Cephalalgia最新文献

BackgroundMigraine attacks are believed to unfold through discrete but interrelated phases, among which the premonitory phase has garnered increasing attention. This early phase, occurring hours to days before pain onset, might reflect neurobiological processes that promote subsequent headache generation. Neuroimaging of experimentally induced attacks enables controlled investigation of the brain mechanisms underlying these early symptoms. This systematic review synthesizes and critically appraises current neuroimaging evidence on the experimentally induced premonitory phase in individuals with migraine.MethodsA systematic literature search of MEDLINE and Embase was performed from database inception through June 1, 2025, using predefined terms related to migraine and premonitory symptoms. Studies were eligible if they reported original neuroimaging findings on experimentally induced migraine attacks and specifically addressed the premonitory phase. Two independent reviewers screened all titles, abstracts, and full-text articles and extracted relevant data. Due to methodological heterogeneity in study design, a narrative synthesis was applied to summarize findings and assess the consistency of reported brain activity patterns across included studies.ResultsSeven studies met the inclusion criteria, all of which used glyceryl trinitrate to induce migraine attacks and applied either positron emission tomography or magnetic resonance imaging to assess brain changes. Across studies, reported alterations in cerebral perfusion and functional connectivity-used as surrogates for neural activity-during the premonitory phase were inconsistent and lacked replication. While some investigations suggested involvement of the thalamus and pons, these findings were derived exclusively from exploratory or uncorrected analyses. Hypothalamic involvement-a hypothesized migraine generator-was only sporadically observed, and reproducibility not investigated. The inconsistencies across studies likely reflect small sample sizes (ranging from 5 to 21 participants), suboptimal definitions of the premonitory phase, absence of appropriate controls, and unconventional use of neuroimaging statistics.ConclusionsNeuroimaging studies investigating the experimentally induced premonitory phase of migraine have largely produced inconsistent findings, likely due to small sample sizes, non-standardized symptom definitions, and exploratory imaging analyses lacking statistical rigor. Current evidence offers limited support for specific neural correlates of this phase, and its translatability to spontaneous migraine remains uncertain. To improve interpretability and clinical relevance, future research should prioritize standardized definitions, adequate control groups, and use of appropriate neuroimaging statistics.Trial RegistrationPROSPERO - Identifier: CRD42023415959.

BackgroundPost-traumatic headache (PTH) is typically described as migraine- or tension-type-like and treated based on presentation. However, the actual presentations of PTH are not well characterized. The aim of this study is to provide a phenotypic characterization of persistent PTH and co-occurring neurological symptoms from a previously completed clinical trial and characterize PTH treatment utilization.MethodsThis study is a secondary analysis of veterans (N = 193) recruited to participate in a randomized clinical trial of cognitive-behavioral therapy, cognitive processing therapy, or treatment as usual for PTH. Descriptive statistics were examined across characteristics of PTH, including age, gender, neurobehavioral symptoms, headache-related disability, pain characteristics, pain locations, accompanying symptoms, and aura symptoms and treatment utilization.ResultsThe median presentation of PTH in this study was a headache with severe pain, lasting about 4 h, and with about 13 headache episodes per month. About half the participants reported a pulsating quality and/or nausea that accompanied head pain. Most characteristics were uncorrelated to each other. The majority of participants used medication to treat persistent PTH. Neurostimulation was the most common non-pharmacological treatment.ConclusionsThe results of this study show that characteristics associated with migraine are more frequently reported with PTH. Correlations among the migraine characteristics were moderate overall, and there was notable variability among reported characteristics of PTH. Treatment utilization for PTH was not associated with current neurobehavioral symptoms and included both pharmacological and non-pharmacological options.Trial RegistrationClinicalTrials.gov Identifier: NCT02419131.

BackgroundTo investigate whether epidemiological characteristics, including comorbidities, income, and education, have changed over time in people with cluster headache compared to controls.MethodsTrends in cardiopulmonary, neurological, and psychiatric comorbidities, and income and education categories, were assessed using linked data from Norwegian health registries for 2009-2022. Comorbidities were defined based on relevant diagnosis codes from both the primary and the specialist healthcare. Income was categorized based on the national median for each year. Education was assessed based on the International Classification Standard for Education. Each cluster headache case was matched with 20 controls without cluster headache. Prevalence rate ratios were calculated using generalized estimating equations.ResultsPeople with cluster headache had higher prevalence than matched controls without cluster headache in all examined comorbidities, particularly migraine (men: 9.8% versus 0.3%; women: 23.1% versus 1.6%), mood disorders (men: 6.7% versus 2.8%; women: 9.2% versus 4.9%), and pulmonary disorders (men: 3.0% versus 1.8%; women: 4.8% versus 2.3%). Hypertension, coronary heart disease, and psychiatric disorders in specific age- and sex groups increased more in people with cluster headache than in controls during the recording period. Low/medium income was more prevalent in people with cluster headache versus controls (men: 50.2% versus 42.2%; women: 51.4% versus 46.6%). Similarly, low/medium education was more prevalent in people with cluster headache than controls (men: 77.0% versus 65.1%; women: 65.0% versus 55.0%). The prevalence of low/medium education increased in young women during the recording period.ConclusionsPeople with cluster headache have a higher prevalence of comorbidities compared to matched controls, particularly migraine, mood disorders, and cardiopulmonary disease. Multiple comorbidities have increased in prevalence over time. Annual income and years of education were lower in people with cluster headache compared to matched controls. Cluster headache is a complex disease that requires specialist follow-up and individualized therapy.

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.