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Tereshko Y, Dal Bello S, Di Lorenzo C, Pittino A, Filippi F, Belgrado E, Lettieri C, Merlino G, Gigli GL, Valente M. The Effect of Three Different Ketogenic Diet Protocols on Migraine and Fatigue in Chronic and High-Frequency Episodic Migraine: A Pilot Study. Nutrients 2023; 15:4334. [PMID: 37892410 PMCID: PMC10609491 DOI: 10.3390/nu15204334] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/03/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
AIMS We aimed to evaluate the efficacy of three different ketogenic diets on migraine and fatigue in chronic and high-frequency episodic migraineurs. METHODS 76 patients with migraine were treated with the KD for at least three months. Three different KD protocols were used (2:1 KD, LGID, and VLCKD). We evaluated the fatigue severity scale (FSS), migraine frequency, migraine intensity, MIDAS, and HIT-6 at the baseline and 3-month follow-up, and we compared the results. We also correlated the mean FSS reduction with the mean migraine frequency, migraine intensity, BMI, fat mass, free-fat mass, MIDAS, and HIT-6 reduction. RESULTS FSS improved from 4.977 ± 1.779 to 3.911 ± 1.779 at the 3-month follow-up (p < 0.001). This improvement was significant in both high-frequency and chronic migraineurs. Moreover, the three KD protocols effectively improved migraine intensity, frequency, MIDAS, and HIT-6. There was a mild correlation between mean FSS reduction (p < 0.001), mean MIDAS (p = 0.001), and HIT-6 (p = 0.002) reduction. CONCLUSIONS The VLCKD, LGID, and 2:1 KD may improve migraine intensity, frequency, and fatigue in chronic and high-frequency episodic migraineurs.
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Affiliation(s)
- Yan Tereshko
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy (F.F.); (G.M.); (M.V.)
| | - Simone Dal Bello
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy (F.F.); (G.M.); (M.V.)
| | - Cherubino Di Lorenzo
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, 04100 Latina, Italy
| | - Alice Pittino
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy (F.F.); (G.M.); (M.V.)
| | - Francesca Filippi
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy (F.F.); (G.M.); (M.V.)
| | - Enrico Belgrado
- Neurology Unit, Udine University Hospital, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy;
| | - Christian Lettieri
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy (F.F.); (G.M.); (M.V.)
| | - Giovanni Merlino
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy (F.F.); (G.M.); (M.V.)
| | - Gian Luigi Gigli
- Department of Medicine (DAME), University of Udine, Via Colugna 50, 33100 Udine, Italy
| | - Mariarosaria Valente
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy (F.F.); (G.M.); (M.V.)
- Department of Medicine (DAME), University of Udine, Via Colugna 50, 33100 Udine, Italy
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Kumar H, Dhamija K, Duggal A, Khwaja GA, Roshan S. Fatigue, chronic fatigue syndrome and migraine: Intersecting the lines through a cross-sectional study in patients with episodic and chronic migraine. J Neurosci Rural Pract 2023; 14:424-431. [PMID: 37692810 PMCID: PMC10483198 DOI: 10.25259/jnrp_63_2022] [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: 12/05/2022] [Accepted: 03/15/2023] [Indexed: 09/12/2023] Open
Abstract
Objectives Fatigue is a common symptom occurring in a variety of disorders. Chronic fatigue syndrome (CFS) is characterized by debilitating fatigue as the core symptom. The risk of CFS is nearly 1.5 times higher in migraine while headaches have been reported in 59% of cases with CFS. However, details of its occurrence and severity remain largely unexplored. The primary objective of our study was to determine the occurrence and severity of fatigue and CFS in patients with episodic and chronic migraine. The secondary objectives were to define their relationship with other common comorbidities. Materials and Methods 60 migraine patients (30 each, episodic [EM] and chronic migraine [CM]) were recruited from Neurology Outpatient Department, GIPMER a tertiary referral center in New Delhi, India. Patients' headache severity was analyzed using the Headache impact test-6 (HIT-6) score while fatigue and other migraine accompaniments were assessed using Fatigue severity scale (FSS), Chalder fatigue scale, CDC diagnostic criteria for CFS, American College of Rheumatology Diagnostic Criteria for fibromyalgia, Hamilton Depression Scale, the Generalized Anxiety Disorder 7-Item Scale, and Epworth sleepiness Scale (ESS). Comparative analysis was further done among migraine patients with and without fatigue and CFS. Results The mean HIT-6 score was significantly higher in CM versus EM. The CM group had a higher mean FSS score (47.87 vs. 37.3 in EM; P = 0.004), a percentage of patients with severe fatigue (60% vs. 20% in EM; P = 0.004), and a higher percentage of patients with pathological fatigue (83.3% vs. 63.3% in EM; P = 0.04). Around 23.33% of CM patients fulfilled the criteria of CFS. Fatigue correlated positively with severity, frequency, attack duration and chronicity of the migraine episodes, along with depression, anxiety, and excessive daytime sleepiness. Conclusion Fatigue and related comorbid disorders are significantly more common in CM than in EM, expanding the morbidity of the condition and underscores the need to address these accompanying symptoms for devising a holistic treatment plan.
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Affiliation(s)
| | - Kamakshi Dhamija
- Department of Neurology, VMMC and Safdarjung Hospital, Delhi, India
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Mueller BR, Ray C, Benitez A, Robinson-Papp J. Reduced cardiovagal baroreflex sensitivity is associated with postural orthostatic tachycardia syndrome (POTS) and pain chronification in patients with headache. Front Hum Neurosci 2023; 17:1068410. [PMID: 36992793 PMCID: PMC10040804 DOI: 10.3389/fnhum.2023.1068410] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/24/2023] [Indexed: 03/16/2023] Open
Abstract
BackgroundNon-cephalgic symptoms including orthostatic intolerance, fatigue, and cognitive impairment, are common in patients with chronic headache disorders and may result from alterations in the autonomic nervous system. However, little is known about the function of autonomic reflexes, which regulate cardiovascular homeostasis and cerebral perfusion in patients with headache.MethodsAutonomic function testing data from patients with headache collected between January 2018 and April 2022 was retrospectively analyzed. Through review of EMR we determined headache pain chronicity and patient self-report of orthostatic intolerance, fatigue, and cognitive impairment. Composite Autonomic Severity Score (CASS), CASS subscale scores, and cardiovagal and adrenergic baroreflex sensitivities were used to quantify autonomic reflex dysfunction. Descriptive analyses (Mann-Whitney-U or χ2, as appropriate) determined associations between autonomic reflex dysfunction and POTS as well as chronic headache. Binomial logistic regression adjusted for age and sex. Spearman’s rank correlation determined the association between the total CASS score and the number of painless symptoms reported by each participant.ResultsWe identified 34 patients meeting inclusion criteria, of whom there were 16 (47.0%) with orthostatic intolerance, 17 (50.0%) with fatigue, 11 (32.4%) with cognitive complaints, and 11 (32.4%) with Postural Orthostatic Tachycardia Syndrome (POTS). The majority of participants had migraine (n = 24, 70.6%), were female (n = 23, 67.6%) and had a chronic (>15 headache days in a month) headache disorder (n = 26, 76.5%). Reduced cardiovagal baroreflex sensitivity (BRS-V) independently predicted chronic headache [aOR: 18.59 (1.16, 297.05), p = 0.039] and POTS [aOR: 5.78 (1.0, 32.5), p = 0.047]. The total CASS was correlated with the total number of non-painful features in the expected direction (r = 0.46, p = 0.007).ConclusionAbnormal autonomic reflexes may play an important role in pain chronification and the development of POTS in patients with headache.
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Effectiveness of Tai Chi on Blood Pressure, Stress, Fatigue, and Sleep Quality among Chinese Women with Episodic Migraine: A Randomised Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:2089139. [PMCID: PMC9605843 DOI: 10.1155/2022/2089139] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/19/2022] [Accepted: 09/27/2022] [Indexed: 11/18/2022]
Abstract
The beneficial effects of Tai Chi on the cardiovascular risk profile and the migraine trigger factors among female migraineurs remain unknown. This study aimed to evaluate the effectiveness of a 12-week Tai Chi training on blood pressure (BP) and migraine-related trigger factors, including stress, fatigue, and sleep quality among Chinese women with episodic migraine. In this study, eligible Hong Kong Chinese women aged 18–65 years were randomly assigned to the Tai Chi group adopting a modified 33-short form of Yang style Tai Chi training for 12 weeks, followed by additional 12 weeks of self-practice or the waiting list control group that maintained the usual lifestyle for 24 weeks. The primary outcome was the changes in BP from the baseline to 12 and 24 weeks. The secondary outcomes included the stress level, fatigue, and sleep quality measured by the perceived stress scale (PSS), the numeric rating scale-fatigue (NRS-fatigue), and the Pittsburgh sleep quality index (PSQI), respectively. Significant between-group differences were found in systolic BP (−6.8 mmHg at 24 weeks, P=0.02), and a decreasing trend was significant across baseline, 12 weeks, and 24 weeks between groups (P < 0.05). The 12-week Tai Chi training significantly reduced the BP level and moderately improved stress level, fatigue status, and sleep quality among Chinese women with episodic migraine. Therefore, Tai Chi could be considered a promising mind-body exercise with good feasibility for migraineurs in the future. This trial is registered with registration number NCT03015753.
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Magdy R, Elmazny A, Soliman SH, Elsebaie EH, Ali SH, Abdel Fattah AM, Hassan M, Yassien A, Mahfouz NA, Elsayed RM, Fathy W, Abdel-Hamid HM, Mohamed J, Hussein M. Post-COVID-19 neuropsychiatric manifestations among COVID-19 survivors suffering from migraine: a case-control study. J Headache Pain 2022; 23:101. [PMID: 35962348 PMCID: PMC9372973 DOI: 10.1186/s10194-022-01468-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/20/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The burden of post-coronavirus disease (COVID)-19 symptoms has been increasing and is of great concern in patients with pre-existing chronic medical conditions.This study aimed to delineate the post-COVID-19 neuropsychiatric symptoms among migraine patients compared to the non-migraine control group. METHODS Two groups, each of 204 COVID-19 survivors, were enrolled in the study after 3 months of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, one group fulfilling the episodic migraine criteria and the other serving as a matching control group. Subjects were evaluated through an in-person interview for post-COVID-19 neuropsychiatric symptoms, including detailed headache patterns and severity, using the visual analogue scale. RESULTS The Frequency of headache during the acute phase of COVID-19 was more frequent in migraine patients (OR = 1.60, 95%CI = 1.04-2.45, P-value = 0.031). The reported significant post-COVID-19 neuropsychiatric symptoms in migraine patients compared to controls were fatigue (OR = 1.662, 95%CI = 1.064-2.596, P-value = 0.025), anosmia/hyposmia (OR = 2.06, 95%CI = 1.164- 3.645, P-value = 0.012), cacosmia (OR = 2.663, 95%CI = 1.145-6.195, P-value = 0.019), depression (OR = 2.259, 95%CI = 1.284- 3.975, P-value = 0.004), anxiety (OR = 3.267, 95%CI = 1.747- 6.108, P-value ≤ 0.001), insomnia (OR = 2.203, 95%CI = 1.298- 3.739, P-value = 0.003), and headache (OR = 3.148, 95%CI = 1.616-6.136, P-value = ≤ 0.001).While there was no statistically significant difference between migraine patients and controls regarding the post-COVID-19 functional status score (P-value = 0.102). The pattern of post-COVID-19 headache was reported as chronic headache transformation in 17.6% of the migraine group, with the median intensity rate being 5.5 and IQR (3-7). In the control group, 14% experienced chronic headache attributed to systemic viral infection with a median intensity rate of 2 and IQR (2-5), while 12% experienced a new daily persistent headache with a median intensity of 5 and IQR (1-6). CONCLUSION The study highlighted the importance of follow-up migraine patients upon recovery from COVID-19 infection, being more vulnerable to post-COVID-19 symptoms.
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Affiliation(s)
- Rehab Magdy
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Alaa Elmazny
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
- Internal Medicine Department, Arabian Gulf University, Manama, Bahrain
| | - Shaimaa H Soliman
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Eman H Elsebaie
- Department of Public Health and Community Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sara H Ali
- Department of Otolaryngology, Faculty of Medicine, Beni-Suef University, Beni- Suef, Egypt
| | - Ali M Abdel Fattah
- Department of Gastroenterology, Hepatology, and Endemic Medicine, Faculty of Medicine, Beni-Suef University, Beni- Suef, Egypt
| | - Mahmoud Hassan
- Department of Internal Medicine, Faculty of Medicine, Beni-Suef University, Beni- Suef, Egypt
| | - Ahmed Yassien
- Department of Critical Care Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Noha A Mahfouz
- Department of Psychiatry Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Radwa M Elsayed
- Department of Family Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Wael Fathy
- Department of Anaesthesia, Surgical ICU and Pain Management, Beni-Suef University, Beni-Suef, Egypt
| | - Hoda M Abdel-Hamid
- Department of Chest Diseases, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Jehan Mohamed
- Department of Anaesthesia, Surgical ICU and Pain Management, Beni-Suef University, Beni-Suef, Egypt
| | - Mona Hussein
- Neurology department, Beni-Suef University, Beni-Suef, Egypt
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Noseda R. Cerebro-Cerebellar Networks in Migraine Symptoms and Headache. FRONTIERS IN PAIN RESEARCH 2022; 3:940923. [PMID: 35910262 PMCID: PMC9326053 DOI: 10.3389/fpain.2022.940923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
The cerebellum is associated with the biology of migraine in a variety of ways. Clinically, symptoms such as fatigue, motor weakness, vertigo, dizziness, difficulty concentrating and finding words, nausea, and visual disturbances are common in different types of migraine. The neural basis of these symptoms is complex, not completely known, and likely involve activation of both specific and shared circuits throughout the brain. Posterior circulation stroke, or neurosurgical removal of posterior fossa tumors, as well as anatomical tract tracing in animals, provided the first insights to theorize about cerebellar functions. Nowadays, with the addition of functional imaging, much progress has been done on cerebellar structure and function in health and disease, and, as a consequence, the theories refined. Accordingly, the cerebellum may be useful but not necessary for the execution of motor, sensory or cognitive tasks, but, rather, would participate as an efficiency facilitator of neurologic functions by improving speed and skill in performance of tasks produced by the cerebral area to which it is reciprocally connected. At the subcortical level, critical regions in these processes are the basal ganglia and thalamic nuclei. Altogether, a modulatory role of the cerebellum over multiple brain regions appears compelling, mainly by considering the complexity of its reciprocal connections to common neural networks involved in motor, vestibular, cognitive, affective, sensory, and autonomic processing—all functions affected at different phases and degrees across the migraine spectrum. Despite the many associations between cerebellum and migraine, it is not known whether this structure contributes to migraine initiation, symptoms generation or headache. Specific cerebellar dysfunction via genetically driven excitatory/inhibitory imbalances, oligemia and/or increased risk to white matter lesions has been proposed as a critical contributor to migraine pathogenesis. Therefore, given that neural projections and functions of many brainstem, midbrain and forebrain areas are shared between the cerebellum and migraine trigeminovascular pathways, this review will provide a synopsis on cerebellar structure and function, its role in trigeminal pain, and an updated overview of relevant clinical and preclinical literature on the potential role of cerebellar networks in migraine pathophysiology.
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Affiliation(s)
- Rodrigo Noseda
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- *Correspondence: Rodrigo Noseda
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Patterson Gentile C, Aguirre GK, Arbogast KB, Master CL. Relationship between Visually Evoked Effects and Concussion in Youth. J Neurotrauma 2022; 39:841-849. [PMID: 35166126 PMCID: PMC9225424 DOI: 10.1089/neu.2021.0475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Increased sensitivity to light is common after concussion. Viewing a flickering light can also produce uncomfortable somatic sensations like nausea or headache. We examined effects evoked by viewing a patterned, flickering screen in a cohort of 81 uninjured youth athletes and 84 concussed youth. We used Multiple correspondence analysis and identified two primary dimensions of variation: the presence or absence of visually evoked effects and variation in the tendency to manifest effects that localized to the eyes (e.g., eye watering) versus more generalized neurological effects (e.g., headache). Based on these two primary dimensions, we grouped participants into three categories of evoked symptomatology: no effects, eye-predominant effects, and brain-predominant effects. A similar proportion of participants reported eye-predominant effects in the uninjured (33.3%) and concussed (32.1%) groups. By contrast, participants who experienced brain-predominant effects were almost entirely from the concussed group (1.2% of uninjured, 35.7% of concussed). The presence of brain-predominant effects was associated with a higher concussion symptom burden and reduced performance on visio-vestibular tasks. Our findings indicate that the experience of negative constitutional, somatic sensations in response to a dynamic visual stimulus is a salient marker of concussion and is indicative of more severe concussion symptomatology. We speculate that differences in visually evoked effects reflect varying levels of activation of the trigeminal nociceptive system.
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Affiliation(s)
- Carlyn Patterson Gentile
- Department of Pediatrics, and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Injury Research and Prevention, Children”s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Geoffrey K. Aguirre
- Department of Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristy B. Arbogast
- Department of Pediatrics, and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Injury Research and Prevention, Children”s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christina L. Master
- Department of Pediatrics, and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Injury Research and Prevention, Children”s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Amiri P, Kazeminasab S, Nejadghaderi SA, Mohammadinasab R, Pourfathi H, Araj-Khodaei M, Sullman MJM, Kolahi AA, Safiri S. Migraine: A Review on Its History, Global Epidemiology, Risk Factors, and Comorbidities. Front Neurol 2022; 12:800605. [PMID: 35281991 PMCID: PMC8904749 DOI: 10.3389/fneur.2021.800605] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/20/2021] [Indexed: 01/09/2023] Open
Abstract
Migraine affects more than one billion individuals each year across the world, and is one of the most common neurologic disorders, with a high prevalence and morbidity, especially among young adults and females. Migraine is associated with a wide range of comorbidities, which range from stress and sleep disturbances to suicide. The complex and largely unclear mechanisms of migraine development have resulted in the proposal of various social and biological risk factors, such as hormonal imbalances, genetic and epigenetic influences, as well as cardiovascular, neurological, and autoimmune diseases. This review presents a comprehensive review of the most up-to-date literature on the epidemiology, and risk factors, as well as highlighting the gaps in our knowledge.
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Affiliation(s)
- Parastoo Amiri
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Research Deputy, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Somayeh Kazeminasab
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Research Deputy, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Aria Nejadghaderi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Systematic Review and Meta-Analysis Expert Group, Universal Scientific Education and Research Network, Tehran, Iran
| | - Reza Mohammadinasab
- Department of History of Medicine, School of Traditional Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hojjat Pourfathi
- Department of Anesthesiology and Pain Management, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mostafa Araj-Khodaei
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Persian Medicine, School of Traditional Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mark J. M. Sullman
- Department of Social Sciences, University of Nicosia, Nicosia, Cyprus
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ali-Asghar Kolahi
| | - Saeid Safiri
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Social Determinants of Health Research Center, Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- *Correspondence: Saeid Safiri
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Delva M, Delva I, Pinchuk V, Kryvchun A, Purdenko T. PREVALENCE AND PREDICTORS OF FATIGUE IN PATIENTS WITH EPISODIC MIGRAINE. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:1970-1974. [PMID: 36129080 DOI: 10.36740/wlek202208205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim: We studied prevalence, intensity and predictors of fatigue in patient with episodic migraine (EM). PATIENTS AND METHODS Materials and methods: We enrolled in the study 85 patients with EM and 88 healthy subjects. Fatigue was identified according to Fatigue Severity Scale. We recorded socio-demographic factors: gender, age, marital status, formal education level, employment status, smoking. Anxiety and depression symptoms were assessed by Hospital Anxiety and Depression Scale, daytime sleepiness was measured by Epworth scale. The co-morbidities included history of low back pain during last year, arterial hypertension, diabetes mellitus and abdominal obesity. It was analyzed usage of non-steroidal anti-inflammatory drugs, combined analgesics, triptans for abortive migraine treatment. RESULTS Results: Fatigue prevalence in patients with EM was 41,2%, which was significantly higher than in healthy controls (11,4%). Fatigue intensity in episodic migraineurs was 5,7 (4,9-6,8) and did not differ significantly from fatigue intensity in healthy individuals - 4,9 (4,5-5,8). In multivariate logistic regression analysis independent predictors of fatigue were only migraine-related factors (number of migraine headache days per month, headache severity and migraine prodrome presence). There was weak direct correlation between the number of headache migraine days per month and fatigue intensity. CONCLUSION Conclusions: 1. Fatigue prevalence in patients with EM is significantly higher than in healthy controls. 2. In patients with EM fatigue has migraine-related predictors.
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Affiliation(s)
| | - Iryna Delva
- POLTAVA STATE MEDICAL UNIVERSITY, POLTAVA, UKRAINE
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Karsan N, Goadsby PJ. Migraine Is More Than Just Headache: Is the Link to Chronic Fatigue and Mood Disorders Simply Due to Shared Biological Systems? Front Hum Neurosci 2021; 15:646692. [PMID: 34149377 PMCID: PMC8209296 DOI: 10.3389/fnhum.2021.646692] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/26/2021] [Indexed: 12/12/2022] Open
Abstract
Migraine is a symptomatically heterogeneous condition, of which headache is just one manifestation. Migraine is a disorder of altered sensory thresholding, with hypersensitivity among sufferers to sensory input. Advances in functional neuroimaging have highlighted that several brain areas are involved even prior to pain onset. Clinically, patients can experience symptoms hours to days prior to migraine pain, which can warn of impending headache. These symptoms can include mood and cognitive change, fatigue, and neck discomfort. Some epidemiological studies have suggested that migraine is associated in a bidirectional fashion with other disorders, such as mood disorders and chronic fatigue, as well as with other pain conditions such as fibromyalgia. This review will focus on the literature surrounding alterations in fatigue, mood, and cognition in particular, in association with migraine, and the suggested links to disorders such as chronic fatigue syndrome and depression. We hypothesize that migraine should be considered a neural disorder of brain function, in which alterations in aminergic networks integrating the limbic system with the sensory and homeostatic systems occur early and persist after headache resolution and perhaps interictally. The associations with some of these other disorders may allude to the inherent sensory sensitivity of the migraine brain and shared neurobiology and neurotransmitter systems rather than true co-morbidity.
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Affiliation(s)
- Nazia Karsan
- Headache Group, Wolfson Centre for Age-Related Diseases, Division of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,NIHR-Wellcome Trust King's Clinical Research Facility, SLaM Biomedical Research Centre, King's College Hospital, London, United Kingdom
| | - Peter J Goadsby
- Headache Group, Wolfson Centre for Age-Related Diseases, Division of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,NIHR-Wellcome Trust King's Clinical Research Facility, SLaM Biomedical Research Centre, King's College Hospital, London, United Kingdom.,Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
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Whitaker RC, Herman AN, Dearth-Wesley T, Hubbell K, Huff R, Heneghan LJ, Rowe PC. The association of fatigue with dispositional mindfulness: relationships by levels of depressive symptoms, sleep quality, childhood adversity, and chronic medical conditions. Prev Med 2019; 129:105873. [PMID: 31644898 DOI: 10.1016/j.ypmed.2019.105873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Abstract
Although mindfulness-based interventions may be effective in addressing the common symptom of fatigue, no population-based studies have examined the relationship between mindfulness and fatigue. We determined whether higher levels of dispositional mindfulness were associated with lower levels of fatigue. Cross-sectional data were obtained through the Pennsylvania Head Start Staff Wellness Survey, a 2012 web-based survey in which 2199 of 3375 (65%) eligible staff participated. The analytic sample was restricted to the 2083 female respondents with complete data on dispositional mindfulness (Cognitive and Affective Mindfulness Scale-Revised) and fatigue (Fatigue Severity Scale). We determined the mean covariate-adjusted fatigue scores in each quartile of dispositional mindfulness. This relationship was examined in the overall sample and within subgroups defined by levels of four variables: depressive symptoms, poor sleep quality, childhood adversity, and chronic medical conditions. The sample was 86% non-Hispanic White, and 61% had a bachelor's or more advanced degree. The mean (SD) Fatigue Severity Scale score was 3.3 (1.3). The adjusted mean fatigue score decreased significantly and in a graded manner across higher quartiles of mindfulness, with the adjusted fatigue score 1.4 points lower (95% confidence interval: -1.5, -1.2) among those in the highest quartile of dispositional mindfulness compared to the lowest. This significant graded relationship was present within each subgroup examined, and there was not a statistically significant interaction between dispositional mindfulness and any subgroup variable. Future trials of mindfulness-based interventions should consider assessing the outcome of fatigue in both clinical and non-clinical populations.
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Affiliation(s)
- Robert C Whitaker
- Columbia-Bassett Program, Cooperstown, NY, United States of America; Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America; Bassett Research Institute, Cooperstown, NY, United States of America; Bassett Medical Center, Cooperstown, NY, United States of America.
| | - Allison N Herman
- Columbia-Bassett Program, Cooperstown, NY, United States of America; Bassett Research Institute, Cooperstown, NY, United States of America; Bassett Medical Center, Cooperstown, NY, United States of America
| | - Tracy Dearth-Wesley
- Columbia-Bassett Program, Cooperstown, NY, United States of America; Bassett Research Institute, Cooperstown, NY, United States of America; Bassett Medical Center, Cooperstown, NY, United States of America
| | - Kenneth Hubbell
- Columbia-Bassett Program, Cooperstown, NY, United States of America; Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Ryan Huff
- Columbia-Bassett Program, Cooperstown, NY, United States of America; Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Liam J Heneghan
- Columbia-Bassett Program, Cooperstown, NY, United States of America; Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Peter C Rowe
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
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12
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Excessive daytime sleepiness and fatigue in neurological disorders. Sleep Breath 2019; 24:413-424. [DOI: 10.1007/s11325-019-01921-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 08/06/2019] [Accepted: 08/08/2019] [Indexed: 12/12/2022]
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13
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Penn IW, Chuang E, Chuang TY, Lin CL, Kao CH. Bidirectional association between migraine and fibromyalgia: retrospective cohort analyses of two populations. BMJ Open 2019; 9:e026581. [PMID: 30962236 PMCID: PMC6500182 DOI: 10.1136/bmjopen-2018-026581] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Fibromyalgia (FM) and migraine are common pain disorders that tend to coexist. This study determined whether these two conditions exhibited any mutual influences. SETTING Cohort study. PARTICIPANTS A retrospective, longitudinal cohort study was conducted using data obtained from a nationwide healthcare database. This study had two arms. Arm 1 comprised 33 216 patients with FM and arm 2 consisted of 7420 patients with migraine; all of these patients were diagnosed between 2000 and 2010. Using the aforementioned database, control subjects who had neither FM nor migraine and were matched with the FM and migraine patients by sex, age and index date of diagnosis were recruited. Each control cohort was four times the size of the corresponding study cohort. Follow-up for the control and study cohorts was conducted until the end of 2011. RESULTS The incidence rates of FM and migraine were calculated in arms 1 and 2, respectively. The overall incidence of migraine was greater in the FM cohort than in the corresponding control cohort (4.39 vs 2.07 per 1000 person-years (PY)); crude HR=2.12, 95% CI=1.96 to 2.30; adjusted HR (aHR)=1.89, 95% CI=1.75 to 2.05). After adjustment for sex, age and comorbidities, the overall incidence of FM in the migraine cohort was 1.57 times greater than that in the corresponding control cohort (7.01 vs 4.49 per 1000 PY; aHR=1.52, 95% CI=1.39 to 1.65). CONCLUSIONS The present study revealed a bidirectional link between FM and migraine.
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Grants
- This work was supported by grants from the Ministry of Health and Welfare, Taiwan (MOHW108-TDU-B-212-133004), China Medical University Hospital (DMR-107-192), Academia Sinica Stroke Biosignature Project (BM10701010021), MOST Clinical Trial Consortium for Stroke (MOST 107-2321-B-039 -004-), Tseng-Lien Lin Foundation, Taichung, Taiwan, and Katsuzo and Kiyo Aoshima Memorial Funds, Japan. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation o
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Affiliation(s)
- I-Wen Penn
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
- Department of Physical Medicine and Rehabilitation, FuJen Catholic University Hospital, Fu Jen Catholic University, NewTaipei City, Taiwan
| | - Eric Chuang
- Intended B.S. Molecular and Cell Biology, University of California Berkeley, Berkeley, California, USA
| | - Tien-Yow Chuang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Hung Kao
- School of Medicine, China Medical University, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
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Pradeep R, Sundarmurthy H, Karan V, Kulkarni P. Prevalence and Predictors of Female Sexual Dysfunction in Migraine. Ann Indian Acad Neurol 2019; 22:291-294. [PMID: 31359940 PMCID: PMC6613415 DOI: 10.4103/aian.aian_508_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background: Migraine is a common cause of primary headache, with women being affected thrice as common as men. Very few studies are available on sexual dysfunction in female migraineurs. There are no published studies done on the same in India till now. This study was done to look for the prevalence and predictors of sexual dysfunction disorder in females suffering from migraine. Materials and Methods: This is a cross-sectional study done to look for the prevalence and predictors of female sexual dysfunction in migraine. Sixty female patients with migraine were studied. The International Headache Society's International Classification of Headache Disorders, 3rd Edition, was followed to diagnose migraine with or without aura. Migraine disability assessment scale was used to assess migraine-related disability, and Female Sexual Function Index (FSFI) score was used to assess female sexual function. Results: Sexual dysfunction was found in 78.3% migraineurs. The mean FSFI score was 23.1 ± 4.76. The FSFI scores in all the domains were lower in the individuals studied. Acute headaches resulted in loss of sexual desire among all the migraineurs. Conclusion: Sexual dysfunction is common in migraine with all domains of sexual function being affected. There is a significant negative correlation of sexual function with duration of acute episodes of headache and increasing frequency of migraine attacks per month.
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Affiliation(s)
- R Pradeep
- Department of Neurology, MS Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Harsha Sundarmurthy
- Department of Neurology, JSS Medical College and Hospital, Mysuru, Karnataka, India
| | - Vivek Karan
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Praveen Kulkarni
- Department of Preventive and Social Medicine, JSS Medical College and Hospital, Mysuru, Karnataka, India
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15
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Özdel S, Özçakar ZB, Cakar N, Aydın F, Çelikel E, Elhan AH, Yalçınkaya F. Fatigue in pediatric patients with familial Mediterranean fever. Mod Rheumatol 2018; 28:1016-1020. [DOI: 10.1080/14397595.2018.1427459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Semanur Özdel
- Department of Pediatrics, Division of Pediatric Rheumatology, Ankara University School of Medicine, Ankara, Turkey
| | - Z. Birsin Özçakar
- Department of Pediatrics, Division of Pediatric Rheumatology, Ankara University School of Medicine, Ankara, Turkey
| | - Nilgün Cakar
- Department of Pediatrics, Division of Pediatric Rheumatology, Ankara University School of Medicine, Ankara, Turkey
| | - Fatma Aydın
- Department of Pediatrics, Division of Pediatric Rheumatology, Ankara University School of Medicine, Ankara, Turkey
| | - Elif Çelikel
- Department of Pediatrics, Division of Pediatric Rheumatology, Ankara University School of Medicine, Ankara, Turkey
| | - Atilla H. Elhan
- Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey
| | - Fatoş Yalçınkaya
- Department of Pediatrics, Division of Pediatric Rheumatology, Ankara University School of Medicine, Ankara, Turkey
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16
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Lai J, Harrison RA, Plecash A, Field TS. A Narrative Review of Persistent Post-Stroke Headache - A New Entry in the International Classification of Headache Disorders, 3rd Edition. Headache 2018; 58:1442-1453. [PMID: 30152015 DOI: 10.1111/head.13382] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 08/22/2016] [Accepted: 05/19/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Persistent post-stroke headache is a clinical entity that has recently entered the International Classification of Headache Disorders, 3rd edition. In contrast to acute headache attributed to stroke, the epidemiology, clinical features, potential pathophysiology, and management of persistent post-stroke headache have not been reviewed. METHODS We summarize the literature describing persistent headache attributed to stroke. RESULTS Persistent headache after ischemic or hemorrhagic stroke affects up to 23% of patients. These persistent headaches tend to have tension-type features and are more frequent and severe than acute stroke-related headaches. Risk factors include younger age, female sex, pre-existing headache disorder, and comorbid post-stroke fatigue or depression. Other factors including obstructive sleep apnea or musculoskeletal imbalances may contribute to headache persistence. Although more evidence is needed, it may be reasonable to treat persistent post-stroke headache according to headache semiology. CONCLUSION Recognition of persistent post-stroke headache as a separate clinical entity from acute stroke-attributed headache is the first step toward better defining its natural history and most effective treatment strategies.
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Affiliation(s)
- Joshua Lai
- Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Rebecca A Harrison
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alyson Plecash
- Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Thalia S Field
- Division of Neurology, University of British Columbia, Vancouver, BC, Canada
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17
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Seo JG, Park SP. Significance of fatigue in patients with migraine. J Clin Neurosci 2018; 50:69-73. [PMID: 29396068 DOI: 10.1016/j.jocn.2018.01.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 01/08/2018] [Indexed: 01/03/2023]
Abstract
Fatigue is often stated as a headache trigger or migraine-specific symptom. We investigated predictors of fatigue and its impact on quality of life (QOL) in patients with migraine. Patients with migraine were recruited from a headache clinic and completed psychosomatic instruments, including the 12-item Allodynia Symptom Checklist (ASC-12), the Migraine Disability Assessment Scale (MIDAS), the Patients Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), the Epworth Sleepiness Scale (ESS), the Insomnia Severity Index (ISI), the Fatigue Severity Scale (FSS), and Migraine-Specific Quality of Life Questionnaire (MSQ). Two hundreds twenty-six patients with migraine were eligible for the study. Pathologic fatigue was manifested in 133 patients (58.8%). The FSS score was significantly associated with age, age of onset, the Visual Analog Scale (VAS) depicting headache intensity, photophobia, phonophobia, and the scores of the ASC-12, the MIDAS, the ESS, the ISI, the PHQ-9 and the GAD-7. The strongest predictor for the FSS was the PHQ-9 (β = 0.432, p < .001), followed by age (β = -0.169, p = .002), the ISI (β = 0.151, p = .016), and the VAS (β = 0.139, p = .018). There was an inverse correlation between the FSS score and three dimensional scores of the MSQ (p < .001). Appropriate interventions for depression, insomnia, and headache intensity are likely to lessen fatigue and improve QOL.
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Affiliation(s)
- Jong-Geun Seo
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
| | - Sung-Pa Park
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
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18
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Unbalanced plasma TNF-α and IL-12/IL-10 profile in women with migraine is associated with psychological and physiological outcomes. J Neuroimmunol 2017; 313:138-144. [PMID: 28950996 DOI: 10.1016/j.jneuroim.2017.09.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 09/07/2017] [Accepted: 09/18/2017] [Indexed: 02/08/2023]
Abstract
Increased plasma pro-inflammatory and decreased anti-inflammatory cytokines have been implicated in physiological and behavioural aspects of mood- and pain-related disorders, including migraine. In this case-control study, we assessed mood scores, cardiorespiratory fitness (VO2Peak), and plasma concentrations of TNF-α, IL-1β, IL-6, IL-8, IL-10, and IL-12p70 interictally in women with episodic migraine with/without aura (ICHD-II), taking no preventive medicine, and in healthy women recruited from São Paulo Hospital and local community, respectively. Thirty-seven participants (mean±SD age=34±10 and BMI=26.5±4.9) were assessed. Groups (Control, n=17; Migraine, n=20) showed no differences in age, BMI, and VO2Peak. Migraine patients showed higher tension (p=0.019) and anxiety scores (p=0.046), TNF-α (p<0.01), and IL-12p70 (p=0.01), while IL-6 (p<0.01), IL-8 (p<0.01), and IL-10 (p<0.01) were decreased compared to control group. Multiple linear regression models showed that migraine was positively associated with TNF-α and IL-12p70, and negatively associated with IL-6, IL-8, and IL-10. Anxiety scores were positively associated with IL-12p70, and VO2Peak was negatively associated with TNF-α. In conclusion, an exaggeratedly skewed cytokine profile, in particular the TNF-α and 12p70/IL-10 balance may be related to migraine pathomechanisms, and its psychiatric comorbidities and functional capacity. Additional studies are needed to confirm these results.
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19
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Abstract
The overview is dedicated to the neuroimmunological mechanisms of headache development and chronification. Based on the analyzed data, the authors determined the relationship between immunological parameters and duration, intensity and other characteristics of this disease. These findings confirm that immunocompetent cells can be used as headache biomarkers and predictors of treatment efficacy. Questions about the role of separate parts of the immune system in the development and maintenance of a headache require further research. Studies of humoral immunity appeared to be very promising.
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Affiliation(s)
- A V Prishchepa
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A B Danilov
- Sechenov First Moscow State Medical University, Moscow, Russia
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20
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Peres MFP, Mercante JPP, Tobo PR, Kamei H, Bigal ME. Anxiety and depression symptoms and migraine: a symptom-based approach research. J Headache Pain 2017; 18:37. [PMID: 28324317 PMCID: PMC5360747 DOI: 10.1186/s10194-017-0742-1] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 03/07/2017] [Indexed: 12/11/2022] Open
Abstract
Background Anxiety and mood disorders have been shown to be the most relevant psychiatric comorbidities associated with migraine, influencing its clinical course, treatment response, and clinical outcomes. Limited information is available on how specific anxiety and depression symptoms are related to migraine. Symptoms-based approach, a current trend in mental health research, may improve our understanding in migraine comorbidity. The purpose of this study was to analyze how anxiety and depression aspects are related to migraine through a symptom-based approach. Methods We studied 782 patients from the general population who completed a self-administered questionnaire assessing demographics, headache features, anxiety and depression symptoms. A binary logistic regression analyses were conducted to test the association between all four ratings in GAD-7 (anxiety) and PHQ-9 (depression) scales subitems as covariates, and migraine vs no headache as the outcome. Results The leading Odd Ratios (OR) observed in individuals with migraine relative to those without migraine were anxiety related, “Not being able to stop or control worrying” on a daily basis [OR (CI 95%)] 49.2 (13.6–178.2), “trouble relaxing” 25.7 (7.1–92.6), “Feeling nervous, anxious or on edge” on a daily basis 25.4 (6.9–93.8), and “worrying too much about different things” 24.4 (7.7–77.6). Although the hallmark symptoms of depression are emotional (hopelessness and sadness), the highest scores found were physical: apetite, fatigue, and poor sleep. Irritability had a significant increase in migraine risk [OR 3.8 (1.9–7.8) if experienced some days, 7.5 (2.7–20.7) more than half the days, and 22.0 (5.7–84.9) when experienced nearly every day]. Conclusions Anxiety was more robustly associated with increase in migraine risk than depression. Lack of ability to properly control worrying and to relax are the most prominent issues in migraine psychiatric comorbidity. Physical symptoms in depression are more linked to migraine than emotional symptoms. A symptom-based approach helps clarifying migraine comorbidity and should be replicated in other studies.
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Affiliation(s)
- Mario Fernando Prieto Peres
- Albert Einstein Hospital, R Joaquim Eugenio de Lima, 881 cj 709, 01403-001, São Paulo, SP, Brazil. .,Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.
| | - Juliane P P Mercante
- Albert Einstein Hospital, R Joaquim Eugenio de Lima, 881 cj 709, 01403-001, São Paulo, SP, Brazil
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21
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Zarei MR, Shabani M, Chamani G, Abareghi F, Razavinasab M, Nazeri M. Migraine patients have a higher prevalence of PTSD symptoms in comparison to chronic tension-type headache and healthy subjects: a case-control study. Acta Odontol Scand 2016; 74:633-635. [PMID: 27644346 DOI: 10.1080/00016357.2016.1232435] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Headache is one of the most common disorders and has a heavy socioeconomic burden on both patients and society. Previous studies have demonstrated a high prevalence of psychological issues (e.g. depression and anxiety) in headache and especially migraine patients. The current study was designed to evaluate the prevalence of post-traumatic stress disorder (PTSD) symptomatology in chronic migraine (CM), chronic tension-type headache (CTTH) and healthy subjects. MATERIAL AND METHODS CM and CTTH subjects were selected consecutively from patients referring to the department of neurology clinic at Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran. PTSD symptomatology was assessed using PTSD checklist civilian version-Persian edition (PCL-C). Control subjects were enrolled from the family members of headache patients who did not have any history of headache. Chi-square test was used to analyse data and p < .05 was considered statistically significant. RESULTS Of the 60 control subjects, 5 had a PTSD symptomatology (8.3%); this prevalence was 13.3% for CTTH and 40% for CM groups. CM patients had a significantly higher prevalence of PTSD symptomatology in comparison to CTTH and control subjects (p < .05). With reference to gender, most of the subjects with PTSD symptomatology were female. CONCLUSION Results of the current study demonstrated that CM patients have a higher prevalence of PTSD symptomatology compared to another chronic headache condition (CTTH) and healthy subjects, which should be considered while treating CM patients. Further studies in larger populations are demanded.
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Kayhan F, Ilik F. Prevalence of personality disorders in patients with chronic migraine. Compr Psychiatry 2016; 68:60-4. [PMID: 27234184 DOI: 10.1016/j.comppsych.2016.04.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 04/04/2016] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The present study aimed to investigate the prevalence of personality disorders (PDs) in patients with chronic migraine (CM). METHODS This study included 105 CM patients who were diagnosed according to the criteria of the International Headache Society (IHS) and 100 healthy volunteers. PDs were diagnosed with the Structured Clinical Interview for DSM, Revised Third Edition Personality Disorders, and pain severity and level of disability were assessed with the Migraine Disability Assessment (MIDAS) test. RESULTS Of the 105 CM patients, 85 (81%) had at least one PD. PDs were more prevalent in the patient group than in the healthy control group, and the most common PDs were obsessive-compulsive (n=53, 50.5%), dependent (n=20, 19%), avoidant (n=20, 19%), and passive-aggressive (n=14, 13.3%) PDs. The MIDAS scores of the CM patients with PDs were higher than those of the CM patients without PDs. CONCLUSION PDs, particularly obsessive-compulsive, dependent, avoidant, and passive-aggressive PDs, were frequently observed in CM patients in the present study.
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Affiliation(s)
- Fatih Kayhan
- Department of Psychiatry, Selcuk University, Faculty of Medicine, Konya, Turkey.
| | - Faik Ilik
- Department of Neurology, Başkent University, Faculty of Medicine, Konya, Turkey.
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Gori S, Lucchesi C, Baldacci F, Bonuccelli U. Preferential occurrence of attacks during night sleep and/or upon awakening negatively affects migraine clinical presentation. FUNCTIONAL NEUROLOGY 2016; 30:119-23. [PMID: 26415784 DOI: 10.11138/fneur/2015.30.2.119] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
It is well known that migraine attacks can preferentially occur during night sleep and/or upon awakening, however the possible implications of this timing on migraine clinical presentation remain unclear. The aim of this study was to assess the possible consequences of sleep-related migraine (defined as ≥ 75% of migraine attacks occurring during night sleep and/or upon awakening) on the migraine clinical picture (i.e. migraine-related disability, attack severity, use of symptomatic drugs), subjective sleep quality, excessive daytime sleepiness and fatigue. Two hundred consecutive migraine without aura patients were enrolled; patients with comorbid disorders or chronic medication use were excluded. 39% of the migraineurs included in the study received a diagnosis of sleep-related migraine. The mean frequency of migraine attacks (days per month) did not significantly differ between the patients with and those without sleep-related migraine, whereas migraine-related disability (p<0.0001), mean attack severity (p<0.0001), and monthly intake of symptomatic drugs (p<0.0001) were significantly higher in patients with migraine preferentially occurring at night-time and/or upon awakening. Subjective sleep quality and excessive daytime sleepiness did not differ significantly between the two groups, whereas fatigue was significantly more present in the patients with sleep-related migraine (p=0.0001). These data seem to support the hypothesis that patients with sleep-related migraine represent a subset of individuals with a more severe and disabling clinical presentation of migraine and greater impairment of daily functioning, as suggested by the higher degree of fatigue. Migraineurs with night-time attacks Preferential occurrence of attacks during night sleep and/or upon awakening negatively affects migraine clinical presentation also showed a greater use of symptomatic drugs, possibly related to delayed use of symptomatic treatment. The identification of subtypes of patients with a higher disability risk profile could have crucial implications for individually tailored management of migraine patients.
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Fiest KM, Fisk JD, Patten SB, Tremlett H, Wolfson C, Warren S, McKay KA, Berrigan LI, Marrie RA. Fatigue and Comorbidities in Multiple Sclerosis. Int J MS Care 2016; 18:96-104. [PMID: 27134583 DOI: 10.7224/1537-2073.2015-070] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Fatigue is commonly reported by people with multiple sclerosis (MS). Comorbidity is also common in MS, but its association with the presence of fatigue or fatigue changes over time is poorly understood. METHODS Nine hundred forty-nine people with definite MS were recruited from four Canadian centers. The Fatigue Impact Scale for Daily Use and a validated comorbidity questionnaire were completed at three visits over 2 years. Participants were classified into groups with no fatigue versus any fatigue. Logistic regression was used to determine the relationship between fatigue and each comorbidity at baseline, year 1, year 2, and overall. RESULTS The incidence of fatigue during the study was 38.8%. The prevalence of fatigue was greater in those who were older (P = .0004), had a longer time since symptom onset (P = .005), and had greater disability (P < .0001). After adjustment, depression (odds ratio [OR], 2.58; 95% confidence interval [CI], 2.03-3.27), irritable bowel syndrome (OR, 1.71; 95% CI, 1.18-2.48), migraine (OR, 1.69; 95% CI, 1.27-2.27), and anxiety (OR, 1.57; 95% CI, 1.15-2.16) were independently associated with fatigue that persisted during the study. There was also an individual-level effect of depression on worsening fatigue (OR, 1.49; 95% CI, 1.08-2.07). CONCLUSIONS Comorbidity is associated with fatigue in MS. Depression is associated with fatigue and with increased risk of worsening fatigue over 2 years. However, other comorbid conditions commonly associated with MS are also associated with persistent fatigue, even after accounting for depression. Further investigation is required to understand the mechanisms by which comorbidities influence fatigue.
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Affiliation(s)
- Kirsten M Fiest
- Department of Internal Medicine, College of Medicine, Faculty of Health Sciences (KMF, RAM), and Department of Community Health Sciences, College of Medicine (RAM), University of Manitoba, Winnipeg, MB, Canada; Departments of Psychiatry, Medicine, Psychology, and Neuroscience, Dalhousie University, Halifax, NS, Canada (JDF); Departments of Psychiatry and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada (SBP); Division of Neurology, Faculty of Medicine (HT), and Department of Experimental Medicine (KAM), University of British Columbia, Vancouver, BC, Canada; Departments of Epidemiology and Biostatistics, Occupational Health, and Medicine, McGill University, Montreal, QC, Canada (CW); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada (SW); and Department of Psychology, St. Francis Xavier University, Antigonish, NS, Canada (LIB)
| | - John D Fisk
- Department of Internal Medicine, College of Medicine, Faculty of Health Sciences (KMF, RAM), and Department of Community Health Sciences, College of Medicine (RAM), University of Manitoba, Winnipeg, MB, Canada; Departments of Psychiatry, Medicine, Psychology, and Neuroscience, Dalhousie University, Halifax, NS, Canada (JDF); Departments of Psychiatry and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada (SBP); Division of Neurology, Faculty of Medicine (HT), and Department of Experimental Medicine (KAM), University of British Columbia, Vancouver, BC, Canada; Departments of Epidemiology and Biostatistics, Occupational Health, and Medicine, McGill University, Montreal, QC, Canada (CW); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada (SW); and Department of Psychology, St. Francis Xavier University, Antigonish, NS, Canada (LIB)
| | - Scott B Patten
- Department of Internal Medicine, College of Medicine, Faculty of Health Sciences (KMF, RAM), and Department of Community Health Sciences, College of Medicine (RAM), University of Manitoba, Winnipeg, MB, Canada; Departments of Psychiatry, Medicine, Psychology, and Neuroscience, Dalhousie University, Halifax, NS, Canada (JDF); Departments of Psychiatry and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada (SBP); Division of Neurology, Faculty of Medicine (HT), and Department of Experimental Medicine (KAM), University of British Columbia, Vancouver, BC, Canada; Departments of Epidemiology and Biostatistics, Occupational Health, and Medicine, McGill University, Montreal, QC, Canada (CW); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada (SW); and Department of Psychology, St. Francis Xavier University, Antigonish, NS, Canada (LIB)
| | - Helen Tremlett
- Department of Internal Medicine, College of Medicine, Faculty of Health Sciences (KMF, RAM), and Department of Community Health Sciences, College of Medicine (RAM), University of Manitoba, Winnipeg, MB, Canada; Departments of Psychiatry, Medicine, Psychology, and Neuroscience, Dalhousie University, Halifax, NS, Canada (JDF); Departments of Psychiatry and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada (SBP); Division of Neurology, Faculty of Medicine (HT), and Department of Experimental Medicine (KAM), University of British Columbia, Vancouver, BC, Canada; Departments of Epidemiology and Biostatistics, Occupational Health, and Medicine, McGill University, Montreal, QC, Canada (CW); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada (SW); and Department of Psychology, St. Francis Xavier University, Antigonish, NS, Canada (LIB)
| | - Christina Wolfson
- Department of Internal Medicine, College of Medicine, Faculty of Health Sciences (KMF, RAM), and Department of Community Health Sciences, College of Medicine (RAM), University of Manitoba, Winnipeg, MB, Canada; Departments of Psychiatry, Medicine, Psychology, and Neuroscience, Dalhousie University, Halifax, NS, Canada (JDF); Departments of Psychiatry and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada (SBP); Division of Neurology, Faculty of Medicine (HT), and Department of Experimental Medicine (KAM), University of British Columbia, Vancouver, BC, Canada; Departments of Epidemiology and Biostatistics, Occupational Health, and Medicine, McGill University, Montreal, QC, Canada (CW); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada (SW); and Department of Psychology, St. Francis Xavier University, Antigonish, NS, Canada (LIB)
| | - Sharon Warren
- Department of Internal Medicine, College of Medicine, Faculty of Health Sciences (KMF, RAM), and Department of Community Health Sciences, College of Medicine (RAM), University of Manitoba, Winnipeg, MB, Canada; Departments of Psychiatry, Medicine, Psychology, and Neuroscience, Dalhousie University, Halifax, NS, Canada (JDF); Departments of Psychiatry and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada (SBP); Division of Neurology, Faculty of Medicine (HT), and Department of Experimental Medicine (KAM), University of British Columbia, Vancouver, BC, Canada; Departments of Epidemiology and Biostatistics, Occupational Health, and Medicine, McGill University, Montreal, QC, Canada (CW); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada (SW); and Department of Psychology, St. Francis Xavier University, Antigonish, NS, Canada (LIB)
| | - Kyla A McKay
- Department of Internal Medicine, College of Medicine, Faculty of Health Sciences (KMF, RAM), and Department of Community Health Sciences, College of Medicine (RAM), University of Manitoba, Winnipeg, MB, Canada; Departments of Psychiatry, Medicine, Psychology, and Neuroscience, Dalhousie University, Halifax, NS, Canada (JDF); Departments of Psychiatry and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada (SBP); Division of Neurology, Faculty of Medicine (HT), and Department of Experimental Medicine (KAM), University of British Columbia, Vancouver, BC, Canada; Departments of Epidemiology and Biostatistics, Occupational Health, and Medicine, McGill University, Montreal, QC, Canada (CW); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada (SW); and Department of Psychology, St. Francis Xavier University, Antigonish, NS, Canada (LIB)
| | - Lindsay I Berrigan
- Department of Internal Medicine, College of Medicine, Faculty of Health Sciences (KMF, RAM), and Department of Community Health Sciences, College of Medicine (RAM), University of Manitoba, Winnipeg, MB, Canada; Departments of Psychiatry, Medicine, Psychology, and Neuroscience, Dalhousie University, Halifax, NS, Canada (JDF); Departments of Psychiatry and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada (SBP); Division of Neurology, Faculty of Medicine (HT), and Department of Experimental Medicine (KAM), University of British Columbia, Vancouver, BC, Canada; Departments of Epidemiology and Biostatistics, Occupational Health, and Medicine, McGill University, Montreal, QC, Canada (CW); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada (SW); and Department of Psychology, St. Francis Xavier University, Antigonish, NS, Canada (LIB)
| | - Ruth Ann Marrie
- Department of Internal Medicine, College of Medicine, Faculty of Health Sciences (KMF, RAM), and Department of Community Health Sciences, College of Medicine (RAM), University of Manitoba, Winnipeg, MB, Canada; Departments of Psychiatry, Medicine, Psychology, and Neuroscience, Dalhousie University, Halifax, NS, Canada (JDF); Departments of Psychiatry and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada (SBP); Division of Neurology, Faculty of Medicine (HT), and Department of Experimental Medicine (KAM), University of British Columbia, Vancouver, BC, Canada; Departments of Epidemiology and Biostatistics, Occupational Health, and Medicine, McGill University, Montreal, QC, Canada (CW); Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada (SW); and Department of Psychology, St. Francis Xavier University, Antigonish, NS, Canada (LIB)
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Bomyea J, Lang AJ, Delano-Wood L, Jak A, Hanson KL, Sorg S, Clark AL, Schiehser DM. Neuropsychiatric Predictors of Post-Injury Headache After Mild-Moderate Traumatic Brain Injury in Veterans. Headache 2016; 56:699-710. [DOI: 10.1111/head.12799] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 12/24/2015] [Accepted: 12/27/2015] [Indexed: 01/19/2023]
Affiliation(s)
- Jessica Bomyea
- Research and Psychology Services, Veterans Affairs San Diego Healthcare System; San Diego CA USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System; San Diego CA USA
| | - Ariel J. Lang
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System; San Diego CA USA
- Department of Psychiatry; University of California; San Diego, La Jolla CA USA
| | - Lisa Delano-Wood
- Research and Psychology Services, Veterans Affairs San Diego Healthcare System; San Diego CA USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System; San Diego CA USA
- Department of Psychiatry; University of California; San Diego, La Jolla CA USA
| | - Amy Jak
- Research and Psychology Services, Veterans Affairs San Diego Healthcare System; San Diego CA USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System; San Diego CA USA
- Department of Psychiatry; University of California; San Diego, La Jolla CA USA
| | - Karen L. Hanson
- Research and Psychology Services, Veterans Affairs San Diego Healthcare System; San Diego CA USA
- Department of Psychiatry; University of California; San Diego, La Jolla CA USA
| | - Scott Sorg
- Research and Psychology Services, Veterans Affairs San Diego Healthcare System; San Diego CA USA
| | - Alexandra L. Clark
- Research and Psychology Services, Veterans Affairs San Diego Healthcare System; San Diego CA USA
- Department of Psychiatry; University of California; San Diego, La Jolla CA USA
- San Diego State University/University of California, San Diego (SDSU/UCSD) Joint Doctoral Program in Clinical Psychology
| | - Dawn M. Schiehser
- Research and Psychology Services, Veterans Affairs San Diego Healthcare System; San Diego CA USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System; San Diego CA USA
- Department of Psychiatry; University of California; San Diego, La Jolla CA USA
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26
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Lau CI, Lin CC, Chen WH, Wang HC, Kao CH. Increased risk of chronic fatigue syndrome in patients with migraine: A retrospective cohort study. J Psychosom Res 2015; 79:514-8. [PMID: 26505533 DOI: 10.1016/j.jpsychores.2015.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 10/02/2015] [Accepted: 10/17/2015] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The common concurrence of migraine and chronic fatigue syndrome (CFS) has been reported but whether migraine poses a higher risk of CFS remains unknown. In this retrospective case-control study, we examined the association between the 2 disorders by using a nationwide, population-based database in Taiwan. METHODS The data were retrieved and analyzed from the National Health Insurance Research Database (NHIRD) of Taiwan; 6902 newly diagnosed migraine cases from 2006-2010 were identified in a subset of the NHIRD, and 27,608 migraine-free individuals were randomly selected as the comparison cohort. The multivariate Cox proportional hazards regression model was used to investigate the risk of CFS in migraineurs after adjustment for demographic characteristics and comorbidities. RESULTS After adjustment for the covariates, the risk of CFS was 1.5-fold higher in the migraine cohort than in the comparison cohort (52.72 vs. 28.85 per 10,000 person-years). Intriguingly, the risk was most prominent in the oldest group (≥ 65 years), with a 2.11-fold increased risk (95% confidence interval 1.31-3.41) of CFS. In addition, the adjusted cumulative incidence of CFS in the follow-up years was higher in the migraine group (log-rank test, P < .0001), and CFS incidence appeared to increase with the frequency of migraine diagnoses. CONCLUSION The current study demonstrated an increased risk of CFS in migraineurs. Proposed mechanisms in previous studies such as mitochondrial dysfunction and central sensitization may underlie the shared pathophysiology of these seemingly distinct but potentially overlapping disorders.
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Affiliation(s)
- Chi-ieong Lau
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; Division of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan
| | - Che-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan
| | - Wei-Hung Chen
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Han-Cheng Wang
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; College of Medicine, Taipei Medical University, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
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27
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Blumenfeld AM, Aurora SK, Laranjo K, Papapetropoulos S. Unmet clinical needs in chronic migraine: Rationale for study and design of COMPEL, an open-label, multicenter study of the long-term efficacy, safety, and tolerability of onabotulinumtoxinA for headache prophylaxis in adults with chronic migraine. BMC Neurol 2015; 15:100. [PMID: 26133547 PMCID: PMC4489131 DOI: 10.1186/s12883-015-0353-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 06/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic migraine is a neurological condition with a large individual and socioeconomic burden of disease. The recently completed Phase III REsearch Evaluating Migraine Prophylaxis Therapy (PREEMPT) clinical development program established the efficacy and safety of onabotulinumtoxinA as a prophylactic treatment for chronic migraine patients. However, clinical questions remain. A long-term evaluation study of onabotulinumtoxinA aims to address some of the remaining questions in the treatment of chronic migraine. The clinical rationale, study design, and treatment plan of this ongoing study are reviewed in this paper. METHODS/DESIGN The Chronic migraine OnabotulinuMtoxinA Prolonged Efficacy open Label (COMPEL) study will enroll approximately 500 adult patients with chronic migraine at international sites. Patients will be evaluated over 108 weeks, following a 4-week baseline period. Qualified subjects will receive 155 U of onabotulinumtoxinA every 12 weeks for 9 open-label cycles. The primary endpoint will be mean change from baseline in frequency of headache days at 108 weeks. Other endpoints will include additional assessments of the efficacy and safety of onabotulinumtoxinA and the effect of onabotulinumtoxinA on quality-of-life measures, disability, and health economic outcomes. The impact of onabotulinumtoxinA on common comorbidities (eg, sleep, anxiety, and fatigue) will also be assessed. DISCUSSION Recruitment and enrollment are ongoing. Post-approval, open-label studies are often designed to more closely resemble clinical practice and provide an opportunity to continue the evaluation of the efficacy and safety of approved treatments. By creating a large database and analyzing a variety of outcome measures over an extended time frame, the COMPEL study will seek to contribute substantially to the existing knowledge of the chronic migraine population and the long-term management of this debilitating disorder. CLINICAL TRIAL REGISTRATION NUMBER NCT01516892.
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Affiliation(s)
- Andrew M Blumenfeld
- The Neurology Center, 320 Santa Fe Drive, Suite 150, Encinitas, CA, 92024, USA.
| | - Sheena K Aurora
- Stanford University, 300 Pasteur Drive, Room A343, MC 5235, Stanford, CA, 94305, USA.
| | - Karen Laranjo
- Formerly an employee of Allergan, Inc., Irvine, CA, USA.
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Boles RG, Zaki EA, Kerr JR, Das K, Biswas S, Gardner A. Increased prevalence of two mitochondrial DNA polymorphisms in functional disease: Are we describing different parts of an energy-depleted elephant? Mitochondrion 2015; 23:1-6. [PMID: 25934187 DOI: 10.1016/j.mito.2015.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 04/18/2015] [Accepted: 04/22/2015] [Indexed: 12/19/2022]
Abstract
About 20% of the population suffers from "functional syndromes". Since these syndromes overlap greatly in terms of co-morbidity, pathophysiology (including aberrant autonomic activity) and treatment responses, common predisposing genetic factors have been postulated. We had previously showed that two common mitochondrial DNA (mtDNA) polymorphisms at positions 16519 and 3010 are statistically associated with the functional syndromes of migraine, cyclic vomiting syndrome and non-specific abdominal pain. Herein, among individuals with mtDNA haplogroup H (HgH), the presence of these two mtDNA polymorphisms were ascertained in additional functional syndromes: chronic fatigue syndrome, complex regional pain syndrome, sudden infant death syndrome, and major depressive disorder. Polymorphic prevalence rates were compared between disease and control groups, and within each disease group in participants with and without specific clinical findings. In all four conditions, one or both of the polymorphisms was significantly associated with the respective condition and/or co-morbid functional symptomatology. Thus, we conclude that these two mtDNA polymorphisms likely modify risk for the development of multiple functional syndromes, likely constituting a proportion of the postulated common genetic factor, at least among individuals with HgH. Pathophysiology likely involves broad effects on the autonomic nervous system.
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Affiliation(s)
- Richard G Boles
- Division of Medical Genetics and the Saban Research Institute, Children's Hospital Los Angeles, CA USA; Department of Pediatrics, Keck School of Medicine at the University of Southern California, Los Angeles, CA USA.
| | - Essam A Zaki
- Division of Medical Genetics and the Saban Research Institute, Children's Hospital Los Angeles, CA USA
| | - Jonathan R Kerr
- Division of Clinical Sciences, St. George's University of London, Cranmer Terrace, London United Kingdom
| | - Kingshuk Das
- Division of Medical Genetics and the Saban Research Institute, Children's Hospital Los Angeles, CA USA
| | - Sawona Biswas
- Division of Medical Genetics and the Saban Research Institute, Children's Hospital Los Angeles, CA USA
| | - Ann Gardner
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm Sweden
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29
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Valença MM, da Silva AA, Bordini CA. Headache Research and Medical Practice in Brazil: An Historical Overview. Headache 2015; 55 Suppl 1:4-31. [DOI: 10.1111/head.12512] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2014] [Indexed: 12/28/2022]
Affiliation(s)
- Marcelo Moraes Valença
- Neurology and Neurosurgery Unit; Department of Neuropsychiatry; Federal University of Pernambuco; Recife Brazil
- Neurology and Neurosurgery Unit, Hospital Esperança; Brazil
| | - Amanda Araújo da Silva
- Neurology and Neurosurgery Unit; Department of Neuropsychiatry; Federal University of Pernambuco; Recife Brazil
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30
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Palmisani S, Al-Kaisy A, Arcioni R, Smith T, Negro A, Lambru G, Bandikatla V, Carson E, Martelletti P. A six year retrospective review of occipital nerve stimulation practice--controversies and challenges of an emerging technique for treating refractory headache syndromes. J Headache Pain 2013; 14:67. [PMID: 23919570 PMCID: PMC3751236 DOI: 10.1186/1129-2377-14-67] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 07/28/2013] [Indexed: 11/28/2022] Open
Abstract
Background A retrospective review of patients treated with Occipital Nerve Stimulation (ONS) at two large tertiary referral centres has been audited in order to optimise future treatment pathways. Methods Patient’s medical records were retrospectively reviewed, and each patient was contacted by a trained headache expert to confirm clinical diagnosis and system efficacy. Results were compared to reported outcomes in current literature on ONS for primary headaches. Results Twenty-five patients underwent a trial of ONS between January 2007 and December 2012, and 23 patients went on to have permanent implantation of ONS. All 23 patients reached one-year follow/up, and 14 of them (61%) exceeded two years of follow-up. Seventeen of the 23 had refractory chronic migraine (rCM), and 3 refractory occipital neuralgia (ON). 11 of the 19 rCM patients had been referred with an incorrect headache diagnosis. Nine of the rCM patients (53%) reported 50% or more reduction in headache pain intensity and or frequency at long term follow-up (11–77 months). All 3 ON patients reported more than 50% reduction in pain intensity and/or frequency at 28–31 months. Ten (43%) subjects underwent surgical revision after an average of 11 ± 7 months from permanent implantation - in 90% of cases due to lead problems. Seven patients attended a specifically designed, multi-disciplinary, two-week pre-implant programme and showed improved scores across all measured psychological and functional parameters independent of response to subsequent ONS. Conclusions Our retrospective review: 1) confirms the long-term ONS success rate in refractory chronic headaches, consistent with previously published studies; 2) suggests that some headaches types may respond better to ONS than others (ON vs CM); 3) calls into question the role of trial stimulation in ONS; 4) confirms the high rate of complications related to the equipment not originally designed for ONS; 5) emphasises the need for specialist multidisciplinary care in these patients.
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Affiliation(s)
- Stefano Palmisani
- Pain Management & Neuromodulation Centre, Guy's & St Thomas NHS Trust, London, UK.
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31
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BIÇAKCI Ş. Comorbidity of Migraine. Noro Psikiyatr Ars 2013; 50:S14-S20. [PMID: 28360578 PMCID: PMC5353072 DOI: 10.4274/npa.y7281] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 06/19/2013] [Indexed: 12/01/2022] Open
Abstract
Migraine is a common neurological disorder and can be severely disabling during attacks. The highest prevalence occurs between the ages of 25 and 55 years. Prior studies have found that migraine occurs together with other illnesses at a greater coincidental rate than is seen in the general population. These occurrences are called "comorbidities". To delineate the comorbidities of migraine is important, because it can help improve treatment strategies and the understanding of the possible pathophysiology of migraine.
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Affiliation(s)
- Şebnem BIÇAKCI
- Çukurova University, Medical Faculty, Department of Neurology, Adana, Turkey
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32
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Macgregor EA, Rosenberg JD, Kurth T. Sex-related differences in epidemiological and clinic-based headache studies. Headache 2013; 51:843-59. [PMID: 21631472 DOI: 10.1111/j.1526-4610.2011.01904.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This manuscript discusses sex-related differences in headache prevalence, the symptoms and natural history of migraine, associated disability, and co-morbid disorders. The role of sex hormones is discussed with reference to the effects of hormonal events across the reproductive years and the specific effects of the menstrual cycle on migraine. Differences between the sexes were identified across all parameters reviewed. Future research should ensure that data are analyzed separately for men and women to ensure that differences between the sexes are identified.
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Rayhan RU, Ravindran MK, Baraniuk JN. Migraine in gulf war illness and chronic fatigue syndrome: prevalence, potential mechanisms, and evaluation. Front Physiol 2013; 4:181. [PMID: 23898301 PMCID: PMC3721020 DOI: 10.3389/fphys.2013.00181] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 06/25/2013] [Indexed: 01/13/2023] Open
Abstract
Objective: To assess the prevalence of headache subtypes in Gulf War Illness (GWI) and Chronic Fatigue Syndrome (CFS) compared to controls. Background: Approximately, 25% of the military personnel who served in the 1990–1991 Persian Gulf War have developed GWI. Symptoms of GWI and CFS have considerable overlap, including headache complaints. Migraines are reported in CFS. The type and prevalence of headaches in GWI have not been adequately assessed. Methods: 50 GWI, 39 CFS and 45 controls had structured headache evaluations based on the 2004 International Headache Society criteria. All subjects had history and physical examinations, fatigue and symptom related questionnaires, measurements of systemic hyperalgesia (dolorimetry), and assessments for exclusionary conditions. Results: Migraines were detected in 64% of GWI (odds ratio = 11.6 [4.1–32.5]) (mean [±95% CI]) and 82% of CFS subjects (odds ratio = 22.5 [7.8–64.8]) compared to only 13% of controls. There was a predominance of females in the CFS compared to GWI and controls. However, migraine status was independent of gender in GWI and CFS groups (x2 = 2.7; P = 0.101). Measures of fatigue, pain, and other ancillary criteria were comparable between GWI and CFS subjects with and without headache. Conclusion: The high prevalence of migraine in CFS was confirmed and extended to GWI subjects. GWI and CFS may share dysfunctional central pathophysiological pathways that contribute to migraine and subjective symptoms. The high migraine prevalence warrants the inclusion of a structured headache evaluation in GWI and CFS subjects, and treatment when present.
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Affiliation(s)
- Rakib U Rayhan
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Georgetown University Washington, DC, USA
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Lucchesi C, Sassi AN, Siciliano G, Gori S. Fatigue Is Increased in Episodic Migraine Without Aura Patients. Headache 2013; 53:1163-5. [DOI: 10.1111/head.12134] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Cinzia Lucchesi
- Department of Neurosciences; Institute of Neurology; University of Pisa; Pisa; Italy
| | - Angela N. Sassi
- Department of Neurosciences; Institute of Neurology; University of Pisa; Pisa; Italy
| | - Gabriele Siciliano
- Department of Neurosciences; Institute of Neurology; University of Pisa; Pisa; Italy
| | - Sara Gori
- Department of Neurosciences; Institute of Neurology; University of Pisa; Pisa; Italy
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35
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Chronic migraine and chronic tension-type headache are associated with concomitant low back pain: Results of the German Headache Consortium study. Pain 2013; 154:484-492. [DOI: 10.1016/j.pain.2012.12.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 11/19/2012] [Accepted: 12/12/2012] [Indexed: 11/19/2022]
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36
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McLean A, Coutts K, Becker WJ. Pacing as a treatment modality in migraine and tension-type headache. Disabil Rehabil 2011; 34:611-8. [DOI: 10.3109/09638288.2011.610496] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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37
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Mercante JPP, Peres MFP, Bernik MA. Primary headaches in patients with generalized anxiety disorder. J Headache Pain 2011; 12:331-8. [PMID: 21298316 PMCID: PMC3094648 DOI: 10.1007/s10194-010-0290-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 12/29/2010] [Indexed: 11/01/2022] Open
Abstract
Although anxiety disorders and headaches are comorbid conditions, there have been no studies evaluating the prevalence of primary headaches in patients with generalized anxiety disorder (GAD). The aim of this study was to analyze the lifetime prevalence of primary headaches in individuals with and without GAD. A total of 60 individuals were evaluated: 30 GAD patients and 30 controls without mental disorders. Psychiatric assessments and primary headache diagnoses were made using structured interviews. Among the GAD patients, the most common diagnosis was migraine, which was significantly more prevalent among the GAD patients than among the controls, as were episodic migraine, chronic daily headache and aura. Tension-type headache was equally common in both groups. Primary headaches in general were significantly more common and more severe in GAD patients than in controls. In anxiety disorder patients, particularly those with GAD, accurate diagnosis of primary headache can improve patient management and clinical outcomes.
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Affiliation(s)
- Juliane P P Mercante
- Anxiety Disorders Program, Institute of Psychiatry, HC-FMUSP, Sao Pãulo, Brazil.
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38
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Ravindran MK, Zheng Y, Timbol C, Merck SJ, Baraniuk JN. Migraine headaches in chronic fatigue syndrome (CFS): comparison of two prospective cross-sectional studies. BMC Neurol 2011; 11:30. [PMID: 21375763 PMCID: PMC3058027 DOI: 10.1186/1471-2377-11-30] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 03/05/2011] [Indexed: 02/19/2023] Open
Abstract
Background Headaches are more frequent in Chronic Fatigue Syndrome (CFS) than healthy control (HC) subjects. The 2004 International Headache Society (IHS) criteria were used to define CFS headache phenotypes. Methods Subjects in Cohort 1 (HC = 368; CFS = 203) completed questionnaires about many diverse symptoms by giving nominal (yes/no) answers. Cohort 2 (HC = 21; CFS = 67) had more focused evaluations. They scored symptom severities on 0 to 4 anchored ordinal scales, and had structured headache evaluations. All subjects had history and physical examinations; assessments for exclusion criteria; questionnaires about CFS related symptoms (0 to 4 scale), Multidimensional Fatigue Inventory (MFI) and Medical Outcome Survey Short Form 36 (MOS SF-36). Results Demographics, trends for the number of diffuse "functional" symptoms present, and severity of CFS case designation criteria symptoms were equivalent between CFS subjects in Cohorts 1 and 2. HC had significantly fewer symptoms, lower MFI and higher SF-36 domain scores than CFS in both cohorts. Migraine headaches were found in 84%, and tension-type headaches in 81% of Cohort 2 CFS. This compared to 5% and 45%, respectively, in HC. The CFS group had migraine without aura (60%; MO; CFS+MO), with aura (24%; CFS+MA), tension headaches only (12%), or no headaches (4%). Co-morbid tension and migraine headaches were found in 67% of CFS. CFS+MA had higher severity scores than CFS+MO for the sum of scores for poor memory, dizziness, balance, and numbness ("Neuro-construct", p = 0.002) and perceived heart rhythm disturbances, palpitations and noncardiac chest pain ("Cardio-construct"; p = 0.045, t-tests after Bonferroni corrections). CFS+MO subjects had lower pressure-induced pain thresholds (2.36 kg [1.95-2.78; 95% C.I.] n = 40) and a higher prevalence of fibromyalgia (47%; 1990 criteria) compared to HC (5.23 kg [3.95-6.52] n = 20; and 0%, respectively). Sumatriptan was beneficial for 13 out of 14 newly diagnosed CFS migraine subjects. Conclusions CFS subjects had higher prevalences of MO and MA than HC, suggesting that mechanisms of migraine pathogenesis such as central sensitization may contribute to CFS pathophysiology. Clinical Trial Registration Georgetown University IRB # 2006-481 ClinicalTrials.gov NCT00810329
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Affiliation(s)
- Murugan K Ravindran
- Division of Rheumatology, Immunology and Allergy, Georgetown University, 3800 Reservoir Road NW, Washington, DC 20007-2197, USA
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Pompili M, Serafini G, Innamorati M, Serra G, Dominici G, Fortes-Lindau J, Pastina M, Telesforo L, Lester D, Girardi P, Tatarelli R, Martelletti P. Patient outcome in migraine prophylaxis: the role of psychopharmacological agents. PATIENT-RELATED OUTCOME MEASURES 2010; 1:107-18. [PMID: 22915957 PMCID: PMC3417910 DOI: 10.2147/prom.s9742] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Migraine is a serious illness that needs correct treatment for acute attacks and, in addition, a treatment prophylaxis, since patients with migraine suffer during acute attacks and also between attacks. METHODS A systematic review of the most relevant clinical trials of migraine headache and its epidemiology, pathophysiology, comorbidity, and prophylactic treatment (medical and nonmedical) was carried out using "Medline" and "PsychINFO" from 1973 to 2009. Approximately 110 trials met our inclusion criteria and were included in the current review. RESULTS The most effective pharmacological treatment for migraine prophylaxis is propranolol and anticonvulsants such as topiramate, valproic acid, and amitriptyline. Nonmedical treatments such as acupuncture, biofeedback, and melatonin have also been proposed. Peripheral neurostimulation has been suggested for the treatment of chronic daily headache that does not respond to prophylaxis and for the treatment of drug-resistant primary headache. The majority of the pharmacological agents available today have limited efficacy and may cause adverse effects incompatible with long-term use. LIMITATIONS The review was limited by the highly variable and often insufficient reporting of the complex outcome data and by the fact that migraine prophylaxis trials typically use headache diaries to monitor the course of the disease. The results of the different studies were also presented in different ways, making comparison of the results difficult. DISCUSSION An adequate prophylaxis is crucial in reducing disability and preventing the evolution of the problem into a chronic progressive illness. The implications of the present findings were discussed.
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Affiliation(s)
- Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Functions, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Italy
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Martínez S, Cáceres C, Mataró M, Escudero D, Latorre P, Dávalos A. Is there progressive cognitive dysfunction in Sjögren Syndrome? A preliminary study. Acta Neurol Scand 2010; 122:182-8. [PMID: 20096020 DOI: 10.1111/j.1600-0404.2009.01293.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to determine the progression of cognitive dysfunction in primary Sjögren Syndrome (SS). METHODS Twelve subjects with SS were compared with ten subjects with migraine and ten healthy controls on neuropsychological, mood and fatigue tests at baseline and 8 years later. RESULTS At follow-up, SS subjects performed below subjects with migraine on the Continuous Performance Test (CPT) but did not differ on other tasks. Compared with controls, both clinical groups obtained lower scores on simple reaction time, patients with SS obtained lower scores on the Wisconsin Card Sorting Test (WCST) and patients with migraine performed below controls on the Benton's Judgment of Line Orientation Test (JOLO). Clinical groups did not differ on cognitive changes over time, except that migraine subjects improved on verbal fluency. Compared with baseline, both SS and migraine patients were more impaired on simple reaction time, Trail Making Test part B, Stroop and JOLO. However, they showed higher scores on verbal and visual memory, WCST and CPT reaction time. SS also showed higher levels of depression and fatigue than migraine and controls, with no significant changes over time. DISCUSSION Preliminary evidence indicates some cognitive deficits in both SS and migraine following a pattern of fronto-subcortical dysfunction without a significant cognitive decline over time.
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Affiliation(s)
- S Martínez
- Neurology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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Wang SJ, Chen PK, Fuh JL. Comorbidities of migraine. Front Neurol 2010; 1:16. [PMID: 21188255 PMCID: PMC3008936 DOI: 10.3389/fneur.2010.00016] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 06/28/2010] [Indexed: 12/18/2022] Open
Abstract
Migraine is a common neurological disorder and can be severely disabling during attacks. The highest prevalence occurs between the ages of 25 and 55 years, potentially the most productive period of life. Migraine leads to a burden not only for the individual, but also for the family and society in general. Prior studies have found that migraine occurs together with other illnesses at a greater coincidental rate than is seen in the general population. These occurrences are called “comorbidities,” which means that these disorders are interrelated with migraine. To delineate the comorbidities of migraine is important, because it can help improve treatment strategies and the understanding of the possible pathophysiology of migraine. The comorbid illnesses in patients with migraine include stroke, sub-clinical vascular brain lesions, coronary heart disease, hypertension, patent foramen ovale, psychiatric diseases (depression, anxiety, bipolar disorder, panic disorder, and suicide), restless legs syndrome, epilepsy and asthma. In this paper, we review the existing epidemiological and hospital-based studies, and illustrate the connections between these illnesses and migraine.
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Affiliation(s)
- Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital Taipei, Taiwan
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Abstract
The concept of a sinus headache is problematic from neurology, allergology, and rhinology perspectives. It may be considered the final neurological diagnosis of exclusion when criteria for other craniofacial pain syndromes are not met. The International Headache Society definition implicates the presence of acute sinusitis, but this requirement is often not met in practice or with a patient's perception of the term. Otorhinolaryngologists have a similar exasperation with this cephalgia but tend to attribute idiopathic, nonallergic rhinopathy as the cause. Allergists often see patients who claim to have a sinus headache but instead have perennial allergic rhinitis or nonallergic rhinitis. A fresh perspective is required to determine the characteristics, differential diagnosis, and veracity of the sinus headache. We recommend using the term with caution only if the clinical picture meets the criteria for acute sinusitis-induced headache.
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Wöber C, Wöber-Bingöl C. Triggers of migraine and tension-type headache. HANDBOOK OF CLINICAL NEUROLOGY 2010; 97:161-172. [PMID: 20816418 DOI: 10.1016/s0072-9752(10)97012-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Identification of trigger factors or precipitants is frequently recommended as a basic strategy in the treatment of migraine and tension-type headache (TTH). Trigger factors increase the probability of headache in the short term. Potential trigger factors have been examined most frequently in migraine and less often in TTH. Many of these factors are related to migraine as well as to TTH, but their prevalence may differ in the two headache types. In this chapter, we will review the findings of retrospective as well as of prospective and controlled studies. Taken together, virtually all aspects of life have been suspected to trigger migraine or TTH, but scientific evidence for many of these triggers is poor. Menstruation has a prominent unfavorable role in migraine and possibly in TTH. There is at least some evidence that environmental factors such as weather, lights, noise and odors, stress and other psychological factors, sleeping problems, fatigue and tiredness may play a role. In addition, intake of alcohol, caffeine withdrawal, skipping meals, and possibly dehydration may trigger migraine and TTH in some patients. Scientific evidence is lacking that any other food or food additive plays a relevant role as a trigger factor of headaches.
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Affiliation(s)
- Christian Wöber
- Department of Neurology, Medical University of Vienna, Vienna, Austria.
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Pompili M, Di Cosimo D, Innamorati M, Lester D, Tatarelli R, Martelletti P. Psychiatric comorbidity in patients with chronic daily headache and migraine: a selective overview including personality traits and suicide risk. J Headache Pain 2009; 10:283-90. [PMID: 19554418 PMCID: PMC3451744 DOI: 10.1007/s10194-009-0134-2] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Accepted: 05/19/2009] [Indexed: 11/27/2022] Open
Abstract
Studies on the prevalence and impact of psychiatric disorders among headache patients have yielded findings that have clarified the relationship between migraine and major affective disorders, anxiety, illicit drug abuse, nicotine dependence, and suicide attempts. Studies in both clinical and community-based settings have demonstrated an association between migraine and a number of specific psychiatric disorders. In large-scale population-based studies, persons with migraine are from 2.2 to 4.0 times more likely to have depression. In longitudinal studies, the evidence supports a bidirectional relationship between migraine and depression, with each disorder increasing the risk of the other disorder. Although a strong association has been demonstrated consistently for migraine and major depression, especially for migraine with aura, there has been less systematic research on the links between migraine and bipolar disorder. This review will focus on the way in which psychiatric disorders decrease the quality of life and result in a worse prognosis, chronicity of the disease, and a worse response to treatment. Short-term pharmaceutical care intervention improves the patients' mental health, but it does not significantly change the number and severity of headaches. The increase in self-efficacy and mental health associated with pharmaceutical care may be instrumental in improving the long-term pharmacotherapy of patients with migraine and headache.
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Affiliation(s)
- Maurizio Pompili
- Department of Psychiatry, Sant'Andrea Hospital, Sapienza University of Rome, 1035 Via di Grottarossa, Rome 00189, Italy.
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Seidel S, Hartl T, Weber M, Matterey S, Paul A, Riederer F, Gharabaghi M, Wöber-Bingöl Ç, Wöber C. Quality of Sleep, Fatigue and Daytime Sleepiness in Migraine—A Controlled Study. Cephalalgia 2009; 29:662-9. [DOI: 10.1111/j.1468-2982.2008.01784.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this study was to evaluate whether the quality of sleep and the degree of fatigue and daytime sleepiness are related to migraine. We investigated 489 subjects comprising 97 patients with eight or more, 77 patients with five to seven and 196 patients with one to four migraine days per month, and 119 migraine-free controls with fewer than six headache days per year. The patients were recruited via articles in newspapers not stressing the subject of the study. All participants underwent a semistructured interview and completed the Pittsburgh Sleep Quality Index (PSQI), the Fatigue Severity Scale (FSS), the Epworth Sleepiness Scale (ESS) and the Self-rating Depression Scale and the Self-rating Anxiety Scale. For statistical analysis we used two way MANOVAs, post hoc univariate two-way ANOVAs and Hochberg's GT2 tests as well as three-way mixed design ANOVAs. The PSQI total score was highest in patients with frequent migraine (5.9 ± 4.3) and lowest in controls (4.3 ± 2.5, P = 0.04). Four subscores of the PSQI showed similar statistically significant differences. The FSS and ESS scores did not differ in the four study groups. Analysing depression and anxiety revealed a significant impact on PSQI, FSS and ESS, but did not demonstrate interactions with migraine, thus suggesting that the impact of migraine is similar in patients without and with psychiatric comorbidity. In conclusion, the quality of sleep is decreased in patients with migraine, whereas fatigue and daytime sleepiness do not differ from healthy controls. The decreased quality of sleep in migraineurs is also a consequence of migraine itself and cannot be explained exclusively by comorbidity with depression or anxiety.
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Affiliation(s)
- S Seidel
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - T Hartl
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - M Weber
- Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - S Matterey
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - A Paul
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - F Riederer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - M Gharabaghi
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Ç Wöber-Bingöl
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - C Wöber
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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Winward C, Sackley C, Metha Z, Rothwell PM. A population-based study of the prevalence of fatigue after transient ischemic attack and minor stroke. Stroke 2009; 40:757-61. [PMID: 19131658 DOI: 10.1161/strokeaha.108.527101] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Fatigue is common after stroke and can be attributable to the increased physical effort associated with severe neurological deficits; however, its presence in those with little motor deficit raises the possibility of confounding by other factors, such as comorbidity, anxiety, and medication. To control for such factors and determine the extent of stroke-specific fatigue, we compared patients with minor stroke who had little or no residual neurological deficit with patients with TIA; both groups had undergone similar investigations and treatment. METHODS The prevalence of fatigue 6 months after TIA or minor stroke was assessed in consecutive patients using the Chalder fatigue scale in a population-based incidence study (Oxford Vascular Study). Patients were included if they were independent in self-care Barthel Index (>or=18/20) and without major cognitive impairment (Mini-Mental State Examination >or=24/30). Stroke severity at baseline was assessed with the National Institute of Health Stroke Scale (NIHSS). Other potential causes of fatigue were assessed including anxiety, depression, recent life events, medication, and abnormalities in biochemistry or hematologic tests. RESULTS Seventy-six participants had minor stroke (mean age, 74.1 years; 42 men) and 73 had TIA (mean age, 72.5 years; 40 men). At 6-month follow-up, median Barthel Index score was 20 (interquartile range, 20-20) in both groups. However, fatigue was more common after stroke than TIA (56% vs 29%; OR, 3.14; 95% CI, 1.51-6.57; P=0.0008). This difference was present both in patients with modified Rankin score of 0 at 6 months (23.8% vs 10.3%) and patients with modified Rankin score >or=1 (69.2% vs 48.6%), and remained more frequent in stroke patients after adjustment for potential confounders. Within the group of patients with stroke, the prevalence of fatigue increased with initial stroke severity (87% NIHSS >or=4 vs 48% NIHSS <or=3; P=0.0087); however, stroke patients with initial NIHSS of 0 were still more fatigued than patients with TIA (57% vs 29%; P=0.015). CONCLUSIONS The prevalence of fatigue after minor stroke is higher than after TIA, suggesting that it is not simply a consequence of the stress of a recent acute cerebral event, comorbidity, medication, or other potential confounders. The high levels of fatigue in stroke patients without neurological impairment suggest it has a central origin rather than being the result of increased physical effort required after stroke.
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Whitehead L. The measurement of fatigue in chronic illness: a systematic review of unidimensional and multidimensional fatigue measures. J Pain Symptom Manage 2009; 37:107-28. [PMID: 19111779 DOI: 10.1016/j.jpainsymman.2007.08.019] [Citation(s) in RCA: 278] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2006] [Revised: 08/22/2007] [Accepted: 08/31/2007] [Indexed: 12/17/2022]
Abstract
Fatigue is a common symptom associated with a wide range of chronic diseases. A large number of instruments have been developed to measure fatigue. An assessment regarding the reliability, validity, and utility of fatigue measures is time-consuming for the clinician and researcher, and few reviews exist on which to draw such information. The aim of this article is to present a critical review of fatigue measures, the populations in which the scales have been used, and the extent to which the psychometric properties of each instrument have been evaluated to provide clinicians and researchers with information on which to base decisions. Seven databases were searched for all articles that measured fatigue and offered an insight into the psychometric properties of the scales used over the period 1980-2007. Criteria for judging the "ideal" measure were developed to encompass scale usability, clinical/research utility, and the robustness of psychometric properties. Twenty-two fatigue measures met the inclusion criteria and were evaluated. A further 17 measures met some of the criteria, but have not been tested beyond initial development, and are reviewed briefly at the end of the article. The review did not identify any instrument that met all the criteria of an ideal instrument. However, a small number of short instruments demonstrated good psychometric properties (Fatigue Severity Scale [FSS], Fatigue Impact Scale [FIS], and Brief Fatigue Inventory [BFI]), and three comprehensive instruments demonstrated the same (Fatigue Symptom Inventory [FSI], Multidimensional Assessment of Fatigue [MAF], and Multidimensional Fatigue Symptom Inventory [MFSI]). Only four measures (BFI, FSS, FSI, and MAF) demonstrated the ability to detect change over time. The clinician and researcher also should consider the populations in which the scale has been used previously to assess its validity with their own patient group, and assess the content of a scale to ensure that the key qualitative aspects of fatigue of the population of interest are covered.
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Affiliation(s)
- Lisa Whitehead
- Department of Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand.
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Assessing Patients with Episodic Tension-Type Headache, Migraine or Chronic Daily Headache Using the Short Pain Inventory. Pharmaceut Med 2008. [DOI: 10.1007/bf03256698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
OBJECTIVES To identify distinct constellations of comorbid disorders occurring in migraineurs, and to examine differences in demographics, headache profiles, and psychosocial features between the comorbidity constellations. METHODS This is a retrospective electronic chart review of consecutive new female outpatients diagnosed with migraine (n = 223) using International Classification of Headache Disorders (ICHD)-II criteria. Questionnaire collected information on comorbid diagnoses, current depression, somatic symptoms, psychosocial stressors, and antidepressant use, social and abuse history. Cluster analysis, based on nonheadache disorders, was performed and differences between the resulting groups were examined. RESULTS We identified 3 groups. Group 1 (n = 55) was defined by hypertension, hyperlipidemia, diabetes mellitus, and hypothyroidism; Group 2 (n = 83) by depression, anxiety, and fibromyalgia; Group 3 (n = 85) by the absence of defining comorbidities. Group 1 had more males (22% vs 5% vs 12%, P < .05), was older (median years: 52 vs 36 vs 32, P < .01), and had later age of headache onset (median years: 22 vs 16 vs 18, P < .05). Group 2 had the greatest disability (P < .05), and the lowest quality of life (P < .001). Persons in Group 2 more commonly reported sexual abuse (OR = 2.7, 95% CI: 1.1 to 6.5), physical abuse (OR = 2.5, 95% CI: 1.2 to 5.1), and emotional abuse (OR = 4.3, 95% CI: 1.9 to 8.9). CONCLUSION Within a headache clinic population, we identified 3 different migraine comorbidity constellations, with differing headache and psychosocial profiles, suggesting heterogeneity of genetic and environmental factors. This may have implications for diagnosis and disease management.
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Affiliation(s)
- Gretchen E Tietjen
- Department of Neurology, The University of Toledo College of Medicine, Toledo, OH 43614, USA
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Tietjen GE, Bushnell CD, Herial NA, Utley C, White L, Hafeez F. Endometriosis Is Associated With Prevalence of Comorbid Conditions in Migraine. Headache 2007; 47:1069-78. [PMID: 17635599 DOI: 10.1111/j.1526-4610.2007.00784.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the headache characteristics of women with migraine and endometriosis (EM), and differences in the prevalence of comorbid conditions between female migraineurs with EM, without EM and nonheadache controls. BACKGROUND Migraine and EM are common conditions in women of reproductive age, and both are influenced by ovarian hormones. The comorbidity of migraine and EM is newly recognized, but reasons for the association are uncertain. METHODS This is a cross-sectional study of female headache outpatients and healthy controls conducted at University of Toledo and Duke University in 2005 and 2006. After a headache specialist determined headache frequency and diagnosis (based on criteria of the second International Classification of Headache Disorders), patients completed a self-administered electronic survey with information on demographics, headache-related disability, menstrual disorders, premenstrual dysphoric disorder (PMDD), vascular event risk, and comorbid conditions, including irritable bowel syndrome (IBS), fibromyalgia (FM), chronic fatigue syndrome (CFS), interstitial cystitis (IC), depression, and anxiety. RESULTS Study enrolled 171 women with migraine and 104 controls. EM was reported more commonly in migraineurs than in controls (22% vs 9.6%, P < .01). Frequency of chronic headache was higher in migraineurs with EM compared to without EM (P= .002) and median headache-related disability scores were also higher in the EM group (P= .025). Symptoms of PMDD were more common in migraineurs, but frequency did not differ by EM status. Migraineurs with EM reported more menorrhagia, dysmenorrhea, and infertility compared to the migraine cohort without EM and to controls. Depression, anxiety, IBS, FM, CFS, and IC were more common in migraine with EM group than in controls. Anxiety (OR = 2.2, 95% CI 1.0-4.7), IC (OR = 10.6, 95% CI 1.9-56.5), and CFS (OR = 3.6, 95% CI 1.1-11.5) were more common in migraine with EM group, than in the cohort with migraine without EM. CONCLUSION Prevalence of EM is higher in women with migraine than in nonheadache controls. Migraineurs with EM have more frequent and disabling headaches, and are more likely to have other comorbid conditions affecting mood and pain, compared to migraineurs without EM.
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Affiliation(s)
- Gretchen E Tietjen
- Department of Neurology, University of Toledo Medical Center, Health Science Campus, 3120 Glendale Avenue, Toledo, OH 43614, USA
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