Search Results (1,224)

Influenza is typically framed as an acute respiratory infection, yet accumulating evidence suggests that—like SARS-CoV-2—it may trigger persistent, multi-organ morbidity consistent with a post-acute infection syndrome (“long flu”). Leveraging the nationwide FinnGen registry infrastructure, we conducted a temporally stratified disease-wide association study (DWAS) to map antecedent risk factors and long-term sequelae following clinically diagnosed influenza and COVID-19. We assembled an exposed cohort comprising 9204 individuals with influenza (ICD-10 J09–J11) and 4258 individuals with COVID-19 (ICD-10 U072) recorded in specialist inpatient/outpatient care between 1998 and 2021, and an unexposed comparator cohort of 420,005 individuals with no recorded influenza or pneumonia (J09–J18) across their available medical history. Across harmonized clinical endpoints, we fitted age- and sex-adjusted Cox proportional hazards models and controlled for multiple testing using a stringent false discovery rate threshold (FDR-adjusted p < 0.001), further interrogating temporal persistence within 1-, 5-, and 15-year windows. The DWAS revealed that both infections are associated with broad, system-spanning disease signatures extending beyond the respiratory tract, including circulatory, neurological, metabolic, musculoskeletal, digestive, mental/behavioural, ocular, and oncologic endpoints. Predisposition analyses demonstrated that infection risk is concentrated in individuals with substantial pre-existing multimorbidity, most prominently cardiovascular disease, alongside cardiometabolic, respiratory, renal, neuropsychiatric, and inflammatory conditions. Post-infection analyses identified a durable burden of incident multi-system morbidity after influenza, with particularly robust and persistent cardiovascular and neurological signatures—encompassing thromboembolic disease and major adverse cardiovascular outcomes, as well as migraine, neurodegenerative disorders, and depression—together with metabolic and renal sequelae that, in subsets, extended across multi-year horizons. Collectively, these longitudinal findings reframe influenza as a systemic event embedded within a chronic disease continuum, motivate recognition of “long flu” as a clinically meaningful post-viral risk landscape, and support intensified prevention and risk-stratified surveillance strategies alongside analogous efforts for long COVID. Full article

Background/Objectives: Vestibular migraine (VM) is one of the most prevalent causes of episodic vertigo, yet it remains underdiagnosed due to overlapping features with other vestibular disorders and the absence of definitive diagnostic tests. Vestibular evoked myogenic potentials (VEMPs) assess otolith and vestibular nerve function and may help identify pathophysiological mechanisms in VM. This systematic review aimed to evaluate the usefulness of VEMP in understanding VM, synthesize existing findings, and explore its clinical implications. Method: A systematic search was performed in PubMed, ProQuest, Scopus, Web of Science, and EMBASE up to 2025 following PRISMA guidelines. Studies were included if they assessed cVEMP and/or oVEMP in patients diagnosed with VM using established clinical criteria. Data extraction and quality assessment were conducted independently by three reviewers using Cochrane and Joanna Briggs Institute tools. A total of 2578 titles and abstracts were screened, and 28 studies met the inclusion criteria. Results: Across 28 studies, 23 reported VEMP abnormalities in VM. The most frequent findings were reduced amplitudes and increased asymmetry ratios compared to healthy controls, indicating potential otolithic dysfunction. Latency prolongations were less consistently reported. Differences between cVEMP and oVEMP findings in individuals with VM suggested variable involvement of saccular and utricular pathways, with oVEMP abnormalities appearing more prominent. Conclusions: VEMP testing reveals subtle vestibular dysfunction in VM, primarily reflected in reduced amplitude and altered asymmetry ratios. However, the association between VEMP abnormality and VM is inconclusive, specifically due to heterogeneity among the included studies. Although findings support its potential as a diagnostic adjunct, methodological variability (including variability in patient recruitment) underscores the need for standardized VEMP protocols to enhance diagnostic accuracy and comparability across studies. Full article

Background/Objectives: Dizziness is a symptom of many disorders across a wide range of etiologies. If dizzy patients are seen for vestibular evaluation with an audiologist and no vestibular reason for the patient’s dizziness is found, the medical referral pathway can become convoluted. This can leave patients feeling discouraged and unable to manage their symptoms. Clinically symptomatic chronic respiratory alkalosis (CSCRA) is an acid–base disorder that typically presents with dizziness but is unfamiliar to practitioners in vestibular and balance care settings. Methods: In a retrospective chart review deemed exempt by the Mayo Clinic Institutional Review Board, 74 patients at Mayo Clinic Arizona were included. All had consultations with both Audiology and Aerospace Medicine to assess their dizzy symptoms. Results: After completing vestibular testing, arterial blood gas (ABG) testing, and a functional test developed at Mayo Clinic Arizona called the Capnic Challenge test, 40% of patients were found to have CSCRA contributing to their dizzy symptoms. Many of these patients also had common comorbidities of CSCRA, like postural orthostatic tachycardia syndrome (POTS), migraines, and sleep apnea. Fewer than one-fourth of these patients had measurable vestibulopathies causing their dizziness. Half of the patients referred by the vestibular audiologist to Aerospace Medicine had a diagnosis of CSCRA. Conclusions: Assessment for CSCRA should be considered as a next step for patients presenting with dizziness without a vestibular component. Being aware of the prevalence of CSCRA and its comorbidities may help balance providers offer quality interprofessional referrals and improve patient quality of life. Full article

Background: Migraine is a prevalent neurological disorder associated with significant morbidity and social burden. Although various triggers for migraine have been identified, the relationship between smoking and migraine remains unclear. This study aimed to compare migraine characteristics between people with and without smoking in Saudi Arabia. Methods: A cross-sectional study using an online survey tool had been conducted in Saudi Arabia. The survey assessed migraine characteristics, smoking behaviour, demographics, and comorbidities. Statistical analyzes were performed to investigate the occurrence of migraine, smoking behaviour, and demographic factors. Descriptive statistics summarized the data, with various statistical tests employed to compare variables between groups. Results: A total of 229 participants were included in the study, with a majority being young adults (48.47%), predominantly females (66.81%), and holding a bachelor’s degree (63.32%). The study found that 19.2% of individuals with migraine were current smokers, with an average smoking duration of 9.7 years. While some reported relief from migraine pain, others experienced increased pain intensity or frequency. No significant differences were found in migraine characteristics between smokers and non-smokers, but younger individuals and males with migraine were more likely to smoke. The study highlights the complex relationship between smoking and migraine, with varying effects on individuals. Conclusions: The study underscores the lack of significant differences in migraine characteristics between smokers and non-smokers, suggesting that smoking does not play a pivotal role in the clinical presentation of migraines. This insight prompts a shift in research focus towards other potential contributors to migraines, such as genetic predispositions, environmental factors, and comorbidities. Understanding these associations can inform public health strategies aimed at alleviating migraine-related burdens. Full article

Background/Purpose: Four patients independently reported episodes of seeing a dimly flickering overlay on an otherwise intact part of their binocular visual field. The aim of the study was to describe the clinical characteristics of this episodic phenomenon, which we call dim flicker. Methods: Retrospective chart review and patient evaluation of an animated reference simulation. Results: The patients described repeated episodes of a seeing a patch of rhythmically oscillating dim flicker overlaid on a circumscribed patch of their otherwise normal binocular visual field. The flicker was typically seen at low ambient light levels and disappeared in bright light or when one or both eyes were covered. Episodes lasted seconds to minutes. Some flicker patches crossed the vertical midline. The flicker was subjectively experienced as coming from one specific eye. Compared to a 7 Hz flicker simulation, patients reported differences in location, prominence, and frequency, with the latter ranging from 3 to 10 Hz. In three patients, the flicker was sometimes experienced during aerobic exercise and in two patients sometimes when they rose at night in the dark. In one patient, the flicker corresponded to an area of ischemic macular edema secondary to central retinal vein occlusion. There was no headache during or after the flicker. Associated maladies included retinal venous congestion, central serous chorioretinopathy, arterial hypertension, atrial fibrillation, and migraine with visual aura distinctly different from the dim flicker. Conclusions: Episodes of seeing an endogenous, rhythmically oscillating transparent overlay within a confined, non-expanding part of an otherwise intact binocular visual field appears to be a distinct nosological entity that can be associated with ocular and systemic vascular disease. Full article

For decades, researchers have explored the therapeutic potential of the vagus nerve through vagus nerve stimulation (VNS). Initially developed for epilepsy, VNS has since been applied to treat resistant depression, stroke recovery, and inflammatory conditions. Transcutaneous VNS (tVNS) now offers a noninvasive alternative, fueling clinical trials in disorders ranging from rheumatoid arthritis and migraines to long COVID-19. Mechanistic studies suggest that afferent and efferent vagal fibers modulate immune responses, mood regulation, and neurotransmitter systems. The SPARC initiative has accelerated mapping of vagal circuits, enabling more precise approaches to stimulation. Despite progress, the results remain mixed: while some patients experience lasting symptom relief, others respond no better than to placebo. Depression studies, in particular, highlight both the promise and the complexity of VNS, as inflammation, motivation circuits, and gut–brain signaling emerge as key modulators. Next-generation closed-loop devices and circuit-specific targeting may improve efficacy and reduce adverse effects. VNS research thus lies at the intersection of neuromodulation, psychiatry, and immunology—offering hope for hard-to-treat conditions, yet demanding rigorous trials to separate myths from medicine. In this article, we review the current clinical and experimental applications of tVNS, analyze its mixed efficacy across psychiatric, immunological, and neurological disorders, and highlight the mechanistic insights, stimulation parameters, and emerging technologies that may shape next-generation therapies. Full article

Botulinum toxin type A (BoNT-A) is an established preventive therapy for chronic migraines; however, uncertainty remains regarding its comparative efficacy and safety. Thus, we aimed to summarize current evidence from high-quality systematic reviews of the therapeutic effects of BoNT-A in migraine management. An umbrella review was conducted following PRISMA guidelines and registered in PROSPERO. High-quality systematic reviews with meta-analysis evaluating BoNT-A efficacy were identified through five databases up to August 2024. Primary outcomes included monthly headache frequency and severity. Methodological quality and risk of bias were assessed using the umbrella review checklist. Fourteen articles were included. Overall, quantitative evidence indicated favorable effects of BoNT-A compared with placebo for chronic migraines, across headache frequency, headache severity, and acute medication use, but less efficacy than topiramate and the CGRP monoclonal antibodies (CGRPmAbs) galcanezumab and fremanezumab. Though the adverse events were frequent, BoNT-A was generally well-tolerated. Comparative data suggested superior tolerability versus topiramate and a safety profile like CGRPmAbs. Although botulinum toxin type A is widely used as a preventive treatment for chronic migraines, the available evidence supports its efficacy at a moderate level. Further head-to-head and long-term analyses are needed to clarify its comparative role alongside newer biologic treatments. Full article

Background/Objectives: Pediatric patients with primary headaches frequently exhibit diverse comorbid conditions, often rendering their headaches intractable. Early identification of and intervention for comorbid conditions are crucial for improving prognosis, yet remain challenging. We hypothesized that headache onset timing can predict the presence of these comorbid conditions. Methods: Headache onset timing of 106 pediatric patients (aged 6–17 [median: 13] years) with migraine or tension-type headache and associated comorbidities, including neurodevelopmental and sleep disorders, orthostatic intolerance (OI), and psychosocial factors, was retrospectively analyzed. Results: Headache onset timing was most frequent upon awakening (33.0%), followed by indeterminate (31.1%) and orthostatic (20.8%) onsets. OI (40.6%) and psychosocial factors (38.7%) were the most prevalent comorbid conditions. Psychosocial factors were most common in the awakening (62.9%) and indeterminate (27.3%) onset groups; OI predominated in the orthostatic group (77.3%). Multivariate analysis revealed that psychosocial factors were a significant risk factor for awakening headache (odds ratio [OR]: 4.59, 95% confidence interval [CI]: 1.80–11.71). OI was a risk factor for orthostatic onset headache (OR: 7.18, 95% CI: 1.92–26.87) and inversely associated with indeterminate headache (OR: 0.15, 95% CI: 0.04–0.54). Conclusions: Our findings suggest that detailed classification of headache onset timing can predict potential risks of specific comorbid conditions in pediatric patients. Full article

Purpose: While migraine is linked to increased cerebrovascular risk, its association with non-arteritic anterior ischemic optic neuropathy (NAION) remains underexplored. Methods: We conducted a retrospective case–control study using population-based electronic medical records. NAION patients were compared to propensity score-matched controls regarding migraine prevalence and clinical characteristics. Results: From 2001 to 2022, among 6,566,619 patients, 1629 NAION cases (mean age 67 ± 13 years; 45% female) and 6433 propensity matched controls were identified. The prevalence of migraine was similar in both groups (3.8% vs. 3.3%, p = 0.3). Among migraine patients, those with NAION (n = 62, age 62 ± 11) and controls (n = 212, age 60 ± 11) had comparable baseline characteristics, except for congestive heart failure (9.7% vs. 2.4%, p = 0.027). Within the NAION cohort, migraineurs (n = 64) were younger (62 ± 12 vs. 67 ± 13 years, p < 0.001), and had lower rates of diabetes mellitus (35% vs. 57%, p < 0.001) and peripheral vascular disease (1.6% vs. 9.6%, p = 0.03). Female migraineurs developed NAION at a younger age than females without migraine (60 ± 12 vs. 69 ± 12 years, p < 0.001); no such difference was seen in males. Multinomial logistic regression revealed that migraine was independently associated with younger age at NAION onset, particularly in patients aged <59 (OR = 5.8, p = 0.001) compared with those >70. An independent 1:4 migraine to non-migraine matched cohort (n = 310) showed similar age-dependent trends. Conclusions: While migraine was not more prevalent among NAION patients, females with migraine developed NAION at a younger age and had fewer vascular comorbidities. Congestive heart failure was more prevalent among migraine patients who developed NAION, suggesting a potential contributory role of systemic hypoperfusion. Full article

Background/Objectives: Migraine is frequently comorbid with Meniere’s disease, which may complicate interpretation of inner ear imaging and clinical diagnosis. While endolymphatic hydrops has been studied in Meniere’s disease and vestibular migraine separately, comparative imaging data for Meniere’s disease patients with and without migraine remain limited. Methods: We retrospectively analyzed 78 patients with definite Meniere’s disease who underwent endolymphatic contrast-enhanced MRI (HYbriD of Reversed image of Positive endolymph signal and native image of positive perilymph signal; or “HYDROPS”). Patients were classified as Meniere’s disease only group (n = 56), or Meniere’s disease with migraine (n = 22). The degree of endolymphatic hydrops (negative, mild, or significant) was assessed separately in the inner ear, the cochlea, and the vestibule. Results: In Meniere’s disease group, the affected ear consistently showed higher rates of significant endolymphatic hydrops compared to the healthy ear across the inner ear, cochlea, and vestibule (p < 0.01). In contrast, Meniere’s disease with migraine group showed no significant interaural differences. Meniere’s disease with migraine group showed a significantly higher frequency of significant endolymphatic hydrops in the healthy cochlea (p < 0.01). Similar patterns were observed in the inner ear (p < 0.025) and vestibule (p = 0.05), although these differences did not reach statistical significance. Bilateral hydrops was significantly more frequent in Meniere’s disease with migraine group than in Meniere’s disease group among all regions investigated (p < 0.05). Conclusions: Meniere’s disease patients with migraine exhibit a distinct endolymphatic hydrops pattern, characterized by bilateral or symmetrical hydrops and involvement of the healthy ear. These findings suggest migraine-related mechanisms may contribute to endolymphatic hydrops, and bilateral endolymphatic hydrops on endolymphatic contrast-enhanced MRI in suspected Meniere’s disease cases should prompt consideration of comorbid migraine, in addition to bilateral Meniere’s disease or asymptomatic hydrops. Full article

Headache is a common symptom during SARS-CoV-2 infection and may persist beyond three months. Both tension-type and migraine-like headaches have been described during SARS-CoV-2 infection and after immunization. The main objective was to characterize headache phenotype during SARS-CoV-2 infection and its relationship with headache recurrence following reinfection and COVID-19 vaccination in a cohort of healthcare professionals. Secondary aims included profiling primary headaches and identifying predictors of post-COVID-19 headache persistence. We included 109 participants (86.2% women, mean age 45.3 ± 2.5 years). During infection, 49.5% met ICHD-3 criteria for tension-type headache and 12.8% for migraine. Headache recurred in 62.5% after reinfection and 59.2% after vaccination. A primary-headache history was present in 77.9% of sampled patients (25.9% migraine, 47.1% tension-type). The COVID-19 headache phenotype typically mirrored patients’ previous headache type during reinfection and post-vaccination. Persistent headache beyond three months from SARS-CoV-2 infection occurred in 22.9% and was associated with fibromyalgia and obesity. These findings suggest that COVID-19-related headache often mirrors the patient’s pre-existing primary headache and tends to recur with the same phenotype following reinfection or vaccination. Full article

This essay explores how sanctity at Helfta was defined not by the perfection of song but by its interruption. The Book of Special Grace and the Herald of Divine Love praise Mechthild of Hackeborn and Gertrude the Great as singers of surpassing sweetness yet linger on the migraines, collapses, and illnesses that silenced their voices in the choir. These moments of suspension disclose muteness as more than absence: they reveal it as the paradoxical condition through which divine presence most fully resounds. Bringing sound studies into dialogue with disability studies, I argue that faltering breath, broken chant, and enforced silence function as theological and literary form. At Helfta, impairment itself becomes a hermeneutic structure, the hinge through which sanctity is revealed and narrative meaning is generated. In this framework, muteness operates as a form of narrative prosthesis—an interruption that both structures the hagiographical imagination and unsettles it by refusing cure or closure. By highlighting the fragility of voice as the very medium of divine disclosure, these texts testify that the sweetest music of Helfta lies not in unbroken chant but in silence transfigured into revelation. Full article

Background/Objectives: Migraine is a complex neurological headache disorder, and transcutaneous auricular vagus nerve stimulation (taVNS) can effectively relieve headache symptoms, but its mechanism of effect is still unclear. This study aimed to explore the regulatory effects of taVNS on the locus coeruleus (LC) and the norepinephrine (NE) system in migraine mice. Methods: C57/BL6 mice were randomly assigned to four experimental groups: the control group, model group, taVNS group, and sham taVNS group. A migraine model was established by administration of nitroglycerin. Headache behaviors were assessed using the orofacial stimulation test (OST) and the mouse grimace scale (MGS). Immunofluorescence staining was conducted to evaluate the expression of NE neurons in the LC, while Western blotting was used to determine the expression levels of α-2A adrenergic receptors in the spinal trigeminal nucleus caudalis (Sp5C). Additionally, fiber-optic recording was employed to monitor the real-time dynamics of NE release in Sp5C. Results: After taVNS intervention, the drinking time of OST in the model mice was significantly prolonged(p < 0.05), and facial expression scores were reduced (p < 0.05). TaVNS increased the number of NE neurons in the LC (p < 0.05), promoted the release of NE in Sp5C (p < 0.05), and upregulated the expression of α-2A adrenergic receptors in Sp5C (p < 0.05). Conclusions: The analgesic effects of taVNS are related to the activation of the LC-NE system and the inhibition of the decrease in Sp5C in migraine mice. Full article

Migraine is a prevalent and disabling neurological disorder with multifactorial origins and complex clinical manifestations. While pharmacologic therapies remain the cornerstone of management, a growing body of evidence highlights the role of extracranial peripheral nerve compression as a significant contributor to migraine pathophysiology in selected patients. This recognition has expanded the therapeutic role of plastic surgery, offering anatomically targeted interventions that complement or surpass traditional medical approaches for refractory cases. From a plastic surgeon’s perspective, optimal migraine care begins with accurate identification of clinical patterns, trigger-site mapping, and the judicious use of diagnostic tools such as nerve blocks and botulinum toxin. Surgical decompression techniques, including endoscopic and open approaches, address compression of the supraorbital, supratrochlear, zygomaticotemporal, greater and lesser occipital, auriculotemporal, and intranasal contact-point trigger sites. Adjunctive strategies such as autologous fat grafting further enhance outcomes by providing neuroprotective cushioning and modulating local inflammation through adipose-derived stem cell activity. Recent advances, including neuromodulation technologies, next-generation biologics, and innovations in surgical visualization, underscore the ongoing shift toward precision-based, mechanism-driven therapy. As understanding of migraine heterogeneity deepens, the integration of surgical expertise with modern neuroscience offers a comprehensive and personalized therapeutic framework. Plastic surgeons, equipped with detailed knowledge of peripheral nerve anatomy and minimally invasive techniques, play an increasingly pivotal role in the multidisciplinary management of refractory migraine. Full article

Chemotherapy-related headaches pose a significant challenge to the well-being and treatment adherence of cancer patients. Despite their prevalence, the underpinning mechanisms and pathobiology remain elusive, limiting treatment options. Herein, we review emerging causes, molecular and functional processes, and mechanisms at play, and discuss research and clinical gaps. We consider the iatrogenic and psychogenic effects of chemotherapy and highlight the need to distinguish chemotherapy-related headaches from primary headache disorders in cancer patients, including migraines or tension-type headaches. We discuss evolving biomarkers and mechanistic models that could facilitate the differential diagnosis and development of effective interventions. Given the global rise of cancer burden and better outcomes of chemotherapy with longer life expectancy, recognition of the detrimental impact of chemotherapy-related headaches and their integration into management plans are expected to improve treatment adherence and post-treatment life quality. Full article