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Sen S, Androulakis XM, Duda V, Alonso A, Chen LY, Soliman EZ, Magnani J, Trivedi T, Merchant AT, Gottesman RF, Rosamond WD. Migraine with visual aura is a risk factor for incident atrial fibrillation: A cohort study. Neurology 2018; 91:e2202-e2210. [PMID: 30429278 PMCID: PMC6329332 DOI: 10.1212/wnl.0000000000006650] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 08/23/2018] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Migraine with visual aura is associated with cardioembolic stroke risk. The aim of this study was to test association between migraine with visual aura and atrial fibrillation (AF), in the Atherosclerosis Risk in Communities study. METHODS In the Atherosclerosis Risk in Communities study, a longitudinal, community-based cohort study, participants were interviewed for migraine history in 1993-1995 and were followed for incident AF through 2013. AF was adjudicated using ECGs, discharge codes, and death certificates. Multivariable Cox proportional hazards models were used to study the relation between migraine and its subtypes with incident AF, compared with controls without headaches. Mediation analysis was conducted to test whether AF was a mediator of migraine with visual aura-associated stroke risk. RESULTS Of 11,939 participants assessed for headache and without prior AF or stroke, 426 reported migraines with visual aura, 1,090 migraine without visual aura, 1,018 nonmigraine headache, and 9,405 no headache. Over a 20-year follow-up period, incident AF was noted in 232 (15%) of 1,516 with migraine and 1,623 (17%) of 9,405 without headache. After adjustment for multiple confounders, migraine with visual aura was associated with increased risk of AF compared to no headache (hazard ratio 1.30, 95% confidence interval 1.03-1.62) as well as when compared to migraine without visual aura (hazard ratio 1.39, 95% confidence interval 1.05-1.83). The data suggest that AF may be a potential mediator of migraine with visual aura-stroke risk. CONCLUSIONS Migraine with aura was associated with increased risk of incident AF. This may potentially lead to ischemic strokes.
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Affiliation(s)
- Souvik Sen
- From the Department of Neurology (S.S., X.M.A., V.D., T.T.), University of South Carolina, School of Medicine, Columbia; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Medicine (L.Y.C.), University of Minnesota, Minneapolis; Department of Epidemiology and Internal Medicine (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Cardiology (J.M.), Department of Medicine, Heart and Vascular Institute, University of Pittsburgh, Medical Center, PA; Department of Epidemiology (A.T.M.), Arnold School of Public Health, University of South Carolina, Columbia; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; and Department of Epidemiology (W.D.R.), Gilling's School of Public Health, University of North Carolina, Chapel Hill.
| | - X Michelle Androulakis
- From the Department of Neurology (S.S., X.M.A., V.D., T.T.), University of South Carolina, School of Medicine, Columbia; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Medicine (L.Y.C.), University of Minnesota, Minneapolis; Department of Epidemiology and Internal Medicine (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Cardiology (J.M.), Department of Medicine, Heart and Vascular Institute, University of Pittsburgh, Medical Center, PA; Department of Epidemiology (A.T.M.), Arnold School of Public Health, University of South Carolina, Columbia; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; and Department of Epidemiology (W.D.R.), Gilling's School of Public Health, University of North Carolina, Chapel Hill
| | - Viktoriya Duda
- From the Department of Neurology (S.S., X.M.A., V.D., T.T.), University of South Carolina, School of Medicine, Columbia; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Medicine (L.Y.C.), University of Minnesota, Minneapolis; Department of Epidemiology and Internal Medicine (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Cardiology (J.M.), Department of Medicine, Heart and Vascular Institute, University of Pittsburgh, Medical Center, PA; Department of Epidemiology (A.T.M.), Arnold School of Public Health, University of South Carolina, Columbia; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; and Department of Epidemiology (W.D.R.), Gilling's School of Public Health, University of North Carolina, Chapel Hill
| | - Alvaro Alonso
- From the Department of Neurology (S.S., X.M.A., V.D., T.T.), University of South Carolina, School of Medicine, Columbia; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Medicine (L.Y.C.), University of Minnesota, Minneapolis; Department of Epidemiology and Internal Medicine (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Cardiology (J.M.), Department of Medicine, Heart and Vascular Institute, University of Pittsburgh, Medical Center, PA; Department of Epidemiology (A.T.M.), Arnold School of Public Health, University of South Carolina, Columbia; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; and Department of Epidemiology (W.D.R.), Gilling's School of Public Health, University of North Carolina, Chapel Hill
| | - Lin Yee Chen
- From the Department of Neurology (S.S., X.M.A., V.D., T.T.), University of South Carolina, School of Medicine, Columbia; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Medicine (L.Y.C.), University of Minnesota, Minneapolis; Department of Epidemiology and Internal Medicine (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Cardiology (J.M.), Department of Medicine, Heart and Vascular Institute, University of Pittsburgh, Medical Center, PA; Department of Epidemiology (A.T.M.), Arnold School of Public Health, University of South Carolina, Columbia; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; and Department of Epidemiology (W.D.R.), Gilling's School of Public Health, University of North Carolina, Chapel Hill
| | - Elsayed Z Soliman
- From the Department of Neurology (S.S., X.M.A., V.D., T.T.), University of South Carolina, School of Medicine, Columbia; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Medicine (L.Y.C.), University of Minnesota, Minneapolis; Department of Epidemiology and Internal Medicine (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Cardiology (J.M.), Department of Medicine, Heart and Vascular Institute, University of Pittsburgh, Medical Center, PA; Department of Epidemiology (A.T.M.), Arnold School of Public Health, University of South Carolina, Columbia; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; and Department of Epidemiology (W.D.R.), Gilling's School of Public Health, University of North Carolina, Chapel Hill
| | - Jared Magnani
- From the Department of Neurology (S.S., X.M.A., V.D., T.T.), University of South Carolina, School of Medicine, Columbia; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Medicine (L.Y.C.), University of Minnesota, Minneapolis; Department of Epidemiology and Internal Medicine (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Cardiology (J.M.), Department of Medicine, Heart and Vascular Institute, University of Pittsburgh, Medical Center, PA; Department of Epidemiology (A.T.M.), Arnold School of Public Health, University of South Carolina, Columbia; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; and Department of Epidemiology (W.D.R.), Gilling's School of Public Health, University of North Carolina, Chapel Hill
| | - Tushar Trivedi
- From the Department of Neurology (S.S., X.M.A., V.D., T.T.), University of South Carolina, School of Medicine, Columbia; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Medicine (L.Y.C.), University of Minnesota, Minneapolis; Department of Epidemiology and Internal Medicine (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Cardiology (J.M.), Department of Medicine, Heart and Vascular Institute, University of Pittsburgh, Medical Center, PA; Department of Epidemiology (A.T.M.), Arnold School of Public Health, University of South Carolina, Columbia; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; and Department of Epidemiology (W.D.R.), Gilling's School of Public Health, University of North Carolina, Chapel Hill
| | - Anwar T Merchant
- From the Department of Neurology (S.S., X.M.A., V.D., T.T.), University of South Carolina, School of Medicine, Columbia; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Medicine (L.Y.C.), University of Minnesota, Minneapolis; Department of Epidemiology and Internal Medicine (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Cardiology (J.M.), Department of Medicine, Heart and Vascular Institute, University of Pittsburgh, Medical Center, PA; Department of Epidemiology (A.T.M.), Arnold School of Public Health, University of South Carolina, Columbia; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; and Department of Epidemiology (W.D.R.), Gilling's School of Public Health, University of North Carolina, Chapel Hill
| | - Rebecca F Gottesman
- From the Department of Neurology (S.S., X.M.A., V.D., T.T.), University of South Carolina, School of Medicine, Columbia; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Medicine (L.Y.C.), University of Minnesota, Minneapolis; Department of Epidemiology and Internal Medicine (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Cardiology (J.M.), Department of Medicine, Heart and Vascular Institute, University of Pittsburgh, Medical Center, PA; Department of Epidemiology (A.T.M.), Arnold School of Public Health, University of South Carolina, Columbia; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; and Department of Epidemiology (W.D.R.), Gilling's School of Public Health, University of North Carolina, Chapel Hill
| | - Wayne D Rosamond
- From the Department of Neurology (S.S., X.M.A., V.D., T.T.), University of South Carolina, School of Medicine, Columbia; Department of Epidemiology (A.A.), Rollins School of Public Health, Emory University, Atlanta, GA; Department of Medicine (L.Y.C.), University of Minnesota, Minneapolis; Department of Epidemiology and Internal Medicine (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Division of Cardiology (J.M.), Department of Medicine, Heart and Vascular Institute, University of Pittsburgh, Medical Center, PA; Department of Epidemiology (A.T.M.), Arnold School of Public Health, University of South Carolina, Columbia; Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD; and Department of Epidemiology (W.D.R.), Gilling's School of Public Health, University of North Carolina, Chapel Hill
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Kuca B, Silberstein SD, Wietecha L, Berg PH, Dozier G, Lipton RB. Lasmiditan is an effective acute treatment for migraine: A phase 3 randomized study. Neurology 2018; 91:e2222-e2232. [PMID: 30446595 PMCID: PMC6329326 DOI: 10.1212/wnl.0000000000006641] [Citation(s) in RCA: 164] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 09/17/2018] [Indexed: 01/03/2023] Open
Abstract
Objective To assess the efficacy and safety of lasmiditan in the acute treatment of migraine. Methods Adult patients with migraine were randomized (1:1:1) to a double-blind dose of oral lasmiditan 200 mg, lasmiditan 100 mg, or placebo and were asked to treat their next migraine attack within 4 hours of onset. Over 48 hours after dosing, patients used an electronic diary to record headache pain and the presence of nausea, phonophobia, and photophobia, one of which was designated their most bothersome symptom (MBS). Results Of the 1,856 patients who treated an attack, 77.9% had ≥1 cardiovascular risk factors in addition to migraine. Compared with placebo, more patients dosed with lasmiditan 200 mg were free of headache pain at 2 hours after dosing (32.2% vs 15.3%; odds ratio [OR] 2.6, 95% confidence interval [CI] 2.0–3.6, p< 0.001), similar to those dosed with lasmiditan 100 mg (28.2%; OR 2.2, 95% CI 1.6–3.0, p< 0.001). Furthermore, compared with those dosed with placebo, more patients dosed with lasmiditan 200 mg (40.7% vs 29.5%; OR 1.6, 95% CI 1.3–2.1, p< 0.001) and lasmiditan 100 mg (40.9%; OR 1.7, 95% CI, 1.3–2.2, p< 0.001) were free of their MBS at 2 hours after dosing. Adverse events were mostly mild or moderate in intensity. Conclusions Lasmiditan dosed at 200 and 100 mg was efficacious and well tolerated in the treatment of acute migraine among patients with a high level of cardiovascular risk factors. ClinicalTrials.gov identifier NCT02439320. Classification of evidence This study provides Class I evidence that for adult patients with migraine, lasmiditan increases the proportion of subjects who are headache pain free at 2 hours after treating a migraine attack.
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Affiliation(s)
- Bernice Kuca
- From CoLucid Pharmaceuticals (B.K.), Inc, Cambridge, MA; Thomas Jefferson University (S.D.S.), Philadelphia, PA; Eli Lilly and Company (L.W., P.H.B.), Indianapolis, IN; IQVIA (G.D.), Durham, NC; and Montefiore Headache Center (R.B.L.), Bronx, NY
| | - Stephen D Silberstein
- From CoLucid Pharmaceuticals (B.K.), Inc, Cambridge, MA; Thomas Jefferson University (S.D.S.), Philadelphia, PA; Eli Lilly and Company (L.W., P.H.B.), Indianapolis, IN; IQVIA (G.D.), Durham, NC; and Montefiore Headache Center (R.B.L.), Bronx, NY
| | - Linda Wietecha
- From CoLucid Pharmaceuticals (B.K.), Inc, Cambridge, MA; Thomas Jefferson University (S.D.S.), Philadelphia, PA; Eli Lilly and Company (L.W., P.H.B.), Indianapolis, IN; IQVIA (G.D.), Durham, NC; and Montefiore Headache Center (R.B.L.), Bronx, NY.
| | - Paul H Berg
- From CoLucid Pharmaceuticals (B.K.), Inc, Cambridge, MA; Thomas Jefferson University (S.D.S.), Philadelphia, PA; Eli Lilly and Company (L.W., P.H.B.), Indianapolis, IN; IQVIA (G.D.), Durham, NC; and Montefiore Headache Center (R.B.L.), Bronx, NY
| | - Gregory Dozier
- From CoLucid Pharmaceuticals (B.K.), Inc, Cambridge, MA; Thomas Jefferson University (S.D.S.), Philadelphia, PA; Eli Lilly and Company (L.W., P.H.B.), Indianapolis, IN; IQVIA (G.D.), Durham, NC; and Montefiore Headache Center (R.B.L.), Bronx, NY
| | - Richard B Lipton
- From CoLucid Pharmaceuticals (B.K.), Inc, Cambridge, MA; Thomas Jefferson University (S.D.S.), Philadelphia, PA; Eli Lilly and Company (L.W., P.H.B.), Indianapolis, IN; IQVIA (G.D.), Durham, NC; and Montefiore Headache Center (R.B.L.), Bronx, NY
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