Serum melatonin levels and in a sample of Iranian patients with migraine.

Migraine, a complex disorder, is characterized by recurrent headache episodes. The production of melatonin in the pineal gland, which is crucial for controlling circadian rhythms and sleep-wake cycles, is altered in various conditions, including neurological disorders such as migraine. Recent studies underscore the significance of serum melatonin levels in patients with chronic and episodic migraine, the focus of this study. This case‒control study, conducted from September 2017 to June 2020 in Tehran, Iran, selected potential participants aged 18-65 years from a headache clinic at Sina Hospital (affiliated with Tehran University of Medical Sciences). Both episodic migraine and chronic migraine were diagnosed following the diagnostic criteria in the International Classification of Headache Disorders' third edition. Melatonin levels were measured according to the instructions of the ELISA kits. There were significant differences in the frequency of headache days and the duration of abortive medication usage between the two groups (P value < 0.001). Besides, analysis revealed significantly lower serum melatonin levels in patients with episodic ((80.45-45.06) 72.83) and chronic migraine ((154.34-63.34) 70.38, P value < 0.001) than in healthy controls (281.25-160.86) 280). Although no considerable differences were found between episodic and chronic migraine patients, the current study demonstrated that serum melatonin levels were substantially greater in healthy controls than in patients with migraine.

Prediction models for identifying medication overuse or medication overuse headache in migraine patients: a systematic review.

BACKGROUND: Migraine is a debilitating neurological disorder that presents significant management challenges, resulting in underdiagnosis and inappropriate treatments, leaving patients at risk of medication overuse (MO). MO contributes to disease progression and the development of medication overuse headache (MOH). Predicting which migraine patients are at risk of MO/MOH is crucial for effective management. Thus, this systematic review aims to review and critique available prediction models for MO/MOH in migraine patients. METHODS: A systematic search was conducted using Embase, Scopus, Medline/PubMed, ACM Digital Library, and IEEE databases from inception to April 22, 2024. The risk of bias was assessed using the prediction model risk of bias assessment tool. RESULTS: Out of 1,579 articles, six studies with nine models met the inclusion criteria. Three studies developed new prediction models, while the remaining validated existing scores. Most studies utilized cross-sectional and prospective data collection in specific headache settings and migraine types. The models included up to 53 predictors, with sample sizes from 17 to 1,419 participants. Traditional statistical models (logistic regression and least absolute shrinkage and selection operator regression) were used in two studies, while one utilized a machine learning (ML) technique (support vector machines). Receiver operating characteristic analysis was employed to validate existing scores. The area under the receiver operating characteristic (AUROC) for the ML model (0.83) outperformed the traditional statistical model (0.62) in internal validation. The AUROCs ranged from 0.84 to 0.85 for the validation of existing scores. Common predictors included age and gender; genetic data and questionnaire evaluations were also included. All studies demonstrated a high risk of bias in model construction and high concerns regarding applicability to participants. CONCLUSION: This review identified promising results for MO/MOH prediction models in migraine patients, although the field remains limited. Future research should incorporate important risk factors, assess discrimination and calibration, and perform external validation. Further studies with robust designs, appropriate settings, high-quality and quantity data, and rigorous methodologies are necessary to advance this field.

Phasic perfusion dynamics among migraine subtypes: a multimodel arterial spin labeling investigation.

BACKGROUND: Migraine-related perfusion changes are documented but inconsistent across studies due to limited sample size and insufficient phenotyping. The phasic and spatial dynamics across migraine subtypes remains poorly characterized. This study aimed to determine spatiotemporal dynamics of gray matter (GM) perfusion in migraine. METHODS: We prospectively recruited episodic (EM) and chronic migraine (CM) patients, diagnosed with the International Headache Society criteria and healthy controls (HCs) between 2021 and 2023 from the headache center in a tertiary medical center, and adjacent communities. Magnetic resonance (3-tesla) arterial spin labeling (ASL) was conducted for whole brain cerebral blood flow (CBF) in all participants. The voxel-wise and whole brain gray matter (GM) CBF were compared between subgroups. Spatial pattern analysis of CBF and its correlations with headache frequency were investigated regarding different migraine phases and subtypes. Sex- and age-adjusted voxel-wise and whole brain GM comparisons were performed between HCs and different EM and CM phases. Spatial pattern analysis was conducted by CBF clusters with phasic differences and spin permutation test. Correlations between headache frequency and CBF were investigated regarding different EM and CM phases. RESULTS: Totally 344 subjects (172 EM, 120 CM, and 52 HCs) were enrolled. Higher CBF in different anatomical locations was identified in ictal EM and CM. The combined panels of the specific locations with altered CBF in ictal EM on receiver operating characteristic curve analysis demonstrated areas under curve of 0.780 (vs. HCs) and 0.811 (vs. preictal EM). The spatial distribution of ictal-interictal CBF alteration of EM and CM were not correlated with each other (p = 0.665; r = - 0.018). Positive correlations between headache frequency and CBF were noted in ictal EM and CM regarding whole GM and specific anatomical locations. CONCLUSIONS: Patients with migraine exhibited unique spatiotemporal CBF dynamics across different phases and distinct between subtypes. The findings provide neurobiological insights into how selected anatomical structures engage in a migraine attack and adapt to plastic change of repeated attacks along with chronicity.

Development and Content Validity of Cervicogenic Headache Patient Questionnaire: New Tool for Assessing Severity and Impact.

BACKGROUND AND AIM: Cervicogenic headache (CGH) is a complicated and common headache disorder that may present itself with cervical spine dysfunction, irritation of the nerves, central sensitization, and muscular tension. Theoretically, this diagnosis should be an exclusionary diagnosis, considering the fact that it requires extended clinical assessment of the cervical spine and an evaluation for other primary headache types. CGH represents a clinical challenge as they habitually present with an array of nonspecific manifestations highly variable among patients. Management of CGHs is properly based on accurate diagnosis and sound understanding of the complaints of the individual. The development of CGH still carries with it a palpable gap in meaningful literature related to really effective assessment tools for the condition. The aim of the current study was to develop and investigate the validity of the content of the Cervicogenic Headache Patient Questionnaire. This questionnaire is designed especially to measure pain intensity, its impact on daily activities, disturbance in sleep, and the overall quality of life in subjects with CGHs. METHODOLOGY AND RESULTS: The content validity ratio (CVR) and Content Validity Index (CVI) have been used to thoroughly examine the content validity. Each item was rated by 10 experts for relevance and clarity. The scale consists of two main parts: demographic information and symptoms. Under the demographic section, the patient is asked for their age, sex, occupation, and any relevant medical history. The Symptom Checklist contains 10 questions concerning headache frequency, intensity, duration, location, and contributing factors, as well as how headaches affect daily activities, sleep, and quality of life. Item-CVI scores ranged from 0.60 to 1.00, and Scale-CVI/Ave was 0.95, which indicates strong overall content validity. The Scale-CVI/Universal Agreement was 0.83, meaning that most items are of high relevance. The clarity assessments resulted in I-CVI ratings of 1.00 for the majority of items. Using CVR analysis, items 1, 2, 5, 6, 7, and 10 all had a CVR of 1.00, whereas all the rest ranged from 0.40 to 0.80, suggesting unanimous agreement among the experts. CONCLUSION: The results underline the strength of the questionnaire in covering all the critical dimensions of cervicogenic headaches, such as pain, daily functioning, sleep, and quality of life. The scores provided by experts for content validity and clarity were high; hence, it is suitable for use as a comprehensive tool both in clinical and research applications.

Clinical outcomes of bariatric surgery in patients with obesity and idiopathic intracranial hypertension.

INTRODUCTION: Obesity is a major risk factor for idiopathic intracranial hypertension (IIH). Effective therapeutics for preventing disease progression and alleviating symptoms are limited. This study aims to examine the effects of bariatric surgery on clinical outcomes of IIH. METHODS: We retrospectively collected data from the medical record of 97 patients with obesity and an existing diagnosis of IIH who underwent primary bariatric surgery at the Cleveland Clinic health system in the USA between 2005 and 2023. Pre- and postoperative data on presence of symptoms and clinical markers of IIH (headaches, visual field defects, papilledema, visual symptoms), intracranial pressure, and usage of IIH medications were compared. RESULTS: A total of 97 patients (98% female, median age 46.7 years, median BMI 48.3 kg/m2) with IIH who underwent bariatric surgery including Roux-en-Y gastric bypass (n = 66, 68%), sleeve gastrectomy (n = 27, 27.8%), and gastric banding (n = 4, 4.1%) were analyzed. In a median follow-up time of 3.0 years, the median total weight loss was 24% (interquartile range, 13-33%). There was a significant improvement in headache, papilledema, visual field deficits, and visual symptoms after bariatric surgery. The mean lumbar opening pressure before and after bariatric surgery was 34.8 ± 8.2 cm CSF and 24.2 ± 7.6 cm CSF, respectively, with a mean reduction of 10.7 cm CSF (95% confidence interval, 4.7 to 16.6), p = 0.003. The dosage of acetazolamide and topiramate, as well as the number of medications taken for IIH, decreased significantly after bariatric surgery (p < 0.001). CONCLUSION: For patients who have obesity, bariatric surgery is a viable treatment modality for alleviation or improvement of symptoms of IIH.

Household income is associated with attack frequency, but not with the prevalence of headache: an analysis of self-reported headache in the general population in Germany.

BACKGROUND: Headache disorders are among the most prevalent neurological disorders worldwide. However, whether groups differing in socioeconomic position (SEP) are disproportionately affected by headache disorders has not yet been adequately clarified. Our aim was to analyse (1) the headache prevalence by socioeconomic position (SEP) and (2) the attack frequency by SEP in a German population-based adult sample. METHODS: Cross-sectional data from a random general population were used. The sample included N = 2,189 participants aged ≥ 18 years. SEP was measured using net equivalised income (NEI) and education. A binary logistic regression model tested the effect of SEP in predicting the prevalence of headache in general. Ordinal logistic regressions were modeled to predict the effect of SEP on the likelihood of attack frequency. Attack frequency was categorized in low frequency episodic headache (LFEH: 0-3 days per month), moderate frequency episodic headache (MFEH: 4-14 days per month) and chronic headache (CH: ≥ 15 days per month). RESULTS: Of the 2,189 participants, 891 reported headache in the last six months. Neither income nor education was associated with headache prevalence. However, significant differences between income groups were found for attack frequency. Compared to participants with NEI > 150%, those with NEI < 60% were 5.21 times more likely (95%CI 2.03, 13.36) to experience higher headache frequency, and those with NEI between 60 and 150% were 2.29 times more likely (95%CI 1.02, 5.11), with adjustments made for a set of potential confounders, including depressive symptoms. CONCLUSIONS: To reduce headache attacks, it is essential to address both low- and middle-income groups affected by headaches. Universal public health prevention campaigns are particularly appropriate.

Cupping Therapy for the Treatment of Migraine Headache: a systematic review and meta-analysis of clinical trials.

Objectives: Cupping therapy is a widely used complementary medicine for the treatment of migraine headaches globally. However, conflicting evidence exists on its effectiveness. To evaluate the safety and efficacy of cupping therapy in treating migraine headache disorder. Methods: Seven databases were systematically searched PubMed/MEDLINE, Clinicaltrials.gov, Cochrane CENTRAL, ScienceDirect, ProQuest, SinoMed, and the National Science and Technology Library. The primary endpoints are the treatment success and the pain intensity reduction. The secondary endpoints were adverse events (AEs) risk and improvement in quality of life (QoL), which was based on the Migraine Disability Scale (MIDAS). Subgroup analyses were performed based on the cupping techniques (wet and dry cupping) and adjunctive complementary treatments (i.e. acupuncture and/or collateral pricking). Results: Eighteen trials out of 348 records were included, pooling 1,446 participants (n = 797 received cupping therapy). Treatment success was significantly higher among those with cupping therapy (risk ratio [RR] [95% CI] = 1.83 [1.52-2.21]); with significant improvement observed only with wet cupping (RR [95% CI] = 1.88 [1.53-2.30]). The adjunctive complementary therapy did not achieve a greater amplitude of treatment success compared to cupping therapy alone. Furthermore, cupping therapy showed significant pain reduction compared to baseline (standardized mean difference [SMD] [95% CI] = 0.55 [0.39-0.70]) and achieved fewer risks of AEs (RR [95% CI] = 1.88 [1.53-2.30]). However, cupping did not improve the overall QoL (MIDAS SMD [95% CI] = -0.79 [-3.55-1.98]). Conclusion: Cupping therapy was an effective complementary modality to treat migraine headaches. However, it did not demonstrate improvement in QoL (PROSPERO CRD42024514509).

Surgical treatment delay in patients with headache disorders and neuralgia correlates with poor postoperative outcome.

INTRODUCTION: Although nerve decompression surgery has proven to be effective in reducing symptoms in patients with head and neck neuralgia and headache disorders, it is currently not part of the treatment algorithms for headache disorders. Therefore, patients wait an average of 20 years from the onset of symptoms to surgery, resulting in high conservative treatment costs ($989,275.65 per patient) and patient morbidity. This study evaluated the clinical impact of treatment delays on surgical outcomes. METHODS: Overall, 282 patients who underwent nerve decompression surgery at Weill Cornell Medicine and Massachusetts General Hospital between September 2012 and January 2024 were enrolled. Information regarding demographics, onset of symptoms, and headache characteristics was collected using patient surveys. The treatment outcome was evaluated by the percentage of symptom reduction in terms of frequency, duration, and pain intensity. An area under the receiver operating characteristic analysis was performed to determine the optimal timepoint to undergo surgery. RESULTS: Postoperative symptom reduction and time between the onset of symptoms and surgery were negatively correlated (r = -0.22; p < 0.001). The most significant difference in outcome was found at 2.9 years from symptom onset; patients who underwent surgery before this timepoint reported an average improvement of 79 ± 23% versus 67 ± 35% in those who were treated after the timepoint (p = 0.021). CONCLUSION: Our results indicate that delays in undergoing nerve decompression surgery beyond 2.9 years from symptom onset leads to less favorable postoperative outcomes, underscoring the need for timely referral to peripheral nerve surgeons when conservative management fails. Nonetheless, even with delays in surgical intervention, patients continued to experience significant symptom reduction.

Headache trajectories in children and adolescents with new onset continuous headache.

BACKGROUND: New daily persistent headache (NDPH) is a challenging and understudied primary headache disorder with no known effective treatment. Although the International Classification of Headache Disorders criteria require that the new onset continuous headache be present for at least three months before diagnosing NDPH, the biologic basis for when a new, continuous headache starts to behave as NDPH is unknown, and some pediatric headache experts consider that the minimum duration criterion could be shorter. METHODS: In this retrospective study, we reviewed the intake questionnaires and medical records of 5-17 year-olds seen in neurology clinic for headache at the Children's Hospital of Philadelphia. Those with a new onset continuous headache of at least one month in duration were eligible. The patient's self-report and clinician's description both had to indicate that the headache was new, of abrupt onset, and continuous to be included, although patients were allowed to have a prior history of infrequent headaches. We compared headache outcomes at last follow-up and at one year after continuous headache onset between those who had a continuous headache duration of 1 to <3 months ("new onset headache", or NOH) at first visit vs. those with ≥3 months (NDPH). We used multivariate regression modeling to examine for predictors of headache outcomes. RESULTS: Of 472 patient records reviewed, 172 met the inclusion criteria for analysis. Of these, 84 had a headache duration of 1 to <3 months in duration and 88 had a duration of ≥3 months. Those with shorter duration continuous headache were younger (median (interquartile range) 13.5 (11.1-15.7) vs. 15.1 (12.3-16.5) years, and less likely to have previously received a prescription preventive for the continuous headache (n = 14 (17%) vs. 26 (30%), p = 0.046), but were otherwise similar to those with NDPH in terms of baseline clinical and demographic variables. Sixty-five (74%) of those with NDPH and 60 (71%) with NOH had follow-up data. At last clinic follow-up, 41/65 (63%) with NDPH and 43/60 (72%) with NOH had experienced any headache benefit (p = 0.307), although 39/65 (60%) with NDPH and 29/60 (48%) with NOH still had continuous headache (p = 0.191). Headache duration was not associated with outcomes in multivariate regression modeling. CONCLUSIONS: Headache outcomes of children and adolescents with new onset continuous headache, whether of 1 to <3 months (NOH) or ≥3 months in duration (NDPH) are suboptimal. More research is needed to improve treatment outcomes for this patient population.

The Prophylactic Effect of Acetaminophen and Caffeine on Post Dural Puncture Headache after Spinal Anesthesia for Cesarean Section: A Randomized Double-Blind Clinical Trial.

Background: Post-dural puncture headache (PDPH) is the most common complication following spinal anesthesia among parturients undergoing cesarean section surgery. The purpose of this study was to evaluate the effectiveness of acetaminophen and caffeine in preventing PDPH. Methods: This double-blind, randomized clinical trial was conducted on 96 obstetric women, who were candidates for elective cesarean section. Following the randomization of participants into two groups, participants in the intervention group received tablets of acetaminophen (500 mg)+caffeine (65 mg), and participants in the control group received placebo tablets orally 2 hours before spinal anesthesia induction and then every 6 hours after surgery up to 24 hours. All parturients were evaluated for frequency and intensity of PDPH every 6 hours until 24 hours after surgery and then 48 and 72 hours after surgery. Overall satisfaction during the first 72 hours of postpartum was evaluated. The data were analyzed using SPSS software. P<0.05 was considered statistically significant. Results: Participants in the intervention group were 70% less likely to experience PDPH after spinal anesthesia (OR=0.31 P=0.01, 95% CI [0.12-0.77]). They also experienced significantly milder headaches 18 hours, 48 hours, and 72 hours later. Participants in the intervention group reported higher levels of satisfaction at the end of the study (P=0.01). No side effects related to the intervention were reported. Conclusion: Prophylactic administration of acetaminophen+caffeine decreases 70% the risk of PDPH and significantly attenuates pain intensity in obstetric patients who underwent spinal anesthesia for cesarean section.

Efficacy and safety of patent foramen ovale closure for mitigating migraine: a systematic review and meta-analysis of randomized trials and observational studies.

Background: Although often asymptomatic, patent foramen ovale (PFO) may cause disabling migraine symptoms. Evidence regarding PFO closure for prevention of migraine is still ambiguous and conflicting. Objectives: This study aims to analyze the efficacy and safety of PFO closure for mitigating migraine symptoms. Design: This is a systematic review and meta-analysis of randomized clinical trials (RCTs) and observational studies. Data sources and methods: A comprehensive search was conducted on the Scopus, Medline, ClinicalTrials.gov, and Cochrane Library databases up until March 12, 2024. This review incorporates literature that examines the comparison between PFO closure and control with outcome data related to migraine. We employed random-effect models to analyze the standardized mean difference (SMD) and odds ratio (OR) for presentation of the outcomes. Results: A total of five RCTs and six observational studies were incorporated. The results of our meta-analysis showed higher reduction of monthly migraine attacks from baseline (SMD -0.34; 95% CI: -0.51, -0.18, p < 0.0001, I 2 = 19%) and monthly migraine days from baseline (SMD -0.30; 95% CI: -0.53, -0.08, p = 0.009, I 2 = 0%) among PFO closure than control. However, the complete resolution of migraine (especially based on the evidence from RCTs; p = 0.24), HIT-6 score (p = 0.08), and MIDAS score (p = 0.15) did not differ significantly between two groups of intervention. The majority of adverse events reported were atrial fibrillation and access site infection/bleeding that only occurred in small proportions of patients (⩽5%). Conclusion: This study suggests better efficacy of PFO closure in reducing monthly migraine attacks and days with similar safety profile when compared to control. Registration: PROSPERO (CRD42023453635).

Stealth cryptococcus in an immunocompetent patient.

Cryptococcosis occurs primarily in immunocompromised patients. It is difficult to suspect in an immunocompetent patient presenting with a headache. The clinical manifestations of cryptococcosis can be subtle in a patient whose immune system is responding, but inadequate. This is the report of a case of fatal cryptococcosis initially misdiagnosed as a sinus headache on the basis of a telephone call, and then misdiagnosed as aseptic meningitis on the basis of mild findings and negative cerebrospinal fluid cultures. Autopsy revealed unsuspected severe cryptococcal meningoencephalitis. Cerebrospinal fluid nuclear acid amplification (NAA) panels including Cryptococcus should enable the diagnosis of unsuspected cryptococcal meningitis in most cases, but can be false positive, which could be adjudicated by cryptococcal antigen and culture. It will remain important to test for cryptococcal antigen and to maintain a broad differential diagnosis for all patients with meningitis.

Efficacy and safety of onabotulinumtoxinA in the treatment of medication overuse headache: a systematic review.

Purpose: Medication overuse headache (MOH) is a chronic headache caused by regular overuse of medications. OnabotulinumtoxinA (BoNTA) is used for preventive treatment of MOH. However, its efficacy and safety remain controversial. Methods: Seven online databases (Cochrane Library, Embase, Medline, PubMed, China National Knowledge Infrastructure, Wanfang data, and Chinese BioMedical Literature Database) were searched for relevant articles published between January 2002 and March 2024. We included randomized controlled trials (RCTs) and cohort studies on the treatment of MOH using BoNTA versus a placebo or other active treatments. Results: We retrieved 487 articles in the database search. Of these, four eligible RCTs were identified after detailed screening. A total of 1,259 patients with MOH (622 patients treated with BoNTA, 607 with placebo, and 30 with topiramate) were included in the four RCTs. We found that BoNTA significantly reduced headache frequency compared with placebo (mean difference, 1.89; 95% confidence interval (CI), 1.11-2.67; I 2 = 0%; p < 0.001). There was no significant difference between BoNTA and the placebo in terms of secondary outcomes, which included reductions in acute medication intake (MD, 1.30; 95% CI, -1.18-3.78; I 2 = 0%; p = 0.30), Migraine Disability Assessment questionnaire scores (MIDAS, MD, -4.04; 95% CI, -29.36-21.28; I 2 = 0%; p = 0.75), and Headache Impact Test scores (HIT-6, MD, 0.03; 95% CI, -1.77-1.83; I 2 = 0%; p = 0.97). BoNTA was more likely to cause adverse events (OR, 1.87; 95% CI, 1.45-2.42; I 2 = 0%; p < 0.001) than placebo. Conclusion: The results of this study show that BoNTA reduces headache frequency and is effective for the treatment of MOH. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022315845.

Atypical Presentation of Sphenoid Sinusitis With Prevertebral Involvement.

Isolated sphenoid sinusitis (ISS) is a rare but potentially serious condition, often leading to severe complications due to delayed diagnosis and treatment. This case report discusses a 75-year-old male with type 2 diabetes mellitus who presented with severe left-sided headache and neck pain. Diagnostic imaging revealed isolated sphenoid sinusitis with prevertebral extension, a rare occurrence that highlights the potential for deep neck space involvement. The patient underwent endoscopic transnasal incision and drainage of the prevertebral abscess with a left sphenoidotomy, resulting in full recovery without recurrence. This case emphasizes the importance of prompt recognition and intervention in ISS, particularly in cases with atypical presentations. The report also discusses the complex anatomy of the sphenoid sinus and its surrounding structures, the broad differential diagnosis of sphenoid sinus opacification, and the necessity for a multidisciplinary approach to management. This case contributes to the limited literature on ISS with prevertebral extension and underscores the critical need for early diagnosis and aggressive treatment to prevent severe complications.

Cyclooxygenase 2 Inhibitors for Headache After Elective Cranial Neurosurgery: Results from a Systematic Review of Efficacy of Cyclooxygenase 2 Inhibitors for Headache After Acute Brain Injury.

Headache management after acute brain injury (ABI) is challenging. Although opioids are commonly used, selective cyclooxygenase 2 inhibitors (COXIBs) may be promising alternatives. However, concerns about cardiovascular effects and bleeding risk have limited their use. We aimed at summarizing available data on efficacy of COXIBs for headache management following ABI. A systematic review was conducted through MEDLINE and Embase for articles published through September 2023 (PROSPERO identifier: CRD42022320453). No language filters were applied to the initial searches. Interventional or observational studies and systematic reviews assessing efficacy of COXIBs for headache in adults with ABI were eligible. Article selection was performed by two independent reviewers using DistillerSR. Descriptive statistics were used for data analysis, and meta-analysis was unfeasible because of study heterogeneity. Of 3190 articles identified, 6 studies met inclusion criteria: 4 randomized controlled trials and 2 retrospective cohort studies, all conducted in elective cranial neurosurgical patients (total N = 738) between 2006 and 2022. Five studies used COXIBs in the intervention group only. Of the six studies, four found a reduction in overall pain scores in the intervention group, whereas one showed improvement only at 6 h postoperatively, and one did not find significant differences. Pain scores decreased between 4 and 15%, the largest shift being from moderate to mild severity. Three studies found an overall opioid use reduction throughout hospitalization in the intervention group, whereas one reported a reduction at 12 h postoperatively only. Opioid consumption decreased between 9 and 90%. Two studies found a decrease in hospital length of stay by ~ 1 day in the intervention group. The one study reporting postoperative hemorrhage found a statistically nonsignificant 3% reduction in the intervention group. COXIBs may serve as opioid-sparing adjunctive analgesics for headache control after elective cranial surgery. Limited or no literature exists for other forms of ABI, and additional safety data remain to be elucidated.

Complete Third Nerve Palsy: A Rare Occurrence in Fulminant IIH Case Report.

Idiopathic Intracranial Hypertension (IIH) is a condition characterized by elevated intracranial pressure of unknown cause. Classic symptoms include headache, vision loss, transient visual obscurations (TVOs), diplopia (often from sixth nerve palsy), divergence insufficiency, and pulsatile tinnitus. However, atypical presentations can occur, including asymmetric or unilateral papilledema, oculomotor disturbances such as third and fourth nerve palsies, internuclear ophthalmoplegia, and olfactory dysfunction, among others. Fulminant IIH is a subtype of IIH defined as acute onset of rapid worsening of vision over days (less than 4 weeks between symptom onset and severe vision loss). This case report details a rare presentation of fulminant IIH with unilateral complete third nerve palsy.

Epidemiological linkage between migraine and diabetes mellitus: a systematic review and meta-analysis.

BACKGROUND: This study aimed to elucidate the nature and extent of the associations between diabetes mellitus (DM) and migraine through a systematic review and meta-analysis. METHODS: We searched the PubMed, Web of Science, and Scopus databases without a specified start date until June 2, 2024. Cross-sectional and cohort studies analyzing the risk of migraine in individuals with DM and vice versa were included. Studies without at least age and sex adjustments were excluded. Data were extracted to calculate odds ratios (ORs) and hazard ratios (HRs). Risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. RESULTS: Eight cross-sectional studies (131,361 patients with DM and 1,005,604 patients with migraine) and four cohort studies (103,205 patients with DM patients and 32,197 patients with migraine) were included. Meta-analyses of the cross-sectional studies showed no significant overall association between DM and migraine. Subgroup analyses revealed that type 1 diabetes reduced the odds of having migraine (OR 0.48, 95% confidence interval [CI] 0.30-0.77), while migraine without aura (MO) increased the odds of having DM (OR 1.19, 95% CI 1.02-1.39). The cohort studies indicated that DM decreased the risk of developing migraine (HR 0.83, 95% CI 0.76-0.90), and a history of migraine increased the risk of developing DM (HR 1.09, 95% CI 1.01-1.17). CONCLUSIONS: DM, particularly type 1 diabetes, is negatively associated with migraine occurrence, whereas migraine, especially MO, is positively associated with DM occurrence. However, most of the results remained at a low or very low level of evidence, indicating the need for further research.

Effectiveness and Tolerability of Anti-Calcitonin Gene-Related Peptide Therapy for Migraine and Other Chronic Headaches in Adolescents and Young Adults: A Retrospective Study in the USA.

This retrospective study assesses the efficacy and tolerability of anti-calcitonin gene-related peptide (anti-CGRP) therapy in adolescents and young adults (ages 12-21) with migraine and chronic daily headaches unresponsive to standard treatments. Migraines in this demographic significantly impair school performance, self-esteem, psychological well-being, and cognitive health. These young patients are also particularly sensitive to the side effects of conventional medications, which are often prescribed off-label and come with high insurance denial rates. Medication overuse, including analgesics, triptans, and NSAIDs, is prevalent due to treatment failures. Elevated plasma CGRP levels observed during migraines suggest that anti-CGRP therapies, successful in adult populations, may also benefit this younger age group. Over a three-year period, patients at a specialized pediatric headache center were evaluated for the impact of anti-CGRP treatments, including monoclonal antibodies (erenumab, fremanezumab, and galcanezumab) and small-molecule CGRP receptor antagonists (ubrogepant, rimegepant, and atogepant), administered either alone or in combination with OnabotulinumtoxinA. Data were extracted from the hospital's electronic medical records, and patient progress was consistently documented using a structured template for each clinic visit. Additional patient satisfaction data were collected via telephone follow-ups and patient message reviews. The study included 23 patients, primarily treated for chronic migraine (CM) (78.3%), with a smaller subset addressing episodic migraine (EM), new daily persistent headaches (NDPHs), and post-traumatic headaches (PTHs). Comprehensive demographic and clinical data, including age, treatment duration, history of preventive treatment failures, and comorbidities like psychiatric conditions and sleep disorders, were collected. Anti-CGRP therapies, particularly when combined with traditional treatments or OnabotulinumtoxinA, resulted in significant improvements: 91.3% of patients experienced reduced migraine duration and intensity, 82.6% reported improvements in other bothersome symptoms, and 73.9% saw an improved response to rescue medications. Additionally, 78.3% of patients reported a reduction in their use of rescue medications per week by more than 50%, and emergency room visits were reduced for 56.5% of patients. Significant reductions in headache days were observed in 82.6% of patients after one month and 87% after three months, with nearly 40% experiencing more than a 50% reduction in both periods. The greatest benefits were observed in patients treated for more than six months. Adverse effects were minimal, with 95.7% of patients reporting no side effects, and patient satisfaction was high, with 69.6% opting to continue treatment. Overall, this study highlights the substantial potential of anti-CGRP therapy in improving outcomes for adolescents and young adults with CM and EM, offering a promising approach for a demographic that faces considerable challenges with conventional treatment options. However, further research is needed to confirm these findings and expand clinical applications in this age group.