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.

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: Evaluate the efficacy and safety of a novel partial rebreathing device for early treatment of acute attacks of migraine with aura.

Background: Earlier clinical studies have indicated a potential for CO₂-enriched gas to be effective for acute treatment of migraine with aura, especially when applied during the early part of the aura stage. We developed a partial rebreathing device inducing moderate, steady-state hypercapnia with normoxia in order to provide a carbon dioxide delivery system combining efficacy, usability, safety, and affordability.

Methods: This randomized, double-blind, sham-controlled, parallel-group, group-sequential study was conducted at 15 study sites, nine located in the United States and six in Germany, between March 2023 and February 2025. The study enrolled patients aged 18-65 years with migraine with aura. The study had a sequential two-stage study design. At the beginning of stage 1, participants were randomized to active or sham and treated up to four attacks. Participants were instructed to treat from the onset of aura and until 5 min after aura cessation. After having reported four attacks in stage 1, participants had the option to continue into stage 2, an open-label extension in which they could treat up to five attacks with the active device. During stage 1, participants recorded symptom scores in a study diary app at the onset of aura and after 1, 2, 24, and 48 h.

Results: The study was terminated at the interim analysis point due to the lack of effect, at which point 142 participants had been enrolled (mean age 39.2 years, 81% women [115/142]). Sixty-seven participants had reported at least one study attack by the time of the study termination. None of the primary or secondary endpoints reached statistical significance. The primary endpoint Absence of Moderate or Severe Pain at 2 hours was 69.7% (46/66) [95.2% confidence interval (CI), 48.5, 90.9] in the sham group and 60.0% (42/70) [95.2% CI, 37.6, 82.4] in the active group (p = 0.379), whereas Pain Freedom at 2 hours was 18.2% (12/66) [95.2% CI, 1.3, 35.1] in the sham group and 21.4% (15/70) [95.2% CI, 3.6, 39.2] in the active group (p = 0.717).

Conclusion: Partial rebreathing inducing moderate hypercapnia with normoxia was not effective for aura-stage treatment of migraine-with-aura attacks. The study was preregistered at ClinicalTrials.gov (registration number NCT05546385).

Objectives/background: To determine whether the volume of specific subcortical structures differ between people with migraine and healthy controls, and whether these volumes vary across distinct migraine subtypes and phases. Subcortical structures, including regions involved in pain processing and sensory integration, play a key role in migraine pathophysiology, yet studies on volumetric differences have shown conflicting results. This study uses a large cohort and robust imaging methods to clarify whether subcortical volumes differ in migraine.

Methods: In this cross-sectional study at the Danish Headache Center in Denmark, conducted between January 2020 and December 2023, adult participants with migraine and age- and sex-matched healthy controls underwent a single magnetic resonance imaging session at 3T. T1-weigthed scans were acquired to measure the volumes of subcortical structures using automated segmentation techniques. The structures analyzed included the thalamus, putamen, caudate nucleus, pallidum, nucleus accumbens, amygdala, and hippocampus.

Results: Imaging data from 295 participants and 154 healthy controls were included in the final analyses. No significant differences were observed between participants with migraine and healthy controls in thalamic volume (migraine: 7243 ± 923 mm³ vs. healthy controls: 7350 ± 782 mm³; p = 0.774) or hippocampal volume (migraine: 4204 ± 398 mm³ vs. healthy controls: 4307 ± 446 mm³; p = 0.337). No differences were observed in any other subcortical structure. Likewise, different subgroup analyses revealed no volumetric differences in episodic versus chronic migraine, migraine with aura versus without aura, ictal versus headache free, or between each migraine subgroup and healthy controls (all p > 0.05 after multiple comparison correction).

Conclusion: In this large cross-sectional study, we found no evidence of subcortical volume differences between adults with migraine and healthy controls. Furthermore, no differences were found across migraine subtypes or phases. These findings indicate that subcortical volumetric measures are not suitable as imaging biomarkers of migraine. Future research should explore functional and metabolic alterations in subcortical structures to better understand the neurobiologic underpinnings of migraine.

Objectives/background: This study aimed to systematically review the literature and summarize, as well as quantitatively pool when feasible, longitudinal evidence regarding psychosocial predictors of headache chronification.

Methods: A comprehensive search was conducted in PubMed/MEDLINE, CINAHL, and PsycInfo. The Domain-Determinants-Outcome framework was used to design the search strategy, and studies were screened according to the Patients Intervention Comparator Outcome Timing Setting framework. Risk of bias was assessed using the Newcastle-Ottawa Scale. A meta-analysis was performed, and the certainty of evidence was evaluated using the Grades of Recommendation, Assessment, Development, and Evaluation approach.

Results: The initial search, including two additional studies identified through hand-searching, yielded 1509 studies after removal of duplicates, of which eight met the inclusion criteria. Seven studies focused on depression as a predictor of migraine chronification and one on depression as a predictor of tension-type headache (TTH) chronification. One study examined anxiety and another studied stress as predictors of both migraine and TTH chronification. Five studies were included in the meta-analysis for depression as predictor; the pooled unadjusted risk ratio was 2.26 (95% confidence interval = 1.69-3.02), the adjusted risk ratio was 1.53 (95% confidence interval = 1.47-1.58), and Grades of Recommendation, Assessment, Development, and Evaluation assessment indicated that depression is a significant predictor of migraine chronification, with a moderate certainty of evidence. For anxiety and stress, the certainty of evidence was rated as moderate. Due to limited data, no firm conclusions could be drawn for other psychosocial factors or for predictors of TTH chronification.

Conclusion: There is moderate certainty of evidence supporting depression as a predictor of migraine chronification. For anxiety and stress in relation to migraine and TTH, the certainty of evidence is moderate.