Digital Education for Migraine Self- Management: A Systematic Review of App-Based Interventions

Presenter: C. Pace

This systematic review evaluated the effectiveness of digital educational interventions, such as smartphone applications, in improving clinical and self-management outcomes in adults with migraine. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included randomized controlled trials (RCTs) identified from PubMed, Embase, PsycINFO, Cochrane Central, and ClinicalTrials.gov through December 2024. The primary outcome was the change in monthly migraine days (MMD), while secondary outcomes included headache intensity, disability, and treatment adherence. Out of 1,124 screened records, 16 randomized controlled trials involving 2,736 participants were included. Meta-analysis showed that digital educational interventions reduced monthly migraine days by a mean of 2.3 days per month compared with control (95% confidence interval [CI], −3.1 to −1.5 days/month). Interventions that incorporated cognitive behavioural therapy (CBT) modules were 35% more effective than basic digital educational interventions. Significant improvements were also observed in headache intensity (standardized mean difference [SMD], −0.41) and migraine-related disability (SMD, −0.38). Participants using the digital interventions also reported high engagement and better disease knowledge.

Overall, the review suggests that digital educational interventions are effective adjuncts to standard migraine care and may improve both migraine outcomes and patient self-management. The greatest benefits were observed with interactive interventions that included cognitive behavioural therapy components, thus demonstrating a scalable form of patient education to enhance self-management.

Real-World Treatment Persistence in Migraine Prevention: A National Registry Comparison of CGRP Monoclonal Antibodies and Oral Preventives

Presenter: M. Überall

This observational cohort study compared treatment persistence and reasons for treatment discontinuation among patients receiving subcutaneous calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs), oral high-evidence preventive therapies (HEVPs), and oral low-evidence preventive therapies (LEVPs) for migraine. The analysis used depersonalized routine-care data from the German Pain e-Registry, a nationwide multicenter clinical registry. Patients with physician-confirmed migraine were followed for 182 days. Treatment persistence was defined as continuous use of the initial preventive therapy, and discontinuations were categorized as due to adverse drug reactions (ADRs) or insufficient efficacy. A total of 36,465 patients were included, comprising 12,347 treated with CGRP monoclonal antibodies, 23,353 with high-evidence oral preventive therapies, and 765 with low-evidence oral preventive therapies. At 6 months, treatment persistence was significantly higher with CGRP monoclonal antibodies (89.3%) than with high-evidence oral preventive therapies (32.7%) or low-evidence oral preventive therapies (42.6%) (p < 0.001). Discontinuation due to adverse drug reactions occurred in 6.8% of patients receiving CGRP monoclonal antibodies, compared with 45.1% of those receiving high-evidence oral preventive therapies and 35.8% receiving low-evidence oral preventive therapies. Discontinuation because of insufficient efficacy occurred in 3.6%, 22.2%, and 21.6% of patients, respectively. Sex and migraine subtype did not have a clinically meaningful effect on treatment persistence. Among the high-evidence oral preventive therapies, tricyclic antidepressants, beta-blockers, and valproic acid had the lowest treatment persistence.

Overall, CGRP monoclonal antibodies demonstrated substantially higher real-world treatment persistence and better tolerability than conventional oral migraine preventive therapies.

Comparing AI with Specialist Ground Truth on Each Headache Attack Using Headache Diary App

Presenter: M. Katsuki

This study evaluated whether artificial intelligence (AI) can accurately classify individual migraine attacks compared with headache specialists. The International Classification of Headache Disorders, 3rd edition (ICHD-3) is designed to diagnose migraine at the patient level but is not intended to classify individual headache attacks. The study aimed to create an expert-reviewed reference dataset and compare the performance of three AI-based classification methods. Patients attending headache specialty clinics in Japan completed standardized questionnaires and recorded their headache attacks using the Migraine Buddy smartphone application for 3 months. Three board-certified headache specialists independently assessed 10 attacks from each of 10 patients. Each attack was assigned a migraine probability score, and majority agreement was used to classify attacks as migraine or non-migraine, providing the reference standard. Of the 100 recorded attacks, 98 were eligible for analysis. Specialists classified 82 attacks as migraine and 16 as non-migraine. The ICHD-3 rule-based decision tree showed high specificity (0.81) but low sensitivity (0.43). Large language models (LLMs) demonstrated high sensitivity (0.95) and moderate specificity (0.69), although their performance varied across repeated analyses. The XGBoost machine learning model provided the most balanced results, with a sensitivity of 0.84 and specificity of 0.88.

Overall, AI-based approaches showed good agreement with specialist assessments for classifying individual migraine attacks. Among the methods evaluated, the XGBoost model achieved the most balanced performance, while the authors emphasized that expert clinical judgment remains important.

Hormonal Migraine Across the Life Course: European Migraine in Women Survey Results (EMHA), H2 2025

Presenter: P. Pozo-Rosich

This cross-sectional survey evaluated the impact of hormonal life stages on migraine and the experiences of women with diagnosis, treatment, and healthcare. The Migraine in Women Survey, launched by the European Migraine & Headache Alliance (EMHA), collected patient-reported data from 13 European countries. Women aged 18–70 years were screened using the validated 3-item ID Migraine tool, and 5,410 respondents who screened positive for migraine were included in the analysis. The survey assessed migraine patterns during menstruation/perimenopause, pregnancy/postpartum, and menopause, with a separate pathway for transgender participants receiving hormone therapy. Overall, 42% of respondents reported not having a formal migraine diagnosis, although 76% had discussed their migraine attacks with a healthcare professional. Among 3,783 respondents who were menstruating or perimenopausal, 66% reported that their migraine attacks were related to their menstrual period. Of these, 38% experienced attacks during most or every period, while 28% experienced them during some periods. Additionally, 47% reported that migraine attacks typically occurred a few days before menstrual bleeding. Compared with non-menstrual attacks, period-related migraine attacks were reported to be more painful (36%), longer-lasting (28%), and more resistant to medication (20%). Despite these findings, only 23% of respondents had been offered specific treatment options for menstrual-related migraine. Overall, 16% rated their current treatments as "very effective," and 72% expressed a need for more education about the relationship between hormones and migraine.

In conclusion, the survey highlights that hormonal influences on migraine are commonly reported across Europe, while substantial gaps remain in diagnosis, healthcare engagement, patient education, and access to tailored management strategies.

Rimegepant for the Prevention of Migraine in Adults with Inadequate Response to 3 or 4 Categories of Non-Migraine-Specific Oral Preventive Medication

Presenter: P. Mathew

This exploratory analysis of a phase 4 clinical trial (National Clinical Trial, NCT05518123) evaluated the efficacy of rimegepant 75 mg orally disintegrating tablet (ODT) for preventing episodic migraine in patients with a documented inadequate response to 3 or 4 categories of non-migraine-specific oral preventive medications (OPMs). After a 28-day observation phase, adults with 4–14 monthly migraine days (MMDs) and fewer than 15 monthly headache days, who were not receiving preventive therapy, were randomized to receive rimegepant 75 mg ODT every other day or placebo for 12 weeks. A total of 114 participants received rimegepant and 109 received placebo. In both groups, most participants had previously shown an inadequate response to 3 OPM categories (81.6% and 84.4%, respectively), and approximately two-thirds had 8 or more monthly migraine days during the observation phase (64.9% and 66.1%, respectively). The primary endpoint favored rimegepant. The mean change in monthly migraine days from the observation phase over the 12-week double-blind treatment period was −2.1 days with rimegepant compared with −0.6 days with placebo, resulting in a between-group difference of −1.5 days (95% confidence interval [CI], −2.4 to −0.6; nominal p = 0.0016). Analyses of the key secondary endpoints also favored rimegepant, with all comparisons reaching nominal statistical significance (p < 0.05).

Overall, rimegepant 75 mg orally disintegrating tablet administered every other day was effective for the prevention of episodic migraine in patients with a documented inadequate response to 3 or 4 categories of non-migraine-specific oral preventive medications.

Effectiveness And Safety of Monthly Versus Quarterly Fremanezumab for migraine prevention: A 12-Month Italian multicenter real-world study

Presenter: R. Messina

This prospective, multicenter, real-world study compared the effectiveness and safety of monthly and quarterly fremanezumab for migraine prevention over 12 months. Fremanezumab, an anti–calcitonin gene-related peptide (CGRP) monoclonal antibody, was administered as either 225 mg monthly or 675 mg quarterly, with the dosing schedule selected according to patient preference. The primary outcomes were changes in monthly migraine days (MMD), monthly headache days (MHD), and the occurrence of adverse events (AEs). Secondary outcomes included responder rates, changes in acute medication use, disability, clinical scores, and medication-overuse headache (MOH) cessation. A total of 294 patients were enrolled, including 152 in the monthly group and 142 in the quarterly group. At 6 months, 138 monthly-treated and 133 quarterly-treated patients remained in follow-up, while at 12 months, follow-up was completed by 98 and 102 patients, respectively. Baseline characteristics were similar between the two groups. Both dosing regimens produced comparable reductions in monthly migraine days and monthly headache days at 3, 6, and 12 months, with no significant differences in adverse events between the groups. Improvements in monthly acute medication days (AMD), monthly acute medication pills (AMP), Migraine Disability Assessment (MIDAS), Headache Impact Test-6 (HIT-6), Numeric Rating Scale (NRS), and Allodynia Symptom Checklist-12 (ASC-12) scores were also similar between the monthly and quarterly treatment groups. In addition, ≥30%, ≥50%, and ≥75% responder rates and rates of medication-overuse headache cessation were comparable with both dosing schedules.

Overall, the study found that monthly and quarterly fremanezumab provided similar effectiveness and safety for migraine prevention over 12 months in routine clinical practice.

Migraine Prevalence and Burden in Africa: A Systematic Review and Meta-Analysis

Presenter: H. Atwan

This systematic review and meta-analysis evaluated the prevalence, patterns, and burden of migraine across African populations. A PubMed, Scopus, Web of Science, African Journals Online, and Google Scholar search was done from database inception to August 2025 for community-based studies reporting migraine prevalence or burden. Study quality was assessed using the Joanna Briggs Institute checklist, and random-effects meta-analyses were performed. A total of 61 studies involving 201,437 participants from 18 African countries were included. The pooled migraine prevalence was 18% (95% confidence interval [CI], 12%–26%), with substantial heterogeneity (I² = 99.7%). The standardized prevalence was 140 cases per 1,000 population (14%; 95% CI, 11%–17%). Migraine was more common in females (63%) than males (37%), corresponding to a female-to-male ratio of approximately 1.7:1. "Migraine without aura was the predominant subtype, while migraine with aura was substantially less common."

Differences in migraine prevalence between urban and rural populations were inconsistent. Overall, 31% of all headache cases were attributed to migraine. Migraine was associated with a substantial burden, including moderate-to-severe disability, reduced quality of life, loss of productivity, and low healthcare utilization. The analysis also identified evidence of small-study effects and potential publication bias.

Overall, the findings indicate that migraine affects a considerable proportion of the African population, particularly females, and is associated with significant disability. It highlights the need for improved recognition, standardized diagnostic approaches, and better resource allocation for headache disorders across Africa.

Effective Migraine Prevention Improves Cognitive Complaints

Presenter: M. Costa Taveira

This prospective observational study evaluated whether subjective cognitive complaints, such as memory and concentration difficulties, improve after effective preventive treatment for migraine. Adults diagnosed with migraine according to the International Classification of Headache Disorders, 3rd edition (ICHD-3) who started preventive treatment with either anti–calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) or onabotulinumtoxinA (BT) were included. Treatment response was defined as a ≥50% reduction in monthly migraine days for episodic migraine and a ≥30% reduction for chronic migraine after 3–6 months. Subjective cognitive complaints were assessed using the Subjective Memory Complaints (SMC) scale, and depressive symptoms were measured using the Hospital Anxiety and Depression Scale–Depression (HADS-D). The study included 100 participants with a mean age of 42.27 years; 98% were women, and 71% had chronic migraine. Of these, 66 received anti-CGRP monoclonal antibodies and 34 received onabotulinumtoxinA. Overall, 57 patients responded to treatment. Responders showed a significant improvement in subjective memory complaints (B = −1.46; p = 0.037). This improvement was similar regardless of whether patients received anti-CGRP monoclonal antibodies or onabotulinumtoxinA (p = 0.857). Improvement in cognitive complaints was also significant in patients without depressive symptoms (p = 0.027). In participants with higher depression scores, improvement in cognitive complaints was associated with improvements in Hospital Anxiety and Depression Scale–Depression scores.

Overall, effective preventive migraine treatment was associated with improvements in subjective cognitive complaints, supporting the view that cognitive symptoms are part of the broader clinical spectrum of migraine.

Migraine in Older Adults: A Multicenter Real-World Analysis from the Italian RICe Registry

Presenter: G. Paparella

This multicenter retrospective study evaluated the distribution of primary headache disorders, particularly migraine, across different age groups using data from the Italian RICe registry. The analysis included patients assessed at 30 headache centers between 2021 and 2025. Patients were categorized as young adults (18–30 years), adults (31–45 years), middle-aged adults (46–59 years), and older adults (≥60 years). Headache diagnoses were based on the International Classification of Headache Disorders, 3rd edition (ICHD-3). A total of 3,472 patients were included: 643 (18.5%) were aged 60 years or older, 1,285 (37.0%) were 46–59 years, 988 (28.5%) were 31–45 years, and 556 (16.0%) were 18–30 years. The distribution of headache diagnoses differed significantly across age groups (χ²(117) = 254; p < 0.001). Older adults were more likely to be diagnosed with chronic migraine (z = 3.41), whereas migraine with aura was more common in younger patients (z = 5.32). Among other primary headache disorders, tension-type headache was more frequent in older adults (z = 2.47). Medication-overuse headache (MOH) occurred more often in middle-aged adults (z = 4.64). Compared with younger age groups, 

"Older adults were more likely to have chronic migraine, characterized by longer attacks and fewer associated symptoms." all p < 0.01).

Overall, headache diagnoses and clinical characteristics varied across age groups. Chronic migraine was more common in older adults, while medication-overuse headache was more frequent in middle-aged patients, highlighting the need for age-specific approaches to diagnosis and management.

Beyond the Aura: Is Burden Measurable in Migraine?

Presenter: Ö. Soylu

Conventionally, migraine is considered a harmless condition, but it can be severely limiting owing to its pathogenic mechanisms like neurogenic inflammation and neuroaxonal involvement. This case-control study evaluated whether serum neurofilament light chain (sNfL) and serum glial fibrillary acidic protein (sGFAP) could serve as biomarkers of subclinical disease burden in patients with migraine. The study included 86 patients with migraine, comprising 62 with migraine with aura (MWA) and 24 with migraine without aura (MWOA), along with 126 age- and sex-matched controls with tension-type headache, dizziness, or functional disorders. Individuals with conditions associated with neuroaxonal damage, obesity, or renal insufficiency were excluded. Biomarker levels were measured using a sensitive immunoassay platform and adjusted for age and sex. Overall, sNfL levels differed significantly between the migraine groups and controls (p = 0.004), whereas sGFAP levels did not differ between groups. In subgroup analyses, patients with migraine without aura had significantly higher sNfL levels than controls (median 0.58; interquartile range [IQR], 4.22 vs median −0.40; IQR, 2.16; p = 0.001). In contrast, no significant difference in sNfL levels was observed between patients with migraine with aura (median −0.26; IQR, 2.00) and controls (p = 0.307).

Overall, the findings suggest that migraine may be associated with neuroaxonal involvement rather than astroglial injury, with evidence of increased neuroaxonal burden observed primarily in patients with migraine without aura. This study highlights the need to explore biological differences between migraine types in order to support better diagnosis and more targeted treatment approaches.

EAN 2026, June 27-30, Geneva, Switzerland.