HeadachePub Date : 2025-05-08DOI: 10.1111/head.14949
Álvaro Planchuelo-Gómez, Carmen Martín-Martín, Ángel L Guerrero, David García-Azorín, Rodrigo de Luis-García, Santiago Aja-Fernández
{"title":"Long-term evolution of white and gray matter structural properties in migraine.","authors":"Álvaro Planchuelo-Gómez, Carmen Martín-Martín, Ángel L Guerrero, David García-Azorín, Rodrigo de Luis-García, Santiago Aja-Fernández","doi":"10.1111/head.14949","DOIUrl":"https://doi.org/10.1111/head.14949","url":null,"abstract":"<p><strong>Objective: </strong>To elucidate the specific brain changes linked to clinical diagnoses and distinct temporal progression in migraine.</p><p><strong>Background: </strong>Gray (GM) and white matter (WM) differences were previously identified in chronic migraine (CM) compared to episodic migraine (EM). Regarding GM, patients with CM showed increased cortical thickness in the inferior temporal gyrus, and reduced surface area in the precuneus cortex, superior frontal and temporal gyri, and supramarginal gyrus. In the WM, widespread reduced axial and mean diffusivity have been observed in patients with CM in tracts such as the middle cerebellar peduncle, the internal capsule, the corticospinal tract, and the sagittal stratum. However, no longitudinal studies with a long follow-up have been conducted to comprehend how those differences evolve over an extended period, in relation to the clinical evolution of the disease.</p><p><strong>Methods: </strong>A longitudinal study with a cohort design was conducted. Brain T1- and diffusion-weighted magnetic resonance imaging data were acquired in patients with migraine at two different timepoints, the first between May 2015 and July 2018, and the second between November 2021 and February 2022. Three WM descriptors and four GM morphometry parameters were extracted. Next, longitudinal changes were analyzed using generalized linear mixed models, after considering three different clinical groups: patients with a stable diagnosis (CM or EM) at both timepoints (24 CM, 31 EM), and 24 patients with CM who improved to EM.</p><p><strong>Results: </strong>Different patterns of structural longitudinal changes were found depending on the clinical evolution. Regarding GM, patients with stable EM showed a longitudinal cortical thickness increase in the parietal and temporal cortex (annual relative change between 0.38% and 0.52% in five regions, adjusted p between 0.013 and 0.017), and the postcentral gyrus (annual relative change of 0.37%, adjusted p = 0.014). Patients with stable CM and EM showed a longitudinal cortical thickness decrease in the posterior cingulate gyrus (annual relative change of 0.51%, adjusted p = 0.027, and 0.34%, adjusted-p = 0.019, respectively), and patients who improved from CM to EM showed no changes (corrected p > 0.05). Moreover, regarding WM, the patients with stable EM showed a longitudinal increase in fractional anisotropy in the cerebral peduncle (annual relative change of 0.24%, adjusted p = 0.014).</p><p><strong>Conclusion: </strong>Differences in clinical evolution are linked to distinct patterns of structural changes, suggesting a heterogeneous impact of disease evolution on brain structure. Patients with CM who improved to EM showed no significant GM differences while those with longitudinally stable diagnoses showed cortical thickness maladaptation in pain processing-related regions and adaptation in other regions associated with migraine. Patients who improved from CM to EM ","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993967","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}
HeadachePub Date : 2025-05-08DOI: 10.1111/head.14942
Andrea M Kuczynski, William S Kingston
{"title":"Genetic migraine disorders and the response to calcitonin gene-related peptide antagonist treatment.","authors":"Andrea M Kuczynski, William S Kingston","doi":"10.1111/head.14942","DOIUrl":"https://doi.org/10.1111/head.14942","url":null,"abstract":"<p><p>Calcitonin gene-related peptide (CGRP) is a potent cerebral vasodilator and part of the trigeminal migraine cascade. Newer migraine therapies target CGRP signaling for both acute and preventative management of headache. In this series, we present two cases of genetic conditions, of which migraine is a key feature, responsive to CGRP antagonist therapy. A 31-year-old female with mitochondrial encephalopathy with lactic acidosis and stroke-like episodes and a phenotype of chronic migraine with visual aura, and a 62-year-old female with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy with a phenotype of chronic migraine and side-locked headache with cranial autonomic symptoms. Each experienced a significant reduction in the frequency of their migraine attacks with monoclonal antibody treatment against CGRP. In this case series, we add to the growing body of evidence that CGRP-blocking medications are safe and effective in some heritable neurological disorders in which vasomodulation is a common underlying pathology. To our knowledge, we present the first cases of galcanezumab use in an individual with mitochondrial encephalopathy with lactic acidosis and stroke-like episodes and eptinezumab in an individual with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007445","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":"Second-line pharmacological treatment strategies for trigeminal neuralgia: A retrospective comparison of lacosamide, gabapentin and baclofen.","authors":"Albert Muñoz-Vendrell, Paloma Valín-Villanueva, Raquel Tena-Cucala, Sergio Campoy, Sergio Martínez-Yélamos, Mariano Huerta-Villanueva","doi":"10.1111/head.14952","DOIUrl":"https://doi.org/10.1111/head.14952","url":null,"abstract":"<p><strong>Background and objectives: </strong>Carbamazepine is commonly used as the first-line treatment for trigeminal neuralgia, but therapeutic failure due to adverse effects is frequent. While various second-line alternatives have been suggested, there is limited evidence directly comparing these options. This study aimed to evaluate and compare the effectiveness and tolerability of lacosamide, gabapentin, and baclofen in patients with refractory trigeminal neuralgia.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed patients with trigeminal neuralgia who, after not responding to carbamazepine, were treated with either lacosamide, gabapentin, or baclofen between January 2015 and December 2023. We collected clinical and demographic data and assessed response variables after 3 months of treatment. We compared pain relief (defined as patient-reported pain reduction and absence of additional treatments or emergency consultations within 3 months) and side effects. Secondary endpoints included absence of pain, treatment retention rates, and the need for subsequent surgery.</p><p><strong>Results: </strong>A total of 49 patients were included, with 22 receiving lacosamide, 13 receiving gabapentin, and 14 receiving baclofen. The mean (standard deviation) age was 62.1 (14.1) years, with 53% female, and the median duration since diagnosis was 3.4 years. Carbamazepine failure was attributed to inefficacy in 76% of patients and intolerance in 24%. There were no significant demographic or clinical differences among the treatment groups, except for the concurrent use of carbamazepine: 68% in the lacosamide group, 54% in the gabapentin group, and 100% in the baclofen group (p = 0.019). Pain relief rates were 68% for lacosamide, 54% for gabapentin, and 64% for baclofen (p = 0.694). Adverse effects were reported in 46% of lacosamide, 31% of gabapentin, and 36% of baclofen users (p = 0.664). Complete pain relief was achieved in 36% with lacosamide, 53% with gabapentin, and 21% with baclofen (p = 0.218). The treatment discontinuation rates due to intolerance were 23% for lacosamide, 31% for gabapentin, and 21% for baclofen (p = 0.825).</p><p><strong>Conclusion: </strong>Lacosamide may be a viable second-line treatment option for refractory trigeminal neuralgia, showing comparable outcomes to gabapentin and baclofen.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008721","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}
HeadachePub Date : 2025-05-05DOI: 10.1111/head.14945
Nur Nihal Türkel, Doğa Vurallı, Hayrunnisa Bolay Belen, Aslı Kuruoğlu
{"title":"The association of migraine and autistic traits effects on anxiety, depression, and headache-related disability.","authors":"Nur Nihal Türkel, Doğa Vurallı, Hayrunnisa Bolay Belen, Aslı Kuruoğlu","doi":"10.1111/head.14945","DOIUrl":"https://doi.org/10.1111/head.14945","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to assess the frequency of autistic traits in patients with migraine and to examine the effect of autistic traits on migraine-related disability, as well as anxiety and depressive symptoms, through the mediating factors of anxiety sensitivity and sensory sensitivity.</p><p><strong>Background: </strong>Autism spectrum disorder (ASD) and migraine are two distinct clinical conditions marked by impaired sensory processing. Both conditions induce widespread alterations in the brain and exhibit symptoms associated with sensory sensitivity. Research examining the relationship between migraine and autistic traits is sparse. Moreover, the occurrence of autistic traits in patients with migraine and their effect on headache-related disability and psychiatric comorbidities has not been thoroughly investigated.</p><p><strong>Methods: </strong>This cross-sectional study included 169 patients with migraine and 112 healthy controls. Data collection for the study was conducted from November 2022 to May 2023. The Autism Spectrum Quotient (AQ), Hospital Anxiety and Depression Scale, Anxiety Sensitivity Index, and Dunn Adolescent/Adult Sensory Profile were given to participants. The Headache Impact Test-6 and the Visual Analogue Scale were used to evaluate quality of life and headache intensity for patients with migraine. Analyses examined how autism affects migraine-related disability, anxiety, and depressive symptoms through anxiety and sensory sensitivity.</p><p><strong>Results: </strong>While 35% of patients with migraine were found to have autistic traits (AQ ≥ 23), this rate was found to be 17% in healthy controls. In the migraine group, autistic traits were positively correlated with sensory sensitivity, anxiety sensitivity, and depressive symptoms. Although autistic traits did not have a direct effect on headache-related disability and anxiety symptoms, indirect effects through anxiety sensitivity and sensory sensitivity were found to be significant (total indirect effect = 0.16, 95% confidence interval [CI] = [0.08, 0.25], total indirect effect = 0.24, 95% CI = [0.14, 0.33]). In addition, autistic traits had a direct effect on depressive symptoms. Indirect effects through anxiety sensitivity and sensory sensitivity were also significant (total indirect effect = 0.14, 95% CI = [0.08, 0.21]).</p><p><strong>Conclusions: </strong>This study shows that autistic traits are more frequent among patients with migraine and that these traits exhibit indirect effects on headache-related disability and psychiatric comorbidities. Recognizing autistic traits in patients with migraine may be crucial for formulating methods to mitigate comorbidities and enhance the quality of life in this population.</p><p><strong>Plain language summary: </strong>Autism and migraine are two different conditions that affect the brain and sensory traits. We do not know much about how these two conditions affect each other, so we compared autism","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989168","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}
HeadachePub Date : 2025-05-01Epub Date: 2024-11-27DOI: 10.1111/head.14860
Gregory A Panza, Michael A L Johnson, Deena E Kuruvilla
{"title":"A post hoc analysis of migraine-associated symptoms from the phase 3 randomized, double-blind, sham-controlled Trial of External trigeminal nerve stimulation for the Acute treatment of Migraine (TEAM) study.","authors":"Gregory A Panza, Michael A L Johnson, Deena E Kuruvilla","doi":"10.1111/head.14860","DOIUrl":"10.1111/head.14860","url":null,"abstract":"<p><strong>Background: </strong>The Trial of External trigeminal nerve stimulation (eTNS) for the Acute treatment of Migraine (TEAM) study demonstrated that eTNS use during active migraine resulted in significantly higher rates of resolution of migraine-associated most bothersome symptom (MBS) compared to sham. However, no previous studies have examined the association between pretreatment MBS subtype and efficacy of eTNS treatment for active migraine.</p><p><strong>Objective: </strong>We conducted a post hoc analysis examining efficacy of eTNS for different pretreatment MBS subtypes using TEAM study data.</p><p><strong>Methods: </strong>Pretreatment MBS subtypes included photophobia (n = 345), nausea (n = 109), phonophobia (n = 73), and vomiting (n = 11). We examined MBS sub-group × treatment group (verum n = 259; sham n = 279) interaction for each post-treatment outcome to explore differential effects conditional on the total sample. We further explored direct, between treatment group comparisons for each MBS subtype, as well as compared treatment outcomes among all MBS subtypes within the sham, verum, and total sample. Finally, clinical heterogeneity of treatment effect (HTE) was assessed using a 1% absolute treatment effect difference as the clinically important threshold.</p><p><strong>Results: </strong>Significant sub-group × treatment interactions were found for resolution of MBS at 2 h (p = 0.008), pain relief at 2 h (p = 0.001), rescue medication between 2 and 24 h (p = 0.012), sustained pain freedom at 24 h (p = 0.033), and sustained pain relief at 24 h (p = 0.003). Significant sub-group × treatment interactions were not found for pain freedom at 2 h (p = 0.054) or absence of all symptoms at 2 h (p = 0.265). Between treatment group comparisons indicated that pain freedom after 2 h of eTNS was not significantly different between the verum and sham groups for any pretreatment MBS. The verum group had a significantly greater proportion of participants who had resolution of nausea MBS after 2 h of treatment compared to sham (37/55 [67.3%] vs. 25/54 [46.3%], respectively; p = 0.028) and resolution of photophobia MBS compared to sham (85/162 [52.5] vs. 71/183 [38.8%], respectively; p = 0.011). There were no significant differences between treatment groups for phonophobia or vomiting. Pain freedom after 2 h of eTNS was not significantly different among pretreatment MBS groups. Within the sham group and total sample, a greater proportion of participants who had vomiting MBS had resolution of their MBS compared to any other pretreatment MBS (p < 0.05 after Bonferroni adjustment). A greater proportion of participants with nausea MBS used rescue medications between 2 and 24 h after eTNS compared to participants with photophobia or phonophobia MBS within the verum and total sample (p < 0.05 after Bonferroni adjustment). No statistical differences were found among MBS groups for any other treatment outcomes. Clinically important HTE was present in v","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"779-790"},"PeriodicalIF":5.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12005609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142728018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
HeadachePub Date : 2025-05-01Epub Date: 2024-12-11DOI: 10.1111/head.14885
Tzu-Hsuan Su, Jou-Kou Wang, Ping-Hung Kuo, Shu-Hui Chang, Lih-Chu Chiou, Wang-Tso Lee, Pi-Chuan Fan
{"title":"The pathogenic role of calcitonin gene-related peptide and predictors of new-onset migraine and long-term outcomes after transcatheter atrial septal defect closure.","authors":"Tzu-Hsuan Su, Jou-Kou Wang, Ping-Hung Kuo, Shu-Hui Chang, Lih-Chu Chiou, Wang-Tso Lee, Pi-Chuan Fan","doi":"10.1111/head.14885","DOIUrl":"10.1111/head.14885","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate factors associated with new-onset migraine (NOM) after transcatheter atrial septal defect (ASD) closure and predictors of unremitting NOM. The pathogenic role of migraine biomarkers such as calcitonin gene-related peptide (CGRP) and neuropeptide Y (NPY) were also assessed.</p><p><strong>Background: </strong>New-onset migraine has been observed after transcatheter ASD closure. Neuropeptides like CGRP and NPY stored both in the brain and heart are implicated in migraine pathophysiology. The potential role of those migraine biomarkers in NOM, as well as the risk factors and long-term outcomes of NOM, remain largely unknown.</p><p><strong>Methods: </strong>We enrolled patients without previous migraine who underwent successful transcatheter ASD closure between 2001 and 2013. The parameters of transthoracic echocardiography, and plasma CGRP and NPY levels measured by enzyme-linked immunosorbent assay, were collected prospectively before and after ASD closure, and compared between patients with NOM and those without. Predictors of NOM were assessed. Telephone interviews were performed in 2022 to assess migraine status. Clinical and procedural characteristics were compared between patients with unremitting migraine and those with transient migraine that remitted within 1 year.</p><p><strong>Results: </strong>Of the 212 patients (median age, 21 years; 75.9% female), 43 (20.3%) had NOM. Potential predictors of NOM included a young age (adjusted odds ratio [aOR] 0.98, 95% confidence interval [CI] 0.96-0.99; p = 0.040), large ASD size (aOR 1.07, 95% CI 1.01-1.14; p = 0.022), and transient residual shunting after closure (aOR 2.78, 95% CI 1.05-7.36; p = 0.039). Post-closure plasma CGRP levels, but not NPY levels, were significantly higher than pre-closure levels (47.9 vs. 38.0 pg/mL, p = 0.023) among patients with NOM. Of the 27 patients with migraine who reported their migraine status at a median 14-year follow-up, 13 (48.1%) had unremitting migraine. Patients with unremitting migraine were more likely to have a smaller device-to-ASD size ratio (1.21 vs. 1.33, p = 0.039) and a larger pulmonary flow-to-systemic flow ratio (2.9 vs. 2.3, p = 0.012) than those with transient migraine.</p><p><strong>Conclusions: </strong>Calcitonin gene-related peptide may play a pathogenic role in NOM after transcatheter ASD closure. A young age, large ASD size, and transient residual shunting potentially predict migraine occurrence after ASD closure. NOM not reaching remission for years may result from a significant shunt before closure.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"791-801"},"PeriodicalIF":5.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806891","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}
HeadachePub Date : 2025-05-01Epub Date: 2024-12-10DOI: 10.1111/head.14881
Ming-Gang Deng, Xiuxiu Zhou, Fang Liu, Kai Wang, Lingli Luo, Min-Jie Zhang, Qianqian Feng, Jiewei Liu
{"title":"Investigating the causal and genetic relationship between migraine and Parkinson's disease.","authors":"Ming-Gang Deng, Xiuxiu Zhou, Fang Liu, Kai Wang, Lingli Luo, Min-Jie Zhang, Qianqian Feng, Jiewei Liu","doi":"10.1111/head.14881","DOIUrl":"10.1111/head.14881","url":null,"abstract":"<p><strong>Objective: </strong>The relationship between migraine and Parkinson's disease (PD) remains controversial. We aimed to investigate the causal and genetic associations between migraine and PD.</p><p><strong>Methods: </strong>Genetic data for migraine [any migraine (AM), migraine without aura (MO), and migraine with aura (MA)] and PD were sourced from the latest genome-wide meta-analyses conducted by the International Headache Genetics Consortium and the International Parkinson's Disease Genomics Consortium, respectively. Various analyses were performed to evaluate the potential causal associations and explore genetic correlations between these conditions.</p><p><strong>Results: </strong>The analyses indicated that AM (odds ratio [OR] 1.02, 95% confidence interval [CI] 0.91-1.14; p = 0.785), MO (OR 0.94, 95% CI 0.84-1.07; p = 0.358), and MA (OR 1.01, 95% CI 0.95-1.06; p = 0.846) were not significantly associated with the risk of PD. Similarly, reverse analyses also demonstrated no significant causality between PD and the risks of migraine or its subtypes. After adjusting for coronary heart disease, AM (OR 0.99, 95% CI 0.90-1.10; p = 0.897), MO (OR 0.94, 95% CI 0.86-1.03; p = 0.207), and MA (OR 1.00, 95% CI 0.93-1.07; p = 0.902) remained unrelated to PD risk. Likewise, PD was found to be unassociated with AM (OR 0.96, 95% CI 0.92-1.02; p = 0.168), MO (OR 0.95, 95% CI 0.86-1.05; p = 0.287), and MA (OR 1.02, 95% CI 0.93-1.13; p = 0.669). These null findings persisted even when adjusting for hypertension. Apart from above causal inference results, no significant genetic correlation was found between AM (r<sub>g</sub> = -0.06, p = 0.127), MA (r<sub>g</sub> = -0.05, p = 0.516), or MO (r<sub>g</sub> = -0.06, p = 0.492) and PD, and no correlations were observed across specific genomic regions. Additionally, no shared heritability was observed between PD and migraine, or its subtypes, in tissue expression.</p><p><strong>Conclusion: </strong>Our study suggests that there is no significant causal association or genetic correlation between migraine and PD from a genetic perspective.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"835-844"},"PeriodicalIF":5.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806887","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}
HeadachePub Date : 2025-05-01Epub Date: 2025-03-19DOI: 10.1111/head.14933
Daniela A Godoi Gonçalves
{"title":"From adolescence to adulthood: The role of dietary quality in headache and temporomandibular disorder risks.","authors":"Daniela A Godoi Gonçalves","doi":"10.1111/head.14933","DOIUrl":"10.1111/head.14933","url":null,"abstract":"","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"729-730"},"PeriodicalIF":5.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656940","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}
HeadachePub Date : 2025-05-01Epub Date: 2025-01-17DOI: 10.1111/head.14887
Kaiden Jobin, Ashley Smith, Christina Campbell, Siobhan M Schabrun, Jean-Michel Galarneau, Kathryn J Schneider, Chantel T Debert
{"title":"The safety and feasibility of transcranial direct current stimulation and exercise therapy for the treatment of cervicogenic headaches: A randomized pilot trial.","authors":"Kaiden Jobin, Ashley Smith, Christina Campbell, Siobhan M Schabrun, Jean-Michel Galarneau, Kathryn J Schneider, Chantel T Debert","doi":"10.1111/head.14887","DOIUrl":"10.1111/head.14887","url":null,"abstract":"<p><strong>Objective: </strong>Our primary objective was to evaluate the safety and feasibility of transcranial direct current stimulation combined with exercise therapy for the treatment of cervicogenic headache. Our exploratory objectives compared symptoms of headache, mood, pain, and quality of life between active and sham transcranial direct stimulation combined with exercise therapy.</p><p><strong>Background: </strong>Cervicogenic headache arises from injury to the cervical spine or degenerative diseases impacting cervical spine structure resulting in pain, reduced quality of life, and impaired function. Current standard-of-care treatments such as radiofrequency ablation, pharmacotherapy, manual therapy, and exercise therapy lack efficacy for some patients. Transcranial direct current stimulation is a neuromodulation technique that has shown promise in treating chronic pain conditions by positively altering neuronal activity but has not been evaluated as treatment for cervicogenic headache.</p><p><strong>Methods: </strong>This double-blind, sham-controlled, randomized, feasibility trial recruited 32 participants between the ages of 18 and 65 years that met the International Classification of Headache Disorders third edition criteria for cervicogenic headache. Participants were randomized to receive either active or sham transcranial direct current stimulation both combined with daily exercise therapy over 6 weeks. Transcranial direct current stimulation was applied over the primary motor cortex ipsilateral to worse pain for 20 min at 2 mA with a 30 s ramp up/down period. Recruitment, retention, and adherence were evaluated for feasibility. Safety was assessed through serious and minor adverse events and an adverse effect questionnaire. Clinical outcome measures assessed headache, pain, quality of life, and mood symptoms at pre-treatment, post-treatment, and 6- and 12-weeks post-treatment.</p><p><strong>Results: </strong>A total of 97 participants were contacted to participate with 32 recruited, 16 randomized into each group, and 14 completing the treatment protocol in both groups. Within each group 12 (active) and nine (sham) completed treatment within the proposed 6 weeks (three sessions per week), others received 18 sessions but took longer. Exercise therapy was completed on an average of 87% of days for both groups. Transcranial direct current stimulation was safe, with no serious adverse events and one minor adverse event in the active group. Itching was a more common post-intervention complaint in the active group (64% active vs. 43% sham). Exploratory analysis revealed significant group × time interactions for average headache pain from pre- to post-treatment (β = -1.012, 95% confidence interval [CI] -1.751 to -0.273; p = 0.008), 6-weeks (β = -1.370, 95% CI -2.109 to -0.631; p < 0.001), and 12-weeks (β = -1.842, 95% CI -2.600 to -1.085; p < 0.001) post-treatment, and for neck pain from pre- to post-treatment (β = -1.184, 95% CI -2.076 ","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"845-862"},"PeriodicalIF":5.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12005617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}