Headache最新文献

{"title":"Trainee highlights.","authors":"Sarah M Bobker","doi":"10.1111/head.14920","DOIUrl":"https://doi.org/10.1111/head.14920","url":null,"abstract":"","PeriodicalId":12844,"journal":{"name":"Headache","volume":"65 3","pages":"389-390"},"PeriodicalIF":5.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566917","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":"Secondary nummular headache: Are they more common than we thought?","authors":"Antonio Sánchez-Soblechero, Elisa Luque-Buzo, Alberto Lozano-Ros, Amparo Guillem","doi":"10.1111/head.14879","DOIUrl":"10.1111/head.14879","url":null,"abstract":"<p><strong>Objective: </strong>To provide a detailed description of symptomatic nummular headache (NH) and to compare them with primary cases in a large series.</p><p><strong>Background: </strong>While most published cases of NH are primary headache, some 'secondary' cases have been reported since its initial description. It remains uncertain why identical clinical presentations can result from primary and 'secondary' etiologies. Thanks to the possibility of offering specific treatments for symptomatic NH, it is crucial to be able to distinguish between them effectively.</p><p><strong>Methods: </strong>This monocentric retrospective study included a cohort of patients diagnosed with NH according to the International Classification of Headache Disorders, Second (ICHD-2) and Third Editions (ICHD-3), and the Pareja et al. first description, over a 20-year period (2002 to 2022). Established ICHD-3 diagnoses were used for each symptomatic case. Causality was attributed if (i) headache had developed in close temporal relation to other symptoms and/or clinical signs, or had led to its diagnosis, and (ii) either the headache had significantly worsened in parallel with other symptoms or clinical or radiological signs of worsening of the underlying disease, or the headache had resolved after treatment of the presumed causative disorder. Symptomatic NH were divided into two groups: \"definite\" or \"probable.\" A comparison between the \"primary\" and \"secondary\" groups is presented.</p><p><strong>Results: </strong>A total of 131 patients (88, 67.2% females) were included in the study. The median (interquartile range) age at onset of symptoms was 52 (36-63.2) years. In all, 34 patients (25.9%) were diagnosed as symptomatic NH (nine post-traumatic, seven attributed to a disorder of the cranial bones, six due to intracranial neoplasia, five attributed to arachnoid cysts, three attributed to vascular malformations, two due to cutaneous disturbances, and two attributed to hypertension). Eight patients were classified as \"definite symptomatic NH\" and 26 as \"probable symptomatic NH.\" Neuroimaging was performed in all cases. Any previous headache (52.9% vs. 29.9%; p = 0.016), a remote head trauma (26.5% vs. 9.3%; p = 0.015), and a longer disease duration (18 vs. 12 months; p = 0.036) were more likely in patients with symptomatic NH. Preventive treatment was more effective (achieved >50% reduction in monthly headache days) in patients with symptomatic NH (72.2% vs. 30.3%; p = 0.002) due to a cause-specific treatment.</p><p><strong>Conclusion: </strong>Symptomatic NH are frequent. The presence of any previous headache or remote head trauma may suggest a diagnosis of symptomatic NH; however, as certain NH might be an early symptom of intracranial mass lesions, neuroimaging is necessary. Finding the cause of NH is essential to offer the most effective targeted treatment.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"439-451"},"PeriodicalIF":5.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768287","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 impact of headache intensity on speech in participants with migraine and acute post-traumatic headache.","authors":"Dani C Smith, Jianwei Zhang, Suren Jayasuriya, Visar Berisha, Amaal Starling, Todd J Schwedt, Catherine D Chong","doi":"10.1111/head.14809","DOIUrl":"10.1111/head.14809","url":null,"abstract":"<p><strong>Background: </strong>Slower speaking rates and higher pause rates are found in individuals with migraine or post-traumatic headache during headache compared to when headache-free. We aimed to determine whether headache intensity influences the speaking rate and pause rate of participants with migraine or acute post-traumatic headache (aPTH) following mild traumatic brain injury (mTBI).</p><p><strong>Methods: </strong>Using a speech elicitation tool, participants with migraine, aPTH, and healthy controls (HC) submitted speech samples over a period of 3 months. Speaking and pause rates were calculated when participants were headache-free and when they had mild or moderate headache. In this observational study, speaking and pause rates in participants with migraine and aPTH were compared to HC, controlling for age, sex, and days since mTBI (participants with aPTH only).</p><p><strong>Results: </strong>A total of 2902 longitudinal speech samples from 13 individuals with migraine (mean age = 33.5, SD = 6.6; 12 females/1 male), 43 individuals with aPTH (mean age = 44.4, SD = 13.5; 28 females/15 males), and 56 HC (mean age = 40.8, SD = 13.0; 36 females/20 males) were collected. There was no difference in speaking rate between HC and the combined headache cohort of participants (migraine and aPTH) when they had headache freedom or a mild headache. When participants had moderate intensity headache, their speaking rate was significantly slower compared to that of HC and compared to their speaking rate during mild headache intensity or headache freedom. For the combined headache cohort of participants, pause rates were significantly higher when they had headache freedom or had a headache of mild or moderate intensity relative to HC. Compared to participants' pause rate during headache freedom, their pause rate was significantly higher during mild and moderate headache intensity. Participants with aPTH had significantly slower speaking rates compared to participants with migraine during headache freedom, mild headache intensity, and moderate headache intensity. Participants with aPTH had significantly higher pause rates compared to participants with migraine when experiencing moderate headache intensity.</p><p><strong>Discussion: </strong>For both aPTH and migraine, more severe headache pain was associated with higher pause rates and slower speaking rates, suggesting that speaking rate and pause rate could serve as objective biomarkers for headache-related pain. Slower speaking rate in participants with aPTH could reflect additional consequences of TBI-related effects on motor control and speech production.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"506-515"},"PeriodicalIF":5.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11868452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080094","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 fremanezumab on migraine-associated symptoms and medication use in Japanese and Korean patients with episodic migraine: Exploratory endpoint analysis of a multicenter, randomized, double-blind, placebo-controlled trial.","authors":"Muneto Tatsumoto, Miki Ishida, Katsuhiro Iba, Byung-Kun Kim, Xiaoping Ning, Chihiro Osawa, Masami Nakai, Yuka Kurita","doi":"10.1111/head.14810","DOIUrl":"10.1111/head.14810","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To describe exploratory endpoints from a previous phase 2b/3 placebo-controlled trial conducted in Japan and Korea, specifically investigating the effect of fremanezumab or placebo on migraine-associated symptoms and acute headache medication use in patients with episodic migraine (EM).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;EM is associated with non-head pain symptoms, including nausea, vomiting, photophobia, or phonophobia, which contribute substantially to the disease burden, healthcare resource utilization, and impaired quality of life. Current EM treatments include a mix of nonspecific/migraine-specific acute headache medications, but medication overuse can induce headaches and progression from EM to chronic migraine (CM). In multiple phase 2b/3 trials, the monoclonal antibody fremanezumab significantly reduced the average number of monthly migraine days experienced by patients with EM/CM compared with placebo.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was a prespecified analysis of exploratory endpoints in a multicenter, randomized, double-blind, placebo-controlled, phase 2b/3 trial conducted in Japanese and Korean patients with EM (NCT03303092). Patients were randomized to receive fremanezumab, either monthly or quarterly, or matching placebo, administered subcutaneously at 4-week/28-day (\"monthly\") intervals to maintain blinding. Exploratory endpoints reported here were the mean change from baseline in the number of days/month with (i) the use of any acute headache medication, (ii) the use of any migraine-specific acute headache medication, (iii) nausea or vomiting, and (iv) photophobia and phonophobia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Overall, 357 Japanese and Korean patients with EM received either monthly (n = 121) or quarterly (n = 119) fremanezumab or placebo (n = 117). Compared with placebo, fremanezumab administered monthly or quarterly was associated with a significant reduction from baseline in the average number of days/month with acute headache medication use over three months (difference vs. placebo -2.81 [95% confidence interval (CI) -3.52, -2.11]; p &lt; 0.001 and -2.79 [95% CI -3.50, -2.08]; p &lt; 0.001, respectively). Similar findings were observed in the monthly average number of days with migraine-specific acute headache medications (difference vs. placebo with monthly and quarterly fremanezumab, -2.63 [95% CI -3.31, -1.95] for both; p &lt; 0.001), the average number of days/month with nausea or vomiting (difference vs. placebo -1.09 [95% CI -1.60, -0.58]; p &lt; 0.001 for monthly fremanezumab and -1.37 [95% CI -1.88, -0.86]; p &lt; 0.001 for quarterly fremanezumab), and the average number of days with photophobia and phonophobia (difference vs. placebo -1.22 [95% CI -1.80, -0.65]; p &lt; 0.001 and -1.64 [95% CI -2.22, -1.06]; p &lt; 0.001, respectively).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Monthly and quarterly administered fremanezumab effectively prevented EM in Japanese and Korean patients. Fremanezumab also improved","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"399-406"},"PeriodicalIF":5.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142106739","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":"Vestibular Migraine Patient Assessment Tool and Handicap Inventory (VM-PATHI) : A narrative review.","authors":"Alireza Sharifi, Ali Kouhi, Kristen K Steenerson, Jeffrey D Sharon","doi":"10.1111/head.14866","DOIUrl":"10.1111/head.14866","url":null,"abstract":"<p><strong>Background: </strong>Vestibular migraine (VM) has a wide range of clinical presentations that can have a significant negative impact on quality of life. Currently, there is no objective test available to confirm the diagnosis or measure the severity of VM. The only available tools for assessing disease severity are patient-reported outcome measures (PROMs), such as the Dizziness Handicap Inventory (DHI).</p><p><strong>Objective: </strong>This manuscript aims to summarize the current knowledge about a newly developed PROM called the Vestibular Migraine Patient Assessment Tool and Handicap Inventory (VM-PATHI).</p><p><strong>Methods: </strong>A comprehensive search was conducted across the Web of Science, Scopus, PubMed, and Google Scholar databases up to February 2024, using the keywords \"Vestibular migraine,\" \"VM-PATHI,\" and \"Patient-Reported Outcome Measure.\" Only studies involving human participants were included, and no additional restrictions were applied. The reference lists of included studies were also reviewed to identify other eligible studies. The main outcome of interest was the evaluation of VM-PATHI in patients with VM.</p><p><strong>Results: </strong>The VM-PATHI is a 25-item questionnaire divided into six sections: headache equivalents, motion sensitivity, anxiety, cognition, disequilibrium/central audiovestibular disturbance, and emotion/sense of being overwhelmed. This tool has demonstrated good face and content validity, discriminant validity, responsiveness, test-retest reliability, and internal reliability (Cronbach's α: 0.92). Patients with VM are likely to show clinical improvement in symptoms if their VM-PATHI scores decrease by ≥6 points. Additionally, VM-PATHI has shown a good correlation with clinical improvement across various treatment modalities.</p><p><strong>Conclusion: </strong>The VM-PATHI may provide advantages over other PROMs by measuring a wider spectrum of disease-specific effects of VM. Scores are correlated with the DHI, dizzy days per month, and other quality of life metrics.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"521-526"},"PeriodicalIF":5.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907109","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":"Trainee highlights.","authors":"Sarah M Bobker","doi":"10.1111/head.14920","DOIUrl":"https://doi.org/10.1111/head.14920","url":null,"abstract":"","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531266","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":"Development and pharmacological characterization of novel multi- calcitonin gene-related peptide and pituitary adenylate cyclase-activating peptide receptor antagonists.","authors":"Zoe Tasma, Andrew Siow, Paul W R Harris, Margaret A Brimble, Debbie L Hay, Christopher S Walker","doi":"10.1111/head.14916","DOIUrl":"https://doi.org/10.1111/head.14916","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to provide proof-of-concept that multi-receptor antagonist peptides can be generated by covalently linking independent antagonist peptides that block calcitonin gene-related peptide (CGRP_8-37) or pituitary adenylate cyclase-activating peptide (PACAP)/vasoactive intestinal peptide (VIP) (PACAP_6-38) activity.</p><p><strong>Background: </strong>The neuropeptides CGRP and PACAP are implicated in migraine and pain pathogenesis. CGRP and PACAP are elevated during a migraine attack, and following infusion of either peptide, patients develop migraine-like attacks. This indicates that targeting both these systems may provide therapeutic benefits. Mechanistic studies suggest that these peptides largely act independently from one another. Therefore, blocking the activity of both CGRP and PACAP simultaneously could provide a clinical advantage over individual blockade. One strategy is to develop a single antagonist capable of inhibiting the signaling of both CGRP and PACAP receptors, a multi-receptor antagonist. N-terminal truncation of CGRP and PACAP generates the antagonists CGRP_8-37 and PACAP_6-38, respectively. These are commonly used as research tools for the CGRP and PACAP receptors. These peptide antagonists were, therefore, used as the basis for the design of multi-receptor antagonists against the CGRP and PACAP receptors and to test their functionality in vitro.</p><p><strong>Methods: </strong>To generate multi-receptor antagonists, CGRP_8-37 was linked through 1,3-dipolar cycloaddition using click chemistry to PACAP_6-38 at amino acid residues 21, 34, or 38. The ability of these multi-receptor antagonists to block CGRP activity (CGRP and AMY₁ receptors) and PACAP-38, PACAP-27, and VIP activity (PAC₁, VPAC₁, and VPAC₂ receptors) was then characterized in transfected Cos7 cells. The peptides were then further examined in pain-relevant rat spinal cord cultures, as a model of endogenous receptors.</p><p><strong>Results: </strong>Multi-receptor antagonists were successfully generated, displaying similar antagonist potency to their parental antagonists in both transfected Cos7 cells and in spinal cord cultures. Interestingly, CGRP_8-37 linked to position 38 of PACAP_6-38 was a more potent antagonist of CGRP activity than CGRP_8-37.</p><p><strong>Conclusion: </strong>This study provides proof-of-concept evidence for the development of potent multi-receptor antagonists capable of blocking both CGRP and PACAP activity.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491684","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":"Utility of acetazolamide for headaches in the setting of pulmonary arterial hypertension - A case report.","authors":"Natalie L Nabaty, Joshua A Tobin","doi":"10.1111/head.14909","DOIUrl":"https://doi.org/10.1111/head.14909","url":null,"abstract":"<p><strong>Background: </strong>Treprostinil, a prostacyclin analog, remedies pulmonary arterial hypertension through vasodilation of both pulmonary and systemic arterial vascular beds. Headache is a known side effect of treprostinil and prostacyclin analogs in general, but the mechanism by which they cause headache is unknown. Current recommendations for treatment of severe headaches from prostacyclin analogs include only one drug class, opioids. Acetazolamide is a carbonic anhydrase inhibitor that lowers intracranial pressure by reducing the production of cerebrospinal fluid.</p><p><strong>Case: </strong>A 44-year-old female inpatient developed a continuous headache, much worse supine than standing, shortly after starting treprostinil for pulmonary artery hypertension. Imaging studies showed no explanatory anatomical process. Her comorbidities precluded the use of triptans, ergots, and non-steroidal anti-inflammatory drugs, but her headache resolved rapidly with acetazolamide 250 mg twice daily. Acetazolamide and furosemide were stopped due to hypokalemia and vomiting, whereupon her headaches returned. Acetazolamide but not furosemide was then restarted, again with resolution of her headaches despite cessation of oxycodone.</p><p><strong>Discussion/conclusion: </strong>This sequence suggests that treprostinil may cause headache by elevating intracranial pressure (ICP), possibly through cerebral vasodilation. We suspect that acetazolamide may have reduced her ICP enough to resolve her headache. To our knowledge, this report is the first description of both the possible underlying mechanism of action whereby prostacyclin analogs may cause headache, as well as treatment of the underlying cause of the headache rather than the symptom.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491686","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":"Prevalence of primary stabbing headache: A meta-analysis.","authors":"Aleksander Osiowski, Maksymilian Osiowski, Dominik Taterra","doi":"10.1111/head.14915","DOIUrl":"https://doi.org/10.1111/head.14915","url":null,"abstract":"<p><strong>Objectives/background: </strong>This study was undertaken to assess the prevalence of primary stabbing headache (PSH) among adult patients seeking medical attention for headache in a clinic-based setting. PSH is a primary headache disorder and is one of the representatives of indomethacin-responsive cephalalgias. The epidemiology of PSH in adult patients assessed for headache in a tertiary care setting remains not well established.</p><p><strong>Methods: </strong>PubMed, Embase, MEDLINE, and ScienceDirect databases were thoroughly searched for observational studies published between January 1, 1988, and August 9, 2024, that reported the relative frequency of PSH among adult patients evaluated for headache in a clinic-based setting. The Meta-Analysis of Observational Studies in Epidemiology guidelines were strictly followed by the study's design. Risk of bias was assessed using the Joanna Briggs Institute Checklist for Studies Reporting Prevalence Data. The study's protocol was preregistered on PROSPERO (ID: CRD42024573776).</p><p><strong>Results: </strong>Of the initial 1153 records, 15 articles (n = 35,904 individuals) met all of the eligibility criteria. Most of the studies revealed a low risk of bias. The prevalence of PSH among adult patients evaluated for headache in a tertiary care setting was 1.6% (95% confidence interval [CI] = 0.7-3.4, 95% prediction interval [PI] = 0.00-0.29), with substantial heterogeneity (I² = 98.42) noted across the studies. PSH was diagnosed more often in females than in males (1.6%, 95% CI = 0.8-3.2, 95% PI = 0.00-0.18 vs. 0.5%, 95% CI = 0.2-1.1, 95% PI = 0.00-0.06). The mean age at onset of PSH was 41.6 years (SD = 13.7), and the mean delay time of diagnosis was 64.6 months (SD = 73.9).</p><p><strong>Conclusion: </strong>Our results showed that PSH is a rare headache disorder among adults evaluated for headache in a clinic-based setting. Moreover, PSH is typically diagnosed in the early fourth decade of life and predominantly in females.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482794","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":"Association of migraine treatments with reduced ischemic stroke risk: Evidence from two large-scale real-world data analyses.","authors":"Eugene Jeong, Mulubrhan F Mogos, You Chen","doi":"10.1111/head.14918","DOIUrl":"10.1111/head.14918","url":null,"abstract":"<p><strong>Objective: </strong>To compare the risk of ischemic stroke in patients with migraine treated with first-line medications, including valproate, topiramate, metoprolol, timolol, or propranolol, versus those not receiving these treatments, using data from two large electronic health records datasets.</p><p><strong>Background: </strong>The impact of first-line migraine medications on ischemic stroke risk in patients with migraine remains uncertain, highlighting the need for further investigation.</p><p><strong>Methods: </strong>We conducted a retrospective case-control study using data from Vanderbilt University Medical Center (VUMC) and the All of Us Research Program. Cases were patients with a primary ischemic stroke diagnosis after their first migraine diagnosis, while controls had no ischemic stroke following their initial migraine diagnosis.</p><p><strong>Results: </strong>In the VUMC database, 356 cases and 15,231 controls were identified; the All of Us database included 256 cases and 6590 controls. Propranolol was the only medication significantly associated with a reduced risk of ischemic stroke in female patients with migraine (VUMC: adjusted odds ratio [aOR] 0.55, 95% confidence interval [CI] 0.33-0.86, p = 0.013; All of Us: aOR 0.41, 95% CI 0.19-0.77, p = 0.010), particularly in those with migraine without aura (VUMC: aOR 0.53, 95% CI 0.29-0.90, p = 0.027; All of Us: aOR 0.28, 95% CI 0.10-0.62, p = 0.006). The Cox model showed lower ischemic stroke rates in propranolol-treated female patients with migraine at 10 years in the VUMC data (adjusted hazard ratio [aHR] 0.45, 95% CI 0.24-0.83; p = 0.011, log-rank p < 0.001) and 10 years in the All of Us data (aHR 0.29, 95% CI 0.09-0.87; p = 0.048, log-rank p = 0.003).</p><p><strong>Conclusions: </strong>Among various migraine treatments, propranolol was notably associated with a significant reduction in ischemic stroke risk among female patients with migraine, particularly those without aura. These findings suggest a potential dual benefit of propranolol in managing migraine and reducing stroke risk, highlighting the need for further prospective studies to confirm these results and potentially inform clinical practice.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425304","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}