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Minen MT, Mahmood N, Khan F, Waire EK, George A, Datta S. Treatment Options for Posttraumatic Headache: A Current Review of the Literature. Curr Pain Headache Rep 2024; 28:205-210. [PMID: 38133705 DOI: 10.1007/s11916-023-01199-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE OF REVIEW We evaluate evidence-based treatments for posttraumatic headache (PTH), a secondary headache disorder resulting from traumatic brain injury (TBI), comprising nearly 4% of all symptomatic headache disorders. Utilizing recent publications, we aim to inform clinicians of current treatment methods. RECENT FINDINGS There is limited research on PTH treatment. A randomized controlled trial (RCT) of metoclopramide with diphenhydramine for acute PTH found that the treatment group (N = 81) experienced more significant pain improvement than placebo by 1.4 points. For persistent PTH, an open-label study of erenumab (N = 89) found that 28% of participants reported ≥ 50% reduction in moderate-to-severe headache days, but an RCT of fremanezumab showed a non-significant reduction in moderate-to-severe headache days. A randomized crossover study of 40 patients with persistent PTH found that onabotulinum toxin-A decreased cumulative number of headaches/week by 43.3% in the treatment group and increased by 35.1% among placebos. In a study of military veterans with severe posttraumatic stress disorder and persistent/delayed onset PTH (N = 193), patients who received Cognitive Behavioral Therapy reported significant improvements in headache-related disability compared to usual care (aggregate mean HIT-6, -3.4). A transcranial magnetic stimulation (N = 24) study found that 58% of participants with mild TBI-related headache experienced a 50% reduction in headache frequency. New studies indicate promise in improving clinically important outcomes of PTH. However, more research is necessary to determine the optimal treatment and whether combining pharmacologic and nonpharmacologic treatment versus a single modality is more effective.
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Affiliation(s)
- Mia T Minen
- Department of Neurology, NYU Langone Health, 222 East 41st Street, New York, NY, 10017, USA.
- Department of Population Health, NYU Langone Health, 222 East 41st Street, New York, NY, 10017, USA.
| | - Naoroz Mahmood
- Macaulay Honors College, the City College of New York, New York, NY, USA
| | - Fardin Khan
- Macaulay Honors College, the City College of New York, New York, NY, USA
| | - Erin K Waire
- Department of Neurology, NYU Langone Health, 222 East 41st Street, New York, NY, 10017, USA
| | - Alexis George
- Department of Neurology, NYU Langone Health, 222 East 41st Street, New York, NY, 10017, USA
| | - Shae Datta
- Department of Neurology, NYU Langone Health, 222 East 41st Street, New York, NY, 10017, USA
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Thawani SP, Minen MT, Grossman SN, Friedman S, Bhatt JM, Foo FYA, Torres DM, Weinberg HJ, Kim NH, Levitan V, Cardiel MI, Zakin E, Conway JM, Kurzweil AM, Hasanaj L, Stainman RS, Seixas A, Galetta SL, Balcer LJ, Busis NA. A Comparison of Patients' and Neurologists' Assessments of their Teleneurology Encounter: A Cross-Sectional Analysis. Telemed J E Health 2024; 30:841-849. [PMID: 37624656 DOI: 10.1089/tmj.2023.0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
Background and Objectives: To better understand patients' and neurologists' assessments of their experiences regarding effectiveness of teleneurology encounters. Methods: Following an audio-video telehealth visit, neurologists asked patients to participate in a survey-based research study about the encounter, and then, the neurologists also recorded their own evaluations. Data were analyzed using standard quantitative and qualitative techniques for dichotomous and ordered-category survey responses in this cross-sectional analysis. Results: The study included unique encounters between 187 patients and 11 general neurologists. The mean patient age was 49 ± 17.5 years. Two thirds of the patients (66.8%, 125/187) were female. One third (33.2%; 62) were patients new to the NYU Langone Health neurology practices. The most common patient chief complaints were headache (69/187, 36.9%), focal and generalized numbness or tingling (21, 11.2%), memory difficulty (15, 8%), spine-related symptoms (12, 6.4%), and vertigo (11, 5.9%). Most patients (94.7%, 177/187) reported that the teleneurology encounter satisfied their needs. Patients and their neurologists agreed that the experience was effective in 91% (162/178) of encounters, regardless of whether the visit was for a new or established patient visit. Discussion: More than 90% of new and established patients and their neurologists agreed that teleneurology encounters were effective despite some limitations of the examination, the occasional need for patient assistance, and technical difficulties. Our results provide further evidence to justify and to expand the clinical use of teleneurology.
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Affiliation(s)
- Sujata P Thawani
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Mia T Minen
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Scott N Grossman
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Steven Friedman
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Jaydeep M Bhatt
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Farng-Yang A Foo
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Daniel M Torres
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Harold J Weinberg
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Nina H Kim
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Valeriya Levitan
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Myrna I Cardiel
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Elina Zakin
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Jenna M Conway
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Arielle M Kurzweil
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Lisena Hasanaj
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Rebecca S Stainman
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Azizi Seixas
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
- Department of Informatics and Health Data Science, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Steven L Galetta
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York, USA
| | - Laura J Balcer
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, New York, USA
| | - Neil A Busis
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
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Minen MT, George A, Cuneo AZ. Factors Associated with Patient Adherence to Biofeedback Therapy Referral for Migraine: An Observational Study. Appl Psychophysiol Biofeedback 2024:10.1007/s10484-024-09622-9. [PMID: 38386246 DOI: 10.1007/s10484-024-09622-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 02/23/2024]
Abstract
Biofeedback has Grade A evidence for the treatment of migraine, yet few studies have examined the factors associated with patients' decisions to pursue biofeedback treatment recommendations. We sought to examine reasons for adherence or non-adherence to referral to biofeedback therapy as treatment for migraine. Patients with migraine who had been referred for biofeedback by a headache specialist/behavioral neurologist were interviewed in person or via Webex. Patients completed an enrollment questionnaire addressing demographics and questions related to their headache histories. At one month, patients were sent a follow-up questionnaire via REDCap and asked if they had pursued the recommendation for biofeedback therapy, their reasons for their decision, and their impressions about biofeedback for those who pursued it. Nearly two-thirds (65%; 33/51) of patients responded at one month. Of these, fewer than half (45%, 15/33) had contacted biofeedback providers, and only 18% (6/33) completed a biofeedback session. Common themes emerged for patients who did not pursue biofeedback, including feeling that they did not have time, concern for financial obstacles (e.g., treatment cost and/or insurance coverage), and having difficulty scheduling an appointment due to limited provider availability. When asked about their preference between type of biofeedback provider (e.g., a physical therapist or psychologist), qualitative responses were mixed; many patients indicated no preference as long as they took insurance and/or were experienced, while others indicated a specific preference for a physical therapist or psychologist due to familiarity, or prior experiences with that kind of provider. Patients with migraine referred for biofeedback therapy face numerous obstacles to pursuing treatment.
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Affiliation(s)
- Mia T Minen
- Department of Neurology, NYU Langone Health, 222 East 41st Street, New York, NY, 10017, USA.
- Department of Population Health, NYU Langone Health, New York, NY, USA.
| | - Alexis George
- Department of Neurology, NYU Langone Health, 222 East 41st Street, New York, NY, 10017, USA
| | - Ami Z Cuneo
- Department of Neurology, University of Washington, Seattle, WA, USA
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Ornello R, Andreou AP, De Matteis E, Jürgens TP, Minen MT, Sacco S. Resistant and refractory migraine: clinical presentation, pathophysiology, and management. EBioMedicine 2024; 99:104943. [PMID: 38142636 PMCID: PMC10788408 DOI: 10.1016/j.ebiom.2023.104943] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/09/2023] [Accepted: 12/13/2023] [Indexed: 12/26/2023] Open
Abstract
Migraine is a leading cause of disability worldwide. A minority of individuals with migraine develop resistant or refractory conditions characterised by ≥ 8 monthly days of debilitating headaches and inadequate response, intolerance, or contraindication to ≥3 or all preventive drug classes, respectively. Resistant and refractory migraine are emerging clinical definitions stemming from better knowledge of the pathophysiology of migraine and from the advent of migraine-specific preventive treatments. Resistant migraine mostly results from drug failures, while refractory migraine has complex and still unknown mechanisms that impair the efficacy of preventive treatments. Individuals with resistant migraine can be treated with migraine-specific preventive drugs. The management of refractory migraine is challenging and often unsuccessful, being based on combinations of different drugs and non-pharmacological treatment. Future research should aim to identify individuals at risk of developing treatment failures, prevent the condition, investigate the mechanisms of refractoriness to treatments, and find effective treatment strategies.
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Affiliation(s)
- Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Anna P Andreou
- Headache Research-Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Headache Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Eleonora De Matteis
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Tim P Jürgens
- Headache Center North-East, Department of Neurology, University Medical Center Rostock, Rostock, Germany; Department of Neurology, KMG Hospital Güstrow, Güstrow, Germany
| | - Mia T Minen
- Departments of Neurology and Population Health, NYU Langone Health, New York, USA
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
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5
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Minen MT, Lebowitz N, Ekhtman J, Oza K, Yusaf I, Katara A, Aymon R, Plovnick C. A critical systematic review of K-12 neurology/neuroscience pipeline programs. Front Med (Lausanne) 2023; 10:1281578. [PMID: 38148913 PMCID: PMC10750406 DOI: 10.3389/fmed.2023.1281578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/30/2023] [Indexed: 12/28/2023] Open
Abstract
Background Early exposure to neuroscience is imperative to strengthening the neuroscience and neurology pipeline and may present an avenue for increasing the number of practicing neurologists and diversifying the neuroscience workforce. Our objective was to systematically review existing K-12 neuroscience education and outreach programs to understand what educational programs have been developed and implemented. Methods We conducted an electronic database search of PubMed, EMBASE, PsycINFO, Education Source, and ERIC. All eligible articles were systematically reviewed to examine the type of program developed, target age group, implementation, and efficacy. Results Our search produced 2,574 results, from which 23 articles were deemed eligible. The breakdown by age group was as follows: 5 elementary school, 8 middle school, 8 high school, and 2 general K-12 range of students. Six articles described programs intended for URM students. All programs were found to be successful in exposing students to neuroscience and inspiring interest in pursuing a career in the field of neurology. Discussion Further efforts are necessary to analyze the long-term effectiveness of K-12 neuroscience education and outreach programs in overcoming the shortage of neurologists and explore the impact of mentorship for various age groups among K-12.Systematic review registrationhttps://doi.org/10.17605/OSF.IO/2G8CN.
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Affiliation(s)
- Mia T. Minen
- Department of Neurology, NYU Langone Health, New York, NY, United States
| | - Naomi Lebowitz
- Barnard College, Columbia University, New York, NY, United States
| | - Jane Ekhtman
- The City College of New York, New York, NY, United States
| | - Khushalee Oza
- The City College of New York, New York, NY, United States
| | - Ishah Yusaf
- The City College of New York, New York, NY, United States
| | - Aarti Katara
- Barnard College, Columbia University, New York, NY, United States
| | - Ramisha Aymon
- The City College of New York, New York, NY, United States
| | - Caitlin Plovnick
- Medical Library, NYU Grossman School of Medicine, New York, NY, United States
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6
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Martelletti P, Leonardi M, Ashina M, Burstein R, Cho SJ, Charway-Felli A, Dodick DW, Gil-Gouveia R, Grazzi L, Lampl C, MaassenVanDenBrink A, Minen MT, Mitsikostas DD, Olesen J, Owolabi MO, Reuter U, Ruiz de la Torre E, Sacco S, Schwedt TJ, Serafini G, Surya N, Tassorelli C, Wang SJ, Wang Y, Wijeratne T, Raggi A. Rethinking headache as a global public health case model for reaching the SDG 3 HEALTH by 2030. J Headache Pain 2023; 24:140. [PMID: 37884869 PMCID: PMC10604921 DOI: 10.1186/s10194-023-01666-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/05/2023] [Indexed: 10/28/2023] Open
Abstract
The 2030 Agenda for Sustainable Development sets out, through 17 Sustainable Development Goals (SDGs), a path for the prosperity of people and the planet. SDG 3 in particular aims to ensure healthy lives and promote well-being for all at all ages and includes several targets to enhance health. This review presents a "headache-tailored" perspective on how to achieve SDG 3 by focusing on six specific actions: targeting chronic headaches; reducing the overuse of acute pain-relieving medications; promoting the education of healthcare professionals; granting access to medication in low- and middle-income countries (LMIC); implementing training and educational opportunities for healthcare professionals in low and middle income countries; building a global alliance against headache disorders. Addressing the burden of headache disorders directly impacts on populations' health, as well as on the possibility to improve the productivity of people aged below 50, women in particular. Our analysis pointed out several elements, and included: moving forward from frequency-based parameters to define headache severity; recognizing and managing comorbid diseases and risk factors; implementing a disease management multi-modal management model that incorporates pharmacological and non-pharmacological treatments; early recognizing and managing the overuse of acute pain-relieving medications; promoting undergraduate, postgraduate, and continuing medical education of healthcare professionals with specific training on headache; and promoting a culture that favors the recognition of headaches as diseases with a neurobiological basis, where this is not yet recognized. Making headache care more sustainable is an achievable objective, which will require multi-stakeholder collaborations across all sectors of society, both health-related and not health-related. Robust investments will be needed; however, considering the high prevalence of headache disorders and the associated disability, these investments will surely improve multiple health outcomes and lift development and well-being globally.
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Affiliation(s)
- Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milan, 20133, Italy
| | - Messoud Ashina
- Department of Neurology, Danish Headache Center, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rami Burstein
- John Hedley-Whyte Professor of Anesthesia and Neuroscience at the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Soo-Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Military Hospital, Hwaseong, Korea
| | | | - David W Dodick
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
| | - Raquel Gil-Gouveia
- Neurology Department, Hospital da Luz Headache Center, Hospital da Luz Lisboa., Lisbon, Portugal
- Center for Interdisciplinary Research in Health, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Licia Grazzi
- Neuroalgology Unit and Headache Center, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Christian Lampl
- Department of Neurology and Stroke Unit, Koventhospital Barmherzige Brüder Linz, Linz, Austria
- Headache Medical Center Linz, Linz, Austria
| | - Antoinette MaassenVanDenBrink
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Mia T Minen
- Department of Neurology, NYU Langone Health, NY, New York, USA
| | - Dimos Dimitrios Mitsikostas
- 1st Neurology Department, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Jes Olesen
- Department of Neurology, Danish Headache Center, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mayowa Ojo Owolabi
- Faculty of Clinical Sciences; Center for Genomic and Precision Medicine, College of Medicine,, University of Ibadan, Ibadan, Nigeria
| | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Universitätsmedizin Greifswald, Greifswald, Germany
| | | | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Todd J Schwedt
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Shuu-Jiun Wang
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yonggang Wang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tissa Wijeratne
- Department of Neurology, Sunshine Hospital, St Albans, VIC, Australia
| | - Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milan, 20133, Italy.
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George A, Minen MT. Episodic Migraine and Psychiatric Comorbidity: A Narrative Review of the Literature. Curr Pain Headache Rep 2023; 27:461-469. [PMID: 37382869 DOI: 10.1007/s11916-023-01123-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE OF REVIEW We evaluate the evolving evidence of psychiatric comorbidities associated with episodic migraine. Utilizing recent research publications, we aim to assess traditional treatment option considerations and discuss recent and evolving non-pharmacologic treatment progress for episodic migraine and related psychiatric conditions. RECENT FINDINGS Recent findings indicate that episodic migraine is strongly linked to comorbid depression, anxiety, posttraumatic stress disorder, and sleep disorders. Not only do patients with episodic migraine have higher rates of psychiatric comorbidity, but a higher number of headache days reported is also strongly linked to an increased risk of developing a psychiatric disorder, indicating there may be a link between frequency and psychiatric comorbidity and that patients with high-frequency episodic migraine should be assessed for psychiatric comorbidity. Few migraine preventive medications have examined the effect of the medication on both migraine and psychiatric comorbidity though we discuss what has been reported in the literature. Non-pharmacologic-based treatments including behavioral therapies and mind-body interventions previously developed for psychiatric conditions, e.g., mindfulness-based CBT (MBCT), acceptance and commitment therapy (ACT), and mindfulness-based stress reduction (MBSR) therapy, have promising results for patients diagnosed with episodic migraine and may therefore be useful in treating migraine and comorbid psychiatric conditions. Psychiatric comorbidity may affect the efficacy of the treatment of episodic migraine. Thus, we must assess for psychiatric comorbidities to inform better treatment plans for patients. Providing patients with episodic migraine with alternate modalities of treatment may help to improve patient-centered care and increase patients' sense of self-efficacy.
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Affiliation(s)
- Alexis George
- Department of Neurology, NYU Langone Health, 222 East 41st Street, New York, NY, 10017, USA
| | - Mia T Minen
- Department of Neurology, NYU Langone Health, 222 East 41st Street, New York, NY, 10017, USA.
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Minen MT, George A, Katara A, Lebowitz N, Snyder IC, Busis NA, Lipchitz JM. Headache clinicians' perspectives on the remote monitoring of patients' electronic diary data: A qualitative study. Headache 2023. [PMID: 37313636 DOI: 10.1111/head.14519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE We assessed headache clinicians' viewpoints on potential remote access to patients' digital headache diary data and the practicalities of data utilization. BACKGROUND With the ubiquitous nature of electronic medical records and the existence of remote monitoring (RM) for many medical conditions, there is now the potential for remote symptom monitoring for patients with headache disorders. While patients are asked to utilize headache diaries, clinicians may or may not have access to the data before patient visits, and their perspectives regarding this emerging technology are currently unknown. METHODS After recruiting participants from the National Institutes of Health Pain Consortium Network, the American Headache Society Special Interest Section listservs, and Twitter and Facebook social media platforms, we conducted 20 semi-structured qualitative interviews of headache providers across the United States from various types of institutions and asked them their perspectives on remote access to patient headache diary data. We transcribed the interviews, which were then coded by two independent coders. Themes and sub-themes were developed using inductive content analysis. RESULTS All clinicians felt the RM data needed to be integrated into the electronic medical record. Six themes emerged from the interviews: (i) Clinician perspectives on how RM could be beneficial but at other times could create obstacles/challenges, (ii) operationally, data integration could benefit headache care, (iii) there should be initial logistical considerations for bringing RM into clinical care, (iv) education may need to be provided to both patients and clinicians, (v) there are likely research benefits associated with RM, and (vi) additional suggestions for considering potential integration of RM into practice. CONCLUSIONS While headache clinicians had mixed opinions on the benefits/challenges that RM presents to patient care, patient satisfaction, and visit time, new ideas emerged that may help advance the field.
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Affiliation(s)
- Mia T Minen
- Department of Neurology, NYU Langone Health, New York, New York, USA
| | - Alexis George
- Department of Neurology, NYU Langone Health, New York, New York, USA
| | - Aarti Katara
- Barnard College of Columbia University, New York, New York, USA
| | - Naomi Lebowitz
- Barnard College of Columbia University, New York, New York, USA
| | | | - Neil A Busis
- Department of Neurology, NYU Langone Health, New York, New York, USA
| | - Jessica M Lipchitz
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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9
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Thawani SP, Minen MT, Stainman RS, Friedman S, Bhatt JM, Foo FYA, Torres DM, Weinberg HJ, Kim NH, Levitan V, Cardiel MI, Zakin E, Conway JM, Kurzweil AM, Hasanaj L, Galetta SL, Balcer LJ, Busis NA. Neurologists' Evaluations of Experience and Effectiveness of Teleneurology Encounters. Telemed J E Health 2023; 29:442-453. [PMID: 35834603 DOI: 10.1089/tmj.2021.0551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives: To better understand neurologists' assessments of the experiences and effectiveness of teleneurology encounters. Methods: After completing an audio-video telehealth visit with verbally consenting patients, neurologists recorded their evaluations of the encounter. Data were analyzed using standard quantitative and qualitative techniques. Results: The study included unique encounters between 187 patients and 11 neurologists. The mean patient age was 49 ± 17.5 years. Two thirds of patients (66.8%, 125/187) were female. One third of patients (33.2%; 62) were new patients. The most common patient complaints were headache (69/187, 36.9%), focal and generalized numbness or tingling (21, 11.2%), memory difficulty (15, 8%), spine-related symptoms (12, 6.4%), and vertigo (11, 5.9%). Neurologists reported that they completed a virtual examination that provided enough information for medical decision-making in 94.9% of encounters (169/178, 9 missing responses). Fourteen of 25 examination elements important for medical decision-making could be performed sufficiently during virtual encounters. Examination assistance was needed for 16.4% (30/183) of patients, who were, on average, 17.3 years older than those who did not require assistance (62.9 years vs. 45.6 years, p = 0.0002). In 19.1% (34/178) of encounters, neurologists learned clinically relevant information from seeing patients in their homes. Neurologists' assessments of the effectiveness of encounters were not related to the presence (97.2%, 35/36 effective) or absence (95%, 134/141 effective) of technical difficulties (p = 0.5729) in 177 encounters (10 missing responses). Discussion: Neurologists reported that nearly 95% of teleneurology encounters were effective despite limitations of the virtual examination, occasional need for patient assistance, and technical difficulties.
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Affiliation(s)
- Sujata P Thawani
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Mia T Minen
- Department of Neurology and NYU Langone Health, New York, New York, USA.,Department of Population Health, NYU Langone Health, New York, New York, USA
| | - Rebecca S Stainman
- Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Steven Friedman
- Department of Population Health, NYU Langone Health, New York, New York, USA
| | - Jaydeep M Bhatt
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Farng-Yang A Foo
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Daniel M Torres
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Harold J Weinberg
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Nina H Kim
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Valeriya Levitan
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Myrna I Cardiel
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Elina Zakin
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Jenna M Conway
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | | | - Lisena Hasanaj
- Department of Neurology and NYU Langone Health, New York, New York, USA
| | - Steven L Galetta
- Department of Neurology and NYU Langone Health, New York, New York, USA.,Department of Ophthalmology, NYU Langone Health, New York, New York, USA
| | - Laura J Balcer
- Department of Neurology and NYU Langone Health, New York, New York, USA.,Department of Population Health, NYU Langone Health, New York, New York, USA.,Department of Ophthalmology, NYU Langone Health, New York, New York, USA
| | - Neil A Busis
- Department of Neurology and NYU Langone Health, New York, New York, USA
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10
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Minen MT, George A, Camacho E, Yao L, Sahu A, Campbell M, Soviero M, Hossain Q, Verma D, Torous J. Assessment of Smartphone Apps for Common Neurologic Conditions (Headache, Insomnia, and Pain): Cross-sectional Study. JMIR Mhealth Uhealth 2022; 10:e36761. [PMID: 35727625 PMCID: PMC9257611 DOI: 10.2196/36761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/17/2022] [Accepted: 05/25/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There are thousands of apps for individuals struggling with headache, insomnia, and pain, but it is difficult to establish which of these apps are best suited for patients' specific needs. If clinicians were to have access to a platform that would allow them to make an informed decision on the efficacy and feasibility of smartphone apps for patient care, they would feel confident in prescribing specific apps. OBJECTIVE We sought to evaluate the quality of apps for some of the top common, disabling neurologic conditions (headache, insomnia, and pain) based on principles derived from the American Psychiatric Association's (APA) app evaluation model. METHODS We used the Mobile Health Index and Navigation database and expanded upon the database's current supported conditions by adding 177 new app entries. Each app was rated for consistency with the APA's app evaluation model, which includes 105 objective questions based on the following 5 major classes of consideration: (1) accessibility, (2) privacy and security, (3) clinical foundation, (4) engagement style, and (5) interoperability. These characteristics were evaluated to gain a broader understanding of the significant features of each app category in comparison against a control group. RESULTS Approximately 90% (187/201) of all apps evaluated were free to download, but only 50% (63/201) of headache- and pain-related apps were truly free. Most (87/106, 81%) sleep apps were not truly free to use. The apps had similar limitations with limited privacy, accessibility, and crisis management resources. For example, only 17% (35/201) of the apps were available in Spanish. The apps offered mostly self-help tools with little tailoring; symptom tracking was the most common feature in headache- (32/48, 67%) and pain-related apps (21/47, 45%), whereas mindfulness was the most common feature in sleep-related apps (73/106, 69%). CONCLUSIONS Although there are many apps for headache, pain, and insomnia, all 3 types of apps have room for improvement around accessibility and privacy. Pain and headache apps share many common features, whereas insomnia apps offer mostly mindfulness-based resources. Given the many available apps to pick from, clinicians and patients should seek apps that offer the highest-quality features, such as complete privacy, remedial features, and the ability to download the app at no cost. These results suggest that there are many opportunities for the improvement of apps centered on headache, insomnia, and pain.
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Affiliation(s)
- Mia T Minen
- Department of Neurology, New York University Langone Health, New York, NY, United States
| | - Alexis George
- Department of Neurology, New York University Langone Health, New York, NY, United States
| | - Erica Camacho
- Department of Psychiatry, Beth Israel Deaconess Medical Center, New York, NY, United States
| | - Leslie Yao
- Barnard College, New York, NY, United States
| | - Ananya Sahu
- Barnard College, New York, NY, United States
| | | | - Mia Soviero
- Barnard College, New York, NY, United States
| | - Quazi Hossain
- The City College of New York, New York, NY, United States
| | - Deepti Verma
- The City College of New York, New York, NY, United States
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, New York, NY, United States
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11
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Begasse De Dhaem O, Aldana SI, Kanner AM, Sperling M, French J, Nadkarni SS, Hope OA, O'Brien T, Morrison C, Winawer M, Minen MT. Association Between Migraine Comorbidity and Psychiatric Symptoms Among People With Newly Diagnosed Focal Epilepsy. J Neuropsychiatry Clin Neurosci 2022; 34:182-187. [PMID: 34961330 DOI: 10.1176/appi.neuropsych.21050124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Little is known about psychiatric symptoms among patients with migraine and newly diagnosed focal epilepsy. The investigators compared symptoms of depression, anxiety, and suicidality among people with newly diagnosed focal epilepsy with migraine versus without migraine. METHODS The Human Epilepsy Project is a prospective multicenter study of patients with newly diagnosed focal epilepsy. Depression (measured with the Center for Epidemiologic Studies Depression Scale), anxiety (measured with the 7-item Generalized Anxiety Disorder scale), and suicidality scores (measured with the Columbia-Suicide Severity Rating Scale [C-SSRS]) were compared between participants with versus without migraine. Data analysis was performed with the Kolmogorov-Smirnov test for normality assessment, the Mann-Whitney U test, chi-square test, and linear regression. RESULTS Of 349 patients with new-onset focal epilepsy, 74 (21.2%) had migraine. There were no differences between the patients without migraine versus those with migraine in terms of age, race, and level of education. There were more women in the group with migraine than in the group without migraine (75.7% vs. 55.6%, p=0.0018). The patients with epilepsy and comorbid migraine had more depressive symptoms than the patients with epilepsy without migraine (35.2% vs. 22.7%, p=0.031). Patients with epilepsy with comorbid migraine had more anxiety symptoms than patients with epilepsy without migraine, but this relation was mediated by age in logistic regression, with younger age being associated with anxiety. Comorbid migraine was not associated with C-SSRS ideation or behavior. CONCLUSIONS Among a sample of patients with newly diagnosed focal epilepsy, 21.2% had migraine. Migraine comorbidity was associated with higher incidence of depressive symptoms. Future studies should be performed to better assess these relationships and possible treatment implications.
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Affiliation(s)
- Olivia Begasse De Dhaem
- New York-Presbyterian Hospital/Columbia University, New York (Begasse De Dhaem); Office of Science and Research, New York University Langone Health, New York (Aldana); Division of Epilepsy, Miller School of Medicine, University of Miami, Miami (Kanner); Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia (Sperling); New York University School of Medicine, Comprehensive Epilepsy Center, New York University Langone Health, New York (French, Nadkarni, Morrison); Department of Neurology, McGovern Medical School, University of Texas Health Science Center-Houston (Hope); The Central Clinical School, Monash University, Melbourne, Victoria, Australia (O'Brien); Gertrude H. Sergievsky Center, Columbia University, New York (Winawer); and Departments of Neurology and Population Health, New York University Langone Health, New York (Minen)
| | - Sandra India Aldana
- New York-Presbyterian Hospital/Columbia University, New York (Begasse De Dhaem); Office of Science and Research, New York University Langone Health, New York (Aldana); Division of Epilepsy, Miller School of Medicine, University of Miami, Miami (Kanner); Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia (Sperling); New York University School of Medicine, Comprehensive Epilepsy Center, New York University Langone Health, New York (French, Nadkarni, Morrison); Department of Neurology, McGovern Medical School, University of Texas Health Science Center-Houston (Hope); The Central Clinical School, Monash University, Melbourne, Victoria, Australia (O'Brien); Gertrude H. Sergievsky Center, Columbia University, New York (Winawer); and Departments of Neurology and Population Health, New York University Langone Health, New York (Minen)
| | - Andres Miguel Kanner
- New York-Presbyterian Hospital/Columbia University, New York (Begasse De Dhaem); Office of Science and Research, New York University Langone Health, New York (Aldana); Division of Epilepsy, Miller School of Medicine, University of Miami, Miami (Kanner); Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia (Sperling); New York University School of Medicine, Comprehensive Epilepsy Center, New York University Langone Health, New York (French, Nadkarni, Morrison); Department of Neurology, McGovern Medical School, University of Texas Health Science Center-Houston (Hope); The Central Clinical School, Monash University, Melbourne, Victoria, Australia (O'Brien); Gertrude H. Sergievsky Center, Columbia University, New York (Winawer); and Departments of Neurology and Population Health, New York University Langone Health, New York (Minen)
| | - Michael Sperling
- New York-Presbyterian Hospital/Columbia University, New York (Begasse De Dhaem); Office of Science and Research, New York University Langone Health, New York (Aldana); Division of Epilepsy, Miller School of Medicine, University of Miami, Miami (Kanner); Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia (Sperling); New York University School of Medicine, Comprehensive Epilepsy Center, New York University Langone Health, New York (French, Nadkarni, Morrison); Department of Neurology, McGovern Medical School, University of Texas Health Science Center-Houston (Hope); The Central Clinical School, Monash University, Melbourne, Victoria, Australia (O'Brien); Gertrude H. Sergievsky Center, Columbia University, New York (Winawer); and Departments of Neurology and Population Health, New York University Langone Health, New York (Minen)
| | - Jacqueline French
- New York-Presbyterian Hospital/Columbia University, New York (Begasse De Dhaem); Office of Science and Research, New York University Langone Health, New York (Aldana); Division of Epilepsy, Miller School of Medicine, University of Miami, Miami (Kanner); Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia (Sperling); New York University School of Medicine, Comprehensive Epilepsy Center, New York University Langone Health, New York (French, Nadkarni, Morrison); Department of Neurology, McGovern Medical School, University of Texas Health Science Center-Houston (Hope); The Central Clinical School, Monash University, Melbourne, Victoria, Australia (O'Brien); Gertrude H. Sergievsky Center, Columbia University, New York (Winawer); and Departments of Neurology and Population Health, New York University Langone Health, New York (Minen)
| | - Siddhartha S Nadkarni
- New York-Presbyterian Hospital/Columbia University, New York (Begasse De Dhaem); Office of Science and Research, New York University Langone Health, New York (Aldana); Division of Epilepsy, Miller School of Medicine, University of Miami, Miami (Kanner); Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia (Sperling); New York University School of Medicine, Comprehensive Epilepsy Center, New York University Langone Health, New York (French, Nadkarni, Morrison); Department of Neurology, McGovern Medical School, University of Texas Health Science Center-Houston (Hope); The Central Clinical School, Monash University, Melbourne, Victoria, Australia (O'Brien); Gertrude H. Sergievsky Center, Columbia University, New York (Winawer); and Departments of Neurology and Population Health, New York University Langone Health, New York (Minen)
| | - Omotola A Hope
- New York-Presbyterian Hospital/Columbia University, New York (Begasse De Dhaem); Office of Science and Research, New York University Langone Health, New York (Aldana); Division of Epilepsy, Miller School of Medicine, University of Miami, Miami (Kanner); Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia (Sperling); New York University School of Medicine, Comprehensive Epilepsy Center, New York University Langone Health, New York (French, Nadkarni, Morrison); Department of Neurology, McGovern Medical School, University of Texas Health Science Center-Houston (Hope); The Central Clinical School, Monash University, Melbourne, Victoria, Australia (O'Brien); Gertrude H. Sergievsky Center, Columbia University, New York (Winawer); and Departments of Neurology and Population Health, New York University Langone Health, New York (Minen)
| | - Terry O'Brien
- New York-Presbyterian Hospital/Columbia University, New York (Begasse De Dhaem); Office of Science and Research, New York University Langone Health, New York (Aldana); Division of Epilepsy, Miller School of Medicine, University of Miami, Miami (Kanner); Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia (Sperling); New York University School of Medicine, Comprehensive Epilepsy Center, New York University Langone Health, New York (French, Nadkarni, Morrison); Department of Neurology, McGovern Medical School, University of Texas Health Science Center-Houston (Hope); The Central Clinical School, Monash University, Melbourne, Victoria, Australia (O'Brien); Gertrude H. Sergievsky Center, Columbia University, New York (Winawer); and Departments of Neurology and Population Health, New York University Langone Health, New York (Minen)
| | - Chris Morrison
- New York-Presbyterian Hospital/Columbia University, New York (Begasse De Dhaem); Office of Science and Research, New York University Langone Health, New York (Aldana); Division of Epilepsy, Miller School of Medicine, University of Miami, Miami (Kanner); Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia (Sperling); New York University School of Medicine, Comprehensive Epilepsy Center, New York University Langone Health, New York (French, Nadkarni, Morrison); Department of Neurology, McGovern Medical School, University of Texas Health Science Center-Houston (Hope); The Central Clinical School, Monash University, Melbourne, Victoria, Australia (O'Brien); Gertrude H. Sergievsky Center, Columbia University, New York (Winawer); and Departments of Neurology and Population Health, New York University Langone Health, New York (Minen)
| | - Melodie Winawer
- New York-Presbyterian Hospital/Columbia University, New York (Begasse De Dhaem); Office of Science and Research, New York University Langone Health, New York (Aldana); Division of Epilepsy, Miller School of Medicine, University of Miami, Miami (Kanner); Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia (Sperling); New York University School of Medicine, Comprehensive Epilepsy Center, New York University Langone Health, New York (French, Nadkarni, Morrison); Department of Neurology, McGovern Medical School, University of Texas Health Science Center-Houston (Hope); The Central Clinical School, Monash University, Melbourne, Victoria, Australia (O'Brien); Gertrude H. Sergievsky Center, Columbia University, New York (Winawer); and Departments of Neurology and Population Health, New York University Langone Health, New York (Minen)
| | - Mia T Minen
- New York-Presbyterian Hospital/Columbia University, New York (Begasse De Dhaem); Office of Science and Research, New York University Langone Health, New York (Aldana); Division of Epilepsy, Miller School of Medicine, University of Miami, Miami (Kanner); Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia (Sperling); New York University School of Medicine, Comprehensive Epilepsy Center, New York University Langone Health, New York (French, Nadkarni, Morrison); Department of Neurology, McGovern Medical School, University of Texas Health Science Center-Houston (Hope); The Central Clinical School, Monash University, Melbourne, Victoria, Australia (O'Brien); Gertrude H. Sergievsky Center, Columbia University, New York (Winawer); and Departments of Neurology and Population Health, New York University Langone Health, New York (Minen)
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12
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Minen MT, Kaplan K, Akter S, Khanns D, Ostendorf T, Rheaume CE, Friedman S, Wells RE. Understanding How to Strengthen the Neurology Pipeline With Insights From Undergraduate Neuroscience Students. Neurology 2022; 98:314-323. [PMID: 34937786 PMCID: PMC8883513 DOI: 10.1212/wnl.0000000000013259] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/17/2021] [Indexed: 11/15/2022] Open
Abstract
Despite increased neuroscience interest at the undergraduate level, a significant shortage of neurologists in the United States exists. To better understand how to generate more interest in neurology, specifically at the undergraduate level, we conducted an anonymous cross-sectional online survey comprising 1,085 undergraduates in either neuroscience courses or majoring/minoring in neuroscience from across the United States to better understand their clinical neurology experiences and perspectives. The survey quantitatively and qualitatively assessed students' clinical neurology exposure inside and outside of the classroom, research experiences, and career goals. Students were from a broad spectrum of undergraduate institutions (public research university [40.8%], liberal arts college [29.7%], and private research university [29.0%]). Most students (89.9%) were looking to pursue graduate studies; 56.9% reported wanting to be a physician, and 17.8% expressed interest in obtaining an MD/PhD. Of importance, students reported first exposure to neuroscience at age 16 years but felt that they could be exposed to neuroscience as early as 13 years. Half (50.5%) decided to major in neuroscience before college, and a quarter (25.6%) decided to major in their first year of college. Despite high interest in clinical neurology exposure, less than one-third of students had spoken with or shadowed a neurologist, and only 13.6% had interacted with clinical neurology populations. Only 20.8% of students felt volunteer and internship opportunities were sufficiently available. Qualitative results include student perspectives from those who did and did not work with a neurologist, describing how they were or were not able to obtain such opportunities. We discuss translating the survey findings into actionable results with opportunities to target the undergraduate neuroscience interest to improve the neurology pipeline. We describe existing programs that could be integrated into everyday neurology practices and new approaches to learning and training to help leverage the significant undergraduate neuroscience interest. We also raise questions for further research, including exploring (1) how students learn of neurologic conditions/expand their knowledge about additional neurologic conditions, (2) whether qualitative investigation of the experiences of neuroscience undergraduates at specific institutions might provide an additional insight, and (3) systems to maintain interest in neuroscience/neurology as students enter medical school.
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Affiliation(s)
- Mia T Minen
- From the Department of Neurology (M.T.M.), NYU Langone Health; Department of Population Health (M.T.M., S.F.), NYU Langone Health; Barnard College (K.K.), Columbia University, New York, NY; City College (S.A., D.K.), City University of New York, NY; American Academy of Neurology (T.O., C.E.R.), Minneapolis, MN; and Department of Neurology (R.E.W.), Wake Forest Baptist Health, NC.
| | - Kayla Kaplan
- From the Department of Neurology (M.T.M.), NYU Langone Health; Department of Population Health (M.T.M., S.F.), NYU Langone Health; Barnard College (K.K.), Columbia University, New York, NY; City College (S.A., D.K.), City University of New York, NY; American Academy of Neurology (T.O., C.E.R.), Minneapolis, MN; and Department of Neurology (R.E.W.), Wake Forest Baptist Health, NC
| | - Sangida Akter
- From the Department of Neurology (M.T.M.), NYU Langone Health; Department of Population Health (M.T.M., S.F.), NYU Langone Health; Barnard College (K.K.), Columbia University, New York, NY; City College (S.A., D.K.), City University of New York, NY; American Academy of Neurology (T.O., C.E.R.), Minneapolis, MN; and Department of Neurology (R.E.W.), Wake Forest Baptist Health, NC
| | - Dennique Khanns
- From the Department of Neurology (M.T.M.), NYU Langone Health; Department of Population Health (M.T.M., S.F.), NYU Langone Health; Barnard College (K.K.), Columbia University, New York, NY; City College (S.A., D.K.), City University of New York, NY; American Academy of Neurology (T.O., C.E.R.), Minneapolis, MN; and Department of Neurology (R.E.W.), Wake Forest Baptist Health, NC
| | - Tasha Ostendorf
- From the Department of Neurology (M.T.M.), NYU Langone Health; Department of Population Health (M.T.M., S.F.), NYU Langone Health; Barnard College (K.K.), Columbia University, New York, NY; City College (S.A., D.K.), City University of New York, NY; American Academy of Neurology (T.O., C.E.R.), Minneapolis, MN; and Department of Neurology (R.E.W.), Wake Forest Baptist Health, NC
| | - Carol E Rheaume
- From the Department of Neurology (M.T.M.), NYU Langone Health; Department of Population Health (M.T.M., S.F.), NYU Langone Health; Barnard College (K.K.), Columbia University, New York, NY; City College (S.A., D.K.), City University of New York, NY; American Academy of Neurology (T.O., C.E.R.), Minneapolis, MN; and Department of Neurology (R.E.W.), Wake Forest Baptist Health, NC
| | - Steven Friedman
- From the Department of Neurology (M.T.M.), NYU Langone Health; Department of Population Health (M.T.M., S.F.), NYU Langone Health; Barnard College (K.K.), Columbia University, New York, NY; City College (S.A., D.K.), City University of New York, NY; American Academy of Neurology (T.O., C.E.R.), Minneapolis, MN; and Department of Neurology (R.E.W.), Wake Forest Baptist Health, NC
| | - Rebecca Erwin Wells
- From the Department of Neurology (M.T.M.), NYU Langone Health; Department of Population Health (M.T.M., S.F.), NYU Langone Health; Barnard College (K.K.), Columbia University, New York, NY; City College (S.A., D.K.), City University of New York, NY; American Academy of Neurology (T.O., C.E.R.), Minneapolis, MN; and Department of Neurology (R.E.W.), Wake Forest Baptist Health, NC
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13
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Minen MT, Khanns D, Guiracocha J, Ehrlich A, Khan FA, Ali AS, Birlea M, Singh NN, Peretz A, Larry Charleston IV. The role of urgent care centers in headache management: a quality improvement project. BMC Health Serv Res 2022; 22:162. [PMID: 35135555 PMCID: PMC8822636 DOI: 10.1186/s12913-021-07457-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/30/2021] [Indexed: 11/24/2022] Open
Abstract
Background Patients with headache often seek urgent medical care to treat pain and associated symptoms that do not respond to therapeutic options at home. Urgent Cares (UCs) may be suitable for the evaluation and treatment of such patients but there is little data on how headache is evaluated in UC settings and what types of treatments are available. We conducted a study to evaluate the types of care available for patients with headache presenting to UCs. Design Cross-Sectional. Methods Headache specialists across the United States contacted UCs to collect data on a questionnaire. Questions asked about UC staffing (e.g. number and backgrounds of staff, hours of operation), average length of UC visits for headache, treatments and tests available for patients presenting with headache, and disposition including to the ED. Results Data from 10 UC programs comprised of 61 individual UC sites revealed: The vast majority (8/10; 80%) had diagnostic testing onsite for headache evaluation. A small majority (6/10; 60%) had the American Headache Society recommended intravenous medications for acute migraine available. Half (5/10) had a headache protocol in place. The majority (6/10; 60%) had no follow up policy after UC discharge. Conclusions UCs have the potential to provide expedited care for patients presenting for evaluation and treatment of headache. However, considerable variability exists amongst UCs in their abilities to manage headaches. This study reveals many opportunities for future research including the development of protocols and professional partnerships to help guide the evaluation, triage, and treatment of patients with headache in UC settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07457-2.
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Affiliation(s)
- Mia T Minen
- Departments of Neurology and Population Health, NYU Langone Health, 222 East 41st Street, 9th floor, New York, NY, 10017, USA.
| | | | | | - Annika Ehrlich
- UCSF Headache Center, University of California, San Francisco, CA, USA.,UCSF School of Nursing, San Francisco, CA, USA
| | - Fawad A Khan
- The McCasland Family Comprehensive Headache Center, Ochsner Neuroscience Institute, Ochsner Clinic Foundation, New Orleans, LA, USA.,The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA, USA.,Tulane University School of Medicine, New Orleans, LA, USA
| | - Ashhar S Ali
- Henry Ford Health System, Department of Neurology, Division of Headache, Detroit, MI, USA.,Wayne State University School of Medicine, Detroit, MI, USA
| | - Marius Birlea
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Niranjan N Singh
- Neurology, University of Missouri, Columbia, MO, USA.,St Mary's Stroke program, St. Mary's Regional Medical Center, Blue Springs, MO, USA.,SSM Neurosciences Institute, SSM Health, St. Louis, MO, USA
| | - Addie Peretz
- Department of Neurology, Division of Headache and Facial Pain, Stanford University, Palo Alto, CA, USA
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14
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Minen MT, Busis NA, Friedman S, Campbell M, Sahu A, Maisha K, Hossain Q, Soviero M, Verma D, Yao L, Foo FYA, Bhatt JM, Balcer LJ, Galetta SL, Thawani S. The use of virtual complementary and integrative therapies by neurology outpatients: An exploratory analysis of two cross-sectional studies assessing the use of technology as treatment in an academic neurology department in New York City. Digit Health 2022; 8:20552076221109545. [PMID: 35874862 PMCID: PMC9297463 DOI: 10.1177/20552076221109545] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 06/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background Prior to the COVID-19 pandemic, about half of patients from populations that sought care in neurology tried complementary and integrative therapies (CITs). With the increased utilization of telehealth services, we sought to determine whether patients also increased their use of virtual CITs. Methods We examined datasets from two separate cross-sectional surveys that included cohorts of patients with neurological disorders. One was a dataset from a study that examined patient and provider experiences with teleneurology visits; the other was a study that assessed patients with a history of COVID-19 infection who presented for neurologic evaluation. We assessed and reported the use of virtual (and non-virtual) CITs using descriptive statistics, and determined whether there were clinical characteristics that predicted the use of CITs using logistic regression analyses. Findings Patients who postponed medical treatment for non-COVID-19-related problems during the pandemic were more likely to seek CITs. Virtual exercise, virtual psychotherapy, and relaxation/meditation smartphone applications were the most frequent types of virtual CITs chosen by patients. In both studies, age was a key demographic factor associated with mobile/virtual CIT usage. Interpretations Our investigation demonstrates that virtual CIT-related technologies were utilized in the treatment of neurologic conditions during the pandemic, particularly by those patients who deferred non-COVID-related care.
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Affiliation(s)
- Mia T Minen
- Department of Neurology, NYU Langone Health, New York, NY, USA
- Department of Population Health, NYU Langone Health, New York, NY, USA
| | - Neil A Busis
- Department of Neurology, NYU Langone Health, New York, NY, USA
| | - Steven Friedman
- Department of Population Health, NYU Langone Health, New York, NY, USA
| | - Maya Campbell
- Barnard College, Columbia University, New York, NY, USA
| | - Ananya Sahu
- The City College of New York, New York, NY, USA
| | - Kazi Maisha
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Quazi Hossain
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Mia Soviero
- The City College of New York, New York, NY, USA
| | | | - Leslie Yao
- Barnard College, Columbia University, New York, NY, USA
| | | | - Jaydeep M Bhatt
- Department of Neurology, NYU Langone Health, New York, NY, USA
| | - Laura J Balcer
- Department of Neurology, NYU Langone Health, New York, NY, USA
- Department of Population Health, NYU Langone Health, New York, NY, USA
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Steven L Galetta
- Department of Neurology, NYU Langone Health, New York, NY, USA
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Sujata Thawani
- Department of Neurology, NYU Langone Health, New York, NY, USA
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Cuneo AZ, Maisha K, Minen MT. Strategies for Behavioral Research in Neurology: Lessons Learned During the COVID-19 Pandemic and Applications for the Future. Curr Neurol Neurosci Rep 2021; 21:63. [PMID: 34705122 PMCID: PMC8548698 DOI: 10.1007/s11910-021-01146-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 11/29/2022]
Abstract
Purpose of Review Behavioral therapies are proven treatments for many neurologic conditions. However, the COVID-19 pandemic has posed significant challenges for conducting behavioral research. This article aims to (1) highlight the challenges of running behavioral clinical trials during the pandemic, (2) suggest approaches to maximize generalizability of pandemic-era studies, and (3) offer strategies for successful behavioral trials beyond the pandemic. Recent Findings Thousands of clinical trials have been impacted by the COVID-19 pandemic, from undergoing protocol revisions to suspension altogether. Furthermore, for ongoing trials, recruitment of diverse populations has suffered, thereby exacerbating existing inequities in clinical research. Patient adherence and retention have been affected by a myriad of pandemic-era restraints, and medical, psychiatric, and other complications from the pandemic have the potential to have long-term effects on pandemic-era study results. Summary In the development of post-pandemic study protocols, attention should be given to designing studies that incorporate successful aspects of pre-pandemic and pandemic-era strategies to (1) broaden recruitment using new techniques, (2) improve access for diverse populations, (3) expand protocols to include virtual and in-person participation, and (4) increase patient adherence and retention.
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Affiliation(s)
- Ami Z Cuneo
- Neurology, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
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Minen MT, Stieglitz EJ. Wearables for Neurologic Conditions: Considerations for Our Patients and Research Limitations. Neurol Clin Pract 2021; 11:e537-e543. [PMID: 34484952 DOI: 10.1212/cpj.0000000000000971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 07/07/2020] [Indexed: 12/24/2022]
Abstract
Purpose of Review In 2019, over 50 million Americans were expected to use wearables at least monthly. The technologies have varied capabilities, with many designed to monitor health conditions. We present a narrative review to raise awareness of wearable technologies that may be relevant to the field of neurology. We also discuss the implications of these wearables for our patients and briefly discuss issues related to researching new wearable technologies. Recent Findings There are a variety of wearables for neurologic conditions, e.g., stroke (for potential arrhythmia capture), epilepsy, Parkinson disease, and sleep. Research is being performed to capture the risk of neuropsychiatric relapse. However, data are limited and adherence to these wearables is often poorly studied. Summary The care of neurology patients may ultimately be improved with the use of wearable technologies. More research needs to examine efficacy and implementation strategies.
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Affiliation(s)
- Mia T Minen
- Division of Headache Medicine (MTM), NYU Langone Departments of Neurology and Population Health, New York, NY; and CIPPA/US (EJS), New York, NY
| | - Eric J Stieglitz
- Division of Headache Medicine (MTM), NYU Langone Departments of Neurology and Population Health, New York, NY; and CIPPA/US (EJS), New York, NY
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Seng EK, Conway AB, Grinberg AS, Patel ZS, Marzouk M, Rosenberg L, Metts C, Day MA, Minen MT, Buse DC, Lipton RB. Response to Mindfulness-Based Cognitive Therapy Differs Between Chronic and Episodic Migraine. Neurol Clin Pract 2021; 11:194-205. [PMID: 34484887 DOI: 10.1212/cpj.0000000000000984] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/21/2020] [Indexed: 11/15/2022]
Abstract
Objective Evaluate whether the benefits of Mindfulness-Based Cognitive Therapy for Migraine (MBCT-M) on headache disability differs among people with episodic and chronic migraine (CM). Methods This is a planned secondary analysis of a randomized clinical trial. After a 30-day baseline, participants were stratified by episodic (6-14 d/mo) and CM (15-30 d/mo) and randomized to 8 weekly individual sessions of MBCT-M or wait list/treatment as usual (WL/TAU). Primary outcomes (Headache Disability Inventory; Severe Migraine Disability Assessment Scale [scores ≥ 21]) were assessed at months 0, 1, 2, and 4. Mixed models for repeated measures tested moderation with fixed effects of treatment, time, CM, and all interactions. Planned subgroup analyses evaluated treatment*time in episodic and CM. Results Of 60 participants (MBCT-M N = 31, WL/TAU N = 29), 52% had CM. CM moderated the effect of MBCT-M on Severe Migraine Disability Assessment Scale, F(3, 205) = 3.68, p = 0.013; MBCT-M vs WL/TAU reduced the proportion of people reporting severe disability to a greater extent among people with episodic migraine (-40.0% vs -14.3%) than CM (-16.4% vs +8.7%). Subgroup analysis revealed MBCT-M (vs WL/TAU) significantly reduced Headache Disability Inventory for episodic (p = 0.011) but not CM (p = 0.268). Conclusions MBCT-M is a promising treatment for reducing headache-related disability, with greater benefits in episodic than CM. Trial Registration Information ClinicalTrials.gov Identifier: NCT02443519. Classification of Evidence This study provides Class III evidence that MBCT-M reduces headache disability to a greater extent in people with episodic than CM.
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Affiliation(s)
- Elizabeth K Seng
- Ferkauf Graduate School of Psychology (EKS, ZSP, MM, LR, DCB), Yeshiva University, Bronx, New York; Saul R. Korey Department of Neurology (EKS, DCB, RBL), Albert Einstein College of Medicine, Bronx, New York; Montefiore Headache Center (EKS, RBL), Montefiore Medical Center, Bronx, New York; Center for Behavioral and Nutritional Health (ABC), Greenwich Hospital, Connecticut; Psychology Service (ASG), VA Connecticut Healthcare System, West Haven, Connecticut; Pathology and Laboratory Medicine (CM), Medical University of South Carolina, Charleston; School of Psychology (MAD), University of Queensland, Brisbane, QLD, Australia; Department of Rehabilitation Medicine (MAD), The University of Washington, Seattle; and Departments of Neurology and Population Health (MTM), New York University Langone Health, New York
| | - Alexandra B Conway
- Ferkauf Graduate School of Psychology (EKS, ZSP, MM, LR, DCB), Yeshiva University, Bronx, New York; Saul R. Korey Department of Neurology (EKS, DCB, RBL), Albert Einstein College of Medicine, Bronx, New York; Montefiore Headache Center (EKS, RBL), Montefiore Medical Center, Bronx, New York; Center for Behavioral and Nutritional Health (ABC), Greenwich Hospital, Connecticut; Psychology Service (ASG), VA Connecticut Healthcare System, West Haven, Connecticut; Pathology and Laboratory Medicine (CM), Medical University of South Carolina, Charleston; School of Psychology (MAD), University of Queensland, Brisbane, QLD, Australia; Department of Rehabilitation Medicine (MAD), The University of Washington, Seattle; and Departments of Neurology and Population Health (MTM), New York University Langone Health, New York
| | - Amy S Grinberg
- Ferkauf Graduate School of Psychology (EKS, ZSP, MM, LR, DCB), Yeshiva University, Bronx, New York; Saul R. Korey Department of Neurology (EKS, DCB, RBL), Albert Einstein College of Medicine, Bronx, New York; Montefiore Headache Center (EKS, RBL), Montefiore Medical Center, Bronx, New York; Center for Behavioral and Nutritional Health (ABC), Greenwich Hospital, Connecticut; Psychology Service (ASG), VA Connecticut Healthcare System, West Haven, Connecticut; Pathology and Laboratory Medicine (CM), Medical University of South Carolina, Charleston; School of Psychology (MAD), University of Queensland, Brisbane, QLD, Australia; Department of Rehabilitation Medicine (MAD), The University of Washington, Seattle; and Departments of Neurology and Population Health (MTM), New York University Langone Health, New York
| | - Zarine S Patel
- Ferkauf Graduate School of Psychology (EKS, ZSP, MM, LR, DCB), Yeshiva University, Bronx, New York; Saul R. Korey Department of Neurology (EKS, DCB, RBL), Albert Einstein College of Medicine, Bronx, New York; Montefiore Headache Center (EKS, RBL), Montefiore Medical Center, Bronx, New York; Center for Behavioral and Nutritional Health (ABC), Greenwich Hospital, Connecticut; Psychology Service (ASG), VA Connecticut Healthcare System, West Haven, Connecticut; Pathology and Laboratory Medicine (CM), Medical University of South Carolina, Charleston; School of Psychology (MAD), University of Queensland, Brisbane, QLD, Australia; Department of Rehabilitation Medicine (MAD), The University of Washington, Seattle; and Departments of Neurology and Population Health (MTM), New York University Langone Health, New York
| | - Maya Marzouk
- Ferkauf Graduate School of Psychology (EKS, ZSP, MM, LR, DCB), Yeshiva University, Bronx, New York; Saul R. Korey Department of Neurology (EKS, DCB, RBL), Albert Einstein College of Medicine, Bronx, New York; Montefiore Headache Center (EKS, RBL), Montefiore Medical Center, Bronx, New York; Center for Behavioral and Nutritional Health (ABC), Greenwich Hospital, Connecticut; Psychology Service (ASG), VA Connecticut Healthcare System, West Haven, Connecticut; Pathology and Laboratory Medicine (CM), Medical University of South Carolina, Charleston; School of Psychology (MAD), University of Queensland, Brisbane, QLD, Australia; Department of Rehabilitation Medicine (MAD), The University of Washington, Seattle; and Departments of Neurology and Population Health (MTM), New York University Langone Health, New York
| | - Lauren Rosenberg
- Ferkauf Graduate School of Psychology (EKS, ZSP, MM, LR, DCB), Yeshiva University, Bronx, New York; Saul R. Korey Department of Neurology (EKS, DCB, RBL), Albert Einstein College of Medicine, Bronx, New York; Montefiore Headache Center (EKS, RBL), Montefiore Medical Center, Bronx, New York; Center for Behavioral and Nutritional Health (ABC), Greenwich Hospital, Connecticut; Psychology Service (ASG), VA Connecticut Healthcare System, West Haven, Connecticut; Pathology and Laboratory Medicine (CM), Medical University of South Carolina, Charleston; School of Psychology (MAD), University of Queensland, Brisbane, QLD, Australia; Department of Rehabilitation Medicine (MAD), The University of Washington, Seattle; and Departments of Neurology and Population Health (MTM), New York University Langone Health, New York
| | - Christopher Metts
- Ferkauf Graduate School of Psychology (EKS, ZSP, MM, LR, DCB), Yeshiva University, Bronx, New York; Saul R. Korey Department of Neurology (EKS, DCB, RBL), Albert Einstein College of Medicine, Bronx, New York; Montefiore Headache Center (EKS, RBL), Montefiore Medical Center, Bronx, New York; Center for Behavioral and Nutritional Health (ABC), Greenwich Hospital, Connecticut; Psychology Service (ASG), VA Connecticut Healthcare System, West Haven, Connecticut; Pathology and Laboratory Medicine (CM), Medical University of South Carolina, Charleston; School of Psychology (MAD), University of Queensland, Brisbane, QLD, Australia; Department of Rehabilitation Medicine (MAD), The University of Washington, Seattle; and Departments of Neurology and Population Health (MTM), New York University Langone Health, New York
| | - Melissa A Day
- Ferkauf Graduate School of Psychology (EKS, ZSP, MM, LR, DCB), Yeshiva University, Bronx, New York; Saul R. Korey Department of Neurology (EKS, DCB, RBL), Albert Einstein College of Medicine, Bronx, New York; Montefiore Headache Center (EKS, RBL), Montefiore Medical Center, Bronx, New York; Center for Behavioral and Nutritional Health (ABC), Greenwich Hospital, Connecticut; Psychology Service (ASG), VA Connecticut Healthcare System, West Haven, Connecticut; Pathology and Laboratory Medicine (CM), Medical University of South Carolina, Charleston; School of Psychology (MAD), University of Queensland, Brisbane, QLD, Australia; Department of Rehabilitation Medicine (MAD), The University of Washington, Seattle; and Departments of Neurology and Population Health (MTM), New York University Langone Health, New York
| | - Mia T Minen
- Ferkauf Graduate School of Psychology (EKS, ZSP, MM, LR, DCB), Yeshiva University, Bronx, New York; Saul R. Korey Department of Neurology (EKS, DCB, RBL), Albert Einstein College of Medicine, Bronx, New York; Montefiore Headache Center (EKS, RBL), Montefiore Medical Center, Bronx, New York; Center for Behavioral and Nutritional Health (ABC), Greenwich Hospital, Connecticut; Psychology Service (ASG), VA Connecticut Healthcare System, West Haven, Connecticut; Pathology and Laboratory Medicine (CM), Medical University of South Carolina, Charleston; School of Psychology (MAD), University of Queensland, Brisbane, QLD, Australia; Department of Rehabilitation Medicine (MAD), The University of Washington, Seattle; and Departments of Neurology and Population Health (MTM), New York University Langone Health, New York
| | - Dawn C Buse
- Ferkauf Graduate School of Psychology (EKS, ZSP, MM, LR, DCB), Yeshiva University, Bronx, New York; Saul R. Korey Department of Neurology (EKS, DCB, RBL), Albert Einstein College of Medicine, Bronx, New York; Montefiore Headache Center (EKS, RBL), Montefiore Medical Center, Bronx, New York; Center for Behavioral and Nutritional Health (ABC), Greenwich Hospital, Connecticut; Psychology Service (ASG), VA Connecticut Healthcare System, West Haven, Connecticut; Pathology and Laboratory Medicine (CM), Medical University of South Carolina, Charleston; School of Psychology (MAD), University of Queensland, Brisbane, QLD, Australia; Department of Rehabilitation Medicine (MAD), The University of Washington, Seattle; and Departments of Neurology and Population Health (MTM), New York University Langone Health, New York
| | - Richard B Lipton
- Ferkauf Graduate School of Psychology (EKS, ZSP, MM, LR, DCB), Yeshiva University, Bronx, New York; Saul R. Korey Department of Neurology (EKS, DCB, RBL), Albert Einstein College of Medicine, Bronx, New York; Montefiore Headache Center (EKS, RBL), Montefiore Medical Center, Bronx, New York; Center for Behavioral and Nutritional Health (ABC), Greenwich Hospital, Connecticut; Psychology Service (ASG), VA Connecticut Healthcare System, West Haven, Connecticut; Pathology and Laboratory Medicine (CM), Medical University of South Carolina, Charleston; School of Psychology (MAD), University of Queensland, Brisbane, QLD, Australia; Department of Rehabilitation Medicine (MAD), The University of Washington, Seattle; and Departments of Neurology and Population Health (MTM), New York University Langone Health, New York
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Strauss LD, Yugrakh MS, Kaplan KE, Minen MT. Headache infusion centers: A survey on treatments provided, infusion center operations, and barriers to developing new infusion centers. Headache 2021; 61:1364-1375. [PMID: 34378185 DOI: 10.1111/head.14172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 05/17/2021] [Accepted: 05/27/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infusion therapy refers to the intravenous administration of medicines and fluids for the treatment of status migrainosus, severe persistent headaches, or chronic headache. Headache practices and centers offer this treatment for patients as an alternative to the emergency department (ED) setting. However, little information is available in the literature on understanding the operations of an infusion center. OBJECTIVE We sought to survey the Inpatient Headache & Emergency Medicine specialty section and the Academic Program Directors listserv of the American Headache Society (AHS) to better understand current practices. METHODS A survey was advertised and distributed to the listservs of both the Inpatient Headache & Emergency Medicine specialty section and the Academic Program Directors, which combined included both academic and private practices. In addition, the survey was available on laptops at related events at an annual AHS meeting in Scottsdale. RESULTS Of the 127 members of the combined group of both listservs, 50 responded with an overall survey response rate of 39%. Ten out of fifty were from programs with more than one responder completing the survey, leaving 40 unique headache programs. Academic programs made up the majority of programs (85%, 34/40). The total of 40 participating programs is comparable with the 47 academic headache programs listed on the American Migraine Foundation website at the time of the survey. Of the academic programs surveyed, most were hospital based (n = 23) compared with a satellite location (n = 11). Of all programs surveyed, 68% (27/40) offered infusion therapy. Of those that did not have an infusion practice (n = 13), the most common reason cited was insufficient staffing (n = 8). Key highlights of the survey included the following: The majority of programs offering infusions obtain prior authorization before scheduling (70%, 19/27) and offer patient availability 5 days/week (78%, 21/27) typically only during business hours (81%, 22/27). Programs reported that they typically give three to four medications during each infusion session (72%, 18/25). Treatment paradigms varied between programs. Programs surveyed were concentrated in the Northeast and Midwest regions of the United States. CONCLUSION The limited number of headache infusion centers overall may contribute to the limited ability of headache infusion centers to prevent ED migraine visits. Headache patients can have unpredictable headache onset, and most of the infusion practices surveyed appeared to adapt to this by offering infusions most days during a work week. However, this need for multiple days per week may also explain the most common reason for not having an infusion practice, which is insufficient staffing. Various treatment paradigms are implemented by different practitioners, and future studies will have to focus on investigation of best practice.
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Affiliation(s)
- Lauren Doyle Strauss
- Department of Neurology, Wake Forest Baptist Medical Center, Brenner Children's Hospital, Winston-Salem, NC, USA
| | | | | | - Mia T Minen
- Department of Neurology, NYU Langone Health, New York, NY, USA.,Department of Population Health, NYU Langone Health, New York, NY, USA
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Kiarashi J, VanderPluym J, Szperka CL, Turner S, Minen MT, Broner S, Ross AC, Wagstaff AE, Anto M, Marzouk M, Monteith TS, Rosen N, Manrriquez SL, Seng E, Finkel A, Charleston L. Factors Associated With, and Mitigation Strategies for, Health Care Disparities Faced by Patients With Headache Disorders. Neurology 2021; 97:280-289. [PMID: 34108270 PMCID: PMC8424498 DOI: 10.1212/wnl.0000000000012261] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 04/19/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To review contemporary issues of health care disparities in headache medicine with regard to race/ethnicity, socioeconomic status (SES), and geography and propose solutions for addressing these disparities. METHODS An Internet and PubMed search was performed and literature was reviewed for key concepts underpinning disparities in headache medicine. Content was refined to areas most salient to our goal of informing the provision of equitable care in headache treatment through discussions with a group of 16 experts from a range of headache subspecialties. RESULTS Taken together, a multitude of factors, including racism, SES, insurance status, and geographical disparities, contribute to the inequities that exist within the health care system when treating headache disorders. Interventions such as improving public education, advocacy, optimizing telemedicine, engaging in community outreach to educate primary care providers, training providers in cultural sensitivity and competence and implicit bias, addressing health literacy, and developing recruitment strategies to increase representation of underserved groups within headache research are proposed as solutions to ameliorate disparities. CONCLUSION Neurologists have a responsibility to provide and deliver equitable care to all. It is important that disparities in the management of headache disorders are identified and addressed.
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Affiliation(s)
- Jessica Kiarashi
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing.
| | - Juliana VanderPluym
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Christina L Szperka
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Scott Turner
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Mia T Minen
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Susan Broner
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Alexandra C Ross
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Amanda E Wagstaff
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Marissa Anto
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Maya Marzouk
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Teshamae S Monteith
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Noah Rosen
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Salvador L Manrriquez
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Elizabeth Seng
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Alan Finkel
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
| | - Larry Charleston
- From the Department of Neurology and Neurotherapeutics (J.K.), UT Southwestern Medical Center, Dallas, TX; Department of Neurology (J.V.), Mayo Clinic, Scottsdale, AZ; Division of Neurology (C.L.S., M.A.), Children's Hospital of Philadelphia, PA; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Neurology (S.T.), School of Medicine, University of Alabama at Birmingham; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York, NY; Department of Neurology (S.B.), Weill Cornell Medical College and New York Presbyterian Hospital, NY; UCSF Benioff Children's Hospital (A.C.R., A.E.W.), University of California, San Francisco; Ferkauf Graduate School of Psychology (M.M.), Yeshiva University, Bronx, NY; Department of Neurology (T.S.M.), University of Miami, Leonard M. Miller School of Medicine, FL; Departments of Neurology and Psychiatry (N.R.), Zucker School of Medicine and Northwell Health, Manhasset, NY; Orofacial Pain (S.L.M.), Division of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles; Saul R. Korey Department of Neurology (E.S.), Albert Einstein College of Medicine, Bronx, NY; Carolina Headache Institute (A.F.), University of North Carolina School of Medicine, Durham; and Department of Neurology and Ophthalmology (L.C.), Michigan State University College of Human Medicine, East Lansing
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Minen MT, Szperka CL, Kaplan K, Ehrlich A, Riggins N, Rizzoli P, Strauss LD. Telehealth as a new care delivery model: The headache provider experience. Headache 2021; 61:1123-1131. [PMID: 34309828 DOI: 10.1111/head.14150] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/09/2021] [Accepted: 04/26/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess telehealth practice for headache visits in the United States. BACKGROUND The rapid roll out of telehealth during the COVID-19 pandemic impacted headache specialists. METHODS American Headache Society (AHS) members were emailed an anonymous survey (9/9/20-10/12/20) to complete if they had logged ≥2 months or 50+ headache visits via telehealth. RESULTS Out of 1348 members, 225 (16.7%) responded. Most were female (59.8%; 113/189). Median age was 47 (interquartile range [IQR] 37-57) (N = 154). The majority were MD/DOs (83.7%; 159/190) or NP/PAs (14.7%; 28/190), and most (65.1%; 123/189) were in academia. Years in practice were 0-3: 28; 4-10: 58; 11-20: 42; 20+: 61. Median number of telehealth visits was 120 (IQR 77.5-250) in the prior 3 months. Respondents were "comfortable/very comfortable" treating via telehealth (a) new patient with a chief complaint of headache (median, IQR 4 [3-5]); (b) follow-up for migraine (median, IQR 5 [5-5]); (c) follow-up for secondary headache (median, IQR 4 [3-4]). About half (51.1%; 97/190) offer urgent telehealth. Beyond being unable to perform procedures, top barriers were conducting parts of the neurologic exam (157/189), absence of vital signs (117/189), and socioeconomic/technologic barriers (91/189). Top positive attributes were patient convenience (185/190), reducing patient travel stress (172/190), patient cost reduction (151/190), flexibility with personal matters (128/190), patient comfort at home (114/190), and patient medications nearby (103/190). Only 21.3% (33/155) of providers said telehealth visit length differed from in-person visits, and 55.3% (105/190) believe that the no-show rate improved. On a 1-5 Likert scale, providers were "interested"/"very interested" in digitally prescribing headache apps (median 4, IQR 3-5) and "interested"/"very interested" in remotely monitoring patient symptoms (median 4, IQR 3-5). CONCLUSIONS Respondents were comfortable treating patients with migraine via telehealth. They note positive attributes for patients and how access may be improved. Technology innovations (remote vital signs, digitally prescribing headache apps) and remote symptom monitoring are areas of interest and warrant future research.
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Affiliation(s)
- Mia T Minen
- Department of Neurology, NYU Langone Health, New York, NY, USA.,Department of Population Health, NYU Langone Health, New York, NY, USA
| | - Christina L Szperka
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Kayla Kaplan
- Department of Biology, Barnard College, Columbia University, New York, NY, USA
| | - Annika Ehrlich
- UCSF Headache Center, San Francisco, San Francisco, CA, USA
| | - Nina Riggins
- UCSF Headache Center, San Francisco, San Francisco, CA, USA
| | - Paul Rizzoli
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
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Minen MT, Yang J, Ashina S, Rosen N, Duarte R. Survey of Pain Medicine Specialists' Familiarity with Migraine Management. Pain Med 2021; 22:3030-3040. [PMID: 34270743 DOI: 10.1093/pm/pnab149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Pain specialists treat patients with headache and interface with those who use opioids more so than neurologists and headache specialists. We assessed headache medicine knowledge and needs of pain specialists. DESIGN/SETTING Cross-sectional online survey. SUBJECTS Members of the American Academy of Pain Medicine. METHODS Survey was based on a prior survey on primary care providers' knowledge and needs and was iteratively updated by four headache specialists, two with pain medicine affiliations. RESULTS Of the 105 respondents, 71.4% were physicians, 34.3% were women, and they averaged 20.0 ± 13.6 years in practice. The most common specialty was anesthesia (36.1%, n = 35/97) followed by neurology (14.4%, n = 14/97). About half of providers (55.7%, n = 34/61 and 53.3%, n = 32/60) were familiar with the American Academy of Neurology Guidelines for pharmacological migraine prevention and the Choosing Wisely Campaign recommendations for limiting neuroimaging and opioids. Less than half of all providers (39.7%, n = 23/58) were familiar with the American Headache Society guidelines for emergency management of migraine. Providers were aware of Level A evidence-based nonpharmacological therapies, with over three-fourths recognizing cognitive behavioral therapy (80.7%, n = 50/62) and biofeedback (75.8%, n = 47/62) as evidence-based interventions. About 80% of providers (n = 50/64) estimate making migraine diagnoses in ≤ 50% of their patients with headache. Providers consider starting preventive headache therapy at 7.1 ± 3.9 days/month and report referring 34.3%±34.2% of patients to behavioral interventions. CONCLUSIONS Dissemination and implementation of headache guidelines is needed for pain medicine specialists. Providers may need help diagnosing migraine based on currently accepted guidelines and referring for evidence-based behavioral therapies.
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Affiliation(s)
- Mia T Minen
- Departments of Neurology and Public Health; NYU Langone Health, 222 E 41st Street, Floor 10, New York, NY 10017
| | - Jackie Yang
- Departments of Neurology and Public Health; NYU Langone Health, 222 E 41st Street, Floor 10, New York, NY 10017
| | | | - Noah Rosen
- Department of Neurology and Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center
| | - Robert Duarte
- Pain and Headache Center, Northwell Department of Neurology, Zucker School of Medicine
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Hershey AD, Armand CE, Berk T, Burch R, Buse DC, Dougherty C, Marmura MJ, Minen MT, Robblee J, Schwarz HB. Updated process for American Headache Society Guidelines. Headache 2021; 61:565-566. [PMID: 33891346 DOI: 10.1111/head.14093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/28/2021] [Accepted: 02/12/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Andrew D Hershey
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA.,Department of Neurology, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - Cynthia E Armand
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Thomas Berk
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, USA
| | - Rebecca Burch
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Carrie Dougherty
- Department of Neurology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Michael J Marmura
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mia T Minen
- Department of Neurology, NYU Langone Health, New York, NY, USA.,Department of Population Health, NYU Langone Health, New York, NY, USA
| | | | - Heidi B Schwarz
- Department of Neurology, University of Rochester, Rochester, NY, USA
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Minen MT. Reader Response: Characterizing Opioid Use in a US Population With Migraine: Results From the CaMEO Study. Neurology 2021; 96:685. [PMID: 33820844 DOI: 10.1212/wnl.0000000000011723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Minen MT. Author Response 1b: Challenges to Successful Research Careers in Neurology: How Gender Differences May Play a Role. Neurology 2021; 96:637. [PMID: 33782163 DOI: 10.1212/wnl.0000000000011661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Friedman BW, Irizarry E, Cain D, Caradonna A, Minen MT, Solorzano C, Zias E, Zybert D, McGregor M, Bijur PE, Gallagher EJ. Randomized Study of Metoclopramide Plus Diphenhydramine for Acute Posttraumatic Headache. Neurology 2021; 96:e2323-e2331. [PMID: 33762421 DOI: 10.1212/wnl.0000000000011822] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 02/02/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether IV metoclopramide 20 mg + diphenhydramine 25 mg (M + D) was more efficacious than IV placebo for acute moderate or severe posttraumatic headache in the emergency room. METHODS We conducted this randomized, double-blind, placebo-controlled, parallel-group study in 2 urban emergency departments (EDs). Participants who experienced head trauma and presented to our EDs within 10 days with a headache fulfilling criteria for acute posttraumatic headache were included. We randomized participants in a 1:1 ratio to M + D or placebo. Participants, caregivers, and outcome assessors were blinded to assignment. The primary outcome was improvement in pain on a scale of 0 to 10 between baseline and 1 hour after treatment. RESULTS This study was completed between August 2017 and March 2020. We screened 414 patients for participation and randomized 160: 81 to M + D and 79 to placebo. Baseline characteristics were comparable between the groups. All enrolled participants provided primary outcome data. Patients receiving placebo reported mean improvement of 3.8 (SD 2.6), while those receiving M + D improved by 5.2 (SD 2.3), for a difference favoring metoclopramide of 1.4 (95% confidence interval [CI] 0.7-2.2, p < 0.01). Adverse events were reported by 35 of 81 (43%) patients who received metoclopramide and 22 of 79 (28%) of patients who received placebo (95% CI 1-30 for difference of 15%, p = 0.04). CONCLUSION M + D was more efficacious than placebo with regard to relief of posttraumatic headache in the ED. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov Identifier: NCT03220958. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that for patients with acute moderate or severe posttraumatic headache, IV M + D significantly improved pain compared to placebo.
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Affiliation(s)
- Benjamin W Friedman
- From the Department of Emergency Medicine (B.W.F., E.I., D.C., D.Z., M.M., P.E.B., E.J.G.) and Medical College (A.C.), Albert Einstein College of Medicine, Montefiore, Bronx; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York; and Pharmacy Department (C.S., E.Z.), Montefiore, Bronx, NY.
| | - Eddie Irizarry
- From the Department of Emergency Medicine (B.W.F., E.I., D.C., D.Z., M.M., P.E.B., E.J.G.) and Medical College (A.C.), Albert Einstein College of Medicine, Montefiore, Bronx; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York; and Pharmacy Department (C.S., E.Z.), Montefiore, Bronx, NY
| | - Darnell Cain
- From the Department of Emergency Medicine (B.W.F., E.I., D.C., D.Z., M.M., P.E.B., E.J.G.) and Medical College (A.C.), Albert Einstein College of Medicine, Montefiore, Bronx; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York; and Pharmacy Department (C.S., E.Z.), Montefiore, Bronx, NY
| | - Arianna Caradonna
- From the Department of Emergency Medicine (B.W.F., E.I., D.C., D.Z., M.M., P.E.B., E.J.G.) and Medical College (A.C.), Albert Einstein College of Medicine, Montefiore, Bronx; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York; and Pharmacy Department (C.S., E.Z.), Montefiore, Bronx, NY
| | - Mia T Minen
- From the Department of Emergency Medicine (B.W.F., E.I., D.C., D.Z., M.M., P.E.B., E.J.G.) and Medical College (A.C.), Albert Einstein College of Medicine, Montefiore, Bronx; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York; and Pharmacy Department (C.S., E.Z.), Montefiore, Bronx, NY
| | - Clemencia Solorzano
- From the Department of Emergency Medicine (B.W.F., E.I., D.C., D.Z., M.M., P.E.B., E.J.G.) and Medical College (A.C.), Albert Einstein College of Medicine, Montefiore, Bronx; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York; and Pharmacy Department (C.S., E.Z.), Montefiore, Bronx, NY
| | - Eleftheria Zias
- From the Department of Emergency Medicine (B.W.F., E.I., D.C., D.Z., M.M., P.E.B., E.J.G.) and Medical College (A.C.), Albert Einstein College of Medicine, Montefiore, Bronx; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York; and Pharmacy Department (C.S., E.Z.), Montefiore, Bronx, NY
| | - David Zybert
- From the Department of Emergency Medicine (B.W.F., E.I., D.C., D.Z., M.M., P.E.B., E.J.G.) and Medical College (A.C.), Albert Einstein College of Medicine, Montefiore, Bronx; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York; and Pharmacy Department (C.S., E.Z.), Montefiore, Bronx, NY
| | - Michael McGregor
- From the Department of Emergency Medicine (B.W.F., E.I., D.C., D.Z., M.M., P.E.B., E.J.G.) and Medical College (A.C.), Albert Einstein College of Medicine, Montefiore, Bronx; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York; and Pharmacy Department (C.S., E.Z.), Montefiore, Bronx, NY
| | - Polly E Bijur
- From the Department of Emergency Medicine (B.W.F., E.I., D.C., D.Z., M.M., P.E.B., E.J.G.) and Medical College (A.C.), Albert Einstein College of Medicine, Montefiore, Bronx; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York; and Pharmacy Department (C.S., E.Z.), Montefiore, Bronx, NY
| | - E John Gallagher
- From the Department of Emergency Medicine (B.W.F., E.I., D.C., D.Z., M.M., P.E.B., E.J.G.) and Medical College (A.C.), Albert Einstein College of Medicine, Montefiore, Bronx; Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, New York; and Pharmacy Department (C.S., E.Z.), Montefiore, Bronx, NY
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Minen MT, Friedman BW, Adhikari S, Corner S, Powers SW, Seng EK, Grudzen C, Lipton RB. Introduction of a smartphone based behavioral intervention for migraine in the emergency department. Gen Hosp Psychiatry 2021; 69:12-19. [PMID: 33485090 PMCID: PMC8721519 DOI: 10.1016/j.genhosppsych.2020.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/24/2020] [Accepted: 12/11/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine whether a smartphone application (app) with an electronic headache diary and a progressive muscle relaxation (PMR) intervention is feasible and acceptable to people presenting to the Emergency Department (ED) with migraine. METHODS This single arm prospective study assessed feasibility by actual use of the app and acceptability by satisfaction with the app. We report preliminary data on change in migraine disability and headache days. RESULTS The 51 participants completed PMR sessions on a mean of 13 ± 19 (0,82) days for the 90-day study period, lasting a median of 11 min (IQR 6.5, 17) each. Median number of days of diary use was 34 (IQR 10, 77). Diaries were completed at least twice a week in half of study weeks (337/663). Participants were likely (≥4/5 on a 5-point Likert scale) to recommend both the app (85%) and PMR (91%). MIDAS scores significantly decreased by a mean of 38 points/participant (p < 0.0001). More frequent PMR use was associated with a higher odds of headache free days (p = 0.0148). CONCLUSION Smartphone-based PMR introduced to patients who present to the ED for migraine is feasible and acceptable. More frequent users have more headache free days. Future work should focus on intervention engagement.
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Affiliation(s)
- Mia T Minen
- Department of Neurology, NYU Langone Health, 550 1st Avenue, New York, NY 10016, United States of America; Department of Population Health, NYU Langone Health, 180 Madison Ave, New York, NY 10016, United States of America.
| | - Benjamin W Friedman
- Department of Emergency Medicine, Albert Einstein College of Medicine, 1300 Morris Park Ave, The Bronx, NY 10461, United States of America
| | - Samrachana Adhikari
- Department of Population Health, NYU Langone Health, 180 Madison Ave, New York, NY 10016, United States of America
| | - Sarah Corner
- Department of Neurology, NYU Langone Health, 550 1st Avenue, New York, NY 10016, United States of America
| | - Scott W Powers
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital; Headache Center, Cincinnati Children's Hospital, 3333 Burnet Ave, Cincinnati, OH 45229, United States of America
| | - Elizabeth K Seng
- Ferkauf Graduate School of Psychology, Yeshiva University; Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, 1165 Morris Park Ave, The Bronx, NY 10461, United States of America
| | - Corita Grudzen
- Department of Population Health, NYU Langone Health, 180 Madison Ave, New York, NY 10016, United States of America; Department of Emergency Medicine, NYU Langone Health, 550 1st Avenue, New York, NY 10016, United States of America
| | - Richard B Lipton
- Montefiore Headache Center; Departments of Neurology, Population Health, and Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, 250 Waters Pl #8, The Bronx, NY 10461, United States of America
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Minen MT, Gopal A, Sahyoun G, Stieglitz E, Torous J. The Functionality, Evidence, and Privacy Issues Around Smartphone Apps for the Top Neuropsychiatric Conditions. J Neuropsychiatry Clin Neurosci 2021; 33:72-79. [PMID: 32669020 PMCID: PMC8670295 DOI: 10.1176/appi.neuropsych.19120353] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE There are more than 325,000 health-related smartphone applications (apps) on the market. To better understand the apps currently on the market for the five most disabling neuropsychiatric conditions, the authors conducted a study investigating their intended uses (target population and intervention), the data collected, and any privacy policies. METHODS This was a cross-sectional study of apps for the five most disabling neuropsychiatric conditions per the World Health Organization: stroke, migraine, depression, Alzheimer's disease and dementia, and anxiety. Up to 15 apps in the U.S. Google Play and Apple app stores were selected based on the following prespecified inclusion criteria: the app appeared in the top 50 search results, offered intervention or tracking capabilities, and listed the condition in the app title or description. Exclusion criteria were <$5.00 to purchase, solely motor versus cognitive-based intervention, or designed for use by caregivers or health care providers. Data abstracted included function, behavior change rewards, and information about intervention, privacy policy, and payment. RESULTS Eighty-three apps were reviewed (stroke, N=8; migraine, N=25; Alzheimer's disease and dementia, N=8; depression, N=7; anxiety, N=14; apps targeting depression and anxiety, N=21). Sixty-nine percent of apps had an intervention component, 18% were deemed evidence based, 77% had a privacy policy, 70% required payment for access to all features, and 19% rewarded user behavior changes. CONCLUSIONS Most apps on the market targeted migraine, depression, and anxiety and contained interventions, although most of the interventions did not appear to be evidence based. Additionally, although most apps had privacy policies, lay people may have difficulty understanding these policies due to their complexities.
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Minen MT, Szperka CL, Cartwright MS, Wells RE. Building the Neurology Pipeline With Undergraduate Students in Research and Clinical Practice. Neurology 2020; 96:430-438. [PMID: 33293387 DOI: 10.1212/wnl.0000000000011351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/13/2020] [Indexed: 11/15/2022] Open
Abstract
There is currently a shortage of neurologists in the United States. Multiple efforts are underway to increase the strength of the neurology workforce. One potential approach is early exposure to neurology research and clinical care to pique interest and promote the specialty as a career choice. This study details the rewarding experience of working with undergraduate students, both in clinical research and clinical care. The logistics, benefits to students, and positive aspects for neurologists are outlined. Examples provided by undergraduate students who have participated in neurology research and clinical care are presented. The ultimate goals of this work are to encourage and inspire academic neurologists to involve undergraduate students in research and clinical care, to facilitate this process by outlining the steps needed to make this pairing successful, and to ultimately promote a pathway to build the neurology pipeline.
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Affiliation(s)
- Mia T Minen
- From the Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, NY, NY; Departments of Neurology and Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, and Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA; and Department of Neurology (M.S.C., R.E.W.), Wake Forest Baptist Medical Center, Winston-Salem, NC.
| | - Christina L Szperka
- From the Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, NY, NY; Departments of Neurology and Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, and Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA; and Department of Neurology (M.S.C., R.E.W.), Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Michael S Cartwright
- From the Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, NY, NY; Departments of Neurology and Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, and Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA; and Department of Neurology (M.S.C., R.E.W.), Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Rebecca Erwin Wells
- From the Departments of Neurology and Population Health (M.T.M.), NYU Langone Health, NY, NY; Departments of Neurology and Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania, and Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA; and Department of Neurology (M.S.C., R.E.W.), Wake Forest Baptist Medical Center, Winston-Salem, NC
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Minen MT, Adhikari S, Padikkala J, Tasneem S, Bagheri A, Goldberg E, Powers S, Lipton RB. Smartphone‐Delivered Progressive Muscle Relaxation for the Treatment of Migraine in Primary Care: A Randomized Controlled Trial. Headache 2020; 60:2232-2246. [DOI: 10.1111/head.14010] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Mia T. Minen
- Department of Neurology NYU Langone Health New York NY USA
- Department of Population Health NYU Langone Health New York NY USA
| | | | - Jane Padikkala
- Center for Healthcare Innovation and Delivery Science NYU Langone Health New York NY USA
| | - Sumaiya Tasneem
- Center for Healthcare Innovation and Delivery Science NYU Langone Health New York NY USA
| | - Ashley Bagheri
- Center for Healthcare Innovation and Delivery Science NYU Langone Health New York NY USA
| | - Eric Goldberg
- Department of Medicine Faculty Group Practices NYU Langone Health New York NY USA
| | - Scott Powers
- Behavioral Medicine Headache Medicine Clinical Psychology Cincinnati Children's Hospital Cincinnati OH USA
| | - Richard B. Lipton
- Montefiore Headache Center Department of Neurology Albert Einstein College of Medicine New York NY USA
- Montefiore Headache Center Department of Population Health Albert Einstein College of Medicine New York NY USA
- Montefiore Headache Center Department of Psychiatry and Behavioral Sciences Albert Einstein College of Medicine New York NY USA
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Huang H, Minen MT, Mehla S, Chiang C, Mehta DG, Patel P, Pham A, Gerson T, Begasse De Dhaem O. Eleven Reasons People Decide to Choose Headache Medicine: There May Be a Headache Medicine Provider Shortage but there are Ways to Foster Interest. Headache 2020; 60:1846-1852. [DOI: 10.1111/head.13838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 11/29/2022]
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Minen MT, Law EF, Harriott A, Seng EK, Hranilovich J, Szperka CL, Wells RE. Challenges to successful research careers in neurology: How gender differences may play a role. Neurology 2020; 95:349-359. [PMID: 32646963 DOI: 10.1212/wnl.0000000000010285] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/17/2020] [Indexed: 12/23/2022] Open
Abstract
There has been a substantial rise in the number of women pursuing careers in neurology. However, research has shown that women in neurology have high rates of burnout with gender disparities in burnout and attrition in the field. Recently, there was a call from the NIH, including the National Institute of Neurological Disorders and Stroke, asking for input on factors that may limit or discourage grant applications from women. As the recipients of the highly coveted NIH career mentored awards (K awards) in headache medicine, we applaud the NIH for asking for gender-specific feedback and for raising awareness of research showing that female faculty on the Research Track are at an increased risk of departure. Using the NIH model for the Responsible Conduct of Research and the tenant of Nurturing the Fertile Environment, we discuss specific challenges in academic research that may contribute to gender differences in neurology research success. Although the rate of women conducting NIH-funded migraine research increased from 23% to 41% over the last 10 years, more women are currently in training compared with independence, with 6/6 of the NIH training grants but only 12/36 of the NIH research-level grants, held by women in fiscal years 2017-2019. We suggest concrete solutions to these challenges to ensure the success of women in research reaching independence.
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Affiliation(s)
- Mia T Minen
- From the Departments of Neurology and Population Health (M.T.M.), NYU Langone Health; Department of Anesthesiology & Pain Medicine (E.F.L.), University of Washington School of Medicine and Center for Child Health, Behavior & Development, Seattle Children's Research Institute; Department of Neurology (A.H.), Massachusetts General Hospital; Ferkauf Graduate School of Psychology (E.K.S.), Yeshiva University; Saul R. Korey Department of Neurology (E.K.S.), Albert Einstein College of Medicine; Department of Pediatrics (J.H.), University of Colorado School of Medicine and Children's Hospital Colorado; Division of Neurology (C.L.S.), Children's Hospital of Philadelphia; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania; and Department of Neurology (R.E.W.), Wake Forest Baptist Health.
| | - Emily F Law
- From the Departments of Neurology and Population Health (M.T.M.), NYU Langone Health; Department of Anesthesiology & Pain Medicine (E.F.L.), University of Washington School of Medicine and Center for Child Health, Behavior & Development, Seattle Children's Research Institute; Department of Neurology (A.H.), Massachusetts General Hospital; Ferkauf Graduate School of Psychology (E.K.S.), Yeshiva University; Saul R. Korey Department of Neurology (E.K.S.), Albert Einstein College of Medicine; Department of Pediatrics (J.H.), University of Colorado School of Medicine and Children's Hospital Colorado; Division of Neurology (C.L.S.), Children's Hospital of Philadelphia; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania; and Department of Neurology (R.E.W.), Wake Forest Baptist Health
| | - Andrea Harriott
- From the Departments of Neurology and Population Health (M.T.M.), NYU Langone Health; Department of Anesthesiology & Pain Medicine (E.F.L.), University of Washington School of Medicine and Center for Child Health, Behavior & Development, Seattle Children's Research Institute; Department of Neurology (A.H.), Massachusetts General Hospital; Ferkauf Graduate School of Psychology (E.K.S.), Yeshiva University; Saul R. Korey Department of Neurology (E.K.S.), Albert Einstein College of Medicine; Department of Pediatrics (J.H.), University of Colorado School of Medicine and Children's Hospital Colorado; Division of Neurology (C.L.S.), Children's Hospital of Philadelphia; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania; and Department of Neurology (R.E.W.), Wake Forest Baptist Health
| | - Elizabeth K Seng
- From the Departments of Neurology and Population Health (M.T.M.), NYU Langone Health; Department of Anesthesiology & Pain Medicine (E.F.L.), University of Washington School of Medicine and Center for Child Health, Behavior & Development, Seattle Children's Research Institute; Department of Neurology (A.H.), Massachusetts General Hospital; Ferkauf Graduate School of Psychology (E.K.S.), Yeshiva University; Saul R. Korey Department of Neurology (E.K.S.), Albert Einstein College of Medicine; Department of Pediatrics (J.H.), University of Colorado School of Medicine and Children's Hospital Colorado; Division of Neurology (C.L.S.), Children's Hospital of Philadelphia; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania; and Department of Neurology (R.E.W.), Wake Forest Baptist Health
| | - Jennifer Hranilovich
- From the Departments of Neurology and Population Health (M.T.M.), NYU Langone Health; Department of Anesthesiology & Pain Medicine (E.F.L.), University of Washington School of Medicine and Center for Child Health, Behavior & Development, Seattle Children's Research Institute; Department of Neurology (A.H.), Massachusetts General Hospital; Ferkauf Graduate School of Psychology (E.K.S.), Yeshiva University; Saul R. Korey Department of Neurology (E.K.S.), Albert Einstein College of Medicine; Department of Pediatrics (J.H.), University of Colorado School of Medicine and Children's Hospital Colorado; Division of Neurology (C.L.S.), Children's Hospital of Philadelphia; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania; and Department of Neurology (R.E.W.), Wake Forest Baptist Health
| | - Christina L Szperka
- From the Departments of Neurology and Population Health (M.T.M.), NYU Langone Health; Department of Anesthesiology & Pain Medicine (E.F.L.), University of Washington School of Medicine and Center for Child Health, Behavior & Development, Seattle Children's Research Institute; Department of Neurology (A.H.), Massachusetts General Hospital; Ferkauf Graduate School of Psychology (E.K.S.), Yeshiva University; Saul R. Korey Department of Neurology (E.K.S.), Albert Einstein College of Medicine; Department of Pediatrics (J.H.), University of Colorado School of Medicine and Children's Hospital Colorado; Division of Neurology (C.L.S.), Children's Hospital of Philadelphia; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania; and Department of Neurology (R.E.W.), Wake Forest Baptist Health
| | - Rebecca Erwin Wells
- From the Departments of Neurology and Population Health (M.T.M.), NYU Langone Health; Department of Anesthesiology & Pain Medicine (E.F.L.), University of Washington School of Medicine and Center for Child Health, Behavior & Development, Seattle Children's Research Institute; Department of Neurology (A.H.), Massachusetts General Hospital; Ferkauf Graduate School of Psychology (E.K.S.), Yeshiva University; Saul R. Korey Department of Neurology (E.K.S.), Albert Einstein College of Medicine; Department of Pediatrics (J.H.), University of Colorado School of Medicine and Children's Hospital Colorado; Division of Neurology (C.L.S.), Children's Hospital of Philadelphia; Departments of Neurology & Pediatrics (C.L.S.), Perelman School of Medicine at the University of Pennsylvania; and Department of Neurology (R.E.W.), Wake Forest Baptist Health
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Minen MT, Jaran J, Boyers T, Corner S. Understanding What People With Migraine Consider to be Important Features of Migraine Tracking: An Analysis of the Utilization of Smartphone‐Based Migraine Tracking With a Free‐Text Feature. Headache 2020; 60:1402-1414. [DOI: 10.1111/head.13851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/15/2020] [Accepted: 04/27/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Mia T. Minen
- Department of Neurology NYU Langone Health New York NY USA
| | - Jana Jaran
- Department of Neuroscience and Behavior Barnard College New York NY USA
| | - Talia Boyers
- Department of Neuroscience and Behavior Barnard College New York NY USA
| | - Sarah Corner
- Department of Neurology NYU Langone Health New York NY USA
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Minen MT, Gumpel T, Ali S, Sow F, Toy K. What are Headache Smartphone Application (App) Users Actually Looking for in Apps: A Qualitative Analysis of App Reviews to Determine a Patient Centered Approach to Headache Smartphone Apps. Headache 2020; 60:1392-1401. [DOI: 10.1111/head.13859] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 01/20/2023]
Affiliation(s)
- Mia T. Minen
- Division of Headache Department of Neurology NYU Langone Health New York NY USA
| | - Tyler Gumpel
- Department of Biology The City College of New York New York NY USA
| | - Seher Ali
- Department of Biotechnology The City College of New York New York NY USA
| | - Fatoumata Sow
- Department of Biology The City College of New York New York NY USA
| | - Kaitlyn Toy
- Department of Biochemistry The City College of New York New York NY USA
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Minen MT, Morio K, Schaubhut KB, Powers SW, Lipton RB, Seng E. Focus group findings on the migraine patient experience during research studies and ideas for future investigations. Cephalalgia 2020; 40:712-734. [PMID: 31870189 PMCID: PMC7754244 DOI: 10.1177/0333102419888230] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES We conducted focus groups in people who had participated in mobile health (mHealth) studies of behavioral interventions for migraine to better understand: (a) Participant experience in the recruitment/enrollment process; (b) participant experience during the studies themselves; (c) ideas for improving participant experience for future studies. METHODS We conducted four focus groups in people who had agreed to participate in one of three studies involving mHealth and behavioral therapy for migraine. Inclusion criteria were being age 18-80, owning a smartphone, and having four or more headache days per month. All participants met the International Classification of Headache Disorders third edition beta version criteria for migraine. Exclusion criteria were not speaking English and having had behavioral therapy for migraine in the past year. Focus groups were audio recorded, fully transcribed and coded using general thematic analysis. RESULTS The 12 focus group participants had a mean age of 45 ± 15, a mean age of headache onset of 21 ± 13 and mean MIDAS disability score was 39 ± 56. Participants were women (100%), white (50%), Asian (33.3%) or members of other racial groups (16.7%). Certain themes emerged from each topic area. With regard to recruitment/enrollment (a), key themes were: (i) Participants joined their study out of an interest in research and/or a desire to try a new migraine treatment modality (behavioral therapy). (ii) Enrollment should be simple and study requirements should be carefully explained prior to enrollment. When asked about their experiences during the studies (b), the following themes emerged: (i) It is difficult to participate in study follow-up and compliance phone calls; (ii) participants prefer to choose from among various options for contact with the study team; (iii) there are barriers that limit app use related to migraine itself, as well as other barriers; (iv) completing diaries on a daily basis is challenging; (v) technical difficulties and uncertainties about app features limit use; (vi) being part of a research study promoted daily behavioral therapy use; (vii) progressive muscle relaxation (PMR) is enjoyable, and has a positive impact on life; (viii) behavioral therapy was a preferred treatment to reduce migraine pain. Ideas for improving study design or patient experience (c) included: (i) Increased opportunity to interact with other people with migraine would be beneficial; (ii) navigating the app and data entry should be easier; (iii) more varied methods for viewing the data and measures of adherence are needed; (iv) more information on and more varied behavioral treatment modalities would be preferred. CONCLUSION Though people with migraine are motivated to participate in mHealth and behavioral treatment studies, better communication up front about interventions as well as greater flexibility in interventions and follow-up methods are desired.
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Affiliation(s)
| | | | | | - Scott W Powers
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Minen MT, Wells RE, Gautreaux JR, Szperka CL, Rayhill M, Orlova Y, Metzler A, Halpern A, Monteith T. Responding to the Needs of Early Career Physicians and Fellows in Headache Medicine: Career Planning, Getting Involved, and Considerations in Building a Headache Center. Headache 2020; 60:1453-1462. [PMID: 32476142 DOI: 10.1111/head.13833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Mia T Minen
- Department of Neurology, NYU Langone Health, New York, NY, USA
| | - Rebecca E Wells
- Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jessica R Gautreaux
- Neurology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | | | - Melissa Rayhill
- Neurology, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Yulia Orlova
- Neurology, University of Florida McKnight Brain Institute, Gainesville, FL, USA
| | - Abby Metzler
- Neurology, University of Minnesota Health, Minneapolis, MN, USA
| | - Audrey Halpern
- Manhattan Center for Headache & Neurology, New York, NY, USA
| | - Teshamae Monteith
- Neurology- Headache Division, University of Miami Miller School of Medicine, Miami, FL, USA
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Minen MT, Robbins MS, Loder E, Nahas S, Gautreaux J, Litin S, Barch C, Cook C, Smith T, Powers SW, Hasan S, Sbar E, Stika CS, Stone F, Sprouse-Blum A. Addressing the Crisis of Diagnosis and Management of Migraine in Primary Care: A Summary of the American Headache Society FrontLine Primary Care Advisory Board. Headache 2020; 60:1000-1004. [PMID: 32267961 DOI: 10.1111/head.13797] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 03/05/2020] [Accepted: 03/13/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Mia T Minen
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA
| | | | - Elizabeth Loder
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Stephanie Nahas
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jessica Gautreaux
- Department of Neurology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Scott Litin
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Carol Barch
- Department of Neurology, Stanford Health Care, Palo Alto, CA, USA
| | - Calli Cook
- Department of Neurology, Emory Healthcare, Atlanta, GA, USA
| | | | - Scott W Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Saba Hasan
- Department of Internal Medicine, Capital Health Regional Medical Center, Trenton, NJ, USA
| | - Evelyn Sbar
- Department of Family and Community Medicine, TTUHSC Amarillo, Amarillo, TX, USA
| | | | - Frederick Stone
- Department of Family Medicine, Prisma Health, Greenville, SC, USA
| | - Adam Sprouse-Blum
- Department of Neurology, University of Vermont Medical Center, Burlington, VT, USA
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Szperka CL, Ailani J, Barmherzig R, Klein BC, Minen MT, Halker Singh RB, Shapiro RE. Migraine Care in the Era of COVID-19: Clinical Pearls and Plea to Insurers. Headache 2020; 60:833-842. [PMID: 32227596 PMCID: PMC7228371 DOI: 10.1111/head.13810] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 03/27/2020] [Indexed: 12/22/2022]
Abstract
Objective To outline strategies for the treatment of migraine which do not require in‐person visits to clinic or the emergency department, and to describe ways that health insurance companies can remove barriers to quality care for migraine. Background COVID‐19 is a global pandemic causing widespread infections and death. To control the spread of infection we are called to observe “social distancing” and we have been asked to postpone any procedures which are not essential. Since procedural therapies are a mainstay of headache care, the inability to do procedures could negatively affect our patients with migraine. In this manuscript we review alternative therapies, with particular attention to those which may be contra‐indicated in the setting of COVID‐19 infection. Design/Results The manuscript reviews the use of telemedicine visits and acute, bridge, and preventive therapies for migraine. We focus on evidence‐based treatment where possible, but also describe “real world” strategies which may be tried. In each section we call out areas where changes to rules from commercial health insurance companies would facilitate better migraine care. Conclusions Our common goal as health care providers is to maximize the health and safety of our patients. Successful management of migraine with avoidance of in‐person clinic and emergency department visits further benefits the current urgent societal goal of maintaining social distance to contain the COVID‐19 pandemic.
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Affiliation(s)
- Christina L Szperka
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Departments of Neurology & Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jessica Ailani
- Department of Neurology, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Rebecca Barmherzig
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brad C Klein
- Abington Neurological Associates, Ltd., Abington, PA, USA.,Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mia T Minen
- Departments of Neurology and Population Health, NYU Langone Health, New York, NY, USA
| | | | - Robert E Shapiro
- Department of Neurological Sciences, Larner College of Medicine, University of Vermont, Burlington, VA, USA
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Minen MT, Jalloh A, Begasse de Dhaem O, Seng EK. Behavioral Therapy Preferences in People With Migraine. Headache 2020; 60:1093-1102. [PMID: 32207148 DOI: 10.1111/head.13790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND There are safe and well-tolerated level A evidence-based behavioral therapies for the prevention of migraine. They are biofeedback, cognitive behavioral therapy, and relaxation. However, the behavioral therapies for the prevention of migraine are underutilized. OBJECTIVES We sought to examine whether people with migraine with 4 or more headache days a month had preferences regarding the type of delivery of the behavioral therapy (in-person, smartphone based, telephone) and whether they would be willing to pay for in-person behavioral therapy. We also sought to determine the predictors of likelihood to pursue the behavioral therapy. METHODS Using a cross-sectional study design, we developed an online survey using TurkPrime, an online survey platform, to assess how likely TurkPrime participants who screened positive for migraine using the American Migraine Prevalence and Prevention screen were to pursue different delivery methods of the behavioral therapy. We report descriptive statistics and quantitative analyses. RESULTS There were 401 participants. Median age was 34 [IQR: 29, 41] years. More than two thirds of participants (70.3%, 282/401) were women. Median number of headache days/ month was 5 [IQR: 2.83, 8.5]. Some (12.5%, 50/401) used evidence-based behavioral therapy for migraine. The participants reported that they were "somewhat likely" to pursue in-person or smartphone behavioral therapy and behavioral therapy covered by insurance but were neutral about pursuing the telephone-based behavioral therapy. Participants were "not very likely" to pay out of pocket for the behavioral therapy. Migraine-related disability as measured by the MIDAS grading score was associated with likelihood to pursue the behavioral therapy in-person (P = .004), via telephone (P = .015), and via smart phone (P < .001), and covered by insurance (P = .001). However, migraine-related disability was not associated with likelihood to pursue out of pocket (P = .769) behavioral therapy. Pain intensity was predictive of likelihood of pursuing the behavioral therapy for migraine when covered by insurance. Other factors including education, employment, and headache days were not predictors. CONCLUSION People with migraine prefer in-person and smartphone-based behavioral therapy to telephone-based behavioral therapy. Migraine-related disability is associated with likelihood to pursue the behavioral therapy (independent of type of delivery of the behavioral therapy-in-person, telephone based or smartphone based). However, participants were not very likely to pay for the behavioral therapy.
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Affiliation(s)
- Mia T Minen
- Departments of Neurology and Population Health, NYU Langone Health, New York, NY, USA
| | - Adama Jalloh
- Department of Psychology, City College of New York Ringgold Standard Institution, New York, NY, USA
| | | | - Elizabeth K Seng
- Ferkauf Graduate School of Psychology, Albert Einstein College of Medicine, New York, NY, USA
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Minen MT, Zhou K, Miller L. A Brief Look at Urgent Care Visits for Migraine: The Care Received and Ideas to Guide Migraine Care in this Proliferating Medical Setting. Headache 2020; 60:542-552. [PMID: 31802490 PMCID: PMC8640612 DOI: 10.1111/head.13717] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE There has been a rise in urgent care centers throughout the country over the past 10 years, leading to an increase in patients accessing medical care in these locations. These centers advertise an alternative to the Emergency Department (ED) for the evaluation and treatment of urgent medical conditions. The goal of this analysis was to examine the use of urgent care visits for migraine within 2 urgent care centers within a large academic medical system in New York City. We examined the trends in management and treatment of migraine in these urgent care settings, as well as prescriptions and instructions given to this patient population upon discharge. We paid particular attention to whether the medications administered and prescribed on discharge were those recommended by American Headache Society migraine management guidelines. METHODS We conducted a retrospective chart review of patients with migraine diagnoses at 2 different urgent care locations within 1 large urban medical center. We determined baseline patient demographics, previous migraine characteristics, frequencies of reasons for urgent care visits as well as various medications administered, medications prescribed on discharge, and characteristics of patient outcomes post-discharge. RESULTS Of the 78 patients who visited urgent care with a migraine diagnosis, 20 (25.6%) had a known primary care provider within the urgent care centers' healthcare system. More than three-fourths of all patients (78.2%) had a self-reported history of either recurrent headache or migraine prior to the urgent care visit. Of those with a documented frequency of prior headaches, 94.1% (32/34) had episodic migraine and 79.4% (27/34) experienced at most 1-2 headache days per month. Of those presenting to the urgent care during an episode of migraine, 12.3% (9/73) were given intravenous metoclopramide and none were given subcutaneous sumatriptan or intravenous prochlorperazine. Of those with reported nausea or vomiting with their migraine, 46.2% (18/39) received an anti-emetic at the visit and 33.3% (13/39) were given an anti-emetic prescription. Only 11.1% (6/54) of patients who did not have a record of previous triptan use were given a triptan prescription at the urgent care visit. CONCLUSIONS The majority of patients in our study who sought medical treatment for migraine in these 2 urgent care centers were not established patients within the urgent care centers' healthcare system. While 93.6% (73/78) of patients were experiencing current pain upon presentation to the urgent care centers, only 12.3% (9/73) received administration of the medications with the highest level of evidence by the American Headache Society (Level B) for acute migraine treatment in an ED. In addition, the majority of patients with a migraine history presenting to the urgent care setting were not given triptans or anti-emetic prescriptions upon discharge from their urgent care visit. Having these migraine-specific prescriptions may improve self-treatment at home should a migraine attack recur.
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Affiliation(s)
- Mia T Minen
- Department of Neurology and Population Health, NYU Langone Health, New York, NY, USA
| | - Kina Zhou
- School of Medicine, University of Rochester, Rochester, NY, USA
| | - Leslie Miller
- Department of Emergency Medicine, NYU Langone Health, New York, NY, USA
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Minen MT, Jalloh A, Ortega E, Powers SW, Sevick MA, Lipton RB. User Design and Experience Preferences in a Novel Smartphone Application for Migraine Management: A Think Aloud Study of the RELAXaHEAD Application. Pain Med 2020; 20:369-377. [PMID: 29868895 DOI: 10.1093/pm/pny080] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Scalable nonpharmacologic treatment options are needed for chronic pain conditions. Migraine is an ideal condition to test smartphone-based mind-body interventions (MBIs) because it is a very prevalent, costly, disabling condition. Progressive muscle relaxation (PMR) is a standardized, evidence-based MBI previously adapted for smartphone applications for other conditions. We sought to examine the usability of the RELAXaHEAD application (app), which has a headache diary and PMR capability. METHODS Using the "Think Aloud" approach, we iteratively beta-tested RELAXaHEAD in people with migraine. Individual interviews were conducted, audio-recorded, and transcribed. Using Grounded Theory, we conducted thematic analysis. Participants also were asked Likert scale questions about satisfaction with the app and the PMR. RESULTS Twelve subjects participated in the study. The mean duration of the interviews (SD, range) was 36 (11, 19-53) minutes. From the interviews, four main themes emerged. People were most interested in app utility/practicality, user interface, app functionality, and the potential utility of the PMR. Participants reported that the daily diary was easy to use (75%), was relevant for tracking headaches (75%), maintained their interest and attention (75%), and was easy to understand (83%). Ninety-two percent of the participants would be happy to use the app again. Participants reported that PMR maintained their interest and attention (75%) and improved their stress and low mood (75%). CONCLUSIONS The RELAXaHEAD app may be acceptable and useful to migraine participants. Future studies will examine the use of the RELAXaHEAD app to deliver PMR to people with migraine in a low-cost, scalable manner.
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Affiliation(s)
- Mia T Minen
- Departments of Neurology and Population Health, NYU Langone Medical Center, New York, New York
| | | | - Emma Ortega
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Scott W Powers
- Department of Population Health, NYU Langone Medical Center, New York, New York
| | - Mary Ann Sevick
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
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Minen MT, Sahyoun G, Gopal A, Levitan V, Pirraglia E, Simon NM, Halpern A. A Pilot Randomized Controlled Trial to Assess the Impact of Motivational Interviewing on Initiating Behavioral Therapy for Migraine. Headache 2020; 60:441-456. [PMID: 31981227 DOI: 10.1111/head.13738] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Relaxation, biofeedback, and cognitive behavioral therapy are evidence-based behavioral therapies for migraine. Despite such efficacy, research shows that only about half of patients initiate behavioral therapy recommended by their headache specialists. OBJECTIVE Motivational interviewing (MI) is a widely used method to help patients explore and overcome ambivalence to enact positive life changes. We tested the hypothesis that telephone-based MI would improve initiation, scheduling, and attending behavioral therapy for migraine. METHODS Single-blind randomized controlled trial comparing telephone-based MI to treatment as usual (TAU). Participants were recruited during their appointments with headache specialists at two sites of a New York City medical center. INCLUSION CRITERIA ages from 16 to 80, migraine diagnosis by United Council of Neurologic Subspecialty fellowship trained and/or certified headache specialist, and referral for behavioral therapy for prevention in the appointment of recruitment. EXCLUSION CRITERIA having done behavioral therapy for migraine in the past year. Participants in the MI group received up to 5 MI calls. TAU participants were called after 3 months for general follow-up data. The prespecified primary outcome was scheduling a behavioral therapy appointment, and secondary outcomes were initiating and attending a behavioral therapy appointment. RESULTS 76 patients were enrolled and randomized (MI = 36, TAU = 40). At baseline, the mean number of headache days was 12.0 ± 9.0. Self-reported anxiety was present for 36/52 (69.2%) and depression for 30/52 (57.7%). Follow-up assessments were completed for 77.6% (59/76, MI = 32, TAU = 27). The mean number of MI calls per participant was 2.69 ± 1.56 [0 to 5]. There was a greater likelihood of those in the MI group to initiating an appointment (22/32, 68.8% vs 11/27, 40.7%, P = .0309). There were no differences in appointment scheduling or attendance. Reasons stated for not initiating behavioral therapy were lack of time, lack of insurance/funding, prioritizing other treatments, and travel plans. CONCLUSIONS Brief telephone-based MI may improve rates of initiation of behavioral therapy for migraine, but other barriers appear to lessen the impact on scheduling and attending behavioral therapy appointments.
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Affiliation(s)
- Mia T Minen
- Department of Neurology, New York University Langone Health, New York, NY, USA
| | - Gabriella Sahyoun
- Department of Neuroscience, Barnard College, Columbia University, New York, NY, USA
| | - Ariana Gopal
- Department of Biology, The City College of New York, City University of New York, New York, NY, USA
| | - Valeriya Levitan
- Department of Neurology, New York University Langone Health, New York, NY, USA
| | - Elizabeth Pirraglia
- Department of Population, Biostatistics Division, New York University Langone Health, New York, NY, USA
| | - Naomi M Simon
- Department of Psychiatry, New York University Langone Health, New York, NY, USA
| | - Audrey Halpern
- Department of Neurology, New York University Langone Health, New York, NY, USA
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Abstract
OBJECTIVE Behavioral treatments for migraine prevention are safe and effective but underutilized in migraine management. Health message framing may be helpful in guiding patients with treatment decision making. The authors assessed associations between message framing and the willingness to seek migraine behavioral treatment among persons with a diagnosis of migraine headache. METHODS A total of 401 individuals (median age=34 years [interquartile range, 12 years]) who screened positive for migraine, as determined by the American Migraine Prevalence and Prevention questionnaire, were assessed. Participants were randomly assigned to receive one of four message frames using TurkPrime: specific loss framing (N=101), specific gain framing (N=98), nonspecific loss framing (N=102), and nonspecific gain framing (N=100). The message frames were initially piloted for 56 participants and then revised by a headache specialist, with input from a communications specialist, and randomly distributed to the larger sample. RESULTS More than two-thirds of participants (70.3%) were women. The median number of headache days per month was 5 (interquartile range, 5.3). Some of the participants (12.5%) had previously used evidence-based behavioral therapy for migraine. No significant differences in the willingness to pursue behavioral treatment for migraine between the four message framing groups were found. The median for all four types of message frames was 4 (interquartile range, 1; Kruskal-Wallis H, p=0.41). CONCLUSIONS Findings revealed that message framing was not associated with willingness to seek behavioral therapy for migraine.
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Affiliation(s)
- Adama Jalloh
- The Department of Psychology, City College of the City University of New York (Jalloh); the Department of Neurology, Columbia University Medical Center, New York (Begasse de Dhaem); the Department of Neurology, Yeshiva University Albert Einstein College of Medicine, Bronx, N.Y. (Seng); and the Department of Neurology and Department of Population Health, New York University (Minen)
| | - Olivia Begasse de Dhaem
- The Department of Psychology, City College of the City University of New York (Jalloh); the Department of Neurology, Columbia University Medical Center, New York (Begasse de Dhaem); the Department of Neurology, Yeshiva University Albert Einstein College of Medicine, Bronx, N.Y. (Seng); and the Department of Neurology and Department of Population Health, New York University (Minen)
| | - Elizabeth Seng
- The Department of Psychology, City College of the City University of New York (Jalloh); the Department of Neurology, Columbia University Medical Center, New York (Begasse de Dhaem); the Department of Neurology, Yeshiva University Albert Einstein College of Medicine, Bronx, N.Y. (Seng); and the Department of Neurology and Department of Population Health, New York University (Minen)
| | - Mia T Minen
- The Department of Psychology, City College of the City University of New York (Jalloh); the Department of Neurology, Columbia University Medical Center, New York (Begasse de Dhaem); the Department of Neurology, Yeshiva University Albert Einstein College of Medicine, Bronx, N.Y. (Seng); and the Department of Neurology and Department of Population Health, New York University (Minen)
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Minen MT, Weissman J, Tietjen GE. The Relationship Between Migraine or Severe Headache and Chronic Health Conditions: A Cross-Sectional Study from the National Health Interview Survey 2013-2015. Pain Med 2019; 20:2263-2271. [PMID: 31127846 PMCID: PMC7963202 DOI: 10.1093/pm/pnz113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To estimate the prevalence of having at least one or two or more chronic health conditions among US adults with self-reported migraine or severe headaches. DESIGN Cross-sectional study. METHODS Using data collected from the 2013-2015 National Health Interview Survey, we examined adults with and without migraine or severe headache and associations with chronic obstructive pulmonary disease, cancer, heart disease, stroke, diabetes, and hypertension. We calculated point estimates, variances, and 95% confidence intervals and conducted bivariate and multivariable logistic regression modeling to examine the relationships between migraine or severe headache and each of the chronic health conditions, as well as multinomial modeling, to examine the relationship between migraine or severe headache and having one or more chronic health conditions. RESULTS A total of 104,926 people were in the study. Adults aged 18 to 44 years (18.2%), women (20.1%), and those with some college education (17.6%) had the greatest proportion with migraine or severe headache (P < 0.0001). Using multinomial modeling with the number of chronic health conditions as the dependent variable, adults reporting migraine had an increased odds of reporting a single chronic health condition (adjusted odds ratio [aOR] = 1.7, 95% confidence interval [CI] = 1.6-1.8) and more than double the odds of reporting two or more chronic health conditions (aOR = 2.5, 95% CI = 2.3-2.8) compared with adults who did not have migraine or severe headache. CONCLUSIONS Our study confirms observed relationships between migraine or severe headache and chronic health conditions and supports the need for further research to uncover the shared biological pathways.
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Affiliation(s)
- Mia T Minen
- Departments of Neurology and Population Health, NYU Langone Health, New York, New York
| | - Judith Weissman
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, New York
| | - Gretchen E Tietjen
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, New York
- Departments of Neurology and Population Health, NYU Langone Medical Center, New York, New York
- Department of Neurology, University of Toledo, Toledo, Ohio, USA
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Seng EK, Singer AB, Metts C, Grinberg AS, Patel ZS, Marzouk M, Rosenberg L, Day M, Minen MT, Lipton RB, Buse DC. Does Mindfulness-Based Cognitive Therapy for Migraine Reduce Migraine-Related Disability in People with Episodic and Chronic Migraine? A Phase 2b Pilot Randomized Clinical Trial. Headache 2019; 59:1448-1467. [PMID: 31557329 PMCID: PMC6788949 DOI: 10.1111/head.13657] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The current Phase 2b study aimed to evaluate the efficacy of mindfulness-based cognitive therapy for migraine (MBCT-M) to reduce migraine-related disability in people with migraine. BACKGROUND Mindfulness-based interventions represent a promising avenue to investigate effects in people with migraine. MBCT teaches mindfulness meditation and cognitive-behavioral skills and directly applies these skills to address disease-related cognitions. METHODS Participants with migraine (6-30 headache days/month) were recruited from neurology office referrals and local and online advertisements in the broader New York City area. During the 30-day baseline period, all participants completed a daily headache diary. Participants who met inclusion and exclusion criteria were randomized in a parallel design, stratified by chronic migraine status, to receive either 8 weekly individual MBCT-M sessions or 8 weeks of waitlist/treatment as usual (WL/TAU). All participants completed surveys including primary outcome evaluations at Months 0, 1, 2, and 4. All participants completed a headache diary during the 30-day posttreatment evaluation period. Primary outcomes were the change from Month 0 to Month 4 in the headache disability inventory (HDI) and the Migraine Disability Assessment (MIDAS) (total score ≥ 21 indicating severe disability); secondary outcomes (headache days/30 days, average headache attack pain intensity, and attack-level migraine-related disability [Migraine Disability Index (MIDI)]) were derived from the daily headache diary. RESULTS Sixty participants were randomized to receive MBCT-M (n = 31) or WL/TAU (n = 29). Participants (M age = 40.1, SD = 11.7) were predominantly White (n = 49/60; 81.7%) and Non-Hispanic (N = 50/60; 83.3%) women (n = 55/60; 91.7%) with a graduate degree (n = 35/60; 55.0%) who were working full-time (n = 38/60; 63.3%). At baseline, the average HDI score (51.4, SD = 19.0) indicated a moderate level of disability and the majority of participants (50/60, 83.3%) fell in the "Severe Disability" range in the MIDAS. Participants recorded an average of 16.0 (SD = 5.9) headache days/30 days, with an average headache attack pain intensity of 1.7 on a 4-point scale (SD = 0.3), indicating moderate intensity. Average levels of daily disability reported on the MIDI were 3.1/10 (SD = 1.8). For the HDI, mean scores decreased more from Month 0 to Month 4 in the MBCT-M group (-14.3) than the waitlist/treatment as an usual group (-0.2; P < .001). For the MIDAS, the group*month interaction was not significant when accounting for the divided alpha, P = .027; across all participants in both groups, the estimated proportion of participants falling in the "Severe Disability" category fell significantly from 88.3% at Month 0 to 66.7% at Month 4, P < .001. For diary-reported headache days/30 days an average headache attack pain intensity, neither the group*month interaction (Ps = .773 and .888, respectively) nor the time effect (Ps = .059 and .428, respectively) was significant. Mean MIDI scores decreased in the MBCT-M group (-0.6/10), whereas they increased in the waitlist/treatment as an usual group (+0.3/10), P = .007. CONCLUSIONS MBCT-M demonstrated efficacy to reduce headache-related disability and attack-level migraine-related disability. MBCT-M is a promising emerging treatment for addressing migraine-related disability.
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Affiliation(s)
- Elizabeth K Seng
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
- Montefiore Headache Center, Montefiore Medical Center, Bronx, NY, USA
| | - Alexandra B Singer
- Psychology Service, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Christopher Metts
- Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Amy S Grinberg
- Psychology Service, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Zarine S Patel
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Maya Marzouk
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Lauren Rosenberg
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Melissa Day
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
| | - Mia T Minen
- Department of Neurology, New York University Langone Health, New York, NY, USA
| | - Richard B Lipton
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dawn C Buse
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
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Abstract
BACKGROUND Migraine is a chronic disabling neurologic condition that can be treated with a combination of both pharmacologic and complementary and integrative health options. EVIDENCE ACQUISITION With the growing interest in the US population in the use of nonpharmacologic treatments, we reviewed the evidence for supplements and behavioral interventions used for migraine prevention. RESULTS Supplements reviewed included vitamins, minerals, and certain herbal preparations. Behavioral interventions reviewed included cognitive behavioral therapy, biofeedback, relaxation, the third-wave therapies, acupuncture, hypnosis, and aerobic exercise. CONCLUSIONS This article should provide an appreciation for the wide range of nonpharmacologic therapies that might be offered to patients in place of or in addition to migraine-preventive medications.
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Affiliation(s)
- Palak S Patel
- Departments of Neurology (PSP, MTM) and Population Health (MTM), NYU Langone Health, New York, New York
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Minen MT, Azarchi S, Sobolev R, Shallcross A, Halpern A, Berk T, Simon NM, Powers S, Lipton RB, Seng E. Factors Related to Migraine Patients' Decisions to Initiate Behavioral Migraine Treatment Following a Headache Specialist's Recommendation: A Prospective Observational Study. Pain Med 2019; 19:2274-2282. [PMID: 29878178 DOI: 10.1093/pm/pny028] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective To evaluate the frequency with which migraine patients initiated behavioral migraine treatment following a headache specialist recommendation and the predictors for initiating behavioral migraine treatment. Methods We conducted a prospective cohort study of consecutive patients diagnosed with migraine to examine whether the patients initiated behavioral migraine treatment following a provider recommendation. The primary outcome was scheduling the initial visit for behavioral migraine treatment. Patients who initiated behavioral migraine treatment were compared with those who did not (demographics, migraine characteristics, and locus of control) with analysis of variance and chi-square tests. Results Of the 234 eligible patients, 69 (29.5%) were referred for behavioral treatment. Fifty-three (76.8%) patients referred for behavioral treatment were reached by phone. The mean duration from time of referral to follow-up was 76 (median 76, SD = 45) days. Thirty (56.6%) patients initiated behavioral migraine treatment. There was no difference in initiation of behavioral migraine treatment with regard to sex, age, age of diagnosis, years suffered with headaches, health care utilization visits, Migraine Disability Assessment Screen, and locus of control (P > 0.05). Patients who had previously seen a psychologist for migraine were more likely to initiate behavioral migraine treatment than patients who had not. Time constraints were the most common barrier cited for not initiating behavioral migraine treatment. Conclusions Less than one-third of eligible patients were referred for behavioral treatment, and only about half initiated behavioral migraine treatment. Future research should further assess patients' decisions regarding behavioral treatment initiation and methods for behavioral treatment delivery to overcome barriers to initiating behavioral migraine treatment.
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Affiliation(s)
- Mia T Minen
- Department of Neurology.,Department of Population Health
| | | | | | | | | | | | - Naomi M Simon
- Department of Psychiatry, NYU Langone Medical Center, New York, New York
| | - Scott Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York
| | - Elizabeth Seng
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York.,Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA
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Begasse de Dhaem OAJ, French J, Morrison C, Meador KJ, Hesdorffer DC, Cristofaro S, Minen MT. Migraine comorbidity and cognitive performance in patients with focal epilepsy. Epilepsy Behav 2019; 97:29-33. [PMID: 31181426 PMCID: PMC6864730 DOI: 10.1016/j.yebeh.2019.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/21/2019] [Accepted: 05/08/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Migraine and epilepsy are comorbid conditions. While it is well known that epilepsy can have an impact on cognitive abilities, there is conflicting evidence in the literature on the relationship between migraine and cognitive function. The aim of this study was to assess whether migraine comorbidity in patients with newly diagnosed focal epilepsy is associated with cognitive dysfunction. METHODS This is a post hoc analysis of data prospectively collected for the Human Epilepsy Project (HEP). There were 349 participants screened for migraine with the 13 questions used in the American Migraine Prevalence and Prevention (AMPP) study. Participants were also screened for depression using the Neurological Disorder Depression Inventory for Epilepsy (NDDI-E) and the Center for Epidemiologic Studies Depression Scale (CES-D) and for anxiety using the Generalized Anxiety Disorder-7 (GAD-7) scale. Cognitive performance was assessed with the Cogstate Brief Battery and Aldenkamp-Baker Neuropsychological Assessment Schedule (ABNAS). RESULTS About a fifth (21.2%) of patients with a new diagnosis of focal epilepsy screened positive for migraine. There were more women and less participants employed full time among the participants with comorbid migraine. They reported slightly more depressive and anxious symptoms than the participants without migraine. Migraine comorbidity was associated with ABNAS memory score (median: 2, range: 0-12, Mann Whitney U p-value: 0.015). However, migraine comorbidity was not associated with Cogstate scores nor ABNAS total scores or other ABNAS domain scores. In linear regressions, depression and anxiety scores were associated with the ABNAS memory score. CONCLUSION In this study, there was no association between migraine comorbidity and objective cognitive scores in patients with newly diagnosed focal epilepsy. The relationship between migraine comorbidity and subjective memory deficits seemed to be mediated by the higher prevalence of depression and anxiety symptoms in patients with epilepsy with comorbid migraine.
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Affiliation(s)
- Olivia A J Begasse de Dhaem
- New York Presbyterian Hospital Columbia University, 710 W 168th Street, 14th Floor, Ericka Ayala's Office, New York, NY 10032, USA.
| | - Jacqueline French
- New York University School of Medicine, NYU Langone Comprehensive Epilepsy Center, 223 East 34th Street, New York, NY 10016, USA
| | - Chris Morrison
- New York University School of Medicine, NYU Langone Comprehensive Epilepsy Center, 223 East 34th Street, New York, NY 10016, USA
| | - Kimford J Meador
- Stanford University Neuroscience Health Center, 213 Quarry Rd Rm 2851, MC 5957, Palo Alto, CA 94304, USA
| | - Dale C Hesdorffer
- Gertrude H.K Sergievsky Center and Department of Epidemiology, Columbia University, 630 West 168th Street, P & S unit 16, PH19, Room 308, New York, NY 10032, USA
| | - Sabrina Cristofaro
- New York University School of Medicine, NYU Langone Comprehensive Epilepsy Center, 223 East 34th Street, New York, NY 10016, USA
| | - Mia T Minen
- New York University School of Medicine, NYU Langone Headache Center, 222 East 41st Street, New York, NY 10017, USA
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Begasse de Dhaem O, Seng E, Minen MT. Screening for Insomnia: An Observational Study Examining Sleep Disturbances, Headache Characteristics, and Psychiatric Symptoms in Patients Visiting a Headache Center. Pain Med 2019; 19:1067-1076. [PMID: 29016937 DOI: 10.1093/pm/pnx161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective Effective treatments for insomnia exist, but few physicians treating headaches have routine methods for screening for insomnia. We sought to 1) describe the migraine characteristics and comorbid conditions that can affect sleep and 2) assess their relationships with positive screens on the Insomnia Severity Index (ISI). Methods This is a retrospective cross-sectional study of the migraine and sleep characteristics of new patients in our headache center (August 15, 2015-October 28, 2015) who were suspected of having migraines based on the new patient intake questionnaire. The questionnaire included the ISI, questions about headache characteristics, and screens for psychiatric comorbidities. Two tailed t tests and analysis of variance evaluated relationships between headache characteristics, comorbidities, and ISI score. Results A total of 61 new patients were suspected to have migraines. The mean number of headache days per month was 11.6. Only 41% of patients reported sleeping seven or more hours; 49.2% had an ISI of 15 or higher (positive screen). Regarding the insomnia scores, there were no differences between moderate and severe headache pain, between episodic and chronic headaches, and between the associated symptoms (nausea/vomiting, photophobia, phonophobia; P > 0.05). Musculoskeletal pain (18.7 vs 13.8, P = 0.027), depression (rho = 0.610), and general anxiety (rho = 0.436) were associated with higher ISI scores. Conclusions Nearly half of the patients with suspected migraines in a headache center screened positive for insomnia, independent of whether they had episodic or chronic headaches. This would generate a substantial number of cognitive behavioral therapy for insomnia (CBT-I) referrals. Given the strong association between comorbid musculoskeletal pain, depression, anxiety, and insomnia, we suggest prioritizing CBT-I referral for those patients regardless of their headache frequency.
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Affiliation(s)
| | - Elizabeth Seng
- Neurology Department, Yeshiva University Ferkauf Graduate School of Psychology, Albert Einstein College of Medicine, New York, New York
| | - Mia T Minen
- Neurology Department, New York University Langone Medical Center, New York, New York, USA
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Affiliation(s)
| | - Mia T Minen
- New York University, Langone Medical Center, New York, NY, USA
| | | | - Lauren D Strauss
- Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
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