Search Results (142)

Background/Objectives: Migraine is common in women and is associated with significant disability and reduced quality of life. Type D personality, characterized by negative affectivity and social inhibition, has been linked to poorer outcomes in chronic illnesses; however, its association with migraine-related impact and functioning in women has not been fully clarified. This study examined the associations of Type D personality with headache impact and overall functioning in women with migraine, with an exploratory focus on the indirect statistical associations involving psychological symptoms, pain severity, and age. Methods: In this cross-sectional study, 204 women with migraine were assessed. Type D personality was measured using the DS14, headache impact using the HIT-6, and functioning using the FAST. Anxiety and depression were measured with the HADS, and pain severity with a visual analog scale. Analyses included group comparisons, correlations, exploratory mediation analyses, and moderation analyses. Results: Type D personality was present in 41.2% of participants. Women with Type D personality had more chronic migraine, physical comorbidities, lower education and employment, and greater functional impairment. Type D personality was correlated with headache impact, functional impairment, anxiety, and depression. Anxiety and pain severity showed significant indirect statistical associations in the relationship between Type D personality and headache impact, while depression showed a significant indirect statistical association in the relationship between Type D personality and functioning. Age moderated the association between Type D personality and headache impact, with a stronger association observed in older women. Conclusions: In women with migraine, Type D personality was associated with greater functional impairment, whereas its association with headache impact was attenuated after adjustment for relevant clinical and psychological factors. Psychological symptoms and pain severity showed significant indirect statistical associations with migraine-related outcomes; however, causal inferences cannot be drawn due to the cross-sectional design. These findings highlight the potential clinical relevance of assessing personality traits and psychological symptoms in women with migraine. Full article

Background/Objectives: This study aimed to examine the associations between diet-related quality of life (DRQOL) and psychological distress, autonomic dysfunction, and migraine in patients with dizziness and balance disorders. Methods: In this retrospective cross-sectional study, 122 patients (56 men, 66 women; mean age 40.4 ± 12.8 years, minimum 14, maximum 65) from the vertigo outpatient clinic at JR Tokyo General Hospital completed self-reported questionnaires. These included the DRQOL scale, Dizziness Handicap Inventory (DHI), Hospital Anxiety and Depression Scale (HADS), Self-rating Depression Scale (SDS), Orthostatic Dysregulation (OD) checklist, and migraine assessments (POUNDing [Pulsating, duration of 4–72 h, Unilateral, Nausea, Disabling], MIDAS, migraine screener). Correlational analyses, group comparisons, and receiver operating characteristic (ROC) analyses were conducted. Results: Higher DRQOL scores indicate poorer DRQOL. DRQOL scores showed positive correlations with psychological distress (SDS: ρ = 0.57; HADS-A: ρ = 0.50; HADS-D: ρ = 0.53; all p < 0.001) and OD severity (ρ = 0.50, p < 0.001) but not with age, DHI, or individual migraine indices. Migraine screener-positive patients had significantly higher DRQOL scores (p < 0.01). DRQOL alone showed modest ability to discriminate migraine screener-positive from migraine screener-negative patients (AUC = 0.65); discrimination improved to an AUC of 0.77 in a multivariable model that also included age and sex. Conclusions: DRQOL appears to capture psychological and autonomic symptom burden rather than vestibular or headache severity, suggesting that it may serve as a complementary, patient-centered metric that adds a multidimensional perspective to conventional vestibular and headache assessments. Full article

Chronic overlapping pain conditions (COPCs) refer to a set of chronic pain disorders that frequently co-occur and may involve partially overlapping mechanisms. The U.S. National Institutes of Health currently recognizes ten COPCs: fibromyalgia, painful temporomandibular disorders, chronic low back pain, chronic migraine headache, chronic tension-type headache, irritable bowel syndrome, endometriosis, interstitial cystitis/bladder pain syndrome, vulvodynia, and myalgic encephalomyelitis/chronic fatigue syndrome. When multiple COPCs coexist, they are associated with a disproportionate multimorbidity burden, including greater pain, poorer psychological well-being, functional limitations, disability, fatigue, sleep disturbances, diminished quality of life, and increased healthcare utilization. Despite their impact, COPCs remain under-recognized, underdiagnosed, and undertreated. Combining structured literature searches and citation tracking with narrative syntheses, this review examines comorbid relationships, the burden of multimorbidity, and potentially overlapping nociplastic mechanisms. By adopting a multimorbidity-based perspective rather than a one-disease, one-treatment approach, it highlights barriers to care—including limited clinical awareness, under-recognition of additional COPCs, limited mechanistic understanding, and fragmented care—and proposes integrated strategies emphasizing prevention, systematic screening, mechanism-informed assessment, and coordinated, patient-centered multimodal management. Full article

Background/Objective: Medication overuse headache (MOH) is a disabling secondary headache disorder that arises from an underlying primary headache, most commonly migraine. Although treatment reduces headache frequency and medication overuse, the interictal burden—the impact experienced between headache attacks—remains poorly characterized over the long term. This study evaluated interictal burden and clinical outcomes two years after MOH diagnosis. Methods: This study was derived from a prospective multicenter cohort of patients with MOH, using data from a single center. Of 149 patients enrolled between April 2020 and November 2022, 117 (78.5%) completed the two-year follow-up. Clinical characteristics, medication overuse, monthly headache days, and standardized questionnaires were assessed at baseline and follow-up. Interictal burden was evaluated at two years using the Migraine Interictal Burden Scale (MIBS-4), with scores ≥5 indicating severe burden. Results: At baseline, patients (81.2% female; median age, 45.0 years) reported a median of 16.0 monthly medication days (interquartile range, 13.0–23.0). Medication overuse decreased from 100% at baseline to 24.2% at one year and 17.1% at two years. Among 117 patients with available two-year MIBS-4 data, 25 (21.4%) had severe interictal burden. Compared with those without severe burden, these patients had greater headache-related impact and disability (HIT-6: 68.0 vs. 64.0, p = 0.019; MIDAS: 110.0 vs. 36.0, p = 0.002), higher psychological burden (PHQ-9: 11.0 vs. 8.0, p = 0.032; GAD-7: 7.0 vs. 4.0, p = 0.010), and were more likely to be current smokers (20.0% vs. 4.3%, p = 0.036). Notably, 14.4% of patients with resolved medication overuse still reported severe interictal burden. Conclusions: Two years after MOH diagnosis, severe interictal burden was observed in a substantial proportion of patients and was associated with greater baseline disability and psychological distress. These findings highlight the need for long-term monitoring and management beyond initial medication withdrawal. Full article

Background: Migraine (MIG) management guidelines support a comprehensive approach combining medication, therapeutic patient education (TPE), behavioral strategies, lifestyle changes, diet, and physical activity (PA). Objective: To present an innovative interdisciplinary outpatient model for individuals with MIG, focusing on PA, sedentary behavior, eating habits (EH), metabolic health, temporomandibular disorders, and postural dysfunctions. Design: A randomized controlled trial will enroll 200 adults with MIG over two years. Inclusion criteria are chronic MIG (≥15 attacks/month for ≥3 months) or high-frequency episodic MIG (8–14 attacks/month), physical inactivity, and independent walking ability. Exclusion criteria include contraindications to PA and lack of informed consent. Participants will be randomized to standard care (SC) or an intervention group receiving TPE plus three months of supervised exercise (EXE). All participants will receive an informational brochure with nutritional tips (included in SC) and undergo: (1) neurological examination, (2) validated questionnaires, (3) kinesiological and postural assessment, and (4) gnathological evaluation. The primary outcome is change in monthly MIG frequency at 6 and 12 months; additional outcomes include disability, quality of life, and intensity of MIG, PA levels, sedentary behavior, medication use, EH, functional capabilities, postural parameters, and temporomandibular disorder-related variables. Results: Hypothetically, the intervention may reduce monthly MIG frequency by approximately 15–20% relative to baseline. Improvements may also occur in disability, quality of life, medication use, lifestyle behaviors, and psychological and cardiometabolic parameters. Conclusions: This trial will evaluate whether adding supervised EXE and TPE to SC may improve MIG outcomes compared with SC alone, supporting a comprehensive management strategy. Full article

Migraines are a common neurological disorder that significantly reduces quality of life. The sensitization of trigeminal afferents is a key factor in the development of the pain syndrome associated with migraine. Carbon monoxide (CO) is produced endogenously by heme oxygenase (HO), widely expressed in structures involved in pain processing. In our study, the role of CO in an acute and chronic nitroglycerin (NTG)-induced rat migraine model was investigated using behavioral, electrophysiological, biochemical and histological methods. The repeated administration of a CO donor (CORM-2) or an HO-1 inducer (CoPP) decreased mechanical hypersensitivity and photophobia of rats in the NTG-induced migraine model. Additionally, CORM-2 and CoPP prevented an increase in trigeminal afferent excitability, which was evaluated by the frequency of action potentials in response to KCl application. Preliminary CORM-2 or CoPP injections promoted mast cell stability in the meninges and prevented NTG-induced CGRP elevation in blood plasma. Our results suggest that exogenously or endogenously produced CO has a protective potential in preventing inflammation and the sensitization of peripheral trigeminal afferents, the activity of which underlies the occurrence of pain in migraine. This could contribute to the development of new approaches for migraine prevention. Full article

Restless legs syndrome (RLS) is a common yet underrecognized neurological disorder characterized by uncomfortable sensations and an irresistible urge to move he legs, typically following a circadian pattern. RLS frequently co-occurs with various other neurological diseases, raising questions about shared mechanisms and clinical consequences. This review synthesizes evidence on the prevalence, outcomes, and pathophysiology of RLS in various neurological disorders, including Parkinson’s disease, multiple sclerosis, migraine, dementia, stroke, epilepsy, and peripheral neuropathy. In Parkinson’s disease, RLS is linked to disease progression and dopaminergic therapy. In stroke and multiple sclerosis, RLS is associated with structural lesions at specific locations, such as the pons or spinal cord. In epilepsy, RLS is associated with refractory or nocturnal seizures. In neuropathies, disruption of small sensory fibers may contribute to RLS symptoms. In dementia, RLS adds diagnostic complexity. Overlapping mechanisms between RLS and its neurological comorbidities include altered sensorimotor processing, brainstem and spinal circuitry, and sleep/arousal regulation. RLS in neurological conditions often worsens sleep quality, mood, and fatigue, and contributes to reduced quality of life and worse outcomes. Future research should prioritize longitudinal designs, standardized diagnostic approaches, and mechanistically driven studies to clarify relationships between RLS and these neurological comorbidities. Full article

Background: Migraine is frequently associated with anxiety, depression, and reduced quality of life, contributing to substantial functional impairment. Objective: To examine longitudinal changes in affective symptoms, headache-related burden, and quality of life following repetitive transcranial magnetic stimulation (rTMS) in individuals with migraine. Methods: In this one-arm longitudinal study, 32 adults with migraine underwent 10 sessions of rTMS. Anxiety (HAMA), depression (HAMD), and migraine-specific quality of life were assessed at baseline, post-treatment, and 3-month follow-up, while headache impact (HIT-6) and disability (MIDAS) were evaluated at baseline and post-treatment. Repeated-measures analyses and paired comparisons were conducted. Results: Significant improvements over time were observed for anxiety, depression, and quality of life (all p < 0.001). Anxiety showed progressive improvement through follow-up, while depressive symptoms improved early with further consolidation at 3 months. Migraine-related quality of life increased significantly across all timepoints. Headache impact and disability decreased significantly following treatment (both p < 0.001), with large effect sizes. Conclusions: rTMS was associated with improvements in affective symptoms, migraine-related burden, and quality of life. However, given the one-arm design, these findings should be interpreted cautiously. Controlled studies are needed to confirm these results. Full article

Migraine severely impacts the quality of life of young adults. During the past few years, many studies have been done regarding the pathophysiology of this condition. There has been intense debate regarding CGRP, but research is still underway about the glymphatic system and PACAP. This review provides an overview of the current literature in this area of migraine pathophysiology. The inflammatory mediators and neuropeptides that activate trigeminovascular pathways can be accumulated during migraine attacks as a result of a failure of glymphatic clearance. Neuroinflammation, CGRP, CSD, and sleep have all been linked to the glymphatic system and migraine. In this article, we also discuss the latest hypotheses regarding the PACAP pathway in the neurophysiology of migraine. Additionally, recent research suggests that glymphatic dysfunction could enhance PACAP-mediated signaling. This article will explore possible correlations between these mechanisms and migraine pathophysiology. Full article

Background and Clinical Significance: Migraine is a common yet debilitating condition that significantly impacts personal lives, productivity, and the healthcare system. Pharmacological interventions provide relief for some migraine sufferers, but for others, are ineffective or accompanied by side effects. Emerging evidence implicates autonomic nervous system dysfunction in migraine pathophysiology, suggesting that mind–body interventions may offer a simple, cost-free therapeutic option. Case Presentation: A 61-year-old woman presented with severe daily migraines that had persisted for years despite medication and dietary changes. Upon starting a regular 10 min slow diaphragmatic breathing practice, her migraines ceased immediately. At a 12-month follow-up, she had only experienced two minor headaches and reported improvements in both daily functioning and quality of life. Conclusions: These findings underscore the potential role of autonomic imbalance in chronic migraine and the preliminary feasibility of breathing interventions as an accessible, low-risk treatment that may, for some, surpass medication in efficacy. Breathing practices may offer a viable alternative to pharmaceutical interventions that benefits both patients and healthcare systems alike. Full article

Migraine is a highly prevalent and disabling neurovascular disorder that represents a major global health burden due to its significant impact on quality of life and socioeconomic costs. Increasing evidence suggests that migraine pathophysiology involves complex interactions between neuronal hyperexcitability, vascular dysregulation, oxidative stress, and neuroinflammatory processes. Oxidative and nitrosative stress are increasingly recognized as key contributors to migraine mechanisms, influencing mitochondrial dysfunction, cortical spreading depression, and trigeminovascular activation. Nitric oxide plays a central role in these processes by regulating vascular tone, nociceptive signaling, and neurogenic inflammation through downstream pathways such as the soluble guanylate cyclase–cyclic guanosine monophosphate (NO–sGC–cGMP) signaling cascade. Dysregulation of nitric oxide signaling and increased oxidative stress may contribute to endothelial dysfunction and impaired cerebrovascular regulation observed in migraine patients. In addition, accumulating evidence highlights the role of neuroinflammatory mechanisms, including microglial activation and cytokine-mediated signaling, which may amplify nociceptive transmission within trigeminal pathways. Migraine is increasingly recognized as a systemic disorder associated with several comorbid conditions, including Parkinson’s disease, fibromyalgia, and autoimmune diseases such as Sjögren’s syndrome. This review summarizes recent advances regarding the interactions between oxidative stress, nitric oxide signaling, endothelial dysfunction, and neuroinflammation in migraine and discusses their potential therapeutic implications. Full article

Background: Migraine in older adults represents an increasingly relevant yet underrecognized clinical challenge in aging societies, where multimorbidity, frailty, and polypharmacy complicate both diagnosis and management. Although traditionally considered a disorder of younger individuals, migraine frequently persists or presents after the age of 60 with atypical features, contributing to diagnostic uncertainty. Methods: This narrative review, conducted in accordance with the SANRA principles, aims to provide a comprehensive overview of the epidemiology, clinical presentation, pathophysiology, and management of migraine in older adults, with particular emphasis on age-related complexities, therapeutic challenges, and unmet clinical needs. Results: Migraine in this population often presents with atypical or misleading features, such as aura without headache, vestibular symptoms, or overlap with cerebrovascular conditions, leading to delayed or incorrect diagnoses. The burden of disease is substantial, affecting physical function, mobility, cognition, emotional well-being, and social participation, and is further amplified by comorbid conditions including cardiovascular and metabolic disorders, mood disturbances, and chronic pain syndromes. Aging-related neurobiological changes, such as impaired pain modulation, endothelial dysfunction, and neuroinflammation, may influence disease expression and treatment response. Therapeutic management is challenged by contraindications, increased susceptibility to adverse drug effects, and the complexity of polypharmacy, highlighting the importance of individualized and non-pharmacological approaches. Conclusions: Migraine in older adults is a significant but often overlooked contributor to disability and reduced quality of life. Improved recognition of its unique clinical features and age-specific vulnerabilities is essential to optimize patient-centered care. Future research should prioritize the inclusion of older populations and the development of tailored, safe, and effective management strategies. Full article

Background: Migraine is a chronic neurological disorder with a high prevalence of psychiatric comorbidity, including anxiety and depression, which compound functional impairment and reduce health-related quality of life (HRQoL). Repetitive transcranial magnetic stimulation (rTMS) is a non-pharmacological neuromodulatory intervention targeting both pain and affective circuits; however, predictors of HRQoL improvement following rTMS remain poorly characterized. Methods: In this exploratory observational study, 32 adults with migraines underwent 10–40 rTMS sessions. Quality of life was assessed using the WHOQOL-BREF and Migraine-Specific Quality of Life Questionnaire (Migraine-QoL). Psychiatric burden, headache impact, and disability were evaluated using HAMA, HAMD, HIT-6, and MIDAS at baseline and post-intervention. Paired t-tests, Spearman correlations, and linear regression identified predictors of QoL change. Results: Both WHOQOL-BREF and Migraine-QoL improved significantly following rTMS (p < 0.001). Antipsychotic use was associated with greater overall QoL improvement (p = 0.026). Given the very small subgroup size (n = 7), this finding should be interpreted with extreme caution and considered hypothesis-generating only. Higher baseline HIT-6 and HAMA correlated with greater Migraine-QoL gains (p = 0.001 and p = 0.013). In multivariate regression, higher headache severity independently predicted Migraine-QoL improvement (R² = 0.514, p < 0.001). Conclusions: rTMS produced clinically meaningful QoL improvements in migraine. Headache burden emerged as an independent predictor, while associations with anxiety severity and antipsychotic use should be considered exploratory. Full article

Background: Migraine is a chronic illness that may impact the daily living and quality of life of affected individuals and might lead to excessive use of antimigraine medications. Quality of life in migraine patients is crucial, as it highlights the significant impact of migraines on daily activities, emotional well-being, and overall health. This study aims to assess the association between medication overuse headache and migraine-specific quality of life in migraine patients. Methods: A cross-sectional study was conducted at a neurology clinic in Riyadh, Saudi Arabia, from April 2025 to October 2025. Data about the quality of life were collected using the Migraine-Specific Quality of Life Questionnaire (MSQ). Medication overuse was identified using the International Classification of Headache Disorders, third edition (ICHD-3) criteria, and migraine severity was classified using the Migraine Symptom Severity Scale. Descriptive statistics were used to describe the study sample. Bivariate tests and multivariable linear regression were used to assess factors associated with MSQ. All statistical analyses were performed using SAS (ver. 9.4). Results: A total of 152 migraine patients were included, of whom 17.1% met the criteria for medication overuse headache (MOH). In bivariate analyses, MOH was significantly associated with lower Migraine-Specific Quality of Life (MSQ) scores across all domains (p < 0.001). Multiple adjusted linear regression confirmed MOH and migraine severity as the factors independently associated with reduced MSQ, with MOH associated with lower RR (β = –11.65), RP (β = –12.84), and EF (β = –16.23) scores (all p < 0.05). Conclusions: Medication overuse headache is common among migraine patients, affecting nearly one in six individuals in this study. It is strongly associated with increased migraine severity and a substantial reduction in quality of life across all domains. These findings highlight the critical need for early identification and appropriate management of medication overuse in clinical practice. Full article

Objective: This retrospective, intention-to-treat real-world study, designed by the Greek Research Alliance for the Study of headache and Pain (GRASP) sought to compare the effectiveness and safety of anti-CGRP monoclonal antibodies (anti-CGRP Mabs) to topiramate in preventing migraine. Patients and methods: Patients received either fremanezumab, erenumab, galcanezumab, eptinezumab, or topiramate for at least six months. Outcomes included reductions in monthly headache days (MHDs), ≥50% and ≥75% responder rates, monthly acute medication intake (MAI), MHDs with peak headache intensity ≥5 on VAS, migraine-related disability (MIDAS, HIT-6), quality of life (EQ-VAS), discontinuation rates and safety. Results: We included 409 migraine patients (median age 45.2 years), predominantly female (80%) and mostly with long-standing disease and high baseline burden. After six months, all treatments reduced MHDs. Mean MHDs decreased by −7.8 days with anti-CGRP Mabs versus −3.8 days with topiramate (p < 0.001). Higher ≥50% and ≥75% responder rates were observed across all anti-CGRP agents, compared to topiramate. Anti-CGRP Mabs also achieved greater reductions in moderate/severe MHDs, MAI, disability metrics, and superior QOL gains. Among the CGRP-targeted therapies, slight differences in effectiveness outcomes were present, though failing to demonstrate any specific superiority. Safety was favorable for anti-CGRP Mabs, whereas topiramate showed substantially higher adverse events and discontinuations. Conclusions: Anti-CGRP Mabs were more effective, produced greater reductions in disability and higher improvements quality-of-life metrics and were better tolerated than topiramate. Differences among individual anti-CGRP agents were modest and unlikely to represent a clinically meaningful superiority, supporting a class-wide benefit vs. topiramate in migraine prevention both in terms of effectiveness and safety. Full article