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Review
. 2023 Nov 14;9(11):e22285.
doi: 10.1016/j.heliyon.2023.e22285. eCollection 2023 Nov.

New management strategies for primary headache disorders: Insights from P4 medicine

Yu Zhang  1 , Wanbin Huang  1 , Songqing Pan  1 , Zhengming Shan  1 , Yanjie Zhou  1 , Quan Gan  1 , Zheman Xiao  1
Affiliations
Review

New management strategies for primary headache disorders: Insights from P4 medicine

Yu Zhang et al. Heliyon. .

Abstract

Primary headache disorder is the main cause of headache attacks, leading to significant disability and impaired quality of life. This disorder is increasingly recognized as a heterogeneous condition with a complex network of genetic, environmental, and lifestyle factors. However, the timely diagnosis and effective treatment of these headaches remain challenging. Precision medicine is a potential strategy based on P4 (predictive, preventive, personalized, and participatory) medicine that may bring new insights for headache care. Recent machine learning advances and widely available molecular biology and imaging data have increased the usefulness of this medical strategy. Precision medicine emphasizes classifying headaches according to their risk factors, clinical presentation, and therapy responsiveness to provide individualized headache management. Furthermore, early preventive strategies, mainly utilizing predictive tools, are critical in reducing headache attacks and improving the quality of life of individuals with headaches. The current review comprehensively discusses the potential application value of P4 medicine in headache management.

Keywords: Cluster headache; Migraine; Personalized management; Precision medicine; Tension-type headache.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
The conceptual framework of P4 medicine strategies for primary headache management is based on predictive, preventive, personalized, and participatory approaches. The foundation of the predictive approach is to develop algorithmic models that integrate personal features, genetics, biomolecular, and neuroimaging data to predict headache risk and the timing of headache occurrence. The targeted preventive approach is implemented to lower headache risk (primary prevention) and headache attacks (secondary prevention). The personalized approach aims to identify the optimal treatment method using individualized techniques, incorporating pharmacogenetics and machine learning. Finally, the participatory approach is involved throughout the headache management process, emphasizing shared decision-making between the patients and their doctors.
Fig. 2
Fig. 2
Schematic diagram of the relationship axis of primary headache disorders and common comorbid diseases. The red arrow represents promoting effects (increased risk), and the green arrow denotes protective effects (decreased risk). Comorbidity networks can be used to group patients based on clinical features and headache outcomes, predicting headache progression risk for targeted prevention and treatment. CH, cluster headache; TTH, tension-type headache. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
See this image and copyright information in PMC

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