Dr. Yohannes W. Woldeamanuel M.D. is a translational physician scientist, currently Instructor at Department of Neurology and Neurological Sciences and Senior Fellow at the Center for Innovation in Global Health, Stanford University School of Medicine. He obtained his M.D. from Addis Abeba University Medical Faculty in 2007. Following graduation, Dr. Woldeamanuel was Head of Department of Anatomy, Histology, Embryology at Jimma University School of Medicine where he successfully instructed medical students and other health profession disciplines for a year and a half. Afterwards, he did Clinical Neurology residency training at Addis Abeba University Medical Faculty combined with Basic Science and Clinical Research Fellowships concentrating in the areas of Neuroinfectious Diseases, Neuropathic Pain, Epilepsy, and Neuroepidemiology at Karolinska Institutet - Sweden, Albert Einstein College of Medicine - USA, University of Heidelberg - Germany, and Imperial College London - UK. He completed his PostDoctoral Fellowship in Headache Medicine at the Stanford Headache Program. He is Awardee of several prestigious Fellowships, namely, the International Brain Research Organization (IBRO) John G. Nicholls 2012, International Association for the Study of Pain (IASP) Scan|Design Foundation 2010, European Neurological Society (ENS) 2011, and International Headache Society (IHS) 2014. He also has vested interest and expertise in Digital Health as shown by his recent developments of clinically-validated self-management apps for neuropathy (CHANT) and migraine. He has strong track record of publishing many peer-reviewed first-authored articles in several high impact medical journals including The Lancet Oncology, Neurology, Pain, Journal of Neurology, Cephalalgia, and Journal of Neurological Sciences. He has been awarded the 2016 Emerging Leader in Global Health Innovation Award, Consortium of Universities for Global Health from Drs. Anvar and Pari Velji Family Foundation based on his leading role in the development, validation, and field-testing of a clinical instrument for the diagnosis of sensory neuropathy and neuropathic pain (Clinical HIV-Associated Neuropathy Tool or CHANT (Woldeamanuel et al., 2016)). He currently serves as the academic editor for Frontiers in Neurology, BMC Neurology, and BioMed Research International and regularly peer reviews for journals such as Neurology, JNNP, Cephalalgia, Headache. He is an invited editorial board member for the highest impact factor headache journal - The Journal of Headache & Pain. He has received the Publons Peer Review Award for 2017-18 as the Top 1% Reviewer on Publons Global Reviewers Database. He is ranked 3rd among headache and migraine experts from Stanford (see Expertscape rankings at He is the first to receive NINDS/NIH award (K01) for headache research at Stanford. He is a certified Quantitative Sensory Testing investigator in accordance with the world-renowned German Research Network on Neuropathic Pain. He is an elected Member of the Juniors Special Interest Group at the International Headache Society since 2015. Dr. Woldeamanuel consults for his clinic in Addis Abeba, Advanced Clinical & Research Center, where he provides his expertise to neurological and general medical patients.

Honors & Awards

  • Feasibility, Acceptability, and Pilot Testing of a Behavioral Intervention for Chronic Migraine, National Institute of Neurological Disorders & Stroke (2021-2026)
  • Efficacy of Brief Behavioral Therapy for Cancer-Related Insomnia in Reducing Headache Burden, National Cancer Institute (National Institutes of Health) (2021-2023)
  • 3rd ranked Expert in Migraine and Headache Disorders at Stanford, Expertscape. (2019, 2020)
  • The Publons Peer Review Award: Top 1% Reviewer on Publons Global Reviewers Database, Publons (2018)
  • Emerging Leader in Global Health, Innovation Award 2016, Consortium of Universities for Global Health & The Velji Family Foundation (2016)
  • International Headache Society (IHS), International Headache Society (IHS) (2014)
  • John G. Nicholls Fellowship, International Brain Research Organization (IBRO) (2012)
  • European Neurological Society (ENS) Fellowship, European Neurological Society (ENS) (2011)
  • International Association for the Study of Pain (IASP) Scan|Design Foundation, International Association for the Study of Pain (IASP) Scan|Design Foundation (2010)


  • Development of Digital Tool for Regular Lifestyle Behavior in Migraine Self-management


    Stanford University

  • Clinical, Biomarker, Neuroimaging Understanding of Chronic Migraine, Stanford University


    Stanford, California

  • Central Autonomic Symptoms among Primary Headache Disorders - a Cross-Sectional Clinical Study


    Stanford University

  • Efficacy of Gepants for Nausea Treatment in Episodic Migraine, Stanford University



  • Medication Overuse Headache in Chronic Migraine Patients Using Cannabis, Stanford University



  • Deep Phenotype Clinical Study on Post-Traumatic Headache, Stanford University



  • Studying the Association between Migraine and Complex Regional Pain Syndrome - a Cross-Sectional Clinical Study


    Stanford University

  • Global Clinico-epidemiologic Study on Measuring the Burden of Migraine Headache, Stanford University
  • Nationwide Cancer Burden Assessment in Ethiopia


    Addis Ababa, Ethiopia

  • Case-Fatality of Adult Tetanus in Africa - Systematic Review and Meta-Analysis


    Stanford and Addis Ababa

  • Headaches Secondary to Infections - Book Chapter


    Stanford University

  • Digit Skin Wrinkling in Distal Peripheral Neuropathy: Early Diagnostic Tool, University of Heidelberg in Mannheim; Stanford University; Addis Ababa University


    Mannheim, Germany

  • Physical Inactivity in Africa: Burden from Community-based Studies in Africa, Stanford University


    Stanford, California

  • CHANT - Clinical HIV-Associated Neuropathy Tool


    Stanford University

Professional Affiliations and Activities

  • Ad Hoc Reviewer, Neurology; Headache; JNNP; Journal of Headache and Pain; Cephalalgia; Journal of Neurology (2016 - Present)
  • Editorial Board Member, The Journal of Headache and Pain (2021 - Present)
  • Associate Editor, BMC Neurology (2019 - Present)
  • Associate Editor, Frontiers in Neurology: Headache Medicine and Facial Pain (2016 - Present)
  • Academic Editor, BioMed Research International (2020 - Present)
  • Member, American Academy of Neurology (AAN) (2014 - Present)
  • Juniors Special Interest Group Committee Member, International Headache Society (IHS) (2016 - Present)
  • Senior Fellow, Center for Innovation in Global Health (CIGH) (2015 - Present)
  • Member, Society of Neuroscientists in Africa (SONA) (2012 - Present)
  • Affiliated Member, Stanford Center for Population Health Sciences (2015 - Present)
  • Reviewer, Stanford Center for Innovation in Global Health Medical Student Admissions (2020 - Present)

All Publications

  • Time It Right! The Application of Circadian Medicine Interventions for the Management of Migraine Annals of Neurology Woldeamanuel, Y. W., Palesh, O., Cowan, R. 2023; 94: S152-S152
  • What is the efficacy of aerobic exercise versus strength training in the treatment of migraine? A systematic review and network meta-analysis of clinical trials. The journal of headache and pain Woldeamanuel, Y. W., Oliveira, A. B. 2022; 23 (1): 134


    BACKGROUND: Multiple clinical trials with different exercise protocols have demonstrated efficacy in the management of migraine. However, there is no head-to-head comparison of efficacy between the different exercise interventions.METHODS: A systematic review and network meta-analysis was performed involving all clinical trials which determined the efficacy of exercise interventions in reducing the frequency of monthly migraine. Medical journal search engines included Web of Science, PubMed, and Scopus spanning all previous years up to July 30, 2022. Both aerobic and strength/resistance training protocols were included. The mean difference (MD, 95% confidence interval) in monthly migraine frequency from baseline to end-of-intervention between the active and control arms was used as an outcome measure. Efficacy evidence from direct and indirect comparisons was combined by conducting a random effects model network meta-analysis. The efficacy of the three exercise protocols was compared, i.e., moderate-intensity aerobic exercise, high-intensity aerobic exercise, and strength/resistance training. Studies that compared the efficacy of migraine medications (topiramate, amitriptyline) to exercise were included. Additionally, the risk of bias in all included studies was assessed by using the Cochrane Risk of Bias version 2 (RoB2).RESULTS: There were 21 published clinical trials that involved a total of 1195 migraine patients with a mean age of 35years and a female-to-male ratio of 6.7. There were 27 pairwise comparisons and 8 indirect comparisons. The rank of the interventions was as follows: strength training (MD=-3.55 [-6.15,-0.95]), high-intensity aerobic exercise (-3.13 [-5.28, -0.97]), moderate-intensity aerobic exercise (-2.18 [-3.25, -1.11]), topiramate (-0.98 [-4.16, 2.20]), placebo, amitriptyline (3.82 [-1.03, 8.68]). The RoB2 assessment showed that 85% of the included studies demonstrated low risk of bias, while 15% indicated high risk of bias for intention-to-treat analysis. Sources of high risk of bias include randomization process and handling of missing outcome data.CONCLUSION: Strength training exercise regimens demonstrated the highest efficacy in reducing migraine burden, followed by high-intensity aerobic exercise.

    View details for DOI 10.1186/s10194-022-01503-y

    View details for PubMedID 36229774

  • Editorial: Lifestyle modifications to manage migraine. Frontiers in neurology Woldeamanuel, Y. W., Shrivastava, S., Vila-Pueyo, M. 2022; 13: 966424

    View details for DOI 10.3389/fneur.2022.966424

    View details for PubMedID 36105771

  • Endogenous glucocorticoids may serve as biomarkers for migraine chronification Therapeutic Advances in Chronic Disease Woldeamanuel , Y. W., Sanjanwala, B. M., Cowan, R. P. 2020; 11

    View details for DOI 10.1177/2040622320939793

  • Exploring Natural Clusters of Chronic Migraine Phenotypes: A Cross-Sectional Clinical Study. Scientific reports Woldeamanuel, Y. W., Sanjanwala, B. M., Peretz, A. M., Cowan, R. P. 2020; 10 (1): 2804


    Heterogeneity in chronic migraine (CM) presents significant challenge for diagnosis, management, and clinical trials. To explore naturally occurring clusters of CM, we utilized data reduction methods on migraine-related clinical dataset. Hierarchical agglomerative clustering and principal component analyses (PCA) were conducted to identify natural clusters in 100 CM patients using 14 migraine-related clinical variables. Three major clusters were identified. Cluster I (29 patients) - the severely impacted patient featured highest levels of depression and migraine-related disability. Cluster II (28 patients) - the minimally impacted patient exhibited highest levels of self-efficacy and exercise. Cluster III (43 patients) - the moderately impacted patient showed features ranging between Cluster I and II. The first 5 principal components (PC) of the PCA explained 65% of variability. The first PC (eigenvalue 4.2) showed one major pattern of clinical features positively loaded by migraine-related disability, depression, poor sleep quality, somatic symptoms, post-traumatic stress disorder, being overweight and negatively loaded by pain self-efficacy and exercise levels. CM patients can be classified into three naturally-occurring clusters. Patients with high self-efficacy and exercise levels had lower migraine-related disability, depression, sleep quality, and somatic symptoms. These results may ultimately inform different management strategies.

    View details for DOI 10.1038/s41598-020-59738-1

    View details for PubMedID 32071349

  • Clinical Features Contributing to Cortical Thickness Changes in Chronic Migraine - A Pilot Study. Headache Woldeamanuel, Y. W., DeSouza, D. D., Sanjanwala, B. M., Cowan, R. P. 2018


    The objectives of this cross-sectional pilot study were threefold: to identify regions of cortical thickness that differentiate chronic migraine (CM) from controls, to assess group differences in interregional cortical thickness covariance, and to determine group differences in associations between clinical variables and cortical thickness.Cortical thickness alterations in relation to clinical features have not been adequately explored in CM. Assessment of this relationship can be useful to describe cortical substrates for disease progression in migraine and to identify clinical variables that warrant management emphasis.Thirty CM cases (mean age 40 years; male-to-female 1:4) and 30 sex-matched healthy controls (mean age 40 years) were enrolled. Participants completed self-administered and standardized questionnaires assessing headache-related clinical features and common psychological comorbidities. T1-weighted brain images were acquired on a 3T MRI. A whole-brain cortical thickness analysis was performed. Additionally, correlations between all brain regions were assessed to examine interregional cortical thickness covariance. Interactions were analyzed to identify clinical variables that were significantly associated with cortical thickness.The whole brain cortical thickness analysis revealed no significant differences between CM patients and controls. However, significant associations between clinical features and cortical thickness were observed for the patients only. These associations included the right superior temporal sulcus (R2  = 0.72, P = .001) and the right insula (R2  = 0.71, P = .002) with distinct clinical variables ie, longer history of CM, posttraumatic stress disorder (PTSD), sleep quality, pain self-efficacy, and somatic symptoms. Higher interregional cortical covariance was found in CM compared to controls (OR = 3.1, CI 2.10-4.56, P < .0001), such that cortical thickness between regions tended to be more correlated in patients, particularly in the temporal and frontal lobes.CM patients have significantly greater cortical covariance compared to controls. Cortical thickness in CM patients was predominantly accounted for by CM duration, PTSD, and poor sleep quality, while improved pain self-efficacy buffered cortical thickness. While it is important to address all CM features and comorbidities, it may be useful to emphasize optimizing the management of certain clinical features that contribute to cortical abnormalities including managing PTSD, early management to shorten duration of CM, and improving pain self-efficacy and sleep quality.

    View details for PubMedID 30468246

  • Migraine affects 1 in 10 people worldwide featuring recent rise: A systematic review and meta-analysis of community-based studies involving 6 million participants Journal of the Neurological Sciences Woldeamanuel, Y. W., Cowan, R. P. 2017; 372: 307-315
  • Migraine and Complex Regional Pain Syndrome: A Case-Referent Clinical Study. BioMed research international Woldeamanuel, Y. W., Cooley, C. n., Foley-Saldena, K. n., Cowan, R. P. 2017; 2017: 5714673


    We studied clinical phenotype differences between migraineurs with CRPS (Mig + CRPS) and those without (Mig - CRPS). Mig + CRPS cases and Mig - CRPS referents aged ≥18 years were enrolled. Diagnosis was made in accordance with International Classification of Headache Disorders-3 beta (ICHD-3 beta) for migraine and Budapest Criteria for CRPS. Migraines both with and without aura were included. A total of 70 Mig + CRPS cases (13% males, mean age 48 years) and 80 Mig - CRPS referents (17% males, mean age 51 years) were included. 33% of Mig + CRPS and 38% of Mig - CRPS exhibited episodic migraine (EM) while 66% of Mig + CRPS and 62% of Mig - CRPS had chronic migraine (CM) (OR = 0.98, CI 0.36, 2.67). Median duration of CRPS was 3 years among EM + CRPS and 6 years among CM + CRPS cohort (p < 0.02). Mig + CRPS (57%) carried higher psychological and medical comorbidities compared to Mig - CRPS (6%) (OR 16.7, CI 10.2, 23.6). Higher migraine frequency was associated with longer CRPS duration. Migraineurs who developed CRPS had higher prevalence of psychological and medical disorders. Alleviating migraineurs' psychological and medical comorbidities may help lower CRPS occurrence.

    View details for PubMedID 29214172

    View details for PubMedCentralID PMC5682894

  • Headache in Resource-Limited Settings. Current pain and headache reports Woldeamanuel, Y. W. 2017; 21 (12): 51


    This review summarizes the unmet need of headache burden and management in resource-limited settings. It provides a general overview of the nuances and peculiarities of headache disorders in resource-limited settings. The review delivers perspectives and explanations for the emerging burden of both primary and secondary headache disorders. Important discussion on demographic and epidemiologic transition pertinent to low-resource settings is included. A critical analysis of headache disorders is made within the context of growing burden non-communicable disorders in low-resource countries. Challenges are examined and prospective feasible solutions tailored to existing resources are provided to address headache disorders in resource-limited settings.Many low-resource countries are entering into the third epidemiological transition featuring increasing burden of non-communicable disorders of which headache disorders contribute a significant proportion. Exponential population growth involving youthful demographic and massive rural-urban migration is taking place in low-resource countries. Youthful demographic is the natural cohort for primary headache such as migraine. Socioeconomic mobility and lifestyle changes are leading to higher levels of physical inactivity and obesity, both of which are related to headache. Life expectancy is rising in some resource-restricted countries; this increases prevalence of secondary headache attributed to neurovascular causes. Many low-resource countries are still burdened with tropical infectious causes of secondary headache. Health care facilities are primarily designed to respond to infectious epidemic and not to chronic burden such as headache. Many low-resource-restricted settings are plagued by poor and corrupt governance, ill-equipped regimes with malfunctioning health policies, war, and poverty. Many low-resource settings do not have access to generic headache medications such as triptans. Headache training and expertise is low. Healthy lifestyle changes emphasizing on improving regular exercise can be inexpensive method to reducing primary headache burden and its comorbidities (e.g. obesity). Addressing the increasing burden of headache disorders in resource-limited settings is important to avert accrued disability which in turn lowers productivity and socioeconomic performance in a young booming population.

    View details for PubMedID 29143899

  • Development, Validation, and Field-Testing of an Instrument for Clinical Assessment of HIV-Associated Neuropathy and Neuropathic Pain in Resource-Restricted and Large Population Study Settings PLOS ONE Woldeamanuel, Y. W., Kamerman, P. R., Veliotes, D. G., Phillips, T. J., Asboe, D., Boffito, M., Rice, A. S. 2016; 11 (10)


    HIV-associated sensory peripheral neuropathy (HIV-SN) afflicts approximately 50% of patients on antiretroviral therapy, and is associated with significant neuropathic pain. Simple accurate diagnostic instruments are required for clinical research and daily practice in both high- and low-resource setting. A 4-item clinical tool (CHANT: Clinical HIV-associated Neuropathy Tool) assessing symptoms (pain and numbness) and signs (ankle reflexes and vibration sense) was developed by selecting and combining the most accurate measurands from a deep phenotyping study of HIV positive people (Pain In Neuropathy Study-HIV-PINS). CHANT was alpha-tested in silico against the HIV-PINS dataset and then clinically validated and field-tested in HIV-positive cohorts in London, UK and Johannesburg, South Africa. The Utah Early Neuropathy Score (UENS) was used as the reference standard in both settings. In a second step, neuropathic pain in the presence of HIV-SN was assessed using the Douleur Neuropathique en 4 Questions (DN4)-interview and a body map. CHANT achieved high accuracy on alpha-testing with sensitivity and specificity of 82% and 90%, respectively. In 30 patients in London, CHANT diagnosed 43.3% (13/30) HIV-SN (66.7% with neuropathic pain); sensitivity = 100%, specificity = 85%, and likelihood ratio = 6.7 versus UENS, internal consistency = 0.88 (Cronbach alpha), average item-total correlation = 0.73 (Spearman's Rho), and inter-tester concordance > 0.93 (Spearman's Rho). In 50 patients in Johannesburg, CHANT diagnosed 66% (33/50) HIV-SN (78.8% neuropathic pain); sensitivity = 74.4%, specificity = 85.7%, and likelihood ratio = 5.29 versus UENS. A positive CHANT score markedly increased of pre- to post-test clinical certainty of HIV-SN from 43% to 83% in London, and from 66% to 92% in Johannesburg. In conclusion, a combination of four easily and quickly assessed clinical items can be used to accurately diagnose HIV-SN. DN4-interview used in the context of bilateral feet pain can be used to identify those with neuropathic pain.

    View details for DOI 10.1371/journal.pone.0164994

    View details for Web of Science ID 000386204500098

    View details for PubMedID 27764177

  • The impact of regular lifestyle behavior in migraine: a prevalence case-referent study JOURNAL OF NEUROLOGY Woldeamanuel, Y. W., Cowan, R. P. 2016; 263 (4): 669-676


    Regular lifestyle behaviors (RLBs) of sleep, exercise, mealtime pattern and hydration status independently affect migraine occurrence. We aimed herein to evaluate the differences in migraine occurrence among participants who do and do not maintain the RLB triumvirate. Cases of chronic migraine (CM) and referents of episodic migraine (EM) ≥aged 15 years with charts regularly documenting RLB notes were continuously enrolled from a retrospective case-referent cohort study performed on electronic chart review from January 1, 2014 to January 1, 2015 at the Stanford Headache and Facial Pain Program. Association between RLB prevalence and migraine occurrence was studied. 175 CM and 175 EM patients were enrolled (mean age 44.4 years, 22 % males). Migraine was diagnosed according to the ICHD-3 beta criteria, and was confirmed by a Headache Specialist attending the Clinic. The CM cohort (22 %) exhibited less RLB than the EM cohort (69 %), with crude odds ratio of 0.13 (95 % confidence interval or CI 0.08-0.21). The adjusted odds ratio and adjusted relative risk between RLB+, Meds+ (those taking medication) and CM were 0.67 (95 % CI 0.32-1.40) and 0.74 (95 % CI 0.43-1.28), indicating no significant effect modification. Engaging in regular lifestyle behavior helps quell chronic migraine.

    View details for DOI 10.1007/s00415-016-8031-5

    View details for Web of Science ID 000373742600006

    View details for PubMedID 26810728

  • The place of corticosteroids in migraine attack management: A 65-year systematic review with pooled analysis and critical appraisal. Cephalalgia Woldeamanuel, Y. W., Rapoport, A. M., COWAN, R. P. 2015; 35 (11): 996-1024


    Headaches recur in up to 87% of migraine patients visiting the emergency department (ED), making ED recidivism a management challenge. We aimed herein to determine the role of corticosteroids in the acute management of migraine in the ED and outpatient care.Advanced search strategies employing PubMed/MEDLINE, Web of Science, and Cochrane Library databases inclusive of a relevant gray literature search was employed for Clinical Studies and Systematic Reviews by combining the terms "migraine" and "corticosteroids" spanning all previous years since the production of synthetic corticosteroids ca. 1950 until August 30, 2014. Methods were in accordance with MOOSE guidelines.Twenty-five studies (n = 3989, median age 37.5 years, interquartile range or IQR 35-41 years; median male:female ratio 1:4.23, IQR 1:2.1-6.14; 52% ED-based, 56% randomized-controlled) and four systematic reviews were included. International Classification of Headache Disorders criteria were applied in 64%. Nineteen studies (76%) indicated observed outcome differences favoring benefits of corticosteroids, while six (24%) studies indicated non-inferior outcomes for corticosteroids. Median absolute risk reduction was 30% (range 6%-48.2%), and 11% (6%-48.6%) for 24-, and 72-hour headache recurrence, respectively. Parenteral dexamethasone was the most commonly (56%) administered steroid, at a median single dose of 10 mg (range 4-24 mg). All meta-analyses revealed efficacy of adjuvant corticosteroids to various abortive medications-indicating generalizability. Adverse effects were tolerable. Higher disability, status migrainosus, incomplete pain relief, and previous history of headache recurrence predicted outcome favorability.Our literature review suggests that with corticosteroid treatment, recurrent headaches become milder than pretreated headaches and later respond to nonsteroidal therapy. Single-dose intravenous dexamethasone is a reasonable option for managing resistant, severe, or prolonged migraine attacks.

    View details for DOI 10.1177/0333102414566200

    View details for PubMedID 25576463

  • Prevalence of migraine headache and its weight on neurological burden in Africa: a 43-year systematic review and meta-analysis of community-based studies. Journal of the neurological sciences Woldeamanuel, Y. W., Andreou, A. P., Cowan, R. P. 2014; 342 (1-2): 1-15


    Headache burden is not adequately explored in Africa. Here, we measured weighted migraine prevalence from community-based studies in Africa.PubMed search was employed using terms 'headache in Africa' AND/OR 'migraine in Africa' for published literature from 1970 until January 31, 2014. PRISMA was applied for systematic review. Forest-plot meta-analysis, inter-study heterogeneity, and odds ratio were used to measure weighted prevalence, inter-gender, and urban-rural differences. Disability adjusted life years (DALYs) for migraine and other neurologic disorders in Africa were extracted from Global Burden of Diseases (GBD) 2000-2030.Among 21 community-based studies included (n=137,277), pooled migraine prevalence was 5.61% (95% CI 4.61, 6.70; random effects) among general population; while 14.89% (14.06, 15.74; fixed effects) among student cohorts. Female students had weighted OR of 2.13 (1.34, 3.37; p=0.0013). Prevalence of migraine was higher among urban population compared to rural settings. Migraine burden is bound to increase by more than 10% DALYs within the next decade.Africa has a crude estimate of 56 million people suffering from migraine. By virtue of mainly afflicting the younger working-age group, migraine disability has wider socioeconomic implications. Improving early headache management access points at community-level, training and research at facility-level, and healthy lifestyle modification among urban residents can help reduce this costly and disabling chronic progressive health problem.

    View details for DOI 10.1016/j.jns.2014.04.019

    View details for PubMedID 24814950

  • Cancer in Ethiopia LANCET ONCOLOGY Woldeamanuel, Y. W., Girma, B., Teklu, A. M. 2013; 14 (4): 289-290


    Ethiopia has a population of more than 84 million people and is expected to become the ninth most populous country in the world by 2050. The growing population coupled with lifestyle changes will mean an increasing burden of cancer. However, oncology services are wholly inadequate--no cancer registry exists, and only one cancer centre, with a handful of doctors and nurses, struggles to serve the entire country.

    View details for Web of Science ID 000317390300034

    View details for PubMedID 23561741

  • Tetanus in Ethiopia: Unveiling the Blight of an Entirely Vaccine-Preventable Disease CURRENT NEUROLOGY AND NEUROSCIENCE REPORTS Woldeamanuel, Y. W. 2012; 12 (6): 655-665


    Today, tetanus exacts its toll only in resource-poor countries like Ethiopia. Agrarian rural life with limited vaccine typifies tetanus risk in Ethiopia where current tetanus control trends on expanding infant immunization and eliminating highly prevalent maternal and neonatal tetanus (MNT). Protection by infant tetanus immunization primers disappears within an average of 3 years, if not followed by boosters. Second-year of life, school-based, and universal 10-yearly tetanus immunizations need to be supplemented. Facility-based reviews in Ethiopia reveal a continued burden of tetanus at tertiary-level hospitals where ICU care is suboptimal. Quality of medical care for tetanus is low - reflected by high case-fatality-rates. Opportunities at primary-health-care-units (antenatal-care, family planning, abortion, wound-care, tetanus-survivors) need to be fully-utilized to expand tetanus immunization. Prompt wound-care with post-exposure prophylaxis and proper footwear must be promoted. Standard ICU care needs to exist. Realization of cold-chain-flexible, needle-less and mono-dose vaccine programs allow avoiding boosters, vaccine-refrigeration, and improve compliance.

    View details for DOI 10.1007/s11910-012-0314-3

    View details for Web of Science ID 000310393500005

    View details for PubMedID 22996275

  • Neurolathyrism: two Ethiopian case reports and review of the literature JOURNAL OF NEUROLOGY Woldeamanuel, Y. W., Hassan, A., Zenebe, G. 2012; 259 (7): 1263-1268


    Neurolathyrism is a toxic myelopathy caused by ingestion of the Lathyrus sativus grasspea. An irreversible acute to subacute spastic paraparesis or quadriparesis ensues. Despite public education, new cases of this preventable disease still occur. Two Ethiopian cases of neurolathyrism are reported to illustrate the disease, followed by a literature review. Two teenage male farmers from the same village developed irreversible spastic myelopathy following L. sativus ingestion. There was no sensory, sphincter or bulbar dysfunction. Likely causative factors identified were increased consumption of L. sativus prior to and following disease onset, heavy physical exertion and male gender, similar to those reported in the literature. Neurolathyrism is an entirely preventable neurotoxic myelopathy with permanent disability accrued. Treatment is symptomatic. Because of personal disability and subsequent socioeconomic effects, this disease warrants further public health measures to prevent occurrence. Education, avoidance of the grasspea and measures to reduce toxin burden are possible methods.

    View details for DOI 10.1007/s00415-011-6306-4

    View details for Web of Science ID 000306125700001

    View details for PubMedID 22081101

  • Case Study: Watch for Tuberculous Encephalopathy in Endemic Areas WORLD NEUROLOGY Gebremichael, S. G., Adeb, M. D., Woldeamanuel, Y. W. 2009; 24 (6): 12
  • The effectiveness of the anti-tumor necrosis factor therapy infliximab in neuro-Behçet's disease: a systematic review and meta-analysis. The Journal of international medical research Mohammed, R. H., Woldeamanuel, Y. W. 2023; 51 (5): 3000605231169895


    To study the effectiveness of infliximab for the treatment of refractory central neuro-Behçet's disease.In this systematic review and meta-analysis, the research question was designed using the 'Population, Intervention, Comparator, and Outcomes' (PICO) model and the search methodology was developed according to the PRISMA statement. The study was registered on PROSPERO. Web of Science, PubMed, and Cochrane Library databases were searched for articles published in English between January 2000 and January 2020. Data were analysed using Meta-Essentials software, version 10.12. Treatment effect size was determined by a random effects model. Interstudy heterogeneity was explored using I2 statistics. Cumulative meta-analysis was conducted to assess the temporal trend for accumulating evidence.Twenty-one studies, comprising 64 patients (mean age, 38 .21 years and mean disease duration, 84.76 months) were included. Effect-size analysis showed that 93.7% of the treated patients in the analysis were responders to infliximab therapy (95% confidence interval 0.88, 0.993). There was no significant inter-study heterogeneity (I2 = 0%). Cumulative analysis showed accumulating evidence favoring increasing effectiveness over the last 20 years.Infliximab showed considerable therapeutic effectiveness in the treatment of refractory neuro-Behçet's disease.

    View details for DOI 10.1177/03000605231169895

    View details for PubMedID 37203384

  • Efficacy of methimazole before the administration of radioactive iodine in the management of Graves' disease: a systematic review and meta-analysis. Sao Paulo medical journal = Revista paulista de medicina Bolakale-Rufai, I. K., Abioro, I., Ngene, S. O., Woldeamanuel, Y. 2023


    BACKGROUND: The efficacy of anti-thyroid drugs in conjunction with radioactive iodine therapy in the management of Graves' disease is still controversial.OBJECTIVE: To compare the efficacy of pretreatment with methimazole before the administration of radioactive iodine for the treatment of Graves' disease.DESIGN AND SETTING: A systematic review and meta-analysis was conducted at a teaching/tertiary hospital in Ibadan, Nigeria.METHODS: A systematic search of the PubMed, Embase, Cochrane Library, and Web of Science databases was performed from inception to December, 2021.RESULTS: Five studies with 297 participants were included. There was no difference in the risk of persistent hyperthyroidism when radioactive iodine was used in conjunction with methimazole compared with when radioactive iodine was used alone (relative risk: 1.02, 95% confidence interval, CI: 0.62-1.66; P = 0.95, I2 = 0%). Subgroup analysis based on the duration between discontinuation of methimazole and the administration of radioactive iodine showed a lower risk of persistent hyperthyroidism when methimazole was discontinued within 7 days before radioactive iodine use, although this did not reach statistical significance (risk ratio: 0.85, CI: 0.28-2.58).CONCLUSIONS: The use of methimazole before radioactive iodine administration was not associated with an increased risk of persistent hyperthyroidism. Concerns about medication toxicity and adverse effects should be considered when clinicians make decisions on combination therapies for the treatment of Graves' disease.PROSPERO REGISTRATION: CRD42020150013,

    View details for DOI 10.1590/1516-3180.2022.0225.R1.19102022

    View details for PubMedID 36629663

  • Diagnostic accuracy of an artificial intelligence online engine in migraine: A multi-center study. Headache Cowan, R. P., Rapoport, A. M., Blythe, J., Rothrock, J., Knievel, K., Peretz, A. M., Ekpo, E., Sanjanwala, B. M., Woldeamanuel, Y. W. 2022


    OBJECTIVE: This study assesses the concordance in migraine diagnosis between an online, self-administered, Computer-based, Diagnostic Engine (CDE) and semi-structured interview (SSI) by a headache specialist, both using International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria.BACKGROUND: Delay in accurate diagnosis is a major barrier to headache care. Accurate computer-based algorithms may help reduce the need for SSI-based encounters to arrive at correct ICHD-3 diagnosis.METHODS: Between March 2018 and August 2019, adult participants were recruited from three academic headache centers and the community via advertising to our cross-sectional study. Participants completed two evaluations: phone interview conducted by headache specialists using the SSI and a web-based expert questionnaire and analytics, CDE. Participants were randomly assigned to either the SSI followed by the web-based questionnaire or the web-based questionnaire followed by the SSI. Participants completed protocols a few minutes apart. The concordance in migraine/probable migraine (M/PM) diagnosis between SSI and CDE was measured using Cohen's kappa statistics. The diagnostic accuracy of CDE was assessed using the SSI as reference standard.RESULTS: Of the 276 participants consented, 212 completed both SSI and CDE (study completion rate=77%; median age=32years [interquartile range: 28-40], female:male ratio=3:1). Concordance in M/PM diagnosis between SSI and CDE was: kappa=0.83 (95% confidence interval [CI]: 0.75-0.91). CDE diagnostic accuracy: sensitivity=90.1% (118/131), 95% CI: 83.6%-94.6%; specificity=95.8% (68/71), 95% CI: 88.1%-99.1%. Positive and negative predictive values=97.0% (95% CI: 91.3%-99.0%) and 86.6% (95% CI: 79.3%-91.5%), respectively, using identified migraine prevalence of 60%. Assuming a general migraine population prevalence of 10%, positive and negative predictive values were 70.3% (95% CI: 43.9%-87.8%) and 98.9% (95% CI: 98.1%-99.3%), respectively.CONCLUSION: The SSI and CDE have excellent concordance in diagnosing M/PM. Positive CDE helps rule in M/PM, through high specificity and positive likelihood ratio. A negative CDE helps rule out M/PM through high sensitivity and low negative likelihood ratio. CDE that mimics SSI logic is a valid tool for migraine diagnosis.

    View details for DOI 10.1111/head.14324

    View details for PubMedID 35657603

  • Association of illness mindsets with health-related quality of life in cancer survivors. Health psychology : official journal of the Division of Health Psychology, American Psychological Association Zeidman, A., Benedict, C., Zion, S. R., Fisher, S., Tolby, L., Kurian, A. W., Berek, J. S., Woldeamanuel, Y. W., Schapira, L., Palesh, O. 2022; 41 (6): 389-395


    This study aimed to examine the association between mindsets-established, but mutable beliefs that a person holds-and health-related quality of life in survivors of breast and gynecologic cancer.A cross-sectional survey study was conducted with breast and gynecologic cancer survivors. Measures included the Illness Mindset Questionnaire and Functional Assessment of Cancer Therapy-General (FACT-G).Two hundred seventy-three survivors (74% breast/26% gynecologic) who were on average 3.9 years post-diagnosis (SD = 4.2), Mage 55 (SD = 12) completed the survey (response rate 80%). Of the survivors, 20.1% (N = 55) endorsed ("agree" or "strongly agree") that Cancer is a Catastrophe, 52.4% (N = 143) endorsed that Cancer is Manageable, and 65.9% (N = 180) endorsed that Cancer can be an Opportunity (not mutually exclusive). Those who endorsed a maladaptive mindset (Cancer is a Catastrophe) reported lower health-related quality of life (HRQOL) compared with those who did not hold this belief (p < .001). Alternatively, those who endorsed more adaptive mindsets (Cancer is Manageable or Cancer can be an Opportunity) reported better HRQOL compared with those who disagreed (all p-values < .05). All three mindsets were independent correlates of HRQOL, explaining 6-15% unique variance in HRQOL, even after accounting for demographic and medical factors.Mindsets about illness are significantly associated with HRQOL in cancer survivors. Our data come from a one-time evaluation of cancer survivors at a single clinic and provide a foundation for future longitudinal studies and RCTs on the relationship between mindsets and psychosocial outcomes in cancer survivors. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

    View details for DOI 10.1037/hea0001186

    View details for PubMedID 35604702

  • Computerized migraine diagnostic tools: a systematic review Therapeutic Advances in Chronic Disease. Woldeamanuel, Y. W., Cowan, R. P. 2022
  • Medication overuse headache in patients with chronic migraine using cannabis: A case-referent study. Headache Zhang, N., Woldeamanuel, Y. W. 2021


    OBJECTIVE: To examine whether cannabis use predicts medication overuse headache (MOH) in patients with chronic migraine (CM).METHODS: Electronic chart review was conducted by combining the terms "CM," "medication overuse," "cannabis," "cannabidiol," and "tetrahydrocannabinol" for patients seen at our headache clinics from 2015 to 2019. Of 729 charts consecutively screened, 368met our inclusion criteria, that is, adult patients with CM with ≥1-year CM duration. The following variables were extracted from the included patient charts: MOH diagnosis, age, sex, migraine frequency, current CM duration, current cannabis use duration, overused acute migraine medications, current MOH duration, and types of cannabis products used. Logistic regression was used to identify variables predicting MOH while controlling for remaining predictors. Agglomerative hierarchical clustering (AHC) was conducted to explore natural clusters using all predictor variables.RESULTS: There were 212 patients with CM and MOH (cases; median age 43years, interquartile range [IQR] 33-54; 177 [83%] females) and 156 patients with CM without MOH (referents; median age 40years, IQR 31-49; 130 [83%] females). MOH was present in 81% (122/150) of current cannabis users compared with 41% (90/218) in those without cannabis use-adjusted odds ratio 6.3 (95% CI: 3.56 to 11.1, p< 0.0001). Current cannabis use was significantly associated with opioid use (Spearman's rho 0.26, p<0.0001). Both current cannabis use (rho 0.40, p<0.0001) and opioid use (rho 0.36, p<0.0001) were significantly associated with MOH. Similarly, AHC revealed two major natural clusters. Cluster I patients featured 9.3 times higher current cannabis use, 9.2 times higher current opioid use, and 1.8 times higher MOH burden than those in Cluster II (p<0.0001).CONCLUSION: Cannabis use was significantly associated with increased prevalence of MOH in CM. Bidirectional cannabis-opioid association was observed-use of one was associated with use of the other. Advising patients with CM and MOH to reduce cannabis use may help treat MOH effectively.

    View details for DOI 10.1111/head.14195

    View details for PubMedID 34370866

  • Headache outcomes of a sleep behavioral intervention in breast cancer survivors: Secondary analysis of a randomized clinical trial. Cancer Woldeamanuel, Y. W., Blayney, D. W., Jo, B., Fisher, S. E., Benedict, C., Oakley-Girvan, I., Kesler, S. R., Palesh, O. 2021


    BACKGROUND: Breast cancer survivors often have persisting headache. In a secondary analysis of the Brief Behavioral Therapy for Cancer-Related Insomnia (BBT-CI) clinical trial ( identifier NCT02165839), the authors examined the effects of BBT-CI on headache outcomes in patients with breast cancer.METHODS: Patients with breast cancer who were receiving chemotherapy were randomly assigned to receive either the BBT-CI intervention or the Healthy EAting Education Learning for healthy sleep (HEAL) control intervention, and both were delivered over 6 weeks by trained staff. Headache outcomes and heart rate variability (HRV) were measured at baseline, 6 weeks, 6 months, and 12 months. Mixed-effects models were used to examine longitudinal headache outcomes in the groups according to the intention to treat. Principal component analysis and agglomerative hierarchical clustering were conducted to reduce 16 variables for data-driven phenotyping.RESULTS: Patients in the BBT-CI arm (n = 73) exhibited a significant reduction in headache burden over time (P = .02; effect size [Cohen d] = 0.43), whereas the reduction was not significant among those in the HEAL arm (n = 66). The first principal component was positively loaded by headache, sleep, fatigue, and nausea/vomiting and was negatively loaded by cognitive, physical, and emotional functioning. Agglomerative hierarchical clustering revealed 3 natural clusters. Cluster I (n = 58) featured the highest burden of headache, insomnia, and nausea/vomiting; cluster II (n = 50) featured the lowest HRV despite a low burden of headache and insomnia; and cluster III (n = 31) showed an inverse relation between HRV and headache-insomnia, signifying autonomic dysfunction.CONCLUSIONS: BBT-CI is efficacious in reducing headache burden in breast cancer survivors. Patient phenotyping demonstrates a headache type featuring sleep disturbance, nausea/vomiting, and low physical functioning-revealing similarities to migraine.LAY SUMMARY: Breast cancer survivors often have persisting headache symptoms. In patients with cancer, treatment of chronic headache disorders using daily medications may be challenging because of drug interactions with chemotherapy and other cancer therapies as well as patients' reluctance to add more drugs to their medicine list. Headache and sleep disorders are closely related to each other. This study demonstrates that a sleep behavioral therapy reduced headache burden in breast cancer survivors. In addition, the majority of headache sufferers had a headache type with similarities to migraine-featuring sleep disturbance, nausea/vomiting, and low physical functioning.

    View details for DOI 10.1002/cncr.33844

    View details for PubMedID 34357593

  • Variable Diagnostic Performance of Stool Xpert in Pediatric Tuberculosis: A Systematic Review and Meta-analysis. Open forum infectious diseases Gebre, M., Cameron, L. H., Tadesse, G., Woldeamanuel, Y., Wassie, L. 2021; 8 (8): ofaa627


    Background: Difficult specimen collection and low bacillary load make microbiological confirmation of tuberculosis (TB) in children challenging. In this study, we conducted a systematic review and meta-analysis to assess the diagnostic accuracy of Xpert on stool for pediatric tuberculosis.Methods: Our search included studies from 2011 through 2019, and specific search terms were used to retrieve articles from Pubmed, EMBASE, BIOSIS,, and Google Scholar. Risk of bias was assessed using the QUADAS 2 tool. The protocol was registered in PROSPERO (CRD42018083637). Summary estimates of sensitivity and specificity were conducted using meta-disc Software assuming a random-effects model.Results: We identified 12 eligible studies, which included data from 2177 children, of whom 295 (13.6%) had bacteriologically confirmed TB on respiratory specimens. The pooled sensitivity of Xpert MTB/RIF on stool specimens compared with bacteriologically confirmed tuberculosis with respiratory specimens was 0.50 (95% CI, 0.44-0.56) with an I 2 of 86%, which was statistically significant (P < .001). The pooled specificity was 0.99 (95% CI, 0.98-0.99; I 2 = 0.0%; P = .44).Conclusions: Despite the observed heterogeneity, stool may be considered an additional specimen to support diagnosis of pulmonary TB in children, especially in settings where it is impossible to get respiratory samples. Further studies should evaluate its optimization as a diagnostic tool.

    View details for DOI 10.1093/ofid/ofaa627

    View details for PubMedID 34430668

  • ILLNESS MINDSETS, DEMOGRAPHIC AND MEDICAL FACTORS, AND HEALTH-RELATED QUALITY OF LIFE IN BREAST & GYNECOLOGIC CANCER SURVIVORS Zeidman, A., Benedict, C., Tolby, L., Zion, S., Fisher, S., Kurian, A. W., Berek, J. S., Woldeamanuel, Y., Schapira, L., Palesh, O. OXFORD UNIV PRESS INC. 2021: S266
  • Plasma Lipolysis and Changes in Plasma and Cerebrospinal Fluid Signaling Lipids Reveal Abnormal Lipid Metabolism in Chronic Migraine. Frontiers in molecular neuroscience Castor, K., Dawlaty, J., Arakaki, X., Gross, N., Woldeamanuel, Y. W., Harrington, M. G., Cowan, R. P., Fonteh, A. N. 2021; 14: 691733


    Background: Lipids are a primary storage form of energy and the source of inflammatory and pain signaling molecules, yet knowledge of their importance in chronic migraine (CM) pathology is incomplete. We aim to determine if plasma and cerebrospinal fluid (CSF) lipid metabolism are associated with CM pathology.Methods: We obtained plasma and CSF from healthy controls (CT, n = 10) or CM subjects (n = 15) diagnosed using the International Headache Society criteria. We measured unesterified fatty acid (UFA) and esterified fatty acids (EFAs) using gas chromatography-mass spectrometry. Glycerophospholipids (GP) and sphingolipid (SP) levels were determined using LC-MS/MS, and phospholipase A2 (PLA2) activity was determined using fluorescent substrates.Results: Unesterified fatty acid levels were significantly higher in CM plasma but not in CSF. Unesterified levels of five saturated fatty acids (SAFAs), eight monounsaturated fatty acids (MUFAs), five omega-3 polyunsaturated fatty acids (PUFAs), and five omega-6 PUFAs are higher in CM plasma. Esterified levels of three SAFAs, eight MUFAs, five omega-3 PUFAs, and three omega-6 PUFAs, are higher in CM plasma. The ratios C20:4n-6/homo-gamma-C20:3n-6 representative of delta-5-desaturases (D5D) and the elongase ratio are lower in esterified and unesterified CM plasma, respectively. In the CSF, the esterified D5D index is lower in CM. While PLA2 activity was similar, the plasma UFA to EFA ratio is higher in CM. Of all plasma GP/SPs detected, only ceramide levels are lower (p = 0.0003) in CM (0.26 ± 0.07%) compared to CT (0.48 ± 0.06%). The GP/SP proportion of platelet-activating factor (PAF) is significantly lower in CM CSF.Conclusions: Plasma and CSF lipid changes are consistent with abnormal lipid metabolism in CM. Since plasma UFAs correspond to diet or adipose tissue levels, higher plasma fatty acids and UFA/EFA ratios suggest enhanced adipose lipolysis in CM. Differences in plasma and CSF desaturases and elongases suggest altered lipid metabolism in CM. A lower plasma ceramide level suggests reduced de novo synthesis or reduced sphingomyelin hydrolysis. Changes in CSF PAF suggest differences in brain lipid signaling pathways in CM. Together, this pilot study shows lipid metabolic abnormality in CM corresponding to altered energy homeostasis. We propose that controlling plasma lipolysis, desaturases, elongases, and lipid signaling pathways may relieve CM symptoms.

    View details for DOI 10.3389/fnmol.2021.691733

    View details for PubMedID 34531722

  • Calcitonin Gene-Related Peptide Receptor Antagonists (Gepants) for the Acute Treatment of Nausea in Episodic Migraine: A Systematic Review and Meta-Analysis. Headache Chan, T. L., Cowan, R. P., Woldeamanuel, Y. W. 2020


    OBJECTIVE: To synthesize the evidence on the efficacy of calcitonin gene-related peptide receptor antagonists (gepants) from all clinical trials addressing nausea treatment for episodic migraine.INTRODUCTION: Nausea is one of the most bothersome symptoms in patients with migraine. The most bothersome symptom is part of the outcomes explored in clinical trials.METHODS: Published clinical trials for this project were identified via searches of 4 bibliographic databases: PubMed (includes MEDLINE), Embase, Web of Science, and the Cochrane Library. Individual search strategies included terms related to calcitonin gene-related peptide, nausea, and vomiting. Random-effects meta-analysis was conducted to estimate the overall efficacy of gepants for nausea treatment. Heterogeneity, publication bias, small-study bias, and potential confounders were explored using Galbraith plot, sensitivity analysis, meta-regression, and Egger's regression tests. Cumulative meta-analysis was done to detect temporal trend from accumulating trials.RESULTS: The meta-analysis involved 23,008 participants in 65 clinical trials from 14 published articles; 10,770 subjects participated in gepant treatment arms while 12,238 subjects participated in placebo or non-gepant arms (85% females, mean age 41years in both arms). Nearly all studies used a 2-hour incidence of nausea as an outcome measure. An overall combined effect size with an odds ratio of 1.29 (95% CI 1.18, 1.40, P=.001; I2 =42.8%) showed the efficacy of gepants for the treatment of nausea in episodic migraine. Galbraith plot demonstrated that 98.4% of studies were within 2 standard deviations from the regression line, indicating lack of significant heterogeneity and outliers. Meta-analysis results were robust to sensitivity analysis, small-study bias, and publication bias (Kendall's Tau -0.09, P=.29; Egger's regression P=.67). Meta-regression showed that both age and sex ratio were not confounding the meta-analysis (omnibus P=.69). Cumulative meta-analysis indicated that the effect size remained stable for studies conducted after 2011, with accumulating evidence continuing to favor efficacy of gepants for the treatment of nausea in episodic migraine.CONCLUSION: There is sufficient evidence to support the efficacy of gepants for the treatment of nausea in episodic migraine. Future research may focus on examining this efficacy in under-represented patient populations (males, older age groups) and in chronic migraine.

    View details for DOI 10.1111/head.13858

    View details for PubMedID 32515018

  • Clinical Predictors associated with Persistent versus Acute Post-Traumatic Headache Chan, L., Woldeamanuel, Y. LIPPINCOTT WILLIAMS & WILKINS. 2020
  • Exploring naturally occurring clinical subgroups of post-traumatic headache. The journal of headache and pain Chan, T. L., Woldeamanuel, Y. W. 2020; 21 (1): 12


    To explore naturally occurring clinical subgroups of post-traumatic headache.Persistent post-traumatic headache (PTH) is defined as a headache developing within 7 days of an injury that lasts for greater than 3 months. However, there is no evidence available from the International Classification of Headache Disorders (ICHD) based classification between persistent and acute PTH based on clinical phenotypes.We conducted a retrospective study using the Stanford Research Repository Cohort Discovery Tool. We reviewed 500 electronic patient charts between January 2015 to September 2019 using inclusion criteria of adults older than 18 years with a diagnosis of PTH. The following variables were extracted from each patient's chart: diagnosis of PTH as dependent variable, and predictor variables as age, sex, history of migraine, loss of consciousness during head injury, pre-existing psychological history, duration of PTH and new PTH-associated comorbidities (e.g. new onset vertigo, post-traumatic stress disorder). Logistic regression was employed to identify clinical phenotypes predicting persistent PTH. All predictor variables were tested in one block to determine their predictive capacity while controlling for other predictors in the model. Two-step cluster analysis was conducted to identify naturally occurring PTH subgroups.A total of 300 patients were included (150 acute, 150 persistent PTH) with a median age of 47 years (IQR 31, 59) and female: male ratio of 2.7:1. Two hundred patients were excluded due to misdiagnoses. Pre-existing psychological history (standardized beta 0.16), history of migraine (0.20), new PTH-associated comorbidities (0.23) and medication overuse (0.37) statistically significantly predicted the presence of persistent PTH (p <  0.0001). Clustering analysis revealed PTH subgrouping comparable to ICHD-based classification: 140 patients in Cluster 1 (76% persistent PTH) and 160 patients in Cluster 2 (83% acute PTH). Four distinct clusters were found within persistent PTH.Pre-existing psychological history, history of migraine, new PTH-associated comorbidities and medication overuse predicted the occurrence of persistent PTH as well as two naturally occurring PTH clusters correlating to acute and persistent PTH. Management emphasis should focus on these phenotypes.

    View details for DOI 10.1186/s10194-020-1080-2

    View details for PubMedID 32033526

    View details for PubMedCentralID PMC7006085

  • Plasma lipid metabolism exemplifies the interoceptive nature of chronic migraine. Experimental Biology 2020 Meeting Fonteh, A. N., Castor, K., Arakaki, X., Woldeamanuel, Y. W., Cowan, R., Harrington, M. 2020
  • Endogenous Glucocorticoids may be Potential Biomarkers for Migraine Chronification Woldeamanuel, Y. W., Sanjanwala, B. M., Cowan, R. P. SAGE PUBLICATIONS LTD. 2019: 379–80
  • Aberrant Structural Network Architecture in Chronic Migraine DeSouza, D. D., Woldeamanuel, Y. W., Sanajanwala, B. M., Bissell, D., Bishop, J. H., Cowan, R. P. SAGE PUBLICATIONS LTD. 2019: 392
  • Exploring Natural Cohorts of Chronic Migraine Phenotype Woldeamanuel, Y., Sanjanwala, B., Peretz, A., Cowan, R. LIPPINCOTT WILLIAMS & WILKINS. 2019
  • Altered structural brain network topology in chronic migraine. Brain structure & function DeSouza, D. D., Woldeamanuel, Y. W., Sanjanwala, B. M., Bissell, D. A., Bishop, J. H., Peretz, A. n., Cowan, R. P. 2019


    Despite its prevalence and high disease burden, the pathophysiological mechanisms underlying chronic migraine (CM) are not well understood. As CM is a complex disorder associated with a range of sensory, cognitive, and affective comorbidities, examining structural network disruption may provide additional insights into CM symptomology beyond studies of focal brain regions. Here, we compared structural interconnections in patients with CM (n = 52) and healthy controls (HC) (n = 48) using MRI measures of cortical thickness and subcortical volume combined with graph theoretical network analyses. The analysis focused on both local (nodal) and global measures of topology to examine network integration, efficiency, centrality, and segregation. Our results indicated that patients with CM had altered global network properties that were characterized as less integrated and efficient (lower global and local efficiency) and more highly segregated (higher transitivity). Patients also demonstrated aberrant local network topology that was less integrated (higher path length), less central (lower closeness centrality), less efficient (lower local efficiency) and less segregated (lower clustering). These network differences not only were most prominent in the limbic and insular cortices but also occurred in frontal, temporal, and brainstem regions, and occurred in the absence of group differences in focal brain regions. Taken together, examining structural correlations between brain areas may be a more sensitive means to detect altered brain structure and understand CM symptomology at the network level. These findings contribute to an increased understanding of structural connectivity in CM and provide a novel approach to potentially track and predict the progression of migraine disorders.This study is registered on (Identifier: NCT03304886).

    View details for DOI 10.1007/s00429-019-01994-7

    View details for PubMedID 31792696

  • Importance of Controlling for Comorbidities in Migraine Association Studies. Pain medicine (Malden, Mass.) Woldeamanuel, Y. W. 2019

    View details for DOI 10.1093/pm/pnz286

    View details for PubMedID 31665512

  • Obesity-Related Cortical Thickness Changes in Chronic Migraine Woldeamanuel, Y. W., DeSouza, D. D., Sanjanwala, B. M., Cowan, R. P. WILEY. 2018: S83
  • Age-related Cortical Thickness Changes in Chronic Migraine Woldeamanuel, Y. W., DeSouza, D. D., Sanjanwala, B. M., Cowan, R. P. WILEY. 2018: 1292
  • Altered Permeability Of The Blood-CSF Barrier In Chronic Migraine Gross, N. B., Sweeney, M., Sagare, A., Zlokovic, B., Castor, K., Fonteh, A. N., Arakaki, X., Woldeamanuel, Y. W., Cowan, R. P., Harrington, M. G. FEDERATION AMER SOC EXP BIOL. 2018
  • Dysfunctional Plasma Lipid Metabolism Contributes to Chronic Migraine Pathology Experimental Biology 2018 Meeting Fonteh, A. N., Castor, K., Kershaw, K., Im, E. J., Dawlaty, J., Gross, N., Arakaki, X., Woldeamanuel, Y., Harrington, M., Cowan, R. 2018: 767.14–767.14
  • Headache Due to Infections and Disorders of Homeostasis Modern Day Management of Headache: Questions and Answers Woldeamanuel, Y. W. Jaypee Brothers Medical Publishers (P) Ltd. . 2017 ; 1st: 291–301
  • Headache Secondary to Nonvascular Intracranial Disorders Modern Day Management of Headache: Questions and Answers Woldeamanuel, Y. W. Jaypee Brothers Medical Publishers (P) Ltd.. 2017; 1st : 280–290
  • Journal Club: Change in brain network connectivity during PACAP38-induced migraine attacks. Neurology DeSouza, D. D., O'Hare, M., Woldeamanuel, Y. W., Cowan, R. P. 2016; 87 (16): e199-e202

    View details for PubMedID 27754916

  • Journal Club: Exacerbation of headache during dihydroergotamine for chronic migraine does not alter outcome. Neurology Woldeamanuel, Y. W., O'Hare, M., DeSouza, D. D., Cowan, R. P. 2016; 87 (16): e196-e198


    Transient headache exacerbation during IV dihydroergotamine (DHE) therapy of migraine may prompt clinicians to prematurely discontinue DHE therapy, potentially depriving patients of the full benefit of DHE infusion. In a recent Neurology® article, Eller et al. evaluated whether or not worsening headache during DHE infusion was associated with suboptimal medium-term headache outcomes.

    View details for PubMedID 27754915

  • Case fatality of adult tetanus in Africa: Systematic review and meta-analysis. Journal of the neurological sciences Woldeamanuel, Y. W., Andemeskel, A. T., Kyei, K., Woldeamanuel, M. W., Woldeamanuel, W. 2016; 368: 292-299


    Tetanus is a continued public health neuroinfectious burden in Africa; it accounts for significant proportion of lengthy intensive care unit (ICU) and hospital admissions.This study aimed to describe the pooled case-fatality rates of adult tetanus at African hospitals along with relevant discussions and recommendations.A systematic review using advanced search strategies employing PubMed/MEDLINE and Web of Science inclusive of gray literature handsearch was conducted for facility-based studies on adult tetanus by combining the terms "tetanus", "Africa" spanning all previous years until January 15, 2016. PRISMA and MOOSE guidelines were followed. Studies from non-African countries and studies on neonatal and childhood tetanus were excluded. A meta-analysis with fixed- and random-effects model was performed to identify pooled migraine prevalence. Inter-study heterogeneity was analyzed employing I Oshinaike et al. (2012) (inconsistency).Twenty-seven studies involving 3043 patients were included. Median age was 33.7years (IQR 30-36). Median female to male ratio was 0.5. The geographic distribution of the studies was as follows: 15 (55.5%) studies were from Nigeria, 7 (26%) from Ethiopia, and the remaining single-centered studies were from Ghana (1; 3.7%), Uganda (1; 3.7%), Senegal (1; 3.7%), Democratic Republic of Congo (1; 3.7%), and Tanzania (1; 3.7%). The majority (88%) of the studies were from tertiary specialized or teaching university hospital settings.Median duration of the study period was 6.5years (IQR 4-9.25). Pooled crude tetanus case-fatality rate was found to be 43.2% (95% CI 36.9%-49.5%) on random-effects meta-analysis and 45.5% (95% CI 43.7%-47.2%) on fixed-effects meta-analysis. There was considerable inter-study heterogeneity. A time-series observation did not reveal a trend of decreasing case-fatality rates. Leading causes of death were complications from dysautonomia, aspiration pneumonia, hypoxemia, and sepsis (in descending order). Longer incubation period and longer onset time were associated with lower fatality; the further the wound site from the head, the longer the incubation period. Mechanical ventilation was not available in 26% of the studies; where available, mechanical ventilation and ICU admission was not utilized among most of the cases as the patients could not afford ICU care costs.Despite declining tetanus incidence rates, case-fatality is still high in African care facilities. High rates of tetanus case fatality indicate lower quality of medical care at hospital settings.Most common causes of death are complication arising from dysautonomia and respiratory arrest secondary to laryngospasm. These can be prevented by potent medications and mechanical ventilation; where resources are lacking, nursing in darker and quieter rooms have been proven to be efficacious in reducing the frequency of spasms.

    View details for DOI 10.1016/j.jns.2016.07.025

    View details for PubMedID 27538652

  • Indomethacin Responsive Headaches: Exhaustive Systematic Review With Pooled Analysis and Critical Appraisal of 81 Published Clinical Studies HEADACHE Bordini, E. C., Bordini, C. A., Woldeamanuel, Y. W., Rapoport, A. M. 2016; 56 (2): 422-435


    The relationship between indomethacin (IMC) and headache treatment has long intrigued clinicians and clinical researchers in Headache Medicine. Why is it efficacious in many types of headache disorders when other medications are not, and what is the mechanism behind its efficacy? IMC and headache related topics that have been explored in detail in the literature include IMC-responsive headache disorders ("traditional"), pharmacology of IMC, symptomatic headaches responsive to IMC, "novel" headache conditions that respond, cluster headache and IMC, IMC provoking headache, the issue about" absolute" and "non-absolute" effect of IMC on headache disorders, and the morphing trigeminal autonomic cephalalgias (TACs).A PubMed/MEDLINE search was used for Clinical Studies Categories and Systematic Reviews on the PubMed Clinical Queries. The search details were "indomethacin" AND "headache" spanning all previous years until February 1, 2015. Methods were in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Articles were excluded if IMC had not been used to treat headache disorders in adults, if the article concerned IMC-responsive headaches but made no reference to the use of IMC, and articles not addressing the above mentioned topics.The "velocity" of publications on IMC and headache seems to be decreasing, particularly on the use of IMC for the treatment of TACs. The science behind the understanding of the putative mechanisms of IMC's action on headache has moved forward, but the answer to why it works better than other nonsteroidal anti-inflammatory drugs has been elusive. There are case reports of other rare headache disorders that may be responsive to IMC. The dosages of IMC used as a tool for detecting IMC responsive disorders vary according to different centers of investigation. In many circumstances, headache disorders similar to "primary" IMC-responsive disorders are actually symptomatic disorders. Cluster headache as an IMC-resistant headache disorder may not be as absolute as once thought. Sometimes, IMC has been found to provoke headache; differentiating IMC-provoked headache from IMC-resistant headache can make headache diagnosis and management difficult. As for the "absolute" responsiveness of IMC, it is possible that using higher dosages leads to higher sensitivity, probably at the expense of decreased specificity. There are many reports about the occurrence of two or more IMC-responsive disorders (latu sensu) in the same patient, which may be coincidental.

    View details for DOI 10.1111/head.12771

    View details for Web of Science ID 000371076900022

    View details for PubMedID 26853085

  • Spontaneous extracranial hemorrhagic phenomena in primary headache disorders: A systematic review of published cases. Cephalalgia Peretz, A. M., Woldeamanuel, Y. W., Rapoport, A. M., Cowan, R. P. 2015


    Head pain is a cardinal feature of primary headache disorders (PHDs) and is often accompanied by autonomic and vasomotor symptoms and/or signs. Spontaneous extracranial hemorrhagic phenomena (SEHP), including epistaxis, ecchymosis, and hematohidrosis (a disorder of bleeding through sweat glands), are poorly characterized features of PHDs.To critically appraise the association between SEHP and PHDs by systematically reviewing and pooling all reports of SEHP associated with headaches.Advanced searches using the PubMed/MEDLINE, Web of Science, Cochrane Library, Google Scholar, and ResearchGate databases were carried out for clinical studies by combining the terms "headache AND ecchymosis", "headache AND epistaxis", and "headache AND hematohidrosis" spanning all medical literature prior to October 10, 2015. Preferred Reporting Items for Systematic Reviews and Meta-analyses and Meta-analysis of Observational Studies in Epidemiology guidelines were applied.A total of 105 cases of SEHP associated with PHDs (83% migraine and 17% trigeminal autonomic cephalgias) were identified (median age 27 years, male to female ratio 1:2.3); 63% had epistaxis, 33% ecchymosis, and 4% hematohidrosis. Eighty-three percent of studies applied the International Classification of Headache Disorders diagnostic criteria. Eighty percent of the reported headaches were episodic and 20% were chronic. Twenty-four percent of studies reported recurrent episodes of SEHP.Our results suggest that SEHP may be rare features of PHDs. Future studies would benefit from the systematic characterization of these phenomena.

    View details for PubMedID 26611681

  • Primary Headaches as a Cause of Non-traumatic Ecchymosis: a 120-Year Systematic Review and Pooled Analysis of Published Case Studies American Academy of Neurology, 67th Annual Meeting Peretz, A., Woldeamanuel, Y., Cowan, R. 2015
  • The Impact of Regular Lifestyle Behaviour in Migraine: a Prevalence Case-Referent Study from a Quaternary Headache Clinical Centre. International Headache Congress Woldeamanuel, Y. W., Cowan, R. P. 2015

    View details for DOI 10.1177/0333102415581304

  • What is the evidence for the use of corticosteroids in migraine? Current pain and headache reports Woldeamanuel, Y. W., Rapoport, A. M., Cowan, R. P. 2014; 18 (12): 464


    Corticosteroids are widely prescribed for the management of migraine attacks. The earliest clinical studies examining the efficacy of corticosteroid monotherapy for managing migraine attacks date back to 1952. Since then, 26 heterogeneous clinical studies and four meta-analyses have been conducted to assess the efficacy of corticosteroids in either aborting acute migraine attacks, prolonged migraine attacks or recurrent headaches. Most of these (86 %) studies employed different comparator arms with corticosteroids monotherapy administration while some studies (14 %) evaluated adjunctive corticosteroid therapy. The majority of these clinical studies revealed the superior efficacy of corticosteroids as mono- or adjunctive-therapy both for recurrent and acute migraine attacks, while the remaining showed non-inferior efficacy. Different forms of oral and parenteral corticosteroids in either single-dose or short-tapering schedules are prescribed; there are clinical studies supporting the efficacy of both methods. Corticosteroids can be administered safely up to six times annually. Corticosteroids are also useful in managing patients who frequent emergency departments with "medication-seeking behavior." Migraine patients with refractory headaches, history of recurrent headaches, severe baseline disability, and status migrainosus were found to have the most beneficial response from corticosteroid therapy.

    View details for DOI 10.1007/s11916-014-0464-x

    View details for PubMedID 25373608

  • Sensory, psychological, and metabolic dysfunction in HIV-associated peripheral neuropathy: A cross-sectional deep profiling study PAIN Phillips, T. J., Brown, M., Ramirez, J. D., Perkins, J., Woldeamanuel, Y. W., Williams, A. C., Orengo, C., Bennett, D. L., Bodi, I., Cox, S., Maier, C., Krumova, E. K., Rice, A. S. 2014; 155 (9): 1846-1860


    HIV-associated Sensory Neuropathy (HIV-SN) is a frequent complication of HIV infection and a major source of morbidity. A cross-sectional deep profiling study examining HIV-SN was conducted in people living with HIV in a high resource setting, using a battery of measures which included: parameters of pain and sensory symptoms (7 day pain diary, Neuropathic Pain Symptom Inventory (NPSI) and Brief Pain Inventory (BPI)), sensory innervation (structured neurological examination, quantitative sensory testing (QST) and intra-epidermal nerve fibre density (IENFD)), psychological state (Pain Anxiety Symptoms Scale-20 (PASS-20), Depression Anxiety and Positive Outlook Scale (DAPOS), and Pain Catastrophizing Scale (PCS), insomnia (Insomnia Severity Index (ISI)) and quality of life (Short-Form (36) Health Survey (SF-36)). The diagnostic utility of the Brief Peripheral Neuropathy Screen (BPNS), Utah Early Neuropathy Scale (UENS) and Toronto Clinical Scoring System (TCSS) were evaluated. Thirty-six healthy volunteers and 66 HIV infected participants were recruited. A novel triumvirate case definition for HIV-SN was used which required two out of three of the following: two or more abnormal QST findings, reduced IENFD and signs of a peripheral neuropathy on a structured neurological examination. Of those with HIV, 42% fulfilled the case definition for HIV-SN (n=28), of whom 75% (n=21) reported pain. The most frequent QST abnormalities in HIV-SN were loss of function in mechanical and vibration detection. Structured clinical examination was superior to QST or IENFD in HIV-SN diagnosis. HIV-SN participants had higher plasma triglyceride concentrations depression, anxiety and catastrophizing scores and prevalence of insomnia than HIV participants without HIV-SN.

    View details for DOI 10.1016/j.pain.2014.06.014

    View details for Web of Science ID 000341873000021

    View details for PubMedID 24973717

  • Contributing towards the betterment of translational epilepsy research in Africa: needs, challenges, resources, and opportunities. Current neurology and neuroscience reports Woldeamanuel, Y. W., Girma, B. 2014; 14 (8): 480-?


    Epilepsy affects approximately 50 million people worldwide. Among them, at least 40 million people are currently living in the developing world, where resources and standards of care are suboptimal. Around 90 % of people with epilepsy in resource-poor countries do not currently receive appropriate treatments, at a time when two thirds of these patients could have achieved good control of their epileptic seizures had they had access to appropriate therapies. Scarcity of epilepsy specialists, poor availability or access to diagnostic facilities and treatments, poor community knowledge about epilepsy-related issues, stigma, and other societal and cultural barriers are only some of the issues contributing to this deficiency. These issues in epilepsy treatment have been well recognized, and ongoing concerted efforts to address them have been undertaken by both local authorities and international organizations. In many cases, patients resort to the use of traditional local and alternative medicines (herbs, religious practices, etc.) that are closer to indigenous cosmovision, are more holistic, and are more culture-friendly, preserving an optimum subtlety of Afrocentric character shading. Compared with imported Western medicines, patients find these approaches to be more relevant to their ways of thinking, their ways of being, and their belief systems, more accessible, and more acceptable methods of dealing with health and disease states. The impressive local wealth in these natural resources has established them as a preferred source of healing in these regions, but has also fueled interest in exploring their therapeutic potential in the very few existing local research centers. In this review, we discuss the known issues related to the epilepsy treatment gap in resource-poor regions, focusing in particular on African countries, introduce the role and issues related to the use and validation of alternative medical therapies in epilepsy, and comment on the importance and repercussions of initiatives to validate such therapies, primarily for local practices, but also for possible wider international applications.

    View details for DOI 10.1007/s11910-014-0480-6

    View details for PubMedID 25005223

  • A 43-year systematic review and meta-analysis: case-fatality and risk of death among adults with tuberculous meningitis in Africa JOURNAL OF NEUROLOGY Woldeamanuel, Y. W., Girma, B. 2014; 261 (5): 851-865


    Tuberculous meningitis (TBM) is a preventable and curable common health problem among African adults. Poor nutrition, poverty, household crowding, drug resistant tuberculosis (TB) strains, AIDS, and malfunctioning TB control programs are important risk factors. We conducted a systematic review and meta-analysis of published literature reporting case-fatalities of TBM among adults in African countries from 1970 till date. A PubMed search identified relevant papers. Employed terms include 'adult tuberculous meningitis' AND 'tuberculosis Africa'. PRISMA review guidelines were applied. Adult TBM case-fatalities, odds ratio (OR), relative risk (RR), forest-plot meta-analysis for weighted OR and RR, funnel plots, L'Abbé plots, meta-regressed bubble plots, and inter-study homogeneity were computed. Among 15 studies included, adult TBM occurred in up to 28 % of all meningitis forms with case-fatality of 60 % (inverse-variance weighted 54 %). Fixed-effect meta-analysis revealed weighted OR and RR of adult TBM fatalities to be 4.37 (95 % CI 3.92, 4.88) and 2.53 (95 % CI 2.38, 2.69), respectively. Inter-study homogeneity was reliable, regional representativeness was adequate allowing generalizability, and funnel-plots behaved symmetrically with insignificant inconsistency. All cases were initiated with anti-TB medication, while some had 'breakthrough' TBM. In Africa, adult TBM has a significant public health importance with a very high fatality which has remained stagnant for the past half-century. This reflects ongoing low quality of medical care at facilities where lengthy referrals end up. Community-based studies can reveal higher unaccounted morbidity, accrued disability, and larger mortality. Improving access points for early TB management at community-level, developing health infra-structure for comprehensive case management at facility-level, and poverty reduction can help combat this multi-faceted problem-whose reduction can in return help fight poverty.

    View details for DOI 10.1007/s00415-013-7060-6

    View details for Web of Science ID 000335772500001

    View details for PubMedID 23963469

  • The Socioeconomic and Neurological Burden of Neurolathyrism in Ethiopia - the saga continues Cassava Cyanide Diseases and Neurolathyrism Network News Woldeamanuel, Y. W. 2014: 3-6
  • EHMTI-0318. The place of corticosteroids in migraine attack management: systematic review and critical appraisal Abstracts from the 4th European Headache and Migraine Trust International Congress: EHMTIC 2014 Woldeamanuel, Y. W., Rapoport, A. M., Cowan, R. P. 2014: G42
  • Tetanus Weighs on Neurological Burden in Ethiopia WORLD NEUROLOGY Woldeamanuel, Y. W., Hassan, A. 2010; 25 (5): 14