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Temporomandibular Dysfunction is Correlated With Central Sensitization in Individuals With Headache
Full text linkIntrodução: A disfunção temporomandibular (DTM) está associada a dores crônicas como cefaleias, condição correlacionada com alodinia cutânea (AC) e sensibilização central. Porém, ainda não está bem estabelecido na literatura se indivíduos com DTM e cefaleia apresentam correlação com AC e sensibilização central. Objetivos: Correlacionar a gravidade da PCR e a sensibilização central com a DTM. Materiais e Métodos: Foram incluídos no estudo adultos jovens de 18 a 40 anos, de ambos os sexos, excluídos aqueles com outras doenças crônicas como fibromialgia e aqueles em tratamento para DTM. O diagnóstico e a gravidade da DTM foram avaliados por meio do Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), AC por meio do Allodynia Symptom Checklist de 12 itens/Brasil (ASC-12/Brasil), sensibilização central por meio do Inventário de Sensibilização Central (CSI ) e dores de cabeça usando o Questionário de Triagem de Cefaléia. Foi utilizado o teste de Shapiro-Wilk para normalidade, correlação de Pearson para análise de correlação e curva ROC para estabelecer ponto de corte para o escore da AC, com nível de significância de p≤ 0,05. Resultados: Foram avaliados 163 indivíduos, sendo 113 com DTM e cefaleia (GCDTM) e 50 sem DTM mas com cefaleia (grupo controle, GC), homogêneos quanto à idade, altura, índice de massa corporal e sexo (p> 0,05), exceto peso (p=0,023). Foi observada correlação positiva significativa do GCDTM com AC (r=0,875) e sensibilização central (r=0,911, p<0,001) em comparação ao GC. Na análise da curva ROC, o ponto de corte para AC foi determinado em 1 ponto. Conclusão: Indivíduos com DTM e cefaleia apresentam correlação positiva significativa com AC e sensibilização central em comparação com indivíduos com cefaleia mas sem DTM, destacando a importância da avaliação da DTM em indivíduos com cefaleia para estabelecer melhores estratégias de tratamento e prognóstico.
Keywords: (Temporomandibular Dysfunction, Cutaneous Allodynia, Central Sensitization).Introdução: A disfunção temporomandibular (DTM) está associada a dores crônicas como a cefaleia, condição que tem sido correlacionada a alodínea Cutânea (AC) e a sensibilização central. Entretanto ainda não está bem estabelecido na literatura se indivíduos com DTM e cefaleia tem correlação com AC e sensibilização central. Objetivos: Correlacionar a severidade da AC e da sensibilização central com a DTM. Materiais e Métodos: Participaram indivíduos adultos jovens, com idades entre 18 e 40 anos, de ambos os gêneros e excluídos aqueles que apresentassem outras doenças crônicas como fibromialgia e estivesse em tratamento para DTM. O diagnóstico e a severidade da DTM foram avaliados com o Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), AC pelo 12 itens da Allodynia Symptom Checklist/Brasil (ASC-12/Brasil), a sensibilização central por meio do Inventário de Sensibilização Central (CSI) e a cefaleia pelo Headache Screening Questionnaire. O teste de Shapiro-Wilk foi utilizado para a normalidade, a correlação de Person para correlação e a Curva Roc estabelecer um ponto de corte para o score de AC, nível de significância estatística adotado foi de p≤ 0,05. Resultados: Foram avaliados n=163 indivíduos, sendo n=113 com DTM e cefaleia (GCDTM) e n=50 sem DTM e com cefaleia grupo controle (GC), homogêneos quanto a idade, altura, Indice de massa corpora e sexo (p>0,05), exceto para o peso (p=0,023). Foi observada correlação positiva significativa em relação ao GCDTM em relação a AC r=0,875 e a sensibilização central r=0,911 p<0,001 quando comparado ao GC. Na análise da curva Roc foi verificado que o ponto de corte estabelecido para AC seria de 1 ponto. Conclusão: Indivíduos com DTM e cefaleia possuem correlação positiva e significativa com AC e sensibilização central em relação a indivíduos com cefaleia e sem DTM, chamando a atenção para a avaliação da DTM em indivíduos com cefaleia afim de estabelecer melhores estratégias de tratamento e prognóstico.
Palavras-chave: (Disfunção Temporomandibular, Alodínia Cutanêa, Sensibilização Central)
Anxiety is correlated with the RAMP1 rs3754701 AA genotype in patients with migraine
Full text linkIntroduction: The most common neurovascular condition affecting people globally is migraine. Numerous areas of the neurological system are affected by migraine; headache symptoms are related to the activation of the trigeminal pathway. A crucial molecule in the progression of migraine is calcitonin gene-related peptide (CGRP), a potent vasodilator neuropeptide involved in nociception, motor function, secretion, and olfaction in the cranial vasculature, acting through interaction with its receptor. RAMP1 is an accessory protein, required for cell surface expression, ligand binding and signaling of CGRP receptor. A single nucleotide variant of RAMP1, called rs3454701 A>T, may impair protein expression, alter CGRP responses and modify migraine-associated symptoms. Objectives: Investigate whether the RAMP1 rs3754701 genotypes contribute to the symptoms associated with migraine. Methods: In a retrospective study, 177 migraine patients were genotyped using Taqman® allelic discrimination assay. Migraine-associated symptoms were assessed through scores: anxiety – STAI-Y1, STAI-Y2, GAD-7; depression – BECK; migraine disability – MIDAS; migraine impact – HIT6; allodynia – ASC-12; and hyperacusis – HQ. The relationship between a gene variation and symptoms was evaluated using correlation analysis. Results: Most symptoms failed to demonstrate a correlation between RAMP1 rs3754701 and the outcomes of the study (p>0.05). Otherwise, patients with the AA genotype showed higher scores on the GAD-7; RAMP1 rs3754701 was strongly associated with general anxiety (rho= -0.853; p=0.031). Conclusion: These results suggested that RAMP1 rs3754701 gene variant might influence anxiety in patients with migraine.Introdução: A migrânea é uma das condições neurovasculares mais comuns que afetam pessoas globalmente. Múltiplas áreas do sistema neurológico são afetadas pela migrânea; os sintomas de dor de cabeça estão relacionados à ativação da via trigeminal. Uma molécula crucial na progressão da migrânea é o peptídeo relacionado ao gene da calcitonina (CGRP), um potente neuropeptídeo vasodilatador envolvido na nocicepção, função motora, secreção e olfação nos vasos cranianos, atuando por meio da interação com seu receptor. O RAMP1 é uma proteína acessória necessária para a expressão na superfície celular, interação com o ligante e sinalização do receptor do CGRP. Uma variante de nucleotídeo único do RAMP1, chamada rs3454701 A>T, pode prejudicar a expressão proteica, alterar as respostas do CGRP e modificar os sintomas associados à migrânea. Objetivos: Investigar se os genótipos do RAMP1 rs3754701 contribuem para os sintomas associados à migrânea. Métodos: Em um estudo retrospectivo, 177 pacientes com migrânea foram genotipados usando o ensaio de discriminação alélica Taqman®. Os sintomas associados à migrânea foram avaliados por meio de escores: ansiedade – STAI-Y1, STAI-Y2, GAD-7; depressão – BECK; incapacidade da migrânea – MIDAS; impacto da migrânea – HIT6; alodinia – ASC-12; e hiperacusia – HQ. A relação entre a variante genética e os sintomas foi avaliada por meio de análise de correlação. Resultados: A maioria dos sintomas não demonstrou correlação entre o RAMP1 rs3754701 e os resultados do estudo (p>0,05). No entanto, pacientes com o genótipo AA apresentaram escores mais altos no GAD-7; o RAMP1 rs3754701 foi fortemente associado à ansiedade geral (rho= -0,853; p=0,031). Conclusão: Esses resultados sugerem que a variante genética RAMP1 rs3754701 pode influenciar a ansiedade em pacientes com migrânea
Glossopharyngeal neuralgia resulting from eagle syndrome
Full text linkGlossopharyngeal Neuralgia Resulting from Eagle Syndrome
INTRODUCTION: Eagle syndrome is a rare and often underdiagnosed cause of craniofacial pain, typically resulting from calcification of the stylohyoid ligament or elongation of the temporal styloid process.The congenital variant, commonly referred to as stylohyoid syndrome, is characterized by pain and symptoms of carotid compression (such as presyncope, syncope, and transient ischemic events) due to an ossified stylohyoid ligament. The syndrome can be mistaken for other conditions like temporomandibular joint disorders or nonspecific glossopharyngeal and occipital nerve neuralgiaOBJECTIVE: Provide a comprehensive overview of glossopharyngeal neuralgia associated with Eagle syndrome, emphasizing the importance of early diagnosis and an integrated therapeutic approach. CASE REPORT: A 55-year-old female teacher with controlled hypertension and diabetes presented with severe, stabbing, shock-like pain lasting several seconds, occurring multiple times daily in the throat and base of the tongue. The pain also affected her cheek and was sometimes accompanied by hoarseness. She had experienced these symptoms for over six years, occasionally accompanied by coughing and syncope. Physical examination revealed no lesions in the oropharynx and tongue, and her neurological exam was normal, leading to a preliminary diagnosis of glossopharyngeal neuralgia. Anticonvulsants were prescribed, resulting in a 50% reduction in symptoms. Further investigation with cranial MRI showed no intracranial lesions. A 3D CT scan with bone window revealed elongation of the temporal styloid process, confirming Eagle syndrome. The elongated styloid process caused intermittent, shock-like pain by compressing the glossopharyngeal nerve, and its proximity to the vagus nerve led to symptoms like hoarseness, syncope, and bradycardia. Surgical treatment was chosen, successfully controlling symptoms and allowing discontinuation of anticonvulsants. The patient remained symptom-free postoperatively. CONCLUSION: Glossopharyngeal neuralgia resulting from Eagle syndrome is a rare but significantly debilitating condition, highlighting the complexity of anatomical and neurological interactions in the human body. This case underscores the necessity for a high index of clinical suspicion and careful differential diagnosis to accurately identify the source of craniofacial and oropharyngeal pain. Detailed imaging, such as computed tomography, is crucial for identifying styloid process elongation or calcification characteristic of Eagle syndrome.
 
The effect of age and sex on volume and fractional anisotropy values of the trigeminal nerve in healthy young adults
Full text linkIntroduction: Some chronic orofacial pain diseases have a well-defined etiology, such as classic trigeminal nerve (TN) neuralgia. However, in idiopathic neuralgia, symptoms suggest problems directly in the TN. Studies that evaluate the volume in different regions of interest (ROIs) of the TN in healthy young adults (HYA) contribute to defining a standard of normality, being scarce in the current literature. Additionally, Diffusion Tensor Imaging (DTI) allows white matter integrity to be assessed using diffusion metrics such as fractional anisotropy (FA).
Purpose: To evaluate the absolute volume (AV), determine the relationship AV/total brain size (RV), in different ROIs of the TN in HYA. Check the effect of AV, RV, age and sex on FA values in a General Linear Model (GLM).
Method: Structural and diffusion MRI data from 300 HYA, 150 men and 150 women (22 to 35 years old), were obtained from the Human Connectome Project (HCP) database, separated into 3 groups considering age and sex. T1w images were used for bilateral marking of the ROIs: total NT, root entry zone, middle portion of the cistern and Merckel\u27s cave. Marking of ROIs, maps and calculation of FA, VA of ROIs and brain size were done using MRTrix3 software. The results were analyzed using the Kurskal-Wallis test (p<0.05) and correlations using GLM.
Results: The effects of sex on AV (male > female) disappear considering RV in relation to total brain size, except for the total volume of the right NT where the effect of larger AV persists in men, regardless of age. In relation to age: in the right Cistern we have an increase and reduction in AV and RV; in Root we have bilateral reduction of AV and RV; in the cave on the right we increase AV and RV. The GLM showed that the variation in FA values is explained by the effect of AV and sex, with the effect of sex being stronger for the model.
Conclusion: AV and FA values are more affected by sex. There is spatial heterogeneity in relation to the evolution of volume with age, affecting more the right side
Botulinum toxin type a in the temporomandibular region for Chronic Migraine treatment: a literature review
Full text linkIntroduction
Migraines, as defined by the 2018 International Headache Society, are attacks lasting 4 to 72 hours with specific characteristics. Surgical treatment of migraines dates back to 1931, with one approach targeting trigger zones, often in the temporo-occipital areas, using botulinum toxin. The success of this treatment has led to the hypothesis that facial muscle blockade with Botulinum Toxin Type A (BoNT-A) could provide similar migraine relief with fewer side effects.
Objective
This study aims to assess the current state of BoNT-A use in the temporomandibular region for chronic migraine with or without aura. A comprehensive literature search was conducted in PubMed using the search terms "(migraine OR headache) AND (botulinum OR toxin) AND (treatment OR therapeutic OR application OR injection) AND (temporal OR temporal muscle OR temporal region OR masseter)," yielding 26 relevant articles for review.
Methodology
While surgical resection of facial peripheral nerve terminals shows promise in treating myofascial pain and neuralgia, it carries significant complications. This study evaluates the efficacy of temporary muscle blockade with BoNT-A for migraine treatment, as reported in clinical trials and literature reviews.
Conclusion
Initial analysis suggests promising results in preventing pain recurrence in cases refractory to standard pharmacological treatment. Intramuscular BoNT-A in the facial region has shown efficacy in prolonging symptom-free periods for tension headaches, localized myofascial pain, neuralgia, and some types of migraine. However, more structured and migraine-specific studies are necessary to minimize adverse effects and complications in treated patients.Migrâneas são definidas, de acordo com o Comitê Internacional de Cefaleias de 2018, como episódios de 4 a 72 horas, tendo 2 dos 4 achados de localização unilateral, qualidade pulsátil, intensidade moderada ou severa e agravamento atividades de rotina ou que leve a evitá-las. A conduta cirúrgica para tratamento de migrânea foi registrada primeiramente em 1931. Desde então, uma das indicações de conduta cirúrgica em tais pacientes é o sucesso terapêutico através da aplicação de toxina botulínica nas zonas de gatilho (usualmente zonas temporo-occipitiais). Devido a isso, acredita-se que o bloqueio muscular facial com uso de Toxina Botulínica Tipo A pode resultar em efeitos semelhantes na resolução das migrâneas com efeitos colaterais reduzidos.
A metodologia do estudo foi constituída de uma busca ativa pela literatura na base de dados Pubmed, considerando os artigos mais relevantes para o tema. A pergunta norteadora foi “Qual o estado atual da utilização de Toxina Butilínica em região temporomandibular para o tratamento de migrânea crônica com ou sem aura”. A busca utilizou dos denominadores “‘(migraine OR headache) AND (botulinum OR toxin) AND (treatment OR therapeutic OR application OR injection) AND (temporal OR temporal muscle OR temporal region OR masseter)”, resultando em 26 trabalhos compatíveis com os critérios que foram elegidos para compor a revisão final.
Estudos mostram que a ressecção cirúrgica de terminais nervosos periféricos faciais possuem resultado promissor na cessação de dores miofaciais e neuralgias, no entanto existem muitas complicações decorrentes do procedimento. O objetivo do estudo é avaliar o bloqueio muscular temporário com o uso de toxina botulínica para tratamento de enxaqueca em ensaios e revisões na literatura.
A análise inicial dos estudos mostrou resultados promissores na prevenção de recorrência de eventos álgicos em casos refratários ao tratamento farmacológico usual. O uso facial de Toxina Botulínica Tipo A Intramuscular, em casos de cefaleias tensionais, dor miofascial localizada, neuralgias e alguns tipos de migrânea, foi eficaz em alargar o tempo de recidiva dos sintomas com diferentes graus de efetividade. No entanto, são necessários estudos mais estruturados e específicos para casos de migrânea, visando a redução de efeitos adversos e complicações nos pacientes acompanhados
Headache in isolated Wai Wai indigenous people: what\u27s different?
No full textIntroduction: Headache is a common health condition that affects individuals\u27 quality of life provoking temporary disability.Waiwai form an indigenous group that live in a remote Amazon region. There are 2503 people with no roads connecting to the cities. They live from agriculture, fishing and hunting, eat few processed foods, including sugar, and the diet is low in salt. Objective: To study the headache occurence in people from the Wai Wai tribes and epidemiological and clinical characteristics of indigenous affected. Methods: This is a retrospective, observational and quantitative study based on primary data from medical records of patients treated at the neurology outpatient clinic in Oriximiná, Pará, Brazil (regional reference center for indigenous health). Data from patients from the Wai wai tribe who complained of headaches were included from January 2009 to January 2024, excluding data from illegible medical records. Results: Seventy participants were included, with 78.57% being female. The average age was 31.11±14.09 years, higher among men (34.13±19.33 years). Most participants could not specify the onset of headache episodes (20.00%). Daily headaches were noted (54.28%; n=38). Regarding the characteristics of intensity, type, and location, there was significant difficulty, predominating pulsatile nature (47.14%). Strong intensity (18.57%), and holocranial location (10.00%).The majority of cases were classified as migraine (64.28%) and had follow-up care for less than one year (54.28%). Among those who had follow-up care for more than one year, an average follow-up duration of 5.02±4.11 years was observed ). A lower presence of patients with associated comorbidities was noted (7.5%). Neurological examination was normal in 98.5% and Amitriptiline was the drug more used for prophylaxis (62.85%). There was an improvement in symptoms in 24.28% of patients. Conclusion: Headache affects indigenous people, and daily frequency was higher than general population, despite having different diet and lifestyle. Migraine is the most prevalent type of headache among members of the Waiwai indigenous tribe. However, the significant lack of detailed answers about the characteristics of the headache can have influenced the results. This study is crucial for directing future health interventions aimed at improving the quality of life and well-being of affected individuals
Status migrainosus and ischemic stroke: clinical and pathophysiological connections
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Introduction: Migraine is one of the most common neurological conditions, affecting a significant proportion of the global population. Within the spectrum of migraines, status migrainosus represents a particularly debilitating and prolonged form, defined by attacks lasting more than 72 hours, with additional neurological risks, particularly ischemic stroke (IS). Objectives: The objective of this review is to synthesize the relationship between status migrainosus and IS, highlighting the underlying mechanisms, risk factors, and clinical implications. Methods: A detailed search was conducted in the PubMed database using the terms "status migrainosus" and "ischemic stroke" to investigate the connection between these two conditions. Thirty-two relevant articles published between 2010 and 2023 were reviewed, exploring the relationship between status migrainosus and IS, including shared pathophysiological mechanisms and common risk factors. Results: Migraine with aura was significantly associated with an increased risk of IS due to mechanisms such as endothelial dysfunction and hypercoagulability. Additionally, blood-brain barrier dysfunction and vascular inflammation were identified as further factors linking aura to IS. Women showed an elevated risk of migraine with aura and IS, which may be attributed to hormonal factors. A shared genetic predisposition between migraine and IS was identified, suggesting that genetic variants may influence the risk of IS in individuals with migraine. Pharmacological therapies have proven effective in the prophylaxis of migraine and reduction of IS risk. Furthermore, lifestyle changes and control of vascular risk factors were highlighted as complementary preventive measures. Conclusion: Although not all articles specifically address status migrainosus in detail, the interconnection between migraine and ischemic stroke is clearly evidenced in the literature. The identification of shared risk factors and common pathophysiological mechanisms underscores the need for an integrated approach in managing patients with migraine, particularly those with prolonged attacks. Continued research in this area is crucial to enhance preventive and therapeutic strategies aimed at reducing the incidence of ischemic events in predisposed individuals
Cefaleia trigêmino-autonômica secundária a Displasia Fibromuscular: Um relato de caso
No full textIntroduction: Fibromuscular Dysplasia (FMD) is an uncommon disease of medium-sized arteries that is non-atherosclerotic and non-inflammatory. The renal and extracranial carotid and vertebral arteries are most commonly affected. Registry data shows a high prevalence of headache among FMD patients, typically migrainous characteristics. Hypertension is the most frequent manifestation of renal artery FMD. Cerebrovascular FMD may present with transient ischemic attack, stroke, dizziness, neck pain, cervical artery dissection, or pulsatile tinnitus.
Objectives: We report a case of a man with a prior history of high-frequency migraine-like headaches, who subsequently experienced a change in headache pattern. The patient developed daily, unilateral headaches, accompanied by trigeminal autonomic symptoms. During the investigation, the etiology was found to be FMD.
Case Report: A 47 year-old male patient presented a previous history of high frequency headaches, that occurred 4 to 5 times per week, migrainous characteristics, preceded by visual aura. In 2020, there was a change in the headache pattern: an intense headache, worse on the left side, with psychomotor agitation at the peak of the pain, associated with eye tearing, ptosis, and ipsilateral ocular hyperemia, symptoms characteristic of Trigeminal Autonomic Cephalalgia. Between episodes, the patient experienced shadow headaches. The pain was responsive to subcutaneous Sumatriptan. Then, he underwent an intracranial MRI angiography that indicated arterial dissection in the high cervical and intracranial petrous segments, with narrowing of flow and distal supraclinoid reestablishment by the Circle of Willis. Additionally, it displayed a saccular aneurysm in the cavernous segment of the right internal carotid artery, which was laterally deviated. Due to his Systemic Arterial Hypertension history, an investigation of abdominal vascular alterations was conducted, which revealed a saccular aneurysm in the left renal artery and parietal irregularity in the renal arteries. Consequently, he was diagnosed with FMD.
Conclusion: The possibility of FMD should be suspected in a young or middle-aged patient who presents to the headache clinician for evaluation of chronic migraine headache, particularly in the setting of pulsatile tinnitus, early onset hypertension, or a cervical or abdominal bruit. Imaging is necessary to confirm the diagnosis and direct medical management
Dopaminergic pathways and their role in medication-overuse headache: behavioral or analgesic?
Full text linkIntroduction. With an estimated prevalence of up to 2% worldwide, medication-overuse headache (MOH) is defined by the International Classification of Headache Disorders 3rd edition (ICHD-3) as a secondary headache, occurring 15 or more days per month, result from a deterioration of a pre-existing headache due to medication use excessive use of acute headache medications for more than 3 months. It is an important factor in the chronicity of primary headaches and its pathophysiology remains under investigation.
Objective. To evaluate the evidence linking dopaminergic dysfunction to the pathophysiology of MOH and determine whether dopamine\u27s role is analgesic, behavioral or both.
Methodology. A comprehensive literature search was conducted using PubMed and Virtual health Library (VHL) Regional Portal as databases, with the descriptors "dopamine" and "medication overuse headache." Inclusion criteria were studies addressing dopaminergic pathways, receptor involvement or neuroimaging findings related to MOH. Therefore, fifteen articles were evaluated.
Results. Genetic studies have found reduced expression of dopamine D2 receptors (DRD2) and dopamine metabolism in patients with MOH, with defects in tyrosine-beta-hydroxylase, resulting in higher levels of available dopamine. Neurofunctionally, the main dopaminergic pathway affected is the mesocorticolimbic pathway (known as the reward system region), with dysfunctions also present in the nigrostriatal pathway. Neuroimaging studies showed reduced activity in the substantia nigra/ventral tegmental area (SN/VTA) and increased activity in the ventromedial prefrontal cortex (VMPFC) in MOH patients, similar do addictions, indicating a link between medication overuse and dopaminergic dysfunction. This scenario points to a behavioral impact, with a greater predisposition to impulsivity and the maintenance of excessive medication consumption, favoring the chronification of the headache. Although medications that act to modulate dopaminergic activity – such as chlorpromazine – are described in the literature, the few studies that demonstrate the analgesic action related to dopamine do so indirectly through their action on prolactin levels and prevention of nociceptor sensitization.
Conclusion. Studies suggest the presence of dopaminergic dysfunction in MOH, especially in the mesocorticolimbic pathway. The findings suggest a mainly behavioral impact of dopamine in controlling the disease, with the potential for treatment strategies that assist in more effective management of MOH
Petasites hybridus: scientific evidence A
Full text linkMigraine is the leading cause of disability in individuals aged 15 to 49 worldwide, emphasizing the need for diverse preventive treatments. In 2023, Brazil introduced highly purified Petasites hybridus. This article comment the manuscript Loder and coworkers, 2012 one of the primary studies that positioned Petasites hybridus among the Level A evidence medications in the American Consensus of the episodic migraine preventive treatment in 2012.DevelopmentA 1990s German study, randomized and placebo-controlled, involved 60 patients using a Petasites hybridus root extract for migraine prevention. Though effective, the study had notable shortcomings. To validate its findings, independent investigators and statisticians conducted a comprehensive efficacy reassessment following International Conference on Harmonisation E9 Guidelines. Results showed a significant -50% reduction in migraine episodes for 45% of the treatment group, compared to 15% in the placebo group. The active treatment group also saw a significant drop in migraine attacks needing acute medication (from 20.6% to 7.1%), unlike the placebo group (12.8% to 11.7%). The reanalysis confirmed the treatment group\u27s superiority across 12 primary efficacy metrics, supporting its effectiveness.CommentarySeveral studies, including this reanalysis and an American study, support Petasites hybridus for migraine prevention, leading to its Level A evidence classification. Its mechanisms include antinociceptive, anti-CGRP, anti-inflammatory, and antispasmodic effects.ConclusionThe reanalysis confirmed the efficacy of Petasites hybridus from Grossman’s study. The German team minimized bias through rigorous statistical methods. Petasites hybridus should be considered for first-line and subsequent migraine prevention, potentially combined with other medications based on patient needs.