Headache最新文献

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.

A 38-year-old woman with temporomandibular joint dysfunction (TMJD) and chronic migraine presented with refractory TMJD-related pain. Conservative treatments and prior injections provided only short-term relief. To achieve longer lasting pain reduction, an ultrasound-guided V3 nerve block was performed, targeting the mandibular nerve with a 4-mL injection of 1% lidocaine. The patient experienced immediate pain relief and sustained improvement. Encouraged by results on the right side, she underwent the same procedure on the left, achieving identical relief. Despite unchanged migraine frequency, TMJD pain resolution significantly enhanced her quality of life, demonstrating the efficacy of ultrasound-guided V3 nerve blocks.

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 describe the real-world safety, tolerability, and effectiveness of eptinezumab for chronic migraine prevention in Australia.

Background: Eptinezumab is a relatively new medication for treatment-resistant chronic migraine prevention. It was only introduced onto the Australian Pharmaceutical Benefits Scheme in August 2023, so there are limited real-world Australian data regarding its tolerability and effectiveness.

Methods: This is a single center retrospective audit of patients receiving eptinezumab for chronic migraine prevention between 1 September 2023 and 31 December 2024. Headache characteristics were compared at baseline and 3 months after eptinezumab administration. Primary outcomes were mean reductions in monthly headache days (MHD) and monthly migraine days (MMD). Secondary outcomes were mean monthly reductions in acute abortive medications, and adverse events.

Results: Of the 60 patients who received eptinezumab during the study period, a total of 54 patients with complete medical records and headache diaries were used in the statistical analysis. The majority were female (43/54, 80%) with mean age 41.7 years (SD 11.4). Three months after eptinezumab infusion, MMD reduced from 23.0 to 15.4 days (p value <0.001), and MHD reduced from 26.5 to 19.2 days (p value <0.001). Acute analgesic use decreased from 16.2 to 11.1 days (p value<0.001). The vast majority (94%, 51/54) had no immediate adverse events. Of 22 patients with 6-month post infusion data, mean MMD and MHD decreased to 11.0 (p < 0.001) and 17.8 days (p < 0.001), respectively, from baseline. Statistically significant reductions to both co-primary outcomes were achieved in those with pre-existing medication-overuse headache and those who had previously not responded to onabotulinumtoxinA, fremanezumab, and galcanezumab.

Conclusions: Our findings show that eptinezumab is a safe, well-tolerated migraine prophylactic that decreases monthly migraine and headache days in a small sample of Australian patients with treatment-resistant chronic migraine. Further prospective studies with larger sample sizes and longer follow-up data are needed to confirm findings of this study.

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.

Objective: The objective of this secondary analysis was to examine engagement with a mobile app for migraine self-management and to identify predictors of migraine app usage.

Background: Migraine self-monitoring and behavioral strategies are central components in migraine self-management, but patient adherence often remains a challenge. Recently, migraine apps have shown promise in enabling more frequent and continuous headache tracking and supporting self-management by integrating behavioral strategies; however, data on patient engagement with these digital interventions are still scarce.

Methods: This secondary analysis of the EMMA trial used the full dataset of the intervention group, which received a migraine app for 24 weeks, and examined app engagement and factors associated with frequent app usage. Outcomes were frequency of app engagement, intensity of app engagement, and time of usage. Potential associated factors included demographics, migraine history, burden of disease, headache management self-efficacy, and first-week app use. Descriptive analyses summarized engagement patterns for the overall app, the diary, and self-management modules. Kaplan-Meier survival curves illustrated usage over time. Univariable linear regression models explored associations between patient characteristics and first-week app usage as predictors of total app usage.

Results: Of the 238 patients, 161 (67.7%) were still actively using the app after 24 weeks. Total active usage days ranged from 1 to 168, with a mean (SD) of 129.7 (52.5) days, corresponding to usage on approximately 77% of days. Among all app modules, the headache and trigger diaries had the highest usage frequencies, with means (SDs) of 110.6 (49.7) and 118.1 (60.9) days, respectively. Engagement with the behavioral self-management modules was lower overall, with faster drop-off rates. Among the behavioral self-management modules, the training module showed the highest usage, with a mean (SD) of 26.2 (33.9) documented training days. Linear regression analyses showed that older age and higher app usage during the first week were associated with more frequent app usage.

Conclusions: This secondary analysis demonstrated high engagement with the headache and trigger diary modules of a migraine app over 6 months. These findings support the potential of smartphone apps to improve adherence to headache self-monitoring. However, engagement with the behavioral self-management modules was lower than intended, highlighting the persistent challenge of promoting adherence to behavioral migraine interventions.

Trial registration: German Clinical Trials Register: DRKS00024174.

Background: Vestibular migraine (VM) is a common migraine subtype characterized by recurrent vestibular symptoms. Despite its prevalence, evidence-based treatment guidelines are lacking. Vestibular rehabilitation (VR) has been proven effective in many vestibular disorders, but its role in managing VM has not been well established. This systematic review aimed to summarize and pool the evidence on the effectiveness of VR for VM using standardized outcome measures, primarily focusing on patient-reported dizziness-related quality-of-life assessments.

Methods: We systematically searched MEDLINE, Embase, Cochrane Library, and Scopus from inception to March 2025 for studies evaluating self-reported and physical outcome measures of VR in patients with VM. Meta-analysis of mean change in Dizziness Handicap Inventory (DHI) scores was performed. Risk of bias was assessed using the Cochrane RoB 2 tool for the randomized controlled trials and the ROBINS-I tool for observational studies.

Results: Seven studies comprising 413 patients (mean age, 45.4; 76% female) with VM treated with VR were included. The effect of vestibular rehabilitation on DHI scores showed a pooled mean difference of -29.3 (95% confidence interval [CI], -40.2 to -18.3), more than the clinically important difference of 18 points. Although, our meta-analysis had high heterogeneity (Cochran's Q p value <0.001, I² = 94.7%).

Conclusion: VR demonstrated a reduction in DHI scores, meeting the clinically significant difference of 18 indicating clinical improvement. However, the considerable heterogeneity limits the generalizability of these results and highlights the need for further standardized randomized controlled trials with subgroup analyses to better determine the specific benefits and optimal protocols of VR in managing VM.