Headache最新文献

{"title":"Tolosa-Hunt syndrome in children and adolescents: A systematic review.","authors":"H Shafeeq Ahmed, Purva Reddy Jayaram, Sukriti Khar","doi":"10.1111/head.14890","DOIUrl":"https://doi.org/10.1111/head.14890","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review aims to consolidate and analyze the existing evidence on Tolosa-Hunt syndrome (THS) in the pediatric population, focusing on clinical features, diagnostic challenges, treatment outcomes, and prognosis.</p><p><strong>Background: </strong>Tolosa-Hunt syndrome is a rare headache disorder caused by idiopathic inflammation of the cavernous sinus, orbital apex, or orbit, resulting in neuro-ophthalmological manifestations. It is uniquely characterized by cranial nerve palsies and often responds well to steroids.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted using three databases along with the gray literature. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the review protocol was registered on International Prospective Register of Systematic Reviews (PROSPERO identifier: CRD42024576802). The review included case reports and case series published in multiple languages that documented pediatric or adolescent cases of THS. We excluded any cases that were irrelevant, had insufficient details, were unsure of the diagnosis, or were later re-diagnosed with another condition. Data on clinical presentations, imaging findings, treatment modalities, and outcomes were extracted and analyzed using Microsoft Excel 2021.</p><p><strong>Results: </strong>The initial literature search provided 325 articles of which 55 articles discussing 61 unique pediatric patients were included. The median (interquartile range [IQR]) age was 11 (8-15) years, with a female predominance (70% [43/61]). Common symptoms included unilateral headache (48% [29/61]), retro-orbital pain (56% [34/61]), and cranial nerve palsies, predominantly involving the oculomotor nerve (66% [40/61]). The median (IQR) duration of symptoms was 14.5 (5-35) days. Imaging often revealed contrast enhancement on magnetic resonance imaging with cavernous sinus/orbital apex lesions. Steroid therapy was the mainstay of treatment, with 91% (52/57) of patients receiving corticosteroids. High-dose steroids ranged from 500-1000 mg/day, with some cases requiring combined therapy (typically intravenous methylprednisolone followed by oral prednisolone) and subsequent tapering. A few patients (5% [3/61]) experienced spontaneous improvement without steroids. Recurrence was noted in 33% (20/61) of patients, often necessitating prolonged or repeated corticosteroid therapy, and some cases required additional immunosuppressive therapies (infliximab/adalimumab) for management. The median (IQR) time to symptom resolution was 14 (4.5-38.5) days, while the median (IQR) duration of follow-up was 730 (195-1095) days.</p><p><strong>Conclusion: </strong>Tolosa-Hunt syndrome in children presents significant diagnostic and management challenges due to the complexity of symptoms and the rarity of the condition. Accurate diagnosis and prompt steroid therapy are crucial after ruling out other causes, althou","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921505","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":"Eicosapentaenoic acid versus placebo as adjunctive therapy in chronic migraine: A randomized controlled trial.","authors":"Ghader Mohammadnezhad, Farhad Assarzadegan, Mohsen Koosha, Hadi Esmaily","doi":"10.1111/head.14808","DOIUrl":"10.1111/head.14808","url":null,"abstract":"<p><strong>Objective: </strong>This study was conducted to assess the efficacy of daily 2000 mg eicosapentaenoic acid (EPA) supplementation in individuals with chronic migraine.</p><p><strong>Background: </strong>Chronic migraine is characterized by a minimum of 15 headache days/month, necessitating a focus on preventive treatment strategies. EPA, a polyunsaturated fatty acid recognized for its anti-inflammatory properties, is examined for its potential effectiveness in chronic migraine management.</p><p><strong>Methods: </strong>A randomized, blinded, placebo-controlled trial of eligible participants with a confirmed diagnosis of chronic migraine were enrolled. The intervention group received 1000 mg of EPA twice daily for 8 weeks, while the control group received two placebo softgels. Symptoms were recorded at 4 and 8 weeks. The primary outcome was assessed using the Headache Impact Test-6 to evaluate changes in patients. Secondary outcomes encompassed migraine headache days, headache severity measured via a visual analog scale, and the number of consumed painkillers. Descriptive analyses were reported in mean (± standard deviation [SD]).</p><p><strong>Results: </strong>A total of 60 patients were included in the study and finally, 56 patients completed the study according to the protocol, including 47 (84%) females. The data comparison at baseline did not show any significant difference between the two groups except in the number of patients using valproic acid as prophylaxis (21 patients in the EPA group, and 13 in the placebo group; p = 0.037). The results showed after 8 weeks, a mean (SD) difference of Headache Impact Test-6 in the EPA and placebo groups was -6.96 (3.34) and -4.43 (5.24), respectively (p = 0.084). Regarding migraine headache days, participants reported a mean (SD) -9.76 (4.15) and -4.60 (4.87) decline in days with headache, respectively (p < 0.001). The number of attacks per month after 8 weeks was 3.0 (95% confidence interval [CI] 2.0-4.0) and 4.0 (95% CI 3.0-6.0), respectively (p < 0.001). Regarding severity, there was no significant difference between the two groups (mean [SD] difference: -0.76 [1.13] and -0.73 [1.04], respectively; p = 0.906). In terms of adverse events, two patients in the EPA group reported intolerable nausea and vomiting, and one patient in the placebo group reported dizziness.</p><p><strong>Conclusions: </strong>This study's findings support the potential of a daily 2000 mg EPA as a prophylactic pharmacotherapy in chronic migraine management, specifically in mitigating migraine attacks, migraine headache days, and overall quality of life.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"153-163"},"PeriodicalIF":5.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142106740","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":"Healthcare resource use and costs associated with the misdiagnosis of migraine.","authors":"Jae Rok Kim, Tae Jin Park, Maria Agapova, Andrew Blumenfeld, Jonathan H Smith, Darshini Shah, Beth Devine","doi":"10.1111/head.14822","DOIUrl":"10.1111/head.14822","url":null,"abstract":"<p><strong>Objective: </strong>To compare healthcare resource utilization and healthcare costs in patients with migraine with or without a history of misdiagnosis.</p><p><strong>Background: </strong>Despite the high prevalence of migraine, migraine is commonly misdiagnosed. The healthcare resource use and cost burden of a misdiagnosis is unknown.</p><p><strong>Methods: </strong>This retrospective cohort study identified adults with an incident migraine diagnosis from the Merative™ Marketscan® Commercial and Medicare Supplemental Databases between June 2018 and 2019. Patients with a diagnosis of commonly considered misdiagnoses (headache, sinusitis, or cervical pain) before their migraine diagnosis were classified as the \"misdiagnosed cohort.\" Patients in the misdiagnosed cohort were potentially misdiagnosed, then eventually received a correct diagnosis. Patients without a history of commonly considered misdiagnoses prior to their migraine diagnosis were classified as the \"correctly diagnosed cohort.\" Healthcare resource utilization and healthcare costs were assessed in the period before migraine diagnosis and compared between the cohorts. Outcomes were reported as per patient per month and compared with incidence rate ratios.</p><p><strong>Results: </strong>A total of 29,147 patients comprised the correctly diagnosed cohort and 3841 patients comprised the misdiagnosed cohort and met the inclusion criteria. Patients in the misdiagnosed cohort had statistically significantly higher rates of inpatient admissions (0.02 vs. 0.01, incidence rate ratio [IRR] 1.61, 95% confidence interval [CI] 1.47-1.74), emergency department visits (0.10 vs. 0.05; IRR 1.89, 95% CI 1.79-1.99), neurologist visits (0.12 vs. 0.02; IRR 5.95, 95% CI 5.40-6.57), non-neurologist outpatient visits (2.64 vs. 1.58; IRR 1.67, 95% CI 1.62-1.72) and prescription fills (2.82 vs. 1.84; IRR 1.53, 95% CI 1.48-1.58) compared to correctly diagnosed patients. Misdiagnosed patients had statistically significantly higher rates of healthcare cost accrual for inpatient admissions ($1362 vs. $518; IRR 2.62, 95% CI 2.50-2.75), emergency department visits ($222 vs. $98; IRR 2.27, 95% CI 2.18-2.36), neurologist visits ($42 vs. $9; IRR 4.39, 95% CI 4.00-4.79), non-neurologist outpatient visits ($1327 vs. $641; IRR 2.07, 95% CI 1.91-2.24), and prescription fills ($305 vs. $215; IRR 1.41, 95% CI 1.18-1.70) compared to correctly diagnosed patients.</p><p><strong>Conclusion: </strong>Patients with migraine who have a history of misdiagnoses have higher rates of healthcare resource utilization and cost accrual versus those without such history.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"35-44"},"PeriodicalIF":5.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11725999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080092","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":"Headache diagnosis and treatment: A pilot knowledge and needs assessment among physical therapists.","authors":"Mia T Minen, Christopher Whetten, Danielle Messier, Sheena Mehta, Anne Williamson, Allison Verhaak, Brian Grosberg","doi":"10.1111/head.14801","DOIUrl":"10.1111/head.14801","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this pilot study was to assess physical therapists' (PTs) knowledge and needs regarding headache diagnosis and management.</p><p><strong>Background: </strong>While there is significant research on physical therapy and cervicogenic headache, studies suggest that migraine is often under-recognized, misdiagnosed, and inadequately treated across society despite its high prevalence and burden. Because migraine commonly includes concurrent neck pain and/or vestibular symptoms, patients with migraine may present to PTs for treatment. Very little is known about PTs' headache and migraine education, knowledge, and clinical practices.</p><p><strong>Methods: </strong>A team of headache specialists and PTs adapted a previously used headache knowledge and needs assessment survey to help ascertain PTs' knowledge and needs regarding headache treatment. The cross-sectional survey was distributed online via Research Electronic Data Capture (REDCap) to PTs within a large healthcare system in Connecticut.</p><p><strong>Results: </strong>An estimated 50.5% (101/200) of PTs invited to complete the survey did so. Only 37.6% (38/101) of respondents reported receiving any formal headache or migraine education in their professional training, leading to knowledge gaps in differentiating and responding to headache subtypes. Only 45.5% (46/101) were able to identify that migraine is characterized by greater pain intensity than tension-type headache, and 22.8% (23/101) reported not knowing the duration of untreated migraine. When asked about the aspects of care they believe their patients with headache would like to see improved, PTs reported education around prevention and appropriate medication use (61/100 [61.0%]), provider awareness of the degree of disability associated with migraine (51/100 [51.0%]), and diagnostics (47/100 [47.0%]).</p><p><strong>Conclusion: </strong>This sample of PTs from one healthcare system demonstrates knowledge gaps and variations in clinical practice for managing their patients with headache. Future research on integrating additional opportunities for headache education for physical therapists, including evidence-based behavioral therapies, is needed to ascertain whether it is likely to improve patient care.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"90-100"},"PeriodicalIF":5.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125511","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":"No association between migraine and HLA alleles in a cohort of 13,210 individuals with migraine from the Danish Blood Donor Study.","authors":"Inga Zalia Tummoszeit, Isa Amalie Olofsson, Mona Ameri Chalmer, Alexander Pil Henriksen, Bitten Aagaard, Søren Brunak, Mie Topholm Bruun, Maria Didriksen, Christian Erikstrup, Henrik Hjalgrim, Christina Mikkelsen, Susan Mikkelsen, Sisse Rye Ostrowski, Ole Birger Vesterager Pedersen, Liam Quinn, Erik Sørensen, Henrik Ullum, Jes Olesen, Karina Banasik, Thomas Folkmann Hansen, Lisette J A Kogelman","doi":"10.1111/head.14784","DOIUrl":"10.1111/head.14784","url":null,"abstract":"<p><strong>Objective: </strong>To determine the association between human leukocyte antigen (HLA) alleles and migraine, migraine subtypes, and sex-specific factors.</p><p><strong>Background: </strong>It has long been hypothesized that inflammation contributes to migraine pathophysiology. This study examined the association between migraine and alleles in the HLA system, a key player in immune response and genetic diversity.</p><p><strong>Methods: </strong>We performed a case-control study and included 13,210 individuals with migraine and 86,738 controls. All participants were part of the Danish Blood Donor Study Genomic Cohort. Participants were genotyped and 111 HLA alleles on 15 HLA genes were imputed. We examined the association between HLA alleles and migraine subtypes, considering sex-specific differences.</p><p><strong>Results: </strong>We found no association between HLA alleles and migraine, neither overall, nor in the sex-specific analysis. In the migraine subtype analysis, three HLA alleles were associated with migraine without aura; however, these associations could not be replicated in an independent Icelandic cohort (2191 individuals with migraine without aura and 278,858 controls). Furthermore, we found no association between HLA alleles and migraine with aura or chronic migraine.</p><p><strong>Conclusion: </strong>We found no evidence of an association between the HLA system and migraine, suggesting that genetic factors related to the HLA system do not play a significant role in migraine susceptibility.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"124-131"},"PeriodicalIF":5.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11726007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142345142","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":"Long-term reductions in acute headache medication use after eptinezumab treatment in patients with migraine and prior preventive treatment failures: Post hoc analysis of the DELIVER randomized trial.","authors":"Anna Gryglas-Dworak, Jack Schim, Anders Ettrup, Line Pickering Boserup, Mette Krog Josiassen, Kristina Ranc, Bjørn Sperling, Messoud Ashina","doi":"10.1111/head.14862","DOIUrl":"10.1111/head.14862","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate long-term reductions in acute headache medication (AHM) use with eptinezumab versus placebo in patients with prior preventive migraine treatment failures and medication overuse (MO).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Preventive migraine treatment is recommended for patients for whom AHMs have failed and for those who are using excessive amounts of AHM. MO may worsen headache and migraine symptoms in people with migraine; it is a risk factor for disease chronification and/or MO headache.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;DELIVER was a multicenter, parallel-group, double-blind, randomized, placebo-controlled, phase 3b clinical trial that randomized adults with migraine and two to four prior preventive failures to eptinezumab 100 mg, 300 mg, or placebo infusion every 12 weeks; patients initially given placebo received eptinezumab 100 mg or 300 mg in the extension period. MO was defined according to diagnostic criteria for MO headache in the baseline diary reports. This post hoc analysis of the DELIVER study included change from baseline in AHM days/month of use (ergotamines, triptans, simple or combination analgesics, and opioids; total and select class-specific use) in the MO population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 890 patients were included in the total population, and 438/890 (49.2%) had MO at baseline. In both the total population and MO population, eptinezumab resulted in greater reductions in total AHM days/month of use during weeks 1-24 than placebo, with triptans showing the largest reduction among AHM classes. Patients switching from placebo to eptinezumab experienced reductions in AHM days/month similar to that of initial eptinezumab treatment. In the extension population, mean (standard error [SE]) changes from baseline in AHM days/month were -4.6 (0.32; 100 mg) and -4.8 (0.32; 300 mg) across weeks 1-4 in patients who received eptinezumab for the entire treatment period and were -4.8 (0.44; placebo-100 mg) and -5.5 (0.44; placebo-300 mg) across weeks 25-28 in patients who switched from placebo to eptinezumab. Mean (SE) changes from baseline in AHM days/month in the extension MO population were -6.5 (0.59; 100 mg) and -6.6 (0.57; 300 mg) across weeks 1-4 in patients who received eptinezumab for the entire treatment period and were -7.1 (0.81; 100 mg) and -8.0 (0.80; 300 mg) across weeks 25-28 in patients who were switched from placebo to eptinezumab. All treatment arms sustained or further reduced AHM use across 18 months of trial participation. Across weeks 1-4, in patients fulfilling criteria for MO at baseline, 68.0% (102/150) of patients treated with eptinezumab 100 mg and 74.7% (109/146) of patients treated with eptinezumab 300 mg reported AHM use below MO thresholds compared to 43.3% (61/141) of patients receiving placebo. In patients with MO at baseline, the proportion of patients without MO remained above 60.0% for all treatment groups during the extension period.&lt;/p&gt;&lt;p&gt;&lt;stro","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"101-112"},"PeriodicalIF":5.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11726011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582109","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":"Flexible modeling of headache frequency fluctuations in migraine with hidden Markov models.","authors":"Gina M Dumkrieger, Ryotaro Ishii, Peter J Goadsby","doi":"10.1111/head.14782","DOIUrl":"10.1111/head.14782","url":null,"abstract":"<p><strong>Objective: </strong>To explore hidden Markov models (HMMs) as an approach for defining clinically meaningful headache-frequency-based groups in migraine.</p><p><strong>Background: </strong>Monthly headache frequency in patients with migraine is known to vary over time. This variation has not been completely characterized and is not well accounted for in the classification of individuals as having chronic or episodic migraine, a diagnosis with potentially significant impacts on the individual. This study investigated variation in reported headache frequency in a migraine population and proposed a model for classifying individuals by frequency while accounting for natural variation.</p><p><strong>Methods: </strong>The American Registry for Migraine Research (ARMR) was a longitudinal multisite study of United States adults with migraine. Study participants completed quarterly questionnaires and daily headache diaries. A series of HMMs were fit to monthly headache frequency data calculated from the diary data of ARMR.</p><p><strong>Results: </strong>Changes in monthly headache frequency tended to be small, with 47% of transitions resulting in a change of 0 or 1 day. A substantial portion (24%) of months reflected daily headache with individuals ever reporting daily headache likely to consistently report daily headache. An HMM with four states with mean monthly headache frequency emissions of 3.52 (95% Prediction Interval [PI] 0-8), 10.10 (95% PI 4-17), 20.29 (95% PI 12-28), and constant 28 days/month had the best fit of the models tested. Of sequential month-to-month headache frequency transitions, 12% were across the 15-headache days chronic migraine cutoff. Under the HMM, 38.7% of those transitions involved a change in the HMM state, and the remaining 61.3% of the time, a change in chronic migraine classification was not accompanied by a change in the HMM state.</p><p><strong>Conclusion: </strong>A divide between the second and third states of this model aligns most strongly with the current episodic/chronic distinction, although there is a meaningful overlap between the states that supports the need for flexibility. An HMM has appealing properties for classifying individuals according to their headache frequency while accounting for natural variation in frequency. This empirically derived model may provide an informative classification approach that is more stable than the use of a single cutoff value.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"132-142"},"PeriodicalIF":5.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11725994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792374","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":"Changes in use of acute and preventive medications for migraine after erenumab initiation over 12 months: A United States retrospective cohort study.","authors":"Jasjit K Multani, Robert Urman, Andrew S Park, Karminder Gill, Fiston Vuvu, Kainan Sun, Leah B Patel, Karen M Stockl, Kevin Hawkins, Christopher Rhyne, Mark E Bensink","doi":"10.1111/head.14820","DOIUrl":"10.1111/head.14820","url":null,"abstract":"<p><strong>Objective: </strong>To assess changes in real-world use of acute and preventive medications for migraine over a 12-month follow-up period in the United States following initiation of the anti-calcitonin gene-related peptide (CGRP) pathway monoclonal antibody (mAb) erenumab.</p><p><strong>Background: </strong>Early assessments of real-world use of acute and preventive medications for migraine after initiation of erenumab have been limited to 6 months of follow-up.</p><p><strong>Methods: </strong>This retrospective cohort study used data from the IQVIA open-source longitudinal prescription (LRx) and medical (Dx) claims databases. Adult patients with an initial claim (index date) for erenumab between May 2018 and April 2020 were identified.</p><p><strong>Results: </strong>Among 201,176 patients who met inclusion criteria, the mean (standard deviation [SD]) age was 47.5 (13.8) years and 85.6% (n = 172,153) were female. Most patients used one or more acute (88.4%; n = 177,795) and one or more traditional preventive (86.1%; n = 173,225) medications during the 12-month pre-index period. Adherence to erenumab (proportion of days covered [PDC] ≥0.80) was 40.2% (n = 80,927) with an overall mean (SD) PDC of 0.60 (0.34). Among all patients, 70.0% (n = 140,809) discontinued erenumab. After accounting for 24.7% (n = 49,720) of patients who restarted erenumab, discontinuation without reinitiation was observed in 45.3% (n = 91,089) of total patients. Switching to a different anti-CGRP pathway mAb was observed in 13.1% (n = 26,446) of total patients. Among 177,795 patients with pre-index use of one or more acute migraine medication class, 86.5% (n = 153,788) had post-index use of the same class, and 56.7% (87,134/153,788) of them discontinued one or more class of acute medication in the 12-month follow-up period. Similarly, among 173,225 patients with pre-index use of one or more traditional migraine preventive medication class, 67.7% (n = 117,274) had post-index use of the same class, and 46.7% (54,790/117,274) of them discontinued one or more class of traditional preventive medication in the 12-month follow-up period.</p><p><strong>Conclusions: </strong>In this long-term study, we observed the discontinuation of both acute and preventive medications for migraine post-erenumab initiation.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"68-79"},"PeriodicalIF":5.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11726006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153708","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":"Effects of multiple-dose administration of zavegepant nasal spray on the single-dose pharmacokinetics of ethinyl estradiol-levonorgestrel.","authors":"Rajinder Bhardwaj, Julie Collins, Jennifer Madonia, Kyle Matschke, Richard Bertz, Jing Liu","doi":"10.1111/head.14863","DOIUrl":"10.1111/head.14863","url":null,"abstract":"<p><strong>Objective: </strong>The potential for drug-drug interaction of multiple-dose intranasal zavegepant on the single-dose oral contraceptive ethinyl estradiol and levonorgestrel (EE-LNG) was evaluated.</p><p><strong>Background: </strong>Zavegepant (as a nasal spray) is a calcitonin gene-related peptide receptor antagonist approved in the United States for treatment of acute migraine in adults.</p><p><strong>Methods: </strong>This single-center, Phase 1, open-label, fixed-sequence study included healthy, nonsmoking females (18-45 years old). In treatment Period 1, a single oral dose of EE-LNG 0.02-0.10 mg was administered on Day 1. In treatment Period 2, intranasal zavegepant (20 mg daily; 10 mg per nostril separated by 1 h) was administered on Days 1-5; 1 oral dose of EE-LNG 0.02-0.10 mg was administered immediately after first 10 mg intranasal zavegepant dose on Day 2. Blood samples for EE-LNG concentrations were collected on Day 1, treatment Period 1, and Day 2, treatment Period 2, and zavegepant concentrations on Day 2, treatment Period 2. Noncompartmental pharmacokinetic parameters included maximum observed concentration (C_max), area under the concentration-time curve (AUC) from Time 0 to last non-zero concentration (AUC_0-t), and AUC from Time 0 to infinity (AUC_0-inf). The safety and pharmacokinetic sample sizes were 26 and 23, respectively.</p><p><strong>Results: </strong>Statistical comparisons of pharmacokinetic exposure parameters after co-administration of zavegepant and EE-LNG versus EE-LNG alone showed small, but statistically insignificant, changes in either EE or LNG exposure. EE comparison ratios (90% confidence intervals [CIs]) were 109.9% (105.3%, 114.8%) for AUC_0-inf and 110.2% (104.6%, 116.1%) for C_max. LNG comparison ratios (90% CIs) were 107.0% (100.2%, 114.3%) for AUC_0-inf and 108.8% (99.9%, 118.4%) for C_max. Frequently reported treatment-emergent adverse events included dysgeusia (n = 25, 96%), throat irritation (n = 11, 42%), headache (n = 10, 39%), nasal discomfort (n = 7, 27%), pharyngeal paresthesia (n = 5, 19%), and nausea (n = 4, 15%).</p><p><strong>Conclusion: </strong>Co-administration of zavegepant nasal spray with a single dose of an oral contraceptive resulted in no clinically meaningful changes (<12% increase) in EE-LNG exposure.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"14-23"},"PeriodicalIF":5.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11725995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582198","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":"Relative frequency, characteristics, and disease burden of patients with migraine unsuitable for triptan treatment: A systematic literature review.","authors":"Richard B Lipton, Astrid Gendolla, Lucy Abraham, Aaron Jenkins, Jersen Telfort, Karin Hygge Blakeman, Phillip A Saccone, Iwona Pustulka, Iain Fotheringham, Anita Engh","doi":"10.1111/head.14854","DOIUrl":"10.1111/head.14854","url":null,"abstract":"<p><strong>Objective: </strong>This review was conducted to systematically identify evidence characterizing patients with migraine who are unsuitable for triptans.</p><p><strong>Background: </strong>Triptans are not suitable as first-line treatment for all patients with migraine due to contraindications, lack of efficacy, and/or poor tolerability. However, there is debate about the frequency and characteristics of these patients and the burden they experience.</p><p><strong>Methods: </strong>MEDLINE, Embase, and conference abstracts (2011-2022) were reviewed for evidence on patients with migraine unsuitable for triptans for any reason. Data from publications describing the frequency and characteristics of this group, as well as the clinical, humanistic, or economic burden of disease in this population, were extracted.</p><p><strong>Results: </strong>Of 1460 records screened, 29 publications met inclusion criteria. Persistence with triptans was low; 51%-66% of patients starting a new triptan did not refill it, and 43%-100% discontinued their initial triptan over 2 years. In one study, 14% of patients with migraine reported prior discontinuation/failure of ≥ 2 triptans due to inadequate efficacy or poor tolerability. Up to 15% of patients with migraine had triptan contraindications, and ≥ 20% of patients receiving triptans had contraindications. In four studies, 10%-44% of patients who tried triptans had insufficient response, although definitions varied. Patients who achieved a sufficient response typically did so with their first triptan; few became responders with additional triptans. Of patients who did not respond to one to two triptans and received another, 45% were dissatisfied with the final triptan. Approximately half of patients who tried two to three triptans had an insufficient response. Greater disability, impact of disease, and depression were reported in triptan discontinuers compared to those with sustained use. Worse quality of life scores and utility values were reported in triptan insufficient versus sufficient responders, as were greater migraine-related costs, work impairment, and health-care resource utilization.</p><p><strong>Conclusion: </strong>The total population of patients unsuitable for triptans is uncertain, but the literature highlights a large group who cannot or do not persist with triptans, and current evidence suggests a high burden in this population and an unmet need for new therapeutic options. Further research is needed to determine the frequency of unsuitability for triptans more precisely and to assess the associated burden.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"164-179"},"PeriodicalIF":5.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11726002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142728063","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}