Headache最新文献

{"title":"Editorial: Migraine as a marker of maternal morbidity.","authors":"Barlas Benkli","doi":"10.1111/head.70090","DOIUrl":"10.1111/head.70090","url":null,"abstract":"","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1017-1018"},"PeriodicalIF":4.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147485786","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":"Chronotype in migraine and tension-type headache: A population study.","authors":"Da Eun Jung, Soomi Cho, Woo-Seok Ha, Hye Jung Shin, Min Kyung Chu","doi":"10.1111/head.70070","DOIUrl":"10.1111/head.70070","url":null,"abstract":"<p><strong>Objectives: </strong>This study was designed to examine the distribution of chronotypes among individuals with migraine and tension-type headache and to evaluate the association between chronotype and clinical headache characteristics in a population-based sample.</p><p><strong>Background: </strong>Although previous research has demonstrated associations between chronotype and migraine, there is limited population-level evidence regarding its relationship with tension-type headache or clinical features of these headache disorders.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis using baseline data from a nationwide population-based survey, conducted in the Republic of Korea in October 2020, which involved adults 20-59 years old. The chronotype was assessed using the Morningness-Eveningness Questionnaire and categorized into morning (score >58), intermediate (score 41-58), and evening (score <41) chronotypes.</p><p><strong>Results: </strong>Among 2838 participants, the evening chronotype was more prevalent in the migraine (58 of 160, 36.3%) and tension-type headache (225 of 890, 25.3%) groups than in the nonheadache control group (185 of 1005, 18.4%, p < 0.001). Among participants with migraine, depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder-7) differed across chronotypes in the overall comparison (p = 0.035 and p = 0.047, respectively), with the morning type showing lower levels than those shown by the intermediate and evening types; however, no pairwise differences were statistically significant in the post hoc analyses. Among participants with tension-type headache, depression and anxiety differed across chronotypes in the overall comparison (Patient Health Questionnaire-9, p < 0.001 and Generalized Anxiety Disorder-7, p = 0.006), which was driven by higher levels in the evening type than in both the morning and intermediate types; however, the morning and intermediate types did not differ. In participants with migraine, a higher Morningness-Eveningness Questionnaire score (greater morningness) was marginally associated with more severe headache days per 30 days (p = 0.046), whereas no significant association was found in those with tension-type headache (p = 0.126). Headache days per 30 days, crystal-clear days per 30 days, headache intensity (Visual Analog Scale), and the impact of headache (Headache Impact Test-6) were not significantly associated with Morningness-Eveningness Questionnaire scores in participants with migraine or tension-type headache.</p><p><strong>Conclusion: </strong>Participants with migraine and tension-type headache showed a significantly higher prevalence of evening chronotype compared with the nonheadache controls. However, greater morningness was associated with more severe headache days in the migraine group but not in the tension-type headache group.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1037-1049"},"PeriodicalIF":4.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13142205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147528454","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":"Post-marketing safety of CGRP monoclonal antibodies and gepants: A systematic review of spontaneous reporting system data.","authors":"Martina Giacon, Salvatore Terrazzino","doi":"10.1111/head.70081","DOIUrl":"10.1111/head.70081","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Calcitonin gene-related peptide (CGRP) inhibitors, including monoclonal antibodies (mAbs) and small-molecule antagonists (gepants), have transformed migraine treatment. Although clinical trials established their efficacy and initial safety, post-marketing surveillance is essential for understanding their real-world safety profile in a broader population. Therefore, this study aims to systematically review and synthesize findings from published pharmacovigilance studies that analyze potential safety signals for CGRP inhibitors using major international databases, including the United States Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS), the World Health Organization's (WHO's) VigiBase, and EudraVigilance, in order to establish a comprehensive real-world safety profile to guide clinical practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic search was conducted in major electronic databases for studies published up to September 2025. Study selection, data extraction, and quality assessment were performed by two independent researchers. We included original research articles analyzing FAERS, VigiBase, or EudraVigilance for AEs associated with erenumab, galcanezumab, fremanezumab, eptinezumab, rimegepant, ubrogepant, atogepant, or zavegepant. Data on key signals of disproportionate reporting (SDRs) and quantitative measures of disproportionality were extracted and synthesized thematically.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The search identified 30 eligible studies. For mAbs, consistent SDRs included injection site reactions, alopecia (e.g., fremanezumab reporting odds ratio (ROR) ranging from 2.73 to 6.9), constipation (primarily for erenumab, RORs ranging from 4.92 to 17.94), and a range of cardiovascular events. For gepants, common SDRs included nausea and fatigue or somnolence, with highly specific SDRs for severe constipation for atogepant (ROR&lt;sub&gt;025&lt;/sub&gt; = 19.99) and dysgeusia for zavegepant (ROR&lt;sub&gt;025&lt;/sub&gt; = 212.07), linked to its nasal administration. A critical divergence was observed for rare but serious cerebrovascular events: SDRs for reversible cerebral vasoconstriction syndrome (RCVS [erenumab ROR 9.43, 95% confidence interval {CI} 4.5-19.8]) and cervical artery dissection (CeAD [galcanezumab ROR 14.0, 95% CI 6.22-31.4]) were associated with certain mAbs. Conversely, no such SDRs have been detected for gepants to date, although this distinction requires confirmation as real-world exposure increases. However, a class-level SDR for cerebrovascular diseases as a whole was identified for CGRP inhibitors as a group (ROR 1.22, 95% CI 1.12-1.33). Also notable were shared SDRs for Raynaud's phenomenon and alopecia across both subclasses. Finally, concerning safety in pregnancy, the data are complex: while comprehensive class-level analyses did not identify a disproportionality signal compared to triptans, some analyses of individual drugs have identified reporting patterns that warra","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1128-1147"},"PeriodicalIF":4.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13142213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463211","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":"Association between wildfire smoke exposure and pediatric emergency department visits for headache.","authors":"Hannah F J Shapiro, Amy A Gelfand, Daniel J Shapiro, Holly Elser, Chen Chen, Joan A Casey","doi":"10.1111/head.15056","DOIUrl":"10.1111/head.15056","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The purpose of this study was to determine whether short-term exposure to wildfire smoke is associated with emergency department visits for headache in children and adolescents.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Wildfires are becoming increasingly common and are associated with numerous adverse health outcomes. However, we currently do not know how wildfire smoke exposure affects children and adolescents with primary headache disorders. Headache disorders in youth are a major contributor to frequently missed school days and youth with headache disorders have high medical care utilization and total healthcare costs. Therefore, understanding factors that may contribute to headache exacerbations and potential increases in healthcare utilization is of particular interest.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was a time-stratified case-crossover study linking daily health data from the California Department of Health Care Access and Information to daily ZIP code-level wildfire PM&lt;sub&gt;2.5&lt;/sub&gt; concentrations between 2006 and 2019. We included all visits for headache to emergency departments in California among youth 5-19 years old during the study period. The primary exposure was the ZIP code-level daily wildfire-specific PM&lt;sub&gt;2.5&lt;/sub&gt; concentration, modeled as a continuous and binary (wildfire-specific PM&lt;sub&gt;2.5&lt;/sub&gt; ≥15 μg/m&lt;sup&gt;3&lt;/sup&gt;) variable. The primary outcome was an emergency department visit for headache. We identified relevant encounters according to the International Classification of Diseases, 9th/10th revision codes assigned in the first diagnostic position. To capture a potential delayed impact, we estimated odds ratios for the association for days 0 to 6 between the exposure and outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We identified 206,230 unique emergency department encounters for primary headache disorders. Most visits were in female patients (61.4%) 15-19 years old (58.5%) who identified as Hispanic (48.8%) and lived in a very low-opportunity (37.7%) or low-opportunity (21.6%) neighborhood. The adjusted odds of an emergency department visit incrementally decreased per unit increase in wildfire-specific PM&lt;sub&gt;2.5&lt;/sub&gt; concentrations from days 0 to 6 after wildfire smoke exposure (same-day adjusted odds ratio [aOR], 1.00; 95% confidence interval [CI], 0.998-1.001; day +6 aOR, 0.995; 95% CI, 0.993-0.997). Using a binary exposure, the adjusted odds of an emergency department visit incrementally decreased from days 0 to 6 after a wildfire smoke day (same day aOR, 0.99; 95% CI, 0.92-1.08; day +6 aOR, 0.84; 95% CI, 0.78-0.92).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Children are less likely to seek care in the emergency department for primary headache in the days following exposure to wildfire smoke, suggesting that healthcare utilization changes during wildfires. Clinicians should ensure youth with headache disorders who experience worsening symptoms associated with air pollution are equipped with strat","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1058-1068"},"PeriodicalIF":4.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13142203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174716","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":"A phase 1 study of the breast milk and plasma pharmacokinetics of zavegepant 10 mg intranasal dose in healthy lactating women.","authors":"Abhijeet Jakate, Yan Weng, Ani Shkrodova, Ogert Fisniku, Ding Ding, Kayce Morton, Benjamin Maligalig, Pamela Garnick, Jing Liu, Mohamed H Shahin","doi":"10.1111/head.70036","DOIUrl":"10.1111/head.70036","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluated the pharmacokinetics of zavegepant in human breast milk and plasma following a single, 10 mg dose of zavegepant nasal spray.</p><p><strong>Background: </strong>Zavegepant nasal spray is a member of the gepant class of medications; small molecule inhibitors of the calcitonin gene-related peptide receptor. It is approved in the United States for the acute treatment of migraine with or without aura in adults. However, the transfer of zavegepant to human breast milk in lactating women has not been assessed previously.</p><p><strong>Methods: </strong>In this Phase 1, open-label, single-arm, single-dose, pharmacokinetic study (NCT06453356), 12 healthy lactating women received a single intranasal dose of 10 mg zavegepant. Blood and breast milk samples were collected over 24 h postdose to assess zavegepant pharmacokinetics. Safety was also assessed. The study was conducted from June 10 to September 26, 2024 at a single-site in the United States.</p><p><strong>Results: </strong>Geometric mean (geometric percent coefficient of variation [CV%]) milk-to-plasma zavegepant concentration ratios were 0.21 (102%), 0.16 (76%), and 0.04 (130%) for area under the concentration-time curve from time 0 to 24 h postdose, area under the concentration-time curve from time 0 extrapolated to infinity, and maximum concentration, respectively. The geometric mean (geometric CV%) body weight normalized infant dose was 0.05 μg/kg/day (120%) and the geometric mean (geometric CV%) body weight normalized maternal dose was 132.8 μg/kg/day (10%). This resulted in a geometric mean (geometric CV%) relative infant dose of 0.04% (128%). One treatment-emergent adverse event (TEAE; mild dizziness) was reported in one (8%) participant. This TEAE was considered mild in severity. No clinically meaningful abnormalities were observed for vital signs, clinical laboratory testing, and local nasal assessments.</p><p><strong>Conclusion: </strong>A single intranasal dose of 10 mg zavegepant was generally safe and well tolerated in healthy lactating women and the estimated infant exposure to zavegepant via breast milk is very low.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1050-1057"},"PeriodicalIF":4.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13142201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145916915","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":"Novel optimization of multi-mechanistic approaches for the acute treatment of a migraine attack: A review.","authors":"Stephen Silberstein, Alan M Rapoport","doi":"10.1111/head.70051","DOIUrl":"10.1111/head.70051","url":null,"abstract":"<p><strong>Objective: </strong>To highlight key factors required to optimize multi-mechanistic approaches with oral combination treatments for the acute management of a migraine attack.</p><p><strong>Background: </strong>Given the complex multi-factorial nature of migraine, combining treatments with different mechanisms of action should improve outcomes compared to monotherapies, but this has not been demonstrated with all treatment combinations.</p><p><strong>Methods: </strong>For this narrative review, we searched PubMed using combinations of these terms: migraine, acute treatment, combination therapy, fixed-dose combination therapy, multi-mechanistic treatment, pharmacokinetics, and pharmacodynamics. All articles considered relevant were included.</p><p><strong>Results: </strong>None of the existing migraine acute treatments as monotherapy effectively treat the key pathophysiological processes of migraine completely. Many patients do not achieve 2-h pain freedom, which is key to avoiding migraine recurrence, medication overuse leading to chronification, and migraine-related disability. The development of combination approaches has led to only two combinations with demonstrated superiority over their individual components: aspirin/acetaminophen/caffeine and sumatriptan/naproxen sodium. The latter is the most effective proven combination treatment because it targets peripheral activation of central pain pathways during the early migraine stages and central sensitization that develops later, independent of peripheral input. Other triptan/nonsteroidal anti-inflammatory drug combinations with higher efficacy as monotherapies could be more effective than sumatriptan/naproxen sodium, particularly if their pharmacokinetic profiles align with the vasoactive mediators of peripheral and central sensitization that they target.</p><p><strong>Conclusions: </strong>Combination treatments with different mechanisms of action targeting key distinct pathophysiological processes of migraine may be more effective than monotherapies, particularly if their pharmacokinetic profiles are optimized to target those processes at the right time. Further research in this area is warranted.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1181-1192"},"PeriodicalIF":4.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13142214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147354739","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":"Microneedles for the treatment of migraine and orofacial pain: A narrative review.","authors":"Baicheng Cao, Qiuyi Chen, Yuhan Liu, Ruozhou Wu, Bin Li, Qing Cai, Lu Liu","doi":"10.1111/head.70074","DOIUrl":"10.1111/head.70074","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Migraine is a common neurological disorder and a primary headache condition. Despite its central origin, migraine pain may be referred to the orofacial region via trigeminal pathways, resulting in phenotypic overlap with other orofacial pain (OFP) conditions. OFP represents a highly prevalent and heterogeneous group of pain disorders that substantially impair quality of life. Microneedle (MN) technology enables minimally invasive, localized, or transdermal drug delivery and has emerged as a promising mechanism-guided strategy for the management of migraine and other OFP conditions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This review aims to systematically summarize the current evidence on MN-based technologies for the treatment of migraine and other OFP conditions and discuss the therapeutic implications, limitations, and future directions of MN technologies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study is a narrative review. PubMed/MEDLINE, Embase, Web of Science, and Google Scholar were systematically searched from inception to November 18, 2025. English-language studies evaluating MN-based technologies for migraine and other OFP conditions, including temporomandibular disorders (TMD) and oral mucosal ulcers, in animal models or human participants were included.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Eleven studies were included, covering migraine (n = 4), TMD (n = 2), and oral mucosal ulcers (n = 5). Across included studies, evidence for MN-based interventions was most advanced in migraine. Preclinical studies demonstrated that transdermal or intranasal MN systems enabled rapid and reliable drug absorption, with bioavailability comparable to subcutaneous injection. Clinical studies of MN-mediated triptan delivery reported high rates of 2 h pain relief and freedom from the most bothersome migraine-associated symptoms, with generally mild and transient local skin reactions. Beyond migraine, MNs were explored for TMD and oral mucosal ulcers, where they enabled localized and sustained analgesic and anti-inflammatory effects and promoted tissue healing, although evidence in these conditions remains limited and largely preclinical.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;MN-based drug delivery represents a promising, minimally invasive strategy for migraine and other OFP management, with the strongest and most clinically relevant evidence currently available for acute migraine treatment. By enabling rapid and reliable drug absorption while bypassing gastrointestinal limitations, MNs may enhance the effectiveness of migraine-specific therapies. Emerging preclinical evidence further suggests potential applicability of MN platforms in other OFP conditions, including TMD and oral mucosal ulcers, through localized and sustained analgesic and anti-inflammatory delivery. Future research should prioritize migraine-focused optimization of MN materials and designs, alongside disease-specific expansion and standardized pain-related outcome reporti","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1148-1161"},"PeriodicalIF":4.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13142208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147456611","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":"The status of status migrainosus: Exploring conceptual and operational limitations of International Classification of Headache Disorders criteria.","authors":"Juliana H VanderPluym","doi":"10.1111/head.70095","DOIUrl":"10.1111/head.70095","url":null,"abstract":"","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1019-1020"},"PeriodicalIF":4.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147527582","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":"Redefining status migrainosus: A narrative review.","authors":"Jennifer Robblee, Jonathan H Smith, Sarah Ahmad, Rachel Geiser, Ashhar Ali","doi":"10.1111/head.70075","DOIUrl":"10.1111/head.70075","url":null,"abstract":"<p><strong>Objectives: </strong>To critically evaluate the current International Classification of Headache Disorders, 3rd edition (ICHD-3) definition of status migrainosus (SM) and assess how well it meets clinical and research needs. The review will also explore additional attack dimensions that could support a more patient-centric and clinically actionable definition.</p><p><strong>Background: </strong>ICHD-3 defines SM as a debilitating migraine attack lasting more than 72 h. This 72-h threshold is historically derived rather than empirically validated, and limited evidence is available to guide treatment. We posit that a primarily duration-based definition restricts both the clinical utility of SM and its usefulness as a construct in acute treatment trials.</p><p><strong>Methods: </strong>This narrative review was structured around five key questions: (Q1) Do we need specific diagnostic criteria for SM; (Q2) Should time be used within the definition; (Q3) Should attack severity and disability be included; (Q4) Should treatment response be included; and (Q5) Should migraine attack phases be considered. Targeted PubMed searches (inception-mid-2025) were performed for questions 2-5. One reviewer was assigned to each of these questions and independently conducted title/abstract screening, full-text review, and data extraction.</p><p><strong>Results: </strong>Searches yielded 36 publications from 504 screened for question 2, 12 from 322 for question 3, 61 from 171 for question 4, and 13 from 1708 for question 5. Q1: Although SM remains clinically useful, the current criteria do not capture the heterogeneity of prolonged attacks and provide limited guidance for treatment escalation. Q2: Attack duration varies widely across migraine phenotypes, and the 72-h cutoff lacks clear justification and is misaligned with real-world practice, where escalation occurs well before 72 h. Q3: \"Debilitating\" is undefined, and pain severity alone insufficiently reflects functional impact; disability may offer a more meaningful indicator for clinical decision-making. Q4: Treatment refractoriness is central to how prolonged attacks are managed but is not incorporated into current criteria, and standardized definitions of acute treatment failure are lacking. Q5: Prodrome, aura, and postdrome can meaningfully contribute to attack burden, yet SM criteria do not specify whether nonheadache phases count toward attack duration.</p><p><strong>Conclusions: </strong>A revised definition of SM should move beyond a rigid 72-h threshold and give greater weight to functional impairment, treatment response, and more explicit definitions of attack duration that clarify how nonheadache phases are handled.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1117-1127"},"PeriodicalIF":4.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147528430","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":"Reversible cerebral vasoconstriction syndrome: A narrative review.","authors":"Ícaro Araújo de Sousa, Abner da Silva Machado, Arthur de Oliveira Veras, Thiago Oscar Goulart, Sarah Galassi Tatsuta, Trajano Aguiar Pires Gonçalves, Eva Rocha, Octávio Marques Pontes-Neto","doi":"10.1111/head.70048","DOIUrl":"10.1111/head.70048","url":null,"abstract":"<p><strong>Objectives/background: </strong>This review summarizes current insights into Reversible cerebral vasoconstriction syndrome (RCVS) diagnosis, management, and outcomes. RCVS is a cerebrovascular disorder characterized by recurrent thunderclap headaches and transient segmental vasoconstriction of cerebral arteries, typically resolving within 3 months.</p><p><strong>Methods: </strong>A comprehensive database search was performed across MEDLINE (via PubMed), Embase, Scopus, and the Cochrane Library.</p><p><strong>Results: </strong>Although often self-limiting, RCVS may cause complications such as subarachnoid hemorrhage, ischemic stroke, and cerebral edema. Triggers include vasoactive substances, pregnancy, postpartum state, and physical or emotional stress. Differentiating RCVS from conditions like primary angiitis of the central nervous system, aneurysmal subarachnoid hemorrhage, and cerebral venous thrombosis is essential because clinical and imaging features may overlap, whereas treatments differ. Advances in neuroimaging, especially magnetic resonance angiography and vessel wall imaging, have enhanced diagnostic accuracy. Management focuses on eliminating triggers and symptomatic support. Calcium channel blockers are frequently used, although their impact on disease evolution remains uncertain.</p><p><strong>Conclusion: </strong>Although most patients recover without major sequelae, chronic symptoms such as long-term headaches and neuropsychological symptoms, including cognitive impairment, underscore the need for ongoing follow-up and suggest a post-RCVS syndrome.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1162-1180"},"PeriodicalIF":4.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13142216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147528439","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}