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Regular or frequent use of analgesics and acute antimigraine drugs can increase the frequency of headache, and induce the transition from episodic to chronic headache or medication overuse headache. The 1-year prevalence of this condition in the general population is between 1% and 2%. Medication overuse headache is more common in women and in people with comorbid depression, anxiety, and other chronic pain conditions. Treatment of medication overuse headache has three components. First, patients need education and counselling to reduce the intake of medication for acute headache attacks. Second, some patients benefit from drug withdrawal (discontinuation of the overused medication). Finally, preventive drug therapy and non-medical prevention might be necessary in patients at onset of treatment or in patients who do not respond to the first two steps. The optimal therapeutic approach requires validation in controlled trials.

Background Autonomic symptoms are mandatory for making the diagnosis of a trigemino-autonomic cephalalgia (TAC). These symptoms can occasionally also occur in migraine and facial pain disorders. This leads to the question whether the trigeminal pain itself can induce autonomic symptoms also in healthy subjects. Methods We enrolled healthy subjects without a history of migraine or a TAC and provoked severe trigeminal pain by injection of 0.05 ml capsaicin (0.01%) into the right forehead. Autonomic symptoms occurring at the right eye or right nostril were registered until they disappeared. We also calculated an autonomic score for the frequency and duration of autonomic symptoms in an individual. Results We enrolled 60 healthy volunteers (30 male, 30 female; mean age 28 +/- 5 years). All but two subjects developed at least one autonomic symptom after injection of capsaicin. One minute after injection, the pain was rated as 9.2 +/- 1.1 and 8.5 +/- 1.2 (scale from 0 to 10) in female and male subjects, respectively. The autonomic score was 4.4 +/- 1.6 and 1.7 +/- 0.9 for female and male subjects, respectively. All differences between female and male subjects were significant. Pain rating and autonomic score showed a significant positive correlation which remained significant even after adjusting for sex. Conclusions Severe trigeminal pain was accompanied by autonomic symptoms in almost all subjects in this experiment. The pain rating and the severity of autonomic symptoms were significantly higher in female subjects than in male. The higher the pain the more severe was this autonomic activation. We conclude that activation of autonomic symptoms is an unspecific consequence of severe trigeminal pain. This does, however, not exclude the possibility that primary headache disorders might have an independent anatomic pathway to induce autonomic symptoms because these symptoms can, although very rarely, also occur without pain.

Hydrogen in materials is an important topic for many research fields in materials science. Hence in the past quite a number of different techniques for determining the amount of hydrogen in materials and for measuring hydrogen permeation through them have been developed. Some of these methods have found widespread application. But for many problems the achievable sensitivity is usually not high enough and ready-to-use techniques providing also good spatial resolution, especially in the submicron range, are very limited, and mostly not suitable for widespread application. In this work this situation will be briefly reviewed and a novel scanning probe technique based method introduced.

BackgroundInsights into the burden, needs and treatment of migraine from internet-based surveys in diverse real-world migraine populations are needed, especially at a time when novel preventive migraine medications are becoming part of the therapeutic armamentarium. The objectives of this analysis are to describe traditional preventive (orals and onabotulinum toxin A) treatment patterns in the OVERCOME (EU) study migraine cohort, as well as treatment patterns and patient satisfaction with current treatment in a subgroup of respondents eligible for migraine preventive medication.MethodsThe cross-sectional non-interventional OVERCOME (EU) study was conducted (October 2020–February 2021) via an online survey among adults (aged ≥ 18 years) resident in Germany or Spain. Participants, registered in existing online panels, who were willing to provide consent were considered. The migraine cohort included participants reporting headache/migraine in the past year, identified based on a validated migraine diagnostic questionnaire and/or self-reported physician diagnosis. A subgroup of survey respondents defined as eligible for migraine preventive medication at the point in time the cross-sectional survey was taken was also analysed. Variables assessed included sociodemographic and migraine-related clinical characteristics, preventive (traditional and calcitonin gene-related peptide monoclonal antibodies) treatment patterns and patient satisfaction with current treatment. Results are descriptive only.ResultsOf the 20,756 participants in the migraine cohort, 78.5% sought professional medical care, 50.8% received a migraine diagnosis and only 17.7% had ever used preventive medication. Half (53.3%) of participants currently using preventives took their most recent medication for six months or less. Most patients (73.9%) classified as eligible for preventive medication (based on headache frequency and/or at least moderate disability due to migraine) reported not using traditional preventives and many of those who did (66.8%) were not satisfied with their current standard of care.ConclusionsOur findings highlight the low proportion of people diagnosed with migraine despite a higher rate of consultation and suggest the need for better access to treatment for people with migraine and new preventive therapies with improved efficacy and safety profiles to improve adherence and patient satisfaction.

Martin Luther (1483–1546) reported attacks of headache and of vertigo in his letters and in his lectures. The symptomatology of his headache attacks fulfilled, at least in part, the diagnostic semiological criteria of migraine. However, because we cannot be sure about the time pattern and the exclusion of other disorders that might explain the headache, the diagnosis of migraine is not final. The vertigo attacks sometimes fulfilled the criteria of Ménière's disease. Vertigo also occurred together with headache attacks fulfilling the International Classification of Headache Disorders, 3rd edition criteria for vestibular migraine; however, we do not know exactly the pattern of attack frequency and duration. In summary, it is possible that Martin Luther suffered from attacks of vestibular migraine and had in addition a comorbidity of migraine and Ménière's disease.

The cerebellum is involved in cognitive procressing including music perception and music production. This narrative review aims to summarize the current knowledge on the activation of the cerebellum by different musical stimuli, on the involvement of the cerebellum in cognitive loops underlying the analysis of music, and on the role of the cerebellum in the motor network underlying music production. A possible role of the cerebellum in therapeutic settings is also briefly discussed. In a second part, the cerebellum as object of musicology (i.e., in classical music, in contemporary music, cerebellar disorders of musicians) is described.

Bistable perception involves the spontaneous alternation between two exclusive interpretations of a single stimulus. Previous research has suggested that this perceptual phenomenon results from winnerless dynamics in the cortex. Indeed, winnerless dynamics can explain many key behavioral characteristics of bistable perception. However, it fails to explain an increase in alternation rate that is typically observed in response to increased stimulus drive and instead predicts a decline in alternation rate. To reconcile this discrepancy, several lines of work have augmented winnerless dynamics with additional processes such as global gain control, input suppression, and release mechanisms. These offer potential explanations at an algorithmic level. But it remains unclear which, if any, of these mechanisms are implemented in the cortex and what their biological substrates might be. We suggest that the answers to these questions may lie within the laminar architecture of the cortical microcircuit. Utilizing a dynamic mean field approach, we implement a laminar columnar circuit with empirically derived interlaminar connectivity. By coupling two such circuits such that they exhibit competition, we are able to produce winnerless dynamics reflective of bistable perception. Within our model, we show that two mechanisms emerge from the layered structure that ensure increased alternation rate in response to increased stimulus drive. First, deep layers act to inhibit the upper layers, thereby reducing the attractor depth and increasing the alternation rate. Second, recurrent connections between superficial and granular layers implement an input suppression mechanism which again reduces the attractor depth of the winnerless competition. These findings suggest the functional significance of the layered cortical architecture as they showcase perceptual implications of neuroanatomical properties such as interlaminar connectivity and layer-specific activation.

Purpose of Review To summarise and analyse the current knowledge of CGRP metabolism in childhood and adolescence and its role in childhood and adolescence migraine. Recent Findings Influencing CGRP pathways is nowadays one of the main mechanisms to treat migraine. In adults, several clinical trials with different drug classes have supported this finding. However, only very little is known on these mechanisms in children and adolescents with migraine. Based on a literature search, it can be concluded that substantial parts of the CGRP pathways are already developed and working in the preterm fetus of animals. Newborn animals show high CGRP levels and high density of CGRP positive neurons and nerve fibres. In human studies, increased levels of CGRP were observed in childhood and adolescent migraine patients. Remedies based on influencing CGRP metabolism are also working in that age group. For triptans, this has clearly been shown; for gepants, no data are available, and for CGRP ligand/receptor antibodies, positive evidence is only available from case series. Summary Only very little is known on CGRP metabolism in childhood and adolescence. However, placebo-controlled clinical trials both on CGRP antagonists and on CGRP ligand/receptor antibodies are under way and will show in some years whether these drug classes are efficacious also in children and adolescents.

Background and Aims Remnants of laundry detergent ingredients are suspected to be in constant contact with the skin. Allergy sufferers need assurance that the chemicals in everyday products do not cause such disruption. The purpose of this study was to evaluate the effects and tolerability of common laundry detergents on the skin microbiome in individuals with atopic dermatitis. Methods Two laundry detergents for sensitive skin were tested on subjects with atopic dermatitis by having to wear detergent‐washed socks for 7 days. The bacterial population from volunteers’ skin swabs was determined and bacterial viability and biodiversity was evaluated before and after wearing the detergent‐washed socks. The tolerability and effect on atopic dermatitis was also evaluated. Results The results showed that the tested laundry detergents did not have a negative effect on bacterial viability or biodiversity on the skin after being exposed to the detergent‐washed socks for a week. The laundry detergents were rated as very good on the tolerability scale and no worsening of skin itch was reported with the use of either detergent. Conclusion The results of the study showed that both laundry detergents are skin and allergy friendly and do not alter the skin microbiome.