Cephalalgia最新文献_第10页

To treat or not to treat? Medication underuse headache, a novel reframing. 治疗还是不治疗？药物使用不足的头痛，一个新的重构。

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Cephalalgia

Pub Date : 2024-05-01 DOI: 10.1177/03331024241252159

Claire H Sandoe, Werner J Becker

引用次数: 0

CLOCK gene circannual expression in cluster headache 丛集性头痛中的 CLOCK 基因环状表达

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Cephalalgia

Pub Date : 2024-04-27 DOI: 10.1177/03331024241247845

Renato Oliveira, Ana Neves-Costa, Dora Pedroso, Tiago Paixão, André B. Barros, Luís F. Moita, Raquel Gil-Gouveia

BackgroundCluster headache is a primary headache disorder characterized by bouts with circadian and circannual patterns. The CLOCK gene has a central role in regulating circadian rhythms. Here, we investigate the circannual CLOCK expression in a population of cluster headache patients in comparison to matched controls.MethodsPatients with cluster headache were sampled two to four times over at least one year, both in or outside bouts, one week after each solstice and equinox. The expression of CLOCK was measured by quantitative real-time polymerase chain reaction (RT-PCR) in the peripheral blood.ResultsThis study included 50 patients and 58 matched controls. Among the patient population, composed of 42/50 males (84%) with an average age of 44.6 years, 45/50 (90%) suffered from episodic cluster headache. Two to four samples were collected from each patient adding up to 161 samples, 36 (22.3%) of which were collected within a bout. CLOCK expression for cluster headache patients was considerably different from that of the control population in winter (p-value mean = 0.006283), spring (p-value mean = 0.000006) and summer (p-value mean = 0.000064), but not in autumn (p-value mean = 0.262272). For each season transition, the variations in CLOCK expression were more pronounced in the control group than in the cluster headache population. No statistically significant differences were found between bout and non-bout samples. No individual factors (age, sex, circadian chronotype, smoking and coffee habits or history of migraine) were related to CLOCK expression.ConclusionsWe observed that CLOCK expression in cluster headache patients fluctuates less throughout the year than in the control population. Bout activity and lifestyle factors do not seem to influence CLOCK expression.

背景丛集性头痛是一种原发性头痛疾病，其特征是具有昼夜节律和周而复始规律的阵发性头痛。CLOCK 基因在调节昼夜节律中起着核心作用。在此，我们将丛集性头痛患者与匹配的对照组进行比较，研究丛集性头痛患者的昼夜节律 CLOCK 表达。结果这项研究包括 50 名患者和 58 名匹配的对照组。患者中有 42/50 名男性（84%），平均年龄为 44.6 岁，其中 45/50 名患者（90%）患有阵发性丛集性头痛。每位患者采集了 2 至 4 个样本，共计 161 个样本，其中 36 个样本（22.3%）是在一次发作中采集的。丛集性头痛患者的 CLOCK 表达在冬季（p 值平均值 = 0.006283）、春季（p 值平均值 = 0.000006）和夏季（p 值平均值 = 0.000064）与对照人群有显著差异，但在秋季（p 值平均值 = 0.262272）则没有差异。在每个季节转换中，对照组的 CLOCK 表达变化比丛集性头痛人群更明显。在阵发性和非阵发性样本之间未发现有统计学意义的差异。没有个体因素（年龄、性别、昼夜节律时型、吸烟和喝咖啡习惯或偏头痛病史）与 CLOCK 表达有关。活动和生活方式因素似乎并不影响CLOCK的表达。

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引用次数: 0

Identification and characterization of migraine in pregnancy: A Norwegian registry-based cohort study 妊娠期偏头痛的识别和特征描述：一项基于挪威登记处的队列研究

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Cephalalgia

Pub Date : 2024-04-26 DOI: 10.1177/03331024241248846

Vera R. Mitter, Angela Lupattelli, Marte-Helene Bjørk, Hedvig M.E. Nordeng

BackgroundMigraine is common in women of reproductive age. Migraine’s episodic manifestation and acute and preventive pharmacological treatment options challenge studying drug safety for this condition during pregnancy. To improve such studies, we aimed to develop algorithms to identify and characterize migraines in electronic healthcare registries and to assess the level of care.MethodsWe linked four registries to detect pregnancies from 2009–2018 and used three algorithms for migraine identification: i) diagnostic codes, ii) triptans dispensed, and iii) a combination of both. We assessed migraine severity using dispensed drugs as proxies. ICD-10 diagnostic subcodes of migraine (G43) allowed the allocation of four subtypes: complicated and/or status migrainosus; with aura; without aura; other/unspecified.ResultsWe included 535,089 pregnancies in 367,908 women with available one-year lookback. The prevalence of migraines identified was 2.9%–4.3% before, and 0.8%–1.5% during pregnancy, depending on algorithm used. Pregnant women with migraine were mostly managed in primary care.ConclusionsPrimary care data in combination with drug dispensation records were instrumental for identification of migraine in electronic healthcare registries. Data from secondary care and drug dispensations allow better characterization of migraines. Jointly, these algorithms may contribute to improved perinatal pharmacoepidemiological studies in this population by addressing confounding by maternal migraine indication.

背景偏头痛在育龄妇女中很常见。偏头痛的发作性表现以及急性和预防性药物治疗方案给孕期药物安全性研究带来了挑战。为了改进此类研究，我们旨在开发算法来识别和描述电子医疗登记中的偏头痛，并评估护理水平。方法我们将四个登记处联系起来，以检测 2009-2018 年间的妊娠情况，并使用三种算法来识别偏头痛：i) 诊断代码；ii) 所配发的曲坦类药物；iii) 两者的组合。我们使用已配药物作为替代物来评估偏头痛的严重程度。通过 ICD-10 偏头痛诊断子编码（G43），我们可以划分出四个亚型：复杂性和/或状态性偏头痛；有先兆；无先兆；其他/未指定。根据所使用的算法，怀孕前偏头痛的发病率为2.9%-4.3%，怀孕期间为0.8%-1.5%。结论初级医疗数据与配药记录相结合，有助于在电子医疗登记中识别偏头痛。来自二级医疗机构的数据和配药记录可以更好地描述偏头痛的特征。联合使用这些算法可以解决产妇偏头痛适应症的混杂问题，从而有助于改进围产期药物流行病学研究。

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引用次数: 0

A comparative study on prophylactic efficacy of cinnarizine and amitriptyline in childhood migraine: a randomized double-blind clinical trial 辛那利嗪和阿米替林对儿童偏头痛预防效果的比较研究：随机双盲临床试验

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Cephalalgia

Pub Date : 2024-04-20 DOI: 10.1177/03331024241230963

Mehrnaz Olfat, Sareh Hosseinpour, Safdar Masoumi, Reena Gogia Rastogi, Eric Vance Hastriter, Kara Stuart Lewis, Robert Little, Kavitha T Karnik, Carolyn Hickman, Morteza Heidari, Reza Shervin Badv, Mahmoud Mohammadi, Gholam Reza Zamani, Masoud Mohammadpour, Mahmoud Reza Ashrafi, Ali Reza Tavasoli

BackgroundPediatric migraine prophylaxis is indicated when headaches are frequent and/or disabling. We aimed to conduct a study to compare the efficacy of cinnarizine and amitriptyline in pediatric migraine prophylaxis.MethodsIn a randomized, double-blind trial, patients aged 4–17 years with migraine who were eligible for prophylaxis enrolled. The primary outcome was a reduction response rate of ≥50% with p < 0.005 with respect to headache characteristics. The secondary outcome was migraine disability assessment. We evaluated patients every four weeks for three months: T1: week 4, T2: week 8 and T3: week 12. The safety profile was also assessed.ResultsThirty patients were randomly assigned to each group. However, 43 patients completed the trial. Headache frequency decreased in amitriptyline group more effectively in T1 ( p = 0.004). Amitriptyline was more successful in reducing the headache duration in all three periods ( p < 0.005). There was no significant difference in severity improvement and reducing disability score between the two groups ( p > 0.005). No serious adverse events were observed.ConclusionsBoth medications are effective in ameliorating migraine headaches and related disabilities. However, amitriptyline appears be a preferable option over cinnarizine, given its faster onset of action, efficacy in reducing headache duration and longer-lasting effects. Trial Registration: The study was registered with the Iranian Registry of Clinical Trials (IRCT) under the code IRCT-20191112045413N1.

背景儿童偏头痛预防适用于头痛频繁和/或致残性头痛。我们旨在开展一项研究，比较辛那利嗪和阿米替林在儿童偏头痛预防中的疗效。方法在一项随机双盲试验中，4-17 岁符合预防条件的偏头痛患者参加了试验。主要结果是头痛特征的缓解反应率≥50%，P< 0.005。次要结果是偏头痛残疾评估。我们每四周对患者进行一次评估，为期三个月：T1：第4周，T2：第8周，T3：第12周。我们还对安全性进行了评估。但有 43 名患者完成了试验。阿米替林组的头痛次数在 T1 阶段减少得更有效（p = 0.004）。阿米替林在三个阶段都能更有效地缩短头痛持续时间（p = 0.005）。两组在改善头痛严重程度和减少残疾评分方面没有明显差异（p > 0.005）。结论两种药物都能有效改善偏头痛及相关残疾。然而，阿米替林似乎比辛那利嗪更可取，因为阿米替林起效更快，能有效缩短头痛持续时间，疗效更持久。试验注册：该研究已在伊朗临床试验注册中心（IRCT）注册，代码为IRCT-20191112045413N1。

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引用次数: 0

Medication “underuse” headache 药物 "使用不足 "引发的头痛

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Cephalalgia

Pub Date : 2024-04-13 DOI: 10.1177/03331024241245658

Wanakorn Rattanawong, Alan Rapoport, Anan Srikiatkhachorn

BackgroundMany risk factors have been associated with migraine progression, including insufficient and ineffective utilization of migraine medications; however, they have been inadequately explored. This has resulted in suboptimal usage of medications without effective altering of prescribing recommendations for patients, posing a risk for migraine chronification.MethodsOur aim is to conduct a comprehensive review of the available evidence regarding the underuse of migraine medications, both acute and preventive. The term “underuse” includes, but is not limited to: ( 1 ) ineffective use of appropriate and inappropriate medication; ( 2 ) underutilization; ( 3 ) inappropriate timing of usage; and ( 4 ) patient dissatisfaction with medication.ResultsThe underuse of both acute and preventive medications has been shown to contribute to the progression of migraine. In terms of acute medication, chronification occurs as a result of insufficient drug use, including failure of the prescriber to select the appropriate type based on pain intensity and disability, patients taking medication too late (more than 60 minutes after the onset or after central sensitization has occurred as evidenced by allodynia), and discontinuation because of lack of effect or intolerable side effects. The underlying cause of inadequate effectiveness of acute medication lies in its inability to halt the propagation of peripheral activation to central sensitization in a timely manner. For oral and injectable preventive migraine medications, insufficient efficacy and intolerable side effects have led to poor adherence and discontinuation with subsequent progression of migraine. The underlying pathophysiology here is rooted in the repetitive stimulation of afferent sensory pain fibers, followed by ascending brainstem pain pathways plus dysfunction of the endogenous descending brainstem pain inhibitory pathway. Although anti-calcitonin gene-related peptide (CGRP) medications partially address pain caused by the above factors, including decreased efficacy and tolerability from conventional therapy, some patients do not respond well to this treatment. Research suggests that initiating preventive anti-CGRP treatment at an early stage (during low frequency episodic migraine attacks) is more beneficial than commencing it during high frequency episodic attacks or when chronic migraine has begun.ConclusionsThe term “medication underuse” is underrecognized, but it holds significant importance. Optimal usage of acute care and preventive migraine medications could potentially prevent migraine chronification and improve the treatment of migraine attacks.

背景许多风险因素都与偏头痛的进展有关，其中包括偏头痛药物使用不足和无效；然而，这些因素尚未得到充分探讨。我们的目的是对偏头痛药物（包括急性和预防性药物）使用不足的现有证据进行全面回顾。术语 "使用不足 "包括，但不限于(结果偏头痛急性期和预防期药物使用不足已被证实会导致偏头痛的恶化。在急性用药方面，慢性化的发生是由于用药不足，包括处方者未能根据疼痛强度和残疾程度选择合适的药物类型、患者用药过晚（发病超过60分钟后或中枢敏化发生后，表现为异痛症），以及由于缺乏疗效或无法忍受的副作用而停药。急性药物疗效不佳的根本原因在于无法及时阻止外周激活向中枢敏化的传播。对于口服和注射预防性偏头痛药物而言，疗效不佳和无法忍受的副作用导致患者不能很好地坚持用药和停药，进而导致偏头痛病情恶化。其潜在的病理生理学根源在于传入感觉痛觉纤维的重复刺激，然后是脑干疼痛上升通路，再加上内源性脑干疼痛下降抑制通路的功能障碍。虽然抗降钙素基因相关肽（CGRP）药物可以部分解决上述因素引起的疼痛，包括传统疗法的疗效和耐受性下降，但有些患者对这种疗法反应不佳。研究表明，在早期阶段（发作性偏头痛低频发作时）开始预防性抗CGRP治疗，比在发作性偏头痛高频发作时或慢性偏头痛开始发作时开始治疗更有益。最佳使用急性治疗和预防性偏头痛药物有可能防止偏头痛慢性化，并改善偏头痛发作的治疗。

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引用次数: 0

The non-decussating and decussating trigeminothalamic tracts in humans: A combination of connectome-based tractography and histological validation 人类三叉丘脑的非断裂和断裂束：基于连通组的束描和组织学验证相结合

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Cephalalgia

Pub Date : 2024-04-13 DOI: 10.1177/03331024241235168

Dylan J.H.A. Henssen, Cynthia Pritsch, Pouyan Nazari, Wim Mulleners, Kris Vissers

BackgroundFunctional anatomical research proposed the existence of a bilateral trigeminal ascending system although the anatomy trajectories of the trigeminothalamic connections cranial to the pons remain largely elusive. This study therefore aimed to clarify the anatomical distributions of the trigeminothalamic connections in humans.MethodsAdvanced deterministic tractography to an averaged template of diffusion tensor imaging data from 1065 subjects from the Human Connectome Project was used. Seedings masks were placed in Montreal Neurological Institute standard space by use of the BigBrain histological dataset. Waypoint masks of the sensory thalamus was obtained from the Brainnetome Atlas.ResultsTractography results were validated by use of the BigBrain histological dataset and Polarized Light Imaging microscopy. The trigeminothalamic tract bifurcated into a decussating ventral and a non-decussating dorsal tract. The ventral and dorsal tracts ascended to the contralateral thalamus and ipsilateral thalamus and reflected the ventral trigeminothalamic tract and the dorsal trigeminothalamic tract, respectively. The projection of the ventral trigeminothalamic tract and the dorsal trigeminothalamic tract to both thalami confirm the existence of a bilateral trigeminothalamic system in humans.ConclusionsBecause our study is strictly anatomical, no further conclusions can be drawn with regard to physiological functionality. Future research should explore if the dorsal trigeminothalamic tract and the ventral trigeminothalamic tract actually transmit signals from noxious stimuli, this offers potential in understanding and possibly treating neuropathology in the orofacial region.

背景功能解剖学研究提出存在双侧三叉神经上升系统，但三叉神经-丘脑连接头颅到脑桥的解剖轨迹在很大程度上仍然难以捉摸。因此，本研究旨在阐明人类三叉神经丘脑连接的解剖学分布。方法采用先进的确定性牵引成像技术，对来自人类连接组计划的 1065 名受试者的扩散张量成像数据的平均模板进行分析。利用 BigBrain 组织学数据集，在蒙特利尔神经研究所标准空间中放置了种子掩膜。结果通过 BigBrain 组织学数据集和偏振光成像显微镜验证了切片成像结果。三叉丘脑束分叉为一个互斥的腹侧束和一个非互斥的背侧束。腹侧束和背侧束上升至对侧丘脑和同侧丘脑，分别反映了三叉丘脑腹侧束和三叉丘脑背侧束。腹侧三叉微丘脑束和背侧三叉微丘脑束向两个丘脑的投射证实了人类存在双侧三叉微丘脑系统。未来的研究应探讨背侧三叉神经丘脑束和腹侧三叉神经丘脑束是否真的能传递有害刺激的信号，这为了解和治疗口面部神经病变提供了可能。

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引用次数: 0

Update on cough, exertional and sex headache 咳嗽、劳累性头痛和性头痛的最新情况

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Cephalalgia

Pub Date : 2024-04-10 DOI: 10.1177/03331024241246241

Peter J. Goadsby

引用次数: 0

A response: Update on cough, exertional and sex headache 回应：咳嗽、劳累性头痛和性头痛的最新情况

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Cephalalgia

Pub Date : 2024-04-04 DOI: 10.1177/03331024241246242

Vicente González-Quintanilla, Jorge Madera, Julio Pascual

引用次数: 0

Breaking barriers in migraine care: Advancing gender medicine to bridge the gap for men. 打破偏头痛治疗的障碍：推进性别医学，为男性缩小差距。

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Cephalalgia

Pub Date : 2024-03-01 DOI: 10.1177/03331024241238157

Simona Sacco, Frank Porreca

引用次数: 0

Melatonin in hemicrania continua and paroxysmal hemicrania. 褪黑素在持续性偏头痛和阵发性偏头痛中的作用。

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Cephalalgia

Pub Date : 2024-03-01 DOI: 10.1177/03331024231226196

Sing-Ngai Cheung, Renato Oliveira, Peter J Goadsby

Background: Hemicrania continua (HC) and paroxysmal hemicrania (PH) belong to a group of primary headache disorders called trigeminal autonomic cephalalgias. One of the diagnostic criteria for both HC and PH is the absolute response to the therapeutic dose of indomethacin. However, indomethacin is discontinued in many patients as a result of intolerance to its side effects. Melatonin, a pineal hormone, which shares similar chemical structure to indomethacin, has been reported to have some efficacy for HC in previous case reports and series. To our knowledge, there is no literature regarding the use of melatonin in PH. We aimed to describe the clinical use of melatonin in the preventive management of HC and PH.

Methods: Patient level data were extracted as an audit from routinely collected clinical records in consecutive patients seen in outpatient neurology clinic at King's College Hospital, London, UK, from September 2014 to April 2023. Our cohort of patients were identified through a search using the keywords: hemicrania continua, paroxysmal hemicrania, melatonin and indomethacin. Descriptive statistics including absolute and relative frequencies, mean ± SD, median and interquartile range (IQR) were used.

Results: Fifty-six HC patients were included with a mean ± SD age of 52 ± 16 years; 43 of 56 (77%) patients were female. Melatonin was taken by 23 (41%) patients. Of these 23 patients, 19 (83%) stopped indomethacin because of different side effects. The doses of melatonin used ranged from 0.5 mg to 21 mg, with a median dose of 10 mg (IQR = 6-13 mg). Fourteen (61%) patients reported positive relief for headache, whereas the remaining nine (39%) patients reported no headache preventive effect. None of the patients reported that they were completely pain free. Two patients continued indomethacin and melatonin concurrently for better symptom relief. Eight patients continued melatonin as the single preventive treatment. Side effects from melatonin were rare. Twenty-two PH patients were included with mean ± SD age of 50 ± 17 years; 17 of 22 (77%) patients were female. Melatonin was given to six (27%) patients. The median dose of melatonin used was 8 mg (IQR = 6-10 mg). Three (50%) patients responded to melatonin treatment. One of them used melatonin as adjunctive treatment with indomethacin.

Conclusions: Melatonin showed some efficacy in the treatment of HC and PH with a well-tolerated side effect profile. It does not have the same absolute responsiveness as indomethacin, at the doses used, although it does offer a well-tolerated option that can have significant ameliorating effects in a substantial cohort of patients.

背景：持续性头痛（HC）和阵发性头痛（PH）属于原发性头痛疾病，被称为三叉神经自律性头痛。HC 和 PH 的诊断标准之一是对治疗剂量吲哚美辛的绝对反应。然而，许多患者因无法忍受吲哚美辛的副作用而停用该药。褪黑素是一种松果体激素，与吲哚美辛具有相似的化学结构，在以往的病例报告和系列研究中，褪黑素被报道对 HC 有一定疗效。据我们所知，目前还没有关于褪黑素在 PH 中应用的文献。我们旨在描述褪黑素在 HC 和 PH 预防性治疗中的临床应用：2014年9月至2023年4月期间，我们从英国伦敦国王学院医院神经病学门诊连续就诊患者的常规临床记录中提取了患者层面的数据。我们的患者队列是通过搜索关键词 "持续性颅内出血、阵发性颅内出血、褪黑素和吲哚美辛 "确定的。描述性统计包括绝对频率和相对频率、平均值±标度、中位数和四分位距（IQR）：56 名 HC 患者中有 43 人（77%）为女性。23名患者（41%）服用了褪黑素。在这 23 名患者中，19 人（83%）因不同的副作用而停用了吲哚美辛。褪黑素的使用剂量从 0.5 毫克到 21 毫克不等，中位剂量为 10 毫克（IQR = 6-13 毫克）。14名患者（61%）表示头痛症状得到了缓解，而其余9名患者（39%）则表示没有预防头痛的效果。没有一名患者表示完全摆脱了疼痛。两名患者继续同时服用吲哚美辛和褪黑素，以更好地缓解症状。八名患者继续将褪黑素作为单一的预防治疗。褪黑素的副作用非常罕见。22名PH患者的平均（±SD）年龄为50±17岁；22名患者中有17名（77%）为女性。6名患者（27%）服用了褪黑素。褪黑素的中位剂量为 8 毫克（IQR = 6-10 毫克）。三名患者（50%）对褪黑素治疗有反应。其中一人使用褪黑素作为吲哚美辛的辅助治疗：褪黑素在治疗HC和PH方面具有一定疗效，且副作用小。在所用剂量下，褪黑素的绝对疗效不如吲哚美辛，但褪黑素确实是一种耐受性良好的选择，可对大量患者产生显著的改善作用。

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引用次数: 0