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Borthwick C, Penlington C, Robinson L. Partners' Experiences of Chronic Pain: A Qualitative Evidence Synthesis. J Clin Psychol Med Settings 2024; 31:585-606. [PMID: 38615080 DOI: 10.1007/s10880-024-10012-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 04/15/2024]
Abstract
This systematic review of qualitative studies synthesised evidence on the experience chronic pain from the perspective of romantic partners. Medline via Ovid, Embase via Ovid, CINAHL via EBSCO, APA PsycInfo via Ovid, Scopus, and Web of Science databases were searched. Studies exploring the impact of chronic pain from partners' perspectives using qualitative data collection methods were eligible for inclusion. Thematic synthesis was conducted, and confidence in the review findings was assessed using GRADE CERQual criteria. A total of 198 participants were represented from 15 primary studies. Four interconnected analytical themes were developed: 'life is different', 'internal conflict between two worlds', 'togetherness vs separateness', and 'coping in the longer term'. Out of 27 review findings, 9 were assessed as high confidence, 12 as moderate confidence, 4 as low confidence, and 2 as very low confidence. Socially isolated partners, those in strained relationships, and partners who continually sacrificed their own needs were more likely to experience distressing emotions. Greater recognition of partners' needs is needed within pain management services.
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Affiliation(s)
- Claire Borthwick
- School of Psychology, Newcastle University, 4th Floor, Dame Margaret Barbour Building, Wallace Street, Newcastle upon Tyne, NE2 4DR, UK.
| | - Chris Penlington
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Lucy Robinson
- School of Psychology, Newcastle University, 4th Floor, Dame Margaret Barbour Building, Wallace Street, Newcastle upon Tyne, NE2 4DR, UK
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Nichols VP, Ellard DR, Griffiths FE, Underwood M, Haywood KL, Taylor SJC. "It's just part of who I am…" Living with chronic headache: voices from the CHESS trial, a qualitative study. BMC Neurol 2024; 24:268. [PMID: 39095730 PMCID: PMC11295303 DOI: 10.1186/s12883-024-03779-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 07/25/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Between 2015 and 2019 the Chronic Headache Education and Self-management Study (CHESS) developed and tested a supportive self-management approach that aimed to improve outcomes for people with chronic migraine or chronic tension type headache with/without episodic migraine. However, a paucity of qualitative research which explored the lived experiences of people with chronic headache was evidenced. In response, we undertook to explore the experiences of living with chronic headaches of people who participated in the CHESS study. METHODS We adopted qualitative methodologies, inviting participants in the CHESS study to participate in semi-structured interviews. In phase 1 (feasibility study), a thematic analysis was conducted. In phase 2 (main CHESS trial), interviews were informed by topic guides developed from our learning from the phase 1 interviews. Pen portrait methodology and thematic analysis was employed allowing us to explore the data longitudinally. RESULTS Phase 1, 15 interviews (10 female) age range 29 to 69 years (median 47 years) revealed the complexities of living with chronic headache. Six overarching themes were identified including the emotional impact and the nature of their headaches. Phase 2, included 66 interviews (26 participants; median age group 50s (range 20s-60s); 20 females. 14 were interviewed at three points in time (baseline, 4 and 12 months) Through an iterative process four overlapping categories of headache impact emerged from the data and were agreed: i) 'I will not let headaches rule my life'; ii) 'Headaches rule my life'; iii) 'Headaches out of control-something needs to change'; and iv) 'Headaches controlled-not ruling my life'. One of these categories was assigned to each pen portrait at each timepoint. The remaining 12 participants were interviewed at two time points during a year; pen portraits were again produced. Analysis revealed that the headache impact categories developed above held true in this sample also providing some validation of the categories. CONCLUSIONS These data give an insight into the complexities of living with chronic headache. Chronic headache is unpredictable, permeating all aspects of an individual's life; even when an individual feels that their headache is controlled and not interfering, this situation can rapidly change. It shows us that more work needs to be done both medically and societally to help people living with this often-hidden condition. TRIAL REGISTRATION ISRCTN79708100.
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Affiliation(s)
- Vivien P Nichols
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - David R Ellard
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
- University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK.
| | - Frances E Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
- University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Kirstie L Haywood
- Warwick Medical School, Warwick Research in Nursing, University of Warwick, Coventry, CV4 7AL, UK
| | - Stephanie J C Taylor
- Wolfson Institute for Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, E1 2AB, UK
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Hee SW, Patel S, Sandhu H, Matharu MS, Underwood M. Does pain self-efficacy predict, moderate or mediate outcomes in people with chronic headache; an exploratory analysis of the CHESS trial. J Headache Pain 2024; 25:77. [PMID: 38745132 PMCID: PMC11094916 DOI: 10.1186/s10194-024-01768-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/08/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Chronic headache disorders are disabling. The CHESS trial studied the effects of a short non-pharmacological intervention of education with self-management support for people affected by migraine and/or tension type headache for at least 15 days per month for at least three months. There were no statistically significant effects on the Headache Impact Test-6 (HIT-6) at 12-months. However, we observed improvement in pain self-efficacy questionnaire (PSEQ) and short-term HIT-6. We explored the impact of the CHESS intervention on PSEQ, and subsequently, on the HIT-6 and chronic headache quality of life questionnaire (CH-QLQ) at four, eighth and 12 months. METHODS We included all 736 participants from the CHESS trial. We used simple linear regression models to explore the change of HIT-6 and CH-QLQ with treatment and PSEQ at baseline (predictor analysis), and the interaction between treatment and baseline PSEQ (moderator analysis). We considered the change of PSEQ from baseline to four months as a mediator in the mediation analysis. RESULTS Baseline PSEQ neither predicted nor moderated outcomes. The prediction effect on change of HIT-6 from baseline to 12 months was 0.01 (95% CI, -0.03 to 0.04) and the interaction (moderation) effect was -0.07 (95% CI, -0.15 to 0.002). However, the change of PSEQ from baseline to 4-month mediated the HIT-6 (baseline to 8-, and 12-month) and all components of CH-QLQ (baseline to 8-, and 12-month). The CHESS intervention improved the mediated variable, PSEQ, by 2.34 (95% CI, 0.484 to 4.187) units and this corresponds to an increase of 0.21 (95% CI, 0.03 to 0.45) units in HIT-6 at 12-months. The largest mediated effect was observed on the CH-QLQ Emotional Function, an increase of 1.12 (95% CI, 0.22 to 2.20). CONCLUSIONS PSEQ was not an effective predictor of outcome. However, change of short-term PSEQ mediated all outcomes, albeit minimally. Future behavioural therapy for chronic headache may need to consider how to achieve larger, and more sustained increases level of self-efficacy than that achieved within the CHESS trial. TRIAL REGISTRATION ISRCTN79708100.
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Affiliation(s)
- Siew Wan Hee
- University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, CV2 2DX, Coventry, UK.
- Warwick Medical School, University of Warwick, CV4 7AL, Coventry, UK.
| | - Shilpa Patel
- University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, CV2 2DX, Coventry, UK
- Warwick Medical School, University of Warwick, CV4 7AL, Coventry, UK
| | - Harbinder Sandhu
- Warwick Medical School, University of Warwick, CV4 7AL, Coventry, UK
| | - Manjit S Matharu
- Queen Square Institute of Neurology, University College London, Queen Square, WC1N 3BG, London, UK
| | - Martin Underwood
- University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, CV2 2DX, Coventry, UK
- Warwick Medical School, University of Warwick, CV4 7AL, Coventry, UK
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Dione MN, Donelle L, Smye V, Befus D. Self-management Experience of Nurses Living with Migraine: A Qualitative Study. Can J Nurs Res 2024; 56:38-48. [PMID: 37700606 DOI: 10.1177/08445621231199652] [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] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Migraine is a neurobiological condition characterized by a constellation of unpredictable symptoms and is the second cause of disability worldwide. Migraine is prevalent among nurses. However, literature exploring nurses' experience of living with migraine is scarce which has important individual and systems implications for health and wellness and patient safety. Self-management is essential in chronic disease management as the patient engages in various strategies to be able to live with their condition. PURPOSE This study explored the experiences of living and working with migraine among female nurses in Ontario, with particular attention to their priorities and strategies for self-management. METHODS Interpretive description methodology was employed to guide this study and informed a thematic analysis approach to examine the self-management experiences of nurses living with migraine. RESULTS Nurses engaged in various self-management strategies including pharmacological and non-pharmacological strategies and highlighted the role of technology in migraine self-management. Participants described experiences of living with migraine as an invisible condition including feelings of not being understood, stigmatization, and the absence of formal support at the workplace. CONCLUSION The implications of these findings support the incorporation of a critical approach to relational engagement that is person-centred including nonjudgemental, strength-based care as a practice approach when caring for persons living with migraines and the need to include experiential learning in educational curriculums as a strategy to reduce stigma against migraines.
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Affiliation(s)
| | - Lorie Donelle
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
- College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | - Victoria Smye
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Deanna Befus
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
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Plener J, Mior S, Atkinson-Graham M, Hogg-Johnson S, Côté P, Ammendolia C. Information is power: a qualitative study exploring the lived experiences of patients with degenerative cervical radiculopathy. Pain 2024; 165:347-356. [PMID: 37625188 PMCID: PMC10785052 DOI: 10.1097/j.pain.0000000000003019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 08/27/2023]
Abstract
ABSTRACT Degenerative cervical radiculopathy (DCR) can lead to severe pain, paraesthesia, and/or motor weakness, resulting in significant morbidity, disability, and reduced quality of life. Typically, individuals suffer from prolonged symptoms, with time to complete recovery spanning months to years. Little is known about the impact DCR has on peoples' lives. Therefore, this study aimed to explore the everyday experiences of individuals living with DCR. A qualitative study was conducted through an interpretivist lens exploring the experiences of participants. Participants were purposefully recruited and interviewed with 2 research team members. Transcripts were independently analyzed by 2 reviewers and coding was finalized by consensus. Analysis was performed using an interpretative phenomenological approach, with emergent themes mapped onto the 5 domains of the International Classification of Functioning, Disability and Health framework. Eleven participants were interviewed between December 2021 and April 2022. Three themes emerged: the biopsychosocial impact of DCR, role of the health care provider, and uncertainty surrounding DCR. Pain and paraesthesia were the most common symptoms experienced by participants, leading to significant psychological distress and impact to daily activities, most notably driving, housecleaning, sleep, and ability to work. Participants described the uncertainty they experienced as a result of the unpredictable nature of DCR and the important role that health care providers play in their journey with DCR. Health care providers were seen acting as either a facilitator or a barrier to their recovery. The findings from this study can be used by clinicians providing patient-centered care to better understand the experiences of people with DCR.
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Affiliation(s)
- Joshua Plener
- Division of Graduate Education, Canadian Memorial Chiropractic College, Toronto, Canada
- Department of Medicine, Mount Sinai Hospital, Toronto, Canada
| | - Silvano Mior
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
- Institute for Disability and Rehabilitation Research, Oshawa, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Melissa Atkinson-Graham
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Sheilah Hogg-Johnson
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
- Institute for Disability and Rehabilitation Research, Oshawa, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Pierre Côté
- Institute for Disability and Rehabilitation Research, Oshawa, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Carlo Ammendolia
- Department of Medicine, Mount Sinai Hospital, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
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Mangrum R, Bryant AL, Gerstein MT, McCarrier KP, Houts CR, McGinley JS, Buse DC, Lipton RB, Wirth RJ. The impacts of migraine on functioning: Results from two qualitative studies of people living with migraine. Headache 2024; 64:156-171. [PMID: 38235605 PMCID: PMC10922598 DOI: 10.1111/head.14664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE To describe the impact of migraine on functioning based on comprehensive data collection, analysis, and reporting of patients' experiences. BACKGROUND Qualitative research conducted to understand patients' perspectives on living with migraine has often focused on narrow topics or specific groups of patients or has been selectively reported. METHODS Qualitative interviews with 71 participants were conducted during two concept elicitation studies as part of the Migraine Clinical Outcome Assessment System (MiCOAS) project, an FDA grant-funded program designed to develop a core set of patient-centered outcome measures for migraine clinical trials. Participants self-reported being diagnosed with migraine by a healthcare professional and participated in semi-structured qualitative interviews about their experiences with the symptoms and impacts of migraine. Interview transcripts were coded to identify and define concepts, which were then grouped into broad domains based on conceptual similarities. RESULTS A total of 66 concepts were identified: 12 for physical functioning, 16 for cognitive functioning, 10 for social role functioning, 19 for emotional and psychological functioning, and 9 related to migraine management. Participants described a complex and varied relationship between migraine attack symptoms and impacts on functioning. Impacts from migraine were further influenced by numerous contextual factors, such as people's individual social environments and the level of day-to-day demand for functioning they face. CONCLUSION Findings showed that migraine impacted individual functioning in multiple ways and the nature of these impacts was dependent on social-contextual factors. The results are being used in the development of core measures designed to improve our understanding of the burden of migraine and the efficacy of migraine therapies. The results also offer new insights and raise new questions about migraine experience that can be used to guide future research.
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Affiliation(s)
- Rikki Mangrum
- Vector Psychometric Group, Chapel Hill, North Carolina, USA
| | | | - Maya T Gerstein
- Patient Centered Outcomes, Open Health Group, Bethesda, Maryland, USA
| | - Kelly P McCarrier
- Patient Centered Outcomes, Open Health Group, Bethesda, Maryland, USA
| | - Carrie R Houts
- Vector Psychometric Group, Chapel Hill, North Carolina, USA
| | | | - Dawn C Buse
- Vector Psychometric Group, Chapel Hill, North Carolina, USA
- Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Richard B Lipton
- Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - R J Wirth
- Vector Psychometric Group, Chapel Hill, North Carolina, USA
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van Rysewyk S, Blomkvist R, Chuter A, Crighton R, Hodson F, Roomes D, Smith BH, Toye F. Understanding the lived experience of chronic pain: A systematic review and synthesis of qualitative evidence syntheses. Br J Pain 2023; 17:592-605. [PMID: 37969135 PMCID: PMC10642495 DOI: 10.1177/20494637231196426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background Although multiple measures of the causes and consequences of chronic non-cancer pain (CNCP) are available and can inform pain management, no quantitative summary of these measures can describe the meaning of pain for a patient. The lived experience of pain tends to be a blind spot in pain management. This study aimed to: (1) integrate qualitative research investigating the lived experience of a range of CNCP conditions; (2) establish common qualitative themes in CNCP experience; and (3) evaluate the relevance of our results through a survey questionnaire based on these themes, administered across the United Kingdom. Methods Four bibliographic databases were searched from inception to February 2021 to identify Qualitative Evidence Syntheses (QES) that investigated the lived experience of CNCP and its impact on everyday life and activities. Themes and trends were derived by thematic qualitative analysis in collaboration with two patient and public involvement representatives who co-created twenty survey statements. The survey was developed for testing the QES themes for validity in people living with pain. Results The research team identified and screened 1323 titles, and considered 86 abstracts, including 20 in the final review. Eight themes were developed from the study findings: (1) my pain gives rise to negative emotions; (2) changes to my life and to myself; (3) adapting to my new normal; (4) effects of my pain management strategies; (5) hiding and showing my pain; (6) medically explaining my pain; (7) relationships to those around me; and (8) working while in pain. Each theme gave rise to one or two survey questions. The survey was shared with members of the UK pain community over a 2-week period in November 2021, and was completed by 1219 people, largely confirming the above themes. Conclusion/Implications This study provides a validated summary of the lived experience of CNCP. It highlights the adverse nature, complications, and consequences of living with CNCP in the UK and the multiple shortcomings in the ways in which pain is addressed by others in the UK. Our findings are consistent with published meta-ethnographies on chronic non-malignant musculoskeletal pain and chronic low-back pain. Despite the underrepresentation of qualitative research in the pain literature compared to quantitative approaches, for understanding the complexity of the lived experience of pain, qualitative research is an essential tool.
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Affiliation(s)
- Simon van Rysewyk
- Department of Philosophy and Gender Studies, School of Humanities, University of Tasmania, Hobart, TAS, Australia
| | - Renée Blomkvist
- Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | | | - Rhea Crighton
- Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, UK
| | | | | | - Blair H Smith
- Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Francine Toye
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Sikorski C, Mavromanoli AC, Manji K, Behzad D, Kreatsoulas C. Adverse Childhood Experiences and Primary Headache Disorders: A Systematic Review, Meta-analysis, and Application of a Biological Theory. Neurology 2023; 101:e2151-e2161. [PMID: 37879940 PMCID: PMC10663032 DOI: 10.1212/wnl.0000000000207910] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/15/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Headache disorders are among the leading causes of disability worldwide. While an association between adverse childhood experiences and primary headaches has been reported, the pooled magnitude across studies and pathways of the association are unknown. Our objectives were (1) to estimate the pooled effect of ≥1 adverse childhood experience (ACE) on primary headache disorders in adulthood and (2) to test the hypothesis that ACEs categorized as "threat" traumas or "deprivation" traumas have distinct effects on primary headaches based on a selected theory from our narrative review of how ACEs affect human development along the life course. METHODS PubMed, EMBASE, MEDLINE, Web of Science, Google Scholar, Biological Psychiatry, and gray literature were searched up to March 16, 2023 (PROSPERO, CRD42020223403). Selected articles included (1) observational studies with a comparator group, (2) ACEs that occurred before 18 years of age, and (3) primary headaches occurring at or after 21 years of age. Pooled odds ratios (ORs) were calculated using multilevel linear random-effects modeling. The narrative review included theories that describe how ACEs affect human development and disease across the life course. We selected a theory from our narrative review and tested ACEs categorized according to this theory for any modification of point estimates. RESULTS Our search identified 32 studies, of which 28 were eligible for meta-analysis (n = 154,739 participants, 19 countries). The occurrence of ≥1 adverse childhood experience(s) was associated with primary headaches (pooled OR = 1.48 [95% CI 1.36-1.61]; high-quality evidence, 134,696 participants). As the number of ACEs increased, the odds of primary headaches increased (range: 1 ACE OR = 1.24 [95% CI 1.14-1.35] to ≥4 ACEs OR = 2.09 [95% CI 1.83-2.38], p for trend <0.0001). From the narrative review, a neurodevelopmental theory that categorizes ACEs into threat or deprivation was tested, and both were independently associated with primary headaches (threat OR = 1.46 [95% CI 1.32-1.60] and deprivation OR = 1.35 [95% CI 1.23-1.49], respectively), accounting for heterogeneity (p = 0.021). DISCUSSION This systematic review and meta-analysis confirm that ACEs are important risk factors of primary headache disorders in adulthood. Our findings provide epidemiologic support that ACEs categorized as threat and deprivation may manifest as distinct pathways of early adversity.
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Affiliation(s)
- Claudia Sikorski
- From the Department of Health Research Methods, Evidence, and Impact (C.S.), McMaster University Hamilton, Ontario, Canada; University Medical Center of the Johannes Gutenberg University (A.C.M.), Mainz, Germany; Department of Family and Community Medicine (K.M.), University of Toronto, Ontario, Canada; Department of Health Sciences (D.B.), Brock University St. Catherines, Ontario, Canada; and Health Policy and Management (C.K.), Harvard T.H. Chan School of Public Health, Boston, MA.
| | - Anna C Mavromanoli
- From the Department of Health Research Methods, Evidence, and Impact (C.S.), McMaster University Hamilton, Ontario, Canada; University Medical Center of the Johannes Gutenberg University (A.C.M.), Mainz, Germany; Department of Family and Community Medicine (K.M.), University of Toronto, Ontario, Canada; Department of Health Sciences (D.B.), Brock University St. Catherines, Ontario, Canada; and Health Policy and Management (C.K.), Harvard T.H. Chan School of Public Health, Boston, MA
| | - Karishma Manji
- From the Department of Health Research Methods, Evidence, and Impact (C.S.), McMaster University Hamilton, Ontario, Canada; University Medical Center of the Johannes Gutenberg University (A.C.M.), Mainz, Germany; Department of Family and Community Medicine (K.M.), University of Toronto, Ontario, Canada; Department of Health Sciences (D.B.), Brock University St. Catherines, Ontario, Canada; and Health Policy and Management (C.K.), Harvard T.H. Chan School of Public Health, Boston, MA
| | - Danial Behzad
- From the Department of Health Research Methods, Evidence, and Impact (C.S.), McMaster University Hamilton, Ontario, Canada; University Medical Center of the Johannes Gutenberg University (A.C.M.), Mainz, Germany; Department of Family and Community Medicine (K.M.), University of Toronto, Ontario, Canada; Department of Health Sciences (D.B.), Brock University St. Catherines, Ontario, Canada; and Health Policy and Management (C.K.), Harvard T.H. Chan School of Public Health, Boston, MA
| | - Catherine Kreatsoulas
- From the Department of Health Research Methods, Evidence, and Impact (C.S.), McMaster University Hamilton, Ontario, Canada; University Medical Center of the Johannes Gutenberg University (A.C.M.), Mainz, Germany; Department of Family and Community Medicine (K.M.), University of Toronto, Ontario, Canada; Department of Health Sciences (D.B.), Brock University St. Catherines, Ontario, Canada; and Health Policy and Management (C.K.), Harvard T.H. Chan School of Public Health, Boston, MA
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Pirthiraj A, Bhagwan R. The physical impact of migraines on female chiropractic patients: A qualitative study. Health SA 2023; 28:2283. [PMID: 37927942 PMCID: PMC10623481 DOI: 10.4102/hsag.v28i0.2283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 05/17/2023] [Indexed: 11/07/2023] Open
Abstract
Background Migraines are highly prevalent among the female population and have a significant burden on one's quality of life and physical functioning. Aim The study explored the physical impact and contributory factors of migraines on women and their experience of chiropractic treatment for migraine pain management. Setting The study was conducted in the eThekwini region of KwaZulu-Natal, South Africa. Methods The study used a qualitative descriptive design and adopted purposive sampling. The data were collected through 12 semi-structured interviews, between March and September 2021, and analysed using thematic analysis. Results The first theme that emerged focused on the physical effects of migraines. The second theme related to the factors that contributed to migraines. The third theme that emerged focused on chiropractic treatment for migraines. Conclusion The majority of the participants experienced chronic migraines and migraines without aura. The participants felt incapacitated and experienced debilitating physical effects with their migraines. The study highlighted that chiropractic treatment was favourable among the female population in improving the quality of life and reducing the severity, disability, duration of suffering and frequency of migraines. It was revealed that chiropractic was the preferred non-pharmacological approach for migraine treatment, as it proved to be a beneficial and effective treatment for migraine pain management. Contribution The findings contribute to a greater awareness of chiropractic as an effective evidence-based treatment approach for migraine pain management, which may be beneficial to migraineurs and healthcare practitioners.
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Affiliation(s)
- Ashalya Pirthiraj
- Department of Chiropractic, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
| | - Raisuyah Bhagwan
- Department of Community Health Studies, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
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10
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Lee SH, Shin DI, Lee SS. The insufficiency of a simple stress question in assessing stress for chronic daily headache in clinical practice. Clin Neurol Neurosurg 2023; 233:107944. [PMID: 37634396 DOI: 10.1016/j.clineuro.2023.107944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND In managing chronic daily headaches (CDH), a comprehensive approach is necessary to evaluate stress, a closely linked factor. However, limited time and costs often lead to the use of a simple stress question in clinical settings. This study aims to assess the validity of using a simple stress question for CDH patients and explore its implications for clinical practice. METHODS We recruited 103 patients with CDH who completed structured self-administered questionnaires, including a simple stress question ("Have you had any stress or concerns in the last 4 weeks?") and validated Korean versions of questionnaires for depression, anxiety, insomnia, and the Brief Encounter Psychosocial Instrument (BEPSI). A headache specialist conducted clinical interviews. The stress group consisted of patients who acknowledged overt stress (answering "yes" to the simple question) and covert stress (initially answering "no" but later admitting during the interview). Results showed no statistical difference between the subgroups, so they were combined as the "acknowledged stress" group. RESULTS Out of 103 patients, 54.4% had chronic migraine, 45.6% had chronic tension-type headache, and 66 patients (64.1%) acknowledged experiencing stress. No significant differences were found in demographic and clinical characteristics, BEPSI stress assessment, or depression, anxiety, and insomnia profiles between patients with overt stress (n = 51) and covert stress (n = 15). The average BEPSI score was 2.3 ± 0.9, with 45.6% of patients exceeding the criteria (>2.4). Two (5.4%) patients in denial of stress had scores above the BEPSI criteria. Among patients below the criteria of BEPSI, 21 acknowledged stress, while 35 denied stress, with no significant differences observed. CONCLUSIONS This study suggests the limitations of relying solely on a simple stress question for assessing stress in patients with CDH in clinical practice. It is possible to encounter covert stress, include individuals who do not exhibit noticeable stress, and misclassify stress levels. To overcome these limitations, it is necessary to foster a supportive environment for open communication on stress and implement a comprehensive assessment strategy when needed.
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Affiliation(s)
- Sung-Hyun Lee
- Department of Neurology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Republic of Korea.
| | - Dong-Ick Shin
- Department of Neurology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Republic of Korea
| | - Sang-Soo Lee
- Department of Neurology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Republic of Korea
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11
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Hervik JB, Foss EB, Stub T. Living with chronic headaches: A qualitative study from an outpatient pain clinic in Norway. Explore (NY) 2023; 19:702-709. [PMID: 36725462 DOI: 10.1016/j.explore.2023.01.004] [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: 08/15/2022] [Revised: 12/26/2022] [Accepted: 01/17/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although headache is considered a frequently experienced type of pain, the challenges, experiences, and perceptions of people suffering from chronic headaches are poorly understood. The aim of this study was to gain subjective information regarding these aspects in daily life, in order to answer the research question "What is life like with a chronic headache?" METHODOLOGY Semi-structured, in-depth interviews were conducted with 16 patients who suffered from chronic headaches. Five main domains were explored: emotions related to headaches; trauma/stressful events; behavioural changes, relationships, and coping mechanisms. ANALYSIS AND INTERPRETATION Participants reported that pain restricted their lives in many ways, including not being able to work, loss of status, identity, freedom, intimate relationships and friends. The majority believed that psychological and/or physiological trauma was the reason for their headaches. New information that emerged from this study was how common life events not usually considered major traumas, initiated and maintained symptoms. Shame and feelings of stigmatization appeared to be strongly associated with chronic pain, leading to a scenario where thriving, contentment and enjoyment were often lacking. MAIN RESULTS This study provided an in-depth understanding of how chronic headache adversely affects the lives of sufferers. Chronic headaches restrict sufferers' lives, resulting in emotional and behavioural changes and a high level of disability. The complexity of chronic headaches in clinical practice is hugely underestimated, and poorly understood by society in general.
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Affiliation(s)
- Jill Brook Hervik
- Department of Anaesthesia, Pain Clinic, Vestfold Hospital Trust, 3116, Tønsberg, Norway
| | - Eva B Foss
- Department of Anaesthesia, Pain Clinic, Vestfold Hospital Trust, 3116, Tønsberg, Norway
| | - Trine Stub
- UiT The Arctic University of Norway National Research Center in Complementary and Alternative Medicine (NAFKAM), Faculty of Health Sciences, Department of Community Medicine, Hansine Hansens veg 19, 9019 Tromsø, Norway.
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12
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Cuomo A, Marinangeli F, Magni A, Petrucci E, Vittori A, Cascella M. Investigating Functional Impairment in Chronic Low Back Pain: A Qualitative Study from the Patients and Specialists' Perspectives. J Pers Med 2023; 13:1012. [PMID: 37374001 DOI: 10.3390/jpm13061012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
Prompt and appropriate treatment of chronic low back pain (cLBP) is of the utmost importance for preventing relevant disability, high burden of disease, and increasing costs for the healthcare system. Recently, the concept of functional impairment has been associated with any type of chronic pain, and mounting attention has been paid to extending the aims of treatment beyond mere pain remission, including restoration of working capacity, everyday functioning, mobility, and quality of life. Nevertheless, a shared definition of functionality is still lacking. Notably, different specialists involved in the treatment of cLBP such as general practitioners, orthopedists, pain therapists, and physiatrists, and patients themselves have different opinions on what "functional impairment" actually means. On these premises, a qualitative interview study was performed to investigate how the concept of "functionality" is interpreted by different specialists involved in the management of cLBP, and by patients. Overall, all different specialists agreed that functionality should be assessed in clinical practice. However, in spite of several instruments available for evaluating functionality, no homogeneity of behavior is observable.
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Affiliation(s)
- Arturo Cuomo
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS, "Fondazione G. Pascale", 80131 Naples, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100 Coppito, Italy
| | - Alberto Magni
- Italian College of General Practitioners and Primary Care (SIMG), Via del Sansovino 179, 50142 Firenze, Italy
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, 67100 L'Aquila, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS, "Fondazione G. Pascale", 80131 Naples, Italy
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Lau CI, Chen WH, Wang HC, Walsh V. Decision-making impairment under ambiguity but not under risk may underlie medication overuse in patients with chronic migraine. Headache 2023; 63:822-833. [PMID: 37232343 DOI: 10.1111/head.14513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 02/26/2023] [Accepted: 03/06/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To explore whether patients with chronic migraine and medication overuse headache (CM + MOH) present with decision-making deficit. BACKGROUND Factors underlying MOH in patients with CM remain unclear. Whether the process of decision-making plays a role in MOH is still controversial. Decision-making varies in the degree of uncertainty: under ambiguity where the probability of outcome is unknown, and under risk where probabilities are known. METHODS Decisions under ambiguity and risk were assessed with the Iowa Gambling Task and the Cambridge Gambling Task, respectively, whereas executive function was assessed by the Wisconsin Card Sorting Test. RESULTS A total of 75 participants: 25 patients with CM + MOH, 25 with CM, and 25 age- and sex-similar healthy controls (HCs), completed this cross-sectional study. There was no significant difference in headache profiles except for more frequent analgesic use (mean ± SD: 23.5 ± 7.6 vs. 6.8 ± 3.4 days; p < 0.001) and higher Severity of Dependence Scores (median [25th-75th percentile]: 8 [5-11] vs. 1 [0-4]; p < 0.001) in patients with CM + MOH compared to CM. Total net score (mean ± SD) on the Iowa Gambling Task in patients with CM + MOH, CM, and HCs were - 8.1 ± 28.7, 10.9 ± 29.6, and 14.2 ± 28.8, respectively. There was a significant difference between the three groups (F(2, 72) = 4.28, p = 0.017), with patients with CM + MOH making significantly more disadvantageous decisions than patients with CM (p = 0.024) and HCs (p = 0.008), while the CM and HC groups did not differ (p = 0.690). By contrast, there was no significant difference between the groups in the Cambridge Gambling Task and the Wisconsin Card Sorting Test. Furthermore, performance on the Iowa Gambling Task was inversely correlated with analgesic consumption (r = -0.41, p = 0.003), suggesting that decision-making under ambiguity may be related to MOH. CONCLUSIONS Our data suggest that patients with CM + MOH had impaired decisions under ambiguous, but not risky situations. This dissociation indicates disrupted emotional feedback processing rather than executive dysfunction, which may underlie the pathogenesis of MOH.
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Affiliation(s)
- Chi Ieong Lau
- Dementia Center, Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- Applied Cognitive Neuroscience Group, Institute of Cognitive Neuroscience, University College London, London, UK
- Institute of Biophotonics, National Yang Ming Chiao Tung University, Taipei, Taiwan
- College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
- Department of Medicine, University Hospital, Taipa, Macau
| | - Wei-Hung Chen
- Dementia Center, Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Han-Cheng Wang
- Dementia Center, Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Vincent Walsh
- Applied Cognitive Neuroscience Group, Institute of Cognitive Neuroscience, University College London, London, UK
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Battista S, Lazzaretti A, Coppola I, Falsiroli Maistrello L, Rania N, Testa M. Living with migraine: A meta-synthesis of qualitative studies. Front Psychol 2023; 14:1129926. [PMID: 37057143 PMCID: PMC10086165 DOI: 10.3389/fpsyg.2023.1129926] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/02/2023] [Indexed: 03/30/2023] Open
Abstract
IntroductionMigraine is one of the top ten causes of disability worldwide. However, migraine is still underrated in society, and the quality of care for this disease is scant. Qualitative research allows for giving voice to people and understanding the impact of their disease through their experience of it. This study aims at synthesising the state of the art of qualitative studies focused on how people with migraine experience their life and pathology.MethodsMEDLINE via PubMed, EMBASE, CINAHL, PsycINFO, and Cochrane Library were consulted up to November 2021 for qualitative studies. Studies to be eligible had to focus on adults (age > 18 years) with a diagnosis of primary episodic or chronic migraine following the International Classification of Headache. The quality of the study was analysed using the CASP (Critical Appraisal Skills Programme) tool. The synthesis was done through a thematic analysis. CERQual (Confidence in Evidence from Reviews of Qualitative research) approach was used to assess the confidence in retrieved evidence.ResultsTen studies were included, counting 262 people with migraine. Our synthesis produced four main themes. (1) “Negative impact of migraine symptoms on overall life” as migraine negatively impacts people's whole life. (2) “Impact of migraine on family, work and social relationship” as migraine reduces the possibility to focus at work and interact with people. (3) “Impact of migraine on emotional health” as people with migraine experience psychological distress. (4) “Coping strategies to deal with migraine” such as keep on living one's own life, no matter the symptoms.ConclusionsMigraine negatively impacts people's whole life, from private to social and work sphere. People with migraine feel stigmatised as others struggle with understanding their condition. Hence, it is necessary to improve awareness among society of this disabling condition, and the quality of care of these people, tackling this disease from a social and health-policy point of view.
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Affiliation(s)
- Simone Battista
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Savona, Italy
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
| | - Arianna Lazzaretti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Savona, Italy
| | - Ilaria Coppola
- Department of Education Sciences, School of Social Sciences, University of Genova, Genova, Italy
| | - Luca Falsiroli Maistrello
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Savona, Italy
- Department of Physical Medicine and Rehabilitation, AULSS9 Scaligera, G. Fracastoro Hospital, San Bonifacio, Verona, Italy
| | - Nadia Rania
- Department of Education Sciences, School of Social Sciences, University of Genova, Genova, Italy
| | - Marco Testa
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Savona, Italy
- *Correspondence: Marco Testa
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Ellard DR, Nichols VP, Griffiths FE, Underwood M, Taylor SJC. Chronic Headache Education and Self-Management Study (CHESS): a process evaluation. BMC Neurol 2023; 23:8. [PMID: 36609224 PMCID: PMC9823254 DOI: 10.1186/s12883-022-02792-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/05/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The Chronic Headache Education and Self-Management Study (CHESS) multicentre randomised trial evaluated the impact a group education and self-management support intervention with a best usual care plus relaxation control for people living with chronic headache disorders (tension type headaches or chronic migraine, with or without medication overuse headache). Here we report the process evaluation exploring potential explanations for the lack of positive effects from the CHESS intervention. METHODS The CHESS trial included 736 (380 intervention: 356 control) people across the Midlands and London UK. We used a mixed methods approach. Our extensive process evaluation looked at context, reach, recruitment, dose delivered, dose received, fidelity and experiences of participating in the trial, and included participants and trial staff. We also looked for evidence in our qualitative data to investigate whether the original causal assumptions underpinning the intervention were realised. RESULTS The CHESS trial reached out to a large diverse population and recruited a representative sample. Few people with chronic tension type headaches without migraine were identified and recruited. The expected 'dose'of the intervention was delivered to participants and intervention fidelity was high. Attendance ("dose received") fell below expectation, although 261/380 (69%) received at least at least the pre-identified minimum dose. Intervention participants generally enjoyed being in the groups but there was little evidence to support the causal assumptions underpinning the intervention were realised. CONCLUSIONS From a process evaluation perspective despite our extensive data collection and analysis, we do not have a clear understanding of why the trial outcome was negative as the intervention was delivered as planned. However, the lack of evidence that the intervention causal assumptions brought about the planned behaviour change may provide some insight. Our data suggests only modest changes in managing headache behaviours and some disparity in how participants engaged with components of the intervention within the timeframe of the study. Moving forwards, we need a better understanding of how those who live with chronic headache can be helped to manage this disabling condition more effectively over time. TRIAL REGISTRATION ISRCTN79708100 .
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Affiliation(s)
- David R. Ellard
- grid.7372.10000 0000 8809 1613Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK ,grid.412570.50000 0004 0400 5079University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX UK
| | - Vivien P. Nichols
- grid.7372.10000 0000 8809 1613Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Frances E. Griffiths
- grid.7372.10000 0000 8809 1613Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Martin Underwood
- grid.7372.10000 0000 8809 1613Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK ,grid.412570.50000 0004 0400 5079University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX UK
| | - Stephanie J. C. Taylor
- grid.4868.20000 0001 2171 1133Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, E1 2AB UK
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Vandenbussche N, Van Hee C, Hoste V, Paemeleire K. Using natural language processing to automatically classify written self-reported narratives by patients with migraine or cluster headache. J Headache Pain 2022; 23:129. [PMID: 36180844 PMCID: PMC9524092 DOI: 10.1186/s10194-022-01490-0] [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: 06/30/2022] [Accepted: 09/01/2022] [Indexed: 11/18/2022] Open
Abstract
Background Headache medicine is largely based on detailed history taking by physicians analysing patients’ descriptions of headache. Natural language processing (NLP) structures and processes linguistic data into quantifiable units. In this study, we apply these digital techniques on self-reported narratives by patients with headache disorders to research the potential of analysing and automatically classifying human-generated text and information extraction in clinical contexts. Methods A prospective cross-sectional clinical trial collected self-reported narratives on headache disorders from participants with either migraine or cluster headache. NLP was applied for the analysis of lexical, semantic and thematic properties of the texts. Machine learning (ML) algorithms were applied to classify the descriptions of headache attacks from individual participants into their correct group (migraine versus cluster headache). Results One-hundred and twenty-one patients (81 participants with migraine and 40 participants with cluster headache) provided a self-reported narrative on their headache disorder. Lexical analysis of this text corpus resulted in several specific key words per diagnostic group (cluster headache: Dutch (nl): “oog” | English (en): “eye”, nl: “pijn” | en: “pain” and nl: “terug” | en: “back/to come back”; migraine: nl: “hoofdpijn” | en: “headache”, nl: “stress” | en: “stress” and nl: “misselijkheid” | en: “nausea”). Thematic and sentiment analysis of text revealed largely negative sentiment in texts by both patients with migraine and cluster headache. Logistic regression and support vector machine algorithms with different feature groups performed best for the classification of attack descriptions (with F1-scores for detecting cluster headache varying between 0.82 and 0.86) compared to naïve Bayes classifiers. Conclusions Differences in lexical choices between patients with migraine and cluster headache are detected with NLP and are congruent with domain expert knowledge of the disorders. Our research shows that ML algorithms have potential to classify patients’ self-reported narratives of migraine or cluster headache with good performance. NLP shows its capability to discern relevant linguistic aspects in narratives from patients with different headache disorders and demonstrates relevance in clinical information extraction. The potential benefits on the classification performance of larger datasets and neural NLP methods can be investigated in the future. Trial registration This study was registered with clinicaltrials.gov with ID NCT05377437. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-022-01490-0.
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Affiliation(s)
- Nicolas Vandenbussche
- Department of Neurology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium. .,Department of Basic and Applied Medical Sciences, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Cynthia Van Hee
- LT3 - Language and Translation Technology Team, Department of Translation, Interpreting and Communication, Faculty of Arts and Philosophy, Ghent University, Groot-Brittanniëlaan 45, B-9000, Ghent, Belgium
| | - Véronique Hoste
- LT3 - Language and Translation Technology Team, Department of Translation, Interpreting and Communication, Faculty of Arts and Philosophy, Ghent University, Groot-Brittanniëlaan 45, B-9000, Ghent, Belgium
| | - Koen Paemeleire
- Department of Neurology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,Department of Basic and Applied Medical Sciences, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
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Romero-Godoy R, Romero-Godoy SR, Romero-Acebal M, Gutiérrez-Bedmar M. Psychiatric Comorbidity and Emotional Dysregulation in Chronic Tension-Type Headache: A Case-Control Study. J Clin Med 2022; 11:jcm11175090. [PMID: 36079022 PMCID: PMC9457147 DOI: 10.3390/jcm11175090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/18/2022] [Accepted: 08/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Chronic tension-type headache (CTTH) is frequently associated with a psychiatric comorbidity of depression and anxiety. Most studies focus their attention on this association, and only few link CTTH with psycho-affective emotional regulation disorders. Objective: To evaluate the association of CTTH with anxiety, depression, positive and negative affectivity, and emotional management in CTTH patients with neither a previous diagnosis of psychiatric disorder nor use of psychoactive drugs or abuse of analgesics. Design: Case-control study. Methods: Validated scores for state and trait anxiety, depression, positive and negative state and trait affect, cognitive reappraisal, and expressive suppression were assessed in 40 subjects with CTTH and 40 healthy subjects. Associations between CTTH and psychological status were assessed through linear multivariate regression models. Results: CTTH was associated with higher scores for depression (Beta = 5.46, 95% CI: 1.04–9.88), state and trait anxiety (Beta = 12.77, 95% CI: 4.99–20.56 and Beta = 8.79, 95% CI: 2.29–15.30, respectively), and negative state affect (Beta = 5.26, 95% CI: 0.88–9.64). Conclusions: CTTH is directly associated with depression, anxiety, and negative affectivity signs despite the absence of a previously diagnosed psychiatric disorder or psychopharmacological intake. The recognition of these comorbid and psycho-affective disorders is essential to adapt the emotional management of these patients for better control.
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Affiliation(s)
- Rosalinda Romero-Godoy
- Department of Nursing and Physiotherapy, University of Balearic Islands, 07122 Palma, Spain
- Cognitive Affective Neuroscience Clinical Psychology Research Group, Institute of Health Science Research (IUNICS-IdISBa), ECYCS Research Group, University of Balearic Islands, 07120 Palma, Spain
- Correspondence: (R.R.-G.); (M.G.-B.)
| | | | - Manuel Romero-Acebal
- Neurology Department, Virgen de la Victoria University Hospital, 29010 Malaga, Spain
| | - Mario Gutiérrez-Bedmar
- Preventive Medicine and Public Health Department, School of Medicine, University of Málaga, 29010 Malaga, Spain
- Biomedical Research Institute of Malaga-IBIMA, 29010 Malaga, Spain
- CIBERCV Cardiovascular Diseases, Carlos III Health Institute, 28029 Madrid, Spain
- Correspondence: (R.R.-G.); (M.G.-B.)
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Loft MI, Foged EM, Koreska M. An Unexpected Journey: The Lived Experiences of Patients with Long-Term Cognitive Sequelae After Recovering from COVID-19. QUALITATIVE HEALTH RESEARCH 2022; 32:1356-1369. [PMID: 35603563 PMCID: PMC9124947 DOI: 10.1177/10497323221099467] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This current study explored the lived experiences of patients with long-term cognitive sequelae after recovering from COVID-19. A qualitative design with in-depth interviews and an analysis inspired by Ricoeur's interpretation theory was utilised. Contracting COVID-19 and suffering long-term sequelae presented as a life-altering event with significant consequences for one's social, psychological and vocational being in the world in the months following the infection. Patients living with long-term cognitive sequelae after COVID-19 were in an unknown life situation characterised by feelings of anxiety, uncertainty and concerns about the future, significantly disrupting their life trajectory and forcing them to change their ways of life. While awaiting studies on treatment, symptom management and recovery after persistent sequelae of COVID-19, clinicians and researchers may find inspiration in experiences of other health conditions with similar phenomenology, such as ME/chronic fatigue syndrome and chronic headaches.
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Affiliation(s)
- Mia I. Loft
- Department of Neurology, Rigshospitalet, Copenhagen, Denmark
- Department of Public Health,
Research Unit for Nursing and Healthcare, Aarhus University, Denmark
| | - Eva M. Foged
- Department of Neurology, Rigshospitalet, Copenhagen, Denmark
| | - Mai Koreska
- Department of Neurology, Rigshospitalet, Copenhagen, Denmark
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Freeman E, Adair M, Beeler D, Casper R, Herman MP, Reeves D, Reinsch S. Patient-identified burden and unmet needs in patients with cluster headache: An evidence-based qualitative literature review. CEPHALALGIA REPORTS 2022. [DOI: 10.1177/25158163221096866] [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
Objectives: To qualitatively identify evidence-based literature related to the daily burden and unmet treatment and psychosocial needs of patients with cluster headache (CH). Methods: A literature search was conducted through October 20, 2020 across MEDLINE, EMBASE, CINAHL, and PsychInfo databases exploring quality of life (QoL) and disease burden in adults with CH. The search was restricted to full-text reports in peer-reviewed journals. Methodologic quality was assessed using the Critical Skills Appraisal Program. Results: From 11 identified publications, QoL was reduced in persons living with CH, with significant psychological, social, and socio-economic burdens, and work-related disability. The CH disease trajectory is complex, with patients experiencing the impact of their disease across multiple domains beyond the biological manifestation of the disease including stigma, employment limitations, and suicidal ideation, and with a lack of effective treatment from the patient perspective. Discussion: These findings strengthen comprehension of the CH patient experience, enabling a deeper understanding of the patients’ perspective and experience of their disease andunmet needs, providing a basis for future research into this debilitating condition. Minor limitations of this study include data extraction and study selection biases.
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20
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Mukuria C, Connell J, Carlton J, Peasgood T, Scope A, Clowes M, Rand S, Jones K, Brazier J. Qualitative Review on Domains of Quality of Life Important for Patients, Social Care Users, and Informal Carers to Inform the Development of the EQ-HWB. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:492-511. [PMID: 35365298 DOI: 10.1016/j.jval.2021.11.1371] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/25/2021] [Accepted: 11/23/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To identify the themes to inform the content of a new generic measure, the EQ-HWB (EQ Health and Wellbeing), that can be used in economic evaluation across health, social care, and public health, based on the views of users and beneficiaries of these services including informal carers. METHODS A qualitative review was undertaken. Systematic and citation searches were undertaken focusing on qualitative evidence of the impact on quality of life from reviews for selected health conditions, informal carers, social care users, and primary qualitative work used in the development of selected measures. A subset of studies was included in the review. Framework analysis and synthesis were undertaken based on a conceptual model. RESULTS A total of 42 reviews and 24 primary studies were selected for inclusion in the review. Extraction and synthesis resulted in 7 high-level themes (with subthemes): (1) feelings and emotions (sadness, anxiety, hope, frustration, safety, guilt/shame); (2) cognition (concentration, memory, confusion, thinking clearly); (3) self-identity (dignity/respect, self-esteem); (4) "coping, autonomy, and control" relationships; (5) social connections (loneliness, social engagement, stigma, support, friendship, belonging, burden); (6) physical sensations (pain, discomfort, sleep, fatigue); and (7) activity (self-care, meaningful activities, mobility, communication, hearing, vision). Apart from physical sensations, most of the other themes and subthemes were relevant across both health and social care, including for informal carers. CONCLUSIONS The findings from this broad review identified themes that go beyond health and that are relevant to patients, informal carers, and social care users. The themes and subthemes informed the domains for the EQ-HWB.
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Affiliation(s)
- Clara Mukuria
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, England, UK.
| | - Janice Connell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, England, UK
| | - Jill Carlton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, England, UK
| | - Tessa Peasgood
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, England, UK
| | - Alison Scope
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, England, UK
| | - Mark Clowes
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, England, UK
| | - Stacey Rand
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, England, UK
| | - Karen Jones
- Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury, England, UK
| | - John Brazier
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, England, UK
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Haywood K, Potter R, Froud R, Pearce G, Box B, Muldoon L, Lipton R, Petrou S, Rendas-Baum R, Logan AM, Stewart K, Underwood M, Matharu M. Core outcome set for preventive intervention trials in chronic and episodic migraine (COSMIG): an international, consensus-derived and multistakeholder initiative. BMJ Open 2021; 11:e043242. [PMID: 34848505 PMCID: PMC8634270 DOI: 10.1136/bmjopen-2020-043242] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Typically, migraine prevention trials focus on reducing migraine days. This narrow focus may not capture all that is important to people with migraine. Inconsistency in outcome selection across trials limits the potential for data pooling and evidence synthesis. In response, we describe the development of core outcome set for migraine (COSMIG). DESIGN A two-stage approach sought to achieve international, multistakeholder consensus on both the core domain set and core measurement set. Following construction of a comprehensive list of outcomes, expert panellists (patients, healthcare professionals and researchers) completed a three-round electronic-Delphi study to support a reduction and prioritisation of core domains and outcomes. Participants in a consensus meeting finalised the core domains and methods of assessment. All stages were overseen by an international core team, including patient research partners. RESULTS There was a good representation of patients (episodic migraine (n=34) and chronic migraine (n=42)) and healthcare professionals (n=33) with high response and retention rates. The initial list of domains and outcomes was reduced from >50 to 7 core domains for consideration in the consensus meeting, during which a 2-domain core outcome set was agreed. CONCLUSION International and multistakeholder consensus emerged to describe a two-domain core outcome set for reporting research on preventive interventions for chronic and episodic migraine: migraine-specific pain and migraine-specific quality of life. Intensity of migraine pain assessed with an 11-point Numerical Rating Scale and the frequency as the number of headache/migraine days over a specified time period. Migraine-specific quality of life assessed using the Migraine Functional Impact Questionnaire.
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Affiliation(s)
- Kirstie Haywood
- Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachel Potter
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Robert Froud
- Institute of Health Sciences, Kristiania University College, Oslo, Norway
| | - Gemma Pearce
- Department of Psychology and Behavioural Sciences, Coventry University, Coventry, UK
| | - Barbara Box
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Lynne Muldoon
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Richard Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, Oxford, UK
| | | | - Anne-Marie Logan
- Neurology Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Kimberley Stewart
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Martin Underwood
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Manjit Matharu
- The Headache Group, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
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22
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Nichols V, Pearce G, Ellard DR, Evans S, Haywood K, Norman C, Potter R, Sandhu H, Stewart K, Underwood M, Patel S. Patient and public involvement in a UK National Institute for Health Research Programme Grant for Applied Research: experiences from the Chronic Headache Education and Self-management Study (CHESS). Prim Health Care Res Dev 2021; 22:e72. [PMID: 34796815 PMCID: PMC8628557 DOI: 10.1017/s1463423621000670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/02/2021] [Accepted: 10/04/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Patient and public involvement (PPI) plays a crucial role in ensuring research is carried out in conjunction with the people that it will impact upon. In this article, we present our experiences and reflections from working collaboratively with patients and public through the lifetime of an National Institute for Health Research (NIHR) programme grant; the Chronic Headache Education and Self-management Study (CHESS) which took place between 2015 and 2020. PPI OVER THE COURSE OF CHESS We worked closely with three leading UK migraine charities and a lay advisory group throughout the programme. We followed NIHR standards and used the Guidance for Reporting Involvement of Patients and the Public checklist. We consulted our PPI contacts using a variety of methods depending on the phase of the study and the nature of the request. This included emails, discussions, and face-to-face contact.PPI members contributed throughout the study in the programme development, in the grant application, ethics documentation, and trial oversight. During the feasibility study; in supporting the development of a classification interview for chronic headache by participating in a headache classification conference, assessing the relevance, and acceptability of patient-reported outcome measures by helping to analyse cognitive interview data, and testing the smartphone application making suggestions on how best to present the summary of data collected for participants. Due to PPI contribution, the content and duration of the study intervention were adapted and a Delphi study with consensus meeting developed a core outcome set for migraine studies. CONCLUSIONS The involvement of the public and patients in CHESS has allowed us to shape its overall design, intervention development, and establish a core outcome set for future migraine studies. We have reflected on many learning points for the future application of PPI.
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Affiliation(s)
- Vivien Nichols
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Gemma Pearce
- School of Psychological, Social and Behavioural Sciences, Coventry University, Coventry, CV1 5FB, UK
| | - David R Ellard
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | | | - Kirstie Haywood
- Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Chloe Norman
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Rachel Potter
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Harbinder Sandhu
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Kimberley Stewart
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
- University Hospitals of Coventry and Warwickshire, Coventry, CV2 2DX, UK
| | - Shilpa Patel
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
- University Hospitals of Coventry and Warwickshire, Coventry, CV2 2DX, UK
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23
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Haywood KL, Achana F, Nichols V, Pearce G, Box B, Muldoon L, Patel S, Griffiths F, Stewart K, Underwood M, Matharu MM. Measuring health-related quality of life in chronic headache: A comparative evaluation of the Chronic Headache Quality of Life Questionnaire and Headache Impact Test (HIT-6). Cephalalgia 2021; 41:1100-1123. [PMID: 33942667 PMCID: PMC8411468 DOI: 10.1177/03331024211006045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/08/2021] [Accepted: 03/07/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare the quality and acceptability of a new headache-specific patient-reported measure, the Chronic Headache Quality of Life Questionnaire (CHQLQ) with the six-item Headache Impact Test (HIT-6), in people meeting an epidemiological definition of chronic headaches. METHODS Participants in the feasibility stage of the Chronic Headache Education and Self-management Study (CHESS) (n = 130) completed measures three times during a 12-week prospective cohort study. Data quality, measurement acceptability, reliability, validity, responsiveness to change, and score interpretation were determined. Semi-structured cognitive interviews explored measurement relevance, acceptability, clarity, and comprehensiveness. RESULTS Both measures were well completed with few missing items. The CHQLQ's inclusion of emotional wellbeing items increased its relevance to participant's experience of chronic headache. End effects were present at item level only for both measures. Structural assessment supported the three and one-factor solutions of the CHQLQ and HIT-6, respectively. Both the CHQLQ (range 0.87 to 0.94) and HIT-6 (0.90) were internally consistent, with acceptable temporal stability over 2 weeks (CHQLQ range 0.74 to 0.80; HIT-6 0.86). Both measures responded to change in headache-specific health at 12 weeks (CHQLQ smallest detectable change (improvement) range 3 to 5; HIT-6 2.1). CONCLUSIONS While both measures are structurally valid, internally consistent, temporally stable, and responsive to change, the CHQLQ has greater relevance to the patient experience of chronic headache.Trial registration number: ISRCTN79708100. Registered 16th December 2015, http://www.isrctn.com/ISRCTN79708100.
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Affiliation(s)
- Kirstie L Haywood
- Warwick Research in Nursing, Warwick Medical School, University
of Warwick, Coventry, UK
| | - Felix Achana
- Warwick Clinical Trials Unit, Warwick Medical School, University
of Warwick, Coventry, UK
- Nuffield Department of Primary Care Health Sciences, Oxford
University, Oxford, UK
| | - Vivien Nichols
- Warwick Clinical Trials Unit, Warwick Medical School, University
of Warwick, Coventry, UK
| | - Gemma Pearce
- School of Psychology, Social and Behavioural Sciences, Coventry
University, Coventry, UK
| | - Barbara Box
- Warwick Clinical Trials Unit, Warwick Medical School, University
of Warwick, Coventry, UK
| | - Lynne Muldoon
- Warwick Clinical Trials Unit, Warwick Medical School, University
of Warwick, Coventry, UK
| | - Shilpa Patel
- Warwick Clinical Trials Unit, Warwick Medical School, University
of Warwick, Coventry, UK
| | - Frances Griffiths
- Social Science and Systems in Health, Warwick Medical School,
University of Warwick, Coventry, UK
| | - Kimberly Stewart
- Warwick Clinical Trials Unit, Warwick Medical School, University
of Warwick, Coventry, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University
of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire, Coventry,
UK
| | - Manjit M Matharu
- The Headache Group, National Hospital for Neurology and
Neurosurgery, University College of London Hospitals NHS Foundation Trust, AC1
London, UK
| | - on behalf of the CHESS Team
- Warwick Research in Nursing, Warwick Medical School, University
of Warwick, Coventry, UK
- Warwick Clinical Trials Unit, Warwick Medical School, University
of Warwick, Coventry, UK
- Nuffield Department of Primary Care Health Sciences, Oxford
University, Oxford, UK
- School of Psychology, Social and Behavioural Sciences, Coventry
University, Coventry, UK
- Social Science and Systems in Health, Warwick Medical School,
University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire, Coventry,
UK
- The Headache Group, National Hospital for Neurology and
Neurosurgery, University College of London Hospitals NHS Foundation Trust, AC1
London, UK
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24
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Mose LS, Bornhøft JO, Primdahl J, Gram B. Coping and Motivation for Change-An Interview Study of the Experience From Participation in an Educational Program for Patients With Medication-Overuse Headache. J Patient Exp 2021; 8:23743735211034289. [PMID: 34395849 PMCID: PMC8358482 DOI: 10.1177/23743735211034289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Patient educational programs (PEP) are recommended as part of the treatment for medication-overuse headache (MOH), however, knowledge of patients' experiences when participating is sparse. This study explored how patients experienced participating in a PEP focusing on empowering coping strategies and motivation for behavioral changes. Eight individual semistructured interviews were conducted among patients suffering from MOH who had attended a PEP intervention in a randomized controlled trial. The PEP involved techniques from Motivational Interviewing as its communicative approach. Data collection, analysis, and interpretation were performed within a phenomenological-hermeneutic framework. Results showed that patients found the educational program relevant regarding coping with headache. Participants shifted from focusing on medication to include other ways to manage headache. Experiences regarding ambivalent feelings for behavioral change and feelings of stigmatization were key issues. Participation in this PEP helped the participants cope with headache in new ways relevant to their everyday lives and challenges. The individualized approach enabled by Motivational Interviewing was experienced as useful by the participants, as it actively involved them in the treatment.
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Affiliation(s)
- Louise Schlosser Mose
- Department of Neurology, University Hospital of Southern Denmark, Esbjerg, Denmark.,Research Unit of Health Sciences, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Jane Orry Bornhøft
- Research Unit of Health Sciences, University Hospital of Southern Denmark, Esbjerg, Denmark.,Department of Endocrinology, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Jette Primdahl
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.,Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Bibi Gram
- Research Unit of Health Sciences, University Hospital of Southern Denmark, Esbjerg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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25
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Parikh SK, Kempner J, Young WB. Stigma and Migraine: Developing Effective Interventions. Curr Pain Headache Rep 2021; 25:75. [PMID: 34873646 PMCID: PMC8647964 DOI: 10.1007/s11916-021-00982-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE OF REVIEW Migraine and other primary headache disorders do not receive adequate research funding, medical resources, or other forms of structural support relative to their prevalence and the disability they cause. In recent research, scholars have argued that stigma associated with headache disorders explains some of this discrepancy. This review will discuss (1) the factors contributing to stigma toward migraine and other primary headache disorders, (2) how structural and enacted stigma may perpetuate individual disability, (3) the impact of internalized stigma, and (4) interventions to mitigate stigma toward headache disorders with an emphasis on outcome monitoring. The review will also propose new areas of stigma research in need of further investigation. RECENT FINDINGS Recent research shows that discrimination can exacerbate chronic pain. Stigma profoundly affects everything from the allocation of federal research funds and healthcare resources to individual patients' self-efficacy and ability to care for themselves. Understanding the stigma of migraine and learning how to develop effective interventions to mitigate this stigma will increase access to appropriate migraine care, improve healthcare providers' ability to care for their migraine patients, and help advocates reverse policies that discriminate against those with migraine. It is important to closely monitor outcomes of anti-stigma efforts for both positive and negative consequences and take note of outcomes and "lessons learned" from anti-stigma campaigns for other diseases.
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Affiliation(s)
- Simy K. Parikh
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA 19107 USA
| | - Joanna Kempner
- Department of Sociology, Institute of Health, Health Care Policy, and Aging Research, Rutgers University, The State University of New Jersey, New Brunswick, NJ 08901 USA
| | - William B. Young
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA 19107 USA
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26
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Donisi V, Mazzi MA, Gandolfi M, Deledda G, Marchioretto F, Battista S, Poli S, Giansante M, Geccherle E, Perlini C, Smania N, Del Piccolo L. Exploring Emotional Distress, Psychological Traits and Attitudes in Patients with Chronic Migraine Undergoing OnabotulinumtoxinA Prophylaxis versus Withdrawal Treatment. Toxins (Basel) 2020; 12:E577. [PMID: 32911799 PMCID: PMC7551686 DOI: 10.3390/toxins12090577] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 12/20/2022] Open
Abstract
This explorative cross-sectional study aims at exploring emotional distress, psychological profiles, and the attitude towards receiving psychological support in eighty-seven patients with chronic migraine (CM) undergoing OnabotulinumtoxinA prophylactic treatment (OBT-A, n = 40) or withdrawal treatment (WT, n = 47). The outcomes were explored through a specific battery of questionnaires. 25% of patients undergoing OBT-A and almost half of the patients undergoing WT reported psychological distress of at least moderate-severe level, respectively. Coping strategies, self-efficacy, and perceived social support were similar in the two groups. Patients undergoing OBT-A presented lower psychological inflexibility than patients undergoing WT. Predictors of higher psychological distress were low perceived social support by friends, low self-efficacy, and higher avoidance strategies. In both groups, most of the patients evaluated receiving psychological support to be useful (79%). The potential beneficial effects of OBT-A on the severity of symptoms and psychological distress might further support its role in the multidisciplinary management of patients with CM. Identifying patients with psychological vulnerabilities who may benefit from psychological support is relevant in patients with CM.
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Affiliation(s)
- Valeria Donisi
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy; (V.D.); (M.A.M.); (C.P.); (L.D.P.)
| | - Maria Angela Mazzi
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy; (V.D.); (M.A.M.); (C.P.); (L.D.P.)
| | - Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), University of Verona, UOC Neurorehabilitation, AOUI Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy;
| | - Giuseppe Deledda
- Clinical Psychological Service, UO of Clinical Psychology, Scientific Institute for Research, Hospitalisation and Health Care (IRCCS), Sacro Cuore—Don Calabria, Negrar di Valpolicella, 37024 Verona, Italy; (G.D.); (S.P.); (M.G.); (E.G.)
| | - Fabio Marchioretto
- Neurological Unit, Scientific Institute for Research, Hospitalisation and Health Care (IRCCS), Sacro Cuore—Don Calabria, Negrar di Valpolicella, 37024 Verona, Italy;
| | - Simone Battista
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Via Magliotto, 2, 17100 Savona, Italy;
| | - Sara Poli
- Clinical Psychological Service, UO of Clinical Psychology, Scientific Institute for Research, Hospitalisation and Health Care (IRCCS), Sacro Cuore—Don Calabria, Negrar di Valpolicella, 37024 Verona, Italy; (G.D.); (S.P.); (M.G.); (E.G.)
| | - Matteo Giansante
- Clinical Psychological Service, UO of Clinical Psychology, Scientific Institute for Research, Hospitalisation and Health Care (IRCCS), Sacro Cuore—Don Calabria, Negrar di Valpolicella, 37024 Verona, Italy; (G.D.); (S.P.); (M.G.); (E.G.)
| | - Eleonora Geccherle
- Clinical Psychological Service, UO of Clinical Psychology, Scientific Institute for Research, Hospitalisation and Health Care (IRCCS), Sacro Cuore—Don Calabria, Negrar di Valpolicella, 37024 Verona, Italy; (G.D.); (S.P.); (M.G.); (E.G.)
| | - Cinzia Perlini
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy; (V.D.); (M.A.M.); (C.P.); (L.D.P.)
| | - Nicola Smania
- Department of Neurosciences, Biomedicine and Movement Sciences, Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), University of Verona, UOC Neurorehabilitation, AOUI Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy;
| | - Lidia Del Piccolo
- Section of Clinical Psychology, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy; (V.D.); (M.A.M.); (C.P.); (L.D.P.)
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27
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Patel S, Achana F, Carnes D, Eldridge S, Ellard DR, Griffiths F, Haywood K, Hee SW, Mistry D, Mistry H, Nichols VP, Petrou S, Pincus T, Potter R, Sandhu HK, Stewart K, Taylor S, Underwood M, Matharu M. Usual care and a self-management support programme versus usual care and a relaxation programme for people living with chronic headache disorders: a randomised controlled trial protocol (CHESS). BMJ Open 2020; 10:e033520. [PMID: 32284387 PMCID: PMC7200026 DOI: 10.1136/bmjopen-2019-033520] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Chronic headaches are poorly diagnosed and managed and can be exacerbated by medication overuse. There is insufficient evidence on the non-pharmacological approaches to helping people living with chronic headaches. METHODS AND ANALYSIS Chronic Headache Education and Self-management Study is a pragmatic randomised controlled trial to test the effectiveness and cost-effectiveness of a self-management education support programme on top of usual care for patients with chronic headaches against a control of usual care and relaxation. The intervention is a 2-day group course based on education, personal reflection and a cognitive behavioural approach, plus a nurse-led one-to-one consultation and follow-up over 8 weeks. We aim to recruit 689 participants (356 to the intervention arm and 333 to the control) from primary care and self-referral in London and the Midlands. The trial is powered to show a difference of 2.0 points on the Headache Impact Test, a patient-reported outcome measure at 12 months post randomisation. Secondary outcomes include health related quality of life, self-efficacy, social activation and engagement, anxiety and depression and healthcare utilisation. Outcomes are being measured at 4, 8 and 12 months. Cost-effectiveness will be expressed in terms of incremental cost per quality-adjusted life year gained. ETHICS AND DISSEMINATION This trial will provide data on effectiveness and cost-effectiveness of a self-management support programme for chronic headaches. The results will inform commissioning of services and clinical practice. North West - Greater Manchester East Research Ethics Committee have approved the trial. The current protocol version is 3.6 date 7 March 2019. TRIAL REGISTRATION NUMBER ISRCTN79708100.
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Affiliation(s)
- Shilpa Patel
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Felix Achana
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Dawn Carnes
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - David R Ellard
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Frances Griffiths
- Warwick Medical School, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Kirstie Haywood
- Warwick Medical School, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Siew Wan Hee
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Dipesh Mistry
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Hema Mistry
- Warwick Medical School, Warwick Evidence, University of Warwick, Coventry, UK
| | - Vivien P Nichols
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Stavros Petrou
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Tamar Pincus
- Department of Psychology, Royal Holloway University of London, Egham, UK
| | - Rachel Potter
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | | | - Kimberley Stewart
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Stephanie Taylor
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Martin Underwood
- Warwick Medical School, Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Manjit Matharu
- University College London Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
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28
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Huckhagel T, Klinger R, Schmidt NO, Regelsberger J, Westphal M, Czorlich P. The burden of headache following aneurysmal subarachnoid hemorrhage: a prospective single-center cross-sectional analysis. Acta Neurochir (Wien) 2020; 162:893-903. [PMID: 32016589 PMCID: PMC7066282 DOI: 10.1007/s00701-020-04235-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/18/2020] [Indexed: 12/17/2022]
Abstract
Background Aneurysmal subarachnoid hemorrhage (SAH) as a serious type of stroke is frequently accompanied by a so-called initial thunderclap headache. However, the occurrence of burdensome long-term headache following SAH has never been studied in detail so far. The aim of this study was to determine the prevalence and characteristics of long-term burdensome headache in good-grade SAH patients as well as its relation to health-related quality of life (HR-QOL). Methods All SAH cases treated between January 2014 and December 2016 with preserved consciousness at hospital discharge were prospectively interviewed regarding burdensome headache in 2018. Study participants were subsequently scrutinized by means of a standardized postal survey comprising validated pain and HR-QOL questionnaires. A retrospective chart review provided data on the initial treatment. Results A total of 93 out of 145 eligible SAH patients participated in the study (62 females). A total of 41% (38/93) of subjects indicated burdensome headache at follow-up (mean 32.6 ± 9.3 months). Comparison between patients with (HA+) and without long-term headache (HA-) revealed significantly younger mean age (47.9 ± 11.8 vs. 55.6 ± 10.3 years; p < .01) as well as more favorable neurological conditions (WFNS I/II: 95% vs. 75%; p = .03) in HA+ cases. The mean average headache of the HA+ group was 3.7 ± 2.3 (10-point numeric rating scale), and the mean maximum headache intensity was 5.7 ± 2.9. Pain and HR-QOL scores demonstrated profound alterations in HA+ compared to HA- patients. Conclusions Our results suggest that a considerable proportion of SAH patients suffers from burdensome headache even years after the hemorrhage. Moreover, long-term headache is associated with reduced HR-QOL in these cases. Electronic supplementary material The online version of this article (10.1007/s00701-020-04235-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Torge Huckhagel
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Regine Klinger
- Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Nils Ole Schmidt
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Jan Regelsberger
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Patrick Czorlich
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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29
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Palacios‐Ceña D, Talavera B, Gómez‐Mayordomo V, García‐Azorín D, Gallego‐Gallego M, Guerrero ÁL, Cuadrado M. The Day My Life Changed: A Qualitative Study of the Experiences of Patients With New Daily Persistent Headache. Headache 2019; 60:124-140. [DOI: 10.1111/head.13712] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Domingo Palacios‐Ceña
- Department of Physical Therapy Occupational Therapy, Rehabilitation and Physical Medicine Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS) Universidad Rey Juan Carlos Alcorcón Spain
| | - Blanca Talavera
- Headache Unit Department of Neurology Hospital Clínico Universitario de Valladolid Valladolid Spain
| | - Víctor Gómez‐Mayordomo
- Headache Unit Department of Neurology Hospital Clínico San Carlos Instituto de Investigación Sanitaria San Carlos (IdISSC) Madrid Spain
| | - David García‐Azorín
- Headache Unit Department of Neurology Hospital Clínico Universitario de Valladolid Valladolid Spain
| | | | - Ángel L. Guerrero
- Headache Unit Department of Neurology Hospital Clínico Universitario de Valladolid Valladolid Spain
- Institute of Biomedical Research of Salamanca (IBSAL) Salamanca Spain
| | - María‐Luz Cuadrado
- Headache Unit Department of Neurology Hospital Clínico San Carlos Instituto de Investigación Sanitaria San Carlos (IdISSC) Madrid Spain
- Department of Medicine School of Medicine Universidad Complutense de Madrid Madrid Spain
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Couples Living with Chronic Migraines: A Phenomenological Study. CONTEMPORARY FAMILY THERAPY 2019. [DOI: 10.1007/s10591-019-09513-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Job Satisfaction Mediates the Association between Perceived Disability and Work Productivity in Migraine Headache Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183341. [PMID: 31510071 PMCID: PMC6765904 DOI: 10.3390/ijerph16183341] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/17/2019] [Accepted: 09/05/2019] [Indexed: 12/15/2022]
Abstract
Migraine headache is the cause of an estimated 250,000,000 lost days from work or school every year and is often associated with decreased work productivity. The aim of this cross-sectional study was to assess the relationship between perceived disability, job satisfaction and work productivity in patients affected by chronic migraineurs. Participants were 98 consecutive adult outpatients admitted to the Regional Referral Headache Centre of the Sant’Andrea Hospital in Rome, Italy. Patients were administered the Italian Perceived Disability Scale, The Quality of Life Enjoyment and Satisfaction Questionnaire–Work Subscale and The Endicott Work Productivity Scale. Perceived disability is significantly associated with job satisfaction and work productivity. Job satisfaction is significantly related to work productivity and mediates the association between perceived disability and work productivity in patients affected by chronic migraineurs. Our results confirm that patients suffering from migraine headaches who have negative perceptions of their disability are less satisfied with their job, which in turn, decreases their work productivity.
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Chen YC, Tsai SJ, Chen JC, Hwang JH. Risks of tinnitus, sensorineural hearing impairment, and sudden deafness in patients with non-migraine headache. PLoS One 2019; 14:e0222041. [PMID: 31490980 PMCID: PMC6730855 DOI: 10.1371/journal.pone.0222041] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/20/2019] [Indexed: 02/07/2023] Open
Abstract
Tinnitus and hearing impairment are prevalent among headache patients. This study aims to investigate the risk of tinnitus, sensorineural hearing impairment, and sudden deafness in patients with non-migraine headache. Participants included 43 294 patients with non-migraine headache (non-migraine headache cohort) and 173 176 patients with no headache of any type (control cohort) frequency-matched with respect to 10-year age interval and sex from the Longitudinal Health Insurance Database 2005 of the Taiwan National Health Insurance Research Database. The mean age of the non-migraine headache cohort was 28.4 ± 14.9 years, and 58.5% of this cohort was male. The incidence rates of tinnitus, sensorineural hearing impairment, and sudden deafness were compared between cohorts using the Kaplan–Meier method with the log-rank test. A Cox proportional hazard model was used to examine the association of tinnitus, sensorineural hearing impairment, and sudden deafness with non-migraine headache, with adjustment for all covariates. The combined risk of either tinnitus, sensorineural hearing impairment, or sudden deafness was higher in the non-migraine headache cohort than in the control cohort (adjusted odds ratio [aHR], 2.73; 95% confidence interval [95% CI], 2.62–2.84; p < 0.0001). Subgroup analysis showed that patients in the non-migraine headache cohort were at significantly higher risk of developing tinnitus (aHR, 3.05; 95% CI, 2.91–3.19; p < 0.0001), sensorineural hearing impairment (aHR, 1.89; 95% CI, 1.74–2.05; p < 0.0001), and sudden deafness (aHR, 2.14; 95% CI, 1.77–2.59; p < 0.0001) than were controls. In this population-based study, the risks of tinnitus, sensorineural hearing impairment, and sudden deafness were found to be significantly higher in patients with non-migraine headache than in those without headache.
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Affiliation(s)
- Yi-Chun Chen
- Department of Nephrology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Shiang-Jiun Tsai
- Deparment of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan
| | - Jin-Cherng Chen
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Neurosurgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan
| | - Juen-Haur Hwang
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Otolaryngology-Head and Neck Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
- * E-mail:
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McKinlay A, Underwood R, Wojewodka G, Mazumder A, Kilner R, Ridsdale L. Should GPs have direct access to imaging for headache? A qualitative study of patients' views in the UK. BMJ Open 2019; 9:e029376. [PMID: 31427332 PMCID: PMC6701632 DOI: 10.1136/bmjopen-2019-029376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE We aimed to describe patients' views of a new referral pathway of general practitioner (GP) direct access to MRI, versus imaging after referral to a specialist. DESIGN This qualitative study involved 20 semistructured interviews. Twenty patients (10 from each pathway) were purposively recruited and interviewed to describe their attitudes. SETTING A neurology headache clinic and neuroradiology services from the boroughs of Southwark and Lambeth in South London, UK. PARTICIPANTS Twenty patients were involved in this study. RESULTS Over half of the participants felt relieved once they received their scan results, while some remained uncertain about the underlying cause of their symptoms. Some participants described a long wait to see a specialist. Others described a long wait time to receive scan results, especially from their GP. Spontaneous reduction in headache symptoms occurred for some participants and for others, normal imaging results allowed them to focus more on symptom management. CONCLUSION Relief was reported especially when scan results had been explained clearly and without too much delay. Those with continuing pain focused on how to get relief from symptoms. Patient experience might be improved with clearer information from GPs about how patients can access results, standard reporting procedures and closer liaison between neuroradiology and GPs.
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Affiliation(s)
- Alison McKinlay
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Raphael Underwood
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Gabriella Wojewodka
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Asif Mazumder
- Neuroradiology Group, Department of Radiology, Lambeth Wing, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | - Rachael Kilner
- Department of Neurology, King’s College Hospital, London, UK
| | - Leone Ridsdale
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Vivekanantham A, Edwin C, Pincus T, Matharu M, Parsons H, Underwood M. The association between headache and low back pain: a systematic review. J Headache Pain 2019; 20:82. [PMID: 31307372 PMCID: PMC6734435 DOI: 10.1186/s10194-019-1031-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/05/2019] [Indexed: 12/11/2022] Open
Abstract
Background To systematically review studies quantifying the association between primary chronic headaches and persistent low back pain (LBP). Main text We searched five electronic databases. We included case-control, cross-sectional and cohort studies that included a headache and back pain free group, reporting on any association between persistent LBP and primary headache disorders. Methodological quality was assessed using Newcastle-Ottawa Scale. Our primary outcome was the association between primary headache disorders and persistent LBP. Our secondary outcomes were any associations between severity of LBP and severity of headache, and the relationship between specific headache sub-types classified as per International Classification of Headache Disorders (ICHD) criteria and persistent LBP. We included 14 studies. The sizes of the studies ranged from 88 participants to a large international study with 404, 206 participants. Odds ratios for the association were between 1.55 (95% confidence interval (CI) 1.13–2.11) and 8.00 (95% CI 5.3–12.1). Study heterogeneity meant statistical pooling was not possible. Only two studies presented data investigating persistent LBP and chronic headache disorders in accordance with ICDH criteria. Conclusions We identified a positive association between persistent LBP and primary headache disorders. The quality of the review findings is limited by diversity of populations, study designs and uncertainly about headache and LBP definitions. Trial registration PROSPERO 2018 CRD42018086557. Electronic supplementary material The online version of this article (10.1186/s10194-019-1031-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Arani Vivekanantham
- University of Warwick, Coventry, UK. .,University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK. .,Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK.
| | - Claire Edwin
- University of Warwick, Coventry, UK.,University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Manjit Matharu
- University College London (UCL) Queen Square Institute of Neurology, London, UK
| | - Helen Parsons
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Martin Underwood
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.,Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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Patel S, Potter R, Matharu M, Carnes D, Taylor SJC, Nichols V, Pincus T, Underwood M, Sandhu H. Development of an education and self-management intervention for chronic headache - CHESS trial (Chronic Headache Education and Self-management Study). J Headache Pain 2019; 20:28. [PMID: 30885120 PMCID: PMC6734363 DOI: 10.1186/s10194-019-0980-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/06/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Self-management interventions are well recognised and widely used in chronic conditions. Their application to chronic headaches has been limited and generally of low quality. We describe here our process for developing an evidence based, and theory driven, education and self-management intervention for those living with chronic headache. METHODS Our intervention was designed using several core information sources; the results of three systematic reviews, qualitative material from those living with chronic headaches, our knowledge from existing self-management interventions; and finally collaborative input from a multidisciplinary team of clinicians, academics, patients, and charity partners. We manualised the intervention and associated training as a package for use in a feasibility study. We made adaptations for its use in a randomised controlled trial. RESULTS We piloted the intervention in four groups with a total of 18 participants. Qualitative feedback from 12 participants and five facilitators allowed the intervention to be refined for the main randomised controlled trial. Some of the key changes included shortening of the overall intervention, changes to the originally planned facilitators and spreading the facilitator training over three days rather than two. We are now testing the final revised intervention in a randomised controlled trial of its clinical and cost effectiveness. The group component of the intervention is delivered over two days with the first day focused on living, understanding and dealing with chronic headaches and the second day exploring how to adapt and take control of one's life with chronic headaches. CONCLUSION Our pilot work indicates that our intervention is feasible to deliver, and with the relevant changes would be acceptable for use with this population. Our randomised control trial is ongoing. We anticipate publishing final results in 2021. TRIAL REGISTRATION ISRCTN79708100. Registered 16th December 2015, http://www.isrctn.com/ISRCTN79708100.
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Affiliation(s)
- Shilpa Patel
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Rachel Potter
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Manjit Matharu
- Headache Group, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG UK
| | - Dawn Carnes
- Centre for Primary Care and Public Health, Blizard Institute Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Stephanie J. C. Taylor
- Centre for Primary Care and Public Health, Blizard Institute Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Vivien Nichols
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Tamar Pincus
- Department of Psychology, Royal Holloway, University of London, Surrey, TW20 0EX UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Harbinder Sandhu
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
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White K, Potter R, Patel S, Nichols VP, Haywood KL, Hee SW, Mistry D, Carnes D, Taylor SJC, Underwood M, Matharu MS. Chronic Headache Education and Self-management Study (CHESS) - a mixed method feasibility study to inform the design of a randomised controlled trial. BMC Med Res Methodol 2019; 19:30. [PMID: 30744571 PMCID: PMC6371558 DOI: 10.1186/s12874-019-0672-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 01/31/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Self-management support programmes are effective in a range of chronic conditions however there is limited evidence for their use in the treatment of chronic headaches. The aim of this study was to test the feasibility of four key aspects of a planned, future evaluative trial of a new education and self-management intervention for people with chronic headache: 1) recruiting people with chronic headache from primary care; 2) a telephone interview for the classification of chronic headaches; 3) the education and self-management intervention itself; and 4) the most appropriate patient reported outcomes (PROMS). METHODS Participants were identified and recruited from general practices in the West Midlands of the UK. We developed a nurse-led chronic headache classification interview and assessed agreement with an interview with headache specialists. We developed and tested a group based education and self-management intervention to assess training and delivery receipt using observation, facilitator, and participant feedback. We explored the acceptability and relevance of PROMs using postal questionnaires, interviews and a smartphone app. RESULTS Fourteen practices took part in the study and participant recruitment equated to 1.0/1000 registered patients. Challenges to recruitment were identified. We did 107 paired headache classification interviews. The level of agreement between nurse and doctor interviews was very good. We piloted the intervention in four groups with 18 participants. Qualitative feedback from participants and facilitators helped refine the intervention including shortening the overall intervention and increasing the facilitator training time. Participants completed 131 baseline questionnaires, measurement data quality, reliability and validity for headache-specific and generic measures was acceptable. CONCLUSION This study indicated that recruiting people with chronic headache from primary care is feasible but challenging, our headache classification interview is fit for purpose, our study intervention is viable, and that our choice of outcome measures is acceptable to participants in a future randomised controlled trial (RCT). TRIAL REGISTRATION ISRCTN, ISRCTN79708100. Registered 16th December 2015, http://www.isrctn.com/ISRCTN79708100.
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Affiliation(s)
- Kimberley White
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Rachel Potter
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Shilpa Patel
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Vivien P. Nichols
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Kirstie L. Haywood
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7A UK
| | - Siew Wan Hee
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7A UK
| | - Dipesh Mistry
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Dawn Carnes
- Faculty of Health, University of Applied Sciences, Fribourg, Western Switzerland Switzerland
| | - Stephanie J. C. Taylor
- Centre for Primary Care and Public Health, Blizard Institute Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Manjit S. Matharu
- Headache Group, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG UK
| | - on behalf of the CHESS team
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7A UK
- Faculty of Health, University of Applied Sciences, Fribourg, Western Switzerland Switzerland
- Centre for Primary Care and Public Health, Blizard Institute Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Headache Group, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG UK
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Abstract
PURPOSE OF REVIEW To review the most relevant developments in the understanding of headache in idiopathic intracranial hypertension (IIH). RECENT FINDINGS The phenotype of the typical IIH headache is diverging from the historical thinking of a raised intracranial pressure headache, with the majority being classified as having migraine. A larger proportion of those with IIH have a past medical history of migraine, compared with the general population, highlighting the importance of re-examining those who have a change or escalation in their headache. The mechanisms underlying headache in IIH are not understood. Additionally, factors which confer a poor headache prognosis are not established. It is clear, however, that headache has a detrimental effect on all aspects of the patient's quality of life and is currently ranked highly as a research priority by IIH patients to better understand the pathophysiology of headache in IIH and identification of potential headache specific therapeutic agents. SUMMARY Headache remains the predominate morbidity in the majority of those with IIH. Headache management is an unmet need in IIH and future studies are required to investigate the probable complex mechanisms, as well as effective management.
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Affiliation(s)
- Susan P. Mollan
- Birmingham Neuro-Ophthalmology, University Hospitals Birmingham, NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham
| | - Jan Hoffmann
- Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, Wellcome Foundation Building, Denmark Hill Campus, King's College London, London
| | - Alexandra J. Sinclair
- Metabolic Neurology, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston
- Department of Neurology, University Hospitals Birmingham, Queen Elizabeth Hospital, Birmingham
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
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Is Medication Overuse Drug Specific or Not? Data from a Review of Published Literature and from an Original Study on Italian MOH Patients. Curr Pain Headache Rep 2018; 22:71. [DOI: 10.1007/s11916-018-0729-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Agosti R. Migraine Burden of Disease: From the Patient's Experience to a Socio-Economic View. Headache 2018; 58 Suppl 1:17-32. [DOI: 10.1111/head.13301] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 03/28/2018] [Accepted: 03/28/2018] [Indexed: 01/03/2023]
Affiliation(s)
- Reto Agosti
- Headache Center Zurich Hirslanden; Zurich Switzerland
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