Migraine disorders Research Papers - Academia.edu (original) (raw)

2025, Arkivoc

the main Sumatriptan impurity, is described, as a model for other related triptan derivatives.

2025, Cephalalgia

In this issue of the journal the editors have initiated an historical section. Hansreudi Isler presents a scholarly paper on cluster headache. Apparently, this case report is the earliest description of this disorder which satisfies the new diagnostic criteria of the IHS classification, an admirable example of the ancient and modern. There are many points of value in this work, even a therapeutic tip that could still be pursued. This paper, considered in the light of Carlyle's wisdom, exemplifies why we believe our readers will consider a periodic step back into the history of headache a rewarding venture. In anticipation of this, we have asked Dr Isler to accept the formal editorship of the Historical Section for future issues. He is well known to many of you as a scholar in the Classics as well as Clinical Neurology, who has long provided contemporary headache science with historical perspective and insight. No-one in our specialty is better suited to take this editorship. I encourage our readers to submit papers of historical interest related to headache and associated disorders directly to Dr Islet at the Neurology Clinic

2025, Cephalalgia

The aim of the study was to evaluate sleep of children with migraine during the interictal period and the modifications of sleep which precede, are concomitant with, or follow migraine attacks. Eighteen patients with migraine without aura were compared with a group of 17 healthy age-matched children. Sleep parameters were monitored for two full weeks by means of actigraphs and self-report diaries. Headache diaries were also filled out in order to evaluate the occurrence and the characteristics of migraine attacks. Fifty-seven attacks were recorded during the monitoring period. During the interictal period, sleep parameters of children suffering from migraine did not differ from those of controls; only sleep onset latency was slightly prolonged in the migraine group. Timing of the attack affected nocturnal motor activity which presented the lowest values on the night preceding the attack, indicating a decrease in cortical activation during sleep preceding migraine attacks. Further st...

2025, Journal of The Pakistan Dental Association

The objective of the present study was to evaluate the prevalence of anterior and posterior tooth wear among dental patients visiting the Oral Medicine and Diagnosis outpatient department (OPD) of Bahria University Medical and Dental College, Karachi (BUMDC) and to assess the associated risk factors related to anterior and posterior tooth wear. METHODOLOGY: It was a cross sectional study conducted from January 2017 to June 2017. Total 526 participants with the chief complain of sensitivity and tooth wear were included in this study and were examined by trained dental surgeons. The examiners were trained on degree of attrition (Tooth Wear Index TWI; by Smith & Knight 1984) via using structured questionnaire. Descriptive analysis, Pearson Chi square test and ordinal regression analysis was performed on SPSS version 23for future predictions. RESULTS: In this study, tooth wear was found to be more prevalent among individuals aged 31-40 years (n=215) 40.9% and (n=145) 27.6% in those who were in social class IIIm (manual skilled workers like bus driver, carpenter etc). The prevalence of anterior tooth wear was (n=169) 32.1%, posterior (n=208)39.5% and both anterior and posterior location were (n=149) 28.3%. It was observed in this study that multiple risk factors had a significant impact on the location of the tooth wear. Majority of participants (n=409) 77.8% were practicing tooth brushing as a mode of oral hygiene with posterior tooth wear as most common finding (n=170,41.5%,P-value=0.0001). Regarding parafuctional habits, majority (n=419, 79.7%, P-value =0.0001) participants were in habit of clenching. There was a remarkable effect of gastro intestinal reflux disease (GERD) on tooth wear, (n=299) 56.8% participants had GERD, (n=147) 49.1% participants had posterior tooth wear (n=55) 18.3% had anterior tooth wear and (n=97) 32.4% had both anterior and posterior tooth wear (P-value=0.0001). There was a significant effect of oral habits (betel nuts chewing) on tooth surfaces (n=243) 46.2% participants were consuming betel quid in which (n=129) 53.08% participants were found with more posterior then anterior tooth wear (P-value=0.0001). A total of 184(75.5%) participants were consuming 5-10 packets/day of betel quid and of these 51.6% (n=95/184) participants reported with posterior tooth wear (P-value=0.0001).To assess the future predictions, ordinal regression analysis were carried out. It was observed that location of tooth wear would be effected by GERD, parafuctional habits (clenching), oral habits (betel nuts chewing) and frequency of oral habits. CONCLUSIONS: We conclude from this study that there were multiple risk factors associated with tooth wear. It was observed that posterior tooth wear, younger age group, social class IIIm, parafuctional habits (clenching), betel nut usage, history of GERD, abrasive oral hygiene practices and technique of brushing were most common findings.

2025, Cephalalgia

Square-wave gratings with particular spatial characteristics in visual illusions. Patients with migraine are particularly susceptible to these illusions and report disc. it. Their discomfort tends to be greater when the gratings are illuminated by red light, a tendency 1 known by controls. Gratings that induce illusions have been found to impair the recognition of opt superimposed targets in headache-free control subjects. We measured the impairment of target detection under illuminants of various chromaticities in migraineurs with and without aura and in mat controls. Migraineurs with aura had significantly higher thresholds for target detection than either migraineurs without aura or controls; in addition, the effect of chromaticity was slightly more pronounced in both migraine groups than in the control group. These findings are consistent with a recent suggestion that migraine with aura might give rise to subclinical damage to the primary visual cortex

2025, Revista brasileira de reumatologia

Enxaqueca crônica Enxaqueca episódica Ácido láctico Fibromialgia r e s u m o Introduc ¸ão: O ácido láctico é um subproduto do metabolismo muscular e do sistema nervoso central. As alterac ¸ões no metabolismo estão relacionadas com diversas condic ¸ões fisiológicas e patológicas. O objetivo deste estudo foi determinar a relac ¸ão entre a enxaqueca e a fibromialgia com os níveis de ácido láctico no sangue. Métodos: Foram estudados 93 pacientes, divididos em cinco grupos: 1) fibromialgia (n = 20); 2) enxaqueca episódica (n = 20); 3) enxaqueca crônica (n = 20); 4) fibromialgia e enxaqueca episódica (n = 13); e 5) fibromialgia e enxaqueca crônica (n = 20), além de 20 indivíduos saudáveis (grupo controle). Os níveis sanguíneos de ácido láctico foram medidos em quatro momentos : em repouso, durante o exercício aeróbico, durante a atividade física anaeróbica e durante o descanso depois do exercício anaeróbico. Resultados: O ácido láctico aumentou em todos os grupos durante a atividade física anaeróbica, sem predominância em qualquer grupo. Durante a atividade física aeróbica, todos os grupos apresentaram um aumento nos níveis de ácido láctico, mas esse aumento foi mais expressivo nos grupos de enxaqueca crônica e enxaqueca crônica com fibromialgia, sem significância estatística. Conclusões: Não foram encontradas anormalidades que envolvessem o metabolismo do ácido láctico na enxaqueca episódica e crônica, na presenc ¸a ou não de fibromialgia.

2025, Revista Brasileira De Reumatologia

Background: Lactic acid is a byproduct of both muscle metabolism and the central nervous system. Changes in metabolism are related to various physiological and pathological conditions. The aim of this study was to determine the relationship between migraine and fibromyalgia with the levels of lactic acid in the blood. We study 93 patients divided into five groups: (1) patients with fibromyalgia (n = 20); (2) episodic migraine (n = 20); (3) chronic migraine (n = 20); (4) fibromyalgia and episodic migraine (n = 13); and (5) fibromyalgia and chronic migraine (n = 20), and 20 healthy subjects (control group). Blood levels of lactic acid were measured at four different time points: at rest, during aerobic exercise, during anaerobic physical activity and while resting after anaerobic exercise. Results: Lactic acid increased in all groups during anaerobic physical activity without predominance for either group. During aerobic physical activity, all groups increased lactic acid levels, but the increase was more expressive in the chronic migraine group and the chronic migraine with fibromyalgia group without statistical significance. We did not found abnormalities involving the metabolism of lactic acid in episodic and chronic migraine with or without fibromyalgia.

2025, Headache: The Journal of Head and Face Pain

In a series of 81 patients with chronic cervicobrachialgia, 54 (67%) reported that they also suffered from recurrent headache. Forty-four (81%) of these patients were classified as having cervical headache, 5 as having migraine, 2 with tension-type headache, and 3 patients were not classifiable according to the diagnostic system of the International Headache Society (IHS). Patients with headache presented significantly higher tenderness scores and pain intensity in the neck-shoulder-arm region than patients without headaches. Twenty-three (52%) of the 44 patients with cervical headache reported that their headache had improved after treatments directed towards their cervicobrachialgia. The IHS classification system of cervical headache is discussed.

2025, Cephalalgia

Migraine headaches are among the leading causes of disability in the world. The burden of migraines is highest in women of reproductive age. This cross-sectional study characterized the prevalence, symptoms and correlates of migrainous headaches in 154 pregnant women attending a prenatal care clinic in Lima, Peru. Lifetime prevalence of migraine defined by modified IHS criteria was 9.1± (95± CI 4.6–13.6). When probable migraines were included, the lifetime prevalence of migraine in this population was 29.2± (95± CI 22.0–36.4). Migraine headaches were associated with a maternal history of headache, childhood carsickness, a diagnosis of allergies, and a high frequency of fatigue. Although headache-related disability was low in terms of missed work and recreation, high rates of headache pain and medicinal use reflect the true impact on this population.

2025, Developmental medicine and child neurology

Migraines in children younger than 7 years of age have received limited attention in the published literature. The aim of this study is to describe the characteristics of migraine phenotypes in children younger than 7 years, and to compare them with migraines in children older than 7 years of age. We reviewed all standard clinical files, collected over 4 years, related to children with a diagnosis of primary headache. We included all children younger than 7 years diagnosed with migraine in our study. A total of 374 children (188 males, 186 females) were affected by migraine with/without aura: 40 of these patients (10.7%; 20 males, 20 females; mean age 5y 7mo, SD 1y 2mo) where younger than 7 years old. The frequencies of the main migraine features in the younger age group were similar to those of children older than 7 years, with the exception of a shorter duration of migraine and reduced frequency of attacks. In children younger than 7 years of age, the clinical phenotype of migrain...

2025, Academic Emergency Medicine

Objectives: Neurogenic inflammation is thought to play a role in the development and perpetuation of migraine headache. The emergency department (ED) administration of dexamethasone in addition to standard antimigraine therapy has been used to decrease the incidence of recurrent headaches at 24 to 72 hours following evaluation. This systematic review details the completed trials that have evaluated the use of dexamethasone in this role. The authors searched MEDLINE, EMBASE, CINAHL, LILACS, recent emergency medicine scientific abstracts, and several prepublication trial registries for potential investigations related to the research question. The authors included studies that incorporated randomized, double-blind, placebocontrolled methodology and that were performed in the ED. A fixed-effects and random-effects model was used to obtain summary risk ratios (RRs) and 95% confidence intervals (CIs) for the self-reported outcome of moderate or severe headache on follow-up evaluation. Results: A pooled analysis of seven trials involving 742 patients suggests a modest but significant benefit when dexamethasone is added to standard antimigraine therapy to reduce the rate of patients with moderate or severe headache on 24-to 72-hour follow-up evaluation (RR = 0.87, 95% CI = 0.80 to 0.95; absolute risk reduction = 9.7%). The treatment of 1,000 patients with acute migraine headache using dexamethasone in addition to standard antimigraine therapy would be expected to prevent 97 patients from experiencing the outcome of moderate or severe headache at 24 to 72 hours after ED evaluation. The sensitivity analysis yielded similar results with sequential trial elimination, indicating that no single trial was responsible for the overall result. Adverse effects related to the administration of a single dose of dexamethasone were infrequent, mild, and transient. Conclusions: These results suggest that dexamethasone is efficacious in preventing headache recurrence and safe when added to standard treatment for the management of acute migraine headache in the ED.

2025, Headache: The Journal of Head and Face Pain

Rizatriptan is a novel 5‐HT1B/1D agonist which is rapidly absorbed after oral administration. The efficacy and tolerability of oral rizatriptan (5 mg and 10 mg) were examined in this multicenter, double‐blind, outpatient study of 1473 migraineurs which featured randomized, placebo‐controlled treatment of migraine recurrences. On experiencing moderate or severe migraine headaches, patients rated headache severity prior to dosing and at 30‐minute intervals for 2 hours after dosing. Onset of effect was seen as early as 30 minutes after dosing with rizatriptan 10 mg. At 2 hours postdose, the percentage of patients with pain relief was significantly higher after rizatriptan 5 mg (62%) or 10 mg (71%) compared with placebo (35%). Complete relief was also significantly higher after rizatriptan 5 mg (33%) and 10 mg (42%) compared with placebo (10%). In patients experiencing headache recurrence after initial benefit, further relief was obtained in 71% with rizatriptan 5 mg (placebo 54%) and i...

2025, Journal of the Neurological Sciences

Two population-based studies have found an increased prevalence of posterior circulation territory (PCT) infarctlike lesions in migraine, which seemed to increase with attack frequency. Objective: To determine whether chronic migraine (CM) patients are at increased risk of PCT infarct-like lesions. Methods: We prospectively obtained brain MRIs from adult women fulfilling CM criteria. To keep radiologists blinded we also obtained brain MRIs in 15 episodic migraine (EM) patients. MRIs were acquired on a 1.5 T unit. Protocol included whole brain weighted images in sagittal T1 (5 mm slices), axial FLAIR T2 (3 mm) and combined proton density and T2 fast spin echo (3 mm). Two independent neuroradiologists carefully analyzed all the images. Results: One hundred women with CM participated. Their ages ranged from 18 to 68 years (mean 43.7) and the length of CM ranged from 0.5 to 38 years (mean 9.8). Sixty-three patients (63%) had at least one vascular risk factor. Thirty-three met analgesic overuse criteria. Fifty-one had a history of migraine with aura attacks, though aura frequency was below one per month in all patients except one. Eleven were not on preventatives. We found PCT infarct-like lesions in only 6 CM patients aged 42-64 years (mean age 54 years) who had at least two vascular risk factors. Conclusions: As frequency of PCT infarct-like lesions in our CM patients was in the low range than that found for EM in general population studies, we conclude that frequency of migraine attacks itself is not a factor increasing PCT infarct-like lesion risk.

2025, Headache: The Journal of Head and Face Pain

A 38-year-old woman reported a history of headache since aged 11 years, occurring about once a month. Triggers included stress and missing a meal, and she described a severe left or right hemicranial throbbing pain with associated nausea, vomiting, photophobia, and phonophobia, but no aura. Attacks lasted up to 3 days. An acetaminophen/aspirin/caffeine combination "dulled" the pain. For the last year, she had a second type of headache involving severe right or left retro-orbital pressure with ipsilateral tearing and nasal congestion. The headache would awaken her from sleep and occurred only around 3:30 AM. Headache duration was 60 to 90 minutes, and the frequency had decreased from daily to once a week over several weeks preceding her presentation. Questions.-How often do migraine and clustertype headache occur in the same individual? How often does unilateral migraine change sides, and how often is the headache side-locked? How often does cluster headache change sides within cluster periods, and how often does cluster headache change sides from one period to the next? What is the female to male ratio of cluster headache?

2025, European Journal of Neurology

Migraine is a common, disabling form of primary neurovascular headache. For most of the twentieth century it was regarded as a vascular headache whose primary pathophysiology lay in the cranial vasculature. Functional brain imaging using positron emission tomography has demonstrated activation of the rostral brain stem in acute migraine. Voxel‐based morphometry is a new fully automated whole brain technique that is sensitive to subtle macroscopic and mesoscopic structural differences between groups of subjects. In this study 11 patients suffering from migraine with aura (10 females, one male: 23–52 years, mean 31); 11 controls (10 females, one male: 23–52, mean 31); 17 patients with migraine without aura (16 females, one male: 24–57, mean 34); 17 controls (16 females, one male: 24–57, mean 34) were imaged with high resolution volumetric magnetic resonance imaging. There was no significant difference in global grey or white matter volumes between either patients with migraine and con...

2025, Journal of Medical Internet Research

Background: Self-reported medical history information is included in many studies. However, data on the validity of Web-based questionnaires assessing medical history are scarce. If proven to be valid, Web-based questionnaires may provide researchers with an efficient means to collect data on this parameter in large populations. The aim of this study was to assess the validity of a Web-based questionnaire on chronic medical conditions, allergies, and blood pressure readings against obstetric records and data from general practitioners. Methods: Self-reported questionnaire data were compared with obstetric records for 519 pregnant women participating in the Dutch PRegnancy and Infant DEvelopment (PRIDE) Study from July 2011 through November 2012. These women completed Web-based questionnaires around their first prenatal care visit and in gestational weeks 17 and 34. We calculated kappa statistics (κ) and the observed proportions of positive and negative agreement between the baseline questionnaire and obstetric records for chronic conditions and allergies. In case of inconsistencies between these 2 data sources, medical records from the woman's general practitioner were consulted as the reference standard. For systolic and diastolic blood pressure, intraclass correlation coefficients (ICCs) were calculated for multiple data points. Results: Agreement between the baseline questionnaire and the obstetric record was substantial (κ=.61) for any chronic condition and moderate for any allergy (κ=.51). For specific conditions, we found high observed proportions of negative agreement (range 0.88-1.00) and on average moderate observed proportions of positive agreement with a wide range (range 0.19-0.90). Using the reference standard, the sensitivity of the Web-based questionnaire for chronic conditions and allergies was comparable to or even better than the sensitivity of the obstetric records, in particular for migraine (0.90 vs 0.40, P=.02), asthma (0.86 vs 0.61, P=.04), inhalation allergies (0.92 vs 0.74, P=.003), hay fever (0.90 vs 0.64, P=.001), and allergies to animals (0.89 vs 0.53, P=.01). However, some overreporting of allergies was observed in the questionnaire and for some nonsomatic conditions sensitivity of both measurement instruments was low. The ICCs for blood pressure readings ranged between 0.72 and 0.92 with very small mean differences between the 2 methods of data collection.

2025, Current Pain and Headache Reports

Migraine headache occurs frequently in children and adolescents but is often not recognized. This underdiagnosis or misdiagnosis results in inappropriate and potentially ineffective treatments. A variety of factors may contribute to this deficiency, including limitations in the current standardized criteria, as well as patient, parent, and care providers' misassumption as to the etiology. The standardized criteria that have been developed to assist with the recognition and accurate diagnoses have recently been revised (the International Classification of Headache Disorders II). These criteria provide the scientific basis for the study of headache, including the determination of the incidence and prevalence of pediatric migraine.

2025, Pain

Air pollution is linked to increased emergency room visits for headache and migraine patients frequently cite chemicals or odors as headache triggers, but the association between air pollutants and headache is not well-understood. We previously reported that chronic environmental irritant exposure sensitizes the trigeminovascular system response to nasal administration of environmental irritants. Here, we examine whether chronic environmental irritant exposure induces migraine behavioral phenotypes. Male rats were exposed to acrolein, a TRPA1 agonist, or room air by inhalation for 4 days prior to meningeal blood flow measurements, periorbital cutaneous sensory testing or other behavioral testing. Touch-induced c-Fos expression in trigeminal nucleus caudalis was compared in animals exposed to room air or acrolein. Spontaneous behavior and olfactory discrimination was examined in open field testing. Acrolein inhalation exposure produced long-lasting potentiation of blood flow responses to a subsequent TRPA1 agonist and sensitized cutaneous responses to mechanical stimulation. C-Fos expression in response to touch was increased in trigeminal nucleus caudalis in animals exposed to acrolein compared to room air. Spontaneous activity in an open field and scent preference behavior were different in acrolein exposed compared to room-air exposed animals. Sumatriptan, an acute migraine treatment, blocked acute blood flow changes in response to TRPA1 or TRPV1 agonists. Pretreatment with valproic acid, a prophylactic migraine treatment, attenuated the enhanced blood flow responses observed after acrolein inhalation exposures. Environmental irritant exposure yields an animal model of chronic migraine in which to study mechanisms for enhanced headache susceptibility after chemical exposure.

2025, Pain

2025, Harm Reduction Journal

Background: Treatment resistant cluster headache and migraine patients are exploring alternative treatments online. The aim of this study was to improve comprehension regarding the use of non-established or alternative pharmacological treatments used by sufferers of cluster headaches and migraines. Methods: A qualitative thematic analysis of the users' own accounts presented in online forum discussions were conducted. The forum boards , , and met the inclusion criteria and were used for the study. Results: The analysis resulted in six themes: a desperate need for effective treatments; the role of the forum-finding alternative treatments and community support; alternative treatment substances; dosage and regimens; effects and treatment results; and adverse effects. The results provide an insight into why, how, and by which substances and methods sufferers seek relief from cluster headache and migraines. Conclusions: These patients are in a desperate and vulnerable situation, and illicit psychoactive substances are often considered a last resort. There appeared to be little or no interest in psychoactive effects per se as these were rather tolerated or avoided by using sub-psychoactive doses. Primarily, psilocybin, lysergic acid diethylamide, and related psychedelic tryptamines were reportedly effective for both prophylactic and acute treatment of cluster headache and migraines. Treatment results with cannabis were more unpredictable. No severe adverse events were reported, but it was observed how desperation sometimes spurred risky behavior when obtaining and testing various treatment alternatives. The forum discourse mainly revolved around maximizing treatment results and minimizing potential harms.

2025, British Journal of Pharmacology

Although botulinum toxin type A (BoNT/A) is approved for chronic migraine treatment, its mechanism of action is still unknown. Dural neurogenic inflammation (DNI) commonly used to investigate migraine pathophysiology can be evoked by trigeminal pain. Here, we investigated the reactivity of cranial dura to trigeminal pain and the mechanism of BoNT/A action on DNI. Because temporomandibular disorders are highly comorbid with migraine, we employed a rat model of inflammation induced by complete Freund's adjuvant, followed by treatment with BoNT/A injections or sumatriptan p.o. DNI was assessed by Evans blueplasma protein extravasation, cell histology and RIA for CGRP. BoNT/A enzymatic activity in dura was assessed by immunohistochemistry for cleaved synaptosomal-associated protein 25 (SNAP-25). BoNT/A and sumatriptan reduced the mechanical allodynia and DNI, evoked by complete Freund's adjuvant. BoNT/A prevented inflammatory cell infiltration and inhibited the increase of CGRP levels in dura. After peripheral application, BoNT/A-cleaved SNAP-25 colocalized with CGRP in intracranial dural nerve endings. Injection of the axonal transport blocker colchicine into the trigeminal ganglion prevented the formation of cleaved SNAP-25 in dura. Pericranially injected BoNT/A was taken up by local sensory nerve endings, axonally transported to the trigeminal ganglion and transcytosed to dural afferents. Colocalization of cleaved SNAP-25 and the migraine mediator CGRP in dura suggests that BoNT/A may prevent DNI by suppressing transmission by CGRP. This might explain the effects of BoNT/A in temporomandibular joint inflammation and in migraine and some other headaches.

2025, Journal of Internal Medicine

. New roles for an old enzyme: Na,K-AT-Pase emerges as an interesting drug target (Review Article).

2025, Cephalalgia

We investigated 341 children and adolescents to evaluate the relevance of psychosocial factors in idiopathic headache. According to the criteria of the International Headache Society, 151 subjects had migraine and 94 had tension-type headache (TTH). Ninety-six subjects were headache-free controls. Psychosocial factors covered family and housing conditions, school problems, relations in the peer group, and several other items. We found that migraine patients did not differ from headache-free controls. Patients with TTH more often had divorced parents than the headache-free controls, and they had fewer peer relations than migraineurs and controls. In addition, migraine patients were significantly more often absent from school due to headache. All other psychosocial factors failed to discriminate between the three study groups. In conclusion, this controlled study in children and adolescents suggests that migraine is not related to family and housing conditions, school situation, or pe...

2025, CNS Drugs

adverse event (AE) rates associated with six oral serotonin 5-HT1B/1D receptor agonists (triptans) used for the treatment of acute migraine, employing data from a previous meta-analysis (that included almotriptan, eletriptan, naratriptan, rizatriptan, sumatriptan and zolmitriptan, but not frovatriptan) in order to provide a rationale for the use of the rate of patients who are SPF plus no AE (SNAE) as an endpoint in trials of medications for acute migraine. Background: The attributes of drug treatment for acute migraine that are most important to people who experience them are complete pain relief, lack of recurrence, rapid onset and lack of AEs. The endpoints used to assess therapy for acute migraine do not always address these elements. Methods: The relationship between SPF and AE rates was explored using nonparametric regression techniques, and the box-plot method was used to identify outliers. The estimated SNAE rate for each triptan was calculated with and without assuming independence between efficacy and tolerability. Results: At the level of the individual agent, there was a significant relationship between the efficacy and tolerability of each triptan, with the exception of almotriptan 12.5mg, which had an AE rate approximately 30% lower than would be expected, and eletriptan 20mg, which had an AE rate approximately 20% higher than would be expected, on the basis of their efficacy. Almotriptan 12.5mg and eletriptan 20mg had the highest and lowest base-case values for SNAE, respectively, and both qualified statistically as outliers to the distribution of SNAE values obtained with the other triptans. The probability that each triptan was superior to the reference agent (sumatriptan 100mg) in terms of SNAE was calculated across all possible values (at the level of the individual patient) for the relationship between efficacy and tolerability. Again, almotriptan 12.5mg and eletriptan 20mg had the highest and lowest values for their SNAE rates, respectively, and almotriptan 12.5mg qualified statistically as an outlier from the distribution of the probabilities obtained for the other triptans.

2025, Journal of Headache and Pain

Headache is a frequent feature of functional gastrointestinal disorders but there is no data on the responsible pathophysiological mechanism. The aim of this study was to verify whether alteration of post-prandial gastric tone or sensitivity might explain this association. Fourteen patients affected by functional dyspepsia (7 migraine without aura) and 7 healthy volunteers (HV) underwent gastric tone measurement in fasting condition and after the administration of a liquid meal by barostat. Gastric volume (GV) and accommodation were calculated as difference between mean post-prandial and mean fasting volume. Mean postprandial GV increase and fasting perception and discomfort threshold (DTh) were similar among the 3 groups. DTh after meal was lower in dyspeptic headache patients than in HV and dyspeptic without headache patients. Patients with migraine and functional dyspepsia may be characterised by mealinduced hypersensitivity of the stomach.

2025, Neurology

To compare the efficacy of oral eletriptan, 40 mg and 80 mg, and oral sumatriptan, 50 mg and 100 mg, in the acute treatment of migraine. Methods: Patients with a history of migraine (n ϭ 1,008) were randomly assigned to receive placebo, 40 mg of eletriptan, 80 mg of eletriptan, 50 mg of sumatriptan, or 100 mg of sumatriptan to treat up to three attacks. Early headache response (at 1 hour) was the primary endpoint, in addition to the standard endpoint, 2-hour headache response. Results: Headache response rates were 12% at 1 hour and 31% at 2 hours for placebo; 24% at 1 hour and 50% at 2 hours for sumatriptan 50 mg; 27% at 1 hour and 53% at 2 hours for sumatriptan 100 mg; 30% at 1 hour and 64% at 2 hours for eletriptan 40 mg; and 37% at 1 hour and 67% at 2 hours for eletriptan 80 mg. More patients receiving eletriptan 80 mg achieved a 1-hour headache response than did patients receiving sumatriptan 50 mg (p Ͻ 0.05). All doses of eletriptan were superior to sumatriptan at 2 hours for headache response and complete pain relief (p Ͻ 0.05). Significantly more patients on eletriptan 80 mg achieved headache response in all attacks than did patients receiving either sumatriptan dose. Eletriptan 40 mg was superior to both sumatriptan doses in functional improvement (p Ͻ 0.005). The superior efficacy of both eletriptan doses was associated with higher rates of patient acceptability than sumatriptan 50 mg (p Ͻ 0.05). Eletriptan and sumatriptan were well tolerated. Conclusion: Oral eletriptan (40 mg and 80 mg) is effective, safe, and tolerable in the acute treatment of migraine and yields a consistent response.

2025, Cephalalgia

According to International Headache Society classification criteria, the presence of pericranial muscle disorder in tension-type headache should be evaluated using one of the following methods: EMG, pressure algometry or manual palpation. The purpose of this study was to compare the results of these three methods in 15 patients with episodic tension-type headache, 29 with chronic tension-type headache and 22 presenting migraine without aura compared to those obtained in healthy individuals. Algometric and EMG recordings at the frontalis muscle during mental arithmetic were more impaired in episodic and chronic tension headache patients than in controls and migraine patients. Chronic tension headache patients were significantly impaired at the trapezius muscle in all three tests compared to controls. Our data indicate that when two or three tests were carried out the diagnostic capacity was significantly improved in comparison to only one test. Moreover, since a different pattern could be seen with pain and without pain, the existence of headache at the time of testing should be taken into consideration. • EMG, manual palpation, migraine, pressure pain threshold, tension-type headache

2025, Neurology

2025, Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia

We report a 49-year-old female migraineur who experienced paradoxical hyperphagia and concurrent intrusive food thoughts leading to rapid weight gain and a substantial increase in waist circumference. A significant reduction in migraine frequency was also observed during topiramate treatment, a widely used migraine prophylactic agent which is generally associated with weight loss. Withdrawal of topiramate saw appetite return to baseline levels, however, migraine frequency was again increased. Topiramate was reinitiated in combination with phentermine, a drug indicated for weight management, without reoccurrence of adverse effects. Migraine control was maintained and progressive weight loss ensued. Combination treatment with phentermine may be a useful strategy should other patients experience this adverse reaction while gaining therapeutic anti-migraine benefit from topiramate.

2025, The journal of headache and pain

Calcitonin gene-related peptide (CGRP) and nitric oxide (NO) are regarded as key mediators in migraine and other primary headaches. Migraineurs respond to infusion of nitroglycerin with delayed headaches, and inhibition of CGRP receptors has been shown to be effective in migraine therapy. In animal experiments nitrovasodilators like nitroglycerin induced increases in spinal trigeminal activity, which were reversed after inhibition of CGRP receptors. In the present study we asked if CGRP receptor inhibition can also prevent spinal trigeminal activity induced by nitroglycerin. In isoflurane anaesthetised rats extracellular recordings were made from neurons in the spinal trigeminal nucleus with meningeal afferent input. The non-peptide CGRP receptor inhibitor MK-8825 (5 mg/kg) dissolved in acidic saline (pH 3.3) was slowly infused into rats one hour prior to prolonged glyceryl trinitrate (nitroglycerin) infusion (250 μg/kg/h for two hours). After infusion of MK-8825 the activity of spi...

2025, Neuroscience

Neurogenic inflammation of the dura, expressed in plasma extravasation and vasodilatation, putatively contributes to different types of headache. A novel in vitro preparation of the fluid-filled skull cavities was developed to measure mediator release from dura mater encephali upon antidromic electrical stimulation of the trigeminal ganglion and after application of a mixture of inflammatory mediators (serotonin, histamine and bradykinin, 10 5 M each, pH 6.1) to the arachnoid side of rat dura. The release of calcitonin gene-related peptide, substance P and prostaglandin E 2 from dura mater was measured in 5-min samples of superfusates using enzyme immunoassays. Orthodromic chemical and antidromic electrical stimulation of dural afferents caused significant release of calcitonin gene-related peptide (2.8and 4.5-fold of baseline). The neuropeptide was found to be increased during the 5-min stimulation period and returned to baseline (20.9 12 pg/ml) in the sampling period after stimulation. In contrast, release of substance P remained at baseline levels (19.3 11 pg/ml) throughout the experiment. Prostaglandin E 2 release was elevated during chemical and significantly also after antidromic electrial stimulation (6-and 4.2-fold of baseline, which was 305 250 pg/ml). Prostaglandin E 2 release outlasted the stimulation period for at least another 5 min. The data support the hypothesis of neurogenic inflammation being involved in headaches and provide new evidence for prostaglandin E 2 possibly facilitating meningeal nociceptor excitation and, hence, pain.

2025, BioMed Research International

2025, Psychiatry Research-neuroimaging

Neuropsychological tests have demonstrated a frontal lobe dysfunction in several psychiatric and neurological disorders. Our purpose was to examine whether similar functional differences would be found in patients with chronic migraine. The Gambling Task (GT), the Tower of Hanoi-3 (TOH-3) and the Object Alternation Test (OAT) were administered to 23 female patients previously treated for chronic migraine and to 23 healthy women who were similar to the patients in age and educational level, and the mean test scores of the two groups were compared (Student's t and Pearson correlation coefficient). The patient group scored significantly higher than the controls on the TOH-3 and, especially, the OAT. In the patients, no significant relationship was found between the neuropsychological test scores and those for the Minnesota Multiple Personality Inventory (MMPI), the Spielberg State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI). In conclusion, the data suggest a relation between chronic headache and dorsolateral function (as tested by the TOH-3) and orbitofrontal function (as tested by the OAT). The decision-making function related to ventromedial prefrontal cortex (tested by the GT) did not show a statistically significant difference between patients and controls. These neuropsychological findings seem to be partly independent of the patient's psychological traits and psychiatric disorders.

2025

Objective: Our objective was to assess the prevalence of accompanying symptoms of migraine and tension-type headache in patients with such conditions (both episodic and chronic) and in headache-free controls, and their relationship with depression and anxiety. Method: A psychological assessment (Axis I, DSM-IV) was performed, and 21 accompanying symptoms were investigated in 506 patients with episodic migraine (231), chronic migraine (102), episodic tension-type headache (83), and chronic tension-type headache (90) and in 80 controls. The relationship between symptoms, headache type, and psychiatric comorbidity was analyzed. Results: The mean number of symptoms was significantly higher in patients (n=10.3) than in controls (n=3.4). Most symptoms were significantly associated with depression and anxiety, while only some of them were significantly associated with headache, with no relevant difference among groups. Conclusion: In headache patients, psychiatric comorbidity (compared with headache type or chronicity) seems to be more strictly associated with an increased burden of accompanying symptoms.

2025, Epilepsia

Summary High prevalence of headache has been reported in patients with refractory epilepsy in cross‐sectional surveys based on retrospective recall. We conducted a prospective study to document the incidence of headache over a 3‐month observation period in a cohort of 227 adult patients with less refractory epilepsy. The mean seizure frequency was 2.46 per month. Fifty (22%) patients reported to have had at least one headache episode, 45 (19.8%) had interictal headache, 11 (4.8%) had periictal headache, and 5 (2.2%) had both interictal and periictal headache. Forty‐nine percent of the patients with headache took over‐the‐counter analgesics as acute treatment. The headache was rated to have made very severe or substantial impact on their lives by 34% of patients. A formal headache diagnosis was not made in any of the patients prior to the survey. Although the incidence of headache in epilepsy patients appeared to be low, it was underdiagnosed and associated with substantial negative ...

2025

Background: Migraine affects approximately 15% of the global population, resulting in significant disability and decreased quality of life. Traditional pharmacological treatments, while effective, often overlook the psychosocial dimensions of the disorder. This systematic review evaluates the effectiveness of psychiatric rehabilitation techniques, specifically cognitive-behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR), in migraine prophylaxis. Methods: A comprehensive literature search was conducted across electronic databases, including PubMed and Cochrane Library, from January 2000 to January 2025. Studies included were randomized controlled trials, cohort studies, and case-control studies focusing on adults diagnosed with migraines undergoing CBT or MBSR, with outcomes measuring migraine frequency and severity, as well as psychological symptoms. Results: A total of 15 studies (1,200 participants) were included. CBT demonstrated a significant effect size (Cohen's d = 0.65) in reducing migraine frequency and improving quality of life, alongside benefits in co-morbid psychological symptoms. MBSR also achieved a moderate effect size (Cohen's d = 0.52) for decreasing migraine frequency and enhancing emotional regulation. Multimodal approaches combining CBT with physical therapy showed additional benefits in migraine management. Conclusions: This review supports the integration of psychiatric rehabilitation techniques into comprehensive migraine management plans, acknowledging their role in improving both headache-related and psychological outcomes. More high-quality, multicenter randomized trials are needed to validate these findings and enhance treatment protocols for migraine sufferers.

2025, The journal of headache and pain

Most women with migraine improve during pregnancy. Some women have their first attack. Migraine often recurs postpartum and can begin for the first time. Drugs are commonly used during pregnancy despite insufficient knowledge about their effects on the growing fetus. Most drugs are not teratogenic. Adverse effects, such as spontaneous abortion, developmental defects and various postnatal effects depend on the dose and route of administration and the timing of the exposure relative to the period of foetal development. While medication use should be limited, it is not absolutely contraindicated in pregnancy. Nonpharmacologic treatment is the ideal solution; however, analgesics such as acetaminophen and opioids can be used on a limited basis. Preventive therapy is a last resort.

2025, Toxicon

The purpose of this study was to test whether the efficacy of prophylactic treatment with botulinum toxin A (BTX-A) on migraine frequency is related to the individual perception of the pain and its directionality, namely, exploding, imploding, or ocular migraine headache. Episodic and chronic migraine patients (n=82) previously treated with BTX-A were interviewed to characterize their migraine headache and its directionality. The magnitude of their response to treatment was analyzed vis-à-vis their individual type of headache. Patients showing a >67% drop in number of migraine days/month were classified as responders; those showing a drop smaller than 33% were labeled nonresponders; patients showing a drop between 34% to 66% were considered questionable responders. After BTX-A treatment, the number of migraine days/month dropped 85.2±1.6% (from 20.1±1.5 to 2.8±0.4; p<0.0001) in 37 responders, 52.4±2.4% (from 16.3±3.5 to 7.2±1.5; p=0.003) in 11 questionable responders, and remained unchanged (21.2±1.8 vs. 21.1±1.7; p>0.78) in 34 nonresponders. The frequency of headache types differed significantly (p<0.0001) across the 3 response sub-groups. Among non-responders, 83% described a buildup of pressure inside their head (exploding headache). Among responders and questionable responders, 84 and 64%, respectively, perceived their head to be crushed, clamped or stubbed by external forces (imploding headache) or an eye-popping pain (ocular headache). The prevalence of exploding, imploding, and ocular headache was similar between episodic and chronic migraine patients. Imploding/ocular migraine headache is more likely than exploding headache to be prevented by prophylactic BTX-A treatment. Further validation of this principle should await large-scale prospective, placebo-controlled studies.

2025, Neurology

Editors' Note: After review by the Editors and further clarification by the authors, it was determined that Cynthia Toso played a role in drafting the original Silberstein et al. manuscript. Ms. Toso was included in the Acknowledgment but should have been included in the byline as a coauthor. Neurology ® 's policy, effective December 15, 2006, states: "Manuscripts submitted for publication must list all authors, including the person who drafted the original manuscript. This includes paid or unpaid medical writers ('ghost writers')." A Correction noting the error is included in this issue.

2025, Headache: The Journal of Head and Face Pain

Objective.—To describe the patterns of medical treatment for migraineurs in the United States.Background.—Over the past decade, many new treatments for migraine have become available and awareness of migraine has improved. However, there is little information about the patterns of medical treatment in the US society.Design/Methods.—A validated self‐administered headache questionnaire was mailed to a random sample of 120,000 US households. Each household member with severe headaches was asked to complete the survey. The questionnaire assessed headache features, disability, and patterns of medical treatment. Subjects were classified according to their use of headache preventive medication, as current users, coincident users (using effective medications for other medical reasons), lapsed users (had used in the past but not at the time of the survey), or never users.Results.—In 162,576 participants, the prevalence of migraine was 17.1% in women and 5.6% in men. Only 56.2% of those with ...

2025, Headache: The Journal of Head and Face Pain

Hemicrania continua (HC) is an idiopathic, chronic disorder characterized by a continuous, strictly unilateral headache associated with ipsilateral cranial autonomic symptoms. The symptoms of HC typically respond dramatically to indomethacin therapy. We describe a patient with traumatic internal carotid artery dissection, who presented with a clinical picture mimicking HC that initially responded to indomethacin. Patients with a clinical picture similar to HC should be managed with a high index of suspicion for a possible cervical arterial dissection.

2025, Headache: The Journal of Head and Face Pain

Migraine is a common, chronic, incapacitating, neurovascular disorder that affects an estimated 12% of the population. Understanding the basic mechanisms of pain is important when treating patients with chronic pain disorders.Pain, an unpleasant sensory and emotional experience, is usually triggered by stimulation of peripheral nerves and often associated with actual or potential tissue damage. Peripheral nerve fibers transmit pain signals from the periphery toward the spinal cord or brain stem. The different diameter pain fibers (A and C) vary in the speed of conduction and the type of pain transmitted (eg, sharp versus dull). When stimulated, peripheral pain fibers carrying sensory input from the body enter at different layers of the dorsal horn, which is then propagated toward the thalamus via the spinothalamic tract within the spinal cord. Conversely, sensory input from the face does not enter the spinal cord but enters the brain stem via the trigeminal nerve.This review describ...

2025, Headache: The Journal of Head and Face Pain

Objective.— To examine frovatriptan's efficacy as preemptive treatment for fasting‐induced migraine.Background.— Fasting is a common migraine trigger that cannot always be avoided. The development of a short‐term preemptive approach would be of benefit. Because of its longer half‐life, frovatriptan has been effectively used for short‐term daily use to prevent menstrually related migraines and might prove useful in the prevention of fasting‐induced migraine.Methods.— This was a double‐blind, placebo‐controlled, randomized, parallel‐group trial.Subjects.— With a history of fasting‐induced episodic migraine were randomly assigned to receive either frovatriptan (5.0 mg) or placebo (ratio 1:1).Subjects.— Took a single dose of study medication at the start of their 20‐hour fast. Information about headache intensity, associated symptoms, and use of rescue medication was captured at defined time points from the start of the fast through 20 hours post‐fast.Results.— Of the 75 subjects sc...

2025, Cephalalgia

Using quantitative sensory testing (QST), we found that many migraineurs seeking secondary and tertiary care exhibit cutaneous allodynia whenever they undergo a migraine attack, but not interictally (i.e. between attacks). When such patients were questionned interictally in the clinic about symptoms of skin sensitivity in past attacks, 76% of them were 'correctly' classified either as allodynic (≥1 symptom) or non-allodynic (zero symptoms) in line with the QST analysis. In this study, patients were classified as allodynic if they documented any one symptom of allodynia during an actual migraine attack which they had already cited in an earlier interictal interview. Of a total of 151 patients, 77% were classified as allodynic, citing on average four symptoms of skin hypersensitivity, three of which were consistently cited in the interictal interview and again during an attack. Among the remaining 23% of patients who were classified as non-allodynic, half cited zero symptoms a...