Headache最新文献

Background: Microstate analysis captures brief but critical fluctuations in brain activity, making it a powerful tool for exploring the cyclic nature of migraine. In this study, we aimed to investigate microstate features during different migraine phases and develop a classification model to identify the pre-ictal phase.

Methods: From May 2023 to June 2024, we conducted a cross-sectional study with consecutive recruitment, collecting resting-state electroencephalography data from 174 individuals with migraine without aura and 50 healthy controls, followed by classification of migraine phases. Microstate features, Lempel-Ziv complexity, and sample entropy were compared across five groups. A model was developed to identify the pre-ictal phase and validated on a test set.

Results: Microstate features, particularly for microstates A and B, exhibited dynamic changes across the migraine cycle. The duration of microstate A was significantly longer in the inter-ictal phase than in the pre-ictal phase, whereas microstate B showed prolonged duration in the pre-ictal phase compared to healthy controls and the post-ictal phase. Microstate A displayed reduced coverage in the pre-ictal phase, whereas microstate B had increased occurrence and coverage during the pre-ictal and ictal phases. Transition probabilities also varied significantly: the pre-ictal phase showed elevated transitions from microstates A, C, and D to B, and the post-ictal phase showed reduced transitions from C and D to A. A classification model based on these microstate features achieved an area under the receiver operating characteristic curve (AUROC) of 0.85 (0.73-0.95), an area under the precision-recall curve (AUPRC) of 0.83 (0.66-0.95), and an F1 score of 0.78 (0.62-0.90) in the training set; and an AUROC of 0.84 (0.69-0.97), an AUPRC of 0.86 (0.67-0.98), and an F1 score of 0.81 (0.65-0.93) in the test set, indicating robust performance in identifying the pre-ictal phase.

Conclusion: Through the observation of cyclic alterations in the microstates of patients with migraine, we identified a reduction in microstate A and an enhancement in microstate B during the pre-ictal phase. These changes may indicate a heightened sensitivity to auditory stimuli and increased activity in the visual cortex, providing new insights into migraine pathophysiology. Our model effectively identified the pre-ictal phase, offering a promising approach for early intervention in migraine attacks.

Objectives/background: To determine whether the volume of specific subcortical structures differ between people with migraine and healthy controls, and whether these volumes vary across distinct migraine subtypes and phases. Subcortical structures, including regions involved in pain processing and sensory integration, play a key role in migraine pathophysiology, yet studies on volumetric differences have shown conflicting results. This study uses a large cohort and robust imaging methods to clarify whether subcortical volumes differ in migraine.

Methods: In this cross-sectional study at the Danish Headache Center in Denmark, conducted between January 2020 and December 2023, adult participants with migraine and age- and sex-matched healthy controls underwent a single magnetic resonance imaging session at 3T. T1-weigthed scans were acquired to measure the volumes of subcortical structures using automated segmentation techniques. The structures analyzed included the thalamus, putamen, caudate nucleus, pallidum, nucleus accumbens, amygdala, and hippocampus.

Results: Imaging data from 295 participants and 154 healthy controls were included in the final analyses. No significant differences were observed between participants with migraine and healthy controls in thalamic volume (migraine: 7243 ± 923 mm³ vs. healthy controls: 7350 ± 782 mm³; p = 0.774) or hippocampal volume (migraine: 4204 ± 398 mm³ vs. healthy controls: 4307 ± 446 mm³; p = 0.337). No differences were observed in any other subcortical structure. Likewise, different subgroup analyses revealed no volumetric differences in episodic versus chronic migraine, migraine with aura versus without aura, ictal versus headache free, or between each migraine subgroup and healthy controls (all p > 0.05 after multiple comparison correction).

Conclusion: In this large cross-sectional study, we found no evidence of subcortical volume differences between adults with migraine and healthy controls. Furthermore, no differences were found across migraine subtypes or phases. These findings indicate that subcortical volumetric measures are not suitable as imaging biomarkers of migraine. Future research should explore functional and metabolic alterations in subcortical structures to better understand the neurobiologic underpinnings of migraine.

Objectives: The aim of this work was to develop an American Headache Society position statement addressing diagnostic screening for migraine among girls and women.

Background: Despite its high prevalence and substantial negative impacts, migraine is underdiagnosed and undertreated. Diagnostic screening for migraine enables more patients to receive timely, appropriate, and effective management.

Methods: Development of this position statement followed the rules established by the American Headache Society Guidelines Committee. The published literature was reviewed to determine if migraine meets criteria for when disease screening is justified, to guide recommendations for screening tools, and to determine subpopulation(s) for which migraine screening is indicated. After author consensus was reached, the position statement was reviewed and approved by the American Headache Society Board of Directors.

Results: Migraine fulfills established criteria for conditions in which screening is appropriate since it is highly prevalent, results in significant morbidity, and exerts substantial economic and social costs. Migraine incidence and prevalence are exceptionally high among girls and women during adolescence and through menopause. Furthermore, there are valid and reliable diagnostic screening methods (e.g., ID Migraine) and effective treatments that reduce migraine symptoms and disease impact.

Conclusion: Yearly diagnostic screening for migraine should be included as part of women's preventive healthcare services, particularly from adolescence to menopause.

Objective: Evaluate the efficacy and safety of a novel partial rebreathing device for early treatment of acute attacks of migraine with aura.

Background: Earlier clinical studies have indicated a potential for CO₂-enriched gas to be effective for acute treatment of migraine with aura, especially when applied during the early part of the aura stage. We developed a partial rebreathing device inducing moderate, steady-state hypercapnia with normoxia in order to provide a carbon dioxide delivery system combining efficacy, usability, safety, and affordability.

Methods: This randomized, double-blind, sham-controlled, parallel-group, group-sequential study was conducted at 15 study sites, nine located in the United States and six in Germany, between March 2023 and February 2025. The study enrolled patients aged 18-65 years with migraine with aura. The study had a sequential two-stage study design. At the beginning of stage 1, participants were randomized to active or sham and treated up to four attacks. Participants were instructed to treat from the onset of aura and until 5 min after aura cessation. After having reported four attacks in stage 1, participants had the option to continue into stage 2, an open-label extension in which they could treat up to five attacks with the active device. During stage 1, participants recorded symptom scores in a study diary app at the onset of aura and after 1, 2, 24, and 48 h.

Results: The study was terminated at the interim analysis point due to the lack of effect, at which point 142 participants had been enrolled (mean age 39.2 years, 81% women [115/142]). Sixty-seven participants had reported at least one study attack by the time of the study termination. None of the primary or secondary endpoints reached statistical significance. The primary endpoint Absence of Moderate or Severe Pain at 2 hours was 69.7% (46/66) [95.2% confidence interval (CI), 48.5, 90.9] in the sham group and 60.0% (42/70) [95.2% CI, 37.6, 82.4] in the active group (p = 0.379), whereas Pain Freedom at 2 hours was 18.2% (12/66) [95.2% CI, 1.3, 35.1] in the sham group and 21.4% (15/70) [95.2% CI, 3.6, 39.2] in the active group (p = 0.717).

Conclusion: Partial rebreathing inducing moderate hypercapnia with normoxia was not effective for aura-stage treatment of migraine-with-aura attacks. The study was preregistered at ClinicalTrials.gov (registration number NCT05546385).

Background: OnabotulinumtoxinA (BoNT-A) is an established preventive treatment for chronic migraine but involves 31 to 40 injections per session, often causing discomfort and post-procedural headaches. Remote electrical neuromodulation (REN) is a noninvasive therapy with efficacy in migraine treatment via conditioned pain modulation but has not been evaluated for procedural pain. This study evaluated REN's effectiveness in reducing acute procedural pain and postprocedural headache associated with BoNT-A injections.

Methods: This was an investigator-initiated single-center, randomized, single-blind, sham-controlled crossover study enrolled 80 adults (aged 22 to 74 years) with chronic migraine undergoing routine BoNT-A treatment. Each participant received one injection session without a device, followed by sessions using active REN and sham in randomized order. REN was applied to the upper arm 10 min prior to injections and removed after injection completion. Pain intensity was measured using a visual analog scale (0 to 100) at pre-procedure, intra-procedure, and post-procedure time points. The primary outcome was procedural pain intensity, and secondary outcomes included post-procedural headache incidence and adverse events. Due to clear benefit, the study was terminated early based on predefined stopping criteria.

Results: Final analysis of 60 participants (mean age 48.0 years; 49/60, 82% female) demonstrated that pre-procedural pain levels were not significantly different between baseline and the active REN or sham (p > 0.999 and p = 0.485, respectively). However, during and after BoNT-A administration, the active REN group reported significantly lower pain scores compared to both the sham and baseline conditions. At intra-procedure, the REN group experienced a mean pain reduction of 15.0 points (p < 0.001), and at post-procedure experienced a 19.1-point reduction (p < 0.001). Sham treatment did not result in significant pain reduction compared to baseline (p > 0.999 for both intra-procedure and post-procedure). Additionally, REN lowered the incidence of headache as an adverse event, with only 15% (8/52) of participants experiencing post-procedural headache compared to 55% (29/53) in the sham group and 39% (23/59) at baseline (odds ratio = 0.28, 95% confidence interval: 0.10 to 0.69, p = 0.008). No additional adverse events were reported.

Conclusions: REN significantly reduces procedural pain and post-procedural headache associated with BoNT-A injections for chronic migraine and may serve as a noninvasive, easily implemented pain management strategy for acute procedural pain. REN represents a promising approach to improving patient comfort during routine migraine treatment as well as reducing post-procedural headache.