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A phase 4, 24-week, open-label study to evaluate the safety and tolerability of once-daily dosing of 75 mg rimegepant for episodic migraine prevention. 一项为期24周的4期开放标签研究,旨在评估每日一次给药75mg rimegepant预防发作性偏头痛的安全性和耐受性。
IF 7.9 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-12-09 DOI: 10.1186/s10194-025-02225-7
Jeremias Antinew, Robert J Fountaine, Vittorio Loprinzo, Esther Straghan, Sergey Dubrovin, Patrizia DeBesi, Nick Vatakis, Terence Fullerton

Background: Rimegepant is a small-molecule calcitonin gene-related peptide receptor antagonist approved in adults for acute treatment of migraine (with or without aura) and preventive treatment of episodic migraine (EM). Rimegepant is well tolerated at approved doses; 75 mg as needed up to once per day for acute treatment and 75 mg every other day for preventive treatment. This study evaluated long-term safety and tolerability of once-daily (QD) rimegepant 75 mg for EM prevention.

Methods: Adults with 4-14 migraine attacks per month received open-label oral rimegepant 75 mg QD for up to 24 weeks. Standard-of-care medications for acute treatment of migraine and stable dosing of preventive migraine medications were permitted. Endpoints included on-treatment adverse events (AEs) occurring in ≥5% of participants, on-treatment serious AEs, on-treatment AEs leading to rimegepant discontinuation, and on-treatment grade 3-4 laboratory test abnormalities. Efficacy was not assessed in this study.

Results: Overall, 250 participants (female = 82.4%, White = 86.4%, mean age = 42.6 years) received ≥1 dose of rimegepant and 74.8% completed open-label treatment. Mean (SD) time on rimegepant was 19.3 (8.7) weeks. Overall, 53.6% of participants had ≥1 on-treatment AE, none had a serious AE, 1.6% had a severe AE, and 2.8% had an AE leading to rimegepant discontinuation. On-treatment AEs occurring in ≥5% of participants included nasopharyngitis (9.2%), COVID-19 (6.4%), and nausea (6.0%). On-treatment grade 3-4 laboratory test abnormalities included low lymphocytes (0.4%), high creatine kinase (3.8%), low glucose (0.4%), high low-density lipoprotein cholesterol (LDL-C; 9.8%), high fasting LDL-C (9.3%), high non-fasting LDL-C (10.2%), high potassium (1.3%), high triglycerides (0.9%), high fasting triglycerides (1.3%), and urine glucose (0.5%). No on-treatment elevations in liver transaminases (alanine aminotransferase [ALT] or aspartate aminotransferase [AST]) > 5× the upper limit of normal (ULN) or potential Hy's law cases (ALT or AST > 3× the ULN concurrent with total bilirubin levels > 2× the ULN) were observed.

Conclusion: Rimegepant 75 mg QD for up to 24 weeks had a favorable safety profile for preventive treatment of EM.

Trial registration: ClinicalTrials.gov NCT05207865 (registered January 12, 2022).

背景:Rimegepant是一种小分子降钙素基因相关肽受体拮抗剂,被批准用于成人偏头痛(有或无先兆)的急性治疗和发作性偏头痛(EM)的预防性治疗。利美吉坦在批准剂量下耐受性良好;急性治疗需要75毫克,每天一次,预防性治疗每隔一天75毫克。本研究评估了每日一次(QD)剂量75 mg预防EM的长期安全性和耐受性。方法:每个月4-14次偏头痛发作的成年人接受开放标签口服瑞美坦75mg, QD,持续24周。偏头痛急性治疗的标准治疗药物和稳定剂量的预防性偏头痛药物被允许。终点包括治疗期间不良事件(ae)发生率≥5%,治疗期间严重ae,治疗期间不良事件导致严重停药,治疗期间3-4级实验室检查异常。本研究未对疗效进行评估。结果:总体而言,250名参与者(女性= 82.4%,白人= 86.4%,平均年龄= 42.6岁)接受了≥1剂量的rimegepant治疗,74.8%完成了开放标签治疗。平均服药时间(SD)为19.3(8.7)周。总体而言,53.6%的参与者在治疗期间发生≥1次不良反应,没有发生严重不良反应,1.6%发生严重不良反应,2.8%发生严重不良反应导致药物停药。≥5%的参与者在治疗期间发生的不良事件包括鼻咽炎(9.2%)、COVID-19(6.4%)和恶心(6.0%)。治疗期3-4级实验室检查异常包括低淋巴细胞(0.4%)、高肌酸激酶(3.8%)、低糖(0.4%)、高低密度脂蛋白胆固醇(LDL-C; 9.8%)、高空腹LDL-C(9.3%)、高非空腹LDL-C(10.2%)、高钾(1.3%)、高甘油三酯(0.9%)、高空腹甘油三酯(1.3%)和尿糖(0.5%)。治疗前未观察到肝转氨酶(谷丙转氨酶[ALT]或谷草转氨酶[AST])升高至正常值(ULN)上限(ALT或AST]升高至正常值(ULN)上限(ALT或AST]升高至ULN上限(ALT或AST]升高至ULN上限的5倍)及总胆红素水平升高至ULN上限的2倍。结论:Rimegepant 75mg QD,治疗24周,具有良好的安全性。试验注册:ClinicalTrials.gov NCT05207865(注册于2022年1月12日)。
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引用次数: 0
Expression of melatonin receptors in trigeminal and sphenopalatine ganglia: potential targets for primary headache disorders. 褪黑激素受体在三叉神经节和蝶腭神经节中的表达:原发性头痛疾病的潜在靶点。
IF 7.9 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-12-09 DOI: 10.1186/s10194-025-02215-9
Aida Maddahi, Jacob C A Edvinsson, Lars Edvinsson, Diana N Krause

Background: Primary headache disorders such as migraine and cluster headache exhibit circadian and circannual variations in attack onset. Melatonin plays a central role in regulating biological rhythms and likely influences the timing of headache attacks. Recent evidence suggests melatonin may be a promising treatment for migraine and cluster headache; however, underlying mechanisms need to be elucidated. Because of the importance of the trigeminovascular system (TVS) and trigeminal-parasympathetic ganglia in these disorders, we proposed that melatonin receptors (MT1 and MT2) are expressed in these pathways.

Methods: The trigeminal ganglion (TG), sphenopalatine ganglion (SPG), dorsal root ganglion (DRG), basilar artery, dura mater and hypothalamus were dissected from adult male and female rats. RT-qPCR and immunohistochemistry were used to assess the expression of mRNA and protein, respectively, for melatonin MT1 and MT2 receptors.

Results: Immunohistochemical analysis showed MT1 and MT2 were differentially expressed in the TG, SPG and DRG. MT1 was widely distributed in the cytoplasm and nuclei of neurons and satellite glial cells (SGCs) in the TG, while MT2 localized mainly in the cytoplasm of neurons and Aδ-fibers. Both MT1 and MT2 co-localized with CGRP and the CGRP receptor component RAMP1. MT2 immunoreactivity was also found in Aδ-fibers throughout the dura mater and was co-expressed with Contactin-associated protein 1(CASPR) at the paranodal regions of Aδ-fibers. No significant sex differences were found in receptor expression in the TG, although mRNA levels of MT1 were approximately twice as high as those for MT2. In SPG, both receptors co-localized with the neuropeptides VIP and PACAP. In cerebral arteries, only MT1 was detected, and it was localized mainly in endothelial and smooth muscle cells.

Conclusions: This study demonstrates that MT1 and MT2 receptors are expressed in the TVS and SPG, key components involved in migraine and cluster headache. Melatonin receptor co-localization with neuropeptides involved in autonomic and sensory neuronal regulation supports a potential mechanism by which melatonin influences headache onset and progression. Together, these findings support a role for melatonin influences in primary headache pathophysiology and point to its potential for novel headache treatment.

背景:原发性头痛疾病如偏头痛和丛集性头痛在发作时表现出昼夜节律和周期性变化。褪黑素在调节生物节律方面起着核心作用,可能影响头痛发作的时间。最近的证据表明,褪黑素可能是治疗偏头痛和丛集性头痛的一种有希望的方法;然而,潜在的机制需要阐明。由于三叉神经血管系统(TVS)和三叉-副交感神经节在这些疾病中的重要性,我们提出褪黑激素受体(MT1和MT2)在这些途径中表达。方法:分别解剖成年雌雄大鼠三叉神经节(TG)、蝶腭神经节(SPG)、背根神经节(DRG)、基底动脉、硬脑膜和下丘脑。RT-qPCR和免疫组织化学分别检测褪黑激素MT1和MT2受体mRNA和蛋白的表达。结果:免疫组化分析显示MT1和MT2在TG、SPG和DRG中有差异表达。MT1广泛分布于TG的神经元和卫星胶质细胞(SGCs)的细胞质和细胞核中,而MT2主要分布于神经元和a - δ纤维的细胞质中。MT1和MT2与CGRP和CGRP受体成分RAMP1共定位。在整个硬脑膜的a δ-纤维中也发现了MT2的免疫反应性,并在a δ-纤维的副神经区与接触蛋白相关蛋白1(CASPR)共表达。尽管MT1的mRNA水平大约是MT2的两倍,但TG中受体的表达没有发现显著的性别差异。在SPG中,这两种受体与神经肽VIP和PACAP共定位。在脑动脉中仅检测到MT1,且主要定位于内皮细胞和平滑肌细胞。结论:本研究表明MT1和MT2受体在偏头痛和丛集性头痛的关键成分TVS和SPG中表达。褪黑激素受体与参与自主神经和感觉神经元调节的神经肽共定位支持褪黑激素影响头痛发病和进展的潜在机制。总之,这些发现支持褪黑激素在原发性头痛病理生理中的作用,并指出其潜在的新型头痛治疗方法。
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引用次数: 0
The emerging role of epigenetic regulation in pain sensitization associated with headache disorders. 表观遗传调控在与头痛疾病相关的疼痛致敏中的新作用。
IF 7.9 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-12-06 DOI: 10.1186/s10194-025-02244-4
Yu Tao, Xingwei Cai, Yufang Sun, Weiwei Lu, Shoupeng Wang, Zitong Huang, Yaqun Zhang, Jin Tao, Yuan Zhang
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引用次数: 0
Epigenetics in migraine: the Junior Editorial Board Members' vision. 偏头痛的表观遗传学:初级编辑委员会成员的视野。
IF 7.9 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-12-05 DOI: 10.1186/s10194-025-02240-8
Damiana Scuteri, Alejandro Labastida-Ramirez, Eloisa Rubio-Beltran, Doga Vuralli, Agnese Onofri
<p><strong>Background: </strong>Migraine represents the third leading cause of disability-adjusted life years among young females worldwide, responsible for physical and emotional distress along with reduced social functioning. The matter is further complicated by resistance and even refractoriness to the available treatments. Indeed, despite the several therapeutic strategies, remarkably improved by the development of the novel, specific drugs directed towards calcitonin-gene related peptide (CGRP) signalling, 40% patients, also undergoing anti-CGRP therapy, are still difficult-to-treat. The potential role of environmental factors and epigenetic modifications in the pathogenesis of migraine and in the responsiveness to treatments still remains poorly investigated. Moreover, the expression of a wide panel of serum microRNAs was recently related to frequency and features of migraine attacks. Thus, the aim of the present study is to analyze the possible epigenetic mechanisms at the root of differences in migraine features and response to treatments.</p><p><strong>Methods: </strong>Eligibility criteria, search strategy and information sources are established a priori. PubMed, Scopus and Web of Science were inspected for studies published from database inception to the date of last search on October 2nd, 2025.</p><p><strong>Results: </strong>A few studies so far support the role of DNA methylation in migraine chronification, indicating that these stable but reversible epigenetic modifications may influence the process of progression and transformation from episodic to chronic migraine. Altered DNA methylation sites were linked to genes involved in synaptic plasticity and estrogen receptor signaling. Up-regulation of circulating miRNAs was reduced following treatment with gepants. Within this complex figure, the role of the transient receptor potential (TRP) vanilloid 1 (TRPV1) in the trigeminal ganglia deserves deep investigation, including the prediction of response to first-line therapies such as triptans. Likewise, TRP ankyrin 1 (TRPA1) expression is subjected to pain-induced epigenetic modifications. DNA methylation and the modulation of histone deacetylase activity are implicated in the mechanisms of action of currently used preventative drugs, such as valproic acid and topiramate, and could serve as biomarkers of drug response. Finally, the role of miRNAs as potential biomarker for predicting the response to novel monoclonal antibodies, such as erenumab, has emerged in recent studies.</p><p><strong>Conclusions: </strong>The role of epigenetic modifications of genes involved in the CGRP pathway, synaptic plasticity and TRPV1, TRPA1 and estrogen receptor signaling in migraine is emerging. Therefore, a deeper understanding of the impact of epigenetics in migraine pathophysiology and neuropharmacology is needed to revert chronification and personalize medicine in the field of migraine, improving efficacy and safety of treatments and widening the th
背景:偏头痛是世界范围内年轻女性残疾调整生命年的第三大原因,导致身体和情绪困扰以及社交功能下降。由于现有的治疗方法具有耐药性甚至难治性,使问题进一步复杂化。事实上,尽管有几种治疗策略,随着针对降钙素基因相关肽(CGRP)信号传导的新型特异性药物的发展而显著改善,40%的患者也在接受抗CGRP治疗,仍然难以治疗。环境因素和表观遗传修饰在偏头痛发病机制和对治疗的反应性中的潜在作用仍未得到充分研究。此外,一组广泛的血清microrna的表达最近与偏头痛发作的频率和特征有关。因此,本研究的目的是分析偏头痛特征和治疗反应差异的可能的表观遗传机制。方法:先验地建立资格标准、搜索策略和信息源。我们检查了PubMed、Scopus和Web of Science从数据库建立到最后一次检索日期(2025年10月2日)发表的研究。结果:到目前为止,一些研究支持DNA甲基化在偏头痛慢性化中的作用,表明这些稳定但可逆的表观遗传修饰可能影响偏头痛从发作性到慢性的进展和转变过程。改变的DNA甲基化位点与参与突触可塑性和雌激素受体信号传导的基因有关。使用gepants治疗后,循环mirna的上调减少。在这个复杂的数字中,瞬时受体电位(TRP)香草酸样蛋白1 (TRPV1)在三叉神经节中的作用值得深入研究,包括预测对曲坦类药物等一线治疗的反应。同样,TRP锚蛋白1 (TRPA1)的表达也受到疼痛诱导的表观遗传修饰的影响。DNA甲基化和组蛋白去乙酰化酶活性的调节与目前使用的预防药物(如丙戊酸和托吡酯)的作用机制有关,并可作为药物反应的生物标志物。最后,在最近的研究中,mirna作为预测对新型单克隆抗体(如erenumab)反应的潜在生物标志物的作用已经出现。结论:CGRP通路、突触可塑性、TRPV1、TRPA1和雌激素受体信号通路相关基因的表观遗传修饰在偏头痛中的作用正在逐渐显现。因此,需要更深入地了解表观遗传学在偏头痛病理生理和神经药理学中的影响,以恢复偏头痛领域的慢性化和个性化治疗,提高治疗的有效性和安全性,扩大治疗范围。
{"title":"Epigenetics in migraine: the Junior Editorial Board Members' vision.","authors":"Damiana Scuteri, Alejandro Labastida-Ramirez, Eloisa Rubio-Beltran, Doga Vuralli, Agnese Onofri","doi":"10.1186/s10194-025-02240-8","DOIUrl":"10.1186/s10194-025-02240-8","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Migraine represents the third leading cause of disability-adjusted life years among young females worldwide, responsible for physical and emotional distress along with reduced social functioning. The matter is further complicated by resistance and even refractoriness to the available treatments. Indeed, despite the several therapeutic strategies, remarkably improved by the development of the novel, specific drugs directed towards calcitonin-gene related peptide (CGRP) signalling, 40% patients, also undergoing anti-CGRP therapy, are still difficult-to-treat. The potential role of environmental factors and epigenetic modifications in the pathogenesis of migraine and in the responsiveness to treatments still remains poorly investigated. Moreover, the expression of a wide panel of serum microRNAs was recently related to frequency and features of migraine attacks. Thus, the aim of the present study is to analyze the possible epigenetic mechanisms at the root of differences in migraine features and response to treatments.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Eligibility criteria, search strategy and information sources are established a priori. PubMed, Scopus and Web of Science were inspected for studies published from database inception to the date of last search on October 2nd, 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A few studies so far support the role of DNA methylation in migraine chronification, indicating that these stable but reversible epigenetic modifications may influence the process of progression and transformation from episodic to chronic migraine. Altered DNA methylation sites were linked to genes involved in synaptic plasticity and estrogen receptor signaling. Up-regulation of circulating miRNAs was reduced following treatment with gepants. Within this complex figure, the role of the transient receptor potential (TRP) vanilloid 1 (TRPV1) in the trigeminal ganglia deserves deep investigation, including the prediction of response to first-line therapies such as triptans. Likewise, TRP ankyrin 1 (TRPA1) expression is subjected to pain-induced epigenetic modifications. DNA methylation and the modulation of histone deacetylase activity are implicated in the mechanisms of action of currently used preventative drugs, such as valproic acid and topiramate, and could serve as biomarkers of drug response. Finally, the role of miRNAs as potential biomarker for predicting the response to novel monoclonal antibodies, such as erenumab, has emerged in recent studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The role of epigenetic modifications of genes involved in the CGRP pathway, synaptic plasticity and TRPV1, TRPA1 and estrogen receptor signaling in migraine is emerging. Therefore, a deeper understanding of the impact of epigenetics in migraine pathophysiology and neuropharmacology is needed to revert chronification and personalize medicine in the field of migraine, improving efficacy and safety of treatments and widening the th","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":" ","pages":"20"},"PeriodicalIF":7.9,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12817528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145678058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Mapping the brain cell-specific regulatory architecture of migraine: a single-cell causal framework nominating inhibitory-neuronal BTBD16 and astrocytic RIMS1 as therapeutic targets. 绘制偏头痛的脑细胞特异性调控结构:一个单细胞因果框架,提名抑制神经元BTBD16和星形胶质细胞RIMS1作为治疗靶点。
IF 7.9 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-12-05 DOI: 10.1186/s10194-025-02241-7
Hong Ye, Yajing Huang, Cheng Wang, Jiancheng Jin, Chaoya Jiang, Junjie Fang, Qiuhan Xu

Background: Migraine is a common, disabling neurological disorder. Genome-wide association studies have mapped numerous migraine risk loci, but the causal genes and their cell-type context remain unclear. Prior work linked migraine GWAS to bulk brain eQTLs; however, tissue-average signals obscure cell-specific regulation.

Methods: We extended these findings to single-cell resolution. Cis-eQTL instruments from 183 human donors across eight brain cell types were filtered by genome-wide significance, LD pruning, and instrument strength, yielding 1,746 independent eGenes. Two-sample Mendelian randomization (MR) tested effects on migraine risk in FinnGen R12 (discovery) with replication in UK Biobank (GCST90473326). To control for multiple testing, we applied within-cell-type Bonferroni correction and global false discovery rate (FDR) adjustment. Bayesian colocalization was performed in both discovery and replication cohorts to evaluate shared causal variants. We also performed a phenome-wide association screen (PheWAS) and profiled regional brain RNA.

Results: Eleven eGenes were significant in FinnGen. Protective associations were observed for BTBD16 in excitatory and inhibitory neurons, RRP15 in excitatory neurons, CCDC146 and GSTM3 in oligodendrocytes, and PDE4B in microglia. Risk-increasing associations were found for GSTM2 (excitatory neurons), RIMS1 and DPH1 (astrocytes), AADAC (microglia), and RBM20 (endothelium). Replication supported signals for inhibitory-neuronal BTBD16 and astrocytic RIMS1. Colocalization analyses indicated shared causal variants at both loci in the discovery cohort (PP.H4 > 0.80). PheWAS showed no genome-wide liabilities for either gene. Regional expression suggested white-matter enrichment for BTBD16 and a cerebellar peak for RIMS1.

Conclusions: Cell-type-specific MR sharpens migraine mechanisms beyond bulk tissue and prioritizes inhibitory-neuronal BTBD16 (protective) and astrocytic RIMS1 (risk-increasing) for mechanistic validation and therapeutic exploration.

背景:偏头痛是一种常见的致残性神经系统疾病。全基因组关联研究已经绘制了许多偏头痛风险位点,但致病基因及其细胞类型背景仍不清楚。先前的研究将偏头痛GWAS与大容量脑qtl联系起来;然而,组织平均信号模糊了细胞特异性调节。方法:我们将这些发现扩展到单细胞分辨率。通过全基因组显著性、LD修剪和仪器强度对来自8种脑细胞类型183名人类供体的Cis-eQTL仪器进行筛选,得到1746个独立的eGenes。双样本孟德尔随机化(MR)测试了FinnGen R12对偏头痛风险的影响(发现),并在英国生物银行(GCST90473326)进行了复制。为了控制多重测试,我们应用了细胞内型Bonferroni校正和全局错误发现率(FDR)调整。在发现和复制队列中进行贝叶斯共定位,以评估共同的因果变异。我们还进行了全现象关联筛选(PheWAS)并分析了区域脑RNA。结果:11个基因在FinnGen中表达显著。BTBD16在兴奋性和抑制性神经元中,RRP15在兴奋性神经元中,CCDC146和GSTM3在少突胶质细胞中,PDE4B在小胶质细胞中观察到保护性关联。发现GSTM2(兴奋性神经元)、RIMS1和DPH1(星形胶质细胞)、AADAC(小胶质细胞)和RBM20(内皮细胞)与风险增加相关。抑制神经元BTBD16和星形细胞RIMS1的复制支持信号。共定位分析表明,在发现队列中,两个位点存在共同的因果变异(PP.H4 bb0 0.80)。PheWAS没有显示这两个基因的全基因组负荷。区域表达提示BTBD16白质富集,RIMS1小脑峰。结论:细胞类型特异性MR强化了偏头痛的机制,并优先考虑抑制神经元BTBD16(保护性)和星形胶质细胞RIMS1(风险增加),以进行机制验证和治疗探索。
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引用次数: 0
Cluster headache suicidality: a systematic review with a meta-analysis. 丛集性头痛自杀:荟萃分析的系统回顾。
IF 7.9 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-12-04 DOI: 10.1186/s10194-025-02140-x
E K Van Obberghen, R Fabre, M Lanteri-Minet

Background: Suicide is considered as common in patients with cluster headache (CH) and is defined as 'suicidal headache'. However, the exact level of suicidality is not known and is intuitively assumed to be correlated with the CH severity.

Methods: This work is a systematic review of data accessible through PubMed and published up to July 25, focusing on the suicidality of CH according to the rates of suicidal ideation and suicide attempts. This meta-analysis was carried out with all selected studies then by considering studies with specialized recruitment and studies with non-specialized recruitment. A qualitative analysis was performed to identify determinants of CH suicidality.

Results: Among the 53 publications identified, 12 were selected corresponding to 10 studies. These selected studies included a total of 34180 subjects (range 75-24131). Eight were performed in a specialized field (headache tertiary center, neurology clinic or via CH patients' association) and 2 in a non-specialized field (via heath registry). The overall rate of suicidal ideation in CH was estimated at 8.0% (95%CI [7.7; 8.3] and overall rate of suicide attempts in CH was estimated at 1.2% (95%CI [1.1; 1.3]). In a non-specialized field, these rates were estimated at 5.2% (95%CI [4.9; 5.4]) and 1.1% (95%CI [1.0; 1.2]) respectively. In specialized field, these rates were estimated at 44.6% (95%CI [42.7; 46.6]) and 5.1% (95%CI [3.9; 6.7]) respectively. The qualitative analysis showed that few determinants have been considered but it appears that the risk is greater during CH attacks, and it involves psychological determinants such as demoralization.

Conclusion: The overall suicidal risk in CH does not appear to be higher than that of the general population, but there is a suicidal risk increase among CH patients followed up in specialized field. This higher risk is indeed probably related to the severity of CH in terms of pain, but it is also probably related to other factors such as impulsive aggressiveness during CH attacks and psychological factors such as demoralization.

Registration: The systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 07/22/2025 (number: CRD420251110095).

背景:丛集性头痛(CH)患者中自杀被认为是常见的,并被定义为“自杀性头痛”。然而,确切的自杀水平尚不清楚,直觉上认为与CH严重程度相关。方法:本研究系统回顾了PubMed截至7月25日发表的数据,根据自杀意念率和自杀企图率对CH的自杀倾向进行了研究。本荟萃分析是对所有选定的研究进行的,通过考虑专业招募的研究和非专业招募的研究。进行定性分析以确定CH自杀的决定因素。结果:从53篇文献中筛选出12篇,对应10篇研究。这些选定的研究共包括34180名受试者(范围75-24131)。8例在专业领域(头痛三级中心、神经病学诊所或通过CH患者协会)进行,2例在非专业领域(通过健康登记)进行。CH患者总体自杀意念率估计为8.0% (95%CI[7.7; 8.3]),总体自杀企图率估计为1.2% (95%CI[1.1; 1.3])。在非专业领域,这些比率分别估计为5.2% (95%CI[4.9; 5.4])和1.1% (95%CI[1.0; 1.2])。在专业领域,这些比率分别为44.6% (95%CI[42.7; 46.6])和5.1% (95%CI[3.9; 6.7])。定性分析表明,几乎没有考虑到决定因素,但似乎在CH攻击期间风险更大,并且涉及到士气低落等心理决定因素。结论:CH患者总体自杀风险不高于一般人群,但专科随访的CH患者自杀风险有所增加。这种较高的风险确实可能与慢性脊髓灰质炎的疼痛程度有关,但也可能与其他因素有关,如慢性脊髓灰质炎发作时的冲动性攻击和士气低落等心理因素。注册:系统评价方案已于2025年7月22日在国际前瞻性系统评价注册(PROSPERO)注册(编号:CRD420251110095)。
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引用次数: 0
The prevalence of headache disorders among children and adolescents in Georgia: a cross-sectional schools-based study. 格鲁吉亚儿童和青少年中头痛疾病的患病率:一项基于学校的横断面研究。
IF 7.9 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-12-04 DOI: 10.1186/s10194-025-02154-5
Nana Nino Tatishvili, Zaza Katsarava, Teona Shatirishvili, Tamar Kipiani, Tinatin Giuashvili, Mariam Lomsianidze, Aleksandre Kotetishvili, Anano Kvernadze, Irakli Tugushi, Salome Maghlakelidze, Vera Nemsadze, Ana Bedoshvili, Tamar Bitskinashvili, Giorgi Sakvarelidze, Tayyar Şaşmaz, Deniz Erdal, Andreas Kattem Husøy, Derya Uludüz, Timothy J Steiner

Background: The Global Campaign against Headache is undertaking a worldwide programme of cross-sectional schools-based studies of headache prevalence and attributed burden among children (6-11 years) and adolescents (12-17). The purpose is to expand the still sparse knowledge of headache among these age groups, using a data-acquisition technique that cluster-samples the world. This survey in Georgia was the fourth in the European Region, following similar studies in Turkey, Austria and Lithuania, and others in African, Eastern Mediterranean, South-East Asia and Western Pacific Regions.

Methods: We used the Global Campaign's standardized protocol, selecting schools representative of the country. The child and adolescent versions of the structured HARDSHIP questionnaire, translated into Georgian language, were completed by pupils under supervision in class. Headache diagnoses followed ICHD-3, with the exception of undifferentiated headache (UdH), which we defined initially as mild and subsequently as mild-to-moderate headache lasting < 1 h. Enquiry timeframes were 1 year, 4 weeks and 1 day (headache yesterday [HY]).

Results: Of 2,790 participants, two thirds (68.5%) reported headache in the preceding year (age- and gender-adjusted 1-year prevalence: 66.3%). HY was reported by 20.4%, a proportion that might be expected to have headache on any day. Headache on ≥ 15 days/month (H15+) was common (4.1%), with probable medication-overuse headache (pMOH) accounting for 0.5% (0.2% among children, 0.7% among adolescents; p = 0.06). UdH took diagnostic precedence over migraine and tension-type headache (TTH), so all other estimates were influenced by the definition of UdH. By the conventional (initial) definition, 1-year prevalence of UdH was 18.2%; by the modified definition, it was 30.2%. Estimates for migraine and TTH, 29.1% and 13.1% respectively with UdH defined conventionally, were reduced to 22.2% and 9.5% with the modified definition.

Conclusions: Headache is very common among children and adolescents in Georgia. The findings raise particular concern about the prevalence of H15 + in young people, with a strong trend of increasing pMOH with age. They also highlight the diagnostic uncertainties inherent in epidemiological studies in these age groups. With the definition of UdH a dominating issue, the findings support the view that it needs to be modified, without offering a definitive solution.

背景:全球防治头痛运动正在开展一项全球规划,对儿童(6-11岁)和青少年(12-17岁)的头痛患病率和相关负担进行以学校为基础的横断面研究。目的是利用一种对世界进行聚类采样的数据采集技术,扩大这些年龄组中仍然稀少的关于头痛的知识。格鲁吉亚的这项调查是欧洲区域的第四项调查,此前在土耳其、奥地利和立陶宛以及在非洲、东地中海、东南亚和西太平洋区域进行了类似的研究。方法:我们使用全球运动的标准化协议,选择具有代表性的国家学校。儿童和青少年的结构困难调查表翻译成格鲁吉亚语,由学生在课堂上监督下完成。头痛诊断遵循ICHD-3,但未分化头痛(UdH)除外,我们最初将其定义为轻度,随后将其定义为轻度至中度持续性头痛。结果:在2,790名参与者中,三分之二(68.5%)报告在前一年头痛(年龄和性别调整后的1年患病率:66.3%)。HY报告的比例为20.4%,这一比例可能会在任何一天出现头痛。头痛≥15天/月(H15+)常见(4.1%),可能的药物过度使用头痛(pMOH)占0.5%(儿童0.2%,青少年0.7%,p = 0.06)。UdH的诊断优先于偏头痛和紧张性头痛(TTH),因此所有其他估计都受到UdH定义的影响。根据传统(初始)定义,1年UdH患病率为18.2%;根据修改后的定义,这一比例为30.2%。偏头痛和TTH的估计值在UdH的传统定义下分别为29.1%和13.1%,在修改定义后分别降至22.2%和9.5%。结论:头痛在乔治亚州的儿童和青少年中非常常见。研究结果引起了人们对年轻人中H15 +患病率的特别关注,随着年龄的增长,pMOH有明显的上升趋势。他们还强调了在这些年龄组的流行病学研究中固有的诊断不确定性。由于UdH的定义是一个主要问题,研究结果支持需要修改的观点,但没有提供明确的解决方案。
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引用次数: 0
The burden attributable to headache disorders among children and adolescents in Mongolia: estimates from a national cross-sectional schools-based study. 蒙古国儿童和青少年中可归因于头痛疾病的负担:来自一项基于学校的全国性横断面研究的估计。
IF 7.9 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-12-04 DOI: 10.1186/s10194-025-02202-0
Otgonbayar Luvsannorov, Tsengunmaa Anisbayar, Munkhzul Davaasuren, Otgonzaya Baatar, Khaliunaa Batmagnai, Khulan Tumurbaatar, Sarantuya Enkhbaatar, Andreas Kattem Husøy, Derya Uluduz, Tayyar Şaşmaz, Elif Tuğçe Solmaz, Timothy J Steiner
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引用次数: 0
Temporal stability and neural complexity in resting-state MEG predict migraine phenotypes. 静息状态脑磁图的时间稳定性和神经复杂性预测偏头痛表型。
IF 7.9 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-12-03 DOI: 10.1186/s10194-025-02169-y
Fu-Jung Hsiao, Wei-Ta Chen, Shih-Pin Chen, Yen-Feng Wang, Kuan-Lin Lai, Gianluca Coppola, Shuu-Jiun Wang
{"title":"Temporal stability and neural complexity in resting-state MEG predict migraine phenotypes.","authors":"Fu-Jung Hsiao, Wei-Ta Chen, Shih-Pin Chen, Yen-Feng Wang, Kuan-Lin Lai, Gianluca Coppola, Shuu-Jiun Wang","doi":"10.1186/s10194-025-02169-y","DOIUrl":"10.1186/s10194-025-02169-y","url":null,"abstract":"","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":"26 1","pages":"280"},"PeriodicalIF":7.9,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12673768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145668004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Is canonical SD a clinically relevant model of migraine? Argument con. 典型SD是偏头痛的临床相关模型吗?反对的论点。
IF 7.9 1区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-12-03 DOI: 10.1186/s10194-025-02177-y
Berkay Alpay, Doga Vuralli, Hayrunnisa Bolay
{"title":"Is canonical SD a clinically relevant model of migraine? Argument con.","authors":"Berkay Alpay, Doga Vuralli, Hayrunnisa Bolay","doi":"10.1186/s10194-025-02177-y","DOIUrl":"10.1186/s10194-025-02177-y","url":null,"abstract":"","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":"26 1","pages":"279"},"PeriodicalIF":7.9,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12673730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145678009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Journal of Headache and Pain
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