https://repositorio.fleni.org.ar/xmlui/handle/123456789/39 2026-06-27T00:21:32Z https://repositorio.fleni.org.ar/xmlui/handle/123456789/1512 Peripheral nerve block in patients with medication-overuse headache : systematic review and meta-analysis Arias-Tello, Piero A.; Coronado-Caceres, Carlos F.; Serrano-Sablich, Mario E.; Mantilla, Guillemo; Goicochea, María Teresa; Alarcon-Ruiz, Christoper A. BACKGROUND: Medication-overuse headache (MOH) is a disabling condition, particularly in settings with limited access to advanced preventive therapies. Peripheral nerve blocks (PNB) may offer a pragmatic option to reduce headache burden during MOH management. We aimed to assess the efficacy and safety of PNB in adults with MOH. METHODS: We conducted a systematic review in January 2025 using Scopus, PubMed, Embase, Web of Science, and the Cochrane Library. Randomized clinical trials comparing PNB with standard of care or other active interventions in adults with MOH were eligible. Primary outcomes included headache frequency, headache intensity, successful detoxification, and adverse effects. Risk of bias was assessed using the Cochrane Risk of Bias Tool 2.0. Random-effects meta-analyses were conducted when appropriate, and certainty of evidence was evaluated using the GRADE approach. RESULTS: Three randomized clinical trials involving 249 adults with MOH were included. All trials evaluated bilateral greater occipital nerve blocks, with variability in anesthetic agents, number of sessions, and use of additional nerve block sites. Standard of care consisted of medication withdrawal, hydration, and preventive therapy. Follow-up ranged from 1 to 4 months. Compared with standard of care alone, a single PNB session significantly reduced headache frequency (–4.56 days/month; 95%CI: − 7.46 to − 1.66) and monthly rescue medication use (–2.30 doses of medication/month; 95%CI: − 2.71 to − 1.89), without significant effects on headache intensity or detoxification success. Multiple PNB sessions were associated with greater reductions in headache frequency (–9.00 days/month; 95%CI: − 9.45 to − 8.55), headache intensity (–2.65 units in visual analog scale; 95%CI: − 2.77 to − 2.53), and monthly rescue medication use (–6.70 doses of medication/month; 95%CI: − 7.10 to − 6.30), with low to moderate certainty of evidence. Compared with topiramate, a single PNB session did not reduce headache frequency (+ 1.50 days/month; 95%CI: +1.21 to + 1.79), with no differences in headache intensity (very low certainty). Adverse effects were only reported by one trial, with no significant differences compared with topiramate. CONCLUSION: PNB, particularly when administered in multiple sessions, may reduce headache frequency and intensity in adults with MOH when other therapies are unavailable. However, given the limited evidence and low certainty, further high-quality trials are needed to define optimal protocols and long-term effectiveness and safety. 2026-02-07T00:00:00Z https://repositorio.fleni.org.ar/xmlui/handle/123456789/1398 Reevaluating triptan contraindications: A follow-up survey among Latin American neurologists Bancalari, Ernesto; Robblee, Jennifer; Goicochea, María Teresa; Muñoz, Joe; Peres, Mario F.P.; Velez, Karina ObjectiveSurvey Latin American (LATAM) neurologists on their comfort with prescribing triptans in the setting of common contraindications. BackgroundTriptans are associated with multiple contraindications due to 5-HT1B-mediated vasoconstriction. A previous survey study examined the comfort level of headache specialists from the American Headache Society (AHS) in prescribing triptans in the setting of various contraindications, but this has not been studied in LATAM countries. MethodsWe sent a modified and translated survey to LATAM neurologists with headache management expertise grouped in the Latin American Headache Association (ASOLAC). The survey was extended to local Neurology Associations to increase the sample. An eleventh question on selective serotonin reuptake inhibitors (SSRI) use was added to the original 10 questions. Responses were assessed with descriptive statistics. ResultsThere were 225 surveys analyzed from 10 LATAM countries. Notable results include that 54.2% (122/225) never use triptans in the setting of stroke, 60.9% (137/225) said never for dissection, and 70.2% (158/225) said never for reversible cerebral vasoconstriction syndrome (RCVS), but for venous thromboembolism responses were sometimes in 26.7% (60/225), rarely in 20.9% (47/225), and never in 31.6% (71/225). 57.8% (130/225) responded never for hemiplegic migraine but prolonged aura responses were 25.3% (57/225) sometimes, 25.3% (58/225) rarely, and 40.4% (91/225) never. Responses for use with aneurysms included 23.6% (53/225) sometimes, 15.6% (25/225) rarely, and 44.0% (99/225) never. For poorly controlled hypertension, 58.2% (131/225) said never. For pregnancy, 57.3% (129/225) reported never. Responses for age over 65 years included 35.6% (80/225) sometimes, 32.0% (72/225) rarely, and 22.2% (50/225) never. For SSRI use, responses were 22.7% (51/225) frequently, 38.7% (87/225) sometimes, and 24.0% (54/225) rarely. ConclusionTriptan contraindications were often considered absolute for RCVS, stroke, dissection, hemiplegic migraine, hypertension, and pregnancy. More studies are needed to clarify the true danger of triptan contraindications. 2025-06-04T00:00:00Z https://repositorio.fleni.org.ar/xmlui/handle/123456789/1356 Evidence-based guidelines for the pharmacological treatment of migraine Ornello, Raffaele; Caponnetto, Valeria; Ahmed, Fayyaz; Al-Khazali, Haidar M.; Ambrosini, Anna; Ashina, Sait; Baraldi, Carlo; Bellotti, Alessia; Brighina, Filippo; Calabresi, Paolo; Casillo, Francesco; Cevoli, Sabina; Cheng, Shuli; Chiang, Chia-Chun; Chiarugi, Alberto; Häckert Christensen, Rune; Kyung Chu, Min; Crema, Santiago; Goicochea, María Teresa We here present evidence-based guidelines for the pharmacological treatment of migraine. These guidelines, created by the Italian Society for the Study of Headache and the International Headache Society, aim to offer clear, actionable recommendations to healthcare professionals. They incorporate evidence-based recommendations from randomized controlled trials and expert-based opinions. The guidelines follow the Grading of Recommendations, Assessment, Development and Evaluation approach for assessing the quality of evidence. The guideline development involved a systematic review of literature across multiple databases, adherence to Cochrane review methods, and a structured framework for data extraction and interpretation. Although the guidelines provide a robust foundation for migraine treatment, they also highlight gaps in current research, such as the paucity of head-to-head drug comparisons and the need for long-term outcome studies. These guidelines serve as a resource to standardize migraine treatment and promote high-quality care across different healthcare settings. 2025-04-25T00:00:00Z https://repositorio.fleni.org.ar/xmlui/handle/123456789/1355 International Headache Society Global Practice Recommendations for Preventive Pharmacological Treatment of Migraine Puledda, Francesca; Sacco, Simona; Diener, Hans-Christoph; Ashina, Messoud; Al-Khazali, Haidar M.; Ashina, Sait; Burstein, Rami; Liebler, Eric; Cipriani, Andrea; Chu, Min Kyung; Cocores, Alexandra; Dodd-Glover, Freda; Ekizoğlu, Esme; Garcìa Azorìn, David; Göbel, Carl; Hassan, Amr; Hirata, Koichi; Hoffmann, Jan; Jenkins, Bronwyn; Goicochea, María Teresa 2024-09-01T00:00:00Z