INTRODUCTION:Migraine is a common neurological disorder and a non-traditional risk factor for ischaemic stroke. Its relationship with specific stroke subtypes and post-stroke outcomes remains unclear. We evaluated the association between migraine (with and without aura), stroke aetiology, functional outcomes, and cardiovascular risk profiles in young patients with ischaemic stroke or TIA. METHODS:Patients aged ≤ 55 years enrolled in the STROKE-CARD long-term follow-up study underwent structured face-to-face headache interviews by headache specialists using ICHD-3 criteria. A predefined protocol collected demographic, clinical, neuroimaging, aetiological, and cardiovascular risk data. RESULTS:Among 289 young stroke patients (median age 48.0 [41-52] years; 36.3% women), 92 (31.8%) had a history of migraine (51.1% with aura). Migraine was more common in women, associated with younger age at stroke onset and more frequent headache at stroke onset, but not with traditional vascular risk factors. PFO was more prevalent in patients with migraine with aura (68.9% vs. 36.9% no migraine, p < 0.001). No significant differences were observed in stroke territory or stroke pattern. Stroke severity (NIHSS) and functional outcome (mRS) at discharge were more favourable in migraineurs (p ≤ 0.001). In multivariable analysis, migraine without aura was independently associated with good functional outcome (OR 7.21, 95% CI 1.93-26.93, p = 0.003). CONCLUSION:In young adults with ischaemic stroke, migraine-particularly with aura-was associated with younger age at stroke onset and a higher prevalence of PFO, while traditional vascular risk factors and stroke characteristics were similar across groups. Despite comparable stroke patterns, patients with migraine experienced more favourable short-term outcomes. TRIAL REGISTRATION:Post-Stroke Disease Management-Stroke Card: NCT02156778; Stroke Card Long-term Follow-Up NCT04205006.

Background: Acute ischemic stroke (AIS) is often complicated by systemic infections that worsen prognosis. Emerging evidence suggests gut microbiota dysbiosis, inflammatory biomarkers, and gut-barrier dysfunction play pivotal roles in post-stroke outcomes. This study aimed to integrate Stroke Dysbiosis Index (SDI), Microbial Dysbiosis Index (MDI), and inflammatory biomarkers to evaluate their prognostic value in AIS patients. Methods: An observational prospective cohort was conducted at a tertiary stroke center in Jakarta (September 2023-September 2024). Eighty AIS patients admitted within 24 h of onset were enrolled. Fecal samples underwent 16S rRNA sequencing for microbiota profiling and SDI/MDI calculation. Blood biomarkers (NMDAR NR2B, butyrate, TMAO, RANKL, iFABP, LPS) and platelet-to-lymphocyte ratio (PLR) were measured. Clinical severity was assessed with NIHSS. Outcomes included infection within 7 days, and complications. Statistical analyses comprised correlation, regression, and ROC curve modeling. Results: Infection occurred in 46.3% of patients, predominantly older (>60 years) and female. Infected patients showed reduced microbial diversity, enrichment of pathogenic taxa (Klebsiella, Escherichia, Salmonella), elevated SDI/MDI, and depleted SCFA producers. Biomarkers revealed increased NMDAR, TMAO, iFABP, and LPS, with reduced butyrate and RANKL (all p < 0.001). These markers correlated strongly with infection status. ROC analysis demonstrated promising discriminative ability in this cohort (bias-corrected AUCs > 0.80 after internal bootstrapping validation). Internal validation using 1,000 bootstrap resamples was performed to estimate optimism in AUC values and obtain bias-corrected confidence intervals. Conclusion: Gut dysbiosis, elevated dysbiosis indices, and inflammatory biomarker derangements were strongly associated with post-stroke infections and adverse prognosis. Integrating microbiota and biomarker profiles with clinical parameters may provide a robust framework for risk stratification and open avenues for microbiota-targeted therapies in AIS.

Background:Post-stroke infection (PSI), particularly pneumonia and urinary tract infection, is a common and serious complication after acute ischemic stroke (AIS). Current diagnostic biomarkers provide limited accuracy when used in isolation. This study aimed to evaluate the diagnostic value of circulating biomarkers and gut microbiota profiling, both individually and in combination, to predict PSI in AIS patients. Methods:We conducted a prospective observational study at Prof. Dr. dr. Mahar Mardjono National Brain Center Hospital, Jakarta. A total of 80 AIS patients admitted within 24 h of onset were enrolled and followed for 7 days to assess PSI. Blood samples were analyzed for NMDAR, butyrate, TMAO, RANKL, iFABP, and LPS. Stool samples were collected for 16S rRNA sequencing. Diagnostic performance was evaluated using ROC curves, with AUC, sensitivity, and specificity calculated. Multivariate logistic regression models were constructed to assess independent predictors and combined diagnostic accuracy. Results:PSI occurred in 37/80 patients (46.3%). NMDAR showed the highest diagnostic performance (AUC 0.911; sensitivity 86.5%; specificity 90.7), followed by iFABP (AUC 0.894), LPS (AUC 0.896), RANKL (AUC 0.881), butyrate (AUC 0.866), and TMAO (AUC 0.865). Gut microbiota analysis revealed reduced evenness and dominance imbalance in infected patients, with enrichment of pathogenic taxa (Escherichia coli, Salmonella enterica) and depletion of SCFA-producing commensals (Faecalibacterium prausnitzii, Roseburia intestinalis). Multivariate models integrating microbiota features and biomarkers improved predictive accuracy compared with single-domain approaches. Conclusion:Integrating circulating biomarkers with gut microbiota profiling significantly enhances early prediction of PSI in AIS. These findings highlight the role of the gut-brain-immune axis in post-stroke complications and support combined biomarker-microbiota models for risk stratification and preventive strategies.

Triptans are highly effective acute treatments for migraine attacks, yet population-level data suggest persistent underuse. Updated real-world data on triptan use and overuse in Austria are lacking. This nationwide, retrospective claims-based study analysed triptan use and overuse in Austria in 2023. Adults (≥ 18 years) with at least one dispensed triptan were identified. Triptan overuse was defined as the dispensing of ≥ 30 defined daily doses (DDDs) in at least one quarter, consistent with the International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria. Data on demographics, preventive migraine therapies, antidepressant use, sick leave, and hospital admissions were assessed and compared with data from 2007 using identical methodology. Among 7.75 million insured adults, 63,729 individuals (0.82

Calcitonin gene-related peptide (CGRP)-targeted therapies, including monoclonal antibodies (mAbs) and gepants, represent a major advancement in migraine prevention, offering greater efficacy and improved tolerability compared with traditional treatments. These agents selectively inhibit the CGRP pathway, a key mediator in migraine pathophysiology, and are increasingly used even as first-line options in selected patients. While clinical trials and real-world data suggest a favorable cardiovascular (CV) safety profile, particularly in patients without major risk factors, evidence remains limited for those with established vascular disease or recent vascular events. Concerns persist regarding long-term effects and the safety of CGRP blockade in high-risk populations. This narrative review focuses on the CV and cerebrovascular safety of CGRP-targeted migraine treatments-an area of growing clinical relevance. We compare these newer agents with traditional migraine preventives and highlight the paucity of data in patients with previous stroke, subarachnoid hemorrhage, myocardial infarction, or significant CV comorbidities. In addition, we discuss the emerging topic of dual CGRP pathway blockade (mAbs plus gepants), which has not previously been reviewed in the context of vascular risk. Based on currently available scientific evidence, we offer structured clinical considerations to guide the use of CGRP-targeted therapies in patients with vascular risk or cerebrovascular disease. Our aim is to support informed decision making in a population that has often been excluded from clinical trials but is becoming increasingly important in clinical practice.

The CGRP pathway targeting antibody fremanezumab is indicated for prevention of migraine in adults with ≥4 migraine days/month. To address the limited availability in real-world long-term data, the FINESSE study was initiated to provide real-world evidence of long-term effectiveness of fremanezumab in clinical practice in an unselected migraine patient cohort. FINESSE was a non-interventional, prospective, multicentre, two-country (Germany, Austria) study observing migraine patients receiving fremanezumab over 24 months in clinical routine. The primary endpoint was the proportion of patients reaching ≥50

Calcitonin gene-related peptide (CGRP) is a pivotal molecule in migraine pathophysiology and a major target of current therapeutic strategies. Accurate plasma quantification is essential for biomarker research, yet concerns persist regarding its preanalytical stability. To assess the stability of plasma CGRP in relation to clinically relevant delays in sample processing and different centrifugation protocols. We conducted an analytical study including 40 healthy participants (22 females, median age 26 years), recruited at the Medical University of Innsbruck, Austria, between January and June 2023. Blood samples were obtained under standardized conditions and processed at predefined intervals (6–180 min), either immediately or following delayed centrifugation. CGRP concentrations were determined by a validated sandwich ELISA. Data analysis included repeated-measures ANOVA with corrections for age and sex, as well as paired t tests. Median plasma CGRP concentrations demonstrated a nonsignificant numerical increase over time, with slightly higher values in women. Repeated-measures ANOVA showed no significant effect of delayed processing on CGRP levels (P = 0.326). The interaction between time and sex was statistically significant (partial η² = 0.069; P = 0.040), but separate analysis for females and males did not yield significant within-subject effects. Immediate versus delayed centrifugation (30 and 60 min) did not significantly influence CGRP concentrations (P = 0.548 and P = 0.305, respectively). Plasma CGRP is stable over a range of preanalytical delays and under varying centrifugation conditions. These findings support robust biomarker approaches in clinical and multicenter studies by minimizing concerns about technical variability.

Cardiovascular autonomic disorders (CAD) were described following COVID-19 infection and vaccination, but previous reports were limited in size and follow-up. Here, we aimed to investigate the type and frequency of newly diagnosed and exacerbated CAD following COVID-19 infection or vaccination, and assessed their associated autonomic and non-autonomic complaints, applied treatment, and clinical outcome at last follow-up. Medical records of individuals referred to the Innsbruck Dysautonomia Center between March 2020 and March 2023 were reviewed for new onset of orthostatic intolerance, recurrent syncope, OR exacerbation of previously diagnosed CAD within 6 weeks from a passed COVID-19 infection or vaccination. Following COVID-19 infection (n = 75), 22 (29

Background/Objectives: Infections after stroke are a serious medical problem and have a significant impact on the outcome of stroke, but data regarding the Asian population are limited. This study aims to determine the bacterial and fungal profile of pathogenic organisms of infections after acute ischemic stroke (AIS). Methods: This is a retrospective study using the medical records of patients at least 18 years old who were hospitalized with AIS in a tertiary stroke hospital from 1 January 2018 to 31 December 2022. Demographic, patient-related, and other examination data were extracted from hospital medical records. Infections after AIS were defined as any infection that developed during the acute phase of ischemic stroke and was confirmed by microbiologic culture as the gold standard. Factors associated with infection were analyzed using multiple logistic regression. Results: Among 599 AIS patients with infection who underwent microbiologic culture, the prevalence of infection with an isolated pathogen was 21.4%, and most organisms were from sputum. Positive microbiologic culture revealed that bacteria such as K. pneumoniae, E. coli, A. baumannii, and S. aureus were the most common causes of infection, while fungi were rare. During the COVID-19 period, bacteria developed resistance to antimicrobials, including β-lactamase antibiotics for Gram-negative bacteria and methicillin for Gram-positive bacteria. Care in the intensive ward, including the stroke unit, reduced the risk of a positive microbiological culture in the COVID-19 and non-COVID-19 period. Urinary catheters promoted infections in the non-COVID-19 period, whereas steroids, total parenteral nutrition, and tracheostomy were negatively associated with infections after AIS in the COVID-19 period. Conclusions: The prevalence and factors associated with infection after stroke changed during the COVID-19 period. The risk of infection after stroke requires preventive measures such as early dysphagia screening.

Background: Anti-CGRP (receptor) antibodies are approved for the preventive treatment of migraines and are increasingly used due to their favorable safety profile and potent efficacy. However, as CGRP is one of the most potent vasodilators, concerns have been raised regarding the possible impact of these drugs on arterial blood pressure. Methods: We present a retrospective cohort study at a tertiary headache center including a total of 259 patients with episodic and chronic migraine who received anti-CGRP antibody treatment for migraine prevention. Blood pressure was measured in a hospital using a standardized setting at baseline and at least at two follow-up visits. Significant increase in blood pressure was defined as an increase in systolic blood pressure ≥ 20 mmHg and/or an increase in diastolic blood pressure ≥ 10 mmHg from the baseline value. Results: Mean age of our population was 39.9 years (±12.1), and 217 (83.8%) were female. Blood pressure measurements between T0 and T2, incorporating all CGRP-antibody groups, showed a significant reduction in systolic (−3.3 mmHg; p = 0.001) and diastolic blood pressure (−2.3 mmHg; p = 0.021), respectively. The repeated-measures generalized linear model analysis revealed no significant variations between the CGRP antibodies relative to blood pressure. The most robust factor predicting systolic hypertensive measurements in the course of anti-CGRP antibody treatment was pre-existing hypertension at baseline (sum of mean squares 7.4; p = 0.019). Conclusions: Our data indicate that treatment with anti-CGRP (receptor) antibodies does not significantly increase blood pressure. However, it seems to be important to monitor patients with pre-existing arterial hypertension.

Hypoxia is triggered by various underlying conditions and initiates a complex cascade of pathophysiological processes culminating in the onset of headache. Key mechanisms include alterations in cerebral blood flow, disruption of metabolic homeostasis, and activation of inflammatory pathways. These factors collectively contribute to the development and maintenance of hypoxia-related headache. Clinically, headaches associated with hypoxia display considerable heterogeneity regarding symptom severity and accompanying features. This variability is influenced by individual susceptibility, comorbidities, and the extent and duration of oxygen deprivation.

BackgroundThe diagnosis, treatment and monitoring of patients with idiopathic intracranial hypertension (IIH) are highly complex processes that require interdisciplinary collaboration with respect to neurology, ophthalmology, neuroradiology, neurosurgery and endocrinology. Accordingly, there is a consensus among international guidelines that the management of these aspects of care should be the responsibility of specialized centers that are equipped with appropriate facilities. The objective of the Austrian Network for Idiopathic Intracranial Hypertension (AN4IH) is to establish a national network of excellence and to provide comprehensive recommendations for the structure and operation of specialized IIH centers (AN4IH centers), including an integrated, interdisciplinary diagnostic and treatment pathway.MethodsThis consensus was developed by an interdisciplinary panel of experts convened by Austrian neurologists, (neuro)ophthalmologists, neuroradiologists, neurosurgeons and endocrinologists. The process adhered to a formal consensus methodology.ResultsThe AN4IH consensus provides a comprehensive, integrated, interdisciplinary framework addressing care infrastructure, urgency stratification, diagnostics, treatment and monitoring, as well as considerations related to family planning and pregnancy in patients with IIH. The AN4IH consensus is explicitly intended as a supplement and extension to existing international guidelines.ConclusionsThe management of IIH necessitates a structured, interdisciplinary approach to optimize patient outcomes. Through formal consensus methodology, the AN4IH provides expert - and where available evidence - based recommendations for specialized care centers, emphasizing standardized diagnostic pathways, urgency stratification and tailored treatment protocols. By fostering collaboration and institutionalizing best practices, the AN4IH model represents a significant advancement in delivering comprehensive, patient-centered care for this complex neurological disorder and encourages participants to create a secure, quality-controlled shared database for the collection of all clinical and paraclinical data, alongside the establishment of a biobank for the storage of biosamples.

Menstrually-related migraine (MRM) affects approximately 31–52

Non-polyglutamine CACNA1A variants underlie an extremely variable phenotypic spectrum encompassing developmental delay, hemiplegic migraine, epilepsy, psychiatric symptoms, episodic and chronic cerebellar signs. We provide our experience with the long-term follow-up of CACNA1A patients and their response to interval therapy. Patients with genetically confirmed non-polyglutamine CACNA1A disease were prospectively followed at the Center for Rare Movement Disorders of the Medical University of Innsbruck from 2004 to 2024. We recruited 41 subjects with non-polyglutamine CACNA1A disease, of which 38 (93

Abstract Background Idiopathic intracranial hypertension (IIH) is a debilitating condition characterized by increased intracranial pressure often presenting with chronic migraine-like headache. Calcitonin gene-related peptide (CGRP) plays an important pathophysiological role in primary headaches such as migraine, whilst its role in IIH has not yet been established. Methods This longitudinal exploratory study included patients with IIH, episodic migraine (EM) in a headache-free interval and healthy controls (HC). Blood samples were collected from a cubital vein and plasma CGRP (pCGRP) levels were measured by standardized ELISA. Results A total of 26 patients with IIH (mean age 33.2 years [SD 9.2], 88.5% female, median BMI 34.8 kg/m2 [IQR 30.0–41.4]), 30 patients with EM (mean age 27.6 years [7.5], 66.7% female) and 57 HC (mean age 25.3 years [5.2], 56.1% female) were included. pCGRP levels displayed a wide variation in IIH as well as in EM and HC on a group-level. Within IIH, those with migraine-like headache had significantly higher pCGRP levels than those with non-migraine-like headache (F(2,524) = 84.79; p < 0.001) and headache absence (F(2,524) = 84.79; p < 0.001) throughout the observation period, explaining 14.7% of the variance in pCGRP levels. CGRP measurements showed strong intraindividual agreement in IIH (ICC 0.993, 95% CI 0.987–0.996, p < 0.001). No association was found between pCGRP levels and ophthalmological parameters. Conclusions Although interindividual heterogeneity of pCGRP levels is generally high, migraine-like headache seems to be associated with higher pCGRP levels. CGRP may play a role in the headache pathophysiology at least in a subgroup of IIH.

BackgroundThere is evidence that iron metabolism may play a role in the underlying pathophysiological mechanism of migraine. Studies using R2∗ (=1/T2∗) relaxometry, a common MRI-based iron mapping technique, have reported increased R2∗ values in various brain structures of migraineurs, indicating iron accumulation compared to healthy controls.PurposeTo investigate whether there are short-term changes in R2∗ during a migraine attack.Population26-year-old male patient diagnosed with episodic migraine with aura according to ICHD-3 criteria.Sequence3 T, 64-channel head coil, for quantification of R2∗ relaxation a multi-echo gradient echo (GRE) sequence with TE = 4.92, 9.84, 14.7, 19.6, 24.6 and 29.51 ms, TR = 35 ms, flip angle = 15°, and 0.9 × 0.9 × 0.9 mm3 isotropic resolution was used.AssessmentQuantitative MRI, including R2∗ relaxometry and diffusion tensor imaging (DTI), was acquired from a migraine patient on 21 consecutive days, including migraine-free days and days with a migraine attack.Statistical testStatistical analysis was performed using R, the Shapiro–Wilk test, the t-test and Mann Whitney U test, analysis of variance (ANOVA) or Kruskal–Wallis test, depending on the distribution of the data. p-value <0.05 was considered significant.ResultsSignificant difference in R2∗ was found between the left and right hemispheres during a migraine attack. An increase in R2∗ was observed in the left hemisphere, whereas in the right hemisphere R2∗ was found to decrease. In the left cerebral white matter, R2∗ increased by 1.8% (p = 0.021), in the right cerebral white matter, R2∗ anisotropy decreased by 17% (p = 0.011) during a migraine attack.Data conclusionOur study showed a decrease and increase in iron content during the migraine cycle. Furthermore, during a migraine attack, white matter iron content increased, accompanied by a decrease in anisotropic tissue components, suggesting additional changes in vascular components.

Migraine and stroke are neurological disorders with significant global prevalence and impact. Recent advances in migraine therapy have focused on the calcitonin gene-related peptide (CGRP) pathway. This review examines the shared pathomechanisms between migraine and stroke, with emphasis on the role of CGRP. We analyze the current literature on CGRP’s functions in cerebrovascular regulation, edema formation, neuroinflammation, and neuroprotection. CGRP acts as a potent vasodilator and plays a crucial role in trigeminovascular activation during migraine attacks. In stroke, CGRP has demonstrated neuroprotective effects by improving collateral circulation and reducing ischemia-reperfusion injury. Concerns have been raised about the potential impact of CGRP inhibitors on stroke risk and outcomes. Studies in animals suggest that CGRP receptor antagonists may worsen cerebral ischemia by impairing collateral flow. We discuss the implications of these findings for the use of CGRP-targeting therapies in migraine patients, especially those at increased risk of stroke. Additionally, we explore the complex interplay between CGRP, endothelial function, and platelet activity in both conditions. This review highlights the need for further research to elucidate the long-term cerebrovascular safety of CGRP pathway inhibitors and to identify potential subgroups of migraine patients who may be at higher risk of adverse cerebrovascular events with these novel therapies.