Headache Pathophysiology – Imaging and Neurophysiology
IHC25-LBA-001Meningeal recordings as a platform for testing novel compounds targeting peripheral mechanisms of migraine pain
Georgii Krivoshein1; Else Tolner1; Rashid Giniatullin2; Arn MJM van den Maagdenberg1
(1) Leiden University Medical Center, Netherlands; (2) University of Eastern Finland, Finland
Objective: The meningeal branches of the trigeminal nerve are considered a primary origin site of migraine pain. These peripheral sensory axons initiate and propagate nociceptive signals to second-order neurons in the brainstem. Stimulation of the trigeminal ganglion (TG) leads to the release of calcitonin gene-related peptide (CGRP) neuropeptide in the meninges, triggering a cascade of events that are thought to underlie migraine headache. Here, we present an experimental platform designed to evaluate novel anti-migraine compounds targeting the peripheral components of the trigeminovascular system, which are relevant to migraine pain.
Methods: By recording nociceptive spikes from the peripheral branches of the trigeminal nerve in mouse and rat meninges, we can investigate their functional activity and examine the expression of various receptors in these distal nerve segments. To this end, mouse hemiskulls with intact meninges are isolated with the brain hemispheres removed. The distal segment of the nervus spinosus—located within the hemiskull between the TG and the middle meningeal artery—is carefully cleaned from surrounding tissue and cut just before its entry into the TG. This nerve segment is then inserted into a borosilicate glass microcapillary filled with artificial cerebrospinal fluid and connected to a microelectrode for electrophysiological recordings (Figure 1).
Results: Local applications of compounds, combined with mechanical and/or thermal stimulation, modulate the peripheral receptive fields of TG meningeal afferents. Modulation of chemosensitive (as cannabinoid (as CB1 and CB2), mechanosensitive (as Piezo), and thermosensitive (as TRP) channels elicit neuronal spiking activity, which can be recorded for subsequent analysis. Advanced clustering and spectral analysis of neuronal activity data are employed post hoc to differentiate spiking patterns based on their temporal dynamics and neurochemical sensitivity to investigate the effects of modulation of single fiber nociceptive activity.
Conclusion: Thus, the meningeal recordings enable evaluation of peripheral trigeminal nerve activity, offering a valuable tool for identifying and characterizing novel anti-migraine therapies.
Disclosure of Interest: None.
Headache Pathophysiology – Imaging and Neurophysiology
IHC25-LBA-002Iron deposition network mapping of clinical subtypes and features in migraine: a prospective study
Xiaoshuang Li1; Yonggang Wang1
(1) Beijing Tiantan Hospital, Capital Medical University, China
Objective: Excessive iron deposition is associated with migraine progression and dysfunction. However, previous studies have shown high heterogeneity and mostly have found specific brain regions, limiting our understanding of brain networks. This study aims to identify iron deposition network maps of migraine subtypes and determine clinical features-related network localizations.
Methods: We prospectively included 78 migraine patients (43 chronic migraine [CM] and 35 episodic migraine [EM]) and 32 matched healthy controls (HCs). All participants underwent quantitative susceptibility mapping (QSM) scans. First, individualized iron deposition maps were generated by comparing each migraine patient’s cerebral gray matter iron content versus HCs. Next, seed-based functional connectivity (FC) analysis using the human connectome (n = 1000) was used to determine regions functionally connected to each patient’s iron deposition site. Subsequently, the network of brain regions functionally connected to each migraine patient’s iron deposition sites was determined using seed-based functional connectivity (FC) analysis based on a large (n = 1000) normative connectome. Finally, iron deposition network mapping was used to identify specific brain networks linked to migraine subtypes and symptoms.
Results: Iron deposition regions varied among migraine patients, but they were connected to the same brain regions, including the superior temporal gyrus (STG), insula, and cerebellum. The FC features between iron deposition maps and the peak of these three regions demonstrated good discriminative performance in the receiver operating characteristic (ROC) analysis (AUC > 0.70), effectively distinguishing migraine patients from HCs. These findings were also present in CM patients, with more pronounced features. Moreover, we further identified several specific networks based on iron deposition network mapping in migraine patients: one in the cerebellum linked to monthly headache days (MHDs; r = 0.367, P = 0.002); another related to sleep quality (r = 0.604, P < 0.001), mainly involving the orbitofrontal cortex (OFC) and nucleus accumbens (NAC); and a third associated with vomiting (P < 0.001), located in the globus pallidus (GP).
Conclusion: This study utilized iron deposition network mapping to reveal specific brain networks associated with migraine subtypes and features, offering potential targets for future neuromodulation therapies.
Disclosure of Interest: None.
Headache Pathophysiology – Imaging and Neurophysiology
IHC25-LBA-003Triptans, Ergotamine, and White Matter Lesions in Migraine: Evidence from a Latin American Cohort
Federico Leonardo Anrriquez1; Fiorella Martin Bertuzzi2; Chiara Rivelis1; Ana Karina Guevara2; Daiana Micucci2; Maria Virginia Borras1; Laura Marina Beccaluva1; Eduardo Daniel Doctorovich1
(1) Hospital Italiano de Buenos Aires, Argentina; (2) Red Cefaloca, Argentina
Objective: To evaluate the association between the use of triptans or ergotamine and the presence of WML in migraine patients from a tertiary headache clinic in Buenos Aires. Secondary objectives included assessing the effect of age, migraine subtype, and clinical follow-up duration on WML prevalence.
Methods: A retrospective cohort study was conducted using data from 200 adult migraine patients who underwent brain MRI and clinical evaluation between 2018 and 2024. Patients were grouped by acute treatment exposure: none, triptans only, ergotamine only, or both. WML presence was determined via neuroradiological MRI reports. Poisson regression models were used to estimate relative risks (RR) of WML.
Results: WMLs were identified in 39.5% (n = 79) of patients. Compared to the untreated group, adjusted RR for WML was 0.68 for triptan-only (p = 0.097), 0.95 for ergotamine-only (p = 0.809), and 0.61 for both treatments (p = 0.068). No significant associations were found between WMLs and age, migraine subtype, or follow-up duration. However, longer follow-up showed a non-significant trend toward higher WML risk.
Conclusion: No statistically significant association was found between triptan or ergotamine use and WML presence. Nevertheless, the trend toward lower WML risk among treated groups, especially those using both drugs, suggests a possible protective effect. These findings support the need for prospective studies in diverse populations to clarify the impact of acute migraine therapies on brain structure.
Disclosure of Interest: None.
Headache Pathophysiology – Imaging and Neurophysiology
IHC25-LBA-004CGRP activates dura-sensitive peripheral and central trigeminovascular neurons, revealing a peripheral window for migraine intervention
Agustin Melo-Carrillo1; Andrew M Strassman2; Rami Burstein1
(1) Beth Israel Deaconess Medical Center. Harvard Medical School, United States; (2) Beth Israel Deaconess Medical Center. Harvard Medical School, United States
Objective: Calcitonin gene-related peptide (CGRP) is thought to be a key player in the pathogenesis of migraine, but there is a fundamental mystery in that the known neuronal actions of CGRP do not account for how it can cause pain. We now report the first finding of CGRP-induced nociceptive neuronal activation, at the low dose used in human headache provocation studies, using a novel method of intra-carotid infusion to achieve a more targeted delivery to cranial tissues.
Methods: Single-unit recordings were performed in anesthetized rats to measure CGRP effects on first- and second-order trigeminovascular neurons. CGRP was administered via intra-carotid infusion. Neuronal activation and sensitization were assessed by spontaneous firing rates and responses to mechanical stimulation of dural and facial receptive fields. Lidocaine was applied locally to the dura or trigeminal ganglion at varying time points to determine the peripheral contribution to CGRP-induced activity.
Results: Intra-carotid CGRP infusion (5 µg/kg/min, 20 min) activated 62% of Aδ-fibers and 56% of C-fibers, with significant increases in firing rates beginning within the first 30 minutes for Aδ-fibers and after one hour for C-fibers. It also activated 75% of central trigeminovascular neurons, significantly increasing spontaneous firing and sensitizing dural and facial receptive fields. Similar effects were produced by CGRP injection into the trigeminal ganglion. These effects of CGRP were impeded by local anesthetic blockade of the dura or trigeminal ganglion before but not 1 hour after CGRP infusion. No significant sex differences were found in baseline firing or in the magnitude and timing of CGRP-induced responses across all neuron types.
Conclusion: These results underscore the pivotal role of peripheral CGRP signaling in initiating migraine-related nociception and support the therapeutic rationale for early, peripherally acting CGRP-targeted treatments in migraine.
Disclosure of Interest: None.
Other
IHC25-LBA-005Bright light stress priming induces periorbital allodynia in response to subthreshold nitroglycerin
Veronica Munday1; Eloisa Rubio-Beltran1; Ivana Rosenzweig1; Philip Holland1
(1) King's College London, United Kingdom
Objective: Stress is a commonly reported trigger among migraine patients, and has been suggested to contribute to migraine chronification. Consequently, there has been increasing interest in using stress to induce migraine-relevant behaviours in animal models. Previous studies have shown repetitive restraint stress can induce periorbital allodynia, and prime mice to respond to subsequent subthreshold doses of nitric oxide donors. However, physical restraint may limit applications of these models to techniques requiring implantation of head-mounted recording devices. Therefore, we aimed to compare an alternate migraine-relevant stressor, bright light stress, with existing restraint stress paradigms.
Methods: Baseline periorbital sensitivity thresholds were assessed using von Frey filaments in male and female C57Bl/6 mice. Mice were then exposed to either restraint (RS) or bright light stress (BLS, 1000 Lux) for 2 hours a day across 3 consecutive days. Control animals were left in their home cage without food or water for the 2-hour period. Sensory testing was repeated on days 1, 4, 7, 11 and 14 post-stress. On day 14, mice received a subthreshold (0.1mg/kg) intraperitoneal injection of nitroglycerin (NTG) and sensory testing was repeated 2-hours post injection.
Results: Mice which underwent RS and BLS demonstrated periorbital allodynia following stress (RS: p=0.003, BLS: p=0.024) which normalised by day 14 (RS: p=>0.99, BLS: p=>0.99). Following this, an acute subthreshold dose of NTG, which had no effect in control animals (p=0.144), resulted in a significant periorbital allodynia in previously stressed animals (RS: p=0.009, BLS: p=0.043). This NTG-induced allodynia had normalised by 72-hours post injection.
Conclusion: In agreement with restraint stress paradigms, bright light stress is able to prime mice to respond to normally subthreshold doses of nitroglycerin, providing a migraine-relevant model which can be used in combination with implantable devices to explore the underlying neural circuits.
Disclosure of Interest: None.
Other
IHC25-LBA-006Optogenetic activation of meningeal CGRP-expressing neurons elicits migraine-like pain
Caroline Machado Kopruszinski1; Grace Lee1; Luiz Henrique Moreira de Souza1; Edita Navratilova1; David W Dodick2; Frank Porreca1
(1) University of Arizona, Department of Pharmacology, College of Medicine, Tucson, Arizona, United States; (2) Atria Academy of Science and Medicine, New York, NY, United States
Objective: The clinical effectiveness of CGRP receptor antagonists supports a causal role in promoting migraine at least in some patients. Nevertheless, the exact mechanisms by which CGRP promotes migraine are not fully understood. A primary physiological role of CGRP is to produce vasodilation. CGRP additionally produces neurogenic inflammation that can result in sensitization of small- to medium-diameter trigeminal neurons. However, whether CGRP activates or sensitizes CGRP-receptor expressing neurons directly or indirectly remains uncertain. Additionally, it remains unclear whether CGRP-expressing nociceptors can be responsible for eliciting the cascade of events producing migraine pain. We investigate whether activation of CGRP-expressing neurons can elicit migraine-like pain using a novel optogenetic mode. Additionally, we determined whether CGRP can directly activate meningeal nociceptors.
Methods: Heterogyzous (HET) Calca-Cre mice expressing cre-dependent red-shifted channelrhodopsin (ReaChR) and wild type (WT) controls were used. Optogenetic devices (NeuroLux; 590 nm wavelength; 4mm) were implanted subcutaneously on the cranial surface of Calca/ReaChR HET and WT mice. Following recovery from surgery, a 10Hz light stimulation protocol was applied. Conditioned place aversion (CPA), hindpaw tactile allodynia, number of rearing and cage behaviors were assessed post-stimulation. Patch-clamp electrophysiology was performed on cultured trigeminal ganglia (TG) neurons from female and male C57BL6J mice 30 minutes following CGRP application.
Results: Confocal imaging confirmed ReaChR expression only in CGRP positive neurons in the dura mater of Calca/ReaChR HET mice. Wireless optogenetic stimulation of these meningeal neurons produced a robust migraine-like pain behaviors with greater effects in female mice, which was prevented by olcegepant. Notably, in electrophysiological experiments, CGRP did not increase the excitability of cultured small- to medium-diameter TG neurons in either sex.
Conclusion: Optogenetic activation of meningeal CGRP-positive neurons was sufficient to elicit spontaneous and evoked migraine-like pain behaviors. Prevention observed with systemic olcegepant suggests that peripheral release of CGRP may be responsible for eliciting pain behaviors. Importantly, the failure of CGRP to directly increase TG neuron excitability in culture suggests that release of CGRP in vivo may activate and/or sensitize trigeminal nociceptors to elicit migraine-like pain through indirect mechanisms.
Disclosure of Interest: None.
Headache and Gender
IHC25-LBA-007Hormonal Therapy Use and Migraine Features in Premenopausal, Perimenopausal and Menopausal Females: A Cross-Sectional Study
Laura Gómez-Dabó1; Rut Mas-de-les-Valls2; Ane Murillo2; Edoardo Caronna2; Marta Torres-Ferrus2; Alicia Alpuente2; Teresa Mateu2; Víctor J Gallardo2; Patricia Pozo-Rosich2
(1) Vall d'Hebron University Hospital, Spain; (2) Vall Hebron University Hospital, Spain
Objective: Migraine predominantly affects females and is influenced by hormonal fluctuations throughout life. This study aimed to (1) describe hormonal therapy (HT) use in a cohort of females with migraine; (2) assess migraine phenotypes across hormonal status and HT type; (3) explore menstrual- and menopause-related symptoms in HT users versus non-users.
Methods: Cross-sectional study conducted in females with migraine from a tertiary Headache Unit. An online survey on HT was distributed in December/2024. Clinical records provided demographic, comorbidity, and migraine data. Participants were classified by hormonal status as premenopausal (preM), perimenopausal (periM), or menopausal (M), and further stratified by HT type: combined oral contraceptives (COCs), progestogen-only pills (POPs), or hormonal intrauterine devices (IUDs). Other HT regimens were excluded. HT users were matched with non-HT users (nonHT) by age and migraine frequency. Migraine features and menstrual symptoms profiles were compared.
Results: Of 613 respondents, 15.8% (96/613) used HT. Among 358 analyzed, 49.2% were preM (176/358), 19.8% periM (71/358) and 31% M (111/358). IUDs were most used (40.6%, 39/96), followed by COCs (25.0%, 24/96) and POPs (24.0%, 23/96). Concomitant gynecological conditions were more frequently reported in patients using POPs (26.1%). HT users reported less osmophobia (COC, IUD;p = 0.047), dizziness (COC, POPs;p=0.035) and neck stiffness (COC;p=0.035) than non-HT users. Migraine with aura was more common in HT users (48.6% vs 24.3%), though not statistically significant (p=0.053). HT users more often failed to ≥3 preventives (54.0% vs 40.5%;p=0.019), especially antidepressants (83.8% vs. 48.6%;p = 0.003). Among all premenopausal females, 68.6% reported more frequent attacks during menstruation, 62.9% experienced longer-lasting attacks, and 52.7% reported more difficult-to-treat-attacks during menstruation. NonHT users reported more menstrual symptoms, including acne (p=0.001), constipation (p<0.001), low back pain (p=0.011), swelling (p<0.001), and fatigue (p=0.012).
Conclusion: HT use is relatively low in females with migraine as compared to the general population, but appears to influence migraine characteristics and menstrual symptoms. Specific HT types were linked with fewer sensory symptoms and greater treatment refractoriness, underscoring the need for personalized migraine management based on hormonal status and therapy.
Disclosure of Interest: LG-D salary has been partialy funded by Río Hortega grant Acción Estratégica en Salud 2021–2023 from Instituto de Salud Carlos III (CM24/ 00072). RM-d-l-V, AM, TM and VJG report no disclosures relevant to the manuscript; EC has received honoraria from Novartis, Chiesi, Lundbeck, MedScape, Lilly, Teva and Dr. Reddy’s; his salary has been partially funded by Río Hortega grant Acción Estratégica en Salud 2017–2020 from Instituto de Salud Carlos III (CM20/00217) and Juan Rodés fellowship, Subprograma Estatal de Incorporación de la Acción Estratégica en Salud 2023 (JR23/00065). He is a junior editor for Cephalalgia. AA has received honoraria from Allergan-AbbVie, Novartis, Chiesi. MT-F has received honoraria from Allergan-AbbVie, Novartis, Chiesi and Teva. PP-R has received, in the last three years, honoraria as a consultant and speaker for: AbbVie, Dr. Reddy’s, Eli Lilly, Lundbeck, Medscape, Novartis, Pfizer, Organon and Teva. Her research group has received research grants from AbbVie, Novartis and Teva; as well as, Instituto Salud Carlos III, EraNet Neuron, European Regional Development Fund (001-P-001682) under the framework of the FEDER Operative Programme for Catalunya 2014-2020 - RIS3CAT; has received funding for clinical trials from AbbVie, Amgen, Biohaven, Eli Lilly, Novartis, Teva. She is the Honorary Secretary of the International Headache Society. She is the founder of www.midolordecabeza.org. PPR does not own stocks from any pharmaceutical company.
Headache Epidemiology, Outcomes and Burden
IHC25-LBA-008Detailed Migraine Characteristics Predictive of Adverse Vascular Outcomes
Rachel Jacqueline Knopp1; Nan Zhang2; Fred M. Cutrer1; Chia-Chun Chiang1
(1) Mayo Clinic, Rochester, Minnesota, United States; (2) Department of Quantitative Health Research, Mayo Clinic, Scottsdale, Arizona, USA, United States
Objective: Stroke and other adverse vascular events are leading causes of death and disability, with increasing incidence among younger individuals. Other than migraine aura, little has been reported on how detailed migraine characteristics affect the risk of adverse vascular events.
Methods: This was a cohort study using the longitudinally established Mayo Clinic Headache Subspeciality Clinic Registry and Electronic Health Record data collected from 2020 to August 2023 on patients with a diagnosis of migraine seen by headache specialists who had documented detailed headache characteristics and follow up information. The composite endpoint included acute ischemic stroke, acute myocardial infarction, venous thromboembolism, and all-cause mortality. Multivariable cox regression analysis was performed for each variable to assess adverse vascular event-free survival.
Results: Of the 6819 patients included, 5549 (81.4%) were female, and 2274 patients (33.3%) had migraine with aura. The mean age was 41.7 years. In our multivariable analysis, we found the following migraine characteristics are predictive of adverse vascular events: associated eyelid swelling (hazard ratio 2.03, 95% confidence interval 1.00- 4.12, p=0.049), increased headache frequency (15 or more versus less than 15 days per month, 1.37 (1.16, 1.62), p<0.001), pain intensity (one unit increase on a 0 to 10 scale, 1.07 (1.02, 1.11), p=0.003), and total number of previous preventive medications tried (one unit increase, 1.05 (1.01, 1.09), p= 0.012). We also found that endorsing missing a meal as a migraine attack trigger was a protective factor (0.79 (0.66, 0.95), p=0.012). Additionally, we found several demographic factors including older age, male sex, marital status (single versus married), higher BMI, hypertension, diabetes, and smoking (current or previous) to be predictive of adverse vascular events [Table 1].
Conclusion: Our large cohort study shows many migraine-specific features elevate risk for cardiovascular outcomes. These findings highlight the importance of a comprehensive risk assessment in patients with migraine, particularly those with more severe or atypical headache presentations.
Disclosure of Interest: CC has served as a consultant for: Pfizer, AbbVie, Amneal, Satsuma and eNeura. She receives research funds from the American Heart Association with funds paid to her institution. This study is funded by the American Heart Association (GRANT_NUMBER: 23MRFSCD1077179).
Headache Pathophysiology – Imaging and Neurophysiology
IHC25-LBA-009A High-Frequency Complex Visuo-Spatial Attentional Task Disrupts Functional Connectivity Among Higher-Order Brain Areas in Patients with Migraine Without Aura
Zeynep Ceren Onlat1; Sertaç Üstün1; Hilal Kolenoğlu1; Merve Ceren Akgör2; Doğa Vurallı3; Hayrunnisa Bolay3
(1) Ankara University, Türkiye; (2) NÖROM, Türkiye; (3) Gazi University, Türkiye
Objective: Altered sensitivity to visuo-spatial input is a common and disabling symptom in individuals with migraine, often present even between attacks. This heightened sensitivity may be related to altered functioning of brain networks responsible for regulating visual input. In this study, we aimed to explore whether a high-frequency complex visuo-spatial attentional task could uncover functional connectivity alterations in such networks in migraineurs.
Methods: Twenty-seven women with migraine without aura were recruited and scanned interictally. Patients underwent two resting-state fMRI scans one before and one immediately after exposure to a 12-minute high-frequency complex visual stimulation paradigm. fMRI data were preprocessed and analyzed using the CONN toolbox. Seed-based connectivity analysis was conducted to examine changes in resting-state functional connectivity involving early visual cortices and higher-order networks related to visual processing, attention, and salience detection.
Results: No significant connectivity changes were observed in early visual areas. In contrast, connectivity between the lateral occipital cortex (higher visual cortex) and the angular gyrus increased. The left pulvinar -the dominant higher-order visual nucleus of the thalamus- exhibited enhanced connectivity with the brainstem. The salience network showed increased connectivity between the right anterior insula and the left angular gyrus, as well as between the left angular gyrus and the right lateral occipital cortex, right anterior insula, and right supramarginal gyrus. Additionally, the anterior cingulate cortex showed increased connectivity with the supramarginal gyrus.
Conclusion: These findings suggest that a high-frequency, complex visuo-spatial attentional task alters the functional organization of large-scale brain networks in individuals with migraine without aura. Increased connectivity among higher-order cognitive and sensory regions including the anterior insula, angular gyrus, supramarginal gyrus, lateral occipital cortex, pulvinar, and brainstem indicates a potential imbalance in top-down control. Importantly, the absence of connectivity changes in primary visual cortices suggests that these effects are not driven by early-stage sensory processing but rather reflect disruptions in higher-level perceptual and integrative systems.
Disclosure of Interest: None.
Genetics and Biomarkers of Headache Disorders
IHC25-LBA-010Association of serum cadmium levels, nicotine exposure, and migraine in the ELSA-Brasil study
Arão Belitardo Oliveira1; Fernando Barbosa Jr.2; Itamar Souza Santos1; Mario F. P. Peres1; Paulo A. Lotufo1; Isabela M. Benseñor1; Alessandra C. Goulart1
(1) Universidade de São Paulo, São Paulo - SP, Brasil; (2) Universidade de São Paulo, Ribeirão Preto - SP, Brasil
Objective: Owing to the presence of the heavy metal cadmium (Cd) in cigars and the association of smoking with migraine, we aimed to explore the relationship between Cd and migraine in the context of nicotine exposure in the ELSA-Brasil study.
Methods: This is a cross-sectional analysis based on the serum Cd levels, nicotine exposure, and migraine in the baseline wave (2008-2010). Cd quantification was performed by Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Nicotine exposure was computed based on the Life’s Essential 8 scoring system (0-100; the lower the score, the higher the exposure), assessed by a self-report questionnaire on smoking and second-hand smoking. Migraine diagnosis was based on ICHD-3. Logistic regression models estimated the odds ratios (OR) with [95% confidence interval] for migraine diagnosis, according to metal concentration quintiles (Q), with the 3rd Q as reference and 1st and 5th quintiles representing the lowest and highest metal levels, respectively. Linear regression computed the associations between nicotine exposure and serum Cd levels. The adjusted models controlled for sex. age, education, race, smoking, alcohol intake, migraine prophylactic medication, and cardiometabolic risk factors.
Results: The study included 2,762 adults, with a mean (SD) age of 52.3 (9.0) years, 52.3% (n = 1,403) females. The prevalence of migraine was 29.1% (806/2,762). The migraine group showed higher median (IQR) values of Cd [0.050 µg/L (0.035, 0.077) vs 0.048 µg/L (0.035, 0.066), p = 0.024] compared to non-migraine group, while there was no difference between groups for nicotine exposure score [80 (55, 100) vs 80 (55, 100), p = 0.527]. There was a strong, inverse linear association between nicotine exposure score and Cd levels (p-trend < 0.001) (Figure 1a). Cd levels and migraine showed a “J”-shaped relationship, but the 5th Q of Cd was associated with higher odds of migraine only [OR: 1.77 (1.02, 3.05), p = 0.039], compared to the 3rd Q in the models adjusted for sex, age, BMI, race, household income, schooling, marital status, nicotine exposure, alcohol consumption, and use of migraine prophylactic and acute medications (Figure 1b).
Conclusion: In the ELSA-Brasil, higher Cd levels were associated with migraine regardless of their relationship with nicotine exposure. This study encourages further research on the participation of Cd in migraine and other headache disorders.
Disclosure of Interest: The authors declare there is no conflict of interest related to this work. This study was funded by the São Paulo Research Support Foundation of the State of São Paulo (FAPESP) (Grant #2020/09468-9). The ELSA-Brasil baseline study and the 4-year follow-up were funded by the Brazilian Ministry of Health (Science and Technology Department) and the Brazilian Ministry of Science and Technology (Brazilian Funding Authority for Studies and Projects – FINEP, and the Brazilian National Research Council – CNPq). Grants of baseline: Rio Grande do Sul State (01 06 0010.00), Bahia State (01 06 0212.00), Espírito Santos State (01 06 0300.00), Minas Gerais State (01 06 0278.00), São Paulo State (01 06 0115.00), and Rio de Janeiro State (01 06 0071.00); grants of 4- year follow-up: Rio Grande do Sul State (01 10 0643-03), Bahia State (01 10 0742-00), Espírito Santos State (01 12 0284-00), Minas Gerais State (01 10 0746-00), São Paulo State (01 10 0773- 00), and Rio de Janeiro State (01 11 0093-01). Arão B Oliveira received a postdoctoral scholarship from FAPESP (Grant #2023/03011-5).
Temporomandibular Disorders
IHC25-LBA-011Can cervical motor control exercise improve clinical symptoms in patients with TMD? Preliminary results of a randomized clinical trial (RCT)
Elisa Bizetti Pelai1; Ester Moreira Castro-Carletti2; Delaine Rodrigues Bigaton1; Susan Armijo-Olivo2
(1) UNICAMP, Piracicaba - SP, Brasil; (2) Universidade de Osnabrück, Germany
Objective: To determine the effectiveness of a cervical motor control program for improving pain intensity and cervical range of motion (ROM) in patients with temporomandibular disorders (TMD).
Methods: This RCT was approved by the ethic committee (CAAE: 29606719.0.0000.5418). Adult women with mixed TMD were included. They were randomized into a motor control exercise program (EG: exercises for the neck flexor and extensor muscles), or a placebo intervention (PG: transcutaneous electrical stimulation (TENS) turned off), 12 treatment sessions with 30 minutes of duration. Patients from both groups were blinded regarding the placebo treatment and hypothesis of the study. Patients were assessed regarding sample characteristics, pain intensity (visual analog scale: VAS), and upper cervical ROM (flexion rotation test:FRT). The assessor measuring the neck ROM was blinded to treatment status. Data were analyzed using SPSS 17.0 using a two-way ANOVA analysis to assess the treatment effect. The level of significance was set at α = 0.05. We calculated and interpreted effect sizes (ES) using the guidelines established by Cohen.
Results: From 72 patients screened, 25 were included and randomized into the EG (n=12) and PG (n=13). Pain intensity: A large ES favoring the EG on pain intensity was found (η2=0.273). It was found a significant difference across time points (p=0.001), and significant interaction between time and group (p=0.013). A large effect favoring the EG was found for cervical mobility (right: η2=0.108; left: η2=0.164), although weak evidence against the null hypothesis was achieved across time between groups or for the interaction between time and group (p values ranged between 0.939 and 0.086). It is important to highlight that patients in the PG decreased their neck ROM, while those in the EG increased their cervical mobility.
Conclusion: The cervical motor control program promoted a significant clinical improvement in pain intensity and cervical mobility and therefore, this exercise program could be useful for treating patients with TMD.
Disclosure of Interest: None.
Psychological and Behavioural Factors and Management
IHC25-LBA-012Cognitive Flexibility Change is Correlated with Anxiety and Serum CGRP Levels in Patients with Migraine
Hale Gök Dağıdır1; Merve Ceren Akgor1; Ceren Z Onlat1; Doğa Vurallı2; Hayrunnisa Bolay2
(1) Gazi University, Neuroscience and Neurotechnology Center of Excellence (NÖROM), Ankara, Türkiye, Türkiye; (2) 1Gazi University, Neuroscience and Neurotechnology Center of Excellence (NÖROM), Ankara, Türkiye 2 Gazi University Hospital, Department of Neurology and Algology, Ankara, Türkiye, Gazi University Neuropsychiatry Center (NPM), Neuroscience and Neurotechnol, Türkiye
Objective: Migraine (M) headache attacks are associated with cognitive dysfunctions, such as reduced attention difficulties, reduced processing speed, and memory issues, besides diagnostic features of nausea and sensory augmentation. Cognitive flexibility, adaptation to new task are often revealed by tests such as the Stroop task, which measures cognitive control.
Methods: This study included 19 women subjects (10 M patients and 9 age-matched healthy controls). Clinical features were recorded and cognitive performance was assessed using the Stroop test. Stroop tests were performed online and reaction times were measured. HAD and MigScog were also performed. Serum CGRP was measured using ELISA.
Results: The mean age of the subjects was 30.50 ± 7.54 years in the migraine group and 30.88± 4.10 years in the healthy control group (p = 0.89). Stroop test results were comparable between groups. HADT (p=0.003, M19.7±5.33-Control 12.55±3.04) was significantly higher in migraine patients. Serum CGRP levels were significantly higher in migraine patients than controls (p=0.020, M 249.73±141.19-Control 122.22 ±49.71). Serum CGRP levels showed a positive correlation with reaction time in the congruent condition of the Stroop test (r=0.790). HADT and MigScog scores showed a positive correlation (r=0.672). HADA (r=0.791) showed a positive correlation with reaction time in the incongruent condition of the Stroop test.
Conclusion: Reduced cognitive flexibility is associated with anxiety and elevated serum CGRP levels in patients with migraine These findings suggest that CGRP could serve not only as a biomarker for migraine pain pathways but also as an indicator of altered attention and cognitive speed in migraine patients. Funding: The study was supported by TÜBİTAK-1004.
Disclosure of Interest: None.
Migraine Preventive Therapy
IHC25-LBA-013Rimegepant for the Prevention of Episodic Migraine in Adults with Prior Inadequate Response to Oral Preventatives
Patricia Pozo-Rosich1; José Antonio Gien López2; Pawel Lisewski3; Ayşe Neslihan Aslan4; Harpreet Seehra5; Alexandra Thiry6; Lucy Abraham5; Luz M Ramirez7; Robert Fountaine6; Terence Fullerton6
(1) Headache Unit, Neurology Department, Vall d'Hebron University Hospital & Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; (2) Star Medica Hospital, Mérida, Mexico; (3) Tricals, Bydgoszcz, Poland; (4) Pfizer Inc., Istanbul, Türkiye; (5) Pfizer R&D UK Ltd., Tadworth, Surrey, United Kingdom; (6) Pfizer Inc., Groton, CT, United States; (7) Pfizer Inc., Princeton, NJ, United States
Objective: Rimegepant 75 mg orally disintegrating tablet (ODT) taken every other day (EOD) is an approved preventive treatment for episodic migraine (EM) in many countries. This phase 4 trial evaluated the efficacy and tolerability of rimegepant for the prevention of EM in participants with a history of inadequate response to oral preventive medications (OPMs).
Methods: Participants with 4-14 monthly migraine days (MMDs), <15 monthly headache days (<7 non-migraine), and a documented history of inadequate response to 2-4 OPM classes were enrolled. Participants were stratified by MMDs in the observation phase (OP) and number of failed OPM classes, then randomised to EOD rimegepant 75 mg ODT or placebo. The primary endpoint was mean change in MMDs from the 28-day untreated OP through the 12-week double-blind treatment (DBT) phase. Key secondary endpoints were tested hierarchically for Type I error control.
Results: 652 participants received treatment (328 rimegepant; 324 placebo); 35% had failed 3/4 OPM classes. MMDs (SD) in the OP were 8.4 (2.4) and 8.3 (2.3) in the rimegepant and placebo groups. Across the DBT phase, participants who received rimegepant had a significantly larger reduction in mean MMDs than those who received placebo (difference = -1.6 [95% CI: -2.13, -1.15]; p<0.0001; Figure). All key secondary endpoints were significant in favour of rimegepant (p<0.0007; Table). Rimegepant was well tolerated with no new safety findings.
Conclusion: Rimegepant 75 mg ODT EOD is efficacious and well tolerated for the prevention of EM in participants with a documented history of inadequate response to OPMs. NCT05518123.
Disclosure of Interest: This study was sponsored by Pfizer. Medical writing support was provided by Jennifer Bodkin of Engage Scientific Solutions and was funded by Pfizer. PPR has received honoraria as a consultant and speaker from AbbVie, Biohaven, Chiesi, Eli Lilly, Lundbeck, Medscape, Novartis, Pfizer and Teva. Her research group has received research grants from AbbVie, AGAUR, EraNet Neuron, FEDER RIS3CAT, Instituto Investigación Carlos III, MICINN, Novartis, and Teva, and has received funding for clinical trials from AbbVie, Biohaven, Eli Lilly, Lundbeck, Novartis and Teva. She is the Honorary Secretary of the International Headache Society, is on the editorial board of the journal Revista de Neurologia, is an associate editor for the journals Cephalalgia, Headache, Neurologia, and Frontiers of Neurology, and is an advisor of the Scientific Committee of the Editorial Board of The Journal of Headache and Pain. She is a member of the Clinical Trials Guidelines Committee and Scientific Committee of the International Headache Society. She has edited the Guidelines for the Diagnosis and Treatment of Headache of the Spanish Neurological Society. She is the founder of www.midolordecabeza.org, a platform to give information and tools to physicians and people who suffer from migraine and other headaches. JAGL has received honoraria as a consultant and speaker from Grunenthal, Torrent and Pfizer. He reports no stocks or funding from any pharmaceutical company. PL has nothing to disclose. AT and LMR were employees of Biohaven Pharmaceuticals. They are now employees of Pfizer and owns stock/options. ANA, HS, LA, TF, and RF are employees of Pfizer and own stock/options.
Migraine Preventive Therapy
IHC25-LBA-014Interim results from a post-marketing surveillance study of patients with migraine treated with fremanezumab in Korea
Dayoung Seo1; Manho Kim2; Mi Ji Lee2; Min Kyung Chu3; Soo-Jin Cho4; Heui-Soo Moon5; Taejin Song6; Soohyun Cho7; Byung Kun Kim8; Gabriela Kivelevitch9
(1) Teva-Handok Pharma Co, Ltd, Seoul, South Korea; (2) Department of Neurology, Seoul National University Hospital, Seoul, South Korea; (3) Department of Neurology, Yonsei University Severance Hospital, Seoul, South Korea; (4) Department of Neurology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea; (5) Department of Neurology, Sungkyunkwan University School of Medicine Kangbuk Samsung Hospital, Seoul, South Korea; (6) Department of Neurology, Ewha Womans University Medical Center, Seoul, South Korea; (7) Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, South Korea; (8) Department of Neurology, Nowon Eulji Medical Center, Seoul, South Korea; (9) Teva Pharmaceutical Industries Ltd, Tel Aviv, Israel
Objective: To evaluate the safety and effectiveness of fremanezumab as a preventive migraine treatment in Korean adults with migraine in real-life clinical practice.
Methods: This was a 6-year, non-interventional, prospective, post-marketing surveillance study in South Korea. Eligible participants were aged ≥18 years, had a formal diagnosis of migraine, and were receiving fremanezumab for the first time. The primary endpoint was the proportion of all new adverse events (AEs), including serious AEs (SAEs), from first administration of fremanezumab to the 12-week observation period or to discontinuation. Secondary endpoints included mean change from baseline in average number of monthly migraine days (MMD) and the proportion of participants achieving ≥50% and ≥75% reductions in MMD. Here we present an interim analysis of data collected up to the third year of the study.
Results: In total, 1262 participants completed follow-up from 24 March 2022 to 6 February 2024. Of these, 1230 participants completed the safety assessment after at least one dose of fremanezumab, and 1096 were included in the efficacy analysis (female, 84.6%; mean [standard deviation, SD] age, 46.1 [13.7] years; episodic migraine/chronic migraine, 45.2%/54.8%; mean [SD] duration of disease, 6.9 [8.2] years). Average MMD in the month prior to fremanezumab initiation was 16.5 (9.1). AEs were reported by 216 (17.6%) participants. The most common AEs were injection site reactions (n = 70, 5.7%), including injection site pruritus (n = 25, 2.0%) and injection site rash (n = 15, 1.2%); all were considered related to treatment. SAEs were infrequent (n = 12, 1.0%), with the most common being migraine and leukopenia (both n = 2, 0.2%). Only one serious adverse drug reaction (i.e., arrhythmia) was reported. Overall, 200 (16.3%) participants discontinued the study; reasons included loss to follow-up (8.8%), AEs (3.5%), withdrawal of consent (0.7%), and investigator's decision (0.5%). After 12 weeks of treatment, mean (SD) change from baseline in MMD was –7.8 (8.1) (p < 0.0001), and 56.5% (95% confidence interval [CI]: 53.5–59.4) and 26.8% (95% CI: 24.2–29.6) of participants achieved ≥50% and ≥75% reductions in MMD, respectively.
Conclusion: Fremanezumab was well tolerated in Korean adults treated for migraine prevention in a real-life setting, with more favorable reductions from baseline in MMD observed than those reported in the HALO-EM and HALO-CM studies, and in clinical trials in Japanese and Korean patients.
Disclosure of Interest: DS and GK are employees of Teva Pharmaceuticals. MK reports participation as an investigator of a clinical trial sponsored by AbbVie, Eli Lilly, and Lundbeck; and participation as an investigator of a post-marketing surveillance study sponsored by Eli Lilly. MJL reports clinical trial support from AbbVie, Biohaven, Ildong Pharmaceutical, Lundbeck, Novartis, Otsuka, Pfizer, Teva Pharmaceuticals, and Yuyu Pharma; participation on data safety monitoring board or advisory board of AbbVie, Eli Lilly, Lundbeck, Pfizer, Samjin, and Teva Pharmaceuticals; lecture honoraria from AbbVie, CKD, Dong-A Pharmaceutical, Eli Lilly, Ildong Pharmaceutical, SK-Pharm, Teva Pharmaceuticals, and Yuyu Pharma; and consulting fees from NuEyne. MKC reports participation as a site investigator for a multicenter trial sponsored by AbbVie Korea, Biohaven, and Ildong Pharmaceutical; lecture honoraria from Organon Korea, SK Chemicals, and Teva-Handok over the past 24 months; grants from the Korea Health Industry Development Institute (HV22C0106), and a National Research Foundation of Korea grant from the Korean Government (MSIT; 2022R1A2C1091767). S-JC reports participation as a site investigator of a multicenter trial sponsored by AbbVie, Allergan, GC Holdings, JW Pharmaceutical, Novartis International AG, and Pfizer; and lecture honoraria from AbbVie, GC Holdings, Organon, SK Chemicals, and Teva Pharmaceuticals in the past 24 months. BKK is on the editorial board of the Journal of Clinical Neurology. He received honoraria as a moderator/speaker/advisor from AbbVie Korea, Dong-A Pharmaceutical, Ildong Pharmaceutical, Lundbeck Korea, Organon Korea, Pfizer Korea, SK-Pharm, Teva-Handok, and Yuyu Pharm. H-SM, TS, and SC have no conflicts to declare.
Migraine Preventive Therapy
IHC25-LBA-015Efficacy and safety of eptinezumab in adults with chronic migraine and medication-overuse headache: 24-week results of the RESOLUTION trial
Rigmor H Jensen1; Christofer Lundqvist2; Henrik W. Schytz1; Cristina Tassorelli3; Fabrizio Vernieri4; Michel Lantéri-Minet5; Gisela M. Terwindt6; Andrew Blumenfeld7; Stewart J Tepper8; Mette Krog Josiassen9; Gary Jansson9; Anders Ettrup9; Aurélia Mittoux9; Richard B Lipton10
(1) Department of Neurology, Danish Headache Center, Rigshospitalet-Glostrup, University of Copenhagen, Denmark; (2) Departments of Neurology and Health Services Research, Akershus University Hospital, United States; (3) Department of Brain and Behavioral Sciences, University of Pavia, Italy; (4) Unit of Headache and Neurosonology, Fondazione Policlinico Universitario Campus Bio-Medico, Italy; (5) Pain Department and FHU InovPain, Centre Hospitalier Universitaire de Nice, France; (6) Department of Neurology, Leiden University Medical Centre, Netherlands; (7) The San Diego Headache Center, United States; (8) The New England Institute for Neurology and Headache, United States; (9) H. Lundbeck A/S, Denmark; (10) Department of Neurology, Albert Einstein College of Medicine, United States
Objective: To evaluate the 24-week efficacy and safety of eptinezumab in participants with chronic migraine (CM) and medication-overuse headache (MOH) who at baseline also received patient education about medication overuse.
Methods: RESOLUTION was a multinational phase 4 clinical trial (NCT05452239) including a 12-week double-blind, placebo-controlled period and 12-week open-label extension (OLE). Adults (18–75y) with CM and MOH (excluding opioid-overuse headache) were randomized (1:1) to IV eptinezumab 100mg or placebo. All received a brief educational intervention about MOH before infusion. At the end of Week 12, all participants received eptinezumab 100mg. Measures for the primary and key secondary efficacy endpoints (all met with eptinezumab vs placebo within Weeks 1–12) were also captured during the OLE period: changes from baseline in monthly migraine days, monthly headache days, monthly days with acute medication use, and average daily pain, and participants no longer meeting thresholds for CM and MOH. Patient-reported outcomes assessed disease-related burden, health-related quality of life, and treatment satisfaction. Safety was assessed via treatment-emergent adverse events (TEAEs).
Results: Of 608 participants randomized at baseline, 593 (97.5%) were treated with eptinezumab in the OLE period; 584/593 (98.5%) completed the trial. Across efficacy and patient-reported outcomes, improvements observed during the placebo-controlled period were sustained during the OLE period for participants initially treated with eptinezumab, with similar levels of improvement gained for those initially receiving placebo. The proportion of participants with TEAEs in the OLE period was similar between eptinezumab–eptinezumab and placebo–eptinezumab treatment sequence groups (30% vs 34%), with few TEAEs leading to withdrawal (<2%) or infusion interruption (<1%).
Conclusion: In participants with CM and MOH that received patient education, eptinezumab treatment in the RESOLUTION trial resulted in early (Weeks 1–4) improvements in disease burden and quality of life, with high levels of treatment satisfaction, compared to placebo that were consistent over Weeks 1–12. These improvements were sustained following a second eptinezumab infusion (Weeks 13–24), with similar improvements observed in participants initially started on placebo then treated with eptinezumab. No new safety signals were identified.
Disclosure of Interest: RHJ has given lectures for Allergan, ATI, Eli Lilly, Lundbeck, Merck, Novartis, Pfizer, and Teva; served as investigator in clinical trials with ATI, Eli Lilly, Lundbeck, Novartis, and Novo Nordisk; is the director of the Danish Headache Center, Lifting The Global Burden of Headache, and Founder of Master of Headache Disorders at University of Copenhagen; and has received research funding from ATI, Lundbeck Foundation, Rigshospitalet, The Medical Society in Copenhagen, NovoNordisk Foundation, Rigshospitalet, Tryg Foundation, and University of Copenhagen. CL has participated on an advisory board and received payment for lectures arranged by AbbVie Pharma AS, Lundbeck, Novartis AS, and Roche AS, and has received research sponsorship from AbbVie Pharma. HWS has received personal fees from AbbVie, Eli Lilly, Lundbeck, Novartis, and Teva, and has received research grants from Novartis and Novo Nordisk Foundation. CT in the past 3 years has received support (financial or drugs) from AbbVie and Novartis for an investigator-initiated trial; consulting fees for the participation in advisory boards for AbbVie, Dompé, Eli Lilly, Ipsen, Lundbeck, Medscape, Pfizer, and Teva; honoraria for scientific lectures and presentations from AbbVie, Eli Lilly, Lundbeck, Pfizer, and Teva; support for attending meetings from AbbVie, Dompé, Eli Lilly, Ipsen, Lundbeck, Pfizer, and Teva; has been Principal Investigator in clinical trials sponsored by AbbVie, Biohaven, Eli Lilly, Ipsen, Lundbeck, Pfizer, and Teva; and received grants from the European Commission, the Italian Ministry of Health, and the Italian Ministry of University. FV has received financial support from AbbVie, Angelini, and Lundbeck for investigator-initiated trials; consulting fees for the participation in advisory boards from AbbVie, Angelini, Eli Lilly, Lundbeck, Organon, Novartis, Pfizer, and Teva; honoraria for scientific lectures and presentations from AbbVie, Eli Lilly, Lundbeck, Novartis, Pfizer, and Teva; support for attending meetings from AbbVie, Eli Lilly, Lundbeck, Pfizer, and Teva; and has been Principal Investigator in clinical trials sponsored by AbbVie, Eli Lilly, Lundbeck, Pfizer, and Teva. ML-M reports personal fees for advisory boards, speaker panels, or investigation studies from Allergan, Amgen, Astellas, ATI, BMS, Boehringer, Boston Scientific, CoLucid, Convergence, Eli Lilly, GlaxoSmithKline, Grunenthal, Eli Lilly, Ipsen, Lundbeck, Medtronic, MSD, Novartis, Orion Pharma, Perfood, Pfizer, Reckitt Benckiser, St. Jude, Salvia BioElectronics, Sanofi-Aventis, Teva, UCB, UPSA, and Zambon. GMT reports grants or consultancy support from AbbVie, Eli Lilly, Lundbeck, Novartis, Organon, Pfizer, and Teva, and independent support from the Clayco Foundation, Dioraphte Foundation, Dutch Brain Foundation, Dutch Heart Foundation, Dutch Research Council, Dutch Heart Foundation, Dutch Brain Foundation, IRRF, and the European Community. AB has served on advisory boards for AbbVie, Aeon, Alder, Amgen, Biohaven, Eaglet, Eli Lilly, Impel, Lundbeck, Novartis, Promius, Revance, Supernus, and Teva; and has received funding for speaking from AbbVie, Amgen, Avanir, Biohaven, Depomed, Eli Lilly, Impel, Lundbeck, Pernix, Promius, Supernus, and Teva. SJT reports grants for research from AbbVie, Aeon, Amgen, Annovis, Axsome, Cassava, Cognition, Eli Lilly, Inhibikase, Ipsen, Lundbeck, Merz, Neurolief, Pfizer, PrecisionMed, Revance, Scilex, Suven, and UCB; has served as a consultant and/or on advisory boards (honoraria) for AbbVie, Aeon, Alphasights, Amgen, Aruene, Atheneum, Axsome Therapeutics, Becker Pharmaceutical Consulting, BioDelivery Sciences International, Biohaven, Catch Therapeutics, ClearView Healthcare Partners, Click Therapeutics, CoolTech, CRG, Decision Resources, Defined Health, DRG, Dr. Reddy’s, Eli Lilly, ExpertConnect, FCB Health, Fenix, Gilmartin Capital, GLG, Guidepoint Global, Health Advances, Health Science Communications, HMP Communications, Impel, Initiator Pharma, Interactive Forums, IQVIA, Keyquest, Ki Health Partners, Krog and Partners, Lundbeck, M3 Global Research, Magellan Health, Magnolia Innovation, Miravo Healthcare, MJH Holdings, Neurofront Therapeutics, Neurolief, Nocira, Novartis, P Value Communications, Pain Insights, Palion Medical, Perfood, Pfizer, Pulmatrix, Putnam Associates, Rehaler, SAI MedPartners, Satsuma, Scilex, Slingshot Insights, Spherix Global Insights, Strategy Inc, Synapse Medical Communication, System Analytic, Taylor and Francis, Tegus, Teva, Theranica, Third Bridge, Tonix, Trinity Partners, Unity HA, Vial, and Xoc; receives salary from Dartmouth-Hitchcock Medical Center, Ki Health Partners, and Thomas Jefferson University, and Ki Health Partners; serves as a speaker for AbbVie, Dr. Reddy’s, Eli Lilly, Lundbeck, Pfizer, Scilex, Teva, and Tonix; and received continuing medical education honoraria from the American Academy of Neurology, American Headache Society, Annenberg Center for Health Sciences, Catamount Medical Education, Diamond Headache Clinic, Forefront Collaborative, Haymarket Medical Education, HMP Global, Medical Education Speakers Network, Medical Learning Institute, Migraine Association of Ireland, Miller Medical Education, National Association for Continuing Education, North American Center for CME, The Ohio State University, PeerView, Physicians’ Education Resource, PlatformQ Education, Primed, Vindico Medical Education, and WebMD/Medscape. MKJ, GJ, AE, and AM are full-time employees of H. Lundbeck A/S. RBL has received research support from the National Institutes of Health, the FDA, and the National Headache Foundation. He serves as consultant, advisory board member, or has received honoraria or research support from AbbVie/Allergan, Amgen, Axon, Axsome, Biohaven, Eli Lilly, GlaxoSmithKline, Lilly, Lundbeck, Merck, Novartis, Pfizer, Teva, Vector, and Vedanta Research; receives royalties from Wolff’s Headache, 8th edition (Oxford University Press, 2009) and Informa; and holds stock/options in Biohaven, Cooltech, Mainistee, and NuVieBio.
Headache Epidemiology, Outcomes and Burden
IHC25-LBA-016Clinical Outcomes in the ContemporAry ProspecTive Understanding of Migraine Real-world Evidence (CAPTURE) Study
Messoud Ashina1; Mario F. P. Peres2; Richard J. Stark3; Michel Lanteri-Minet4; Yingyi Liu5; Jessica Lam6; Huy Ha6; Laurent Delahaye5; Patricia Pozo-Rosich7
(1) Department of Neurology, Danish Headache Center, Copenhagen University Hospital, Rigshospitalet & Department of Clinical Medicine, University of Copenhagen, Denmark; (2) University of São Paulo, São Paulo - SP, Brasil; (3) Alfred Hospital and Monash University, Australia; (4) Pain Department and FHU InovPain, CHU Nice and Côte Azur University & INSERM U1107 Migraine and Trigeminal Pain, Auvergne University, France; (5) AbbVie, United States; (6) AbbVie, Canada; (7) Headache Unit, Neurology Department, Vall d’Hebron University Hospital, and Headache and Neurological Pain Research Group, Vall d’Hebron Institute of Research, Universitat Autònoma de Barcelona, Spain
Objective: To evaluate longitudinal changes in monthly headache days (MHDs), monthly migraine days (MMDs), and acute medication use among individuals with migraine in the ContemporAry ProspecTive Understanding of Migraine Real-world Evidence (CAPTURE) study.
Methods: CAPTURE is a 2-year, international, prospective, longitudinal, observational study of disease burden and treatment patterns among patients with migraine currently consulting at specialty clinics. Participants aged ≥18 years with a migraine diagnosis for ≥1 year who used ≥1 migraine medication and experienced ≥4 MHDs in the 3 months before screening were stratified by headache frequency during 30-day screening: 4–<8 MHDs (Cohort 1), 8–<15 MHDs (Cohort 2), and ≥15 MHDs (Cohort 3). Change from baseline was assessed using a mixed-effects model for repeated measures.
Results: The population (N=555; Cohort 1=139, Cohort 2=251, Cohort 3=165) had a mean age of 41.4-43.0 years and was >83% female and >94% White. Over the 12-month period, participants in Cohorts 2 and 3 showed substantial reductions in MHDs, MMDs, and acute medication use days (Table). The percentages of participants who were in the same cohort at baseline and Month 12 were 34% (17/50) for Cohort 1, 41.4% (41/99) for Cohort 2, and 55% (33/60) for Cohort 3. Many (36% [18/50]) Cohort 1 participants experienced <4 MHDs at Month 12.
Conclusion: The CAPTURE study demonstrates improved migraine frequency and reduced acute medication use over 12 months, particularly among participants with higher baseline headache frequencies. These findings underscore the clinical value of longitudinal real-world observational data in guiding therapeutic expectations and management strategies for migraine.
Disclosure of Interest: This study was supported by AbbVie. MA has received personal fees from AbbVie. MFPP has received personal fees as a consultant for AbbVie. RJS has received speaker and consulting fees from Allergan/AbbVie. ML-M reports no relevant disclosures. PP-R has received personal fees for advisory boards and speaker panels from AbbVie; is the principal investigator for clinical trials sponsored by AbbVie; and has received (with her group) grants from AbbVie. LD, JL, HH, and YL are employees of AbbVie and may hold AbbVie stock.
Migraine Preventive Therapy
IHC25-LBA-017Cannabinoids in Migraine Treatment (CAMTREA) Trial: a double-blind, randomized, placebo-controlled pilot study of a cannabidiol, cannabigerol, and tetrahydrocannabinol 133/66/4mg formulation as adjunctive therapy in chronic migraine
Alexandre Ottoni Kaup1; Paula Salvador Toledo1; Isadora Santos Ferreira1; Fernanda Agra Victoriano1; Frederico Monfardini1; Gabriel Castro Micheli2; Flavio Rezende Costa2
(1) Hospital Israelita Albert Einstein, São Paulo - SP, Brasil; (2) Health Meds Industria Farmacêutica, Rio de Janeiro - RJ, Brasil
Objective: To evaluate the safety and efficacy of a CGMP-grade cannabinoid oil formulation containing cannabidiol (CBD), cannabigerol (CBG), and tetrahydrocannabinol (THC) in a maximum daily dose of 133/66/4 mg respectively, as adjunctive therapy in patients with chronic migraine (CM) already undergoing preventive treatment.
Methods: This study was registered at ClinicalTrials.gov (NCT04989413). Eligible participants were adults aged 25–65 years with CM, on stable preventive treatment for at least 3 months, and reporting ≥5 headache days during a 4-week baseline period (V0–V1). Participants had not previously used CBD and/or THC for migraine. Subjects were randomized (V1) to receive either placebo or the active formulation for 12 weeks, with follow-up visits every 4 weeks (V2, V3, V4). Both treatments were delivered as sublingual drops twice a day. Outcome measures included change in headache days, migraine-related disability, safety, and tolerability between V1 and V4. A total of 75 patients were randomized (38 placebo, 37 active). Participants used a digital diary to record headache data and medication use.
Results: Seventy participants completed the study (35 per group). The mean reduction in headache days was greater in the active group (from 14.62 to 9.24; -5.39 days) than in the placebo group (from 14.52 to 9.66; -4.86 days), although not statistically significant. Clinically meaningful improvement in disability was observed in the active group, with a >30% reduction in MIDAS (Migraine Disability Assessment Scale) scores and a 3.19-point advantage in HIT-6 (Headache Impact Test) scores compared to placebo at V4 (p = 0.023). The scores of HIT-6 decreased 6.15 and 2.22 points to active and placebo groups, respectively. At baseline (V1), 88% of active and 83% of placebo group participants were classified as high-impact on HIT-6; by V4, this decreased to 50% in the active group and 70% in the placebo group. No serious adverse events were reported. There were no significant differences between groups in analgesic use or daytime somnolence. Figure 1 shows the proportion of hedache days distribution and HIT-6 during the 12-week treatment period for placebo and active groups.
Conclusion: In this pilot study the adjunctive treatment with a CGMP cannabinoid formulation (CBD/CBG/THC - 133/66/4mg) was safe and associated with significant improvements in migraine-related disability in patients with chronic migraine. These findings support further investigation in larger, adequately powered trials.
Disclosure of Interest: FHdRC is director of research and development at HealthMeds Laboratories, and has shares in the company.
Cluster Headache and Other Trigeminal Autonomic Cephalalgias
IHC25-LBA-018A randomized, double-blind, double-dummy, placebo-controlled, parallel-group study comparing the efficacy and safety of oral prednisolone versus greater occipital nerve block as a transitional preventive for episodic cluster headache (PRO TEM STUDY)
Debashish Chowdhury1; Arunav Garg1; Manju Yadav1; Arijit Pal1; Sujata Roshan1; Arun Koul1
(1) GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
Objective: To study and compare the efficacy and safety of greater occipital nerve block (GONB) versus oral prednisolone as a transitional preventive treatment for episodic cluster headache (ECH).
Methods: This interventional, double-blind double-dummy, randomized placebo-controlled study enrolled consecutive ECH patients diagnosed by ICHD-3 criteria, aged 18–65, with a history of at least one cluster period (CP) prior to the current bout and with ≥1 attacks per 24 hours in the three preceding days before randomization. The patients (1:1) received either GONB (2ml of methylprednisolone (80mg) and 2ml of lignocaine (2%) plus placebo oral tablets matching oral prednisolone tablets) or sham GONB (4ml of saline injections) plus oral prednisolone tablets, based on their allocation (figure). All received verapamil for long-term prophylaxis, which was gradually titrated to 360 mg/day by 2 weeks. The baseline week’s attack frequency was estimated based on the patient's self-reported history and prorated to 7 days prior to randomization. The primary outcome was the proportion of patients achieving complete cessation of cluster attacks at Week 1. Key secondary outcomes included the mean change in weekly attack frequency (WAF) and a 50% decrease in WAF from baseline at Weeks 1 and 2 (CT registry no: CTRI/2023/11/059586).
Results: Forty patients with ECH were screened, and 34 were randomized. All were available for efficacy and safety analysis. The baseline demographic and headache characteristics were comparable between the two groups. Five patients (29.4%) receiving active GONB achieved complete cessation of attacks compared with 6 (35.3%) receiving oral prednisolone (OR 0.8, 95% CI=10.2 to 3.2, p=0.714) at Week 1. Changes in WAF from baseline to Weeks 1 and 2 were -6.9 (-10.4 to -3.3) and -8.4 (-11.9 to -4.8) for those receiving GONB versus -4.9 (-8.4 to -1.5) and -5.6 (-9.1 to -2.2) for those receiving oral prednisolone respectively (p<0.05). Twelve (70.6%) and 13 (76.5%) patients receiving GONB versus 9 (52.9%) and 11 (64.7%) receiving oral prednisolone achieved a 50% decrease in the WAF compared with baseline at Weeks 1 and 2 respectively (p<0.05). Patients receiving oral prednisolone had a greater number of adverse events (3.1±1.8 vs 1.7±1.7; p=0.032). No serious adverse events were reported.
Conclusion: Both GONB and oral prednisolone were equally efficacious as a transitional treatment for ECH. Adverse events were more common in those receiving oral prednisolone.
Disclosure of Interest: None.
Access to Headache Care in low and middle-income countries
IHC25-LBAPO-001Access to Headache Treatment in Mongolia: Barriers, Challenges, and the Path Forward
Otgonbayar Luvsannorov1; Aynur Özge2; Derya Uludüz3; Semih Taşdelen4; Sarkhan Amirguliyev5; Tayyar Şaşmaz6; Rami Burstein7
(1) School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia, Mongolia; (2) University, School of Medicine, Mersin, Türkiye, Türkiye; (3) Brain 360 Integrative Brain Health Clinic, İstanbul, Türkiye, Türkiye; (4) Department of Neurology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey., Türkiye; (5) State Institute of Advanced Training of Doctors named after Aziz Aliyev, Baku, Azerbaijan, Azerbaijan; (6) Professor of Public Health, Mersin University, School of Medicine, Mersin, Türkiye, Türkiye; (7) Department of Anaesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA, United States
Objective: Headache disorders are a significant but underrecognized public health burden, especially in low- and middle-income countries (LMICs) where access to specialized care and effective treatments is limited. Mongolia presents a unique case due to its vast geography, rural population distribution, and underdeveloped headache care infrastructure. This study offers the first nationwide assessment of Mongolia’s headache care landscape, highlighting patient burden, medication accessibility, healthcare provider preparedness, and systemic barriers to treatment.
Methods: As part of the International Headache Society (IHS) and MENAA Headache Group initiative, a cross-sectional survey was conducted using a modified version of the HARDSHIP questionnaire. 377 healthcare providers from 32 regions in Mongolia completed the survey. Data on patient demographics, medication access, affordability, provider training, and regional care disparities were analyzed using descriptive and comparative statistics.
Results: Providers managed an average of 20.9 headache patients per week, with 63% of cases involving women and 57.1% of patients over 25 years old. A significant proportion of patients (45.0%) could not afford medication, and only a minority had access to triptans or migraine-specific therapies. Essential treatments, such as CGRP monoclonal antibodies and botulinum toxin A, were unavailable. Only 43.4% of providers had received formal training in headache care, with rural areas served mainly by non-specialists. Neurologists were significantly more likely to have received headache training and to treat adult cases, whereas non-specialists reported a higher proportion of paediatric cases. These findings reveal significant gaps in workforce capacity, treatment access, and the overall care structure.
Conclusion: This study identifies critical shortcomings in Mongolia’s headache care system and highlights urgent needs for reform. Recommended actions include establishing structured headache care pathways, expanding access to medications through national formularies and insurance, enhancing provider training, and utilizing telemedicine to reach underserved regions. Mongolia’s experience offers valuable lessons for other low- and middle-income countries (LMICs) seeking to establish equitable, cost-effective, and sustainable headache care.
Disclosure of Interest: None.
IHC25-LBAPO-002Bridging the Gap in Headache Care: Insights from the IHS Survey in Nepal
Rajeev Ojha1; Bikram Prasad Gajurel1; Ragesh Karn1; Reema Rajbhandari1; Niraj Gautam1; Abhisekh Chapagain1; Ravi Raj Timasina2; Derya Uludüz3; Aynur Özge4; Semih Taşdelen5; Sarxhan Amirguilev6; Tayyar Şaşmaz7; Rami Burstein8
(1) Department of Neurology, Tribhuvan University Institute of Medicine Teaching Hospital, Kathmandu, Nepal, Nepal; (2) Department of Psychiatry, Kathmandu University Gandaki Medical College Teaching Hospital, Pokhara, Nepal, Nepal; (3) 360 Integrative Brain Health Clinic, İstanbul, Türkiye, Nepal; (4) Professor of Neurology, Mersin University, School of Medicine, Mersin, Türkiye, Türkiye; (5) Department of Neurology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey, Türkiye; (6) Azerbaijan State Institute of Advanced Training of Doctors named after Aziz Aliyev,Baku, Azerbaijan, Azerbaijan; (7) Professor of Public Health, Mersin University, School of Medicine, Mersin, Türkiye, Türkiye; (8) Department of Anaesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA, United States
Objective: Headache disorders impose a substantial public health burden worldwide, with low- and middle-income countries (LMICs) like Nepal facing pronounced challenges due to limited healthcare infrastructure, inadequate provider training, and restricted access to essential treatments. This study aimed to assess the current state of headache care in Nepal, focusing on the distribution and training of healthcare providers, access to medications, and socioeconomic factors that affect treatment adherence.
Methods: A cross-sectional survey was conducted as part of a multinational joint initiative by the International Headache Society (IHS) and MENAA Headache Associations. Data were collected from 232 healthcare providers across Nepal using an adapted version of the HARDSHIP questionnaire. Descriptive and comparative analyses assessed geographic disparities, medication accessibility, and provider preparedness.
Results: Most healthcare providers were concentrated in urban centers, with 80.2% reporting some form of training in headache care. However, training gaps persisted among rural and non-specialist providers. An estimated 72.0% of patients had to pay out-of-pocket for medications, with 38.7% unable to afford treatment. Access to migraine-specific therapies, such as triptans, topiramate, and amitriptyline, was substantially lower in rural areas. Providers in urban settings reported seeing more adult patients with greater medication access, while rural providers more frequently served younger, socioeconomically disadvantaged populations with limited treatment options.
Conclusion: This study highlights significant disparities in headache care delivery in Nepal, driven by geographic, economic, and educational barriers. To bridge these gaps, national policies should prioritize structured headache training, including essential headache medications in public formularies, and deploying telemedicine-based models in underserved regions. These strategies are crucial for achieving equitable and effective headache care in Nepal and other low- and middle-income countries (LMICs).
Disclosure of Interest: None.
IHC25-LBAPO-003Epidemiological and Financial Analysis of Migraine (G43) in Older Adults in Brazil – 2024
Letícia Hanna Moura da Silva Gattas Graciolli1; Luana Mendes dos Santos2; Douglas Setimo do Rozário3; Gisella de Deus Almeida Freire4; Jéssica Liara Santos Magalhães Oliveira5; Diane Yuka Botelho Sugui6; Tiffany Mie Botelho Sugui7; Tiago Ramalho De Oliveira8; Thiago Souza Azevedo9; Ana Caroline da Rocha Coutinho Santos10; Larissa camargos de Brito Vilela11
(1) Faculty of Medicine of Jundiaí, Jundiaí - SP, Brasil; (2) FMUSP, SP - SP, Brasil; (3) Instituto Capixaba de Ensino, Pesquisa e Inovação em Saúde (ICEPi), Vitória - ES, Brasil; (4) Centro universitário Atenas (UNIATENAS), Passos - MG, Brasil; (5) universidade Nove de Julho (UNINOVE), SBC - SP, Brasil; (6) Universidade Presbiteriana Mackenzie (UPM), SP - SP, Brasil; (7) Universidade Anhembi Morumbi (UAM), SP - SP, Brasil; (8) Universidade Federal de Santa Maria (UFSM), Santa Maria - RS, Brasil; (9) Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Teófilo Otoni - MG, Brasil; (10) Universidade Nove de Julho (UNINOVE), SBC - RN, Brasil; (11) Faminas, BH - MG, Brasil
Objective: Migraine (ICD-10: G43) is a prevalent neurological disorder that significantly affects quality of life and generates substantial healthcare costs. Although often associated with younger populations, it remains relevant among older adults, particularly given the growing elderly population in Brazil. To analyze the distribution and economic burden of hospital admissions for migraine in elderly individuals (≥60 years) in Brazil during 2024, stratified by sex and race/ethnicity.
Methods: Data were extracted from the SIH-SUS (Hospital Information System) for the year 2024, including individuals aged 60–69, 70–79, and ≥80 years. Analyses considered total hospitalizations and corresponding costs by sex and race/ethnicity.
Results: A total of 277 hospitalizations were recorded among elderly patients due to migraine, with a predominance of females (n=168; 60.6%) over males (n=109; 39.4%). White individuals accounted for the majority of admissions (n=194; 70.0%), followed by mixed-race (parda) individuals (n=65; 23.5%), Black individuals (n=14; 5.1%), and Yellow individuals (n=4; 1.4%). The total cost of hospitalizations reached BRL 144,918.95. Females incurred higher healthcare expenditures (BRL 90,353.25; 62.4%) than males (BRL 54,565.70; 37.6%). White individuals represented the largest financial burden (BRL 104,764.41; 72.3%), followed by mixed-race (BRL 29,632.62; 20.4%), Black (BRL 9,066.42; 6.3%), and Yellow individuals (BRL 1,455.50; 1.0%).
Conclusion: Migraine imposes a notable epidemiological and financial burden among the elderly in Brazil, especially among females and white individuals. These findings emphasize the need for targeted strategies for diagnosis, management, and cost-effective care in older populations.
Disclosure of Interest: None.
IHC25-LBAPO-004Epidemiological and Financial Analysis of Migraine Hospitalizations in Adults in Brazil, 2024
Luana Mendes dos Santos1; Maíra Abreu Cruz de Moraes2; Ana Elisa de Castro Ferreira3; Bárbara Moura da Silva4
(1) Faculdade de Medicina da USP, São Paulo - SP, Brasil; (2) Faculdade Ciências Médicas MG, Belo Horizonte - MG, Brasil; (3) Faculdade de Medicina de Barbacena, Barbacena - MG, Brasil; (4) Instituto Couto Maia (ICOM), Salvador - BA, Brasil
Objective: Migraine is a chronic neurological disorder with significant individual and societal burden, particularly among adults of working age. While typically managed in outpatient settings, severe cases can lead to hospitalization and generate substantial healthcare expenditures. This study aims to assess the epidemiological profile and economic impact of migraine-related hospital admissions in Brazil in 2024, stratified by sex and adult age groups.
Methods: A descriptive epidemiological and financial analysis was performed using data from the SIH-SUS (Hospital Information System of the Brazilian Unified Health System). We examined adult patients (aged 20–59 years) hospitalized with a primary diagnosis of migraine (ICD-10 G43) in 2024. The data were stratified by sex and age group (20–29, 30–39, 40–49, 50–59 years), considering both frequency of admissions and total hospitalization costs in Brazilian Reais (BRL).
Results: A total of 1,230 hospitalizations for migraine were recorded in adults during 2024, with a marked predominance among females (n = 918; 74.6%) compared to males (n = 312; 25.4%). The highest number of hospitalizations occurred in the 30–39 years age group (n = 337; 27.4%), followed by 40–49 years (n = 331; 26.9%), and 50–59 years (n = 255; 20.7%). Female hospitalizations peaked at 30–39 years (n = 252), whereas male hospitalizations were most frequent among those aged 40–49 years (n = 87). The total cost of migraine hospitalizations in adults reached BRL 562,690.16. Women accounted for 69% of these expenses (BRL 388,651.88), and men for 31% (BRL 174,038.28). The age group with the highest financial burden was 40–49 years, with BRL 182,226.77 in total costs. The data reveal a significant epidemiological and financial burden of migraine in adult women, particularly between 30 and 49 years. This aligns with global evidence indicating hormonal influence and peak prevalence during reproductive years. The predominance of hospitalizations in the economically active population suggests potential losses in productivity and highlights the need for improved outpatient management and early intervention strategies.
Conclusion: Migraine hospitalization in Brazil in 2024 disproportionately affected adult females and individuals aged 30–49 years, with substantial public health expenditures. These findings support the implementation of targeted health policies aimed at prevention, early diagnosis, and effective outpatient care to reduce severe cases requiring hospital admission.
Disclosure of Interest: None.
IHC25-LBAPO-005Epidemiological Profile of Migraine (G43) in the State of São Paulo – 2024
Letícia Hanna Moura da Silva Gattas Graciolli1; Luana Mendes dos Santos2; Isabella de la Jara Gagliardi3; Rafaela Natali Vasconcelos4; Júlia Helena Estrella5; André Luis Silva de Sousa6; Caroline Maemy Honda Cardoso7; Giulia Rossi Trevizaneli7; Anna Raquel Carneiro Araújo8; Alice Lima Costa da Silva9; Caroline Cavalcante Leite10; Heloysa Costa de Tulio5; Heloysa Costa de Tulio5
(1) Faculty of Medicine of Jundiaí, Jundiaí - SP, Brasil; (2) Fmusp, SP - SP, Brasil; (3) UNISA, Jundiaí - SP, Brasil; (4) UMC, Mogi das Cruzes - SP, Brasil; (5) UNINOVE, SP - SP, Brasil; (6) UMAX, Paraguay; (7) FAMEMA, Marília - SP, Brasil; (8) UNIME, Lauro de Freitas - BA, Brasil; (9) FPS, Recife - PE, Brasil; (10) UNISA, SP - SP, Brasil
Objective: Migraine is a disabling neurological disorder that affects individuals across all age groups and is a major cause of morbidity and reduced quality of life. Understanding its distribution is essential for public health planning and resource allocation. To describe the epidemiological profile of hospital admissions for migraine in the state of São Paulo in 2024, stratified by age and sex.
Methods: Data were collected from the Hospital Information System of SUS (SIH-SUS) for the state of São Paulo. All hospitalizations due to migraine (ICD-10: G43) in 2024 were analyzed by age group and sex.
Results: A total of 1,824 hospitalizations for migraine were recorded. Females accounted for the majority of cases (n=1,311; 71.9%), while males comprised 28.1% (n=513), demonstrating a significant sex disparity. The age groups with the highest number of admissions were 30–39 years (n=337; 18.5%), 40–49 years (n=331; 18.1%), and 20–29 years (n=307; 16.8%). A progressive decrease in cases was observed with advancing age, with 153 admissions in the 60–69 group, 90 in the 70–79 group, and 34 among those aged 80 years or older. In the pediatric population, cases were recorded even in early childhood, including three cases under 1 year and 13 cases in the 1–4 age group. The total number of hospitalizations in individuals under 20 years was 304 (16.7%).
Conclusion: Migraine hospitalizations in São Paulo are markedly more common in females and peak in early to mid-adulthood, particularly between 20 and 49 years. Although less frequent in the elderly, a significant number of cases still occur in this age group, reinforcing the chronic and recurrent nature of the condition. Public health policies should target both early diagnosis and long-term management strategies tailored to high-risk groups.
Disclosure of Interest: None.
IHC25-LBAPO-006Financial Analysis of Hospitalizations Due to Migraine (G43) in the State of São Paulo – 2024
Letícia Hanna Moura da Silva Gattas Graciolli1; Letícia Hanna Moura da Silva Gattas Graciolli1; Luana Mendes dos Santos2; Luana Mendes dos Santos2; Isabella de la Jara Gagliardi3; Isabella de la Jara Gagliardi3; Rafaela Natali Vasconcelos4; Rafaela Natali Vasconcelos4; Júlia Helena Estrella5; Júlia Helena Estrella5; André Luis Silva de Sousa6; André Luis Silva de Sousa6; Caroline Maemy Honda Cardoso7; Caroline Maemy Honda Cardoso7; Giulia Rossi Trevizaneli7; Giulia Rossi Trevizaneli7; Anna Raquel Carneiro Araujo8; Anna Raquel Carneiro Araujo8; Alice Lima Costa da Silva9; Alice Lima Costa da Silva9; Caroline Cavalcante Leite3; Caroline Cavalcante Leite3; Heloysa Costa de Tulio10
(1) Faculty of Medicine of Jundiaí, SP - SP, Brasil; (2) FMUSP, SP - SP, Brasil; (3) UNISA, SP - SP, Brasil; (4) UMC, Mogi das Cruzes - SP, Brasil; (5) UNINOVE, SP - SP, Brasil; (6) UMAX, Paraguay; (7) FAMEMA, Marília - SP, Brasil; (8) UNIME, Lauro de Freitas - BA, Brasil; (9) FPS, Recife - PE, Brasil; (10) Uninove, SP - SP, Brasil
Objective: Migraine poses a substantial economic burden on public health systems, particularly when hospital admissions are necessary. Quantifying these costs supports evidence-based decisions for resource allocation and targeted interventions. Financial data on hospitalizations for migraine (ICD-10: G43) in the state of São Paulo during 2024 were obtained from the SIH-SUS (DATASUS). Total hospitalization costs were analyzed according to sex and age group.
Methods: Financial data on hospitalizations for migraine (ICD-10: G43) in the state of São Paulo during 2024 were obtained from the SIH-SUS (DATASUS). Total hospitalization costs were analyzed according to sex and age group.
Results: The total cost of hospitalizations for migraine in 2024 was R$ 1,036,874.38. Female patients accounted for the majority of expenses, totaling R$ 752,318.08 (72.5%), while male patients incurred R$ 284,556.30 (27.5%). Costs were most concentrated in the following age groups: • 30–39 years: R$ 207,784.82 (20.0%) • 40–49 years: R$ 204,107.62 (19.7%) • 20–29 years: R$ 191,342.58 (18.4%) • 50–59 years: R$ 163,282.46 (15.7%) Although fewer in number, older adults (≥60 years) still represented a notable portion of expenses, with: • 60–69 years: R$ 93,847.43 • 70–79 years: R$ 61,759.31 • 80+ years: R$ 23,312.04 Pediatric and adolescent groups (≤19 years) represented a smaller share of total expenditures, with progressive increase by age: • 10–14 years: R$ 33,424.26 • 15–19 years: R$ 47,210.11
Conclusion: The financial burden of migraine hospitalizations in São Paulo is heavily skewed toward women and individuals in their economically active years (20–49 years). Nonetheless, elderly patients still generate significant costs, which underscores the need for comprehensive outpatient care to reduce admissions. Policies aimed at prevention, early management, and access to effective treatments could reduce hospitalization rates and overall expenditures.
Disclosure of Interest: None.
IHC25-LBAPO-007Headache in post-covid syndrome vs. primary headaches: clinical characteristics and functional impact
Gabriela Dutra Keller1; Luana Mendes Dos Santos2; Giulia de Moraes Grilo3; Beatriz Rodrigues Pedrosa4; Carolina Bombonato Patrício de Azambuja5; Julia Emilly Silva6; Thaionara Santos Santana7; Isabelle Cristina Moraes Mota8
(1) Universidade Nove de Julho (UNINOVE), São Paulo - SP, Brasil; (2) USP, SP - SP, Brasil; (3) Faculdade de Ciências Médicas e da Saúde PUC-SP, SOROCABA - SP, Brasil; (4) Universidade Nove de Julho (UNINOVE), SP - SP, Brasil; (5) Universidade Anhembi Morumbi, SP (UAM - Mocca) - SP - SP, Brasil; (6) Faculdade São Leopoldo Mandic, ARARAS - SP, Brasil; (7) Universidade Santo Amaro, SP - SP, Brasil; (8) Universidade Nove de Julho (UNINOVE), GUARULHOS - SP, Brasil
Objective: To analyze the clinical characteristics and functional impact of headache in patients with post-COVID syndrome, compared to those with primary headaches.
Methods: A search was conducted in the PubMed database using the MeSH terms: ("COVID-19" AND "Post-Acute COVID-19 Syndrome" AND "Headache"), filtered for articles published within the last five years and available in full text. Of the 55 results, 44 were fully accessible, and 10 articles were selected based on their relevance to the PICO question and methodological quality. Studies addressing the clinical characteristics, functional impact, and treatment response of headache in patients with post-COVID syndrome were included.
Results: The reviewed studies demonstrate that headache is a frequent and persistent symptom in both acute COVID-19 and post-COVID syndrome, often associated with reduced quality of life, fatigue, depressive symptoms, and cognitive impairment. Headache prevalence was high during the acute phase and persisted long after, affecting approximately one-third of patients up to two years post-infection. Risk factors for persistent headache included female sex, preexisting psychiatric conditions, hospital admission, and pulmonary complications. Additionally, healthcare professionals who were infected exhibited a higher risk of headache and cognitive symptoms compared to controls. Neuroimaging findings from PET (Positron Emission Tomography) scans revealed hypometabolism in brain regions such as the frontal, parietal, and temporal lobes, trigeminovascular activation mechanisms, and the presence of headache accompanied by hyposmia (reduced sense of smell). These findings highlight the significance of headache as a lasting neurological manifestation of COVID-19, with considerable functional impact and the need for a multidisciplinary approach in patient follow-up.
Conclusion: Headache is a highly prevalent neurological manifestation during and after COVID-19 infection. Due to its frequency and the associated functional burden, consistent follow-up and management of these patients are essential.
Disclosure of Interest: None.
IHC25-LBAPO-008How Patients Are Treated with Physiotherapy at a Headache and Orofacial Outpatient Clinic in a Brazilian Tertiary Hospital
Felipe Daniel Sambini1; Amanda Rodrigues2; Carina Pinheiro-Araújo1; Débora Bevilaqua-Grossi1
(1) University of São Paulo, Ribeirão Preto - SP, Brasil; (2) University of São Paulo, Ribierão Preto - SP, Brasil
Objective: To describe how individuals with headaches and orofacial pain are referred to and re treated by the physiotherapy service in a tertiary hospital in Brazil.
Methods: To present the flow of patients referred from the Headache and Craniofacial Pain outpatient Clinic (HCPC) to physiotherapy.
Results: Over a 6 months period (from July to December 2024), 595 individuals were treated by neurologists at the headache outpatient clinic. Of these, 56 were referred to physiotherapy. All individuals with headache were diagnosed using the third edition of the International Classification of Headache Disorders. Table 1 shows diagnoses in treated population. Figure 1 shows the flow of patients with headache and orofacial pain in the Healthcare System. Brazilian tertiary hospital. After referral, these patients undergo a comprehensive evaluation of the cervical spine, including the presence of trigger points, strength and cervical ROM, in addition to specific tests, such as the CCFT and FRT. Mandibular ROM and postural assessment are also performed. The initial treatment phase includes education in pain neuroscience, diaphragmatic breathing associated with cervical traction and mobilization, and release of trigger points. A second phase includes active stretching of the cervical spine and strengthening exercises for the deep flexors and cervical extensors, and cervical resistance training. In the advanced phase, scapular strengthening exercises are included. Patients usually undergo treatment for 8 or 12 weeks, after which they are re-evaluated. At this point, two outcomes are possible: discharge or redefinition of therapeutic goals.
Table 1 - Diagnoses at the Headache and Craniofacial Pain Clinic and in the Physiotherapy Service Diagnosis: HCPC (n=768) - Physiotherapy (n=56) Migraine: 374- 38 Idiopathic intracranial hypertension (IIH): 74 - 2 Trigeminal autonomic headaches: 45 - 1 Temporomandibular Disorders: 36 - 9 Trigeminal Neuralgia : 25 - 3 Cervicogenic headache: 23 - 9 Posttraumatic headache: 11 - 1 Tension-type headache: 9 – 2.
Conclusion: The public tertiary hospital in Ribeirão Preto offers free care through a multidisciplinary team that collaborates to meet patients’ needs.
Disclosure of Interest: None.
IHC25-LBAPO-009Migraine and Cephalic Pain: A Brazilian Epidemiological Study
Letícia Hanna Moura Da Silva Gattas Graciolli1; André Vítor Szynkaruk Forest2; Thainara Villani3; Tobias Moraes Bueno da Silva4; Mariane Arakawa Pamplona5; Marina Santos Moreira Guimarães6; Eduarda Belchior Capovilla7; Douglas Tenório Paes8; Thiago Antonino Gonçalves9; Camila Fernandes Mochiuti10; Maíla Araújo Pinto11; Artur Pires de Oliveira Longo10; Caio Mendonça Parreiras12; Luana Mendes dos Santos13
(1) Faculty of Medicine of Jundiaí, Jundiaí - SP, Brasil; (2) Universidade do Vale do Taquari (UNIVATES), Lajeado - RS, Brasil; (3) Universidade Luterana do Brasil, Canoas - RS, Brasil; (4) Universidade de Taubaté (UNITAU), Caraguatatuba - SP, Brasil; (5) Universidade de Medicina Campus Formosa, Formosa - GO, Brasil; (6) Universidade Federal de Ouro Preto, Ouro Preto - MG, Brasil; (7) Università degli Studi ‘’Magna Graecia’’, Italy; (8) Faculdade Pernambucana de Saúde (FPS)., Recife - PE, Brasil; (9) Universidade Nove de Julho, São Paulo - SP, Brasil; (10) Faculdade Santa Marcelina, São Paulo - SP, Brasil; (11) Universidade Professor Edson Antônio Velano (UNIFENAS), Belo Horizonte - MG, Brasil; (12) UNESP, Botucatu - SP, Brasil; (13) Faculdade de Medicina de USP, São Paulo - SP, Brasil
Objective: To analyze the epidemiological profile of hospitalizations related to migraine and other cephalic pain syndromes in Brazil between 2020 and 2024, with a focus on regional distribution, sex, age group, duration of hospitalizations.
Methods: This study is an analysis of epidemiological data, using the database from the Department of Informatics of the Brazilian Unified Health System (DATASUS). Codes from the International Classification of Diseases - 10th Revision (ICD-10) were used, accessed through the official DATASUS website, considering the period from 2020 to 2024. The variables included were: sex, age group, time period, and ICD-10 code.
Results: Between 2020 and 2024, a total of 33,314 hospitalizations for migraine and other cephalic pain syndromes were recorded in Brazil. The distribution among the Brazilian regions shows that the Southeast had the highest number of hospitalizations, with 10,349 cases (31.1%), followed by the Northeast with 9,775 (29.3%), South with 7,939 (23.8%), North with 3,145 (9.4%), and lastly, the Central-West with 2,106 hospitalizations (6.3%). In addition, there was a predominance of female hospitalizations (66.2%), with the highest gender disparity seen in the Central-West (70.2%) and Southeast (69.3%), remaining above 60% in all regions. Regarding age groups, most hospitalizations occurred among individuals aged 30 to 39 years, totaling 9,082 cases (27.2%), followed by those aged 40 to 49 years with 8,666 hospitalizations (26%), 20 to 29 years with 8,587 (25.8%), and 50 to 59 years with 6,979 hospitalizations (20.9%). The average hospital stay was approximately four days. The North had the highest average (5.0 days) and the Central-West the lowest (2.8 days). The national average fluctuated from 3.7 days in 2020 to 4.2 days in 2022–2023, decreasing to 4.0 in 2024, reflecting differences in hospital approaches and severity.
Conclusion: The data show that hospitalizations due to migraine and cephalic pain syndromes in Brazil are concentrated in the Southeast and Northeast regions, predominantly affecting adults aged 30 to 49 years, with a clear female predominance (66.2%). These findings highlight the need for targeted public policies, especially for women of working age, and for more standardized care protocols across Brazilian regions, aiming to optimize clinical management and reduce the socioeconomic impact of this neurological condition.
Disclosure of Interest: None.
IHC25-LBAPO-010Migraine in Azerbaijan: A Call for Enhanced Diagnosis, Awareness, and Treatment Accessibility
Sarkhan Amirguliyev1; Aynur Özge2; Derya Uludüz3; Semih Taşdelen4; Tayyar Şaşmaz5; Rami Burstein6
(1) Azerbaijan State Institute of Advanced Training of Doctors named after Aziz Aliyev,Baku, Azerbaijan, Azerbaijan; (2) Mersin University, School of Medicine, Mersin, Türkiye, Türkiye; (3) Brain 360 Integrative Brain Health Clinic, İstanbul, Türkiye, Türkiye; (4) Department of Neurology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey, Türkiye; (5) Professor of Public Health, Mersin University, School of Medicine, Mersin, Türkiye, Türkiye; (6) 8Department of Anaesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA, United States
Objective: Headache disorders are prevalent in Azerbaijan, yet data on system-level care delivery, treatment access, and provider preparedness remain scarce. This study aimed to assess the current state of headache care in Azerbaijan as part of the International Headache Society (IHS)–MENAA initiative.
Methods: A national cross-sectional survey was conducted among 333 healthcare professionals, including neurologists (25.9%), general practitioners (27.9%), pharmacists (21.9%), and pediatricians (24.3%). Data were collected using a modified HARDSHIP-based questionnaire addressing provider training, medication access, treatment practices, and perceptions of patient demographics. Descriptive statistics and comparative analyses were performed to assess regional and professional disparities.
Results: All providers reported receiving some form of training in headache care. Urban providers, especially those based in Baku (17% of respondents), reported significantly higher headache patient volumes, with neurologists seeing an average of 7.9 ± 8.9 headache cases per week compared to 1.9 ± 1.5 cases for general practitioners (p < 0.001). Medication use was primarily directed toward NSAIDs (67.3%) and paracetamol (27.6%), with lower prescription rates for triptans (15.0%), topiramate (10.5%), and amitriptyline (75.7%). Preventive medications such as magnesium (51.1%) and gabapentin (24.6%) were prescribed more often than newer therapies like CGRP monoclonal antibodies or gepants, which were unavailable.
Conclusion: This study reveals significant disparities in headache care across Azerbaijan, primarily driven by geographic centralization, limited medication access, and underutilization of standardized care pathways. To improve outcomes, national policies must support the development of structured headache services, expansion of training, and equitable access to essential treatments. These data offer a foundation for system-level reforms aligned with international best practices.
Disclosure of Interest: None.
IHC25-LBAPO-011Needs and Experiences of People with Headache Disorders in Argentina: Insights from a Patient Community Survey Promoted by AMyCA
Lucia Noemi Balbastro1; Ivana Partnoy1; Cecilia Galasso1; Maria Agustina Hildt1; Martin Tiscornia1; Silvia Boneta1; Fiorella Martin Bertuzzi1
(1) Asociación Migraña y Cefaleas Argentina, Argentina
Objective: To describe the demographic, clinical, and experiential profile of individuals with headache disorders who participated in a patient-centered survey conducted by the Asociación Migraña y Cefaleas Argentina (AMyCA).
Methods: A cross-sectional descriptive study was conducted based on responses from 702 participants who joined an AMyCA-promoted outreach activity with headache experts between june 2023 and may 2025. The online survey captured demographic data, headache characteristics, healthcare provider, treatment experiences, and patients’ needs.
Results: Out of the 702 participants, 95.6% were female, with a mean age of 43.5 years (range: 17–77). A majority (92.7%) had a headache diagnosis by a professional, with migraine being the most reported (89.3%). The mean number of days with headache per month was 13.2, and the mean pain intensity was 7.2/10. Over half of the participants (53.8%) reported follow-up with a headache specialist. Among 467 respondents, main unmet needs included information on treatment risks/benefits (52.25%) and headache causes (50.11%). Patients also cited poor communication (38.33%) and long wait times (35.55%). Of 480 participants, most identified exercise (60.63%) and stress management (57.92%) as key self-care strategies. Preferred activities (n=482) included education programs (62.45%), crisis protocol access (53.53%), and treatment information platforms (50.41%).
Conclusion: These findings underscore the importance of integrating educational, communicational, and organizational strategies into headache care. Enhancing access to clear information, empathetic support, and structured patient engagement tools may significantly improve patient experience and empowerment, even in the absence of clinical symptom improvement.
Disclosure of Interest: None.
IHC25-LBAPO-012Patient Satisfaction and Type of Headache Follow-up: A Comparative Analysis of Specialist Versus Non-Specialist Care in Argentina
Fiorella Martin Bertuzzi1; Lucia Noemi Balbastro1; Maria Agustina Hildt1; Cecilia Galasso1; Ivana Partnoy1; Martin Tiscornia1; Silvia Boneta1
(1) Asociación Migraña y Cefaleas Argentina, Argentina
Objective: To examine whether follow-up with neurologists, particularly headache specialists, is associated with greater patient satisfaction, independent of headache frequency and intensity.
Methods: This cross-sectional study analyzed responses from individuals with headache disorders who completed a structured survey promoted by the Asociación Migraña y Cefaleas Argentina (AMyCA). Satisfaction with care was compared between patients followed by neurologists versus non-neurologists, and between those followed by headache specialists versus other providers. Pain frequency and intensity were analyzed as covariates.
Results: A total of 702 participants completed the AMyCA survey. Satisfaction levels differed notably by provider type: patients followed by headache specialists reported the highest satisfaction (35 very satisfied, 60 quite satisfied), followed by those under general neurologists (38 and 70, respectively). In contrast, respondents followed by general practitioners or other providers reported lower satisfaction, with only 7 very satisfied and higher dissatisfaction rates. Chi-squared analysis confirmed significant associations between provider type and satisfaction (p < 0.000000001 for specialists vs non-specialists; p = 0.0032 for neurologists vs non-neurologists). No significant differences were found in headache frequency or days with pain across groups. However, pain intensity was consistently lower among those followed by specialists (mean 5.94 vs 6.52; p = 0.09) and neurologists (6.09 vs 6.57; p = 0.08), though not statistically significant.
Conclusion: Follow-up by neurologists, and particularly by headache specialists, is significantly associated with higher patient satisfaction, despite similar clinical profiles. Improving access to specialized care may enhance patient-perceived quality without necessarily changing headache frequency.
Disclosure of Interest: None.
IHC25-LBAPO-013Understanding Headache Care in Low-Resource Settings: Key Lessons from the IHS Survey in the Republic of Moldova
Oxana Grosu1; Aynur Özge2; Derya Uludüz3; Semih Taşdelen4; Sarkhan Amirguliyev5; Tayyar Şaşmaz6; Marina Sangheli7; Stela Odobescu1; Rami Burstein8
(1) Diomid Gherman Institute of Neurology and Neurosurgery, Headache centre, Chisinau, the Republic of Moldova, Moldova; (2) Mersin University, School of Medicine, Mersin, Türkiye, Türkiye; (3) Brain 360 Integrative Brain Health Clinic, İstanbul, Türkiye, Türkiye; (4) Department of Neurology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey, Türkiye; (5) Azerbaijan State Institute of Advanced Training of Doctors named after Aziz Aliyev1, Baku, Azerbaijan, Azerbaijan; (6) tsasmaz@mersin.edu.tr, Türkiye; (7) Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, the Republic of Moldova., Moldova; (8) Department of Anaesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA, United States
Objective: Headache disorders are among the leading causes of disability globally, and their impact is magnified in low—and middle-income countries (LMICs) due to limited access to specialized care, medications, and provider training. The Republic of Moldova, as part of the International Headache Society’s MENAA initiative, was assessed to identify current gaps and opportunities for improving headache care delivery. This study aimed to evaluate the distribution and training of healthcare providers, the accessibility and affordability of headache medications, and prescribing behaviours across Moldova to inform targeted policy and healthcare interventions.
Methods: A cross-sectional survey was conducted among 212 healthcare professionals in the Republic of Moldova, including neurologists, general physicians, and other providers. Data on demographics, training background, medication prescribing patterns, affordability estimates, and perceptions of patient characteristics were analysed. Supplementary network diagrams and heatmaps were generated to visualize provider–medicine interactions and medication accessibility disparities.
Results: Headache care was highly centralized, with 45% of providers in the capital, Chișinău, and 72.2% practicing in hospital-based settings. Only 60.8% of respondents had formal headache training. Financial barriers were prominent: 41.0% of patients paid out-of-pocket, and 35.9% could not afford treatment. NSAIDs and paracetamol were the most prescribed medications, while triptans and preventive therapies were rarely accessible, especially for low-income patients. Visual tools highlighted disparities in access and treatment consistency.
Conclusion: Significant challenges exist in the Republic of Moldova’s headache care landscape, including provider concentration, limited training, and economic barriers. Addressing these issues through structured training, decentralized services, and policy-level reforms is essential to improving equitable headache care in Moldova and similar LMIC settings.
Disclosure of Interest: None.
IHC25-LBAPO-014Understanding Headache Patient Language in AMyCA’s WhatsApp Group: A Retrospective AI-Based NLP Study (2020–2025)
Fiorella Martin Bertuzzi1; Lucía Noemí Balbastro1; Cecilia Galasso1; Ivana Partnoy1; Silvia Boneta1; Martin Tiscornia1; Maria Agustina Hildt1
(1) Asociación Migraña y Cefaleas Argentina, Argentina
Objective: This study aimed to analyze the content of patient interactions in a WhatsApp support group for headache sufferers in Argentina, using natural language processing (NLP) to evaluate message frequency, thematic trends, sentiment, and treatment-related discussion across two periods: 2020–2021 and 2023–2025.
Methods: We conducted a retrospective observational study analyzing 103,090 anonymized WhatsApp messages from 158 subjects. Preprocessing included tokenization, lemmatization, and exclusion of non-informative content. Sentiment analysis and thematic clustering were performed using the GPT-4o model, Python-based scripts and manual curation. Treatment mentions were extracted manually and assessed for frequency and associated sentiment.
Results: A total of 103,090 anonymized WhatsApp messages from 158 subjects were included after pre-prossesing. The number of messages increased from 39,692 in 2020–2021 to 62,008 in 2023–2025. There is a significant peak activity on Wednesday evenings. Sentiment analysis classified 38% of messages as positive, 25% negative, 21% neutral, and 16% mixed. The most frequent terms were “dolor”(pain), “migraña” (migraine), and “cabeza” (head). A significant rise in mentions of evidence-based treatments—topiramato, amitriptilina, botox, and monoclonal antibodies—was observed (p < 0.0001), along with the emergence of gepante in the second period. In contrast, mentions of cefaly and piercing significantly declined. Of 32 identified treatment terms, 21 showed statistically significant variation across periods (Table 1). Cannabis and diclofenac approached significance, suggesting emerging interest. Thematic analysis revealed recurring topics such as treatment efficacy, lifestyle strategies, and side effects.
Conclusion: Online support groups may function as both emotional outlets and evolving educational environments for patients with headache disorders. Trends in treatment terminology suggest shifts in patient awareness and orientation toward pharmacological options. These findings support the integration of moderated peer-support platforms into multidisciplinary headache care and highlight the value of NLP in understanding patient communication dynamics.
Disclosure of Interest: None.
AI, Data Science, and Big Data
IHC25-LBAPO-015Artificial intelligence–based automatic segmentation for reproducible quantification and characterization of trigeminal ganglion neurons in histological sections: a pilot study
Victor Augusto Benedicto dos Santos1; Thiago Zilli2; Paulo Fernando Ribeiro Izepão1; Flávia Alessandra Araújo da Costa1; Thiago de Lima Prado2; Sergio Roberto Lopes2; Juliana Geremias Chichorro1
(1) Department of Pharmacology, Federal University of Parana, Curitiba - PR, Brasil; (2) Department of Physics, Federal University of Parana, Curitiba - PR, Brasil
Objective: The present study aimed to characterize an automatic segmentation tool for trigeminal ganglion neurons counting and characterization in histological sections based on hematoxylin-eosin staining using a deep learning-based cell segmentation algorithm [Cellpose] that allows a reproducible morphological analysis in physiological and pathological conditions.
Methods: Six adult male Wistar rats (60 days) were euthanized for trigeminal ganglion excision (CEUA/BIO-UFPR; #1637). The trigeminal ganglia were fixed in buffered formalin (pH 7.3) for 24 h, dehydrated, cleared, embedded in paraffin, and sectioned longitudinally at 6 µm for hematoxylin-eosin staining. Six histological images at ×20 magnification were used for image segmentation, performed using an algorithm based on a modified convolutional neural network architecture [Cellpose], trained to predict cell masks and flow vectors that guide each pixel toward the cell center. The pre-trained nuclei model was applied, with diameter parameters adjusted and optimized to match the morphological characteristics of neurons stained with hematoxylin-eosin, and the results were compared to those obtained by a manual method [ImageJ].
Results: Threshold analysis for automatic neuron detection identified an optimal diameter of 130 pixels (Figure 1). The automatic cell counting method identified a mean of 92 neurons with a coefficient of variation (CV) of 38.42%, compared to 99 neurons with a CV of 29.90% for the manual cell counting method, with no significant difference (unpaired t-test, P = 0.7315). The mean (CV) neuron area was 638.5 µm² (55.36%) for the automatic method and 526.3 µm² (60.05%) for the manual method. Although the total neuron area differed significantly between the methods (Mann-Whitney, P < 0.0001), no significant difference was found in the coefficients of variation (Mann-Whitney, P = 0.3095).
Conclusion: The automatic segmentation method enhanced by artificial intelligence showed comparable performance to the manual method. However, there is currently no gold standard for automatic segmentation of hematoxylin-eosin-stained neurons, which hinders consistent comparisons across studies. Therefore, the development and validation of standardized automatic methods are essential to ensure reproducibility and consistency in morphological analyses.
Disclosure of Interest: The authors have no conflicts of interest to declare. This work was supported by the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) [grant number 444139/2024-9].
IHC25-LBAPO-016The Contribution of Menstrual Migraine to Risk for Cardiovascular and Cerebrovascular Disease
Gina Dumkrieger1; Todd J Schwedt1; Imon Banerjee1; Amara Tariq1; Oana Dumitrascu1; Catherine Chong1
(1) Mayo Clinic, United States
Objective: The relationship between migraine and increased risk of cardiovascular and cerebrovascular disease (CVD) is well established, particularly the increased risk in individuals with migraine with aura. However, the potential contribution of menstrual migraine (MM) to CVD risk has not been investigated. In this study we analyzed a large cohort of women with migraine to assess their risk of atherosclerotic CVD events and their connection to menstrual migraine (MM).
Methods: A cohort of women with at least one migraine ICD diagnostic code was identified from the Mayo Clinic Electronic Health Record, and 2013 American College of Cardiology (ACC)/American Heart Association (AHA) atherosclerotic cardiovascular disease (ASCVD) risk scores were calculated. The MM ICD code was introduced in 2008 so the cohort was restricted to those who were 50 years of age or younger in 2008 and who had at least one diagnosis since 2008. The training and test sets for the Cox Proportional Hazards (CoxPH) models were restricted to women between the ages of 40 and 79 The cohort was stratified into African American (AA) and other individuals, consistent with the White and AA models and ACC/AHA recommendations. Using the White cohort CoxPH models were fit 1)using only ACC/AHA covariates 2) ACC/AHA covariates plus migraine features: aura, chronic migraine, and menstrual migraine. The predictive accuracy of these models was compared to the original ACC/AHA score and each other.
Results: In the full cohort (n=52,153) MM is associated with higher HDL and lower systolic BP compared to those without MM who are the same age; total cholesterol was similar between those with MM and those without(Figure 1). Those with MM were less likely to have a lifetime ASCVD event (Fisher exact: p<0.001) and were not more likely to have chronic migraine or aura (p= 0.085, p = 0.606) 31,963 women were included in the CoxPH models, which outperform the existing ACC/AHA score. Adding MM increased the predictive performance of the model (Anova p =0.002). The coefficients for chronic migraine and aura were significant(p<0.001) and positive. The coefficient for MM was significant and negative (p=0.004).
Conclusion: In this retrospective cohort of women with migraine, those who ever received a MM diagnosis were less likely to have ASCVD events than those without. MM may represent a migraine subtype with different underlying biological mechanisms and potentially reduced association with CVD risk.
Disclosure of Interest: This work was funded by a grant from the American Heart Association 23MRFSCD1077177. No other disclosures.
IHC25-LBAPO-017Vascular Risk Prediction in Migraine: A Multimodality Risk Score Based on Artificial Intelligence-Electrocardiogram Output, Echocardiography, and Detailed Migraine Characteristics
Keiko Ihara1; Nan Zhang1; Ping-Hao Yang1; Chieh-Ju Chao1; Francisco Lopez-Jimenez1; Kathryn E Mangold1; Itzhak Zachi Attia1; Paul A. Friedman1; Peter A. Noseworthy1; Chia-Chun Chiang1
(1) Mayo Clinic, United States
Objective: Patients with migraine have higher risks for stroke and other adverse vascular events. We have conducted prior analyses on how artificial intelligence (AI)-electrocardiogram (ECG) algorithms (atrial fibrillation prediction model and age estimation model), echocardiogram parameters, and detailed migraine characteristics separately predict vascular events. However, the relative importance and combined effects of each modality have not been established.
Methods: We developed a multimodality prediction model to evaluate the vascular risks in patients with migraine based on comprehensive clinical information, including AI-ECG atrial fibrillation prediction model output and computed delta age (ECG age minus chronological age), echocardiogram parameters, and migraine characteristics. We conducted retrospective observational study on patients with at least one 12-lead ECG, transthoracic echocardiogram and a visit with a headache specialist at any Mayo Clinic site within 3 years. The outcome is a composite endpoint of acute ischemic stroke, acute myocardial infarction, venous thromboembolism, and all-cause mortality. We selected 20 risk parameters, including (a) demographics, (b) comorbidities, (c) AI-ECG outputs, (d) echocardiogram, (e) migraine characteristics found to be predictive of vascular events. Each variable was assigned a different risk score according to the hazard ratio (HR) and beta coefficient from prior Cox regression analysis. We used Contal and Q’Quigley’s method to find the optimal cut-off, and an additional multivariate Cox regression was conducted to assess the relative risk of each parameter category.
Results: We included 297 patients with migraine, of whom 247 were female and 109 had migraine with aura. The mean age was 39.0±13.3 and follow-up period was 68.9±60.9 months. Thirty-five developed the composite endpoint (11.8%). Those with a risk score ≥15 had significantly shorter vascular event-free survival (HR [95% CI], 3.85 [1.90–7.81]; p<0.001) compared to those scored <15 (Figure 1). Furthermore, comorbidity (HR, 1.17 [1.06–1.30]; p=0.003) and migraine characteristics (HR, 1.34 [1.05–1.71]; p=0.018) were significantly predictive of the composite endpoint, whereas other categories were not.
Conclusion: This study supports the use of combined AI-ECG output, echocardiogram and migraine characteristics for vascular risk prediction, and highlights the importance of obtaining detailed migraine information for risk stratification.
Disclosure of Interest: This study is funded by the American Heart Association (GRANT_NUMBER: 23MRFSCD1077179). KI receives Postdoctoral Fellowship Grant from the American Heart Association with funds paid to her institution. CC has served as a consultant for: Pfizer, AbbVie, Amneal, Satsuma and eNeura. She receives research funds from the American Heart Association with funds paid to her institution.
Cluster Headache and Other Trigeminal Autonomic Cephalalgias
IHC25-LBAPO-018Alterations in parietal EEG features during high-flow oxygen therapy of episodic cluster headache patients
Jiahao Li1; Meng Wei1; Yi Qi1; Xiangyu Lei1; Xiao Liu1; Panpan Zhang1; Xinyue Sun1; Rui Liu1; Guogang Luo1
(1) The First Affiliated Hospital of Xi'an Jiaotong University, China
Objective: High-flow oxygen therapy is an effective treatment for episodic cluster headache patients (eCH), with about 60% efficiency. However, the central nervous system mechanisms associated with this are lacking. This study aimed to evaluate the electroencephalography (EEG) features during oxygen therapy in eCH and to deepen the understanding of the neural mechanisms in cluster headache.
Methods: Thirty in-bout eCH were enrolled, each patient underwent resting-state EEG recording under two conditions: 1) 20-minute high-flow oxygen therapy (15 L/min, 100%O2), and 2) 10 minutes after oxygen therapy to maintain steady, clinical scales were also completed after EEG. Following EEG data preprocessing, the signals were decomposed into seven frequency bands: Delta, Theta, Alpha, Low Beta, High Beta, Low Gamma, and High Gamma. For each band, power spectral density (PSD), four classical microstate (A to D) relevant parameters, and functional connectivity (FC) based on phase-locked values (PLV) were calculated. Paired-sample t-tests were employed to compare EEG indicators differences during and after oxygen therapy, and to evaluate the correlation of differential indicators with clinical scales
Results: （1）PSD: Eyes closed: During oxygen therapy, the PSD of T6 electrodes in Low Gamma and High Gamma bands was significantly higher than that in steady state (P=0.047; P=0.032). Furthermore, Low Gamma band PSD of T6 electrodes showed a marginally significant positive correlation with visual analog scores (VAS) (r=0.366, P=0.055). （2）Eyes opened: During oxygen therapy, the PSD of P4 electrode in Delta band was lower than that in steady state. (P=0.016). （3）Microstate analysis: Eyes closed: Mean global field power (GFP) was lower in microstate A during oxygen therapy than in steady state (P=0.045). Moreover, this mean GFP exhibited a significant positive correlation with Pittsburgh Sleep Quality Index (PSQI) (r=0.411, P=0.030) and a significant negative correlation with VAS (r=-0.611, P<0.001). （4）Eyes opened: the mean duration of microstate A during oxygen therapy was higher than that in steady state (P=0.027). （5）Functional connectivity: Eyes closed: FC in the High Gamma band was lower in the oxygen therapy state than in steady state (P=0.037), and this FC was associated with anxiety only in the oxygen therapy state (r=0.408, P=0.031).
Conclusion: High-flow oxygen therapy may modulate local parietal electrical activity and the short-term dynamics of brain networks in episodic cluster headache patients.
Disclosure of Interest: None.
IHC25-LBAPO-019Cluster Headache phenotype of 137 Cases in Brazil
Maria Eduarda Nobre1; Gabriela Accioly1
(1) UFF, Rio de Janeiro - RJ, Brasil
Objective: Cluster headache (CH), certainly the most intriguing of the headache syndromes, is a rare disorder with peculiar clinical characteristics. Cluster headaches occur in 0.1% of the general population. The disease is more common in men, but this relationship has decreased over the years, perhaps due to an improvement in diagnostic accuracy in women, who are often misdiagnosed as migraine instead of cluster headache. The objective of the study is to describe the phenotype of CH in Brazil. Our goal was to collect clinical data, analyze diagnostic delays and the most frequent misdiagnoses in our country.
Methods: This study was conducted from April to June of 2025. Patients with a previous diagnosis of CH completed an online questionnaire (n = 137). Diagnoses were assigned according to the criteria of the International Classification for Headache Disorders. We obtained demographic information (age, gender, race), described the color of the eyes, initial assigned diagnosis, pattern of pain, frequency, schedule, location, lateralization and severity of pain, history of smoking and of alcohol consumption, family history, comorbidities, subsidiary investigation, body mass index, and history of snoring for all patients.
Results: We summarize data from some of the variables collected. Interestingly, the incidence of CH among men and women was statistically similar (50.4% men and 49.6% women), at ratio 1:1. Most were white (55,1%) and had brown eyes (65,7%). The first medical diagnosis received by these individuals was CH in only 5 (3,8%) of them. The most common misdiagnosis was migraine at 48.9%. CH strictly on the right side occurred in 54.4% of the sufferers; strictly on the left occurred in 43.4%, alternating unilateral CH happened in 2.2%. Pain was excruciating in 75.2% of the cases, and tearing was the most frequent associated symptom (92%). Most attacks happened from 1-3 am. A total of 65.4% of patients reported that they had never smoke.
Conclusion: Surprisingly, the incidence among men and women was similar, which corroborates the misdiagnosis, especially in women, with a high incidence of migraine as the first diagnosis. Lacrimation is the most common autonomic symptom and is possibly a point that should be questioned by the physician in all patients with fixed unilateral headache. Delayed diagnosis was the norm, suggesting that continuous medical education on cluster headaches is necessary to relieve the incredible burden of these sufferers.
Disclosure of Interest: None.
IHC25-LBAPO-020Efficacy and Safety of Galcanezumab for Cluster Headache Prevention: A Systematic Review and Meta-Analysis
Yasmin da Silva Moura1; Richard Aldib2; Luana Mendes dos Santos3; Letícia Hanna Moura da Silva Gattas Graciolli4; Emilly Luz Alves dos Anjos5; Maria do Socorro de Macedo Silva6; Giovana Gotardo Gonçalves7; Giordano Crivilatti Soldera8; João Francisco Honorato da Nóbrega9
(1) Universidade Salvador, Salvador - BA, Brasil; (2) Centro Universitário São Camilo (CUSC), SP - SP, Brasil; (3) USP, SP - SP, Brasil; (4) Faculdade de Medicina de Jundiaí, Jundiaí - SP, Brasil; (5) Universidad central del Paraguay, Paraguay; (6) Centro Universitário Uninovafapi, Teresina - PI, Brasil; (7) famema, SP - SP, Brasil; (8) UFSM, Santa Maria - RS, Brasil; (9) UNICID, SP - SP, Brasil
Objective: Calcitonin gene-related peptide (CGRP) plays a central role in the nociceptive pathways involved in migraine and cluster headache pathophysiology. CGRP antagonists, such as galcanezumab, have emerged as promising preventive strategies, especially for patients refractory to conventional therapies. This meta-analysis aims to evaluate the efficacy and safety of galcanezumab in reducing the frequency of cluster headache attacks.
Methods: Four randomized clinical trials were included, identified through PubMed (PMIDs: 31291515, 32050782, 34806783, 33179263), comparing galcanezumab to placebo in adult patients with cluster headache. Extracted variables included weekly attack frequency reduction and treatment-emergent adverse events (TEAEs). A fixed-effects model was used for statistical analysis, calculating standardized mean difference (SMD) and 95% confidence intervals (CI).
Results: In a 2019 study, galcanezumab reduced weekly attacks by a mean of 8.7 over 1–3 weeks, compared to 5.2 with placebo. A ≥50% reduction in attack frequency occurred in 71% of patients receiving galcanezumab versus 53% with placebo. In another study of Cephalalgia 2020, the reduction was 5.4 vs. 4.6 attacks/week, and in a Headache study, 11.0 vs. 5.5 attacks/week. The meta-analysis showed a combined SMD of 1.31 (95% CI: 1.13 to 1.49), significantly favoring galcanezumab. Common TEAEs included erythema, nasopharyngitis (17.6%), injection site pain (14.2%), and hypersensitivity events (27.5%).
Conclusion: Galcanezumab demonstrated superior efficacy to placebo in reducing weekly cluster headache attacks, with early and consistent clinical response across studies. Despite frequent local adverse effects, the safety profile is acceptable. These findings support the use of CGRP antagonists as promising preventive therapeutic options in the management of cluster headache.
Disclosure of Interest: None.
IHC25-LBAPO-021Efficacy and safety of greater occipital nerve block for the treatment of cluster headache: a systematic review and meta-analysis of randomized clinical trials
Thiago Luís Marques Lopes1; Mateus Dutra Balsells1; Marconny Alexandre Cavalcante1; Camilly Ramos Sales2; Emily Bittencourt de Souza Martins1
(1) Universidade Estadual do Ceará, Fortaleza - CE, Brasil; (2) Unichristus, Fortaleza - CE, Brasil
Objective: Cluster headache (CH) is recognized as one of the most intense pain syndromes described in the literature. One therapeutic approach is the greater occipital nerve block (GONB), which involves the suboccipital injection of a local anesthetic combined with corticosteroids to modulate nociceptive input. Although promising, robust evidence regarding its efficacy and safety in CH remains limited. To address this gap, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to provide more definitive evidence.
Methods: A systematic review of the literature was conducted using PubMed, Embase, and Cochrane databases. The outcomes of interest were the number of free-attacks patients and the presence of adverse effects. Statistical analyses were performed using Review Manager version 5.4.1.
Results: Of the 483 articles initially identified, three RCTs comprising a total of 105 patients were included. The studies had a mean follow-up duration of four weeks, with 53 patients (50.48%) receiving GONB treatment. At 3 days post-intervention, the GONB group demonstrated statistically significant superiority over the control group (RR: 3.22; 95% CI: [1.48–7.00]; p = 0.003; I² = 0%). At 1 week, GONB remained significantly superior to the control (RR: 3.19; 95% CI: [1.50–6.80]; p = 0.003; I² = 22.1%). However, at 4 weeks, no statistically significant difference was observed between groups (RR: 1.18; 95% CI: [0.90–1.56]; p = 0.225; I² = 17.5%). Regarding adverse events, the proportion of patients experiencing at least one adverse effect over the 4-week period did not differ significantly between the groups (RR: 1.16; 95% CI: [0.90–1.51]; p = 0.245; I² = 20.6%).
Conclusion: This study demonstrates that GONB is an effective and safe short-term treatment for CH. However, due to the limited sample size, the findings should be interpreted with caution. Future RCTs are warranted to assess the long-term efficacy of GONB and to explore the potential benefits of repeated therapeutic applications.
Disclosure of Interest: None.
Comorbidity of Primary Headaches
IHC25-LBAPO-022Cognitive impairment, its risk associations and event related potential P300 in patients with migraine: a prospective case control study
Bhargav Prajapati1
(1) Aiims, New Delhi, India
Objective: This study aims at understanding the frequency and magnitude of Cognitive impairment, its risk associations and event related potential P300 in patients with migraine (interictal phase) in a prospective case control design.
Methods: A Prospective case control study was conducted in a tertiary hospital in India. The demography, migraine type, migraine related factors, cognitive, sleep and psychological parameters were noted in patients and controls. Neuropsychological tests including TMT A & B, phonemic fluency, TNI- 93 and Event related Potential P300 performed in patients and controls during July 2022 to November 2023.
Results: A total of 50 patients with migraine and 50 controls were enrolled. Mean age was 31.3 ± 7.4 and 31.7 ± 7 years in patients and controls, respectively. The total numbers of years of education were higher in controls compared to migraineurs. In migraineurs 40% had MCI, 4% had SCD while 56% were normal. Patients with MCI had longer duration of illness, higher levels of depression, poor sleep quality, and anxiety compared Non-MCI patients. However, none of the parameter was significant independent risk factor for MCI. 22% of patients had impairment in attention & executive function domain. Migraineurs had lower P300 amplitude compared to controls, while no significant difference was seen in P300 latency between both groups.
Conclusion: In conclusion, our study highlights the significance of addressing cognitive and psychological parameters in migraine care, emphasizing the need for personalized therapeutic approaches. Future treatments may benefit from targeted cognitive interventions and a holistic understanding to enhance the management of this neurological condition.
Disclosure of Interest: None.
IHC25-LBAPO-023The Effects of Medical Comorbidities and Patient Demographics on Migraine Preventive Medication Selection and Treatment Outcomes
Keiko Ihara1; Gina Dumkrieger1; F. Michael Cutrer1; Todd J Schwedt1; Chia-Chun Chiang1
(1) Mayo Clinic, United States
Objective: Medical comorbidities and patient demographics might be considered when selecting amongst preventive medications for patients with migraine. The objective of this real-world electronic health record (EHR) study was to determine if comorbidities impact treatment selection and outcomes.
Methods: This is a retrospective study using two comprehensive and longitudinally established EHR Databases, one with all patients with migraine seen at any Mayo Clinic site and another with those seen by headache specialists at Mayo Clinic with documented treatment outcomes. We analyzed demographics, comorbidities (hypertension, seizure, depression/anxiety, obesity, cancer), number of preventive medication trials, and responses to beta-blockers, topiramate, tricyclic antidepressants (TCA), onabotulinumotoxinA (BoNT/A), and CGRP monoclonal antibodies (mAbs).
Results: We included 71,863 patients (female, 58,953 [82%]; chronic migraine, 21,640 [30%]) with migraine for prescription analysis and 4620 for response analysis (female, 3356 [73%]; chronic migraine, 3217 [70%]). Male patients were more likely to receive beta-blockers (odds ratio [95% confidence interval]: 1.22 [1.16–1.29]) and TCA (1.28 [1.21–1.35]), but less likely to be prescribed topiramate (0.65 [0.62–0.69]) and BoNT/A (0.79 [0.72–0.86]); they were less likely to respond to TCA (0.68 [0.50–0.92]) and BoNT/A (0.535 [0.39–0.74]). Patients with chronic migraine were less likely to be prescribed beta-blockers (0.56 [0.53–0.59]), topiramate (0.69 [0.65–0.73]), and TCA (0.51 [0.48–0.54]), but more likely to be prescribed BoNT/A (8.87 [8.19–9.62]) and CGRP mAbs (1.81 [1.68–1.94]). The positive predictors of response included thyroid disorders (1.32 [1.01–1.74]) for BoNT/A and migraine with aura for CGRP mAbs (1.60 [1.07–2.40]). Notably, patients with hypertension were less likely to receive (0.61 [0.57–0.64)]), but more likely to respond to topiramate (1.41 [1.03–1.93]). Patients with depression/anxiety were more likely to receive (1.29 [1.24–1.35]) but less likely to respond to TCA (0.68 [0.53–0.88]) (Figure 1).
Conclusion: Using our comprehensive EHR databases, we found that the presence of certain demographics and medical comorbidities influence prescription patterns and response to migraine preventives. The mechanisms by which comorbidities affect treatment response should be further explored.
Disclosure of Interest: KI receives Postdoctoral Fellowship Grant from the American Heart Association with funds paid to her institution. CC has served as a consultant for: Pfizer, AbbVie, Amneal, Satsuma and eNeura. She receives research funds from the American Heart Association with funds paid to her institution. GD has no conflicting interests. Within the prior 48 months, TJS has received compensation for consulting with AbbVie, Amgen, Linpharma, Lundbeck, Salvia, and Scilex. He received royalties from UpToDate and has stock options in Allevalux and Nocira. His institution received research grant funding on his behalf from The American Heart Association, Flinn Foundation, Henry Jackson Foundation, National Headache Foundation, National Institutes of Health, Patient Centered Outcomes Research Institute, Pfizer, Spark Neuro, and the United States Department of Defense.
IHC25-LBAPO-024Arbovirus infection as a possible trigger for chronic migraine: a case report
João Vitor Moreira Nogueira1; Bruna Barbosa Nobre1; Enzo Lima Alcântara Parente1; Marina Marques Maia1; Maria Luísa Brandão Cunha1; André Borges Ferreira Gomes1
(1) Centro Universitário Christus, Fortaleza - CE, Brasil
Objective: To describe a clinical case of a patient with a previous diagnosis of migraine and the possible association between a dengue virus infection and the subsequent chronification and refractoriness of the headache.
Methods: The data were extracted from medical records for the period 2016 to 2025, in a patient followed up in a private service in a capital city in northeastern Brazil.
Results: A 21-year-old patient with a previous diagnosis of episodic migraine without aura since the age of 16. In 2022, she presented with fever, dizziness, myalgia, and severe headache, symptoms that persisted for a week. As there was no improvement with symptomatic treatment, she sought hospital care and was diagnosed with dengue fever by serology. After this episode, she began to experience headaches with typical migraine characteristics, but more intense and frequent. An investigation was conducted to identify secondary causes, including neuroimaging, but no changes were identified. Treatment was then initiated with different prophylactic agents—including sodium valproate, propranolol, topiramate, candesartan cilexetil, fremanezumab, and galcanezumab—but even with combinations between classes, the patient presented significant clinical refractoriness. Currently, four years after the start of treatment, she continues to experience daily headaches, although with less intensity under the current regimen, which includes the combination of sodium valproate, candesartan cilexetil, and propranolol.
Conclusion: This case raises a question that has not yet been fully clarified in the literature regarding the role of viral infections as triggers for the chronicity and refractoriness of primary headaches, such as migraine. This association has an even greater impact in regions endemic for neurotropic viruses, such as dengue virus, and further epidemiological studies and follow-up of patients with primary headaches after infection are needed to better understand this correlation.
Disclosure of Interest: None.
Genetics and Biomarkers of Headache Disorders
IHC25-LBAPO-025A Simple, Low-Cost, and Readily Available Biomarker: Increased Neutrophil-to-Monocyte Ratio in Migraine
Aline Vitali-Silva1; VIctor M Pavão1; Matheus M Silva1; Isabelly N Franco1; Maria Fernanda P Vitro1; Caroline Zapelini1; Luiz A Netto1; Lia M H Imai1; Dilter J P C Oliveira1; Adriano T Antonucci1
(1) Universidade Estadual de Londrina, Londrina - PR, Brasil
Objective: To evaluate hematological parameters in individuals with migraine compared to non-migraine controls.
Methods: This was a retrospective case-control study including individuals aged 18–69 years with chronic migraine and age- and sex-matched controls diagnosed with epilepsy. Participants were selected from a university-based outpatient clinic and had at least one complete blood count (CBC) performed between January 2023 and May 2025. CBC parameters including platelet count were compared between groups, as well as combined ratios: neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-monocyte ratio (NMR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-monocyte ratio (PMR).
Results: A total of 25 individuals with migraine and 29 with epilepsy were included, with no significant differences in sex or age (p>0.05). Among migraine patients, 84% had migraine without aura and 75% were undergoing preventive treatment. Most individuals in the epilepsy group (72.5%) had focal epilepsy, and 93.1% were on antiepileptic medication. Migraine patients had an NMR of 11.42 (8.53–12.94), compared to 7.76 (6.13–10.17) in controls (p=0.029) (figure 1). There was no statistically significant difference in other parameters.
Conclusion: The neutrophil-to-monocyte ratio is a simple, low-cost, and easily accessible inflammatory marker that has been investigated as a prognostic biomarker in various conditions. Previous studies have shown elevated NMR in migraine, as well as correlations with headache intensity. The increase in NMR may indicate a predominance of the rapid and transient innate immune response mediated by neutrophils over the slower and more prolonged monocytic innate activity.
Disclosure of Interest: None.
Global Burden of Disease
IHC25-LBAPO-026Global Prevalence of Undiagnosed Migraine Among Adults: A Meta-Analysis of 202,167 Individuals
Ivy Liger Riso1; Georgia K. Westenhofen1; Mario Fernando P. Peres1
(1) Institute of Psychiatry, Faculty of Medicine at the University of São Paulo, São Paulo - SP, Brasil
Objective: To estimate the global prevalence of undiagnosed migraine among adults based on population-based studies.
Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. We included observational studies reporting the proportion of adults with migraine lacking prior diagnosis. An electronic search was performed in Medline (PubMed) for articles published in English from 2000 onwards; the search strategy was applied through April 2025, followed by manual screening in May 2025. After removing duplicates, two independent reviewers screened titles and abstracts, and full texts were assessed for eligibility. Discrepancies were resolved by consensus. Studies were included after full-text review. Data extraction was conducted independently. Analyses were performed in R (v4.4.1). Proportions were transformed using the logit method. Pooled estimates were calculated under fixed-effect and random-effects models (inverse variance method), with the latter prioritized due to high heterogeneity. Heterogeneity was assessed using Q, I2, H, and τ2 (REML, Q-profile CI). Hartung-Knapp adjustment was applied to improve CI precision. Exact Clopper-Pearson CIs were used for individual proportions.
Results: Given the high heterogeneity across studies (I2 = 99.7%; Q = 6163.0; p < 0.001), the random-effects model was selected as the primary analytical approach. The pooled prevalence of undiagnosed migraine was estimated at 68.5% (95% CI: 54.7%–79.6%) (Figure 1). Between-study heterogeneity remained high (τ2 = 1.27; 95% CI: 0.70–3.02), reflecting methodological and regional variability.
Conclusion: A considerable proportion of adults with migraine remain undiagnosed, with a global pooled estimate exceeding 68%. This underdiagnosis highlights a critical gap in migraine care, with implications for burden, quality of life, and healthcare access. Subgroup analyses by region, income level, and diagnostic criteria are needed to explore sources of heterogeneity and guide policy and practice.
Disclosure of Interest: None.
IHC25-LBAPO-027Quantifying the Migraine Prevention Gap: A Meta-Analysis of Global Undertreatment
Ivy Riso Liger1; Georgia K Westenhofen1; Mario Fernando Prieto Peres
(1) University of São Paulo, São Paulo - SP, Brasil; (2) University of São Paulo, São Paulo - SC, Brasil
Objective: To estimate the global prevalence of untreated migraine among individuals clinically eligible for preventive treatment.
Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. We retrieved 541 articles, including studies reporting the proportion of individuals eligible for migraine prophylaxis but not receiving it. Eligibility for preventive care was considered according to IHS guidelines recommendation. An electronic search was performed in Medline (PubMed) for articles published in English from 2000 onwards; the search strategy was applied through April 2025, followed by manual screening in May 2025. Following deduplication, two reviewers independently screened titles, abstracts, and full texts, with consensus for discrepancies. Eligible studies underwent independent data extraction. Analyses were performed in R (v4.4.1). Logit-transformed proportions were pooled via inverse variance under fixed and random-effects models; the latter was prioritized given heterogeneity. Between-study heterogeneity was assessed using Q, I², H, and τ² statistics (REML estimation; Q-profile confidence intervals). Hartung-Knapp adjustment was applied for confidence intervals, and exact Clopper-Pearson CIs were used for individual study proportions.
Results: Twelve studies comprising 28,861 preventive candidates of all were included. Among them, 22,499 were not receiving preventive treatment. The fixed-effect model estimated a pooled proportion of 76.0% (95% CI: 75.5%–76.5%), while the random-effects model indicated a higher pooled prevalence of 88.5% (95% CI: 77.8%–94.4%). Heterogeneity was extreme (I² = 99.3%; τ² = 1.29; 95% CI: 0.55–4.40), reflecting wide variability across populations and settings. According to pooled estimates from the same studies, 36.1% (95% CI: 27.5% - 45.7%) of individuals with migraine met criteria for preventive therapy according to IHS guidelines recommendation, highlighting the magnitude of the target population.
Conclusion: Migraine affects approximately 1,16 billion people worldwide. Applying the pooled estimate, 36.1% of them - or about 418,8 million - would be eligible for preventive therapy. Among this group, 88.5% are not receiving preventive treatment, equating to an estimated 370,6 million untreated preventive candidates globally. Targeted policies and health system strategies are urgently needed to reduce therapeutic inertia and ensure equitable access to preventive treatment.
Disclosure of Interest: None.
Headache Classification
IHC25-LBAPO-028Secondary headaches - precipitated primary headache syndromes with subsequent independent course
Hoda Hamod1; Symeon Symeonidis1; Anish Bahra1
(1) University College London, United Kingdom
Objective: Headache is the most common neurological symptom, often classified as ‘primary’ or ‘secondary’ based on underlying aetiology. The current International classification of headache disorders (ICHD) categorises the secondary headaches is based upon precipitating pathology, associated with headache which, in most cases, resolves with resolution of the pathology. There is no diagnostic clarification of precipitated headache syndrome. This study characterises the different secondary headaches as defined by the International Classification Committee, to include clinical features, assess outcomes and treatment responses.
Methods: This was a retrospective observational study of patients diagnosed with secondary headache disorders. Patients were identified from secondary and tertiary neurology clinics at the National Hospital for Neurology and Neurosurgery (NHNN) and Barts Health, London. For each case, clinical presentation was reviewed and classified according to the ICHD criteria . Data was collected for demographics, headache characteristics, pre-existing and family history of headache, exacerbating factors, treatments received, and clinical outcomes. The analysis focused on further development of the classification in terms of diagnostic utility and management.
Results: The largest category in this cohort was post-traumatic headache followed by category 14.2. The latter group consisted of secondary pathologies not defined by the ICHD Almost all the secondary headaches precipitated could be classified according to primary headache phenotypes, irrelevant of the precipitating pathology. The most common syndrome was migraine, chronic followed by episodic. Treatment of the underlying precipitating pathology did not consistently result in resolution of the headache. There was no disease-specific syndrome.
Conclusion: These findings support a syndromic approach to management of the headache whereby treatment is guided by the headache phenotype rather than the underlying aetiology alone. The latter is treated independently and recurrent headache is not necessarily an indicator of ongoing pathology. The classification does not provide a guide to one of the most pertinent issues facing any clinician which is differentiation between primary and secondary headache. The results have important implications for appropriate diagnosis and treatment, particularly in the context of over investigation in ongoing headache, and potential medicalisation of the presentation.
Disclosure of Interest: None.
Headache Disorders in Children and Adolescents
IHC25-LBAPO-029Clinical-Therapeutic Profile of Pediatric Migraine: A Tertiary Headache Clinic Experience
Dominick Esthephanny Monteiro-Silva1; Lucas Barbosa Napolitano de Moraes1; Patrick Emanuell Mesquita Sousa-Santos1; Renato Arruda2; Gustavo Arruda Alves1; Beatriz Medeiros Gurgel Blanco1; Érica Virgínia Batista Pereira Freire de Mello1; Mariza Paiva Carvalho1; Caio Russoni1; Lua flora Pereira Bezerra1; Isabella Allegretti1; Isabella Vargas Baldon1; João Pedro Franco Leal de Oliveira1
(1) Universidade Estadual Paulista (UNESP) - Botucatu, SP, Brasil; (2) Universidade São Paulo, Ribeirão Preto - SP, Brasil
Objective: To characterize the demographic and therapeutic profile of pediatric patients with migraine followed at a tertiary pediatric headache clinic, with emphasis on prophylactic treatment patterns and comparisons with adult clinical profiles.
Methods: This is a retrospective cross-sectional study including 203 patients, aged 5 to 15 years, currently followed in 2025 at the Pediatric Headache Clinic of the Hospital das Clínicas da Faculdade de Medicina de Botucatu – UNESP, a tertiary-level public institution and reference center for pediatric neurology in the regional Unified Health System (SUS). Among them, 160 patients (78.8%) were diagnosed with migraine, with or without aura, according to ICHD-3 criteria, while 43 were diagnosed with tension-type headache. Clinical and therapeutic data were extracted from electronic medical records and analyzed descriptively.
Results: Migraine patients were predominantly female (56.8%, n=91). Of these, 9.3% had migraine with aura, and 83.1% had at least one comorbidity, mainly neuropsychiatric disorders (24.3%) and epilepsy (23.1%). Prophylactic treatment was prescribed in 59.3%. Among those, amitriptyline was most used (26.8%), followed by flunarizine (10.6%), valproic acid (10.0%), and topiramate (9.4%). Less commonly prescribed agents included nortriptyline, venlafaxine, and cyproheptadine (1.9% each). Combination therapy was required in only 5.0%. Discontinuation due to inefficacy or adverse effects occurred in 20.0%, mostly involving valproate and amitriptyline.
Conclusion: Most pediatric migraine patients in this cohort were successfully managed with monotherapy or did not require prophylaxis, contrasting with adult cohorts where polytherapy is more common. The female predominance mirrors adult epidemiology. However, some first-line agents in adults, such as venlafaxine, remain off-label in pediatrics, reinforcing the need for age-specific strategies. These findings underscore the value of specialized longitudinal care to support individualized decisions, avoid unnecessary polypharmacy, and optimize pediatric migraine outcomes.
Disclosure of Interest: None.
IHC25-LBAPO-030Epidemiological Profile of Migraine-Related Hospitalizations in Adolescents in the State of São Paulo: Analysis of DATASUS Data (2010–2024)
João Lucas Anselmo dos Santos1; Julia Nathaly Cavalcanti Mendes de Sales2; Pedro Henrique Abbade Mendes3; Marcella Abranches Gil de Castro4; Raquel Maria Ayres Monteiro5; Iasmin Costa Magalhães6; Thiago Souza Azevedo7; Isabella Wakim Ferla8; Déborah Medeiros Magalhães9; Luana Mendes dos Santos10
(1) Universidade Federal da Grande Dourados (UFGD), Dourados - MS, Brasil; (2) Faculdade Pernambucana de Saúde, Recife - PE, Brasil; (3) Universidade Santo Amaro, São Paulo - SP, Brasil; (4) Universidade Federal do Rio de Janeiro, RJ - RJ, Brasil; (5) Faculdades Israelita de Ciências da Saúde Albert Einstein, São Paulo - SP, Brasil; (6) Universidade Católica de Pelotas, Pelotas - RS, Brasil; (7) Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Campus do Mucuri, Teófilo Otoni - MG, Brasil; (8) Universidade Católica Puc Campinas (PUCCAMP), Campinas - SP, Brasil; (9) Universidade Nove de Julho (UNINOVE), São Paulo - SP, Brasil; (10) Faculdade de Medicina da USP, São Paulo - SP, Brasil
Objective: To investigate the epidemiological characteristics of hospital admissions due to migraine among adolescents in the state of São Paulo, based on data from the Brazilian public health system.
Methods: This is a cross-sectional, retrospective, and descriptive epidemiological study with a quantitative approach, using data from the Hospital Information System of SUS (SIH/SUS), available through the Informatics Department of the Brazilian Unified Health System (DATASUS). The analysis included the number of hospitalizations for migraine (ICD-10 G43) and other headache syndromes (ICD-10 G44) in adolescents from 2010 to 2024 in the state of São Paulo, according to race/ethnicity, sex, age group (10 to 19 years), type of care (elective or emergency), average length of stay, and mortality rate.
Results: Between 2010 and 2024, a total of 4,240 hospitalizations for migraine were recorded among adolescents (10 to 19 years old) in the state of São Paulo. A predominance of females (68.1%) was observed. Regarding race/ethnicity, most hospitalized patients identified as white (58.7%), followed by mixed-race (22.9%) and Black (3.1%); cases with missing information accounted for 14.3%. The 15–19-year age group represented 56.5% of the hospitalizations. The majority of admissions were emergencies, totaling 4,106 (96.8%), while only 134 (3.1%) were elective. The average hospital stay was 3.2 days. Over time, the number of hospitalizations remained relatively stable, with peaks in 2011 (355 hospitalizations) and 2015 (349 hospitalizations), and a significant decrease in 2020 (201 hospitalizations).
Conclusion: This study offered an epidemiological overview of migraine-related hospitalizations in the state of São Paulo from 2010 to 2024. The findings demonstrated a predominance of young female patients and a high frequency of emergency admissions, underscoring the clinical burden of migraine in this population. The relative stability in hospitalization rates over the years—apart from the decline during the COVID-19 pandemic—emphasizes the persistent need for improved awareness, timely diagnosis, and targeted interventions aimed at managing migraine in adolescents.
Disclosure of Interest: None.
IHC25-LBAPO-031Hemiplegic migraine as presenting symptom of Evans syndrome: a case report
Laura D'Acunto1; Francesco Menna2; Adriana Cristofano3; Ilaria Bitetti4; Celeste Tucci4; Antonio Varone4
(1) Department of Neurosciences, Paediatric Neurology, Santobono-Pausilipon Children's Hospital (AORN), Naples, Italy; (2) Department of Oncohematology, Santobono-Pausilipon Children's Hospital (AORN), Naples, Italy; (3) Pediatric Neuroradiology, Department of Neurosciences, Santobono-Pausilipon Children's Hospital (AORN), Naples, Italy; (4) Department of Neurosciences, Paediatric Neurology, Santobono-Pausilipon Children's Hospital (AORN), Naples, Italy
Objective: Hemiplegic migraine (HM) represents a rare form of migraine with aura, presenting with episodes of transient motor weakness/hemiparesis. Evans syndrome (ES) is an autoimmune condition that presents with two or more cytopenias, which include autoimmune haemolytic anaemia and thrombocytopenia.
Methods: We report a case of ES with episodes of HM as symptoms of onset in a female adolescent.
Results: A 14-year-old woman, with no contributory history for hemiplegic migraine, was referred to the emergency department of our hospital for three episodes occurring in one week, characterised by gradual development of scintillating scotomas, followed by paraesthesia on the left arm, then left hemiparesis and speech disturbance. Each symptom lasted approximately 10 minutes, was fully reversible, and was followed by a migrainous headache. CT brain, conducted in the emergency department of another hospital, excluded ischemic/haemorrhagic stroke. Haematological tests revealed anaemia (haemoglobin 6.2 g/dL), with increased LDH (1148 U/L), thrombocytopenia (136,000/mm³) and reticulocytosis. A fourth episode of transitory left hemiparesis occurred, so she underwent to an urgent multimodal brain MRI that excluded acute stroke, showing on the right hemisphere reduced flow signal representation at distal arterial branches A2/A3, M2/M3/M4, P3/P4 associated with perisylvian cortical venous congestion, and a concomitant hypoperfusion on the entire right hemisphere compared to contralateral hemisphere, as seen on pCASL sequences (fig.1). Symptoms fully recovered and neurological examination was normal (NIHSS=0). On suspicion of an immune-mediated haemolytic process (Coombs test positive), therapy was started with IV immunoglobulin (0,5g/kg/die for five days), IV methylprednisolone (2,5mg/kg/die) and blood transfusions. Causes of secondary Evans Syndrome were ruled out. After starting specific therapy for ES, the patient no longer presented episodes of HM.
Conclusion: To the best of our knowledge, it is the first case of ES with episodes of HM as presenting symptoms. ES should be considered a cause of new-onset HM.
Disclosure of Interest: None.
IHC25-LBAPO-032Pediatric Migraine and Neuropsychiatric Comorbidities: Data from a Tertiary Pediatric Neurology Referral Center
Dominick Esthephanny Monteiro-Silva1; Lucas Barbosa Napolitano de Moraes1; Patrick Emanuell Mesquita Sousa-Santos1; Renato Arruda2
(1) Universidade Estadual Paulista (UNESP), Botucatu - SP, Brasil; (2) Instituto Glia, Ribeirão Preto - SP, Brasil
Objective: Pediatric migraine is a prevalent neurological condition, often associated with a spectrum of neurodevelopmental and neuropsychiatric comorbidities. Understanding the comorbidity profile in these patients is essential for individualized treatment approaches and improved outcomes. This study aims to describe the prevalence of neurodevelopmental, psychiatric, sleep, and other neurological comorbidities in children and adolescents diagnosed with migraine at a tertiary pediatric neurology center in Brazil.
Methods: A cross-sectional analysis was conducted using data from 160 pediatric patients with migraine (with or without aura), aged 5 to 15 years, followed from March 2024 to June 2025 at the Pediatric Headache Clinic of the Hospital das Clínicas da Faculdade de Medicina de Botucatu – UNESP, a tertiary-level public institution and reference center for pediatric neurology in the regional Unified Health System (SUS) network.
Results: Of 160 patients with migraine, 56.87% were female. Neurodevelopmental comorbidities included Attention Deficit Hyperactivity Disorder(5.6%), autism spectrum disorder (1.25%), and global developmental delay (2.5%). Psychiatric comorbidities included generalized anxiety disorder (15%), depression (4.37%), oppositional defiant disorder (3.12%), obsessive-compulsive disorder (0.62%), Tourette syndrome (0.62%), and tics (0.62%). Sleep disorders were also reported: obstructive breathing (7.5%), mixed (4.37%), and parasomnias (1.87%). Visual disorders (mainly refractive errors) were present in 16.87%, and epilepsy in 23.12%. Learning difficulties were reported in 15.65%.
Conclusion: Migraine in pediatric patients is frequently associated with a range of neuropsychiatric and neurodevelopmental comorbidities, particularly epilepsy, anxiety disorders, and sleep disturbances. These findings highlight the complex neurobiological overlap between migraine, cortical excitability, and behavioral regulation. The observed comorbidity rates in this population are considerably higher than those reported in general pediatric populations, suggesting shared pathophysiological pathways or referral bias. Early recognition of these conditions is crucial for optimized migraine management and may influence therapeutic choices, especially in the selection of prophylactic treatments with dual neuropsychiatric benefits.
Disclosure of Interest: None.
IHC25-LBAPO-033Posterior Reversible Encephalopathy Syndrome (PRES) induced by Ibuprofen intake: a case report
Laura D'Acunto1; Giuditta Bargiacchi2; Oriana De Marco3; L Annicchiarico Petruzzelli4; G Malgieri4; Celeste Tucci5; Antonio Varone5
(1) Pediatric Neurology, Department of Neurosciences, Santobono-Pausilipon Children Hospital, Naples, Italy; (2) Clinic of Child and Adolescent Neuropsychiatry, Department of Mental, Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy; (3) Chair of Nephrology, Department of Public Health, University Federico II of Naples, Naples, Italy; (4) Department of Pediatric Specialties, Pediatric Nephrology, Dialysis and Renal Transplantation Santobono Pausilipon Children's Hospital, Naples, Italy; (5) Pediatric Neurology, Department of Neurosciences, Santobono-Pausilipon Children Hospital, Naples, Italy
Objective: Posterior reversible encephalopathy syndrome (PRES) represents a rare acute/subacute condition characterized by reversible vasogenic oedema shown on brain MRI, usually on posterior regions, and acute neurological symptoms, in the setting of blood pressure fluctuations, renal failure, pre-eclampsia or eclampsia, autoimmune disorders and exogenous drugs (mainly cytotoxic drugs). However, no anecdotal cases of PRES have been reported among the assumption of NSAIDS in paediatric patients.
Methods: A six-year-old female patient came to the emergency department for the onset of a focal, prolonged epileptic seizure during sleep. Her personal and family history was not contributive. She reported a headache and abdominal pain one week before the onset of seizures. At home, the headache was initially treated with paracetamol and then, due to the lack of responsiveness, with five doses of ibuprofen within 24-48 hours before the acute onset. At admission, she was afebrile (temperature: 36 °C) with a heart rate of 100 beats/minute and normal blood pressure. The neurological examination revealed right arm weakness and slow responsiveness. Emergency EEG showed slow waves over bilateral temporo-occipital regions, with a right-sided predominance, consistent with focal status epilepticus, so an antiepileptic prophylaxis with levetiracetam was started. Urgent brain MRI with T2-weighted reveals abnormal cortical and subcortical signal in the occipital regions of both cerebral hemispheres and the right parietal region, so a diagnosis of PRES was made.
Results: After 7 hours from onset, blood pressure was 160/110 mmHg and treated with a low-sodium diet and amlodipine 5 mg/die and close monitoring of blood pressure. Laboratory tests, including renal function, hormones, urinary catecholamines, and autoimmunity panels, were not contributive. Infectious and autoimmune causes were excluded via serum and CSF testing (oligoclonal bands, antineuronal antibodies). No other causes of PRES were identified. After 14 days from onset, vasogenic oedema was completely remitted on brain MRI. With antihypertensives therapy, blood pressure was controlled after 24 hours, and decalage was performed until therapeutic suspension.
Conclusion: This is the first reported case of PRES associated with ibuprofen intake in a child, without underlying kidney disease.
Disclosure of Interest: None.
IHC25-LBAPO-034Tolerability of Migraine Prophylactic Agents in Children: Clinical Insights from Pediatric Headache Cohort
Dominick Esthephanny Monteiro-Silva1; Lucas Barbosa Napolitano de Moraes1; Patrick Emanuell Mesquita Sousa-Santos1; Renato Arruda2
(1) Universidade Estadual Paulista (UNESP), Botucatu - SP, Brasil; (2) Universidade São Paulo, Ribeirão Preto - SP, Brasil
Objective: To evaluate the tolerability and discontinuation rates of commonly prescribed prophylactic medications in pediatric patients with migraine followed at a specialized tertiary headache clinic.
Methods: We conducted a retrospective cross-sectional analysis of 160 pediatric patients diagnosed with migraine, aged 5 to 15 years, currently followed in 2025 at the Pediatric Headache Clinic of the Hospital das Clínicas da Faculdade de Medicina de Botucatu – UNESP, a tertiary-level public institution and reference center for pediatric neurology in the regional Unified Health System (SUS) network.
Results: Prophylactic treatment was in 59.3% of cases (n=95/160). The most prescribed medications were amitriptyline (n = 43; 26.9%), flunarizine (n=17; 10.6%), valproate (n= 16; 10%), topiramate (n=15; 9.4%). Nortriptyline, venlafaxine and cyproheptadine were prescribed in 3 cases each (n=3; 1.9%). Only 8 patients (5%) received combination regimens. Overall, 31.5% of patients (n=28) discontinued at least one prophylactic agent. Valproate had the highest discontinuation rate (54.1% n=19/35), due to inefficacy (n=10), thrombocytopenia (n=2), gastrointestinal intolerance (n=2), increased appetite (1), and others/undocumented reasons. Amitriptyline was discontinued in 12.2% (n=6/49) of cases, for sedation (n=4), behavioral agitation (1), inefficacy (1). Nortriptyline had a discontinuation rate of 25% (1/4). Topiramate and flunarizine showed discontinuation rates of 11.8% (n=2/17) and 5.5% (n= 1/17), respectively. No treatment interruptions were observed with cyproheptadine or venlafaxine, though these were used in small cases.
Conclusion: Flunarizine and topiramate demonstrated the best tolerability, while valproate showed relevant limitations. Interpreting adverse effects in pediatric patients remains challenging due to reliance on caregiver reporting and the presence of confounding factors.
Disclosure of Interest: None.
IHC25-LBAPO-035New Daily Persistent Headache (NDPH): A Biomarker Study in Children and Adolescents
Klaus Georg Werner1; Christopher Donnell Lavoghn Wickware2,3; Ashley Anne Moore2,3; Timothy Alan Collins2; Carlene Drucilla Moore2,3
(1) Division of Child Neurology, Department of Pediatrics, Duke University Medical Center, United States; (2) Division of Headache and Pain, Department of Neurology, Duke University Medical Center, United States; (3) Division of Translational Brain Sciences, Department of Neurology, Duke University Medical Center, United States
Objective: To characterize the clinical phenotype and peripheral inflammatory profile of pediatric patients with New Daily Persistent Headache (NDPH) and to identify potential biomarkers that differentiate NDPH from chronic migraine (CM) and healthy controls.
Methods: Observational, prospective, case-control study measuring serum cytokine and neuropeptide levels in three groups of children and adolescents (ages 10–18) diagnosed with NDPH (n=13), CM (n=12), and healthy controls (n=12) between April 2024 and April 2025. We used the U-PLEX human cytokine immunoassay to quantify 11 cytokines and chemokines: BDNF, βNGF, IL-1β, IL-10, IL-4, IL-6, IL-8, IL-18, TNF-α, MCP-1, and TGFβ. Additionally, enzyme-linked immunosorbent assays (ELISAs) were used to measure CGRP, PACAP, and VIP concentrations. The primary outcome measures were differences in mean concentrations of CGRP, TNF-α, IL-6, and IL-8 between the three groups, as these markers were identified in a recent meta-analysis as differentiators between CM and healthy controls.
Results: CGRP levels (mean ± SEM) were significantly higher in NDPH (15.74± 4.168pg/mL) compared to CM (8.324± 2.803pg/mL) and healthy controls (3.918± 1.411pg/mL) (p = 0.0430 between groups; p = 0.0334 between NDPH and controls). TNF-α levels were elevated in NDPH (4.236 ± 0.6624 pg/mL) compared to CM (2.590 ± 0.2030 pg/mL) and healthy controls (3.046 ± 2.183 pg/mL) (p = 0.0275 between groups; p = 0.0254 between NDPH and CM). IL-8 concentrations were also higher in NDPH (11.19 ± 0.6397 pg/mL) compared to CM (8.251 ± 0.5903 pg/mL) and healthy controls (9.985 ± 0.6951 pg/mL) (p = 0.0066 between groups; p = 0.0048 between NDPH and CM). IL-6 levels were elevated in NDPH (5.407 ± 1.232 pg/mL) relative to CM (2.860 ± 0.1663 pg/mL) and healthy controls (3.099 ± 0.2689 pg/mL) (p = 0.0454 between groups). No significant differences were found between groups for the other cytokines and neuropeptides measured.
Conclusion: This study demonstrates that pediatric patients with NDPH have elevated levels of CGRP, TNF-α, IL-8, and IL-6 compared to CM patients and healthy controls. These markers may serve as potential biomarkers to differentiate NDPH from chronic migraine in pediatric populations. However, further studies with larger cohorts and standardized methodologies are needed to validate the diagnostic utility of these markers, individually or in combination.
Disclosure of Interest: None.
Headache Education for Clinicians and Patients
IHC25-LBAPO-036Improving Headache Care through Specialized Education: A Cross-Sectional Global Perspective
Lucia Jimena Zavala1; Rigmor Højland Jensen2; Henrik Winther Schytz2
(1) Danish Headache Center, Department of Neurology, Copenhagen University Hospital Rigshospitalet, Argentina; (2) Danish Headache Center, Department of Neurology, Copenhagen University Hospital Rigshospitalet, Denmark
Objective: Headache disorders are prevalent yet underdiagnosed and undertreated. In 2021, 40% of the global population (3.1 billion people) suffered from headache disorders, but still access to specialized care remains very limited globally. This substantial mismatch between disease burden and specialist availability underscores the need for structured educational interventions aimed at enhancing healthcare professionals’ competencies in diagnosis, management, and treatment of headache disorders. We aimed to explore the impact of an academic master program on the graduates' career trajectories, work status, and educational needs.
Methods: In this observational cross-sectional study performed between July and September 2024, 88 Master of Headache Disorders (MHD) graduates from the University of Copenhagen were invited to participate in an anonymous online structured survey. The survey investigated the impact of the MHD on the graduates' career trajectories, work status, and educational needs.
Results: Data from 80 respondents (representing a 91% response rate) across cohorts from 2018 (MHD1) to 2024 (MHD4) were analyzed. The sample was predominantly female (63%), with 43% of respondents aged 35–44 years, and participants represented 36 countries. Before program enrollment, the majority held bachelor’s or master’s degrees, predominantly in neurology 48%, nursing 13% and physiotherapy 8%. Post-graduation, 69% of respondents remained actively engaged in headache care, while 90% disseminated headache-related knowledge 38% every month and 24% weekly. Additionally, 96% reported career advancement and 47% experienced a salary increase. Notably, the master Thesis resulted in a clinical or research study and 7% had published their thesis in a peer-reviewed journal, with 23% planning to pursue publication.
Conclusion: The survey findings provide empirical evidence that structured headache education among healthcare professionals is associated with sustained engagement in headache care, enhanced professional career trajectories, and improved dissemination of headache-related knowledge among peers. Despite limited long-term data, our results highlight the need for accessible headache education programs to mitigate the global burden of headache disorders. Further research should evaluate the long-term clinical impact.
Disclosure of Interest: None.
Headache Epidemiology, Outcomes and Burden
IHC25-LBAPO-037Burden of Encephalitis in South America and Brazil: Analysis of Prevalence, Incidence, Mortality, and Regional Disparities in 2021
Yasmin da Silva Moura1; Richard Aldib2; Letícia Hanna Moura da Silva Gattas Graciolli3; Luana Mendes dos Santos4; Thayná Carvalho Juvenal5
(1) Universidade Salvador (UNIFACS), Salvador - BA, Brasil; (2) Centro Universitário São Camilo (CUSC), SP - SP, Brasil; (3) Faculdade de Medicina de Jundiaí (FMJ), Jundiaí - SP, Brasil; (4) USP, SP - SP, Brasil; (5) Universidade Anhembi Morumbi (UAM), SP - SP, Brasil
Objective: To evaluate the epidemiological burden of encephalitis in South America and Brazil in 2021, focusing on prevalence, incidence, and mortality rates by age group and geographic region.
Methods: This is a descriptive ecological study based on secondary data from two official sources: the Global Burden of Disease (GBD) database and the Brazilian Unified Health System (DATASUS) via the TABNET platform. The GBD data provided information on prevalence (absolute number, percentage, and rate), incidence (absolute number, percentage, and rate), and deaths related to encephalitis in South America. Mortality rates by age group and Brazilian states were extracted from TABNET/SIH-SUS. As the study involves open-access, anonymized public data, it is exempt from approval by a Research Ethics Committee, in accordance with Resolution No. 510/2016 of the Brazilian National Health Council.
Results: In 2021, the number of deaths from encephalitis in South America was 299.29 (95% UI: 279.60–320.42), with a death rate of 0.44 per 100,000 inhabitants. Prevalence reached 10,781.62 cases (UI: 7,573.17–13,936.67), corresponding to a rate of 15.93 per 100,000. The number of incident cases was 3,748.41 (UI: 3,327.91–4,194.04), with an incidence rate of 5.54 per 100,000. In Brazil, mortality rates varied widely by region and age. The North and Northeast regions recorded the highest rates, with extreme values in Amazonas (16.67 among children under 1 year), Ceará (33.33 in ages 40–49), and Tocantins (100 in multiple age groups). The South region also showed concerning rates, particularly in Rio Grande do Sul (18.18 among ages 50–59 and 25.00 among the elderly). The Midwest had notable rates in Goiás (25.00 in those over 80). Younger populations were also affected, with mortality in the 5–9 age group reaching 100 in states such as Pará and Tocantins. The total mortality rate for Brazil was 5.04 per 100,000 inhabitants, revealing a significant burden that surpasses expectations for a condition considered relatively rare.
Conclusion: Viral encephalitis, a rare condition, showed in 2021 a prevalence of 15.93 cases per 100,000 inhabitants in South America and Brazil, with an incidence of 5.54 and a mortality rate of 5.04 per 100,000. These figures exceed expectations for a low-occurrence disease. High mortality rates in Brazil’s North and Northeast regions suggest clinical unpredictability, delays in early diagnosis, and unequal access to healthcare. Timely management and expanded services are essential.
Disclosure of Interest: None.
IHC25-LBAPO-038Burden of Migraine in South America and Brazil: Analysis of Prevalence, Incidence, and Mortality by Age Group and Region in 2021
Yasmin da Silva Moura1; Richard Aldib2; Letícia Hanna Moura da Silva Gattas Graciolli3; Luana Mendes dos Santos4; Thayná Carvalho Juvenal5
(1) Universidade Salvador (UNIFACS), Salvador - BA, Brasil; (2) Centro Universitário São Camilo (CUSC), SP - SP, Brasil; (3) Faculdade de Medicina de Jundiaí (FMJ), Jundiaí - SP, Brasil; (4) USP, SP - SP, Brasil; (5) Universidade Anhembi Morumbi (UAM), SP - SP, Brasil
Objective: To analyze the epidemiological burden of migraine in South America and Brazil, assessing prevalence, incidence, and mortality rates by age group and geographic region in 2021.
Methods: This is a descriptive ecological study based on secondary data extracted from two official sources: the Global Burden of Disease (GBD) study and the TABNET system of the Brazilian Unified Health System (DATASUS). The GBD database provided data on prevalence (absolute number, percentage, and rate) and incidence (absolute number, percentage, and rate) for the South American population. Mortality rates by age group and Brazilian regions were obtained from the TABNET/SIH-SUS platform. As this study used public, anonymized, and open-access data, it is exempt from approval by a Research Ethics Committee, according to Resolution No. 510/2016 of the Brazilian National Health Council.
Results: In 2021, the number of prevalent migraine cases in South America was 8,402,383.48 (95% UI: 7,195,355.61–9,789,775.46), corresponding to a prevalence rate of 12,412.22 per 100,000 inhabitants and a prevalence percentage of 0.13%. The number of new cases (incidence) was 632,667.99 (95% UI: 538,295.52–735,076.23), with an incidence rate of 934.59 per 100,000 and a percentage close to 0%. In Brazil, mortality rates related to migraine and other headache syndromes were higher in older age groups, especially from 60 years onwards. The highest mortality rates were observed in the North and Northeast regions. The states of Pará (13.16), Ceará (12.22), and Tocantins (11.11) showed alarming mortality rates among those aged 70 to 79 years. In the elderly population (80 years and over), rates reached 16.67 in Bahia and 9.84 in Ceará. Mortality rates among adults aged 40 to 59 years were also relevant in Ceará (up to 3.21) and Espírito Santo (6.25). Despite being a condition typically associated with high morbidity and low mortality, the data reveal significant mortality burdens in specific regions and age groups, particularly in the elderly.
Conclusion: This study highlighted the chronic and recurrent nature of migraine, with high prevalence in South America (over 8 million cases; >12,000 per 100,000 inhabitants). In Brazil, it is associated with low mortality and high morbidity. However, higher mortality rates were found among the elderly and in the North and Northeast regions. Therefore, early diagnosis and continuous treatment are essential, especially in areas with weak healthcare systems and among the elderly population.
Disclosure of Interest: None.
IHC25-LBAPO-039Comparable Response Rates Between Physiotherapy and Usual Care in Migraine Management: Results from a Prospective Cohort
Carina Ferreira Pinheiro-Araujo1; Gabriella Almeida Tolentino1; Juliana Pradela1; Amanda Rodrigues1; Felipe Daniel Sambini1; Fabiola Dach1; Debora Bevilaqua-Grossi1
(1) Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto - SP, Brasil
Objective: To investigate the rate of positive treatment response among individuals with migraine undergoing physiotherapy interventions and pharmacological treatment.
Methods: This prospective cohort study included 112 patients diagnosed with migraine. Each participant underwent a 12-week intervention, allocated to one of the following groups: manual therapy (MT, n=25; mean age 35.2±8.5 years), pain education (PE, n=25; 34.0±9.6 years), a multimodal approach combining manual therapy, pain education, and cervical exercises (MM, n=25; 32.5±8.5 years), or usual care with pharmacological treatment (UC, n=37; 39.6±8.6 years). Migraine impact was assessed using the Headache Impact Test (HIT-6) before and after treatment, and participants rated their overall improvement at week 12 using the Patient Global Impression of Change (PGIC). Participants with a PGIC score ≥5 and a HIT-6 reduction ≥6 points were classified as responders. Between groups comparisons was performed with Student’s T-test and Chi-square test (p < 0.05).
Results: After treatment, all groups showed a reduction in migraine frequency and impact, and the average perceived improvement was considered moderate (p < 0.05). The response rates were similar across groups, ranging from 56% to 68% (Table 1).
Conclusion: Patients with migraine benefit from both conventional pharmacological treatment and physiotherapy-based interventions, with no superiority observed in the response rates among the different approaches. These results support the inclusion of physiotherapy in multidisciplinary migraine management protocols and support the necessity to identify predictors of treatment success to optimize patient referral to the most appropriate therapeutic approach.
Disclosure of Interest: None.
IHC25-LBAPO-040Epidemiology of Hospital Admissions for Migraine in São Paulo, Brazil: Age, Racial Profile, and Hospital Costs (2020–2024)
Lara Beatriz Belão Barbosa1; Luísa Andriely Maia2; Luana Mendes dos Santos3
(1) Faculdade de Medicina de Marília (FAMEMA), Marília - SP, Brasil; (2) Universidade professor Edson Antonio Velano (UNIFENAS-BH), Belo Horizonte - MG, Brasil; (3) Faculdade de Medicina de USP, São Paulo - SP, Brasil
Objective: To analyze the epidemiological profile of hospital admissions due to migraine and other headache syndromes in the state of São Paulo, Brazil, from 2020 to 2024.
Methods: This descriptive, quantitative epidemiological study used data extracted from the TABNET platform (DATASUS), maintained by the Brazilian Ministry of Health. The filters "Migraine and other headache syndromes" and "São Paulo" were applied. The number of admissions and total hospital expenditures were analyzed and stratified by sex, race, and age group from 2020 to 2024. Comparisons were then made across these groups.
Results: A total of 9,446 hospitalizations were recorded during the study period. Females accounted for 69.6% of admissions and 67.3% of total costs, with a progressive increase in absolute numbers over the years. The total cost of hospitalizations reached R$ 4,689,359, showing an upward trend until 2023, followed by a slight decline in 2024—possibly indicating stabilization or changes in hospital care demand. The most affected age group was 30 to 49 years (40.1% of admissions), a segment within the economically active population, highlighting the disease’s indirect socioeconomic burden. Children and adolescents (0–19 years) represented 16.4% of cases, emphasizing the importance of early diagnosis. The average length of hospital stay ranged from 3.3 to 3.7 days, being slightly longer among Black (3.6) and Brown (3.9) individuals. Regarding race, White patients accounted for the majority of hospitalizations (60.1%) and R$ 2.87 million in hospital costs. However, a notable proportional increase in admissions was observed among Brown and Black populations—52.8% and 56.9%, respectively—between 2020 and 2024, possibly reflecting barriers to healthcare access and delayed treatment-seeking behavior.
Conclusion: The findings reveal a significant impact of migraine on the economically active population and a considerable financial burden on the public healthcare system. These results highlight the need for preventive strategies, early diagnosis, and effective outpatient management. Additionally, the longer hospital stays observed among Black and Brown patients underscore the importance of addressing inequities in access to primary healthcare services.
Disclosure of Interest: None.
IHC25-LBAPO-041Headaches in individuals in the city of Goiania: analysis of the epidemiological profile, clinical and diagnostic approaches
Andrezza Barros Prehl1; Isadora Xavier Pereira de Maria1; Gabriel Rocha Santos Knorst1
(1) Centro Universitário de Mineiros, Goiânia - GO, Brasil
Objective: Identify the clinical and epidemiological profile of individuals with headache in the city of Goiania and investigate the quality of diagnosis and treatment received by them.
Methods: Cross-sectional, observational and qualitative study in the general population with questionnaire application during health education event, in celebration of the month of national awareness, elaborated with 25 questions covering characteristics of the functional impact, search for medical care and therapeutic conduct adopted. The responses of participants who expressed ethical consent and presented at least one episode of headache were included in the study, characterizing a sample with value n=24 and analyzing the data in a descriptive statistical way.
Results: The majority of participants reported significant impairment in their activities: 54% reported impact on school or professional performance, 50% avoided social events due to pain and 58% reported interference with usual activities. Although 54,2% have already sought medical help for headaches, the number of primary headache diagnoses was surprisingly low, raising doubts about the adequacy of clinical evaluation. Among the few cases with an established diagnosis, none reported the use of adequate prophylactic medication, with the treatments described being limited to abortive analgesics.
Conclusion: The results suggest that in everyday practice there are still gaps in the clinical recognition and use of prophylactic therapies, inappropriate use of drugs and negative impact on patients’ functionality. It reinforces the need for training of professionals and health education strategies aimed at improving the management of headaches in primary care.
Disclosure of Interest: None.
IHC25-LBAPO-042Hospital Admissions, Costs and ICU Use for Migraine in the Brazilian Public Health System: An Analysis of Healthcare Inequities
Luana Mendes Dos Santos1; Richard Aldib2; Yasmin da Silva Moura3; Letícia Hanna Moura da Silva Gattas Graciolli4; José de Oliveira Fernandes5; Alice de Carvalho Maués6; Rafaela Del Piccolo Campos7; Camila Kwiatkowski Alberti8; Laura Borges Matos9
(1) USP, SP - SP, Brasil; (2) Centro Universitário São Camilo (CUSC), SP - SP, Brasil; (3) Universidade Salvador (UNIFACS), Salvador - BA, Brasil; (4) Faculdade de Medicina de Jundiaí (FMJ), Jundiaí - SP, Brasil; (5) Universidade Santo Amaro (UNISA), SP - SP, Brasil; (6) Faculdade de Minas, FAMINAS BH, BH - MG, Brasil; (7) Universidade Santo Amaro, UNISA, SP - SP, Brasil; (8) Universidade Positivo, UP, Curitiba - PR, Brasil; (9) Centro Universitário do Planalto Central Apparecido dos Santos (UNICEPLAC), Gama - DF, Brasil
Objective: To analyze hospital admission patterns, associated costs, and intensive care unit (ICU) utilization for migraine within the Brazilian Unified Health System (SUS), with a focus on identifying potential healthcare inequities across age groups and racial/ethnic categories.
Methods: This is a descriptive, retrospective study based on secondary data from the Hospital Information System of SUS (SIH-SUS), extracted from the official hospital information panel. Data regarding authorized hospital admissions (AIHs), total hospitalization costs, and ICU daily usage were analyzed. The data were stratified by age group (from under 1 year to 80 years and over) and race/ethnicity (White, Black, Brown, Yellow, and Unknown).
Results: A total of 9,126 hospital admissions for migraine were recorded. Most cases occurred among White patients (5,233), followed by Brown (2,389), Unknown (963), Black (452), and Yellow (89) patients. The most affected age groups were 20–39 years, totaling 3,534 admissions. The total cost of hospitalizations reached BRL 3,547,703.11, with the highest expenditure for White patients (BRL 2,052,050.29), followed by Brown (BRL 1,002,348.98), Unknown (BRL 278,077.94), Black (BRL 172,294.20), and Yellow (BRL 42,931.70). The 20–49 years age group accounted for the largest share of costs, exceeding BRL 1.9 million. There were 825 ICU days recorded, mainly among White patients (418), followed by Brown (287), Unknown (66), and Black (31). ICU use was concentrated in patients aged 20–59 years, particularly in the 50–59 (172 days) and 40–49 (141 days) age groups.
Conclusion: The analysis of data from the SUS Hospital Information System revealed patterns of hospital admissions, costs, and ICU utilization for migraines, highlighting healthcare inequities. The majority of admissions occurred among White patients, particularly in the 20-39 age group. Hospitalization costs were highest for White patients, followed by Brown patients. ICU use was concentrated among White patients and in the 40-59 age groups. These disparities suggest that racial and age factors may influence access to and costs of migraine treatment within the SUS, pointing to the need for public policies aimed at reducing these inequities.
Disclosure of Interest: None.
IHC25-LBAPO-043Profile of hospitalizations for migraine and other headache syndromes in the Brazilian Unified Health System (SUS): who are the patients hospitalized in Ceará?
Bruna Barbosa Nobre1; João Vítor Moreira Nogueira1; Davi Feitosa Gonçalves1; Enzo Lima Alcântara Parente1; Aline Vieira de Vasconcelos1; Marina Marques Maia1
(1) Centro Universitário Christus, Fortaleza - CE, Brasil
Objective: To analyze the epidemiological profile of hospital admissions for migraine and other headache syndromes in the Brazilian Unified Health System (SUS), specifically in the state of Ceará, identifying the main clinical and demographic characteristics of affected patients.
Methods: This is a quantitative and retrospective study, with secondary data obtained from the SUS Hospital Information System, referring to the state of Ceará, via the DATASUS platform. Hospitalizations for migraine and other headache syndromes (ICD-10: G43 and G44) were analyzed. The variables used included gender, age group (15 to 69 years old), and length of hospital stay.
Results: Between January 2020 and December 2024, 5,030 hospitalizations for migraine and other headache syndromes were recorded in the state of Ceará, according to DATASUS data. There was a predominance of females, with 2,764 hospitalizations (54.9%), especially in the 35 to 49 age group. Among males, there were 2,266 hospitalizations, corresponding to 45.1% of the total recorded. It was also noted that the average length of stay for these patients was 6.1 days for women and 6.2 days for men.
Conclusion: The epidemiological analysis of hospital admissions for migraine and other headache syndromes in the state of Ceará between 2020 and 2024 showed a predominance of the condition in females, especially in women of childbearing age, between 35 and 49 years old. It was observed that, despite the higher frequency of female cases, the average length of hospital stay was similar between the sexes, indicating comparable clinical severity in hospitalizations. These results highlight the relevance of migraine as a public health problem, with a significant impact on quality of life and productivity, particularly in women of working age. Understanding the profile of hospitalized patients is essential to assess the problem, adequately plan health system resources, promote prevention strategies, reduce the socioeconomic impacts of the disease, and strengthen care strategies based on local realities.
Disclosure of Interest: None.
IHC25-LBAPO-044The economic impact of migraine and other headache syndromes on the Brazilian Unified Health System: an analysis of hospital costs
Enzo Lima Alcântara Parente1; Marina Marques Maia1; João Victor Moreira Nogueira1; Davi Feitosa Gonçalves1; Bruna Barbosa Nobre1; Aline Vieira De Vasconcelos1
(1) Centro Universitário Christus, UNICHRISTUS, Fortaleza - CE, Brasil
Objective: To analyze hospital costs related to migraine and other headache syndromes, as well as their economic impact on the Brazilian Unified Health System (SUS).
Methods: This is a quantitative, retrospective study using secondary data on hospitalizations for migraine and other headache syndromes from January 2008 to April 2025, obtained from the Hospital Information System (SIH/SUS).
Results: The analysis revealed that the average cost of hospitalizations in Brazil was R$449.71 per hospitalization. The Northeast region stood out as the one with the highest cost, with an average value of R$572.39, followed by the North region, with R$523.50. The South region had an average cost close to the national average. In contrast, the Southeast and Central-West regions had the lowest expenditures per hospitalization, with values of R$369.01 and R$240.35, respectively. A detailed review of the Federation Units reveals significant disparities, namely: In the Northeast, Piauí (R$181.47) and Maranhão (R$182.12) had the lowest average costs related to hospitalizations, while Paraíba (R$673.97), Pernambuco (R$631.89), and Ceará (R$946.95) stood out with the highest costs. In the North, there are also significant discrepancies, such as the high cost in Pará (R$768.33) and the lowest expenditures in Roraima (R$184.10) and Amapá (R$183.25). In addition, the Southeast region presented more homogeneous values, with the lowest in Espírito Santo (R$303.83) and the highest in São Paulo (R$381.78). In the South region, Rio Grande do Sul showed the lowest expenditure (R$406.14) and Paraná the highest (R$501.78). Finally, in the Central-West Region, Goiás recorded the lowest value in the region and one of the lowest in the country (R$184.42), while Mato Grosso do Sul had the highest (R$337.46), presenting the lowest overall average in the country.
Conclusion: The analysis reveals significant regional variation in Brazil, indicating the need for a differentiated approach to health policies. Disparities in average costs suggest that economic and structural factors may influence access and quality of care, highlighting the importance of considering regional particularities in the planning and implementation of public policies aimed at the treatment of migraine and cephalic pain syndromes.
Disclosure of Interest: None.
Headache in History and the Arts
IHC25-LBAPO-045Charles Darwin and headaches: an analysis of personal accounts in light of the ICHD-3
Enzo Lima Alcântara Parente1; Bruna Barbosa Nobre1; Aline Vieira De Vasconcelos1; João Victor Moreira Nogueira1
(1) Centro Universitário Christus, UNICHRISTUS, Fortaleza - CE, Brasil
Objective: To analyze Charles Darwin's autobiographical and epistolary accounts related to headaches, comparing them to the diagnostic criteria of the International Classification of Headache Disorders, 3rd edition (ICHD-3) for migraine without aura. The objective is to assess the diagnostic plausibility of migraine in a historical figure of scientific relevance, promoting the interface between neurology, medical history, and biography.
Methods: Darwin's personal diaries, correspondence, and historical documents were examined, focusing on descriptions of headache attacks. The reports were cross-referenced with the ICHD-3 criteria for migraine without aura (code 1.1), with an emphasis on recurrence, duration, pain characteristics, associated symptoms (nausea, photophobia, phonophobia), and functional impact. Contemporary clinical aspects and secondary analyses of his medical condition were also considered.
Results: A detailed analysis of Darwin's autobiographical and epistolary records revealed a consistent pattern of recurrent headaches with a clinical phenotype strongly suggestive of migraine without aura. Strictly unilateral pain attacks were documented, as explicitly reported in a letter from 1865, often accompanied by incapacitating nausea and vomiting. The severity of the attacks, ranging from moderate to severe, is corroborated by the interruption of his scientific and social activities, requiring complete rest for periods ranging from hours to days. Although there is no direct textual mention of photophobia and phonophobia, Darwin's well-known aversion to noisy and stimulating social environments allows us to clinically infer the presence of these sensory symptoms. The absence of a clear description of the pulsating nature of the pain is notable, an inherent limitation of the analysis of historical documents. Headaches, therefore, emerged as a distinct and prominent nosological entity, overlapping with his complex chronic gastrointestinal symptoms.
Conclusion: The analysis suggests that Charles Darwin probably lived with migraine without aura, according to the ICHD-3 criteria, characterized by unilateral pain, nausea, and significant functional impact. This study reinforces the importance of integration between neurology and medical history for understanding the experiences of pain in historical figures, enriching the multidisciplinary understanding of headaches.
Disclosure of Interest: None.
IHC25-LBAPO-046The Cultural and Historical Faces of Headache: A Narrative Journey through Art and Time
Carolina Barbosa Redig1; Thor Castro2
(1) Centro Universitário Metropolitano da Amazônia (UNIFAMAZ), Belém - PA, Brasil; (2) Universidade Federal do Pará (UFPA), Belém - PA, Brasil
Objective: Headaches have accompanied humanity since ancient times, affecting not only daily life but also artistic expression, philosophy, and medicine. This study proposes a narrative exploration of the role of headache throughout history and the arts, focusing on how it has been understood, represented, and re-signified over time. The present paper objective is to investigate the presence and symbolism of headaches in historical records, artworks, and literature, discussing how these manifestations reflect the evolving medical and cultural understanding of pain.
Methods: Narrative review based on secondary sources (medical literature, history books, iconographic records, and artistic texts) organized into three axes: 1) historical records from Antiquity to the 19th century; 2) visual representations in paintings, sculptures, and engravings; 3) mentions in classical and modern literature. Selection favored works with vivid and contextualized descriptions of headache or cranial suffering.
Results: From Egyptian papyri describing rituals for 'head spirits' to Edvard Munch’s expressionist drawings, headache has been portrayed as a mystical phenomenon, divine punishment, and emotional affliction. In texts by Hippocrates and Galen, it was a sign of humoral imbalance. During the Middle Ages, 'demonic headache' appeared in religious icons. In the 19th century, as medicine became more systematized, artists like Cézanne and writers like Virginia Woolf began representing headache with psychological nuances, anticipating modern conceptions such as migraine with aura.
Conclusion: Headache, beyond being a clinical entity, is a cultural and symbolic phenomenon. Its historical trajectory reveals the deep link between pain, art, and how humanity interprets suffering. Understanding this context enriches an empathic and holistic approach to modern headache care.
Disclosure of Interest: None.
Headache Pathophysiology – Imaging and Neurophysiology
IHC25-LBAPO-047Cortical Spreading Depolarizations Alter Intestinal Permeability: Implications for Gut-Brain Axis Crosstalk
Ayse Ece Gezen Yilmaz1; Reza Ghouri2; Elif Akaydin1; Hayrunnisa Bolay3; Yildirim Sara1
(1) Hacettepe University School of Medicine Department of Medical Pharmacology & Neuroscience and Neurotechnology Center of Excellence NÖROM, Türkiye; (2) Neuroscience and Neurotechnology Center of Excellence NÖROM, Türkiye; (3) Gazi University School of Medicine Department of Neurology and Algology & Neuroscience and Neurotechnology Center of Excellence NÖROM, Türkiye
Objective: Cortical spreading depolarization (CSD), characterized by a wave of transient suppression of cortical neuronal activity, is implicated in migraine. While migraine is primarily a neurological disorder, gastrointestinal comorbidities frequently accompany. Increased intestinal permeability or "leaky gut" has been reported in migraineurs and is hypothesized to contribute to systemic inflammation and symptom exacerbation. This study aimed to evaluate the effects of repeated cortical KCl-induced CSDs, used as a chronic migraine (CM) model, on colonic permeability in rats, with a specific focus on proximal and distal colon segments.
Methods: Male Wistar rats (300 g) underwent stereotaxic surgery for intracranial tube placement. After 7 days of recovery, rats received five infusions of 1 M KCl on alternating days over 9 days to induce recurrent CSDs. Controls received NaCl. KCl-induced behavioral pain testing was evaluated using von Frey filaments before and after every infusion. On the 10th day, proximal and distal colon segments were excised for ex vivo fluorescein-based permeability assays. Serosal samples were collected at 0, 30, 60, 90, and 120 minutes, and fluorescein concentration was quantified spectrophotometrically.
Results: CM group demonstrated an increase in intestinal permeability (0,015±0,001) in the proximal colon compared to controls (0.007±0,0007) (p < 0.005), while the distal colon did not show significant changes. Time-dependent increases (ΔQ/Δt) in fluorescein diffusion indicated progressive compromise of mucosal barrier function in the CM group. These findings suggest that multiple CSDs induce region-specific alterations in gut barrier integrity.
Conclusion: Our findings show that repeated CSDs impair intestinal barrier function, especially in the proximal colon, reflecting brain-gut axis disruption in a chronic migraine model. This setup may help explore how migraine-related CNS activity impacts GI physiology and guide gut-targeted therapies.
Disclosure of Interest: None.
IHC25-LBAPO-048Immunological and Neuroinflammatory Mechanisms in Migraine: Updates and Therapeutic Implications
Bruna Barbosa Nobre1; João Vítor Moreira Nogueira1; Davi Feitosa Gonçalves1; Luiza Chaves Aguiar1; Enzo Lima Alcântara Parente1; Silvia Fernandes Ribeiro da Silva2
(1) Centro Universitário Christus, Fortaleza - CE, Brasil; (2) Silvia Fernandes Ribeiro da Silva, Fortaleza - CE, Brasil
Objective: To review the current literature on immunological and neuroinflammatory mechanisms involved in the pathophysiology of migraine, focusing on key biomarkers and cellular pathways.
Methods: This is a narrative literature review. Searches were conducted in the PubMed and Scielo databases using the keywords: “migraine”, “neuroinflammation”, “immune response”, “cytokines”, and “CGRP”. Three original articles and review papers published in the last four years were included, addressing the interaction between immunological mechanisms, inflammation, and migraine.
Results: Evidence indicates that migraine involves complex immune dysfunction, characterized by elevated levels of pro-inflammatory cytokines (IL-6 and TNF-α) and reduced levels of anti-inflammatory cytokines (IL-10). Neurogenic inflammation, driven by the activation of the trigeminovascular system, is a central process that leads to the release of neuropeptides such as calcitonin gene-related peptide (CGRP) from trigeminal nerve endings, resulting in vasodilation of meningeal vessels. Elevated levels of CGRP are consistently reported during migraine attacks, positioning it as a primary therapeutic target. Changes in cellular immunity further reinforce the pro-inflammatory environment, evidenced by an increase in CD4+ T cells and a reduction in CD8+ T cells and regulatory T cells (Tregs), whose decrease may compromise immune tolerance and relate to autoimmune comorbidities. There is also evidence of complement system activation and involvement of the NLRP3 inflammasome, which mediates the release of IL-1β and contributes to pain signaling in experimental models. These findings highlight the significant immunological contribution to migraine pathophysiology.
Conclusion: Migraine is intrinsically associated with immunological and inflammatory dysfunctions that modulate its pathophysiology. The central mechanisms include elevated levels of pro-inflammatory cytokines, cellular immune dysfunction with a reduction in Tregs, and neuroinflammation mediated by the activation of the trigeminovascular system with CGRP release. Integrating this knowledge is essential for the development of targeted therapies, particularly anti-CGRP treatments, enabling a more effective and personalized management of migraine.
Disclosure of Interest: None.
IHC25-LBAPO-049Inflamed Minds: Microglial Mechanisms in Migraine Pathogenesis
Chenchen Xie1
(1) Clinical Medical College & Affiliated Hospital of Chengdu University, China
Objective: Microglia, the CNS-resident immune cells, have emerged as active contributors to migraine pathophysiology. Their activation is associated with neuroinflammation, central sensitization, and enhanced cortical excitability. This study aims to review current findings on microglial involvement in migraine pathophysiology, with an emphasis on molecular signaling pathways, sex-specific responses, and therapeutic implications.
Methods: We conducted a literature review of preclinical and clinical studies (2018–2025) investigating microglial function in migraine models, focusing on inflammatory mediators, neuron–glia interactions, and genetic or pharmacological manipulation of microglial activity.
Results: Experimental studies demonstrate that microglial activation in key migraine-related brain regions (e.g., trigeminal nucleus caudalis, thalamus, cortex) precedes or accompanies headache-like behavior in animal models. Activated microglia release pro-inflammatory cytokines (IL-1β, TNF-α) and promote neuronal sensitization via purinergic (P2X4, P2X7), TLR4, and cGAS-STING pathways. Notably, sex-dependent differences in microglial responses have been observed, potentially contributing to the female predominance in migraine prevalence. Emerging data also suggest that CGRP and microglial signaling may intersect to exacerbate pain pathways.
Conclusion: Microglia are not passive bystanders but active modulators of migraine pathophysiology. Targeting microglial signaling offers a novel therapeutic avenue and may help refine current treatments by accounting for neuroimmune mechanisms. Further studies are needed to delineate the temporal dynamics and regional specificity of microglial responses in migraine.
Disclosure of Interest: None.
IHC25-LBAPO-050Trigeminal Neuralgia in the V2 Territory Secondary to Neurovascular Conflict in the Pterygopalatine Fossa: A Case Report
Genor Benavides Padilla1; Hernán Rodríguez Gallardo1; María Trinidad San Martín Jullian1; Bernardita De La Maza Acevedo1
(1) Universidad del desarrollo, Chile
Objective: To describe the clinical evolution, diagnosis, and therapeutic management of a patient with trigeminal neuralgia in the maxillary branch (V2) secondary to neurovascular conflict in the pterygopalatine fossa.
Methods: A 55-year-old female presented with right hemifacial electric shock-like pain, in the V2 territory, without a refractory period, triggered by touch, speech, and mastication, rated 10/10 on the Visual Analogue Scale. She had been previously diagnosed with trigeminal neuralgia and unsuccessfully treated with carbamazepine. A high-resolution MRI revealed neurovascular contact between the sphenopalatine artery and the infraorbital nerve in the pterygopalatine fossa. A sequential multimodal treatment was implemented: diagnostic and therapeutic infraorbital nerve blocks (intraoral and extraoral), ganglion sphenopalatine block, topical lidocaine (Versatis®), pregabalin titration, corticosteroids, and botulinum toxin infiltration. Pain evolution and response to treatment were recorded.
Results: The initial nerve blocks produced immediate and significant pain relief, eliminating trigger zones. Topical anesthetics and neuromodulators (pregabalin and gabapentin) helped reduce intensity and frequency of pain. The use of botulinum toxin achieved further symptom control. At follow-up, the patient reported a >80% improvement in distribution, frequency, and intensity of pain, allowing return to daily activities. Pain recurrence occurred four months later, associated with increased intensity and expansion of the affected area. A new series of anesthetic and corticosteroid nerve blocks led to partial symptom remission, and the patient resumed adequate functionality.
Conclusion: Neurovascular conflict in the pterygopalatine fossa should be considered in cases of refractory trigeminal neuralgia in the V2 territory. High-resolution MRI and a multimodal treatment strategy, including nerve blocks and neuromodulation, can offer significant pain relief and functional recovery in selected cases.
Disclosure of Interest: None.
Holistic Approach for Headache
IHC25-LBAPO-051Healing Beyond Pills: A Holistic Perspective on Migraine Care Through Mind-Body and Lifestyle Interventions
Carolina Barbosa Redig1; Thor Castro2
(1) Centro Universitário Metropolitano da Amazônia (UNIFAMAZ), Belém - PA, Brasil; (2) UNIVERSIDADE FEDERAL DO PARÁ (UFPA), Belém - PA, Brasil
Objective: Migraine is a highly disabling neurological condition that significantly impacts quality of life and daily functioning. Although pharmacological therapies are the mainstay of treatment, many patients report insufficient symptom control or intolerance to medications. This review aims to explore holistic, non-pharmacological approaches for migraine management, focusing on mind-body interventions and lifestyle modifications, as supported by original studies indexed in PubMed.
Methods: A narrative review was conducted using original research articles retrieved from PubMed with the following descriptors: “migraine”, “mind-body interventions”, “lifestyle modification”, “diet”, and “non-pharmacological treatment”, using Boolean operators (AND). Articles published in English in the last 10 years were prioritized. Studies were included if they investigated the impact of holistic interventions on migraine frequency, intensity, or quality of life.
Results: Mind-body techniques, such as mindfulness-based stress reduction (MBSR), yoga, and biofeedback, have demonstrated positive outcomes in reducing migraine frequency and psychological distress. Randomized controlled trials have shown significant reductions in headache days and improvements in quality of life when patients engage in structured meditative or relaxation programs. Dietary factors, including elimination diets (low histamine, gluten-free, ketogenic) and anti-inflammatory eating patterns, have also been associated with lower migraine burden. Regular sleep hygiene, physical activity, and stress management were consistent predictors of clinical improvement across studies.
Conclusion: Holistic strategies integrating mind-body practices and lifestyle modifications present promising adjuncts in migraine management, especially in patients with high treatment resistance or preference for non-drug therapies. Further high-quality studies are needed to standardize interventions and better understand their long-term efficacy. The integration of these approaches into multidisciplinary care models may enhance patient autonomy and overall well-being.
Disclosure of Interest: None.
IHC25-LBAPO-052The impact of artificial barometric pressure changes on migraine: A randomized, single-blind controlled study
Keiko Ihara1; Narumi Watanabe1; Naoki Ishikawa2; Chisato Iba1; Naoki Miyazaki3; Ryo Takemura3; Mamoru Shibata4; Shigeaki Suzuki5; Jin Nakahara1; Satoshi Umeda6; Tsubasa Takizawa7
(1) Department of Neurology, Keio University School of Medicine, Japan; (2) Graduate School of Human Relations, Keio University, Japan; (3) Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Japan; (4) Department of Neurology, Tokyo Dental College Ichikawa General Hospital, Japan; (5) Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan; (6) Department of Psychology, Keio University Faculty of Letters, Japan; (7) Department of Neurology, Keio University School of Medicine, Japan
Objective: Barometric pressure change is a controversial trigger of headache in patients with migraine. However, no interventional study has investigated the impact of isolated barometric pressure change.
Methods: This was a randomized, single-blind, controlled study. Each individual entered the pressure-controllable chamber and spent approx. 22 min, accompanied by barometric pressure changes between 883 hPa and the standard atmosphere (approx. 1013 hPa) only in the exposure group. Headache occurrence and characteristics for up to 60 hours (i.e., within 10 min, day 1, day 2, and day 3) were recorded by our survey, and the differences between the two groups were analyzed.
Results: 56 patients with migraine were randomly assigned to either the exposure (n=28) or control (n=28) group. The average age was 45.71 ± 11.15, and 50 (89%) patients were female; they had 6.63 ± 3.62 monthly headache days, and 15 (27%) patients experienced aura. According to our pre-experiment survey, while seven (13%) patients answered that low barometric pressure “always” triggers migraine attacks, 23 (41%), 12 (21%), 9 (16%), and 5 (9%) answered “often,” “sometimes,” “occasionally,” and “never,” respectively. The frequency of headache occurrence after our experiment was not significantly different between the two groups within 10 min (12 vs. 7; p = 0.26), on day 1 (20 vs. 17; p = 0.57), on day 2 (14 vs. 15; p = 1.00), and on day 3 (15 vs. 14; p = 1.00). Their pre-experiment response identifying low barometric pressure as a trigger was not significantly associated with headache occurrence. In the control group, 16 patients falsely reported that they subjectively perceived barometric pressure changes (i.e., false perception), even though they were blinded throughout the experimental procedure and survey period. Comparison of psychiatric measures (e.g., Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale-7, and State-Trait Anxiety Inventory) between 16 patients with false perception and 12 without false perception in the control group showed no significant difference. Additionally, false perception was not significantly associated with headache occurrence within 10 min (6/7 vs. 10/21; p = 0.18), on day 1 (10/17 vs. 6/11; p= 1.00), on day 2 (8/15 vs. 8/13; p = 0.72), and on day 3 (8/14 vs. 8/14; p = 1.00) (Figure 1).
Conclusion: This study revealed no significant association between headache occurrence in patients with migraine and isolated artificial barometric pressure changes between 883 and 1013 hPa in 22 min.
Disclosure of Interest: TT is a consultant/advisor and/or serves on an advisory board for Eli Lilly, Otsuka, Amgen, Pfizer, and Teijin and has received speaker honoraria from Eli Lilly, Daiichi Sankyo, Otsuka, Amgen, Sawai, Kowa, Kyowa Kirin, Eisai, UCB Japan, Takeda, and Santen Pharmaceutical and grant/funding from Eli Lilly, Pfizer, and Tsumura outside the submitted work; JN received honoraria and research scholarships from Amgen, Novartis, and Daiichi Sankyo; Remaining authors: None.
Migraine Acute Therapy
IHC25-LBAPO-053Defining Response Assessment criteria and Inadequate Response in Acute Migraine Attack: A Delphi Expert Consensus from headache experts in India
Debashish Chowdhury1; K Ravishankar2; Sanjay Prakash3; MV Francis4; Sumit Singh5; Girish Kulkarni6; Sanjith Aaron7; Ishan Patel8; Ashish Bondia8; Amod Tilak8
(1) GB Pant Institute of post graduate medical education and research, India; (2) Jaslok and Lilavati Hospitals, India; (3) SBKS Medical Institute, Baroda, India; (4) Eye and Migraine center Cherthala, India; (5) Artemis Hospitals, Gurgaon, India; (6) NIMHANS Bengaluru, India; (7) CMC Vellore, India; (8) Pfizer Limited, India
Objective: The objective of this consensus was to define response assessment criteria and inadequate response to therapy for acute migraine attack in India.
Methods: A modified Delphi method was adopted to develop consensus-based recommendations for defining response assessment criteria and inadequate response to acute treatment of migraine in India (Figure 1). After targeted literature search, 15 statements were drafted under 5 themes: treatment response assessment criteria and timepoint; defining non-response to therapy; triptan cycling; tolerability; and comorbidities. Statements were validated by a steering committee of 6 headache experts followed by a Delphi round involving 19 headache experts.
Results: Based on inputs in the first round of validation for clarity and clinical relevance, desired CVI score was achieved for 11/15 statements, 4 statements were modified and 1 statement added. The second round of validation achieved desired CVI score(>0.83) for all 16 statements. Based on 19 responses to the survey, consensus was obtained on most of the statements (88.89% to 100%) except for defining response to acute treatment (2-hour pain freedom vs. pain relief) and how to proceed in patients with meaningful relief after taking an abortive treatment but with moderate to severe adverse effects. There was 100% consensus on 6 statements concerning need to restore function after 2 hours following acute treatment, defining inadequate response to acute treatments, and contraindications for triptan use. 22.22% respondents did not agree to the statement that ‘after use of medication for acute attack of migraine, headache recurrence and need for rescue medication within 24 hours is a valid marker of non-response to treatment for that attack’.
Conclusion: This expert consensus defining response assessment criteria and inadequate response to therapy in acute migraine attack may help establish uniform clinical practice for management of acute migraine attack in India.
Disclosure of Interest: IP, AB and AT are an employee of Pfizer and hold stocks in Pfizer.
IHC25-LBAPO-054Perceptions and Willingness to Use Acute Treatments Among Individuals With Migraine: Cross-Sectional Analysis in Argentina
Fiorella Martin Bertuzzi1; Federico Leonardo Anrriquez2; Ana Karina Guevara1; Eduardo Daniel Doctorovich2
(1) Red Cefaloca, Argentina; (2) Hospital Italiano de Buenos Aires, Argentina
Objective: Objective: To evaluate perceptions and willingness to use 16 acute migraine medications among individuals with self-reported migraine in Argentina.
Methods: Methods: A cross-sectional online survey was conducted between December 2024 and April 2025 in adults with self-reported migraine. Participants rated their willingness to take 16 medications presented under blinded fictitious names, based on efficacy and adverse effect data from published clinical trials. Willingness was assessed using a 0–5 Likert scale before and after price disclosure.
Results: Results: A total of 430 participants (mean age 41.4 ± 10.1 years; 97% female) completed the survey. Price disclosure significantly increased willingness for diclofenac potassium (+0.70; 95% CI: 0.42–0.98; p < 0.001), sumatriptan (+0.43; 95% CI: 0.13–0.73; p = 0.001), ergotamine + caffeine (+0.55; 95% CI: 0.32–0.77; p < 0.001), dipyrone (+0.41; 95% CI: 0.24–0.59; p < 0.001), and aspirin (+0.44; 95% CI: 0.20–0.67; p < 0.001). Willingness significantly decreased for rimegepant (–0.74; 95% CI: –0.96 to –0.52; p < 0.001), sumatriptan + naproxen (–0.60; 95% CI: –0.92 to –0.27; p < 0.001), and aspirin + caffeine + paracetamol (–0.35; 95% CI: –0.57 to –0.12; p = 0.003). No significant association was found between price-related willingness change and education, insurance, or age. Willingness was positively correlated with perceived efficacy (r = +0.61; p = 0.013) and negatively (though not significantly) with perceived adverse effects (r = –0.44; p = 0.087).
Conclusion: Conclusions: Willingness to use acute migraine medications is influenced by the efficacy, adverse effects, and price. Nevertheless, costs significantly modify willingness over efficacy and security. As integrating patient preferences and economic considerations into migraine treatment decisions will lead to better outcomes, this study provides a new poin of view into patient preferences in Argentina and supports incorporating patient voice into shared decision-making.
Disclosure of Interest: FMB has received educational grants from Medtronic, Raffo, Abbvie, Pfizer, and Novartis; speaker honoraria from Teva, Raffo, Abbvie, Pfizer, Novartis, Aspen, and Casasco; travel and congress support from Raffo, Baliarda, Elea, Gador, and Rontag; and has served on advisory boards for Abbvie and Pfizer. EDD has received speaker honoraria from Raffo, Abbvie, Pfizer, Novartis, Elea, and Casasco; travel support from Raffo, Elea, and Casasco; and has served on advisory boards for Abbvie, Pfizer, and Novartis. FLA has received educational grants from Pfizer and travel support from Raffo. AKG has received educational grants from Pfizer, speaker honoraria from Teva, and travel support from Raffo.
Migraine Preventive Therapy
IHC25-LBAPO-055Clinical response to rimegepant in a real-world refractory migraine cohort in Argentina: A retrospective analysis
Fiorella Martin Bertuzzi1; Ana Karina Guevara1; Diana Micucci1; Maria Virginia Borras1
(1) Red Cefaloca, Argentina
Objective: The objective of this study was to evaluate the clinical effectiveness of rimegepant in a real-world cohort of patients with refractory migraine treated at a private headache clinic in Argentina.
Methods: We conducted a retrospective observational study at Red Cefaloca, a private headache clinic in Buenos Aires. Patients prescribed rimegepant between September 2023 and May 2025 who completed both pre- and post-treatment questionnaires were included. Outcomes assessed included HIT-6 scores, headache frequency, migraine crisis frequency, and pain intensity (VAS 0–10). Paired t-tests compared pre- and post-treatment values. Responder rates (≥50% and ≥75% reduction) were calculated for each outcome.
Results: Out of 46 patients prescribed rimegepant, 23 met inclusion criteria. Mean age was 39.1 years; 91% were female. The average number of prior preventive treatments was 4.2, indicating a refractory cohort. Mean follow-up was 82.9 days. Post-treatment analysis showed statistically significant improvements in all outcomes: HIT-6 (–4.2 points, p = 0.0127), headache frequency (–3.74 episodes/month, p = 0.047), migraine crisis frequency (–2.96 episodes, p = 0.0016), and pain intensity (–1.78 points, p = 0.00007). Responder analysis revealed that 47.8% achieved ≥50% reduction in migraine crisis frequency, 17.4% in headache frequency, and 13.0% in pain intensity. For the ≥75% threshold, rates were 26.1%, 8.7%, and 0%, respectively.
Conclusion: In this real-world Argentine cohort with high treatment refractoriness, rimegepant was associated with meaningful reductions in migraine burden, particularly in migraine crises. While intensity response was less pronounced, the findings support its clinical utility in select patient populations. Prospective studies are needed to validate these results.
Disclosure of Interest: FMB has received educational grants from Medtronic, Raffo, Abbvie, Pfizer, and Novartis; speaker honoraria from Teva, Raffo, Abbvie, Pfizer, Novartis, Aspen, and Casasco; travel and congress support from Raffo, Baliarda, Elea, Gador, and Rontag; and has served on advisory boards for Abbvie and Pfizer. AKG has received educational grants from Pfizer, speaker honoraria from Teva, and travel support from Raffo. DM has received educational grants from Pfizer, and travel support from Cassasco. MVB has received educational grants and travel support from Pfizer.
IHC25-LBAPO-056Efficacy and safety of melatonin for migraine prophylaxis: A systematic review of randomized clinical trials
Evelyn Victória Braselino1
(1) Universidade Anhembi Morumbi, São Paulo - SP, Brasil
Objective: To investigate the efficacy and safety of melatonin as migraine prophylaxis compared to placebo and traditional drugs.
Methods: Systematic review according to PRISMA 2020, with a research question structured by the PECO strategy. Studies with migraine sufferers undergoing melatonin prophylaxis were included. Comparators were placebo or widely used prophylactic drugs such as propranolol and amitriptyline. The primary endpoint was reduction in seizure frequency, while secondary endpoints included seizure intensity and duration, sleep quality, and adverse events. Searches were carried out in electronic databases using (“Migraine Disorders” OR “Migraine” OR “Headache”) AND (“Melatonin”) AND (‘Prophylaxis’ OR “Prevention”), with filters for randomized clinical trials published in the last 10 years, in English. Of 95 initial studies, 7 were included.
Results: Studies showed heterogeneous results regarding melatonin efficacy, but with a favorable safety profile in all comparisons. In 5 studies, melatonin had similar or superior efficacy to traditional drugs such as amitriptyline and valproate, significantly reducing frequency, intensity, and duration of seizures. Additionally, there was improvement in sleep quality and a higher clinical response rate (≥50%) compared to placebo. In contrast, 2 studies showed no significant superiority of melatonin over placebo, with slight or no differences in pain-day frequency, possibly due to low statistical power and high loss rate. Comparisons with naproxen and propranolol alone also showed clinical improvement, but without consistent statistical significance for all outcomes. The average monthly reduction in migraine frequency with melatonin was approximately 4 days, considering studies with absolute reduction values (n = 3). Regarding pain intensity, an average decrease of around 2.9 points on the visual analog scale was observed (n = 2). In terms of safety, melatonin showed tolerability similar to placebo and better than traditional drugs, with a lower incidence of adverse events, generally mild (fatigue, drowsiness, dizziness) and self-limiting. In some studies, weight reduction was observed in the melatonin group, in contrast to weight gain linked to other medications.
Conclusion: Melatonin is an effective and safe migraine prophylactic, comparable to traditional drugs, with better tolerability. However, study heterogeneity necessitates further research to confirm its definitive preventive role.
Disclosure of Interest: None.
IHC25-LBAPO-057Greater Occipital Nerve BLOCK with and without steroids FOR Chronic Migraine (GONBLOCK-FOR-CM): A Randomized Double-Blind Placebo-Controlled Study
Arijit Pal1; Debashish Chowdhury1; Manju Yadav1; Akhil Sahib1; Aastha Bansal1
(1) G B Pant Institute of Postgraduate Medical Education and Research, India
Objective: To study the efficacy and tolerability of greater occipital nerve block (GONB) using methylprednisolone (MPS) plus lidocaine, lidocaine alone and placebo in patients with chronic migraine (CM).
Methods: This was a randomized, double-blind, placebo-controlled trial involving adults (18–65 years) with CM diagnosed by ICHD-3 criteria. After a 4-week baseline period, eligible patients were randomized (1:1:1) to receive bilateral GONB with 2ml MPS (80mg) plus 2ml lidocaine(2%), GONB with 2ml lidocaine(2%) plus 2ml normal saline (NS) and 4ml NS as placebo every 4 weeks for 12 weeks. The primary endpoint was the change in the mean monthly migraine days (MMD) from baseline to weeks 9–12. Key secondary endpoints included change in monthly headache days (MHD) and ≥50% reduction in MHD compared with baseline. Other secondary outcomes including adverse effects were assessed. Efficacy analysis included all patients who received at least one injection of GONB and had one four-week follow-up. The least-squares mean (LSM) was calculated by a linear mixed-effects model. The significance level was set at p<0.05. The trial was registered with the Clinical Trials Registry of India (CTRI 2023/04/051913).
Results: 332 patients were randomized as per study design (figure 1) of which 315 were included in efficacy analysis. Baseline demographic and headache characteristics of the three groups were comparable. At baseline, the group receiving MPS plus lidocaine, lidocaine alone and placebo had MMD of 22.3 ± 5.3, 20.9 ± 6.4 and 20.2 ± 6.6 respectively. Compared with placebo, LSM difference in MMD and MHD were –8.4 days and -6.5 days respectively for the MPS plus lidocaine group and –6.0 days and -4.5 days respectively for the lidocaine alone group (p < 0.001 for both). The proportion of patients achieving ≥50% reduction in MHD at 12 weeks compared with baseline in MPS plus lidocaine, lidocaine alone and placebo group were 38.8%, 27.9% and 9.3% respectively. The MPS plus lidocaine group showed statistically greater reduction in MMD compared with lidocaine alone group (LSM difference –2.4 days; p < 0.01), but no significant differences in key secondary endpoints. Adverse effects were mild and comparable across the three groups.
Conclusion: GONB using either MPS plus lidocaine or lidocaine alone significantly reduced MMD and MHD in patients with CM compared with placebo at 12 weeks. GONB using MPS plus lidocaine had additional benefit in reducing MMD as compared to GONB without MPS. GONB was safe and well-tolerated.
Disclosure of Interest: None.
IHC25-LBAPO-058Outcomes after discontinuation of preventive treatment blocking calcitonin gene-related peptide: a real-world study
Samaira Younis1; Faisal Mohammad Amin1
(1) Danish Headache Center, Denmark
Objective: Use of monoclonal antibodies that target the calcitonin gene-related peptide (CGRP) pathway is considered a third-line preventive treatment for episodic and chronic migraine, often serving as the last available option for prevention. We aimed to investigate why patients discontinue anti-CGRP treatment and which subsequent treatment options are recommended when anti-CGRP treatment is no longer viable due to inefficacy or adverse events.
Methods: We conducted a retrospective real-world study. We reviewed electronic medical records of migraine patients after they terminated treatment with anti-CGRP at the Danish Headache Center.
Results: In total, 160 patients were included (98% with chronic migraine). Hereof, 135 patients (84%) discontinued anti-CGRP treatment due to lack of efficacy, while 25 patients (16%) discontinued treatment due to adverse events. Forty-one patients (26%) had tried more than one anti-CGRP treatment. Subsequent treatment recommendations were: Botox (n=74, 46%), optimization of acute treatment (n=6, 4%), other preventive therapies (n=31, 19%), and no recommendations (n=49, 31%). In total, 110 patients had previously received Botox therapy, whereas 35 of the 74 patients were administered Botox for the first time.
Conclusion: In conclusion, our study shows that Botox may be an effective treatment option to consider for patients with chronic migraine when anti-CGRP treatment is not an option.
Disclosure of Interest: SY reports personal fees from Pfizer, outside of the submitted work. FMA has received Honoria or personal fees from Pfizer, Teva, Novartis, Lundbeck, AbbVie and Eli Lilly for lecturing or participating in advisory boards; is principal investigator for phase IV trials sponsored by Novartis and by Teva; serves as president of Danish Headache Society and board member of the European Headache Federation; serves as associate editor for Acta Neurol Scand, Front Neurol, Front Res Pain, and Headache Medicine.
IHC25-LBAPO-059Role of brivaracetam use for treatment of episodic migraine (ROBUST-EM): a randomised double blind placebo controlled study
Manju Yadav1; Arijit Pal1; Debashish Chowdhury1
(1) G B Pant Institute of Post Graduate Medical Education and Research, New Delhi, India, India
Objective: To study the efficacy and tolerability of BRV (50 mg/day and 100 mg/day) compared with placebo for the prevention of episodic migraine (EM).
Methods: This was a single-centre, double-blind, randomized, placebo-controlled trial. EM patients diagnosed by ICHD-3 criteria for at least 12 months with monthly 4-14 migraine headache days (MHD), aged 18–65 years, without preventive medications for the last three months before randomization were included. Patients older than 50 years at migraine onset, previous therapeutic failure of >2 established preventive drugs, with significant suicidal ideation [Columbia Suicide Severity Rating Scale (C-SSRS) ≥2], pregnant women, and female patients not willing for effective contraception were excluded. Patients were randomized 1:1:1 to receive BRV 50 mg, BRV 100 mg or matching placebo for 12 weeks (figure 1). The primary endpoint was the change in mean MHD per 28 days from baseline to Week 12. Key secondary endpoint was the ≥50% reduction in MHD from baseline at Week 12. Additional secondary endpoints including adverse events were studied. The efficacy analysis using a linear mixed-effects model was performed in a modified intention-to-treat population receiving at least one complete dose of the study drug with one 4-week follow-up. The level of significance was set at p<0.05. The trial was registered with the Clinical Trials Registry of India (CTRI/2023/04/051915).
Results: Out of 216 patients (72 in each arm), 208 patients were included in the efficacy analysis (67 in BRV 50 mg, 70 in BRV 100 mg, 71 in placebo). At Week 12, the mean MHD reduction from baseline was -3.7 (BRV 50 mg), -4.0 (BRV 100 mg), and -0.6 (placebo). The least-square-mean differences from placebo were -3.1 (95% CI -4.0 to -2.2, p<0.001) for BRV 50 mg and -3.4 (95% CI -4.3 to -2.5, p<0.001) for BRV 100 mg. ≥50% reduction in MHD from baseline at Week 12 was significantly higher in BRV groups (28.4% for 50 mg, 58.6% for 100 mg) versus placebo (9.1%). All other secondary endpoints including migraine-related disability showed significant improvements in BRV arms compared with placebo (p<0.05). BRV was well-tolerated; the most common adverse events were dizziness and somnolence. No serious psychiatric or serious adverse events occurred. The trial design is shown in Figure 1.
Conclusion: BRV at both daily 50 mg and 100 mg doses significantly reduced MHD, severity and disability at Week 12 compared with placebo, with a favourable tolerability profile.
Disclosure of Interest: None.
IHC25-LBAPO-060Tolerability, Safety, and Efficacy of Atogepant Versus Topiramate in Participants Requiring Preventive Treatment for Migraine: Results From the Head-To-Head TEMPLE Trial
Uwe Reuter1; Annelies Van Dycke2; Stewart Tepper3; Mark Kristof Farkas4; Giovanna Forero5; Lei Luo5; Hua Guo5; Eric Cohen5; Krisztian Nagy5
(1) University Hospital Greifswald; Charité Universitätsmedizin Berlin, Germany; (2) Department of Neurology, General Hospital Sint-Jan Bruges, Belgium; (3) New England Institute for Neurology and Headache, United States; (4) Semmelweis University, Hungary; (5) AbbVie, United States
Objective: We compared the tolerability, safety, and efficacy between atogepant (ato), an oral calcitonin gene-related peptide receptor antagonist, and topiramate (topi) in participants requiring preventive migraine treatment.
Methods: TEMPLE was a 24-week, randomized, double-blind (DB), double-dummy, active controlled trial with a 52-week open-label safety extension to evaluate tolerability, safety, and efficacy of atogepant 60mg once daily (QD) compared to the highest tolerated dose of topiramate (50, 75, or 100 mg/day) for preventive treatment of migraine in participants with episodic or chronic migraine. The primary endpoint was treatment discontinuation due to treatment-emergent adverse events (TEAEs) in the safety population (ato n=273; topi n=267) during the 24-week DB period. Secondary clinical efficacy endpoints included the proportion of participants with a ≥50% reduction in mean monthly migraine days (MMDs) and change from baseline (CFB) in mean MMDs across Months 4-6 of the DB period in the modified intent-to-treat population (ato n=270; topi n=257).
Results: Atogepant demonstrated superior tolerability compared to topiramate with significantly lower treatment discontinuations due to TEAEs (ato=12.1%; topi=29.6%; RR:0.41[0.28,0.59],P<.0001) across 24 weeks. A higher proportion of participants experienced TEAEs with topiramate compared to atogepant (88.8% vs 76.9%). A higher proportion of participants experienced TEAEs related to study treatment with topiramate compared to atogepant (77.9% vs 56.0%). Atogepant demonstrated superior efficacy compared to topiramate with a significantly greater proportion of participants achieving a ≥50% response (ato=64.1%; topi=39.3%; RR:1.63 [1.37,1.95], P<.0001) and a significant mean MMD reduction (ato=-6.27; topi=-4.49; Δ:-1.78[-2.52,-1.04], P<.0001) across Months 4-6.
Conclusion: Atogepant 60mg QD demonstrated superior tolerability and efficacy compared with topiramate. Atogepant was generally safe and well tolerated and no new safety signals were identified.
Disclosure of Interest: UR has received institutional honoraria for services on advisory boards for AbbVie, Eli Lilly, Lundbeck, Novartis, Pfizer, and Teva and has received institutional honoraria for lectures from , Allergan, Abbvie, Eli Lilly, Lundbeck, Novartis, StreaMedUp, and Teva, received institutional honoraria for consulting services from Lundbeck, Pfizer, and Abbvie; received research funding from Novartis (CHERUB01) and the German Federal Ministry of Education and Research; and is an associate editor of the Journal of Headache and Pain. SJT is an advisor, consultant, and/or on advisory boards and/or scientific boards for Aeon, AbbVie, Alphasights, Amgen, Aruene, Atheneum, Axsome Therapeutics, Becker Pharmaceutical Consulting, ClearView Healthcare Partners, ClickTherapeutics, CoolTech, CRG, Decision Resources, Defined Health, DRG, Eli Lilly, ExpertConnect, FCB Health, Fenix, GLG, Guidepoint Global, Health Advances, Health Science Communications, HMP Communications, Impel, Initiatior Pharma, InteractiveForums, Keyquest, Ki Health Partners, Krog and Partners, Lundbeck, M3 Global Research, Magnolia Innovation, MJH Holdings, Miravo Healthcare, Neurofront Therapeutics, Neurolief, Novartis, P Value Communications, Pain Insights, Inc, Palion Medical, Pfizer, Pulmatrix, Putnam Associates, Rehaler, SAI MedPartners, Satsuma, Scilex, Slingshot Insights, Spherix Global Insights, Strategy Inc, Synapse Medical Communication, System Analytic, Taylor and Francis, Tegus, Teva, Theranica, Trinity Partners, Unity HA, Vial, XOC. He has received CME honoraria from American Academy of Neurology, American Headache Society, Annenberg Center for Health Sciences, Catamount Medical Education, Diamond Headache Clinic, Forefront Collaborative, Haymarket Medical Education, HMP Global, Medical Education Speakers Network, Medical Learning Institute Peerview, Miller Medical Education, National Association for Continuing Education, North American Center for CME, The Ohio State University, Physicians’ Education Resource, PlatformQ Education, Primed, Vindico Medical Education, WebMD/Medscape. He has received speaker bureau honoraria from AbbVie, Eli Lilly, Pfizer, Scilex, Teva. He has received research funding from Aeon, Abbvie, Eli Lilly, Lundbeck, Neurocrine, Neurolief, Pfizer, Suven, UCB. He has received travel compensation from AbbVie, American Headache Society, Diamond Headache Clinic, Eli Lilly, Pfizer, Scilex. MKF has no disclosures to report. AVD has served on advisory/scientific boards and/or given lectures for AbbVie, Allergan, Angelini Pharma, Eli Lilly, Lundbeck, Neuraxpharm, Novartis, Organon, Pfizer, TEVA and UCB, for which she has received honoraria. GF, LL, HG, EC, and KN are employees of AbbVie and may hold AbbVie stock.
IHC25-LBAPO-061Long-term sustainability and effectiveness of anti-CGRP monoclonal antibodies in migraine: 2-year results from the EUREkA cohort
Edoardo Caronna1; Rut Mas-de-les-Valls2; Gabriella Egeo3; Manuel Millán Vázquez4; Candela Nieves Castellanos5; Leonardo Portocarrero6; Gloria Vaghi7; Joana Rodríguez-Montolio8; Alex Jaimes Sanchez9; Albert Muñoz-Vendrell10; Renato Oliveira11; Marcos Polanco12; Yesica González Osorio13; Javiera Canales14; Jordi Sanahuja15; Marta Waliszewska-Prosół16; Liliana Pereira17; Almudena Layos-Romero18; Isabel Luzeiro19; Laura Dorado20; Maria Rocio Álvarez Escudero21; Isabel Pavão Martins22; Christina Sundal23; Pablo Irimia24; Alberto Lozano Ros25; Ana Beatriz Gago-Veiga26; Fernando Velasco Juanes27; Ruth Ruscheweyh28; Simona Sacco29; David García-Azorín13; Vicente González-Quintanilla12; Raquel Gil-Gouveia11; Mariano Huerta-Villanueva30; Jaime Rodriguez-Vico31; Sonia Santos-Lasaosa32; Mona Ghadiri-Sani33; Cristina Tassorelli7; Javier Díaz-deTerán6; Samuel Díaz Insa5; Carmen González Oria4; Piero Barbanti3; Patricia Pozo-Rosich1
(1) Headache Clinic, Neurology Department, Vall d’Hebron Hospital, Barcelona, Spain; (2) Headache and Neurological Pain Research Group, VHIR, Barcelona, Spain; (3) Headache and Pain Unit, IRCCS San Raffaele, Roma, Italy; Italian Migraine Registry (IGRAINE) study group, Italy; (4) Unidad de Cefaleas, Hospital Universitario Virgen del Rocío, Sevilla, Spain; (5) Headache Unit. Neurology. Hospital Universitari i Politècnic La Fe. Valencia. Spain; (6) Headache Unit, Neurology Department, La Paz University Hospital. Madrid, Spain; (7) Headache Science & Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy; (8) 10. Neurology Department, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain; (9) 12. Headache Unit. Hospital Universitario Fundación Jiménez Díaz. Madrid, Spain; (10) Headache Unit. Neurology Department, Hospital Universitari de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; (11) Hospital da Luz Headache Center, Neurology Department, Hospital da Luz – Lisboa, Portugal; (12) University Hospital Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain; (13) Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain; (14) Neurology Department, Pontificia Universidad Católica de Chile, Hospital Biprovincial Quillota Petorca, Quillota, Chile; (15) Headache Unit, Neurology Department, Hospital Universitari Arnau de Vilanova-IRBLleida, Lleida, Spain; (16) Department of Neurology, Wroclaw Medical University, Wroclaw, Poland; (17) Neurology Department, Hospital Garcia de Orta, Almada, Portugal; (18) Headache Unit, Neurology Department, Hospital General Universitario de Albacete, Albacete, Spain; (19) Headache Outpatient Unit of Hospitalar and University Centre of Coimbra, Coimbra, Portugal; (20) Headache Unit, Department of neurosciences, Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain; (21) Unidad de cefaleas, Hospital Universitario Central de Asturias, Oviedo, Spain; (22) Hospital Universitario Sta Maria, Faculty of Medicine University of Lisbon &, Campus Neurologico, Lisbon, Portugal; (23) NeuroClinicNorway, Dep.of Neurology, Norway; (24) Department of Neurology. Clinica Universidad de Navarra. Pamplona, Spain; (25) Headache Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; (26) Headache Unit. Neurology Department. Hospital Universitario La Princesa, Spain; (27) Neurology Department. Hospital Universitario Cruces. Biocruces Bizkaia Health Research Institute. Bilbao. Spain; (28) Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany; (29) Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy; (30) Neurology Department, Hospital de Viladecans-IDIBELL, Viladecans, Barcelona, Spain; (31) Headache Unit. Hospital Universitario Fundación Jiménez Díaz. Madrid, Spain; (32) Neurology Department, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain; (33) The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
Objective: To describe the long-term sustainability and effectiveness of anti-CGRP monoclonal antibodies (MAbs) in migraine in a large European multicentric real-world cohort.
Methods: Prospective observational registry-based study of anti-CGRP mAbs for migraine treatment (EUREkA). We collected clinical efficacy variables (monthly headache days-MHD) during 24-months (M24). We analyzed patterns of response when data was available at 4 time points (6-12-18-24 months). We defined MHD reponse as: sustained (SR) ≥50% reduction ≥3/4 time points; unsustained (UR) ≥50% reduction 1-2/4 time points; no-response (NR) <50% in all time points. We compared M24 (ON-group) with discontinuation group due to lack of effectiveness (OFF-group).
Results: 1340 individuals reached M24 (ON-group). Median MHD at baseline was 20.0(13.0, 28.0); the proportion of subjects at M24 with ≥50% MHD reduction was 60.4% (809/1340). Pattern of response (n= 264) at M24 was: SR 53.8%(142/264), UR 27.3%(72/264) and NR 18.9%(50/264). Comparisons between ON and OFF (n=1057) groups showed statistically significant greater baseline MHD (ON: 20.0(13.0, 28.0) vs. OFF: 25.0(16.0, 28.0)) and higher proportions of subjects with depression (ON: 22.8% vs. OFF: 37.9%) and obesity (ON: 7.2% vs. OFF:19.1%) (p<0.001) in the OFF-group.
Conclusion: Sustained response at 2-years to anti-CGRP treatment is confirmed. Several variables, including delayed treatment onset, depression and obesity negatively impact response.
Disclosure of Interest: EC has received honoraria from Novartis, Chiesi, Lundbeck, MedScape, Lilly; his salary has been partially funded by Río Hortega grant Acción Estratégica en Salud 2017–2020 from Instituto de Salud Carlos III (CM20/00217) and Juan Rodés fellowship, Subprograma Estatal de Incorporación de la Acción Estratégica en Salud 2023 (JR23/00065). He is a junior editor for Cephalalgia. PPR has received, in the last three years, honoraria as a consultant and speaker for: AbbVie, Dr. Reddy’s, Eli Lilly, Lundbeck, Medscape, Novartis, Organon, Pfizer and Teva. Her research group has received research grants from AbbVie, Novartis and Teva; as well as, Instituto Salud Carlos III, EraNet Neuron, European Regional Development Fund (001-P-001682) under the framework of the FEDER Operative Programme for Catalunya 2014-2020 - RIS3CAT; has received funding for clinical trials from AbbVie, Amgen, Biohaven, Eli Lilly, Novartis, Pfizer, Teva. She is the Honorary Secretary of the International Headache Society. She is an associate editor for Cephalalgia and Neurologia. She is the founder of www.midolordecabeza.org. PPR does not own stocks from any pharmaceutical company.
Migraine Acute Therapy
IHC25-LBAPO-062Sustained response and clinical impact of anti-CGRP treatment in migraine patients: a retrospective observational study
Rita Rato1; Rafael Dias1; Madalena Pinto2; Andreia Costa1
(1) 1.Department of Neurology, Unidade Local de Saúde São João, Porto 2.Department of Clinical Neurosciences and Mental Health, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; (2) 1.Department of Neurology, Unidade Local de Saúde São João, Porto, Portugal
Objective: Introduction: Migraine is a prevalent and disabling neurological disorder. Fremanezumab, a monoclonal anti-CGRP antibody, has demonstrated efficacy in its prevention. Objective: To compare the efficacy of two consecutive treatment cycles with fremanezumab in patients with episodic and chronic migraine.
Methods: This was a retrospective observational study. Efficacy was assessed based on a ≥75% reduction in the monthly mean number of migraine days (MMD), with an optimal response defined as MMD ≤4 days. Quality of life impact was evaluated using the headache impact test (HIT-6). Statistical analyses included Student's t-test, Wilcoxon signed-rank test, and McNemar’s test (statistical significance set at p≤0.05).
Results: A total of 52 patients were included (50 women; mean age 45.7 ± 8.7 years), 25 diagnosed with episodic migraine and 27 with chronic migraine. The treatment cycles were separated by a median interval of 5.5 months (P25: 3 months; P75: 10 months). Prior to the first cycle, the MMD was 14.3 ± 6 days, decreasing to 4 ± 2.61 at 3 months, 3.37 ± 3.6 at 6 months, and 2.83 ± 2.5 at 12 months. Before the second cycle, the MMD was 11 ± 5.7 days, decreasing to 4.8 ± 2.43 at 3 months, 3.5 ± 2.1 at 6 months, and 2.71 ± 2.3 at 12 months (3 months: p=0.028; 6 months: p=0.188; 12 months: p=0.516). The proportion of patients with MMD ≤4 did not differ significantly between cycles (p=0.143 at 3 months; p=1 at 6 and 12 months). However, considering a ≥75% reduction in MMD, the second cycle showed greater efficacy during the first 6 months (p=0.03), significantly reducing migraine days and increasing the proportion of responders. At 12 months, 60% and 66% of patients in the first and second cycles, respectively, reported reduced headache impact (HIT-6 <55).
Conclusion: The second fremanezumab treatment cycle demonstrated additional benefits during the initial 6 months, with sustained and comparable efficacy at 12 months, supporting the value of reinitiation in previously responsive patients.
Disclosure of Interest: None.
Other
IHC25-LBAPO-063Brain dynamics characterization of herpes zoster patients based on Landau-Stuart oscillator network model
Qianyun Zhang1; Jiahao Li2; Kang Huo2; Guogang Luo2; Junjie Jiang1
(1) Xi’an Jiaotong University, China; (2) The First Affiliated Hospital of Xi'an Jiaotong University, China
Objective: Herpes zoster (HZ) pain often manifests as hyperalgesia, readily progresses to chronicity, and is frequently accompanied by psychological comorbidities. Abnormalities in brain structure and function represent key mechanisms underlying its persistence, yet current diagnosis heavily relies on subjective assessments, lacking reliable neuroimaging biomarkers. To address this, we integrated structural and functional imaging data with the Landau-Stuart oscillator network model, which is a nonlinear dynamics method to simulate mesoscale interactions between brain regions, aiming to reveal dynamic alterations in HZ pain.
Methods: 55 HZ patients, 57 postherpetic neuralgia (PHN) patients, and 35 matched healthy controls (HC) underwent magnetic resonance imaging (MRI) scans and clinical assessments. Preprocessed structural and functional MRI datas were used to construct connectivity matrices for the Landau-Stuart oscillator model. An adaptive whole-brain dynamics framework was implemented, featuring: 1) Subject-specific initialization of global coupling strength (G) and bifurcation parameters; 2) fractional amplitude of low-frequency fluctuations (fALFF) guided gradient descent with approximate loss functions to optimize MRI data fitting. Statistical analysis included: 1) Network and regional level group comparisons; 2) Correlation analyses for abnormal dynamical regions. Finally, diagnostic utility of functional connectivity versus brain dynamics for HZ and PHN discrimination was evaluated.
Results: (1) The relationship among the global coupling strengths G for HZ, PHN and HC was HC = 1.0763 < HZ = 1.1345 < PHN = 1.2789 (P<0.05). (2) Brain network dynamics comparison revealed significant abnormalities in the salience network (P=0.031) and limbic network (P=0.031) between HZ and PHN groups. Additionally, PHN patients exhibited localized dynamic abnormalities in the bilateral superior frontal gyri (P < 0.001) compared with HZ patients. (3) The combined application of bifurcation parameters and global coupling strength achieved 76.80% classification accuracy in distinguishing HZ and PHN patients, demonstrating superior performance to traditional functional connectivity-based methods. (4) PHN's right angular gyrus dynamics negatively correlated with pain duration (r=-0.449, P=0.015).
Conclusion: Landau-Stuart oscillator network model improved neuroimaging identification accuracy in HZ patients and detected dynamic abnormalities in functional subregions including the superior frontal gyrus and angular.
Disclosure of Interest: None.
IHC25-LBAPO-064Descriptive analysis of Clinical Trial activity in a Headache Unit: 10 years of Experience and Lessons learned
Teresa Mateu1; Javiera Canales2; Edoardo Caronna3; Marta Torres-Ferrús3; Laura Gómez-Dabó3; Alicia Alpuente3; Raquel Lastra4; Patricia Pozo-Rosich3
(1) Vall d'Hebron Univerisity Hospital. Vall d'Hebron Research Institute. Hospital de Mollet, Spain; (2) Pontificia Universidad Catolica de Chile-Red de salud UC Christus. Hospital Biprovincial Quillota Petorca, Chile; (3) Vall d'Hebron University Hospital. Vall d'Hebron Research Institute, Spain; (4) Vall d'Hebron Research Institute, Spain
Objective: To describe the clinical trial (CT) activity carried out in a specialized Headache Unit, focusing on determining the main reasons for screen failure (SF) and early termination (ET).
Methods: We carried out a retrospective study of all clinical trials conducted in our Headache Unit from January 2015 to May 2025. Variables related to the trial (type of intervention, study design, protocol) and related to the patients included (age, sex, level of education) were collected. Reasons for SF and ET were collected.
Results: Throughout 10 years, 40 clinical trials have been initiated (35 Phase 3 CT and 5 Phase 4 CT): 87.5% (35/40) in migraine (80% (28/35) preventive treatment in chronic or episodic migraine, 20% (7/35) migraine attack treatment), 12.5% (5/40) in Cluster Headache (preventive). 65% (26/40) of studies were in adult population (both migraine and cluster headache) and 35% (14/40) were in pediatric population (6-17 years old, migraine). 496 patients were included in the screening phase (72.8% ( 361/496) adult, 27.2% (135/496) pediatric). The overall SF rate was 41.5% (206/496), being 42.4%(153/361) adult and 39.3% (53/135) pediatric. The main SF reason in adults was discordant headache frequency according to protocol requirements, both in migraine (40.5% (62/153)) and cluster headache (58.8% (10/17)). In pediatric CTs the main reason for SF was low eDiary compliance 32.1% (17/53). The ET ratio was 10.5% (52/496), being 17.3% (9/52) due to adverse events.
Conclusion: Experience in CT in headache shows the need to optimize the design of protocols and pre-screening strategies, as well as to develop tools in the pediatric population that enhance compliance.
Disclosure of Interest: None.
IHC25-LBAPO-065Gut Microbiota and Primary Headaches: A Review of Clinical Evidence
Beatriz Viguetti Godoy1; Luana Mendes dos Santos2; Evelyn Victória Braselino3; Edoarda Carolina Bertholdi4; Lara Freitas Andrade5; Sthefany Vitória Barcellos Alves Peres1; Raissa Piassali Carvalho6; Ana Beatriz Carvalho de Oliveira Guilherme7; Leonardo Oliveira Risso da Costa8; Layaly Ayoub Silva5; Lorena Pedro de Oliveira9
(1) Universidade Nove de Julho (UNINOVE), SP - SP, Brasil; (2) USP, SP - SP, Brasil; (3) Universidade Anhembi Morumbi (UAM), SP - SP, Brasil; (4) Universidade do Vale do Itajaí (UNIVALI), Itajaí - SC, Brasil; (5) Universidade Santo Amaro (UNISA), SP - SP, Brasil; (6) Faculdade De Medicina Do ABC(FMABC), SP - SP, Brasil; (7) Fundação Educacional do Município de Assis (FEMA), Assis - SP, Brasil; (8) Centro Universitário de Adamantina (FAI), Adamantina - SP, Brasil; (9) Faculdade Santa Marcenaria (FASM), SP - SP, Brasil
Objective: This integrative review aimed to explore the relationship between gut microbiota and primary headaches.
Methods: The study was based on an integrative literature review approach and used the PECO strategy to structure the research question. A literature search was conducted in the PubMed database using the descriptors “Microbiota” AND “Headache” OR “Migraine,” with filters for randomized controlled trials, free full-text access and publications from the last five years.
Results: After screening 78 identified articles, 8 were selected for qualitative analysis. The findings indicate a significant association between gut microbiota composition and primary headaches, especially migraine. Diets with a microbiota-friendly profile were linked to a 10% reduction in migraine prevalence (p=0.005). However, some studies showed negative correlations between certain dietary habits and headache prevalence, often mediated by excessive medication use and dietary triggers. These factors were associated with microbial imbalances, including increased levels of Desulfovibrioand Dialister and reduced Ruminococcus, confirmed by elevated inflammatory serum markers. Specific microbial taxa were identified in relation to migraine risk. The presence of Helicobacter pylori, Coprobacter, and bacteria from the families Porphyromonadaceae, Hungatella and Marvinbryantia, as well as the species Phascolarctobacterium succinatutens, were associated with increased migraine risk. In contrast, beneficial effects were linked to the family Bifidobacteriaceae and genera such as Coprococcus3 and Anaerotruncus, found in both migraine with and without aura. Additionally, family XIII and genera such as Blautia, Eubacterium nodosum group, and the species Bacteroides fragiliswere considered potentially protective. Several clinical trials demonstrated that interventions with probiotics, vitamin D, vitamin B2 and short-chain fatty acids led to a reduction of up to 40% in migraine frequency and intensity.
Conclusion: In conclusion, this integrative review supports a link between gut dysbiosis and primary headaches, highlighting the role of specific microbial profiles in the pathophysiology of migraine. These findings suggest that modulation of the gut microbiota may serve as a promising adjunctive strategy for managing migraines. Nonetheless, further well-designed clinical studies are required to establish causality and to better understand the gut–brain axis mechanisms underlying this association.
Disclosure of Interest: None.
IHC25-LBAPO-066Headache and medication abuse
Marina Dotto1; Claudia Bellorio2
(1) Universidade Santo Amaro, São Paulo - SP, Brasil; (2) Universidade Nove de JUlho, Sorocaba - SP, Brasil
Objective: To analyze the clinical and neuropsychological impacts of headache due to medication abuse, addressing its main risk factors and therapeutic strategies.
Methods: The research was conducted using databases such as Scielo, Pubmed and Cochrane Library, using articles in English and Portuguese, published between 2015 and 2023. The search terms used were “Headache”, “Drug misure” and “Medication-overuse headache”.
Results: Medication overuse headache (MOH) severely impacts the patient's daily life, affecting the ability to concentrate, social life, productivity and abandonment of activities. MOH affects approximately 1% to 2% of the world's population, with a higher prevalence in women. The most consistent risk factors are high frequency of headache attacks, more than or equal to 10 days per month, regular use of analgesics, thirties or opioids for more than 3 months, presence of psychiatric disorders such as anxiety and depression, obesity and other comorbidities and therapeutic resistance. The therapeutic approach should be individualized, multidisciplinary and progressive, focusing on patient education, intoxication and relapse prevention. Symptomatic medication withdrawal remains the main axis of MOH treatment. Abrupt withdrawal of analgesics is usually effective, but withdrawal symptoms such as severe rebound headache, nausea, irritability, anxiety and insomnia make treatment adherence difficult. Therefore, monitoring by a headache nurse significantly increases the success rate of medication withdrawal.
Conclusion: MOH represents a clinical challenge, given its high prevalence and significant functional impact on patients' quality of life. The data analyzed demonstrate that the clinical and neuropsychological effects of this condition are relevant, and are often associated with psychiatric disorders, cognitive impairment, and limitations in daily activities. Early identification of risk factors, such as high frequency of attacks, prolonged and inappropriate use of analgesics, as well as the presence of psychiatric comorbidities, is essential for the prevention and adequate management of MOH. The most effective therapeutic strategies include gradual discontinuation of medication, multidisciplinary monitoring, and the introduction of pharmacological and nonpharmacological preventive measures. Therefore, timely recognition and treatment of medication-related headache are essential for the recovery of the physical and mental well-being of affected patients.
Disclosure of Interest: None.
IHC25-LBAPO-067Quality of life of patients with migraine attended in a multidisciplinary approach: a sectional study
Alcylene Carla Jesus Santos1; Josiene Da Silva Santos1; Giulia Santos Santana1
(1) Universidade Do Estado Da Bahia, Salvador - BA, Brasil
Objective: To evaluate the quality of life of patients with migraine treated at the Interdisciplinary Project for Attention to Migraine Patients at the Universidade do Estado da Bahia, Campus I, Salvador-BA.
Methods: This is a descriptive study, carried out with individuals with migraine, assisted in the project Free of Migraine. Patients of both sexes were included, and minors and patients with cognitive problems were excluded. Data collection was carried out in September 2021, after approval by the Ethics and Research Committee, through an online form with socio-demographic variables, an instrument to assess quality of life Short Form Health Survey 36, and the Free and Informed Consent Form.
Results: 24 patients were contacted. All met the eligibility criteria, but ten (41.6%) were not located, and seven (29.2%) did not complete the form. Seven composed the study, six (85.7%) women, aged between 21 and 49 years (85.8%). Four (57.1%) were brown, and six (85.7%) had no marital status. Seven (100%) studied for 12 years or more, and three (42.9%) were unemployed. In the domains of emotional aspects, mental health, and vitality, most responses scored below 50.
Conclusion: It is possible to assume that the impact of migraine includes multiple alterations and, in general, approaches with interdisciplinary care favor the maintenance of high levels of quality of life.
Disclosure of Interest: None.
IHC25-LBAPO-068Shifting Authorship Landscapes: Two-Decade Gender Trends in High-Impact Headache Journals
Maria Emília Servin Berden1; Natasha Leitão2; Andrezza Lauria Moura3; Daniela Aparecida Godoi Gonçalves4; Vanise Grassi5; Juliana Stuginski-Barbosa6
(1) Bauru School of Dentistry, University of São Paulo, Bauru - SP, Brasil; (2) DOFAM, Grupo de Dor Orofacial do Amazonas, Manaus - AM, Brasil; (3) Universidade Federal do Amazonas, Manaus - AM, Brasil; (4) School of Dentistry, Araraquara, Sao Paulo State University, Araraquara - SP, Brasil; (5) Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre - RS, Brasil; (6) Bauru Orofacial Pain Group, Bauru - SP, Brasil
Objective: Quantify gender representation among first and last authors of original articles in Cephalalgia, Headache and The Journal of Headache and Pain (2004, 2014, 2024), test temporal trends, compare 2024 h-index values, and explore sex-linked research themes using Keywords Plus®.
Methods: Web of Science Core Collection (WoS) was searched on 12 Apr 2025; letters, reviews and corrections were excluded. Author sex was verified through institutional sources; indeterminate cases (<1 %) were omitted from regressions. Extracted variables: year, journal, last-author country, and h-index (2024). χ² trend tests and logistic regression estimated annual change in female authorship; Mann-Whitney U compared h-index distributions. Keywords Plus® terms were tallied to identify thematic clusters by sex.
Results: Nine-hundred-and-eight articles were included (2004 = 260; 2014 = 308; 2024 = 340). Female first-author proportions were 41.6 %, 31.9 %, 37.9 %; last-author, 25.2 %, 29.3 %, 14.4 %. Female first-authorship fell 2.3 % per year (β = -0.023; p = 0.006); the drop for last authors (β = -0.009; p = 0.34) lacked significance. Journal effects were non-significant (all p > 0.24). Odds of female first authorship were >3-fold higher in Denmark and England (OR ≥ 3.3) and 71 % lower in China (OR = 0.29) versus Italy; analogous patterns appeared for last authors (England OR = 3.25; China OR = 0.23). In 2024, deduplicated last authors (n = 373) showed no h-index difference (Female 24, IQR 13–35 vs Male 26, 16–55; p = 0.52). Keywords Plus® revealed that male last authors clustered around pharmacological/neurobiological terms (e.g., CGRP, 5-HT1B/1D agonists) whereas female last authors emphasized quality-of-life and psychosocial concepts (e.g., burden, stress).
Conclusion: Female leadership in headache research remains uneven. First-author participation declined modestly, yet last female authorship dropped sharply to 14 % in 2024. Geographic factors outweighed journal effects: Northern Europe showed the most balanced leadership, East Asia the least. Comparable h-indices indicate that, once last authorship is attained, women achieve impact similar to men. Divergent Keywords Plus® profiles suggest gender-linked thematic preferences, underscoring the need for inclusive funding and mentorship to close both quantitative and qualitative gaps.
Disclosure of Interest: None.
IHC25-LBAPO-069Subdural hematoma post-spinal anesthesia in an obstetric patient: a case report
Arthur Vinícius Lôbo Siqueira Lira1; Alana Maria Caland de Holanda Lustosa1; José Fortes Napoleão do Rêgo Neto1; Yasmin Vitória Luz Alves1; Gustavo Sousa Noleto1; Raimundo Feitosa Neto1
(1) UFPI, Teresina - PI, Brasil
Objective: To describe the progression of a patient that evolved with subdural hematoma after spinal anesthesia, analyzing the imaging results and therapeutic approach considering the case.
Methods: This case report was developed according to the CARE guidelines. Patient data were collected through analysis of imaging reports and follow-up interviews. Informed written consent was obtained from the patient for publication of anonymized data.
Results: A 34-year-old female patient from Teresina was submitted to elective cesarean delivery under spinal anesthesia. The patient reported that the administration of the anesthesia was difficult, and that she felt a shock-like sensation throughout her entire leg in one of the three attempts at administration. Soon after the end of the surgery, the patient began experiencing headache after assuming an upright position. The patient was diagnosed with post-dural puncture headache (PDPH) and was hospitalized for two days until her condition improved and she was discharged. The patient reported experiencing an acute, severe headache affecting the entire head on the same day, which subsided throughout the day. The headache persisted for 13 days, at which point there was a substantial improvement of the condition. In the subsequent days, the patient reported mild pain when assuming an upright position, which she used Paracetamol 500 mg once a day to relieve the symptoms. Several days afterward, the patient reported an episode of seizure with a decerebrate posturing pattern, preceded by aphasia, and was taken to the hospital for further evaluation, where the diagnosis of bilateral subdural hematoma was confirmed by cranial CT scan. The patient underwent surgical drainage of the hematoma, without complications. No motor deficits were observed in the patient after procedure. A month after the surgery the patient underwent a magnetic resonance imaging (MRI) and an electroencephalogram (EEG), which revealed no significant finding. Currently, the patient is taking Lamotrigine 25 mg daily, reporting dizziness as a side effect.
Conclusion: Subdural hematoma after spinal anesthesia is a rare complication that requires a high degree of clinical suspicion. CT scan was essential for diagnosis, and surgical drainage proved to be an effective and safe treatment. This case highlights the importance of careful monitoring of patients with persistent post-spinal headaches, contributing to the growing understanding of this uncommon complication in the obstetric setting.
Disclosure of Interest: None.
IHC25-LBAPO-070Use of a Mobile Application for Body Balance Rehabilitation in Patients with Vestibular Migraine
Jonatan Pereira Fraga1; Maria da Gloria Canto Sousa2; Acassia Benjamin Leal Pires2; Luana Oliveira Leite2; Alcylene Carla Jesus Santos3; Eduardo Souza Cardoso2
(1) PROMÉDICA, Salvador - BA, Brasil; (2) Universidade do Estado da Bahia, Salvador - BA, Brasil; (3) Universidade do Estado da Bahia, Salvador - BA, Brasil
Objective: To assess how effectively the Dizziness App restores body balance in volunteers suffering from Vestibular Migraine.
Methods: This exploratory, prospective, descriptive, and analytical study included a convenience sample of seven individuals diagnosed with Vestibular Migraine at the University Pharmacy of UNEB. The study was approved by the Research Ethics Committee (CEP) under protocol number 4,600,298. Participants underwent ten weekly sessions, with pre- and post-intervention assessments using the Dizziness Handicap Inventory (DHI). In addition to the exercises guided by the Dizziness App, each session incorporated relaxation techniques focused on the shoulder girdle. To evaluate progress, total and domain-specific DHI scores (physical, functional, and emotional) were compared at baseline, mid-therapy, and post-therapy.
Results: Before starting rehabilitation, DHI results showed that 42.9% of the participants experienced severe limitations in the physical domain, an identical 42.9% exhibited severe dysfunction in daily activities (functional domain), and 14.3% reported severe emotional impairment. After completing the program, all participants recorded scores indicating no disability in any domain. Vestibular disorders often cause not only physical discomfort but also emotional distress, undermining professional, social, and domestic functioning, and compromising overall well-being. By segmenting the scores into physical, functional, and emotional domains, the DHI provides a clear framework for understanding how dizziness disrupts the daily lives of individuals with Vestibular Migraine.
Conclusion: In this small cohort, vestibular rehabilitation delivered through the Dizziness App demonstrated high effectiveness. Participants reported improved access to therapy, strong adherence to the intervention, and appreciation for the flexibility of home-based sessions—factors that collectively contributed to a significant enhancement in their quality of life.
Disclosure of Interest: None.
IHC25-LBAPO-071Migraine and Sleep Disorders: A Two-Way Path to Dysregulation
Carolina Barbosa Redig1; Thor Castro2
(1) Centro Universitário Metropolitano da Amazônia (UNIFAMAZ), Belém - PA, Brasil; (2) Universidade Federal do Pará (UFPA), Belém - PA, Brasil
Objective: Migraine and sleep disturbances are frequently comorbid conditions, each capable of exacerbating the other through overlapping neurobiological pathways. Sleep disorders—particularly insomnia, poor sleep quality, and altered REM architecture—are prevalent among migraine patients and often precede or prolong headache episodes. Conversely, recurrent migraine attacks may disrupt circadian and homeostatic sleep mechanisms. This narrative review aims to synthesize current evidence regarding the bidirectional relationship between migraine and sleep dysfunction, highlighting shared mechanisms and therapeutic opportunities.
Methods: A narrative review was conducted using original studies retrieved from PubMed. The search included articles published in the last 10 years using the descriptors “migraine,” “sleep disorders,” “insomnia,” and “non-pharmacological treatment,” combined with Boolean operators (AND). Studies were selected if they investigated the physiological, clinical, or therapeutic aspects of the migraine–sleep interface.
Results: Multiple studies demonstrate that disrupted sleep—especially insomnia and reduced REM or slow-wave sleep—is a significant risk factor for migraine chronification. Bidirectional mechanisms include hypothalamic dysregulation, orexin and serotonin imbalance, and shared thalamocortical networks involved in pain and sleep modulation. Cognitive-behavioral therapy for insomnia (CBT-I), mindfulness-based stress reduction, melatonin, and sleep hygiene interventions have shown promise in reducing headache frequency and severity. Improved sleep quality is consistently associated with better migraine outcomes, especially in chronic or treatment-resistant populations.
Conclusion: The relationship between migraine and sleep disorders is deeply interconnected, creating a feedback loop of neurobiological dysregulation. Addressing sleep dysfunction as a therapeutic target may optimize migraine management and enhance patient outcomes. Integrative approaches that include behavioral and lifestyle-based interventions deserve broader implementation and further high-quality investigation.
Disclosure of Interest: None.
IHC25-LBAPO-072Preclinical re-evaluation of a possible role of substance P (SP) in migraine pathophysiology
Caroline Machado Kopruszinski1; Gege Guzman1; Edita Navratilova1; David W. Dodick2; Frank Porreca1
(1) University of Arizona, Department of Pharmacology, College of Medicine, Tucson, Arizona, United States; (2) Atria Academy of Science and Medicine, New York, NY, United States
Objective: Calcitonin gene-related peptide (CGRP)-receptor antagonists have been demonstrated to be effective in acute treatment of migraine. In contrast, NK1 receptor antagonists were not effective in acute or preventive treatment of migraine suggesting that substance P is not critical in migraine pathophysiology. Nevertheless, in trigeminal neurons, SP and calcitonin gene-related peptide (CGRP) are co-localized and likely to be co-released. Emerging evidence suggests the potential involvement of receptors beyond NK1 in the actions of SP. The potential contribution of SP to migraine therefore remains uncertain. This preclinical study investigated if (a) SP may promote migraine-like headache pain behaviors and (b) whether SP might act synergistically with CGRP to elicit migraine-like headache pain.
Methods: Supradural administration of SP and CGRP were given alone, or in combination, to induce migraine-like headache in female and male mice. Periorbital cutaneous allodynia served as a surrogate preclinical measure of migraine-like pain.
Results: Supradural SP and CGRP independently produced dose-dependent migraine-like headache pain behavior in mice. Co-administration of subthreshold doses of SP and CGRP onto the dura mater of mice failed to induce migraine-like headache pain behavior.
Conclusion: SP independently induced migraine-like headache pain in both male and female mice, with no observed sex differences. However, very high doses of SP were required to elicit migraine-like responses. Synergistic effects were not observed between subthreshold doses of SP and CGRP. Therefore, despite the known co-release of both CGRP and SP from neurons and their established pronociceptive roles in preclinical models, it is unlikely that SP significantly contributes to migraine like headache pain either alone or in enhancing the effects of CGRP to promote migraine.
Disclosure of Interest: None.
Other Secondary Headache Disorders
IHC25-LBAPO-073The beauty chip and the possibility of a catastrophic event - Case Report
Marcela Paula Agostinho1; Marcela Paula Agostinho1; João Paulo Oliveira Mello2; João Paulo Oliveira Mello2
(1) Bueno Medical Center, Goiânia - GO, Brasil; (2) Center X, Goiânia - GO, Brasil
Objective: Report a case of a 42-year-old man who took testosterone chips, tadalafil, and metformin, aiming to achieve greater performance in workouts and muscle mass and evolved with severe headache, vertebral artery dissection and thrombosis.
Methods: Observational study and analysis of tests. G.C.P., male, 42 years old, had a hormonal chip implanted on April 25,2025 and after 15 days began experiencing daily, progressive headaches that were resistant to anti-inflammatories, analgesics, triptans, and amitriptyline. After 15 days of intense pain, he sought neurological care. He reported a history of headaches but they had never been this intense and would cease with any analgesic. He experienced blurry vision, bright spots at times, and also cervical pain. He expressed anxiety and had been using Venvanse 70mg for 4 years. He had been using a hormonal chip for 3 years, but it only contained testosterone. This time, he switched nutritionists and to achieve better results, the chip would have more testosterone, along with tadalafil and metformin. At the time of the consultation, his blood pressure was 130 x 80 and heart rate: 110 bpm. Sertraline 50mg and Sodium Valproate 300mg were initiated.
Results: An Angiography MRI of the skull was requested, which was performed on may 30,2025 with the result: asymmetrical vertebral arteries, with the right being dominant compared to the contralateral, showing narrowing in a 'flame-shaped' pattern affecting segment V4 of the left vertebral artery, near the confluence with the basilar artery (dissection? obstruction?). The brain parenchyma showed no changes. Blood work from 02/06/2025: hematocrit: 52.3% and hemoglobin: 17.2, Testosterone: 884. Transcranial Doppler performed on 04/06/2025: right-to-left shunt with passage of few microemboli. The neurologist requested the immediate removal of the hormonal chip. The hormonal pellets, which were spread from the right flank to the lumbar spine, were removed: 5/10 testosterone, 3/3 metformin, and 2/4 tadalafil. After 24 hours post-surgery, we started Edoxaban 60mg and performed venesection, withdrawing 450 ml. After 3 days of pellet removal, the headache had significantly improved and the Angio MRI was normal.
Conclusion: Dissection of cervical arteries is responsible for about 25% of strokes in young adults, being one of the main causes of sequelae in this group. After the measures taken immediately upon diagnosis, we avoided a cerebral ischemic event.
Disclosure of Interest: None
IHC25-LBAPO-074Essential thrombocythemia as a cause of headache and tremor: a case report
Gabriel Rocha Santos Knorst1; Julia dos Anjos Borges2; Roberani Borges Vaz Gonçalves2; Luis Antonio Macedo Milhomem2; Ana Flávia Silva Santos2; Gustavo Souza Miranda da Silva2; Matheus Maia Garcia3
(1) Hospital das Clínicas da Universidade Federal de Goiás (HC-UFG), Goiânia - GO, Brasil; (2) Centro Universitário de Mineiros (UNIFIMES) – Trindade/GO, Trindade - GO, Brasil; (3) Hospital do Servidor Público Estadual de São Paulo (HSPE IAMSPE), São Paulo - SP, Brasil
Objective: This report aims to address an infrequent cause of headache, highlighting the importance of investigating secondary causes.
Methods: This paper consists of a case report of atypical headache associated with tremor.
Results: Male, 46, presented with a holocranial headache, with daily frequency, intensity nine out of ten and refractory to multiple medications for 30 days. He complained of nausea, associated photophobia and phonophobia, in addition to a tremor bilateral in the hands. He reported a personal history of migraine with aura in the past and a recent episode of sudden unilateral visual blurring, with a diagnosis of retinal toxoplasmosis. Underwent treatment with sulfamethoxazole + trimethoprim and prednisone for 45 days. No focal neurological deficits on physical examination. The blood count showed a leukocyte count of 14,760 and platelets of 791,000. A diagnostic hypothesis of migraine was raised and treatment was initiated with valproic acid, triptan and naproxen, however, additional tests were requested to rule out secondary headache due to the presence of warning signs. After 2 weeks, the patient returned reporting headache improvement, but feeling tired, with tremors and diffuse body pain. Imaging tests showed no changes. However, the blood count showed poikilocytosis with ovalocytes, anisocytosis (RDW 20.6%), leukocytosis (15,200) and thrombocytosis (1,397,000) with the presence of macroplatelets. He was urgently referred for hematologic investigation. A V617F mutation in the JAK2 gene was detected, suggestive of Essential Thrombocythemia. A bone marrow biopsy was performed, which confirmed the diagnosis. Treatment with hydroxyurea was started and the patient became asymptomatic after the first dose.
Conclusion: Essential Thrombocythemia (ET) is a rare chronic myeloproliferative neoplasm whose incidence ranges from 0.2 to 2.5:100,000 people per year, and prevalence from 38 to 57 cases per 100,000 people.It is characterized by thrombocytosis accentuated, thrombotic and hemorrhagic risk, and clinically it can occur with headache, dizziness and acral paresthesias, which result from thrombotic phenomena in small vessels, exacerbated by platelet hyperactivity. The formal diagnosis of ET requires exclusion of other myeloid neoplasms. Bone marrow morphology demonstrates an elevation of apparently mature megakaryocytes. In order to prevent thrombosis, low-dose aspirin is suggested for most patients, either alone or in combination with a cytoreductive drug for high-risk patients.
Disclosure of Interest: None.
IHC25-LBAPO-075Headache and Performance: Do Exercise-Induced Hypoxia and Low Aerobic Capacity Predispose to Pain During Marathons?
Andrea Marengo1; Andrea Marengo1; Malena Tejada2; Malena Tejada2; Pablo Salgado3; Pablo Salgado3; Fiorella Bertuzzi4; Fiorella Bertuzzi4; Karina Guevara4; Karina Guevara4; Michele Germain5; Michele Germain5; Maximiliano Giraud Billoud6; Maximiliano Giraud Billoud6
(1) Hospital Perrupato, Argentina; (2) Hospital Caterina, Spain; (3) Instituto de Investigaciones en Salud Pública. UBA, Argentina; (4) Red Cefaloca, Argentina; (5) Universidad de Lyon, France; (6) CONICET - UNCuyo, Argentina
Objective: Exercise-induced headache is a common complaint among endurance runners, yet its physiological basis remains poorly understood. According to the International Headache Society, it is defined as a primary pulsatile, bilateral headache occurring during or after physical exertion, with no structural or secondary cause identified. This study aimed to compare physical fitness, race performance, and neurophysiological parameters between runners who experienced headache during a marathon (HM) and those who did not (NHM), during 42-km races held in Mendoza, Argentina, between 2020 and 2024.
Methods: A total of 46 healthy runners (aged 18–65) were included. Pre-race assessments involved ergometry, clinical evaluation, electroencephalography (EEG), and peak expiratory flow measurements. Data were also collected on sleep, diet, substance use, and headache history. During the race, heart rate and oxygen saturation (SpO2) were continuously monitored at five checkpoints (start, 8 km, 16 km, 32 km, and 42 km).
Results: Headache during the race occurred in 8.7% of runners (n=4). No significant differences were found in age, sex, or lifestyle habits. However, HM was more prevalent among those with a prior history of migraine (p=0.025). The HM group showed significantly lower VO2max (p=0.007) and reduced oxygen saturation at early checkpoints (D1: p=0.027; D2: p=0.0008). Statistical analyses were performed using the Mann-Whitney test due to small subgroup size.
Conclusion: These findings suggest that lower aerobic capacity and relative hypoxemia during exertion may contribute to the development of exercise-induced headache at altitude. Larger studies are needed to confirm these associations and elucidate underlying mechanisms.
Disclosure of Interest: None.
IHC25-LBAPO-076Reduced Aerobic Capacity as a Risk Factor for High-Altitude Headache
Andrea Marengo1; Malena Tejada2; Pablo Salgado3; Maximiliano Giraud Billoud4; Fiorella Martin Bertuzzi5; karina Guevara5; Michele Germain6
(1) Hospital Perrupato, Argentina; (2) Hospital Santa Caterina, Spain; (3) Instituto de Investigaciones en Salud Pública. UBA, Argentina; (4) CONICET - UNCuyo - UNViMe., Argentina; (5) Red Cefaloca, Argentina; (6) Universidad de Lyon, France
Objective: Exercise at high altitude is a recognized risk factor for high-altitude headache (HAH). This study aimed to identify risk factors associated with HAH and their relationship with pre-race physical condition and electroencephalographic patterns in marathon runners competing at 2000 meters above sea level (masl) in Mendoza, Argentina.
Methods: A cross-sectional, observational, and correlational study was conducted between 2020 and 2024 in runners of a 42-km marathon with a cumulative ascent of +2000 masl. Participants were divided into two groups: those who developed HAH and those who did not (non-HAH). Pre-race assessments included medical history (headaches, sleep, substance use, training type), physical examination, vital signs, VO2max testing, electroencephalogram (EEG), and peak expiratory flow rate (PEFR). Heart rate and oxygen saturation (SpO2) were continuously monitored during the race.
Results: Out of 60 runners, 14 were excluded for not completing the race. Of the remaining 46, 14 developed HAH and 32 did not. No significant age differences were observed (p=0.168), but gender distribution (p=0.029) and history of headaches (p=0.005) differed significantly between groups. The HAH group showed lower SpO2 during the race and a significantly reduced VO2max (p=0.001; OR=0.133). A decrease in baseline frontal EEG activity was also associated with headache onset (p=0.003).
Conclusion: HAH was more common in women and among those with history of headaches. Reduced oxygen saturation and diminished aerobic capacity were identified as key factors increasing the risk of high-altitude headache in marathon runners, emphasizing the importance of pre-race physiological assessment for high-altitude competition. Also individuals with HAH presented EEG compatible with central fatige.
Disclosure of Interest: None.
Post-Traumatic Headache
IHC25-LBAPO-077Risk Factors for Persistent Post-Traumatic Headache Following Mild Traumatic Brain Injury: A Systematic Review and Meta-Analysis
Mateus Dutra Balsells1; João Marcos Secundino Treigher1; Thiago Luís Marques Lopes1; Marconny Alexandre Cavalcante1; Felipe Barros Mendes1; Emily Bittencourt de Souza Martins1
(1) Universidade Estadual do Ceará, Fortaleza - CE, Brasil
Objective: Post-traumatic headache (PTH) is a frequent and debilitating consequence of mild traumatic brain injury (mTBI), affecting approximately 69 million individuals worldwide annually and significantly impairing quality of life and daily functioning. Despite its prevalence, the predictors for PTH chronification remain unclear, hindering early identification of high-risk patients and the development of effective interventions. To address this gap, we conducted a systematic review and meta-analysis to identify risk factors that predict the persistence of PTH after mild TBI.
Methods: We performed a systematic review and meta-analysis using PubMed, Embase, Cochrane, and Web of Science, with included studies evaluating the risk factors for development of pPTH: glasgow coma scale at admission, transient loss of consciousness, post-traumatic amnesia and abnormalities in imaging. Analysis used Review Manager 5.4.1.
Results: Five observational studies (2.295 patients) were included: 1.176 developed pPTH after mild TBI; others did not develop the pPTH. Mean age was 39.32 years; 38% were female. Motor-vehicle accidents represent 36.1% in mild TBI cases. Most studies were conducted in Europe, with a mean follow-up of 15 months. No significant differences were found in these risk factors: post-traumatic amnesia (OR 1.06; 95% CI 0.46–2.47; p = 0.89), or abnormalities in imaging (OR 1.65; 95% CI 0.81–3.35; p = 0.17). In addition, the Glasgow Coma Scale was not correlated with the pPTH. However, one study reports an association between transient loss of consciousness and the development of pPTH.
Conclusion: This meta-analysis did not identify consistent clinical predictors for the development of persistent post-traumatic headache after mild TBI. However, the observed trends highlight possible directions for future research. These findings contribute to the growing understanding of PTH chronification and underscores the need for further prospective studies in diverse populations to improve risk stratification and guide early interventions.
Disclosure of Interest: None.
Psychological and Behavioural Factors and Management
IHC25-LBAPO-078Can kinesiophobia serve as a marker of clinical response in migraine? Insights from a prospective study
Carina Ferreira Pinheiro-Araujo1; Gabriella Almeida Tolentino1; Juliana Pradela1; Amanda Rodrigues1; Felipe Daniel Sambini1; Fabiola Dach1; Debora Bevilaqua-Grossi1
(1) Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto - SP,
Brasil
Objective: To investigate changes in cutaneous allodynia, neck disability, and psychosocial variables between responders and non-responders to migraine treatment.
Methods: This prospective cohort study included 112 patients diagnosed with migraine. Participants underwent a 12-week intervention consisting of either physiotherapy-based approaches or pharmacological treatment alone. All participants completed the Headache Impact Test (HIT-6), the 12-item Allodynia Symptom Checklist (ASC-12), the Neck Disability Index (NDI), the Tampa Scale for Kinesiophobia (TSK), and the Pain Catastrophizing Scale (PCS) at baseline and after the intervention. The Patient Global Impression of Change (PGIC) was assessed at the end of the 12-week period. Treatment response was defined as a combination of patient-reported improvement (PGIC ≥5) and a clinically meaningful reduction in HIT-6 (≥6 points). Comparisons between responders and non-responders over time were performed using repeated measures ANOVA and Student’s t-test (p<0.05).
Results: From the 112 patients, 67 (60%) were classified as responders and 45 (40%) as non-responders. Both groups showed improvements in questionnaire scores, except for the TSK in the non-responder group. Furthermore, the magnitude of change was greater among responders for all assessed variables (Table 1).
Conclusion: Although changes in cutaneous allodynia, neck disability, and pain catastrophizing occurred in both groups, only responders showed a reduction in kinesiophobia. This suggests that kinesiophobia may be a sensitive indicator of true clinical improvement. Identifying outcome measures that more closely align with perceived clinical improvement may help refine treatment evaluation and optimize therapeutic decision-making.
Disclosure of Interest: None.
IHC25-LBAPO-079Cognitive-Behavioral Therapies for Headaches
Dante Gehring Bueno1; Nathália Martins Franzoi2; Gabriel Paschoal Oliveira3; Gabriella Lima Polloni3; Giovanna Volpato Segura3; Carol Cristine Inácio3; João Miguel Fernandes Wouters3; Ana Luiza Azambuja Davantel4; Sheila Reis Oliveira Carvalho Ferreira5
(1) Universidade Federal do Rio de Janeiro, Rio de Janeiro - RJ, Brasil; (2) Centro Universitário Ingá, Maringá - PR, Brasil; (3) Universidade Estadual de Maringá, Maringá - PR, Brasil; (4) Universidade Estadual do Mato Grosso do Sul, Campo Grande - MS, Brasil; (5) Universidade Federal de Santa Catarina, Florianópolis - SC, Brasil
Objective: To assess the efficacy of Cognitive-Behavioral Therapies (CBT) as a tool for reducing the frequency, intensity, and functional impact of chronic headaches, exploring its application as a complementary strategy in the clinical and psychosocial management of persistent pain.
Methods: A systematic review of 49 PubMed articles identified 15 randomized clinical trials assessing CBT efficacy in headache patients, including migraine and tension-type headaches. Interventions were delivered by clinical psychologists, measuring headache frequency, pain intensity, depressive symptoms, anxiety, and quality of life before, during, and up to four months post-treatment. Participants varied in age, clinical profiles, and included subgroups with comorbidities.
Results: Overall, the outcomes converged toward an average reduction of 30 to 50% in the frequency of headache episodes across different populations, decreased use of analgesics, and improvement in emotional symptoms and quality of life. In comparative studies, CBT proved similar to standard pharmacological treatment but with a lower incidence of adverse effects, and superior when combined with other therapies. Online modalities and adaptations for older adults and children also showed high acceptance and effectiveness.
Conclusion: The systematic review prioritized presenting CBT in multiple clinical contexts with heterogeneous patient groups. The analyses revealed frequent reductions in the rate of headache occurrence, as well as a positive impact on patients’ quality of life. Thus, CBT has demonstrated to be a non-pharmacological treatment of significance and versatility when integrated into interventions across different clinical contexts of headache. Despite the promising results, this initial research has limitations inherent to its exploratory nature, and further studies are needed to more rigorously evaluate the potential of CBT as a treatment for headache.
Disclosure of Interest: None.
IHC25-LBAPO-080Does Migraine Make Us More Empathetic? Assessing Empathy Using the Toronto Empathy Questionnaire in Migraine, Other Headache Types, and Headache-Free Controls
Fiorella Martin Bertuzzi1; Andrea Marengo2; Ana Karina Guevara1; Daiana Micucci1
(1) Red Cefaloca, Buenos Aires, Argentina; (2) Hospital Alfredo Italo Perrupato, San Martín, Mendoza, Argentina
Objective: We aimed to investigate whether migraine frequency and disability are associated with empathy levels, measured by the Toronto Empathy Questionnaire (TEQ) validated in rioplatense spanish.
Methods: In a cross-sectional design, online-delivered questionnaire, 409 adults were recruited from online platforms (Whatsapp, Facebook and Instagram). All participants completed the epidemiological data and TEQ. They were asked to report a headache diagnosis by a healthcare professional, reported migraine and headache frequency and characteristics, age at the beginning of episodes, and Headache Impact Test-6 (HIT-6). Statistical analyses included Kruskal–Wallis, Mann–Whitney U, correlations and multiple regression.
Results: Migraine participants (n = 291) had significantly higher empathy scores (median = 47.87) compared with those with other headache types (p = 0.0027) or no headaches (p = 0.0477). TEQ score was not associated with HIT-6 scores or age, but showed a weak positive correlation with headache duration (r = 0.117, p = 0.045). Multiple regression revealed duration of migraine as the only significant predictor of empathy (β = 0.0071, p = 0.045), but the model explained limited variance.
Conclusion: These findings suggest a very modest link between prolonged migraine experience and higher empathy, underscoring the psychosocial complexity of migraine. This findings are similar to previously reported. Further research is needed to explore mechanistic pathways and clinical implications.
Disclosure of Interest: None.
IHC25-LBAPO-081Health perception in individuals with migraine is associated with neck pain-related disability and pain catastrophizing
Carina Ferreira Pinheiro-Araujo1; Gabriella Almeida Tolentino1; Juliana Pradela1; Amanda Rodrigues1; Felipe Daniel Sambini1; Fabiola Dach1; Debora Bevilaqua-Grossi1
(1) Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto - SP, Brasil
Objective: To investigate the association between health perception and migraine clinical characteristics, disability, and pain-related psychosocial factors.
Methods: This cross-sectional study included 112 individuals (mean age 35.8 ± 9.0 years, 92% female) diagnosed with migraine according to the International Classification of Headache Disorders, third edition. Migraine clinical characteristics were collected, and participants completed the following measures: Headache Impact Test (HIT-6), 12-item Allodynia Symptom Checklist (ASC-12), Neck Disability Index (NDI), Tampa Scale for Kinesiophobia (TSK), Pain Catastrophizing Scale (PCS), and EQ-5D-5L-VAS. The EQ-5D-5L VAS measures health perception on a scale from 0 to 100, with higher scores indicating better perceived health. A multiple linear regression analysis (backward method) was performed in three blocks to assess the association between health perception (EQ-5D-5L VAS) and: (1) migraine and neck pain frequency and intensity (block 1); (2) HIT-6 and NDI scores (block 2); and (3) TSK, PCS, and ASC-12 scores (block 3) (p < 0.05).
Results: The mean of health perception (0 to 100) was 65.1±20.0. Among all tested variables, only neck pain disability (NDI) and pain catastrophizing (PCS) were significantly associated with health perception, explaining 23% of the variance in EQ-5D-5L VAS scores (Table 1).
Conclusion: Health perception in individuals with migraine is associated with neck pain-related disability and pain catastrophizing. Understanding the factors influencing patients' health perception may contribute to more comprehensive and patient-centered approaches in migraine management.
Disclosure of Interest: None.
IHC25-LBAPO-082Mindfulness and Relaxation Techniques for Patients with Chronic Headache
Nathália Martins Franzoi1; Dante Gehring Bueno2; Gabriella Lima Poloni3; Giovanna Volpato Segura3; Gabriel Paschoal Oliveira3; Carol Cristine Inácio3; João Miguel Fernandes Wouters3; Ana Luiza Azambuja Davantel4; Sheila Reis Oliveira Carvalho Ferreira5
(1) Centro Universitário Ingá, Maringá - PR, Brasil; (2) Universidade Federal do Rio de Janeiro, Rio de Janeiro - RJ, Brasil; (3) Universidade Estadual de Maringá, Maringá - PR, Brasil; (4) Universidade Estadual de Mato Grosso do Sul, Campo Grande - MS, Brasil; (5) Universidade Federal de Santa Catarina, Florianópolis - SC, Brasil
Objective: To correlate mindfulness practice with headache symptoms, especially in individuals with chronic migraine, as an effective alternative to reduce the frequency, intensity, and duration of attacks, while decreasing medication use and improving quality of life.
Methods: Following PRISMA 2020 guidelines, a systematic review was conducted of 49 randomized clinical trials from PubMed investigating mindfulness, meditation, and relaxation interventions for chronic headaches, including migraine. Twenty selected studies evaluated primary outcomes such as pain frequency, duration, intensity, and associated symptoms like depression and quality of life. Interventions included structured programs like Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT), with follow-ups ranging from weeks to months. Independent reviewers ensured methodological rigor and focus on relevant clinical outcomes.
Results: Progressive relaxation training reduced pain intensity, frequency, and disability in women with tension-type headache (TTH) and migraine, with stronger effects in TTH. It also lowered acute medication use and headache days. Incorporating mindfulness into chronic migraine and medication overuse headache (MOH) treatment yielded clinical and economic benefits, including greater disease acceptance, stigma reduction, and improved emotional regulation. Mindfulness-based stress reduction programs (MBSR+) effectively decreased headache days and disability, while spiritual meditation reduced migraine frequency and analgesic use, underscoring the value of integrative approaches in headache management.
Conclusion: Non-pharmacological therapies like mindfulness can reduce headache intensity and frequency, offering emotional and economic benefits, highlighting their importance as complementary clinical interventions for headache management. Although this study presents limitations intrinsic to its preliminary nature, it makes a significant contribution to the understanding of the potential of Mindfulness in the treatment of headache, reinforcing the importance of future investigations to consolidate and expand these findings.
Disclosure of Interest: None.
Temporomandibular Disorders
IHC25-LBAPO-083Oral behaviors in patients with acromegaly
Carolina Orge1; Juliana Melo1; Adroaldo Rossetti1; Ailton Melo1
(1) Federal University of Bahia, Salvador - BA, Brasil
Objective: The stomatognathic system performs essential functions such as mastication, swallowing, speech, and breathing. However, it is common to observe oral behaviors that go beyond expected functional activity. These parafunctional habits include a variety of repetitive motor patterns such as teeth clenching, onychophagia and object biting, which have no specific physiological function but place significant stress on the teeth and the temporomandibular joint. The aim of this study is to determine whether oral behaviors are more frequent in patients with acromegaly compared to a group with similar age, social and cultural characteristics.
Methods: This cross-sectional observational study included 22 patients with acromegaly and 22 matched controls, recruited at a university hospital in Brazil. Oral behaviors were assessed using the Portuguese version of the Oral Behavior Checklist (OBC), which scores 21 items on a 0–4 Likert scale. The OBC mean score was calculated for each group. Differences in OBC scores were analyzed using the Mann-Whitney test, with a significance level set at p < 0.05. This study was approved by the Ethics and Research Committee of Edgard Santos University Hospital of the Federal University of Bahia, under number 68984823.4.0000.0049.
Results: The acromegaly group had a significantly lower parafunctional habits compared to controls (p = 0.01). Significant differences were observed for the following OBC items “Use chewing gum” (p = 0.009), “Chew food on one side only” (p = 0.01), “Sustained talking” (p < 0.001), and “Hold telephone between head and shoulder” (p < 0.001). The figure shows mandibular growth, third-class malocclusion, dental inclination and thickening of gingival tissues; which impairs the management of food.
Conclusion: Oral behaviors were less frequent in acromegalic patients probably due to anatomical facial and oral disturbances, which consequently brings difficulty to breathing, maintain sustained talking and adequate occlusion. Temporomandibular disorders specialists, otorhinolaryngologists and endocrinologists must be aware of these problems, in order to understand the temporomandibular problems in acromegalic patients.
Disclosure of Interest: None.
IHC25-LBAPO-084Patient Expectations in Orofacial Pain and TMD: Influence of Demographic, Clinical, and Psychosocial Factors
Juliana Stuginski-Barbosa1; Juliana Stuginski-Barbosa1; Letycia ACCIOLY SIMÕES Coelho2; Letycia ACCIOLY SIMÕES Coelho2; Rafaela Rosa Salbego2; Rafaela Rosa Salbego2; Paulo César Rodrigues Conti2; Paulo César Rodrigues Conti2; Leonardo Rigoldi Bonjardim2; Leonardo Rigoldi Bonjardim2
(1) Bauru Orofacial Pain Group, Bauru - SP, Brasil; (2) Bauru School of Dentistry, Bauru - SP, Brasil
Objective: To evaluate patient expectations regarding orofacial pain and temporomandibular disorder (TMD) treatment, based on demographic, clinical, and psychosocial variables.
Methods: A retrospective cohort of 609 patients (mean age 38.2±14.7 years; 78.7% women), seen at a private TMD clinic between 2021 and 2024, completed a pre-consultation questionnaire. Collected data included demographics, pain intensity (Visual Analogue Scale), duration and frequency, previous treatments, Generalized Anxiety Disorder-7 (GAD-7), Pittsburgh Sleep Quality Index (PSQI), and Pain Catastrophizing Scale (PCS). Expectations were categorized per Kravitz’s model as outcome expectations (e.g., cure, improvement, diagnosis, none) and process expectations (e.g., professional behavior). Responses were analyzed using natural language processing and categorized by level of detail. Multinomial logistic regression was applied (α=0.05).
Results: Most patients reported pain (84.1%) and previous treatments (63.0%). Women with pain lasting over one year commonly expected cure or improvement, while men were more likely to focus on process-related expectations (Odds Ratio [OR]=7.74; p=0.020). Persistent pain decreased improvement expectations (p=0.040), and prior treatments increased skepticism (p=0.032). Poor sleep quality was associated with stronger outcome expectations (p=0.007), and higher PCS scores plus longer pain duration correlated with detailed expectation reporting (p=0.015).
Conclusion: Expectations for TMD treatment vary by gender and pain chronicity. Women and chronic pain patients prioritize symptom relief, while men value the treatment process. Prior negative experiences may reduce optimism, and poor sleep quality increases the desire for symptom resolution. Understanding these patterns may improve communication, satisfaction, and adherence to treatment.
Disclosure of Interest: None.
Trigeminal Neuralgia and Other Cranial Neuropathies
IHC25-LBAPO-085Ultrasound-guided interventional management of head and facial pain: a frontier to be explored
Leandro Infantini Dini1; Simone Afonso Dini1; Eduardo Melo Rodrigues1; Maria Eduarda Christmann Hartz1
(1) Plural Pain Center, Novo Hamburgo - RS, Brasil
Objective: The number of headache and facial pain patients which do not respond properly to medical therapy is significant. Minimally invasive procedures to adopt in an office setting to help relieve otherwise medically resistant headaches should be more widespread among neurologists. Our objective is to compilate the most relevant ultrasound-guided approaches for head and facial pain management focusing on anatomy, sonoanatomy and techniques.
Methods: A narrative review of publications during the last decade in English language of the related topics using Academic databases Pubmed, EMBASE, Cochrane Library, and Up toDate was conducted. An anatomical study was performed in adult cadavers at FEEVALE University, in Novo Hamburgo city, to establish applicable anatomical landmarks for the ultrasound-guided techniques. The sonoanatomy images were obtained from volunteers, acquired in a LogiqE, General Electric ultrasound equipment, with high-frequency probes. All the information was compiled as an anatomical atlas.
Results: Sympathetic and parasympathetic blocks, trigeminal nerve blocks, greater and lesser occipital nerve blocks, third occipital nerve and medial branch blocks are presented in this paper. The review includes the relevant anatomy, sonoanatomy and the description of the procedures techniques.
Conclusion: Ultrasound technology is growing exponentially for pain management interventions due to its many advantages. We present an anatomical atlas to enable and encourage neurologists to use ultrasound as a guide for interventional pain blocks for headache and facial pain in selected patients. The ultrasound-guided techniques are reliable, safe and can be standardized as part of the interventional armamentarium even in an office-based scenario.
Disclosure of Interest: None.
Wearable Technologies for Headache
IHC25-LBAPO-086Mobile applications for the clinical management of headaches: A critical analysis of functionalities and scientific evidence
João Vítor Moreira Nogueira1; Bruna Barbosa Nobre1; Enzo Lima Alcântara Parente1; Marina Marques Maia1; Aline Vieira de Vasconcelos1; Davi Feitosa Gonçalves1; André Borges Ferreira Gomes1
(1) Centro Universitário Christus, Fortaleza - CE, Brasil
Objective: Critically evaluate the use of mobile applications (apps) for headache management, focusing on functionalities, clinical efficacy, and scientific rationale.
Methods: This review evaluated pre-existing apps on the market, distinguishing between diaries for tracking or monitoring prescribed digital therapies (PDTs). Headache-related apps were included, prioritizing those with scientific evidence from randomized clinical trials (RCTs), etc. A literature review was conducted from 2014 to 2025 to find scientific evidence on the impact of using these tools to monitor patients with headaches.
Results: The sixteen mobile headache apps offer a range of features, including the ability to keep comprehensive records of symptoms, triggers, and medications. Some apps also incorporate artificial intelligence to monitor relevant factors such as sleep (apps offering this feature include Migraine Buddy and N1-Headache). These apps facilitate communication between doctors and patients and generate data with real clinical impact, such as information on the efficacy of a certain class of medication in controlling a patient's pain. However, RCTs directly testing their effectiveness in reducing migraine frequency are generally lacking. CT-132 (Click Therapeutics) is the first PDT to be approved by the U.S. Food and Drug Administration (FDA) for preventing episodic migraines in adults. Its 12-week intervention uses cognitive behavioural therapy techniques to modulate neurocircuits associated with migraine. Other apps explore biofeedback (e.g., Juva for Migraine) or hypnosis, although the evidence is less robust. Meta-analyses from the last five years highlight that, despite the potential of mobile health (mHealth) interventions, which use devices such as smartphones to improve access to healthcare, robust evidence of their effectiveness is lacking. This emphasises the need for randomised controlled trials (RCTs) to determine the effectiveness of individual apps.
Conclusion: Mobile headache apps offer valuable tools for tracking and reporting and generate real-world data. The emergence of apps with PDTs that are approved by regulatory agencies and supported by rigorous RCTs sets a new standard. However, more comprehensive scientific validation via RCTs is imperative for a broader spectrum of apps that aim to deliver tangible clinical benefits and be more widely integrated into standard practice.
Disclosure of Interest: None.
Author Index
A
Aaron Sanjith 48
Abraham Lucy 9
Accioly Gabriela 27
Agostinho Marcela Paula 61
Aguiar Luiza Chaves 45
Akaydin Elif 44
Akgör Merve Ceren 6
Akgor Merve Ceren 8
Alberti Camila Kwiatkowski 41
Aldib Richard 28, 38, 39, 41
Allegretti Isabella 33
Alpuente Alicia 4, 56
Alves Gustavo Arruda 33
Alves Yasmin Vitória Luz 59
Amin Faisal Mohammad 51
Amirguilev Sarxhan 16, 15, 21, 23
Andrade Lara Freitas 57
Anrriquez Federico Leonardo 2, 49
Antonucci Adriano T 30
Araújo Anna Raquel Carneiro 17
Araujo Anna Raquel Carneiro 18
Armijo-Olivo Susan 7
Arruda Renato 33, 35, 37
Ashina Messoud 13
Aslan Ayşe Neslihan 9
Attia Itzhak Zachi 25
Azevedo Thiago Souza 16, 34
B
Bahra Anish 32
Balbastro Lucia Noemi 21, 22
Balbastro Lucía Noemí 23
Baldon Isabella Vargas 33
Balsells Mateus Dutra 28, 64
Banerjee Imon 25
Bansal Aastha 51
Barbanti Piero 54
Barbosa Lara Beatriz Belão 40
Barbosa Jr. Fernando 7
Bargiacchi Giuditta 36
Beccaluva Laura Marina 2
Bellorio Claudia 57
Benseñor Isabela M. 7
Berden Maria Emília Servin 58
Bertholdi Edoarda Carolina 57
Bertuzzi Fiorella Martin 2, 21, 22, 23, 49, 63, 66
Bertuzzi Fiorella 63, 63
Bevilaqua-Grossi Débora 19
Bevilaqua-Grossi Debora 40, 64, 66
Bezerra Lua flora Pereira 33
Bigaton Delaine Rodrigues 7
Billoud Maximiliano Giraud 63
Bitetti Ilaria 34
Blumenfeld Andrew 11
Bolay Hayrunnisa 6, 8, 44
Bondia Ashish 48
Boneta Silvia 21, 22, 23
Bonjardim Leonardo Rigoldi 68
Borras Maria Virginia 2, 49
Braselino Evelyn Victória 50, 57
Bueno Dante Gehring 65, 67
Burstein Rami 3, 15, 16, 21, 23
C
Campos Rafaela Del Piccolo 41
Canales Javiera 54, 56
Capovilla Eduarda Belchior 20
Cardoso Caroline Maemy Honda 17, 18
Cardoso Eduardo Souza 60
Caronna Edoardo 4, 54, 56
Carvalho Mariza Paiva 33
Carvalho Raissa Piassali 57
Castellanos Candela Nieves 54
Castro Thor 44, 46, 60
Castro-Carletti Ester Moreira 7
Cavalcante Marconny Alexandre 28, 64
Chao Chieh-Ju 25
Chapagain Abhisekh 16
Chiang Chia-Chun 5, 25, 29
Chichorro Juliana Geremias 24
Cho Soo-Jin 10
Cho Soohyun 10
Chong Catherine 25
Chowdhury Debashish 14, 48, 51, 52
Chu Min Kyung 10
Coelho Letycia ACCIOLY SIMÕES 68
Cohen Eric 52
Collins Timothy Alan 37
Conti Paulo César Rodrigues 68
Costa Flavio Rezende 13
Costa Andreia 55
Cristofano Adriana 34
Cunha Maria Luísa Brandão 30
Cutrer Fred M. 5
Cutrer F. Michael 29
D
D'Acunto Laura 34, 36
Díaz-deTerán Javier 54
da Costa Flávia Alessandra Araújo 24
da Costa Leonardo Oliveira Risso 57
da Nóbrega João Francisco Honorato 28
da Rocha Coutinho Santos Ana Caroline 16
da Silva Bárbara Moura 17
da Silva Alice Lima Costa 17, 18, 18
da Silva Tobias Moraes Bueno 20
da Silva Silvia Fernandes Ribeiro 45
da Silva Gustavo Souza Miranda 62
da Silva Gattas Graciolli Letícia Hanna Moura 16, 17, 18, 18, 20, 28, 38, 39, 41
da Silva Moura Yasmin 28, 38, 39, 41
Da Silva Santos Josiene 58
Dağıdır Hale Gök 8
Dach Fabiola 40, 64, 66
Davantel Ana Luiza Azambuja 65, 67
de Azambuja Carolina Bombonato Patrício 19
de Brito Vilela Larissa camargos 16
de Carvalho Maués Alice 41
de Castro Marcella Abranches Gil 34
de Castro Ferreira Ana Elisa 17
de Holanda Lustosa Alana Maria Caland 59
de la Jara Gagliardi Isabella 17, 18
De La Maza Acevedo Bernardita 46
de Lima Prado Thiago 24
de Macedo Silva Maria do Socorro 28
De Marco Oriana 36
de Maria Isadora Xavier Pereira 41
de Mello Érica Virgínia Batista Pereira Freire 33
de Moraes Maíra Abreu Cruz 17
de Moraes Lucas Barbosa Napolitano 33, 35, 37
de Moraes Grilo Giulia 19
De Oliveira Tiago Ramalho 16
de Oliveira João Pedro Franco Leal 33
de Oliveira Lorena Pedro 57
de Oliveira Fernandes José 41
de Oliveira Guilherme Ana Beatriz Carvalho 57
de Oliveira Longo Artur Pires 20
de Sales Julia Nathaly Cavalcanti Mendes 34
de Sousa André Luis Silva 17, 18
de Souza Luiz Henrique Moreira 4
de Souza Martins Emily Bittencourt 28, 64
de Tulio Heloysa Costa 17, 17, 18
de Vasconcelos Aline Vieira 42, 43, 69
Delahaye Laurent 13
Dias Rafael 55
Dini Leandro Infantini 69
Dini Simone Afonso 69
do Rêgo Neto José Fortes Napoleão 59
do Rozário Douglas Setimo 16
Doctorovich Eduardo Daniel 2, 49
Dodick David W 4, 61
Dorado Laura 54
dos Anjos Emilly Luz Alves 28
dos Anjos Borges Julia 62
dos Santos Luana Mendes 16, 17, 17, 18, 19, 20
dos Santos Victor Augusto Benedicto 24
dos Santos Luana Mendes 28
dos Santos João Lucas Anselmo 34
dos Santos Luana Mendes 34, 38, 39, 40, 41, 57
Dotto Marina 57
Dumitrascu Oana 25
Dumkrieger Gina 25, 29
Dycke Annelies Van 52
E
Egeo Gabriella 54
Escudero Maria Rocio Álvarez 54
Estrella Júlia Helena 17, 18
Ettrup Anders 11
F
Farkas Mark Kristof 52
Ferla Isabella Wakim 34
Ferreira Isadora Santos 13
Ferreira Sheila Reis Oliveira Carvalho 65, 67
Forero Giovanna 52
Forest André Vítor Szynkaruk 20
Fountaine Robert 9
Fraga Jonatan Pereira 60
Francis MV 48
Franco Isabelly N 30
Franzoi Nathália Martins 65, 67
Freire Gisella de Deus Almeida 16
Friedman Paul A. 25
Fullerton Terence 9
G
Gómez-Dabó Laura 4, 56
Gago-Veiga Ana Beatriz 54
Gajurel Bikram Prasad 16
Galasso Cecilia 21, 22, 23
Gallardo Víctor J 4
Gallardo Hernán Rodríguez 46
García-Azorín David 54
Garcia Matheus Maia 62
Garg Arunav 14
Gautam Niraj 16
Germain Michele 63, 63
Ghadiri-Sani Mona 54
Ghouri Reza 44
Gien López José Antonio 9
Gil-Gouveia Raquel 54
Giniatullin Rashid 1
Godoy Beatriz Viguetti 57
Gomes André Borges Ferreira 30, 69
Gonçalves Thiago Antonino 20
Gonçalves Giovana Gotardo 28
Gonçalves Davi Feitosa 42, 43, 45
Gonçalves Daniela Aparecida Godoi 58
Gonçalves Roberani Borges Vaz 62
Gonçalves Davi Feitosa 69
González-Quintanilla Vicente 54
Goulart Alessandra C. 7
Grassi Vanise 58
Grosu Oxana 23
Guevara Ana Karina 2, 49
Guevara Karina 63, 63
Guevara Ana Karina 66
Guimarães Marina Santos Moreira 20
Guo Hua 52
Gurgel Blanco Beatriz Medeiros 33
Guzman Gege 61
H
Ha Huy 13
Hamod Hoda 32
Hartz Maria Eduarda Christmann 69
Hildt Maria Agustina 21, 22, 23
Holland Philip 3
Huerta-Villanueva Mariano 54
Huo Kang 56
I
Iba Chisato 47
Ihara Keiko 25, 29, 47
Imai Lia M H 30
Inácio Carol Cristine 65, 67
Insa Samuel Díaz 54
Irimia Pablo 54
Ishikawa Naoki 47
Izepão Paulo Fernando Ribeiro 24
J
Jansson Gary 11
Jensen Rigmor H 11
Jensen Rigmor Højland 38
Jiang Junjie 56
Josiassen Mette Krog 11
Juanes Fernando Velasco 54
Jullian María Trinidad San Martín 46
Juvenal Thayná Carvalho 38, 39
K
Karn Ragesh 16
Kaup Alexandre Ottoni 13
Keller Gabriela Dutra 19
Kim Manho 10
Kim Byung Kun 10
Kivelevitch Gabriela 10
Knopp Rachel Jacqueline 5
Knorst Gabriel Rocha Santos 41, 62
Kolenoğlu Hilal 6
Kopruszinski Caroline Machado 4, 61
Koul Arun 14
Krivoshein Georgii 1
Kulkarni Girish 48
L
Lam Jessica 13
Lantéri-Minet Michel 11
Lanteri-Minet Michel 13
Lastra Raquel 56
Layos-Romero Almudena 54
Lee Grace 4
Lee Mi Ji 10
Lei Xiangyu 26
Leitão Natasha 58
Leite Caroline Cavalcante 17, 18
Leite Luana Oliveira 60
Li Xiaoshuang 2
Li Jiahao 26, 56
Liger Ivy Riso 32
Lipton Richard B 11
Lira Arthur Vinícius Lôbo Siqueira 59
Lisewski Pawel 9
Liu Yingyi 13
Liu Xiao 26
Liu Rui 26
Lopes Sergio Roberto 24
Lopes Thiago Luís Marques 28, 64
Lopez-Jimenez Francisco 25
Lotufo Paulo A. 7
Lundqvist Christofer 11
Luo Guogang 26
Luo Lei 52
Luo Guogang 56
Luvsannorov Otgonbayar 15
Luzeiro Isabel 54
M
Magalhães Iasmin Costa 34
Magalhães Déborah Medeiros 34
Magalhães Oliveira Jéssica Liara Santos 16
Maia Marina Marques 30
Maia Luísa Andriely 40
Maia Marina Marques 42, 43, 69
Malgieri G 36
Mangold Kathryn E 25
Marengo Andrea 63, 63, 66
Martins Isabel Pavão 54
Mas-de-les-Valls Rut 4, 54
Mateu Teresa 4, 56
Matos Laura Borges 41
Mello João Paulo Oliveira 61
Melo Juliana 67
Melo Ailton 67
Melo-Carrillo Agustin 3
Mendes Pedro Henrique Abbade 34
Mendes Felipe Barros 64
Menna Francesco 34
Micheli Gabriel Castro 13
Micucci Daiana 2, 66
Micucci Diana 49
Milhomem Luis Antonio Macedo 62
Mittoux Aurélia 11
Miyazaki Naoki 47
Mochiuti Camila Fernandes 20
Monfardini Frederico 13
Monteiro Raquel Maria Ayres 34
Monteiro-Silva Dominick Esthephanny 33, 35, 37
Moon Heui-Soo 10
Moore Ashley Anne 37
Moore Carlene Drucilla 37
Mota Isabelle Cristina Moraes 19
Moura Andrezza Lauria 58
Muñoz-Vendrell Albert 54
Munday Veronica 3
Murillo Ane 4
N
Nagy Krisztian 52
Nakahara Jin 47
Navratilova Edita 4, 61
Neto Raimundo Feitosa 59
Netto Luiz A 30
Nobre Maria Eduarda 27, 30, 42, 43, 45, 69
Nogueira João Vitor Moreira 30, 43
Nogueira João Vítor Moreira 42, 45, 69
Noleto Gustavo Sousa 59
Noseworthy Peter A. 25
O
Odobescu Stela 23
Ojha Rajeev 16
Oliveira Arão Belitardo 7
Oliveira Dilter J P C 30
Oliveira Renato 54
Oliveira Gabriel Paschoal 65, 67
Onlat Zeynep Ceren 6
Onlat Ceren Z 8
Orge Carolina 67
Oria Carmen González 54
Osorio Yesica González 54
Özge Aynur 15, 16, 21, 23
P
Padilla Genor Benavides 46
Paes Douglas Tenório 20
Pal Arijit 14, 51, 52
Pamplona Mariane Arakawa 20
Parente Enzo Lima Alcântara 30, 43, 43, 45, 69
Parreiras Caio Mendonça 20
Partnoy Ivana 21, 22, 23
Patel Ishan 48
Pavão VIctor M 30
Pedrosa Beatriz Rodrigues 19
Pelai Elisa Bizetti 7
Pereira Liliana 54
Peres Mario F. P. 7, 13
Peres Mario Fernando P. 31
Peres Mario Fernando Prieto 32
Peres Sthefany Vitória Barcellos Alves 57
Petruzzelli L Annicchiarico 36
Pinheiro-Araújo Carina 19
Pinheiro-Araujo Carina Ferreira 40, 64, 66
Pinto Maíla Araújo 20
Pinto Madalena 55
Pires Acassia Benjamin Leal 60
Polanco Marcos 54
Polloni Gabriella Lima 65
Poloni Gabriella Lima 67
Porreca Frank 4, 61
Portocarrero Leonardo 54
Pozo-Rosich Patricia 4, 9, 13, 54, 56
Pradela Juliana 40, 64, 66
Prajapati Bhargav 29
Prakash Sanjay 48
Prehl Andrezza Barros 41
Q
Qi Yi 26
R
Rajbhandari Reema 16
Ramirez Luz M 9
Rato Rita 55
Ravishankar K 48
Redig Carolina Barbosa 44, 46, 60
Reuter Uwe 52
Riso Ivy Liger 31
Rivelis Chiara 2
Rodríguez-Montolio Joana 54
Rodrigues Amanda 19, 40, 64, 66
Rodrigues Eduardo Melo 69
Rodriguez-Vico Jaime 54
Ros Alberto Lozano 54
Rosenzweig Ivana 3
Roshan Sujata 14
Rossetti Adroaldo 67
Rubio-Beltran Eloisa 3
Ruscheweyh Ruth 54
Russoni Caio 33
S
Sacco Simona 54
Sahib Akhil 51
Salbego Rafaela Rosa 68
Sales Camilly Ramos 28
Salgado Pablo 63
Sambini Felipe Daniel 19, 40, 64, 66
Sanahuja Jordi 54
Sanchez Alex Jaimes 54
Sangheli Marina 23
Santana Thaionara Santos 19
Santana Giulia Santos 58
Santos Itamar Souza 7
Santos Alcylene Carla Jesus 58, 60
Santos Ana Flávia Silva 62
Santos-Lasaosa Sonia 54
Sara Yildirim 44
Şaşmaz Tayyar 15, 16, 21, 23
Schwedt Todd J 25, 29
Schytz Henrik W. 11
Schytz Henrik Winther 38
Seehra Harpreet 9
Segura Giovanna Volpato 65, 67
Seo Dayoung 10
Shibata Mamoru 47
Silva Julia Emilly 19
Silva Matheus M 30
Silva Layaly Ayoub 57
Singh Sumit 48
Soldera Giordano Crivilatti 28
Song Taejin 10
Sousa Maria da Gloria Canto 60
Sousa-Santos Patrick Emanuell Mesquita 33, 35, 37
Stark Richard J. 13
Strassman Andrew M 3
Stuginski-Barbosa Juliana 58, 68
Sugui Diane Yuka Botelho 16
Sugui Tiffany Mie Botelho 16
Sun Xinyue 26
Sundal Christina 54
Suzuki Shigeaki 47
Symeonidis Symeon 32
T
Taşdelen Semih 15, 16, 21, 23
Takemura Ryo 47
Takizawa Tsubasa 47
Tariq Amara 25
Tassorelli Cristina 11, 54
Tejada Malena 63
Tepper Stewart J 11
Tepper Stewart 52
Terwindt Gisela M. 11
Thiry Alexandra 9
Tilak Amod 48
Timasina Ravi Raj 16
Tiscornia Martin 21, 22, 23
Toledo Paula Salvador 13
Tolentino Gabriella Almeida 40, 64, 66
Tolner Else 1
Torres-Ferrús Marta 56
Torres-Ferrus Marta 4
Treigher João Marcos Secundino 64
Trevizaneli Giulia Rossi 17, 18
Tucci Celeste 34, 36
U
Uludüz Derya 15, 16, 21, 23
Umeda Satoshi 47
Üstün Sertaç 6
V
Vázquez Manuel Millán 54
Vaghi Gloria 54
van den Maagdenberg Arn MJM 1
Varone Antonio 34, 36
Vasconcelos Rafaela Natali 17, 18
Vernieri Fabrizio 11
Victoriano Fernanda Agra 13
Villani Thainara 20
Vitali-Silva Aline 30
Vitro Maria Fernanda P 30
Vurallı Doğa 6, 8
W
Waliszewska-Prosół Marta 54
Wang Yonggang 2
Watanabe Narumi 47
Wei Meng 26
Werner Klaus Georg 37
Westenhofen Georgia K. 31, 32
Wickware Christopher Donnell Lavoghn 37
Wouters João Miguel Fernandes 65, 67
X
Xie Chenchen 45
Y
Yadav Manju 14, 51, 52
Yang Ping-Hao 25
Yilmaz Ayse Ece Gezen 44
Younis Samaira 51
Z
Zapelini Caroline 30
Zavala Lucia Jimena 38
Zhang Nan 5, 25
Zhang Panpan 26
Zhang Qianyun 56
Zilli Thiago 24
