Headache最新文献

{"title":"Virtual issue: Challenges of headache treatment in children and adolescents with refractory headache.","authors":"P M Estave, E Ackley","doi":"10.1111/head.70120","DOIUrl":"https://doi.org/10.1111/head.70120","url":null,"abstract":"","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837048","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":"Mesoscale CISS imaging for the detection of dural defects in spinal CSF leaks: A retrospective case series.","authors":"Michelle L Wegscheid, Zack Nigogosyan, Arindam R Chatterjee, Cyrus A Raji, Martin N Reis, Nicholas P Fleege, Sherwin N Azad, Benjamin A Plog, John Ogunlade, Ananth K Vellimana, Manu S Goyal, Arash Nazeri","doi":"10.1111/head.70123","DOIUrl":"https://doi.org/10.1111/head.70123","url":null,"abstract":"<p><strong>Objective: </strong>This retrospective, single-center, descriptive case series evaluates early adoption of a two-stage spine MRI protocol incorporating high-resolution, three-dimensional mesoscale constructive interference in steady state (meso-CISS) for targeted cerebrospinal fluid (CSF) leak localization.</p><p><strong>Background: </strong>Spontaneous intracranial hypotension (SIH) results from CSF leaks at the spinal canal, yet precise localization of dural defects remains challenging. Although fat-saturated heavily T2-weighted magnetic resonance (MR) myelography (HT2-MRM) is sensitive to spinal longitudinal extradural CSF collections (SLECs), it does not reliably localize the leak site.</p><p><strong>Methods: </strong>Thirty-six consecutive patients with suspected SIH underwent a standardized total spine MRI protocol, including three-dimensional HT2-MRM for SLEC screening at Barnes-Jewish Hospital/Washington University School of Medicine between December 2023 and November 2025. In 11 SLEC-positive cases, meso-CISS was performed for targeted high-resolution leak localization.</p><p><strong>Results: </strong>Among the 10 patients with SIH with interpretable meso-CISS imaging, findings consistent with dural defects were visualized in six (0.5-8 mm in size), with additional supportive features suggestive of dural defects identified in three patients. Compared with HT2-MRM, meso-CISS provided higher spatial detail, allowing clearer delineation of dural defects.</p><p><strong>Conclusion: </strong>A two-stage spine MRI protocol incorporating HT2-MRM and meso-CISS may aid in the noninvasive localization of dural defects in SIH. Meso-CISS provides high spatial resolution for visualization of small dural defects and associated pathology. Larger studies are required to clarify how this approach may be incorporated into existing diagnostic workflows for spinal CSF leak localization.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837122","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":"Bridging old and new: The 2026 American Headache Society Annual Scientific Meeting.","authors":"Mark J Burish, Christina L Szperka","doi":"10.1111/head.70124","DOIUrl":"https://doi.org/10.1111/head.70124","url":null,"abstract":"","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837007","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":"Comparative analysis of real-world acute prescription migraine therapy outcomes: Insights from the HeAD-US study.","authors":"Devin Teichrow, Babak Khorsand, Kristina M Fanning, Alexandre Urani, François Cadiou, Richard B Lipton, Ali Ezzati","doi":"10.1111/head.70113","DOIUrl":"10.1111/head.70113","url":null,"abstract":"<p><strong>Background: </strong>Triptans have long served as the primary acute migraine treatment, whereas gepants represent a newer, non-vasoconstrictive alternative. Although clinical trials have explored efficacy within each class, head-to-head studies are lacking, and real-world data on optimal treatment response and patient-level predictors of outcomes remain limited. We leverage cross-sectional data from the Headache Assessment via Digital Platform in United States study to conduct real-world comparisons of triptans and gepants for 2-h pain freedom (2hPF) and 24-h pain relief (24hPR), and to identify demographic, clinical, and treatment-related predictors of these outcomes.</p><p><strong>Methods: </strong>Head-US is a survey conducted between September and December of 2023 among users of the Migraine Buddy application (Aptar, Crystal Lake, IL). Eligible participants completed the survey, met ICHD-3 criteria for migraine, and reported using acute monotherapy with gepants or a triptan. Primary outcomes, 2hPF and 24hPR posttreatment, were assessed using the Migraine Treatment Optimization Questionnaire-6 item. Potential predictors included demographic factors, clinical measures, and treatment-related factors.</p><p><strong>Results: </strong>Among 1570 eligible respondents, 567 used gepants and 1003 used a triptan. Mean age was 43.35 years (standard deviation = 13.04), and 91.2% were female. Gepant users demonstrated 36% higher odds of achieving 24hPR compared to triptan users (adjusted odds ratio = 1.36, 95% confidence interval: 1.09-1.71), although there were no significant differences the 2hPF outcome. Reduced odds of adequate 2hPF were associated with higher migraine symptom severity, high-frequency episodic migraine, chronic migraine, severe pain intensity, and severe migraine disability. Odds of achieving 24hPR were reduced in those with higher attack frequency, severe migraine disability, and preventive medication use. Predictors of treatment response were similar in the pooled sample and in those using gepants and in those using triptans.</p><p><strong>Conclusion: </strong>In this large, real-world cohort, triptans and gepants did not significantly differ for 2hPF, but gepants demonstrated a significant advantage for 24hPR. Clinical features such as symptom severity, headache frequency, disability, and comorbid treatment burden were important predictors of treatment response. These findings support the need for larger, head-to-head clinical trials definitively comparing these medication classes for migraine management and may inform personalized selection of acute migraine therapies in clinical practice.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147814288","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":"IV dexamethasone as adjuvant therapy to metoclopramide for acute posttraumatic headache in the ED: A randomized controlled trial.","authors":"Kareem Joudi, Abigael Nsenga, Andrew R Williams, Sharon I Lee, Sadie Johnson, Eddie Irizarry, Benjamin Wolkin Friedman","doi":"10.1111/head.70027","DOIUrl":"10.1111/head.70027","url":null,"abstract":"<p><strong>Objective: </strong>We conducted a randomized study to determine if, among emergency department (ED) patients with acute posttraumatic headache, the combination of intravenous (IV) metoclopramide plus dexamethasone would result in less headache intensity during the 48 h after ED discharge than IV metoclopramide plus placebo.</p><p><strong>Background: </strong>Intravenous metoclopramide can improve acute posttraumatic headache among ED patients, though this benefit is not sustained beyond the ED visit.</p><p><strong>Methods: </strong>This was a randomized, double-blind, placebo-controlled, parallel group study of IV dexamethasone for acute posttraumatic headache. We enrolled patients who presented to two EDs in the Bronx, NY, with moderate or severe headache that met criteria for acute posttraumatic headache, per the International Classification of Headache Disorders, 3rd edition. All study participants received metoclopramide 10 mg IV. They also were randomized to receive dexamethasone 10 mg IV or placebo (normal saline). The primary outcome was absence of moderate or severe headache within 48 h of ED discharge and no use of analgesic or headache medication within that time. We also report frequency of sustained headache relief. It defined as obtaining and maintaining a headache intensity of mild or none, without the use of rescue medication, for 48 h.</p><p><strong>Results: </strong>Over a 42-month period commencing in June 2021, 2220 patients were approached for participation and 162 were enrolled. At baseline, slightly more patients in the placebo arm reported severe versus moderate pain. No other baseline differences were noted. After accounting for age, sex, and baseline pain intensity, dexamethasone was not associated with the primary outcome (Adjusted odds ratio 1.11, 95% confidence interval [CI] 0.57, 2.19, p = 0.751). Sustained pain relief was reported by 10/77 (13.0%) of dexamethasone participants and 12/79 (15.2%) of placebo participants (95% CI for difference - 2.2%: -13.1, 8.7%).</p><p><strong>Conclusion: </strong>Among ED patients with acute moderate or severe posttraumatic headache, one dose of IV dexamethasone did not improve headache outcomes.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1081-1087"},"PeriodicalIF":4.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933011","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":"Zavegepant and lactation: What the pharmacokinetic data suggests.","authors":"Annika Ehrlich, Kaitlin Keenan","doi":"10.1111/head.70059","DOIUrl":"10.1111/head.70059","url":null,"abstract":"","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1023-1024"},"PeriodicalIF":4.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146131610","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":"A study of migraine-like headache caused by topical aryl hydrocarbon receptor agonist tapinarof.","authors":"Toshiyuki Hikita, Toshiyuki Kudo, Yasuko Ogawa, Natsue Nakamoto, Kiyomi Ito","doi":"10.1111/head.70077","DOIUrl":"10.1111/head.70077","url":null,"abstract":"","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1200-1201"},"PeriodicalIF":4.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147369510","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":"Cortical synchronization of spontaneous trigeminal neuropathic pain monitored with in vivo optical imaging of calcium activity in freely moving mice.","authors":"Qianxi Liu, Zhenxing Li, Hongyi Wang, Qian Qin, Dong Huang, Rong Hu, Xing Liu, Haocheng Zhou","doi":"10.1111/head.70084","DOIUrl":"10.1111/head.70084","url":null,"abstract":"<p><strong>Objective: </strong>To determine the impact of neuropathic lesion on cortical synchronization in processing spontaneous pain-like behavior.</p><p><strong>Background: </strong>In vivo optical monitoring of neuronal activity may provide insightful mechanisms underlying the complexity of spontaneous pain-like behavior in freely moving animals.</p><p><strong>Methods: </strong>We examined the synchronized pattern of the pyramidical neurons in anterior cingulate cortex during spontaneous grooming behavior using optical monitoring of Ca²⁺ activity. A chronic constriction injury of infraorbital nerve model was performed to induce trigeminal neuropathic pain. We then analyzed the synchronized patterns of cortical population and computed Shannon entropy values to assess the uncertainty of neural coding during spontaneous pain-like behavior.</p><p><strong>Results: </strong>Following nerve injury, mice exhibited significantly prolonged isolated grooming behavior compared to the control group. Our data indicate that, while neuropathic pain enhanced synchronized activity of cortical network during spontaneous grooming behavior, craniofacial nociception reduced the uncertainty of neural firing. Interestingly, this transition to a synchronized state of cortical ensembles in neuropathic pain conditions was significantly disrupted by spontaneous grooming behavior.</p><p><strong>Conclusion: </strong>Our findings provided a method of monitoring the synchronized activity of cortical ensemble in freely moving animals. Synchronization index may be used to decode spontaneous neuropathic pain-like behavior.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1108-1116"},"PeriodicalIF":4.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463175","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":"Delayed urticaria during treatment with anti-CGRP monoclonal antibodies in migraine.","authors":"Christoph T Berger, Federico Burguet Villena, Severin B Vogt, Lukas Heydrich, Karin Hartmann, Athina Papadopoulou","doi":"10.1111/head.70082","DOIUrl":"10.1111/head.70082","url":null,"abstract":"<p><strong>Objective: </strong>To characterize clinical presentation and management of urticaria associated with calcitonin gene-related peptide (CGRP) -targeting monoclonal antibodies (mAbs) for migraine prophylaxis.</p><p><strong>Background: </strong>CGRP-targeting mAbs are effective in migraine prophylaxis, but have been associated with hypersensitivity reactions, including urticaria. The underlying mechanisms, risk factors, and therapeutic consequences of these anti-CGRP mAb-related hypersensitivity reactions remain poorly understood.</p><p><strong>Methods: </strong>We performed a retrospective case series with descriptive analysis on five patients who developed urticaria after anti-CGRP mAb administration. Timing of reactions, history of urticaria, re-exposure strategies including premedication, and clinical outcomes were analyzed by chart review.</p><p><strong>Results: </strong>Urticaria occurred after the first injection in three patients and after the third or sixth injection in two. Onset was delayed (12-48 h) in all patients, indicating a non-IgE-mediated hypersensitivity. Four of five patients had a prior history of urticaria. All patients were re-exposed: two to the same anti-CGRP mAb and three to a different. Three patients received H1-antihistamine premedication. All premedicated patients in this series tolerated re-exposure, irrespective of switching. One patient experienced worsening urticaria with repeated dosing without premedication despite negative allergy testing, but later tolerated the same anti-CGRP mAb with premedication. In contrast, urticaria or angioedema recurred in two patients who switched anti-CGRP mAb without premedication. One subsequently tolerated rimegepant.</p><p><strong>Conclusion: </strong>Anti-CGRP mAb-associated urticaria in this case series was delayed and likely non-immunoglobulin E (non-IgE)-mediated. Our experience supports that in selected patients with delayed urticaria, individualized management, including H1 antihistamine premedication, may allow continuation of effective migraine prophylaxis. Larger cohorts are needed to identify risk factors and to inform general management recommendations.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1193-1199"},"PeriodicalIF":4.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13142211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463116","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}

{"title":"Differential impact of migraine on severe maternal morbidity and postpartum readmissions: Insights from a national cohort study.","authors":"Michelle T Tram, Nan Cheng, Crystal Jicha","doi":"10.1111/head.70080","DOIUrl":"10.1111/head.70080","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluates severe maternal morbidity (SMM) and hospital readmissions in women with migraine.</p><p><strong>Background: </strong>There has been a rising incidence of SMM and growing urgency to monitor SMM as a measure of maternal outcomes. Migraine is the leading cause of disability in reproductive-aged women and is linked to numerous obstetric comorbidities that likely contribute to SMM, rehospitalization, and resulting healthcare costs. However, population-level data examining these outcomes are limited.</p><p><strong>Methods: </strong>Using the 2019 National Readmissions Database, we performed a retrospective cohort analysis of index characteristics and postpartum rehospitalizations for women with migraine from January to November 2019. Baseline demographics, hospital characteristics, and indications for readmission were obtained. Odds of SMM at delivery and 30-day nonelective readmission were compared between women with and without migraine. Validated obstetric comorbidity scores and cost of hospitalization were also compared. Models were adjusted for baseline patient and hospital demographics, method of delivery, body mass index (BMI), aspirin use, and obstetric comorbidities.</p><p><strong>Results: </strong>Out of all qualifying deliveries in 2019, 22,074 women had migraine (1.2%). Only 14.2% of these women had a specific migraine diagnosis (n = 3145), of whom 61.7% had migraine with aura (MA; n = 1941) and 38.3% had migraine without aura (MO; n = 1204). Overall, women with migraine had higher obstetric comorbidity scores than those without migraine. Higher odds of SMM were also associated with migraine (odds ratio [OR] 1.82, 95% confidence interval [CI] [1.68, 1.96]). However, after additionally adjusting for comorbidities, this relationship was no longer significant. In contrast, migraine was independently associated with greater odds of 30-day postpartum readmission (migraine: adjusted odds ratio [aOR] 1.29, 95% CI [1.17, 1.41]; MO: aOR 1.49, 95% CI [1.02, 2.10]) and higher hospitalization costs (migraine: adjusted incidence rate ratio [aIRR] 1.18, 95% CI [1.17, 1.19]).</p><p><strong>Conclusion: </strong>Women with migraine have higher obstetric comorbidity scores, which may contribute to the elevated risk of SMM. Migraine itself is independently associated with increased 30-day nonelective readmission rates and hospitalization costs. These associations, along with the large number of unspecified migraine diagnoses, highlight the importance of thorough migraine screening and documentation, which may help guide interventions to improve maternal outcomes and reduce healthcare burden.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1025-1036"},"PeriodicalIF":4.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147456649","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}