BACKGROUND:Accumulating evidence indicates that the locus coeruleus (LC) plays a pivotal role in pain modulation and related network dysfunction in migraine. This study aimed to examine functional connectivity (FC) between the LC and other brain regions in patients with migraine without aura (MwoA) compared with healthy controls (HCs). METHODS:A total of 55 patients with MwoA and 50 age-, sex-, and education-matched HCs underwent resting-state functional magnetic resonance imaging (fMRI). Seed-to-voxel whole-brain FC analysis was performed using the bilateral LC as seed regions. Different clinical and neuropsychological assessments are included. Pearson correlation analysis was used to determine the relationships between altered FC and clinical variables, and receiver operating characteristic (ROC) analysis was further performed to evaluate the discriminatory performance of significant FC measures. RESULTS:Compared with HCs, patients with MwoA exhibited increased FC between the left LC and the right superior temporal gyrus (STG)/left cerebellar posterior lobe (CPL), as well as between the right LC and the left STG/left inferior occipital gyrus (IOG) (p < 0.05). Decreased FC was observed between the bilateral LC and the right superior frontal gyrus (SFG) (p < 0.05). Positive correlations were identified between disease duration and FC of the left LC-right STG connection (p = 0.012, r = 0.341), and between SDS scores and FC of the right LC-left IOG connection (p = 0.011, r = 0.344). ROC analysis demonstrated that FC between the right LC and right SFG had the best discriminatory performance (sensitivity 81.82%, specificity 68.00%). CONCLUSIONS:Patients with MwoA exhibited altered LC-related resting-state FC involving brain regions associated with pain processing, sensory integration, and emotional regulation. By separately characterizing the whole-brain connectivity patterns of the bilateral LC, this study extends previous LC-related imaging findings in migraine and provides a more refined description of LC-centered network dysfunction in MwoA.
BACKGROUND:Making a measure of orofacial pain available for use among Arabic-speakers might contribute to the development of prevention and therapeutic programs that consider psychosocial and behavioral determinants of the Lebanese population. This study aimed to translate, culturally adapt, and validate the Arabic version of the Orofacial Awakening Symptoms Questionnaire (OFASQ) among Lebanese adults. METHODS:A cross-sectional web-based survey was conducted during August-September 2025 and included 427 participants (mean age = 27.5 ± 10.6 years; 56% women). The OFASQ was translated to Arabic using the forward-backward translation protocol. RESULTS:Confirmatory Factor Analysis (CFA) supported a single-factor structure with good fit indices (χ2/df = 2.67, Comparative Fit Index (CFI) = 0.970, Tucker-Lewis Index (TLI) = 0.941, Root Mean Square Error of Approximation (RMSEA) = 0.144 (90% Confidence Interval (CI): 0.086-0.207), and Standardized Root Mean Square Residual (SRMR) = 0.033). Internal consistency was good (Cronbach's α = 0.85). Measurement invariance across gender was established, with females scoring higher than males on the OFASQ. For criterion validity, higher OFASQ scores were significantly associated with worse sleep quality, more insomnia severity, and higher migraine. CONCLUSIONS:The Arabic OFASQ displayed reliability, validity, and cultural appropriateness for evaluating orofacial awakening indicators of bruxism and temporomandibular disorders in Arabic-speaking populations, validating its use in both clinical and research settings.
This conceptual review (ⅰ) analyzes the outcomes predicted, data modalities, modeling approaches, validation strategies, and reporting quality of existing artificial intelligence (AI)-driven prognostic models in temporomandibular disorders (TMD) and chronic orofacial pain (OFP); (ⅱ) identifies enduring methodological and ethical constraints that hinder clinical translation; and (ⅲ) proposes a pragmatic research framework to guide the responsible development of clinically relevant prognostic tools for TMD and OFP. The review covers peer-reviewed and other relevant publications from the previous decade, emphasizing AI or machine-learning (ML) based models for prognosis, outcome prediction, or trajectory modeling in TMD and OFP populations. Established paradigms, including the Transparent Reporting of a multivariable prediction model for individual Prognosis Or Diagnosis plus Artificial Intelligence extension (TRIPOD + AI) and the Prediction model Risk Of Bias Assessment Tool (PROBAST), were used to assess the literature. Methodologies remain highly inconsistent, and current literature lacks the volume and rigor required for clinical translation. Most AI research has concentrated on diagnostic classification rather than prognostic modeling. Small sample sizes, short follow-up, single-center datasets, omission of psychosocial factors, and a general lack of external validation hamper the few prognostic studies that exist. Most model outputs are neither clinically actionable nor suitable for direct use in treatment decisions, limiting their value for clinicians and their potential impact on patient outcomes. Research applying AI to forecast TMD and OFP remains in its early stages. Without a prognosis-first research design, longitudinal data integration, inclusion of biopsychosocial predictors, and clinically significant outcome objectives, existing models are unlikely to influence clinical practice. Clear research objectives, reporting criteria, and ethical norms must be established before AI-based prognostic models can be confidently adopted in TMD and OFP clinical practice. Future objectives comprise establishing multicenter longitudinal cohorts, conducting trajectory-based modeling, employing federated learning for external validation, and initiating prospective clinical trials to demonstrate clear clinical benefit.
Temporomandibular disorders (TMD) are common causes of orofacial pain, influenced by psychological and behavioural factors. Non-pharmacological interventions, such as hypnosis and relaxation techniques, have been proposed to modulate pain perception, reduce muscle hyperactivity, and improve coping. However, their role in TMD management remains unclear. We conducted a scoping review to synthesize the available evidence on the use of hypnosis and relaxation interventions in adolescents and adults with TMD. A systematic search of PubMed, Embase, Web of Science, Cochrane Library, PsycINFO, and Google Scholar databases from January 1992 to January 2026 identified a limited number of eligible studies (n = 10), comprising randomized controlled trials and quasi-experimental studies, with substantial methodological heterogeneity in study design. Methodological quality was appraised using a simplified Joanna Briggs Institute tool. Interventions included medical hypnosis, hypnosis combined with cognitive-behavioural therapy, and various relaxation techniques, delivered as stand-alone or adjunctive therapies. Findings for the 661 participants were inconsistent: hypnosis-based interventions suggested potential reductions in pain intensity and psychological distress, whereas relaxation techniques showed mixed results, particularly when compared to standard treatments such as occlusal splints. Methodological appraisal revealed variability in study quality, with three studies at low risk of bias, four at moderate risk, and three at high risk. Overall, the small number of studies and their marked heterogeneity substantially limit the interpretability and comparability of findings, thereby constraining their integration into a robust evidence-based biopsychosocial model for TMD management. Consequently, current evidence remains preliminary and insufficient to support firm clinical recommendations. Nevertheless, these approaches are conceptually aligned with the biopsychosocial model of TMD, and preliminary results suggest that hypnosis and relaxation may represent low-risk adjunctive strategies within multimodal TMD management, particularly for patients with stress-sensitive or centrally sensitized pain profiles. Future well-designed, adequately powered trials with standardized interventions and multidimensional outcomes are needed to clarify their clinical utility.
BACKGROUND:Assessing suicidal ideation (SI) in patients with primary temporomandibular disorders (TMD) is crucial for its early identification and intervention. This study aimed to investigate the biopsychosocial factors associated with SI in the overall TMD sample and across subgroups of painful TMD patients. METHODS:A total of 441 TMD patients were enrolled. TMD was diagnosed using the diagnostic criteria for TMD, and SI was assessed via item 9 of the Patient Health Questionnaire-9. SI prevalence was compared across painful TMD subgroups, stratified by pain duration, and classified according to the International Association for the Study of Pain (IASP) diagnostic criteria. Sociodemographic, Axis I and II, and pain characteristics were compared between the SI and non-SI groups using the Chi-square and Mann-Whitney tests. Binary logistic regression, incorporating pain persistence and depression, was performed to identify the key factors independently associated with SI. RESULTS:In the overall TMD sample, encompassing both painful and non-painful patients, 8.2% reported SI. Among the painful TMD subgroups, SI prevalence was 5.7% in acute cases and 12.0% in chronic cases by pain duration, rising to 20.9% when chronic pain was defined by IASP criteria (p < 0.001). Patients with SI were more frequently divorced, had higher rates of TMD-attributed headache and myofascial pain with referral, and reported greater perceived pain intensity. They also exhibited markedly elevated depression, anxiety, non-specific physical symptoms, pain catastrophizing, and overall distress (p < 0.001), as well as greater disability (p = 0.004). Pain duration was not independently associated with SI, whereas depression emerged as a significant independent predictor (p < 0.001). CONCLUSIONS:These findings highlight the substantial psychological burden in TMD patients, particularly those with chronic pain, and underscore the critical role of depression in SI. Incorporating routine biopsychosocial assessment and SI screening into TMD clinical practice is, therefore, highly recommended.
BACKGROUND:This study aimed to determine the prevalence of self-reported bruxism among dental students and to examine its association with stress, sleep quality, insomnia, and temporomandibular disorder (TMD) symptoms. METHODS:A total of 480 dental students participated in the study. Based on self-reported questionnaires (subject-based assessment), participants were classified into four groups: combined bruxism, sleep bruxism, awake bruxism, and non-bruxism. Bruxism-related parameters were assessed using the Fonseca Anamnestic Index (FAI), Perceived Stress Scale-10 (PSS-10), Pittsburgh Sleep Quality Index (PSQI), and Insomnia Severity Index (ISI). Statistical analyses were performed using Pearson's chi-square and Kruskal-Wallis tests to compare group differences, followed by multinomial logistic regression analyses to adjust for confounders. Statistical significance was defined as p < 0.05. RESULTS:The overall prevalence of self-reported bruxism was 73.3% and was significantly higher in women (p = 0.001). The proportions of sleep bruxism, awake bruxism, and combined bruxism were 17.1%, 11.9%, and 44.4%, respectively. In univariate analyses, the combined bruxism group demonstrated significantly greater TMD symptom severity as measured by the FAI (p < 0.001; η2 = 0.28). In addition, perceived stress (PSS-10; p < 0.001; η2 = 0.04), sleep quality (PSQI; p = 0.008; η2 = 0.02), and insomnia severity (ISI; p = 0.006; η2 = 0.02) also differed significantly between groups; however, the corresponding effect sizes were small. In multinomial logistic regression analyses, only FAI remained independently associated with bruxism subtypes, whereas stress measures, sleep-related parameters, and demographic variables were not retained as significant predictors after adjustment. CONCLUSIONS:Within the limitations of a subject-based assessment, self-reported bruxism was frequently observed among dental students. Although combined bruxism was associated with higher TMD symptoms, stress, and sleep disturbances in univariate analyses, only TMD symptom severity remained independently associated after adjustment. These findings highlight the importance of assessing bruxism subtypes separately in relation to TMD symptom burden.
Temporomandibular disorders (TMDs) are the second most common reason for orofacial pain with myalgia being the most prevalent diagnosis. Overuse of the masticatory muscles and the presence of stress are both risk factors for myalgia. The extent to which these risk factors interact remains unclear, including whether psychological stress contributes to increased masticatory muscle activity. The purpose of this scoping review was to identify, examine, and map the available literature exploring the relationship between psychological stress and masticatory muscle electromyography (EMG). Pre-clinical and clinical studies that studied adults with or without TMD who were exposed to psychological stress and had masticatory muscle electromyography recordings were included. The electronic databases CINAHL, EMBASE, Medline, and PsycINFO were searched in March 2025. Using a pre-defined data extraction sheet, basic study information and specific results regarding the research question were extracted. These were analysed and the results were described based on the type of study (pre-clinical vs. clinical), as well as the type of stress (experimental vs. clinical). Following screening, 38 studies (published between 1971 and 2025) were included: 29 clinical experimental studies, 3 cross-sectional studies and 6 pre-clinical studies. All pre-clinical and cross-sectional studies demonstrated that psychological stress increased masticatory muscle EMG. Among the clinical studies, 25 of the 29 studies reported that psychological stress increased masticatory muscle EMG. Psychological stress consistently increased masticatory muscle EMG in both human and animal models, although some caution is warranted given the paucity of manipulation checks in the included studies. Putative biological mechanisms are discussed herein. A trend towards greater EMG amplitude in response to stress in patients with TMD compared to healthy controls was demonstrated. Given the high prevalence of psychological stress in Western populations, these findings argue that the presence of psychological stress should be consistently evaluated when assessing patients with TMD.
BACKGROUND:Migraine is a major cause of disability globally, yet its epidemiological impact on postmenopausal women (aged ≥55 years) is not well understood. This study aims to fill this knowledge gap by analyzing long-term trends in migraine burden from 1990 to 2021. METHODS:Data from the Global Burden of Disease (GBD) 2021 study were utilized to estimate prevalence, incidence, and disability-adjusted life years (DALYs), stratified by age group, Socio-demographic Index (SDI), and geographical region. Temporal trends were assessed using the estimated annual percentage change (EAPC), while socioeconomic inequalities were evaluated through the Slope Index of Inequality (SII) and Concentration Index (CIX). RESULTS:The number of prevalent cases of migraine among postmenopausal women increased by 118.3% globally, rising from 55.29 million to 120.68 million between 1990 and 2021. Age-standardized rates (ASRs) in this population displayed contrasting trends: while age-standardized prevalence and incidence rates experienced slight increases (EAPC: 0.07-0.17), the age-standardized DALY rate (ASDR) remained stable. Middle-SDI regions faced the highest absolute burden of migraine in postmenopausal women and showed the most rapid growth in ASRs. Inequality analyses highlighted persistent socioeconomic disparities, revealing significant efficiency gaps in health resource utilization in high-SDI countries. CONCLUSIONS:This study highlights the increasing absolute burden of migraine among postmenopausal women, despite stable age-standardized rates. This underscores the need for context-specific interventions across SDI strata to reduce health inequities and optimize resource allocation in migraine care.
Gepants, oral antagonists of the calcitonin gene-related peptide (CGRP) receptor, represent a new therapeutic class in migraine management. This review aims to assess the efficacy and safety profile of the two gepants currently available in France: atogepant and rimegepant. A review of the literature was conducted in July 2024 using the PubMed, Cochrane Library, and Web of Science databases. Randomized controlled trials evaluating the efficacy and/or safety of atogepant and rimegepant in adult patients with migraine were included. Sixteen randomized controlled trials were selected (nine evaluating atogepant and seven evaluating rimegepant). In migraine prevention, atogepant significantly reduced the mean number of monthly migraine days (-0.7 to -2.4 days vs. placebo), with an improvement in quality-of-life scores (Migraine-Specific Quality of Life questionnaire-Role Function-Restrictive domain (MSQ-RFR): +9.9 to +10.8 points). Rimegepant, administered every other day, achieved a smaller reduction (-0.8 days/month) but was comparable to that observed with some anti-CGRP monoclonal antibodies. In acute treatment, a single dose of rimegepant 75 mg provided complete pain relief at 2 hours in 31-33% of patients versus 15% with placebo. Adverse events, mainly gastrointestinal (constipation and nausea), were generally mild to moderate, with no signal of hepatic or cardiovascular toxicity. Gepants represent a major therapeutic advance combining clinically meaningful efficacy with a favorable safety profile. Atogepant appears particularly promising for migraine prevention, whereas rimegepant offers an effective and well-tolerated option for acute treatment. Their use in clinical practice remains limited in France due to high cost and restricted reimbursement. Further real-world and long-term studies are needed to better define their place within current migraine management strategies.
BACKGROUND:Vestibular migraine (VM) has been associated with altered central sensory processing; however, objective measures of autonomic involvement remain insufficiently characterized. Quantitative pupillometry enables standardized assessment of both static and dynamic pupil responses. This study compared pupillary parameters between patients with VM and healthy controls under controlled illumination conditions. METHODS:Seventy participants were enrolled, including 40 patients diagnosed with VM according to the International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria, and 30 age- and sex-matched controls. Bilateral pupillometry was performed using an automated infrared system under scotopic, mesopic, low photopic, high photopic, and resting light conditions. Static pupil diameter and dynamic parameters (including constriction amplitude, latency, duration, velocity, and dilation metrics) were recorded. Between-group comparisons were conducted using parametric or nonparametric tests, as appropriate based on the data distribution. RESULTS:No significant differences were observed between groups in mean pupil diameter across illumination conditions (all p > 0.05). Dynamic pupillary parameters also did not differ significantly between the study groups. However, both groups demonstrated mild right-to-left asymmetry in static measurements, with a statistically significant interocular difference observed in the VM group under high-photopic conditions (p = 0.001). Dynamic asymmetries were minimal and not clinically meaningful. CONCLUSIONS:Interictal static and dynamic pupillary parameters did not differ significantly between patients with VM and healthy controls. Although minor light-dependent asymmetries were observed, their clinical significance remains uncertain. Further studies incorporating longitudinal designs and multimodal autonomic assessments are warranted to clarify the relationship between autonomic function and VM.
BACKGROUND:Weather-related influences on pain and neurological symptoms are widely discussed in biometeorology. However, the long-term impact of climatic variables on primary care headache consultations remains unclear. This study aimed to examine whether climatic variables are associated with consultations for cluster headaches, tension-type headaches (TTH), and unspecified headaches over 14 years. METHODS:Data (2010-2023) were extracted from medical records using International Classification of Primary Care, Second Edition (ICPC-2) codes. Meteorological variables (temperature, rainfall, wind direction, barometric pressure, and sunshine hours) were obtained from the State Meteorological Agency. Time-series analyses used Exponential Smoothing State Space Model with External Regressors (ETSX) and AutoRegressive Integrated Moving Average Models with External Regressors (ARIMAX) using age, sex, and meteorological factors as external regressors. Model accuracy was evaluated using the Root Mean Squared Error (RMSE), Symmetric Mean Absolute Percentage Error (SMAPE), and Mean Absolute Scaled Error (MASE). RESULTS:A total of 5127 headache consultations were analyzed (mean age, 45.0 ± 19.9 years; 68.9% female). ETSX models best fit the overall, unspecified, and cluster headache series, whereas the ARIMAX model provided optimal performance for TTH. Sex was the strongest predictor across all models. In TTH, female sex increased consultations (p < 0.001), whereas higher temperature (p = 0.031) and wind direction (cosine component; p = 0.027) were associated with fewer consultations. For cluster headache, male sex was associated with fewer consultations (p = 0.020), and no climatic variables showed a significant association. Meteorological variables were not independently associated with unspecified headache consultations. CONCLUSIONS:Climatic variables showed limited, subtype-specific associations, with only temperature and wind direction independently associated with TTH. No weather variables predicted cluster headache or unspecified consultations. Demographic factors appeared to be more strongly associated with healthcare utilization than climatic variables, although ETSX and ARIMAX models may support forecasting and resource planning.
BACKGROUND:Temporomandibular disorders (TMDs) are characterised by pain and dysfunction in the temporomandibular joints and surrounding muscles. Dizziness is a frequent symptom reported by TMD patients, but the prevalence of dizziness in this population remains unclear. METHODS:A systematic review and meta-analysis was conducted to identify relevant studies assessing the prevalence of dizziness in TMD patients. Seven electronic databases were searched using a combination of Boolean operators and Medical Subject Headings (MeSH) keywords to maximise sensitivity and specificity. RESULTS:The meta-analysis revealed a significant association between TMDs and dizziness in descriptive studies (pooled odds ratio (OR): 0.42, 95% confidence interval (CI): 0.20-0.88) but found a non-significant association in analytical studies (pooled OR: 0.55, 95% CI: 0.19-1.59). Heterogeneity was low in analytical studies (0%), while descriptive studies showed higher heterogeneity (96%). The studies included in the review generally reported a significant prevalence of vertigo and other aural symptoms in TMD patients. Some investigations highlighted the value of sociodemographic characteristics and the statistical association between TMD and vestibular symptoms. Furthermore, dizziness was quantitatively attributed to TMDs in some studies, while others reported a correlation between TMDs and otolaryngological symptoms. CONCLUSIONS:The current review demonstrated that TMDs are associated with increased dizziness and vestibular symptoms, particularly in descriptive research. A causal relationship could not be established due to the heterogeneity and observational nature of the studies included. These findings emphasise the need for careful interpretation and recommend prospective studies to clarify the relationship. When diagnosing and treating TMD patients, clinicians should consider these symptoms together. THE PROSPERO REGISTRATION:CRD420251026371.
Hyperpolarization-activated cyclic nucleotide-gated (HCN) channels have recently emerged as promising targets for the treatment of neuropathic pain. This study investigated the potential involvement of HCN2 channels in the development of trigeminal neuropathic pain following peripheral nerve injury. Infraorbital nerve chronic constriction injury (ION-CCI) model was adopted to rats, and head withdrawal thresholds (HWT) to mechanical stimulation were assessed pre- and postoperatively, as well as after pharmacological intervention. In the trigeminal ganglion (TG), intracellular cyclic adenosine monophosphate (cAMP) and cytoplasmic protein kinase A (PKA) levels were quantified by Enzyme-Linked Immunosorbent Assay (ELISA), while Hcn2 mRNA expression was evaluated by quantitative Polymerase Chain Reaction (qPCR). Immunohistochemical analysis was performed to assess phosphorylated cAMP response element-binding protein (pCREB) expression in the TG and HCN2 expression in infraorbital nerve (ION) axons. In the TG, cAMP and pCREB levels were elevated, whereas cytoplasmic PKA and Hcn2 mRNA levels were reduced. Axonal HCN2 expression was increased in CCI rats. On day 14, HWT was significantly reduced following CCI but was ameliorated by local administration of the HCN channel blocker ivabradine at the site of axonal injury. Collectively, these findings suggest that CCI-induced alterations in cAMP-PKA-pCREB signaling promote HCN2 accumulation in injured axons, thereby contributing to the development of orofacial neuropathic pain following peripheral nerve injury.
Background: Migraine frequently co-occurs with cardiovascular and metabolic diseases. Observational studies examining the association between conventional lipid profiles and migraine risk have yielded inconsistent results and cannot establish causality. This study aimed to investigate the causal effects of specific lipid species on migraine and its primary subtypes: migraine with aura (MA) and without aura (MO). Methods: Using a Mendelian randomization (MR) methodology, this study analyzed genome-wide association study (GWAS) data from the UK Biobank and FinnGen Consortium. Exposures comprised seven lipids and 179 lipid species while the outcomes were overall migraine and its subtypes. Pleiotropy and heterogeneity were assessed using sensitivity analyses such as MR-Egger, weighted median, and Pleiotropy Residual Sum and Outlier (MR-PRESSO). Results: Genetically predicted higher levels of high-density lipoprotein cholesterol (HDL-C; odds ratio (OR) = 0.88; 95% confidence interval (CI), 0.82-0.93) and apolipoprotein A1 (ApoA1, OR = 0.89; 95% CI, 0.84-0.95) were associated with a reduced risk of migraine. Conversely, higher triglycerides (TG) increased the risk of overall migraine. Lipidomic analysis revealed 15 specific lipid species causally associated with overall migraine. Subtype-specific analyses revealed divergent causal profiles for MO and MA. Seven triacylglycerol (TAG) species were specifically associated with an increased risk of MO, whereas only sphingomyelins (SM) (d36:1) was linked to an increased risk of MA. Conclusions: This study provides robust evidence for a causal relationship between lipid metabolism and migraine, demonstrating that these effects are highly specific to individual lipid molecules and migraine subtypes. These findings enhance our understanding of the lipid-mediated mechanisms in migraine pathogenesis and highlight potential subtype-specific pathways for developing future therapeutic and preventive strategies.
Osteoarthritis (OA) is a common joint disorder characterized primarily by cartilage degeneration and osteophyte formation, leading to a substantial decline in patients' quality of life. Temporomandibular joint OA (TMJOA) is a degenerative lesion within temporomandibular joint disorders, accounting for approximately 8%-16% of diagnosed cases. Its clinical manifestations include joint pain, limited mouth opening, joint noises, and related symptoms. Cellular senescence plays a pivotal role in OA pathogenesis. Senescent processes contribute to functional impairment of chondrocytes, synovial cells, and osteocytes through multiple signaling pathways. DNA damage, telomere attrition, oxidative stress, and the release of inflammatory mediators are major drivers of cellular senescence. However, current literature lacks a systematic integration of senescence-related mechanisms in OA and TMJOA. Furthermore, anti-aging therapeutic strategies for these conditions lack targeted approaches that account for interactions among distinct senescence mechanisms. This review elucidates the various characteristic types of cellular senescence, their interactions, and the senescence-induced pathogenesis of OA and TMJOA. A comprehensive investigation into the mechanisms of cellular senescence may yield novel insights and inform the development of therapeutic strategies for managing OA.
Background: Multiple sclerosis (MS) is a chronic inflammatory disease causing multifocal demyelination and axonal damage in the central nervous system. Recent studies indicate that MS patients have a higher prevalence of migraine than the general population. This cross-sectional, single-centre study assessed migraine prevalence in MS patients receiving disease-modifying therapies (DMTs). Methods: A total of 205 MS patients were included. All participants were assessed for migraine diagnosis according to the International Classification of Headache Disorders, 3rd edition (ICHD-3), by a qualified physician. Migraine subtypes (episodic or chronic, with or without aura) were determined per ICHD-3 criteria. Each participant provided data on age, gender, current DMT type and duration, previous DMT history, MS-related symptoms, and MS relapses in the past 12 months. Results: Episodic migraine was identified in 36 patients, corresponding to a prevalence of 17.56% (95% CI (confidence interval): 12.4%-22.8%). Age-stratified analysis revealed higher prevalence in younger participants: 21.4% in those under 40 years (n = 98) compared to 14.0% in those aged 40 years or older (n = 107). The majority of cases (n = 28) presented without aura, with aura occurring in 8 patients. No chronic migraine was detected in the cohort. A total of 193 patients were diagnosed with relapsing-remitting multiple sclerosis (RRMS), 2 with secondary progressive MS (SPMS), and 10 with primary progressive MS (PPMS). No cases of progressive-relapsing MS (PRMS) were reported. Among the participants, 193 were receiving DMT, while 12 patients were not undergoing chronic immunotherapy. No significant correlations were found between migraine occurrence and MS type, type of DMT, disease duration, or Expanded Disability Status Scale (EDSS) score. Conclusions: Migraine does not seem to be less common in MS patients compared to the general population but further, age-stratified and controlled studies are needed to investigate if it is more/as common.
BACKGROUND:Classical trigeminal neuralgia is thought to be primarily caused by neurovascular contact of the trigeminal nerve root. However, neurovascular contact is also seen in individuals without trigeminal neuralgia on magnetic resonance imaging (MRI). Understanding this reciprocal association is important for clinical decision-making, as microvascular decompression is usually considered in medication-refractory cases. METHODS:We performed a systematic review and meta-analysis of MRI studies evaluating neurovascular contact in patients with trigeminal neuralgia and in individuals without trigeminal neuralgia. PubMed, ScienceDirect, and the Cochrane Library were searched for studies published between 2015 and 2025. Seven studies involving 699 patients and 1092 trigeminal nerves (357 symptomatic and 735 asymptomatic) met the inclusion criteria and were analyzed. RESULTS:Neurovascular contact was present in 66.7% of nerves in individuals without trigeminal neuralgia (95% confidence interval: 58.9-73.8%) and in 87.5% of nerves in patients with trigeminal neuralgia (95% CI: 81.3-91.8%). The symptomatic side showed neurovascular contact at significantly higher rates than asymptomatic nerves. Severe contact was rarely observed in non-trigeminal neuralgia patients, but was strongly associated with symptomatic nerves. Neurovascular contact at the root entry zone was not significantly linked to the symptomatic side. Interpretation across studies was limited by heterogeneous and non-standardized reporting of neurovascular contact location and severity. CONCLUSIONS:Simple neurovascular contact is common in individuals without trigeminal neuralgia, whereas severe contact is more specific to symptomatic nerves, supporting a reciprocal association between neurovascular conflict and trigeminal neuralgia. Neurovascular contact should not be regarded as a binary MRI finding; severity, location, and vessel type appear to be important for symptom development. Standardized MRI reporting protocols and larger, well-designed studies are needed to refine diagnostic criteria and imaging-based assessment of trigeminal neuralgia. THE PROSPERO REGISTRATION:CRD420250611313.
BACKGROUND:We aimed to clarify the occurrence and variables associated with postoperative chronic postsurgical pain in orthognathic surgery patients (OS). METHODS:This retrospective single-center study included patients ≥18 years old undergoing bilateral sagittal split osteotomy (BSSO) with or without Le Fort I osteotomy between January 2016 and December 2022. The outcome variable was the occurrence of chronic postsurgical pain three months after OS. SPSS software (IBM Corporation, 28.0.0.0) was used to analyze the associations between predictor variables and outcome. RESULTS:Chronic postsurgical pain was observed in 7.9% of the 317 patients included in this study. In univariate analysis, the outcome was predicted by older age (odds ratio (OR) = 1.044; 95% confidence interval (CI): 1.003-1.087; p = 0.033) and use of early gabapentinoid medication at hospital discharge (OR = 3.526; 95% CI: 1.286-9.666; p = 0.014). In multivariate analysis, only early gabapentinoid medication predicted outcome independently (adjusted odds ratio (aOR) = 2.975; 95% CI: 1.055-8.388; p = 0.039). CONCLUSIONS:Chronic postsurgical pain represents a significant postoperative disadvantage in OS, yet surgical factors appear to have limited influence on its development. More detailed information on other variables, such as psychosocial factors and resilience, is needed to predict postoperative pain in this specific patient group.
Medication Overuse Headache (MOH) is a secondary headache resulting from the sustained overuse of acute headache medications, and represents a clinical challenge for its complex pathophysiology and high relapse rate. This narrative review examines non-pharmacological strategies for the management of MOH, and explores the potential role of a multidisciplinary approach in improving patient outcomes. The available evidence on patient education, psychotherapy, behavioral interventions, physical therapy, and neuromodulation techniques was reviewed, along with other non-pharmacological approaches, such as dietary modifications, Ayurveda, and acupuncture. These interventions may help in targeting multiple dimensions of MOH pathophysiology, and could be tailored to individual patient needs. Integrating multimodal non-pharmacological interventions with medication withdrawal and, when appropriate, bridging therapies appears promising in improving outcomes and reducing the overall burden of MOH. However, further research is required to identify the optimal combination and duration of multidisciplinary interventions.
