Headache & Pain*

This systematic review and meta-analysis comprehensively compares and analyzes the strengths and weaknesses of three neuromodulating treatment options—electroconvulsive therapy (ECT), transcranial magnetic stimulation (rTMS), and psychedelics—for pain management in individuals with Fibromyalgia, a chronic illness characterized by widespread musculoskeletal pain, fatigue, and cognitive difficulties. This review takes a multidisciplinary approach, drawing inspiration from both Psychiatry and Rheumatology fields, to examine neuromodulation through a lens that focuses on managing Fibromyalgia pain rather than the traditional purpose of mood regulation. By exploring the effects of neuromodulation of pain and investigating the mechanisms of nociceptive transmission, we aim to gain a deeper understanding of the potential impact of these treatments on Fibromyalgia pain management. ​

In this presentation we will discuss visual symptoms including aura related to migraine and differentiate these symptoms from common ocular symptoms that can be confused with migraine. We will discuss other visual phenomena that can be confused with migraine like visual snow. We will highlight the most bothersome symptom of migraine, photophobia. With each of these topics we will discuss our understanding of the the pathophysiology.

Diffusion tensor image analysis along perivascular space (DTI-ALPS) has recently been used to evaluate glymphatic system activity associated with several neurological disorders. However, methods of selecting the region of interest (ROI) for DTI-ALPS have varied across studies. This study aimed to investigate the variability and reproducibility of 3 ROI selection methods (manual selection on unregistered FA maps by a board-certified neuroradiologist, standardized fixed Montreal Neurological Institute (MNI) coordinates on the registered FMRIB58_FA (1mm) template by 2 neuroradiologists and 2 physicists, ICBM-DTI-81 white matter atlas-based ROI determination). Our findings suggest that the ALPS indices calculated by the fixed MNI coordinate method were comparable to the manual ROI methods. The atlas-based method showed a smaller variability but differed from other methods. The reproducibility of these methods to measure glymphatic activities is promising; however, their clinical utility remains to be evaluated by more studies.

This presentation will provide insights into migraine pathophysiology gained from brain functional imaging studies, focusing on the prodrome, aura, and headache phases of the migraine attack.