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Background: Cluster headache (CH) is one of the most disabling primary headaches. Nowadays, it is unknown if it has an impact on reducing life expectancy. Methods: We calculated years of potential life lost (YPLL) in deceased individuals from a CH registry of a third‐level hospital, using as cutoff the estimated life expectancy for our general population according to their sex and year of death. Furthermore, a descriptive and comparative analysis of the main causes of death, risk factors, and toxic habits was carried out. Results: There were 25 deaths among the 152 individuals included. Twenty‐one (84%) died earlier than expected with a mean of 9.14 YPLL (p = 0.001). Cancer was the most common cause of death in CH patients (64% of deaths vs. 28.5% expected in general population, p ≤ 0.001). Eighty percent and 45% of our deceased patients were smokers and 60% and 45% regular alcohol consumers at the diagnosis of CH and at death, respectively. The percentage of smokers at diagnosis was significantly higher than that in the reference population (80% vs. 33.2%, p < 0.001). There was a significantly higher frequency of arterial hypertension (76% vs. 19.82%, p < 0.001) and diabetes mellitus (40% vs. 7.8%, p < 0.001) at death in CH individuals compared to general population. Conclusions: CH implies a loss of almost one decade of life expectancy by an increase in cancer deaths. Tobacco and alcohol consumption seem to be the main underlying causes. These results call for an action plan for a better management of CH patients since their diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Breast cancer in males is a very rare entity, and survival is mainly influenced by the stage at diagnosis. The lack of early detection tools in men results in a diagnostic delay of about 5–10 years and a higher percentage of metastatic disease at diagnosis. However, the characteristics of head metastases are not well defined. Case Reports: We present 2 cases of male breast cancer with metastases affecting cranial nervous structures and we provide imaging and histologic data. Both were middle-aged patients with ductal-type, HER-2- negative, and androgen receptor-positive primary tumors. Conclusion: Although central nervous system involvement is uncommon, this entity should be considered in middle-aged males with focal neurologic symptoms. More cases would be necessary to better understand the biology of this condition in order to establish an adequate diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Objective: To analyze the specificity of calcitonin gene–related peptide (CGRP) levels, we measured alpha‐CGRP circulating levels in a large series of patients with a recent diagnosis of inflammatory bowel disease (IBD) who were interviewed regarding comorbid headache. Background: Several studies have found an association between migraine and IBD. Methods: In this cross‐sectional study performed in an IBD clinic, morning serum alpha‐CGRP levels were measured by enzyme‐linked immunosorbent assay in 96 patients who were recently diagnosed with IBD and compared to those from 50 similar patients with chronic migraine (CM) and 50 healthy controls (HC). Results: Alpha‐CGRP levels were higher in patients with IBD (median [interquartile range] 56.9 [35.6–73.9] pg/mL) and patients with CM (53.0 [36.7–73.9] pg/mL) compared to HC (37.2 [30.0–51.8] pg/mL; p = 0.003; p = 0.019, respectively). Regarding IBD diagnostic subtypes, alpha‐CGRP levels for ulcerative colitis (67.2 ± 49.3 pg/mL; 57.0 [35.6–73.4] pg/mL) and Crohn's disease (54.9 ± 27.5 pg/mL; 57.7 [29.1–76.1] pg/mL) were significantly higher than those of HC (p = 0.013, p = 0.040, respectively). Alpha‐CGRP levels were further different in patients with IBD with migraine (70.9 [51.8–88.7] pg/mL) compared to HC (p < 0.001), patients with IBD without headache (57.5 [33.3–73.8] pg/mL; p = 0.049), and patients with IBD with tension‐type headache but without migraine (41.7 [28.5–66.9] pg/mL; p = 0.004), though alpha‐CGRP levels in patients with IBD without migraine (53.7 [32.9–73.5] pg/mL) remained different over HC (p = 0.028). Conclusion: Together with CM, circulating alpha‐CGRP levels are different in patients with IBD, perhaps reflecting a chronic inflammatory state. IBD is an example of how alpha‐CGRP levels are not a totally specific migraine biomarker. However, alpha‐CGRP levels were further increased in patients with IBD who have a history of migraine, which reinforces its role as a biomarker in migraine patients, always bearing in mind their comorbidities. Plain Language Summary: Alpha‐calcitonin gene–related peptide (CGRP) levels may be a potential migraine biomarker, but it is unclear if this is the case because changes in CGRP concentrations can also be present in other conditions. We measured morning serum alpha‐CGRP levels in 96 patients with a recent inflammatory bowel disease (IBD) diagnosis, and compared them to 50 matched healthy participants and 50 matched patients with chronic migraine (CM). We found a significant increase in serum alpha‐CGRP levels in both patients with IBD and CM compared to healthy controls, which we think may reflect chronic inflammation found in IBD; these results offer another example that alpha‐CGRP concentrations are not totally specific for migraine. [ABSTRACT FROM AUTHOR]

Background: Real-world studies have shown the sustained therapeutic effect and favourable safety profile of OnabotulinumtoxinA (BoNTA) in the long term and up to 4 years of treatment in chronic migraine (CM). This study aims to assess the safety profile and efficacy of BoNTA in CM after 5 years of treatment in a real-life setting. Methods: We performed a retrospective chart review of patients with CM in relation to BoNTA treatment for more than 5 years in 19 Spanish headache clinics. We excluded patients who discontinued treatment due to lack of efficacy or poor tolerability. Results: 489 patients were included [mean age 49, 82.8% women]. The mean age of onset of migraine was 21.8 years; patients had CM with a mean of 6.4 years (20.8% fulfilled the aura criteria). At baseline, patients reported a mean of 24.7 monthly headache days (MHDs) and 15.7 monthly migraine days (MMDs). In relation to effectiveness, the responder rate was 59.1% and the mean reduction in MMDs was 9.4 days (15.7 to 6.3 days; p < 0.001). The MHDs were also reduced by 14.9 days (24.7 to 9.8 days; p < 0.001). Regarding the side effects 17.5% experienced neck pain, 17.3% headache, 8.5% eyelid ptosis, 7.5% temporal muscle atrophy and 3.2% trapezius muscle atrophy. Furthermore, after longerterm exposure exceeding 5 years, there were no serious adverse events (AE) or treatment discontinuation because of safety or tolerability issues. Conclusion: Treatment with BoNTA led to sustained reductions in migraine frequency, even after long-term exposure exceeding 5 years, with no evidence of new safety concerns. [ABSTRACT FROM AUTHOR]

• SPMS represents a considerable negative impact on patients' HRQoL • Unfortunately, there is a lack of data about the impact of SPMS disability on HRQoL • DISCOVER study is an observational, retrospective study in clinical practice in Spain • DISCOVER study assess the impact of SPMS on participants' functional status and HRQoL • People with SPMS experience a high physical impact, fatigue and cognitive impairment People with secondary progressive multiple sclerosis (pwSPMS) experience increasing disability, which impacts negatively on their health-related quality of life (HRQoL). Our aims were to assess the impact of secondary progressive multiple sclerosis (SPMS) on functional status and HRQoL and describe the clinical profile in this population. DISCOVER is an observational, cross-sectional, multicenter study with retrospective data collection in real-world clinical practice in Spain. Sociodemographic and clinical variables, functional and cognitive scales, patient-reported outcomes (PROs), and direct healthcare, and non-healthcare and indirect costs were collected. A total of 297 evaluable pwSPMS with a EDSS score between 3-6.5 participated: 62.3 % were female and 18.9 % had active SPMS. At the study visit, 77 % of them presented an Expanded Disability Scale Score (EDSS) of 6–6.5. Nearly 40 % did not receive any disease-modifying treatment. Regarding the working situation, 61.6 % were inactive due to disability. PROs: 99.3 % showed mobility impairment in EuroQoL-5 Dimensions-5 Levels, and about 60 % reported physical impact on the Multiple Sclerosis Impact Scale-29. Fatigue was present in 76.1 %, and almost 40 % reported anxiety or depression. The Symbol Digit Modalities Test was used to assess cognitive impairment; 80 % of the patients were below the mean score. Participants who presented relapses two years before and had high EDSS scores had a more negative impact on HRQoL. PwSPMS with a negative impact on HRQoL presented a higher cost burden, primarily due to indirect costs. PwSPMS experience a negative impact on their HRQoL, with a high physical impact, fatigue, cognitive impairment, and a high burden of indirect costs. [ABSTRACT FROM AUTHOR]

This letter, published in the journal Cephalalgia, is a response to a review paper on exertional headaches. The authors acknowledge that they did not mention lumbar puncture as a treatment option for primary cough headache in their update. They express skepticism about the value of this invasive procedure, citing the lack of certainty in diagnosing primary cough headache before the MRI era and the potential for low intracranial pressure to cause cough headache. They also discuss the relationship between primary sex headache and exertional headache, noting that some patients experience both types of headaches while others only have one or the other. The authors agree with the need for further data to better understand these headache types. [Extracted from the article]

The article examines that a brain lymphatic system has been demonstrated in the last decade. Topics include considered that "glymphatic system" (GS) is composed of paravascular channels in surrounding arterial and venous brain vessels and dural lymphatics parallel to the venous sinuses and cleans the interstitial space.

Introduction: Effectiveness of candesartan in migraine prevention is supported by two randomized controlled trials. We aimed to assess the effectiveness, tolerability, and response predictors of candesartan in the preventive treatment of migraine. Methods: Observational, multicenter, prospective cohort study. The 50%, 75% and 30% responder rates, between weeks 8–12 and 20–24, were compared with the baseline. Treatment emergent adverse effects were systematically evaluated. Response predictors were estimated by multivariate regression models. Results: Eighty-six patients were included, 79.1% females, aged 39.5 (inter-quartile range [IQR] 26.3–50.3), with chronic migraine (43.0%), medication overuse headache (55.8%) and a median of two (inter-quartile range: 0.75–3) prior preventive treatments. At baseline patients had 14 (10–24) headache and 8 (5–11) migraine days per month. The 30%, 50% and 75% responder rates were 40%, 34.9% and 15.1% between weeks 8–12, and 48.8%, 36%, and 18.6% between weeks 20–24. Adverse effects were reported by 30 (34.9%) and 13 (15.1%) patients between weeks 0–12 and 12–24, leading to discontinuation in 15 (17.4%) patients. Chronic migraine, depression, headache days per month, medication overuse headache, and daily headache at baseline predicted the response between weeks 20–24. Conclusion: Candesartan effectiveness and tolerability in migraine prevention was in line with the clinical trials' efficacy. Trial registration: The study protocol is registered in ClinicalTrials.gov (NCT04138316). [ABSTRACT FROM AUTHOR]