5 percent against 14 percent, alongside more obesity. The two groups come from different years with different referral patterns, so this is a question about school stress rather than an answer to one.

This new network meta-analysis pooled 32 randomized trials setting acupuncture against migraine drugs, sham acupuncture and placebo. Acupuncture cut about 2.3 monthly attacks compared with placebo and matched the drugs on migraine days, but it did not beat sham acupuncture on anything. Needling at the wrong points worked about as well as needling at the right ones.

This new systematic review pulled together 61 studies and 123 genetic variants in the sodium-potassium pump, sorting which variant goes with which condition. Variants in the ATP1A2 subunit are the ones tied to familial hemiplegic migraine type 2 and the sporadic version. A reference catalog rather than a new finding.

This new study compared 118 adolescents who have migraine against 50 who do not, and found 79 percent of the migraine group sleeping badly, with anxiety and depression scores running higher too. Once everything was adjusted for, pain intensity and disability were the two things independently tied to the poor sleep.

This new analysis of 72 adults with migraine found a higher neutrophil-to-lymphocyte ratio went with more disability and more perceived stress, while lower vitamin D went with more tenderness in the head and neck muscles. A secondary analysis of 72 people at a single point in time, so it is a reason to ask the question properly rather than a reason to start supplementing.

This new review pooled studies on thinking and memory in vestibular migraine, combining 208 patients against 180 healthy comparisons, and found overall cognitive scores well below the comparison groups, with about three quarters of patients meeting each study's threshold for impairment. The authors searched only PubMed, which is thin for a systematic review.

This new review asked what CGRP-targeted drugs actually do to sleep and concluded that nobody can say yet. People report sleeping better on them, but nearly all of that comes from questionnaires, and there is no way to separate a direct effect on sleep from the simple fact of having fewer migraine days.

This new study screened 1,010 pregnant and postpartum women at a hospital in Cairo and found 30.4 percent had neurological symptoms, tingling most common at 53.1 percent and headache next at 50.5 percent, most of it migraine. The symptoms predated the pregnancy in 55.7 percent and 66 percent said pregnancy made them worse.

This new survey of 333 healthcare providers across Azerbaijan found NSAIDs leading acute treatment at 67.3 percent against triptans at 15.3 percent, amitriptyline leading prevention at 75.7 percent, and anti-CGRP antibodies and gepants not available in the country at all.

This new study compared 84 people hospitalised in Japan with reversible cerebral vasoconstriction syndrome, splitting them by whether their scans showed narrowed arteries, and found no meaningful difference in anything: same age, same thunderclap headache pattern, same treatment, same recovery. Close to 60 percent of both groups had a history of migraine, and the practical point is that a clean angiogram does not rule the syndrome out.

This new trial put 40 adults in Iran through either ten hour-long hypnotherapy sessions or a waiting list, and found lower pain scores and fewer migraine symptoms in the hypnotherapy group. A waiting list controls for none of what attention and expectation contribute, and 40 people split across three migraine subtypes leaves very little to work with.

This new cohort followed nearly 60,000 Dutch nurses and found that having ever worked shifts went with about 13 percent higher odds of migraine six years later. The link with headache in general faded once sleep problems were accounted for, and currently working shifts showed no consistent association at all.

Anti-nausea drugs are routine in migraine care, and this new review sorts them by how far they stretch the heart's electrical cycle. Ondansetron carried a much stronger signal than the alternatives, enough that the FDA pulled its highest intravenous dose back in 2012, while palonosetron barely registered.

This new study tested two cheap blood-count markers across 100 people with vestibular migraine, 100 with Meniere disease and 100 with neither, and found nothing. No difference between groups, and no link to attack frequency or disability. A useful negative, given both keep being floated as shortcuts.

Atogepant is the first CGRP drug to report positive results in menstrual migraine, though the effect is small AbbVie announced that its phase 3 LUNA trial met its primary endpoint. 468 women took atogepant for seven days per cycle, starting three days before menstruation began. Perimenstrual migraine days fell by 1.20 compared with 0.40 on placebo. The difference works out at 0.80 days per cycle, and this is a company press release rather than a published paper.

This new study worked through what was causing dizziness in 519 children and teenagers at a specialist centre and found vestibular migraine at the top of the list at 41 percent, ahead of functional dizziness at 18 percent. About a quarter had something rarer, including brain tumours, so the authors set out which signs point where, aiming to spare children unnecessary scans.

This new pooled analysis of 12 studies and 658 people found ultrasound-guided greater occipital nerve blocks cut monthly headache days by about 9 and pain scores by 3.5 points, with injections closer to the spine doing better. Those are very large numbers and the studies varied enormously, so treat the size with caution.

This new survey of 509 women with migraine found that those on stable hormonal treatment, whether the combined pill, a progestogen-only pill or a hormonal coil, had much the same migraine pattern and preventive use as those on none. Among women still cycling regularly, 86 percent had menstrually-related migraine.

People who have already had a stroke or heart trouble were kept out of the CGRP antibody trials. This new registry report follows the 17 such patients at one Swiss centre across 31 patient-years and records no new strokes, no worsening heart disease and no fresh lesions, while 76 percent halved their migraine days. Seventeen people is far too few to call anything safe.

This new analysis of US health records matched 431,492 people who had neck manipulation from a chiropractor against the same number prescribed ibuprofen, all seeking care for new neck pain or headache, and found no increase in torn neck arteries in the following 30 days. It ran in a chiropractic journal, and the authors' own checks for hidden bias came out only partly clean.

When the German Migraine and Headache Society's diary app stopped sending its daily reminder for two weeks because of a technical fault, its 4,236 users logged 11 percent fewer entries, took nearly 50 percent longer to fill them in, and dropped out at a higher rate. Everything went back to normal once reminders returned.

This new review works through what actually causes light sensitivity, from eye conditions to migraine, meningitis and head injury, and traces the wiring: light-sensing cells in the retina that play no part in vision, feeding into the trigeminal pain pathway and up through the thalamus.

Vestibular Rehabilitation for Vestibular Migraine: What 7 Studies Show Seven studies and 272 adults with vestibular migraine show a pooled 23.97 point drop in dizziness handicap after vestibular rehabilitation, above the usual threshold for clinical meaningfulness. Balance confidence did not improve as much, and the heterogeneity between studies was very high.

This new pooled analysis of 12 studies and 3,603 people found depression and anxiety scores fell consistently while people were on CGRP-targeted migraine prevention, on every rating scale used, with the improvement tracking how well the migraine responded. Almost none of it was placebo-controlled, so whether the drugs lift mood directly or fewer attacks do it is still open.

This new study followed 27,074 Japanese children and teenagers with migraine through a claims database and found about 5 percent crossed into overprescription of anti-inflammatories within five years, teenagers more than twice as often as younger children. Only a small fraction were still filling anything a year later.

This new pooled analysis of 16 studies found lasmiditan, the one acute migraine drug that does not narrow blood vessels, roughly doubled the odds of being pain free at two hours with no vasoconstrictive heart events across 5,126 participants. The awkward part: the maker has since withdrawn it for commercial reasons rather than safety ones.

Taiwan's headache society updated its acute migraine guideline for the first time since 2022, naming rimegepant a first-line option for people who cannot take triptans or are heading towards medication overuse, restating the two-days-a-week ceiling on acute medicines, and ruling out opioids beyond limited oral tramadol.

This new review sets out how to take a history for a spinal fluid leak, a condition regularly mistaken for migraine, and flags chronic migraine that has not budged despite multiple treatments as worth a second look. Normal brain imaging does not rule a leak out.

This new trial split 20 people with migraine without aura between a month of acupuncture at a single point on the foot and needling at non-acupoints, and found larger drops in pain scores in the real acupuncture group. Twenty people is far too few to settle anything.

This new real-world study tracked 2,169 migraine attacks treated with rimegepant and found meaningful pain relief within two hours in 61 percent, against 50 percent for the other acute medicines the same people used, holding up across every type of preventive. Attacks were self-reported through an app and the study was funded by the drug's maker.

This new study asked 109 people at a dizziness clinic what set their symptoms off and what they did about it, and found the workarounds tracked the diagnosis: reading while travelling pointed to vestibular migraine, visually busy environments to persistent postural-perceptual dizziness, and head movements to BPPV.

This new multicenter study built a two-part scorecard, monthly acute medication days plus a six-item questionnaire, to flag who is carrying a heavy migraine burden. Across 1,161 patients it separated high from low burden well, with an area under the curve of 0.87 in external validation, though it overestimated risk until recalibrated.

This new study imaged the retinas of 54 people newly diagnosed with migraine and 55 without, and found lower blood vessel density on every measure in the migraine group, with those who had aura affected most. A single snapshot, so it cannot say whether the difference comes before migraine or after.

England is adding migraine to the list of conditions a pharmacist can treat without a GP NHS England announced that migraine will be one of five new conditions treatable at a high street pharmacy, alongside acne, scabies, ear infections and rhinitis. The pathway covers low frequency episodic migraine in adults only, and starts in autumn at the small number of pharmacies employing a pharmacist with a prescribing qualification.

This new meta-analysis of four randomized trials and 1,764 people found that fremanezumab left someone about 80 percent more likely to halve their monthly migraine days than placebo, and cut about 2 migraine days a month on top of that, with side effects tracking placebo apart from hardening at the injection site.

This new study followed 151 people with headache through three phases of the pandemic and found that nocebo-prone behavior, the tendency to expect a side effect and then get it, fell from 17 percent during lockdown to 9 percent once restrictions lifted, tracking with anxiety and with how many headache days someone had.

This new network meta-analysis of 14 trials and 791 people found probiotics cut the most migraine days, about 2.6 a month against placebo, with coenzyme Q10 and vitamins close behind, while magnesium did not reduce frequency but was the only one that lowered attack severity.

This new meta-analysis of seven studies and 272 adults with vestibular migraine found that vestibular rehabilitation cut dizziness handicap scores by about 24 points, a clinically meaningful drop, though balance confidence did not improve meaningfully and the authors grade the evidence low to moderate quality.

This new cohort of 470 people with vestibular migraine or probable vestibular migraine found 40 percent had some hearing loss and 88 percent had abnormal eye movement testing, with no meaningful difference between the two diagnoses.

Botox for Chronic Migraine: What 479 Real-World Patients Show A multicenter study followed 479 people with chronic migraine through three rounds of Botox over nine months. The post walks through what happened to their headache days, how many halved them, and what became of the medication overuse.

This new study took 413 hormone samples across 87 menstrual cycles in 46 women and found that those with menstrual migraine had a 49 percent higher peak estradiol in the luteal phase and a 90 percent steeper drop as the period approached, pointing at the size of the fall rather than the level itself.

This new review looked for sex differences in CGRP and its receptor, the target of the newer migraine drugs, and found only a handful of small studies with contradictory results, so the common assumption that this pathway simply works differently in women is not yet settled by the evidence.

This new review gathers imaging and electrophysiology work into a model of migraine as a cycling brain state rather than a single event, with raised cortical excitability between attacks, hypothalamic changes in the hours before one, and pain network amplification during it.

This new study of 20 people with vestibular migraine triggered attacks with intravenous nitroglycerin and found vestibular symptoms in 14 of them but no measurable group-level change in eye movement, while half reported visual symptoms and six had Alice in Wonderland type distortions.

This new systematic review of 19 studies found that research on status migrainosus, an attack lasting more than 72 hours, defines the condition inconsistently, with only 13 of them naming which edition of the diagnostic criteria they used.

This new modeling study behind the label for zavegepant nasal spray found that common CYP3A and P-glycoprotein drugs should not meaningfully change how much of it reaches the blood, but drugs blocking the OATP1B3 and NTCP liver transporters could roughly double it.

This new meta-analysis of five randomized trials and 258 adults found that osteopathic manipulative treatment cut 0.38 more monthly migraine days than control, but the individual trials disagreed with each other so severely that the authors say the pooled number cannot be generalized.

This new study of 230 Norwegian 15-year-olds found that those with an untreated vision problem were more likely to meet migraine criteria, 20 percent versus 8 percent, and that teens classified with migraine more often had trouble with eye teaming and focusing up close.

This new study of 320 people found that among those with migraine and no major vascular risk factors, white matter spots on MRI went with longer disease duration, more monthly headache days, higher CRP and a worse cholesterol ratio.

A machine learning model spotted migraine without being told anything about the headache Norwegian researchers trained a model on health and lifestyle data from 43,197 people, leaving out headache symptoms, and it still separated migraine from headache-free controls with an area under the curve of 0.80. Asked to find natural groupings, it split the migraine cluster into four subgroups: one entirely men, one dominated by neck pain, one with musculoskeletal pain alongside anxiety and depression, and one resembling classic migraine with aura.

This new survey of 103 US adults with migraine found that perceived stress accounted for part of the link between migraine stigma and disability during attacks, while pain catastrophizing accounted for part of it between attacks, though a one-time survey cannot show which comes first.

This new study built and tested a four-item migraine severity score with the European Migraine and Headache Alliance across 874 patients in Spanish and English, and found that how reliably acute treatment works was the main factor separating it from HIT-6 and MIDAS.

This new imaging study of 71 people with migraine and 31 without found that an indirect marker of brain fluid clearance was lower in high-frequency episodic migraine than in low-frequency migraine and tracked with attack frequency, though what that means in practice is still unclear.