Headache最新文献

Objective: To investigate, in two cohorts including patients with multiple sclerosis (MS) and migraine, (i) the prevalence of the "central vein sign" (CVS), (ii) the spatial distribution of positive CVS (CVS+) lesions, (iii) the threshold of CVS+ lesions able to distinguish MS from migraine with high sensitivity and specificity.

Methods: A total of 70 patients with MS/clinically isolated syndrome and 50 age- and sex-matched patients with migraine underwent a 3-T magnetic resonance imaging scan. The CVS was evaluated according to current guidelines, excluding eight patients with migraine who did not show white matter (WM) lesions. A receiver operating characteristic curve analysis was performed to identify the best threshold in terms of proportion of CVS+ lesions and the absolute number of CVS+ lesions able to differentiate MS from migraine.

Results: Lesion volume was different between CVS+ and CVS negative lesions (median 1043 vs. 176.5 mm³ for MS cohort; median 35.1 vs. 52.2 mm³ for migraine cohort; p < 0.001 for all). A higher proportion of CVS+ lesions was associated with a higher probability of being diagnosed as MS (adjusted odds ratio 1.09, 95% confidence interval [CI] 1.04-1.14; p < 0.001). CVS+ lesion volume and number were higher in MS with respect to migraine, both considering the whole brain and its subregions (p < 0.001). The proportion of CVS+ lesions in juxtacortical and infratentorial areas was higher in MS than in migraine (p = 0.015 and p = 0.034, respectively). The best CVS proportion-based threshold able to differentiate MS from migraine was 35.0% (sensitivity 97.1%, specificity 85.7%) with an area under the curve of 0.95 (95% CI 0.90-1.00). The "select 6" rule seemed to be preferable in terms of specificity with respect to the "select 3" rule.

Conclusions: A CVS proportion-based threshold of 35.0% is capable of distinguishing MS from migraine with high sensitivity and specificity. The "select 6" algorithm may be useful in the clinical setting.

Antibodies targeting either the calcitonin gene-related peptide (CGRP), such as galcanezumab, fremanezumab, and eptinezumab, or the receptor (erenumab) have been approved for the prevention of episodic and chronic migraine. Although widely used and generally effective, a proportion of patients discontinue treatment due to lack of efficacy. In both randomized controlled trials and observational studies, all anti-CGRP monoclonal antibodies (mAbs) have consistently demonstrated comparable efficacy and tolerability, suggesting a pharmacological class effect. However, differences in therapeutic targets, structure, and pharmacokinetic characteristics may influence their efficacy and safety differently. Therefore, in patients not achieving a clinically meaningful response with one anti-CGRP antibody, switching to a different antibody may be a viable option. This review examines the pharmacological characteristics and distinctions among anti-CGRP mAbs, highlighting their mechanisms of action and pharmacokinetic profiles, along with the clinical observational data of switching. Finally, we summarize suggestions from international guidelines.

Objective: To evaluate whether patients with tension-type headache (TTH) exhibit abnormal brain functional connectivity compared to healthy controls.

Background: TTH is one of the most prevalent headache disorders throughout the world. The present study delves into brain functional connectivity in patients with TTH to enhance the understanding of its underlying pathophysiology.

Methods: A cross-sectional study was conducted, enrolling patients with TTH diagnosed in line with the International Classification of Headache Disorders, 3rd edition beta criteria and a cohort of healthy controls (HCs). We used four metrics-global brain functional connectivity, functional connectivity, Granger causality analysis, and dynamic functional connectivity-to evaluate alterations of functional connectivity patterns in patients with TTH from both static and dynamic perspectives. Furthermore, correlational analyses were performed to explore the relationships between abnormal brain activities and clinical characteristics.

Results: A total of 33 patients with TTH (mean age = 42.3; 13 males/20 females) and 30 HCs (mean age = 37.1; 13 males/17 females) were included in the current study. Compared to HCs, patients with TTH showed altered global brain functional connectivity in the right dorsolateral superior frontal gyrus (SFGdor, t = 4.60). Abnormal functional connectivity was also detected between the right SFGdor and the right superior temporal gyrus (t = 4.56). Furthermore, the right SFGdor exhibited altered information flow with several brain regions, including the left precuneus (t = 5.16), right middle temporal gyrus (MTG, t = 4.72/-4.41), right inferior temporal gyrus (t = 4.64), right caudate nucleus (t = 4.09), and right thalamus (THA, t = -4.04). In terms of dynamic functional connectivity, disconnection was observed between the right SFGdor and the right MTG (t = -3.10), right Rolandic operculum (ROL, t = 3.60), left opercular inferior frontal gyrus (t = -3.48), and left medial superior frontal gyrus (t = -3.00). In addition, the correlation analyses revealed that activities in the MTG (r = 0.48), THA (r = -0.38), and ROL (r = 0.36) were significantly correlated with disease duration, while THA activity was associated with Visual Analogue Scale scores (r = 0.50).

Conclusions: This study revealed alterations in both static and dynamic brain functional connectivity in patients with TTH within regions implicated in sensory perception, emotional processing, cognition, and pain regulation. These results may promote the understanding of the neural networks involved in TTH and potentially inform future therapeutic approaches for the condition.

Background: Serum 25-hydroxyvitamin D (25[OH]D) concentrations have been shown to be low in patients with migraine, but results are controversial regarding the current role of vitamin D in migraine severity. Using a case-control design, we aimed to evaluate serum 25(OH)D levels in a group of females with high-frequency episodic migraine/chronic migraine (HF/CM) and analyze its association with headache frequency and serum calcitonin gene-related peptide (CGRP) levels.

Methods: Serum 25(OH)D levels were measured in 97 females with HF/CM (age 48.9 ± 9.4 years) and 146 healthy females (47.4 ± 8.1 years). Participants taking vitamin D supplements were excluded. Serum concentrations of 25(OH)D were determined by electrochemiluminescence (Roche, Germany), and CGRP levels were measured by enzyme-linked immunosorbent assay (Abbexa, UK).

Results: Mean 25(OH)D levels in females with HF/CM (median [interquartile range] 19.0 [13.0-24.5] ng/mL) were below the values considered for insufficiency or deficiency and significantly lower than controls (25.0 [19-29.8] ng/mL; p < 0.0001). Fifty (51.5%) patients with HF/CM had levels below 20 ng/mL. There was no significant association between vitamin D levels and monthly headache days (Spearman's rank correlation coefficient [rho]: -0.086; p = 0.404) or with serum α (rho: 0.114; p = 0.267) and β-CGRP (rho: 0.113; p = 0.276) levels. Serum 25(OH)D levels in females with HF/CM with a minimum daily sunlight exposure were significantly higher than those without (23.0 [15.0-26.0] ng/mL vs. 14.0 [10.0-20.0] ng/mL; p < 0.001). Females with HF/CM who performed exercise had higher, albeit not significant, plasma 25(OH)D levels than those who did not (21.0 [15.5-28.0] ng/mL vs. 16.5 [12.0-24.0] ng/mL; p = 0.059).

Conclusions: Serum concentrations of 25(OH)D were low in many patients with HF/CM. Because there was no correlation with migraine frequency or serum CGRP levels, this deficiency seems to be a direct consequence of the migraine impact. Our data do not support either a relationship of 25(OH)D levels with migraine severity or the use of vitamin D supplements as a specific migraine treatment, although further studies are needed.

Objective: This study was conducted to assess the efficacy of daily 2000 mg eicosapentaenoic acid (EPA) supplementation in individuals with chronic migraine.

Background: Chronic migraine is characterized by a minimum of 15 headache days/month, necessitating a focus on preventive treatment strategies. EPA, a polyunsaturated fatty acid recognized for its anti-inflammatory properties, is examined for its potential effectiveness in chronic migraine management.

Methods: A randomized, blinded, placebo-controlled trial of eligible participants with a confirmed diagnosis of chronic migraine were enrolled. The intervention group received 1000 mg of EPA twice daily for 8 weeks, while the control group received two placebo softgels. Symptoms were recorded at 4 and 8 weeks. The primary outcome was assessed using the Headache Impact Test-6 to evaluate changes in patients. Secondary outcomes encompassed migraine headache days, headache severity measured via a visual analog scale, and the number of consumed painkillers. Descriptive analyses were reported in mean (± standard deviation [SD]).

Results: A total of 60 patients were included in the study and finally, 56 patients completed the study according to the protocol, including 47 (84%) females. The data comparison at baseline did not show any significant difference between the two groups except in the number of patients using valproic acid as prophylaxis (21 patients in the EPA group, and 13 in the placebo group; p = 0.037). The results showed after 8 weeks, a mean (SD) difference of Headache Impact Test-6 in the EPA and placebo groups was -6.96 (3.34) and -4.43 (5.24), respectively (p = 0.084). Regarding migraine headache days, participants reported a mean (SD) -9.76 (4.15) and -4.60 (4.87) decline in days with headache, respectively (p < 0.001). The number of attacks per month after 8 weeks was 3.0 (95% confidence interval [CI] 2.0-4.0) and 4.0 (95% CI 3.0-6.0), respectively (p < 0.001). Regarding severity, there was no significant difference between the two groups (mean [SD] difference: -0.76 [1.13] and -0.73 [1.04], respectively; p = 0.906). In terms of adverse events, two patients in the EPA group reported intolerable nausea and vomiting, and one patient in the placebo group reported dizziness.

Conclusions: This study's findings support the potential of a daily 2000 mg EPA as a prophylactic pharmacotherapy in chronic migraine management, specifically in mitigating migraine attacks, migraine headache days, and overall quality of life.

Objective: To compare healthcare resource utilization and healthcare costs in patients with migraine with or without a history of misdiagnosis.

Background: Despite the high prevalence of migraine, migraine is commonly misdiagnosed. The healthcare resource use and cost burden of a misdiagnosis is unknown.

Methods: This retrospective cohort study identified adults with an incident migraine diagnosis from the Merative™ Marketscan® Commercial and Medicare Supplemental Databases between June 2018 and 2019. Patients with a diagnosis of commonly considered misdiagnoses (headache, sinusitis, or cervical pain) before their migraine diagnosis were classified as the "misdiagnosed cohort." Patients in the misdiagnosed cohort were potentially misdiagnosed, then eventually received a correct diagnosis. Patients without a history of commonly considered misdiagnoses prior to their migraine diagnosis were classified as the "correctly diagnosed cohort." Healthcare resource utilization and healthcare costs were assessed in the period before migraine diagnosis and compared between the cohorts. Outcomes were reported as per patient per month and compared with incidence rate ratios.

Results: A total of 29,147 patients comprised the correctly diagnosed cohort and 3841 patients comprised the misdiagnosed cohort and met the inclusion criteria. Patients in the misdiagnosed cohort had statistically significantly higher rates of inpatient admissions (0.02 vs. 0.01, incidence rate ratio [IRR] 1.61, 95% confidence interval [CI] 1.47-1.74), emergency department visits (0.10 vs. 0.05; IRR 1.89, 95% CI 1.79-1.99), neurologist visits (0.12 vs. 0.02; IRR 5.95, 95% CI 5.40-6.57), non-neurologist outpatient visits (2.64 vs. 1.58; IRR 1.67, 95% CI 1.62-1.72) and prescription fills (2.82 vs. 1.84; IRR 1.53, 95% CI 1.48-1.58) compared to correctly diagnosed patients. Misdiagnosed patients had statistically significantly higher rates of healthcare cost accrual for inpatient admissions ($1362 vs. $518; IRR 2.62, 95% CI 2.50-2.75), emergency department visits ($222 vs. $98; IRR 2.27, 95% CI 2.18-2.36), neurologist visits ($42 vs. $9; IRR 4.39, 95% CI 4.00-4.79), non-neurologist outpatient visits ($1327 vs. $641; IRR 2.07, 95% CI 1.91-2.24), and prescription fills ($305 vs. $215; IRR 1.41, 95% CI 1.18-1.70) compared to correctly diagnosed patients.

Conclusion: Patients with migraine who have a history of misdiagnoses have higher rates of healthcare resource utilization and cost accrual versus those without such history.

Objective: The objective of this pilot study was to assess physical therapists' (PTs) knowledge and needs regarding headache diagnosis and management.

Background: While there is significant research on physical therapy and cervicogenic headache, studies suggest that migraine is often under-recognized, misdiagnosed, and inadequately treated across society despite its high prevalence and burden. Because migraine commonly includes concurrent neck pain and/or vestibular symptoms, patients with migraine may present to PTs for treatment. Very little is known about PTs' headache and migraine education, knowledge, and clinical practices.

Methods: A team of headache specialists and PTs adapted a previously used headache knowledge and needs assessment survey to help ascertain PTs' knowledge and needs regarding headache treatment. The cross-sectional survey was distributed online via Research Electronic Data Capture (REDCap) to PTs within a large healthcare system in Connecticut.

Results: An estimated 50.5% (101/200) of PTs invited to complete the survey did so. Only 37.6% (38/101) of respondents reported receiving any formal headache or migraine education in their professional training, leading to knowledge gaps in differentiating and responding to headache subtypes. Only 45.5% (46/101) were able to identify that migraine is characterized by greater pain intensity than tension-type headache, and 22.8% (23/101) reported not knowing the duration of untreated migraine. When asked about the aspects of care they believe their patients with headache would like to see improved, PTs reported education around prevention and appropriate medication use (61/100 [61.0%]), provider awareness of the degree of disability associated with migraine (51/100 [51.0%]), and diagnostics (47/100 [47.0%]).

Conclusion: This sample of PTs from one healthcare system demonstrates knowledge gaps and variations in clinical practice for managing their patients with headache. Future research on integrating additional opportunities for headache education for physical therapists, including evidence-based behavioral therapies, is needed to ascertain whether it is likely to improve patient care.

Objective: To determine the association between human leukocyte antigen (HLA) alleles and migraine, migraine subtypes, and sex-specific factors.

Background: It has long been hypothesized that inflammation contributes to migraine pathophysiology. This study examined the association between migraine and alleles in the HLA system, a key player in immune response and genetic diversity.

Methods: We performed a case-control study and included 13,210 individuals with migraine and 86,738 controls. All participants were part of the Danish Blood Donor Study Genomic Cohort. Participants were genotyped and 111 HLA alleles on 15 HLA genes were imputed. We examined the association between HLA alleles and migraine subtypes, considering sex-specific differences.

Results: We found no association between HLA alleles and migraine, neither overall, nor in the sex-specific analysis. In the migraine subtype analysis, three HLA alleles were associated with migraine without aura; however, these associations could not be replicated in an independent Icelandic cohort (2191 individuals with migraine without aura and 278,858 controls). Furthermore, we found no association between HLA alleles and migraine with aura or chronic migraine.

Conclusion: We found no evidence of an association between the HLA system and migraine, suggesting that genetic factors related to the HLA system do not play a significant role in migraine susceptibility.