Treatment Of Headache Research Articles

The safety and feasibility of transcranial direct current stimulation and exercise therapy for the treatment of cervicogenic headaches: A randomized pilot trial.

Our primary objective was to evaluate the safety and feasibility of transcranial direct current stimulation combined with exercise therapy for the treatment of cervicogenic headache. Our exploratory objectives compared symptoms of headache, mood, pain, and quality of life between active and sham transcranial direct stimulation combined with exercise therapy. Cervicogenic headache arises from injury to the cervical spine or degenerative diseases impacting cervical spine structure resulting in pain, reduced quality of life, and impaired function. Current standard-of-care treatments such as radiofrequency ablation, pharmacotherapy, manual therapy, and exercise therapy lack efficacy for some patients. Transcranial direct current stimulation is a neuromodulation technique that has shown promise in treating chronic pain conditions by positively altering neuronal activity but has not been evaluated as treatment for cervicogenic headache. This double-blind, sham-controlled, randomized, feasibility trial recruited 32 participants between the ages of 18 and 65 years that met the International Classification of Headache Disorders third edition criteria for cervicogenic headache. Participants were randomized to receive either active or sham transcranial direct current stimulation both combined with daily exercise therapy over 6 weeks. Transcranial direct current stimulation was applied over the primary motor cortex ipsilateral to worse pain for 20 min at 2 mA with a 30 s ramp up/down period. Recruitment, retention, and adherence were evaluated for feasibility. Safety was assessed through serious and minor adverse events and an adverse effect questionnaire. Clinical outcome measures assessed headache, pain, quality of life, and mood symptoms at pre-treatment, post-treatment, and 6- and 12-weeks post-treatment. A total of 97 participants were contacted to participate with 32 recruited, 16 randomized into each group, and 14 completing the treatment protocol in both groups. Within each group 12 (active) and nine (sham) completed treatment within the proposed 6 weeks (three sessions per week), others received 18 sessions but took longer. Exercise therapy was completed on an average of 87% of days for both groups. Transcranial direct current stimulation was safe, with no serious adverse events and one minor adverse event in the active group. Itching was a more common post-intervention complaint in the active group (64% active vs. 43% sham). Exploratory analysis revealed significant group × time interactions for average headache pain from pre- to post-treatment (β = -1.012, 95% confidence interval [CI] -1.751 to -0.273; p = 0.008), 6-weeks (β = -1.370, 95% CI -2.109 to -0.631; p < 0.001), and 12-weeks (β = -1.842, 95% CI -2.600 to -1.085; p < 0.001) post-treatment, and for neck pain from pre- to post-treatment (β = -1.184, 95% CI -2.076 to -0.292; p = 0.010) and 12-weeks (β = -1.029, 95% CI -1.944 to -0.114; p = 0.028) post-treatment favoring active vs. sham. There were no significant group × time interactions for quality of life or mood. The combination of transcranial direct stimulation and exercise therapy is safe and feasible for treating cervicogenic headache. While some promise has been shown for reducing headache and neck pain, larger scale trials with adequate power are needed to confirm these findings.

Intra-arterial lidocaine administration of lidocaine in middle meningeal artery for short-term treatment of subarachnoid hemorrhage-related headaches.

We report short- and intermediate-term effects on headaches with intra-arterial injection of lidocaine in the middle meningeal artery in patients with severe headaches associated with subarachnoid hemorrhage. We treated seven patients with intra-arterial lidocaine in doses up to 50 mg in each middle meningeal artery via a microcatheter bilaterally (except in one patient). We recorded the maximum intensity of headache (graded by 11-point numeric rating scale) prior to procedure and every day for the next 10 days or discharge, whichever came first. We identified changes in the middle meningeal artery pre- and post-intra-arterial lidocaine administration and quantified from Grade 0 (no change) to Grade 5 (severe narrowing or near occlusion of anterior and posterior dural branches or proximal middle meningeal artery that precludes adequate imaging of distal branches). We observed improvement in severity of headaches of headache in all seven subarachnoid hemorrhage patients. The resolution of headache was immediate and complete in four patients, unilateral immediate resolution in one patient, and delayed complete resolution in patient. Two patients met the definition of severe headache (defined as 2 or more days with maximum pain scores of 8 or greater or need for 3 or more different analgesics for 2 or more days) post-lidocaine treatment. One of these patients had are lapse in headache with the severity matching pretreatment severity and required a second treatment. On analysis of angiographic data, there was consistent narrowing of middle meningeal arteries after administration of intra-arterial lidocaine and was graded as 5 in 2 arteries, 4 in 10 arteries, and 3 in 2 arteries. We found that intra-arterial injection of lidocaine can result in consistent amelioration of headache in patients with subarachnoid hemorrhage. The therapeutic benefit may be related to vasoconstriction (reversal of vasodilation) in the middle meningeal arteries after administration of lidocaine.

Dialysis Headache: An Updated Literature Review.

The objective of this review is to describe recent updates in the understanding of dialysis headache. These recent findings will be placed in a historical context that reviews the clinical features, classification, epidemiology, pathophysiology, and treatment of dialysis headache. There is something intrinsic to the dialysis procedure itself that leads to headaches in susceptible individuals. Proposed mechanisms include fluid and electrolyte shifts, blood pressure parameters, the release of neuroinflammatory particles, and the mechanics of the dialysis procedure. Recent findings quantify the potential roles of CGRP and substance P in dialysis headache pathophysiology. Advances in dialysis techniques, like online hemodiafiltration, have also been found to vastly reduce headache incidence. Caffeine, which has anecdotally been considered potentially therapeutic for dialysis headache, may not actually provide benefit. Dialysis headache significantly impairs quality of life in many individuals on hemodialysis, a procedure which is itself already burdensome. A clearer understanding of the pathophysiology of dialysis headache has the potential to drive therapeutic advances.

Knowledge and use of pericranial nerve blocks in headache treatment in Mexico

Knowledge and use of pericranial nerve blocks in headache treatment in Mexico

Examining the Effect of Intramuscular vs Intravenous Metoclopramide for Treatment of Acute Headaches to Expedite Throughput in the Emergency Department

Examining the Effect of Intramuscular vs Intravenous Metoclopramide for Treatment of Acute Headaches to Expedite Throughput in the Emergency Department

Transcutaneous electrical nerve stimulation of the occipital nerves as treatment for chronic cluster headache.

Chronic cluster headache (CCH) is an excruciatingly painful condition that can be difficult to treat sufficiently with the available medical treatment options. The greater occipital nerves (GON) are of major interest in treating CCH, and various invasive treatment modalities, such as stimulating or blocking the nerves, have been applied. Because the terminal segment of the GON has a superficial course, the nerve is also accessible for non-invasive transcutaneous stimulation. Transcutaneous electrical nerve stimulation (TENS) has been suggested as a treatment for different chronic headaches, but evidence of the efficacy in patients with CCH is scarce. Additionally, no consensus exists on the optimal placement of the transcutaneous stimulation electrodes or the treatment usage pattern. In this explorative open-label clinical study, 36 patients with CCH were treated with TENS of the GON for 8-12 consecutive weeks between August 2021 and October 2023 as a separate part of the study protocol for a trial on stimulation of the GON (Clinicaltrials.gov identifier: NCT05023460). After a baseline period, TENS was used primarily as a preventive treatment, stimulating for 30 min twice daily at a minimum. The primary outcome was a change in attack frequency and safety with TENS treatment. Secondary outcomes were change in attack duration and pain intensity on the numeric rating scale, abortive treatments, and the Patient Global Impression of Change (PGIC) with TENS treatment. The change in attack frequency, duration, pain intensity, and use of abortive treatment was analyzed by comparing the baseline data with 4-weekly data from TENS treatment. The study aimed to systematically investigate the effect of TENS of the GON as a preventive treatment for CCH. Weekly attack frequency decreased from a median of 15.7 (95% confidence interval [CI] 11.2-22.1) at baseline to 11.0 (95% CI 7.4-16.4) with TENS. In all, 13 of the 36 (36%) patients had a minimum 30% reduction in attack frequency. In the group of 30% responders, the number of weekly attacks decreased from 15.8 (95% CI 9.8-24.5) at baseline to 5.8 (95% CI 3.3-10.5) attacks with TENS. Five patients became entirely or nearly attack-free. For the entire cohort, attack duration and pain intensity were also significantly reduced with TENS. The use of oxygen was reduced by 42%, and triptan injections decreased by 55%. Overall, 15 (42%) patients reported a clinically important improvement with TENS treatment, rated on the PGIC scale. The 100 Hz stimulation programs were preferred over 10 Hz. No serious adverse events were registered. Transcutaneous electrical nerve stimulation of the GON significantly reduced the frequency, intensity, and duration of weekly headache attacks in patients with severe CCH. Not all patients benefitted from TENS, but the treatment responders had a substantial improvement in their cluster headache. TENS treatment was well-tolerated with little or no side effects and could be a relevant supplement to conventional preventive treatment. A standard TENS apparatus is low cost, making the treatment accessible to most patients. This paper includes a detailed, comprehensive description of our clinical application of the therapy.

Prevalence and risk factors of headache in Chinese with stroke: a cross-sectional study based on CHARLS

BackgroundStroke ranks as the second leading cause of death worldwide. Meanwhile, headaches are considered the second leading cause of disability, and they often occur as a stroke complication. However, insufficient attention has been given to the treatment and rehabilitation of headaches among stroke patients, and the research on the epidemiology and risk factors of headaches in stroke patients in China is limited. Therefore, in this study, China Health and Retirement Longitudinal Study (CHARLS) data were utilized for a cross-sectional analysis to estimate the prevalence of headaches in stroke patients and identify the associated risk factors.MethodThis study utilized data, which included those of participants aged 45 and above from 28 provinces across China, from the nationally representative CHARLS 2018 database. A total of 876 stroke patients and 17,469 nonstroke patients were considered in this work. Stroke diagnosis and headache status were determined based on self-reported questionnaire responses. Cross-sectional analysis determined the prevalence of headaches in patients with strokes and those without through quantification of individuals diagnosed with headaches. Categorical variables were presented as percentages and counts, and univariate and multivariate logistic regression models were used to calculate the odds ratios (OR) for the risk factors associated with headaches in stroke patients.ResultsIn the 2018 data, 328 individuals with stroke-related headaches were screened and compared with 4,249 individuals without the condition. Overall, a cross-sectional survey revealed that the headache prevalence among stroke patients reached 37.44% (95% confidence interval (CI): 34.23%-40.74%), which was higher than the overall headache prevalence among nonstroke patients 24.32% (95% CI: 23.69%-24.97%). Headaches were considerably more common in women (45.95%; 95% CI: 41.31%-50.58%) than in men (26.70%; 95% CI: 24.44%-32.97%; gender difference, p < 0.001). According to multifactorial logistic regression analysis, the risk factors for stroke-related headaches included being female (OR: 1.45, 95% CI: 1.02–2.07), residency in Central (2.50, 1.37–4.54), Eastern (1.87, 1.07–3.27), and Northwest China (2.49, 1.06–5.84), Very poor self-health (4.06, 1.90–8.68), diabetes (1.85, 1.11–3.07), shoulder pain (4.01, 2.77–5.81), back pain (2.01, 1.32–3.05), and chest pain (2.51, 1.55–4.06).ConclusionEnhancement of self-awareness of health, effective management of diabetes, and minimization of the physical discomfort in the shoulders, back, and chest may contribute to the decreased occurrence of headaches. Therefore, targeted prevention and treatment of headaches are necessary.

Exercise as an abortive treatment for cluster headaches: Insights from a large patient registry.

This study aimed to evaluate the potential of exercise as an abortive treatment for patients with cluster headache (CH). A cross-sectional survey was conducted among CH patients at a single center in Korea. Demographics and headache characteristics were compared between those who found exercise effective and those who did not. We analyzed the type and intensity of exercise used. Headache improvement was measured as intensity reduction, with ≥50% improvement defined as a reduction in intensity by half or more. Exercise intensity was categorized as moderate ("possible to talk but hard to sing") or high ("difficult to speak without pausing"). Case reports of patients exercising during CH attacks were also reviewed. Among 167 registered CH patients, 136 patients provided responses about exercise during CH attacks; 39.7% (54/136) attempted exercise as treatment. Improvement was reported by 42.6% (23/54), with ≥50% improvement in 29.6% (16/54). Patients who found exercise effective had lower Headache Impact Test-6 scores. Effective exercises included running (39.1%), squats (30.4%), and stair climbing (21.7%), with high-intensity exercise effective for 52.2% and moderate intensity for 43.5%. Among the 23 patients who benefited from exercise, 18 reported their most effective treatment, which were exercise alone in 50% (9/18), followed by exercise with triptans in 38.9% (7/18), and oxygen with or without triptans in 5.5% (1/18). About 40% of CH patients attempted exercise for acute CH management, with 30% experiencing over 50% improvement. While evidence is limited, exercise may help alleviate headaches and could be considered an adjunctive treatment for CH attacks.

Cluster headache and galcanezumab: the first real-world Brazilian study and an expert consensus on its use among other treatments

ObjectiveTo present the first Brazilian real-world results with galcanezumab and provide a consensus expert opinion on the prophylactic treatment of cluster headache (CH) in Brazil.MethodsThe first part of the study (real-world results) was observational, prospective, uncontrolled, and descriptive. A sample of 44 consecutive patients with episodic or chronic CH were evaluated and treated in a traditional tertiary clinic from March 2020 to June 2024. The second part (consensus expert opinion) consisted of a survey completed by ten Brazilian headache clinicians with at least 25 years of clinical experience, who published at least 15 headache papers and attended at least 15 national or international headache conferences.ResultsForty-four patients (86.4% men, 13.6% women) were included. The average age was 45.9 ± 14.2 years. The diagnosis was made 27.3 ± 13.6 years after the onset of headache bouts. In 84.1% of the patients, CH was classified as episodic. Verapamil, lithium, or verapamil plus lithium were prescribed to respectively, 25%, 9.1%, and 6.8% of patients. Galcanezumab was prescribed to all and the majority (65.9%) used a dose of 300 mg once. There was a reduction in headache frequency of ≥ 50% at 3 weeks in 65.9% of patients for all doses of galcanezumab, and in 72.4% of those using galcanezumab 300 mg. Verapamil was recommended as a first-line treatment by 6 of 10 experts and a second-line treatment by the other 4 experts; galcanezumab was recommended as a first-line treatment by 4 of 10 experts and as a second-line treatment by 3 of 10 experts.ConclusionsThis study presented the first real-world data with galcanezumab in Brazilian patients with CH and showed a reduction in headache frequency in most patients. A survey of Brazilian experts not meant to represent the country’s guidelines, favored galcanezumab as either the first or the second option in prophylaxis. Collectively, these results highlighted galcanezumab’s promising efficacy as a new tool in CH patients.

ПОСТПУНКЦИОННАЯ ГОЛОВНАЯ БОЛЬ: КЛИНИЧЕСКИЙ СЛУЧАЙ ПРИМЕНЕНИЯ ПЛОМБИРОВАНИЯ ЭПИДУРАЛЬНОГО ПРОСТРАНСТВА АУТОКРОВЬЮ (ПЭПА)

Abstract. Introduction. Post-dural puncture headache is the most common complication of spinal anesthesia. It is a headache caused by the loss of cerebrospinal fluid, appears or intensifies when taking an upright stance, decreases upon taking a horizontal position, and is accompanied by at least one of the following symptoms: Pain and stiffness in the neck, tinnitus, hearing loss, photophobia, and nausea. Despite the presence of numerous reviews on the prevention and treatment of post-dural puncture headache, most of them do not provide any structured recommendations. The aim of the study was to analyze the effectiveness of epidural blood patch. Materials and Methods. The article provides a case report on a patient with a post-dural puncture headache, who was treated with using the epidural blood patch technique. Results and Discussion. Patient S., 38 years old, complaining of a headache that worsens with verticalization, turned to City Clinical Hospital No. 7 named after M.N. Sadykov. It is known from the anamnesis that on the day after spinal anesthesia, when trying to verticalize, he felt a headache, that did not bother him while lying down. Infusion therapy was performed with a temporary effect. Due to the ineffectiveness of conservative therapy at the previous stage of treatment, it was decided to use an epidural blood patch. The clinical case presented demonstrates the need for limiting the period of conservative treatment of postdural headache and high effectiveness of epidural blood patch with rapid achievement of a clinical result. Conclusions. The advanced technique of epidural blood patch is much more efficient for the treatment of post-dural puncture headaches, compared to conservative treatment methods. The findings allow starting this procedure in a timely manner, improving the quality of patients’ life without wasting time on using ineffective conservative therapy.

Pain Assessment Following Opioid Administration in Aneurysmal Subarachnoid Hemorrhage Associated Headache

Background: Headache is a debilitating complication following an aneurysmal subarachnoid hemorrhage (aSAH). Despite its impact on morbidity and quality of life, limited evidence characterizes the effectiveness of opioids. Objective: The aim of this study was to evaluate opioid associated reduction in pain scores in patients with aSAH-associated headache. Methods: This is a retrospective study of adult patients with an aSAH, Hunt and Hess grades I – III, admitted to a neurosciences intensive care unit. Descriptive and inferential statistics were used to characterize headache treatment strategies and opioid associated reduction in pain scores. Results: Opioids were used in up to 97.6% of patients for the management of aSAH-associated headache. Median reduction in pain after opioid administration was −1 (IQR: -3-0). Correlation between opioid dose and change in pain scores was negligible (rs = .01). Overall, 68.8% of patients were discharged on an opioid analgesic with predictive factors being severe headache (OR 2.52; 1.04 – 6.14) and oral morphine milligram equivalents ≥60 mg per day during the hospital stay (OR 3.02; 1.22 – 7.47). Conclusions: Opioids were associated with a small reduction in pain when assessed via the NRS. An increased opioid dose did not correlate with a greater reduction in assessed pain scores. A high percentage of patients remained on opioids throughout hospitalization and were eventually discharged on an opioid. The impact of discharge opioid prescriptions and risk of opioid persistence creates a cause for concern. It is imperative that we seek improved pain management strategies for aSAH-associated headache.

Chrysanthemum indicum L. ameliorates muscle atrophy by improving glucose tolerance in CT26-induced cancer cachexia.

Cancer cachexia is associated with various metabolic mechanisms such as inflammatory response, insulin resistance, and increased muscle proteolysis. However, effective treatment methods have not yet been standardized. Chrysanthemum indicum L. (CI) is a perennial plant belonging to the Asteraceae family, and its flowers have been used for the treatment of headaches, colds, and rhinitis in Asia. This study investigated the effect of CI on cancer cachexia. We subcutaneously injected CT26 colon cancer cells (5 × 105 cells/mouse) into the right flank of BALB/c mice. After 1week, the mice were orally administered vehicle, CI (100mg/kg), or Celecoxib (50mg/kg) for 3weeks. CI improved loss of body weight and impaired glucose tolerance, but celecoxib did not recover the body weight and glucose intolerance. CI not only improved the decreased myofiber diameters but also inhibited muscle protein degradation factors, MAFbx and MuRF1. CI also increased cellular membrane GLUT4 in CT26 conditioned medium-treated C2C12 myofibers and cancer cachexia-induced mice. Furthermore, we found that linarin, a constituent of CI, was responsible for the improvement of muscle atrophy. Our findings indicate that CI can ameliorate muscle atrophy by improving glucose uptake, suggesting that CI could be a therapeutic agent for cancer cachexia.

The Q2-Approach for Percutaneous Peripheral Neuromodulation Stimulator Implant Targeting C2 Dorsal Root Ganglion at C2 Lamina for Treating Intractable Headache: A Technical Note.

Despite significant medical treatment advancements, interventional treatments for intractable headache disorders are limited. This study's objective is to detail a novel percutaneous approach ("Q2-approach") and its technical considerations for implanting peripheral neuromodulation stimulators (PNS) to the C2 dorsal root ganglion (C2-DRG) at C2 lamina, a previously unattempted target, as a treatment for intractable headache. In an outpatient setting, PNS electrodes could be percutaneously implanted at C2-DRG in patients under moderate sedation using combined ultrasound and fluoroscopic guidance. The final electrode position was determined by intraoperative patient feedback to ensure optimal stimulation. Four patients were included to demonstrate technical parameters and feasibility. Follow-ups were conducted on postoperative days 10, 30, 60, and 100-120. The Q2-approach allows safe C2-DRG PNS implants in an outpatient setting. Average operative duration was <60 minutes. All four patients achieved >50% pain relief during the 60-day implant period and 3/4 demonstrated sustained benefit beyond the implant period. No complications (e.g., lead migration or infection) were observed. The current technical note demonstrated the feasibility of a novel, safe, minimally invasive approach to access C2-DRG at the C2 lamina for the treatment of intractable headaches. The utilization of PNS on C2-DRG fills an important gap in headache management as it provides an alternative neuromodulation treatment modality to the existing destruction/denervation-based techniques.

The American Headache Society First Contact-Headache in Primary Care program: Current metrics, knowledge assessments, and direction for future initiatives.

This study examines the American Headache Society First Contact-Headache in Primary Care program metrics to date in order to assess the program's reach and provide direction for future initiatives. Approximately 4 million primary care office visits annually are headache-specific encounters. Therefore, it is important that primary care providers are knowledgeable about headache management. Recognizing the need, the American Headache Society First Contact designed the comprehensive First Contact-Headache in Primary Care program with input from an advisory board comprised of a diverse group of physicians and advanced practice providers with backgrounds in family and internal medicine, pediatrics, obstetrics and gynecology, and neurology. This is the first study to assess the reach of the program and critically examine how to best meet the needs of clinicians and patients going forward. We report descriptive statistics for the First Contact website metrics from October 2020 to June 2023 and grand rounds program data from May 2020 to December 2023. We also conducted a cross-sectional analysis of survey data from presentations conducted at two large national family medicine symposia, as well as a thematic analysis of the question: "Please indicate what areas of your practice could be enhanced or improved with additional education?" The First Contact program homepage was the second most visited page on the American Headache Society website (>100,000 views). A total of 20 podcast episodes were created for the program (>3500 plays). The First Contact program held 99 events (72 institutional grand rounds, 22 State-level meetings, and five national meetings), reaching >7000 clinicians. The institutional grand rounds and state-level meetings were held across 27 States and Washington D.C. Only 31.9% (30/94) of First Contact program events (excluding national meetings) occurred in the West census region, which has the fewest headache subspecialists and lowest headache subspecialist density in the United States. When examining survey data of participants who attended the two virtual national family medicine symposia (39.3% response rate, N = 636/1620), 85.7% (544/635) reported being "completely confident" or "veryconfident" in their ability to recognize and accurately diagnose patients presenting with a primary complaint of headache and 81.5% (517/634) reported being "completely confident" or "very confident" in their ability to develop evidence-based treatment plans that are tailored to the needs of individual patients. The use of diagnostic tools to recognize patients with migraine (60.4%, 384/636) and translating standards of care to the practice setting (42.5%, 270/636) were the most reported intended changes by participants. Most participants reported that program content was of clinical relevance and would improve their patients' outcomes (90.5% [571/631] and 90.6% [572/631], respectively). Over three-quarters (77.8%, 495/636) of participants reported areas of their practice that can be improved by additional education specifically regarding workflow, diagnosis, and management. This study evaluates one of the first national initiatives for primary care education. Data from the two First Contact Family Medicine national symposia indicate the program is generally well received with most participants reporting improved confidence and intention to implement key changes in practice to improve care for patients with headache; however, there remain areas of exploration for education that could further enhance participant experience and expand the reach of the initiatives. Areas for future programming include continued education on multifactorial approaches to headache treatment and suggestions for addressing cost, insurance, and time constraints. Also, future work may examine where the First Contact program might focus initiatives based on specific areas of need in headache care, such as geographic "desert" areas, racial and ethnic disparities, and uninsured/underinsured populations.

Digitization in the diagnosis and treatment of headache

In recent years, machine learning, particularly Natural Language Processing, has emerged as a valuable tool for analyzing unstructured health data, such as headache anamneses. Studies demonstrate that algorithms can identify specific patterns and automate headache diagnoses. Various studies have also shown that machine learning algorithms achieve high diagnostic accuracy in distinguishing between headache types, including migraine and cluster headaches. Additionally, machine learning models are being used to predict potential triggers, treatment responses, and even the progression of headache disorders. Digital headache diaries and trigger-analysis apps are becoming increasingly important in therapy. Through digital health applications, new scalable non-drug options for headache and migraine therapy are available.

Worldwide availability of medications for migraine and tension-type headache: A survey of the International Headache Society

Background In this study, we aimed to evaluate the differing global access to acute and preventive medications for migraine and tension-type headache. Methods A custom-built questionnaire created by members of the International Headache Society Juniors Group was sent to International Headache Society members worldwide, including a list of acute and preventive treatments for migraine and tension-type headache. This list was based on evidence-based medicine guidelines. For each treatment, participants were asked about availability, type of reimbursement and variability of access within their country. Results Eighty-four members completed the questionnaire providing data for 84 countries. The majority were neurologists (88%) and worked at an academic/university hospital (62%). Of participants, 36% were located in high-income economy countries and 13% were located in low-income economies. Common preventive treatments such as propranolol and topiramate were available in most countries (respectively in 99% and 92% of responding countries). Sumatriptan was available in most countries (95%), whereas other triptan availability was lower. Novel migraine treatments such as rimegepant and erenumab were only available in 14% and 46% of the assessed countries, respectively. Conclusions Availability of headache medications, ranging from simple analgesics to novel therapies migraine-specific drugs, varied greatly across the world. Actions are needed to improve effective drug availability in many countries to ensure an adequate management of people living with headache.

Causal Effects of Sleep Quality on Primary Headache and the Mediation via Gut Microbiota: A Mendelian Randomization Study.

Previous studies have shown that sleep quality plays an essential role in primary headaches to varying degrees. However, it is unclear precisely whether gut microbiota plays a critical role in mediating changes in sleep quality and affecting primary headaches. We utilized Mendelian randomization (MR) to examine the causal relationships between sleep quality and primary headaches. The data encompass eight sleep traits (staying asleep during periods of anxiety, trouble falling asleep, daytime dozing, sleep apnea syndrome, oversleeping, undersleeping, snoring, and sleeplessness). The primary statistical method employed was inverse variance weighting. Eventually, we explored whether gut microbiota mediate the relationship between sleep quality and primary headaches. Our study found that a genetic predisposition to poor sleep quality increases the risk of primary headaches. Two-step MR analysis revealed that the genus Coprococcus1 mediates the causal relationship between trouble falling asleep and cluster headaches, with a mediating effect of 23.6%. These findings could inform targeted interventions and treatments for primary headaches. This study suggests that trouble falling asleep increases the incidence of cluster headaches mediated by gut microbiota. It highlights the crucial impact of sleep quality on primary headaches.

Beyond Pain: Innovative Approaches to Tension-Type Headache Management and Treatment

Introduction: Tension-type headache (TTH) is a common neurological disorder characterized by bilateral head pain and muscle tension, affecting up to 78% of the population. Despite its prevalence, TTH has historically received less attention than migraines. However, recent years have seen increased interest in understanding its pathophysiology and treatment options. This review comprehensively analyzes TTH management, covering non-pharmacological and pharmacological approaches to guide clinical practice and future research effectively. State of Knowledge: TTHs manifest as bilateral, pressing, encircling head pain, profoundly affecting individuals' quality of life. Recent years have witnessed increased interest in TTH understanding and treatment. Non-pharmacological interventions, including behavioral modifications, exercise, dietary adjustments, sleep hygiene, physical therapy, psychotherapy, and pharmacological treatments like over-the-counter medications, prophylactic drugs, psychedelics, and botulinum toxin A, have shown promise in alleviating symptoms. Conclusion: This review highlights the multifaceted management of TTH. Non-pharmacological interventions, including behavioral modifications and psychotherapy, offer symptom relief. Body awareness therapy, exercise, and psychotherapy benefit TTH symptoms and quality of life. Paracetamol, ibuprofen, and amitriptyline are standard treatments, with emerging options like psychedelics and botulinum toxin A. Personalizing treatment and understanding TTH mechanisms pose challenges. A multidisciplinary approach is essential for enhancing management and outcomes. More research is required to identify optimal treatments and long-term efficacy. Despite challenges, progress in TTH management brings hope for better patient care.

Intranasal administration of recombinant human BDNF as a potential therapy for some primary headaches

BackgroundIn addition to its critical role in neurogenesis, brain-derived neurotrophic factor (BDNF) modulates pain and depressive behaviors.MethodsIn a translational perspective, we tested the anti-migraine activity of highly purified and characterized recombinant human BDNF (rhBDNF) in an animal model of cephalic pain based on the chronic and intermittent NTG administration (five total injections over nine days), used to mimic recurrence of attacks over a given period. To achieve this, we assessed the effects of two doses of rhBDNF (40 and 80 µg/kg) administered intranasally to adult male Sprague–Dawley rats, on trigeminal hyperalgesia (by orofacial formalin test), gene expression (by rt-PCR) of neuropeptides and inflammatory cytokines in specific areas of the brain related to migraine pain. Serum levels of CGRP, PACAP, and VIP (by ELISA) were also evaluated. The effects of rhBDNF were compared with those of sumatriptan (5 mg/kg i.p), administered 1 h before the last NTG administration.ResultsBoth doses of rhBDNF significantly reduced NTG-induced nocifensive behavior in Phase II of the orofacial formalin test. The anti-hyperalgesic effect of intranasal high-dose rhBDNF administration in the NTG-treated animals was associated with a significant modulation of mRNA levels of neuropeptides (CGRP, PACAP, VIP) and cytokines (IL-1beta, IL-10) in the trigeminal ganglion, medulla-pons, and hypothalamic area. Of note, the effects of rhBNDF treatment were comparable to those induced by the administration of sumatriptan. rhBDNF administration at both doses significantly reduced serum levels of PACAP, while the higher dose also significantly reduced serum levels of VIP.ConclusionsThe findings suggest that intranasal rhBDNF has the potential to be a safe, non-invasive and effective therapeutic approach for the treatment of primary headache, particularly migraine.

A personalized approach to the treatment of chronic tension-type headache: quality of life of patients

Objective: to evaluate the quality of life in a personalized approach to the treatment of chronic tension-type headache (CTTH) in comparison with a standard treatment protocol.Material and methods. The study involved 61 patients with CTTH. Patients were randomly divided into two groups. The first (main) group consisted of patients (n=30) who received a personalized approach with a psychotherapist contributing to the treatment. The comparison group consisted of patients (n=31) who were treated according to a standard protocol with counselling and observation by a neurologist. Pain intensity was assessed using the visual analogue pain scale (VAS). The SF-36 questionnaire was used to assess quality of life. Differences between the groups were analyzed by assessing individual changes in eight different domains of the SF-36 questionnaire for each patient.Results. In the main group, parameters characterizing the physical (pain intensity) and emotional experience of the pain (mental health, social functioning, life activity; p&lt;0.05) decreased after 6 months of treatment when a personalized approach to the treatment of CTTH was applied, compared to the control group (with a standard patient management protocol).Conclusion. The personalized approach showed an improvement of the quality of life of patients with CTTH compared with the standard protocol, allowing us to recommend it for a wider application in clinical practice.