Cephalalgia最新文献

AimTo compare cortical microstructural features in people with persistent post-traumatic headache (PPTH), migraine and healthy controls (HCs) using quantitative magnetic resonance imaging (qMRI).MethodsThis cross-sectional study included 103 participants with PPTH, 296 with migraine and 155 HCs. All underwent 3.0 Tesla qMRI using standardized sequences to generate quantitative T2 (qT2), quantitative T1 (qT1) and apparent diffusion coefficient (ADC) maps. Intracortical voxel values were projected onto the cortical surface for surface-based analysis. Group comparisons were adjusted for age and sex, with correction for multiple comparisons. Associations with clinical variables were explored in regions showing significant group differences.ResultsCompared with HCs, participants with PPTH showed elevated qT2 values in the left lateral occipital cortex (p_cluster = 0.0002). Compared with migraine, those with PPTH exhibited lower ADC values in the left superior frontal cortex (p_cluster = 0.0020). Relative to migraine with aura, additional reductions in qT1 and ADC values were found in the right middle and inferior temporal gyri (all p_cluster < 0.01), and, relative to migraine without aura, lower ADC values were detected in the right middle temporal gyrus (p_cluster = 0.0002).ConclusionsCortical microstructural alterations in PPTH suggest underlying neurobiological processes distinct from both migraine and healthy adults. The findings support a pathophysiological model involving chronic low-grade neuroinflammation.

AimPost-traumatic headache (PTH) attributed to mild traumatic brain injury (mTBI) frequently co-occurs with other physical, cognitive, and emotional symptoms. This study assessed associations between PTH improvement and these symptoms in individuals with acute headaches (APTH) and compared symptoms between those who had recently developed persistent PTH (PPTH) to those who had long-standing PPTH.MethodsThis study included 105 individuals with APTH (mean age = 43.4, SD = 15.8; 70 females, 35 males) and 46 individuals with PPTH (mean age = 38.2, SD = 10.9; 16 females, 30 males) with an average duration of 11.3 years from two prospective longitudinal studies. For those who had APTH, PTH improvement was assessed at three months post-enrollment using an electronic headache diary. Participants completed questionnaires evaluating physical (including headache symptoms, photosensitivity, hyperacusis, insomnia, autonomic symptoms, and disability), emotional (including depression, anxiety, pain catastrophizing, and post-traumatic stress disorder screening), and cognitive symptoms (including memory and attention). The APTH cohort completed questionnaires at baseline, follow-up #1 (three to four months from baseline), and follow-up #2 (six to seven months from baseline). Mixed Effects Models were used to analyze the temporal trend of symptoms among the APTH improved and non-improved groups.ResultsAmong the 105 individuals with APTH, 60 experienced PTH improvement and 45 did not. At baseline, compared to those who had PTH improvement, those who did not have PTH improvement had higher SCAT total scores and physical subscores, greater levels of hyperacusis, pain catastrophizing, anxiety and depression. At follow-up #1 (three to four months), these individuals continued to show more pronounced physical and emotional symptoms and worse cognitive function and insomnia. Most of these group differences persisted at follow-up #2 (six to seven months). Most symptoms showed progressive improvement over three months for individuals who had PTH improvement but not for those without PTH improvement. Furthermore, individuals with long-standing PPTH showed more severe insomnia, pain catastrophizing, and PTSD compared to those who had recently developed PPTH.ConclusionIndividuals with APTH who did not experience PTH improvement at three months had more severe physical, cognitive, and emotional symptoms at baseline compared to those who had PTH improvement. While most symptoms normalized in individuals with PTH improvement, symptoms overall persisted at three and at six months for those with PTH persistence. Individuals who had long-standing PPTH had more severe insomnia and more negative cognitive/emotional responses to pain compared to those who had recently developed PPTH.

AimCorneal confocal microscopy (CCM) is a non-invasive ophthalmic imaging technique for evaluating the corneal microstructure, particularly the subepithelial nerve plexus. This dense, dynamic plexus contains small nerve fibers from the ophthalmic branch of the trigeminal nerve. This study aimed to evaluate corneal nerve alterations in individuals with migraine, including its subtypes and visual hypersensitivity (measured with the Leiden visual sensitivity scale (L-VISS), a validated nine-item questionnaire).MethodsIn total, 55 migraine participants were included, including 26 with episodic migraine and 29 with chronic migraine, as well as 55 age- and sex-matched controls. All subjects underwent CCM, and automated corneal nerve fiber density (ACNFD), length (ACNFL) and branch density (ACNBD) were assessed using the Rostock Cornea Module (Heidelberg Retina Tomograph III). Data were compared with age- and sex-matched healthy volunteers.ResultsReduced ACNFD, ACNFL and ACNBD were found in migraine participants compared to controls (all p < 0.001). No difference was found between episodic migraine and chronic migraine, and regression analysis showed no significant effect for (inter)ictal visual hypersensitivity.ConclusionsThese findings support the utility of CCM as a sensitive tool for detecting nerve fiber pathology in migraine and highlight its potential in further understanding migraine pathophysiology. The observed nerve changes, present irrespective of migraine frequency status or visual hypersensitivity, suggest a broader role for peripheral nerve dysfunction in migraine beyond sensory hypersensitivity symptoms.

AimThis study aimed to identify risk factors associated with non-optimal triptan response among migraine patients, leveraging the unique combination of genetic and longitudinal data available in the FinnGen project.MethodsWe analyzed register data from 5351 consistent triptan users within the FinnGen project, focusing on patients who switched triptan medications at least once within a two-year period. We assessed 528 variables, including disease diagnoses, drug purchases and socio-economic status, aiming to evaluate clinical risk factors. Moreover, a genome-wide association study (GWAS) was conducted to explore genetic predispositions to triptan switching behavior in the same cohort of patients. Since no significant single nucleotide polymorphisms (SNPs) were found in the GWAS, a supplementary analysis based on previously reported SNPs associated with migraine susceptibility and triptan response was performed.ResultsOur cohort consisted predominantly of women (87%) with an average age of 38 years at the time of their first triptan purchase. In this population of patients who consistently use triptans, 85% of patients did not switch medications, while 9% switched once, 3% switched twice and 3% switched three or more times. Younger patients were more likely to switch medications. Clinical risk factors for switching included fibromyalgia and the use of gastro-oesophageal reflux medications for those who switched twice, and oral cavity disorders, intestinal disorders and gynecological diagnoses for those who switched three or more times. No significant genetic associations were identified.ConclusionsNon-optimal triptan response in migraine patients is associated with several clinical characteristics, including prior medical diagnoses and the use of other medications. No genetic associations were observed in this cohort.