Nummular headache (NH) is a primary headache characterized by superficial coin-shaped pain. NUMITOR (NCT 05475769) is an observational study evaluating the responder rate of preventive drugs in NH patients. The treatment response was assessed between weeks 8 and 12 compared with the baseline. Patients were included between February 2002 and October 2022. Demographic and clinical variables were assessed; treatment response was estimated by 50%, 30%, and 75% responder rates and treatment discontinuation due to inadequate tolerability. A total of 183 out of 282 patients fulfilled eligibility criteria and completed the study. Patients were aged 49.5 (standard deviation (SD): 16.8) years, and 60.7% were female. NH phenotype was a parietal circular pain of four centimeters’ diameter, moderate intensity, and oppressive quality. At baseline, patients had 25 (interquartile range) pain days per month. Preventive treatment was used by 114 (62.3%) patients. The highest 50% and 75% responder rates corresponded to onabotulinumtoxinA (62.5%, 47.5%), followed by gabapentin (43.7%, 35.2%). Oral preventive drugs were not tolerated by 12.9–25%. The present study provides class IV evidence of the effectiveness of oral preventive drugs and onabotulinumtoxinA in the treatment of primary NH. OnabotulinumtoxinA was the most effective and best-tolerated drug, positioning it as first-line treatment of NH.

Background and purpose: According to the latest European guidelines, discontinuation of monoclonal antibodies against calcitonin gene‐related peptide (anti‐CGRP MAb) may be considered after 12–18 months of treatment. However, some patients may worsen after discontinuation. In this study, we assessed the response following treatment resumption.Methods: This was a prospective study conducted in 14 Headache Units in Spain. We included patients with response to anti‐CGRP MAb with clinical worsening after withdrawal and resumption of treatment. Numbers of monthly migraine days (MMD) and monthly headache days (MHD) were obtained at four time points: before starting anti‐CGRP MAb (T‐baseline); last month of first treatment period (T‐suspension); month of restart due to worsening (T‐worsening); and 3 months after resumption (T‐reintroduction). The response rate to resumption was calculated. Possible differences among periods were analysed according to MMD and MHD.Results: A total of 360 patients, 82% women, with a median (interquartile range [IQR]) age at migraine onset of 18 (12) years. The median (IQR) MHD at T‐baseline was 20 (13) and MMD was 5 (6); at T‐suspension, the median (IQR) MHD was 5 (6) and MMD was 4 (5); at T‐worsening, the median (IQR) MHD was 16 (13) and MMD was 12 (6); and at T‐reintroduction, the median (IQR) MHD was 8 (8) and MHD was 5 (5). In the second period of treatment, a 50% response rate was achieved by 57.4% of patients in MHD and 65.8% in MMD. Multivariate models showed significant differences in MHD between the third month after reintroduction and last month before suspension of first treatment period (p < 0.001).Conclusion: The results suggest that anti‐CGRP MAb therapy is effective after reintroduction. However, 3 months after resumption, one third of the sample reached the same improvement as after the first treatment period.

To describe the need and effectiveness of acute and preventive medications in a series of 100 consecutive patients referred due to COVID-19-related headaches. Patients were aged 48.0 (standard deviation (SD): 12.4), 84% were female, and 56% had a prior history of headache. The most common headache phenotype was holocranial (63%), frontal (48%), pressing (75%), of moderate intensity (7 out of 10), and accompanied by photophobia (58%). Acute medication was required by 93%, with paracetamol (46%) being the most frequently used drug, followed by ibuprofen (44%). The drugs with the highest proportion of a 2 h pain-freedom response were dexketoprofen (58.8%), triptans (57.7%), and ibuprofen (54.3%). Preventive treatment was required by 75% of patients. The most frequently used drugs were amitriptyline (66%), anesthetic blockades (18%), and onabotulinumtoxinA (11%). The drugs with the highest 50% responder rate were amitriptyline (45.5%), mirtazapine (50%), and anesthetic blockades (38.9%). The highest 75% responder rate was experienced following onabotulinumtoxinA (18.2%). In conclusion, most patients required acute medication, with triptans and non-steroidal anti-inflammatory drugs achieving the best responses. Three-quarters of patients required preventive medication. The most frequently used drug was amitriptyline, which obtained the best results. In some treatment-resistant patients, anesthetic blockades and onabotulinumtoxinA were also beneficial.

ICHD-3 integrates neuralgias affecting trigeminal terminal branches within broader trigeminal pain categories rather than defining them as distinct entities. In this context, their frequency and clinical characteristics remain poorly characterized. We aimed to describe their frequency and clinical characteristics in a headache unit registry. We conducted a retrospective, descriptive cohort study based on a prospective registry initiated in January 2008 at a headache unit. Patients diagnosed between January 2008 and January 2023 who fulfilled ICHD-2 criteria for nasociliary (code 13.5), supraorbital (13.6), or other terminal branch neuralgias (13.7) were included. Demographic and clinical data were collected and analyzed. Among 8728 patients evaluated during the study period, 108 (1.2%) met inclusion criteria; 71 (65.7%) were women. Mean age at symptom onset was 47.4 ± 18.7 years (range 6–89), and mean time from onset to diagnosis was 34.4 ± 68.5 months (range 1–420). The most frequent neuralgias were supraorbital (39.8%) and auriculotemporal (25.9%), followed by supratrochlear (8.3%), infraorbital (7.4%), lacrimal (7.4%), mental (5.6%), nasociliary (4.6%), and infratrochlear (0.9%). Trigeminal terminal branch neuralgias represent a small but consistent clinical presentation defined by topographic distribution and sensory features. Recognition of these features supports anatomically guided evaluation and peripheral interventions.

Background: Short- and mid-term real-world data support the effectiveness of atogepant for migraine prevention, but evidence beyond 6 months remains scarce. This study evaluated the 12-month effectiveness, safety, persistence, and predictors of response in a large treatment-resistant migraine cohort. Methods: This prospective multicentre study enrolled patients from 15 tertiary Headache Units in Spain within the GEMA Project. Clinical and demographic characteristics, previous and concomitant preventive treatments, monthly headache days (MHD), monthly migraine days (MMD), and adverse events were systematically collected at baseline and after 3, 6, and 12 months. In a subset of patients, Headache Impact Test (HIT-6), Hospital Anxiety and Depression Scale (HADS), and Insomnia Severity Index (ISI) were also assessed. Results: A total of 513 patients were included. The cohort showed marked treatment resistance, with a median of 6 previous preventive failures; 74% ( n = 380) had chronic migraine, 84% ( n = 423) had previously failed onabotulinumtoxinA, and more than half had prior exposure to anti-CGRP monoclonal antibodies ( n = 270). Treatment persistence was approximately 80% at 6 months ( n = 409) and 60% at 12 months ( n = 304), with lack of effectiveness as the main reason for discontinuation. Among patients remaining on treatment with complete data at all follow-up visits, median MHD decreased from 20 days at baseline to 10 days at 3 months and 9 days at 6 months, remaining stable at 9 days at 12 months. Median MMD decreased from 13 days to 6 days at 3 months, 5 days at 6 months, and remained at 5 days at 12 months ( p < 0.0001 versus baseline for all time points). At 12 months, ≥ 50% response rates were 52.3% for MHD and 57.8% for MMD in the observed-case analysis, and approximately 31% and 33%, respectively, using non-responder imputation in the full baseline cohort. Improvements in disability and medication overuse were observed, while exploratory analyses in smaller subsets suggested improvements in anxiety, depression, and insomnia. A greater burden of previous preventive treatment failures independently predicted lower odds of achieving a ≥ 50% response at 12 months. The frequency of most reported adverse events was lower at later follow-up visits, and no new safety signals emerged. Conclusions: Atogepant was associated with maintained clinical benefit over 12 months among patients who remained on treatment, with a favourable long-term safety profile in a highly treatment-resistant migraine population. Greater previous preventive failure burden predicted lower response rates, reinforcing the importance of earlier preventive optimisation. Trial registration: ClinicalTrials.gov, NCT07699549, retrospectively registered on 8th of July 2026.