Headache最新文献

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.

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.