Journal of Headache and Pain最新文献

{"title":"Overview of migraine care, impact of the disease, and patient experience in France through patient voices: a cross-sectional and participatory survey study.","authors":"Anne Duburcq, Manon Molins, Sabine Debremaeker, Julie Joie, Luna Lopes, Camille Nevoret, Olivia Begasse de Dhaem","doi":"10.1186/s10194-025-02018-y","DOIUrl":"https://doi.org/10.1186/s10194-025-02018-y","url":null,"abstract":"<p><strong>Background: </strong>This study aims to improve the understanding of the patient journey via the perspectives of patients with migraine.</p><p><strong>Methods: </strong>The questionnaire was created by patients. It was based on the experiences of 24 patients with migraine and 4 members of the patient advocacy organization La Voix des Migraineux. Two focus groups were held to assess the various dimensions of the patient journey. This survey was accessible on the MoiPatient online platform between March 19th and May 17th, 2022.</p><p><strong>Results: </strong>Out of the 683 participants (average age: 41.8 years; female: 92.4%; average age at first migraine attack: 16.2 years), 95.9% had received a formal migraine diagnosis from a physician. Migraine had a significant impact on most participants (96.0% had a severe HIT-6 score and 70.7% had severe disability on the MIDAS). Unmet patients' needs highlighted in this study included diagnosis delay (mean 7.5 years), treatment delay, limited access to neurologists and/or headache specialists, long trial-and-error process of different medications (participants had tried an average of 5.6 acute treatments and 5.0 preventive treatments), numerous (7.2 side effects per participants on average) and often inadequately addressed side effects, suboptimal patient education, and the need for a therapeutic, empathic, and supportive relationship between patients and healthcare professionals. Participants had a negative perception of the care journey and experience with healthcare professionals: 36.2% described their care journey as an uphill battle (\"parcours du combatant\"). More than half of patients did not feel heard nor supported by healthcare professionals.</p><p><strong>Conclusion: </strong>Patients with migraine have to face a multitude of complex obstacles trying to get the care they deserve. The burden of disease is amplified by the complexity of the migraine patient's journey, both in terms of diagnosis and treatment. This study highlights specific areas in need for improvement.</p>","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":"26 1","pages":"76"},"PeriodicalIF":7.3,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11995651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in pharmacological migraine treatment across different levels of clinical headache care - a cross-sectional study.","authors":"Mira Pauline Fitzek, Lucas Hendrik Overeem, Marlene Ulrich, Ja Bin Hong, Carolin Luisa Hoehne, Kristin Sophie Lange, Yones Salim, Uwe Reuter, Bianca Raffaelli","doi":"10.1186/s10194-025-02027-x","DOIUrl":"https://doi.org/10.1186/s10194-025-02027-x","url":null,"abstract":"<p><strong>Background: </strong>Migraine significantly impairs quality of life, reduces workplace productivity, and imposes a substantial socio-economic burden. The severity of migraine correlates with its impact on quality of life and healthcare costs, emphasizing the need for adequate management. In the past, primary care services often faced issues of inadequate treatment. This study evaluates differences in pharmacological recommendations for acute and preventive migraine treatments across primary, secondary, and tertiary care settings.</p><p><strong>Methods: </strong>This cross-sectional study involves patients with confirmed migraine (with or without aura) visiting the tertiary headache center at Charité Berlin between 12/2015 and 01/2023 for the first time. Data on headache characteristics and prior treatments for acute and prophylactic treatments at primary/secondary and recommendations from tertiary level of care were retrieved from medical letters written after first consultation.</p><p><strong>Results: </strong>Among 1,047 migraine patients (42 years, 84% women), 99% had received treatment for acute migraine attacks by primary/secondary care facilities, and 96% were using it at their first consultation, with 63% advised to use a triptan. The average number of triptans tested prior to referral was 1 ± 0.99. Prophylactic treatment was prescribed to 52% of patients by primary/secondary care facilities, with an average of 1.2 ± 1.6 prior prophylactic attempts per patient, and 44% were actively using it at the time of consultation. More than two thirds of patients with over four monthly migraine days were not using prophylactic treatment at referral. Tricyclic antidepressants, beta-blocker and, anticonvulsants were prescribed significantly more often in primary/secondary care settings while Onabotulinumtoxin-A and Calcitonin Gene-Related Peptide(-receptor) antibodies were more commonly initiated in tertiary care. Treatment recommendations from primary/secondary settings were revised in 77% of patients following consultation at the tertiary headache clinic.</p><p><strong>Conclusion: </strong>Compared to previous studies, the overall prescription of acute and prophylactic therapies in primary and secondary care facilities has improved. Further progress is needed in expanding the range of triptans and prophylactic treatments tested before referring patients to specialized centers. However, given the selected study population, the findings may not be fully applicable to all patients treated in primary/secondary care, especially those already receiving adequate care without being referred to specialized settings.</p>","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":"26 1","pages":"78"},"PeriodicalIF":7.3,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11995486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lower spinal levels and male sex are associated with greater epidural blood patch volume in spontaneous intracranial hypotension.","authors":"Woo-Seok Ha, JaeWook Jeong, Seungwon Song, Jungyon Yum, Soomi Cho, Hee Jung Kim, Min Kyung Chu","doi":"10.1186/s10194-025-02015-1","DOIUrl":"https://doi.org/10.1186/s10194-025-02015-1","url":null,"abstract":"<p><strong>Background: </strong>The epidural blood patch (EBP) is the treatment of choice for spontaneous intracranial hypotension (SIH). Studies have shown that targeted EBP is more effective than blind EBP. Additionally, a greater volume of injected blood during EBP has been associated with better therapeutic outcomes. However, symptoms such as back pain often prevent achieving the desired blood volume. This study aimed to analyse factors influencing the tolerable EBP volume, including structural, clinical, and psychological factors.</p><p><strong>Methods: </strong>This retrospective study included patients diagnosed with SIH who underwent single-level EBP at a tertiary care centre from 2019 to 2024. Data collected encompassed target levels, cross-sectional area, types of EBP, demographics, imaging findings, maximum intensity of orthostatic headache, Headache Impact Test-6, psychological state (Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9), and somatic symptom burden (Widespread Pain Index and Symptom Severity Scale). A linear mixed model (LMM) was used to investigate factors influencing the total injected blood volume, accounting for repeated EBP procedures per patient. Sensitivity analysis was performed to assess model robustness.</p><p><strong>Results: </strong>A total of 103 EBP procedures from 53 patients (62% female; mean age, 39.9 ± 11.1 years) were analysed. The results of the LMM revealed that lower spinal levels (beta = 0.306, P = 0.029) and male sex (beta = 4.347, P = 0.024) were significantly associated with higher tolerable EBP volumes. Psychological factors or somatic symptom burden did not have a significant impact on the injected blood volume. In the sensitivity analysis, the number of EBP procedures (beta = -0.804, P = 0.001) was also significantly associated with lower tolerable EBP volume.</p><p><strong>Conclusions: </strong>Lower spinal levels and male sex were associated with higher tolerable EBP volumes in patients with SIH. The trade-off between spinal level and tolerable EBP volume should be considered when developing targeted blood patch strategies and evaluating their efficacy.</p>","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":"26 1","pages":"75"},"PeriodicalIF":7.3,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11995639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Migraine with and without aura-two distinct entities? A narrative review.","authors":"Olga Grodzka, Ketevan Dzagoevi, Tayla Rees, Goncalo Cabral, Piotr Chądzyński, Stefano Di Antonio, Patryk Sochań, Antoinette MaassenVanDenBrink, Christian Lampl","doi":"10.1186/s10194-025-01998-1","DOIUrl":"https://doi.org/10.1186/s10194-025-01998-1","url":null,"abstract":"<p><p>Migraine is a primary headache disorder, with a prevalence estimated at approximately 15% globally. According to the International Classification of Headache Disorders, 3rd edition (ICHD3), there are three significant types of migraine: migraine without aura (MO), migraine with aura (MA), and chronic migraine (CM), the former being the most common. Migraine diagnosis is based on official criteria specific to each type. Although a lot is already known about the origin of migraine aura, its pathophysiology is still an object of research.Long-term discussions have been held about MO and MA, with some evidence for the same underlying pathogenesis of both and other arguments against it. In this narrative review, we decided to analyse multiple factors from the perspective of similarities and differences between these two types of migraine. The aim was to understand better the bases underlying both types of migraine.Aspects such as genetics, molecular bases, relation with hormones, epidemiological and clinical features, neuroimaging, neurophysiology, treatment response, and migraine complications are covered to find similarities and differences between MO and MA. Although epidemiology shares similarities for both types, there are slight alterations in sex and age distribution. Genetics and pathogenesis showed some crucial differences. Conditions, such as vestibular symptoms and depression, were found to correlate similarly with both types of migraine. For some features, including increased cardiovascular risk, the tendency appeared to be the same; however, migraine types differ in the strength of correlation. Finally, in cases such as hormones, the influence has shown opposite directions. Therefore, although migraine with and without aura are considered two types of the same disease, more research should focus on their differences, thus finally enabling better specific treatment options for both types of migraine.</p>","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":"26 1","pages":"77"},"PeriodicalIF":7.3,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11995571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between mental disorders and trigeminal neuralgia: a cohort study and Mendelian randomization analysis.","authors":"Jianke Wang, Mingxiao Li, Ze Zhang, Yu Duan, Ziyi Zhang, Hanlin Liu, Ke Yang, Jiang Liu","doi":"10.1186/s10194-025-02026-y","DOIUrl":"https://doi.org/10.1186/s10194-025-02026-y","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Clinical observational evidence suggests a close association between Trigeminal Neuralgia (TN) and Mental disorders (MDs). However, the causal relationship between the two remains unclear. This study aims to observe and analyse the associations between depression, anxiety, insomnia, and TN through clinical research. It also employs Mendelian randomization (MR) analysis to verify the potential genetic correlation between TN and various mental disorders. offering new insights for the diagnosis, prevention, and intervention strategies for TN.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In the cohort study section, clinical data were collected from 154 patients with TN, all of whom were excluded from preoperative use of psychotropic drugs such as carbamazepine. The PHQ-9, GAD-7, and ISI scales were used to assess preoperative symptoms of depression, anxiety, and insomnia. Multivariable linear regression models were used to identify factors associated with questionnaire scores, with model performance evaluated by adjusted R², AIC, BIC, and p-values. Patients with significant positive symptoms preoperatively were followed up one-year after surgery, and non-parametric tests were employed to examine changes in mental disorder symptoms after pain relief. In MR analysis section, the main MR analysis methods include Inverse Variance Weighted (IVW), MR Egger, Weighted Median, Simple Mode, and Weighted Mode. The Benjamini-Hochberg (BH) method was used to adjust the p -values ​​and control the false discovery rate (FDR). Subsequent sensitivity analyses involved Cochran's Q test, MR-Egger regression intercept, MR-pleiotropy residual sum and outlier test (MR-PRESSO).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Multiple linear regression analyses revealed that longer disease duration and greater involvement of trigeminal branches were consistently associated with higher PHQ-9, GAD-7, and ISI scores, while demographic factors and baseline BNI scores showed no significant predictive value. MR analysis indicated that autism (OR = 0.697, 95% CI [0.494-0.982], P = 0.039), schizophrenia (OR = 0.910, 95% CI [0.831-0.997], P = 0.042), and ADHD combined with OCD (OR = 0.175, 95% CI [0.044-0.693], P = 0.013) reduced the risk of TN. Conversely, bipolar disorder (OR = 1.249, 95% CI [1.016-1.535], P = 0.034), depression (OR = 2.375, 95% CI [1.043-5.409], P = 0.039), anxiety (OR = 1.174, 95% CI [1.008-1.368], P = 0.039), and insomnia (OR = 2.036, 95% CI [1.074-3.861], P = 0.029)increased the risk of TN. TN also elevated the risk of anxiety (OR = 1.43, 95% CI [1.04-1.96], P = 0.034), depression (OR = 1.00305, 95% CI [1.00036-1.00549], P = 0.013), and insomnia (OR = 1.00918, 95% CI [1.00236-1.01605], P = 0.008).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Longer disease duration and broader trigeminal nerve involvement were independently associated with increased severity of depressive, anxiety, and insomnia symptoms, highlighting the importance of early clinical intervention in","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":"26 1","pages":"74"},"PeriodicalIF":7.3,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11992777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomarkers in headaches as a potential solution to simplify differential diagnosis of primary headache disorders: a systematic review.","authors":"Olga Grodzka, Wiktor Łagowski, Ceren Eyileten, Izabela Domitrz","doi":"10.1186/s10194-025-02023-1","DOIUrl":"https://doi.org/10.1186/s10194-025-02023-1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;According to the International Classification of Headache Disorders, 3rd edition (ICHD-3), headache disorders can be divided into two main groups: primary, which are not caused by any other disease, and secondary, which are symptomatic of underlying disease. Differentiating between both groups is crucial for the patient's prognosis. The diagnosis of primary headache disorders relies solely on official clinical criteria, with no additional diagnostic tools available. Therefore, they usually remain underdiagnosed, decreasing the patient's quality of life.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This systematic review aimed to analyse the available literature on the topic of biomarkers in the differentiation between different types of headaches. To be included, a primary study had to cover the abovementioned topic. Studies comparing one type of headache to healthy controls were excluded since the review focused on differential diagnosis. Articles to be considered had to describe original research and be written in English or Polish. No publication year limits were applied. A selection process was performed between October 19th, 2024, and January 1st, 2025, through six databases (PubMed, Embase, Scopus, Cochrane, Web of Science, Medline Ultimate), according to the PRISMA 2020. The risk of bias was assessed accordingly using the Prediction Model Risk of Bias Assessment Tool (PROBAST), and data synthesis was performed narratively. The review was registered in PROSPERO.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;The findings from 21 included studies (with a wide range of publication years between 1990 and 2023) demonstrated several biomarkers, mainly comparing migraine to other primary headaches, tension-type headaches and cluster headaches, and some secondary headaches: medication-overuse headaches and post-traumatic headaches. The main types of biomarkers were blood biomarkers and imaging biomarkers. Among the former, molecules such as magnesium and calcitonin gene-related peptide (CGRP) or inflammatory markers could be found. The latter group focused mainly on assessing volumes or functional connections in brain magnetic resonance imaging and seem to have a significant impact in the nearest future. Saliva analyses were covered only by two research groups, showing the putative role of magnesium and CGRP. Similarly, two research groups described evoked potentials' value only in the paediatric population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;There is a clear gap in the literature regarding biomarkers for the differential diagnosis of headaches. However, an analysis of the most recent studies suggests that imaging biomarkers are the most promising group since they have gained the most attention in the past few years. Finding high-value biomarkers can simplify differential diagnosis of headaches, especially when clinical presentation is atypical. Nevertheless, more research on biomarkers of all types is highly needed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Prospero: ","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":"26 1","pages":"73"},"PeriodicalIF":7.3,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11987472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cluster headache diagnostic delay and its predictors: a systematic review with a meta-analysis.","authors":"E K Van Obberghen, R Fabre, M Lanteri-Minet","doi":"10.1186/s10194-025-02001-7","DOIUrl":"https://doi.org/10.1186/s10194-025-02001-7","url":null,"abstract":"<p><strong>Background: </strong>Despite its characteristic clinical expression, cluster headache (CH) often remains unrecognized in clinical practice, with patients suffering from CH having to wait a long time before receiving a correct diagnosis and benefit from appropriate treatment.</p><p><strong>Methods: </strong>This work is a systematic review of data accessible through PubMed and published up to December 2024, focusing on the delay in CH diagnosis and its predictors. A meta-analysis was performed to estimate the mean CH diagnostic delay using the inverse of variance as the weight. A qualitative analysis was performed to identify predictors of this delay.</p><p><strong>Results: </strong>Among the 108 studies identified, 22 and 11 were selected for the qualitative analysis and meta-analysis respectively. These selected studies included a total of 8654 subjects (range 23-1604). This whole population was composed of 6383 men, 2180 women and 91 subjects with sex not specified. CH form was indicated for 7177 subjects with 5808, 1182 and 187 with episodic CH, chronic CH and undetermined form respectively. Meta-analysis estimated the overall CH diagnostic delay at 10,43 years (95% CI [9.09; 11.77]) with a reduction in the CH diagnostic delay over time since the sixties and the continuation of such a reduction every decade since 2000. Qualitative analyses identified several predictors of this diagnostic delay. Autonomic symptoms were associated with a decrease in the delay of diagnosis, whereas lower age of CH onset, alternating attack side and nocturnal headaches were associated with an increase in the delay of diagnosis.</p><p><strong>Conclusion: </strong>This systematic review including meta-analysis confirms an important unmet need in terms of CH diagnosis. Further work is needed to identify more precisely the predictors of this delay for better management of patients suffering from CH. TRIAL REGISTRATION: The systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 01/10/2025 (registration number: CRD42025630779).</p>","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":"26 1","pages":"71"},"PeriodicalIF":7.3,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prioritising patient involvement in patient reported outcome measures- a PROMising way to improve headache care.","authors":"Lakshini Gunasekera, Jason C Ray, Neha Kaul, Helmut Butzkueven, Elspeth Hutton, Terence J O'Brien","doi":"10.1186/s10194-025-02019-x","DOIUrl":"https://doi.org/10.1186/s10194-025-02019-x","url":null,"abstract":"<p><strong>Background: </strong>The optimal management of migraine involves care strategies that reflect what matters most to patients. This usually involves an assessment of treatment efficacy with respect to headache reduction, safety of prescribed medications and overall patient satisfaction and/or improved quality of life. Traditionally, neurologists focus on objective measures such as monthly reductions to headache and migraine days from baseline. This is complemented with various patient reported outcome measures (PROMs) to quantify morbidity and treatment effect from the patient's perspective. We present a review of currently available headache specific PROMs to summarise the design, key attributes, response format, recall period and length of questionnaires.</p><p><strong>Methods: </strong>A literature search was conducted using OVID Medline, Embase and Cochrane Library. The search strategy involved: (satisfaction OR patient satisfaction OR efficacy OR effectiveness) AND (disability OR morbidity OR burden OR severity OR impact OR patient reported outcomes OR PROMs OR outcome measures OR MIDAS OR HIT6 OR HDI OR MSQ OR MIG-SCOG OR Eq. 5D OR WPAI OR PGIC OR quality of life or QOL) AND (migraine OR chronic migraine OR headache OR primary headache OR cephalalgia OR headache disorder). A total of 16,024 articles returned. Removal of duplicates (n = 111), title and abstract screening (n = 15,853) and subsequent full text analysis (n = 19), left 41 articles. Reviewer comments led to addition of further 3 articles to our review. In total, of 44 included articles there were 20 headache-specific PROMs analysed.</p><p><strong>Results and conclusion: </strong>Our findings show that there is a significant lack of patient involvement in creation of headache PROMs thus there may be a gap between perceived treatment efficacy from the perspective of neurologists and that of patients. We suggest future assessment of migraine treatment efficacy considers what is important to the patient as a priority, in an effort to improve satisfaction with care.</p>","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":"26 1","pages":"72"},"PeriodicalIF":7.3,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11983965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of new-onset migraine using clinical-genotypic data from the HUNT Study: a machine learning analysis.","authors":"Fahim Faisal, Antonios Danelakis, Marte-Helene Bjørk, Bendik Winsvold, Manjit Matharu, Parashkev Nachev, Knut Hagen, Erling Tronvik, Anker Stubberud","doi":"10.1186/s10194-025-02014-2","DOIUrl":"10.1186/s10194-025-02014-2","url":null,"abstract":"<p><strong>Background: </strong>Migraine is associated with a range of symptoms and comorbid disorders and has a strong genetic basis, but the currently identified risk loci only explain a small portion of the heritability, often termed the \"missing heritability\". We aimed to investigate if machine learning could exploit the combination of genetic data and general clinical features to identify individuals at risk for new-onset migraine.</p><p><strong>Method: </strong>This study was a population-based cohort study of adults from the second and third Trøndelag Health Study (HUNT2 and HUNT3). Migraine was captured in a validated questionnaire and based on modified criteria of the International Classification of Headache Disorders (ICHD) and participants underwent genome-wide genotyping. The primary outcome was new-onset migraine defined as a change in disease status from headache-free in HUNT2 to migraine in HUNT3. The migraine risk variants identified in the largest GWAS meta-analysis of migraine were used to identify genetic input features for the models. The general clinical features included demographics, selected comorbidities, medication and stimulant use and non-headache symptoms as predictive factors. Several standard machine learning architectures were constructed, trained, optimized and scored with area under the receiver operating characteristics curve (AUC). The best model during training and validation was used on unseen test sets. Different methods for model explainability were employed.</p><p><strong>Results: </strong>A total of 12,995 individuals were included in the predictive modelling (491 new-onset cases). A total of 108 genetic variants and 67 general clinical variables were included in the models. The top performing decision-tree classifier achieved a test set AUC of 0.56 when using only genotypic data, 0.68 when using only clinical data and 0.72 when using both genetic and clinical data. Combining the genotype only and clinical data only models resulted in a lower predictivity with an AUC of 0.67. The most important clinical features were age, marital status and work situation as well as several genetic variants.</p><p><strong>Conclusion: </strong>The combination of genotype and routine demographic and non-headache clinical data correctly predict the new onset of migraine in approximately 2 out of 3 cases, supporting that there are important genotypic-phenotypic interactions partaking in the new-onset of migraine.</p>","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":"26 1","pages":"70"},"PeriodicalIF":7.3,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11977938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Limbic system abnormalities in episodic cluster headache: a 7T MRI multimodal study.","authors":"Xinyu Wang, Luhua Zhang, Yongqin Xiong, Mengmeng Hou, Shuhua Zhang, Caohui Duan, Song Wang, Xiaoyu Wang, Haoxuan Lu, Jiayu Huang, Yan Li, Zhixuan Li, Zhao Dong, Xin Lou","doi":"10.1186/s10194-025-02009-z","DOIUrl":"10.1186/s10194-025-02009-z","url":null,"abstract":"<p><strong>Background: </strong>Although the limbic system has long been thought to be involved in the pathophysiology of cluster headache, inconsistencies in imaging studies of episodic cluster headache (eCH) patients and limited understanding of the specific regions within the limbic system have prevented a full explanation of its involvement in the disease. Therefore, we performed multimodal imaging analysis using 7 T MRI with the aim of exploring structural-functional abnormalities in subregions of the limbic system and their relationship with clinical features.</p><p><strong>Methods: </strong>In this cross-sectional study, we employed 7T MRI to investigate structural (volumetric) and functional (fractional amplitude of low-frequency fluctuations (fALFF), regional homogeneity (ReHo)) alterations in limbic subregions (hypothalamus, thalamus, amygdala, hippocampus) among 69 in-bout but outside the attacks eCH patients and 63 healthy controls (HCs). Automated volumetry and resting-state functional MRI analyses were performed after adjusting for age, Generalized Anxiety Disorder scale, sex (and intracranial volume when evaluating volumetric measures). Then functional-structural coupling indices were computed to assess network-level relationships.</p><p><strong>Results: </strong>In eCH patients, volumes in right anterior inferior and right posterior of hypothalamus, left molecular_layer_hippocampal-head, left lateral-nucleus and left Central-nucleus on the headache side, as well as left tuberal inferior and left tuberal superior of hypothalamus, and right parasubiculum on the contralateral side were significantly altered compared with HCs (P < 0.05). Additionally, the volume of the right anterior inferior was positively correlated with the duration of last headache episode. After false discovery rate correction, widespread alterations in fALFF and ReHo values were observed among hypothalamic, thalamic, hippocampal, and amygdalar subregions, some of which correlated with clinical measures. Furthermore, the structure-function coupling indices in the right anterior inferior and the left lateral geniculate nucleus on the headache side differed significantly between eCH patients and HCs.</p><p><strong>Conclusions: </strong>Our findings demonstrate that in-bout but outside the attacks eCH patients present anatomical and functional maladaptation of the limbic system. Moreover, the observed dissociation between localized abnormalities and largely preserved network coupling-except in the hypothalamus and thalamus-suggests that these two regions may be particularly susceptible to eCH-related dysfunction, while broader brain networks retain compensatory capacity in pathological states. These findings refine potential neuromodulation targets and highlight the value of ultrahigh-field imaging in eCH research.</p>","PeriodicalId":16013,"journal":{"name":"Journal of Headache and Pain","volume":"26 1","pages":"69"},"PeriodicalIF":7.3,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11974220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}