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Francavilla M, Facchetti S, Demartini C, Zanaboni AM, Amoroso C, Bottiroli S, Tassorelli C, Greco R. A Narrative Review of Intestinal Microbiota's Impact on Migraine with Psychopathologies. Int J Mol Sci 2024; 25:6655. [PMID: 38928361 PMCID: PMC11203823 DOI: 10.3390/ijms25126655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/12/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
Migraine is a common and debilitating neurological disorder characterized by the recurrent attack of pulsating headaches typically localized on one side of the head associated with other disabling symptoms, such as nausea, increased sensitivity to light, sound and smell and mood changes. Various clinical factors, including the excessive use of migraine medication, inadequate acute treatment and stressful events, can contribute to the worsening of the condition, which may evolve to chronic migraine, that is, a headache present on >15 days/month for at least 3 months. Chronic migraine is frequently associated with various comorbidities, including anxiety and mood disorders, particularly depression, which complicate the prognosis, response to treatment and overall clinical outcomes. Emerging research indicates a connection between alterations in the composition of the gut microbiota and mental health conditions, particularly anxiety and depression, which are considered disorders of the gut-brain axis. This underscores the potential of modulating the gut microbiota as a new avenue for managing these conditions. In this context, it is interesting to investigate whether migraine, particularly in its chronic form, exhibits a dysbiosis profile similar to that observed in individuals with anxiety and depression. This could pave the way for interventions aimed at modulating the gut microbiota for treating difficult-to-manage migraines.
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Affiliation(s)
- Miriam Francavilla
- Department of Brain and Behavioral Sciences, University of Pavia, Via Bassi 21, 27100 Pavia, Italy; (M.F.); (S.F.); (A.M.Z.); (S.B.); (C.T.)
- Headache Science and Neurorehabilitation Centre, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy;
| | - Sara Facchetti
- Department of Brain and Behavioral Sciences, University of Pavia, Via Bassi 21, 27100 Pavia, Italy; (M.F.); (S.F.); (A.M.Z.); (S.B.); (C.T.)
- Headache Science and Neurorehabilitation Centre, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy;
| | - Chiara Demartini
- Headache Science and Neurorehabilitation Centre, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy;
| | - Anna Maria Zanaboni
- Department of Brain and Behavioral Sciences, University of Pavia, Via Bassi 21, 27100 Pavia, Italy; (M.F.); (S.F.); (A.M.Z.); (S.B.); (C.T.)
- Headache Science and Neurorehabilitation Centre, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy;
| | - Chiara Amoroso
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20135 Milan, Italy;
| | - Sara Bottiroli
- Department of Brain and Behavioral Sciences, University of Pavia, Via Bassi 21, 27100 Pavia, Italy; (M.F.); (S.F.); (A.M.Z.); (S.B.); (C.T.)
- Headache Science and Neurorehabilitation Centre, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy;
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Via Bassi 21, 27100 Pavia, Italy; (M.F.); (S.F.); (A.M.Z.); (S.B.); (C.T.)
- Headache Science and Neurorehabilitation Centre, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy;
| | - Rosaria Greco
- Headache Science and Neurorehabilitation Centre, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy;
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2
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Saby A, Alvarez A, Smolins D, Petros J, Nguyen L, Trujillo M, Aygün O. Effects of Embodiment in Virtual Reality for Treatment of Chronic Pain: Pilot Open-Label Study. JMIR Form Res 2024; 8:e34162. [PMID: 38363591 PMCID: PMC10907942 DOI: 10.2196/34162] [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: 10/22/2021] [Revised: 07/13/2022] [Accepted: 09/21/2023] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Chronic pain has long been a major health burden that has been addressed through numerous forms of pharmacological and nonpharmacological treatment. One of the tenets of modern medicine is to minimize risk while providing efficacy. Further, because of its noninvasive nature, virtual reality (VR) provides an attractive platform for potentially developing novel therapeutic modalities. OBJECTIVE The purpose of this study was to determine the feasibility of a novel VR-based digital therapy for the treatment of chronic pain. METHODS An open-label study assessed the feasibility of using virtual embodiment in VR to treat chronic pain. In total, 24 patients with chronic pain were recruited from local pain clinics and completed 8 sessions of a novel digital therapeutic that combines virtual embodiment with graded motor imagery to deliver functional rehabilitation exercises over the course of 4 weeks. Pain intensity as measured by a visual analog scale before and after each virtual embodiment training session was used as the primary outcome measure. Additionally, a battery of patient-reported pain questionnaires (Fear-Avoidance Beliefs Questionnaire, Oswestry Low Back Pain Disability Questionnaire, Pain Catastrophizing Scale, and Patient Health Questionnaire) were administered before and after 8 sessions of virtual embodiment training as exploratory outcome measures to assess if the measures are appropriate and warrant a larger randomized controlled trial. RESULTS A 2-way ANOVA on session × pre- versus postvirtual embodiment training revealed that individual virtual embodiment training sessions significantly reduced the intensity of pain as measured by the visual analog scale (P<.001). Perceived disability due to lower back pain as measured by the Oswestry Low Back Pain Disability Questionnaire significantly improved (P=.003) over the 4-week course of virtual embodiment regimen. Improvement was also observed on the helplessness subscale of the Pain Catastrophizing Scale (P=.02). CONCLUSIONS This study provides evidence that functional rehabilitation exercises delivered in VR are safe and may have positive effects on alleviating the symptoms of chronic pain. Additionally, the virtual embodiment intervention may improve perceived disability and helplessness of patients with chronic pain after 8 sessions. The results support the justification for a larger randomized controlled trial to assess the extent to which virtual embodiment training can exert an effect on symptoms associated with chronic pain. TRIAL REGISTRATION ClinicalTrials.gov NCT04060875; https://clinicaltrials.gov/ct2/show/NCT04060875.
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Affiliation(s)
- Adam Saby
- Department of Emergency Medicine, Occupational Health Division, University of California Los Angeles, Los Angeles, CA, United States
| | | | | | - James Petros
- Allied Pain and Spine, San Jose, CA, United States
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Brown D, Schenk S, Genent D, Zernikow B, Wager J. A scoping review of chronic pain in emerging adults. Pain Rep 2021; 6:e920. [PMID: 34712883 PMCID: PMC8546842 DOI: 10.1097/pr9.0000000000000920] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/06/2021] [Accepted: 02/22/2021] [Indexed: 12/26/2022] Open
Abstract
Much of the adult chronic pain literature addresses pain in typical pain cohorts of middle-aged to older individuals. To date, little research has focused on chronic pain in younger adults, who likely have a completely different pain experience. This scoping review aimed to address this gap by describing the emerging adult (18-29 years) chronic pain experience regarding prevalence, associated factors, outcomes, and pain management. Searches of primary electronic databases including PubMed, Embase, PsycINFO, and CINAHL were performed on February 26, 2020, restricting the publication date from database inception to December 31, 2019. The search strategy, conducted in English, covered search term combinations of "chronic pain" and "young adults." A total of 6,612 records were considered-3,141 after removing duplicates. These records were screened by title and abstract; 871 through full-text screening. Of these, 78 articles covered the topic of emerging adults with chronic pain. Collectively, results indicated that between 5% and 30% of emerging adults experience chronic pain, depending on the sample and exact chronic pain definition. The most consistent associated factors were female sex, familial chronic pain, and previous experiences of chronic pain in childhood. Anxiety, depression, and sleep issues appeared associated both before and after the onset of chronic pain. Outcomes of pain included interruptions to study and work, poorer physical functioning, and pain-related interference to socializing. We observed that few pain treatments have been tested specifically in this cohort. A greater ongoing focus on chronic pain in emerging adults is required to improve long-lasting outcomes.
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Affiliation(s)
- Donnamay Brown
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Germany
| | - Sabrina Schenk
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Germany
| | - Dunja Genent
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Germany
| | - Boris Zernikow
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Germany
| | - Julia Wager
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Germany
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4
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Caronna E, Gallardo VJ, Fonseca E, Gómez-Galván JB, Alpuente A, Torres-Ferrus M, Pozo-Rosich P. How Does Migraine Change After 10 Years? A Clinical Cohort Follow-Up Analysis. Headache 2020; 60:916-928. [PMID: 32068897 DOI: 10.1111/head.13774] [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: 09/12/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To describe the 10-year evolution of a cohort of migraine patients, focusing on prognostic factors of improvement. BACKGROUND Migraine is one of the most prevalent and disabling diseases and migraineurs often want to know about the evolutionary timeline of their condition. Yet, data from longitudinal studies with a long-term follow-up is scarce. METHODS This is a 10-year longitudinal study. In 2008, we recruited 1109 consecutive migraine patients who answered an initial survey. In 2018, we did a follow-up. We compared initial and final (after 10 years) data. A reduction ≥50% in Headache days/month was considered as improvement. A comparative study was carried out to identify predictors of improvement or no improvement. RESULTS After 10 years, 380 patients completed the survey (34.3% of the initial cohort), 77.1% (293/380) were women; mean age 41.0 ± 10.6 years and 73.7% (280/380) had an initial diagnosis of episodic migraine (EM). After 10 years, 48.2% (183/380) of patients did not have a medical follow-up of their migraine; 47.4% (180/380) decreased ≥50% in frequency, which increased the proportion of EM (73.7% vs 87.4%) (P < .001) as compared to the initial results. Factors independently associated with improvement were: a baseline frequency >10 days/month (OR[95%]: 3.04 [1.89, 4.89]; P < .001), nonsmoking (2.13 [1.23, 3.67]; P = .006) and a medical follow-up for migraine (2.45 [1.54, 3.90]; P < .001). Additionally, after 10 years, we observed a reduction in the use of preventive treatment (48.7% vs 23.5%) and an increase in monotherapy (42.2% vs 72.7%) (P < .001). CONCLUSION After 10 years, in almost half of the patients who answered the survey, migraine improved. Other than the natural pathophysiology of migraine, having a medical follow-up and healthy habits such as nonsmoking were independent factors associated with improvement.
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Affiliation(s)
- Edoardo Caronna
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Victor José Gallardo
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Fonseca
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Alicia Alpuente
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Torres-Ferrus
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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D'Antona L, Matharu M. Identifying and managing refractory migraine: barriers and opportunities? J Headache Pain 2019; 20:89. [PMID: 31443629 PMCID: PMC6734232 DOI: 10.1186/s10194-019-1040-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 08/12/2019] [Indexed: 02/06/2023] Open
Abstract
The term refractory migraine has been used to describe persistent headache that is difficult to treat or fails to respond to standard and/or aggressive treatments. This subgroup of migraine patients are generally highly disabled and experience impaired quality of life, despite optimal treatments. Several definitions and criteria for refractory migraine have been published, but as yet, an accepted or established definition is not available. This article reviews the published criteria and proposes a new set of criteria. The epidemiology, pathophysiology and management options are also reviewed.
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Affiliation(s)
- Linda D'Antona
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - Manjit Matharu
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK.
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Wasim S, Suddaby JS, Parikh M, Leylachian S, Ho B, Guerin A, So J. Pain and gastrointestinal dysfunction are significant associations with psychiatric disorders in patients with Ehlers-Danlos syndrome and hypermobility spectrum disorders: a retrospective study. Rheumatol Int 2019; 39:1241-1248. [PMID: 30923956 DOI: 10.1007/s00296-019-04293-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/20/2019] [Indexed: 12/20/2022]
Abstract
In this retrospective study, we investigate the frequency and types of psychiatric disorders and their relationship to systemic manifestations in a cohort of 391 Ehlers-Danlos syndromes (EDS) and hypermobility spectrum disorder (HSD) patients based on the current 2017 International Classification of EDS diagnostic criteria. A detailed, systematic retrospective chart review was undertaken for patients assessed for HSD or EDS at two Canadian health centres. Patients were diagnosed according to the Villefranche criteria and reclassified for this study according to the 2017 International Classification of EDS. Data validation and statistical analyses were conducted. Psychiatric disorders were very common, with 49.4% of the total cohort affected; 28.9% reported multiple psychiatric diagnoses. Mood (34.5%) and somatoform (28.6%) disorders were most common. Interestingly, attention-deficit/hyperactivity disorder (ADHD) was significantly enriched in the HSD, but not EDS cohort (p = 0.0002, 95% CI 3.48-9.00) compared to the general population. There were no differences in the systemic associations with having psychiatric manifestations in the HSD compared to the EDS subsets. Muscle/body pain (OR 1.99) and gastrointestinal dysfunction (OR 2.07) were significantly associated with having mood disorders, and gastrointestinal dysfunction (OR 2.61) and nerve-related pain (OR 3.27) were associated with having somatoform disorders across the cohort. The common systemic associations with the presence of psychiatric manifestations in both HSD and EDS reaffirm that the conditions should be treated as a spectrum rather than as wholly separate entities, particularly with respect to psychiatric management. EDS and HSD patients share common psychiatric presentations, though ADHD is more common with HSD.
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Affiliation(s)
- S Wasim
- Fred A. Litwin Family Centre in Genetic Medicine, University Health Network and Mount Sinai Hospital, 60 Murray Street, Box 34, 3rd Floor, Room 400, Toronto, ON, M5T 3L9, Canada
| | - J S Suddaby
- Fred A. Litwin Family Centre in Genetic Medicine, University Health Network and Mount Sinai Hospital, 60 Murray Street, Box 34, 3rd Floor, Room 400, Toronto, ON, M5T 3L9, Canada
| | - M Parikh
- Fred A. Litwin Family Centre in Genetic Medicine, University Health Network and Mount Sinai Hospital, 60 Murray Street, Box 34, 3rd Floor, Room 400, Toronto, ON, M5T 3L9, Canada
| | - S Leylachian
- Fred A. Litwin Family Centre in Genetic Medicine, University Health Network and Mount Sinai Hospital, 60 Murray Street, Box 34, 3rd Floor, Room 400, Toronto, ON, M5T 3L9, Canada
| | - B Ho
- Fred A. Litwin Family Centre in Genetic Medicine, University Health Network and Mount Sinai Hospital, 60 Murray Street, Box 34, 3rd Floor, Room 400, Toronto, ON, M5T 3L9, Canada.,Department of Pediatrics, Division of Medical Genetics, Queen's University, Kingston, Canada
| | - A Guerin
- Department of Pediatrics, Division of Medical Genetics, Queen's University, Kingston, Canada
| | - J So
- Fred A. Litwin Family Centre in Genetic Medicine, University Health Network and Mount Sinai Hospital, 60 Murray Street, Box 34, 3rd Floor, Room 400, Toronto, ON, M5T 3L9, Canada. .,Centre for Addiction and Mental Health, Toronto, Canada. .,Departments of Medicine, Psychiatry, and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.
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7
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Friedman LE, Aponte C, Perez Hernandez R, Velez JC, Gelaye B, Sánchez SE, Williams MA, Peterlin BL. Migraine and the risk of post-traumatic stress disorder among a cohort of pregnant women. J Headache Pain 2017; 18:67. [PMID: 28685258 PMCID: PMC5500599 DOI: 10.1186/s10194-017-0775-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/07/2017] [Indexed: 01/03/2023] Open
Abstract
Background Individually both migraine and post-traumatic stress disorder (PTSD) prevalence estimates are higher among women. However, there is limited data on the association of migraine and PTSD in women during pregnancy. Methods We examined the association between migraine and PTSD among women attending prenatal clinics in Peru. Migraine was characterized using the International Classification of Headache Disorders (ICHD)-III beta criteria. PTSD was assessed using the PTSD Checklist-Civilian Version (PCL-C). Multivariable logistic regression analyses were performed to estimate odds ratios (OR) and 95% confidence intervals (CI) after adjusting for confounders. Results Of the 2922 pregnant women included, 33.5% fulfilled criteria for any migraine (migraine 12.5%; probable migraine 21.0%) and 37.4% fulfilled PTSD criteria. Even when controlling for depression, women with any migraine had almost a 2-fold increased odds of PTSD (OR: 1.97; 95% CI: 1.64–2.37) as compared to women without migraine. Specifically, women with migraine alone (i.e. excluding probable migraine) had a 2.85-fold increased odds of PTSD (95% CI: 2.18–3.74), and women with probable migraine alone had a 1.61-fold increased odds of PTSD (95% CI: 1.30–1.99) as compared to those without migraine, even after controlling for depression. In those women with both migraine and comorbid depression, the odds of PTSD in all migraine categories were even further increased as compared to those women without migraine. Conclusion In a cohort of pregnant women, irrespective of the presence or absence of depression, the odds of PTSD is increased in those with migraine. Our findings suggest the importance of screening for PTSD, specifically in pregnant women with migraine. Electronic supplementary material The online version of this article (doi:10.1186/s10194-017-0775-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lauren E Friedman
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, K501, Boston, MA, 02115, USA.
| | - Christina Aponte
- Multidisciplinary International Research Training Program, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Rigoberto Perez Hernandez
- Multidisciplinary International Research Training Program, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Juan Carlos Velez
- Departamento de Rehabilitación, Hospital del Trabajador, Santiago, Chile
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, K501, Boston, MA, 02115, USA.,Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Sixto E Sánchez
- Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Asociación Civil PROESA, Lima, Peru
| | - Michelle A Williams
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, K501, Boston, MA, 02115, USA
| | - B Lee Peterlin
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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8
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Grassini S, Nordin S. Comorbidity in Migraine with Functional Somatic Syndromes, Psychiatric Disorders and Inflammatory Diseases: A Matter of Central Sensitization? Behav Med 2017; 43:91-99. [PMID: 26431372 DOI: 10.1080/08964289.2015.1086721] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
To approach the questions as to why migraine appears to be associated with functional somatic syndromes (FSSs) and whether central sensitization may be an underlying mechanism, the present study investigated (a) comorbidity with diagnoses of three FSSs, three psychiatric disorders, and three inflammatory diseases, (b) degree of mental health problems (stress, burnout, anxiety, depression and somatization), and (c) prevalence of ten cognitive/affective and nine airway symptoms in persons with migraine in the general population. From a randomized and stratified Swedish adult sample, questionnaire data were analyzed from 151 individuals with a diagnosis of migraine and 3,255 without migraine. The results showed (a) significant comorbidity in migraine with all FSSs, psychiatric disorders and inflammatory diseases, (b) significantly elevated scores on stress, burnout, anxiety, depression, and somatization, and (c) relatively high prevalence rates on almost all symptoms. Taken together, the results motivate future study of central sensitization as a mechanism underlying migraine.
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Affiliation(s)
- Simone Grassini
- a Department of Psychology , Umeå University , Umeå , Sweden
| | - Steven Nordin
- a Department of Psychology , Umeå University , Umeå , Sweden
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9
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Baykan B, Ertas M, Karlı N, Uluduz D, Uygunoglu U, Ekizoglu E, Kocasoy Orhan E, Saip S, Zarifoglu M, Siva A. Migraine incidence in 5 years: a population-based prospective longitudinal study in Turkey. J Headache Pain 2015; 16:103. [PMID: 26634568 PMCID: PMC4669335 DOI: 10.1186/s10194-015-0589-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 11/30/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The incidence of migraine has been investigated only in a few studies worldwide and it is not known in our country. We, therefore, aimed to estimate the migraine incidence in a previously accomplished population-based prevalence study sample of 5323 individuals in the year 2008. METHODS The former Turkish headache prevalence study has been completed as a nationwide, randomized, home-based study of face-to-face examination by physicians trained for headache diagnosis by using ICHD criteria. Five years after this study an optimized survey including 50 questions was performed to estimate the migraine incidence in migraine-free individuals in the previous study, with a 56.4 % responder rate. Two validation studies for this survey were performed prior and after the study each in 100 subjects by comparing the gold standard of expert diagnosis of headache, showing high rate of reliability (Crohnbach alpha: 0.911 and 0.706, respectively). RESULTS Migraine incidence was estimated as 2.38 % (2.98 % in women and 1.93 % in men) per year in 2563 migraine-free individuals; if the population at risk is defined as the group without any headaches, the migraine incidence decreased to 1.99 %. The chronic migraine (CM) incidence [without medication overuse (MOH)] was 0.066 % and that of MOH was 0.259 %. We found a significant burden of the disease on the occupational functionality as well as on social and family life, even in the early years of the migraine. The family history of headaches especially in the fathers could be useful to predict new cases of migraine, besides the well-known risk factor, diagnosis of depression, whereas income and education did not seem to relate to migraine onset. CONCLUSIONS Our study with a large population-based nation-wide sample, using ICHD-II criteria, with structured headache interviews as well as blinded re-validation of the questionnaire diagnoses showed a 2.38 % incidence rate of migraine in Turkey, higher than most of the other previous reports; a finding which could be related to genetic factors and also to the methodological differences in the study designs. Moreover the incidence of CM was found to be 0.066 %.
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Affiliation(s)
- Betul Baykan
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Millet Cad, 34390, Capa/Istanbul, Turkey.
| | - Mustafa Ertas
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Millet Cad, 34390, Capa/Istanbul, Turkey.
| | - Necdet Karlı
- Department of Neurology, School of Medicine, University of Uludag, Bursa, Turkey.
| | - Derya Uluduz
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Millet Cad, 34390, Capa/Istanbul, Turkey.
| | - Ugur Uygunoglu
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Millet Cad, 34390, Capa/Istanbul, Turkey.
| | - Esme Ekizoglu
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Millet Cad, 34390, Capa/Istanbul, Turkey.
| | - Elif Kocasoy Orhan
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Millet Cad, 34390, Capa/Istanbul, Turkey.
| | - Sabahattin Saip
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Millet Cad, 34390, Capa/Istanbul, Turkey.
| | - Mehmet Zarifoglu
- Department of Neurology, School of Medicine, University of Uludag, Bursa, Turkey.
| | - Aksel Siva
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Millet Cad, 34390, Capa/Istanbul, Turkey.
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10
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Hershenfeld SA, Wasim S, McNiven V, Parikh M, Majewski P, Faghfoury H, So J. Psychiatric disorders in Ehlers–Danlos syndrome are frequent, diverse and strongly associated with pain. Rheumatol Int 2015; 36:341-8. [DOI: 10.1007/s00296-015-3375-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 09/25/2015] [Indexed: 12/21/2022]
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11
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Differential associations of specific depressive and anxiety disorders with somatic symptoms. J Psychosom Res 2015; 78:116-22. [PMID: 25524436 DOI: 10.1016/j.jpsychores.2014.11.007] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 11/07/2014] [Accepted: 11/09/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Previous studies have shown that depressive and anxiety disorders are strongly related to somatic symptoms, but much is unclear about the specificity of this association. This study examines the associations of specific depressive and anxiety disorders with somatic symptoms, and whether these associations are independent of comorbid depressive and anxiety disorders. METHODS Cross-sectional data were derived from The Netherlands Study of Depression and Anxiety (NESDA). A total of 2008 persons (mean age: 41.6 years, 64.9% women) were included, consisting of 1367 patients with a past-month DSM-diagnosis (established with the Composite International Diagnostic Interview [CIDI]) of depressive disorder (major depressive disorder, dysthymic disorder) and/or anxiety disorder (generalized anxiety disorder, social phobia, panic disorder, agoraphobia), and 641 controls. Somatic symptoms were assessed with the somatization scale of the Four-Dimensional Symptom Questionnaire (4DSQ), and included cardiopulmonary, musculoskeletal, gastrointestinal, and general symptoms. Analyses were adjusted for covariates such as chronic somatic diseases, sociodemographics, and lifestyle factors. RESULTS All clusters of somatic symptoms were more prevalent in patients with depressive and/or anxiety disorders than in controls (all p<.001). Multivariable logistic regression analyses showed that all types of depressive and anxiety disorders were independently related to somatic symptoms, except for dysthymic disorder. Major depressive disorder showed the strongest associations. Associations remained similar after adjustment for covariates. CONCLUSION This study demonstrated that depressive and anxiety disorders show strong and partly differential associations with somatic symptoms. Future research should investigate whether an adequate consideration and treatment of somatic symptoms in depressed and/or anxious patients improve treatment outcomes.
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Fornaro M, De Berardis D, De Pasquale C, Indelicato L, Pollice R, Valchera A, Perna G, Iasevoli F, Tomasetti C, Martinotti G, Koshy AS, Fasmer OB, Oedegaard KJ. Prevalence and clinical features associated to bipolar disorder-migraine comorbidity: a systematic review. Compr Psychiatry 2015; 56:1-16. [PMID: 25306379 DOI: 10.1016/j.comppsych.2014.09.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 09/18/2014] [Accepted: 09/23/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The prevalence and clinical features associated with bipolar disorders (BDs)-migraine comorbidity have been reported inconsistently across different studies, therefore warranting a systematic review on the matter. METHODS A systematic review was conducted in accordance with the PRISMA statement searching major electronic databases for documents indexed between January, 2000 and July, 2014. Eligible studies were those including quantitative data on prevalence rates and clinical features associated to BD-migraine comorbidity; case reports excluded. Three authors independently conducted searches, quality assessment of the studies and data extraction. RESULTS Several cross-sectional studies, and a handful of retrospective follow-up studies or non-systematic reviews assessed the prevalence and/or the clinical correlates of migraine-BD comorbidity. High prevalence rates and a significant burden of BD-migraine comorbidity were common findings, particularly in case of BD-II women (point-prevalence rates up to 77%), migraine with aura (up to 53%) and/or cyclothymic temperament (up to 45% of the cases). LIMITATIONS Some of the biases encountered in a few studies accounted by the present review may nonetheless have hampered the generalizability of the overall conclusions drawn herein. CONCLUSIONS BD-migraine comorbidity may comprise of a sub-phenotype of BDs requiring patient-tailored therapeutic interventions to achieve an optimal outcome. Specifically, additional studies including longitudinal follow-up studies are aimed in order to shed further light on the actual prevalence rates and clinical features associated to BD-migraine comorbidity, with a special emphasis towards the clinically suggestive potential connection between mixed features, bipolar depression, migraine, and increased risk for suicidality. PROSPERO registration number: CRD42014009335.
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Affiliation(s)
- Michele Fornaro
- Department of Education Science, University of Catania, Catania, Italy.
| | - Domenico De Berardis
- National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini", ASL 4, Teramo, Italy.
| | | | - Luisa Indelicato
- Department of Education Science, University of Catania, Catania, Italy.
| | - Rocco Pollice
- Service for Monitoring and early Intervention against psychoLogical and mEntal suffering in young people" (SMILE), L'Aquila University, Italy.
| | - Alessandro Valchera
- Hermanas Hospitalarias, Villa San Giuseppe Hospital, 63100 Ascoli Piceno, Italy.
| | - Giampaolo Perna
- Department of Clinical Neuroscience, Villa San Benedetto Menni, Hermanas Hospitalarias, Albese con Cassano, Como, Italy.
| | - Felice Iasevoli
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University "Federico II" of Naples, Via Pansini 5, 80131 Naples, Italy.
| | - Carmine Tomasetti
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University "Federico II" of Naples, Via Pansini 5, 80131 Naples, Italy.
| | - Giovanni Martinotti
- Department of Neurosciences and Imaging, University "G. d'Annunzio" of Chieti, 66013 Chieti, Italy.
| | - Ann Sarah Koshy
- St. John's National Academy of Health Sciences, Bangalore, India.
| | - Ole Bernt Fasmer
- Department of Clinical Medicine, Section for Psychiatry, University of Bergen, Bergen, Norway.
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Merikangas KR. Contributions of epidemiology to our understanding of migraine. Headache 2013; 53:230-46. [PMID: 23432441 DOI: 10.1111/head.12038] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2012] [Indexed: 12/21/2022]
Abstract
BACKGROUND During the past decade, the introduction of the second edition of the International Classification of Headache Disorders (ICHD-II) and the initiation of active campaigns to increase awareness of the high magnitude, burden, and impact of migraine have stimulated numerous studies of population-based data on the prevalence, correlates, and impact of migraine. OBJECTIVE This paper provides an update of the literature on the worldwide epidemiology of migraine from studies that included the ICHD-II criteria. The aims of this paper are: (1) to review evidence regarding the magnitude of migraine; (2) to summarize information on the correlates and impact of migraine; and (3) to discuss the contributions, challenges, and future directions in the epidemiology of migraine. Evidence on the magnitude of migraine is divided into the following types of data: (1) prevalence rates of ICHD-II-defined migraine and tension-type headache from international population-based studies of adults; (2) the magnitude of migraine in U.S. studies; (3) ICHD-II-based international prevalence rates of ICHD-II-defined migraine in children; and (4) incidence rates of migraine from prospective longitudinal studies. METHODS A comprehensive review of the literature on the prevalence of migraine subtypes and tension-type headache defined by ICHD-II criteria during the past decade was conducted and aggregate weighted rates across studies were derived. RESULTS Across the 19 studies of adults that employed the ICHD-II criteria, the aggregate weighted estimates of the 12-month prevalence of definite migraine are 11.5%, and probable migraine of 7%, yielding a total of 18.5%. The cross-study weighted aggregate rate of migraine with aura is 4.4%, chronic migraine is 0.5%, and of tension-type headache is 13%. There has been even greater growth in international prevalence data on migraine in children, with a total of 21 studies of children that have employed the ICDH-II criteria. The aggregate weighted rate of definite migraine in children is 10.1% and migraine with aura is 1.6%. The well-established demographic correlates of migraine including the equal sex ratio in childhood, with increasing prevalence of migraine in females across adolescence to mid-adulthood were confirmed in these studies. Despite increasing effort to increase awareness of migraine, approximately 50% of those with frequent and/or severe migraine do not receive professional treatment. CONCLUSIONS This review demonstrates that the descriptive epidemiology of migraine has reached its maturity. The prevalence rates and sociodemographic correlates have been stable across 50 years. These developments justify a shift in efforts to the application of the designs and methods of analytic epidemiology. Retrospective case-control studies followed by prospective cohort studies that test specific associations are likely to enhance our understanding of the predictors of incidence and progression of migraine, subtypes of migraine with differential patterns of onset and course, and specific environmental exposures that may have either causal or provocative influences on migraine etiology.
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Affiliation(s)
- Kathleen R Merikangas
- Genetic Epidemiology Research Branch, National Institute of Mental Health, Bethesda, MD 20892, USA
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Smitherman TA, Kolivas ED. Trauma exposure versus posttraumatic stress disorder: relative associations with migraine. Headache 2013; 53:775-86. [PMID: 23464926 DOI: 10.1111/head.12063] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent research has uncovered associations between migraine and experiencing traumatic events, the latter of which in some cases eventuates in the development of posttraumatic stress disorder (PTSD). However, existing studies have not attempted to explore the relative associations with migraine between experiencing trauma and suffering from PTSD. OBJECTIVES The aim of this cross-sectional study was to assess the predictive utility of trauma exposure vs PTSD in predicting migraine status and headache frequency, severity, and disability. METHODS One thousand fifty-one young adults (mean age = 18.9 years [SD = 1.4]; 63.1% female; 20.6% non-Caucasian) without secondary causes of headache provided data from measures of headache symptomatology and disability, trauma and PTSD symptomatology, and depression and anxiety. Three hundred met diagnostic criteria for migraine and were compared on trauma exposure and PTSD prevalence with 751 participants without migraine. RESULTS Seven hundred twenty-eight participants (69.3%) reported experiencing at least 1 traumatic event consistent with Criterion A for PTSD, of whom 184 also met diagnostic criteria for PTSD. Migraineurs were almost twice as likely as controls to meet criteria for PTSD (25.7% vs 14.2%, P < .0001) and reported a higher number of traumatic event types that happened to them personally (3.0 vs 2.4, P < .0001). However, experiencing a Criterion A event only was not a significant predictor of migraine either alone (odds ratio [OR] = 1.17, P = nonsignificant) or after adjustment for covariates. By comparison, the OR of migraine for those with a PTSD diagnosis (vs no Criterion A event) was 2.30 (P < .0001), which remained significant after controlling for relevant covariates (OR = 1.75, P = .009). When using continuous variables of trauma and PTSD symptomatology, PTSD was again most strongly associated with migraine. Numerous sensitivity analyses confirmed these findings. PTSD symptomatology, but not the number of traumas, was modestly but significantly associated with headache frequency, severity, and disability in univariate analyses. CONCLUSIONS Consistently across analyses, PTSD was a robust predictor of migraine, whereas trauma exposure alone was not. These data support the notion that it is not exposure to trauma itself that is principally associated with migraine, but rather the development and severity of PTSD symptoms resulting from such exposure.
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Affiliation(s)
- Todd A Smitherman
- Department of Psychology, University of Mississippi, Oxford, MS 38677, USA.
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Smitherman TA, Kolivas ED, Bailey JR. Panic disorder and migraine: comorbidity, mechanisms, and clinical implications. Headache 2012; 53:23-45. [PMID: 23278473 DOI: 10.1111/head.12004] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2012] [Indexed: 12/17/2022]
Abstract
A growing body of literature suggests that comorbid anxiety disorders are more common and more prognostically relevant among migraine sufferers than comorbid depression. Panic disorder (PD) appears to be more strongly associated with migraine than most other anxiety disorders. PD and migraine are both chronic diseases with episodic manifestations, involving significant functional impairment and shared symptoms during attacks, interictal anxiety concerning future attacks, and an absence of identifiable secondary pathology. A meta-analysis of high-quality epidemiologic study data from 1990 to 2012 indicates that the odds of PD are 3.76 times greater among individuals with migraine than those without. This association remains significant even after controlling for demographic variables and comorbid depression. Other less-rigorous community and clinical studies confirm these findings. The highest rates of PD are found among migraine with aura patients and those presenting to specialty clinics. Presence of PD is associated with greater negative impact of migraine, including more frequent attacks, increased disability, and risk for chronification and medication overuse. The mechanisms underlying this common comorbidity are poorly understood, but both pathophysiological (eg, serotonergic dysfunction, hormonal influences, dysregulation of the hypothalamic-pituitary-adrenal axis) and psychological (eg, interoceptive conditioning, fear of pain, anxiety sensitivity, avoidance behavior) factors are implicated. Means of assessing comorbid PD among treatment-seeking migraineurs are reviewed, including verbal screening for core PD symptoms, ruling out medical conditions with panic-like features, and administering validated self-report measures. Finally, evidence-based strategies for both pharmacologic and behavioral management are outlined. The first-line migraine prophylactics are not indicated for PD, and the selective serotonin re-uptake inhibitors used to treat PD are not efficacious for migraine; thus, separate agents are often required to address each condition. Core components of behavioral treatments for PD are reviewed, and their integration into clinical headache practice is discussed.
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Affiliation(s)
- Todd A Smitherman
- Department of Psychology, University of Mississippi, Oxford, MS, USA
| | | | - Jennifer R Bailey
- Department of Psychology, University of Mississippi, Oxford, MS, USA
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Peng KP, Wang SJ. Migraine diagnosis: screening items, instruments, and scales. ACTA ACUST UNITED AC 2012; 50:69-73. [PMID: 22769861 DOI: 10.1016/j.aat.2012.05.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 04/17/2012] [Accepted: 04/20/2012] [Indexed: 10/28/2022]
Abstract
Migraine is a common and disabling disorder with a 1-year prevalence of 4.5-6% in men and 14.5-18% in women. The diagnosis of migraine is usually made according to the second edition of the International Classification of Headache Disorders (ICHD-2) criteria; however, not all physicians are familiar with the diagnostic criteria. Underdiagnosis remains a major issue in general practice, resulting in inadequate treatment. Several instruments are designed to improve the diagnosis of migraine, to identify the comorbid psychological disturbances, to measure the burden and disability, and to access any reduction in quality of life (QoL) that occurs due to migraine attacks with good reliability and validity. Furthermore, the disability and QoL measured by certain instruments serve as surrogate targets when treating migraines. In this review, we examine the instruments that are in common use in daily practice and current research on migraines, focusing on the purpose of each instrument, clinical applications, pitfalls in interpretation, and, if any, minimally clinically important difference(s) (MCID). In general, a structured intake form and a headache diary are recommended in approaching patients with headache. In addition, ID-Migraine, a three-item screening test, has been validated in primary care settings as a way to improve the rapid diagnosis of migraine. The Visual Aura Rating Scale (VARS) is helpful for the diagnosis of migraine with aura. In addition, migraine is commonly associated with psychiatric comorbidities, which can be assessed by the Beck Depression Inventory (BDI), 9-item Patient Health Questionnaire (PHQ-9), and Hospital Anxiety and Depression Scale (HADS). To evaluate the impact of migraines, disability can be assessed using the Migraine Disability Assessment Questionnaire (MIDAS). Reduction in QoL can be evaluated using the Migraine-Specific Quality of Life Survey (MSQ 2.1), European Quality of Life-Five Dimensions (EQ-5D), or Short-Form 36 (SF-36). Despite all these instruments, proper selection and interpretation of each instrument remain crucial.
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Affiliation(s)
- Kuan-Po Peng
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taiwan
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Magnusson JE, Riess CM, Becker WJ. Modification of the SF-36 for a headache population changes patient-reported health status. Headache 2012; 52:993-1004. [PMID: 22553950 DOI: 10.1111/j.1526-4610.2012.02156.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Using standard quality of life and disability measures may not accurately capture these constructs in specific health populations such as headache patients. Modifying the wording of standard measures such as the Short-Form 36 (SF-36) should be considered in order to make them more applicable to specific patient populations. OBJECTIVE To investigate the possibility that headache patients may not consider their headaches when responding to SF-36 questions pertaining to health, physical health, pain, and bodily pain. METHODS The wording of several SF-36 questions were adapted for a headache population by making specific reference to "headaches" when asking people to rate the impact of health issues on their life. The results of the modified "Headache" SF-36 were compared with a similar population of transformed migraine patients who had completed the "Standard" SF-36. RESULTS Significant differences were found between scores for the "Standard" SF-36 group and the "Headache" SF-36 group across all SF-36 variables except for "General Health." CONCLUSIONS Misinterpretation of the concepts of "health,""physical health,""pain," and "bodily pain," although commonly used by the SF-36 in many populations, could influence responses on this measure, as respondents may not relate their head/headaches to these constructs. To ensure that accurate data are obtained in relation to the quality of life of headache patients, consideration should be given to using a form of the SF-36 that has been modified to allow appropriate interpretation of the questions completed by headache patients.
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Affiliation(s)
- Jane E Magnusson
- Department of Sport and Exercise Science, University of Auckland, Auckland, New Zealand.
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Chai NC, Rosenberg JD, Lee Peterlin B. The epidemiology and comorbidities of migraine and tension-type headache. ACTA ACUST UNITED AC 2012. [DOI: 10.1053/j.trap.2012.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Modgill G, Jette N, Wang JL, Becker WJ, Patten SB. A population-based longitudinal community study of major depression and migraine. Headache 2011; 52:422-32. [PMID: 22084834 DOI: 10.1111/j.1526-4610.2011.02036.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine whether major depressive episodes (MDEs) are associated with an increased risk of migraine in the general population and to examine whether migraine is associated with an increase risk of MDE. BACKGROUND Population-based cross-sectional studies have consistently reported an association between migraine and depression. However, longitudinal studies about this potentially bidirectional association are inconsistent. METHODS This retrospective cohort study used 12 years of follow-up data from the Canadian National Population Health Survey (15,254 respondents, age >12). Stratified analysis, logistic regression, and proportional hazard modeling were used to quantify the effect of migraine on subsequent MDE status and vice versa. RESULTS After adjusting for sex, age, and other chronic health conditions, respondents with migraine were 60% more likely (HR 1.6, 95% confidence interval 1.3-1.9) to develop MDE compared with those without migraine. Similarly adjusting for sex and age, respondents with MDE were 40% more likely (HR 1.4, 95% confidence interval 1.0-1.9) to develop migraine compared with those without MDE. However, the latter association disappeared after adjustment for stress and childhood trauma. CONCLUSIONS The current study provides substantial evidence that migraine is associated with the later development of MDEs, but does not provide strong causal evidence of an association in the other direction. Environmental factors such as childhood trauma and stress may shape the expression of this bidirectional relationship; however, the precise underlying mechanisms are not yet known.
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Affiliation(s)
- Geeta Modgill
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.
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Pitrou I, Shojaei T, Chan-Chee C, Wazana A, Boyd A, Kovess-Masféty V. The associations between headaches and psychopathology: a survey in school children. Headache 2011; 50:1537-48. [PMID: 21198562 DOI: 10.1111/j.1526-4610.2010.01781.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Headaches are common in childhood and significantly impact children's quality of life. On the contrary to the adolescent and adult population, there are few data on the associations between headaches and psychopathology in young children. OBJECTIVE The aim of this study was to examine the relationships between child headaches, emotional and behavioral difficulties in children aged 6-11 years old. METHODS A cross-sectional survey was conducted in 2004 in 100 primary schools from a large French region, with 2341 children aged 6-11 years old randomly selected. Child headache status, comorbid physical conditions, and socioeconomic characteristics were collected in parent-administered questionnaires. Child psychopathology outcomes were assessed using child- and parent-reported standardized instruments: respectively, the Dominic Interactive and the Strengths and the Difficulties Questionnaire. Associations were estimated using logistic regression models. RESULTS Response rates to the parent questionnaire and the Dominic Interactive were 57.4% and 95.1%, respectively. The final sample size was 1308 children. Eleven percent of the children already experienced frequent headaches in their lifetime, with no difference by age or gender. Headaches were associated with parent-reported emotional problems (OR=1.76; 95% CI: 1.03-3.01) and self-reported general anxiety disorder (OR=1.99; 1.13-3.52). Comorbid physical conditions ≥2 appeared as an independent factor significantly associated with headaches (OR =1.75; 95% CI: 1.13-2.73). Inversely, low parental punitive behaviors were less frequently associated with headaches (OR=0.41; 95% CI: 0.18-0.94). CONCLUSION Our results suggest some associations between headaches, emotional disorders, and comorbid physical conditions in young children aged 6-11 years old. Those results should be considered in the treatment approaches of childhood headaches and from the etiological aspect.
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Affiliation(s)
- Isabelle Pitrou
- EA 4069 Paris Descartes University, Ecole des Hautes Etudes de Santé Publique (EHESP), Paris, France
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Smitherman TA, McDermott MJ, Buchanan EM. Negative Impact of Episodic Migraine on a University Population: Quality of Life, Functional Impairment, and Comorbid Psychiatric Symptoms. Headache 2011; 51:581-9. [DOI: 10.1111/j.1526-4610.2011.01857.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gayman MD, Brown RL, Cui M. Depressive symptoms and bodily pain: The role of physical disability and social stress. Stress Health 2011; 27:52-53. [PMID: 21359108 PMCID: PMC3045212 DOI: 10.1002/smi.1319] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study evaluates the bi-directional association between depressive symptoms and bodily pain, and examines the role of physical disability and perceived social stress in the depression-pain relationship. Data are employed from a two-wave panel study of Miami-Dade county residents (n = 1,459) that includes a substantial over-sampling of individuals who identify as physically-disabled. Findings indicate that the bi-directional relationship between depression and pain is similar for those with and without a physical disability. Results also demonstrate that stress exposure, specifically recent life events and daily discrimination, partially mediated the relationship between prior levels of depression and changes in pain. Directions for future research and the need for a more comprehensive model of health incorporating physical, psychological, and social factors are discussed.
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Affiliation(s)
| | | | - Ming Cui
- Department of Family & Child Sciences, Florida State University, FL, USA
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Yamada K, Moriwaki K, Oiso H, Ishigooka J. High prevalence of comorbidity of migraine in outpatients with panic disorder and effectiveness of psychopharmacotherapy for both disorders: a retrospective open label study. Psychiatry Res 2011; 185:145-8. [PMID: 20546930 DOI: 10.1016/j.psychres.2009.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Revised: 06/16/2009] [Accepted: 08/13/2009] [Indexed: 11/18/2022]
Abstract
We investigated the comorbidity rate of migraine in outpatients with panic disorder, and the efficacy of pharmacotherapy for both disorders. Fifty-four patients who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria for panic disorder were recruited in the study. Forty-three patients were female, and their age ranged from 20 to 71 (38.8±11.2; mean±S.D.) years. Forty-one patients had agoraphobia. In these patients, we diagnosed migraine and other types of headache, using the International Classification of Headache Disorders, Second Edition (ICHD-II). Forty-three (79.6%) patients were diagnosed as having some type of headache; 33 (61.1%) migraine, 32 tension-type headache, and one cluster headache. In patients with migraine, treatment for panic disorder also improved their migraine in 19 (57.6%) patients. The mean onset age of panic disorder in patients with migraine was statistically significantly younger than that in non-migraine patients. The Clinical Global Impression Improvement (CGI-I) score of panic disorder was statistically significantly correlated with the CGI-I score of migraine. A high comorbidity rate (61.1%) of migraine was observed in outpatients with panic disorder, and our result suggests that treatment with antidepressants for panic disorder may also be effective for prophylaxis of migraine.
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Affiliation(s)
- Kazuo Yamada
- Department of Psychiatry, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan.
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Konuk E, Epözdemir H, Atçeken ŞH, Aydın YE, Yurtsever A. EMDR Treatment of Migraine. JOURNAL OF EMDR PRACTICE AND RESEARCH 2011. [DOI: 10.1891/1933-3196.5.4.166] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This pilot study was conducted at Gaziosmanpaşa Hospital, Istanbul, to investigate the effectiveness of eye movement desensitization and reprocessing (EMDR) on migraine headache by specifically treating traumas related to headaches. The sample consisted of 11 Turkish participants with chronic daily headache: 9 women (mean age of 31.7 years) and 2 men (mean age of 30.5 years). Participants had a history of migraine ranging from 2 to 30 years (mean = 12 years). Variables included participant daily ratings of headache frequency, duration, and intensity; medication intake; hospital emergency room (ER) visits; and scores on the Symptom Assessment-45 Questionnaire. The results showed a significant decrease in headache frequency and duration with no reduction in pain intensity. There was a significant decrease in the use of painkillers and ER visits. All results were maintained at 3-month follow-up, providing some preliminary evidence that EMDR may be effective and useful as an alternative treatment for migraine.
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Senaratne R, Van Ameringen M, Mancini C, Patterson B, Bennett M. The prevalence of migraine headaches in an anxiety disorders clinic sample. CNS Neurosci Ther 2010; 16:76-82. [PMID: 20415837 DOI: 10.1111/j.1755-5949.2009.00103.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The association between migraine and psychiatric disorders has been reported in both clinical and epidemiological studies. The prevalence of psychiatric disorders has been found to be increased among individuals with migraine. Studies assessing migraine in psychiatric patients are limited and the majority of these studies have focused solely on examining patients with major depression. In the present study, we examined the prevalence and characteristics of migraine headache in an anxiety disorders clinic sample in order to better understand the relationship between these commonly associated conditions. We evaluated 206 consecutive outpatients to an Anxiety Disorders Clinic for the prevalence of migraine. The presence of migraine was established using International Headache Society Criteria. Subjects completed a modified self-report version of the Headache Diagnostic Questionnaire. In order to assess the relationship between migraine and anxiety disorder symptom severity, subjects completed standardized measures of symptom severity. The prevalence of migraine in our anxiety disorder clinic sample was 67%. Anxiety disorder patients with migraine presented with a significantly greater number of comorbid psychiatric disorders than patients without migraine (P= 0.012). The prevalence of migraine was significantly higher in patients with a diagnosis of either panic disorder with agoraphobia (P= 0.048) or major depressive disorder/dysthymia (P= 0.008) compared to other psychiatric disorders. The severity of anxiety disorder symptoms was significantly higher in patients with migraine compared to patients without migraine. This study suggests that there is an increased prevalence of migraine headaches among anxiety disorder patients as compared to the general population. Migraine comorbidity may have important clinical implications, such that the treatment of one condition could potentially ameliorate the development or progression of the other. Further research is required to better understand the nature and implications of the association between migraine and psychiatric disorders.
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Affiliation(s)
- Rhandi Senaratne
- Department of Psychology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
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Stokes DA, Lappin MS. Neurofeedback and biofeedback with 37 migraineurs: a clinical outcome study. Behav Brain Funct 2010; 6:9. [PMID: 20205867 PMCID: PMC2826281 DOI: 10.1186/1744-9081-6-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 02/02/2010] [Indexed: 11/17/2022] Open
Abstract
Background Traditional peripheral biofeedback has grade A evidence for effectively treating migraines. Two newer forms of neurobiofeedback, EEG biofeedback and hemoencephalography biofeedback were combined with thermal handwarming biofeedback to treat 37 migraineurs in a clinical outpatient setting. Methods 37 migraine patients underwent an average of 40 neurofeedback sessions combined with thermal biofeedback in an outpatient biofeedback clinic. All patients were on at least one type of medication for migraine; preventive, abortive or rescue. Patients kept daily headache diaries a minimum of two weeks prior to treatment and throughout treatment showing symptom frequency, severity, duration and medications used. Treatments were conducted an average of three times weekly over an average span of 6 months. Headache diaries were examined after treatment and a formal interview was conducted. After an average of 14.5 months following treatment, a formal interview was conducted in order to ascertain duration of treatment effects. Results Of the 37 migraine patients treated, 26 patients or 70% experienced at least a 50% reduction in the frequency of their headaches which was sustained on average 14.5 months after treatments were discontinued. Conclusions All combined neuro and biofeedback interventions were effective in reducing the frequency of migraines with clients using medication resulting in a more favorable outcome (70% experiencing at least a 50% reduction in headaches) than just medications alone (50% experience a 50% reduction) and that the effect size of our study involving three different types of biofeedback for migraine (1.09) was more robust than effect size of combined studies on thermal biofeedback alone for migraine (.5). These non-invasive interventions may show promise for treating treatment-refractory migraine and for preventing the progression from episodic to chronic migraine.
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Affiliation(s)
- Deborah A Stokes
- The Better Brain Center, Inc, 2121 Eisenhower Ave Suite 604 Alexandria, VA 22314, USA.
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Dilsaver SC, Benazzi F, Oedegaard KJ, Fasmer OB, Akiskal KK, Akiskal HS. Migraine headache in affectively ill latino adults of mexican american origin is associated with bipolarity. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2009; 11:302-6. [PMID: 20098521 PMCID: PMC2805565 DOI: 10.4088/pcc.08m00728] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Accepted: 12/10/2008] [Indexed: 10/20/2022]
Abstract
BACKGROUND The objective of this cross-sectional study was to determine the prevalence of migraine headache among depressed Latino adults of Mexican American origin meeting the criteria for bipolar disorder (BPD) or major depressive disorder (MDD) relative to patients in a psychiatric comparison group. METHOD In a mental health clinic for the indigent, consecutively and systematically evaluated acutely depressed Latino adults received structured diagnostic psychiatric interviews based on modules extracted from the Structured Clinical Interview for DSM-IV. All were asked as part of routine assessment whether they had headaches "in the last week." Patients with unilateral, pounding, pulsating headache were classified as having migraine headache. The prevalence of migraine headache among the patients with BPD and MDD was contrasted with that of patients in a psychiatric comparison group composed of patients with disorders other than schizophrenia or schizoaffective disorder. Logistic regression was used to test for associations and control for confounding effects. The data were collected between August 2001 and November 2004. RESULTS Eighty-seven patients had BPD and 123 had MDD. Bipolar patients were 2.9 times more likely to have migraine headaches than patients with MDD (P < .0001). There was a trend for patients with MDD to have a higher prevalence of migraine than patients in the psychiatric comparison group. CONCLUSIONS Bipolar patients had a high prevalence of migraine headache relative to patients with MDD. This study suggests that migraine is linked to bipolarity.
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Affiliation(s)
- Steven C Dilsaver
- Comprehensive Doctors Medical Group, Inc, Arcadia, California and The Mental Health Mental Retardation Clinic, Rio Grande City, Texas, USA.
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Dodick DW. Reflections and Speculations on Refractory Migraine: Why Do Some Patients Fail to Improve With Currently Available Therapies? Headache 2008; 48:828-37. [DOI: 10.1111/j.1526-4610.2008.01158.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tunks ER, Crook J, Weir R. Epidemiology of chronic pain with psychological comorbidity: prevalence, risk, course, and prognosis. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2008; 53:224-34. [PMID: 18478825 DOI: 10.1177/070674370805300403] [Citation(s) in RCA: 197] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To review the relation between chronic pain and psychological comorbidities, and the influence on course and prognosis, based on epidemiologic and population studies. METHOD We present a narrative overview of studies dealing with the epidemiology of chronic pain associated with mental health and psychiatric factors. Studies were selected that were of good quality, preferably large studies, and those that dealt with prevalences, course and prognosis of chronic pain, risk factors predicting new pain and comorbid disorders, and factors that affect health outcomes. RESULTS Chronic pain is a prevalent condition, and psychological comorbidity is a frequent complication that significantly changes the prognosis and course of chronic pain. In follow-up studies, chronic pain significantly predicts onset of new depressions, and depression significantly predicts onset of new chronic pain and other medical complaints. Age, sex, severity of pain, psychosocial problems, unemployment, and compensation are mediating factors in course and prognosis. CONCLUSION In assessment of chronic pain, the evidence from epidemiologic studies makes it clear that chronic pain can best be understood in the context of psychosocial factors.
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Affiliation(s)
- Eldon R Tunks
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario.
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Rueda-Sánchez M, Diaz-Martinez LA. Prevalence and Associated Factors for Episodic and Chronic Daily Headache in the Colombian Population. Cephalalgia 2008; 28:216-25. [DOI: 10.1111/j.1468-2982.2007.01499.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
There are multiple risk factors for chronic daily headache (CDH), but they are usually assessed in an isolated form without an adequate control for confounders. CDH is considered a variant of episodic headache, but studies have not gathered enough evidence to evaluate simultaneously CDH and episodic in the same population. We set out to establish simultaneously the factors associated with chronic daily or episodic headache in a population setting, using a cross-sectional survey in a random sample of 1505 adult urban inhabitants (Bucaramanga, Colombia). The survey asked questions about headache, family and personal history of disease, and consumption or abuse of caffeine, alcohol, hypnotics and analgesics. The association among independent variables and CDH or episodic headache was made with multinomial logistic regression. Female gender, arterial hypertension or cranial trauma history, and a high score in the depression scale are associated with episodic headache and CDH. Parents with CDH, the complaint of multiple arousals during sleep and use of hypnotics are associated with CDH, but not with episodic headache. Age < 36 years, alcoholism and snoring are factors associated only with episodic headache. Chronic daily headache and episodic headache have several common risk factors, but there are other factors not shared by both conditions.
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Affiliation(s)
- M Rueda-Sánchez
- Neuropsychiatry Research Group, Biomedical Research Centre, School of Medicine, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - LA Diaz-Martinez
- Neuropsychiatry Research Group, Biomedical Research Centre, School of Medicine, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
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Jette N, Patten S, Williams J, Becker W, Wiebe S. Comorbidity of migraine and psychiatric disorders--a national population-based study. Headache 2007; 48:501-16. [PMID: 18070059 DOI: 10.1111/j.1526-4610.2007.00993.x] [Citation(s) in RCA: 224] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Migraine is common, with an estimated lifetime prevalence of 7-17%. Population-based studies have reported an association between various psychiatric conditions and migraine. This is a population-based study exploring the association between migraine and psychiatric disorders in a large cohort and assessing various health-related outcomes. OBJECTIVE (1) Determine the prevalence of various psychiatric conditions in association with migraine; (2) describe the patterns of association of these comorbidities with a variety of health-related outcomes. METHODS Data from the 2002 Canadian Community Health Survey were used. This is a national health survey which included administration of the World Mental Health Composite International Diagnostic Interview to a sample of 36,984 subjects. Health-related outcomes included 2-week disability, restriction of activities, quality-of-life, and mental health care utilization. RESULTS The prevalence of physician-diagnosed migraine (n=36,984) was 15.2% for females and 6.1% for males. Migraine was most common in those between ages 25 and 44 years and in those of lower income. Migraine was associated with major depressive disorder, bipolar disorder, panic disorder, and social phobia, all occurring more than twice as often in those with migraines compared with those without. Migraine was not associated with drug, alcohol, or substance dependence. The higher prevalence of psychiatric disorders in migraineurs was not related to sociodemographic variables. Psychiatric disorders were less common in those over 65 years, in those who were in a relationship, and in those of higher income whether migraine was present or not. Health-related outcomes were worst in those with both migraines and a psychiatric disorder and intermediate in those with either condition alone. CONCLUSION Migraine is associated with major depressive disorder, bipolar disorder, panic disorder, and social phobia. Migraine in association with various mental health disorders results in poorer health-related outcomes compared with migraine or a psychiatric condition alone. Understanding the psychiatric correlates of migraine is important in order to adequately manage this patient population and to guide public health policies regarding health services utilization and health-care costs.
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Affiliation(s)
- Nathalie Jette
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
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Abstract
Although most individuals with recurrent headache disorders in the general population do not experience severe psychopathology, population-based studies and clinical investigations find high rates of comorbidity between headache and mood and anxiety disorders. When present, psychiatric disorders may complicate headache treatment and portend a poorer treatment response. The negative prognosis associated with psychiatric comorbidity emphasizes the importance of the identification of psychopathology among those with headache beginning at an early age, and suggests that the treatment of psychiatric comorbidity is warranted to improve the outcome of headache management. In this article we describe the mood and anxiety disorders most commonly associated with migraine, tension-type headache, and chronic daily headache. We provide recommendations for the assessment of comorbid mood and anxiety disorders as well as a brief overview of treatment options. Last, we discuss the clinical implications of mood and anxiety disorders on the treatment and outcome of headache.
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Affiliation(s)
- Steven M Baskin
- New England Institute for Behavioral Medicine, Stamford, CT 06902, USA
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Abstract
Migraine is a common and recurrent headache disorder that may present with a variety of neurologic and non-neurologic manifestations. It has been classified into migraine with aura and migraine without aura. Research has shown that migraine affects verbal, visuo-spatial memory, and selective attention tasks. Cognitive impairments observed in migraineurs have been found to occur during a migraine attack, after the attack, and even when the individual does not exhibit any residual effects of the attack. Individuals with migraine are at a greater risk of developing anxiety and depression. Migraine disability is most commonly assessed using the Migraine Disability Assessment Scale (MIDAS), a simple five-item scale that assesses the individual's level of performance and areas of impairment. This review assesses the neuropsychological aspects of the complex malady that is migraine.
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Abstract
In this article, we consider the possible reasons and supporting evidence for the comorbidity of chronic pain conditions. To simplify the discussion, we primarily focus on the epidemiology of headache with other pain conditions, dividing studies into those based on children or adolescents and those based on adults. We consider exogenous and endogenous factors, and methodological challenges, in understanding whether and how 2 pain conditions may be related.
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Affiliation(s)
- Ann I Scher
- Department of Preventive Medicine and Biometrics, Uniformed Services University, Bethesda, MD 20814, USA
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Abstract
Most clinicians agree that psychological factors are important considerations in the evaluation and treatment of headache patients. There has been a lack of systematic research, however, that has examined the relationship between these variables. Attention to such factors may become a greater concern as the frequency of a patient's headaches increases, there is increased disability secondary to headaches, and/or there is an inadequate response to usually effective treatment. In addition, there is no consensus as to the proper method to assess psychopathology in headache patients.
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Affiliation(s)
- Randall Weeks
- New England Institute for Behavioral Medicine, Stamford, CT, USA
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Strine TW, Chapman DP, Balluz LS. Population-based U.S. study of severe headaches in adults: psychological distress and comorbidities. Headache 2006; 46:223-32. [PMID: 16492231 DOI: 10.1111/j.1526-4610.2006.00340.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the associations between severe headaches (SH), psychological distress, and comorbid conditions among U.S. adults. BACKGROUND The lifetime prevalence of headaches is over 90% and headaches, particularly migraines, have been associated with disability, increased healthcare costs, and mood disorders. METHODS We analyzed data obtained from adults aged 18 years or older (n = 29,828) who participated in the 2002 National Health Interview Survey, an ongoing, computer-assisted personal interview of a representative sample of the U.S. population. RESULTS Approximately 15.1% of adults aged 18 years or older reported SH in the previous 3 months. Those reporting such headaches were significantly more likely, than those who did not, to report insomnia, excessive sleepiness, recurrent pain, and depressive or anxiety symptoms during the preceding 12 months. Approximately 88% of those who reported having had SH within the previous 3 months also indicated that they had at least one comorbid medical condition, relative to 67% of those without SH. CONCLUSION Despite their episodic nature, our results suggest that SH are associated with impairments in both physical and mental health. As the presence of SH may serve as an indicator of significant psychological distress and medical comorbidities, eliciting information about their occurrence during a standard medical examination appears to be warranted.
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Affiliation(s)
- Tara W Strine
- Division of Adult and Community Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
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Ruiz-Gayo M, González MC, Fernández-Alfonso S. Vasodilatory effects of cholecystokinin: new role for an old peptide? ACTA ACUST UNITED AC 2006; 137:179-84. [PMID: 16889840 DOI: 10.1016/j.regpep.2006.06.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2006] [Revised: 06/22/2006] [Accepted: 06/22/2006] [Indexed: 02/07/2023]
Abstract
Cholecystokinin (CCK) peptides are involved in the control of multiple functions both in the central nervous system (CNS) and in the gastrointestinal tract where they act as neurotransmitters and regulate digestive functions. This review deals with the role of CCK peptides as vasoactive mediators. Recent work from our group demonstrates that CCK peptides induce neurogenic vasodilatation both in cerebral and mesenteric vessels. Such an effect is mediated by nitric oxide and seems to be presynaptic. These findings suggest that endogenous CCK peptides could be relevant vasodilatory agents involved in regulating both cerebral and splanchnic blood flow. We hypothesize here how such an effect could be useful in the interpretation of, in a new conceptual frame, the eventual contribution of CCK to some physiological and physiopathological events, such as splanchnic postprandial hyperaemia, panic attack or migraine.
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Affiliation(s)
- Mariano Ruiz-Gayo
- Departamento de Farmacología, Tecnología y Desarrollo Farmacéutico, Facultad de Farmacia, Universidad San Pablo, CEU, Madrid, Spain
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Strine TW, Okoro CA, McGuire LC, Balluz LS. The associations among childhood headaches, emotional and behavioral difficulties, and health care use. Pediatrics 2006; 117:1728-35. [PMID: 16651331 DOI: 10.1542/peds.2005-1024] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Headaches are common among children and adolescents, particularly migraine and tension-type headaches. They contribute to missed school days, affect children's peer and family relationships, and significantly impact children's quality of life, often times into adulthood. OBJECTIVES This study, based on responses to the Strengths and Difficulties Questionnaire, was designed to examine difficulties and impairments related to emotions, concentration, behavior, and social functioning among children with frequent or severe headaches (FSH). METHODS We used a cross-sectional study of 9264 children aged 4-17 years from the 2003 National Health Interview Survey, an ongoing, computer-assisted personal interview survey of the noninstitutionalized US population. RESULTS Approximately 6.7% of children experienced FSH during the previous 12 months. Overall, children with FSH were 3.2 times more likely than children without FSH to have a high level of difficulties and 2.7 times more likely to have a high level of impairment, suggesting potential mental health issues. More specifically, analyses revealed that children with FSH were significantly more likely than those without FSH to exhibit high levels of emotional, conduct, inattention-hyperactivity, and peer problems and were significantly more likely than children without FSH to be upset or distressed by their difficulties and to have their difficulties interfere with home life, friendships, classroom learning, and leisure activities. CONCLUSION Because children with FSH experience notable pain, mental health issues, and functional limitations, integrated care using a biopsychosocial approach is warranted.
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Affiliation(s)
- Tara W Strine
- Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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Abstract
BACKGROUND The impact of migraine and other headache types among psychiatric outpatients with major depressive disorder (MDD) has not been fully described. OBJECTIVE To investigate the impact of migraine on the severity, physical, and anxiety symptoms in patients with MDD and to examine the interaction between headache and depression. METHODS This clinic-based study enrolled consecutive psychiatric outpatients meeting DSM-IV criteria for MDD. Headache types were diagnosed based on the International Classification of Headache Disorders, 2nd edition (2004). Three psychometric instruments were used to evaluate anxiety, depression, and physical components: the Hamilton Depression Rating Scale, the Beck Depression Inventory, and the Hospital Anxiety and Depression Scale. In addition, the interactions between headache and their depressive episode were also evaluated. RESULTS Compared with patients without migraine, MDD patients with comorbid migraine (n = 73, 48.3%) had higher physical and anxiety scores on the three psychometric instruments. Migraine accounted for 5% to 11% of the variance of the total scores on the three psychometric scales. Approximately half (48.5%) of patients reported headache worsening during or after a depressive episode. CONCLUSIONS Our study found that comorbidity of migraine in patients with MDD was associated with more anxiety and physical symptoms. Headache should not be considered as only a somatic symptom of depression, but should be treated as an important comorbid disorder because it might exacerbate or interact with depression during a depressive episode.
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Affiliation(s)
- Ching-I Hung
- Department of Psychiatry, Chang Gung Memorial Hospital and Chang Gung University School of Medicine, Taoyuan, Taiwan
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Lake AE, Rains JC, Penzien DB, Lipchik GL. Headache and psychiatric comorbidity: historical context, clinical implications, and research relevance. Headache 2005; 45:493-506. [PMID: 15953266 DOI: 10.1111/j.1526-4610.2005.05101.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The comorbidity of headache and psychiatric disorders is a well-recognized clinical phenomenon warranting further systematic research. Affective disorders occur with at least three-fold greater frequency among migraineurs than among the general population, and the prevalence increases in clinical populations, especially with chronic daily headache. When present, psychiatric comorbidity complicates headache management and portends a poorer prognosis for headache treatment. However, the relationship between headache and psychopathology has historically been misunderstood, and measures of psychopathology have not always met the standard of formal Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria. In some cases, headache has been inappropriately attributed to psychological or psychiatric features, based on anecdotal observations. The challenge for future studies is to employ research methods and designs that accurately identify and classify the subset of headache patients with psychiatric disorders, evaluate their impact on headache symptoms and treatment, and identify optimal behavioral and pharmacologic treatment strategies. This article offers methodological considerations and recommendations for future research including: (i) ascribing dual-International Classification of Headache Disorders, 2nd ed. (ICHD-2) headache and DSM-IV psychiatric diagnoses according to reliable and valid diagnostic criteria, (ii) differentiating subclinical levels of depression and anxiety from major psychiatric disorders, (iii) encouraging validation studies of the recently published ICHD-2 diagnoses for "headache attributed to psychiatric disorder," (iv) expanding epidemiological research to address the range of DSM-IV Axis I and II psychiatric diagnoses among various headache populations, (v) identifying relevant psychiatric and behavioral mediator/moderator variables, and (vi) developing empirically based screening and treatment algorithms.
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Affiliation(s)
- Alvin E Lake
- Behavioral Medicine Division, Michigan Head Pain and Neurological Institute, Ann Arbor 48104, USA
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Mercante JPP, Peres MFP, Guendler V, Zukerman E, Bernik MA. Depression in chronic migraine: severity and clinical features. ARQUIVOS DE NEURO-PSIQUIATRIA 2005; 63:217-20. [PMID: 16100965 DOI: 10.1590/s0004-282x2005000200005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION: Chronic migraine (CM) is a common medical condition affecting 2.4% of the general population. Depression is one of the most frequent comorbid disorders in CM. METHOD: Seventy patients diagnosed with chronic migraine were studied. All patients evaluated filled out the Beck Depression Inventory (BDI). Depression severity was divided into none or minimal depression, mild, moderate, and severe. RESULTS: BDI ranged from 4 to 55, mean 21 ± 10.7. Moderate or severe depression, were present in 58.7% of the patients . Some degree of depression appeared in 85.8% of patients. The BDI scores correlated with pain intensity (p = 0.02). Severe depression was more frequent in patients with comorbid fibromyalgia and in patients reporting fatigue. CONCLUSION: The BDI is an easy tool to access depression in CM patients. Suicide risk assessment is needed in CM patients. Patients with fibromyalgia and fatigue are at even higher risk for severe depression.
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Affiliation(s)
- Juliane Prieto Peres Mercante
- Psicóloga, pesquisadora do Instituto de Ensino e Pesquisa do Hospital Israelita Albert Einstein, São Paulo SP, Brasil.
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Oedegaard KJ, Fasmer OB. Is migraine in unipolar depressed patients a bipolar spectrum trait? J Affect Disord 2005; 84:233-42. [PMID: 15708421 DOI: 10.1016/j.jad.2003.11.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2003] [Accepted: 11/12/2003] [Indexed: 11/29/2022]
Abstract
BACKGROUND It is well known that affective disorders and migraine often coexist in the same patients, and some information is available indicating that migraine is particularly prevalent in bipolar II disorder. The aims of this study were to compare the clinical features in unipolar depressed patients with and without comorbid migraine to bipolar patients. METHODS Semi-structured interview of 201 patients with major affective disorders, using DSM-IV criteria for affective disorders combined with Akiskal's criteria for affective temperaments, and IHS-criteria for migraine. RESULTS Compared to the group of patients having unipolar depressions without comorbid migraine (n = 51) the group with unipolar depression and migraine (n = 63) had a higher number of depressive episodes (4.5 vs. 2.5, P = 0.017), significantly higher prevalences of affective temperaments (46% vs. 16%, P = 0.001), irritability (70% vs. 45%, P = 0.008), seasonal variation (22% vs. 5%, P = 0.017), agoraphobia (44% vs. 26%, P = 0.036), asthma (25% vs. 6%, P = 0.006) and migraine in family (59% vs. 29%, P = 0.002). The clinical features of unipolar depressed patients with comorbid migraine resemble the bipolar II patients (n = 51) in this sample. LIMITATIONS Non-blind, cross-sectional assessment. CONCLUSIONS These results indicate that there may be important clinical differences between unipolar depressed patients with and without comorbid migraine, possibly indicating that migraine in depressed patients is a bipolar spectrum trait.
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Abstract
OBJECTIVE To examine the direct medical costs associated with migraine, when diagnosed alone and in conjunction with anxiety and/or depression in adults and children. BACKGROUND Migraine is a common disorder that can often be accompanied by comorbid anxiety and/or depression. Given the prevalence of migraine and the likelihood for comorbid conditions, it is not surprising that migraine is extremely costly for society. METHODS Migraine cohorts were identified in a 1999-2000 database capturing inpatient, outpatient, and prescription drug services from approximately 45 large employers. Four cohorts of adults (migraine only, migraine and anxiety, migraine and depression, migraine and both conditions), and two cohorts of children (migraine only, migraine and anxiety and/or depression), were compared to respective "healthy" cohorts. t-statistics were used to capture differences in costs between the migraine cohorts and the healthy cohorts whereas ANOVA was used to test for differences in costs between subgroups of migraine sufferers. RESULTS Compared to nonmigraineurs, adults and children with migraine had significantly higher total direct medical costs in all examined categories (P < .0001) (7,089 US Dollars vs US Dollars adults; 4,272 US Dollars vs 1,400 US Dollars children). For adults, the presence of depression and/or anxiety along with migraine equated to significantly greater total direct medical costs when compared to their matched healthy cohorts (P < .0001) (12,642 US Dollars vs 5,179 US Dollars anxiety; 11,290 US Dollars vs 3,135 US Dollars depression). Children with migraine and either anxiety or depression (or both) incurred an average of 9,875 US Dollars in total direct medical costs as compared with only 1,165 US Dollars for healthy comparators. For children and adults, the presence of comorbid anxiety or depression was associated with significantly higher medical costs when compared to migraine alone (P < .0001). CONCLUSIONS This analysis quantifies the economic impact of a migraine diagnosis for both adults and children. The results of this analysis demonstrate that individuals identified as migraineurs have significantly higher medical costs than healthy comparators, with or without comorbid anxiety and/or depression. This study also suggests that clinicians should be aware that while proper treatment of migraine with effective acute and prophylactic therapy is important, attention must also be directed to comorbid conditions.
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Affiliation(s)
- Jacqueline Pesa
- Health Economics and Outcomes Research, AstraZeneca, Willmington, DE, USA
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Anttila P, Sourander A, Metsähonkala L, Aromaa M, Helenius H, Sillanpää M. Psychiatric symptoms in children with primary headache. J Am Acad Child Adolesc Psychiatry 2004; 43:412-9. [PMID: 15187801 DOI: 10.1097/00004583-200404000-00007] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To examine the association of psychiatric symptoms with migraine and tension-type headache in children. METHOD A questionnaire completed by 1,135 Finnish children in the sixth grade identified 154 children with migraine, 138 with tension-type headache, and 407 children who were headache-free. Seventy children were randomly selected from each group and evaluated by a structured interview to confirm headache type, resulting in a sample of 59 children with migraine, 65 with tension-type headache, and 59 without headache. The children completed the Children's Depression Inventory, and the parents completed the Child Behavior Checklist and General Functioning scale of the McMaster Family Assessment Device. RESULTS Children with migraine had significantly higher levels of total, internalizing, and somatic symptoms, as well as social and family problems, than those without headache and had higher levels of somatic symptoms than children with tension-type headache. Children with tension-type headache had significantly higher levels of somatic symptoms and family problems than those without headache. CONCLUSIONS The association between psychiatric symptoms and headaches shows differences between different headache types. However, a minority of children with migraine or tension-type headache have high levels of psychiatric symptoms.
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Affiliation(s)
- Pirjo Anttila
- Department of Child and Adolescent Health Care, Turku City Hospital, Finland.
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Bayliss MS, Dewey JE, Dunlap I, Batenhorst AS, Cady R, Diamond ML, Sheftell F. A study of the feasibility of Internet administration of a computerized health survey: the headache impact test (HIT). Qual Life Res 2004; 12:953-61. [PMID: 14651414 DOI: 10.1023/a:1026167214355] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Headache impact test (HIT) is a precise, practical tool that quantifies the impact of headache on respondents' lives. It is the first widely-available dynamic health assessment (DynHA). Applications of this brief, precise survey include population based screening for disabling headaches, tracking of individual patient scores over time, disease management programs and others. We use data from Internet HIT assessments during the fall of 2000 to (1) evaluate characteristics of respondents and assessments, (2) assess the utility of joint administration of HIT and the SF-8 Health Survey (SF-8) to screen for migraine and depression, and (3) explore associations between HIT scores and subsequent healthcare-related attitudes and behaviors. METHODS We analyzed Internet HIT surveys completed between 9/1 and 11/30/2000 (n = 19,195). Subsamples include respondents who also completed (1) a 12-item Internet survey assessing severity, frequency, cause and management of headaches; (2) an e-mail survey measuring healthcare-related behaviors; (3) the SF-8; or (4) the website registration process, providing age and gender data. We used analysis of variance (ANOVA) to evaluate HIT score differences associated with age, gender, headache severity or frequency, and healthcare-related behaviors and attitudes and chi2 tests to assess the prevalence and comorbidity of migraine and depression. RESULTS Three-quarters of respondents achieved a precise HIT score in < or = 5 items. Most had moderate/severe headaches; 65% had headaches at least monthly. HIT scores were directly related to headache severity and frequency. Most respondents were females, with significantly higher HIT scores than males. Most HIT respondents were between ages 25 and 54 (HIT scores were higher for younger respondents). Sixty four percent screened positive for migraine; 20% for depression. Both conditions were more prevalent among females than males. Comorbid migraine and depression was 50% more prevalent among females and increased with age until age 50. Patients with worse headache impact were more likely to seek care, discuss headaches with their providers and find HIT useful. CONCLUSIONS It is feasible to use Internet-based dynamic assessments to measure health status. These data complement previous results showing that HIT differentiates respondents according to headache characteristics (severity and frequency). HIT plus SF-8 yields a practical screen for migraine and depression in headache patients and may lead to more effective treatment for patients with these conditions. Preliminary findings suggest that the experience of taking HIT on the Internet may motivate headache patients to seek care and discuss headaches with their providers.
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Affiliation(s)
- M S Bayliss
- QualityMetric Incorporated, Lincoln, RI, USA.
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Turner-Bowker DM, Bayliss MS, Ware JE, Kosinski M. Usefulness of the SF-8 Health Survey for comparing the impact of migraine and other conditions. Qual Life Res 2004; 12:1003-12. [PMID: 14651418 DOI: 10.1023/a:1026179517081] [Citation(s) in RCA: 246] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Migraine headaches have been shown to have substantial personal and societal implications. Health-related quality of life (HRQOL) assessments of migraineurs have been used to monitor and evaluate patient- and population-based outcomes, and to evaluate effectiveness and responsiveness to treatment. In this paper, we test a new, even shorter generic health survey, the SF-8 Health Survey (SF-8), an alternate form that uses one question to measure each of the eight SF-36 Health Survey (SF-36) domains, in a sub-sample of migraine sufferers. METHODS Data from 7557 participants surveyed via the Internet and mail were used to document the burden of migraine on HRQOL and to compare the relative burden of migraine with other chronic conditions using the SF-8. RESULTS Migraineurs' HRQOL is similar to those with congestive heart failure, hypertension and diabetes, and is better than those with depression. Migraine sufferers experience better physical health and worse mental health (MH) than those with osteoarthritis. Results support prior research indicating that the burden of migraine on functional health and well-being is considerable and comparable to other chronic conditions known to have substantial impact on HRQOL. CONCLUSIONS The SF-8 may provide a more practical and efficient method to describe the burden of migraine in population studies.
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