Headache最新文献

{"title":"Subspecialty headache clinic visit reduced healthcare utilization in patients with migraine: Single institution retrospective cohort study.","authors":"Megan Trenz, Raja Narendra Divakar Addanki, Jason Raad, Robert Kaniecki, Janel Hanmer, Manisha Jhamb, Wesley T Kerr, Parthasarathy D Thirumala","doi":"10.1111/head.70220","DOIUrl":"https://doi.org/10.1111/head.70220","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate whether care in a subspecialty headache center, compared with a general neurology clinic, was associated with lower 90-day unplanned healthcare utilization (HCU) in patients with migraine and to identify patient-level factors associated with higher unplanned HCU.</p><p><strong>Background: </strong>Migraine is a common, disabling condition that frequently prompts emergency department (ED) evaluation and treatment. It ranks among the leading global causes of years lived with disability and imposes a substantial financial burden. People with migraine are most often managed in general neurology clinics rather than in specialty centers. Subspecialty headache centers can offer more advanced and guideline-based care, but their impact on post-visit HCU is not well defined.</p><p><strong>Methods: </strong>This was a retrospective cohort study of adults with a migraine diagnosis cared for at the University of Pittsburgh Medical Center from 2018 to 2023. Unplanned HCU was defined as any ED visit, urgent care encounter, or hospital admission within 90 days after the index outpatient general neurology or subspecialty headache center visit (first qualifying migraine-coded encounter in the study period). Associations between clinic type and unplanned HCU were evaluated with adjustment for age, sex, race, ethnicity, insurance, Area Deprivation Index, and comorbidities, and, in a subset with available data, Patient-Reported Outcomes Measurement Information System 16-item Profile (PROMIS-16) domains.</p><p><strong>Results: </strong>Of 38,472 patients included, 16,209 (42.1%) were evaluated in the subspecialty headache center. Total 90-day unplanned HCU was 12.6% in the subspecialty headache center vs. 15.4% in general neurology clinics (p < 0.001). Subspecialty headache center evaluation was associated with 15% lower odds of unplanned HCU (adjusted odds ratio [aOR] = 0.85, 95% confidence interval [CI]: 0.79-0.90, p < 0.001). The association remained after accounting for patient characteristics (aOR = 0.87, 95% CI: 0.81-0.92) and PROMIS-16 domains (aOR = 0.67, 95% CI: 0.59-0.76). Higher unplanned HCU was also associated with younger age at diagnosis, Medicaid and Medicare insurance/coverage, non-White races, comorbidities like chronic obstructive pulmonary disease, hypertension, and worse pain interference and physical function scores.</p><p><strong>Conclusion: </strong>Evaluation in a subspecialty headache center was associated with approximately 15% lower odds of 90-day unplanned HCU. Subspecialized migraine care may represent a high-value care model.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192947","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 MIND study: Design, feasibility, and baseline characteristics of a smartphone-based migraine cohort.","authors":"Babak Khorsand, Devin Teichrow, Richard B Lipton, Ali Ezzati","doi":"10.1111/head.70244","DOIUrl":"https://doi.org/10.1111/head.70244","url":null,"abstract":"<p><strong>Objectives/background: </strong>Our objective was to describe the design, feasibility, and baseline characteristics of the Migraine Impact on Neurocognitive Dynamics study, a 30-day smartphone-based, prospective, decentralized, observational cohort study evaluating high-frequency assessment of cognition and symptoms in adults with migraine. Cognitive symptoms are an important component of migraine burden, but they are difficult to measure using single-visit testing or retrospective questionnaires. Repeated smartphone-based assessments may better capture real-world variability in cognition and symptoms.</p><p><strong>Methods: </strong>Adults meeting International Classification of Headache Disorders, 3rd edition, criteria for migraine were enrolled remotely and completed 30 days of once-daily ecological momentary assessments and mobile cognitive tasks delivered through the Mobile Monitoring of Cognitive Change platform. Baseline measures assessed demographics, migraine characteristics, disability, mood, stress, and treatment patterns. Feasibility was evaluated using enrollment, completion, and retention metrics.</p><p><strong>Results: </strong>A total of 177 participants enrolled nationwide across the United States (mean age 38.8±11.9 years; 79.7% female), including 80 (45.2%) with chronic migraine. Across the 30-day protocol, 3688 daily assessments were completed, representing 69.5% of all possible study days, and 70.6% of participants completed at least 20 days of monitoring. Completion remained >60% across study days. At baseline, chronic migraine was associated with greater burden than low-frequency and high-frequency episodic migraine, including higher Migraine Disability Assessment Scale scores (98.6 vs. 38.7 and 70.3), more days with concentration difficulty (16.0 vs. 7.6 and 13.0), and more days with functional interference (18.5 vs. 7.9 and 11.5).</p><p><strong>Conclusion: </strong>The Migraine Impact on Neurocognitive Dynamics study demonstrates the feasibility of high-frequency smartphone-based assessment of cognition and symptoms in migraine and provides a methodological foundation for future analyses of within-person cognitive and symptom dynamics across the migraine cycle.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181247","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":"Plasma amylin levels in migraine and after erenumab treatment: A REFORM study.","authors":"Rogelio Domínguez-Moreno, Tyla I Alexander, William K Karlsson, Haidar M Al-Khazali, Michael L Garelja, Rune H Christensen, Messoud Ashina, Debbie L Hay, Håkan Ashina","doi":"10.1111/head.70193","DOIUrl":"https://doi.org/10.1111/head.70193","url":null,"abstract":"<p><strong>Objective: </strong>To investigate whether plasma amylin concentrations differ between adults with migraine and healthy controls (HCs) and whether baseline or longitudinal amylin levels are associated with treatment response to erenumab.</p><p><strong>Background: </strong>Amylin is a calcitonin family peptide closely related to calcitonin gene-related peptide, with overlapping receptor pharmacology, and has been implicated in migraine. Human provocation studies have shown that pramlintide, an amylin analogue, triggers migraine attacks, but it remains unclear whether plasma amylin distinguishes people with migraine from HCs, varies across migraine subtypes, predicts response to erenumab, or changes during treatment.</p><p><strong>Methods: </strong>This prospective longitudinal analysis was conducted within the Registry for Migraine study at the Danish Headache Center (Copenhagen, Denmark). Adults with migraine (≥4 monthly migraine days) and age- and sex-similar HCs were enrolled between September 2020 and June 2022. Plasma samples were collected under standardized conditions at baseline and after 24 weeks of erenumab treatment (140 mg every 4 weeks). Treatment response was defined as a ≥50% reduction in monthly migraine days during weeks 13 to 24 compared with baseline. Plasma amylin was quantified from November 2023 to March 2024 using a competitive immunoassay that was selected after head-to-head kit validation, which included assessment of parallelism and spike recovery with human plasma.</p><p><strong>Results: </strong>A total of 121 adults with migraine and 63 HCs were enrolled; 100 participants with migraine completed 24 weeks of erenumab treatment and provided evaluable efficacy data. At baseline, plasma amylin concentrations were not significantly different between erenumab responders (n = 55) and nonresponders (n = 45) (9.0 ± 2.3 vs. 8.6 ± 1.7 ng/mL; p > 0.999), and concentrations of both groups were not statistically significantly different from HCs (9.2 ± 1.7 ng/mL; p > 0.999 and p = 0.220, respectively). At 24 weeks, plasma amylin concentrations did not differ significantly between responders and nonresponders (8.8 ± 2.2 vs. 8.3 ± 2.1 ng/mL; p = 0.676). In paired analyses (n = 100), plasma amylin levels did not change from baseline to week 24 (p = 0.208). Baseline plasma amylin concentrations did not differ across migraine subgroups (episodic vs. chronic, with aura vs. without aura, ictal vs. interictal) and were not associated with key clinical variables.</p><p><strong>Conclusion: </strong>Plasma amylin levels did not differ between adults with migraine and HCs, across clinically relevant migraine subgroups, or by response to erenumab. These findings do not support plasma amylin as a clinically useful disease or treatment-response biomarker and are consistent with the broader concept that migraine-relevant peptidergic signaling may be compartmentalized and not captured by peripheral venous blood sampling.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181255","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 disorders among Indigenous communities: A scoping review undertaken with knowledge keeper guidance.","authors":"Maia Kelly, Candice M Todd, Ojistoh Kahnawahere Horn, Emily Simmonds, Diane Longboat, Cynthia White, Suvendrini Lena","doi":"10.1111/head.70235","DOIUrl":"https://doi.org/10.1111/head.70235","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We performed a scoping review of literature on headache etiology, classification, prevalence, and treatment in Indigenous communities in Canada, the United States, Australia, and New Zealand.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In the United States, analysis of national prevalence indicates that Indigenous Americans lead all other racial/ethnic groups in headache prevalence. Risk factors associated with headache burden, including diabetes, head injury, psychological trauma, environmental exposures, and lack of access to appropriate diagnosis and treatment, have been documented in Indigenous communities across the geographies studied.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic search of literature in PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, and Informit Indigenous Collection was conducted through January 2026 using descriptors of headache, migraine, and Indigenous populations across Canada, the United States, Australia, and New Zealand. Of the 616 citations identified, 30 publications from 1981 to 2024 were included in the present review and analyzed under the following areas of inquiry: (1) headache classification, (2) headache etiology, (3) headache prevalence, (4) headache treatment, and (5) barriers to headache care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Analysis of national data in the United States indicates a higher prevalence of headache in Indigenous communities in comparison to all other communities. In Canada, evidence from smaller studies suggests a similar pattern. Prevalence data for Indigenous communities in Australia and New Zealand remains limited. Ethnographic data and expert informant data from Indigenous communities demonstrate conceptualization and treatment of headaches within biopsychosocial models that relate individuals to the life of their community and land. There were no data from medical headache treatment trials or intervention studies specific to or inclusive of Indigenous patients with headache. Barriers to headache care for Indigenous peoples were identified prior to diagnosis, at the point of assessment, and in treatment. Addressing these barriers demands system level changes as well as development of individual relations of respect and care for Indigenous patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Included studies from Canada, the United States, Australia, and New Zealand reported a high prevalence of headache in some Indigenous communities and suggest that this burden may result from or be associated with a combination of intergenerational trauma, adverse childhood experiences, lower socioeconomic status, head injury, environmental contaminants, and systemic racism resulting in barriers to diagnosis and care. Despite this apparent burden, the literature reveals a paucity of quality, headache-specific research conducted with Indigenous peoples across all four regions of study. To close gaps in headache diagnosis, treatment, and prevention, research and","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171363","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":"Pregnancy outcomes following exposure to galcanezumab: Analysis of cases from the galcanezumab clinical trials and postmarketing database.","authors":"Irene Boz, Jan Lewis Brandes, Christopher Robinson, Maria Fernanda Scantamburlo Fernandes, Sarah Lipsius, LaRonda Morford, Enemona Emmanuel Adaji, Anaclara Prada Jardim, Holland C Detke","doi":"10.1111/head.70242","DOIUrl":"https://doi.org/10.1111/head.70242","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study was conducted to describe pregnancy outcomes reported following maternal or paternal exposure to galcanezumab in clinical trials and postmarketing surveillance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Galcanezumab is a calcitonin gene-related peptide-inhibiting monoclonal antibody indicated for the preventive treatment of migraine. This long-acting injectable medication has a half-life of 27 days. Despite high migraine prevalence in women during their childbearing years, information on the use of migraine preventive medications during pregnancy is limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This is a pooled analysis of clinical trial data with a descriptive case series from a pharmacovigilance database. First, all completed phase 1-3 galcanezumab clinical trials were searched for cases of pregnancy. Additionally, the manufacturer's worldwide safety database was searched for all postmarketing reports of galcanezumab-exposed pregnancy through September 27, 2024. Maternal and fetal outcomes, trimester of exposure, and maternal risk factors were evaluated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In all, 52 pregnancies with maternal or paternal exposure were identified in 12 clinical trials, and 426 were identified in postmarketing reports. In clinical trials, pregnancy exposure to the full therapeutic galcanezumab concentration did not exceed the first trimester. Because of its long half-life, subtherapeutic galcanezumab concentrations persisted into the second trimester in 16 of 30 maternal exposures. The exposure pattern was similar in postmarketing reports when information on the timing of dosing and conception was available, with 88 of 108 confirmed maternal exposures at therapeutic concentrations during the first trimester only, and 34 of 47 confirmed maternal exposures at subtherapeutic concentrations during the first and second trimester. Among pregnancies with reported outcomes, live births were recorded in 22 of 34 clinical trial pregnancies and 62 of 108 postmarketing pregnancies. Among pregnancies with available fetal outcome data, normal fetal outcomes were reported in 21 of 22 clinical trial pregnancies and 56 of 76 postmarketing pregnancies. Preexisting maternal risk factors were identified in 11 of 14 preterm births (three from clinical trials and 11 from postmarketing) and 23 of 44 spontaneous abortions (three from clinical trials and 41 from postmarketing). Nine cases of major congenital anomaly were identified among postmarketing cases, with none identified in clinical trials. Among these nine cases, no consistent pattern of system organ class involvement was observed, and five of the nine anomalies had a one or more relevant maternal risk factor.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Based on the available data from this pooled analysis, this review did not identify any qualitative safety signal suggesting a causal relationship between galcanezumab exposure and adverse maternal or fetal outcomes. Because exp","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148077","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":"Perceived headache responses to exercise in patients with migraine: A cross-sectional study.","authors":"Young-Eun Gil, Mi Ji Lee","doi":"10.1111/head.70208","DOIUrl":"https://doi.org/10.1111/head.70208","url":null,"abstract":"<p><strong>Objective: </strong>To characterize patient-perceived headache responses to exercise in migraine and to identify associated clinical factors using a large-scale registry.</p><p><strong>Background: </strong>Regular exercise is often recommended for patients with migraine; however, it can also trigger migraine attacks. This complex effect makes it challenging for both patients and clinicians to determine the appropriate role of exercise in migraine management.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey of patients with migraine who visited the headache clinic of a university hospital in Seoul, South Korea, between October 2022 and December 2024. Based on the responses to a structured questionnaire, patients were classified into four mutually exclusive groups: no-association, provocation, headache-improvement-during-exercise, and headache-worsening-without exercise. Self-reported headache responses to exercise were further analyzed according to monthly headache days (low-frequency episodic migraine [LFEM]: 0-7 days/month, high-frequency episodic migraine [HFEM]: 8-14 days/month, and chronic migraine [CM]: ≥15 days/month).</p><p><strong>Results: </strong>A total of 1828 patients responded to the survey. Among them, 883 (48.3%) reported no association between exercise and headache, 443 (24.2%) reported provocation, 457 (25.0%) reported headache improvement during exercise, and 45 (2.5%) reported headache worsening without exercise. The perceived likelihood of exercise-related headache provocation was greater among patients with more frequent headaches; compared with LFEM, both HFEM (adjusted odds ratio [aOR] 1.71, 95% confidence interval [CI] 1.19-2.46) and CM (aOR 2.50, 95% CI 1.88-3.31) were associated with greater odds of provocation. Younger age, higher migraine burden (HFEM, CM), the presence of allodynia (Allodynia Symptom Checklist-12 item ≥ 3), and self-reported anxiety were independently associated with exercise-related headache provocation. Headache improvement during exercise was associated with older age, CM (vs. LFEM, aOR 1.42, 95% CI 1.09-1.86), and self-reported anxiety (aOR 1.58, 95% CI 1.12-2.25).</p><p><strong>Conclusions: </strong>Perceived headache responses to exercise are highly heterogeneous and vary according to migraine burden and clinical characteristics. These findings underscore the importance of individualized clinical counseling over uniform exercise recommendations in migraine management.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148402","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":"Opioid use, disability, and patient-reported cognitive impairment in migraine: Multi-country results from the Chronic Migraine Epidemiology and Outcomes-International Study.","authors":"Elizabeth Leroux, Dawn C Buse, Michel Lanteri-Minet, Fumihiko Sakai, Manjit Matharu, Zaza Katsarava, Kristina M Fanning, Karen Carr, Nicole Naccara, Janette Contreras-De Lama, Richard B Lipton","doi":"10.1111/head.70241","DOIUrl":"https://doi.org/10.1111/head.70241","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To characterize the population who do and do not use opioids to treat migraine in the Chronic Migraine Epidemiology and Outcomes-International (CaMEO-I) Study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Opioids are not recommended for migraine treatment because of efficacy and safety limitations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was a post hoc analysis of CaMEO-I, an international, cross-sectional, observational, Web-based survey conducted in six countries from 2021 to 2022. Migraine status was determined by applying modified International Classification of Headache Disorders, 3rd edition, criteria, using a validated diagnostic questionnaire. Opioid users were defined as those who used opioids or kept them on hand to treat headache over the previous 30 days. Disability was assessed with the MIDAS, patient-reported cognitive impairment with the Migraine Cognitive Impairment Questionnaire (MCIQ), and acute treatment optimization with the Migraine Treatment Optimization Questionnaire (mTOQ). Multivariable binary logistic regression models evaluated the association between current opioid use and headache-related disability. Odds ratios (ORs) were adjusted for age, gender at birth, current consultation with a headache specialist, education, employment status, and treatment optimization.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 12,612 respondents with migraine who used prescription or over-the-counter medication for acute treatment of headaches (mean age, 41.8 years; 71.3% female) were included; 23.5% (2965/12,612) used opioids. Rates of opioid use for migraine ranged from 6.3% (127/2023) in Japan to 37.2% (814/2186) in France. The proportions of respondents with moderate to severe disability were higher among opioid users than nonusers at each level of treatment optimization on the mTOQ (very poor [64.7% {123/190} vs. 49.7% {373/750}], poor [62.6% {1110/1772} vs. 46.5% {2208/4747}], moderate [51.0% {338/663} vs. 35.6% {824/2314}], maximum [38.8% {132/340} vs. 19.9% {366/1836}]). Poorer treatment optimization was associated with significantly greater odds of moderate to severe disability (p &lt; 0.001), and opioid use was associated with increased disability across all countries (p &lt; 0.001). Opioid users had higher median (interquartile range [IQR]) patient-reported cognitive impairment scores on the MCIQ than nonusers (61.1 [44.4, 83.3] vs. 50.0 [33.3, 72.2], p &lt; 0.001). Higher proportions of opioid users than nonusers had one or more doctor visits (49.3% [1462/2965] vs. 20.3% [1960/9647]), emergency department/urgent care visits (14.4% [426/2965] vs. 3.5% [336/9647]), and hospital stays (19.4% [571/2949] vs. 4.9% [472/9617]) for headache during the past 6 months (p &lt; 0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Among CaMEO-I respondents with migraine, opioid users were more likely to have moderate or severe disability and patient-reported cognitive impairment, although causality cannot be determined from cross-sectional analys","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149258","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":"Taking the LEAD in headache advocacy: Focus on migraine at school.","authors":"Kaitlin Greene, Scott B Turner","doi":"10.1111/head.70239","DOIUrl":"https://doi.org/10.1111/head.70239","url":null,"abstract":"","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136338","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 among patients undergoing cardiac stress testing: Prevalence, clinical characteristics, and identification of myocardial ischemia.","authors":"Sanjay Prakash, Cinosh Mathew, Manju Yadav, Chaturbhuj Rathore, Varoon Vadodaria","doi":"10.1111/head.70221","DOIUrl":"https://doi.org/10.1111/head.70221","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Cardiac cephalalgia is an uncommon secondary headache disorder caused by myocardial ischemia and may occur with or without typical anginal symptoms. Most available literature consists of isolated case reports, and data regarding its prevalence among patients undergoing evaluation for coronary artery disease (CAD) are limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To determine the prevalence and clinical characteristics of headache among patients undergoing treadmill stress test(ing) (TMT) and to identify patients with cardiac cephalalgia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This cross-sectional study with a nested case series was conducted in the cardiology-stress testing laboratory of a tertiary care teaching hospital in Western India between August 2024 and January 2026. Consecutive adult patients undergoing TMT were screened. Demographic characteristics, cardiovascular symptoms, headache history, cardiovascular risk factors, stress-test findings, laboratory investigations, and cardiac evaluations were recorded. Patients developing headache during TMT underwent detailed assessment for cardiac cephalalgia according to the International Classification of Headache Disorders, 3rd Edition (ICHD-3) based on clinical criteria. Clinical characteristics of patients with cardiac cephalalgia were compared with those of patients with other exertional headaches.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 243 patients underwent TMT during the study period. After exclusion of 22 patients, 221 patients were included in the final analysis. Sixty-nine of 221 patients (69/221, 31.2%) had a positive TMT suggestive of myocardial ischemia. Overall, headache occurred in 21/221 (9.5%; 95% confidence interval [CI], 6.0%-14.1%) patients, including 8/69 (11.6%) TMT-positive patients and 13/152 (8.6%) TMT-negative patients. Cardiac cephalalgia fulfilling ICHD-3 diagnostic criteria was identified in 8/221 (3.6%; 95% CI, 1.6%-7.0%) patients, representing 8/69 (11.6%; 95% CI, 5.1%-21.6%) of TMT-positive patients and 8/21 (38.1%; 95% CI, 18.1%-61.6%) patients reporting headache. Patients with cardiac cephalalgia had a mean age of 63.9 ± 5.8 years, and 75% (6/8) of patients were male. Seven of eight patients (7/8; 87.5%) reported headache episodes during the preceding 3 months, including three with occasional exertional headaches; however, none sought medical attention because of headache. All patients developed their characteristic headache during TMT in association with ischemic electrocardiograph (ECG) changes. Four of eight patients (4/8; 50%) did not report typical anginal chest pain. Compared with patients with other exertional headaches, patients with cardiac cephalalgia were older and had a greater burden of cardiovascular risk factors and adverse cardiometabolic profiles in these exploratory analyses. Coronary angiography demonstrated significant CAD in all eight patients. At the 8-week follow-up, headache resolved completely in 7/8 (87.5%) pat","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136289","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 evidence of aquaporin-4 dysregulation and neuroinflammatory stress underlying blood-brain barrier dysfunction in idiopathic intracranial hypertension: A case-control study.","authors":"Vaishali Sharma, Jitender Singh, Pramod Avti, Shiv Lal Soni, Aastha Takkar, Swapnajeet Sahoo, Sucharita Ray, Kamalesh Chakravarty","doi":"10.1111/head.70232","DOIUrl":"https://doi.org/10.1111/head.70232","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate aquaporins (AQP), heat shock proteins (HSP), and CD146 (cluster of differentiation) as molecular markers of blood-brain barrier (BBB) disruption and neuroinflammation in idiopathic intracranial hypertension (IIH).</p><p><strong>Background: </strong>Emerging evidence implicates BBB dysfunction and neuroinflammation, yet their mechanistic basis in IIH is unclear.</p><p><strong>Methods: </strong>In this case-control study with cross-sectional exposure ascertainment, conducted in Postgraduate Institute of Medical Education and Research, Chandigarh, India, from March 2023 to September 2024, newly diagnosed patients with IIH and age- and sex-matched healthy individuals undergoing spinal anesthesia for non-neurological disease anesthesia controls (AC) and age- and sex-matched healthy controls (HC) were enrolled. Protein levels of AQPs and gene expression of HSPs and CD146 were quantified in blood and cerebrospinal fluid (CSF) and correlated with clinical features and severity.</p><p><strong>Results: </strong>Patients with IIH were predominantly female (87%), with mean body mass index (BMI) 28.1 ± 5.2 kg/m² and mean CSF opening pressure 27.4 ± 4.8 cm CSF. Patients with IIH demonstrated reduced AQP4_CSF levels as compared to AC group (2.65 [2.09, 3.70] vs. 3.07 [1.65, 7.15], p = 0.016) and increased gene expression of HSP70_Blood as compared to AC and HC (3.86 [1.02, 5.61] vs. 1.08 [0.78, 2.91] vs. 1.77 [0.43, 2.27], p = 0.002); increased gene expression of HSP60_CSF as compared to AC (1.28 [0.37, 2.44] vs. 0.52 [0.23, 1.26], p = 0.038); and increased gene expression of CD146_Blood as compared to AC and HC (1.27 [0.50, 4.29] vs. 0.53 [0.35, 1.36] vs. 0.91 [0.58, 1.70], p = 0.008). HSP70_CSF, HSP60_Blood, and CD146_Blood corelated positively with Headache Impact Test-6 (HIT-6) and MIDAS scores (ρ = 0.41, p = 0.01; ρ = 0.34, p = 0.032; ρ = 0.35, p = 0.029, ρ = 0.35) indicating an association with disease severity.</p><p><strong>Conclusion: </strong>The findings provide molecular evidence of BBB disruption and neuroinflammatory pathway involved in the pathophysiology of IIH.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127243","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}