Headache最新文献

{"title":"Visual, vestibular, and ocular motor changes during nitroglycerin-triggered vestibular migraine.","authors":"Maria Dolores Villar-Martinez, Francesca Puledda, Caroline Domingos-Belo, Adolfo M Bronstein, Peter J Goadsby","doi":"10.1111/head.70194","DOIUrl":"10.1111/head.70194","url":null,"abstract":"<p><strong>Background: </strong>Intravenous nitroglycerin (NTG) is a well-established model for provoking migraine attacks, but it has not previously been used to characterize vestibular migraine (VM). Different types of nystagmus have been reported during spontaneous VM attacks. We aimed to measure changes in nystagmus during NTG-induced migraine in participants with VM.</p><p><strong>Methods: </strong>We studied 20 participants with definite VM (Barany-International Classification of Headache Disorders, 3rd edition criteria) undergoing NTG provocation in a prospective, within-subject repeated-measures pharmacological provocation study under three conditions at the National Institute for Health and Care Research King's Clinical Research Facility, London, between November 2024 to December 2025. Median (interquartile range [IQR]) age was 32 (29 to 38) years, and 16/20 were female. 3D video-oculography was used to quantify total slow-phase velocity (SPV) (°/s) of nystagmus without fixation in the center, left, right, up, and down positions. Recordings were repeated before NTG, after NTG, and after subcutaneous sumatriptan. Subjective vestibular symptoms and headache intensity were quantified with an ordinal numeric scale. Longitudinal changes in SPV were analyzed.</p><p><strong>Results: </strong>All the participants developed headache, with median peak severity 6/10 (IQR 4 to 7). Vestibular symptoms were triggered in 14/20 participants following NTG, with a median maximum intensity of 2.5 (IQR 0 to 4). Median (IQR) summed SPV (°/s) was 2 (1 to 3.25) at baseline, 1.5 (0 to 4.75) following NTG, and 1 (0 to 2.75) after sumatriptan. In Tweedie generalized linear mixed-effects models, no significant group-level effect of condition on total SPV was detected. Estimated marginal means were 1.87 (95% confidence interval [CI] 1.02 to 3.41) at baseline, 2.10 (95% CI 1.16 to 3.80) following NTG, and 1.73 (95% CI 0.93 to 3.19) after sumatriptan. Compared with baseline, neither NTG (β = 0.118, standard error [SE] = 0.267, P = 0.658) nor sumatriptan (β = -0.078, SE = 0.278, P = 0.780) showed significant effects. NTG provocation was associated with complex perceptions such as visual symptoms (10/20) and Alice in Wonderland syndrome type or dissociative symptoms (6/20), including derealization/depersonalization, metamorphopsia, macropsia and pelopsia, dysmorphopsia, and distorted passage of time.</p><p><strong>Conclusions: </strong>Quantitative slow phase velocity measures of nystagmus did not show a uniform group-level change during NTG provocation in VM, despite frequent subjective vestibular symptoms. VM episodes may reflect altered central sensory processing and vestibular hypersensitivity rather than changes in vestibulo-oculomotor output.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1991-2005"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891558","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":"Pharmacologic Treatment for Migraine Prevention in Adults Practice Guideline Recommendations: Report of the AAN Guidelines Subcommittee and the American Headache Society.","authors":"Sonja Potrebic, Sarah Tanveer, Werner J Becker, Rebecca Burch, Lara J Cooke, Todd Fenton, Jeff J Fletcher, Gillian L Gordon Perue, Andrew D Hershey, Jeffrey L Jackson, Shirley Kessel, Elizabeth W Loder, Mia T Minen, Maryam Oskoui, Vijay K Ramanan, Michelle Murren, Todd J Schwedt, Stephen D Silberstein, Don B Smith, Kylie A Botchway-Doe, Heather M Silsbee, Tamara Pringsheim","doi":"10.1111/head.70199","DOIUrl":"10.1111/head.70199","url":null,"abstract":"<p><p>This practice guideline provides updated evidence-based recommendations regarding the use of pharmacologic migraine prevention in adults. A multidisciplinary panel conducted a systematic review and developed practice recommendations following the process outlined in the 2017 edition of the American Academy of Neurology Clinical Practice Guideline Process Manual. The systematic review includes studies published through June 6, 2024, and is available in a companion publication. Recommendations are supported by structured rationales that integrate evidence from the systematic review, related evidence, principles of care, and inferences from evidence. Recommendations are provided on how to decide when it is appropriate to start a pharmacologic migraine preventive medication and how to decide which migraine preventive medication to start. Recommendations address decision making on appropriate choices of migraine preventive medications in specific situations and populations, including patients with fibromyalgia, obesity, or hypertension; considerations for older adults; treatment during pregnancy and lactation; sex-related factors in choosing medications; and treatment for patients with medication overuse. Recommendations on assessment of treatment efficacy, adverse effects, and discontinuing migraine preventive medications are provided.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"2173-2184"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864595","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 diagnostic order of migraine-depression comorbidity associates with physical, mental, and social disability.","authors":"Daniel Baksa, Nora Eszlari, Dora Torok, Tamas Nagy, Gabor Hullam, Peter Petschner, Gyorgy Bagdy, Gabriella Juhasz","doi":"10.1111/head.70171","DOIUrl":"10.1111/head.70171","url":null,"abstract":"<p><strong>Objectives/background: </strong>There is a known bidirectional association between migraine and depression; however, potential effects of the diagnostic trajectory of the diseases are not known. Therefore, we investigated the association of the diagnostic order of migraine and depression with the physical and mental health status of groups with different disease trajectories.</p><p><strong>Methods: </strong>A sample of the UK Biobank was used (n = 327,234; 51.2% female, median age: 58 years) in our cross-sectional study. Based on ICD-10 codes from electronic health record, the following groups were compared: first migraine, then depression (M-D, n = 2036), first depression, then migraine (D-M, n = 1217), only migraine (M, n = 13,318), only depression (D, n = 33,831), and controls (C, n = 276,832). Data covered general descriptive data, socioeconomic status, lifestyle and health, social support, and mental health, collected mostly between 2006 and 2010.</p><p><strong>Results: </strong>Bonferroni-corrected significant results (p < 0.001) emerged between the groups, adjusted for sex. D-M patients showed the highest level of sleeping problems (odds ratio [OR] = 3.26, 95% confidence interval [CI]: 2.72-3.92), neuroticism (β = 3.26, 95% CI: 3.09-3.44), stress (OR = 3.68, 95% CI: 3.19-4.25), the worst rated overall health (OR = 22.93, 95% CI: 17.72-29.68), and the highest Townsend Deprivation Index (β = 0.76, 95% CI: 0.59-0.93). The D-M and M-D patients shared the highest body mass index (β = 1.57, 95% CI: 1.31-1.83; 1.3, 95% CI: 1.09-1.5, respectively) and the lowest physical activity (OR = 0.55, 95% CI: 0.47-0.64; 0.59, 95% CI: 0.53-0.67, respectively). The D patients reported the lowest level of education (OR = 0.71, 95% CI: 0.68-0.73) and income (OR = 0.29, 95% CI: 0.27-0.31), and two comorbid groups showed similarly low values.</p><p><strong>Conclusion: </strong>Our study suggests that the diagnostic order is an important feature of migraine-depression comorbidity by revealing that the depression diagnosed first associates with a stronger physical, mental, and social disability even among comorbid cases and this needs specific attention by clinicians.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1958-1970"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792165","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":"Geographic variation in certified headache subspecialty availability in the United States.","authors":"Bradley Ong, Nicolas Thompson, Heidi Mueller, Amaal J Starling, Nan Cheng","doi":"10.1111/head.70197","DOIUrl":"10.1111/head.70197","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives/background: &lt;/strong&gt;Our objectives were to characterize the geographic distribution and local availability of United Council for Neurologic Subspecialties-certified headache specialists across US counties, hospital referral regions, and states, and to examine associations with socioeconomic deprivation, social vulnerability, and urbanicity. Headache disorders are highly prevalent and disabling, yet local availability of certified headache subspecialty care in the United States remains uneven. Although prior studies have described national and state-level distributions of United Council for Neurologic Subspecialties-certified headache specialists, important gaps remain in understanding county-level availability and disparities in access. Prior state-level summaries may mask within-state differences in access to United Council for Neurologic Subspecialties-certified headache specialists.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a cross-sectional geospatial workforce analysis of United Council for Neurologic Subspecialties-certified headache specialists in the United States as of January 7, 2026. Practice locations were mapped to counties, hospital referral regions, and states, and compared with general neurologist supply from the National Provider Identifier registry. Estimated population need was calculated by applying a national migraine prevalence to adult population denominators. We examined associations between specialist distribution and county-level socioeconomic vulnerability, urbanicity, and region.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 3144 US counties, 2870 (91.3%) had no United Council for Neurologic Subspecialties-certified headache specialists, and 2085 (66.3%) had no neurologists. Headache specialists were entirely absent from counties without neurologists. Median county-level headache specialist density was 0 per 100,000 adults, reflecting the absence of local subspecialty care in most US counties. Accounting for county adult population, neurologist density, urbanicity, and region, higher Area Deprivation Index and Social Vulnerability Index scores were associated with lower headache specialist rates. Each 10-point increase in Area Deprivation Index was associated with lower expected headache specialist rate (adjusted incidence rate ratio = 0.87, 95% confidence interval = 0.82-0.93), and each 0.1-unit increase in Social Vulnerability Index was also associated with lower expected rate (adjusted incidence rate ratio = 0.94, 95% confidence interval = 0.90-0.98). Headache specialist availability relative to estimated population need varied markedly across counties, with substantial estimated local differences between migraine burden and certified subspecialty supply that were not apparent in state-level summaries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;United Council for Neurologic Subspecialties-certified headache specialists are unevenly distributed across the United States, with limited local availability of ce","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"2006-2019"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792148","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":"Responding With Evidence and Access for Childhood Headaches (REACH) study: A comparative effectiveness trial of cognitive behavioral therapy monotherapy versus combined cognitive behavioral therapy-pharmacotherapy with amitriptyline for the prevention of childhood migraine-The study protocol.","authors":"Estée C H Feldman, Michelle M Ernst, Maya A Marzouk, Robert C Gibler, Brooke L Reidy, Leigh A Chamberlin, Megan Kirschman, James Peugh, Marielle Kabbouche, Susan L LeCates, Joanne Kacperski, Jessica A Saunders, Andrew D Hershey, Marcy E Yonker, Christina L Szperka, Amy A Gelfand, Scott W Powers","doi":"10.1111/head.70176","DOIUrl":"10.1111/head.70176","url":null,"abstract":"<p><p>Migraine is one of the most common chronic health problems in children and adolescents, resulting in high levels of functional disability. Symptoms frequently persist into and impact the course of adulthood for affected individuals. Current practice recommendations include a combined therapy approach of preventive medication and cognitive behavioral therapy (CBT); however, no trials have systematically assessed whether a combined therapy approach is superior to a cognitive behavioral monotherapy intervention. The REACH (Responding With Evidence and Access for Childhood Headaches) trial will compare the impact of a CBT monotherapy to a combined treatment for prevention of migraine in youth, while addressing barriers to CBT access by utilizing a teletherapy approach. The study will include youth with migraine between the ages of 10 and 17 years from 15 sites across the United States, who will be randomly assigned to a CBT + pill (amitriptyline) group or CBT-alone group. Both groups will complete six sessions of telehealth CBT, as well as three booster sessions, over the course of 6 months. Participants will report on headache and migraine frequency and related disability via a daily headache diary before (28-day baseline), during, and after completion of the intervention (the last 28 days on the protocol). The CBT + pill group will also undergo a dose titration of clinically prescribed amitriptyline throughout the active treatment phase. Primary treatment outcomes are a ≥50% reduction in headache days and reduction in migraine-related disability (i.e., Pediatric Migraine Disability Assessment score ≤20). Findings of the REACH study may confirm current practice guidelines or provide evidence of comparable effectiveness of combined therapy and CBT monotherapy for prevention of migraine. This trial is designed to reinforce current guidelines for preventive headache management strategies in youth with migraine. The study will also advance knowledge by determining whether CBT alone, without the potential side effects of medication, is sufficient.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"2185-2198"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906186","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":"Correction to \"American Headache Society 68th Annual Scientific Meeting June 4-7, 2026, Orlando, Florida\".","authors":"","doi":"10.1111/head.70229","DOIUrl":"10.1111/head.70229","url":null,"abstract":"","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"2206"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911795","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":"Which comes first may matter: The depression-migraine comorbidity dyad.","authors":"Dawn C Buse, Steven M Baskin, Richard B Lipton","doi":"10.1111/head.70189","DOIUrl":"10.1111/head.70189","url":null,"abstract":"","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1950-1952"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792230","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":"Efficacy and cardiovascular safety of lasmiditan in patients with cardiovascular risk factors: A systematic review and meta-analysis with updated synthesis of triptan safety data.","authors":"Shankar Biswas, Sindhu Vasireddy, Yashasvi Srivastava, Dhruv Gehlot, C Fasil, Hira A Natarajan, I M Khalid Reza, Jieun Youn, Nand Gopal Bajaj, Zoya Hussain, Shivalika Singh, Ganji Ushodaya, Masoud Altabawi, Anagha Shankar","doi":"10.1111/head.70182","DOIUrl":"10.1111/head.70182","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study was conducted to evaluate lasmiditan efficacy and cardiovascular (CV) safety in patients with CV risk factors, and provide an updated synthesis of observational evidence on long-term triptan-related CV outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Approximately 20% of patients with migraine have CV contraindications to triptans. Lasmiditan, a selective 5-hydroxytryptamine (5-HT)&lt;sub&gt;1&lt;/sub&gt;F receptor agonist without vasoconstrictive properties, may offer a safer alternative to triptans for these patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this systematic review and meta-analysis, we systematically searched MEDLINE, Embase, Scopus, and Cochrane CENTRAL from inception to June 2025 following a retrospectively registered International Prospective Register of Systematic Reviews protocol (CRD420251208584). Primary outcomes were pain freedom at 2 h (efficacy; randomized controlled trials) and major adverse CV events (observational studies). Random-effects meta-analyses used odds ratios (ORs) for binary efficacy outcomes and hazard ratios for time-to-event safety data. Rare cardiac adverse events were analyzed using Peto ORs. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Sixteen studies were included (six lasmiditan studies involving three randomized controlled trials [two phase 3 and one phase 2] enrolling 5126 participants, two post hoc analyses, one open-label extension, and 10 triptan CV safety studies). In the meta-analysis of three independent randomized controlled trials (eight dose-specific comparisons), lasmiditan significantly increased pain freedom at 2 h versus placebo (OR, 2.09; 95% confidence interval [CI], 1.66-2.63, p &lt; 0.001; heterogeneity statistic (I&lt;sup&gt;2&lt;/sup&gt;) = 58.9%; GRADE: high certainty), with clear dose-dependent effects (50 mg OR ≈ 1.50; 100 mg OR ≈ 2.0; 200 mg OR ≈ 2.60; subgroup p &lt; 0.001) and number needed to treat of 4.1-15.4. Most bothersome symptom freedom was similarly improved (OR, 1.79; 95% CI, 1.45-2.22, p &lt; 0.001; I&lt;sup&gt;2&lt;/sup&gt; = 54.5%; GRADE: high certainty). Observational triptan safety data (14 comparisons from 10 studies) showed apparent CV protection (hazard ratio, 0.82; 95% CI, 0.73-0.92), although certainty was very low due to confounding by indication, inconsistency (I&lt;sup&gt;2&lt;/sup&gt; = 82.4%), and comparator indirectness. Cardiac treatment-emergent adverse events were rare with lasmiditan (&lt;1%; Peto OR, 3.14; 95% CI, 1.10-8.98, based on 14 total events; GRADE: low certainty), with zero vasoconstrictive CV events across all trials. Common adverse events included dizziness (risk ratio [relative risk] [RR], 5.71), somnolence (RR, 2.68), and paresthesia (RR, 5.02), all dose-dependent.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Lasmiditan demonstrated efficacy and favorable CV safety in CV-risk populations, with no vasoconstrictive events detected across 5126 parti","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"2156-2172"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929583","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":"Glucagon-like peptide-1 receptor agonists in idiopathic intracranial hypertension: A systematic review and meta-analysis.","authors":"Luciano Falcão, Leonardo B O Brenner, Pedro Lucas Machado Magalhães, Abhishek Goyal, Mariana Leticia de Bastos Maximiano, Kenzo Ogasawara Donato, Rafael Andrade Sampaio Silva, Joao Victor Pereira Gonzalez, da Silva, Anderson Silva Corin, Katherine Zarroli","doi":"10.1111/head.70131","DOIUrl":"10.1111/head.70131","url":null,"abstract":"<p><strong>Objectives/background: </strong>Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), initially developed for type 2 diabetes and obesity, have emerged as promising candidates for idiopathic intracranial hypertension (IIH) due to their metabolic and neurophysiological effects. This systematic review and meta-analysis aims to summarize, synthesize, and quantitatively pool the available evidence on the use of GLP-1 RAs in patients with IIH, focusing on clinical outcomes.</p><p><strong>Methods: </strong>PubMed, Embase, Web of Science, and the Cochrane Library were searched through December 2025 for randomized trials and cohort studies assessing GLP-1 RAs in patients with IIH. Risk of bias was assessed by Risk of Bias in Nonrandomized Studies of Interventions and Cochrane Risk of Bias 2.0. Primary outcomes included papilledema, headache burden, refractory IIH, and visual disturbances.</p><p><strong>Results: </strong>Eight studies comprising 13,243 patients met inclusion criteria. GLP-1 RAs significantly reduced papilledema risk at 3 months (risk ratio [RR], 0.430; 95% confidence interval [CI], 0.281-0.659; I-squared statistic [I²] = 62.5%) and maintained the benefit through 24 months (RR, 0.469; 95% CI, 0.382-0.576; I² = 18.0%). Headache frequency was also consistently lower at 3 months (RR, 0.690; 95% CI, 0.557-0.853; I² = 71.0%) and at 24 months (RR, 0.796; 95% CI, 0.691-0.916; I² = 68.9%), with similar improvements in visual disturbances at 3 months (RR, 0.408; 95% CI, 0.304-0.547; I² = 36.0%) and 24 months (RR, 0.433; 95% CI, 0.236-0.796; I² = 79.0%), and refractory IIH at 3 months (RR, 0.696; 95% CI, 0.574-0.843; I² = 60.0%) and 24 months (RR, 0.808; 95% CI, 0.715-0.908; I² = 52.0%) compared to control group.</p><p><strong>Conclusion: </strong>GLP-1 RAs appear associated with improvements in clinical outcomes in IIH, including reductions in papilledema, headache, and visual symptoms. The current evidence base is dominated by observational studies with moderate to serious risk of confounding, resulting in low-certainty, hypothesis-generating evidence. These findings should be interpreted cautiously and primarily serve to inform the design of future well powered randomized controlled trials.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"2117-2128"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792186","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":"Thyroid dysfunction and migraine across racial and age groups: A multinational cohort study.","authors":"Isaac Bai, Niki Mascarenhas, Kritika Maharjan, Han Wang, Chien-Chih Chou, I-An Lai, Ching-Heng Lin, Chien-Hsiang Weng","doi":"10.1111/head.70173","DOIUrl":"10.1111/head.70173","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate whether thyroid dysfunction, including hypothyroidism and hyperthyroidism, is associated with migraine across racial and age groups using a large, multinational electronic health record database.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Thyroid disorders are highly prevalent worldwide, with hypothyroidism affecting over 200 million individuals and hyperthyroidism affecting approximately 2.5% of adults. Migraine is a leading cause of disability globally. Prior studies have suggested potential links between thyroid dysfunction and migraine, but evidence has been limited by small sample sizes, restricted population diversity, and inadequate control of confounding. Whether associations differ by thyroid subtype, race, or age remains unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We performed two parallel retrospective cohort analyses within the TriNetX Global Collaborative Network, comprising over 200 million patients across 21 countries, using patient records from January 2004 to December 2024. Adults aged 18-100 years with hypothyroidism or hyperthyroidism, defined by ≥3 clinical encounters within 20 years, were identified. Individuals with psychiatric disorders (including mood, anxiety, and stress-related disorders), sleep disorders, epilepsy or recurrent seizures, or known migraine-related genetic mutations were excluded. Each thyroid cohort was compared with a control group without thyroid disease, with groups balanced on key demographic and clinical characteristics including age, sex, and hypertension; beta-blocker use was additionally considered in the hyperthyroidism cohort. The primary outcome was diagnosis of migraine (International Classification of Diseases, 10th Revision, code G43) within 5 years of index date. Subgroup analyses were conducted by race (Caucasian, African American/Black, Asian) and age (18-40, 40-65, 65-100 years). Sensitivity analyses assessed robustness to alternative visit thresholds and expanded covariate adjustment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 33,327,750 patients were included in the hypothyroidism analysis and 28,182,377 in the hyperthyroidism analysis. Baseline differences between groups were minimized after cohort balancing. Hypothyroidism was associated with higher odds of migraine across all racial groups, strongest among African American/Black (odds ratio [OR] 2.04; 95% confidence interval [CI] 1.91-2.17), followed by White (OR 1.93; 95% CI 1.89-1.96) and Asian (OR 1.83; 95% CI 1.69-1.98). Hyperthyroidism was similarly associated with increased migraine odds, most prominently among White (OR 1.64; 95% CI 1.59-1.70), with smaller but significant associations in African American/Black (OR 1.28; 95% CI 1.14-1.44) and Asian (OR 1.18; 95% CI 1.07-1.29). Elevated odds were observed across all age strata, generally increasing with age. Findings were consistent in sensitivity analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In this large, multinational real-world study, both hy","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"2020-2031"},"PeriodicalIF":3.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148455670","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}