Letter to the Editor regarding “Effect of Altmetric score on manuscript citations: A randomized-controlled trial”

Dear Editor,

We have with great interest read the recent paper by Peres et al., entitled Effect of Altmetric score on manuscript citations: A randomized-controlled trial (1).

Social media represents a powerful tool to disseminate scientific results to a broader audience, and several journals have already developed strategies for an online media presence including those of the International Headache Society, the European Headache Federation, and the American Headache Society. Online web-based metrics for scholarly publications, e.g., Altmetric Attention Score, has emerged as a complement to conservative citation-based metrics such as the h-index to measure the impact of a publication (2). The Altmetric Attention Score represents a record of volume of attention a research publication has received on online mainstream media including social media and web forums.

In the recent paper by Peres et al. (1), the authors demonstrated that promoting papers on social media can lead to a significant increase in the Altmetric score in parallel with a higher number of scientific citations.

Yet, there are most likely many other factors at play when it comes to scientific outreach. When we analyzed the 100 highest ranked publications according to their Altmetric Attention Score on migraine (Table 1), we did not find a correlation between the Altmetric Attention Score and number of citations, which is in line with previous reports (3). So while randomized trials have demonstrated that promotion on social media is associated with a higher number of scientific citations (1), these findings may only hold true for those papers with less interest to the general public. As such, a deliberate social media strategy is just one of many factors that may play a role in scientific outreach. Of note, several scientific landmark findings within the migraine field are not included on this ranking list.

Table 1.

The top 100 most popular migraine articles according to their Altmetric Attention Score.

Rank	Title	First Author	Year	Journal	Altmetric Attention Score	Scientific Citations, n
1	Fremanezumab for the Preventive Treatment of Chronic Migraine	Stephen D Silberstein	2017	New England Journal of Medicine	2110	358
2	Prospective Cohort Study of Caffeinated Beverage Intake as a Potential Trigger of Headaches among Migraineurs	Elizabeth Mostofsky	2019	The American Journal of Medicine	1917	9
3	Changes in health in the countries of the UK and 150 English Local Authority areas 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016	Nicholas Steel	2018	The Lancet	1700	110
4	A Controlled Trial of Erenumab for Episodic Migraine	Peter J. Goadsby	2017	New England Journal of Medicine	1460	433
5	Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States	Richard L. Nahin	2016	Mayo Clinic Proceedings	1170	117
6	Migraine and vascular disease	Rebecca C Burch	2016	The BMJ	1131	4
7	Meta-analysis of 375,000 individuals identifies 38 susceptibility loci for migraine	Padhraig Gormley	2016	Nature Genetics	1128	345
8	Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015	Theo Vos	2016	The Lancet	1079	3897
9	Trial of Amitriptyline, Topiramate, and Placebo for Pediatric Migraine	Scott W. Powers	2016	New England Journal of Medicine	1073	192
10	Migraine and risk of cardiovascular disease in women: prospective cohort study	Tobias Kurth	2016	The BMJ	1048	170
11	Racial and ethnic disparities in emergency department analgesic prescription	Joshua H. Tamayo-Sarver	2003	American Journal of Public Health	1021	238
12	Migraine photophobia originating in cone-driven retinal pathways	Rodrigo Noseda	2016	Brain	975	80
13	Fragranced consumer products: exposures and effects from emissions	Anne Steinemann	2016	Air Quality, Atmosphere & Health	931	50
14	Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016	Theo Vos	2017	The Lancet	954	3469
15	Migraines Are Correlated with Higher Levels of Nitrate-, Nitrite-, and Nitric Oxide-Reducing Oral Microbes in the American Gut Project Cohort	Antonio Gonzalez	2016	mSystems	917	31
16	Migraine: the seventh disabler	Timothy J. Steiner	2013	The Journal of Headache and Pain	880	190
17	A retrospective cost-analysis of additional homeopathic treatment in Germany: Long-term economic outcomes	Julia K. Ostermann	2017	PLOS One	875	6
18	Nonpainful remote electrical stimulation alleviates episodic migraine pain	David Yarnitsky	2017	Neurology	823	58
19	Carvedilol blocks neural regulation of breast cancer progression in vivo and is associated with reduced breast cancer mortality in patients	Ryan D. Gillis	2021	European Journal of Cancer	817	9
20	CGRP — The Next Frontier for Migraine	Andrew D. Hershey	2017	New England Journal of Medicine	805	18
21	Dietary omega 3 fatty acids for migraine	Rebecca Burch	2021	The BMJ	804	2
22	Migraine and risk of cardiovascular diseases: Danish population based matched cohort study	Kasper Adelborg	2018	The BMJ	786	116
23	Guidelines for the Prevention of Stroke in Women	Cheryl Bushnell	2014	Stroke	786	578
24	A limited survey-based uncontrolled follow-up study of children born after ooplasmic transplantation in a single centre	Serena H. Chen	2016	Reproductive BioMedicine Online	779	31
25	Short- and Long-Term Effects of Cannabis on Headache and Migraine	Carrie Cuttler	2019	Journal of Pain	766	16
26	The impact of sexual activity on idiopathic headaches: An observational study	Anke Hambach	2013	Cephalalgia	750	8
27	Altered Placebo and Drug Labeling Changes the Outcome of Episodic Migraine Attacks	Slavenka Kam-Hansen	2014	Science Translational Medicine	737	268
28	Chiropractic spinal manipulative therapy for migraine: a three‐armed, single‐blinded, placebo, randomized controlled trial	A. Chaibi	2016	European Journal of Neurology	731	24
29	A multicenter, prospective, single arm, open label, observational study of sTMS for migraine prevention (ESPOUSE Study)	Amaal J. Starling	2018	Cephalalgia	677	76
30	Migraine and risk of cardiovascular disease	Tobias Kurth	2018	The BMJ	670	5
31	TRP Channels as Potential Targets for Sex-Related Differences in Migraine Pain	Maite Artero-Morales	2018	Frontiers in Molecular Biosciences	662	21
32	Diagnosis and management of migraine in ten steps	Anna K. Eigenbrodt	2021	Nature Reviews Neurology	645	5
33	Effects of Medical Marijuana on Migraine Headache Frequency in an Adult Population	Danielle N. Rhyne	2016	Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy	642	54
34	Postmarketing safety surveillance data reveals antidepressant effects of botulinum toxin across various indications and injection sites	Tigran Makunts	2020	Scientific Reports	639	5
35	Migraine prevention with a supraorbital transcutaneous stimulator	Jean Schoenen	2013	Neurology	606	227
36	Can Additional Homeopathic Treatment Save Costs? A Retrospective Cost-Analysis Based on 44500 Insured Persons	Julia K. Ostermann	2015	PLOS One	599	14
37	Persistent Brainstem Dysfunction in Long-COVID: A Hypothesis	Shin Jie Yong	2021	ACS Chemical Neuroscience	593	21
38	Atogepant for the Preventive Treatment of Migraine	Jessica Ailani	2021	New England Journal of Medicine	592	1
39	Randomized study of IV prochlorperazine plus diphenhydramine vs IV hydromorphone for migraine	Benjamin W. Friedman	2017	Neurology	590	44
40	Effect of yoga as add-on therapy in migraine (CONTAIN): A randomized clinical trial.	Anand Kumar	2020	Neurology	560	7
41	Clinical Endocannabinoid Deficiency Reconsidered: Current Research Supports the Theory in Migraine, Fibromyalgia, Irritable Bowel, and Other Treatment-Resistant Syndromes	Ethan B. Russo	2016	Cannabis and Cannabinoid Research	554	73
42	Factors Related to Migraine Patients’ Decisions to Initiate Behavioral Migraine Treatment Following a Headache Specialist’s Recommendation: A Prospective Observational Study	Mia T. Minen	2018	Pain Medicine	553	18
43	Global, regional, and national burden of neurological disorders during 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015	Valery L Feigin	2017	The Lancet Neurology	543	966
44	Towards improved migraine management: Determining potential trigger factors in individual patients	Francesc Peris	2016	Cephalalgia	540	55
45	A Comparison of the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study and American Migraine Prevalence and Prevention (AMPP) Study: Demographics and Headache‐Related Disability	Richard B. Lipton	2016	Headache The Journal of Head and Face Pain	524	77
46	The Prevalence and Burden of Migraine and Severe Headache in the United States: Updated Statistics From Government Health Surveillance Studies	Rebecca C. Burch	2015	Headache The Journal of Head and Face Pain	516	321
47	FDA just approved the first drug to prevent migraines. Here’s the story of its discovery—and its limitations	Emily Underwood	2018	Science	507	2
48	User Design and Experience Preferences in a Novel Smartphone Application for Migraine Management: A Think Aloud Study of the RELAXaHEAD Application	Mia T. Minen	2018	Pain Medicine	504	19
49	Practice guideline update summary	David M. Simpson	2016	Neurology	504	300
50	Self-reported Physical Health of Women Who Did and Did Not Terminate Pregnancy After Seeking Abortion Services: A Cohort Study.	Lauren J. Ralph	2019	Annals of Internal Medicine	501	20
51	Diet and Headache: Part 1	Vincent T. Martin	2016	Headache The Journal of Head and Face Pain	500	33
52	Screening for Insomnia: An Observational Study Examining Sleep Disturbances, Headache Characteristics, and Psychiatric Symptoms in Patients Visiting a Headache Center.	Olivia Begasse de Dhaem	2017	Pain Medicine	496	4
53	Effect of Ubrogepant vs Placebo on Pain and the Most Bothersome Associated Symptom in the Acute Treatment of Migraine	Richard B. Lipton	2019	JAMA	487	97
54	Body composition status and the risk of migraine	Bizu Gelaye	2017	Neurology	473	52
55	Acupuncture for the prevention of episodic migraine	Klaus Linde	2016	Cochrane Database of Systematic Reviews	470	162
56	Assessing Barriers to Chronic Migraine Consultation, Diagnosis, and Treatment: Results From the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study	David W. Dodick	2016	Headache The Journal of Head and Face Pain	463	108
57	Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial	Marc M. Cohen	2017	The Medical Journal of Australia	462	30
58	Dietary alteration of n-3 and n-6 fatty acids for headache reduction in adults with migraine: randomized controlled trial	Christopher E. Ramsden	2021	The BMJ	465	2
59	Cgrp May Play A Causative Role in Migraine	LH Lassen	2002	Cephalalgia	449	673
60	Novel Intranasal Delivery of Sumatriptan as a Route to Rapid and Sustained Relief in the Acute Treatment of Migraine	Deborah I. Friedman	2016	US Neurology	449	0
61	The Long-term Effect of Acupuncture for Migraine Prophylaxis: A Randomized Clinical Trial	Ling Zhao	2017	JAMA Internal Medicine	446	133
62	Safety and efficacy of AMG 334 for prevention of episodic migraine: a randomised, double-blind, placebo-controlled, phase 2 trial	Hong Sun	2016	The Lancet Neurology	439	243
63	Functional Changes of the Perigenual Part of the Anterior Cingulate Cortex after External Trigeminal Neurostimulation in Migraine Patients	Antonio Russo	2017	Frontiers in Neurology	433	35
64	Clinical experience with transcutaneous supraorbital nerve stimulation in patients with refractory migraine or with migraine and intolerance to topiramate: a prospective exploratory clinical study	Michail Vikelis	2017	BMC Neurology	433	26
65	Safety and efficacy of erenumab for preventive treatment of chronic migraine: a randomised, double-blind, placebo-controlled phase 2 trial	Stewart Tepper	2017	The Lancet Neurology	432	364
66	Transcutaneous supraorbital neurostimulation for the prevention of chronic migraine: a prospective, open-label preliminary trial	Paola Di Fiore	2017	Neurological Sciences	428	34
67	Insights into the Functional Anatomy Behind the PREEMPT Injection Paradigm: Guidance on Achieving Optimal Outcomes	Andrew M. Blumenfeld	2017	Headache The Journal of Head and Face Pain	423	29
68	QuickStats: Percentage* of Adults Aged ≥18 Years Who Reported Having a Severe Headache or Migraine in the Past 3 Months,† by Sex and Age Group — National Health Interview Survey,§ United States, 2015	Anjel Vahratian	2017	MMWR Morbidity and Mortality Weekly Report	419	4
69	Vagus Nerve Stimulation and Headache	Hsiangkuo Yuan	2015	Headache The Journal of Head and Face Pain	419	35
70	Vitamin D status in pediatric irritable bowel syndrome	Benjamin Udoka Nwosu	2017	PLOS One	416	13
71	Current understanding of photophobia, visual networks and headaches	Rodrigo Noseda	2018	Cephalalgia	416	32
72	Fluctuations in episodic and chronic migraine status over the course of 1 year: implications for diagnosis, treatment and clinical trial design	Daniel Serrano	2017	The Journal of Headache and Pain	415	96
73	Association between human papillomavirus vaccination and serious adverse events in South Korean adolescent girls: nationwide cohort study	Dongwon Yoon	2021	The BMJ	414	3
74	Human local adaptation of the TRPM8 cold receptor along a latitudinal cline	Felix M. Key	2018	PLOS Genetics	411	48
75	Rimegepant, an Oral Calcitonin Gene–Related Peptide Receptor Antagonist, for Migraine	Richard B. Lipton	2019	New England Journal of Medicine	405	115
76	Case Report: Neurocysticercosis Acquired in Australia.	Daniel Forster	2020	American Journal of Tropical Medicine and Hygiene	383	2
77	A randomized trial of telemedicine for migraine management	Deborah I. Friedman	2019	Cephalalgia	374	29
78	CGRP as a neuropeptide in migraine: lessons from mice	Andrew F. Russo	2015	British Journal of Clinical Pharmacology	370	28
79	Association between Fine Particulate Air Pollution and Daily Clinic Visits for Migraine in a Subtropical City: Taipei, Taiwan	Chih-Cheng Chen	2015	International Journal of Environmental Research and Public Health	369	15
80	Chronic Migraine: Epidemiology and Disease Burden	Aubrey N. Manack	2010	Current Pain and Headache Reports	367	139
81	Undiagnosed intracranial lipoma associated with sudden death	Carlos Durão	2017	Human Pathology Case Reports	365	1
82	The effect and safety of monoclonal antibodies to calcitonin gene-related peptide and its receptor on migraine: a systematic review and meta-analysis	Min Hou	2017	The Journal of Headache and Pain	364	36
83	Acute prolonged motor aura resembling ischemic stroke after COVID-19 vaccination (CoronaVac): the first case report	Wanakorn Rattanawong	2021	The Journal of Headache and Pain	363	2
84	American Medical Society for Sports Medicine position statement: concussion in sport	Kimberly G. Harmon	2012	British Journal of Sports Medicine	358	768
85	Effect of Fremanezumab Compared With Placebo for Prevention of Episodic Migraine: A Randomized Clinical Trial	David W. Dodick	2018	JAMA	355	229
86	Aspirin in the Treatment and Prevention of Migraine Headaches: Possible Additional Clinical Options for Primary Healthcare Providers	Bianca Biglione	2019	The American Journal of Medicine	352	5
87	The Cannabis sativa Versus Cannabis indica Debate: An Interview with Ethan Russo, MD	Daniele Piomelli	2016	Cannabis and Cannabinoid Research	350	90
88	Clinical Risk Score for Persistent Postconcussion Symptoms Among Children With Acute Concussion in the ED	Roger Zemek	2016	JAMA	348	391
89	Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010	Theo Vos	2012	The Lancet	344	5288
90	Migraine and risk of perioperative ischemic stroke and hospital readmission: hospital based registry study	Fanny P. Timm	2017	The BMJ	343	46
91	Migraine prevalence, disease burden, and the need for preventive therapy	Richard B. Lipton	2007	Neurology	332	1576
92	Safety and efficacy of remote electrical neuromodulation for the acute treatment of chronic migraine: an open-label study.	Brian Grosberg	2021	PAIN Reports	328	327
93	A chronological map of 308 physical and mental health conditions from 4 million individuals in the English National Health Service	Valerie Kuan	2019	The Lancet Digital Health	326	72
94	Substitution of medical cannabis for pharmaceutical agents for pain, anxiety, and sleep	Brian J. Piper	2017	Journal of Psychopharmacology	325	92
95	Common Variant Burden Contributes to the Familial Aggregation of Migraine in 1,589 Families	Padhraig Gormley	2018	Neuron	317	34
96	TEV-48125 for the preventive treatment of chronic migraine	Marcelo E. Bigal	2016	Neurology	317	68
97	Manual acupuncture versus sham acupuncture and usual care for prophylaxis of episodic migraine without aura: multicentre, randomised clinical trial	Shabei Xu	2020	The BMJ	316	21
98	Suboptimal magnesium status in the United States: are the health consequences underestimated?	Andrea Rosanoff	2012	Nutrition Reviews	316	179
99	Omega-3 Fatty Acids in Inflammation and Autoimmune Diseases	Artemis P. Simopoulos	2002	Journal of the American College of Nutrition	309	1321
100	Global, regional, and national burden of neurological disorders, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016	Valery L. Feigin	2019	The Lancet Neurology	308	882

Two investigators (SA, TPD) independently extracted data for the included publications. The search was performed on 22 November 2021 with the following search string and no restrictions for date of publication: “migraine”, free text in title and abstract using the Altmetric Explorer database. Altmetric Attention Score and citation numbers was assessed by Spearman’s rank correlation coefficient; one analysis was done for all publications and one for publications with a publication year ≥5 years. There was no correlation between the Altmetric Attention Score and citation numbers for all publications (p = 0.80876). There was no correlation between the Altmetric Attention Score and citation numbers for with a publication year ≥5 years prior to the year of inquiry (p = 0.29544).

To break the glass ceiling of scientific outreach, we must continue to identify factors that influence our communication and contact to the general population as researchers. Interestingly, almost all of the publications in the top 100 were primarily related to clinical research (Table 1). These findings suggest that basic science does not have a wide public outreach. Factual knowledge levels of the recipient affect receptivity to a message (4), which may be one of the factors that limits the outreach of basic science. Basic science generally delves into pathophysiological mechanisms whereas results of clinical trials may be easier to translate into a public message, e.g., is the drug effective and tolerable?

We praise Peres et al. for increasing the available evidence on scientific outreach within the headache field, especially considering the novelty of their trial. It is one of first many important steps towards increasing the general knowledge of headache disorders amongst the general population. Further research should aim to identify which factors that influence outreach of headache research and strategies to improve our communication on internet-based communication platforms.