The Journal of Headache and Pain最新文献

{"title":"Using natural language processing to automatically classify written self-reported narratives by patients with migraine or cluster headache.","authors":"Nicolas Vandenbussche,&nbsp;Cynthia Van Hee,&nbsp;Véronique Hoste,&nbsp;Koen Paemeleire","doi":"10.1186/s10194-022-01490-0","DOIUrl":"https://doi.org/10.1186/s10194-022-01490-0","url":null,"abstract":"<p><strong>Background: </strong>Headache medicine is largely based on detailed history taking by physicians analysing patients' descriptions of headache. Natural language processing (NLP) structures and processes linguistic data into quantifiable units. In this study, we apply these digital techniques on self-reported narratives by patients with headache disorders to research the potential of analysing and automatically classifying human-generated text and information extraction in clinical contexts.</p><p><strong>Methods: </strong>A prospective cross-sectional clinical trial collected self-reported narratives on headache disorders from participants with either migraine or cluster headache. NLP was applied for the analysis of lexical, semantic and thematic properties of the texts. Machine learning (ML) algorithms were applied to classify the descriptions of headache attacks from individual participants into their correct group (migraine versus cluster headache).</p><p><strong>Results: </strong>One-hundred and twenty-one patients (81 participants with migraine and 40 participants with cluster headache) provided a self-reported narrative on their headache disorder. Lexical analysis of this text corpus resulted in several specific key words per diagnostic group (cluster headache: Dutch (nl): \"oog\" | English (en): \"eye\", nl: \"pijn\" | en: \"pain\" and nl: \"terug\" | en: \"back/to come back\"; migraine: nl: \"hoofdpijn\" | en: \"headache\", nl: \"stress\" | en: \"stress\" and nl: \"misselijkheid\" | en: \"nausea\"). Thematic and sentiment analysis of text revealed largely negative sentiment in texts by both patients with migraine and cluster headache. Logistic regression and support vector machine algorithms with different feature groups performed best for the classification of attack descriptions (with F1-scores for detecting cluster headache varying between 0.82 and 0.86) compared to naïve Bayes classifiers.</p><p><strong>Conclusions: </strong>Differences in lexical choices between patients with migraine and cluster headache are detected with NLP and are congruent with domain expert knowledge of the disorders. Our research shows that ML algorithms have potential to classify patients' self-reported narratives of migraine or cluster headache with good performance. NLP shows its capability to discern relevant linguistic aspects in narratives from patients with different headache disorders and demonstrates relevance in clinical information extraction. The potential benefits on the classification performance of larger datasets and neural NLP methods can be investigated in the future.</p><p><strong>Trial registration: </strong>This study was registered with clinicaltrials.gov with ID NCT05377437.</p>","PeriodicalId":501630,"journal":{"name":"The Journal of Headache and Pain","volume":" ","pages":"129"},"PeriodicalIF":7.4,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9524092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40386566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alterations in metabolic flux in migraine and the translational relevance.","authors":"Olivia Grech,&nbsp;Matilde Sassani,&nbsp;Gisela Terwindt,&nbsp;Gareth G Lavery,&nbsp;Susan P Mollan,&nbsp;Alexandra J Sinclair","doi":"10.1186/s10194-022-01494-w","DOIUrl":"https://doi.org/10.1186/s10194-022-01494-w","url":null,"abstract":"<p><strong>Background: </strong>Migraine is a highly prevalent disorder with significant economical and personal burden. Despite the development of effective therapeutics, the causes which precipitate migraine attacks remain elusive. Clinical studies have highlighted altered metabolic flux and mitochondrial function in patients. In vivo animal experiments can allude to the metabolic mechanisms which may underlie migraine susceptibility. Understanding the translational relevance of these studies are important to identifying triggers, biomarkers and therapeutic targets in migraine.</p><p><strong>Main body: </strong>Functional imaging studies have suggested that migraineurs feature metabolic syndrome, exhibiting hallmark features including upregulated oxidative phosphorylation yet depleted available free energy. Glucose hypometabolism is also evident in migraine patients and can lead to altered neuronal hyperexcitability such as the incidence of cortical spreading depression (CSD). The association between obesity and increased risk, frequency and worse prognosis of migraine also highlights lipid dysregulation in migraine pathology. Calcitonin gene related peptide (CGRP) has demonstrated an important role in sensitisation and nociception in headache, however its role in metabolic regulation in connection with migraine has not been thoroughly explored. Whether impaired metabolic function leads to increased release of peptides such as CGRP or excessive nociception leads to altered flux is yet unknown.</p><p><strong>Conclusion: </strong>Migraine susceptibility may be underpinned by impaired metabolism resulting in depleted energy stores and altered neuronal function. This review discusses both clinical and in vivo studies which provide evidence of altered metabolic flux which contribute toward pathophysiology. It also reviews the translational relevance of animal studies in identifying targets of biomarker or therapeutic development.</p>","PeriodicalId":501630,"journal":{"name":"The Journal of Headache and Pain","volume":" ","pages":"127"},"PeriodicalIF":7.4,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9523955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40380775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A c-Fos activation map in nitroglycerin/levcromakalim-induced models of migraine.","authors":"Shouyi Wu,&nbsp;Xiao Ren,&nbsp;Chenlu Zhu,&nbsp;Wei Wang,&nbsp;Kaibo Zhang,&nbsp;Zhilei Li,&nbsp;Xuejiao Liu,&nbsp;Yonggang Wang","doi":"10.1186/s10194-022-01496-8","DOIUrl":"https://doi.org/10.1186/s10194-022-01496-8","url":null,"abstract":"<p><strong>Background: </strong>Chronic migraine is a common and highly disabling disorder. Functional MRI has indicated that abnormal brain region activation is linked with chronic migraine. Drugs targeting the calcitonin gene-related peptide (CGRP) or its receptor have been reported to be efficient for treating chronic migraine. The CGRP signaling was also shared in two types of chronic migraine models (CMMs). However, it remains unclear whether the activation of specific brain regions could contribute to persistent behavioral sensitization, and CGRP receptor antagonists relieve migraine-like pain in CMMs by altering specific brain region activation. Therefore, it's of great interest to investigate brain activation pattern and the effect of olcegepant (a CGRP receptor-specific antagonist) treatment on alleviating hyperalgesia by altering brain activation in two CMMs, and provide a reference for future research on neural circuits.</p><p><strong>Methods: </strong>Repeated administration of nitroglycerin (NTG) or levcromakalim (LEV) was conducted to stimulate human migraine-like pain and establish two types of CMMs in mice. Mechanical hypersensitivity was evaluated by using the von Frey filament test. Then, we evaluated the activation of different brain regions with c-Fos and NeuN staining. Olcegepant was administered to explore its effect on mechanical hyperalgesia and brain region activation.</p><p><strong>Results: </strong>In two CMMs, acute and basal mechanical hyperalgesia was observed, and olcegepant alleviated mechanical hyperalgesia. In the NTG-induced CMM, the medial prefrontal cortex (mPFC), anterior cingulate cortex (ACC), and the caudal part of the spinal trigeminal nucleus (Sp5c) showed a significant increase of c-Fos expression in the NTG group (p < 0.05), while pre-treatment with olcegepant reduced c-Fos expression compared with NTG group (p < 0.05). No significant difference of c-Fos expression was found in the paraventricular thalamic nucleus (PVT) and ventrolateral periaqueductal gray (vlPAG) between the vehicle control and NTG group (p > 0.05). In the LEV-induced CMM, mPFC, PVT, and Sp5c showed a significant increase of c-Fos expression between vehicle control and LEV group, and olcegepant reduced c-Fos expression (p < 0.05). No significant difference in c-Fos expression was found in vlPAG and ACC (p > 0.05).</p><p><strong>Conclusions: </strong>Our study demonstrated the activation of mPFC and Sp5c in two CMMs. Olcegepant may alleviate hyperalgesia of the hind paw and periorbital area by attenuating brain activation in CMMs.</p>","PeriodicalId":501630,"journal":{"name":"The Journal of Headache and Pain","volume":" ","pages":"128"},"PeriodicalIF":7.4,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9524028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40387685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Synaptic alterations in visual cortex reshape contrast-dependent gamma oscillations and inhibition-excitation ratio in a genetic mouse model of migraine.","authors":"Nicolò Meneghetti,&nbsp;Chiara Cerri,&nbsp;Eleonora Vannini,&nbsp;Elena Tantillo,&nbsp;Angelita Tottene,&nbsp;Daniela Pietrobon,&nbsp;Matteo Caleo,&nbsp;Alberto Mazzoni","doi":"10.1186/s10194-022-01495-9","DOIUrl":"https://doi.org/10.1186/s10194-022-01495-9","url":null,"abstract":"<p><strong>Background: </strong>Migraine affects a significant fraction of the world population, yet its etiology is not completely understood. In vitro results highlighted thalamocortical and intra-cortical glutamatergic synaptic gain-of-function associated with a monogenic form of migraine (familial-hemiplegic-migraine-type-1: FHM1). However, how these alterations reverberate on cortical activity remains unclear. As altered responsivity to visual stimuli and abnormal processing of visual sensory information are common hallmarks of migraine, herein we investigated the effects of FHM1-driven synaptic alterations in the visual cortex of awake mice.</p><p><strong>Methods: </strong>We recorded extracellular field potentials from the primary visual cortex (V1) of head-fixed awake FHM1 knock-in (n = 12) and wild type (n = 12) mice in response to square-wave gratings with different visual contrasts. Additionally, we reproduced in silico the obtained experimental results with a novel spiking neurons network model of mouse V1, by implementing in the model both the synaptic alterations characterizing the FHM1 genetic mouse model adopted.</p><p><strong>Results: </strong>FHM1 mice displayed similar amplitude but slower temporal evolution of visual evoked potentials. Visual contrast stimuli induced a lower increase of multi-unit activity in FHM1 mice, while the amount of information content about contrast level remained, however, similar to WT. Spectral analysis of the local field potentials revealed an increase in the β/low γ range of WT mice following the abrupt reversal of contrast gratings. Such frequency range transitioned to the high γ range in FHM1 mice. Despite this change in the encoding channel, these oscillations preserved the amount of information conveyed about visual contrast. The computational model showed how these network effects may arise from a combination of changes in thalamocortical and intra-cortical synaptic transmission, with the former inducing a lower cortical activity and the latter inducing the higher frequencies ɣ oscillations.</p><p><strong>Conclusions: </strong>Contrast-driven ɣ modulation in V1 activity occurs at a much higher frequency in FHM1. This is likely to play a role in the altered processing of visual information. Computational studies suggest that this shift is specifically due to enhanced cortical excitatory transmission. Our network model can help to shed light on the relationship between cellular and network levels of migraine neural alterations.</p>","PeriodicalId":501630,"journal":{"name":"The Journal of Headache and Pain","volume":" ","pages":"125"},"PeriodicalIF":7.4,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9523950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40380770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does MIDAS reduction at 3 months predict the outcome of erenumab treatment? A real-world, open-label trial.","authors":"Roberto De Icco,&nbsp;Gloria Vaghi,&nbsp;Marta Allena,&nbsp;Natascia Ghiotto,&nbsp;Elena Guaschino,&nbsp;Daniele Martinelli,&nbsp;Lara Ahmad,&nbsp;Michele Corrado,&nbsp;Federico Bighiani,&nbsp;Federica Tanganelli,&nbsp;Sara Bottiroli,&nbsp;Francescantonio Cammarota,&nbsp;Grazia Sances,&nbsp;Cristina Tassorelli","doi":"10.1186/s10194-022-01480-2","DOIUrl":"https://doi.org/10.1186/s10194-022-01480-2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In Italy, monoclonal antibodies targeting the CGRP pathway are subsidized for the preventive treatment of high frequency and chronic migraine (CM) in patients with a MIgraine Disability ASsessment (MIDAS) score ≥ 11. Eligibility to treatment continuation requires a ≥ 50% MIDAS score reduction at three months (T3). In this study, we evaluate whether a ≥ 50% MIDAS score reduction at T3 is a reliable predictor of response to one-year erenumab treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this prospective, open-label, real-world study, 77 CM patients were treated with erenumab 70-140 mg s.c. every 28 days for one year (T13). We collected the following variables: monthly migraine days (MMDs), monthly headache days (MHDs), days of acute medication intake, MIDAS, HIT-6, anxiety, depression, quality of life and allodynia. Response to erenumab was evaluated as: i) average reduction in MMDs during the 1-year treatment period; and ii) percentage of patients with ≥ 50% reduction in MMDs during the last 4 weeks after the 13&lt;sup&gt;th&lt;/sup&gt; injection (Responders&lt;sup&gt;T13&lt;/sup&gt;).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Erenumab induced a sustained reduction in MMDs, MHDs and intake of acute medications across the 12-month treatment period, with 64.9% of patients qualifying as Responders&lt;sup&gt;T13&lt;/sup&gt;. At T3, 55.8% of patients reported a ≥ 50% reduction in MIDAS score (MIDAS&lt;sup&gt;Res&lt;/sup&gt;) and 55.4% of patients reported a ≥ 50% reduction in MMDs (MMD&lt;sup&gt;Res&lt;/sup&gt;). MIDAS&lt;sup&gt;Res&lt;/sup&gt; and MMD&lt;sup&gt;Res&lt;/sup&gt; patients showed a more pronounced reduction in MMDs during the 1-year treatment as compared to NON-MIDAS&lt;sup&gt;Res&lt;/sup&gt; (MIDAS&lt;sup&gt;Res&lt;/sup&gt;: T0: 23.5 ± 4.9 vs. T13: 7.7 ± 6.2; NON- MIDAS&lt;sup&gt;Res&lt;/sup&gt;: T0: 21.6 ± 5.4 vs. T13: 11.3 ± 8.8, p = 0.045) and NON-MMD&lt;sup&gt;Res&lt;/sup&gt; (MMD&lt;sup&gt;Res&lt;/sup&gt;: T0: 23.0 ± 4.5 vs. T13: 6.6 ± 4.8; NON-MMD&lt;sup&gt;Res&lt;/sup&gt;: T0: 22.3 ± 6.0 vs. T13: 12.7 ± 9.2, p &lt; 0.001) groups. The percentage of Responders&lt;sup&gt;T13&lt;/sup&gt; did not differ between MIDAS&lt;sup&gt;Res&lt;/sup&gt; (74.4%) and NON-MIDAS&lt;sup&gt;Res&lt;/sup&gt; (52.9%) patients (p = 0.058), while the percentage of Responders&lt;sup&gt;T13&lt;/sup&gt; was higher in the MMD&lt;sup&gt;Res&lt;/sup&gt; group (83.3%) when compared to NON-MMD&lt;sup&gt;Res&lt;/sup&gt; (42.9%) (p = 0.001). MMD&lt;sup&gt;Res&lt;/sup&gt; predicted the long-term outcome according to a multivariate analysis (Exp(B) = 7.128; p = 0.001), while MIDAS&lt;sup&gt;Res&lt;/sup&gt; did not. Treatment discontinuation based on MIDAS&lt;sup&gt;Res&lt;/sup&gt; would have early excluded 36.0% of Responders&lt;sup&gt;T13&lt;/sup&gt;. Discontinuation based on \"either MIDAS&lt;sup&gt;Res&lt;/sup&gt; or MMD&lt;sup&gt;Res&lt;/sup&gt;\" would have excluded a lower percentage (16%) of Responders&lt;sup&gt;T13&lt;/sup&gt;.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;MIDAS&lt;sup&gt;Res&lt;/sup&gt; only partly reflects the 12-month outcome of erenumab treatment in CM, as it excludes more than one third of responders. A criterion based on the alternative consideration of ≥ 50% reduction in MIDAS score or MMDs in the first three months of treatment represents a more pr","PeriodicalId":501630,"journal":{"name":"The Journal of Headache and Pain","volume":" ","pages":"123"},"PeriodicalIF":7.4,"publicationDate":"2022-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9482180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40365671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review of economic evaluations of pharmacological treatments for adults with chronic migraine.","authors":"Saval Khanal, Martin Underwood, Seyran Naghdi, Anna Brown, Callum Duncan, Manjit Matharu, Hema Mistry","doi":"10.1186/s10194-022-01492-y","DOIUrl":"10.1186/s10194-022-01492-y","url":null,"abstract":"<p><strong>Background and aims: </strong>Chronic migraine is a common neurovascular brain disorder with substantial economic costs. We performed a systematic review to identify economic evaluations of pharmacological treatments for adults with chronic migraine.</p><p><strong>Methods: </strong>We undertook systematic literature searches using terms for migraine/headache and prophylactic drug interventions, combined with economic/cost terms where appropriate. Using inclusion and exclusion criteria, two reviewers independently assessed the citations and abstracts, and full-text articles were retrieved. A review of study characteristics and methodological quality was assessed.</p><p><strong>Results: </strong>Sixteen citations met the inclusion criteria and were model-based cost-utility studies evaluating: Botox (n = 6); Erenumab (n = 8); Fremanezumab (n = 2); and Galcanezumab (n = 1) as the main treatment. They varied in their use of comparators, perspective, and model type. Botox was cost-effective compared to placebo with an incremental cost-effectiveness ratio (ICER) ranging between £15,028 (€17,720) and £16,598 (€19,572). Erenumab, Fremanezumab and Galcanezumab when compared to Botox, was associated with ICERs ranging between £59,712 ($81,080) and £182,128 (€218,870), with the ICERs above the most common willingness-to-pay thresholds (WTPs). But they were cost-effective within the commonly used WTPs among the population for whom the previous treatments including Botox were failed. Three studies compared the cost-effectiveness of Erenumab against the placebo and found that Erenumab was dominant. All studies performed sensitivity analyses to check the robustness of their results. None of the findings from the included articles were generalisable and none of the included studies fulfilled all the criteria mentioned in the CHEERS 2022 reporting checklist and Phillips's checklist for economic models.</p><p><strong>Conclusions: </strong>Evidence to support the cost-effectiveness of pharmacological treatments of chronic migraine in the adult population using Botox and Erenumab were identified. Our findings suggest that both Botox and Erenumab, are cost-effective compared to placebo; although Erenumab had more incremental economic benefits compared to Botox, the ICERs were above the most common willingness-to-pay thresholds. Hence, Erenumab might be an acceptable treatment for chronic migraine for patients whom other treatments such as Botox do not work. Further research is needed to help characterise the data to adequately structure and parameterise an economic model to support decision-making for chronic migraine therapies.</p>","PeriodicalId":501630,"journal":{"name":"The Journal of Headache and Pain","volume":" ","pages":"122"},"PeriodicalIF":0.0,"publicationDate":"2022-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9479409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40363681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventive treatment can reverse cognitive impairment in chronic migraine.","authors":"Cristina González-Mingot,&nbsp;Anna Gil-Sánchez,&nbsp;Marc Canudes-Solans,&nbsp;Silvia Peralta-Moncusi,&nbsp;Maria José Solana-Moga,&nbsp;Luis Brieva-Ruiz","doi":"10.1186/s10194-022-01486-w","DOIUrl":"https://doi.org/10.1186/s10194-022-01486-w","url":null,"abstract":"<p><strong>Objective: </strong>To study the impact of chronic migraine (CM) on the cognition and quality of life (QoL) of patients in the interictal period, and to analyse the degree of reversibility of any observed alterations following the use of preventive treatment.</p><p><strong>Background: </strong>CM is a highly disabling disease, and migraineurs often have associated comorbidities, such as subjective memory problems, that are involved in the development of cognitive impairment. Our hypotheses are that patients suffering from chronic migraine experience objective cognitive alterations that are not only due to the pain that they suffer or their current emotional state. Furthermore, preventive treatment should be capable of reversing, or at least reducing, the impact of CM on the cognition and QoL of migraineurs.</p><p><strong>Methods: </strong>The cognition and QoL of 50 control subjects and 46 patients with CM were assessed using a battery of tests, prior to the use of preventive treatment based on botulinum toxin or oral drugs and after 3 months of this treatment.</p><p><strong>Results: </strong>Compared with controls, patients with CM had lower scores on the assessment of cognitive performance (Rey-Osterrieth Complex Figure test [ROCF] (p<0.05), Trail Making Test [TMT] B) (p < 0.05) and QoL (p < 0.05). Three months after the use of preventive treatment, improvement was observed in all cognitive parameters (p < 0.05) and QoL (p < 0.05), except the ROCF copy task (p = 0.79). No statistically significant differences were observed when these outcomes were compared based on treatment.</p><p><strong>Conclusions: </strong>This study confirms poor cognitive performance that is not explained by migraine pain itself, as it occurs in the interictal period, irrespective of the patient's emotional status. Our findings show that these effects are reversible in some cases with preventive treatment of CM, reaffirming the important impact of this condition on the QoL of these patients, and the need to establish preventive treatment guidelines.</p>","PeriodicalId":501630,"journal":{"name":"The Journal of Headache and Pain","volume":" ","pages":"121"},"PeriodicalIF":7.4,"publicationDate":"2022-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9476561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40358540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum CGRP in migraine patients using erenumab as preventive treatment.","authors":"Simone de Vries Lentsch,&nbsp;Ingrid M Garrelds,&nbsp;A H Jan Danser,&nbsp;Gisela M Terwindt,&nbsp;Antoinette MaassenVanDenBrink","doi":"10.1186/s10194-022-01483-z","DOIUrl":"https://doi.org/10.1186/s10194-022-01483-z","url":null,"abstract":"<p><strong>Aim: </strong>Serum levels of Calcitonin Gene-Related Peptide (CGRP)-like immunoreactivity (CGRP-LI) in migraine patients before and after starting treatment with erenumab were measured to evaluate the association with clinical treatment response.</p><p><strong>Methods: </strong>Blood samples were collected from the cubital fossa before (T0) and 2-4 weeks after (T1) starting treatment with erenumab. Clinical response was monitored using a daily headache e-diary. Serum levels of CGRP-LI, assessed using radioimmunoassay, were compared between T0 and T1, correcting for migraine reduction. In addition, for both T0 and T1, linear regression models were constructed using migraine reduction as outcome and serum CGRP-LI as independent variable, corrected for age, gender and monthly migraine days (MMD) at baseline.</p><p><strong>Results: </strong>Serum CGRP-LI did not differ between T0 and T1 (p = 0.30). However, there was an interaction between time and reduction in MMD (p = 0.01). Absolute reduction in MMD in the third month after treatment with erenumab was associated with serum CGRP-LI at T1, 2-4 weeks after starting treatment with erenumab (p = 0.003), but not with serum CGRP-LI at T0 (p = 0.24).</p><p><strong>Conclusion: </strong>Lower serum CGRP-LI 2-4 weeks after starting treatment with erenumab was associated with a higher reduction in migraine days after three months of treatment. Although the underlying mechanisms remain to be determined, this suggests that changes in CGRP levels, shortly after starting erenumab, are important for its clinical effect.</p>","PeriodicalId":501630,"journal":{"name":"The Journal of Headache and Pain","volume":" ","pages":"120"},"PeriodicalIF":7.4,"publicationDate":"2022-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9464612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33458797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional connectivity and structural changes of thalamic subregions in episodic migraine.","authors":"Ying Yang,&nbsp;Huang Xu,&nbsp;Ziru Deng,&nbsp;Wenwen Cheng,&nbsp;Xiuxiu Zhao,&nbsp;Yan Wu,&nbsp;Yuhua Chen,&nbsp;Gui Wei,&nbsp;Ying Liu","doi":"10.1186/s10194-022-01491-z","DOIUrl":"https://doi.org/10.1186/s10194-022-01491-z","url":null,"abstract":"<p><strong>Background: </strong>The thalamus plays a crucial role in transmitting nociceptive information to various cortical regions involving migraine-related allodynia and photophobia. Abnormal structural and functional alterations related to the thalamus have been well established. However, it is unknown whether the brain structure and function of the thalamic subregions are differentially affected in this disorder. In this study, we aimed to clarify this issue by comparing the structure and function of 16 thalamic subregions between patients with episodic migraine (EM) and healthy controls (HCs).</p><p><strong>Methods: </strong>Twenty-seven patients with EM and 30 sex-, age- and education-matched HCs underwent resting-state functional and structural magnetic resonance imaging scans. Functional connectivity (rsFC), grey matter volume (GMV), and diffusion tensor imaging (DTI) parameters of each subregion of the thalamus were calculated and compared between the two groups. Furthermore, correlation analyses between neuroimaging changes and clinical features were performed in this study.</p><p><strong>Results: </strong>First, compared with HCs, patients with EM exhibited decreased rsFC between the anterior-medial-posterior subregions of the thalamus and brain regions mainly involved in the medial system of the pain processing pathway and default mode network (DMN). Second, for the whole thalamus and each of its subregions, there were no significant differences in GMV between patients with EM and HCs (P > 0.05, Bonferroni corrected). Third, there was no significant difference in DTI parameters between the two groups (P > 0.05). Finally, decreased rsFC was closely related to scores on the Hamilton Rating Scale for Anxiety (HAMA) and Big Five Inventory (BFI) scales.</p><p><strong>Conclusion: </strong>Selective functional hypoconnectivity in the thalamic subregions provides neuroimaging evidence supporting the important role of thalamocortical pathway dysfunction in episodic migraine, specifically, that it may modulate emotion and different personality traits in migraine patients.</p>","PeriodicalId":501630,"journal":{"name":"The Journal of Headache and Pain","volume":" ","pages":"119"},"PeriodicalIF":7.4,"publicationDate":"2022-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9463803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33458646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of monoclonal antibody against calcitonin gene-related peptide or its receptor for migraine patients with prior preventive treatment failure: a network meta-analysis.","authors":"Xing Wang,&nbsp;Dingke Wen,&nbsp;Qiang He,&nbsp;Chao You,&nbsp;Lu Ma","doi":"10.1186/s10194-022-01472-2","DOIUrl":"https://doi.org/10.1186/s10194-022-01472-2","url":null,"abstract":"<p><strong>Objective: </strong>The relative effects of monoclonal antibody against calcitonin gene-related peptide (CGRP) or its receptor for adult migraine patients with prior treatment failure remains uncertain. Therefore, this study systematically assessed the comparative effectiveness of different CGRP binding monoclonal antibodies (mAbs) for these patients.</p><p><strong>Methods: </strong>Several online databases including Ovid MEDILNE, Ovid EMBASE, Cochrane Library, and ClinicalTrials.gov were systematically searched from inception to June 15, 2022. We included randomized clinical trials (RCT) of adult migraine patients with previous treatment failure that assessed any CGRP monoclonal antibody. The primary efficacy outcome was change in monthly migraine days (MMDs), and the primary safety outcome was treatment-emergent adverse events (TEAEs).</p><p><strong>Results: </strong>Overall, seven studies totaling 3, 052 patients were included. Three-node analysis showed that CGRP mAbs was superior to CGRP receptor mAbs in reducing MMDs (MD: -1.55, 95% CrI: - 2.43 to - 0.44) and improving at least 50% response rates (RR: 1.52, 95% CrI: 1.04 to 2.21). Nine-node analysis showed galcanezumab 240 mg ranked first in reducing MMDs (MD -4.40, 95% CrI - 7.60 to - 1.19) and improving 50% response rates (RR: 4.18, 95% CrI: 2.63 to 6.67). Moreover, treatment with fremanezumab or eptinezumab 300 mg provides a significant advantage over erenumab 140 mg regarding an improved response rate of at least 50%. The analysis did not show difference in incidences of TEAEs and serious adverse events in any of the comparisons.</p><p><strong>Conclusions: </strong>It appears that CGRP mAbs, especially galcanezumab 240 mg, monthly fremanezumab, and eptinezumab 300 mg, seem to be the best choice for the treatment of migraine patients with previous treatment failures. This finding also calls for future research that examine the associations between these medications in migraine therapy among the same patient group to testify the present findings.</p>","PeriodicalId":501630,"journal":{"name":"The Journal of Headache and Pain","volume":" ","pages":"105"},"PeriodicalIF":7.4,"publicationDate":"2022-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9454201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33447962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}