Headache最新文献

Objective: To examine the association between mental health symptoms in youth and their mothers, and youth incident migraine, using prospectively collected, longitudinal data from the "All Our Families" (AOF) cohort study.

Background: Internalizing mental health symptoms, such as anxiety and depression, whether experienced by a child or his/her parent(s), have been linked to migraine and chronic pain conditions, but causal inferences have been limited by gaps in the current literature. We hypothesized a priori that elevated youth and/or maternal internalizing symptoms across childhood would be associated with elevated odds of incident migraine in early adolescence, providing insights into the modifiable mental health contributors to incident migraine.

Methods: A community-recruited sample of urban youth (N = 1062, 48% female) living in Alberta, Canada were followed through the AOF prospective cohort study from 2008 to 2023. The study outcome, youth migraine, was ascertained through a validated migraine diagnostic questionnaire, administered to 12-year-old youth. The exposures of interest, anxiety and depressive symptoms in youth and mothers, were derived from multiple timepoints when these symptoms were measured, across youth ages 4-12 years. The analysis compared odds of incident migraine in youth with a history of elevated internalizing symptoms, and/or exposure to elevated maternal symptoms, versus unexposed youth. Covariates accounted for included age, sex, gender and racial identity, household income, and parental migraine status.

Results: The odds of incident migraine, diagnosed at a mean age of 12.9 years (standard deviation [SD] 0.8 years) were increased by ~29% with each additional timepoint when maternal anxiety symptoms were elevated across childhood (adjusted odds ratio [aOR] 1.29 per exposure, 95% confidence interval [CI] 1.02-1.64, p = 0.036). Similarly, the odds of incident migraine increased by ~29% with each additional exposure to significant youth depressive symptoms across childhood (aOR 1.29 per exposure, 95% CI 1.03-1.61, p = 0.026). Sex did not modify this association.

Conclusion: Findings suggest that maternal anxiety and youth depressive symptoms have an antecedent role in youth migraine risk. Although certain migraine risk factors remain non-modifiable (e.g., genetic inheritance), child and parent mental health symptoms may be alleviated through evidence-based mental health treatments. Future clinical research should explore whether reducing exposure to child and parent mental health symptoms could prevent or delay the development of new migraine cases ("incident migraine").

Objective: To characterize clinical presentation and management of urticaria associated with calcitonin gene-related peptide (CGRP) -targeting monoclonal antibodies (mAbs) for migraine prophylaxis.

Background: CGRP-targeting mAbs are effective in migraine prophylaxis, but have been associated with hypersensitivity reactions, including urticaria. The underlying mechanisms, risk factors, and therapeutic consequences of these anti-CGRP mAb-related hypersensitivity reactions remain poorly understood.

Methods: We performed a retrospective case series with descriptive analysis on five patients who developed urticaria after anti-CGRP mAb administration. Timing of reactions, history of urticaria, re-exposure strategies including premedication, and clinical outcomes were analyzed by chart review.

Results: Urticaria occurred after the first injection in three patients and after the third or sixth injection in two. Onset was delayed (12-48 h) in all patients, indicating a non-IgE-mediated hypersensitivity. Four of five patients had a prior history of urticaria. All patients were re-exposed: two to the same anti-CGRP mAb and three to a different. Three patients received H1-antihistamine premedication. All premedicated patients in this series tolerated re-exposure, irrespective of switching. One patient experienced worsening urticaria with repeated dosing without premedication despite negative allergy testing, but later tolerated the same anti-CGRP mAb with premedication. In contrast, urticaria or angioedema recurred in two patients who switched anti-CGRP mAb without premedication. One subsequently tolerated rimegepant.

Conclusion: Anti-CGRP mAb-associated urticaria in this case series was delayed and likely non-immunoglobulin E (non-IgE)-mediated. Our experience supports that in selected patients with delayed urticaria, individualized management, including H1 antihistamine premedication, may allow continuation of effective migraine prophylaxis. Larger cohorts are needed to identify risk factors and to inform general management recommendations.

Objective: To determine the impact of neuropathic lesion on cortical synchronization in processing spontaneous pain-like behavior.

Background: In vivo optical monitoring of neuronal activity may provide insightful mechanisms underlying the complexity of spontaneous pain-like behavior in freely moving animals.

Methods: We examined the synchronized pattern of the pyramidical neurons in anterior cingulate cortex during spontaneous grooming behavior using optical monitoring of Ca²⁺ activity. A chronic constriction injury of infraorbital nerve model was performed to induce trigeminal neuropathic pain. We then analyzed the synchronized patterns of cortical population and computed Shannon entropy values to assess the uncertainty of neural coding during spontaneous pain-like behavior.

Results: Following nerve injury, mice exhibited significantly prolonged isolated grooming behavior compared to the control group. Our data indicate that, while neuropathic pain enhanced synchronized activity of cortical network during spontaneous grooming behavior, craniofacial nociception reduced the uncertainty of neural firing. Interestingly, this transition to a synchronized state of cortical ensembles in neuropathic pain conditions was significantly disrupted by spontaneous grooming behavior.

Conclusion: Our findings provided a method of monitoring the synchronized activity of cortical ensemble in freely moving animals. Synchronization index may be used to decode spontaneous neuropathic pain-like behavior.

Objective: This study evaluates severe maternal morbidity (SMM) and hospital readmissions in women with migraine.

Background: There has been a rising incidence of SMM and growing urgency to monitor SMM as a measure of maternal outcomes. Migraine is the leading cause of disability in reproductive-aged women and is linked to numerous obstetric comorbidities that likely contribute to SMM, rehospitalization, and resulting healthcare costs. However, population-level data examining these outcomes are limited.

Methods: Using the 2019 National Readmissions Database, we performed a retrospective cohort analysis of index characteristics and postpartum rehospitalizations for women with migraine from January to November 2019. Baseline demographics, hospital characteristics, and indications for readmission were obtained. Odds of SMM at delivery and 30-day nonelective readmission were compared between women with and without migraine. Validated obstetric comorbidity scores and cost of hospitalization were also compared. Models were adjusted for baseline patient and hospital demographics, method of delivery, body mass index (BMI), aspirin use, and obstetric comorbidities.

Results: Out of all qualifying deliveries in 2019, 22,074 women had migraine (1.2%). Only 14.2% of these women had a specific migraine diagnosis (n = 3145), of whom 61.7% had migraine with aura (MA; n = 1941) and 38.3% had migraine without aura (MO; n = 1204). Overall, women with migraine had higher obstetric comorbidity scores than those without migraine. Higher odds of SMM were also associated with migraine (odds ratio [OR] 1.82, 95% confidence interval [CI] [1.68, 1.96]). However, after additionally adjusting for comorbidities, this relationship was no longer significant. In contrast, migraine was independently associated with greater odds of 30-day postpartum readmission (migraine: adjusted odds ratio [aOR] 1.29, 95% CI [1.17, 1.41]; MO: aOR 1.49, 95% CI [1.02, 2.10]) and higher hospitalization costs (migraine: adjusted incidence rate ratio [aIRR] 1.18, 95% CI [1.17, 1.19]).

Conclusion: Women with migraine have higher obstetric comorbidity scores, which may contribute to the elevated risk of SMM. Migraine itself is independently associated with increased 30-day nonelective readmission rates and hospitalization costs. These associations, along with the large number of unspecified migraine diagnoses, highlight the importance of thorough migraine screening and documentation, which may help guide interventions to improve maternal outcomes and reduce healthcare burden.

Objective: Assess the epidemiology and characteristics of status migrainosus (SM) in a cohort of patients from a tertiary care headache clinic to identify the prevalence, 1-year incidence, attack features, treatments, and healthcare utilization for SM.

Background: SM is a debilitating migraine attack lasting at least 72 h according to the International Classification of Headache Disorders, 3rd edition. SM has not been well characterized.

Methods: This retrospective observational cohort study evaluated SM in a subspecialty headache center in Arizona using chart review from electronic health records for patients seen in 2022. The primary endpoints were clinic-observed lifetime prevalence and 1-year incidence (January 1 to December 31, 2022) of SM. Secondary outcomes assessed the clinical features and treatments tried for the SM attacks using descriptive statistics from those with sufficient detail available in electronic health records.

Results: A total of 1184 patients seen in 2022 were screened; of those, 1043 (88.1%) had a diagnosis of migraine, including 458 patients with any lifetime episode of SM, with 373 meeting inclusion criteria. The median age was 47.0 years (interquartile range [IQR] 38.0, 57.0) and 87.7% were female (327/373). The majority had chronic migraine and nearly half reported a history of aura. The clinic-observed SM prevalence was 43.9% (458/1043; 95% confidence interval 40.9%, 46.9%) within the migraine-only population. The 2022 clinic-observed SM incidence in patients with migraine was 24.2% (187/772; 95% confidence interval 21.3%, 27.4%). The median midpoint SM severity was 8.0/10.0 (IQR 7.0-9.0) with median SM attack duration of 10.0 days (IQR 4.0-30.0, range 3.0-330.0 days). SM treatments included: 48.3% (175/362) migraine-specific, 40.1% (145/362) NSAIDs, 37.8% (137/362) steroids, 21.3% (77/362) anti-dopaminergic drugs, 18.8% (68/362) nerve blocks, 23.2% (84/362) new preventive, 4.4% (16/362) opioids, and 1.7% (6/362) butalbital-containing medications. There were 17.7% (64/361) with a recorded emergency department visit and 6.4% (23/360) with a recorded admission for the SM episode.

Conclusion: SM is common in a tertiary headache population, affecting nearly half of specialty clinic patients with migraine over their lifetime and one in five in a single year. In this population, patients with SM tend to have chronic migraine with high rates of aura. This study highlights the need for improved diagnostic consistency and treatment.

Objective: To highlight key factors required to optimize multi-mechanistic approaches with oral combination treatments for the acute management of a migraine attack.

Background: Given the complex multi-factorial nature of migraine, combining treatments with different mechanisms of action should improve outcomes compared to monotherapies, but this has not been demonstrated with all treatment combinations.

Methods: For this narrative review, we searched PubMed using combinations of these terms: migraine, acute treatment, combination therapy, fixed-dose combination therapy, multi-mechanistic treatment, pharmacokinetics, and pharmacodynamics. All articles considered relevant were included.

Results: None of the existing migraine acute treatments as monotherapy effectively treat the key pathophysiological processes of migraine completely. Many patients do not achieve 2-h pain freedom, which is key to avoiding migraine recurrence, medication overuse leading to chronification, and migraine-related disability. The development of combination approaches has led to only two combinations with demonstrated superiority over their individual components: aspirin/acetaminophen/caffeine and sumatriptan/naproxen sodium. The latter is the most effective proven combination treatment because it targets peripheral activation of central pain pathways during the early migraine stages and central sensitization that develops later, independent of peripheral input. Other triptan/nonsteroidal anti-inflammatory drug combinations with higher efficacy as monotherapies could be more effective than sumatriptan/naproxen sodium, particularly if their pharmacokinetic profiles align with the vasoactive mediators of peripheral and central sensitization that they target.

Conclusions: Combination treatments with different mechanisms of action targeting key distinct pathophysiological processes of migraine may be more effective than monotherapies, particularly if their pharmacokinetic profiles are optimized to target those processes at the right time. Further research in this area is warranted.