Headache最新文献

Objectives/background: Heated tobacco products (HTPs) are novel alternatives to conventional cigarettes that heat tobacco leaves to generate nicotine-containing aerosols for inhalation. This study aimed to investigate the association between both conventional cigarette use and HTP use with self-reported frequent headache. Although the association between cigarette smoking and headache has been reported, evidence regarding HTPs remains limited.

Methods: We utilized data from the Japan Society and New Tobacco Internet Survey, an ongoing internet-based cohort cross-sectional study launched in 2015 to monitor conventional cigarette and HTP use. Participants were recruited from a nationally representative online panel, comprising over 2 million individuals. Among 28,000 respondents in the 2025 wave, we included 23,228 individuals with valid responses. Self-reported frequent headache was defined as responding "occasionally" or "frequently" to the question, "Have you experienced headaches in the past year?" (other options: "never" and "rarely"). We conducted a multivariable analysis adjusting for demographic, socioeconomic, lifestyle, and clinical variables. We then compared the adjusted odds ratios (aORs) of conventional cigarettes and HTP use for the prevalence of self-reported frequent headache.

Results: Of the 23,228 participants, 25.5% (5923/23,228) reported headaches. Regarding tobacco use, 12.2% (2823/23,228) were current cigarette users, 31.8% (7393/23,228) were former cigarette users, 56.0% (13,012/23,228) were never cigarette users; 11.6% (2688/23,228) were current HTP users, 10.0% (2326/23,228) were former HTP users, and 78.4% (18,214/23,228) were never HTP users. Multivariable analysis with multiple imputation revealed that current (aOR = 1.71 [95% confidence interval [CI] = 1.44-2.03]) and former (aOR = 1.54 [95% CI = 1.37-1.73]) cigarette use, and current (aOR = 1.15 [95% CI = 1.01-1.32]) HTP use were significantly associated with self-reported frequent headache. Former HTP use was not significantly associated with headache (aOR = 1.09 [95% CI = 0.96-1.24]). Postestimation comparisons indicated a weaker association for HTPs than for cigarettes (current smokers vs. current HTP users: ratio of aORs = 1.48 [95% CI = 1.19-1.84]).

Conclusion: Both current and former cigarette use were significantly associated with a higher prevalence of self-reported frequent headache, and current HTP use also showed a modest but significant association. Although HTPs are often perceived as less harmful, they still emit nicotine and other constituents, which may be associated with self-reported frequent headache.

Objective: To assess the prevalence, frequency, and characteristics of headache disorders in transgender individuals receiving gender-affirming hormone therapy (GAHT), and to explore the relationship between GAHT and headache pathophysiology. We hypothesized that estrogen-based GAHT would be associated with increased risk of headache, particularly migraine, whereas testosterone-based GAHT would be associated with reduced headache burden.

Background: Migraine is a highly disabling headache disorder that disproportionately affects cisgender women, with hormonal fluctuations playing a key role in its pathophysiology. Despite extensive research in cisgender populations, there is a gap in our understanding about the prevalence and characteristics of headache disorders, including migraine, in transgender and nonbinary individuals undergoing GAHT, and there is true urgency to fill this knowledge gap.

Methods: We conducted a cross-sectional, observational study using an anonymous online survey targeting transgender and nonbinary individuals in Argentina from October 2023 to February 2024. Eligible participants were aged ≥18 years and receiving GAHT. The validated Migraine Screen Questionnaire (MS-Q) was used to identify migraine-like headaches. Additional items assessed changes in headache characteristics associated with GAHT.

Results: Of 160 participants, 102 (63.7%; 95% confidence interval [CI] 56.1%-70.8%) reported experiencing headaches. Of these, 86.3% (number [n] = 88) were receiving testosterone, 11.8% (n = 12) estrogens, and 2.0% (n = 2) were receiving other GAHT. Only 24.5% (n = 24) reported a prior headache diagnosis, including 18 participants (17.6%; 95% CI 11.3%-26.2%) with migraine. Based on the MS-Q, 46.1% (n = 47) screened positive for migraine-like headaches. New headache or worsening of headache was more frequently reported by estrogen users (66.6%) compared to those using testosterone (27.2%). Improvement or resolution of headaches was reported by 26.1% of testosterone users compared to 8.3% of estrogen users.

Conclusion: Estrogen-based GAHT was associated with a higher proportion of individuals reporting new or worsening headaches, whereas testosterone-based GAHT was more often associated with headache improvement. These associations underscore the need for further research into how GAHT modulates headache patterns, as well as the high rate of underdiagnosed headache disorders in this population.

Objective: We set out to examine detailed phenotypic data from our clinic for associations of vertigo in chronic migraine.

Background: Vertigo is a non-canonical, common symptom of migraine. Little is known about its associations with other symptoms within the migraine phenotype. There is significant methodological heterogeneity and therefore inadequate overall evidence about the potential differences in efficacy of any migraine treatments in patients with problematic vertigo associated with migraine, compared to those without vertigo. Enhancing understanding of migraine-related vertigo could help guide treatment and inform on mechanisms of vestibular migraine, a poorly understood diagnostic entity.

Methods: Chronic migraine extended phenotypes of patients seen within the adult headache service at King's College Hospital Tertiary Headache Service between January 2014 and December 2021 (n = 589) were extracted from the first documented clinic consultation letter retrospectively. For those with information about vertigo (n = 562), potential associations of interest for the presence of vertigo (gender, allodynia, aura, photophobia, phonophobia and osmophobia, baseline headache frequency, number of premonitory symptoms, presence of cranial autonomic symptoms, and age) were analyzed using a regression model (IBM SPSS v 29). Missing data were excluded (final n = 435).

Results: The total sample size for analysis in the regression model was n = 435, after excluding missing data (n = 126) and outliers (n = 1). Patients were 16-92 years old (median, 47; interquartile range, 37-55), and the majority (83.4%) were female. Vertigo associated with migraine was present in 275 of 562 (49%) patients. Within the regression model, the presence of aura (odds ratio, 2.13; 95% confidence interval, 1.4-3.23, P < 0.001) and allodynia (odds ratio, 2.74; 95% confidence interval, 1.76-4.26, P < 0.001) were positively associated with vertigo.

Conclusions: Vertigo in chronic migraine is common and may be associated with a more enriched phenotype independent of baseline headache frequency. Future treatment strategies should be evaluated for their effects on this often under-recognized yet disabling symptom.

Objective: This study was conducted to investigate the association between migraine frequency and insomnia severity.

Background: Migraine and insomnia frequently co-occur, yet the relationship between migraine characteristics and insomnia severity remains poorly understood. Both conditions substantially impair quality of life and daily functioning, potentially because of shared pathophysiological mechanisms. In this study, we investigated the association between migraine frequency and insomnia severity and examined the impact of aura, psychological factors, and restless legs syndrome (RLS).

Methods: This cross-sectional controlled study included 2155 participants (1954 individuals with migraine and 201 controls) who visited the neurology outpatient department of a tertiary medical center between January 2019 and October 2023. Migraine diagnosis adhered to the International Classification of Headache Disorders, 3rd edition criteria, with all participants evaluated by a board-certified neurologist and headache specialist. Insomnia severity was assessed using the Insomnia Severity Index (ISI), and psychological factors were measured using the Beck Depression Inventory-II and Hospital Anxiety and Depression Scale. RLS was diagnosed as per international criteria, and individuals with migraine were stratified by headache frequency (1-7, 8-14, or ≥15 days/month) and aura status.

Results: High migraine frequency was associated with increased ISI scores (adjusted regression coefficient [β] = 0.75, 95% confidence interval [CI], 0.50-1.01) and increased prevalence of clinical insomnia (ISI ≥ 15) (adjusted odds ratio [aOR] = 1.34; 95% CI, 1.17-1.53) after controlling for demographic, lifestyle, and clinical factors. In the univariate analysis, patients with migraine with aura showed higher ISI scores than those without aura (p < 0.001); however, this difference was no longer significant after adjustment for migraine frequency, depression, anxiety, RLS, and other confounders (adjusted β = 0.48; 95% CI, -0.24 to 1.20; p = 0.191). Multivariable analyses revealed significant associations between ISI total score and depression (adjusted β = 0.21; 95% CI, 0.17-0.24), anxiety (adjusted β = 0.34; 95% CI, 0.27-0.41), and RLS (adjusted β = 1.02; 95% CI, 0.53-1.51). RLS prevalence was significantly higher in the migraine group than in the control group (32.4% vs. 12.9%).

Conclusions: Migraine frequency showed a graded association with insomnia severity, with additional independent contributions from psychological factors and RLS, but not from aura status. These findings underscore the multifactorial nature of sleep disturbances in migraine and the need for comprehensive management strategies that address both headache-specific factors and comorbid conditions.

Methods: We conducted a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, retrieving data from PubMed, Elsevier, Web of Science, and Cochrane Central Register of Controlled Trials . Primary outcomes included changes from baseline in acute headache medication days and monthly migraine days (MMD). Secondary outcomes comprised the incidence of adverse events (AEs), common AEs, and the proportion of patients achieving a ≥ 50% reduction in MMDs.

Results: Five randomized controlled trials including 875 patients (mean age of 42.7 years) were analyzed. Erenumab treatment was associated with significant reductions in acute headache medication days (mean difference = -1.72; 95% confidence interval [CI]: -2.81 to -0.62; p = 0.002) and MMDs (mean difference = -1.88; 95% CI: -2.68 to -1.07; p < 0.001). Whereas erenumab increased the risk of common AEs such as constipation (risk ratio [RR] = 1.43; 95% CI: 1.17 to 1.76; I² = 14%), the overall incidence of AEs was not significantly different compared to placebo (RR = 1.02; 95% CI: 0.92 to 1.14; I² = 57%). A higher proportion of patients achieved a ≥50% reduction in MMDs after 3 months in the erenumab group (RR = 1.49; 95% CI: 1.26 to 1.77; I² = 22%).

Conclusion: Erenumab appears effective in reducing migraine frequency and symptomatic medication use among patients with chronic migraine MOH, with an acceptable tolerability profile.