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Gibler RC, Marzouk MA, Peugh J, Reidy BL, Ernst MM, Daffin ML, Powers SW, Kabbouche Samaha M, Kacperski J, Hershey AD, O'Brien H, Slater SK. Clinic-Based Characterization of Adolescents and Young Adults With Migraine: Psychological Functioning, Headache Days, and Disability. Neurol Clin Pract 2024; 14:e200294. [PMID: 38682006 PMCID: PMC11052567 DOI: 10.1212/cpj.0000000000200294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/24/2024] [Indexed: 05/01/2024]
Abstract
Background and Objectives This cross-sectional observational study retrospectively examined clinical data collected from adolescents and young adults (AYAs) seeking care in a specialty headache clinic. We characterized participants' headache characteristics and psychological functioning and examined the association between self-reported anxiety and depressive symptoms and headache frequency, severity, and disability. Methods During their clinic visit, AYAs (M age = 18.36; range = 14-32, 79.5% female) completed an intake questionnaire and reported about their headache characteristics (i.e., frequency, severity, and duration of symptoms in months), mental health history (i.e., previous diagnosis of an anxiety or depressive disorder), and utilization of emergency department (ED) services for migraine. AYAs also completed psychometrically validated screening tools for anxiety and depressive symptoms (i.e., the GAD-7 and PHQ-9). We computed descriptive statistics and examined associations among scores on psychological measures and headache characteristics, including migraine-related disability. We also tested whether individuals with clinically elevated GAD-7 and PHQ-9 scores had higher levels of disability relative to those with fewer/subclinical levels of anxiety and depressive symptoms. Results Participants (N = 283) reported more than 19 headache days per month on average, with more than 90% describing their average headache intensity as moderate or severe. Nearly half of AYAs reported severe headache-related disability. Approximately one-quarter of AYAs reported a previous diagnosis anxiety or depressive disorder diagnosis, and more than one-third scored above clinical cutoffs on the PHQ-9 and GAD-7. Higher scores on both psychological screening instruments were associated with greater headache frequency. More than 10% of patients endorsed current suicidal ideation; this was not related to headache-related disability. Participants reported a high degree of ED utilization for headache; these rates were unrelated to endorsement of psychological comorbidities. Discussion In this sample of AYAs, headache characteristics were generally unrelated to scores on measures on psychological functioning. However, the observed rates of clinically elevated anxiety/depressive symptoms and suicidality in this sample of AYAs underscore the importance of screening for psychological comorbidities in neurology clinics that serve this age group, irrespective of self-reported disability. Results also emphasize the need to expand access to behavioral health services for AYAs with headache disorders and the importance of incorporating a biopsychosocial perspective to the transition of health care from pediatrics to adult neurology practice.
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Affiliation(s)
- Robert C Gibler
- Division of Behavioral Medicine and Clinical Psychology (RCG, MAM, JP, BLR, MME, SWP, SKS); Headache Center (RCG, MAM, BLR, SWP, MKS, JK, ADH, SKS), Cincinnati Children's Hospital Medical Center; now with the Department of Pediatrics (RCG), University of Kansas Medical Center, Kansas City, KS; Department of Pediatrics (JP, BLR, MME, SWP, MKS, JK, ADH, SKS), University of Cincinnati College of Medicine, OH; Clinical Child and Adolescent Psychology (MLD), Norton Children's Hospital; University of Louisville School of Medicine (MLD), KY; Division of Neurology (MKS, JK, ADH), Cincinnati Children's Hospital Medical Center; and Headache Center of Hope (HOB), Cincinnati, OH
| | - Maya A Marzouk
- Division of Behavioral Medicine and Clinical Psychology (RCG, MAM, JP, BLR, MME, SWP, SKS); Headache Center (RCG, MAM, BLR, SWP, MKS, JK, ADH, SKS), Cincinnati Children's Hospital Medical Center; now with the Department of Pediatrics (RCG), University of Kansas Medical Center, Kansas City, KS; Department of Pediatrics (JP, BLR, MME, SWP, MKS, JK, ADH, SKS), University of Cincinnati College of Medicine, OH; Clinical Child and Adolescent Psychology (MLD), Norton Children's Hospital; University of Louisville School of Medicine (MLD), KY; Division of Neurology (MKS, JK, ADH), Cincinnati Children's Hospital Medical Center; and Headache Center of Hope (HOB), Cincinnati, OH
| | - James Peugh
- Division of Behavioral Medicine and Clinical Psychology (RCG, MAM, JP, BLR, MME, SWP, SKS); Headache Center (RCG, MAM, BLR, SWP, MKS, JK, ADH, SKS), Cincinnati Children's Hospital Medical Center; now with the Department of Pediatrics (RCG), University of Kansas Medical Center, Kansas City, KS; Department of Pediatrics (JP, BLR, MME, SWP, MKS, JK, ADH, SKS), University of Cincinnati College of Medicine, OH; Clinical Child and Adolescent Psychology (MLD), Norton Children's Hospital; University of Louisville School of Medicine (MLD), KY; Division of Neurology (MKS, JK, ADH), Cincinnati Children's Hospital Medical Center; and Headache Center of Hope (HOB), Cincinnati, OH
| | - Brooke L Reidy
- Division of Behavioral Medicine and Clinical Psychology (RCG, MAM, JP, BLR, MME, SWP, SKS); Headache Center (RCG, MAM, BLR, SWP, MKS, JK, ADH, SKS), Cincinnati Children's Hospital Medical Center; now with the Department of Pediatrics (RCG), University of Kansas Medical Center, Kansas City, KS; Department of Pediatrics (JP, BLR, MME, SWP, MKS, JK, ADH, SKS), University of Cincinnati College of Medicine, OH; Clinical Child and Adolescent Psychology (MLD), Norton Children's Hospital; University of Louisville School of Medicine (MLD), KY; Division of Neurology (MKS, JK, ADH), Cincinnati Children's Hospital Medical Center; and Headache Center of Hope (HOB), Cincinnati, OH
| | - Michelle M Ernst
- Division of Behavioral Medicine and Clinical Psychology (RCG, MAM, JP, BLR, MME, SWP, SKS); Headache Center (RCG, MAM, BLR, SWP, MKS, JK, ADH, SKS), Cincinnati Children's Hospital Medical Center; now with the Department of Pediatrics (RCG), University of Kansas Medical Center, Kansas City, KS; Department of Pediatrics (JP, BLR, MME, SWP, MKS, JK, ADH, SKS), University of Cincinnati College of Medicine, OH; Clinical Child and Adolescent Psychology (MLD), Norton Children's Hospital; University of Louisville School of Medicine (MLD), KY; Division of Neurology (MKS, JK, ADH), Cincinnati Children's Hospital Medical Center; and Headache Center of Hope (HOB), Cincinnati, OH
| | - Morgan L Daffin
- Division of Behavioral Medicine and Clinical Psychology (RCG, MAM, JP, BLR, MME, SWP, SKS); Headache Center (RCG, MAM, BLR, SWP, MKS, JK, ADH, SKS), Cincinnati Children's Hospital Medical Center; now with the Department of Pediatrics (RCG), University of Kansas Medical Center, Kansas City, KS; Department of Pediatrics (JP, BLR, MME, SWP, MKS, JK, ADH, SKS), University of Cincinnati College of Medicine, OH; Clinical Child and Adolescent Psychology (MLD), Norton Children's Hospital; University of Louisville School of Medicine (MLD), KY; Division of Neurology (MKS, JK, ADH), Cincinnati Children's Hospital Medical Center; and Headache Center of Hope (HOB), Cincinnati, OH
| | - Scott W Powers
- Division of Behavioral Medicine and Clinical Psychology (RCG, MAM, JP, BLR, MME, SWP, SKS); Headache Center (RCG, MAM, BLR, SWP, MKS, JK, ADH, SKS), Cincinnati Children's Hospital Medical Center; now with the Department of Pediatrics (RCG), University of Kansas Medical Center, Kansas City, KS; Department of Pediatrics (JP, BLR, MME, SWP, MKS, JK, ADH, SKS), University of Cincinnati College of Medicine, OH; Clinical Child and Adolescent Psychology (MLD), Norton Children's Hospital; University of Louisville School of Medicine (MLD), KY; Division of Neurology (MKS, JK, ADH), Cincinnati Children's Hospital Medical Center; and Headache Center of Hope (HOB), Cincinnati, OH
| | - Marielle Kabbouche Samaha
- Division of Behavioral Medicine and Clinical Psychology (RCG, MAM, JP, BLR, MME, SWP, SKS); Headache Center (RCG, MAM, BLR, SWP, MKS, JK, ADH, SKS), Cincinnati Children's Hospital Medical Center; now with the Department of Pediatrics (RCG), University of Kansas Medical Center, Kansas City, KS; Department of Pediatrics (JP, BLR, MME, SWP, MKS, JK, ADH, SKS), University of Cincinnati College of Medicine, OH; Clinical Child and Adolescent Psychology (MLD), Norton Children's Hospital; University of Louisville School of Medicine (MLD), KY; Division of Neurology (MKS, JK, ADH), Cincinnati Children's Hospital Medical Center; and Headache Center of Hope (HOB), Cincinnati, OH
| | - Joanne Kacperski
- Division of Behavioral Medicine and Clinical Psychology (RCG, MAM, JP, BLR, MME, SWP, SKS); Headache Center (RCG, MAM, BLR, SWP, MKS, JK, ADH, SKS), Cincinnati Children's Hospital Medical Center; now with the Department of Pediatrics (RCG), University of Kansas Medical Center, Kansas City, KS; Department of Pediatrics (JP, BLR, MME, SWP, MKS, JK, ADH, SKS), University of Cincinnati College of Medicine, OH; Clinical Child and Adolescent Psychology (MLD), Norton Children's Hospital; University of Louisville School of Medicine (MLD), KY; Division of Neurology (MKS, JK, ADH), Cincinnati Children's Hospital Medical Center; and Headache Center of Hope (HOB), Cincinnati, OH
| | - Andrew D Hershey
- Division of Behavioral Medicine and Clinical Psychology (RCG, MAM, JP, BLR, MME, SWP, SKS); Headache Center (RCG, MAM, BLR, SWP, MKS, JK, ADH, SKS), Cincinnati Children's Hospital Medical Center; now with the Department of Pediatrics (RCG), University of Kansas Medical Center, Kansas City, KS; Department of Pediatrics (JP, BLR, MME, SWP, MKS, JK, ADH, SKS), University of Cincinnati College of Medicine, OH; Clinical Child and Adolescent Psychology (MLD), Norton Children's Hospital; University of Louisville School of Medicine (MLD), KY; Division of Neurology (MKS, JK, ADH), Cincinnati Children's Hospital Medical Center; and Headache Center of Hope (HOB), Cincinnati, OH
| | - Hope O'Brien
- Division of Behavioral Medicine and Clinical Psychology (RCG, MAM, JP, BLR, MME, SWP, SKS); Headache Center (RCG, MAM, BLR, SWP, MKS, JK, ADH, SKS), Cincinnati Children's Hospital Medical Center; now with the Department of Pediatrics (RCG), University of Kansas Medical Center, Kansas City, KS; Department of Pediatrics (JP, BLR, MME, SWP, MKS, JK, ADH, SKS), University of Cincinnati College of Medicine, OH; Clinical Child and Adolescent Psychology (MLD), Norton Children's Hospital; University of Louisville School of Medicine (MLD), KY; Division of Neurology (MKS, JK, ADH), Cincinnati Children's Hospital Medical Center; and Headache Center of Hope (HOB), Cincinnati, OH
| | - Shalonda K Slater
- Division of Behavioral Medicine and Clinical Psychology (RCG, MAM, JP, BLR, MME, SWP, SKS); Headache Center (RCG, MAM, BLR, SWP, MKS, JK, ADH, SKS), Cincinnati Children's Hospital Medical Center; now with the Department of Pediatrics (RCG), University of Kansas Medical Center, Kansas City, KS; Department of Pediatrics (JP, BLR, MME, SWP, MKS, JK, ADH, SKS), University of Cincinnati College of Medicine, OH; Clinical Child and Adolescent Psychology (MLD), Norton Children's Hospital; University of Louisville School of Medicine (MLD), KY; Division of Neurology (MKS, JK, ADH), Cincinnati Children's Hospital Medical Center; and Headache Center of Hope (HOB), Cincinnati, OH
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Broder JS, Oliveira J E Silva L, Bellolio F, Freiermuth CE, Griffey RT, Hooker E, Jang TB, Meltzer AC, Mills AM, Pepper JD, Prakken SD, Repplinger MD, Upadhye S, Carpenter CR. Guidelines for Reasonable and Appropriate Care in the Emergency Department 2 (GRACE-2): Low-risk, recurrent abdominal pain in the emergency department. Acad Emerg Med 2022; 29:526-560. [PMID: 35543712 DOI: 10.1111/acem.14495] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/18/2022] [Accepted: 03/19/2022] [Indexed: 02/07/2023]
Abstract
This second Guideline for Reasonable and Appropriate Care in the Emergency Department (GRACE-2) from the Society for Academic Emergency Medicine is on the topic "low-risk, recurrent abdominal pain in the emergency department." The multidisciplinary guideline panel applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of evidence and strength of recommendations regarding four priority questions for adult emergency department patients with low-risk, recurrent, undifferentiated abdominal pain. The intended population includes adults with multiple similar presentations of abdominal signs and symptoms recurring over a period of months or years. The panel reached the following recommendations: (1) if a prior negative computed tomography of the abdomen and pelvis (CTAP) has been performed within 12 months, there is insufficient evidence to accurately identify populations in whom repeat CTAP imaging can be safely avoided or routinely recommended; (2) if CTAP with IV contrast is negative, we suggest against ultrasound unless there is concern for pelvic or biliary pathology; (3) we suggest that screening for depression and/or anxiety may be performed during the ED evaluation; and (4) we suggest an opioid-minimizing strategy for pain control. EXECUTIVE SUMMARY: The GRACE-2 writing group developed clinically relevant questions to address the care of adult patients with low-risk, recurrent, previously undifferentiated abdominal pain in the emergency department (ED). Four patient-intervention-comparison-outcome-time (PICOT) questions were developed by consensus of the writing group, who performed a systematic review of the literature and then synthesized direct and indirect evidence to formulate recommendations, following GRADE methodology. The writing group found that despite the commonality and relevance of these questions in emergency care, the quantity and quality of evidence were very limited, and even fundamental definitions of the population and outcomes of interest are lacking. Future research opportunities include developing precise and clinically relevant definitions of low-risk, recurrent, undifferentiated abdominal pain and determining the scope of the existing populations in terms of annual national ED visits for this complaint, costs of care, and patient and provider preferences.
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Affiliation(s)
- Joshua S Broder
- Department of Surgery, Division of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Fernanda Bellolio
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Caroline E Freiermuth
- Department of Emergency Medicine, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Richard T Griffey
- Department of Emergency Medicine and Emergency Care Research Core, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Edmond Hooker
- Department of Health Services Administration, Xavier University, Cincinnati, Ohio, USA
| | - Timothy B Jang
- Department of Emergency Medicine, University of California Los Angeles, UCLA Santa Monica Medical Center, Torrance, California, USA
| | - Andrew C Meltzer
- Department of Emergency Medicine, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Angela M Mills
- Department of Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA.,Society for Academic Emergency Medicine, Des Plaines, Illinois, USA
| | | | | | - Michael D Repplinger
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Suneel Upadhye
- Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Christopher R Carpenter
- Department of Emergency Medicine and Emergency Care Research Core, Washington University School of Medicine, St. Louis, Missouri, USA.,Society for Academic Emergency Medicine, Des Plaines, Illinois, USA
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