Headache最新文献

Objective: Cluster headache (CH) significantly impacts patients' quality of life (QoL). We aim to validate the Cluster Headache Quality of Life scale (CHQ) for measuring QoL changes in patients with CH.

Methods: In this multicenter, prospective, longitudinal psychometric validation study, participants, all with chronic CH (CCH), completed the CHQ at a 3-monthly interval alongside headache diaries and general QoL questionnaires (36-item Short Form [SF-36], Hospital Anxiety and Depression Scale [HADS], and EuroQol 5 Dimensions [EQ-5D]). CHQ's ability to measure changes was validated in three steps following COSMIN guidelines: (1) convergent validity, (2) responsiveness, and (3) interpretability. Baseline scores were used for step 1; change scores for steps 2 and 3 (Δ baseline-follow-up). Twelve correlation hypotheses were formulated and tested for steps 1 and 2. Validity was rated by % rejected hypotheses (high: ≤25%, moderate: 26%-50%, poor: ≥50%). Data were collected in the Netherlands (Leiden, Nijmegen, Heerlen) between 9 December 2021 and 18 November 2024.

Results: For step 1, 117 participants were included (n = 70 for SF-36/HADS analyses, n = 42 for EQ-5D analyses) and 82 were included for steps 2 and 3 (n = 48 for SF-36/HADS analyses, n = 29 for EQ-5D analyses). At baseline, overall QoL was poor (CHQ: 60.9 ± 23.1, SF-36: 46.7 ± 19.9) and worse in participants with more intense and frequent CH attacks (>CHQ scores: β = 2.92 (95% confidence interval [CI] 0.91 to 4.93), p = 0.005; β = 0.27 (95% CI 0.02 to 0.53), p = 0.033). Convergent and responsiveness validity was high (≤25% hypotheses rejected). CHQ baseline scores correlated strongly with the HADS, SF-36, and EQ-5D (ρ = 0.68, ρ = -0.60, ρ = -0.52), but weakly with attack frequency (ρ = 0.27). Change scores correlated strongly with HADS and SF-36 (ρ = 0.51, ρ = -0.56) and moderately with EQ-5D (ρ = -0.38). Step 3 indicated ≤ -3.5 points change as clinically relevant improvement and ≥7.5 points as deterioration.

Conclusion: The CHQ has a high validity to measure change in QoL. CH attack frequency influences QoL, but QoL is more strongly correlated with mental health and activity restrictions than attack frequency. Implementing the CHQ may improve understanding of disease burden, enabling more targeted treatment strategies and thus improving overall disease management.

Objective: The aim of this case series is to describe a clinical phenotype of midfacial pain and suggest its potential as a candidate for future iterations of headache and facial pain classifications.

Background: Patients with facial pain that is located in the middle part of the face often consult otorhinolaryngologic, neurologic, or pain specialists. In the past, a diagnosis of midfacial pain was suggested if other causes were excluded.

Methods: This case series is based on a retrospective analysis of patients consulted in two headache and facial pain centers. The patients were selected if the pain was located in the zygomatic, infraorbital, or nasal region, and rhinosinusitis and other primary or secondary facial pain syndromes were excluded during a comprehensive diagnostic process.

Results: Twelve patients in the 18-74 years age group (median, 40.5 years; interquartile range [IQR], 18.3; 4 of 12 [33%] patients were women), from two tertiary headache and facial pain centers in Warsaw and Hamburg were included in the case series based on consultations conducted between January 1, 2024, and December 31, 2024. Patients reported 20-30 (median, 30; IQR, 2.8; mean = 28.1; standard deviation, 3.2) monthly facial pain days of mostly moderate intensity (range from 1 to 9; median, 5; IQR, 2.125; mean = 5.2; SD, 1.9) on Numeric Rating Scale. Pain was described as dull, pressing, or tension-like and was bilateral in 10 of 12 (83%) patients. Seven of 12 (58%) patients described pain occurring simultaneously in regions innervated by the first (nasal region) and second branch (infraorbital) of the trigeminal nerve.

Conclusions: This study provides preliminary evidence for a distinct phenotype of idiopathic midfacial pain that is not caused by rhinosinusitis, stomatognathic disorders, or facial manifestations of primary headaches. Our data call for prospective studies on this type of idiopathic facial pain for future International Classification of Headache Disorders and International Classification of Orofacial Pain editions.

Background: Evidence suggests that exercise has clinically relevant benefits for migraine, but an optimal prescription standard remains undefined. We aimed to assess the effectiveness of aerobic exercise on migraine intensity and frequency through a dose-response meta-analysis.

Methods: A data search was performed in PubMed, PEDro, Google Scholar, and EBSCO from inception to September 1, 2024. Randomized controlled trials and quasi-experimental studies of aerobic exercise in patients with a clinical diagnosis of migraine were included. The outcome measures were pain intensity and migraine frequency. The dose-response relationship was evaluated using a dose-response meta-analysis.

Results: Fifteen studies (253 participants) were included. Meta-analysis showed a statistically significant decrease in pain intensity between pre and post intervention (standardized mean differences [SMD], -1.1; 95% confidence interval [CI], -1.72 to -0.47). The spline model showed a U-shape statistically significant association (χ² = 112.03, df = 2, p < 0.001) between total minutes of aerobic exercise and reduction in pain intensity. A minimum dose of 200 min was required for moderate effects, with a maximum effect at 900 min (SMD, -2.4; 95% CI, -2.85 to -1.95). Meta-analysis showed a statistically significant decrease in migraine frequency between pre and post intervention (SMD, -0.79; 95% CI, -1.1 to -0.47). The spline model showed a U-shape statistically significant association (χ² = 86.41, dl = 2, p < 0.001) between total minutes of aerobic exercise and reduction in migraine frequency. A minimum dose of 300 total minutes of aerobic exercise program duration was required to obtain a moderate effect in reducing migraine frequency, with a maximum effect at 950 min (SMD, -1.55; 95% CI, -1.87 to -1.22).

Conclusions: This meta-analysis suggests that aerobic exercise may be effective in reducing both pain intensity and migraine frequency in people with migraine. The greatest observed effect on both variables was observed at a cumulative dose of approximately 900-950 total minutes of aerobic exercise during the program, and higher doses may not present additional benefits. These findings support a preliminary recommendation of 3 weekly 30-min sessions over 10-11 weeks, to be confirmed in future high-quality trials.

Background/objective: Hemorrhagic stroke comprises about 20% of all strokes, with intracerebral hemorrhage (ICH) being the most common type. While post-stroke care often focuses on motor and functional recovery, post-stroke headaches remain underrecognized and understudied. This study aimed to summarize and pool the evidence on the prevalence and patterns of headaches after hemorrhagic stroke.

Methods: We conducted a systematic review and meta-analysis of studies published from database inception to December 2024, identifying observational studies that investigated headaches after hemorrhagic stroke. Studies enrolling five or more adult patients were included. Meta-analyses were conducted to estimate pooled prevalence of overall, acute/subacute, persistent, and severe headaches. Acute/subacute headache was defined as onset within 3 months of stroke, while persistent headache as headache lasting more than 3 months. Severe headache was defined as either a ≥ 7/10 pain intensity or functional impairment.

Results: Twenty-four studies comprising 4688 patients (58.2% female; mean age 56.9) were included. The overall pooled headache prevalence of 46.1% (95% confidence interval [CI]: 36.3%-56.1%; 95% prediction interval [PI]: 4.3%-91.8%; I² = 96.7%) following hemorrhagic stroke. Stratified analyses showed that the prevalence was 58.3% (95% CI: 44.4%-71.6%, I² = 97.5%) in patients with subarachnoid hemorrhage (SAH) and 36.1% (95% CI: 26.7%-46.0%, I² = 93.9%) in those with ICH. Acute/subacute headache occurred in 55.9% (95% CI: 41.1%-70.1%; I² = 97.6%), while persistent headache occurred in 36.7% (95% CI: 25.6%-48.5%, I² = 93.1%). Severe headaches were reported in 42.7% (95% CI: 15.8%-72.1%; I² = 98.0%) of patients with acute/subacute headache and 14.3% (95% CI: 10.4%-18.7%; I² = 71.5%) with persistent headache. In both SAH and ICH, headaches frequently become chronic. No significant differences were observed by study design, geographic region, Human Development Index, or risk of bias.

Conclusion: Headache is a common but understudied condition that can manifest at or soon after a hemorrhagic stroke and can persist for years, potentially contributing to long-term morbidity. Standardized headache definitions and longitudinal assessments are needed to improve recognition and inform future clinical trials targeting this underappreciated source of post-stroke morbidity. Further research is essential to better understand the nature of these headaches, which will help shape treatment protocols and enhance patient care.

Objective: To investigate the relationship between prenatal nutrition and the development of painful temporomandibular disorders (p-TMD) and headaches in offspring during young adulthood.

Background: p-TMD are a common source of chronic orofacial pain and are often comorbid with headaches. Dietary quality may influence chronic musculoskeletal pain, but its role on the development of p-TMD and headache is less known.

Methods: The study was conducted as a prospective longitudinal cohort study. Survey data from the Danish National Birth Cohort (DNBC) were analyzed. Data included prenatal nutritional information assessed using a healthy eating index (HEI) derived from a food frequency questionnaire collected between 1996 and 2002 and offspring's p-TMD and headache status at age 18-23 years, assessed in 2021. HEI was categorized into quartile levels of dietary quality. A total of 10,382 individuals had complete data on both exposure and outcome.

Results: No statistically significant association was found between prenatal HEI and offspring's p-TMD status. Offspring of mothers with higher HEI scores were significantly less likely to report one or fewer headaches per month in young adulthood (adjusted OR [aOR] = 0.84; 95% confidence interval [CI], 0.73-0.96, p = 0.006). Specific pre-natal dietary domains associated with reduced headache risk included red meat scores (aOR = 0.98; 95% CI, 0.97-0.99, p = 0.006) and saturated fatty acids (aOR = 0.92; 95% CI, 0.86-0.99, p = 0.039).

Conclusion: Offspring of mothers with higher HEI scores, that is, healthier dietary choices during pregnancy, had significantly lower odds of reporting headaches but not p-TMD in young adulthood. Lower maternal intake of saturated fatty acids and red meat were associated with decreased odds of reporting headaches later in life.