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Şahin O, Güneş M, Şahin EHK, Dönmez R. The effect of greater occipital nerve block on amplification of somatic symptoms and anxiety and depression levels in chronic migraine. Acta Neurol Belg 2024:10.1007/s13760-024-02585-y. [PMID: 38814378 DOI: 10.1007/s13760-024-02585-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 05/14/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVES It is known that chronic migraine (CM) is often accompanied by anxiety, depression, and psychosomatic complaints. We designed this study with the assumption that greater occipital nerve (GON) block treatment could potentially improve not only pain symptoms but also psychosomatic complaints. This study aimed to evaluate the changes in the visual analog scale (VAS), somatosensory amplification scale (SSAS), beck depression ınventory (BDI), and beck anxiety ınventory (BAI) with GON block treatment in patients with CM. METHODS This study was conducted retrospectively on 164 patients with CM between December 2018 and January 2023. Patients underwent six sessions of GON block treatment at weeks 0, 1, 2, 3, 5, and 7. VAS, SSAS, BAI, and BDI scores; number of attacks per month (NAM); attack pain duration (APD); and monthly use of analgesics (UA) were compared before the start and at week 8 of GON block treatment. RESULTS The mean age of the subjects was 38 ± 9 years. Statistical analysis revealed that VAS, SSAS, BAI, and BDI scores; NAM; APD; and monthly UA were statistically significantly lower following GON block treatment than before GON block treatment (p < 0.001 each). CONCLUSION GON block treatment was effective for pain and somatic complaints (amplification of physical symptoms), anxiety, and depressive symptoms accompanying CM in patients with CM.
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Affiliation(s)
- Oruç Şahin
- Neurology Clinic, Aksaray University Training and Research Hospital, Aksaray, Turkey.
| | - Muzaffer Güneş
- Neurology Clinic, Aksaray University Training and Research Hospital, Aksaray, Turkey
| | | | - Recep Dönmez
- Neurology Clinic, Aksaray University Training and Research Hospital, Aksaray, Turkey
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De La Rosa JS, Brady BR, Ibrahim MM, Herder KE, Wallace JS, Padilla AR, Vanderah TW. Co-occurrence of chronic pain and anxiety/depression symptoms in U.S. adults: prevalence, functional impacts, and opportunities. Pain 2024; 165:666-673. [PMID: 37733475 PMCID: PMC10859853 DOI: 10.1097/j.pain.0000000000003056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 09/23/2023]
Abstract
ABSTRACT Co-occurrence of chronic pain and clinically significant symptoms of anxiety and/or depression is regularly noted in the literature. Yet, little is known empirically about population prevalence of co-occurring symptoms, nor whether people with co-occurring symptoms constitute a distinct subpopulation within US adults living with chronic pain or US adults living with anxiety and/or depression symptoms (A/D). To address this gap, this study analyzes data from the 2019 National Health Interview Survey, a representative annual survey of self-reported health status and treatment use in the United States (n = 31,997). Approximately 12 million US adults, or 4.9% of the adult population, have co-occurring chronic pain and A/D symptoms. Unremitted A/D symptoms co-occurred in 23.9% of US adults with chronic pain, compared with an A/D prevalence of 4.9% among those without chronic pain. Conversely, chronic pain co-occurred in the majority (55.6%) of US adults with unremitted A/D symptoms, compared with a chronic pain prevalence of 17.1% among those without A/D symptoms. The likelihood of experiencing functional limitations in daily life was highest among those experiencing co-occurring symptoms, compared with those experiencing chronic pain alone or A/D symptoms alone. Among those with co-occurring symptoms, 69.4% reported that work was limited due to a health problem, 43.7% reported difficulty doing errands alone, and 55.7% reported difficulty participating in social activities. These data point to the need for targeted investment in improving functional outcomes for the nearly 1 in 20 US adults living with co-occurring chronic pain and clinically significant A/D symptoms.
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Affiliation(s)
- Jennifer S. De La Rosa
- Comprehensive Pain and Addiction Center, University of Arizona Health Sciences, Tucson, AZ, United States
| | - Benjamin R. Brady
- Comprehensive Pain and Addiction Center, University of Arizona Health Sciences, Tucson, AZ, United States
- Arizona Center for Rural Health, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
- School of Interdisciplinary Health Programs, College of Health and Human Services, Western Michigan University, Kalamazoo, MI, United States
| | - Mohab M. Ibrahim
- Comprehensive Pain and Addiction Center, University of Arizona Health Sciences, Tucson, AZ, United States
- Department of Anesthesiology, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Katherine E. Herder
- Comprehensive Pain and Addiction Center, University of Arizona Health Sciences, Tucson, AZ, United States
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Jessica S. Wallace
- Comprehensive Pain and Addiction Center, University of Arizona Health Sciences, Tucson, AZ, United States
- Departments of Family and Community Medicine and
| | - Alyssa R. Padilla
- Comprehensive Pain and Addiction Center, University of Arizona Health Sciences, Tucson, AZ, United States
| | - Todd W. Vanderah
- Comprehensive Pain and Addiction Center, University of Arizona Health Sciences, Tucson, AZ, United States
- Pharmacology, College of Medicine, University of Arizona, Tucson, AZ, United States
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Pizer JH, Aita SL, Myers MA, Hawley NA, Ikonomou VC, Brasil KM, Hernandez KA, Pettway EC, Owen T, Borgogna NC, Smitherman TA, Hill BD. Neuropsychological Function in Migraine Headaches: An Expanded Comprehensive Multidomain Meta-Analysis. Neurology 2024; 102:e208109. [PMID: 38252898 DOI: 10.1212/wnl.0000000000208109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 11/07/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND AND OBJECTIVES A sizable literature has studied neuropsychologic function in persons with migraine (PwM), but despite this, few quantitative syntheses exist. These focused on circumscribed areas of the literature. In this study, we conducted an expanded comprehensive meta-analysis comparing performance on clinical measures of neuropsychological function both within and across domains, between samples of PwM and healthy controls (HCs). METHODS For this Meta-analyses Of Observational Studies in Epidemiology-compliant meta-analysis, a unified search strategy was applied to OneSearch (a comprehensive collection of electronic databases) to identify peer-reviewed original research published across all years up until August 1, 2023. Using random-effects modeling, we examined aggregated effect sizes (Hedges' g), between-study heterogeneity (Cochran Q and I2), moderating variables (meta-regression and subgroup analyses), and publication bias (Egger regression intercept and Duval and Tweedie Trim-and-Fill procedure). Study bias was also coded using the NIH Study Quality Assessment Tools. RESULTS Omnibus meta-analysis from the 58 studies included (PwM n = 5,452, HC n = 16,647; 612 effect sizes extracted) indicated lower overall cognitive performance in PwM vs HCs (g = -0.37; 95% CI -0.47 to -0.28; p < 0.001), and high between-study heterogeneity (Q = 311.25, I2 = 81.69). Significant domain-specific negative effects were observed in global cognition (g = -0.46, p < 0.001), executive function (g = -0.45, p < 0.001), processing speed (g = -0.42, p < 0.001), visuospatial/construction (g = -0.39, p = 0.006), simple/complex attention (g = -0.38, p < 0.001), learning/memory (g = -0.25, p < 0.001), and language (g = -0.24, p < 0.001). Orientation (p = 0.146), motor (p = 0.102), and intelligence (p = 0.899) were not significant. Moderator analyses indicated that age (particularly younger HCs), samples drawn from health care facility settings (e.g., tertiary headache centers) vs community-based populations, and higher attack duration were associated with larger (negative) effects and accounted for a significant proportion of between-study heterogeneity in effects. Notably, PwM without aura yielded stronger (negative) effects (omnibus g = -0.37) vs those with aura (omnibus g = -0.10), though aura status did not account for heterogeneity observed between studies. DISCUSSION Relative to HCs, PwM demonstrate worse neurocognition, as detected by neuropsychological tests, especially on cognitive screeners and tests within executive functioning and processing speed domains. Effects were generally small to moderate in magnitude and evident only in clinic (vs community) samples. Aura was not meaningfully associated with neurocognitive impairment.
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Affiliation(s)
- Jasmin H Pizer
- From the Department of Psychology (J.H.P., M.A.M., N.A.H., V.C.I., K.M.B., K.A.H., B.D.H.), University of South Alabama, Mobile; Department of Mental Health (S.L.A.), VA Maine Healthcare System, Augusta; Department of Psychology (S.L.A.), University of Maine, Orono; Department of Neuroscience (K.A.H.), Ochsner Health Center, Baton Rouge, LA; Alzheimer's Disease Research Center (E.C.P.), Boston University, MA; Department of Psychological Science (T.O., N.C.B.), Texas Tech University, Lubbock; and Department of Psychology (T.A.S.), University of Mississippi, Oxford
| | - Stephen L Aita
- From the Department of Psychology (J.H.P., M.A.M., N.A.H., V.C.I., K.M.B., K.A.H., B.D.H.), University of South Alabama, Mobile; Department of Mental Health (S.L.A.), VA Maine Healthcare System, Augusta; Department of Psychology (S.L.A.), University of Maine, Orono; Department of Neuroscience (K.A.H.), Ochsner Health Center, Baton Rouge, LA; Alzheimer's Disease Research Center (E.C.P.), Boston University, MA; Department of Psychological Science (T.O., N.C.B.), Texas Tech University, Lubbock; and Department of Psychology (T.A.S.), University of Mississippi, Oxford
| | - Melissa A Myers
- From the Department of Psychology (J.H.P., M.A.M., N.A.H., V.C.I., K.M.B., K.A.H., B.D.H.), University of South Alabama, Mobile; Department of Mental Health (S.L.A.), VA Maine Healthcare System, Augusta; Department of Psychology (S.L.A.), University of Maine, Orono; Department of Neuroscience (K.A.H.), Ochsner Health Center, Baton Rouge, LA; Alzheimer's Disease Research Center (E.C.P.), Boston University, MA; Department of Psychological Science (T.O., N.C.B.), Texas Tech University, Lubbock; and Department of Psychology (T.A.S.), University of Mississippi, Oxford
| | - Nanako A Hawley
- From the Department of Psychology (J.H.P., M.A.M., N.A.H., V.C.I., K.M.B., K.A.H., B.D.H.), University of South Alabama, Mobile; Department of Mental Health (S.L.A.), VA Maine Healthcare System, Augusta; Department of Psychology (S.L.A.), University of Maine, Orono; Department of Neuroscience (K.A.H.), Ochsner Health Center, Baton Rouge, LA; Alzheimer's Disease Research Center (E.C.P.), Boston University, MA; Department of Psychological Science (T.O., N.C.B.), Texas Tech University, Lubbock; and Department of Psychology (T.A.S.), University of Mississippi, Oxford
| | - Vasilios C Ikonomou
- From the Department of Psychology (J.H.P., M.A.M., N.A.H., V.C.I., K.M.B., K.A.H., B.D.H.), University of South Alabama, Mobile; Department of Mental Health (S.L.A.), VA Maine Healthcare System, Augusta; Department of Psychology (S.L.A.), University of Maine, Orono; Department of Neuroscience (K.A.H.), Ochsner Health Center, Baton Rouge, LA; Alzheimer's Disease Research Center (E.C.P.), Boston University, MA; Department of Psychological Science (T.O., N.C.B.), Texas Tech University, Lubbock; and Department of Psychology (T.A.S.), University of Mississippi, Oxford
| | - Kyle M Brasil
- From the Department of Psychology (J.H.P., M.A.M., N.A.H., V.C.I., K.M.B., K.A.H., B.D.H.), University of South Alabama, Mobile; Department of Mental Health (S.L.A.), VA Maine Healthcare System, Augusta; Department of Psychology (S.L.A.), University of Maine, Orono; Department of Neuroscience (K.A.H.), Ochsner Health Center, Baton Rouge, LA; Alzheimer's Disease Research Center (E.C.P.), Boston University, MA; Department of Psychological Science (T.O., N.C.B.), Texas Tech University, Lubbock; and Department of Psychology (T.A.S.), University of Mississippi, Oxford
| | - Katherine A Hernandez
- From the Department of Psychology (J.H.P., M.A.M., N.A.H., V.C.I., K.M.B., K.A.H., B.D.H.), University of South Alabama, Mobile; Department of Mental Health (S.L.A.), VA Maine Healthcare System, Augusta; Department of Psychology (S.L.A.), University of Maine, Orono; Department of Neuroscience (K.A.H.), Ochsner Health Center, Baton Rouge, LA; Alzheimer's Disease Research Center (E.C.P.), Boston University, MA; Department of Psychological Science (T.O., N.C.B.), Texas Tech University, Lubbock; and Department of Psychology (T.A.S.), University of Mississippi, Oxford
| | - Erika C Pettway
- From the Department of Psychology (J.H.P., M.A.M., N.A.H., V.C.I., K.M.B., K.A.H., B.D.H.), University of South Alabama, Mobile; Department of Mental Health (S.L.A.), VA Maine Healthcare System, Augusta; Department of Psychology (S.L.A.), University of Maine, Orono; Department of Neuroscience (K.A.H.), Ochsner Health Center, Baton Rouge, LA; Alzheimer's Disease Research Center (E.C.P.), Boston University, MA; Department of Psychological Science (T.O., N.C.B.), Texas Tech University, Lubbock; and Department of Psychology (T.A.S.), University of Mississippi, Oxford
| | - Tyler Owen
- From the Department of Psychology (J.H.P., M.A.M., N.A.H., V.C.I., K.M.B., K.A.H., B.D.H.), University of South Alabama, Mobile; Department of Mental Health (S.L.A.), VA Maine Healthcare System, Augusta; Department of Psychology (S.L.A.), University of Maine, Orono; Department of Neuroscience (K.A.H.), Ochsner Health Center, Baton Rouge, LA; Alzheimer's Disease Research Center (E.C.P.), Boston University, MA; Department of Psychological Science (T.O., N.C.B.), Texas Tech University, Lubbock; and Department of Psychology (T.A.S.), University of Mississippi, Oxford
| | - Nicholas C Borgogna
- From the Department of Psychology (J.H.P., M.A.M., N.A.H., V.C.I., K.M.B., K.A.H., B.D.H.), University of South Alabama, Mobile; Department of Mental Health (S.L.A.), VA Maine Healthcare System, Augusta; Department of Psychology (S.L.A.), University of Maine, Orono; Department of Neuroscience (K.A.H.), Ochsner Health Center, Baton Rouge, LA; Alzheimer's Disease Research Center (E.C.P.), Boston University, MA; Department of Psychological Science (T.O., N.C.B.), Texas Tech University, Lubbock; and Department of Psychology (T.A.S.), University of Mississippi, Oxford
| | - Todd A Smitherman
- From the Department of Psychology (J.H.P., M.A.M., N.A.H., V.C.I., K.M.B., K.A.H., B.D.H.), University of South Alabama, Mobile; Department of Mental Health (S.L.A.), VA Maine Healthcare System, Augusta; Department of Psychology (S.L.A.), University of Maine, Orono; Department of Neuroscience (K.A.H.), Ochsner Health Center, Baton Rouge, LA; Alzheimer's Disease Research Center (E.C.P.), Boston University, MA; Department of Psychological Science (T.O., N.C.B.), Texas Tech University, Lubbock; and Department of Psychology (T.A.S.), University of Mississippi, Oxford
| | - Benjamin D Hill
- From the Department of Psychology (J.H.P., M.A.M., N.A.H., V.C.I., K.M.B., K.A.H., B.D.H.), University of South Alabama, Mobile; Department of Mental Health (S.L.A.), VA Maine Healthcare System, Augusta; Department of Psychology (S.L.A.), University of Maine, Orono; Department of Neuroscience (K.A.H.), Ochsner Health Center, Baton Rouge, LA; Alzheimer's Disease Research Center (E.C.P.), Boston University, MA; Department of Psychological Science (T.O., N.C.B.), Texas Tech University, Lubbock; and Department of Psychology (T.A.S.), University of Mississippi, Oxford
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Exploratory study to understand association of emotional comorbidities and sleep with migraine. Int J Neurosci 2020; 132:985-993. [PMID: 33272086 DOI: 10.1080/00207454.2020.1858830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Migraine is often associated with psychiatric and emotional co-morbidities. Several studies have shown association of sleep problems and/or emotional co-morbidities among migraineurs. However, less is known about the association of migraine disability with sleep and emotional co-morbidities. OBJECTIVE To explore the association of emotional co-morbidities and sleep quality with migraine disability among migraineurs in the central part of India. METHODS AND MATERIAL A cross-sectional study enrolling 132 patients of migraine was conducted at a tertiary care centre. They were evaluated for migraine disability by Migraine Disability Assessment Test (MIDAS), emotional co-morbidities by depression, anxiety, stress scale (DASS-21) and sleep quality by Pittsburgh Sleep Quality Index (PSQI). RESULT Mean age of participants was 32.9 ± 9.8 and 83.3% (n = 110) were females. Fourty seven percentage(n = 62) patients reported moderate to severe disability on MIDAS. Anxiety was most frequent (n = 87; 65.9%) emotional co-morbidity followed by depression (n = 70;53%) and stress (n = 52;39.4%). Severity of emotional co-morbidities increased while sleep quality deteriorated with increasing migraine disability. However, migraine frequency had positive correlation only with sleep quality. Stress showed a linear relationship with migraine disability at highest second-third decile of MIDAS. CONCLUSION Migraineurs in central India have higher emotional co-morbidities. These co-morbidities increased and sleep quality deteriorated with increasing migraine disability. Frequency of migraine has no association with emotional co-morbidities. Linear association of stress at higher migraine disability prompts possible role of stress management to break the complex relationship between stress and migraine.
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Stress-Induced Alteration in Chloride Transporters in the Trigeminal Nerve May Explain the Comorbidity between Depression and Migraine. PSYCHIATRY INTERNATIONAL 2020. [DOI: 10.3390/psychiatryint1020006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Migraine is frequently comorbid with depression and anxiety disorders. In the case of depression and panic disorder, the associations seem to be bidirectional. Stress (activation of the hypothalamic-pituitary-adrenal axis) is thought to be involved in increasing the attack frequency. In the current review, it is argued that elevated levels of cortisol increase the function of chloride-ion transporter NKCC1 and decrease the function of chloride-extruder KCC2 in the trigeminal nerve. This leads to a diminished inhibitory effect of gamma-aminobutyric acid (GABA) and an enhanced likelihood of a migraine attack. Since migraine attacks themselves are stressful, and since brain areas are activated that could contribute to panic, anxiety and depression, a number of self-sustaining circular processes could occur that would explain the bi-directionality of the associations. On the basis of this hypothesis, several novel therapeutic approaches to counter the pathological process can be proposed. These include inhibition of corticotrophin releasing factor by CRF1 receptor antagonists, blockade of adrenocorticotropic hormone (ACTH) at the MC2 receptor, and inhibition of the hyperactive NKCC1 chloride-transporter.
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Gil-Martínez A, Navarro-Fernández G, Mangas-Guijarro MÁ, Díaz-de-Terán J. Hyperalgesia and Central Sensitization Signs in Patients with Cluster Headache: A Cross-Sectional Study. PAIN MEDICINE 2020; 20:2562-2570. [PMID: 30958885 DOI: 10.1093/pm/pnz070] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate central sensitization (CS) in cluster headache (CH) and to evaluate its relationship with disease characteristics and psychological comorbidities. DESIGN Cross-sectional study. SETTINGS Whether CS occurs in CH, as it does in other primary headaches, is a subject of debate. Few studies have evaluated the presence of CS and its relationship with psychological comorbidities in patients with CH. SUBJECTS Twenty patients with episodic or chronic CH and 16 healthy controls were recruited. METHODS The variables evaluated included frequency, intensity and duration of headache attacks, pressure pain thresholds (PPTs) and wind-up (WU) ratios of pain bilaterally measured over trigeminal and extratrigeminal areas, and results of questionnaires regarding anxiety and depression (Hospital Anxiety and Depression Scale [HADS], Beck Depression Inventory [BDI], State-Trait Anxiety Inventory [STAI]), quality of life (Short Form-36 [SF-36]), headache impact (Headache Impact Test [HIT-6]), and allodynia (Allodynia Symptom Checklist [ASC]). RESULTS PPT levels were significantly lower in the CH group compared with the healthy participants (all tested points, P < 0.001). No differences were found in WU ratios between groups. However, differences in HADS (P < 0.01), BDI (P < 0.01), STAI (P < 0.01), SF-36 (P < 0.01), HIT-6 (P < 0.001), and ASC (P < 0.01) were observed between groups. The healthy group showed a moderate negative correlation between SF-36 and BDI (rho = -0.59, P = 0.03). Likewise, the CH group showed a moderate negative correlation between frequency and BDI (rho = -0.52, P = 0.03), a strong positive correlation between duration and HADS (rho = 0.86, P < 0.01), and a moderate negative correlation between intensity and PPT over symptomatic V1 (rho = -0.66, P < 0.01) and over asymptomatic V1 (rho = -0.65, P < 0.01). The CH group also showed a moderate negative correlation between SF-36 and anxiety and depression variables. CONCLUSIONS Our findings show that patients with CH have lower PPT levels at cranial and extracranial points, suggesting, as in other primary headaches, the presence of CS. We have also found a high prevalence of psychiatric comorbidities that correlate with the length and frequency of attacks. These findings highlight the importance of a multidisciplinary approach to the treatment of patients with CH.
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Affiliation(s)
- Alfonso Gil-Martínez
- Departament of Physiotherapy, La Salle University Center for Advanced Studies, Autonomous University of Madrid, Madrid, Spain.,Motion in Brains Research Group, Institute of Neurosciences and Movement Sciences, La Salle University Center for Advanced Studies, Autonomous University of Madrid, Madrid, Spain.,La Paz University Hospital Institute for Health Research, Madrid, Spain.,Institute for Functional Rehabilitation, La Salle, Madrid, Spain
| | - Gonzalo Navarro-Fernández
- Motion in Brains Research Group, Institute of Neurosciences and Movement Sciences, La Salle University Center for Advanced Studies, Autonomous University of Madrid, Madrid, Spain.,Institute for Functional Rehabilitation, La Salle, Madrid, Spain
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Chan TLH, Woldeamanuel YW. Exploring naturally occurring clinical subgroups of post-traumatic headache. J Headache Pain 2020; 21:12. [PMID: 32033526 PMCID: PMC7006085 DOI: 10.1186/s10194-020-1080-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 01/29/2020] [Indexed: 12/20/2022] Open
Abstract
Objective To explore naturally occurring clinical subgroups of post-traumatic headache. Background Persistent post-traumatic headache (PTH) is defined as a headache developing within 7 days of an injury that lasts for greater than 3 months. However, there is no evidence available from the International Classification of Headache Disorders (ICHD) based classification between persistent and acute PTH based on clinical phenotypes. Methods We conducted a retrospective study using the Stanford Research Repository Cohort Discovery Tool. We reviewed 500 electronic patient charts between January 2015 to September 2019 using inclusion criteria of adults older than 18 years with a diagnosis of PTH. The following variables were extracted from each patient’s chart: diagnosis of PTH as dependent variable, and predictor variables as age, sex, history of migraine, loss of consciousness during head injury, pre-existing psychological history, duration of PTH and new PTH-associated comorbidities (e.g. new onset vertigo, post-traumatic stress disorder). Logistic regression was employed to identify clinical phenotypes predicting persistent PTH. All predictor variables were tested in one block to determine their predictive capacity while controlling for other predictors in the model. Two-step cluster analysis was conducted to identify naturally occurring PTH subgroups. Results A total of 300 patients were included (150 acute, 150 persistent PTH) with a median age of 47 years (IQR 31, 59) and female: male ratio of 2.7:1. Two hundred patients were excluded due to misdiagnoses. Pre-existing psychological history (standardized beta 0.16), history of migraine (0.20), new PTH-associated comorbidities (0.23) and medication overuse (0.37) statistically significantly predicted the presence of persistent PTH (p < 0.0001). Clustering analysis revealed PTH subgrouping comparable to ICHD-based classification: 140 patients in Cluster 1 (76% persistent PTH) and 160 patients in Cluster 2 (83% acute PTH). Four distinct clusters were found within persistent PTH. Conclusion Pre-existing psychological history, history of migraine, new PTH-associated comorbidities and medication overuse predicted the occurrence of persistent PTH as well as two naturally occurring PTH clusters correlating to acute and persistent PTH. Management emphasis should focus on these phenotypes.
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Affiliation(s)
- T L H Chan
- Division of Headache & Facial Pain, Department of Neurology & Neurological Sciences, Stanford University, Palo Alto, California, USA.
| | - Y W Woldeamanuel
- Division of Headache & Facial Pain, Department of Neurology & Neurological Sciences, Stanford University, Palo Alto, California, USA
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Cengiz GF, Sacmaci H, Aktürk T, Hacimusalar Y. Comparison of patients with migraine and tension-type headache in terms of somatosensory amplification and health anxiety. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:768-774. [PMID: 31826132 DOI: 10.1590/0004-282x20190132] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 06/19/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Although it is known that anxiety and depressive disorders frequently accompany migraine and TTH, the role of somatic amplification (SSA) and health anxiety in these diseases is not adequately known. OBJECTIVE The aim of this study is to compare SSA and health anxiety in patients with migraine or TTH, and healthy controls and to investigate the relationships between SSA, health anxiety, headache characteristics, anxiety and depressive symptoms. METHODS Fifty-four migraine, 50 TTH patients from the outpatient unit of the neurology department and 53 healthy volunteers were recruited for the study. The somatosensory amplification scale (SSAS), health anxiety inventory, Beck depression (BDI) and anxiety inventory (BAI) were administered to all participants. RESULTS The SSAS scores were significantly higher in migraineurs compared with the healthy controls. The health anxiety scores were significantly higher in both migraine and TTH groups. The BDI and BAI scores were also significantly higher in migraine and TTH groups compared with the controls. A significant positive correlation was found between headache frequency and BAI scores, the visual analogue scale scores and SSAS and BDI scores in migraineurs. The SSAS scores were also significantly correlated with the BDI and BAI scores in both of the headache groups. A similar correlation was determined with the health anxiety scores. CONCLUSIONS While patients with migraine and TTH evalute, taking into account the SSA and health anxiety may contribute to the prognosis and treatment of these diseases.
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Affiliation(s)
- Gül Ferda Cengiz
- Bozok Üniversites Tip Fakültesi, Psikiyatri Anabilim Dali, Yozgat, Turkey
| | - Hikmet Sacmaci
- Bozok Üniversites Tip Fakültesi, Nöroloji Anabilim Dali, Yozgat, Turkey
| | - Tülin Aktürk
- Bozok Üniversites Tip Fakültesi, Nöroloji Anabilim Dali, Yozgat, Turkey
| | - Yunus Hacimusalar
- Bozok Üniversites Tip Fakültesi, Psikiyatri Anabilim Dali, Yozgat, Turkey
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Rammohan K, Mundayadan SM, Das S, Shaji CV. Migraine and Mood Disorders: Prevalence, Clinical Correlations and Disability. J Neurosci Rural Pract 2019; 10:28-33. [PMID: 30765967 PMCID: PMC6337984 DOI: 10.4103/jnrp.jnrp_146_18] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Introduction Both migraine and mood disorders are prevalent disorders with many studies demonstrating that they are comorbid with each other with increased migraine-related disability in such patients. Aim The aim of the study is to test the hypothesis that mood disorders are comorbid with migraine with increased disability and to identify any clinical features in migraineurs which may be associated with mood disorders. Materials and Methods Patients presenting with complaints of headache to the Neurology Outpatient Department of a Tertiary CARE Hospital from August 01, 2016 to February 28, 2017, were subjected to International Classification of Headache Disorder 3 beta criteria to satisfy a diagnosis of migraine and were assessed in detail as to headache characteristics. Mood disorders were assessed by Hospital Anxiety and Depression Scale and migraine-related disability was assessed by Migraine Disability Assessment Questionnaire. Patients with serious medical complaints, known previous psychiatric disease, other types of headaches and recent prophylactic drug intake were carefully excluded. Results A total of 133 patients were studied. The duration and frequency of migraine headaches were found to correlate with the presence of mood disorders and the migraine-related disability in patients with comorbid mood disorders was significantly higher. Factors such as total duration of migraine, aura, vomiting, phono, and photophobia were not found to be statistically correlated with mood disorders. Conclusions Rates of depression and anxiety in migraine vary widely in various studies due to variations in study criteria, population characteristics and various scales used. We found a prevalence of 16.54% of anxiety and 9.02% of depression in migraineurs, a rate comparable to or less than many studies in international literature and a significantly increased disability in individuals with comorbid mood disorders and migraine. Routinely including questionnaires such as HAD in screening patients with migraine to rule out comorbid mood disorders may be warranted. Because we have carefully excluded all other primary (especially tension and medication overuse headaches) and secondary headaches and selected prophylactic drug naïve patients, we contend that this study provides a clear clinical profile of migraineurs with mood disorders.
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Affiliation(s)
- K Rammohan
- Department of Neurology, TD MCH, Alappuzha, Kerala, India
| | | | - Soumitra Das
- Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
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Dresler T, Caratozzolo S, Guldolf K, Huhn JI, Loiacono C, Niiberg-Pikksööt T, Puma M, Sforza G, Tobia A, Ornello R, Serafini G. Understanding the nature of psychiatric comorbidity in migraine: a systematic review focused on interactions and treatment implications. J Headache Pain 2019; 20:51. [PMID: 31072313 PMCID: PMC6734261 DOI: 10.1186/s10194-019-0988-x] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/27/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Migraine is a highly prevalent and disabling neurological disorder which is commonly linked with a broad range of psychiatric comorbidities, especially among subjects with migraine with aura or chronic migraine. Defining the exact nature of the association between migraine and psychiatric disorders and bringing out the pathophysiological mechanisms underlying the comorbidity with psychiatric conditions are relevant issues in the clinical practice. METHODS A systematic review of the most relevant studies about migraine and psychiatric comorbidity was performed using "PubMed", "Scopus", and "ScienceDirect" electronic databases from 1 January 1998 to 15 July 2018. Overall, 178 studies met our inclusion criteria and were included in the current review. RESULTS According to the most relevant findings of our overview, the associations with psychiatric comorbidities are complex, with a bidirectional association of major depression and panic disorder with migraine. Importantly, optimizing the pharmacological and non-pharmacological treatment of either migraine or its psychiatric comorbidities might help clinicians to attenuate the burden of both these conditions. CONCLUSIONS The available data highlight the need for a comprehensive evaluation of psychiatric disorders in migraine in order to promote an integrated model of care and carefully address the burden and psychosocial impairment related to psychiatric comorbidities in migraine.
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Affiliation(s)
- Thomas Dresler
- Department of Psychiatry & Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany.,LEAD Graduate School & Research Network, University of Tuebingen, Tuebingen, Germany
| | - Salvatore Caratozzolo
- Neurology Unit - Neurological and Vision Sciences Department, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Kaat Guldolf
- Department of Neurology, University Hospital Brussels, Jette, Belgium
| | - Jana-Isabel Huhn
- Praxis Gendolla, Specialized care for Psychiatry, Neurology, Psychotherapy and Pain Therapy, Essen, Germany
| | - Carmela Loiacono
- Child Neuropsychiatry school, University of Palermo, Palermo, Italy
| | | | - Marta Puma
- Headache Centre & Neurocritical Care Unit, Department of Human Neurosciences, Sapienza - University of Rome, Viale dell'Università 30, 00185, Rome, Italy
| | - Giorgia Sforza
- Child Neurology Unit, Department of Neuroscience and Neurorehabilitation, Headache Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Anna Tobia
- Child Neuropsychiatry Unit, ASL 3, Turin, Italy
| | - Raffaele Ornello
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy. .,IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
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Affiliation(s)
- Vimal Kumar Paliwal
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Borsook D, Youssef AM, Simons L, Elman I, Eccleston C. When pain gets stuck: the evolution of pain chronification and treatment resistance. Pain 2018; 159:2421-2436. [PMID: 30234696 PMCID: PMC6240430 DOI: 10.1097/j.pain.0000000000001401] [Citation(s) in RCA: 147] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
It is well-recognized that, despite similar pain characteristics, some people with chronic pain recover, whereas others do not. In this review, we discuss possible contributions and interactions of biological, social, and psychological perturbations that underlie the evolution of treatment-resistant chronic pain. Behavior and brain are intimately implicated in the production and maintenance of perception. Our understandings of potential mechanisms that produce or exacerbate persistent pain remain relatively unclear. We provide an overview of these interactions and how differences in relative contribution of dimensions such as stress, age, genetics, environment, and immune responsivity may produce different risk profiles for disease development, pain severity, and chronicity. We propose the concept of "stickiness" as a soubriquet for capturing the multiple influences on the persistence of pain and pain behavior, and their stubborn resistance to therapeutic intervention. We then focus on the neurobiology of reward and aversion to address how alterations in synaptic complexity, neural networks, and systems (eg, opioidergic and dopaminergic) may contribute to pain stickiness. Finally, we propose an integration of the neurobiological with what is known about environmental and social demands on pain behavior and explore treatment approaches based on the nature of the individual's vulnerability to or protection from allostatic load.
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Affiliation(s)
- David Borsook
- Center for Pain and the Brain, Boston Children’s (BCH), McLean and Massachusetts Hospitals (MGH), Boston MA
- Departments of Anesthesia (BCH), Psychiatry (MGH, McLean) and Radiology (MGH)
| | - Andrew M Youssef
- Center for Pain and the Brain, Boston Children’s (BCH), McLean and Massachusetts Hospitals (MGH), Boston MA
| | - Laura Simons
- Department of Anesthesia, Stanford University, Palo Alto, CA
| | | | - Christopher Eccleston
- Centre for Pain Research, University of Bath, UK
- Department of Clinical and Health Psychology, Ghent University, Belgium
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Abstract
Pain is essential for avoidance of tissue damage and for promotion of healing. Notwithstanding the survival value, pain brings about emotional suffering reflected in fear and anxiety, which in turn augment pain thus giving rise to a self-sustaining feedforward loop. Given such reciprocal relationships, the present article uses neuroscientific conceptualizations of fear and anxiety as a theoretical framework for hitherto insufficiently understood pathophysiological mechanisms underlying chronic pain. To that end, searches of PubMed-indexed journals were performed using the following Medical Subject Headings' terms: pain and nociception plus amygdala, anxiety, cognitive, fear, sensory, and unconscious. Recursive sets of scientific and clinical evidence extracted from this literature review were summarized within the following key areas: (1) parallelism between acute pain and fear and between chronic pain and anxiety; (2) all are related to the evasion of sensory-perceived threats and are subserved by subcortical circuits mediating automatic threat-induced physiologic responses and defensive actions in conjunction with higher order corticolimbic networks (e.g., thalamocortical, thalamo-striato-cortical and amygdalo-cortical) generating conscious representations and valuation-based adaptive behaviors; (3) some instances of chronic pain and anxiety conditions are driven by the failure to diminish or block respective nociceptive information or unconscious treats from reaching conscious awareness; and (4) the neural correlates of pain-related conscious states and cognitions may become autonomous (i.e., dissociated) from the subcortical activity/function leading to the eventual chronicity. Identifying relative contributions of the diverse neuroanatomical sources, thus, offers prospects for the development of novel preventive, diagnostic, and therapeutic strategies in chronic pain patients.
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Affiliation(s)
- Igor Elman
- Boonshoft School of Medicine, Wright State University, Dayton VA Medical Center, Dayton, OH, United States
| | - David Borsook
- Harvard Medical School, Center for Pain and the Brain, Boston Children's Hospital, Massachusetts General Hospital, McLean Hospital, Boston, MA, United States
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The treatment of migraine patients within chiropractic: analysis of a nationally representative survey of 1869 chiropractors. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:519. [PMID: 29202816 PMCID: PMC5715542 DOI: 10.1186/s12906-017-2026-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 11/22/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND While the clinical role of manual therapies in migraine management is unclear, the use of chiropractors for this condition is considerable. The aim of this study is to evaluate the prevalence and characteristics of chiropractors who frequently manage patients with migraine. METHODS A national cross-sectional survey of chiropractors collected information on practitioner characteristics, clinical management characteristics and practice settings. A secondary analysis was conducted on 1869 respondents who reported on their migraine caseload to determine the predictors associated with the frequent management of patients with migraine. RESULTS A large proportion of chiropractors report having a high migraine caseload (HMC) (n = 990; 53.0%). The strongest factors predicting a chiropractor having a HMC include the frequent treatment of patients with axial neck pain (OR = 2.89; 95%CI: 1.18, 7.07), thoracic pain (referred/radicular) (OR = 2.52; 95%CI: 1.58, 3.21) and non-musculoskeletal disorders (OR = 3.06; 95%CI: 2.13, 4.39). CONCLUSIONS Several practice-setting and clinical management characteristics are associated with chiropractors managing a HMC. These findings raise key questions about the therapeutic approach to chiropractic migraine management that deserves further examination. There is a need for more primary research to assess the approach to headache and migraine management provided by chiropractors and to understand the prevalence, burden and comorbidities associated with migraine found within chiropractic patient populations. This information is vital in helping to inform safe, effective and coordinated care for migraine sufferers within the wider health system.
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Minen MT, Begasse De Dhaem O, Kroon Van Diest A, Powers S, Schwedt TJ, Lipton R, Silbersweig D. Migraine and its psychiatric comorbidities. J Neurol Neurosurg Psychiatry 2016; 87:741-9. [PMID: 26733600 DOI: 10.1136/jnnp-2015-312233] [Citation(s) in RCA: 268] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 11/26/2015] [Indexed: 11/04/2022]
Abstract
Migraine is a highly prevalent and disabling neurological disorder associated with a wide range of psychiatric comorbidities. In this manuscript, we provide an overview of the link between migraine and several comorbid psychiatric disorders, including depression, anxiety and post-traumatic stress disorder. We present data on psychiatric risk factors for migraine chronification. We discuss the evidence, theories and methods, such as brain functional imaging, to explain the pathophysiological links between migraine and psychiatric disorders. Finally, we provide an overview of the treatment considerations for treating migraine with psychiatric comorbidities. In conclusion, a review of the literature demonstrates the wide variety of psychiatric comorbidities with migraine. However, more research is needed to elucidate the neurocircuitry underlying the association between migraine and the comorbid psychiatric conditions and to determine the most effective treatment for migraine with psychiatric comorbidity.
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Affiliation(s)
- Mia Tova Minen
- Department of Neurology, NYU Langone Medical Center, New York, New York, USA
| | | | - Ashley Kroon Van Diest
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Medical Center, Cincinnati, Ohio, USA
| | - Scott Powers
- Cincinnati Children's Medical Center, Headache Center, Office for Clinical and Translational Research, Center for Child Behavior and Nutrition Research and Training, Pediatrics, Cincinnati, Ohio, USA
| | | | - Richard Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - David Silbersweig
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Lee SM, Yoon JR, Yi YY, Eom S, Lee JS, Kim HD, Cheon KA, Kang HC. Screening for depression and anxiety disorder in children with headache. KOREAN JOURNAL OF PEDIATRICS 2015; 58:64-8. [PMID: 25774198 PMCID: PMC4357774 DOI: 10.3345/kjp.2015.58.2.64] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 09/03/2014] [Accepted: 09/24/2014] [Indexed: 11/27/2022]
Abstract
Purpose The purpose of this study was to investigate the importance of initial screening tests for depression and anxiety disorders in children with headache. In addition, this study evaluated whether the Children's Depression Inventory (CDI) and Revised Children's Manifest Anxiety Scale (RCMAS) are suitable for screening symptoms of depression and anxiety. Methods A retrospective chart review was conducted of 720 children aged 7-17 years who had visited a pediatric neurology clinic for headaches and were referred to a pediatric psychiatric clinic for psychiatric symptoms from January 2010 to December 2011. All patients completed the CDI and RCMAS. Among them, charts of patients with clinically significant total scores (cutoff>15) for psychiatric symptoms, as defined by the CDI and RCMAS scoring scales, were reviewed. Results Nineteen patients had headaches and clinically significant total scores for psychiatric symptoms. The mean age at headache diagnosis was 11.7 years, and 57% were male. Mean duration of headache was 11.5 months. Two point eight percent of the patients were diagnosed with psychiatric disorders including major depression (1.7%), generalized anxiety disorder (1.1%), and bipolar disorder (0.1%). Four patients (0.6%) were diagnosed with attention deficit/hyperactivity disorder (ADHD). Total mean CDI and RCMAS scores of patients referred to the psychiatric clinic were 18.8 and 22.2, respectively. There was no correlation between CDI or RCMAS total scores and headache frequency, duration, or severity. Conclusion We recommend that all patients with headache should be screened for depression and anxiety by CDI and RCMAS scores.
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Affiliation(s)
- Sang Mi Lee
- Department of Medicine, Graduate School, Yonsei University, Seoul, Korea
| | - Jung-Rim Yoon
- Department of Medicine, Graduate School, Yonsei University, Seoul, Korea
| | - Yoon Young Yi
- Department of Medicine, Graduate School, Yonsei University, Seoul, Korea
| | - Soyong Eom
- Division of Pediatric Neurology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Soo Lee
- Division of Pediatric Neurology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Heung Dong Kim
- Division of Pediatric Neurology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Keun-Ah Cheon
- Department of Psychiatry, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hoon-Chul Kang
- Division of Pediatric Neurology, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
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Biagianti B, Grazzi L, Usai S, Gambini O. Dependency-like behaviors and pain coping styles in subjects with chronic migraine and medication overuse: results from a 1-year follow-up study. BMC Neurol 2014; 14:181. [PMID: 25234249 PMCID: PMC4172841 DOI: 10.1186/s12883-014-0181-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 09/10/2014] [Indexed: 11/10/2022] Open
Abstract
Background Even after successful detoxification, 20-40% of subjects presenting chronic migraine with symptomatic medication overuse (CMwMO) relapse into medication overuse within one year. In this restrospective analysis on subjects referred to our center for detoxification, we investigated whether personality traits, dependency-like behaviors and pain coping styles predicted those who relapsed into medication overuse within the 12 months following the detoxification and those who did not. Methods 63 patients with CMwMO were assessed for personality traits, mood and anxiety, pain coping styles and dependency-like behaviors prior-to and one year after a detoxification program. Results Of the 42 subjects who attended 1-year follow-up interviews, 11 relapsed into medication overuse despite a temporary benefit from detoxification and did not show clinical or psychological improvement, instead reporting increased anxiety and unmodified perpetuation of severe dependency-like behaviors. In contrast, subjects who did not relapse into medication overuse had clinical improvements that generalized to untreated domains, including decreased depressive symptoms and dependency-like behaviors, although showing unmodified low internal control over pain. Conclusions Subjects who did not fall into medication overuse throughout the 12 months following the detoxification showed improved clinical, affective and dependence-related outcomes, but not pain coping strategies. Conversely, subjects who relapsed within one year into CMwMO continued to experience significant disability, pain intensity, and dependency-like behaviors. We believe that the persistence of maladaptive pain coping strategies and residual symptomatology increase the risk for recurrent relapses, against which pharmacological interventions are only partially effective. Further studies investigating predictors of relapse are needed to inform multi-disciplinary interventions for CMwMO.
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Affiliation(s)
- Bruno Biagianti
- San Francisco Department of Veterans Affairs Medical Center, Building 16, 4150 Clement Street, San Francisco 94121, CA, USA.
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Abstract
This review summarizes the various forms of behavioral treatment of migraine which could demonstrate empirical efficacy. The main unimodal kinds of treatment are thermal and electromyography (EMG) biofeedback training and progressive muscle relaxation. The various relaxation techniques do not differ in their efficacy in treating migraine. On average a reduction in migraine frequency of 35-45 % is achieved. The mean effect sizes (ES) of various biofeedback techniques are between 0.4 and 0.6. Cognitive-behavioral treatment is applied as a multimodal treatment and on average achieves an improvement in migraine activity by 39 % and an ES of 0.54. All behavioral procedures can be used in combination or as an alternative to drug prophylaxis with comparable success. A combination of pharmacological and behavioral treatment can achieve additional success. There is strong evidence for the clinically significant efficacy of all forms of behavioral treatment in childhood and adolescence. There are no signs of differential indications.
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Grazzi L. Multidisciplinary approach to patients with chronic migraine and medication overuse: experience at the Besta Headache Center. Neurol Sci 2013; 34 Suppl 1:S19-21. [DOI: 10.1007/s10072-013-1380-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Irrespective of diagnosis, chronic daily, morning, or "awakening" headache patterns are soft signs of a sleep disorder. Sleep apnea headache may emerge de novo or may present as an exacerbation of cluster, migraine, tension-type, or other headache. Insomnia is the most prevalent sleep disorder in chronic migraine and tension-type headache, and increases risk for depression and anxiety. Sleep disturbance (e.g., sleep loss, oversleeping, schedule shift) is an acute headache trigger for migraine and tension-type headache. Snoring and sleep disturbance are independent risk factors for progression from episodic to chronic headache.
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Affiliation(s)
- Jeanetta C Rains
- Center for Sleep Evaluation, Elliot Hospital, 185 Queen City Avenue, Manchester, NH 03102, USA.
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Smitherman TA, Kolivas ED, Bailey JR. Panic disorder and migraine: comorbidity, mechanisms, and clinical implications. Headache 2012; 53:23-45. [PMID: 23278473 DOI: 10.1111/head.12004] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2012] [Indexed: 12/17/2022]
Abstract
A growing body of literature suggests that comorbid anxiety disorders are more common and more prognostically relevant among migraine sufferers than comorbid depression. Panic disorder (PD) appears to be more strongly associated with migraine than most other anxiety disorders. PD and migraine are both chronic diseases with episodic manifestations, involving significant functional impairment and shared symptoms during attacks, interictal anxiety concerning future attacks, and an absence of identifiable secondary pathology. A meta-analysis of high-quality epidemiologic study data from 1990 to 2012 indicates that the odds of PD are 3.76 times greater among individuals with migraine than those without. This association remains significant even after controlling for demographic variables and comorbid depression. Other less-rigorous community and clinical studies confirm these findings. The highest rates of PD are found among migraine with aura patients and those presenting to specialty clinics. Presence of PD is associated with greater negative impact of migraine, including more frequent attacks, increased disability, and risk for chronification and medication overuse. The mechanisms underlying this common comorbidity are poorly understood, but both pathophysiological (eg, serotonergic dysfunction, hormonal influences, dysregulation of the hypothalamic-pituitary-adrenal axis) and psychological (eg, interoceptive conditioning, fear of pain, anxiety sensitivity, avoidance behavior) factors are implicated. Means of assessing comorbid PD among treatment-seeking migraineurs are reviewed, including verbal screening for core PD symptoms, ruling out medical conditions with panic-like features, and administering validated self-report measures. Finally, evidence-based strategies for both pharmacologic and behavioral management are outlined. The first-line migraine prophylactics are not indicated for PD, and the selective serotonin re-uptake inhibitors used to treat PD are not efficacious for migraine; thus, separate agents are often required to address each condition. Core components of behavioral treatments for PD are reviewed, and their integration into clinical headache practice is discussed.
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Affiliation(s)
- Todd A Smitherman
- Department of Psychology, University of Mississippi, Oxford, MS, USA
| | | | - Jennifer R Bailey
- Department of Psychology, University of Mississippi, Oxford, MS, USA
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Grazzi L, Bussone G. What future for treatment of chronic migraine with medication overuse? Neurol Sci 2011; 32 Suppl 1:S19-22. [PMID: 21533706 DOI: 10.1007/s10072-011-0553-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Chronic headaches have increasingly become a focus within the field of head pain. Most of the patients with frequent headache eventually overuse their medications, and if it happens [the percentage is approximately 4%], the diagnosis of chronic migraine with medication-overuse headache is clinically important, because patients rarely respond to preventive medications while overusing acute medications. This kind of headache is recognized as a biobehavioral disorder, a complex condition wherein emotion and pain are intermingled. Properly treating medication overuse with adequate strategies by different and specific steps are essential components for helping these patients to improve and for preventing relapses. The clinical experience performed at our Headache Unit, the necessity of withdrawal, different treatment schedules, and different treatment strategies of our center were discussed.
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Affiliation(s)
- Licia Grazzi
- Department of Neurological Sciences, Headache Unit, Neurological Institute C.Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy.
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Smitherman TA, Ward TN. Psychosocial Factors of Relevance to Sex and Gender Studies in Headache. Headache 2011; 51:923-31. [DOI: 10.1111/j.1526-4610.2011.01919.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Balottin U, Chiappedi M, Rossi M, Termine C, Nappi G. Childhood and adolescent migraine: A neuropsychiatric disorder? Med Hypotheses 2011; 76:778-81. [DOI: 10.1016/j.mehy.2011.02.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Revised: 01/18/2011] [Accepted: 02/06/2011] [Indexed: 11/15/2022]
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Gambini O, Barbieri V, Biagianti B, Scarone S. Consultation-liaison psychiatry for patients with headaches. Neurol Sci 2011; 32 Suppl 1:S81-3. [PMID: 21533719 DOI: 10.1007/s10072-011-0533-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Screening of headache patients for psychiatric disorders is needed, because of the well-known high rates of comorbidity with depression and anxiety. Screening for both depression and anxiety is highly advisable in order to identify subjects who need psychiatric consultation and therapy. Screening tools for depression and anxiety range from informal questions to self-report instruments to structured interviews and the choice is up to the clinician and the setting of the clinical evaluation. Data on psychiatric disorders and medication overuse are till now not consistent. The treatment of mood and anxiety disorders in headache patients needs to take into account the possible drug interactions with headache therapies. The collaboration between neurologists and consultation-liaison psychiatrists helps the identification of headache patients who need a psychiatric therapeutic program and follow-up.
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Affiliation(s)
- O Gambini
- DMCO, Università degli Studi di Milano, AO San Paolo, Via A. di Rudinì 8, 20100 Milan, Italy.
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Anxiety disorders in headache patients in a specialised clinic: prevalence and symptoms in comparison to patients in a general neurological clinic. J Headache Pain 2011; 12:323-9. [PMID: 21298462 PMCID: PMC3094676 DOI: 10.1007/s10194-011-0293-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 01/09/2011] [Indexed: 11/16/2022] Open
Abstract
Data from several studies indicate an association of headache with anxiety disorders. In this study, we assessed and differentiated anxiety disorders in 100 headache patients by using the PSWQ (Penn State Worry Questionnaire) screening tool for generalised anxiety disorder (GAD) and the ACQ (Agoraphobic Cognitions Questionnaire) and BSQ (Body Sensation Questionnaire) for panic disorder (PD). Control groups were constructed: (1) on the basis of epidemiological studies on PD and GAD in the general population and (2) by including neurological patients. 37.0% of headache patients had a GAD. 27% of headache patients met the score for PD in the BSQ, 4.0% in the ACQ. Significant results were obtained in comparison to the general population (p < 0.001) and with regard to GAD in comparison with a sample of neurological patients (p < 0.005). The BSQ significantly correlated with the number of medication days (p < 0.005). The results confirm the increased prevalence of GAD in headache patients. PD seems to increase the risk of medication overuse.
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Gambini O, Islam L, Demartini B, Scarone S. Psychiatric issues in patients with headaches. Neurol Sci 2010; 31 Suppl 1:S111-3. [PMID: 20464598 DOI: 10.1007/s10072-010-0300-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Comorbidities among headaches and psychiatric disorders have been consistently reported in several clinical studies and reviews. In this paper, we review some recent clinical studies on migraine and tension-type headaches associated with mood, anxiety and somatoform disorders, focusing on therapeutic strategies for the psychiatric disorders.
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Affiliation(s)
- O Gambini
- Cattedra di Psichiatria - Dipartimento di Medicina, Chirurgia e Odontoiatria, Università degli Studi di Milano, AO San Paolo, Via A. di Rudinì 8, 20100, Milan, Italy.
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Smitherman TA, Rains JC, Penzien DB. Psychiatric comorbidities and migraine chronification. Curr Pain Headache Rep 2010; 13:326-31. [PMID: 19586598 DOI: 10.1007/s11916-009-0052-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A growing body of literature has implicated comorbid psychopathology as a potential risk factor for the chronification of migraine. Of the psychiatric disorders, depressive and anxiety disorders have been most consistently associated with the chronification of migraine. A shared dysfunction of the serotonergic system, medication overuse, and psychological factors have been proposed to mediate this relationship, although the responsible mechanisms are still largely unclear. This article overviews literature on psychiatric comorbidities and migraine chronification, considers mechanisms underlying this relationship, and notes directions for future clinical and empirical work.
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Affiliation(s)
- Todd A Smitherman
- Department of Psychology, University of Mississippi, University, MS 38677, USA.
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Abstract
The role of the psychologist in chronic headache needs to be tailored to the patient's presentation. For some patients, psychological issues need to be directly addressed (eg, psychiatric comorbidity, difficulties coping with headache, significant problems with sleep and/or stress, medication overuse, and history of abuse). Other situations (eg, patients' beliefs about their readiness to change ability to actively manage headaches, medication adherence, and managing triggers) involve behavioral/psychological principles even when there is no direct contact with a psychologist. This article reviews the literature on the importance of psychological issues in headache management and provides suggestions for how to address behavioral and cognitive factors and their potential for improved headache care.
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Affiliation(s)
- Robert A Nicholson
- Department of Neurology & Psychiatry, Saint Louis University School of Medicine, St. Louis, MO 63104, USA.
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Current World Literature. Curr Opin Neurol 2009; 22:321-9. [DOI: 10.1097/wco.0b013e32832cf9cb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Galli F, Canzano L, Scalisi TG, Guidetti V. Psychiatric disorders and headache familial recurrence: a study on 200 children and their parents. J Headache Pain 2009; 10:187-97. [PMID: 19352592 PMCID: PMC3451992 DOI: 10.1007/s10194-009-0105-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Accepted: 01/31/2009] [Indexed: 11/23/2022] Open
Abstract
The main aim of the study was to examine the relationship between headache and familial recurrence of psychiatric disorders in parents and their children. Headache history and symptomatology have been collected in a clinical sample of 200 patients and their families, using a semi-structured interview (ICHD-II criteria). Psychiatric comorbidity was assessed by DSM-IV criteria. Chi squares and a loglinear analysis were computed in order to evaluate the main effects and interactions between the following factors: frequency and headache subtypes (migraine/not-migraine) in children, headache (migraine/not-migraine-absent/present) in parents, headache (absent/present) in grandparents, and psychiatric comorbidity (absent/present) have been analyzed: 94 mothers (47%) and 51 fathers (25.5%) had at least one psychiatric disorder, mainly mood and anxiety disorders. Considering the significant prevalence of Psi-co in children (P < 0.0001), we compared it with the presence of familiarity to headache: a significant interaction has been found (P < 0.05) showing that migraineurs with high familial recurrence of headache had a higher percentage (74.65%) of psychiatric disorders, than no-migraineurs (52.17%). Absence of headache familial loading seems to be related to psi-co only in no-migraine headache (87.5 vs. 45.5%). The occurrence of psychiatric disorders is high in children with headache, but a very different pattern seems to characterize migraine (familial co-transmission of migraine and Psi-Co?) if compared with non-migraine headache.
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Affiliation(s)
- Federica Galli
- Department of Child and Adolescent Neurology, Psychiatry and Rehabilitation, University of Rome “La Sapienza”, Via dei Sabelli, 108-00185 Rome, Italy
| | - Loredana Canzano
- Department of Child and Adolescent Neurology, Psychiatry and Rehabilitation, University of Rome “La Sapienza”, Via dei Sabelli, 108-00185 Rome, Italy
| | - Teresa Gloria Scalisi
- Department of Developmental and Social Psychology, University of Rome “La Sapienza”, Rome, Italy
| | - Vincenzo Guidetti
- Department of Child and Adolescent Neurology, Psychiatry and Rehabilitation, University of Rome “La Sapienza”, Via dei Sabelli, 108-00185 Rome, Italy
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Smitherman TA, Penzien DB, Maizels M. Anxiety disorders and migraine intractability and progression. Curr Pain Headache Rep 2009; 12:224-9. [PMID: 18796274 DOI: 10.1007/s11916-008-0039-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Comorbid psychopathology has been implicated as a risk factor for the chronification and progression of migraine. Although past research has focused principally on depression and migraine, recent research consistently has confirmed that a disproportionate number of migraineurs suffer from one or more comorbid anxiety disorders. Moreover, this research has implicated anxiety disorders as factors potentially associated with migraine intractability and progression; growing evidence suggests that anxiety disorders may be even more prognostically significant than depression. This article summarizes these recent developments, considers mechanisms underlying this comorbidity, discusses strategies for assessing and managing comorbid anxiety, and notes directions for future clinical and empiric work.
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Affiliation(s)
- Todd A Smitherman
- Head Pain Center, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS 39216, USA.
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Non-pharmacological approaches to treating chronic migraine with medication overuse. Neurol Sci 2009; 30 Suppl 1:S89-93. [DOI: 10.1007/s10072-009-0081-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Headache. Curr Opin Neurol 2008; 21:284-7. [DOI: 10.1097/wco.0b013e3282ffb560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rains JC. Chronic headache and potentially modifiable risk factors: screening and behavioral management of sleep disorders. Headache 2008; 48:32-9. [PMID: 18184283 DOI: 10.1111/j.1526-4610.2007.00972.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Sleep-related variables have been identified among risk factors for frequent and severe headache conditions. It has been postulated that migraine, chronic daily headache, and perhaps other forms of chronic headache are progressive disorders. Thus, sleep and other modifiable risk factors may be clinical targets for prevention of headache progression or chronification. The present paper is part of the special series of papers entitled "Chronification of Headache" describing the empirical evidence, future research directions, proposed mechanisms, and risk factors implicated in headache chronification as well as several papers addressing individual risk factors (ie, sleep disorders, medication overuse, psychiatric disorders, stress, obesity). Understanding the link between risk factors and headache may yield novel preventative and therapeutic approaches in the management of headache. The present paper in the special series reviews epidemiological research as a means of quantifying the relationship between chronic headache and sleep disorders (sleep-disordered breathing, insomnia, circadian rhythm disorders, parasomnias) discusses screening for early detection and treatment of more severe and prevalent sleep disorders, and discusses fundamental sleep regulation strategies aimed at headache prevention for at-risk individuals.
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Affiliation(s)
- Jeanetta C Rains
- Center for Sleep Evaluation at Elliot Hospital, Manchester, NH 03103-3599, USA
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Penzien DB, Rains JC, Lipton RB. Introduction to the Special Series on the Chronification of Headache: Mechanisms, Risk Factors, and Behavioral Strategies Aimed at Primary and Secondary Prevention of Chronic Headache. Headache 2007. [DOI: 10.1111/j.1526-4610.2007.00968.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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