Cephalalgia最新文献

{"title":"Treatment outcomes in new daily persistent headache in children and adolescents.","authors":"Nassim Abuhalaweh, Amy A Gelfand, Morgan Evans, Blanca Marquez de Prado, Carlyn Patterson Gentile, Nichelle Raj, Andrew D Hershey, Christina L Szperka","doi":"10.1177/03331024261426562","DOIUrl":"10.1177/03331024261426562","url":null,"abstract":"<p><p>BackgroundNew daily persistent headache (NDPH) is a primary headache disorder that often presents in adolescence. Presently, there is no effective treatment for NDPH and a paucity of clinical trials exploring therapeutic options. In this study, we explored the relative benefit of currently used treatments to help inform future trials and clinical decision-making.MethodsIn this retrospective chart review study, patients aged 5-17 years with abrupt onset continuous headache and headache duration of at least one month (constituting NDPH or probable NDPH) were identified based on responses to a Headache Questionnaire in child neurology clinic and confirmed with chart review. We included all treatments (transitional therapy, preventive supplement, preventive medication and preventive non-medication therapy) started during continuous headache until both break in continuous headache and sustained improvement in headache were achieved. For treatments tried by at least 10 patients and for the first treatment tried in each category, we calculated proportions of any documented benefit, including \"Significant\" (≥30% improvement lasting ≥4 weeks) and \"Some improvement\" (all other improvement) and proportions of negative outcome (those with worsened headaches or side effects warranting discontinuation), as well as median time to treatment. We used multivariable regression modeling to examine for factors associated with headache outcomes. Treatments may have overlapped.ResultsOf the 165 patients, the largest proportion of patients experienced benefit with the first transitional therapy (62/108; 57%), which was usually intravenous medications ± oral corticosteroids. The first supplement tried, usually riboflavin ± magnesium, offered benefit in (36/118; 31%), with few negative outcomes (3/118; 3%). The first prescription preventive tried, usually amitriptyline or topiramate, offered similar benefit (37/106; 35%) as the first supplement, but with more negative outcomes (25/106; 24%). Despite being tried after oral preventives, onabotulinumtoxinA injections offered benefit to the largest proportion of patients (14/20; 70%) without negative outcomes (0%). Overall, the time to first therapy was weeks to months into continuous headache: shortest for transitional therapies (median = 49 days, interquartile range = 17-92 days), and longest for non-medication therapies (median = 144 days, interquartile range = 61-381 days). Increased time to any first treatment was associated with decreased odds of headache improvement at one-year follow-up (odds ratio = 0.823, 95% confidence interval = 0.715-0.946, <i>p</i> = 0.006).ConclusionsChildren and adolescents with new onset continuous headache experience treatment delays which are associated with worse outcomes. Clinicians should consider use of transitional therapies in combination with preventive treatments as early as possible. Prospective natural history studies and trials are needed to improve treatment outcomes for p","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 6","pages":"3331024261426562"},"PeriodicalIF":5.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148276240","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":"CGRP, VIP and PACAP plasmatic levels in migraine patients before and after anti-CGRP(R) monoclonal antibodies treatment.","authors":"Davide Chiasserini, Alessia Bellotti, Alfredo Megaro, Giuseppe Tringali, Ilenia Corbelli, Elena Cresta, Valeria Teti, Daniela Fruttini, Paolo Calabresi, Pierluigi Navarra, Lucilla Parnetti, Paola Sarchielli","doi":"10.1177/03331024261429802","DOIUrl":"10.1177/03331024261429802","url":null,"abstract":"<p><p>AimCalcitonin gene-related peptide (CGRP), vasoactive intestinal peptide (VIP) and pituitary adenylate cyclase-activating peptide (PACAP) play a crucial role in migraine pathophysiology. In recent years, anti-CGRP(R) monoclonal antibodies (mAbs) have emerged as the first targeted and highly effective therapy for migraine. This study aimed to assess any changes in plasma CGRP levels following prophylactic treatment with anti-CGRP(R) mAbs and to compare CGRP dynamics between anti-receptor (erenumab) and anti-ligand (galcanezumab, fremanezumab) therapies. Secondary objectives were: (i) to evaluate changes in VIP and PACAP plasma levels following treatment with anti-CGRP(R) mAbs and (ii) to investigate whether baseline or post-treatment plasma levels of CGRP, VIP and PACAP were associated with clinical response to anti-CGRP(R) monoclonal antibody therapy.MethodsBetween February 2022 and February 2023, we enrolled 56 migraine patients who initiated prophylaxis with either erenumab (26 patients), galcanezumab (16 patients) or fremanezumab (14 patients). Responders were defined as those achieving a ≥50% reduction in monthly migraine days after six months. Blood samples were collected at baseline and at each follow-up visit (baseline, T0; three months, T1; six months, T2; 12 months, T3). Plasma levels of CGRP, VIP and PACAP were measured using a validated radioimmunoassay and commercially available enzyme-linked immunosorbent assay kits.ResultsOverall, 80.3% (45 out of 56) of patients responded to anti-CGRP(R) mAbs. No correlation was found between baseline CGRP, VIP and PACAP plasma levels and clinical response to anti-CGRP(R) mAbs therapy. Regarding CGRP trend, significant differences were found between patients treated with the anti-receptor monoclonal antibody (erenumab) and those receiving anti-ligand therapies. In patients treated with erenumab, CGRP levels did not show a significant change over the treatment period (T1-T3), whereas, in the galcanezumab group, CGRP levels significantly decreased as early as T1 (<i>p</i> < 0.01). CGRP longitudinal assessment of the fremanezumab group were excluded due to assay interference with the drug. VIP and PACAP plasma levels remained stable over time for all treatments, with no significant differences between responders and non-responders.ConclusionsGalcanezumab reduced CGRP plasmatic levels already after three months, whereas erenumab did not affect significantly CGRP plasmatic levels. VIP and PACAP levels were not influenced by the therapy.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 6","pages":"3331024261429802"},"PeriodicalIF":5.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148263577","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":"Impaired bone status in high frequency episodic or chronic migraine women: A case-control study with blood and densitometric parameters.","authors":"Marina Haro, María Muñoz-San Martín, Gabriel Gárate, Lucia De La Guerra, Vicente González-Quintanilla, Jorge Madera, Sara Pérez-Pereda, Carmen Valero, José Manuel Olmos, José Luis Hernández, Julio Pascual","doi":"10.1177/03331024261453582","DOIUrl":"10.1177/03331024261453582","url":null,"abstract":"<p><p>Background/AimMigraine and osteoporosis are highly prevalent in women and represent a substantial socio-health burden. We aimed to comprehensively assess bone status in women with frequent migraine.Patients and MethodsAdult women with high-frequency episodic migraine (HFEM) or chronic migraine (CM) were recruited and compared with age- and body mass index-matched female controls. Serum parameters of bone metabolism, including 25-hydroxyvitamin D (25[OH]D), calcium and parathyroid hormone (PTH), as well as bone turnover markers (procollagen type 1 N-terminal propeptide [P1NP] and C-terminal telopeptide of type I collagen [CTX]), were measured. Bone mineral density (BMD), T-scores and trabecular bone score (TBS) were assessed by dual-energy X-ray absorptiometry.ResultsA total of 108 women with CM/HFEM and 129 matched controls were included. Compared with controls, women with migraine had lower serum 25(OH)D and calcium levels (p ≤ 0.001) and higher adjusted CTX levels (p = 0.039). Densitometric assessment revealed significantly reduction in BMD at femoral neck (g/cm² and T-score) and total hip (T-score) in the migraine group (p < 0.001). Lumbar TBS was also lower in CM/HFEM patients (p < 0.001). After multivariable adjustment, TBS remained independently associated with migraine status. These alterations remained in women with HFEM and in those younger than 50 years, and were associated with reduced physical activity and sun exposure.ConclusionsWomen with frequent migraine exhibit impaired bone health, characterized by alterations in bone mass and trabecular microarchitecture. TBS appears to be a sensitive marker of early skeletal involvement in this population. The presence of bone impairment in HFEM and in premenopausal women supports early assessment of bone status and reinforcement of lifestyle interventions, including adequate physical activity and sun exposure.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 6","pages":"3331024261453582"},"PeriodicalIF":5.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148307214","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":"Diagnostic tests and headache misdiagnoses in individuals with resistant and refractory migraine - data from the REFINE study.","authors":"Federico De Santis, Chiara Rosignoli, Agnese Onofri, Mark Braschinsky, Olga Sved, Raquel Gil-Gouveia, Renato Oliveira, Christian Lampl, Jakob Paungarttner, Paolo Martelletti, William David Wells-Gatnik, Isabel Pavao Martins, Dimos D Mitsikostas, Loukia Apostolakopoulou, Aynur Ozge, Dilan Bayar Narin, Patricia Pozo-Rosich, Albert Munoz-Vendrell, Maria Pia Prudenzano, Martino Gentile, Kristina Ryliskiene, Jurgita Vainauskiene, Margarita Sanchez-Del-Rio, Fabrizio Vernieri, Gianmarco Iaccarino, Marta Waliszewska-Prosół, Sławomir Budrewicz, Marta Carnovali, Zaza Katsarava, Simona Sacco, Raffaele Ornello","doi":"10.1177/03331024261443712","DOIUrl":"10.1177/03331024261443712","url":null,"abstract":"<p><p>BackgroundIndividuals with difficult-to-treat migraine, including resistant migraine (ResM) and refractory migraine (RefM), might experience treatment delays, undergo unnecessary diagnostic tests and receive misdiagnoses, which might influence treatment outcomes. For this reason, we hypothesized that individuals with ResM and RefM might report more diagnostic tests and misdiagnoses in their medical history compared with those with non-resistant/non-refractory migraine (NRNRM).MethodsThis analysis used baseline, cross-sectional data from the REFINE study, a multicenter, prospective observational study conducted in 15 European tertiary headache centers. Adults with episodic or chronic migraine were classified into RefM, ResM, or NRNRM groups. Baseline data were analyzed to assess the frequency of previous diagnostic tests and misdiagnoses.ResultsOverall, 689 participants were included with a median age of 46 years (interquartile range 36-53); 570 participants (82.7%) were female; 355 (51.5%) had NRNRM, 261 (37.9%) ResM, and 73 (10.9%) RefM. Referring to diagnostic tests, 335 participants (48.7%) had one and 237 (34.4%) multiple brain magnetic resonance imaging scans. ResM and RefM participants underwent more diagnostic tests than NRNRM. Overall, 193 participants (28.0%) had at least one prior headache misdiagnosis, most commonly cervical spine disorders and sinusitis; misdiagnoses were more frequent in NRNRM and ResM than in RefM (31.1%, 28.5%, and 15.1%, respectively; p = 0.025). Misdiagnosis rates were not influenced by age, sex, disease duration, or comorbidities.ConclusionsDiagnostic tests use and misdiagnoses are highly prevalent in all the three groups of individuals with ResM, RefM, and NRNRM with some differences across the three groups that may depend on multiple factors. Our findings emphasize a need for better diagnostic accuracy and care pathway across the entire spectrum of migraine, to avoid unnecessary diagnostic tests and misdiagnoses.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 6","pages":"3331024261443712"},"PeriodicalIF":5.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148162103","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":"Distribution of intranasal lidocaine and its effect on electrically-evoked calcium signals in mouse trigeminal ganglion neurons.","authors":"Lisa Tiebl, Hans Jürgen Solinski, Sara Belejova, Sabrina Soares, Claudia Pitzer, Roland Palkovacs, Gernot Poschet, Martin Schmelz, Beatrice Oehler, Richard Carr","doi":"10.1177/03331024261453548","DOIUrl":"10.1177/03331024261453548","url":null,"abstract":"<p><p>BackgroundLidocaine applied intranasally has shown promise in treating post-dural puncture headache and has been explored as a potential treatment for cluster headache and migraine. However, the mechanisms underlying its analgesic effects remain unclear. This study aimed to determine the concentration of lidocaine that reaches target tissues after intranasal application and its impact on the excitability of trigeminal ganglion neurons.MethodsA mouse model was used to examine lidocaine (10%) distribution after intranasal administration, employing liquid chromatography-mass spectrometry (LC-MS). Fluorescence calcium imaging with electrical field stimulation on acutely cultured murine trigeminal ganglion cells was applied to determine the effects of the pre-determined lidocaine concentrations on their excitability.ResultsAfter intranasal application, lidocaine concentrations ranged from approximately 2.5 μM in plasma to 7 μM in trigeminal ganglia. Calcium imaging revealed that 100 μM lidocaine was required to decrease electrical responses in capsaicin-unresponsive trigeminal ganglion neurons. In capsaicin-responsive nociceptive neurons such an inhibition was already observed at 10 μM lidocaine and these neurons also displayed a sustained increase in calcium that failed to return to baseline levels.ConclusionsThese findings suggest that intracranial lidocaine concentrations after intranasal administration are sufficiently high to selectively affect depolarized trigeminal nociceptors with ongoing activity, providing a potential mechanism for the analgesic effects of intranasally applied lidocaine. These results have implications for the use of intranasal lidocaine as a treatment for headache.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 6","pages":"3331024261453548"},"PeriodicalIF":5.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148307191","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":"Real-world achievement of higher standards for migraine prevention with CGRP monoclonal antibodies.","authors":"Keisuke Suzuki, Shiho Suzuki, Saro Kobayashi, Mukuto Shioda, Hiroaki Fujita, Yasuo Haruyama, Ryotaro Hida, Koichi Hirata","doi":"10.1177/03331024261453284","DOIUrl":"10.1177/03331024261453284","url":null,"abstract":"<p><p>ObjectiveTo evaluate the achievement of the International Headache Society (IHS) higher standards for migraine prevention in patients treated with calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) in real-world practice.MethodsWe retrospectively analyzed 307 migraine patients treated with CGRP mAbs at a single center. Monthly migraine days (MMDs) were assessed at baseline and during follow-up (1-24 months). According to IHS recommendations, migraine control was categorized as optimal (<4 migraine days/month), modest (4-6 days/month), or insufficient (>6 days/month). Patients were further classified by the timing of achieving optimal control.ResultsThe percentage of patients achieving a ≥ 50% reduction in MMDs increased from 36.2% at month 1 to 71.0% at month 24; optimal control increased from 15.0% to 38.8%. Among patients with a ≥ 50% response, 38.7-55.7% achieved optimal control during follow-up. Migraine freedom remained relatively uncommon (1.6-10.1%). Patients who achieved optimal control early (≤3 months) had a lower baseline migraine burden, whereas nonachievers had a higher baseline disease burden and more prior preventive treatment failures.ConclusionsCGRP mAbs were associated with substantial reductions in migraine frequency; however, achieving optimal control and migraine freedom remains challenging in real-world practice, particularly in patients with a higher baseline burden.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 6","pages":"3331024261453284"},"PeriodicalIF":5.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136813","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":"Smoking and medication-overuse headache: Exploring the potential link between nicotine dependence and analgesic overuse.","authors":"Mona Hussein, Amr Hassan, Rehab Magdy, Ahmed Dahshan, Osama Yacoub, Mohamed Abdelghaffar, Nourhan Abdelmohsen Taha, Ahmed Essmat, May M Fayez, Nahla Merghany, Anas Elgenidi, Ramez Reda Moustafa, Anter Mothenna Abdullah Nasser, Alaa Elmazny","doi":"10.1177/03331024261453544","DOIUrl":"10.1177/03331024261453544","url":null,"abstract":"<p><p>BackgroundDespite consistent epidemiological evidence identifying smoking as a risk factor for medication-overuse headache (MOH), the mechanisms underlying this association remain incompletely elucidated. The aim of this work was to explore the relationship between the severity of analgesic dependence, headache-related disability, nicotine dependence, psychological distress, and addiction-related personality traits in patients with MOH.MethodsThis multicenter cross-sectional study was conducted on 442 patients with primary headache disorders. Participants underwent structured face-to-face interviews and were asked to fill out the following questionnaires: Headache Impact Test-6 (HIT-6), Severity of Dependence Scale (SDS), Depression Anxiety Stress Scales-12 (DASS-12), and Substance Use Risk Profile Scale (SURPS). Smoking status was documented for all participants. Current smokers were asked to complete Fagerström Test for Nicotine Dependence questionnaire (FTND).ResultsThis study included 442 patients with primary headache disorders, of whom 150 had MOH and 292 did not. Patients with MOH (n = 150) reported significantly higher monthly headache days (MHD), acute medication days (AMD), HIT-6, DASS-12, and SURPS scores than those without MOH (n = 292) (all P-values < 0.001). Smoking prevalence and FTND scores were significantly higher among MOH patients than those without MOH (all P-values < 0.001). Smokers demonstrated higher MHD, AMD, prevalence of MOH, DASS-12, and SURPS scores than non-smokers (all P-values < 0.05). Among smokers, FTND correlated positively with MHD, AMD, HIT-6, DASS-12, and SURPS (all P-values < 0.001). In patients with MOH, SDS scores showed positive correlations with AMD, HIT-6, DASS-12, and SURPS (all P-values < 0.05).ConclusionSeverity of dependence on analgesics in patients with MOH is strongly associated with headache burden, nicotine dependence, psychological distress, and addiction-related personality traits.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 6","pages":"3331024261453544"},"PeriodicalIF":5.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148142766","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":"Beyond headache: Cognitive improvement in patients with migraine responding to anti-CGRP monoclonal antibodies or botulinum toxin.","authors":"Isabel Pavão Martins, Mariana Costa Taveira, Maria Couto, Sofia Velasco, Rita Rato, Andreia Costa, Bárbara Martins, Filipa Dourado Sotero","doi":"10.1177/03331024261458424","DOIUrl":"10.1177/03331024261458424","url":null,"abstract":"<p><p>BackgroundCognitive functioning worsens during migraine attacks and in the interictal period, especially in chronic migraine. This study aims to evaluate whether preventive treatment with anti-CGRP monoclonal antibodies (mAbs) or botulinum toxin (BoNT) improves interictal cognitive performance in migraine patients, and to compare cognitive changes between treatment responders and non-responders, controlling for treatment type.MethodsA two-center prospective longitudinal comparative study of patients with Episodic (EM) or Chronic (CM) migraine receiving either mAbs or BoNT. Participants underwent two comprehensive cognitive evaluations targeting attention/processing speed, executive functions, episodic memory, and language, at baseline (visit 1) and after three to six months of treatment (visit 2). The primary end point was the degree of improvement measured by the z scores of each cognitive domain (adjusted for age and education), from baseline to follow-up, assessed using repeated-measures analysis with time as the within-subject factor and treatment response as the between-subject factor, controlling for treatment group. Treatment response was defined as a decrease in monthly moderate-to-severe headache days of ≥30% in CM or ≥50% in EM at follow-up.ResultsOne hundred patients were included, and 90 completed the study (median age = 42 years, 96.7% women, 58 (64.4%) with CM, 64 (71.1%) treated with mAbs, and 26 (28.8%) with BoNT. Forty-seven (52.2%) were responders (59.4% in the mAbs group and 34.6% in the BoNT group) after a mean follow-up time of 4.5 months. Improvement in a measure of executive functions (comprising tests of working memory, alternating attention, and phonological fluency) was significantly higher in responders than in non-responders, independently of treatment group. No significant differences between responders and non-responders were observed in episodic memory, language, or processing speed. Among responders, the change in executive function score was not associated with the reduction in monthly moderate-severe headache days or the final number of monthly headache-free days.ConclusionsPerformance on measures of executive capacities, may improve in migraine patients after a few months of effective migraine treatment with mAbs or BoNT, regardless of the treatment group. Further research is needed to determine whether this effect augments over time, is associated to the reduction of pre-ictal and post-ictal days and /or to brain networks reorganization.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 6","pages":"3331024261458424"},"PeriodicalIF":5.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249520","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":"Achieving International Headache Society-aspired optimal migraine control in fremanezumab-treated patients: A post-hoc analysis of a real-world, prospective study from the GRASP study group.","authors":"Andreas A Argyriou, Emmanouil V Dermitzakis, Dimitrios Rikos, Maria Chondrogianni, Aikaterini Foska, Panagiotis Soldatos, Eleni Mavraki, Georgia Xiromerisiou, Pantelis Litsardopoulos, Georgios Tsivgoulis, Michail Vikelis","doi":"10.1177/03331024261456247","DOIUrl":"10.1177/03331024261456247","url":null,"abstract":"<p><p>ObjectiveTo evaluate whether the conventional ≥50% reduction in monthly migraine days (MMDs) accurately reflects clinically meaningful benefit compared with IHS-aspired migraine control definitions in difficult-to-treat high-frequency episodic migraine (HFEM).MethodsIn this post-hoc analysis of a prospective, real-world registry, conducted by the Greek Research Alliance for the Study of Headache and Pain (GRASP), 114 HFEM patients who had failed ≥3 preventive therapies and achieved a sustained ≥50% reduction in MMDs with monthly fremanezumab over 24 months, were included. Treatment response (≥50% and ≥75% MMD reduction) and IHS-defined control states (freedom, optimal, modest, insufficient control) were assessed using headache diaries at baseline (T0), month 12 (T1), and month 24 (T2). Secondary outcomes included headache intensity, analgesic use, and migraine-related disability.ResultsAt T1, fremanezumab significantly improved all efficacy and disability outcomes (p < 0.001), with mean MMDs reduced from 11.9 at baseline to 5.1 at T1. While 78.1% achieved ≥50% MMD reduction, only 19.3% reached optimal control (<4 MMDs), highlighting a mismatch between relative response and true disease control. At T2, MMDs further declined to 4.3, while optimal control increased to 29.8% and insufficient control declined to 7.8%. Overall, most patients remained moderately controlled (60.6%) with residual 4-6 MMDs. Non-prior exposure to other anti-CGRP therapies emerged as the only independent predictor of optimal long-term control (OR:2.1; p = 0.03).ConclusionAchieving a ≥ 50% MMD reduction with CGRP-targeted therapies may not always correspond to clinically-meaningful benefit. More ambitious outcome measures are essential for more accurately evaluating treatment effectiveness and achieving clinically-meaningful reduction of migraine's disability.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 6","pages":"3331024261456247"},"PeriodicalIF":4.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148154891","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 limitations of anxiety screening tools used in migraine studies -a narrative review.","authors":"Monica Yen Hoang Pham, Jasmin Asheer, Fatima Ali, Rikke Hilker, Poul Videbech, Henrik Winther Schytz","doi":"10.1177/03331024261453541","DOIUrl":"10.1177/03331024261453541","url":null,"abstract":"<p><p>BackgroundAnxiety is commonly reported among patients with migraine, and anxiety questionnaires are frequently used to assess anxiety symptoms. This narrative review examines how common anxiety screening tools are applied in migraine studies and whether they are applied and interpreted appropriately.MethodA PubMed search included studies using the Hospital Anxiety Depression Scale (HADS), Generalized Anxiety Disorder 7-Items (GAD-7) or Beck Anxiety Inventory (BAI). The search also included studies using the Hamilton Anxiety Rating Scale (HAM-A) or State Anxiety Inventory (STAI). Eligible patients were diagnosed with migraine according to the International Classification of Headache Disorders (ICHD-2 or ICHD-3).ResultsNinety-eight studies met the inclusion criteria. In 42 studies (41%), an anxiety score above the cut-off was interpreted as an anxiety diagnosis. This approach was used in 52%, 44%, 41%, 29% and 38% of studies using HADS-A, GAD-7, BAI, HAM-A and STAI. Only three studies confirmed the diagnosis through a structured clinical interview. Data presentation and interpretation across the studies were heterogeneous. Only a few of the scales are validated in a population of migraine patients.ConclusionThis study shows that anxiety screening tools are commonly used in migraine studies but with considerable variation in cut-off scores and interpretation. Such methodological differences and limited validation of these tools may make it difficult to determine the true prevalence of anxiety in migraine studies. Further studies are needed to validate these instruments and to establish clear guidelines for their use in migraine research.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 6","pages":"3331024261453541"},"PeriodicalIF":5.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148263516","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}