Cephalalgia最新文献

BackgroundIn Pakistan, we have shown that both migraine (one-year prevalence of 22.5%) and tension-type headache (TTH: 44.6%) are more common among the adult population than reported globally. Here, to inform local health policy and add to knowledge of the global burden of headache, we estimate the lost health and other burdens attributable to headache in this populous Eastern Mediterranean Region country.MethodsIn a cross-sectional survey using cluster-randomized sampling, we visited households unannounced in Punjab, Sindh, Khyber Pakhtunkhwa and Baluchistan. We randomly selected and interviewed one adult member (aged 18-65 years) of each household, using a validated Urdu version of the HARDSHIP (i.e. Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation) structured questionnaire. Burden enquiry was in multiple domains.ResultsIn total, there were 4223 participants. Those with headache spent on average 6.4% of their time with headache of moderate intensity, with females worse affected than males. Participants with migraine were worse affected than those with TTH. Those with probable medication-overuse headache or other headache on ≥15 days/month spent 39.7% and 30.2% of their total time with headache. Quality of life, productivity and participation in social or leisure activities were impaired. Factoring in prevalence and adjusting for age and gender, we estimated that 4.9-5.9% of all time in this population was spent with headache, and, on average, 3.1 and 3.8 days were lost from paid and household work in the preceding three months. Over half (57.5%) of the population were assessed as needing care, but education promoting effective self-care might reduce this to 28.7% in need of professional care.ConclusionsThe burdens of headache in Pakistan are therefore very substantial in terms of health and productivity losses. These findings are important to national health and economic policies. The benefits in health gain from nationwide implementation of structured headache services, cost-effective in themselves, should be accompanied by enhancements in productivity, offsetting the cost of these services.

BackgroundThe integration of artificial intelligence (AI) into medical education and clinical decision-making is rapidly expanding. ChatGPT-4o, a multimodal AI model, offers real-time access to a vast corpus of biomedical knowledge. Nonetheless, concerns persist regarding the scientific accuracy and interpretive reliability of its responses when applied to clinical subjects such as migraine.AimTo assess the reliability and factual accuracy of ChatGPT-4o when addressing key clinical questions regarding migraine.MethodsEight clinically relevant questions were submitted to ChatGPT-4o, covering migraine pathophysiology, diagnosis and treatment. Each response was compared with current evidence from high-impact medical literature and rated as satisfactory, partially satisfactory or unsatisfactory. Classifications were based on conceptual accuracy, reference validity and clinical coherence.ResultsOf the eight responses analyzed, 62.5% were classified as satisfactory, while 37.5% were deemed partially satisfactory. No response was considered entirely unsatisfactory. The most common limitations included reference-related AI hallucinations and insufficient technical depth in selected answers.ConclusionsChatGPT-4o demonstrates potential as a support tool in the dissemination of structured medical information about migraine. However, its clinical use must remain supervised by professionals, given its limitations in bibliographic precision and interpretive nuance.

BackgroundTension-type headache (TTH) is the most common primary headache, yet its neural basis remains unclear. Magnetoencephalography (MEG) combined with graph-theoretical analysis enables precise mapping of functional brain networks. This study aimed to identify network-level connectivity alterations in TTH using resting-state MEG and graph-based metrics.MethodsWe analyzed resting-state MEG data from 27 TTH patients during the interictal period and 37 age- and gender-matched healthy controls, all with eyes closed. Functional connectivity (FC) across 1-45 Hz was mapped and analyzed using graph theory. Network topology metrics were computed, and their associations with clinical symptoms were assessed.ResultsTTH patients showed increased FC across 1-45 Hz, notably between the right somatomotor and frontal operculum and insula (FrOperIns), and between the temporo-occipital-parietal (TempOccPar) and visual regions, with the latter positively correlated with Headache Impact Test-6 scores. Frequency-specific increases were observed between the left prefrontal and right orbitofrontal cortices (delta, theta), somatomotor and FrOperIns (theta), and TempOccPar and visual areas (beta). Graph theory analysis revealed nodal abnormalities, particularly in the left precuneus and posterior cingulate and prefrontal cortices, along with elevated local efficiency and clustering coefficient.ConclusionsThese findings indicate that TTH is associated with frequency-specific alterations in functional connectivity and disrupted network topology, particularly involving regions implicated in pain processing and cognitive control. Graph-theoretical MEG analysis may offer valuable insights into the neural mechanisms of TTH and support the development of network-based biomarkers.Trial Registration: ClinicalTrials.gov Identifier: NCT05334927.

AimTo evaluate the efficacy and safety of greater occipital nerve (GON) block combined with triple therapy versus triple therapy alone in the treatment of acute migraine in the emergency department for severe or refractory cases setting.MethodsWe conducted a prospective, randomized, controlled trial without use of placebo control in adult patients with migraine according to International Classification of Headache Disorders, 3rd editon criteria. Patients were randomly assigned (1:1), without blinding method, to receive either a GON block (methylprednisolone 80 mg + lidocaine 20 mg) plus triple intravenous therapy (ketorolac, paracetamol, metoclopramide) or triple therapy alone. The primary outcome was the proportion of patients achieving ≥50% reduction in headache intensity on a visual analog scale (VAS) two hours post-treatment. Secondary outcomes included changes in monthly migraine days, pain-free days, Headache Impact Test-6 (HIT-6) scores and hospital readmissions at 30-day follow-up.ResultsForty-two patients were enrolled (21 per group). A ≥50% VAS reduction at two hours occurred in 95.2% of patients receiving the GON block versus 47.6% in the control group (p = 0.0003). Median pain reduction was 6.0 vs. 3.0 points, respectively (p < 0.001). At 30 days, the intervention group reported fewer migraine days (median 3.0 vs. 7.0 days; p = 0.0355), more pain-free days (14.0 vs. 5.0 days; p = 0.0379) and lower HIT-6 scores (59.0 vs. 65.0; p = 0.1584). Readmission rates were lower in the intervention group (9.5% vs. 23.8%) but not statistically significant. Adverse events associated with the GON block were mild and transient, including local pain (47.6%) and minor bleeding (14.3%).ConclusionsGON block as an adjunct to triple therapy is effective and well tolerated for the acute treatment of migraine, providing significant short-term relief and improving outcomes at 30-day follow-up. Our failure to blind the outcome assessors limit the validity of our results, which supports the use of GON block as an adjunct to parenteral therapy for patients with migraine in the emergency department.Trial RegistrationThis study was not registered in a public trial registry.

IntroductionThe international headache classification has been enormously important promoting research and clinical management of patients with headache. It is a living document that develops from edition to edition and changes have been increasingly based on research, so called classification research. The aim of the present review is to present recent results of such research and to characterize the methods available for it.MethodsPublished research was identified by systematic search of PubMed. Lists of references of identified articles and the table of content of the last five years of Cephalalgia were screened.ResultsThe major results of identified articles are summarized. Thereafter the different methodologies applied in these studies are described. Finally, some suggestions are made for the future consideration of the fourth classification committee.ConclusionClassification research is emerging as an important avenue of headache research. It has a multitude of different designs available and many of them do not need advanced equipment.

BackgroundNeck pain is common in migraine patients, occurring during all migraine phases and between attacks. It can be a migraine symptom, trigger or a coexisting condition, and is associated with greater disability and poorer treatment response. There is evidence that neck pain associated with headaches can be frequently incorrectly diagnosed as a cervical disorder rather than migraine, resulting in a lack of appropriate treatment. Accurately assessing the connection between neck pain and migraine is crucial for effective treatment.MethodsThis narrative review aims to summarise existing research on the role and contribution of neck pain in migraine, both as a symptom and a trigger, and outlines future research needed to deepen our understanding of this relationship. It also proposes a structured approach for assessing neck pain in migraine and a treatment algorithm, offering guidance for clinical evaluation and treatment. For this purpose, a comprehensive narrative review was conducted using PubMed, covering preclinical, clinical, neurophysiological and imaging evidence on migraine and neck pain.ResultsMigraine patients frequently exhibit cervical dysfunction, tenderness and altered posture, with overlapping neuroanatomical pathways of the neck and trigeminal systems, suggesting shared mechanisms of nociception and migraine initiation. Clinical assessment involves a thorough history, physical exam and exclusion of secondary causes. Standard migraine therapies, such as amitriptyline and onabotulinumtoxinA, may help reduce neck pain and non-pharmacological treatments, such as physical therapy, acupuncture and behavioural strategies, show some promise. However, evidence on neck pain relief is limited.ConclusionsAccurately distinguishing whether neck pain is a symptom, trigger or comorbid condition in migraine is essential for guiding effective treatment strategies. Both pharmacological and non-pharmacological approaches may help manage migraine-associated neck pain. However, few studies have assessed the effects of acute or preventive migraine therapies, particularly calcitonin gene-related peptide-targeted treatments, on neck pain, highlighting a significant gap in our current knowledge. Future research should evaluate the effectiveness of these therapies on neck pain, both alone and in combination with non-pharmacological interventions.