{"title":"Zavegepant and lactation: What the pharmacokinetic data suggests.","authors":"Annika Ehrlich, Kaitlin Keenan","doi":"10.1111/head.70059","DOIUrl":"https://doi.org/10.1111/head.70059","url":null,"abstract":"","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146131610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Konstantinos Tourlas, Sruthi Ilangovan, Chelsea White, Samantha L Irwin, Sara Pavitt
Objective: This study aims to evaluate the tolerability and effectiveness of the off-label use of rimegepant as acute migraine treatment in adolescents.
Background: Calcitonin gene-related peptide (CGRP) levels are elevated during migraine attacks. Gepants, oral CGRP receptor antagonists, have demonstrated effectiveness as acute and preventive migraine treatment in adults. They are generally well tolerated with limited side effects. Their use for migraine is approved by the United States Food and Drug Administration (FDA) in adults; however, data on their use in adolescents remain limited.
Methods: This is a retrospective chart review of pediatric patients <18 years of age who received at least one dose of rimegepant as acute migraine treatment at Dell Children's Medical Center between 2020 and 2023. Effectiveness was evaluated using patient-reported outcomes during clinic visits. Tolerability was assessed through vital signs, laboratory data, and patient-reported side effects pre- and post-rimegepant use. Data were analyzed using descriptive and inferential statistics.
Results: Twelve adolescents who received at least one dose of rimegepant were identified. The mean age at first dose was 15.3 years (SD ± 1.5); nine (75%) were female. Migraine types included episodic migraine without aura (n = 4, 33%), episodic migraine with aura (n = 1, 8%), chronic migraine without aura (n = 4, 33%), and hemiplegic migraine (n = 3, 25%). The mean number of headache days per month at baseline was 11.5 (SD ± 11.8). Patients tried a mean of 3.9 (SD ± 2.4) acute medications prior to rimegepant use. During follow-up, 10 of 12 (83%) patients reported either resolution or improvement of their migraine attacks with rimegepant use. There were no statistically significant height, weight, blood pressure, or laboratory changes after rimegepant use, and no patients reported side effects.
Conclusion: Rimegepant may be a safe and effective acute migraine treatment in adolescents. No adverse events occurred, and the medication appears to be safe and well-tolerated. These findings support the need for larger prospective and randomized controlled trials to further evaluate the tolerability and effectiveness of gepants in the pediatric population.
{"title":"Retrospective analysis of the tolerability and effectiveness of rimegepant for the acute treatment of migraine in adolescents.","authors":"Konstantinos Tourlas, Sruthi Ilangovan, Chelsea White, Samantha L Irwin, Sara Pavitt","doi":"10.1111/head.70033","DOIUrl":"https://doi.org/10.1111/head.70033","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to evaluate the tolerability and effectiveness of the off-label use of rimegepant as acute migraine treatment in adolescents.</p><p><strong>Background: </strong>Calcitonin gene-related peptide (CGRP) levels are elevated during migraine attacks. Gepants, oral CGRP receptor antagonists, have demonstrated effectiveness as acute and preventive migraine treatment in adults. They are generally well tolerated with limited side effects. Their use for migraine is approved by the United States Food and Drug Administration (FDA) in adults; however, data on their use in adolescents remain limited.</p><p><strong>Methods: </strong>This is a retrospective chart review of pediatric patients <18 years of age who received at least one dose of rimegepant as acute migraine treatment at Dell Children's Medical Center between 2020 and 2023. Effectiveness was evaluated using patient-reported outcomes during clinic visits. Tolerability was assessed through vital signs, laboratory data, and patient-reported side effects pre- and post-rimegepant use. Data were analyzed using descriptive and inferential statistics.</p><p><strong>Results: </strong>Twelve adolescents who received at least one dose of rimegepant were identified. The mean age at first dose was 15.3 years (SD ± 1.5); nine (75%) were female. Migraine types included episodic migraine without aura (n = 4, 33%), episodic migraine with aura (n = 1, 8%), chronic migraine without aura (n = 4, 33%), and hemiplegic migraine (n = 3, 25%). The mean number of headache days per month at baseline was 11.5 (SD ± 11.8). Patients tried a mean of 3.9 (SD ± 2.4) acute medications prior to rimegepant use. During follow-up, 10 of 12 (83%) patients reported either resolution or improvement of their migraine attacks with rimegepant use. There were no statistically significant height, weight, blood pressure, or laboratory changes after rimegepant use, and no patients reported side effects.</p><p><strong>Conclusion: </strong>Rimegepant may be a safe and effective acute migraine treatment in adolescents. No adverse events occurred, and the medication appears to be safe and well-tolerated. These findings support the need for larger prospective and randomized controlled trials to further evaluate the tolerability and effectiveness of gepants in the pediatric population.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146131620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Larry Charleston, Cynthia E Armand, Teshamae S Monteith, Hope L O'Brien, Chandra C Abbott, Glenn C Pixton, Terence Fullerton
<p><strong>Objective: </strong>This post hoc subgroup analysis was conducted using pooled data from three US-based clinical trials to compare efficacy and safety of rimegepant 75 mg versus placebo in acute migraine in adults who are Black or African American.</p><p><strong>Background: </strong>Migraine, characterized by recurring moderate-to-severe unilateral head pain, affects approximately 13% of the population and in the United States affects Black or African American and White populations at similar rates. Despite this, there is stark underrepresentation of Black or African American patients in clinical trials. Rimegepant, an oral small molecule calcitonin gene-related peptide receptor blocker or antagonist, is approved for acute migraine treatment in the United States; however, treatment has not previously been analyzed in Black or African American adults.</p><p><strong>Methods: </strong>Using pooled data from three US-based, double-blind, randomized, placebo-controlled, multicenter clinical trials (ClinicalTrials.gov, NCT03235479; NCT03237845; NCT03461757), efficacy analyses were conducted on a modified intent-to-treat population including all participants who received study medication, had a migraine attack of moderate or severe pain intensity at the time of dosing, and provided ≥1 efficacy datapoint after receiving study treatment. Trials were conducted July 2017 to January 2018 (NCT03235479, NCT03237845) or February 2018 to October 2018 (NCT03461757). The coprimary efficacy endpoints of each trial were freedom from pain (score 0 = none on a 4-point pain scale) and freedom from most bothersome symptom (MBS) at 2 h post dose. Safety was assessed through reported on-treatment adverse events, defined as events occurring on or after treatment was received. Analyses were performed in the Black or African American population, in the White population, and in the overall pooled study population (including Black or African American, White, Asian, American Indian or Alaskan Native, Native Hawaiian or other Pacific Islander, and multiple races).</p><p><strong>Results: </strong>Overall, 3551 treated participants were in the pooled population; 696 (19.6%) were Black or African American; 2700 (76.0%) were White. In the Black or African American population, rimegepant showed improvements versus placebo in the two coprimary endpoints. For pain freedom 2 h post dose, the stratified risk was 24.4% (88/359) for rimegepant and 18.2% (59/323) for placebo in Black or African American participants; risk difference was 6.2% (95% confidence interval [CI]: 0.1, 12.3; p = 0.047). For MBS freedom 2 h post dose, the stratified risk was 43.1% (155/359) for rimegepant and 35.5% (115/323) for placebo in Black or African American participants; risk difference was 7.6% (95% CI: 0.3, 14.9; p = 0.041). The risk difference was similar in White participants: 7.9% (95% CI: 5.2, 10.6; p < 0.001) for pain freedom 2 h post dose and 9.9% (95% CI: 6.5, 13.4; p < 0.001) for MBS free
{"title":"Efficacy and safety of rimegepant for the acute treatment of migraine in Black or African American adults: A post hoc pooled subgroup analysis from three randomized, placebo-controlled clinical trials.","authors":"Larry Charleston, Cynthia E Armand, Teshamae S Monteith, Hope L O'Brien, Chandra C Abbott, Glenn C Pixton, Terence Fullerton","doi":"10.1111/head.70034","DOIUrl":"https://doi.org/10.1111/head.70034","url":null,"abstract":"<p><strong>Objective: </strong>This post hoc subgroup analysis was conducted using pooled data from three US-based clinical trials to compare efficacy and safety of rimegepant 75 mg versus placebo in acute migraine in adults who are Black or African American.</p><p><strong>Background: </strong>Migraine, characterized by recurring moderate-to-severe unilateral head pain, affects approximately 13% of the population and in the United States affects Black or African American and White populations at similar rates. Despite this, there is stark underrepresentation of Black or African American patients in clinical trials. Rimegepant, an oral small molecule calcitonin gene-related peptide receptor blocker or antagonist, is approved for acute migraine treatment in the United States; however, treatment has not previously been analyzed in Black or African American adults.</p><p><strong>Methods: </strong>Using pooled data from three US-based, double-blind, randomized, placebo-controlled, multicenter clinical trials (ClinicalTrials.gov, NCT03235479; NCT03237845; NCT03461757), efficacy analyses were conducted on a modified intent-to-treat population including all participants who received study medication, had a migraine attack of moderate or severe pain intensity at the time of dosing, and provided ≥1 efficacy datapoint after receiving study treatment. Trials were conducted July 2017 to January 2018 (NCT03235479, NCT03237845) or February 2018 to October 2018 (NCT03461757). The coprimary efficacy endpoints of each trial were freedom from pain (score 0 = none on a 4-point pain scale) and freedom from most bothersome symptom (MBS) at 2 h post dose. Safety was assessed through reported on-treatment adverse events, defined as events occurring on or after treatment was received. Analyses were performed in the Black or African American population, in the White population, and in the overall pooled study population (including Black or African American, White, Asian, American Indian or Alaskan Native, Native Hawaiian or other Pacific Islander, and multiple races).</p><p><strong>Results: </strong>Overall, 3551 treated participants were in the pooled population; 696 (19.6%) were Black or African American; 2700 (76.0%) were White. In the Black or African American population, rimegepant showed improvements versus placebo in the two coprimary endpoints. For pain freedom 2 h post dose, the stratified risk was 24.4% (88/359) for rimegepant and 18.2% (59/323) for placebo in Black or African American participants; risk difference was 6.2% (95% confidence interval [CI]: 0.1, 12.3; p = 0.047). For MBS freedom 2 h post dose, the stratified risk was 43.1% (155/359) for rimegepant and 35.5% (115/323) for placebo in Black or African American participants; risk difference was 7.6% (95% CI: 0.3, 14.9; p = 0.041). The risk difference was similar in White participants: 7.9% (95% CI: 5.2, 10.6; p < 0.001) for pain freedom 2 h post dose and 9.9% (95% CI: 6.5, 13.4; p < 0.001) for MBS free","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146131656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sara Pavitt, Sruthi Ilangovan, Zoë Allen, Samantha L Irwin, Irene Patniyot
<p><strong>Objectives: </strong>The International Pediatric Headache Didactic Series (IPHDS) was developed to provide free, comprehensive pediatric headache education to healthcare professionals worldwide. The objective of this study was to describe the design, implementation, and impact of this prospective educational intervention.</p><p><strong>Background: </strong>Headache is the most common neurological symptom within the pediatric population. Yet, only nine fellowships are offered in pediatric headache medicine. Limitations in access to education and training are often cited as reasons for diagnostic and management barriers. To address this gap, the IPHDS was established in July 2022.</p><p><strong>Methods: </strong>IPHDS is a recurring series consisting of 23 biweekly lectures. Lectures are delivered virtually via Zoom and available for asynchronous learning on an open-access website. Lecture topics are based on the United Council for Neurologic Subspecialties' curriculum recommendations. Pre- and post-surveys were developed collaboratively by content experts and administered to attendees. Quantitative data were analyzed using descriptive and inferential statistics, and qualitative data were analyzed using conventional qualitative content analysis.</p><p><strong>Results: </strong>From July 2022 to July 2023, over 480 people signed up for IPHDS. Lecture attendees represented a variety of clinical backgrounds including advanced practice providers (26.4%, n = 128/484), MD/DO headache providers (25.4%, n = 123/484), adult headache fellows (12.6%, n = 61/484), pediatric headache fellows (10.3%, n = 50/484), residents (8.1%, n = 39/484), clinical nurses (8.1%, n = 39/484), MD/DO neurology (non-headache) providers (2.1%, n = 10/484), researchers (1.6%, n = 8/484), medical students (1.4%, n = 7/484), orofacial pain providers (1.0%, n = 5/484), psychologists (<1%, n = 3/484), and pharmacists (<1%, n = 3/484). Lecture attendees represented nine countries and 31 US states. Median attendance for live lectures was 34.0 people [interquartile range: 28.3-42.5], and median viewership of the posted lectures to date was 79.0 views [interquartile range: 52.0-93.0]. Prior to attending IPHDS, only 56.7% (n = 230/406) of participants reported being competent or very competent in headache medicine knowledge. After attending IPHDS, 76.9% (n = 40/52) of participants reported being competent or very competent in knowledge of headache medicine, as indicated in their post-survey. Similarly, 78.8% (n = 41/52) of participants indicated that this didactic series moderately or significantly added to their knowledge of pediatric headache medicine.</p><p><strong>Conclusion: </strong>This novel didactic series successfully delivered free pediatric headache education to healthcare professionals worldwide. Furthermore, this didactic series serves as a framework for other subspecialties looking to disseminate education from specialists in the field. IPHDS continues on an annual
{"title":"The International Pediatric Headache Didactic Series: A Novel Curriculum Innovation.","authors":"Sara Pavitt, Sruthi Ilangovan, Zoë Allen, Samantha L Irwin, Irene Patniyot","doi":"10.1111/head.70056","DOIUrl":"https://doi.org/10.1111/head.70056","url":null,"abstract":"<p><strong>Objectives: </strong>The International Pediatric Headache Didactic Series (IPHDS) was developed to provide free, comprehensive pediatric headache education to healthcare professionals worldwide. The objective of this study was to describe the design, implementation, and impact of this prospective educational intervention.</p><p><strong>Background: </strong>Headache is the most common neurological symptom within the pediatric population. Yet, only nine fellowships are offered in pediatric headache medicine. Limitations in access to education and training are often cited as reasons for diagnostic and management barriers. To address this gap, the IPHDS was established in July 2022.</p><p><strong>Methods: </strong>IPHDS is a recurring series consisting of 23 biweekly lectures. Lectures are delivered virtually via Zoom and available for asynchronous learning on an open-access website. Lecture topics are based on the United Council for Neurologic Subspecialties' curriculum recommendations. Pre- and post-surveys were developed collaboratively by content experts and administered to attendees. Quantitative data were analyzed using descriptive and inferential statistics, and qualitative data were analyzed using conventional qualitative content analysis.</p><p><strong>Results: </strong>From July 2022 to July 2023, over 480 people signed up for IPHDS. Lecture attendees represented a variety of clinical backgrounds including advanced practice providers (26.4%, n = 128/484), MD/DO headache providers (25.4%, n = 123/484), adult headache fellows (12.6%, n = 61/484), pediatric headache fellows (10.3%, n = 50/484), residents (8.1%, n = 39/484), clinical nurses (8.1%, n = 39/484), MD/DO neurology (non-headache) providers (2.1%, n = 10/484), researchers (1.6%, n = 8/484), medical students (1.4%, n = 7/484), orofacial pain providers (1.0%, n = 5/484), psychologists (<1%, n = 3/484), and pharmacists (<1%, n = 3/484). Lecture attendees represented nine countries and 31 US states. Median attendance for live lectures was 34.0 people [interquartile range: 28.3-42.5], and median viewership of the posted lectures to date was 79.0 views [interquartile range: 52.0-93.0]. Prior to attending IPHDS, only 56.7% (n = 230/406) of participants reported being competent or very competent in headache medicine knowledge. After attending IPHDS, 76.9% (n = 40/52) of participants reported being competent or very competent in knowledge of headache medicine, as indicated in their post-survey. Similarly, 78.8% (n = 41/52) of participants indicated that this didactic series moderately or significantly added to their knowledge of pediatric headache medicine.</p><p><strong>Conclusion: </strong>This novel didactic series successfully delivered free pediatric headache education to healthcare professionals worldwide. Furthermore, this didactic series serves as a framework for other subspecialties looking to disseminate education from specialists in the field. IPHDS continues on an annual","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146131671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shaista Anwar Siddiqi, Abubaker Almadani, Faisal Rabeeah, Maria Khan
Objective: The primary objective of the study was to estimate the prevalence of primary headache disorders (HDs) among Emiratis aged 18-65 years in Dubai. The secondary objective was to assess the association of primary HDs and MIDAS scores with various demographic and clinical factors.
Background: Primary HDs pose a significant public health challenge, necessitating precise diagnostic and management strategies. Limited data on prevalence of primary HDs among Emirati population living in Dubai, United Arab Emirates, underscore the need for investigation.
Methods: A cross-sectional study utilizing telephonic interviews included Emirati individuals aged 18-65 years for 6 months from November 1, 2022, to May 30, 2023. The Headache-Attributed Restriction, Disability, Social Handicap, and Impaired Participation questionnaire was used for collecting data. The prevalence of different types of primary HDs including frequent episodic tension-type headache (TTH), episodic migraine headache, chronic migraine, and infrequent episodic TTH was determined. Disability caused by primary HDs was determined using the MIDAS scores.
Results: Of the 2681 eligible participants, the study included 2000 participants (39.3 ± 11 years; female: 52.7%). Primary HDs were prevalent among 39.1% (n = 781), particularly in the age group of 31-40 years (35.9%). About 41.2% (n = 322) of participants reported frequent episodic TTH, whereas 34.8% (n = 272) reported episodic migraine. About 51.9% of the participants reported grade I (little/no disability) MIDAS level. Independent factors associated with primary HDs based on multivariable analysis were female sex (adjusted odds ratio [aOR] 1.53; 95% confidence interval [CI] 1.24-1.91), marital status (aOR 3.94; 95% CI 1.81-8.62), educational attainment (aOR 2.79; 95% CI 1.54-5.06), and employment status (aOR 1.69; 95% CI 1.14-2.51). Disability, as measured by MIDAS, was significantly associated with age and the type of medical consultation sought (p = 0.025 and p < 0.001, respectively). The type of primary HDs was significantly associated with age (p = 0.022), marital status (p = 0.042), type of headache management (p < 0.001), and medication used (p < 0.001).
Conclusion: One-year prevalence of primary HDs was 39.1% in adult Emiratis residing in Dubai. Individuals who were females, divorced/separated, widow/widower, held a high academic degree, or who were self-employed were more likely to develop primary HDs, whereas age did not appear to influence primary HDs. Further, age and type of consultation were significantly associated with disability caused by primary HDs.
目的：本研究的主要目的是估计迪拜18-65岁阿联酋人原发性头痛疾病（hd）的患病率。次要目的是评估原发性hd和MIDAS评分与各种人口统计学和临床因素的关系。背景：原发性hd构成了重大的公共卫生挑战，需要精确的诊断和管理策略。关于居住在阿拉伯联合酋长国迪拜的阿联酋人口中原发性hd患病率的有限数据强调了调查的必要性。方法：从2022年11月1日至2023年5月30日，采用电话访谈的横断面研究包括18-65岁的阿联酋人，为期6个月。使用头痛受限、残疾、社会障碍和参与障碍问卷收集数据。确定了不同类型的原发性HDs的患病率，包括频繁发作性紧张性头痛（TTH）、发作性偏头痛、慢性偏头痛和不频繁发作性TTH。使用MIDAS评分确定原发性hd引起的残疾。结果：在2681名符合条件的参与者中，研究包括2000名参与者（39.3±11岁，女性占52.7%）。原发性hd患病率为39.1% (n = 781)，尤其是31-40岁年龄组（35.9%）。约41.2% （n = 322）的参与者报告了频繁的发作性TTH，而34.8% （n = 272）的参与者报告了发作性偏头痛。约51.9%的参与者报告I级（轻度/无残疾）MIDAS水平。基于多变量分析，与原发性hd相关的独立因素为女性（调整优势比[aOR] 1.53； 95%可信区间[CI] 1.24-1.91）、婚姻状况（aOR 3.94; 95% CI 1.81-8.62）、受教育程度（aOR 2.79; 95% CI 1.54-5.06）和就业状况（aOR 1.69; 95% CI 1.14-2.51）。MIDAS测量的残疾与年龄和寻求医疗咨询的类型显著相关（p = 0.025和p）。结论：居住在迪拜的成年阿联酋人一年内原发性hd患病率为39.1%。女性、离婚/分居、寡妇/鳏夫、拥有高学历或自雇的人更有可能患上原发性hd，而年龄似乎对原发性hd没有影响。此外，年龄和咨询类型与原发性hd引起的残疾显著相关。
{"title":"Prevalence and factors associated with primary headache disorders among Emirati population in Dubai, United Arab Emirates: A cross-sectional study.","authors":"Shaista Anwar Siddiqi, Abubaker Almadani, Faisal Rabeeah, Maria Khan","doi":"10.1111/head.70039","DOIUrl":"https://doi.org/10.1111/head.70039","url":null,"abstract":"<p><strong>Objective: </strong>The primary objective of the study was to estimate the prevalence of primary headache disorders (HDs) among Emiratis aged 18-65 years in Dubai. The secondary objective was to assess the association of primary HDs and MIDAS scores with various demographic and clinical factors.</p><p><strong>Background: </strong>Primary HDs pose a significant public health challenge, necessitating precise diagnostic and management strategies. Limited data on prevalence of primary HDs among Emirati population living in Dubai, United Arab Emirates, underscore the need for investigation.</p><p><strong>Methods: </strong>A cross-sectional study utilizing telephonic interviews included Emirati individuals aged 18-65 years for 6 months from November 1, 2022, to May 30, 2023. The Headache-Attributed Restriction, Disability, Social Handicap, and Impaired Participation questionnaire was used for collecting data. The prevalence of different types of primary HDs including frequent episodic tension-type headache (TTH), episodic migraine headache, chronic migraine, and infrequent episodic TTH was determined. Disability caused by primary HDs was determined using the MIDAS scores.</p><p><strong>Results: </strong>Of the 2681 eligible participants, the study included 2000 participants (39.3 ± 11 years; female: 52.7%). Primary HDs were prevalent among 39.1% (n = 781), particularly in the age group of 31-40 years (35.9%). About 41.2% (n = 322) of participants reported frequent episodic TTH, whereas 34.8% (n = 272) reported episodic migraine. About 51.9% of the participants reported grade I (little/no disability) MIDAS level. Independent factors associated with primary HDs based on multivariable analysis were female sex (adjusted odds ratio [aOR] 1.53; 95% confidence interval [CI] 1.24-1.91), marital status (aOR 3.94; 95% CI 1.81-8.62), educational attainment (aOR 2.79; 95% CI 1.54-5.06), and employment status (aOR 1.69; 95% CI 1.14-2.51). Disability, as measured by MIDAS, was significantly associated with age and the type of medical consultation sought (p = 0.025 and p < 0.001, respectively). The type of primary HDs was significantly associated with age (p = 0.022), marital status (p = 0.042), type of headache management (p < 0.001), and medication used (p < 0.001).</p><p><strong>Conclusion: </strong>One-year prevalence of primary HDs was 39.1% in adult Emiratis residing in Dubai. Individuals who were females, divorced/separated, widow/widower, held a high academic degree, or who were self-employed were more likely to develop primary HDs, whereas age did not appear to influence primary HDs. Further, age and type of consultation were significantly associated with disability caused by primary HDs.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146124836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: The aim of this study was to elucidate the adverse factors associated with brain arteriovenous malformation (BAVM)-related de novo headache after stereotactic radiosurgery (SRS) or microsurgery.
Background: There is a paucity of literature on posttreatment de novo headaches in initially headache-naïve patients who undergo treatment.
Methods: This retrospective cohort study analyzed patients aged 18 years or older who underwent SRS or microsurgery for a BAVM at our single center in Sichuan Province, China, between January 2010 and December 2019. Patients who did not present with headaches before treatment were included. Headache diagnosis and characteristics were performed according to the International Classification of Headache Disorders, 3rd edition criteria. The primary outcome was BAVM-related de novo headache after treatment. Statistical analysis was conducted on demographic, clinical, and radiographic characteristics to assess the distributions of the two groups of patients with and without posttreatment de novo headache. Subgroup analysis was further conducted on the SRS and microsurgery.
Results: Over the 10-year study period, we identified 194 patients with BAVM who presented without headache and who underwent SRS or microsurgery. Thirty-seven patients (19.1%) developed posttreatment de novo headache. In the SRS treatment cohort, statistically significant differences were detected between the headache and nonheadache subgroups with respect to the Spetzler-Martin (SM) grade (p = 0.018) and lesion diameter (p = 0.028). Multivariable logistic regression analysis confirmed that only the higher SM grade remained an independent adverse factor for de novo headache (adjusted odd ratio [OR] = 3.48, 95% confidence interval [CI] = 1.29-9.35, p = 0.013; high grade versus low grade BAVM). In the microsurgery treatment cohort, the lesion size in the de novo headache subgroup was significantly larger than that in the nonheadache subgroup, with a mean lesion diameter of 3.8 ± 0.3 cm versus 2.9 ± 0.2 cm (p = 0.024). Univariable logistic regression analysis revealed that only a larger diameter was significantly associated with increased odds of de novo headache (OR = 1.52, 95% CI = 1.04-2.21, p = 0.030; per 1 cm increase in diameter).
Conclusion: In the microsurgery treatment subgroup, a larger BAVM was associated with increased odds of de novo headache (per 1 cm increase); in the SRS treatment subgroup, grades III-V were associated with increased odds of de novo headache.
目的：探讨立体定向放射治疗（SRS）或显微外科手术后脑动静脉畸形（BAVM）相关从头头痛的相关不利因素。背景：关于headache-naïve患者最初接受治疗后复发性头痛的文献很少。方法：本回顾性队列研究分析了2010年1月至2019年12月在中国四川省单一中心接受SRS或显微手术治疗BAVM的18岁及以上患者。治疗前未出现头痛症状的患者也包括在内。根据国际头痛疾病分类第3版标准进行头痛诊断和特征。主要终点是治疗后与bavm相关的从头头痛。统计分析两组患者的人口学、临床和影像学特征，以评估有无治疗后头痛患者的分布。进一步对SRS和显微外科进行亚组分析。结果：在10年的研究期间，我们确定了194例没有头痛的BAVM患者，他们接受了SRS或显微手术。37例患者（19.1%）出现治疗后头痛。在SRS治疗队列中，头痛亚组和非头痛亚组在Spetzler-Martin （SM）分级（p = 0.018）和病变直径（p = 0.028）方面存在统计学差异。多变量logistic回归分析证实，只有较高的SM等级仍然是新发头痛的独立不利因素（调整奇比[OR] = 3.48, 95%可信区间[CI] = 1.29-9.35, p = 0.013；高级别vs低级别BAVM）。在显微手术治疗组中，新发头痛亚组的病变大小明显大于非头痛亚组，平均病变直径分别为3.8±0.3 cm和2.9±0.2 cm （p = 0.024）。单变量logistic回归分析显示，只有直径越大，从头开始头痛的几率增加（OR = 1.52, 95% CI = 1.04-2.21, p = 0.030；直径每增加1厘米）。结论：在显微手术治疗亚组中，较大的BAVM与新发头痛的几率增加相关（每增加1 cm）；在SRS治疗亚组中，III-V级与新发头痛的几率增加相关。
{"title":"De novo headache after microsurgical resection or stereotactic radiosurgery of brain arteriovenous malformation.","authors":"Gui-Jun Zhang, Wei Wang, Jun-Feng Huo, Wei Dong, Liang-Wen Zhang","doi":"10.1111/head.70028","DOIUrl":"https://doi.org/10.1111/head.70028","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to elucidate the adverse factors associated with brain arteriovenous malformation (BAVM)-related de novo headache after stereotactic radiosurgery (SRS) or microsurgery.</p><p><strong>Background: </strong>There is a paucity of literature on posttreatment de novo headaches in initially headache-naïve patients who undergo treatment.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed patients aged 18 years or older who underwent SRS or microsurgery for a BAVM at our single center in Sichuan Province, China, between January 2010 and December 2019. Patients who did not present with headaches before treatment were included. Headache diagnosis and characteristics were performed according to the International Classification of Headache Disorders, 3rd edition criteria. The primary outcome was BAVM-related de novo headache after treatment. Statistical analysis was conducted on demographic, clinical, and radiographic characteristics to assess the distributions of the two groups of patients with and without posttreatment de novo headache. Subgroup analysis was further conducted on the SRS and microsurgery.</p><p><strong>Results: </strong>Over the 10-year study period, we identified 194 patients with BAVM who presented without headache and who underwent SRS or microsurgery. Thirty-seven patients (19.1%) developed posttreatment de novo headache. In the SRS treatment cohort, statistically significant differences were detected between the headache and nonheadache subgroups with respect to the Spetzler-Martin (SM) grade (p = 0.018) and lesion diameter (p = 0.028). Multivariable logistic regression analysis confirmed that only the higher SM grade remained an independent adverse factor for de novo headache (adjusted odd ratio [OR] = 3.48, 95% confidence interval [CI] = 1.29-9.35, p = 0.013; high grade versus low grade BAVM). In the microsurgery treatment cohort, the lesion size in the de novo headache subgroup was significantly larger than that in the nonheadache subgroup, with a mean lesion diameter of 3.8 ± 0.3 cm versus 2.9 ± 0.2 cm (p = 0.024). Univariable logistic regression analysis revealed that only a larger diameter was significantly associated with increased odds of de novo headache (OR = 1.52, 95% CI = 1.04-2.21, p = 0.030; per 1 cm increase in diameter).</p><p><strong>Conclusion: </strong>In the microsurgery treatment subgroup, a larger BAVM was associated with increased odds of de novo headache (per 1 cm increase); in the SRS treatment subgroup, grades III-V were associated with increased odds of de novo headache.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146093017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Calli Cook, Marshall C Freeman, Jessica Ailani, Annika Ehrlich, Brian Grosberg, Marielle Kabbouche, Maureen Moriarty, Karissa Secora, Juliana VanderPluym, Brad Klein, Marius Birlea
Objectives: Discuss the current status of advanced practice providers (APPs) onboarding to headache medicine (HM) practices in the United States and present recommendations of the American Headache Society (AHS) APP Work Group to improve the onboarding process.
Background: A high demand for care, national shortage of specialists, and multiple advancements in HM have led to an increasing interest and presence of APPs of various backgrounds in the field, currently without a unifying onboarding process. Efforts to standardize and optimize the onboarding process for APPs in HM practices are necessary, to ensure high standards in quality of care.
Methods: The APP Work Group of the AHS Practice Management Committee developed comprehensive recommendations through literature review, survey of AHS members, and expert consensus. A modified Delphi protocol was used to establish key onboarding goals, definitions, and best practice recommendations.
Results: Recommendations are made regarding duration of onboarding, appropriate supervision, formal education and procedural skills, scope of practice, grading and documentation of competence, and reciprocal feedback.
Conclusion: Currently, there are no standard onboarding and training guidelines for APPs in the field of HM. We provide recommendations for a more systematic approach to help develop qualified providers and enhance their retention in HM practices.
{"title":"Towards a standardized process of onboarding advanced practice providers into headache medicine practices in the United States: Expert consensus from the American Headache Society practice management committee.","authors":"Calli Cook, Marshall C Freeman, Jessica Ailani, Annika Ehrlich, Brian Grosberg, Marielle Kabbouche, Maureen Moriarty, Karissa Secora, Juliana VanderPluym, Brad Klein, Marius Birlea","doi":"10.1111/head.70038","DOIUrl":"https://doi.org/10.1111/head.70038","url":null,"abstract":"<p><strong>Objectives: </strong>Discuss the current status of advanced practice providers (APPs) onboarding to headache medicine (HM) practices in the United States and present recommendations of the American Headache Society (AHS) APP Work Group to improve the onboarding process.</p><p><strong>Background: </strong>A high demand for care, national shortage of specialists, and multiple advancements in HM have led to an increasing interest and presence of APPs of various backgrounds in the field, currently without a unifying onboarding process. Efforts to standardize and optimize the onboarding process for APPs in HM practices are necessary, to ensure high standards in quality of care.</p><p><strong>Methods: </strong>The APP Work Group of the AHS Practice Management Committee developed comprehensive recommendations through literature review, survey of AHS members, and expert consensus. A modified Delphi protocol was used to establish key onboarding goals, definitions, and best practice recommendations.</p><p><strong>Results: </strong>Recommendations are made regarding duration of onboarding, appropriate supervision, formal education and procedural skills, scope of practice, grading and documentation of competence, and reciprocal feedback.</p><p><strong>Conclusion: </strong>Currently, there are no standard onboarding and training guidelines for APPs in the field of HM. We provide recommendations for a more systematic approach to help develop qualified providers and enhance their retention in HM practices.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146093040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comfort matters: A new strategy to ease injection pain during headache treatment procedures.","authors":"Hannah F J Shapiro","doi":"10.1111/head.70050","DOIUrl":"https://doi.org/10.1111/head.70050","url":null,"abstract":"","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146040884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Faraidoon Haghdoost, Dilara Bahceci, Candice Delcourt, Tissa Wijeratne, Rigmor H Jensen, Carl Cincinnato, Susan Tomlinson, Bob Wold, Vince Polito, Cheryl Carcel, Usman Ashraf, Bronwyn Jenkins, Anja Sofie Petersen, Jason C Ray, Emmanuelle A D Schindler, Benjamin Tsang, Chris Gianacas, Anthony Rodgers
<p><strong>Objective: </strong>This study was undertaken to identify gaps in cluster headache management, highlight patient-prioritized research needs, and assess patient interest in, and preferences for, clinical trial participation.</p><p><strong>Background: </strong>Many people with cluster headache still lack effective treatment options to control or prevent attacks. There is a critical need for more studies, particularly clinical trials, in this field. To design and conduct successful trials, it is essential to identify priority research areas, allocate resources effectively, and ensure patient engagement and support.</p><p><strong>Methods: </strong>This study was an online survey conducted among Australian adults with self-reported cluster headache. Participants were recruited using a multi-channel approach, including direct outreach by clinicians, support from patient advocacy groups, and broad social media distribution. It collected data on demographics, treatment experiences, and perspectives on future research, including research priorities, and preferred outcomes and interventions. Additionally, participants' interest in joining clinical trials was assessed to help identify potential candidates for future studies.</p><p><strong>Results: </strong>Of the 219 individuals who began the survey, 17 (8%) were excluded due to providing no responses beyond demographic data or reporting no cluster headache diagnosis by a healthcare professional. The final sample consisted of 202 participants, with an average age of 46 years, 77% aged 25-54 years, 55% male, 72% had been living with cluster headache for more than 10 years, and 29% reported attacks occurring almost every month throughout the year. A quarter of participants had not followed up with a healthcare provider for cluster headache management when they completed the survey. Among those who sought care (n = 145 [72%]), general practitioners were the most frequently consulted (86%), followed by neurologists (66%). Treatments were considered "not at all effective" or "somewhat ineffective" by 35% of all participants, while 27% reported only partial effectiveness. The main treatment challenges were ineffectiveness (74%), side effects (54%), cost (53%), and difficulties with access (39%). Among the 202 participants, 126 (62%) indicated interest in participating in future cluster headache trials, while 26 (13%) responded with "maybe." Psilocybin was the highest-ranked treatment in terms of participants who were "very interested," with 66% selecting this option. The combined proportion of participants who were "very interested" or "interested" was 84% for combination therapies, 82% for psilocybin, 71% for medical devices, and 66% for anti-CGRP treatments.</p><p><strong>Conclusion: </strong>Participants with reported cluster headache highlighted inadequate treatment options, emphasized the need for further research, and expressed interest in future clinical trials, particularly those involving psil
{"title":"Patient perspectives on research gaps in cluster headache.","authors":"Faraidoon Haghdoost, Dilara Bahceci, Candice Delcourt, Tissa Wijeratne, Rigmor H Jensen, Carl Cincinnato, Susan Tomlinson, Bob Wold, Vince Polito, Cheryl Carcel, Usman Ashraf, Bronwyn Jenkins, Anja Sofie Petersen, Jason C Ray, Emmanuelle A D Schindler, Benjamin Tsang, Chris Gianacas, Anthony Rodgers","doi":"10.1111/head.70031","DOIUrl":"https://doi.org/10.1111/head.70031","url":null,"abstract":"<p><strong>Objective: </strong>This study was undertaken to identify gaps in cluster headache management, highlight patient-prioritized research needs, and assess patient interest in, and preferences for, clinical trial participation.</p><p><strong>Background: </strong>Many people with cluster headache still lack effective treatment options to control or prevent attacks. There is a critical need for more studies, particularly clinical trials, in this field. To design and conduct successful trials, it is essential to identify priority research areas, allocate resources effectively, and ensure patient engagement and support.</p><p><strong>Methods: </strong>This study was an online survey conducted among Australian adults with self-reported cluster headache. Participants were recruited using a multi-channel approach, including direct outreach by clinicians, support from patient advocacy groups, and broad social media distribution. It collected data on demographics, treatment experiences, and perspectives on future research, including research priorities, and preferred outcomes and interventions. Additionally, participants' interest in joining clinical trials was assessed to help identify potential candidates for future studies.</p><p><strong>Results: </strong>Of the 219 individuals who began the survey, 17 (8%) were excluded due to providing no responses beyond demographic data or reporting no cluster headache diagnosis by a healthcare professional. The final sample consisted of 202 participants, with an average age of 46 years, 77% aged 25-54 years, 55% male, 72% had been living with cluster headache for more than 10 years, and 29% reported attacks occurring almost every month throughout the year. A quarter of participants had not followed up with a healthcare provider for cluster headache management when they completed the survey. Among those who sought care (n = 145 [72%]), general practitioners were the most frequently consulted (86%), followed by neurologists (66%). Treatments were considered \"not at all effective\" or \"somewhat ineffective\" by 35% of all participants, while 27% reported only partial effectiveness. The main treatment challenges were ineffectiveness (74%), side effects (54%), cost (53%), and difficulties with access (39%). Among the 202 participants, 126 (62%) indicated interest in participating in future cluster headache trials, while 26 (13%) responded with \"maybe.\" Psilocybin was the highest-ranked treatment in terms of participants who were \"very interested,\" with 66% selecting this option. The combined proportion of participants who were \"very interested\" or \"interested\" was 84% for combination therapies, 82% for psilocybin, 71% for medical devices, and 66% for anti-CGRP treatments.</p><p><strong>Conclusion: </strong>Participants with reported cluster headache highlighted inadequate treatment options, emphasized the need for further research, and expressed interest in future clinical trials, particularly those involving psil","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146009620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dawn C Buse, Lindsay A Videnieks, Karissa Charles, Killian Lozach, Kristina M Fanning, Talia A Guidi, Richard B Lipton
<p><strong>Objective: </strong>This study was undertaken to report rates of payer blocking of prescribed branded migraine medications in total and by race/ethnicity, income, and education, and to examine the relationship between payer blocking and emergency department and inpatient encounters for migraine-specific and all-cause reasons in a large US claims database.</p><p><strong>Background: </strong>Access to prescribed branded migraine medications can be challenging due to restrictive utilization management protocols and may be related to increased healthcare resource utilization. These barriers may disproportionately affect patients based on sociodemographic factors.</p><p><strong>Methods: </strong>This observational cohort study analyzed data from an integrated database containing electronic medical records, specialty pharmacy, and in-office dispensing datasets. Individuals with a migraine diagnosis who experienced payer blocking-defined as denial of prescribed branded migraine medications ≥2 times due to step therapy, prior authorization, or related restrictions-between January 1, 2019, and December 31, 2021, were included. Rates of payer blocking were reported for the total sample and by sociodemographic groups. Emergency department (ED) and inpatient encounter rates for migraine-specific and all-cause reasons were compared by payer blocking status. Differences were assessed using χ<sup>2</sup> tests with Bonferroni corrected α (p < 0.0018). Effect sizes were estimated using Cramer's V.</p><p><strong>Results: </strong>Among 7.7 million patients with ≥1 migraine-related prescription claim(s), 370,560 actively treated individuals met inclusion criteria for analysis. One in five (20.6%) experienced payer blocking. There were significant differences in the distribution of race/ethnicity, annual household income, and educational attainment categories across payer blocking status groups (p < 0.001 for all), with small effect sizes (Cramer's V = 0.014-0.034). Patients with a history of payer blocking had significantly higher rates of ED and inpatient encounters for both all-cause and migraine-specific reasons (p < 0.001 for all), although effect sizes were small. This pattern was consistent within racial/and ethnic groups, with significant differences observed for White patients both for migraine-related and all-cause ED and inpatient encounters, and Black/African American and Hispanic/Latino patients for migraine-related encounters (p < 0.001 for all).</p><p><strong>Conclusion: </strong>Payer blocking of branded migraine medications was fairly common, affecting one in five patients and was broadly associated with increased healthcare utilization. These findings suggest that payer blocking may disproportionately impact patients according to race/ethnicity, household income, and educational attainment. Although effect sizes were small, the outcomes may provide useful hypotheses for understanding and addressing healthcare disparities in migraine [Co
{"title":"Rates and healthcare resource utilization for people with branded acute and preventive migraine prescription medication order payer denials: An open, multi-source dataset, observational cohort study.","authors":"Dawn C Buse, Lindsay A Videnieks, Karissa Charles, Killian Lozach, Kristina M Fanning, Talia A Guidi, Richard B Lipton","doi":"10.1111/head.70026","DOIUrl":"10.1111/head.70026","url":null,"abstract":"<p><strong>Objective: </strong>This study was undertaken to report rates of payer blocking of prescribed branded migraine medications in total and by race/ethnicity, income, and education, and to examine the relationship between payer blocking and emergency department and inpatient encounters for migraine-specific and all-cause reasons in a large US claims database.</p><p><strong>Background: </strong>Access to prescribed branded migraine medications can be challenging due to restrictive utilization management protocols and may be related to increased healthcare resource utilization. These barriers may disproportionately affect patients based on sociodemographic factors.</p><p><strong>Methods: </strong>This observational cohort study analyzed data from an integrated database containing electronic medical records, specialty pharmacy, and in-office dispensing datasets. Individuals with a migraine diagnosis who experienced payer blocking-defined as denial of prescribed branded migraine medications ≥2 times due to step therapy, prior authorization, or related restrictions-between January 1, 2019, and December 31, 2021, were included. Rates of payer blocking were reported for the total sample and by sociodemographic groups. Emergency department (ED) and inpatient encounter rates for migraine-specific and all-cause reasons were compared by payer blocking status. Differences were assessed using χ<sup>2</sup> tests with Bonferroni corrected α (p < 0.0018). Effect sizes were estimated using Cramer's V.</p><p><strong>Results: </strong>Among 7.7 million patients with ≥1 migraine-related prescription claim(s), 370,560 actively treated individuals met inclusion criteria for analysis. One in five (20.6%) experienced payer blocking. There were significant differences in the distribution of race/ethnicity, annual household income, and educational attainment categories across payer blocking status groups (p < 0.001 for all), with small effect sizes (Cramer's V = 0.014-0.034). Patients with a history of payer blocking had significantly higher rates of ED and inpatient encounters for both all-cause and migraine-specific reasons (p < 0.001 for all), although effect sizes were small. This pattern was consistent within racial/and ethnic groups, with significant differences observed for White patients both for migraine-related and all-cause ED and inpatient encounters, and Black/African American and Hispanic/Latino patients for migraine-related encounters (p < 0.001 for all).</p><p><strong>Conclusion: </strong>Payer blocking of branded migraine medications was fairly common, affecting one in five patients and was broadly associated with increased healthcare utilization. These findings suggest that payer blocking may disproportionately impact patients according to race/ethnicity, household income, and educational attainment. Although effect sizes were small, the outcomes may provide useful hypotheses for understanding and addressing healthcare disparities in migraine [Co","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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