Researchers from Montefiore Health System and Albert Einstein College of Medicine will present new findings on how to effectively treat migraine, and forecast the onset of pain in a number of neurological conditions including  dementia in older adults. Those are among the presentations at the 67^th Annual Meeting of the American Academy of Neurology (AAN) being held April 18 – 25 in Washington, D.C. The wide array of research will provide insights into some of the most prevalent neurological disorders and outline new clinical guidance for treatment of these conditions. 

“Our abstracts are helping to improve understanding of how the brain develops and gives rise to changes in behavior,” said Richard B. Lipton, M.D., director of Montefiore Headache Center and vice chair of neurology, and the Edwin S. Lowe Chair in Neurology, Albert Einstein College of Medicine. “We will focus on how neurological disorders like migraine and variables like sleep and stress impact our daily activities. We are excited to share this research with our colleagues and examine the implications these findings will have on clinical practices and training for the next generation of neurologists and related specialists.” Dr. Lipton also serves as the director of the Division of Cognitive Aging and Dementia at Montefiore and as director of the Einstein Aging Study. 

This year’s meeting will feature lectures, oral abstracts and poster presentations made by nationally and internationally renowned neurological experts. Dr. Lipton will also direct a half-day session highlighting recent epidemiological data on episodic and chronic migraine, including new methods for diagnosis and treating these forms of headache. He will be joined by Matthew S. Robbins, M.D., FAHS, director, Inpatient Services, Montefiore Headache Center, chief of Neurology, Einstein Division, Montefiore; and associate professor of Clinical Neurology, Einstein, as well as Dawn C. Buse, Ph.D., director, Behavioral Medicine, Montefiore Headache Center and associate professor of Clinical Neurology, Einstein. 

The aging research findings are derived from the Einstein Aging Study, which has tracked cognition in elderly Bronx residents since the 1980s. Investigators for each of these studies are available to speak with media. 

Migraine presentations:

1. Perception of the Family Burden of Chronic Migraine: Results of the CaMEO (Chronic Migraine Epidemiology & Outcomes) Study – The latest presentation from a national, longitudinal survey of persons with chronic and episodic migraine, the CaMEO study, found that of 11,518 respondents who suffer from chronic migraine, 72.5 percent thought they would be better partners and 59.1 percent thought they would be better parents if they did not suffer from this ailment. More than 20 percent of respondents cancelled a family vacation in the prior year. Presented by Dr. Dawn Buse. Poster #P5-039, Neuroepidemiology: Headache, Global Health and Infectious Disease. Wednesday, April 22 at 2:00PM. 

2. Consistency of Response in the COMPASS Study [Breath Powered^TM Nasal Delivery of 22 MG Sumatriptan Powder (AVP-825)Versus 100 MG Oral Sumatriptan in Acute Migraine: A Comparative Clinical Trial] – An investigational Breath Powered^TM device provided pain relief during multiple migraine attacks within 30 minutes of treatment being administered, according to this multicenter, crossover study of 185 patients. The findings suggest a pharmacokinetic advantage of sumatriptan powder being delivered into the nasal cavity. Presented by Dr. Lipton. Platform #S23.001, Headache: Epidemiology and Clinical. Wednesday, April 22 at 2:00PM.

3. Procedural Headache Medicine in Neurology Training: A Survey of U.S. Residency Program Directors – Injectable treatments like Botox have become standard of care for migraine and are used by thousands of practitioners worldwide. Despite this, programs to train neurology residents in these procedures do not exist. A nationwide survey of 55 neurology residency program directors found that though residents are exposed to such procedures for headache, formal education to gain the proper skills is quite rare, highlighting a gap in training. Presented by Dr. Robbins. Platform #S19.005. Tuesday, April 21 at 4:15PM.

4. Acute Headache Diagnosis in Pregnancy: A 5-Year Registry Study – A retrospective analysis of 140 pregnant women with acute headache, and who received neurological consultations, found that more than one-third had a secondary disorder such as preeclampsia/eclampsia. This study suggests need for new clinical guidelines for this population. Presented by Dr. Robbins and Dr. Lipton. Platform #S51.004. Headache: Imaging and Physiology. Thursday, April 23 at 4:00PM.

Aging studies:

1. Total Intracranial Volume and Current Total Brain Volume Are Linked to Level of Pain in Older Adults – Evaluating a person’s total intracranial volume and total brain volume may help improve prediction of how pain will interfere with daily activities in older adults. Pain interference has been linked to quality of pain management and has been recommended as a standard for pain measurement. Presented by Dr. Lipton and Mindy Joy Katz, M.P.H., senior associate in the Department of Neurology at Einstein. Platform #P3.302, Pain and Palliative Care. Tuesday, April 21 at 2:00PM.

2. Verbal Episodic Memory and Spatial Memory Correlate Differentially with Hippocampal Volume in Older Adults – A review of 101 adults over the age of 70, without dementia, found that the left part of the hippocampus, a small region of the brain, plays a critical role in episodic memory, while both the left and right hippocampal atrophy is associated with spatial memory. It is recommended that right and left hippocampal atrophy be assessed to help predict incident dementia. Presented by Dr. Lipton and Ms. Katz. Poster #P5.019, Aging Dementia, Cognitive and Behavioral Neurology. Wednesday, April 22 at 2:00PM.

3. Pain and Sleep Disturbance in the Elderly: Evaluation of the Role of Stress and Depression –

A cross-sectional analysis of 564 adults age 70 and older found that pain, stress and depression each had strong, independent associations with sleep disturbance. However, when including all three factors, stress and depression weakened the relationship between pain and sleep by approximately 35 percent and 22 percent, respectively. Presented by Dr. Richard Lipton, Ms. Mindy Katz and Molly Zimmerman, Ph.D., research associate professor of Neurology at Einstein. Poster #P7-310. Sleep: Restless Legs and REM Disorders. Thursday, April 23 at 2:00PM.

4. Pain Intensity and Pain Interference in Older Adults: Role of Gender, Obesity and Inflammation – A review of reported pain intensity and pain interference in daily life found that obesity and being overweight continue to be significantly associated with pain interference in women. In men, obesity and inflammatory marker high-sensitivity C-reactive protein is not associated with pain intensity or pain interference. Presented by Dr. Lipton and Ms. Mindy Katz. Poster #P3.310: Pain and Palliative Care. Tuesday, April 21 at 2:00PM.

Stroke:

1. Anxiety Influences TIA Diagnosis – Transient ischemic attacks (TIA), known as “mini-strokes,” might be over diagnosed, due to an association with anxiety. In an analysis of more than 6,500 cases at Montefiore hospitals from January 2009 – June 2014, anxiety remained an independent predictor of TIA diagnosis, alongside age, sex, race/ethnicity and hospital site. Presented by Daniel L. Labovitz, M.D., director, Stern Stroke Center, Montefiore and assistant professor of Clinical Neurology, Einstein and Deepa Bhupali, M.D., a neurologist at Montefiore and assistant professor of Neurology, Einstein. Poster #P7.134. Cerebrovascular Disease and Interventional Neurology: Stroke, Depression and Anxiety. Thursday, April 23 at 2:00PM.