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Cohen F, Brooks CV, Sun D, Buse DC, Reed ML, Fanning KM, Lipton RB. Prevalence and burden of migraine in the United States: A systematic review. Headache 2024. [PMID: 38700185 DOI: 10.1111/head.14709] [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] [Received: 10/01/2023] [Revised: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND This study reviewed migraine prevalence and disability gathered through epidemiologic survey studies in the United States conducted over the past three decades. We summarized these studies and evaluated changing patterns of disease prevalence and disability. METHODS We conducted a systematic review of US studies addressing the prevalence, disability, and/or burden of migraine, including both episodic migraine (EM) and chronic migraine (CM). A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol was used in conjunction with the PubMed search engine. Eligible studies were published before February 2022, were conducted in the United States, included representative samples, and used a case definition of migraine based on the International Classification of Headache Disorders (ICHD). The primary measure of disease burden was the Migraine Disability Assessment Scale (MIDAS). The MIDAS measures days lost due to migraine over 3 months in three domains and defines groups with moderate (Grade III) or severe disability (Grade IV) using cut-scores. RESULTS Of the 1609 identified records, 26 publications from 11 US population-based studies met eligibility criteria. The prevalence of migraine in the population has remained relatively consistent for the past 30 years: ranging from 11.7% to 14.7% overall, 17.1% to 19.2% in women, and 5.6% to 7.2% in men in the studies reviewed. CM prevalence is 0.91% (1.3% among women and 0.5% of men) in adults and 0.8% in adolescents. The proportion of people with migraine and moderate-to-severe MIDAS disability (Grades III-IV), has trended upward across studies from 22.0% in 2005 to 39.0% in 2012, to 43.2% in 2016, and 42.4% in 2018. A consistently higher proportion of women were assigned MIDAS Grades III/IV relative to men. CONCLUSION The prevalence of migraine in the United States has remained stable over the past three decades while migraine-related disability has increased. The disability trend could reflect changes in reporting, study methodology, social and societal changes, or changes in exacerbating or remediating factors that make migraine more disabling, among other hypotheses. These issues merit further investigation.
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Affiliation(s)
- Fred Cohen
- Mount Sinai Center for Headache and Facial Pain, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Caroline V Brooks
- Department of Sociology, Indiana University, Bloomington, Indiana, USA
| | - Daniel Sun
- Department of Neurology, Montefiore Medical Center, Bronx, New York, USA
| | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | | | - Richard B Lipton
- Department of Neurology, Montefiore Medical Center, Bronx, New York, USA
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
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Dodick DW, Reed ML, Lee L, Balkaran BL, Umashankar K, Parikh M, Gandhi P, Buse DC. Impact of headache frequency and preventive treatment failure on quality of life, disability, and direct and indirect costs among individuals with episodic migraine in the United States. Headache 2024; 64:361-373. [PMID: 38523435 DOI: 10.1111/head.14684] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/14/2023] [Accepted: 01/03/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE To evaluate unmet needs among individuals with episodic migraine (EM) in the United States (US). BACKGROUND Data are limited on the impact of headache frequency (HF) and preventive treatment failure (TF) on the burden of migraine in the US. METHODS A retrospective, cross-sectional analysis of 2019 National Health and Wellness Survey (NHWS) data was conducted from an opt-in online survey that identified respondents (aged ≥18 years) in the US with self-reported physician-diagnosed migraine. Participants were stratified by HF (low: 0-3 days/month; moderate-to-high: 4-14 days/month) and prior preventive TF (preventive naive; 0-1 TF; ≥2 TFs). Comparisons were conducted between preventive TF groups using multivariable regression models controlling for patient demographic and health characteristics. RESULTS Among individuals with moderate-to-high frequency EM, the NHWS identified 397 with ≥2 TFs, 334 with 0-1 TF, and 356 as preventive naive. The 36-item Short-Form Health Survey (version 2) Physical Component Summary scores were significantly lower among those with ≥2 TFs, at a mean (standard error [SE]) of 41.4 [0.8] versus the preventive-naive 46.8 [0.9] and 0-1 TF 44.5 [0.9] groups; p < 0.001 for both). Migraine Disability Assessment Scale scores were significantly higher in the ≥2 TFs, at a mean (SE) of 37.7 (3.9) versus preventive-naive 26.8 (2.9) (p < 0.001) and 0-1 TF 30.1 (3.3) (p = 0.011) groups. The percentages of time that respondents experienced absenteeism (mean [SE] 21.6% [5.5%] vs. 13.4% [3.6%]; p = 0.022), presenteeism (mean [SE] 55.0% [8.3%] vs. 40.8% [6.5%]; p = 0.015), overall work impairment (mean [SE] 59.4% [5.6%] vs. 45.0% [4.4%]; p < 0.001), and activity impairment (mean [SE] 56.8% [1.0%] vs. 44.4% [0.9%]; p < 0.001) were significantly higher in the ≥2 TFs versus preventive-naive group. Emergency department visits (preventive-naive, p = 0.006; 0-1 TF, p = 0.008) and hospitalizations (p < 0.001 both) in the past 6 months were significantly higher in the ≥2 TFs group. Direct and indirect costs were significantly higher in the ≥2 TFs (mean [SE] $24,026 [3460]; $22,074 [20]) versus 0-1 TF ($10,897 [1636]; $17,965 [17]) and preventive-naive ($11,497 [1715]; $17,167 [17]) groups (p < 0.001 for all). Results were similar in the low-frequency EM group. CONCLUSIONS In this NHWS analysis, individuals with more prior preventive TFs experienced significantly higher humanistic and economic burden regardless of HF.
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Affiliation(s)
- David W Dodick
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Lulu Lee
- Cerner Enviza, Kansas City, Missouri, USA
| | | | | | | | | | - Dawn C Buse
- Albert Einstein College of Medicine, Bronx, New York, USA
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Shapiro RE, Nicholson RA, Seng EK, Buse DC, Reed ML, Zagar AJ, Ashina S, Muenzel EJ, Hutchinson S, Pearlman EM, Lipton RB. Migraine-Related Stigma and Its Relationship to Disability, Interictal Burden, and Quality of Life: Results of the OVERCOME (US) Study. Neurology 2024; 102:e208074. [PMID: 38232340 DOI: 10.1212/wnl.0000000000208074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/30/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND AND OBJECTIVES This population-based analysis characterizes the relative frequency of migraine-related stigma and its cross-sectional relationship to migraine outcomes. We hypothesized that migraine-related stigma would be inversely associated with favorable migraine outcomes across headache day categories. METHODS OVERCOME (US) is a web-based observational study that annually recruited a demographically representative US sample and then identified people with active migraine using a validated migraine diagnostic questionnaire. It also assessed how frequently respondents experienced migraine-related stigma using a novel 12-item questionnaire (Migraine-Related Stigma, MiRS) that contained 2 factors; feeling that others viewed migraine as being used for Secondary Gain (8 items, α = 0.92) and feeling that others were Minimizing disease Burden (4 items, α = 0.86). We defined 5 groups: (1) MiRS-Both (Secondary Gain and Minimizing Burden often/very often; (2) MiRS-SG (Secondary Gain often/very often); (3) MiRS-MB (Minimizing Burden often/very often); (4) MiRS-Rarely/Sometimes; (5) MiRS-Never. Using MiRS group as the independent variable, we modeled its cross-sectional relationship to disability (Migraine Disability Assessment, MIDAS), interictal burden (Migraine Interictal Burden Scale-4), and migraine-specific quality of life (Migraine Specific Quality of Life v2.1 Role Function-Restrictive) while controlling for sociodemographics, clinical features, and monthly headache day categories. RESULTS Among this population-based sample with active migraine (n = 59,001), mean age was 41.3 years and respondents predominantly identified as female (74.9%) and as White (70.1%). Among respondents, 41.1% reported experiencing, on average, ≥4 monthly headache days and 31.7% experienced migraine-related stigma often/very often; the proportion experiencing migraine-related stigma often/very often increased from 25.5% among those with <4 monthly headache days to 47.5% among those with ≥15 monthly headache days. The risk for increased disability (MIDAS score) was significant for each MiRS group compared with the MiRS-Never group; the risk more than doubled for the MiRS-Both group (rate ratio 2.68, 95% CI 2.56-2.80). For disability, interictal burden, and migraine-specific quality of life, increased migraine-related stigma was associated with increased disease burden across all monthly headache day categories. DISCUSSION OVERCOME (US) found that 31.7% of people with migraine experienced migraine-related stigma often/very often and was associated with more disability, greater interictal burden, and reduced quality of life.
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Affiliation(s)
- Robert E Shapiro
- From the Larner College of Medicine (R.E.S.), University of Vermont, Burlington; Eli Lilly and Company (R.A.N., A.J.Z., E.J.M., E.M.P.), Indianapolis, IN; Yeshiva University (E.K.S.), New York, NY; Albert Einstein College of Medicine (D.C.B., R.B.L.), Montefiore Medical Center, Bronx, NY; Vedanta Research (M.L.R.), Chapel Hill, NC; Harvard Medical School (S.A.), Beth Israel Deaconess Medical Center, Boston, MA; and Orange County Migraine and Headache Center (S.H.), Irvine, CA
| | - Robert A Nicholson
- From the Larner College of Medicine (R.E.S.), University of Vermont, Burlington; Eli Lilly and Company (R.A.N., A.J.Z., E.J.M., E.M.P.), Indianapolis, IN; Yeshiva University (E.K.S.), New York, NY; Albert Einstein College of Medicine (D.C.B., R.B.L.), Montefiore Medical Center, Bronx, NY; Vedanta Research (M.L.R.), Chapel Hill, NC; Harvard Medical School (S.A.), Beth Israel Deaconess Medical Center, Boston, MA; and Orange County Migraine and Headache Center (S.H.), Irvine, CA
| | - Elizabeth K Seng
- From the Larner College of Medicine (R.E.S.), University of Vermont, Burlington; Eli Lilly and Company (R.A.N., A.J.Z., E.J.M., E.M.P.), Indianapolis, IN; Yeshiva University (E.K.S.), New York, NY; Albert Einstein College of Medicine (D.C.B., R.B.L.), Montefiore Medical Center, Bronx, NY; Vedanta Research (M.L.R.), Chapel Hill, NC; Harvard Medical School (S.A.), Beth Israel Deaconess Medical Center, Boston, MA; and Orange County Migraine and Headache Center (S.H.), Irvine, CA
| | - Dawn C Buse
- From the Larner College of Medicine (R.E.S.), University of Vermont, Burlington; Eli Lilly and Company (R.A.N., A.J.Z., E.J.M., E.M.P.), Indianapolis, IN; Yeshiva University (E.K.S.), New York, NY; Albert Einstein College of Medicine (D.C.B., R.B.L.), Montefiore Medical Center, Bronx, NY; Vedanta Research (M.L.R.), Chapel Hill, NC; Harvard Medical School (S.A.), Beth Israel Deaconess Medical Center, Boston, MA; and Orange County Migraine and Headache Center (S.H.), Irvine, CA
| | - Michael L Reed
- From the Larner College of Medicine (R.E.S.), University of Vermont, Burlington; Eli Lilly and Company (R.A.N., A.J.Z., E.J.M., E.M.P.), Indianapolis, IN; Yeshiva University (E.K.S.), New York, NY; Albert Einstein College of Medicine (D.C.B., R.B.L.), Montefiore Medical Center, Bronx, NY; Vedanta Research (M.L.R.), Chapel Hill, NC; Harvard Medical School (S.A.), Beth Israel Deaconess Medical Center, Boston, MA; and Orange County Migraine and Headache Center (S.H.), Irvine, CA
| | - Anthony J Zagar
- From the Larner College of Medicine (R.E.S.), University of Vermont, Burlington; Eli Lilly and Company (R.A.N., A.J.Z., E.J.M., E.M.P.), Indianapolis, IN; Yeshiva University (E.K.S.), New York, NY; Albert Einstein College of Medicine (D.C.B., R.B.L.), Montefiore Medical Center, Bronx, NY; Vedanta Research (M.L.R.), Chapel Hill, NC; Harvard Medical School (S.A.), Beth Israel Deaconess Medical Center, Boston, MA; and Orange County Migraine and Headache Center (S.H.), Irvine, CA
| | - Sait Ashina
- From the Larner College of Medicine (R.E.S.), University of Vermont, Burlington; Eli Lilly and Company (R.A.N., A.J.Z., E.J.M., E.M.P.), Indianapolis, IN; Yeshiva University (E.K.S.), New York, NY; Albert Einstein College of Medicine (D.C.B., R.B.L.), Montefiore Medical Center, Bronx, NY; Vedanta Research (M.L.R.), Chapel Hill, NC; Harvard Medical School (S.A.), Beth Israel Deaconess Medical Center, Boston, MA; and Orange County Migraine and Headache Center (S.H.), Irvine, CA
| | - E Jolanda Muenzel
- From the Larner College of Medicine (R.E.S.), University of Vermont, Burlington; Eli Lilly and Company (R.A.N., A.J.Z., E.J.M., E.M.P.), Indianapolis, IN; Yeshiva University (E.K.S.), New York, NY; Albert Einstein College of Medicine (D.C.B., R.B.L.), Montefiore Medical Center, Bronx, NY; Vedanta Research (M.L.R.), Chapel Hill, NC; Harvard Medical School (S.A.), Beth Israel Deaconess Medical Center, Boston, MA; and Orange County Migraine and Headache Center (S.H.), Irvine, CA
| | - Susan Hutchinson
- From the Larner College of Medicine (R.E.S.), University of Vermont, Burlington; Eli Lilly and Company (R.A.N., A.J.Z., E.J.M., E.M.P.), Indianapolis, IN; Yeshiva University (E.K.S.), New York, NY; Albert Einstein College of Medicine (D.C.B., R.B.L.), Montefiore Medical Center, Bronx, NY; Vedanta Research (M.L.R.), Chapel Hill, NC; Harvard Medical School (S.A.), Beth Israel Deaconess Medical Center, Boston, MA; and Orange County Migraine and Headache Center (S.H.), Irvine, CA
| | - Eric M Pearlman
- From the Larner College of Medicine (R.E.S.), University of Vermont, Burlington; Eli Lilly and Company (R.A.N., A.J.Z., E.J.M., E.M.P.), Indianapolis, IN; Yeshiva University (E.K.S.), New York, NY; Albert Einstein College of Medicine (D.C.B., R.B.L.), Montefiore Medical Center, Bronx, NY; Vedanta Research (M.L.R.), Chapel Hill, NC; Harvard Medical School (S.A.), Beth Israel Deaconess Medical Center, Boston, MA; and Orange County Migraine and Headache Center (S.H.), Irvine, CA
| | - Richard B Lipton
- From the Larner College of Medicine (R.E.S.), University of Vermont, Burlington; Eli Lilly and Company (R.A.N., A.J.Z., E.J.M., E.M.P.), Indianapolis, IN; Yeshiva University (E.K.S.), New York, NY; Albert Einstein College of Medicine (D.C.B., R.B.L.), Montefiore Medical Center, Bronx, NY; Vedanta Research (M.L.R.), Chapel Hill, NC; Harvard Medical School (S.A.), Beth Israel Deaconess Medical Center, Boston, MA; and Orange County Migraine and Headache Center (S.H.), Irvine, CA
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Lipton RB, Lanteri-Minet M, Leroux E, Manack Adams A, Contreras-De Lama J, Reed ML, Fanning KM, Buse DC. Pre- and post-headache phases of migraine: multi-country results from the CaMEO - International Study. J Headache Pain 2023; 24:151. [PMID: 37940856 PMCID: PMC10634176 DOI: 10.1186/s10194-023-01683-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Individuals with migraine frequently experience pre- and post-headache symptoms. This analysis aimed to characterize the relative frequency and burden of pre- and post-headache symptoms in people with migraine using data collected through the Chronic Migraine Epidemiology and Outcomes - International Study. METHODS This cross-sectional, observational, web-based survey was conducted in 2021-2022 in Canada, France, Germany, Japan, the United Kingdom, and the United States. Respondents who met modified International Classification of Headache Disorders, 3rd edition, criteria were offered the opportunity to participate. Information collected included migraine-related disability, depression/anxiety symptoms, cutaneous allodynia, activity limitations, and acute treatment optimization. Respondents indicated how often they had pre- or post-headache symptoms using a 5-point scale, ranging from 0 to 4, with a rating of 2 or higher classified as a pre- or post-headache symptom case. Modeling was used to examine relationships with monthly headache days (MHDs) and activity limitations during pre-headache and post-headache phases. RESULTS Among a total of 14,492 respondents, pre-headache symptoms were reported by 66.9%, while post-headache symptoms were reported by 60.2%. Both pre-headache and post-headache symptoms were reported by 49.5% of respondents, only pre-headache by 17.4%, only post-headache by 10.7%, and neither pre- nor post-headache symptoms by 22.4%. Compared with respondents who experienced only pre- or post-headache symptoms, respondents who experienced both pre- and post-headache symptoms had the highest rates of 4-7, 8-14, and ≥ 15 monthly headache days (23.1%, 14.1%, and 10.9%, respectively). Of respondents with both pre- and post-headache symptoms, 58.5% reported moderate-to-severe disability, 47.7% reported clinically significant symptoms of depression, 49.0% reported clinically significant symptoms of anxiety, and 63.8% reported cutaneous allodynia with headache (ASC-12). Moderate-to-severe activity limitations were reported during the pre-headache (29.5%) and post-headache phases (27.2%). For all outcomes modeled, after controlling for covariates, having pre-headache symptoms, post-headache symptoms, or both were associated with worse outcomes than having neither. CONCLUSIONS Pre- and post-headache phases of migraine are common, carry unrecognized burden, and may be a target for treatment.
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Affiliation(s)
| | - Michel Lanteri-Minet
- Pain Department and FHU InovPain, CHU Nice and Côte Azur University, Nice, France
- INSERM U1107 Migraine and Trigeminal Pain, Auvergne University, Clermont-Ferrand, France
| | | | | | | | | | | | - Dawn C Buse
- Albert Einstein College of Medicine, Bronx, NY, USA
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Lipton RB, Pozo-Rosich P, Orr SL, Reed ML, Fanning KM, Dabruzzo B, Buse DC. Impact of monthly headache days on migraine-related quality of life: Results from the Chronic Migraine Epidemiology and Outcomes (CaMEO) study. Headache 2023; 63:1448-1457. [PMID: 37795746 DOI: 10.1111/head.14629] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/10/2023] [Accepted: 07/14/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE To characterize the direct impact of monthly headache days (MHDs) on health-related quality of life (HRQoL) in people with migraine and the potential mediating effects of anxiety, depression, and allodynia. BACKGROUND Although the general relationship between increased migraine frequency (i.e., MHDs) and reduced HRQoL is well established, the degree to which reduced HRQoL is due to a direct effect of increased MHDs or attributable to mediating factors remains uncertain. METHODS Cross-sectional baseline data from participants with migraine who completed the Core and Comorbidities/Endophenotypes modules in the 2012-2013 US Chronic Migraine Epidemiology and Outcomes (CaMEO) study, a longitudinal web-based survey study, were analyzed. The potential contribution of depression, anxiety, and/or allodynia to the observed effects of MHDs on HRQoL as measured by the Migraine-Specific Quality-of-Life Questionnaire version 2.1 (MSQ) was evaluated. RESULTS A total of 12,715 respondents were included in the analyses. The MSQ domain scores demonstrated progressive declines with increasing MHD categories (B = -1.23 to -0.60; p < 0.001). The observed HRQoL decrements associated with increasing MHDs were partially mediated by the presence of depression, anxiety, and allodynia. The MHD values predicted 24.0%-32.4% of the observed variation in the MSQ domains. Depression mediated 15.2%-24.3%, allodynia mediated 9.6%-16.1%, and anxiety mediated 2.3%-6.0% of the observed MHD effects on the MSQ. CONCLUSIONS Increased MHD values were associated with lower MSQ scores; the impact of MHDs on the MSQ domain scores was partially mediated by the presence of depression, anxiety, and allodynia. MHDs remain the predominant driver of the MSQ variation; moreover, most of the variation in the MSQ remains unexplained by the variables we analyzed. Future longitudinal analyses and studies may help clarify the contribution of MHDs, comorbidities, and other factors to changes in HRQoL.
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Affiliation(s)
- Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Headache Research Group, VHIR, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Serena L Orr
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Brett Dabruzzo
- Medical Affairs (Neurosciences - Migraine), AbbVie, Illinois, North Chicago, USA
| | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
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Weisbrot DM, Carlson GA, Ettinger AB, Reed ML, Fanning KM, Bostic RC. Psychiatric Characteristics of Students Who Make Threats Toward Others at School. J Am Acad Child Adolesc Psychiatry 2023; 62:764-776. [PMID: 36608740 DOI: 10.1016/j.jaac.2022.12.016] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/04/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE While studies have focused on identifying potential school shooters, little is known about the mental health and other characteristics of students who make threats. This study aimed to describe these students and factors prompting psychiatric interventions and treatment recommendations. METHOD Child and adolescent psychiatry threat assessment evaluations of 157 consecutive school-referred youths in grades K-12 between 1998 and 2019 were reviewed for demographics, reasons for referral, nature of threat, psychiatric diagnosis, and psychiatric and educational recommendations. Predictors of recommendations for psychiatric interventions were modeled using multivariable logistic regression as a function of above-mentioned covariates. RESULTS Mean (SD) age of referred students was 13.37 (2.79) years; 88.5% were male; 79.7%, White; 11.6%, Hispanic; 10.1%, Black; 2.5%, Asian. Of students, 51.6% were receiving special education services. Verbal threat was made by 80%, and 29.3% brought a weapon to school. History included being bullied in 43.4%, traumatic family events in 52.2%, physical abuse in 5.1%, sexual abuse in 5.7%, and verbal abuse in 36.3%. Frequently encountered psychiatric diagnoses were attention-deficit/hyperactivity, learning, depressive, anxiety, and autism spectrum disorders, usually in combinations. History of medication treatment was reported in 79 (50.3%) and psychotherapeutic interventions in 57 (36.3%). Recommendations to return the student to their prior schools were made for 63.1%. Recommendations for psychotherapy were made for 79.9%, medication for 88.5%, and both for 70.1%. Therapeutic school setting or psychiatric hospitalization was more likely recommended (with statistical significance) with a prior threat history (odds ratio [OR] 5.47, 95% CI 1.91-15.70), paranoid symptoms (OR 5.72, 95% CI 1.55-21.14, p = .009), autism spectrum disorders (OR 3.45, 95% CI 1.32-9.00), mood disorder (OR 5.71, 95% CI 1.36-23.96), personality disorder (OR 9.47, 95% CI 1.78-50.55), or with psychotherapy recommendation (OR 4.84, 95% CI 1.08-21.75). CONCLUSION Students who make threats have diverse psychiatric profiles and warrant treatments. A trauma and/or abuse history is common. Evaluations of youths who make threats need to go beyond simply assessing the threat itself and should include identifying underlying psychiatric problems. Psychiatric evaluation of students who issue threats of any type can lead to revelations about psychiatric diagnoses and crucial treatment and educational recommendations. DIVERSITY & INCLUSION STATEMENT The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.
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Affiliation(s)
| | | | - Alan B Ettinger
- United Medical Monitoring and United Diagnostics, Garden City Park, New York
| | | | | | - Ryan C Bostic
- MIST Research and Statistical Consulting, Wilmington, Delaware
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Adams AM, Buse DC, Leroux E, Lanteri-Minet M, Sakai F, Matharu MS, Katsarava Z, Reed ML, Fanning K, Sommer K, Lipton RB. Chronic Migraine Epidemiology and Outcomes - International (CaMEO-I) Study: Methods and multi-country baseline findings for diagnosis rates and care. Cephalalgia 2023; 43:3331024231180611. [PMID: 37314231 DOI: 10.1177/03331024231180611] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The Chronic Migraine Epidemiology and Outcomes-International study provides insight into people with migraine in multiple countries. METHODS This cross-sectional, observational, web-based cohort study was conducted in Canada, France, Germany, Japan, United Kingdom, and United States. An initial Screening Module survey solicited general healthcare information from a representative sample and identified participants with migraine based on modified International Classification of Headache Disorders-3 criteria; those with migraine completed a detailed survey based on validated migraine-specific assessments. RESULTS Among 90,613 people who correctly completed the screening surveys, 76,121 respondents did not meet the criteria for migraine, while 14,492 did. Among respondents with migraine, mean age ranged from 40 to 42 years. The median number of monthly headache days ranged from 2.33 to 3.33 across countries, while the proportion of respondents with moderate-to-severe disability (measured by Migraine Disability Assessment) ranged from 30% (Japan) to 52% (Germany). The proportion of respondents with ≥15 monthly headache days ranged from 5.4% (France) to 9.5% (Japan). Fewer than half of respondents with migraine in each country reported having received a migraine diagnosis. CONCLUSION These results demonstrated high rates of migraine-related disability and underdiagnosis of migraine across six countries. This study will characterize country-level burden, treatment patterns, and geographical differences in care.
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Affiliation(s)
| | - Dawn C Buse
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Michel Lanteri-Minet
- Pain Department and FHU InovPain, CHU Nice and Côte Azur University, Nice, France
| | - Fumihiko Sakai
- Saitama International Headache Center, Chuo-ku, Saitama City, Japan
| | | | - Zaza Katsarava
- Evangelical Hospital Unna, Unna, Germany
- Department of Neurology, University of Duisburg-Essen, Germany
| | | | | | | | - Richard B Lipton
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
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Buse DC, Nahas SJ, Stewart W(BF, Armand CE, Reed ML, Fanning KM, Manack Adams A, Lipton RB. Optimized Acute Treatment of Migraine Is Associated With Greater Productivity in People With Migraine: Results From the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study. J Occup Environ Med 2023; 65:e261-e268. [PMID: 36701797 PMCID: PMC10090340 DOI: 10.1097/jom.0000000000002801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This study aimed to ascertain whether level of optimization of acute treatment of migraine is related to work productivity across the spectrum of migraine. METHODS Data were from the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study, an internet-based longitudinal survey. Respondents with migraine who reported full-time employment and use of ≥1 acute prescription medication for migraine were included. We determined relationships among lost productive time (LPT; measured with the Migraine Disability Assessment Scale), acute treatment optimization (Migraine Treatment Optimization Questionnaire- ), and monthly headache days (MHDs). RESULTS There was a direct relationship between LPT and MHD category. Greater acute treatment optimization was associated with lower total LPT, less absenteeism, and less presenteeism within each MHD category. CONCLUSIONS Optimizing acute treatment for migraine may reduce LPT in people with migraine and reduce indirect costs.
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Ezzati A, Fanning KM, Reed ML, Lipton RB. Predictors of treatment-response to caffeine combination products, acetaminophen, acetylsalicylic acid (aspirin), and nonsteroidal anti-inflammatory drugs in acute treatment of episodic migraine. Headache 2023; 63:342-352. [PMID: 36748728 DOI: 10.1111/head.14459] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/03/2022] [Accepted: 11/07/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To identify predictors of acute treatment optimization for migraine with "over-the-counter" (OTC) or prescription nonsteroidal anti-inflammatory drugs (NSAIDs) as well as other widely used OTCs including acetaminophen, caffeine combination products (CCP), and acetylsalicylic acid (ASA, aspirin) among people with episodic migraine and to develop models that predict treatment response to each class of OTCs. BACKGROUND Efficacy of acute OTC medications for migraine varies greatly. Identifying predictors of treatment response to particular classes of medication is a step toward evidence-based personalized therapy. METHODS For this prediction model development study, we used data from 2224 participants from the American Migraine Prevalence and Prevention (AMPP) study who were aged ≥18 years, met criteria for migraine, had <15 monthly headache days, and reported being on monotherapy for acute migraine attacks with one of the following classes medications: CCP (N = 711), acetaminophen (N = 643), ASA (N = 110), and prescription or OTC NSAIDs (N = 760). The primary outcome measures of treatment optimization were adequate 2-h pain freedom (2hPF) and adequate 24-h pain relief (24hPR), which were defined by responses of half the time or more to the relevant items on the Migraine Treatment Optimization Questionnaire-6. RESULTS The mean (SD) age of the participants was 46.2 (13.1) years, 79.4% (1765/2224) were female, 43.7% (972/2224) reported adequate 2hPF, and 46.1% (1025/2224) reported adequate 24hPR. Those taking CCP had better 2hPF and 24PR outcomes. For those taking NSAIDs, better outcomes were associated with lower average pain intensity (2hPF: odds ratio [OR] 0.89, 95% confidence interval [CI] 0.80-0.99; 24PR: OR 0.86, 95% CI 0.77-0.96), cutaneous allodynia (2hPF: OR 0.92, 95% CI 0.89-0.96; 24PR: OR 0.91, 95% CI 0.87-0.95), depressive symptoms (2hPF: OR 0.95, 95% CI 0.92-0.98; 24PR: OR 0.95, 95% CI 0.91-0.99), and Migraine Disability Assessment Scale (MIDAS) grade (2hPF: OR 0.76, 95% CI 0.64-0.90; 24PR: OR 0.79, 95% CI 0.65-0.95). Adequate 2hPF for those taking CCP was associated with male gender (OR 1.83, 95% CI 1.21-2.77), lower average pain intensity (OR 0.80, 95% CI 0.70-0.91), lower cutaneous allodynia (OR 0.94, 95% CI 0.90-0.97), and lower Migraine Symptom Severity Scale Score (MSSS; OR 0.91, 95% CI 0.86-0.97). Adequate 24hPR for those taking CCP was associated with lower average pain intensity (OR 0.85, 95% CI 0.75-0.96), lower cutaneous allodynia (OR 0.92, 95% CI 0.89-0.96), and lower MIDAS grade (OR 0.81, 95% CI 0.68-0.96). Participants who were married (OR 1.51, 95% CI 1.05-2.19), had lower average pain intensity (OR 0.79, 95% CI 0.70-0.89), lower MSSS (OR 0.93, 95% CI 0.88-0.99), less depression (OR 0.96, 95% CI 0.93-0.99), and lower MIDAS grade (OR 0.72, 95% CI 0.59-0.87) had adequate 2hPF after taking acetaminophen. Participants who were married (OR 1.50, 95% CI 1.02-2.21), had lower pain intensity (OR 0.78, 95% CI 0.69-0.88), less depression (OR 0.95, 95% CI 0.91-0.98) and lower MIDAS grade (OR 0.53, 95% CI 0.42-0.67) had higher 24hPR following use of acetaminophen. A lower MSSS was the only factor associated with higher 2hPF and 24PR after using ASA (OR 0.78, 95% CI 0.67-0.92 and OR 0.79, 95% CI 0.67-0.93). Predictive models had modest performance in identifying responders to each class of OTC. CONCLUSION A large subgroup of people with migraine had an inadequate response to their usual acute OTC migraine treatment 2- and 24-h after dosing. These findings suggest a need to improve OTC treatment for some and to offer prescription acute medications for others. Predictive models identified several factors associated with better treatment-response in each OTC class. Selecting OTC treatment based on factors predictive of treatment optimization might improve patient outcomes.
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Affiliation(s)
- Ali Ezzati
- Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | | | | | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
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Ezzati A, Buse DC, Fanning KM, Reed ML, Martin VT, Lipton RB. Predictors of treatment-response to Acute Prescription Medications in Migraine: Results from the American Migraine Prevalence and Prevention (AMPP) Study. Clin Neurol Neurosurg 2022; 223:107511. [DOI: 10.1016/j.clineuro.2022.107511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/21/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
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Ezzati A, Fanning KM, Buse DC, Pavlovic JM, Armand CE, Reed ML, Martin VT, Lipton RB. Predictive models for determining treatment response to nonprescription acute medications in migraine: Results from the American Migraine Prevalence and Prevention Study. Headache 2022; 62:755-765. [PMID: 35546653 DOI: 10.1111/head.14312] [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] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To identify predictors of acute treatment response for nonprescription (over-the-counter [OTC]) medications among people with migraine and develop improved models for predicting treatment response. BACKGROUND Pain freedom and sustained pain relief are important priorities in the acute treatment of migraine. OTC medications are widely used for migraine; however, it is not clear which treatment works best for each patient without going through the trial and error process. METHODS A prediction model development study was completed using the 2006 American Migraine Prevalence and Prevention Study survey, from participants who were aged ≥18, met criteria and headache day frequency for episodic migraine, did not take prescription medication for migraine, and used ≥1 of the following acute migraine medication classes: acetaminophen, aspirin, NSAIDs, or caffeine containing combination products (CCP). Two items from the Migraine Treatment Optimization Questionnaire were used to evaluate treatment response, adequate 2-h pain freedom (2hPF) and 24-h pain relief (24hPR), which were defined by a response to treatment ≥half the time at 2 h and 24 h post treatment, respectively. We identified predictors of adequate treatment response and developed models to predict probability of treatment response to each medication class. RESULTS The sample included 3852 participants (3038 [79.0%] females) with an average age of 45.0 years (SD = 12.8). Only 1602/3852 (41.6%) and 1718/3852 (44.6%) of the participants reported adequate 2hPF and 24hPR, respectively. Adequate treatment-response was significantly predicted by lower average headache pain intensity, less cutaneous allodynia, and lower depressive symptom scores. Lower migraine symptom severity was predictive of adequate 2hPF and fewer monthly headache days was predictive of adequate 24hPR. Among participants reporting OTC monotherapy (n = 2168, 56.3%) individuals taking CCP were more likely to have adequate 2hPF (OR = 1.55, 95% CI 1.23-1.95) and 24hPR (OR = 1.79, 95% CI 1.18-1.88) in comparison with those taking acetaminophen. Predictive models were modestly predictive of responders to OTC medications (c-statistics = 0.65; 95% CI 0.62-0.68). CONCLUSION These results show that response to acute migraine treatments is not optimized in the majority of people with migraine treating with OTC medications. Predictive models can improve our ability to choose the best therapeutic option for individuals with episodic migraine and increase the proportion of patients with optimized response to treatments.
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Affiliation(s)
- Ali Ezzati
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Dawn C Buse
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jelena M Pavlovic
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Cynthia E Armand
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Vincent T Martin
- University of Cincinnati Headache and Facial Pain Center, Cincinnati, Ohio, USA
| | - Richard B Lipton
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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Lipton RB, Nicholson RA, Reed ML, Araujo AB, Jaffe DH, Faries DE, Buse DC, Shapiro RE, Ashina S, Cambron-Mellott MJ, Rowland JC, Pearlman EM. Diagnosis, consultation, treatment, and impact of migraine in the US: Results of the OVERCOME (US) study. Headache 2022; 62:122-140. [PMID: 35076091 PMCID: PMC9305407 DOI: 10.1111/head.14259] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [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: 02/22/2021] [Revised: 11/20/2021] [Accepted: 12/09/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The ObserVational survey of the Epidemiology, tReatment and Care of MigrainE (OVERCOME; United States) study is a multicohort, longitudinal web survey that assesses symptomatology, consulting, diagnosis, treatment, and impact of migraine in the United States. BACKGROUND Regularly updating population-based views of migraine in the United States provides a method for assessing the quality of ongoing migraine care and identifying unmet needs. METHODS The OVERCOME (US) 2018 migraine cohort involved: (I) creating a demographically representative sample of US adults using quota sampling (n = 97,478), (II) identifying people with active migraine in the past year via a validated migraine diagnostic questionnaire and/or self-reported medical diagnosis of migraine (n = 24,272), and (III) assessing consultation, diagnosis, and treatment of migraine (n = 21,143). The current manuscript evaluated whether those with low frequency episodic migraine (LFEM; 0-3 monthly headache days) differed from other categories on outcomes of interest. RESULTS Among the migraine cohort (n = 21,143), 19,888 (94.1%) met our International Classification of Headache Disorders, 3rd edition-based case definition of migraine and 12,905 (61.0%) self-reported a medical diagnosis of migraine. Respondents' mean (SD) age was 42.2 (15.0) years; 15,697 (74.2%) were women. Having at least moderate disability was common (n = 8965; 42.4%) and around half (n = 10,783; 51.0%) had consulted a medical professional for migraine care in the past year. Only 4792 (22.7%) of respondents were currently using a triptan. Overall, 8539 (40.4%) were eligible for migraine preventive medication and 3555 (16.8%) were currently using migraine preventive medication. Those with LFEM differed from moderate and high frequency episodic migraine and chronic migraine on nearly all measures of consulting, diagnosis, and treatment. CONCLUSION The OVERCOME (US) 2018 cohort revealed slow but steady progress in diagnosis and preventive treatment of migraine. However, despite significant impact among the population, many with migraine have unmet needs related to consulting for migraine, migraine diagnosis, and getting potentially beneficial migraine treatment. Moreover, it demonstrated the heterogeneity and varying unmet needs within episodic migraine.
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Affiliation(s)
- Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | | | | | | | | | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Robert E Shapiro
- Department of Neurological Sciences, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Sait Ashina
- Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Anesthesia, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Schwedt TJ, Buse DC, Argoff CE, Reed ML, Fanning KM, Hussar CR, Adams AM, Lipton RB. Medication Overuse and Headache Burden: Results From the CaMEO Study. Neurol Clin Pract 2021; 11:216-226. [PMID: 34476122 PMCID: PMC8382341 DOI: 10.1212/cpj.0000000000001037] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 07/30/2020] [Accepted: 01/04/2021] [Indexed: 12/25/2022]
Abstract
Objective To estimate the relative frequency of acute medication overuse (AMO) among people with episodic migraine and chronic migraine, to characterize the types of acute medications overused for migraine, and to identify factors associated with AMO. Methods We analyzed data from the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study (ClinicalTrials.gov, NCT01648530), a cross-sectional and longitudinal internet study that included a systematic sampling of the US population. From September 2012 to November 2013, the CaMEO Study respondents participated in different modules to collect data on the clinical course of migraine, family burden, barriers to care, endophenotypes, and comorbidities. Among people who met the criteria for migraine consistent with the International Classification of Headache Disorders, third edition (ICHD-3), we evaluated types and frequency of medications used for headache/migraine, selected comorbidities, and emergency department (ED) and urgent care (UC) use. AMO was defined by days per month of medication use as specified by ICHD-3 criteria for medication overuse headache (MOH) without the requirement for ≥15 monthly headache days (MHDs). Nested, multivariable binary logistic regression modeling was used to identify factors associated with an increased risk of AMO. Results Of 16,789 CaMEO respondents with migraine, 2,975 (17.7%) met the AMO criteria. Approximately 67.9% (2,021/2,975) of AMO respondents reported <15 MHDs. Simple analgesics, combination analgesics, and opioids were the medication classes most commonly overused. Factors associated with AMO in the final multivariable logistic regression model included ≥15 MHDs, moderate to severe disability, severe migraine interictal burden, use of preventive medication, and an ED/UC visit for headache within 6 months. Conclusions Approximately two-thirds of respondents with AMO reported <15 MHDs and therefore did not meet the criteria for MOH. Those with AMO had greater disease burden and increased ED/UC utilization relative to people with migraine but not AMO.
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Affiliation(s)
- Todd J Schwedt
- Mayo Clinic (TJS), Phoenix, AZ; Albert Einstein College of Medicine (DCB, RBL), Bronx, NY; Albany Medical Center (CEA), NY; Vedanta Research (MLR, KMF), Chapel Hill, NC; Peloton Advantage, LLC, an OPEN Health company (CRH), Parsippany, NJ; and AbbVie (AMA), Irvine, CA
| | - Dawn C Buse
- Mayo Clinic (TJS), Phoenix, AZ; Albert Einstein College of Medicine (DCB, RBL), Bronx, NY; Albany Medical Center (CEA), NY; Vedanta Research (MLR, KMF), Chapel Hill, NC; Peloton Advantage, LLC, an OPEN Health company (CRH), Parsippany, NJ; and AbbVie (AMA), Irvine, CA
| | - Charles E Argoff
- Mayo Clinic (TJS), Phoenix, AZ; Albert Einstein College of Medicine (DCB, RBL), Bronx, NY; Albany Medical Center (CEA), NY; Vedanta Research (MLR, KMF), Chapel Hill, NC; Peloton Advantage, LLC, an OPEN Health company (CRH), Parsippany, NJ; and AbbVie (AMA), Irvine, CA
| | - Michael L Reed
- Mayo Clinic (TJS), Phoenix, AZ; Albert Einstein College of Medicine (DCB, RBL), Bronx, NY; Albany Medical Center (CEA), NY; Vedanta Research (MLR, KMF), Chapel Hill, NC; Peloton Advantage, LLC, an OPEN Health company (CRH), Parsippany, NJ; and AbbVie (AMA), Irvine, CA
| | - Kristina M Fanning
- Mayo Clinic (TJS), Phoenix, AZ; Albert Einstein College of Medicine (DCB, RBL), Bronx, NY; Albany Medical Center (CEA), NY; Vedanta Research (MLR, KMF), Chapel Hill, NC; Peloton Advantage, LLC, an OPEN Health company (CRH), Parsippany, NJ; and AbbVie (AMA), Irvine, CA
| | - Cory R Hussar
- Mayo Clinic (TJS), Phoenix, AZ; Albert Einstein College of Medicine (DCB, RBL), Bronx, NY; Albany Medical Center (CEA), NY; Vedanta Research (MLR, KMF), Chapel Hill, NC; Peloton Advantage, LLC, an OPEN Health company (CRH), Parsippany, NJ; and AbbVie (AMA), Irvine, CA
| | - Aubrey Manack Adams
- Mayo Clinic (TJS), Phoenix, AZ; Albert Einstein College of Medicine (DCB, RBL), Bronx, NY; Albany Medical Center (CEA), NY; Vedanta Research (MLR, KMF), Chapel Hill, NC; Peloton Advantage, LLC, an OPEN Health company (CRH), Parsippany, NJ; and AbbVie (AMA), Irvine, CA
| | - Richard B Lipton
- Mayo Clinic (TJS), Phoenix, AZ; Albert Einstein College of Medicine (DCB, RBL), Bronx, NY; Albany Medical Center (CEA), NY; Vedanta Research (MLR, KMF), Chapel Hill, NC; Peloton Advantage, LLC, an OPEN Health company (CRH), Parsippany, NJ; and AbbVie (AMA), Irvine, CA
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Buse DC, Armand CE, Charleston L, Reed ML, Fanning KM, Adams AM, Lipton RB. Barriers to care in episodic and chronic migraine: Results from the Chronic Migraine Epidemiology and Outcomes Study. Headache 2021; 61:628-641. [PMID: 33797078 DOI: 10.1111/head.14103] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 12/03/2020] [Revised: 02/04/2021] [Accepted: 02/18/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess rates of and factors associated with traversing fundamental barriers to good medical outcomes and pharmacologic care in individuals with episodic migraine (EM) and chronic migraine (CM), including socioeconomic status and race. BACKGROUND Barriers to good outcomes in migraine include the lack of appropriate medical consultation, failure to receive an accurate diagnosis, not being offered a regimen with acute and preventive pharmacologic treatments (if indicated), and not avoiding medication overuse. METHODS The Chronic Migraine Epidemiology and Outcomes (CaMEO) Study was a longitudinal Internet-based survey. Respondents who met criteria for migraine consistent with the International Classification of Headache Disorders, 3rd edition, had a Migraine Disability Assessment score ≥ 6, and provided health insurance coverage status were included in this analysis. Successfully traversing each barrier to care and the effects of sociodemographic characteristics were examined. RESULTS Among 16,789 respondents with migraine, 9184 (54.7%; EM: 7930; CM: 1254) were eligible. Current headache consultation was reported by 27.6% (2187/7930) of EM and 40.8% (512/1254) of CM respondents. Among consulters, 75.7% (1655/2187) with EM and 32.8% (168/512) with CM were accurately diagnosed. Among diagnosed consulters, 59.9% (992/1655) with EM and 54.2% (91/168) with CM reported minimally appropriate acute and preventive pharmacologic treatment. Among diagnosed and treated consulters, in the EM group 31.8% (315/992) and in the CM group 74.7% (68/91) met medication overuse criteria. Only 8.5% (677/7930) of EM and 1.8% (23/1254) of CM respondents traversed all four barriers. Higher income was positively associated with likelihood of traversing each barrier. Blacks and/or African Americans had higher rates of consultation than other racial groups. Blacks and/or African Americans and multiracial people had higher rates of acute medication overuse. CONCLUSIONS Efforts to improve care should focus on increasing consultation and diagnosis rates, improving the delivery of all appropriate guideline-based treatment, and avoidance of medication overuse.
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Affiliation(s)
- Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Cynthia E Armand
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Larry Charleston
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Michael L Reed
- Department of Outcomes Research, Vedanta Research, Chapel Hill, NC, USA
| | | | | | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
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Pavlovic JM, Yu JS, Silberstein SD, Reed ML, Cowan RP, Dabbous F, Pulicharam R, Viswanathan HN, Lipton RB. Evaluation of the 6-item Identify Chronic Migraine screener in a large medical group. Headache 2021; 61:335-342. [PMID: 33421098 PMCID: PMC7986415 DOI: 10.1111/head.14035] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 11/02/2020] [Accepted: 11/02/2020] [Indexed: 12/12/2022]
Abstract
Objective To evaluate the sensitivity and specificity of the 6‐item Identify Chronic Migraine screener (ID‐CM[6]), designed to improve the detection of chronic migraine (CM). Background CM is often undertreated and underdiagnosed. Survey‐based studies have found that approximately 75–80% of people meeting criteria for CM do not report having received an accurate diagnosis. Methods This study used claims data of patients enrolled in a large medical group who had at least one medical claim with an International Classification of Diseases 9th/10th revision diagnostic code for migraine in the 12‐month prescreening period. The Identify Chronic Migraine survey was administered by e‐mail, in‐person, or over the telephone to all enrolled patients. A Semi‐Structured Diagnostic Interview (SSDI) was administered by telephone by a trained physician. The ID‐CM(6) and SSDI classifications of CM status were compared to evaluate sensitivity and specificity of the ID‐CM(6) screening tool. Results The analysis of the ID‐CM(6) screening tool included 109 patients, with 65/109 (59.6%) positive for CM based on the SSDI. The mean (standard deviation) age of the patient sample was 49 (15) years and 100/109 (91.7%) were female. Using the SSDI as the diagnostic gold standard, the ID‐CM(6) had a sensitivity of 70.8% (46/65) and a specificity of 93.2% (41/44). Conclusion The ID‐CM(6) demonstrated acceptable sensitivity and good specificity in determining CM status. The results of this analysis support the real‐world utility of the ID‐CM(6) as a simple and useful tool to identify patients with CM.
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Affiliation(s)
- Jelena M Pavlovic
- Department of Neurology, Montefiore Medical Center, Bronx, NY, USA.,Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Justin S Yu
- Allergan, an AbbVie Company, Irvine, CA, USA
| | | | | | - Robert P Cowan
- Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | - Richard B Lipton
- Department of Neurology, Montefiore Medical Center, Bronx, NY, USA.,Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
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Lipton RB, Buse DC, Dodick DW, Schwedt TJ, Singh P, Munjal S, Fanning K, Bostic Bs R, Reed ML. Burden of increasing opioid use in the treatment of migraine: Results from the Migraine in America Symptoms and Treatment Study. Headache 2020; 61:103-116. [PMID: 33326608 DOI: 10.1111/head.14018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 06/15/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE We sought to assess factors associated with the frequency of self-reported prescription opioid use in persons with migraine, including demographic variables, comorbidities, headache characteristics, and patterns of consultation. BACKGROUND Despite the dose-dependent effect of opioids on migraine progression and the association with negative outcomes, migraine treatment often includes opioids. The Migraine in America Symptoms and Treatment Study focuses on individuals with migraine who receive prescription acute medications, including those receiving and those not receiving opioids. METHODS This web-based panel survey identified people in the United States with migraine using a validated screener. This analysis stratified people with migraine into 4 groups based on days of monthly opioid use: non-opioid users, ≤3 days, 4-9 days, and ≥10 days per month. RESULTS Of 15,133 respondents with migraine, 4701 (31%) reported acute prescription medication use for headache/migraine in the previous 3 months (mean age 45 years, 71.6% [3367/4701] female), of whom 32.5% (1528/4701) reported opioid use. About one-third of respondents with primary care or neurology consults in the prior 6 months reported receiving an opioid, and more than half of respondents (209/391, 53.5%) with a pain clinic consultation did so. Models compared those using opioids ≤3 days/month (879/4701, 18.7%), 4-9 days/month (304/4701, 6.5%), ≥10 days/month (345/4701, 7.3%) to non-opioid users (3173/4701, 67.5%). Compared to non-opioid users, infrequent users (≤3 days/month) were more likely to be male and less likely to have chronic migraine or to screen positive for anxiety and depression; and frequent opioid users (the 4-9 days/month and the ≥10 days/month groups) were more likely to be male, to smoke, to be obese, to report greater pain interference, to have moderate to severe disability, to have symptoms of anxiety and depression, to use fewer triptans and nonsteroidal anti-inflammatory drugs, and to have poor acute treatment optimization. CONCLUSION Among prescription medication users, this cross-sectional analysis shows that increasing use of prescription opioids is associated with male gender, chronic migraine, more severe disability, anxiety and depression, poor acute treatment optimization, and treatment in a pain clinic.
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Affiliation(s)
- Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Neurology and the Montefiore Headache Center, Montefiore Medical Center, Bronx, NY, USA
| | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | | | | | | | - Kristina Fanning
- Department of Clinical Research, Vedanta Research, Chapel Hill, NC, USA
| | - Ryan Bostic Bs
- Department of Clinical Research, Vedanta Research, Chapel Hill, NC, USA
| | - Michael L Reed
- Department of Clinical Research, Vedanta Research, Chapel Hill, NC, USA
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Christopher-Stine L, Wan GJ, Kelly W, McGowan M, Bostic R, Reed ML. Patient-reported dermatomyositis and polymyositis flare symptoms are associated with disability, productivity loss, and health care resource use. J Manag Care Spec Pharm 2020; 26:1424-1433. [PMID: 33119444 PMCID: PMC10391285 DOI: 10.18553/jmcp.2020.26.11.1424] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Flare activity or worsening symptoms are not well defined for myositis. OBJECTIVES: To (a) characterize dermatomyositis (DM) and polymyositis (PM) flares from the patient perspective and (b) report the corresponding disability and rate of unplanned medical encounters. METHODS: Online survey data were collected from volunteer patients from The Myositis Association and Johns Hopkins Myositis Center. Flare frequency; Health Assessment Questionnaire Disability Index (HAQ-DI), HAQ-Pain Index, Work Productivity and Activity Impairment (WPAI) scales; emergency department/urgent care (ED/UC) visits; and hospital admissions during the past year were examined. RESULTS: 564 individuals with selfreported diagnoses of DM/PM were surveyed between December 2017 and May 2018. Recall of symptom flares was reported by 524 respondents (78.1% were female, mean age of 55 years). Among the respondents, 378 (72.1%) reported ≥ 1 flare in the past year. The pattern of flare frequency was similar for DM and PM respondents. The most common symptoms were muscle weakness (83%), extreme fatigue (78%), and muscle pain/discomfort (64%). Increasing flare frequency was associated with significantly (P < 0.01) greater mean HAQ-DI and HAQ-Pain scores, myositis-related ED/UC visits, hospital admissions, WPAI work productivity loss (among those employed), and WPAI nonwork activity impairment. CONCLUSIONS: DM/PM-related flares are common with exacerbations of muscle weakness and fatigue being the most common flare symptoms. Flare frequency was associated with greater disability, pain, work productivity loss, nonwork activity impairment, and increased ED/UC utilization. Higher frequency of patient-reported flares may serve as a marker of worsening physical functioning and intensifying health care needs and, therefore, suggests their importance in the clinical assessment of patients with DM/PM. DISCLOSURES: This study was supported by Mallinckrodt Pharmaceuticals (Bedminster, NJ) via grants to Vedanta Research and The Myositis Association. Christopher-Stine has received compensation from previous Mallinckrodt Advisory Board meetings, unrelated to this subject matter. Wan is an employee of Mallinckrodt Pharmaceuticals and is a stockholder of the company. Reed and Bostic received grant support from Mallinckrodt Pharmaceuticals for data collection and analysis. McGowan is an employee of The Myositis Foundation, which received grant funding to support study data collection. Kelly has no conflicts to disclose. This study was presented, in part or full, at the 2019 Annual American College of Rheumatology and Association of Rheumatology Professional Meeting (November 8-13, 2018; Atlanta, GA) and at the Third Global Conference on Myositis (March 27, 2019; Berlin, Germany).
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Buse DC, Reed ML, Fanning KM, Bostic RC, Lipton RB. Demographics, Headache Features, and Comorbidity Profiles in Relation to Headache Frequency in People With Migraine: Results of the American Migraine Prevalence and Prevention (AMPP) Study. Headache 2020; 60:2340-2356. [PMID: 33090481 DOI: 10.1111/head.13966] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/03/2020] [Accepted: 08/29/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Migraine is typically divided into 2 headache frequency denominated categories, episodic migraine (EM) and chronic migraine (CM). Characterizing more narrow headache day frequency groups may be of value for better understanding the broad range of migraine experience and making treatment decisions. OBJECTIVE To characterize the impact and burden of migraine in 4 monthly headache day (MHD) categories. METHODS Respondents to the American Migraine Prevalence and Prevention Study 2005 survey who met criteria for migraine were categorized into low frequency episodic migraine (LFEM) 0-3, moderate frequency episodic migraine (MFEM) 4-7, high frequency episodic migraine (HFEM) 8-14, and CM with ≥15 headache days per month. Data including sociodemographics, headache features and symptomology, comorbidities, cutaneous allodynia, and severe migraine-related disability were compared among groups. We combined the low- and medium-frequency EM groups (L/MFEM) and compared them with the HFEM group in 1 set of models and compared the HFEM and CM groups in a second set of models. Binary logistic regression, linear regression, and ordered logistic regression were used depending upon the variable type and adjusted for sociodemographics. RESULTS Among 11,603 eligible respondents with migraine, 67.7% (7860/11,603) were categorized with LFEM, 17.7% (2051/11,603) with MFEM, 7.8% (898/11,603) with HFEM, and 6.8% (794/11,603) with CM. The mean age was 46 (SD 13.7), 80.2% (9301/11,603) were female, and 90.0% (10,187/11,323) were White, 6.9% were Black (784/11,323), and 3.1% (352/11,323) were identified as Other race(s). Individuals with HFEM differed from L/MFEM on a wide range of sociodemographic variables in the categories of headache features, disability, and comorbidities while few differences were found when modeling HFEM vs CM. In comparison with L/MFEM and HFEM, the HFEM group was more likely to have severe disability (P < .001 OR = 1.74 [1.42, 2.15]), chronic pain (P ≤ .007 OR = 1.35 [1.09, 1.69]), arthritis (P = .001 OR = 1.44 [1.15, 1.80]), high cholesterol (P = .005, OR = 1.37 [1.10, 1.70]), ulcers (P = .016, OR = 1.44 [1.07, 1.93]), and depression (Patient Health Questionnaire [PHQ-9]) (P < .001 OR = 1.50 [1.22, 1.84]). CONCLUSION While rates of migraine symptoms, headache impact and disability, and comorbidities generally increased with increases in MHD frequency, respondents with HFEM and CM were remarkably similar on a broad range of variables including sociodemographics, disability/impact, and comorbidities. There were many more significant differences between the HFEM and L/MFEM groups on the same variables. Future work should use empirical strategies to identify naturally occurring groups and possibly reconsider the boundary between CM and HFEM.
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Affiliation(s)
- Dawn C Buse
- Albert Einstein College of Medicine, Bronx, NY, USA
| | | | | | | | - Richard B Lipton
- Albert Einstein College of Medicine, Bronx, NY, USA
- Montefiore Medical Center, Bronx, NY, USA
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Lipton RB, Fanning KM, Buse DC, Martin VT, Hohaia LB, Manack Adams A, Reed ML, Goadsby PJ. Author response: Migraine progression in subgroups of migraine based on comorbidities: Results of the CaMEO Study. Neurology 2020; 95:707-708. [DOI: 10.1212/wnl.0000000000010721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Lipton RB, Seng EK, Chu MK, Reed ML, Fanning KM, Adams AM, Buse DC. The Effect of Psychiatric Comorbidities on Headache-Related Disability in Migraine: Results From the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study. Headache 2020; 60:1683-1696. [PMID: 33448374 PMCID: PMC7496280 DOI: 10.1111/head.13914] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [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: 03/16/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To examine the influences of depression and anxiety on headache-related disability in people with episodic migraine or chronic migraine. BACKGROUND Depression and anxiety are common comorbidities in people with migraine, especially among those with chronic migraine. METHODS This cross-sectional analysis of data from the longitudinal, internet-based Chronic Migraine Epidemiology and Outcomes Study assessed sociodemographic and headache features, and headache-related disability (Migraine Disability Assessment Scale). Four groups were defined based on scores from validated screeners for depression (9-item Patient Health Questionnaire) and anxiety (7-item Generalized Anxiety Disorder Scale): depression alone, anxiety alone, both, or neither. RESULTS Respondents (N = 16,788) were predominantly women (74.4% [12,494/16,788]) and white (84.0% [14,044/16,788]); mean age was 41 years. Depression was more likely in persons with chronic migraine vs episodic migraine (56.6% [836/1476] vs 30.0% [4589/15,312]; P < .001), as were anxiety (48.4% [715/1476] vs 28.1% 4307/15,312]; P < .001) and coexisting depression and anxiety (42.0% [620/1476] vs 20.8% [3192/15,312]; P < .001). After controlling for headache frequency and other covariates, depression alone, and anxiety alone were associated with 56.0% (rate ratio [RR], 1.56; 95% confidence interval [CI], 1.46-1.66) and 39.0% (RR, 1.39; 95% CI, 1.30-1.50) increased risks of moderate/severe migraine-related disability (both P < .001), respectively; the combination had an even greater effect on risk of moderate/severe disability (79.0% increase; RR, 1.79; 95% CI, 1.71-1.87; P < .001). CONCLUSIONS Depression alone and anxiety alone are associated with greater headache-related disability after controlling for sociodemographic and headache features. Coexisting depression and anxiety are more strongly associated with disability than either comorbidity in isolation. Interventions targeting depression and anxiety as well as migraine itself may improve headache-related disability in people with migraine.
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Affiliation(s)
- Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Neurology, Montefiore Medical Center, Bronx, NY, USA.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Elizabeth K Seng
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Neurology, Montefiore Medical Center, Bronx, NY, USA.,Department of Psychology, Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University, Seoul, Korea
| | | | | | | | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Psychology, Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA
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Katz P, Wan GJ, Daly P, Topf L, Connolly-Strong E, Bostic R, Reed ML. Patient-reported flare frequency is associated with diminished quality of life and family role functioning in systemic lupus erythematosus. Qual Life Res 2020; 29:3251-3261. [PMID: 32683643 DOI: 10.1007/s11136-020-02572-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 06/26/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE To understand the influence of the systemic lupus erythematosus (SLE)-related flares on patient's health-related quality of life (HRQoL). METHODS An online survey included individuals with self-reported physician's diagnosis of SLE or lupus nephritis (LN). Lupus impact tracker (LIT) assessed lupus symptoms and HRQoL, SLE-Family questionnaire measured family role functioning, and Healthy Days Core Module (HDCM) measured overall mental and physical health. Chi-square and analysis of variance evaluated differences by flare frequency. Multivariable linear regression and generalized linear models evaluated the independent relationships of flare frequency to HRQoL. RESULTS 1066 respondents with SLE or LN completed the survey. Mean (SD) duration of illness was 12.4 (10.1) years. 93.4% (n = 996) were women, 82.3% (n = 830) were White, and 49.7% (n = 530) were employed or students. More frequent flares were associated with significantly worse scores on all HRQoL measures: LIT (adjusted means: 0 flares, 31.8; 1-3 flares, 47.0; 4-6 flares, 56.1; ≥ 7 flares, 63.6; P < 0.001); SLE-Family (adjusted means: 0 flares, 3.1; 1-3 flares 3.8; 4-6 flares, 4.3; ≥ 7 flares, 4.6, P < 0.001); HDCM unhealthy days (0 flares, 8.7; 1-3 flares, 17.4; 4-6 flares, 21.5; ≥ 7 flares, 26.2 days, P < 0.001). CONCLUSION Lupus flares contributed to impaired functional and psychological well-being, family functioning, and number of monthly healthy days. Better understanding of the burden of flare activity from the patient's perspective will support a holistic approach to lupus management.
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Affiliation(s)
- Patricia Katz
- School of Medicine, University of California San Francisco, San Francisco, CA, USA.
- Arthritis Research Group, University of California San Francisco, 3333 California Street, San Francisco, CA, 94143-0936, USA.
| | - George J Wan
- Global Head of Health Economics and Outcomes Research, Mallinckrodt Pharmaceuticals, Bedminster, NJ, USA
| | - Paola Daly
- The Lupus Foundation of America, Washington, DC, USA
| | - Lauren Topf
- The Lupus Foundation of America, Washington, DC, USA
| | - Erin Connolly-Strong
- Global Head of Health Economics and Outcomes Research, Mallinckrodt Pharmaceuticals, Bedminster, NJ, USA
- Field Medical Affairs, Mallinckrodt Pharmaceuticals, Bedminster, NJ, USA
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Lipton RB, Buse DC, Friedman BW, Feder L, Adams AM, Fanning KM, Reed ML, Schwedt TJ. Characterizing opioid use in a US population with migraine: Results from the CaMEO study. Neurology 2020; 95:e457-e468. [PMID: 32527971 PMCID: PMC7455347 DOI: 10.1212/wnl.0000000000009324] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 05/20/2019] [Accepted: 11/07/2019] [Indexed: 01/20/2023] Open
Abstract
Objective To determine the prevalence of and risk factors associated with opioid use in the treatment of migraine, we examined demographics and clinical characteristics of 867 individuals who reported using opioids for the treatment of migraine. Methods We analyzed data from the CaMEO study (Chronic Migraine Epidemiology and Outcomes), a cross-sectional, longitudinal, Internet study, to compare sociodemographics, clinical characteristics, and migraine burden/disability of opioid users vs nonusers. Covariates were entered as categorical or continuous variables. Factors associated with opioid use were identified using nested, multivariable binary logistic regression models. Results Of 2,388 respondents with migraine using prescription medications for acute treatment, 36.3% reported that they currently used or kept on hand opioid medications to treat headaches. Current opioid users had significantly more comorbidities, greater headache-related burden, and poorer quality of life than nonusers. Regression models revealed factors significantly associated with opioid use, including male sex, body mass index, allodynia, increasing monthly headache frequency, Total Pain Index score (excluding head, face, neck/shoulder), anxiety, depression, ≥1 cardiovascular comorbidity, and emergency department/urgent care use for headache in the past 6 months. Self-reported physician-diagnosed migraine/chronic migraine was associated with significantly decreased likelihood of opioid use. Conclusions Of respondents who were using acute prescription medications for migraine, more than one-third used or kept opioids on hand, contrary to guidance. This analysis could not distinguish risk factors from consequences of opioid use; thus further research is needed to guide the development of strategies for reducing the inappropriate use of opioids in migraine.
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Affiliation(s)
- Richard B Lipton
- From the Department of Neurology (R.B.L., D.C.B., B.W.F.), Albert Einstein College of Medicine, Bronx, NY; Peloton Advantage, LLC, an OPEN Health Company (L.F.), Parsippany, NJ; Global Medical Affairs (A.M.A.), Allergan plc, Irvine, CA; Vedanta Research (K.M.F., M.L.R.), Chapel Hill, NC; and Neurology Research (T.J.S.), Mayo Clinic, Phoenix, AZ.
| | - Dawn C Buse
- From the Department of Neurology (R.B.L., D.C.B., B.W.F.), Albert Einstein College of Medicine, Bronx, NY; Peloton Advantage, LLC, an OPEN Health Company (L.F.), Parsippany, NJ; Global Medical Affairs (A.M.A.), Allergan plc, Irvine, CA; Vedanta Research (K.M.F., M.L.R.), Chapel Hill, NC; and Neurology Research (T.J.S.), Mayo Clinic, Phoenix, AZ
| | - Benjamin W Friedman
- From the Department of Neurology (R.B.L., D.C.B., B.W.F.), Albert Einstein College of Medicine, Bronx, NY; Peloton Advantage, LLC, an OPEN Health Company (L.F.), Parsippany, NJ; Global Medical Affairs (A.M.A.), Allergan plc, Irvine, CA; Vedanta Research (K.M.F., M.L.R.), Chapel Hill, NC; and Neurology Research (T.J.S.), Mayo Clinic, Phoenix, AZ
| | - Lisa Feder
- From the Department of Neurology (R.B.L., D.C.B., B.W.F.), Albert Einstein College of Medicine, Bronx, NY; Peloton Advantage, LLC, an OPEN Health Company (L.F.), Parsippany, NJ; Global Medical Affairs (A.M.A.), Allergan plc, Irvine, CA; Vedanta Research (K.M.F., M.L.R.), Chapel Hill, NC; and Neurology Research (T.J.S.), Mayo Clinic, Phoenix, AZ
| | - Aubrey Manack Adams
- From the Department of Neurology (R.B.L., D.C.B., B.W.F.), Albert Einstein College of Medicine, Bronx, NY; Peloton Advantage, LLC, an OPEN Health Company (L.F.), Parsippany, NJ; Global Medical Affairs (A.M.A.), Allergan plc, Irvine, CA; Vedanta Research (K.M.F., M.L.R.), Chapel Hill, NC; and Neurology Research (T.J.S.), Mayo Clinic, Phoenix, AZ
| | - Kristina M Fanning
- From the Department of Neurology (R.B.L., D.C.B., B.W.F.), Albert Einstein College of Medicine, Bronx, NY; Peloton Advantage, LLC, an OPEN Health Company (L.F.), Parsippany, NJ; Global Medical Affairs (A.M.A.), Allergan plc, Irvine, CA; Vedanta Research (K.M.F., M.L.R.), Chapel Hill, NC; and Neurology Research (T.J.S.), Mayo Clinic, Phoenix, AZ
| | - Michael L Reed
- From the Department of Neurology (R.B.L., D.C.B., B.W.F.), Albert Einstein College of Medicine, Bronx, NY; Peloton Advantage, LLC, an OPEN Health Company (L.F.), Parsippany, NJ; Global Medical Affairs (A.M.A.), Allergan plc, Irvine, CA; Vedanta Research (K.M.F., M.L.R.), Chapel Hill, NC; and Neurology Research (T.J.S.), Mayo Clinic, Phoenix, AZ
| | - Todd J Schwedt
- From the Department of Neurology (R.B.L., D.C.B., B.W.F.), Albert Einstein College of Medicine, Bronx, NY; Peloton Advantage, LLC, an OPEN Health Company (L.F.), Parsippany, NJ; Global Medical Affairs (A.M.A.), Allergan plc, Irvine, CA; Vedanta Research (K.M.F., M.L.R.), Chapel Hill, NC; and Neurology Research (T.J.S.), Mayo Clinic, Phoenix, AZ
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Hutchinson S, Lipton RB, Ailani J, Reed ML, Fanning KM, Adams AM, Buse DC. Characterization of Acute Prescription Migraine Medication Use: Results From the CaMEO Study. Mayo Clin Proc 2020; 95:709-718. [PMID: 32247344 DOI: 10.1016/j.mayocp.2019.11.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/21/2019] [Accepted: 11/13/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To characterize self-reported use of acute prescription medication for migraine in a sample representing the US population. PATIENTS AND METHODS Data were obtained from the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study. The CaMEO Study is an Internet-based cross-sectional longitudinal survey administered between September 17, 2012, and November 19, 2013. Demographic characteristics, migraine-related disability, symptom severity, quality of life, and psychiatric comorbidity profiles were evaluated. RESULTS Data from 13,624 respondents were analyzed, including 3121 (22.9%) self-reported current users of acute prescription medication for migraine, 1719 (12.6%) previous/discontinued users, and 8784 (64.5%) who had never used acute prescription medication for migraine. Mean ± SD monthly headache frequency was 7.3±7.1 days for current users, 5.6±6.6 days for those who discontinued, and 3.9±4.9 days for respondents who never used acute prescription medication for migraine. Current users experienced the highest degree of migraine-related disability based on Migraine Disability Assessment scores and the highest levels of migraine symptom severity based on Migraine Symptom Severity Scale scores. Current users also had the highest scores on the depression and anxiety questionnaires. The most commonly reported prescription medications used or "kept on hand" by current users were triptans (47.2%; 1474 of 3121), opioids (37.3%; 1164 of 3121), nonsteroidal anti-inflammatory drugs (31.9%; 997 of 3121), and barbiturates (12.8%; 399 of 3121), with many people reporting more than 1 medication. CONCLUSION Despite reporting moderate to severe migraine-related disability and impairment, many people with migraine have never used acute prescription migraine medication. The burden related to migraine is great, especially among individuals currently using acute prescription medication for migraine.
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Affiliation(s)
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY
| | | | | | | | | | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY
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Buse DC, Reed ML, Fanning KM, Bostic R, Dodick DW, Schwedt TJ, Munjal S, Singh P, Lipton RB. Comorbid and co-occurring conditions in migraine and associated risk of increasing headache pain intensity and headache frequency: results of the migraine in America symptoms and treatment (MAST) study. J Headache Pain 2020; 21:23. [PMID: 32122324 PMCID: PMC7053108 DOI: 10.1186/s10194-020-1084-y] [Citation(s) in RCA: 123] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 02/04/2020] [Indexed: 12/30/2022] Open
Abstract
Background Migraine has many presumed comorbidities which have rarely been compared between samples with and without migraine. Examining the association between headache pain intensity and monthly headache day (MHD) frequency with migraine comorbidities is novel and adds to our understanding of migraine comorbidity. Methods The MAST Study is a prospective, web-based survey that identified US population samples of persons with migraine (using modified International Classification of Headache Disorders-3 beta criteria) and without migraine. Eligible migraine participants averaged ≥1 MHDs over the prior 3 months. Comorbidities “confirmed by a healthcare professional diagnosis” were endorsed by respondents from a list of 21 common cardiovascular, neurologic, psychiatric, sleep, respiratory, dermatologic, pain and medical comorbidities. Multivariable binary logistic regression calculated odds ratios (OR) and 95% confidence intervals for each condition between the two groups adjusting for sociodemographics. Modeling within the migraine cohort assessed rates of conditions as a function of headache pain intensity, MHD frequency, and their combination. Results Analyses included 15,133 people with migraine (73.0% women, 77.7% White, mean age 43 years) and 77,453 controls (46.4% women, 76.8% White, mean age 52 years). People with migraine were significantly (P < 0.001) more likely to report insomnia (OR 3.79 [3.6, 4.0]), depression (OR 3.18 [3.0, 3.3]), anxiety (OR 3.18 [3.0 3.3]), gastric ulcers/GI bleeding (OR 3.11 [2.8, 3.5]), angina (OR 2.64 [2.4, 3.0]) and epilepsy (OR 2.33 [2.0, 2.8]), among other conditions. Increasing headache pain intensity was associated with comorbidities related to inflammation (psoriasis, allergy), psychiatric disorders (depression, anxiety) and sleep conditions (insomnia). Increasing MHD frequency was associated with increased risk for nearly all conditions and most prominent among those with comorbid gastric ulcers/GI bleeding, diabetes, anxiety, depression, insomnia, asthma and allergies/hay fever. Conclusions In regression models controlled for sociodemographic variables, all conditions studied were reported more often by those with migraine. Whether entered into the models separately or together, headache pain intensity and MHD frequency were associated with increased risk for many conditions. Future work is required to understand the causal sequence of relationships (direct causality, reverse causality, shared underlying predisposition), the potential confounding role of healthcare professional consultation and treatment, and potential detection bias.
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Affiliation(s)
- Dawn C Buse
- Albert Einstein College of Medicine, 1250 Waters Place, 8th Floor, Bronx, NY, 10461, USA.
| | - Michael L Reed
- Vedanta Research, 23 Tanyard Court, Chapel Hill, NC, 27517, USA
| | | | - Ryan Bostic
- Vedanta Research, 23 Tanyard Court, Chapel Hill, NC, 27517, USA
| | | | | | - Sagar Munjal
- Promius Pharma, 107 College Road East, Princeton, NJ, 08534, USA
| | - Preeti Singh
- Promius Pharma, 107 College Road East, Princeton, NJ, 08534, USA
| | - Richard B Lipton
- Albert Einstein College of Medicine, 1250 Waters Place, 8th Floor, Bronx, NY, 10461, USA.,Montefiore Medical Center, 1165 Morris Park Avenue, Rousso Building, Room 332, Bronx, NY, 10461, USA
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Katz P, Nelson WW, Daly RP, Topf L, Connolly-Strong E, Reed ML. Patient-Reported Lupus Flare Symptoms Are Associated with Worsened Patient Outcomes and Increased Economic Burden. J Manag Care Spec Pharm 2020; 26:275-283. [PMID: 32105178 PMCID: PMC10390967 DOI: 10.18553/jmcp.2020.26.3.275] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Lupus flares significantly contribute to health resource utilization and hospitalizations. Identification of flare activity may be hindered since validated assessment scales are rarely used in clinical practice and flare severity may fall below clinician-assessed thresholds. Therefore, patient-reported outcomes of lupus flare frequency are important assessment tools for lupus management. OBJECTIVE To better understand the relationship between lupus flares as reported by persons with lupus and specific direct and indirect costs, including hospital admission, unplanned urgent care (UC)/emergency department (ED) visits, work productivity loss, and nonwork activity impairment. METHODS In this cross-sectional analysis, persons with lupus were drawn from 2 enriched sampling sources. Data were collected via an online survey and included individuals with self-reported physician's diagnosis of systemic lupus erythematosus, skin or discoid lupus, or lupus nephritis. Respondents were asked the total number of hospitalizations and ED/UC visits for any reason and for lupus-related hospitalizations and ED/UC visits. Work productivity loss and nonwork activity impairment were measured via the Work Productivity and Activity Impairment - General Health scale. The sample was stratified into those with 0 flares, 1-3 flares, 4-6 flares, and 7 or more flares, with 0 flares used as the reference. Chi-square tests for trend and analyses of variance were used to evaluate differences among flare frequency groups. Multivariable regression modeling was conducted to evaluate the independent relationship of flare frequency to health care use and productivity loss. RESULTS We studied 1,288 survey respondents with known flare frequency in the past 12 months. Flare frequency increased with duration of illness. The mean number of lupus-related hospital admissions was significantly associated with increasing flare frequency for the total sample (F = 3.9; P < 0.009). Compared to patients with no flare, those who reported flare activities had 1.72-3.13 times higher rates of hospitalizations. The mean number of lupus-related ED/UC visits were also found to be significantly associated with increasing flare frequency for the total sample (F = 23.4; P < 0.001), and rates were increased by 6.98- to 16.12-fold for unplanned ED/UC visits depending on flare frequency. Rates of employment were significantly related to increasing flare frequency. With respect to work-related impairment, absenteeism increased with greater lupus flare frequency (F = 6.2; P < 0.001), as did presenteeism (F = 31.5; P < 0.001) and the combined value of total work productivity loss (F = 30.4; P < 0.001). Mean work-related activity impairment was 12%-32% more among patients who reported flare activities compared to those who reported no flares. CONCLUSIONS Increased lupus-related flare frequency is associated with worsened patient outcomes as measured by increased hospitalizations, visits to the ED/UC, work productivity loss, and activity impairment. This association may be an important indicator of disease severity and resource burden and therefore suggests an unmet need among patients experiencing lupus-related flares. DISCLOSURES This study was sponsored by Mallinckrodt Pharmaceuticals via grants to Vedanta Research and The Lupus Foundation of America. Katz received consulting fees from Vedanta Research, which received grant support from Mallinckrodt Pharmaceuticals to support data collection and analysis. Nelson and Connolly-Strong are employees of Mallinckrodt Pharmaceuticals and are stockholders in the company. Reed is an employee of Vedanta Research. Daly and Topf are employees of the Lupus Foundation of America, which received grant funding to support data collection. This study was a podium presentation at The American College of Rheumatology (ACR) Annual Meeting 2018; October 19-24, 2018; Chicago, IL.
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Rouya E, Reed ML, Kelly RG, Bart-Smith H, Begley M, Zangari G. Synthesis of Nanoporous Gold Structures via Dealloying of Electroplated Au-Ni Alloy Films. ACTA ACUST UNITED AC 2019. [DOI: 10.1149/1.2790413] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Munjal S, Singh P, Reed ML, Fanning K, Schwedt TJ, Dodick DW, Buse DC, Lipton RB. Most Bothersome Symptom in Persons With Migraine: Results From the Migraine in America Symptoms and Treatment (MAST) Study. Headache 2019; 60:416-429. [PMID: 31837007 PMCID: PMC7027490 DOI: 10.1111/head.13708] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [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: 10/29/2019] [Indexed: 01/03/2023]
Abstract
Objectives The objectives of this study were to determine the rates of nausea, phonophobia, and photophobia reported overall and as the most bothersome symptom (MBS) in individuals with migraine and to identify individual characteristics associated with each of the 3 candidate MBSs. Background The MBS has emerged as an important coprimary efficacy endpoint in clinical trials of acute treatments for migraine, as recommended by the Food and Drug Administration. The current understanding of how persons with migraine designate an associated symptom as the most bothersome has been assessed primarily in the context of randomized trials. Methods Respondents (n = 95,821) in the cross‐sectional, observational Migraine in America Symptoms and Treatment (MAST) study were adults (aged ≥18 years) recruited from a US nationwide online research panel. A validated diagnostic screener identified 15,133 individuals who met modified International Classification of Headache Disorders (ICHD)‐3 beta criteria for migraine and reported at least 1 monthly headache day (MHD) over the previous 3 months. The survey ascertained sociodemographic variables, headache‐related disability, MHDs, cutaneous allodynia, medication overuse, a migraine symptom severity score, pain interference, noncephalic pain, anxiety and depression symptoms, visual aura over the previous year, and acute treatment optimization. The current analysis is based on respondents who also completed a 6‐month follow‐up assessment that included questions about their most bothersome headache symptom. Results A total of 7518 respondents completed the 6‐month follow‐up, and 6045 met inclusion criteria and were included in the analysis. The mean age of respondents was 47 (SD 13.4) years, 76.0% (4596/6045) were women, and 84.8% (5103/6017) were white. Among all respondents, 64.9% reported all 3 migraine symptoms. The MBS was photophobia in 49.1% (2967/6045), nausea in 28.1% (1697/6045), and phonophobia in 22.8% (1381/6045). Respondents reporting photophobia as the MBS were more likely to be men, to be obese, and to report visual aura. Those reporting nausea as the MBS were more likely to be women, to have lower incomes, and to report lower levels of treatment optimization. Respondents reporting phonophobia as the MBS were more likely to have cutaneous allodynia and less likely to have visual aura. Conclusion Most people with migraine in the MAST observational study reported all 3 cardinal symptoms of nausea, photophobia, and phonophobia. As in clinical trials, the most common MBS was photophobia. Patient profiles differed among the groups defined by their MBS.
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Affiliation(s)
| | | | | | | | | | | | - Dawn C Buse
- Albert Einstein College of Medicine, Bronx, NY, USA
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Lipton RB, Fanning KM, Buse DC, Martin VT, Hohaia LB, Adams AM, Reed ML, Goadsby PJ. Migraine progression in subgroups of migraine based on comorbidities: Results of the CaMEO Study. Neurology 2019; 93:e2224-e2236. [PMID: 31690685 PMCID: PMC6937494 DOI: 10.1212/wnl.0000000000008589] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [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: 01/10/2019] [Accepted: 06/26/2019] [Indexed: 02/04/2023] Open
Abstract
Objective To test the hypothesis that statistically defined subgroups of migraine (based on constellations of comorbidities and concomitant conditions; henceforth comorbidities), previously identified using Chronic Migraine Epidemiology and Outcomes (CaMEO) Study data, differ in prognosis, as measured by rates of progression from episodic migraine (EM) to chronic migraine (CM). Methods The onset of CM was assessed up to 4 times over 12 months in individuals with EM and ≥1 comorbidity at baseline, based on constellations of comorbidities (comorbidity classes). The “fewest comorbidities” class served as reference. Individuals completing ≥1 follow-up survey from the web-based CaMEO Study were included. Covariates included sociodemographic variables and headache characteristics. Sex, income, cutaneous allodynia, and medication overuse were modeled as binary variables; age, body mass index, headache-related disability (Migraine Disability Assessment [MIDAS]), and Migraine Symptom Severity Scale as continuous variables. CM onset was assessed using discrete time analysis. Results In the final sociodemographic model, all comorbidity classes had significantly elevated hazard ratios (HRs) for risk of progression to CM from EM, relative to fewest comorbidities. HRs for CM onset ranged from 5.34 (95% confidence interval [CI] 3.89–7.33; p ≤ 0.001) for most comorbidities to 1.53 (95% CI 1.17–2.01; p < 0.05) for the respiratory class. After adjusting for headache covariates independently, each comorbidity class significantly predicted CM onset, although HRs were attenuated. Conclusions Subgroups of migraine identified by comorbidity classes at cross-section predicted progression from EM (with ≥1 comorbidity at baseline) to CM. The relationship of comorbidity group to CM onset remained after adjusting for indicators of migraine severity, such as MIDAS. Clinicaltrials.gov identifier NCT01648530.
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Affiliation(s)
- Richard B Lipton
- From the Albert Einstein College of Medicine (R.B.L., D.C.B.), Bronx, NY; Vedanta Research (K.M.F., M.L.R.), Chapel Hill, NC; University of Cincinnati Headache and Facial Pain Center (V.T.M.), University of Cincinnati College of Medicine, OH; CHC Group, LLC (L.B.H.), North Wales, PA; Allergan plc (A.M.A.), Irvine, CA; NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), King's College, London, UK; and Department of Neurology (P.J.G.), University of California, San Francisco.
| | - Kristina M Fanning
- From the Albert Einstein College of Medicine (R.B.L., D.C.B.), Bronx, NY; Vedanta Research (K.M.F., M.L.R.), Chapel Hill, NC; University of Cincinnati Headache and Facial Pain Center (V.T.M.), University of Cincinnati College of Medicine, OH; CHC Group, LLC (L.B.H.), North Wales, PA; Allergan plc (A.M.A.), Irvine, CA; NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), King's College, London, UK; and Department of Neurology (P.J.G.), University of California, San Francisco
| | - Dawn C Buse
- From the Albert Einstein College of Medicine (R.B.L., D.C.B.), Bronx, NY; Vedanta Research (K.M.F., M.L.R.), Chapel Hill, NC; University of Cincinnati Headache and Facial Pain Center (V.T.M.), University of Cincinnati College of Medicine, OH; CHC Group, LLC (L.B.H.), North Wales, PA; Allergan plc (A.M.A.), Irvine, CA; NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), King's College, London, UK; and Department of Neurology (P.J.G.), University of California, San Francisco
| | - Vincent T Martin
- From the Albert Einstein College of Medicine (R.B.L., D.C.B.), Bronx, NY; Vedanta Research (K.M.F., M.L.R.), Chapel Hill, NC; University of Cincinnati Headache and Facial Pain Center (V.T.M.), University of Cincinnati College of Medicine, OH; CHC Group, LLC (L.B.H.), North Wales, PA; Allergan plc (A.M.A.), Irvine, CA; NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), King's College, London, UK; and Department of Neurology (P.J.G.), University of California, San Francisco
| | - Lee B Hohaia
- From the Albert Einstein College of Medicine (R.B.L., D.C.B.), Bronx, NY; Vedanta Research (K.M.F., M.L.R.), Chapel Hill, NC; University of Cincinnati Headache and Facial Pain Center (V.T.M.), University of Cincinnati College of Medicine, OH; CHC Group, LLC (L.B.H.), North Wales, PA; Allergan plc (A.M.A.), Irvine, CA; NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), King's College, London, UK; and Department of Neurology (P.J.G.), University of California, San Francisco
| | - Aubrey Manack Adams
- From the Albert Einstein College of Medicine (R.B.L., D.C.B.), Bronx, NY; Vedanta Research (K.M.F., M.L.R.), Chapel Hill, NC; University of Cincinnati Headache and Facial Pain Center (V.T.M.), University of Cincinnati College of Medicine, OH; CHC Group, LLC (L.B.H.), North Wales, PA; Allergan plc (A.M.A.), Irvine, CA; NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), King's College, London, UK; and Department of Neurology (P.J.G.), University of California, San Francisco
| | - Michael L Reed
- From the Albert Einstein College of Medicine (R.B.L., D.C.B.), Bronx, NY; Vedanta Research (K.M.F., M.L.R.), Chapel Hill, NC; University of Cincinnati Headache and Facial Pain Center (V.T.M.), University of Cincinnati College of Medicine, OH; CHC Group, LLC (L.B.H.), North Wales, PA; Allergan plc (A.M.A.), Irvine, CA; NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), King's College, London, UK; and Department of Neurology (P.J.G.), University of California, San Francisco
| | - Peter J Goadsby
- From the Albert Einstein College of Medicine (R.B.L., D.C.B.), Bronx, NY; Vedanta Research (K.M.F., M.L.R.), Chapel Hill, NC; University of Cincinnati Headache and Facial Pain Center (V.T.M.), University of Cincinnati College of Medicine, OH; CHC Group, LLC (L.B.H.), North Wales, PA; Allergan plc (A.M.A.), Irvine, CA; NIHR-Wellcome Trust King's Clinical Research Facility (P.J.G.), King's College, London, UK; and Department of Neurology (P.J.G.), University of California, San Francisco
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Pomeroy KO, Reed ML, LoManto B, Harris SG, Hazelrigg WB, Kelk DA. Cryostorage tank failures: temperature and volume loss over time after induced failure by removal of insulative vacuum. J Assist Reprod Genet 2019; 36:2271-2278. [PMID: 31650453 DOI: 10.1007/s10815-019-01597-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 06/14/2019] [Accepted: 09/25/2019] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To determine liquid nitrogen evaporation rates of intact liquid nitrogen storage tanks and tanks with their vacuum removed. METHODS Donated storage tank performance (LN2 evaporation) was evaluated before and after induced vacuum failure. Vacuum of each tank was removed by drilling through the vacuum port. Temperature probes were placed 2 in. below the bottom of the styrofoam cap/plug, and tanks were weighed every 3 h. Evaporation rate and time from failure to the critical temperature was determined. RESULT Storage tanks with failed vacuum have a much higher evaporation rate than those with intact vacuum; evaporation rates increased dramatically within 3 to 6 h in the smaller tanks, and time to complete depletion varied according to starting LN2 volume. Tanks with storage racks/specimens may have altered evaporation profiles compared to tanks without. Locating temperature probes 2 in. below the styrofoam cap/plug suggests that for most applications, alarms would sound approximately 1 h prior to reaching the critical warming temperature, approximately - 130 °C. External signs of vacuum loss were dramatic: vapor, frost, and audible movement of air. CONCLUSION For the first time, we have data on how liquid nitrogen storage tanks behave when their vacuum is removed. These findings are conservative; each lab must consider starting volume, tank size/capacity, function (storage or shipping), age, and pre-existing evaporation behavior in order to develop an emergency response to critical tank failure. Times to complete failure/evaporation and critical warming temperature after vacuum loss are different; these data should be considered when evaluating tank alarm systems.
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Affiliation(s)
- Kimball O Pomeroy
- The World Egg Bank, 7227 North 16th Street, Suite 160, Phoenix, AZ, 85020, USA.
| | - Michael L Reed
- Fertility Center of New Mexico, 201 Cedar Street SE, Suite S1-20, Albuquerque, NM, 87106, USA
| | - Brian LoManto
- The World Egg Bank, 7227 North 16th Street, Suite 160, Phoenix, AZ, 85020, USA
| | - Stanley G Harris
- Kaiser Permanente Center for Reproductive Health, 39141 Civic Center Drive, Suite 350, Fremont, CA, 94538, USA
| | - W Brent Hazelrigg
- Repro Tech, Ltd., 18 South Ninth Street, Suite 201, Columbia, MO, 65201, USA
| | - Dawn A Kelk
- Yale Fertility Center, 150 Sargent Drive, New Haven, CT, 06511, USA
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Lipton RB, Hutchinson S, Ailani J, Reed ML, Fanning KM, Manack Adams A, Buse DC. Discontinuation of Acute Prescription Medication for Migraine: Results From the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study. Headache 2019; 59:1762-1772. [PMID: 31544244 PMCID: PMC6899725 DOI: 10.1111/head.13642] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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] [Accepted: 08/10/2019] [Indexed: 12/26/2022]
Abstract
Objective This analysis assessed migraine‐related burden and treatment decisions in Chronic Migraine Epidemiology and Outcomes (CaMEO) Study survey respondents who stopped taking acute prescription medications for migraine. Background Migraine is a common yet underdiagnosed and undertreated neurological disease often associated with significant disability. Acute prescription medications are underused, in part because patients discontinue treatment. Rates and reasons for discontinuing acute prescription medications require exploration. Methods The CaMEO Study is a longitudinal, Internet‐based survey that identified and followed people who met modified ICHD‐3 migraine criteria. For this analysis, eligible respondents had used acute prescription medication for migraine in the past but no longer used or kept these treatments on hand (discontinued users). Respondents who reported discontinuing acute prescription treatment answered questions about length of time since last use and reasons for stopping. Reasons for discontinuing were thematically summarized. Monthly headache day frequency, Migraine Disability Assessment (MIDAS), Patient Health Questionnaire 9‐item depression screener, Generalized Anxiety Disorder 7‐item screener, and the 12‐item Allodynia Symptom Checklist were also assessed. Results Of 13,624 respondents with migraine, 4840 (35.5%) had ever used acute prescription medications and 1719 (35.5%) of those were discontinued users. Discontinued users had a mean (SD) age of 42.1 (14) years, and 1348/1719 (78.4%) were female. Monthly headache frequency of 0‐4 days was reported by 1073/1719 (62.4%) of respondents, 5‐9 days by 322/1719 (18.7%), 10‐14 days by 135/1719 (7.9%), and ≥15 days by 189/1719 (11.0%). Two‐thirds (1160/1719 [67.5%]) of discontinued users reported a receiving migraine (or chronic migraine) diagnosis from a doctor or other health professional in the past. Although all had spoken to a doctor about their headaches, 1504/1719 (87.5%) had stopped having their headaches managed or treated by a doctor for at least 12 months. Only 1 in 5 discontinued users reported being able to work or function normally with a headache, and 717/1719 (41.7%) had moderate to severe disability (MIDAS). Among the most commonly reported reasons for prescription medication discontinuation were switching to non‐prescription pain medication (782/1719 [45.5%]), as well as concerns about prescription medication efficacy (484/1719 [28.2%]) and tolerability (428/1719 [24.9%]). Nearly half of respondents who reported either efficacy or tolerability concerns had moderate to severe disability. Conclusions People with migraine who discontinue acute prescription medication have a high level of unmet treatment need. The majority cannot work or function normally with headaches, with 646/1719 (37.6%) of discontinued users reporting 5 or more headache days per month.
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Affiliation(s)
- Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Jessica Ailani
- Medstar Georgetown University Hospital, Washington, DC, USA
| | | | | | | | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
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Lipton RB, Munjal S, Buse DC, Alam A, Fanning KM, Reed ML, Schwedt TJ, Dodick DW. Unmet Acute Treatment Needs From the 2017 Migraine in America Symptoms and Treatment Study. Headache 2019; 59:1310-1323. [PMID: 31410844 PMCID: PMC6771753 DOI: 10.1111/head.13588] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [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: 06/03/2019] [Indexed: 12/20/2022]
Abstract
Objectives To characterize unmet treatment needs in a sample of Migraine in America Symptoms and Treatment (MAST) Study participants using oral, acute prescription migraine medications. Background The MAST Study is a 2017 study of US adults with migraine that profiles current treatment patterns and identifies and quantifies unmet treatment needs. Methods Cross‐sectional data from an online survey of US adults meeting ICHD‐3 beta criteria for migraine. For inclusion in this paper, respondents self‐reported a history of 3 or more monthly headache days (MHDs) in the past 3 months and at least 1 MHD in the past 30 days, and current use of orally administered acute prescription medication for headache. Three domains of unmet need were identified: inadequate treatment response (ie, inadequate 2‐hour pain freedom, recurrence within 24 hours of initial relief), demanding attack characteristics (rapid onset of attack, headache associated with sleep), and unique patient characteristics (opioid or barbiturate overuse, cardiovascular comorbidity). Sociodemographics, oral medication use, and coexisting conditions and symptoms (ie, level of treatment optimization, psychological symptoms, attack‐related cutaneous allodynia, and migraine symptom severity) were assessed for each domain and by the number of unmet need domains. Results Overall, 15,133 respondents met inclusion criteria, 26.0% (3930/15,133) reported current use of oral acute prescription medication to treat headache. Eligible participants had a mean age of 45.0 years, 73.6% [2892/3930] were women and 81.1% [3186/3930]) were White. A total of 95.8% (3765/3930) of respondents had at least 1 unmet acute treatment need; 89.5% (3516/3930) reported demanding attack characteristics, 74.1% (2912/3930) reported inadequate treatment response, and 16.1% (634/3930) presented with unique patient characteristics. Common areas of unmet need were rapid headache onset (65.3% [2567/3930]), moderate to severe disability (55.6% [2187/3930]), inadequate 2‐hours pain freedom (49.0% [1892/3930]), and headache recurrence within 24 hours (38.0% [1493/3930]). An increasing number of unmet treatment need domains was associated with worsening psychological symptoms, attack‐related cutaneous allodynia and migraine symptom severity. Conclusion Nearly all MAST Study respondents using acute oral prescription medications for migraine reported at least 1 unmet treatment need. As unmet needs increased, so did coexisting conditions and symptom severity.
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Affiliation(s)
- Richard B Lipton
- The Saul R. Korey Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Dawn C Buse
- The Saul R. Korey Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Buse DC, Fanning KM, Reed ML, Murray S, Dumas PK, Adams AM, Lipton RB. Life With Migraine: Effects on Relationships, Career, and Finances From the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study. Headache 2019; 59:1286-1299. [PMID: 31407321 PMCID: PMC6771487 DOI: 10.1111/head.13613] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [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] [Accepted: 06/26/2019] [Indexed: 12/23/2022]
Abstract
Objective To assess the effects of migraine on important life domains and compare differences between respondents with episodic and chronic migraine and between sexes. Background Migraine is associated with a substantial personal and societal burden and can also affect the interpersonal dynamics, psychological health and well‐being, and financial stability of the entire family of the person with migraine. Methods The Chronic Migraine Epidemiology and Outcomes (CaMEO) Study is a prospective, longitudinal, Web‐based survey study undertaken between September 2012 and November 2013 in a systematic U.S. sample of people meeting modified International Classification of Headache Disorders, 3rd edition migraine criteria: 19,891 respondents were invited to complete the Family Burden Module, which assessed the perceived impact of migraine on family relationships and life, career and finances, and overall health. Respondents were stratified by episodic migraine (<15 headache days/month) and chronic migraine (≥15 headache days/month) and sex for comparisons. Results A total of 13,064 respondents (episodic migraine: 11,944 [91.4%]; chronic migraine: 1120 [8.6%]) provided valid data. Approximately 16.8% of respondents not currently in a romantic relationship (n = 536 of 3189) and 17.8% of those in a relationship but not living together (n = 236 of 1323) indicated that headaches had contributed to relationship problems. Of those in a relationship and living together (n = 8154), 3.2% reported that they chose not to have children, delayed having children or had fewer children because of migraine (n = 260; episodic migraine: n = 193 of 7446 [2.6%]; chronic migraine: n = 67 of 708 [9.5%]; P < .001). Of individuals responding to career/finance items (n = 13,061/13,036), 32.7% indicated that headaches negatively affected ≥1 career area (n = 4271; episodic migraine: n = 3617 of 11,942 [30.3%]; chronic migraine: n = 654 of 1119 [58.4%]), and 32.1% endorsed worry about long‐term financial security due to migraine (n = 4180; episodic migraine: n = 3539 of 11,920 [29.7%]; chronic migraine: n = 641 of 1116 [57.4%]). Conclusions Migraine can negatively affect many important aspects of life including marital, parenting, romantic and family relationships, career/financial achievement and stability, and overall health. Reported burden was consistently greater among those with chronic migraine than among people with episodic migraine; however, few differences were seen between the sexes.
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Affiliation(s)
- Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | | | - Sharron Murray
- American Migraine Foundation Partner, Wenatchee, WA, USA
| | - Paula K Dumas
- Executive Team, Migraine Again LLC, Alpharetta, GA, USA
| | | | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore Headache Center, Bronx, NY, USA
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Reed ML, Said AH. Estimation of embryo transfer media viscosity and consideration of its effect on media and uterine fluid interactions. Reprod Biomed Online 2019; 39:931-939. [PMID: 31677922 DOI: 10.1016/j.rbmo.2019.07.034] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/09/2019] [Accepted: 07/24/2019] [Indexed: 01/09/2023]
Abstract
RESEARCH QUESTION What are the viscosities of media used for human embryo transfer and what is the possible effect of viscosity as it relates to interactions between transfer media and uterine fluid. DESIGN Chamber slide filling times, in seconds, were used to calculate viscosity for each commercial and in-house modified medium, with 12 or 24 replicates per medium under standard operating procedure temperature and gas equilibration conditions used for embryo transfer. Means, standard deviations and coefficients of variation were calculated, and each viscosity was estimated using a regression equation; viscosities for each medium were presented for comparative purposes. RESULTS Complete culture media (G1-Plus, G2-Plus, G-TL, 1-Step, Global Total, Global Total HEPES, and Sperm Wash Medium) had viscosity estimates of 1.65 cP, 1.77 cP, 1.68 cP, 1.29cP, 1.18 cP, 1.15 cP, and 1.20 cP, respectively. Complete transfer media (EmbryoGlue, UTM), had viscosity estimates of 3.59 cP and 1.28 cP, respectively. Global HEPES medium with 10%, 20%, 30%, and 50% synthetic serum substitute (SSS) volume per volume had viscosity estimates 1.16 cP, 1.23 cP, 1.25 cP, and 1.34 cP, respectively. For reference, water had a viscosity estimate of 1.06 cP. CONCLUSIONS A relatively narrow distribution of viscosities was observed across several transfer media despite the various commercial or in-house modifications. These data demonstrate the vast difference between viscosities of embryo transfer media and the assumed viscosity of uterine fluid (1000 cP). Contemporary embryo transfer media may be well-suited for IVF, but evaluation of all variables, e.g. media viscosity in the context of embryo transfer, adds to the knowledge base that should be available to practitioners.
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Affiliation(s)
- Michael L Reed
- The Fertility Center of New Mexico, 201 Cedar Street SESuite S1-20, Albuquerque New Mexico 87106, USA.
| | - Al-Hasen Said
- The Fertility Center of New Mexico, 201 Cedar Street SESuite S1-20, Albuquerque New Mexico 87106, USA
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Pavlovic JM, Yu JS, Silberstein SD, Reed ML, Kawahara SH, Cowan RP, Dabbous F, Campbell KL, Shewale AR, Pulicharam R, Kowalski JW, Viswanathan HN, Lipton RB. Development of a claims-based algorithm to identify potentially undiagnosed chronic migraine patients. Cephalalgia 2019; 39:465-476. [PMID: 30854881 DOI: 10.1177/0333102418825373] [Citation(s) in RCA: 9] [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] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To develop a claims-based algorithm to identify undiagnosed chronic migraine among patients enrolled in a healthcare system. METHODS An observational study using claims and patient survey data was conducted in a large medical group. Eligible patients had an International Classification of Diseases, Ninth/Tenth Revision (ICD-9/10) migraine diagnosis, without a chronic migraine diagnosis, in the 12 months before screening and did not have a migraine-related onabotulinumtoxinA claim in the 12 months before enrollment. Trained clinicians administered a semi-structured diagnostic interview, which served as the gold standard to diagnose chronic migraine, to enrolled patients. Potential claims-based predictors of chronic migraine that differentiated semi-structured diagnostic interview-positive (chronic migraine) and semi-structured diagnostic interview-negative (non-chronic migraine) patients were identified in bivariate analyses for inclusion in a logistic regression model. RESULTS The final sample included 108 patients (chronic migraine = 64; non-chronic migraine = 44). Four significant predictors for chronic migraine were identified using claims in the 12 months before enrollment: ≥15 versus <15 claims for acute treatment of migraine, including opioids (odds ratio = 5.87 [95% confidence interval: 1.34-25.63]); ≥24 versus <24 healthcare visits (odds ratio = 2.80 [confidence interval: 1.08-7.25]); female versus male sex (odds ratio = 9.17 [confidence interval: 1.26-66.50); claims for ≥2 versus 0 unique migraine preventive classes (odds ratio = 4.39 [confidence interval: 1.19-16.22]). Model sensitivity was 78.1%; specificity was 72.7%. CONCLUSIONS The claims-based algorithm identified undiagnosed chronic migraine with sufficient sensitivity and specificity to have potential utility as a chronic migraine case-finding tool using health claims data. Research to further validate the algorithm is recommended.
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Affiliation(s)
- Jelena M Pavlovic
- 1 Montefiore Headache Center, Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | | | | | | | - Robert P Cowan
- 6 Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | | | | | | | - Richard B Lipton
- 8 Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
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Dodick DW, Reed ML, Fanning KM, Munjal S, Alam A, Buse DC, Schwedt TJ, Lipton RB. Predictors of allodynia in persons with migraine: Results from the Migraine in America Symptoms and Treatment (MAST) study. Cephalalgia 2019; 39:873-882. [DOI: 10.1177/0333102418825346] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background Cutaneous allodynia is a common clinical feature of migraine that has been associated with reduced efficacy of acute migraine treatments and an increased risk of disease progression. Objective Identify factors associated with allodynia in a sample of adults with migraine. Methods An online survey panel was used to identify adults with migraine who averaged at least 1 monthly headache day over the previous 3 months. Data on sociodemographics, headache frequency, headache pain intensity, migraine symptom severity, medication use, depression and anxiety, and cutaneous allodynia (via the Allodynia Symptom Checklist) were obtained. Binary logistic modeling predicted the presence of allodynia. Odds ratios and 95% confidence intervals (CI) were calculated. Results In total, 15,133 individuals with migraine met the eligibility criteria. Mean age was 43.1 years, 73.0% were female, and 81.0% were Caucasian. Allodynia was present in 39.9%. The fully adjusted model, controlling for sociodemographics and headache features, demonstrated that allodynia was significantly associated with a higher migraine symptom severity score (odds ratio 1.17, confidence interval 1.15, 1.19) and more severe pain intensity (odds ratio 1.11, confidence interval 1.08, 1.14); probable depression and/or anxiety (odds ratio 1.83, confidence interval 1.67, 2.00); and overuse of acute medication (odds ratio 1.23, confidence interval 1.09, 1.38). A higher number of monthly headache days increased the likelihood of allodynia, but the effect was attenuated in the fully adjusted model. Conclusion In a representative sample of US adults with migraine, there were significant associations between allodynia and headache frequency and intensity, anxiety and/or depression, symptom severity, and acute medication overuse.
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Affiliation(s)
| | | | | | - Sagar Munjal
- Promius Pharma, a subsidiary of Dr. Reddy’s Laboratories, Princeton, NJ, USA
| | - Aftab Alam
- Promius Pharma, a subsidiary of Dr. Reddy’s Laboratories, Princeton, NJ, USA
| | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA
| | | | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA
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Buse DC, Rains JC, Pavlovic JM, Fanning KM, Reed ML, Manack Adams A, Lipton RB. Sleep Disorders Among People With Migraine: Results From the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study. Headache 2018; 59:32-45. [PMID: 30381821 DOI: 10.1111/head.13435] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [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: 08/07/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVES We examined the cross-sectional association of sleep apnea and indices of sleep quality with both episodic migraine (EM) and chronic migraine (CM). BACKGROUND Sleep apnea and abnormal patterns of sleep, such as insomnia, were associated with migraine onset, severity, and progression in previous research. METHODS The Chronic Migraine Epidemiology & Outcomes Study, a longitudinal study, used a series of web-based surveys to assess migraine symptoms, burden, and patterns of health care utilization. Quota sampling was used from September 2012 to November 2013 to generate a representative sample of the US population. Persons who screened positive for sleep apnea on the Berlin Questionnaire are said to be at "high risk" for sleep apnea. Respondents indicated if they believed that they had sleep apnea, if a physician had diagnosed it, and if and how they were treated. Other aspects of sleep quality were assessed using the Medical Outcomes Study (MOS) Sleep Measures. RESULTS Of 12,810 eligible respondents with migraine and data on sleep, 11,699 with EM (91.3%) and 1111 with CM (8.7%) provided valid data for this analyses. According to the Berlin Questionnaire, 4739/12,810 (37.0%) were at "high risk" for sleep apnea, particularly persons with CM vs EM (575/1111 [51.8%] vs 4164/11,699 [35.6%]), men vs women (1431/3220 [44.4%] vs 3308/9590 [34.5%]), people with higher body mass index, and older people (all P < .001). Among respondents to the MOS Sleep Measures, persons with CM were more likely to report poor sleep quality than those with EM, including sleep disturbance (mean [SD] values: 53.2 [26.9] vs 37.9 [24.3]), snoring (38.0 [33.9] vs 31.0 [32.1]), shortness of breath (34.9 [29.8] vs 15.3 [20.6]), somnolence (44.1 [23.4] vs 32.2 [21.2]), and less likely to report sleep adequacy (34.0 [24.2] vs 39.2 [22.1]). CONCLUSIONS Compared with respondents with EM, a larger proportion of those with CM were at "high risk" for sleep apnea and reported poor sleep quality. This reflects an association between CM vs EM and sleep apnea and poor sleep quality; the potential relationships are discussed.
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Affiliation(s)
- Dawn C Buse
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jeanetta C Rains
- Elliot Hospital, Center for Sleep Evaluation, Manchester, NH, USA
| | - Jelena M Pavlovic
- Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore Headache Center, Bronx, NY, USA
| | | | | | | | - Richard B Lipton
- Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore Headache Center, Bronx, NY, USA
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Lipton RB, Munjal S, Alam A, Buse DC, Fanning KM, Reed ML, Schwedt TJ, Dodick DW. Migraine in America Symptoms and Treatment (MAST) Study: Baseline Study Methods, Treatment Patterns, and Gender Differences. Headache 2018; 58:1408-1426. [PMID: 30341895 DOI: 10.1111/head.13407] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [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: 03/16/2018] [Revised: 07/06/2018] [Accepted: 07/06/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To summarize the baseline methods for the Migraine in America Symptoms and Treatment (MAST) Study and evaluate gender differences in sociodemographics and headache features; consultation and diagnosis patterns; and patterns of acute and preventive treatment use for migraine among study participants. BACKGROUND The MAST Study is a longitudinal, internet-based panel study of symptoms, approaches to management, and unmet treatment needs among US adults with migraine. This analysis focuses on the initial cross-sectional survey, conducted beginning in 2016, and is intended to update results from earlier national epidemiologic surveys of people with migraine in the United States. METHODS Respondents to the MAST Study were recruited from a US nationwide online research panel. Stratified random sampling identified a representative cohort of adults (aged ≥18 years). We administered a validated diagnostic screener based on modified ICHD-3 beta criteria to identify individuals with migraine averaging at least 1 monthly headache day (MHD) over the previous 3 months. A baseline assessment evaluated sociodemographic and headache features, patterns of consultation and diagnosis, and use of acute and preventive medications for migraine. Frequency data and chi-square contrasts (P < .05) were used to compare respondents based on gender. RESULTS Baseline survey data (N = 95,821) identified 18,353 respondents who met criteria for migraine, including 15,133 (women n = 11,049, men n = 4084) reporting at least 1 MHD for the preceding 3 months. The mean age of the sample was 43.1 (13.6) years; 73.0% of respondents were women, and 81.0% were Caucasian. Compared with men, women were younger (46.1 vs 42.0 years; P < .001); had more MHDs (5.6 vs 5.3; P < .001); and were more likely to report moderate or severe headache-related disability (45.9% vs 35.8%; P < .001) and cutaneous allodynia (43.7% vs 29.5%; P < .001). The lifetime rate of medical consultation for headache was 79.8% overall and slightly higher in women than in men. Women were more likely than men to have been diagnosed with migraine (48.3% vs 38.8%, P < .001). While 95.1% of people with migraine currently used acute treatment, the majority (58.9%) used over-the-counter (OTC) drugs to the exclusion of prescription drugs, while 11.3% used exclusively prescription drugs, and 20.5% used both. Among acute prescription medication users, women were more likely than men to take triptans (17.7% vs 14.3%, P < .001), while men were more likely than women to take opioids (14.5% vs 9.2%, P < .001). Oral formulations were used predominately (92.7% of the medication users), but men were more likely to use nasal sprays (13.6% vs 9.4%, P < .001) and injectables (7.9% vs 3.4%, P < .001). Men (14.5%) were also significantly more likely than women (10.4%) to be taking daily oral preventive medication (P < .001). CONCLUSIONS The MAST Study identified a large sample of women and men with migraine from a sampling frame that broadly resembles the US population. Low participation rate increases the risk of response bias, however, comparisons with Census data and prior population studies for the demographic and headache characteristics of the current sample suggest that findings are generalizable to the population of people with migraine. Women had more MHDs than men, and they were more likely to report migraine-related disability and cutaneous allodynia. The lifetime consultation rate for headache was relatively high, but many with migraine symptoms reported never having received a diagnosis of migraine from a healthcare professional. Acute prescription and preventive migraine treatments are underused. Migraine persists as an underdiagnosed and undertreated public health problem in 2018, and there are many opportunities to improve the diagnosis and treatment of people with this painful, disabling condition.
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Affiliation(s)
- Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore Medical Center, Bronx, NY, USA.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | | | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
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Lipton RB, Fanning KM, Buse DC, Martin VT, Reed ML, Manack Adams A, Goadsby PJ. Identifying Natural Subgroups of Migraine Based on Comorbidity and Concomitant Condition Profiles: Results of the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study. Headache 2018; 58:933-947. [DOI: 10.1111/head.13342] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2018] [Indexed: 01/07/2023]
Affiliation(s)
- Richard B. Lipton
- Montefiore Headache Center; Bronx NY USA
- Albert Einstein College of Medicine; Bronx NY USA
| | | | - Dawn C. Buse
- Albert Einstein College of Medicine; Bronx NY USA
| | - Vincent T. Martin
- University of Cincinnati Headache and Facial Pain Center, University of Cincinnati College of Medicine; Cincinnati OH USA
| | | | | | - Peter J. Goadsby
- NIHR-Wellcome Trust King's Clinical Research Facility, King's College London; London UK
- Department of Neurology; University of California, San Francisco; San Francisco CA USA
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Schwedt TJ, Alam A, Reed ML, Fanning KM, Munjal S, Buse DC, Dodick DW, Lipton RB. Factors associated with acute medication overuse in people with migraine: results from the 2017 migraine in America symptoms and treatment (MAST) study. J Headache Pain 2018; 19:38. [PMID: 29797100 PMCID: PMC5968010 DOI: 10.1186/s10194-018-0865-z] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/10/2018] [Indexed: 01/03/2023] Open
Abstract
Background The MAST Study is a longitudinal, cross-sectional survey study of US adults with migraine. These analyses were conducted to estimate rates of acute medication overuse (AMO) and determine associations of AMO with individual and headache characteristics. Methods Eligible respondents had ICHD-3-beta migraine, reported ≥3 monthly headache days (MHDs) in the past 3 months, ≥1 MHD in the past 30 days, and currently took acute headache medication. AMO was defined according to ICHD-3-beta thresholds for monthly days of medication taking when diagnosing medication overuse headache. Results Eligible respondents (N = 13,649) had a mean age of 43.4 ± 13.6 years; most were female (72.9%) and Caucasian (81.9%). Altogether, 15.4% of respondents met criteria for AMO. Compared with those not overusing medications, respondents with AMO were significantly more likely to be taking triptans (31.3% vs 14.2%), opioids (23.8% vs 8.0%), barbiturates (7.8% vs 2.7%), and ergot alkaloids (3.1% vs 0.6%) and significantly less likely to be taking NSAIDs (63.3% vs 69.8%) (p < 0.001 for all comparisons). Respondents with AMO had significantly more MHDs (12.9 ± 8.6 vs 4.3 ± 4.3, p < 0.001); higher migraine symptom severity (17.8 ± 2.7 vs 16.4 ± 3.0, p < 0.001), higher pain intensity scores (7.4 vs 6.5, p < 0.001); and higher rates of cutaneous allodynia (53.7% vs 37.5%, p < 0.001). Adjusted for MHDs, the odds of AMO were increased by each additional year of age (OR 1.02, 95% CI 1.02, 1.03); being married (OR 1.19, 95% CI 1.06, 1.34); smoking (OR 1.54, 95% CI 1.31, 1.81); having psychological symptoms (OR 1.62, 95% CI 1.43, 1.83) or cutaneous allodynia (OR 1.22, 95% CI 1.08, 1.37); and greater migraine symptom severity (OR 1.06, 95% CI 1.04, 1.09) and pain intensity (OR 1.27, 95% CI 1.22, 1.32). Cutaneous allodynia increased the risk of AMO by 61% in males (OR 1.61, 95% CI 1.28, 2.03) but did not increase risk in females (OR 1.08, 95% CI 0.94, 1.25). Conclusions AMO was present in 15% of respondents with migraine. AMO was associated with higher symptom severity scores, pain intensity, and rates of cutaneous allodynia. AMO was more likely in triptan, opioid, and barbiturate users but less likely in NSAID users. Cutaneous allodynia was associated with AMO in men but not women. This gender difference merits additional exploration.
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Affiliation(s)
- Todd J Schwedt
- Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA.
| | - Aftab Alam
- Promius Pharma, 107 College Rd East, Princeton, NJ, 08540, USA
| | - Michael L Reed
- Vedanta Research, 23 Tanyard Ct, Chapel Hill, NC, 27517, USA
| | | | - Sagar Munjal
- Promius Pharma, 107 College Rd East, Princeton, NJ, 08540, USA
| | - Dawn C Buse
- Albert Einstein College of Medicine, 1250 Waters Place, 8th Floor, Bronx, NY, 10461, USA
| | - David W Dodick
- Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA
| | - Richard B Lipton
- Montefiore Medical Center, The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, 1165 Morris Park Avenue, Rousso Building, Room 332, Bronx, NY, 10461, USA
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Steiner TJ, Buse DC, Al Jumah M, Westergaard ML, Jensen RH, Reed ML, Prilipko L, Mennini FS, Láinez MJA, Ravishankar K, Sakai F, Yu SY, Fontebasso M, Al Khathami A, MacGregor EA, Antonaci F, Tassorelli C, Lipton RB. The headache under-response to treatment (HURT) questionnaire, an outcome measure to guide follow-up in primary care: development, psychometric evaluation and assessment of utility. J Headache Pain 2018; 19:15. [PMID: 29445880 PMCID: PMC5812954 DOI: 10.1186/s10194-018-0842-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 01/08/2018] [Accepted: 01/27/2018] [Indexed: 01/03/2023] Open
Abstract
Background Headache disorders are both common and burdensome but, given the many people affected, provision of health care to all is challenging. Structured headache services based in primary care are the most efficient, equitable and cost-effective solution but place responsibility for managing most patients on health-care providers with limited training in headache care. The development of practical management aids for primary care is therefore a purpose of the Global Campaign against Headache. This manuscript presents an outcome measure, the Headache Under-Response to Treatment (HURT) questionnaire, describing its purpose, development, psychometric evaluation and assessment for clinical utility. The objective was a simple-to-use instrument that would both assess outcome and provide guidance to improving outcome, having utility across the range of headache disorders, across clinical settings and across countries and cultures. Methods After literature review, an expert consensus group drawn from all six world regions formulated HURT through item development and item reduction using item-response theory. Using the American Migraine Prevalence and Prevention Study’s general-population respondent panel, two mailed surveys assessed the psychometric properties of HURT, comparing it with other instruments as external validators. Reliability was assessed in patients in two culturally-contrasting clinical settings: headache specialist centres in Europe (n = 159) and primary-care centres in Saudi Arabia (n = 40). Clinical utility was assessed in similar settings (Europe n = 201; Saudi Arabia n = 342). Results The final instrument, an 8-item self-administered questionnaire, addressed headache frequency, disability, medication use and effect, patients’ perceptions of headache “control” and their understanding of their diagnoses. Psychometric evaluation revealed a two-factor model (headache frequency, disability and medication use; and medication efficacy and headache control), with scale properties apparently stable across disorders and correlating well and in the expected directions with external validators. The literature review found few instruments linking assessment to clinical advice or suggested actions: HURT appeared to fill this gap. In European specialist care, it showed utility as an outcome measure across headache disorders. In Saudi Arabian primary care, HURT (translated into Arabic) was reliable and responsive to clinical change. Conclusions With demonstrated validity and clinical utility across disorders, cultures and settings, HURT is available for clinical and research purposes. Electronic supplementary material The online version of this article (10.1186/s10194-018-0842-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- T J Steiner
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, NO-7941, Trondheim, Norway. .,Division of Brain Sciences, Imperial College London, London, UK.
| | - D C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore Headache Center, Montefiore Medical Center, Bronx, NY, USA
| | - M Al Jumah
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - M L Westergaard
- Danish Headache Centre, Department of Neurology, Rigshospitalet Glostrup University of Copenhagen, Glostrup, Denmark
| | - R H Jensen
- Danish Headache Centre, Department of Neurology, Rigshospitalet Glostrup University of Copenhagen, Glostrup, Denmark
| | - M L Reed
- Vedanta Research, Chapel Hill, NC, USA
| | - L Prilipko
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - F S Mennini
- CEIS EEHTA, Faculty of Economics, University of Rome "Tor Vergata", Rome, Italy.,Institute of Leadership and Management in Health, Kingston University, Kingston upon Thames, UK
| | - M J A Láinez
- Department of Neurology, University Clinic Hospital, Catholic University of Valencia, Valencia, Spain
| | - K Ravishankar
- The Headache and Migraine Clinic, Jaslok Hospital and Research Centre, Mumbai, India.,Lilavati Hospital and Research Centre, Mumbai, India
| | - F Sakai
- Saitama International Headache Center, Tokyo, Japan
| | - S-Y Yu
- Department of Neurology, Chinese PLA General Hospital, Bejing, People's Republic of China
| | - M Fontebasso
- Headache Expert, Author and Headache Education Facilitator, York, UK
| | - A Al Khathami
- King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - E A MacGregor
- Centre for Neuroscience & Trauma, Blizard Institute of Cell and Molecular Science, London, UK
| | - F Antonaci
- Headache Science Centre, C Mondino National Neurological Institute, Pavia, Italy.,Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - C Tassorelli
- Headache Expert, Author and Headache Education Facilitator, York, UK.,Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - R B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore Headache Center, Montefiore Medical Center, Bronx, NY, USA
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Buse DC, Powers SW, Gelfand AA, VanderPluym JH, Fanning KM, Reed ML, Adams AM, Lipton RB. Adolescent Perspectives on the Burden of a Parent's Migraine: Results from the CaMEO Study. Headache 2018; 58:512-524. [DOI: 10.1111/head.13254] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Dawn C. Buse
- Montefiore Medical Center; Bronx NY USA
- Department of Neurology; Albert Einstein College of Medicine; Bronx NY USA
| | - Scott W. Powers
- Headache Center and Division of Behavioral Medicine and Clinical Psychology; Cincinnati Children's Hospital; Cincinnati OH USA
- University of Cincinnati College of Medicine; Cincinnati OH USA
| | - Amy A. Gelfand
- UCSF Pediatric Headache Center and Division of Child Neurology; San Francisco CA USA
| | | | | | | | | | - Richard B. Lipton
- Montefiore Medical Center; Bronx NY USA
- Department of Neurology; Albert Einstein College of Medicine; Bronx NY USA
- Department of Epidemiology and Population Health; Albert Einstein College of Medicine; Bronx NY USA
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Lipton RB, Reed ML, Kurth T, Fanning KM, Buse DC. Framingham-Based Cardiovascular Risk Estimates Among People With Episodic Migraine in the US Population: Results from the American Migraine Prevalence and Prevention (AMPP) Study. Headache 2017; 57:1507-1521. [PMID: 28990165 DOI: 10.1111/head.13179] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [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: 05/28/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Cardiovascular (CV) events, conditions, and procedures (ECPs) are common in persons with migraine and are a contraindication to triptan and ergot use. In a prior study, we estimated that there are 2.6 million American adults with episodic migraine (EM) who have had CV ECPs. However, the prior analysis did not assess persons with migraine without CV ECPs who are at high risk for a first cardiovascular disease (CVD) event. OBJECTIVES To use the Framingham nonlaboratory CVD events risk equation to estimate the number of individuals with EM who are at elevated risk for a first CVD event in the next 10 years using data from the American Migraine Prevalence and Prevention Study, and then to extrapolate the findings to the US population to estimate the scope of people with EM for whom triptan and ergot therapies may be problematic. METHODS Data from respondents to the 2009 American Migraine Prevalence and Prevention (AMPP) Study questionnaire aged ≥22 who met criteria and headache day frequency for EM were included in this cross-sectional analysis. Ten-year, first CVD event risk was calculated using the nonlaboratory Framingham CV disease risk score (FRS). Variables were collected via respondent self-report and included sex, age, height, and weight to calculate body mass index (BMI), smoking status, and the presence of hypertension and diabetes among other variables. Standard FRS cut scores of ≥21 for women and ≥16 for men were used, which indicate a 30% or greater risk of a first CVD event in the next 10 years. History of CV ECPs was collected via self-report of ever having the ECP and for events and conditions that were diagnosed by a physician. We applied rates of positive ECPs and rates of high FRS to age and sex stratified estimates of the number of people with EM in the US derived from 2015 US Census data to estimate rates of both in the population. RESULTS The AMPP Study analysis sample included 5227 women and 1496 men with EM. Results showed that 69.5% of women and 73.4% of men had at least one CV risk factor from the FRS, 38.9% of women and 41.6% of men had ≥2 risk factors, and 18.6% of women and 19.1% of men had ≥3 risk factors. The proportion of women with high FRS was 0% for those aged 22-39, 0.8% (95%CI: 0.5-1.2%) among 40- to 59-year-olds and 15.2% (95% CI: 13.3-17.4%) among the ≥60 age group. For men, the corresponding proportions were 0, 7.3% (95% CI: 5.7-9.4%), and 53.0% (95% CI: 4.7-58.1%). Projecting to a national US sample, the number of persons with EM and high FRS was 403,000 for women and 510,000 for men. The proportion of women and men at high risk for future CV events based on a prior CV ECP, a high FRS or both increased with age from 20-39 (women 4.5%, men 4.2%), 40-59 (women 11.8%, men 18.6%), and ≥60 (women 31.2%, men 61.8%). An estimated 141,000 men aged 40-59 and 187,000 aged ≥60 and 34,000 women aged 40-59 and 181,000 women aged ≥60 in the US population with EM have not had a CV ECP but are at increased risk for a future CV event within the next 10 years based upon their FRS alone. CONCLUSION Among people with EM in the US population, the number of women and men with relative contraindications to triptans and ergots based on a high FRS includes over 900,000 women and men. This includes more than half a million individuals with EM who have not had a prior CV ECP.
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Affiliation(s)
- Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine and Montefiore Headache Center, Bronx, NY (Richard B. Lipton and Dawn C. Buse).,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (Richard B. Lipton)
| | - Michael L Reed
- Vedanta Research, Chapel Hill, NC (Michael L. Reed and Kristina M. Fanning)
| | - Tobias Kurth
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Germany (Tobias Kurth)
| | - Kristina M Fanning
- Vedanta Research, Chapel Hill, NC (Michael L. Reed and Kristina M. Fanning)
| | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine and Montefiore Headache Center, Bronx, NY (Richard B. Lipton and Dawn C. Buse)
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Serrano D, Lipton RB, Scher AI, Reed ML, Stewart WBF, Adams AM, Buse DC. Fluctuations in episodic and chronic migraine status over the course of 1 year: implications for diagnosis, treatment and clinical trial design. J Headache Pain 2017; 18:101. [PMID: 28980171 PMCID: PMC5628086 DOI: 10.1186/s10194-017-0787-1] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [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: 06/01/2017] [Accepted: 07/14/2017] [Indexed: 01/03/2023] Open
Abstract
Background Relatively little is known about the stability of a diagnosis of episodic migraine (EM) or chronic migraine (CM) over time. This study examines natural fluctuations in self-reported headache frequency as well as the stability and variation in migraine type among individuals meeting criteria for EM and CM at baseline. Methods The Chronic Migraine Epidemiology and Outcomes (CaMEO) Study was a longitudinal survey of US adults with EM and CM identified by a web-questionnaire. A validated questionnaire was used to classify respondents with EM (<15 headache days/month) or CM (≥15 headache days/month) every three months for a total of five assessments. We described longitudinal persistence of baseline EM and CM classifications. In addition, we modelled longitudinal variation in headache day frequency per month using negative binomial repeated measures regression models (NBRMR). Results Among the 5464 respondents with EM at baseline providing four or five waves of data, 5048 (92.4%) had EM in all waves and 416 (7.6%) had CM in at least one wave. Among 526 respondents with CM at baseline providing four or five waves of data, 140 (26.6%) had CM in every wave and 386 (73.4%) had EM for at least one wave. Individual plots revealed striking within-person variations in headache days per month. The NBRMR model revealed that the rate of headache days increased across waves of observation 19% more per wave for CM compared to EM (rate ratio [RR], 1.19; 95% CI, 1.13–1.26). After adjustment for covariates, the relative difference changed to a 26% increase per wave (RR, 1.26; 95% CI, 1.2–1.33). Conclusions Follow-up at three-month intervals reveals a high level of short-term variability in headache days per month. As a consequence, many individuals cross the CM diagnostic boundary of ≥15 headache days per month.Nearly three quarters of persons with CM at baseline drop below this diagnostic boundary at least once over the course of a year. These findings are of interest in the consideration of headache classification and diagnosis, the design and interpretation of epidemiologic and clinical studies, and clinical management. Electronic supplementary material The online version of this article (doi:10.1186/s10194-017-0787-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Richard B Lipton
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA. .,Montefiore Headache Center; Department of Neurology and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Ann I Scher
- Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | | | | | - Dawn C Buse
- Montefiore Medical Center, Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
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Lipton RB, Munjal S, Buse DC, Bennett A, Fanning KM, Burstein R, Reed ML. Allodynia Is Associated With Initial and Sustained Response to Acute Migraine Treatment: Results from the American Migraine Prevalence and Prevention Study. Headache 2017; 57:1026-1040. [PMID: 28603893 DOI: 10.1111/head.13115] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [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: 04/18/2017] [Accepted: 04/18/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVE In a population sample of persons with migraine treating with a single category of acute migraine medication, to identify rates and factors associated with acute treatment outcomes, including 2-hour pain freedom (2hPF), 24-hour pain response (24hPR), and 24-hour sustained pain response (24hSPR). Key predictors include acute treatment type (triptans and other medication categories), the influence of allodynia on response to medication, and the interaction between medication category and presence of allodynia in response to treatment among people with migraine. BACKGROUND Cutaneous allodynia was previously associated with inadequate 2hPF, 24hPR, and 24hSPR (sustained response at 24 hours among those with adequate 2hPF) among people with migraine in the American Migraine Prevalence and Prevention (AMPP) Study. METHODS The AMPP Study obtained data from a representative US sample of persons with migraine by mailed questionnaire. The 2006 survey included 8233 people with migraine aged 18 or over who completed the Migraine Treatment Optimization Questionnaire (mTOQ). mTOQ was used to assess acute treatment outcomes including 2hPF, 24hPR, and 24hSPR. Eligible individuals used only a single category of acute prescription migraine treatments (n = 5236, 63.6%). This sample was stratified into 5 categories of type of acute prescription headache medication used (triptans, nonsteroidal anti-inflammatory drugs, barbiturate-combinations, opioids, and opioid combinations and ergot alkaloids). Separate binary logistic regression models evaluated: (1) triptans vs other medication types; (2) presence of allodynia vs no allodynia; and (3) the interaction of medication category with allodynia. Sociodemographic variables, health insurance status, over-the-counter and preventive medication use were included as covariates. Odds ratios (OR) and 95% confidence intervals (CI) were generated for each acute treatment outcome. RESULTS Among eligible participants, the mean age was 46 years, and 82.5% were women. The triptan use group had better outcomes than other medication groups for 2hPF (OR range: 2.00-2.63, all significant except ergot alkaloids) and 24hPR (OR range: 2.10-6.22, all significant). No significant medication effects were found for the 24hSPR outcome. The presence of allodynia was associated with significantly worse outcomes for both 2hPF (OR range: 1.42-1.55, all significant) and 24hPR (OR range: 1.30-1.32, all significant, except for ergot alkaloids, P = .051). Allodynia effects were not significant for the 24hSPR. The interaction between medication and allodynia was also not significant (OR range for 2hPF: .68-2.02; OR range for 2hPR: .35-1.34; OR range for 24hSPR: 1.21-2.72) in any of the models, suggesting allodynia is an important predictor of treatment response regardless of the medication group prescribed. CONCLUSIONS The use of triptan medication was associated with significantly better 2hPF (except vs ergot alkaloids) and significantly better 24hPR outcomes compared with other acute medication categories. The presence of allodynia significantly increased the likelihood of an inadequate treatment response for both of these outcomes. Triptan use was generally associated with the best outcomes. Because allodynia was associated with inadequate outcomes for all medication groups, we suggest that allodynia is an area of unmet treatment need.
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Affiliation(s)
- Richard B Lipton
- Montefiore Medical Center, Bronx, NY, USA.,Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sagar Munjal
- Dr. Reddy's Laboratories and its affiliate Promius Pharma, Princeton, NJ, USA
| | - Dawn C Buse
- Montefiore Medical Center, Bronx, NY, USA.,Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alix Bennett
- Dr. Reddy's Laboratories and its affiliate Promius Pharma, Princeton, NJ, USA
| | | | - Rami Burstein
- Beth Israel Deaconess Medical Center, Boston, MA, USA
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Lipton RB, Buse DC, Adams AM, Varon SF, Fanning KM, Reed ML. Family Impact of Migraine: Development of the Impact of Migraine on Partners and Adolescent Children (IMPAC) Scale. Headache 2017; 57:570-585. [PMID: 28185239 PMCID: PMC5396278 DOI: 10.1111/head.13028] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 07/07/2016] [Revised: 10/28/2016] [Accepted: 11/29/2016] [Indexed: 11/08/2022]
Abstract
Objective To describe the development of the Impact of Migraine on Partners and Adolescent Children (IMPAC) scale. Background Although existing data and clinical experience suggest that the impact of migraine is pervasive and extends beyond the individual with migraine, no validated tools exist for assessing the impact of migraine on the family. Methods The Chronic Migraine Epidemiology and Outcomes (CaMEO) Study is a longitudinal study of people with migraine in the United States. The Family Burden Module (FBM) of the CaMEO Study contained an item pool of 53 questions derived through literature review, clinician input, and patient focus groups pertaining to the following concepts: impact of migraine on family interpersonal relationships, activities, well‐being, finances, and health‐related quality of life. Respondents with migraine (ie, probands) were categorized into 4 groups based on household composition: migraine probands with partners/spouses and children (M‐PC), migraine probands with partners/spouses only (M‐P), migraine probands with child(ren) only (M‐C), and migraine probands without a partner/spouse or child(ren) (M‐O). The IMPAC scale was developed in 3 steps: (1) exploratory factor analysis and item reduction, (2) bifactor analysis, confirmatory factor analysis, and scoring, and (3) reliability and construct validity analyses. Results The analysis of data from 13,064 respondents to the FBM meeting criteria for migraine yielded a 12‐item IMPAC scale, with 4 items applying to all of the groups, 4 more items applying to the groups with partners (M‐P and M‐PC), and 4 additional items to the groups with children (M‐C and M‐PC). Item responses can be summed and converted into a scoring system assessing mild (<0.5 SD below mean; IMPAC scale Grade I), moderate (0.5 SD below to <0.5 SD above mean; Grade II), severe (0.5‐<1.5 SD above mean; Grade III), and very severe (≥0.5 SD above mean; Grade IV) family impact. Test information curves relating to the IMPAC scale for each household type indicated adequate reliability across a large range of family burden severity (from ∼1 SD below to ∼3 SD above mean) and IMPAC scores showed moderate‐to‐large correlations with other validated tools (range, ± 0.38‐0.52), providing support for construct validity. Conclusions We developed a questionnaire to assess family burden attributed to migraine that is brief, robust, and psychometrically sound, with a simple scoring algorithm that can be applied to various household compositions. This questionnaire may be valuable in research settings to provide quantifiable data on the impact of migraine on family dynamics and in clinical settings to facilitate conversations about family burden as a target and a motivation for better treatment.
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Affiliation(s)
- Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore Medical Center, Bronx, NY, USA
| | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore Medical Center, Bronx, NY, USA
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Golish SR, Reed ML. Spinal devices in the United States-investigational device exemption trials and premarket approval of class III devices. Spine J 2017; 17:150-157. [PMID: 27737804 DOI: 10.1016/j.spinee.2016.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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] [Received: 10/08/2015] [Revised: 06/28/2016] [Accepted: 09/14/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Recently, there has been increased public awareness of regulatory actions by the United States Food and Drug Administration (FDA) on spinal devices. There has also been increased scrutiny of the pivotal clinical trials of these devices. PURPOSE To investigate the premarket approval (PMA) of class III spinal devices in the United States since the turn of the century. To explore clinically relevant issues that affect the interpretation of investigational device exemption trials. STUDY DESIGN Literature review. METHODS From 2000 to 2015, data on PMA applications for spinal devices were obtained from two sources. First, meetings of FDA's Orthopaedic and Rehabilitation Devices Panel were identified from the Federal Register. Second, the FDA database of approved PMA applications was queried. For each device, two authors reviewed all archival data. There was no external source of funding. RESULTS Twenty-one devices met the study criteria. There were 76.2% that received approval and 47.6% that went to panel. Arthroplasty devices were most common (52.4%), least likely to go to panel (3 of 11), and most likely to be approved after panel (3 of 3). Biologic devices were most likely to go to panel (3 of 3) and least likely to be approved after panel (1 of 3). Before and after 2009, there was no decrease in the number of spinal devices approved. All 21 devices were studied in a pivotal clinical trial. All trials except one were randomized controlled trials, and all trials except one were two-arm noninferiority designs. CONCLUSIONS There has been no decrease in the number of new FDA-approved class III spinal devices since the turn of the century. The majority of devices have been for cervical arthroplasty. By contrast, biologic devices were most likely to go to panel and least likely to be approved after panel. The pivotal trials for nearly all devices were randomized, two-arm, noninferiority trials.
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Affiliation(s)
- S Raymond Golish
- Department of Surgery, Jupiter Medical Center, Palm Beach, FL, USA.
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Buse DC, Reed ML, Fanning KM, Kurth T, Lipton RB. Cardiovascular Events, Conditions, and Procedures Among People With Episodic Migraine in the US Population: Results from the American Migraine Prevalence and Prevention (AMPP) Study. Headache 2016; 57:31-44. [PMID: 27861837 DOI: 10.1111/head.12962] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [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: 08/20/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Though migraine, particularly migraine with aura, is a cardiovascular (CV) risk factor, the scope and distribution of cardiovascular disease in representative samples of people with migraine are not known. This is important because many widely used acute migraine treatments, including triptans, ergot alkaloids, and nonsteroidal anti-inflammatory drugs, carry precautions, warnings, or contraindications for use in persons with CV disease. OBJECTIVES To assess the scope and distribution of cardiovascular events, conditions, and procedures in persons with episodic migraine in a representative sample of the US population, using data from the American Migraine Prevalence and Prevention (AMPP) Study. METHODS Eligible subjects completed the 2009 AMPP survey, met ICHD-3beta criteria for migraine, and had a headache frequency of less than 15 days per month (episodic migraine). A survey on cardiovascular events (ie, myocardial infarction), conditions (ie, angina), and procedures (ie, carotid endarterectomy) was adopted from the Women's Health Study and the Physician's Health Studies. Cardiovascular events and conditions were defined by participant reports of having both experienced and received a physician diagnosis for a particular event or condition. The distribution of CV events, conditions, and procedures was summarized for the entire migraine sample and in groups defined by gender and age (22-39, 40-59, and ≥60). To assess the numbers of persons with episodic migraine in the US, we applied age and gender stratified estimates of migraine prevalence to the 2015 Census data. To estimate the number of cardiovascular events, conditions, and procedures in the US migraine population, we applied age and gender stratified event rates to the number of persons with episodic migraine in each stratum. RESULTS The 2009 AMPP Study survey was returned by 11,792 study participants out of 16,983 (64.9% response rate), including 6723 individuals who met study criteria for episodic migraine (5227 women and 1496 men). Among 22-39 year olds with episodic migraine, 3.4% reported having received a physician diagnosis of CV events or conditions and 1.1% reported undergoing CV related procedures. Among 40-59 year olds, 10.2% reported having received a physician diagnosis of CV events or conditions and 3.5% reported CV related procedures. For those age 60 or older, 22.3% reported CV events or conditions and 8.8% reported CV procedures. Prevalence of events, conditions, and procedures was higher in men than women and also in older age groups. However, the absolute number of CV events, procedures, and conditions was greater for women than men due to the higher population prevalence of episodic migraine in women. We projected that 2.0 million women and 665,000 men in the US had episodic migraine and a history of one or more CV event, condition, or procedure. By age group, it is estimated that 579,000 among those aged 22-39, 1.37 million of those aged 40-59, and 696,000 of those 60 and older with episodic migraine have ever had at least one CV event, procedure, or condition. CONCLUSION Based on these analyses, we estimate that there are roughly 2.6 million people with episodic migraine aged 22 and older in the US with one or more prior CV event, condition, or procedure. For this group, cardiovascular contraindications to many migraine-specific acute migraine therapies may make treatment challenging.
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Affiliation(s)
- Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine and Montefiore Headache Center, Bronx, NY, USA
| | | | | | - Tobias Kurth
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Richard B Lipton
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Germany
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Lipton RB, Munjal S, Buse DC, Fanning KM, Bennett A, Reed ML. Predicting Inadequate Response to Acute Migraine Medication: Results From the American Migraine Prevalence and Prevention (AMPP) Study. Headache 2016; 56:1635-1648. [DOI: 10.1111/head.12941] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Richard B. Lipton
- Saul R. Korey Department of Neurology; Albert Einstein College of Medicine; Bronx NY USA
- Montefiore Medical Center; Bronx NY USA
| | - Sagar Munjal
- Promius Pharma; a subsidiary of Dr. Reddy's Laboratories; Princeton NJ USA
| | - Dawn C. Buse
- Saul R. Korey Department of Neurology; Albert Einstein College of Medicine; Bronx NY USA
| | | | - Alix Bennett
- Promius Pharma; a subsidiary of Dr. Reddy's Laboratories; Princeton NJ USA
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Wright D, Edelbrock C, Reed ML. Convergent and Discriminant Validity of the Burks Behavior Rating Scales. Journal of Psychoeducational Assessment 2016. [DOI: 10.1177/073428298300100305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The construct validity of the Burks Behavior Rating Scales was investigated by the multitrait-multimethod matrix procedure. Correlations between parent and teacher ratings of 38 children referred for psychological evaluations supported the convergent and discriminant validity of 9 of the 19 scales. Analyses of teacher-teacher correlations for 40 referred children supported the validity of 16 scales. The construct validity of three previously derived broad-band factors labeled Neurotic, Immature, and Hostile-Aggressive was not supported. Results were discussed in terms of the differential validity of the Burks scales. Caution was urged in interpreting scores on scales labeled Poor Intellectuality and Excessive Suffering, as well as scores on the three broad-band factors.
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Lipton RB, Manack Adams A, Buse DC, Fanning KM, Reed ML. A Comparison of the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study and American Migraine Prevalence and Prevention (AMPP) Study: Demographics and Headache-Related Disability. Headache 2016; 56:1280-9. [PMID: 27349336 PMCID: PMC5132024 DOI: 10.1111/head.12878] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [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: 03/02/2016] [Revised: 05/03/2016] [Accepted: 05/09/2016] [Indexed: 01/03/2023]
Abstract
Objective To compare the methods and baseline characteristics of the American Migraine Prevalence and Prevention (AMPP) and Chronic Migraine Epidemiology and Outcomes (CaMEO) studies. Background The AMPP and CaMEO studies are the largest longitudinal efforts designed to improve our understanding of episodic and chronic migraine in the United States. The studies have complementary strengths and weaknesses. Methods This analysis compares and contrasts the study methods and participation rates of the AMPP and CaMEO studies. We then compare and contrast baseline results in terms of demographic characteristics, headache features, and disability as measured by the Migraine Disability Assessment Scale (MIDAS) among people with episodic and chronic migraine. Results AMPP and CaMEO sampled from panels constructed to be representative of the US population. The AMPP Study collected data using a mailed questionnaire while CaMEO relied on a web survey methodology. Response rates were higher in AMPP (64.8%) than in CaMEO (16.5%). Both studies assessed headache features using the American Migraine Study/AMPP diagnostic module. Both identified persons with episodic (<15 headache days/month) and chronic migraine (≥15 headache days/month) based on the International Classification of Headache Disorders. AMPP collected data annually over 5 years, while CaMEO collected data quarterly over 15 months. Baseline demographic distribution was generally similar, indicating that each study was broadly representative of the US population. The proportion of persons with migraine who had chronic migraine was similar (AMPP, 6.6%; CaMEO, 8.8%). Respondents had similar median headache frequency (days/month) by sex for chronic migraine (AMPP: men = 21.7, women = 20.0; CaMEO: men = 20.0, women = 20.0) and episodic migraine (AMPP: men = 1.7, women = 2.0; CaMEO: men = 2.0, women = 3.0). Median MIDAS scores were substantially higher in both studies for chronic migraine (severe disability [Grade IV]; AMPP: men = 33.0, women = 45.0; CaMEO: men = 32.0, women = 38.0) than episodic migraine (little/mild disability [Grade I/II]; AMPP: men = 3.0, women = 6.0; CaMEO: men = 4.0, women = 7.0). Rates of moderate/severe disability (Grade III/IV) were substantially higher in both studies for chronic migraine (AMPP: men = 66.9%, women = 78.9%; CaMEO: men = 71.0%, women = 82.6%) than episodic migraine (AMPP: men = 23.0%, women = 31.8%; CaMEO: men = 26.7%, women = 37.9%). More women than men respondents in both studies experienced moderate/severe disability. Conclusions AMPP and CaMEO are longitudinal cohort studies that used different methods, but yielded similar results for demographic features, headache frequency, and headache‐related disability. Both studies found more severe headache‐related disability in those with chronic versus episodic migraine.
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Affiliation(s)
- Richard B Lipton
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA. .,Montefiore Medical Center, Bronx, NY, USA.
| | | | - Dawn C Buse
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore Medical Center, Bronx, NY, USA
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