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Patrono A, Renzetti S, Guerini C, Macgowan M, Moncada SM, Placidi D, Memo M, Lucchini RG. Social isolation consequences: lessons from COVID-19 pandemic in a context of dynamic lock-down in Chile. BMC Public Health 2024; 24:599. [PMID: 38402167 PMCID: PMC10893693 DOI: 10.1186/s12889-024-18064-1] [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: 10/17/2023] [Accepted: 02/10/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Chile did not adopt general and unified lockdowns for the whole nation but organized itself with dynamic and sometimes irregular lockdowns. These dynamics and consequences of social isolation could be generalized to other contexts of isolation such as those affecting minorities such as immigrants, prisoners, refugees. METHODS In this study, we investigated the physical and mental health symptoms associated with lifestyle changes due to lockdown among university students in Chile. We examined psychopathological variations in relation to mental health problems in a healthy young population. Our goal was to develop interventions to address these new psychosocial problems in potentially comparable post-pandemic contexts. From May 10th 2021 to June 2th 2021, 420 University students took part in an anonymous survey asking for information on habits and symptoms that emerged during the lockdown in response to the COVID-19 pandemic. Three health outcomes were assessed: digestive disorders; headache; fear of COVID-19. Covariates including conditions and lifestyle during the pandemic, SARS-CoV-2 infections in the family, financial situation and productivity were considered in the analysis. RESULTS Participants experienced headache and fear of COVID-19 quite frequently during the lockdown period. More than half of the sample also experienced social isolation. Female gender, sleep quality, memory difficulties, and a change in eating habits resulted associated with an increased risk of health outcomes such as headaches and digestive disorders. CONCLUSIONS The results of this study fit within an original pandemic context: The results of this study can help identify needs and promote solutions applicable to different contexts. Future interventions should focus on the promotion and implementation of healthy habits focused on sleep hygiene, psychoeducation on the use of mobile devices and gender medicine with the support of healthcare organizations and University.
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Affiliation(s)
- Alessandra Patrono
- Department of Molecular Medicine e. Translational, v.le Europa 11, 25121, Brescia, Italy.
| | - Stefano Renzetti
- Department of Medical-Surgical Specialties, Radiological Sciences and Public Health, v.le Europa 11, 25121, Brescia, Italy
| | - Cristian Guerini
- Department of Medical-Surgical Specialties, Radiological Sciences and Public Health, v.le Europa 11, 25121, Brescia, Italy
| | - Mark Macgowan
- Robert Stempel College of Public Health & Social Work, School of Social Work, Florida International University, 11200 SW 8th Street, AHC-5 Room 513, Miami, Florida, 33199, USA
| | - Stefanny M Moncada
- Departamento de Gobierno, Universidad del Desarrollo, Chile, 7610658, Las Condes, Región Metropolitana, Chile
| | - Donatella Placidi
- Department of Medical-Surgical Specialties, Radiological Sciences and Public Health, v.le Europa 11, 25121, Brescia, Italy
| | - Maurizio Memo
- Department of Molecular Medicine e. Translational, v.le Europa 11, 25121, Brescia, Italy
| | - Roberto G Lucchini
- Department of Medical-Surgical Specialties, Radiological Sciences and Public Health, v.le Europa 11, 25121, Brescia, Italy
- Department of Environmental Health Sciences, School of Public Health, Florida International University, 11200 SW 8th St #500, Miami, FL, 33174, USA
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2
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Moskatel LS, Graber-Naidich A, He Z, Zhang N. Real world evidence of changes in CGRP monoclonal antibody and onabotulinumtoxinA prescription practices at the start of the COVID-19 pandemic: An observational, retrospective study. Headache 2023; 63:1180-1182. [PMID: 37358470 DOI: 10.1111/head.14585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/09/2023] [Accepted: 05/17/2023] [Indexed: 06/27/2023]
Affiliation(s)
- Leon S Moskatel
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA
| | - Anna Graber-Naidich
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, California, USA
| | - Zihuai He
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, California, USA
| | - Niushen Zhang
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, California, USA
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3
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Fisher M, Aher A, Araga M, Franks B. Patient Factors in the Dose Selection of Oral Sumatriptan for Acute Migraine: A Post Hoc Analysis of Two Randomized Controlled Studies. Pain Ther 2023; 12:853-861. [PMID: 37103731 PMCID: PMC10134697 DOI: 10.1007/s40122-023-00511-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/30/2023] [Indexed: 04/28/2023] Open
Abstract
INTRODUCTION Patients are seeking greater involvement in their healthcare. It therefore may be beneficial to provide guidance on initial oral sumatriptan dose selection for the treatment of acute migraine in nontraditional settings, such as telehealth and other remote forms of medical care. We sought to determine whether clinical or demographic factors are predictive of oral sumatriptan dose preference. METHODS This was a post hoc analysis of two clinical studies designed to determine preference for 25, 50, or 100 mg oral sumatriptan. Patients were aged 18-65 years with at least a 1 year history of migraine and experienced, on average, between one and six severe or moderately severe migraine attacks per month, with or without aura. Predictive factors were demographic measures, medical history, and migraine characteristics. Possibly predictive factors were identified using three analyses: classification and regression tree analysis, marginal significance (P < 0.1) within a full-model logistic regression, and/or selection within a forward-selection procedure in a logistic regression. A reduced model containing the variables identified in the preliminary analyses was developed. Due to differences in study design, data were not combined. RESULTS A dose preference was expressed by 167 patients in Study 1 and 222 patients in Study 2. Gender and medical history of urologic and/or psychological conditions in Study 1 and duration of migraine history, height, and medical history of endocrine or neurologic disease and headache severity in Study 2 were identified as possibly predictive. The predictive model showed low positive predictive value (PPV; 23.8%) and low sensitivity (21.7%) for Study 1. For Study 2, the model showed moderate PPV (60.0%) but low sensitivity (10.9%). CONCLUSIONS No clinical or demographic characteristics alone or in combination were consistently or strongly associated with preference for oral sumatriptan dose level. TRIAL REGISTRATION The studies on which this paper is based were conducted before trial registration indexes were introduced.
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Affiliation(s)
- Matt Fisher
- Haleon, 184 Liberty Corner Road, Warren, NJ, 07059, USA.
| | - Abhay Aher
- Haleon, 184 Liberty Corner Road, Warren, NJ, 07059, USA
| | - Mako Araga
- Haleon, 184 Liberty Corner Road, Warren, NJ, 07059, USA
| | - Billy Franks
- GlaxoSmithKline Consumer Healthcare B.V., Amersfoort, Netherlands
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4
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Kaufman MC, Xian J, Galer PD, Parthasarathy S, Gonzalez AK, McKee JL, Prelack MS, Fitzgerald MP, Helbig I. Child neurology telemedicine: Analyzing 14 820 patient encounters during the first year of the COVID-19 pandemic. Dev Med Child Neurol 2023; 65:406-415. [PMID: 38767061 DOI: 10.1111/dmcn.15406] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 11/28/2022]
Abstract
AIM To determine the long-term impact of telemedicine in child neurology care during the COVID-19 pandemic and with the reopening of outpatient clinics. METHOD We performed an observational cohort study of 34 837 in-person visits and 14 820 telemedicine outpatient visits across 26 399 individuals. We assessed differences in care across visit types, time-period observed, time between follow-ups, patient portal activation rates, and demographic factors. RESULTS We observed a higher proportion of telemedicine for epilepsy (International Classification of Diseases, 10th Revision G40: odds ratio [OR] 1.4, 95% confidence interval [CI] 1.3-1.5) and a lower proportion for movement disorders (G25: OR 0.7, 95% CI 0.6-0.8; R25: OR 0.7, 95% CI 0.6-0.9) relative to in-person visits. Infants were more likely to be seen in-person after reopening clinics than by telemedicine (OR 1.6, 95% CI 1.5-1.8) as were individuals with neuromuscular disorders (OR 1.6, 95% CI 1.5-1.7). Self-reported racial and ethnic minority populations and those with highest social vulnerability had lower telemedicine participation rates (OR 0.8, 95% CI 0.8-0.8; OR 0.7, 95% CI 0.7-0.8). INTERPRETATION Telemedicine continued to be utilized even once in-person clinics were available. Pediatric epilepsy care can often be performed using telemedicine while young patients with neuromuscular disorders often require in-person assessment. Prominent barriers for socially vulnerable families and racial and ethnic minorities persist.
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Affiliation(s)
- Michael C Kaufman
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Julie Xian
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Peter D Galer
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, USA
| | - Shridhar Parthasarathy
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Alexander K Gonzalez
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Jillian L McKee
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Marisa S Prelack
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Mark P Fitzgerald
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Ingo Helbig
- Division of Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA
- The Epilepsy NeuroGenetics Initiative, Children's Hospital of Philadelphia, Philadelphia, USA
- Departments of Neurology and Pediatrics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
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Chen X, Luo Y. Digital Therapeutics in Migraine Management: A Novel Treatment Option in the COVID-19 Era. J Pain Res 2023; 16:111-117. [PMID: 36660558 PMCID: PMC9842514 DOI: 10.2147/jpr.s387548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/22/2022] [Indexed: 01/13/2023] Open
Abstract
Migraine is a chronic and often lifelong disease that directly affects over one billion people globally. Because access to migraine medical services is limited, only a minority of migraine patients are treated adequately. This situation worsened during the COVID-19 pandemic. Digital therapeutics (DTx) is an emerging therapeutic approach that opens up many new possibilities for remote migraine management. For instance, migraine management tools, online migraine diagnosis, guideline-based treatment options, digitally networked patients, and collecting anonymized information about migraine attacks and course parameters for scientific evaluation. Various applications of DTx in migraine management have been studied in recent years, such as the usefulness of digital migraine self-management tools in diagnosing and tracking migraine attacks, and the efficacy and safety of digital cognitive behavioural therapy. However, the development of DTx is still in its infancy and still faces many obstacles. The primary goal of this study is to review the latest research on DTx in migraine management, identify challenges, and outline future trends.
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Affiliation(s)
- Xingchen Chen
- Tianjin Baodi Hospital, Baodi Clinical College of Tianjin Medical University, Tianjin, 301800, People’s Republic of China
| | - Yujia Luo
- Department of Pain Medicine, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, People’s Republic of China,Brain and Mind Centre, Faculty of Medicine and Health, the University of Sydney, Sydney, NSW, 2006, Australia,Correspondence: Yujia Luo, Email
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6
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Hrytsenko O, Kopchak O, Kozyk M, Strubchevska K. The impact of the COVID-19 pandemic on patients with migraine. SAGE Open Med 2023; 11:20503121231170726. [PMID: 37143608 PMCID: PMC10151915 DOI: 10.1177/20503121231170726] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/03/2023] [Indexed: 05/06/2023] Open
Abstract
Objectives The aim of our work was to assess the impact of the COVID-19 pandemic and quarantine measures on migraine patients in regards to the activity of the disease, the psycho-emotional background of the patients and their quality of life. Methods his study included 133 patients with established diagnosis of migraine. All study participants were divided into two clinical groups: A-patients with chronic and episodic forms of migraine, who had a history of positive PCR test for COVID-19, and B-patients with chronic and episodic forms of migraine who did not have a history of coronavirus disease. Results We detected increase in the number of antimigraine medication (p = 0.04), frequency of headache attacks (p = 0.01), and the psycho-emotional state deterioration (increase in the Hamilton anxiety scale score) (p = 0.002) in patients after recovery from the coronavirus disease. There was no significant difference in the headache's intensity according to the VAS scale (p = 0.51) as well as in the dynamics of the Beck depression scale score (p = 0.09) before and after the COVID-19 infection. Conclusion Patients with a history of migraine who recovered from COVID-19 showed increased frequency of migraine headache attacks and anxiety.
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Affiliation(s)
- Olena Hrytsenko
- Department of Neurology, Psychiatry and
Physical Rehabilitation, Private Higher Educational Establishment “Kyiv Medical
University”, Kyiv, Ukraine
- Olena Hrytsenko, Department of Neurology,
Psychiatry and Physical Rehabilitation, Private Higher Educational Establishment
“Kyiv Medical University”, 2, Boryspilska Street, Kyiv 02099, Ukraine.
| | - Oksana Kopchak
- Department of Neurology, Psychiatry and
Physical Rehabilitation, Private Higher Educational Establishment “Kyiv Medical
University”, Kyiv, Ukraine
| | - Marko Kozyk
- Internal Medicine Resident, Corewell
Health William Beaumont University Hospital, Royal Oak, MI, USA
| | - Kateryna Strubchevska
- Internal Medicine Resident, Corewell
Health William Beaumont University Hospital, Royal Oak, MI, USA
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7
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Chebil D, Ben Hassine D, Melki S, Nouira S, Kammoun Rebai W, Hannachi H, Merzougui L, Ben Abdelaziz A. Place of distancing measures in containing epidemics: a scoping review. Libyan J Med 2022; 17:2140473. [DOI: 10.1080/19932820.2022.2140473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Dhekra Chebil
- Infection Prevention Control Department, Ibn Al Jazzar University Hospital, Kairouan, Tunisia
- Research Laboratory, LR19SP01, Sousse, Tunisia
- Faculty of medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Donia Ben Hassine
- Research Laboratory, LR19SP01, Sousse, Tunisia
- Information System Direction (DSI), Sahloul University Hospital, Sousse, Tunisia
| | - Sarra Melki
- Research Laboratory, LR19SP01, Sousse, Tunisia
- Information System Direction (DSI), Sahloul University Hospital, Sousse, Tunisia
| | - Sarra Nouira
- Research Laboratory, LR19SP01, Sousse, Tunisia
- Information System Direction (DSI), Sahloul University Hospital, Sousse, Tunisia
| | - Wafa Kammoun Rebai
- Regional Training Center supported by WHO-TDR for East Mediterranean Region (EMR), Pasteur Institute of Tunis, Tunisia
| | - Hajer Hannachi
- Infection Prevention Control Department, Ibn Al Jazzar University Hospital, Kairouan, Tunisia
- Faculty of medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Latifa Merzougui
- Infection Prevention Control Department, Ibn Al Jazzar University Hospital, Kairouan, Tunisia
- Faculty of medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Ahmed Ben Abdelaziz
- Research Laboratory, LR19SP01, Sousse, Tunisia
- Faculty of medicine of Sousse, University of Sousse, Sousse, Tunisia
- Information System Direction (DSI), Sahloul University Hospital, Sousse, Tunisia
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8
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Elkurwi N, Elkurwi Q. The Pathophysiological Relationship Between Migraine and SARS-CoV-2 Infection: A Comprehensive Literature Review. EUROPEAN MEDICAL JOURNAL 2022. [DOI: 10.33590/emj/10054250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
People with migraine, and individuals with other neurological conditions, have suffered in multiple aspects during the COVID-19 pandemic. This paper will discuss the factors that impacted the neurology department. The emergence of severe acute respiratory syndrome coronavirus 2 in late 2019 has generated new challenges in healthcare systems across the globe. Similar to the fields of pulmonology and cardiology that saw an increase in research, the neurology department was in search of possible relationships between COVID-19 and other medical conditions. Research on the possible common pathophysiological mechanism between COVID-19 and migraine is currently being studied. The most recent hypothesis suggests the following: migraine is caused by an increased release of calcitonin gene-related peptide from the trigeminal ganglion, which will cause an increase in nitric oxide and IL-1β, resulting in vasodilation and inducing hyperalgesia. COVID-19 causes an increase in nod-like receptor protein 3, which causes the production of IL-1β and again induces an inflammatory response. This review article looks at the mechanisms of migraine and COVID-19, and tries to link a common pathophysiological pathway between the two. This report also serves as a gateway for further research regarding possible management that could potentially target both of these mechanisms.
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Affiliation(s)
- Noor Elkurwi
- Department of Neurology, Stroke and Neurorehabilitation, Barlicki Hospital, Medical University of Łódź, Poland
| | - Qabas Elkurwi
- Department of Neurology, Stroke and Neurorehabilitation, Barlicki Hospital, Medical University of Łódź, Poland
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9
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Post-COVID Headache: A Literature Review. Curr Pain Headache Rep 2022; 26:835-842. [PMID: 36197571 PMCID: PMC9533267 DOI: 10.1007/s11916-022-01086-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 11/08/2022]
Abstract
Purpose of Review Post-COVID headache may be unique in presentation and mechanism, often presenting as a new phenotype in patients with a history of a primary headache disorder or resulting in a new headache syndrome in those without history of headache. This review presents a description of the literature published focused on post-COVID headache. Additionally, we discuss potential mechanisms and considerations for treatment of post-COVID headache. Recent Findings Headache is one of the most common symptoms of COVID. Common characteristics are revealed when reviewing the phenotypes of headaches that have been described in patients with COVID-19, with most headache phenotypes resembling migraine and new persistent daily headache. Post-COVID headaches are often described as moderate to severe, persistent, and treatment refractory. Summary This review highlights the diversity of presentation of headaches that present as a complication of COVID-19. Treatment of post-COVID headache is challenging, especially in the setting of a pandemic where resources are limited. Clinical Case A 42-year-old woman with a history of episodic migraine without aura presents over video visit with a new headache type. Her typical headaches are predominantly left sided, throbbing in nature, and associated with photophobia and phonophobia. They are fully relieved by oral sumatriptan 2 h after treatment. She describes this new headache as a constant, pulsating, holocephalic pain with no other migrainous features that have been ongoing for 6 weeks. She notes that the headache has been persistent since that time. She has tried over-the-counter acetaminophen and ibuprofen and her typical migraine abortive therapy without relief. She is debilitated and wonders if there is anything that will take the pain away. She shares that she tested positive for COVID-19 about 2 days prior to headache onset and has associated rhinorrhea, anosmia, and ageusia.
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10
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Migraine Headache in an Employed Population. J Occup Environ Med 2022; 64:679-685. [DOI: 10.1097/jom.0000000000002564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Gelfand AA, Halker Singh RB, Robbins MS. Worsening migraine: Another casualty of natural disasters. Headache 2022; 62:645-647. [DOI: 10.1111/head.14325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Amy A. Gelfand
- Child & Adolescent Headache Program UCSF San Francisco California USA
- Headache Journal Headache Editorial Office Plymouth Massachusetts USA
| | - Rashmi B. Halker Singh
- Headache Journal Headache Editorial Office Plymouth Massachusetts USA
- Mayo Clinic Scottsdale Arizona USA
| | - Matthew S. Robbins
- Headache Journal Headache Editorial Office Plymouth Massachusetts USA
- Department of Neurology Weill Cornell Medicine New York New York USA
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12
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Spina E, Tedeschi G, Russo A, Trojsi F, Iodice R, Tozza S, Iovino A, Iodice F, Abbadessa G, di Lorenzo F, Miele G, Maida E, Cerullo G, Sparaco M, Silvestro M, Leocani L, Bonavita S, Manganelli F, Lavorgna L. Telemedicine application to headache: a critical review. Neurol Sci 2022; 43:3795-3801. [PMID: 35075575 PMCID: PMC8786371 DOI: 10.1007/s10072-022-05910-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/19/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Migraine affects more than a billion people all over the world and requires critical employment of healthcare resources. Telemedicine could be a reasonable tool to manage people suffering from headaches, and it received a big push from the COVID-19 pandemic. OBJECTIVE This review aims to propose a practical approach for the virtual management of these patients. METHODS To do this, we conducted a literature search, including 32 articles relevant to the topic treated in this review. RESULTS The most challenging step in telemedicine applied to practical neurology remains the clinical assessment, but through a careful headache history and a recently proposed entirely virtual neurological assessment, this hitch can be easily overcome. Electronic diary compilations and virtual administration of disability-measuring scales, conversely, are the key features of effective long-term follow-up although we do not have apps that met the criteria of scientific reliability. Furthermore, tele-rehabilitation seems to be effective and has demonstrated to be a solution to alternatively treat chronic patients at home, and can be considered part of the remote management of headache patients. Moreover, virtual management of headaches finds an application in specific communities of patients, as pediatric patients and for rural communities of low- and middle-income countries suffer from health disparities, with inadequate resources and knowledge gaps. CONCLUSION Telemedicine could be promising for patients with no regular or convenient access to headache specialists and seems to be a priority in managing migraine patients to avoid non-urgent hospitalizations.
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Affiliation(s)
- Emanuele Spina
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples "Federico II" Via Pansini, 5, 81028, Naples, Italy.
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, AOU University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Antonio Russo
- 1st Clinic Of Neurology, AOU University of Campania "Luigi Vanvitelli,", Caserta, Italy
| | - Francesca Trojsi
- Department of Advanced Medical and Surgical Sciences, AOU University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Rosa Iodice
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples "Federico II" Via Pansini, 5, 81028, Naples, Italy
| | - Stefano Tozza
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples "Federico II" Via Pansini, 5, 81028, Naples, Italy
| | - Aniello Iovino
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples "Federico II" Via Pansini, 5, 81028, Naples, Italy
| | | | - Gianmarco Abbadessa
- Department of Advanced Medical and Surgical Sciences, AOU University of Campania "Luigi Vanvitelli", Caserta, Italy
| | | | - Giuseppina Miele
- 1st Clinic Of Neurology, AOU University of Campania "Luigi Vanvitelli,", Caserta, Italy
| | - Elisabetta Maida
- Department of Advanced Medical and Surgical Sciences, AOU University of Campania "Luigi Vanvitelli", Caserta, Italy
| | | | - Maddalena Sparaco
- 1st Clinic Of Neurology, AOU University of Campania "Luigi Vanvitelli,", Caserta, Italy
| | - Marcello Silvestro
- 1st Clinic Of Neurology, AOU University of Campania "Luigi Vanvitelli,", Caserta, Italy
| | - Letizia Leocani
- Experimental Neurophysiology Unit, Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Simona Bonavita
- Department of Advanced Medical and Surgical Sciences, AOU University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Fiore Manganelli
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples "Federico II" Via Pansini, 5, 81028, Naples, Italy
| | - Luigi Lavorgna
- 1st Clinic Of Neurology, AOU University of Campania "Luigi Vanvitelli,", Caserta, Italy
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13
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Headache Diary Mobile Application for Monitoring and Characterizing Posttraumatic Headaches. J Head Trauma Rehabil 2022; 37:171-177. [PMID: 35293366 DOI: 10.1097/htr.0000000000000771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study analyzed the data collected using a headache diary mobile application to characterize posttraumatic headaches (PTHs) in a sample of US veterans. Specifically, we measured patient engagement with the mobile application and compared our findings with previous literature regarding PTHs. SETTING A Headache Center of Excellence (HCoE) in a Veterans Health Administration facility. PARTICIPANTS Forty-nine veterans currently being treated for ongoing PTH-related complaints with English fluency, reliable access to the internet, and a mobile phone. DESIGN Observational study of PTH characteristics using the mobile application over the course of 1 year. MEASURES Main outcome measures were collected via a headache diary mobile application developed for patients to track headache-associated symptoms, headache location, triggers, type, intensity, and duration. Patients also completed a baseline Headache Impact Test (HIT-6) survey. RESULTS In total, 1569 entries were completed during the first year of application deployment. On average, patients completed 2.5 entries per week and used the application for 70 days. They frequently reported associated PTH symptoms of photophobia (56.7%) and headaches triggered by emotional stress (35.1%). Network analyses revealed patterns of co-occurrence in triggers of headache pain, associated symptoms, and headache pain location. Headache pain severity and impact ratings from the headache diary demonstrated convergent validity with the established HIT-6 measure. CONCLUSIONS Headache diary mobile applications are a promising tool for monitoring and characterizing PTHs in veterans. Present results mirror past studies of PTH characteristics. Mobile application headache diaries may be used in both clinical and research settings to monitor headache symptoms and communicate the functional impact of headaches in real time.
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14
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Buse DC, Gerstein MT, Houts CR, McGinley JS, Uzumcu AA, McCarrier KP, Cooke A, Touba NM, Nishida TK, Wirth RJ, Lipton RB. Impact of the COVID-19 pandemic on people living with migraine: Results of the MiCOAS qualitative study. Headache 2022; 62:284-293. [PMID: 35294046 PMCID: PMC9111729 DOI: 10.1111/head.14274] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 01/12/2022] [Accepted: 01/16/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic is an ongoing global health crisis that has had a range of impacts on people living with migraine. METHODS Qualitative interviews performed as part of the Migraine Clinical Outcome Assessment System project, a multi-stage Food and Drug Administration-grant funded program to develop a patient-centered core set of outcome measures for use in migraine clinical trials, offered an opportunity to explore the experience of living with migraine during the pandemic as well as to examine whether migraine treatment priorities, symptoms, and associated disability changed due to the pandemic. Semi-structured interviews were conducted in the United States between the summer and fall of 2020 with 40 individuals with self-reported, medically diagnosed migraine who self-reported that they had not tested positive for or been diagnosed with COVID-19. RESULTS Seventy percent (n = 28) of the sample reported ≥1 pandemic-related impact on their life with migraine. Fourteen participants reported both positive and negative impacts, twelve reported negative impacts only, and two reported positive impacts only. Among those reporting ≥1 pandemic-related impact, nine participants (32%) reported more frequent and five (17%) reported less frequent migraine attacks. Other negative impacts included interrupted medical care (n = 9; 32%), and greater stress (n = 13; 46%). The most frequent positive impact reported was greater access to health care (n = 8; 29%). Ictal and interictal symptoms were not noted to change due to the pandemic, but some respondents reported less disability due to increased flexibility of schedules and reduced expectations. Treatment priorities did not change due to the pandemic. CONCLUSION The global COVID-19 pandemic has resulted in both negative and positive impacts for people living with migraine. Lessons to be considered when moving into a post-pandemic world include benefits of and satisfaction with telehealth and the benefits and importance of healthy lifestyle habits and flexibility such as improved sleep, reduced stress, and fewer social expectations.
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Affiliation(s)
- Dawn C. Buse
- Vector Psychometric Group, LLCChapel HillNorth CarolinaUSA
- NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
| | | | | | | | | | | | - Alexis Cooke
- Patient Centered OutcomesOpen Health GroupBethesdaMarylandUSA
| | - Nancy M. Touba
- Patient Centered OutcomesOpen Health GroupBethesdaMarylandUSA
| | | | - R. J. Wirth
- Vector Psychometric Group, LLCChapel HillNorth CarolinaUSA
| | - Richard B. Lipton
- NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
- HeadacheMontefiore Medical CenterBronxNew YorkUSA
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15
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Shapiro HFJ, Sant J, Minster A, Antonelli RC. Development and Evaluation of an Integrated Outpatient Infusion Care Model for the Treatment of Pediatric Headache. Pediatr Neurol 2022; 127:41-47. [PMID: 34959159 DOI: 10.1016/j.pediatrneurol.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 11/10/2021] [Accepted: 11/28/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Care for pediatric patients with headache often occurs in high-cost settings such as emergency departments (EDs) and inpatient settings. Outpatient infusion centers have the potential to reduce care costs for pediatric headache management. METHODS In this quality improvement study, we describe our experience in creating the capacity to support an integrated outpatient pediatric headache infusion care model through an infusion center. We compare costs of receiving headache treatment in this model with those in the emergency and inpatient settings. Because dihydroergotamine (DHE) is a costly infusion, encounters at which DHE was administered were analyzed separately. We track the number of ED visits and inpatient admissions for headache using run charts. As a balancing measure, we compare treatment efficacy between the infusion care model and the inpatient setting. RESULTS The mean percentage increase in cost of receiving headache treatment in the inpatient setting with DHE was 61% (confidence interval [CI]: 30-99%), and that without DHE was 582% (CI: 299-1068%) compared with receiving equivalent treatments in the infusion center. The mean percentage increase in cost of receiving headache treatment in the ED was 30% (CI: -15 to 100%) compared with equivalent treatment in the infusion center. After the intervention, ED visits and inpatient admissions for headache decreased. The mean change in head pain was similar across care settings. CONCLUSIONS Our findings demonstrate that developing an integrated ambulatory care model with infusion capacity for refractory pediatric headache is feasible, and our early outcomes suggest this may have a favorable impact on the overall value of care for this population.
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Affiliation(s)
- Hannah F J Shapiro
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.
| | - Jenifer Sant
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Anna Minster
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
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16
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Burton WN, Schultz AB, Shepherd ME, McCluskey M, Hines D. Results of a Virtual Migraine Education Program in an Employed Population. J Occup Environ Med 2022; 64:52-57. [PMID: 34310543 DOI: 10.1097/jom.0000000000002334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Migraine affects about 15% of the world's population and disproportionately affects adults who are working age. It is associated with higher healthcare costs, absenteeism, and lost productivity. A metropolitan school district in the southern United States offered a virtual migraine education program to their teaching employees. METHODS Seventy-nine employees completed a migraine questionnaire at both baseline and 3-month follow-up. The program included webinars, educational videos, and other intranet-based resources. RESULTS Results found that program participants reported a significant improvement in the frequency and severity of migraine as well as a reduction in lost on-the-job productivity. A majority of participants reported making positive changes to reduce triggers and better manage stress. CONCLUSIONS An employer-offered migraine education program distributed virtually to remote workers has the potential to improve migraine symptoms and treatment as well as productivity.
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Affiliation(s)
- Wayne N Burton
- Environmental and Occupational Sciences, University of Illinois School of Public Health, Chicago, Illinois (Dr Burton); Global Health Management Research Core, Ann Arbor, Michigan (Dr Schultz); Vanderbilt Health at Metro Nashville Public Schools, Nashville, Tennessee (Dr Shepherd); Health and Wellness Disease Education Specialist, Orland Park, Illinois (Ms McCluskey); Employee Benefits, Metro Nashville Public Schools, Nashville, Tennessee (Mr Hines)
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17
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Cerami C, Crespi C, Bottiroli S, Santi GC, Sances G, Allena M, Vecchi T, Tassorelli C. High perceived isolation and reduced social support affect headache impact levels in migraine after the Covid-19 outbreak: A cross sectional survey on chronic and episodic patients. Cephalalgia 2021; 41:1437-1446. [PMID: 34256651 PMCID: PMC8619713 DOI: 10.1177/03331024211027568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/14/2021] [Accepted: 06/01/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Psychosocial variables are key factors influencing psycho-physical equilibrium in migraine patients. Social isolation and vulnerability to stressors may prevent efficient psychological adjustment negatively affecting adaptation to life changes, as that imposed during Covid-19 lockdown. Here, we explored psychosocial dimensions and changes in clinical condition during Covid-19 lockdown in migraine patients, with regard to migraine type and headache impact. METHODS Sixty-four migraine patients (32 episodic and 32 chronic) and 64 healthy control subjects were included in a case-control cross-sectional study. A two-step clustering procedure split patients into two clusters, based on the Headache Impact Test. Perceived global distress, loneliness, empathy, and coping levels were compared in groups, as well as changes in clinical condition. RESULTS Migraine patients reported higher general loneliness and lower social support compared to healthy control subjects. Emotional loneliness was more marked in patients with higher headache impact. This subgroup of patients more frequently reported changes in the therapeutic and care paths as the perceived cause of the occurrence of motor or extra-motor symptomatology. CONCLUSIONS Migraine patients, especially those more severely affected, proved more vulnerable than healthy control subjects to Covid-19 lockdown. Long-lasting interruption of social interactions may be detrimental in fragile patients that are in need of structured support interventions to maintain psycho-physical wellbeing.
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Affiliation(s)
- Chiara Cerami
- Scuola Universitaria Superiore IUSS Pavia, Pavia, Italy
- Cognitive Computational Neuroscience Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Chiara Crespi
- Cognitive Computational Neuroscience Research Unit, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, University of Pavia, Pavia, Italy
| | - Sara Bottiroli
- Faculty of Law, Giustino Fortunato University, Benevento, Italy
- Headache Science and Neurorehabilitation Centre, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Grazia Sances
- Headache Science and Neurorehabilitation Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Marta Allena
- Headache Science and Neurorehabilitation Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Tomaso Vecchi
- Department of Brain and Behavioral Sciences, University of Pavia, University of Pavia, Pavia, Italy
- Cognitive Psychology Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, University of Pavia, Pavia, Italy
- Headache Science and Neurorehabilitation Centre, IRCCS Mondino Foundation, Pavia, Italy
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18
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Amelot A, Jacquot A, Terrier LM, Aggad M, Planty-Bonjour A, Fouquet B, Cook AR, Zemmoura I, Velut S, Destrieux C, François P, Borius PY, Mathon B. Chronic low back pain during COVID-19 lockdown: is there a paradox effect? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 31:167-175. [PMID: 34729679 PMCID: PMC8562766 DOI: 10.1007/s00586-021-07049-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 10/27/2021] [Indexed: 11/28/2022]
Abstract
Purpose The coronavirus 2019 (COVID-19) pandemic led to a compulsory lockdown of 3 months with strict restrictions. The impact of the COVID-19 pandemic has shown broad repercussions on patients with chronic pain; especially for conditions that present a significant emotional participation such as chronic low back pain (cLBP). Methods We performed a prospective study on 50 patients. Pre- and 1-month post-lockdown questionnaires such as: the Impact of Event Scale (IES), the Oswestry Disability Index (ODI), the Roland–Morris questionnaire (RMQ) and the visual analogue scale (VAS) for back and leg pain intensity were collected. Results The mean time of the evolution of cLBP was 33.04 months (range 5–120 months). Eighteen (36%) patients improved their cLBP (i-cLBP), whereas for 14 (28%) it was worse (w-cLBP). Cox multivariate proportional hazard model identified that MODIC 1 disc disease [OR 19.93, IC95% (2.81–102.13), p = 0.015] and at-home workouts [OR 18.854, IC95% (1.151–204.9), p = 0.040] were good prognosis factors of the improvement of cLBP while subclinical/mild Covid-19 anxiety (IES score < 26) was a poor prognosis factor in improving cLBP [OR 0.21, IC95% (0.001–0.384), p = 0.009]. Furthermore, pre-lockdown benzodiazepine medication [OR 2.554, IC95% (1.20–9.9), p = 0.002] was a prognosis factor of worse cLBP. In contrast, patients with severe Covid-19 anxiety (IES score > 26) significantly improved their cLBP [OR 0.58, IC95% (0.025–0.834), p = 0.01]. Conclusion Lockdown affected the somatic component of cLBP by decreasing activities and physical measures, whereas the SARS-CoV-2 pandemic spectrum paradoxically improved the psychic and emotional component of cLBP.
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Affiliation(s)
- Aymeric Amelot
- Department of Neurosurgery, CHU Tours, 2 Boulevard de Tonnelle, 37000, Tours, France.
| | - Anais Jacquot
- Physical Medicine and Rehabilitation Department, CHU de Tours, Tours, France
| | - Louis-Marie Terrier
- Department of Neurosurgery, CHU Tours, 2 Boulevard de Tonnelle, 37000, Tours, France
| | - Mourad Aggad
- Department of Neurosurgery, CHU Tours, 2 Boulevard de Tonnelle, 37000, Tours, France
| | - Alexia Planty-Bonjour
- Department of Neurosurgery, CHU Tours, 2 Boulevard de Tonnelle, 37000, Tours, France
| | - Bernard Fouquet
- Physical Medicine and Rehabilitation Department, CHU de Tours, Tours, France
| | - Ann-Rose Cook
- Department of Neurosurgery, CHU Tours, 2 Boulevard de Tonnelle, 37000, Tours, France
| | - Ilyess Zemmoura
- Department of Neurosurgery, CHU Tours, 2 Boulevard de Tonnelle, 37000, Tours, France
| | - Stephane Velut
- Department of Neurosurgery, CHU Tours, 2 Boulevard de Tonnelle, 37000, Tours, France
| | - Christophe Destrieux
- Department of Neurosurgery, CHU Tours, 2 Boulevard de Tonnelle, 37000, Tours, France
| | - Patrick François
- Department of Neurosurgery, CHU Tours, 2 Boulevard de Tonnelle, 37000, Tours, France
| | | | - Bertrand Mathon
- Department of Neurosurgery, La Pitié-Salpêtrière, Paris, France
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19
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Grozeva V, Mínguez-Olaondo A, Vila-Pueyo M. Experiment in vivo: How COVID-19 Lifestyle Modifications Affect Migraine. Front Neurol 2021; 12:744796. [PMID: 34707560 PMCID: PMC8544242 DOI: 10.3389/fneur.2021.744796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/03/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: The coronavirus disease 2019 (COVID-19) pandemic represents a unified lifestyle modification model, which was developed by the globally applied measures. The lockdowns designed the perfect study settings for observing the interaction between migraine and the adopted changes in lifestyle. An experiment in vivo took place unexpectedly to determine how the lockdown lifestyle modifications can influence migraine. Subsection 1: Overall lifestyle modifications during the pandemic: People stay home, and outdoor activities and public contacts are restricted. Sleep is disturbed. Media exposure and prolonged screen use are increased. Working conditions change. In-person consultations and therapies are canceled. The beneficial effects of short-term stress, together with the harmful effects of chronic stress, were observed during the pandemic. Subsection 2: Short-term effects: Substantial lifestyle changes happened, and knowing how vulnerable migraine patients are, one could hypothesize that this would have resulted in severe worsening of headache. Surprisingly, even though the impacts of changing social conditions were significant, some patients (including children) experienced a reduction in their migraine during the first lockdown. Subsection 3: Long-term effects: Unfortunately, headache frequency returned to the basal state during the second pandemic wave. The risk factors that could have led to this worsening are the long-term disruption of sleep and dietary habits, stress, anxiety, depression, non-compliance to treatment, and working during the pandemic. Discussion: Sudden short-term lifestyle changes taking migraine patients out of their usual routine may be beneficial for headache management. It is not necessary to have a natural disaster in place for a drastic lifestyle modification with 6–8-week duration, if we know that this will improve migraine.
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Affiliation(s)
| | - Ane Mínguez-Olaondo
- Department of Neurology, Hospital Universitario Donostia, San Sebastián, Spain
| | - Marta Vila-Pueyo
- Headache Group, Wolfson Centre for Age Related Diseases, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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20
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Abstract
The COVID-19 pandemic has spread rapidly across the world in 2020, affecting both adults and, to a lesser extent, children. In this article, the authors describe the neurologic manifestations of COVID-19 in children, including the epidemiology, pathogenesis, clinical features, laboratory and imaging findings, and treatment options. The management of patients with concomitant neuroimmunologic disorders and drug interactions between medications used to treat COVID-19 and other neurologic disorders (especially immune-modifying drugs) is also discussed.
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Affiliation(s)
- Tuhina Govil-Dalela
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA; Department of Neurology, Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA; Department of Pediatric Neurology, Children's Hospital of Michigan Specialty Center, 2nd Floor, 3950 Beaubien Street, Detroit, MI 48202, USA
| | - Lalitha Sivaswamy
- Department of Pediatric Neurology, Children's Hospital of Michigan Specialty Center, 2nd Floor, 3950 Beaubien Street, Detroit, MI 48202, USA; Department of Pediatrics, Central Michigan University, Pleasant, MI, USA; Department of Neurology, Central Michigan University, Pleasant, MI, USA.
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21
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Underuse of Behavioral Treatments for Headache: a Narrative Review Examining Societal and Cultural Factors. J Gen Intern Med 2021; 36:3103-3112. [PMID: 33527189 PMCID: PMC7849617 DOI: 10.1007/s11606-020-06539-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/21/2020] [Indexed: 12/26/2022]
Abstract
Migraine affects over 40 million Americans and is the world's second most disabling condition. As the majority of medical care for migraine occurs in primary care settings, not in neurology nor headache subspecialty practices, healthcare system interventions should focus on primary care. Though there is grade A evidence for behavioral treatment (e.g., biofeedback, cognitive behavioral therapy (CBT), and relaxation techniques) for migraine, these treatments are underutilized. Behavioral treatments may be a valuable alternative to opioids, which remain widely used for migraine, despite the US opioid epidemic and guidelines that recommend against them. Identifying and removing barriers to the use of headache behavioral therapy could help reduce the disability as well as the personal and social costs of migraine. These techniques will have their greatest impact if offered in primary care settings to the lower socioeconomic status groups at greatest risk for migraine. We review the societal and cultural challenges that impose barriers to optimal use of non-pharmacological treatment services. These barriers include insufficient knowledge of migraine/headache behavioral treatments and insufficient availability of clinicians trained in non-pharmacological treatment delivery; limited access in underserved communities; financial burden; and stigma associated with both headache and mental health diagnoses and treatment. For each barrier, we discuss potential approaches to minimizing its effect and thus enhancing non-pharmacological treatment utilization.Case ExampleA 25-year-old graduate student with a prior history of headaches in college is attending school in the evenings while working a full-time job. Now, his headaches have significant nausea and photophobia. They are twice weekly and are disabling enough that he is unable to complete homework assignments. He does not understand why the headaches occur on Saturdays when he pushes through all week to get through his examinations that take place on Friday evenings. He tried two different migraine preventive medications, but neither led to the 50% reduction in headache days his doctor had hoped for. His doctor had suggested cognitive behavioral therapy (CBT) before initiating the medications, but he had been too busy to attend the appointments, and the challenges in finding an in-network provider proved difficult. Now with the worsening headaches, he opted for the CBT and by the fifth week had already noted improvements in his headache frequency and intensity.
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22
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Gonzalez-Martinez A, Planchuelo-Gómez Á, Guerrero ÁL, García-Azorín D, Santos-Lasaosa S, Navarro-Pérez MP, Odriozola-González P, Irurtia MJ, Quintas S, de Luis-García R, Gago-Veiga AB. Evaluation of the Impact of the COVID-19 Lockdown in the Clinical Course of Migraine. PAIN MEDICINE 2021; 22:2079-2091. [PMID: 33659991 PMCID: PMC8108628 DOI: 10.1093/pm/pnaa449] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Previous studies have demonstrated that emotional stress, changes in lifestyle habits and infections can worsen the clinical course of migraine. We hypothesize that changes in habits and medical care during coronavirus disease 2019 (COVID-19) lockdown might have worsened the clinical course of migraine. DESIGN Retrospective survey study collecting online responses from migraine patients followed-up by neurologists at three tertiary hospitals between June and July 2020. METHODS We used a web-based survey that included demographic data, clinical variables related with any headache (frequency) and migraine (subjective worsening, frequency, and intensity), lockdown, and symptoms of post-traumatic stress. RESULTS The response rate of the survey was 239/324 (73.8%). The final analysis included 222 subjects. Among them, 201/222 (90.5%) were women, aged 42.5 ± 12.0 (mean±SD). Subjective improvement of migraine during lockdown was reported in 31/222 participants (14.0%), while worsening in 105/222 (47.3%) and was associated with changes in migraine triggers such as stress related to going outdoors and intake of specific foods or drinks. Intensity of attacks increased in 67/222 patients (30.2%), and it was associated with the subjective worsening, female sex, recent insomnia, and use of acute medication during a headache. An increase in monthly days with any headache was observed in 105/222 patients (47.3%) and was related to symptoms of post-traumatic stress, older age and living with five or more people. CONCLUSIONS Approximately half the migraine patients reported worsening of their usual pain during the lockdown. Worse clinical course in migraine patients was related to changes in triggers and the emotional impact of the lockdown.
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Affiliation(s)
- Alicia Gonzalez-Martinez
- Headache Unit, Department of Neurology, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain.,Department of Neurology, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Ángel L Guerrero
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - David García-Azorín
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Sonia Santos-Lasaosa
- Headache Unit, Department of Neurology, Hospital Clínico Universitario Lozano Blesa & Aragon Institute for Health Research (IIS Aragón), Zaragoza, Spain
| | - María Pilar Navarro-Pérez
- Headache Unit, Department of Neurology, Hospital Clínico Universitario Lozano Blesa & Aragon Institute for Health Research (IIS Aragón), Zaragoza, Spain
| | | | | | - Sonia Quintas
- Headache Unit, Department of Neurology, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain.,Department of Neurology, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Ana Beatriz Gago-Veiga
- Headache Unit, Department of Neurology, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain.,Department of Neurology, Universidad Autónoma de Madrid, Madrid, Spain
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23
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Joshi C, Jacobson M, Silveira L, Shea S, Yang M, Eschbach K. Risk of Admission to the Emergency Room/Inpatient Service After a Neurology Telemedicine Visit During COVID-19 Pandemic. Pediatr Neurol 2021; 122:15-19. [PMID: 34243046 PMCID: PMC9758016 DOI: 10.1016/j.pediatrneurol.2021.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND We compared emergency department (ED) and overnight inpatient admission (admission) rates within eight weeks of home-based telemedicine visits during COVID-19 in 2020 with in-person visits (conventional visit) in 2019. This was a quality improvement project prompted by an adverse event after a telemedicine visit. METHODS We reviewed all completed telemedicine and conventional visits from March 26 to June 1 of 2020 and 2019 to identify patients who required an ED visit or hospital admission within eight weeks after the visit. RESULTS In 2020, the overall rate of ED visits of hospital admission within eight weeks of a neurology visit was less than 5%. Comparing 2020 with 2019: (1) cohorts were similar for age, payor, state of residence, medical complexity, recommendation for close follow-up, new medications, or new tests ordered; (2) it took longer to present to the ED (by 10 days) or to be hospitalized (by three days); (3) planned admissions were approximately 50% lower; (4) on multivariate analysis, risk factors for any ED/admission included a patient call within seven days before the ED/admission (P = 0.0004) or being seen by an epilepsy specialist (P = 0.02); (5) a presenting complaint of worsening symptoms had a lower odds ratio of subsequent ED visit/admission (P = 0.005). CONCLUSIONS Telemedicine is safe, with a similar likelihood of ED or hospital admission during the pandemic in 2020 versus before the pandemic in 2019. In 2020, even if patients described worse symptoms at the time of their clinic visit, the odds of ED or hospital admission were lower than in 2019, but those who called after the telemedicine visit were more likely to be seen in ED or require hospitalization.
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Affiliation(s)
- Charuta Joshi
- Division of Pediatric Neurology, Children's Hospital Colorado, Anschutz Medical Centre, University of Colorado School of Medicine, Aurora, Colorado.
| | - Mona Jacobson
- Division of Pediatric Neurology, Children's Hospital Colorado, Anschutz Medical Centre, University of Colorado School of Medicine, Aurora, Colorado
| | - Lori Silveira
- Department of Pediatrics, Children's Hospital Colorado, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colorado
| | - Stephanie Shea
- Division of Pediatric Neurology, Children's Hospital Colorado, Anschutz Medical Centre, University of Colorado School of Medicine, Aurora, Colorado
| | - Michele Yang
- Division of Pediatric Neurology, Children's Hospital Colorado, Anschutz Medical Centre, University of Colorado School of Medicine, Aurora, Colorado
| | - Krista Eschbach
- Division of Pediatric Neurology, Children's Hospital Colorado, Anschutz Medical Centre, University of Colorado School of Medicine, Aurora, Colorado
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24
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Strauss LD, Yugrakh MS, Kaplan KE, Minen MT. Headache infusion centers: A survey on treatments provided, infusion center operations, and barriers to developing new infusion centers. Headache 2021; 61:1364-1375. [PMID: 34378185 DOI: 10.1111/head.14172] [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: 08/25/2020] [Revised: 05/17/2021] [Accepted: 05/27/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infusion therapy refers to the intravenous administration of medicines and fluids for the treatment of status migrainosus, severe persistent headaches, or chronic headache. Headache practices and centers offer this treatment for patients as an alternative to the emergency department (ED) setting. However, little information is available in the literature on understanding the operations of an infusion center. OBJECTIVE We sought to survey the Inpatient Headache & Emergency Medicine specialty section and the Academic Program Directors listserv of the American Headache Society (AHS) to better understand current practices. METHODS A survey was advertised and distributed to the listservs of both the Inpatient Headache & Emergency Medicine specialty section and the Academic Program Directors, which combined included both academic and private practices. In addition, the survey was available on laptops at related events at an annual AHS meeting in Scottsdale. RESULTS Of the 127 members of the combined group of both listservs, 50 responded with an overall survey response rate of 39%. Ten out of fifty were from programs with more than one responder completing the survey, leaving 40 unique headache programs. Academic programs made up the majority of programs (85%, 34/40). The total of 40 participating programs is comparable with the 47 academic headache programs listed on the American Migraine Foundation website at the time of the survey. Of the academic programs surveyed, most were hospital based (n = 23) compared with a satellite location (n = 11). Of all programs surveyed, 68% (27/40) offered infusion therapy. Of those that did not have an infusion practice (n = 13), the most common reason cited was insufficient staffing (n = 8). Key highlights of the survey included the following: The majority of programs offering infusions obtain prior authorization before scheduling (70%, 19/27) and offer patient availability 5 days/week (78%, 21/27) typically only during business hours (81%, 22/27). Programs reported that they typically give three to four medications during each infusion session (72%, 18/25). Treatment paradigms varied between programs. Programs surveyed were concentrated in the Northeast and Midwest regions of the United States. CONCLUSION The limited number of headache infusion centers overall may contribute to the limited ability of headache infusion centers to prevent ED migraine visits. Headache patients can have unpredictable headache onset, and most of the infusion practices surveyed appeared to adapt to this by offering infusions most days during a work week. However, this need for multiple days per week may also explain the most common reason for not having an infusion practice, which is insufficient staffing. Various treatment paradigms are implemented by different practitioners, and future studies will have to focus on investigation of best practice.
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Affiliation(s)
- Lauren Doyle Strauss
- Department of Neurology, Wake Forest Baptist Medical Center, Brenner Children's Hospital, Winston-Salem, NC, USA
| | | | | | - Mia T Minen
- Department of Neurology, NYU Langone Health, New York, NY, USA.,Department of Population Health, NYU Langone Health, New York, NY, USA
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Sato K, Mano T, Niimi Y, Iwata A, Toda T, Iwatsubo T. The impact of COVID-19 pandemic on the utilization of ambulatory care for patients with chronic neurological diseases in Japan: Evaluation of an administrative claims database. Biosci Trends 2021; 15:219-230. [PMID: 34261836 DOI: 10.5582/bst.2021.01194] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The COVID-19 pandemic has affected not only the emergency medical system, but also patients' regular ambulatory care, as such decrease in the number of patients visiting outpatient clinics decreased in 2020 than in 2019, or the ban lifting of subsequent visits by telephone for outpatient clinics since March 2020 in lieu of ambulatory care for chronic diseases. In this context, we investigate the impact of the COVID-19 pandemic on ambulatory care at Japanese outpatient clinics for patients with chronic neurological diseases during 2020. We collected data from the administrative claims database (DeSC database) covering more than 1 million individuals. Serial changes in the frequency of subsequent outpatient visits to clinics or hospitals (excluding large hospitals) for chronic ambulatory care of epilepsy, migraine, Parkinson's disease (PD), and Alzheimer's disease (AD) in 2020 were measured. As a result, since April 2020, the monthly outpatient visits for epilepsy, PD, and AD decreased slightly but significantly (approximately 0.90 in relative risk [RR]) but visits for migraine increased (RR = 1.15). Telephone visit was most frequently used in April-May, in less than 5% of monthly outpatient clinic visits for the examined neurological diseases. Outpatient visits for migraine treatment were more likely to be done by telephone than in case of other diseases (adjusted Odds ratio = 2.08). These results suggest that the impact of COVID-19 pandemic on regular ambulatory care for several chronic neurological diseases yielded different effect depending on the disease, in terms of the frequency or type of outpatient visits.
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Affiliation(s)
- Kenichiro Sato
- Department of Neuropathology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.,Department of Neurology, The University of Tokyo Hospital, Tokyo, Japan
| | - Tatsuo Mano
- Department of Neurology, The University of Tokyo Hospital, Tokyo, Japan
| | - Yoshiki Niimi
- Unit for Early and Exploratory Clinical Development, The University of Tokyo Hospital, Tokyo, Japan
| | - Atsushi Iwata
- Department of Neurology, Tokyo Metropolitan Geriatric Center Hospital, Tokyo, Japan
| | - Tatsushi Toda
- Department of Neurology, The University of Tokyo Hospital, Tokyo, Japan
| | - Takeshi Iwatsubo
- Department of Neuropathology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.,Unit for Early and Exploratory Clinical Development, The University of Tokyo Hospital, Tokyo, Japan
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Fernández-de-las-Peñas C, Gómez-Mayordomo V, García-Azorín D, Palacios-Ceña D, Florencio LL, Guerrero AL, Hernández-Barrera V, Cuadrado ML. Previous History of Migraine Is Associated With Fatigue, but Not Headache, as Long-Term Post-COVID Symptom After Severe Acute Respiratory SARS-CoV-2 Infection: A Case-Control Study. Front Hum Neurosci 2021; 15:678472. [PMID: 34295230 PMCID: PMC8290894 DOI: 10.3389/fnhum.2021.678472] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/03/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To investigate the association of pre-existing migraine in patients hospitalised and who recovered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with the presence of post-coronavirus disease (COVID) symptoms. BACKGROUND No study has investigated the role of migraine as a risk factor for development of post-COVID symptoms. METHODS A case-control study including individuals hospitalised during the first wave of the pandemic (from February 20 to May 31, 2020) was conducted. Patients with confirmed previous diagnosis of migraine were considered cases. Two age- and sex-matched individuals without a history of headache per case were also recruited as controls. Hospitalisation/clinical data were collected from hospital medical records. Patients were scheduled for a telephone interview. A list of post-COVID symptoms was systematically evaluated, but participants were invited to freely report any symptom. The Hospital Anxiety and Depression Scale and the Pittsburgh Sleep Quality Index were used to assess anxiety/depressive symptoms and sleep quality. Multivariable conditional logistic regression models were constructed. RESULTS Overall, 57 patients with confirmed diagnosis of migraine and 144 non-migraine controls who had recovered from COVID-19 were assessed at 7.3 months (SD 0.6) after hospital discharge. The number of post-COVID symptoms in the migraine group was significantly greater (OR 1.70, 95% CI 1.29-2.25, P < 0.001) than in the non-migraine group. Fatigue was significantly more prevalent (OR 2.89, 95% CI 1.32-6.32, P = 0.008) in the migraine group. However, no between-groups difference in the prevalence of headache as a post-COVID symptom was detected. CONCLUSION Patients with a history of migraine who recovered from COVID-19 exhibited more long-term fatigue as post-COVID sequelae than those without migraine. Some of the pathophysiological changes associated with migraine could predispose to the occurrence of post-COVID symptoms.
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Affiliation(s)
- César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain
| | | | - David García-Azorín
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Neuroscience Research Unit, Institute for Biomedical Research of Salamanca, Salamanca, Spain
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Lidiane L. Florencio
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Angel L. Guerrero
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Neuroscience Research Unit, Institute for Biomedical Research of Salamanca, Salamanca, Spain
- Department of Medicine, Universidad de Valladolid, Valladolid, Spain
| | | | - María L. Cuadrado
- Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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Raffaelli B, Mecklenburg J, Scholler S, Overeem LH, Oliveira Gonçalves AS, Reuter U, Neeb L. Primary headaches during the COVID-19 lockdown in Germany: analysis of data from 2325 patients using an electronic headache diary. J Headache Pain 2021; 22:59. [PMID: 34157977 PMCID: PMC8218554 DOI: 10.1186/s10194-021-01273-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 06/07/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Lockdown measures due to the COVID-19 pandemic have led to lifestyle changes, which in turn may have an impact on the course of headache disorders. We aimed to assess changes in primary headache characteristics and lifestyle factors during the COVID-19 lockdown in Germany using digital documentation in the mobile application (app) M-sense. MAIN BODY We analyzed data of smartphone users, who entered daily data in the app in the 28-day period before lockdown (baseline) and in the first 28 days of lockdown (observation period). This analysis included the change of monthly headache days (MHD) in the observation period compared to baseline. We also assessed changes in monthly migraine days (MMD), the use of acute medication, and pain intensity. In addition, we looked into the changes in sleep duration, sleep quality, energy level, mood, stress, and activity level. Outcomes were compared using paired t-tests. The analysis included data from 2325 app users. They reported 7.01 ± SD 5.64 MHD during baseline and 6.89 ± 5.47 MHD during lockdown without significant changes (p > 0.999). MMD, headache and migraine intensity neither showed any significant changes. Days with acute medication use were reduced from 4.50 ± 3.88 in the baseline to 4.27 ± 3.81 in the observation period (p < 0.001). The app users reported reduced stress levels, longer sleep duration, reduced activity levels, along with a better mood, and an improved energy level during the first lockdown month (p ≤ 0.001). In an extension analysis of users who continued to use M-sense every day for 3 months after initiation of lockdown, we compared the baseline and the subsequent months using repeated-measures ANOVA. In these 539 users, headache frequency did not change significantly neither (6.11 ± 5.10 MHD before lockdown vs. 6.07 ± 5.17 MHD in the third lockdown month, p = 0.688 in the ANOVA). Migraine frequency, headache and migraine intensity, and acute medication use were also not different during the entire observation period. CONCLUSION Despite slight changes in factors that contribute to the generation of headache, COVID-19-related lockdown measures did not seem to be associated with primary headache frequency and intensity over the course of 3 months.
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Affiliation(s)
- Bianca Raffaelli
- Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Jasper Mecklenburg
- Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Simon Scholler
- Newsenselab GmbH, Blücherstraße 22, 10961, Berlin, Germany
| | - Lucas Hendrik Overeem
- Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | | | - Uwe Reuter
- Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Lars Neeb
- Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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28
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Impact of the COVID-19 pandemic on migraine in Japan: a multicentre cross-sectional study. J Headache Pain 2021; 22:53. [PMID: 34098873 PMCID: PMC8182734 DOI: 10.1186/s10194-021-01263-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/24/2021] [Indexed: 12/13/2022] Open
Abstract
Objectives To assess the impacts of social situation changes due to the coronavirus disease 2019 (COVID-19) pandemic on headache-related disability and other symptoms in patients with migraine in Japan. Methods We conducted a multicentre, cross-sectional study including 659 outpatients with migraine diagnosed by headache specialists. The participants were asked about the impacts of the first wave of the COVID-19 pandemic on headache-related disability, headache days, headache intensity, stress, physical activity, hospital access and their work and home lives. For headache-related disability, the total Migraine Disability Assessment (MIDAS) score and part A and B scores were analysed. Multivariate stepwise linear regression analysis was performed to identify the clinical predictors of changes in the total MIDAS score before and during the COVID-19 pandemic. Logistic regression analysis was performed to determine the factors related to new-onset headache during the COVID-19 pandemic. Results Finally, 606 migraine patients (73 M/533 F; age, 45.2 ± 12.0 years) were included in the study, excluding those with incomplete data. Increased stress, substantial concern about COVID-19 and negative impacts of the first wave of the COVID-19 pandemic on daily life were reported in 56.8 %, 55.1 and 45.0 % of the participants, respectively. The total MIDAS and A and B scores did not significantly change after the first wave of the COVID-19 pandemic. New-onset headache, which was observed in 95 patients (15.7 %), was associated with younger age and worsened mood and sleep in the logistic regression analysis. The multivariate stepwise linear regression analysis of changes in the total MIDAS score before and during the first wave of COVID-19 pandemic identified worsened sleep, increased acute medication use, increased stress, medication shortages, comorbidities, the absence of an aura and new-onset headache were determinants of an increased total MIDAS score during the first wave of the COVID-19 pandemic. Conclusions In this multicentre study, clinical factors relevant to headache-related disability, such as new-onset headache, stress and sleep disturbances, were identified, highlighting the importance of symptom management in migraine patients during the first wave of the COVID-19 pandemic. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-021-01263-1.
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Alqahtani M, Barmherzig R, Lagman-Bartolome AM. Approach to Pediatric Intractable Migraine. Curr Neurol Neurosci Rep 2021; 21:38. [PMID: 34089140 DOI: 10.1007/s11910-021-01128-9] [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: 05/27/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW Intractable migraine in children and adolescents is a significant cause of disability and decreased quality of life (QoL) in this population. Challenges include lack of unifying definition for intractable migraine, and limited data on best-practice management in this age group, with most current treatment pathways extrapolated from adult studies or expert consensus. RECENT FINDINGS A comprehensive approach in the evaluation and management of intractable migraine in this age group encompasses excluding secondary causes of headache; making an accurate diagnosis; identifying and appropriately managing modifiable risk factors; and initiating appropriate pharmacologic therapy to reduce disability, improve health-related quality of life, reduce risk of progression, and develop adaptive pain coping strategies. Several strategies for management of pediatric intractable migraine including use of acute medications, bridge therapy in outpatient setting, emerging therapies for preventive therapy, and a stepwise combination therapy for management of pediatric intractable migraine in emergency and inpatient setting are presented based on available clinical data, safety/tolerability, availability, cost-effectiveness, and expert consensus. This descriptive review of the available literature focuses on approach to therapy for acute intractable migraine in a pediatric population including outpatient, emergency department (ED), and inpatient management.
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Affiliation(s)
- Mohammed Alqahtani
- Division of Neurology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - Rebecca Barmherzig
- Pediatric Headache Program, Division of Neurology, Children's Hospital of Philadelphia (CHOP), 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Ana Marissa Lagman-Bartolome
- Division of Neurology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada. .,Centre for Headache, Women's College Hospital, University of Toronto, 76 Grenville Street, Toronto, Ontario, M5B1S2, Canada.
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Li C, Li Y, Ma M, Zhang Y, Bao J, Ge W, Liu Y, Peng C, He L. The impact of COVID-19 pandemic on headache symptoms and drug withdrawal among patients with medication overuse headache: a cross-sectional study. J Headache Pain 2021; 22:41. [PMID: 34020588 PMCID: PMC8139545 DOI: 10.1186/s10194-021-01256-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/10/2021] [Indexed: 02/08/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) bring about a range of psychological distress and symptom deterioration to headache patients especially to some migraineurs. Compared to migraineurs or normal control, medication overuse headache (MOH) patients are more likely to experience a worse psychological distress and poorer outcome in non-COVID-19 time. However, in COVID-19 pandemic, whether MOH patients would have greater physical and mental symptom deterioration or worse relief of headache symptoms and medications overuse remained unclear. We aim to investigate the impact of COVID-19 on MOH patients to guide for a better management in this study. Methods We enrolled MOH patients who were diagnosed and treated at headache clinic of West China Hospital. Information of the pre-pandemic 3 months period and COVID-19 pandemic period was collected. Univariate and multivariate logistic regression were performed to identify independent factors associated with changes in headache symptoms and drug withdrawal. Results Seventy-eight MOH patients were enrolled into the study ultimately. In comparison to pre-pandemic period, fewer MOH patients reported decreased headache days, intensity and days with acute medications per month during the pandemic. Available access to regular prophylactic medications was significantly associated with a reduction of at least 50% in headache days and decrease in headache intensity per month with respective odds ratios of 39.19 (95% CI 3.75–409.15, P = 0.002) and 10.13 (95% CI 2.33–44.12, P = 0.002). Following abrupt withdrawal and high educational level were both significant factors in decreasing headache intensity. Male sex was significantly associated with decrease in days with acute medication per month during the pandemic (odds ratios 4.78, 95%CI 1.44–15.87, P = 0.011). Conclusions Our findings reflect that MOH patients experienced a worse relief of headache symptoms and drug withdrawal during the pandemic. Available access to regular prophylactic medications was the significant independent factor for improvement of headache symptoms. Male sex was significantly associated with decreased days with acute medications per month.
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Affiliation(s)
- Changling Li
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Wainan Guoxue Xiang, Chengdu, 610041, China
| | - Yanbo Li
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Wainan Guoxue Xiang, Chengdu, 610041, China
| | - Mengmeng Ma
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Wainan Guoxue Xiang, Chengdu, 610041, China
| | - Yang Zhang
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Wainan Guoxue Xiang, Chengdu, 610041, China
| | - Jiajia Bao
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Wainan Guoxue Xiang, Chengdu, 610041, China
| | - Wenjing Ge
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Wainan Guoxue Xiang, Chengdu, 610041, China
| | - Yanqin Liu
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Wainan Guoxue Xiang, Chengdu, 610041, China
| | - Cheng Peng
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Wainan Guoxue Xiang, Chengdu, 610041, China
| | - Li He
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Wainan Guoxue Xiang, Chengdu, 610041, China.
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Dias L, Martins B, Pinto MJ, Rocha AL, Pinto M, Costa A. Headache teleconsultation in the era of COVID-19: Patients' evaluation and future directions. Eur J Neurol 2021; 28:3798-3804. [PMID: 33991365 PMCID: PMC8239939 DOI: 10.1111/ene.14915] [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: 04/19/2021] [Accepted: 05/05/2021] [Indexed: 12/22/2022]
Abstract
Background and purpose Literature regarding headache teleconsultation and patient satisfaction is scarce. The SARS‐CoV‐2 pandemic led to the restructuring of traditional clinical activity by adopting telemedicine. Our objectives were to evaluate patients' satisfaction with headache teleconsultation by telephone during the SARS‐CoV‐2 pandemic and assess patients' preferred model of appointment (face‐to‐face, teleconsultation by telephone, or both). Methods Patients with a previous diagnosis of primary headache or neuropathies and facial pain disorders, and at least one telephone headache visit during the first wave of COVID‐19, filled out an online questionnaire regarding sociodemographic parameters, satisfaction with teleconsultation, and preferred model of appointment. Results We included 83 patients (valid response rate of 64.3%); most had migraine (83.1%). Regarding teleconsultation, 81.9% considered this model adequate for follow‐up, 88.0% were satisfied with the information provided about the disease/treatment, and 73.5% were satisfied with the medication modification. Ninety percent would agree with a new tele‐evaluation if stable after the pandemic. The mixed model was the preferred medical consultation type for the postpandemic period (43.4%), followed by face‐to‐face visits (33.7%). Conclusions Patients were satisfied with the headache teleconsultation during the COVID‐19 era. However, an exclusive model of telemedicine does not seem suitable for monitoring all patients. A mixed approach could be integrated into clinical practice after the pandemic to optimize health care.
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Affiliation(s)
- Leonor Dias
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal.,Clinical Neuroscience and Mental Health Department, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Bárbara Martins
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal.,Clinical Neuroscience and Mental Health Department, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Maria João Pinto
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal.,Clinical Neuroscience and Mental Health Department, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ana Luísa Rocha
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal.,Clinical Neuroscience and Mental Health Department, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Madalena Pinto
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal
| | - Andreia Costa
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal.,Clinical Neuroscience and Mental Health Department, Faculty of Medicine, University of Porto, Porto, Portugal
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The impact of Coronavirus disease 2019 (COVID-19) pandemic on migraine disorder. J Neurol 2021; 268:4429-4435. [PMID: 33950336 PMCID: PMC8098636 DOI: 10.1007/s00415-021-10590-x] [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: 03/08/2021] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 12/05/2022]
Abstract
Objective To evaluate the impact of the Coronavirus disease of 2019 (COVID‐19) pandemic on patients with migraine. Methods Self-reported data from a migraine tracking smartphone application, Migraine Buddy, were used. Data were collected from users who reported at least one attack in the Jan, Feb, Mar and Apr of 2018, 2019 and 2020. In addition, a survey was conducted to evaluate the impact of COVID‐19 on migraine management. Results On average, data from 124,717 users per month (mean age 36.3 ± 10.9 years and 89% female) were collected. Overall, the mean frequency of migraine headache was higher in 2020 than in 2019 and higher in 2019 than in 2018. The four commonest headache triggers in 2018, 2019 and 2020 were stress in 39.7, 38.4 and 36.1%, lack of sleep in 25, 25 and 22.8%, neck pain, 20, 20.4 and 19.3 and anxiety in 19, 18.4 and 18.4% of participants, respectively. 1689 users participated in the survey and they reported that they preferred face-to-face (54.29%) to telehealth (11.9%) consultations. Conclusion An increase in migraine frequency from 2018 to 2020 was reported by the users of the mobile phone. This could reflect a real increase or change in reporting habits. Stress, lack of sleep, neck pain and anxiety were the commonest attack triggers. The frequency of these triggers decreased slightly in 2020 compared to 2019 and 2018. An increase in telehealth consultations with specialists was reported in the survey but migraine patients preferred face-to-face consultations.
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Chiang C, Halker Singh R, Lalvani N, Shubin Stein K, Henscheid Lorenz D, Lay C, Dodick DW, Newman LC. Patient experience of telemedicine for headache care during the COVID-19 pandemic: An American Migraine Foundation survey study. Headache 2021; 61:734-739. [PMID: 34021595 PMCID: PMC8206943 DOI: 10.1111/head.14110] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 03/03/2021] [Accepted: 03/17/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We sought to investigate the patient experience of telemedicine for headache care during the coronavirus disease 2019 (COVID-19) pandemic. BACKGROUND The use of telemedicine has rapidly expanded and evolved since the beginning of the COVID-19 pandemic. Telemedicine eliminates the physical and geographic barriers to health care, preserves personal protective equipment, and prevents the spread of COVID-19 by allowing encounters to happen in a socially distanced way. However, few studies have assessed the patient perspective of telemedicine for headache care. METHODS The American Migraine Foundation (AMF) designed a standardized electronic questionnaire to assess the patient experience of telemedicine for headache care between March and September 2020 to help inform future quality improvement as part of its patient advocacy initiative. The date parameters were identified as the emergence of severe acute respiratory syndrome coronavirus 2 disease and the declaration of a national emergency in the United States. The questionnaire was distributed electronically to more than 100,000 members of the AMF community through social media platforms and the AMF email database. RESULTS A total of 1172 patients responded to our electronic questionnaire, with 1098 complete responses. The majority, 1081/1153 (93.8%) patients, had a previous headache diagnosis prior to the telemedicine encounter. A total of 648/1127 (57.5%) patients reported that they had used telemedicine for headache care during the study period. Among those who participated in telehealth visits, 553/647 (85.5%) patients used it for follow-up visits; 94/647 (14.5%) patients used it for new patient visits. During the telemedicine encounters, 282/645 (43.7%) patients were evaluated by headache specialists, 222/645 (34.4%) patients by general neurologists, 198/645 (30.7%) patients by primary care providers, 73/645 (11.3%) patients by headache nurse practitioners, and 21/645 (3.2%) patients by headache nurses. Only 47/633 (7.4%) patients received a new headache diagnosis from telemedicine evaluation, whereas the other 586/633 (92.6%) patients did not have a change in their diagnoses. During these visits, a new treatment was prescribed for 358/636 (52.3%) patients, whereas 278/636 (43.7%) patients did not have changes made to their treatment plan. The number (%) of patients who rated the telemedicine headache care experience as "very good," "good," "fair," "poor," and "other" were 396/638 (62.1%), 132/638 (20.7%), 67/638 (10.5%), 23/638 (3.6%), and 20/638 (3.1%), respectively. Detailed reasons for "other" are listed in the manuscript. Most patients, 573/638 (89.8%), indicated that they would prefer to continue to use telemedicine for their headache care, 45/638 (7.1%) patients would not, and 20/638 (3.1%) patients were unsure. CONCLUSIONS Our study evaluating the patient perspective demonstrated that telemedicine facilitated headache care for many patients during the COVID-19 pandemic, resulting in high patient satisfaction rates, and a desire to continue to use telemedicine for future headache care among those who completed the online survey.
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Affiliation(s)
| | | | - Nim Lalvani
- American Migraine FoundationMount RoyalNJUSA
| | - Ken Shubin Stein
- Department of NeurologyNorthwell Health, Zucker School of MedicineHempsteadNYUSA
| | | | - Christine Lay
- Department of NeurologyUniversity of TorontoTorontoONCanada
| | | | - Lawrence C. Newman
- Department of NeurologyNew York University Langone Medical CenterNew YorkNYUSA
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Di Stefano V, Ornello R, Gagliardo A, Torrente A, Illuminato E, Caponnetto V, Frattale I, Golini R, Di Felice C, Graziano F, Caccamo M, Ventimiglia D, Iacono S, Matarazzo G, Armetta F, Battaglia G, Firenze A, Sacco S, Brighina F. Social Distancing in Chronic Migraine during the COVID-19 Outbreak: Results from a Multicenter Observational Study. Nutrients 2021; 13:1361. [PMID: 33921674 PMCID: PMC8074143 DOI: 10.3390/nu13041361] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The restrictions taken to control the rapid spread of COVID-19 resulted in a sudden, unprecedented change in people's lifestyle, leading to negative consequences on general health. This study aimed to estimate the impact of such changes on migraine severity during 2020 March-May lockdown. METHODS Patients affected by migraine with or without aura, diagnosed by expert physicians, completed a detailed interview comprehensive of: assessment of migraine characteristics; measure of physical activity (PA) levels; measure of the intake frequency of main Italian foods; the Insomnia Severity Index (ISI) questionnaire investigating sleep disorders. RESULTS We included 261 patients with a mean age of 44.5 ± 12.3 years. During social distancing, 72 patients (28%) reported a headache worsening, 86 (33%) an improvement, and 103 (39%) a stable headache frequency. A significant decrease of the PA levels during COVID-19 quarantine in the whole study sample was observed (median total metabolic equivalent task (METs) decreased from 1170 to 510; p < 0.001). Additionally, a significant difference was reported on median ISI scores (from 7 to 8; p < 0.001), which were increased in patients who presented a stable or worsening headache. CONCLUSIONS Our study confirmed that the restrictions taken during the pandemic have affected the practice of PA levels and sleep quality in migraine. Hence, PA and sleep quality should be assessed to find strategies for an improvement in quality of life.
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Affiliation(s)
- Vincenzo Di Stefano
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy; (A.G.); (A.T.); (F.G.); (M.C.); (D.V.); (S.I.); (F.B.)
| | - Raffaele Ornello
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy; (R.O.); (V.C.); (I.F.); (G.M.); (S.S.)
| | - Andrea Gagliardo
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy; (A.G.); (A.T.); (F.G.); (M.C.); (D.V.); (S.I.); (F.B.)
| | - Angelo Torrente
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy; (A.G.); (A.T.); (F.G.); (M.C.); (D.V.); (S.I.); (F.B.)
| | - Elisa Illuminato
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (E.I.); (F.A.); (A.F.)
| | - Valeria Caponnetto
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy; (R.O.); (V.C.); (I.F.); (G.M.); (S.S.)
| | - Ilaria Frattale
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy; (R.O.); (V.C.); (I.F.); (G.M.); (S.S.)
| | - Raffaella Golini
- Department of Internal Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (R.G.); (C.D.F.)
| | - Chiara Di Felice
- Department of Internal Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (R.G.); (C.D.F.)
| | - Fabiola Graziano
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy; (A.G.); (A.T.); (F.G.); (M.C.); (D.V.); (S.I.); (F.B.)
| | - Maria Caccamo
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy; (A.G.); (A.T.); (F.G.); (M.C.); (D.V.); (S.I.); (F.B.)
| | - Davide Ventimiglia
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy; (A.G.); (A.T.); (F.G.); (M.C.); (D.V.); (S.I.); (F.B.)
| | - Salvatore Iacono
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy; (A.G.); (A.T.); (F.G.); (M.C.); (D.V.); (S.I.); (F.B.)
| | - Gabriella Matarazzo
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy; (R.O.); (V.C.); (I.F.); (G.M.); (S.S.)
| | - Francesco Armetta
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (E.I.); (F.A.); (A.F.)
| | - Giuseppe Battaglia
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90127 Palermo, Italy;
| | - Alberto Firenze
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (E.I.); (F.A.); (A.F.)
| | - Simona Sacco
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy; (R.O.); (V.C.); (I.F.); (G.M.); (S.S.)
| | - Filippo Brighina
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy; (A.G.); (A.T.); (F.G.); (M.C.); (D.V.); (S.I.); (F.B.)
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Migraine during COVID-19: Data from Second Wave Pandemic in an Italian Cohort. Brain Sci 2021; 11:brainsci11040482. [PMID: 33920175 PMCID: PMC8070557 DOI: 10.3390/brainsci11040482] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 12/24/2022] Open
Abstract
Objectives: The study aims to assess the impact of the second COVID-19 pandemic wave on migraine characteristics. Methods: This is an observational cross-sectional study conducted on migraine patients previously interviewed during the first Italian pandemic outbreak. A second structured telephone interview was conducted between 20 November 2020 and 18 January 2021. We compared migraine characteristics among T0 (before pandemic), T1 (during the first pandemic phase), and T2 (during the second pandemic phase). Results: Among the 433 patients interviewed during the first pandemic phase, 304 cases were finally considered. One hundred forty-eight patients had a control visit between March 2020 and December 2020, 120 had an in-person visit, 14 by phone, the remainder used telemedicine software provided by the hospital. Frequency of headache, number of symptomatic drugs and headache intensity worsened during T2, compared to T0 and T1, especially in episodic migraine. Headache intensity increased relating to the negative emotional impact of the pandemic. Migraine management during the pandemic did not influence the clinical outcome. Conclusion: The prolongation of the pandemic seems to have a negative impact on migraine evolution. The arousal and negative psychological behavior toward the COVID-19 outbreak seem to worsen migraine.
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Guzik AK, Martin-Schild S, Tadi P, Chapman SN, Al Kasab S, Martini SR, Meyer BC, Demaerschalk BM, Wozniak MA, Southerland AM. Telestroke Across the Continuum of Care: Lessons from the COVID-19 Pandemic. J Stroke Cerebrovasc Dis 2021; 30:105802. [PMID: 33866272 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105802] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/23/2021] [Accepted: 03/28/2021] [Indexed: 12/22/2022] Open
Abstract
While use of telemedicine to guide emergent treatment of ischemic stroke is well established, the COVID-19 pandemic motivated the rapid expansion of care via telemedicine to provide consistent care while reducing patient and provider exposure and preserving personal protective equipment. Temporary changes in re-imbursement, inclusion of home office and patient home environments, and increased access to telehealth technologies by patients, health care staff and health care facilities were key to provide an environment for creative and consistent high-quality stroke care. The continuum of care via telestroke has broadened to include prehospital, inter-facility and intra-facility hospital-based services, stroke telerehabilitation, and ambulatory telestroke. However, disparities in technology access remain a challenge. Preservation of reimbursement and the reduction of regulatory burden that was initiated during the public health emergency will be necessary to maintain expanded patient access to the full complement of telestroke services. Here we outline many of these initiatives and discuss potential opportunities for optimal use of technology in stroke care through and beyond the pandemic.
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Affiliation(s)
- Amy K Guzik
- Department of Neurology, Wake Forest University, Winston-Salem, NC, USA.
| | - Sheryl Martin-Schild
- Department of Neurology, Touro Infirmary and New Orleans East Hospital, New Orleans, LA, USA
| | - Prasanna Tadi
- Department of Neurology, Creighton University, Omaha, NE, USA
| | - Sherita N Chapman
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - Sami Al Kasab
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Sharyl R Martini
- Department of Neurology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA
| | - Brett C Meyer
- Department of Neurosciences, University of California San Diego, San Diego, CA, USA
| | - Bart M Demaerschalk
- Department of Neurology, Center for Connected Care, and Center for Digital Health, Mayo Clinic College of Medicine and Science, Phoenix, AZ, USA
| | - Marcella A Wozniak
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew M Southerland
- Department of Neurology, University of Virginia, Charlottesville, VA, USA; Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
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Eslami P, Niakan Kalhori SR, Taheriyan M. eHealth solutions to fight against COVID-19: A scoping review of applications. Med J Islam Repub Iran 2021; 35:43. [PMID: 34268231 PMCID: PMC8271222 DOI: 10.47176/mjiri.35.43] [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: 07/30/2020] [Indexed: 12/23/2022] Open
Abstract
Background: eHealth has a notable potential to help in prevention, diagnosis, treatment, screening, management, and control of the COVID-19 pandemic. Since ehealth is considered here broadly, as an umbrella term, it also covers subsets like telehealth and mhealth. This study aimed to review the literature to identify and classify subdomains of eHealth solutions that have been utilized, developed, or suggested for the COVID-19 pandemic.
Methods: A comprehensive literature search was performed using the PubMed, Scopus, Embase, and Cochrane library databases in April 2020, with no time limitation. The search strategy was built based on 2 concept domains of eHealth solutions and covid-19. For each concept domain, the search query comprised a combination of free text keywords identified from reference papers and controlled vocabulary terms. Obtained results were classified, graphically presented, and discussed.
Results: Of the 423 studies identified initially, 35 were included in this study. From related papers, general characteristics, study objective, eHealth-related outcomes, target populations, eHealth interventions, health service category, eHealth solution, and eHealth domain were extracted, classified, and tabulated. Most publication types were ideas, editorials, or opinions (46%). The most targeted populations were people of the community and medical staff (80%). The most implemented or suggested eHealth solution was telehealth (63%), followed by mhealth, health information technology, and health data analytics. Most of the COVID-19 ehealth interventions designed or suggested for improving prevention (48%) and diagnosis (48%). Most of the studies applied or proposed eHealth solutions for general practice or epidemiological purposes (48%).
Conclusion: eHealth solutions have the potential to provide useful services to help in COVID-19 pandemics in terms of prevention, diagnosis, treatment, screening, surveillance, resource allocation, education, management, and control. The obtained results from this review might be used for a better understanding of current ehealth solutions provided or recommended in response to the COVID-19 pandemic.
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Affiliation(s)
- Parisa Eslami
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Sharareh R Niakan Kalhori
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Moloud Taheriyan
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
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Gonzalez-Martinez A, Planchuelo-Gómez Á, Guerrero ÁL, García-Azorín D, Santos-Lasaosa S, Navarro-Pérez MP, Odriozola-González P, Irurtia MJ, Quintas S, de Luis-García R, Gago-Veiga AB. Effects of the onabotulinumtoxinA follow-up delay in migraine course during the COVID-19 lockdown. Neurol Sci 2021; 42:5087-5092. [PMID: 33768436 PMCID: PMC7994064 DOI: 10.1007/s10072-021-05180-8] [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: 09/06/2020] [Accepted: 03/13/2021] [Indexed: 12/23/2022]
Abstract
Background Face-to-face procedures have been postponed during COVID-19 pandemic. We aim to evaluate the impact of onabotulinumtoxinA follow-up delay in migraine during COVID-19 pandemic. Methods Subjective worsening, intensity of migraine attacks, and frequency of headache and migraine were retrospectively compared between patients with unmodified and interrupted onabotulinumtoxinA follow-up in Headache Units. Results We included 67 patients with chronic migraine or high-frequency episodic migraine under onabotulinumtoxinA treatment, 65 (97.0%) female, 44.5 ± 12.1 years old. Treatment administration was voluntarily delayed in 14 (20.9%) patients and nine (13.4%) were unable to continue follow-up. Patients with uninterrupted follow-up during lockdown presented 7.6 and 8.1 less monthly days with headache (adjusted p = 0.017) and migraine attacks (adjusted p = 0.009) compared to patients whose follow-up was interrupted, respectively. Conclusion Involuntary delay of onabotulinumtoxinA follow-up in patients with migraine due to COVID-19 pandemic was associated with a higher frequency of headache and migraine attacks. Safe administration of onabotulinumtoxinA during lockdown should be promoted. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-021-05180-8.
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Affiliation(s)
- Alicia Gonzalez-Martinez
- Headache Unit, Department of Neurology, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain.,Department of Neurology, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Ángel L Guerrero
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - David García-Azorín
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain. .,Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.
| | - Sonia Santos-Lasaosa
- Headache Unit, Department of Neurology, Hospital Clínico Universitario Lozano Blesa and Aragon Institute for Health Research (IIS Aragón), Zaragoza, Spain
| | - María Pilar Navarro-Pérez
- Headache Unit, Department of Neurology, Hospital Clínico Universitario Lozano Blesa and Aragon Institute for Health Research (IIS Aragón), Zaragoza, Spain
| | | | | | - Sonia Quintas
- Headache Unit, Department of Neurology, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain.,Department of Neurology, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Ana Beatriz Gago-Veiga
- Headache Unit, Department of Neurology, Hospital Universitario de La Princesa and Instituto de Investigación Sanitaria de La Princesa, Madrid, Spain.,Department of Neurology, Universidad Autónoma de Madrid, Madrid, Spain
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Sharawat IK, Panda PK. Caregiver Satisfaction and Effectiveness of Teleconsultation in Children and Adolescents With Migraine During the Ongoing COVID-19 Pandemic. J Child Neurol 2021; 36:296-303. [PMID: 33170754 DOI: 10.1177/0883073820968653] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The ongoing COVID-19 pandemic and the lockdown measures have forced clinicians across the world to look on telemedicine. Although migraine as such seems an ideal option for telemedicine, a systematic study reviewing feasibility, efficacy, and advantages of current advanced telecommunication technologies in children with migraine is lacking. METHODS Clinical details of telephonic consultations performed between March 25 and June 4, 2020, including migraine characteristics, analgesic/prophylactic drug regimens, headache frequency/severity/disability, compliance, drug-related/unrelated adverse effects and unavailability of drugs were recorded. Suitable change in the dose/commercial brand of drug regimen and the addition of new drugs were done as required. Voice call, text messages, picture/video messages, and all other possible measures were used to accumulate maximum clinical information in real time. Unless contacted for trivial reasons, most children were later followed up telephonically to ensure health care concern was resolved and to fill up one 6-item trichotomous quality control questionnaire. RESULTS A total of 146 telephone consultations were performed in 51 participants. Thirty-six patients were identified to have 42 significant clinical events (worsening clinical status/partial response to medications [18; 44%], drug-related adverse effects [10; 19%], unrelated systemic complaints [7; 13%], and worsening of headache due to stress/triggers [7; 13%]). In the rest of the patients, the query of the caregiver included concern regarding COVID-19-related symptoms. Twenty-nine children required increment in drug dose or addition of new drug or commercial brand. Around 90% of caregivers were satisfied with the quality of teleconsultation. CONCLUSION Teleconsultation is a feasible and efficacious option, with excellent caregiver satisfaction for children with migraine.
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Affiliation(s)
- Indar Kumar Sharawat
- Pediatric Neurology Division, Department of Pediatrics, 442339All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Prateek Kumar Panda
- Pediatric Neurology Division, Department of Pediatrics, 442339All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Datta P, Barrett W, Bentzinger M, Jasinski T, Jayagopal LA, Mahoney A, Pearon C, Swaminathan A, Vuppala A, Samson KK, Wang H, Taraschenko O. Ambulatory care for epilepsy via telemedicine during the COVID-19 pandemic. Epilepsy Behav 2021; 116:107740. [PMID: 33545652 PMCID: PMC8803629 DOI: 10.1016/j.yebeh.2020.107740] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/10/2020] [Accepted: 12/20/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To assess feasibility, patient satisfaction, and financial advantages of telemedicine for epilepsy ambulatory care during the current COVID-19 pandemic. METHODS The demographic and clinical characteristics of all consecutive patients evaluated via telemedicine at a level 4 epilepsy center between March 20 and April 20, 2020 were obtained retrospectively from electronic medical records. A telephone survey to assess patient satisfaction and preferences was conducted within one month following the initial visit. RESULTS Among 223 telehealth patients, 85.7% used both synchronous audio and video technology. During the visits, 39% of patients had their anticonvulsants adjusted while 18.8% and 11.2% were referred to laboratory/diagnostic testing and specialty consults, respectively. In a post-visit survey, the highest degree of satisfaction with care was expressed by 76.9% of patients. The degree of satisfaction tended to increase the further a patient lived from the clinic (p = 0.05). Beyond the pandemic, 89% of patients reported a preference for continuing telemedicine if their epilepsy symptoms remained stable, while only 44.4% chose telemedicine should their symptoms worsen. Inclement weather and lack of transportation were factors favoring continued use of telemedicine. An estimated cost saving to patient attributed to telemedicine was $30.20 ± 3.8 per visit. SIGNIFICANCE Our findings suggest that epilepsy care via telemedicine provided high satisfaction and economic benefit, without compromising patients' quality of care, thereby supporting the use of virtual care during current and future epidemiological fallouts. Beyond the current pandemic, patients with stable seizure symptoms may prefer to use telemedicine for their epilepsy care.
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Affiliation(s)
- Proleta Datta
- Department of Neurological Science, University of Nebraska Medical Center, Omaha, NE, United States.
| | - Wattana Barrett
- Department of Neurological Science, University of Nebraska Medical Center, Omaha, NE, United States
| | | | - Tracy Jasinski
- Department of Neurological Science, University of Nebraska Medical Center, Omaha, NE, United States
| | - Lakshman Arcot Jayagopal
- Department of Neurological Science, University of Nebraska Medical Center, Omaha, NE, United States
| | - Alexa Mahoney
- Nebraska Medicine Hospital, Omaha, NE, United States
| | | | - Arun Swaminathan
- Department of Neurological Science, University of Nebraska Medical Center, Omaha, NE, United States
| | - Aditya Vuppala
- Department of Neurological Science, University of Nebraska Medical Center, Omaha, NE, United States
| | - Kaeli K. Samson
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, United States
| | - Hongmei Wang
- Department of Health Service Research and Administration, University of Nebraska Medical Center, Omaha, NE, United States
| | - Olga Taraschenko
- Department of Neurological Science, University of Nebraska Medical Center, Omaha, NE, United States
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Shah AC, Badawy SM. Telemedicine in Pediatrics: Systematic Review of Randomized Controlled Trials. JMIR Pediatr Parent 2021; 4:e22696. [PMID: 33556030 PMCID: PMC8078694 DOI: 10.2196/22696] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/07/2021] [Accepted: 02/01/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Telemedicine modalities, such as videoconferencing, are used by health care providers to remotely deliver health care to patients. Telemedicine use in pediatrics has increased in recent years. This has resulted in improved health care access, optimized disease management, progress in the monitoring of health conditions, and fewer exposures to patients with illnesses during pandemics (eg, the COVID-19 pandemic). OBJECTIVE We aimed to systematically evaluate the most recent evidence on the feasibility and accessibility of telemedicine services, patients' and care providers' satisfaction with these services, and treatment outcomes related to telemedicine service use among pediatric populations with different health conditions. METHODS Studies were obtained from the PubMed database on May 10, 2020. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. In this review, we included randomized controlled trials from the last 10 years that used a telemedicine approach as a study intervention or assessed telemedicine as a subspecialty of pediatric care. Titles and abstracts were independently screened based on the eligibility criteria. Afterward, full texts were retrieved and independently screened based on the eligibility criteria. A standardized form was used to extract the following data: publication title, first author's name, publication year, participants' characteristics, study design, the technology-based approach that was used, intervention characteristics, study goals, and study findings. RESULTS In total, 11 articles met the inclusion criteria and were included in this review. All studies were categorized as randomized controlled trials (8/11, 73%) or cluster randomized trials (3/11, 27%). The number of participants in each study ranged from 22 to 400. The health conditions that were assessed included obesity (3/11, 27%), asthma (2/11, 18%), mental health conditions (1/11, 9%), otitis media (1/11, 9%), skin conditions (1/11, 9%), type 1 diabetes (1/11, 9%), attention deficit hyperactivity disorder (1/11, 9%), and cystic fibrosis-related pancreatic insufficiency (1/11). The telemedicine approaches that were used included patient and doctor videoconferencing visits (5/11, 45%), smartphone-based interventions (3/11, 27%), telephone counseling (2/11, 18%), and telemedicine-based screening visits (1/11, 9%). The telemedicine interventions in all included studies resulted in outcomes that were comparable to or better than the outcomes of control groups. These outcomes were related to symptom management, quality of life, satisfaction, medication adherence, visit completion rates, and disease progression. CONCLUSIONS Although more research is needed, the evidence from this review suggests that telemedicine services for the general public and pediatric care are comparable to or better than in-person services. Patients, health care professionals, and caregivers may benefit from using both telemedicine services and traditional, in-person health care services. To maximize the potential of telemedicine, future research should focus on improving patients' access to care, increasing the cost-effectiveness of telemedicine services, and eliminating barriers to telemedicine use.
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Affiliation(s)
- Aashaka C Shah
- University of Illinois College of Medicine, Chicago, IL, United States
| | - Sherif M Badawy
- Division of Hematology, Oncology, Neuro-Oncology and Stem Cell Transplant, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Singh S, Ahirwar AK, Asia P, Gopal N, Kaim K, Ahirwar P. COVID-19 and neurology perspective. Horm Mol Biol Clin Investig 2021; 42:69-75. [PMID: 33617700 DOI: 10.1515/hmbci-2020-0069] [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: 09/19/2020] [Accepted: 02/06/2021] [Indexed: 11/15/2022]
Abstract
COVID-19 caused by SARS CoV2 (The novel corona virus) has already taken lives of many people across the globe even more than anyone could have imagined. This outbreak occurred in China and since then it is expanding its devastating effects by leaps and bounds. Initially it appeared to be an outbreak of pneumonia but soon it was found to be much more than that and the infectivity was found to be very high. This is the reason that it has taken whole globe in its trap and become a pandemic in such a short span of time. Death is occurring because it is a new virus and human body has no specific antibodies for it. Presently there is no approved vaccine so everyone is susceptible but people with co-morbidities appear to be in more risk and the best way for protection is social distancing and increasing one's natural immunity by taking healthy diet and exercise. When a person is infected the clinical presentation ranges from asymptomatic to severe ARDS, sudden onset of anosmia, headache, cough may be the initial symptoms. This review is focused on immunopathology and effect of COVID-19 on neurological disorders and also the neurological manifestations and the treatment.
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Affiliation(s)
- Shivani Singh
- All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Ashok Kumar Ahirwar
- Department of Biochemistry, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Priyanka Asia
- Department of Biochemistry, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Niranjan Gopal
- Department of Biochemistry, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Kirti Kaim
- Department of Ophthalmology, Indira Gandhi ESI Hospital, New Delhi, India
| | - Pradeep Ahirwar
- Department of Radio-diagnosis, Index Medical College, Hospital and Research Centre, Indore, Madhya Pradesh, India
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Bobker SM, Robbins MS. Virtual Issue: COVID-19 and headache. Headache 2021; 61:412-413. [PMID: 33591579 PMCID: PMC8013424 DOI: 10.1111/head.14085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Sarah M Bobker
- UCSF Headache Center, University of California at San Francisco, San Francisco, CA, USA
| | - Matthew S Robbins
- Department of Neurology, Weill Cornell Medicine, New York Presbyterian, New York, NY, USA
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Verhagen IE, van Casteren DS, de Vries Lentsch S, Terwindt GM. Effect of lockdown during COVID-19 on migraine: A longitudinal cohort study. Cephalalgia 2021; 41:865-870. [PMID: 33430642 PMCID: PMC8166402 DOI: 10.1177/0333102420981739] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background The objective of this study was to assess whether migraine-related outcomes changed during intelligent lockdown when compared with the prior period. Methods This was a cohort study evaluating the first month of intelligent lockdown in the Netherlands (12 March to 8 April 2020) compared with one baseline month (13 February to 11 March 2020). We identified 870 migraine patients treated at the Leiden Headache Center with headache e-diaries during the period of interest. Adherence to the e-diary had to be ≥80%, yielding 592 enrolled patients. Results Intelligent lockdown led to a decrease in monthly migraine days (−0.48; 95% CI: −0.78 to −0.18, p = 0.002) and acute medication days (−0.48; 95% CI: −0.76 to −0.20, p < 0.001), and an increase in general well-being (0.11; 95% CI: 0.06 to 0.17, p < 0.001). No differences in non-migrainous headache days and pain coping were observed. Consistent results were found in a subset that was followed for 4 months. Conclusions Our findings imply that intelligent lockdown measures can improve migraine disability despite of the potential negative effects of COVID-19 and lockdown. We hypothesise that this effect is a combined result of working from home, scaling down demanding social lives, and freedom to choose how to organise one’s time.
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Affiliation(s)
| | | | | | - Gisela M Terwindt
- Gisela M Terwindt, Leiden University Medical Center, Department of Neurology, P.O. 9600, 2300 RC Leiden, the Netherlands.
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45
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Pohl H, Gantenbein AR. [COVID-19 and Headaches]. PRAXIS 2021; 110:201-206. [PMID: 33726510 DOI: 10.1024/1661-8157/a003661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
COVID-19 and Headaches Abstract. Headaches are a common symptom of COVID-19 infections. Patients generally describe them as bilateral, predominantly frontal, squeezing and of moderate or severe intensity. Searching for "Red Flags" often allows distinction from primary headaches - usually fever, cough, and elevated inflammatory markers accompany COVID-19-associated headaches. Prospective studies did not confirm caveats against the use of ibuprofen as symptomatic treatment. While carrying facial masks often caused headaches, probably by compressing sensory nerves, many patients' migraine frequencies dropped during lockdown. Treatment of patients with primary headaches was complicated by quarantine and many centres offered online consultations.
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Affiliation(s)
- Heiko Pohl
- Klinik für Neurologie, Universitätsspital Zürich
| | - Andreas R Gantenbein
- Klinik für Neurologie, Universitätsspital Zürich
- Neurologie & Neurorehabilitation, RehaClinic Bad Zurzach
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46
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Smith M, Nakamoto M, Crocker J, Tiffany Morden F, Liu K, Ma E, Chong A, Van N, Vajjala V, Carrazana E, Viereck J, Liow K. Early impact of the COVID-19 pandemic on outpatient migraine care in Hawaii: Results of a quality improvement survey. Headache 2020; 61:149-156. [PMID: 33316097 DOI: 10.1111/head.14030] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/30/2020] [Accepted: 09/04/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE A survey was implemented for early assessment of pandemic-related practice processes and quality improvement (QI). BACKGROUND In response to the public health measures in Hawaii to curtail the coronavirus 2019 pandemic, Hawaii Pacific Neuroscience (HPN) adapted their patient care to ensure continuity of neurological treatment. METHODS The telephone survey was conducted on patients seen at HPN during the period of April 22, 2020-May 18, 2020 to address four areas related to patients' outpatient experience: delivery of care, general well-being, experience with telemedicine, and disease-specific questions. RESULTS A total of 928 patients were contacted of which 429 (46.2%) patients responded and 367 (85.5%) agreed to participate. A total of 133 patients with migraine and 234 patients with other neurological conditions provided responses. Our migraine patients' survey responses suggest that their well-being was disproportionately negatively affected by the pandemic. Survey respondents with migraine were significantly more likely than their non-migraine peers to report worsening anxiety and sleep problems [62/132 (47.0%) vs. 78/234 (33.3%), χ2 = 6.64, p = 0.010, and 64/132 (48.5%) vs. 73/234 (31.2%), χ2 = 10.77, p = 0.001]; migraine patients also reported worsening of depression as a result of the pandemic more than patients with other diagnoses, though this was not statistically significant [44/132 (33.3%) vs. 57/234 (24.4%), χ2 = 3.40, p = 0.065]. In regard to access to healthcare, significantly more migraine patients reported running out of medications than those with other diagnoses [20/133 (15.0%) vs. 18/234 (7.7%), χ2 = 4.93, p = 0.026]. More avoided seeking medical help for new health problems because of the pandemic [30/133 (22.6%) vs. 30/234 (12.8%), χ2 = 5.88, p = 0.015]. Migraine patients were also significantly impacted economically by the pandemic; 43/132 (32.4%) of migraine patients reported losing their jobs as the result of the pandemic versus 34/234 (14.5%) of their peers (χ2 = 11.20, p < 0.001). An increase in headache severity or frequency was reported in 39/118 (33.1%) of respondents and 19/118 (16.1%) reported to using more abortive therapy than usual. Telemedicine was well received by almost all patients who took advantage of the option. Most of those patients found telemedicine to be easy to use and as valuable as an in-person visit. Migraine patients indicated with more frequency that without the telemedicine option, they would have missed their medical appointments [37/68 (54.4%) vs. 56/144 (38.6%), χ2 = 4.31, p = 0.038]; a majority would prefer or consider telemedicine for future appointments over in-person visits. CONCLUSIONS Insights gained from this QI survey to the practice's new pandemic-related processes include stressing lifestyle modification, optimizing treatment plans, and continuing the option of telemedicine.
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Affiliation(s)
- Maiya Smith
- John Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Max Nakamoto
- John Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Julie Crocker
- John Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | | | - Keke Liu
- John Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Enze Ma
- John Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Ariel Chong
- Undergraduate Education, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Nicholas Van
- Undergraduate Education, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Vimala Vajjala
- Headache & Facial Pain Center, Hawaii Pacific Neuroscience, Honolulu, HI, USA
| | - Enrique Carrazana
- Clinical Research Center, Brain Research, Innovation & Translation Labs, Hawaii Pacific Neuroscience, Honolulu, HI, USA
| | - Jason Viereck
- Clinical Research Center, Brain Research, Innovation & Translation Labs, Hawaii Pacific Neuroscience, Honolulu, HI, USA
| | - Kore Liow
- Clinical Research Center, Brain Research, Innovation & Translation Labs, Hawaii Pacific Neuroscience, Honolulu, HI, USA
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47
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Tan L, Lin ZC, Ray J, Wesselingh R, Oxley TJ, McFadyen J, Kapoor M, Hutton E. Neurological implications of COVID-19: a review of the science and clinical guidance. BMJ Neurol Open 2020; 2:e000101. [PMID: 33681805 PMCID: PMC7871721 DOI: 10.1136/bmjno-2020-000101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/13/2020] [Accepted: 11/18/2020] [Indexed: 12/15/2022] Open
Abstract
COVID-19 is a significant global health burden. The pulmonary morbidity and mortality of COVID-19 is well described, however, there is mounting evidence of neurological manifestations of SARS-CoV-2, which may be of prognostic significance. This paper summarises the available evidence in order to provide clinicians with a concise summary of the peripheral and central neurological manifestations of COVID-19, discusses specific issues regarding the management of chronic neurological disease in the context of the pandemic, and provides a summary of the thrombotic implications of the disease for the neurologist.
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Affiliation(s)
- Lynn Tan
- Neurology Department, Alfred Hospital, Melbourne, Victoria, Australia
| | - Zhiliang Caleb Lin
- Monash Emergency, Monash University School of Clinical Sciences at Monash Health, Clayton, Victoria, Australia
| | - Jason Ray
- Neurology Department, Alfred Hospital, Melbourne, Victoria, Australia.,Neuroscience Department, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Robb Wesselingh
- Neurology Department, Alfred Hospital, Melbourne, Victoria, Australia.,Neuroscience Department, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Thomas J Oxley
- Cerebrovascular Centre, Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA.,Vascular Bionics Laboratory, Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - James McFadyen
- Haematology Department, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Clayton, Victoria, Australia.,Atherothrombosis and Vascular Biology Program, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Mahima Kapoor
- Neurology Department, Alfred Hospital, Melbourne, Victoria, Australia.,Neuroscience Department, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Elspeth Hutton
- Neurology Department, Alfred Hospital, Melbourne, Victoria, Australia.,Neuroscience Department, Monash University Central Clinical School, Melbourne, Victoria, Australia
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Dresler T, Guth AL, Lüpke J, Kropp P. [Psychological treatment of headache in times of COVID-19]. Schmerz 2020; 34:503-510. [PMID: 33030591 PMCID: PMC7543037 DOI: 10.1007/s00482-020-00507-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/17/2020] [Accepted: 09/03/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has substantially changed life worldwide in 2020. This also influences the psychological treatment options of patients with headache. AIM The present article intends to illustrate the different psychological forms of treatment for headache patients and their implementation during the COVID-19 pandemic. MATERIAL AND METHODS Literature review and case reports. RESULTS Even during the COVID-19 pandemic, psychological treatment enables the increased stress level in headache patients to be counteracted by using cognitive behavioral therapy and relaxation techniques. The changed living conditions are often unfavorable but sometimes also favorable in the course of disease. It can be shown that even during the pandemic, such favorable changes can be used to support patients to cope with their headache. CONCLUSION The digital implementation of psychological approaches makes a major contribution to maintaining psychological treatment of headache patients, so that the individually changed needs can be addressed. With respect to content, stress regulation techniques and increased acceptance gain in importance. Regarding biofeedback there are limitations, which may be overcome by improved technical devices.
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Affiliation(s)
- T Dresler
- Klinik für Psychiatrie und Psychotherapie, Universität Tübingen, Calwerstr. 14, 72076, Tübingen, Deutschland.
- Graduiertenschule & Forschungsnetzwerk LEAD, Universität Tübingen, Tübingen, Deutschland.
| | - A-L Guth
- Migräne- und Kopfschmerzklinik Königstein, Königstein, Deutschland
| | - J Lüpke
- Institut für Medizinische Psychologie und Medizinische Soziologie, Universitätsmedizin Rostock, Rostock, Deutschland
| | - P Kropp
- Institut für Medizinische Psychologie und Medizinische Soziologie, Universitätsmedizin Rostock, Rostock, Deutschland
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Life with chronic pain during COVID-19 lockdown: the case of patients with small fibre neuropathy and chronic migraine. Neurol Sci 2020; 42:389-397. [PMID: 33205374 PMCID: PMC7670980 DOI: 10.1007/s10072-020-04890-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/05/2020] [Indexed: 01/03/2023]
Abstract
Objective We aimed at investigating the impact of COVID-19-related distress on patients with chronic pain, highlighting the effects of changes in individual habits and public health care reconfiguration on physical and psychological health. Methods During the pandemic, 80 participants (25 patients with small fibre neuropathy (SFN), 42 patients with chronic migraine (CM) and 13 patients’ healthy family members (HFM)) were asked to evaluate their COVID-19 complains, changes in habits and clinical management, behaviour, mood, loneliness, quality of life (QoL), physical and mental health and coping strategies. Data were analysed by Spearman rho correlations and Mann-Whitney U tests. Results Patients had lower QoL, lower physical health and higher catastrophizing attitude towards pain than HFM. During the pandemic, SFN patients referred greater decline in clinical symptoms, worries about contagion and discomfort for disease management changes than CM patients. In the SFN group, the higher levels of disability were associated with suffering from changes in neurologist-patient relationship. CM patients complained of agitation/anxiety that was related to feelings of loneliness, depressive mood and catastrophism. Discussion Despite similar complains of change in habits and worries about COVID-19 pandemic, SFN and CM patients had distinct reactions. In SFN patients, pandemic distress impacted on physical health with worsening of clinical conditions, especially suffering from changes in their care. In CM patients, pandemic distress affected behaviour, mainly with psychological frailty. This suggests the need to customize public health care for patients with distinct chronic pain conditions.
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50
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Delussi M, Gentile E, Coppola G, Prudenzano AMP, Rainero I, Sances G, Abagnale C, Caponnetto V, De Cesaris F, Frattale I, Guaschino E, Marcinnò A, Ornello R, Pistoia F, Putortì A, Roca ME, Roveta F, Lupi C, Trojano M, Pierelli F, Geppetti P, Sacco S, de Tommaso M. Investigating the Effects of COVID-19 Quarantine in Migraine: An Observational Cross-Sectional Study From the Italian National Headache Registry (RICe). Front Neurol 2020; 11:597881. [PMID: 33240213 PMCID: PMC7683429 DOI: 10.3389/fneur.2020.597881] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 10/05/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Previous studies during SARS and Ebola pandemics have shown that quarantine is associated with several negative psychological effects, such as post-traumatic stress symptoms, confusion, and anger. These conditions may affect the course of many diseases, including migraine. Although it is possible that the quarantine measures for the current COVID-19 pandemic affect migraine burden, no information is currently available on this issue. Aim: In this study, we aimed to: (1) explore the possible changes in migraine frequency, severity, and days with acute medication intake during quarantine period; (2) evaluate possible differences in migraine outcomes in consideration of lifestyle changes, emotions, pandemic diffusion, and COVID-19 infection. Methods: We interviewed patients who were included in the observational Italian Headache Registry (Registro Italiano Cefalee, RICE), retrospectively collecting information on main headache features, lifestyle factors, emotions, individual infection status, and perception of COVID-19 for 2 months before (pre-quarantine) and after the beginning of the quarantine (quarantine). Inclusion criteria were: age > 18, diagnosis of migraine without aura, migraine with aura and chronic migraine, last in-person visit more than 3 months preceding the beginning of quarantine. Results: A total of 433 migraine subjects agreed to be interviewed. We found an overall reduction in headache frequency (9.42 ± 0.43 days with headache vs. 8.28 ± 0.41) and intensity (6.57 ± 0.19 vs. 6.59 ± 0.21) during the quarantine, compared to pre-quarantine. There was a correlation between improvement and number of days of stay-at-home. When results were stratified for geographic area, we found a tendency toward worsening of headache frequency in northern Italy. Disgust regarding viral infection corresponded to a minor improvement in migraine. Conclusions: Migraine patients showed a mild improvement of migraine features, probably attributable to resilient behavior toward pandemic distress. Disgust regarding the contagion whereas potentially favoring defensive behavior, could potentially worsen migraine. The spontaneous limitation of migraine burden during quarantine could favor patient follow-up via the use of telemedicine visits, reliable diaries, and frequent remote contacts.
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Affiliation(s)
- Marianna Delussi
- Applied Neurophysiology and Pain Unit, Scienze Mediche di Base, Neuroscienze e Organi di Senso Department, Bari Aldo Moro University, Bari, Italy
| | - Eleonora Gentile
- Applied Neurophysiology and Pain Unit, Scienze Mediche di Base, Neuroscienze e Organi di Senso Department, Bari Aldo Moro University, Bari, Italy
| | | | | | - Innocenzo Rainero
- Department of Neuroscience “Rita Levi Montalcini,” Headache Center, University of Torino, Turin, Italy
| | - Grazia Sances
- Headache Science Centre, Istituto di Ricerca a Carattere Scientifico Mondino Foundation, Pavia, Italy
| | | | - Valeria Caponnetto
- Headache Regional Referral Center, Azienda Sanitaria Locale 1 Abruzzo, L'Aquila University, L'Aquila, Italy
| | | | - Ilaria Frattale
- Headache Regional Referral Center, Azienda Sanitaria Locale 1 Abruzzo, L'Aquila University, L'Aquila, Italy
| | - Elena Guaschino
- Headache Science Centre, Istituto di Ricerca a Carattere Scientifico Mondino Foundation, Pavia, Italy
| | - Andrea Marcinnò
- Department of Neuroscience “Rita Levi Montalcini,” Headache Center, University of Torino, Turin, Italy
| | - Raffaele Ornello
- Headache Regional Referral Center, Azienda Sanitaria Locale 1 Abruzzo, L'Aquila University, L'Aquila, Italy
| | - Francesca Pistoia
- Headache Regional Referral Center, Azienda Sanitaria Locale 1 Abruzzo, L'Aquila University, L'Aquila, Italy
| | - Alessia Putortì
- Headache Science Centre, Istituto di Ricerca a Carattere Scientifico Mondino Foundation, Pavia, Italy
| | - Maria Elena Roca
- Headache Center, Amaducci Neurological Clinic, Policlinico General Hospital, Bari, Italy
| | - Fausto Roveta
- Department of Neuroscience “Rita Levi Montalcini,” Headache Center, University of Torino, Turin, Italy
| | | | - Maria Trojano
- Headache Center, Amaducci Neurological Clinic, Policlinico General Hospital, Bari, Italy
| | - Francesco Pierelli
- Sapienza University of Rome Polo Pontino, Latina, IRCCS - Neuromed, Pozzilli, Italy
| | | | - Simona Sacco
- Headache Regional Referral Center, Azienda Sanitaria Locale 1 Abruzzo, L'Aquila University, L'Aquila, Italy
| | - Marina de Tommaso
- Applied Neurophysiology and Pain Unit, Scienze Mediche di Base, Neuroscienze e Organi di Senso Department, Bari Aldo Moro University, Bari, Italy
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