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Daou M, Vgontzas A. Sleep Symptoms in Migraine. Curr Neurol Neurosci Rep 2024; 24:245-254. [PMID: 38864968 DOI: 10.1007/s11910-024-01346-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE OF REVIEW To review replicated and highlight novel studies of sleep in children and adults with episodic and chronic migraine. RECENT FINDINGS Attack-related sleep symptoms are most common in the prodrome and may represent early activation of the hypothalamus rather than migraine triggers. Interictally, patients with migraine report poor sleep quality and high rates of insomnia symptoms. Cognitive behavioral therapy for insomnia in adults and adolescents with chronic migraine and comorbid insomnia results in significant improvement on their headache burden. Thus far, objective studies report that migraine per se is a not associated with sleep apnea. At the present time, there is minimal evidence that migraine is under circadian influence. The current body of evidence suggests that the insomnia symptoms and poor sleep quality commonly reported by patients with migraine are not attack-related but occur interictally and are a marker of worsening disease. The development of clinical guidelines to approach sleep symptoms and expansion of CBT-I trials in those with episodic migraine would be clinically valuable.
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Affiliation(s)
- Marc Daou
- Department of Neurology, Tufts Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Angeliki Vgontzas
- Division of Headache Medicine, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Graham Headache Center, Department of Neurology, Brigham and Women's Faulkner Hospital, 1153 Centre Street Suite 4H, 02130, Boston, MA, USA.
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Cha C, Kim O, Pang Y, Jeong H, Lee JE, Lee H, Dan H. Migraine incidence and coffee consumption among child-bearing age women: the Korea Nurses' Health Study. Sci Rep 2024; 14:12760. [PMID: 38834559 DOI: 10.1038/s41598-024-53302-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 01/30/2024] [Indexed: 06/06/2024] Open
Abstract
This longitudinal study aimed to identify factors that influence migraines in Korean women nurses using data from the Korea Nurses' Health Study. Among those who participated in Survey 1 (2013-2014) and the follow-up survey (2015-2019), we selected 2605 participants for Cox proportional hazard regression analysis, 521 participants who were newly diagnosed with migraine and 2084 controls using a 1:4 incidence density sampling approach. Consuming coffee (≥ 3 cups: RR = 1.666; 95% CI = 1.175-2.362, < 3 cups: RR = 1.439; 95% CI = 1.053-1.966), being obese (BMI ≥ 25: RR = 1.341, 95% CI = 1.003-1.793), and engaging in vigorous physical activity (RR = 1.010; 95% CI = 1.000-1.019) increased the risk of developing a migraine. Nurses with an annual salary greater than $3500 were less likely to develop migraines (RR = 0.786, 95% CI = 0.631-0.979). The results imply that lifestyle factors, such as the amount of coffee consumption, BMI level, and degree of physical activity could be considered when formulating treatment plans for women who have newly developed migraines.
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Grants
- 2013-E63006-00, 2016-ER-6305-00, 2016-ER-6305-02, 2019-ER-7101-02 Research of the Korea National Institute of Health
- 2013-E63006-00, 2016-ER-6305-00, 2016-ER-6305-02, 2019-ER-7101-02 Research of the Korea National Institute of Health
- 2013-E63006-00, 2016-ER-6305-00, 2016-ER-6305-02, 2019-ER-7101-02 Research of the Korea National Institute of Health
- 2013-E63006-00, 2016-ER-6305-00, 2016-ER-6305-02, 2019-ER-7101-02 Research of the Korea National Institute of Health
- 2013-E63006-00, 2016-ER-6305-00, 2016-ER-6305-02, 2019-ER-7101-02 Research of the Korea National Institute of Health
- 2013-E63006-00, 2016-ER-6305-00, 2016-ER-6305-02, 2019-ER-7101-02 Research of the Korea National Institute of Health
- 2013-E63006-00, 2016-ER-6305-00, 2016-ER-6305-02, 2019-ER-7101-02 Research of the Korea National Institute of Health
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Affiliation(s)
- Chiyoung Cha
- College of Nursing, Ewha Womans University, Seoul, Korea
- System Health and Engineering Major in Graduate School, Ewha Research Institute of Nursing Science, Ewha Womans University, Seoul, Korea
| | - Oksoo Kim
- College of Nursing, Ewha Womans University, Seoul, Korea
| | - Yanghee Pang
- Department of Nursing, Seoil University, Seoul, Korea
| | - Hyunseon Jeong
- College of Nursing, Seoul Woman's College of Nursing, Seoul, Korea
| | - Jung Eun Lee
- Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul, Korea
- Research Institute of Human Ecology, Seoul National University, Seoul, Korea
| | - Heayoung Lee
- Department of Nursing, Doowon Technical University, AnSung-Si, Korea
| | - Hyunju Dan
- Department of Nursing, Hwasung Medi-Science University, 400-5, Namyangchungang-Ro, Namyang-Eup, Hwasung-Si, 18274, Kyunggi-Do, Korea.
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Pohl H, Neumeier MS, Hänsel M, Wegener S. The prevalence of head and face pain decreased from 1997 to 2017 in Switzerland. Pain Pract 2024; 24:709-716. [PMID: 38251757 DOI: 10.1111/papr.13346] [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] [Indexed: 01/23/2024]
Abstract
BACKGROUND Pain in the head and the face is highly prevalent but may have changed during the past years. This study aimed to analyze changes in the prevalence of pain in the head and the face in Switzerland from 1997 to 2017. METHODS This is a secondary analysis of data collected in the Swiss Health Surveys of 1997-2017. Included persons were 15 years and older. Besides studying demographic data, we analyze the item assessing the presence of "headache, pressure in the head, or facial pain" during the past 4 weeks. Percentages with their Wilson confidence intervals are reported for each response option of categorical variables. Moreover, we calculate the age-standardized number of persons affected by the pain. RESULTS While 41% reported head and face pain in 1997, the proportion dropped to 31% in 2017. There was a decrease of 19.5% in women and 29.4% in men; after age standardization, the decrease was 16.5% in women and 25.4% in men. The most considerable numerical changes in the percentages of women with pain occurred in those aged 55-69 and 85 and above. In men, the changes were not limited to specific age groups. CONCLUSIONS The proportion of people reporting headaches, pressure in the head, or facial pain has dropped in Switzerland from 1997 to 2017. However, in women, the prevalence diminished more strongly and consistently in the middle-aged and the elderly than in the young.
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Affiliation(s)
- Heiko Pohl
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | | | - Martin Hänsel
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Susanne Wegener
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
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Cho S, Kim KM, Chu MK. Coffee consumption and migraine: a population-based study. Sci Rep 2024; 14:6007. [PMID: 38472388 PMCID: PMC10933282 DOI: 10.1038/s41598-024-56728-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/11/2024] [Indexed: 03/14/2024] Open
Abstract
Although coffee is one of the most consumed caffeinated beverages worldwide, the role of coffee consumption in migraine is controversial. This study examined the relationship between coffee consumption and clinical characteristics in participants with migraine compared to those with non-migraine headache. This cross-sectional study used data from a nationwide survey on headache and sleep. Coffee consumption was classified as no-to-low (< 1 cup/day), moderate (1-2 cups/day), or high (≥ 3 cups/day). Of the 3030 survey participants, 170 (5.6%) and 1,768 (58.3%) were identified as having migraine and non-migraine headache, respectively. Coffee consumption tended to increase in the order of non-headache, non-migraine headache, and migraine (linear-by-linear association, p = 0.011). Although psychiatric comorbidities (depression for migraine and anxiety for non-migraine headache) and stress significantly differed according to coffee consumption, most headache characteristics and accompanying symptoms did not differ among the three groups for participants with migraine and non-migraine headache. Response to acute headache treatment-adjusted for age, sex, depression, anxiety, stress, preventive medication use, and current smoking-was not significantly different by coffee consumption in participants with migraine and non-migraine headache. In conclusion, most headache-related characteristics and acute treatment response did not significantly differ by coffee consumption in migraine and non-migraine headache.
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Affiliation(s)
- Soomi Cho
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Kyung Min Kim
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Lateef TM, Dey D, Leroux A, Cui L, Xiao M, Zipunnikov V, Merikangas KR. Association Between Electronic Diary-Rated Sleep, Mood, Energy, and Stress With Incident Headache in a Community-Based Sample. Neurology 2024; 102:e208102. [PMID: 38266217 PMCID: PMC11383878 DOI: 10.1212/wnl.0000000000208102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/07/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to examine the diurnal links between average and changes in average levels of prospectively rated mood, sleep, energy, and stress as predictors of incident headache in a community-based sample. METHODS This observational study included structured clinical diagnostic assessment of both headache syndromes and mental disorders and electronic diaries that were administered 4 times per day for 2 weeks yielding a total of 4,974 assessments. The chief outcomes were incident morning (am) and later-day (pm) headaches. Generalized linear mixed-effects models were used to evaluate the average and lagged values of predictors including subjectively rated mood, anxiety, energy, stress, and sleep quality and objectively measured sleep duration and efficiency on incident am and pm headaches. RESULTS The sample included 477 participants (61% female), aged 7 through 84 years. After adjusting for demographic and clinical covariates and emotional states, incident am headache was associated with lower average (ß = -0.206*; confidence intervals: -0.397 to -0.017) and a decrease in average sleep quality on the prior day (ß = -0.172*; confidence interval: -0.305, -0.039). Average stress and changes in subjective energy levels on the prior day were associated with incident headaches but with different valence for am (decrease) (ß = -0.145* confidence interval: -0.286, -0.005) and pm (increase) (ß = 0.157*; confidence interval: 0.032, 0.281) headache. Mood and anxiety disorders were not significantly associated with incident headache after controlling for history of a diagnosis of migraine. DISCUSSION Both persistent and acute changes in arousal states manifest by subjective sleep quality and energy are salient precursors of incident headaches. Whereas poorer sleep quality and decreased energy on the prior day were associated with incident morning headache, an increase in energy and greater average stress were associated with headache onsets later in the day. Different patterns of predictors of morning and later-day incident headache highlight the role of circadian rhythms in the manifestations of headache. These findings may provide insight into the pathophysiologic processes underlying migraine and inform clinical intervention and prevention. Tracking these systems in real time with mobile technology provides a valuable ancillary tool to traditional clinical assessments.
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Affiliation(s)
- Tarannum M Lateef
- From the Children's National Health System (T.M.L.), Pediatric Specialists of Virginia, and George Washington University of Medicine; Intramural Research Program (T.M.L., D.D., L.C., K.R.M.), Section on Developmental Genetic Epidemiology, National Institute of Mental Health, Bethesda, MD; Department of Biostatistics and Informatics (A.L.), University of Colorado School of Public Health, Denver; Child Mind Institute (M.X.), New York; Department of Biostatistics (V.Z.); and Department of Epidemiology (K.R.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Debangan Dey
- From the Children's National Health System (T.M.L.), Pediatric Specialists of Virginia, and George Washington University of Medicine; Intramural Research Program (T.M.L., D.D., L.C., K.R.M.), Section on Developmental Genetic Epidemiology, National Institute of Mental Health, Bethesda, MD; Department of Biostatistics and Informatics (A.L.), University of Colorado School of Public Health, Denver; Child Mind Institute (M.X.), New York; Department of Biostatistics (V.Z.); and Department of Epidemiology (K.R.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Andrew Leroux
- From the Children's National Health System (T.M.L.), Pediatric Specialists of Virginia, and George Washington University of Medicine; Intramural Research Program (T.M.L., D.D., L.C., K.R.M.), Section on Developmental Genetic Epidemiology, National Institute of Mental Health, Bethesda, MD; Department of Biostatistics and Informatics (A.L.), University of Colorado School of Public Health, Denver; Child Mind Institute (M.X.), New York; Department of Biostatistics (V.Z.); and Department of Epidemiology (K.R.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lihong Cui
- From the Children's National Health System (T.M.L.), Pediatric Specialists of Virginia, and George Washington University of Medicine; Intramural Research Program (T.M.L., D.D., L.C., K.R.M.), Section on Developmental Genetic Epidemiology, National Institute of Mental Health, Bethesda, MD; Department of Biostatistics and Informatics (A.L.), University of Colorado School of Public Health, Denver; Child Mind Institute (M.X.), New York; Department of Biostatistics (V.Z.); and Department of Epidemiology (K.R.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mike Xiao
- From the Children's National Health System (T.M.L.), Pediatric Specialists of Virginia, and George Washington University of Medicine; Intramural Research Program (T.M.L., D.D., L.C., K.R.M.), Section on Developmental Genetic Epidemiology, National Institute of Mental Health, Bethesda, MD; Department of Biostatistics and Informatics (A.L.), University of Colorado School of Public Health, Denver; Child Mind Institute (M.X.), New York; Department of Biostatistics (V.Z.); and Department of Epidemiology (K.R.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Vadim Zipunnikov
- From the Children's National Health System (T.M.L.), Pediatric Specialists of Virginia, and George Washington University of Medicine; Intramural Research Program (T.M.L., D.D., L.C., K.R.M.), Section on Developmental Genetic Epidemiology, National Institute of Mental Health, Bethesda, MD; Department of Biostatistics and Informatics (A.L.), University of Colorado School of Public Health, Denver; Child Mind Institute (M.X.), New York; Department of Biostatistics (V.Z.); and Department of Epidemiology (K.R.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kathleen R Merikangas
- From the Children's National Health System (T.M.L.), Pediatric Specialists of Virginia, and George Washington University of Medicine; Intramural Research Program (T.M.L., D.D., L.C., K.R.M.), Section on Developmental Genetic Epidemiology, National Institute of Mental Health, Bethesda, MD; Department of Biostatistics and Informatics (A.L.), University of Colorado School of Public Health, Denver; Child Mind Institute (M.X.), New York; Department of Biostatistics (V.Z.); and Department of Epidemiology (K.R.M.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Zhu G, Wang M, Wang Y, Kong F. Assessing the association between age at first sexual intercourse and migraine: a Mendelian randomization study. Front Neurol 2024; 15:1347831. [PMID: 38379708 PMCID: PMC10876792 DOI: 10.3389/fneur.2024.1347831] [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: 12/01/2023] [Accepted: 01/23/2024] [Indexed: 02/22/2024] Open
Abstract
Background and objectives As indicated by observational and genetic variation studies, age at first sexual intercourse (AFS) may be associated with migraine attack, but there is a lack of evidence from real-world studies due to ethical concerns. Therefore, we conducted a Mendelian randomization study to determine the causal relationship between AFS and migraine. Methods We extracted instrumental variables from summary data of a genome-wide association study (GWAS) on AFS and migraine and then conducted two-sample Mendelian randomization analyses. GWAS data for AFS and migraine were obtained from 397,338 unrelated individuals (214,547 females and 182,791 males) and 306,314 individuals (18,477 patients and 287,837 control individuals), respectively. Results There was a causal relationship between AFS and risk for migraine (odds ratio (OR) = 0.73, 95% confidence interval (CI) [0.61 to 0.86]), both for migraine with aura (MWA; OR = 0.72, 95% CI [0.58 to 0.89]) and migraine without aura (MOA; OR = 0.66, 95% CI [0.51 to 0.86]). Stratified analyses provided suggestive evidence of the causal relationship between delayed AFS and a decreased risk of migraine for both males (OR = 0.71, 95% CI [0.59 to 0.84]) and females (OR = 0.73, 95% CI [0.61 to 0.89]). Reverse Mendelian randomization did not reveal any effect of migraine on AFS (p > 0.05). No pleiotropy was detected. Discussion A delayed AFS is a protective factor against migraine (for both MWA and MOA) in both males and females. This causal relationship indicates the presence of extracranial regulatory pathways of migraine.
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Affiliation(s)
- Guoliang Zhu
- Department of Neurology, The Affiliated Hospital of Yunnan University, Kunming, Yunnan, China
- School of Clinical Medicine, Dali University, Dali, Yunnan, China
| | - Miao Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yawen Wang
- School of Clinical Medicine, Dali University, Dali, Yunnan, China
- Department of Radiology, The Affiliated Hospital of Yunnan University, Kunming, Yunnan, China
| | - Fanyi Kong
- Department of Neurology, The Affiliated Hospital of Yunnan University, Kunming, Yunnan, China
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Tereshko Y, Dal Bello S, Di Lorenzo C, Pittino A, Filippi F, Belgrado E, Lettieri C, Merlino G, Gigli GL, Valente M. The Effect of Three Different Ketogenic Diet Protocols on Migraine and Fatigue in Chronic and High-Frequency Episodic Migraine: A Pilot Study. Nutrients 2023; 15:4334. [PMID: 37892410 PMCID: PMC10609491 DOI: 10.3390/nu15204334] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/03/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
AIMS We aimed to evaluate the efficacy of three different ketogenic diets on migraine and fatigue in chronic and high-frequency episodic migraineurs. METHODS 76 patients with migraine were treated with the KD for at least three months. Three different KD protocols were used (2:1 KD, LGID, and VLCKD). We evaluated the fatigue severity scale (FSS), migraine frequency, migraine intensity, MIDAS, and HIT-6 at the baseline and 3-month follow-up, and we compared the results. We also correlated the mean FSS reduction with the mean migraine frequency, migraine intensity, BMI, fat mass, free-fat mass, MIDAS, and HIT-6 reduction. RESULTS FSS improved from 4.977 ± 1.779 to 3.911 ± 1.779 at the 3-month follow-up (p < 0.001). This improvement was significant in both high-frequency and chronic migraineurs. Moreover, the three KD protocols effectively improved migraine intensity, frequency, MIDAS, and HIT-6. There was a mild correlation between mean FSS reduction (p < 0.001), mean MIDAS (p = 0.001), and HIT-6 (p = 0.002) reduction. CONCLUSIONS The VLCKD, LGID, and 2:1 KD may improve migraine intensity, frequency, and fatigue in chronic and high-frequency episodic migraineurs.
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Affiliation(s)
- Yan Tereshko
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy (F.F.); (G.M.); (M.V.)
| | - Simone Dal Bello
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy (F.F.); (G.M.); (M.V.)
| | - Cherubino Di Lorenzo
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, 04100 Latina, Italy
| | - Alice Pittino
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy (F.F.); (G.M.); (M.V.)
| | - Francesca Filippi
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy (F.F.); (G.M.); (M.V.)
| | - Enrico Belgrado
- Neurology Unit, Udine University Hospital, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy;
| | - Christian Lettieri
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy (F.F.); (G.M.); (M.V.)
| | - Giovanni Merlino
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy (F.F.); (G.M.); (M.V.)
| | - Gian Luigi Gigli
- Department of Medicine (DAME), University of Udine, Via Colugna 50, 33100 Udine, Italy
| | - Mariarosaria Valente
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy (F.F.); (G.M.); (M.V.)
- Department of Medicine (DAME), University of Udine, Via Colugna 50, 33100 Udine, Italy
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Vgontzas A, Pavlović J, Bertisch S. Sleep Symptoms and Disorders in Episodic Migraine: Assessment and Management. Curr Pain Headache Rep 2023; 27:511-520. [PMID: 37665530 DOI: 10.1007/s11916-023-01160-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE OF REVIEW We review research on sleep symptoms and disorders in patients with episodic migraine and propose a framework for evaluating sleep symptoms in this patient population. RECENT FINDINGS Patients with episodic migraine consistently report poorer sleep on validated self-reports compared to those without migraine. In polysomnographic studies, children with migraine have objectively shorter sleep duration and lower percentage of REM sleep interictally. Prospective actigraphy studies in adults and children suggest that there are no significant changes in sleep duration, efficiency, or quality in the night before or after a migraine attack. The relationship between sleep and migraine is multifaceted. Patients with episodic migraine report poorer sleep and have higher risk of some sleep disorders, including insomnia, sleep-related bruxism, and restless legs syndrome. Sleep screening questions may be incorporated into headache evaluations. Care should be taken to avoid headache medications that may exacerbate sleep symptoms. Evidence-based treatments for insomnia may be initiated while patients await CBT-I. Further studies are needed to assess whether treatment of comorbid sleep disorders results in improvement in migraine-related burden in those with episodic migraine.
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Affiliation(s)
- Angeliki Vgontzas
- Division of Headache Medicine, Department of Neurology, John R. Graham Headache Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Jelena Pavlović
- Montefiore Headache Center, Department of Neurology, Albert Einstein College of Medicine, NY, Bronx, USA
| | - Suzanne Bertisch
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Edgley K, Horne AW, Saunders PTK, Tsanas A. Symptom tracking in endometriosis using digital technologies: Knowns, unknowns, and future prospects. Cell Rep Med 2023; 4:101192. [PMID: 37729869 PMCID: PMC10518625 DOI: 10.1016/j.xcrm.2023.101192] [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: 02/03/2023] [Revised: 06/12/2023] [Accepted: 08/18/2023] [Indexed: 09/22/2023]
Abstract
Endometriosis is a common chronic pain condition with no known cure and limited treatment options. Digital technologies, ranging from smartphone apps to wearable sensors, have shown potential toward facilitating chronic pain assessment and management; however, to date, many of these tools have not been specifically deployed or evaluated in patients with endometriosis-associated pain. Informed by previous studies in related chronic pain conditions, we discuss how digital technologies may be used in endometriosis to facilitate objective, continuous, and holistic symptom tracking. We postulate that these pervasive and increasingly affordable technologies present promising opportunities toward developing decision-support tools assisting healthcare professionals and empowering patients with endometriosis to make better-informed choices about symptom management.
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Affiliation(s)
- Katherine Edgley
- EXPPECT and MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh EH16 4UU, Scotland, UK.
| | - Andrew W Horne
- EXPPECT and MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh EH16 4UU, Scotland, UK
| | - Philippa T K Saunders
- Centre for Inflammation Research, University of Edinburgh, Edinburgh EH16 4UU, Scotland, UK
| | - Athanasios Tsanas
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh EH16 4UX, Scotland, UK; Alan Turing Institute, London NW1 2DB, UK
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Stanyer EC, Brookes J, Pang JR, Urani A, Holland PR, Hoffmann J. Investigating the relationship between sleep and migraine in a global sample: a Bayesian cross-sectional approach. J Headache Pain 2023; 24:123. [PMID: 37679693 PMCID: PMC10486047 DOI: 10.1186/s10194-023-01638-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/24/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND There is a bidirectional link between sleep and migraine, however causality is difficult to determine. This study aimed to investigate this relationship using data collected from a smartphone application. METHODS Self-reported data from 11,166 global users (aged 18-81 years, mean: 41.21, standard deviation: 11.49) were collected from the Migraine Buddy application (Healint Pte. Ltd.). Measures included: start and end times of sleep and migraine attacks, and pain intensity. Bayesian regression models were used to predict occurrence of a migraine attack the next day based on users' deviations from average sleep, number of sleep interruptions, and hours slept the night before in those reporting ≥ 8 and < 25 migraine attacks on average per month. Conversely, we modelled whether attack occurrence and pain intensity predicted hours slept that night. RESULTS There were 724 users (129 males, 412 females, 183 unknown, mean age = 41.88 years, SD = 11.63), with a mean monthly attack frequency of 9.94. More sleep interruptions (95% Highest Density Interval (95%HDI [0.11 - 0.21]) and deviation from a user's mean sleep (95%HDI [0.04 - 0.08]) were significant predictors of a next day attack. Total hours slept was not a significant predictor (95%HDI [-0.04 - 0.04]). Pain intensity, but not attack occurrence was a positive predictor of hours slept. CONCLUSIONS Sleep fragmentation and deviation from typical sleep are the main drivers of the relationship between sleep and migraine. Having a migraine attack does not predict sleep duration, yet the pain associated with it does. This study highlights sleep as crucial in migraine management.
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Affiliation(s)
- Emily C Stanyer
- Wolfson Centre for Age-Related Diseases, Institute for Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- Current address: Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | | | | | | | - Philip R Holland
- Wolfson Centre for Age-Related Diseases, Institute for Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Jan Hoffmann
- Wolfson Centre for Age-Related Diseases, Institute for Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
- NIHR-Wellcome Trust King's Clinical Research Facility/SLaM Biomedical Research Centre, King's College Hospital, London, UK.
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11
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Li Z, Feng J, Yin S, Chen X, Yang Q, Gao X, Che D, Zhou L, Yan H, Zhong Y, Zhu F. Effects of acupuncture on mental health of migraine patients: a systematic review and meta-analysis. BMC Complement Med Ther 2023; 23:278. [PMID: 37542321 PMCID: PMC10401757 DOI: 10.1186/s12906-023-04103-8] [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: 02/05/2023] [Accepted: 07/23/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Migraine is a neurological disease characterized by moderate to severe headache and various neurological symptoms. It is often cause mood and anxiety disorders that can seriously affect quality of life. Acupuncture has been claimed to have a role in treating neuropsychiatric disorders and is becoming increasingly popular. However, it remains unclear whether current evidence is sufficient to support acupuncture in improving mental health in migraine patients. OBJECTIVES This systematic review and meta-analysis aimed to investigate the effect of acupuncture on the management of pain and mood disorders in patients with migraine. METHODS We searched PubMed, Cochrane Library, Embase, Web of Science, Chinese National Knowledge Infrastructure (CNKI) and Wan Fang Data Knowledge Service Platform for reports, conferences and academic papers published before January 1, 2022. Randomized controlled trials (RCTs) including acupuncture, sham acupuncture and medication for migraine were included. Stata 16.0 software and Cochrane RoB2.0 were used for data processing and migration risk analysis. RESULT Thirteen randomized controlled trials containing 1766 migraine patients were included in the present study, the results showed that compared with sham acupuncture and medication, acupuncture seemed to have advantage in improving SAS (WMD: -5.64;95% CI: -10.89, -0.39; p = 0.035) and SDS (WMD: -4.65; 95% CI: -9.25, -0.05; p = 0.048) in migraine patients. And it seems to be more effective in improving MH (SMD: 0.77; 95% CI: 0.19, 1.35; p = 0.009), VAS (SMD: -1.06; 95% CI: -1.73, -0.4; p = 0.002;) and MSQ (WMD: 4.76; 95% CI: 2.36, 7.15; p < 0.001) than sham acupuncture and medication. CONCLUSION The present results suggest that, compared with Western medicine and sham acupuncture, acupuncture seems to be able to effectively improve anxiety and depression in migraine patients.And it may be more effective in improving SF36-mental health, VAS and MSQ than shame acupuncture or Western medicine. The results of this study need to be verified by higher quality RCTs.
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Affiliation(s)
- Zhao Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jie Feng
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shao Yin
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xin Chen
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qicheng Yang
- Department of Medical Information Engineering, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xu Gao
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Deya Che
- Zigong First People's Hospital, Zigong, China
| | - Li Zhou
- Zigong First People's Hospital, Zigong, China
| | - Hui Yan
- Zigong First People's Hospital, Zigong, China
| | - Yue Zhong
- Zigong First People's Hospital, Zigong, China
| | - Fengya Zhu
- Zigong First People's Hospital, Zigong, China.
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12
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Chernyshev OY. Sleep Deprivation and Its Consequences. Continuum (Minneap Minn) 2023; 29:1234-1252. [PMID: 37590831 DOI: 10.1212/con.0000000000001323] [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: 08/19/2023]
Abstract
OBJECTIVE This article reviews the clinical, cognitive, behavioral, and physiologic consequences of sleep deprivation in relation to general neurology practice. LATEST DEVELOPMENTS Despite being one of the most common sleep problems in modern society, the role of sleep deprivation is underrecognized and underestimated in clinical medicine and general neurology practice. The recognition, diagnosis, and management of sleep deprivation in neurologic practice have only recently received close attention. The consequences of sleep deprivation involve all aspects of general neurology practice, including individuals with neurologic disease, neurologists, communities, and health care systems. The identification and timely management of sleep deprivation symptoms may help to improve symptoms of underlying primary neurologic disorders. ESSENTIAL POINTS This article emphasizes complexities related to the identification and evaluation of sleep deprivation in general neurology practice and describes the consequences of sleep deprivation. By recognizing sleep deprivation in patients with neurologic conditions, the neurologist can provide comprehensive care and contribute to improved clinical and neurologic outcomes.
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13
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Zduńska A, Cegielska J, Zduński S, Domitrz I. Caffeine for Headaches: Helpful or Harmful? A Brief Review of the Literature. Nutrients 2023; 15:3170. [PMID: 37513588 PMCID: PMC10385675 DOI: 10.3390/nu15143170] [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] [Received: 06/24/2023] [Revised: 07/14/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023] Open
Abstract
Consumption of caffeine in the diet, both daily and occasional, has a significant biological effect on the nervous system. Caffeine, through various and not yet fully investigated mechanisms, affects headaches. This is especially noticeable in migraine. In other headaches such as hypnic headache, post-dural puncture headache and spontaneous intracranial hypotension, caffeine is an important therapeutic agent. In turn, abrupt discontinuation of chronically used caffeine can cause caffeine-withdrawal headache. Caffeine can both relieve and trigger headaches.
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Affiliation(s)
- Anna Zduńska
- Department of Neurology, Faculty of Medicine and Dentistry, Medical University of Warsaw, 01-809 Warsaw, Poland
| | - Joanna Cegielska
- Department of Neurology, Faculty of Medicine and Dentistry, Medical University of Warsaw, 01-809 Warsaw, Poland
| | - Sebastian Zduński
- Medical Rehabilitation Facility, The National Institute of Medicine of the Ministry of Interior and Administration, 02-507 Warsaw, Poland
| | - Izabela Domitrz
- Department of Neurology, Faculty of Medicine and Dentistry, Medical University of Warsaw, 01-809 Warsaw, Poland
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14
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Rahimi MD, Hassani P, Kheirkhah MT, Fadardi JS. Effectiveness of eye movement exercise and diaphragmatic breathing with jogging in reducing migraine symptoms: A preliminary, randomized comparison trial. Brain Behav 2023; 13:e2820. [PMID: 36454123 PMCID: PMC9847608 DOI: 10.1002/brb3.2820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 10/30/2022] [Accepted: 10/31/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Migraine is a multifactorial headache disorder. Maladaptive functional networks or altered circuit-related connectivity in the brain with migraine appear to perturb the effects of usual treatments. OBJECTIVES In the present preliminary trial, we aim to study the effectiveness of performing pieces of body-mind, cognitive, or network reconstruction-based training (i.e., eye movement exercise plus jogging; EME+J and diaphragmatic breathing plus jogging; DB+J) in decreasing migraine symptoms. METHODS We used a three-arm, triple-blind, non-inferiority randomized comparison design with pre-test, post-test, and follow-up measurements to assess the effectiveness of EME+J and DB+J in the brain with migraine. Participants were randomly assigned to one of the study groups to perform either 12 consecutive weeks of EME+J (n = 22), DB+J (n = 19), or receiving, treatment as usual, TAU (n = 22). RESULTS The primary outcome statistical analysis through a linear mixed model showed a significant decrease in the frequency (p = .0001), duration (p = .003), and intensity (p = .007) of migraine attacks among the interventions and measurement times. The pairwise comparisons of simple effects showed that EME+J and DB+J effectively reduced migraine symptoms at the post-test and follow-up (p < .05). Cochran's tests showed that interventions decreased the number of menses-related migraine attacks. EME+J and DB+J effectively decreased over-the-counter (OTC) drug use, refreshed wake-up mode, and improved sleep and water drinking patterns. These are the secondary outcomes that Cochran's tests showed in the interventional groups after the interventions and at 12 months of follow-up. CONCLUSION EME+J or DB+J can be an effective and safe method with no adverse effects to decrease the symptoms of migraine attacks. Moreover, a reduction in the frequency of menstrual cycle-related attacks, OTC drug use, and improved quality of sleep and drinking water were the secondary outcomes of the post-test and a 12-month follow-up.
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Affiliation(s)
| | - Pouriya Hassani
- Department of Cognitive Neuroscience and Clinical Neuropsychology, University of Padova, Padua, Italy
| | | | - Javad Salehi Fadardi
- Faculty of Education and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran.,School of Community and Global Health, Claremont Graduate University, Claremont, California, USA.,School of Psychology, Bangor University, Bangor, UK
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15
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Headache in Workers: A Matched Case-Control Study. Eur J Investig Health Psychol Educ 2022; 12:1852-1866. [PMID: 36547031 PMCID: PMC9777382 DOI: 10.3390/ejihpe12120130] [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: 08/28/2022] [Revised: 11/16/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
Abstract
A case−control study including 446 workers reporting headaches (cases; 136 males and 310 females, mean age 46.71 ± 10.84 years) and 446 age- and sex-matched colleagues without headaches (controls; mean age 45.44 ± 10.13) was conducted in the second half of 2020 in a sample drawn from socio health and commercial services companies to investigate the association of headache with lifestyle, metabolic, and work-related factors. Workers suffering from headache reported higher body weight (OR: 1.92, 95% CI: 1.46−2.53, p < 0.001), higher blood cholesterol (OR: 2.01, 95% CI: 1.46−2.77, p < 0.001), triglyceride (OR: 2.01, 95% CI: 1.20−3.35, p < 0.01), blood glucose (OR: 1.91, 95% CI: 1.16−3.24, p < 0.01), and blood pressure levels (OR: 1.76, 95% CI: 1.23−2.52, p < 0.01). In the year preceding the survey, cases had experienced a higher frequency of workplace violence (OR: 2.29, 95% CI: 1.25−4.20, p < 0.01 for physical aggression, OR: 2.22, 95% CI: 1.45−3.41, p < 0.001 for threat, OR: 2.74, 95% CI: 1.72−4.38, p < 0.001 for harassment) and were more frequently distressed (effort/reward ratio > 1) (OR: 1.82, 95% CI: 1.39−2.40, p < 0.001) than the controls. Compared to the controls, cases also had higher scores on anxiety and depression scales, lower scores on happiness, and lower levels of sleep quality (p < 0.001). The association of headaches with metabolic and mental health problems suggests that monitoring headaches in the workplace could help to identify workers at risk of impairment.
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16
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Bonfert MV, Sollmann N, Renner T, Börner C, Urban G, Schandelmaier P, Hannibal I, Huß K, Parisi C, Gerstl L, Vill K, Blaschek A, Koenig H, Klose B, Heinen F, Landgraf MN, Albers L. Burden of disease and lifestyle habits in adolescents and young adults prone
to frequent episodic migraine: A secondary comparative analysis. J Child Health Care 2022; 26:215-227. [PMID: 33955272 PMCID: PMC9194962 DOI: 10.1177/13674935211008712] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this study was to assess the burden of disease and prevalence of lifestyle factors for adolescents and young adults with frequent episodic migraine. We conducted a secondary comparative analysis of data collected during two previous studies. Inclusion criteria for this analysis were age 15-35 years, 15 to 44 migraine episodes within 12 weeks, and completeness of Migraine Disability Assessment and lifestyle questionnaire data. Datasets of 37 adults (median age [interquartile range]: 25 [6]) and 27 adolescents (median age [interquartile range]: 15 [1]) were analyzed. 81% (n = 30) of adults reported severe disability (16% [n = 3] of adolescents; p < 0.001). Headache frequency (24 vs. 17 days; p = 0.005) and prevalence of regular analgesic use (60% [n = 22] vs. 18% [n = 5]; p = 0.002) were significantly higher in adults. In adults, sleep duration on weekdays was significantly lower (8.5 vs. 10 h; p < 0.001). Any consumption of caffeine tended to be higher in adolescents and alcohol consumption tended to be higher in adults (p > 0.05). This study underlines the importance of educating adolescents and young adults with migraine about lifestyle habits that are likely to interfere with the condition.
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Affiliation(s)
- Michaela V Bonfert
- Department of Pediatric Neurology and
Developmental Medicine and LMU Center for Children with Medical Complexity, Dr von Hauner
Children’s Hospital, Ludwig-Maximilians-Universität, Germany,Michaela V Bonfert, Department of Pediatric
Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity,
Dr von Hauner Children’s Hospital, LMU Hospital, Lindwurmstraße 4, Munich, Bavaria 80337,
Germany.
| | - Nico Sollmann
- Department of Diagnostic and Interventional
Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Germany,TUM-Neuroimaging Center, Klinikum Rechts
der Isar, Technical University of Munich, Germany,Department of Diagnostic and Interventional
Radiology, University Hospital Ulm, Germany
| | - Tabea Renner
- Department of Pediatric Neurology and
Developmental Medicine and LMU Center for Children with Medical Complexity, Dr von Hauner
Children’s Hospital, Ludwig-Maximilians-Universität, Germany
| | - Corinna Börner
- Department of Pediatric Neurology and
Developmental Medicine and LMU Center for Children with Medical Complexity, Dr von Hauner
Children’s Hospital, Ludwig-Maximilians-Universität, Germany
| | - Giada Urban
- Department of Pediatric Neurology and
Developmental Medicine and LMU Center for Children with Medical Complexity, Dr von Hauner
Children’s Hospital, Ludwig-Maximilians-Universität, Germany
| | - Paul Schandelmaier
- Department of Pediatric Neurology and
Developmental Medicine and LMU Center for Children with Medical Complexity, Dr von Hauner
Children’s Hospital, Ludwig-Maximilians-Universität, Germany
| | - Iris Hannibal
- Department of Pediatric Neurology and
Developmental Medicine and LMU Center for Children with Medical Complexity, Dr von Hauner
Children’s Hospital, Ludwig-Maximilians-Universität, Germany
| | - Kristina Huß
- Department of Pediatric Neurology and
Developmental Medicine and LMU Center for Children with Medical Complexity, Dr von Hauner
Children’s Hospital, Ludwig-Maximilians-Universität, Germany
| | - Carmen Parisi
- Department of Pediatric Neurology and
Developmental Medicine and LMU Center for Children with Medical Complexity, Dr von Hauner
Children’s Hospital, Ludwig-Maximilians-Universität, Germany
| | - Lucia Gerstl
- Department of Pediatric Neurology and
Developmental Medicine and LMU Center for Children with Medical Complexity, Dr von Hauner
Children’s Hospital, Ludwig-Maximilians-Universität, Germany
| | - Katharina Vill
- Department of Pediatric Neurology and
Developmental Medicine and LMU Center for Children with Medical Complexity, Dr von Hauner
Children’s Hospital, Ludwig-Maximilians-Universität, Germany
| | - Astrid Blaschek
- Department of Pediatric Neurology and
Developmental Medicine and LMU Center for Children with Medical Complexity, Dr von Hauner
Children’s Hospital, Ludwig-Maximilians-Universität, Germany
| | - Helene Koenig
- Department of Pediatric Neurology and
Developmental Medicine and LMU Center for Children with Medical Complexity, Dr von Hauner
Children’s Hospital, Ludwig-Maximilians-Universität, Germany
| | - Birgit Klose
- Department of Pediatric Neurology and
Developmental Medicine and LMU Center for Children with Medical Complexity, Dr von Hauner
Children’s Hospital, Ludwig-Maximilians-Universität, Germany
| | - Florian Heinen
- Department of Pediatric Neurology and
Developmental Medicine and LMU Center for Children with Medical Complexity, Dr von Hauner
Children’s Hospital, Ludwig-Maximilians-Universität, Germany
| | - Mirjam N Landgraf
- Department of Pediatric Neurology and
Developmental Medicine and LMU Center for Children with Medical Complexity, Dr von Hauner
Children’s Hospital, Ludwig-Maximilians-Universität, Germany
| | - Lucia Albers
- Department of Pediatric Neurology and
Developmental Medicine and LMU Center for Children with Medical Complexity, Dr von Hauner
Children’s Hospital, Ludwig-Maximilians-Universität, Germany,Department of Neurosurgery, Klinikum Rechts
der Isar, Technical University of Munich, Germany
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17
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Al-Hashel JY, Abokalawa F, Ahmed SF. New precipitating factors for migraine during Covid-19 pandemic lockdown. HEADACHE MEDICINE 2022. [DOI: 10.48208/headachemed.2022.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Lock down caused sudden lifestyle changes and represented a massive impact on human health. We aimed to report new migraine headache precipitating factors due to lifestyle changes during coronavirus disease 2019 (COVID-19) Pandemic lockdown.
Methods: This cross-sectional survey included patients diagnosed with migraine based on The International Classification of Headache Disorders, 3rd edition (ICDH-3). During the lockdown, we submitted an online self-reported web-based questionnaire to patients already diagnosed with migraine and attending headache clinic at Ibn Sian Hospital in Kuwait. Questions explored different new precipitating factors of migraine headache attacks during COVID-19 pandemic lockdown compared to precipitating factors before lockdown.
Results: A total of 340 migraine patients responded to online questionnaire. The mean age of them is 34.65 years. Females were predominant 79.1%. Majority of the cohort 85 % has more than one trigger of migraine headache attack. During pandemic, the common precipitating factors were smell of strong odors in 214 (62.9%), followed by certain food in 175 (51.8%), sleep disturbance in 120 (35.3%), emotional or mental stress in 80 (23.6%), caffeine in 80 (23.6%), flickers of light in 78 (22.9%), weather changes in 68(20%), smoking in 65 (19.12%), noise in 56 (16.5%), sun light exposure in 41 (12.1%), fasting/ hypoglycemia in 40 (11.7%), hormonal changes in 37 (10.6%), physical excretion/fatigue in 24 (7.1%), screen exposure in 20 (5.9%), and dehydration in 14 (4.1%) patients. Before pandemic, noises 200 (58.8%), flicker of light 180 (52.9%), weather changes 175 (51.5%), sun light 170 (50%), food 160 (48.5%) and 130 (38.2%) sleep deprivation were the most common precipitating factors of migraine. 40% did not report precipitating factors for migraine before lockdown.
Conclusions: Change of habits during lock down exposed migraine patients to different precipitating factors. Strong odors, food, sleep disturbance and stress were the most common migraine headache precipitating factors during COVID-19 lockdown.
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18
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Behavioral Management of Episodic Migraine: Maintaining a Healthy Consistent Lifestyle. Curr Pain Headache Rep 2022; 26:247-252. [PMID: 35212864 DOI: 10.1007/s11916-022-01023-z] [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: 01/23/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW To describe the most recent findings related to lifestyle behaviors and migraine. RECENT FINDINGS An individualized conceptualization of how lifestyle factors impact migraine activity has increased our understanding of the role of behavioral interventions for episodic migraine. Healthy diets of several types have been associated with migraine attack reduction, whereas disruptions in diet like skipping meals are associated with migraine attack onset. Both aerobic activity and lower intensity yoga interventions show promise for migraine prevention. Sleep disruption has been associated with migraine day and may have a bi-directional relationship. Both increases and decreases in stress have been associated with migraine activity. Evidence is converging around the principle that highly unusual disruptions in daily routine are particularly associated with migraine attack onset and that a consistent healthy lifestyle is a key feature of effective behavioral migraine prevention strategies.
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19
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Bentivegna E, Tassorelli C, De Icco R, Sances G, Martelletti P. Tele-healthcare in migraine medicine: from diagnosis to monitoring treatment outcomes. Expert Rev Neurother 2022; 22:237-243. [PMID: 35196206 DOI: 10.1080/14737175.2022.2045954] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION : Primary headaches represent a huge cost in terms of decreased productivity and migraine occupies the first position among disabilities in working population. Migraine has a high incidence, disproportionate to the available primary care centres. In most cases, migraine can be managed through the simple and accurate collection of clinical history, which makes it an ideal candidate for tele-healthcare. AREAS COVERED : In this narrative review we retrace the most important scientific evidence regarding use of tele-healthcare in headache medicine. Over the last few years, it has proved to be a valid and useful tool for the management of migraine. Furthermore, current pandemic has imposed a drastic change in the way of thinking and setting up medicine, forcing clinicians and patients to a huge expansion of telemedicine. EXPERT OPINION : We should permanently insert the culture of telemedicine in the headache care not only in academies and scientific societies, but extend it to specialized hospitals for the treatment of headaches. Only by broadening the old book-based strategy, we will be able to open the door to the multidimensional culture of headache medicine. Experts of excellence centres should set an example and pave the way for the rest of the clinicians.
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Affiliation(s)
- Enrico Bentivegna
- Emergency Medicine Unit, Regional Referral Headache Center, Sant'Andrea University Hospital, Rome, Italy.,Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Cristina Tassorelli
- Headache Science and Neurorehabilitation Center, National Neurological Institute C. Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Roberto De Icco
- Headache Science and Neurorehabilitation Center, National Neurological Institute C. Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Grazia Sances
- Headache Science and Neurorehabilitation Center, National Neurological Institute C. Mondino Foundation, Pavia, Italy
| | - Paolo Martelletti
- Emergency Medicine Unit, Regional Referral Headache Center, Sant'Andrea University Hospital, Rome, Italy.,Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
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20
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Raoof M, Amanpour S, Roghani A, Abbasnejad M, Kooshki R, Askari-Zahabi K, Mohamadi-Jorjafki E, Majdzadeh B, Aarab G, Lobbezoo F. The effects of neonatal maternal deprivation and chronic unpredictable stresses on migraine-like behaviors in adult rats. Neurosci Lett 2022; 772:136444. [PMID: 35007689 DOI: 10.1016/j.neulet.2022.136444] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/29/2021] [Accepted: 01/02/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Stress is known to cause migraine. This study investigates the effects of neonatal maternal deprivation (MD) and chronic unpredictable stress (CUS) on migraine in rats. METHODS Seventy rats were randomly divided into ten groups (five groups of each sex, and seven rats/group). The groups included: untreated intact, nitroglycerin (NTG) only, NTG + MD, NTG + CUS (10 weeks after birth), and NTG + MD + CUS. For the induction of MD, pups were separated from their mothers from postnatal day 2 to day 14. The CUS was conducted by daily exposure to different stressors for 2 weeks. For the induction of migraine after stress, NTG (5 mg/kg/IP) was administered every second day for 9 days. Afterward, NTG-related symptoms, including climbing behavior, facial rubbing, body grooming, freezing behavior, and head-scratching, were recorded for 90 min. Statistical differences between the groups were analyzed by one-way and two-way ANOVA followed by the Newman-Keuls test. RESULTS Migraine symptoms, including increased head-scratching, facial rubbing, and decreased climbing behavior, were more significant in females than in males. Head scratching and facial rubbing increased in stressed females, but not in males as compared to NTG-treated rats. Body grooming was significantly decreased in MD males compared to the NTG group. The effects of NTG in MD + CUS on the rats did not differ from those in the MD or CUS groups. CONCLUSIONS MD and CUS had a sex-related aggravating effect on the development of migraine, while the combination of MD and CUS had no additive migraine-aggravating effect.
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Affiliation(s)
- Maryam Raoof
- Endodontology Research Center, Kerman University of Medical Sciences, Kerman, Iran; Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Sara Amanpour
- Department of Oral Pathology, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
| | - Arman Roghani
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Mehdi Abbasnejad
- Department of Biology, Faculty of Sciences, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Razieh Kooshki
- Department of Biology, Faculty of Sciences, Lorestan University, Khorramabad, Iran
| | - Khadijeh Askari-Zahabi
- Department of Biology, Faculty of Sciences, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Elham Mohamadi-Jorjafki
- Department of Biology, Faculty of Sciences, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Baharosadat Majdzadeh
- Department of Biology, Faculty of Sciences, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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21
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Artemenko AR, Filatova E, Vorobyeva YD, Do TP, Ashina M, Danilov AB. Migraine and light: A narrative review. Headache 2022; 62:4-10. [PMID: 35041220 DOI: 10.1111/head.14250] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE In this narrative review, we summarize clinical and experimental data on the effect of light in migraine and discuss future prospects. BACKGROUND Effective nonpharmacological treatment of hypersensitivity to light in migraine is an unmet clinical need. Current management strategies primarily consist of seeking a dark room and avoiding light exposure. Advances in the past 2 decades have improved our understanding of the underlying pathophysiology of how migraine is influenced by light. This may provide promising avenues for novel approaches in clinical management. METHODS We searched MEDLINE for articles published from database inception up to September 1, 2021. We used the search term "migraine" with the search terms "light," "photophobia," "treatment," "trigger," "circadian rhythm," "environment," and/or "pathophysiology." RESULTS Light is commonly reported as a trigger factor of migraine attacks, however, early manifestation of photophobia and false attribution is likely the actual cause based on data deriving from retrospective, prospective, and experimental studies. The most common photophobia symptoms in migraine are exacerbation of headache by light and abnormal sensitivity to light with the underlying neural pathways likely being dependent on ongoing activity in the trigeminovascular system. Clinical studies and experimental models have identified mediators of photophobia and uncovered narrow wavebands of the light spectrum that may reduce pain intensity during a migraine attack. Consequently, novel devices have undergone exploratory clinical trials with promising results. CONCLUSION False attribution is likely the reason why light is commonly reported as a trigger factor of migraine attacks, and a prospective confirmation is required to prevent unnecessary avoidance. The observation that individuals with migraine are not equally photophobic to all wavebands of the light spectrum opens the potential for innovative pain management strategies. In this context, using human-centric lighting (also called integrative lighting) to mimic the natural daylight cycle and avoid harmful wavebands through modern technology may prove beneficial. Future research should identify direct and indirect consequences of light and other environmental factors in migraine to fill out knowledge gaps and enable evidence-based care strategies within institutions, work environments, and other settings.
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Affiliation(s)
- Ada R Artemenko
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Elena Filatova
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Yulia D Vorobyeva
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Thien Phu Do
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Messoud Ashina
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Danish Knowledge Center on Headache Disorders, Glostrup, Denmark.,Department of Neurology, Azerbaijan Medical University, Baku, Azerbaijan
| | - Alexey B Danilov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Ragab AH, Kishk NA, Hassan A, Yacoub O, El Ghoneimy L, Elmazny A, Elsawy EH, Mekkawy D, Othman AS, Rizk HI, Mohammad ME, Shehata HS, Shalaby N, Magdy R. Changes in migraine characteristics over 30 days of Ramadan fasting: A prospective study. Headache 2021; 61:1493-1498. [PMID: 34726767 DOI: 10.1111/head.14231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To study Ramadan's effect on migraine from the start to the end of the month and the tolerability of patients with migraine to fasting. BACKGROUND Fasting is a well-known trigger for migraine. Whether this effect on migraine is the same throughout the whole month, or whether it varies from the first to the last days of the month, has not been studied yet. METHODS A prospective cohort observational study was carried out on persons with migraine who fasted from 24 April to 23 May during Ramadan 2020. Each patient was asked to fill out their headache diary starting from Shaaban (the month before Ramadan) to the end of Ramadan. The Ramadan diary was divided by 10 days each, by which the patient was asked to accurately describe their migraine attacks in terms of frequency, duration, and intensity by using the Visual Analog Scale. Migraine attacks during the first day of fasting were assessed separately. RESULTS A total of 292 known persons with migraine from Egypt completed the study. Their median age was 33 years; 72/292 (24.7%) were male, and 220/292 (75.3%) were female. About 126/236 (53.4%) of the patients had migraine attacks on Ramadan's first day, most of them during fasting. The frequency of migraine attacks was significantly increased in Ramadan (median 4, interquartile range [IQR] 2-7) compared with Shaaban (median 3, IQR 1-6), p = 0.009. The number of attacks was significantly reduced in both the second (median 1, IQR 0-2.25) and the third 10 days of Ramadan (median 1, IQR 1-3) compared with the first 10 days (median 3, IQR 1-5) (p < 0.001 for each). CONCLUSION Ramadan's potential exacerbating effect on the frequency of migraine attacks should be discussed with patients with migraine. This effect appears to be limited to the first 10 days of Ramadan and then subsides with successive days of fasting.
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Affiliation(s)
- Amany H Ragab
- Department of Neurology, Kasr-Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nirmeen A Kishk
- Department of Neurology, Kasr-Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amr Hassan
- Department of Neurology, Kasr-Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Osama Yacoub
- Department of Neurology, Kasr-Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Lobna El Ghoneimy
- Department of Neurology, Kasr-Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Alaa Elmazny
- Department of Neurology, Kasr-Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.,Department of Internal Medicine, Arabian Gulf University, Manama, Bahrain
| | - Enji H Elsawy
- Department of Neurology, Kasr-Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Doaa Mekkawy
- Department of Neurology, Kasr-Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Alshimaa S Othman
- Department of Neurology, Kasr-Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hoda Ibrahim Rizk
- Department of Public Health and Community Medicine, Cairo University, Cairo, Egypt
| | | | - Hatem S Shehata
- Department of Neurology, Kasr-Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nevin Shalaby
- Department of Neurology, Kasr-Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rehab Magdy
- Department of Neurology, Kasr-Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
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Lee W, Min IK, Yang KI, Kim D, Yun CH, Chu MK. Classifying migraine subtypes and their characteristics by latent class analysis using data of a nation-wide population-based study. Sci Rep 2021; 11:21595. [PMID: 34732803 PMCID: PMC8566532 DOI: 10.1038/s41598-021-01107-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 10/25/2021] [Indexed: 12/30/2022] Open
Abstract
Migraine neither presents with a definitive single symptom nor has a distinct biomarker; thus, its diagnosis is based on combinations of typical symptoms. We aimed to identify natural subgroups of migraine based on symptoms listed in the diagnostic criteria of the third edition of the International Classification of Headache Disorders. Latent class analysis (LCA) was applied to the data of the Korean Sleep-Headache Study, a nationwide population-based survey. We selected a three-class model based on Akaike and Bayesian information criteria and characterized the three identified classes as “mild and low frequency,” “photophobia and phonophobia,” and “severe and high frequency.” In total, 52.0% (65/125) of the participants were classified as “mild and low frequency,” showing the highest frequency of mild headache intensity but the lowest overall headache frequency. Meanwhile, “photophobia and phonophobia” involved 33.6% (42/125) of the participants, who showed the highest frequency of photophobia and phonophobia. Finally, “severe and high frequency” included 14.4% (18/125) of the participants, and they presented the highest frequency of severe headache intensity and highest headache frequency. In conclusion, LCA is useful for analyzing the heterogeneity of migraine symptoms and identifying migraine subtypes. This approach may improve our understanding of the clinical characterization of migraine.
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Affiliation(s)
- Wonwoo Lee
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - In Kyung Min
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
| | - Kwang Ik Yang
- Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea
| | - Daeyoung Kim
- Department of Neurology, Chungnam National University Hospital, Daejeon, Korea
| | - Chang-Ho Yun
- Department of Neurology, Bundang Clinical Neuroscience Institute, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
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24
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Kim BK, Cho SJ, Kim CS, Sakai F, Dodick DW, Chu MK. Disability and Economic Loss Caused by Headache among Information Technology Workers in Korea. J Clin Neurol 2021; 17:546-557. [PMID: 34595863 PMCID: PMC8490897 DOI: 10.3988/jcn.2021.17.4.546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/03/2021] [Accepted: 05/03/2021] [Indexed: 01/03/2023] Open
Abstract
Background and Purpose Headache disorders are a leading cause of disability globally. However, there is inadequate information available about these disorders and the related economic loss in the workplace in Asian countries. Information technology (IT) jobs are intellectually and cognitively challenging, and hence IT workers are a suitable population for assessing headache disorders and related economic loss. Methods We sent invitation emails to all employees of selected IT companies. A comprehensive Web-based questionnaire regarding headache characteristics, disability, quality of life, and economic loss was completed by 522 participants from 8 companies. Results The participants included 450 (86.2%) who had experienced headache more than once during the previous year. The frequencies of migraine, probable migraine (PM), and tension-type headache (TTH) were 18.2%, 21.1%, and 37.0%, respectively. The Migraine Disability Assessment score was higher for participants with migraine [median and interquartile range, 3.0 (0.0–6.0)] than for those with PM [0.0 (0.0–2.0), p<0.001] and TTH [0.0 (0.0–1.0), p<0.001]. The estimated annual economic losses caused by migraine per person associated with absenteeism and presenteeism were USD 197.5±686.1 and USD 837.7±22.04 (mean±standard deviation), respectively. The total annual economic loss per person caused by migraine (USD 1,023.3±1,972.7) was higher than those caused by PM (USD 424.8±1,209.1, p<0.001) and TTH (USD 197.6±636.4, p<0.001). Conclusions Migraine, PM, and TTH were found to be prevalent among IT workers in Korea. Disability and economic loss were significantly greater in participants with migraine than in those with PM or TTH.
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Affiliation(s)
- Byung Kun Kim
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Soo Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Chang Soo Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Fumihiko Sakai
- The Saitama International Headache Center, Saitama, Japan
| | | | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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25
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Vellinga A, Farrell K, Fallon R, Hare D, Sutton-Fitzpatrick U, Cormican M. Presentation, Treatment, and Natural Course of Severe Symptoms of Urinary Tract Infections Measured by a Smartphone App: Observational and Feasibility Study. J Med Internet Res 2021; 23:e25364. [PMID: 34477567 PMCID: PMC8449294 DOI: 10.2196/25364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/04/2021] [Accepted: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background Urinary tract infections (UTIs) are one of the most common conditions in women. Current information on the presentation, management, and natural course of the infection is based on paper diaries filled out and subsequently posted by patients. Objective The aim of this study is to explore the feasibility of a smartphone app to assess the natural course and management of UTIs. Methods A smartphone app was developed to collect data from study participants presenting with symptoms of UTI in general practice. After initial demographic and treatment information, symptom severity was recorded by the patient after a reminder on their smartphone, which occurred twice daily for a period of 7 days or until symptom resolution. Results A total of 181 women aged 18-76 years downloaded the smartphone app. The duration of symptoms was determined from the results of 178 participants. All patients submitted a urine sample, most patients were prescribed an antibiotic (163/181, 90.1%), and 38.7% (70/181) of the patients had a positive culture. Moderately bad or worse symptoms lasted a mean of 3.8 (SD 3.2; median 4) days, and 70.2% (125/178) of the patients indicated that they were cured on day 4 after consultation. This compares with other research assessing symptom duration and management of UTIs using paper diaries. Patients were very positive about the usability of the smartphone app and often found the reminders supportive. On the basis of the feedback and the analysis of the data, some suggestions for improvement were made. Conclusions Smartphone diaries for symptom scores over the course of infections are an efficient and acceptable means of collecting data in research.
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Affiliation(s)
- Akke Vellinga
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Karen Farrell
- School of Medicine, Health Research Board Primary Care Clinical Trials Network Ireland, National University of Ireland Galway, Galway, Ireland
| | - Roisin Fallon
- School of Medicine, Health Research Board Primary Care Clinical Trials Network Ireland, National University of Ireland Galway, Galway, Ireland
| | - Daniel Hare
- Department of Clinical Microbiology, University Hospital Galway, Galway, Ireland
| | | | - Martin Cormican
- Health Service Executive, Antimicrobial Resistance and Infection Control Team, Dublin, Ireland.,Discipline of Bacteriology, National University of Ireland Galway, Galway, Ireland
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Goadsby PJ, Constantin L, Ebel-Bitoun C, Igracki Turudic I, Hitier S, Amand-Bourdon C, Stewart A. Multinational descriptive analysis of the real-world burden of headache using the Migraine Buddy application. Eur J Neurol 2021; 28:4184-4193. [PMID: 34309986 PMCID: PMC9291858 DOI: 10.1111/ene.15037] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/09/2021] [Accepted: 07/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE A large proportion of headache sufferers do not routinely seek medical care. App-based technologies permit the collection of real-world data over time and between countries that can help assess true burden of headache. This study used a mobile phone application to collect information on the real-world burden of self-diagnosed headache and to describe its impact on daily life in headache sufferers who do not routinely seek medical advice. METHODS This retrospective, non-interventional, cross-sectional study analysed self-reported data from users of the 'Migraine Buddy' app. The main objective was to describe self-reported characteristics of headache and migraine (triggers, duration, frequency), treatment patterns and impact on daily activity in headache sufferers from Australia, Brazil, France, Germany and Japan. Data including demographics, self-diagnosed episode type (headache/migraine), duration, potential triggers and impact on daily activity are reported. All analyses were exploratory and performed per country. RESULTS Self-reported data were collected from 60,474 users between August 2016 and August 2018. Approximately 90% of users were females; >60% were aged 24-45 years. Over one-third of users reported having two to five episodes of headache or migraine per month; impact included impaired concentration, being slower and missing work or social activities. Variations across countries were observed; within countries, episode characteristics were very similar for self-diagnosed headache versus migraine. CONCLUSIONS Headache tracking was used to describe the experience, impact and self-management approaches of migraine and headache sufferers in a real-world setting. Headache disorders present a range of important issues for patients that deserve more study and reinforce the need for better approaches to management.
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Affiliation(s)
- Peter J Goadsby
- NIHR-Wellcome Trust King's Clinical Research Facility, King's College London, London, UK
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27
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Noutsios CD, Boisvert-Plante V, Perez J, Hudon J, Ingelmo P. Telemedicine Applications for the Evaluation of Patients with Non-Acute Headache: A Narrative Review. J Pain Res 2021; 14:1533-1542. [PMID: 34103978 PMCID: PMC8179807 DOI: 10.2147/jpr.s309542] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/09/2021] [Indexed: 12/17/2022] Open
Abstract
The COVID-19 pandemic has spurred a hasty transition to virtual care but also an abundance of new literature highlighting telehealth’s capabilities and limitations for various healthcare applications. In this review, we aim to narrate the current state of the literature on telehealth applied to migraine care. First, telemedicine in the context of non-acute headache management has been shown to produce non-inferior patient outcomes when compared to traditional face-to-face appointments. The assignment of patients to telehealth appointments should be made after referring more urgent cases to dedicated in-person clinics. During the virtual appointment, physicians can ask their patients about the “3 F’s” in order to perform a thorough assessment of their headaches: frequency of headache days, frequency of acute medication usage and functional impairment. Clinical assessment scores that have been studied and deemed feasible for telemedicine, safe and efficient include the HIT-6, VAS and MIDAS scores. Although MIDAS was found to be redundant and inadequate to use on a daily basis, we suggest that it can be useful in periodic remote follow-up appointments. Additionally, several mobile health apps have been studied including Migraine Buddy, Migraine Coach and Migraine Monitor. All of these are appropriate for use in telemedicine when combined with an adequate trial period with Migraine Buddy being rated the highest, as it captures the most detailed clinical picture. High satisfaction rates have been reported for virtual headache management which were shown to be equal to in-person consults. These are based on patients’ perceived increase in convenience due to avoided travel time, less disruption of their daily routine and feeling more comfortable in the environment of their choice. Despite this, limitations such as technological knowledge, access to videoconferencing modalities and having a more impersonal consultation with the physician may hinder some patients from adopting this service.
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Affiliation(s)
| | | | - Jordi Perez
- Alan Edwards Pain Management Unit. Montreal General Hospital, McGill University Health Center, Montreal, QC, Canada.,Alan Edwards Centre for Pain Research, McGill University, Montreal, QC, Canada
| | - Jonathan Hudon
- Alan Edwards Pain Management Unit. Montreal General Hospital, McGill University Health Center, Montreal, QC, Canada.,Alan Edwards Centre for Pain Research, McGill University, Montreal, QC, Canada.,Edwards Family Interdisciplinary Complex Pain Centre, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada.,Faculty Lecturer (Clinical), Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada.,Division of Secondary Care, Department of Family Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Pablo Ingelmo
- Alan Edwards Centre for Pain Research, McGill University, Montreal, QC, Canada.,Edwards Family Interdisciplinary Complex Pain Centre, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
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29
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Alkhalawi E, Orban E, Schramm S, Katsarava Z, Hoffmann B, Moebus S. Residential traffic noise exposure and headaches: Results from the population-based heinz nixdorf recall study. Noise Health 2021; 23:1-10. [PMID: 33753676 PMCID: PMC8140531 DOI: 10.4103/nah.nah_1_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context and aim The link between headaches and exposure to loud noise in occupational settings has been established. However, the effect of less intense but chronic residential traffic noise exposure on headache occurrence is less clear. Settings and design We included 3,025 participants from the Heinz Nixdorf Recall study in Germany for this cross-sectional analysis. Methods and material Residential road traffic noise exposure at the 2006-2008 address was modelled in A-weighted decibels (dB(A)) according to the European Noise Directive (2002/49/EC) for 24-hour (Lden) and night-time noise (22-6 h, Lnight). Indoor traffic noise exposure was obtained by modifying Lden and Lnight based on residence orientation, window type, and personal window opening habits. Traffic noise exposure below 55, 45 dB(A), 35 and 25 dB(A) were set as the reference for Lden, Lnight, Lden,indoor and Lnight,indoor, respectively. Average number of days with headache per month over the past three months was ascertained during the follow-up (2011-2015) medical interview. Statistical analysis used Prevalence Odds Ratios (POR) of having eight or more headaches per month per 5 dB(A) increase in traffic noise exposure were calculated using logistic regression, adjusting for age, sex, sport, number of chronic conditions, years of education and smoking status. Results The mean age of participants was 58.3. Mean Lden was 54 dB(A). Median monthly headache days was one. No association was seen between traffic noise exposure and having ≥8 headaches/month for all the examined traffic noise indicators. However, traffic noise was positively associated with traffic noise-annoyance and insomnia; and night-time traffic noise-annoyance and insomnia were positively associated with headache. Conclusion In conclusion, our data did not provide any evidence for an association between chronic traffic noise exposure and prevalence of headaches at this population's exposure levels. This should be explored in different populations given that this is the first study of its type and that noise exposure was generally low in our population.
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Affiliation(s)
- Eman Alkhalawi
- Centre for Urban Epidemiology (CUE), Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Essen
- Department of Family and Community Medicine, King Abdulaziz University, Rabigh, Saudi Arabia, Germany
| | - Ester Orban
- Centre for Urban Epidemiology (CUE), Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Essen, Germany
| | - Sara Schramm
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Essen, Germany
| | - Zaza Katsarava
- Department of Neurology, University of Duisburg-Essen, University Hospital Essen, Hufelandstr. 55, 45122 Essen
- Department of Neurology, Evangelical Hospital Unna, Holbeinstr. 10, 59423 Unna
- EVEX Medical Corporation, Tbilisi, Republic of Georgia
- IM Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation, Germany
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Heinrich-Heine-University, Medical Faculty, Duesseldorf, Germany
| | - Susanne Moebus
- Centre for Urban Epidemiology (CUE), Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Essen, Germany
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Vgontzas A, Li W, Mostofsky E, Mittleman MA, Bertisch SM. Baseline sleep quality, stress, and depressive symptoms, and subsequent headache occurrence in a six-week prospective cohort study of patients with episodic migraine. Headache 2021; 61:727-733. [PMID: 33749835 DOI: 10.1111/head.14105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/02/2021] [Accepted: 02/15/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES/BACKGROUND Despite the high prevalence of sleep disturbance, stress, and depressive symptoms among patients with episodic migraine, there has been limited prospective research examining how these comorbid symptoms relate to future headache risk. METHODS We conducted an a priori secondary analysis of a prospective cohort study of 98 adults with episodic migraine recruited through Harvard-affiliated medical centers and local college student clinics in Boston, MA. At baseline, participants completed validated questionnaires on sleep quality, stress, and depressive symptoms. Over the next 6 weeks, they recorded headaches on twice-daily diaries. We conducted time-to-event analyses to evaluate whether these baseline symptoms were associated with headache recurrence. RESULTS At baseline, 45/98 (46%) participants had poor sleep quality, 51/98 (52%) reported moderate/high stress levels, and 18/98 (18%) had high depressive symptom scores. Over 4,406 person-days, we observed 823 discrete headaches. In multivariable models, the hazard ratios for headache recurrence were: 1.22 (95% CI 1.02, 1.46) for people with baseline poor sleep, 1.12 (95% CI 0.93, 1.35) for those with baseline moderate/high stress compared to lower levels, and 1.31 (95% CI 1.05, 1.65) for the combination of poor sleep and moderate/high stress compared to the combination of good sleep and low stress. There was no association between depression scores and headache risk. CONCLUSION Among patients with episodic migraine, poor sleep was associated with a higher rate of headache recurrence over the next 6 weeks, especially among those with coexisting moderate/high stress.
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Affiliation(s)
- Angeliki Vgontzas
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Wenyuan Li
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Elizabeth Mostofsky
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Murray A Mittleman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Suzanne M Bertisch
- Department of Medicine, Harvard Medical School, Boston, MA, USA.,Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
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Abstract
PURPOSE OF REVIEW With this review, we aimed to investigate the effect of exercise on migraine and explored the possibility of exercise as a treatment option for migraine. RECENT FINDINGS A close association of physical activity and exercise with migraine has been reported in clinical and population-based studies. Recent randomized controlled trials investigating the effect of aerobic exercise as a migraine-preventive treatment have revealed a notable improvement in migraine symptoms. Data on the effect of anaerobic exercise and exercise for flexibility, coordination, and relaxation on migraine are currently insufficient to make any recommendations. Possible pathways for the attenuation of migraine by exercise include the endogenous opioid and cannabinoid systems, brain-derived neurotrophic factor, inflammation, and behavioral/psychological factors. Regarding efficacy, side effects, and health benefits, aerobic exercise is a potentially beneficial strategy in the preventive treatment of migraine. Further studies are needed to delineate an evidence-based exercise program for migraine treatment.
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Kim S, Bae DW, Park SG, Park JW. The impact of Pain-related emotions on migraine. Sci Rep 2021; 11:577. [PMID: 33436778 PMCID: PMC7804193 DOI: 10.1038/s41598-020-80094-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/14/2020] [Indexed: 02/07/2023] Open
Abstract
The response to pain is highly individual and can be influenced by complex emotional perception. This study aims to investigate the status of the pain-related emotional response, and the influence on headache characteristics and disability in migraine. We studied the pain-related emotional response in 145 consecutive migraine patients using the Pain Anxiety Symptoms Scale (PASS), the Pain Catastrophizing Scale (PCS), and the Pain Sensitivity Questionnaire (PSQ) and compared them with 106 healthy controls. We investigated the relationship between emotional factors and migraine characteristics. The effect of pain-related emotion on migraine-related disability assessed with the Headache Impact Test-6 (HIT-6) and the Migraine Disability Assessment (MIDAS). Migraine patients showed significantly higher scores on total PASS (p < 0.001), PCS (p < 0.001) and PSQ (p = 0.002) compared to the healthy controls. The HIT-6 was weakly correlated with PASS (r = 0.390, p < 0.001) and PCS (r = 0.354, p < 0.001). PASS-Total (p = 0.001), headache frequency (p = 0.003), and HADS-Anxiety (p = 0.028) were independent variables associated with HIT-6. Headache frequency (p < 0.001) was an independent variable associated with MIDAS. The structural equation model indicated that headache severity has direct loading on emotion and subsequently influenced migraine-related disability. Disability has a significant effect on the frequency of abortive medication use. Migraine patients have altered emotional responses to pain perception. Pain-related anxiety made an important contribution to headache-related disability. The present results suggest that the management of disability by considering various pain-related emotional factors may be necessary for the therapeutic aspects of migraine.
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Affiliation(s)
- Seonghoon Kim
- Department of Neurology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dae-Woong Bae
- Department of Neurology, St. Vincent's hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang-Gue Park
- Department of Applied Statistics, Chung-Ang University, Seoul, Republic of Korea
| | - Jeong-Wook Park
- Department of Neurology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Pohl H, Gantenbein AR. [COVID-19 and Headaches]. PRAXIS 2021; 110:201-206. [PMID: 33726510 DOI: 10.1024/1661-8157/a003661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
COVID-19 and Headaches Abstract. Headaches are a common symptom of COVID-19 infections. Patients generally describe them as bilateral, predominantly frontal, squeezing and of moderate or severe intensity. Searching for "Red Flags" often allows distinction from primary headaches - usually fever, cough, and elevated inflammatory markers accompany COVID-19-associated headaches. Prospective studies did not confirm caveats against the use of ibuprofen as symptomatic treatment. While carrying facial masks often caused headaches, probably by compressing sensory nerves, many patients' migraine frequencies dropped during lockdown. Treatment of patients with primary headaches was complicated by quarantine and many centres offered online consultations.
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Affiliation(s)
- Heiko Pohl
- Klinik für Neurologie, Universitätsspital Zürich
| | - Andreas R Gantenbein
- Klinik für Neurologie, Universitätsspital Zürich
- Neurologie & Neurorehabilitation, RehaClinic Bad Zurzach
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Sassi KLM, Martins LB, de Miranda AS, Teixeira AL. Renin-Angiotensin-Aldosterone System and Migraine: A Systematic Review of Human Studies. Protein Pept Lett 2020; 27:512-519. [PMID: 31995000 DOI: 10.2174/0929866527666200129160136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/23/2019] [Accepted: 11/17/2019] [Indexed: 12/12/2022]
Abstract
Migraine is a common neurologic condition marked by recurrent episodes of headache. Its pathophysiology is highly complex involving neuronal, inflammatory and vascular mechanisms. The Renin-Angiotensin System (RAS) can modulate all these mechanism, being a potential pharmacological target for migraine treatment. We carried out a systematic review of the studies evaluating the involvement of RAS in patients with migraine. There is evidence from genetic studies exploring the relation between migraine and RAS-related genes and from clinical trials evaluating the efficacy of Angiotensin II Type 1 (AT1) receptor antagonists and angiotensin converting enzyme inhibitors in migraine prophylaxis. RAS seems to play a role in the pathophysiology of migraine, but more direct evidence is still missing.
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Affiliation(s)
- Karina Lúcia Moreira Sassi
- Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Laís Bhering Martins
- Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Aline Silva de Miranda
- Department of Morphology, Institute of Biological Sciences, The Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Antonio Lucio Teixeira
- Neuropsychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
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Mostofsky E, Bertisch SM, Vgontzas A, Buettner C, Li W, Rueschman M, Mittleman MA. Prospective cohort study of daily alcoholic beverage intake as a potential trigger of headaches among adults with episodic migraine. Ann Med 2020; 52:386-392. [PMID: 32306754 PMCID: PMC7486262 DOI: 10.1080/07853890.2020.1758340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To determine whether alcohol intake is associated with occurrence of headaches on the following day. METHODS In this prospective cohort study, adults with episodic migraine completed electronic diaries every morning and evening for at least six weeks in March 2016-October 2017. Every day, participants reported alcohol intake, lifestyle factors, and details about each headache. We constructed within-person fixed-effect models adjusted for time-varying factors to calculate odds ratios for the association between 1,2,3,4, or 5+ servings of alcohol and headache the following day. We also calculated the adjusted risk of headache the following day for each level of intake. RESULTS Among 98 participants who reported 825 headaches over 4,467 days, there was a statistically significant linear association (p-trend = 0.03) between alcohol and headache the following day. Compared to no alcohol, 1-2 servings were not associated with headaches, but 5+ servings were associated with a 2.08-fold (95% confidence interval [CI] 1.16-3.73) odds of headache. The adjusted absolute risk of headaches was 20% (95%CI 19%-22%) on days following no alcohol compared with 33% (95%CI 22%-44%) on days following 5+ servings. CONCLUSION 1-2 servings of alcoholic beverages were not associated with higher risk of headaches the following day, but 5+ servings were associated with higher risk. KEY MESSAGES 1-2 servings of alcoholic beverages were not associated with a higher risk of headaches on the following day, but higher levels of intake may be associated with higher risk. Five or more servings were associated with 2.08 times (95% confidence interval 1.16-3.73 the odds of headache on the following day. The adjusted absolute risk of headaches was 20% (95%CI 19%-22%) on days following no alcohol consumption compared with 33% (95% CI 22%-44%) on days following 5+ servings.
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Affiliation(s)
- Elizabeth Mostofsky
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Suzanne M Bertisch
- Harvard Medical School, Boston, MA, USA.,Program in Sleep Medicine Epidemiology, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
| | - Angeliki Vgontzas
- Harvard Medical School, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Catherine Buettner
- Harvard Medical School, Boston, MA, USA.,Department of Medicine, Mount Auburn Hospital, Cambridge, MA, USA
| | - Wenyuan Li
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michael Rueschman
- Program in Sleep Medicine Epidemiology, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
| | - Murray A Mittleman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Rafique N, Al-Asoom LI, Latif R, Alsunni AA, Salem AM, Alkhalifa ZH, Almaharfi RM, Alramadan RS, Aldajani ZF, Alghadeer FAT, Albaghli LA. Prevalence of Migraine and its Relationship with Psychological Stress and Sleep Quality in Female University Students in Saudi Arabia. J Pain Res 2020; 13:2423-2430. [PMID: 33116786 PMCID: PMC7547128 DOI: 10.2147/jpr.s270847] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/17/2020] [Indexed: 01/03/2023] Open
Abstract
Purpose This study aimed to determine the prevalence of migraine in young female adults and to identify if a relationship exists between psychological stress or poor sleep quality and migraine. Materials and Methods This case control study was carried out at Imam Abdulrahman Bin Faisal University (IAU), Dammam, KSA from March 2019 to March 2020 on 1,990 female students (17- to 26-years-old). The study tools were Migraine Screening Questionnaire (MS-Q), International Headache Society (IHS) Criteria for Migraine, K10 Psychological Distress Instrument (K10) and Pittsburgh Sleep Quality Index (PSQI). Results A total of 103 out of 1,990 (5.17%) participants were identified to have migraine. Migraineurs compared to controls had significantly higher average stress scores; felt more tired, nervous, restless, could not sit still, felt that everything was an effort, and nothing cheered them up (p values; 0.008, 0.001, 0.02, 0.01, 0.004, 0.009, 0.02 respectively). Moreover, presence of migraine was significantly correlated with various stress parameters including "High K10 scores," "being tired," "being nervous," "restlessness," "inability to sit still," and "feeling that everything is an effort" (p values: 0.01, 0.002, 0.018, 0.01,0.005, 0.01,0.02). Regarding sleep quality and sleep parameters, no statistically significant difference was found between migraineurs and controls. No correlation was found between presence of migraine and poor sleep quality. Conclusions The results of this study indicate that 5.17% of young females (17- to 26-years-old) suffer from migraine. It also concludes that poor sleep quality is not correlated with migraine, whereas high stress scores are significantly correlated with migraine in young female adults.
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Affiliation(s)
- Nazish Rafique
- Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Lubna Ibrahim Al-Asoom
- Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Rabia Latif
- Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ahmed A Alsunni
- Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ayad Mohammed Salem
- Department of Physiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | | | - Rawan Sami Alramadan
- College of Medicine, Imam Abdulrahman Bin Faisal University Dammam, Dammam, Saudi Arabia
| | - Zainab Falah Aldajani
- College of Medicine, Imam Abdulrahman Bin Faisal University Dammam, Dammam, Saudi Arabia
| | | | - Laila Abbas Albaghli
- College of Medicine, Imam Abdulrahman Bin Faisal University Dammam, Dammam, Saudi Arabia
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Holsteen KK, Hittle M, Barad M, Nelson LM. Development and Internal Validation of a Multivariable Prediction Model for Individual Episodic Migraine Attacks Based on Daily Trigger Exposures. Headache 2020; 60:2364-2379. [PMID: 33022773 DOI: 10.1111/head.13960] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 07/14/2020] [Accepted: 08/12/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To develop and internally validate a multivariable predictive model for days with new-onset migraine headaches based on patient self-prediction and exposure to common trigger factors. BACKGROUND Accurate real-time forecasting of one's daily risk of migraine attack could help episodic migraine patients to target preventive medications for susceptible time periods and help decrease the burden of disease. Little is known about the predictive utility of common migraine trigger factors. METHODS We recruited adults with episodic migraine through online forums to participate in a 90-day prospective daily-diary cohort study conducted through a custom research application for iPhone. Every evening, participants answered questions about migraine occurrence and potential predictors including stress, sleep, caffeine and alcohol consumption, menstruation, and self-prediction. We developed and estimated multivariable multilevel logistic regression models for the risk of a new-onset migraine day vs a healthy day and internally validated the models using repeated cross-validation. RESULTS We had 178 participants complete the study and qualify for the primary analysis which included 1870 migraine events. We found that a decrease in caffeine consumption, higher self-predicted probability of headache, a higher level of stress, and times within 2 days of the onset of menstruation were positively associated with next-day migraine risk. The multivariable model predicted migraine risk only slightly better than chance (within-person C-statistic: 0.56, 95% CI: 0.54, 0.58). CONCLUSIONS In this study, episodic migraine attacks were not predictable based on self-prediction or on self-reported exposure to common trigger factors. Improvements in accuracy and breadth of data collection are needed to build clinically useful migraine prediction models.
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Affiliation(s)
- Katherine K Holsteen
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael Hittle
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Meredith Barad
- Department of Anesthesia, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Lorene M Nelson
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, CA, USA
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Nowaczewska M, Wiciński M, Kaźmierczak W. The Ambiguous Role of Caffeine in Migraine Headache: From Trigger to Treatment. Nutrients 2020; 12:nu12082259. [PMID: 32731623 PMCID: PMC7468766 DOI: 10.3390/nu12082259] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/25/2020] [Accepted: 07/26/2020] [Indexed: 02/06/2023] Open
Abstract
Migraine is a chronic disorder, and caffeine has been linked with migraine for many years, on the one hand as a trigger, and on the other hand as a cure. As most of the population, including migraineurs, consume a considerable amount of caffeine daily, a question arises as to whether it influences their headaches. Indeed, drinking coffee before a migraine attack may not be a real headache trigger, but a consequence of premonitory symptoms, including yawning, diminished energy levels, and sleepiness that may herald a headache. Here, we aim to summarize the available evidence on the relationship between caffeine and migraines. Articles concerning this topic published up to June 2020 were retrieved by searching clinical databases, and all types of studies were included. We identified 21 studies investigating the prevalence of caffeine/caffeine withdrawal as a migraine trigger and 7 studies evaluating caffeine in acute migraine treatment. Among them, in 17 studies, caffeine/caffeine withdrawal was found to be a migraine trigger in a small percentage of participants (ranging from 2% to 30%), while all treatment studies found caffeine to be safe and effective in acute migraine treatment, mostly in combination with other analgesics. Overall, based on our review of the current literature, there is insufficient evidence to recommend caffeine cessation to all migraine patients, but it should be highlighted that caffeine overuse may lead to migraine chronification, and sudden caffeine withdrawal may trigger migraine attacks. Migraine sufferers should be aware of the amount of caffeine they consume and not exceed 200 mg daily. If they wish to continue drinking caffeinated beverages, they should keep their daily intake as consistent as possible to avoid withdrawal headache.
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Affiliation(s)
- Magdalena Nowaczewska
- Department of Otolaryngology, Head and Neck Surgery, and Laryngological Oncology, Faculty of Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, M. Curie 9, 85-090 Bydgoszcz, Poland
- Correspondence: ; Tel.: +48-52-585-4716
| | - Michał Wiciński
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, M. Curie 9, 85-090 Bydgoszcz, Poland;
| | - Wojciech Kaźmierczak
- Department of Sensory Organs Examination, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, M. Curie 9, 85-090 Bydgoszcz, Poland;
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Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the role of avoidance behavior in headache-related disability and overview relevant clinical implications. RECENT FINDINGS Avoidance occupies a central role in contemporary psychological perspectives on headache disorders and other chronic pain conditions. Several cognitive constructs of relevance to headache are influenced and maintained by avoidance behavior. A growing body of literature attests to the notion that avoidance of headache triggers, of stimuli that exacerbate headache, and of broader life domains can negatively affect headache progression, disability/quality of life, and comorbid psychiatric symptoms. Interventions targeting avoidance behavior, such as therapeutic exposure to headache triggers, mindfulness, and acceptance and commitment therapy (ACT), hold promise for headache disorders but need to be tested in larger trials. Researchers and clinicians are encouraged to attend to functional impairment as a critically important treatment outcome. Comprehensive understanding of headache disorders necessitates attention not merely to diagnostic symptoms and their reduction, but to patterns of avoidance behavior that inadvertently exacerbate headache and contribute to functional impairment.
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40
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Hindiyeh NA, Zhang N, Farrar M, Banerjee P, Lombard L, Aurora SK. The Role of Diet and Nutrition in Migraine Triggers and Treatment: A Systematic Literature Review. Headache 2020; 60:1300-1316. [PMID: 32449944 PMCID: PMC7496357 DOI: 10.1111/head.13836] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 12/19/2022]
Abstract
Background Migraine is a disabling primary headache disorder often associated with triggers. Diet‐related triggers are a common cause of migraine and certain diets have been reported to decrease the frequency of migraine attacks if dietary triggers or patterns are adjusted. Objective The systematic literature review was conducted to qualitatively summarize evidence from the published literature regarding the role of diet patterns, diet‐related triggers, and diet interventions in people with migraine. Methods A literature search was carried out on diet patterns, diet‐related triggers, and diet interventions used to treat and/or prevent migraine attacks, using an a priori protocol. MEDLINE and EMBASE databases were searched to identify studies assessing the effect of diet, food, and nutrition in people with migraine aged ≥18 years. Only primary literature sources (randomized controlled trials or observational studies) were included and searches were conducted from January 2000 to March 2019. The NICE checklist was used to assess the quality of the included studies of randomized controlled trials and the Downs and Black checklist was used for the assessment of observational studies. Results A total of 43 studies were included in this review, of which 11 assessed diet patterns, 12 assessed diet interventions, and 20 assessed diet‐related triggers. The overall quality of evidence was low, as most of the (68%) studies assessing diet patterns and diet‐related triggers were cross‐sectional studies or patient surveys. The studies regarding diet interventions assessed a variety of diets, such as ketogenic diet, elimination diets, and low‐fat diets. Alcohol and caffeine uses were the most common diet patterns and diet‐related triggers associated with increased frequency of migraine attacks. Most of the diet interventions, such as low‐fat and elimination diets, were related to a decrease in the frequency of migraine attacks. Conclusions There is limited high‐quality randomized controlled trial data on diet patterns or diet‐related triggers. A few small randomized controlled trials have assessed diet interventions in preventing migraine attacks without strong results. Although many patients already reported avoiding personal diet‐related triggers in their migraine management, high‐quality research is needed to confirm the effect of diet in people with migraine.
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Affiliation(s)
| | - Niushen Zhang
- Department of Neurology, Stanford University, Stanford, CA, USA
| | | | - Pixy Banerjee
- Eli Lilly Services India Pvt. Ltd., Bangalore, India
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Crawford MR, Luik AI, Espie CA, Taylor HL, Burgess HJ, Jones AL, Ong JC. Digital Cognitive Behavioral Therapy for Insomnia in Women With Chronic Migraines. Headache 2020; 60:902-915. [PMID: 32112436 DOI: 10.1111/head.13777] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/26/2020] [Accepted: 01/27/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE/BACKGROUND Insomnia commonly co-occurs with chronic migraines (CM). Non-pharmacological treatments for insomnia in CM patients remain understudied. This is a proof-of-concept study, which aims to evaluate the feasibility, acceptability, and preliminary efficacy of a digital cognitive behavioral therapy for insomnia (dCBT-I) for individuals with CM and insomnia (CM-I) in the United States. METHODS We recruited 42 females with CM-I symptoms from a U.S.-based observational cohort and from the general population via advertisements. Within a multiple baseline design, participants were randomized to receive dCBT-I after 2, 4, or 6 weeks of completing baseline sleep diaries. DCBT-I was scrutinized against benchmarks for completion rates (≥90% to complete dCBT-I), acceptability (≥80% to find dCBT-I acceptable), and posttreatment changes in insomnia symptoms (≥50% indicating a clinically relevant improvement in their insomnia symptoms). As a secondary measure, we also reported percentage of individuals reverting to episodic migraines. RESULTS Out of 42 randomized, 35 (83.3%) completed dCBT-I within the 12 weeks provided. Of these completers, 33 (94.3%) reported being satisfied (n = 16) or very satisfied (n = 17) with treatment. Additionally, 65.7% of completers responded to treatment as per universally accepted criteria for insomnia. Lastly, 34% of completers reverted from CM to episodic migraine. CONCLUSION This study provides evidence for the feasibility and acceptability of dCBT-I in patients with CM-I complaints. Effects of improving insomnia and migraines were suggested. These results indicate that a randomized controlled trial is needed to determine the efficacy of dCBT-I in CM patients.
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Affiliation(s)
- Megan R Crawford
- School of Psychological Science and Health, University of Strathclyde, Glasgow, UK.,Psychology Department, Swansea University, Glasgow, UK
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Colin A Espie
- Sleep & Circadian Neuroscience Institute (SCNi), University of Oxford, Oxford, UK
| | - Hannah L Taylor
- The Maine Sleep Center, Chest Medicine Associates, Portland, ME, USA
| | - Helen J Burgess
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Alex L Jones
- Psychology Department, Swansea University, Glasgow, UK
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- Rush University Medical Center, Chicago, IL, USA
| | - Jason C Ong
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Nowaczewska M, Wiciński M, Kaźmierczak W, Kaźmierczak H. To Eat or Not to Eat: A Review of the Relationship between Chocolate and Migraines. Nutrients 2020; 12:nu12030608. [PMID: 32110888 PMCID: PMC7146545 DOI: 10.3390/nu12030608] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 02/13/2020] [Accepted: 02/22/2020] [Indexed: 12/20/2022] Open
Abstract
Migraine is a chronic disorder with episodic attacks, and patients with a migraine often report that certain factors can trigger their headache, with chocolate being the most popular type of food-based trigger. Many studies have suggested a link between chocolate and headaches; however, the underlying physiological mechanisms are unclear. As premonitory symptoms may herald migraine attacks, a question arises regarding whether eating chocolate before a headache is a consequence of a food craving or indeed a real trigger. Here, we aim to summarize the available evidence on the relationship between chocolate and migraines. All articles concerning this topic published up to January 2020 were retrieved by searching clinical databases, including EMBASE, MEDLINE, PubMed, and Google Scholar. All types of studies have been included. Here, we identify 25 studies investigating the prevalence of chocolate as a trigger factor in migraineurs. Three provocative studies have also evaluated if chocolate can trigger migraine attacks, comparing it to a placebo. Among them, in 23 studies, chocolate was found to be a migraine trigger in a small percentage of participants (ranging from 1.3 to 33), while all provocative studies have failed to find significant differences between migraine attacks induced by eating chocolate and a placebo. Overall, based on our review of the current literature, there is insufficient evidence that chocolate is a migraine trigger; thus, doctors should not make implicit recommendations to migraine patients to avoid it.
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Affiliation(s)
- Magdalena Nowaczewska
- Department of Otolaryngology, Head and Neck Surgery, and Laryngological Oncology, Faculty of Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, M. Curie 9, 85-090 Bydgoszcz, Poland
- Correspondence: ; Tel.: +48-52-585-4716
| | - Michał Wiciński
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, M. Curie 9, 85-090 Bydgoszcz, Poland
| | - Wojciech Kaźmierczak
- Department of Sensory Organs Examination, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, M. Curie 9, 85-090 Bydgoszcz, Poland
| | - Henryk Kaźmierczak
- Department of Otolaryngology, Head and Neck Surgery, and Laryngological Oncology, Faculty of Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, M. Curie 9, 85-090 Bydgoszcz, Poland
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Bertisch SM, Li W, Buettner C, Mostofsky E, Rueschman M, Kaplan ER, Fung J, Huntington S, Murphy T, Stead C, Burstein R, Redline S, Mittleman MA. Nightly sleep duration, fragmentation, and quality and daily risk of migraine. Neurology 2020; 94:e489-e496. [PMID: 31843807 PMCID: PMC7080287 DOI: 10.1212/wnl.0000000000008740] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/22/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To test the hypotheses that insufficient duration, high fragmentation, and poor sleep quality are temporally associated with migraine onset on the day immediately following the sleep period (day 0) and the following day (day 1). METHODS In this prospective cohort study of 98 adults with episodic migraine, participants completed twice-daily electronic diaries on sleep, headaches, and other health habits, and wore wrist actigraphs for 6 weeks. We estimated the incidence of migraine following nights with short sleep duration, high fragmentation, or low quality compared to nights with adequate sleep with conditional logistic regression models stratified by participant and adjusted for caffeine intake, alcohol intake, physical activity, stress, and day of week. RESULTS Participants were a mean age of 35.1 ± 12.1 years. We collected 4,406 days of data, with 870 headaches reported. Sleep duration ≤6.5 hours and poor sleep quality were not associated with migraine on day 0 or day 1. Diary-reported low efficiency was associated with 39% higher odds of headache on day 1 (odds ratio [OR] 1.39, 95% confidence interval [CI] 1.06-1.81). Actigraphic-assessed high fragmentation was associated with lower odds of migraine on day 0 (wake after sleep onset >53 minutes, OR 0.64, 95% CI 0.48-0.86; efficiency ≤88%, OR 0.74, 95% CI 0.56-0.99). CONCLUSION Short sleep duration and low sleep quality were not temporally associated with migraine. Sleep fragmentation, defined by low sleep efficiency, was associated with higher odds of migraine on day 1. Further research is needed to understand the clinical and neurobiologic implications of sleep fragmentation and risk of migraine.
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Affiliation(s)
- Suzanne M Bertisch
- From the Program in Sleep Medicine Epidemiology, Division of Sleep and Circadian Disorders, Department of Medicine (S.M.B., M.R., E.R.K., S.R.), Brigham and Women's Hospital; Harvard Medical School (S.M.B., C.B., R.B., S.R., M.A.M.); Department of Epidemiology (W.L., E.M., M.A.M.), Harvard T.H. Chan School of Public Health; Cardiovascular Epidemiology Research Unit (W.L., E.M., M.A.M.), Harvard Catalyst (J.F., S.H., T.M., C.S.), and Department of Anesthesiology (R.B.), Beth Israel Deaconess Medical Center, Boston; and Department of Medicine (C.B.), Mount Auburn Hospital, Cambridge, MA.
| | - Wenyuan Li
- From the Program in Sleep Medicine Epidemiology, Division of Sleep and Circadian Disorders, Department of Medicine (S.M.B., M.R., E.R.K., S.R.), Brigham and Women's Hospital; Harvard Medical School (S.M.B., C.B., R.B., S.R., M.A.M.); Department of Epidemiology (W.L., E.M., M.A.M.), Harvard T.H. Chan School of Public Health; Cardiovascular Epidemiology Research Unit (W.L., E.M., M.A.M.), Harvard Catalyst (J.F., S.H., T.M., C.S.), and Department of Anesthesiology (R.B.), Beth Israel Deaconess Medical Center, Boston; and Department of Medicine (C.B.), Mount Auburn Hospital, Cambridge, MA
| | - Catherine Buettner
- From the Program in Sleep Medicine Epidemiology, Division of Sleep and Circadian Disorders, Department of Medicine (S.M.B., M.R., E.R.K., S.R.), Brigham and Women's Hospital; Harvard Medical School (S.M.B., C.B., R.B., S.R., M.A.M.); Department of Epidemiology (W.L., E.M., M.A.M.), Harvard T.H. Chan School of Public Health; Cardiovascular Epidemiology Research Unit (W.L., E.M., M.A.M.), Harvard Catalyst (J.F., S.H., T.M., C.S.), and Department of Anesthesiology (R.B.), Beth Israel Deaconess Medical Center, Boston; and Department of Medicine (C.B.), Mount Auburn Hospital, Cambridge, MA
| | - Elizabeth Mostofsky
- From the Program in Sleep Medicine Epidemiology, Division of Sleep and Circadian Disorders, Department of Medicine (S.M.B., M.R., E.R.K., S.R.), Brigham and Women's Hospital; Harvard Medical School (S.M.B., C.B., R.B., S.R., M.A.M.); Department of Epidemiology (W.L., E.M., M.A.M.), Harvard T.H. Chan School of Public Health; Cardiovascular Epidemiology Research Unit (W.L., E.M., M.A.M.), Harvard Catalyst (J.F., S.H., T.M., C.S.), and Department of Anesthesiology (R.B.), Beth Israel Deaconess Medical Center, Boston; and Department of Medicine (C.B.), Mount Auburn Hospital, Cambridge, MA
| | - Michael Rueschman
- From the Program in Sleep Medicine Epidemiology, Division of Sleep and Circadian Disorders, Department of Medicine (S.M.B., M.R., E.R.K., S.R.), Brigham and Women's Hospital; Harvard Medical School (S.M.B., C.B., R.B., S.R., M.A.M.); Department of Epidemiology (W.L., E.M., M.A.M.), Harvard T.H. Chan School of Public Health; Cardiovascular Epidemiology Research Unit (W.L., E.M., M.A.M.), Harvard Catalyst (J.F., S.H., T.M., C.S.), and Department of Anesthesiology (R.B.), Beth Israel Deaconess Medical Center, Boston; and Department of Medicine (C.B.), Mount Auburn Hospital, Cambridge, MA
| | - Emily R Kaplan
- From the Program in Sleep Medicine Epidemiology, Division of Sleep and Circadian Disorders, Department of Medicine (S.M.B., M.R., E.R.K., S.R.), Brigham and Women's Hospital; Harvard Medical School (S.M.B., C.B., R.B., S.R., M.A.M.); Department of Epidemiology (W.L., E.M., M.A.M.), Harvard T.H. Chan School of Public Health; Cardiovascular Epidemiology Research Unit (W.L., E.M., M.A.M.), Harvard Catalyst (J.F., S.H., T.M., C.S.), and Department of Anesthesiology (R.B.), Beth Israel Deaconess Medical Center, Boston; and Department of Medicine (C.B.), Mount Auburn Hospital, Cambridge, MA
| | - Jacqueline Fung
- From the Program in Sleep Medicine Epidemiology, Division of Sleep and Circadian Disorders, Department of Medicine (S.M.B., M.R., E.R.K., S.R.), Brigham and Women's Hospital; Harvard Medical School (S.M.B., C.B., R.B., S.R., M.A.M.); Department of Epidemiology (W.L., E.M., M.A.M.), Harvard T.H. Chan School of Public Health; Cardiovascular Epidemiology Research Unit (W.L., E.M., M.A.M.), Harvard Catalyst (J.F., S.H., T.M., C.S.), and Department of Anesthesiology (R.B.), Beth Israel Deaconess Medical Center, Boston; and Department of Medicine (C.B.), Mount Auburn Hospital, Cambridge, MA
| | - Shaelah Huntington
- From the Program in Sleep Medicine Epidemiology, Division of Sleep and Circadian Disorders, Department of Medicine (S.M.B., M.R., E.R.K., S.R.), Brigham and Women's Hospital; Harvard Medical School (S.M.B., C.B., R.B., S.R., M.A.M.); Department of Epidemiology (W.L., E.M., M.A.M.), Harvard T.H. Chan School of Public Health; Cardiovascular Epidemiology Research Unit (W.L., E.M., M.A.M.), Harvard Catalyst (J.F., S.H., T.M., C.S.), and Department of Anesthesiology (R.B.), Beth Israel Deaconess Medical Center, Boston; and Department of Medicine (C.B.), Mount Auburn Hospital, Cambridge, MA
| | - Tess Murphy
- From the Program in Sleep Medicine Epidemiology, Division of Sleep and Circadian Disorders, Department of Medicine (S.M.B., M.R., E.R.K., S.R.), Brigham and Women's Hospital; Harvard Medical School (S.M.B., C.B., R.B., S.R., M.A.M.); Department of Epidemiology (W.L., E.M., M.A.M.), Harvard T.H. Chan School of Public Health; Cardiovascular Epidemiology Research Unit (W.L., E.M., M.A.M.), Harvard Catalyst (J.F., S.H., T.M., C.S.), and Department of Anesthesiology (R.B.), Beth Israel Deaconess Medical Center, Boston; and Department of Medicine (C.B.), Mount Auburn Hospital, Cambridge, MA
| | - Courtney Stead
- From the Program in Sleep Medicine Epidemiology, Division of Sleep and Circadian Disorders, Department of Medicine (S.M.B., M.R., E.R.K., S.R.), Brigham and Women's Hospital; Harvard Medical School (S.M.B., C.B., R.B., S.R., M.A.M.); Department of Epidemiology (W.L., E.M., M.A.M.), Harvard T.H. Chan School of Public Health; Cardiovascular Epidemiology Research Unit (W.L., E.M., M.A.M.), Harvard Catalyst (J.F., S.H., T.M., C.S.), and Department of Anesthesiology (R.B.), Beth Israel Deaconess Medical Center, Boston; and Department of Medicine (C.B.), Mount Auburn Hospital, Cambridge, MA
| | - Rami Burstein
- From the Program in Sleep Medicine Epidemiology, Division of Sleep and Circadian Disorders, Department of Medicine (S.M.B., M.R., E.R.K., S.R.), Brigham and Women's Hospital; Harvard Medical School (S.M.B., C.B., R.B., S.R., M.A.M.); Department of Epidemiology (W.L., E.M., M.A.M.), Harvard T.H. Chan School of Public Health; Cardiovascular Epidemiology Research Unit (W.L., E.M., M.A.M.), Harvard Catalyst (J.F., S.H., T.M., C.S.), and Department of Anesthesiology (R.B.), Beth Israel Deaconess Medical Center, Boston; and Department of Medicine (C.B.), Mount Auburn Hospital, Cambridge, MA
| | - Susan Redline
- From the Program in Sleep Medicine Epidemiology, Division of Sleep and Circadian Disorders, Department of Medicine (S.M.B., M.R., E.R.K., S.R.), Brigham and Women's Hospital; Harvard Medical School (S.M.B., C.B., R.B., S.R., M.A.M.); Department of Epidemiology (W.L., E.M., M.A.M.), Harvard T.H. Chan School of Public Health; Cardiovascular Epidemiology Research Unit (W.L., E.M., M.A.M.), Harvard Catalyst (J.F., S.H., T.M., C.S.), and Department of Anesthesiology (R.B.), Beth Israel Deaconess Medical Center, Boston; and Department of Medicine (C.B.), Mount Auburn Hospital, Cambridge, MA
| | - Murray A Mittleman
- From the Program in Sleep Medicine Epidemiology, Division of Sleep and Circadian Disorders, Department of Medicine (S.M.B., M.R., E.R.K., S.R.), Brigham and Women's Hospital; Harvard Medical School (S.M.B., C.B., R.B., S.R., M.A.M.); Department of Epidemiology (W.L., E.M., M.A.M.), Harvard T.H. Chan School of Public Health; Cardiovascular Epidemiology Research Unit (W.L., E.M., M.A.M.), Harvard Catalyst (J.F., S.H., T.M., C.S.), and Department of Anesthesiology (R.B.), Beth Israel Deaconess Medical Center, Boston; and Department of Medicine (C.B.), Mount Auburn Hospital, Cambridge, MA
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Headache Hygiene in Pediatrics: Brushing Up on the Basics. Pediatr Neurol 2020; 103:3-7. [PMID: 31843350 DOI: 10.1016/j.pediatrneurol.2019.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 10/02/2019] [Accepted: 10/10/2019] [Indexed: 01/18/2023]
Abstract
Headache hygiene refers to self-management behaviors and practices aimed at reducing headache-related disability and improving self-efficacy. Although self-management interventions have an established place in the management of a wide range of chronic conditions, there is still not a standardized approach to this in pediatric headache. In this article, we focus on headache hygiene approaches including education, lifestyle interventions, and psychologic interventions. We also present our center's resource compilation, made available to patients by quick response code technology, as an example of a structured approach to headache hygiene. Further work should explore a standardized approach to headache hygiene and strategies to support adherence, including the use of technology as an innovative health care delivery pathway.
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Mostofsky E, Mittleman MA, Buettner C, Li W, Bertisch SM. Prospective Cohort Study of Caffeinated Beverage Intake as a Potential Trigger of Headaches among Migraineurs. Am J Med 2019; 132:984-991. [PMID: 31402050 PMCID: PMC6744320 DOI: 10.1016/j.amjmed.2019.02.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/18/2019] [Accepted: 02/19/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE We aimed to evaluate the role of caffeinated beverage intake as a potential trigger of migraine headaches on that day or on the following day. METHODS In this prospective cohort study, 101 adults with episodic migraine completed electronic diaries every morning and evening. Ninety-eight participants completed at least 6 weeks of diaries in March 2016-October 2017. Every day, participants reported caffeinated beverage intake, other lifestyle factors, and the timing and characteristics of each migraine headache. We compared a participant's incidence of migraines on days with caffeinated beverage intake to the incidence of migraines among the same individual on days with no intake, accounting for day of week. We used conditional logistic regression to estimate odds ratios (OR) and 95% confidence intervals. RESULTS Among 98 participants (86 women, 12 men) with mean age 35.1 years, 83% white, and 10% Hispanic or Latino, the average age when headaches started was 16.3 years. In total, the participants reported 825 migraines during 4467 days of observation. There was a statistically significant nonlinear association between the number of caffeinated beverages and the odds of migraine headache occurrence on that day (P-quadratic trend = .024), though estimates for each level of intake were not statistically significant. The associations varied according to habitual intake and oral contraceptive use. CONCLUSIONS There was a nonlinear association between caffeinated beverage intake and the odds of migraine headache occurrence on that day. This suggests that high levels of caffeinated beverage intake may be a trigger of migraine headaches on that day.
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Affiliation(s)
- Elizabeth Mostofsky
- Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, Mass; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass.
| | - Murray A Mittleman
- Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, Mass; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Catherine Buettner
- Harvard Medical School, Boston, Mass; Department of Medicine, Mount Auburn Hospital, Cambridge, Mass
| | - Wenyuan Li
- Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, Mass; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Suzanne M Bertisch
- Harvard Medical School, Boston, Mass; Department of Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Mass; Sleep Medicine Epidemiology Program, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Mass
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Koller LS, Diesner SC, Voitl P. Quality of life in children and adolescents with migraine: an Austrian monocentric, cross-sectional questionnaire study. BMC Pediatr 2019; 19:164. [PMID: 31126268 PMCID: PMC6533686 DOI: 10.1186/s12887-019-1537-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 05/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Migraine is a disabling primary headache disorder that occurs in about 10 % of children and might lead to a lower quality of life. There are several possible migraine triggers in a patient's environment, which should be avoided where possible. The objective of this Austrian monocentric study was to identify migraine triggers and the areas, in which children and adolescents with migraine have a lower quality of life than healthy, headache-free children. METHODS In this cross-sectional, questionnaire study, 76 children from ages 8 to 17 years were included. Thirty-seven were classified as migraineurs, 39 as non-migraineurs. Participants filled in a questionnaire surveying the areas of physical, socio-economic and school functioning. Migraineurs further answered migraine-specific questions. RESULTS The study included 33 (43.4%) males and 43 (56.6%) females. Median age was 13.00 (10.00-16.00) years. Average age of onset for migraine was 9.22 ± 3.34 years. Non-migraineurs skipped trendwise fewer meals (p.adjust = 0.108) and exercised more often (p.adjust = 0.108). In socio-economic functioning, the father's nationality being Austrian might be related to migraine (p.adjust = 0.108). Children with migraine had a significantly lower quality of life in school functioning (PedsQL 4.0 questionnaire, p.adjust = 0.04) and had significantly less often "good" grades than children without migraine (p.adjust = 0.048). CONCLUSION Children with migraine show a reduced quality of life in the areas of physical, socio-economic and school functioning.
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Affiliation(s)
- Lydia Stella Koller
- First Vienna Pediatric Medical Center, Donau-City Straße 1, 1220 Vienna, Austria
| | - Susanne C. Diesner
- First Vienna Pediatric Medical Center, Donau-City Straße 1, 1220 Vienna, Austria
| | - Peter Voitl
- First Vienna Pediatric Medical Center, Donau-City Straße 1, 1220 Vienna, Austria
- Sigmund Freud University Vienna, Freudplatz 1, 1020 Vienna, Austria
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Fragrance inhalation and adverse health effects: The question of causation. Regul Toxicol Pharmacol 2019; 104:151-156. [PMID: 30904429 DOI: 10.1016/j.yrtph.2019.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 02/18/2019] [Accepted: 03/16/2019] [Indexed: 12/28/2022]
Abstract
The toxicology of fragrance materials is largely well understood. Although most are benign, a minority have the potential to cause adverse health effects, notably allergic contact dermatitis resulting from skin sensitization. As a consequence, industry guidelines have banned certain materials and strictly limited the use of others. Recently, data have been published that have been interpreted to suggest that inhalation of fragrances is associated with the occurrence of a variety of health effects, ranging from headaches to asthma attacks. In this review, the evidence basis for these assertions is examined critically and the biological basis and mechanistic plausibility for causation by fragranced products of these health effects is explored. This review concludes that respiratory effects, including irritation and allergy appear highly unlikely to occur by this route. While some sensory/psychosomatic effects are possible, this does not explain the very high rates of adverse effects reported in the recently published questionnaire studies, which this review concludes are more likely to be attributed to methodological weaknesses. Ultimately, it is concluded that adverse health effects arising from fragrance inhalation are uncommon and remain to be identified and confirmed by methodologically rigorous epidemiological investigations supported by a convincing biological and mechanistic basis.
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Klarendic M, Kojovic M. The Christmas gathering: a household guide to neurological symptoms. How to use the most versatile and common object patients use, a home, in neurological diagnostics. Postgrad Med J 2019; 94:675-677. [PMID: 30700612 DOI: 10.1136/postgradmedj-2018-136272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 12/04/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Maja Klarendic
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Maja Kojovic
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
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