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Introduction: Migraine, a debilitating neurological disorder characterized by recurrent headaches, affects over 1.1 billion individuals globally. Diabetes mellitus (DM), a chronic metabolic condition marked by high blood sugar levels, affects 463 million individuals according to the International Diabetes Federation. Our study aimed to evaluate the association between migraine and DM and to identify several demographic, socioeconomic, and lifestyle factors, as well as medical and psychiatric comorbidities, associated with migraine among individuals with DM. Methods: This cross-sectional study is based on data from the European Health Interview Surveys conducted in 2009, 2014, and 2019 in Hungary. Pearson's chi-squared tests and multiple logistic regression models were used to assess associations. Statistical significance was set at p<0.05. Results: In multiple regression analyses, we found no significant association between DM and migraine after adjusting for socioeconomic status, various health conditions, and lifestyle factors (OR=0.84, 95% CI: 0.66-1.06). However, adults with DM who had comorbid conditions including stroke (OR=2.08, 95% CI: 1.06-4.08), low back pain (OR=3.52, 95% CI: 2.13-5.84), and depression (OR=4.91, 95% CI: 2.84-8.47) were significantly more likely to suffer from migraine. Discussion: Our study found no significant difference in the prevalence of migraine among adults with and without diabetes mellitus. However, several comorbidities were found to be significantly associated with migraine occurrence in those with DM. Thus, the study's results highlight the need for proper management of diabetes, especially in terms of comorbidities, to mitigate migraine risk factors and improve patient outcomes.

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BACKGROUND: Triptans revolutionized the acute treatment of migraine; however, varied responses to triptans, as a result of poor efficacy and tolerability, are reported. A standardized definition of triptan non-response was recently proposed by the European Headache Federation (EHF). There is currently limited data available on the prevalence of triptan non-response. METHODS: We used clinic letters over a two-year duration to evaluate the triptan response and triptan efficacy or tolerability failure, or both, in a London-based tertiary headache service. RESULTS: In total, 419 adult migraine patients (females: 83.8%, age: 46 ± 18 years, chronic migraine: 88.5%) were included in a service evaluation. In line with the EHF definitions, "triptan non-response" was seen in 63.8% of patients (264/414), whereas 37.7% of patients (156/414) had failed at least two triptans (EHF "triptan resistant") and 4.6% of patients (19/414) had failed at least three triptans, including a subcutaneous formulation (EHF "triptan refractory"). Notably, 21.3% of patients (88/414) had failed at least three triptans inclusive and exclusive of subcutaneous triptan use. Advancing age (p < 0.001) and the presence of medication overuse (p = 0.006) increased the probability of triptan response, whereas an increased number of failed preventives (p < 0.001) and the use of calcitonin gene-related peptide monoclonal antibodies (p = 0.022) increased the probability of triptan non-response. The largest proportion of patients responded to eletriptan (49.5%), followed by nasal zolmitriptan (44.4%) and rizatriptan (35.7%). CONCLUSIONS: Our findings highlight an alarming prevalence of triptan non-response among adult migraineurs receiving treatment in a London-based tertiary headache service. It is imperative for clinicians to explore methods to optimize acute medication efficacy, whether this comprises changing to a triptan with a superior response rate, advocating for early intervention or considering alternative acute medication classes, such as gepants or ditans.

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BACKGROUND: Recent studies suggested that persons with migraine might be at higher risk of structural brain changes, including cerebral small vessel disease and atrophy. However, findings in the literature are inconsistent, with variations observed in the direction, magnitude, and population characteristics of reported effects, and large-scale population-based evidence remains scarce. Hence, we investigated the association of migraine with structural brain changes in a middle-aged and elderly population. METHODS: Within the population-based Rotterdam Study, lifetime history of migraine was assessed using a validated questionnaire between 2006 and 2011. Magnetic resonance imaging of the brain was performed in 4920 participants (median age 61.7 [IQR 45.5, 97.5] years, 55.4% female) to assess imaging markers of cerebral small vessel disease and brain atrophy. We used linear and logistic regression models to examine the cross-sectional association of migraine with brain volumes (total grey and white matter volumes in mL) and cerebral small vessel disease markers (white matter hyperintensity volume in mL, presence of lacunes and cerebral microbleeds). Adjustments were made for age, sex, intracranial volume and cardiovascular variables. Analyses were also stratified by sex and presence of aura. RESULTS: The lifetime prevalence of migraine was 15.3% (752/4920). In multivariable adjusted regression models, we found no statistically significant differences between participants with and without migraine in terms of total brain volume (mean difference [MD]: 2.21 mL, 95% confidence interval [CI]: -0.38 ; 4.81), grey matter volume (MD: 0.38 mL, 95% CI: -1.98 ; 2.74), white matter volume (MD: 2.19 mL, 95% CI: -0.56 ; 4.93), log white matter hyperintensity volume (MD: -0.04 mL, 95% CI: -0.10 ; 0.02), presence of lacunes (odds ratio [OR]: 0.82, 95% CI: 0.58-1.15), and presence of cerebral microbleeds (OR: 0.95, 95% CI: 0.76-1.18). CONCLUSION: In this study, we found that middle-aged and elderly participants with migraine were not more likely to have structural brain changes on magnetic resonance imaging.

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Importance: Open burn pits have commonly been used for waste disposal by the US military but have not been systematically investigated as an independent risk factor for headache disorders. Objective: To evaluate the association between exposure to open burn pits and incidence of headache and migraine. Design, Setting, and Participants: This retrospective cohort study used data from the Veterans Health Administration Headache Cohort along with data from the US Department of Defense and the Airborne Hazards and Open Burn Pit (AH&OBP) Registry to assess registry participants with potential exposure to open burn pits in the Veterans Health Administration from April 1, 2014, through October 31, 2022. Participants were included by linking data from the AH&OBP Registry to their US Department of Defense and Veterans Health Administration electronic health records. Those with preexisting headache were removed from the analytic sample. The analysis was conducted between November 1, 2022, and January 31, 2024. Exposure: Open burn pit exposure composite variables based on the registry questionnaire were examined, specifically being near open burn pits, days near open burn pits, and having open burn pit duties. Main Outcomes and Measures: Primary incident outcomes included medically diagnosed headache disorders and medically diagnosed migraine. Results: The analytic sample included 247 583 veterans (mean [SD] age, 27.9 [7.7] years; 222 498 [89.9%] male). After covariates were controlled for at baseline, participants who were near an open burn pit with open burn pit duties had the highest adjusted odds of medically diagnosed headache disorders (adjusted odds ratio [AOR], 1.59; 95% CI, 1.46-1.74), migraine (AOR, 1.60; 95% CI, 1.43-1.79), and self-reported disabling migraine (AOR, 1.93; 95% CI, 1.69-2.20) compared with those without exposure. The 2 highest quartiles of cumulative burn pit exposure (290-448 days and >448 days) had significantly higher adjusted odds of medically diagnosed headache (290-448 days: AOR, 1.20; 95% CI, 1.09-1.31; >448 days: AOR, 1.55; 95% CI, 1.41-1.70) and migraine (290-448 days: AOR, 1.19; 95% CI, 1.07-1.34; >448 days: AOR, 1.48; 95% CI, 1.32-1.65). Conclusions and Relevance: In this cohort study, a dose-dependent association existed between open burn pit exposure and medically diagnosed headache and migraine. These new data identify potentially important associations between open burn bit exposure and new-onset headache among service personnel as well as a possible health condition that may be encountered more frequently in Veterans Health Administration facilities during mandatory screening for military exposures.

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BACKGROUND: Migraine is an episodic disorder and a frequent form of headache. An impaired balance between free radical production and an impaired antioxidant defense system leading to oxidative damage may play a major role in migraine etiology. We sought to investigate whether dietary antioxidant quality score (DAQS) is associated with migraine intensity and frequency among women suffering from migraine. METHODS: This cross-sectional study was conducted on 265 women. The data related to anthropometric measures and dietary intake were collected. DAQS score was calculated based on FFQ (food frequency questionnaire) vs. the reference daily intake (RDI) quantity. To measure migraine intensity, the migraine disability assessment questionnaire (MIDAS) and visual analog scale (VAS) were used. The frequency of headaches was defined as the days the participants had headaches in the last month and a 30-day headache diary was used. RESULTS: The results of the study demonstrated that VAS, MIDAS, and frequency of headaches were reduced significantly from the low DAQS (poor quality of antioxidants) to high DAQS (high quality of antioxidants) after adjusting covariates. Also, multinomial regression showed there was an inverse association between higher DAQS and the frequency of headaches. In the adjusted model, subjects with the higher DAQS were 69% less likely to have moderate migraine disability, compared with those with the lower DAQS. Linear regression showed, there was an inverse association between vitamin C intake and the grades of pain severity.َAlso in a crude model, a negative association was found between vitamin E and the frequency of headaches. CONCLUSION: In conclusion, Participants with higher DAQS had lower migraine intensity and headache frequency. In addition, the consumption of vitamin C may potentially associate with decreasing the severity of headaches. Dietary antioxidants should be monitored closely in individuals suffering from migraine.

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BACKGROUND: Female sexual dysfunction (FSD) is an underdiagnosed and undertreated problem. Few studies have addressed sexual distress in migraine. We aimed to perform a pilot study to determine if there is an association between migraine and sexual dysfunction/distress in premenopausal women and to identify their respective risk factors. METHODS: Retrospective, cross-sectional pilot study, including 71 premenopausal female patients with migraine, from the headache outpatient clinic of a tertiary hospital, and 34 age-matched-controls. Female Sexual Function Index-6 (FSFI-6), Female Sexual Distress Scale-Revised (FSDS-R), Migraine Disability Assessment (MIDAS) Scale, Brief Pain Inventory (BPI), Hospital Anxiety and Depression Scale (HADS) and Sleep Health Scale (RU-SATED) were applied. RESULTS: Of the 71 patients [40.0 (IQR = 11.00) years], only 12.7 % (n = 9) were not under migraine prophylactic treatment, and most (n = 33, 62.3 %) reported severe disability (MIDAS-IV). FSD and sexual distress were present in 50.7 % (36) patients with migraine [vs 20.6 % (7) controls]. Migraine patients showed lower FSFI-6 scores [19.0 (9.0) vs 24.0 (6.0), p = 0.005], with significantly lower levels of desire (p = 0.011), lubrication (p = 0.002), and satisfaction (p = 0.013), higher sexual distress [11.2 (25.6) vs 3.2 (9.6), p = 0.001], anxiety (p < 0.001), and depression (p < 0.001) levels, and lower sleep health scores (p = 0.005). Old age of onset, being under preventive medication, anxiety/depression, and dysfunctional sleep, were significantly associated with sexual distress. Certain domains of sexual function were associated with sociodemographic and migraine characteristics, anxiety, depression, and sleep health. CONCLUSIONS: This pilot study highlights the possible association between migraine and elevated sexual dysfunction/distress levels among premenopausal women. It underscores the importance of sexual health assessments in these individuals, particularly those with higher levels of anxiety, depression, or poor sleep quality. It is important to exercise caution when interpreting results, as they may not be applicable to a wider context. This research paves the way for a larger study that will include a broader population of women from the community and encompass patients followed in different levels of health care.

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BACKGROUND: Childhood abuse is associated with an increased risk of migraines. However, the literature on this association is limited. OBJECTIVE: To determine the pooled effect size of the association between childhood abuse and migraines. PARTICIPANTS AND SETTING: System review and meta-analysis. METHODS: A systematic literature search for studies published until September 20, 2023, was performed using the Embase, PubMed, and Web of Science databases. Specifically, original articles reporting the statistical effect size (odds ratio) of the association between childhood abuse and migraines were selected. Pooled odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated using random- or fixed-effects models. Publication bias was examined using funnel plots, and sensitivity analysis was used to explore the stability of the pooled results. RESULTS: Twelve studies involving 110,776 participants were included. Individuals with childhood abuse (OR = 1.60, 95 % CI: 1.49, 1.71) were at increased risk of migraine when compared with individuals with no childhood abuse. Of the different types of childhood abuse examined, sexual abuse (OR = 1.71, 95 % CI: 1.43, 2.04), physical abuse (OR = 1.47, 95 % CI: 1.38, 1.56), and emotional abuse (OR = 1.71, 95 % CI: 1.52, 1.93) were associated with an increased risk of migraine. CONCLUSIONS: Childhood abuse increases migraine risk. Multifaceted interventions to curb abuse and related behaviors can effectively reduce migraine risk. However, considering that multiple factors, such as obesity and anxiety, are causatively associated with both childhood abuse and migraines, our findings should be interpreted with caution.

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BACKGROUND: Few studies of migraine have evaluated migraine disability across multiple countries using the same methodology. METHODS: This cross-sectional, web-based survey was conducted in 2021-2022 in Canada, France, Germany, Japan, UK and USA. Respondents with migraine were identified based on modified International Classification of Headache Disorders, 3rd edition, criteria. Headache features (Migraine Symptom Severity Score (MSSS, range: 0-21), presence of allodynia (Allodynia Symptom Checklist, ASC-12)) and migraine burden (Patient Health Questionnaire-4 (PHQ-4), Migraine-Specific Quality of Life questionnaire version 2.1 (MSQ v2.1), Work Productivity and Activity Impairment (WPAI) questionnaire) were evaluated. RESULTS: Among 14,492 respondents with migraine across countries, the mean ± SD MSSS was 15.4 ± 3.2 and 48.5% (7026/14,492) of respondents had allodynia based on ASC-12. Of all respondents living with migraine, 35.5% (5146/14,492) reported moderate to severe anxiety and/or depression symptoms. Mean ± SD MSQ v2.1 Role Function-Restrictive, Role Function-Preventive and Emotional Function domain scores were 60.7 ± 22.9, 71.5 ± 23.0 and 65.1 ± 27.2, respectively. The WPAI mean ± SD percentages of respondents who missed work or worked impaired as a result of migraine were 6.8 ± 18.1% and 41.0 ± 30.1%, respectively. CONCLUSIONS: For every country surveyed, migraine was associated with high levels of symptom severity, with allodynia and with substantial burden.

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The variants of heterotypic comorbidity of anxiety disorders (AD) with attention deficit hyperactivity disorder, autism spectrum disorders, speech and language development disorders, specific learning disabilities (dyslexia, dysgraphia, dyscalculia), migraine, tension type headache in children and adolescents are discussed. In cases of heterotypic comorbidity the patients with AD referrals to specialists may be primarily associated with their emotional problems. Meanwhile, the comorbidity of AD with these diseases leads to a deterioration of their clinical manifestations and a worsening of the prognosis, and anxiety symptoms often not only persist, but also increase with age. It should be borne in mind that AD in children with neurodevelopmental disorders contribute to a decrease in the quality of life, academic failure, have a negative impact on peer relationships and the family environment, and in young adulthood, patients have an increased risk of depression and substance abuse. Therefore, early intervention and a comprehensive therapeutic approach with a dynamic assessment of the patient's condition are becoming important. When choosing pharmacotherapy, it is advisable to choose medictions that have a complex effect on the pathogenetic mechanisms of the underlying disease and concomitant AD, which include Tenoten for children.

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BACKGROUND: Multiple sclerosis (MS) is a chronic, immune mediated demyelinating illness of the central nervous system. This study looks at various comorbidities associated with MS, focusing on their impact on disease progression. Understanding comorbidities in MS is important as it can impact treatment selection and overall disease management and prognosis. AIMS AND OBJECTIVES: Our aim is to show the prevalence of comorbidities along with MS. This research focuses on the comorbidities associated with MS and their impact on disease progression in the Arab Gulf region, with a special emphasis on Jeddah, Saudi Arabia. MATERIAL AND METHODS: A retrospective record review was conducted from July 2022 to July 2023. The study included 286 patients, selected based on a definitive MS diagnosis in accordance with McDonald's 2017 criteria. Data collected included demographic information, MS type, duration of diagnosis, type of disease modifying therapy (DMT) used, Expanded Disability Status Scale (EDSS) score, and type of comorbidities. RESULTS: The majority of the patients were female (70%) with an average age of 36 years. Most patients had relapsing remitting MS, and the majority were on DMTs, with fingolimod being the most common. Nearly half of the patients had comorbidities, with mood disorders, diabetes mellitus (DM), migraine, and hypertension (HTN) being prevalent. A significant positive association was found between the EDSS scores and both DM and HTN, but there was no significant link with migraine. CONCLUSION: The findings indicate that individuals with MS have an increased risk of developing comorbidities such as migraine, DM, and HTN. Emphasizing a healthy lifestyle could potentially reduce the incidence of DM and HTN and their related vascular complications. The research also notes the prevalence of mood disorders among the MS population, although it remains inconclusive whether these are separate comorbid conditions or inherent symptoms of MS.

Résumé Contexte:La sclérose en plaques (SEP) est une maladie démyélinisante chronique à médiation immunitaire du système nerveux central. Cette étude examine diverses comorbidités associées à la SEP, en se concentrant sur leur impact sur la progression de la maladie. Comprendre les comorbidités liées à la SEP est important car cela peut avoir un impact sur le choix du traitement ainsi que sur la prise en charge globale et le pronostic de la maladie.Buts et objectifs:Notre objectif est de montrer la prévalence des comorbidités ainsi que la SEP. Cette recherche se concentre sur les comorbidités associées à la SEP et leur impact sur la progression de la maladie dans la région arabe du Golfe, avec un accent particulier sur Djeddah, en Arabie Saoudite.Matériel et méthodes:Un examen rétrospectif des dossiers a été réalisé de juillet 2022 à juillet 2023. L'étude a inclus 286 patients, sélectionnés sur la base d'un diagnostic définitif de SEP conformément aux critères McDonald's 2017. Les données collectées comprenaient des informations démographiques, le type de SEP, la durée du diagnostic, le type de traitement modificateur de la maladie (DMT) utilisé, le score EDSS (Expanded Disability Status Scale) et le type de comorbidités.Résultats:La majorité des patients étaient des femmes (70 %) avec un âge moyen de 36 ans. La plupart des patients souffraient de SEP rémittente et la majorité étaient sous DMT, le fingolimod étant le plus courant. Près de la moitié des patients présentaient des comorbidités, avec des troubles de l'humeur, un diabète sucré (DM), une migraine et une hypertension (HTN) prédominants. Une association positive significative a été trouvée entre les scores EDSS et le DM et le HTN, mais il n'y avait pas de lien significatif avec la migraine.Conclusion:Les résultats indiquent que les personnes atteintes de SEP ont un risque accru de développer des comorbidités telles que la migraine, le diabète et l'HTN. Mettre l'accent sur un mode de vie sain pourrait potentiellement réduire l'incidence du diabète et du HTN et de leurs complications vasculaires associées. La recherche note également la prévalence des troubles de l'humeur au sein de la population atteinte de SEP, même si l'on ne sait toujours pas s'il s'agit de conditions comorbides distinctes ou de symptômes inhérents à la SEP.

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Background: Smoking is known to be a significant risk factor for various diseases. Migraine, a condition requiring careful lifestyle management, currently lacks specific guidelines advocating for smoking cessation as a preventive measure. Although cross-sectional studies have suggested a potential link between smoking and an increased risk of migraine, the findings have been inconsistent and conflicting. To date, there has been no longitudinal study which investigated the effect of smoking on the risk of migraine in a prospective setting. Objective: This longitudinal study aimed to investigate the impact of smoking on the incidence of migraine in women and examine the modifying effect of menopausal status. Methods: Using nationally representative National Health Insurance Service (NHIS) data, women aged ≥40 years who participated in national breast cancer screening in 2009 were followed-up until the end of 2019. Baseline data on smoking status (non-, ex-, and current smoker) as well as the duration and amount of cigarette smoking were collected. A Cox proportional hazards regression model was used to examine the independent effect of smoking on the risk of incident migraine after adjusting for demographics, comorbidities, and female reproductive factors. The results were stratified by menopausal status, and an interaction analysis (smoking × menopause) was performed. Results: In total, 1,827,129 women were included in the analysis. Women with a history of smoking exhibited a higher risk of developing migraine, compared with nonsmokers. Specifically, a higher risk of migraine was observed in women with past (adjusted hazard ratio [HR] 1.044, 95% CI 1.000-1.089) and current cigarette use (adjusted HR 1.050, 95% CI, 1.023-1.079) than in nonsmokers. The effect was greater in premenopausal women (adjusted HR 1.140, 95% CI, 1.108-1.172) than in postmenopausal women (adjusted HR 1.045, 95% CI 1.018-1.073; P<.001). The risk increased with an increased amount of smoking, with a greater association in premenopausal women (P<.001). Conclusions: Smoking increases the risk of migraine in women, with a dose-dependent relationship. Menopause modifies this effect. Our findings suggest that smoking is an important modifiable risk factor of migraine, with a higher impact in premenopausal women. The interaction between smoking and estrogen may increase the vulnerability of the migraine brain.

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The Global Burden of Disease (GBD) study is pivotal in shaping health policies by providing comprehensive data on mortality and disability. An updated GBD2021 analysis, published in Lancet Neurology on 14 March 2024, expands the scope of neurological disorders to include 37 conditions, revealing their significant impact on global health. Neurological disorders affect 3.4 billion people, or 43.1% of the global population, making them the leading cause of disability-adjusted life years (DALYs) in 2021, with an 18.2% increase since 1990. The top three causes of DALYs in this category are stroke, neonatal encephalopathy and migraine. Migraine, affecting 1.16 billion people, ranks first among children and adolescents and second among adults aged under 60 years. Despite its substantial impact, migraine often lacks proper attention because of its non-fatal nature, invisibility and historical neglect of neurological disorders. The International Headache Society calls for recognizing migraine as a serious medical condition, promoting research and integrating migraine management into public health strategies. Effective interventions include raising awareness, improving access to treatment, adding migraine to the epidemiological surveillance agenda and exploring new treatment strategies. A coordinated effort among stakeholders is essential to alleviate the burden of migraine on individuals and society.

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INTRODUCTION: The complex neurological disorder of migraine is prevalent (19%) and burdensome in university students. Qualitative research exploring the lived experience of migraine in students has yet to be conducted. METHODS: Students clinically diagnosed with migraine were recruited (purposive sampling) from a sample of Irish third-level institutions for a one-time anonymized Zoom focus group or individual interview. Focus group questions were sent to participants in advance. Interviews were iterative. Participants were also invited to submit a drawing. The interviews were audio-recorded, transcribed, and sent to participants for triangulation. Reflexive thematic content analysis was undertaken, data was imported to Microsoft Excel, initial codes were generated, and themes and sub-themes were derived from the codes. The Standards for Reporting Qualitative Studies Checklist (S1 File) ensured study rigour. RESULTS: Twenty students from three Irish universities participated (mean age 23.8 years). The four key themes identified were (i) Migraine Characteristics, (ii) Migraine Self-Management, (iii) Migraine Clinical Management, and (iii) Migraine Impacts. Migraine was described as not just a headache but a debilitating sensory experience. A notable high level of self-management satisfaction indicated hopeful coping strategies. However, many participants said medications were ineffective and had side effects, and clinical management could be improved. Additionally, there was a marked academic and social impact of migraine, psychological issues abounded, and several participants worried about finances. CONCLUSIONS: Migraine is impactful in a cohort of students attending Irish third-level institutions, with students carrying a wide range of debilitating migraine burdens. Students demonstrate an attitude of resilience and determination despite these challenges. Migraine awareness and education campaigns on university campuses are warranted.

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OBJECTIVE: To assess rates of traversing barriers to care to access optimal clinical outcomes in people with migraine internationally. BACKGROUND: People in need of medical care for migraine should consult a health care professional knowledgeable in migraine management, obtain an accurate diagnosis, and receive an individualized treatment plan, which includes scientific society guideline-recommended treatments where appropriate. METHODS: The Chronic Migraine Epidemiology and Outcomes-International (CaMEO-I) Study was a cross-sectional, web-based survey conducted from July 2021 through March 2022 in Canada, France, Germany, Japan, the United Kingdom, and the United States (US). Respondents who met modified International Classification of Headache Disorders, 3rd edition, criteria for migraine and had Migraine Disability Assessment Scale (MIDAS) scores of ≥ 6 (i.e., mild, moderate, or severe disability) were deemed to need medical care and were included in this analysis. Minimally effective treatment required that participants were currently consulting a health care professional for headache (barrier 1), reported an accurate diagnosis (barrier 2), and reported use of minimally appropriate pharmacologic treatment (barrier 3; based on American Headache Society 2021 Consensus Statement recommendations). Proportions of respondents who successfully traversed each barrier were calculated, and chi-square tests were used to assess overall difference among countries. RESULTS: Among 14,492 respondents with migraine, 8,330 had MIDAS scores of ≥ 6, were deemed in need of medical care, and were included in this analysis. Current headache consultation was reported by 35.1% (2926/8330) of respondents. Compared with the US, consultation rates and diagnosis rates were statistically significantly lower in all other countries except France where they were statistically significantly higher. Total appropriate treatment rates were also statistically significantly lower in all other countries compared with the US except France, which did not differ from the US. All 3 barriers were traversed by only 11.5% (955/8330) of respondents, with differences among countries (P < 0.001). CONCLUSIONS: Of people with migraine in need of medical care for migraine, less than 15% traverse all 3 barriers to care. Although rates of consultation, diagnosis, and treatment differed among countries, improvements are needed in all countries studied to reduce the global burden of migraine. TRIAL REGISTRATION: NA.

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BACKGROUND AND OBJECTIVES: Migraine and Parkinson disease (PD) are common neurologic disorders, which are hypothesized to share some pathophysiologic mechanisms. However, data on the association between migraine and risk of developing PD are sparse. We estimate the effect of migraine, migraine subtypes, and migraine episode frequency on the risk of developing PD in middle-aged and older women. METHODS: We used data from the Women's Health Study, a United States-based cohort of women in health professions aged 45 years and older at baseline (1992-1995). Only women with complete self-reported information on migraine and headache and no history of PD were included. Participants were followed up for self-reported physician-diagnosed PD through December 31, 2021. We used multivariable Cox proportional hazards models to estimate hazard ratios (HRs) and corresponding 95% CIs of the association between migraine, migraine subtypes, and migraine episode frequency and the risk of developing PD. RESULTS: A total of 39,312 women were included in the analyses. Among those, 7,321 women (18.6%) reported any migraine at baseline, of whom 2,153 (5.5%) reported a history of migraine, 2,057 (5.2%) reported migraine with aura, and 3,111 (7.9%) reported migraine without aura. During a mean follow-up of 22.0 years, 685 PD cases were reported. Of those, 128 (18.7%) were reported by women who also reported any migraine and 557 (81.3%) by women without any migraine. After adjusting for confounding, the HR for the association of any migraine on the risk of PD was 1.07 (0.88-1.29). Compared with women without migraine, the HRs (95% CI) for PD were 0.87 (0.59-1.27) for migraine with aura, 1.21 (0.93-1.58) for migraine without aura, and 1.05 (0.76-1.45) for history of migraine. Compared with those with a migraine frequency of less than monthly, the HRs were 1.09 (0.64-1.87) for a monthly frequency and 1.10 (0.44-2.75) for a weekly or greater frequency. DISCUSSION: In this large cohort of women, the risk of developing PD was not elevated among those experiencing migraine, irrespective of migraine subtypes or the frequency of migraine. The generalizability of our findings to other populations, such as men, should be further investigated. TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov Identifier: NCT00000479.

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Despite observational studies suggesting a link between psoriatic disease (including psoriasis and psoriatic arthritis) and migraine, it is unclear whether there is a shared genetic etiology or a causal relationship between the two conditions. We aimed to reveal the genetic overlap and causality using the Mendelian randomization (MR) framework. The genetic analysis utilized summary data from the most extensive European genome-wide association study (GWAS) of migraine. Well-powered psoriatic disease GWAS data were obtained from two independent cohort studies, which served as discovery and validation datasets. Global and regional genetic correlations between psoriatic disease and migraine were assessed, and pleiotropic regions identified by pairwise GWAS analysis were further annotated. We further applied a two-sample MR multivariate MR to investigate the potential causal relationship between them. The global genetic correlation test indicated weak correlations between psoriatic disease and migraine, while regional correlation analyses delineated one significant shared locus between psoriasis and migraine. Pathway enrichment analysis revealed that shared genes were involved biological processes to the major histocompatibility and antigen processing and presentation. In terms of causality estimates, genetically predicted psoriasis (Pmeta = 0.003) and psoriatic arthritis (Pmeta = 0.028) were associated with an increased risk of migraine. Multivariate MR analysis indicated that psoriasis was an independent risk factor for migraine (P < 0.05). No significant associations were found in the reverse direction. Our study supported the causal role of psoriasis on migraine, and the central role for immunomodulatory etiology. These findings have significant implications for the management of migraine and clinical practice in patients with psoriasis.

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OBJECTIVE: To investigate the impact of migraine on the tinnitus-specific health-related quality of life (HRQOL) and psychiatric comorbidities in patients with tinnitus. METHODS: This cross-sectional study included 227 consecutive patients with tinnitus as their primary complaint. Patients who were diagnosed as having comorbid migraine were asked whether their tinnitus exacerbated during attacks of migraine. All the patients completed three questionnaires: the Tinnitus Handicap Inventory (THI), the Hearing Handicap Inventory for Adults (HHIA) or its counterpart for the Elderly (HHIE), and the Hospital Anxiety and Depression Scale (HADS). RESULTS: Among the 227 tinnitus patients, 60 (26.4%) had comorbid migraine. There were no significant differences in the THI or HHIA/HHIE scores between patients with migraine and those without migraine (both p > 0.05). The HADS score was significantly higher in patients with migraine than those without migraine (p < 0.05).Out of the 60 tinnitus patients with comorbid migraine, 27 (45.0%) experienced exacerbation of tinnitus during migraine attacks. Patients whose tinnitus exacerbated during migraine attacks had significantly higher scores in THI, HHIA/HHIE, and HADS compared to those whose tinnitus did not change during migraine attacks (p < 0.05 for THI and HADS, p < 0.01 for HHIA/HHIE). CONCLUSION: The presence of migraine did not affect the tinnitus-specific HRQOL in tinnitus patients but had significant impacts on their psychiatric comorbidities. However, in patients who experienced exacerbation of tinnitus during migraine attacks, the presence of migraine had a significant impact on the tinnitus-specific HRQOL, hearing handicap, and psychiatric comorbidities.

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BACKGROUND: Migraine, a widespread neurological condition, substantially affects the quality of life, particularly for adolescents and young adults. While its impact is significant, there remains a paucity of comprehensive global research on the burden of migraine in younger demographics. Our study sought to elucidate the global prevalence, incidence, and disability-adjusted life-years (DALYs) associated with migraine in the 15-39 age group from 1990 to 2021, utilizing data from the Global Burden of Disease (GBD) 2021 study. METHODS: Our comprehensive study analyzed migraine data from the GBD 2021 report, examining the prevalence, incidence, and DALYs across 204 countries and territories over a 32-year span. We stratified the information by age, sex, year, geographical region, and Socio-demographic Index (SDI). To evaluate temporal trends in these metrics, we employed the estimated annual percentage change (EAPC) calculation. RESULTS: Between 1990 and 2021, the worldwide prevalence of migraine among 15-39 year-olds increased substantially. By 2021, an estimated 593.8 million cases were reported, representing a 39.52% rise from 425.6 million cases in 1990. Global trends showed increases in age-standardized prevalence rate, incidence rate, and DALY rate for migraine during this period. The EAPC were positive for all three metrics: 0.09 for ASPR, 0.03 for ASIR, and 0.09 for DALY rate. Regions with medium SDI reported the highest absolute numbers of prevalent cases, incident cases, and DALYs in 2021. However, high SDI regions demonstrated the most elevated rates overall. Across the globe, migraine prevalence peaked in the 35-39 age group. Notably, female rates consistently exceeded male rates across all age categories. CONCLUSION: The global impact of migraine on youths and young adults has grown considerably from 1990 to 2021, revealing notable variations across SDI regions, countries, age groups, and sexes. This escalating burden necessitates targeted interventions and public health initiatives, especially in areas and populations disproportionately affected by migraine.

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OBJECTIVE: The objective of this study was to describe and discuss patterns of migraine medication use in the entire Norwegian population. METHODS: In this nationwide, observational study, all individuals with a migraine-related prescription between 2010 and 2020 were identified using the Norwegian Prescription Database. The outcomes of interest were the incidence and 1-year prevalence of migraine medication users, as well as individuals with triptan overuse. Patterns of medication use were statistically compared between women and men adjusted for age, year of treatment start, comorbidities and county of residence calculating adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS: We identified 327,904 migraine medication users. The incidence ranged from 0.39% to 0.46%, and the 1-year prevalence increased from 1.99% to 2.99%. Preventive use increased >50% during the study period. Preventives were significantly more often prescribed to women than to men (39.72% vs. 33.75%; aOR 1.41, 95% CI 1.38 to 1.44). Triptan overuse was significantly more common among women, but women with overuse were more often using preventives, as compared to men (56.64% vs 52.69%; aOR = 1.43, 95% CI 1.37 to 1.49). CONCLUSION: The prevalence of medically treated migraine is low. Overuse of triptans is frequent, especially among women. Clinicians should be encouraged to try out different triptans, recognize triptan overuse, and prescribe preventives when indicated.

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BACKGROUND: While growing evidence suggests a relationship between migraine and cardiovascular disease, the genetic evidence for a causal relationship between migraine and cardiovascular disease is still scarce. Investigating the causal association between migraine and cardiovascular disease is vital. METHODS: We carried out a bidirectional Mendelian randomization (MR) study including discovery samples and replication samples using publicly available genome-wide association study (GWAS) summary datasets and stringent screening instrumental variables. Four different MR techniques-Inverse variance weighted (IVW), MR ‒Egger, weighted median, and weighted mode-as well as various sensitivity analyses-Cochran's Q, IVW radial, leave-one-out (LOO), and MR-PRESSO-were utilized to investigate the causal relationship between cardiovascular disease and migraine. RESULTS: The protective causal effects of genetically predicted migraine on coronary artery disease (OR, 0.881; 95% CI 0.790-0.982; p = 0.023) and ischemic stroke (OR, 0.912; 95% CI 0.854-0.974; p = 0.006) were detected in forward MR analysis but not in any other cardiovascular disease. Consistently, we also discovered protective causal effects of coronary atherosclerosis (OR, 0.865; 95% CI 0.797-0.940; p = 0.001) and myocardial infarction (OR, 0.798; 95% CI 0.668-0.952; p = 0.012) on migraine in reverse MR analysis. CONCLUSION: We found a potential protective effect of migraine on coronary artery disease and ischemic stroke and a potential protective effect of coronary atherosclerosis and myocardial infarction on migraine. We emphasised epidemiological and genetic differences and the need for long-term safety monitoring of migraine medications and future research to improve cardiovascular outcomes in migraine patients.

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