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Casas-Limón J, Quintas S, López-Bravo A, Alpuente A, Andrés-López A, Castro-Sánchez MV, Membrilla JA, Morales-Hernández C, González-García N, Irimia P. Unravelling Migraine Stigma: A Comprehensive Review of Its Impact and Strategies for Change. J Clin Med 2024; 13:5222. [PMID: 39274435 PMCID: PMC11396411 DOI: 10.3390/jcm13175222] [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: 07/22/2024] [Revised: 08/30/2024] [Accepted: 08/31/2024] [Indexed: 09/16/2024] Open
Abstract
Migraine-related stigma is a pervasive issue impacting nearly half of chronic migraine patients, with significant consequences for their quality of life, disability and mental health. Despite its profound effects, migraine stigma remains under-recognised in both clinical practice and research. This narrative review explores the three primary types of stigmas affecting migraine patients: public, structural and internalised. Public stigma involves negative societal attitudes and stereotypes that trivialise the condition. Structural stigma is reflected in policies that restrict access to necessary care and resources. Internalised stigma occurs when patients absorb these negative views, leading to self-blame and diminished self-worth. Addressing these different types of stigmas is crucial for improving the understanding, diagnosis and treatment of migraine. Educational efforts, advocacy and policy reform are essential strategies in this context. A deep understanding of stigma is vital for developing effective interventions that enhance clinical management and patient quality of life. Ultimately, reducing stigma can lead to better health outcomes and a more comprehensive approach to migraine care.
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Affiliation(s)
- Javier Casas-Limón
- Headache Unit, Hospital Universitario Fundación Alcorcón, 28922 Alcorcón, Spain
| | - Sonia Quintas
- Headache Unit, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), 28006 Madrid, Spain
| | | | - Alicia Alpuente
- Headache Unit, Hospital Universitario Vall d'Hebron, 08035 Barcelona, Spain
| | - Alberto Andrés-López
- Headache Unit, Complejo Hospitalario Universitario de Albacete, 02006 Albacete, Spain
| | | | | | | | | | - Pablo Irimia
- Headache Unit, Clínica Universitaria de Navarra, 31008 Pamplona, Spain
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Mingels S, Granitzer M, Luedtke K, Dankaerts W. What is the Status Quo of Patient-Centred Physiotherapy Management of People with Headache within a Biopsychosocial Model? - A Narrative Review. Curr Pain Headache Rep 2024:10.1007/s11916-024-01306-7. [PMID: 39141253 DOI: 10.1007/s11916-024-01306-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE OF REVIEW Patient-centred care (PCC) is deemed essential in the rehabilitation of musculoskeletal pain. Integrating such care within a biopsychosocial framework, enables to address all facets of the individual pain experience, and to manage the individual instead of the condition. This narrative review describes the status quo of PCC physiotherapy management of people with headache within a biopsychosocial model. PubMed, EMBASE, Web of Science, Scopus were searched (update 07.05.2024). The search-query comprised terminology relating to "headache", "patient-centred", "biopsychosocial", "physiotherapy". Additional eligibility criteria were reviews, trials, cohort, case report, case-control studies in English, Dutch, French. RECENT FINDINGS Gaps are exposed in patient-centred physiotherapy management of migraine, tension-type headache, and cervicogenic headache. While a biopsychosocial approach is advised to manage migraine and tension-type headache, its use in clinical practice is not reflected by the literature. A biopsychosocial approach is not advised in cervicogenic headache. Psychosocial-lifestyle interventions are mainly delivered by health-care providers other than physiotherapists. Additionally, psychologically-informed practice is barely introduced in physiotherapy headache management. Though, managing the social context within a biopsychosocial framework is advised, the implementation by physiotherapists is unclear. Comparable conclusions apply to PCC. PCC is recommended for the physiotherapy management of primary and secondary headache. Such recommendation remains however theoretical, not reaching clinical implementation. Yet, a shift from the traditional disease-centred model of care towards PCC is ongoing and should be continued in physiotherapy management. With this implementation, clinical and economical studies are needed to evaluate its effectiveness.
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Affiliation(s)
- Sarah Mingels
- Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Leuven University, Leuven, Belgium.
- Faculty of Rehabilitation Sciences and Physiotherapy, REVAL Rehabilitation Research Centre, Hasselt University, Hasselt, Belgium.
| | - Marita Granitzer
- Faculty of Rehabilitation Sciences and Physiotherapy, REVAL Rehabilitation Research Centre, Hasselt University, Hasselt, Belgium
| | - Kerstin Luedtke
- Department of Physiotherapy, Pain and Exercise Research, Institute of Health Sciences, Universität Zu Lübeck, Zu Lübeck, Germany
| | - Wim Dankaerts
- Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Leuven University, Leuven, Belgium
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Guerra F, Di Giacomo D, Ranieri J, Saporito G, Sucapane P, Totaro R, Pistoia F. Network analysis of negative emotions in patients with episodic migraine: need for a multidisciplinary perspective. Front Neurol 2024; 15:1418188. [PMID: 39015320 PMCID: PMC11249559 DOI: 10.3389/fneur.2024.1418188] [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: 04/16/2024] [Accepted: 06/10/2024] [Indexed: 07/18/2024] Open
Abstract
Background Episodic migraine (EM) is the second most prevalent neurological disorder worldwide and is responsible for more disability than all other neurological disorders combined. Triggers for the development of migraine include, stress, emotional burden, low blood sugar levels, tobacco, skipped meals, anxious and depressive feelings. Migraine affects both children and adults, occurring three times more frequently in women than in men. Objective The aim of this study was to evaluate the psychological profile of EM patients and the relationship among negative emotions in EM patients, analyzing self-efficacy measures in pain management. Design We performed an observational study in 60 outpatients aged 18-55 years (mean age 33.8; SD ±10.4) with EM. Methods All patients have been enrolled at the Headache Center of the San Salvatore Hospital of L'Aquila. The assessment comprised five standardized psychological self-assessments investigating relevant emotional dimensions and pain self-efficacy, along with two questionnaires assessing migraine-related disability. A network analysis of negative emotions was performed to evaluate which emotional traits and relationships play a crucial role in pain coping and management. Results Our findings indicate that migraine significantly impairs the quality of life of patients in their daily lives. Over half of the patients reported experiencing severe disability, with negative emotions significantly influencing their ability to cope with pain and maintain productivity during migraine attacks. Dysphoric variables (irritability, interpersonal resentment, and surrender) were correlated with difficulties in emotion regulation ability and with the capacity of engaging in goal-directed behaviors despite experiencing pain. The ability to regulate one's emotions and manage dysphoria were positively correlated with pain self-efficacy, whereas positive mental health was associated with individuals' confidence in performing activities despite experiencing pain. Conclusion Negative emotions had a negative correlation with positive mental health and were linked to a lower capacity to carry out daily activities despite experiencing migraine pain. This suggests that psychological interventions could improve mental health and potentially surpassing the effects of pharmacological interventions alone in migraine management. An integrated, patient-centered approach may represent an effective paradigm to address and reduce the burden of migraine, leading to a reduction in healthcare costs.
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Affiliation(s)
- Federica Guerra
- Postgraduate School on Clinical Psychology, University of L’Aquila, L’Aquila, Italy
| | - Dina Di Giacomo
- Postgraduate School on Clinical Psychology, University of L’Aquila, L’Aquila, Italy
- Department of MESVA, University of L’Aquila, L’Aquila, Italy
| | - Jessica Ranieri
- Postgraduate School on Clinical Psychology, University of L’Aquila, L’Aquila, Italy
| | - Gennaro Saporito
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | | | | | - Francesca Pistoia
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
- San Salvatore Hospital, L’Aquila, Italy
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Shimoda M, Hoshikawa K, Oda S, Imai M, Osada T, Aoki R, Sunaga A, Shinohara C. Cortical Hyperperfusion on MRI Arterial Spin-Labeling during the Interictal Period of Patients with Migraine Headache. AJNR Am J Neuroradiol 2024; 45:686-692. [PMID: 38663988 PMCID: PMC11288597 DOI: 10.3174/ajnr.a8208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/25/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND AND PURPOSE Concentrations of calcitonin gene-related peptide, a neuropeptide and potent endogenous vasodilator, are reportedly higher in patients with migraine than in healthy subjects, both during and between migraine attacks, reflecting ongoing activation of the trigeminal nervous system. In this prospective study, we measured CBF during the interictal period of patients with migraine after considering insomnia and depression and examined the effects of ongoing activation of the trigeminal nervous system, including during the interictal period, on CBF. MATERIALS AND METHODS In a total of 242 patient with migraine (age range, 18-75 years), CBF was measured by MR imaging arterial spin-labeling during the interictal period and was compared with results from 26 healthy volunteers younger than 45 years of age as control subjects (age range, 22-45 years). Cortical hyperperfusion was defined as identification of ≥2 cerebral cortical regions with regional CBF values at least 2 SDs above the mean regional CBF in control subjects. RESULTS The overall frequency of cortical hyperperfusion was significantly higher in patients with migraine (115 of 242, 48%) than in control subjects (1 of 26, 4%). Multivariable analysis revealed the 18- to 40-year age group and patients with migraine without insomnia as significant positive clinical factors associated with cortical hyperperfusion. Among patients with migraine without insomnia, the frequency of cortical hyperperfusion was >92% (89 of 97). One-way ANOVA showed that in all ROIs of the cortex, regional CBF was significantly higher in patients with migraine without insomnia than in patients with migraine with insomnia or control subjects. In patients with migraine without insomnia, cortical hyperperfusion findings showed a sensitivity of 0.918 and a specificity of 0.962 for migraine in the interictal period, representing excellent accuracy. In contrast, among patients with migraine with insomnia, sensitivity was only 0.179 but specificity was 0.962. CONCLUSIONS Patients with migraine without insomnia may have cortical hyperperfusion during the interictal period; however, the findings of the present study need to be prospectively validated on a larger scale before clinical applicability can be considered.
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Affiliation(s)
- Masami Shimoda
- From the Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Kaori Hoshikawa
- From the Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Shinri Oda
- From the Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Masaaki Imai
- From the Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Takahiro Osada
- From the Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Rie Aoki
- From the Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Azusa Sunaga
- From the Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Chiaki Shinohara
- From the Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo, Japan
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Yeh PK, An YC, Hung KS, Yang FC. Influences of Genetic and Environmental Factors on Chronic Migraine: A Narrative Review. Curr Pain Headache Rep 2024; 28:169-180. [PMID: 38363449 DOI: 10.1007/s11916-024-01228-4] [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] [Accepted: 02/07/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE OF REVIEW In this narrative review, we aim to summarize recent insights into the complex interplay between environmental and genetic factors affecting the etiology, development, and progression of chronic migraine (CM). RECENT FINDINGS Environmental factors such as stress, sleep dysfunction, fasting, hormonal changes, weather patterns, dietary compounds, and sensory stimuli are critical triggers that can contribute to the evolution of episodic migraine into CM. These triggers are particularly influential in genetically predisposed individuals. Concurrently, genome-wide association studies (GWAS) have revealed over 100 genetic loci linked to migraine, emphasizing a significant genetic basis for migraine susceptibility. In CM, environmental and genetic factors are of equal importance and contribute to the pathophysiology of the condition. Understanding the bidirectional interactions between these elements is crucial for advancing therapeutic approaches and preventive strategies. This balanced perspective encourages continued research into the complex gene-environment nexus to improve our understanding and management of CM.
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Affiliation(s)
- Po-Kuan Yeh
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Section 2, Cheng-Kung Road, Neihu 114, No. 325, Taipei, Taiwan
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Beitou Branch, Taipei, Taiwan
| | - Yu-Chin An
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kuo-Sheng Hung
- Center for Precision Medicine and Genomics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Fu-Chi Yang
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Section 2, Cheng-Kung Road, Neihu 114, No. 325, Taipei, Taiwan.
- Center for Precision Medicine and Genomics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Mercante JPP, Oliveira AB, Peres MFP, Wang YP, Brunoni AR, Lotufo PA, Benseñor IM, Goulart AC. Association of mental health symptoms with the migraine-tension-type headache spectrum in the Brazilian longitudinal study of adult health. J Psychosom Res 2024; 179:111624. [PMID: 38432062 DOI: 10.1016/j.jpsychores.2024.111624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To investigate the relationship between mental health symptoms and the migraine-tension-type headache (TTH) spectrum in middle-aged adults from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil study). METHODS In this cross-sectional analysis (baseline data: 2008-2010), it was evaluated the relationship between each mental health symptom assessed by the Clinical Interview Schedule-Revised (CIS-R) questionnaire and headache subtypes (migraine and TTH) according to international criteria. It was performed binary logistic regression models, with estimated odds ratios (OR) with their respective 95% confidence intervals (CI) adjusted for confounders including migraine attack frequency. RESULTS Among 13,916 participants, 70.1% reported any major primary headache subtype within the last year. The most common subtype was definite TTH (33.4%), followed by probable migraine (21.0%), definite migraine (8.5%), and probable TTH (7.2%). Our main findings indicated positive associations between anxiety-related symptoms and the migraine-tension type headache (TTH) spectrum with a clear trend toward definite migraine more than tension-type headache. The presence of somatic symptoms presented a high likelihood for the associations with headaches, mainly definite migraine (OR: 7.9, 95% CI: 6.4-9.8), probable migraine (OR: 4.5, 95% CI 3.7-5.4) and probable TTH (OR: 3.0, 95% CI: 2.3-3.8). Other symptoms associated with headache disorders included fatigue, panic, irritability, anxiety symptoms, concentration problems, forgetfulness, depressive symptoms, and worry. The effect of associations remained significant after controlling for headache attack frequency. CONCLUSION This study provides evidence of consistent associations between mental health symptoms and primary headache disorders, with a higher burden of anxiety-based symptoms observed in people with migraine than those with TTH.
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Affiliation(s)
- Juliane Prieto Peres Mercante
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Arão Belitardo Oliveira
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Mario Fernando Prieto Peres
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil; Instituto de Psiquiatria, Departamento de Psiquiatria, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Yuan-Pang Wang
- Instituto de Psiquiatria, Departamento de Psiquiatria, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Andre Russowsky Brunoni
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil; Instituto de Psiquiatria, Departamento de Psiquiatria, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil; School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Paulo Andrade Lotufo
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil; Instituto de Psiquiatria, Departamento de Psiquiatria, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Isabela Martins Benseñor
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil; Instituto de Psiquiatria, Departamento de Psiquiatria, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Alessandra Carvalho Goulart
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brazil; Departament of Epidemiology, School of Public Health, Universidade de São Paulo, São Paulo, SP, Brazil
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Filzmoser N, Webber I, Kerr G, Alaa A, El Asmar MI, Karki M, Riboli-Sasco E, El-Osta A. Exploring the link between self-management of migraine and emotional wellbeing: a cross-sectional study of community-dwelling migraine sufferers. BMC Neurol 2024; 24:47. [PMID: 38279088 PMCID: PMC10821553 DOI: 10.1186/s12883-024-03535-0] [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: 03/29/2023] [Accepted: 01/12/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Globally, an estimated 14% of adults live with migraine disease which impacts their physical, emotional and social wellbeing. To target the disease comprehensively, research recommends a multidisciplinary approach to migraine management. Yet, at present, migraine management primarily centers around pharmaceutical treatments. The aim of this study was to investigate the extent to which emotional awareness could influence the uptake of self-care behaviours of community-dwelling adults with migraine. METHODS A cross-sectional online survey explored personal experiences with migraine disease and strategies or behaviours to manage migraine attacks. Chi-squared tests were used to investigate differences in ratings of migraine prevention and management strategies between users and non-users of the strategies. Univariable logistic regressions were used to assess the effectiveness of self-care behaviours to manage or prevent migraine attacks. RESULTS We surveyed 170 community-dwelling adults with migraine in the United Kingdom, Austria, Germany and the United States. Most (85%) respondents had experienced migraine for over five years, where 42% of attacks usually lasted several days. Whereas we did not differentiate between diagnosis by a neurologist or self-diagnosis, the most common diagnoses in the cohort were migraine without aura (38.9%) and migraine with aura (29%). Staying hydrated was the most popular preventative strategy (87%), 70.2% used prescription medication and 64.9% changed their diet and/or supplements. Almost all ( 92.4%) respondents stated that their mood or emotions could trigger their migraine attacks. Keeping a headache or mood diary was the lowest-rated prevention strategy and was rated as "probably ineffective" or causing "no change" in preventing migraine attacks. Over a third (39.7%) kept track of their physical wellbeing and symptoms. Reasons stated for tracking symptoms included to identify triggers (65.8%), show reports to a healthcare professional (59.6%), understand when they must take medication (48.1%), track improvements (67.3%) or deteriorations (67.3%). CONCLUSIONS Migraine management is dominated by pharmaceutical management for acute pain attacks and lifestyle changes for managing migraine long-term. Perception of the effectiveness of those techniques is high, whereas perception of interventions that target the emotional or psychological components of chronic pain management (keeping a mood diary, and mental health support) is mixed. There exists a gap between the recommended biopsychosocial approach and the current state of migraine management.
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Affiliation(s)
- Nicola Filzmoser
- Department of Primary Care & Public Health, Self-Care Academic Research Unit (SCARU) Imperial College London, Charing Cross Hospital, London, W6 8RF, UK.
| | - Iman Webber
- Department of Primary Care & Public Health, Self-Care Academic Research Unit (SCARU) Imperial College London, Charing Cross Hospital, London, W6 8RF, UK
| | - Gabriele Kerr
- Department of Primary Care & Public Health, Self-Care Academic Research Unit (SCARU) Imperial College London, Charing Cross Hospital, London, W6 8RF, UK
| | - Aos Alaa
- Department of Primary Care & Public Health, Self-Care Academic Research Unit (SCARU) Imperial College London, Charing Cross Hospital, London, W6 8RF, UK
| | - Marie Iine El Asmar
- Department of Primary Care & Public Health, Self-Care Academic Research Unit (SCARU) Imperial College London, Charing Cross Hospital, London, W6 8RF, UK
| | - Manisha Karki
- Department of Primary Care & Public Health, Self-Care Academic Research Unit (SCARU) Imperial College London, Charing Cross Hospital, London, W6 8RF, UK
| | - Eva Riboli-Sasco
- Department of Primary Care & Public Health, Self-Care Academic Research Unit (SCARU) Imperial College London, Charing Cross Hospital, London, W6 8RF, UK
| | - Austen El-Osta
- Department of Primary Care & Public Health, Self-Care Academic Research Unit (SCARU) Imperial College London, Charing Cross Hospital, London, W6 8RF, UK
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Ornello R, Andreou AP, De Matteis E, Jürgens TP, Minen MT, Sacco S. Resistant and refractory migraine: clinical presentation, pathophysiology, and management. EBioMedicine 2024; 99:104943. [PMID: 38142636 PMCID: PMC10788408 DOI: 10.1016/j.ebiom.2023.104943] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/09/2023] [Accepted: 12/13/2023] [Indexed: 12/26/2023] Open
Abstract
Migraine is a leading cause of disability worldwide. A minority of individuals with migraine develop resistant or refractory conditions characterised by ≥ 8 monthly days of debilitating headaches and inadequate response, intolerance, or contraindication to ≥3 or all preventive drug classes, respectively. Resistant and refractory migraine are emerging clinical definitions stemming from better knowledge of the pathophysiology of migraine and from the advent of migraine-specific preventive treatments. Resistant migraine mostly results from drug failures, while refractory migraine has complex and still unknown mechanisms that impair the efficacy of preventive treatments. Individuals with resistant migraine can be treated with migraine-specific preventive drugs. The management of refractory migraine is challenging and often unsuccessful, being based on combinations of different drugs and non-pharmacological treatment. Future research should aim to identify individuals at risk of developing treatment failures, prevent the condition, investigate the mechanisms of refractoriness to treatments, and find effective treatment strategies.
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Affiliation(s)
- Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Anna P Andreou
- Headache Research-Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Headache Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Eleonora De Matteis
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Tim P Jürgens
- Headache Center North-East, Department of Neurology, University Medical Center Rostock, Rostock, Germany; Department of Neurology, KMG Hospital Güstrow, Güstrow, Germany
| | - Mia T Minen
- Departments of Neurology and Population Health, NYU Langone Health, New York, USA
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
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Basedau H, Ornello R, Matteis ED, Davaasuren B, Kadyrova B, Vuralli D, Bozhenko M, Azizova I, Bitsadze N, Eralieva E, Ashina M, Mitsikostas D, Puledda F. Placebo and nocebo in the treatment of migraine: How much does real world effectiveness depend on contextual effects? Cephalalgia 2023; 43:3331024231218392. [PMID: 38041833 DOI: 10.1177/03331024231218392] [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: 12/04/2023]
Abstract
PURPOSE Treatments in medicine impact individuals beyond their intended effects, due to phenomena such as the placebo and nocebo effects. The placebo effect arises from the positive expectation of a treatment being beneficial, while the nocebo effect stems from the negative expectation of a treatment causing harm. Both in real-world practice and clinical trials, treatments can lead to outcomes unrelated to their intended mechanism of action, which we categorize as placebo and nocebo responses. These responses, combined with the inherent fluctuation in a condition's natural progression, regression to the mean, and random comorbidities, make up a significant part of the therapeutic experience. Particularly in pain management, placebo and nocebo effects play a substantial role. By addressing modifiable contextual factors such as patient expectations, lifestyle choices, and the therapeutic relationship, healthcare providers can enhance the effectiveness of migraine treatments, paving the way for a more comprehensive, individualized approach to patient care. We must also consider non-modifiable factors like personal experiences, beliefs, and information from social media and the internet. CONCLUSION This review offers a summary of our current understanding of the placebo and nocebo effects in migraine management.
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Affiliation(s)
- Hauke Basedau
- Department of Systems Neuroscience, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
| | - Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Eleonora De Matteis
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Begimai Kadyrova
- Department of Special Clinical Disciplines, International School of Medicine of International University of Kyrgyzstan, Bishkek, Kyrgyzstan
| | - Doga Vuralli
- Department of Neurology and Algology, Neuropsychiatry Center, Neuroscience and Neurotechnology Center of Excellence (NÖROM), Gazi University, Ankara, Turkey
| | - Myroslav Bozhenko
- Department of Neurology, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Ilaha Azizova
- Neurological Clinic "New Medical Technologies", Baku, Azerbaijan
| | | | | | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Dimos Mitsikostas
- Department of Neurology Α, Aegintion Hospital, National and Kapidistrian University of Athens, Athens, Greece
| | - Francesca Puledda
- Headache Group, Wolfson SPaRC, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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10
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Alshareef MH, Alsharif BH. Headache Prevalence and Its Associated Factors in Makkah, Saudi Arabia. Biomedicines 2023; 11:2853. [PMID: 37893226 PMCID: PMC10604832 DOI: 10.3390/biomedicines11102853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/07/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Primary headaches are more prevalent and associated with several risk factors, such as chronic diseases, unhealthy lifestyles, smoking, caffeine intake, work, and stress. However, these factors are not associated with specific headache disorders. We investigated the prevalence of primary headache disorders and the associated risk factors in Makkah. This cross-sectional study, conducted over a 6-month period, used an anonymous survey disseminated through online platforms. The questionnaire was a modified version of a validated questionnaire used to assess headaches in relation to modifiable and non-modifiable risk factors. In total, 1177 participants aged 18-65 (mean, 31.5 ± 12.6) years were included. Headaches were diagnosed among 44.2% of participants aged 20-59 years, with a high prevalence among young adults; additionally, 71.5% of participants with headaches reported experiencing headaches for <15 days per month. Chronic headaches were found in 28.5% of participants. Age, chronic diseases, work, caffeine consumption, and smoking were associated with having a significant effect on headache prevalence. The prevalence of headaches in Makkah has increased in comparison to that reported in previous studies. Certain modifiable and non-modifiable risk factors have been associated with headaches. Headaches impact all life aspects of individuals and communities. An educational program for professionals and patients can improve patient outcomes.
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Affiliation(s)
- Maram H. Alshareef
- Department of Community Medicine and Pilgrims Health, Faculty of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia
| | - Bayan Hashim Alsharif
- Hajj and Umrah Research and Epidemiology Administration, King Abdullah Medical City, Makkah 24331, Saudi Arabia;
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11
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Licina E, Radojicic A, Jeremic M, Tomic A, Mijajlovic M. Non-Pharmacological Treatment of Primary Headaches-A Focused Review. Brain Sci 2023; 13:1432. [PMID: 37891800 PMCID: PMC10605615 DOI: 10.3390/brainsci13101432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/25/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023] Open
Abstract
Headache disorders are a significant global health burden, leading to reduced quality of life. While vast pharmacological treatments are available, they may be associated with adverse effects or inadequate efficacy for some patients, therefore there is a need for exploring alternate treatment strategies. This review gives a brief explanation and evaluation of some established and emerging non-pharmacological approaches for headache management, focusing on nutraceuticals and diet, acupuncture, cognitive behavioral therapy (CBT), biofeedback, relaxation techniques, autogenic training, and neuromodulation. Special consideration is given to psychological interventions as they increase patient self-efficacy and provide strategies for managing chronic pain. Future research should focus on optimizing these therapies, identifying patient-specific factors influencing their effectiveness, and integrating them into holistic headache management strategies.
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Affiliation(s)
- Emir Licina
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (E.L.); (A.R.); (A.T.)
| | - Aleksandra Radojicic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (E.L.); (A.R.); (A.T.)
- Neurology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Marta Jeremic
- Neurology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Aleksandra Tomic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (E.L.); (A.R.); (A.T.)
- Neurology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Milija Mijajlovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (E.L.); (A.R.); (A.T.)
- Neurology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
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12
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Stanyer EC, Brookes J, Pang JR, Urani A, Holland PR, Hoffmann J. Investigating the relationship between sleep and migraine in a global sample: a Bayesian cross-sectional approach. J Headache Pain 2023; 24:123. [PMID: 37679693 PMCID: PMC10486047 DOI: 10.1186/s10194-023-01638-6] [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: 05/24/2023] [Accepted: 07/24/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND There is a bidirectional link between sleep and migraine, however causality is difficult to determine. This study aimed to investigate this relationship using data collected from a smartphone application. METHODS Self-reported data from 11,166 global users (aged 18-81 years, mean: 41.21, standard deviation: 11.49) were collected from the Migraine Buddy application (Healint Pte. Ltd.). Measures included: start and end times of sleep and migraine attacks, and pain intensity. Bayesian regression models were used to predict occurrence of a migraine attack the next day based on users' deviations from average sleep, number of sleep interruptions, and hours slept the night before in those reporting ≥ 8 and < 25 migraine attacks on average per month. Conversely, we modelled whether attack occurrence and pain intensity predicted hours slept that night. RESULTS There were 724 users (129 males, 412 females, 183 unknown, mean age = 41.88 years, SD = 11.63), with a mean monthly attack frequency of 9.94. More sleep interruptions (95% Highest Density Interval (95%HDI [0.11 - 0.21]) and deviation from a user's mean sleep (95%HDI [0.04 - 0.08]) were significant predictors of a next day attack. Total hours slept was not a significant predictor (95%HDI [-0.04 - 0.04]). Pain intensity, but not attack occurrence was a positive predictor of hours slept. CONCLUSIONS Sleep fragmentation and deviation from typical sleep are the main drivers of the relationship between sleep and migraine. Having a migraine attack does not predict sleep duration, yet the pain associated with it does. This study highlights sleep as crucial in migraine management.
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Affiliation(s)
- Emily C Stanyer
- Wolfson Centre for Age-Related Diseases, Institute for Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- Current address: Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | | | | | | | - Philip R Holland
- Wolfson Centre for Age-Related Diseases, Institute for Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Jan Hoffmann
- Wolfson Centre for Age-Related Diseases, Institute for Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
- NIHR-Wellcome Trust King's Clinical Research Facility/SLaM Biomedical Research Centre, King's College Hospital, London, UK.
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13
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Persson M, Rembeck G, Weineland S. Conceptualising migraine attacks from a biopsychosocial model using qualitative and functional behavioural analysis. Scand J Prim Health Care 2023; 41:257-266. [PMID: 37409784 PMCID: PMC10478623 DOI: 10.1080/02813432.2023.2231034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/25/2023] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVE The aim of this study was to explore patients' experiences and management of pain in connection with a migraine attack in episodic migraine. DESIGN, SETTING AND SUBJECTS This qualitative study used a semi-structured interview format based on functional behavioural analysis as commonly used in cognitive behavioural therapy. We interviewed eight participants and analysed their responses using systematic text condensation. RESULTS Participants' descriptions of their experiences and management of pain from episodic migraine were sorted into three description First physical sensations, Automatic reactions and Acts according to the interpretation. CONCLUSION From a biopsychosocial perspective, a migraine attack is much more complex than just an experience of pain. The purely biological pain prompts a number of automatic reactions leading to strategies for pain management.
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Affiliation(s)
- Marie Persson
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Care, Research, Region Västra Götaland, Sweden
- Närhälsan, Region Västra Götaland, Sweden
| | - Gun Rembeck
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Care, Research, Region Västra Götaland, Sweden
- Regional Health, Borås Youth Guidance Centre, Region Västra Götaland, Sweden
| | - Sandra Weineland
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Care, Research, Region Västra Götaland, Sweden
- Närhälsan, Region Västra Götaland, Sweden
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
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14
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Amatrudo G, Kengetter J, McCrea S, Amatrudo M. Cognitive Behavioral Therapy for the Management of Episodic Migraine. Curr Pain Headache Rep 2023; 27:471-477. [PMID: 37395898 DOI: 10.1007/s11916-023-01129-y] [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: 06/05/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE OF REVIEW This article provides an overview of the application of CBT in the management of episodic migraine while also providing context and insight into the underlying neurophysiological mechanisms of therapeutic change. It discusses the theoretical foundations of CBT and highlights key components including education, cognitive restructuring, behavioral interventions, relaxation techniques, and lifestyle changes. RECENT FINDINGS Cognitive behavioral therapy (CBT) is an empirically based treatment that is well suited for the management of episodic migraine. Although first-line treatments of migraine are typically pharmacological, a review of empirical literature suggests growing evidence for the use of CBT as a standard non-pharmacological treatment of headache conditions. In summary, this article explores evidence supporting the efficacy of CBT in reducing the frequency, intensity, and duration of migraine attacks as well as improving the quality of life and psychological well-being of those with episodic migraine.
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15
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Bottiroli S, Renzi A, Ballante E, De Icco R, Sances G, Tanzilli A, Vecchi T, Tassorelli C, Galli F. Personality in Chronic Headache: A Systematic Review with Meta-Analysis. Pain Res Manag 2023; 2023:6685372. [PMID: 37671122 PMCID: PMC10477030 DOI: 10.1155/2023/6685372] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/21/2023] [Accepted: 08/16/2023] [Indexed: 09/07/2023]
Abstract
Background Chronic headache (CH) is a condition that includes different subtypes of headaches and that can impair different life domains. Personality traits can play a relevant role both in the development and in coping with this medical condition. The first aim of the present study is to realize a systematic review of the personality traits associated with CH compared to healthy controls; the second objective is to carry out a quantitative meta-analysis with the studies using the same instrument to assess personality traits. Method The literature search encompassed articles published from 1988 until December 2022 on the major databases in the field of health and social sciences: PubMed, Scopus, PsychInfo, and Web of Science. Results Thirteen studies were included in the systematic review, but only three studies were deeply explored in a meta-analysis since the only ones used a common instrument for personality assessment (Minnesota Multiphasic Personality Inventory). According to the meta-analysis, different subtypes of CH patients scored higher than healthy controls on Hypochondriasis and Hysteria Scales. The systematic review showed higher levels of depressive and anxious personality dimensions and pain catastrophizing in CH compared to healthy controls. Moreover, frequent-chronic forms and medication-overuse headache were the most symptomatic and frail categories showing higher levels of dysfunctional personality traits and psychopathological symptoms. Conclusions These results seem to confirm a "neurotic profile" in patients suffering from CH. The identification of the main personality traits involved in the onset and maintenance of headache disorders represents an important objective for developing psychological interventions.
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Affiliation(s)
- Sara Bottiroli
- Giustino Fortunato University, Benevento, Italy
- Headache Science and Neurorehabilitation Centre, IRCCS C. Mondino Foundation, Pavia, Italy
| | - Alessia Renzi
- Department of Dynamic and Clinical Psychology and Health Studies, “Sapienza” University of Rome, Rome, Italy
| | - Elena Ballante
- BioData Science Unit, IRCCS C. Mondino Foundation, Pavia, Italy
- Department of Political and Social Sciences, University of Pavia, Italy
| | - Roberto De Icco
- Headache Science and Neurorehabilitation Centre, IRCCS C. Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Grazia Sances
- Headache Science and Neurorehabilitation Centre, IRCCS C. Mondino Foundation, Pavia, Italy
| | - Annalisa Tanzilli
- Department of Dynamic and Clinical Psychology and Health Studies, “Sapienza” University of Rome, Rome, Italy
| | - Tomaso Vecchi
- Headache Science and Neurorehabilitation Centre, IRCCS C. Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Cristina Tassorelli
- Headache Science and Neurorehabilitation Centre, IRCCS C. Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Federica Galli
- Department of Dynamic and Clinical Psychology and Health Studies, “Sapienza” University of Rome, Rome, Italy
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16
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Liu J, Quan S, Zhao L, Yuan K, Wang Y, Zhang Y, Wang Z, Sun M, Hu L. Evaluation of a Clustering Approach to Define Distinct Subgroups of Patients With Migraine to Select Electroacupuncture Treatments. Neurology 2023; 101:e699-e709. [PMID: 37349112 PMCID: PMC10437024 DOI: 10.1212/wnl.0000000000207484] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/18/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The objective of this study was to propose a clustering approach to identify migraine subgroups and test the clinical usefulness of the approach by providing prognostic information for electroacupuncture treatment selection. METHODS Participants with migraine without aura (MWoA) were asked to complete a daily headache diary, self-rating depression and anxiety, and quality-of-life questionnaires. Whole-brain functional connectivities (FCs) were assessed on resting-state functional MRI (fMRI). By integrating clinical measurements and fMRI data, partial least squares correlation and hierarchical clustering analysis were used to cluster participants with MWoA. Multivariate pattern analysis was applied to validate the proposed subgrouping strategy. Some participants had an 8-week electroacupuncture treatment, and the response rate was compared between different MWoA subgroups. RESULTS In study 1, a total of 97 participants (age of 28.2 ± 1.0 years, 70 female participants) with MWoA and 77 healthy controls (HCs) (age of 26.8 ± 0.1 years, 61 female participants) were enrolled (dataset 1), and 2 MWoA subgroups were defined. The participants in subgroup 1 had a significantly lower headache frequency (times/month of 4.4 ± 1.1) and significantly higher self-ratings of depression (depression score of 49.5 ± 2.3) when compared with participants in subgroup 2 (times/month of 7.0 ± 0.6 and depression score of 43.4 ± 1.2). The between-group differences of FCs were predominantly related to the amygdala, thalamus, hippocampus, and parahippocampal area. In study 2, 33 participants with MWoA (age of 30.9 ± 2.0 years, 28 female participants) and 23 HCs (age of 29.8 ± 1.1 years, 13 female participants) were enrolled as an independent dataset (dataset 2). The classification analysis validated the effectiveness of the 2-cluster solution of participants with MWoA in datasets 1 and 2. In study 3, 58 participants with MWoA were willing to receive electroacupuncture treatment and were assigned to different subgroups. Participants in different subgroups exhibited different response rates (p = 0.03, OR CI 0.086-0.93) to electroacupuncture treatment (18% and 44% for subgroups 1 and 2, respectively). DISCUSSION Our study proposed a novel clustering approach to define distinct MWoA subgroups, which could be useful for refining the diagnosis of participants with MWoA and guiding individualized strategies for pain prophylaxis and analgesia.
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Affiliation(s)
- Jixin Liu
- From the Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information (J.L., S.Q., K.Y.), School of Life Science and Technology, Xidian University, Shaanxi; Acupuncture and Tuina School (L.Z., Y.W., Y.Z., Z.W., M.S.), Chengdu University of Traditional Chinese Medicine; CAS Key Laboratory of Mental Health (L.H.), Institute of Psychology, Chinese Academy of Sciences; and Department of Psychology (L.H.), University of Chinese Academy of Sciences, Beijing, China
| | - Shilan Quan
- From the Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information (J.L., S.Q., K.Y.), School of Life Science and Technology, Xidian University, Shaanxi; Acupuncture and Tuina School (L.Z., Y.W., Y.Z., Z.W., M.S.), Chengdu University of Traditional Chinese Medicine; CAS Key Laboratory of Mental Health (L.H.), Institute of Psychology, Chinese Academy of Sciences; and Department of Psychology (L.H.), University of Chinese Academy of Sciences, Beijing, China
| | - Ling Zhao
- From the Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information (J.L., S.Q., K.Y.), School of Life Science and Technology, Xidian University, Shaanxi; Acupuncture and Tuina School (L.Z., Y.W., Y.Z., Z.W., M.S.), Chengdu University of Traditional Chinese Medicine; CAS Key Laboratory of Mental Health (L.H.), Institute of Psychology, Chinese Academy of Sciences; and Department of Psychology (L.H.), University of Chinese Academy of Sciences, Beijing, China
| | - Kai Yuan
- From the Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information (J.L., S.Q., K.Y.), School of Life Science and Technology, Xidian University, Shaanxi; Acupuncture and Tuina School (L.Z., Y.W., Y.Z., Z.W., M.S.), Chengdu University of Traditional Chinese Medicine; CAS Key Laboratory of Mental Health (L.H.), Institute of Psychology, Chinese Academy of Sciences; and Department of Psychology (L.H.), University of Chinese Academy of Sciences, Beijing, China
| | - Yanan Wang
- From the Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information (J.L., S.Q., K.Y.), School of Life Science and Technology, Xidian University, Shaanxi; Acupuncture and Tuina School (L.Z., Y.W., Y.Z., Z.W., M.S.), Chengdu University of Traditional Chinese Medicine; CAS Key Laboratory of Mental Health (L.H.), Institute of Psychology, Chinese Academy of Sciences; and Department of Psychology (L.H.), University of Chinese Academy of Sciences, Beijing, China
| | - Yutong Zhang
- From the Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information (J.L., S.Q., K.Y.), School of Life Science and Technology, Xidian University, Shaanxi; Acupuncture and Tuina School (L.Z., Y.W., Y.Z., Z.W., M.S.), Chengdu University of Traditional Chinese Medicine; CAS Key Laboratory of Mental Health (L.H.), Institute of Psychology, Chinese Academy of Sciences; and Department of Psychology (L.H.), University of Chinese Academy of Sciences, Beijing, China
| | - Ziwen Wang
- From the Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information (J.L., S.Q., K.Y.), School of Life Science and Technology, Xidian University, Shaanxi; Acupuncture and Tuina School (L.Z., Y.W., Y.Z., Z.W., M.S.), Chengdu University of Traditional Chinese Medicine; CAS Key Laboratory of Mental Health (L.H.), Institute of Psychology, Chinese Academy of Sciences; and Department of Psychology (L.H.), University of Chinese Academy of Sciences, Beijing, China
| | - Mingsheng Sun
- From the Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information (J.L., S.Q., K.Y.), School of Life Science and Technology, Xidian University, Shaanxi; Acupuncture and Tuina School (L.Z., Y.W., Y.Z., Z.W., M.S.), Chengdu University of Traditional Chinese Medicine; CAS Key Laboratory of Mental Health (L.H.), Institute of Psychology, Chinese Academy of Sciences; and Department of Psychology (L.H.), University of Chinese Academy of Sciences, Beijing, China
| | - Li Hu
- From the Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information (J.L., S.Q., K.Y.), School of Life Science and Technology, Xidian University, Shaanxi; Acupuncture and Tuina School (L.Z., Y.W., Y.Z., Z.W., M.S.), Chengdu University of Traditional Chinese Medicine; CAS Key Laboratory of Mental Health (L.H.), Institute of Psychology, Chinese Academy of Sciences; and Department of Psychology (L.H.), University of Chinese Academy of Sciences, Beijing, China.
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Gross E, Ruiz de la Torre E, Martelletti P. The Migraine Stigma Kaleidoscope View. Neurol Ther 2023; 12:703-709. [PMID: 36871256 DOI: 10.1007/s40120-023-00456-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 02/17/2023] [Indexed: 03/06/2023] Open
Abstract
The stigma of migraine, despite an impressive body of data on the epidemiological of migraine and the associated disability, burden and cost of migraine to patients, has not been fully evaluated as an important factor in the chronicization of the disease and social isolation of the patient. In this commentary, we present three points of view. From the point of view of a European advocacy body active in the field of migraine medicine, actions to improve the perception of migraine within the community regarding the stigma for people with migraine are presented at the personal, relational and occupational levels. From the point of view of a clinician who is an expert on migraine, proposals are made for treatment and rehabilitation paths specifically dedicated to the reintegration of these individuals into social contexts.
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Affiliation(s)
| | | | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.
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18
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Ou-Yang ZY, Feng Y, Yang YF, Chen NX, Su XL, Zhang Q, Zhong MM, Hu J, Ye Q, Zhao J, Zhao YQ, Chen Y, Tan L, Liu Q, Feng YZ, Guo Y. Oral Health-Related Quality of Life among Chinese Chronic Orofacial Pain Patients with Psychological Health Problems: A Moderated Mediation Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3244. [PMID: 36833938 PMCID: PMC9962568 DOI: 10.3390/ijerph20043244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/25/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
Psychological therapies are important for comprehensive chronic orofacial pain (COFP) treatment. This study is to validate the effects of psychological factors on oral health-related quality of life (OHRQoL) among COFP patients in China. Pain catastrophizing, which is a subjective cognitive emotion used to manage the psychological aspects of pain among COFP patients, was examined in relation to COFP severity and OHRQoL. All 479 participants were recruited in Changsha, Hunan Province, China. Cronbach's alpha coefficients (0.868-0.960), composite reliability scores (0.924-0.969), and average variance extracted from each construct (0.555-0.753) all indicated a good model fit. Pearson's correlation analysis showed that age and education status have a positive correlation with COFP severity, pain catastrophizing, and anxiety. COFP severity was related to anxiety, depression, and COFP-OHRQoL. Pain catastrophizing was related to employment status. Anxiety and depression symptoms indirectly mediated the correlation between COFP severity and COFP-OHRQoL. As a second-stage moderator, pain catastrophizing moderated the mediating effects of anxiety symptoms and depression symptoms. Our findings suggest that anxiety, depression, and pain catastrophizing should be evaluated jointly to improve COFP-OHRQoL among COFP patients. This evidence will help therapists to comprehensively treat patients for the best treatment effect.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Yun-Zhi Feng
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Yue Guo
- Department of Stomatology, The Second Xiangya Hospital, Central South University, Changsha 410011, China
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19
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Grazzi L, Montisano DA, Rizzoli P, Guastafierro E, Marcassoli A, Fornari A, Raggi A. A Single-Group Study on the Effect of OnabotulinumtoxinA in Patients with Chronic Migraine Associated with Medication Overuse Headache: Pain Catastrophizing Plays a Role. Toxins (Basel) 2023; 15:toxins15020086. [PMID: 36828401 PMCID: PMC9967692 DOI: 10.3390/toxins15020086] [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: 12/06/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 01/19/2023] Open
Abstract
Pain catastrophizing and cutaneous allodynia are commonly altered in patients with chronic migraine associated with medication overuse headache (CM-MOH) and tend to improve in parallel with clinical improvement. The relation between pain catastrophizing and cutaneous allodynia is poorly understood in patients with CM-MOH receiving OnabotulinumtoxinA therapy. In this single-arm open-label longitudinal observational study, patients with CM-MOH were assigned to structured withdrawal and then administered OnabotulinumtoxinA (5 sessions on a three-month basis, 195 UI per 31 sites). Headache frequency, medication intake, disability, impact, cutaneous allodynia and pain catastrophizing were evaluated with specific questionnaires. In total, 96 patients were enrolled and 79 completed the 12-month follow-up. With the exclusion of cutaneous allodynia and the magnification subscale of the pain catastrophizing questionnaire, all variables showed significant improvement by the sixth month, which was maintained at 12 months. Reduction of pain catastrophizing, and particularly of its helplessness subscale, was a significant predictor of reduction in headache frequency and medication intake. Pain catastrophizing is often implicated in the clinical improvement in patients with CM-MOH receiving behavioral treatments, but, in this study, also showed a role in patients receiving OnabotulinumtoxinA; combining OnabotulinumtoxinA and behavioral treatments specifically addressing pain catastrophizing might further enhance patients' clinical outcome.
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Affiliation(s)
- Licia Grazzi
- Centro Cefalee, Fondazione IRRCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
- Correspondence: (L.G.); (A.R.)
| | | | - Paul Rizzoli
- Brigham & Women’s Faulkner Hospital, John Graham Headacche Center, Harvard Medical School, Boston, MA 02115, USA
| | - Erika Guastafierro
- UOC Neurologia Salute Pubblica e Disabilità, Fondazione IRRCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
| | - Alessia Marcassoli
- UOC Neurologia Salute Pubblica e Disabilità, Fondazione IRRCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
| | - Arianna Fornari
- UOC Neurologia Salute Pubblica e Disabilità, Fondazione IRRCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
| | - Alberto Raggi
- UOC Neurologia Salute Pubblica e Disabilità, Fondazione IRRCS Istituto Neurologico Carlo Besta, 20133 Milano, Italy
- Correspondence: (L.G.); (A.R.)
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20
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Viñals Narváez AC, Sánchez-Sánchez T, García-González M, Ardizone García I, Cid-Verdejo R, Sánchez Romero EA, Jiménez-Ortega L. Psychological and Behavioral Factors Involved in Temporomandibular Myalgia and Migraine: Common but Differentiated Profiles. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1545. [PMID: 36674300 PMCID: PMC9863553 DOI: 10.3390/ijerph20021545] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Many studies have revealed high comorbidity and a clear association between temporomandibular disorders (TMD) and migraine. Furthermore, evidence points out that common psychological and behavioral factors might be related to the observed TMD and migraine association. However, this association and the underlying psychological factors are poorly understood. OBJECTIVE The main goal of this study was to describe the psychological and behavioral factors involved in TMD myalgia and migraine. METHODS A sample of 142 participants were recruited to form 4 groups: migraine patients (ICHD-III criteria), painful-TMD patients (Myalgia DC/TMD criteria), patients suffering from both pathologies according to the same criteria, and control patients. After a dental and neurological examination, the patients filled several psychological questionnaires validated for the Spanish population to assess anxiety (STAI), depression (DEP), stress coping (CRI), and somatic, anxiety, and depression symptoms (BSI-18). RESULTS The TMD myalgia patients, in general, showed a state of elevated anxiety, somatization, and reduced coping strategies, while the patients with migraine presented greater anxiety symptoms, depression (dysthymia trait and state), and somatization. CONCLUSIONS According to the data of the present study, situational anxiety (transient emotional state), together with the lack of coping strategies, could be more associated with TMD myalgia, while anxiety, as a more stable and long-lasting emotional state, together with depression, might be more related to migraine. Further longitudinal studies are needed to unravel whether these differentiated profiles are a consequence or possible risk factors for migraine and TMD.
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Affiliation(s)
- Ana Cristina Viñals Narváez
- Department of Psychobiology and Behavioral Sciences Methods, Faculty of Odontology, Complutense University of Madrid, 28040 Madrid, Spain
- Department of Conservative and Prosthetic Dentistry, Faculty of Odontology, Complutense University of Madrid, 28040 Madrid, Spain
| | - Teresa Sánchez-Sánchez
- Department of Psychobiology and Behavioral Sciences Methods, Faculty of Odontology, Complutense University of Madrid, 28040 Madrid, Spain
| | - Maria García-González
- Department of Psychobiology and Behavioral Sciences Methods, Faculty of Odontology, Complutense University of Madrid, 28040 Madrid, Spain
- Department of Clinical Dentistry, Faculty of Biomedical Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
| | - Ignacio Ardizone García
- Department of Conservative and Prosthetic Dentistry, Faculty of Odontology, Complutense University of Madrid, 28040 Madrid, Spain
| | - Rosana Cid-Verdejo
- Department of Conservative and Prosthetic Dentistry, Faculty of Odontology, Complutense University of Madrid, 28040 Madrid, Spain
- Department of Clinical Dentistry, Faculty of Biomedical Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
| | - Eleuterio A. Sánchez Romero
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain
- Physiotherapy and Orofacial Pain Working Group, Sociedad Española de Disfunción Craneomandibular y Dolor Orofacial (SEDCYDO), 28009 Madrid, Spain
| | - Laura Jiménez-Ortega
- Department of Psychobiology and Behavioral Sciences Methods, Faculty of Odontology, Complutense University of Madrid, 28040 Madrid, Spain
- Center of Human Evolution and Behavior, UCM-ISCIII, 28029 Madrid, Spain
- Psychology and Orofacial Pain Working Group, Sociedad Española de Disfunción Craneomandibular y Dolor Orofacial (SEDCYDO), 28009 Madrid, Spain
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21
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Giakas A, Mangold K, Androulakis A, Hyduke N, Galynker I, Thiam M, Cai G, Androulakis XM. Risks of suicide in migraine, non-migraine headache, back, and neck pain: a systematic review and meta-analysis. Front Neurol 2023; 14:1160204. [PMID: 37153662 PMCID: PMC10157105 DOI: 10.3389/fneur.2023.1160204] [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: 02/06/2023] [Accepted: 03/30/2023] [Indexed: 05/10/2023] Open
Abstract
Objective To conduct a systematic review and meta-analysis on suicidal ideation, attempts, and death in patients with head, neck, and back pain. Method Search was performed using PubMed, Embase, and Web of Science from the date of the first available article through September 31, 2021. A random effects model was used to estimate the pooled odds ratios (ORs) and 95% confidence intervals (95% CI) for the association between suicidal ideation and/or attempt and head, back/neck pain conditions. Articles describing non-migraine headache disorders and death by suicide were also reviewed but not included in the meta-analysis due to an insufficient number of studies. Results A total of 20 studies met criteria for systemic review. A total of 186,123 migraine patients and 135,790 of neck/back pain patients from 11 studies were included in the meta-analysis. The meta-analysis showed that the estimated risk of combined suicidal ideation and attempt in migraine [OR 2.49; 95% CI: 2.15-2.89] is greater than that in back/neck pain pain [OR 2.00; 95% CI: 1.63-2.45] compared to non-pain control groups. Risk of suicide ideation/planning is 2 folds higher [OR: 2.03; 95% CI: 1.92-2.16] and risk of suicide attempt is more than 3 folds higher [OR: 3.47; 95% CI: 2.68-4.49] in migraine as compared to healthy controls. Conclusion There is an elevated risk of suicidal ideation and attempt in both migraine and neck/back pain patients in comparison to healthy controls, and this risk is particularly higher among migraine patients. This study underscores the critical need for suicide prevention in migraine patients.
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Affiliation(s)
- Alec Giakas
- Department of Orthopedic Surgery, University of South Carolina School of Medicine, Columbia, SC, United States
| | - Kiersten Mangold
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Anthony Androulakis
- Department of Biological Sciences, University of South Carolina, Columbia, SC, United States
| | - Noah Hyduke
- Department of Psychiatry, University of South Carolina School of Medicine, Columbia, SC, United States
| | - Igor Galynker
- Department of Psychiatry, Beth Israel Medical Center, New York, NY, United States
| | - Melinda Thiam
- Department of Psychiatry, New Mexico VA Hospital System, Albuquerque, NM, United States
| | - Guoshuai Cai
- Department of Environmental Health Sciences, University of South Carolina, Columbia, SC, United States
| | - X. Michelle Androulakis
- Department of Neurology, Columbia VA Healthcare System, Columbia, SC, United States
- Department of Neurology, University of South Carolina School of Medicine, Columbia, SC, United States
- *Correspondence: X. Michelle Androulakis
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