Headache最新文献

{"title":"Telemedicine is effective and safe for clinical management of patients with headache disorders: An American Headache Society position statement.","authors":"Karissa N Arca, Allyson B Bazarsky, Derek Y Yuan, Raissa Villanueva, Deborah I Friedman, Andrew Charles","doi":"10.1111/head.15084","DOIUrl":"https://doi.org/10.1111/head.15084","url":null,"abstract":"<p><strong>Objectives/background: </strong>This study was undertaken to review the published literature and provide a position statement from the American Headache Society regarding the safety, efficacy, and impact on access to care of telemedicine for the clinical management of patients with headache disorders. Access to specialized care in headache medicine is severely limited in the United States and worldwide. Telemedicine has been used as an approach to care delivery in headache medicine for more than a decade, with accelerated adoption during the COVID-19 pandemic. There is now uncertainty regarding the extent to which telemedicine will be accepted by health systems and reimbursed by payers moving forward. The purpose of this position statement is to summarize evidence and clinical experience supporting the utility of telemedicine in headache medicine.</p><p><strong>Methods: </strong>Evidence regarding the safety and efficacy of telemedicine, and patient and clinician satisfaction with the use of telemedicine for headache specialty care, was gathered from a variety of sources, including PubMed, Google Scholar, and ClinicalTrials.gov. The results and conclusions based upon these results were reviewed and discussed by the authors and the Board of Directors of the American Headache Society to confirm consistency with clinical experience and to achieve consensus.</p><p><strong>Results: </strong>Several randomized clinical trials and observational studies have been performed to compare telemedicine with in-person visits in the management of patients with headache disorders. These studies showed consistently that telemedicine is noninferior to in-person care based upon multiple outcome measures, including disability measures, patient satisfaction, and clinician satisfaction. In addition, these studies found that telemedicine rarely leads to a missed diagnosis of secondary headache or mismanagement of primary headache. Telemedicine has substantial advantages for patients, including improved access to care and reduced costs associated with obtaining care. Studies evaluating health care utilization indicate no significant differences between patients evaluated and treated virtually versus in person. Obvious limitations of telemedicine include the inability to perform an in-person physical exam or to perform injections. For a substantial number of patients, however, these limitations are outweighed by its advantages. The experience with telemedicine reported in the literature is consistent with the experience of the Board of Directors of the American Headache Society, who endorse its use for patients when feasible and appropriate.</p><p><strong>Conclusion: </strong>Telemedicine has significantly advanced the care of patients with headache disorders. Its further development and deployment should be supported and reimbursed.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145299723","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":"Migraine and patent foramen ovale: correlation, coexistence, dependence. A narrative review.","authors":"Olga Grodzka, Michał Borończyk, Anna Zduńska, Julia Węgrzynek-Gallina, Izabela Domitrz, Anetta Lasek-Bal","doi":"10.1111/head.15067","DOIUrl":"https://doi.org/10.1111/head.15067","url":null,"abstract":"<p><strong>Objective: </strong>This review was conducted to analyze the current knowledge on the topic of the relation between migraine and patent foramen ovale (PFO) and indicate the most crucial clinical implications.</p><p><strong>Background: </strong>Migraine is a primary headache disorder that affects a significant part of the global population. Importantly, it has been considered a risk factor for ischemic stroke, especially in women with migraine with aura. The foramen ovale is a physiological opening in the atrial septum formed during fetal life, which closes in most people in the first year after birth. However, in some people, it can be present in adulthood and is called the patent foramen ovale. PFO is more likely to occur in patients with migraine compared to the population not experiencing migraine headaches.</p><p><strong>Methods: </strong>Two review teams, comprising migraine experts and stroke experts, were engaged in the screening process, resulting in the inclusion of 204 relevant publications. To be considered for inclusion, an article had to directly cover the topic of PFO or migraine.</p><p><strong>Results: </strong>In the following work, we have focused on several aspects regarding the direct and indirect relationship between migraine and PFO. Although analyzing migraine pathogenesis, apart from the straight link between PFO and migraine, others are also considered, such as a prominent Eustachian valve or Chiari valve, causing a high-risk PFO or a paradoxical embolism. Regarding the clinical practice, the prevalence of PFO and migraine, indications for exact therapies, and subsequently, neuroimaging in the view of PFO and migraine, have been scrutinized. Another crucial aspect of this review is the risk of stroke in patients with migraine, considering the PFO presence. It is suggested that patients with migraine have more vascular lesions on magnetic resonance imaging and more often experience strokes. Thus, the question arises whether PFO should be closed as stroke prophylaxis in every migraine patient.</p><p><strong>Conclusions: </strong>Several aspects have been explored; however, more research is needed to draw clear conclusions with further indications for clinical practice. Nevertheless, it seems that not in all patients with migraine with PFO should the closure procedure be performed, but when the PFO is of a high-risk form or there are other indications, it should at least be considered.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145291952","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 contribution of lumbar puncture opening pressure in the diagnosis of spontaneous intracranial hypotension: A systematic literature review and meta-analysis.","authors":"Simy K Parikh, Constance R Deline, Morgan McCreary, Farnaz Amoozegar, Tim J Amrhein, Ian R Carroll, Jeremy K Cutsforth-Gregory, Linda G Leithe, Peter G Kranz, Charles Louy, Marcel M Maya, Abhay Moghekar, Jill Rau, Stephen Silberstein, Wouter I Schievink, Deborah I Friedman","doi":"10.1111/head.15060","DOIUrl":"https://doi.org/10.1111/head.15060","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The objective of this study was to summarize the available evidence regarding the clinical value and trend over time of lumbar cerebrospinal fluid (CSF) opening pressure utilization to diagnose spontaneous intracranial hypotension (SIH).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;CSF opening pressure obtained via lumbar puncture is one of the diagnostic criteria for SIH based on the International Criteria for Headache Disorders, 3rd Edition (ICHD-3), but it has questionable utility as an initial investigation for diagnosing SIH.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The authors performed a systematic literature review and meta-analysis. PubMed/MEDLINE, Scopus, and Cochrane Library were searched from inception to October 2022. Original studies and case series in English reporting three or more patients with suspected or known SIH and CSF pressure measurement were included. Meta-analyses and meta-regression were used to calculate pooled estimates and examine the impact of age, sex, and publication year on outcomes, including CSF pressure &lt; 60 mm CSF, orthostatic headache, and positive findings on brain magnetic resonance imaging (MRI), spinal imaging, and radionuclide studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;For every 1-year increase in the year of publication, the odds of reporting low CSF pressure decreased by 6.20% (adjusted odds ratio [aOR] = 0.94, aOR 95% confidence interval [CI] = [0.90, 0.97], p = 0.001), the odds of reporting a positive brain MRI increased by 4.67% (aOR = 1.05, aOR 95% CI = [1.01, 1.09], p = 0.026), and the odds of reporting orthostatic headache increased by 9.13% (aOR = 1.09, aOR 95% CI = [1.03, 1.15], p = 0.002). Each 1% increase in the percentage of patients with orthostatic headache was associated with a 3.13% increase in the odds of low CSF pressure (aOR = 1.03, aOR 95% CI = [1.01, 1.05], p = 0.003). Similarly, as the percentage of patients with low CSF pressure increased by 1%, there was a 2.53% increase in the odds of orthostatic headache (aOR = 1.03, aOR 95% CI = [1.01, 1.04], p = 0.005). It was estimated that 31.9% of patients with SIH had normal opening pressure (95% CI = [24.0%, 40.8%], prediction interval = [5.0%, 80.5%]). Every 1% increase in the percentage of patients with positive brain MRI was associated with a 5.25% increase in the odds of positive spinal imaging (aOR = 1.05, aOR 95% CI = [1.00, 1.11], p = 0.047). Age and positive radionuclide study did not significantly impact the outcomes measured. The corresponding I&lt;sup&gt;2&lt;/sup&gt; for each outcome was reduced by controlling for study-wide covariates believed to impact the prevalence of each outcome. Sensitivity analyses did not reveal discrepancies in results when studies requiring outcomes of interest were removed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Our analysis found that recent studies indicate a reduced reliance on opening pressure for diagnosing SIH. Rather, results suggest an increasing reliance on contrast-enhanced brain MRI, spine ","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145291920","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 much aerobic exercise is needed to reduce migraine? A dose-response meta-analysis of pain intensity and frequency.","authors":"Daniel C Ogrezeanu, Rodrigo Núñez-Cortés, Joaquín Salazar-Méndez, Iván Cuyul-Vásquez, Rubén López-Bueno, Francisco José Ferrer-Sargues, Lars Louis Andersen, Joaquín Calatayud, Luis Suso-Martí","doi":"10.1111/head.15070","DOIUrl":"https://doi.org/10.1111/head.15070","url":null,"abstract":"<p><strong>Background: </strong>Evidence suggests that exercise has clinically relevant benefits for migraine, but an optimal prescription standard remains undefined. We aimed to assess the effectiveness of aerobic exercise on migraine intensity and frequency through a dose-response meta-analysis.</p><p><strong>Methods: </strong>A data search was performed in PubMed, PEDro, Google Scholar, and EBSCO from inception to September 1, 2024. Randomized controlled trials and quasi-experimental studies of aerobic exercise in patients with a clinical diagnosis of migraine were included. The outcome measures were pain intensity and migraine frequency. The dose-response relationship was evaluated using a dose-response meta-analysis.</p><p><strong>Results: </strong>Fifteen studies (253 participants) were included. Meta-analysis showed a statistically significant decrease in pain intensity between pre and post intervention (standardized mean differences [SMD], -1.1; 95% confidence interval [CI], -1.72 to -0.47). The spline model showed a U-shape statistically significant association (χ² = 112.03, df = 2, p < 0.001) between total minutes of aerobic exercise and reduction in pain intensity. A minimum dose of 200 min was required for moderate effects, with a maximum effect at 900 min (SMD, -2.4; 95% CI, -2.85 to -1.95). Meta-analysis showed a statistically significant decrease in migraine frequency between pre and post intervention (SMD, -0.79; 95% CI, -1.1 to -0.47). The spline model showed a U-shape statistically significant association (χ² = 86.41, dl = 2, p < 0.001) between total minutes of aerobic exercise and reduction in migraine frequency. A minimum dose of 300 total minutes of aerobic exercise program duration was required to obtain a moderate effect in reducing migraine frequency, with a maximum effect at 950 min (SMD, -1.55; 95% CI, -1.87 to -1.22).</p><p><strong>Conclusions: </strong>This meta-analysis suggests that aerobic exercise may be effective in reducing both pain intensity and migraine frequency in people with migraine. The greatest observed effect on both variables was observed at a cumulative dose of approximately 900-950 total minutes of aerobic exercise during the program, and higher doses may not present additional benefits. These findings support a preliminary recommendation of 3 weekly 30-min sessions over 10-11 weeks, to be confirmed in future high-quality trials.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145286098","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":"Comprehensive assessment of erenumab efficacy in participants with high-frequency episodic migraine with at least one previously failed preventive treatment: The EMBRACE study.","authors":"Gabriel Paiva da Silva Lima, Renata Rao, Gyöngyi Szabó, Sebastian Szklener, Cristina Tassorelli, Marcin Nastaj, Denise E Chou, Ani C Khodavirdi, Mahan Chehrenama, Yineng Zhu, Ajay K Bhatia, David W Dodick","doi":"10.1111/head.15071","DOIUrl":"https://doi.org/10.1111/head.15071","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the effect of erenumab treatment beyond monthly migraine days in patients with high-frequency episodic migraine who did not respond to at least one previous migraine preventive treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Reduction in monthly migraine days has been the efficacy standard for migraine preventive treatments; however, it does not fully capture the holistic benefit of the therapy. Erenumab, a monoclonal antibody targeting the calcitonin gene-related peptide pathway, has demonstrated reduction in monthly migraine days and improvement in function in patients with episodic and chronic migraine.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this phase 4, interventional, double-blind, randomized, placebo-controlled, multicenter, global study, treatment with erenumab was assessed over 4 months in adults with high-frequency episodic migraine. The study was conducted at 61 sites located across North America and Europe between September 2020 and October 2023. Patients with ≥1 qualifying oral triptan-treated migraine attack at baseline were randomized to receive erenumab 140 mg or placebo subcutaneously once monthly. The primary endpoint was change from baseline in mean monthly hours of at least moderate headache pain intensity over months 1, 2, and 3; secondary endpoints included change from baseline in mean monthly function, mean monthly duration of at least moderate pain intensity in migraine attacks, and mean monthly peak migraine pain intensity. Safety outcomes were also assessed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 512 randomized patients, 510 received erenumab 140 mg (n = 254) or placebo (n = 256) once monthly. Demographics and baseline characteristics were balanced between the two treatment arms. Erenumab 140 mg was superior to placebo in reducing duration of moderate or severe headache pain intensity over months 1, 2, and 3 (least squares mean [95% confidence interval {CI}] difference, -7.95 [-11.45, -4.46]; p &lt; 0.001). Compared with placebo, erenumab significantly reduced migraine functional impact as assessed by the four domains of the Migraine Functional Impact Questionnaire, with a least squares mean (95% CI) difference of -7.36 (-10.80, -3.92) for physical functioning, -7.10 (-10.34, -3.87) for usual activities, -6.82 (-10.37, -3.27) for social functioning, and - 7.05 (-10.76, -3.34) for emotional functioning (p &lt; 0.001 for all domains). Significant reductions with erenumab compared with placebo were also observed in duration of at least moderate pain intensity in residual or break-through migraine attacks (least squares mean [95% CI] difference, -1.07 [-1.92, -0.22]; p = 0.013) and peak migraine pain intensity (-0.48 [-0.85, -0.11]; p = 0.011). Incidence of grade 3 adverse events was 1.6% with erenumab and 1.2% with placebo; no grade 4 or fatal adverse events were reported in either treatment arm.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Findings from the EMBRACE study demonstrated that treatment with er","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145286049","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":"Effectiveness and tolerability of galcanezumab for migraine prevention in patients ≥65 years: A real-life multicenter study.","authors":"Julia Peris-Subiza, Víctor Obach, Daniel Guisado-Alonso, Fernando Velasco Juanes, Rocío Álvarez Escudero, María Martín Bujanda, Sonsoles Aranceta, Aintzine Ruisánchez, Natalia Roncero, Ane Mínguez-Olaondo, Amaya Echeverria, Alba López-Bravo, Ángel Luis Guerrero-Peral, David García-Azorín, Elisa Cuadrado-Godia","doi":"10.1111/head.15064","DOIUrl":"https://doi.org/10.1111/head.15064","url":null,"abstract":"<p><strong>Background: </strong>Patients with migraine aged ≥65 years old are underrepresented in clinical trials. This study compares effectiveness, excellent response, and tolerability of galcanezumab in patients ≥65 years and those younger than 65 years, specifically assessing age as a predictor of response.</p><p><strong>Methods: </strong>This real-life, multicenter cohort study included patients with chronic or high-frequency episodic migraine who did not respond to more than or equal to three preventive drugs, treated with galcanezumab, and followed for 12 months from 12 Spanish hospitals, between November 2019 and January 2022. Effectiveness was defined as ≥50% reduction in monthly headache days (MHD), and excellent response as ≥75% reduction at 6 months. Tolerability was based on the percentage of patients discontinuing due to adverse events.</p><p><strong>Results: </strong>We included 1055 patients (934 patients <65 years, 121 patients ≥65 years). Older patients had higher baseline MHD [25 (interquartile range [IQR] 15-30) vs. 20 (14-30), p = 0.045], but lower HIT-6 scores [67 (IQR 63-72) vs. 69 (66-73), p < 0.001]. Effectiveness was similar across age groups at 3 (57.0% vs. 48.8%, p = 0.090), 6 (57.0% vs. 51.8%, p = 0.281), and 12 months (52.1% vs. 51.4%, p = 0.889). However, excellent response was more frequent in the ≥65 years group at 3 months (32.2% vs. 23.1%, p = 0.028) and 6 months (33.9% vs. 23.5%, p = 0.012), with a non-significant difference at 12 months (33.1% vs. 25.4%, p = 0.071). Tolerability was comparable within age groups (5.8% discontinuation due to adverse effects in patients ≥65 years vs. 6.7% in patients <65 years; p = 0.837). Age was independently associated with effectiveness (adjusted odds ratio [aOR]: 1.02; 95% confidence interval [CI]: 1.004-1.03) and excellent response (aOR: 1.02; 95% CI: 1.01-1.04). A statistically significant association was found in the logistic regression model for excellent response when age was dichotomized at 65 years, with increasing age linked to a higher likelihood of an excellent treatment response (aOR: 1.79; 95% CI: 1.13-2.82, p = 0.012).</p><p><strong>Conclusions: </strong>Galcanezumab is as effective and well-tolerated in patients aged ≥65 years as in younger patients but older patients showed a higher rate of excellent response. Age is associated with a better response to galcanezumab.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145286101","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":"Building a national headache medicine research network: The BE WELL with Migraine Champion Providers Network™.","authors":"Rebecca Erwin Wells, Junelyn Floyd, Hannah O'Brien, Nicole Tamol, Caroline Oliver, Camden Nelson, Joshua Phillips, Paige M Estave, Shivani Vaidya, Brian Moore, Katherine Hamilton, Ellie Adam, Nathaniel O'Connell, Justin B Moore, Richard B Lipton, Timothy T Houle, Zev Schuman-Olivier, Paula Gardiner, Scott W Powers","doi":"10.1111/head.15065","DOIUrl":"https://doi.org/10.1111/head.15065","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Our objective was to develop and assess the effectiveness of a national network of clinicians referring adults with migraine for a remotely delivered clinical trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;A national practice-based research network in Headache Medicine would facilitate referrals into clinical trials. Given our unique, entirely virtual study, we established a national network of health care professionals to identify potential participants.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The BE WELL with Migraine Champion Providers Network™ began to support clinician referrals across the United States into a remotely conducted clinical trial evaluating the efficacy of a nondrug virtual group intervention. Participant trial recruitment includes community outreach and clinician referrals, then potential participants complete a multi-step eligibility process. The primary study team obtains informed consent and collects all study outcomes. Clinicians interested in referring patients register for the Network via a Research Electronic Data Capture survey. The ongoing clinical trial allows for recruitment of trial participants and network members through 2026. We analyzed Network survey results through February 25, 2025, with descriptive statistics and qualitative analyses. We compared participant progression through eligibility assessment between clinician referral and community outreach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The BE WELL with Migraine Champion Providers Network™ includes 46 clinicians across the United States through February 2025, and most (89%) of them are headache specialists. Although many have previously served as trial principal investigator (PI) (54%) or recruited (72%) for a trial in the past, 28% are recruiting for a clinical trial for the first time. Top motivating factors for Network participation included nonpharmacological option (n = 12), research contribution (n = 11), potential for patient improvement (n = 11), and working with PI (n = 9). To date, 905 participants completed the initial online screener, with 5% (n = 41) from clinician referrals and 95% (n = 864) from community recruitment. Of those, 12.3% (n = 107) were eligible to continue and consented and completed the virtual interview. After the interview, 65 participants progressed to the headache log run-in period and then were randomized/eligible for randomization (six from referrals, 59 from community). Of the original participants from clinician referrals who completed the online screener, 14.6% (six of 41) were randomized/eligible for randomization, compared to 6.8% (59 of 864) recruited via community. Once consented, 100% (six of six) of Network-referred patients progressed to randomization/eligibility for randomization versus only 58% (59 of 101) from community recruitment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The BE WELL with Migraine Champion Providers Network™ models the development and implementation of a national clinician referring ne","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250848","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":"Navigating the patient journey in migraine prevention: An American Migraine Foundation position paper.","authors":"Lawrence C Newman, Christine Lay, Richard B Lipton, Jessica Ailani, Kathleen B Digre, Arthur Caplan, Nim Singh, Heather Phillips, Rachel Koh, Royce Warrick, David W Dodick","doi":"10.1111/head.15062","DOIUrl":"https://doi.org/10.1111/head.15062","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to understand the factors limiting access to medications for the preventive treatment of migraine and to improve access to evidence-based preventive care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;For decades, the effective use of medication for the preventive treatment of migraine was limited by slow onset, slow and complex dose titration schedules, modest benefits, drug interactions, frequent side effects, and very low long-term adherence. The calcitonin gene-related peptide (CGRP) targeted preventive medications mitigate some of these limitations and demonstrated substantial therapeutic benefits in a significant proportion of adults with migraine. The American Headache Society considers these medications among the first-line options for migraine prevention, although access to them remains limited. The American Migraine Foundation hosted a single-day, multidisciplinary expert panel discussion to identify barriers to optimal preventive care and developed recommendations to address them.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Participants identified and prioritized barriers and used a modified nominal group technique to achieve consensus on them. A series of moderated discussions in plenary and breakout sessions was used to create possible solutions. Modified nominal group technique was also employed to achieve consensus on the priorities among these barriers and to achieve whole-group consensus on the recommendations. Ethical issues that inform access were discussed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Participants included eight neurologists and board-certified headache specialists, six representatives of reimbursement decision-makers, six employees of life sciences companies, four patient advocates with lived experience with migraine, and a medical ethicist. Among those who have consulted healthcare professionals and received a diagnosis of migraine, we identified four main barriers to accessing preventive treatment: restrictive prior authorization requirements, the perceived lack of real-world evidence and treatment guidelines, the need for clinician education, and the need for patient education. Consensus recommendations for eliminating barriers centered on using new evidence to evaluate policies that restrict the selection of first-line therapies, initiating/improving collaboration among stakeholders, sharing of data and best practices, and increased training. Participants agreed to explore novel definitions of the value of preventive treatment and to establish the Migraine Prevention Network to facilitate ongoing cooperation and collective action. However, due to financial limitations, staffing changes, and time constraints, post-meeting discussions led to a shift from establishing a broad Migraine Prevention Network to forming smaller task forces focused on the top-priority barriers (real-world evidence and The Patient Playbook) identified through collaborative voting among American Headache Society, American","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225302","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":"Can atogepant be a preventive treatment for cluster headache?-Insights from a case series.","authors":"Catarina Serrão, Filipa Dourado Sotero, Linda Azevedo Kaupilla, Isabel Pavão Martins","doi":"10.1111/head.15066","DOIUrl":"https://doi.org/10.1111/head.15066","url":null,"abstract":"<p><p>Cluster headache (CH) is a disabling primary headache disorder with limited therapeutic options. Calcitonin gene-related peptide (CGRP) is known to be involved in CH pathophysiology; however, except for galcanezumab (300 mg) in episodic CH, anti-CGRP monoclonal antibodies did not reduce CH attacks in randomized clinical trials. Atogepant is an oral, small-molecule, CGRP receptor antagonist, which is approved for the preventive treatment of migraine. Here, we describe four case reports of CH (two episodic CH and two chronic CH), unresponsive to previous prophylactic treatments, who responded to daily atogepant (60 mg). Chronic CH cases were refractory to subcutaneous galcanezumab. In one case, a reduction to atogepant (30 mg daily) resulted in recurrence of headache attacks, which subsided on reintroduction of the initial dose. No serious adverse effects were reported. Despite the limited number of cases and the open retrospective design, our case series suggests atogepant as a possible prophylactic treatment for CH. Further research on CGRP signaling in CH and the implementation of well-designed clinical trials are necessary.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225325","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":"Migraine in the workplace: Work productivity impact in a large US-based healthcare system using a cross-sectional employee survey.","authors":"Olivia Begasse de Dhaem, Allison Verhaak, Meghan Fajardo, Brian Grosberg","doi":"10.1111/head.15053","DOIUrl":"10.1111/head.15053","url":null,"abstract":"<p><strong>Objective: </strong>(1) To estimate the impact of migraine on work productivity among employees at a large healthcare system in the United States. (2) To assess the knowledge and perception of migraine among employees and to evaluate the number of employees interested in receiving migraine care to help plan a future workplace migraine education and management program.</p><p><strong>Background: </strong>Despite advances in treatment, migraine is underdiagnosed and undertreated and remains a leading cause of disability in the world. Workplace migraine education and/or management programs have been shown to improve migraine-related productivity. However, there has not yet been a published organization-wide workplace migraine education and management program in the United States.</p><p><strong>Methods: </strong>This is a cross-sectional, online survey of employees at a large healthcare system in the Northeast region of the United States that was open from November 1, 2024, to January 3, 2025. Survey questions queried employment status (one question), knowledge and perceptions of migraine (two questions), headache and migraine screen (four questions), productivity impact (two questions), and potential interest in receiving care for headaches (one question).</p><p><strong>Results: </strong>Out of 33,761 employees, 20,000 were reached via internal communication, 6583 (32.9%) agreed to participate, and 5771 (28.9%) completed the survey. The majority of employees who chose to complete the survey (5337/5771; 92.5%) endorsed having headaches; of these, 59.6% (3183/5337) screened positive on the ID Migraine screen. The participants who screened positive for migraine reported 0.66 missed workdays and 3.77 days with productivity reduced by at least 50% due to migraine in the past 3 months, leading to an estimated lost productive time (LPT) of 10.12 days annually per employee with migraine. Participants reported associating the word \"migraine\" most closely with headache or pain (4182/5754; 72.7%). Only about half of participants answered the knowledge question correctly (2819/5751; 49.0%). Of the 5771 survey participants, 992 (17.2%) were interested in receiving headache care.</p><p><strong>Conclusion: </strong>Migraine significantly impacts workplace productivity at a large healthcare system, particularly presenteeism. Migraine tends to be perceived as a headache and about half of the participants did not answer the knowledge question correctly. This survey study supports a need for a workplace migraine education and management program for healthcare workers.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1634-1640"},"PeriodicalIF":4.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023118","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}