1
|
Lipton RB, Harriott AM, Ma JY, Smith JH, Stokes J, Gandhi P, Jariwala-Parikh K, Jensen GS, Trugman JM, Dodick DW. Effect of Ubrogepant on Patient-Reported Outcomes When Administered During the Migraine Prodrome: Results From the Randomized PRODROME Trial. Neurology 2024; 103:e209745. [PMID: 39197113 PMCID: PMC11379431 DOI: 10.1212/wnl.0000000000209745] [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: 08/30/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Ubrogepant is a calcitonin gene-related peptide receptor antagonist approved for the acute treatment of migraine. The PRODROME trial previously demonstrated that ubrogepant treatment during prodrome prevents the onset of moderate or severe headache. In this analysis of the PRODROME trial, the benefits of ubrogepant treatment during the prodrome on patient-reported outcomes (PROs) are evaluated. METHODS PRODROME was a multicenter, randomized, double-blind, placebo-controlled, crossover trial that enrolled adults who experienced 2-8 migraine attacks per month with moderate-severe headache pain. Eligible participants treated 2 qualifying prodrome events, defined as a migraine attack with prodromal symptoms when the participant was confident a headache would follow within 1-6 hours. Participants were randomized to treatment sequence A (placebo then ubrogepant 100 mg) or sequence B (ubrogepant 100 mg then placebo). This analysis evaluated the ability to function normally over 24 hours (secondary end point) and at specific time points after dose (additional end point). Other PRO end points included activity limitation over 24 hours and satisfaction with study medication at 8 and 24 hours. RESULTS Of 518 randomized participants, 477 comprised the modified intent-to-treat population. After treatment of qualifying prodrome events, a significantly greater ability to function normally over 24 hours was observed for participants after treatment with ubrogepant 100 mg compared with placebo (odds ratio [OR] 1.66, 95% CI 1.40-1.96; p < 0.0001). As early as 2 hours after dose, a greater proportion of ubrogepant-treated participants reported "no disability, able to function normally" compared with placebo (OR 1.76, 95% CI 1.32-2.35; nominal p = 0.0001). Ubrogepant administered during the prodrome was also associated with a greater reduction in activity limitations over 24 hours after dose (OR 2.07, 95% CI 1.61-2.67; nominal p < 0.0001). At 8 and 24 hours after dose, rates of being "satisfied" or "extremely satisfied" were greater for ubrogepant than for placebo (8 hours: OR 2.37, 95% CI 1.78-3.15; nominal p < 0.0001; 24 hours: OR 2.32, 95% CI 1.78-3.02; nominal p < 0.0001). DISCUSSION Ubrogepant 100 mg administered during the prodrome was associated with significantly greater ability to function normally, greater reduction in activity limitations over 24 hours, and greater satisfaction with study medication, compared with placebo. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov NCT04492020. Submitted: July 27, 2020; first patient enrolled: August 21, 2020. clinicaltrials.gov/ct2/show/NCT04492020. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that taking ubrogepant 100 mg during a migraine prodrome allows more patients to function normally over the next 24 hours.
Collapse
Affiliation(s)
- Richard B Lipton
- From the Albert Einstein College of Medicine (R.B.L.), Bronx, NY; Massachusetts General Hospital (A.M.H.), Boston; AbbVie (J.Y.M., J.S., P.G., J.M.T.), Madison, NJ; AbbVie (J.H.S., K.J.-P., G.S.J.), North Chicago, IL; Department of Neurology (D.W.D.), Mayo Clinic, Scottsdale, AZ; and Atria Academy of Science and Medicine (D.W.D.), New York, NY
| | - Andrea M Harriott
- From the Albert Einstein College of Medicine (R.B.L.), Bronx, NY; Massachusetts General Hospital (A.M.H.), Boston; AbbVie (J.Y.M., J.S., P.G., J.M.T.), Madison, NJ; AbbVie (J.H.S., K.J.-P., G.S.J.), North Chicago, IL; Department of Neurology (D.W.D.), Mayo Clinic, Scottsdale, AZ; and Atria Academy of Science and Medicine (D.W.D.), New York, NY
| | - Julia Y Ma
- From the Albert Einstein College of Medicine (R.B.L.), Bronx, NY; Massachusetts General Hospital (A.M.H.), Boston; AbbVie (J.Y.M., J.S., P.G., J.M.T.), Madison, NJ; AbbVie (J.H.S., K.J.-P., G.S.J.), North Chicago, IL; Department of Neurology (D.W.D.), Mayo Clinic, Scottsdale, AZ; and Atria Academy of Science and Medicine (D.W.D.), New York, NY
| | - Jonathan H Smith
- From the Albert Einstein College of Medicine (R.B.L.), Bronx, NY; Massachusetts General Hospital (A.M.H.), Boston; AbbVie (J.Y.M., J.S., P.G., J.M.T.), Madison, NJ; AbbVie (J.H.S., K.J.-P., G.S.J.), North Chicago, IL; Department of Neurology (D.W.D.), Mayo Clinic, Scottsdale, AZ; and Atria Academy of Science and Medicine (D.W.D.), New York, NY
| | - Jonathan Stokes
- From the Albert Einstein College of Medicine (R.B.L.), Bronx, NY; Massachusetts General Hospital (A.M.H.), Boston; AbbVie (J.Y.M., J.S., P.G., J.M.T.), Madison, NJ; AbbVie (J.H.S., K.J.-P., G.S.J.), North Chicago, IL; Department of Neurology (D.W.D.), Mayo Clinic, Scottsdale, AZ; and Atria Academy of Science and Medicine (D.W.D.), New York, NY
| | - Pranav Gandhi
- From the Albert Einstein College of Medicine (R.B.L.), Bronx, NY; Massachusetts General Hospital (A.M.H.), Boston; AbbVie (J.Y.M., J.S., P.G., J.M.T.), Madison, NJ; AbbVie (J.H.S., K.J.-P., G.S.J.), North Chicago, IL; Department of Neurology (D.W.D.), Mayo Clinic, Scottsdale, AZ; and Atria Academy of Science and Medicine (D.W.D.), New York, NY
| | - Krutika Jariwala-Parikh
- From the Albert Einstein College of Medicine (R.B.L.), Bronx, NY; Massachusetts General Hospital (A.M.H.), Boston; AbbVie (J.Y.M., J.S., P.G., J.M.T.), Madison, NJ; AbbVie (J.H.S., K.J.-P., G.S.J.), North Chicago, IL; Department of Neurology (D.W.D.), Mayo Clinic, Scottsdale, AZ; and Atria Academy of Science and Medicine (D.W.D.), New York, NY
| | - Gabriel S Jensen
- From the Albert Einstein College of Medicine (R.B.L.), Bronx, NY; Massachusetts General Hospital (A.M.H.), Boston; AbbVie (J.Y.M., J.S., P.G., J.M.T.), Madison, NJ; AbbVie (J.H.S., K.J.-P., G.S.J.), North Chicago, IL; Department of Neurology (D.W.D.), Mayo Clinic, Scottsdale, AZ; and Atria Academy of Science and Medicine (D.W.D.), New York, NY
| | - Joel M Trugman
- From the Albert Einstein College of Medicine (R.B.L.), Bronx, NY; Massachusetts General Hospital (A.M.H.), Boston; AbbVie (J.Y.M., J.S., P.G., J.M.T.), Madison, NJ; AbbVie (J.H.S., K.J.-P., G.S.J.), North Chicago, IL; Department of Neurology (D.W.D.), Mayo Clinic, Scottsdale, AZ; and Atria Academy of Science and Medicine (D.W.D.), New York, NY
| | - David W Dodick
- From the Albert Einstein College of Medicine (R.B.L.), Bronx, NY; Massachusetts General Hospital (A.M.H.), Boston; AbbVie (J.Y.M., J.S., P.G., J.M.T.), Madison, NJ; AbbVie (J.H.S., K.J.-P., G.S.J.), North Chicago, IL; Department of Neurology (D.W.D.), Mayo Clinic, Scottsdale, AZ; and Atria Academy of Science and Medicine (D.W.D.), New York, NY
| |
Collapse
|
2
|
Stubberud A, Langseth H, Nachev P, Matharu MS, Tronvik E. Artificial intelligence and headache. Cephalalgia 2024; 44:3331024241268290. [PMID: 39099427 DOI: 10.1177/03331024241268290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
BACKGROUND AND METHODS In this narrative review, we introduce key artificial intelligence (AI) and machine learning (ML) concepts, aimed at headache clinicians and researchers. Thereafter, we thoroughly review the use of AI in headache, based on a comprehensive literature search across PubMed, Embase and IEEExplore. Finally, we discuss limitations, as well as ethical and political perspectives. RESULTS We identified six main research topics. First, natural language processing can be used to effectively extract and systematize unstructured headache research data, such as from electronic health records. Second, the most common application of ML is for classification of headache disorders, typically based on clinical record data, or neuroimaging data, with accuracies ranging from around 60% to well over 90%. Third, ML is used for prediction of headache disease trajectories. Fourth, ML shows promise in forecasting of headaches using self-reported data such as triggers and premonitory symptoms, data from wearable sensors and external data. Fifth and sixth, ML can be used for prediction of treatment responses and inference of treatment effects, respectively, aiming to optimize and individualize headache management. CONCLUSIONS The potential uses of AI and ML in headache are broad, but, at present, many studies suffer from poor reporting and lack out-of-sample evaluation, and most models are not validated in a clinical setting.
Collapse
Affiliation(s)
- Anker Stubberud
- NorHead Norwegian Centre for Headache Research, Trondheim, Norway
- Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Helge Langseth
- NorHead Norwegian Centre for Headache Research, Trondheim, Norway
- Department of Computer Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Parashkev Nachev
- High Dimensional Neurology Group, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Manjit S Matharu
- NorHead Norwegian Centre for Headache Research, Trondheim, Norway
- Headache and Facial Pain Group, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Erling Tronvik
- NorHead Norwegian Centre for Headache Research, Trondheim, Norway
- Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurology and Clinical Neurophysiology, Neuroclinic, StOlav University Hospital, Trondheim, Norway
| |
Collapse
|
3
|
Thuraiaiyah J, Ashina H, Christensen RH, Al-Khazali HM, Ashina M. Postdromal symptoms in migraine: a REFORM study. J Headache Pain 2024; 25:25. [PMID: 38383318 PMCID: PMC10880332 DOI: 10.1186/s10194-024-01716-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 01/14/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Migraine is a multiphasic neurovascular disorder, where headache can be succeeded by postdromal symptoms. However, there are limited research on postdromal symptoms. This study aimed to investigate the proportion of individuals with migraine from a tertiary care unit reporting postdromal symptoms in adherence with the ICHD-3 definition. We also aimed to examine how the means of enquiry might influence the estimated proportions. Additionally, we explored whether any clinical features might affect the likelihood of reporting postdromal symptoms. Finally, we assessed to what extend the postdromal symptoms might impact the disease burden. METHODS In a cross-sectional study, we enrolled adult participants diagnosed with migraine who were asked to report their postdromal symptoms (i.e., unprompted reporting). Subsequently, a 16-item list was used to further ascertain the occurrence of postdromal symptoms (i.e., prompted reporting). Clinical characteristics were obtained through a semi-structured interview. Moreover, electronic questionnaires were used to assess the disease burden, i.e., the Six-Item Headache Impact Test (HIT-6), Migraine Disability Assessment (MIDAS), and the World Health Organization Disability Assessment 2.0 (WHODAS 2.0). RESULTS Among 631 participants with migraine, a higher proportion experienced at least one postdromal symptom when prompted (n = 509 [80.7%]) compared with unprompted reporting (n = 421 [66.7%], P < 0.001). Furthermore, the total number of postdromal symptoms experienced was greater with prompted than unprompted reporting (medians 3 [IQR 1 - 6] versus 1 [IQR 0 - 2]; P < 0.001). Furthermore, the likelihood of reporting postdromal symptoms increased with the presence of premonitory symptoms and decreased with higher number of monthly migraine days. Weak correlations were identified between the number of postdromal symptoms reported and both HIT-6 (ρ = 0.14; P < 0.001) and WHODAS scores (ρ = 0.15; P < 0.001), whilst no correlation was observed with MIDAS score (ρ = 0.08; P = 0.054). CONCLUSIONS Postdromal symptoms are prevalent in individuals with migraine from a tertiary care unit. However, reported estimates warrant cautious interpretation as they depend on the means of enquiry, presence of premonitory symptoms, and frequency of monthly migraine days. Moreover, a weak correlation was identified between the number of postdromal symptoms and both HIT-6 and WHODAS scores, indicating only a marginal influence on the disease burden.
Collapse
Affiliation(s)
- Janu Thuraiaiyah
- Danish Headache Center, Department of Neurology, Rigshospitalet - Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, 2600, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Håkan Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet - Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, 2600, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Brain and Spinal Cord Injury, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Rune Häckert Christensen
- Danish Headache Center, Department of Neurology, Rigshospitalet - Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, 2600, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Haidar M Al-Khazali
- Danish Headache Center, Department of Neurology, Rigshospitalet - Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, 2600, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet - Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, 2600, Glostrup, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Danish Knowledge Center On Headache Disorders, Glostrup, Denmark.
| |
Collapse
|
4
|
Thuraiaiyah J, Ashina H, Christensen RH, Al-Khazali HM, Wiggers A, Amin FM, Steiner TJ, Ashina M. Premonitory symptoms in migraine: A REFORM Study. Cephalalgia 2024; 44:3331024231223979. [PMID: 38299579 DOI: 10.1177/03331024231223979] [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] [Indexed: 02/02/2024]
Abstract
BACKGROUND Estimates of proportions of people with migraine who report premonitory symptoms vary greatly among previous studies. Our aims were to establish the proportion of patients reporting premonitory symptoms and its dependency on the enquiry method. Additionally, we investigated the impact of premonitory symptoms on disease burden using Headache Impact Test (HIT-6), Migraine Disability Assessment (MIDAS) and World Health Organization Disability Assessment 2.0 (WHODAS 2.0), whilst investigating how various clinical factors influenced the likelihood of reporting premonitory symptoms. METHODS In a cross-sectional study, premonitory symptoms were assessed among 632 patients with migraine. Unprompted enquiry was used first, followed by a list of 17 items (prompted). Additionally, we obtained clinical characteristics through a semi-structured interview. RESULTS Prompted enquiry resulted in a greater proportion reporting premonitory symptoms than unprompted (69.9% vs. 43.0%; p < 0.001) and with higher symptom counts (medians 2, interquartile range = 0-6 vs. 1, interquartile range = 0-1; p < 0.001). The number of symptoms correlated weakly with HIT-6 (ρ = 0.14; p < 0.001) and WHODAS scores (ρ = 0.09; p = 0.041). Reporting postdromal symptoms or triggers increased the probability of reporting premonitory symptoms, whereas monthly migraine days decreased it. CONCLUSIONS The use of a standardized and optimized method for assessing premonitory symptoms is necessary to estimate their prevalence and to understand whether and how they contribute to disease burden.
Collapse
Affiliation(s)
- Janu Thuraiaiyah
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Håkan Ashina
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Brain and Spinal Cord Injury, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Rune H Christensen
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Haidar M Al-Khazali
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Astrid Wiggers
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Faisal Mohammad Amin
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Brain and Spinal Cord Injury, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Timothy J Steiner
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Division of Brain Sciences, Imperial College London, London, UK
| | - Messoud Ashina
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Danish Knowledge Center on Headache Disorders, Glostrup, Denmark
| |
Collapse
|
5
|
Paemeleire K, Vandenbussche N, Stark R. Migraine without aura. HANDBOOK OF CLINICAL NEUROLOGY 2023; 198:151-167. [PMID: 38043959 DOI: 10.1016/b978-0-12-823356-6.00007-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Migraine without aura is the commonest form of migraine in both children and adults. The diagnosis is made by applying the International Classification of Headache Disorders Third Edition subsection for migraine without aura (ICHD-3 subsection 1.1). Attacks in patients with migraine without aura are characterized by their polyphasic presentation (prodrome, headache phase, postdromal phase). The symptomatology of attacks is diverse and heterogeneous, with most common symptoms being photophobia, phonophobia, nausea, vomiting, and aggravation of pain by movement. The clinician and researcher who wants to learn about migraine without aura needs to be able to apply the ICHD-3 criteria with its specific symptomatology to make a correct diagnosis, but also needs to be aware about the plethora of symptoms patients may experience. In this chapter, the reader will explore the clinical phenotypical features of migraine without aura.
Collapse
Affiliation(s)
- Koen Paemeleire
- Department of Neurology, Ghent University Hospital, Ghent, Belgium.
| | | | - Richard Stark
- Department of Neurology, Alfred Hospital, Monash University, Melbourne, VIC, Australia; Department of Neurosciences, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
6
|
Gollion C, De Icco R, Dodick DW, Ashina H. The premonitory phase of migraine is due to hypothalamic dysfunction: revisiting the evidence. J Headache Pain 2022; 23:158. [PMID: 36514014 PMCID: PMC9745986 DOI: 10.1186/s10194-022-01518-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/31/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To critically appraise the evidence for and against premonitory symptoms in migraine being due to hypothalamic dysfunction. DISCUSSION Some premonitory symptoms (e.g. fatigue, mood changes, yawning, and food craving) are associated with the physiologic effects of neurotransmitters such as orexins, neuropeptide Y, and dopamine; all of which are expressed in hypothalamic neurons. In rodents, electrophysiologic recordings have shown that these neurotransmitters modulate nociceptive transmission at the level of second-order neurons in the trigeminocervical complex (TCC). Additional insights have been gained from neuroimaging studies that report hypothalamic activation during the premonitory phase of migraine. However, the available evidence is limited by methodologic issues, inconsistent reporting, and a lack of adherence to ICHD definitions of premonitory symptoms (or prodromes) in human experimental studies. CONCLUSIONS The current trend to accept that premonitory symptoms are due to hypothalamic dysfunction might be premature. More rigorously designed studies are needed to ascertain whether the neurobiologic basis of premonitory symptoms is due to hypothalamic dysfunction or rather reflects modulatory input to the trigeminovascular system from several cortical and subcortical areas. On a final note, the available epidemiologic data raises questions as to whether the existence of premonitory symptoms and even more so a distinct premonitory phase is a true migraine phenomenon. Video recording of the debate held at the 1st International Conference on Advances in Migraine Sciences (ICAMS 2022, Copenhagen, Denmark) is available at: https://www.youtube.com/watch?v=d4Y2x0Hr4Q8 .
Collapse
Affiliation(s)
- Cedric Gollion
- Danish Headache Center, Department of Neurology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, University Hospital of Toulouse, Toulouse, France
| | - Roberto De Icco
- Department of Brain and Behavioral Science, University of Pavia, Pavia, Italy
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - David W Dodick
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hakan Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Department of Neurorehabilitation / Traumatic Brain Injury, Rigshospitalet, Copenhagen, Denmark.
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
7
|
Eigenbrodt AK, Christensen RH, Ashina H, Iljazi A, Christensen CE, Steiner TJ, Lipton RB, Ashina M. Premonitory symptoms in migraine: a systematic review and meta-analysis of observational studies reporting prevalence or relative frequency. J Headache Pain 2022; 23:140. [DOI: 10.1186/s10194-022-01510-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Observational studies on the prevalence of premonitory symptoms in people with migraine, preceding the headache pain (or aura) phase, have shown conflicting results. We conducted a systematic review and meta-analysis to estimate the prevalence, and relative frequency among clinic populations, of premonitory symptoms in people with migraine, overall and of the multifarious individual symptoms, and to review the methodologies used to assess them.
Methods
We searched PubMed and Embase for studies published from database inception until 31st of May 2022. Two investigators independently screened titles, abstracts, and full texts. We retrieved observational studies that reported the prevalence/relative frequency of one or more premonitory symptoms in people with migraine. Two investigators independently extracted data and assessed risk of bias. Results were pooled using random-effects meta-analysis. Our main outcomes were the percentage of people with migraine who experienced at least one premonitory symptom and the percentages who experienced different individual premonitory symptoms. To describe our outcomes, we used the terms prevalence for data from population-based samples and relative frequency for data from clinic-based samples. We also descriptively and critically assessed the methodologies used to assess these symptoms.
Results
The pooled estimated prevalence in population-based studies of at least one premonitory symptom was 29% (95% CI: 8–63; I2 99%) and the corresponding pooled estimated relative frequency in clinic-based studies was 66% (95% CI: 45–82; I2 99%). The data from clinic-based studies only supported meta-analysis of 11 of 96 individual symptoms, with relative frequency estimates ranging from 11 to 49%. Risk of bias was determined as high in 20 studies, moderate in seven, and low in two.
Conclusions
The substantial between-study heterogeneity demands cautious interpretation of our estimates. Studies showed wide methodological variations, and many lacked rigor. Overall, the evidence was insufficient to support reliable prevalence estimation or characterization of premonitory symptoms. More data are needed, of better quality, to confirm the existence of a distinctive premonitory phase of migraine, and its features. Methodological guidelines based on expert consensus are a prerequisite.
Collapse
|
8
|
Vives-Mestres M, Casanova A. Modeling and visualizing two-way contingency tables using compositional data analysis: A case-study on individual self-prediction of migraine days. Stat Med 2020; 40:213-225. [PMID: 33113589 DOI: 10.1002/sim.8769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/18/2020] [Indexed: 11/10/2022]
Abstract
Two-way contingency tables arise in many fields, such as in medical studies, where the relation between two discrete random variables or responses is to be assessed. We propose to analyze and visualize a sample of 2 × 2 tables in the context of single-subject repeated measurements design by means of compositional data (CoDa) methods. First, we propose to visualize the tables in a quaternary diagram. Second, we show how to represent these tables by means of logratios indicating the relationship between the two variables as well as their strength and direction of dependency. Finally, we describe a technique to model those tables with a simplicial regression model. Data from a real-world study of self-prediction of migraine attack onset is used to illustrate this methodology. For each individual, the 2 × 2 table of their migraine expectation vs next day migraine occurrence is computed, generating a sample of tables. Then we visualize and interpret the prediction ability of individuals both in the simplex and in terms of logratios of components. Finally, we model the self-prediction ability with respect to demographic variables, days tracked and disease characteristics. Our application demonstrates that CoDa can be a useful tool for visualizing, modeling, and interpreting the components of 2 × 2 tables.
Collapse
Affiliation(s)
- Marina Vives-Mestres
- Department of Computer Science, Applied Mathematics and Statistics, Universitat de Girona, Girona, Spain.,Clinical Statistics, Curelator Inc., Cambridge, Massachusetts, USA
| | - Amparo Casanova
- Clinical Statistics, Curelator Inc., Cambridge, Massachusetts, USA
| |
Collapse
|
9
|
Termini SD, Wöber C, Brannath W. Early use of acute medication for preventing migraine attacks: Results from a diary-based cohort study. CEPHALALGIA REPORTS 2020. [DOI: 10.1177/2515816320944928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Treating migraine attacks early may improve outcome. The aim of this analysis was to investigate whether certain premonitory symptoms could be indicators for taking acute medication. Methods: We analyzed 3-month diary data recorded by 271 patients with episodic migraine and looked at all migraine-free intervals. For investigating the interaction between acute medication and neck discomfort associated with sensitivity to lights, noises, or odors, we used a marginal structural model and a Cox regression analysis adjusted for moderate or severe headache. Results: The patients (mean age 43 ± 15.4 years, 88% women) recorded a total of 20,219 diary days without migraine. In the marginal structural model analysis, the risk for occurrence of a migraine attack on the subsequent day was reduced when acute medication was used in the presence of neck discomfort associated with sensitivity to lights (hazard ratio 0.4; 95% confidence interval 0.2–0.7), noises (0.4; 0.3–0.7), or odors (0.2; 0.1–0.4). The marginal structural model showed lower risk of migraine attacks than the Cox regression analysis adjusted for moderate or severe headache in the majority of the cases. Conclusion: Migraine attacks may be prevented when acute medication is used in the presence of neck discomfort associated with sensitivity to lights, noises, or odors. The results of this study may stimulate further prospective trials.
Collapse
Affiliation(s)
- Susanna Di Termini
- Competence Center for Clinical Trials, University of Bremen, Bremen, Germany
| | - Christian Wöber
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Werner Brannath
- Competence Center for Clinical Trials, University of Bremen, Bremen, Germany
| |
Collapse
|
10
|
Bao X, Liu H, Liu HY, Long Y, Tan JW, Zhu ZM. The effect of intermittent hypoxia training on migraine: a randomized controlled trial. Am J Transl Res 2020; 12:4059-4065. [PMID: 32774759 PMCID: PMC7407698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 06/03/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To study the effect of intermittent hypoxia training (IHT) for migraine. DESIGN A single-blind, randomized controlled trial. All participants were recruited from a rehabilitation department in an acute university-affiliated hospital. METHODS Participants with migraines were randomly assigned to two groups (IHT group and control group). The Migraine Disability Assessment (MIDAS), Visual Analog Scale (VAS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Vascular endothelial growth factor (VEGF), calcitonin gene related peptide (CGRP) and cerebrovascular hemodynamic parameters were collected at baseline and end of the 8th week. The attack frequencies of migraines were evaluated at 3 months. RESULTS Among the 48 subjects, five males and forty-three females, the ages ranged from 19 to 53 years old (mean ± SD = 31.3±7.78). MIDAS, SF-36, VAS, BAI, BDI, VEGF, CGRP and cerebrovascular hemodynamic parameters were improved after IHT intervention. There were significant differences between IHT group and the control group in MIDAS, SF-36, VAS, BAI, BDI, VEGF, CGRP and cerebrovascular hemodynamic parameters at the end of the 8th weeks (P<0.05). Attack frequencies were improved within 3 months after IH training intervention (P<0.01), but not in the control group (P>0.05). No adverse events occurred during the study. CONCLUSION IHT could improve migraines after intervention up to three months. IHT could be an effective method for relieving a migraine.
Collapse
Affiliation(s)
- Xiao Bao
- Department of Rehabilitation Medicine, Yue Bei People’s HospitalShaoguan, China
| | - Howe Liu
- Department of Physical Therapy, University of North Texas Health Science CenterFort Worth, USA
| | - Hui-Yu Liu
- Department of Rehabilitation Medicine, Yue Bei People’s HospitalShaoguan, China
| | - Ying Long
- Department of Hyperbaric Oxygen Medicine, Shenzhen People’s HospitalShenzhen, China
| | - Jie-Wen Tan
- Department of Rehabilitation Medicine, Xinhua College of Sun Yat-sen UniversityGuangzhou, China
| | - Zhi-Min Zhu
- Department of Rehabilitation Medicine, Lianjiang People’s HospitalLianjiang, China
| |
Collapse
|
11
|
von Deneen KM, Zhao L, Liu J. Individual differences of maladaptive brain changes in migraine and their relationship with differential effectiveness of treatments. BRAIN SCIENCE ADVANCES 2020. [DOI: 10.26599/bsa.2019.9050021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Migraine is a difficult disorder to identify with regard to its pathophysiological mechanisms, and its treatment has been primarily difficult owing to interindividual differences. Substantial rates of nonresponsiveness to medications are common, making migraine treatment complicated. In this review, we systematically analyzed recent studies concerning neuroimaging findings regarding the neurophysiology of migraine. We linked the current imaging research with anecdotal evidence from interindividual factors such as duration and pain intensity of migraine, age, gender, hormonal interplay, and genetics. These factors suggested the use of nonpharmacological therapies such as transcranial magnetic stimulation, transcranial direct current stimulation, and placebo therapy for the treatment of migraine. Finally, we discussed how interindividual differences are related to such nondrug treatments.
Collapse
Affiliation(s)
- Karen M. von Deneen
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi’an 710126, Shaanxi, China
- Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi’an 710126, Shaanxi, China
| | - Ling Zhao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, Sichuan, China
| | - Jixin Liu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi’an 710126, Shaanxi, China
- Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi’an 710126, Shaanxi, China
| |
Collapse
|
12
|
Goadsby PJ, Evers S. International Classification of Headache Disorders - ICHD-4 alpha. Cephalalgia 2020; 40:887-888. [DOI: 10.1177/0333102420919098] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Peter J Goadsby
- NIHR-Wellcome Trust King's Clinical Research Facility & SLaM Biomedical Research Centre, King’s College London, London, UK
| | | |
Collapse
|
13
|
Karsan N, Goadsby PJ. Imaging the Premonitory Phase of Migraine. Front Neurol 2020; 11:140. [PMID: 32269547 PMCID: PMC7109292 DOI: 10.3389/fneur.2020.00140] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/07/2020] [Indexed: 01/06/2023] Open
Abstract
Migraine is a common and disabling brain disorder with a broad and heterogeneous phenotype, involving both pain and painless symptoms. Over recent years, more clinical and research attention has been focused toward the premonitory phase of the migraine attack, which can start up to days before the onset of head pain. This early phase can involve symptomatology, such as cognitive and mood change, yawning, thirst and urinary frequency and sensory sensitivities, such as photophobia and phonophobia. In some patients, these symptoms can warn of an impending headache and therefore offer novel neurobiological insights and therapeutic potential. As well as characterization of the phenotype of this phase, recent studies have attempted to image this early phase using functional neuroimaging and tried to understand how the symptoms are mediated, how a migraine attack may be initiated, and how nociception may follow thereafter. This review will summarize the recent and evolving findings in this field and hypothesize a mechanism of subcortical and diencephalic brain activation during the start of the attack, including that of basal ganglia, hypothalamus, and thalamus prior to headache, which causes a top-down effect on brainstem structures involved in trigeminovascular nociception, leading ultimately to headache.
Collapse
Affiliation(s)
- Nazia Karsan
- Headache Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Peter J. Goadsby
- NIHR-Wellcome Trust King's Clinical Research Facility and SLaM Biomedical Research Centre, King's College London, London, United Kingdom
| |
Collapse
|
14
|
Naranjo-Hernández D, Reina-Tosina J, Roa LM. Sensor Technologies to Manage the Physiological Traits of Chronic Pain: A Review. SENSORS (BASEL, SWITZERLAND) 2020; 20:E365. [PMID: 31936420 PMCID: PMC7014460 DOI: 10.3390/s20020365] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/03/2020] [Accepted: 01/05/2020] [Indexed: 12/15/2022]
Abstract
Non-oncologic chronic pain is a common high-morbidity impairment worldwide and acknowledged as a condition with significant incidence on quality of life. Pain intensity is largely perceived as a subjective experience, what makes challenging its objective measurement. However, the physiological traces of pain make possible its correlation with vital signs, such as heart rate variability, skin conductance, electromyogram, etc., or health performance metrics derived from daily activity monitoring or facial expressions, which can be acquired with diverse sensor technologies and multisensory approaches. As the assessment and management of pain are essential issues for a wide range of clinical disorders and treatments, this paper reviews different sensor-based approaches applied to the objective evaluation of non-oncological chronic pain. The space of available technologies and resources aimed at pain assessment represent a diversified set of alternatives that can be exploited to address the multidimensional nature of pain.
Collapse
Affiliation(s)
- David Naranjo-Hernández
- Biomedical Engineering Group, University of Seville, 41092 Seville, Spain; (J.R.-T.); (L.M.R.)
| | | | | |
Collapse
|
15
|
Fang X, Kong W, Yu Z, Qiu J, Duan H. Letter to the editor regarding "To what extent are patients with migraine able to predict attacks?". J Pain Res 2018; 12:93-94. [PMID: 30588083 PMCID: PMC6305161 DOI: 10.2147/jpr.s191178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Xiang Fang
- Department of Orthopedics, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China,
| | - Weili Kong
- Department of Otolaryngology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Zeping Yu
- Department of Orthopedics, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China,
| | - Jianqing Qiu
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Hong Duan
- Department of Orthopedics, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China,
| |
Collapse
|