Background Preventing migraine chronification is a key treatment goal, yet environmental and lifestyle contributors remain understudied in Asian populations. We investigated predictors of the transition from episodic migraine (EM) to chronic migraine (CM) in a prospective Chinese clinical-based cohort.Methods This multicenter, prospective study involved 1642 participants with EM meeting ICHD-3 criteria. Baseline characteristics, including environmental factors and psychological scales, were captured via a Clinical Decision Support System (CDSS). Longitudinal follow-up was conducted using a web-based mini-program. Risk factors were identified using multi-variable Cox proportional hazards models, validated by LASSO and stepwise regression.Results During a median 6-month follow-up, 47 (2.9%) patients progressed to CM. Multivariable analysis identified anxiety symptoms [Generalized Anxiety Disorder-7 (GAD-7) score: Hazard Ratio (HR) 1.15, 95% Confidence Interval (CI) 1.06-1.25], baseline analgesic use frequency (HR 1.07, 95% CI 1.01-1.14), and age (HR 1.04, 95% CI 1.01-1.06) as independent risk factors. Conversely, weekly physical activity duration emerged as a significant protective factor (HR 0.66, 95% CI 0.45-0.98).Conclusion Anxiety and higher frequency of analgesic use are independent risk factors of migraine chronification in this Chinese cohort, while regular physical activity offers protection. These findings support an integrated management strategy combining psychological intervention, medication education, and exercise therapy.

BACKGROUND:Primary headache and psychiatric diseases are bidirectional correlated. The real-world data of depression and anxiety in Chinese patients hospitalized for primary headache, considering all subtypes, remain unclear. METHODS:This study enrolled patients attending eight Chinese headache centers from October 2022 to September 2023. A WeChat mini-program was designed to collect data. Headache was diagnosed and confirmed by two headache specialists. The Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 were used to assess depression and anxiety. RESULTS:Overall, 1963 patients with primary headache were analyzed; the prevalence of depression and anxiety was 20.1% (396/1963) and 14.8% (290/1963), respectively. Of the 1963 patients, 217 (11.1%) had history of anxiety or depression and 184 (9.4%) had undergone assessments. Patients with both primary headache and depression were more likely to be women (77.8% vs 71.9%), experience more severe headache (numerical rating scale; 6.2 ± 1.9 vs 5.7 ± 1.9) and greater impacts on quality of life (Headache Impact Test-6; 65.3± 8.5 vs 58.1 ± 11.5). Those with both primary headache and anxiety exhibited similar results and were less educated. Depression and anxiety were more prevalent in chronic migraineurs (CM) than in episodic migraineurs (36.8% vs 16.9% and 28.9% vs 12.3%, respectively) and in those with chronic (CTTH) than in those with episodic tension-type headache (30.6% vs 15.1% and 20.1% vs 12.8%, respectively). CONCLUSION:Depression and anxiety are inadequately diagnosed and strongly associated with sex, severe headache, chronification and disability in patients with primary headache in China. To improve the health of patients with primary headaches, early screening for depression and anxiety is important.

OBJECTIVE:To investigate the long-term outcomes of stenting for isolated pulsatile tinnitus (PT) caused by cerebral venous sinus stenosis. STUDY DESIGN:Retrospective study. SETTING:The First Medical Center, Chinese PLA General Hospital. PATIENTS:Patients diagnosed to have isolated PT secondary to cerebral venous sinus stenosis at our institution between December 2009 and March 2023. INTERVENTION:Cerebral venous sinus stenting. MAIN OUTCOME MEASURES:Morphological features of the cerebral venous sinus, endovascular technique, and clinical outcomes. RESULTS:The study included 80 patients with a mean age of 39.4 ± 9.6 years and an average body mass index of 23.9 kg/m. The mean age at symptom onset was 35.1 ± 8.7 years. Seventy-five of the patients (93.8%) were women. PT was the primary symptom. All patients reported feeling anxious because PT had severely affected their day-to-day lives. The PT was right-sided in 52 cases (65%). All procedures were technically successful. The mean trans-stenotic pressure gradient decreased from 4.3 ± 3.3 mm Hg before stenting to 0.4 ± 0.9 mm Hg after stent placement. Twenty-one patients (26.3%) experienced poststenting headache. The mean follow-up duration was 80.5 ± 46.3 months, with 26 patients followed for over 120 months. PT resolved in all cases after stenting, and there were no recurrences. Follow-up radiographic examination of 23 patients (28.8%) at a mean of 71.2 ± 43.1 months identified only one case of restenosis. CONCLUSIONS:Long-term follow-up of these patients confirmed the efficacy and safety of stenting for isolated venous sinus stenosis-related PT.

There is no dedicated stent for isolated venous pulsatile tinnitus (IVPT). This retrospective study aimed to evaluate the the clinical outcomes and associated factors of Precise stent (Cordis) implantation in the management of IVPT. We analyzed data from IVPT patients treated at our center between December 2009 and August 2024. Baseline characteristics, venous sinus morphology, endovascular techniques, clinical outcomes, and follow-up data were reviewed. Among 111 IVPT patients, 64 (57.7

BACKGROUND:The clinical profile of cluster headache may differ among different regions of the world, warranting interest in the data obtained from the initial Chinese Cluster Headache Register Individual Study (CHRIS) for better understanding. METHODS:We conducted a multicenter, prospective, longitudinal cohort study on cluster headache across all 31 provinces of China, aiming to gather clinical characteristics, treatment approaches, imaging, electrophysiological and biological samples. RESULTS:In total 816 patients were enrolled with a male-to-female ratio of 4.33:1. The mean age at consultation was 34.98 ± 9.91 years, and 24.89 ± 9.77 years at onset. Only 2.33% were diagnosed with chronic cluster headache, and 6.99% had a family history of the condition. The most common bout was one to two times per year (45.96%), lasting two weeks to one month (44.00%), and occurring frequently in spring (76.23%) and winter (73.04%). Of these, 68.50% experienced one to two attacks per day, with the majority lasting one to two hours (45.59%). The most common time for attacks was between 9 am and 12 pm (75.86%), followed by 1 am and 3 am (43.48%). Lacrimation (78.80%) was the most predominant autonomic symptom reported. Furthermore, 39.22% of patients experienced a delay of 10 years or more in receiving a correct diagnosis. Only 35.67% and 24.26% of patients received common acute and preventive treatments, respectively. CONCLUSION:Due to differences in ethnicity, genetics and lifestyle conditions, CHRIS has provided valuable baseline data from China. By establishing a dynamic cohort with comprehensive multidimensional data, it aims to advance the management system for cluster headache in China.

Patients with migraine often experience not only headache pain but also cognitive dysfunction, particularly in attention, which is frequently overlooked in both diagnosis and treatment. The influence of these attentional deficits on the pain-related clinical characteristics of migraine remains poorly understood, and clarifying this relationship could improve care strategies. This study included 52 patients with migraine and 34 healthy controls. We employed the Attentional Network Test for Interactions and Vigilance–Executive and Arousal Components paradigm, combined with electroencephalography, to assess attentional deficits in patients with migraine, with an emphasis on phasic alerting, orienting, executive control, executive vigilance, and arousal vigilance. An extreme gradient boosting binary classifier was trained on features showing group differences to distinguish patients with migraine from healthy controls. Moreover, an extreme gradient boosting regression model was developed to predict clinical characteristics of patients with migraine using their attentional deficit features. For general performance, patients with migraine presented a larger inverse efficiency score, a higher prestimulus beta-band power spectral density and a lower gamma-band event-related synchronization at Cz electrode, and stronger high alpha-band activity at the primary visual cortex, compared to healthy controls. Although no behavior differences in three basic attentional networks were found, patients showed magnified N1 amplitude and prolonged latency of P2 for phasic alerting-trials as well as an increased orienting evoked-P1 amplitude. For vigilance function, improvements in the hit rate of executive vigilance-trials were exhibited in controls but not in patients. Besides, patients with migraine exhibited longer reaction time as well as larger variability in arousal vigilance-trials than controls. The binary classifier developed by such attentional deficit features achieved an F1 score of 0.762 and an accuracy of 0.779 in distinguishing patients with migraine from healthy controls. Crucially, the predicted value available from the regression model involving attentional deficit features significantly correlated with the real value for the frequency of headache. Patients with migraine demonstrated significant attentional deficits, which can be used to differentiate migraine patients from healthy populations and to predict clinical characteristics. These findings highlight the need to address cognitive dysfunction, particularly attentional deficits, in the clinical management of migraine.

Objective Migraine has been demonstrated to exhibit abnormal functional connectivity of large‐scale brain networks, which is closely associated with its pathophysiology and has not yet been explored by edge functional connectivity. We used an edge‐centric approach combined with motif analysis to evaluate higher‐order communication patterns of brain networks in migraine. Methods We investigated edge‐centric metrics in 108 interictal migraine patients and 71 healthy controls. We parcellated the brain into networks using independent component analysis. We applied edge graph construction, k‐means clustering, community overlap detection, graph‐theory‐based evaluations, and clinical correlation analysis. We conducted motif analysis to explore the interactions among regions, and a classification model to test the specificity of edge‐centric results. Results The normalized entropy of lateral thalamus was significantly increased in migraine, which was positively correlated with the baseline headache duration, and negatively correlated with headache duration reduction following preventive medications at 3‐month follow‐up. Network‐wise entropy of the sensorimotor network was significantly elevated in migraine. The community similarity between lateral thalamus and postcentral gyrus was enhanced in migraine. Migraine patients showed overrepresented L‐shape and diverse motifs, and underrepresented forked motifs with lateral thalamus serving as the reference node. Furthermore, migraine patients presented with overrepresented L‐shape triads, where the postcentral gyrus shared different edges with the lateral thalamus. The classification model showed that entropy of the lateral thalamus had the highest discriminative power, with an area under the curve of 0.86. Interpretation Our findings indicated an abnormal higher‐order thalamo–cortical communication pattern in migraine patients. The thalamo–cortical–somatosensory disturbance of concerted working may potentially lead to aberrant information flow and deficit pain processing of migraine. ANN NEUROL 2023;94:1168–1181

METHODS:Thirty-three consecutive patients with 34 TVIAs were prospectively recruited and treated with endovascular techniques. The volume of TVIAs and the required length of coils were calculated by the AngioSuite software before embolization. The treatment efficacy of TVIAs was assessed using the Raymond scale (Rs) and the modified Rankin scale (mRs).RESULTS:Of the 34 aneurysms with an average volume of 7.16 mm3, 13 aneurysms were treated with sole coil embolization, 19 by stent-assisted embolization, and 2 by balloon-assisted embolization. The average coil length was 5.32 cm, and the average packing density was 41.21%. The immediate DSA showed that total occlusion (Rs = 1) was achieved in 15 aneurysms, subtotal (Rs = 2) in 9, and partial (Rs = 3) in 11. Total occlusion was achieved in 30 aneurysms and subtotal in the other 4 aneurysms at 6-month follow-up. Baseline volume and diameter of aneurysms were significantly correlated with the coil length (r = 0.801, P < 0.001; r = 0.711, P < 0.001).CONCLUSIONS:Coil embolization of TVIAs was easy to achieve high packing density. According to the data from AngioSuite, relative few coils can increase the safety in procedure and stenting may reduce risk of aneurysmal recurrence.

Drainage dysfunction of stenotic internal jugular veins (IJVs) is considered an etiology of cough headache as a result of fluctuation and imbalance of intracranial pressure.

METHODS:Between January 2016 and October 2018, sixty-four consecutive patients who underwent a total of 66 stenting procedures were screened for symptomatic and asymptomatic atherosclerotic VAOS. Of these patients, 57 had complete follow-up data. The baseline patient demographics and morphological features of the VAO were recorded. Potential factors influencing ISR, including conventional cerebrovascular disease risk factors, were assessed, together with outcome events including recurrent transient ischemic attack (TIA), stroke, and vascular-related mortality.RESULTS:The average follow-up period was 13.2 ± 4.6 months. Technical success was achieved in all interventions. The degree of stenosis was reduced from 77.2 ± 6.1% to 13.7 ± 8.9% after the procedure. ISR was detected in eight treated vessels (14.0%) and occlusion in two (5.3%) arteries. Of the 57 patients, one had an ischemic stroke and 5 had TIAs. The angle of the VAO at the subclavian artery was associated with the risk of restenosis (preoperative, P = 0.04; postoperative, P = 0.02).CONCLUSIONS:Stenting is a feasible and effective treatment for VAOS. The angle of the VAO at the subclavian artery may contribute to the development of ISR.

Background Vascular angioplasty and stenting of middle cerebral artery (MCA) and basilar artery (BA) stenoses are associated with poor clinical outcomes and high mortality rates thought to be related to the abundance of perforating arteries in those segments. This study explores the use of Solitaire AB as an off-label vascular stent to treat stenoses in the MCA and BA. Methods Solitaire AB stents were placed during angioplasty and stenting of MCA and BA stenoses in patients at our department between January 2015 and May 2017 with 6-36 months follow-up. Operative results were assessed by follow-up angiography and transcranial doppler after the procedure. Neurologic status was evaluated before and after treatment according to the modified Ranking Scale (mRS). Results A total of 32 patients were included in the study. Seventeen (53.12%) patients presented with MCA stenosis and 15 (46.87%) with BA stenosis. The 30-day rate of procedure-related complications was 3.1% (1/32). Post-stenting residual stenosis degrees ranged from 0% to 40% (mean 13.44% ± 10.66%). Mean degree of residual stenosis in 26 patients followed up by DSA was 8.64% ± 9.67%. The mRS 0-2 was achieved in all (100%) patients at 6-12 months post-procedure. Conclusions Our study indicates the off-label use of Solitaire AB for stenting is effective and safe for MCA and BA stenoses with high technical success and low complications. We recommend that lesion-specific therapy with an anatomically fitted stent design enables optimal treatment for intracranial stenosis.

Background The diagnostic criteria for headache attributable to cranial venous sinus stenting were first formalized in the recently published third edition of the International Classification of Headache Disorders (ICHD-3). However, the diagnostic criteria for headache caused by cranial venous sinus stenting are based on very few data and the condition is poorly characterized. Objectives To validate the diagnostic criteria for cranial venous sinus stenting headache by retrospectively studying the characteristics of headache in patients with isolated pulsatile tinnitus who underwent curative cranial venous sinus stenting and who had not previously complained of headache. Patients and methods We retrospectively studied clinical, radiological, and manometric data from patients with isolated venous pulsatile tinnitus who had not previously reported headache. All patients underwent lateral sinus stenting in our institution between October 2010 and February 2018. Results Forty eight patients, 47 females and one male, were enrolled. The mean age at symptom onset was 36.2 ± 8.7 years and the mean body mass index was 24.0 ± 3.2 kg/m2. Lateral sinus stenosis was evident in 47 patients and a sigmoid diverticulum in one. Fourteen patients experienced headaches after recovering from general anesthesia. All were female, with a mean age of 35.5 ± 9.6 years. Headache persisted for less than 3 days in six patients (42.8%); for 3 days to 3 months in four (28.6%); and for longer than 3 months in four (28.6%). The headaches were located on the same sides as the cranial venous sinus stents in 13 patients (92.9%) and were principally occipital, being oppressive in nine patients (64.3%) and of moderate intensity in seven (50%). Age at onset of pulsatile tinnitus and body mass index were significantly associated with headache (p < 0.05; t-test). Conclusion To the best of our knowledge, this is the first study to describe cranial venous sinus stenting headache in detail. We found that de novo headache developed after cranial venous sinus stenting, and was usually mild to moderate, unilateral, but oppressive; almost one-third of such headaches persisted for more than 3 months. Researchers and clinicians must become familiar with this headache spectrum; further prospective studies are required.

目的:分析急性缺血性卒中相关头痛与脑梗死部位和前后循环分布的关系.方法:回顾性收集我院515例诊断为"急性缺血性卒中"的住院病人,收集卒中和头痛资料,分析不同梗死部位和前后循环头痛发生率以及头痛部位与前后循环、梗死侧别的相关性.结果:515例急性缺血性卒中病人总体头痛发生率为7％,枕叶受累脑梗死病人头痛发生率明显高于枕叶未受累者,前循环系统梗死病人右侧半球脑梗死头痛发生率明显高于左侧,头痛部位与梗死前后循环分布、梗死侧别均无明显相关性.结论:急性缺血性卒中头痛的发生与脑梗死部位可能有一定关系,其中累及枕叶的脑梗死更容易发生头痛,头痛部位不能预测梗死部位或供应血管.