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Triadou D, Bar-Shalom Y, Pollak M, Gal S, Nathan K, Yakovlev M, Genizi J. Weekend Headaches in School-Age Children. Healthcare (Basel) 2023; 12:60. [PMID: 38200966 PMCID: PMC10778602 DOI: 10.3390/healthcare12010060] [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: 11/23/2023] [Revised: 12/24/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
Children commonly encounter primary headaches, with various factors playing a role in their onset. The daily routine notably contributes to the occurrence of primary headaches in children. This study aims to profile children experiencing headaches on weekends (WH) in comparison to those primarily having headaches midweek (MWH). Out of 109 children visiting a pediatric headache clinic, 60 prospectively filled out questionnaires regarding their headaches. The average age was 11.8 years, and 63% were of female sex. Most of the children suffered from migraine headaches (60%), while the rest suffered from tension-type headaches (TTH, 15%), mixed headaches (17%), or undetermined headaches (8%). None of the children suffered from a headache only on the weekend. In contrast, 14 (23%) children suffered from a headache exclusively in midweek. Children with learning difficulties were similarly distributed between the WH and the MWH groups (48% and 52%, respectively). Children without learning difficulties suffered significantly more from MWH compared to WH (79% vs. 21%, respectively). In conclusion, children did not suffer from WH alone. Self-reported triggers were not significantly different in WH and MWH patients. Proper profiling of headache types and triggers may lead to more accurate management of these patients.
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Affiliation(s)
- Daniel Triadou
- Pediatric Department, Bnai Zion Medical Center, Haifa 3104802, Israel; (D.T.); (Y.B.-S.); (S.G.); (K.N.); (M.Y.); (J.G.)
| | - Yoel Bar-Shalom
- Pediatric Department, Bnai Zion Medical Center, Haifa 3104802, Israel; (D.T.); (Y.B.-S.); (S.G.); (K.N.); (M.Y.); (J.G.)
| | - Mordechai Pollak
- Pediatric Department, Bnai Zion Medical Center, Haifa 3104802, Israel; (D.T.); (Y.B.-S.); (S.G.); (K.N.); (M.Y.); (J.G.)
- Bruce Rappaport Faulty of Medicine, Technion, Haifa 3109601, Israel
| | - Shoshana Gal
- Pediatric Department, Bnai Zion Medical Center, Haifa 3104802, Israel; (D.T.); (Y.B.-S.); (S.G.); (K.N.); (M.Y.); (J.G.)
- Bruce Rappaport Faulty of Medicine, Technion, Haifa 3109601, Israel
| | - Keren Nathan
- Pediatric Department, Bnai Zion Medical Center, Haifa 3104802, Israel; (D.T.); (Y.B.-S.); (S.G.); (K.N.); (M.Y.); (J.G.)
- Bruce Rappaport Faulty of Medicine, Technion, Haifa 3109601, Israel
| | - Megi Yakovlev
- Pediatric Department, Bnai Zion Medical Center, Haifa 3104802, Israel; (D.T.); (Y.B.-S.); (S.G.); (K.N.); (M.Y.); (J.G.)
| | - Jacob Genizi
- Pediatric Department, Bnai Zion Medical Center, Haifa 3104802, Israel; (D.T.); (Y.B.-S.); (S.G.); (K.N.); (M.Y.); (J.G.)
- Bruce Rappaport Faulty of Medicine, Technion, Haifa 3109601, Israel
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Stubberud A, Buse DC, Kristoffersen ES, Linde M, Tronvik E. Is there a causal relationship between stress and migraine? Current evidence and implications for management. J Headache Pain 2021; 22:155. [PMID: 34930118 PMCID: PMC8685490 DOI: 10.1186/s10194-021-01369-6] [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: 10/16/2021] [Accepted: 12/01/2021] [Indexed: 12/13/2022] Open
Abstract
Background The purpose of this narrative review is to examine the literature investigating a causal relationship between stress and migraine and evaluate its implications for managing migraine. Methods PubMed, PsycINFO and CINAHL were searched from 1988 to August 2021, identifying 2223 records evaluating the relationship between stress and migraine. Records were systematically screened. All potentially relevant records were thematically categorized into six mechanistic groups. Within each group the most recent reports providing new insights were cited. Results First, studies have demonstrated an association of uncertain causality between high stress loads from stressful life events, daily hassles or other sources, and the incidence of new-onset migraine. Second, major stressful life events seem to precede the transformation from episodic to chronic migraine. Third, there is some evidence for changes in levels of stress as a risk factor for migraine attacks. Research also suggests there may be a reversed causality or that stress-trigger patterns are too individually heterogeneous for any generalized causality. Fourth, migraine symptom burden seems to increase in a setting of stress, partially driven by psychiatric comorbidity. Fifth, stress may induce sensitization and altered cortical excitability, partially explaining attack triggering, development of chronic migraine, and increased symptom burden including interictal symptom burden such as allodynia, photophobia or anxiety. Finally, behavioral interventions and forecasting models including stress variables seem to be useful in managing migraine. Conclusion The exact causal relationships in which stress causes incidence, chronification, migraine attacks, or increased burden of migraine remains unclear. Several individuals benefit from stress-oriented therapies, and such therapies should be offered as an adjuvant to conventional treatment and to those with a preference. Further understanding the relationship between stress, migraine and effective therapeutic options is likely to be improved by characterizing individual patterns of stress and migraine, and may in turn improve therapeutics.
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Affiliation(s)
- Anker Stubberud
- Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway. .,National Advisory Unit on Headaches, Department of Neurology, St. Olavs Hospital, Trondheim, Norway.
| | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Espen Saxhaug Kristoffersen
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway.,Department of General Practice, University of Oslo, Oslo, Norway
| | - Mattias Linde
- Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway.,National Advisory Unit on Headaches, Department of Neurology, St. Olavs Hospital, Trondheim, Norway
| | - Erling Tronvik
- Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway.,National Advisory Unit on Headaches, Department of Neurology, St. Olavs Hospital, Trondheim, Norway
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Vives-Mestres M, Casanova A, Buse DC, Donoghue S, Houle TT, Lipton RB, Mian A, Shulman KJ, Orr SL. Patterns of Perceived Stress Throughout the Migraine Cycle: A Longitudinal Cohort Study Using Daily Prospective Diary Data. Headache 2020; 61:90-102. [PMID: 32918830 DOI: 10.1111/head.13943] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To describe patterns of perceived stress across stages of the migraine cycle, within and between individuals and migraine episodes as defined for this study. METHODS Individuals with migraine aged ≥18 years, who were registered to use the digital health platform N1-HeadacheTM , and completed 90 days of daily data entry regarding migraine, headache symptoms, and lifestyle factors were eligible for inclusion. Perceived stress was rated once a day at the participant's chosen time with a single question, "How stressed have you felt today?" with response options graded on a 0-10 scale. Days were categorized into phases of the migraine cycle: Ppre = pre-migraine headache (the 2 days prior to the first day with migraine headache), P0 = migraine headache days, Ppost = post-migraine headache (the 2 days following the last migraine day with migraine headache), and Pi = interictal days (all other days). Episodes, defined as discrete occurrences of migraine with days in all 4 phases, were eligible if there was at least 1 reported daily perceived stress value in each phase. Individuals with ≥5 valid episodes, and ≥75% compliance (tracking 90 days in 120 calendar days or less) were eligible for inclusion in the analysis. RESULTS Data from 351 participants and 2115 episodes were included in this analysis. Eighty-six percent of the sample (302/351) were female. The mean number of migraine days per month was 6.1 (range 2-13, standard deviation = 2.3) and the mean number of episodes was 6.0 (range 5-10, standard deviation = 1.0) over the 90-day period. Only 8 (8/351, 2.3%) participants had chronic migraine (defined as 15 or more headache days per month with at least 8 days meeting criteria for migraine). Cluster analysis revealed 3 common patterns of perceived stress variation across the migraine cycle. For cluster 1, the "let down" pattern, perceived stress in the interictal phase (Pi ) falls in the pre-headache phase (Ppre ) and then decreases more in the migraine phase (P0 ) relative to Pi . For cluster 2, the "flat" pattern, perceived stress is relatively unchanging throughout the migraine cycle. For cluster 3, the "stress as a trigger/symptom" pattern, perceived stress in Ppre increases relative to Pi , and increases further in P0 relative to Pi . Episodes were distributed across clusters as follows: cluster 1: 354/2115, 16.7%; cluster 2: 1253/2115, 59.2%, and cluster 3: 508/2115, 24.0%. Twelve participants (12/351, 3.4%) had more than 50% of their episodes fall into cluster 1, 216 participants (216/351, 61.5%) had more than 50% of their episodes fall into cluster 2, and 25 participants (25/351, 7.1%) had more than 50% of their episodes fall into cluster 3. There were 40 participants with ≥90% of their episodes in cluster 2, with no participants having ≥90% of their episodes in cluster 1 or 3. CONCLUSIONS On an aggregate level, perceived stress peaks during the pain phase of the migraine cycle. However, on an individual and episode basis, there are 3 dominant patterns of perceived stress variation across the migraine cycle. Elucidating how patterns of perceived stress vary across the migraine cycle may contribute insights into disease biology, triggers and protective factors, and provide a framework for targeting individualized treatment plans.
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Affiliation(s)
- Marina Vives-Mestres
- Curelator Inc., Cambridge, MA, USA.,Department of Computer Science and Applied Mathematics, Universitat de Girona, Girona, Spain
| | | | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Timothy T Houle
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.,Department of Anesthesia, Harvard Medical School, Boston, MA, USA
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Departments of Neurology, Psychiatry and Behavioral Sciences and Epidemiology and Population Health, Montefiore Medical Center, Bronx, NY, USA
| | | | | | - Serena L Orr
- Department of Pediatrics, Alberta Children's Hospital, Calgary, Canada.,Departments of Pediatrics, Clinical Neurosciences and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Balkaya M, Seidel JL, Sadeghian H, Qin T, Chung DY, Eikermann-Haerter K, van den Maagdenberg AMJM, Ferrari MD, Ayata C. Relief Following Chronic Stress Augments Spreading Depolarization Susceptibility in Familial Hemiplegic Migraine Mice. Neuroscience 2019; 415:1-9. [PMID: 31299346 DOI: 10.1016/j.neuroscience.2019.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 06/29/2019] [Accepted: 07/01/2019] [Indexed: 11/25/2022]
Abstract
Cortical spreading depolarization (CSD) is the electrophysiological substrate of migraine aura, and a putative trigger of trigeminovascular activation and migraine headache. Many migraineurs report stress or relief after a stress triggers an attack. We tested whether various stress conditions might modulate CSD susceptibility and whether this is dependent on genetic factors. Male and female wild type and familial hemiplegic migraine type1 (FHM1) knock-in mice heterozygous for the S218L missense mutation were subjected to acute or chronic stress, or chronic stress followed by relief (36 h). Acute stress was induced by restraint and exposure to bright light and white noise (3 h). Chronic stress was induced for 28 days by two cycles of repeated exposure of mice to a rat (7 days), physical restraint (3 days), and forced swimming (3 days). Electrical CSD threshold and KCl-induced (300 mM) CSD frequency were determined in occipital cortex in vivo at the end of each protocol. Relief after chronic stress reduced the electrical CSD threshold and increased the frequency of KCl-induced CSDs in FHM1 mutants only. Acute or chronic stress without relief did not affect CSD susceptibility in either strain. Stress status did not affect CSD propagation speed, duration or amplitude. In summary, relief after chronic stress, but not acute or chronic stress alone, augments CSD in genetically susceptible mice. Therefore, enhanced CSD susceptibility may explain why, in certain patients, migraine attacks typically occur during a period of stress relief such as weekends or holidays.
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Affiliation(s)
- Mustafa Balkaya
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Jessica L Seidel
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Homa Sadeghian
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Tao Qin
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - David Y Chung
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Katharina Eikermann-Haerter
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Arn M J M van den Maagdenberg
- Department of Neurology Leiden University Medical Center, Leiden 2300, RC, the Netherlands; Human Genetics, Leiden University Medical Center, Leiden 2300, RC, the Netherlands
| | - Michel D Ferrari
- Department of Neurology Leiden University Medical Center, Leiden 2300, RC, the Netherlands
| | - Cenk Ayata
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA.
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Drescher J, Wogenstein F, Gaul C, Kropp P, Reinel D, Siebenhaar Y, Scheidt J. Distribution of migraine attacks over the days of the week: Preliminary results from a web-based questionnaire. Acta Neurol Scand 2019; 139:340-345. [PMID: 30636039 DOI: 10.1111/ane.13065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 01/07/2019] [Accepted: 01/09/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The purpose of this work is the analysis of migraine attack reports collected online within the project Migraine Radar in respect to the distribution of the migraine attacks over the week on a single-participant level. MATERIALS & METHODS Recording data using a web app as well as smartphone apps made it possible to collect data of 44 639 migraine attacks of 1085 participants who reported seven or more attacks over a participation period of at least 90 days. This allows the investigation of attack distributions on a single-participant level. Considering the day of the week with the highest attack frequency for each participant-the mode of the individual distribution-allows identifying participants suffering from weekend migraines. Namely, a weekend pattern is assumed if the mode falls on a Saturday or Sunday. RESULTS For 15.9% of the participants, the attacks were not distributed equally (P < 0.05) over the days of the week. Instead, participants show different individual patterns for the distribution of their migraine attacks. Furthermore, the modes of the individual distributions are not distributed equally over the week. In fact, Saturday seems to be the predominant day for migraine attacks for a greater proportion of participants (195 of 1085). CONCLUSIONS Concerning the individual attack distributions, we found that participants show individual attack patterns and weekend migraine can be determined for a subgroup of participants, while other participants show accumulations of their attacks on other days of the week.
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Affiliation(s)
- Johannes Drescher
- Institute of Information Systems; University of Applied Sciences Hof; Hof Germany
- Institute of Medical Psychology and Medical Sociology; University of Rostock; Rostock Germany
| | - Florian Wogenstein
- Institute of Information Systems; University of Applied Sciences Hof; Hof Germany
- Institute of Medical Psychology and Medical Sociology; University of Rostock; Rostock Germany
| | - Charly Gaul
- Migraine and Headache Clinic Königstein; Königstein Germany
| | - Peter Kropp
- Institute of Medical Psychology and Medical Sociology; University of Rostock; Rostock Germany
| | - Dirk Reinel
- Institute of Information Systems; University of Applied Sciences Hof; Hof Germany
| | - Yannic Siebenhaar
- Institute of Information Systems; University of Applied Sciences Hof; Hof Germany
| | - Jörg Scheidt
- Institute of Information Systems; University of Applied Sciences Hof; Hof Germany
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Chen W, Shen X, Liu X, Luo B, Liu Y, Yu R, Sun G, Shen M, Wang W. Passive Paradigm Single-Tone Elicited ERPs in Tension-Type Headaches and Migraine. Cephalalgia 2016; 27:139-44. [PMID: 17257234 DOI: 10.1111/j.1468-2982.2006.01256.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The active 'oddball' event-related potential (ERP) P3 is elongated or reduced in migraine and tension-type headaches, indicating a deficit of active attention in these primary headaches. It is then reasonable to study the passive attention function in these headaches through the technology of passive paradigm singletone elicited ERPs. We invited 32 patients suffering from chronic tension-type headache (CTTH), 17 from frequent episodic tension-type headache (FETH) and 32 from interictal migraine without aura, as well as 28 healthy subjects to undergo passive paradigm single-tone ERPs. There were no statistically significant differences when the mean latencies and amplitudes of N1, P2, N2 or the mean latencies of P3 of the four groups were considered. In contrast, the P3 amplitudes were significantly reduced in the patient groups when compared with healthy controls. However, no further significant difference was found between patient groups when considering P3 amplitude. Our study demonstrated a deficit of passive attention in CTTH, FETH and migraine, but could not separate these headache types in this regard. The reduced P3 in patients might be due to the head pain experienced.
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Affiliation(s)
- W Chen
- Department of Clinical Psychology and Psychiatry, Zhejiang University, Hangzhou, China
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Martin PR. Stress and Primary Headache: Review of the Research and Clinical Management. Curr Pain Headache Rep 2016; 20:45. [DOI: 10.1007/s11916-016-0576-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Shin YW, Park HJ, Shim JY, Oh MJ, Kim M. Seasonal Variation, Cranial Autonomic Symptoms, and Functional Disability in Migraine: A Questionnaire-Based Study in Tertiary Care. Headache 2015. [DOI: 10.1111/head.12613] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yong-Won Shin
- Department of Neurology; Seoul National University Hospital; Seoul South Korea
| | - Hyun-Jung Park
- Department of Neurology; Seoul National University Hospital; Seoul South Korea
| | - Ji-Young Shim
- Department of Neurology; Seoul National University Hospital; Seoul South Korea
| | - Min-Jung Oh
- Department of Neurology; Seoul National University Hospital; Seoul South Korea
| | - Manho Kim
- Department of Neurology; Seoul National University Hospital; Seoul South Korea
- Protein Metabolism Medical & Neuroscience Research Center; College of Medicine; Seoul National University; Seoul South Korea
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Wei X, Yan J, Tillu D, Asiedu M, Weinstein N, Melemedjian O, Price T, Dussor G. Meningeal norepinephrine produces headache behaviors in rats via actions both on dural afferents and fibroblasts. Cephalalgia 2015; 35:1054-64. [PMID: 25601915 DOI: 10.1177/0333102414566861] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 12/06/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Stress is commonly reported to contribute to migraine although mechanisms by which this may occur are not fully known. The purpose of these studies was to examine whether norepinephrine (NE), the primary sympathetic efferent transmitter, acts on processes in the meninges that may contribute to the pain of migraine. METHODS NE was applied to rat dura using a behavioral model of headache. Primary cultures of rat trigeminal ganglia retrogradely labeled from the dura mater and of rat dural fibroblasts were prepared. Patch-clamp electrophysiology, Western blot, and ELISA were performed to examine the effects of NE. Conditioned media from NE-treated fibroblast cultures was applied to the dura using the behavioral headache model. RESULTS Dural injection both of NE and media from NE-stimulated fibroblasts caused cutaneous facial and hindpaw allodynia in awake rats. NE application to cultured dural afferents increased action potential firing in response to current injections. Application of NE to dural fibroblasts increased phosphorylation of ERK and caused the release of interleukin-6 (IL-6). CONCLUSIONS These data demonstrate that NE can contribute to pro-nociceptive signaling from the meninges via actions on dural afferents and dural fibroblasts. Together, these actions of NE may contribute to the headache phase of migraine.
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Affiliation(s)
- Xiaomei Wei
- Department of Pharmacology, The University of Arizona College of Medicine, USA
| | - Jin Yan
- Department of Pharmacology, The University of Arizona College of Medicine, USA
| | - Dipti Tillu
- Department of Pharmacology, The University of Arizona College of Medicine, USA
| | - Marina Asiedu
- Department of Pharmacology, The University of Arizona College of Medicine, USA School of Behavioral and Brain Sciences, The University of Texas at Dallas, USA
| | - Nicole Weinstein
- Department of Pharmacology, The University of Arizona College of Medicine, USA
| | - Ohannes Melemedjian
- Department of Pharmacology, The University of Arizona College of Medicine, USA
| | - Theodore Price
- Department of Pharmacology, The University of Arizona College of Medicine, USA School of Behavioral and Brain Sciences, The University of Texas at Dallas, USA
| | - Gregory Dussor
- Department of Pharmacology, The University of Arizona College of Medicine, USA School of Behavioral and Brain Sciences, The University of Texas at Dallas, USA
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Lipton RB, Buse DC, Hall CB, Tennen H, Defreitas TA, Borkowski TM, Grosberg BM, Haut SR. Reduction in perceived stress as a migraine trigger: testing the "let-down headache" hypothesis. Neurology 2014; 82:1395-401. [PMID: 24670889 DOI: 10.1212/wnl.0000000000000332] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To test whether level of perceived stress and reductions in levels of perceived stress (i.e., "let-down") are associated with the onset of migraine attacks in persons with migraine. METHODS Patients with migraine from a tertiary headache center were invited to participate in a 3-month electronic diary study. Participants entered data daily regarding migraine attack experience, subjective stress ratings, and other data. Stress was assessed using 2 measures: the Perceived Stress Scale and the Self-Reported Stress Scale. Logit-normal, random-effects models were used to estimate the odds ratio for migraine occurrence as a function of level of stress over several time frames. RESULTS Of 22 enrolled participants, 17 (median age 43.8 years) completed >30 days of diaries, yielding 2,011 diary entries including 110 eligible migraine attacks (median 5 attacks per person). Level of stress was not generally associated with migraine occurrence. However, decline in stress from one evening diary to the next was associated with increased migraine onset over the subsequent 6, 12, and 18 hours, with odds ratios ranging from 1.5 to 1.9 (all p values < 0.05) for the Perceived Stress Scale. Decline in stress was associated with migraine onset after controlling for level of stress for all time points. Findings were similar using the Self-Reported Stress Scale. CONCLUSIONS Reduction in stress from one day to the next is associated with migraine onset the next day. Decline in stress may be a marker for an impending migraine attack and may create opportunities for preemptive pharmacologic or behavioral interventions.
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Affiliation(s)
- Richard B Lipton
- From the Saul B. Korey Department of Neurology (R.B.L., D.C.B., C.B.H., T.A.D., T.M.B., B.M.G., S.R.H.) and Department of Epidemiology and Population Health (R.B.L., C.B.H.), Albert Einstein College of Medicine, Bronx; Montefiore Headache Center (R.B.L., D.C.B., T.A.D., B.M.G.), Bronx, NY; and Department of Community Medicine (H.T.), University of Connecticut School of Medicine, Farmington, CT
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Guidotti M, Barrilà C, Leva S, De Piazza C, Omboni S. Symptomatic or prophylactic treatment of weekend migraine: an open-label, nonrandomized, comparison study of frovatriptan versus naproxen sodium versus no therapy. Neuropsychiatr Dis Treat 2013; 9:81-5. [PMID: 23355779 PMCID: PMC3552429 DOI: 10.2147/ndt.s39373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Migraine often occurs during weekends. The efficacy of frovatriptan, naproxen sodium, or no therapy for the acute or prophylactic treatment of weekend migraineurs was tested in an open-label, nonrandomized pilot study. METHODS Twenty-eight subjects (mean age 36 ± 12 years, including 18 females) suffering from migraine without aura were followed up for six consecutive weekends. No treatment was administered during the first two weekends. On the third and fourth weekends, patients were given frovatriptan 2.5 mg and on the fifth and sixth weekends naproxen sodium 500 mg. Treatment was taken on Saturday and Sunday morning, regardless of the occurrence of migraine. Efficacy was evaluated through a diary, where patients reported the severity of migraine on a scale from 0 (no migraine) to 10 (severe migraine) and use of rescue medication. RESULTS The migraine severity score was significantly lower with frovatriptan (4.8 [95% confidence interval (CI) 3.8-5.9]) than with naproxen sodium (5.7 [CI 5.1-6.4], P< 0.05 versus frovatriptan) or no therapy (6.6 [6.2-7.0], P< 0.01 versus frovatriptan). The difference in favor of frovatriptan was more striking in patients not taking rescue medication (frovatriptan, 1.9 [1.5-2.3]) versus naproxen sodium 3.6 [3.0-4.2], P< 0.001) and versus no therapy (5.1 [4.4-5.8], P< 0.001) and on the second day of treatment. The rate of use of rescue medication was significantly (P< 0.05) lower on frovatriptan (12.5%) than on naproxen sodium (31.3%) or no therapy (56.3%). CONCLUSION This pilot study provides the first evidence of the efficacy of a second-generation triptan as symptomatic or prophylactic treatment for weekend migraine.
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12
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Epidemiology of chronic musculoskeletal pain. Best Pract Res Clin Rheumatol 2011; 25:173-83. [DOI: 10.1016/j.berh.2010.01.012] [Citation(s) in RCA: 241] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2010] [Indexed: 11/21/2022]
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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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Abstract
It is a general belief that migraine attacks are prone to occur on days off. Only a few studies, however, have addressed this issue. The objective of this study was to investigate the periodicity of migraine with respect to weekly (circaseptan) variations. Eighty-nine females of fertile age who had participated in a previous questionnaire-based study volunteered to record in detail every migraine attack for 12 consecutive months. Eighty-four patients completed recordings for a mean of 311 days (s.d. = 95.9, range 30-365). A total of 2314 attacks were recorded. Migraine occurrence was almost equally distributed during the week, except on Sundays, when there were significantly fewer attacks (t = -4.42, d.f. = 83, P < 0.001). A Mantel-Haenszel estimate of the relative risk of having an attack on a holiday vs. another day, not Sundays included, was 0.64 (95% CI 0.49-0.85). Our study suggests that days off protect against migraine.
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Affiliation(s)
- K B Alstadhaug
- Department of Neurology, Nordlandssykehuset, Bodø, Norway.
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15
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Abstract
Based on an overview of the literature, this contribution critically discusses the importance of non-alimentary trigger factors of migraine and tension-type headache. Menstruation, environmental factors, psychological effects as well as sleep disorders and fatigue are mentioned most frequently. According to controlled studies, menstruation is indubitably associated with an increased risk of headache. Although a correlation between specific meteorological parameters and the appearance of headaches was established in some patients, the subjective observations of the patients did not however correlate with the objective weather data. Sensory stimuli function as triggers particularly for migraine with aura. Psychological factors, especially stress and everyday pressures, have been confirmed as trigger factors, but further prospective trials addressing this issue would be advantageous. Additional studies are also needed to elucidate the significance of sleep (disorders) and fatigue since their importance as triggers or symptoms of a headache attack has not been conclusively determined.
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Affiliation(s)
- J Holzhammer
- Univ.-Klinik für Neurologie, Medizinische Universität Wien
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Matta APDC, Moreira Filho PF. Cefaléia do tipo tensional episódica: avaliação clínica de 50 pacientes. ARQUIVOS DE NEURO-PSIQUIATRIA 2006; 64:95-9. [PMID: 16622561 DOI: 10.1590/s0004-282x2006000100019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Com o objetivo de estudar os aspectos clínicos, a história familiar e o impacto da dor nas atividades laborativas, foi conduzido estudo de série de casos de 50 pacientes portadores de cefaléia do tipo tensional episódica (CTTE). Foram avaliados 40 mulheres e 10 homens, com idade média de 30 (±12) anos. Dor constrictiva esteve presente em 40 pacientes (80%). O enjôo foi o principal fenômeno acompanhante (20%). A dor bilateral predominou; entretanto, a localização unilateral também esteve presente (10%). Embora classicamente descrita como uma dor leve, observou-se que a CTTE pode se manifestar como crises de forte intensidade (16%). A história familiar foi positiva em 12 pacientes (24%). O impacto nas atividades laborativas foi detectado em 14% da amostra. Os achados a respeito das características da dor estão de acordo com a literatura. O impacto representado pela CTTE a nível individual e na sociedade deve, entretanto, ser reconsiderado.
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