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Nyberg J, Rosenbacke R, Ben-Menachem E. Digital clinics for diagnosing and treating migraine. Curr Opin Support Palliat Care 2024:01263393-990000000-00082. [PMID: 38990711 DOI: 10.1097/spc.0000000000000715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
PURPOSE OF REVIEW Several innovative digital technologies have begun to be applied to diagnosing and treating migraine. We reviewed the potential benefits and opportunities from delivering migraine care through comprehensive digital clinics. RECENT FINDINGS There are increasing applications of digitization to migraine diagnosis and management, including e-diaries, and patient self-management, especially after the COVID-19 pandemic. Digital care delivery appears to better engage chronic migraine sufferers who may struggle to present to physical clinics. SUMMARY Digital clinics appear to be a promising treatment modality for patients with chronic migraine. They potentially minimize travel time, shorten waiting periods, improve usability, and increase access to neurologists. Additionally, they have the potential to provide care at a much lower cost than traditional physical clinics. However, the current state of evidence mostly draws on case-reports, suggesting a need for future randomized trials comparing digital interventions with standard care pathways.
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Affiliation(s)
- Johan Nyberg
- Stortorgets neurologmottagning, Helsingborg, Sweden
| | - Rikard Rosenbacke
- Centre for Corporate Governance, Department of Accounting, Copenhagen Business School, Copenhagen, Denmark
| | - Elinor Ben-Menachem
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Sweden
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Niiberg-Pikksööt T, Laas K, Aluoja A, Braschinsky M. Implementing a digital solution for patients with migraine-Developing a methodology for comparing digitally delivered treatment with conventional treatment: A study protocol. PLOS DIGITAL HEALTH 2024; 3:e0000295. [PMID: 38421955 PMCID: PMC10903846 DOI: 10.1371/journal.pdig.0000295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 01/18/2024] [Indexed: 03/02/2024]
Abstract
Migraine is one of the most frequent and expensive neurological disease in the world. Non-pharmacological and digitally administered treatment options have long been used in the treatment of chronic pain and mental illness. Digital solutions increase the patients' possibilities of receiving evidence-based treatment even when conventional treatment options are limited. The main goal of the study is to assess the efficacy of interdisciplinary digital interventions compared to conventional treatment. The maximum number of participants in this multi-centre, open-label, prospective, randomized study is 600, divided into eight treatment groups. The participants will take part in either a conventional or a digital intervention, performing various tests and interdisciplinary tasks. The primary outcome is expected to be a reduction in the number of headache days. We also undertake to measure various other headache-related burdens as a secondary outcome. The sample size, digital interventions not conducted via video calls, the lack of human connection, limited intervention program, and the conducting of studies only in digitally sophisticated countries are all significant limitations. However, we believe that digitally mediated treatment options are at least as effective as traditional treatment options while also allowing for a significantly higher patient throughput. The future of chronic disease treatment is remote monitoring and high-quality digitally mediated interventions.The study is approved by the Ethics Committee of the University of Tartu for Human Research (Permission No. 315T-17, 10.08.2020) and is registered at ClinicalTrials.gov: NTC05458817 (14.07.2022).
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Affiliation(s)
- Triinu Niiberg-Pikksööt
- Neurosciences, Institute of Clinical Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia
- Headache Clinic, Department of Neurology, Tartu University Hospital, Tartu, Estonia
- Migrevention OÜ, Tallinn, Estonia
| | - Kariina Laas
- Institute of Psychology, University of Tartu, Tartu, Estonia
| | - Anu Aluoja
- Department of Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia
- Psychiatry Clinic, Tartu University Hospital, Tartu, Estonia
| | - Mark Braschinsky
- Headache Clinic, Department of Neurology, Tartu University Hospital, Tartu, Estonia
- Migrevention OÜ, Tallinn, Estonia
- Neurology Clinic, University of Tartu, Tartu, Estonia
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Minen M, George A, Lebowitz N, Katara A, Snyder I. Headache providers' perspectives of headache diaries in the era of increasing technology use: a qualitative study. Front Neurol 2024; 14:1270555. [PMID: 38322798 PMCID: PMC10844531 DOI: 10.3389/fneur.2023.1270555] [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: 07/31/2023] [Accepted: 12/31/2023] [Indexed: 02/08/2024] Open
Abstract
Background No matter what type of headache is being considered across various populations, one of the mainstays of headache medicine is headache tracking. This self-management tool enables patients and their providers to understand patients' underlying symptoms and the effects of treatments they have tried. This is important to determining whether headaches are related to menses for women's health, to determining the time of headache occurrence, e.g., hypnic headache, and the location and duration of symptoms, e.g., trigeminal autonomic cephalgia. Prior research has investigated what people with headaches perceive about headache diary use and how people with headaches utilize electronic headache diaries. However, headache providers' perspectives on the important factors related to headache diaries are less known. Previously, using the Modified Delphi Process, a panel of four experts opined what they perceived as the most important factors for a headache diary. We sought to better understand headache providers' perspectives about headache diary/app usage from providers working in various institutions nationwide. Methods We conducted 20 semi-structured qualitative interviews of headache providers across the US from various institutions and asked them their perspectives on headache diary use. We transcribed the interviews, which two independent coders then coded. Themes and subthemes were developed using grounded theory qualitative analysis. Results Six themes emerged: (1) Providers were generally agnostic regarding the headache tracking method, but nearly all recommend the use of smartphones for tracking; (2) Providers had concerns regarding the accessibility of headache trackers; (3) Providers noted benefits to integrating headache tracking data into the EMR but had mixed opinions on how this integration might be done; (4) Providers had mixed opinions regarding the utility and interpretation of the data, specifically regarding data accuracy and efficiency; (5) Providers generally felt that headache tracking lends itself to more collaborative plan management; (6) Providers recommend behavioral health apps for patients but stated that there are few digital behavioral health interventions for headache specifically. Conclusion Interviews of headache providers, recommenders, and users of headache data are vital informants who can provide a robust amount of information about headache diary development, use in different populations, integration, and more.
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Affiliation(s)
- Mia Minen
- Department of Neurology, NYU Langone Health, New York, NY, United States
| | - Alexis George
- Department of Neurology, NYU Langone Health, New York, NY, United States
| | - Naomi Lebowitz
- Barnard College, New York, NY, United States
- Ferkauf Graduate School of Psychology, New York, NY, United States
| | - Aarti Katara
- Barnard College, New York, NY, United States
- Ferkauf Graduate School of Psychology, New York, NY, United States
| | - Ivy Snyder
- Department of Psychology, Yeshiva University, New York, NY, United States
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Young NP, Ridgeway JL, Haddad TC, Harper SB, Philpot LM, Christopherson LA, McColley SM, Phillips SA, Brown JK, Zimmerman KS, Ebbert JO. Feasibility and Usability of a Mobile App-Based Interactive Care Plan for Migraine in a Community Neurology Practice: Development and Pilot Implementation Study. JMIR Form Res 2023; 7:e48372. [PMID: 37796560 PMCID: PMC10587810 DOI: 10.2196/48372] [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: 04/23/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Migraine is a common and major cause of disability, poor quality of life, and high health care use. Access to evidence-based migraine care is limited and projected to worsen. Novel mobile health app-based tools may effectively deliver migraine patient education to support self-management, facilitate remote monitoring and treatment, and improve access to care. The risk that such an intervention may increase the care team workload is a potential implementation barrier. OBJECTIVE This study aims to describe a novel electronic health record-integrated mobile app-based Migraine Interactive Care Plan (MICP) and evaluate its feasibility, usability, and impact on care teams in a community neurology practice. METHODS Consecutive enrollees between September 1, 2020, and February 16, 2022, were assessed in a single-arm observational study of usability, defined by 74.3% (127/171) completing ≥1 assigned task. Task response rates, rate and type of care team escalations, and patient-reported outcomes were summarized. Patients were prospectively recruited and randomly assigned to routine care with or without the MICP from September 1, 2020, to September 1, 2021. Feasibility was defined by equal to or fewer downstream face-to-face visits, telephone contacts, and electronic messages in the MICP cohort. The Wilcoxon rank-sum test was used to compare continuous variables, and the chi-square test was used for categorical variables for those with at least 3 months of follow-up. RESULTS A total of 171 patients were enrolled, and of these, 127 (74.3%) patients completed ≥1 MICP-assigned task. Mean escalations per patient per month was 0.9 (SD 0.37; range 0-1.7). Patient-confirmed understanding of the educational materials ranged from 26.6% (45/169) to 56.2% (95/169). Initial mean headache days per week was 4.54 (SD 2.06) days and declined to 2.86 (SD 1.87) days at week 26. The percentage of patients reporting favorable satisfaction increased from a baseline of 35% (20/57) to 83% (15/18; response rate of 42/136, 30.9% to 28/68, 41%) over the first 6 months. A total of 121 patients with MICP were compared with 62 patients in the control group. No differences were observed in the rate of telephone contacts or electronic messages. Fewer face-to-face visits were observed in the MICP cohort (13/121, 10.7%) compared with controls (26/62, 42%; P<.001). CONCLUSIONS We describe the successful implementation of an electronic health record-integrated mobile app-based care plan for migraine in a community neurology practice. We observed fewer downstream face-to-face visits without increasing telephone calls, medication refills, or electronic messages. Our findings suggest that the MICP has the potential to improve patient access without increasing care team workload and the need for patient input from diverse populations to improve and sustain patient engagement. Additional studies are needed to assess its impact in primary care.
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Affiliation(s)
- Nathan P Young
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Integrated Community Specialty Practice, Mayo Clinic, Rochester, MN, United States
| | - Jennifer L Ridgeway
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, United States
| | - Tufia C Haddad
- Department of Oncology, Mayo Clinic, Rochester, MN, United States
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States
| | - Sarah B Harper
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States
| | - Lindsey M Philpot
- Community Internal Medicine, Mayo Clinic, Rochester, MN, United States
- Qualitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | | | - Samantha M McColley
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States
- Clinical Informatics and Practice Support, Mayo Clinic, Rochester, MN, United States
| | - Sarah A Phillips
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States
| | - Julie K Brown
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States
| | - Kelly S Zimmerman
- Integrated Community Specialty Practice, Mayo Clinic, Rochester, MN, United States
| | - Jon O Ebbert
- Community Internal Medicine, Mayo Clinic, Rochester, MN, United States
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Moyes C, Belaghi R, Webster RJ, Whitley N, Pohl D. Cognitive Behavioral Therapy for Children With Headaches: Will an App Do the Trick? J Child Neurol 2023; 38:169-177. [PMID: 37097885 DOI: 10.1177/08830738231170067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Participants were enrolled into a pilot randomized-controlled 4-week trial comparing the efficacy and feasibility of app-based cognitive behavioral therapy (CBT) to a stretching program. Headache-related disability and quality of life were assessed using the Pediatric Migraine Disability Scale (PedMIDAS), Kidscree27, and Pediatric Quality of Life Inventory. Multivariable regression analysis were performed to assess the group effects in the presence of adherence and other covariates. Twenty participants completed the study. Adherence was significantly higher in the stretching than in the CBT app group (100% vs 54%, P < .034). When controlling for adherence and baseline scores, the stretching group showed greater reduction in PedMIDAS score (average: 29.2, P < .05) as compared to the CBT app group. However, in terms of the Quality-of-Life Indicators, pre- and postintervention raw scores were not significantly different between groups (P > .05). App-based CBT was not superior to a stretching program in reducing headache-related disability in a select population of pediatric headache patients. Future studies should assess if implementing features to the CBT app, like tailoring to pediatric age groups, would improve outcomes.
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Affiliation(s)
- Carinna Moyes
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Reza Belaghi
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Richard J Webster
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Nicole Whitley
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Daniela Pohl
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
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Chen X, Luo Y. Digital Therapeutics in Migraine Management: A Novel Treatment Option in the COVID-19 Era. J Pain Res 2023; 16:111-117. [PMID: 36660558 PMCID: PMC9842514 DOI: 10.2147/jpr.s387548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/22/2022] [Indexed: 01/13/2023] Open
Abstract
Migraine is a chronic and often lifelong disease that directly affects over one billion people globally. Because access to migraine medical services is limited, only a minority of migraine patients are treated adequately. This situation worsened during the COVID-19 pandemic. Digital therapeutics (DTx) is an emerging therapeutic approach that opens up many new possibilities for remote migraine management. For instance, migraine management tools, online migraine diagnosis, guideline-based treatment options, digitally networked patients, and collecting anonymized information about migraine attacks and course parameters for scientific evaluation. Various applications of DTx in migraine management have been studied in recent years, such as the usefulness of digital migraine self-management tools in diagnosing and tracking migraine attacks, and the efficacy and safety of digital cognitive behavioural therapy. However, the development of DTx is still in its infancy and still faces many obstacles. The primary goal of this study is to review the latest research on DTx in migraine management, identify challenges, and outline future trends.
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Affiliation(s)
- Xingchen Chen
- Tianjin Baodi Hospital, Baodi Clinical College of Tianjin Medical University, Tianjin, 301800, People’s Republic of China
| | - Yujia Luo
- Department of Pain Medicine, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, People’s Republic of China,Brain and Mind Centre, Faculty of Medicine and Health, the University of Sydney, Sydney, NSW, 2006, Australia,Correspondence: Yujia Luo, Email
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Shetty A, Delanerolle G, Zeng Y, Shi JQ, Ebrahim R, Pang J, Hapangama D, Sillem M, Shetty S, Shetty B, Hirsch M, Raymont V, Majumder K, Chong S, Goodison W, O’Hara R, Hull L, Pluchino N, Shetty N, Elneil S, Fernandez T, Brownstone RM, Phiri P. A systematic review and meta-analysis of digital application use in clinical research in pain medicine. Front Digit Health 2022; 4:850601. [PMID: 36405414 PMCID: PMC9668017 DOI: 10.3389/fdgth.2022.850601] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 10/07/2022] [Indexed: 01/18/2023] Open
Abstract
IMPORTANCE Pain is a silent global epidemic impacting approximately a third of the population. Pharmacological and surgical interventions are primary modes of treatment. Cognitive/behavioural management approaches and interventional pain management strategies are approaches that have been used to assist with the management of chronic pain. Accurate data collection and reporting treatment outcomes are vital to addressing the challenges faced. In light of this, we conducted a systematic evaluation of the current digital application landscape within chronic pain medicine. OBJECTIVE The primary objective was to consider the prevalence of digital application usage for chronic pain management. These digital applications included mobile apps, web apps, and chatbots. DATA SOURCES We conducted searches on PubMed and ScienceDirect for studies that were published between 1st January 1990 and 1st January 2021. STUDY SELECTION Our review included studies that involved the use of digital applications for chronic pain conditions. There were no restrictions on the country in which the study was conducted. Only studies that were peer-reviewed and published in English were included. Four reviewers had assessed the eligibility of each study against the inclusion/exclusion criteria. Out of the 84 studies that were initially identified, 38 were included in the systematic review. DATA EXTRACTION AND SYNTHESIS The AMSTAR guidelines were used to assess data quality. This assessment was carried out by 3 reviewers. The data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURES Before data collection began, the primary outcome was to report on the standard mean difference of digital application usage for chronic pain conditions. We also recorded the type of digital application studied (e.g., mobile application, web application) and, where the data was available, the standard mean difference of pain intensity, pain inferences, depression, anxiety, and fatigue. RESULTS 38 studies were included in the systematic review and 22 studies were included in the meta-analysis. The digital interventions were categorised to web and mobile applications and chatbots, with pooled standard mean difference of 0.22 (95% CI: -0.16, 0.60), 0.30 (95% CI: 0.00, 0.60) and -0.02 (95% CI: -0.47, 0.42) respectively. Pooled standard mean differences for symptomatologies of pain intensity, depression, and anxiety symptoms were 0.25 (95% CI: 0.03, 0.46), 0.30 (95% CI: 0.17, 0.43) and 0.37 (95% CI: 0.05, 0.69), respectively. A sub-group analysis was conducted on pain intensity due to the heterogeneity of the results (I 2 = 82.86%; p = 0.02). After stratifying by country, we found that digital applications were more likely to be effective in some countries (e.g., United States, China) than others (e.g., Ireland, Norway). CONCLUSIONS AND RELEVANCE The use of digital applications in improving pain-related symptoms shows promise, but further clinical studies would be needed to develop more robust applications. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/, identifier: CRD42021228343.
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Affiliation(s)
- Ashish Shetty
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Gayathri Delanerolle
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Yutian Zeng
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen, China,Alan Turing Institute, London, United Kingdom
| | - Jian Qing Shi
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen, China,Alan Turing Institute, London, United Kingdom
| | - Rawan Ebrahim
- Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Joanna Pang
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Dharani Hapangama
- Department of Women and Children’s Health, Liverpool Women’s NHS Foundation, Liverpool, United Kingdom
| | - Martin Sillem
- Praxisklinik am Rosengarten Mannheim, Saarland University Medical Centre, Homburg, Germany
| | | | | | - Martin Hirsch
- Queen Square Institute of Neurology, University College London, London, United Kingdom,Oxford University Hospitals NHS Foundation Trust, Gynaecology, Oxford, United Kingdom
| | - Vanessa Raymont
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Kingshuk Majumder
- University of Manchester NHS Foundation Trust, Gynaecology, Manchester, United Kingdom
| | - Sam Chong
- University College London Hospitals NHS Foundation Trust, London, United Kingdom,Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - William Goodison
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Rebecca O’Hara
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Louise Hull
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | | | - Naresh Shetty
- Department of Orthopedics, M.S. Ramaiah Medical College, Bangalore, India
| | - Sohier Elneil
- University College London Hospitals NHS Foundation Trust, London, United Kingdom,Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Tacson Fernandez
- Queen Square Institute of Neurology, University College London, London, United Kingdom,Chronic Pain Medicine, Royal National Orthopaedic Hospital, London, United Kingdom
| | - Robert M. Brownstone
- Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Peter Phiri
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, United Kingdom,Primary Care, Population Sciences and Medical Education Division, University of Southampton, Southampton, United Kingdom,Correspondence: Peter Phiri
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Begasse De Dhaem O, Aldana SI, Kanner AM, Sperling M, French J, Nadkarni SS, Hope OA, O'Brien T, Morrison C, Winawer M, Minen MT. Association Between Migraine Comorbidity and Psychiatric Symptoms Among People With Newly Diagnosed Focal Epilepsy. J Neuropsychiatry Clin Neurosci 2022; 34:182-187. [PMID: 34961330 DOI: 10.1176/appi.neuropsych.21050124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Little is known about psychiatric symptoms among patients with migraine and newly diagnosed focal epilepsy. The investigators compared symptoms of depression, anxiety, and suicidality among people with newly diagnosed focal epilepsy with migraine versus without migraine. METHODS The Human Epilepsy Project is a prospective multicenter study of patients with newly diagnosed focal epilepsy. Depression (measured with the Center for Epidemiologic Studies Depression Scale), anxiety (measured with the 7-item Generalized Anxiety Disorder scale), and suicidality scores (measured with the Columbia-Suicide Severity Rating Scale [C-SSRS]) were compared between participants with versus without migraine. Data analysis was performed with the Kolmogorov-Smirnov test for normality assessment, the Mann-Whitney U test, chi-square test, and linear regression. RESULTS Of 349 patients with new-onset focal epilepsy, 74 (21.2%) had migraine. There were no differences between the patients without migraine versus those with migraine in terms of age, race, and level of education. There were more women in the group with migraine than in the group without migraine (75.7% vs. 55.6%, p=0.0018). The patients with epilepsy and comorbid migraine had more depressive symptoms than the patients with epilepsy without migraine (35.2% vs. 22.7%, p=0.031). Patients with epilepsy with comorbid migraine had more anxiety symptoms than patients with epilepsy without migraine, but this relation was mediated by age in logistic regression, with younger age being associated with anxiety. Comorbid migraine was not associated with C-SSRS ideation or behavior. CONCLUSIONS Among a sample of patients with newly diagnosed focal epilepsy, 21.2% had migraine. Migraine comorbidity was associated with higher incidence of depressive symptoms. Future studies should be performed to better assess these relationships and possible treatment implications.
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Affiliation(s)
- Olivia Begasse De Dhaem
- New York-Presbyterian Hospital/Columbia University, New York (Begasse De Dhaem); Office of Science and Research, New York University Langone Health, New York (Aldana); Division of Epilepsy, Miller School of Medicine, University of Miami, Miami (Kanner); Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia (Sperling); New York University School of Medicine, Comprehensive Epilepsy Center, New York University Langone Health, New York (French, Nadkarni, Morrison); Department of Neurology, McGovern Medical School, University of Texas Health Science Center-Houston (Hope); The Central Clinical School, Monash University, Melbourne, Victoria, Australia (O'Brien); Gertrude H. Sergievsky Center, Columbia University, New York (Winawer); and Departments of Neurology and Population Health, New York University Langone Health, New York (Minen)
| | - Sandra India Aldana
- New York-Presbyterian Hospital/Columbia University, New York (Begasse De Dhaem); Office of Science and Research, New York University Langone Health, New York (Aldana); Division of Epilepsy, Miller School of Medicine, University of Miami, Miami (Kanner); Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia (Sperling); New York University School of Medicine, Comprehensive Epilepsy Center, New York University Langone Health, New York (French, Nadkarni, Morrison); Department of Neurology, McGovern Medical School, University of Texas Health Science Center-Houston (Hope); The Central Clinical School, Monash University, Melbourne, Victoria, Australia (O'Brien); Gertrude H. Sergievsky Center, Columbia University, New York (Winawer); and Departments of Neurology and Population Health, New York University Langone Health, New York (Minen)
| | - Andres Miguel Kanner
- New York-Presbyterian Hospital/Columbia University, New York (Begasse De Dhaem); Office of Science and Research, New York University Langone Health, New York (Aldana); Division of Epilepsy, Miller School of Medicine, University of Miami, Miami (Kanner); Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia (Sperling); New York University School of Medicine, Comprehensive Epilepsy Center, New York University Langone Health, New York (French, Nadkarni, Morrison); Department of Neurology, McGovern Medical School, University of Texas Health Science Center-Houston (Hope); The Central Clinical School, Monash University, Melbourne, Victoria, Australia (O'Brien); Gertrude H. Sergievsky Center, Columbia University, New York (Winawer); and Departments of Neurology and Population Health, New York University Langone Health, New York (Minen)
| | - Michael Sperling
- New York-Presbyterian Hospital/Columbia University, New York (Begasse De Dhaem); Office of Science and Research, New York University Langone Health, New York (Aldana); Division of Epilepsy, Miller School of Medicine, University of Miami, Miami (Kanner); Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia (Sperling); New York University School of Medicine, Comprehensive Epilepsy Center, New York University Langone Health, New York (French, Nadkarni, Morrison); Department of Neurology, McGovern Medical School, University of Texas Health Science Center-Houston (Hope); The Central Clinical School, Monash University, Melbourne, Victoria, Australia (O'Brien); Gertrude H. Sergievsky Center, Columbia University, New York (Winawer); and Departments of Neurology and Population Health, New York University Langone Health, New York (Minen)
| | - Jacqueline French
- New York-Presbyterian Hospital/Columbia University, New York (Begasse De Dhaem); Office of Science and Research, New York University Langone Health, New York (Aldana); Division of Epilepsy, Miller School of Medicine, University of Miami, Miami (Kanner); Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia (Sperling); New York University School of Medicine, Comprehensive Epilepsy Center, New York University Langone Health, New York (French, Nadkarni, Morrison); Department of Neurology, McGovern Medical School, University of Texas Health Science Center-Houston (Hope); The Central Clinical School, Monash University, Melbourne, Victoria, Australia (O'Brien); Gertrude H. Sergievsky Center, Columbia University, New York (Winawer); and Departments of Neurology and Population Health, New York University Langone Health, New York (Minen)
| | - Siddhartha S Nadkarni
- New York-Presbyterian Hospital/Columbia University, New York (Begasse De Dhaem); Office of Science and Research, New York University Langone Health, New York (Aldana); Division of Epilepsy, Miller School of Medicine, University of Miami, Miami (Kanner); Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia (Sperling); New York University School of Medicine, Comprehensive Epilepsy Center, New York University Langone Health, New York (French, Nadkarni, Morrison); Department of Neurology, McGovern Medical School, University of Texas Health Science Center-Houston (Hope); The Central Clinical School, Monash University, Melbourne, Victoria, Australia (O'Brien); Gertrude H. Sergievsky Center, Columbia University, New York (Winawer); and Departments of Neurology and Population Health, New York University Langone Health, New York (Minen)
| | - Omotola A Hope
- New York-Presbyterian Hospital/Columbia University, New York (Begasse De Dhaem); Office of Science and Research, New York University Langone Health, New York (Aldana); Division of Epilepsy, Miller School of Medicine, University of Miami, Miami (Kanner); Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia (Sperling); New York University School of Medicine, Comprehensive Epilepsy Center, New York University Langone Health, New York (French, Nadkarni, Morrison); Department of Neurology, McGovern Medical School, University of Texas Health Science Center-Houston (Hope); The Central Clinical School, Monash University, Melbourne, Victoria, Australia (O'Brien); Gertrude H. Sergievsky Center, Columbia University, New York (Winawer); and Departments of Neurology and Population Health, New York University Langone Health, New York (Minen)
| | - Terry O'Brien
- New York-Presbyterian Hospital/Columbia University, New York (Begasse De Dhaem); Office of Science and Research, New York University Langone Health, New York (Aldana); Division of Epilepsy, Miller School of Medicine, University of Miami, Miami (Kanner); Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia (Sperling); New York University School of Medicine, Comprehensive Epilepsy Center, New York University Langone Health, New York (French, Nadkarni, Morrison); Department of Neurology, McGovern Medical School, University of Texas Health Science Center-Houston (Hope); The Central Clinical School, Monash University, Melbourne, Victoria, Australia (O'Brien); Gertrude H. Sergievsky Center, Columbia University, New York (Winawer); and Departments of Neurology and Population Health, New York University Langone Health, New York (Minen)
| | - Chris Morrison
- New York-Presbyterian Hospital/Columbia University, New York (Begasse De Dhaem); Office of Science and Research, New York University Langone Health, New York (Aldana); Division of Epilepsy, Miller School of Medicine, University of Miami, Miami (Kanner); Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia (Sperling); New York University School of Medicine, Comprehensive Epilepsy Center, New York University Langone Health, New York (French, Nadkarni, Morrison); Department of Neurology, McGovern Medical School, University of Texas Health Science Center-Houston (Hope); The Central Clinical School, Monash University, Melbourne, Victoria, Australia (O'Brien); Gertrude H. Sergievsky Center, Columbia University, New York (Winawer); and Departments of Neurology and Population Health, New York University Langone Health, New York (Minen)
| | - Melodie Winawer
- New York-Presbyterian Hospital/Columbia University, New York (Begasse De Dhaem); Office of Science and Research, New York University Langone Health, New York (Aldana); Division of Epilepsy, Miller School of Medicine, University of Miami, Miami (Kanner); Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia (Sperling); New York University School of Medicine, Comprehensive Epilepsy Center, New York University Langone Health, New York (French, Nadkarni, Morrison); Department of Neurology, McGovern Medical School, University of Texas Health Science Center-Houston (Hope); The Central Clinical School, Monash University, Melbourne, Victoria, Australia (O'Brien); Gertrude H. Sergievsky Center, Columbia University, New York (Winawer); and Departments of Neurology and Population Health, New York University Langone Health, New York (Minen)
| | - Mia T Minen
- New York-Presbyterian Hospital/Columbia University, New York (Begasse De Dhaem); Office of Science and Research, New York University Langone Health, New York (Aldana); Division of Epilepsy, Miller School of Medicine, University of Miami, Miami (Kanner); Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia (Sperling); New York University School of Medicine, Comprehensive Epilepsy Center, New York University Langone Health, New York (French, Nadkarni, Morrison); Department of Neurology, McGovern Medical School, University of Texas Health Science Center-Houston (Hope); The Central Clinical School, Monash University, Melbourne, Victoria, Australia (O'Brien); Gertrude H. Sergievsky Center, Columbia University, New York (Winawer); and Departments of Neurology and Population Health, New York University Langone Health, New York (Minen)
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9
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De Brouwer M, Vandenbussche N, Steenwinckel B, Stojchevska M, Van Der Donckt J, Degraeve V, Vaneessen J, De Turck F, Volckaert B, Boon P, Paemeleire K, Van Hoecke S, Ongenae F. mBrain: towards the continuous follow-up and headache classification of primary headache disorder patients. BMC Med Inform Decis Mak 2022; 22:87. [PMID: 35361224 PMCID: PMC8969243 DOI: 10.1186/s12911-022-01813-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 03/09/2022] [Indexed: 12/04/2022] Open
Abstract
Background The diagnosis of headache disorders relies on the correct classification of individual headache attacks. Currently, this is mainly done by clinicians in a clinical setting, which is dependent on subjective self-reported input from patients. Existing classification apps also rely on self-reported information and lack validation. Therefore, the exploratory mBrain study investigates moving to continuous, semi-autonomous and objective follow-up and classification based on both self-reported and objective physiological and contextual data. Methods The data collection set-up of the observational, longitudinal mBrain study involved physiological data from the Empatica E4 wearable, data-driven machine learning (ML) algorithms detecting activity, stress and sleep events from the wearables’ data modalities, and a custom-made application to interact with these events and keep a diary of contextual and headache-specific data. A knowledge-based classification system for individual headache attacks was designed, focusing on migraine, cluster headache (CH) and tension-type headache (TTH) attacks, by using the classification criteria of ICHD-3. To show how headache and physiological data can be linked, a basic knowledge-based system for headache trigger detection is presented. Results In two waves, 14 migraine and 4 CH patients participated (mean duration 22.3 days). 133 headache attacks were registered (98 by migraine, 35 by CH patients). Strictly applying ICHD-3 criteria leads to 8/98 migraine without aura and 0/35 CH classifications. Adapted versions yield 28/98 migraine without aura and 17/35 CH classifications, with 12/18 participants having mostly diagnosis classifications when episodic TTH classifications (57/98 and 32/35) are ignored. Conclusions Strictly applying the ICHD-3 criteria on individual attacks does not yield good classification results. Adapted versions yield better results, with the mostly classified phenotype (migraine without aura vs. CH) matching the diagnosis for 12/18 patients. The absolute number of migraine without aura and CH classifications is, however, rather low. Example cases can be identified where activity and stress events explain patient-reported headache triggers. Continuous improvement of the data collection protocol, ML algorithms, and headache classification criteria (including the investigation of integrating physiological data), will further improve future headache follow-up, classification and trigger detection. Trial registration This trial was retrospectively registered with number NCT04949204 on 24 June 2021 at www.clinicaltrials.gov. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01813-w.
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Affiliation(s)
| | - Nicolas Vandenbussche
- Department of Neurology, Ghent University Hospital, 9000, Ghent, Belgium.,4BRAIN, Institute for Neuroscience, Department of Head and Skin, Ghent University, 9000, Ghent, Belgium
| | | | | | | | - Vic Degraeve
- IDLab, Ghent University - imec, 9052, Ghent, Belgium
| | | | | | | | - Paul Boon
- Department of Neurology, Ghent University Hospital, 9000, Ghent, Belgium.,4BRAIN, Institute for Neuroscience, Department of Head and Skin, Ghent University, 9000, Ghent, Belgium
| | - Koen Paemeleire
- Department of Neurology, Ghent University Hospital, 9000, Ghent, Belgium
| | | | - Femke Ongenae
- IDLab, Ghent University - imec, 9052, Ghent, Belgium
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10
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Woldeamanuel YW, Cowan RP. Computerized migraine diagnostic tools: a systematic review. Ther Adv Chronic Dis 2022; 13:20406223211065235. [PMID: 35096362 PMCID: PMC8793115 DOI: 10.1177/20406223211065235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/18/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Computerized migraine diagnostic tools have been developed and validated since 1960. We conducted a systematic review to summarize and critically appraise the quality of all published studies involving computerized migraine diagnostic tools. METHODS We performed a systematic literature search using PubMed, Web of Science, Scopus, snowballing, and citation searching. Cutoff date for search was 1 June 2021. Published articles in English that evaluated a computerized/automated migraine diagnostic tool were included. The following summarized each study: publication year, digital tool name, development basis, sample size, sensitivity, specificity, reference diagnosis, strength, and limitations. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool was applied to evaluate the quality of included studies in terms of risk of bias and concern of applicability. RESULTS A total of 41 studies (median sample size: 288 participants, median age = 43 years; 77% women) were included. Most (60%) tools were developed based on International Classification of Headache Disorders criteria, half were self-administered, and 82% were evaluated using face-to-face interviews as reference diagnosis. Some of the automated algorithms and machine learning programs involved case-based reasoning, deep learning, classifier ensemble, ant-colony, artificial immune, random forest, white and black box combinations, and hybrid fuzzy expert systems. The median diagnostic accuracy was concordance = 89% [interquartile range (IQR) = 76-93%; range = 45-100%], sensitivity = 87% (IQR = 80-95%; range = 14-100%), and specificity = 90% (IQR = 77-96%; range = 65-100%). Lack of random patient sampling was observed in 95% of studies. Case-control designs were avoided in all studies. Most (76%) reference tests exhibited low risk of bias and low concern of applicability. Patient flow and timing showed low risk of bias in 83%. CONCLUSION Different computerized and automated migraine diagnostic tools are available with varying accuracies. Random patient sampling, head-to-head comparison among tools, and generalizability to other headache diagnoses may improve their utility.
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Affiliation(s)
- Yohannes W. Woldeamanuel
- Division of Headache & Facial Pain, Department of Neurology & Neurological Sciences, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Robert P. Cowan
- Division of Headache & Facial Pain, Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
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11
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OUP accepted manuscript. PAIN MEDICINE 2022; 23:1544-1549. [DOI: 10.1093/pm/pnac021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/22/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022]
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12
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Underuse of Behavioral Treatments for Headache: a Narrative Review Examining Societal and Cultural Factors. J Gen Intern Med 2021; 36:3103-3112. [PMID: 33527189 PMCID: PMC7849617 DOI: 10.1007/s11606-020-06539-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/21/2020] [Indexed: 12/26/2022]
Abstract
Migraine affects over 40 million Americans and is the world's second most disabling condition. As the majority of medical care for migraine occurs in primary care settings, not in neurology nor headache subspecialty practices, healthcare system interventions should focus on primary care. Though there is grade A evidence for behavioral treatment (e.g., biofeedback, cognitive behavioral therapy (CBT), and relaxation techniques) for migraine, these treatments are underutilized. Behavioral treatments may be a valuable alternative to opioids, which remain widely used for migraine, despite the US opioid epidemic and guidelines that recommend against them. Identifying and removing barriers to the use of headache behavioral therapy could help reduce the disability as well as the personal and social costs of migraine. These techniques will have their greatest impact if offered in primary care settings to the lower socioeconomic status groups at greatest risk for migraine. We review the societal and cultural challenges that impose barriers to optimal use of non-pharmacological treatment services. These barriers include insufficient knowledge of migraine/headache behavioral treatments and insufficient availability of clinicians trained in non-pharmacological treatment delivery; limited access in underserved communities; financial burden; and stigma associated with both headache and mental health diagnoses and treatment. For each barrier, we discuss potential approaches to minimizing its effect and thus enhancing non-pharmacological treatment utilization.Case ExampleA 25-year-old graduate student with a prior history of headaches in college is attending school in the evenings while working a full-time job. Now, his headaches have significant nausea and photophobia. They are twice weekly and are disabling enough that he is unable to complete homework assignments. He does not understand why the headaches occur on Saturdays when he pushes through all week to get through his examinations that take place on Friday evenings. He tried two different migraine preventive medications, but neither led to the 50% reduction in headache days his doctor had hoped for. His doctor had suggested cognitive behavioral therapy (CBT) before initiating the medications, but he had been too busy to attend the appointments, and the challenges in finding an in-network provider proved difficult. Now with the worsening headaches, he opted for the CBT and by the fifth week had already noted improvements in his headache frequency and intensity.
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13
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Barad MJ, Sturgeon JA, Hong J, Aggarwal AK, Mackey SC. Characterization of chronic overlapping pain conditions in patients with chronic migraine: A CHOIR study. Headache 2021; 61:872-881. [PMID: 34184263 DOI: 10.1111/head.14129] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/30/2021] [Accepted: 04/12/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Chronic overlapping pain conditions (COPCs) represent a co-aggregation of widespread pain disorders. We characterized differences in physical and psychosocial functioning in patients with chronic migraine (CM) and those with CM and COPCs. BACKGROUND Patients with CM and COPCs have been identified as a distinct subgroup of patients with CM, and these patients may be vulnerable to greater symptom severity and burden. METHODS Data were extracted from Collaborative Health Outcomes Information Registry (an open-source learning health-care system), completed at the patients' first visit at a large tertiary care pain management center and electronic medical records. In 1601 patients with CM, the number of non-cephalic areas of pain endorsed on a body map was used to examine the differences in pain, physical and psychosocial function, adverse life experience, and health-care utilization. RESULTS Patients endorsing more body map regions reported significantly worse symptoms and function across all domains. Scored on a t-score metric (mean = 50, SD = 10), endorsement of one additional body map region corresponded with a 0.69-point increase in pain interference (95% CI = 0.55, 0.82; p < 0.001; Cohen's f = 0.328), 1.15-point increase in fatigue (95% CI = 0.97, 1.32; p < 0.001; Cohen's f = 0.432), and 1.21-point decrease in physical function (95% CI = -1.39, -1.03; p < 0.001; Cohen's f = 0.560). Patients with more widespread pain reported approximately 5% more physician visits (95% CI = 0.03, 0.07; p < 0.001), and patients reporting adverse life events prior to age 17 endorsed 22% more body map regions (95% CI = 0.11, 0.32; p < 0.001). CONCLUSIONS Patients with CM and other overlapping pain conditions as noted on the body map report significantly worse pain-related physical function, psychosocial functioning, increased health-care utilization, and greater association with adverse life experiences, compared with those with localized CM. This study provides further evidence that patients with CM and co-occurring pain conditions are a distinct subgroup of CM and can be easily identified through patient-reported outcome measures.
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Affiliation(s)
- Meredith J Barad
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - John A Sturgeon
- Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Juliette Hong
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Anuj K Aggarwal
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Sean C Mackey
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
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Goadsby PJ, Lantéri-Minet M, Michel MC, Peres M, Shibata M, Straube A, Wijeratne T, Ebel-Bitoun C, Constantin L, Hitier S. 21st century headache: mapping new territory. J Headache Pain 2021; 22:19. [PMID: 33794761 PMCID: PMC8015309 DOI: 10.1186/s10194-021-01233-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/16/2021] [Indexed: 11/25/2022] Open
Abstract
Background With headache experienced by up to 75% of adults worldwide in the last year, primary headache disorders constitute a major public health problem, yet they remain under-diagnosed and under-treated. Headache prevalence and burden is changing as society evolves, with headache now occurring earlier in life. Contributing factors, mostly associated with changing life style, such as stress, bad posture, physical inactivity, sleep disturbance, poor diet and excess use of digital technology may be associated with the phenomenon that could be labelled as ‘21st century headache’. This is especially notable in workplace and learning environments where headache impacts mental clarity and therefore cognitive performance. The headache-related impact on productivity and absenteeism negatively influences an individual’s behaviour and quality of life, and is also associated with a high economic cost. Since the majority of sufferers opt to self-treat rather than seek medical advice, substantial knowledge on headache prevalence, causation and burden is unknown globally. Mapping the entire population of headache sufferers can close this knowledge gap, leading to better headache management. The broad use of digital technology to gather real world data on headache triggers, burden and management strategies, in self-treated population will allow these sufferers to access appropriate support and medication, and therefore improve quality of life. Conclusion These data can yield important insights into a substantial global healthcare issue and form the basis for improved patient awareness, professional education, clinical study design and drug development.
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Affiliation(s)
- Peter J Goadsby
- NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London, SE5 9PJ, UK. .,Department of Neurology, University of California, Los Angeles, USA.
| | - Michel Lantéri-Minet
- Pain Department and FHU InovPain, CHU Nice - Côte Azur Université, Nice, France.,INSERM U1107 Migraine and Trigeminal Pain, Auvergne University, Clermont-Ferrand, France
| | - Martin C Michel
- Department of Pharmacology, Johannes Gutenberg University, Mainz, Germany
| | - Mario Peres
- Universidade Federal de São Paulo, São Paulo, Brazil
| | - Mamoru Shibata
- Department of Neurology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Andreas Straube
- Department of Neurology, Ludwig-Maximilians University, Munich, Germany
| | - Tissa Wijeratne
- AIMSS, Department of Neurology, Melbourne Medical School, Sunshine Hospital, Western Health, The University of Melbourne, Melbourne, Australia
| | | | | | - Simon Hitier
- Sanofi, 82, Avenue Raspail, 94255, Gentilly Cedex, France
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15
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Minen MT, Friedman BW, Adhikari S, Corner S, Powers SW, Seng EK, Grudzen C, Lipton RB. Introduction of a smartphone based behavioral intervention for migraine in the emergency department. Gen Hosp Psychiatry 2021; 69:12-19. [PMID: 33485090 PMCID: PMC8721519 DOI: 10.1016/j.genhosppsych.2020.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/24/2020] [Accepted: 12/11/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine whether a smartphone application (app) with an electronic headache diary and a progressive muscle relaxation (PMR) intervention is feasible and acceptable to people presenting to the Emergency Department (ED) with migraine. METHODS This single arm prospective study assessed feasibility by actual use of the app and acceptability by satisfaction with the app. We report preliminary data on change in migraine disability and headache days. RESULTS The 51 participants completed PMR sessions on a mean of 13 ± 19 (0,82) days for the 90-day study period, lasting a median of 11 min (IQR 6.5, 17) each. Median number of days of diary use was 34 (IQR 10, 77). Diaries were completed at least twice a week in half of study weeks (337/663). Participants were likely (≥4/5 on a 5-point Likert scale) to recommend both the app (85%) and PMR (91%). MIDAS scores significantly decreased by a mean of 38 points/participant (p < 0.0001). More frequent PMR use was associated with a higher odds of headache free days (p = 0.0148). CONCLUSION Smartphone-based PMR introduced to patients who present to the ED for migraine is feasible and acceptable. More frequent users have more headache free days. Future work should focus on intervention engagement.
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Affiliation(s)
- Mia T Minen
- Department of Neurology, NYU Langone Health, 550 1st Avenue, New York, NY 10016, United States of America; Department of Population Health, NYU Langone Health, 180 Madison Ave, New York, NY 10016, United States of America.
| | - Benjamin W Friedman
- Department of Emergency Medicine, Albert Einstein College of Medicine, 1300 Morris Park Ave, The Bronx, NY 10461, United States of America
| | - Samrachana Adhikari
- Department of Population Health, NYU Langone Health, 180 Madison Ave, New York, NY 10016, United States of America
| | - Sarah Corner
- Department of Neurology, NYU Langone Health, 550 1st Avenue, New York, NY 10016, United States of America
| | - Scott W Powers
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital; Headache Center, Cincinnati Children's Hospital, 3333 Burnet Ave, Cincinnati, OH 45229, United States of America
| | - Elizabeth K Seng
- Ferkauf Graduate School of Psychology, Yeshiva University; Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, 1165 Morris Park Ave, The Bronx, NY 10461, United States of America
| | - Corita Grudzen
- Department of Population Health, NYU Langone Health, 180 Madison Ave, New York, NY 10016, United States of America; Department of Emergency Medicine, NYU Langone Health, 550 1st Avenue, New York, NY 10016, United States of America
| | - Richard B Lipton
- Montefiore Headache Center; Departments of Neurology, Population Health, and Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, 250 Waters Pl #8, The Bronx, NY 10461, United States of America
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Heartrate variability biofeedback for migraine using a smartphone application and sensor: A randomized controlled trial. Gen Hosp Psychiatry 2021; 69:41-49. [PMID: 33516964 PMCID: PMC8721520 DOI: 10.1016/j.genhosppsych.2020.12.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/24/2020] [Accepted: 12/08/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Although hand temperature and electromyograph biofeedback have evidence for migraine prevention, to date, no study has evaluated heartrate variability (HRV) biofeedback for migraine. METHODS 2-arm randomized trial comparing an 8-week app-based HRV biofeedback (HeartMath) to waitlist control. Feasibility/acceptability outcomes included number and duration of sessions, satisfaction, barriers and adverse events. Primary clinical outcome was Migraine-Specific Quality of Life Questionnaire (MSQv2). RESULTS There were 52 participants (26/arm). On average, participants randomized to the Hearthmath group completed 29 sessions (SD = 29, range: 2-86) with an average length of 6:43 min over 36 days (SD = 27, range: 0, 88) before discontinuing. 9/29 reported technology barriers. 43% said that they were likely to recommend Heartmath to others. Average MSQv2 decreases were not significant between the Heartmath and waitlist control (estimate = 0.3, 95% CI = -3.1 - 3.6). High users of Heartmath reported a reduction in MSQv2 at day 30 (-12.3 points, p = 0.010) while low users did not (p = 0.765). DISCUSSION App-based HRV biofeedback was feasible and acceptable on a time-limited basis for people with migraine. Changes in the primary clinical outcome did not differ between biofeedback and control; however, high users of the app reported more benefit than low users.
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Stubberud A, Linde M, Brenner E, Heier M, Olsen A, Aamodt AH, Gravdahl GB, Tronvik E. Self‐administered biofeedback treatment app for pediatric migraine: A randomized pilot study. Brain Behav 2020. [PMCID: PMC7882181 DOI: 10.1002/brb3.1974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective To investigate the effect size, safety, and tolerability of a therapist‐independent biofeedback treatment app among adolescent with migraine. Materials and Methods This was a prospective, 3:1 ratio randomized, sham‐controlled, double‐blind, pilot study with 16 adolescents diagnosed with migraine randomized to eight weeks of biofeedback treatment (n = 12) or sham biofeedback (n = 4), carried out at two university hospitals in Norway. The prespecified and primary objective of the study was to observe changes in outcomes within the active treatment group. The sham control group was included in a minor ratio primarily to evaluate its feasibility. The primary outcome was change in headache frequency. A modified intention to treat analysis was performed, including participants completing at least seven biofeedback sessions in weeks 1–4 (n = 12 vs. n = 4) and weeks 5–8 (n = 7 vs. n = 2). Results Adherence was poor with 40% (136/336) of planned biofeedback sessions completed during weeks 5–8. Within the biofeedback group, a not statistically significant reduction in headache frequency was observed at weeks 1–4 (2.92 days/month, 95% CI −1.00 to 6.84, p = .145) and weeks 5–8 (1.85 days/month, 95% CI −2.01 to 5.72, p = .395). The biofeedback group experienced a median of one fewer headache days/month versus sham that did not reach significance (95% CI −4.0 to 9.0, p = .760). Conclusions We observed a small reduction in headache frequency in the active treatment group. Findings were likely undermined by low adherence and underpowered analyses but indicate that a therapist‐independent biofeedback treatment app has the potential to be an effective, tolerable, and inexpensive treatment option.
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Affiliation(s)
- Anker Stubberud
- Department of Neuromedicine and Movement ScienceNTNU Norwegian University of Science and TechnologyTrondheimNorway
| | - Mattias Linde
- Department of Neuromedicine and Movement ScienceNTNU Norwegian University of Science and TechnologyTrondheimNorway
- Norwegian Advisory Unit on Headaches, Department of NeurologySt. Olavs HospitalTrondheimNorway
| | - Eiliv Brenner
- Department of Neuromedicine and Movement ScienceNTNU Norwegian University of Science and TechnologyTrondheimNorway
- Norwegian Advisory Unit on Headaches, Department of NeurologySt. Olavs HospitalTrondheimNorway
| | - Martin Heier
- Department of Clinical Neuroscience for ChildrenOslo University HospitalOsloNorway
| | - Alexander Olsen
- Department of PsychologyNTNU Norwegian University of Science and TechnologyTrondheimNorway
- Department of Physical Medicine and RehabilitationSt. Olavs HospitalTrondheimNorway
| | | | - Gøril B. Gravdahl
- Department of Neuromedicine and Movement ScienceNTNU Norwegian University of Science and TechnologyTrondheimNorway
- Norwegian Advisory Unit on Headaches, Department of NeurologySt. Olavs HospitalTrondheimNorway
| | - Erling Tronvik
- Department of Neuromedicine and Movement ScienceNTNU Norwegian University of Science and TechnologyTrondheimNorway
- Norwegian Advisory Unit on Headaches, Department of NeurologySt. Olavs HospitalTrondheimNorway
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Minen MT, Adhikari S, Padikkala J, Tasneem S, Bagheri A, Goldberg E, Powers S, Lipton RB. Smartphone-Delivered Progressive Muscle Relaxation for the Treatment of Migraine in Primary Care: A Randomized Controlled Trial. Headache 2020; 60:2232-2246. [PMID: 33200413 PMCID: PMC8721526 DOI: 10.1111/head.14010] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Scalable, accessible forms of behavioral therapy for migraine prevention are needed. We assessed the feasibility and acceptability of progressive muscle relaxation (PMR) delivered by a smartphone application (app) in the Primary Care setting. METHODS This pilot study was a non-blinded, randomized, parallel-arm controlled trial of adults with migraine and 4+ headache days/month. Eligible participants spoke English and owned a smartphone. All participants were given the RELAXaHEAD app which includes an electronic headache diary. Participants were randomized to receive 1 of the 2 versions of the app-one with PMR and the other without PMR. The primary outcomes were measures of feasibility (adherence to the intervention and diary entries during the 90-day interval) and acceptability (satisfaction levels). We conducted exploratory analyses to determine whether there was a change in Migraine Disability Assessment Scale (MIDAS) scores or a change in headache days. RESULTS Of 139 participants (77 PMR, 62 control), 116 (83%) were female, mean age was 41.7 ± 12.8 years. Most patients 108/139 (78%) had moderate-severe disability. Using a 1-5 Likert scale, participants found the app easy to use (mean 4.2 ± 0.7) and stated that they would be happy to engage in the PMR intervention again (mean 4.3 ± 0.6). For the first 6 weeks, participants practiced PMR 2-4 days/week. Mean per session duration was 11.1 ± 8.3 minutes. Relative to the diary-only group, the PMR group showed a greater non-significant decline in mean MIDAS scores (-8.7 vs -22.7, P = .100) corresponding to a small-moderate mean effect size (Cohen's d = 0.38). CONCLUSION Smartphone-delivered PMR may be an acceptable, accessible form of therapy for migraine. Mean effects show a small-moderate mean effect size in disability scores.
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Affiliation(s)
- Mia T Minen
- Department of Neurology, NYU Langone Health, New York, NY, USA
- Department of Population Health, NYU Langone Health, New York, NY, USA
| | | | - Jane Padikkala
- Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, NY, USA
| | - Sumaiya Tasneem
- Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, NY, USA
| | - Ashley Bagheri
- Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, NY, USA
| | - Eric Goldberg
- Department of Medicine Faculty Group Practices, NYU Langone Health, New York, NY, USA
| | - Scott Powers
- Behavioral Medicine, Headache Medicine, Clinical Psychology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Richard B Lipton
- Montefiore Headache Center, Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA
- Montefiore Headache Center, Department of Population Health, Albert Einstein College of Medicine, New York, NY, USA
- Montefiore Headache Center, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York, NY, USA
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Smartphone based behavioral therapy for pain in multiple sclerosis (MS) patients: A feasibility acceptability randomized controlled study for the treatment of comorbid migraine and ms pain. Mult Scler Relat Disord 2020; 46:102489. [PMID: 32950893 DOI: 10.1016/j.msard.2020.102489] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/26/2020] [Accepted: 09/04/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Multiple Sclerosis (MS) and Migraine are comorbid neurologic conditions. Migraine prevalence is three times higher in the MS clinic population compared to the general population, and patients with MS and migraine are more symptomatic than patients with MS without migraine. OBJECTIVE We sought to conduct a pilot feasibility and acceptability study of the RELAXaHEAD app in MS-Migraine patients and to assess whether there was any change in migraine disability and MS pain-related disability. METHODS Randomized controlled study of patients with MS-migraine ages 18-80 years with 4+ headache days/ month who were willing to engage in smartphone based behavioral therapy. Half received the RELAXaHEAD app with progressive muscle relaxation (PMR) and the other half received the app without the PMR. Data was collected for 90 days on measures of recruitment, retention, engagement, and adherence to RELAXaHEAD. Preliminary data was also collected on migraine disability (MIDAS) and MS pain (PES). RESULTS Sixty-two subjects with MS-migraine were enrolled in the study (34 in PMR arm, 28 in monitored usual care arm). On average, during the 90 days, participants played the PMR on average 1.8 times per week, and for 12.9 min on days it was played. Forty-one percent (14/34) of the participants played the PMR two or more times weekly on average. Data was entered into the daily diaries, on average, 49% (44/90) of the days. There were major challenges in reaching subjects in follow-up for the efficacy data, and there was no significant change in migraine disability (MIDAS) scores or MS Pain (PES) scores from baseline to the endpoints. During the six-month follow-up, most patients felt either positively or neutral about the relaxation therapy. CONCLUSION There was interest in scalable accessible forms of behavioral therapy to treat migraine and MS-related pain in patients with MS and comorbid migraine. Similar to prior studies, a significant minority were willing to practice the PMR at least twice weekly. In the societal shift from telephone to more text and internet-based interactions, follow up was challenging, but those reached indicated that they appreciated the PMR and would recommend it to others. Future work should focus on engagement and efficacy.
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Minen MT, Morio K, Schaubhut KB, Powers SW, Lipton RB, Seng E. Focus group findings on the migraine patient experience during research studies and ideas for future investigations. Cephalalgia 2020; 40:712-734. [PMID: 31870189 PMCID: PMC7754244 DOI: 10.1177/0333102419888230] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES We conducted focus groups in people who had participated in mobile health (mHealth) studies of behavioral interventions for migraine to better understand: (a) Participant experience in the recruitment/enrollment process; (b) participant experience during the studies themselves; (c) ideas for improving participant experience for future studies. METHODS We conducted four focus groups in people who had agreed to participate in one of three studies involving mHealth and behavioral therapy for migraine. Inclusion criteria were being age 18-80, owning a smartphone, and having four or more headache days per month. All participants met the International Classification of Headache Disorders third edition beta version criteria for migraine. Exclusion criteria were not speaking English and having had behavioral therapy for migraine in the past year. Focus groups were audio recorded, fully transcribed and coded using general thematic analysis. RESULTS The 12 focus group participants had a mean age of 45 ± 15, a mean age of headache onset of 21 ± 13 and mean MIDAS disability score was 39 ± 56. Participants were women (100%), white (50%), Asian (33.3%) or members of other racial groups (16.7%). Certain themes emerged from each topic area. With regard to recruitment/enrollment (a), key themes were: (i) Participants joined their study out of an interest in research and/or a desire to try a new migraine treatment modality (behavioral therapy). (ii) Enrollment should be simple and study requirements should be carefully explained prior to enrollment. When asked about their experiences during the studies (b), the following themes emerged: (i) It is difficult to participate in study follow-up and compliance phone calls; (ii) participants prefer to choose from among various options for contact with the study team; (iii) there are barriers that limit app use related to migraine itself, as well as other barriers; (iv) completing diaries on a daily basis is challenging; (v) technical difficulties and uncertainties about app features limit use; (vi) being part of a research study promoted daily behavioral therapy use; (vii) progressive muscle relaxation (PMR) is enjoyable, and has a positive impact on life; (viii) behavioral therapy was a preferred treatment to reduce migraine pain. Ideas for improving study design or patient experience (c) included: (i) Increased opportunity to interact with other people with migraine would be beneficial; (ii) navigating the app and data entry should be easier; (iii) more varied methods for viewing the data and measures of adherence are needed; (iv) more information on and more varied behavioral treatment modalities would be preferred. CONCLUSION Though people with migraine are motivated to participate in mHealth and behavioral treatment studies, better communication up front about interventions as well as greater flexibility in interventions and follow-up methods are desired.
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Affiliation(s)
| | | | | | - Scott W Powers
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Minen MT, Jalloh A, Begasse de Dhaem O, Seng EK. Behavioral Therapy Preferences in People With Migraine. Headache 2020; 60:1093-1102. [PMID: 32207148 DOI: 10.1111/head.13790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND There are safe and well-tolerated level A evidence-based behavioral therapies for the prevention of migraine. They are biofeedback, cognitive behavioral therapy, and relaxation. However, the behavioral therapies for the prevention of migraine are underutilized. OBJECTIVES We sought to examine whether people with migraine with 4 or more headache days a month had preferences regarding the type of delivery of the behavioral therapy (in-person, smartphone based, telephone) and whether they would be willing to pay for in-person behavioral therapy. We also sought to determine the predictors of likelihood to pursue the behavioral therapy. METHODS Using a cross-sectional study design, we developed an online survey using TurkPrime, an online survey platform, to assess how likely TurkPrime participants who screened positive for migraine using the American Migraine Prevalence and Prevention screen were to pursue different delivery methods of the behavioral therapy. We report descriptive statistics and quantitative analyses. RESULTS There were 401 participants. Median age was 34 [IQR: 29, 41] years. More than two thirds of participants (70.3%, 282/401) were women. Median number of headache days/ month was 5 [IQR: 2.83, 8.5]. Some (12.5%, 50/401) used evidence-based behavioral therapy for migraine. The participants reported that they were "somewhat likely" to pursue in-person or smartphone behavioral therapy and behavioral therapy covered by insurance but were neutral about pursuing the telephone-based behavioral therapy. Participants were "not very likely" to pay out of pocket for the behavioral therapy. Migraine-related disability as measured by the MIDAS grading score was associated with likelihood to pursue the behavioral therapy in-person (P = .004), via telephone (P = .015), and via smart phone (P < .001), and covered by insurance (P = .001). However, migraine-related disability was not associated with likelihood to pursue out of pocket (P = .769) behavioral therapy. Pain intensity was predictive of likelihood of pursuing the behavioral therapy for migraine when covered by insurance. Other factors including education, employment, and headache days were not predictors. CONCLUSION People with migraine prefer in-person and smartphone-based behavioral therapy to telephone-based behavioral therapy. Migraine-related disability is associated with likelihood to pursue the behavioral therapy (independent of type of delivery of the behavioral therapy-in-person, telephone based or smartphone based). However, participants were not very likely to pay for the behavioral therapy.
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Affiliation(s)
- Mia T Minen
- Departments of Neurology and Population Health, NYU Langone Health, New York, NY, USA
| | - Adama Jalloh
- Department of Psychology, City College of New York Ringgold Standard Institution, New York, NY, USA
| | | | - Elizabeth K Seng
- Ferkauf Graduate School of Psychology, Albert Einstein College of Medicine, New York, NY, USA
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