Headache最新文献

Objective: This study aimed to evaluate the choroid plexus volume in patients with spontaneous intracranial hypotension (SIH), including the lateral, third, and fourth ventricles, and explore its potential relationship with clinical characteristics.

Background: SIH is caused by cerebrospinal fluid (CSF) leaks. The choroid plexus is predominantly responsible for CSF production and has been implicated in altered CSF dynamics in various neurological conditions.

Methods: This retrospective case control study included 25 patients with SIH who were diagnosed between 2022 and 2024 from a single tertiary center. In addition, 25 age- and sex-matched healthy controls were included. Choroid plexus volumes were manually segmented from 3D contrast-enhanced magnetization-prepared rapid acquisition gradient echo MRI sequences using 3D Slicer. The total intracranial volume was also calculated. Clinical data, including the Bern score and Headache Impact Test-6 score, were collected from patients with SIH. Group differences in choroid plexus volumes were assessed using a generalized linear mixed model for the lateral ventricles and multivariable linear regression for the third and fourth ventricles, adjusting for age, sex, body mass index, and total intracranial volume. Associations with clinical variables were evaluated using univariable linear regression.

Results: After adjusting for covariates, the choroid plexus volume in the lateral ventricles was significantly higher in patients with SIH compared to that in healthy controls (unstandardized regression coefficient = 201.81 mm³, p = 0.016). However, no significant differences were observed in the choroid plexus volumes of the third (p = 0.617) and fourth ventricles (p = 0.314). Additionally, choroid plexus volume was not associated with disease duration (p = 0.292), Bern score (p = 0.580), and Headache Impact Test-6 score (p = 0.539) in patients with SIH.

Conclusion: The lateral ventricular choroid plexus is enlarged in patients with SIH, which may represent a compensatory response to CSF hypovolemia.

Background: Chronic migraine is one of the most common causes of headache, belonging to the chronic primary pain (CPP) classification, along with fibromyalgia syndrome (FMS), temporomandibular disorders (TMD), and irritable bowel syndrome (IBS), based on the International Classification of Diseases-11. The comorbidity between these pain disorders is commonly seen in the clinic. Stress directly and indirectly affects the pathophysiological mechanisms related to migraine and plays an important role in the co-occurrence and development of migraine, FMS, TMD, and IBS.

Methods: We systematically searched PubMed and Web of Science databases, using combined keywords: stress, migraine, comorbidity, fibromyalgia syndrome, temporomandibular disorders, irritable bowel syndrome, pathological mechanisms, animal models, and treatment strategies, while emphasizing high impact studies. Literature was screened based on relevance, scientific rigor, and evidence level, prioritizing studies on stress-related comorbidity mechanisms, models, or treatments. Exclusion criteria included single case reports, non-full-text conference abstracts, non-English articles, low-relevance studies, low-quality methodologies, and general opinions (except authoritative consensus/guidelines).

Results: Clinical and preclinical studies support that potential stress-related mechanisms underlie these comorbidities, including dysfunction of hypothalamic-pituitary-adrenal axis, dysregulation of autonomic nervous system, and central sensitization. We highlight the development and application of preclinical stress-induced comorbid models as crucial tools for investigating these shared mechanisms. Stress targeted interventions have potential in managing these conditions, but mechanisms and efficacy stability remain to be clarified.

Conclusion: Stress may be a key driver of migraine and CPP comorbidities. Stress induced preclinical models support mechanism exploration, and stress-targeted therapies hold promise for improving patient prognosis. Future research should deepen mechanistic studies and optimize models/therapies to enhance clinical care.

Background: Eptinezumab is an anti-calcitonin gene-related peptide monoclonal antibody used for migraine prevention. During clinical trials, hypersensitivity to eptinezumab was described without a clear underlying mechanism. To determine if the reaction was immunoglobulin E-mediated, the team of Nice University Hospital (Nice, France) performed the eptinzeumab skin tests. A 10-step desensitization protocol has been proposed to manage these reactions.

Findings: Two patients presenting with immediate hypersensitivity reactions underwent the eptinezumab skin test. Neither skin test was positive, suggesting a non-immunoglobulin E-mediated mechanism. The patients then completed the desensitization protocol successfully.

Conclusion: This hospital-based 10-step desensitization protocol appears safe and effective.

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.