Publisher: Sage Publications   (Total: 1166 journals)

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Showing 1 - 200 of 1166 Journals sorted alphabetically
AADE in Practice     Hybrid Journal   (Followers: 6)
Abstracts in Anthropology     Full-text available via subscription   (Followers: 29)
Academic Pathology     Open Access   (Followers: 6)
Accounting History     Hybrid Journal   (Followers: 18, SJR: 0.527, CiteScore: 1)
Acta Radiologica     Hybrid Journal   (Followers: 1, SJR: 0.754, CiteScore: 2)
Acta Radiologica Open     Open Access   (Followers: 2)
Acta Sociologica     Hybrid Journal   (Followers: 39, SJR: 0.939, CiteScore: 2)
Action Research     Hybrid Journal   (Followers: 53, SJR: 0.308, CiteScore: 1)
Active Learning in Higher Education     Hybrid Journal   (Followers: 398, SJR: 1.397, CiteScore: 2)
Adaptive Behavior     Hybrid Journal   (Followers: 9, SJR: 0.288, CiteScore: 1)
Administration & Society     Hybrid Journal   (Followers: 18, SJR: 0.675, CiteScore: 1)
Adoption & Fostering     Hybrid Journal   (Followers: 25, SJR: 0.313, CiteScore: 0)
Adsorption Science & Technology     Open Access   (Followers: 9, SJR: 0.258, CiteScore: 1)
Adult Education Quarterly     Hybrid Journal   (Followers: 262, SJR: 0.566, CiteScore: 2)
Adult Learning     Hybrid Journal   (Followers: 51)
Advances in Dental Research     Hybrid Journal   (Followers: 11, SJR: 1.791, CiteScore: 4)
Advances in Developing Human Resources     Hybrid Journal   (Followers: 35, SJR: 0.614, CiteScore: 2)
Advances in Mechanical Engineering     Open Access   (Followers: 156, SJR: 0.272, CiteScore: 1)
Advances in Methods and Practices in Psychological Science     Full-text available via subscription   (Followers: 20)
Advances in Structural Engineering     Full-text available via subscription   (Followers: 51, SJR: 0.599, CiteScore: 1)
AERA Open     Open Access   (Followers: 14)
Affilia     Hybrid Journal   (Followers: 6, SJR: 0.496, CiteScore: 1)
Africa Spectrum     Open Access   (Followers: 17)
Agrarian South : J. of Political Economy     Hybrid Journal   (Followers: 3)
Air, Soil & Water Research     Open Access   (Followers: 13, SJR: 0.214, CiteScore: 1)
Alexandria : The J. of National and Intl. Library and Information Issues     Full-text available via subscription   (Followers: 68)
Allergy & Rhinology     Open Access   (Followers: 5)
AlterNative : An Intl. J. of Indigenous Peoples     Full-text available via subscription   (Followers: 39, SJR: 0.194, CiteScore: 0)
Alternative Law J.     Hybrid Journal   (Followers: 12, SJR: 0.176, CiteScore: 0)
Alternatives : Global, Local, Political     Hybrid Journal   (Followers: 12, SJR: 0.351, CiteScore: 1)
Alternatives to Laboratory Animals     Full-text available via subscription   (Followers: 11, SJR: 0.297, CiteScore: 1)
American Behavioral Scientist     Hybrid Journal   (Followers: 26, SJR: 0.982, CiteScore: 2)
American Economist     Hybrid Journal   (Followers: 7)
American Educational Research J.     Hybrid Journal   (Followers: 260, SJR: 2.913, CiteScore: 3)
American J. of Alzheimer's Disease and Other Dementias     Hybrid Journal   (Followers: 23, SJR: 0.67, CiteScore: 2)
American J. of Cosmetic Surgery     Hybrid Journal   (Followers: 9)
American J. of Evaluation     Hybrid Journal   (Followers: 18, SJR: 0.646, CiteScore: 2)
American J. of Health Promotion     Hybrid Journal   (Followers: 35, SJR: 0.807, CiteScore: 1)
American J. of Hospice and Palliative Medicine     Hybrid Journal   (Followers: 47, SJR: 0.65, CiteScore: 1)
American J. of Law & Medicine     Full-text available via subscription   (Followers: 12, SJR: 0.204, CiteScore: 1)
American J. of Lifestyle Medicine     Hybrid Journal   (Followers: 7, SJR: 0.431, CiteScore: 1)
American J. of Medical Quality     Hybrid Journal   (Followers: 13, SJR: 0.777, CiteScore: 1)
American J. of Men's Health     Open Access   (Followers: 9, SJR: 0.595, CiteScore: 2)
American J. of Rhinology and Allergy     Hybrid Journal   (Followers: 11, SJR: 0.972, CiteScore: 2)
American J. of Sports Medicine     Hybrid Journal   (Followers: 249, SJR: 3.949, CiteScore: 6)
American Politics Research     Hybrid Journal   (Followers: 36, SJR: 1.313, CiteScore: 1)
American Review of Public Administration     Hybrid Journal   (Followers: 28, SJR: 2.062, CiteScore: 2)
American Sociological Review     Hybrid Journal   (Followers: 358, SJR: 6.333, CiteScore: 6)
American String Teacher     Full-text available via subscription   (Followers: 3)
Analytical Chemistry Insights     Open Access   (Followers: 26, SJR: 0.224, CiteScore: 1)
Angiology     Hybrid Journal   (Followers: 5, SJR: 0.849, CiteScore: 2)
Animation     Hybrid Journal   (Followers: 15, SJR: 0.197, CiteScore: 0)
Annals of Clinical Biochemistry     Hybrid Journal   (Followers: 10, SJR: 0.634, CiteScore: 1)
Annals of Otology, Rhinology & Laryngology     Hybrid Journal   (Followers: 20, SJR: 0.807, CiteScore: 1)
Annals of Pharmacotherapy     Hybrid Journal   (Followers: 59, SJR: 1.096, CiteScore: 2)
Annals of the American Academy of Political and Social Science     Hybrid Journal   (Followers: 51, SJR: 1.225, CiteScore: 3)
Annals of the ICRP     Hybrid Journal   (Followers: 4, SJR: 0.548, CiteScore: 1)
Anthropocene Review     Hybrid Journal   (Followers: 8, SJR: 3.341, CiteScore: 7)
Anthropological Theory     Hybrid Journal   (Followers: 48, SJR: 0.739, CiteScore: 1)
Antitrust Bulletin     Hybrid Journal   (Followers: 14)
Antiviral Chemistry and Chemotherapy     Open Access   (Followers: 2, SJR: 0.635, CiteScore: 2)
Antyajaa : Indian J. of Women and Social Change     Hybrid Journal   (Followers: 1)
Applied Biosafety     Hybrid Journal   (Followers: 1, SJR: 0.131, CiteScore: 0)
Applied Psychological Measurement     Hybrid Journal   (Followers: 21, SJR: 1.17, CiteScore: 1)
Applied Spectroscopy     Full-text available via subscription   (Followers: 27, SJR: 0.489, CiteScore: 2)
Armed Forces & Society     Hybrid Journal   (Followers: 25, SJR: 0.29, CiteScore: 1)
Arthaniti : J. of Economic Theory and Practice     Full-text available via subscription  
Arts and Humanities in Higher Education     Hybrid Journal   (Followers: 49, SJR: 0.305, CiteScore: 1)
Asia Pacific Media Educator     Hybrid Journal   (Followers: 1, SJR: 0.23, CiteScore: 0)
Asia-Pacific J. of Management Research and Innovation     Full-text available via subscription   (Followers: 3)
Asia-Pacific J. of Public Health     Hybrid Journal   (Followers: 15, SJR: 0.558, CiteScore: 1)
Asia-Pacific J. of Rural Development     Hybrid Journal   (Followers: 2)
Asian and Pacific Migration J.     Full-text available via subscription   (Followers: 8, SJR: 0.324, CiteScore: 1)
Asian Cardiovascular and Thoracic Annals     Hybrid Journal   (Followers: 2, SJR: 0.305, CiteScore: 0)
Asian J. of Comparative Politics     Hybrid Journal   (Followers: 5)
Asian J. of Legal Education     Full-text available via subscription   (Followers: 4)
Asian J. of Management Cases     Hybrid Journal   (Followers: 6, SJR: 0.101, CiteScore: 0)
ASN Neuro     Open Access   (Followers: 2, SJR: 1.534, CiteScore: 3)
Assessment     Hybrid Journal   (Followers: 19, SJR: 1.519, CiteScore: 3)
Assessment for Effective Intervention     Hybrid Journal   (Followers: 15, SJR: 0.578, CiteScore: 1)
Australasian J. of Early Childhood     Hybrid Journal   (Followers: 7, SJR: 0.535, CiteScore: 1)
Australasian Psychiatry     Hybrid Journal   (Followers: 18, SJR: 0.433, CiteScore: 1)
Australian & New Zealand J. of Psychiatry     Hybrid Journal   (Followers: 30, SJR: 1.801, CiteScore: 2)
Australian and New Zealand J. of Criminology     Hybrid Journal   (Followers: 547, SJR: 0.612, CiteScore: 1)
Australian J. of Career Development     Hybrid Journal   (Followers: 5)
Australian J. of Education     Hybrid Journal   (Followers: 51, SJR: 0.403, CiteScore: 1)
Australian J. of Management     Hybrid Journal   (Followers: 13, SJR: 0.497, CiteScore: 1)
Autism     Hybrid Journal   (Followers: 358, SJR: 1.739, CiteScore: 4)
Autism & Developmental Language Impairments     Open Access   (Followers: 17)
Avian Biology Research     Hybrid Journal   (Followers: 6, SJR: 0.401, CiteScore: 1)
Behavior Modification     Hybrid Journal   (Followers: 14, SJR: 0.877, CiteScore: 2)
Behavioral and Cognitive Neuroscience Reviews     Hybrid Journal   (Followers: 27)
Behavioral Disorders     Hybrid Journal   (Followers: 2)
Beyond Behavior     Hybrid Journal   (Followers: 2)
Bible Translator     Hybrid Journal   (Followers: 13)
Biblical Theology Bulletin     Hybrid Journal   (Followers: 24, SJR: 0.184, CiteScore: 0)
Big Data & Society     Open Access   (Followers: 55)
Biochemistry Insights     Open Access   (Followers: 7)
Bioinformatics and Biology Insights     Open Access   (Followers: 12, SJR: 1.141, CiteScore: 2)
Biological Research for Nursing     Hybrid Journal   (Followers: 7, SJR: 0.685, CiteScore: 2)
Biomarker Insights     Open Access   (Followers: 1, SJR: 0.81, CiteScore: 2)
Biomarkers in Cancer     Open Access   (Followers: 11)
Biomedical Engineering and Computational Biology     Open Access   (Followers: 14)
Biomedical Informatics Insights     Open Access   (Followers: 8)
Bioscope: South Asian Screen Studies     Hybrid Journal   (Followers: 4, SJR: 0.235, CiteScore: 0)
BMS: Bulletin of Sociological Methodology/Bulletin de Méthodologie Sociologique     Hybrid Journal   (Followers: 4, SJR: 0.226, CiteScore: 0)
Body & Society     Hybrid Journal   (Followers: 29, SJR: 1.531, CiteScore: 3)
Bone and Tissue Regeneration Insights     Open Access   (Followers: 2)
Brain and Neuroscience Advances     Open Access  
Brain Science Advances     Open Access  
Breast Cancer : Basic and Clinical Research     Open Access   (Followers: 12, SJR: 0.823, CiteScore: 2)
British J. of Music Therapy     Hybrid Journal   (Followers: 9)
British J. of Occupational Therapy     Hybrid Journal   (Followers: 253, SJR: 0.323, CiteScore: 1)
British J. of Pain     Hybrid Journal   (Followers: 31, SJR: 0.579, CiteScore: 2)
British J. of Politics and Intl. Relations     Hybrid Journal   (Followers: 39, SJR: 0.91, CiteScore: 2)
British J. of Visual Impairment     Hybrid Journal   (Followers: 14, SJR: 0.337, CiteScore: 1)
British J.ism Review     Hybrid Journal   (Followers: 18)
BRQ Business Review Quarterly     Open Access   (Followers: 1)
Building Acoustics     Hybrid Journal   (Followers: 4, SJR: 0.215, CiteScore: 1)
Building Services Engineering Research & Technology     Hybrid Journal   (Followers: 3, SJR: 0.583, CiteScore: 1)
Bulletin of Science, Technology & Society     Hybrid Journal   (Followers: 9)
Business & Society     Hybrid Journal   (Followers: 15)
Business and Professional Communication Quarterly     Hybrid Journal   (Followers: 9, SJR: 0.348, CiteScore: 1)
Business Information Review     Hybrid Journal   (Followers: 17, SJR: 0.279, CiteScore: 0)
Business Perspectives and Research     Hybrid Journal   (Followers: 3)
Cahiers Élisabéthains     Hybrid Journal   (Followers: 1, SJR: 0.111, CiteScore: 0)
Calcutta Statistical Association Bulletin     Hybrid Journal   (Followers: 1)
California Management Review     Hybrid Journal   (Followers: 37, SJR: 2.209, CiteScore: 4)
Canadian Association of Radiologists J.     Full-text available via subscription   (Followers: 2, SJR: 0.463, CiteScore: 1)
Canadian J. of Kidney Health and Disease     Open Access   (Followers: 8, SJR: 1.007, CiteScore: 2)
Canadian J. of Nursing Research (CJNR)     Hybrid Journal   (Followers: 15)
Canadian J. of Occupational Therapy     Hybrid Journal   (Followers: 168, SJR: 0.626, CiteScore: 1)
Canadian J. of Psychiatry     Hybrid Journal   (Followers: 28, SJR: 1.769, CiteScore: 3)
Canadian J. of School Psychology     Hybrid Journal   (Followers: 12, SJR: 0.266, CiteScore: 1)
Canadian Pharmacists J. / Revue des Pharmaciens du Canada     Hybrid Journal   (Followers: 3, SJR: 0.536, CiteScore: 1)
Cancer Control     Open Access   (Followers: 2)
Cancer Growth and Metastasis     Open Access   (Followers: 1)
Cancer Informatics     Open Access   (Followers: 4, SJR: 0.64, CiteScore: 1)
Capital and Class     Hybrid Journal   (Followers: 10, SJR: 0.282, CiteScore: 1)
Cardiac Cath Lab Director     Full-text available via subscription   (Followers: 1)
Cardiovascular and Thoracic Open     Open Access   (Followers: 1)
Career Development and Transition for Exceptional Individuals     Hybrid Journal   (Followers: 10, SJR: 0.44, CiteScore: 1)
Cartilage     Hybrid Journal   (Followers: 6, SJR: 0.889, CiteScore: 3)
Cell Transplantation     Open Access   (Followers: 5, SJR: 1.023, CiteScore: 3)
Cephalalgia     Hybrid Journal   (Followers: 8, SJR: 1.581, CiteScore: 3)
Cephalalgia Reports     Open Access   (Followers: 4)
Child Language Teaching and Therapy     Hybrid Journal   (Followers: 34, SJR: 0.501, CiteScore: 1)
Child Maltreatment     Hybrid Journal   (Followers: 11, SJR: 1.22, CiteScore: 3)
Child Neurology Open     Open Access   (Followers: 6)
Childhood     Hybrid Journal   (Followers: 19, SJR: 0.894, CiteScore: 2)
Childhood Obesity and Nutrition     Open Access   (Followers: 12)
China Information     Hybrid Journal   (Followers: 9, SJR: 0.767, CiteScore: 2)
China Report     Hybrid Journal   (Followers: 11, SJR: 0.221, CiteScore: 0)
Chinese J. of Sociology     Full-text available via subscription   (Followers: 5)
Christian Education J. : Research on Educational Ministry     Hybrid Journal   (Followers: 1)
Chronic Illness     Hybrid Journal   (Followers: 6, SJR: 0.672, CiteScore: 2)
Chronic Respiratory Disease     Hybrid Journal   (Followers: 12, SJR: 0.808, CiteScore: 2)
Chronic Stress     Open Access  
Citizenship, Social and Economics Education     Full-text available via subscription   (Followers: 6, SJR: 0.145, CiteScore: 0)
Cleft Palate-Craniofacial J.     Hybrid Journal   (Followers: 8, SJR: 0.757, CiteScore: 1)
Clin-Alert     Hybrid Journal   (Followers: 1)
Clinical and Applied Thrombosis/Hemostasis     Open Access   (Followers: 32, SJR: 0.49, CiteScore: 1)
Clinical and Translational Neuroscience     Open Access   (Followers: 1)
Clinical Case Studies     Hybrid Journal   (Followers: 3, SJR: 0.364, CiteScore: 1)
Clinical Child Psychology and Psychiatry     Hybrid Journal   (Followers: 45, SJR: 0.73, CiteScore: 2)
Clinical EEG and Neuroscience     Hybrid Journal   (Followers: 8, SJR: 0.552, CiteScore: 2)
Clinical Ethics     Hybrid Journal   (Followers: 13, SJR: 0.296, CiteScore: 1)
Clinical Medicine Insights : Arthritis and Musculoskeletal Disorders     Open Access   (Followers: 3, SJR: 0.537, CiteScore: 2)
Clinical Medicine Insights : Blood Disorders     Open Access   (Followers: 1, SJR: 0.314, CiteScore: 2)
Clinical Medicine Insights : Cardiology     Open Access   (Followers: 8, SJR: 0.686, CiteScore: 2)
Clinical Medicine Insights : Case Reports     Open Access   (Followers: 1, SJR: 0.283, CiteScore: 1)
Clinical Medicine Insights : Circulatory, Respiratory and Pulmonary Medicine     Open Access   (Followers: 4, SJR: 0.425, CiteScore: 2)
Clinical Medicine Insights : Ear, Nose and Throat     Open Access   (Followers: 2)
Clinical Medicine Insights : Endocrinology and Diabetes     Open Access   (Followers: 34, SJR: 0.63, CiteScore: 2)
Clinical Medicine Insights : Oncology     Open Access   (Followers: 3, SJR: 1.129, CiteScore: 3)
Clinical Medicine Insights : Pediatrics     Open Access   (Followers: 3)
Clinical Medicine Insights : Psychiatry     Open Access   (Followers: 10)
Clinical Medicine Insights : Reproductive Health     Open Access   (Followers: 1, SJR: 0.776, CiteScore: 0)
Clinical Medicine Insights : Therapeutics     Open Access   (Followers: 1, SJR: 0.172, CiteScore: 0)
Clinical Medicine Insights : Trauma and Intensive Medicine     Open Access   (Followers: 4)
Clinical Medicine Insights : Urology     Open Access   (Followers: 3)
Clinical Medicine Insights : Women's Health     Open Access   (Followers: 4)
Clinical Nursing Research     Hybrid Journal   (Followers: 34, SJR: 0.471, CiteScore: 1)
Clinical Pathology     Open Access   (Followers: 5)
Clinical Pediatrics     Hybrid Journal   (Followers: 25, SJR: 0.487, CiteScore: 1)
Clinical Psychological Science     Hybrid Journal   (Followers: 16, SJR: 3.281, CiteScore: 5)
Clinical Rehabilitation     Hybrid Journal   (Followers: 78, SJR: 1.322, CiteScore: 3)
Clinical Risk     Hybrid Journal   (Followers: 5, SJR: 0.133, CiteScore: 0)
Clinical Trials     Hybrid Journal   (Followers: 22, SJR: 2.399, CiteScore: 2)
Clothing and Textiles Research J.     Hybrid Journal   (Followers: 28, SJR: 0.36, CiteScore: 1)
Collections : A J. for Museum and Archives Professionals     Full-text available via subscription   (Followers: 3)
Common Law World Review     Full-text available via subscription   (Followers: 17)
Communication & Sport     Hybrid Journal   (Followers: 8, SJR: 0.385, CiteScore: 1)
Communication and the Public     Hybrid Journal   (Followers: 2)
Communication Disorders Quarterly     Hybrid Journal   (Followers: 15, SJR: 0.458, CiteScore: 1)
Communication Research     Hybrid Journal   (Followers: 24, SJR: 2.171, CiteScore: 3)
Community College Review     Hybrid Journal   (Followers: 8, SJR: 1.451, CiteScore: 1)
Comparative Political Studies     Hybrid Journal   (Followers: 293, SJR: 3.772, CiteScore: 3)
Compensation & Benefits Review     Hybrid Journal   (Followers: 8)
Competition & Change     Hybrid Journal   (Followers: 12, SJR: 0.843, CiteScore: 2)

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Similar Journals
Journal Cover
Cephalalgia
Journal Prestige (SJR): 1.581
Citation Impact (citeScore): 3
Number of Followers: 8  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0333-1024 - ISSN (Online) 1468-2982
Published by Sage Publications Homepage  [1166 journals]
  • Guidelines of the International Headache Society for clinical trials with
           neuromodulation devices for the treatment of migraine

    • Free pre-print version: Loading...

      Authors: Cristina Tassorelli, Hans-Christoph Diener, Stephen D Silberstein, David W Dodick, Peter J Goadsby, Rigmor H Jensen, Delphine Magis, Patricia Pozo-Rosich, Hsiangkuo Yuan, Daniele Martinelli, Thomas van den Hoek, Marie Deen, Messoud Ashina, Gisela M Terwindt
      Pages: 1135 - 1151
      Abstract: Cephalalgia, Volume 41, Issue 11-12, Page 1135-1151, October 2021.
      BackgroundAlthough the European Medicines Agency and the US Food and Drug Administration have cleared several devices that use neuromodulation to provide clinical benefits in the acute or preventive treatment of migraine, the Clinical Trials Committee of the International Headache Society has not developed guidelines specifically for clinical trials of neuromodulation devices. In recognition of the distinct needs and challenges associated with their assessment in controlled trials, the Committee provides these recommendations for optimizing the design and conduct of controlled trials of neuromodulation devices for the acute and/or preventive treatment of migraine.MethodsAn international group of headache scientists and clinicians with expertise in neuromodulation evaluated clinical trials involving neuromodulation devices that have been published since 2000. The Clinical Trials Committee incorporated findings from this expert analysis into a new guideline for clinical trials of neuromodulation devices for the treatment of migraine.ResultsKey terms were defined and recommendations provided relative to the assessment of neuromodulation devices for acute treatment in adults, preventive treatment in adults, and acute and preventive treatment in children and adolescents. Ethical and administrative responsibilities were outlined, and a bibliography of previous research involving neuromodulation devices was created.ConclusionsAdoption of these recommendations will improve the quality of evidence regarding this important area in migraine treatment.
      Citation: Cephalalgia
      PubDate: 2021-05-15T02:06:21Z
      DOI: 10.1177/03331024211010413
      Issue No: Vol. 41, No. 11-12 (2021)
       
  • Efficacy of erenumab in chronic migraine patients with and without ictal
           allodynia

    • Free pre-print version: Loading...

      Authors: Richard B Lipton, Rami Burstein, Dawn C Buse, David W Dodick, Reija Koukakis, Jan Klatt, Sunfa Cheng, Denise E Chou
      Pages: 1152 - 1160
      Abstract: Cephalalgia, Volume 41, Issue 11-12, Page 1152-1160, October 2021.
      BackgroundIctal cutaneous allodynia, common in chronic migraine, is associated with reduced responses to acute treatment with triptans. Allodynia’s impact on the efficacy of newer preventive treatments such as erenumab is unknown.MethodsPost-hoc subgroup analysis of a double-blind, randomized, placebo-controlled 12-week study of erenumab in chronic migraine, contrasting those with no allodynia with those with moderate-severe allodynia assessed with the Allodynia Symptom Checklist-12, was undertaken.ResultsOf 648 randomized individuals with baseline Allodynia Symptom Checklist-12 scores, 386 (59.6%) had no allodynia and 153 (23.6%) had moderate-to-severe allodynia. Mean (standard deviation) baseline monthly migraine days were 17.6 (4.8) and 18.9 (4.3), respectively. Compared to placebo, the erenumab group had greater reductions in monthly migraine days and monthly acute migraine-specific medication days in both no allodynia and allodynia subgroups. Mean (95% confidence interval) treatment differences in change from baseline for monthly migraine days at week 12 were −2.5 (−3.7, −1.4) in the no allodynia subgroup and −3.3 (−5.3, −1.3) in the moderate-severe allodynia subgroup. Change in acute migraine-specific medication days were −3.3 (−4.3, −2.3) and −2.5 (−4.3, −0.8), respectively.ConclusionsErenumab’s efficacy in reducing monthly migraine days and acute migraine-specific medication days in chronic migraine was not impacted by the presence of moderate-severe ictal allodynia.Trial registration: ClinicalTrials.gov NCT02066415
      Citation: Cephalalgia
      PubDate: 2021-05-13T10:45:53Z
      DOI: 10.1177/03331024211010305
      Issue No: Vol. 41, No. 11-12 (2021)
       
  • Severe abrupt (thunderclap) non-traumatic headache at the pediatric
           emergency department – a retrospective study

    • Free pre-print version: Loading...

      Authors: Yoel Levinsky, Yehezkel Waisman, Tal Eidlitz-Markus
      Pages: 1172 - 1180
      Abstract: Cephalalgia, Volume 41, Issue 11-12, Page 1172-1180, October 2021.
      BackgroundAdult abrupt severe non-traumatic headache (thunderclap) is often related to serious underlying etiologies such as subarachnoid hemorrhage. However, data are sparse regarding thunderclap headache in the pediatric population.ObjectiveThe aim of the study was to evaluate the prevalence, characteristics and causes of thunderclap headache in the pediatric and adolescent population, aged 6–18 years, presenting to a pediatric emergency department.MethodsThe electronic database of a tertiary care pediatric emergency department was searched for children presenting with acute headache during 2016–2018. Headache severity was defined by pain scales, either a visual analogue scale or by the Faces Pain Scale–Revised.ResultsThunderclap headache was diagnosed in 19/2290 (0.8%) of the included patients, all of them with a pain score of 10/10. All the patients had a benign course. Primary headache was diagnosed in 15/19 (78.9%), six patients had migraine and eight were diagnosed with primary thunderclap headache. Four of the 19 patients were diagnosed with secondary headache: three with infectious causes and one with malignant hypertension.ConclusionsThunderclap headache is rare among children and adolescents presenting to the emergency department. This headache is generally of a primary origin. Extensive evaluation is still needed to rule out severe diagnosis problems.
      Citation: Cephalalgia
      PubDate: 2021-05-13T10:45:54Z
      DOI: 10.1177/03331024211014612
      Issue No: Vol. 41, No. 11-12 (2021)
       
  • Impact on monthly migraine days of discontinuing anti-CGRP antibodies
           after one year of treatment – a real-life cohort study

    • Free pre-print version: Loading...

      Authors: Andreas R Gantenbein, Reto Agosti, Claudio Gobbi, Dominique Flügel, Christoph J Schankin, Dragana Viceic, Chiara Zecca, Heiko Pohl
      Pages: 1181 - 1186
      Abstract: Cephalalgia, Volume 41, Issue 11-12, Page 1181-1186, October 2021.
      ObjectiveThis study aims to analyse the effect of the discontinuation of anti-calcitonin gene-related peptide antibodies on monthly migraine days after 12 treatment months.BackgroundAnti-calcitonin gene-related peptide antibodies have been a game changer in migraine prophylaxis. However, high treatment costs warrant reducing treatment duration to the essential minimum.MethodsWe collected data of patients with migraine who had received anti-calcitonin gene-related peptide antibodies and had received treatment for 12 months.ResultsWe included 52 patients. The average number of monthly migraine days was 16 ± 7 days at baseline, 6 ± 6 in the third, and 5 ± 4 in the 12th treatment month. After treatment interruption, the number of monthly migraine days was 6 ± 4 days in the first month, 9 ± 4 days in the second, and 11 ± 5 days in the third month. Most patients (88.9%) restarted treatment.ConclusionOnly little of the therapeutic effect of anti-calcitonin gene-related peptide antibodies outlasts their pharmacological effect. After treatment interruption, migraine frequency rose in most patients, and prophylaxis was required again in most cases.Limiting treatment to benefitting patients and confirming the need for prophylaxis periodically is reasonable. However, our data does not support the need for prescheduled treatment discontinuation after 12 months and a fixed duration of the treatment interruption of 3 months.
      Citation: Cephalalgia
      PubDate: 2021-05-18T06:24:10Z
      DOI: 10.1177/03331024211014616
      Issue No: Vol. 41, No. 11-12 (2021)
       
  • Targeting reactive nitroxidative species in preclinical models of migraine

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      Authors: Simon Akerman, Daniela Salvemini, Marcela Romero-Reyes
      Pages: 1187 - 1200
      Abstract: Cephalalgia, Volume 41, Issue 11-12, Page 1187-1200, October 2021.
      BackgroundReactive nitroxidative species, such as nitric oxide but particularly peroxynitrite, have been strongly implicated in pain mechanisms. Targeting peroxynitrite is anti-nociceptive in pain models, but little is known about its role in migraine mechanisms. Given the need to validate novel targets for migraine headache, our objective was to study the potential of reactive nitroxidative species, particularly peroxynitrite, as novel targets for drug discovery and their role in migraine mechanisms.MethodsWe recorded neuronal activity in rats with extracellular electrodes and examined the effects of targeting nitric oxide or peroxynitrite on ongoing and cranial-evoked firing rates of central trigeminocervical neurons. We injected calcitonin gene-related peptide (which produces migraine-like headache in migraineurs) and characterized neuronal responses to cranial stimulation and on behavioral responses to nociceptive periorbital stimulation and determined the effects of targeting reactive nitroxidative species on the mediated changes.ResultsL-NAME (nitric oxide synthase inhibitor) and Fe(III)5,10,15,20-tetrakis(4-sulfonatophenyl)porphyrinato chloride (FeTPPS; peroxynitrite decomposition catalyst) inhibited ongoing and dural-evoked responses of trigeminocervical neurons, without affecting normal facial-cutaneous responses. Calcitonin gene-related peptide caused activation and sensitization of dural-responsive trigeminovascular neurons with hypersensitivity to intracranial and extracranial stimulation, and reduction of periorbital withdrawal thresholds. Only the peroxynitrite decomposition catalyst prevented these neuronal and behavioral nociceptive responses.DiscussionThe data support that calcitonin gene-related peptide mediates the underlying neurobiological mechanisms related to the development of migraine-like headache. They also confirm the role of nitric oxide and implicate peroxynitrite production along the trigeminovascular migraine pathway in these mechanisms. The data also support peroxynitrite as a novel and potentially effective target for migraine treatment. The current drug development focus on peroxynitrite decomposition catalysts for chronic pain disorders should therefore extend to migraine.
      Citation: Cephalalgia
      PubDate: 2021-07-14T05:15:25Z
      DOI: 10.1177/03331024211017884
      Issue No: Vol. 41, No. 11-12 (2021)
       
  • Postprandial fasting related headache during Ramadan in Saudi Arabia: A
           cross-sectional study

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      Authors: Abdullah AlAmri, Mohammed AlMuaigel, Mona AlSheikh, Mohammad Zeeshan, Wejdan Suwayyid, Foziah AlShamrani
      Pages: 1201 - 1207
      Abstract: Cephalalgia, Volume 41, Issue 11-12, Page 1201-1207, October 2021.
      BackgroundHeadache disorders are classified as primary or secondary; however, among the secondary headaches, those attributed to food ingestion are not well understood. Therefore, we conducted this study to describe and characterize a new headache entity that occurred during the holy month of Ramadan. This headache occurred within 4 h of breaking the fast.MethodsThis is a nationwide descriptive community-based cross-sectional study conducted during the last 10 days of Ramadan, based on a random sample of adults living in Saudi Arabia. The demographic data, headache symptomatology, nature and distribution of the pain, possible triggering and relieving factors, and patient management programs were analyzed.ResultsCompleted questionnaires were obtained from 16,031 participants. Of those, 3147 (19.6%) reported headaches after breaking the fast in Ramadan. In 84.1% of cases, there was no previous diagnosis of headache or migraine. The characteristics of these postprandial fasting-related headaches mostly was episodic in nature (72%). The nature of the headache was variable, mostly heaviness or tightness (53.9%). Triggering factors included ingestion of fried food in (45%) and coffee (26.3%). Lying down and sleeping was found to be an important relieving factor (61%).ConclusionA new headache entity is being described. Appears to be quite common, occurs less than 2 h following the first meal, and is mostly of the heaviness and tension type.
      Citation: Cephalalgia
      PubDate: 2021-06-17T05:40:33Z
      DOI: 10.1177/03331024211017915
      Issue No: Vol. 41, No. 11-12 (2021)
       
  • Association and genetic overlap between clinical chemistry tests and
           migraine

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      Authors: Hamzeh M Tanha, Nicholas G Martin, John B Whitfield, Dale R Nyholt
      Pages: 1208 - 1221
      Abstract: Cephalalgia, Volume 41, Issue 11-12, Page 1208-1221, October 2021.
      IntroductionIn this paper, we studied several serum clinical chemistry tests of cardiovascular disease (CVD), iron deficiency anemia, liver and kidney disorders in migraine.MethodsWe first explored the association of 22 clinical chemistry tests with migraine risk in 697 migraine patients and 2722 controls. To validate and interpret association findings, cross-trait genetic analyses were conducted utilising genome-wide association study (GWAS) data comprising 23,986 to 452,264 individuals.ResultsSignificant associations with migraine risk were identified for biomarkers of CVD risk, iron deficiency and liver dysfunction (odds ratios = 0.86–1.21; 1 × 10−4 
      Citation: Cephalalgia
      PubDate: 2021-06-16T05:28:03Z
      DOI: 10.1177/03331024211018131
      Issue No: Vol. 41, No. 11-12 (2021)
       
  • CGRP-antibodies, topiramate and botulinum toxin type A in episodic and
           chronic migraine: A systematic review and meta-analysis

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      Authors: Florian Frank, Hanno Ulmer, Victoria Sidoroff, Gregor Broessner
      Pages: 1222 - 1239
      Abstract: Cephalalgia, Volume 41, Issue 11-12, Page 1222-1239, October 2021.
      BackgroundThe approval of monoclonal antibodies for prevention of migraine has revolutionized treatment for patients. Oral preventatives are still considered first line treatments as head-to-head trials comparing them with antibodies are lacking.MethodsThe main purpose of this study was to provide a comparative overview of the efficacy of three commonly prescribed migraine preventative medication classes. For this systematic review and meta-analysis, we searched the databases CENTRAL, EMBASE, and MEDLINE until 20 March 2020. We included RCTs reporting the 50% response rates for topiramate, Botulinum Toxin Type A and monoclonal antibodies against CGRP(r). Studies were excluded if response rates were not reported, treatment allocation was unclear, or if study quality was insufficient. Primary outcome measure were the 50% response rates. The pooled odds ratios with 95% confidence intervals were calculated with the random effects model. The study was registered at PROSPERO (CRD42020222880).FindingsWe identified 6552 reports. Thirty-two were eligible for our review. Studies assessing monoclonal antibodies included 13,302 patients and yielded pooled odds ratios for the 50% response rate of 2.30 (CI: 2.11–2.50). Topiramate had an overall effect estimate of 2.70 (CI: 1.97–3.69) with 1989 included patients and Botulinum Toxin Type A achieved 1.28 (CI: 0.98–1. 67) with 2472 patients included.InterpretationTopiramate, botulinum toxin type A and monoclonal antibodies showed higher odds ratios in achieving a 50% response rate compared to placebo. Topiramate numerically demonstrated the greatest effect size but also the highest drop-out rate.
      Citation: Cephalalgia
      PubDate: 2021-06-16T05:28:21Z
      DOI: 10.1177/03331024211018137
      Issue No: Vol. 41, No. 11-12 (2021)
       
  • Photophobia in migraine: A symptom cluster'

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      Authors: Arnold J Wilkins, Sarah M Haigh, Omar A Mahroo, Gordon T Plant
      Pages: 1240 - 1248
      Abstract: Cephalalgia, Volume 41, Issue 11-12, Page 1240-1248, October 2021.
      Photophobia is one of the most common symptoms in migraine, and the underlying mechanism is uncertain. The discovery of the intrinsically-photosensitive retinal ganglion cells which signal the intensity of light on the retina has led to discussion of their role in the pathogenesis of photophobia. In the current review, we discuss the relationship between pain and discomfort leading to light aversion (traditional photophobia) and discomfort from flicker, patterns, and colour that are also common in migraine and cannot be explained solely by the activity of intrinsically-photosensitive retinal ganglion cells. We argue that, at least in migraine, a cortical mechanism provides a parsimonious explanation for discomfort from all forms of visual stimulation, and that the traditional definition of photophobia as pain in response to light may be too restrictive. Future investigation that directly compares the retinal and cortical contributions to photophobia in migraine with that in other conditions may offer better specificity in identifying biomarkers and possible mechanisms to target for treatment.
      Citation: Cephalalgia
      PubDate: 2021-05-15T02:07:21Z
      DOI: 10.1177/03331024211014633
      Issue No: Vol. 41, No. 11-12 (2021)
       
  • Dysregulation of the peripheral glutamatergic system: A key player in
           migraine pathogenesis'

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      Authors: Tarique Benbow, Brian E Cairns
      Pages: 1249 - 1261
      Abstract: Cephalalgia, Volume 41, Issue 11-12, Page 1249-1261, October 2021.
      BackgroundAlthough the role of glutamate in migraine pathogenesis remains uncertain, there has been significant interest in the development of drug candidates that target glutamate receptors. Activation of trigeminovascular afferent fibers is now recognized as a crucial step to the onset of a migraine episode. New evidence suggests a dysfunction in peripheral glutamate regulation may play a role in this process.ObjectiveTo provide a narrative review of the role of peripheral glutamate dysfunction in migraine.MethodA review of recent literature from neurobiological, pharmacological and genomic studies was conducted to support peripheral glutamate dysfunction as a potential element in migraine pathogenesis.ResultsStudies in rats suggest that elevated blood glutamate mechanically sensitizes trigeminal afferent fibers and stimulates the release of calcitonin-gene related peptide and other neuropeptides to promote and maintain neurogenic inflammation. These effects may be driven by upregulation of glutamate receptors, and modifications to reuptake and metabolic pathways of glutamate. Furthermore, genome wide association studies have found polymorphisms in glutamate receptor and transporter genes that are associated with migraine.ConclusionThe role of peripheral glutamate signalling in the onset and maintenance of migraine is not completely elucidated and future studies are still needed to confirm its role in migraine pathogenesis.
      Citation: Cephalalgia
      PubDate: 2021-06-20T03:46:39Z
      DOI: 10.1177/03331024211017882
      Issue No: Vol. 41, No. 11-12 (2021)
       
  • CGRP release in an experimental human trigeminal pain model

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      Authors: Achim Frese, Oliver Summ, Stefan Evers
      Pages: 1268 - 1271
      Abstract: Cephalalgia, Volume 41, Issue 11-12, Page 1268-1271, October 2021.
      BackgroundMigraine and trigemino-autonomic cephalalgia attacks are associated with an increase of α-calcitonin-gene related peptide levels in the ipsilateral jugular vein. It is however unknown whether trigeminal pain stimulation in healthy subjects without headache disorders also induces increase of calcitonin-gene related peptide levels.FindingsWe measured α-calcitonin-gene related peptide levels in eight healthy subjects after subcutaneous injection of capsaicin in the forehead and in the mandibular region and after injection of sodium chloride in the forehead. We observed a significant increase of α-calcitonin-gene related peptide level only after injection of capsaicin in the forehead (i.e. first trigeminal branch). We also observed trigemino-autonomic activation (lacrimation, rhinorrhea etc.) only after injection of capsaicin in the forehead.ConclusionIncrease of α-calcitonin-gene related peptide levels do not only occur in primary headache attacks but also after experimental trigeminal pain of the first branch. This finding suggests that α-calcitonin-gene related peptide elevation is, at least an additional, unspecific effect of first trigeminal branch stimulation following pain activation and not a specific mechanism of idiopathic headache disorders.
      Citation: Cephalalgia
      PubDate: 2021-06-20T03:46:48Z
      DOI: 10.1177/03331024211017250
      Issue No: Vol. 41, No. 11-12 (2021)
       
  • Restless legs-like syndrome as an emergent adverse event of CGRP
           monoclonal antibodies: A report of two cases

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      Authors: Vicente González-Quintanilla, Sara Pérez-Pereda, Andrea González-Suárez, Jorge Madera, María Toriello, Julio Pascual
      Pages: 1272 - 1275
      Abstract: Cephalalgia, Volume 41, Issue 11-12, Page 1272-1275, October 2021.
      AbstractBackgroundOne of the advantages of CGRP monoclonal antibodies is their excellent safety and tolerability. However, postmarketing surveillance, is essential to detect potential rare emergent adverse events.ObjectivesTo report two patients who developed restless legs syndrome symptoms after treatment with CGRP antibodies.Methods and resultsTwo women with chronic refractory migraine, with no significant medical antecedents, developed typical restless legs syndrome symptoms 1.5 and 4 months after starting erenumab 140 mg, respectively. In case 1 symptoms resolved when erenumab was stopped for two months but reappeared on galcanezumab. In both patients migraine attacks had dramatically decreased and no iron deficiency was found.ConclusionsEven though caution is needed before establishing a causal relationship, these cases suggest that restless legs-like symptoms might be an emergent adverse event of CGRP antibodies, regardless of the mechanism of action. We propose that plastic changes in CGRP sensory fibers, which are very abundant in legs, induced by CGRP monoclonal antibodies could be the reason for restless legs syndrome development.
      Citation: Cephalalgia
      PubDate: 2021-06-04T07:09:29Z
      DOI: 10.1177/03331024211017879
      Issue No: Vol. 41, No. 11-12 (2021)
       
  • Critique of the analysis of the time course for the antimigraine effect of
           ubrogepant 50 mg. Clinical relevance versus statistical significance

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      Authors: Peer Tfelt-Hansen, Anika Hüsing, Hans-Christoph Diener
      Pages: 1276 - 1278
      Abstract: Cephalalgia, Volume 41, Issue 11-12, Page 1276-1278, October 2021.

      Citation: Cephalalgia
      PubDate: 2021-05-13T10:45:51Z
      DOI: 10.1177/03331024211014625
      Issue No: Vol. 41, No. 11-12 (2021)
       
  • Board Walk – October 2021

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      Authors: Cristina Tassorelli
      Pages: 1279 - 1280
      Abstract: Cephalalgia, Volume 41, Issue 11-12, Page 1279-1280, October 2021.

      Citation: Cephalalgia
      PubDate: 2021-10-07T09:17:21Z
      DOI: 10.1177/03331024211042713
      Issue No: Vol. 41, No. 11-12 (2021)
       
  • Polygenic risk provides biological validity for the ICHD-3 criteria among
           Finnish migraine families

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      Authors: Paavo Häppölä, Padhraig Gormley, Marjo E Nuottamo, Ville Artto, Marja-Liisa Sumelahti, Markku Nissilä, Petra Keski-Säntti, Matti Ilmavirta, Mari A Kaunisto, Eija I Hämäläinen, Samuli Ripatti, Matti Pirinen, Maija Wessman, Aarno Palotie, Mikko Kallela
      Abstract: Cephalalgia, Ahead of Print.
      BackgroundMigraine is diagnosed using the extensively field-tested International Classification of Headache Disorders (ICHD-3) consensus criteria derived by the International Headache Society. To evaluate the criteria in respect to a measurable biomarker, we studied the relationship between the main ICHD-3 criteria and the polygenic risk score, a measure of common variant burden in migraine.MethodsWe used linear mixed models to study the correlation of ICHD-3 diagnostic criteria, underlying symptoms, and main diagnoses with the polygenic risk score of migraine in a cohort of 8602 individuals from the Finnish Migraine Genome Project.ResultsMain diagnostic categories and all underlying diagnostic criteria formed a consistent continuum along the increasing polygenic burden. Polygenic risk was associated with the heterogeneous clinical picture starting from the non-migraine headache (mean 0.07; 95% CI 0.02–0.12; p = 0.008 compared to the non-headache group), to probable migraine (mean 0.13; 95% CI 0.08–0.18; p 
      Citation: Cephalalgia
      PubDate: 2021-10-14T04:46:00Z
      DOI: 10.1177/03331024211045651
       
  • Evaluation of serum neuron specific enolase levels among patients with
           primary and secondary burning mouth syndrome

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      Authors: Jaimala Kishore, Fouzia Shaikh, Adnan Mustafa Zubairi, Sana Mirza, Montaser N Alqutub, Abdulrahman M AlMubarak, Tariq Abduljabbar, Fahim Vohra
      Abstract: Cephalalgia, Ahead of Print.
      IntroductionBurning mouth syndrome is a painful condition of the oral cavity with ambiguous pathogenesis and diagnosis. Neuron-specific enolase is increased in several conditions including peripheral neuropathy of diabetes, ophthalmopathies, spinal cord injuries and tumors. Evidence on association of burning mouth syndrome and neuron-specific enolase is limited.AimThis study aims to evaluate neuron-specific enolase levels in primary and secondary burning mouth syndrome patients and compare the levels of neuron-specific enolase with associated conditions in secondary burning mouth syndrome.MethodsOne hundred and twenty-eight patients of more than 18 years of age with no gender predilection and having clinical symptoms of burning mouth syndrome and 135 healthy subjects were included. All the patients fulfilled Scala’s criteria for the diagnosis of burning mouth syndrome, including “primary” (idiopathic) and “secondary” (resulting from identified precipitating factors) burning mouth syndrome patients. Blood samples were obtained from burning mouth syndrome patients. Serum neuron-specific enolase was evaluated using enzyme-linked immunosorbent assay. To compare means and standard deviations, among primary and secondary burning mouth syndrome, data was analysed with analysis of variance and multiple comparisons test.ResultsThe mean age of the study participants for burning mouth syndrome and healthy subjects was 53.30 and 51.6 years, respectively. Amongst the secondary burning mouth syndrome group, 32 (25%) of the patients had menopause, 15 (11.7%) had diabetes, eight (6.2%) of the patients had nutritional deficiency, seven (5.4%) had combined diabetes, menopause, and depression, six (4.6%) had combined diabetes and depression, four (3.1%) were diagnosed with Sjögren’s syndrome. A minor percentage of 2.3% (three) had gastroesophageal reflux disease, while the remaining three (2.3%) patients in the secondary burning mouth syndrome group were on anti-depressants. There was a statistically significant increase in the levels of neuron-specific enolase in primary burning mouth syndrome as compared to the secondary burning mouth syndrome and healthy groups. Among the subgroups of secondary burning mouth syndrome, diabetic individuals showed a significant increase in neuron-specific enolase level when compared with other conditions in the secondary burning mouth syndrome patients.Discussion and conclusion: The raised serum neuron-specific enolase levels in patients suffering from primary burning mouth syndrome highlight a possible neuropathic mechanism. It was also increased in the sub-group of secondary burning mouth syndrome patients having diabetes. Although it cannot be ascertained whether the deranged values in the diabetic group were due to burning mouth syndrome or due to diabetes, the raised quantity of neuron-specific enolase in the primary burning mouth syndrome group is a reliable diagnostic indicator. Future studies on the assessment of neuron-specific enolase levels as a diagnostic tool for onset and management of primary and secondary burning mouth syndrome are recommended.
      Citation: Cephalalgia
      PubDate: 2021-10-13T05:27:55Z
      DOI: 10.1177/03331024211046613
       
  • Clinical correlates of hypothalamic functional changes in migraine
           patients

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      Authors: Roberta Messina, Maria A Rocca, Paola Valsasina, Paolo Misci, Massimo Filippi
      Abstract: Cephalalgia, Ahead of Print.
      ObjectiveTo elucidate the hypothalamic involvement in episodic migraine and investigate the association between hypothalamic resting state functional connectivity changes and migraine patients’ clinical characteristics and disease progression over the years.MethodsNinety-one patients with episodic migraine and 73 controls underwent interictal resting state functional magnetic resonance imaging. Twenty-three patients and controls were re-examined after a median of 4.5 years. Hypothalamic resting state functional connectivity changes were investigated using a seed-based correlation approach.ResultsAt baseline, a decreased functional interaction between the hypothalamus and the parahippocampus, cerebellum, temporal, lingual and orbitofrontal gyrus was found in migraine patients versus controls. Increased resting state functional connectivity between the hypothalamus and bilateral orbitofrontal gyrus was demonstrated in migraine patients at follow-up versus baseline. Migraine patients also experienced decreased right hypothalamic resting state functional connectivity with ipsilateral lingual gyrus. A higher migraine attack frequency was associated with decreased hypothalamic-lingual gyrus resting state functional connectivity at baseline, while greater headache impact at follow-up correlated with decreased hypothalamic-orbitofrontal gyrus resting state functional connectivity at baseline. At follow-up, a lower frequency of migraine attacks was associated with higher hypothalamic-orbitofrontal gyrus resting state functional connectivity.ConclusionsDuring the interictal phase, the hypothalamus modulates the activity of pain and visual processing areas in episodic migraine patients. The hypothalamic-cortical interplay changes dynamically over time according to patients’ clinical features.
      Citation: Cephalalgia
      PubDate: 2021-10-13T05:26:54Z
      DOI: 10.1177/03331024211046618
       
  • Effect of antibody switch in non-responders to a CGRP receptor antibody
           treatment in migraine: A multi-center retrospective cohort study

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      Authors: Lucas Hendrik Overeem, Andreas Peikert, Maxi Dana Hofacker, Katharina Kamm, Ruth Ruscheweyh, Astrid Gendolla, Bianca Raffaelli, Uwe Reuter, Lars Neeb
      Abstract: Cephalalgia, Ahead of Print.
      BackgroundSwitching between antibody classes might be a treatment option in migraine patients who have not responded to one class of a CGRP-(receptor) monoclonal antibody (mAb), but there are no efficacy data so far. In this real-world analysis, we assessed the treatment response to a CGRP-mAb in patients that have previously failed the CGRP-receptor-mAb erenumab.MethodsWe analyzed retrospective headache diary data of 78 patients with migraine who switched between CGRP-mAbs classes at four German headache centers either due to lack of efficacy or intolerable side effects. Among these, we identified 25 patients who did not respond to erenumab after three treatment cycles (defined as
      Citation: Cephalalgia
      PubDate: 2021-10-13T05:26:45Z
      DOI: 10.1177/03331024211048765
       
  • T2* reduction in patients with acute post-traumatic headache

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      Authors: Simona Nikolova, Todd J Schwedt, Jing Li, Teresa Wu, Gina M Dumkrieger, Katherine B Ross, Visar Berisha, Catherine D. Chong
      Abstract: Cephalalgia, Ahead of Print.
      ObjectivesAlthough iron accumulation in pain-processing brain regions has been associated with repeated migraine attacks, brain structural changes associated with post-traumatic headache have yet to be elucidated. To determine whether iron accumulation is associated with acute post-traumatic headache, magnetic resonance transverse relaxation rates (T2*) associated with iron accumulation were investigated between individuals with acute post-traumatic headache attributed to mild traumatic brain injury and healthy controls.MethodsTwenty individuals with acute post-traumatic headache and 20 age-matched healthy controls underwent 3T brain magnetic resonance imaging including quantitative T2* maps. T2* differences between individuals with post-traumatic headache versus healthy controls were compared using age-matched paired t-tests. Associations of T2* values with headache frequency and number of mild traumatic brain injuries were investigated using multiple linear regression in individuals with post-traumatic headache. Significance was determined using uncorrected p-value and cluster size threshold.ResultsIndividuals with post-traumatic headache had lower T2* values compared to healthy controls in cortical (bilateral frontal, bilateral anterior and posterior cingulate, right postcentral, bilateral temporal, right supramarginal, right rolandic, left insula, left occipital, right parahippocampal), subcortical (left putamen, bilateral hippocampal) and brainstem regions (pons). Within post-traumatic headache subjects, multiple linear regression showed a negative association between T2* in the right inferior parietal/supramarginal regions and number of mild traumatic brain injuries and a negative association between T2* in bilateral cingulate, bilateral precuneus, bilateral supplementary motor areas, bilateral insula, right middle temporal and right lingual areas and headache frequency.ConclusionsAcute post-traumatic headache is associated with iron accumulation in multiple brain regions. Correlations with headache frequency and number of lifetime mild traumatic brain injuries suggest that iron accumulation is part of the pathophysiology or a marker of mild traumatic brain injury and post-traumatic headache.
      Citation: Cephalalgia
      PubDate: 2021-10-13T05:26:36Z
      DOI: 10.1177/03331024211048509
       
  • Lasmiditan efficacy in the acute treatment of migraine was independent of
           prior response to triptans: Findings from the CENTURION study

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      Authors: Uwe Reuter, John H Krege, Louise Lombard, Elisa Gomez Valderas, Judith Krikke-Workel, Grazia Dell-Agnello, Sherie A Dowsett, Dawn C Buse
      Abstract: Cephalalgia, Ahead of Print.
      BackgroundA significant proportion of triptan users exhibit an insufficient response or inadequate tolerability to a triptan, and some may develop a contraindication. Lasmiditan, a selective 5-HT1F receptor agonist, may be an option for these individuals. We assessed lasmiditan efficacy in a subgroup of patients in CENTURION (Phase 3 migraine consistency study) who exhibited an insufficient response to triptans, including a subgroup with insufficient response due to efficacy only.MethodsPatients were randomized to lasmiditan 200 mg for four attacks, lasmiditan 100 mg for four attacks, or placebo for three and lasmiditan 50 mg for one attack. Triptan insufficient responders were pre-defined as patients with insufficient efficacy or tolerability, or who developed a contraindication.ResultsIn triptan insufficient responders, lasmiditan was superior to placebo (p 
      Citation: Cephalalgia
      PubDate: 2021-10-13T05:26:35Z
      DOI: 10.1177/03331024211048507
       
  • The gut microbiome modulates nitroglycerin-induced migraine-related
           hyperalgesia in mice

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      Authors: Li Kang, Wenjing Tang, Yaofen Zhang, Mingjie Zhang, Jing Liu, Yingji Li, Shanshan Kong, Dengfa Zhao, Shengyuan Yu
      Abstract: Cephalalgia, Ahead of Print.
      BackgroundGut microbiota disturbance is increasingly suggested to be involved in the pathogenesis of migraine but this connection remains unsubstantiated. This study aimed to investigate whether the gut microbiome influences migraine-related hyperalgesia.MethodsNitroglycerin-induced hyperalgesia was evaluated in mice with different gut microbiota statuses as follows: Specific pathogen-free mice; germ-free mice; specific pathogen-free mice treated with antibiotics to deplete the gut microbiome (ABX mice); and germ-free mice transplanted with the gut microbial profile from specific pathogen-free mice (GFC mice). Moreover, nitroglycerin-induced hyperalgesia was compared between recipient mice transplanted with gut microbiota from a patient with migraine and those that received gut microbiota from a sex- and age-matched healthy control.ResultsIn specific pathogen-free mice, a decreased mechanical threshold in the hind paw, increased grooming time, increased c-Fos expression level and decreased calcitonin gene-related peptide expression level as well as increased tumor necrosis factor-α concentration in the trigeminal nucleus caudalis were observed after nitroglycerin administration compared with saline treatment. However, increased basal sensitivity and higher basal concentrations of TNF-α in the trigeminal nucleus caudalis were observed in germ-free and ABX mice, while no significant difference in hyperalgesia was observed between the nitroglycerin group and saline group in germ-free and ABX mice. Moreover, significant hyperalgesia was induced by nitroglycerin administration in GFC mice. The mice transplanted with the gut microbial profile from a patient with migraine had more severe nitroglycerin-induced hyperalgesia than the mice receiving microbiota from a matched healthy control.ConclusionOur findings highlight the involvement of the gut microbiome in normal mechanical pain sensation and pathogenesis of migraine.
      Citation: Cephalalgia
      PubDate: 2021-10-13T05:26:18Z
      DOI: 10.1177/03331024211050036
       
  • No structural brain alterations in new daily persistent headache – a
           cross sectional VBM/SBM study

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      Authors: Steffen Naegel, Julia Zeller, Anders Hougard, Christopher Michael Weise, Stefan Zuelow, Christoph Kleinschnitz, Mark Obermann, Kasja Solbach, Dagny Holle
      Abstract: Cephalalgia, Ahead of Print.
      ObjectiveTo identify grey matter alterations in patients suffering new daily persistent headache to enrich the pathophysiological concept of this rare headache disorder characterised by a distinct, clearly remembered onset and its instant chronification.MethodMagnetic resonance-based voxel-based and surface-based morphometry was used to investigate 23 patients suffering from new daily persistent headache and 23 age- and gender-matched healthy controls with 1.5 Tesla MRI.Independent statistical analysis was performed at three sites using statistical parametric mapping, as well as FSL(FMRIB Software Library)-based approaches. ResultsNo grey matter changes were detected using this sophisticated and cross-checked method.ConclusionThe absence of structural brain changes in patients with new daily persistent headache contribute to the recent discussion regarding structural alterations in primary headache disorders in general and does not provide evidence for grey matter changes being associated with the pathophysiology of new daily persistent headache. Future research will have to determine the underlying pathophysiological mechanisms of this disorder.
      Citation: Cephalalgia
      PubDate: 2021-10-04T07:28:21Z
      DOI: 10.1177/03331024211045653
       
  • Salivary CGRP can monitor the different migraine phases: CGRP
           (in)dependent attacks

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      Authors: Alicia Alpuente, Victor J Gallardo, Laila Asskour, Edoardo Caronna, Marta Torres-Ferrus, Patricia Pozo-Rosich
      Abstract: Cephalalgia, Ahead of Print.
      BackgroundCGRP plays a key role in the transmission and modulation of nociceptive signals and is a critical component in the pathogenesis of migraine.ObjectiveTo assess saliva as a substrate to measure CGRP by comparing interictal levels in patients with episodic migraine and controls; and to evaluate CGRP’s temporal profile during migraine attacks.MethodsThis prospective observational pilot study included young women with episodic migraine and healthy controls. We monitored salivary CGRP-like immunoreactivity (CGRP-LI) during 30 consecutive days and during migraine attacks. We considered six timepoints for the analysis: interictal (72h headache free), preictal (PRE-24h before the attack), ictal (headache onset, after 2h, after 8h), postictal (POST-24h after the attack). CGRP levels were quantified by ELISA.Results44 women (22 with episodic migraine, 22 healthy controls) were recruited. Differences in interictal salivary levels of CGRP between patients and controls (Me [IQR]: 98.0 [80.3] (95% CI 56.6, 124.0) vs. 54.3 [44.0] (95% CI 42.2, 70.1) pg/mL, p = 0.034) were found. An increase in CGRP levels during migraine attacks was detected (pre:169.0 [95% CI 104.2–234.0]; headache onset: 247.0 [181.9–312.0]; after 2h: 143.0 [77.6–208.0]; after 8h: 169.0 [103.5–234.0], post: 173.0 [107.8–238.0]). Patients were classified as having CGRP-dependent (79.6%) and non-CGRP dependent migraine attacks (20.4%) according to the magnitude of change between preictal and ictal phase. Accompanying symptoms such as photophobia and phonophobia were significantly associated to the first group.ConclusionsSalivary CGRP-LI levels, which interictally are elevated in episodic migraine patients, usually increase during a migraine attack in the majority of patients. However, not every attack is CGRP-dependent, which in turn, might explain different underlying pathophysiology and response to treatment.
      Citation: Cephalalgia
      PubDate: 2021-10-04T07:28:19Z
      DOI: 10.1177/03331024211040467
       
  • The chicken and egg problem: CGRP release due to trigeminal activation or
           vice versa'

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      Authors: Karl Messlinger
      Abstract: Cephalalgia, Ahead of Print.

      Citation: Cephalalgia
      PubDate: 2021-10-04T07:28:18Z
      DOI: 10.1177/03331024211042360
       
  • Migraine evolution after the cessation of CGRP(-receptor) antibody
           prophylaxis: a prospective, longitudinal cohort study

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      Authors: Bianca Raffaelli, Maria Terhart, Lucas Hendrik Overeem, Jasper Mecklenburg, Lars Neeb, Maureen Steinicke, Uwe Reuter
      Abstract: Cephalalgia, Ahead of Print.
      BackgroundNational and international guidelines recommend stopping migraine prophylaxis with CGRP(-receptor) monoclonal antibodies after 6–12 months of successful therapy. In this study, we aimed to analyze the course of migraine for four months after the cessation of CGRP(-receptor) antibodies use.MethodsThis longitudinal cohort study included patients with migraine who received a CGRP-(receptor) antibody for ≥8 months before treatment cessation. We analyzed headache data in the four-week period prior to mAb treatment initiation (baseline), in the month before the last mAb injection, in weeks 5–8 and 13–16 after last treatment. Primary endpoint of the study was the change of monthly migraine days from the month before last treatment to weeks 13–16. Secondary endpoints were changes in monthly headache days and monthly days with acute medication use.ResultsA total of 62 patients equally distributed between prophylaxis with the CGRP-receptor antibody erenumab and the CGRP antibodies galcanezumab or fremanezumab participated in the study. Patients reported 8.2 ± 6.6 monthly migraine days in the month before last treatment. Monthly migraine days gradually increased to 10.3 ± 6.8 in weeks 5–8 (p = 0.001) and to 12.5 ± 6.6 in weeks 13–16 (p  0.999). Monthly headache days and monthly days with acute medication use showed a similar pattern.ConclusionsThe cessation of CGRP(-receptor) antibodies migraine prophylaxis was associated with a significant increase of migraine frequency and acute medication intake over time.
      Citation: Cephalalgia
      PubDate: 2021-09-28T02:12:44Z
      DOI: 10.1177/03331024211046617
       
  • The time sequence of brain MRI findings in spontaneous intracranial
           hypotension

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      Authors: Shu-Ting Chen, Jr-Wei Wu, Yen-Feng Wang, Jiing-Feng Lirng, Shu-Shya Hseu, Shuu-Jiun Wang
      Abstract: Cephalalgia, Ahead of Print.
      ObjectivesTo investigate the time sequence of brain magnetic resonance imaging findings of spontaneous intracranial hypotension.MethodsWe retrospectively reviewed the medical records and brain magnetic resonance imaging findings of consecutive patients with spontaneous intracranial hypotension hospitalized between January 2007 and December 2017. Patients were divided into quartiles based on intervals between initial spontaneous intracranial hypotension symptom onset and brain magnetic resonance imaging scan. Six categorical and five continuous brain magnetic resonance imaging findings were assessed, including venous distension sign, enlarged pituitary gland, diffuse pachymeningeal enhancement, mid-brain pons deformity, subdural fluid collection, flattening of pons, midbrain-pons angle, descent of cerebral aqueduct, mamillopontine distance, distance of suprasellar cistern, and distance of prepontine cistern. In addition, we also calculated the neuroimaging scores with a score ≥5 classified as ‘high probability of spontaneous intracranial hypotension' and a score ≥3 as ‘intermediate-to-high probability.' Then, we analyzed the linkage between the onset-neuroimaging interval and brain magnetic resonance imaging findings, as well as different neuroimaging scores.ResultsA total of 173 patients (57 males and 116 females) were included in the analysis, and the range of onset-neuroimaging interval was 1 to 89 days (median [interquartile range]  =  17 [7 to 30 days]). We divided the patients into quartiles based on their onset-neuroimaging interval (the first quartile: 0–6 days; the second quartile: 7–16 days; the third quartile: 17–29 days; the fourth quartile: ≥30 days). Among brain magnetic resonance imaging findings, the incidence of venous distension sign was high (>75%), with no difference among quartiles (p = 0.876). The incidence of diffuse pachymeningeal enhancement (p = 0.001), severe midbrain-pons deformity (p = 0.001), and subdural fluid collection (
      Citation: Cephalalgia
      PubDate: 2021-09-28T02:12:42Z
      DOI: 10.1177/03331024211044424
       
  • Time to retire ‘New daily persistent headache’: Mode of onset of
           chronic migraine and tension-type headache

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      Authors: Rhannon Lobo, Mu Wang, Sean Lobo, Anish Bahra
      Abstract: Cephalalgia, Ahead of Print.
      Abstract New daily persistent headache is described as an enigmatic condition with daily headache from onset. It has posed challenges diagnostically and therapeutically.Methods: We conducted a study of patients referred to headache services based in Central and North-East London, United Kingdom, meeting the International Classificaiton of Headache Disorders – 3 criteria for New daily persistent headache. Information on demographics, phenotype and treatment responses were collected. The syndrome of the daily headache was also classified according any other ICHD-3-defined syndrome.Results: Of 162 patients, females comprised 68.5% with median age of onset 35 years. The daily headache experienced was chronic migraine in 89.7% and tension-type headache in 8.8%. Thunderclap-onset New daily persistent headache occurred in 14.8%. More than one headache syndrome was experienced in 15.4%, including cough, hypnic, sexual and stabbing headache. All aura types were experienced, most commonly brainstem aura in 39%. Prior headache was reported 53.7%. A persisting sub-form was present in 51.2%, relapsing remitting in 12.3% and 14.0% reported improvement; 19.8% were lost to follow-up. Only 11.1% reported an antecedent trigger. The most common premorbid disorders were psychiatric in 35.7%. A fifth improved on preventative medication, most commonly amitriptyline, propranolol and topiramate.Conclusion: Our cohort of New daily persistent headache is consistent with a mode of onset of migraine and tension-type headache which occurs in predisposed individuals.
      Citation: Cephalalgia
      PubDate: 2021-09-28T02:12:40Z
      DOI: 10.1177/03331024211044440
       
  • The influence of endogenous and exogenous hormonal factors on migraine in
           spontaneous postmenopausal women: A nationwide population-based study in
           South Korea

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      Authors: Seonghoon Kim, Si Baek Lee, Yun Jeong Hong, Yongbang Kim, Kyungdo Han, Jeong Wook Park
      Abstract: Cephalalgia, Ahead of Print.
      BackgroundHormonal and menstrual factors are known to influence migraines in women. However, studies in the postmenopausal period are relatively insufficient for clinical translation. This study investigated the influence of endogenous and exogenous hormonal factors on migraines in spontaneous menopausal women.MethodsWe obtained and analyzed the data related to hormonal factors from the Korean Health Examination database. A migraine diagnosis was identified using the Korean National Health Insurance Service database between 2009 and 2018. We observed migraine occurrence in spontaneous postmenopausal women. Study populations were divided into two groups depending on new diagnosis of migraine during the follow up periods. We investigated the association between endogenous and exogenous hormonal factors and migraine.Results1,114,742 spontaneous postmenopausal women were enrolled. Migraine risk tended to increase in the shorter lifetime number of years of menstruation group compared to the group with lifetime number of years of menstruation ≥40 years. All of the hormone replacement therapy (HRT) groups showed higher risk compared with the non-HRT group. Migraine risk tends to increase with greater postmenopausal years compared to the postmenopausal
      Citation: Cephalalgia
      PubDate: 2021-09-28T02:12:40Z
      DOI: 10.1177/03331024211044441
       
  • TOP-PRO study: A randomized double-blind controlled trial of topiramate
           versus propranolol for prevention of chronic migraine

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      Authors: Debashish Chowdhury, Luv Bansal, Ashish Duggal, Debabrata Datta, Ankit Mundra, Anand Krishnan, Arun Koul, Anu Gupta
      Abstract: Cephalalgia, Ahead of Print.
      Abstract ObjectiveThe aim of the TOP-PRO-study, a double-blind randomized controlled trial, was to assess the efficacy (non-inferiority) and tolerability of propranolol compared to topiramate for the prevention of chronic migraine.BackgroundExcept for topiramate, oral preventive treatment for chronic migraine lacks credible evidence.MethodsChronic migraine patients aged above 18 years and less than 65 years of age, not on any preventive treatment were randomly allocated to receive topiramate (100 mg/day) or propranolol (160 mg/day). The primary efficacy outcome was the mean change in migraine days per 28 days at the end of 24 weeks from baseline. A mean difference of 1.5 days per four weeks was chosen as the cut-off delta value. Multiple secondary efficacy outcomes and treatment emergent adverse events were also assessed.ResultsAs against the planned sample size of 244, only 175 patients could be enrolled before the spread of the corona virus disease-2019 pandemic and enforcement of lockdown in India. Of the 175 randomized patients, 95 (topiramate 46 and propranolol 49) completed the trial. The mean change in migraine days was −5.3 ± 1.2 vs −7.3 ± 1.1 days (p = 0.226) for topiramate and propranolol groups respectively. Propranolol was found to be non-inferior and not superior to topiramate (point estimate of −1.99 with a 95% confidence interval of −5.23 to 1.25 days). Multiple secondary outcomes also did not differ between the two groups. Intention to treat analysis of 175 patients and per-protocol analysis of 95 patients yielded concordant results. There was no significant difference in the incidence of adverse events between the two groups.ConclusionPropranolol (160mg/day) was non-inferior, non-superior to topiramate (100mg/day) for the preventive treatment of chronic migraine and had a comparable tolerability profile.Trial Registration: Clinical Trials Registry-India CTRI/2019/05/018997)
      Citation: Cephalalgia
      PubDate: 2021-09-28T02:12:38Z
      DOI: 10.1177/03331024211047454
       
  • Headache in progressive facial hemiatrophy (Parry-Romberg syndrome): A
           paradigmatic case and systematic review of the literature

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      Authors: Thomas Foiadelli, Alessandra Rossi, Chiara Trabatti, Eugenia Spreafico, Viola Santi, Alessandro Orsini, Alberto Verrotti, Salvatore Savasta
      Abstract: Cephalalgia, Ahead of Print.
      BackgroundParry-Romberg syndrome is a neuro-cutaneous disease characterized by progressive hemifacial atrophy. Although common, headache in this population is scarcely reported in the literature.ObjectiveTo evaluate the clinical features of headache in pediatric and adult patients with Parry-Romberg syndrome, and to discuss diagnostic and treatment approaches of headache in Parry-Romberg syndrome.MethodsWe conducted a systematic review in accordance with PRISMA guidelines. We searched the MEDLINE database to identify eligible studies and identified patients with Parry-Romberg syndrome and headache. We further reported a paradigmatic case with a complex headache disorder and described its management and outcome.ResultsWe identified 74 articles, 41 of which were included in the analysis. A total of 52 patients (55.8% female) were included for data analysis. The main age at onset of headache was 20 years (SD 15.2; range 3–56). A diagnosis of migraine was made in 53.9%. Abnormal brain imaging was found in 82.2% of patients.ConclusionLong-term follow-up of patients is required, because headache may develop (and evolve) at any time over the course of the disease. Primary and secondary headaches often co-occur in patients with Parry-Romberg syndrome. Further research into the underlying etiopathogenesis and therapeutic targets would be recommended.
      Citation: Cephalalgia
      PubDate: 2021-09-27T05:06:48Z
      DOI: 10.1177/03331024211043452
       
  • Incidence of spontaneous intracranial hypotension in a community. Beverly
           Hills, California, 2006–2020

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      Authors: Wouter I Schievink, M Marcel Maya, Franklin G Moser, Paul Simon, Miriam Nuño
      Abstract: Cephalalgia, Ahead of Print.
      Abstract BackgroundSpontaneous intracranial hypotension is diagnosed with an increasing frequency, but epidemiologic data are scarce. The aim of this study was to determine the incidence rate of spontaneous intracranial hypotension in a defined population.MethodsUsing a prospectively maintained registry, all patients with spontaneous intracranial hypotension residing in Beverly Hills, California, evaluated at our Medical Center between 2006 and 2020 were identified in this population-based incidence study. Our Medical Center is a quaternary referral center for spontaneous intracranial hypotension and is located within 1.5 miles from downtown Beverly Hills.ResultsA total of 19 patients with spontaneous intracranial hypotension were identified. There were 12 women and seven men with a mean age of 54.5 years (range, 28 to 88 years). The average annual incidence rate for all ages was 3.7 per 100,000 population (95% confidence interval [CI]: 2.0 to 5.3), 4.3 per 100,000 for women (95% CI, 1.9 to 6.7) and 2.9 per 100,000 population for men (95% CI, 0.8 to 5.1).ConclusionThis study, for the first time, provides incidence rates for spontaneous intracranial hypotension in a defined population.
      Citation: Cephalalgia
      PubDate: 2021-09-23T11:10:25Z
      DOI: 10.1177/03331024211048510
       
  • Greater occipital nerve block in migraine may have a place in migraine
           treatment

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      Authors: Levent Ertuğrul İnan, Nurten İnan
      Abstract: Cephalalgia, Ahead of Print.

      Citation: Cephalalgia
      PubDate: 2021-09-23T11:09:59Z
      DOI: 10.1177/03331024211045644
       
  • Efficacy and safety of exogenous beta-hydroxybutyrate for preventive
           treatment in episodic migraine: A single-centred, randomised,
           placebo-controlled, double-blind crossover trial

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      Authors: Niveditha Putananickal, Elena C Gross, Anna-Lena Orsini, Simone Schmidt, Patricia Hafner, Vanya Gocheva, Sara Nagy, Bettina C Henzi, Daniela Rubino, Deborah R Vogt, Sven Cichon, Peter Sandor, Dirk Fischer
      Abstract: Cephalalgia, Ahead of Print.
      BackgroundSeveral studies propose that brain energy deficit might be partially involved in the pathophysiology of migraine. Previously, studies demonstrated that ketogenic diet causes a substantial reduction in migraine frequency. Since the ketogenic diet is restricting and its adherence is difficult, we proposed to supplement ketone bodies exogenously to provide a prophylactic effect in migraineurs.AimTo evaluate the prophylactic effect of exogenous DL-beta-hydroxybutyrate supplementation in episodic migraineurs.MethodsA double-blind, placebo-controlled, randomised crossover trial was conducted, involving 41 patients with episodic migraine. Patients were randomised 1:1 into placebo or beta-hydroxybutyrate group before entering the first treatment period. Each treatment period was 12 weeks long, followed by four weeks of washout phase and four weeks of run-in phase before entering into the corresponding second treatment period. The primary endpoint was the number of migraine days in the last four weeks of treatment, adjusted for baseline.ResultsWe observed no clinically significant amelioration of migraine frequency or intensity under DL-beta-hydroxybutyrate treatment as compared to placebo regarding number of migraine days (mean difference [95% CI]: −1.1[−5.07, 2.85]), migraine intensity (0–10 VAS: 1.5[−0.8, 3.7]).ConclusionThe selected dose of supplemented exogenous DL-beta-hydroxybutyrate did not demonstrate efficacy in episodic migraineurs.ClinicalTrials.gov Identifier: NCT03132233
      Citation: Cephalalgia
      PubDate: 2021-09-20T12:10:34Z
      DOI: 10.1177/03331024211043792
       
  • COVID-19-related headache and sinonasal inflammation: A longitudinal study
           analysing the role of acute rhinosinusitis and ICHD-3 classification
           difficulties in SARS-CoV-2 infection

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      Authors: Marcin Straburzyński, Magdalena Nowaczewska, Sławomir Budrewicz, Marta Waliszewska-Prosół
      Abstract: Cephalalgia, Ahead of Print.
      Abstract BackgroundThe genesis of headache in coronavirus disease 2019 (COVID-19) is currently unclear and the multitude of disease symptoms often further hinders locating the source of pain. Interestingly, many subjects with COVID-19 have symptoms of acute rhinosinusitis. The relation between nasal symptoms and headache in SARS-CoV-2 infection remains unknown.MethodsThis bi-center longitudinal study evaluated symptoms in consecutive COVID-19 patients in the participating practices. The first assessment was performed during the initial consultation after infection confirmation. That was followed up by a second consultation after a median 9 days.Results130 patients were included in the study (80 women, 50 men; mean age 46.9 years). Headache was highly prevalent at the first visit (72%) and significantly associated with acute rhinosinusitis symptoms. The odds ratio for headache in subjects with rhinosinusitis was 3.5. Headache could be attributed to systemic viral infection in 96% and to acute rhinosinusitis in 51% of cases according to 3rd edition of the International Classification of Headache Disorders. Criterium C.3 (exacerbation of headache by pressure applied over paranasal sinuses) and C.4 (ipsilaterality of headache and sinusitis) had low sensitivity in headache attributed to acute rhinosinusitis.ConclusionsNasal inflammation is associated with headache in COVID-19, although the pain mechanism lies probably in a systemic reaction to the virus. 3rd edition of the International Classification of Headache Disorders criteria for headache attributed to acute rhinosinusitis need adjusting to the current understanding of acute sinonasal infection.
      Citation: Cephalalgia
      PubDate: 2021-09-20T12:09:54Z
      DOI: 10.1177/03331024211040753
       
  • Validity of the Severity of Dependence Scale for detecting dependence
           behaviours in chronic migraine with medication overuse

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      Authors: Sara Bottiroli, Federica Galli, Elena Ballante, Stefania Pazzi, Grazia Sances, Elena Guaschino, Marta Allena, Cristina Tassorelli
      Abstract: Cephalalgia, Ahead of Print.
      AimsIn this study, we tested the validity of the Severity of Dependence Scale in detecting dependence behaviours in patients with chronic migraine and medication overuse (CM + MO) using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and the Leeds Dependence Questionnaire as gold standard measures.MethodsFour hundred and fifty-four patients with CM + MO filled in the Severity of Dependence Scale and the Leeds Dependence Questionnaire and underwent a psychological evaluation for the diagnosis of substance dependence according to the DSM-IV criteria.ResultsSixty-nine percent of subjects (n = 313) presented substance dependence according to the DSM-IV criteria. These patients scored significantly higher than those without substance dependence in Severity of Dependence Scale total score (Z = −3.29, p = 0.001), and in items 1 (Z = −2.44, p = 0.015), 2 (Z = −2.50, p = 0.012), 4 (Z = −2.05, p = 0.04), and 5 (Z = −3.39, p = 0.001). Severity of Dependence Scale total score (β = 0.13, SE = 0.04, z = 3.49, p 
      Citation: Cephalalgia
      PubDate: 2021-09-20T12:07:31Z
      DOI: 10.1177/03331024211039817
       
  • CORRIGENDUM to ‘Anti-CGRP monoclonal antibodies for migraine prevention:
           A systematic review and likelihood to help or harm analysis’

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      Abstract: Cephalalgia, Ahead of Print.

      Citation: Cephalalgia
      PubDate: 2021-09-15T06:40:58Z
      DOI: 10.1177/03331024211042798
       
  • Indirect costs attributed to headache: A nation-wide survey of an active
           working population

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      Authors: Raquel Gil-Gouveia, Raquel Miranda
      Abstract: Cephalalgia, Ahead of Print.
      BackgroundThe economic burden of headache in European countries is substantial, mostly related to indirect work-productivity loss costs, yet data for Portugal is scarce.MethodsAn anonymous web-based survey of headache was distributed to a convenience sample of Portuguese companies’ workforces, to assess last-year headache and “yesterday”-point prevalence. Preexisting headaches were classified into migraine and non-migraine headache and work impact (absenteeism and presenteeism) was evaluated in relation to point prevalence. If no significant selection biases were detected, projected work-loss costs for the whole country were to be calculated.ResultsEleven (17%) of 65 invited companies participated, around 15,000 active workers were exposed to the survey and 3624 (24.3%) responded, 73% females, 84.3% with previous (“last-year”) headaches, 53% with migraine. Due to participation and gender bias, national cost-projections were not calculated. Workday point-prevalence was 21% (migraine) and 9% (non-migraine headache), resulting in 14 employees with migraine losing, on average, 4 h and 32 min of work time. Presenteeism occurred in 29% of migraine and 15% of NMH employees. Yearly cost of each employee with a headache disorder was €664.88.DiscussionHeadache has a significant economic burden, as measured by work loss costs, in Portugal. Company-based interventions should aim to support employees’ access to headache diagnosis and treatment, including non-pharmacological coping strategies, in order to reduce headache related economic costs.
      Citation: Cephalalgia
      PubDate: 2021-09-15T06:40:56Z
      DOI: 10.1177/03331024211043795
       
  • Time course of efficacy of atogepant for the preventive treatment of
           migraine: Results from the randomized, double-blind ADVANCE trial

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      Authors: Todd J Schwedt, Richard B Lipton, Jessica Ailani, Stephen D Silberstein, Cristina Tassorelli, Hua Guo, Kaifeng Lu, Brett Dabruzzo, Rosa Miceli, Lawrence Severt, Michelle Finnegan, Joel M Trugman
      Abstract: Cephalalgia, Ahead of Print.
      BackgroundAtogepant is an oral, small-molecule, calcitonin gene–related peptide receptor antagonist for the preventive treatment of migraine.MethodsIn the double-blind, phase 3 ADVANCE trial, participants with 4–14 migraine days/month were randomized to atogepant 10 mg, 30 mg, 60 mg, or placebo once daily for 12 weeks. We evaluated the time course of efficacy of atogepant for the preventive treatment of migraine. Analyses included change from baseline in mean monthly migraine days during each of the three 4-week treatment periods, change in weekly migraine days during weeks 1–4, and proportion of participants with a migraine on each day during the first week.ResultsWe analyzed 873 participants (n = 214 atogepant 10 mg, n = 223 atogepant 30 mg, n = 222 atogepant 60 mg, n = 214 placebo). For weeks 1–4, mean change from baseline in mean monthly migraine days ranged from −3.1 to −3.9 across atogepant doses vs −1.6 for placebo (p 
      Citation: Cephalalgia
      PubDate: 2021-09-15T06:40:51Z
      DOI: 10.1177/03331024211042385
       
  • A prolactin-dependent sexually dimorphic mechanism of migraine
           chronification

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      Authors: Daigo Ikegami, Edita Navratilova, Xu Yue, Aubin Moutal, Caroline M Kopruszinski, Rajesh Khanna, Amol Patwardhan, David W Dodick, Frank Porreca
      Abstract: Cephalalgia, Ahead of Print.
      ObjectiveDetermination of possible sex differences in mechanisms promoting migraine progression and the contribution of prolactin and the prolactin long (PRLR-L) and short (PRLR-S) receptor isoforms. BackgroundThe majority of patients with chronic migraine and medication overuse headache are female. Prolactin is present at higher levels in women and increases migraine. Prolactin signaling at the PRLR-S selectively sensitizes nociceptors in female rodents, while expression of the PRLR-L is protective.MethodsMedication overuse headache was modeled by repeated sumatriptan administration in male and female mice. Periorbital and hindpaw cutaneous allodynia served as a surrogate of migraine-like pain. PRLR-L and PRLR-S isoforms were measured in the trigeminal ganglion with western blotting. Possible co-localization of PRLR with serotonin 5HT1B and 5HT1D receptors was determined with RNAscope. Cabergoline, a dopamine receptor agonist that inhibits circulating prolactin, was co-administered with sumatriptan. Nasal administration of CRISPR/Cas9 plasmid was used to edit expression of both PRLR isoforms.ResultsPRLR was co-localized with 5HT1B or 5HT1D receptors in the ophthalmic region of female trigeminal ganglion. A single injection of sumatriptan increased serum PRL levels in female mice. Repeated sumatriptan promoted cutaneous allodynia in both sexes but down-regulated trigeminal ganglion PRLR-L, without altering PRLR-S, only in females. Co-administration of sumatriptan with cabergoline prevented allodynia and down-regulation of PRLR-L only in females. CRISPR/Cas9 editing of both PRLR isoforms in the trigeminal ganglion prevented sumatriptan-induced periorbital allodynia in females.InterpretationWe identified a sexually dimorphic mechanism of migraine chronification that involves down-regulation of PRLR-L and increased signaling of circulating prolactin at PRLR-S. These studies reveal a previously unrecognized neuroendocrine mechanism linking the hypothalamus to nociceptor sensitization that increases the risk of migraine pain in females and suggest opportunities for novel sex-specific therapies including gene editing through nasal delivery of CRISPR/Cas9 constructs.
      Citation: Cephalalgia
      PubDate: 2021-09-13T04:06:27Z
      DOI: 10.1177/03331024211039813
       
  • The characteristics of COVID-19 vaccine-related headache: Clues gathered
           from the healthcare personnel in the pandemic

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      Authors: Esme Ekizoglu, Haşim Gezegen, Pınar Yalınay Dikmen, Elif Kocasoy Orhan, Mustafa Ertaş, Betül Baykan
      Abstract: Cephalalgia, Ahead of Print.
      IntroductionHeadache is a frequent adverse event after viral vaccines. We aimed to investigate the frequency and clinical associations of COVID-19 vaccine-related headache.MethodsThe characteristics, associations of this headache, main comorbidities, headache history following the influenza vaccine and during COVID-19 were investigated using a web-based questionnaire.ResultsA total of 1819 healthcare personnel (mean age: 44.4 ± 13.4 years, 1222 females), vaccinated with inactivated virus, contributed to the survey; 209 (11.4%) had been infected with COVID-19. A total of 556 participants (30.6%) reported headache with significant female dominance (36.1% vs. 19.3%), 1.8 ± 3.5 (median: 1; IQR: 0–2) days following vaccination. One hundred and forty-four participants (25.9%) experienced headache lasting ≥3 days. Headache was mostly bilateral without accompanying phenomena, less severe, and shorter than COVID-19-related headache. The presence of primary headaches and migraine were significantly associated with COVID-19 vaccine-related headache (ORs = 2.16 [95% CI 1.74–2.68] and 1.65 [1.24–2.19], respectively). Headache during COVID-19 or following influenza vaccine also showed significant association with headache following COVID-19 vaccine (OR = 4.3 [95% CI 1.82–10.2] and OR = 4.84 [95% CI 2.84–8.23], respectively). Only thyroid diseases showed a significant association (OR = 1.54 [95% CI 1.15–2.08]) with vaccine-related headache among the common comorbidities.ConclusionHeadache is observed in 30.6% of the healthcare workers following COVID-19 vaccine and mostly experienced by females with pre-existing primary headaches, thyroid disorders, headache during COVID-19, or headache related to the influenza vaccine.
      Citation: Cephalalgia
      PubDate: 2021-09-13T04:06:26Z
      DOI: 10.1177/03331024211042390
       
  • Reduction in migraine pain intensity in patients treated with erenumab: A
           post hoc analysis of two pivotal randomized studies

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      Authors: Richard B Lipton, David W Dodick, David Kudrow, Uwe Reuter, Nadia Tenenbaum, Feng Zhang, Gabriel Paiva da Silva Lima, Denise E Chou, Daniel D Mikol
      Abstract: Cephalalgia, Ahead of Print.
      BackgroundErenumab (erenumab-aooe in the US) effectively reduces monthly migraine days in episodic and chronic migraine. This traditional outcome does not capture the intensity of headache pain on days with migraine.MethodsThis post hoc analysis of two pivotal randomized, placebo-controlled studies in patients with episodic migraine and chronic migraine examined the effect of erenumab 70 and 140 mg on migraine pain. Cumulative monthly migraine pain intensity is the sum of the peak pain intensity scores (0 = no migraine to 3 = migraine day with severe pain) on migraine days. Change from baseline in cumulative monthly migraine pain and average monthly pain intensity was assessed over months 4 to 6 for episodic migraine and month 3 for chronic migraine; change in average monthly pain intensity was assessed among monthly migraine days responders/non-responders.ResultsEfficacy analysis included 946 patients for the episodic migraine study and 656 patients for the chronic migraine study. Cumulative monthly migraine pain decreased significantly with erenumab versus placebo (p 
      Citation: Cephalalgia
      PubDate: 2021-08-19T06:18:20Z
      DOI: 10.1177/03331024211028966
       
  • Doubtful use of placebo following placebo in recent controlled trials of
           lasmiditan and ubrogepant for the treatment of migraine attacks

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      Authors: Peer Tfelt-Hansen, Karsten Jørgensen, Hans-Christoph Diener
      Abstract: Cephalalgia, Ahead of Print.
      PurposeIn four large controlled trials with lasmiditan and ubrogepant placebo was administered in the first step to demonstrate an effect on migraine attack. In the same trials the investigators also asked the question: is a second dose of the drug effective in non-responders to the first dose' In this phase patients who received placebo in the first phase of the trial again after 2 hours received another dose of placebo.ConclusionTo be ethical, clinical research requires balancing rigorous science with the protection of human subjects; and it is, in our view, questionable whether placebo was used with “scientific rigor” in the second step of these trials, and this design is not recommended.
      Citation: Cephalalgia
      PubDate: 2021-08-19T06:18:20Z
      DOI: 10.1177/03331024211029939
       
  • CGRP-dependent signalling pathways involved in mouse models of GTN-
           cilostazol- and levcromakalim-induced migraine

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      Authors: Sarah L Christensen, Rikke H Rasmussen, Charlotte Ernstsen, Sanne La Cour, Arthur David, Jade Chaker, Kristian A Haanes, Søren T Christensen, Jes Olesen, David M Kristensen
      Abstract: Cephalalgia, Ahead of Print.
      BackgroundKnowledge of exact signalling events during migraine attacks is lacking. Various substances are known to trigger migraine attacks in patients and calcitonin gene-related peptide antagonising drugs are effective against migraine pain. Here, we investigated the signalling pathways involved in three different mouse models of provoked migraine and relate them to calcitonin gene-related peptide and other migraine-relevant targets.MethodsIn vivo mouse models of glyceryl trinitrate-, cilostazol- and levcromakalim-induced migraine were applied utilising tactile sensitivity to von Frey filaments as measuring readout. Signalling pathways involved in the three models were dissected by use of specific knockout mice and chemical inhibitors. In vivo results were supported by ex vivo wire myograph experiments measuring arterial dilatory responses and ex vivo calcitonin gene-related peptide release from trigeminal ganglion and trigeminal nucleus caudalis from mice.ResultsGlyceryl trinitrate-induced hypersensitivity was dependent on both prostaglandins and transient receptor potential cation channel, subfamily A, member 1, whereas cilostazol- and levcromakalim-induced hypersensitivity were independent of both. All three migraine triggers activated calcitonin gene-related peptide signalling, as both receptor antagonism and antibody neutralisation of calcitonin gene-related peptide were effective inhibitors of hypersensitivity in all three models. Stimulation of trigeminal ganglia and brain stem tissue samples with cilostazol and levcromakalim did not result in release of calcitonin gene-related peptide, and vasodilation following levcromakalim stimulation was independent of CGRP receptor antagonism.ConclusionThe mouse models of glyceryl trinitrate-, cilostazol- and levcromakalim- induced migraine all involve calcitonin gene-related peptide signalling in a complex interplay between different cell/tissue types. These models are useful in the study of migraine mechanisms.
      Citation: Cephalalgia
      PubDate: 2021-08-19T06:18:18Z
      DOI: 10.1177/03331024211038884
       
  • E-book review: The end of migraines: 190 ways to stop your pain

    • Free pre-print version: Loading...

      Authors: Uwe Reuter
      Abstract: Cephalalgia, Ahead of Print.

      Citation: Cephalalgia
      PubDate: 2021-08-19T06:18:16Z
      DOI: 10.1177/03331024211030902
       
  • Activation of the trigeminal system as a likely target of SARS-CoV-2 may
           contribute to anosmia in COVID-19

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      Authors: Karl Messlinger, Winfried Neuhuber, Arne May
      Abstract: Cephalalgia, Ahead of Print.
      Clinical publications show consistently that headache is a common symptom in the coronavirus disease of 2019 (COVID-19). Several studies specifically investigated headache symptomatology and associated features in patients with COVID-19. The headache is frequently debilitating with manifold characters including migraine-like characteristics. Studies suggested that COVID-19 patients with headache vs. those without headache are more likely to have anosmia. We present a pathophysiological hypothesis which may explain this phenomenon, discuss current hypotheses about how the coronavirus SARS-CoV-2 enters the central nervous system and suggest that activation of the trigeminal nerve may contribute to both headache and anosmia in COVID-19.
      Citation: Cephalalgia
      PubDate: 2021-08-19T06:18:16Z
      DOI: 10.1177/03331024211036665
       
  • A national Swedish case-control study investigating incidence and factors
           associated with idiopathic intracranial hypertension

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      Authors: Anna Sundholm, Sarah Burkill, Elisabet Waldenlind, Shahram Bahmanyar, A Ingela M Nilsson Remahl
      Abstract: Cephalalgia, Ahead of Print.
      ObjectiveTo study the incidence of idiopathic intracranial hypertension in Sweden and to explore whether previously proposed risk factors are associated with idiopathic intracranial hypertension by investigating the odds of exposure one year prior to diagnosis in patients compared to controls.MethodsUsing Swedish health care registers and validated diagnostic algorithms, idiopathic intracranial hypertension patients diagnosed between 2000–2016 were compared with randomly selected matched controls, five from the general population and five with obesity.ResultsWe identified 902 idiopathic intracranial hypertension patients and 4510 matched individuals in each control group. Mean incidence among inhabitants ≥18 years of age was 0.71 per 100,000; rising from 0.53 in 2000–2005 to 0.95 in 2012–2016. There were increased odds for idiopathic intracranial hypertension patients compared to general population for exposure to: kidney failure (odds ratio =13.2 (4.1–42.0)), arterial hypertension (odds ratio =17.5 (10.5–29.3)), systemic lupus erythematosus (odds ratio =13.8 (4.3–44.7)), tetracyclines, sulphonamides, lithium, and corticosteroids. In obese controls, odds ratios were also significantly increased for these exposures. Hormonal contraceptive use and exposure to pregnancy did not appear to be associated factors for idiopathic intracranial hypertension development.ConclusionsThe incidence of idiopathic intracranial hypertension in Sweden is lower relative to reports from other countries but is on the rise. This case-control study confirms several previously reported risk factors associated with idiopathic intracranial hypertension.
      Citation: Cephalalgia
      PubDate: 2021-08-19T06:18:14Z
      DOI: 10.1177/03331024211024166
       
  • Indomethacin has no effect on trigeminally provoked parasympathetic output

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      Authors: Maike Möller, Celina Schröder, Stefanie Iwersen-Bergmann, Jan Mehnert, Arne May
      Abstract: Cephalalgia, Ahead of Print.
      BackgroundUnlike other non-steroidal anti-inflammatory drugs, indomethacin has been shown to be highly effective in two forms of trigeminal autonomic cephalalgias, hemicrania continua and paroxysmal hemicrania and in some forms of idiopathic stabbing headaches. This specificity is unique in the headache field. Previous findings suggest the involvement of the trigeminal autonomic reflex to play an important role in the pathophysiology of these diseases.Methods22 healthy participants were enrolled in a double-blind, three-day within-subject design. The participants received indomethacin, ibuprofen or placebo in a randomized order. After an incubation period of 65 min the baseline lacrimation and the lacrimation during intranasal stimulation evoked by kinetic oscillation stimulation were assessed using Schirmer II lacrimation tests. The lacrimation difference in mm was calculated and compared in a repeated measures ANOVA.ResultsNo significant differences were found between the three conditions.ConclusionIn our study, neither indomethacin nor ibuprofen had an inhibitory effect on the trigeminal autonomic reflex. We suggest that blocking this reflex may not be the treatment mechanism of indomethacin.
      Citation: Cephalalgia
      PubDate: 2021-08-19T06:18:14Z
      DOI: 10.1177/03331024211030901
       
  • Are PROMs passing the message' A reflection with real-life migraine
           patients

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      Authors: Raquel Gil-Gouveia, António Gouveia Oliveira
      Abstract: Cephalalgia, Ahead of Print.
      BackgroundSeveral patient-reported outcome measures are available to monitor headache impact, but are those reliable in real-life clinical practice'MethodsTwo identical patient-reported outcome measures (HALT-90 and MIDAS) were applied simultaneously in each clinical visit to a series of patients treated with monoclonal antibodies for migraine and intra-individual agreement was evaluated using the intraclass correlation coefficients.ResultsOur sample included 92 patients, 92.4% females, 45 years old on average. Moderate (0.50 to 0.75) and even poor (
      Citation: Cephalalgia
      PubDate: 2021-08-19T06:18:13Z
      DOI: 10.1177/03331024211034509
       
  • Physical inactivity and headache disorders: Cross-sectional analysis in
           the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

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      Authors: Arão Belitardo de Oliveira, Juliane Prieto Peres Mercante, Mario Fernando Prieto Peres, Maria Del Carmen B Molina, Paulo A Lotufo, Isabela M Benseñor, Alessandra C Goulart
      Abstract: Cephalalgia, Ahead of Print.
      BackgroundPhysical inactivity has been linked to headache disorders but estimates based on the current World Health Organization physical activity guidelines are unknown.ObjectiveTo test the associations between headache disorders and physical inactivity in the ELSA-Brasil cohort.MethodsIn a cross-sectional analysis, linear (continuous variables) and logistic regression models (categorical variables) tested the associations of physical activity levels in the leisure time, commuting time, and combined leisure time physical activity + commuting time physical activity domains with headache disorders, adjusted for the effects of sociodemographic data, cardiovascular risk variables, psychiatric disorders, and migraine prophylaxis medication.ResultsOf 15,105 participants, 14,847 (54.4% women) provided data on physical activity levels and headache. Higher physical activity levels (continuous values) in the leisure time physical activity domain associated with lower migraine and tension-type headache occurrence and lower headache attack frequency, while in the commuting time physical activity domain it associated with more frequent headache attacks. Compared to people who met World Health Organization physical activity levels in the leisure time physical activity or combining leisure time physical activity + commuting time physical activity domains (i.e. ≥150 min.wk−1 of moderate and/or ≥75 min.wk−1 of vigorous physical activity), physical inactivity associated with higher migraine occurrence, while somewhat active (i.e. not meeting World Health Organization recommendations) associated with higher migraine and tension-type headache occurrence. Physical inactivity in the commuting time physical activity domain associated with higher tension-type headache in men and lower migraine in women. Physical inactivity within vigorous leisure time physical activity intensity, but not moderate leisure time physical activity, associated with higher migraine, mostly in women. Finally, physical inactivity associated with higher headache attack frequency regardless headache subtype.ConclusionPhysical inactivity and unmet World Health Organization physical activity levels associate with primary headaches, with heterogeneous associations regarding headache subtype, sex, physical activity domain/intensity, and headache frequency in the ELSA-Brasil study.
      Citation: Cephalalgia
      PubDate: 2021-08-19T06:18:10Z
      DOI: 10.1177/03331024211029217
       
  • Micturition-triggered severe headache associated with bladder
           paraganglioma: A case report

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      Authors: Yonghui Liu, Tianlu Wei
      Abstract: Cephalalgia, Ahead of Print.
      BackgroundParagangliomas are rare neuroendocrine tumors, especially in the bladder. Although many paragangliomas are non-functional, functioning paragangliomas present with many non-specific signs and symptoms, such as hypertension and headache, complicating their diagnosis. Here, we report a case of micturition-induced severe headache associated with a bladder paraganglioma.Case description: This report describes a severe headache disorder triggered by micturition and associated with a bladder paraganglioma in a middle-aged woman. Her pain occurred consistently after micturition, beginning from the left side of the nose and gradually extended to the forehead and the parietal and occipital regions. The headaches lasted 5–10 min. Removal of the paraganglioma completely eliminated the patient’s pain syndrome.ConclusionThis case elucidates the association between micturition-triggered headaches and bladder paragangliomas. The presence of a post-micturition severe headache should suggest the possibility of a bladder paraganglioma.
      Citation: Cephalalgia
      PubDate: 2021-08-19T06:18:09Z
      DOI: 10.1177/03331024211036155
       
  • Incidence of headache after COVID-19 vaccination in patients with history
           of headache: A cross-sectional study

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      Authors: Koji Sekiguchi, Narumi Watanabe, Naoki Miyazaki, Kei Ishizuchi, Chisato Iba, Yu Tagashira, Shunsuke Uno, Mamoru Shibata, Naoki Hasegawa, Ryo Takemura, Jin Nakahara, Tsubasa Takizawa
      Abstract: Cephalalgia, Ahead of Print.
      BackgroundHeadache is an adverse event of coronavirus 2019 (COVID-19) vaccination. Whether patients with history of headache suffer more from vaccination-induced headaches is unknown. We aimed to uncover if headache patients develop more headaches after COVID-19 mRNA vaccination than healthy controls.MethodsWe performed a questionnaire survey for nursing staff in our hospital from April to May 2021. Based on baseline characteristics, we divided the participants into migraine, non-migrainous headache, and healthy control, and examined the occurrence and features of headache after COVID-19 vaccinations.ResultsWe included 171 participants (15.2% migraine and 24.6% non-migrainous headache). Headache incidence after vaccinations was significantly higher in the migraine (69.2%) and non-migrainous headache (71.4%) groups than in the healthy control (37.9%) group. The incidence of headaches was significantly higher after the second dose compared to the first (45.6% vs. 20.5%).ConclusionMigraineurs and non-migrainous headache participants developed more headaches compared to the healthy controls after COVID-19 vaccination.
      Citation: Cephalalgia
      PubDate: 2021-08-19T06:18:09Z
      DOI: 10.1177/03331024211038654
       
  • Aura in trigeminal autonomic cephalalgia is probably mediated by comorbid
           migraine with aura

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      Authors: Kuan-Po Peng, Marlene Schellong, Arne May
      Abstract: Cephalalgia, Ahead of Print.
      ObjectiveThe presence of aura is rare in cluster headache, and even rarer in other trigeminal autonomic cephalalgias. We hypothesized that the presence of aura in patients with trigeminal autonomic cephalalgias is frequently an epiphenomenon and mediated by comorbid migraine with aura.MethodsThe study retrospectively reviewed 480 patients with trigeminal autonomic cephalalgia in a tertiary medical center for 10 years. Phenotypes and temporal correlation of aura with headache were analyzed. Trigeminal autonomic cephalalgia patients with aura were further followed up in a structured telephone interview.ResultsSeventeen patients with aura (3.5%) were identified from 480 patients with trigeminal autonomic cephalalgia, including nine with cluster headache, one with paroxysmal hemicrania, three with hemicrania continua, and four with probable trigeminal autonomic cephalalgia. Compared to trigeminal autonomic cephalalgia patients without aura, trigeminal autonomic cephalalgia patients with aura were more likely to have a concomitant diagnosis of migraine with aura (odds ratio [OR] = 109.0, 95% CI 30.9–383.0, p 
      Citation: Cephalalgia
      PubDate: 2021-08-19T06:18:06Z
      DOI: 10.1177/03331024211030499
       
  • Measuring headache day severity using multiple features in daily diary
           designs

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      Authors: James S McGinley, Carrie R Houts, RJ Wirth, Richard B Lipton
      Abstract: Cephalalgia, Ahead of Print.
      ObjectiveThough migraine is thought of as a symptom complex, symptoms are typically assessed one at a time. For use in clinical research, we developed a composite measure of headache day severity by combining eight well-known symptoms captured in daily diaries.Subjects and MethodsData came from adults with a self-reported diagnosis of migraine (n  =  4380) who provided daily diary information assessed using a novel digital platform. Nine observed features theoretically linked to headache day severity were analyzed using latent variable modeling to create a psychometrically robust headache day severity score. Logistic regression was used to assess the cross-sectional relationships of headache day severity scores against an array of clinically-relevant outcomes.ResultsParticipants were largely females (90%), approaching middle age (mean age of 37.3) and living in the United States (49%) or United Kingdom (23%). Findings supported a single latent headache day severity construct based on eight observed headache features. Headache day severity scores were associated with an increased odds of physician visits (Odds ratio[95% CI]: 1.71[1.32–2.21]), emergency department visits (4.12[2.23-7.60]), missed school/work (2.90[2.56–3.29]), missed household work (3.37[3.06–3.72]), and missed other activities (3.29[2.97–3.64]) (p 
      Citation: Cephalalgia
      PubDate: 2021-08-19T06:18:04Z
      DOI: 10.1177/03331024211033829
       
  • Pediatric-onset trigeminal autonomic cephalalgias: A systematic review and
           meta-analysis

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      Authors: Ankita Ghosh, Emma Silva, Mark J Burish
      Abstract: Cephalalgia, Ahead of Print.
      Background and objectiveThere are five headache disorders composing the trigeminal autonomic cephalalgias (cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT), short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA), and hemicrania continua). Little is known about these disorders in the pediatric population. The objectives of this study are to report the full age ranges of pediatric trigeminal autonomic cephalalgias and to determine if pediatric-onset trigeminal autonomic cephalalgias display similar signs and symptoms as adult onset.MethodsSearch criteria in Medline Ovid, Embase, PsycINFO, and Cochrane Library were created by a librarian. The remainder of the steps were independently performed by two neurologists using PRISMA guidelines. Inclusion criteria for titles and abstracts were articles discussing cases of trigeminal autonomic cephalalgias with age of onset 18 or younger, as well as any epidemiological report on trigeminal autonomic cephalalgias (as age of onset data was often found in the results section but not in the title or abstract). Data extracted included age of onset, sex, and International Classification of Headache Disorders criteria for trigeminal autonomic cephalalgias (including pain location, duration, frequency, autonomic features, restlessness) and some migraine criteria (photophobia, phonophobia, and nausea). Studies that did not meet full criteria for trigeminal autonomic cephalalgias were examined separately as “atypical trigeminal autonomic cephalalgias”; secondary headaches were excluded from this category.ResultsIn all, 1788 studies were searched, 86 met inclusion criteria, and most () examined cluster headache. In cluster headache, onset occurred at every pediatric age (range 1–18 years) with a full range of associated features. Autonomic and restlessness features were less common in pediatric patients, while migrainous features (nausea, photophobia, and phonophobia) were found at similar rates. The sex ratio of pediatric-onset cluster headache (1.8, 79 male and 43 female) may be lower than that of adult-onset cluster headache. Data for other trigeminal autonomic cephalalgias, while more limited, displayed most of the full range of official criteria. The data for atypical trigeminal autonomic cephalalgias were also limited, but the most common deviations from the official criteria were abnormal frequencies and locations of attacks.ConclusionsTrigeminal autonomic cephalalgias can start early in life and have similar features to adult-onset trigeminal autonomic cephalalgias. Specifically, pediatric-onset cluster headache patients display the full range of each criterion for cluster headache (except maximum frequency of six instead of eight attacks per day). However, cranial autonomic features and restlessness occur at a lower rate in pediatrics. Additional information is needed for the other trigeminal autonomic cephalalgias. As for expanding the ICHD-3 criteria for pediatric-onset trigeminal autonomic cephalalgias, we have only preliminary data from atypical cases, which suggests that the frequency and location of attacks sometimes extend beyond the official criteria.Trial Registration: This study was registered as a systematic review in PROSPERO (registration number CRD42020165256).
      Citation: Cephalalgia
      PubDate: 2021-08-19T06:17:57Z
      DOI: 10.1177/03331024211027560
       
  • Reversible cerebral vasoconstriction syndrome developing after an erenumab
           injection for migraine prevention

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      Authors: Todd D Rozen, Alok A Bhatt
      Abstract: Cephalalgia, Ahead of Print.
      BackgroundReversible cerebral vasoconstriction syndrome is normally triggered by vasoactive compounds or illicit drugs. A new type of migraine preventive medication blocks calcitonin gene-related peptide utilizing monoclonal antibodies. Calcitonin gene-related peptide is a potent vasodilator for the cerebrovascular system. Could blocking calcitonin gene-related peptide be a trigger for cerebral artery vasospasm in patients susceptible to developing reversible cerebral vasoconstriction syndrome (migraine patients) or in individuals using vasoactive compounds' We present a case of reversible cerebral vasoconstriction syndrome occurring after calcitonin gene-related peptide monoclonal antibody treatment.Case reportA 43-year -old woman with a history of episodic migraine developed an acute headache with orgasm two days after taking her second injection of erenumab. Ten days after erenumab injection she developed a thunderclap headache while completing a high intensity workout. These new headaches were only left sided. Computed tomography angiography demonstrated mild to moderate areas of narrowing involving the left middle and anterior cerebral arteries, concerning for reversible cerebral vasoconstriction syndrome. She denied exposure to any known reversible cerebral vasoconstriction syndrome precipitant medication or illicit drugs. She did endorse recent exposure to high altitude prior to erenumab therapy. She was started on verapamil 40 mg three times per day and her headache ceased within 24 h of initiating treatment. A repeat CT angiogram completed 4 weeks after the initial study noted resolution of the areas of vessel stenosis.ConclusionA case of reversible cerebral vasoconstriction syndrome developing after treatment with a calcitonin gene-related peptide monoclonal antibody is presented. The timing of the new type of headache occurring 2 days post erenumab injection suggests a possible cause and effect relationship. Reversible cerebral vasoconstriction syndrome as a possible treatment-related complication to the usage of calcitonin gene-related peptide monoclonal antibodies needs to be studied further.
      Citation: Cephalalgia
      PubDate: 2021-08-18T09:25:14Z
      DOI: 10.1177/03331024211037277
       
  • Could erectile dysfunction be a side effect of CGRP inhibition' A case
           report

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      Authors: Linda Al-Hassany, Tessa de Vries, Johannes A Carpay, Antoinette MaassenVanDenBrink
      Abstract: Cephalalgia, Ahead of Print.
      Abstract BackgroundRecently, antimigraine drugs targeting the calcitonin gene-related peptide pathway have been approved for clinical use as preventive migraine medication.Case reportWe present a case of a 54-year-old male migraine patient, who reported erectile dysfunction as a possible side effect of treatment with galcanezumab, a monoclonal antibody targeting calcitonin gene-related peptide. His potency recovered after treatment discontinuation.DiscussionAs calcitonin gene-related peptide is involved in mammalian penile erection, erectile dysfunction is a conceivable side effect associated with calcitonin gene-related peptide inhibition. Postmarketing surveillance will elucidate the actual incidence of erectile dysfunction in patients using these new antimigraine drugs, and determine whether a causal relationship between calcitonin gene-related peptide inhibition and erectile dysfunction exists. This would be relevant not only because of the direct sexual consequences of erectile dysfunction, but also considering the potential cardiovascular consequences of calcitonin gene-related peptide (receptor) blockade and the association of both migraine and erectile dysfunction with cardiovascular disease.ConclusionErectile dysfunction might be an overlooked, but reversible side effect in male migraine patients using monoclonal antibodies that inhibit the calcitonin gene-related peptide pathway, including galcanezumab. This paper may raise clinical awareness and suggest that this potential side effect needs to be studied further.
      Citation: Cephalalgia
      PubDate: 2021-08-18T07:43:52Z
      DOI: 10.1177/03331024211037304
       
  • What do people want to know about “Growing Up with Migraine”'
           Results of a preference survey of people with lived experience to guide
           future research

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      Authors: James S McGinley, Andrea Savord, Carrie R Houts, RJ Wirth, Richard B Lipton, Dawn C Buse
      Abstract: Cephalalgia, Ahead of Print.
      In recent years, emphasis has been placed on conducting headache research that is patient-centered to more explicitly incorporate the input of people who live with headache diseases. The Growing Up with Migraine Study was developed with this intention using a two-step process: 1. develop and administer a survey to identify research areas that matter most to people with adolescent migraine and/or their caregivers and 2. use the survey results to guide future secondary data analyses. This brief report summarizes the survey results from 373 individuals impacted by adolescent migraine. Findings suggested that people with history of adolescent migraine and/or their caregivers are most interested in research about migraine comorbidities and effects on psychological/social/emotional health, along with health-related outcomes and family-related topics. Future quantitative studies are planned that will explore these patient-identified priorities through secondary data analysis of an existing dataset.
      Citation: Cephalalgia
      PubDate: 2021-08-18T07:43:52Z
      DOI: 10.1177/03331024211038526
       
  • Update on “Treatment of orthostatic headache without intracranial
           hypotension: A case report” – nine years later

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      Authors: Gonçalo V Bonifácio, Raquel Gil-Gouveia
      Abstract: Cephalalgia, Ahead of Print.
      BackgroundIn 2013, one of the authors described a 36-year-old female with orthostatic headache without documented intracranial hypotension or evidence of cerebrospinal fluid leak, despite extensive workup. Headache was unresponsive to conservative treatment since 2010, showed only transient benefit after repeated epidural blood patches while vitamin A supplementation resulted in progressive improvement.CaseSince 2013, the patient followed a relapsing and remitting course yet relapse control became difficult after a drug induced liver injury required vitamin A discontinuation in 2017, when her headache became chronic. Greater occipital nerve blocks provided pain relief as alternative but were stopped due to the pandemic and her latest severe relapse, in late 2020, required not only restarting anaesthetic blocks and aggressive medication management, but also reassessing and treating comorbidities (obstructive sleep apnoea and major depressive disorder) with modest benefit.ConclusionOrthostatic headache without intracranial hypotension is rare, with only 28 cases reported so far, all treated empirically and all treatment options revealing to be mostly ineffective. Vitamin A anecdotally appeared to be useful in our case but had to be stopped for severe side effects, so unfavourable long-term prognosis, in ours and 2/3 of the reported cases, seems to be the rule in this intriguing entity.
      Citation: Cephalalgia
      PubDate: 2021-08-18T07:43:51Z
      DOI: 10.1177/03331024211038656
       
  • Quality appraisal of existing guidelines for the management of headache
           disorders by the AGREE II’s method

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      Authors: Juliana MA Vaz, Bárbara MCS Alves, Djane B Duarte, Luciene AM Marques, Rafael S Santana
      Abstract: Cephalalgia, Ahead of Print.
      ObjectiveTo evaluate the quality of existing clinical practice guidelines for headache management and their main recommendations.BackgroundEvidence-based clinical practice guidelines have been developed to support the clinical decision-making. However, to achieve this goal, the quality of these guidelines must be ensured.MethodsA systematic search for clinical practice guidelines for headache management was conducted in the PubMed database, in websites of known guideline developers and in websites of known headache associations. The quality appraisal was performed through the Appraisal of Guidelines for Research and Evaluation II method.ResultsTwelve guidelines were evaluated. The domains of rigor of development, applicability, and editorial independence, which most influence the overall quality of guidelines, had the lowest average scores and the highest standard deviation rates (61% ± 23; 37% ± 20; 53% ± 31). The main recommendations regarding medication use for acute treatment of episodic tension-type headache and migraine in adult patients consisted of paracetamol, acetylsalicylic acid, and other nonsteroidal anti-inflammatory drugs in all guidelines.ConclusionsThe statistical results indicate that the appraised guidelines have room for both individual and collective improvement. In addition, there is a well-established medication recommendation pattern among all guidelines evaluated.
      Citation: Cephalalgia
      PubDate: 2021-08-18T07:37:13Z
      DOI: 10.1177/03331024211037297
       
  • Genome-wide association study reveals susceptibility loci for
           self-reported headache in a large community-based Asian population

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      Authors: Yu-Chien Tsao, Shuu-Jiun Wang, Chia-Lin Hsu, Yen-Feng Wang, Jong-Ling Fuh, Shih-Pin Chen, Cathy Shen-Jang Fann
      Abstract: Cephalalgia, Ahead of Print.
      BackgroundThe genetic substrate for headache in the general population has not been identified in Asians. We investigated susceptible genetic variants for self-reported headache in a large community-based Asian population.MethodsWe conducted a genome-wide association study in participants recruited from a community-based cohort to identify the genetic variants associated with headache in Taiwanese. All participants received a structured questionnaire for self-reported headache. A total of 2084 patients with “self-reported headache” and 11,822 age- and sex-matched controls were enrolled. Gene enrichment analysis using the Genotype-Tissue Expression version 6 database was performed to explore the potential function of the identified variants.ResultsWe identified two novel loci, rs10493859 in TGFBR3 and rs13312779 in FGF23, that are functionally relevant to vascular function and migraine to be significantly associated with self-reported headache after adjusting age, sex and top 10 principal components (p = 8.53 × 10−11 and p = 1.07 × 10−8, respectively). Gene enrichment analysis for genes with GWAS suggestive significance (p 
      Citation: Cephalalgia
      PubDate: 2021-08-18T07:20:35Z
      DOI: 10.1177/03331024211037269
       
  • A systematic review of treatment for patients with burning mouth syndrome

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      Authors: Huann Lan Tan, Jared G Smith, Jan Hoffmann, Tara Renton
      Abstract: Cephalalgia, Ahead of Print.
      BackgroundBurning mouth syndrome is a chronic idiopathic intractable intraoral dysaesthesia that remains a challenge to clinicians due to its poorly understood pathogenesis and inconsistent response to various treatments.AimThis review aimed to study the short- (≤3 months) and long-term (>3 months) effectiveness and sustainable benefit of different burning mouth syndrome treatment strategies and the associated side effects.Materials and methodsRandomised controlled trials of burning mouth syndrome treatment compared with placebo or other interventions with a minimum follow up of 2 months were searched from the PubMed, Embase and Cochrane database (published to July 2020).ResultsTwenty-two studies were selected based on the inclusion and exclusion criteria and analysed. Nine categories of burning mouth syndrome treatment were identified: Anticonvulsant and antidepressant agents, phytomedicine and alpha lipoic acid supplements, low-level laser therapy, saliva substitute, transcranial magnetic stimulation, and cognitive behaviour therapy. Cognitive behaviour therapy, topical capsaicin and clonazepam, and laser therapy demonstrated favourable outcome in both short- and long-term assessment. Phytomedicines reported a short-term benefit in pain score reduction. The pooled effect of alpha lipoic acid (ALA) pain score improvement was low, but its positive effects increased in long term assessment.ConclusionA more significant volume in terms of sample size, multi-centres, and multi-arm comparison of therapeutic agents with placebo and longitudinal follow-up studies is recommended to establish a standardised burning mouth syndrome treatment protocol. Further studies are required to assess the analgesic benefits of topical clonazepam and capsaicin, alternative medicines with neurodegenerative prevention capability and psychology support in treating burning mouth syndrome and reducing systemic adverse drug reactions.Registration International Prospective Register of Systematic Reviews (PROSPERO):Protocol ID - CRD42020160892.
      Citation: Cephalalgia
      PubDate: 2021-08-18T07:20:33Z
      DOI: 10.1177/03331024211036152
       
  • Manual joint mobilisation techniques, supervised physical activity,
           psychological treatment, acupuncture and patient education in migraine
           treatment. A systematic review and meta-analysis

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      Authors: Dagmar Beier, Henriette E Callesen, Louise N Carlsen, Kirsten Birkefoss, Hanna Tómasdóttir, Hanne Wűrtzen, Henrik W Christensen, Lotte S Krøll, Mette Jensen, Christel V Høst, Jakob M Hansen
      Abstract: Cephalalgia, Ahead of Print.
      BackgroundMany people suffering from migraine combine pharmacological and non-pharmacological treatments. The purpose of this systematic review is to provide an updated guideline for some widely used non-pharmacological treatment options for migraine.MethodsWe conducted a systematic literature review of randomized studies of adults with migraine treated with manual joint mobilisation techniques, supervised physical activity, psychological treatment, acupuncture and patient education. The main outcomes measured were days with headache and quality of life. Recommendations were formulated based on the Grade of Recommendation, Assessment, Development and Evaluation (GRADE) approach including patient preferences based on expert opinion and questionnaire data.ResultsThe overall level of certainty of the evidence was low to very low. Manual therapy techniques and psychological treatment did not change the studied outcomes. Supervised physical activity might have a positive impact on quality of life, acupuncture on headache frequency, intensity, quality of life and the use of attack-medicine. Patient education might improve self-rated health and quality of life and increase the number of well-informed patients.ConclusionBased on observed effects, the lack of serious adverse events, and patients’ preferences, we make weak recommendations for considering the investigated interventions as a supplement to standard treatment.Protocol registration: Prospero CRD42020220132.
      Citation: Cephalalgia
      PubDate: 2021-08-18T07:16:01Z
      DOI: 10.1177/03331024211034489
       
  • BoNT-A efficacy in high frequency migraine: an open label, single arm,
           exploratory study applying the PREEMPT paradigm

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      Authors: Daniele Martinelli, Sebastiano Arceri, Roberto De Icco, Marta Allena, Elena Guaschino, Natascia Ghiotto, Vito Bitetto, Gloria Castellazzi, Giuseppe Cosentino, Grazia Sances, Cristina Tassorelli
      Abstract: Cephalalgia, Ahead of Print.
      Abstract IntroductionIn this open label, single-arm trial we evaluated the efficacy of onabotulinum toxin-A in the prevention of high-frequency episodic migraine (8–14 migraine days/month).MethodsWe enrolled 32 high-frequency episodic migraine subjects (age 44.8 ± 11.9 years, 11.0 ± 2.2 migraine days, 11.5 ± 2.1 headache days, 7 females). After a 28-day baseline period, subjects underwent 4 subsequent onabotulinum toxin-A treatments according to the phase III research evaluating migraine prophylaxis therapy (PREEMPT) paradigm, 12-weeks apart. The primary outcome was the reduction of monthly migraine days from baseline in the 12-week period following the last onabotulinum toxin-A treatmentResultsOnabotulinum toxin-A reduced monthly migraine days by 3.68 days (−33.1%, p 
      Citation: Cephalalgia
      PubDate: 2021-08-18T07:16:00Z
      DOI: 10.1177/03331024211034508
       
  • Trajectory of treatment response in the child and adolescent migraine
           prevention (CHAMP) study: A randomized clinical trial

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      Authors: Brooke L Reidy, James Peugh, Andrew D Hershey, Christopher S Coffey, Leigh A Chamberlin, Dixie J Ecklund, Elizabeth A Klingner, Jon W Yankey, Leslie L Korbee, Linda L Porter, Marielle A Kabbouche, Joanne Kacperski, Scott W Powers
      Abstract: Cephalalgia, Ahead of Print.
      ObjectiveIdentify preventive medication treatment response trajectories among youth participating in the Childhood and Adolescent Migraine Prevention study.MethodsData were evaluated from 328 youth (ages 8–17). Childhood and Adolescent Migraine Prevention study participants completed headache diaries during a 28-day baseline period and a 168-day active treatment period during which youth took amitriptyline, topiramate, or placebo. Daily headache occurrence trajectories were established across baseline and active treatment periods using longitudinal hierarchical linear modeling. We tested potential treatment group differences. We also compared final models to trajectory findings from a clinical trial of cognitive behavioral therapy plus amitriptyline for youth with chronic migraine to test for reproducibility.ResultsDaily headache occurrence showed stability across baseline. Active treatment models revealed decreases in headache frequency that were most notable early in the trial period. Baseline and active treatment models did not differ by treatment group and replicated trajectory cognitive behavioral therapy plus amitriptyline trial findings.ConclusionsReplicating headache frequency trajectories across clinical trials provides strong evidence that youth can improve quickly. Given no effect for medication, we need to better understand what drives this clinically meaningful improvement. Results also suggest an expected trajectory of treatment response for use in designing and determining endpoints for future clinical trials.Trial Registration. ClinicalTrials.gov Identifier: NCT01581281
      Citation: Cephalalgia
      PubDate: 2021-08-18T06:49:46Z
      DOI: 10.1177/03331024211033551
       
  • Somatosensory dysfunction in patients with posttraumatic headache: A
           systematic review

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      Authors: Julia Jessen, Özüm S. Özgül, Oliver Höffken, Peter Schwenkreis, Martin Tegenthoff, Elena K Enax-Krumova
      Abstract: Cephalalgia, Ahead of Print.
      ObjectivesAim of the review is to summarize the knowledge about the sensory function and pain modulatory systems in posttraumatic headache and discuss its possible role in patients with posttraumatic headache.BackgroundPosttraumatic headache is the most common complication after traumatic brain injury, and significantly impacts patients’ quality of life. Even though it has a high prevalence, its origin and pathophysiology are poorly understood. Thereby, the existing treatment options are insufficient. Identifying its mechanisms can be an important step forward to develop target-based personalized treatment.MethodsWe searched the PubMed database for studies examining pain modulation and/or quantitative sensory testing in individuals with headache after brain injury.ResultsThe studies showed heterogenous alterations in sensory profiles (especially in heat and pressure pain perception) compared to healthy controls and headache-free traumatic brain injury-patients. Furthermore, pain inhibition capacity was found to be diminished in subjects with posttraumatic headache.ConclusionsDue to the small number of heterogenous studies a distinct sensory pattern for patients with posttraumatic headache could not be identified. Further research is needed to clarify the underlying mechanisms and biomarkers for prediction of development and persistence of posttraumatic headache.
      Citation: Cephalalgia
      PubDate: 2021-08-18T06:49:43Z
      DOI: 10.1177/03331024211030496
       
  • Perinatal outcomes in women affected by different types of headache
           disorders: A prospective cohort study

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      Authors: Isabella Neri, Daniela Menichini, Francesca Monari, Ludovica Spanò Bascio, Federico Banchelli, Fabio Facchinetti
      Abstract: Cephalalgia, Ahead of Print.
      Abstract ObjectiveThis study aims to investigate pregnancy and perinatal outcomes in women with tension-type headache, migraine without aura and migraine with aura by comparing them to women without any headache disorders.Study designProspective cohort study including singleton pregnancies attending the first trimester aneuploidy screening at the University Hospital of Modena, in Northern Italy, between June 2018 and December 2019.ResultsA total of 515 consecutive women were included and headache disorders were reported in 43.5% of them (224/515). Tension-type headache was diagnosed in 24.3% of the cases, while 14% suffered from migraine without aura and 5.2% from migraine with aura. Birthweight was significantly lower in women affected by migraine with aura respective to other groups, and a significantly higher rate of small for gestational age infants was found in tension-type headache (10.4%) and in migraine with aura (24.9%) groups respective to the others (p 90th centile (OR 3.66, p = 0.01), low multiple of the median (MoM) of Pregnancy-associated plasma protein-A (PAPP-A) (OR 0.48, p = 0.05) and high MoM of Inhibin-A (OR 3.24, p = 0.03) at first trimester, are independently associated with the delivery of small for gestational age infants when compared to women without headache disorders. ConclusionMigraine with aura and tension type headache expose women to an increased risk of delivering small for gestational age infants, in association with some utero-placenta markers evaluated at first trimester. These women with headache disorders have an additional indication to undergo first trimester aneuploidy screening and would possibly benefit from specific interventions.
      Citation: Cephalalgia
      PubDate: 2021-07-20T11:04:04Z
      DOI: 10.1177/03331024211029236
       
  • Diagnosis and classification of headache associated with sexual activity
           using a composite algorithm: A cohort study

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      Authors: Po-Tso Lin, Yen-Feng Wang, Jong-Ling Fuh, Jiing-Feng Lirng, Yu-Hsiang Ling, Shih-Pin Chen, Shuu-Jiun Wang
      Abstract: Cephalalgia, Ahead of Print.
      BackgroundTo differentiate primary headache associated with sexual activity from other devastating secondary causes.MethodsIn this prospective cohort, we recruited consecutive patients with at least 2 attacks of headache associated with sexual activity from the headache clinics or emergency department of a national medical center from 2005 to 2020. Detailed interview, neurological examination, and serial thorough neuroimaging including brain magnetic resonance imaging and magnetic resonance angiography scans were performed on registration and during follow-ups. Patients were categorized into four groups, i.e. primary headache associated with sexual activity, reversible cerebral vasoconstriction syndrome, probable reversible cerebral vasoconstriction syndrome, and other secondary headache associated with sexual activity through a composite clinic-radiological diagnostic algorithm. We compared the clinical profiles among these groups, including sex, age of onset, duration, quality, and clinical course (“chronic” indicates disease course ≥ 1 year). In addition, we also calculated the score of the reversible cerebral vasoconstriction syndrome2, a scale developed to differentiate reversible cerebral vasoconstriction syndrome from other intracranial vascular disorders.ResultsOverall, 245 patients with headache associated with sexual activity were enrolled. Our clinic-radiologic composite algorithm diagnosed and classified all patients into four groups, including 38 (15.5%) with primary headache associated with sexual activity, 174 (71.0%) with reversible cerebral vasoconstriction syndrome, 26 (10.6%) with probable reversible cerebral vasoconstriction syndrome, and 7 (2.9%) with other secondary causes (aneurysmal subarachnoid hemorrhage (n = 4), right internal carotid artery dissection (n = 1), Moyamoya disease (n = 1), and meningioma with hemorrhage (n = 1)). These four groups shared similar clinical profiles, except 26% of the patients with primary headache associated with sexual activity had a 3 times greater chance of running a chronic course (≥ 1 year) than patients with reversible cerebral vasoconstriction syndrome. Of note, the reversible cerebral vasoconstriction syndrome2 score could not differentiate reversible cerebral vasoconstriction syndrome from other groups.ConclusionOur composite clinic-radiological diagnostic algorithm successfully classified repeated headaches associated with sexual activity, which were predominantly secondary and related to vascular disorders, and predicted the prognosis. Primary headache associated with sexual activity and reversible cerebral vasoconstriction syndrome presented with repeated attacks of headache associated with sexual activity may be of the same disease spectrum.
      Citation: Cephalalgia
      PubDate: 2021-07-19T04:45:26Z
      DOI: 10.1177/03331024211028965
       
  • Pain in the temple' Headache, muscle pain or both: A retrospective
           analysis

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      Authors: Fernando G Exposto, Nicole Renner, Karina H Bendixen, Peter Svensson
      Abstract: Cephalalgia, Ahead of Print.
      AimHeadache attributed to temporomandibular disorders and myalgia are two diagnoses included in the diagnostic criteria for temporomandibular disorders (DC/TMD). However, it is not clear if these two diagnoses are different clinical entities given their similar presentation and way in which they are diagnosed, when the myalgia is within the temporalis muscle. The purpose of this retrospective study was to assess the overlap between headache attributed to temporomandibular disorders and myalgia of the temporalis muscle.MethodsThe charts of 671 patients seeking treatment at the Section of Orofacial Pain and Jaw Function, Aarhus University, Denmark, between January 2015 and February 2020 were screened for a diagnosis of headache attributed to temporomandibular disorders, myalgia of the temporalis muscle, or both.ResultsA total of 89 patients fulfilled the DC/TMD criteria for either headache attributed to TMD, myalgia of the temporalis or both. Of these, two had a diagnosis of headache attributed to TMD, 16 of myalgia of the temporalis, and 71 were diagnosed with both. In 97.3% of the times that headache attributed to temporomandibular disorders was diagnosed, the patient was also diagnosed with myalgia of the temporalis. The Jaccard index was 0.8, indicating a substantial overlap between the two diagnoses. Finally, the overlap of pain location between the two diagnoses was substantial, with a Jaccard index of 0.9.ConclusionsIn the present study, headache attributed to temporomandibular disorders was almost exclusively diagnosed together with myalgia of the temporalis. Therefore, we propose that headache attributed to temporomandibular disorders and myalgia of the temporalis muscle have more clinical similarities than differences and as such could be considered one single clinical entity. Further studies will be needed to address the clinical consequences of this proposal.
      Citation: Cephalalgia
      PubDate: 2021-07-19T04:45:25Z
      DOI: 10.1177/03331024211029234
       
  • Delivery of care for migraine in the Asian Oceanian region: A
           cross-sectional study

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      Authors: Artemio Roxas, Liz Edenberg Quiles, Shuu-Jiun Wang
      Abstract: Cephalalgia, Ahead of Print.
      ObjectiveTo determine the current availability of care for headaches, in particular migraine in the Asian Oceanian region.MethodA questionnaire-based, cross-sectional study from August 2020 to February 2021, surveyed country representatives from the member countries of the Asian Oceanian Association of Neurology. The items of the survey were influenced by the findings and recommendations of the 2011 Atlas of Headache by Lifting the Burden and the World Health Organization.ResultsRespondents from all of the 21 member countries of the Asian Oceanian Association of Neurology and 3 other Asian countries participated in this survey. All countries have an established neurological association except for Brunei where there are only 6 neurologists. Thirteen countries (54%) have a dedicated council for headaches. The majority have no subspecialty training program for headaches (75%). Prevalence studies are available in 14 countries while 10 out of the 24 have clinical practice guidelines. Among the 6 countries who offer subspecialty training for headache, only 3 countries cater foreign neurologists. Most of the countries have a wide selection of non-specific migraine drugs. All countries except for Mongolia have at least 1 triptan but non-oral forms for triptans are only available in 8 countries. Monoclonal antibody for migraine prophylaxis is available in 12 out of 24 countries (50%). The majority of respondents agree that migraine is under-diagnosed and under-treated by non-neurologists and that more time should be allotted for lectures dedicated to primary headaches in medical schools.ConclusionThe survey showed the scarcity of clinical guidelines, subspecialty training, dedicated headache clinics, and patient advocacy organization for the care of headache patients in the participating countries. Acute and prophylactic medications approved for migraine are available in most countries but approved non-pharmacologic devices are lacking. The recommendations in the 2011 Atlas of Headache Disorders are still to be achieved.
      Citation: Cephalalgia
      PubDate: 2021-07-19T04:45:24Z
      DOI: 10.1177/03331024211024153
       
  • Naratriptan is as effective as sumatriptan for the treatment of migraine
           attacks when used properly. A mini-review

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      Authors: Peer Tfelt-Hansen
      Abstract: Cephalalgia, Ahead of Print.
      BackgroundNaratriptan, marketed in a low oral dose of 2.5 mg, is generally regarded as a less-effective triptan with a slower onset of action than most other triptans in the treatment of migraine attacks. In this review, naratriptan will be compared with sumatriptan, the standard triptan.MethodsPapers on pharmacodynamics and pharmacokinetics and results from comparative clinical trials with oral and subcutaneous naratriptan versus other triptans were retrieved from PubMed.ResultsNaratriptan and sumatriptan have similar effects in relevant animal models. In a randomized controlled trial, oral naratriptan 2.5 mg is less effective than oral sumatriptan 100 mg after both 2 h and 4 h. In contrast, oral naratriptan 10 mg has a similar time-effect curve as oral sumatriptan 100 mg, in both its steepness and the efficacy at 2 h and 4 h. Subcutaneous naratriptan 10 mg (88% pain free at 2 h) was in one trial superior to subcutaneous sumatriptan 6 mg (55% pain free at 2 h).ConclusionNaratriptan was marketed for the treatment of migraine attacks as the “gentle triptan” in a low oral dose of 2.5 mg, a dose with no more adverse events than placebo. This low dose results in the slow onset of action and low efficacy of oral naratriptan, but in high doses oral naratriptan is similar to oral sumatriptan. Based on one randomized controlled trial, subcutaneous naratriptan has probably the greatest effect of any triptan.
      Citation: Cephalalgia
      PubDate: 2021-07-19T04:45:24Z
      DOI: 10.1177/03331024211028959
       
  • CGRP measurements in human plasma – a methodological study

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      Authors: Karl Messlinger, Birgit Vogler, Annette Kuhn, Julika Sertel-Nakajima, Florian Frank, Gregor Broessner
      Abstract: Cephalalgia, Ahead of Print.
      BackgroundCalcitonin gene-related peptide plasma levels have frequently been determined as a biomarker for primary headaches. However, published data is often inconsistent resulting from different methods that are not precisely described in most studies.MethodsWe applied a well-proven enzyme-linked immunosorbent assay to measure calcitonin gene-related peptide concentrations in human blood plasma, we modified parameters of plasma preparation and protein purification and used calcitonin gene-related peptide-free plasma for standard solutions, which are described in detail.ResultsCalcitonin gene-related peptide levels are stable in plasma with peptidase inhibitors and after deep-freezing. Calcitonin gene-related peptide standard solutions based on synthetic intercellular fluid or pooled plasma with pre-absorbed calcitonin gene-related peptide influenced the measurements but yielded both comprehensible results. In a sample of 56 healthy subjects the calcitonin gene-related peptide plasma levels varied considerably from low (500 pg/mL) values. After a 12-hour exposure of these subjects to normobaric hypoxia the individual calcitonin gene-related peptide levels remained stable.ConclusionBuffering with peptidase inhibitors and immediate freezing or processing of plasma samples is essential to achieve reliable measurements. Individuals show considerable differences and partly high calcitonin gene-related peptide plasma levels without detectable pathological reason. Thus plasma measurements are suited particularly to follow calcitonin gene-related peptide levels in longitudinal studies.The use of data for this study was approved by the Ethics Committee of the MedicalUniversity of Innsbruck (https://www.i-med.ac.at/ethikkommission/; EK Nr: 1242/2017).
      Citation: Cephalalgia
      PubDate: 2021-07-16T07:47:23Z
      DOI: 10.1177/03331024211024161
       
  • The role of neurovascular conflict in patients with multiple sclerosis and
           trigeminal neuralgia

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      Authors: Nicola Montano, Alessandro Rapisarda
      Abstract: Cephalalgia, Ahead of Print.

      Citation: Cephalalgia
      PubDate: 2021-07-14T05:15:31Z
      DOI: 10.1177/03331024211027359
       
  • Reply: The role of neurovascular contact in patients with multiple
           sclerosis

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      Authors: Navid Noory, Lars Bendtsen, Stine Maarbjerg
      Abstract: Cephalalgia, Ahead of Print.

      Citation: Cephalalgia
      PubDate: 2021-07-14T05:15:30Z
      DOI: 10.1177/03331024211027358
       
  • The molecular clock gene cryptochrome 1 (CRY1) and its role in cluster
           headache

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      Authors: Carmen Fourier, Caroline Ran, Christina Sjöstrand, Elisabet Waldenlind, Anna Steinberg, Andrea Carmine Belin
      Abstract: Cephalalgia, Ahead of Print.
      BackgroundCluster headache is a severe primary headache disorder commonly featuring a strikingly distinct circadian attack pattern. Therefore, the circadian system has been suggested to play a crucial role in the pathophysiology of cluster headache. Cryptochromes are key components of the molecular clock generating circadian rhythms and have previously been shown to be associated with several psychiatric disorders, including seasonal affective disorder, bipolar disorder, and depression.MethodsIn this case-control study, we investigated the role of cryptochrome (CRY) genes in cluster headache by screening 628 cluster headache patients and 681 controls from Sweden for four known genetic variants in the CRY1 (rs2287161 and rs8192440) and CRY2 (rs10838524 and rs1554338) genes. In addition, we analyzed CRY1 gene expression in primary fibroblast cell lines from eleven patients and ten controls.ResultsThe exonic CRY1 variant rs8192440 was associated with cluster headache on allelic level (p=0.02) and this association was even more pronounced in a subgroup of patients with reported diurnal rhythmicity of attacks (p=0.002). We found a small significant difference in CRY1 gene expression between cluster headache patients and control individuals (p=0.04), but we could not identify an effect of the associated variant rs8192440 on CRY1 expression.ConclusionsWe discovered a disease-associated variant in the CRY1 gene and slightly increased CRY1 gene expression in tissue from cluster headache patients, strengthening the hypothesis of circadian dysregulation in cluster headache. How this gene variant may contribute to the pathophysiology of the disease remains subject to further studies.
      Citation: Cephalalgia
      PubDate: 2021-07-14T05:15:29Z
      DOI: 10.1177/03331024211024165
       
  • High perceived isolation and reduced social support affect headache impact
           levels in migraine after the Covid-19 outbreak: A cross sectional survey
           on chronic and episodic patients

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      Authors: Chiara Cerami, Chiara Crespi, Sara Bottiroli, Gaia Chiara Santi, Grazia Sances, Marta Allena, Tomaso Vecchi, Cristina Tassorelli
      Abstract: Cephalalgia, Ahead of Print.
      ABSTRACTBackgroundPsychosocial variables are key factors influencing psycho-physical equilibrium in migraine patients. Social isolation and vulnerability to stressors may prevent efficient psychological adjustment negatively affecting adaptation to life changes, as that imposed during Covid-19 lockdown. Here, we explored psychosocial dimensions and changes in clinical condition during Covid-19 lockdown in migraine patients, with regard to migraine type and headache impact.MethodsSixty-four migraine patients (32 episodic and 32 chronic) and 64 healthy control subjects were included in a case-control cross-sectional study. A two-step clustering procedure split patients into two clusters, based on the Headache Impact Test. Perceived global distress, loneliness, empathy, and coping levels were compared in groups, as well as changes in clinical condition.ResultsMigraine patients reported higher general loneliness and lower social support compared to healthy control subjects. Emotional loneliness was more marked in patients with higher headache impact. This subgroup of patients more frequently reported changes in the therapeutic and care paths as the perceived cause of the occurrence of motor or extra-motor symptomatology.ConclusionsMigraine patients, especially those more severely affected, proved more vulnerable than healthy control subjects to Covid-19 lockdown. Long-lasting interruption of social interactions may be detrimental in fragile patients that are in need of structured support interventions to maintain psycho-physical wellbeing.
      Citation: Cephalalgia
      PubDate: 2021-07-14T05:15:27Z
      DOI: 10.1177/03331024211027568
       
  • Assessing migraine therapeutics

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      Authors: Cen Xu, Jeanine Bussiere
      Abstract: Cephalalgia, Ahead of Print.

      Citation: Cephalalgia
      PubDate: 2021-06-30T12:35:44Z
      DOI: 10.1177/03331024211021569
       
  • Response to letter to the Editor: Assessing migraine therapeutics

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      Authors: Kimberly D Mackenzie, Jennifer R Stratton
      Abstract: Cephalalgia, Ahead of Print.

      Citation: Cephalalgia
      PubDate: 2021-06-30T12:35:14Z
      DOI: 10.1177/03331024211021563
       
  • Randomised, controlled trial of erenumab for the prevention of episodic
           migraine in patients from Asia, the Middle East, and Latin America: The
           EMPOwER study

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      Authors: Shuu-Jiun Wang, Artemio A Roxas, Bibiana Saravia, Byung-Kun Kim, Debashish Chowdhury, Naji Riachi, Mei-Ling Sharon Tai, Surat Tanprawate, Tai Tran Ngoc, Yi Jing Zhao, Daniel D Mikol, Shaloo Pandhi, Shihua Wen, Subhayan Mondal, Nadia Tenenbaum, Peggy Hours-Zesiger
      Abstract: Cephalalgia, Ahead of Print.
      ObjectiveEMPOwER, a double-blind, randomised, phase 3 study, evaluated the efficacy and safety of erenumab in adults with episodic migraine from Asia, the Middle East, and Latin America.MethodsRandomised patients (N = 900) received monthly subcutaneous injections of placebo, erenumab 70 mg, or 140 mg (3:3:2) for 3 months. Primary endpoint was change from baseline in monthly migraine days at Month 3. Other endpoints included achievement of ≥50%, ≥75%, and 100% reduction in monthly migraine days, change in monthly acute migraine-specific medication treatment days, patient-reported outcomes, and safety assessment.ResultsAt baseline, mean (standard deviation) age was 37.5 (9.9) years, 81.9% were women, and monthly migraine days was 8.2 (2.8). At Month 3, change from baseline in monthly migraine days (primary endpoint) was −3.1, −4.2, and −4.8 days for placebo, erenumab 70 mg, and erenumab 140 mg, respectively, with a statistically significant difference for erenumab versus placebo (P = 0.002 [70 mg], P 
      Citation: Cephalalgia
      PubDate: 2021-06-26T06:31:50Z
      DOI: 10.1177/03331024211024160
       
  • Explosive sound without external stimuli following electroencephalography
           kappa rhythm fluctuation: A case report

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      Authors: Yukiyoshi Sumi, Towa Miyamoto, Satoshi Sudo, Hiroshi Kadotani, Yuji Ozeki, Makoto Imai
      Abstract: Cephalalgia, Ahead of Print.
      BackgroundThe pathology underlying exploding head syndrome, a parasomnia causing a loud sound/sense of explosion, is not well understood. Kappa rhythm is a type of electroencephalogram alpha band activity with maximum potential between contralateral temporal electrodes We report a case of preceding kappa activity before exploding head syndrome attacks.Case reportA 57-year-old woman complained of explosive sounds for 2 months; a loud sound would transpire every day before sleep onset. She was diagnosed with exploding head syndrome. During polysomnography and the multiple sleep latency test, the exploding head syndrome attacks occurred six times. A kappa wave with activity disappearing a few seconds before most exploding head syndrome attacks was observed. The alpha band power in T3-T4 derivation gradually waxed followed by termination around the attacks.ConclusionThis case demonstrated that the dynamics of kappa activity precede exploding head syndrome attacks. Finding ways to modulate electroencephalogram oscillation could elucidate their causality and lead to therapeutic intervention.
      Citation: Cephalalgia
      PubDate: 2021-06-24T05:35:18Z
      DOI: 10.1177/03331024211021773
       
  • Migraine and the development of additional psychiatric and pain disorders
           in the transition from adolescence to adulthood

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      Authors: Lucia Gerstl, Natalie Tadych, Florian Heinen, Christine Kainz, Michaela V Bonfert, Iris Hannibal, Kristina Huss, Ruth Ruscheweyh, Andreas Straube, Viola Obermeier, Rüdiger von Kries, Mirjam N Landgraf
      Abstract: Cephalalgia, Ahead of Print.
      IntroductionThe transition from childhood to adolescence and from adolescence to adulthood are vulnerable phases in life. In these phases, late or insufficient treatment of diseases may lead to chronification and favor development of additional disorders. In adolescents, migraine often has a highly negative impact on school performance and everyday life. The hypothesis of the present study was that adolescents with migraine have a higher risk for developing additional disorders such as psychiatric disorders or other pain syndromes in the course of the disease.Materials and methodsIn this study, we analyzed health insurance data of 56,597 German adolescents at the age of 15 years in the year 2006. By using the International Classification of Diseases (ICD 10), we determined a group with migraine diagnosis in the year 2006 and a control group without any headache diagnosis in 2006. We then compared both groups regarding the development of additional disorders (based on the ICD 10) during the following 10 years (2007 to 2016).ResultsAdolescents with migraine had a 2.1 fold higher risk than persons without migraine diagnosis to develop an additional affective or mood disorder, a 1.8 fold higher risk to obtain neurotic, stress-related and somatoform disorders, a 1.8 fold higher risk to subsequently suffer from behavioral syndromes, a 1.6 higher risk to get back pain and a 1.5 fold higher risk for irritable bowel syndrome during the next 10 years.ConclusionAdolescents with migraine are at risk for developing additional disorders later. Considering and addressing the patient’s risks and potential medical and psychosocial problems might improve the long-term outcome significantly.
      Citation: Cephalalgia
      PubDate: 2021-06-24T05:35:17Z
      DOI: 10.1177/03331024211021792
       
  • Poor social support and loneliness in chronic headache: Prevalence and
           effect modifiers

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      Authors: Maria Lurenda Westergaard, Cathrine Juel Lau, Karen Allesøe, Anne Helms Andreasen, Rigmor Højland Jensen
      Abstract: Cephalalgia, Ahead of Print.
      ObjectiveTo explore the prevalence of poor social support and loneliness among people with chronic headache, and how these might be effect modifiers in the relationships between chronic headache and stress, medication overuse, and self-rated health.BackgroundPoor social support and loneliness are consistently linked to worse health outcomes. There are few epidemiologic studies on their effect on headache.MethodsThe Danish Capital Region Health Survey, a cross-sectional survey, was conducted in 2017. Participants were asked about headache, pain medication use, social support, loneliness, perceived stress, and self-rated health. Data were accessed from sociodemographic registers. Logistic regression analyses were performed to test for effect modification.ResultsThe response rate was 52.6% (55,185 respondents) and was representative of the target population. People with chronic headache were more likely to report poor social support and loneliness compared to those without chronic headache (p 
      Citation: Cephalalgia
      PubDate: 2021-06-24T05:35:15Z
      DOI: 10.1177/03331024211020392
       
  • If headache has any association with hypertension, it is negative.
           Evidence from a population-based study in Nepal

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      Authors: Kedar Manandhar, Ajay Risal, Rajendra Koju, Mattias Linde, Timothy J Steiner
      Abstract: Cephalalgia, Ahead of Print.
      BackgroundHypertension and headache disorders are major contributors to public ill health, linked by a long-standing but questionable belief that hypertension is a conspicuous cause of headache. In Nepal, where hypertension is common and often untreated, we assessed the substance of this belief, hypothesising that, should hypertension be a significant cause of headache, a clear positive association between these disorders would exist.MethodsIn a cross-sectional, nationwide study, trained health workers conducted face-to-face structured interviews, during unannounced home visits, with a representative sample of the Nepalese adult population (18–65 years). They applied standard diagnostic criteria for headache disorders and measured blood pressure digitally. Hypertension was defined as systolic pressure ≥140 and/or diastolic ≥90 mm Hg.ResultsOf 2,100 participants (59.0% female, mean age 36.4 ± 12.8 years), 317 (15.1%) had hypertension (41.0% female) and 1,794 (85.4%) had headache (61.6% female; 728 migraine, 863 tension-type headache, 161 headache on ≥15 days/month [mutually exclusive diagnoses]; 42 unclassified headaches).All headache collectively was less prevalent among hypertension cases (78.9%) than non-cases (86.6%; p = 0.001). A negative association between hypertension and all headache was demonstrated in bivariate analysis (odds ratio: 0.6 [95% Confidence interval: 0.4–0.8]; p 
      Citation: Cephalalgia
      PubDate: 2021-06-20T03:46:46Z
      DOI: 10.1177/03331024211020398
       
  • A brief diagnostic screen for cluster headache: Creation and initial
           validation of the Erwin Test for Cluster Headache

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      Authors: Randika Parakramaweera, Randolph W Evans, Larry I Schor, Stuart M Pearson, Rebecca Martinez, Jacob S Cammarata, Amisha J Amin, Seung-Hee Yoo, Wei Zhang, Yuanqing Yan, Mark J Burish
      Abstract: Cephalalgia, Ahead of Print.
      Abstract ObjectiveTo use 1) newly generated data, 2) existing evidence, and 3) expert opinion to create and validate a new cluster headache screening tool.MethodsIn phase 1 of the study, we performed a prospective study of an English translation of an Italian screen on 95 participants (45 with cluster headache, 17 with other trigeminal autonomic cephalalgias, 30 with migraine, and 3 with trigeminal neuralgia). In phase 2, we performed a systematic review in PubMed of all studies until September 2019 with diagnostic screening tools for cluster headache. In phase 3, a 6-person panel of cluster headache patients, research coordinators, and headache specialists analyzed the data from the first two phases to generate a new diagnostic screening tool. Finally, in phase 4 this new screen was validated on participants at a single headache center (all diagnoses) and through research recruitment (trigeminal autonomic cephalalgias only, as recruitment was essential but was otherwise low).ResultsIn total, this study included 319 unique participants including 109 cluster headache participants (95 total participants/45 cluster headache participants in phase 1, and 224 total participants/64 cluster headache participants in phase 4). It also found 123 articles on potential screening tools in our systematic review. In phase 1, analysis of the English translation of an Italian screen generated 7 questions with high sensitivity and specificity against migraine, trigeminal neuralgia, and other trigeminal autonomic cephalalgias, but had grammatical and other limitations as a general screening tool. In phase 2, the systematic review revealed nine studies that met inclusion criteria as diagnostic screening tools for cluster headache, including four where sensitivity and specificity were available for individual questions or small groups of questions. In phase 3, this data was reviewed by the expert panel to generate a brief (6-item), binary (yes/no), written screening test. In phase 4, a total of 224 participants completed the new 6-item screening test (81 migraine, 64 cluster headache, 21 other trigeminal autonomic cephalalgias, 35 secondary headaches, 7 neuralgias, 5 probable migraine, and 11 other headache disorders). Answers to the 6 items were combined in a decision tree algorithm and three items had a sensitivity of 84% (confidence interval or 95% confidence interval 73–92%), specificity of 89% (95% confidence interval 84–94%), positive predictive value of 76% (95% confidence interval 64-85%), and negative predictive value of 93% (95% confidence interval 88–97%) for the diagnosis of cluster headache. These three items focused on headache intensity, duration, and autonomic features.ConclusionThe 3-item Erwin Test for Cluster Headache is a promising diagnostic screening tool for cluster headache.
      Citation: Cephalalgia
      PubDate: 2021-06-20T03:46:42Z
      DOI: 10.1177/03331024211018138
       
  • The presence of headache at onset in SARS-CoV-2 infection is associated
           with long-term post-COVID headache and fatigue: A case-control study

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      Authors: César Fernández-de-las-Peñas, Víctor Gómez-Mayordomo, María L Cuadrado, Domingo Palacios-Ceña, Lidiane L Florencio, Angel L Guerrero, David García-Azorín, Valentín Hernández-Barrera, Lars Arendt-Nielsen
      Abstract: Cephalalgia, Ahead of Print.
      ObjectiveTo investigate the association of headache during the acute phase of SARS-CoV-2 infection with long-term post-COVID headache and other post-COVID symptoms in hospitalised survivors.MethodsA case-control study including patients hospitalised during the first wave of the pandemic in Spain was conducted. Patients reporting headache as a symptom during the acute phase and age- and sex-matched patients without headache during the acute phase participated. Hospitalisation and clinical data were collected from medical records. Patients were scheduled for a telephone interview 7 months after hospital discharge. Participants were asked about a list of post-COVID symptoms and were also invited to report any additional symptom they might have. Anxiety/depressive symptoms and sleep quality were assessed with the Hospital Anxiety and Depression Scale and the Pittsburgh Sleep Quality Index.ResultsOverall, 205 patients reporting headache and 410 patients without headache at hospitalisation were assessed 7.3 months (Standard Deviation 0.6) after hospital discharge. Patients with headache at onset presented a higher number of post-COVID symptoms (Incident Rate Ratio: 1.16, 95% CI: 1.03–1.30). Headache at onset was associated with a previous history of migraine (Odd Ratio: 2.90, 95% Confidence Interval: 1.41–5.98) and with the development of persistent tension-type like headache as a new post-COVID symptom (Odd Ratio: 2.65, 95% CI: 1.66–4.24). Fatigue as a long-term symptom was also more prevalent in patients with headache at onset (Odd Ratio: 1.55, 95% CI: 1.07–2.24). No between-group differences in the prevalence of anxiety/depressive symptoms or sleep quality were seen.ConclusionHeadache in the acute phase of SARS-CoV-2 infection was associated with higher prevalence of headache and fatigue as long-term post-COVID symptoms. Monitoring headache during the acute phase could help to identify patients at risk of developing long-term post-COVID symptoms, including post-COVID headache.
      Citation: Cephalalgia
      PubDate: 2021-06-17T05:40:45Z
      DOI: 10.1177/03331024211020404
       
  • Erenumab prevents the occurrence of migraine attacks and not just migraine
           days: Post-hoc analyses of a phase III study

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      Authors: Hans-Christoph Diener, Messoud Ashina, Shannon Ritter, Gabriel Paiva Da Silva Lima, Soeren Rasmussen, Ronald Zielman, Peer Tfelt-Hansen
      Abstract: Cephalalgia, Ahead of Print.
      BackgroundThis post-hoc analysis was conducted to evaluate the effect of erenumab on monthly migraine days, monthly migraine attacks, and attack duration in patients with episodic migraine to investigate whether erenumab actually prevents the occurrence of migraine attacks and/or shortens them.MethodsWe conducted a post-hoc analysis of the data from the STRIVE study, in 955 patients with episodic migraine. Relative changes from baseline to mean over months 4, 5 and 6 of the double-blind treatment phase in monthly migraine days, monthly migraine attacks and mean migraine attack duration were assessed.ResultsErenumab reduced monthly migraine days and monthly migraine attacks compared with placebo in a similar way. Erenumab had only a minor impact on shortening the duration of migraine attacks.ConclusionThese post-hoc analyses demonstrate that the decrease in monthly migraine days by erenumab is mainly driven by a reduction in the frequency of monthly migraine attacks and to a much lesser extent by shortening the duration of migraine attacks.Trial registration: This study is registered at ClinicalTrials.gov (NCT02456740)
      Citation: Cephalalgia
      PubDate: 2021-05-03T05:54:49Z
      DOI: 10.1177/03331024211010308
       
  • E-diary use in clinical headache practice: A prospective observational
           study

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      Authors: Daphne S van Casteren, Iris E Verhagen, Irene de Boer, Simone de Vries Lentsch, Rolf Fronczek, Erik W van Zwet, Antoinette MaassenVanDenBrink, Gisela M Terwindt
      Abstract: Cephalalgia, Ahead of Print.
      AimTo determine whether our E-diary can be used to diagnose migraine and provide more reliable migraine-related frequency numbers compared to patients’ self-reported estimates.MethodsWe introduced a self-developed E-diary including automated algorithms differentiating headache and migraine days, indicating whether a patient has migraine. Reliability of the E-diary diagnosis in combination with two previously validated E-questionnaires was compared to a physician’s diagnosis as gold standard in headache patients referred to the Leiden Headache Clinic (n = 596). In a subset of patients with migraine (n = 484), self-estimated migraine-related frequencies were compared to diary-based results.ResultsThe first migraine screening approach including an E-headache questionnaire, and the E-diary revealed a sensitivity of 98% and specificity of 17%. In the second approach, an E-migraine questionnaire was added, resulting in a sensitivity of 79% and specificity of 69%. Mean self-estimated monthly migraine days, non-migrainous headache days and days with acute medication use were different from E-diary-based results (absolute mean difference ± standard deviation respectively 4.7 ± 5.0, 6.2 ± 6.6 and 4.3 ± 4.8).ConclusionThe E-diary including algorithms differentiating headache and migraine days showed usefulness in diagnosing migraine. The use emphasised the need for E-diaries to obtain reliable information, as patients do not reliably recall numbers of migraine days and acute medication intake. Adding E-diaries will be helpful in future headache telemedicine.
      Citation: Cephalalgia
      PubDate: 2021-05-03T05:12:47Z
      DOI: 10.1177/03331024211010306
       
 
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