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Background: Headache disorders are among the most prevalent neurological disorders worldwide. However, whether groups differing in socioeconomic position (SEP) are disproportionately affected by headache disorders has not yet been adequately clarified. Our aim was to analyse (1) the headache prevalence by socioeconomic position (SEP) and (2) the attack frequency by SEP in a German population-based adult sample., Methods: Cross-sectional data from a random general population were used. The sample included N = 2,189 participants aged ≥ 18 years. SEP was measured using net equivalised income (NEI) and education. A binary logistic regression model tested the effect of SEP in predicting the prevalence of headache in general. Ordinal logistic regressions were modeled to predict the effect of SEP on the likelihood of attack frequency. Attack frequency was categorized in low frequency episodic headache (LFEH: 0-3 days per month), moderate frequency episodic headache (MFEH: 4-14 days per month) and chronic headache (CH: ≥ 15 days per month)., Results: Of the 2,189 participants, 891 reported headache in the last six months. Neither income nor education was associated with headache prevalence. However, significant differences between income groups were found for attack frequency. Compared to participants with NEI > 150%, those with NEI < 60% were 5.21 times more likely (95%CI 2.03, 13.36) to experience higher headache frequency, and those with NEI between 60 and 150% were 2.29 times more likely (95%CI 1.02, 5.11), with adjustments made for a set of potential confounders, including depressive symptoms., Conclusions: To reduce headache attacks, it is essential to address both low- and middle-income groups affected by headaches. Universal public health prevention campaigns are particularly appropriate., (© 2024. The Author(s).)

Introduction: Despite having sufficient formal education, a large group of people cannot complete everyday tasks like reading, writing, or making basic calculations. Regarding reading, millions of people are not able to understand more complex texts despite the ability to read simple words or sentences; they have low literacy skills. Even though this problem has been known for decades, the causes and predictors of their poor reading comprehension skills are not fully explored. Socioeconomic, sociodemographic, and reading-related (i.e., linguistic) factors, especially of English-speaking participants and thus users of an opaque orthography, were often assessed. The goal of this study was to examine which linguistic, domain-general, or numerical factors predict substandard complex text reading as the core symptom of low literacy skills in adulthood., Methods: To this end, we assessed a group of German-speaking participants-users of a transparent orthography-who are at risk for complex text reading deficits., Results: The results indicated that linguistic variables (reduced word/pseudoword reading, weaker oral semantic and grammatical comprehension), working memory, and age predicted lower performance in text comprehension. This model explained 73% of the total variance, indicating that most of the deficits in complex text reading can be explained by a group of basic underlying linguistic and domain-general factors., Discussion: We conclude that interventions for adults with low literacy skills and others at risk for complex text reading deficits should address word/pseudoword reading and focus on both written and oral comprehension., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Vágvölgyi, Sahlender, Schröter, Nagengast, Dresler, Schrader and Nuerk.)

Background: The Migraine Disability Assessment (MIDAS) is widely used. However, there are limited data on how much a reduction in the MIDAS score indicates a change that matters to the patient., Methods: Data from the DMKG (i.e. German Migraine and Headache Society) Headache Registry were used to determine the minimal important difference (MID) of the MIDAS, using the Patient Global Impression of Change (PGIC) as anchor and applying average change and receiver operating characteristic curve methods., Results: In total, 1218 adult migraine patients (85.6% female, 40.2 ± 12.8 years, baseline MIDAS 44.2 ± 47.4, follow-up MIDAS 36.5 ± 45.3) were included. For patients with baseline MIDAS >20 (MIDAS grade IV, n = 757), different methods using PGIC "somewhat improved" as anchor yielded percent change MIDs of the MIDAS between -29.4% and -33.2%. For baseline MIDAS between 6 and 20 (grades II and III, n = 334), using PGIC "much improved" as anchor, difference change MIDs were between -3.5 and -4.5 points., Conclusions: Based on the above results, we estimated the MID of the MIDAS at -30% for patients with a baseline MIDAS >20, and at -4 points for those with a baseline MIDAS of 6-20, for a tertiary headache care population., Trial Registration: The DMKG Headache Registry is registered with the German Clinical Trials Register (DRKS 00021081)., Competing Interests: Declaration of conflicting interestsRR has received travel grants and/or honoraria for lectures or advisory boards from Allergan/AbbVie, Lilly, Lundbeck, Novartis, Pfizer and TEVA. GG has received honoraria from Lilly, Novartis Pharma, TEVA, Lundbeck, and research grants from Novartis Pharma during the last three years. She does not hold any stocks of pharmaceutical companies. TD has received honoraria for consulting and lectures from Hormosan Pharma, Novartis Pharma, and TEVA. TF received honoraria for advisory boards from Novartis, TEVA and Lundbeck and honoraria for lectures from Novartis, TEVA, Lilly, Bayer and UCB. SF has received honoraria from Allergan/AbbVie, Hormosan, Eli Lilly, Lundbeck, Novartis, Sanofi and TEVA. She served on Advisory Boards for Hormosan, Eli Lilly, Lundbeck, Novartis, Sanofi and TEVA. CG has received honoraria for consulting and lectures within the past three years from Abbvie, Lilly, Novartis Pharma, Hormosan Pharma, Grünenthal, Sanofi-Aventis, Lundbeck, Perfood, Reckitt, Chordate and TEVA. His research is supported by a grant of the German Research Foundation (DFG). He does not hold any stocks of pharmaceutical companies. TK has received travel grants and/or honoraria from Allergan/AbbVie, Hormosan, Lilly, Novartis and TEVA. LN has received honoraria for lectures and consulting within the past three years from Abbvie, Lilly, Lundbeck, Novartis, Perfood and TEVA. VR received the Soyka award as a research grant from Novartis. JS declares no conflict of interest. TPJ has received honoraria from Allergan/AbbVie, Grünenthal, Hormosan, Lilly, Lundbeck, Novartis, Sanofi and TEVA. He served on Advisory Boards and/or consulted for Allergan/AbbVie, Hormosan, Lilly, Lundbeck, Novartis and TEVA.TPJ has received honoraria from Allergan/AbbVie, Grünenthal, Hormosan, Lilly, Lundbeck, Novartis, Sanofi and TEVA. He served on Advisory Boards and/or consulted for Allergan/AbbVie, Hormosan, Lilly, Lundbeck, Novartis and TEVA.

Background: Patient and public involvement (PPI) describes the participation of patients and relatives, i.e., experts by experience (EE), in the research process. The PPI has not been widely adopted in the fields of medicine and clinical psychology in Germany and there is a notable absence of institutional support. The German Center for Mental Health (DZPG), which has been under construction since May 2023, aims to achieve nationwide and cross-center implementation of PPI, constituting one of its primary objectives. Participation of EE is to be implemented in the DZPG at all levels of decision-making., Objectives: The article describes the origins, development and challenges associated with the implementation of participation structures and projects in the DZPG. The central political PPI committee in the DZPG, the Trilogue Center Council (TZR), developed a comprehensive PPI strategy for the DZPG in almost 3 years of work, before the beginning of the financial support of the DZPG. Among various measures, the strategy entails establishing a far-reaching representation for EE in all decision-making bodies of the DZPG, to involve EE as reviewers in evaluating research proposals, to integrate participatory elements into all studies of the DZGG and to foster user-initiated research endeavors. The implementation of the strategy is ensured by a cross-center PPI infrastructure, the Center for PPI, and scientific PPI consultants. The Center for PPI's tasks include supporting the voice of the EE and developing instruments and guidelines for participatory research, bringing together EE and researchers for joint DZPG projects as well as the documentation and quality assurance for participatory research. One of the particular challenges for the successful implementation of the PPI strategy is the limited experience with PPI in Germany in the field of mental health research and the widespread lack of structural implementation. Currently developed solution strategies include training for researchers and EE to communicate the benefits and pathways in the realization of PPI and thus enable shared decision-making and research. In addition, extensive access to knowledge and resources for EE will be created and uniform remuneration regulations for EE will be developed., Conclusion: A PPI strategy at the DZPG has been successfully developed and is currently being implemented by the cross-center infrastructure Center for PPI., (© 2024. The Author(s).)

Primary headaches are among the most common pain disorders. They include migraines (prevalence 15%), tension headaches (up to 80%), and others, including trigeminal autonomic headaches (about 0.2%). Migraine, in particular, leads to significant impairment of personal life and high societal costs. Therefore, the need for effective and sustainable therapeutic procedures is high. This article provides an overview of psychological procedures in headache therapy and critically summarizes the empirical evidence for the effectiveness of interdisciplinary multimodal pain therapy (IMST) consisting of psychotherapy and pharmacotherapy. It can be shown that psychoeducation, relaxation procedures, cognitive behavioral therapy, and biofeedback are psychological procedures from which headache patients can benefit. In the synopsis of multimodal approaches in the treatment of headache, consistently greater effects can be observed when both pharmacological treatment and psychotherapeutic procedures are used. This added value should be regularly taken into account in the treatment of headache disorders. This requires close cooperation between headache specialists and psychotherapists who specialize in the treatment of pain., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Humans spontaneously take the perspective of others when encoding spatial information in a scene, especially with agentive action cues present. This functional near-infrared spectroscopy (fNIRS) study explored how action observation influences implicit spatial perspective-taking (SPT) by adapting a left-right spatial judgment task to investigate whether transformation strategies underlying altercentric SPT can be predicted on the basis of cortical activation. Strategies associated with two opposing neurocognitive accounts (embodied versus disembodied) and their proposed neural correlates (human mirror neuron system; hMNS versus cognitive control network; CCN) are hypothesized. Exploratory analyses with 117 subjects uncover an interplay between perspective-taking and post-hoc factor, consistency of selection, in regions alluding to involvement of the CCN. Descriptively, inconsistent altercentric SPT elicited greater activation than consistent altercentric SPT and/or inconsistent egocentric SPT in the left inferior frontal gyrus (IFG), left dorsolateral prefrontal cortex (DLPFC) and left motor cortex (MC), but not the inferior parietal lobules (IPL). Despite the presence of grasping cues, spontaneous embodied strategies were not evident during implicit altercentric SPT. Instead, neural trends in the inconsistent subgroups (22 subjects; 13 altercentric; 9 egocentric) suggest that inconsistency in selection modulates the decision-making process and plausibly taps on deliberate and effortful disembodied strategies driven by the CCN. Implications for future research are discussed., (© 2023. The Author(s).)

Background: Triptans are effective for many migraine patients, but some do not experience adequate efficacy and tolerability. The European Headache Federation (EHF) has proposed that patients with lack of efficacy and/or tolerability of ≥ 2 triptans ('triptan resistance') could be considered eligible for treatment with the novel medications from the ditan and gepant groups. There is little data on the frequency of 'triptan resistance'., Methods: We used patient self-report data from the German Migraine and Headache Society (DMKG) Headache Registry to assess triptan response and triptan efficacy and/or tolerability failure., Results: A total of 2284 adult migraine patients (females: 85.4%, age: 39.4 ± 12.8 years) were included. 42.5% (n = 970) had failed ≥ 1 triptan, 13.1% (n = 300) had failed ≥ 2 triptans (meeting the EHF definition of 'triptan resistance'), and 3.9% (n = 88) had failed ≥ 3 triptans. Compared to triptan responders (current use, no failure, n = 597), triptan non-responders had significantly more severe migraine (higher frequency (p < 0.001), intensity (p < 0.05), and disability (p < 0.001)), that further increased with the level of triptan failure. Responders rates were highest for nasal and oral zolmitriptan, oral eletriptan and subcutaneous sumatriptan., Conclusion: In the present setting (specialized headache care in Germany), 13.1% of the patients had failed ≥ 2 triptans. Triptan failure was associated with increased migraine severity and disability, emphasizing the importance of establishing an effective and tolerable acute migraine medication. Acute treatment optimization might include switching to one of the triptans with the highest responder rates and/or to a different acute medication class., Trial Registration: The DMKG Headache Registry is registered with the German Clinical Trials Register (DRKS 00021081)., (© 2023. Springer-Verlag Italia S.r.l., part of Springer Nature.)

Background: Most migraine patients need an effective acute medication. Real-world data can provide important information on the performance of acute migraine medication in clinical practice., Methods: We used data from the German Migraine and Headache Society Headache Registry, where patients rate efficacy and tolerability of and satisfaction with each of their acute headache medications., Results: A total of 1756 adult migraine patients (females: 85%, age: 39.5 ± 12.8 years, headache days per month: 13.5 ± 8.1) were included. Of these, 93% used acute medication, most frequently triptans (59.3%) and/or non-opioid analgesics (56.4%), and 58.5% rated efficacy as good or very good. This was more frequent for triptans (75.4%) than for non-opioid analgesics (43.6%, p < 0.001). Among non-opioid analgesics, naproxen was rated most effective (61.9% very good or good, p < 0.001 compared to ibuprofen, acetylsalicylic acid and paracetamol). Patient-rated efficacy significantly declined with higher headache frequencies (p < 0.001), and this effect remained significant after omitting patients overusing acute medication., Conclusion: In the present population recruited at specialized headache centers, patients rated triptans as more effective than non-opioid analgesics, naproxen as more effective than ibuprofen, and acute medication efficacy decreased with increasing headache frequency.Trial registration: The German Migraine and Headache Society Headache Registry is registered with the German Clinical Trials Register (DRKS 00021081).

(1) Cognitive impairments such as working memory (WM) deficits are amongst the most common dysfunctions characterizing bipolar disorder (BD) patients, severely contributing to functional impairment. We aimed to investigate WM performance and associated brain activation during the acute phase of BD and to observe changes in the same patients during remission. (2) Frontal brain activation was recorded using functional near-infrared spectroscopy (fNIRS) during n-back task conditions (one-back, two-back and three-back) in BD patients in their acute depressive ( n = 32) and remitted ( n = 15) phases as well as in healthy controls ( n = 30). (3) Comparison of BD patients during their acute phase with controls showed a trend ( p = 0.08) towards lower dorsolateral prefrontal cortex (dlPFC) activation. In the remitted phase, BD patients showed lower dlPFC and ventrolateral prefrontal cortex (vlPFC) activation ( p = 0.02) compared to controls. No difference in dlPFC and vlPFC activation between BD patients' phases was found. (4) Our results showed decreased working memory performance in BD patients during the working memory task in the acute phase of disease. Working memory performance improved in the remitted phase of the disease but was still particularly attenuated for the more demanding conditions.

Backgound: Headache disorders are not only among the most prevalent, they are also among the most disabling disorders worldwide. This paper investigates the association between headache impact on daily life and the socioeconomic status (SES) of headache sufferers., Methods: Data stem from a random general population sample in Germany. Respondents who reported having headache for at least a year and were aged ≥ 18 years were included in the study. A standardized questionnaire addressing headache and headache treatment was filled in during the face-to-face survey. The impact of headache on daily life was measured using the German version of the Headache Impact Test (HIT-6)., Results: Higher headache impact was found in low and medium SES compared to high SES. After adjustment for sociodemographics, headache-related factors (analgesic use, headache duration, headache frequency, migraine diagnosis), depressive symptoms, physical inactivity and obesity, an increased odds ratio of having higher headache impact in low SES compared to high SES was found: OR = 1.83, 95% CI [1.43, 2.23], p = .014. When the interactions "SES*obesity", "SES*depressive symptoms", and "SES*physical inactivity" were added, the results showed a significant interaction effect of "SES*obesity". Obese persons with low SES were 3.64 times more likely to have higher headache impact than non-obese persons with low SES. No significant differences between obese and non-obese persons were found in the medium and high SES groups., Conclusions: SES is an important factor that should not be neglected in headache awareness campaigns and headache treatment. Longitudinal studies are needed in the future to investigate whether lifestyle interventions, such as weight reduction, can help to reduce headache impact in people in lower SES., (© 2023. The Author(s).)

Migraine is the most common neurological disorder and can be associated with a high degree of disability. In addition to non-pharmacological approaches to reduce migraine frequency, pharmacological migraine preventatives are available. Evidence-based guidelines from the German Migraine and Headache Society (DMKG), and German Society for Neurology (DGN), Austrian Headache Society (ÖKSG), and Swiss Headache Society (SKG) are available for indication and application. For therapy-relevant questions such as the duration of a pharmacological migraine prevention, no conclusions can be drawn from currently available study data. The aim of this review is to present a therapy consensus statement that integrates the current data situation and, where data are lacking, expert opinions. The resulting current recommendations on the duration of therapy for pharmacological migraine prophylaxis are shown here., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Overweight with and without comorbid binge-eating disorder (BED) has been associated with increased reward sensitivity, though evidence is heterogeneous. To disentangle this heterogeneity and gain insights into mechanisms of impaired reward processing, this study applied multi-method neuro-behavioural techniques. Reward sensitivity was investigated in N = 49 participants allocated to three subgroups: overweight individuals with BED (BED+, n = 17), overweight individuals without BED (BED-, n = 15), and normal-weight controls (NWC, n = 17). Applying a free exploration paradigm (food vs. non-food stimuli), eye tracking and electroencephalographic data were gathered. A valid cue before stimulus onset indicated the position of food, and the end points analysed after the cue and stimulus onset were attentional approach, attention allocation, and conflict processing (e.g., conflict between looking at the potentially rewarding food stimulus or not). The effect of negative mood was tested using mood induction. The study's main hypothesis was that individuals with overweight, particularly under negative mood, would have increased food-related reward sensitivity. All participants showed increased food-specific attentional approach (p < .001). BED + allocated more attention to food stimuli than non-food stimuli compared to the healthy control (p = .045). For individuals with overweight but without BED (BED-), results indicate that conflict processing might be prolonged after the stimulus onset (p = .011). No group-specific effect of negative mood was found. Preliminary results in overweight individuals with and without comorbid BED suggest that food stimuli are generally rewarding stimuli, but even more so for participants with binge eating psychopathology. Prolonged conflict processing during the confrontation with competing food and non-food stimuli was solely found in the BED- sample and might indicate a compensation mechanism. Replication is warranted. The multi-method approach seems to be promising to give indications for the development of psychotherapeutic treatment., Competing Interests: Declaration of competing interest None., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Migraine is the most common neurological disorder and can be associated with a high degree of disability. In addition to non-pharmacological approaches to reduce migraine frequency, pharmacological migraine preventatives are available. Evidence-based guidelines from the German Migraine and Headache Society (DMKG), and German Society for Neurology (DGN), Austrian Headache Society (ÖKSG), and Swiss Headache Society (SKG) are available for indication and application. For therapy-relevant questions such as the duration of a pharmacological migraine prevention, no conclusions can be drawn from currently available study data. The aim of this review is to present a therapy consensus statement that integrates the current data situation and, where data are lacking, expert opinions. The resulting current recommendations on the duration of therapy for pharmacological migraine prophylaxis are shown here., (© 2022. The Author(s).)

Introduction: Chronic headache due to the overuse of medication for the treatment of migraine attacks has a prevalence of 0.5-2.0%. This guideline provides guidance for the management of medication overuse (MO) and medication overuse headache (MOH)., Recommendations: Treatment of headache due to overuse of analgesics or specific migraine medications involves several stages. Patients with medication overuse (MO) or medication overuse headache (MOH) should be educated about the relationship between frequent use of symptomatic headache medication and the transition from episodic to chronic migraine (chronification), with the aim of reducing and limiting the use of acute medication. In a second step, migraine prophylaxis should be initiated in patients with migraine and overuse of analgesics or specific migraine drugs. Topiramate, onabotulinumtoxinA and the monoclonal antibodies against CGRP or the CGRP-receptor are effective in patients with chronic migraine and medication overuse. In patients with tension-type headache, prophylaxis is performed with amitriptyline. Drug prophylaxis should be supplemented by non-drug interventions. For patients in whom education and prophylactic medication are not effective, pausing acute medication is recommended. This treatment can be performed in an outpatient, day hospital or inpatient setting. Patients with headache due to overuse of opioids should undergo inpatient withdrawal. The success rate of the stepped treatment approach is 50-70% after 6 to 12 months. A high relapse rate is observed in patients with opioid overuse. Tricyclic antidepressants, neuroleptics (antiemetics) and the administration of steroids are recommended for the treatment of withdrawal symptoms or headaches during the medication pause. Consistent patient education and further close monitoring reduce the risk of relapse., (© 2022. The Author(s).)

While arithmetic training reduces fronto-temporo-parietal activation related to domain-general processes in typically developing (TD) children, we know very little about the training-related neurocognitive changes in children with mathematical disabilities (MD), who seek evidenced-based educational interventions. In a within-participant design, a group of 20 children (age range = 10-15 years old) with MD underwent 2 weeks of arithmetic training. Brain activation was measured using functional near-infrared spectroscopy (fNIRS) before and after training to assess training-related changes. Two weeks of training led to both behavioral and brain changes. Training-specific change for trained versus untrained (control) simple multiplication solving was observed as activation increase in the bilateral temporo-parietal region including angular gyrus and middle temporal gyrus. Training-specific change for trained versus untrained (control) complex multiplication solving was observed as activation increase in the bilateral parietal region including intraparietal sulcus, superior parietal lobule, and supramarginal gyrus. Unlike the findings of a similar study in TD children, 2 weeks of multiplication training led to brain activation increase in the fronto-parietal network in children with MD. Interestingly, these brain activation differences between the current findings and a recent similar study in TD children underlie a rather similar behavioral improvement as regards response time and accuracy after 2 weeks of training. This finding provides valuable insights into underlying mechanisms of mathematics learning in special samples and suggests that the findings in TD children may not be readily generalized to children with MD., (© 2022. The Author(s).)

Introduction: The aim of this analysis is to determine whether regular physical activity is associated with less analgesic use in men and women suffering from headache disorders based on population-based cross-sectional data., Methods: We used data from a random general population sample in Germany that comprised 2477 participants aged ≥ 14 years. A standardized questionnaire addressing headache and headache treatment was filled in during the face-to-face survey., Results: Thirty-nine percent of the participants reported headache. Of these, 37.5% of men and 33.6% of women were physically active. Of the participants with headache, 43.3% reported taking analgesics on < 2 days a month, 40.7% on 2-5 days a month, 10.1% on 6-10 days a month, and 5.9% on > 10 days a month. Frequent headache, severe impact of headache on daily life, and depressive symptoms were associated with higher analgesic use in both men and women. For women, physical inactivity was associated with the frequency of analgesic use adjusted for sociodemographic and headache-related variables. For men, results did not suggest any association between physical inactivity and frequency of analgesic use., Conclusions: There are both sex-unspecific and sex-specific factors associated with analgesic use among men and women with headache. In women with increased analgesic use, promoting physical activity may reduce analgesic use. For men, education about the therapeutic effects of physical activity for headaches is an important resource., (© 2022. The Author(s).)

Most children use their fingers when learning to count and calculate. These sensorimotor experiences were argued to underlie reported behavioral associations of finger gnosis and counting with mathematical skills. On the neural level, associations were assumed to originate from overlapping neural representations of fingers and numbers. This study explored whether finger-based training in children would lead to specific neural activation in the sensorimotor cortex, associated with finger movements, as well as the parietal cortex, associated with number processing, during mental arithmetic. Following finger-based training during the first year of school, trained children showed finger-related arithmetic effects accompanied by activation in the sensorimotor cortex potentially associated with implicit finger movements. This indicates embodied finger-based numerical representations after training. Results for differences in neural activation between trained children and a control group in the IPS were less conclusive. This study provides the first evidence for training-induced sensorimotor plasticity in brain development potentially driven by the explicit use of fingers for initial arithmetic, supporting an embodied perspective on the representation of numbers.

We aimed to investigate stress-reactive rumination in response to social stress and its association with social anxiety and trait rumination. From previous investigations we know that people with a certain vulnerability to rumination show increased stress-reactive rumination. However, up to date the possible influence of social anxiety on this relationship is still unclear. Therefore, we reanalyzed the data of two of our previous studies assessing healthy low and high trait ruminators and depressed patients performing the Trier Social Stress Test (TSST). We measured cortical oxygenation using functional Near-Infrared Spectroscopy (fNIRS) as well as different behavioral outcome measures (subjective stress levels, negative affect, state rumination). On a behavioral level, we found an influence of both, social anxiety and trait rumination, on state rumination, even when correcting for the other factor, respectively, implying two potentially independent factors of influence. On a neural level, we observed reduced activation in brain regions of the cognitive control network (CCN) for higher social anxiety and trait rumination, which might be a result of reduced cognitive and attentional control. Results indicate a specific role of social anxiety, at least on a behavioral level, and therefore implicate a crucial factor to be considered in the treatment of depression., (© 2022. The Author(s).)

Auditory verbal hallucinations (AVH) are a characteristic symptom of psychosis. An influential cognitive model accounting for the mechanisms in the generation of AVHs describes a defective monitoring of inner speech, leading to the misidentification of internally generated thoughts as externally generated events. In this study, we utilized an inner speech paradigm during a simultaneous measurement with functional near-infrared spectroscopy (fNIRS) and functional magnetic resonance imaging (fMRI), in order to replicate the findings of neural correlates of inner speech and auditory verbal imagery (AVI) in healthy subjects, reported in earlier studies, and to provide the first validation of the paradigm for fNIRS measurements. To this end, 20 healthy subjects were required to generate and silently recite first and second person sentences in their own voice (inner speech) and imagine the same sentences in a different, alien voice (AVI). Furthermore, questionnaires were deployed to assess the predisposition to acoustic hallucinations and schizotypal traits to investigate their connection to activation patterns associated with inner speech and monitoring processes. The results showed that both methods, fNIRS and fMRI, exhibited congruent activations in key brain areas, claimed to be associated with monitoring processes, indicating that the paradigm seems to be applicable using fNIRS alone. Furthermore, the results showed similar brain areas activated during inner speech and monitoring processes to those from earlier studies. However, our results indicate that the activations were dependent more on the sentence form and less on the imaging condition, showing more active brain areas associated with second person sentences. Integration of the sentence construction into the model of inner speech and deficient monitoring processes as the basis for the formation of AVHs should be considered in further studies. Furthermore, negative correlations between questionnaires' scores and activations in precentral gyrus and premotor cortex indicate a relationship of schizotypal characteristics and a deficient activation pattern., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Storchak, Hudak, Dresler, Haeussinger, Fallgatter and Ehlis.)

Recent research has emphasized rumination as an important maintaining factor in various mental disorders. However, operationalization and therefore induction of rumination in experimental settings poses a major challenge in terms of ecological validity. As stress seems to play a key role in everyday situations eliciting rumination, we conducted two stress paradigms while assessing behavioral and neurophysiological measures. Aiming to replicate previous findings on induced rumination by means of the Trier Social Stress Test (TSST) and comparing them to physiological (pain) stress, a clinical sample of patients with Major Depressive Disorder (MDD; n = 22) and healthy controls (HC; n = 23) was recruited. Cortical blood oxygenation was assessed during the stress paradigms using functional near-infrared spectroscopy (fNIRS). Further, we used ecological momentary assessment (EMA) of stress, rumination and mood to be able to correlate ruminative responses during induced stress and everyday rumination. Our results showed that social stress but not physiological stress induced depressive rumination in MDD but not in HC. Further, rumination reactivity in response to social stress but not to physiological stress was significantly associated with rumination reactivity in everyday life as assessed with EMA. With respect to cortical oxygenation, MDD subjects showed hypoactivity in the Cognitive Control Network during the TSST, which mediated the differences between MDD and HC in post-stress rumination. Our findings emphasize the role of negative social triggers in depressive rumination and validate the TSST as an induction method for depressive rumination. The results inform future developments in psychotherapeutic treatment for depressive rumination., Competing Interests: No author reported conflict of interest., (© 2021 The Authors.)

Previous research repeatedly found basic numerical abilities (e.g., magnitude understanding, arithmetic fact knowledge, etc.) to predict young students' current and later arithmetic achievement as assessed by achievement tests - even when controlling for the influence of domain-general abilities (e.g., intelligence, working memory). However, to the best of our knowledge, previous studies hardly addressed this issue in secondary school students. Additionally, they primarily assessed basic numerical abilities in a between-task approach (i.e., using different tasks for different abilities). Finally, their relevance for real-life academic outcomes such as mathematics grades has only rarely been investigated. The present study therefore pursued an approach using one and the same task (i.e., a within-task approach) to reduce confounding effects driven by between-task differences. In particular, we evaluated the relevance of i) number magnitude understanding, ii) arithmetic fact knowledge, and iii) conceptual and procedural knowledge for the mathematics grades of 81 students aged between ten and thirteen (i.e., in Grades 5 and 6) employing the number bisection task. Results indicated that number magnitude understanding, arithmetic fact knowledge, and conceptual and procedural knowledge contributed to explaining mathematics grades even when controlling for domain-general cognitive abilities. Methodological and practical implications of the results are discussed., (Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Digitalization offers support and innovative approaches in the diagnosis and therapy of headaches. With the German digital health care act (Digitale-Versorgung-Gesetz) it is now possible to integrate this into regular care for the first time. However, it is currently difficult to assess the various offers; quality standards and conclusive studies to determine the efficacy and safety are missing., Aim: Overview of current digital approaches in headache treatment and presentation of two specific examples (App M‑sense and DMKG headache registry)., Materials and Methods: Literature research, product information, and presentations by the project managers., Results: Most digital offers for headache treatment are currently headache calendars, mostly as a smartphone app. However, there are also promising extensions (e.g. trigger analysis) and new approaches such as digital instructions for relaxation and endurance sports, chatbots for patients, as well as support for doctors through structured collection of patient data and processing for diagnostic purposes., Conclusion: Different digital approaches could support practitioners and patients effectively in headache treatment and therapy guidance in the near future. However, high-quality studies are necessary to evaluate their benefits and efficacy.

Background: The coronavirus disease 2019 (COVID-19) pandemic has substantially changed life worldwide in 2020. This also influences the psychological treatment options of patients with headache., Aim: The present article intends to illustrate the different psychological forms of treatment for headache patients and their implementation during the COVID-19 pandemic., Material and Methods: Literature review and case reports., Results: Even during the COVID-19 pandemic, psychological treatment enables the increased stress level in headache patients to be counteracted by using cognitive behavioral therapy and relaxation techniques. The changed living conditions are often unfavorable but sometimes also favorable in the course of disease. It can be shown that even during the pandemic, such favorable changes can be used to support patients to cope with their headache., Conclusion: The digital implementation of psychological approaches makes a major contribution to maintaining psychological treatment of headache patients, so that the individually changed needs can be addressed. With respect to content, stress regulation techniques and increased acceptance gain in importance. Regarding biofeedback there are limitations, which may be overcome by improved technical devices.

Background: Headache sufferers in need of professional health care often do not utilize the care available, and factors influencing headache-specific physician consultation are not yet understood. Objectives of this study are (1) to assess self-reported headache-specific physician consultations and (2) to identify headache-related and sociodemographic predictors., Methods: Data of a random sample of the general population in Germany aged ≥14 years were analyzed (N = 2461). A multivariate binary logistic regression was conducted to identify a parsimonious model to predict physician consultation., Results: 50.7% of the participants with headache reported at least one headache-specific physician consultation during lifetime. Of these, 53.6% had seen one, 26.1% two, and 20.3% more than two physicians because of their headaches. The odds of physician consultation increased with the number of headache days per month (HDM) [(reference HDM < 1) HDM 1-3 (OR = 2.29), HDM 4-14 (OR = 2.41), and HDM ≥15 (OR = 4.83)] and increasing Headache Impact Test score (HIT-6) [(reference "no or little impact") moderate impact (OR = 1.74), substantial impact (OR = 3.01), and severe impact (OR = 5.08)]. Middle-aged participants were more likely to have consulted than younger and older ones [(reference 14-34 years) 35-54 years (OR = 1.90), 55-74 years (OR = 1.96), ≥75 years (OR = 1.02)]. The odds of physician consultation among self-employed subjects were lower than among employed manual workers (OR = 0.48). The living environment (rural versus urban) did not have an influence on the consultation frequency., Conclusion: The results indicate that apart from burden-related factors (headache frequency; headache impact), health care utilization patterns are also influenced by patients' occupational status and age. Further research is needed to analyze whether the lower consultation rate means that the self-employed have a higher risk of chronification or that they have more effective self-management strategies regarding headache.

Functional lateralization is established for various cognitive functions, but was hardly ever investigated for arithmetic processing. Most neurocognitive models assume a central role of the bilateral intraparietal sulcus (IPS) in arithmetic processing and there is some evidence for more pronounced left-hemispheric activation for symbolic arithmetic. However, evidence was mainly obtained by studies in right-handers. Therefore, we conducted a functional near-infrared spectroscopy (fNIRS) study, in which IPS activation of left-handed adults was compared to right-handed adults in a symbolic approximate calculation task. The results showed that left-handers had a stronger functional right-lateralization in the IPS than right-handers. This finding has important consequences, as the bilateral IPS activation pattern for arithmetic processing seems to be shaped by functional lateralization and thus differs between left- and right-handers. We propose three possible accounts for the observed functional lateralization of arithmetic processing.

Attention-deficit/hyperactivity disorder (ADHD) is a neuropsychiatric disorder normally diagnosed in childhood and persisting into adulthood in up to two-thirds of the patients. Its core symptoms comprise inattention and hyperactive-impulsive behaviours. Several studies suggest that patients with ADHD show alterations in self-regulation and self-monitoring. So far, it has not been described whether these deficits also affect the awareness of one's own bodily signals, that is, interoceptive awareness. To investigate possible alterations in interoceptive awareness, 14 adult patients with ADHD and 16 healthy controls performed a heartbeat detection task, in which they had to count their heartbeat without any external help (e.g. visualization on a screen). As an indicator of the individual interoceptive awareness ability, a score based on the comparison between recorded and counted heart beats was calculated. Our results showed that patients with ADHD performed significantly worse on this task than controls, which indicates that they were less aware of internal bodily signals while additionally experiencing deficits in regulating and monitoring their own (overt) behaviours.

Background: Reliable population-based data on the prevalence and characteristics of primary headache across the lifespan are essential. However, robust data are lacking. Methods: We utilized questionnaire data from a random general population sample in Germany, that comprised 2,478 participants aged ≥14 years. A standardized questionnaire addressing headache and headache treatment was filled in during the face-to-face survey. Results: The 6-month prevalence of self-reported headache in the total sample amounted to 39.0% (known diagnosis of migraine 7.2%; tension-type headache 12.4%; another diagnosis or unknown diagnosis 23.4%). Age-specific prevalence rates were 37.9% (14-34 years), 44.6% (35-54 years), 38.5% (55-74 years), and 26.9% (≥75 years). Compared to age group 14-34, participants aged 35-54 were more ( OR = 1.29, 95%- CI 1.05-1.60, p = 0.018) and those aged ≥75 were less ( OR = 0.55, 95%- CI 0.40-0.76, p < 0.001) likely to have any headache. Of the participants with headache, 79.5% reported headache on <4 days per month, 15.6% on 4-14 days per month and 4.9% on >14 days per month. The frequency of headache did not differ significantly between age groups in men [ χ ( 3 ,   N   =   384 ) 2 = 1.45, p > 0.05], but in women [ χ ( 3 ,   N   =   651 ) 2 = 21.57, p < 0.001]: women aged ≥75 years were over-represented in the group reporting 4-14 headache days per month. The analgesic use (days per month) differed significantly between age groups among participants with headache on <4 days per month and on >14 days per month: 1.8 (14-34 years), 2.5 (35-54 years), 3.2 (55-74 years), and 3.4 (≥75 years), respectively 7.9 (14-34 years), 11.4 (35-54 years), 18.4 (55-74 years), and 22.8 (≥75 years). Conclusions: In general, the prevalence of headache decreases with age. However, older women suffer from more frequent attacks and older participants take analgesics on more days per month than younger participants. This might put them at risk of medication overuse which may lead to medication overuse headache. More research is needed to understand these specifics in headache frequency and treatment behavior in older people., (Copyright © 2019 Müller, Dresler, Gaul, Glass, Jürgens, Kropp, Ruscheweyh, Straube and Förderreuther.)

Objectives: Elevated behavioural impulsivity has been shown to be a core feature of bipolar disorder. However, no study has so far investigated impulsivity-related brain activation in patients with BD during acute versus remitted phase. To address the question whether elevated behavioural impulsivity and its differential neural pathways is a state or trait marker of BD, we employed a combined stop signal-go/no-go task in 30 controls, and 37 depressed and 15 remitted patients who were retested. Methods: Frontal brain activation was recorded using near-infrared spectroscopy. Results: Behaviourally, we found increased impulsivity as indexed by higher stop signal reaction time for patients in their depressed phase while remitted patients did not differ from controls in any measure. In contrast, brain activation measurements revealed an opposite pattern: compared to controls, depressed patients did not show significant differences, while the remitted group displayed significantly decreased activation in bilateral prefrontal cortex during successful inhibition. Analysis of the remaining conditions (go, no-go, unsuccessful inhibition) did not reveal significant differences. Conclusions: Therefore, behavioural impulsivity and prefrontal hypoactivation do not seem to be a trait marker of BD. As only successful inhibition differentiated between groups, a specific dysfunction of this inhibitory process and its neural pathway may be postulated in BD.

Attention biases towards threat signals have been linked to the etiology and symptomatology of social anxiety disorder (SAD). Dysfunction of the dorsolateral prefrontal cortex (dlPFC) may contribute to attention biases in anxious individuals. The aim of this study was to investigate the feasibility of near-infrared spectroscopy (NIRS) neurofeedback (NF) training-targeting the dlPFC-and its effects on threat-related attention biases of individuals with SAD. 12 individuals with SAD participated in the NIRS-NF training lasting 6-8 weeks and including a total of 15 sessions. NF performance increased significantly, while the attention bias towards threat-related stimuli and SAD symptom severity decreased after the training. The individual increase in neurofeedback performance as well as the individual decrease in SAD symptom severity was correlated with decreased responses to social threat signals in the cerebral attention system. Thus, this pilot study does not only demonstrate that NIRS-based NF is feasible in SAD patients, but also may be a promising method to investigate the causal role of the dlPFC in attention biases in SAD. Its effectiveness as a treatment tool might be examined in future studies.

Some individuals experience more difficulties with math than others, in particular when arithmetic problems get more complex. Math ability, on one hand, and arithmetic complexity, on the other hand, seem to partly share neural underpinnings. This study addresses the question of whether this leads to an interaction of math ability and arithmetic complexity for multiplication and division on behavioral and neural levels. Previously screened individuals with high and low math ability solved multiplication and division problems in a written production paradigm while brain activation was assessed by combined functional near-infrared spectroscopy (fNIRS) and electroencephalography (EEG). Arithmetic complexity was manipulated by using single-digit operands for simple multiplication problems and operands between 2 and 19 for complex multiplication problems and the corresponding division problems. On the behavioral level, individuals with low math ability needed more time for calculation, especially for complex arithmetic. On the neural level, fNIRS results revealed that these individuals showed less activation in the left supramarginal gyrus (SMG), superior temporal gyrus (STG) and inferior frontal gyrus (IFG) than individuals with high math ability when solving complex compared to simple arithmetic. This reflects the greater use of arithmetic fact retrieval and also the more efficient processing of arithmetic complexity by individuals with high math ability. Oscillatory EEG analysis generally revealed theta and alpha desynchronization with increasing arithmetic complexity but showed no interaction with math ability. Because of the discovered interaction for behavior and brain activation, we conclude that the consideration of individual differences is essential when investigating the neurocognitive processing of arithmetic.

Background: Migraine is a highly prevalent and disabling neurological disorder which is commonly linked with a broad range of psychiatric comorbidities, especially among subjects with migraine with aura or chronic migraine. Defining the exact nature of the association between migraine and psychiatric disorders and bringing out the pathophysiological mechanisms underlying the comorbidity with psychiatric conditions are relevant issues in the clinical practice., Methods: A systematic review of the most relevant studies about migraine and psychiatric comorbidity was performed using "PubMed", "Scopus", and "ScienceDirect" electronic databases from 1 January 1998 to 15 July 2018. Overall, 178 studies met our inclusion criteria and were included in the current review., Results: According to the most relevant findings of our overview, the associations with psychiatric comorbidities are complex, with a bidirectional association of major depression and panic disorder with migraine. Importantly, optimizing the pharmacological and non-pharmacological treatment of either migraine or its psychiatric comorbidities might help clinicians to attenuate the burden of both these conditions., Conclusions: The available data highlight the need for a comprehensive evaluation of psychiatric disorders in migraine in order to promote an integrated model of care and carefully address the burden and psychosocial impairment related to psychiatric comorbidities in migraine.

Most studies have investigated brain activation changes after the course of arithmetic learning, and the question remains whether these changes are detectable during the course of learning, i.e., before memory consolidation. Twenty-four fifth graders solved multiplication problems while ongoing electroencephalography (EEG) was recorded. The arithmetic training revealed reduced errors together with a power increase in theta (4-7 Hz) but not in lower alpha (8-10 Hz) or upper alpha (10-13 Hz) bands. We conclude that increases in theta power subserved a shift from slow, procedural strategies to more efficient, automated procedural and retrieval strategies, which led to more efficient performance.

Math anxiety impairs academic achievements in mathematics. According to the processing efficiency theory (PET), the adverse effect is the result of reduced processing capacity in working memory (WM). However, this relationship has been examined mostly with correlational designs. Therefore, using an intervention paradigm, we examined the effects of math anxiety on math learning. Twenty-five 5th graders underwent seven training sessions of multiplication over the course of 2 weeks. Children were faster and made fewer errors in solving trained problems than untrained problems after learning. By testing the relationship between math anxiety, WM, and math learning, we found that if children have little or no math anxiety, enough WM resources are left for math learning, so learning is not impeded. If they have high math anxiety and high visuospatial WM, some WM resources are needed to deal with math anxiety but learning is still supported. However, if they have high math anxiety and low visuospatial WM capacity, math learning is significantly impaired. These children have less capacity to learn new math content as cognitive resources are diverted to deal with their math anxiety. We conclude that math anxiety not only hinders children's performance in the present but potentially has long-lasting consequences, because it impairs not only math performance but also math learning. This intervention study partially supports the PET because only the combination of high math anxiety and low WM capacity seems critical for hindering math learning. Moreover, an adverse effect of math anxiety was observed on performance effectiveness (response accuracy) but not processing efficiency (response time).

Neuroimaging has undergone enormous progress during the last two and a half decades. The combination of neuroscientific methods and educational practice has become a focus of interdisciplinary research in order to answer more applied questions. In this realm, conditions that hamper learning success and have deleterious effects in the population - such as learning disorders (LD) - could especially profit from neuroimaging findings. At the moment, however, there is an ongoing debate about how far neuroscientific research can go to inform the practical work in educational settings. Here, we put forward a theoretical translational framework as a method of conducting neuroimaging and bridging it to education, with a main focus on dyscalculia and dyslexia. Our work seeks to represent a theoretical but mainly empirical guide on the benefits of neuroimaging, which can help people working with different aspects of LD, who need to act collaboratively to reach the full potential of neuroimaging. We provide possible ideas regarding how neuroimaging can inform LD at different levels within our multidirectional framework, i.e., mechanisms, diagnosis/prognosis, training/intervention, and community/education. In addition, we discuss methodological, conceptual, and structural limitations that need to be addressed by future research.

Mathematical abilities are essential for an individual, as they predict career prospects among many other abilities. However, little is known about whether neural correlates of arithmetic problem difficulty differ between individuals with high and low math ability. For instance, the difficulty of two-digit addition and subtraction increases whenever a carry or borrow operation is required. Therefore, we systematically investigated the spatial and temporal neural correlates of the carry and borrow effects for high and low performers in a written production paradigm using combined functional near-infrared spectroscopy (fNIRS) and event-related potential (ERP) measurements. Effects of arithmetic difficulty interacted with an individual's math ability. High performers showed increased frontal activation especially in the left inferior frontal gyrus associated with the carry and borrow effects, whereas low performers did not. Furthermore, high and low performers even differed in their early processing of the borrow effect, as reflected by differences in slow waves at 1000-1500 ms at frontal sites. We conclude that the processing of arithmetic difficulty relies on an individual's mathematical ability, and suggest that individual differences should be taken into account when investigating mental arithmetic in an ecologically valid assessment.

Background: The frequent or regular use of analgesics and anti-migraine drugs can make headache more frequent and induce the transformation of episodic to chronic headache. Chronic headache due to medication overuse is defined as headache that is present on ≥ 15 days per month for at least three months in a patient who previously suffered from primary headaches, and who takes analgesics on ≥ 15 days per month or anti-migraine drugs (triptans or ergot alkaloids), opioid drugs, or combined analgesics on ≥ 10 days per month., Methods: This review is based on pertinent articles published up to December 2017 that were retrieved by a selective search in PubMed employing the terms "medication overuse AND headache" and "medication overuse headache.", Results: The prevalence of medication overuse headache in the general population in Germany is 0.7% -1%. This disorder is more common in women and in persons suffering from comorbid mental disorders or other painful conditions. The treatment of medication overuse headache consists of three steps. Patient education and counseling are given with the goal of reducing the intake of medication for acute headache treatment. The ensuing headache prophylaxis is with topiramate, amitriptyline, or onabotulinum toxin A. If these treatment strategies fail, a drug holiday is recommended. This can be in the outpatient, day clinic, or inpatient setting, depending on the severity of the condition and its comorbidities., Conclusion: Patients who frequently take acute medication to treat headache episodes must be identified early in order to avoid headache chronification and medication overuse headache. The suggested treatment algorithm is still in need of validation by randomized trials.

In this review, we aim to highlight the application of functional near-infrared spectroscopy (fNIRS) as a useful neuroimaging technique for the investigation of cognitive development. We focus on brain activation changes during the development of mathematics and language skills in schoolchildren. We discuss how technical limitations of common neuroimaging techniques such as functional magnetic resonance imaging (fMRI) have resulted in our limited understanding of neural changes during development, while fNIRS would be a suitable and child-friendly method to examine cognitive development. Moreover, this technique enables us to go to schools to collect large samples of data from children in ecologically valid settings. Furthermore, we report findings of fNIRS studies in the fields of mathematics and language, followed by a discussion of the outlook of fNIRS in these fields. We suggest fNIRS as an additional technique to track brain activation changes in the field of educational neuroscience.

In our daily lives, we are constantly exposed to numbers and letters. However, it is still under debate how letters and numbers are processed in the brain, while information on this topic would allow for a more comprehensive understanding of, for example, known influences of language on numerical cognition or neural circuits shared by numerical cognition and language processing. Some findings provide evidence for a double dissociation between numbers and letters, with numbers being represented in the right and letters in the left hemisphere, while the opposing view suggests a shared neural network. Since processing may depend on the task, we address the reported inconsistencies in a very basic symbol copying task using functional near-infrared spectroscopy (fNIRS). fNIRS data revealed that both number and letter copying rely on the bilateral middle and left inferior frontal gyri. Only numbers elicited additional activation in the bilateral parietal cortex and in the left superior temporal gyrus. However, no cortical activation difference was observed between copying numbers and letters, and there was Bayesian evidence for common activation in the middle frontal gyri and superior parietal lobules. Therefore, we conclude that basic number and letter processing are based on a largely shared cortical network, at least in a simple task such as copying symbols. This suggests that copying can be used as a control condition for more complex tasks in neuroimaging studies without subtracting stimuli-specific activation.

Background: Arithmetic processing in adults is known to rely on a frontal-parietal network. However, neurocognitive research focusing on the neural and behavioral correlates of arithmetic development has been scarce, even though the acquisition of arithmetic skills is accompanied by changes within the fronto-parietal network of the developing brain. Furthermore, experimental procedures are typically adjusted to constraints of functional magnetic resonance imaging, which may not reflect natural settings in which children and adolescents actually perform arithmetic. Therefore, we investigated the longitudinal neurocognitive development of processes involved in performing the four basic arithmetic operations in 19 adolescents. By using functional near-infrared spectroscopy, we were able to use an ecologically valid task, i.e., a written production paradigm., Results: A common pattern of activation in the bilateral fronto-parietal network for arithmetic processing was found for all basic arithmetic operations. Moreover, evidence was obtained for decreasing activation during subtraction over the course of 1 year in middle and inferior frontal gyri, and increased activation during addition and multiplication in angular and middle temporal gyri. In the self-paced block design, parietal activation in multiplication and left angular and temporal activation in addition were observed to be higher for simple than for complex blocks, reflecting an inverse effect of arithmetic complexity., Conclusions: In general, the findings suggest that the brain network for arithmetic processing is already established in 12-14 year-old adolescents, but still undergoes developmental changes.