Iʼve started researching on migraine when I entered to the graduate school of Keio University School of Medicine immediately after graduating from Nagoya City University School of Medicine. My boss, Professor of Department of Neurology, Keio University told me that a graduate student should do research on one topic each for basical and clinical researches, and I was assigned to a group that investigated diseases of autonomic dysfunctions. As for basical research, I belonged the group which was investigated on cerebral ischemia. In clinical research group, since migraine also has abnormalities in the autonomic nervous system, we performed tilt-up tests and other tests were widely performed at the time, and various neuropeptides, including CGRP, were measured in migraine patients. After returning from studying abroad, I wondered if there was a migraine model other than the cortical spreading depression (CSD) model, and focused on lymphoblasts derived from migraine patients, and used them as a migraine pathopysiologic model to conduct various experiments. Since headaches are a disease that only humans can feel specifically, it is not easy to create a disease model, and there was also the problem that migraine diagnoses differ depending on doctors because their diagnoses are based on symptoms. Therefore, I have been searching for biomarkers that anyone can diagnose migraine using this lymphoblast model or an omics approach. Although we have found some candidate molecules using several methods, we have not yet found anything conclusive. In recent years, we have also been doing research into the relationship between light and migraine, the relationship between intrinsic retinal ganglion cells (ipRGCs) and migraine patients, and ultimately the relationship with CSD. Although the research is consistent, we believe that a multifaceted approach will provide clues to elucidating the migraine pathopysiology, and we are doing research every day. I would like to talk about the history of my migraine research and its future prospects.

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  It is well known that migraine has accompanying symptoms such as hypersensitivity (photophobia, phonophobia, and osmophobia) in addition to migraine attacks. In particular, photophobia is common in migraineurs, and sunlight and LED lights (especially, blue light) can induce migraine attacks, and also worsen symptoms during migraine attacks. In recent years, it has been found that migraine and photophobia are related to the reactivity of intrinsic photosensitive retinal ganglion cells (ipRGCs) present on the retina, and that ipRGCs in migraineurs are overly reactive compared to healthy controls. Furthermore, similar experiments were performed using a mouse CSD model, revealing that ipRGCs are deeply involved in the development of CSD.

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[in Japanese]

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  Accurate investigation into the subjective symptoms of the patients is crucial to diagnose migraine and migraine-related conditions. In other words, accurate descriptions of the subjective symptoms in the writings, such as novels and diaries, often serve for diagnosing the writers’migraine and migraine-related conditions.

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[in Japanese]

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  It is important to be aware of triggers and aggravation factors for migraine sufferers, as avoiding them in daily life can help prevent migraine attacks. The most common trigger is stress. Environmental factors include changes in the workplace or school environment. As for weather, attacks are more common during the rainy season, and attacks are often induced after low pressure. In women, it is known that migraine attacks are induced in correlation with blood estrogen levels. Furthermore, it is said that migraine attacks are more likely to be induced when foods contain substances with vasoactive effects. Frequent exposure to triggers and aggravation factors can progress to chronic migraine.

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  This study examines secondary headaches in the field of otorhinolaryngology and head and neck surgery. According to the International Classification of Headache Disorders, 3rd edition（ICHD-3）, headaches associated with otolaryngological diseases include those caused by ear diseases, acute and chronic rhinosinusitis, and nasal mucosa, turbinate, and septal disorders. We reviewed the clinical characteristics of otogenic migraine, vestibular migraine, headaches due to acute and chronic rhinosinusitis, and nasal mucosa contact point headaches, discussing their diagnosis and treatment. In particular, otogenic migraine should be considered when patients present with ear pain associated with migraines, requiring accurate diagnosis and appropriate treatment. We reported cases where surgical intervention was necessary for headaches due to acute rhinosinusitis. Additionally, we evaluated the effectiveness of surgical treatment for headaches related to chronic rhinosinusitis and nasal mucosa contact point headaches. These findings contribute to the management of headaches in the field of otorhinolaryngology and head and neck surgery.

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[in Japanese]

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  The treatment of primary headaches typically centers around pharmacological interventions, including nonsteroidal anti-inflammatory drugs (NSAIDs) , triptans, and lasmiditan. In recent years, the advent of calcitonin gene-related peptide (CGRP) antagonists has brought new attention to the prophylactic treatment of migraine, thereby expanding therapeutic options. However, refractory cases that do not respond adequately to pharmacological therapy continue to present significant clinical challenges, highlighting the need for the establishment of effective non-pharmacological treatment strategies.
  Among such non-pharmacological approaches, acupuncture (ACU) has already been widely accepted in Western countries as a therapeutic option for chronic pain, including headache. If the efficacy of ACU for headache management becomes more broadly recognized in Japan, it may contribute to establishing its role as a viable non-pharmacological alternative and enhance flexibility in clinical decision-making. Furthermore, when administered directly by physicians, ACU allows for more integrated care by enabling treatment based on real-time assessment of the patientʼs clinical status.
  In this report, we present the clinical outcomes of acupuncture therapy for tension-type headache conducted at our institution and discuss the associated challenges and future perspectives.

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[in Japanese]

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  Goreisan is a traditional Kampo medicine with diuretic effects, commonly used for treating dizziness and headaches in the field of otorhinolaryngology. This study explores the clinical application of Goreisan, particularly its efficacy in vestibular migraine and Ménièreʼs disease. Vestibular migraine is characterized by recurrent dizziness and migraines, while Ménièreʼs disease involves hearing loss and vertigo caused by endolymphatic hydrops. Our findings indicate that Goreisan, either alone or in combination with other Kampo medicines (such as Goshuyuto and Ryokeijutsukanto) , is effective for these conditions. Case reports demonstrate that combined Kampo therapy, including Goreisan, contributed to the treatment of intractable Ménièreʼs disease and vestibular migraine. While Kampo combination therapy is a valuable treatment option, considerations regarding insurance coverage and potential side effects must be addressed. This study highlights the utility of Goreisan in otorhinolaryngology and suggests the need for further research.

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  We examined the effects of galcanezumab in migraine patients using a headache graph developed by our own quantitative evaluation method. The headache graph was calculated as the Headache Volume (HV) for one month by using a line graph with 11 levels of VAS on the vertical axis and the area bounded by a baseline line with input every 5 hours per day on the horizontal axis. In 23 migraine patients (M: F＝4:19, age 46. 2±10. 2, EM17, CM6) who received galcanezumab, the HV values for 3 months before and 6 months after administration were compared, and the mean HV values were significantly improved and maintained for 6 months from baseline. The frequency, intensity, and duration of pain were also significantly reduced after administration. The HV value of the headache graph visualized the intensity of the headache and the course of time without omission, enabling a more precise quantitative evaluation, and demonstrating the effectiveness of galcanezumab.

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  A questionnaire survey was conducted to clarify the thoughts and problems of patients receiving home self-injection of CGRP-related monoclonal antibodies, and to devise and implement better guidance so that patients can safely and securely perform home self-injection.
  The subjects were 115 migraine patients who had started home self-injection of CGRP-related monoclonal antibodies. Although 57％ of the patients said they had concerns before starting self-injection, 90％ of patients said they were happy with self-injection, and the most common answer regarding the benefits was that it reduced the number of hospital visits. The fact that more patients than expected answered that they had no worries about self-injection was attributed to patients’ expectations about the effects of CGRP-related monoclonal antibodies and the simplicity of the autoinjector. Further, the successful experience of being able to self-inject without failure during practice was thought to have boosted their confidence. The increase in the number of patients self-injecting at home is not only beneficial for patients, but also for nurses, as it reduces their workload for in-hospital injections, which is considered to be beneficial for both parties.

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  The purpose of our study is survey on actual conditions for education scene in headache. A questionnaire survey was conducted among teaching staff in elementary and junior high school. Responses were received from 21 teaching staff (survey response rate: 95.5％) . 57.1％ of respondents had experience of being consulted about headaches. The most common measure was to have the student rest or go to the infirmary. However, there were also cases where it was difficult to deal with the situation in the educational setting, such as not knowing which hospital to go to or having trouble with learning due to headaches. In the future, it will be necessary to promote collaboration not only among headache specialists but also among a wide range of other professionals, including school doctors, teaching staff, and school nurses, in order to provide better care for children and adolescents with headaches. It is also hoped that more people will become aware of the disease.

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  We report a case of severe right-sided headache with ipsilateral rhinorrhea and lacrimation lasting two hours twice daily for over a year. The patient was considered to have chronic cluster headache according to the International Classification of Headache Disorders (ICHD) , but various medications were completely ineffective. Indomethacin 75 mg/day was started and the headaches resolved the next day. After seven years of treatment, the patient was able to discontinue indomethacin. There are overseas reports of the effectiveness of indomethacin in chronic cluster headache, but the doses used are high and it takes more than a week to see an effect. Although the duration and frequency of headache in this case differs from the diagnostic criteria of ICHD, it was thought to be similar to the pathophysiology of paroxysmal hemicrania because of the rapid and absolute effect of indomethacin.

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  Greater occipital nerve block has been reported as effective for primary headaches in children. While unilateral block is generally the approach, we present a case where bilateral greater occipital nerve block proved effective. The patient was a 14-year-old female suffering from migraine without aura, chronic migraine, and chronic tension-type headache. Her headache history began at age 8, and she had found analgesics, triptans, and preventive medications to be ineffective. A right-sided block injection improved her pain. However, the following day, she developed pain in the left occipital region and requested treatment on that side, leading to a left-sided injection. Subsequently, approximately 3 weeks and 7 weeks later, unilateral blocks were again performed, but pain on the opposite side recurred the next day, necessitating a block on that side. Despite the general understanding that a unilateral block is usually sufficient, this case highlighted to us that bilateral blocks are sometimes required.

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