Headache最新文献

{"title":"Potential role of tirzepatide, a dual GLP-1 and GIP receptor agonist, for preventive treatment of migraine: A case series.","authors":"Tulsi Shah, Carrie Dougherty, Jessica Ailani, Thomas Kerrigan","doi":"10.1111/head.70152","DOIUrl":"10.1111/head.70152","url":null,"abstract":"<p><strong>Background: </strong>Obesity is a known comorbidity of migraine that can increase attack frequency and severity and lead to disease chronification. Glucagon-like peptide-1 (GLP-1) receptor agonists and related medications have demonstrated benefits beyond glycemic control and weight management, with emerging evidence suggesting a potential role in pain modulation. Clinical observations have also suggested the role of GLP-1 based therapies for the treatment of idiopathic intracranial hypertension, but their role in migraine has not been established.</p><p><strong>Case series: </strong>Here, we report two cases of patients with migraine who experienced a reduction in migraine headache frequency following initiation of tirzepatide, a dual GLP-1 and glucose-dependent insulinotropic polypeptide receptor agonist.</p><p><strong>Discussion: </strong>These cases suggest that GLP-1 receptor agonists and dual GLP-1 and glucose-dependent insulinotropic polypeptide receptor agonists may have potential therapeutic relevance in migraine management. Notably, both patients experienced weight loss with treatment, which represents a significant confounding factor that limits conclusions about a direct migraine-specific effect. These cases should be interpreted as preliminary observations. Future studies evaluating migraine outcomes in patients treated with these medications are needed to better understand the underlying mechanism and explore their potential role as novel therapeutic pathways for migraine.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1916-1919"},"PeriodicalIF":3.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148390759","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":"Predictive factors of epidural blood patch success in intracranial hypotension syndrome.","authors":"Anna Le Moal-Baczynski, Alexandre Castelli, Vincent Doat-Sarfati, Sylvain Redon, Anne Donnet, Nicolas Bruder, François Antonini, Jules Henri, Jean-François Hak, Victor Lebreton, Jeanne Morel, Mehdi Assal, Lionel Velly, Pierre Simeone","doi":"10.1111/head.70191","DOIUrl":"10.1111/head.70191","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to identify predictors of epidural blood patch (EBP) success in patients with intracranial hypotension syndrome.</p><p><strong>Background: </strong>The epidural blood patch remains the gold standard treatment for intracranial hypotension syndrome, yet its effectiveness varies, and predictors of sustained success remain uncertain.</p><p><strong>Methods: </strong>We performed a single-center retrospective cohort study. We analyzed 139 epidural blood patches performed for non-obstetric intracranial hypotension syndrome between April 2015 and July 2025. Demographic, clinical, biological, radiological, and procedural data were collected. Complete symptom resolution or highly significant improvement at 1 month was defined as treatment success.</p><p><strong>Results: </strong>Among 93 patients, 1-month complete success was achieved after 31% of procedures (43/139). Early improvement within 48 h was associated with higher odds of 1-month EBP success (adjusted odds ratio [aOR] = 9.70, 95% confidence interval [CI]: 3.66-28.96; p < 0.001) as was the occurrence of rebound headache (aOR = 5.34, 95% CI: 1.27-26.44; p = 0.028). Conversely, symptom exacerbation during the Valsalva maneuver was associated with lower odds of 1-month EBP success (aOR = 0.30, 95% CI: 0.10-0.81; p = 0.020). Lower baseline platelet and fibrinogen levels and osteophytic leaks were negatively associated with early effectiveness but not with 1-month outcome. Targeted epidural blood patches and shorter delay from symptom onset to procedure were associated with higher success rates in univariate analysis, though not independently. Model performance was robust with an area under the curve (AUC) of 0.88 (95% CI: 0.80-0.90). No infectious complications were observed; rebound headaches and transient back pain were the most common secondary events.</p><p><strong>Conclusion: </strong>Early clinical improvement and rebound headache are strong positive predictors of durable epidural blood patch effectiveness in intracranial hypotension syndrome, whereas Valsalva-related symptom worsening indicates a higher risk of failure. Radiological severity did not predict outcomes in our study. These easily identifiable clinical factors can assist in individualized management and reduce unnecessary repeat procedures.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1847-1858"},"PeriodicalIF":3.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148455655","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":"Frequency and characteristics of multi-domain autonomic dysfunction in patients with spontaneous intracranial hypotension.","authors":"Woo-Seok Ha, Da Eun Jung, Sojung Yoon, Joonho Kim, Min Kyung Chu","doi":"10.1111/head.70186","DOIUrl":"10.1111/head.70186","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to evaluate multi-domain autonomic function in patients with spontaneous intracranial hypotension (SIH) and investigate its association with clinical and radiological features.</p><p><strong>Background: </strong>SIH often presents with orthostatic symptoms that overlap with autonomic disorders; however, the prevalence and distribution of autonomic dysfunction in SIH remain poorly characterized.</p><p><strong>Methods: </strong>In this cross-sectional study conducted at a tertiary care center in Seoul, Republic of Korea, 34 patients with imaging-confirmed SIH underwent a comprehensive autonomic function testing between October 2024 and February 2025. The autonomic function testing battery included heart rate response to deep breathing, Valsalva maneuver, head-up tilt test, and quantitative sudomotor axon reflex test. Hemodynamic responses during head-up tilt were monitored using both intermittent brachial and continuous beat-to-beat blood pressure measurements. Autonomic abnormalities were determined using age- and sex-matched Korean normative data.</p><p><strong>Results: </strong>All enrolled patients presented with extradural fluid collection on spinal magnetic resonance imaging, indicating SIH due to dural tears. Autonomic dysfunction was identified in 18 of 34 (52.9%) of patients in the orthostatic domain, nine of 34 (26.5%) in the cardiovagal domain, and 10 of 34 (29.4%) in the sudomotor domain. Postural orthostatic tachycardia syndrome was the most frequent orthostatic abnormality, observed in 12 of 34 (35.3%) patients, followed by classical orthostatic hypotension in four of 34 (11.8%), syncope in one of 34 (2.9%), and delayed orthostatic hypotension in one of 34 (2.9%). No significant associations were identified between domains of autonomic dysfunction and the clinical or imaging features of SIH in false discovery rate-corrected analyses.</p><p><strong>Conclusion: </strong>In patients with SIH due to dural tears, orthostatic hemodynamic abnormalities were common, with postural orthostatic tachycardia syndrome being the most frequent phenotype.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1890-1897"},"PeriodicalIF":3.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148455647","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":"College students' migraine perceptions and lived experiences: A qualitative study.","authors":"Mia T Minen, Julia Dorf, Sara Novo, David Gima, Shreya Nasker, Mara Getz","doi":"10.1111/head.70103","DOIUrl":"10.1111/head.70103","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Our objectives were to understand migraine-related perceptions among college students and the lived experiences of those with migraine on college campuses and to generate recommendations for supporting college students with migraine.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;During young adulthood, there is a sharp growth in migraine prevalence and disability-adjusted life years. Migraine prevalence is approximately 16% among university students and negatively influences several aspects of a student's college experience.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was a qualitative study using phenomenological inquiry via virtual semistructured focus groups. Recruitment took place between April 2025 and July 2025. An initial 60-min focus group was conducted in May 2025 with an all-women's college to assess our questions' relevance and comprehensiveness. We then conducted four national focus groups in June 2025 and July 2025 with college students from across the United States. All focus groups included students with and without severe headache or migraine (self-reported). Focus groups were transcribed and independently coded twice. We developed themes for the five focus groups using content analysis. Qualitative analysis was conducted between July 2025 and September 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Three students attended the all-women's college focus group and 47 students attended one of the four national focus groups (n = 50). The following themes emerged from the five focus groups: (1) Migraine is often misunderstood and not discussed on campus, with misconceptions surrounding severity and its distinction from headache. (2) The impact of migraine on campus is significant, with students reporting various triggering environments, difficulty maintaining focus, attending class, performing academically, preserving social relationships, and participating in extracurricular activities. (3) The most commonly reported accommodations for migraine were academic, specifically exam- and attendance-related, though not always honored by professors. (4) Access to migraine care for students is challenging, with reports that student health centers are typically unapproachable, inconvenient, and unhelpful, with students seeking external providers for migraine. Students recommended more awareness and education initiatives for improved understanding of migraine as well as increased access to migraine resources and accommodations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The experiences captured in our study provide unique qualitative insights by highlighting how misunderstanding of migraine on campus contributes to social and academic challenges faced by students with migraine. Students described unmet needs related to widespread misunderstanding of migraine, limited academic flexibility, environmental triggers, limited access to care, and inconsistent implementation of accommodations, highlighting that greater awareness of migraine, especially by p","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1812-1826"},"PeriodicalIF":3.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148301630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 51-year-old female presenting with headache and vision loss.","authors":"Laurel Ovrom, Zachary Pardieck, Randy Christopher Bowen, Neena R Cherayil","doi":"10.1111/head.70130","DOIUrl":"10.1111/head.70130","url":null,"abstract":"","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1928-1932"},"PeriodicalIF":3.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148294703","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":"Adverse childhood experiences, migraine, and adverse pregnancy outcomes among teenage mothers.","authors":"Yinxian Chen, Mahika Rawat, Maria L Jimenez, B Lee Peterlin, Sixto E Sanchez, Marta B Rondon, Bizu Gelaye","doi":"10.1111/head.70149","DOIUrl":"10.1111/head.70149","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to assess the individual and joint association of adverse childhood experiences (ACEs) and migraine with adverse pregnancy outcomes.</p><p><strong>Purpose: </strong>Teenage pregnancy is prevalent, particularly in low- and middle-income countries. Teenage mothers sustain higher risk of adverse birth outcomes compared to their adult counterparts. ACEs and migraine are prevalent among teenage mothers and may contribute to adverse pregnancy outcomes.</p><p><strong>Methods: </strong>Cross-sectional data were obtained from 819 Peruvian teenage mothers (aged 14 to 18 years) enrolled in the Teen Pregnancy Outcomes, Maternal, and Infant Study from November 2016 to September 2018 in Lima, Peru. Mothers having 4+ ACEs were considered as having high ACEs. Migraine was classified based on ICHD-3 criteria. Adverse pregnancy outcomes included preterm birth (PTB) and low birth weight (LBW).</p><p><strong>Results: </strong>High ACEs were associated with greater odds of PTB (adjusted odds ratio [aOR] = 2.25, 95% confidence interval [CI]: 1.25, 3.95) and LBW (aOR = 2.64, 95% CI: 1.46, 4.67). Participants with migraine also had higher odds of PTB (aOR = 2.15, 95% CI: 1.20, 3.77). When examined jointly, those with only migraine (aOR = 2.79, 95% CI: 1.41, 5.52) or only high ACEs (aOR = 2.94, 95% CI: 1.48, 5.83) showed increased odds of PTB, whereas the combined exposure to both was weaker (aOR = 2.69, 95% CI: 1.04, 6.95), suggestive of a possible negative interaction, although inferences from this are limited by our relatively small sample size as reflected by the wide 95% CI. Similar patterns were observed for LBW.</p><p><strong>Conclusions: </strong>High ACEs and migraine were each independently associated with increased odds of PTB and LBW, but joint exposure did not increase the odds beyond the individual contributions. The suggestion of a possible negative interaction between high ACEs and migraine warrants further investigation to confirm.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1827-1836"},"PeriodicalIF":3.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13456096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148390734","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":"Migraine in the cradle of civilization: Evaluating ancient Mesopotamian texts through the lens of ICHD-3.","authors":"Bulent Diri, Bilge Piri Cinar, Zeynep Sena Diri, Okan Bolukbasi, Peter J Goadsby, Aynur Ozge","doi":"10.1111/head.70172","DOIUrl":"10.1111/head.70172","url":null,"abstract":"<p><strong>Background: </strong>Migraine is a neurological disorder with well-established diagnostic criteria. In its current formulation, migraine is a modern-day diagnosis, whereas descriptions consistent with migraine may date back to ancient civilizations.</p><p><strong>Objective: </strong>This study aimed to investigate whether symptoms consistent with migraine without aura, as defined by criteria of ICHD-3, are present in cuneiform medical texts from ancient Mesopotamia.</p><p><strong>Methods: </strong>A total of 37 Akkadian-language cuneiform medical texts dated between the second and first millennia bce were analyzed. Texts containing references to secondary headache or aura symptoms were excluded. Each remaining text was examined for descriptions corresponding to ICHD-3 diagnostic criteria (B: duration; C: pain characteristics; D: associated symptoms).</p><p><strong>Results: </strong>Among the 37 texts, 15 included expressions equivalent to continuous or prolonged pain, satisfying criterion B. Criterion C (unilateral, throbbing, and severe pain) was met in 37 texts (26 completely +11 partially). Criterion D (nausea, photophobia, phonophobia) was present in 21 of 37 texts.</p><p><strong>Conclusion: </strong>This study presents compelling evidence that the fundamental features of migraine without aura were described in Mesopotamian medical texts nearly 3000 years ago. These findings suggest that the diagnostic framework of migraine, as captured by ICHD-3, reflects the earliest documented medical traditions.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1878-1889"},"PeriodicalIF":3.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148602257","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":"Clinical characteristics, neurovascular compression, and treatment outcomes in SUNCT and SUNA: A contemporary Japanese consecutive case series.","authors":"Shoji Kikui, Daisuke Danno, Masahiro Nawata, Yoshiyasu Iwai, Takao Takeshima","doi":"10.1111/head.70181","DOIUrl":"10.1111/head.70181","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to characterize the contemporary clinical phenotype of short-lasting unilateral neuralgiform headache attacks (SUNHA) in Japan, evaluate the prevalence and clinical relevance of neurovascular compression (NVC), and assess real-world medical and surgical treatment outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;SUNHA, comprising short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and those with cranial autonomic symptoms (SUNA), is a rare trigeminal autonomic cephalalgia disorder. Although several large cohorts have been reported in Western countries, data from Asia, particularly Japan, remain limited. Moreover, the clinical significance of NVC and the role of microvascular decompression (MVD) in medically refractory cases have not been fully established, and no standardized operational definition of refractory SUNHA exists.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a retrospective consecutive case series of 28 patients with SUNHA (14 SUNCT and 14 SUNA) who were evaluated at a tertiary headache center in Japan between 2011 and 2024. Diagnoses were made according to the International Classification of Headache Disorders, 3rd edition. Clinical features, trigger factors, cranial autonomic symptoms, comorbidities, and treatment responses were systematically reviewed and analyzed. High-resolution constructive interference in steady-state (CISS) magnetic resonance imaging was used to assess the NVC. Treatment response was defined as a subjective reduction of ≥50% in the attack burden. Refractory SUNHA was operationally defined as failure of or intolerance to at least two of the three principal preventive drug classes (lamotrigine, gabapentinoids, and topiramate). Surgical outcomes following MVD were evaluated in the refractory cases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;SUNHA accounted for 0.2% of all patients with headache evaluated in this study. The mean age at onset was 53.1 ± 20.9 years, with 17 male and 11 female patients. Right-sided pain (20/28, 71%) and ophthalmic (V1) trigeminal distribution (20/28, 71%) predominated. No statistically significant differences were detected between SUNCT and SUNA with respect to attack duration, frequency, triggers, or treatment responsiveness. NVC was identified in 17 of 27 evaluable patients (17/27, 63%; 95% confidence interval [CI]: 44.3%-78.5%) and was strongly associated with a history of TN-like pain (12/17 vs. 0/10, p &lt; 0.001). Seven of 28 patients (7/28, 25%; 95% CI: 12.7%-43.4%) met criteria for refractory SUNHA, and all refractory cases (7/7, 100%; 95% CI: 64.6%-100%) demonstrated NVC. Five of seven refractory patients (5/7, 71%) underwent MVD and achieved complete and sustained remission.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In this contemporary Japanese SUNHA cohort, no statistically significant clinical differences were detected between SUNCT and SUNA. NVC was relatively common and appeared to be associated w","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1837-1846"},"PeriodicalIF":3.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148591290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of prodromal symptoms in predicting headache onset: A longitudinal electronic momentary assessment study.","authors":"Megan Lacritz, Richard B Lipton, Christopher Metts, Elizabeth K Seng","doi":"10.1111/head.70146","DOIUrl":"10.1111/head.70146","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This longitudinal observational study investigated the role of prodromal symptoms in predicting headache onset, using electronic headache diaries to assess symptom occurrence and predictive utility in individuals with migraine.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Prodromal symptoms are early indicators of migraine that occur 2-48 h before the headache phase. Whereas commonly reported symptoms include fatigue, stiff neck, and sensitivity to light and sound, few studies have assessed their predictive abilities for headache onset. Understanding the relationship and reliability of these symptoms is important for early migraine intervention strategies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This is a secondary analysis of a longitudinal observational headache diary study. Participants with episodic migraine (N = 43) were recruited from Einstein College of Medicine between 2017 and 2021 and completed a mobile headache diary three times daily over 3 months. They reported the presence of 11 prodromal symptoms and headache anticipation during headache-free intervals. Associations between prodromal symptoms, anticipation, and subsequent headache onset were examined across multiple time lags. Headache anticipation was evaluated as a moderator of these relationships.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Across 7061 headache-free observations, prodromal symptoms were reported in 52.7% of cases (n = 3721). Phonophobia doubled the odds of head pain onset 6 h before head pain. Nausea, photophobia, and difficulty thinking/concentrating were associated with higher odds of head pain within 24 h of symptom reporting. Blurred vision was associated with higher odds of future head pain at all time points evaluated. Thirst and dizziness were associated with higher odds of head pain 18-36 h before head pain onset. All prodromal symptoms were associated with increased odds of headache anticipation. Headache anticipation itself was associated with higher odds of headache onset within the ~6, 12, and 36 h prior to headache onset (~6 h odds ratio [OR] = 3.35, 95% confidence interval [CI] [2.57, 4.36]). Anticipation weakened the predictive value of several symptoms on headache occurrence, including feeling tired/weary (OR = 0.50, 95% CI [0.37, 0.68]); difficulty thinking/concentrating (0.37, 95% CI [0.24, 0.58]); thirst (OR = 0.42, 95% CI [0.31, 0.58]); blurred vision (OR = 0.63, 95% CI [0.42, 0.93]); photophobia (OR = 0.15, 95% CI [0.07, 0.33]); phonophobia (OR = 0.19, 95% CI [0.12, 0.28]); nausea (OR = 0.33, 95% CI [0.17, 0.65]); and dizziness (OR = 0.17, 95% CI [0.08, 0.35]).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Cardinal (phonophobia, photophobia, and nausea) symptoms of migraine were all associated with higher odds of future head pain 24 h before head pain onset. Other neurologic and homeostatic symptoms also emerged as predictors for head pain. However, predictive performance was modest; therefore, these symptoms should not be considered stand-alone migra","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1767-1778"},"PeriodicalIF":3.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13337128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148204584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A patient-centered conceptual model and measurement framework for migraine experience developed by the Migraine Clinical Outcome Assessment System.","authors":"Rikki Mangrum, Alexandra L Bryant, Carrie R Houts, James S McGinley, Dawn C Buse, Richard B Lipton, R J Wirth","doi":"10.1111/head.70122","DOIUrl":"10.1111/head.70122","url":null,"abstract":"<p><strong>Objective: </strong>To develop a comprehensive, evidence-based, patient-centered conceptual model of migraine and to derive a measurement framework for the development or selection of clinical outcome assessments used in clinical trials of treatments for migraine.</p><p><strong>Background: </strong>Improving ways of assessing the outcomes that matter to people who live with migraine is an important goal for treatment development and evaluation. The Migraine Clinical Outcome Assessment System (MiCOAS) project aimed to gather qualitative data directly from people with migraine and develop a patient-centered core set of outcomes and endpoints for migraine clinical trials. Data gathered by the MiCOAS research team was used to develop a patient-centered conceptual model of migraine and a measurement framework designed to capture outcomes that matter to patients.</p><p><strong>Methods: </strong>A post hoc, pooled secondary interpretive analysis of the results from two MiCOAS qualitative studies (executed in 2020 and 2021 with 71 US adults with migraine) was conducted to develop the conceptual model using iterative diagramming methods to create a visualization. Supporting information exhibits for the visualization were created to record concept definitions and describe their interrelationships. The conceptual model was used to guide development of a measurement framework intended to support the selection or development of patient-reported outcome assessments suitable for regulated clinical trials of both acute and preventive migraine therapies. Input from people with migraine, patient advocates, clinical researchers, and subject matter experts was integrated into the model and the measurement framework.</p><p><strong>Results: </strong>The comprehensive conceptual model diagram organizes patient-reported experiences into domains for symptoms and impacts of migraine and depicts commonly occurring mediating contextual factors (e.g., perceived pain tolerance) that can affect patients' self-reported disease experiences. The measurement framework identifies concepts that are widely experienced or highly disabling to patients with episodic or chronic migraine but also meet the needs of clinical trial endpoint design (e.g., are cross-culturally relevant and amenable to treatment effect within a 3-month trial period) and are capable of capturing experiences during all phases of migraine, including interictal periods.</p><p><strong>Conclusions: </strong>The patient-centered conceptual model of migraine provides a concise but comprehensive framework for describing and measuring patient experiences of migraine disease and its treatment, including symptoms, daily functioning, and distal outcomes that result from the aggregation of migraine experiences over time. The measurement framework was developed to support comprehensive endpoint design for migraine clinical trials and has been used to guide the development of the MiCOAS measurement instruments.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1753-1766"},"PeriodicalIF":3.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148294706","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}