Headache最新文献

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.

Objectives: Discuss the current status of advanced practice providers (APPs) onboarding to headache medicine (HM) practices in the United States and present recommendations of the American Headache Society (AHS) APP Work Group to improve the onboarding process.

Background: A high demand for care, national shortage of specialists, and multiple advancements in HM have led to an increasing interest and presence of APPs of various backgrounds in the field, currently without a unifying onboarding process. Efforts to standardize and optimize the onboarding process for APPs in HM practices are necessary, to ensure high standards in quality of care.

Methods: The APP Work Group of the AHS Practice Management Committee developed comprehensive recommendations through literature review, survey of AHS members, and expert consensus. A modified Delphi protocol was used to establish key onboarding goals, definitions, and best practice recommendations.

Results: Recommendations are made regarding duration of onboarding, appropriate supervision, formal education and procedural skills, scope of practice, grading and documentation of competence, and reciprocal feedback.

Conclusion: Currently, there are no standard onboarding and training guidelines for APPs in the field of HM. We provide recommendations for a more systematic approach to help develop qualified providers and enhance their retention in HM practices.

Objective: To assess the efficacy of cannabis for the treatment of acute migraine.

Background: Preclinical and retrospective studies suggest cannabinoids may be effective in migraine treatment. However, there have been no randomized clinical trials examining the efficacy of cannabinoids for acute migraine.

Methods: In this randomized, double-blind, placebo-controlled, crossover trial, adults with migraine treated up to four separate migraine attacks, one each with vaporized (1) 6% Δ9-tetrahydrocannabinol (THC) (THC-dominant), (2) 11% cannabidiol (CBD) (CBD-dominant), (3) 6% THC + 11% CBD, and (4) placebo cannabis flower in a randomized order. Washout period between treated migraine attacks was ≥1 week. The primary endpoint was pain relief, and secondary endpoints were pain freedom and most bothersome symptom freedom, all assessed at 2-h post-vaporization.

Results: Ninety-two participants were enrolled and randomized, and 247 migraine attacks were treated. THC + CBD was superior to placebo at achieving pain relief (67.2% vs. 46.6%, odds ratio [95% confidence interval] 2.85 [1.22, 6.65], p = 0.016), pain freedom (34.5% vs. 15.5%, 3.30 [1.24, 8.80], p = 0.017), and most bothersome symptom freedom (60.3% vs. 34.5%, 3.32 [1.45, 7.64], p = 0.005) at 2 h, as well as sustained pain freedom at 24 h and sustained most bothersome symptom freedom at 24 and 48 h. THC-dominant was superior to placebo for pain relief (68.9% vs. 46.6%, 3.14 [1.35, 7.30], p = 0.008) but not pain freedom or most bothersome symptom freedom at 2 h. CBD-dominant was not superior to placebo for pain relief, pain freedom, or most bothersome symptom freedom at 2 h. There were no serious adverse events.

Conclusion: Acute migraine treatment with 6% THC + 11% CBD was superior to placebo at 2-h post-treatment with sustained benefits at 24 and 48 h.

Objective: We conducted a randomized study to determine if, among emergency department (ED) patients with acute posttraumatic headache, the combination of intravenous (IV) metoclopramide plus dexamethasone would result in less headache intensity during the 48 h after ED discharge than IV metoclopramide plus placebo.

Background: Intravenous metoclopramide can improve acute posttraumatic headache among ED patients, though this benefit is not sustained beyond the ED visit.

Methods: This was a randomized, double-blind, placebo-controlled, parallel group study of IV dexamethasone for acute posttraumatic headache. We enrolled patients who presented to two EDs in the Bronx, NY, with moderate or severe headache that met criteria for acute posttraumatic headache, per the International Classification of Headache Disorders, 3rd edition. All study participants received metoclopramide 10 mg IV. They also were randomized to receive dexamethasone 10 mg IV or placebo (normal saline). The primary outcome was absence of moderate or severe headache within 48 h of ED discharge and no use of analgesic or headache medication within that time. We also report frequency of sustained headache relief. It defined as obtaining and maintaining a headache intensity of mild or none, without the use of rescue medication, for 48 h.

Results: Over a 42-month period commencing in June 2021, 2220 patients were approached for participation and 162 were enrolled. At baseline, slightly more patients in the placebo arm reported severe versus moderate pain. No other baseline differences were noted. After accounting for age, sex, and baseline pain intensity, dexamethasone was not associated with the primary outcome (Adjusted odds ratio 1.11, 95% confidence interval [CI] 0.57, 2.19, p = 0.751). Sustained pain relief was reported by 10/77 (13.0%) of dexamethasone participants and 12/79 (15.2%) of placebo participants (95% CI for difference - 2.2%: -13.1, 8.7%).

Conclusion: Among ED patients with acute moderate or severe posttraumatic headache, one dose of IV dexamethasone did not improve headache outcomes.

Objective: This study evaluated the pharmacokinetics of zavegepant in human breast milk and plasma following a single, 10 mg dose of zavegepant nasal spray.

Background: Zavegepant nasal spray is a member of the gepant class of medications; small molecule inhibitors of the calcitonin gene-related peptide receptor. It is approved in the United States for the acute treatment of migraine with or without aura in adults. However, the transfer of zavegepant to human breast milk in lactating women has not been assessed previously.

Methods: In this Phase 1, open-label, single-arm, single-dose, pharmacokinetic study (NCT06453356), 12 healthy lactating women received a single intranasal dose of 10 mg zavegepant. Blood and breast milk samples were collected over 24 h postdose to assess zavegepant pharmacokinetics. Safety was also assessed. The study was conducted from June 10 to September 26, 2024 at a single-site in the United States.

Results: Geometric mean (geometric percent coefficient of variation [CV%]) milk-to-plasma zavegepant concentration ratios were 0.21 (102%), 0.16 (76%), and 0.04 (130%) for area under the concentration-time curve from time 0 to 24 h postdose, area under the concentration-time curve from time 0 extrapolated to infinity, and maximum concentration, respectively. The geometric mean (geometric CV%) body weight normalized infant dose was 0.05 μg/kg/day (120%) and the geometric mean (geometric CV%) body weight normalized maternal dose was 132.8 μg/kg/day (10%). This resulted in a geometric mean (geometric CV%) relative infant dose of 0.04% (128%). One treatment-emergent adverse event (TEAE; mild dizziness) was reported in one (8%) participant. This TEAE was considered mild in severity. No clinically meaningful abnormalities were observed for vital signs, clinical laboratory testing, and local nasal assessments.

Conclusion: A single intranasal dose of 10 mg zavegepant was generally safe and well tolerated in healthy lactating women and the estimated infant exposure to zavegepant via breast milk is very low.

Objectives/background: This study was undertaken to evaluate patient reasons for nonadoption of migraine-preventive medications. Despite clear recommendations and eligibility criteria for migraine-preventive treatment by the American Headache Society and the availability of these treatments, many people with migraine are not taking appropriate preventive medications. Many are not seeking medical care in the first place, but even among those who are seeking medical care and have a diagnosis of migraine, the uptake of preventive medications remains low.

Methods: The OVERCOME (Observational Survey of the Epidemiology, Treatment, and Care of Migraine) study is an observational, longitudinal web-based survey conducted in more than 60,000 adults with migraine in the United States (US). The current analysis, a secondary post hoc analysis of the 2018-2020 baseline cross-sectional surveys, evaluated medication use in participants. In particular, the analysis investigates why some participants have never taken prescription medication for migraine prevention and examines how this group differs from those who are taking preventive medication, specifically in terms of disease severity and other patient-reported outcomes.

Results: Our findings revealed that among OVERCOME (US) participants who met criteria for migraine (n = 59,001), only approximately half (51.3%) had sought medical care for migraine in the previous 12 months, approximately one third (36.3%) had sought care and received a migraine diagnosis, and only 10% of participants had sought care, received a diagnosis of migraine, and were currently taking prescription medications for migraine prevention. Furthermore, among those who were eligible for migraine-preventive medication based on their headache frequency and associated disability (n = 22,249), 65.3% indicated they had never taken a preventive medication for migraine. The reasons for this were mostly medication-related (25.5% stated they were concerned about side effects, 23.3% said they did not like taking prescription medication, and 20.8% stated that their other medications worked well enough); however, there were also other reasons related to stigma, access, and communication with the health care provider that were noted by participants.

Conclusion: This study highlights an important need for patient education, especially as many of these individuals who had never taken medications to prevent migraine reported experiencing ≥15 monthly headache days (25.3%), severe interictal burden (43.3%), and severe migraine-related disability (53.1%). We believe that these results may be of interest to health care providers who see people with migraine and help them better understand and anticipate their patients' educational needs regarding migraine prevention.