27 General introduction 1 This thesis can be roughly divided into three parts. Part I focusses on the use of E-diaries for clinical and research purposes. Part II focusses on migraine in women in relation to the menstrual cycle. Part III highlights the pros and cons of treating migraine with anti-CGRP (ligand or receptor) antibodies. Part I. The use of telemedicine in the monitoring and treatment of migraine Chapter 2 introduces an electronic E-diary developed and validated by the Leiden Headache Center. This chapter offers insights into the practical experiences with this E-diary, including patient and clinician satisfaction and its user-friendliness. In chapter 3, the definitions of a migraine day and a headache day are reevaluated in light of the emerge of E-diaries, which have established new standards. It emphasizes the importance of adhering to consistent outcome measurements. Chapter 4 demonstrates the broad potential of headache E-diaries for ad hoc research, particularly during the COVID-19 pandemic. Data is collected prospectively with a 48-hour time-lock, minimizing recall bias and creating a unique dataset to assess the impact of COVID-19 vaccinations and infections. Part II. Migraine in women in relation to the menstrual cycle In chapter 5, differences between migraine with aura and migraine without aura are examined concerning their association with menstruation and other hormonal milestones like pregnancy and breastfeeding. It also provides a cross-sectional analysis of the effects of the oral contraceptive pill, but chapter 6 details the rationale and protocol for the ongoing WHAT! Trial, which is the first large randomized trial studying the effect of continuous combined oral contraceptive pill as a preventive treatment for menstrual migraine. Chapter 7 is evaluating the course of migraine during the menstrual cycle, particularly in regards to ovulation, as there is still limited evidence whether the ovulation period is also associated with an increase in migraine. In chapter 8, serum hormone levels are collected throughout the menstrual cycle and compared between women with migraine and healthy controls, in order to study the underlying pathophysiology of menstrual migraine. Part III. Safety of treatment with anti-CGRP (receptor) antibodies Chapter 9 discusses cardiovascular safety outcomes during at least 12 months of treatment with these medications and assesses related safety considerations. Chapter 10 presents the results of a systematic review on the impact of anti-CGRP monoclonal antibody treatments on blood pressure in patients with migraine.
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