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Background: Because the prevalence and characteristics of primary headache have yet to be thoroughly studied in patients with hypersomnia disorders, including narcolepsy and idiopathic hypersomnia, we examined these parameters in the Japanese population., Methods: In a multicentre cross-sectional survey, among 576 consecutive outpatients with sleep disorders, 68 narcolepsy patients and 35 idiopathic hypersomnia patients were included. Additionally, 61 healthy control subjects participated. Semi-structured headache questionnaires were administered to all participants., Results: The patients with narcolepsy (52.9%) and idiopathic hypersomnia (77.1%) more frequently experienced headache than the healthy controls (24.6%; p<0.0001). The prevalence rates were 23.5%, 41.2% and 4.9% for migraine (p<0.0001) and 16.2%, 23.5% and 14.8% (p = 0.58) for tension-type headache among the narcolepsy patients, the idiopathic hypersomnia patients and the control subjects, respectively. Those who experienced migraine more frequently experienced excessive daytime sleepiness, defined as an Epworth Sleepiness Scale score of ≥10, than those who did not experience headache among the patients with narcolepsy (93.8% vs. 65.6%, p = 0.040) and idiopathic hypersomnia (86.7% vs. 37.5%, p = 0.026). Dream-enacting behaviour (DEB), as evaluated by the rapid eye movement sleep disorders questionnaire, was more frequently observed in the narcolepsy patients than in the idiopathic hypersomnia patients and the control subjects. An increased DEB frequency was observed in the narcolepsy patients with migraines compared to those without headache., Conclusions: Migraines were frequently observed in patients with narcolepsy and idiopathic hypersomnia. DEB is a characteristic of narcolepsy patients. Further studies are required to assess the factors that contribute to migraines in narcolepsy and idiopathic hypersomnia patients.

Acute hemicerebellitis, marked by headache with or without cerebellar signs, is a rare clinical entity involving a unilateral cerebellar hemisphere. The pathogenesis of acute hemicerebellitis remains unclear, and the disease rarely occurs in adults. Here, we report an 18-year-old woman who presented with a lack of coordination of the right hand and leg lasting longer than one week, following a pulsatile headache. A neurological examination disclosed ocular dysmetria, right-sided limb ataxia and slight truncal ataxia. Cerebrospinal fluid analysis showed mononuclear pleocytosis. The serology and autoimmune studies were unremarkable. Brain magnetic resonance imaging (MRI) revealed a focal signal change in the right cerebellar hemisphere and vermis. Acute hemicerebellitis was diagnosed, and the patient was treated with intravenous methylprednisolone sodium succinate and acyclovir. Subsequently, the headache resolved, and the cerebellar signs were markedly improved. Twenty days after admission, she became asymptomatic and brain MRI showed resolution of cerebellar hyperintensity on the right side. In conclusion, we identified only 6 additional patients with adult-onset acute hemicerebellitis from previous reports, highlighting the importance of recognizing this rare clinical entity. Its clinical outcome is usually favorable, but in the acute phase, attention should be directed toward clinical symptoms that are suggestive of increased intracranial pressure., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Objective: The importance of psychiatric comorbidity in migraine has long been recognized. There is a growing body of evidence that these psychiatric comorbidities share diverse epidemiological properties, pathophysiological mechanisms, and treatment response. The prevalence of psychiatric comorbidities is high in patients with medication-overuse headache (MOH)., Methods: To understand the characteristics of mood disorders in MOH in Japanese patients, we studied and evaluated the characteristics of psychiatric comorbidities in MOH., Results: The results suggested that mood disorders in MOH are similar to those in endogenous depression but different from those of secondary mood disorders associated with other diseases. Suspicion of depression and intervention are essential for providing medical care for patients with MOH., Conclusion: Affective disorders diagnosed in migraine patients might later progress to MOH. In contrast, migraine patients without MOH and healthy subjects had a similar prevalence of mood disorders.

Background: Surveys using questionnaires to collect epidemiologic data may be subject to misclassification. Here, we analyzed a headache questionnaire to evaluate which questions led to a classification other than migraine. Methods: Anonymized surveys coupled with medical claims data from individuals 19–74 years old were obtained from DeSC Healthcare Inc. to examine proportions of patients with primary headache disorders (i.e.; migraine, tension-type headache, cluster headache, and "other headache disorders"). Six criteria that determined migraine were used to explore how people with other headache disorders responded to these questions. Results: Among the 21480 respondents, 7331 (34.0%) reported having headaches. 691 (3.2%) respondents reported migraine, 1441 (6.7%) had tension-type headache, 21 (0.1%) had cluster headache, and 5208 (24.2%) reported other headache disorders. Responses of participants with other headache disorders were analyzed, and the top 3 criteria combined with "Symptoms associated with headache" were "Site of pain" (7.3%), "Headache changes in severity during daily activities" (6.4%), and the 3 criteria combined (8.8%). The symptoms associated with headache were "Stiff shoulders" (13.6%), "Stiff neck" (9.4%), or "Nausea or vomiting" (8.7%), Photophobia" (3.3%) and "Phonophobia" (2.5%). Conclusions: Prevalence of migraine as diagnosed by questionnaire was much lower than expected while the prevalence of "other headache" was higher than expected. We believe the reason for this observation was due to misclassification, and resulted from the failure of the questionnaire to identify some features of migraine that would have been revealed by clinical history taking. Questionnaires should, therefore, be carefully designed, and doctors should be educated, on how to ask questions and record information when conducting semi-structured interviews with patients, to obtain more precise information about their symptoms, including photophobia and phonophobia. Highlights: It is difficult to correctly identify "symptoms associated with headache" in a single response survey. Surveys with questions regarding photophobia and phonophobia should be carefully designed to help headache classification. It is necessary to educate patients to understand the symptoms of photophobia and phonophobia. [ABSTRACT FROM AUTHOR]

Background: Anti-calcitonin gene-related peptide monoclonal antibodies (CGRPmAbs) have greatly changed migraine treatment options. In Japan, although CGRPmAb guidelines (≥ 4 monthly migraine days (MMDs) and ≥ 1 previous preventive failure) are well-acknowledged, the actual use of CGRPmAbs and the circumstances of the related headache care are unknown. Methods: We conducted an online survey of Japanese Headache Society members, inquiring about the physicians' experience with CGRPmAbs and how they make decisions related to their use. Results: Of the 397 respondents, 320 had prescribed CGRPmAbs. The threshold number of previous preventive failures for recommending a CGRPmAb was two for the majority of the respondents (n = 170, 54.5%), followed by one (n = 64, 20.5%). The MMD threshold was ≥ 4 for 71 respondents (22.8%), ≥ 6 for 68 (21.8%), ≥ 8 for 76 (24.4%), and ≥ 10 for 81 (26.0%). The respondents tended to assess treatment efficacy after 3 months (episodic migraine: n = 217, 69.6%, chronic migraine: n = 188, 60.3%). The cost of CGRPmAbs was described by many respondents in two questions: (i) any request for a CGRPmAb (27.7%), and (ii) the most frequently reported reason for responders to discontinue CGRPmAbs (24.4%). Conclusions: Most of the respondents recommended CGRPmAbs to patients with ≥ 2 preventive failures, followed by ≥ 1. The MMD threshold ranged mostly from ≥ 4 to ≥ 10. The concern for costs was raised as a major limiting factor for prescribing CGRPmAbs. [ABSTRACT FROM AUTHOR]

Background: Migraine is a chronic disease characterized by episodic headache attacks. No recent studies have, however been conducted on the epidemiology of migraine or the treatment landscape in Japan. This study was conducted as a fact-finding survey using medical claims data and an online survey on migraine and headaches, conducted among members of health insurance associations with the objective of gaining an understanding of migraine prevalence and the treatment status in Japan. Methods: The study methodology utilized a unique approach of combined data sources. The data sources used in this study are medical claims data and linked online survey data provided by DeSC Healthcare Inc (DeSC). The primary outcomes (from survey responses) were: the overall number and proportion of migraine patients; and the overall prevalence of migraine, stratified by age and sex. The secondary outcomes (from survey responses) were use of medical care; and clinical features/headache symptoms. The analysis population included all individuals who had response data for surveys conducted by DeSC. The online survey data and medical claims data were summarized. Results: The data population comprised 21,480 individuals. On the basis of the survey results, including probable cases, the overall prevalence of migraine was 3.2%. The highest prevalence of migraine was observed in patients aged 30–39 years. The prevalence of migraine in women was 4.4 times higher than in men. The percentage of migraine patients who had not been seen by a doctor was 81.0%. More than 80% of patients were taking over-the-counter drugs and 4.8% took prescription medicines only. Approximately 52.9% of patients considered that the intensity of pain symptoms was severe. Moreover, the majority of patients (72.9%) considered that the impairment of daily life activities was of moderate or severe degree. Conclusions: In Japan, the percentage of people with migraine who did not receive medical attention is as high as 80%. Additionally, the majority of patients tend to endure symptoms and continue with everyday activities. With innovative treatment approaches becoming available it is necessary to disseminate information that migraine is not a simple headache but an illness that requires medical treatment and consultation. [ABSTRACT FROM AUTHOR]

Background: Cranial autonomic symptoms (CASs) during migraine attacks are reported to be quite common regardless of ethnicity. In our previous study investigating 373 migraineurs, we found that 42.4% of them had CASs. The patients with CASs more frequently had cutaneous allodynia than did those without CASs, and we speculated that CASs were associated with central sensitization. The present study searched for substantial evidence on the relationship between CASs and central sensitization in migraine patients.Methods: This was a prospective cross-sectional study. We studied a new independent cohort of 164 migraineurs who presented to the Tominaga Hospital Headache Center from July 2018 until December 2019. The clinical features of CASs according to the criteria in ICHD-3 (beta) were investigated. We also evaluated central sensitization based on the 25 health-related symptoms utilizing the validated central sensitization inventory (CSI), and each symptom was rated from 0 to 4 resulting a total score of 0-100.Results: The mean age was 41.8 (range: 20 to 77) years old. One hundred and thirty-one patients (78.9%) were women. Eighty-six of the 164 (52.4%) patients had at least 1 cranial autonomic symptom. The CSI score of the patients with ≥3 CASs reflected a moderate severity and was significantly higher than in those without CASs (41.9 vs. 30.7, p = 0.0005). The score of the patients with ≥1 conspicuous CAS also reflected a moderate severity and was significantly higher than in those without CASs (40.7 vs. 33.2, p = 0.013). The patients in the CSI ≥40 group had lacrimation, aural fullness, nasal blockage, and rhinorrhea, which are cranial autonomic parasympathetic symptoms, significantly more frequently than those in the CSI < 40 group.Conclusions: Migraine patients with CASs showed significantly greater central sensitization than those without such symptoms. In particular, cranial parasympathetic symptoms were more frequent in centrally sensitized patients than in nonsensitized patients, suggesting that cranial parasympathetic activation may contribute to the maintenance of central sensitization.Trial Registration: This study was retrospectively registered with UMIN-CTR on 29 Aug 2020 ( UMIN000041603 ). [ABSTRACT FROM AUTHOR]

The ObserVational survey of the Epidemiology, tReatment, and Care Of MigrainE study in Japan (OVERCOME [Japan]) aimed to provide an up-to-date assessment of migraine epidemiology in Japan. OVERCOME (Japan) was a cross-sectional, population-based web survey of Japanese adults recruited from consumer panels. People with active migraine (met modified International Classification of Headache Disorders, 3rd edition [ICHD-3] criteria or had a self-reported physician diagnosis of migraine) answered questions about headache features, physician consultation patterns, and migraine medication use. The burden and impact of migraine were assessed using Migraine Disability Assessment (MIDAS) and Work Productivity and Activity Impairment scales. In total, 231,747 respondents accessed the screener, provided consent, and were eligible for the survey. The migraine group included 17,071 respondents (mean ± SD age 40.7 ± 13.0 years; 66.5% female). ICHD-3 migraine criteria were met by 14,033 (82.2%) respondents; 9667 (56.6%) self-reported a physician diagnosis of migraine. The mean number of monthly headache days was 4.5 ± 5.7 and pain severity (0–10 scale) was 5.1 ± 2.2. In the migraine group, 20.7% experienced moderate to severe migraine-related disability (MIDAS score ≥ 11). Work productivity loss was 36.2% of work time missed, including 34.3% presenteeism. Only 57.4% of respondents had ever sought medical care for migraine/severe headache. Most respondents (75.2%) were currently using over-the-counter medications for migraine; 36.7% were using prescription nonsteroidal anti-inflammatory drugs, and only 14.8% were using triptans. Very few (9.2%) used preventive medications. Unmet needs for migraine health care among people with migraine in Japan include low rates of seeking care and suboptimal treatment. [ABSTRACT FROM AUTHOR]

Background: Primary brain calcification (PBC) is a rare neurodegenerative disorder characterized by bilateral calcification in the brain. No nationwide survey on headache has been performed in Japan. Aim: A questionnaire survey was performed to clarify the situation of headache in PBC patients. Methods: The first questionnaire survey was conducted on 173 patients diagnosed as having PBC in Japan. Subsequently, the second survey was performed using two types of questionnaire: Headache Impact Test (HIT‐6) and Migraine Disability Assessment (MIDAS). Results: In the first survey, 27 of 82 patients had headaches. Only one patient was able to be classified in accordance with the criteria as having migraine without aura. In the second survey, 10 of 17 patients showed a significant score of 50 and higher in HIT‐6, and five of 17 patients showed a significant score of 6 and higher in MIDAS. No significant correlation was found between total calcification score and HIT‐6 score or MIDAS score in the second survey. All patients carrying the PDGFB variant and two of three patients carrying the SLC20A2 variant showed some effects of headache on their daily life as judged from their MIDAS scores or HIT‐6 score. Conclusions: The headaches in PBC patients could not be classified as the primary headache. Those headaches in PBC patients may be of the secondary headache caused by the dysfunction of the blood‐brain barrier. This first report on headaches of Japanese patients with PBC will contribute to the understanding of PBC patients' difficulties in their daily lives. [ABSTRACT FROM AUTHOR]

Objective: Sensory hypersensitivities such as photophobia, phonophobia, and osmophobia are common in patients with migraine. We investigated the burden of these multiple sensory hypersensitivities in migraine. Methods: In this cross-sectional study, 187 consecutive patients with migraine (26 men/161 women; age, 45.9 ± 13.2 years) were included. Sensory hypersensitivity symptoms such as photo−/phono−/osmophobia and accompanying symptoms were determined by neurologists in interviews. The Migraine Disability Assessment (MIDAS) was used to assess headache-related disability. The Kessler Psychological Distress Scale (K6) was also administered. Results: Photophobia, phonophobia and osmophobia were observed in 75.4%, 76.5% and 55.1% of the patients with migraine, respectively. A significant overlap in sensory hypersensitivities (photo−/phono−/osmophobia) was found; the proportions of patients with 2 and 3 coexisting sensory hypersensitivities were 33.2% and 41.7%, respectively. The MIDAS score was higher in those with 3 sensory hypersensitivity symptoms than in those with 0 to 2 sensory hypersensitivity symptoms. A generalized linear model with ordinal logistic regression analysis revealed that multiple sensory hypersensitivities, younger age, more migraine days per month, and a higher K6 score were significantly related to the higher MIDAS score. Conclusion: Our study showed that sensory hypersensitivities commonly occur and overlap in patients with migraine and that multiple sensory hypersensitivity symptoms have a significant impact on headache-related disability. [ABSTRACT FROM AUTHOR]

Objective: A phase 2, double‐blind, placebo‐controlled study to evaluate the efficacy and safety of erenumab for the prevention of episodic migraine in Japanese patients was conducted. Background: Previous global clinical studies have demonstrated the efficacy of erenumab in the prevention of migraine. Methods: Patients were randomized to placebo or erenumab 28, 70, or 140 mg administered subcutaneously once per month for 6 months. The primary endpoint was change from baseline in mean monthly migraine days over months 4‐6 of the double‐blind treatment phase. Secondary endpoints included the proportion of patients achieving ≥50% reduction from baseline in mean monthly migraine days (≥50% response) and change from baseline in mean monthly acute migraine‐specific medication treatment days (MSMD) and mean Headache Impact Test (HIT‐6™) scores. Efficacy outcomes were also determined at months 1, 2, and 3. Results: Four hundred and seventy five patients were randomized 2:1:2:2 to placebo and erenumab 28, 70, and 140 mg, respectively. Greater reductions in monthly migraine days were observed for erenumab vs placebo with differences of –1.25 (95% CI: –2.10 to –0.41; P = .004), –2.31 (95% CI: –3.00 to –1.62; P < .001), and –1.89 (95% CI: –2.58 to –1.20; P < .001) days for erenumab 28, 70, and 140 mg. The odds of having a ≥50% response were 3.2, 5.6, and 4.7 times greater for erenumab 28 mg (95% CI: 1.30‐7.88; P = .009), 70 mg (95% CI: 2.60‐12.06; P < .001), and 140 mg (95% CI: 2.24‐9.99; P < .001) than for placebo. Greater reductions from baseline in mean acute monthly MSMD were observed for erenumab vs placebo with differences of –1.07 (95% CI: –1.80 to –0.35; P = .004), –2.07 (95% CI: –2.66 to –1.49; P < .001), and –2.04 (95% CI: –2.63 to –1.45; P < .001) days for erenumab 28, 70, and 140 mg. Erenumab 70 and 140 mg also resulted in greater improvements in HIT‐6™ scores. The safety profile was similar across treatment groups. The most common adverse event was nasopharyngitis, which occurred in 29.4% of patients in the placebo group and 28.9%‐33.3% of patients in the erenumab groups. Conclusion: Monthly subcutaneous injections of erenumab 70 mg demonstrated statistically significant and numerically maximal efficacy with a favorable safety profile, suggesting that erenumab is a potential new therapy for migraine prevention in Japan. [ABSTRACT FROM AUTHOR]

A correction is presented to the article "A Study to Investigate the Prevalence of Headache Disorders and Migraine Among People Registered in a Health Insurance Association in Japan" which appeared in the 2022 issue.

Background: Medication‐overuse headache (MOH) is one of the most common chronic headache disorders and represents a public health problem. Aim: As we have encountered cases of MOH treated effectively using yokukansan, we planned to analyze the effects of yokukansan on MOH in patients with migraine. Methods: To analyze the effects of yokukansan on MOH in patients with migraine, we planned the study using a double‐blind, randomized, and placebo‐controlled trial. Results: We started to register patients from October 2015, enrolling eight patients in 2015, 35 patients in 2016, 19 patients in 2017, and nine patients as of the time of writing in 2018. We have now collected 71 cases, but recruitment to the trial has not been completed. We need to register more cases to reach the desired number of 80. Conclusion: This article presents the protocol for a double‐blind, randomized, and placebo‐controlled trial to collect evidence of the effects of yokukansan on MOH. The final objective of this study is to reduce headache in MOH while maintaining patient quality of life in good condition. [ABSTRACT FROM AUTHOR]

The article discusses Parkinson's Disease (PD) patients with headache or migraine showed a pronounced reduction in the overall severity of their headaches after the onset of PD. Topics include PD onset include chronic dopaminergic treatment and degeneration of the brainstem nuclei; and the migraine group had a higher prevalence of poor sleeper, PD-related sleep problems, and depression than the no-headache and non-migraine headache groups.

Abstract We studied headache associated with sleep apnea syndrome (SAS) in 36 SAS inpatients (mean age: 45.5 years; mean body mass index: 31.0 kg/m2 ; mean apnea–hypopnea index: 53.3/h). Thirteen of the patients (36.1%) complained of headache, which occurred in the morning in all cases. These 13 patients complained more of unrefreshing sleep than the patients without a headache, and their Epworth Sleepiness Scale scores were significantly higher (P < 0.05). Unrefreshing sleep and daytime sleepiness seem to be associated with morning headache in SAS patients. [ABSTRACT FROM AUTHOR]

Background Previous studies have reported a lower migraine prevalence in Parkinson's disease (PD) patients and improvements in migraine headaches after PD onset, but the clinical association of migraines with PD is unclear. Methods We analysed headache and migraine prevalence and clinical correlates in 436 PD patients (mean age, 69.3 ± 7.8 years) and 401 age- and sex-matched controls (mean age, 69.2 ± 8.6 years) in a case-controlled, multicentre study. Migraines were diagnosed by a questionnaire developed according to the International Classification of Headache Disorders, second edition. We evaluated changes in headache intensity, frequency and severity over several years around the onset of PD among PD patients with headaches or migraines, and over the past several years among control subjects with headaches or migraines. Results PD patients had lower lifetime (9.6% vs. 18.0%) and 1-year (6.7% vs. 11.0%) migraine prevalences than controls. However, lifetime (38.5% vs. 38.9%) and 1-year (26.1% vs. 26.2%) headache prevalence did not differ between PD patients and controls. After adjusting for gender, timing of the evaluation of headache changes, and recall period, PD patients with headaches or migraines exhibited a pronounced reduction in the intensity, frequency and overall severity of their headaches and migraines after the onset of PD compared with controls with headaches or migraines. PD patients with migraines exhibited a higher rate of depression and higher Pittsburgh Sleep Quality Index and PD sleep scale-2 scores than those without headaches. Conclusion While overall headache and migraine severity reduced after PD onset, the presence of migraines was associated with sleep disturbances and depression in PD patients. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the prevalence and characteristics of typical aura without headache (TAWH) in Japan. We distributed a self-report questionnaire comprising seven items. Of 1914 cases, the number of patients who provided valid answers was 1063. They included 1063 out-patients with 81 of these patients positive in the ID migraine screener Japanese version. TAWH was diagnosed in 35 patients (3.2%), aged 23–87 years, and included 12 males and 23 females. The age of patients with TAWH showed a biphasic distribution (20–39 years and 60–69 years), similar to the age distribution of all patients. Migraine with aura was diagnosed in 67 patients (6.3%) and showed a monophasic age distribution (40–49 years). These data suggest that TAWH is not a rare headache type in clinics especially in a setting of general ophthalmology clinics, and some patients of migraine with aura may transform to TAWH with ageing. [ABSTRACT FROM AUTHOR]