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Zi-Yang Y, Hezhi L, Dongling L, Ximeng W, Caojin Z. Rationale and design of the SPRING trail: effectivity and safety of Pfo closuRe vs medIcine in alleviatiNg migraine, a multicenter, randomized and open-label trail. BMC Cardiovasc Disord 2024; 24:198. [PMID: 38580946 PMCID: PMC10998302 DOI: 10.1186/s12872-024-03866-3] [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: 02/29/2024] [Accepted: 03/30/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Migraine is a leading cause of disability worldwide. Several retrospective studies have suggested that the closure of the Patent Foramen Ovale (PFO) may provide relief from migraines. However, three randomized controlled trials did not meet their primary endpoints regarding migraine cessation, reduction in monthly migraine days, and responder rates. METHODS The SPRING study is a multicenter, prospective, randomized, and open-label trial designed to compare the effectiveness and safety of PFO closure versus medication in the relief of migraines. The primary endpoint is the total cessation of migraines, as recorded in patient headache diaries during the follow-up period. Additional diagnostic tools include echocardiography with agitated saline contrast, transcranial Doppler, and routine laboratory measurements. CONCLUSION The SPRING trial aims to assess the effectiveness and safety of PFO closure versus medication in mitigating migraines in real-world settings. (Clinical Trails ID: NCT04946734).
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Affiliation(s)
- Yang Zi-Yang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Zhong Shan Er Road No. 106, Yue Xiu District, Guangzhou, Guangdong, 510080, China
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, Guangdong, China
| | - Li Hezhi
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Zhong Shan Er Road No. 106, Yue Xiu District, Guangzhou, Guangdong, 510080, China
| | - Luo Dongling
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Zhong Shan Er Road No. 106, Yue Xiu District, Guangzhou, Guangdong, 510080, China
| | - Wang Ximeng
- Global Health Research Center, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Zhang Caojin
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Zhong Shan Er Road No. 106, Yue Xiu District, Guangzhou, Guangdong, 510080, China.
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, Guangdong, China.
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Gimbel SI, Hungerford LD, Twamley EW, Ettenhofer ML. White Matter Organization and Cortical Thickness Differ Among Active Duty Service Members With Chronic Mild, Moderate, and Severe Traumatic Brain Injury. J Neurotrauma 2024; 41:818-835. [PMID: 37800726 PMCID: PMC11005384 DOI: 10.1089/neu.2023.0336] [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: 10/07/2023] Open
Abstract
Abstract This study compared findings from whole-brain diffusion tensor imaging (DTI) and volumetric magnetic resonance imaging (MRI) among 90 Active Duty Service Members with chronic mild traumatic brain injury (TBI; n = 52), chronic moderate-to-severe TBI (n = 17), and TBI-negative controls (n = 21). Data were collected on a Philips Ingenia 3T MRI with DTI in 32 directions. Results demonstrated that history of TBI was associated with differences in white matter microstructure, white matter volume, and cortical thickness in both mild TBI and moderate-to-severe TBI groups relative to controls. However, the presence, pattern, and distribution of these findings varied substantially depending on the injury severity. Spatially-defined forms of DTI fractional anisotropy (FA) analyses identified altered white matter organization within the chronic moderate-to-severe TBI group, but they did not provide clear evidence of abnormalities within the chronic mild TBI group. In contrast, DTI FA "pothole" analyses identified widely distributed areas of decreased FA throughout the white matter in both the chronic mild TBI and chronic moderate-to-severe TBI groups. Additionally, decreased white matter volume was found in several brain regions for the chronic moderate-to-severe TBI group compared with the other groups. Greater number of DTI FA potholes and reduced cortical thickness were also related to greater severity of self-reported symptoms. In sum, this study expands upon a growing body of literature using advanced imaging techniques to identify potential effects of brain injury in military Service Members. These findings may differ from work in other TBI populations due to varying mechanisms and frequency of injury, as well as a potentially higher level of functioning in the current sample related to the ability to maintain continued Active Duty status after injury. In conclusion, this study provides DTI and volumetric MRI findings across the spectrum of TBI severity. These results provide support for the use of DTI and volumetric MRI to identify differences in white matter microstructure and volume related to TBI. In particular, DTI FA pothole analysis may provide greater sensitivity for detecting subtle forms of white matter injury than conventional DTI FA analyses.
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Affiliation(s)
- Sarah I. Gimbel
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Naval Medical Center San Diego, San Diego, California, USA
- General Dynamics Information Technology, Falls Church, Virginia, USA
| | - Lars D. Hungerford
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Naval Medical Center San Diego, San Diego, California, USA
- General Dynamics Information Technology, Falls Church, Virginia, USA
| | - Elizabeth W. Twamley
- University of California, San Diego, San Diego, California, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA
| | - Mark L. Ettenhofer
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland, USA
- Naval Medical Center San Diego, San Diego, California, USA
- General Dynamics Information Technology, Falls Church, Virginia, USA
- University of California, San Diego, San Diego, California, USA
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3
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de Vries Lentsch S, van der Arend BWH, de Boer I, van Zwet EW, MaassenVanDenBrink A, Terwindt GM. Depression and treatment with anti-calcitonin gene related peptide (CGRP) (ligand or receptor) antibodies for migraine. Eur J Neurol 2024; 31:e16106. [PMID: 37847221 PMCID: PMC11235758 DOI: 10.1111/ene.16106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/04/2023] [Accepted: 10/01/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND AND PURPOSE The aim was to evaluate the effect of anti-calcitonin gene related peptide (CGRP) (ligand or receptor) antibodies on depressive symptoms in subjects with migraine and to determine whether depressive symptoms predict treatment response. METHODS Patients with migraine treated with erenumab and fremanezumab at the Leiden Headache Centre completed daily E-headache diaries. A control group was included. Depressive symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS) and the Center for Epidemiological Studies Depression Scale (CES-D) questionnaires at baseline (T0) and after 3 months (T1). First, the effect of treatment on the reduction in HADS-D and CES-D scores was assessed, with reduction in depression scores as the dependent variable and reduction in monthly migraine days (MMD) and treatment with anti-CGRP medication as independent variables. Second, depression as a predictor of treatment response was investigated, using the absolute reduction in MMD as a dependent variable and age, gender, MMD, active depression, impact, stress and locus of control scores as independent variables. RESULTS In total, n = 108 patients were treated with erenumab, n = 90 with fremanezumab and n = 68 were without active treatment. Treatment with anti-CGRP medication was positively associated with a reduction in the HADS-D (β = 1.65, p = 0.01) compared to control, independent of MMD reduction. However, the same effect was not found for the CES-D (β = 2.15, p = 0.21). Active depression predicted poorer response to erenumab (p = 0.02) but not to fremanezumab (p = 0.09). CONCLUSION Anti-CGRP (ligand or receptor) monoclonals lead to improvement of depressive symptoms in individuals with migraine, independent of migraine reduction. Depression may predict treatment response to erenumab but not to fremanezumab.
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Affiliation(s)
| | - Britt W. H. van der Arend
- Department of NeurologyLeiden University Medical CentreLeidenThe Netherlands
- Division of Vascular Medicine and Pharmacology, Department of Internal MedicineErasmus University Medical CentreRotterdamThe Netherlands
| | - Irene de Boer
- Department of NeurologyLeiden University Medical CentreLeidenThe Netherlands
| | - Erik W. van Zwet
- Department of Medical StatisticsLeiden University Medical CentreLeidenThe Netherlands
| | - Antoinette MaassenVanDenBrink
- Division of Vascular Medicine and Pharmacology, Department of Internal MedicineErasmus University Medical CentreRotterdamThe Netherlands
| | - Gisela M. Terwindt
- Department of NeurologyLeiden University Medical CentreLeidenThe Netherlands
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McCulloch KL, Oh AS, Cecchini AS, Zhang W, Harrison C, Favorov O. Validity and Responsiveness of the Portable Warrior Test of Tactical Agility After Rehabilitation in Service Members With Mild Traumatic Brain Injury. Phys Ther 2023; 103:pzad100. [PMID: 37847662 PMCID: PMC10641927 DOI: 10.1093/ptj/pzad100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 01/23/2023] [Accepted: 03/26/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVE The Portable Warrior Test of Tactical Agility (POWAR-TOTAL) is a performance-based test designed to assess active-duty service members diagnosed with mild traumatic brain injuries (mTBIs) and could potentially inform return to duty decisions. To examine the validity and responsiveness of the POWAR-TOTAL measure, this study collected self-reported and performance measures by active-duty service members before and after an episode of physical therapist care. METHODS Seventy-four individuals, enrolled in care for mTBI symptoms at 1 of 2 concussion specialty Intrepid Spirit Centers, were examined the week that they initiated physical therapy with the intention to return to active duty. Self-reported measures of concussion symptoms, pain, posttraumatic stress, headache, dizziness, and sleep quality were used, as were concurrent measures of mobility and balance. The POWAR-TOTAL task (motor and cognitive skills in single and dual-task conditions) was administered. Forty-nine active-duty service members returned for posttherapy testing using the same test battery. Effect sizes for change in measures were calculated. Construct validity was assessed by correlating change scores on POWAR with concurrent self-report and mobility measures. Responsiveness was evaluated using an anchor-based approach. RESULTS Significant improvements in self-reported and performance-based measures, including POWAR, were observed after therapy with moderate to large effect sizes. Improvement in POWAR performance correlated with improvement in both performance and self-reported measures. After therapy, individuals who registered improvement on the Patient Global Impression of Change scale demonstrated significantly faster POWAR motor performance than those who rated little or no improvement in their condition. CONCLUSION The POWAR-TOTAL captured improvement on a military-specific task after completing physical therapy for mTBI and could serve as an indicator of physical recovery and readiness for return to duty. IMPACT Challenging cognitive and motor measures for service members may aid in the assessment of recovery and the ability to successfully return to duty after concussion as part of a comprehensive examination approach.
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Affiliation(s)
- Karen L McCulloch
- Curriculum in Human Movement Science and Division of Physical Therapy, Department of Allied Health Sciences, School of Medicine, UNC–Chapel Hill, Chapel Hill, North Carolina, USA
| | - Annabell S Oh
- The Geneva Foundation, Joint Base Lewis-McChord, Madigan Army Medical Center, Intrepid Spirit Center, Tacoma, Washington, USA
| | - Amy S Cecchini
- The Geneva Foundation, Fort Liberty (Fort Bragg), Womack Army Medical Center, Intrepid Spirit Center, Fayetteville, North Carolina, USA
| | - Wanqing Zhang
- Office of Research and Scholarship, Department of Allied Health Sciences, School of Medicine, UNC–Chapel Hill, Chapel Hill, North Carolina, USA
| | - Courtney Harrison
- Curriculum in Human Movement Science and Division of Physical Therapy, Department of Allied Health Sciences, School of Medicine, UNC–Chapel Hill, Chapel Hill, North Carolina, USA
| | - Oleg Favorov
- Department of Biomedical Engineering, School of Medicine, UNC–Chapel Hill, Chapel Hill, North Carolina, USA
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Agtarap S, Hungerford LD, Ettenhofer ML. Identifying Unique Symptom Groups Following Mild Traumatic Brain Injury Using the Neurobehavioral Symptom Inventory and PTSD Checklist-5 in Military Personnel: A Bifactor Analysis. J Head Trauma Rehabil 2023; 38:E371-E383. [PMID: 36951920 DOI: 10.1097/htr.0000000000000854] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
OBJECTIVE To identify both shared and unique groups of posttraumatic stress and postconcussive symptoms using bifactor analysis. SETTING Two large military outpatient traumatic brain injury (TBI) rehabilitation clinics in the Southwestern United States. PARTICIPANTS A sample of 1476 Active Duty Service Members seeking treatment for a mild TBI sustained more than 30 days previously, without history of moderate or severe TBI, who completed measures of postconcussive and posttraumatic stress symptoms assessed at clinic intake. DESIGN Observational, correlational study with data taken from an institutional review board-approved clinical registry study. MAIN MEASURES Neurobehavioral Symptom Inventory (NSI) and Posttraumatic Stress Disorder (PTSD) Checklist for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) ( DSM-V ) (PCL-5). Concurrent measures were Patient Health Questionnaire (PHQ-8), Pittsburgh Sleep Quality Index (PSQI), and Headache Impact Test (HIT-6). RESULTS Results identified a bifactor model demonstrating unique posttraumatic stress, depressive, cognitive, and neurological/somatic symptom groups that were still evident after accounting for a universal factor representing general distress. These symptom groups were differentially related to concurrently measured clinical outcomes. CONCLUSION Use of a bifactor structure may help derive clinically useful signals from self-reported symptoms among Active Duty Service Members seeking outpatient treatment for mild TBI.
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Affiliation(s)
- Stephanie Agtarap
- Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland (Drs Agtarap, Hungerford, and Ettenhofer); Naval Medical Center San Diego, San Diego, California (Drs Agtarap, Hungerford, and Ettenhofer); General Dynamics Information Technology, Falls Church, Virginia (Drs Agtarap, Hungerford, and Ettenhofer); Craig Hospital, Englewood, Colorado (Dr Agtarap); and University of California, San Diego, La Jolla, California (Dr Ettenhofer)
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6
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Caprio M, Moriconi E, Camajani E, Feraco A, Marzolla V, Vitiello L, Proietti S, Armani A, Gorini S, Mammi C, Egeo G, Aurilia C, Fiorentini G, Tomino C, Barbanti P. Very-low-calorie ketogenic diet vs hypocaloric balanced diet in the prevention of high-frequency episodic migraine: the EMIKETO randomized, controlled trial. J Transl Med 2023; 21:692. [PMID: 37794395 PMCID: PMC10548576 DOI: 10.1186/s12967-023-04561-1] [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: 07/20/2023] [Accepted: 09/22/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Migraine is the second world's cause of disability. Among non-pharmacological treatments, nutritional intervention, particularly ketogenic diet, represents one of the most promising approaches. METHODS This a prospective, single center, randomized, controlled study aimed at evaluating the efficacy of a very low-calorie ketogenic diet (VLCKD) compared to a hypocaloric balanced diet (HBD) in migraine prophylaxis in patients affected by high-frequency episodic migraine (HFEM) with a Body Mass Index (BMI) > 27 kg/m2. Fifty-seven patients were randomly assigned to a VLCKD (group 1) or HBD (group 2). Group 1 patients followed a VLCKD for 8 weeks, followed by a low calorie diet (LCD, weeks 9-12), and a HBD (weeks 13-24), whereas group 2 patients followed a HBD from week 0 to 24. Anthropometric indexes, urine and blood chemistry were assessed at enrollment, baseline, weeks 4, 8, 12, and 24. Migraine characteristics were evaluated at baseline, weeks 8, 12 and 24. Change in monthly migraine days (MMDs) at weeks 5-8 compared to baseline was the primary endpoint. Secondary endpoints encompassed changes in visual analogue scale (VAS), Headache Impact Test-6 (HIT-6) and Short Form Health Survey-36 (SF-36) scores. We also studied effects on circulating lymphocytes and markers of inflammation, changes in plasma aldosterone and renin levels before and after VLCKD or HBD treatment. RESULTS Reduction from baseline in MMDs was greater in VLCKD compared to HBD group at week 8 (p = 0.008), at week 12 (p = 0.007), when ketosis had been interrupted by carbohydrates reintroduction, and at week 24 (p = 0.042), when all patients were following the same dietary regimen. Quality of life scores (SF-36) were improved in VLCKD group at week 8 and 12, and were also improved in HBD group, but only at week 12. Weight-loss was significantly higher in VLCKD group at week 8 (p = 0.002) and week 12 (p = 0.020). At the end of the study weight loss was maintained in VLCKD group whereas a slight weight regain was observed in HBD group. Inflammatory indexes, namely C reactive protein (CRP), neutrophil to lymphocyte ratio (NLR) and total white blood cell count (WBC) were significantly reduced (p < 0.05) in VLCKD group at week 12. Aldosterone plasma level were significantly increased in both groups at week 8, particularly in VLCKD group. However, electrolytes and renin plasma levels were never altered throughout the study in both groups. CONCLUSIONS VLCKD is more effective than HBD in reducing MMD in patients with HFEM and represents an effective prophylaxis in patients with overweight/obesity. Trial registration ClinicalTrials.gov identifier: NCT04360148.
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Affiliation(s)
- Massimiliano Caprio
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele, Rome, Italy.
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy.
| | - Eleonora Moriconi
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele, Rome, Italy
| | - Elisabetta Camajani
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
| | - Alessandra Feraco
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele, Rome, Italy
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
| | - Vincenzo Marzolla
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele, Rome, Italy
| | - Laura Vitiello
- Laboratory of Flow Cytometry, IRCCS San Raffaele, Rome, Italy
| | - Stefania Proietti
- Clinical and Molecular Epidemiology, IRCCS San Raffaele, Rome, Italy
| | - Andrea Armani
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele, Rome, Italy
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
| | - Stefania Gorini
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele, Rome, Italy
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
| | - Caterina Mammi
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele, Rome, Italy
| | | | | | - Giulia Fiorentini
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
- Headache and Pain Unit, IRCCS San Raffaele, Rome, Italy
| | - Carlo Tomino
- Scientific Direction, IRCSS San Raffaele, Rome, Italy
| | - Piero Barbanti
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
- Headache and Pain Unit, IRCCS San Raffaele, Rome, Italy
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Goldstein ED, Gopal N, Badi MK, Hodge DO, de Havenon A, Glover P, Durham PL, Huang JF, Lin MP, Baradaran H, Majersik JJ, Meschia JF. CGRP, Migraine, and Brain MRI in CADASIL: A Pilot Study. Neurologist 2023; 28:231-236. [PMID: 36729391 PMCID: PMC10277309 DOI: 10.1097/nrl.0000000000000478] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Migraine is associated with neuroimaging differences in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). However, it is unknown if migraine-related disability (MRD) or if calcitonin gene-related peptide (CGRP), a vasoactive peptide important in migraine pathology, have radiographic implications. The aims of this study were to identify whether MRD or interictal serum CGRP levels impacted neuroimaging findings for those with CADASIL. MATERIALS AND METHODS A cross-sectional analysis was performed. The primary outcomes were neuroimaging differences associated with MRD among those with migraine or interictal serum CGRP levels of those with and without migraine. MRD was defined by 2 migraine disability scales (Migraine Disability Assessment, Headache Impact Test-6). Retrospective brain magnetic resonance imaging was reviewed (average 1.7 ± 2.0 y before enrollment). Rank-sum and χ 2 tests were used. RESULTS Those with migraine (n=25, vs. n=14 without) were younger [median 49 (25 to 82) y vs. 60 (31 to 82) y, P <0.007], had fewer cerebral microbleeds (0 to 31 vs. 0 to 50, P =0.02) and less frequently had anterior temporal lobe T2 hyperintensities [68% (17/25) vs 100% (14/14), P =0.02]. MRD scale outcomes had no significant radiographic associations. Interictal serum CGRP did not differ (migraine: n=18, 27.0±9.6 pg/mL vs. no migraine: n=10, 26.8±15.7 pg/mL, P =0.965). CONCLUSIONS Migraine may forestall microangiopathy in CADASIL, though possibly independent of severity as measured by MRD. Interictal serum CGRP did not differ in our cohort suggesting CGRP may not be vital to migraine pathophysiology in CADASIL. Larger studies are needed to account for age differences.
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Affiliation(s)
- Eric D. Goldstein
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Neethu Gopal
- Department of Neurology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Mohammed K. Badi
- Department of Neurology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - David O. Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Adam de Havenon
- Department of Neurology, Yale University, New Haven, CT, USA
| | - Patrick Glover
- Department of Neurology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Paul L. Durham
- Department of Biology, Missouri State University, Springfield, MO, USA
| | | | - Michelle P Lin
- Department of Neurology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Hediyeh Baradaran
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | | | - James F. Meschia
- Department of Neurology, Mayo Clinic Florida, Jacksonville, FL, USA
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Mihaiu J, Bodog F, Mohan A, Vieriu G. Successful management of chronic migraine through manual therapy. A case report. J Med Life 2023; 16:953-956. [PMID: 37675175 PMCID: PMC10478666 DOI: 10.25122/jml-2023-0222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/18/2023] [Indexed: 09/08/2023] Open
Abstract
Migraine is the second most debilitating condition affecting a significant portion of the general population, particularly young adults under 50. Despite extensive research, the etiology of migraine remains diverse and often multifactorial, with limited clarity on the specific underlying pathogenic processes. Consequently, the treatment of migraine lacks a mechanism-based approach. We present the case of a young female patient suffering for 8 years of chronic migraine and tension-type headaches. The manual therapy techniques successfully released the muscular tensions, considerably improving her quality of life in terms of pain and emotional well-being.
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Affiliation(s)
- Judit Mihaiu
- Doctoral School of Biomedical Sciences, University of Oradea, Oradea, Romania
| | - Florian Bodog
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | - Aurel Mohan
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | - Georgiana Vieriu
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
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9
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Duan S, Ren Z, Xia H, Wang Z, Zheng T, Li G, Liu L, Liu Z. Associations between anxiety, depression with migraine, and migraine-related burdens. Front Neurol 2023; 14:1090878. [PMID: 37181566 PMCID: PMC10166814 DOI: 10.3389/fneur.2023.1090878] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 03/28/2023] [Indexed: 05/16/2023] Open
Abstract
Background Anxiety and depression are the most common psychiatric comorbidities in migraine, but their impact on the risk of developing migraine and their gender and age differences are unclear, and research on their associations with migraine-related burdens are limited. Objective To systematically explore the association between anxiety and depression with migraine and migraine-related burdens, including the risk of developing migraine, as well as migraine frequency, severity, disability, headache impact, quality of life and sleep quality. Methods A total of 170 migraineurs and 85 sex-and age-matched healthy control subjects were recruited consecutively for this study. Anxiety and depression were assessed using Zung's Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS), respectively. Logistic regression and linear regression analyses were used to explore the associations between anxiety and depression with migraine and its burdens. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of SAS score and SDS score on migraine and its severe burdens. Results After adjusting for confounders, anxiety and depression remained significantly associated with an increased risk of developing migraine, with odds ratios of 5.186 (95% CI:1.755-15.322) and 3.147 (95% CI:1.387-7.141), respectively. Meanwhile, there were significant additive interactions between the association of anxiety and depression with the risk of developing migraine in gender and age (P for interaction <0.05), and the stronger correlations were found in participants with an age ≤ 36 years old and females. In addition, anxiety and depression were significantly independently associated with the migraine frequency, severity, disability, headache impact, quality of life, and sleep quality in migraine patients (P trend <0.05). The area under the ROC curve (AUC) of SAS score in predicting developing migraine was significantly higher than that of SDS score [0.749 (95% CI: 0.691-0.801) vs. 0.633 (95% CI: 0.571-0.692), p < 0.0001]. Conclusion Anxiety and depression were significantly independently associated with the increased risk of migraine and migraine-related burdens. Enhanced assessment of SAS score and SDS score is of great clinical value for the early prevention and treatment of migraine and its burdens.
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Affiliation(s)
- Shaojie Duan
- Department of Geriatrics, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
| | - Zhiying Ren
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Hui Xia
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Ziyao Wang
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Tao Zheng
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Guanglu Li
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Lei Liu
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Zunjing Liu
- Department of Neurology, Peking University People’s Hospital, Beijing, China
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10
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Gimbel SI, Wang CC, Hungerford L, Twamley EW, Ettenhofer ML. Associations of mTBI and post-traumatic stress to amygdala structure and functional connectivity in military Service Members. FRONTIERS IN NEUROIMAGING 2023; 2:1129446. [PMID: 37554633 PMCID: PMC10406312 DOI: 10.3389/fnimg.2023.1129446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/07/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Traumatic brain injury (TBI) is one of the highest public health priorities, especially among military personnel where comorbidity with post-traumatic stress symptoms and resulting consequences is high. Brain injury and post-traumatic stress symptoms are both characterized by dysfunctional brain networks, with the amygdala specifically implicated as a region with both structural and functional abnormalities. METHODS This study examined the structural volumetrics and resting state functional connectivity of 68 Active Duty Service Members with or without chronic mild TBI (mTBI) and comorbid symptoms of Post-Traumatic Stress (PTS). RESULTS AND DISCUSSION Structural analysis of the amygdala revealed no significant differences in volume between mTBI and healthy comparison participants with and without post-traumatic stress symptoms. Resting state functional connectivity with bilateral amygdala revealed decreased anterior network connectivity and increased posterior network connectivity in the mTBI group compared to the healthy comparison group. Within the mTBI group, there were significant regions of correlation with amygdala that were modulated by PTS severity, including networks implicated in emotional processing and executive functioning. An examination of a priori regions of amygdala connectivity in the default mode network, task positive network, and subcortical structures showed interacting influences of TBI and PTS, only between right amygdala and right putamen. These results suggest that mTBI and PTS are associated with hypo-frontal and hyper-posterior amygdala connectivity. Additionally, comorbidity of these conditions appears to compound these neural activity patterns. PTS in mTBI may change neural resource recruitment for information processing between the amygdala and other brain regions and networks, not only during emotional processing, but also at rest.
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Affiliation(s)
- Sarah I. Gimbel
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, United States
- Traumatic Brain Injury Clinic, Naval Medical Center San Diego, San Diego, CA, United States
- General Dynamics Information Technology, Falls Church, VA, United States
| | - Cailynn C. Wang
- Department of Psychology, University of California, San Diego, San Diego, CA, United States
| | - Lars Hungerford
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, United States
- Traumatic Brain Injury Clinic, Naval Medical Center San Diego, San Diego, CA, United States
- General Dynamics Information Technology, Falls Church, VA, United States
| | - Elizabeth W. Twamley
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Mark L. Ettenhofer
- Traumatic Brain Injury Center of Excellence, Silver Spring, MD, United States
- Traumatic Brain Injury Clinic, Naval Medical Center San Diego, San Diego, CA, United States
- General Dynamics Information Technology, Falls Church, VA, United States
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
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11
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Hoydonckx Y, Singh M, Gilron I, Khan J, Narouze S, Dahan A, Curtis K, Cao X, Kara J, Bhatia A. Trial protocol for a multicenter randomized controlled trial to assess the efficacy and safety of intravenous ketamine for chronic daily headaches: the "KetHead" trial. Trials 2023; 24:155. [PMID: 36855160 PMCID: PMC9976458 DOI: 10.1186/s13063-023-07186-3] [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: 11/08/2022] [Accepted: 02/18/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Chronic daily headaches (CDH) are common and associated with significant morbidity, poor quality of life, and substantial burden on the healthcare system. CDH tends to be refractory to conventional medical management and/or patients cannot afford expensive treatments. It is stipulated that CDH share a mechanism of central sensitization in the trigeminocervical complex, mediated by activation of the N-methyl-D-aspartate (NMDA) receptors. Ketamine, a non-competitive NMDA antagonist, has been used in the treatment of chronic pain, but its role in CDH has not been completely established. This trial aims to evaluate the effect of high-dose IV ketamine infusions (compared to placebo) on the number of headache days at 28 days post-infusion. METHODS A multicenter, placebo-controlled, randomized controlled trial will be conducted with two parallel groups and blinding of participants and outcome assessors. The study will include 56 adults with a CDH diagnosis as per ICHD-3 criteria. Participants will be randomized (1:1) to either ketamine (1 mg. kg-1 bolus followed by infusion of 1 mg. kg-1. h-1 for 6 h) or placebo (0.9% saline in the same volume and infusion rate as the trial medication) bolus and infusion for 6 h. The impact on the number of monthly headache days, headache intensity, physical activity, mood, sleep, quality of life, analgesic consumption, and adverse effects will be recorded at baseline, immediately post-infusion, and from 1 to 28 days, 29 to 56 days, and 57 to 84 days after the infusion DISCUSSION: Despite advancements in treatment, many patients continue to suffer from CDH. This trial investigates whether high-dose IV ketamine infusions can effectively and safely improve the CDH burden as compared to a placebo infusion. This treatment could become a safe, affordable, and widely available option for patients living with refractory headache. TRIAL REGISTRATION ClinicalTrials.gov NCT05306899. Registered on April 1, 2022.
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Affiliation(s)
- Yasmine Hoydonckx
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto Western Hospital, McL 2-405, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada.
| | - Mandeep Singh
- grid.17063.330000 0001 2157 2938Department of Anesthesia and Pain Medicine, University of Toronto, Toronto Western Hospital, McL 2-405, 399 Bathurst Street, Toronto, Ontario M5T 2S8 Canada
| | - Ian Gilron
- grid.410356.50000 0004 1936 8331Departments of Anesthesiology & Perioperative Medicine and Biomedical & Molecular Sciences, Centre for Neuroscience Studies, School of Policy Studies, Queens University, Kingston, Canada
| | - James Khan
- grid.17063.330000 0001 2157 2938Department of Anesthesia and Pain Medicine, University of Toronto, Sinai Health System, Toronto, Ontario Canada
| | - Samer Narouze
- grid.473820.a0000 0004 4686 1367Department of Anesthesia and Pain Medicine, Western Reserve Hospital, Cuyahoga Falls, OH USA
| | - Albert Dahan
- grid.10419.3d0000000089452978Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Kathryn Curtis
- grid.17063.330000 0001 2157 2938Department of Anesthesia and Pain Medicine, University of Toronto, Toronto Western Hospital, McL 2-405, 399 Bathurst Street, Toronto, Ontario M5T 2S8 Canada ,grid.231844.80000 0004 0474 0428Comprehensive Integrated Pain Program, University Health Network, Toronto, Canada
| | - Xingshan Cao
- grid.17063.330000 0001 2157 2938Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Jamal Kara
- grid.17063.330000 0001 2157 2938Department of Anesthesia and Pain Medicine, University of Toronto, Toronto Western Hospital, McL 2-405, 399 Bathurst Street, Toronto, Ontario M5T 2S8 Canada
| | - Anuj Bhatia
- grid.17063.330000 0001 2157 2938Department of Anesthesia and Pain Medicine, University of Toronto, Toronto Western Hospital, McL 2-405, 399 Bathurst Street, Toronto, Ontario M5T 2S8 Canada
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12
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Nabity PS, Reed DE, McGeary CA, Houle TT, Jaramillo CA, Resick PA, Eapen BC, Litz BT, Mintz J, Penzien DB, Keane TM, Young-McCaughan S, Peterson AL, McGeary DD. Mechanisms of change in posttraumatic headache-related disability: A mediation model. Headache 2023; 63:410-417. [PMID: 36905163 DOI: 10.1111/head.14480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 03/12/2023]
Abstract
OBJECTIVE To explore whether the association between change in headache management self-efficacy and posttraumatic headache-related disability is partially mediated by a change in anxiety symptom severity. BACKGROUND Many cognitive-behavioral therapy treatments for headache emphasize stress management, which includes anxiety management strategies; however, little is currently known about mechanisms of change in posttraumatic headache-related disability. Increasing our understanding of mechanisms could lead to improvements in treatments for these debilitating headaches. METHODS This study is a secondary analysis of veterans (N = 193) recruited to participate in a randomized clinical trial of cognitive-behavioral therapy, cognitive processing therapy, or treatment as usual for persistent posttraumatic headache. The direct relationship between headache management self-efficacy and headache-related disability, along with partial mediation through change in anxiety symptoms was tested. RESULTS The mediated latent change direct, mediated, and total pathways were statistically significant. The path analysis supported a significant direct pathway between headache management self-efficacy and headache-related disability (b = -0.45, p < 0.001; 95% confidence interval [CI: -0.58, -0.33]). The total effect of change of headache management self-efficacy scores on change in Headache Impact Test-6 scores was significant with a moderate-to-strong effect (b = -0.57, p = 0.001; 95% CI [-0.73, -0.41]). There was also an indirect effect through anxiety symptom severity change (b = -0.12, p = 0.003; 95% CI [-0.20, -0.04]). CONCLUSIONS In this study, most of the improvements in headache-related disability were related to increased headache management self-efficacy with mediation occurring through change in anxiety. This indicates that headache management self-efficacy is a likely mechanism of change of posttraumatic headache-related disability with decreases in anxiety explaining part of the improvement in headache-related disability.
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Affiliation(s)
- Paul S Nabity
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science at San Antonio, San Antonio, Texas, USA
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - David E Reed
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Cindy A McGeary
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science at San Antonio, San Antonio, Texas, USA
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Timothy T Houle
- Department of Anesthesia, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Carlos A Jaramillo
- Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio, Texas, USA
- Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Patricia A Resick
- Department of Psychiatry and Behavioral Sciences, Duke Health, Durham, North Carolina, USA
| | - Blessen C Eapen
- Department of Physical Medicine and Rehabilitation, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Division of Physical Medicine and Rehabilitation, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Brett T Litz
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science at San Antonio, San Antonio, Texas, USA
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Donald B Penzien
- Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Terence M Keane
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science at San Antonio, San Antonio, Texas, USA
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Alan L Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science at San Antonio, San Antonio, Texas, USA
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Donald D McGeary
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science at San Antonio, San Antonio, Texas, USA
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
- Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio, Texas, USA
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas, USA
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13
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Buchanan EM, Manley HR, Sly JS, Cady RJ, Wikowsky A, Cunningham AL. Development of the functional assessment of migraine scale using a patient guided approach. Qual Life Res 2023; 32:867-879. [PMID: 36282448 DOI: 10.1007/s11136-022-03279-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2022] [Indexed: 10/31/2022]
Abstract
PURPOSE A better understanding of the multi-dimensional burden and impact of migraine has grown over recent years, yet the tools used to measure these concepts have not been updated to reflect such findings. Additionally, due to the increase in the number of both prophylactic and acute therapeutic options for migraine, a comprehensive assessment of treatment response is necessary. The goal of this project was to develop a patient guided outcome measure which evaluates patient identified efficacy factors when appraising migraine treatment response. METHODS A group of patients with migraine (N = 10) were given an in-person semi-structured interview collecting information regarding a patient's perspective on meaningful response to headache and migraine treatment. Using the patient information collected during these interviews, a set of questions aimed at evaluating meaningful response were developed. Two additional groups (N = 100, 200) of patients with migraine then provided feedback on the drafted questions in an online setting. RESULTS Interviews indicated thematic areas of interest to patients with migraine are not commonly assessed on popular measures. Over two hundred items were developed to assess thematic areas indicated by patients. Factor analysis used on the focus groups' results led to the development of an 18-item scale (Functional Assessment of Migraine Scale-Research: FAMS-R) that assesses the impact of migraine on a patient and shows the potential to measure treatment response. CONCLUSION The FAMS portrays promising results at measuring a multi-faceted migraine treatment response and disease impact.
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Affiliation(s)
- Erin M Buchanan
- Harrisburg University of Science and Technology, 326 Market St., Harrisburg, PA, 17101, USA.
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14
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Ziegeler B, D' Souza W, Vinton A, Mulukutla S, Shaw C, Carne R. Neurological Health: Not Merely the Absence of Disease: Current Wellbeing Instruments Across the Spectrum of Neurology. Am J Lifestyle Med 2023; 17:299-316. [PMID: 36896041 PMCID: PMC9989493 DOI: 10.1177/15598276221086584] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Well-being and quality of life can vary independently of disease. Instruments measuring well-being and quality of life are commonly used in neurology, but there has been little investigation into the extent in which they accurately measure wellbeing/quality of life or if they merely reflect a diseased state of an individual. DESIGN Systematic searches, thematic analysis and narrative synthesis were undertaken. Individual items from instruments represented in ≥ 5 publications were categorised independently, without prior training, by five neurologists and one well-being researcher, as relating to 'disease-effect' or 'Well-being' with a study-created instrument. Items were additionally categorised into well-being domains. DATA SOURCES MEDLINE, EMBASE, EMCARE and PsycINFO from 1990 to 2020 were performed, across the 13 most prevalent neurological diseases. RESULTS 301 unique instruments were identified. Multiple sclerosis had most unique instruments at 92. SF-36 was used most, in 66 studies. 22 instruments appeared in ≥ 5 publications: 19/22 'well-being' outcome instruments predominantly measured disease effect (Fleiss kappa = .60). Only 1/22 instruments was categorised unanimously as relating to well-being. Instruments predominantly measured mental, physical and activity domains, over social or spiritual. CONCLUSIONS Most neurological well-being or quality-of-life instruments predominantly measure disease effect, rather than disease-independent well-being. Instruments differed widely in well-being domains examined.
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Affiliation(s)
| | | | | | | | - Cameron Shaw
- University Hospital Geelong, Deakin University, Geelong, VIC, Australia
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15
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Lipton RB, Pozo-Rosich P, Blumenfeld AM, Li Y, Severt L, Stokes JT, Creutz L, Gandhi P, Dodick D. Effect of Atogepant for Preventive Migraine Treatment on Patient-Reported Outcomes in the Randomized, Double-blind, Phase 3 ADVANCE Trial. Neurology 2023; 100:e764-e777. [PMID: 36396451 PMCID: PMC9984220 DOI: 10.1212/wnl.0000000000201568] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/28/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The oral calcitonin gene-related peptide receptor antagonist atogepant is indicated for the preventive treatment of episodic migraine. We evaluated changes in patient-reported outcomes with atogepant in adults with migraine. METHODS In this phase 3, 12-week, multicenter, randomized, double-blind, placebo-controlled, parallel-group trial (ADVANCE), adults with 4-14 migraine days per month received atogepant (10, 30, or 60 mg) once daily or placebo. Secondary endpoints included changes from baseline in Migraine-Specific Quality-of-Life Questionnaire (MSQ) version 2.1 Role Function-Restrictive (RFR) domain at week 12 and mean monthly Activity Impairment in Migraine-Diary (AIM-D) Performance of Daily Activities (PDA) and Physical Impairment (PI) domains across the 12-week treatment period. Exploratory endpoints included change in MSQ Role Function-Preventive (RFP) and Emotional Function (EF) domains; AIM-D total scores; and change in Headache Impact Test (HIT)-6 scores. RESULTS Of 910 participants randomized, 873 comprised the modified intent-to-treat population (atogepant: 10 mg [n = 214]; 30 mg [n = 223]; and 60 mg [n = 222]; placebo [n = 214]). All atogepant groups demonstrated significantly greater improvements vs placebo in MSQ RFR that exceeded minimum clinically meaningful between-group difference (3.2 points) at week 12 (least-square mean difference [LSMD] vs placebo: 10 mg [9.9]; 30 mg [10.1]; 60 mg [10.8]; all p < 0.0001). LSMDs in monthly AIM-D PDA and PI scores across the 12-week treatment period improved significantly for the atogepant 30 (PDA: -2.54; p = 0.0003; PI: -1.99; and p = 0.0011) and 60 mg groups (PDA: -3.32; p < 0.0001; PI: -2.46; p < 0.0001), but not for the 10 mg group (PDA: -1.19; p = 0.086; PI: -1.08; p = 0.074). In exploratory analyses, atogepant 30 and 60 mg were associated with nominal improvements in MSQ RFP and EF domains, other AIM-D outcomes, and HIT-6 scores at the earliest time point (week 4) and throughout the 12-week treatment period. Results varied for atogepant 10 mg. DISCUSSION Atogepant 30 and 60 mg produced significant improvements in key patient-reported outcomes including MSQ-RFR scores and both AIM-D domains. Nominal improvements also occurred for other MSQ domains and HIT-6, reinforcing the beneficial effects of atogepant as a new treatment for migraine prevention. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov NCT03777059. Submitted: December 13, 2018; First patient enrolled: December 14, 2018. CLINICALTRIALS gov/ct2/show/NCT03777059. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that daily atogepant is associated with improvements in health-related quality-of-life measures in patients with 4-14 migraine days per month.
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Affiliation(s)
| | | | | | - Ye Li
- From the Albert Einstein College of Medicine and the Montefiore Headache Center (R.B.L.), Bronx, NY; Headache Unit, Neurology Department (P.P.-R.), Vall d'Hebron University Hospital, Barcelona; Headache Research Group, VHIR (P.P.-R.), Universitat Autonoma of Barcelona, Barcelona, Spain; Headache Center of Southern California (A.M.B.), Carlsbad, CA; AbbVie (Y.L., L.S., J.T.S., P.G.), Madison, NJ; Peloton Advantage LLC, an OPEN Health Company (L.C.), Parsippany, NJ; and Department of Neurology (D.W.D.), Mayo Clinic, Scottsdale, AZ.
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di Cola FS, Bolchini M, Caratozzolo S, Ceccardi G, Cortinovis M, Liberini P, Rao R, Padovani A. Migraine Disability Improvement during Treatment with Galcanezumab in Patients with Chronic and High Frequency Episodic Migraine. Neurol Int 2023; 15:273-284. [PMID: 36810472 PMCID: PMC9944445 DOI: 10.3390/neurolint15010017] [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: 01/11/2023] [Revised: 02/02/2023] [Accepted: 02/08/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND The aim of the present study was to assess the migraine outcome, in particular migraine disability, in chronic (CM) and high frequency episodic migraine (HFEM) patients in treatment with galcanezumab. METHODS The present study was conducted at the Headache Centre of Spedali Civili of Brescia. Patients were treated with galcanezumab 120 mg monthly. Clinical and demographical information were collected at the baseline (T0). Data about outcome, analgesics consumption and disability (MIDAS and HIT-6 scores) were collected quarterly. RESULTS Fifty-four consecutive patients were enrolled. Thirty-seven patients had a diagnosis of CM, 17 of HFEM. During treatment, patients reported a significant reduction in terms of mean headache/migraine days (p < 0.001), the attacks' pain intensity (p = 0.001) and monthly consumed analgesics (p < 0.001). The MIDAS and HIT-6 scores also documented a significant improvement (p < 0.001). At the baseline, all patients documented a severe degree of disability (MIDAS score ≥ 21). Following six months of treatment, only 29.2% of patients still documented a MIDAS score ≥ 21, with one third of patients documenting little or no disability. A > 50% MIDAS reduction, compared to baseline, was observed in up to 94.6% of patients, following the first three months of treatment. A similar outcome was found for HIT-6 scores. A significant positive correlation was found between headache days and MIDAS at T3 and T6 (T6 > T3), but not baseline. DISCUSSION Monthly prophylactic treatment with galcanezumab was found to be effective in both CM and HFEM, especially in reducing migraine burden and disability.
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Affiliation(s)
- Francesca Schiano di Cola
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, 25122 Brescia, Italy
- Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, 25122 Brescia, Italy
- Correspondence: ; Tel.: +39-0303995632
| | - Marco Bolchini
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, 25122 Brescia, Italy
- Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, 25122 Brescia, Italy
| | - Salvatore Caratozzolo
- Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, 25122 Brescia, Italy
| | - Giulia Ceccardi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, 25122 Brescia, Italy
- Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, 25122 Brescia, Italy
| | - Matteo Cortinovis
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, 25122 Brescia, Italy
| | - Paolo Liberini
- Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, 25122 Brescia, Italy
| | - Renata Rao
- Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, 25122 Brescia, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, 25122 Brescia, Italy
- Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, 25122 Brescia, Italy
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17
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Chowdhury D, Tomar A, Deorari V, Duggal A, Krishnan A, Koul A. Greater occipital nerve blockade for the preventive treatment of chronic migraine: A randomized double-blind placebo-controlled study. Cephalalgia 2023; 43:3331024221143541. [PMID: 36739512 DOI: 10.1177/03331024221143541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Greater occipital nerve blockade for the prevention of chronic migraine has a limited evidence base. A robust randomized double-blind, placebo-controlled trial is needed. METHODS This double-blind, placebo-controlled, parallel-group trial, following a baseline period of four weeks, randomly assigned patients of chronic migraine 1:1 to receive four-weekly bilateral greater occipital nerve blockade with either 2 ml of 2% (40 mg) lidocaine (active group) or 2 ml of 0.9% saline (placebo) injections for 12 weeks. The primary and key secondary efficacy endpoints were a change from the baseline in the mean number of headache and migraine days and the achievement of ≥50% reduction in headache days from baseline across the weeks 9-12 respectively. Safety evaluations included the documentation and reporting of serious and other adverse events. RESULTS Twenty-two patients each were randomly allocated to the active and placebo group. Baseline demography and clinical characteristics were similar between the two groups. Mean headache and migraine days at baseline (±SD) were 23.4 ± 4.4 and 15.6 ± 5.7 days in the active group and 22.6 ± 5.0 and 14.6 ± 4.6 days in the placebo group respectively. The active group compared to the placebo had a significantly greater least-squares mean reduction in the number of headache and migraine days (-4.2 days [95% CI: -7.5 to -0.8; p = 0.018] and -4.7 days [95%CI: -7.7 to -1.7; p = 0.003] respectively). 40.9% of patients in the active group achieved ≥50% reduction in headache days as compared with 9.1% of patients receiving a placebo (p = 0.024). Overall, 64 mild and transient adverse events were reported by 16 patients in the active group and 15 in the placebo. No death or serious adverse events were reported. CONCLUSION Four-weekly greater occipital nerve blockade with 2% lidocaine for 12 weeks was superior to placebo in decreasing the average number of headache and migraine days in patients with chronic migraine with a good tolerability profile.Clinical trial.gov no. CTRI 2020/07/026709.
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Affiliation(s)
- Debashish Chowdhury
- Department of Neurology, G B Pant institute of Post Graduate Medical Education and Research, Maulana Azad Medical College, New Delhi, India
| | - Apoorva Tomar
- Department of Neurology, G B Pant institute of Post Graduate Medical Education and Research, Maulana Azad Medical College, New Delhi, India
| | - Vaibhav Deorari
- Department of Neurology, G B Pant institute of Post Graduate Medical Education and Research, Maulana Azad Medical College, New Delhi, India
| | - Ashish Duggal
- Department of Neurology, G B Pant institute of Post Graduate Medical Education and Research, Maulana Azad Medical College, New Delhi, India
| | - Anand Krishnan
- Department of Community Medicine, All India Institute of Medical sciences, New Delhi, India
| | - Arun Koul
- Department of Neurology, G B Pant institute of Post Graduate Medical Education and Research, Maulana Azad Medical College, New Delhi, India
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Leonardi M, Guastafierro E, Toppo C, D'Amico D. Societal and personal impact of migraine. HANDBOOK OF CLINICAL NEUROLOGY 2023; 198:23-29. [PMID: 38043966 DOI: 10.1016/b978-0-12-823356-6.00015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Migraine is one of the main causes of years lived with disability (YLDs) worldwide, as showed in the Global Burden of Diseases Study. Its influence on patients' life is relevant and pervasive, with a specific impact on social, family, and work functioning, considering that migraine mainly affects adults under the age of 50. Several studies demonstrated that relations inside the family as well as in every social context are negatively influenced by migraine. According to the results of studies and surveys from different countries, patients' daily activities are often limited during migraine attacks, particularly in terms of performance in social and domestic activities and in terms of reduced productivity in work and school duties. Also an interictal burden is present. Migraineurs are conditioned by the fear of the next attack, often suffer from comorbid conditions such as anxiety and depression, and are subject to different forms of stigma. Consequently, migraine implies relevant costs for the individuals and for society, with higher figures for indirect costs (related to reduced participation and to limited productivity) than indirect costs (related to drugs, medical visits, examinations, and hospitalization).
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Affiliation(s)
- Matilde Leonardi
- UOC Neurologia, Salute Pubblica, Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy.
| | - Erika Guastafierro
- UOC Neurologia, Salute Pubblica, Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Claudia Toppo
- UOC Neurologia, Salute Pubblica, Disabilità, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Domenico D'Amico
- UOC Neuroalgologia, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
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19
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Ernst MJ, Klaus S, Lüdtke K, Gallina A, Falla D, Barbero M, Brunner B, Cornwall J, Da Cruz Pereira Y, Deforth ME, Distler O, Dratva J, Dressel H, Egli T, Elfering A, Ernst MJ, Etzer-Hofer I, Falla D, Gisler M, Haas M, Johnston V, Klaus S, Kobelt GM, Lüdtke K, Luomajoki H, Melloh M, Nicoletti C, Niggli S, Nüssle A, Richard S, Sax N, Schülke K, Sjøgaard G, Staub L, Volken T, Zweig T. Inter-rater reliability, discriminatory and predictive validity of neck movement control tests in office workers with headache and/or neck pain. Musculoskelet Sci Pract 2022; 62:102685. [PMID: 36370624 DOI: 10.1016/j.msksp.2022.102685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 10/23/2022] [Accepted: 10/30/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Movement control tests (MCTs) are clinical tests to evaluate impairment of movement and associated neuromuscular control and are commonly used to evaluate people with neck pain or headache conditions. The aim of this study was to establish inter-rater reliability as well as discriminatory and predictive validity for seven MCTs of the upper (UCS) and lower cervical spine (LCS) in office workers with headache or neck pain. METHODS Seven MCTs of the UCS (3) and LCS (4) were performed at baseline on 140 office workers which were included in a cluster randomized controlled trial. The occurrences of headache and neck pain were established at baseline (discriminatory validity) and at a 15-month follow-up (predictive validity). Inter-rater-reliability was established in a separate cross-sectional study. RESULTS MCTs showed slight to almost perfect inter-rater reliability but limited discriminatory (baseline) and limited to small predictive validity (15-month follow up) for different subgroups of office workers with headache and/or neck pain. MCTs of the UCS showed limited discriminatory validity, especially for rotation in participants with headache and neck pain compared to those with headache only (Negative Likelihood-ratio: 0.82, 95% CI: 0.69-0.98). Participants with neck pain only and ≥1/4 positive MCTs for the sagittal plane had an increased risk for future neck pain (Relative risk: 3.33, 95% CI: 1.05-10.56). DISCUSSION MCTs of the UCS and LCS are reliable but have only limited to small validity to predict future headache events in office workers. Insufficient sagittal plane movement control may predict neck pain relapses in the future.
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Affiliation(s)
- Markus J Ernst
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, UK; Institute of Physiotherapy, School of Health Sciences, Zurich University of Applied Sciences, Katharina Sulzer Platz 9, 8400, Winterthur, Switzerland.
| | - Sandro Klaus
- Institute of Physiotherapy, School of Health Sciences, Zurich University of Applied Sciences, Katharina Sulzer Platz 9, 8400, Winterthur, Switzerland
| | - Kerstin Lüdtke
- Institute of Health Sciences, Department of Physiotherapy, University of Luebeck, Germany
| | - Alessio Gallina
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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20
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Modulation of Central Nociceptive Transmission by Manual Pressure Techniques in Patients with Migraine: An Observational Study. J Clin Med 2022; 11:jcm11216273. [PMID: 36362501 PMCID: PMC9656592 DOI: 10.3390/jcm11216273] [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: 09/08/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Manual pressure in the upper cervical spine is used to provoke and reduce the familiar migraine headache. Information is scarce on the segmental levels, myofascial structure provocation, and reduction occurrences. The required dosage (amount of pressure, number of repetitions, and duration) has not been objectified yet. Methods: Prospective observational study. Thirty patients with migraine were examined interictally. Manual pressure was applied at four sites: the posterior arch of C1, the articular pillar of C2, the rectus capitis posterior major muscle, and the obliquus capitis inferior muscle, bilaterally. On sites where the familiar headache was provoked, the pressure was sustained to induce pain reduction (three repetitions). Provocation of familiar headache (yes/no), headache intensity (numerical pain rating scale), time to obtain a reduction of the headache (seconds), and applied pressure (g/cm2) were recorded. Results: Provocation of the familiar headache occurred at the posterior arches C1 in 92%, and at one of the articular pillars of C2 in 65.3% of cases. At one of the rectus capitis major muscles, the familiar headache was provoked in 84.6% of cases; at one of the oblique capitis inferior muscles, the familiar headache was provoked in 76.9% of cases. The applied mean pressure ranged from 0.82 to 1.2 kg/cm2. Maintaining the pressure reduced headache pain intensity significantly between the start and end of each of the three consecutive trials (p < 0.04). This reduction occurred faster in the third application than in the first application (p = 0.03). Conclusion: Manual pressure at upper cervical segments provokes familiar referred migraine headaches, with low manual pressure. Maintaining the pressure reduces the referred head pain significantly, indicating modulation of central nociceptive transmission.
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21
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Schwedt TJ, Tassorelli C, Silberstein SD, Szperka CL, Kurth T, Pozo-Rosich P, Amin FM, Lipton RB, Dodick DW, Ashina M, Diener HC, Terwindt GM. Guidelines of the International Headache Society for Clinic-Based Headache Registries, 1 st edition. Cephalalgia 2022; 42:1099-1115. [PMID: 35514209 PMCID: PMC10141527 DOI: 10.1177/03331024221099035] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Clinic-based headache registries collect data for a wide variety of purposes including delineating disease characteristics, longitudinal natural disease courses, headache management approaches, quality of care, treatment safety and effectiveness, factors that predict treatment response, health care resource utilization, clinician adherence to guidelines, and cost-effectiveness. Registry data are valuable for numerous stakeholders, including individuals with headache disorders and their caregivers, healthcare providers, scientists, healthcare systems, regulatory authorities, pharmaceutical companies, employers, and policymakers. This International Headache Society document may serve as guidance for developing clinic-based headache registries. Use of registry data requires a formal research protocol that includes: 1) research aims; 2) methods for data collection, harmonization, analysis, privacy, and protection; 3) methods for human subject protection; and 4) publication and dissemination plans. Depending upon their objectives, headache registries should include validated headache-specific questionnaires, patient reported outcome measures, data elements that are used consistently across studies (i.e., "common data elements"), and medical record data. Amongst other data types, registries may be linked to healthcare and pharmacy claims data, biospecimens, and neuroimaging data. Headache diagnoses should be made according to the International Classification of Headache Disorders diagnostic criteria. The data from well-designed headache registries can provide wide-ranging and novel insights into the characteristics, burden, and treatment of headache disorders and ultimately lead to improvements in the management of patients with headache.
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Affiliation(s)
| | - Cristina Tassorelli
- Headache Science & Neurorehabilitation Unit, National Neurological Institute C. Mondino Foundation, Pavia, Italy
- Dept. of Brain and Behavioral Sciences, University of Pavia, Pavia (I)
| | | | - Christina L. Szperka
- Division of Neurology, Children’s Hospital of Philadelphia & Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tobias Kurth
- Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Vall d’Hebron University Hospital & Headache Research Group, Vall d’Hebron Research Institute, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Faisal Mohammad Amin
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
- Department of Neurorehabilitation/Traumatic Brain Injury, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Richard B. Lipton
- Department of Neurology, Department of Epidemiology and Population Health, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Hans-Christoph Diener
- Institute for Medical Informatics, Biometry and Epidemiology, University Duisburg-Essen, Essen, Germany
| | - Gisela M. Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
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22
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Mamlouk MD, Shen PY, Dahlin BC. Headache response after
CT‐guided
fibrin glue occlusion of
CSF‐venous
fistulas. Headache 2022; 62:1007-1018. [DOI: 10.1111/head.14379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 06/21/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Mark D. Mamlouk
- Department of Radiology The Permanente Medical Group, Kaiser Permanente Medical Center Santa Clara California USA
- Department of Radiology and Biomedical Imaging University of California San Francisco California USA
| | - Peter Y. Shen
- Department of Radiology The Permanente Medical Group, Kaiser Permanente Medical Center Santa Clara California USA
| | - Brian C. Dahlin
- Department of Radiology The Permanente Medical Group, Kaiser Permanente Medical Center Sacramento California USA
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23
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Krimmel SR, Keaser ML, Speis D, Haythornthwaite JA, Seminowicz DA. Migraine disability, pain catastrophizing, and headache severity are associated with evoked pain and targeted by mind-body therapy. Pain 2022; 163:e1030-e1037. [PMID: 35297801 PMCID: PMC9288557 DOI: 10.1097/j.pain.0000000000002578] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Meta-analysis suggests that migraine patients are no more sensitive to experimentally evoked pain than healthy control subjects. At the same time, studies have linked some migraine symptoms to quantitative sensory testing (QST) profiles. Unfortunately, previous studies associating migraine symptoms and QST have important methodological shortcomings, stemming from small sample sizes, and frequent use of univariate statistics for multivariate research questions. In the current study, we seek to address these limitations by using a large sample of episodic migraine patients (n = 103) and a multivariate analysis that associates pain ratings from many thermal intensities simultaneously with 12 clinical measures ranging from headache frequency to sleep abnormalities. We identified a single dimension of association between thermal QST and migraine symptoms that relates to pain ratings for all stimulus intensities and a subset of migraine symptoms relating to disability (Headache Impact Test 6 and Brief Pain Inventory interference), catastrophizing (Pain Catastrophizing Scale), and pain severity (average headache pain, Brief Pain Inventory severity, and Short-Form McGill Pain Questionnaire 2). Headache frequency, allodynia, affect, and sleep disturbances were unrelated to this dimension. Consistent with previous research, we did not observe any difference in QST ratings between migraine patients and healthy control subjects. Additionally, we found that the linear combination of symptoms related to QST was modified by the mind-body therapy enhanced mindfulness-based stress reduction (MBSR+). These results suggest that QST has a selective relationship with pain symptoms even in the absence of between-subjects differences between chronic pain patients and healthy control subjects.
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Affiliation(s)
- Samuel R. Krimmel
- Department of Neural and Pain Sciences, School of
Dentistry, and Center to Advance Chronic Pain Research, University of Maryland,
Baltimore, MD, 21201, USA
- Program in Neuroscience, University of Maryland School of
Medicine, Baltimore, MD, 21201 USA
| | - Michael L. Keaser
- Department of Neural and Pain Sciences, School of
Dentistry, and Center to Advance Chronic Pain Research, University of Maryland,
Baltimore, MD, 21201, USA
| | - Darrah Speis
- Department of Neural and Pain Sciences, School of
Dentistry, and Center to Advance Chronic Pain Research, University of Maryland,
Baltimore, MD, 21201, USA
| | - Jennifer A. Haythornthwaite
- Department of Psychiatry and Behavioral Sciences, Johns
Hopkins University School of Medicine, Baltimore, MD, USA
| | - David A. Seminowicz
- Department of Neural and Pain Sciences, School of
Dentistry, and Center to Advance Chronic Pain Research, University of Maryland,
Baltimore, MD, 21201, USA
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24
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McAllister P, Cohen JM, Campos VR, Ning X, Janka L, Barash S. Impact of fremanezumab on disability outcomes in patients with episodic and chronic migraine: a pooled analysis of phase 3 studies. J Headache Pain 2022; 23:112. [PMID: 36038833 PMCID: PMC9422163 DOI: 10.1186/s10194-022-01438-4] [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: 02/18/2022] [Accepted: 06/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background Migraine is the second leading cause of disability worldwide. Although many preventive treatments reduce migraine frequency and severity, it is unclear whether these treatments reduce migraine-related disability in a clinically meaningful way. This pooled analysis evaluated the ability of fremanezumab to reduce migraine-related disability, based on responses and shifts in severity in patient-reported disability outcomes. Methods This pooled analysis included 3 double-blind phase 3 trials (HALO EM, HALO CM, FOCUS) in which patients with episodic or chronic migraine were randomly assigned 1:1:1 to quarterly or monthly fremanezumab or matched placebo for 12 weeks. Migraine-related disability was assessed using the 6-item Headache Impact Test (HIT-6) and Migraine Disability Assessment (MIDAS) questionnaires. A clinically meaningful improvement in disability was defined per American Headache Society guidelines: for HIT-6, a ≥ 5-point reduction; for MIDAS, a ≥ 5-point reduction when baseline score was 11 to 20 or ≥ 30% reduction when baseline score was > 20. Proportions of patients who demonstrated shifts in severity for each outcome were also evaluated. Results For patients with baseline MIDAS scores of 11 to 20 (n = 234), significantly higher proportions achieved 5-point reductions from baseline in MIDAS scores with fremanezumab (quarterly, 71%; monthly, 70%) compared with placebo (49%; both P ≤ 0.01). For patients with baseline MIDAS scores of > 20 (n = 1266), proportions achieving ≥30% reduction from baseline in MIDAS scores were also significantly higher with fremanezumab (quarterly, 69%; monthly, 79%) compared with placebo (58%; both P < 0.001). For HIT-6 scores, proportions of patients achieving 5-point reductions from baseline were significantly higher with fremanezumab (quarterly, 53%; monthly, 55%) compared with placebo (39%; both P < 0.0001). Proportions of patients with shifts of 1 to 3 grades down in MIDAS or HIT-6 disability severity were significantly greater with quarterly and monthly fremanezumab compared with placebo (all P < 0.0001). Conclusion Fremanezumab demonstrated clinically meaningful improvements in disability severity in this pooled analysis. Trial registrations HALO CM, NCT02621931; HALO EM, NCT02629861; FOCUS, NCT03308968.
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Affiliation(s)
- Peter McAllister
- New England Institute for Neurology and Headache - Neurology, 30 Buxton Farm Road, Suite 230, Stamford, CT, 06905, USA.
| | - Joshua M Cohen
- Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA
| | | | - Xiaoping Ning
- Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA
| | - Lindsay Janka
- Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA
| | - Steve Barash
- Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA
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25
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Duan S, Ren Z, Xia H, Wang Z, Zheng T, Liu Z. Association between sleep quality, migraine and migraine burden. Front Neurol 2022; 13:955298. [PMID: 36090858 PMCID: PMC9459411 DOI: 10.3389/fneur.2022.955298] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe relationship between sleep and migraine is well known to be bidirectional. However, few studies have systematically assessed the association between sleep quality and the risk of developing migraine, and its gender and age differences are unclear. And there is currently limited evidence on the associations between sleep quality and migraine-related burdens.ObjectiveThe objectives of this study were to: (1) explore the association between sleep quality and the risk of developing migraine, and its gender and age differences; (2) investigate the associations between sleep quality and the total pain burden, severity, disability, headache impact, quality of life, anxiety, and depression of migraine patients.MethodsThis study consecutively enrolled 134 migraine patients and 70 sex- and age-matched healthy control subjects. Sleep quality was assessed through the Pittsburgh Sleep Quality Index (PSQI). Logistic regression and linear regression analyses were used to explore the associations between sleep quality with the risk of developing migraine and the migraine-related burdens.ResultsThe prevalence of poor sleep quality in migraine patients was significantly higher than that in subjects without migraine (P < 0.001). After adjusting for various confounding factors, the risk of migraine with poor sleep quality remained 3.981 times that of those with good sleep quality. The subgroup analysis showed that there were significant additive interactions between poor sleep quality and the risk of migraine in gender, age, and education level (P for interaction < 0.05), and the stronger correlations were found in females, populations with ages more than 35 years old, and with lower education levels. In addition, multivariate linear regression analysis showed that poor sleep quality was significantly and independently associated with the total pain burden, severity, headache impact, quality of life, anxiety, and depression in migraine patients (P trend < 0.05).ConclusionPoor sleep quality was significantly independently associated with an increased risk of developing migraine and the migraine-related burdens. Strengthening PSQI assessment is valuable for the early prevention and treatment of migraine patients.
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Affiliation(s)
- Shaojie Duan
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Zhiying Ren
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Hui Xia
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Ziyao Wang
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Tao Zheng
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Zunjing Liu
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
- Department of Neurology, Peking University People's Hospital, Beijing, China
- *Correspondence: Zunjing Liu
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26
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Potential Add-On Effects of Manual Therapy Techniques in Migraine Patients: A Randomised Controlled Trial. J Clin Med 2022; 11:jcm11164686. [PMID: 36012924 PMCID: PMC9410040 DOI: 10.3390/jcm11164686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/27/2022] [Accepted: 08/09/2022] [Indexed: 12/12/2022] Open
Abstract
Objective: To ascertain whether the combination of soft tissue and articulatory manual techniques is more effective than either one of these techniques alone for reducing migraine impact; Methods: Seventy-five participants with migraine were randomly divided into three groups (n = 25 per group): (i) soft tissue (STG), (ii) articulatory (AG), and (iii) combined treatment (STAG). Pain, frequency of occurrence, duration, disability and impact, depression and anxiety levels, and perception of change were analysed at baseline, post intervention (T2) and at four-week follow-up (T3); Results: STAG showed a significantly greater reduction in pain versus STG and AG at T2 (p < 0.001; p = 0.014) and at T3 (p < 0.001; p = 0.01). Furthermore, STAG achieved a significantly greater reduction in pain duration versus STG at T2 (p = 0.020) and T3 (p = 0.026) and a greater impression of change versus STG (p = 0.004) and AG (p = 0.037) at T3. Similar effects were observed in all groups for frequency of occurrence, migraine disability, impact, and depression and anxiety levels; Conclusions: A combined manual therapy protocol including soft tissue and articulatory techniques yields larger improvements on pain and perception of change than either technique alone, yet the three therapeutic approaches show similar benefits for reducing pain, disability and impact caused by the migraine, depression or anxiety levels.
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27
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McGeary DD, Resick PA, Penzien DB, McGeary CA, Houle TT, Eapen BC, Jaramillo CA, Nabity PS, Reed DE, Moring JC, Bira LM, Hansen HR, Young-McCaughan S, Cobos BA, Mintz J, Keane TM, Peterson AL. Cognitive Behavioral Therapy for Veterans With Comorbid Posttraumatic Headache and Posttraumatic Stress Disorder Symptoms: A Randomized Clinical Trial. JAMA Neurol 2022; 79:746-757. [PMID: 35759281 PMCID: PMC9237802 DOI: 10.1001/jamaneurol.2022.1567] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Question Do cognitive behavioral therapies for posttraumatic headache and posttraumatic stress disorder (PTSD) symptoms improve headache-related disability in veterans compared with treatment per usual? Findings A randomized clinical trial of 193 post-9/11 combat veterans with posttraumatic headache and PTSD symptoms found headache disability was significantly improved with cognitive behavioral therapy for headaches compared with treatment per usual. Though participants randomly assigned to cognitive processing therapy reported significantly greater improvement in PTSD symptom severity compared with treatment per usual, there was no significant effect of cognitive processing therapy on headache disability. Meaning Cognitive behavioral therapies are efficacious treatments for veterans with comorbid posttraumatic headache and PTSD symptoms. Importance Posttraumatic headache is the most disabling complication of mild traumatic brain injury. Posttraumatic stress disorder (PTSD) symptoms are often comorbid with posttraumatic headache, and there are no established treatments for this comorbidity. Objective To compare cognitive behavioral therapies (CBTs) for headache and PTSD with treatment per usual (TPU) for posttraumatic headache attributable to mild traumatic brain injury. Design, Setting, and Participants This was a single-site, 3–parallel group, randomized clinical trial with outcomes at posttreatment, 3-month follow-up, and 6-month follow-up. Participants were enrolled from May 1, 2015, through May 30, 2019; data collection ended on October 10, 2019. Post-9/11 US combat veterans from multiple trauma centers were included in the study. Veterans had comorbid posttraumatic headache and PTSD symptoms. Data were analyzed from January 20, 2020, to February 2, 2022. Interventions Patients were randomly assigned to 8 sessions of CBT for headache, 12 sessions of cognitive processing therapy for PTSD, or treatment per usual for headache. Main Outcomes and Measures Co–primary outcomes were headache-related disability on the 6-Item Headache Impact Test (HIT-6) and PTSD symptom severity on the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (PCL-5) assessed from treatment completion to 6 months posttreatment. Results A total of 193 post-9/11 combat veterans (mean [SD] age, 39.7 [8.4] years; 167 male veterans [87%]) were included in the study and reported severe baseline headache-related disability (mean [SD] HIT-6 score, 65.8 [5.6] points) and severe PTSD symptoms (mean [SD] PCL-5 score, 48.4 [14.2] points). For the HIT-6, compared with usual care, patients receiving CBT for headache reported −3.4 (95% CI, −5.4 to −1.4; P < .01) points lower, and patients receiving cognitive processing therapy reported −1.4 (95% CI, −3.7 to 0.8; P = .21) points lower across aggregated posttreatment measurements. For the PCL-5, compared with usual care, patients receiving CBT for headache reported −6.5 (95% CI, −12.7 to −0.3; P = .04) points lower, and patients receiving cognitive processing therapy reported −8.9 (95% CI, −15.9 to −1.9; P = .01) points lower across aggregated posttreatment measurements. Adverse events were minimal and similar across treatment groups. Conclusions and Relevance This randomized clinical trial demonstrated that CBT for headache was efficacious for disability associated with posttraumatic headache in veterans and provided clinically significant improvement in PTSD symptom severity. Cognitive processing therapy was efficacious for PTSD symptoms but not for headache disability. Trial Registration ClinicalTrials.gov Identifier: NCT02419131
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Affiliation(s)
- Donald D McGeary
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio.,Department of Rehabilitation Medicine, The University of Texas Health Science Center at San Antonio, San Antonio.,South Texas Veterans Health Care System, San Antonio.,Department of Psychology, The University of Texas at San Antonio, San Antonio
| | - Patricia A Resick
- Department of Psychiatry and Behavioral Sciences, Duke Health, Durham, North Carolina
| | - Donald B Penzien
- Departments of Psychiatry and Behavioral Medicine & Neurology, Wake Forest University, Winston-Salem, North Carolina
| | - Cindy A McGeary
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio.,South Texas Veterans Health Care System, San Antonio
| | - Timothy T Houle
- Department of Anesthesia, Massachusetts General Hospital, Boston
| | - Blessen C Eapen
- Greater Los Angeles Veterans Health Care System, Los Angeles, California.,Department of Physical Medicine and Rehabilitation, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles
| | - Carlos A Jaramillo
- Department of Rehabilitation Medicine, The University of Texas Health Science Center at San Antonio, San Antonio.,South Texas Veterans Health Care System, San Antonio
| | - Paul S Nabity
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio.,South Texas Veterans Health Care System, San Antonio
| | - David E Reed
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio
| | - John C Moring
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio.,South Texas Veterans Health Care System, San Antonio
| | - Lindsay M Bira
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio
| | - Hunter R Hansen
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio.,South Texas Veterans Health Care System, San Antonio
| | - Briana A Cobos
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio.,Department of Psychology, The University of Texas at San Antonio, San Antonio
| | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio.,South Texas Veterans Health Care System, San Antonio
| | - Terence M Keane
- Behavioral Science Division, National Center for PTSD, Boston, Massachusetts.,VA Boston Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Alan L Peterson
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center San Antonio, San Antonio.,South Texas Veterans Health Care System, San Antonio.,Department of Psychology, The University of Texas at San Antonio, San Antonio
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28
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Schwedt TJ, Hentz JG, Sahai-Srivastava S, Murinova N, Spare NM, Treppendahl C, Martin VT, Birlea M, Digre K, Watson D, Leonard M, Robert T, Dodick DW. Patient-Centered Treatment of Chronic Migraine With Medication Overuse: A Prospective, Randomized, Pragmatic Clinical Trial. Neurology 2022; 98:e1409-e1421. [PMID: 35169011 DOI: 10.1212/wnl.0000000000200117] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/11/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Overuse of symptomatic (i.e., acute) medications is common among those with chronic migraine. It is associated with developing frequent headaches, medication side effects, and reduced quality of life. The optimal treatment strategy for patients who have chronic migraine with medication overuse (CMMO) has long been debated. The study objective was to determine whether migraine preventive therapy without switching or limiting the frequency of the overused medication was noninferior to migraine preventive therapy with switching from the overused medication to an alternative medication that could be used on ≤2 d/wk. METHODS The Medication Overuse Treatment Strategy (MOTS) trial was an open-label, pragmatic clinical trial, randomizing adult participants 1:1 to migraine preventive medication and (1) switching from the overused medication to an alternative used ≤2 d/wk or (2) continuation of the overused medication with no maximum limit. Participants were enrolled between February 2017 and December 2020 from 34 clinics in the United States, including headache specialty, general neurology, and primary care clinics. The primary outcome was moderate to severe headache day frequency during weeks 9 to 12 and subsequently during weeks 1 to 2 after randomization. RESULTS Seven hundred twenty participants were randomized; average age was 44 (SD 13) years; and 87.5% were female. At baseline, participants averaged 22.5 (SD 5.1) headache days over 4 weeks, including 12.8 (SD 6.7) moderate to severe headache days and 21.4 (SD 5.8) days of symptomatic medication use. Migraine preventive medication without switching of the overused medication was not inferior to preventive medication with switching for moderate to severe headache day frequency during weeks 9 to 12 (switching 9.3 [SD 7.2] vs no switching 9.1 [SD 6.8]; p = 0.75, 95% CI -1.0 to 1.3). The treatment strategies also provided similar outcomes during the first 2 weeks (switching 6.6 [SD 3.7] moderate to severe headaches days vs no switching 6.4 [SD 3.6]; p = 0.57, 95% CI -0.4 to 0.7). DISCUSSION When reduction in moderate to severe headache days was used as the outcome of interest for the management of CMMO, migraine preventive medication without switching or limiting symptomatic medication is not inferior to migraine preventive medication with switching to a different symptomatic medication with a maximum limit of 2 treatment days per week. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov identifier NCT02764320. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that, for patients who have CMMO, migraine preventive medication without switching or limiting the overused medication is noninferior to migraine preventive medication with switching and limiting symptomatic medication.
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Affiliation(s)
- Todd J Schwedt
- From the Department of Neurology (T.J.S., J.G.H., M.L., D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.S.-S.), University of Southern California, Los Angeles; Department of Neurology (N.M.), University of Washington, Seattle; Department of Neurology (N.M.S.), Thomas Jefferson University, Philadelphia, PA; The Headache Center (C.T.), Ridgeland, MS; Department of Internal Medicine (V.T.M.), University of Cincinnati, OH; Department of Neurology (M.B.), University of Colorado, Denver; Department of Neurology (K.D.), University of Utah, Salt Lake City; Department of Neurology (D.W.), West Virginia University Rockefeller Neuroscience Institute, Morgantown; and patient advocate and educator (T.R.), Washington, WV.
| | - Joseph G Hentz
- From the Department of Neurology (T.J.S., J.G.H., M.L., D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.S.-S.), University of Southern California, Los Angeles; Department of Neurology (N.M.), University of Washington, Seattle; Department of Neurology (N.M.S.), Thomas Jefferson University, Philadelphia, PA; The Headache Center (C.T.), Ridgeland, MS; Department of Internal Medicine (V.T.M.), University of Cincinnati, OH; Department of Neurology (M.B.), University of Colorado, Denver; Department of Neurology (K.D.), University of Utah, Salt Lake City; Department of Neurology (D.W.), West Virginia University Rockefeller Neuroscience Institute, Morgantown; and patient advocate and educator (T.R.), Washington, WV
| | - Soma Sahai-Srivastava
- From the Department of Neurology (T.J.S., J.G.H., M.L., D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.S.-S.), University of Southern California, Los Angeles; Department of Neurology (N.M.), University of Washington, Seattle; Department of Neurology (N.M.S.), Thomas Jefferson University, Philadelphia, PA; The Headache Center (C.T.), Ridgeland, MS; Department of Internal Medicine (V.T.M.), University of Cincinnati, OH; Department of Neurology (M.B.), University of Colorado, Denver; Department of Neurology (K.D.), University of Utah, Salt Lake City; Department of Neurology (D.W.), West Virginia University Rockefeller Neuroscience Institute, Morgantown; and patient advocate and educator (T.R.), Washington, WV
| | - Natalia Murinova
- From the Department of Neurology (T.J.S., J.G.H., M.L., D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.S.-S.), University of Southern California, Los Angeles; Department of Neurology (N.M.), University of Washington, Seattle; Department of Neurology (N.M.S.), Thomas Jefferson University, Philadelphia, PA; The Headache Center (C.T.), Ridgeland, MS; Department of Internal Medicine (V.T.M.), University of Cincinnati, OH; Department of Neurology (M.B.), University of Colorado, Denver; Department of Neurology (K.D.), University of Utah, Salt Lake City; Department of Neurology (D.W.), West Virginia University Rockefeller Neuroscience Institute, Morgantown; and patient advocate and educator (T.R.), Washington, WV
| | - Nicole M Spare
- From the Department of Neurology (T.J.S., J.G.H., M.L., D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.S.-S.), University of Southern California, Los Angeles; Department of Neurology (N.M.), University of Washington, Seattle; Department of Neurology (N.M.S.), Thomas Jefferson University, Philadelphia, PA; The Headache Center (C.T.), Ridgeland, MS; Department of Internal Medicine (V.T.M.), University of Cincinnati, OH; Department of Neurology (M.B.), University of Colorado, Denver; Department of Neurology (K.D.), University of Utah, Salt Lake City; Department of Neurology (D.W.), West Virginia University Rockefeller Neuroscience Institute, Morgantown; and patient advocate and educator (T.R.), Washington, WV
| | - Christina Treppendahl
- From the Department of Neurology (T.J.S., J.G.H., M.L., D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.S.-S.), University of Southern California, Los Angeles; Department of Neurology (N.M.), University of Washington, Seattle; Department of Neurology (N.M.S.), Thomas Jefferson University, Philadelphia, PA; The Headache Center (C.T.), Ridgeland, MS; Department of Internal Medicine (V.T.M.), University of Cincinnati, OH; Department of Neurology (M.B.), University of Colorado, Denver; Department of Neurology (K.D.), University of Utah, Salt Lake City; Department of Neurology (D.W.), West Virginia University Rockefeller Neuroscience Institute, Morgantown; and patient advocate and educator (T.R.), Washington, WV
| | - Vincent T Martin
- From the Department of Neurology (T.J.S., J.G.H., M.L., D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.S.-S.), University of Southern California, Los Angeles; Department of Neurology (N.M.), University of Washington, Seattle; Department of Neurology (N.M.S.), Thomas Jefferson University, Philadelphia, PA; The Headache Center (C.T.), Ridgeland, MS; Department of Internal Medicine (V.T.M.), University of Cincinnati, OH; Department of Neurology (M.B.), University of Colorado, Denver; Department of Neurology (K.D.), University of Utah, Salt Lake City; Department of Neurology (D.W.), West Virginia University Rockefeller Neuroscience Institute, Morgantown; and patient advocate and educator (T.R.), Washington, WV
| | - Marius Birlea
- From the Department of Neurology (T.J.S., J.G.H., M.L., D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.S.-S.), University of Southern California, Los Angeles; Department of Neurology (N.M.), University of Washington, Seattle; Department of Neurology (N.M.S.), Thomas Jefferson University, Philadelphia, PA; The Headache Center (C.T.), Ridgeland, MS; Department of Internal Medicine (V.T.M.), University of Cincinnati, OH; Department of Neurology (M.B.), University of Colorado, Denver; Department of Neurology (K.D.), University of Utah, Salt Lake City; Department of Neurology (D.W.), West Virginia University Rockefeller Neuroscience Institute, Morgantown; and patient advocate and educator (T.R.), Washington, WV
| | - Kathleen Digre
- From the Department of Neurology (T.J.S., J.G.H., M.L., D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.S.-S.), University of Southern California, Los Angeles; Department of Neurology (N.M.), University of Washington, Seattle; Department of Neurology (N.M.S.), Thomas Jefferson University, Philadelphia, PA; The Headache Center (C.T.), Ridgeland, MS; Department of Internal Medicine (V.T.M.), University of Cincinnati, OH; Department of Neurology (M.B.), University of Colorado, Denver; Department of Neurology (K.D.), University of Utah, Salt Lake City; Department of Neurology (D.W.), West Virginia University Rockefeller Neuroscience Institute, Morgantown; and patient advocate and educator (T.R.), Washington, WV
| | - David Watson
- From the Department of Neurology (T.J.S., J.G.H., M.L., D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.S.-S.), University of Southern California, Los Angeles; Department of Neurology (N.M.), University of Washington, Seattle; Department of Neurology (N.M.S.), Thomas Jefferson University, Philadelphia, PA; The Headache Center (C.T.), Ridgeland, MS; Department of Internal Medicine (V.T.M.), University of Cincinnati, OH; Department of Neurology (M.B.), University of Colorado, Denver; Department of Neurology (K.D.), University of Utah, Salt Lake City; Department of Neurology (D.W.), West Virginia University Rockefeller Neuroscience Institute, Morgantown; and patient advocate and educator (T.R.), Washington, WV
| | - Michael Leonard
- From the Department of Neurology (T.J.S., J.G.H., M.L., D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.S.-S.), University of Southern California, Los Angeles; Department of Neurology (N.M.), University of Washington, Seattle; Department of Neurology (N.M.S.), Thomas Jefferson University, Philadelphia, PA; The Headache Center (C.T.), Ridgeland, MS; Department of Internal Medicine (V.T.M.), University of Cincinnati, OH; Department of Neurology (M.B.), University of Colorado, Denver; Department of Neurology (K.D.), University of Utah, Salt Lake City; Department of Neurology (D.W.), West Virginia University Rockefeller Neuroscience Institute, Morgantown; and patient advocate and educator (T.R.), Washington, WV
| | - Teri Robert
- From the Department of Neurology (T.J.S., J.G.H., M.L., D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.S.-S.), University of Southern California, Los Angeles; Department of Neurology (N.M.), University of Washington, Seattle; Department of Neurology (N.M.S.), Thomas Jefferson University, Philadelphia, PA; The Headache Center (C.T.), Ridgeland, MS; Department of Internal Medicine (V.T.M.), University of Cincinnati, OH; Department of Neurology (M.B.), University of Colorado, Denver; Department of Neurology (K.D.), University of Utah, Salt Lake City; Department of Neurology (D.W.), West Virginia University Rockefeller Neuroscience Institute, Morgantown; and patient advocate and educator (T.R.), Washington, WV
| | - David W Dodick
- From the Department of Neurology (T.J.S., J.G.H., M.L., D.W.D.), Mayo Clinic, Phoenix, AZ; Department of Neurology (S.S.-S.), University of Southern California, Los Angeles; Department of Neurology (N.M.), University of Washington, Seattle; Department of Neurology (N.M.S.), Thomas Jefferson University, Philadelphia, PA; The Headache Center (C.T.), Ridgeland, MS; Department of Internal Medicine (V.T.M.), University of Cincinnati, OH; Department of Neurology (M.B.), University of Colorado, Denver; Department of Neurology (K.D.), University of Utah, Salt Lake City; Department of Neurology (D.W.), West Virginia University Rockefeller Neuroscience Institute, Morgantown; and patient advocate and educator (T.R.), Washington, WV
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Garrigós-Pedrón M, Segura-Ortí E, Gracia-Naya M, La Touche R. Predictive factors of sleep quality in patients with chronic migraine. NEUROLOGÍA (ENGLISH EDITION) 2022; 37:101-109. [PMID: 35279224 DOI: 10.1016/j.nrleng.2018.11.009] [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: 08/15/2018] [Accepted: 11/01/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION One of the factors contributing to transformation of migraine are sleep disorders, which can act as a trigger and/or perpetuating factor in these patients. This study's primary objective was to identify predictive factors related to sleep quality in patients with chronic migraine (CM); the secondary objective was to identify any differences in psychological variables and disability between patients with CM with better or poorer sleep quality. METHODS A total of 50 patients with CM were included in an observational, cross-sectional study. We recorded data on demographic, psychological, and disability variables using self-administered questionnaires. RESULTS A direct, moderate-to-strong correlation was observed between the different disability and psychological variables analysed (P < .05). Regression analysis identified depressive symptoms, headache-related disability, and pain catastrophising as predictors of sleep quality; together, these factors explain 33% of the variance. Statistically significant differences were found between patients with better and poorer sleep quality for depressive symptoms (P = .016) and pain catastrophising (P = .036). CONCLUSIONS The predictive factors for sleep quality in patients with CM were depressive symptoms, headache-related disability, and pain catastrophising. Patients with poorer sleep quality had higher levels of pain catastrophising and depressive symptoms.
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Affiliation(s)
- M Garrigós-Pedrón
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain; Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.
| | - E Segura-Ortí
- Department of Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | - M Gracia-Naya
- Departamento de Neurología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - R La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain; Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain; Instituto de Neurociencia y Dolor Craneofacial (INDCRAN), Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
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Garrigós-Pedrón M, Segura-Ortí E, Gracia-Naya M, La Touche R. Predictive factors of sleep quality in patients with chronic migraine. Neurologia 2022; 37:101-109. [PMID: 30857790 DOI: 10.1016/j.nrl.2018.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/26/2018] [Accepted: 11/01/2018] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION One of the factors contributing to transformation of migraine are sleep disorders, which can act as a trigger and/or perpetuating factor in these patients. This study's primary objective was to identify predictive factors related to sleep quality in patients with chronic migraine (CM); the secondary objective was to identify any differences in psychological variables and disability between patients with CM with better or poorer sleep quality. METHODS A total of 50 patients with CM were included in an observational, cross-sectional study. We recorded data on demographic, psychological, and disability variables using self-administered questionnaires. RESULTS A direct, moderate-to-strong correlation was observed between the different disability and psychological variables analysed (P<.05). Regression analysis identified depressive symptoms, headache-related disability, and pain catastrophising as predictors of sleep quality; together, these factors explain 33% of the variance. Statistically significant differences were found between patients with better and poorer sleep quality for depressive symptoms (P=.016) and pain catastrophising (P=.036). CONCLUSIONS The predictive factors for sleep quality in patients with CM were depressive symptoms, headache-related disability, and pain catastrophising. Patients with poorer sleep quality had higher levels of pain catastrophising and depressive symptoms.
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Affiliation(s)
- M Garrigós-Pedrón
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España; Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España.
| | - E Segura-Ortí
- Department of Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, España
| | - M Gracia-Naya
- Departamento de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - R La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España; Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, España; Instituto de Neurociencia y Dolor Craneofacial (INDCRAN), Madrid, España; Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, España
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Associations between potential inflammatory properties of the diet and frequency, duration, and severity of migraine headaches: a cross-sectional study. Sci Rep 2022; 12:2878. [PMID: 35190593 PMCID: PMC8861209 DOI: 10.1038/s41598-022-06819-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 02/08/2022] [Indexed: 12/23/2022] Open
Abstract
Despite a large body of literature on the association between the dietary inflammatory index (DII) and various chronic diseases, limited knowledge is available regarding the association between DII and migraine. Therefore, we assessed the relationship between the DII and migraine characteristics, including duration, frequency, and severity of migraine headaches, Headache Impact Test-6 (HIT-6), and serum levels of nitric oxide (NO). This population-based cross-sectional study was conducted from August 2019 to June 2020 among 262 patients (38 men and 224 women; 20–50 years). A 168-item semiquantitative food frequency questionnaire (FFQ) was gathered to evaluate dietary intake, and subsequently, an energy-adjusted DII score was calculated. After controlling for potential confounders, an increase of 3.48 in headache frequency was observed when the DII score increased from − 4.04 to − 1.83 (β = 3.48; 95% CI 1.43, 5.54). In the crude model, headache duration tended to be inversely associated with DII in the subjects with the pro-inflammatory diet compared to those with the anti-inflammatory diet (β = − 0.22; 95% CI − 0.46, 0.02). After adjustment for confounders, those with the highest DII values were at a higher risk of severe headaches than those with the lowest values (OR = 2.25; 95% CI 1.17, 4.32). No other significant results were found in terms of the association between DII and HIT-6 or serum NO levels. We found evidence suggesting that higher adherence to a diet with anti-inflammatory properties was significantly and inversely related to headache frequency. Furthermore, our results suggest that the DII score is substantially related to migraine severity.
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"The Triptan's Hangover": A Multicentric Cross-sectional Observational Study of the Adverse Events of Triptans in Patients With Migraine. Clin Neuropharmacol 2022; 45:21-26. [PMID: 35185146 DOI: 10.1097/wnf.0000000000000498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT The emergence of triptans represented a breakthrough in the treatment of migraine, but in clinical practice, patients describe symptoms that resemble those of a hangover after taking them. We propose the use of the Hangover Symptoms Scale (HSS) to evaluate this syndrome in patients that take triptans, which may help identify patients at higher risk of presenting these adverse effects that may interfere with therapeutic compliance.A cross-sectional observational pilot study with prospective data collection through a clinical-demographic questionnaire and the HSS was carried out on patients with migraine treated in headache units in 3 tertiary hospitals in Madrid.Sixty-six patients were included in the study. The median HSS was 4 and all symptoms were present in at least 15% of the patients, with difficulty to concentrate being the most frequent (57.6%). No significant differences were found between the presence of a higher HSS score and the sociodemographic characteristics of the patient or his migraine. The presence of aura was associated with a higher percentage of trembling (P = 0.029) and fatigue (nonvisual, polymodal auras; P = 0.017).According to our study, triptans are responsible for a set of symptoms overlapping with those that occur during a hangover. Therefore, we propose that the HSS could be a useful tool for the evaluation and quantification of these effects in patients receiving triptans. In addition, we found that clinical features could be more frequently associated with the appearance of these adverse effects that, however, are not related to any particular patient profile.
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Atraszkiewicz D, Ito R, Bahra A. The efficacy of botulinum toxin type-A for intractable chronic migraine patients with no pain-free time. Br J Pain 2022; 16:41-49. [PMID: 35111313 PMCID: PMC8801685 DOI: 10.1177/20494637211014544] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
AIM This is a retrospective report of the efficacy of botulinum toxin-A, Botox® (Allergan), in intractable chronic migraine patients non-responsive to previous pharmacological management and with largely no pain-free time, including those with new onset daily persistent headache. METHODS Thirty-three patients, all with severe Headache Impact Test (HIT)-6 scores at baseline, received 3-monthly injections of Botox® as per Phase III REsearch Evaluating Migraine Prophylaxis Therapy (PRE-EMPT) protocol over a maximum 33-month period. Response criteria were a sustained reduction of HIT-6 scores below 60. RESULTS Four patients had headache on at least 20 days a month; the remaining patients had daily headache with no pain-free time, including nine patients with new onset persistent migraine. There was a significant reduction in HIT-6 scores following Botox® therapy (x̅ = -5.45, p = 0.000920). Twenty-one percent of the cohort exhibited a sustained reduction in HIT-6 scores below 60. The number of headache days and pain-free time did not change in five of the six responders, but disability improved. There was no difference between patients with episodic migraine evolving to chronic as opposed to those with chronic migraine from onset. CONCLUSION This report suggests that Botox® treatment is efficacious in intractable chronic migraine without pain-free time. The HIT-6 is a reliable and practical parameter to assess disability in this patient group. Use of such validated parameters should be considered with greater weight in future International Classification of Headache Disorders (ICHD) guidelines for controlled clinical trials.
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Affiliation(s)
| | - Rieko Ito
- The National Hospital for Neurology and Neurosurgery, London, UK
| | - Anish Bahra
- The National Hospital for Neurology and Neurosurgery, London, UK,Barts Health NHS Trust, London, UK,Anish Bahra, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.
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Oliveira Gonçalves AS, Panteli D, Neeb L, Kurth T, Aigner A. HIT-6 and EQ-5D-5L in patients with migraine: assessment of common latent constructs and development of a mapping algorithm. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:47-57. [PMID: 34245392 PMCID: PMC8882092 DOI: 10.1007/s10198-021-01342-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 06/29/2021] [Indexed: 05/22/2023]
Abstract
OBJECTIVE The aims of this study were to assess whether there is a conceptual overlap between the questionnaires HIT-6 and EQ-5D and to develop a mapping algorithm allowing the conversion of HIT-6 to EQ-5D utility scores for Germany. METHODS This study used data from an ongoing randomised controlled trial for patients suffering from migraine. We assessed the conceptual overlap between the two instruments with correlation matrices and exploratory factor analysis. Linear regression, tobit, mixture, and two-part models were used for mapping, accounting for repeated measurements, tenfold cross-validation was conducted to validate the models. RESULTS We included 1010 observations from 410 patients. The EQ-5D showed a substantial ceiling effect (47.3% had the highest score) but no floor effect, while the HIT-6 showed a very small ceiling effect (0.5%). The correlation between the instruments' total scores was moderate (- 0.30), and low to moderate among each domain (0.021-0.227). The exploratory factor analysis showed insufficient conceptual overlap between the instruments, as they load on different factors. Thus, there is reason to believe that the instruments' domains do not capture the same latent constructs. To facilitate future mapping, we provide coefficients and a variance-covariance matrix for the preferred model, a two-part model with the total HIT-6 score as the explanatory variable. CONCLUSION This study showed that the German EQ-5D and the HIT-6 lack the conceptual overlap needed for appropriate mapping. Thus, the estimated mapping algorithms should only be used as a last resort for estimating utilities to be employed in economic evaluations.
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Affiliation(s)
| | - Dimitra Panteli
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
| | - Lars Neeb
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Kurth
- Institute of Public Health, Charité - Universitätsmedizin, Berlin, Charitépl. 1, 10117 Berlin, Germany
| | - Annette Aigner
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
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Younis A, Qasem Y, Ali Neamat Sulaiman Alallaf. The Frequency of Fibromyalgia in Migraine Patients. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Fibromyalgia (FM) is a prevailing debilitating ailment that has been described in patients with migraines in several investigations.
AIM: The study aimed to investigate the frequency of FM in migraine patients and to study the characteristics of migraine patients with comorbid FM.
METHODS: This case–control study was piloted in the Neurology Unit, Department of Medicine in Ibn Sina Teaching Hospital in Mosul, Iraq, between March and November 2020. One hundred consecutive patients with migraine and 100 healthy controls were included in this study. The sociodemographic and headache characteristics of the patients were recorded.
RESULTS: The frequency of FM was statistically higher among participants with migraines (27%) when compared to the controls (5%). Migraine patients with FM had a substantially older mean age and a higher ratio of female gender than migraine patients without FM. FM was found to be more common in patients without versus with aura. Patients with comorbid FM had greater headache frequency (p = 0.0002), headache intensity (p = 0.007), and higher scores on the “Headache Impact Test (HIT-6)” (p = 0.0001).
CONCLUSIONS: There is a high frequency of FM in patients with migraines. Patients with coexistent “FM” and “migraine” tended to have more depressive symptoms, greater headache intensity, headache frequency, and when compared to healthy people, they are more likely to have a significant headache-related disability.
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Bauer RM, Jaffee MS. Behavioral and Cognitive Aspects of Concussion. Continuum (Minneap Minn) 2021; 27:1646-1669. [PMID: 34881730 DOI: 10.1212/con.0000000000001057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This review provides the reader with an overview of concussion and mild traumatic brain injury (TBI). Key aspects of the pathophysiology, signs, and symptoms, treatment and rehabilitation, and recovery from concussion/mild TBI are reviewed with an emphasis on the variety of factors that may contribute to cognitive concerns following injury. RECENT FINDINGS Concussion remains a clinical diagnosis based on symptoms that occur in the immediate aftermath of an applied force and in the hours, days, and weeks thereafter. Although advances have been made in advanced diagnostics, including neuroimaging and fluid biomarkers in hopes of developing objective indicators of injury, such markers currently lack sufficient specificity to be used in clinical diagnostics. The symptoms of concussion are heterogeneous and may be seen to form subtypes, each of which suggests a targeted rehabilitation by the interdisciplinary team. Although the majority of patients with concussion recover within the first 30 to 90 days after injury, some have persistent disabling symptoms. The concept of postconcussion syndrome, implying a chronic syndrome of injury-specific symptoms, is replaced by a broader concept of persistent symptoms after concussion. This concept emphasizes the fact that most persistent symptoms have their basis in complex somatic, cognitive, psychiatric, and psychosocial factors related to risk and resilience. This framework leads to the important conclusion that concussion is a treatable injury from which nearly all patients can be expected to recover. SUMMARY Concussion/mild TBI is a significant public health problem in civilian, military, and organized athletic settings. Recent advances have led to a better understanding of underlying pathophysiology and symptom presentation and efficacious treatment and rehabilitation of the resulting symptoms. An interdisciplinary team is well-positioned to provide problem-oriented, integrated care to facilitate recovery and to advance the evidence base supporting effective practice in diagnosis, treatment, and prevention.
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Nahas SJ, Naegel S, Cohen JM, Ning X, Janka L, Campos VR, Krasenbaum LJ, Holle-Lee D, Kudrow D, Lampl C. Efficacy and safety of fremanezumab in clinical trial participants aged ≥60 years with episodic or chronic migraine: pooled results from 3 randomized, double-blind, placebo-controlled phase 3 studies. J Headache Pain 2021; 22:141. [PMID: 34819017 PMCID: PMC8903616 DOI: 10.1186/s10194-021-01351-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/31/2021] [Indexed: 01/17/2023] Open
Abstract
Background Although migraine is less common in older people, preventive treatment of migraine in these individuals may be more challenging due to the presence of multiple comorbidities and polypharmacy. Additionally, evidence for migraine treatment efficacy, safety, and tolerability is limited in this population. We evaluated efficacy, safety, and tolerability of fremanezumab, a fully humanized monoclonal antibody (IgG2Δa) that selectively targets calcitonin gene–related peptide (CGRP), in clinical trial participants aged ≥60 years with episodic migraine (EM) or chronic migraine (CM). Methods This analysis included data from 3 randomized, double-blind, placebo-controlled phase 3 studies: the HALO EM study, HALO CM study, and FOCUS study in participants with EM or CM and prior inadequate response to 2–4 migraine preventive medication classes. Participants in all studies were randomized 1:1:1 to receive 12 weeks of subcutaneous treatment with quarterly fremanezumab (Months 1/2/3: EM/CM, 675 mg/placebo/placebo), monthly fremanezumab (Months 1/2/3: EM, 225 mg/225 mg/225 mg; CM, 675 mg/225 mg/225 mg), or matched monthly placebo. Results These pooled analyses included 246 participants aged ≥60 years. Reductions in monthly migraine days from baseline over 12 weeks were significantly greater with fremanezumab (least-squares mean change from baseline [standard error]: quarterly fremanezumab, − 4.3 [0.59]; monthly fremanezumab, − 4.6 [0.54]) versus placebo (placebo, − 2.3 [0.57]; both P < 0.01 vs placebo). As early as Week 1, significant reductions from baseline in weekly migraine days were observed with fremanezumab versus placebo (both P < 0.01). With fremanezumab treatment versus placebo, a significantly higher proportion of participants achieved ≥50% reduction in monthly migraine days, and significant improvements in disability and quality-of-life outcomes were observed (P < 0.05). Proportions of participants experiencing serious adverse events and adverse events leading to discontinuation were low and similar in the fremanezumab and placebo groups. Efficacy and safety results were comparable to the overall pooled population (N = 2843). Conclusions This pooled subgroup analysis demonstrates that fremanezumab treatment is efficacious and well-tolerated over 12 weeks in participants aged ≥60 years with EM or CM. These data may help healthcare providers with clinical decision making and preventive treatment selection for older patients with migraine. Trial registration ClinicalTrials.gov identifiers: HALO CM: NCT02621931; HALO EM: NCT02629861; FOCUS: NCT03308968. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-021-01351-2.
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Affiliation(s)
- Stephanie J Nahas
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Steffen Naegel
- Department of Neurology, University Hospital Halle (Saale) and University Halle-Wittenberg, Halle, Germany
| | | | - Xiaoping Ning
- Teva Pharmaceutical Industries, West Chester, PA, USA
| | - Lindsay Janka
- Teva Pharmaceutical Industries, West Chester, PA, USA
| | | | | | - Dagny Holle-Lee
- Department of Neurology and Westgerman Headache Center Essen, University Hospital, Essen, Germany
| | - David Kudrow
- California Medical Clinic for Headache, Santa Monica, CA, USA
| | - Christian Lampl
- Headache Medical Centre, Linz, Austria.,Department of Neurology, Konventhospital Barmherzige Brüder, Linz, Austria
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Feitosa H, Wanderley D, Barros MMMB, Silva SFD, Santos AKDL, Tenório ADS, Oliveira DAD. Is it possible to sort the disability of individuals with migraine based on the International Classification of Functioning, Disability and Health? — A Scoping Review. HEADACHE MEDICINE 2021. [DOI: 10.48208/headachemed.2021.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
PurposeTo identify the most frequent outcomes related to disability assessed in individuals with migraine and to correlate these findings with the categories of International Classification of Functioning, Disability and Health.Material and methodThis scoping review was developed based on studies with adult population (18-55 years) of both sexes and assessing the disability generated by migraine. We included studies in which patients had a diagnosis of migraine based on International Classification of Headache Disorders.Results52 articles were found with 42 outcomes related to 17 categories of International Classification of Functioning, Disability and Health, including the four main components of the classification, with seven categories in "Body Functions", one in "Body Structures", four in “Activities and Participation” and five in "Environmental Factors".ConclusionThe findings show that disabilities, activity limitation, or participation restriction generated by migraine can be classified by International Classification of Functioning, Disability and Health. The components "body functions", "environmental factors" and "activities and participation" were the most identified in the present study. Thus, this classification is important to classify the disability caused by migraine and to guide a rehabilitation more focused onthe patient's real demands, as well as directing the research involving this population.
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Nabity PS, Jaramillo CA, Resick PA, McGeary CA, Eapen BC, Straud CL, Hale WJ, Houle TT, Litz BT, Mintz J, Penzien DB, Young-McCaughan S, Keane TM, Peterson AL, McGeary DD. Persistent posttraumatic headaches and functioning in veterans: Injury type can matter. Headache 2021; 61:1334-1341. [PMID: 34570899 DOI: 10.1111/head.14210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/20/2021] [Accepted: 07/19/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To characterize the relationship between head trauma types (blast injury, blunt injury, combined blast+blunt injury) with subsequent headache presentations and functioning. BACKGROUND Posttraumatic headaches (PTHs), the most common sequelae of traumatic brain injury (TBI), are painful and disabling. More than 400,000 veterans report having experienced a TBI, and understanding the predictors of PTHs may guide treatment developments. METHODS This study used a nested-cohort design analyzing baseline data from a randomized clinical trial of cognitive behavioral therapy for PTH (N = 190). Participants had PTH (from blast and/or blunt head trauma) and symptoms of posttraumatic stress disorder (PTSD). The Structured Diagnostic Interview for Headache-Revised and Ohio State University Traumatic Brain Injury Identification Method were used to phenotype headaches and head injury histories, respectively. RESULTS Individuals with persistent PTHs after a combined blast and blunt head trauma were more likely (OR =3.45; 95% CI [1.41, 8.4]) to experience chronic (vs. episodic) PTHs compared with the blunt trauma only group (23/33, 70% vs. 26/65, 40%, respectively); and they were more likely (OR =2.51; 95% CI [1.07, 5.9]) to experience chronic PTH compared with the blast trauma only group (44/92, 48%). There were no differences between head injury type on headache-related disability, depression symptoms, or severity of PTSD symptoms. CONCLUSION The combination of blast and blunt injuries was associated with headache chronicity, but not headache disability. Considering the refractory nature of chronic headaches, the potential added and synergistic effects of distinct head injuries warrant further study.
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Affiliation(s)
- Paul S Nabity
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Carlos A Jaramillo
- Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio, Texas, USA.,Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Patricia A Resick
- Department of Psychiatry and Behavioral Sciences, Duke Health, Durham, North Carolina, USA
| | - Cindy A McGeary
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Blessen C Eapen
- Department of Physical Medicine and Rehabilitation, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Department of Medicine, Division of Physical Medicine and Rehabilitation, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Casey L Straud
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA.,Department of Psychology, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Willie J Hale
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Department of Psychology, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Timothy T Houle
- Department of Anesthesia, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Brett T Litz
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Donald B Penzien
- Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Terence M Keane
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.,National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Alan L Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA.,Department of Psychology, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Donald D McGeary
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA.,Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,Department of Psychology, University of Texas at San Antonio, San Antonio, Texas, USA
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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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41
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de Vries Lentsch S, Verhagen IE, van den Hoek TC, MaassenVanDenBrink A, Terwindt GM. Treatment with the monoclonal calcitonin gene-related peptide receptor antibody erenumab: A real-life study. Eur J Neurol 2021; 28:4194-4203. [PMID: 34424593 PMCID: PMC9291504 DOI: 10.1111/ene.15075] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/19/2021] [Indexed: 11/28/2022]
Abstract
Background and purpose New prophylactics for migraine, targeting calcitonin gene‐related peptide (CGRP), have recently emerged. Real‐world data are important for a comprehensive understanding of treatment response. We assessed the consistency of response to erenumab, a monoclonal CGRP receptor antibody, in a real‐world setting, in order to determine which patients may be considered responders in clinical practice. Methods All erenumab‐treated patients (n = 100) completed a time‐locked daily electronic diary, and an automated algorithm was used to monitor treatment response. Monthly migraine days (MMD), non‐migrainous headache days, days of acute medication use (MAMD), well‐being and coping with pain were assessed for a 6‐month period. The primary outcome was reduction in MMD compared to baseline. Results The numbers of MMD and MAMD decreased in all months, in both episodic and chronic migraine patients, compared to baseline (p < 0.001), while general well‐being (p < 0.001) and coping with pain (p < 0.001) also improved. Of all patients, 36% had an MMD reduction of ≥50% in ≥3/6 months, and 6% had such a reduction in all 6 months. For a ≥30% MMD reduction, the figures were 60% and 24%, respectively. Almost 90% of patients with an average MMD reduction of ≥30% over the first 3 months had a sustained response in the last 3 months. In addition, 20% of patients without an initial response (average <30%), had a delayed response (average ≥30%) in the last 3 months. Conclusion Erenumab was effective in migraine patients who were highly refractory to previous prophylactics. As a practical guideline, we propose that treatment be continued for at least 6 months and that patients with a ≥30% MMD reduction in at least half of the treatment period should be considered to be responders.
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Affiliation(s)
| | - Iris E Verhagen
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Antoinette MaassenVanDenBrink
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
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Wang TY, Karikari IO, Amrhein TJ, Gray L, Kranz PG. Clinical Outcomes Following Surgical Ligation of Cerebrospinal Fluid-Venous Fistula in Patients With Spontaneous Intracranial Hypotension: A Prospective Case Series. Oper Neurosurg (Hagerstown) 2021; 18:239-245. [PMID: 31134267 DOI: 10.1093/ons/opz134] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 01/30/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Cerebrospinal fluid-venous fistula (CVF) is a recently described cause of spontaneous intracranial hypotension (SIH). Surgical ligation of CVF has been reported, but clinical outcomes are not well described. OBJECTIVE To determine the clinical efficacy of surgical ligation for treatment of CVF. METHODS Outcomes metrics were collected in this prospective, single-arm, cross-sectional investigation. Inclusion criteria were as follows: diagnosis of SIH, demonstration of CVF on myelography, and surgical treatment of CVF. Pre- and postoperative headache severity was assessed with the Headache Impact Test (HIT-6), a validated headache scale ranging from 36 (asymptomatic) to 78 (most severe). Patient satisfaction with treatment was measured with Patient Global Impression of Change (PGIC). RESULTS Twenty subjects were enrolled, with mean postoperative follow-up at 16.0 ± 9.7 mo. All CVFs were located in the thoracic region (between T4 and T12). Pretreatment headache severity was high (mean HIT-6 scores 65 ± 6). Surgical treatment resulted in marked improvement in headache severity (mean HIT-6 change of -21 ± -9, mean postoperative HIT-6 of 44 ± 8). Of subjects with baseline headache scores in the most severe category, 83% showed a major improvement in severity (transition to the lowest 2 severity categories) after surgery. All subjects (100%) reported clinically significant levels of satisfaction with treatment (PGIC score 6 or 7); 90% reported the highest level of satisfaction. There were no short- or long-term complications or 30-d readmissions. CONCLUSION Surgical ligation is highly effective for the treatment of SIH due to CVF. Larger controlled trials with longer follow-up period are indicated to better assess its long-term efficacy and safety profile.
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Affiliation(s)
- Timothy Y Wang
- Duke University Department of Neurological Surgery, Durham, North Carolina
| | - Isaac O Karikari
- Duke University Department of Neurological Surgery, Durham, North Carolina
| | | | - Linda Gray
- Duke University Department of Radiology, Durham, North Carolina
| | - Peter G Kranz
- Duke University Department of Radiology, Durham, North Carolina
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Schwedt TJ, Sahai-Srivastava S, Murinova N, Birlea M, Ahmed Z, Digre K, Lopez K, Mullally W, Blaya MT, Pippitt K, Cutrer FM, DeLange J, Schecht H, Rizzoli P, Lane J, Wald J, Cortez MM, Martin VT, Spare NM, Hentz JG, Robert T, Dodick DW. Determinants of pain interference and headache impact in patients who have chronic migraine with medication overuse: Results from the MOTS trial. Cephalalgia 2021; 41:1053-1064. [PMID: 33938249 DOI: 10.1177/03331024211006903] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE "Pain interference" and "headache impact" refer to negative consequences that pain and headache have on one's life. This study investigated determinants of these negative impacts in a large patient cohort who have chronic migraine with medication overuse. METHODS Six hundred and eleven adults were enrolled from 34 headache, neurology, and primary care clinics. Negative consequences of chronic migraine with medication overuse were determined using the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference 6b questionnaire and the Headache Impact Test 6. Relationships between PROMIS-6b and Headache Impact Test 6 scores with demographics, headache characteristics, medication use, anxiety symptoms, and depression symptoms were assessed with linear regression. Elastic Net regression was used to develop a multiple regression model. RESULTS PROMIS-6b T-Scores averaged 65.2 (SD 5.4) and Headache Impact Test 6 scores averaged 65.0 (SD 5.3), indicating severe negative consequences of chronic migraine with medication overuse. Chronic migraine with medication overuse interfered with enjoyment of life, concentration, daily activities, doing tasks away from home, and socializing. Depression symptom severity had the strongest relationship with pain interference and headache impact. Moderate-to-severe headache frequency, headache intensity, and anxiety symptoms were also associated with pain interference and headache impact. CONCLUSIONS Chronic migraine with medication overuse is associated with substantial negative consequences, the extent of which is most strongly related to depression symptoms.
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Affiliation(s)
| | | | - Natalia Murinova
- University of Washington, Department of Neurology, Seattle, WA, USA
| | - Marius Birlea
- University of Colorado, Department of Neurology, Denver, CO, USA
| | - Zubair Ahmed
- Cleveland Clinic Foundation, Department of Neurology, Cleveland, OH, USA
| | - Kathleen Digre
- University of Utah, Department of Neurology, Salt Lake City, UT, USA
| | - Kristina Lopez
- West Virginia University, Department of Neurology, Morgantown, WV, USA
| | - William Mullally
- Brigham and Women's Hospital, Department of Neurology, Boston, MA, USA
| | | | - Karly Pippitt
- University of Utah, Department of Family and Preventive Medicine, Salt Lake City, UT, USA
| | | | - Justin DeLange
- Northern Arizona Healthcare, Department of Neurology, Flagstaff, AZ, USA
| | - Howard Schecht
- The Toledo Clinic, Department of Neurology, Toledo, OH, USA
| | - Paul Rizzoli
- Brigham and Women's Hospital, Department of Neurology, Boston, MA, USA
| | - Judy Lane
- Blue Sky Neurology, Department of Neurology, Denver, CO, USA
| | - John Wald
- Henry Ford Allegiance, Department of Neurology, Jackson, MI, USA
| | - Melissa M Cortez
- University of Utah, Department of Neurology, Salt Lake City, UT, USA
| | - Vincent T Martin
- University of Cincinnati, Department of Internal Medicine, Cincinnati, OH, USA
| | - Nicole M Spare
- Thomas Jefferson University, Department of Neurology, Philadelphia, PA, USA
| | | | - Teri Robert
- Patient advocate and educator, Washington, WV, USA
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Cortez MM, Millsap L, Rea NA, Sciarretta C, Brennan KC. Photophobia and allodynia in persistent post-traumatic headache are associated with higher disease burden. Cephalalgia 2021; 41:1089-1099. [PMID: 33910382 DOI: 10.1177/03331024211010304] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess photophobia and allodynia in subjects with post-traumatic headache and examine how these sensory hypersensitivities associate with clinical measures of disease burden. BACKGROUND Post-traumatic headache is the most frequent and disabling long-term consequence of mild traumatic brain injury. There is evidence of sensory dysfunction in acute post-traumatic headache, and it is known from other headache conditions that sensory amplifications correlate with more severe disease. However, systematic studies in post-traumatic headache are surprisingly scarce. METHODS We tested light and tactile sensitivity, along with measures of disease burden, in 30 persistent post-traumatic headache subjects and 35 controls. RESULTS In all, 79% of post-traumatic headache subjects exhibited sensory hypersensitivity based on psychophysical assessment. Of those exhibiting hypersensitivity, 54% exhibited both light and tactile sensitivity. Finally, sensory thresholds were correlated across modalities, as well as with headache attack frequency. CONCLUSIONS In this study, post-traumatic headache subjects with both light and tactile sensitivity had significantly higher headache frequencies and lower sensitivity thresholds to both modalities, compared to those with single or no sensory hypersensitivity. This pattern suggests that hypersensitivity across multiple modalities may be functionally synergistic, reflect a higher disease burden, and may serve as candidate markers of disease.
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Affiliation(s)
- Melissa M Cortez
- University of Utah, Department of Neurology, Salt Lake City, UT, USA
| | - Leah Millsap
- University of Utah, Department of Neurology, Salt Lake City, UT, USA
| | - Natalie A Rea
- University of Utah, School of Medicine, Salt Lake City, UT, USA.,Mayo Clinic, Rochester, MN, USA
| | | | - K C Brennan
- University of Utah, Department of Neurology, Salt Lake City, UT, USA
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45
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Smith KE, Thomas JG, Steffen KJ, Lipton RB, Farris SG, Pavlovic JM, Bond DS. Naturalistic assessment of patterns and predictors of acute headache medication use among women with comorbid migraine and overweight or obesity. Transl Behav Med 2021; 11:1495-1506. [PMID: 33823051 DOI: 10.1093/tbm/ibab027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Given the potential for obesity to complicate migraine treatment outcomes, there is a need to understand patterns and correlates of acute medication use among individuals with this comorbidity. Experience sampling methodology (ESM) was used to characterize patterns of acute medication use among those with migraine and overweight/obesity and to examine individual and momentary factors related to medication use (both migraine-specific and nonspecific medications). Women with migraine and overweight/obesity (N = 170) seeking behavioral migraine treatment completed questionnaires followed by 28 days of daily ESM headache diaries. Participants used medications to treat 71.9% of attacks, 20% of which were treated with migraine-specific medications. Participants were more likely to use medication in the context of longer and more severe attacks that started earlier in the day. Presence of aura and greater work-related pain interference uniquely related to migraine-specific medication use. Questionnaire-assessed factors were not related to medication use, although older age and higher educational attainment related to more frequent use. A substantial proportion of attacks were left untreated, suggesting unmet treatment needs in this population. Results also suggest that ESM-assessed factors are more salient correlates of medication use compared to questionnaires. Additional investigation of barriers to medication use is needed.
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Affiliation(s)
- Kathryn E Smith
- Department of Psychiatry and Behavioral Sciences, University of Southern California, 2250 Alcazar St #2200, Los Angeles, CA, USA
| | - J Graham Thomas
- Weight Control and Diabetes Research Center, The Miriam Hospital/Brown Alpert Medical School, Providence, RI, USA
| | - Kristine J Steffen
- Sanford Center for Bio-behavioral Research, Fargo, ND, USA.,Department of Pharmaceutical Sciences, College of Health Professions, North Dakota State University, Fargo, ND, USA
| | - Richard B Lipton
- Montefiore Headache Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Samantha G Farris
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Jelena M Pavlovic
- Montefiore Headache Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dale S Bond
- Weight Control and Diabetes Research Center, The Miriam Hospital/Brown Alpert Medical School, Providence, RI, USA
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Díaz-de-Terán J, Sastre-Real M, Lobato-Pérez L, Navarro-Fernández G, Elizagaray-García I, Gil-Martínez A. Cluster headache, beyond the pain: a comparative cross-sectional study. Neurol Sci 2021; 42:3673-3680. [PMID: 33439388 DOI: 10.1007/s10072-020-04996-0] [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: 09/21/2020] [Accepted: 12/12/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the presence of allodynia, pain catastrophizing, and the impact of headaches on patients with cluster headache (CH) and healthy individuals. Our second aim was to analyze the relationship between catastrophism, psychological comorbidities, and the impact in CH. METHODS We designed this cross-sectional study to compare various factors among 47 patients diagnosed with CH and 40 healthy controls, and then focus on catastrophism, anxiety, depression, and impact in the CH group. RESULTS There were statistically significant differences between CH and the asymptomatic group in Allodynia Symptom Checklist (ASC) (p < 0.001), Pain Catastrophizing Scale (p < 0.001), and HIT-6 (p < 0.001) scores. We found a correlation among ASC, PCS, anxiety-depression, EuroQoL, and HIT-6 for the CH group. In this group, we observed a strong positive correlation between PCS and anxiety (rho = 0.69; p < 0.001), PCS and depression (rho = 0.62; p < 0.001) and depression and EuroQoL (rho = - 0.68; p < 0.001). The regression model showed that the combination of anxiety and HIT-6 was a significant predictor of PCS (adjusted R2 = 0.52). DISCUSSION Our findings reveal significant differences regarding allodynia, pain catastrophism, and impact in CH group compared with controls. We found a significant relationship between psychological comorbidity, pain catastrophism, and quality of life in CH patients. Anxiety and HIT-6 were a predictor (adjusted R2 = 52%) of pain catastrophism. Screening for these comorbidities should be implemented through a multidisciplinary approach.
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Affiliation(s)
- Javier Díaz-de-Terán
- Department of Neurology, La Paz University Hospital, Madrid, Spain
- La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Departamento de Fisioterapia, Universidad Autónoma de Madrid, Madrid, Spain
| | - María Sastre-Real
- Department of Neurology, La Paz University Hospital, Madrid, Spain
- La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Luis Lobato-Pérez
- Department of Neurology, La Paz University Hospital, Madrid, Spain
- La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Gonzalo Navarro-Fernández
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Departamento de Fisioterapia, Universidad Autónoma de Madrid, Madrid, Spain
- Centro Superior de Estudios Universitarios La Salle, Departamento de Fisioterapia, Universidad Autónoma de Madrid, C/La Salle, 10, Edificio C, 28036, Madrid, Spain
| | - Ignacio Elizagaray-García
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Departamento de Fisioterapia, Universidad Autónoma de Madrid, Madrid, Spain
- Centro Superior de Estudios Universitarios La Salle, Departamento de Fisioterapia, Universidad Autónoma de Madrid, C/La Salle, 10, Edificio C, 28036, Madrid, Spain
| | - Alfonso Gil-Martínez
- La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain.
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Departamento de Fisioterapia, Universidad Autónoma de Madrid, Madrid, Spain.
- Centro Superior de Estudios Universitarios La Salle, Departamento de Fisioterapia, Universidad Autónoma de Madrid, C/La Salle, 10, Edificio C, 28036, Madrid, Spain.
- Unit of Physiotherapy, La Paz University Hospital, Madrid, Spain.
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Schwedt TJ, Hentz JG, Sahai-Srivastava S, Spare NM, Martin VT, Treppendahl C, Digre K, Bennett NL, Birlea M, Watson D, Murinova N, Robert T, Dodick DW. Headache characteristics and burden from chronic migraine with medication overuse headache: Cross-sectional observations from the Medication Overuse Treatment Strategy trial. Headache 2021; 61:351-362. [PMID: 33432635 DOI: 10.1111/head.14056] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/12/2020] [Accepted: 12/02/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To describe headache characteristics, medication use, disability, and quality of life in a large patient cohort from the United States who have chronic migraine (CM) and medication overuse headache (MOH). METHODS In all, 610 adult patients were enrolled into the Medication Overuse Treatment Strategy trial from 34 healthcare clinics, including headache specialty, general neurology, and primary care clinics. Descriptive statistics characterize baseline demographics, headache characteristics, medication use, disability (Headache Impact Test 6 [HIT-6] and Migraine Functional Impact Questionnaire [MFIQ]), pain interference (PROMIS Pain Interference), and quality of life (EQ-5D-5L). Relationships with headache frequency were assessed. RESULTS Mean age was 45 years (SD 13) and 531/608 (87.3%) were females. Mean headache days per 30 was 24.3 (SD 5.5), including 13.6 (SD 7.1) with moderate to severe headache. Daily headaches were reported by 36.1% (219/607) of patients. Acute headache medications were used on 21.5 (SD 7.5) per 30 days. The most commonly overused medications were simple analgesics (378/607, 62% of patients), combination analgesics (246/607, 41%), and triptans (128/607, 21%). HIT-6, MFIQ, PROMIS Pain Interference, and EQ-5D-5L scores demonstrated substantial negative impact from CM with MOH on patient functioning and quality of life. Higher headache frequency was associated with more moderate-severe headache days, more frequent acute headache medication use, greater headache-related disability, and lower quality of life. Only 272/606 (44.9%) were taking migraine preventive medication. CONCLUSIONS CM with MOH is associated with a large burden on patients in the United States. Higher headache frequency is associated with greater impact on functioning, pain interference, and quality of life.
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Affiliation(s)
| | | | | | - Nicole M Spare
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vincent T Martin
- Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA
| | | | - Kathleen Digre
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | | | - Marius Birlea
- Department of Neurology, University of Colorado, Denver, CO, USA
| | - David Watson
- Department of Neurology, West Virginia University, Morgantown, WV, USA
| | - Natalia Murinova
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Teri Robert
- Patient Advocate and Educator, Washington, WV, USA
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Pradela J, Bevilaqua-Grossi D, Chaves TC, Dach F, Carvalho GF. Measurement properties of the Headache Impact Test (HIT-6™ Brazil) in primary and secondary headaches. Headache 2021; 61:527-535. [PMID: 33432581 DOI: 10.1111/head.14049] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Headache Impact Test-6™ is a widely recommended questionnaire to evaluate the impact of headaches. However, its measurement properties were never evaluated in both primary and secondary headaches, and the Brazilian Portuguese version of the questionnaire was never assessed at all. OBJECTIVE To assess the reliability, and structural and construct validity of the Headache Impact Test-Brazil™ in patients with primary and secondary headaches. METHODS In total, 132 patients with primary and secondary headaches were included, screened from a headache tertiary clinic. They completed the Headache Impact Test-Brazil™ questionnaire, the 12-Item Short-Form Survey (SF-12), and the Headache Disability Inventory-Brazil. Pearson's correlation analysis was performed among the three questionnaires for validity assessment. One to three weeks after the first application, the Headache Impact Test-Brazil™ was answered again by 67 patients for reliability assessment. RESULTS The validity sample consisted of 86/132 (65.1%) patients with primary and 46/132 (34.9%) secondary headaches, with mean age of 39.6 (SD: 12.7) years. The reliability sample consisted of 39/67 (58.2%) patients with primary and 28/67 (41.8%) secondary headaches, with mean age of 36.8 (12.5) years. According to the confirmatory factor analysis, the Headache Impact Test-Brazil™ consists of single factor. Its internal consistency was α = 0.97 and the question number 3 had the lowest factor loading (0.31). The Headache Impact Test-Brazil™ exhibited a moderate correlation with both the SF-12 questionnaire (r = -0.64, 95%CI: -0.72 to -0.52, p = 0.001) and the Headache Disability Inventory-Brazil (r = 0.67, 95%CI: 0.56 to 0.75, p = 0.001). The correlation between the Headache Impact Test-Brazil™ and the headache frequency was weak (r = 0.22, 95%CI: 0.04 to 0.39, p = 0.001), and with the headache intensity, moderate (r = 0.44, 95%CI: 0.23 to 0.62, p = 0.001). The Headache Impact Test-Brazil™ test-retest reliability was excellent (ICC = 0.95) with a standard error of 1.58 and a smallest detectable change of 4.38 points. CONCLUSION The Headache Impact Test-6-Brazil™ can be considered as a valid and reliable tool to assess the impact of several headache types. Future studies may revise the questionnaire items to confirm its redundancy.
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Affiliation(s)
- Juliana Pradela
- Department of Health Sciences - Ribeirão Preto Medical School, University de São Paulo, Ribeirão Preto, Brazil
| | - Débora Bevilaqua-Grossi
- Department of Health Sciences - Ribeirão Preto Medical School, University de São Paulo, Ribeirão Preto, Brazil
| | - Thais C Chaves
- Department of Health Sciences - Ribeirão Preto Medical School, University de São Paulo, Ribeirão Preto, Brazil
| | - Fabiola Dach
- Department of Neurosciences and Behavioral Sciences - Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Gabriela F Carvalho
- Department of Health Sciences - Ribeirão Preto Medical School, University de São Paulo, Ribeirão Preto, Brazil.,Institute of Health Sciences, Academic Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), University of Luebeck, Luebeck, Germany
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Silberstein SD, Cohen JM, Yang R, Gandhi SK, Du E, Jann AE, Marmura MJ. Treatment benefit among migraine patients taking fremanezumab: results from a post hoc responder analysis of two placebo-controlled trials. J Headache Pain 2021; 22:2. [PMID: 33413075 PMCID: PMC7792179 DOI: 10.1186/s10194-020-01212-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/12/2020] [Indexed: 12/23/2022] Open
Abstract
Background Monoclonal antibodies targeting the calcitonin gene-related peptide (CGRP) pathway, including the fully humanized monoclonal antibody (IgG2Δa) fremanezumab, have demonstrated safety and efficacy for migraine prevention. Clinical trials include responders and nonresponders; efficacy outcomes describe mean values across both groups and thus provide little insight into the clinical benefit in responders. Clinicians and their patients want to understand the extent of clinical improvement in patients who respond. This post hoc analysis of fremanezumab treatment attempts to answer this question: what is the benefit in subjects who responded to treatment during the two, phase 3 HALO clinical trials? Methods We included subjects with episodic migraine (EM) or chronic migraine (CM) who received fremanezumab quarterly (675 mg/placebo/placebo) or monthly (EM: 225 mg/225 mg/225 mg; CM: 675 mg/225 mg/225 mg) during the 12-week randomized, double-blind, placebo-controlled HALO EM and HALO CM clinical trials. EM and CM responders were defined as participants with a reduction of ≥ 2 or ≥ 4 monthly migraine days, respectively. Treatment benefits evaluated included reductions in monthly migraine days, acute headache medication use, and headache-related disability, and changes in health-related quality of life (HRQoL). Results Overall, 857 participants from the HALO trials were identified as responders (EM: 429 [73.8%]; CM: 428 [56.7%]). Reductions in the monthly average number of migraine days were greater among EM (quarterly: 5.4 days; monthly: 5.5 days) and CM (quarterly: 8.7 days; monthly: 9.1 days) responders compared with the overall population. The proportion of participants achieving ≥ 50% reduction in the average monthly number of migraine days was also greater in responders (EM: quarterly, 59.8%; monthly, 63.7%; CM: quarterly, 52.8%; monthly, 59.0%) than in the overall population. Greater reductions in the average number of days of acute headache medication use, greater reductions in headache-related disability scores, and larger improvements in HRQoL were observed among EM and CM responders compared with the overall populations. Conclusions Fremanezumab responders achieved clinically meaningful improvements in all outcomes. The magnitude of improvements with fremanezumab across efficacy outcomes was far greater in responders than in the overall trial population, providing insight into expected treatment benefits in participants who respond to fremanezumab in clinical practice. Trial registration ClinicalTrials.gov identifiers: NCT02629861 (HALO EM) and NCT02621931 (HALO CM).
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Affiliation(s)
| | - Joshua M Cohen
- Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA
| | - Ronghua Yang
- Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA
| | - Sanjay K Gandhi
- Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA
| | - Evelyn Du
- Teva Branded Pharmaceutical Products R&D, Inc., West Chester, PA, USA
| | - Adelene E Jann
- Department of Neurology, NYU Langone Health, New York, NY, USA
| | - Michael J Marmura
- Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, USA
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50
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Treatment of migraine: a review of disease burden and an update on the therapeutic landscape for pharmacists. DRUGS & THERAPY PERSPECTIVES 2020. [DOI: 10.1007/s40267-020-00801-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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