Headache最新文献

英文中文

Plain Language Summary Publication: Low-dose psilocybin in short-lasting unilateral neuralgiform headache attacks: Results from an open-label phase Ib ascending dose study. 纯语言摘要出版物：低剂量迷幻药治疗短时单侧神经性头痛发作：一项开放标签 Ib 期递增剂量研究的结果。

IF 5.4 2区医学 Q1 CLINICAL NEUROLOGY

Headache

Pub Date : 2024-10-09 DOI: 10.1111/head.14846

James Rucker, Matt Butler, Sadie Hambleton, Catherine Bird, Mathieu Seynaeve, Sanjay Cheema, Kete Campbell-Coker, Carolina Maggio, Fiona Dunbar, Giorgio Lambru, Manjit Matharu

引用次数: 0

Assessment of pharmacokinetic and pharmacodynamic interactions between zavegepant and sumatriptan: A phase 1, randomized, placebo-controlled study in healthy adults. 评估扎韦格潘与舒马曲坦之间的药代动力学和药效学相互作用：一项针对健康成年人的 1 期随机安慰剂对照研究。

IF 5.4 2区医学 Q1 CLINICAL NEUROLOGY

Headache

Pub Date : 2024-10-04 DOI: 10.1111/head.14853

Rajinder Bhardwaj, Mary K Donohue, Jennifer Madonia, Kyle Matschke, Matt S Anderson, Beth Morris, Richard Bertz, Robert Croop, Jing Liu

Objective: To evaluate the pharmacodynamic (PD) and pharmacokinetic (PK) interactions between zavegepant and sumatriptan in healthy adults.Background: Zavegepant is a high-affinity, selective, small-molecule calcitonin gene-related peptide receptor antagonist administered as a nasal spray approved in the United States for the acute treatment of migraine. Triptans, including sumatriptan, are a different class of drugs for acute migraine treatment and are associated with a risk of increased blood pressure (BP). Hence, it is important to study the drug-drug interactions between zavegepant and sumatriptan due to potential coadministration in clinical settings.Methods: This was a Phase 1, single-center, partially blind, randomized, placebo-controlled, single-arm study. Eligible participants were males aged ≥ 18 and ≤ 40 years or females aged ≥ 18 and ≤ 50 years. On Day 1, participants received sumatriptan 2 × 6 mg subcutaneous injections (1 h apart) and were then randomized (6:1 ratio) to receive zavegepant 2 × 10 mg nasal spray (1 in each nostril) or placebo on Days 2 and 3. On Day 4, zavegepant or placebo was coadministered with sumatriptan after the second sumatriptan injection. BP, PK, and safety were evaluated at pre-specified time points.Results: Forty-two participants enrolled in the study received at least one dose of any treatment and were included in the safety analyses. Forty-one participants who completed the study were included in the BP and PK analyses. The mean (standard deviation) time-weighted average (TWA) of mean arterial pressure (MAP [sumatriptan + zavegepant 87.2 (6.8) vs. sumatriptan 86.9 (6.0)]), diastolic BP (DBP [sumatriptan + zavegepant 72.3 (6.8) vs. sumatriptan 72.1 (6.2)]), and systolic BP (SBP [sumatriptan + zavegepant 116.8 (10.2) vs. sumatriptan 116.2 (8.6)]) did not change following zavegepant and sumatriptan coadministration on Day 4 compared to sumatriptan alone on Day 1. Statistical comparisons of the TWA of MAP, DBP, and SBP between sumatriptan and zavegepant coadministration and sumatriptan alone were similar; the differences observed were 0.04 mmHg for MAP (90% confidence interval [CI]: -0.69, 0.77 mmHg), 0.00 mmHg for DBP (90% CI: -0.76, 0.76 mmHg), and 0.33 mmHg for SBP (90% CI: -0.97, 1.63 mmHg). Sumatriptan PK after sumatriptan and zavegepant coadministration versus sumatriptan alone was similar; the comparison ratios were 102.5% (90% CI: 100.7%, 104.2%) for AUC0-inf and 104.1% (90% CI: 98.0%, 110.6%) for Cmax. A small difference in zavegepant PK exposure after sumatriptan and zavegepant coadministration versus zavegepant alone was not considered clinically relevant: the comparison ratios were 112.4% (90% CI: 103.4%, 122.3%) for AUC0-24 and 96.7% (90% CI: 88.9%, 105.2%) for Cmax. Overall, 90% (38/42) of participants experienced ≥ 1 treatment-emergent adverse event that was m

目的：评估zavegepant和舒马曲坦在健康成人中的药效学（PD）和药代动力学（PK）相互作用：评估zavegepant和舒马曲坦在健康成人中的药效学（PD）和药代动力学（PK）相互作用：背景：Zavegepant 是一种高亲和性、选择性、小分子降钙素基因相关肽受体拮抗剂，在美国被批准作为鼻腔喷雾剂用于偏头痛的急性治疗。包括舒马曲坦在内的曲坦类药物是治疗急性偏头痛的另一类药物，与血压（BP）升高的风险有关。因此，研究zavegepant和舒马曲普坦在临床上可能联合用药时的药物相互作用非常重要：这是一项第一阶段、单中心、部分盲法、随机、安慰剂对照、单臂研究。符合条件的参与者为年龄≥18岁且≤40岁的男性或年龄≥18岁且≤50岁的女性。第1天，参与者接受舒马曲坦2×6毫克皮下注射（间隔1小时），然后在第2天和第3天随机（6:1比例）接受扎韦格潘2×10毫克鼻腔喷雾剂（每个鼻孔1支）或安慰剂。第 4 天，在第二次注射舒马曲普坦后，zavegepant 或安慰剂与舒马曲普坦同时给药。在预先指定的时间点对血压、PK 和安全性进行评估：42名参加研究的人员至少接受了一次治疗，并纳入了安全性分析。41名完成研究的参与者参与了血压和 PK 分析。平均动脉压（MAP [sumatriptan + zavegepant 87.2 (6.8) vs. sumatriptan 86.9 (6.0)]）、舒张压（DBP [sumatriptan + zavegepant 72.3 (6.8) vs. sumatriptan 72.1（6.2）]）和收缩压（SBP [舒马曲普坦 + 扎韦格潘 116.8（10.2） vs. 舒马曲普坦 116.2（8.6）]）在第 4 天联合使用扎韦格潘和舒马曲普坦后与第 1 天单独使用舒马曲普坦相比没有变化。对舒马曲普坦和扎韦格潘联合用药与单用舒马曲普坦之间的MAP、DBP和SBP的TWA进行的统计比较结果相似；观察到的差异为：MAP为0.04毫米汞柱（90%置信区间[CI]：-0.69，0.77毫米汞柱），DBP为0.00毫米汞柱（90%置信区间：-0.76，0.76毫米汞柱），SBP为0.33毫米汞柱（90%置信区间：-0.97，1.63毫米汞柱）。舒马曲普坦与扎韦格潘联合用药后的舒马曲普坦PK与单用舒马曲普坦的PK相似；AUC0-inf的比较比率为102.5%（90% CI：100.7%，104.2%），Cmax的比较比率为104.1%（90% CI：98.0%，110.6%）。舒马曲普坦和扎韦格潘联合用药后扎韦格潘的PK暴露量与单独用药后扎韦格潘的PK暴露量之间的微小差异被认为与临床无关：AUC0-24的比较比率为112.4%（90% CI：103.4%，122.3%），Cmax的比较比率为96.7%（90% CI：88.9%，105.2%）。总体而言，90%（38/42）的参与者经历了≥1次轻度或中度的治疗突发不良事件。所有治疗总体上安全且耐受性良好：结论：在健康成年人中，zavegepant与舒马曲普坦联合用药是安全的，并且不存在PD或PK相互作用。

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引用次数: 0

Characterization of rimegepant drug-drug interactions using the cytochrome P450 probe drugs, itraconazole, rifampin, fluconazole, and midazolam. 使用细胞色素 P450 探针药物伊曲康唑、利福平、氟康唑和咪达唑仑分析利美昔班药物之间的相互作用。

IF 5.4 2区医学 Q1 CLINICAL NEUROLOGY

Headache

Pub Date : 2024-10-04 DOI: 10.1111/head.14836

Rajinder Bhardwaj, Beth Morris, Kyle T Matschke, Richard Bertz, Robert Croop, Jing Liu

Objective: Reported here are the results of four rimegepant phase I studies, in healthy participants, aimed at determining the in vivo potential of rimegepant (75 mg) for cytochrome P450 (CYP) 3A4-related drug-drug interactions (DDIs).

Background: Rimegepant orally disintegrating tablet (Pfizer Inc., New York, NY, USA) is a calcitonin gene-related peptide receptor antagonist approved for acute treatment of migraine and preventive treatment of episodic migraine. People with migraine commonly use multiple drug treatments, with the potential for DDIs.

Methods: Each study was an open-label, single-arm, single-sequence, crossover study. Rimegepant was tested as a victim drug by separate co-administration of itraconazole (a strong CYP3A4 inhibitor and P-glycoprotein inhibitor) in Study 1, rifampin (a strong CYP3A4 inducer and moderate CYP2C9 inducer) in Study 2, and fluconazole (a strong CYP2C9 inhibitor and moderate CYP3A4 inhibitor) in Study 3, and as a perpetrator drug by co-administration with midazolam (a CYP3A4 substrate) in Study 4.

Results: Mean values of single-dose rimegepant maximum concentration (C_max) and area under the curve from time 0 to infinity (AUC_0-inf) increased with itraconazole co-administration (n = 22) by 1.42-fold (90% confidence interval [CI] 1.25-1.61) and by 4.14-fold (90% CI 3.87-4.44), respectively, and decreased with rifampin co-administration (n = 21) to 36% (90% CI 31.2-41.4%) and to 19% (90% CI 16.3-21.4%), respectively. Co-administration with fluconazole (n = 23) increased rimegepant mean AUC_0-inf by 1.80-fold (90% CI 1.68-1.93), with no impact on C_max (1.04-fold; 90% CI 0.94-1.15). Co-administration of rimegepant single dose (300 mg; n = 14) or multiple doses (150 mg/day; n = 14) increased the mean C_max of midazolam by 1.38-fold (90% CI 1.13-1.67) and 1.53-fold (90% CI 1.32-1.78), respectively, and the AUC_0-inf of midazolam by 1.86-fold (90% CI 1.58-2.19) and 1.91-fold (90% CI 1.63-2.25), respectively.

Conclusions: Based on the magnitude of DDIs, these studies indicate the following: co-administration of rimegepant with a strong CYP3A4 inhibitor should be avoided; during co-administration with a moderate CYP3A4 inhibitor, another dose of rimegepant within 48 h should be avoided; co-administration of rimegepant with a strong or moderate CYP3A4 inducer should be avoided; CYP2C9 does not play a meaningful role in rimegepant metabolism; and there is no clinically meaningful CYP3A4 inhibition by rimegepant.

研究目的本文报告了在健康参与者中进行的四项利美君 I 期研究的结果，这些研究旨在确定利美君（75 毫克）在体内与细胞色素 P450 (CYP) 3A4 相关的药物相互作用 (DDI) 的可能性：Rimegepant口腔崩解片（辉瑞公司，美国纽约）是一种降钙素基因相关肽受体拮抗剂，已被批准用于偏头痛的急性治疗和发作性偏头痛的预防性治疗。偏头痛患者通常使用多种药物治疗，因此有可能出现 DDIs：每项研究都是一项开放标签、单臂、单序列、交叉研究。在研究1中，瑞美潘作为一种受害药物分别与伊曲康唑（一种强CYP3A4抑制剂和P-糖蛋白抑制剂）、利福平（一种强CYP3A4诱导剂和中度CYP2C9诱导剂）和氟康唑（一种强CYP3A4诱导剂和中度CYP2C9诱导剂）联合用药进行测试、在第 3 项研究中，利福平（强 CYP2C9 抑制剂和中度 CYP3A4 抑制剂）和氟康唑（强 CYP2C9 抑制剂和中度 CYP3A4 抑制剂）；在第 4 项研究中，氟康唑与咪达唑仑（CYP3A4 底物）合用，作为致病药物。研究结果联合服用伊曲康唑（n = 22）后，单剂量利眠宁的最大浓度（Cmax）和从时间 0 到无穷远的曲线下面积（AUC0-inf）的平均值增加了 1.42 倍（90% 置信区间）。与利福平联合用药（n = 21）时，Cmax 和从时间 0 到无穷大的曲线下面积（AUC0-inf）分别增加 1.42 倍（90% 置信区间 [CI] 1.25-1.61）和 4.14 倍（90% 置信区间 3.87-4.44），分别减少 36%（90% 置信区间 31.2-41.4%）和 19%（90% 置信区间 16.3-21.4%）。同时服用氟康唑（n = 23）会使利美昔康的平均 AUC0-inf 增加 1.80 倍（90% CI 1.68-1.93），但对 Cmax 没有影响（1.04 倍；90% CI 0.94-1.15）。同时服用利美昔班单次剂量（300 毫克；n = 14）或多次剂量（150 毫克/天；n = 14）会使咪达唑仑的平均 Cmax 分别增加 1.38 倍（90% CI 1.13-1.67）和 1.53 倍（90% CI 1.32-1.78），咪达唑仑的 AUC0-inf 分别增加 1.86 倍（90% CI 1.58-2.19）和 1.91 倍（90% CI 1.63-2.25）：根据 DDIs 的程度，这些研究表明了以下几点：结论：根据 DDIs 的程度，这些研究表明：应避免利美喷与强 CYP3A4 抑制剂联合用药；在与中度 CYP3A4 抑制剂联合用药期间，应避免在 48 小时内再次服用利美喷；应避免利美喷与强或中度 CYP3A4 诱导剂联合用药；CYP2C9 在利美喷的代谢中不起作用；利美喷对 CYP3A4 没有临床意义的抑制作用。

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引用次数: 0

Plain Language Summary Publication: Hyperactivity of the medial thalamus in patients with photophobia-associated migraine. 纯语言摘要出版物：畏光性偏头痛患者丘脑内侧的过度活跃。

IF 5.4 2区医学 Q1 CLINICAL NEUROLOGY

Headache

Pub Date : 2024-10-01 Epub Date: 2024-08-01 DOI: 10.1111/head.14792

Yukihisa Suzuki, Motohiro Kiyosawa, Masato Wakakura, Kenji Ishii

引用次数: 0

Advanced clinical reasoning in the diagnosis of spinal cerebrospinal fluid leaks. 诊断脊髓脑脊液漏的高级临床推理。

IF 5.4 2区医学 Q1 CLINICAL NEUROLOGY

Headache

Pub Date : 2024-10-01 Epub Date: 2024-08-13 DOI: 10.1111/head.14812

Matthew S Robbins, Gayle R Salama, J Levi Chazen

引用次数: 0

Plain language summary publication: Headache-related disability as a function of migraine aura: A daily diary study. 通俗易懂的摘要出版物：偏头痛先兆导致的头痛相关残疾：每日日记研究。

IF 5.4 2区医学 Q1 CLINICAL NEUROLOGY

Headache

Pub Date : 2024-10-01 Epub Date: 2024-08-23 DOI: 10.1111/head.14811

Delora E Denney, Aaron A Lee, Stephen H Landy, Todd A Smitherman

引用次数: 0

No association between migraine and HLA alleles in a cohort of 13,210 individuals with migraine from the Danish Blood Donor Study. 在丹麦献血者研究的 13,210 名偏头痛患者中，偏头痛与 HLA 等位基因之间没有关联。

IF 5.4 2区医学 Q1 CLINICAL NEUROLOGY

Headache

Pub Date : 2024-10-01 DOI: 10.1111/head.14784

Inga Zalia Tummoszeit, Isa Amalie Olofsson, Mona Ameri Chalmer, Alexander Pil Henriksen, Bitten Aagaard, Søren Brunak, Mie Topholm Bruun, Maria Didriksen, Christian Erikstrup, Henrik Hjalgrim, Christina Mikkelsen, Susan Mikkelsen, Sisse Rye Ostrowski, Ole Birger Vesterager Pedersen, Liam Quinn, Erik Sørensen, Henrik Ullum, Jes Olesen, Karina Banasik, Thomas Folkmann Hansen, Lisette J A Kogelman

Objective: To determine the association between human leukocyte antigen (HLA) alleles and migraine, migraine subtypes, and sex-specific factors.

Background: It has long been hypothesized that inflammation contributes to migraine pathophysiology. This study examined the association between migraine and alleles in the HLA system, a key player in immune response and genetic diversity.

Methods: We performed a case-control study and included 13,210 individuals with migraine and 86,738 controls. All participants were part of the Danish Blood Donor Study Genomic Cohort. Participants were genotyped and 111 HLA alleles on 15 HLA genes were imputed. We examined the association between HLA alleles and migraine subtypes, considering sex-specific differences.

Results: We found no association between HLA alleles and migraine, neither overall, nor in the sex-specific analysis. In the migraine subtype analysis, three HLA alleles were associated with migraine without aura; however, these associations could not be replicated in an independent Icelandic cohort (2191 individuals with migraine without aura and 278,858 controls). Furthermore, we found no association between HLA alleles and migraine with aura or chronic migraine.

Conclusion: We found no evidence of an association between the HLA system and migraine, suggesting that genetic factors related to the HLA system do not play a significant role in migraine susceptibility.

目的：确定人类白细胞抗原（HLA）等位基因与偏头痛、偏头痛亚型和性别特异性因素之间的关系：确定人类白细胞抗原（HLA）等位基因与偏头痛、偏头痛亚型和性别特异性因素之间的关系：背景：长期以来，人们一直假设炎症是偏头痛的病理生理学因素之一。本研究探讨了偏头痛与 HLA 系统等位基因之间的关系，HLA 系统是免疫反应和遗传多样性的关键因素：我们进行了一项病例对照研究，纳入了 13210 名偏头痛患者和 86738 名对照者。所有参与者都是丹麦献血者研究基因组队列的成员。对参与者进行了基因分型，并对 15 个 HLA 基因上的 111 个 HLA 等位基因进行了估算。考虑到性别差异，我们研究了 HLA 等位基因与偏头痛亚型之间的关系：结果：无论是总体分析还是性别特异性分析，我们都没有发现 HLA 等位基因与偏头痛之间存在关联。在偏头痛亚型分析中，三个 HLA 等位基因与无先兆偏头痛相关；但是，这些关联在一个独立的冰岛队列（2191 名无先兆偏头痛患者和 278,858 名对照者）中无法重复。此外，我们没有发现HLA等位基因与有先兆偏头痛或慢性偏头痛之间存在关联：我们没有发现 HLA 系统与偏头痛之间存在关联的证据，这表明与 HLA 系统相关的遗传因素在偏头痛易感性中并不扮演重要角色。

{"title":"No association between migraine and HLA alleles in a cohort of 13,210 individuals with migraine from the Danish Blood Donor Study.","authors":"Inga Zalia Tummoszeit, Isa Amalie Olofsson, Mona Ameri Chalmer, Alexander Pil Henriksen, Bitten Aagaard, Søren Brunak, Mie Topholm Bruun, Maria Didriksen, Christian Erikstrup, Henrik Hjalgrim, Christina Mikkelsen, Susan Mikkelsen, Sisse Rye Ostrowski, Ole Birger Vesterager Pedersen, Liam Quinn, Erik Sørensen, Henrik Ullum, Jes Olesen, Karina Banasik, Thomas Folkmann Hansen, Lisette J A Kogelman","doi":"10.1111/head.14784","DOIUrl":"10.1111/head.14784","url":null,"abstract":"Objective: To determine the association between human leukocyte antigen (HLA) alleles and migraine, migraine subtypes, and sex-specific factors.Background: It has long been hypothesized that inflammation contributes to migraine pathophysiology. This study examined the association between migraine and alleles in the HLA system, a key player in immune response and genetic diversity.Methods: We performed a case-control study and included 13,210 individuals with migraine and 86,738 controls. All participants were part of the Danish Blood Donor Study Genomic Cohort. Participants were genotyped and 111 HLA alleles on 15 HLA genes were imputed. We examined the association between HLA alleles and migraine subtypes, considering sex-specific differences.Results: We found no association between HLA alleles and migraine, neither overall, nor in the sex-specific analysis. In the migraine subtype analysis, three HLA alleles were associated with migraine without aura; however, these associations could not be replicated in an independent Icelandic cohort (2191 individuals with migraine without aura and 278,858 controls). Furthermore, we found no association between HLA alleles and migraine with aura or chronic migraine.Conclusion: We found no evidence of an association between the HLA system and migraine, suggesting that genetic factors related to the HLA system do not play a significant role in migraine susceptibility.","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142345142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Plain Language Summary Publication: Evaluating the use of paracetamol to prevent fasting headache during the first week of Ramadan: A randomized, open-label, clinical trial. 通俗易懂的摘要出版物：评估在斋月第一周使用扑热息痛预防空腹头痛：随机、开放标签临床试验。

IF 5.4 2区医学 Q1 CLINICAL NEUROLOGY

Headache

Pub Date : 2024-10-01 DOI: 10.1111/head.14848

Omar A Almohammed, Sary Alsanea, Nouf Albishi, Lamia AlMuhareb, Rana AlMotawa, Sara Alrasheed, Fawaz Alasmari, Faris Almutairi, Mohammed A Assiri, Ali Alghamdi, Abdulrazaq Albilali, Riham A ElToukhy, Abdulrahman Alwhaibi

引用次数: 0

Advancing toward precision migraine treatment: Predicting responses to preventive medications with machine learning models based on patient and migraine features. 推进偏头痛的精准治疗：利用基于患者和偏头痛特征的机器学习模型预测对预防性药物的反应。

IF 5.4 2区医学 Q1 CLINICAL NEUROLOGY

Headache

Pub Date : 2024-10-01 Epub Date: 2024-08-23 DOI: 10.1111/head.14806

Chia-Chun Chiang, Todd J Schwedt, Gina Dumkrieger, Liguo Wang, Chieh-Ju Chao, Heather A Ouellette, Imon Banerjee, Yi-Chieh Chen, Brandon M Jones, Krista M Burke, Han Wang, Ann M Murray, Monique M Montenegro, Jennifer I Stern, Mark Whealy, Narayan Kissoon, Fred M Cutrer

Objective: To develop machine learning models using patient and migraine features that can predict treatment responses to commonly used migraine preventive medications.Background: Currently, there is no accurate way to predict response to migraine preventive medications, and the standard trial-and-error approach is inefficient.Methods: In this cohort study, we analyzed data from the Mayo Clinic Headache database prospectively collected from 2001 to December 2023. Adult patients with migraine completed questionnaires during their initial headache consultation to record detailed clinical features and then at each follow-up to track preventive medication changes and monthly headache days. We included patients treated with at least one of the following migraine preventive medications: topiramate, beta-blockers (propranolol, metoprolol, atenolol, nadolol, timolol), tricyclic antidepressants (amitriptyline, nortriptyline), verapamil, gabapentin, onabotulinumtoxinA, and calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) (erenumab, fremanezumab, galcanezumab, eptinezumab). We pre-trained a deep neural network, "TabNet," using 145 variables, then employed TabNet-embedded data to construct prediction models for each medication to predict binary outcomes (responder vs. non-responder). A treatment responder was defined as having at least a 30% reduction in monthly headache days from baseline. All model performances were evaluated, and metrics were reported in the held-out test set (train 85%, test 15%). SHapley Additive exPlanations (SHAP) were conducted to determine variable importance.Results: Our final analysis included 4260 patients. The responder rate for each medication ranged from 28.7% to 34.9%, and the mean time to treatment outcome for each medication ranged from 151.3 to 209.5 days. The CGRP mAb prediction model achieved a high area under the receiver operating characteristics curve (AUC) of 0.825 (95% confidence interval [CI] 0.726, 0.920) and an accuracy of 0.80 (95% CI 0.70, 0.88). The AUCs of prediction models for beta-blockers, tricyclic antidepressants, topiramate, verapamil, gabapentin, and onabotulinumtoxinA were: 0.664 (95% CI 0.579, 0.745), 0.611 (95% CI 0.562, 0.682), 0.605 (95% CI 0.520, 0.688), 0.673 (95% CI 0.569, 0.724), 0.628 (0.533, 0.661), and 0.581 (95% CI 0.550, 0.632), respectively. Baseline monthly headache days, age, body mass index (BMI), duration of migraine attacks, responses to previous medication trials, cranial autonomic symptoms, family history of headache, and migraine attack triggers were among the most important variables across all models. A variable could have different contributions; for example, lower BMI predicts responsiveness to CGRP mAbs and beta-blockers, while higher BMI predicts responsiveness to onabotulinumtoxinA, topiramate, and gabapentin.Conclusion: We developed an acc

目的：利用患者和偏头痛特征开发机器学习模型，以预测常用偏头痛预防药物的治疗反应：利用患者和偏头痛特征开发机器学习模型，以预测常用偏头痛预防药物的治疗反应：背景：目前，还没有准确预测偏头痛预防药物反应的方法，标准的试错法效率低下：在这项队列研究中，我们分析了梅奥诊所头痛数据库从 2001 年至 2023 年 12 月期间收集的前瞻性数据。成年偏头痛患者在初次头痛就诊时填写调查问卷，记录详细的临床特征，然后在每次随访时跟踪预防性药物的更换情况和每月头痛天数。我们纳入了至少接受过以下一种偏头痛预防药物治疗的患者：托吡酯、β-受体阻滞剂（普萘洛尔、美托洛尔、阿替洛尔、纳多洛尔、噻吗洛尔）、三环类抗抑郁药（阿米替林、去甲替林）、维拉帕米、加巴喷丁、奥那布林妥昔单抗（onabotulinumtoxinA）和降钙素基因相关肽（CGRP）单克隆抗体（mAbs）（erenumab、fremanezumab、galcanezumab、eptinezumab）。我们使用 145 个变量预先训练了一个深度神经网络 "TabNet"，然后利用 TabNet 嵌入的数据为每种药物构建预测模型，以预测二元结果（应答者与非应答者）。治疗应答者的定义是每月头痛天数比基线至少减少 30%。对所有模型的性能进行了评估，并在保留的测试集中报告了指标（训练占 85%，测试占 15%）。为了确定变量的重要性，我们进行了SHAPLEY Additive exPlanations（SHAP）分析：我们的最终分析包括 4260 名患者。每种药物的应答率从 28.7% 到 34.9% 不等，每种药物治疗结果的平均时间从 151.3 天到 209.5 天不等。CGRP mAb预测模型的接收者操作特征曲线下面积（AUC）高达0.825（95%置信区间[CI] 0.726，0.920），准确率为0.80（95% CI 0.70，0.88）。β-受体阻滞剂、三环类抗抑郁药、托吡酯、维拉帕米、加巴喷丁和阿糖胞苷的预测模型的 AUC 值分别为分别为 0.664（95% CI 0.579，0.745）、0.611（95% CI 0.562，0.682）、0.605（95% CI 0.520，0.688）、0.673（95% CI 0.569，0.724）、0.628（0.533，0.661）和 0.581（95% CI 0.550，0.632）。在所有模型中，每月头痛天数基线、年龄、体重指数（BMI）、偏头痛发作持续时间、对之前药物试验的反应、头颅自主神经症状、头痛家族史和偏头痛发作诱因是最重要的变量。一个变量可能有不同的贡献；例如，较低的体重指数可预测对CGRP mAbs和β-受体阻滞剂的反应，而较高的体重指数可预测对onabotulinumtoxinA、托吡酯和加巴喷丁的反应：我们利用开始治疗前从头痛问卷中收集到的偏头痛详细特征，开发出了一个准确的 CGRP mAbs 治疗反应预测模型。采用同样的方法，模型对其他药物的预测结果虽然与文献中报道的机器学习模型对其他疾病的预测结果相似，但却不尽如人意。这可能是由于CGRP mAbs具有偏头痛特异性。将并发症、基因组和影像学因素纳入模型可能会提高模型性能。我们证明了偏头痛特征在预测治疗反应方面的重要性，并确定了七种预防性药物中最关键的预测因素。我们的研究结果表明，偏头痛的精准治疗是可行的。

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引用次数: 0

Parental mental health and migraine in youth: An evolving story historically plagued with sparse and inadequate literature and mother-blaming. 父母的心理健康与青少年偏头痛：历史上，由于文献资料稀少、不足以及对母亲的指责，偏头痛的发病率一直在不断上升。

IF 5.4 2区医学 Q1 CLINICAL NEUROLOGY

Headache

Pub Date : 2024-10-01 Epub Date: 2024-06-27 DOI: 10.1111/head.14779

Serena L Orr

引用次数: 0

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