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

New in Cephalalgia Reports! An interesting case presented with both intracranial hyper and hypotension, associated with cerebellar tonsillar displacement as a navigator. Tonsillar displacement can be associated with both intracranial hypertension and hypotension. This phenomenon should be understood as a dynamic process instead of a fixed or unidirectional force. • It is crucial to understand the pathophysiology of CSF dynamics and to recognize the imaging findings. • Careful clinical and imaging surveillance are essential for managing patients with conditions related to intracranial pressure. journals.sagepub.com/doi/10.… #migraine #headache #brain #pain #neurology #neuroscience

New in Cephalalgia Reports! Meta-analysis of FDA trial data shows anti-CGRP therapies are not associated with clinically significant increases in blood pressure, supporting their cardiovascular safety in migraine treatment. journals.sagepub.com/doi/10.… #migraine #headache #brain #pain #neurology #neuroscience @faradoost

New in Cephalalgia Reports! Protocol for a systematic review/meta-analysis assessing whether migraine—especially with aura—is associated with increased white matter hyperintensity burden on MRI, addressing conflicting evidence using rigorous, population-based methods. journals.sagepub.com/doi/10.… #migraine #headache #brain #pain #neurology #neuroscience

New in Cephalalgia Reports! Can pitolisant, a selective H3 receptor inverse agonist, trigger migraine-like attacks in women with migraine without aura? This randomized, double-blind, placebo-controlled crossover study in 14 women will provide novel insights into the involvement of the H3 receptor in migraine pathophysiology and clarify whether selective modulation of this receptor is sufficient to provoke migraine-like attacks. journals.sagepub.com/doi/10.… #migraine #headache #brain #pain #neurology #neuroscience

New in Cephalalgia Reports! Migraine-related healthcare interaction status was associated with substance-use indicators among U.S. college students engaged in care. • No treatment after appointment/discussion or being told no treatment was necessary showed elevated substance-use odds. • Depression, anxiety, or PTSD explained only a modest portion of selected associations. • Findings are hypothesis-generating, not evidence of treatment adequacy or mechanistic mediation. journals.sagepub.com/doi/10.… #migraine #headache #brain #pain #neurology #neuroscience

New in Cephalalgia Reports! A systematic review of 17 studies with 1857 pediatric patients with status migrainosus highlights literature gaps and brings attention to an under-recognized condition. ............................. Status migrainosus in pediatric populations is under-recognized, mostly affecting adolescent girls. • Evidence on pediatric status migrainosus is limited to observational, non-comparative, predominantly retrospective studies; no randomized trials were identified. • Stress, chronic migraine, and psychiatric comorbidities are reported associated factors. • Nerve blocks showed a trend toward short-term pain control in observational, non-randomized studies. • Pediatric-focused, standardized, acute management protocols from clinical trials are urgently needed. journals.sagepub.com/doi/10.… #migraine #headache #brain #pain #neurology #neuroscience @MoIbr_X