Evaluation of the Dutch version of the migraine quality of life instrument (MSQOL) and its application in headache coping

Medium-term effectiveness of online behavioral training in migraine self-management: A randomized trial controlled over 10 months

AIM

This randomized, controlled trial examined the medium-term effectiveness of online behavioral training in migraine self-management (oBT; N = 195) versus waitlist control (WLC; N = 173) on attack frequency, indicators of self-management (primary outcomes), headache top intensity, use of rescue medications, quality of life and disability (secondary outcomes).

METHODS

An online headache diary following the ICHD-II and questionnaires were completed at baseline (T0), post-training (T1) and six months later (T2). Missing data (T1: 24%; T2: 37%) were handled by multiple imputation. We established effect sizes (ES) and tested between-group differences over time with linear mixed modelling techniques based on the intention-to-treat principle.

RESULTS

At T2, attack frequency had improved significantly in oBT (-23%, ES = 0.66) but also in WLC (-19%; ES = 0.52). Self-efficacy, internal and external control in migraine management--and triptan use--improved only in oBT, however. This indicates different processes in both groups and could signify (the start of) active self-management in oBT. Also, only oBT improved migraine-specific quality of life to a sizable extent.

CONCLUSIONS

oBT produced self-management gains but could not account for improved attack frequency, because WLC improved as well. The perspective that BT effects develop gradually, and that online delivery will boost BT outreach, justifies further research.

Long-term follow-up of home-based behavioral management training provided by migraine patients

BACKGROUND

Behavioral migraine approaches are effective in reducing headache attacks. Availability of treatment might be increased by using migraine patients as trainers. Therefore, Mérelle and colleagues developed and evaluated a home-based behavioral management training (BMT) by lay trainers (1). The maintenance of effects at long-term follow-up is studied in the present study.

METHOD

Measurements were taken pre-BMT (T0), post-BMT (T1), at six-month follow-up (T2), and at long-term follow-up, i.e. two to four years after BMT (T3). Data of 127 participants were analyzed with longitudinal multi-level analyses.

RESULTS

Short-term improvements in attack frequency and self-efficacy post-BMT were maintained at long-term follow-up ( DT0T3  = -.34 and DT0T3  = .69, respectively). The level of internal control that increased during BMT decreased from post-BMT to long-term follow-up ( DT0T3  = .18). Quality of life and migraine-related disability improved gradually over time ( DT0T3  = .45 and DT0T3  = -.26, respectively).

CONCLUSIONS

Although the results should be interpreted with caution because of the lack of a follow-up control group and the inability to gather information about additional treatments patients may have received during the follow-up period, the findings suggest that lay BMT for migraine may be beneficial over the long term. If so, this could make migraine treatments more widely available.

A randomized trial on the effects of regular water intake in patients with recurrent headaches

BACKGROUND

Previously published investigations suggest a positive effect of increased water intake on headache, but a randomised controlled trial has not been done.

OBJECTIVE

To investigate the effects of increased water intake on headache.

METHODS

Randomised controlled trial in primary care with two groups and a follow-up period of 3 months. Patients were included if they had at least two episodes of moderately intense headache or at least five mildly intense episodes per month and a total fluid intake of less than 2.5 l/day. Both groups received written instructions about stress reduction and sleep improvement strategies. The intervention group additionally received the instruction to increase the daily water intake by 1.5 l. The main outcome measures were Migraine-Specific Quality of Life (MSQOL) and days with at least moderate headache per month.

RESULTS

We randomised 50 patients to the control group and 52 patients to the intervention group. Drinking more water resulted in a statistically significant improvement of 4.5 (confidence interval: 1.3-7.8) points on MSQOL. In addition, 47% in the water group reported much improvement (6 or higher on a 10-point scale) on perceived intervention effect against 25% in the control group. However, drinking more water did not result in relevant changes in days with at least moderate headache.

CONCLUSIONS

Considering the observed positive subjective effects, it seems reasonable to recommend headache patients to try this non-invasive intervention for a short period of time to see whether they experience improvement.

The GRIM2005 Study of Migraine Consultation in France. III: Psychological Features of Subjects With Migraine

The objective of this analysis was to describe psychological and cognitive variables in subjects with migraine and to identify those associated with chronicity. Data were collected from 10 000 subjects during face-to-face interview. Subjects with episodic migraine ( n = 1127) or chronic daily headache ( n = 407) with migrainous features were identified using an algorithm based on the International Classification of Headache Disorders, 2nd edn classification. Data on headache impact was obtained with the Headache Impact Test-6, on psychological distress with the Hospital Anxiety and Depression Scale, on coping with the Coping Strategy Questionnaire catastrophizing score and the Brief COPE inventory, on illness perception with the Brief Illness Perception Questionnaire and on locus of control. Psychological variables associated with chronicity include perceived headache impact, psychological distress, the use of catastrophizing and avoidance coping strategies and an externalized locus of control. In conclusion, maladaptive coping strategies should be taken into account in the management of patients with migraine. Longitudinal studies will be necessary to address the causality of the relationship observed.

Migraine patients as trainers of their fellow patients in non-pharmacological preventive attack management: short-term effects of a randomized controlled trial

In conformity with current views on patient empowerment, we designed and evaluated the effects of home-based behavioural training (BT) provided by lay trainers with migraine to small groups of fellow patients. The primary aims of BT were to reduce attack frequency and increase perceived control over and self-confidence in attack prevention. In a randomized controlled trial the BT group (n = 51) was compared with a waitlist-control group (WLC), receiving usual care (n = 57). BT produced a minor (-21%) short-term effect on attack frequency and clinically significant improvement in 35% of the participants. Covariance analysis showed a non-significant trend (P = 0.07) compared with WLC. However, patients' perceived control over migraine attacks and self-confidence in attack prevention increased significantly with large effect sizes. Patients with high baseline attack frequency might benefit more from BT than those with low attack frequency. In conclusion, lay trainers with migraine strengthened fellow patients' perceived control, but did not induce a significant immediate improvement in attack frequency.

Quality of life research in patients suffering from tension type headache

The tension type headache is the most common headache type, which many men and women suffer from in one period of their life and aggravates business productivity, family and social functioning. Quality of life estimation in patients suffering from tension type headache enables us to get a better insight into the impact of the disease on the patient. The comparison among the quality of life in the patients suffering from tension type headache and the quality of life in the control group subjects has been carried out in a research by applying the QVM questionnaire. The obtained results have shown a significant difference in the quality of life and its sub domains indicating worse quality in the patients suffering from tension type headache.

The impact of headache severity on quality of life of patients with migraine

Migraine is a chronic disease characterized by episodic headache attacks, most often on one side of the head with pulsating, moderate to severe pain. We conducted an assessment of headache severity by using the MIGSEV questionnaire, and the quality of life assessment by using the QVM questionnaire, on a sample of 30 patients suffering from migraine. Afterwards, the research results were compared. The research results indicate that the majority of patients suffer from severe and moderate headaches. The quality of life is poorer in patients suffering from severe headaches.

Translating instruments for cross-cultural studies in headache research

OBJECTIVE

To describe translation methods, to outline current recommendations for translation and to give an overview of translation procedures used in headache.

BACKGROUND

In health-care research, particularly in the domain of health-related quality of life, an increasing number of questionnaires are translated for cross- cultural comparison. A number of headache-related questionnaires have also been translated. To ensure true cross-cultural comparison, it is important to use rigorous translation methods to ensure a high quality translated version of the instruments.

METHODS

Literature relevant to cross-cultural translations was reviewed, as well as literature concerning translation of headache-related instruments.

CONCLUSION

More information on the translation process for headache-related instruments is essential to carry out high quality cross-cultural research. Recommendation are given to encourage good translation practices.

The preliminary effectiveness of migraine lay trainers in a home-based behavioural management training

OBJECTIVES

This pilot study examined the effectiveness and trainer skills of the first migraine lay trainers (MLTs).

METHODS

In a stepwise training program eight MLTs participated in a behavioural management training (BMT) aimed at the prevention of migraine attacks by proactive relaxation and trigger management. After successful reduction of their migraine attacks, three MLTs provided BMT under supervision at home to one fellow patient and subsequently to a small group.

RESULTS

Migraine frequency was significantly reduced in five out of eight patients trained by MLTs (mean 48%) and medication use decreased substantially in four patients (mean 47%). Qualities of MLTs concerned their motivational assistance, knowledge of premonitory symptoms and exchange of disease specific problems. Pitfalls were that migraine symptoms hampered an active guidance of the sessions and providing tailored feedback was difficult.

CONCLUSION

The first MLTs were successful in training fellow patients in behavioural prevention of migraine attacks.

PRACTICE IMPLICATIONS

Continuous supervision of MLTs health and trainer skills is recommended but is likely to have implications for cost-effectiveness.

Increasing the daily water intake for the prophylactic treatment of headache: a pilot trial

Dehydration is commonly believed to result in headache, but the effectiveness of increasing the water intake in patients who frequently suffer from headaches has not been studied thus far. In a pilot study, we examined the possible effects and feasibility of increased water intake in headache patients. Eighteen headache patients (all had migraine, two also had tension-type headache) were randomly allocated to placebo medication, or the advice to additionally drink 1.5 l of water per day, for a period of 12 weeks. Effect measurements consisted of a 2 weeks headache diary and the Migraine Specific Quality of Life (MSQOL) questionnaire. The advice to increase the daily fluid intake by 1.5 l increased the fluid intake in the intervention group by approximately 1 l. This reduced the total hours of headache in 2 weeks by 21 h (95% CI: -48 to 5). Mean headache intensity decreased by 13 mm (95% CI: -32 to 5) on a visual analogue scale (VAS). The effects on MSQOL, number of headache episodes, and medication seemed to be small. The data of the present study suggest a reduction in the total number of hours and intensity of headache episodes after increased water intake. Our results seem to justify larger scaled research on the effectiveness of increased water intake in headache patients.

Development and psychometric properties of a pain-related problem list for adolescents (PPL)

Instruments for measuring pain-related problems in adolescents with chronic pain are sparse, especially those based on the personal experiences of these adolescents. This study aimed to develop and test such an instrument, the pain-related problem list for adolescents (PPL). A sample of 129 adolescents with chronic pain without documented physiological etiology completed the 57-item problem list, which was based on interviews with a similar group of adolescents with chronic pain. Principal components analysis yielded four domains: problems related to (1) concentration; (2) mobility; (3) adaptability; and (4) mood. The questionnaire was shortened to 18 items and has good reliability (total alpha = 0.82; concentration alpha = 0.86; mobility alpha = 0.77; adaptability alpha = 0.71; and mood alpha = 0.78); the validity also proved to be adequate, especially in the general population sample. The PPL provides a tool to assess the impact of chronic pain in adolescents. Future research should focus on further validation of the PPL in a large clinical population and establishing its test-retest reliability.

Migraine and chronic daily headache management: a qualitative study of patients' perceptions

AIM

The aim of the study was to gain insight into the patients' perceptions of migraine and chronic daily headache (CDH) management.

METHODS

Thirteen, semi-structured and individual interviews with seven migraine and five CDH patients were carried out and analysed in QSR NUD*IST5, using a grounded theory methodology.

RESULTS

The participants described using five areas of management: 1) health care use; 2) medication use; 3) alternative therapies; 4) social support; and 5) lifestyle and self-help. The participants described their expectations, preferences, worries and (dis)satisfaction in relation to these five areas of management. The participants adapted headache management to suit their needs and preferences, making migraine and CDH management highly individual and giving the headache patient a central role within their own care.

CONCLUSION

Health care is changing towards a greater involvement of the patients in their own care. Therefore, it is important to increase understanding of the patients' perspective of chronic diseases, including migraine and CDH. The results from this study inform health care professionals of the range of their patients' needs and preferences. This knowledge can be used to shape clinical practice, to develop patient education programmes and to further research efforts into issues that are important to the headache patient.

Reduced impact of migraine in everyday life: an observational study in the Dutch Society of Headache Patients

OBJECTIVE

To explore the percentage of patients who report a reduced impact of migraine on their life, and to which factors this improvement can be attributed.

METHODS

Four hundred forty-eight members of the Dutch Society of Headache Patients answered a set of structured questionnaires, including the Migraine-Specific Quality of Life instrument (MSQOL).

RESULTS

Of this group, 70% reported a reduced impact of migraine. The most frequently reported reason for this reduction was a change in medication (77%); in particular, change to a triptan. Other favorable factors included a change in life-style (56%): 42% of patients reported more relaxed coping with migraine, a reduction of stress in general (28%) and of stress related to work (24%), and leading a more regular life-style (21%). In addition, social support was frequently mentioned, particularly that offered by the Dutch Society of Headache Patients (58%), family (46%), and their general practitioner (28%). The patients who reported a reduced impact of migraine had less migraine attacks and a higher quality of life than those who did not report such a reduction.

CONCLUSION

The results confirm that factors that are proven effective in clinical trials on migraine also have these effects outside a formal experimental environment.

Assessing health-related quality of life in patients with migraine

BACKGROUND

The place of health-related quality of life (HRQoL) instruments in clinical research trials and clinical practice as compared to more traditional clinical outcome measures such as headache intensity and frequency is unclear.

OBJECTIVES

To review the current status of HRQoL measurement in migraine.

METHODS

A literature search was done for HRQoL and migraine. Selected articles dealing with migraine and commonly used HRQoL instruments and HRQoL measures used in recent clinical trials were reviewed.

RESULTS

Several general and migraine specific HRQoL instruments can detect changes over time in response to at least major changes in migraine therapy. Both also show a correlation with clinical headache features. However, their sensitivity to detect clinically significant changes over time is not clear.

CONCLUSION

The SF-36, a general HRQoL measure and several migraine-specific HRQoL instruments are useful endpoints for migraine clinical trials. Their role in clinical practice is yet to be established.