Headache Medicine

Petasites hybridus: evidence 1A on migraine prophylaxis

Carlos Alberto Bordini — 2025-03-31

Petasites hybridus extract is part of the therapeutic arsenal for migraine prophylaxis. In this commentary, we discuss the study by Lipton et al. (2004), published in Neurology, which presents a high-quality clinical trial demonstrating the efficacy of Petasites hybridus for migraine prevention. The study, conducted by renowned researchers, classifies Petasites hybridus as a Level A treatment (established efficacy based on >2 Class I trials). Despite this strong evidence, questions often arise regarding the appropriate clinical scenarios for prescribing this medication. In addition to analyzing the findings of this seminal study, this commentary explores potential indications for Petasites hybridus in clinical practice.

Prevention of migraine in children and adolescents: results of an open-label study with special extract of Petasites hybridus root

Alexandre Kaup — 2025-03-30

Introduction

Migraine is a genetic disease that has a major impact on life. Its prevalence is estimated to be 7.7% up to the age of 20. Preventive treatment of migraine in childhood and adolescence remains a challenge, due to the few studies conducted for this population and the presence of side effects in the use of the medications used.

Method

In this article, we evaluated the prospective open study conducted by Pothmann and Danesch using Petasites hybridus extract as a preventive treatment for migraine in children (6-9 years) and adolescents (10-17 years).

Results

This open study showed that at the end of the 4 months of treatment with Petasites hydbridus the reduction in migraine attacks in the total sample was 63.2%, 67% for children aged 6 to 9 years and 61.9% for adolescents aged 10 to 17 years. The overall response rate was 77.2%, with 85.7% for the 6- to 9-year-old group and 74.1% for the 10- to 17-year-old group. There was also a reduction in the mean duration of attacks in 62.7% of patients, from approximately 10 hours to 7 hours. No significant side effects were observed.

Conclusion

Petasites hybridus proved to be a safe and effective option for the preventive treatment of migraine in children and adolescents.

Low dose Galcanezumab for treating trigeminal autonomic cephalalgias: clinical observation from Colombia and Mexico on behalf of ASOLAC

Joe Muñoz-Cerón — 2025-03-30

Background

Although evidence exists regarding the efficacy of galcanezumab in treating cluster headaches and other trigeminal autonomic cephalalgias (TACs), data on its effectiveness at lower doses are still lacking.

Objective

To report the clinical outcomes of Latin American patients treated with galcanezumab (GNZ) at a dose approved for migraine.

Methods

This case series included patients with cluster headaches, hemicrania continua, and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT-SUNA) who were treated with a 240 mg loading dose of GNZ followed by 120 mg monthly.

Results

A total of 18 subjects were included: 12 with cluster headaches, 4 with hemicrania continua, and 2 with SUNCT-SUNA who received 1 to 24 monthly cycles of GNZ. Among those with episodic cluster headaches, 7 of 8 patients experienced a reduction in attack frequency of more than 50%. In the chronic cluster headache group, this reduction was achieved in 2 of 4 patients. Additionally, 2 of the 4 patients with hemicrania continua became headache-free. In the SUNCT-SUNA group, 2 were included, both reduced their daily attack frequency from 120 to 30 and from 10 to 2, respectively.

Conclusions

These clinical observations suggest that lower doses of GNZ may be a viable option for treating Latin American patients with TACs.

Descriptive epidemiological study of migraine in three emergency departments of the public health network of Chile

Cristián Neira Osses — 2025-03-30

Background

Migraine is a prevalent neurological disorder with a significant impact on public health. This study aims to describe the epidemiological profile of migraine cases treated in three public emergency departments in Chile.

Methods

A descriptive epidemiological study was conducted using data from patients diagnosed with migraine in three emergency departments. Patient demographics, clinical presentation, and treatment approaches were analyzed.

Results

During the study period, 199,263 patients were seen across three hospitals. Migraine consultations accounted for 1.47% of visits, with 1.65% at HLF, 1.2% at HFB, and 1.58% at HCM. The majority of cases were in women at HLF and HFB, while men represented 71.6% of cases at HCM. The highest frequency of cases was observed in the active age groups.

Conclusions

This study highlights the burden of migraine in public emergency departments in Chile. The findings emphasize the need for optimized treatment protocols and preventive strategies to improve patient outcomes.

Hyperacusis and plasma levels of cytokines in migraine

Franciela Massi de Castro — 2025-03-30

Introduction
Migraine is a chronic pain that represents a public health problem and compromises quality of life, with an inflammatory factor involved in its pathophysiology.
Objective
To verify whether there is an increase in serum cytokines in patients with migraine associated with hyperacusis.
Methods
The sample consisted of 80 participants in the episodic and/or chronic migraine group, with/without aura, and 80 healthy individuals; aged 18 to 60 years of both sexes. Instruments used: ID-migraine, Migraine Disability Assessment (MIDAS); Short-Form Headache Impact Test (HIT-6), State Trait Anxiety Inventory (STAI) Y1 Y2, Beck Inventory, Allodynia and Hyperacusis Questionnaire; interleukin dosage by flow cytometry.
Results
The sample was homogeneous for sex, age and race (p>0.05). There was an association between hyperacusis and migraine (p<0.001). 41.2% of patients with migraine had hyperacusis. The majority of the population with migraine had phonophobia (87.8%); photophobia (93.7%); osmophobia (61.5%); episodic migraine (65.4%); prodrome and postdrome in 80% of them; half of them did not have aura (52%) or allodynia (53.2%). Regarding serum cytokine levels, they had higher levels of IL-2 and TNF-α (Mann-Whitney, p<0.001). INF-γ, IL-4, IL-6, IL-10 in plasma did not differ statistically between the control and migraine groups (Mann-Whitney, p>0.05). The association of hyperacusis with cytokines IL-2, IL-4 and TNFA (Mann-Whitney, p>0.05) in migraine patients was observed.
Conclusion
It was possible to verify that there was a significant difference in plasma cytokine levels between the groups. The increase in inflammatory markers indicates the possibility of complementary treatment, allowing the intervention of other professionals from multi and interdisciplinary teams.

Menstrual migraine in university students

Isabela Montegutti Coan — 2025-03-31

Introduction
Migraine is a chronic neurological disease that mostly affects women, mainly due to hormonal fluctuations during the menstrual cycle. It is estimated that menstrual migraine (MM) affects around 6% of women in reproductive age and, despite this, remains underdiagnosed, mostly due to lack of epidemiological data.
Objective
This study aims to analyze the prevalence and impacts of menstrual migraine in students at a university in the south of Santa Catarina, Brazil.
Methods
We developed a cross-sectional analytical observational study carried out with 613 female students from a university in the south of Santa Catarina. A self-administered online questionnaire was created based on the ICHD-3 migraine diagnostic criteria and the HIT-6 questionnaire, internationally validated for measuring the impacts of headaches. Furthermore, personal and sociodemographic data were collected.
Results
A prevalence of approximately 12% (n=71) of female students who met the criteria for MM was found among the 613 participants, with a mean age of 24.87 ± 6.96 years. Of these, 50.7% were using hormonal contraceptive methods, mostly combined oral contraceptives with hormone-free interval. Regarding the impacts generated by MM, 69% of the participants had a severe impact on functionality, according to the HIT-6 questionnaire, and 43.6% reported abstaining from their leisure activities approximately 1 to 4 times in the last year due to MM.
Conclusion
The results suggest that the prevalence of MM is important among the studied population and contributes to severe impacts on daily activities.

Physiotherapy Committee of Brazilian Headache Society is represented in the Physiotherapy Specialist Interest Group

Debora Bevilaqua Grossi — 2025-03-30

Acute and long-term neurological manifestations of Covid-19: insights from virology and neurology

Kirolos Eskandar — 2025-03-30

Introduction

This literature review examines the profound impact of Covid-19, caused by SARS-CoV-2, on the nervous system. While the virus is predominantly associated with respiratory complications, emerging evidence highlights its strong neurotropic potential, leading to a broad spectrum of neurological disorders. This review explores the convergence of virology and neurology, emphasizing both acute and long-term neurological consequences of the disease.

Methods

A systematic review following PRISMA guidelines was conducted using databases such as PubMed, Scopus, and Web of Science. Studies were selected based on their relevance to the pathophysiology, clinical presentations, and prolonged neurological effects of Covid-19. Preference was given to peer-reviewed research, including meta-analyses and clinical case reports published between 2020 and 2024.

Results

The review identifies various pathways through which SARS-CoV-2 affects the nervous system, including direct neuroinvasion and systemic inflammatory responses. Acute neurological conditions such as encephalitis, stroke, and Guillain-Barré syndrome have been frequently reported, while chronic complications include cognitive dysfunction, neurodegenerative disorders, and psychiatric disturbances. These findings highlight the intricate and enduring neurological burden of Covid-19.

Conclusion

Neuro-Covid presents an ongoing challenge in the post-pandemic landscape. A deeper understanding of its neurological implications is essential for enhancing patient management and shaping future research directions. This review highlights the importance of increased clinical vigilance and a multidisciplinary strategy to effectively address the complex and evolving spectrum of Covid-19-related neurological disorders.

Migraine and brain tumors: a bibliometric analysis and narrative review

Heba Ramadan — 2025-03-30

Introduction

The relationship between migraine and brain tumors remains an area of active research, with mixed findings across studies. Understanding this connection is crucial for improving clinical diagnoses and patient management.

Objective

This study aims to conduct a bibliometric analysis and narrative review to explore the trends, key contributors, and findings on the association between migraine and brain tumors.

Methodology

A total of 740 studies were retrieved from the Scopus database using search terms “migraine” AND “brain tumor” for the period January 2015 to December 2024. These studies were analyzed using VOSviewer. The review employed a combination of bibliometric techniques and narrative analysis to identify key publications, authors, institutions, and frequently discussed terms.

Results

The United States was the largest contributor, followed by Italy and the United Kingdom. BMJ Case Reports published the most documents on the topic, with Harvard Medical School being the leading institution. Key terms included migraine, headache, brain tumor, neuroimaging, and brain neoplasms. Studies presented varying findings: some suggested an increased risk of brain tumors in migraine patients, while others found no significant association. Notable studies highlighted the role of specific tumor types, such as pituitary adenomas and meningiomas, in causing headache symptoms.

Conclusions

The association between migraine and brain tumors remains complex and inconsistent. While some studies indicate a potential risk, others fail to confirm a significant relationship. Further large-scale, prospective studies are needed to clarify this association and inform clinical practices.

Best time for the application of the "blood patch" technique for post-spinal anesthesia headache: a systematic review

Ana Letícia Borghetti — 2025-03-30

Introduction

With the puncture of the dura mater during spinal anesthesia, excessive cerebrospinal fluid (CSF) leakage can occur, leading to intracranial hypotension and, consequently, post-dural puncture headache. Currently, there are symptomatic supportive treatments, but they do not provide complete relief. The epidural blood patch has emerged as a treatment option with proven success, but there are still questions about the best timing for its use.

Objective
To identify the best timing for the application of the epidural blood patch.

Method
Systematic review of clinical trials and randomized clinical trials on PubMed from 2000 to 2023.

Results
The review of the articles covers various topics on the use of the blood patch, including its effectiveness, comparison with conservative treatment, volume applied, timing of application, duration of supine positioning due to pain incapacity, and needle size. However, data regarding the timing of application were not extensively highlighted.

Conclusion
It was not possible to accurately determine the best timing for the application of the technique due to the lack of data, but its effectiveness is well-known, requiring further studies to better prescribe this treatment.

Dialysis headache: a systematic review and meta-analysis

Heba Ramadan — 2025-03-31

Introduction
Dialysis headache (DH) is a known but underexplored complication of hemodialysis, affecting some patients during treatment. While, it is recognized, the reported frequency, diagnostic criteria, and associated risk factors vary.
Objective
This systematic review and meta-analysis aim to determine the percentage and characteristics of dialysis headache, identify associated factors, and summarize available evidence from existing literature.
Methods
A comprehensive literature search was conducted across Scopus, Medline, PubMed, and Google Scholar for studies published from 2000 to the present. A total of 15 studies were included, encompassing various study designs and geographic locations. Data on patients demographics, headache characteristics, diagnostic criteria, and hemodialysis parameters were extracted and analyzed. A proportional meta-analysis was performed using R-4.3.2.
Results
The included studies reported DH prevalence ranging from 7% to 53%. The overall pooled estimate was 28% (95% CI: 19-36%). After refining the dataset by excluding studies with confounding factors and improving study selection criteria, the updated prevalence estimate was 16% (95% CI: 9-24%). DH onset typically occurred during hemodialysis sessions, predominantly in the second or third hour, and most cases resolved within four hours post-dialysis. Headaches were generally of moderate intensity and managed with simple analgesics.
Conclusions
Dialysis headache remains a prevalent but inconsistently reported complication of hemodialysis. Standardized diagnostic criteria and further research are needed to better understand its pathophysiology and improve management strategies.