Cephalalgia最新文献

{"title":"Value of lumbar puncture in identifying secondary causes of visual snow syndrome: A case-control study.","authors":"Tim Mader, Antonia Klein, Elena Wenz, Adrian Scutelnic, Nedelina Slavova, Sophie De Beukelaer, Laura Weichsel, Michael Horn, Franz Riederer, Christoph J Schankin","doi":"10.1177/03331024261469080","DOIUrl":"10.1177/03331024261469080","url":null,"abstract":"<p><p>AimVisual Snow Syndrome (VSS) typically begins in early life with no significant diagnostic findings in the neurological and ophthalmological workups. Still, secondary forms of VSS have been reported. This study examines the diagnostic value of cerebrospinal fluid (CSF) analysis and the search for autoimmune encephalitis antibodies in patients with VSS.MethodsIn this retrospective case-control study, CSF samples from 36 VSS patients were analyzed and compared to a control group matched for age, sex, and migraine. In addition, serum and CSF antibodies associated with autoimmune encephalitis or paraneoplastic syndromes were analyzed in VSS patients. Cases with CSF abnormalities were further characterized.ResultsNo significant systematic differences in CSF cell count or protein levels were observed between VSS patients (n = 36) and controls (n = 31). CSF abnormalities in the VSS group included elevated cell counts (n = 4), elevated protein level (n = 1) and oligoclonal bands (n = 1). Autoantibodies associated with autoimmune encephalitis or paraneoplastic syndromes were not detected in either serum or CSF of VSS patients.ConclusionThis corresponds to grade 3b evidence (case-control study), suggesting that lumbar puncture and search for autoimmune encephalitis should not be routinely performed in patients presenting with typical VSS without red flags for additional comorbidities.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 8","pages":"3331024261469080"},"PeriodicalIF":5.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148697102","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":"Methodological considerations regarding smoking, psychological distress, and medication-overuse headache.","authors":"Nabira Tariq, Muhammad Awais Amir","doi":"10.1177/03331024261471862","DOIUrl":"https://doi.org/10.1177/03331024261471862","url":null,"abstract":"","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 8","pages":"3331024261471862"},"PeriodicalIF":5.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648432","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":"Fremanezumab for the preventive treatment of migraine in Chinese adults: A Phase 3, randomized controlled trial with an open-label extension.","authors":"Shengyuan Yu, Hui Su, Hebo Wang, Meiyun Zhang, Steve Barash, Glenn Chen, Gloria Yiu, Juline Bryson, Yoel Kessler, Yael Carmeli Schwartz, Zipi Roth-Ben Arie, Michal Benedek-Segal, Xiaoping Ning","doi":"10.1177/03331024261462833","DOIUrl":"10.1177/03331024261462833","url":null,"abstract":"<p><p>AimFremanezumab is approved for migraine prevention in Europe, the United States (US), Japan, South Korea, and several other countries; however, there are no data available on fremanezumab as a migraine preventive treatment in a Chinese population. This study evaluated the efficacy and safety of fremanezumab in Chinese adults with migraine.MethodsThis randomized, multicenter, Phase 3 trial consisted of a 4-week screening period, a 12-week double-blind period (DBP), and a 12-week open-label extension (OLE). Chinese adults with episodic and chronic migraine were randomized 1:1:2 to receive fremanezumab monthly (225 mg), fremanezumab quarterly (675 mg), or matched monthly placebo during the DBP. During the OLE, all participants received fremanezumab monthly (225 mg). The primary endpoint was mean change from baseline in monthly migraine days (MMD) during the DBP. Secondary endpoints included mean change from baseline in migraine days during the first 4 weeks of treatment and in monthly number of days with acute headache medication use during the DBP. Similar endpoints were assessed during the OLE. Safety assessments included, but were not limited to, adverse event (AE) reporting.ResultsIn total, 365/454 screened participants were randomized to fremanezumab (n = 182 [monthly, n = 91; quarterly, n = 91]) or placebo (n = 183). Significantly greater changes from baseline in MMD were observed with fremanezumab versus placebo during the DBP (-4.6 vs -2.8; <i>p</i> < 0.0001) and in mean migraine days during the first 4 weeks of treatment (-4.5 vs -2.2; <i>p</i> < 0.0001). The mean change from baseline in days of acute headache medication use during the DBP was -3.0 with fremanezumab and -1.1 for placebo (<i>p</i> < 0.0001). During the OLE, the mean change from baseline in MMD was -6.8 and -7.2 for those assigned to fremanezumab and placebo, respectively, during the DBP. The percentage of participants with any AE was similar between fremanezumab and placebo groups during the DBP (47% vs 43%); serious AEs were infrequent (fremanezumab, 1%; placebo, <1%). Similar trends in AEs were observed during the OLE.ConclusionIn this study, fremanezumab demonstrated significant improvements over placebo with respect to reductions in MMD and days with acute headache medication use, with these reductions being maintained over the OLE. Fremanezumab demonstrated a favorable safety profile, with no safety signals. These results are comparable to pivotal adult trials in Europe and the US, supporting the use of fremanezumab in Chinese adults living with migraine.Clinical trial pre-registrationClinicalTrials.gov identifier: NCT05458011; submitted: 11 July 2022; first participant enrolled: 30 September 2022; available at: https://clinicaltrials.gov/study/NCT05458011; first submitted: 11 July 2022).</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 8","pages":"3331024261462833"},"PeriodicalIF":5.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788922","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":"Baseline severity is not treatment timing in acute rimegepant treatment for vestibular migraine.","authors":"Yuhan Liang, Haoyang Hu","doi":"10.1177/03331024261474832","DOIUrl":"https://doi.org/10.1177/03331024261474832","url":null,"abstract":"","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 8","pages":"3331024261474832"},"PeriodicalIF":5.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788911","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":"Photophobia in migraine: Electrophysiological analysis of chromatic opponent responses via electroretinogram and visual evoked potential.","authors":"Francesco Casillo, Antonio Di Renzo, Gabriele Sebastianelli, Chiara Abagnale, Francesco Martelli, Cherubino Di Lorenzo, Lucia Ziccardi, Benedetto Falsini, Vincenzo Parisi, Gianluca Coppola","doi":"10.1177/03331024261476232","DOIUrl":"10.1177/03331024261476232","url":null,"abstract":"<p><p>BackgroundMigraine is characterized by recurrent headaches and sensory hypersensitivities, with photophobia affecting up to 90% of patients during attacks. The mechanisms underlying ictal photophobia remain unclear, potentially involving altered excitability of the visual cortex, trigeminovascular sensitization, or cone-driven retinal pathways. Prior interictal studies have shown preserved macular cone opponent mechanisms, but ictal investigations are lacking.MethodsIn this prospective study, we simultaneously recorded Ganzfeld blue-red (B-R) and blue-yellow (B-Y) focal flash (8 Hz) macular cone electroretinogram (ERG) and the subsequent visual evoked potential (VEP) in 11 patients with migraine without aura during acute attacks and in 20 healthy volunteers. First (1F) and second (2F) harmonic amplitudes and phases were analyzed using discrete Fourier transformation and T²circ statistics. Responses were correlated with clinical variables, including photophobia severity (0-10 scale) during attacks, using Spearman's coefficient.ResultsFor B-Y stimuli, a selective reduction in ERG 1F amplitude was noted in patients (F = 4.19, <i>p</i> = 0.02), with preserved phases and no differences in other harmonics or VEP responses. A significant negative correlation was observed between the phase of the first harmonic of the VEP and the level of photophobia during the attack. No significant differences were observed in 1F or 2F ERG/VEP amplitudes or phases for B-R stimuli between patients with migraine and HVs.ConclusionsIctal macular cone-opponent pathways remain largely intact in migraine, with a specific S-cone amplitude attenuation suggesting an autonomic-mediated inference on blue-light hypersensitivity. The finding of a correlation of B-Y VEP phase with photophobia implies that this symptom may arise from subcortico-cortical integrations (e.g., thalamic-trigemino-cortical convergence) rather than focal retinal dysfunction.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 8","pages":"3331024261476232"},"PeriodicalIF":5.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788916","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":"Blood levels of PACAP in migraine: A systematic review.","authors":"Pil L Jørgensen, Sarra Al-Khazali, Rune Häckert Christensen, Haidar M Al-Khazali, Messoud Ashina, Håkan Ashina","doi":"10.1177/03331024261468031","DOIUrl":"10.1177/03331024261468031","url":null,"abstract":"<p><p>ObjectiveTo examine whether plasma or serum pituitary adenylate cyclase-activating polypeptide (PACAP) levels differ between people with migraine and healthy controls (HCs), and to assess evidence for dynamic alterations during migraine attacks.MethodsA systematic literature search was conducted in PubMed and Embase from inception to December 19, 2025. Eligible studies measured PACAP in plasma or serum of adult or pediatric participants with migraine and reported comparisons with HCs, and/or between ictal and interictal phases. Two reviewers independently screened articles, extracted data, and assessed risk of bias using the QUADAS-2 tool.ResultsEleven studies met the inclusion criteria, comprising seven adult and four pediatric studies. Findings were inconsistent across studies, with some reporting higher PACAP-38 levels in participants with migraine, while others found no differences or even lower levels compared with HCs. Five studies compared ictal and interictal levels, but results were incongruent and lacked intraindividual measurements. Furthermore, all studies were judged to be at high overall risk of bias, primarily due to limitations in participant selection and index test methodology.ConclusionsCurrent evidence on plasma or serum PACAP-38 levels in migraine is limited and inconsistent. The lack of intraindividual ictal-interictal comparisons and variability in study design and assays further weaken conclusions. Standardized, high-quality studies are essential to resolve existing uncertainties.Trial RegistrationThe study protocol was prospectively registered in PROSPERO (CRD42024601373).</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 8","pages":"3331024261468031"},"PeriodicalIF":5.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705262","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":"Substance P and PACAP activate dural mast cells through MRGPRX2, not NK1R or PAC₁/VPAC receptors.","authors":"Lanfranco Pellesi, Lars Edvinsson","doi":"10.1177/03331024261480167","DOIUrl":"10.1177/03331024261480167","url":null,"abstract":"<p><p>AimSubstance P (SP) and pituitary adenylate cyclase-activating polypeptide (PACAP) are mast-cell-activating peptides implicated in headache and of growing therapeutic interest, but the receptors through which they act on mast cells remain poorly defined, since each peptide can signal through several receptors. Here we set out to determine which of these receptors are expressed by dural mast cells.MethodsWe reanalysed a pan-organ single-cell mast-cell atlas, profiling the candidate receptors for both peptides, corroborated the findings at the protein level in an independent quantitative proteomic atlas of human skin and tested them directly in a single-cell dataset of human dural mast cells.ResultsIn mouse connective tissue mast cells (CTMCs), Mrgprb2 was expressed in 58% of cells versus 0-0.6% for the canonical receptors. In human CTMCs, MRGPRX2 (5.9%) exceeded every canonical receptor (≤ 0.7%). Given the known single-cell dropout of low-abundance receptor transcripts, this enrichment was confirmed at the protein level, where MRGPRX2 was mast-cell-enriched and the canonical receptors undetected. A similar pattern was found in human dural mast cells, where the canonical receptors were essentially absent (PAC₁, NK2R and NK3R undetected, NK1R 0.7%) and MRGPRX2 was the only receptor detected (2.2%).ConclusionOf the candidate receptors for SP and PACAP, only MRGPRX2 is expressed by CTMCs and dural mast cells at appreciable levels. MRGPRX2 is the likely route through which both peptides act on these cells and represents a potential drug target for primary headaches.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 8","pages":"3331024261480167"},"PeriodicalIF":5.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788868","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":"Distinct brain metabolic patterns reflect biological heterogeneity and relate to clinical outcome in chronic migraine with medication overuse.","authors":"Hung-Yu Liu, Hsin-Hsien Yeh, Pei-Lin Lee, Ing-Jou Chen, Yen-Hui Liao, Kun-Hsien Chou, Shuu-Jiun Wang","doi":"10.1177/03331024261476230","DOIUrl":"10.1177/03331024261476230","url":null,"abstract":"<p><p>AimChronic migraine with medication overuse (CMwMO) is a disabling phenotype of migraine with heterogenous responses to medication withdrawal and preventive treatments. We investigated whether baseline brain metabolic patterns reflect biological heterogeneity associated with 1-year clinical outcome in CMwMO.MethodsWe prospectively enrolled patients with CMwMO and healthy controls and obtained baseline headache profiles, psychological and dependence-related assessment as well as FDG-PET/MRI data. Patients received preventive treatments along with structured medication-withdrawal education. Poor outcome (n = 13) was defined as ongoing analgesic overuse together with <50% reduction in monthly headache days compared with baseline at one year follow-up. All other patients (n = 14) were classified as having a good outcome. Whole-brain metabolic comparisons, seed-based metabolic covariance analyses, and correlations with clinical variables were performed.ResultsAmong 27 patients with CMwMO, baseline headache frequency, disability, and medication use were similar between good and poor outcome groups, but the poor-outcome group was older, showed greater dependence severity, and had a longer duration of chronic headache. Compared with healthy controls (n = 17), only the poor-outcome group demonstrated hypermetabolism in the nucleus accumbens, thalamus, orbitofrontal cortex, and cerebellum. When compared to the good-outcome group, the poor-outcome group exhibited cerebellar hypermetabolism and stronger cerebellar metabolic covariance with the putamen and occipital cortex. Integrities of cerebellar-putamen metabolic coupling correlated with dependence severity, whereas cerebellar-occipital coupling correlated with duration of chronic headache and 1-year clinical outcomes.ConclusionsCMwMO appears to comprise biologically distinct subgroups with different baseline metabolic patterns. Treatment-refractory patients were characterized by metabolic alterations involving reinforcement and sensory prediction networks. Early identification of this subgroup may facilitate more individualized management targeting both headache burden and dependence-related behaviors.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 8","pages":"3331024261476230"},"PeriodicalIF":5.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705205","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":"Headache in patients with joint hypermobility.","authors":"Welber Sousa Oliveira, Jan Hoffmann, Angélle Aragonez Essado Jácomo, Raul De Omena Martins, Ricardo Henrique Almeida Barbosa, Mario F P Peres","doi":"10.1177/03331024261477381","DOIUrl":"10.1177/03331024261477381","url":null,"abstract":"<p><p>BackgroundHeadache disorders are highly prevalent in patients with joint hypermobility, particularly in hypermobility spectrum disorders and hypermobile Ehlers-Danlos syndrome, yet they remain frequently underrecognized in routine clinical practice. Failure to identify underlying hypermobility may lead to diagnostic oversimplification, delayed recognition of secondary headache mechanisms, and suboptimal therapeutic strategies.MethodsWe conducted a narrative review with a structured literature search to synthesize current evidence on the epidemiology, clinical characteristics, pathophysiological mechanisms, and management of headache in patients with joint hypermobility.ResultsIn hypermobile populations, migraine is the most common primary headache phenotype; however, secondary causes, including spontaneous intracranial hypotension, craniocervical instability, temporomandibular dysfunction, Chiari malformation, and vascular complications, occur with increased frequency and require systematic consideration. Dysautonomia and orthostatic intolerance frequently interact with headache expression, contributing to clinical heterogeneity and management complexity.ConclusionsRecognition of joint hypermobility broadens the differential diagnosis of headache. We highlight key clinical red flags, outline a structured, mechanism-based approach to multimodal assessment, including musculoskeletal and autonomic evaluation, and discuss practical considerations for individualized management.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 8","pages":"3331024261477381"},"PeriodicalIF":5.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817551","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":"Reply to: Baseline severity is not treatment timing in acute rimegepant treatment for vestibular migraine.","authors":"Yingqiang Li, Lingling Yu, Dan Bing","doi":"10.1177/03331024261474833","DOIUrl":"https://doi.org/10.1177/03331024261474833","url":null,"abstract":"","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 8","pages":"3331024261474833"},"PeriodicalIF":5.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788870","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}