Introduction Migraine is a prevalent and disabling neurological disorder with subtypes mainly classified and managed based on monthly headache frequency. This study investigates a novel, data-driven clustering approach that uses comprehensive clinical features in addition to headache frequency to further understand migraine subtyping and management. Methods This cross-sectional observational study included participants with a diagnosis of migraine based on self-reported surveys recruited from the Stanford Headache Clinic and surrounding community between 2012 and 2020. This study represents a secondary analysis of a previously collected cohort, incorporating newly added episodic migraine (EM) data alongside existing clinical and demographic variables. This approach extends prior work to refine data-driven migraine subtyping. Participants completed comprehensive surveys capturing clinical, demographic, and treatment-related information. A data-driven clustering approach was applied using hierarchical agglomerative clustering. To determine the optimal number of clusters, visual inspection of the dendrogram, scree plot, and principal component analysis was used. Descriptive statistics and logistic regression models were used to explore clinical characteristics and medication outcomes for each cluster. Results 180 participants were included in the clustering analysis. Two distinct clusters were identified and compared. Cluster 1 ( n = 66; chronic migraine (CM) = 62; EM = 4) had a significantly ( p ≤ 0.001) higher migraine frequency, greater migraine-related disability, higher pain catastrophizing, and more comorbidities (including anxiety, depression, sleep disorders, post-traumatic stress disorder, and somatic symptoms). Cluster 2 ( n = 114; CM = 68; EM = 46) had significantly ( p ≤ 0.001) more years with headache and higher levels of pain self-efficacy. Treatment response differed significantly between clusters for acute medications, with Cluster 2 showing more favorable response rates to triptans and non-steroidal anti-inflammatory drugs ( p ≤ 0.001) and a higher proportion of individuals who indicated that acute medication helped to improve their migraine compared to Cluster 1. Conclusion This study supports the potential use of a comprehensive phenotype-based clustering approach to determine migraine subtypes that correlate with acute treatment outcome.
Objective The Contemporary Prospective Understanding of Migraine Real-world Evidence (CAPTURE) study will provide 2 years of international, prospective, longitudinal data describing the migraine disease course, determinants of disease evolution, and associated treatment patterns. Methods Adults with ≥1 year migraine history who were <50 years of age at onset and currently receiving ≥1 acute and/or preventive migraine medication were enrolled at headache centers (target sample size: n = 1600). Eligible participants were required to have experienced ≥4 monthly headache days in the 3 months before screening. The study population was stratified into 3 cohorts based on monthly headache day frequency during the 1-month screening period: cohort 1: 4 to <8; cohort 2: 8 to <15; cohort 3: ≥15. We collected baseline descriptive demographic and clinical data, including treatment patterns. We will assess migraine evolution over a 24-month follow-up by measuring changes in headache frequency, acute and preventive medication use, patient-reported outcomes (migraine-related disability, quality of life, work productivity, and activity), and migraine-related health care resource utilization. Results As of November 2024, 1062 participants, who were predominantly female and from Europe, were enrolled and included in the full analysis set. Ages were similar across cohorts (mean [range] years, cohort 1: 42.3 [18–72]; cohort 2: 42.2 [18–79]; cohort 3: 43.0 [19–77]). At baseline, >50% of participants were receiving both acute and preventive migraine treatments (cohort 1: 50.0%; cohort 2: 56.4%; cohort 3: 57.6%). Approximately 25% were receiving only acute treatment at baseline (cohort 1: 26.8%; cohort 2: 24.3%; cohort 3: 23.0%), and <20% were receiving only preventive treatment at baseline (cohort 1: 17.3%; cohort 2: 14.0%; cohort 3: 12.8%). Triptans were the most frequent acute treatment at baseline for all cohorts (56.7–59.4%). CGRP mAbs were the most common preventive treatment at baseline for cohorts 1 (20.5%) and 2 (17.8%); onabotulinumtoxinA (22.4%) was the most common in cohort 3. Migraine-related quality-of-life and work productivity decreased proportionally with higher headache frequency. All cohorts reported high migraine-related disability and the presence of interictal burden, with increasing severity from cohort 1 through cohort 3. Similar trends were also observed for anxiety and depression symptoms, and patient-rated disease severity. Cohort 3 also had the lowest acute treatment optimization scores. Conclusion CAPTURE will provide greatly needed international longitudinal data assessing determinants of the evolution of migraine and its associated burden in the context of contemporary treatment patterns. These results will enhance our understanding of predictors of the course of migraine over time.
Background Migraine is a debilitating neurological disorder that imposes a substantial global health burden, with a substantial burden in the Arab world. It frequently coexists with gastrointestinal disorders, particularly irritable bowel syndrome (IBS) and gastroesophageal reflux disease (GERD), potentially reflecting shared gut-brain axis mechanisms. Objective The present study aimed to estimate the prevalence of screening-positive migraine and examine its associations with IBS and GERD, while identifying sociodemographic, dietary, and lifestyle factors associated with screening-positive migraine among adults across Arab countries. Methods A multinational cross-sectional study was conducted between September 2025 and March 2026 using a validated bilingual (Arabic/English) online self-administered questionnaire distributed to adults across Arab countries. The questionnaire assessed sociodemographic characteristics, personal and dietary habits, migraine using the Migraine Screening Questionnaire (MS-Q), IBS according to the Rome IV criteria, and GERD using the GERD Questionnaire. Univariate and hierarchical multivariable logistic regression analyses were performed to identify factors associated with a positive migraine screen. Results Of 3317 participants, 59.7% were female, 46.4% were aged 18–24 years, 77.9% lived in urban areas, and 24.5% had a family history of migraine. Regarding lifestyle factors, 29.7% reported no physical activity, 33.6% slept ≤6 h/night, 44.0% reported low fluid intake (<2 liters/day), 24.9% frequently consumed spicy food, 8.7% ate fast food daily, and 62.2% reported using self-medicated painkillers. A total of 22.4% screened positive for migraine, with 20.5% reporting comorbid IBS and 21.8% reporting comorbid GERD. Common triggers were sleep disturbance, noise, anxiety, and stress while resting, sleep, and self-medicated painkillers were the main relieving factors. Female sex, family history of migraine, IBS, GERD, daily fast-food consumption, and spicy-food intake were independently associated with higher odds of screening-positive migraine. In contrast, higher physical activity levels, adequate sleep duration, more frequent daily meals, and higher family income were associated with lower odds of screening-positive migraine. Conclusion This multinational study found a high prevalence of screening-positive migraine, with strong independent associations with IBS and GERD. Several potential modifiable lifestyle and dietary factors were also associated with screening-positive migraine, highlighting opportunities for integrated gut-brain axis care and targeted public-health interventions promoting regular meals, adequate sleep, physical activity, and reduced fast-food/spicy-food consumption in the region.
Background Headache disorders are among the leading causes of disability worldwide, yet patient education remains underemphasized and inconsistently delivered in clinical practice. We aimed to review the evidence on patient education across headache disorders and summarize educational content relevant to clinical practice in migraine. Methods We conducted a narrative review of educational interventions in migraine, medication-overuse headache (MOH), and other headache disorders, including tension-type headache, cluster headache, post-traumatic headache, and unspecified headache conditions. We examined educational content, delivery approaches, clinical and behavioral outcomes, and practical considerations for implementation. We distinguished standalone educational interventions from multicomponent programs in which education was combined with behavioral, pharmacological, rehabilitative, or multidisciplinary care. Results Evidence for patient education is most developed in migraine and MOH. In migraine, standalone educational interventions and broader programs incorporating education have been associated with improvements in headache outcomes, disability, quality of life, self-efficacy, medication use, and other treatment behaviors. Common educational topics for patients with migraine include understanding the diagnosis, managing lifestyle factors and triggers, using pharmacological treatments appropriately, recognizing complications, and participating in ongoing follow-up. A practical section translates these educational topics into approaches for routine migraine care. In MOH, interventions ranging from brief advice to structured programs may reduce headache frequency and acute medication use and facilitate reversion from MOH to non-MOH status. However, education has frequently been delivered alongside treatment optimization, behavioral training, physiotherapy, or multidisciplinary care. Consequently, the benefits observed in these programs generally cannot be attributed specifically to education unless the study design permits its independent effect to be assessed. Evidence for other headache disorders remains limited and heterogeneous and is derived predominantly from multicomponent behavioral or rehabilitation programs. Conclusions Patient education is an important component of headache management, with the strongest evidence currently available for migraine and MOH. Although educational approaches may improve clinical outcomes and self-management behaviors, the independent contribution of education remains uncertain when it is embedded within broader interventions. Further studies should evaluate clearly defined educational interventions, distinguish their effects from those of concurrent treatments, and determine which components provide meaningful and sustained benefits.
Background Rheumatoid meningitis (RM) is a rare inflammatory complication of rheumatoid arthritis (RA). Because headache may predominate, distinguishing RM from primary headache disorders can be challenging. Case A 44-year-old woman with migraine with aura developed a marked increase in headache frequency during tapering of immunosuppressive therapy for RA, in parallel with worsening arthralgia. The core features remained similar to her previous migraine attacks, including scintillating scotoma, throbbing pain, and nausea, although posterior neck discomfort was new. This change in frequency and associated symptoms prompted brain magnetic resonance imaging, which showed bilateral high-convexity sulcal hyperintensities on diffusion-weighted and fluid-attenuated inversion recovery imaging. Cerebrospinal fluid examination demonstrated pleocytosis, elevated protein, and interleukin-6, and a markedly elevated anti-cyclic citrullinated peptide antibody index, supporting a clinical diagnosis of RM. Intensified corticosteroid therapy was followed by sustained improvement without recurrence. Conclusions This case highlights that a marked change in attack frequency or course in a patient with an established primary headache disorder should prompt evaluation for secondary headache. RM-associated inflammatory activity may have altered susceptibility to cortical spreading depression through inflammatory mediators, thereby exacerbating the patient's typical migraine phenotype. Early neuroimaging and cerebrospinal fluid evaluation are important for timely diagnosis.
