Involvement of non-ocular motor cranial nerves, such as the trigeminal, facial or hypoglossal nerves, has rarely been reported in recurrent painful ophthalmoplegic neuropathy (RPON). This study aimed to determine the incidence and clinical significance of multi-cranial nerve involvement in RPON.

Eight patients (females = 5; mean age = 53.3 ± 15.6 years) who met International Classification of Headache Disorders-3 diagnostic criteria for RPON were enrolled at a single tertiary hospital. Repeated evaluations were performed for differential diagnosis, including cranial nerve examination, brain MRI, CSF analysis and serologic testing for autoimmune and tumor markers. Clinical features, neuroimaging findings and laboratory results were reviewed.

Five patients (62.5%) had a present or past history of migraine. Among 25 ophthalmoplegic attacks, the abducens nerve was most frequently affected (60%), followed by the oculomotor nerve (32%). Most attacks were preceded by ipsilateral headache (4.0 ± 2.9 days; 88%). Facial nerve involvement was common (7/8, 87.5%); two patients had three recurrent facial neuropathies on the same side, and one showed simultaneous ipsilateral oculomotor and facial neuropathies. All facial neuropathies were peripheral. Of the three patients who underwent MRI for facial neuropathy, two demonstrated focal facial nerve enhancement. Postauricular pain usually preceded facial neuropathy and lacked migrainous features. Both facial neuropathy and ophthalmoplegia resolved within days to weeks.

Facial neuropathy may be more common in RPON than previously recognized. Despite similarities to Bell’s palsy, our findings support considering facial neuropathy within the RPON spectrum and suggest that recurrent, multifocal and alternating cranial neuropathy may underlie its pathophysiology.

Chronic headache, including migraine, is often associated with psychiatric conditions and adverse childhood experiences. This study examines the feasibility of Creating Calm (CC), a modified form of Emotional Awareness and Expression Therapy (EAET) that targets the emotional impacts of adversity in headache patients at a tertiary headache center. We also explored changes in headache days, disability, psychosocial well-being and possible mechanisms to plan for a randomized controlled trial.

We conducted a prospective single-arm pragmatic pilot study to evaluate the feasibility of CC delivered as nine weekly group telehealth sessions in a tertiary headache clinic for adults with high-frequency episodic and chronic headache. Continuation of medical treatments was consistent with the pragmatic design. CC integrates education, mindfulness, cognitive and behavioral approaches, with an emotion-focused mind-body approach used in EAET. Feasibility was based on recruitment, retention and adherence measures. Acceptability was measured through participant satisfaction. We also explored changes in headache, psychosocial and mechanism measures before, after, and 2 months post-treatment.

Of the 33 participants recruited, 30 (91%) completed at least 7 out of 9 sessions, and 28 (85%) completed surveys. Participants reported satisfaction with the intervention (mean [SD] 47.6 [10.4] out of 60 Satisfaction with Therapy and Therapist Scale-Revised [STTS-R]). Exploratory analyses found a signal of reduction in headache days per month (mean [SD], 20.8 [7.6] to 15.5 [7.8], p = 0.004), disability, depression and improvement in global mental health following intervention.

This real-world pilot study supports the feasibility and acceptability of modified EAET for patients with headache, warranting a prospective randomized clinical trial.

In this systematic review, we identify and critically appraise randomised controlled trials of effectiveness of available educational, behavioural, cognitive, and self-management support interventions for individuals with chronic migraine.

Non-pharmacological interventions have the potential to help people living with chronic migraine. Little is known about their true effectiveness.

We searched Cochrane, Embase, Medline, PsychINFO, Scopus, and Web of Science for randomised controlled trials assessing the effectiveness of educational, behavioural, cognitive, and self-management support interventions, compared to usual care, for adults with chronic migraine. Our outcomes of interest were headache frequency, headache-related disability, quality of life, pain intensity, medication consumption, and psychological wellbeing at baseline and follow-up.

We included six randomised controlled trials (713 participants) whose interventions met our inclusion criteria: two educational, two psycho-educational, and two behavioural interventions. Trial heterogeneity precluded statistical pooling. Several small trials reported some between-group differences. One trial (N = 177) found more people had ≥50 reduction in headache frequency at 12 months following a psychological (mindfulness-based) intervention added to acute medication withdrawal in people with medication overuse headache: 43/89 (48%) control vs. 69/88 (78%) intervention, p < 0.001. However, the largest included study (N = 396) had effectively excluded the possibility that their intervention had a worthwhile effect on headache-related disability at 12 months; mean difference in Headache Impact Test (HIT-6) 0.7 (95% Confidence Interval −0.65 to 1.97). Current evidence does not support the use of educational, behavioural, cognitive, and self-management support interventions for individuals with chronic migraine to improve headache-related symptoms and quality of life. Very limited evidence suggests they may contribute towards headache frequency reduction.

Migraine is one of the most common neurological diseases, presenting different characteristics among patients. Therefore, there is a need to identify preventive medications that offer more efficacy and fewer adverse effects. Melatonin is a promising therapeutic alternative in this context due to its analgesic, neuromodulatory and cerebral blood flow regulatory mechanism.

This study aims to evaluate the efficacy of melatonin treatment compared to placebo and other drugs in reducing migraine episodes’ frequency and secondary outcomes by analyzing randomized clinical trials.

The databases Cochrane, Embase and PubMed were used to search and select relevant studies, according to their specific inclusion criteria. Afterward, the relevant data was extracted, and statistical analysis was conducted with R Studio version 4.3.1, applying appropriate models to maintain heterogeneity within them and produce a combined estimate. Results were interpreted considering potential biases and limitations to form our final statement with the Risk of Bias (RoB 2.0) tool from Cochrane.

A total of nine studies involving 783 patients were included in our analysis. Treatment methods were composed of seven different strategies. The network meta-analysis showed no statistically significant differences related to monthly headache frequency between melatonin and amitriptyline (SD: −1.8; 95% Crl [−5.2, 1.0]); naproxen (SD: −0.98; 95% Crl [−5.5, 3.8]); valproic acid (SD: −0.60; 95% Crl [−5., 3.6]); topiramate (SD: 0.081; 95% Crl [−5.0, 4.7]); propanolol (SD: 1.4; 95% Crl [−3.7, 6.6]) and placebo (SD: 0.49; 95% Crl [−1.6, 2.7]). Other outcomes assessed were the MIDAS score, the mean number of analgesics used and headache duration, in hours, all of which had nonsignificant differences among treatment arms.

This systematic review and network meta-analysis found no substantial support for the efficacy of melatonin treatment in patients with episodic migraine, challenging the assumption of their correlation. Although the results showed no significant association between the disease and melatonin administration, more research is necessary to explore the influence of melatonin in migraine’s pathophysiology and further potential indirect mechanisms by which melatonin usage could benefit those who have not responded to conventional therapies.

Knowledge of environmental triggers for migraine attacks is limited and has mostly been acquired by studies using emergency room (ER) visits. However, it is unlikely that ER visits are a random sample of migraine events, even within strata of migraine severity. Additionally, time lags between attack onset and ER visits may vary across the population, posing challenges for assessing causal links of migraine with community-level or ecologic exposures.

Our objective was to assess the relationship between demographic and geographic measures and self-reported migraine-related ER visits.

We analyzed a targeted non-probability survey of ER use related to migraine in Canada and the USA. The 18-question online survey addressed ER use and behaviors related to recording attacks.

The final dataset included 389 respondents (Canada = 164 [42.2%], USA = 225 [57.8%]); 51 (13.1%) were Migraine Buddy app users who shared their diaries. In both countries, participants reported similar migraine symptoms. Barriers to attending the ER included cost and wait times. There was more variability in delays between attack onset and arrival to the ER than between onset and recording in the smartphone app. Younger participants and participants living in Canada were significantly more likely to present to the ER.

The sample of patients presenting to the ER for migraine may be biased toward younger patients and depend on the jurisdiction. Smartphone app records may have fewer barriers to creation and more consistent time lags compared to ER visit records.