Headache最新文献

Objectives/background: Migraine is common among women, particularly during their reproductive years. There is limited research on the use of antimigraine medication before and during pregnancy. This study was undertaken to describe the use of antimigraine medication 3 months before pregnancy and in the first trimester among women with migraine and to evaluate maternal characteristics associated with continued use in the first trimester.

Methods: In this cross-sectional study, we used patient-reported data from the Copenhagen Pregnancy Cohort from October 2013 to May 2019 and included all women with migraine before pregnancy. The use of antimigraine medication before pregnancy and during the first trimester was assessed descriptively.

Results: Among women with migraine (N = 1586), 1241 of 1586 (78.2%) reported use of any antimigraine medication before pregnancy, and 347 of 1586 (21.8%) in the first trimester. Before pregnancy, paracetamol was the most used medication (793/1586, 50.0%), followed by ibuprofen (417/1586, 26.3%) and sumatriptan (191/1586, 12.0%). In the first trimester, paracetamol remained the most common medication (271/1586, 17.1%), followed by sumatriptan (49/1586, 3.1%), whereas the use of ibuprofen declined to 11 of 1586 (0.7%). A total of 278 of 1586 (17.5%) reported frequent use (daily or 1-2 times/week) of antimigraine medication before pregnancy, but only 79 of 1586 (5.0%) in the first trimester. Having a short length of education of 1-2 years, other chronic somatic diseases, or mental illness were, after adjustment for maternal age and parity, associated with frequent use of antimigraine medication in the first trimester compared to women with higher education, without other chronic somatic diseases, or without mental illness, respectively (adjusted odds ratio [aOR] = 3.09, 95% confidence interval [CI] = 1.93-4.95; aOR = 1.92, 95% CI = 1.14-3.23; and aOR = 2.14, 95% CI = 1.05-4.38).

Conclusion: Most women with migraine used antimigraine medication before pregnancy, whereas usage decreased markedly in the first trimester. Only a few women had frequent use in the first trimester. Women with a short length of education of 1-2 years, additional chronic somatic diseases, or mental illness were more likely to report use of antimigraine medication. By offering an overview of patient-reported use of antimigraine medication before and during early pregnancy in a hospital-based setting, this study contributes to existing knowledge in the field and provides valuable insights for clinicians working with pregnant women affected by migraine.

Objectives/background: This study was undertaken to test the ability of a widely used enzyme-linked immunosorbent assay (ELISA) kit to detect calcitonin gene-related peptide (CGRP) isoforms to better understand currently published clinical data. There is significant interest in measuring CGRP as a biomarker in headache and migraine research, with ELISAs being the preferred detection method. ELISAs use antibodies that have been raised against an antigen to allow selective quantification of an analyte in a sample. Understanding the specificity of these antibodies is crucial to interpreting results. One commercially available kit (Cusabio CSB-E08210h, Kit A) is purported to specifically detect β-CGRP (one of the two CGRP isoforms) over α-CGRP and has been used to investigate the potential for CGRP to be used as a biomarker for migraine. We investigated the ability of this kit to detect multiple isoforms of CGRP to better interpret published clinical results. We used a second ELISA kit (Bertin Bioreagent, A05481, Kit B) that is nonselective for the different CGRP isoforms as a control to ensure the CGRP we used could be detected in ELISAs.

Methods: We performed ELISAs according to the manufacturer's instructions, testing concentrations within the advertised range of each kit. At least three independent experiments were conducted for each kit.

Results: Kit B was able to detect both human and mouse α-CGRP and β-CGRP with a high degree of reproducibility. In contrast, Kit A did not detect bioactive forms of human α-CGRP or β-CGRP, nor mouse α-CGRP or β-CGRP.

Conclusion: Kit A may not be reliable for future studies, as it does not appear to detect mature bioactive CGRP. Importantly, conclusions from previous studies that used this kit may need to be reevaluated, as it is not clear what analyte the kit has detected. Our findings also highlight the importance of understanding research tools to ensure accurate interpretation of results.

Objective: The aim of this study was to evaluate the efficacy and safety of a 60-day peripheral nerve stimulation (PNS) treatment targeting the occipital nerves for reducing pain and improving function in individuals diagnosed with cervicogenic headache or occipital neuralgia.

Background: Headache conditions are prevalent and commonly disabling, and conventional therapeutic strategies are often insufficient. Development of a percutaneous 60-day PNS treatment has created new opportunities to evaluate PNS of the occipital nerves.

Methods: This study was an institutional review board-approved, multicenter, prospective, single-arm study that enrolled participants from October 2022 to March 2024. Participants with cervicogenic headache or occipital neuralgia received a 60-day PNS treatment targeting the occipital nerves. The primary endpoint was the proportion reporting clinically significant (≥30%) reductions in average pain and/or pain interference at end of treatment (EOT). Additional analysis included the proportion of participants with ≥50% reduction in average pain intensity and/or pain interference and additional outcomes including Patient Global Impression of Change, six-item Headache Impact Test, and Neck Disability Index.

Results: At EOT, 90% of participants (18/20) met the primary endpoint. Further, 85% (17/20) and 83% (15/18) reported ≥50% reductions in pain and/or pain interference at EOT and 3 months, respectively. Clinically meaningful improvements were observed in functional and headache-related disability and quality-of-life measures. All study-related adverse events were non-serious.

Conclusion: Most participants reported significant reductions in pain and/or pain interference following 60-day PNS targeting the occipital nerves. Outcomes through 3 months demonstrate how 60-day PNS offers an effective approach for the treatment of headache.

Objectives/background: Treatment options for children and adolescents with chronic headache are limited. Greater occipital nerve block (GONB) has been shown to be effective in headache relief in adults, with minimal side effects, whereas similar evidence for pediatric patients remains to be determined. This study was undertaken to assess the effectiveness, acceptability, and tolerability of GONB in the management of chronic headache in children and adolescents, based on our own clinic experience and a systematic review of the literature.

Methods: This longitudinal observational study included all children and adolescents with chronic headache who received GONB at a large tertiary hospital for children between February 2018 and June 2024. Patients were given 10 mg lidocaine with 40 mg methylprednisolone on one or both sides. Data were collected on patients' demographics, clinical diagnosis of the headache disorder, previous treatments, GONB procedure details, response to the treatment, and reported adverse reactions. Diagnoses of headache disorders were made based on the International Classification of Headache Disorders, 3rd edition. A good response was defined as resolution of headache for at least 2 weeks, whereas a partial response was defined as relief of headache lasting less than 2 weeks or a reduction in headache intensity. Statistical analysis assessed responses to the first procedure and all subsequent treatment sessions separately. The findings from this study were analyzed alongside similar original data from published clinical trials, case series, and case reports on the use of GONB in the treatment of patients younger than 18 years with chronic headache, utilizing the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist.

Results: Ninety-eight patients aged 10-17 years, 75 of 98 (77%) female, with chronic headache were given 164 treatment sessions of GONB over a 6-year period. In 53 of 164 (32%) cases, GONB was administered on one side, whereas 111 of 164 (68%) patients received the injections on both sides. One hundred five of 164 (64%) treatment sessions resulted in a good or partial response (84/164 [51%] and 21/164 [13%], respectively). A positive response to GONB was associated with a diagnosis of chronic or episodic migraine and younger age of patients at the first treatment. Furthermore, the response to the first treatment was predictive of responses to the subsequent injections. The procedure was well tolerated, with only mild to moderate adverse reactions in 33 of 164 (20%) treatment sessions. A systematic review showed that GONB was predominantly used for children with chronic migraine and demonstrated an effectiveness rate of 67%.

Conclusion: GONB is a safe, well-tolerated, and effective treatment option for children and adolescents with chronic headaches, particularly migraine.