Cephalalgia最新文献

BackgroundMenstrually-related migraine (MRM) is a subtype of migraine associated with the ovarian cycle that imposes a significant burden on female patients. Although MRM and non-menstrual migraine (NMM) differ in clinical presentation and treatment response, their distinct neural mechanisms remain unclear. Emerging evidence suggests that alterations in intrinsic functional connectivity (FC) within and between large-scale brain networks may underlie the phenotypic heterogeneity of migraine subtypes. This study investigated FC alterations between patients with MRM and NMM, explored their correlations with clinical characteristics, and assessed the preliminary utility of FC in subtype differentiation.MethodsResting-state functional magnetic resonance imaging (MRI) with independent component analysis was used to examine whole-brain FC in 50 patients with MRM, 50 with NMM and 50 age-balanced healthy controls (HC). We analyzed within- and between-network connectivity across major resting-state networks, including the frontoparietal, default mode, salience and dorsal attention networks, and applied logistic regression to test whether FC values could classify migraine subtypes. Correlation analyses were further performed between FC measures and clinical indices, including disease duration, headache frequency, visual analog scale scores and Headache Impact Test (HIT-6) scores.ResultsBoth MRM and NMM groups showed weaker within-network connectivity compared to HCs, primarily in the right frontoparietal, default mode and salience networks. Compared with NMM, the MRM group exhibited significantly stronger connectivity in the left frontoparietal network and weaker between-network connectivity between the dorsal attention and default mode networks. In the women with migraine, FC within the dorsal attention network (DAN) was negatively correlated with disease duration (r = -0.200, p = 0.046) and HIT-6 score (r = -0.183, p = 0.049). Furthermore, FC between the DAN and auditory network was inversely associated with disease duration (r = -0.225, p = 0.025). The logistic regression model achieved an area under the receiver operating characteristic curve of 0.73 (sensitivity = 0.70; specificity = 0.64) in distinguishing MRM from NMM.ConclusionsOur findings reveal both shared and distinct alterations in large-scale brain networks in MRM and NMM, potentially explaining differences in clinical presentation and treatment response. This enhanced understanding of migraine pathophysiology supports the development of subtype-specific diagnostic tools and targeted therapies and underscores the value of resting-state fMRI as a non-invasive tool for migraine phenotyping and personalized care.Registration NumberChiCTR2200065586.

BackgroundMigraine is a complex disabling neurological disease characterized by recurrent headache attacks lasting 4-72 h with moderate to severe intensity and other accompanying symptoms. While chronic migraine (CM) and episodic migraine (EM) are primarily differentiated by the frequency of headache and migraine days, underlying clinical and functional differences have been described. OnabotulinumtoxinA (onabotA) has been approved as a preventive treatment for CM with controlled clinical and real-world evidence suggesting potential benefits for treatment of EM. Given the lack of randomized controlled trial data, PRECLUDE, a prospective phase 3 trial was designed to evaluate the efficacy and safety of onabotA for the preventive treatment of EM.MethodsThe PRECLUDE trial was a phase 3 multicenter, randomized, double-blind, placebo-controlled, parallel-group trial with an open-label onabotA 195 U extension phase. In total, 775 patients aged 18-65 years with a history of migraine attacks were randomized (1:1:1) to receive placebo, onabotA 155 U, or onabotA 195 U. Patients recorded daily headache data and medication use via an electronic diary (eDiary) during a four-week screening phase, 24-week double-blind phase, followed by a 24-week open-label extension phase. The primary endpoint was the change in the frequency of monthly migraine days from baseline across months 5 and 6.ResultsAll treatment groups showed a reduction in the frequency of monthly migraine days from baseline; however, neither the onabotA 155 U group nor the 195 U group demonstrated a statistically significant improvement compared to the placebo group (p >0 .05). Similarly, secondary endpoints, including changes in monthly headache days, 50% responder rates and monthly acute medication use days, did not reach statistical significance. Adverse events in this trial were consistent with previous findings for onabotA in CM and were generally mild to moderate in severity.ConclusionsThe PRECLUDE trial demonstrated that onabotA was well tolerated but did not show significant efficacy compared to placebo for the endpoint reducing migraine days from baseline in patients with EM as defined by the trial protocol. While onabotA is effective for CM, these findings highlight the need for further research to better understand the pathophysiological differences between EM and CM and to understand whether there is a potential subset of EM patients which respond to onabotA.

AimTo evaluate the effect of treatment onset-time on the effectiveness of remote electrical neuromodulation (REN) for acute treatment of migraine.MethodsA real-world evidence study on migraine patients who treated with REN . REN treatments initiated within one hour of migraine attack onset (headache or aura) were classified as "early"; those initiated after one hour were classified as "late". Treatments with baseline and two-hour reports were termed "evaluable" and analyzed.ResultsAmong 55,261 patients (37.9 ± 18.5 years, 83.4% female) who conducted 586,981 treatments, 56.5% were administered early. Effectiveness was calculated from "evaluable" treatments, varying between 6413 and 35,581 treatments depending on the outcome. Early treatments yielded higher responder-rates than late (p < 0.001, significant following Bonferroni correction for multiple comparisons) for pain relief (65.1% vs. 46.6%; Δ = 18.5%), pain freedom (28.8% vs. 14.5%; Δ = 14.3%), functional disability relief (58.1% vs. 49.3%; Δ = 8.8%), functional disability freedom (35.4% vs. 20.9%; Δ = 14.5%), and freedom from photophobia (26.9% vs. 19.0%; Δ = 7.9%), phonophobia (34.0% vs. 25.9%; Δ = 8.1%) and nausea/vomiting (51.5% vs. 38.7%; Δ = 12.8%). Similarly, patients consistently treating early with REN (in 50% or more of their treatments) experienced higher efficacy (p < 0.001). Similar effects were seen in youths.ConclusionsEarly acute treatment with REN enhanced patient outcomes by up to two-fold compared to late treatment onset. Educating providers and patients to "treat as early as possible" boosts clinical and patient-centered results.

BackgroundWhile the association between migraine, neck pain, and cervical musculoskeletal dysfunctions is well established in adults, such a relationship remains unclear in the pediatric population. This gap limits our understanding of early pathophysiological mechanisms and hinders the development of targeted interventions.ObjectiveTo assess self-reported neck pain, pressure pain threshold (PPT), global cervical range of motion (ROM), and upper cervical mobility in children and adolescents with and without migraine.MethodsA cross-sectional study was conducted with 102 participants in total (51 with migraine - MG - and 51 controls - CG), aged six to 16 years. Neck pain characteristics (presence, frequency, intensity, and duration) were recorded. Cervical ROM was measured in flexion, extension, lateral flexion, and rotation. Upper cervical mobility was evaluated using the Flexion Rotation Test (FRT), and PPT was bilaterally assessed in the sternocleidomastoid, levator scapulae, suboccipital, upper trapezius, and anterior scalene muscles. Comparisons between groups were made using Student's t-test, Mann-Whitney U test, or Chi-square test, with a significance level set at 5%.ResultsCompared to the control group, the MG showed a higher prevalence of neck pain (39.2% vs. 5.9%; p < 0.001) and longer average duration (19 ± 8.6 vs. 8 ± 3.4 h; p = 0.046). Reduced lateral flexion (p < 0.001) and reduced upper cervical mobility (p < 0.001) were observed in the MG. Additionally, all evaluated muscles exhibited significantly lower PPT values in the MG (p < 0.001) than controls, indicating increased pain sensitivity.ConclusionSimilar to adults, children and adolescents with migraine demonstrate cervical musculoskeletal impairments, including neck pain, reduced cervical mobility-especially in lateral flexion and upper cervical rotation-and heightened sensitivity in craniocervical muscles. These findings support the routine inclusion of cervical musculoskeletal assessments in the clinical management of pediatric migraine.

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.

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.