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Serum C-Reactive Protein/ Albumin Ratio in the Initial Evaluation of Patients with Migraine Attack Presented to the Emergency Department. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2020. [DOI: 10.21673/anadoluklin.756421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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102
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Hansson-Hedblom A, Axelsson I, Jacobson L, Tedroff J, Borgström F. Economic consequences of migraine in Sweden and implications for the cost-effectiveness of onabotulinumtoxinA (Botox) for chronic migraine in Sweden and Norway. J Headache Pain 2020; 21:99. [PMID: 32787820 PMCID: PMC7424684 DOI: 10.1186/s10194-020-01162-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/17/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Migraine is a common and incapacitating condition, with severe impact on the quality of life (QoL) of the afflicted and their families, and negative economic consequences through decreased workforce participation, reduced functional ability and elevated healthcare costs. This study aimed to describe the economic consequences of migraine in Sweden using cost of illness survey data and, based on this data, assess the cost-effectiveness of onabotulinumtoxinA (Botox) for the treatment of chronic migraine in Sweden and Norway. METHODS A survey study was conducted in Swedish migraine patients, with questions on patient characteristics, headache frequency and severity, effect on daily activities and work, QoL, health resource utilization, and medication use. Resulting costs were estimated as annual averages over subgroups of average monthly headache days. Some results were used to inform a Markov cost-effectiveness chronic migraine model. The model was adapted to Sweden and Norway using local data. The analysis perspective was semi-societal. Results' robustness was tested using one-way, structural, and probabilistic sensitivity analyses. RESULTS Results from the cost of illness analysis (n = 454) indicated a clear correlation between decreased QoL and increased costs with increasing monthly headache days. Total annual costs ranged from EUR 6221 in patients with 0-4 headache days per month, to EUR 57,832 in patients with 25-31. Indirect costs made up the majority of costs, ranging from 82% of total costs in the 0-4 headache days group, to 91% in 25-31 headache days. The cost-effectiveness analyses indicated that in Sweden, Botox was associated with 0.223 additional QALYs at an additional cost of EUR 4126 compared to placebo, resulting in an incremental cost-effectiveness ratio (ICER) of EUR 18,506. In Norway, Botox was associated with 0.216 additional QALYs at an additional cost of EUR 4301 compared to placebo, resulting in an ICER of EUR 19,954. CONCLUSIONS In people with migraine, an increase in monthly headache days is clearly related to lower QoL and higher costs, indicating considerable potential costs-savings in reducing the number of headache days. The main cost driver for migraine is indirect costs. Botox reduces headache days and is a cost-effective treatment for chronic migraine in Sweden and Norway.
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103
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Irimia P, Garrido-Cumbrera M, Santos-Lasaosa S, Braçe O, Colomina I, Blanch C, Pozo-Rosich P. Estimating the savings associated with a migraine-free life: results from the Spanish Atlas. Eur J Neurol 2020; 27:2616-2624. [PMID: 32643853 DOI: 10.1111/ene.14431] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 07/01/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Migraine is a common and costly neurological disorder. The aims of this study were to quantify the costs of chronic (CM) and episodic migraine (EM) in Spain, evaluating the impact of psychiatric comorbidities and disability, and to estimate the economic savings associated with reducing the number of migraine-days by 50%. METHODS This was an observational, cross-sectional analysis of data from migraine patients who participated in the Spanish Migraine Atlas. The participants were invited to complete a structured questionnaire including the following scales: the Headache Needs Assessment, the Hospital Anxiety and Depression Scale, and the Migraine Disability Assessment Scale (MIDAS). RESULTS A total of 475 patients were included, of whom 187 had CM (39.4%). Total costs per patient/year were: €16 578.2 ± €34 568.1 for CM and €6227.8 ± €6515.7 for EM. A higher degree of disability, according to MIDAS, significantly increased the total cost of migraine, while the presence of psychiatric comorbidity increased costs for EM patients only. A reduction of 1 migraine-day per month decreased average total costs by €744.14 per patient/year for EM and €663.20 per patient/year for CM, while a reduction in the number of migraine-days by 50% would result in economic savings of €2232.44 per patient/year (R2 = 0.927) for EM and €6631.99 per patient/year (R2 = 0.886) for CM. CONCLUSIONS The costs associated with migraine were driven by migraine frequency and the degree of disability, whereas psychiatric comorbidity only influenced the cost of EM. These results highlight the need to optimize migraine management to reduce the economic migraine burden. Future studies are needed to confirm our results.
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Affiliation(s)
- P Irimia
- Neurology Department, Clínica Universidad de Navarra, Pamplona, Spain.,Navarra's Health Research Institute (IDISNA), Pamplona, Spain.,Headache Study Group of the Spanish Neurological Society (GECSEN), Madrid, Spain
| | - M Garrido-Cumbrera
- Health and Territory Research (HTR), Universidad de Sevilla, Sevilla, Spain
| | - S Santos-Lasaosa
- Headache Study Group of the Spanish Neurological Society (GECSEN), Madrid, Spain.,Neurology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.,Instituto de Investigación Sanitaria IIS Aragón, Zaragoza, Spain
| | - O Braçe
- Health and Territory Research (HTR), Universidad de Sevilla, Sevilla, Spain
| | - I Colomina
- President of the Spanish Patient's Association of Migraine and Headache (AEMICE), Madrid, Spain
| | - C Blanch
- Market Access, Novartis, Barcelona, Spain
| | - P Pozo-Rosich
- Headache Study Group of the Spanish Neurological Society (GECSEN), Madrid, Spain.,Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Headache Research Group, VHIR, Universitat Autónoma de Barcelona, Barcelona, Spain
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104
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Asawavichienjinda T, Imruetaijaroenchoke W, Phanthumchinda K. Thai-version Migraine Disability Assessment (MIDAS) questionnaire: concurrent validity, test-retest reliability, internal consistency, and factors predictive for migraine-related disability. ASIAN BIOMED 2020; 14:139-150. [PMID: 37551384 PMCID: PMC10373388 DOI: 10.1515/abm-2020-0021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Background A Thai-version of the Migraine Specific Quality of Life Questionnaire (MSQ 2.1) is available, but a qualified questionnaire used specifically for disability assessment was not available. The most relevant practical disability assessment tested during this study was the Migraine Disability Assessment (MIDAS) Questionnaire. Objectives To test the concurrent validity, test-retest reliability, and internal consistency of a Thai-version MIDAS questionnaire, and factors to predict disability in people with migraine. Methods We conducted the present prospective study at a tertiary care teaching hospital in Bangkok. The original English MIDAS Questionnaire was translated into Thai with back-translation into English and the language equivalence was assessed. The Thai-version MIDAS Questionnaire was tested for concurrent validity, test-retest reliability, and internal consistency, and factors including duration of migraine history, migraine characteristics, and comorbidity were assessed for the ability to predict migraine-related disability of migraineurs. Results Of the 58 participants, 31 were eligible to be included. The validity of the Thai-version questionnaire between the MIDAS total score and the mean headache severity (question B), the mean pain duration per attack, and the mean pain numerical rating scale (NRS) score were moderately correlated with a Spearman correlation coefficient range 0.42-0.58. The test-retest reliability of MIDAS grade had a weighted κ of 0.66, and for individual questions of the MIDAS total score, questions A and B assessed by intraclass correlation coefficients ranged 0.89-0.98. The internal consistency had a Cronbach α of 0.98. The mean pain NRS score in the past 3 months was an independent predictive factor for migraine-related disability. Conclusion The Thai-version MIDAS Questionnaire has moderate concurrent validity, acceptable internal consistency, and excellent test-retest reliability. It would be helpful to assess clinical outcomes. Future study with a standardized translation process for the Thai-version questionnaire and a larger sample size is warranted to confirm internal consistency and determine all probable predictive factors for migraine-related disability.
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Affiliation(s)
- Thanin Asawavichienjinda
- Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok10330, Thailand
| | - Warangkana Imruetaijaroenchoke
- Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok10330, Thailand
| | - Kammant Phanthumchinda
- Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok10330, Thailand
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Qin ZX, Su JJ, He XW, Zhu Q, Cui YY, Zhang JL, Wang MX, Gao TT, Tang W, Hu Y, Liu YS, Qiao Y, Liu JR, Li JQ, Du XX. Altered resting-state functional connectivity between subregions in the thalamus and cortex in migraine without aura. Eur J Neurol 2020; 27:2233-2241. [PMID: 32562320 DOI: 10.1111/ene.14411] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/14/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE Migraine is a complex and disabling neurological disorder, the exact neurological mechanisms of which remain unclear. The thalamus is considered to be the hub of the central processing and integration of nociceptive information, as well as the modulation of these processes. METHODS A total of 48 migraineurs without aura (MWoAs) during the interictal phase and 48 age- and sex-matched healthy controls underwent resting-state functional magnetic resonance imaging scans. We utilized masked independent component analysis and seed-based functional connectivity (FC) to investigate whether MWoAs exhibited abnormal FC between subregions in the thalamus and the cortex regions. RESULTS The MWoAs showed significantly weaker FC between the anterior dorsal thalamic nucleus and left precuneus. Additionally, MWoAs exhibited significantly reduced FC between the ventral posterior nucleus (VPN) and left precuneus, right inferior parietal lobule (R-IPL) and right middle frontal gyrus. Furthermore, the FC Z-scores between the VPN and R-IPL were negatively correlated with pain intensity in MWoAs. The disease duration of patients was negatively correlated with the FC Z-scores between the VPN and R-IPL. CONCLUSION These altered thalamocortical connectivity patterns may contribute to multisensory integration abnormalities, deficits in pain attention, cognitive evaluation and pain modulation. Pain sensitivity and disease duration are closely tied to abnormal FC between the VPN and R-IPL. Remarkably, recurrent headache attacks might contribute to this maladaptive functional plasticity closely related to pain intensity.
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Affiliation(s)
- Z X Qin
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, Shanghai
| | - J J Su
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - X W He
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Q Zhu
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, Shanghai
| | - Y Y Cui
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, Shanghai
| | - J L Zhang
- Clinical Science, Philips Healthcare, Shanghai
| | - M X Wang
- College of Medical Imaging, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - T T Gao
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, Shanghai
| | - W Tang
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, Shanghai
| | - Y Hu
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Y S Liu
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Y Qiao
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - J R Liu
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - J Q Li
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, Shanghai
| | - X X Du
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, Shanghai
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Torres-Ferrus M, Gallardo VJ, Alpuente A, Pozo-Rosich P. Influence of headache pain intensity and frequency on migraine-related disability in chronic migraine patients treated with OnabotulinumtoxinA. J Headache Pain 2020; 21:88. [PMID: 32652924 PMCID: PMC7353810 DOI: 10.1186/s10194-020-01157-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 07/06/2020] [Indexed: 02/08/2023] Open
Abstract
Background There is a need to establish which are the more relevant headache-related outcomes that have an impact on our patient’s lives to accurately evaluate treatment response in daily clinical practice. Objective The aim of this study was to evaluate the relevance of clinical trial endpoints in clinical real-life disability improvement in response to migraine preventive treatment with OnabotulinumtoxinA. Methods This is an observational prospective study. We included patients with chronic migraine fulfilling ICHD-3beta/3 criteria. We prospectively collected data of 8 headache-related and acute medication use endpoints recommended by the Guidelines of the International Headache Society for controlled trials of preventive treatment of chronic migraine. We evaluated their impact on disability improvement after 6 months of treatment with OnabotulinumtoxinA. We defined as a responder in disability, patients with ≥50% MIDAS score reduction after 2 cycles of treatment following PREEMPT protocol. We performed an analysis to measure the impact of improvement in the evaluated outcome measures according to perceived disability in clinical practice. Results We included 395 patients (85.1% women, mean age 46.7 ± 12.6 years). Mean headache frequency at baseline was 26.5 ± 5.2 headache days/month. After 6 months, 49.1% of patients were headache-related disability responders. From all outcome measures collected, variables independently associated to disability improvement were headache days reduction (p = 0.02) and ≥ 50% pain intensity reduction (p = 0.04). A ≥ 50% reduction in headache frequency or pain intensity showed similar influence on disability improvement after treatment. Conclusions Headache pain intensity is as important as frequency when evaluating the clinical response and impact on patient headache-related disability after migraine preventive treatment with OnabotulinumtoxinA.
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Affiliation(s)
- Marta Torres-Ferrus
- Headache and Craniofacial Pain Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Victor José Gallardo
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Alicia Alpuente
- Headache and Craniofacial Pain Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Patricia Pozo-Rosich
- Headache and Craniofacial Pain Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain. .,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Barcelona, Spain.
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Masson R, Lévêque Y, Demarquay G, ElShafei H, Fornoni L, Lecaignard F, Morlet D, Bidet-Caulet A, Caclin A. Auditory attention alterations in migraine: A behavioral and MEG/EEG study. Clin Neurophysiol 2020; 131:1933-1946. [PMID: 32619799 DOI: 10.1016/j.clinph.2020.05.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 04/14/2020] [Accepted: 05/05/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To evaluate alterations of top-down and/or bottom-up attention in migraine and their cortical underpinnings. METHODS 19 migraineurs between attacks and 19 matched control participants performed a task evaluating jointly top-down and bottom-up attention, using visually-cued target sounds and unexpected task-irrelevant distracting sounds. Behavioral responses and magneto- and electro-encephalography signals were recorded. Event-related potentials and fields were processed and source reconstruction was applied to event-related fields. RESULTS At the behavioral level, neither top-down nor bottom-up attentional processes appeared to be altered in migraine. However, migraineurs presented heightened evoked responses following distracting sounds (orienting component of the N1 and Re-Orienting Negativity, RON) and following target sounds (orienting component of the N1), concomitant to an increased recruitment of the right temporo-parietal junction. They also displayed an increased effect of the cue informational value on target processing resulting in the elicitation of a negative difference (Nd). CONCLUSIONS Migraineurs appear to display increased bottom-up orienting response to all incoming sounds, and an enhanced recruitment of top-down attention. SIGNIFICANCE The interictal state in migraine is characterized by an exacerbation of the orienting response to attended and unattended sounds. These attentional alterations might participate to the peculiar vulnerability of the migraine brain to all incoming stimuli.
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Affiliation(s)
- Rémy Masson
- Lyon Neuroscience Research Center (CRNL), INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France.
| | - Yohana Lévêque
- Lyon Neuroscience Research Center (CRNL), INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Geneviève Demarquay
- Lyon Neuroscience Research Center (CRNL), INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France; Neurological Hospital Pierre Wertheimer, Functional Neurology and Epilepsy Department, Hospices Civils de Lyon and Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Hesham ElShafei
- Lyon Neuroscience Research Center (CRNL), INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Lesly Fornoni
- Lyon Neuroscience Research Center (CRNL), INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Françoise Lecaignard
- Lyon Neuroscience Research Center (CRNL), INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Dominique Morlet
- Lyon Neuroscience Research Center (CRNL), INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Aurélie Bidet-Caulet
- Lyon Neuroscience Research Center (CRNL), INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Anne Caclin
- Lyon Neuroscience Research Center (CRNL), INSERM UMRS 1028, CNRS UMR 5292, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
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108
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Klan T, Bräscher AK, Vales A, Liesering-Latta E, Witthöft M, Gaul C. Determination of psychosocial factors in cluster headache - construction and psychometric properties of the Cluster Headache Scales (CHS). Cephalalgia 2020; 40:1240-1249. [PMID: 32484060 DOI: 10.1177/0333102420928076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Cluster headache (CH) is clinically associated with considerable psychosocial burden. However, instruments to assess and characterize psychosocial factors in cluster headache more specifically are lacking. This study aimed to develop a self-report questionnaire, which assesses the broadest possible spectrum of psychosocial factors in cluster headache, the Cluster Headache Scales (CHS). METHOD Items of the Cluster Headache Scales were constructed based on a literature review and semi-structured interviews with several experts (including persons with cluster headache). A cross-sectional online survey was conducted to determine the psychometric properties and the factor structure of the Cluster Headache Scales. Data was analyzed using exploratory factor analysis as well as exploratory structural equation modelling (ESEM). RESULTS In total, n = 342 subjects with cluster headache (mean age 47.8, 63% male, 51% with episodic cluster headache) were included. Factor analysis yielded eight clearly interpretable factors: Medical care, medication side effects, fear of attacks, disability, (auto)aggression, coping, physical activity, and financial burden, which are assessed via 36 items. The internal consistencies of the subscales were acceptable to excellent and ranged between Cronbach's alpha = .76 and .93. The pattern of correlations with related instruments provides first evidence for convergent validity. CONCLUSION The CHS represents a reliable and valid self-report instrument for the assessment of psychosocial factors in persons with cluster headache, which appears useful for both clinical practice as well as research.Trial registration: The study was registered at the German Clinical Trials Register (www.drks.de, ID-Number: DRKS00016502).
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Affiliation(s)
- Timo Klan
- Department of Psychology, Johannes Gutenberg University of Mainz, Mainz, Germany
| | | | - Annabella Vales
- Department of Psychology, Johannes Gutenberg University of Mainz, Mainz, Germany
| | | | - Michael Witthöft
- Department of Psychology, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Charly Gaul
- Migraine and Headache Clinic Königstein, Königstein, Germany
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109
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Qin Z, Su J, He XW, Ban S, Zhu Q, Cui Y, Zhang J, Hu Y, Liu YS, Zhao R, Qiao Y, Li J, Liu JR, Du X. Disrupted functional connectivity between sub-regions in the sensorimotor areas and cortex in migraine without aura. J Headache Pain 2020; 21:47. [PMID: 32375638 PMCID: PMC7203097 DOI: 10.1186/s10194-020-01118-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/28/2020] [Indexed: 01/29/2023] Open
Abstract
Background Migraine is a severe and disabling brain disorder, and the exact neurological mechanisms remain unclear. Migraineurs have altered pain perception, and headache attacks disrupt their sensory information processing and sensorimotor integration. The altered functional connectivity of sub-regions of sensorimotor brain areas with other brain cortex associated with migraine needs further investigation. Methods Forty-eight migraineurs without aura during the interictal phase and 48 age- and sex-matched healthy controls underwent resting-state functional magnetic resonance imaging scans. We utilized seed-based functional connectivity analysis to investigate whether patients exhibited abnormal functional connectivity between sub-regions of sensorimotor brain areas and cortex regions. Results We found that patients with migraineurs without aura exhibited disrupted functional connectivities between the sensorimotor areas and the visual cortex, temporal cortex, posterior parietal lobule, prefrontal areas, precuneus, cingulate gyrus, sensorimotor areas proper and cerebellum areas compared with healthy controls. In addition, the clinical data of the patients, such as disease duration, pain intensity and HIT-6 score, were negatively correlated with these impaired functional connectivities. Conclusion In patients with migraineurs without aura, the functional connectivities between the sensorimotor brain areas and other brain regions was reduced. These disrupted functional connectivities might contribute to abnormalities in visual processing, multisensory integration, nociception processing, spatial attention and intention and dysfunction in cognitive evaluation and modulation of pain. Recurrent headache attacks might lead to the disrupted network between primary motor cortex and temporal regions and between primary somatosensory cortex and temporal regions. Pain sensitivity and patient quality of life are closely tied to the abnormal functional connectivity between sensorimotor regions and other brain areas.
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Affiliation(s)
- Zhaoxia Qin
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, 3663 North Zhong-Shan Road, 200062, Shanghai, People's Republic of China
| | - Jingjing Su
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, 200011, Shanghai, People's Republic of China
| | - Xin-Wei He
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, 200011, Shanghai, People's Republic of China.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Shiyu Ban
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, 3663 North Zhong-Shan Road, 200062, Shanghai, People's Republic of China
| | - Qian Zhu
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, 3663 North Zhong-Shan Road, 200062, Shanghai, People's Republic of China
| | - Yangyang Cui
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, 3663 North Zhong-Shan Road, 200062, Shanghai, People's Republic of China
| | - Jilei Zhang
- Clinical Science, Philips Healthcare, Shanghai, 200040, P. R. China
| | - Yue Hu
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, 200011, Shanghai, People's Republic of China.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Yi-Sheng Liu
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, 200011, Shanghai, People's Republic of China
| | - Rong Zhao
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, 200011, Shanghai, People's Republic of China.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Yuan Qiao
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, 200011, Shanghai, People's Republic of China.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Jianqi Li
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, 3663 North Zhong-Shan Road, 200062, Shanghai, People's Republic of China
| | - Jian-Ren Liu
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, 200011, Shanghai, People's Republic of China. .,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Xiaoxia Du
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, 3663 North Zhong-Shan Road, 200062, Shanghai, People's Republic of China.
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110
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Altered Macular Vasculature in Migraine Patients without Aura: Is It Associated with Ocular Vasculature and White Matter Hyperintensities? J Ophthalmol 2020; 2020:3412490. [PMID: 32351718 PMCID: PMC7174908 DOI: 10.1155/2020/3412490] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/30/2020] [Indexed: 11/17/2022] Open
Abstract
Aim We aimed to determine the alterations in macular and optic nerve vasculature in patients with migraine without aura using optical coherence tomography-angiography (OCTA). We also aimed to determine whether there were clinical differences and alterations in ocular structures in migraine cases with white matter hyperintensities (WMH) using magnetic resonance imaging (MRI). Materials and Methods. The study group comprised patients with migraine without aura and age- and sex-matched healthy controls. Detailed histories of the patients with migraine were recorded including the disease duration, number of attacks in the last month, and attack durations. Visual evoked potentials (VEP) were recorded in all migraine patients. The migraine disability assessment (MIDAS) questionnaire was administered to all patients. The patients were divided into two groups as migraine with WMHs and migraine without WMHs. All subjects underwent a complete neurological and ophthalmological examination. Only the right eyes of the patients were included in the study. Retinal imaging was performed using OCT and OCTA. Results A total of 66 migraine patients (29 with WMH and 37 without WMH) and 43 healthy controls were included in this study. Among the migraine patients, disease duration, attack frequency in the last month, attack durations, and the visual analogue scale (VAS), MIDAS, and VEP scores were all similar between those with and without WMHs. There was no significant difference between the groups regarding the ganglion cell complex, foveal, and retinal nerve fiber layer thicknesses. The superficial or deep vascular perfusion densities of the optic disc were also similar between the groups. The foveal avascular zone (FAZ) was significantly larger (P=0.034), and both superficial and deep macular vascular densities were significantly lower in the migraine groups compared with the healthy controls (P=0.001). There was no significant difference concerning the FAZ size or vascular densities between the migraine groups with and without WMHs. In the correlation analysis performed between the migraine patients, the FAZ size was correlated with age and VAS and MIDAS scores while both superficial and deep macular vascular densities were negatively correlated with age and VAS and MIDAS scores. Conclusion We suggest that for not only migraine with aura but also migraine without aura, neurovascular structures play an important role in pathogenesis, and novel studies are warranted to elucidate the alterations in these and determine the significance of WMHs in these patient groups.
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Diener HC, Förderreuther S, Gaul C, Giese F, Hamann T, Holle-Lee D, Jürgens TP, Kamm K, Kraya T, Lampl C, May A, Reuter U, Scheffler A, Tfelt-Hansen P. Prevention of migraine with monoclonal antibodies against CGRP or the CGRP receptor: Addition to the S1 guideline: Therapy of migraine attacks and prevention of migraine. Recommendations of the Germany Society of Neurology and the German Migraine and Headache Society. Neurol Res Pract 2020; 2:11. [PMID: 33324917 PMCID: PMC7650107 DOI: 10.1186/s42466-020-00057-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Monoclonal antibodies against the calcitonin gene-related peptide (CGRP) receptor (Erenumab) or against CGRP (Eptinezumab, Fremanezumab, Galcanezumab) are new substances for the preventive treatment of migraine. They represent an extension of the therapeutic options, which already exist in migraine prevention. In randomized, placebo-controlled studies, the efficacy and good tolerability of these specific substances have been demonstrated in patients with episodic and chronic migraine. The following treatment recommendation presents a summary of the pivotal studies. Recommendations are provided for the targeted selection of patients as well as for the evaluation of therapeutic success and the duration of treatment. Finally, possible restrictions on the use of this new substance group are discussed. This guideline is an abridged and translated version of the guideline published by Diener H-C, May A et al., Prevention of migraine with monoclonal antibodies against CGRP or the CGRP receptor, Supplement to S1 Guideline Therapy of Migraine Attack and Prevention of Migraine, 2019, Deutsche Gesellschaft für Neurologie (eds.), Guidelines for Diagnostics and Therapy in Neurology. A complete version of this guideline can be found on the website of the Deutsche Gesellschaft für Neurologie (www.dgn.org/leitlinien) and the AWMF (Arbeitsgemeinschaft wissenschaftlicher Medizinischer Gesellschaften). This guideline has been approved by the German Neurological Society (DGN) and the German Migraine and Headache Society (GMHS) and was reviewed by the two societies.
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Affiliation(s)
- Hans-Christoph Diener
- Medizinische Fakultät der Universität Duisburg-Essen, Institut für Medizinische Informatik, Biometrie und Epidemiologie (IMIBE), Hufelandstr. 26, 45147 Essen, Germany
| | - Stefanie Förderreuther
- Neurologische Klinik, Ludwig-Maximilians-Universität München, Klinikum Großhadern, Marchioninistr. 15, 81377 Munich, Germany
| | - Charly Gaul
- Migräne- und Kopfschmerzklinik Königstein, Ölmühlweg 31, 61462 Königstein im Taunus, Germany
| | - Florian Giese
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Halle, Gütchenstr. 14, 06108 Halle, Germany
| | - Till Hamann
- Klinik und Poliklinik für Neurologie und Kopfschmerzzentrum Nord-Ost, Universitätsmedizin Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - Dagny Holle-Lee
- Klinik für Neurologie und Westdeutsches Kopfschmerzzentrum Universitätsklinikum Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Tim P Jürgens
- Klinik und Poliklinik für Neurologie und Kopfschmerzzentrum Nord-Ost, Universitätsmedizin Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany
| | - Katharina Kamm
- Neurologische Klinik, Ludwig-Maximilians-Universität München, Klinikum Großhadern, Marchioninistr. 15, 81377 Munich, Germany
| | - Torsten Kraya
- Klinik für Neurologie, Klinikum St. Georg Leipzig, Delitzscher Str. 141, 04129 Leipzig, Germany
| | - Christian Lampl
- Akutgeriatrie und Remobilisation, Kopfschmerzzentrum Seilerstätte, Ordensklinikum Linz Barmherzige Schwestern, Seilerstätte 4, A-4010 Linz, Austria
| | - Arne May
- Institut für Systemische Neurowissenschaften, Universitätsklinikum Hamburg-Eppendorf (UKE), Gebäude W34, 3. Stock, Martinistraße 52, 20246 Hamburg, Germany
| | - Uwe Reuter
- Kopfschmerzzentrum, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Armin Scheffler
- Klinik für Neurologie, Universitätsklinikum Essen, Hufelandstr. 55, 45147 Essen, Germany
| | - Peer Tfelt-Hansen
- Department of Neurology, Danish Headache Center, Rigshospitalet-Glostrup Hospital, University Hospital of Copenhagen, Glostrup Hospital, Ringvejen, DK-2600 Glostrup, Denmark
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112
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Liu HY, Lee PL, Chou KH, Lai KL, Wang YF, Chen SP, Chen WT, Wang SJ. The cerebellum is associated with 2-year prognosis in patients with high-frequency migraine. J Headache Pain 2020; 21:29. [PMID: 32188423 PMCID: PMC7081533 DOI: 10.1186/s10194-020-01096-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 03/09/2020] [Indexed: 11/15/2022] Open
Abstract
Background The increase of headache frequency is associated with higher headache related disability and lower quality of life in patients with migraine. However, the pathophysiology of migraine progression, persistence, or remission is elusive. The purpose of this study is to identify the brain signatures that are predictive of the long-term outcomes among patients with high-frequency migraine (HFM: 10–30 headache days/month). Methods We prospectively enrolled patients with HFM and healthy controls and collected their baseline clinical profiles and brain-MRI data at first visit. We longitudinally followed the patients and determined their outcomes at 2-year follow-up. Good outcome was defined as ≥50% reduction of baseline headache days and poor outcome was defined as reduction < 50% or frequency increase. Voxel-based morphometry was used to study gray matter volume (GMV), and structural covariance was used to investigate structural connectivity. Results Among 56 patients with HFM, 37 had good outcome and 19 poor outcome. Compared to the healthy controls (n = 37), patients with poor outcome had decreased GMV over the left posterior cingulate gyrus, and increased GMV over the bilateral cerebellum and the right precentral gyrus. Further, patients with poor outcome had greater GMV over the right and the left cerebella compared to patients with good outcome, and the GMVs of the cerebella were correlated to 2-year headache frequencies (right: r = 0.38, P = 0.005; left: r = 0.35, P = 0.009). Structural connectivity were increased between the cerebellum and the cuneus, the calcarine cortex, and the temporal lobe, respectively, in patients with poor outcome, and was decreased between the cerebellum and the prefrontal cortex in patients with poor outcome. The structural covariance integrities between the right cerebellum and the right cuneus were correlated to 2-year headache frequencies (r = 0.36, P = 0.008). Conclusions Structural volume and connectivity changes of the cerebellum may underlie headache persistence in patients with HFM.
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Affiliation(s)
- Hung-Yu Liu
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec. 2 Shih-Pai Rd, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Pei-Lin Lee
- Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan
| | - Kun-Hsien Chou
- Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Kuan-Lin Lai
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec. 2 Shih-Pai Rd, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yen-Feng Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec. 2 Shih-Pai Rd, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Pin Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec. 2 Shih-Pai Rd, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan.,Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Ta Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec. 2 Shih-Pai Rd, Taipei, Taiwan. .,School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Brain Research Center, National Yang-Ming University, Taipei, Taiwan.
| | - Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec. 2 Shih-Pai Rd, Taipei, Taiwan. .,School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Brain Research Center, National Yang-Ming University, Taipei, Taiwan.
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113
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Rodríguez-Almagro D, Achalandabaso A, Rus A, Obrero-Gaitán E, Zagalaz-Anula N, Lomas-Vega R. Validation of the Spanish version of the migraine disability assessment questionnaire (MIDAS) in university students with migraine. BMC Neurol 2020; 20:67. [PMID: 32093620 PMCID: PMC7038557 DOI: 10.1186/s12883-020-01646-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/17/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The Migraine Disability Assessment (MIDAS) questionnaire is widely used to determine the degree of migraine-related disability of subjects. So far, and to the best of our knowledge, no Spanish version of this tool has been validated. The questionnaire comprises seven items, with the first five constituting the main scale while the sixth and seventh items referring, respectively, to the frequency and intensity of headache. The present study aims to analyze the clinimetric properties of the Spanish version of the MIDAS questionnaire in a population of university students. METHODS We performed a cross-sectional study of validation for this measuring instrument. A total of 153 subjects participated in the study. We analyzed construct validity using factor analysis, test-retest reliability by the Intraclass Correlation Coeficient (ICC), internal consistency, and concurrent validity with respect to the 12-Item Short Form Health Survey (SF-12). RESULTS Factor analysis revealed a two-factor structure. The questionnaire has good reliability for the MIDAS main-scale score ([ICC = 0.81; 95% CI: 0.63-0.90]), excellent reliability for headache frequency (ICC = 0.90; 95%; CI: [0.79-0.95]), and moderately good reliability for headache intensity (ICC = 0.63; 95% CI: [0.34-0.80]). The analysis also yielded good internal consistency results (α Cronbach = 0.797) and a moderate correlation between MIDAS-main scale and the physical component summary of SF-12 (Rho = - 0.326; p < 0.001). CONCLUSIONS The Spanish version of the MIDAS questionnaire is a valid and reliable tool to measure migraine-related disability in university subjects. The two additional items provide information that could help clinicians in making decisions.
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Affiliation(s)
- Daniel Rodríguez-Almagro
- Department of Health Sciences, (Building B3, Office 205), University of Jaén, Paraje, Campus Las Lagunillas s/n, 23071, Jaén, Spain
| | - Alexander Achalandabaso
- Department of Health Sciences, (Building B3, Office 205), University of Jaén, Paraje, Campus Las Lagunillas s/n, 23071, Jaén, Spain.
| | - Alma Rus
- Department of Cell Biology, University of Granada, Avenida de Fuente Nueva s/n, 18071, Granada, Spain
| | - Esteban Obrero-Gaitán
- Department of Health Sciences, (Building B3, Office 205), University of Jaén, Paraje, Campus Las Lagunillas s/n, 23071, Jaén, Spain
| | - Noelia Zagalaz-Anula
- Department of Health Sciences, (Building B3, Office 205), University of Jaén, Paraje, Campus Las Lagunillas s/n, 23071, Jaén, Spain
| | - Rafael Lomas-Vega
- Department of Health Sciences, (Building B3, Office 205), University of Jaén, Paraje, Campus Las Lagunillas s/n, 23071, Jaén, Spain
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Sohn JH, Park JW, Lee MJ, Chung PW, Chu MK, Chung JM, Ahn JY, Kim BS, Kim SK, Choi YJ, Kim D, Song TJ, Oh K, Moon HS, Park KY, Kim BK, Bae DW, Chung CS, Cho SJ. Clinical factors influencing the impact of cluster headache from a prospective multicenter study. Sci Rep 2020; 10:2428. [PMID: 32051496 PMCID: PMC7015942 DOI: 10.1038/s41598-020-59366-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 01/23/2020] [Indexed: 01/12/2023] Open
Abstract
Although many patients with cluster headaches (CH) are disabled by their condition, few studies have examined this in detail. This cross-sectional, multicenter observational study prospectively collected demographic and clinical questionnaire data from 224 consecutive patients with CH. We assessed headache impact using the six-item Headache Impact Test (HIT-6) and evaluated the factors associated with the impact of CH. Participants with a HIT-6 score ≥ 60 were classified into a severe impact group. The majority (190, 84.8%) of the participants were classified into the severe impact group. These patients were characterized by younger age, earlier onset of CH, longer duration of each headache attack, higher pain intensity, more cranial autonomic symptoms, a higher proportion of depression or anxiety, higher score of stress, and lower score of quality of life. The anxiety (OR = 1.19, 95% CI: 1.08–1.31, p = 0.006), greater pain intensity (OR = 1.06, 95% CI: 1.02–1.10, p = 0.002), and age (OR = 0.99, 95% CI: 0.99–1.00, p = 0.008) were significant predictors for a severe impact of CH patients. According to the HIT-6 results, most of the CH patients were significantly affected by CH. As well as pain intensity, anxiety and age modulated CH’s impact on their lives.
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Affiliation(s)
- Jong-Hee Sohn
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si, Korea
| | - Jeong-Wook Park
- Department of Neurology, Uijeongbu St.Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | - Mi Ji Lee
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pil-Wook Chung
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Kyung Chu
- Department of Neurology, Severance hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Myun Chung
- Department of Neurology, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jin-Young Ahn
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Byung-Su Kim
- Department of Neurology, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea
| | - Soo-Kyoung Kim
- Department of Neurology, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Yun-Ju Choi
- Department of Neurology, Presbyterian Medical Center, Jeonju, Korea
| | - Daeyoung Kim
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Tae-Jin Song
- Department of Neurology, Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
| | - Heui-Soo Moon
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Byung-Kun Kim
- Department of Neurology, Eulji Hospital, Eulji University, Seoul, Korea
| | - Dae-Woong Bae
- Department of Neurology, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Chin-Sang Chung
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.
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115
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AlHarbi FG, AlAteeq MA. Quality of life of migraine patients followed in neurology clinics in Riyadh, Saudi Arabia. J Family Community Med 2020; 27:37-45. [PMID: 32030077 PMCID: PMC6984026 DOI: 10.4103/jfcm.jfcm_185_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/13/2019] [Accepted: 11/26/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Migraine is a chronic disorder that negatively affects a patient's quality of life (QOL). As little is known about the QOL of migraine sufferers in Saudi Arabia, our aim was to investigate the QOL and the level of migraine-associated disability of migraine patients. MATERIALS AND METHODS This cross-sectional study was conducted in neurology clinics at King Abdulaziz Medical City for National Guard and Prince Sultan Military Medical City in Riyadh, Saudi Arabia, from August to December 2018. The migraine-specific QOL questionnaire (MSQ), version 2.1, was used to measure restrictive, preventive, and emotional domains. The sum of the item responses ranged between 0 and 100, with higher scores indicating better QOL. A descriptive analysis of numerical variables was reported in terms of means and standard deviation, while categorical variables were described using frequencies and percentages. RESULTS A total of 300 migraine patients completed the questionnaire; 67% were females. Age of participants ranged from 20 to 53 years, with mean age of 34.21 (SD=7.26). The mean score in the QOL restrictive domain was 51.8 ± 19, whereas the mean scores for preventive and emotional domains were 54 ± 18 and 46.3 ± 23.4, respectively. Low QOL scores were associated with young ages, long disease duration, frequent migraine attacks, and presence of chronic diseases. CONCLUSION Chronic migraine has a negative impact on QOL, predominantly in young patients, patients with frequent attacks, those not using preventive medications, and those suffering from chronic diseases.
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Affiliation(s)
- Fatima G AlHarbi
- Department of Family Medicine and Primary Health Care, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed A AlAteeq
- Department of Family Medicine and Primary Health Care, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
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116
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Associations between migraine occurrence and the effect of aura, age at onset, family history, and sex: A cross-sectional study. PLoS One 2020; 15:e0228284. [PMID: 32023286 PMCID: PMC7001916 DOI: 10.1371/journal.pone.0228284] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 01/10/2020] [Indexed: 12/23/2022] Open
Abstract
Introduction The relationships between family history, sex, age at onset, and migraine occurrence have been documented. However, the associations between these factors across different sexes and subgroups of patients have yet to be elucidated. This study evaluated the association between family history and migraine in male and female patients experiencing episodic and chronic migraine with and without aura. Methods This cross-sectional, case–control study included 299 headache-free controls and 885 patients receiving outpatient treatment for migraine. Participants were classified into episodic (1–14 days/month) and chronic (≥15 days/month) migraine groups. Results Positive family history was significantly more frequently observed in the episodic group than in the chronic group (49.5% vs. 26%; P < 0.001) in male patients, particularly in male patients without aura (50.3% vs. 21.9%; P = 0.003); it was less frequently observed (58.7% vs. 73.7%; P = 0.048) in female patients with aura. Family history was correlated with an earlier age at onset (20.7 years vs. 22.8 years; P = 0.002), particularly in patients without aura (21 years vs. 23.7 years; P = 0.002), who were women (20.9 years vs. 23.9 years; P = 0.002). Conclusions Different patterns of association between family history and migraine can be observed between men and women. A positive family history of migraine is correlated with an earlier age at onset, particularly among female patients without aura.
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Wayne PM, Bernstein C, Kowalski M, Connor JP, Osypiuk K, Long CR, Vining R, Macklin E, Rist PM. The Integrative Migraine Pain Alleviation through Chiropractic Therapy (IMPACT) trial: Study rationale, design and intervention validation. Contemp Clin Trials Commun 2020; 17:100531. [PMID: 32043014 PMCID: PMC6997836 DOI: 10.1016/j.conctc.2020.100531] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/06/2020] [Accepted: 01/19/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction Approximately 15% of the US population experiences migraine, with women afflicted three times as often as men. While medications are often used as first-line treatments, up to 50% of people with migraine pursue complementary and integrative medicine. One promising non-pharmacological approach for migraine is chiropractic care, due to the co-occurrence of migraine disease and musculoskeletal tension and pain. To date, no large-scale trials have evaluated the impact of a comprehensive model of chiropractic care on migraine. Methods The Integrative Migraine Pain Alleviation through Chiropractic Therapy (IMPACT) study is a two-arm pilot pragmatic randomized clinical trial evaluating a multimodal chiropractic care intervention plus enhanced usual care (UC) vs. enhanced UC alone for adult women with episodic migraine. A total of 60 women aged 20–55 who meet criteria for episodic migraine will be randomly assigned to an evidence-informed, musculoskeletal focused multimodal chiropractic care (10 sessions over 14 weeks) plus enhanced UC vs. enhanced UC alone. Enhanced UC includes conventional care, migraine education materials, and biweekly check-in phone calls. Study specific aims include: 1) Determine safety and feasibility of the study design; 2) Provide preliminary data on the effectiveness of chiropractic care on migraine frequency, severity, duration and medication use; and 3) Provide preliminary estimates of the effects of chiropractic care on disability, health-related quality of life, and psychosocial well-being. Discussion Findings will be used to inform the design of a full-scale trial evaluating chiropractic care for women with episodic migraines.
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Affiliation(s)
- P M Wayne
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA.,Division of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | - C Bernstein
- John Graham Headache Center, Department of Neurology, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA.,Osher Clinical Center, Brigham and Women's Hospital, Boston, MA, USA
| | - M Kowalski
- Osher Clinical Center, Brigham and Women's Hospital, Boston, MA, USA
| | - J P Connor
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | - K Osypiuk
- Osher Center for Integrative Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | - C R Long
- Palmer College of Chiropractic, Davenport, IA, USA
| | - R Vining
- Palmer College of Chiropractic, Davenport, IA, USA
| | - E Macklin
- Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - P M Rist
- Division of Preventive Medicine, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
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D'Amico D, Grazzi L, Grignani E, Leonardi M, Sansone E, Raggi A. HEADWORK Questionnaire: Why Do We Need a New Tool to Assess Work-Related Disability in Patients With Migraine? Headache 2020; 60:497-504. [PMID: 31943176 DOI: 10.1111/head.13735] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This article reviews current headache disability measures and clinical need, as well as presenting the rationale for a new measure addressing work-related disability in migraine patients and the steps devoted to this aim. BACKGROUND Episodic and chronic migraine (EM and CM) constitute an enormous economic burden to societies, and the vast majority of this burden is attributable to indirect costs, ie those associated with productivity loss. A measure of work-related disability is therefore needed to quantify the impact of EM and CM on patients' ability to carry out work tasks. METHODS We briefly present the advantages and disadvantages of the disability measures that have been most commonly used for this purpose and the rationale for developing a new measure. RESULTS The entire process of development of HEADWORK, a questionnaire designed to assess work-related disability, is presented together with short-term sensitivity to change. CONCLUSIONS Current headache disability measures need improvement. HEADWORK is a valid, reliable, and sensitive questionnaire to address the amount and severity of work-related difficulties and of the factors contributing to such difficulties. HEADWORK is suitable for daily clinical practice, epidemiological research and for clinical trials, and potentially to define work-related disability weights for the calculation of migraine indirect costs.
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Affiliation(s)
- Domenico D'Amico
- Neuroalgology Unit, and Headache Center, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Licia Grazzi
- Neuroalgology Unit, and Headache Center, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Eleonora Grignani
- Neuroalgology Unit, and Headache Center, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Emanuela Sansone
- Neuroalgology Unit, and Headache Center, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Schroeder J, Karkar R, Murinova N, Fogarty J, Munson SA. Examining Opportunities for Goal-Directed Self-Tracking to Support Chronic Condition Management. PROCEEDINGS OF THE ACM ON INTERACTIVE, MOBILE, WEARABLE AND UBIQUITOUS TECHNOLOGIES 2019; 3:151. [PMID: 32656490 PMCID: PMC7351123 DOI: 10.1145/3369809] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Although self-tracking offers potential for a more complete, accurate, and longer-term understanding of personal health, many people struggle with or fail to achieve their goals for health-related self-tracking. This paper investigates how to address challenges that result from current self-tracking tools leaving a person's goals for their data unstated and lacking explicit support. We examine supporting people and health providers in expressing and pursuing their tracking-related goals via goal-directed self-tracking, a novel method to represent relationships between tracking goals and underlying data. Informed by a reanalysis of data from a prior study of migraine tracking goals, we created a paper prototype to explore whether and how goal-directed self-tracking could address current disconnects between the goals people have for data in their chronic condition management and the tools they use to support such goals. We examined this prototype in interviews with 14 people with migraine and 5 health providers. Our findings indicate the potential for scaffolding goal-directed self-tracking to: 1) elicit different types and hierarchies of management and tracking goals; 2) help people prepare for all stages of self-tracking towards a specific goal; and 3) contribute additional expertise in patient-provider collaboration. Based on our findings, we present implications for the design of tools that explicitly represent and support an individual's specific self-tracking goals.
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Affiliation(s)
| | - Ravi Karkar
- Computer Science & Engineering, University of Washington
| | | | - James Fogarty
- Computer Science & Engineering, University of Washington
| | - Sean A Munson
- Human Centered Design & Engineering, University of Washington
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Turner DP, Leffert LR, Houle TT. Appraisal of Headache Trigger Patterns Using Calendars. Headache 2019; 60:370-381. [PMID: 31784989 DOI: 10.1111/head.13703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Using experimental, yet realistic, headache calendars, this laboratory study evaluated the ability of individuals to identify the degree of association between triggers and headaches. BACKGROUND Individuals with headache often record daily diaries or calendars to identify their patterns of triggers. METHODS This cross-sectional, observational study included adults with migraine, tension-type, or cluster headache who had ever experienced more than 5 attacks. Participants (N = 300) were presented with headache calendars and asked to rate the strength of the relationship (how strongly one causes the other) between 3 experimental triggers (high stress, poor sleep, and cinnamon) and headache using a 0 ("no relationship") to 10 ("perfect relationship") scale for each calendar. RESULTS Calendars with a high positive correlation between trigger and headache had higher participant ratings than those with low correlations. The median [25th, 75th] of ratings for each correlation level was low correlation: 1 [0, 4], medium: 4 [2, 5], and high: 5 [4, 8], P < .0001. However, participants appeared to ignore negative associations (ie, trigger present with no headache) and rated calendars with more headache days as having higher associations, regardless of the true relationship. The ratings for 2, 6, and 26 headache days were 1 [0, 3], 4 [1, 6], and 8 [0, 10], respectively (P < .0001). Participants' previous beliefs about the triggers also affected their ratings (average correlation across triggers: r = 0.25, P < .0001). CONCLUSIONS This laboratory task supports the notion that individuals with headache are able to identify the association between headaches and triggers using headache calendars. However, these judgments can be biased by the individuals' previous beliefs about the trigger and by the degree of headache activity.
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Affiliation(s)
- Dana P Turner
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lisa R Leffert
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Timothy T Houle
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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121
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Mose LS, Pedersen SS, Jensen RH, Gram B. Medication-overuse headache: The effect of a patient educational programme-A randomized controlled trial. Eur J Pain 2019; 24:435-447. [PMID: 31661579 DOI: 10.1002/ejp.1500] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/16/2019] [Accepted: 10/20/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Little is known about the effects of non-pharmacological interventions among medication-overuse headache (MOH) patients, although non-pharmacological approaches combined with pharmacological treatment are recommended. The objective was to evaluate the effect of an educational programme as an add-on to standard treatment. METHODS Medication-overuse headache patients were randomized (1:1) in a single-centre setting to standard treatment with 12 weeks of education (I-group) versus standard treatment (C-group). The primary outcome was measurement of reduction in headache days/last month at 9 months' follow-up. Secondary outcomes were headache intensity, acute medication intake, bothersomeness, disability, physical activity and patient satisfaction. The between-group differences were analysed using a mixed-effects model for repeated measurements with a between group factor (I-group vs. C-group) and a time factor (baseline, 4 and 9 months). RESULTS Ninety-eight patients were randomized (I-group: n = 48, C-group: n = 50), with 40 and 39 patients completing the study, respectively. Intention-to-treat analyses showed that both groups experienced statistically significant reductions in headache days/last month (I-group: -4 ± 6 days (95% CI 2.47; 5.95), p < .001) versus C-group: -4 ± 9 days ([95% CI 1.53; 6.79], p = .003), but there were no significant differences between groups (mean ± SE):Δ: 0.7 days ([95% CI, -2.50; 3.93], p = .66). At follow-up, 85% from the I-group and 86% from C-group, no longer fulfilled the criteria for MOH. CONCLUSION The compliance rate was high, indicating that patients were motivated for receiving education, but we found no additional benefits of adding an educational programme to standard treatment. Future research focusing on the MOH complexity, group heterogeneity, duration and content of educational programmes is warranted. SIGNIFICANCE Randomized controlled trials (RCTs) of non-pharmacological intervention such as patient educational programmes are of great importance, as this approach is common in the clinical practice. Medication-overuse headache (MOH) is a heterogenetic patient group, which must be taken into account when conducting RCTs of non-pharmacological interventions. An educational programme based on Motivational Interviewing is well-tolerated among MOH patients, however, no superior effects were found from adding the educational programme to standard treatment versus standard treatment alone.
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Affiliation(s)
- Louise S Mose
- Department of Neurology, University Hospital of Southern Denmark, Esbjerg, Denmark.,Research Unit of Health Sciences, University Hospital of Southern Denmark, Esbjerg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Rigmor H Jensen
- Department of Neurology, Danish Headache Centre, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Bibi Gram
- Research Unit of Health Sciences, University Hospital of Southern Denmark, Esbjerg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Qin Z, He XW, Zhang J, Xu S, Li GF, Su J, Shi YH, Ban S, Hu Y, Liu YS, Zhuang MT, Zhao R, Shen XL, Li J, Liu JR, Du X. Structural changes of cerebellum and brainstem in migraine without aura. J Headache Pain 2019; 20:93. [PMID: 31477012 PMCID: PMC6734280 DOI: 10.1186/s10194-019-1045-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 08/26/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Increasing evidence has suggested that the cerebellum is associated with pain and migraine. In addition, the descending pain system of the brainstem is the major site of trigeminal pain processing and modulation and has been discussed as a main player in the pathophysiology of migraine. Cerebellar and brainstem structural changes associated with migraineurs remain to be further investigated. METHODS Voxel-based morphometry (VBM) (50 controls, 50 migraineurs without aura (MWoAs)) and diffusion tensor imaging (DTI) (46 controls, 46 MWoAs) were used to assess cerebellum and brainstem anatomical alterations associated with MWoAs. We utilized a spatially unbiased infratentorial template toolbox (SUIT) to perform cerebellum and brainstem optimized VBM and DTI analysis. We extracted the average diffusion values from a probabilistic cerebellar white matter atlas to investigate whether MWoAs exhibited microstructure alterations in the cerebellar peduncle tracts. RESULTS MWoAs showed decreased fractional anisotropy (FA) in the vermis VI extending to the bilateral lobules V and VI of the cerebellum. We also found higher axial diffusivity (AD), mean diffusivity (MD), and radial diffusivity (RD) in the right inferior cerebellum peduncle tract in MWoAs. MWoAs exhibited both reduced gray matter volume and increased AD, MD and RD in the spinal trigeminal nucleus (SpV). CONCLUSION MWoAs exhibited microstructural changes in the cerebellum and the local brainstem. These structural differences might contribute to dysfunction of the transmission and modulation of noxious information, trigeminal nociception, and conduction and integration of multimodal information in MWoAs. These findings further suggest involvement of the cerebellum and the brainstem in the pathology of migraine without aura.
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Affiliation(s)
- Zhaoxia Qin
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, 3663 North Zhong-Shan Road, 200062, Shanghai, People's Republic of China
| | - Xin-Wei He
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, 200011, Shanghai, People's Republic of China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Jilei Zhang
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, 3663 North Zhong-Shan Road, 200062, Shanghai, People's Republic of China
| | - Shuai Xu
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, 3663 North Zhong-Shan Road, 200062, Shanghai, People's Republic of China
| | - Ge-Fei Li
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, 200011, Shanghai, People's Republic of China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Jingjing Su
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, 200011, Shanghai, People's Republic of China
| | - Yan-Hui Shi
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, 200011, Shanghai, People's Republic of China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Shiyu Ban
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, 3663 North Zhong-Shan Road, 200062, Shanghai, People's Republic of China
| | - Yue Hu
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, 200011, Shanghai, People's Republic of China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Yi-Sheng Liu
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, 200011, Shanghai, People's Republic of China
| | - Mei-Ting Zhuang
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, 200011, Shanghai, People's Republic of China
| | - Rong Zhao
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, 200011, Shanghai, People's Republic of China
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Xiao-Lei Shen
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, 200011, Shanghai, People's Republic of China
| | - Jianqi Li
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, 3663 North Zhong-Shan Road, 200062, Shanghai, People's Republic of China
| | - Jian-Ren Liu
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, 200011, Shanghai, People's Republic of China.
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Xiaoxia Du
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, 3663 North Zhong-Shan Road, 200062, Shanghai, People's Republic of China.
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Emadi F, Sharif F, Shaygan M, Shaygan M, Sharifi N, Ashjazadeh N. Comparison of Pain-Related and Psychological Variables between Acute and Chronic Migraine Patients, and Factors Affecting Headache Chronicity. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2019; 7:192-200. [PMID: 31341918 PMCID: PMC6614348 DOI: 10.30476/ijcbnm.2019.44994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background: Migraine headache is classified as acute or chronic. In recent years, efforts have been made to identify the factors that might predispose individuals to develop the chronic-type headache. The present study aimed to draw a comparison between patients with acute and chronic migraine in terms of demographic, pain-related, and psychological variables. In addition, we also investigated factors affecting headache chronicity in such patients.
Methods: The present cross-sectional study was conducted during 2017-2018. The target sample consisted of 250 patients with acute or chronic migraine who referred to various clinics affiliated to Shiraz University of Medical Sciences (SUMS), Shiraz, Iran, recruited by convenience sampling. All the participants filled in the questionnaires related to demographic characteristics, pain intensity, disability, depression, emotional intelligence, and anger. The data were analyzed using SPSS software (version 22.0) with t test, Chi-square test, and logistic regression analysis. P<0.05 was considered statistically significant.
Results: Patients suffering from chronic migraine experienced higher levels of disability, depression, anger, and had lower levels of emotional intelligence compared to those with acute migraine. Based on the logistic regression analysis, variables that had a significant effect on headache chronicity were female gender (OR=5.81), married status (OR=3.77), patients with lower level of education (OR=0.26), headache duration (OR=1.53), disability (OR=0.28), depression (OR=3.66), and anger (OR=5.04).
Conclusion: Variables such as disability, depression, and lack of anger control were among the key factors associated with headache chronicity in migraine patients.
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Affiliation(s)
- Farhad Emadi
- Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farkhondeh Sharif
- Community Based Psychiatric Care Research Center, Department of Mental Health Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Shaygan
- Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Shaygan
- Community Based Psychiatric Care Research Center, Department of Mental Health Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrin Sharifi
- Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nahid Ashjazadeh
- Department of Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Forcelini CM, Gradaschi RTS, Tonin GA, Bianchi DF, Gonçalves GK, Hirt G, Porto Neto AC. Is allergic rhinitis related to migraine disability in adults? ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:424-428. [PMID: 31314845 DOI: 10.1590/0004-282x20190063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 04/07/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Migraine is a chronic condition with complex pathophysiology. Although immunologic disturbances have been linked to migraine, only few attempts have been made to assess the possibility of allergic rhinitis as a worsening factor of migraine in adults. This survey aimed to compare migraine disability between adult migraineurs with and without current allergic rhinitis. METHODS This cross-sectional study comprised 118 adult migraineurs who were consecutively assisted at an outpatient clinic. After ordinary neurological evaluation, participants were evaluated for headache disability using the Migraine Disability Assessment (MIDAS). The presence of current allergic rhinitis, allergic rhinoconjunctivitis and seasonal allergic rhinitis was scored for each participant according to the International Study of Asthma and Allergies in questionnaire. RESULTS There was no significant difference between the MIDAS scores of those with current allergic rhinitis, allergic rhinoconjunctivitis, or seasonal allergic rhinitis and nonatopic migraineurs. The disability caused by allergic symptoms also did not influence the MIDAS scores of patients with allergic rhinitis. The frequency of headache days during the last three months was higher in the subset of patients without allergic rhinitis (median and interquartile range 12 [8-19.2] vs. 8 [4-14]; p = 0.03). CONCLUSIONS Our results suggest that current allergic rhinitis, allergic rhinoconjunctivitis, and seasonal allergic rhinitis are not related to headache disability in adults with episodic migraine.
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Affiliation(s)
| | | | | | | | | | - Gustavo Hirt
- Universidade de Passo Fundo, Faculdade de Medicina, Passo Fundo RS, Brasil
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127
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Effect of Pramipexole on Headache Relief in Patients with Concomitant Migraine and Restless Legs Syndrome; A Randomized, Controlled, Clinical Trial. Jundishapur J Nat Pharm Prod 2019. [DOI: 10.5812/jjnpp.62178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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128
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Doty EG, Krege JH, Jin L, Raskin J, Halker Singh RB, Kalidas K. Sustained responses to lasmiditan: Results from post-hoc analyses of two Phase 3 randomized clinical trials for acute treatment of migraine. Cephalalgia 2019; 39:1569-1576. [PMID: 31266353 PMCID: PMC6791026 DOI: 10.1177/0333102419859313] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sustained pain freedom is an important attribute of acute migraine therapies for patients and physicians. Here we report efficacy of the centrally penetrant, highly selective, 5-HT1F agonist lasmiditan on sustained pain freedom and other outcomes at 24 and 48 hours post-dose. STUDY DESIGN AND METHODS Data from the similarly designed, Phase 3, double-blind studies SAMURAI (NCT02439320) and SPARTAN (NCT02605174) were pooled to more precisely estimate efficacy effects in these post-hoc analyses. In both studies, inclusion criteria were 3-8 migraine attacks per month and Migraine Disability Assessment Score of ≥ 11 (at least moderate disability). Patients were randomized equally to lasmiditan 200 mg, 100 mg, 50 mg (50 mg only in SPARTAN), or to placebo. The study drug was to be taken within 4 hours of onset of pain for non-improving headache of at least moderate severity. Sustained pain freedom was defined as being pain free at 2 hours and at the given time point (24 or 48 hours) post-dose without use of additional study drug or migraine medications. Sustained responses were assessed similarly for most bothersome symptom-free, total migraine-free, and disability-free outcomes. For comparisons with previously published data on other acute medications, an additional endpoint of modified sustained pain freedom at 24 hours was defined as being pain free at 2 hours and no moderate-to-severe headache at 24 hours post-dose without use of additional study drug or migraine medications. RESULTS Significantly higher proportions of patients treated with lasmiditan versus placebo achieved headache pain freedom at 2 hours post-dose: 200 mg: 35.6%; 100 mg: 29.9%; 50 mg: 28.6%; placebo: 18.3% (all p < 0.001). Sustained pain freedom was significantly higher in patients treated with lasmiditan versus placebo at 24 hours: 200 mg: 21.2%; 100 mg: 16.9%; 50 mg: 17.4%; placebo: 10.3% (all p < 0.01); and at 48 hours: 200 mg: 18.4%; 100 mg: 15.2%; 50 mg: 14.9%; placebo: 9.6% (all p < 0.05). Similar sustained benefits of lasmiditan versus placebo at 24 and 48 hours were noted for most bothersome symptom-free, total migraine-free and disability-free responses. Modified sustained pain freedom at 24 hours was also observed in significantly higher proportions of lasmiditan-treated patients versus placebo: 200 mg: 27.0%; 100 mg: 21.7%; 50 mg: 21.7%; placebo: 12.9% (all p < 0.01). CONCLUSION Sustained responses at 24 and 48 hours were noted in significantly more patients treated with lasmiditan versus placebo for several efficacy outcomes including pain freedom, most bothersome symptom-free, total migraine-free and disability-free responses. CLINICALTRIALS.GOV IDENTIFIER NUMBERS SAMURAI: NCT02439320; SPARTAN: NCT02605174.
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Affiliation(s)
| | | | - Leah Jin
- Covance Chiltern, Princeton, NJ, USA
| | - Joel Raskin
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Kavita Kalidas
- Division of Headache Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
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Nilsson B, Back V, Wei R, Plane F, Jurasz P, Bungard TJ. Potential Antimigraine Effects of Warfarin: An Exploration of Biological Mechanism with Survey of Patients. TH OPEN 2019; 3:e180-e189. [PMID: 31259301 PMCID: PMC6598089 DOI: 10.1055/s-0039-1692989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/20/2019] [Indexed: 11/05/2022] Open
Abstract
Case reports suggest a link between anticoagulant use and improved migraine symptoms, and a role for platelet-induced cerebral vasoconstriction in migraine pathobiology. Hence, we investigated the mechanism by which warfarin may affect migraine symptoms and whether there is a change in migraine symptomology in patients initiating oral anticoagulants, most commonly warfarin. The effects of warfarin on human platelet aggregation and secretion as well as platelet-induced rat cerebral artery vasoconstriction were studied. A survey of migraine and symptom change after starting or stopping oral anticoagulants was also conducted. Warfarin inhibited platelet aggregation and 5-hydroxytryptamine (5-HT) secretion in a concentration-dependent manner. Warfarin-inhibited platelet secretion products constricted middle cerebral arteries from male but not from female rats. For the survey, patient demographic information, migraine and medical history, and Migraine Disability Assessment Score (MIDAS) changes were collected. Out of 175 consenting, 40 respondents met the criteria for migraine and completed the survey. A total of 11 patients reported migraine symptom change, all coinciding with starting warfarin. Of those having symptom and MIDAS improvement, most were female with migraines with aura, whereas those worsening were male with fewer having migraine with aura. Of those reporting migraine symptom change with warfarin, female sex may be associated with improved MIDAS, and those experiencing an aura component are more likely to report a symptom change. Warfarin-mediated symptom improvement in females may occur due to inhibition of platelet 5-HT secretion and a lower sensitivity of female cerebral blood vessels to platelet-derived 5-HT-induced vasoconstriction.
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Affiliation(s)
- Benjamin Nilsson
- Alberta Health Services, Edmonton, Alberta, Canada.,Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Valentina Back
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada.,Cardiovascular Research Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Ran Wei
- Cardiovascular Research Centre, University of Alberta, Edmonton, Alberta, Canada.,Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Frances Plane
- Cardiovascular Research Centre, University of Alberta, Edmonton, Alberta, Canada.,Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Paul Jurasz
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada.,Cardiovascular Research Centre, University of Alberta, Edmonton, Alberta, Canada.,Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Alberta Mazankowski Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Tammy J Bungard
- Department of Cardiology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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130
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Tepper SJ, Krege JH, Lombard L, Asafu‐Adjei JK, Dowsett SA, Raskin J, Buchanan AS, Friedman DI. Characterization of Dizziness After Lasmiditan Usage: Findings From the SAMURAI and SPARTAN Acute Migraine Treatment Randomized Trials. Headache 2019; 59:1052-1062. [DOI: 10.1111/head.13544] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2019] [Indexed: 11/29/2022]
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131
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Cortez MM, Rae N, Millsap L, McKean N, Brennan KC. Pupil Cycle Time Distinguishes Migraineurs From Subjects Without Headache. Front Neurol 2019; 10:478. [PMID: 31139137 PMCID: PMC6518457 DOI: 10.3389/fneur.2019.00478] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 04/23/2019] [Indexed: 01/03/2023] Open
Abstract
Migraine is a neurological disorder characterized by paroxysms of head pain accompanied by trigeminovascular system activation and autonomic dysfunction. Diagnosis is currently based on clinical diagnostic criteria. Though physiological differences exist between migraineurs and non-headache controls, true physiological biomarkers have been elusive, especially for the full clinical spectrum of migraine, inclusive of chronic, episodic, and probable migraine. We used edge-light pupil cycle time (PCT) as a probe of the pupillary light circuit in migraine, paired with clinical assessment of migraine characteristics, and compared these to non-headache controls. We found significantly increased PCT in probable, episodic, and chronic migraine, compared to controls. Additionally, increased PCT correlated with the presence of craniofacial autonomic symptoms, linking pupillary circuit dysfunction to peripheral trigeminal sensitization. The sensitivity of PCT, especially for all severities of disease, distinguishes it from other physiological phenotypes, which may make it useful as a potential biomarker.
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Affiliation(s)
- Melissa M Cortez
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - Natalie Rae
- School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Leah Millsap
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - Nick McKean
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - K C Brennan
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
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132
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Leonardi M, Raggi A. A narrative review on the burden of migraine: when the burden is the impact on people's life. J Headache Pain 2019; 20:41. [PMID: 31023226 PMCID: PMC6734273 DOI: 10.1186/s10194-019-0993-0] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 04/08/2019] [Indexed: 12/14/2022] Open
Abstract
Background The burden of headache disorders, and of migraine in particular, is multifaceted and fragmented. The aim of this narrative review is to provide a description the main topics underlying the concepts of burden and impact of migraine disorders. Main results MedLine has been searched for publications covering the period 1990–2018 dealing with the terms burden or impact of migraine, including both episodic and chronic migraine. The main results and themes are reported in a descriptive way, and were grouped by similarity of content into overarching categories. A total of 49 papers, published over 25 years (1994–2018), were retained for the qualitative analysis. Six main themes were identified: prevalence of migraine disorders, overall impact of migraine disorders, impact on work or school activities, family impact, interictal burden, and disease costs. Majority of included studies concluded that patients with migraine reported an higher burden or impact in one or more of the six main themes herein identified, compared to non-headache patients or to patients with tension-type headache, with a tendency towards worse outcomes consistently with higher headache frequency. Conclusions The results of this narrative review show that the meaning of a sentence like “migraine is a burdensome condition” is not univocal: rather, it may refer to different concepts and meanings. In our opinion, future research should focus on understanding and facing the impact of migraine on work-related activities and on everyday life activities, as these aspects are highly connected to some tangible (i.e. cost) and less tangible (i.e. interictal burden and reduced quality of life) facets of migraine burden. Disease-specific measures have been implemented and should be exploited to enhance our understanding of migraine burden. This approach would allow to better understand the real impact on people’s life of such a burdensome disease.
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Affiliation(s)
- Matilde Leonardi
- Neurology, Public Health and Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
| | - Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
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133
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Sajobi TT, Amoozegar F, Wang M, Wiebe N, Fiest KM, Patten SB, Jette N. Global assessment of migraine severity measure: preliminary evidence of construct validity. BMC Neurol 2019; 19:53. [PMID: 30947702 PMCID: PMC6448190 DOI: 10.1186/s12883-019-1284-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 03/26/2019] [Indexed: 11/13/2022] Open
Abstract
Background In persons with migraine, severity of migraine is an important determinant of several health outcomes (e.g., patient quality of life and health care resource utilization). This study investigated how migraine patients rate the severity of their disease and how these ratings correlate with their socio-demographic, clinical, and psycho-social characteristics. Methods This is a cohort of 263 adult migraine patients consecutively enrolled in the Neurological Disease and Depression Study (NEEDs). We obtained a broad range of clinical and patient-reported measures (e.g., patients’ ratings of migraine severity using the Global Assessment of Migraine Severity (GAMS), and migraine-related disability, as measured by the Migraine Disability Scale (MIDAS)). Depression was measured using the 9-item Patient Health Questionnaire (PHQ-9) and the 14-item Hospital Anxiety and Depression Scale (HADS). Median regression analysis was used to examine the predictors of patient ratings of migraine severity. Results The mean age for the patients was 42.5 years (SD = 13.2). While 209 (79.4%) patients were females, 177 (67.4%) participants reported “moderately severe” to “extremely severe” migraine on the GAMS, and 100 (31.6%) patients had chronic migraine. Patients’ report of severity on the GAMS was strongly correlated with patients’ ratings of MIDAS global severity question, overall MIDAS score, migraine type, PHQ-9 score, and frequency of migraine attacks. Mediation analyses revealed that MIDAS mediated the effect of depression on patient ratings of migraine severity, accounting for about 32% of the total effect of depression. Overall, migraine subtype, frequency of migraine, employment status, depression, and migraine-related disability were statistically significant predictors of patient-ratings of migraine severity. Conclusions This study highlights the impact of clinical and psychosocial determinants of patient-ratings of migraine severity. GAMS is a brief and valid tool that can be used to assess migraine severity in busy clinical settings.
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Affiliation(s)
- Tolulope T Sajobi
- Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Cumming School of Medicine 3280 Hospital Drive NW Calgary, Calgary, Alberta, T2N 4Z6, Canada.
| | - Farnaz Amoozegar
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Meng Wang
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Natalie Wiebe
- Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Cumming School of Medicine 3280 Hospital Drive NW Calgary, Calgary, Alberta, T2N 4Z6, Canada
| | - Kirsten M Fiest
- Department of Critical Medicine, University of Calgary, Calgary, Canada
| | - Scott B Patten
- Department of Psychiatry, University of Calgary, Calgary, Canada
| | - Nathalie Jette
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
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134
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Kristoffersen ES, Stavem K, Lundqvist C, Russell MB. Impact of chronic headache on workdays, unemployment and disutility in the general population. J Epidemiol Community Health 2019; 73:360-367. [PMID: 30683804 DOI: 10.1136/jech-2018-211127] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 12/04/2018] [Accepted: 12/12/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Data on the socioeconomic burden of chronic headache (≥15 days/last month or >180 days/year) is lacking. This study investigated the impact of chronic headache on sickness absence, unemployment and disutility in the general population in Norway. METHODS 30 000 persons aged 30-44 from the general population were screened for chronic headache by a screening questionnaire. The responder rate was 71%. The International Classification of Headache Disorders was used. We analysed the association of chronic headache with lost workdays, days with ≥50% reduced productivity, sick leave, unemployment and disutility, as assessed with the Short-Form Six-Dimension (SF-6D) in separate regression analyses. RESULTS Eighty-three per cent (427/516, 79% women) of the eligible participants completed the data on workdays and utility. They reported a mean of 9.7 (SD 24.8) workdays lost over the last 3 months, because of headache. The mean disutility score (1-SF-6D score) was 0.41. Thirty-three per cent were on long-term (>1 year) sick leave. The OR for being on sick leave was 1.9 (95% CI 1.1 to 3.2, p=0.017) for those with secondary compared with primary chronic headache. Similarly, the OR for increased number of workdays lost to headache was 3.5 (95% CI 1.8 to 6.5, p<0.001) and for unemployment 1.7 (95% CI 1.0 to 2.9, p=0.07), for those with secondary compared with primary chronic headache. Secondary chronic headache, high headache frequency and high psychological distress were significantly associated with higher disutility score. CONCLUSIONS The burden of chronic headache in the general population is substantial with high rates of lost workdays and disutility.
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Affiliation(s)
- Espen Saxhaug Kristoffersen
- Head and Neck Research Group, Research Centre, Akershus Universitetssykehus HF, Lorenskog, Norway.,Department of General Practice, HELSAM, University of Oslo, Oslo, Norway.,Department of Neurology, Akershus University Hospital, Lorenskog, Norway
| | - Knut Stavem
- Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Oslo, Norway.,Department of Pulmonary Medicine, Medical Division, Akershus University Hospital, Lorenskog, Norway.,HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway
| | - Christofer Lundqvist
- Head and Neck Research Group, Research Centre, Akershus Universitetssykehus HF, Lorenskog, Norway.,Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Oslo, Norway.,HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway.,Department of Neurology, Akershus University Hospital, Lorenskog, Norway
| | - Michael Bjørn Russell
- Head and Neck Research Group, Research Centre, Akershus Universitetssykehus HF, Lorenskog, Norway.,Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Oslo, Norway
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135
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Ruscheweyh R, Pereira D, Hasenbring MI, Straube A. Pain-related avoidance and endurance behaviour in migraine: an observational study. J Headache Pain 2019; 20:9. [PMID: 30658566 PMCID: PMC6734268 DOI: 10.1186/s10194-019-0962-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 01/14/2019] [Indexed: 01/03/2023] Open
Abstract
Background The role of avoidance and endurance behaviour is well established in chronic musculoskeletal pain, but less is known about its significance in migraine. Methods The Avoidance-Endurance Questionnaire behavioural subscales, the Pain Disability Index (PDI), the Migraine Disability Assessment Scale (MIDAS) and the Hospital Anxiety and Depression Scale (HADS) were obtained from 128 migraine patients (90 episodic, 38 chronic). Sixty nine of them were re-evaluated after 3–6 months. Results At baseline, there were positive relations between avoidance (especially social avoidance behaviour) and pain-related disability as assessed by the PDI (Wald χ2 [1] = 32.301, p < 0.001) and the MIDAS (Wald χ2 [1] = 14.387, p < 0.001). A negative relation of endurance behaviour with PDI scores did not survive multiple regression analysis. In addition, there was a positive relation of social avoidance with the HADS depression score (Wald χ2 [1] = 3.938, p = 0.047) and a negative relation of endurance (especially the humour-distraction subscale) with the HADS anxiety score (Wald χ2 [1] = 6.163, p = 0.013). Neither avoidance nor endurance were related to headache intensity or frequency, or to a diagnosis of episodic vs. chronic migraine. 3–6 months after treatment at our headache centre, headache frequency, intensity and pain-related disability were significantly improved (all p < 0.01) while avoidance and endurance were unchanged. Conclusions This indicates that improvement in headache frequency and disability can be achieved in the absence of changes in avoidance or endurance behaviour. However, because of its significant link to headache-related disability, avoidance behaviour (especially social avoidance) should be investigated as a potential additional target of migraine therapy.
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Affiliation(s)
- Ruth Ruscheweyh
- Department of Neurology, Ludwig Maximilians University, Marchioninistr. 15, 81377, Munich, Germany.
| | - Diana Pereira
- Department of Neurology, Ludwig Maximilians University, Marchioninistr. 15, 81377, Munich, Germany.,Department of Anesthesiology and Pain Medicine, Ludwig Maximilians University, Munich, Germany
| | - Monika I Hasenbring
- Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr-University of Bochum, Bochum, Germany
| | - Andreas Straube
- Department of Neurology, Ludwig Maximilians University, Marchioninistr. 15, 81377, Munich, Germany
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Mac Donald CL, Barber J, Patterson J, Johnson AM, Dikmen S, Fann JR, Temkin N. Association Between 5-Year Clinical Outcome in Patients With Nonmedically Evacuated Mild Blast Traumatic Brain Injury and Clinical Measures Collected Within 7 Days Postinjury in Combat. JAMA Netw Open 2019; 2:e186676. [PMID: 30646193 PMCID: PMC6324322 DOI: 10.1001/jamanetworkopen.2018.6676] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Although previous work has examined clinical outcomes in combat-deployed veterans, questions remain regarding how symptoms evolve or resolve following mild blast traumatic brain injury (TBI) treated in theater and their association with long-term outcomes. OBJECTIVE To characterize 5-year outcome in patients with nonmedically evacuated blast concussion compared with combat-deployed controls and understand what clinical measures collected acutely in theater are associated with 5-year outcome. DESIGN, SETTING, AND PARTICIPANTS A prospective, longitudinal cohort study including 45 service members with mild blast TBI within 7 days of injury (mean 4 days) and 45 combat deployed nonconcussed controls was carried out. Enrollment occurred in Afghanistan at the point of injury with evaluation of 5-year outcome in the United States. The enrollment occurred from March to September 2012 with 5-year follow up completed from April 2017 to May 2018. Data analysis was completed from June to July 2018. EXPOSURES Concussive blast TBI. All patients were treated in theater, and none required medical evacuation. MAIN OUTCOMES AND MEASURES Clinical measures collected in theater included measures for concussion symptoms, posttraumatic stress disorder (PTSD) symptoms, depression symptoms, balance performance, combat exposure intensity, cognitive performance, and demographics. Five-year outcome evaluation included measures for global disability, neurobehavioral impairment, PTSD symptoms, depression symptoms, and 10 domains of cognitive function. Forward selection multivariate regression was used to determine predictors of 5-year outcome for global disability, neurobehavior impairment, PTSD, and cognitive function. RESULTS Nonmedically evacuated patients with concussive blast injury (n = 45; 44 men, mean [SD] age, 31 [5] years) fared poorly at 5-year follow-up compared with combat-deployed controls (n = 45; 35 men; mean [SD] age, 34 [7] years) on global disability, neurobehavioral impairment, and psychiatric symptoms, whereas cognitive changes were unremarkable. Acute predictors of 5-year outcome consistently identified TBI diagnosis with contribution from acute concussion and mental health symptoms and select measures of cognitive performance depending on the model for 5-year global disability (area under the curve following bootstrap validation [AUCBV] = 0.79), neurobehavioral impairment (correlation following bootstrap validation [RBV] = 0.60), PTSD severity (RBV = 0.36), or cognitive performance (RBV = 0.34). CONCLUSIONS AND RELEVANCE Service members with concussive blast injuries fared poorly at 5-year outcome. The results support a more focused acute screening of mental health following TBI diagnosis as strong indicators of poor long-term outcome. This extends prior work examining outcome in patients with concussive blast injury to the larger nonmedically evacuated population.
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Affiliation(s)
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle
| | - Jana Patterson
- Department of Neurological Surgery, University of Washington, Seattle
| | - Ann M. Johnson
- Center for Clinical Studies, Washington University, Saint Louis Missouri
| | - Sureyya Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Jesse R. Fann
- Department of Psychiatry, University of Washington, Seattle
| | - Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle
- Department of Biostatistics, University of Washington, Seattle
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137
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Kristoffersen ES, Lundqvist C, Russell MB. Illness perception in people with primary and secondary chronic headache in the general population. J Psychosom Res 2019; 116:83-92. [PMID: 30654999 DOI: 10.1016/j.jpsychores.2018.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 12/02/2018] [Accepted: 12/02/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic headache (headache ≥15 days/month) is a leading cause of disability. Illness perception, beliefs and cognitive models are likely central for patient understanding of their chronic pain condition and are associated with treatment outcome. However, these factors are insufficiently described in chronic headache. OBJECTIVE To describe illness perception, and to explore the effect of background variables and headache characteristics on illness perceptions in primary and secondary chronic headaches in the general population. METHODS 30,000 persons aged 3044 from the general population were screened for chronic headache by a mailed questionnaire. Those with self-reported chronic headache were interviewed by headache specialists. The questionnaire response rate was 71%, and the interview participation rate was 74%. The International Classification of Headache Disorders III was applied. Illness perception was assessed by the Revised Illness Perception Questionnaire (IPQ-R). The statistical approach was exploratory. RESULTS 405 of the 516 eligible participants (78%) completed the IPQ-R. Confirmatory factor analysis showed good internal validity in chronic headache. People believed their chronic headache to be long-lasting, with negative life consequences including emotional distress. Severe headache-related disability was associated with more perception of chronicity, more perceived consequences, emotional load and illness identity and less illness coherence. People with secondary chronic headache scored significantly higher on chronicity and life consequences, and had less personal control than those with primary chronic headache. CONCLUSION Chronic primary and secondary headache is associated with a high symptom burden and chronicity with large perceived negative consequences for daily living, suggesting multidisciplinary management may be necessary.
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Affiliation(s)
- Espen Saxhaug Kristoffersen
- Head and Neck Research Group, Research Centre, Akershus University Hospital, Lørenskog, Norway; Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Christofer Lundqvist
- Head and Neck Research Group, Research Centre, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Nordbyhagen, Norway; HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway; Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Michael Bjørn Russell
- Head and Neck Research Group, Research Centre, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Nordbyhagen, Norway
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138
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Kuca B, Silberstein SD, Wietecha L, Berg PH, Dozier G, Lipton RB. Lasmiditan is an effective acute treatment for migraine: A phase 3 randomized study. Neurology 2018; 91:e2222-e2232. [PMID: 30446595 PMCID: PMC6329326 DOI: 10.1212/wnl.0000000000006641] [Citation(s) in RCA: 164] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 09/17/2018] [Indexed: 01/03/2023] Open
Abstract
Objective To assess the efficacy and safety of lasmiditan in the acute treatment of migraine. Methods Adult patients with migraine were randomized (1:1:1) to a double-blind dose of oral lasmiditan 200 mg, lasmiditan 100 mg, or placebo and were asked to treat their next migraine attack within 4 hours of onset. Over 48 hours after dosing, patients used an electronic diary to record headache pain and the presence of nausea, phonophobia, and photophobia, one of which was designated their most bothersome symptom (MBS). Results Of the 1,856 patients who treated an attack, 77.9% had ≥1 cardiovascular risk factors in addition to migraine. Compared with placebo, more patients dosed with lasmiditan 200 mg were free of headache pain at 2 hours after dosing (32.2% vs 15.3%; odds ratio [OR] 2.6, 95% confidence interval [CI] 2.0–3.6, p< 0.001), similar to those dosed with lasmiditan 100 mg (28.2%; OR 2.2, 95% CI 1.6–3.0, p< 0.001). Furthermore, compared with those dosed with placebo, more patients dosed with lasmiditan 200 mg (40.7% vs 29.5%; OR 1.6, 95% CI 1.3–2.1, p< 0.001) and lasmiditan 100 mg (40.9%; OR 1.7, 95% CI, 1.3–2.2, p< 0.001) were free of their MBS at 2 hours after dosing. Adverse events were mostly mild or moderate in intensity. Conclusions Lasmiditan dosed at 200 and 100 mg was efficacious and well tolerated in the treatment of acute migraine among patients with a high level of cardiovascular risk factors. ClinicalTrials.gov identifier NCT02439320. Classification of evidence This study provides Class I evidence that for adult patients with migraine, lasmiditan increases the proportion of subjects who are headache pain free at 2 hours after treating a migraine attack.
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Affiliation(s)
- Bernice Kuca
- From CoLucid Pharmaceuticals (B.K.), Inc, Cambridge, MA; Thomas Jefferson University (S.D.S.), Philadelphia, PA; Eli Lilly and Company (L.W., P.H.B.), Indianapolis, IN; IQVIA (G.D.), Durham, NC; and Montefiore Headache Center (R.B.L.), Bronx, NY
| | - Stephen D Silberstein
- From CoLucid Pharmaceuticals (B.K.), Inc, Cambridge, MA; Thomas Jefferson University (S.D.S.), Philadelphia, PA; Eli Lilly and Company (L.W., P.H.B.), Indianapolis, IN; IQVIA (G.D.), Durham, NC; and Montefiore Headache Center (R.B.L.), Bronx, NY
| | - Linda Wietecha
- From CoLucid Pharmaceuticals (B.K.), Inc, Cambridge, MA; Thomas Jefferson University (S.D.S.), Philadelphia, PA; Eli Lilly and Company (L.W., P.H.B.), Indianapolis, IN; IQVIA (G.D.), Durham, NC; and Montefiore Headache Center (R.B.L.), Bronx, NY.
| | - Paul H Berg
- From CoLucid Pharmaceuticals (B.K.), Inc, Cambridge, MA; Thomas Jefferson University (S.D.S.), Philadelphia, PA; Eli Lilly and Company (L.W., P.H.B.), Indianapolis, IN; IQVIA (G.D.), Durham, NC; and Montefiore Headache Center (R.B.L.), Bronx, NY
| | - Gregory Dozier
- From CoLucid Pharmaceuticals (B.K.), Inc, Cambridge, MA; Thomas Jefferson University (S.D.S.), Philadelphia, PA; Eli Lilly and Company (L.W., P.H.B.), Indianapolis, IN; IQVIA (G.D.), Durham, NC; and Montefiore Headache Center (R.B.L.), Bronx, NY
| | - Richard B Lipton
- From CoLucid Pharmaceuticals (B.K.), Inc, Cambridge, MA; Thomas Jefferson University (S.D.S.), Philadelphia, PA; Eli Lilly and Company (L.W., P.H.B.), Indianapolis, IN; IQVIA (G.D.), Durham, NC; and Montefiore Headache Center (R.B.L.), Bronx, NY
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Medrano Martínez V, Francés Pont I, Hernández Rubio L, González Fernández L, Fernández Izquierdo S, Mallada Frechin J. Perception of the validity of the Migraine Disability Assessment questionnaire in a population of patients with chronic migraine. Neurologia 2018; 36:S0213-4853(18)30195-6. [PMID: 30455123 DOI: 10.1016/j.nrl.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 09/12/2018] [Accepted: 09/23/2018] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES The Migraine Disability Assessment (MIDAS) questionnaire is the most frequently used instrument for assessing the level of disability in studies into migraine. This study aims to determine the level of completion of the questionnaire, assess the ease of use, and understand patients' subjective perception of the questionnaire's actual ability to measure disability. MATERIAL AND METHODS We performed a prospective study of a sample of 78 patients with chronic migraine, determining their level of education and employment status. In a baseline visit, patients were trained to properly complete the questionnaire. At 3 months, we determined the total score and level of completion. Patients also completed a survey measuring ease of use of the questionnaire and patients' perception of whether the score accurately reflected their disability. RESULTS Only 46% of patients fully completed the questionnaire. Sixty-nine percent reported finding it difficult to complete (this was influenced by patient's employment status but not by educational level). Sixty-two percent of respondents believed that the questionnaire did not fully reflect their own perception of their disability. CONCLUSIONS Although the validity and consistence of the MIDAS questionnaire are well documented, a high percentage of the study population reported finding it difficult to complete; many patients also considered that the questionnaire did not accurately reflect their disability. Understanding patients' opinions of the suitability of questionnaires used in consultation is crucial to improving completion.
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Affiliation(s)
- V Medrano Martínez
- Servicio de Neurología, Hospital Universitario Virgen de la Salud, Elda, Alicante, España.
| | - I Francés Pont
- Servicio de Neurología, Hospital Universitario Virgen de la Salud, Elda, Alicante, España
| | - L Hernández Rubio
- Servicio de Neurología, Hospital Universitario Virgen de la Salud, Elda, Alicante, España
| | - L González Fernández
- Servicio de Neurología, Hospital Universitario Virgen de la Salud, Elda, Alicante, España
| | - S Fernández Izquierdo
- Servicio de Neurología, Hospital Universitario Virgen de la Salud, Elda, Alicante, España
| | - J Mallada Frechin
- Servicio de Neurología, Hospital Universitario Virgen de la Salud, Elda, Alicante, España
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Espí-López GV, Ruescas-Nicolau MA, Nova-Redondo C, Benítez-Martínez JC, Dugailly PM, Falla D. Effect of Soft Tissue Techniques on Headache Impact, Disability, and Quality of Life in Migraine Sufferers: A Pilot Study. J Altern Complement Med 2018; 24:1099-1107. [DOI: 10.1089/acm.2018.0048] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Gemma-Victoria Espí-López
- Department of Physical Therapy, University of Valencia, Valencia, Spain
- Research Unit in Manual Locomotor Therapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | | | | | | | - Pierre-Michel Dugailly
- Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Deborah Falla
- Center of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, United Kingdom
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Sorgenfrei V, Kropp P, Straube A, Ruscheweyh R. High Achievement Motivation is Not Related to Increased Use of Acute Headache Medication in Migraine: A Cross-sectional Observational Cohort Study. Headache 2018; 58:1629-1638. [PMID: 30367817 DOI: 10.1111/head.13431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/17/2018] [Accepted: 07/17/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To determine if migraine patients with high achievement motivation have an increased use of acute headache medication. BACKGROUND It has been hypothesized that high achievement-motivated migraine patients have an increased use of acute headache medication to be able to perform at work and during daily life, putting them at risk for medication overuse headache (MOH). METHODS The Achievement Motivation Inventory and use of acute headache medication were assessed in 117 migraine patients (60 episodic, 57 chronic) at their first appointment at our tertiary headache center. RESULTS Patients with low vs high achievement motivation were not significantly different in acute headache medication days per month (10.8 ± 6.9 vs 10.9 ± 7.8, P = .98), in acute headache medication use in the absence of headache (to prevent occurrence of headache later that day: 51.8% vs 48.2%, P = .38), in having a diagnosis of MOH (37.9 vs 23.7%, P = .12), or in reduction of acute headache medication days at 3 and 6 months follow-up (both P > .20). CONCLUSIONS High achievement motivation in migraine patients was not associated with increased acute headache medication use or more frequent diagnosis of MOH.
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Affiliation(s)
- Verena Sorgenfrei
- Department of Neurology, Ludwig Maximilians University, Munich, Germany.,MVZ für Psychotherapie, Munich, Germany
| | - Peter Kropp
- Institute of Medical Psychology and Medical Sociology, Medical Faculty, University of Rostock, Rostock, Germany
| | - Andreas Straube
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
| | - Ruth Ruscheweyh
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
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Abstract
The Research to Practice Column is designed to improve translational research critique skills of nurse practitioners (NPs). In this issue, the article "Randomized study of IV prochlorperazine plus diphenhydramine vs IV hydromorphone for migraine" is discussed in the context of a patient with an acute headache presenting to the emergency department (ED). The study was designed to assess the efficacy of intravenous prochlorperazine and diphenhydramine as compared with intravenous hydromorphone for patients with acute migraine in the ED. With the growing trend to avoid the use of opiates to curb potential addiction and increased ED length of stay, NPs need to be aware of efficacious, evidence-based treatments for acute migraines, a common ED presentation.
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Lipton RB, Munjal S, Alam A, Buse DC, Fanning KM, Reed ML, Schwedt TJ, Dodick DW. Migraine in America Symptoms and Treatment (MAST) Study: Baseline Study Methods, Treatment Patterns, and Gender Differences. Headache 2018; 58:1408-1426. [PMID: 30341895 DOI: 10.1111/head.13407] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 07/06/2018] [Accepted: 07/06/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To summarize the baseline methods for the Migraine in America Symptoms and Treatment (MAST) Study and evaluate gender differences in sociodemographics and headache features; consultation and diagnosis patterns; and patterns of acute and preventive treatment use for migraine among study participants. BACKGROUND The MAST Study is a longitudinal, internet-based panel study of symptoms, approaches to management, and unmet treatment needs among US adults with migraine. This analysis focuses on the initial cross-sectional survey, conducted beginning in 2016, and is intended to update results from earlier national epidemiologic surveys of people with migraine in the United States. METHODS Respondents to the MAST Study were recruited from a US nationwide online research panel. Stratified random sampling identified a representative cohort of adults (aged ≥18 years). We administered a validated diagnostic screener based on modified ICHD-3 beta criteria to identify individuals with migraine averaging at least 1 monthly headache day (MHD) over the previous 3 months. A baseline assessment evaluated sociodemographic and headache features, patterns of consultation and diagnosis, and use of acute and preventive medications for migraine. Frequency data and chi-square contrasts (P < .05) were used to compare respondents based on gender. RESULTS Baseline survey data (N = 95,821) identified 18,353 respondents who met criteria for migraine, including 15,133 (women n = 11,049, men n = 4084) reporting at least 1 MHD for the preceding 3 months. The mean age of the sample was 43.1 (13.6) years; 73.0% of respondents were women, and 81.0% were Caucasian. Compared with men, women were younger (46.1 vs 42.0 years; P < .001); had more MHDs (5.6 vs 5.3; P < .001); and were more likely to report moderate or severe headache-related disability (45.9% vs 35.8%; P < .001) and cutaneous allodynia (43.7% vs 29.5%; P < .001). The lifetime rate of medical consultation for headache was 79.8% overall and slightly higher in women than in men. Women were more likely than men to have been diagnosed with migraine (48.3% vs 38.8%, P < .001). While 95.1% of people with migraine currently used acute treatment, the majority (58.9%) used over-the-counter (OTC) drugs to the exclusion of prescription drugs, while 11.3% used exclusively prescription drugs, and 20.5% used both. Among acute prescription medication users, women were more likely than men to take triptans (17.7% vs 14.3%, P < .001), while men were more likely than women to take opioids (14.5% vs 9.2%, P < .001). Oral formulations were used predominately (92.7% of the medication users), but men were more likely to use nasal sprays (13.6% vs 9.4%, P < .001) and injectables (7.9% vs 3.4%, P < .001). Men (14.5%) were also significantly more likely than women (10.4%) to be taking daily oral preventive medication (P < .001). CONCLUSIONS The MAST Study identified a large sample of women and men with migraine from a sampling frame that broadly resembles the US population. Low participation rate increases the risk of response bias, however, comparisons with Census data and prior population studies for the demographic and headache characteristics of the current sample suggest that findings are generalizable to the population of people with migraine. Women had more MHDs than men, and they were more likely to report migraine-related disability and cutaneous allodynia. The lifetime consultation rate for headache was relatively high, but many with migraine symptoms reported never having received a diagnosis of migraine from a healthcare professional. Acute prescription and preventive migraine treatments are underused. Migraine persists as an underdiagnosed and undertreated public health problem in 2018, and there are many opportunities to improve the diagnosis and treatment of people with this painful, disabling condition.
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Affiliation(s)
- Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore Medical Center, Bronx, NY, USA.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | | | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
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144
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Suzuki K, Suzuki S, Haruyama Y, Kobashi G, Shiina T, Hirata K. Restless legs syndrome is associated with headache-related disabilities in patients with migraine: a prospective 7-year follow-up study. Eur J Neurol 2018; 26:238-245. [PMID: 30169898 DOI: 10.1111/ene.13796] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/28/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE No prospective study has evaluated the impact of restless legs syndrome (RLS) on clinical factors in patients with migraine. We planned a prospective study to assess the impact of RLS comorbid status on clinical factors in patients with migraine. METHODS A total of 101 patients with migraine who were evaluated for RLS twice at 7-year intervals in a university hospital setting were included in this study. The RLS group was defined as positive for RLS at either baseline or follow-up and the non-RLS group was defined as negative for RLS at both baseline and follow-up. The Migraine Disability Assessment (MIDAS) questionnaire, Beck Depression Inventory-II (BDI-II), Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale were administered to all patients. RESULTS The RLS prevalence was 16.8% at baseline and 20.8% at follow-up. Compared with the non-RLS group (n = 27), the RLS group (n = 74) showed a significantly higher rate of smoking and higher MIDAS and BDI-II scores at 7-year follow-up. A significant reduction in MIDAS and BDI-II scores at 7-year follow-up compared with those at baseline was observed in the non-RLS group, but not in the RLS group. The non-RLS group showed a significantly lower MIDAS score at 7-year follow-up than the RLS group after adjusting for confounding variables such as age, gender, smoking status, Epworth Sleepiness Scale and PSQI scores using analysis of covariance. The persistent RLS group (n = 11) (positive for RLS at both baseline and follow-up) showed a significantly higher rate of smoking and increased MIDAS, BDI-II and PSQI scores compared with the non-RLS group (n = 74) at 7-year follow-up. CONCLUSION Our prospective study showed that RLS had a significant impact on headache-related disability in patients with migraine.
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Affiliation(s)
- K Suzuki
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - S Suzuki
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Y Haruyama
- Department of Public Health School of Medicine, Dokkyo Medical University, Tochigi, Japan
| | - G Kobashi
- Department of Public Health School of Medicine, Dokkyo Medical University, Tochigi, Japan
| | - T Shiina
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - K Hirata
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
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Vasudha MS, Manjunath NK, Nagendra HR. Changes in MIDAS, Perceived Stress, Frontalis Muscle Activity and Non-Steroidal Anti-Inflammatory Drugs Usage in Patients with Migraine Headache without Aura following Ayurveda and Yoga Compared to Controls: An Open Labeled Non-Randomized Study. Ann Neurosci 2018; 25:250-260. [PMID: 31000965 DOI: 10.1159/000492269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/19/2018] [Indexed: 01/03/2023] Open
Abstract
Background There has been a significant increase in the use of complementary and integrative medicine to provide long-term healing solutions in migraine headache patients. Knowing the limitations of conventional medical approach, the present study evaluated the influence of two Indian traditional systems of medicine on migraine-related disability, autonomic variables, perceived stress, and muscle activity in patients with migraine headache without aura. Methods Thirty subjects recruited to the Ayurveda and Yoga (AY) group underwent traditional Panchakarma (Bio-purification) using therapeutic Purgation followed by yoga therapy, while 30 subjects of control (CT) group continued on symptomatic treatment (non-steroidal anti-inflammatory drugs [NSAID's]) for 90 days. Migraine disability assessment score, perceived stress, heart rate variability (HRV), and surface electromyography (EMG) of frontalis muscle were measured on day 1, day 30, and day 90 in both groups. Results Significant reduction in migraine disability and perceived stress scores were observed in the AY group. The low-frequency component of the HRV decreased significantly, the high-frequency component increased and their ratio showed improved sympathovagal balance. The EMG showed decreased activity of the frontalis muscle in the AY group compared to the control group. Conclusion The integrative approach combining Ayurveda and Yoga therapy reduces migraine-related disability, perceived stress, sympathetic arousal, and muscle tension.
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Affiliation(s)
- M S Vasudha
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA) A Deemed to be University, Bengaluru, India
| | - N K Manjunath
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA) A Deemed to be University, Bengaluru, India
| | - H R Nagendra
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA) A Deemed to be University, Bengaluru, India
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146
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Raggi A, Covelli V, Guastafierro E, Leonardi M, Scaratti C, Grazzi L, Bartolini M, Viticchi G, Cevoli S, Pierangeli G, Tedeschi G, Russo A, Barbanti P, Aurilia C, Lovati C, Giani L, Frediani F, Di Fiore P, Bono F, Rapisarda L, D'Amico D. Validation of a self-reported instrument to assess work-related difficulties in patients with migraine: the HEADWORK questionnaire. J Headache Pain 2018; 19:85. [PMID: 30203193 PMCID: PMC6131677 DOI: 10.1186/s10194-018-0914-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/04/2018] [Indexed: 01/03/2023] Open
Abstract
Background The degree to which work-related difficulties are recognized in headache research is poor and often carried out with inadequate information such as “reduced ability to work as usual”, which do not capture at all the variety of difficulties and the factors that impact over them. The aim of this paper is to present the validation of the HEADWORK questionnaire, which addresses the amount and severity of difficulties in work-related tasks and the factors that impact over them. Methods We developed a set of items based on a previous literature review and patients’ focus groups and tested it on a wide set of patients with episodic and chronic migraine attending eight different Italian headache centers. HEADWORK factor structure was assessed with exploratory and confirmatory factor analysis; internal consistency and construct validity were addressed as well. Results The validation sample (N = 373) was mostly composed of patients with episodic migraine without aura (64.3%) and of females (81%). Factor analysis retrieved two different scales: “Work-related difficulties”, composed of eleven items which explain 67.1% of the total variance, and “Factors contributing to work difficulties”, composed of six items which explain 52.1% of the total variance. Both HEADWORK subscales have good measurement properties, with higher scores being associated to higher disability, lower quality of life, lower productivity, higher headache frequency and pain intensity. Conclusions HEADWORK is a 17-item, two-scale questionnaire addressing the impact of migraine on work-related difficulties in terms of difficulties in general or specific skills, and the factors contributing to these difficulties, defined as negative impact on work tasks. It can be used to address disability weights for the purpose of calculating the burden of migraine, and to assess the balance between therapeutic and side effects of medication on productivity. Electronic supplementary material The online version of this article (10.1186/s10194-018-0914-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
| | | | - Erika Guastafierro
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Chiara Scaratti
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Licia Grazzi
- Headache and Neuroalgology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marco Bartolini
- Clinica di Neurologia, Università Politecnica delle Marche, Ancona, Italy
| | - Giovanna Viticchi
- Clinica di Neurologia, Università Politecnica delle Marche, Ancona, Italy
| | - Sabina Cevoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giulia Pierangeli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,DIBINEM - Alma Mater Studiorum, Università di Bologna, Bologna, Italy
| | - Gioacchino Tedeschi
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Russo
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Piero Barbanti
- Headache and Pain Unit, Department of Neurological, Motor and Sensorial Sciences. IRCCS San Raffaele Pisana, Rome, Italy.,San Raffaele University, Rome, Italy
| | - Cinzia Aurilia
- Headache and Pain Unit, Department of Neurological, Motor and Sensorial Sciences. IRCCS San Raffaele Pisana, Rome, Italy
| | - Carlo Lovati
- Neurology Unit, Headache Center, Ospedale L, Sacco University of Milan, Milan, Italy
| | - Luca Giani
- Neurology Unit, Headache Center, Ospedale L, Sacco University of Milan, Milan, Italy
| | - Fabio Frediani
- Neurological and Stroke Unit Department, Headache Center, ASST Santi Paolo e Carlo, San Carlo Borromeo Hospital, Milan, Italy
| | - Paola Di Fiore
- Neurological and Stroke Unit Department, Headache Center, ASST Santi Paolo e Carlo, San Carlo Borromeo Hospital, Milan, Italy
| | - Francesco Bono
- Headache Center, Institute of Neurology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Laura Rapisarda
- Headache Center, Institute of Neurology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Domenico D'Amico
- Headache and Neuroalgology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Kristoffersen ES, Aaseth K, Grande RB, Lundqvist C, Russell MB. Psychological distress, neuroticism and disability associated with secondary chronic headache in the general population - the Akershus study of chronic headache. J Headache Pain 2018; 19:62. [PMID: 30116914 PMCID: PMC6095768 DOI: 10.1186/s10194-018-0894-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 07/24/2018] [Indexed: 11/16/2022] Open
Abstract
Background Primary headaches are associated with psychological distress, neuroticism and disability. However, little is known about headache-related disability and psychological distress among people with secondary chronic headaches. Methods 30,000 persons aged 30–44 from the general population was screened for headache by a questionnaire. The responder rate was 71%. The International Classification of Headache Disorders with supplementary definitions for chronic rhinosinusitis and cervicogenic headache were used. The Hopkins Symptom Checklist-25 assessed high psychological distress, the Migraine Disability Assessment questionnaire assessed disability, and Eysenck Personality Questionnaire assessed neuroticism. Results Ninety-five of the 113 eligible participants (84%) completed the self-reported questionnaire. A total of 38 people had chronic post-traumatic headache, 21 had cervicogenic headache, and 39 had headache attributed to chronic rhinosinusitis, while 9 had co-occurrence of chronic post-traumatic and cervicogenic headache. Six persons had miscellaneous secondary chronic headaches. Overall, 49% of those with secondary chronic headache reported high psychological distress, which is significantly higher than in the general population. A high level of neuroticism was significantly more common in those with secondary chronic headache than in the general population. Severe headache-related disability was reported by 69%. 92 persons were followed up after 3 years. A low headache frequency was the only significant predictor of improvement of ≥ 25% in headache days. Having post-traumatic or cervicogenic headache and not headache attributed to chronic rhinosinusitis predicted an increased risk > 25% worsening of headache days or having a severe disability at 3 years follow-up. Conclusion Psychological distress and neuroticism were more common among people with secondary chronic headache than in the general population. Only a high headache frequency was significantly associated with increased headache disability at baseline and a poor prognosis in the long term.
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Affiliation(s)
- Espen Saxhaug Kristoffersen
- Department of General Practice, Institute of Health and Society, University of Oslo, Box 1130 Blindern, 0318, Oslo, PO, Norway. .,Head and Neck Research Group, Research Centre, Akershus University Hospital, Lørenskog, Norway.
| | - Kjersti Aaseth
- Head and Neck Research Group, Research Centre, Akershus University Hospital, Lørenskog, Norway
| | - Ragnhild Berling Grande
- Head and Neck Research Group, Research Centre, Akershus University Hospital, Lørenskog, Norway.,The National Center for Epilepsy, Oslo University Hospital, Oslo, Norway
| | - Christofer Lundqvist
- Head and Neck Research Group, Research Centre, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Nordbyhagen, Norway.,HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway.,Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Michael Bjørn Russell
- Head and Neck Research Group, Research Centre, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Nordbyhagen, Norway
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148
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Sirri L, Pierangeli G, Cevoli S, Cortelli P, Grandi S, Tossani E. Illness perception in patients with migraine: An exploratory study in a tertiary care headache centre. J Psychosom Res 2018; 111:52-57. [PMID: 29935755 DOI: 10.1016/j.jpsychores.2018.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/18/2018] [Accepted: 05/18/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Illness perception is significantly related to several outcome measures in different medical conditions. However, little is known about headache-related causal attributions and cognitive and emotional representations in patients with migraine. OBJECTIVE To examine perceived causes of headache and demographic, clinical, and psychological correlates and predictors of illness perception in patients with migraine attending a tertiary care headache centre. METHODS A sample of 143 patients with migraine (85.3% women, mean age 44.0 ± 12.1 years) completed the Brief Illness Perception Questionnaire (Brief IPQ), the Symptom Questionnaire (SQ), and the Migraine Disability Assessment (MIDAS) Questionnaire. A set of demographic and clinical characteristics was also collected. RESULTS Stress, heredity, and nervousness were the most frequent perceived causes of headache. Female gender was significantly related to higher Brief IPQ "consequences" and "emotional response" scores. Increased psychological distress and a poorer clinical course were significantly associated with more negative illness representations. In multiple regression analysis, a longer illness duration, increased depressive symptoms, and higher levels of headache-related disability and painfulness of headache attacks independently predicted a worse illness perception. CONCLUSIONS In patients with migraine, depressive symptoms and a worse disease status, characterized by a longer history of suffering, higher disability and more painful headache attacks, may negatively affect illness perception. It could also be that dysfunctional illness representations lead to depressive symptoms and decrease patients' motivation to adhere to treatments, resulting in a worse outcome. Future studies should examine whether the improvement of illness perception through specific psychological interventions may promote a better adaptation to migraine.
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Affiliation(s)
- Laura Sirri
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy.
| | - Giulia Pierangeli
- Department of Biomedical and NeuroMotor Sciences - DiBiNeM, University of Bologna, Bologna, Italy; IRCCS Institute of Neurological Sciences of Bologna - AUSL Bologna, Bologna, Italy.
| | - Sabina Cevoli
- Department of Biomedical and NeuroMotor Sciences - DiBiNeM, University of Bologna, Bologna, Italy; IRCCS Institute of Neurological Sciences of Bologna - AUSL Bologna, Bologna, Italy.
| | - Pietro Cortelli
- Department of Biomedical and NeuroMotor Sciences - DiBiNeM, University of Bologna, Bologna, Italy; IRCCS Institute of Neurological Sciences of Bologna - AUSL Bologna, Bologna, Italy.
| | - Silvana Grandi
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy.
| | - Eliana Tossani
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy.
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149
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Whealy M, Nanda S, Vincent A, Mandrekar J, Cutrer FM. Fibromyalgia in migraine: a retrospective cohort study. J Headache Pain 2018; 19:61. [PMID: 30066109 PMCID: PMC6068065 DOI: 10.1186/s10194-018-0892-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 07/20/2018] [Indexed: 01/02/2023] Open
Abstract
Background Migraine is a common and disabling disorder. Fibromyalgia has been shown to be commonly comorbid in patients with migraine and can intensify disability. The aim of this study was to determine if patients with co-morbid fibromyalgia and migraine report more depressive symptoms, have more headache related disability, or report higher intensity of headache as compared to patients with migraine only. Cases of comorbid fibromyalgia and migraine were identified using a prospectively maintained headache database at Mayo Clinic Rochester. One-hundred and fifty seven cases and 471 controls were identified using this database and the Mayo Clinic electronic medical record. Findings Depressive symptoms as assessed by PHQ-9, intensity of headache, and migraine related disability as assessed by MIDAS were primary measures used to compare migraine patients with comorbid fibromyalgia versus those without. Patients with comorbid fibromyalgia reported significantly higher PHQ-9 scores (OR 1.08, p < .0001) and headache intensity scores (OR 1.149, p = .007). There was no significant difference in migraine related disability (OR 1.002, p = .075). Patients with fibromyalgia were more likely to score in a higher category of depression severity (OR 1.467, p < .0001) and more likely to score in a higher category of migraine related disability (OR 1.23, p = .004). Conclusion Patients with comorbid fibromyalgia and migraine report more depressive symptoms, higher headache intensity, and are more likely to have severe headache related disability as compared to controls without fibromyalgia. Clinicians who care for patients with migraine may consider screening for comorbid fibromyalgia particularly in patients with moderate to severe depressive symptoms, high headache intensity and/or high headache related disability. This is the first matched study to look at these characterisitcs, and it replicates previous findings from unmatched studies.
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Affiliation(s)
- Mark Whealy
- Department of Neurology, Division of Headache, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Sanjeev Nanda
- Department of Medicine, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA
| | - Ann Vincent
- Department of Medicine, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jay Mandrekar
- Department of Health Sciences Research, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA
| | - F Michael Cutrer
- Department of Neurology, Division of Headache, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA
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Lipton RB, Fanning KM, Buse DC, Martin VT, Reed ML, Manack Adams A, Goadsby PJ. Identifying Natural Subgroups of Migraine Based on Comorbidity and Concomitant Condition Profiles: Results of the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study. Headache 2018; 58:933-947. [DOI: 10.1111/head.13342] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2018] [Indexed: 01/07/2023]
Affiliation(s)
- Richard B. Lipton
- Montefiore Headache Center; Bronx NY USA
- Albert Einstein College of Medicine; Bronx NY USA
| | | | - Dawn C. Buse
- Albert Einstein College of Medicine; Bronx NY USA
| | - Vincent T. Martin
- University of Cincinnati Headache and Facial Pain Center, University of Cincinnati College of Medicine; Cincinnati OH USA
| | | | | | - Peter J. Goadsby
- NIHR-Wellcome Trust King's Clinical Research Facility, King's College London; London UK
- Department of Neurology; University of California, San Francisco; San Francisco CA USA
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