HeadachePub Date : 2025-02-01Epub Date: 2024-12-26DOI: 10.1111/head.14883
Riccardo Rosa, Filippo Lionetto, Domenico Angilecchia, Laura Carmillo, Matteo Castaldo, Giuseppe Giovannico, Cherubino Di Lorenzo, Leonardo Pellicciari
{"title":"Italian version of the Headache Disability Inventory: Cross-cultural adaptation, validity, and reliability.","authors":"Riccardo Rosa, Filippo Lionetto, Domenico Angilecchia, Laura Carmillo, Matteo Castaldo, Giuseppe Giovannico, Cherubino Di Lorenzo, Leonardo Pellicciari","doi":"10.1111/head.14883","DOIUrl":"10.1111/head.14883","url":null,"abstract":"<p><strong>Objective: </strong>To translate and cross-culturally adapt the Headache Disability Inventory (HDI) into Italian and study its reliability and validity.</p><p><strong>Methods: </strong>A total of 132 participants with primary and secondary headaches were included. The translation was performed following international guidelines with forward and back translation procedures. Structural validity, internal consistency, test-retest reliability, measurement error, and construct validity were studied. Test-retest reliability and measurement error were tested on a subsample of 32 participants.</p><p><strong>Results: </strong>The cross-cultural adaptation into Italian was performed without issues. Confirmatory factor analysis supports the structural validity partially (comparative fit index = 0.963; Tucker-Lewis index = 0.959; root mean square error of approximation = 0.051; standardized root mean square residual = 0.084), showing a two-factor structure (i.e., emotional and functional). Each subscale presented high internal consistency (α = 0.87 and 0.87 for the emotional and functional subscales, respectively), excellent and good test-retest reliability (intraclass correlation coefficient = 0.93 and 0.88 for the emotional and functional subscales, respectively), and acceptable measurement error (standard error of the measurement [SEM] = 3.6 points, minimal detectable change [MDC] = 10.0 points for the emotional subscale; SEM = 3.8 points, MDC = 10.7 points for the functional subscale). Construct validity was satisfactory for the emotional subscale and moderate for the functional subscale, as 85.7% (6/7) and 57.1% (4/7) of a priori hypotheses were met, respectively.</p><p><strong>Conclusion: </strong>The HDI was successfully translated into Italian and has acceptable psychometric properties. The Italian version of the HDI can be used in daily clinical practice and research to assess the functional and emotional impact of primary and secondary headaches. Further research should study other psychometric properties (i.e., content validity, responsiveness, and reliability in a larger sample).</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"230-241"},"PeriodicalIF":5.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142893967","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}
HeadachePub Date : 2025-02-01Epub Date: 2024-09-02DOI: 10.1111/head.14817
James S McGinley, Rikki Mangrum, Maya T Gerstein, Kelly P McCarrier, Carrie R Houts, Dawn C Buse, Alexandra L Bryant, R J Wirth, Richard B Lipton
{"title":"Symptoms across the phases of the migraine cycle from the patient's perspective: Results of the MiCOAS qualitative study.","authors":"James S McGinley, Rikki Mangrum, Maya T Gerstein, Kelly P McCarrier, Carrie R Houts, Dawn C Buse, Alexandra L Bryant, R J Wirth, Richard B Lipton","doi":"10.1111/head.14817","DOIUrl":"10.1111/head.14817","url":null,"abstract":"<p><strong>Objective: </strong>To better understand the breadth and frequency of symptoms across the phases of the migraine cycle using data captured from qualitative patient interviews conducted through the Migraine Clinical Outcome Assessment System (MiCOAS) project.</p><p><strong>Background: </strong>People living with migraine experience a range of symptoms across the pre-headache, headache, post-headache, and interictal phases of the migraine cycle. Although clinical diagnostic criteria and clinical trial endpoints focus largely on cardinal symptoms or monthly migraine days, migraine symptom profiles are far more complex. As a part of the MiCOAS project, semi-structured qualitative interviews were undertaken to better understand the migraine-related symptomology from the patient's viewpoint.</p><p><strong>Methods: </strong>This concept elicitation study used iterative purposeful sampling to select 40 people with self-reported medical diagnosis of migraine for interviews that were conducted via audio-only web conferencing. Key topics related to migraine symptoms, including mood/emotion symptoms, were identified using content analysis. Interview transcripts were also coded to reflect the phase of migraine under discussion, so that patient experiences could be compared by phase.</p><p><strong>Results: </strong>Forty participants (50%, n = 20 episodic migraine; 50%, n = 20 chronic migraine), aged from 21 to 70 years old reported a total of 60 unique symptoms, which were categorized into 30 broader symptom categories. Participants reported between 7 and 22 unique symptom categories across all phases. During pre-headache and headache, participants reported a median of 7.5 (interquartile range [IQR] = 5.5) and 8 (IQR = 4.0) different symptom categories compared to 4 (IQR = 3.0) and 1.5 (IQR = 2.5) for the post-headache and interictal periods, respectively. Head pain during the headache phase was the only universally reported symptom (100%, n = 40). Pooling across all phases, the next most reported symptoms were light sensitivity (93%, n = 37), nausea (88%, n = 35), irritability/impatience (83%, n = 24), sound sensitivity (80%, n = 32), and fatigue/exhaustion (80%, n = 32). One or more interictal symptoms were reported by 73% (n = 29) of participants and included mood/emotion symptoms, such as anxiety (30%, n = 12), depression (18%, n = 7), and anger (15%, n = 6), as well as cardinal symptoms, such as light sensitivity (13%, n = 5) and nausea (13%, n = 5).</p><p><strong>Conclusions: </strong>Patients experience a range of symptoms across the phases of the migraine cycle. Results often aligned with clinical expectations, but non-cardinal migraine-related symptoms were reported both inside and outside the headache phase, including between attacks. These discoveries highlight the importance of assessing a range of symptoms and timing when developing patient-reported outcome measures for migraine clinical trials.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"303-314"},"PeriodicalIF":5.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11794970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142106743","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}
HeadachePub Date : 2025-02-01Epub Date: 2024-10-04DOI: 10.1111/head.14853
Rajinder Bhardwaj, Mary K Donohue, Jennifer Madonia, Kyle Matschke, Matt S Anderson, Beth Morris, Richard Bertz, Robert Croop, Jing Liu
{"title":"Assessment of pharmacokinetic and pharmacodynamic interactions between zavegepant and sumatriptan: A phase 1, randomized, placebo-controlled study in healthy adults.","authors":"Rajinder Bhardwaj, Mary K Donohue, Jennifer Madonia, Kyle Matschke, Matt S Anderson, Beth Morris, Richard Bertz, Robert Croop, Jing Liu","doi":"10.1111/head.14853","DOIUrl":"10.1111/head.14853","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the pharmacodynamic (PD) and pharmacokinetic (PK) interactions between zavegepant and sumatriptan in healthy adults.</p><p><strong>Background: </strong>Zavegepant is a high-affinity, selective, small-molecule calcitonin gene-related peptide receptor antagonist administered as a nasal spray approved in the United States for the acute treatment of migraine. Triptans, including sumatriptan, are a different class of drugs for acute migraine treatment and are associated with a risk of increased blood pressure (BP). Hence, it is important to study the drug-drug interactions between zavegepant and sumatriptan due to potential coadministration in clinical settings.</p><p><strong>Methods: </strong>This was a Phase 1, single-center, partially blind, randomized, placebo-controlled, single-arm study. Eligible participants were males aged ≥ 18 and ≤ 40 years or females aged ≥ 18 and ≤ 50 years. On Day 1, participants received sumatriptan 2 × 6 mg subcutaneous injections (1 h apart) and were then randomized (6:1 ratio) to receive zavegepant 2 × 10 mg nasal spray (1 in each nostril) or placebo on Days 2 and 3. On Day 4, zavegepant or placebo was coadministered with sumatriptan after the second sumatriptan injection. BP, PK, and safety were evaluated at pre-specified time points.</p><p><strong>Results: </strong>Forty-two participants enrolled in the study received at least one dose of any treatment and were included in the safety analyses. Forty-one participants who completed the study were included in the BP and PK analyses. The mean (standard deviation) time-weighted average (TWA) of mean arterial pressure (MAP [sumatriptan + zavegepant 87.2 (6.8) vs. sumatriptan 86.9 (6.0)]), diastolic BP (DBP [sumatriptan + zavegepant 72.3 (6.8) vs. sumatriptan 72.1 (6.2)]), and systolic BP (SBP [sumatriptan + zavegepant 116.8 (10.2) vs. sumatriptan 116.2 (8.6)]) did not change following zavegepant and sumatriptan coadministration on Day 4 compared to sumatriptan alone on Day 1. Statistical comparisons of the TWA of MAP, DBP, and SBP between sumatriptan and zavegepant coadministration and sumatriptan alone were similar; the differences observed were 0.04 mmHg for MAP (90% confidence interval [CI]: -0.69, 0.77 mmHg), 0.00 mmHg for DBP (90% CI: -0.76, 0.76 mmHg), and 0.33 mmHg for SBP (90% CI: -0.97, 1.63 mmHg). Sumatriptan PK after sumatriptan and zavegepant coadministration versus sumatriptan alone was similar; the comparison ratios were 102.5% (90% CI: 100.7%, 104.2%) for AUC<sub>0-inf</sub> and 104.1% (90% CI: 98.0%, 110.6%) for C<sub>max</sub>. A small difference in zavegepant PK exposure after sumatriptan and zavegepant coadministration versus zavegepant alone was not considered clinically relevant: the comparison ratios were 112.4% (90% CI: 103.4%, 122.3%) for AUC<sub>0-24</sub> and 96.7% (90% CI: 88.9%, 105.2%) for C<sub>max</sub>. Overall, 90% (38/42) of participants experienced ≥ 1 treatment-emergent adverse event that was m","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"315-325"},"PeriodicalIF":5.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11794967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371628","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}
HeadachePub Date : 2025-02-01Epub Date: 2024-11-10DOI: 10.1111/head.14867
Raghavan Gopalakrishnan, Nitesh Singh Malan, Nymisha Mandava, Eric J Dunn, Neil Nero, Richard C Burgess, MaryAnn Mays, Olivia Hogue
{"title":"Magnetoencephalography studies in migraine and headache disorders: A systematic review.","authors":"Raghavan Gopalakrishnan, Nitesh Singh Malan, Nymisha Mandava, Eric J Dunn, Neil Nero, Richard C Burgess, MaryAnn Mays, Olivia Hogue","doi":"10.1111/head.14867","DOIUrl":"10.1111/head.14867","url":null,"abstract":"<p><strong>Background: </strong>Understanding the neural mechanisms underlying migraine and other primary headache disorders is critical for the development of long-term cures. Magnetoencephalography (MEG), an imaging modality that measures neuronal currents and cortical excitability with high temporal and superior spatial resolution, has been increasingly used in neurological research. Initial MEG studies showed promise in directly recording cortical spreading depression-a cortical correlate of migraine with aura. However, lately MEG technology has highly evolved with greater potential to reveal underlying pathophysiology of migraine and primary headache disorders, and aid in the identification of biomarkers.</p><p><strong>Objective: </strong>To systematically review the use of MEG in migraine and other primary headache disorders and summarize findings.</p><p><strong>Methods: </strong>We conducted a systematic search and selection of MEG studies in migraine and primary headache disorders from inception until June 8, 2023, in Medline, Embase, Cochrane, and Scopus databases. Peer-reviewed English articles reporting the use of MEG for clinical or research purposes in migraine and primary headache disorders were selected.</p><p><strong>Results: </strong>We found 560 articles and included 38 in this review after screening. Twelve studies investigated resting-state, while others investigated a sensory modality using an evoked or event-related paradigm with a total of 35 cohort and 3 case studies. Thirty-two studies focused exclusively on migraine, while the rest reported other primary headache disorders.</p><p><strong>Conclusion: </strong>The findings show an evolution of MEG from a 7- to a 306-channel system and analysis evolving from sensor-level evoked responses to more advanced source-level connectivity measures. A relatively few MEG studies portrayed migraine and primary headache disorders as a sensory abnormality, especially of the visual system. We found heterogeneity in the datasets, data reporting standards (due to constantly evolving MEG technology and analysis methods), and patient characteristics. Studies were inadequately powered and there was no evidence of blinding procedures to avoid selection bias in case-control studies, which could have led to false-positive findings. More studies are needed to investigate the affective-cognitive aspects that exacerbate pain and disability in migraine and primary headache disorders.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"353-366"},"PeriodicalIF":5.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11794981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618745","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}
HeadachePub Date : 2025-02-01Epub Date: 2025-01-17DOI: 10.1111/head.14903
Marina Romozzi, Antonio Munafò, Andrea Burgalassi, Francesco De Cesaris, Giulia Vigani, Claudia Altamura, Veronica Rivi, Simona Guerzoni, Paolo Calabresi, Bianca Raffaelli, Luigi Francesco Iannone
{"title":"Pharmacological differences and switching among anti-CGRP monoclonal antibodies: A narrative review.","authors":"Marina Romozzi, Antonio Munafò, Andrea Burgalassi, Francesco De Cesaris, Giulia Vigani, Claudia Altamura, Veronica Rivi, Simona Guerzoni, Paolo Calabresi, Bianca Raffaelli, Luigi Francesco Iannone","doi":"10.1111/head.14903","DOIUrl":"10.1111/head.14903","url":null,"abstract":"<p><p>Antibodies targeting either the calcitonin gene-related peptide (CGRP), such as galcanezumab, fremanezumab, and eptinezumab, or the receptor (erenumab) have been approved for the prevention of episodic and chronic migraine. Although widely used and generally effective, a proportion of patients discontinue treatment due to lack of efficacy. In both randomized controlled trials and observational studies, all anti-CGRP monoclonal antibodies (mAbs) have consistently demonstrated comparable efficacy and tolerability, suggesting a pharmacological class effect. However, differences in therapeutic targets, structure, and pharmacokinetic characteristics may influence their efficacy and safety differently. Therefore, in patients not achieving a clinically meaningful response with one anti-CGRP antibody, switching to a different antibody may be a viable option. This review examines the pharmacological characteristics and distinctions among anti-CGRP mAbs, highlighting their mechanisms of action and pharmacokinetic profiles, along with the clinical observational data of switching. Finally, we summarize suggestions from international guidelines.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"342-352"},"PeriodicalIF":5.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004122","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}
HeadachePub Date : 2025-02-01Epub Date: 2024-10-04DOI: 10.1111/head.14836
Rajinder Bhardwaj, Beth Morris, Kyle T Matschke, Richard Bertz, Robert Croop, Jing Liu
{"title":"Characterization of rimegepant drug-drug interactions using the cytochrome P450 probe drugs, itraconazole, rifampin, fluconazole, and midazolam.","authors":"Rajinder Bhardwaj, Beth Morris, Kyle T Matschke, Richard Bertz, Robert Croop, Jing Liu","doi":"10.1111/head.14836","DOIUrl":"10.1111/head.14836","url":null,"abstract":"<p><strong>Objective: </strong>Reported here are the results of four rimegepant phase I studies, in healthy participants, aimed at determining the in vivo potential of rimegepant (75 mg) for cytochrome P450 (CYP) 3A4-related drug-drug interactions (DDIs).</p><p><strong>Background: </strong>Rimegepant orally disintegrating tablet (Pfizer Inc., New York, NY, USA) is a calcitonin gene-related peptide receptor antagonist approved for acute treatment of migraine and preventive treatment of episodic migraine. People with migraine commonly use multiple drug treatments, with the potential for DDIs.</p><p><strong>Methods: </strong>Each study was an open-label, single-arm, single-sequence, crossover study. Rimegepant was tested as a victim drug by separate co-administration of itraconazole (a strong CYP3A4 inhibitor and P-glycoprotein inhibitor) in Study 1, rifampin (a strong CYP3A4 inducer and moderate CYP2C9 inducer) in Study 2, and fluconazole (a strong CYP2C9 inhibitor and moderate CYP3A4 inhibitor) in Study 3, and as a perpetrator drug by co-administration with midazolam (a CYP3A4 substrate) in Study 4.</p><p><strong>Results: </strong>Mean values of single-dose rimegepant maximum concentration (C<sub>max</sub>) and area under the curve from time 0 to infinity (AUC<sub>0-inf</sub>) increased with itraconazole co-administration (n = 22) by 1.42-fold (90% confidence interval [CI] 1.25-1.61) and by 4.14-fold (90% CI 3.87-4.44), respectively, and decreased with rifampin co-administration (n = 21) to 36% (90% CI 31.2-41.4%) and to 19% (90% CI 16.3-21.4%), respectively. Co-administration with fluconazole (n = 23) increased rimegepant mean AUC<sub>0-inf</sub> by 1.80-fold (90% CI 1.68-1.93), with no impact on C<sub>max</sub> (1.04-fold; 90% CI 0.94-1.15). Co-administration of rimegepant single dose (300 mg; n = 14) or multiple doses (150 mg/day; n = 14) increased the mean C<sub>max</sub> of midazolam by 1.38-fold (90% CI 1.13-1.67) and 1.53-fold (90% CI 1.32-1.78), respectively, and the AUC<sub>0-inf</sub> of midazolam by 1.86-fold (90% CI 1.58-2.19) and 1.91-fold (90% CI 1.63-2.25), respectively.</p><p><strong>Conclusions: </strong>Based on the magnitude of DDIs, these studies indicate the following: co-administration of rimegepant with a strong CYP3A4 inhibitor should be avoided; during co-administration with a moderate CYP3A4 inhibitor, another dose of rimegepant within 48 h should be avoided; co-administration of rimegepant with a strong or moderate CYP3A4 inducer should be avoided; CYP2C9 does not play a meaningful role in rimegepant metabolism; and there is no clinically meaningful CYP3A4 inhibition by rimegepant.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"291-302"},"PeriodicalIF":5.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11794968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371629","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}
HeadachePub Date : 2025-02-01Epub Date: 2024-12-30DOI: 10.1111/head.14896
Patricia A Olson, Scott W Powers
{"title":"Behavior and migraine virtual issue.","authors":"Patricia A Olson, Scott W Powers","doi":"10.1111/head.14896","DOIUrl":"10.1111/head.14896","url":null,"abstract":"","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"203-205"},"PeriodicalIF":5.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907106","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}