Headache Medicine

What we wish we had known before starting a headache clinical registry: insights from the Italo-Brazilian partnership

Vanise Grassi — 2025-06-30

Abstract

Headache registries have emerged as a logical solution for bridging the gap between what we know and what we do, empowering disease awareness, enhancing knowledge and facilitating personalized management. The role of headache registries in expanding our understanding of patients’ journeys, sociodemographic characteristics, endophenotypes, treatments and healthcare resource utilization is well documented around the world. This perspective article will explore some practical ideas to develop a headache clinical registry from the ground up, through the original contributions of Italian and Brazilian registries.

Sinus migraine: a systematic review and meta-analysis

Heba Ramadan — 2025-06-30

Introduction

Sinus headache is frequently misdiagnosed, with growing evidence suggesting that many cases may actually be migraine with sinus-like features.

Objective

To evaluate the prevalence of migraine among patients initially diagnosed with sinus headache and assess how often migraine is mistaken for sinus-related conditions.

Methods

This systematic review and meta-analysis adhered to PRISMA guidelines. Literature searches were performed in Scopus, Medline, PubMed, and Google Scholar using terms such as “sinus headache” and “sinus migraine.” Studies were screened based on predefined inclusion and exclusion criteria. A proportional meta-analyses were performed using conducted in R (version 4.3.2), and study quality was assessed using the JBI checklist.

Results

Twelve studies involving 4,392 patients were included. Eight studies (Group 1) assessed patients with sinus headache, finding a pooled migraine prevalence of 55% (95% CI: 0.42-0.68), increasing to 59% when probable migraine was included, and 65% when tension-type headache cases were considered. Four studies (Group 2) examined patients with confirmed migraine previously misdiagnosed as sinus headache, with misdiagnosis rates up to 81.5% and diagnosis delays up to 38 years. Female predominance was noted in both groups: 65% (95% CI: 53-77%) in Group 1 and 75% (95% CI: 71-80%) in Group 2.

Conclusions

A significant proportion of patients diagnosed with sinus headache were ultimately found to have migraine, with consistently high female predominance-particularly in cases of confirmed migraine misdiagnosis. Enhanced diagnostic vigilance and awareness are needed to reduce misclassification and promote appropriate treatment.

Addressing sick building syndrome and its connection to headache disorders

Marcelo Moraes Valença — 2025-06-30

Introduction

Sick Building Syndrome (SBS), a term introduced by the World Health Organization in 1983, refers to the occurrence of acute health and comfort issues in individuals occupying specific indoor environments without an identifiable clinical cause. Among the most commonly reported symptoms are headaches, particularly migraines and tension-type headaches, which significantly affect daily functioning and workplace productivity.

Review

This review examines the primary environmental, chemical, biological, and psychosocial factors contributing to SBS and their influence on the onset and exacerbation of headaches. Poor indoor air quality, inadequate ventilation, and elevated carbon dioxide (CO₂) levels are identified as major physical factors. CO₂ concentrations above 1000 ppm are associated with impaired cognitive function, cerebral vasodilation, and the onset of headaches. Exposure to volatile organic compounds from office materials and cleaning agents, as well as biological contaminants such as mold and dust mites and electromagnetic radiation, is also implicated. In parallel, psychosocial elements such as occupational stress, poor ergonomics, and limited access to natural light exacerbate headache symptoms. The cumulative effect of these stressors contributes not only to physical discomfort but also to decreased performance and increased presenteeism. Preventive measures include improving ventilation systems, implementing green building practices, regulating humidity levels, implementing ergonomic interventions, and promoting mental well-being in the workplace.

Conclusions

SBS is a complex occupational health issue strongly associated with headache disorders. Addressing its multifactorial causes through integrated environmental and organizational strategies is essential for enhancing employee health, reducing headache incidence, and improving productivity. Tackling SBS represents both a health imperative and a strategic investment in workplace sustainability.

Medication overuse headache: a pragmatic 5-year, real-world study

Abouch Krymchantowski — 2025-06-30

Background

Medication overuse headache (MOH) impacts 1-7% worldwide. Effective treatment involves the abrupt discontinuation of the overused medication, the implementation of transition therapy during the initial period, and the simultaneous commencement of preventive treatment.

Objective

To describe a 5-year follow-up of patients with chronic migraine and MOH, focusing on the effectiveness of withdrawal treatment, use of traditional preventive medication, and requirement of anti-CGRP monoclonal antibodies.

Method

A single-center, prospective, and descriptive study was conducted. Convenience sampling of consecutive patients diagnosed with chronic migraine and MOH was the inclusion criterion. Demographics and clinical data at baseline, at 12 months, and during a follow-up period of 5 years, were collected in clinical records. The statistical analyses were performed with the Statistical Package for Social Sciences (SPSS®) version 18.2.2.

Results

We were able to follow one hundred and forty patients (116 W, 26 M), ages 18-78 years (mean 42.1±14.3) for 5 years. The diagnosis was carried out 24.9±14.7 years after the onset of the headache, and 6.3±7.6 years, was the time with headache ≥15 days per month. On baseline, the average number of headache days per month (HDM) was 25.2±5.9. There was a meaningful reduction in HDM. At 1 year and 5 years, a ≥ 75% reduction in HDM was observed, respectively, in 51.4% and 70.4% of the sample.

Conclusions

After five years, patients with chronic migraine and MOH who withdrew from excessive medication, used preventive pharmacological agents, and optionally added anti-CGRP monoclonal antibody showed a significant decrease in HDM frequency.

Journal Citation Reports 2025: the international landscape of headache journals and the path of Headache Medicine

Juliana Ramos de Andrade — 2025-06-30

Migraine associated with psychosocial factors such as catastrophizing, anxiety and stress

Erlene Roberta Ribeiro Santos — 2025-06-30

Introduction

Migraine is a prevalent and disabling neurological disorder characterized by recurrent episodes of intense headache, often accompanied by nausea, photophobia, and phonophobia. Beyond its neurovascular and genetic nature, migraine is influenced by psychosocial factors that modulate symptom severity and frequency. Among these, pain catastrophizing, anxiety, and stress are highly relevant due to their impact on clinical outcomes and quality of life. This narrative review aims to synthesize the current literature on the influence of these psychosocial factors in migraine.

Methodology

This is a narrative literature review focused on the relationship between migraine and the psychosocial factors pain catastrophizing, anxiety, and stress. A search was conducted in the databases PubMed, Web of Science, and the Virtual Health Library (VHL) using the keywords: “catastrophizing” AND “anxiety” AND “migraine”.

Results

Pain catastrophizing is associated with increased pain intensity, reduced treatment response, and greater disability in individuals with migraine. Anxiety is a prevalent comorbidity that exacerbates symptoms through hyperactivation of limbic circuits. Stress acts as both a trigger and perpetuating factor, particularly in individuals with low adaptive capacity. These three factors interact dynamically, forming a biopsychosocial triad that contributes to migraine chronification and diminished quality of life.

Conclusion

Psychosocial variables significantly influence the course and burden of migraine. Their identification and management through integrative care strategies and public health initiatives are essential to improving clinical outcomes and reducing the societal impact of migraine.

Spontaneous posterior vitreous detachment and chronification of migraine with aura: A case report exploring visual snow syndrome

João Guilherme Bochnia Küster — 2025-06-30

Introduction

Posterior vitreous detachment is characterized by the separation of the vitreous humor from the retina, with its spontaneous occurrence involving photopsias and floaters. Treatment options in cases without retinal involvement are limited and observation is recommended. Migraine with aura may have visual snow syndrome as a comorbidity, with visual snow corresponding to dynamic visual changes similar to static dots.

Case Report

A 57-year-old woman reported the sudden onset of complex bright flashes filling her visual field, dysmorphous multicolored rays and progressive left-sided headache of severe intensity with a pattern similar to her migraine with aura, although the visual manifestations were distinct from her typical aura presentations. Neurological examination was normal and direct ophthalmoscopy showed no retinal alterations. After complementary investigation, left posterior vitreous detachment was demonstrated with ultra-wide field retinal imaging. She maintained higher migraine frequency and intensity after the event in the following year, with the floaters being occasionally accompanied by photophobia, impaired night vision and small moving snow dots occurring in the vision of both eyes and contributing to the headache.

Conclusion

This case indicates the importance of considering acute ocular abnormalities with the establishment of flashes and floaters and explores the development of secondary visual snow, an atypical clinical condition, after posterior vitreous detachment, which may be related to the chronification of the migraine.

Intermittent tactile nummular allodynia: expanding the spectrum of nummular headache?

Marcelo Moraes Valença — 2025-06-30

Introduction
Nummular headache (NH) is a rare primary headache characterized by pain in a well-defined, small, round, or oval area of the scalp, often associated with abnormal local sensations such as paresthesia or allodynia. However, sensory scalp disturbances without pain, such as intermittent tactile nummular allodynia (ITNA), remain poorly understood. This report aims to describe a case of ITNA and discuss its clinical significance in the spectrum of nummular syndromes.
Case Report
A 53-year-old woman presented with a 9-year history of intermittent tactile allodynia in the right parietal region, affecting a round area of approximately 6 cm in diameter. The episodes occurred 6–7 times per year, each lasting about four days. The patient experienced significant discomfort upon touching or combing the area but denied spontaneous pain or headache. Neurological examination was unremarkable. Brain MRI showed no abnormalities. The patient also had a history of fibromyalgia. No other systemic or dermatological conditions were identified. The clinical picture was consistent with localized, episodic tactile hypersensitivity without persistent symptoms or headache.
Conclusion
This case expands the clinical spectrum of focal scalp sensory disturbances and suggests that ITNA may represent a distinct entity or a non-painful variant of nummular headache. The absence of spontaneous pain, the circumscribed location, and the touch-evoked dysesthesia support a localized sensory dysfunction, possibly involving cutaneous nerve branches. Greater awareness of ITNA is essential to prevent misdiagnosis and unnecessary treatment; further studies are needed to define its pathophysiology and diagnostic boundaries better.

español

Joel Hurtado Dominguez — 2025-05-21

Background
Secondary headaches can signal serious underlying conditions and require early recognition to guide appropriate diagnostic and therapeutic interventions. The SNOOP10 criteria assist clinicians in identifying red flags suggestive of secondary causes. Sinonasal tumors, such as mucoceles and undifferentiated carcinomas, may present with similar symptoms and radiological features, making differentiation challenging without histological confirmation.
Case Presentation
We report the case of a 32-year-old woman with a one-year history of right-sided pressing periocular headaches, initially responsive to NSAIDs. Over time, the pain intensified, became less responsive to treatment, and was associated with visual impairment, ptosis, and periorbital paresthesia. Imaging revealed a right maxillary paranasal mass initially suspected to be a mucocele. However, biopsy and immunohistochemistry confirmed a diagnosis of sinonasal undifferentiated carcinoma (SNUC). The patient underwent radiotherapy, with partial recovery of ocular motility and ptosis, though visual loss persisted.
Conclusion
This case illustrates the importance of recognizing red flags in headache evaluation and highlights the utility of the SNOOP10 tool in identifying secondary headache disorders. In patients with atypical headache patterns and orbital involvement, early imaging and biopsy are essential for accurate diagnosis and timely management.