Context: Migraine is a disabling neurological disorder. Diet may be a factor to consider because measures of diet quality have been linked to both frequency and severity of attacks. Objectives: To investigate the effects of dietary interventions on the clinical symptoms of migraine, quality of life, and body composition of patients with migraine. Data Sources: The MEDLINE, Embase, and Web of Sciences databases were searched since database inception to February 13, 2024. We included articles on randomized clinical trials that assessed the effect dietary interventions on clinical symptoms of migraines and the quality of life and body composition of individuals with migraine. Data Extraction: Data from the included articles were independently extracted by 2 researchers; another independent reviewer further verified the extractions. The Cochrane risk-of-bias tool was used to evaluate the risk of bias of selected studies, and the Physiotherapy Evidence Database scale was used to assess the methodological quality. Results: Eight articles were included in this review. Of these, 3 reported on studies that assessed the ketogenic diet (KD), 2 reported on the Dietary Approaches to Stop Hypertension (DASH), and 3 reported on studies of other dietary strategies. Strong evidence exists regarding the effectiveness of the KD and DASH in reducing the frequency of migraine attacks, whereas their efficacy in improving patients’ quality of life was supported only by limited evidence. There also is strong evidence regarding the effectiveness of DASH in reducing migraine’s severity and patients’ body weight. Insufficient evidence was found regarding the effectiveness of the other dietary interventions on all variables. Conclusions: The DASH and KD may help reduce migraine frequency and severity. However, more high-quality studies are needed to confirm their effectiveness. Systematic Review Registration: PROSPERO No. CRD42024516161.

Migraine headache (MH) and cluster headache (CH) are debilitating primary headache disorders that impose a significant global burden. While they share certain clinical features, such as unilateral pain and autonomic dysfunction, their underlying pathophysiological mechanisms remain distinct. Advances in the understanding of neurophysiological features, such as neuroimaging and biomarker research, have provided critical insights into both their overlapping and divergent characteristics. Neurophysiological research has revealed differences in nociceptive processing, cortical excitability, and sensory integration, underscoring the complexity of these conditions. Neuroimaging studies reveal common activation patterns within pain-processing networks, including the trigeminal system and hypothalamus, while highlighting key differences, such as hypothalamic hyperactivity in CH and cortical alterations in MH. Additionally, biomarker research has identified shared elements, including elevated calcitonin gene-related peptide (CGRP), yet distinct variations in its regulation and genetic predispositions. Genome-wide association studies have further elucidated the genetic architecture of these disorders, uncovering susceptibility loci that reinforces their unique yet occasionally intersecting genetic foundations. These multifield advancements not only enhance the understanding of MH and CH pathophysiology but also pave the way for improved diagnostic precision, personalized therapeutic strategies, and future research.

Background and Objectives: Low back pain (LBP) is highly prevalent and often associated with altered muscle function, including in the quadratus lumborum (QL) muscle. While some studies have highlighted the clinical relevance of QL muscle stiffness in LBP, the findings remain inconsistent, and the role of this parameter in relation to clinical severity indicators is not well understood. Considering the high prevalence of myofascial trigger points among patients, objectively and reliably quantifying QL stiffness and its association with other clinical parameters could improve the identification of early stages of the condition before other alterations become apparent. Therefore, this study aimed to explore the association between QL stiffness and multiple indicators of LBP severity. Materials and Methods: A cross-sectional observational study was conducted involving the participation of seventy-six patients suffering from chronic LBP. An ultrasound scanner with shear-wave elastography (SWE) was used to determine the participants’ QL stiffness. Additional information was collected on LBP-associated pain intensity, disability, central sensitization, and quality of life. Results: QL muscle stiffness was negatively correlated with pain intensity (p < 0.01) and central sensitization (p < 0.01), and it was positively correlated with physical quality of life (p < 0.01). Muscle stiffness influenced the variance in pain intensity along with physical quality of life, central sensitization, and chronicity (together explaining 49% of the variance) but did not explain the variance in central sensitization. Conclusions: Assessing QL muscle stiffness in patients with LBP is recommended, as greater muscle softness is linked to higher pain intensity, central sensitization, and poorer physical quality of life. Regression analyses further highlighted that QL stiffness helps explain the variance in pain intensity, physical quality of life, central sensitization, and chronicity, but it did not directly affect the central sensitization variance.

Background/Objectives: The quadratus lumborum (QL) muscle is a key structure involved in patients with low back pain (LBP). Since the discriminative capability of morphological descriptors is uncertain and considering the high prevalence of myofascial trigger points and the poor reliability of manual palpation in this condition, developing a reliable procedure for assessing the QL’s tenderness is needed for facilitating the diagnosis and monitoring changes over time. We aimed to analyze the intra- and inter-examiner reliability of SWE for calculating the QL tenderness in patients with LBP. Methods: Using a convex transducer, longitudinal shear wave elastography (SWE) images of the QL muscle were acquired bilaterally twice in 52 volunteers with moderate LBP and disability by one experienced examiner and one novel examiner to measure shear wave speed and Young’s modulus as stiffness metrics. Results: Intra-examiner reliability estimates demonstrated high consistency independently of the examiner’s experience (intraclass correlation coefficients (ICCs) > 0.930) for both metrics. However, experienced examiners showed smaller minimal detectable changes. Additionally, inter-examiner reliability was lower, with ICCs ranging from 0.57 to 0.68, and significant differences in mean values between examiners (p < 0.01) were found. Conclusions: This procedure exhibited excellent intra-examiner reliability for assessing QL muscle stiffness in patients suffering LBP, indicating high repeatability of measurements when performed by the same examiner. In addition, experienced examiners demonstrated greater sensitivity in detecting real changes not attributed to measurement errors. However, inter-examiner reliability was moderate, highlighting the need for consistent examiner use to avoid measurement variability and averaging multiple measurements to enhance the accuracy.

Chronic pain is a significant burden affecting more than 30% of people worldwide. Within the multiple biopsychosocial factors affected in people suffering from chronic pain, neurocognitive impairments represent a significant but often under-recognized aspect of the chronic pain experience that impacts daily life and healthcare. Multiple neurocognitive domains, including attention, executive function, learning, and memory, have been commonly associated with chronic pain. Within novel approaches, extended reality (XR) has been highlighted for its potential in chronic pain management. XR offers unique features to enhance traditional neurocognitive interventions, including dual tasks, gamification, ecological validity, and enriched experience, to increase engagement and motivation in rehabilitation. This systematic–narrative hybrid literature review aims to shed light on the potential benefits, challenges, and future directions of XR technology to address neurocognitive impairments associated with chronic pain. While preliminary evidence suggests that XR-based neurocognitive training may be beneficial in overcoming neurocognitive impairments found in chronic pain, some challenges still need to be addressed for effective translation into clinical practice. Within a transdiagnostic approach, XR-based neurocognitive training appears to be valuable across different diagnoses in chronic pain, wherein XR may emerge as a promising first-line intervention toward personalized multimodal management for chronic pain. Despite the rapid development of substantial growing evidence for XR, enhanced methodological rigor and reporting quality are recommended in future studies. More research is needed to fully understand the mechanisms and optimal application of XR-based neurocognitive training in different chronic pain conditions.

Determining the prevalence of different shoulder subclassification-based diagnoses using a defined exclusion-type diagnostic algorithm. Analyzing the relationships between cervical contribution and other shoulder diagnoses. A proposal of a shoulder pain diagnosis based on functional subclassification was carried out in all subjects. The included diagnoses were cervical contribution, acromioclavicular joint pain, stiff shoulder, atraumatic unstable shoulder, rotator cuff-related shoulder pain, and 'Others'. Each diagnosis was based on a defined exclusion-type diagnostic algorithm. Cervical contribution was considered if a > 30% shoulder symptom modification in pain intensity was recorded after a cervical spine screening. Since a > 30% change in symptoms does not definitively indicate a categorical diagnosis, cervical contribution was presumed to potentially coexist with other diagnostic labels in these cases. If there was a complete (100%) resolution of shoulder symptoms after the cervical spine screening, cervical contribution was deemed the sole diagnosis. Sixty subjects were analyzed. Rotator cuff-related shoulder pain was the most prevalent diagnosis (36.7%, n = 22), followed by stiff shoulder, being present in 30% (n = 18) of subjects. Cervical contribution (13.3%, n = 8), atraumatic unstable shoulder (11.7%, n = 7), others (6.7%, n = 4) and acromioclavicular joint pain (1,7%, n = 1) completed the results. In patients diagnosed with rotator cuff-related shoulder pain, cervical contribution coexisted in 71,4% of them. Thus, a statistically significant association between cervical contribution and rotator cuff-related shoulder pain was found (p = 0,002). This association was not observed in any of the other diagnoses. Rotator cuff-related shoulder pain was the most prevalent diagnosis, followed by stiff shoulder and cervical contribution. Cervical contribution may coexist with other diagnoses or even be considered as a unique diagnosis itself. Patients diagnosed with rotator cuff-related shoulder pain are more likely to have cervical contribution.