New in Cephalalgia! The chronicization process in migraine patients involves changes in the structure, function, iron content, and clearance function of multiple nuclei. • Migraine was associated with subcortical dysfunction, including selective subcortical functional and glymphatic changes. • These abnormalities provide new insight into chronic migraine pathophysiology. journals.sagepub.com/doi/10.… #migraine #headache #brain #pain #neurology #neuroscience

New in Cephalalgia! 3,000 migraine papers. 1 in 5 open with the same tired 'common, prevalent, disabling' line. This Cephalalgia letter says: it's not plagiarism, it's just boring, and asks authors (and reviewers) to try harder. journals.sagepub.com/doi/10.… #migraine #headache #brain #pain #neurology #neuroscience

New in Cephalalgia! From Aristotle’s metaphysics to IHS higher standards: shifting migraine prevention from relative response to residual disease control, requiring real-world evidence, education, and routine clinical implementation. journals.sagepub.com/doi/10.… #migraine #headache #brain #pain #neurology #neuroscience

New in Cephalalgia! Al-Sayegh et al. reported that CGRP-targeted therapies consistently reduced depressive and anxiety symptoms in migraine patients across 12 studies (n=2,796), likely secondary to migraine control rather than direct psychotropic effects. .... Placebo-controlled evidence did not confirm a direct psychotropic effect, suggesting improvements may be mediated through effective migraine control. • The predominance of open-label designs underscores the need for randomised controlled trials with prespecified psychiatric endpoints. journals.sagepub.com/doi/10.… #migraine #headache #brain #pain #neurology #neuroscience

New in Cephalalgia! In TTH, tension is not stress or muscle tension. A single word shapes how doctors talk about the condition, how patients understand their own bodies, and how easily they fall into the hands of unproven or costly treatments. Time to change! journals.sagepub.com/doi/10.… #migraine #headache #brain #pain #neurology #neuroscience @cherubinodilorenzo

New in Cephalalgia! Developed and externally validated the Migraine Analgesic Usage (MAU) Index, a simple triage score using acute medication days and Migraine Treatment Optimization Questionnaire 6-item version (MTOQ-6) to identify high multidimensional migraine burden. It supports Green/Yellow/Red clinical prioritisation. journals.sagepub.com/doi/10.… #migraine #headache #brain #pain #neurology #neuroscience

New in Cephalalgia! Escalation to eptinezumab 300 mg was associated with improved population-averaged outcomes in this selected cohort of difficult-to-treat partial responders to 100 mg, supporting, as such, dose escalation over switching therapy. • Escalation converted partial 100 mg responders: 57.9% and 64.9% achieved ≥ 50% MHD reduction after first and second 300 mg cycles. • After two 300 mg cycles, MHD decreased from 17 to 5, and MIDAS scores dropped from 93 to 39. • Greater 100 mg MHD reduction and no prior erenumab exposure independently predicted ≥ 50% response, supporting escalation before switching treatment. journals.sagepub.com/doi/10.… #migraine #headache #brain #pain #neurology #neuroscience

New in Cephalalgia! Migraine-related alterations in the interstitial microenvironment vary with headache phase and disease burden • Individuals with migraine experiencing headache and with higher disease burden showed reduced extracellular volume fraction and increased intracellular volume fraction, suggesting a microenvironment that may influence interstitial fluid dynamics and glymphatic activity. • Observed alterations involved major white matter tracts implicated in multisensory processing and migraine pathophysiology. • Diffusion-derived alterations vary with headache phase and disease burden rather than representing a static trait. journals.sagepub.com/doi/10.… #migraine #headache #brain #pain #neurology #neuroscience @_RobertaMessina

New in Cephalalgia! A structured two-tier headache curriculum defines core competencies for general neurologists and advanced skills for specialists—aligning education with ICHD-3, modern therapeutics, and multidisciplinary care to improve headache diagnosis. journals.sagepub.com/doi/10.… @amrhasanneuro #migraine #headache #brain #pain #neurology #neuroscience

New in Cephalalgia! Comment from the authors: "We therefore view the contribution by Wasserman and colleagues not as an alternative to our proposal, but as an important extension that illustrates the breadth of hypotheses that can be systematically explored within a shared descriptive framework" journals.sagepub.com/doi/10.… #migraine #headache #brain #pain #neurology #neuroscience

New in Cephalalgia! Musella et al. propose a multidimensional Oral Dysaesthetic and Perceptual Disorder (ODPD) framework for burning mouth syndrome and call for psychiatric input. This reply: the perceptual dimension is exactly where that input is needed — psychoanalytic, interoceptive & Complex Regional Pain Syndrome (CRPS) accounts converge. journals.sagepub.com/doi/10.… #migraine #headache #brain #pain #neurology #neuroscience

Headache medicine is full of questions. Are we always asking the right ones? How do we recognise the less obvious presentations? Navigate diagnostic pitfalls? Make better treatment decisions? A new educational initiative is coming to Cephalalgia Reports: Masterclass in Headache — a series featuring contributions from leading experts in the field, bringing practical, evidence-informed insights to clinicians who want to improve the way they diagnose and manage headache disorders. Our introductory editorial has just been published. This is only the beginning. 📖 Read the editorial: journals.sagepub.com/doi/10.… More knowledge. More practical insights. Better headache care. #Headache #Migraine #IHS #CephalalgiaReports #MasterclassInHeadache @Simona_Sacco_ @MarcioNattan

New in Cephalalgia Reports! The Arabic Migraine Attacks–Subjective Cognitive Impairments (Mig-SCog) demonstrated good internal consistency and acceptable construct validity in Arabic-speaking individuals with migraine. Its correlations with HIT-6, MoCA, and monthly migraine days support its utility as a screening tool. journals.sagepub.com/doi/10.… #migraine #headache #brain #pain #neurology #neuroscience

New in Cephalalgia Reports! In adults with episodic migraine, higher retrospective premonitory symptom burden was associated with greater cephalic and extracephalic allodynia, but not clinically meaningful HIT-6 change. journals.sagepub.com/doi/10.… #migraine #headache #brain #pain #neurology #neuroscience

New in Cephalalgia Reports! Lamotrigine should be considered with caution as a preventive treatment for migraine with aura. Lamotrigine showed minimal effectiveness for preventing migraine with aura, with only one responder out of 52 patients. • No improvements in aura symptoms were reported across the cohort. • Nearly one quarter discontinued treatment due to adverse effects. journals.sagepub.com/doi/10.… #migraine #headache #brain #pain #neurology #neuroscience

New in Cephalalgia Reports! Trigeminal autonomic cephalalgias (TACs) are severe headaches that sometimes do not respond to medication. This study reviewed surgical options and found that microvascular decompression can provide lasting relief, especially when imaging shows nerve compression. journals.sagepub.com/doi/10.… #migraine #headache #brain #pain #neurology #neuroscience

New in Cephalalgia Reports! Aerobic training increased resting-state alpha wave activity than Biofeedback and Placebo. Sleep quality and quality of life improved significantly, with large effect sizes. Pain reduction did not differ significantly between groups. journals.sagepub.com/doi/10.… #migraine #headache #brain #pain #neurology #neuroscience

New in Cephalalgia Reports! Atraumatic-first lumbar puncture was associated with a low post-dural puncture headache (PDPH) incidence of 4.1% in 344 neurological outpatients undergoing diagnostic LP at a tertiary neurological outpatient clinic. Younger age, but not sex, BMI or puncture attempts, predicted PDPH. Findings support routine atraumatic-first LP. journals.sagepub.com/doi/10.… #migraine #headache #brain #pain #neurology #neuroscience