Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 8 appraisals
Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
Telemedicine for headache disorders in real-world practice: from patient experience to health system impact.
BACKGROUND: Telemedicine has expanded rapidly in neurological care and is increasingly applied to headache management to improve access and continuity of follow-up. However, patient experience and healthcare system impact in real-world practice remain insufficiently explored. OBJECTIVE: The objective of this narrative review is to evaluate clinical effectiveness, patient experience, and healthcare system impact in the management of headache disorders. METHODS: A narrative review of the literature was conducted, including randomized controlled trials, observational studies, real-world evidence contributions, and reviews addressing telemedicine in headache care. Evidence was synthesized thematically, focusing on clinical outcomes, patient acceptance, and implementation aspects. RESULTS: Available evidence supports the clinical effectiveness and safety of telemedicine in selected headache patients, particularly in non-acute settings and structured follow-up pathways. Outcomes assessed using validated instruments (HIT-6, MIDAS, VAS) are generally comparable to in-person visits. High patient satisfaction and willingness to continue telemedicine are consistently reported, mainly due to convenience and time and cost savings. Real-world studies suggest telemedicine may improve access to specialist care and optimize healthcare resource utilization, although challenges related to digital literacy, organizational requirements, and equity remain. CONCLUSIONS: Telemedicine is a valuable component of contemporary headache management when integrated into structured clinical pathways. Beyond clinical effectiveness, patient experience and organizational context are critical for successful implementation. Future research should focus on standardized care models, larger populations, and long-term real-world outcomes.
5 July 2026
Read appraisal →The journal of headache and pain
The emerging role of the meningeal lymphatic and glymphatic systems in migraine pathophysiology: a systematic review
BACKGROUND/OBJECTIVE: Migraine is a common, debilitating neurological disorder of unclear pathophysiology. Recent evidence has implicated impaired meningeal lymphatic function and its interaction with the glymphatic system in the development of neuroinflammation and pain sensitization. This systematic review aimed to summarize existing evidence on the role of the meningeal lymphatic and glymphatic systems in migraine pathophysiology. METHODS: Following the PRISMA 2020 recommendations, we searched PubMed, Web of Science, and Scopus from inception to December 15, 2025. Inclusion criteria comprised human or animal studies examining meningeal lymphatic or glymphatic function in migraine or validated migraine animal models. SYRCLE's risk of bias tool for animal studies and the Joanna Briggs Institute (JBI) critical appraisal tools were used for quality assessment. RESULTS: The search yielded a total number of 457 records, out of which 10 articles fulfilled the eligibility criteria. These comprised six imaging studies conducted on human populations and four preclinical studies performed on animal models. Studies using dynamic contrast-enhanced (DCE)-MRI have shown changes in lymphatic enhancement characteristics in both episodic and chronic migraines. Diffusion tensor imaging along perivascular spaces (DTI-ALPS) yielded heterogeneous findings, with abnormalities more consistently observed in chronic and high-frequency migraine. Preclinical models demonstrated that cortical spreading depression, nitroglycerin exposure, and familial hemiplegic migraine mutations impaired glymphatic influx and reduced cerebrospinal fluid efflux through meningeal lymphatic vessels. DISCUSSION: Initial research has shown that altered lymphatic and glymphatic systems may be related to migraine. Nonetheless, there is no existing literature on whether these conditions can be considered causative agents for migraines. There is a need for longitudinal imaging studies in a larger population. REGISTRATION: PROSPERO ID: CRD420251266296.
20 June 2026
Read appraisal →Medical science monitor : international medical journal of experimental and clinical research
Utility of Acupuncture Therapy for Adult Chronic Daily Headache Prophylaxis: A Systematic Review and Meta-Analysis
BACKGROUND Chronic daily headache (CDH) management remains challenging due to limited efficacy of standard preventive pharmacotherapies. Acupuncture has shown promise in chronic headache management. This study evaluated its sustained prophylactic efficacy for CDH. MATERIAL AND METHODS Following PRISMA guidelines, we systematically searched PubMed, EMBASE, the Cochrane Library, CNKI, VIP, Sinomed, and Wanfang Data (inception to September 2025) for randomized controlled trials (RCTs) comparing acupuncture with other interventions for CDH. Primary outcomes included headache frequency, days, intensity, duration, and analgesic use; subgroup analyses covered treatment modality, CDH subtype, and duration. RESULTS Twenty-two RCTs (1449 patients) were included. Compared with control, acupuncture significantly reduced headache frequency (mean difference [MD], -0.32; P=0.001), headache days (MD, -0.72; P<0.00001), intensity (standardized mean difference [SMD], -0.63; P=0.001), duration (SMD, -1.18; P=0.0001), and analgesic use (MD, -0.52; P<0.00001) after the intervention. These benefits persisted during follow-up: headache days (standardized mean difference [SMD], -0.70; P<0.00001), intensity (SMD, -1.11; P=0.008), duration (SMD, -1.83; P=0.003), and analgesic use (SMD, -0.60; P=0.007) remained reduced; headache frequency showed a trend toward reduction (SMD, -0.47; P=0.05). Subgroup analyses revealed consistent efficacy across various CDH subtypes, including chronic migraine and chronic tension-type headache, treatment durations (4-12 weeks), and intervention strategies (acupuncture alone or combined with medication), indicating broad clinical applicability. CONCLUSIONS Acupuncture yields clinically meaningful, sustained improvements in CDH, supporting its role as an effective routine and adjunctive prophylaxis and broader application in this population.
25 May 2026
Read appraisal →BMC neurology
The impact of caffeine consumption on migraine: a systematic review.
BACKGROUND: Migraine is a common, disabling neurological disorder affecting over one billion people worldwide, characterized by recurrent unilateral, pulsating headaches lasting 4-72 h. Caffeine, a widely consumed psychoactive alkaloid found in coffee, tea, and other beverages, is frequently implicated as both a trigger and a treatment for attacks. OBJECTIVES: We aim to comprehensively evaluate the association between caffeine exposure and migraine by integrating observational evidence with Mendelian Randomization (MR) studies. METHODS: A comprehensive search was conducted through PubMed, Scopus, Web of Science, and the Cochrane Library till August 2025. We included primary studies assessing the impact of caffeine exposure on migraine risk. RESULTS: 19 studies (nine cross-sectional, seven MR, and three cohort) were included in our review. MR studies included over one million participants, while cross-sectional studies involved over 43,000 participants, and the cohort studies included 421 migraine cases. MR reflected lifelong genetic liability (population-level, chronic exposure) and associated with a reduced risk with overall odds ratio (OR) ranging from 0.53 to 0.71, with stronger associations reported in migraine with aura (ORs as low as 0.37-0.39). Observational studies captured short-term, acute effects and showed that abrupt withdrawal or acute excessive intake (≥ 3 drinks/day) can trigger attacks in some people (P = 0.024). While habitual moderate use was generally not linked to higher average migraine burden. CONCLUSIONS: Lifelong genetic liability to higher coffee/caffeine intake is associated with a reduced risk of migraine especially for migraines with aura. However, acute excessive intake or sudden changes in caffeine habits can trigger attacks in some people. More future large, well prospective cohorts and carefully designed MR studies are needed to confirm our results and clarify the precise impact of caffeine on migraine risk.
20 May 2026
Read appraisal →Current pain and headache reports
Addressing the Treatment Gap for Pediatric Headache in Underserved Regions
PURPOSE OF REVIEW: This review explores innovative strategies to address the treatment gap for pediatric headache disorders in underserved regions worldwide. RECENT FINDINGS: Global Burden of Disease studies indicate that the fastest growth in pediatric headache burden occurs in low- and middle-income countries, where reported prevalence likely underestimates true disease burden due to healthcare access barriers. Telemedicine demonstrates comparable efficacy, safety, and satisfaction to in person care. Artificial intelligence based diagnostic models achieve high accuracy for pediatric migraine identification. School-based interventions leveraging existing educational infrastructure improve headache knowledge and coping behaviors. Task shifting and integrated care delivery models are increasingly recognized as essential components of sustainable care. Telemedicine, artificial intelligence, school-based interventions, task shifting, and integrated care networks represent scalable solutions for extending headache care to underserved pediatric populations. Realizing their potential requires integrating technological innovation with workforce capacity building, community engagement, and policy advocacy.
14 May 2026
Read appraisal →Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
Efficacy and safety of CGRP monoclonal antibodies for cluster headache: a systematic review and network meta-analysis of randomized controlled trials
INTRODUCTION: Cluster headache (CH) is a severe unilateral trigeminal autonomic cephalalgia with limited well tolerated therapies. Calcitonin gene related peptide monoclonal antibodies, including galcanezumab, fremanezumab, and eptinezumab, have established efficacy in migraine and are under evaluation in CH. This study assesses their efficacy and safety using pairwise and network meta analysis. METHODS: PubMed, Embase, Scopus, and ClinicalTrials.gov were searched through April 2025. Randomized controlled trials enrolling adults with episodic or chronic CH were included. The primary endpoint was change in weekly attack frequency. Secondary outcomes included subtype specific effects and adverse events. Frequentist random effects network meta analysis and pairwise meta analysis were performed in R. RESULTS: Five trials with approximately 1,000 participants were included. No agent demonstrated statistically significant reduction in weekly attack frequency versus placebo, although consistent numerical improvements were observed. Dose specific network estimates showed mean differences of - 0.81 for galcanezumab 300 mg, - 0.17 for eptinezumab 400 mg, 0.71 for fremanezumab 675/225 mg, and - 1.27 for fremanezumab 900/225 mg. Pooled dose estimates were - 0.81 for galcanezumab, - 0.27 for fremanezumab, and - 0.17 for eptinezumab. Pairwise meta analysis yielded a pooled mean difference of - 0.41. Subgroup analysis indicated minimal change in chronic CH and greater numerical reduction in episodic CH. CONCLUSION: CGRP monoclonal antibodies demonstrate modest directional reductions in attack frequency without statistical significance. Signals appear more pronounced in episodic CH, supporting the need for adequately powered, subtype specific trials.
14 May 2026
Read appraisal →Current pain and headache reports
Telemedicine in Pediatric Headache in a Post-COVID-19 World: A Narrative Review and Practical Implementation
PURPOSE OF REVIEW: Pediatric migraine is a leading cause of disability worldwide, yet access to pediatric headache specialists remains limited due to workforce scarcities and geographic disparities. This review examines the evolution of telemedicine in headache care, evaluates current evidence for safety and efficacy, and explores its role in improving access and multidisciplinary management. RECENT FINDINGS: Randomized trials and observational studies demonstrate that telemedicine provides clinical outcomes comparable to in-person visits with high patient satisfaction and reduced logistical burden. Emerging data support its safety in non-acute headache evaluation as well as benefit of supporting multidisciplinary care. Professional societies, including the American Headache Society and the American Academy of Pediatrics, endorse telemedicine as an appropriate modality for headache management. Telemedicine has matured into a sustainable, evidence-based approach for pediatric headache care. When implemented thoughtfully, it expands access, supports multidisciplinary treatment, and maintains safety, positioning it as an essential component of future headache care delivery models.
12 May 2026
Read appraisal →Neurology
Wearable Technology and Its Role in Neurologic Care: Emerging Issues in Neurology
Consumer wearable devices are commonly used by patients and consumers for several reasons with increasing application as new technologies are developed. Use of these devices is an emerging issue in Neurology because of increased adoption and the additional data reported to providers by patients. Understanding of possible functions, limitations, and effect on patients of non-US Food and Drug Administration (FDA)-cleared wearable technology to inform neurologic care is needed. A common theme in people with neurologic conditions regarding consumer wearables and associated tracking applications is that there is significant promise in these tools, but adherence (days per use/per week), continued engagement (attrition), and unintended consequences such as heightened anxiety remain important issues. Further understanding and validation of these devices is needed within the field of Neurology before full use and confidence can be achieved. Below, we provide examples of non-FDA-cleared wearable devices used in Neurology in the areas of epilepsy, headache, cardiac monitoring, and sleep.
14 Apr 2026
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