Headache最新文献

Objective: This review was conducted to analyze the current knowledge on the topic of the relation between migraine and patent foramen ovale (PFO) and indicate the most crucial clinical implications.

Background: Migraine is a primary headache disorder that affects a significant part of the global population. Importantly, it has been considered a risk factor for ischemic stroke, especially in women with migraine with aura. The foramen ovale is a physiological opening in the atrial septum formed during fetal life, which closes in most people in the first year after birth. However, in some people, it can be present in adulthood and is called the patent foramen ovale. PFO is more likely to occur in patients with migraine compared to the population not experiencing migraine headaches.

Methods: Two review teams, comprising migraine experts and stroke experts, were engaged in the screening process, resulting in the inclusion of 204 relevant publications. To be considered for inclusion, an article had to directly cover the topic of PFO or migraine.

Results: In the following work, we have focused on several aspects regarding the direct and indirect relationship between migraine and PFO. Although analyzing migraine pathogenesis, apart from the straight link between PFO and migraine, others are also considered, such as a prominent Eustachian valve or Chiari valve, causing a high-risk PFO or a paradoxical embolism. Regarding the clinical practice, the prevalence of PFO and migraine, indications for exact therapies, and subsequently, neuroimaging in the view of PFO and migraine, have been scrutinized. Another crucial aspect of this review is the risk of stroke in patients with migraine, considering the PFO presence. It is suggested that patients with migraine have more vascular lesions on magnetic resonance imaging and more often experience strokes. Thus, the question arises whether PFO should be closed as stroke prophylaxis in every migraine patient.

Conclusions: Several aspects have been explored; however, more research is needed to draw clear conclusions with further indications for clinical practice. Nevertheless, it seems that not in all patients with migraine with PFO should the closure procedure be performed, but when the PFO is of a high-risk form or there are other indications, it should at least be considered.

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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.

Objective: This study aimed to summarize and pool real-world evidence on the clinical effectiveness and safety of galcanezumab.

Background: Migraine is a disabling primary headache disorder. Several drugs that target calcitonin gene-related peptide, such as galcanezumab, have recently been developed. However, real-world effects have not been well studied.

Methods: A systematic search of PubMed, Scopus, and Web of Science was conducted from inception to February 2025. Studies that estimated the real-world effects of galcanezumab on monthly migraine days (MMDs), monthly headache days (MHDs), Headache Impact Test, Migraine Disability Assessment Scale, number of days in medication, acute monthly intake (AMI), pain intensity, and safety outcomes were included. Meta-analyses of proportions or mean differences were performed.

Results: Thirty-six studies were included, with an agreement of 0.93 [95% confidence interval (CI): 0.90, 0.96]. One month after the first injection, the reduction effects were -6.93 days (95% CI: -7.88, -5.99) for MMD, -8.55 days (95% CI: -11.32, -5.78) for MHD, and -7.96 points (95% CI: -8.93, -6.99) for Headache Impact Test. Over 60% of patients achieved a reduction in MMD/MHD of at least 50% within 3 months. The effect increased gradually and slightly up to 12 months. The adverse event rates were 0.25 (95% CI: 0.14, 0.38) and 0.35 (95% CI: 0.27, 0.45) at 6 and 12 months, respectively, with constipation being the most common.

Conclusion: Galcanezumab appears to be associated with clinically meaningful improvements in migraine and favorable safety outcomes, although the evidence certainty is limited by heterogeneity.

Background: Migraine and glaucoma represent substantial public health concerns. Previous epidemiological studies on their direct association have yielded inconsistent findings, though shared pathophysiological mechanisms are proposed. This large, population-based cohort study aimed to explore the migraine-glaucoma association, assessing glaucoma prevalence, clinical presentation, and disease severity markers in patients with migraine compared to nonmigraine controls.

Methods: This retrospective cohort study, conducted in southern Israel using data from Clalit Health Services and Soroka University Medical Center, used medical records from 2000 to 2023. Adult patients with migraine (identified by ICD-9 codes/triptan claims) were matched with nonmigraine controls. The primary outcome was ophthalmologist-diagnosed glaucoma (ICD-9 code, ≥1 intraocular pressure measurement). We evaluated the association between migraine and glaucoma risk using adjusted models and compared the time to glaucoma diagnosis between groups. In the glaucoma subcohort, we compared clinical outcomes, treatment patterns, and time to first surgical intervention between migraine and nonmigraine groups.

Results: The cohort included 83,758 individuals (30,733 migraine, 53,025 controls). Patients with migraine had lower glaucoma diagnosis-free survival (p < 0.001) and a 31% higher relative risk of glaucoma diagnosis (adjusted relative risk = 1.31; 95% confidence interval, 1.15-1.48; p < 0.001). In the glaucoma subcohort (n = 2306), patients with migraine had earlier and more frequent ophthalmic surveillance (p < 0.001). These patients also showed lower use of topical hypotensive medications (p = 0.058) and a lower hazard of glaucoma surgery (adjusted hazard ratio = 0.66; 95% confidence interval, 0.43-1.00; p = 0.047).

Conclusions: This population-based study provides evidence for an association between migraine and an increased risk of glaucoma. Although increased ophthalmologic surveillance among patients with migraine likely contributes to earlier diagnosis and detection of milder cases, shared biological mechanisms may also play a role. Furthermore, patients with migraine and glaucoma demonstrated lower medication use and fewer surgical interventions, potentially indicating a less severe disease course.

Objectives/background: The intent of this review is to provide practical guidance for trainees considering a headache medicine fellowship and examine key factors that contribute to program selection. Headache medicine continues to gain appeal as a neurologic subspecialty, and the number of headache fellowship programs across the country has paralleled that growth. Residents who develop interest in the field must decide whether to pursue fellowship for more specialized training. Establishing a framework for navigating this process can help trainees better evaluate programs and make informed decisions.

Methods: This narrative review was conducted as an initiative by the New Investigators and Trainees Special Interest Group of the American Headache Society in collaboration with a group of academic leaders and headache clinicians who participated in headache fellowship and/or the match process. Topics were selected based on themes identified in existing literature on fellowship selection across other disciplines. Headache-specific information was obtained from a review of literature on headache education and fellowship, along with relevant professional society and program institution websites. This information was supplemented by the authors' perspectives when available evidence was limited.

Results: Physicians choose headache medicine for various reasons. This career path derives from inspiration through mentorship received during residency, exposure to a diverse patient population during training, and the desire to provide new therapies and procedural interventions. Headache medicine fellowships offer structured and in-depth training through clinical, educational, professional, and scholarly activities. Programs may vary in size, structure, support, and patient care settings. These factors can help trainees decide whether to pursue fellowship and what to evaluate in different programs.

Conclusion: This review identifies key factors in pursuing a headache medicine fellowship, allowing trainees to seek programs that support professional interests and career aspirations.

Objective: This study summarizes the evidence on the clinical effects of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in adults with idiopathic intracranial hypertension (IIH).

Background: IIH is characterized by elevated intracranial pressure with normal neuroimaging and cerebrospinal fluid composition. Standard therapies (e.g., acetazolamide, topiramate) provide modest benefit and are often poorly tolerated. GLP-1 RAs, which induce weight loss and have been shown experimentally to reduce cerebrospinal-fluid secretion, are emerging as potential adjuncts, but clinical evidence has not been synthesized comprehensively.

Methods: PubMed, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the World Health Organization-International Clinical Trials Registry Platform were searched from inception to July 2025. Human studies evaluating any GLP-1RA in IIH were eligible. Two reviewers independently screened records, extracted data, and appraised risk of bias (Risk Of Bias in Randomized Studies tool for randomized trials, Risk Of Bias In Nonrandomized Studies-of Interventions tool and Risk Of Bias In Nonrandomized Studies-of Exposures for observational cohorts, Joanna Briggs Institute for case reports). Heterogeneity and overlapping cohorts precluded meta-analysis; findings were synthesized narratively. The protocol was registered in International Prospective Register of Systematic Reviews (CRD420251058602).

Results: Twelve reports met criteria: three randomized controlled trials, six retrospective cohorts, one case-control study, and two case reports. Across these studies, GLP-1RA treatment generally aligned with improvements in papilledema, headache burden, and body mass index, whereas visual outcomes and intracranial pressure data were more variable. The database cohorts suggested a consistent benefit, whereas findings in prospectively followed patients were mixed. Reported adverse effects were mostly mild gastrointestinal symptoms; some cohorts noted reduced reliance on acetazolamide and no cognitive decline. Evidence certainty was low because of observational designs, short follow-up, and nonstandardized outcome definitions.

Conclusion: Low-certainty evidence suggests GLP-1 RAs may reduce papilledema, headache burden, and body weight in IIH without apparent cognitive harm, but findings are inconsistent and driven largely by database analyses and small trials. Larger, well-powered randomized studies with uniform ophthalmic and headache endpoints, quality-of-life measures, and dose-response evaluation are needed to confirm efficacy and define long-term safety.

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.

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.