Cephalalgia最新文献

{"title":"Eptinezumab in treatment-resistant chronic migraine: Four-year real-world effectiveness and treatment persistence.","authors":"Wan-Jen Hsieh, Kelly Nicol, Chai Ching Ng, Tsung-Wei Hou, Phillip Phan, Scott W Keith, Brittany Heckel, Michael J Marmura, Hsiangkuo Yuan","doi":"10.1177/03331024261451427","DOIUrl":"10.1177/03331024261451427","url":null,"abstract":"<p><p>AimTo evaluate 48-month real-world outcomes of eptinezumab users in chronic migraine (CM), including longitudinal effectiveness, treatment persistence, reasons for discontinuation, and post-discontinuation anti-calcitonin gene-related peptide (CGRP) treatment patterns.MethodsWe conducted a retrospective cohort study of 112 CM subjects initiating eptinezumab at a tertiary headache center between 2019 and 2021. Monthly headache days (MHD), migraine disability assessment (MIDAS), and average pain intensity (API) were extracted at baseline and every 6 months for up to 48 months using a predefined outcome form at each visit. Longitudinal changes were analyzed using generalized estimating equations (GEE) with an unstructured correlation matrix, adjusting for age, sex, and body mass index (BMI). Analyses were performed in four predefined analytic cohorts: all initiators, on-treatment, continuation, and discontinuation. Estimated marginal means (EMMs) quantified adjusted mean changes from baseline at each timepoint. No imputation or censoring for treatment discontinuation was applied. Treatment persistence, reasons for discontinuation, factors associated with discontinuation, and post-discontinuation anti-CGRP treatment patterns were summarized descriptively.ResultsAmong 112 patients (mean age 50.2 ± 13.7; 77.7% female; baseline MHD median 30 [IQR 25-30]), most had failed prior anti-CGRP therapies (90.2% ≥ 1 failure; 70.6% ≥ 2 failures). In all-initiators, significant reductions in MHD were observed at 6, 18-42, corresponding to model-estimated reductions of 1.5-1.9 MHD. MIDAS increased at 6 months, corresponding to a 44-point increase, but declined over time. API improved significantly at 24, 36 and 48 months, corresponding to a 0.4-0.6-point reduction. Treatment persistence declined to 55.4%, 39.2%, 35.7%, and 29.5% at 1, 2, 3, and 4 years, respectively; the median time to discontinuation was 8 months. Ineffectiveness (34.2%), loss of effectiveness (19.0%), and insurance-related barriers (16.5%) were the most common reasons for discontinuation. After discontinuation, 54.4% initiated another anti-CGRP therapy, 26.6% stopped anti-CGRP therapy entirely, and 20.3% were lost to follow-up.ConclusionsIn this treatment-resistant CM cohort, eptinezumab produced modest but durable benefit, particularly among patients who continued treatment. Persistence declined substantially over time, and post-discontinuation care followed diverse and often complex pathways. Regular reassessment and timely adjustment of preventive strategies remain essential as clinical responses evolve. Larger prospective studies will help clarify long-term effectiveness and treatment trajectories.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 5","pages":"3331024261451427"},"PeriodicalIF":5.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147970889","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":"Rethinking Burning Mouth Syndrome: Toward a multidimensional classification of oral dysaesthetic and perceptual disorders in ICHD-4.","authors":"Gennaro Musella, Daniela Adamo, Vito Carlo Alberto Caponio, Lorenzo Lo Muzio, Michele Davide Mignogna","doi":"10.1177/03331024261452682","DOIUrl":"https://doi.org/10.1177/03331024261452682","url":null,"abstract":"","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 5","pages":"3331024261452682"},"PeriodicalIF":4.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148027600","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":"Environmental and psychological risk factors for migraine chronification in China: A multicenter prospective cohort study.","authors":"Longteng Ma, Linfeng Liu, Ye Ran, Xun Han, Hui Su, Mingjie Zhang, Xiaolin Wang, Xingkai An, Liang Zhang, Suiyi Xu, Wenping Gu, Shilun Zuo, Yuncheng Wu, Yan Li, Yuhu Zhang, Ming Dong, Qian Tian, Shengyuan Yu, Zhao Dong","doi":"10.1177/03331024261446614","DOIUrl":"10.1177/03331024261446614","url":null,"abstract":"<p><p>BackgroundPreventing migraine chronification is a key treatment goal, yet environmental and lifestyle contributors remain understudied in Asian populations. We investigated predictors of the transition from episodic migraine (EM) to chronic migraine (CM) in a prospective Chinese clinical-based cohort.MethodsThis multicenter, prospective study involved 1642 participants with EM meeting ICHD-3 criteria. Baseline characteristics, including environmental factors and psychological scales, were captured via a Clinical Decision Support System (CDSS). Longitudinal follow-up was conducted using a web-based mini-program. Risk factors were identified using multi-variable Cox proportional hazards models, validated by LASSO and stepwise regression.ResultsDuring a median 6-month follow-up, 47 (2.9%) patients progressed to CM. Multivariable analysis identified anxiety symptoms [Generalized Anxiety Disorder-7 (GAD-7) score: Hazard Ratio (HR) 1.15, 95% Confidence Interval (CI) 1.06-1.25], baseline analgesic use frequency (HR 1.07, 95% CI 1.01-1.14), and age (HR 1.04, 95% CI 1.01-1.06) as independent risk factors. Conversely, weekly physical activity duration emerged as a significant protective factor (HR 0.66, 95% CI 0.45-0.98).ConclusionAnxiety and higher frequency of analgesic use are independent risk factors of migraine chronification in this Chinese cohort, while regular physical activity offers protection. These findings support an integrated management strategy combining psychological intervention, medication education, and exercise therapy.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 5","pages":"3331024261446614"},"PeriodicalIF":5.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834422","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":"The effects of angiotensin receptor blockers as prophylactic migraine treatment: A systematic review and meta-analysis.","authors":"Hedda Skogum Riise, Helene Thorvik, Lise Rystad Øie, Lars Jacob Stovner, Erling Andreas Tronvik, Mattias Linde, Knut Hagen, Samita Giri, Tore Wergeland","doi":"10.1177/03331024261451481","DOIUrl":"10.1177/03331024261451481","url":null,"abstract":"<p><p>BackgroundThe role of angiotensin II receptor blockers (ARBs) in migraine prophylaxis varies globally, partly due to insufficient evidence from randomized controlled trials (RCTs) supporting their efficacy. We aimed to conduct a systematic review and meta-analysis of ARBs in migraine prophylaxis.MethodsWe searched PubMed/MEDLINE, Embase, Cochrane, Google Scholar, Clinicaltrials.gov, ITCRP, and EudraCT from database inception to 22 September 2025. The searches were conducted between 19 and 22 September 2025 for controlled trials comparing any ARB to placebo or other preventive migraine drugs in individuals with episodic or chronic migraine. Guidelines, letters, editorials, narrative reviews, case reports, and news were excluded. Summary data were extracted by two reviewers, and random-effects meta-analyses were performed, with heterogeneity assessed using Cochrane I² statistic. Primary outcomes were monthly headache/migraine days or attacks, and response rates. Adverse event occurrence was also assessed. The risk of bias was assessed using the Cochrane RoB2 tool and the certainty of evidence was assessed using GRADEpro. The study was pre-registered in Prospero (CRD42023405372) and received no funding.ResultsFour trials published between 2003 and 2025 were included in the meta-analysis: three RCTs on candesartan, and one on telmisartan. All four studies reported the outcomes migraine days and responder (≥50% reduction of migraine days) rates, and three reported headache days. A total of 659 participants were included in the meta-analysis. The combined effect size for migraine days and headache days were reductions of -1.00 (95% CI: -1.51 to -0.49, p<0.001), and -1.21 (95% CI: -1.62 to -0.81, p<0.001) days per month from baseline respectively. The odds ratio for being a responder was 2.68 (95% CI: 1.91 to 3.78, p<0.001). The certainty of evidence was low for migraine days, moderate for responder rates and high for headache days, with heterogeneity between studies categorized as 'might not be important' and no serious risk of bias.DiscussionThe systematic review and meta-analysis provide robust evidence on the effect of ARBs, particularly candesartan, in prevention of episodic migraine, supporting the rationale for reconsidering its position in international guidelines.Trial RegistrationProspero CRD42023405372.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 5","pages":"3331024261451481"},"PeriodicalIF":5.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148052959","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":"Magnetic resonance spectroscopy during migraine attacks: A systematic review.","authors":"Delia-Ioana Radutiu, Edina Szabo, Rune Häckert Christensen, Eva-Maria Ratai, Nouchine Hadjikhani, Haidar Muhsen Al-Khazali, Messoud Ashina, Håkan Ashina","doi":"10.1177/03331024261441576","DOIUrl":"10.1177/03331024261441576","url":null,"abstract":"<p><p>BackgroundThe neurobiological basis of migraine remains incompletely understood. Magnetic resonance spectroscopy (MRS) allows non-invasive quantification of neurochemical and metabolic patterns in the brain, offering unique insights into biochemical processes during distinct migraine phases. This systematic review provides a critical appraisal of existing evidence describing MRS-derived neurochemical and metabolic alterations during spontaneous and experimentally provoked migraine attacks.MethodsA systematic review was conducted in accordance with the PRISMA statement and prospectively registered in PROSPERO. Comprehensive searches of PubMed, Embase, and Scopus were performed from database inception through August 1, 2025. Eligible studies included observational or interventional investigations acquiring ¹H-MRS or ³¹P-MRS data during the ictal phase in adults with migraine, incorporating either non-ictal comparisons or healthy controls. Considerable variability in study design, brain regions, and metabolite outcomes precluded quantitative synthesis, necessitating a structured qualitative analysis organized by MRS technique and anatomical region.ResultsEight studies published between 1988 and 2022 met inclusion criteria, comprising five ¹H-MRS investigations and three ³¹P-MRS studies, some of which derived from overlapping participant cohorts. Brain regions examined included occipital cortex, pons, frontal cortex, basal ganglia, and parieto-occipital areas. In individual ¹H-MRS studies, occipital cortex analyses demonstrated ictal elevations in total choline and total N-acetyl aspartate, while lower glutathione concentrations were observed. A single ¹H-MRS study targeting the pons identified ictal increases in total creatine and total N-acetyl aspartate. Findings from ³¹P-MRS studies indicated altered cerebral energy metabolism during migraine attacks.ConclusionsAvailable MRS evidence suggests that migraine attacks are associated with altered cerebral energy metabolism, particularly within visual cortical and brainstem regions. However, existing studies differ substantially in design, acquisition parameters, regions of interest, and analytical approaches, such that few directly address comparable questions. Thus, the reproducibility of reported findings remains uncertain. Establishing reliable attack-related metabolic signatures will require well-designed longitudinal MRS investigations capable of directly probing ictal dynamics.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 5","pages":"3331024261441576"},"PeriodicalIF":5.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147940487","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":"Perception of headache-related disability in individuals with and without headache disorders working in a municipal government in the Tokyo Metropolitan Area.","authors":"Mamoru Shibata, Toshihiko Shimizu, Ryo Takemura, Fumihiko Sakai","doi":"10.1177/03331024261444665","DOIUrl":"10.1177/03331024261444665","url":null,"abstract":"<p><p>AimThe discrepancy in headache perception between people with and without headache disorders remains poorly studied. We aimed to gain insights into the factors that determine headache perception in individuals with and without headache disorders.MethodsA questionnaire-based headache survey was administered to municipal employees in the Tokyo Metropolitan Area. The participants were divided into four groups: Group A, individuals with current headache; Group B, individuals with a history of headache; Group C, individuals without headache and without nearby individuals with headaches; and Group D, individuals without headache but with nearby individuals with headaches. In Groups A and B, migraine without aura (MO), migraine with aura (MA), probable MO (pMO), and tension-type headache (TTH) were classified according to the International Classification of Headache Disorders, 3rd edition (ICHD-3). All participants were asked about their perceptions of headaches.ResultsThe response rate was 52.3% (1156 males and 764 females). There were 518 individuals in Group A (MO, 116; MA, 93; pMO, 95; TTH, 214) and 137 in Group B (MO, 24; MA, 24; probable MO, 29; TTH, 60). In Group A, headache severity (headache intensity, duration, and frequency), visual aura, and throbbing pain contributed to the perception of headaches as disabling. Individuals with MA were more likely to consider their headaches disabling than those with TTH (<i>p</i> = 0.0003). However, there were no differences in the proportion of respondents who perceived headaches as disabling across headache disorders in Group B. The perception of headaches as disabling was more common in individuals without headaches (Groups C and D combined) than in those with headaches (<i>p</i> < 0.0001 vs. Group A; <i>p</i> = 0.0078 vs. Group B). However, 9.7% of them responded that headaches were not a disease. In individuals without headaches, males were more likely than females to consider headaches life-threatening (<i>p</i> = 0.0037). Among females, more individuals considered headaches disabling in Group D than in Group C (<i>p</i> = 0.0306).ConclusionHeadache severity, visual aura, and throbbing pain appear to be key therapeutic targets for attenuating headache-related disability. Headache perception varied between individuals with and without headaches, and these differences were further modified by sex among those without headaches. These findings suggest that males without headaches are more likely to perceive headaches as a serious condition, whereas females without headaches appear to be influenced by the presence of nearby individuals with headaches.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 5","pages":"3331024261444665"},"PeriodicalIF":4.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811369","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":"How do we facilitate individuals with recurrent headache and migraine receiving evidence-based behavioral treatment?","authors":"Paul R Martin","doi":"10.1177/03331024261439266","DOIUrl":"https://doi.org/10.1177/03331024261439266","url":null,"abstract":"","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 4","pages":"3331024261439266"},"PeriodicalIF":4.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147670913","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":"Molecular triggers of migraine aura: A systematic review of human pharmacological provocation studies.","authors":"Zahra Hakimzadeh, Basit Ali Chaudhry, Haidar M Al-Khazali, Rune Häckert Christensen, Messoud Ashina, Håkan Ashina","doi":"10.1177/03331024261429112","DOIUrl":"10.1177/03331024261429112","url":null,"abstract":"<p><p>BackgroundMigraine aura reflects transient neurological disturbances attributed to cortical spreading depolarization (CSD), yet the upstream molecular events that promote or precipitate this phenomenon remain uncertain. Human pharmacological provocation models provide a controlled approach to identifying endogenous signaling pathways capable of triggering aura and thereby clarifying their mechanistic role in migraine pathogenesis.MethodsThis systematic review was pre-registered in PROSPERO (ID: CRD420250636266) and conducted in accordance with the Synthesis Without Meta-Analysis (SWiM) guideline. PubMed and Embase were searched from database inception through January 1, 2026, without language restrictions, to identify experimental studies administering pharmacological agents to individuals with migraine with aura under controlled lab conditions. Two reviewers independently performed study selection, data extraction, and methodological assessment. Extracted variables included participant characteristics, study design, pharmacological trigger, dosing protocol, and the incidence, timing, and phenotype of provoked aura and headache. Because of substantial heterogeneity, findings were synthesized qualitatively.ResultsFourteen studies met inclusion criteria, examining seven pharmacological agents: calcitonin gene-related peptide (CGRP), levcromakalim (ATP-sensitive potassium (K_ATP) channels opener), glyceryl trinitrate (GTN), sildenafil, cilostazol, endothelin-1, and histamine. Across studies, aura induction occurred far less frequently than headache induction. CGRP provoked aura in 17 (32%) of 53 participants across three studies, with latencies ranging from 10 to 360 min. Pharmacological opening of vascular K_ATP channels by levcromakalim elicited aura in 14 (27%) of 52 participants in randomized crossover trials, with onset between 20 and 120 min. Other agents produced minimal or no aura responses.ConclusionsHuman pharmacological provocation provides a reproducible framework for dissecting molecular pathways that can trigger migraine aura. Current evidence implicates CGRP signaling and vascular ATP-sensitive potassium channel activation as the most plausible associated candidate pathways. However, standardized protocols and larger controlled studies are required to confirm these mechanisms and refine experimental models of aura biology.Trial RegistrationPROSPERO (ID: CRD420250636266).</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 4","pages":"3331024261429112"},"PeriodicalIF":5.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147590323","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":"Spinal trigeminal nucleus lesions in trigeminal zoster-associated neuralgia: A retrospective cohort study on diagnostic value and prognostic factors.","authors":"Lina Wang, Yang Chen, Mingrui Li, Yin Dong, Jun-Nan Wang, Tao Sun","doi":"10.1177/03331024261435927","DOIUrl":"10.1177/03331024261435927","url":null,"abstract":"<p><p>BackgroundTrigeminal zoster-associated neuralgia (TZAN) is a refractory intractable craniofacial neuropathic pain with a high risk of progressing to postherpetic neuralgia. Abnormal T2-weighted magnetic resonance imaging (MRI) hyperintensity in the spinal trigeminal nucleus (STN) has been reported in TZAN patients, but its diagnostic value, influencing factors and association with prognosis remain insufficiently explored. This study aimed to investigate the correlation between STN lesions and TZAN and identify factors affecting STN signal characteristics and TZAN therapeutic efficacy.MethodsThis retrospective cohort study included 105 TZAN patients, 105 non-TZAN normal controls (NC) and 287 classical trigeminal neuralgia (CTN) patients who underwent cranial MRI at Shandong Provincial Hospital Affiliated to Shandong First Medical University between September 2018 and March 2024. Propensity score matching (1:1, caliper = 0.1) was used to balance baseline differences between the TZAN and CTN groups. STN lesions were evaluated in a blinded manner by two radiologists, and clinical data (pain Numeric Rating Scale scores, pregabalin dosage) were collected via medical records and 6-month telephone follow-up. Multivariate logistic regression analyzed factors associated with STN hyperintensity and TZAN efficacy (pain relief ≥ 80% defined as \"excellent response\").ResultsSTN lesion detection rate was significantly higher in TZAN than in NC (62.9% vs. 1.0%, <i>p</i> < 0.001) and matched CTN (68.9% vs. 0%, <i>p</i> < 0.001), with 62.9% sensitivity, 99.0% specificity and 81.0% accuracy for TZAN diagnosis. Age (odds ratio (OR) = 1.06, 95% confidence interval (CI) = 1.006-1.116, <i>p</i> = 0.030) and subacute phase (vs. acute: OR = 32.01; vs. chronic: OR = 46.40, both <i>p</i> < 0.001) independently predicted STN hyperintensity. STN-normal patients had better short-term efficacy (discharge Numeric Rating Scale = 2 (1, 3) vs. 3 (2, 4), <i>p</i> = 0.042; excellent response rate: 38.5% vs. 19.7%, <i>p</i> = 0.036) but no long-term difference (3 and 6 months post-discharge, <i>p</i> > 0.05). Chronic phase predicted poor prognosis (vs. acute: OR = 6.55, <i>p</i> = 0.005; vs. subacute: OR = 5.39, <i>p</i> = 0.017).ConclusionsSTN lesions are highly specific for TZAN and may serve as an auxiliary diagnostic indicator. STN hyperintensity is most prominent in elderly TZAN patients in the subacute phase, potentially acting as a subacute-phase imaging marker. Early intervention in subacute TZAN may be critical for improving prognosis.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 4","pages":"3331024261435927"},"PeriodicalIF":5.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147670860","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 effectiveness of anti-CGRP monoclonal antibodies treatment in the prevention of cluster headache attacks: A systematic review and meta-analysis.","authors":"Lukasz Kolakowski, Marie Therese Kleinsorge, Susanne Wegener, Heiko Pohl","doi":"10.1177/03331024261434209","DOIUrl":"10.1177/03331024261434209","url":null,"abstract":"<p><p>BackgroundCluster headache (CH) is one of the most severe types of pain, yet pharmacological treatment options are limited. In the present study, we aimed to systematically evaluate the effect of treatment with monoclonal antibodies (mAbs) blocking calcitonin gene-related peptide (CGRP) in the prevention of episodic cluster headache (eCH) and chronic (cCH) cluster headache.MethodsWe searched Embase, Medline, Cochrane CENTRAL and Web of Science. Included were all clinical trials, case series and single case reports that reported the effects of anti-CGRP treatment on CH. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were used for abstracting data. Risk of bias was evaluated using the Risk of Bias 2 (RoB 2) tool for randomized trials and Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) for non-randomized studies. The collected data from all studies were summarized using descriptive statistics. Data from randomized trials were additionally reported as odds ratio (OR) with 95% confidence interval (CI) using a random-effects meta-analysis. Given the variability in study design and the diverse formats of reported outcome data, we primarily focused on the ≥ 50% responder rate reported closest to the 4-week point following drug administration, which was consistently reported in almost all studies.ResultsFrom 734 identified records, 25 articles were included, comprising a total of 1587 patients. Meta-analysis of randomized, placebo-controlled trials suggests that anti-CGRP treatment had a statistically significant positive effect in eCH (OR = 1.65, 95% CI = 1.07-2.55, <i>p</i> = 0.02), with galcanezumab 300 mg and eptinezumab 400 mg being more effective than placebo in achieving a ≥ 50% responder rate in eCH attacks at the 4-week mark following administration. Simultaneously, a significant mean reduction in weekly attack frequency at week 4 was observed only for galcanezumab 300 mg (<i>p</i> = 0.04). Despite findings from some non-randomized trials, the meta-analysis showed no statistically significant effect in cCH (OR = 1.07, 95% CI = 0.78-1.48, <i>p</i> = 0.68).ConclusionsOur analysis revealed a beneficial effect of anti-CGRP mAbs in eCH, while no effect was observed in cCH. Despite these positive findings, the favourable results with galcanezumab and eptinezumab in eCH should be interpreted with caution due to discrepancies in the outcome data and the challenges associated with selecting endpoints in CH trials. The discrepancy between real-world data and findings from controlled trials further highlights the need for continued discussions among experts to develop more adequate methods for conducting CH trials.Trial RegistrationPROSPERO ID: CRD420250609351.</p>","PeriodicalId":10075,"journal":{"name":"Cephalalgia","volume":"46 4","pages":"3331024261434209"},"PeriodicalIF":5.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147653953","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}