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Purpose of Review: To review replicated and highlight novel studies of sleep in children and adults with episodic and chronic migraine., Recent Findings: Attack-related sleep symptoms are most common in the prodrome and may represent early activation of the hypothalamus rather than migraine triggers. Interictally, patients with migraine report poor sleep quality and high rates of insomnia symptoms. Cognitive behavioral therapy for insomnia in adults and adolescents with chronic migraine and comorbid insomnia results in significant improvement on their headache burden. Thus far, objective studies report that migraine per se is a not associated with sleep apnea. At the present time, there is minimal evidence that migraine is under circadian influence. The current body of evidence suggests that the insomnia symptoms and poor sleep quality commonly reported by patients with migraine are not attack-related but occur interictally and are a marker of worsening disease. The development of clinical guidelines to approach sleep symptoms and expansion of CBT-I trials in those with episodic migraine would be clinically valuable., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose of Review: This review aimed to investigate emerging evidence regarding the effectiveness of exercise for migraines, focusing on the results of recent trials. Additionally, it explored the possibility of exercise as a treatment for migraines., Recent Findings: Between 2020 and 2023, five, four, one, and two trials were conducted regarding the effect of aerobic exercise, anaerobic exercise, Tai Chi, and yoga, respectively, on migraine; all studies showed significant effects. Two trials on aerobic exercise showed that high-intensity exercise was similar to or slightly more effective than moderate-intensity exercise as a treatment for migraines. Three trials on anaerobic exercise reported its effectiveness in preventing migraines. Regarding efficacy, side effects, and health benefits, aerobic exercises and yoga are potentially beneficial strategies for the prevention of migraines. Further studies are needed to develop evidence-based exercise programs for the treatment of migraines., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose of Review: Migraine brings hours or even days of disability, affecting 15% of the US population and one billion people worldwide. Migraine treatments have improved over the years and there is now a range of non-pharmacologic therapies that can be administered as monotherapy, combined with pharmacologic therapy or combined with other non-pharmacologic therapies to give greater options for those who do not tolerate, do not respond to, or who wish to reduce or avoid pharmacologic treatments., Recent Findings: We conducted a review of the literature on auricular therapy as acute or preventive treatment for migraine, searching the databases of MEDLINE and ClinicalTrials.gov from 2013 to 2023. A total of 43 articles contained at least one search term, with three studies specific to acute or prevention of migraine (one for acute only, one for prevention only and one for both acute and prevention). The population was limited to, adults with migraine ages 18 or older, with the administration of auricular therapy as the intervention. While there have been studies on the use of auricular therapy for pain on two specific standardized auricular therapies, Battlefield Acupuncture (BFA) and National Acupuncture Detoxification Association (NADA), neither of these protocols were utilized in any of the studies specific to migraine management. Each of the three studies used different techniques, with one using acupuncture needles and five specific points and two using semi-permanent needles (remained in for a few days) that were placed in areas that showed high activity. Each of these studies showed auricular therapy to have benefit for the management of migraine. However, the authors of each of the studies recommended further studies. Auricular therapy may be a helpful adjunctive treatment to abort a current migraine attack or aid in reducing the frequency or severity of migraine attacks., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose of Review: To provide an update on comorbidity of vestibular symptoms and migraine., Recent Findings: Multisensory processing and integration is a key concept for understanding mixed presentation of migraine and vestibular symptoms. Here, we discuss how vestibular migraine should be distinguished from a secondary migraine phenomenon in which migraine symptoms may coincide with or triggered by another vestibular disorder. We also have some updates on the diagnostic criteria of vestibular migraine, its pathophysiology, and common approaches used for its treatment. As a common clinical presentation of migraine and vestibular symptoms, vestibular migraine should be distinguished from a secondary migraine phenomenon, in which migraine symptoms may be triggered by or coincide with another vestibular disorder. Recent experimental evidence suggests vestibular symptoms in vestibular migraine are linked to multisensory mechanisms that control body motion and orientation in space., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose of Review: This review assesses the effectiveness and safety of light therapy, particularly green light therapy, as an emerging non-pharmacological treatment for chronic migraine (CM). It aims to highlight alternative or complementary approaches to traditional pharmacological remedies, focusing the need for diverse treatment options., Recent Findings: Despite sensitivity to light being a defining feature of migraine, light therapy has shown promising signs in providing substantial symptom relief. Studies have provided insights into green light therapy's role in managing CM. These studies consistently demonstrate its efficacy in reducing the frequency, severity, and symptoms of migraines. Additional benefits observed include improvements in sleep quality and reductions in anxiety. Importantly, green light therapy has been associated with minimal side effects, indicating its potential as a suitable option for migraine sufferers. In addition to green light, other forms of light therapy, such as infrared polarized light, low-level laser therapy (LLLT), and intravascular irradiation of blood (ILIB), are also being explored with potential therapeutic effects. Light therapies, especially green light therapy, are recognized as promising, safe, and non-pharmacological interventions for treating CM. They have been shown to be effective in decreasing headache frequency and enhancing the overall quality of life. However, current studies, often limited by small sample sizes, prompt more extensive clinical trials to better understand the full impact of light therapies. The exploration of other light-based treatments, such as LLLT and ILIB, warrants further research to broaden the scope of effective migraine management strategies., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose of Review: To provide information from preclinical and clinical studies on the biological activity and health benefits of dietary inclusion of nutraceuticals as a safe, effective, non-pharmacological approach for the treatment of migraine., Recent Findings: There is emerging evidence of the therapeutic benefit of nutraceuticals to inhibit oxidative stress, suppress inflammation, and prevent changes in the normal gut microbiome, which are implicated in migraine pathology. Nutraceuticals can be enriched in polyphenols, which act as molecular scavengers to reduce the harmful effects of reactive oxygen species and phytosterols that suppress inflammation. Nutraceuticals also function to inhibit dysbiosis and to maintain the commensal intestinal bacteria that produce anti-inflammatory molecules including short-chain fatty acids that can act systemically to maintain a healthy nervous system. Dietary inclusion of nutraceuticals that exhibit antioxidant, anti-inflammatory, and anti-nociceptive properties and maintain the gut microbiota provides a complementary and integrative therapeutic strategy for migraine., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose of Review: The objective of this study is to review the recent literature on yoga for migraine prevention either as adjuvant or standalone therapy. Yoga is one of the most widely used complementary and integrative medicine (CIM) therapies; clinicians should be familiar with yoga practice so that they can best advise interested patients. It is also important to assess study design and types of yoga offered. Using PubMed and Litmaps, research published from 2018 to 2023 addressing yoga and migraine was assessed., Recent Findings: Two systematic reviews and six studies have recently been published on yoga as adjunctive migraine preventive treatment. There is class III evidence and a grade B recommendation for yoga as an adjunct migraine preventive treatment. Yoga has been shown to reduce headache frequency, disability, and likely also pain intensity and self-efficacy. Two studies (one in children and one in adults) suggested that yoga as standalone migraine preventive treatment reduces pain intensity, disability, and perceived stress. More research is needed on the long-term efficacy (including change in monthly migraine days specifically in addition to headache frequency) and adherence to yoga practice for the prevention of migraine. In addition, to our knowledge, there is no study evaluating yoga practice in the prodromal or headache phase of migraine as acute treatment., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose of Review: To define, describe, and identify potential solutions for health disparities in the uninsured and underinsured with migraine in the USA., Recent Findings: Uninsured and underinsured patients with migraine experience health disparities in diagnosis and treatment of migraine. Migraine patients have higher healthcare costs and higher employment disability, which contribute to a higher likelihood of uninsured or underinsured status. Uninsured or underinsured status, combined with factors such as race, socioeconomic status, geographic location, and care location, are correlated with delays in or decreased migraine diagnosis and treatment. Migraine prevalence is increased in the uninsured and underinsured. Potential solutions include advocacy for policy changes that improve access to care, increasing awareness and representation of underrepresented groups, providing resources to patients to reduce costs, and active patient engagement in migraine care. Continued efforts from all stakeholders have the potential to reduce health disparities in uninsured and underinsured patients with migraine, reducing disability and improving quality of life., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose of Review: Episodic migraine is a common and disabling neurological disorder that is underdiagnosed and undertreated. Additional barriers are put in place for those who belong to an underserved population. This could be based on race, ethnicity, gender, sexual orientation, or socioeconomic status., Recent Findings: There has been a lot of interest in understanding the extent of these disparities, but studies for many of these groups are lacking. More work is needed to understand the disparities and needs of underserved populations. Most of the literature has been done for Black populations but there are many other underserved communities that need assessment and intervention. The healthcare community needs to take action to improve support for populations with a higher incidence of migraine and disability, yet a lower rate of diagnosis and treatment. Some recommendations include awareness of biases, systemic changes, education, and including diverse populations in research and training., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose of Review: This article provides an overview of the application of CBT in the management of episodic migraine while also providing context and insight into the underlying neurophysiological mechanisms of therapeutic change. It discusses the theoretical foundations of CBT and highlights key components including education, cognitive restructuring, behavioral interventions, relaxation techniques, and lifestyle changes., Recent Findings: Cognitive behavioral therapy (CBT) is an empirically based treatment that is well suited for the management of episodic migraine. Although first-line treatments of migraine are typically pharmacological, a review of empirical literature suggests growing evidence for the use of CBT as a standard non-pharmacological treatment of headache conditions. In summary, this article explores evidence supporting the efficacy of CBT in reducing the frequency, intensity, and duration of migraine attacks as well as improving the quality of life and psychological well-being of those with episodic migraine., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose of Review: Migraine is common and interventions to treat or manage it vary. Physical therapists possess a varied skill set that can assess and treat limitations related to migraine and its symptoms. Conservative and non-pharmacological examination and treatment techniques for migraine and headache management are reviewed in terms of efficacy and relevance in order to describe the physical therapist's abilities and clinical reasoning process when confronting a patient with migraine symptoms., Recent Findings: A thorough examination is necessary to detect red flags and will reveal a person with migraine's biopsychosocial limitations to manage their symptoms. Strength, endurance, cervical mobility, and visual deficits are common in those reporting headaches and examination techniques, along with patient-reported outcome measures, can elicit objective data for re-assessment during an episode of care. Exercise interventions, manual therapy, biofeedback techniques, and vestibular therapy have become viable and efficacious non-pharmacological interventions in recent years to assist the patient with managing and mitigating their migraine symptoms, along with mindfulness-based exercises. A case study, with individualized treatment approaches based on examination findings, current evidence, and accrued expertise, demonstrates the clinical applicability of a physical therapist's multimodal approach to treating migraine. Psychologically- informed physical therapy with mindfulness-based approaches and biofeedback can help a patient gain more control over their symptoms and their body's response to head pain, while exercise and vestibular therapy can assist the system with recovery and adaptation from deficits related to migraine symptoms. A thorough examination, with an individually- tailored rehabilitation plan incorporating movement and mindfulness-based therapies, is recommended., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose of Review: We evaluate the evolving evidence of psychiatric comorbidities associated with episodic migraine. Utilizing recent research publications, we aim to assess traditional treatment option considerations and discuss recent and evolving non-pharmacologic treatment progress for episodic migraine and related psychiatric conditions., Recent Findings: Recent findings indicate that episodic migraine is strongly linked to comorbid depression, anxiety, posttraumatic stress disorder, and sleep disorders. Not only do patients with episodic migraine have higher rates of psychiatric comorbidity, but a higher number of headache days reported is also strongly linked to an increased risk of developing a psychiatric disorder, indicating there may be a link between frequency and psychiatric comorbidity and that patients with high-frequency episodic migraine should be assessed for psychiatric comorbidity. Few migraine preventive medications have examined the effect of the medication on both migraine and psychiatric comorbidity though we discuss what has been reported in the literature. Non-pharmacologic-based treatments including behavioral therapies and mind-body interventions previously developed for psychiatric conditions, e.g., mindfulness-based CBT (MBCT), acceptance and commitment therapy (ACT), and mindfulness-based stress reduction (MBSR) therapy, have promising results for patients diagnosed with episodic migraine and may therefore be useful in treating migraine and comorbid psychiatric conditions. Psychiatric comorbidity may affect the efficacy of the treatment of episodic migraine. Thus, we must assess for psychiatric comorbidities to inform better treatment plans for patients. Providing patients with episodic migraine with alternate modalities of treatment may help to improve patient-centered care and increase patients' sense of self-efficacy., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose of Review: Over the past few years, there have been many systematic reviews (SRs) and meta-analyses (MAs) used to assess the safety and efficacy of acupuncture in the treatment of migraine. Our aim is to assess the methodological and reporting quality of SRs/MAs and make an evaluation about the available evidence of the safety and efficacy of acupuncture in the treatment of migraine., Recent Findings: Migraine is one of the most common primary headaches, with various symptoms, threatening human health. Acupuncture is a specific treatment of Traditional Chinese Medicine (TCM), and a validated non-pharmaceutical option as well, widely used in the treatment of migraine, and has gained remarkable therapeutic effect. An overview can evaluate research methods and evidence for SRs/MAs in evidence-based medicine, although there is much relevant research, it's still a hard work to synthesis all the evidence or to make robust conclusions, the variation in the methodological and quality evidence in such SRs/MAs play a significant role. For this overview, we searched six electronic databases from inception until 8 September 2022, and without languages restrictions, the results showed that, acupuncture as a more safety and more convenient therapeutic, and it has been shown to be effective in the treatment of migraine, that is worthy of clinical promotion. However, there are also some limitations because of the low-quality evidence of most of the studies. In conclusion, most included SRs/MAs suggested that acupuncture was more effective than the control group in the treatment of migraine. However, the quality evidence of most of the studies still needs to be improved., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose of Review: The purpose of this review is to discuss the current evidence for Cognitive Behavioral Therapy for Insomnia (CBT-I) for patients with migraine and comorbid insomnia. In this article, we provide a narrative review of the literature on CBT-I and migraine, highlighting recent advances in research into this topic. Finally, we propose a way for clinicians to integrate CBT-I into clinical practice., Recent Findings: Multiple studies support CBT-I as a validated modality for the treatment of insomnia in migraine. CBT-I is used to treat insomnia and should be offered as first line therapy. Clinicians should screen for insomnia in all patients with headache, especially in those with migraine, to best manage this condition through the implementation of specific insomnia treatment., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose of Review: Migraine is one of the top reasons for consulting a pediatric neurologist. Although the majority of children and adolescents who receive evidence-based first-line interventions for migraine will improve substantially, a subset of patients develop resistant or refractory migraine., Recent Findings: In this review, we summarize the level of evidence for a variety of acute and preventive treatment options to consider in children and adolescents with resistant or refractory migraine. We describe the level of evidence for interventional procedures (onabotulinumtoxinA injections, greater occipital and other nerve blocks), neuromodulation (single-pulse transcranial magnetic stimulation, external trigeminal nerve stimulation, remote electrical neuromodulation, and non-invasive vagal nerve stimulation), calcitonin gene-related peptide (CGRP) pathway antagonists (anti-CGRP monoclonal antibodies and gepants), psychological therapies, and manual therapies (acupuncture, craniosacral therapy, massage and physical therapy, and spinal manipulation)., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose of Review: In this review, the role of the autonomic nervous system in tension-type headache and migraine is reviewed., Recent Findings: A pathophysiological model for tension-type headache is proposed that is compatible with most physiological and behavioral literature. A treatment protocol is described that follows from this model. For migraine, incorporating autonomic factors into the pathophysiology offers rationales for behavioral interventions that have been shown to be useful in migraine treatment and a biofeedback protocol is proposed., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose of Review: To explore recent developments in vestibular migraine (VM)., Recent Findings: This review discusses the current diagnostic criteria for VM in the adult and pediatric populations, as proposed by the International Headache Society and Bárány Society. Recent VM studies confirm the prior findings and reveal new insights, including the wide range of vestibular symptoms, symptoms in the attack-free period, and triggers. Many patients experience persistent vestibular symptoms, even in the absence of acute attacks, which often significantly impact patients' quality of life. The syndrome of benign recurrent vertigo and its relationship to migraine, VM, and Meniere's disease is also discussed. There is a dearth of randomized controlled trials in VM treatment. Prospective and retrospective studies support the benefit of many migraine treatments are effective in VM, including neuromodulation, and calcitonin gene-related peptide monoclonal antibodies. VM affects almost 3% of the population, but remains under-diagnosed. Recent diagnostic criteria can help clinicians diagnose VM in adults and children., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose of Review: The goal of this article is to describe migraine advocacy as an essential means to advance the field of headache medicine. Special attention is spent outlining advocacy initiatives and priorities., Recent Findings: There is little written about "migraine advocacy" in the literature. However, organizational and expert priorities include advocating for policies that improve systems of care, telemedicine, education, research, and public initiatives that reduce health disparities and the stigma of migraine. This summary includes the latest advocacy efforts to support policies that may improve migraine care, strengthen the field of headache medicine, and eliminate the burden of migraine., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose of Review: This review will briefly summarize recent literature published on headache disparities in underserved and vulnerable populations. It will also report the personal observations of headache medicine providers working with underserved and vulnerable populations in the USA, specifically in an urban practice dedicated to patients in a safety net program and a rural practice dedicated to Native American patients., Recent Findings: Headache disorders are recognized as one of the most prevalent neurological conditions. People with headache and migraine encounter several barriers to obtaining appropriate care, which are magnified in vulnerable and underserved populations. Research has shown disparities in headache and migraine diagnosis, prevalence rates, treatment, and outcomes based on race, socioeconomic status, and geography. Continued research regarding disparities in headache medicine is required. Strategies to address the identified challenges, including structural competence and the underrepresented in medicine pipeline, are reviewed., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose of Review: This review provides an update on sex differences in chronic migraine (CM), with a focus on clinical characteristics, pathophysiology, and treatments., Recent Findings: Approximately 6.8-7.8% of all migraineurs have CM, with an estimated prevalence of 1.4-2.2% in the general population. The economic burden caused by CM, including medical costs and lost working ability, is threefold higher than that caused by episodic migraine (EM). Notably, the prevalence of migraine is affected by age and sex. Female migraineurs with CM experience higher levels of headache-related disability, including longer headache duration, higher frequency of attacks, and more severely impacted efficiency at work. Sex hormones, including estrogen, testosterone, and progesterone, contribute to the sexually dimorphic characteristics and prevalence of migraine in men and women. Recent neuroimaging studies have indicated that migraine may have a greater impact and cause greater dysfunction in the organization of resting-state functional networks in women. Accumulating evidence suggests that topiramate, Onabotulinumtoxin A and calcitonin gene-related peptide (CGRP) monoclonal antibodies are effective as the preventative treatments for CM. Recent evidence highlights a divergence in the characteristics of CM between male and female populations. The data comparing the treatment response for CM regarding sex are lacking., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose of Review: Migraine is and continues to be a significant medical issue in older adults. Migraine can have different characteristics in older adults and specific diagnostic and treatment considerations need to be applied when managing headache and migraine in this population, which is increasing in both size and diversity. Contrary to widely held beliefs, migraine may not improve in older women following menopause and can have new onset in older age. The purpose of this review is to give an update on the diagnosis and treatment of episodic migraine in older adults., Recent Findings: As the population ages, migraine in older adults will become a more significant public health issue. Migraine in older adults can present with different clinical symptoms than in a younger population and is primarily a diagnosis of exclusion in older adults. Migraine treatment considerations for older adults should include comorbidities and medication interactions. Recent findings suggest there are medications that should be avoided when treating seniors with migraine. The purpose of this review is to give an update on the most important aspects regarding the diagnosis and treatment of headache and migraine in older adults. In addition, recommendations will be made concerning medications that need careful consideration when prescribing to seniors., (© 2022. The Author(s).)

Purpose of Review: This paper will examine the efficacy and safety of occipital nerve stimulation as a non-pharmacological alternative treatment for migraine., Recent Findings: Migraine is characterized as a primary headache disorder with possible premonitory and aura phases, both of which vary greatly in symptomatology. The most common treatments for chronic migraine are pharmacological and are aimed at both acute relief (e.g., nonsteroidal anti-inflammatory drugs, triptans, and ergots) and prophylaxis (e.g., propranolol, valproic acid, and topiramate). For patients with medically refractory migraine, acute relief medication overuse can increase the risk of developing more severe and more frequent migraine attacks. Occipital nerve stimulation is a non-pharmacological alternative treatment for chronic migraine, which could eliminate the risk of adverse effects from acute relief medication overuse. Neurostimulation is thought to prevent pain by blocking signal transduction from small nociceptive fibers with non-painful signaling in larger adjacent fibers. Existing data from clinical trials support the overall safety and efficacy of occipital nerve stimulation for the treatment of chronic migraine. However, few large controlled, double-blinded studies have been conducted, due to both practical and ethical concerns. Currently, occipital nerve stimulation is available as an off-label use of neurostimulation for pain prevention but is not approved by the FDA specifically for the treatment of chronic migraine., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose of Review: We reviewed the literature that explored the use of central and peripheral neuromodulation techniques for chronic daily headache (CDH) treatment., Recent Findings: Although the more invasive deep brain stimulation (DBS) is effective in chronic cluster headache (CCH), it should be reserved for extremely difficult-to-treat patients. Percutaneous occipital nerve stimulation has shown similar efficacy to DBS and is less risky in both CCH and chronic migraine (CM). Non-invasive transcutaneous vagus nerve stimulation is a promising add-on treatment for CCH but not for CM. Transcutaneous external trigeminal nerve stimulation may be effective in treating CM; however, it has not yet been tested for cluster headache. Transcranial magnetic and electric stimulations have promising preventive effects against CM and CCH. Although the precise mode of action of non-invasive neuromodulation techniques remains largely unknown and there is a paucity of controlled trials, they should be preferred to more invasive techniques for treating CDH., (© 2022. The Author(s).)

Purpose of Review: This review summarizes key findings from recent investigations of psychological interventions for pediatric headache disorders and discusses important avenues for future research., Recent Findings: Cognitive Behavioral Therapy (CBT) is effective in reducing headache days among youth with chronic headache. There is mixed evidence for the benefit of CBT on reducing disability associated with migraine, suggesting that there is room to optimize CBT by leveraging complementary or alternative psychological interventions, such as Acceptance and Commitment Therapy (ACT) and mindfulness-based approaches. Tailoring CBT may be especially important for youth with more impairing or complex clinical presentations, such as those with continuous headache. Using eHealth and novel study designs to expand access to and dissemination of psychological interventions is promising. Although CBT is the gold standard psychological treatment for youth with migraine, we are only beginning to understand how and why it is effective. Other promising psychological treatments are available, and studies are beginning to examine how CBT can be optimized to fit the unique needs of each patient. Improving access and equitability of care for youth with migraine will require tailoring psychological treatments for patients with varying headache presentations and youth from a variety of cultural, racial, ethnic, and linguistic backgrounds., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose of Review: Headache disorders in children and adolescents are common. Among the different headache disorders, migraine and tension headache are highly prevalent and often debilitating. Pharmacological treatments for pediatric patients are often not approved or effective. Practice guidelines for prevention of pediatric headache and migraine are now incorporating information and recommendations regarding non-pharmacologic therapeutic options. Understanding the mechanism of action, safety, and efficacy of the non-pharmacologic as well as mindful-based therapeutic alternatives currently available for the management and treatment of headache and migraine may allow additional treatment alternatives for children with these conditions., Recent Findings: Studies have been published looking at non-pharmacologic treatments, and mindful-based approaches, namely relaxation, mindfulness meditation, yoga, and hypnosis as options for the treatment of headache and migraine, although there are few that examine these in children and adolescents. Several recent studies that have relevance to the care of children with headache and migraine are reviewed. Non-pharmacologic and mindful-based approaches for the prevention and treatment of headache and migraine in children show safety and efficacy data that is promising. Consider incorporating these multi-modal approaches into the therapeutic management strategies for the child or adolescent with headache and migraine. Additional prospective studies and/or randomized-controlled trials are necessary to further assess the efficacy and cost-effectiveness of these methods., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose of Review: Migraine and other primary headache disorders do not receive adequate research funding, medical resources, or other forms of structural support relative to their prevalence and the disability they cause. In recent research, scholars have argued that stigma associated with headache disorders explains some of this discrepancy. This review will discuss (1) the factors contributing to stigma toward migraine and other primary headache disorders, (2) how structural and enacted stigma may perpetuate individual disability, (3) the impact of internalized stigma, and (4) interventions to mitigate stigma toward headache disorders with an emphasis on outcome monitoring. The review will also propose new areas of stigma research in need of further investigation., Recent Findings: Recent research shows that discrimination can exacerbate chronic pain. Stigma profoundly affects everything from the allocation of federal research funds and healthcare resources to individual patients' self-efficacy and ability to care for themselves. Understanding the stigma of migraine and learning how to develop effective interventions to mitigate this stigma will increase access to appropriate migraine care, improve healthcare providers' ability to care for their migraine patients, and help advocates reverse policies that discriminate against those with migraine. It is important to closely monitor outcomes of anti-stigma efforts for both positive and negative consequences and take note of outcomes and "lessons learned" from anti-stigma campaigns for other diseases., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose of Review: Neuromodulation devices have become an attractive alternative to traditional pharmacotherapy for migraine, especially for patients intolerant to medication or who prefer non-pharmacological options. In the past decades, many studies demonstrated the efficacy of neuromodulation devices in patients with episodic migraine (EM). However, the benefit of these devices on chronic migraine (CM), which is typically more debilitating and refractory than EM, remains not well studied., Recent Findings: We reviewed the literature within the last five years on using FDA-cleared and investigational devices for CM. There were eight randomized controlled trials and 15 open-label observational studies on ten neuromodulation devices. Neuromodulation is promising for use in CM, although efficacy varies among devices or individuals. Noninvasive devices are usually considered safe with minimal adverse events. However, stimulation protocol and methodology differ between studies. More well-designed studies adhering to the guideline may facilitate FDA clearance and better insurance coverage., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose of Review: Intractable migraine in children and adolescents is a significant cause of disability and decreased quality of life (QoL) in this population. Challenges include lack of unifying definition for intractable migraine, and limited data on best-practice management in this age group, with most current treatment pathways extrapolated from adult studies or expert consensus., Recent Findings: A comprehensive approach in the evaluation and management of intractable migraine in this age group encompasses excluding secondary causes of headache; making an accurate diagnosis; identifying and appropriately managing modifiable risk factors; and initiating appropriate pharmacologic therapy to reduce disability, improve health-related quality of life, reduce risk of progression, and develop adaptive pain coping strategies. Several strategies for management of pediatric intractable migraine including use of acute medications, bridge therapy in outpatient setting, emerging therapies for preventive therapy, and a stepwise combination therapy for management of pediatric intractable migraine in emergency and inpatient setting are presented based on available clinical data, safety/tolerability, availability, cost-effectiveness, and expert consensus. This descriptive review of the available literature focuses on approach to therapy for acute intractable migraine in a pediatric population including outpatient, emergency department (ED), and inpatient management.

Purpose of Review: To summarize the clinical neuroimaging evidence pertaining to the potential mechanisms of acupuncture for migraine prophylaxis., Recent Findings: From a descriptive perspective, converging evidence from recent neuroimaging studies, mainly from functional MRI (fMRI) studies, has demonstrated that when compared with sham acupuncture, verum acupuncture could normalize the decrease of the functional connectivity of the rostral ventromedial medulla-trigeminocervical complex (RVM/TCC) network, frontal-parietal network, cingulo-opercular networks, and default mode network and could normalize sensorimotor network connectivity with sensory-, affective-, and cognitive-related brain areas. These areas overlap with those of the pain matrix. Verum acupuncture works in a more targeted and unique manner compared with sham acupuncture in patients with migraine. These findings from neuroimaging studies may provide new perspectives on the validation of acupoints specificity and confirm the central modulating effects of acupuncture as a migraine prevention treatment. However, the exact mechanism by which acupuncture works for migraine prophylaxis remains unclear and warrants investigation. Future studies with larger sample sizes are still needed to confirm the current results and to further evaluate the complex and specific effects of acupuncture by analyzing different stimulus conditions, such as verum vs. sham acupuncture, deqi vs. no deqi, different acupuncture points or meridians, and different manipulation methods. Moreover, instead of focusing on the changes in a single area of the brain, researchers should focus more on the relationships among the functional connectivity network of brain areas such as the RVM/TCC, thalamus, anterior cingulate cortex (ACC), superior temporal gyrus (STG), and supplementary motor area (SMA) to explore the underlying mechanism of the effects of acupuncture.

Purpose of Review: This review aims to summarize the last 15 years of literature and case reports detailing retinal migraine-an uncommon and somewhat poorly understood migraine variant., Recent Findings: In the last 15 years, only 12 cases of retinal migraine have been outlined. Similar to other migraine statistics, retinal migraine appears to affect women more so than men and presents with unilateral headache which tends to be ipsilateral to the side of vision loss. The pathophysiology may relate to vasoconstriction of retinal vessels, as evidenced by ictal fundus photography in the past few years. Retinal migraine is a rare entity, with a paucity of described cases in the literature. Retinal migraine is a diagnosis of exclusion, as monocular vision loss might be ascribed to several concerning disorders requiring urgent diagnosis and treatment, and any patient presenting as such should be thoroughly investigated. Patients suffering from retinal migraine appear to respond to typical migraine abortive therapies including NSAIDs and migraine prophylactic medications.

Purpose of Review: With this review, we aimed to investigate the effect of exercise on migraine and explored the possibility of exercise as a treatment option for migraine., Recent Findings: A close association of physical activity and exercise with migraine has been reported in clinical and population-based studies. Recent randomized controlled trials investigating the effect of aerobic exercise as a migraine-preventive treatment have revealed a notable improvement in migraine symptoms. Data on the effect of anaerobic exercise and exercise for flexibility, coordination, and relaxation on migraine are currently insufficient to make any recommendations. Possible pathways for the attenuation of migraine by exercise include the endogenous opioid and cannabinoid systems, brain-derived neurotrophic factor, inflammation, and behavioral/psychological factors. Regarding efficacy, side effects, and health benefits, aerobic exercise is a potentially beneficial strategy in the preventive treatment of migraine. Further studies are needed to delineate an evidence-based exercise program for migraine treatment.

Purpose of Review: The past two decades has seen an influx of noninvasive neuromodulation devices aimed at treatment of various primary headache disorders, including cluster headache and migraine. This narrative review is to summarize the current options in noninvasive neuromodulation in migraine., Recent Findings: A variety of noninvasive neuromodulation devices have been FDA cleared and marketed for use in migraine, including single-pulse transcranial magnetic stimulation (sTMS), noninvasive vagal nerve stimulators (nVNS), and external trigeminal nerve stimulators (eTNS). Newer devices include peripheral electrical stimulation devices (PES), caloric stimulation, and others. Each has varying levels of evidence supporting its use in migraine, tolerability profiles, and access issues. Noninvasive neuromodulation devices can be beneficial when used in patients with migraine, with minimal side effects. As more devices are developed, approved, and marketed in the future, rigorous research on efficacy and safety remain a top priority.

Purpose of Review: Migraine is a common disorder which in many cases can be adequately treated with medications. However, there are some patients who may either not respond to medications or have contraindications to their use. In this review, we will evaluate the available literature on the interventional procedures available to treat patients with episodic migraine. We will review the technical details of performing the procedures, the potential mechanisms of action, and available data on their effectiveness., Recent Findings: Recent studies conducted on the subject of interventional procedures including peripheral nerve blocks and onabotulinumtoxinA indicate that some patients with episodic migraine may find benefit from such procedures. In patients with episodic migraine whom traditional treatments have not been effective or are contraindicated, interventional procedures may offer an opportunity to provide additional treatment options.

Purpose of Review: This narrative review examines the use of behavioral interventions for acute treatment of headache and pain in the emergency department (ED)/urgent care (UC) and inpatient settings., Recent Findings: Behavioral interventions demonstrate reductions of pain and associated disability in headache, migraine, and other conditions in the outpatient setting. Behavioral treatments may be a useful addition for patients presenting with acute pain to hospitals and emergency departments. We review challenges and limitations and offer suggestions for implementation of behavioral interventions in the acute setting. Some evidence exists for relaxation-based treatments, mindfulness-based treatments, hypnosis/self-hypnosis, and immersive virtual reality for acute pain, migraine, and headache. There are few high-quality studies on behavioral treatments in the inpatient and emergency department settings. Further research is warranted to determine the efficacy and cost-effectiveness of these interventions. Given the general safety and cost-effectiveness of behavioral interventions, healthcare professionals may want to include these therapies in treatment plans.

Purpose: The purpose of this paper is to review and outline the similarities and differences in the treatment of athletes compared with that of other populations with a persistent post-traumatic headache after a concussion., Recent Findings: After an extensive review of the literature and despite well over 2 million Americans experiencing post-traumatic headache (PTH) each year, a number of which will continue to experience persistent post-traumatic headache (PPTH). There is little evidence on the management of the disorder and essentially no evidence-based research when it comes to the management of athletes. With little evidence available for the treatment of individuals with PPTH, be it athletes or non-athletes, the clinician will need to rely on their experience and the application of existing treatments for migraine and chronic migraine. Clearly, more research is needed, especially with respect to the management of athletes versus non-athletes.

Purpose of Review: Migraine disease is a neurological brain disorder that has been associated with significant disability and socioeconomic burden affecting women three times more commonly than men. Menstrual migraine is a subclass of migraine disease affecting 42-61% of females living with migraine disease. Menstrual migraine is often far more disabling, of longer duration, and more resistant to treatment. It is crucial to gain a deeper understanding of the ongoing biological changes and have a current awareness of the management of this debilitating form of migraine disease to improve the quality of life of these females living with migraine disease., Recent Findings: In new treatment options such as devices and with large-scale genome-wide association studies in migraine, genes related to migraine are being identified. This article will review the current literature regarding the pathophysiology, epidemiology, and treatment of menstrual migraine.

Purpose of Review: Primary headaches are less common and differ in presentation in older versus younger individuals. Secondary headaches become more common among older patients., Recent Findings: Diagnosis and management of headaches in those > 65 years are discussed. Migraine and tension-type headaches are rarely new onset in this age group and should be a diagnosis of exclusion. In older individuals, migraine is more likely to be bilateral with less sensory sensitivities. Migraine aura may present without headache; careful assessment is needed to exclude stroke. Other primary headaches discussed include cough, hypnic, and other headaches. Secondary causes discussed include giant cell arteritis, trigeminal post-herpetic neuropathy, sleep apnea, cardiac cephalgia, cervicogenic pain, vascular etiologies, medications, and burning-mouth syndrome. In older individuals, primary headaches are diagnoses of exclusion, and treatment is affected by comorbidities and polypharmacy. Secondary headaches are a major consideration requiring appropriate workup. Many treatments can safely be offered regardless of age.

Purpose of Review: The purpose of this review is to discuss the current evidence for acupuncture in migraine and to provide insight into which patients may benefit most from acupuncture., Recent Findings: Multiple studies support acupuncture as a validated modality for the prevention of episodic migraine. While small studies on acupuncture for the prevention of chronic migraine are encouraging, evidence for its benefit is limited. Likewise, the existing studies on acupuncture for acute migraine treatment are insufficient. Acupuncture is commonly used to treat migraine and has gained popularity as a validated non-pharmaceutical option. Although the specific mechanisms of acupuncture are not clearly understood, there is evidence for its effectiveness in treating migraine. Results of acupuncture studies are quite variable and depend on multiple factors, including frequency, duration, and consistency of treatments, as well as acupoint selection. A better understanding of the flaws inherent in acupuncture research will help guide the development of future studies.

Purpose: This work aims at describing a technique "The ALblation technique" for treating migraine headache. This technique describes radiofrequency ablation for supraorbital, supratrochlear, lesser occipital and greater occipital nerves bilaterally for treating migraine headache. This is a novel procedure that was not described before., Recent Findings: Author published some articles on radiofrequency ablation for the pericranial nerves for treating different types of headache with consistent positive outcomes. Success of this procedure depends on identifying the appropriate nerves to treat the headache and associated neuralgia.

Purpose of Review: People with headache usually experienced significantly lower health-related quality of life (HRQoL) than the healthy subjects. The goal of this systematic review was to evaluate the effectiveness of manual therapy on HRQoL in patients with tension-type headache (TTH), migraine (MH) or cervicogenic headache (CGH)., Recent Findings: We searched randomized controlled trials (RCTs) on MEDLINE, COCHRANE and PEDro databases. Treatment was manual therapy compared to usual care or placebo. The outcome was the HRQoL that could be measured by Headache Impact Test (HIT-6), Headache Disability Inventory (HDI), Migraine Disability Assessment Questionnaire (MIDAS) and Short Form Health Survey 12/36 (SF-12/36). For the RCT internal validity, we used the Cochrane risk of bias (RoB) tool. For the level of evidence, we used the Grading of Recommendations, Assessment, Development and Evaluation approach (GRADE). We identified a total of 10 RCTs, 7 of which were included into the meta-analysis. For HIT-6 scale, meta-analysis showed statistically significant differences in favour to manual therapy both after treatment (mean difference (MD) - 3.67; 95% CI from - 5.71 to - 1.63) and at follow-up (MD - 2.47; 95% CI from - 3.27 to - 1.68). For HDI scale, meta-analysis showed statistically significant differences in favour to manual therapy both after treatment (MD - 4.01; 95% CI from - 5.82 to - 2.20) and at follow-up (MD - 5.62; 95% CI from - 10.69 to - 0.54). Other scales provided inconclusive results. Manual therapy should be considered as an effective approach in improving the quality of life in patients with TTH and MH, while in patients with CGH, the results were inconsistent. Those positive results should be considered with caution due to the very low level of evidence. Researchers should in future design primary studies using valid and reliable disease-specific outcome measures.

Purpose of Review: The purpose of this review is to evaluate evidence from the last 3 years on complementary and integrative medicine treatment options for episodic migraine. Using Pubmed, Embase, and Cochrane databases, research published from 2015-2018 evaluating the modalities of mind/body therapies, supplements, and manual therapies for treatment of migraine were assessed., Recent Findings: Although many studies had major methodological challenges that limit interpretation, several studies reported decreased headache frequency, improved quality of life, or less affective responses to pain. The evidence is currently most promising for the mind/body treatment options of mindfulness, yoga, and tai chi. Mindfulness meditation may be as effective as pharmacological treatment for medication-overuse headache after the offending medication is withdrawn. While older research has shown magnesium, riboflavin, feverfew, and butterbur to be helpful in migraine treatment, new research is promising to suggest potential benefit with melatonin, vitamin D, higher dosages of vitamin B 6 (80 mg)/folic acid 5 mg combinations, and the combination of magnesium 112.5 mg/CoQ10 100 mg/feverfew 100 mg. Omega 3s have limited evidence of efficacy in migraine. Butterbur needs to be free of pyrrolizidine alkaloids (PA) to ensure safety given their hepatotoxicity. Physical therapy (PT) continues to have strong evidence of support, and acupuncture is superior to sham acupuncture and placebo. Side effects and risks reported were minimal and well tolerated overall, with the exception of the life-threatening risk of cervical artery dissection with high-velocity chiropractic manipulation and hepatotoxicity with the PAs in butterbur. Several studies are ongoing to further evaluate mindfulness, melatonin, PT, exercise, chiropractic manipulation, and acupuncture. The American Academy of Neurology (AAN) and American Headache Society (AHS) are currently updating the guidelines for integrative treatment options for migraine, so additional recommendations may be available soon. In conclusion, many complementary and integrative treatment options may be helpful for patients with migraines, and understanding potential efficacy, benefits, and risks can help providers discuss these modalities with their patients. Such a conversation can empower patients, build the therapeutic relationship, and increase self-efficacy, thus improving outcomes and patient-centered care.

Purpose of Review: In other disease states, adherence to behavioral therapies has gained attention, with a greater amount of studies discussing, defining, and optimizing adherence. For example, a meta-analysis formally discussed adherence in 25 studies of CBT for 11 different disorders, with only 6 of the 25 omitting addressing or defining adherence. Many studies have discussed the use of text messages, graph-based adherence rates, and email/telephone reminders to improve adherence. This paper examined the available literature regarding adherence to behavioral therapy for migraine as well as adherence to similar therapies in other disease states. The goal of this research is to apply lessons learned from adherence to behavioral therapy for other diseases in better understanding how we can improve adherence to behavioral therapy for migraine., Recent Findings: Treatment for migraine typically includes both pharmacologic and non-pharmacologic therapies, including progressive muscle relaxation (PMR), cognitive behavioral therapy (CBT), and biofeedback. Behavioral therapies have been shown to significantly reduce headache frequency and intensity, but high attrition rates and suboptimal adherence can undermine their efficacy. Traditionally, adherence to behavioral therapy has been defined by self-report, including paper headache diaries and assignments. In person attendance has also been employed as a method of defining and monitoring adherence. With the advent of personal electronics, measurements of adherence have shifted to include electronic-based methods such as computer-based programs and mobile-based therapies. Furthermore, some studies have taken advantage of electronic methods such as email reminders, push notifications, and other mobile-based reminders to optimize adherence. The JITA-I, a novel method of engaging individual patient adherence, has also been suggested as a possible method to improve adherence by tailoring engagement with a mobile health app-based on patient input. These novel methods may be utilized in behavioral therapy for migraine for further optimizing adherence. Few intervention studies to date have addressed the optimal ways to impact adherence to migraine behavioral therapy. Further research is required regarding adherence with behavioral therapies, specifically via mobile health interventions to better understand how to define and improve adherence via this novel forum. Once we are able to understand optimal methods of tracking adherence, we will be better equipped to understand the role of adherence in shaping outcomes for behavioral therapy in migraine.

Migraine is a common neurologic disorder. This article will discuss a few factors that influence migraine (mostly episodic) and its treatment, such as sleep, obstructive sleep apnea (OSA), obesity, and affective disorders, as well as autoimmune diseases. Practitioners must be aware of these coexisting conditions (comorbidities) as they affect treatment. It is noted in literature that both the quantity (too much or too few hours) and the quality (OSA related) of sleep may worsen migraine frequency. An associated risk factor for OSA, obesity also increases migraine frequency in episodic migraine cases. A bidirectional relationship with migraine along with depression and anxiety is debated in the literature. Retrospective cohort studies are undecided and lack statistical significance, but prospective studies do show promising results on treatment of anxiety and depression as a means of improving migraine control. Finally, we address the topic of autoimmune diseases and migraine. While few studies exist at this time, there are cohort study groups looking into the association between rheumatoid arthritis, hypothyroidism, and antiphospholipid antibody. There is also evidence for the link between migraine and vascular diseases, including coronary and cerebral diseases. We suggest that these comorbid conditions be taken into account and individualized for each patient along with their pharmaceutical regimen. Physicians should seek a multifactorial treatment plan including diet, exercise, and healthy living to reduce migraine frequency.

Purpose of Review: Episodic migraine is very common in children and adolescents, seen by primary care and specialists. In kids, this can greatly affect quality of life, including significant disability, specifically in terms of missed school and other activities. The goal of this paper is to give an overview of the most up-to-date thoughts on episodic migraine in the pediatric population., Recent Findings: Current options for both abortive and preventative treatments in kids, as well as specific non-pharmacological and lifestyle management recommendations for children, will be reviewed, as well as options for status migrainosus in the pediatric patient. Migraine pathophysiology is similar in adults and children with episodic migraine, but the approach to the management needs to be modified and adjusted in kids. Recognizing the impact on quality of life especially with regard to school and knowing appropriate treatment options can improve treatment and decrease the disability from this disorder.

Purpose of Review: Despite recognition of rising prevalence and significant burden, migraine remains underestimated, underdiagnosed, and undertreated. This is especially true among groups who have been historically, socially, and economically marginalized such as communities of color, women, people experiencing poverty, people with lower levels of education, and people who hold more than one of these marginalized identities. While there is growing public and professional interest in disparities in migraine prevalence, there is a paucity of research focusing on racial/ethnic and socioeconomic disparities, and the social and structural determinants of health and equity that perpetuate these disparities. From a health equity perspective, migraine research and treatment require an examination not only of biological and behavioral factors, but of these identities and underlying, intersecting social and structural determinants of health., Recent Findings: Significant disparities in migraine incidence, prevalence, migraine-related pain and disability, access to care, and quality of care persist among marginalized and underserved groups: African Americans, Hispanics, people experiencing poverty, un- or under-employment, the un- and under-insured, people who have been exposed to stressful and traumatic events across the lifespan, and people experiencing multiple, overlapping marginalized identities. These same groups are largely underrepresented in migraine research, despite bearing disproportionate burden. Current approaches to understanding health disparities in migraine largely assume an essentializing approach, i.e., documenting differences between single identity groups-e.g., race or income or education level-rather than considering the mechanisms of disparities: the social and structural determinants of health. While disparities in migraine are becoming more widely acknowledged, we assert that migraine is more aptly understood as a health equity issue, that is, a condition in which many of the health disparities are avoidable. It is important in research and clinical practice to consider perspectives that incorporate a cultural understanding of racial, ethnic, and socioeconomic identity within and across all levels of society. Incorporating perspectives of intersectionality provides a strong foundation for understanding the role of these complex combination of factors on migraine pain and treatment. We urge the adoption of intersectional and systems perspectives in research, clinical practice, and policy to examine (1) interplay of race, gender, and social location as key factors in understanding, diagnosing, and treating migraine, and (2) the complex configurations of social and structural determinants of health that interact to produce health inequities in migraine care. An intentional research and clinical focus on these factors stands to improve how migraine is identified, documented, and treated among marginalized populations.

Purpose of Review: This review evaluates and explains our current understanding of a rare subtype of migraine, typical aura without headache, also known as migraine aura without headache or acephalgic migraine., Recent Findings: Typical aura without headache is a known entity within the spectrum of migraine. Its pathophysiology is suggested to be similar to classic migraines, with cortical spreading depression leading to aura formation but without an associated headache. No clinical trials have been performed to evaluate treatment options, but case reports suggest that most patients will respond to the traditional treatments for migraine with aura. Bilateral greater occipital nerve blocks may be helpful in aborting migraine with prolonged aura. Transcranial magnetic stimulation has shown efficacy in aborting attacks of migraine with aura but has not been specifically tested in isolated aura. Typical aura without headache occurs exclusively in 4% patients with migraine, and may take place at some point in 38% of patients with migraine with aura. Typical aura without headache commonly presents with visual aura without headache, brainstem aura without headache, and can also develop later in life, known as late-onset migraine accompaniment.

Purpose of Review: This article reviews the recent research and development of electronic health (eHealth) and, in particular, mobile health (mHealth) strategies to deliver behavioral treatment for migraine. Prospects for future development and research of mobile health in migraine are suggested., Recent Findings: Advances in digital technology and mobile technology have led to an era where electronic and mobile approaches are applied to several aspects of healthcare. Electronic behavioral interventions for migraine seem to be acceptable and feasible, but efficacy measures are uncertain. Clinical trials on mHealth-based classical behavioral therapies, such as relaxation, biofeedback, and cognitive behavioral therapy are missing in the literature. Within mHealth, headache diaries are the most researched and scientifically developed. Still, there is a gap between commercially available apps and scientifically validated and developed apps. Digital technology and mobile health has not yet lived out its potential in behavioral migraine therapy. Application of proper usability and functionality designs towards the right market, together with appraisal of medical and technological recommendations, may facilitate rapid development of eHealth and mHealth, while also establishing scientific evidence.

Purpose of Review: To provide an updated overview of Photophobia with a particular focus on photophobia related to migraine., Recent Findings: Melanopsin-containing photoreceptors called intrinsically photosensitive retinal ganglion cells (ipRGCs) have been identified in the retina and explain the rational for photophobia in individuals who are blind. Photophobia, a sensory disturbance provoked by light, is a common neurological and ophthalmological symptom. Migraine, a common neurological condition, is pathognomonic of photophobia; however, other primary headache conditions, traumatic brain injury, and impairment of the optic pathway can cause photophobia. In addition, anterior and posterior segment ocular pathology, medications, and psychiatric conditions can result in photophobia. At least 2 (possibly three) distinct neural pathways are involved in photophobia. Some of the basic science regarding these pathways is discussed in this review including the role of calcitonin gene-related peptide (CGRP) and pituitary adenylate cyclase-activating polypeptide. Management of photophobia includes treatment of the underlying etiology and conservative strategies such as wearing sunglasses.

Purpose of Review: Migraine is a debilitating disease, that is encountered in countless medical offices every day and since it is highly prevalent in women, it is imperative to have a clear understanding of how to manage migraine. There is a growing body of evidence regarding the patterns we see in women throughout their life cycle and how we approach migraine diagnosis and treatment at those times., Recent Findings: New guidelines regarding safety of medication during pregnancy and lactation are being utilized to help guide management decisions in female migraineurs. There is also new data surrounding the risk of stroke in individuals who suffer from migraine with aura. This article seeks to provide an overview of a woman's migraine throughout her lifetime, the impact of hormones and an approach to management.

Purpose of Review: Chronic migraine (CM) is a recalcitrant subtype of migraine which causes high degrees of disability, poor treatment responses, and frequent recurrences in sufferers. However, the pathophysiological mechanisms underlying the development and chronification of migraine attacks remain incompletely understood. A validated animal model could help to decipher the pathogenic mechanism of the disease, facilitating the development of possible therapeutic strategies for CM. In this review, we aimed to summarize current animal models of CM and discuss the validity of these models., Recent Findings: Several methods have been available to induce recurrent headache-like behaviors or biochemical changes in rodents, including repeated dural application of inflammatory soup, chronic systemic infusion of nitroglycerin, repeated administration of acute migraine abortive treatment to simulate medication overuse headache, or genetic modification. These models exhibit some features that are believed to be associated with migraine; however, none of the model can recapitulate all the clinical phenotypes found in humans and each has its own weakness. The complex features of CM increase the difficulty of constructing a proper animal model. Nonetheless, currently available models are valid to certain degrees. Future directions might consider simulating the spontaneity and chronicity of migraine by combining known genetic substrates and allostatic loads into the same model.