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Purpose To update findings of the 2000–2010 Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders and evaluate the effectiveness of non-invasive and non-pharmacological interventions for the management of patients with headaches associated with neck pain (i.e., tension-type, cervicogenic, or whiplash-related headaches). Methods We searched five databases from 1990 to 2015 for randomized controlled trials (RCTs), cohort studies, and case–control studies comparing non-invasive interventions with other interventions, placebo/sham, or no interventions. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria to determine scientific admissibility. Studies with a low risk of bias were synthesized following best evidence synthesis principles. Results We screened 17,236 citations, 15 studies were relevant, and 10 had a low risk of bias. The evidence suggests that episodic tension-type headaches should be managed with low load endurance craniocervical and cervicoscapular exercises. Patients with chronic tension-type headaches may also benefit from low load endurance craniocervical and cervicoscapular exercises; relaxation training with stress coping therapy; or multimodal care that includes spinal mobilization, craniocervical exercises, and postural correction. For cervicogenic headaches, low load endurance craniocervical and cervicoscapular exercises; or manual therapy (manipulation with or without mobilization) to the cervical and thoracic spine may also be helpful. Conclusions The management of headaches associated with neck pain should include exercise. Patients who suffer from chronic tension-type headaches may also benefit from relaxation training with stress coping therapy or multimodal care. Patients with cervicogenic headache may also benefit from a course of manual therapy.

A vaccine containing an RNA molecule encoding the SARS-CoV-2 spike protein was tested in a trial in which two injections were given 3 weeks apart. After the second injection, Covid-19 developed in 162 patients receiving placebo, with a median follow-up of 2 months, and in 8 patients receiving the vaccine. Side effects were mainly mild-to-moderate injection-site pain and swelling.

In patients with idiopathic normal-pressure hydrocephalus responsive to CSF drainage, shunting improved gait and balance at 3 months, but not cognition or incontinence, and was associated with some procedure-related risks.

A comparison has been made between the cervicogenic headache criteria in the new IHS classification of headaches (3 rd edition- beta version) and The Cervicogenic Headache International Study Group’s (GHISG) criteria from 1998. In a more recent version, the CHISG criteria consist of 7 different items. While “core cases” of cervicogenic headache (CEH) usually fulfill all 7 criteria, the IHS classification - 3 rd edition beta version- fulfills only 3 criteria. Although the new three beta version represents an improvement from the previous one, it does not quite seem to live up to the expectations for a diagnostic system for routine, clinical use.

Ebola remains a global threat. In a randomized, controlled trial to assess the safety and immunogenicity of two vaccines against Ebola virus disease in Liberia, no safety signals were found. The vaccines elicited immune responses lasting at least 1 year.

To investigate the association of unintentional dural puncture (UDP) and postdural puncture headache (PDPH) with the risk of chronic headache, backache, neckache and depression. We also investigated if epidural blood patch (EBP) is associated with reduced risk of these morbidities. Systematic review and meta-analysis. Pregnant women who experienced UDP and/or PDPH versus those who had uneventful neuraxial procedures, and women who received EBP versus those who did not. None. Primary outcomes were headache, backache, and neckache lasting ≥12 months, and depression ≥1 month. Secondary outcomes included chronic headache, backache, and neckache persisting ≥1 and ≥ 6 months, and the effects of EBP on those outcomes at ≥1 and ≥ 12 months. Subgroup analyses of prospective studies and sensitivity analyses of primary outcomes excluding poor quality studies were performed. Twelve studies compared 6541 women with UDP and/or PDPH versus 1,004,510 with uncomplicated neuraxial procedures. Eight studies compared EBP (n = 3610) with no EBP (n = 3154). UDP and/or PDPH were associated with increased risk of headache (RR 3.95; 95%CI 2.13 to 7.34; I2 42%), backache (RR 2.72; 95%CI 2.04 to 3.62; I2 1%), and neckache (RR 8.09; 95%CI 1.03 to 63.35) persisting ≥12 months, and depression (RR 3.12; 95%CI 1.44 to 6.77; I2 90%) lasting ≥1 month. Results were consistent in analyses at ≥1 and ≥ 6 months, subgroup analyses of prospective studies, and after exclusion of one poor-quality study from our primary outcome. EBP was not associated with significant reduction in the risk of long-term morbidities. UDP and/or PDPH were associated with increased risk of chronic headache, backache, neckache, and depression. EBP was not associated with a significant reduction in those risks, but this conclusion is limited by the heterogeneity of current data and lack of information on the success of EBP in relieving acute PDPH symptoms. •Unintentional dural puncture is associated with chronic headache, neckache, backache.•Unintentional dural puncture is associated with increased postpartum depression risk.•Headache, neckache, backache and depression are not reduced with epidural blood patch.

The purpose of this study was to investigate the effect of flexion exercise of the deep cervical muscles on headache and sleep disorders in patients with tension headaches and forward head posture. A total of 32 patients with tension headaches and forward head posture were randomly assigned to two groups: an experimental group (n = 16) and a control group (n = 16). The experimental group performed cervical deep muscle flexion exercises for 4 weeks, whereas the control group performed stretching exercises for the same period. The Henry Ford Hospital Headache Disability Inventory (HDI) was used for headache assessment, and the Korean version of the Pittsburgh Sleep Quality Index (PSQI-K) was used for sleep disorder assessment. The experimental group showed a significant reduction in both HDI and PSQI-K score after 4 weeks of intervention (p < 0.001), while no significant difference was found in the control group (p > 0.05). On comparing the experimental and control groups, we found a significant difference in changes in the HDI and PSQI-K between the groups (p < 0.05). The results indicate that flexion exercise of the deep cervical muscles in patients with tension headache and forward head posture will improve the quality of life and activities of daily life by mitigating headaches and sleep disorders.

Characteristics of persistent post-traumatic headache (PTH) in young individuals are poorly known leading to diagnostic problems and diverse management. We aimed to describe headache phenotypes and self-reported management strategies in young individuals with PTH following mild traumatic brain injury (mTBI). A comprehensive structured questionnaire was used to evaluate headache phenotypes/characteristics and management strategies to relieve headache in 107, 15–30-year-old individuals with PTH. Around 4 months post-injury, migraine-like headache in combination with tension-type like headache (40%) was the most commonly encountered headache phenotype followed by migraine-like headache (36%). Around 50% reported aura-like symptoms before/during the headache attack. Medication-overuse headache was diagnosed in 10%. Stress, sleep disturbances, and bright lights were the most common trigger factors. More than 80% reported that their headache was worsened by work-related activity and alleviated by rest/lying down. Simple analgesics were commonly used (88%) whereas prophylactic drugs were rarely used (5%). Bedrest and physiotherapy were also commonly used as management strategies by 56% and 34% of the participants, respectively. In conclusion, most young individuals with PTH after mTBI presented with combined migraine-like and tension-type-like headache followed by migraine-like headache, only. Preventive headache medication was rarely used, while simple analgesics and bedrest were commonly used for short-term headache relief.

In cesarean section surgery, spinal anesthesia can lead to a reduction in intracranial pressure (ICP), which may result in headaches. Adequate fluid replacement is generally required postoperatively to prevent low ICP. However, excessive empirical fluid replacement can increase the circulatory burden on the patient and potentially elevate ICP, thereby contributing to the occurrence of headaches. This trial aims to investigate whether fluid management guided by ultrasound measurement of the optic nerve sheath diameter can reduce the incidence of postoperative headaches in patients. This single-center randomized controlled clinical trial was conducted at Ganzhou People’s Hospital in China from December 2022 to July 2023. A total of 138 ASA II and III patients aged 18 years and older, scheduled for cesarean section under spinal anesthesia, were randomly assigned to either a restricted infusion group (Group E, n  = 71), which underwent restrictive infusion adjustments to maintain the optic nerve sheath diameter within the normal range (2.2–5 mm), or an empirical infusion group (Group C, n  = 67), where the optic nerve sheath diameter was solely monitored, and empirical infusion treatment was employed. Within 72 h post-operation, all patients were monitored every 12 h for ultrasound-measured optic nerve sheath diameter (ONSD) and the occurrence of postoperative headaches. The primary outcome was the incidence of postoperative headaches. Secondary outcomes included ONSD assessed by ultrasound, pain scores using the visual analog scale (VAS), postoperative fluid supplementation, nausea and vomiting, back pain, mean arterial pressure (MAP), heart rate (HR), length of hospital stay, and patient satisfaction. The incidence of postoperative headache in Group E was lower than that in Group C, however, this difference was not statistically significant ( P =  0.094). There was no difference in the volume of fluid replacement between the two groups within the first 0–12 h post-surgery, but significant difference was observed between 12 and 24 h ( P =  0.002). Additionally, there was no significant reduction in discharge time between two groups ( P =  0.309). Under ultrasound guidance, maintaining a normal diameter of the optic nerve sheath does not decrease the incidence of postoperative headaches in women with cesarean section receiving a spinal anesthesia. However, it may offer patients a more effective approach to fluid replacement. Trial registration: ChiCTR.org.cn (ChiCTR2400089214). Date of registration: 4/9/2024.

This systematic review summarizes the existing data on headache and pregnancy with a scope on clinical headache phenotypes, treatment of headaches in pregnancy and effects of headache medications on the child during pregnancy and breastfeeding, headache related complications, and diagnostics of headache in pregnancy. Headache during pregnancy can be both primary and secondary, and in the last case can be a symptom of a life-threatening condition. The most common secondary headaches are stroke, cerebral venous thrombosis, subarachnoid hemorrhage, pituitary tumor, choriocarcinoma, eclampsia, preeclampsia, idiopathic intracranial hypertension, and reversible cerebral vasoconstriction syndrome. Migraine is a risk factor for pregnancy complications, particularly vascular events. Data regarding other primary headache conditions are still scarce. Early diagnostics of the disease manifested by headache is important for mother and fetus life. It is especially important to identify “red flag symptoms” suggesting that headache is a symptom of a serious disease. In order to exclude a secondary headache additional studies can be necessary: electroencephalography, ultrasound of the vessels of the head and neck, brain MRI and MR angiography with contrast ophthalmoscopy and lumbar puncture. During pregnancy and breastfeeding the preferred therapeutic strategy for the treatment of primary headaches should always be a non-pharmacological one. Treatment should not be postponed as an undermanaged headache can lead to stress, sleep deprivation, depression and poor nutritional intake that in turn can have negative consequences for both mother and baby. Therefore, if non-pharmacological interventions seem inadequate, a well-considered choice should be made concerning the use of medication, taking into account all the benefits and possible risks.