Cephalalgia最新文献

{"title":"Transcultural headache medicine: A framework for integrating cultural contexts into headache science and care - a call to action from the International Headache Society.","authors":"Mario F P Peres, Giancarlo Lucchetti, Homero Vallada, Ivy L Riso, Georgia K Westenhofen, Marcelo Moraes Valença, Juliana Ramos de Andrade, K C Brennan, Morris Levin, Tsubasa Takizawa, Zhao Dong, Yonggang Wang, Wanakorn Rattanawong, Henry Riyanto Sofyan, Massimo Leone, Freda Dodd-Glover, Hsiangkuo Yuan, Abdulrazaq Albilali, Taoufik Alsaadi, Leonardo Caixeta, Anna P Andreou, Peter J Goadsby, Antoinette MaassenVanDenBrink, Sait Ashina, Rami Burstein, Patricia Pozo-Rosich, Fayyaz Ahmed, Shuu-Jiun Wang","doi":"10.1177/03331024261432929","DOIUrl":"https://doi.org/10.1177/03331024261432929","url":null,"abstract":"<p><p>Headache disorders are among the most disabling neurological conditions, affecting over 1.5 billion people globally. Despite advances in pharmacological therapies, major inequities persist due to underdiagnosis, undertreatment and limited access to effective care, particularly in low- and middle-income countries. Social determinants of health, including cultural meanings, language and health beliefs, are increasingly recognized as key drivers of disparities in burden, diagnosis and treatment outcomes. Traditional medicine, used by more than 80% of the global population, remains first-line care in many regions and continues to influence therapeutic choices in high-income settings. Major systems such as Ayurveda, Traditional Chinese Medicine, Unani and Tibetan medicine, as well as diverse indigenous traditions, emphasize holistic approaches that integrate mental and physical symptoms into diagnosis and management. Additionally, religious and spiritual practices are commonly used to relieve suffering and pain. These culturally grounded explanatory models not only strongly shape health-seeking behavior, treatment adherence and patient narratives, but also may delay biomedical care when misconceptions or unsafe practices predominate. This paper introduces Transcultural Headache Medicine as an emerging framework that integrates cultural contexts, linguistic diversity and traditional practices into headache research, clinical care and policy. We review global traditions and therapeutic modalities including herbal, physical, mental and spiritual approaches, and propose a research agenda combining ethnography, culturally adapted diagnostic tools, experimental studies and clinical trials to evaluate benefits, risks, and contextual effects. We conclude with a call to action from the International Headache Society, aiming to map and evaluate culturally embedded practices, strengthen rigorous evidence and build a global learning network that supports culturally safe integration of effective, affordable and safe headache care.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 4","pages":"3331024261432929"},"PeriodicalIF":4.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147580662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-specific orchestration of morphometric similarity networks in children and adolescents with migraine.","authors":"Laura Papetti, Alessia Guarnera, Daniela Longo, Antonio Napolitano, Giulia Baldassari, Greta Pirani, Giorgia Sforza, Gabriele Monte, Fabiana Ursitti, Francesco Dellepiane, Maria Vaccaro, Alessia Carboni, Maria Camilla Rossi-Espagnet, Giulia Moltoni, Carlo Gandolfo, Massimiliano Valeriani","doi":"10.1177/03331024261416494","DOIUrl":"https://doi.org/10.1177/03331024261416494","url":null,"abstract":"<p><p>BackgroundMigraine accounts for most primary headaches in children and adolescents and is related to cortical and connectivity changes. However, the underlying mechanisms remain unclear. Morphometric similarity mapping has not yet been applied to children and adolescents with migraine.MethodsEighty-three patients (6-17 years) with migraine without aura and 81 age- and sex-matched controls were retrospectively included. High-resolution 3D T1-weighted and diffusion-weighted magnetic resonance imaging scans were processed to extract cortical morphometric parameters and compute morphometric similarity networks (MSN). Global and regional MSN differences were assessed between patients and controls, and across subgroups defined by sex, attack frequency and migraine-associated symptoms.ResultsPatients showed significant MSN alterations, particularly in temporal and cingulate regions. Sex emerged as the strongest factor influencing MSN architecture, with additional modulations linked to attack frequency and clinical symptoms. Affected pathways encompassed the executive control, nociceptive and default mode networks.ConclusionsMigraine in children and adolescents is associated with widespread MSN abnormalities, likely reflecting cortical reorganization mechanisms. Male and female patients appear to engage distinct neural \"orchestras\", each emphasizing different network sections (sensory-affective in males and cognitive-attentive in females) to produce a shared clinical experience. These findings highlight sex as a key determinant of migraine neurobiology in developmental age.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 4","pages":"3331024261416494"},"PeriodicalIF":4.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147622047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visually-induced hemodynamic response and white matter hyperintensities in middle-aged women with ischemic stroke or migraine with aura.","authors":"Nelleke van der Weerd, Mariam Ali, Thijs W van Harten, Ay-Min Ma, Ghislaine Holswilder, Annelise E Wilms, Erik W van Zwet, Mark C Kruit, Arn M J M van den Maagdenberg, Gisela M Terwindt, Matthias J P van Osch, Hendrikus J A van Os, Marieke J H Wermer","doi":"10.1177/03331024261439256","DOIUrl":"https://doi.org/10.1177/03331024261439256","url":null,"abstract":"<p><p>BackgroundMigraine, especially with aura (MA), increases the risk of brain white matter hyperintensities (WMH) and ischemic stroke. Altered microvascular function has been proposed as a shared underlying mechanism, potentially involving endothelial dysfunction. Visually-induced hemodynamic response describes the process by which cerebral blood flow is locally increased to meet the metabolic demands of neuronal activity and may serve as a surrogate measure of cerebral endothelial function. We investigated the relationship between visually-induced hemodynamic responseand WMH volume in middle-aged women with ischemic stroke or MA.MethodsWe cross-sectionally measured hemodynamic response using blood-oxygen-level-dependent (BOLD) fMRI upon visual stimulation on 7T-MRI, and WMH volume on 3T-MRI, in three groups of women aged 40-60 with: (I)ischemic stroke, (II)MA, and (III)no history of stroke or migraine. We assessed the associations between BOLD parameters in the posterior circulation (amplitude, time-to-peak [TTP], and time-to-baseline [TTB]) and WMH volume using multivariable linear regression within each group.ResultsWe included 87 women (mean age 51 years): (I)25 with ischemic stroke, (II)25 with MA, and (III)37 without stroke or migraine. Visually-induced hemodynamic response was similar across groups and not associated with WMH volume overall. However, lower amplitude was associated with higher deep WMH volume in those without stroke or migraine (adjusted-β= -0.28;95%CI = -0.53 to -0.02 mL), shorter TTB with greater periventricular WMH volume in women with MA (adjusted-β= -0.12;95%CI = -0.21 to -0.02 mL), and longer TTP with increased periventricular WMH volume in women with stroke (adjusted-β=0.22;95%CI = 0.06 to 0.40 mL).ConclusionsNo overall association was observed between visually-induced hemodynamic response and WMH volume. Exploratory findings suggest potential differences in hemodynamic response in the posterior circulation across groups, which require replication in larger datasets and confirmation in longitudinal studies to clarify their temporal or mechanistic relevance to WMH development.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 4","pages":"3331024261439256"},"PeriodicalIF":4.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and outcomes of pharmacological treatments for headaches after traumatic brain injury: A systematic review.","authors":"Shirin Saleh, Elizabeth M Sanford, Donald D McGeary, Melissa M Cortez, Matt Hayward, Erin D Bouldin, Jacob Kean, Mary Jo V Pugh","doi":"10.1177/03331024261441563","DOIUrl":"https://doi.org/10.1177/03331024261441563","url":null,"abstract":"<p><p>BackgroundHeadache following traumatic brain injury (TBI) is a common, yet disabling, disorder with diverse mechanisms and treatment needs that remain poorly defined. Pharmacological regimens are the primary source of remedies for individuals with post-traumatic headaches (PTH). The main objective of this review is to describe the efficacy of pharmacological medications for the treatment of PTH with a specific focus on the effect of these medications on headache characteristics and headache-related quality of life (QoL).MethodsThis systematic review (CRD42024537719) followed PRISMA and SWiM guidelines. PubMed, CINAHL, Scopus, PsycINFO and the Cochrane Library were searched in April 2024 for peer-reviewed articles published in English between 2009 and 2024. Eligible studies included randomized controlled trials, controlled cohort studies, and systematic reviews or meta-analyses evaluating pharmacological treatments for PTH in adults. Studies were excluded if they did not assess outcomes related to PTH pain, only included pediatric populations, used animal models, investigated only non-pharmacological interventions, were case reports, narrative reviews, editorials or conference abstracts, or did not involve human participants with TBI-related headache. Risk of bias was assessed using RoB-2 for Randomized controlled trials (RCTs) and ROBINS-I for the non-randomized studies of the effects of interventions.ResultsSixteen studies were included in the final review, comprising retrospective observational (<i>n</i> = 7), non-randomized prospective (<i>n</i> = 4) and randomized controlled trials (<i>n</i> = 5). Most studies reported some improvements in headache frequency and intensity following pharmacological treatment, although findings for headache-related QoL were inconsistent. Erenumab showed potential benefits for persistent PTH in small, uncontrolled studies of civilian samples. However, findings on its impact on headache-related QoL should be interpreted with caution, given the high discontinuation rate observed. Prazosin demonstrated similar benefits in military populations, with minimal side effects. In the acute care setting, metoclopramide, co-administered with diphenhydramine to minimize side effects, was associated with short-term relief of headache symptoms. Of the RCTs, only two had a low risk of bias, of which only one specifically focused on PTH.ConclusionsPharmacological treatments for PTH may provide improvements in headache frequency and intensity; however, evidence for their efficacy is limited and inconsistent. Given the limited high-quality evidence overall, no specific clinical recommendations can be made at this time. Future research should prioritize rigorous, controlled studies, particularly comparative effectiveness trials, and explore holistic, personalized approaches that incorporate treatment of psychiatric comorbidities and consider patient context.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 4","pages":"3331024261441563"},"PeriodicalIF":4.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147715806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward quantifying disability in spontaneous intracranial hypotension: A patient-derived disability weight.","authors":"Florian Volz, Mazin Omer, Manou Overstijns, Amir El Rahal, Marc Hohenhaus, Jan-Helge Klingler, Niklas Lützen, Horst Urbach, Charlotte Zander, Ian Carroll, Jürgen Beck, Katharina Wolf","doi":"10.1177/03331024261444662","DOIUrl":"https://doi.org/10.1177/03331024261444662","url":null,"abstract":"<p><p>IntroductionSpontaneous intracranial hypotension (SIH) due to a spinal CSF leak is associated with substantial health loss. However, SIH is not represented as a distinct condition in the Global Burden of Disease framework, and no disease specific disability weight has been reported. A disability weight is the fundamental basis for comparative analyses of disease burden. The objective of this study was to estimate a patient-derived disability weight for SIH based on pre-treatment health-related quality of life data and to contextualize this estimate relative to published values for other conditions.MethodsWe conducted a retrospective observational study of consecutive patients with confirmed spinal CSF leaks treated at a tertiary referral center between October 2020 and October 2025. Pre-treatment quality of life and headache burden were assessed using the EQ-5D-5L and HIT-6 questionnaires. After calculating the EQ-Index using the German value set, the mean disability weight and its 95% confidence interval were derived using a linear transformation. For contextual interpretation, the newly estimated disability weight was compared descriptively with published values for deliberately selected neurological, headache- or pain-related, and chronic conditions.ResultsA total of 321 patients with confirmed spinal CSF leaks before targeted treatment were included (60.4% female; median age 47 years [IQR 37-56.). Most patients had a ventral leak (192/321, 60%), followed by CSF-venous fistulas (67/321, 21%) and lateral leaks (62/321, 19%). The mean EQ-Index was 0.568 (95% CI 0.533-0.603), the median EQ-VAS was 45.5 (IQR 30-65). The median HIT-6 score was 65 (IQR 59-68). All scores showed no significant differences between the three leak types. Based on EQ-5D-5L data, the resulting mean disability weight for SIH was 0.432 (95% CI 0.40-0.47).ConclusionThis study provides a first patient-derived disability weight estimate of 0.432 for ongoing SIH. This indicates a substantial non-fatal health loss that is comparable to or exceeding that of other chronic conditions. This estimate enables contextual comparison with other conditions and provides a foundation for future burden-of-disease assessments of this curable condition.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 4","pages":"3331024261444662"},"PeriodicalIF":4.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic variability within molecular core clock genes in cluster headache.","authors":"Clémence Deborgies Sanches, Stefan Spulber, Felicia Jennysdotter Olofsgård, Carmen Fourier, Anna Sundholm, Maria Lantz, Christina Sjöstrand, Elisabet Waldenlind, Anna Steinberg, Henry Houlden, Manjit Matharu, Caroline Ran, Andrea Carmine Belin","doi":"10.1177/03331024261440136","DOIUrl":"https://doi.org/10.1177/03331024261440136","url":null,"abstract":"<p><p>Background / HypothesisHeadache attacks are reported to occur with circadian rhythmicity by 2/3 of individuals with cluster headache, hinting to potential dysfunctions of the molecular clock. The aim of this study was to investigate the contribution of genetic markers in core clock genes, alone or in combinations, to the genetic risk for cluster headache.MethodsSeven markers in core clock genes <i>BMAL1</i> and <i>NPAS2</i> were genotyped using TaqMan qPCR in 707 individuals with cluster headache and 682 controls. Genetic data from eleven additional markers located in six other core clock genes (<i>CLOCK</i>, <i>CRY1-2</i>, and <i>PER1-3</i>) was obtained from the database of the Centre for Cluster Headache at Karolinska Institutet. Genotype analysis was applied for risk analysis for combinations of up to three markers. For validation we used a cluster headache cohort from the National Hospital for Neurology and Neurosurgery, London, UK.Results and interpretationSingle marker analysis of the newly genotyped markers in <i>BMAL1</i> and <i>NPAS2</i> found rs3789327 and rs3768984 more frequently among individuals with cluster headache (p < 0.01 and p < 0.05 respectively). Multiallelic analysis revealed that the median number of risk alleles was eight for controls and nine for individuals with cluster headache, which justifies the analysis of combinations of markers. The analysis of combinations of up to three markers identified 258 out of 897 combinations to be associated with significant risk. Further investigation starting from the function of genes in the molecular clock transcription-translation feedback loop (TTFL) found that 80% of the combinations had >50% markers located in the positive arm of the TTFL. The comparison between Swedish and UK cohorts identified 39 concordant combinations, which confirmed the risk associated with rs3768984 (<i>NPAS2</i>), as well as the enrichment in markers in <i>BMAL1</i>, <i>CLOCK</i>, and <i>NPAS2</i> in combinations associated with significant risk.ConclusionOur data points to molecular clock dysfunction playing a central role in the manifestation of cluster headache.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 4","pages":"3331024261440136"},"PeriodicalIF":4.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147670937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety, tolerability, and efficacy of atogepant added to onabotulinumtoxinA for the preventive treatment of chronic migraine: A phase 3, multicenter, 24-week, open-label study.","authors":"John Rothrock, Umer Najib, Jessica Ailani, Sait Ashina, Jia Bao, Jonathan H Smith, Aubrey M Adams, Brett Dabruzzo, Kimberly Pfleeger, Andrew Blumenfeld","doi":"10.1177/03331024261429118","DOIUrl":"https://doi.org/10.1177/03331024261429118","url":null,"abstract":"<p><p>BackgroundTreatment with onabotulinumtoxinA is effective in reducing migraine day frequency and duration in individuals with chronic migraine (CM), but given the severity of the disease, those with CM often need additional treatment to achieve optimal outcomes. Combining preventive treatments with distinctly different physiological targets may yield greater benefit than monotherapy. This study evaluated the safety, tolerability, and efficacy of adding atogepant to onabotulinumtoxinA for preventive treatment of CM.MethodsIn this 24-week, Phase 3, open-label, single arm, multicenter study (NCT05216263), 75 participants on a stable dose of onabotulinumtoxinA (155-200U) with baseline mean monthly migraine days (MMDs) of 8-23 (inclusive) received add-on atogepant 60 mg once daily. Primary safety endpoints included treatment-emergent adverse events (TEAEs), and exploratory efficacy endpoints included changes in MMDs, changes in mean monthly headache days (MHDs) and responder rates (RRs) (≥50%, ≥75%, and 100% MMDs) over Weeks 1-12, Weeks 13-24, and at each 4-week interval.ResultsThe mean age of study participants was 48 (13.68) years (mean (SD)); 89% were women, and 97% were white. Participants had an established CM diagnosis for 15 (13.27) years (mean (SD)) and had been treated with onabotulinumtoxinA for 4 (3.45) years (mean (SD)). In the safety population (n = 75), the incidence of TEAEs was 65.3%. TEAEs occurring in ≥5% of participants were constipation (n = 12, 16.0%), nausea (n = 10, 13.3%), and urinary tract infection (n = 6, 8.0%). An AE was considered the primary reason for drug discontinuation in 2 (2.7%) participants. Treatment-emergent serious AEs (TESAEs) occurred in 2 participants; neither were considered treatment-related by the investigators. In the modified intention-to-treat population (n = 72), the least squares (LS) mean change from baseline of 14.34 MMDs was -6.45 MMDs (95% CI: -7.7, -5.1) at Weeks 1-4, -6.89 MMDs (95% CI: -8.1, -5.6) across Weeks 1-12, and -7.20 MMDs (95% CI: -8.4, -5.9) across Weeks 13-24. The least square mean change from baseline of 17.00 MHDs was -6.57 MHDs (95% CI: -7.8, -5.3) at Weeks 1-4, -7.33 MHDs (95% CI: -8.6, -6.0) across Weeks 1-12 and -8.15 MHDs (95% CI: -9.4, -6.8) across Weeks 13-24. A ≥ 50% RR in MMD was achieved by 54.2% and 61.9% of participants across Weeks 1-12 and Weeks 13-24 of combined treatment, respectively. A ≥ 75% RR was achieved by 30.6% and 38.1% of participants.ConclusionsIn this study, combination preventive treatment for CM with onabotulinumtoxinA and atogepant was safe and generally well-tolerated. Furthermore, the addition of atogepant to those stable on onabotulinumtoxinA resulted in clinically meaningful reductions in migraine days and improvement in responder rates, suggesting a benefit of combining treatments with distinct and complementary mechanisms of action for suppression of CM.Trial RegistrationClinical Trials.gov NCT05216263.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 4","pages":"3331024261429118"},"PeriodicalIF":4.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing light sensitivity during and between migraine attacks: A prospective study investigating spectral tuning of white light.","authors":"Mahya Fani, Nina Sharp, Todd J Schwedt","doi":"10.1177/03331024261439257","DOIUrl":"https://doi.org/10.1177/03331024261439257","url":null,"abstract":"<p><p>BackgroundPhotophobia is experienced by most individuals with migraine, and it is frequently the most bothersome symptom other than headache. Light is not perceived uniformly; spectral composition and intensity influence discomfort and can exacerbate symptoms. While monochromatic green light shows therapeutic potential, it appears visually unnatural and is impractical for daily use. This study aimed to determine whether spectrally tailored white light, more visually acceptable in everyday environments, reduces light sensitivity among those with migraine.MethodsTwenty adults (18-44 years) with episodic migraine completed two research sessions: one during an acute migraine attack and one between migraine attacks. Participants were exposed to four spectrally distinct white light conditions (red-, green-, cyan-, and blue-enriched) in a randomized order delivered at ten intensity levels (50-590 lux). After each exposure, visual discomfort was rated on a 0-10 scale. Pupil size was measured using a pupillometer. Repeated-measures ANOVAs examined the effects of light spectrum, intensity, and migraine state on visual discomfort and pupil response.ResultsMigraine attack status significantly increased visual discomfort (<i>F</i>(1,19) = 25.84, <i>p</i> < .001, η² = .576). White light spectrum (<i>F</i>(3,57) = 12.47, <i>p</i> < .001, η² = .396) and light intensity (<i>F</i>(9171) = 124.30, <i>p</i> < .001, η² = .867) were associated with intensity of visual discomfort. Post-hoc analyses indicated that visual discomfort increased with increasing light intensity, especially at higher light intensities. Among all tested spectra, green-enriched white light resulted in the least visual discomfort; blue-, red-, and cyan-enriched white light produced significantly higher discomfort (all p < .001). Pupil size varied by spectrum (<i>F</i>(3,57) = 14.13, <i>p</i> < .001, η² = .426), with green-enriched white light producing the largest pupil size.ConclusionSpectral composition, light intensity, and migraine state jointly influence both subjective and physiological responses to light. Across lighting spectra, lower light intensity was consistently associated with reduced visual discomfort, indicating greater visual comfort at lower intensities. These results identify green-enriched white light at lower intensities as a visually acceptable, migraine-conscious lighting option with potential for real-world application.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 4","pages":"3331024261439257"},"PeriodicalIF":4.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proposed changes to current definitions of ICHD-3 regarding headache and facial pain attributed to the disorder of the nose or paranasal sinuses.","authors":"Marcin Straburzyński, Adrian M Agius, Claire Hopkins, Amber U Luong, Eugenio De Corso, Arne May, Timothy L Smith, Casper P Zwetsloot, Richard R Orlandi, Wytske Fokkens","doi":"10.1177/03331024261439265","DOIUrl":"https://doi.org/10.1177/03331024261439265","url":null,"abstract":"<p><p>BackgroundClinicians encounter difficulties in differentiating between headache/facial pain of true sinogenic origin, and clinically similar pain related to primary headache disorders, such as migraine. The International Classification of Headache Disorders and International Classification of Orofacial Pain, together with clinical definitions of acute and chronic rhinosinusitis as refined by the European Position Paper on Rhinosinusitis and Nasal Polyps, have produced a unique opportunity to improve the current diagnostic criteria of headache/facial pain attributed to rhinosinusitis.MethodsAn international multidisciplinary panel reviewed clinical evidence regarding the overlap of primary headaches and rhinosinusitis in order to harmonize and clarify diagnostic frameworks.ResultsThe proposal integrates validated rhinologic definitions into headache and facial pain classifications. Key suggestions include the removal or adjustment of non-specific criteria (e.g., headache exacerbated by pressure applied over the paranasal sinuses) which also frequently occur in primary headache disorders. To enhance specificity, evidence-based negative predictors - such as the absence of nausea, osmophobia or photophobia and phonophobia - are introduced. Only for chronic rhinosinusitis, it has been proposed to include endoscopic or radiological evidence of inflammation, as necessary to confirm the diagnosis.ConclusionAligning ICHD-4 with contemporary rhinologic guidelines through the use of positive and negative predictors may help improve diagnostic accuracy, ensure appropriate therapy and increase the reliability of trial design.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 4","pages":"3331024261439265"},"PeriodicalIF":4.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical activity in migraine: Identifying an engagement threshold and patient clusters in a population-based cohort.","authors":"Ido Peles, Shaked Sharvit, Victor Novack, Gal Ifergane","doi":"10.1177/03331024261426569","DOIUrl":"https://doi.org/10.1177/03331024261426569","url":null,"abstract":"<p><p>BackgroundPhysical activity (PA) has been associated with reduced migraine burden, but patients with frequent or comorbid migraine often report difficulty sustaining regular activity. We examined the association between minimal PA and migraine-related outcomes, and explored whether a disease burden threshold limits PA engagement.MethodsWe analyzed data from 550 participants with migraine in the Negev Migraine Cohort in southern Israel who completed a questionnaire assessing PA (≥2 h/week), migraine-related disability (MIDAS), depressive symptoms (DASS-21), and psychosocial functioning. Between-group comparisons and multivariable linear regression models were conducted to assess the independent associations of PA with key outcomes, adjusting for demographic characteristics. We also explored the probability of engaging in PA by migraine frequency, and conducted unsupervised clustering based on migraine days, depressive symptoms, and PA status to identify patient profiles.ResultsPhysically active participants (46%) reported significantly fewer migraine days per month (median 3.0 vs. 5.0), lower use of triptans per month (mean 2.6 vs. 4.1 pills), and reduced migraine-related disability (median MIDAS score 26.0 vs. 36.0). They also reported fewer days of presenteeism per month (median 3.5 vs. 5.0). In addition, they experienced less impairment in overall life satisfaction (mean 4.49 vs. 5.14). In fully adjusted models, PA remained independently associated with reduced disability (β = -0.14, 95% CI -0.28 to -0.1) and improved life satisfaction (β = -0.46, 95% CI -0.9 to -0.1). Probability modeling showed that individuals with more than three migraine days per month had less than 50% likelihood of meeting PA targets. Clustering analysis identified three subgroups: a high-burden and low-activity group, an intermediate group, and an active and well-functioning group.ConclusionsMinimal PA was associated with lower migraine-related disability and better life satisfaction. The identification of an activity engagement threshold and distinct patient clusters suggests a staged care model where pharmacologic stabilization enables PA, which may itself serve as a marker of recovery.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 4","pages":"3331024261426569"},"PeriodicalIF":4.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}