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Burns KN, Zhao H, Master C, Langford D, Tierney R, McDevitt J. Migraine epidemiology in collegiate student-athletes: Findings from the Concussion Assessment, Research, and Education (CARE) Consortium. Headache 2024. [PMID: 39023397 DOI: 10.1111/head.14799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/04/2024] [Accepted: 05/10/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVE This cross-sectional study evaluated de-identified data from the National Collegiate Athletic Association-Department of Defense Grand Alliance from 2014 to 2020 to determine the prevalence of migraine and migraine medication and to describe differences in migraine prevalence by sex, race, and sport. BACKGROUND Epidemiological studies can help identify underdiagnosed and undertreated populations. Understanding migraine prevalence in collegiate student-athletes is essential for positive healthcare outcomes including development of prevention and treatment plans. METHODS From a concussion baseline assessment, participant's self-reported demographics (e.g., age, sex, sport), migraine diagnosis (i.e., yes/no), and migraine medication usage (e.g., yes/no, type) determined prevalence of migraine and medication use in collegiate student-athletes. RESULTS Migraine was reported in 5.6% (2617/47,060; 95% confidence interval [CI] 5.4%-5.8%) of the student-athletes, with higher prevalence in females, 7.5% (1319/17,628; 95% CI 7.1%-7.9%), than males, 4.6% (1298/28,116; 95% CI 4.4%-4.9%). Medication usage was reported by 36.2% (947/2617; 95% CI 34.3%-38.0%) of individuals with migraine. Migraine reporting differed by race, with Caucasian reporting highest (5.9%; 1990/33,913; 95% CI 5.6%-6.1%) and Asian the lowest (2.7%; 55/2027; 95% CI 2.1%-3.5%). Women's sports, including golf, gymnastics, and lacrosse, and men's diving and squash had higher migraine reporting than other sports. CONCLUSION Caucasian females reported higher rates than other groups and sport influenced rates of migraine diagnosis.
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Affiliation(s)
- Karlee N Burns
- Department of Kinesiology, Temple University, Philadelphia, Pennsylvania, USA
| | - Huaqing Zhao
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Christina Master
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dianne Langford
- Virtua Health College of Medicine & Life Sciences, Rowan University, Stratford, New Jersey, USA
| | - Ryan Tierney
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, Pennsylvania, USA
| | - Jane McDevitt
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, Pennsylvania, USA
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2
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Sharma A, Khurana P, Venkatraman A, Gupta M. Subsume Pediatric Headaches in Psychiatric Disorders? Critiques on Delphic Nosology, Diagnostic Conundrums, and Variability in the Interventions. Curr Pain Headache Rep 2024; 28:651-662. [PMID: 38367199 DOI: 10.1007/s11916-024-01225-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2024] [Indexed: 02/19/2024]
Abstract
PURPOSE OF REVIEW Tension-type headache (TTH) continues to be the most prevalent type of headache across all age groups worldwide, and the global burden of migraine and TTH together account for 7% of all-cause years lived with disability (YLDs). TTH has been shown to have a prevalence of up to 80% in several studies and presents a wide range and high variability in clinical settings. The aim of this review is to identify gaps in diagnostics, nosology, and variability in the treatment of children and adolescents who present with headaches without an identifiable etiology. RECENT FINDINGS Migraine and TTH have been debated to have more similarities than distinctions, increasing chances of misdiagnosis and leading to significant cases diagnosed as probable TTH or probable migraine. The lack of specificity and sensitivity for TTH classification often leads to the diagnosis being made by negating associated migraine symptoms. Although pathology is not well understood, some studies have suggested a neurological basis for TTH, in need of further validation. Some research indicates that nitric oxide signaling plays an integral part in the pain mechanisms related to TTH. Analgesics and non-steroidal anti-inflammatories are usually the first lines of treatment for children with recurring headaches, and additional treatment options include medication and behavioral therapies. With high prevalence and socioeconomic burden among children and adolescents, it's essential to further study Tension-type headaches and secondary headaches without known cause and potential interventions. Treatment studies involving randomized controlled trials are also needed to test the efficacy of various treatments further.
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Affiliation(s)
- Aditya Sharma
- Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA
| | - Priyal Khurana
- Department of Psychology, Christ University, Delhi, NCR, India
| | - Akila Venkatraman
- Department of Pediatric Neurology, Geisinger Health System, Danville, PA, USA
| | - Mayank Gupta
- Southwood Psychiatric Hospital, Pittsburgh, PA, USA.
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Albilali A, Al-Hashel J, Elchami Z, Al Rukn S, Al Madani AB, AlTunaiji M, Al Ali J, Fathy M, Joury J. Unmet Needs of Patients Living with Migraine in the Gulf Cooperation Council (GCC) Countries. Pain Ther 2024; 13:201-210. [PMID: 38280147 DOI: 10.1007/s40122-024-00576-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/04/2024] [Indexed: 01/29/2024] Open
Abstract
The scale of migraine and its impact on the lives of patients in the Gulf Cooperation Council (GCC) countries may be underestimated by healthcare professionals and the public and unmet needs in the provision of migraine medical care may exist. This article reports the key outcomes from a meeting of migraine specialists and their patients organised by the Emirates Neurology Society to learn more about the patient diagnosis and treatment journey and the extent to which migraine affects daily life. Patient stories indicate that the burden of migraine is underestimated, migraine is not generally recognised as a disease, delayed and incorrect diagnoses are common, and that achieving symptom control is often more a question of good luck rather than good management. Disease awareness campaigns are recommended to elevate societal understanding of migraine and reduce stigma toward patients affected by migraine. Recommendations for an improved healthcare system experience for patients affected by migraine include education initiatives targeting patients and physicians as well as initiatives to address gaps in the diagnosis and treatment of migraine.
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Affiliation(s)
- Abdulrazaq Albilali
- Neurology Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Jasem Al-Hashel
- Department of Neurology, Ibn Sina Hospital, Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Ziad Elchami
- Advanced Neuro-Musculoskeletal Care Center, Dr Samir Abbas Hospital, Jeddah, Saudi Arabia
| | - Suhail Al Rukn
- Department of Neurology, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Abu Baker Al Madani
- Department of Neurology, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | | | | | - Mohamed Fathy
- Pfizer Gulf FZ LLC, Atlas Building, Dubai Media City, P.O. Box 502749, Dubai, United Arab Emirates
| | - Jean Joury
- Pfizer Gulf FZ LLC, Atlas Building, Dubai Media City, P.O. Box 502749, Dubai, United Arab Emirates.
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Leonardi M, Martelletti P, Burstein R, Fornari A, Grazzi L, Guekht A, Lipton RB, Mitsikostas DD, Olesen J, Owolabi MO, Ruiz De la Torre E, Sacco S, Steiner TJ, Surya N, Takeshima T, Tassorelli C, Wang SJ, Wijeratne T, Yu S, Raggi A. The World Health Organization Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders and the headache revolution: from headache burden to a global action plan for headache disorders. J Headache Pain 2024; 25:4. [PMID: 38178049 PMCID: PMC10768290 DOI: 10.1186/s10194-023-01700-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/01/2023] [Indexed: 01/06/2024] Open
Abstract
The World Health Organization (WHO) Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders was developed by WHO to address the worldwide challenges and gaps in provision of care and services for people with epilepsy and other neurological disorders and to ensure a comprehensive, coordinated response across sectors to the burden of neurologic diseases and to promote brain health across life-course. Headache disorders constitute the second most burdensome of all neurological diseases after stroke, but the first if young and midlife adults are taken into account. Despite the availability of a range of treatments, disability associated with headache disorders, and with migraine, remains very high. In addition, there are inequalities between high-income and low and middle income countries in access to medical care. In line with several brain health initiatives following the WHOiGAP resolution, herein we tailor the main pillars of the action plan to headache disorders: (1) raising policy prioritization and strengthen governance; (2) providing effective, timely and responsive diagnosis, treatment and care; (3) implementing strategies for promotion and prevention; (4) fostering research and innovation and strengthen information systems. Specific targets for future policy actions are proposed. The Global Action Plan triggered a revolution in neurology, not only by increasing public awareness of brain disorders and brain health but also by boosting the number of neurologists in training, raising research funding and making neurology a public health priority for policy makers. Reducing the burden of headache disorders will not only improve the quality of life and wellbeing of people with headache but also reduce the burden of neurological disorders increasing global brain health and, thus, global population health.
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Affiliation(s)
- Matilde Leonardi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
| | | | - Rami Burstein
- John Hedley-Whyte Professor of Anesthesia and Neuroscience at the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Arianna Fornari
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Licia Grazzi
- Neuroalgology Unit and Headache Center, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Richard B Lipton
- Montefiore Headache Center and the Albert Einstein College of Medicine, New York, Bronx, USA
| | - Dimos Dimitrios Mitsikostas
- 1st Neurology Department, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Jes Olesen
- Department of Neurology, Danish Headache Center, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mayowa Ojo Owolabi
- Faculty of Clinical Sciences, Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Timothy J Steiner
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Edvard Griegs gate, Trondheim, Norway
- Department of Neurology, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
- Division of Brain Sciences, Imperial College London, London, UK
| | | | - Takao Takeshima
- Department of Neurology, Headache Center, Tominaga Hospital, Osaka, Japan
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Shuu-Jiun Wang
- College of Medicine and Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tissa Wijeratne
- Department of Neurology, Sunshine Hospital, St Albans, VIC, Australia
- Australian Institute of Migraine, Pascoe Vale South, Victoria, Australia
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
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Straburzynski M, Nowaczewska M, Czapinska-Ciepiela EK, Gryglas-Dworak A, Budrewicz S, Waliszewska-Prosół M. Sinonasal symptoms in migraine without aura: results from the cross-sectional 'Migraine in Poland' study. Front Neurol 2023; 14:1321261. [PMID: 38046593 PMCID: PMC10690933 DOI: 10.3389/fneur.2023.1321261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/03/2023] [Indexed: 12/05/2023] Open
Abstract
Background Migraine without aura (MwoA) is often mistaken for rhinosinusitis. The purpose of this study was to assess the prevalence of sinonasal symptoms, sinusitis-targeting medication use and burden of migraine in a large group of people with MwoA attacks accompanied by rhinologic symptoms. Methods Data was collected in a cross-sectional online survey based on an adapted population-based study questionnaire. The analysis included the prevalence of rhinorrhea, mucopurulent nasal discharge, nasal congestion, facial pressure and tenderness to palpation, hyposmia/anosmia and osmophobia. Results 1,679 (52.73%) MwoA people were identified among 3,225 respondents (women n = 2,809, 87.10%) aged 13-80 years (median age 39; standard deviation 10.4). 1004/1679 (59.8%) migraine patients reported one or more rhinologic symptoms and 341/1679 (20.3%) MwoA respondents had symptoms that met rhinosinusitis clinical diagnostic criteria during their headache attacks. In migraine patients, osmophobia was associated with hyposmia [n = 141 (12.7%) vs. n = 41 (7.2%); p = 0.001] and a sensation of unpleasant smells [n = 216 (19.4%) vs. n = 45 (8.5%); p = 0.001], while facial tenderness to palpation was associated with facial allodynia [n = 532 (50.4%) vs. n = 211 (33.9%); p < 0.001]. People with migraine accompanied by rhinosinusitis-like symptoms experienced more disease burden and used 'sinus medications' more often. Conclusion MwoA patients with rhinosinusitis-like symptoms during migraine attacks require cautious assessment, especially that some symptoms seem to have little value in distinguishing between these disorders (i.e., facial tenderness, hyposmia), while many of these patients have a greater disease burden and therefore often choose medications targeting rhinologic instead of neurologic mechanisms.
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Affiliation(s)
- Marcin Straburzynski
- Department of Family Medicine and Infectious Diseases, University of Warmia and Mazury, Olsztyn, Poland
| | - Magdalena Nowaczewska
- Department of Otolaryngology, Head and Neck Surgery and Laryngological Oncology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
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Juhasz G, Gecse K, Baksa D. Towards precision medicine in migraine: Recent therapeutic advances and potential biomarkers to understand heterogeneity and treatment response. Pharmacol Ther 2023; 250:108523. [PMID: 37657674 DOI: 10.1016/j.pharmthera.2023.108523] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/11/2023] [Accepted: 08/29/2023] [Indexed: 09/03/2023]
Abstract
After 35 years since the introduction of the International Classification of Headache Disorders (ICHD), we are living in the era of the second great revolution in migraine therapies. First, discoveries of triptans provided a breakthrough in acute migraine treatment utilizing bench-to-bedside research results on the role of serotonin in migraine. Next, the discovery of the role of neuropeptides, more specifically calcitonin gene-related peptide (CGRP) in migraine attack led to the development of anti-CGRP therapies that are effective both in acute and preventive treatment, and are also able to reduce migraine-related burden. Here, we reviewed the most recent clinical studies and real-world data on available migraine-specific medications, including triptans, ditants, gepants and anti-CGRP monoclonal antibodies. Novel drug targets, such as PACAP and amylins were also discussed. To address the main challenges of migraine therapy, the high heterogeneity of people with migraine, the prevalent presence of various comorbid disorders, and the insufficient medical care of migraine patients were covered. Promising novel approaches from the fields of omics, blood and saliva biomarker, imaging and provocation studies might bring solutions for these challenges with the potential to identify further drug targets, distinguish more homogeneous patient subgroups, contribute to more optimal drug selection strategies, and detect biomarkers in association with headache features or predicting treatment efficacy. In the future, the combined analysis of data of different biomarker modalities with machine learning algorithms may serve precision medicine in migraine treatment.
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Affiliation(s)
- Gabriella Juhasz
- Department of Pharmacodynamics, Faculty of Pharmaceutical Sciences, Semmelweis University, Budapest, Hungary; NAP3.0 Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary.
| | - Kinga Gecse
- Department of Pharmacodynamics, Faculty of Pharmaceutical Sciences, Semmelweis University, Budapest, Hungary; NAP3.0 Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
| | - Daniel Baksa
- Department of Pharmacodynamics, Faculty of Pharmaceutical Sciences, Semmelweis University, Budapest, Hungary; NAP3.0 Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary; Department of Personality and Clinical Psychology, Institute of Psychology, Faculty of Humanities and Social Sciences, Pazmany Peter Catholic University, Budapest, Hungary
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7
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Vaghi G, De Icco R, Tassorelli C, Goadsby PJ, Vicente-Herrero T, de la Torre ER. Who cares about migraine? Pathways and hurdles in the European region - access to care III. J Headache Pain 2023; 24:120. [PMID: 37653377 PMCID: PMC10472594 DOI: 10.1186/s10194-023-01652-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/15/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Migraine is a highly prevalent primary headache disorder and a leading cause of disability. Difficulties in access to care during diagnostic and therapeutic journey contribute to the disease burden. Several target-specific drugs have reached the market in the past four years and have modified the treatment paradigm in migraine. The aim of this study is to provide an updated snapshot of the pathways and hurdles to care for migraine in different European countries by directly asking patients. METHODS In 2021 the European Migraine and Headache Alliance proposed a 39-item questionnaire that was administered online to an adult migraine population in European countries. Questions were focused on socio-demographic and migraine data, access to diagnosis and treatment, disease-related burden and the main channel for disease information. RESULTS A total of 3169 questionnaires were returned from 10 European countries. Responders were predominantly females, age range 25-59 years, with a migraine history longer than 10 years in 82% of cases, and with at least 8 headache days per month in 57% of cases. Respondents reported limitations in social, working and personal life during both the ictal and interictal phase. The activities mostly impaired during the attacks were driving (55%), cooking or eating (42%), taking care of family/childcare (40%) and getting medicines at the pharmacy (40%). The most frequently reported unmet need was the long delay between the first visit and migraine diagnosis: 34% of respondents had to see ≥ 4 specialists before being correctly diagnosed, and between the diagnosis and treatment prescription: > 5 years in 40% of cases. The most relevant needs in terms of quality of life were the desire for a lower migraine frequency, an effective treatment and a greater involvement in society. CONCLUSIONS Data from the present survey point to the existence and persistence of multiple hurdles that result in significant limitations to access to care and to the patients' social life. A close cooperation between decision makers, healthcare workers and patients is needed to overcome these barriers.
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Affiliation(s)
- Gloria Vaghi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Roberto De Icco
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Peter J. Goadsby
- NIHR King’s Clinical Research Facility, King’s College London, London, UK
| | - Teófila Vicente-Herrero
- ADEMA-SALUD University Institute of Health Sciences-IUNICS Illes Balears, Illes Balears, Spain
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8
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Liu H, Dong M, Liu K, Jia Z, Gui W, Cheng Y, Lv Y, Qu K, Zhao H, Chen J, Zhang D, Fan Z, Yang X, Hu D, Xie H, Li M, Wen B, Chen S, Xu P, Rong Q, He Q, Ren Z, Yan F, Zhao H, Chen M, Yu T, Qu H, An X, Guo H, Zhang X, Pan X, Wang X, Qiu S, Zhang L, Zhao H, Pan X, Wan Q, Yan L, Liu J, Yu Z, Zhang M, Ran Y, Han X, Yu S, Dong Z. Status of diagnosis and preventative treatment for primary headache disorders: real-world data of unmet needs in China. J Headache Pain 2023; 24:119. [PMID: 37653478 PMCID: PMC10472552 DOI: 10.1186/s10194-023-01654-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/15/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Headache disorders are widely prevalent and pose a considerable economic burden on individuals and society. Globally, misdiagnosis and inadequate treatment of primary headache disorders remain significant challenges, impeding the effective management of such conditions. Despite advancements in headache management over the last decade, a need for comprehensive evaluations of the status of primary headache disorders in China regarding diagnosis and preventative treatments persists. METHODS In the present study, we analyzed the established queries in the Survey of Fibromyalgia Comorbidity with Headache (SEARCH), focusing on previous diagnoses and preventative treatment regimens for primary headache disorders. This cross-sectional study encompassed adults diagnosed with primary headache disorders who sought treatment at 23 hospitals across China between September 2020 to May 2021. RESULTS The study comprised 2,868 participants who were systematically examined. Migraine and tension-type headaches (TTH) constituted a majority of the primary headache disorders, accounting for 74.1% (2,124/2,868) and 23.3% (668/2,868) of the participants, respectively. Medication overuse headache (MOH) affected 8.1% (231/2,868) of individuals with primary headache disorders. Over half of the individuals with primary headache disorders (56.6%, 1,624/2,868) remained undiagnosed. The previously correct diagnosis rates for migraine, TTH, TACs, and MOH were 27.3% (580/2,124), 8.1% (54/668), 23.2% (13/56), and 3.5% (8/231), respectively. The misdiagnosis of "Nervous headache" was found to be the most prevalent among individuals with migraine (9.9%, 211/2,124), TTH (10.0%, 67/668), trigeminal autonomic cephalalgias (TACs) (17.9%, 10/56), and other primary headache disorders (10.0%, 2/20) respectively. Only a minor proportion of individuals with migraine (16.5%, 77/468) and TTH (4.7%, 2/43) had received preventive medication before participating in the study. CONCLUSIONS While there has been progress made in the rate of correct diagnosis of primary headache disorders in China compared to a decade ago, the prevalence of misdiagnosis and inadequate treatment of primary headaches remains a veritable issue. As such, focused efforts are essential to augment the diagnosis and preventive treatment measures related to primary headache disorders in the future.
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Affiliation(s)
- Huanxian Liu
- Department of Neurology, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- International Headache Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Ming Dong
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin, 130021, China
| | - Kaiming Liu
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, 310009, China
| | - Zhihua Jia
- Department of Neurology, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- International Headache Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Wei Gui
- Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Lujiang Road 17, Hefei, 230001, China
| | - Yingying Cheng
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin, 130021, China
| | - Yudan Lv
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin, 130021, China
| | - Kang Qu
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Jilin, 130021, China
| | - Hongru Zhao
- Department of Neurology, The First Affiliated Hospital of Soochow University, Jiangsu, 215006, China
| | - Jianjun Chen
- Department of Neurology, Lishui Municipal Central Hospital, Zhejiang, 323000, China
| | - Dan Zhang
- Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang, 310020, China
| | - Zhiliang Fan
- Department of Neurology, Xing Tai People's Hospital, Hebei, 054001, China
| | - Xiaosu Yang
- Department of Neurology, Xiangya Hospital, Central South University, Hunan, 410013, China
| | - Dongmei Hu
- Department of Neurology, The Second Affiliated Hospital of Shandong First Medical University, Shandong, 271000, China
| | - Hongyan Xie
- Department of Neurology, The Second Affiliated Hospital of Shandong First Medical University, Shandong, 271000, China
| | - Mingxin Li
- Department of Neurology, Qilu Hospital, Shandong, 250012, China
| | - Bing Wen
- Department of Neurology, Qilu Hospital, Shandong, 250012, China
| | - Sufen Chen
- Department of Neurology, Changsha Central Hospital Affiliated to the University of South China, Hunan, 410004, China
| | - Peng Xu
- Department of Neurology, Affiliated Hospital of Jining Medical University, Shandong, 272000, China
| | - Qingqing Rong
- Department of Neurology, Affiliated Hospital of Jining Medical University, Shandong, 272000, China
| | - Qiu He
- Department of Neurology, The People's Hospital of Liaoning Province, Liaoning, 110016, China
| | - Zhanxiu Ren
- Department of Neurology, The People's Hospital of Liaoning Province, Liaoning, 110016, China
| | - Fanhong Yan
- Department of Neurology, Linyi Jinluo Hospital, Shandong, 276036, China
| | - Heling Zhao
- Department of Neurology, Linyi Jinluo Hospital, Shandong, 276036, China
| | - Min Chen
- Department of Neurology, Zhengzhou University First Affiliated Hospital, Henan, 450052, China
| | - Tingmin Yu
- Department of Neurology, The Second Hospital of Jilin University, Jilin, 130041, China
| | - Hongli Qu
- Department of Neurology, The First Affiliated Hospital of Xiamen University, Jilin, 130041, China
| | - Xingkai An
- Department of Neurology, The First Affiliated Hospital of Xiamen University, Jilin, 130041, China
| | - Huailian Guo
- Department of Neurology, People's Hospital, Peking University, Beijing, 100044, China
| | - Xinhua Zhang
- Department of Neurology, People's Hospital, Peking University, Beijing, 100044, China
| | - Xiaoping Pan
- Department of Neurology, Guangzhou First People's Hospital, Guangdong, 510180, China
| | - Xiaojuan Wang
- Department of Neurology, Guangzhou First People's Hospital, Guangdong, 510180, China
| | - Shi Qiu
- Department of Neurology, Aerospace Center Hospital, Beijing, 100049, China
| | - Lvming Zhang
- Department of Neurology, Aerospace Center Hospital, Beijing, 100049, China
| | - Hongling Zhao
- Department of Neurology, Da Lian Municipal Central Hospital, Liaoning, 116033, China
| | - Xin Pan
- Department of Neurology, Da Lian Municipal Central Hospital, Liaoning, 116033, China
| | - Qi Wan
- Department of Neurology, Jiangsu Province Hospital, Jiangsu, 210029, China
| | - Lanyun Yan
- Department of Neurology, Jiangsu Province Hospital, Jiangsu, 210029, China
| | - Jing Liu
- Department of Neurology, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- International Headache Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Zhe Yu
- Department of Neurology, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- International Headache Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Mingjie Zhang
- Department of Neurology, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- International Headache Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Ye Ran
- Department of Neurology, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- International Headache Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Xun Han
- Department of Neurology, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- International Headache Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Shengyuan Yu
- Department of Neurology, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
- International Headache Center, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Zhao Dong
- Department of Neurology, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
- International Headache Center, Chinese PLA General Hospital, Beijing, 100853, China.
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9
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Prakash S, Rana K. Indian Version of ID-Migraine Questionnaire. Ann Indian Acad Neurol 2023; 26:373. [PMID: 37970310 PMCID: PMC10645228 DOI: 10.4103/aian.aian_376_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 05/01/2023] [Indexed: 11/17/2023] Open
Affiliation(s)
- Sanjay Prakash
- Department of Neurology, Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| | - Kaushik Rana
- Department of Neurology, Smt. B. K. Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
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10
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Ali Z, Humaidan H. Assessment of Knowledge, Attitude, and Practice Towards Migraine Among the General Population in the Kingdom of Bahrain. Cureus 2023; 15:e40928. [PMID: 37496548 PMCID: PMC10368191 DOI: 10.7759/cureus.40928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 07/28/2023] Open
Abstract
OBJECTIVE The primary objective of this research is to assess the general population's knowledge, attitude, and practice towards migraine. METHOD A cross-sectional study was conducted on a total sample of 255 participants. The data were obtained from a self-administered electronic questionnaire (Appendix) distributed through social media. Data analysis was done using the IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp. For statistics, frequency, percentage, median, and standard deviation were calculated. Results: Among the Bahraini population, knowledge about migraine definition, triggers, risk factors, symptoms, and treatment is satisfactory. However, knowledge about migraine prophylaxis is limited. Attitude and practice towards the disease showed adequate responses among the population, as they prefer consulting a doctor and believe that lifestyle modification is the best migraine treatment. CONCLUSION The general population of the Kingdom of Bahrain needs more awareness regarding migraine. Although the majority of the population showed good responses, which displayed some knowledge of the disease, community-based campaigns are still needed.
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Affiliation(s)
- Zainab Ali
- General Practice, Royal College of Surgeons in Ireland, Medical University of Bahrain, Busaiteen, BHR
| | - Hani Humaidan
- Neurology, Clinical Neurosciences, Salmaniya Medical Complex, Manama, BHR
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11
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Do TP, Andreou AP, de Oliveira AB, Shapiro RE, Lampl C, Amin FM. The increasing role of electronic media in headache. BMC Neurol 2023; 23:194. [PMID: 37198539 DOI: 10.1186/s12883-023-03196-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/03/2023] [Indexed: 05/19/2023] Open
Abstract
Most individuals with access to the internet use social media platforms. These platforms represent an excellent opportunity to disseminate knowledge about management and treatment to the benefit of patients. The International Headache Society, The European Headache Federation, and The American Headache Society have electronic media committees to promote and highlight the organizations' expertise and disseminate research findings. A growing mistrust in science has made dealing with infodemics (i.e., sudden access to excessive unvetted information) an increasing part of clinical management. An increasing role of these committees will be to address this challenge. As an example, recent studies have demonstrated that the most popular online content on migraine management is not evidence-based and is disseminated by for-profit organizations. As healthcare professionals and members of professional headache organizations, we are obliged to prioritize knowledge dissemination. A progressive social media strategy is associated not only with increased online visibility and outreach, but also with a higher scientific interest. To identify gaps and barriers, future research should assess the range of available information on headache disorders in electronic media, characterize direct and indirect consequences on clinical management, and recognize best practice and strategies to improve our communication on internet-based communication platforms. In turn, these efforts will reduce the burden of headache disorders by facilitating improved education of both patients and providers.
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Affiliation(s)
- Thien Phu Do
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Danish Knowledge Center on Headache Disorders, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anna P Andreou
- Headache Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Headache Research, Wolfson CARD, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Arao Belitardo de Oliveira
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo - USP, São Paulo, Brazil
| | - Robert E Shapiro
- Department of Neurological Sciences, Larner College of Medicine, University of Vermont, Burlington, VT, 05401-3456, USA
| | - Christian Lampl
- Department of Neurology, Headache Medical Center, Koventhopsital Barmherzige Brüder Linz, Linz, Austria
- Department of Geriatric Medicine, Ordensklinikum Linz, Linz, Austria
| | - Faisal Mohammad Amin
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Department of Brain and Spinal Cord Injury, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
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12
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Waliszewska-Prosół M, Straburzyński M, Czapińska-Ciepiela EK, Nowaczewska M, Gryglas-Dworak A, Budrewicz S. Migraine symptoms, healthcare resources utilization and disease burden in a large Polish migraine cohort : Results from 'Migraine in Poland'-a nationwide cross-sectional survey. J Headache Pain 2023; 24:40. [PMID: 37041492 PMCID: PMC10091674 DOI: 10.1186/s10194-023-01575-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/03/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND The Migraine in Poland study is the first large scale nationwide cross-sectional online survey of symptoms, approaches to management, treatment patterns, quality of life, and sociodemographic characteristics of the Polish migraine patients' cohort, conducted from August 2021 to June 2022. METHODS A cross-sectional online survey was designed based on the American Migraine Prevalence and Prevention (AMPP) Study. Participants were recruited through broad advertisement through various channels. The survey included questions allowing for the diagnosis of migraine without aura (MwoA) based on the third edition of the International Classification of Headache Disorders (ICHD-3). Moreover, the questionnaire assessed sociodemographic and headache features, comorbidities, consultation rates with medical professionals, as well as the use of abortive or preventive treatment, including non-pharmacological methods, psychological symptoms and the burden of migraine. RESULTS A structured online questionnaire was submitted by 3225 respondents aged 13 to 80 (mean age 38.9, 87.1% women). In this group 1679 (52.7%) of participants fulfilled ICHD-3 diagnostic criteria for MwoA, which was in most cases (88.3%) confirmed by a medical professional in the past. In this group the average number of monthly headache days was 4.7, while 47.8% of participants had at least 4 migraine days per month. Mean Migraine Disability Assessment score was 42.65 (median 32). Among MwoA respondents, 1571 (93.6%) had consulted their headache with a medical professional in the past - mostly neurologists (n = 1450 (83.4%) and primary care physicians (n = 1393 (82.9%). In the MwoA cohort, 1553 (92.5%) of participants declared the current use of some form of treatment, although only 193 (11.5%) respondents were currently on preventive medications. The most prevalent comorbidities included: chronic rhinitis (37.1%), allergies (35.9%) and low blood pressure (26.9%). Anxiety (20.4%) and depression (21.3%) were highly prevalent among participants. CONCLUSIONS People with migraine in Poland face similar difficulties as their peers in other countries. Despite relatively high access to neurologist consultations and good diagnosis accuracy, migraine still poses diagnostic and therapeutic difficulties. In this context, migraine undertreatment in Polish population must be underlined, especially in context of high disease burden.
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Affiliation(s)
- Marta Waliszewska-Prosół
- Department of Neurology, Wrocław Medical University, Borowska 213 Str., 50-556, Wrocław, Poland.
| | - Marcin Straburzyński
- Department of Family Medicine and Infectious Diseases, University of Warmia and Mazury, Olsztyn, Poland
| | | | - Magdalena Nowaczewska
- Department of Otolaryngology, Head and Neck Surgery and Laryngological Oncology, LudwikRydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | | | - Sławomir Budrewicz
- Department of Neurology, Wrocław Medical University, Borowska 213 Str., 50-556, Wrocław, Poland
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13
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Gou C, Yang S, Hou Q, Rudder P, Tanglay O, Young I, Peng T, He W, Yang L, Osipowicz K, Doyen S, Mansouri N, Sughrue ME, Wang X. Functional connectivity of the language area in migraine: a preliminary classification model. BMC Neurol 2023; 23:142. [PMID: 37016325 PMCID: PMC10071619 DOI: 10.1186/s12883-023-03183-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/25/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Migraine is a complex disorder characterized by debilitating headaches. Despite its prevalence, its pathophysiology remains unknown, with subsequent gaps in diagnosis and treatment. We combined machine learning with connectivity analysis and applied a whole-brain network approach to identify potential targets for migraine diagnosis and treatment. METHODS Baseline anatomical T1 magnetic resonance imaging (MRI), resting-state functional MRI(rfMRI), and diffusion weighted scans were obtained from 31 patients with migraine, and 17 controls. A recently developed machine learning technique, Hollow Tree Super (HoTS) was used to classify subjects into diagnostic groups based on functional connectivity (FC) and derive networks and parcels contributing to the model. PageRank centrality analysis was also performed on the structural connectome to identify changes in hubness. RESULTS Our model attained an area under the receiver operating characteristic curve (AUC-ROC) of 0.68, which rose to 0.86 following hyperparameter tuning. FC of the language network was most predictive of the model's classification, though patients with migraine also demonstrated differences in the accessory language, visual and medial temporal regions. Several analogous regions in the right hemisphere demonstrated changes in PageRank centrality, suggesting possible compensation. CONCLUSIONS Although our small sample size demands caution, our preliminary findings demonstrate the utility of our method in providing a network-based perspective to diagnosis and treatment of migraine.
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Affiliation(s)
- Chen Gou
- Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, 637000, China
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Shuangfeng Yang
- Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, 637000, China
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Qianmei Hou
- Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, 637000, China
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Peter Rudder
- Omniscient Neurotechnology, Sydney, NSW, 2000, Australia
| | - Onur Tanglay
- Omniscient Neurotechnology, Sydney, NSW, 2000, Australia
| | - Isabella Young
- Omniscient Neurotechnology, Sydney, NSW, 2000, Australia
| | - Tingting Peng
- Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, 637000, China
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Weiwei He
- Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, 637000, China
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Liuyi Yang
- Shenzhen Xijia Medical Technology Company, Shenzhen, Guangdong Province, 518052, China
| | | | - Stephane Doyen
- Omniscient Neurotechnology, Sydney, NSW, 2000, Australia
| | - Negar Mansouri
- Omniscient Neurotechnology, Sydney, NSW, 2000, Australia
| | | | - Xiaoming Wang
- Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, 637000, China.
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China.
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14
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Testing the Decision Support Tool for Responsible Pain Management for Headache and Facial Pain Diagnosis with Opioid-Risk-Stratified Treatment. SN COMPREHENSIVE CLINICAL MEDICINE 2023; 5:91. [PMID: 36872955 PMCID: PMC9969375 DOI: 10.1007/s42399-023-01423-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 03/03/2023]
Abstract
In primary and urgent care, headache and facial pain are common and challenging to diagnose and manage, especially with using opioids appropriately. We therefore developed the Decision Support Tool for Responsible Pain Management (DS-RPM) to assist healthcare providers in diagnosis (including multiple simultaneous diagnoses), workup (including triage), and opioid-risk-informed treatment. A primary goal was to supply sufficient explanations of DS-RPM's functions allowing critique. We describe the process of iteratively designing DS-RPM adding clinical content and testing/defect discovery. We tested DS-RPM remotely with 21 clinician-participants using three vignettes-cluster headache, migraine, and temporal arteritis-after first training to use DS-RPM with a trigeminal-neuralgia vignette. Their evaluation was both quantitative (usability/acceptability) and qualitative using semi-structured interviews. The quantitative evaluation used 12 Likert-type questions on a 1-5 scale, where 5 represented the highest rating. The mean ratings ranged from 4.48 to 4.95 (SDs ranging 0.22-1.03). Participants initially found structured data entry intimidating but adapted and appreciated its comprehensiveness and speed of data capture. They perceived DS-RPM as useful for teaching and clinical practice, making several enhancement suggestions. The DS-RPM was designed, created, and tested to facilitate best practice in management of patients with headaches and facial pain. Testing the DS-RPM with vignettes showed strong functionality and high usability/acceptability ratings from healthcare providers. Risk stratifying for opioid use disorder to develop a treatment plan for headache and facial pain is possible using vignettes. During testing, we considered the need to adapt usability/acceptability evaluation tools for clinical decision support, and future directions.
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15
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Muacevic A, Adler JR, Madabushi J. Off-Label Cyproheptadine in Children and Adolescents: Psychiatric Comorbidities, Interacting Variables, Safety, and Risks of Hepatotoxicity. Cureus 2023; 15:e33745. [PMID: 36788882 PMCID: PMC9922522 DOI: 10.7759/cureus.33745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 01/15/2023] Open
Abstract
Cyproheptadine is a widely prescribed first-generation antihistamine, and due to its unique chemical structure, it has a popular off-label choice for a range of clinical conditions. Its efficacy is widely debated in the literature, but there are reports of hepatotoxicity as a rare adverse effect. Its benefits in migraine prophylaxis and appetite stimulation also underscore a highly overlapping clinical pathway that requires additional assessment and evaluation. The evidence suggests a baseline metabolic profile before initiation and assessment for co-occurring mental health conditions may improve overall response with evidence-based mental health interventions.
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16
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Peles I, Asla M, Abayev M, Gordon M, Novack V, Ribalov R, Lengil T, Maor R, Elizur M, Ifergane G. Migraine epidemiology and comorbidities in Southern Israel: a clinical database study in a universal health coverage setting. J Headache Pain 2022; 23:160. [PMID: 36517741 PMCID: PMC9749247 DOI: 10.1186/s10194-022-01513-w] [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: 06/07/2022] [Accepted: 10/27/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Understanding migraine epidemiology and its burden is crucial for planning health policies and interventions at the local level as well as at the global level. National policies in Israel rely on global estimations and not on local data since local epidemiologic studies had not previously been performed. In this study, we evaluated the epidemiology of migraine in the southern district of Israel using the electronic medical records database of the largest Israeli health maintenance organization (HMO). METHODS In this population-based, retrospective, observational cohort study, adult migraine patients were identified in the computerized database of the southern district of the Clalit Health Services HMO (total population, 0.75 million). Patients were identified based on recorded diagnosis (International Classification of Diseases, Ninth Revision) and/or claims for specific anti-migraine medication (triptans) between 2000 and 2018. A 1:2 age-, gender-, and primary care clinic-matched control group was used for evaluation of comorbidities. RESULTS In 2018, a total of 29,938 patients with migraine were identified out of 391,528 adult HMO members. Most of the patients were women (75.8%), and the mean ± standard deviation age at diagnosis was 36.94 ± 13.61 years. The overall prevalence of migraine (per 10,000) was 764.64 (7.65%), 1143.34 (11.43%) for women and 374.97 (3.75%) for men. The highest prevalence was observed in patients aged 50 to 60 years and 40 to 50 years (1143.98 [11.44%] and 1019.36 [10.19%], respectively), and the lowest prevalence was among patients aged 18 to 30 years and > 70 years (433.45 [4.33%] and 398.49 [3.98%], respectively). CONCLUSIONS This is the first large-scale epidemiologic study of migraine prevalence in Israel. Compared to international estimations, migraine appears to be underdiagnosed in the southern district of Israel.
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Affiliation(s)
- Ido Peles
- grid.7489.20000 0004 1937 0511Clinical Research Center, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Mohnnad Asla
- grid.7489.20000 0004 1937 0511Department of Neurology, Brain Medicine Division, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Mariya Abayev
- grid.7489.20000 0004 1937 0511Clinical Research Center, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Michal Gordon
- grid.7489.20000 0004 1937 0511Clinical Research Center, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Victor Novack
- grid.7489.20000 0004 1937 0511Clinical Research Center, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel ,grid.7489.20000 0004 1937 0511Internal Medicine Division, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Rinat Ribalov
- grid.452797.a0000 0001 2189 710XTeva Pharmaceuticals Industries Ltd, Tel Aviv, Israel
| | - Tamar Lengil
- grid.452797.a0000 0001 2189 710XTeva Pharmaceuticals Industries Ltd, Tel Aviv, Israel
| | - Ron Maor
- grid.452797.a0000 0001 2189 710XTeva Pharmaceuticals Industries Ltd, Tel Aviv, Israel
| | - Mayera Elizur
- grid.452797.a0000 0001 2189 710XTeva Pharmaceuticals Industries Ltd, Tel Aviv, Israel
| | - Gal Ifergane
- grid.7489.20000 0004 1937 0511Department of Neurology, Brain Medicine Division, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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17
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Atherton K, Forshaw MJ, Kidd TM. Readability of online health information pertaining to migraine and headache in the UK. Br J Pain 2022; 17:117-125. [PMID: 37057254 PMCID: PMC10088424 DOI: 10.1177/20494637221134461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
An estimated 46% of the worldwide adult population live with an active headache disorder, and it is thought that there is a proportion of headache and migraine sufferers who do not attend for medical care, instead choosing to manage their symptoms at home. The internet continues to act as a source of online health information for self-management, however, it is important that this information can be understood by the user. Research indicates that most health information online is written at a level too difficult for much of the UK population to understand. The aim of this study was to investigate the readability of online health information pertaining to headache and migraine for a UK-based internet user accessing the top four search engines. Searches for ‘headache’ and ‘migraine’ were performed on each search engine and results from the first page were selected for analysis. Five validated readability tests were used to analyse readability; Flesch-Kincaid Grade Level, Flesch Reading Ease, Gunning Fog Index, Coleman-Liau Index and Simple Measure of Gobbledygook Index. We found that the majority of online health information about migraine and headache is too difficult for the UK adult population to read. Findings highlight work is required to ensure that information from a wider variety of sources is easier to comprehend for much of the population in order for individuals to make informed decisions about health seeking and self-management of headache and migraine. Health information providers should weave readability analysis into their content design process, incorporating shorter sentences and simpler words in their description of conditions and treatment.
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Affiliation(s)
- Kate Atherton
- School of Psychology, Liverpool John Moores University, UK
| | | | - Tara M. Kidd
- School of Psychology, Liverpool John Moores University, UK
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18
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Tana C, Bentivegna E, Cho SJ, Harriott AM, García-Azorín D, Labastida-Ramirez A, Ornello R, Raffaelli B, Beltrán ER, Ruscheweyh R, Martelletti P. Long COVID headache. J Headache Pain 2022; 23:93. [PMID: 35915417 PMCID: PMC9340759 DOI: 10.1186/s10194-022-01450-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 06/28/2022] [Indexed: 02/07/2023] Open
Abstract
Headache is among the most frequent symptoms persisting or newly developing after coronavirus disease 2019 (COVID-19) as part of the so-called long COVID syndrome. The knowledge on long COVID headache is still limited, however growing evidence is defining the features of this novel condition, in particular regarding clinical characteristics, some pathophysiological mechanisms and first treatment recommendations. Long COVID headache can present in the form of worsening of a preexisting primary headache, or, more specifically, in the form of a new (intermittent or daily) headache starting during the acute infection or after a delay. It often presents together with other long COVID symptoms, most frequently with hyposmia. It can manifest with a migrainous or, more frequently, with a tension-type-like phenotype. Persistent activation of the immune system and trigeminovascular activation are thought to play a role. As there are virtually no treatment studies, treatment currently is largely guided by the existing guidelines for primary headaches with the corresponding phenotype. The present report, a collaborative work of the international group of the Junior Editorial Board of The Journal of Headache and Pain aims to summarize the most recent evidence about long COVID headache and suggests approaches to the diagnosis and treatment of this disorder.
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Affiliation(s)
- Claudio Tana
- Center of Excellence On Headache, Geriatrics and COVID-19 Clinic, SS Annunziata Hospital of Chieti, 66100, Chieti, Italy.
| | - Enrico Bentivegna
- Internal Medicine and Emergency Medicine, Sant' Andrea Hospital, Sapienza University, Rome, Italy
| | - Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
| | - Andrea M Harriott
- Headache and Neuropathic Pain Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David García-Azorín
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Alejandro Labastida-Ramirez
- Headache Group, Wolfson Center for Age Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Raffaele Ornello
- Departement of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Bianca Raffaelli
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Eloísa Rubio Beltrán
- Headache Group, Wolfson Center for Age Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ruth Ruscheweyh
- Department of Neurology, Ludwig Maximilians University, Munich, Germany.,German Migraine and Headache Society, Frankfurt, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Munich, Germany
| | - Paolo Martelletti
- Internal Medicine and Emergency Medicine, Sant' Andrea Hospital, Sapienza University, Rome, Italy
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19
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Do TP, Stefansen S, Dømgaard M, Steiner TJ, Ashina M. One-quarter of individuals with weekly headache have never consulted a medical doctor: a Danish nationwide cross-sectional survey. J Headache Pain 2022; 23:84. [PMID: 35850614 PMCID: PMC9295511 DOI: 10.1186/s10194-022-01460-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Large numbers of people with headache who would benefit are not reached by headache services. Among the causes are poor or disorganized provision of headache services, but reluctance to seek healthcare has frequently been identified as a significant barrier. We conducted a national survey of people with headache to assess the extent of this problem in Denmark, a country with well organized, highly resourced, and readily accessible services. METHODS We conducted a nationwide cross-sectional survey of adults ≥ 18 years old in Denmark reporting at least one headache day in the last year. We used social media (Facebook) to publicize and drive a recruitment campaign. The survey investigated five items: (1) disease burden, (2) social life, (3) presenteeism, (4) social support, and (5) healthcare utilization. RESULTS We included 6,567 respondents from May 2021 to June 2021; 70.2% were female, 39.8% male, and mean age was 43.2 ± 13.4 years. Of the respondents, 54.2% reported headache at least once a week, 33.4% reported headache a couple of times a month, and 12.4% reported headache a couple of times a year. Two-thirds of respondents (66.6%) reported that headache limited their social lives occasionally or frequently. Most respondents (86.8%) reported going to work or attending educational activities occasionally or more frequently even though they had headache. Half of the respondents (49.5%) experienced lack of understanding of their headaches from people occasionally or more frequently. Almost half of respondents (43.7%) had never consulted a medical doctor for their headache; even of those with weekly headache, more than a quarter (28.3%) had never done so in their lifetimes. CONCLUSIONS Headache disorders continue to be a problem, even in a high-income country with free and easily accessible headache services. Further studies are needed to investigate and clarify why even people with the highest burden are hesitant to seek and make use of widely available headache services.
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Affiliation(s)
- Thien Phu Do
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Danish Knowledge Center On Headache Disorders, Rigshospitalet Glostrup, Valdemar Hansens Vej 2, 2600, Glostrup, Denmark
| | - Simon Stefansen
- Danish Knowledge Center On Headache Disorders, Rigshospitalet Glostrup, Valdemar Hansens Vej 2, 2600, Glostrup, Denmark
| | - Mikala Dømgaard
- Danish Knowledge Center On Headache Disorders, Rigshospitalet Glostrup, Valdemar Hansens Vej 2, 2600, Glostrup, Denmark
| | - Timothy J Steiner
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Division of Brain Sciences, Imperial College London, London, UK
| | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. .,Danish Knowledge Center On Headache Disorders, Rigshospitalet Glostrup, Valdemar Hansens Vej 2, 2600, Glostrup, Denmark.
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20
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Magnavita N. Headache in the Workplace: Analysis of Factors Influencing Headaches in Terms of Productivity and Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063712. [PMID: 35329399 PMCID: PMC8953285 DOI: 10.3390/ijerph19063712] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 12/15/2022]
Abstract
Headache is a very common condition that can have a significant impact on work. This study aimed to assess the prevalence of headaches and their impact on a sample of 1076 workers from 18 small companies operating in different sectors. The workers who volunteered to participate were asked to fill in the Headache Impact Test-6 (HIT-6) and answer questions designed to assess stressful and traumatic factors potentially associated with headaches. The volunteers subsequently underwent a medical examination and tests for diagnosing metabolic syndrome. Out of the 1044 workers who completed the questionnaire (participation rate = 97%), 509 (48.8%) reported suffering from headaches. In a multivariate logistic regression model, female gender, recent bereavement, intrusive leadership, and sleep problems were significantly associated with headaches. In univariate logistic regression models, headache intensity was associated with an increased risk of anxiety (OR 1.10; CI95% 1.09; 1.12) and depression (OR 1.09; CI95% 1.08; 1.11). Headache impact was also associated with the risk of metabolic syndrome (OR 1.02; CI95% 1.00, 1.04), obesity (OR 1.02, CI95% 1.01; 1.03), and reduced HDL cholesterol (OR 1.03; CI95% 1.01; 1.04). The impact of headache calls for intervention in the workplace not only to promote a prompt diagnosis of the different forms of headaches but also to improve work organization, leadership style, and the quality of sleep.
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Affiliation(s)
- Nicola Magnavita
- Postgraduate School of Occupational Health, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Roma, Italy;
- Department of Science of Woman, Child and Public Health, A. Gemelli Foundation IRCCS, Largo A. Gemelli 8, 00168 Roma, Italy
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21
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Abo El-Enin HA, Mostafa RE, Ahmed MF, Naguib IA, A. Abdelgawad M, Ghoneim MM, Abdou EM. Assessment of Nasal-Brain-Targeting Efficiency of New Developed Mucoadhesive Emulsomes Encapsulating an Anti-Migraine Drug for Effective Treatment of One of the Major Psychiatric Disorders Symptoms. Pharmaceutics 2022; 14:pharmaceutics14020410. [PMID: 35214142 PMCID: PMC8874718 DOI: 10.3390/pharmaceutics14020410] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/05/2022] [Accepted: 02/08/2022] [Indexed: 12/04/2022] Open
Abstract
Migraine is one of the major symptoms of many psychiatric and mental disorders like depression and anxiety. Eletriptan Hydrobromide (EH) is a well-tolerated drug in migraine treatment, but suffers from low oral bioavailability and low brain targeting after oral delivery. New nasal mucoadhesive EH-emulsomes development could be a new means to direct the drug from the nose-to-brain to achieve rapid onset of action and high drug concentration in the brain for acute migraine treatment. Eletriptan mucoadhesive emulsomes formulations were prepared using thin-film hydration method and 23 full factorial design was adopted to study different formulation factors’ effect on the emulsomes characters. The emulsomes were characterized for entrapment efficiency (EE%), zeta potential (ZP), particle size (PS), morphology, and ex-vivo permeation through the nasal mucosa. The selected formula was evaluated in mice for its in-vivo bio-distribution in comparison with EH intranasal and intravenous solutions. Drug targeting efficacy (DTE%) and nose-to-brain direct transport percentage (DTP%) were calculated. The optimization formulation showed a nanoparticle size of 177.01 nm, EE 79.44%, and ZP = 32.12 ± 3.28 mV. In addition, in-vitro permeability studies revealed enhanced drug permeability with suitable mean residence time up to 120 ± 13 min. EH-emulsomes were stable under different storage conditions for three months. In vivo examination and pharmacokinetic drug targeting parameters revealed EH transport to the CNS after EH nanoparticle nasal administration. Histopathology study showed no ciliotoxic effect on the nasal mucosa. From the results, it can be confirmed that the emulsomes formulation of EH proved safe direct nose-to-brain transport of EH after nasal administration of EH emulsomes.
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Affiliation(s)
- Hadel A. Abo El-Enin
- Department of Pharmaceutics, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia;
| | - Rasha E. Mostafa
- Pharmacology Department, Medical Research and Clinical Studies Institute, National Research Centre, Giza 12622, Egypt;
| | - Marwa F. Ahmed
- Department of Pharmaceutical Chemistry, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia;
- Correspondence: (M.F.A.); (M.A.A.)
| | - Ibrahim A. Naguib
- Department of Pharmaceutical Chemistry, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia;
| | - Mohamed A. Abdelgawad
- Department of Pharmaceutical Chemistry, College of Pharmacy, Jouf University, Sakaka 72341, Saudi Arabia
- Correspondence: (M.F.A.); (M.A.A.)
| | - Mohammed M. Ghoneim
- Department of Pharmacy Practice, Faculty of Pharmacy, AlMaarefa University, Ad Diriyah 13713, Saudi Arabia;
| | - Ebtsam M. Abdou
- Department of Pharmaceutics, National Organization of Drug Control and Research (NODCAR), Giza 12622, Egypt;
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22
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Woldeamanuel YW, Cowan RP. Computerized migraine diagnostic tools: a systematic review. Ther Adv Chronic Dis 2022; 13:20406223211065235. [PMID: 35096362 PMCID: PMC8793115 DOI: 10.1177/20406223211065235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/18/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Computerized migraine diagnostic tools have been developed and validated since 1960. We conducted a systematic review to summarize and critically appraise the quality of all published studies involving computerized migraine diagnostic tools. METHODS We performed a systematic literature search using PubMed, Web of Science, Scopus, snowballing, and citation searching. Cutoff date for search was 1 June 2021. Published articles in English that evaluated a computerized/automated migraine diagnostic tool were included. The following summarized each study: publication year, digital tool name, development basis, sample size, sensitivity, specificity, reference diagnosis, strength, and limitations. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool was applied to evaluate the quality of included studies in terms of risk of bias and concern of applicability. RESULTS A total of 41 studies (median sample size: 288 participants, median age = 43 years; 77% women) were included. Most (60%) tools were developed based on International Classification of Headache Disorders criteria, half were self-administered, and 82% were evaluated using face-to-face interviews as reference diagnosis. Some of the automated algorithms and machine learning programs involved case-based reasoning, deep learning, classifier ensemble, ant-colony, artificial immune, random forest, white and black box combinations, and hybrid fuzzy expert systems. The median diagnostic accuracy was concordance = 89% [interquartile range (IQR) = 76-93%; range = 45-100%], sensitivity = 87% (IQR = 80-95%; range = 14-100%), and specificity = 90% (IQR = 77-96%; range = 65-100%). Lack of random patient sampling was observed in 95% of studies. Case-control designs were avoided in all studies. Most (76%) reference tests exhibited low risk of bias and low concern of applicability. Patient flow and timing showed low risk of bias in 83%. CONCLUSION Different computerized and automated migraine diagnostic tools are available with varying accuracies. Random patient sampling, head-to-head comparison among tools, and generalizability to other headache diagnoses may improve their utility.
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Affiliation(s)
- Yohannes W. Woldeamanuel
- Division of Headache & Facial Pain, Department of Neurology & Neurological Sciences, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Robert P. Cowan
- Division of Headache & Facial Pain, Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
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23
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A pilot analysis of headache disorders in breast cancer patients. Neurol Sci 2021; 43:3313-3320. [PMID: 34817729 DOI: 10.1007/s10072-021-05698-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 10/24/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The interaction between breast cancer and migraine is complex and not fully elucidated. Large epidemiological studies point towards a beneficial effect of migraines on breast cancer (BC). We aimed to investigate the BC-migraine relationship, with strict data checks and clinical evaluations of both BC and common headache forms. METHODS Consecutive BC patients were evaluated with the International Classification of Headache Disorders. Clinical data on the BC subtypes and treatments were collected. Parametric and nonparametric statistics were used according to data distributions. RESULTS Fifty patients were recruited. The mean age was 53.5 ± 12.5 years; 42% were postmenopausal, 52% were premenopausal, and 6% were peri-menopausal. Eleven patients were diagnosed as luminal A, nine as luminal B, 24 as HER2-positive (HER2 +), six as triple-negative BC. Thirty-eight (76%) patients had hormone receptor-positive disease. Ninety-two percent received chemotherapy, 66% received endocrine therapy, and 52% received radiotherapy. Nine out of 50 reported a worsening of headache after systemic treatment. Migraine was diagnosed in 29 patients (18 with menstrual migraine), tension-type headache (TTH) in nine, and no headache in 12. Patients with migraine were younger (48.4 ± 10.7 vs. 60.5 ± 12; p < 0.01). Patients with migraine and TTH had a higher chance of having a HER2 + BC (p < 0.05). Active migraine was associated with a higher expression of estrogen receptors (p = 0.04). CONCLUSIONS Patients with active migraine had higher estrogen receptor expression, while migraine and TTH patients mainly had HER2 + BC. This association was not known earlier and could be helpful to understand deeper the relationship between BC and headache.
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24
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Kristoffersen ES, Faiz KW, Hansen JM, Tronvik EA, Frich JC, Lundqvist C, Winsvold BS. The management and clinical knowledge of headache disorders among general practitioners in Norway: a questionnaire survey. J Headache Pain 2021; 22:136. [PMID: 34763647 PMCID: PMC8582095 DOI: 10.1186/s10194-021-01350-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 10/28/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND General practitioners (GPs) diagnose and manage a majority of headache patients seeking health care. With the aim to understand the potential for clinical improvement and educational needs, we performed a study to investigate Norwegian GPs knowledge about headache and its clinical management. METHODS We invited GPs from a random sample of 130 Norwegian continuous medical education (CME) groups to respond to an anonymous questionnaire survey. RESULTS 367 GPs responded to the survey (73% of invited CME groups, 7.6% of all GPs in Norway). Mean age was 46 (SD 11) years, with an average of 18 (SD 10) years of clinical experience. In general the national treatment recommendations were followed, while the International Classification of Headache Disorders and other international guidelines were rarely used. Overall, 80% (n = 292) of the GPs suggested adequate prophylactic medication for frequent episodic migraine, while 28% (n = 101) suggested adequate prophylactic medication for chronic tension-type headache (CTTH). Half (52%, n = 191)) of the respondents were aware that different types of acute headache medication can lead to medication-overuse headache (MOH), and 59% (n = 217) knew that prophylactic headache medication does not lead to MOH. GPs often used MRI in the diagnostic work-up. GPs reported that lack of good treatment options was a main barrier to more optimized treatment of headache patients. CONCLUSION The knowledge of management of CTTH and MOH was moderate compared to migraine among Norwegian GPs.
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Affiliation(s)
- Espen Saxhaug Kristoffersen
- Department of General Practice, University of Oslo, PO Box 1130, Blindern, 0318, Oslo, Norway. .,Department of Neurology, Akershus University Hospital, Lørenskog, Norway. .,Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway.
| | - Kashif Waqar Faiz
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Jakob Møller Hansen
- Danish Knowledge Centre on Headache Disorders, Rigshospitalet-Glostrup, University, of Copenhagen, Glostrup, Denmark
| | - Erling Andreas Tronvik
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology, National Advisory Unit on Headaches, St. Olavs Hospital, Trondheim, Norway
| | - Jan C Frich
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Christofer Lundqvist
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bendik Slagsvold Winsvold
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
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25
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Sun S, Zheng G, Zhou D, Zhu L, He X, Zhang C, Wang C, Yuan C. Emodin Interferes With Nitroglycerin-Induced Migraine in Rats Through CGMP-PKG Pathway. Front Pharmacol 2021; 12:758026. [PMID: 34744735 PMCID: PMC8563583 DOI: 10.3389/fphar.2021.758026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/05/2021] [Indexed: 02/03/2023] Open
Abstract
The purpose of this research was to explore the effect and mechanism of emodin in interfering with nitroglycerin-induced migraine rats. We carried out behavioral research within 2 h post-nitroglycerin (NTG) injection, and blood samples were collected through the abdominal aorta for measurements of nitric oxide (NO), calcitonin gene-related peptide (CGRP), substance P (SP), tumor necrosis factor (TNF-α) and cyclic guanosine monophosphate (cGMP) levels. Immunohistochemistry was adopted to detect the activation of c-Fos immunoreactive neurons in brain tissues. The number and integrated optical density (IOD) of c-Fos positive cells were measured using Image-Pro Plus. Western blotting was applied to detect the levels of PKG protein in rat brain tissues. The results showed that emodin can alleviate the pain response of migraine rats and significantly reduce the levels of NO, CGRP, SP, TNF-α and cGMP in migraine rats. In addition, emodin can significantly reduce the number of c-Fos positive cells and the IOD value. Moreover, the expression of PKG protein was significantly inhibited by emodin. Therefore, it is inferred that emodin can relieve migraine induced by NTG through the cGMP-PKG pathway, and can be used as a potential botanical medicine for the treatment of migraine.
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Affiliation(s)
- Shuding Sun
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Guo Zheng
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Decui Zhou
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Lili Zhu
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Xin He
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong, SAR China
| | - Chunfeng Zhang
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Chongzhi Wang
- Tang Center of Herbal Medicine Research and Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL, United States
| | - Chunsu Yuan
- Tang Center of Herbal Medicine Research and Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL, United States
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26
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Tinelli M, Leonardi M, Paemeleire K, Raggi A, Mitsikostas D, de la Torre ER, Steiner TJ. Structured headache services as the solution to the ill-health burden of headache. 3. Modelling effectiveness and cost-effectiveness of implementation in Europe: findings and conclusions. J Headache Pain 2021; 22:90. [PMID: 34380429 PMCID: PMC8359596 DOI: 10.1186/s10194-021-01305-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There have been several calls for estimations of costs and consequences of headache interventions to inform European public-health policies. In a previous paper, in the absence of universally accepted methodology, we developed headache-type-specific analytical models to be applied to implementation of structured headache services in Europe as the health-care solution to headache. Here we apply this methodology and present the findings. METHODS Data sources were published evidence and expert opinions, including those from an earlier economic evaluation framework using the WHO-CHOICE model. We used three headache-type-specific analytical models, for migraine, tension-type-headache (TTH) and medication-overuse-headache (MOH). We considered three European Region case studies, from Luxembourg, Russia and Spain to include a range of health-care systems, comparing current (suboptimal) care versus target care (structured services implemented, with provider-training and consumer-education). We made annual and 5-year cost estimates from health-care provider and societal perspectives (2020 figures, euros). We expressed effectiveness as healthy life years (HLYs) gained, and cost-effectiveness as incremental cost-effectiveness-ratios (ICERs; cost to be invested/HLY gained). We applied WHO thresholds for cost-effectiveness. RESULTS The models demonstrated increased effectiveness, and cost-effectiveness (migraine) or cost saving (TTH, MOH) from the provider perspective over one and 5 years and consistently across the health-care systems and settings. From the societal perspective, we found structured headache services would be economically successful, not only delivering increased effectiveness but also cost saving across headache types and over time. The predicted magnitude of cost saving correlated positively with country wage levels. Lost productivity had a major impact on these estimates, but sensitivity analyses showed the intervention remained cost-effective across all models when we assumed that remedying disability would recover only 20% of lost productivity. CONCLUSIONS This is the first study to propose a health-care solution for headache, in the form of structured headache services, and evaluate it economically in multiple settings. Despite numerous challenges, we demonstrated that economic evaluation of headache services, in terms of outcomes and costs, is feasible as well as necessary. Furthermore, it is strongly supportive of the proposed intervention, while its framework is general enough to be easily adapted and implemented across Europe.
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Affiliation(s)
- Michela Tinelli
- Care Policy Evaluation Centre, The London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
| | | | - Koen Paemeleire
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Alberto Raggi
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Dimos Mitsikostas
- 1st Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Timothy J Steiner
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Division of Brain Sciences, Imperial College London, London, UK
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27
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Are doctors accurate when diagnosing themselves with migraine? A study on migraine prevalence among doctors in a tertiary care hospital. Acta Neurol Belg 2021; 121:1045-1051. [PMID: 34218428 DOI: 10.1007/s13760-021-01727-w] [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: 02/16/2021] [Accepted: 06/14/2021] [Indexed: 10/20/2022]
Abstract
Migraine is considered an underdiagnosed disease in general population. Different studies show a higher prevalence in neurologists. However, there are few studies about its prevalence in doctors of other specialties, where it could also be superior than in general population. Our aim was to define migraine lifetime prevalence among doctors according to three parameters (previous diagnosis, self-diagnosis and positivity of a screening test). Single-center, descriptive, cross-sectional study based on online surveys with collection of sociodemographic and clinical variables, addressed to doctors of a tertiary hospital. Participants who reported 5 or more headaches throughout their lives were considered "headache sufferers" and were divided in different groups according to their position (specialists or trainees) and their specialty (medical, medical-surgical and surgical or specialties with no direct contact with the patient). The Spanish validated version of the Migraine Screen Questionnaire (MS-Q) was used as screening test. There were 217 participants (response rate of 29%), 72% were women and 56% trainees, mean age 34 years (SD10). 77% were "headache sufferers" Among all participants, migraine lifetime prevalence according to diagnosis by another physician was 15.2%, self-diagnosis 38.2% and positivity of the MS-Q 20.3%; those categories were not mutually exclusive Greater but not statistically significant coexistence of self-diagnosis and positive MS-Q was seen in specialists compared to trainees and in medical specialties. Migraine prevalence among doctors in a tertiary care hospital was higher than in general population, according to all three parameters analyzed. Self-diagnosis was the highest which could reflect an overdiagnosis; further studies are needed to determine this possibility.
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28
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Goadsby PJ, Constantin L, Ebel-Bitoun C, Igracki Turudic I, Hitier S, Amand-Bourdon C, Stewart A. Multinational descriptive analysis of the real-world burden of headache using the Migraine Buddy application. Eur J Neurol 2021; 28:4184-4193. [PMID: 34309986 PMCID: PMC9291858 DOI: 10.1111/ene.15037] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/09/2021] [Accepted: 07/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE A large proportion of headache sufferers do not routinely seek medical care. App-based technologies permit the collection of real-world data over time and between countries that can help assess true burden of headache. This study used a mobile phone application to collect information on the real-world burden of self-diagnosed headache and to describe its impact on daily life in headache sufferers who do not routinely seek medical advice. METHODS This retrospective, non-interventional, cross-sectional study analysed self-reported data from users of the 'Migraine Buddy' app. The main objective was to describe self-reported characteristics of headache and migraine (triggers, duration, frequency), treatment patterns and impact on daily activity in headache sufferers from Australia, Brazil, France, Germany and Japan. Data including demographics, self-diagnosed episode type (headache/migraine), duration, potential triggers and impact on daily activity are reported. All analyses were exploratory and performed per country. RESULTS Self-reported data were collected from 60,474 users between August 2016 and August 2018. Approximately 90% of users were females; >60% were aged 24-45 years. Over one-third of users reported having two to five episodes of headache or migraine per month; impact included impaired concentration, being slower and missing work or social activities. Variations across countries were observed; within countries, episode characteristics were very similar for self-diagnosed headache versus migraine. CONCLUSIONS Headache tracking was used to describe the experience, impact and self-management approaches of migraine and headache sufferers in a real-world setting. Headache disorders present a range of important issues for patients that deserve more study and reinforce the need for better approaches to management.
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Affiliation(s)
- Peter J Goadsby
- NIHR-Wellcome Trust King's Clinical Research Facility, King's College London, London, UK
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29
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Omaer A, Aldosari FM, McGlamery E, Alrashed S, Wool S, Fazel MT. Calcitonin Gene-Related Peptide (CGRP) Antagonists: A comprehensive review of safety, efficacy and prescribing information. J Clin Pharm Ther 2021; 47:i. [PMID: 34254331 DOI: 10.1111/jcpt.13445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/20/2021] [Accepted: 05/11/2021] [Indexed: 12/19/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES Migraine is a disabling disorder that affects individuals of all ages. To date, there are multiple limitations to using guidelines-recommended treatments and preventive therapies. The goal of this review was to provide a comprehensive clinical review of the safety, efficacy and prescribing information of the emerging calcitonin gene-related peptide (CGRP) antagonists. Agents in this new pharmacologic class were approved by the US Food and Drug Administration (FDA) for the treatment of acute migraine attack pain and the management of episodic and chronic migraine. METHODS A total of 12 randomized, placebo-controlled clinical trials were identified and included in the review utilizing databases such as clinicaltrial.gov, PubMed and EMBASE. The trials collectively evaluated six CGRP antagonists starting from the orally administered CGRPs such as rimegepant and ubrogepant, to the quarterly IV administered CGRP such as eptinezumab, and the monthly/quarterly subcutaneously administered agents such as erenumab, fremanezumab and galcanezumab. RESULTS AND DISCUSSION All agents displayed significant efficacy compared with placebo, measured by reduction in mean monthly migraine days (MMD). In addition, CGRP antagonists displayed a great tolerability profile with few adverse effects. These medications were neither associated with any cardiovascular-related adverse effects, nor do they currently have specific contraindications to pre-existing cardiovascular conditions. This can present a safe alternative to a wide range of patients who cannot be appropriately treated with first-line treatments such as triptans. No treatment-related death was reported in any of the clinical trials outlined and discussed. WHAT IS NEW AND CONCLUSION Calcitonin gene-related peptide antagonists are safe and efficacious medications both in treating acute migraine headache pain and the management of episodic and chronic migraine. Head-to-head comparative studies with current guideline-recommended treatments are needed. However, CGRP antagonists are promising agents that present an alternative solution for patients living with migraine.
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Affiliation(s)
- Abubker Omaer
- Department of Clinical Pharmacy, King Saud Medical City, Riyadh, Saudi Arabia.,Department of Pharmacy Practice & Science, College of Pharmacy, The University of Arizona, Tucson, AZ, USA.,Endocrinology and Diabetes Clinic, Banner - University Medical Center South Campus, Tucson, AZ, USA
| | - Fahad M Aldosari
- Department of Clinical Pharmacy, King Saud Medical City, Riyadh, Saudi Arabia.,Department of Pharmacy Practice & Science, College of Pharmacy, The University of Arizona, Tucson, AZ, USA.,Endocrinology and Diabetes Clinic, Banner - University Medical Center South Campus, Tucson, AZ, USA
| | | | | | - Steven Wool
- Personalized Health Care of Tucson, Tucson, AZ, USA
| | - Maryam T Fazel
- Department of Pharmacy Practice & Science, College of Pharmacy, The University of Arizona, Tucson, AZ, USA.,Endocrinology and Diabetes Clinic, Banner - University Medical Center South Campus, Tucson, AZ, USA
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30
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Liang Z, Thomas L, Jull G, Minto J, Zareie H, Treleaven J. Neck pain associated with migraine does not necessarily reflect cervical musculoskeletal dysfunction. Headache 2021; 61:882-894. [PMID: 34214181 DOI: 10.1111/head.14136] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/07/2021] [Accepted: 04/01/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To identify how frequently the neck pain associated with migraine presents with a pattern of cervical musculoskeletal dysfunction akin to cervical musculoskeletal disorders, and to determine if pain hypersensitivity impacts on cervical musculoskeletal function in persons with migraine. BACKGROUND Many persons with migraine experience neck pain and often seek local treatment. Yet neck pain may be part of migraine symptomology and not from a local cervical source. If neck pain is of cervical origin, a pattern of musculoskeletal impairments with characteristics similar to idiopathic neck pain should be present. Some individuals with migraine may have neck pain of cervical origin, whereas others may not. However, previous studies have neglected the disparity in potential origins of neck pain and treated persons with migraine as a homogenous group, which does not assist in identifying the origin of neck pain in individuals with migraine. METHODS This cross-sectional, single-blinded study was conducted in a research laboratory at the University of Queensland, Australia. Persons with migraine (total n = 124: episodic migraine n = 106, chronic migraine = 18), healthy controls (n = 32), and persons with idiopathic neck pain (n = 21) were assessed using a set of measures typically used in the assessment of a cervical musculoskeletal disorder, including cervical movement range and accuracy, segmental joint dysfunction, neuromuscular and sensorimotor measures. Pain hypersensitivity was assessed using pressure pain thresholds and the Allodynia Symptom Checklist. People with migraine with diagnoses of comorbid neck disorders were excluded. Cluster analysis was performed to identify how participants grouped on the basis of their performance across cervical musculoskeletal assessments. Post hoc analyses examined the effects of pain hypersensitivity on musculoskeletal function, and if any symptoms experienced during testing were related to musculoskeletal function. RESULTS Two distinct clusters of cervical musculoskeletal function were found: (i) neck function similar to healthy controls (n = 108) and (ii) neck dysfunction similar to persons with neck pain disorders (n = 69). Seventy-six of the individuals with migraine (62 with neck pain and 14 without neck pain) were clustered as having normal cervical musculoskeletal function, whereas the remaining 48 with neck pain had cervical dysfunction comparable with a neck disorder. Musculoskeletal dysfunction was not related to pain hypersensitivity or symptoms experienced during testing. CONCLUSIONS Neck pain when present with migraine does not necessarily indicate the existence of cervical musculoskeletal dysfunction. Skilled assessment without reliance only on the person reporting symptoms is needed to identify actual cervical dysfunction. Treatments suitable for neck musculoskeletal disorders would seem inappropriate for the individuals without cervical dysfunction. Future studies evaluating any potential effects of such treatments should only select participants with neck pain of cervical origin.
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Affiliation(s)
- Zhiqi Liang
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Lucy Thomas
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Gwendolen Jull
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Joanne Minto
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Hossein Zareie
- Department of Neurology, Royal Brisbane & Women's Hospital, Herston, QLD, Australia
| | - Julia Treleaven
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
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Ashina M, Katsarava Z, Do TP, Buse DC, Pozo-Rosich P, Özge A, Krymchantowski AV, Lebedeva ER, Ravishankar K, Yu S, Sacco S, Ashina S, Younis S, Steiner TJ, Lipton RB. Migraine: epidemiology and systems of care. Lancet 2021; 397:1485-1495. [PMID: 33773613 DOI: 10.1016/s0140-6736(20)32160-7] [Citation(s) in RCA: 287] [Impact Index Per Article: 95.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/11/2020] [Accepted: 10/14/2020] [Indexed: 02/06/2023]
Abstract
Migraine is a neurovascular disorder that affects over 1 billion people worldwide. Its widespread prevalence, and associated disability, have a range of negative and substantial effects not only on those immediately affected but also on their families, colleagues, employers, and society. To reduce this global burden, concerted efforts are needed to implement and improve migraine care that is supported by informed health-care policies. In this Series paper, we summarise the data on migraine epidemiology, including estimates of its very considerable burden on the global economy. First, we present the challenges that continue to obstruct provision of adequate care worldwide. Second, we outline the advantages of integrated and coordinated systems of care, in which primary and specialist care complement and support each other; the use of comprehensive referral and linkage protocols should enable continuity of care between these systems levels. Finally, we describe challenges in low and middle-income countries, including countries with poor public health education, inadequate access to medication, and insufficient formal education and training of health-care professionals resulting in misdiagnosis, mismanagement, and wastage of resources.
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Affiliation(s)
- Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Danish Knowledge Center on Headache Disorders, Glostrup, Denmark; Department of Neurology, Azerbaijan Medical University, Baku, Azerbaijan; Department of Neurology, IM Sechenov First Moscow State Medical University, Moscow, Russia.
| | - Zaza Katsarava
- Department of Neurology, Evangelical Hospital Unna, Unna, Germany; Department of Neurology, University of Duisburg-Essen, Essen, Germany; EVEX Medical Corporation, Tbilisi, Georgia; Department of Neurology, IM Sechenov First Moscow State Medical University, Moscow, Russia
| | - Thien Phu Do
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Aynur Özge
- Department of Neurology, Mersin University, School of Medicine, Mersin, Turkey
| | | | - Elena R Lebedeva
- Department of Neurology, International Headache Centre Europe-Asia, the Ural State Medical University, Yekaterinburg, Russia
| | - Krishnamurthy Ravishankar
- The Headache and Migraine Clinic, Jaslok Hospital and Research Centre, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Shengyuan Yu
- Department of Neurology, People's Liberation Army General Hospital, Beijing, China
| | - Simona Sacco
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Sait Ashina
- Comprehensive Headache Center, Department of Neurology and Anesthesia, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Samaira Younis
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Timothy J Steiner
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway; Division of Brain Sciences, Imperial College London, London, UK
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA; Montefiore Medical Center, Bronx, NY, USA
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Narrative Medicine to integrate patients', caregivers' and clinicians' migraine experiences: the DRONE multicentre project. Neurol Sci 2021; 42:5277-5288. [PMID: 33856582 PMCID: PMC8047556 DOI: 10.1007/s10072-021-05227-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/26/2021] [Indexed: 01/03/2023]
Abstract
Background Although migraine is widespread and disabling, stigmatisation and poor awareness of the condition still represent barriers to effective care; furthermore, research on migraine individual and social impact must be enhanced to unveil neglected issues, such as caregiving burden. The project investigated the migraine illness experience through Narrative Medicine (NM) to understand daily life, needs and personal resources of migraneurs, their caregivers and clinicians, and to provide insights for clinical practice. Methods The project involved 13 Italian headache centres and targeted migraneurs, their caregivers and migraine specialists at these centres. Written narratives, composed by a sociodemographic survey and illness plot or parallel chart, were collected through the project’s webpage. Illness plots and parallel charts employed open words to encourage participants’ expression. Narratives were analysed through Nvivo software, interpretive coding and NM classifications. Results One hundred and seven narratives were collected from patients and 26 from caregivers, as well as 45 parallel charts from clinicians. The analysis revealed migraine perception in social, domestic and work life within the care pathway evolution and a bond between chaos narratives and day loss due to migraine; furthermore, narratives suggested the extent of the caregiving burden and a risk of underestimation of migraine burden in patients’ and caregivers’ life. Conclusion The project represents the first investigation on migraine illness experience through NM simultaneously considering migraneurs’, caregivers’ and clinicians’ perspectives. Comparing narratives and parallel charts allowed to obtain suggestions for clinical practice, while NM emerged as able to foster the pursuing of migraine knowledge and awareness. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-021-05227-w.
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Need of guidance in disabling and chronic migraine identification in the primary care setting, results from the european MyLife anamnesis survey. BMC FAMILY PRACTICE 2021; 22:54. [PMID: 33743604 PMCID: PMC7980340 DOI: 10.1186/s12875-021-01402-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 02/23/2021] [Indexed: 12/20/2022]
Abstract
Background Migraine affects 80.8 million people in Western Europe and is the first cause of disability among people between ages 15 and 49 worldwide. Despite being a highly prevalent and disabling condition, migraine remains under-diagnosed and poorly managed. Methods An international, online survey was conducted among 201 general practitioners (GPs) from 5 European countries (France, Germany, Italy, Spain and the UK) who are experienced in the management of headache disorders. Results The majority of GPs (82%) did not refer patients with chronic migraine (CM) to migraine specialists. Among those patients, the participants estimated that around 55% received preventive medication. Some differences between countries were observed regarding referral rate and prescription of preventive treatment. Most GPs (87%) reported a lack of training or the need to be updated on CM management. Accordingly, 95% of GPs considered that a migraine anamnesis guide could be of use. Overall, more than 95% of GPs favoured the use of a patient diary, a validated diagnostic tool and a validated scale to assess impact of migraine on patients’ daily life. Similarly, 96% of the GPs considered that the inclusion of warning features (red flags) in an anamnesis guide would be useful and 90% favoured inclusion of referral recommendations. Conclusions The results from this survey indicate that more education on diagnosis and management of CM is needed in primary care. Better knowledge on the recognition and management of migraine in primary care would improve both prognosis and diagnosis and reduce impact of migraine on patients’ lives, healthcare utilization and societal burden. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01402-2.
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Southwell J, Afridi SK. The burden of migraine on acute and emergency services in a London teaching hospital. Cephalalgia 2021; 41:905-912. [PMID: 33601941 DOI: 10.1177/0333102420981734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is a lack of data on the burden of primary headache disorders such as migraine on emergency services. Existing data relies on a coding of "headache", which encompasses both primary and secondary headache of all causes; for example, subarachnoid haemorrhage. Guy's and St Thomas' NHS Trust in London is one of the UK's busiest emergency departments with 150,000 attendances per year. Our aim was to assess the healthcare resource utilisation of primary headaches, in particular migraine, in acute medical services. METHODS We conducted an audit of all adult presentations to the emergency department of Guy's and St Thomas' Hospitals which were coded as "headache" over the first 6 months of 2018. We reviewed the initial diagnosis at presentation and also at discharge, investigations and outcome. RESULTS Of 78,273 attendances to the emergency department, there were 976 presentations to the emergency department with "headache" as their primary complaint. "Migraine" was the most frequent of all diagnoses, accounting for 30% of all headache presentations and 25% of headache admissions. We calculated the cost of admitting and investigating migraine as £131,250 over the 6-month period. CONCLUSION Emergency admissions for migraine represent an avoidable cost and burden for both the hospital and the migraineur. This data informs us about the need to develop better care pathways for migraine in the community and to improve headache education for physicians and patients.
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Affiliation(s)
| | - Shazia K Afridi
- Department of Neurology, Guy's and St Thomas' NHS Trust, London, UK.,King's College London, London, UK
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Nabity PS, Moore BA, Peterson AL, McGeary DD. Incidence (2008-2015) of post-traumatic headaches in United States military personnel. Brain Inj 2021; 35:436-443. [PMID: 33517790 DOI: 10.1080/02699052.2021.1878555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: To conduct a descriptive transversal study to evaluate the incidence and demographic characteristics of post-traumatic headache using data from the Defense Medical Epidemiology Database.Methods: A retrospective cohort study was conducted of data from 2008 to 2015 based on the International Classification of Diseases codes for both acute and chronic post-traumatic headache.Results: A total of 17,010 new cases of post-traumatic headaches were diagnosed among active duty military personnel. Reported incidence rates of post-traumatic headaches in the military increased 29-fold over the timeframe analyzed. Males enlisted in the Army were more likely to be diagnosed with post-traumatic headaches than females (O/E = 0.76), other branches, and officers.Conclusion: Findings of this study indicate that there is a significant incidence of post-traumatic headaches in the U.S. military. However, the incidence rates of post-traumatic headaches in the military are much lower than what was expected considering the number of traumatic brain injuries in the United States military reported by the Department of Defense for the same period. Additional research is needed to further evaluate these differences and the impact of PTHs on military personnel.
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Affiliation(s)
- Paul S Nabity
- University of Texas Health Science Center, Department of Psychiatry and Behavioral Sciences
| | - Brian A Moore
- South Texas Veterans Health Care System, Psychology Service.,Kennesaw State University, Department of Psychological Science
| | - Alan L Peterson
- University of Texas Health Science Center, Department of Psychiatry and Behavioral Sciences.,South Texas Veterans Health Care System, Psychology Service.,University of Texas San Antonio, Department of Psychology
| | - Donald D McGeary
- University of Texas Health Science Center, Department of Psychiatry and Behavioral Sciences.,South Texas Veterans Health Care System, Psychology Service
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Bojazar R, Do TP, Hansen JM, Dodick DW, Ashina M. Googling migraine: A study of Google as an information resource of migraine management. Cephalalgia 2020; 40:1633-1644. [PMID: 32703015 DOI: 10.1177/0333102420942241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Health information is one of the most frequently searched topics on the internet. In this observational cross-sectional study, we evaluated the content of the highest indexed Google search results related to migraine management. METHODS We identified the five most used search terms related to migraine management via Google Trends in the time period 1 January 2004 to 2 October 2019. We entered each search term into Google's search engine and retrieved the search results from the first three pages from each search query. We stratified the recommended treatment options and evaluated the websites using the DISCERN tool. RESULTS In total, 73 unique websites recommended a total of 77 different migraine treatment options, consisting of 35 (45%) acute and 42 (55%) preventive treatments. For acute treatments, pharmacological options were more frequently recommended (88% of websites), whereas non-pharmacological options were more frequent among preventive treatments (67%). Evaluation of the consumer health information using the DISCERN tool showed that non-governmental organizations had the highest mean total score with 3.8 (±0.19). CONCLUSIONS Googling when looking for migraine treatments reveals a multitude of management proposals of varying quality. Non-governmental organizations provide the overall highest quality of written consumer health information on migraine treatments among search results. We encourage stakeholders to optimize and distribute high-quality and peer-reviewed information on migraine management.
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Affiliation(s)
- Rachid Bojazar
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Thien Phu Do
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Jakob Møller Hansen
- Danish Headache Knowledge Center, Rigshospitalet Glostrup, Glostrup, Denmark
| | | | - Messoud Ashina
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
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Saffi H, Do TP, Hansen JM, Dodick DW, Ashina M. The migraine landscape on YouTube: A review of YouTube as a source of information on migraine. Cephalalgia 2020; 40:1363-1369. [PMID: 32703016 DOI: 10.1177/0333102420943891] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION YouTube is the most widely used video hosting website in the world; however, the quality and reliability of information is unknown. The aim of this study is to evaluate the content and distribution of the most popular videos on YouTube about migraine. METHODS We searched for migraine-related videos on the online video hosting resource YouTube (http://youtube.com/). Two authors screened the titles and video descriptions independently for all videos with a view count of ≥ 10,000 views. For each video we recorded descriptive data, the source/author and the primary purpose/content. RESULTS We identified 351 eligible videos. In total, there was more than 3 days of content viewed more than 163 million times. Only 9% of these videos were authored by healthcare professionals. The majority (44%) of videos focused on complementary and alternative medicine. DISCUSSION YouTube provides a wide array of easily accessible information on migraine, ranging from authoritative sources to potentially questionable content. If used uncritically, this may result in inadequate clinical management. Peer-reviewed information on migraine mechanisms and treatment is needed to provide the best available evidence for the public and patients. Ideally, a professional society or foundation such as the International Headache Society would develop, curate, and distribute content.
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Affiliation(s)
- Hillah Saffi
- Danish Headache Center, Department of Neurology, 70590Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thien Phu Do
- Danish Headache Center, Department of Neurology, 70590Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Møller Hansen
- Danish Headache Knowledge Center, 70590Rigshospitalet Glostrup, Glostrup, Denmark
| | | | - Messoud Ashina
- Danish Headache Center, Department of Neurology, 70590Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Abstract
INTRODUCTION The most common and multifaceted migraine aura symptoms are visual disturbances. Health information is one of the most popular topics on the internet but the quality and reliability of publicized information is unknown. The aim of this study was to analyze images of migraine aura on Google to determine the frequency of correct presentations of visual aura and distribution of visual aura phenotypes. METHODS Two authors screened the 100 highest indexed migraine aura related images on Google. The content of the images was categorized into elementary visual symptoms. RESULTS Forty out of 100 images were accurate representations of visual migraine aura. Such images included 31 different visual aura phenotypes. The majority had more than one elementary visual symptom (median 2, IQR 1-3), most commonly "bean-like" forms (45%), zigzag lines (40%), and foggy/blurred vision (33%). DISCUSSION Forty percent of images were accurate portrayals of visual migraine aura symptoms, but these presented limited phenotypes. The information derived from the internet photos may hinder the effective recognition of aura symptoms. Thus, there is a need to provide a more comprehensive representation of visual migraine aura symptoms on the internet.
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Affiliation(s)
- Michele Viana
- Headache Group, Department of Basic and Clinical Neurosciences, King's College London, London, UK.,Headache Center, Neurocenter of Southern Switzerland (NSI), Regional Hospital Lugano, Switzerland
| | - Anders Hougaard
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Copenhagen, Denmark
| | - Thien Phu Do
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Copenhagen, Denmark
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Gvantseladze K, Do TP, Hansen JM, Shapiro RE, Ashina M. The Stereotypical Image of a Person With Migraine According to Mass Media. Headache 2020; 60:1465-1471. [DOI: 10.1111/head.13846] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/14/2020] [Accepted: 04/28/2020] [Indexed: 12/12/2022]
Affiliation(s)
| | - Thien Phu Do
- Danish Headache Center Department of Neurology Rigshospitalet Glostrup Copenhagen Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | | | - Robert E. Shapiro
- Department of Neurological Sciences Larner College of Medicine University of Vermont Burlington VT USA
| | - Messoud Ashina
- Danish Headache Center Department of Neurology Rigshospitalet Glostrup Copenhagen Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
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