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Stearns SA, Xun H, Haddad A, Rinkinen J, Bustos VP, Lee BT. Therapeutic Options for Migraines in the Microsurgical Patient: A Scoping Review. Plast Reconstr Surg 2024; 153:988e-1001e. [PMID: 37337332 DOI: 10.1097/prs.0000000000010861] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND There exists an increasing array of treatments proposed to prevent, alleviate, and abort symptoms of a migraine; however, for patients who undergo reconstructive microsurgery, caution must be taken to preserve vascular integrity. This study is the first-to-date scoping review of vascular and bleeding risk of current migraine therapies, with the purpose of identifying potential therapeutic agents for postoperative migraine management appropriate for microsurgical patients. METHODS Currently available migraine therapeutics were compiled from the UpToDate software system and the American Academy of Family Physicians. A PubMed literature review was performed for each therapeutic's effect on bleeding or vascular involvement. Data were compiled into tables of abortive, symptom-controlling and prophylactic, and nonpharmacologic treatments. Expert microsurgeons reviewed the data to provide recommendations for optimized patient care. RESULTS Triptans and other ergot derivatives demonstrated strong evidence of vasoconstriction and were greatly advised against for immediate postmicrosurgical use. Novel pharmaceutical therapies such as lasmiditan and calcitonin gene-related peptide antagonists have no literature indicating potential for vasoconstriction or hematoma and remain an investigational option for abortive medical treatment. For symptom control, acetaminophen appears the safest option, with clinical judgment and further research needed for use of nonsteroidal antiinflammatory drugs. Alternative treatment techniques may include migraine prophylaxis with botulinum toxin injection or nutraceutical treatment by means of magnesium supplementation or coenzyme Q10 administration, minimizing the need for additional medication in the postoperative setting. CONCLUSIONS Patients undergoing reconstructive microsurgery have a unique medical profile limiting the therapeutic options available to treat migraines. This review provides preliminary evidence to be considered as a guide for prescribing therapeutics for migraine in the postoperative setting.
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Affiliation(s)
| | - Helen Xun
- the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Anthony Haddad
- the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Jacob Rinkinen
- the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Valeria P Bustos
- the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Bernard T Lee
- the Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
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Singh S, Kopruszinski CM, Watanabe M, Dodick DW, Navratilova E, Porreca F. Female-selective mechanisms promoting migraine. J Headache Pain 2024; 25:63. [PMID: 38658853 PMCID: PMC11040950 DOI: 10.1186/s10194-024-01771-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
Sexual dimorphism has been revealed for many neurological disorders including chronic pain. Prelicinal studies and post-mortem analyses from male and female human donors reveal sexual dimorphism of nociceptors at transcript, protein and functional levels suggesting different mechanisms that may promote pain in men and women. Migraine is a common female-prevalent neurological disorder that is characterized by painful and debilitating headache. Prolactin is a neurohormone that circulates at higher levels in females and that has been implicated clinically in migraine. Prolactin sensitizes sensory neurons from female mice, non-human primates and humans revealing a female-selective pain mechanism that is conserved evolutionarily and likely translationally relevant. Prolactin produces female-selective migraine-like pain behaviors in rodents and enhances the release of calcitonin gene-related peptide (CGRP), a neurotransmitter that is causal in promoting migraine in many patients. CGRP, like prolactin, produces female-selective migraine-like pain behaviors. Consistent with these observations, publicly available clinical data indicate that small molecule CGRP-receptor antagonists are preferentially effective in treatment of acute migraine therapy in women. Collectively, these observations support the conclusion of qualitative sex differences promoting migraine pain providing the opportunity to tailor therapies based on patient sex for improved outcomes. Additionally, patient sex should be considered in design of clinical trials for migraine as well as for pain and reassessment of past trials may be warranted.
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Affiliation(s)
- Shagun Singh
- Banner - University Medicine Sunrise Primary Care, Tucson, AZ, 85750, USA
| | - Caroline M Kopruszinski
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ, 85724, USA
| | - Moe Watanabe
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ, 85724, USA
| | - David W Dodick
- Department of Neurology, Mayo Clinic, Phoenix, AZ, USA
- Atria Academy of Science and Medicine, New York, NY, USA
| | - Edita Navratilova
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ, 85724, USA
- Department of Neurology, Mayo Clinic, Phoenix, AZ, USA
| | - Frank Porreca
- Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ, 85724, USA.
- Department of Neurology, Mayo Clinic, Phoenix, AZ, USA.
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Liu X, Liu R, Liu W, Hua R, Xu H. Association between oxidative balance score and self-reported severe headache or migraine based on NHANES 1999 to 2004 data: A cross-sectional study. Heliyon 2024; 10:e27426. [PMID: 38500974 PMCID: PMC10945180 DOI: 10.1016/j.heliyon.2024.e27426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/20/2024] Open
Abstract
Purpose The pathophysiological mechanisms underlying migraine remain elusive, with oxidative stress hypothesized as a potential etiological factor. The Oxidative Balance Score (OBS) is a comprehensive tool for assessing the impact of diet and lifestyle on oxidative stress, thereby gauging an individual's overall antioxidant capacity. In this cross-sectional study, we explored the correlation between OBS and migraine prevalence among a cohort of US adults. Methods We analyzed data from 6195 participants aged 20 years and above, drawn from the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2004. We employed multiple logistic regression, coupled with sensitivity analyses, to investigate the relationship between OBS and migraine. Subsequent subgroup analyses and interaction tests were performed to assess the consistency of this association across the population. Results Multiple logistic regression revealed an inverse relationship between OBS and the likelihood of experiencing migraines. Specifically, individuals in the highest OBS quartile exhibited a significantly reduced migraine risk compared to those in the lowest quartile (OR = 0.98, 95% Confidence Interval (CI): 0.97-0.99, P = 0.0001). Furthermore, restricted cubic spline curves indicated a non-linear association between dietary OBS and migraine incidence (non-linear P = 0.0258). Discussion Our findings suggest that adherence to an antioxidant-rich diet may be an effective strategy for mitigating migraine, potentially by influencing oxidative balance.
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Affiliation(s)
- Xinxin Liu
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ran Liu
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wenbin Liu
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Rong Hua
- The Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Haoyou Xu
- The Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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4
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Peled ZM, Gfrerer L. Introduction to VSI: Migraine surgery in JPRAS open. JPRAS Open 2024; 39:217-222. [PMID: 38293285 PMCID: PMC10827495 DOI: 10.1016/j.jpra.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 12/13/2023] [Indexed: 02/01/2024] Open
Affiliation(s)
- Ziv M. Peled
- Peled Plastic Surgery, 2100 Webster Street, Suite 109, San Francisco, CA 94115, United States
| | - Lisa Gfrerer
- Surgery Plastic and Reconstructive Surgery Weill Cornell Medicine, 425 East 61st Street, 10th Floor, New York, NY 10065, United States
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5
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Takagishi SC, Grinberg AS, Lindsey H, Goldman RE, Baird SA, Burrone L, Sico JJ, Damush TM. Headache Specialists' Perceptions of the Role of Health Psychologists in Headache Management: A Qualitative Study. Cureus 2024; 16:e56175. [PMID: 38618328 PMCID: PMC11015910 DOI: 10.7759/cureus.56175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 04/16/2024] Open
Abstract
Background Since headache specialists cannot treat all the patients with headache disorders, multidisciplinary teams that include health psychologists are becoming more prevalent. Health psychologists mainly use a form of cognitive-behavioral therapy (CBT), along with biofeedback on occasion, to effectively address patients' pain and headache disorders. The Veterans Health Administration (VHA) is one setting that routinely includes a health psychologist with advanced training in pain disorders in their pain care to its veterans. The VHA has established Headache Centers of Excellence (HCoE) around the country to provide multidisciplinary treatment for patients with headache disorders, which enables headache specialists to regularly interact with health psychologists. Objective The study's objective is to evaluate headache specialists' views of health psychologists in the treatment of patients with headache disorders. Method Semi-structured interviews were conducted with headache specialists in academic-based healthcare settings, the community, and VHA HCoE sites. The interviews were audio-recorded and de-identified so they could be transcribed and analyzed using content matrix analysis. Results Four themes emerged: headache specialists desired to work with health psychologists and included them as members of multidisciplinary teams; valued health psychologists because they provided non-pharmacological treatments, such as CBT and biofeedback; preferred in-person communication with health psychologists; and used multiple titles when referring to health psychologists. Conclusion Headache specialists valued health psychologists as providers of behavioral and non-pharmacological treatments and considered them essential members of multidisciplinary teams. Headache specialists should strive to work with a headache psychologist, not just a general health psychologist. By committing to this, headache specialists can foster changes in the quality of care, resource allocation, and training experiences related to health psychologists.
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Affiliation(s)
- Stanley Curtis Takagishi
- Headache Centers of Excellence (HCoE) Research & Evaluation Center, Veterans Health Administration, Department of Veterans Affairs, Orange, USA
- Psychology, James A. Haley Veterans' Hospital, Tampa, USA
| | - Amy S Grinberg
- Headache Centers of Excellence (HCoE) Research & Evaluation Center, Veterans Health Administration, Department of Veterans Affairs, Orange, USA
- Neurology, VA (Veterans Affairs) Connecticut Healthcare System, West Haven, USA
- Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA (Veterans Affairs) Connecticut Healthcare System, West Haven, USA
| | - Hayley Lindsey
- Headache Centers of Excellence (HCoE) Research & Evaluation Center, Veterans Health Administration, Department of Veterans Affairs, Orange, USA
- Neurology, VA (Veterans Affairs) Connecticut Healthcare System, West Haven, USA
| | - Roberta E Goldman
- Headache Centers of Excellence (HCoE) Research & Evaluation Center, Veterans Health Administration, Department of Veterans Affairs, Orange, USA
- Anthropology & Family Medicine, Warren Alpert Medical School of Brown University, Providence, USA
- Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Sean A Baird
- Health Research & Development Service, Richard L. Roudebush VA (Veterans Affairs) Medical Center, Indianapolis, USA
| | - Laura Burrone
- Headache Centers of Excellence (HCoE) Research & Evaluation Center, Veterans Health Administration, Department of Veterans Affairs, Orange, USA
- Neurology, VA (Veterans Affairs) Connecticut Healthcare System, West Haven, USA
- Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA (Veterans Affairs) Connecticut Healthcare System, West Haven, USA
| | - Jason J Sico
- Headache Centers of Excellence (HCoE) Research & Evaluation Center, Veterans Health Administration, Department of Veterans Affairs, Orange, USA
- Neurology, VA (Veterans Affairs) Connecticut Healthcare System, West Haven, USA
- Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA (Veterans Affairs) Connecticut Healthcare System, West Haven, USA
- Neurology, Yale School of Medicine, New Haven, USA
| | - Teresa M Damush
- Headache Centers of Excellence (HCoE) Research & Evaluation Center, Veterans Health Administration, Department of Veterans Affairs, Orange, USA
- Health Research & Development Service, Richard L. Roudebush VA (Veterans Affairs) Medical Center, Indianapolis, USA
- Center for Health Services and Outcomes Research, Indiana University School of Medicine, Indianapolis, USA
- Center for Health Services and Outcomes Research, Regenstrief Institute, Inc., Indianapolis, USA
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Zwack CC, Haghani M, de Bekker-Grob EW. Research trends in contemporary health economics: a scientometric analysis on collective content of specialty journals. HEALTH ECONOMICS REVIEW 2024; 14:6. [PMID: 38270771 PMCID: PMC10809694 DOI: 10.1186/s13561-023-00471-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 11/28/2023] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Health economics is a thriving sub-discipline of economics. Applied health economics research is considered essential in the health care sector and is used extensively by public policy makers. For scholars, it is important to understand the history and status of health economics-when it emerged, the rate of research output, trending topics, and its temporal evolution-to ensure clarity and direction when formulating research questions. METHODS Nearly 13,000 articles were analysed, which were found in the collective publications of the ten most specialised health economic journals. We explored this literature using patterns of term co-occurrence and document co-citation. RESULTS The research output in this field is growing exponentially. Five main research divisions were identified: (i) macroeconomic evaluation, (ii) microeconomic evaluation, (iii) measurement and valuation of outcomes, (iv) monitoring mechanisms (evaluation), and (v) guidance and appraisal. Document co-citation analysis revealed eighteen major research streams and identified variation in the magnitude of activities in each of the streams. A recent emergence of research activities in health economics was seen in the Medicaid Expansion stream. Established research streams that continue to show high levels of activity include Child Health, Health-related Quality of Life (HRQoL) and Cost-effectiveness. Conversely, Patient Preference, Health Care Expenditure and Economic Evaluation are now past their peak of activity in specialised health economic journals. Analysis also identified several streams that emerged in the past but are no longer active. CONCLUSIONS Health economics is a growing field, yet there is minimal evidence of creation of new research trends. Over the past 10 years, the average rate of annual increase in internationally collaborated publications is almost double that of domestic collaborations (8.4% vs 4.9%), but most of the top scholarly collaborations remain between six countries only.
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Affiliation(s)
- Clara C Zwack
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia.
| | - Milad Haghani
- School of Civil and Environmental Engineering, University of New South Wales, Sydney, NSW, Australia
| | - Esther W de Bekker-Grob
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Janis JE, Hehr J, Huayllani MT, Khansa I, Gfrerer L, Kavanagh K, Blake P, Gokun Y, Austen WG. Functional outcomes between headache surgery and targeted botox injections: A prospective multicenter pilot study. JPRAS Open 2023; 38:152-162. [PMID: 37920284 PMCID: PMC10618225 DOI: 10.1016/j.jpra.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 09/20/2023] [Indexed: 11/04/2023] Open
Abstract
Introduction Chronic migraine headaches (MH) are a principal cause of disability worldwide. This study evaluated and compared functional outcomes after peripheral trigger point deactivation surgery or botulinum neurotoxin A (BTA) treatment in patients with MH. Methods A long-term, multicenter, and prospective study was performed. Patients with chronic migraine were recruited at the Ohio State University and Massachusetts General Hospital and included in each treatment group according to their preference (BTA or surgery). Assessment tools including the Migraine Headache Index (MHI), Migraine Disability Assessment Questionnaire (MIDAS) total, MIDAS A, MIDAS B, Migraine Work and Productivity Loss Questionnaire-question 7 (MWPLQ7), and Migraine-Specific Quality of Life Questionnaire (MSQ) version 2.1 were used to evaluate functional outcomes. Patients were evaluated prior to treatment and at 1, 2, and 2.5 years after treatment. Results A total of 44 patients were included in the study (surgery=33, BTA=11). Patients treated surgically showed statistically significant improvement in headache intensity as measured on MIDAS B (p = 0.0464) and reduced disability as measured on MWPLQ7 (p = 0.0120) compared to those treated with BTA injection. No statistical difference between groups was found for the remaining functional outcomes. Mean scores significantly improved over time independently of treatment for MHI, MIDAS total, MIDAS A, MIDAS B, and MWPLQ 7 (p<0.05). However, no difference in mean scores over time was observed for MSQ. Conclusions Headache surgery and targeted BTA injections are both effective means of addressing peripheral trigger sites causing headache pain. However, lower pain intensity and work-related disabilities were found in the surgical group.
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Affiliation(s)
- Jeffrey E. Janis
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jason Hehr
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Maria T. Huayllani
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ibrahim Khansa
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Lisa Gfrerer
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass, USA
| | - Kaitlin Kavanagh
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Pamela Blake
- Headache Center of River Oaks, Houston, TX, USA
- University of Texas Health Science Center, Houston, TX, USA
| | - Yevgeniya Gokun
- Center for the Biostatistics, Department of Biomedical Informatics, The Ohio State University Wexner Center, Columbus, OH, USA
| | - William G. Austen
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass, USA
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Pu LL, Miller E, Schenk R. Utilizing directional preference in the management of cervicogenic headache: a case series. J Man Manip Ther 2023; 31:466-473. [PMID: 37261421 PMCID: PMC10642309 DOI: 10.1080/10669817.2023.2217592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 05/10/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND/PURPOSE Headaches are among the most common complaints requiring medical care, and annual expenditures for this condition are estimated to be 14 billion US dollars. The International Headache Society (IHS) describes cervicogenic headache (CGH) as a secondary type of headache emanating from the cervical spine which may be referred to one or more regions of the head and/or face. Mechanical Diagnosis and Therapy (MDT) is an approach shown to be effective in the management of spinal musculoskeletal disorders; however, there is limited evidence as to its efficacy in the management of CGH. The purpose of this case series was to examine the MDT approach in the assessment, classification, and management of a sample of patients experiencing cervicogenic headache. CASE DESCRIPTION This study was a prospective case series. Following IRB approval, 15 patients meeting the study inclusion criteria were recruited from a hospital-based outpatient physical therapy clinic. All subjects received a physical therapy examination by a Diploma trained MDT clinician which included but was not limited to patient self-report forms and the testing of repeated end range movements. The Numerical Pain Rating Scale (NPRS), Neck Disability Index (NDI), Headache Disability Index (HDI), Yellow Flag Risk Form (YFRF), Cervical Flexion Rotation Test (CFRT), and the Craniocervical Flexion Test (CCFT) were administered at the initial visit, 5th visit, and 10th visit or discharge, whichever occurred first. The NPRS, NDI, and HDI were re-administered at a 3 month follow up. Following the initial examination, patients were classified into the MDT categories of derangement, dysfunction, postural, or 'other' and then received intervention based on directional preference. OUTCOMES Fifteen subjects (mean age, 45.9 years; F = 11, M = 4; symptom duration, 44.3 months; average visits, 8.8) received an examination and intervention and completed follow-up outcome measures. Based on MDT classification criteria, all 15 subjects in this case series were classified as derangements. A non-parametric Friedman test of Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation differences among repeated measures was conducted on all outcome measures revealing statistically significant improvements in NPRS (p < .01), NDI(p < .01), and HDI (p < .01) scores at visit 10 and 3 month follow up. The mean change scores exceeded the minimal clinical important difference (MCID) for NPRS (4.2), NDI (7.6), and HDI (28.5). CCFT scores improved significantly from the initial examination to visit 5 (p < .01) and YFRF scores improved significantly between visits 5 and 10 (p < .01). DISCUSSION/CONCLUSION The diagnosis of CGH is difficult to determine based on pathoanatomical assessment. This case series suggests that the patient's response to repeated end range movements may indicate a directional preference for manual procedures and exercises which may be used in management of musculoskeletal conditions such as CGH.
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Affiliation(s)
- Lan Lin Pu
- Faith Regional Health Services, Department of Physical Therapy, Norfolk, NE, USA
| | - Eric Miller
- Program in Physical Therapy, D’Youville University, Buffalo, NY, USA
| | - Ronald Schenk
- Department of Physical Therapy, Tufts University School of Medicine, Boston, MA, USA
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Peled ZM, Gfrerer L, Hagan R, Al-Kassis S, Savvides G, Austen G, Valenti A, Chinta M. Anatomic Anomalies of the Nerves Treated during Headache Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5439. [PMID: 38025616 PMCID: PMC10662871 DOI: 10.1097/gox.0000000000005439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023]
Abstract
Background Headache surgery is a well-established, viable option for patients with chronic head pain/migraines refractory to conventional treatment modalities. These operations involve any number of seven primary nerves. In the occipital region, the surgical targets are the greater, lesser, and third occipital nerves. In the temporal region, they are the auriculotemporal and zygomaticotemporal nerves. In the forehead, the supraorbital and supratrochlear are targeted. The typical anatomic courses of these nerves are well established and documented in clinical and cadaveric studies. However, variations of this "typical" anatomy are quite common and relatively poorly understood. Headache surgeons should be aware of these common anomalies, as they may alter treatment in several meaningful ways. Methods In this article, we describe the experience of five established headache surgeons encompassing over 4000 cases with respect to the most common anomalies of the nerves typically addressed during headache surgery. Descriptions of anomalous nerve courses and suggestions for management are offered. Results Anomalies of all seven nerves addressed during headache operations occur with a frequency ranging from 2% to 50%, depending on anomaly type and nerve location. Variations of the temporal and occipital nerves are most common, whereas anomalies of the frontal nerves are relatively less common. Management includes broader dissection and/or transection of accessory injured nerves combined with strategies to reduce neuroma formation such as targeted reinnervation or regenerative peripheral nerve interfaces. Conclusions Understanding these myriad nerve anomalies is essential to any headache surgeon. Implications are relevant to preoperative planning, intraoperative dissection, and postoperative management.
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Affiliation(s)
- Ziv M. Peled
- From the Peled Plastic Surgery, San Francisco, Calif
| | - Lisa Gfrerer
- Department of Plastic Surgery, New York Presbyterian Weill Cornell Medical Center, New York, N.Y
| | | | - Salam Al-Kassis
- Division of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Georgia Savvides
- Department of Medical Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Gerald Austen
- Division of Plastic Surgery, Massachusetts General Hospital, Boston, Mass
| | - Alyssa Valenti
- Department of Plastic Surgery, New York Presbyterian Weill Cornell Medical Center, New York, N.Y
| | - Malini Chinta
- Department of Plastic Surgery, New York Presbyterian Weill Cornell Medical Center, New York, N.Y
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Alzahrani F, Alahmadi YM, Thagfan SSA, Alolayan S, Elbadawy HM. Migraine Management in Community Pharmacies: Knowledge, Attitude and Practice Patterns of Pharmacists in Saudi Arabia. PHARMACY 2023; 11:155. [PMID: 37888500 PMCID: PMC10610077 DOI: 10.3390/pharmacy11050155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/29/2023] [Accepted: 09/21/2023] [Indexed: 10/28/2023] Open
Abstract
In Saudi Arabia, community pharmacies offer healthcare services for different conditions. However, clarity of the competence of pharmacists in managing migraines is lacking. This study aimed to explore the current knowledge, attitude, and practice patterns of community pharmacists concerning migraine management in the northwestern part of Saudi Arabia. A cross-sectional study was carried out between June and September 2022 among 215 Saudi community pharmacists. Data analysis was performed by descriptive and inferential statistics using SPSS version 27. Most community pharmacists (87.9%) feel that migraine management is essential to their practice, and 83.3% suggest between one and five over-the-counter (OTC) migraine products daily. Among the study pharmacists, 83.7% feel migraine patients should try OTC before prescription medications. Only 9.3% of the community pharmacists do not believe that migraine is a neurological disorder. The medications most prescribed for migraine were triptans, representing 52.1% of prescriptions. There were significant differences between the gender of the pharmacists and their knowledge, attitude, and practice overall score (p-value = 0.04). Male pharmacists exhibited higher knowledge, attitude, and practice scores than female pharmacists. Although many community pharmacists acknowledge their expertise and involvement in managing migraines, there is a requirement for further education and training to enhance their capacity to offer complete care to migraine patients. Pharmacists should also consider non-pharmacological interventions and complementary therapies when treating migraine symptoms.
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Affiliation(s)
- Fahad Alzahrani
- Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Madinah 42353, Saudi Arabia
| | - Yaser M Alahmadi
- Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Madinah 42353, Saudi Arabia
| | - Sultan S Al Thagfan
- Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Madinah 42353, Saudi Arabia
| | - Sultan Alolayan
- Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Madinah 42353, Saudi Arabia
| | - Hossein M Elbadawy
- Department of Pharmacology and Toxicology, College of Pharmacy, Taibah University, Madinah 42353, Saudi Arabia
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Ramon AE, Possemato K, Beehler GP. Headache Disorders in VHA Primary Care: Prevalence, Psychiatric Comorbidity, and Health Care Utilization. Behav Med 2023:1-10. [PMID: 37712622 DOI: 10.1080/08964289.2023.2249169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 09/16/2023]
Abstract
Military veterans are at increased risk for headache disorders compared to the general population, yet the prevalence and burden associated with headache disorders among veterans is not yet well understood. In this electronic medical record study, we examined the prevalence of headache disorders among veterans seen in a northeastern network of Veterans Health Administration (VHA) primary care during 2017-2018. We also examined rates of psychiatric comorbidity and health care utilization of veterans with headache disorders for the year following the date of the first headache code in the medical record. Of the total population of veterans in the network, 1.3% had a headache disorder and another 3.5% had a possible headache disorder. Migraine and chronic migraine represented the majority of cases. Posttraumatic stress disorder was the most frequent psychiatric comorbidity. Having a headache disorder was associated with higher rates of primary care, neurology, pain clinic, and mental health service use but not higher rates of emergency department or Whole Health (e.g., patient-centered, holistic health services) use. Prevalence findings are comparable to those previously found among veterans, but a substantial proportion of veterans may have been misdiagnosed. Veterans with headache disorders have high rates of psychiatric comorbidity and use several types of health services at higher rates. Findings highlight the need for interdisciplinary care and further education and support for primary care providers. Primary care settings that integrate evidence-based behavioral and Whole Health services may be an optimal way of providing more holistic care for headache disorders.
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Kalkman DN, Couturier EGM, El Bouziani A, Dahdal J, Neefs J, Woudstra J, Vogel B, Trabattoni D, MaassenVanDenBrink A, Mehran R, de Winter RJ, Appelman Y. Migraine and cardiovascular disease: what cardiologists should know. Eur Heart J 2023; 44:2815-2828. [PMID: 37345664 DOI: 10.1093/eurheartj/ehad363] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/06/2023] [Accepted: 05/22/2023] [Indexed: 06/23/2023] Open
Abstract
Migraine is a chronic neurovascular disease with a complex, not fully understood pathophysiology with multiple causes. People with migraine suffer from recurrent moderate to severe headache attacks varying from 4 to 72 h. The prevalence of migraine is two to three times higher in women compared with men. Importantly, it is the most disabling disease in women <50 years of age due to a high number of years lived with disability, resulting in a very high global socioeconomic burden. Robust evidence exists on the association between migraine with aura and increased incidence of cardiovascular disease (CVD), in particular ischaemic stroke. People with migraine with aura have an increased risk of atrial fibrillation, myocardial infarction, and cardiovascular death compared with those without migraine. Ongoing studies investigate the relation between migraine and angina with non-obstructive coronary arteries and migraine patients with patent foramen ovale. Medication for the treatment of migraine can be preventative medication, such as beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, antiepileptics, antidepressants, some of the long-acting calcitonin gene-related peptide receptor antagonists, or monoclonal antibodies against calcitonin gene-related peptide or its receptor, or acute medication, such as triptans and calcitonin gene-related peptide receptor antagonists. However, these medications might raise concerns when migraine patients also have CVD due to possible (coronary) side effects. Specifically, knowledge gaps remain for the contraindication to newer treatments for migraine. All cardiologists will encounter patients with CVD and migraine. This state-of-the-art review will outline the basic pathophysiology of migraine and the associations between migraine and CVD, discuss current therapies, and propose future directions for research.
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Affiliation(s)
- Deborah N Kalkman
- Department of Clinical and Experimental Cardiology, Heart Center; Amsterdam Cardiovascular Sciences, Amsterdam UMC-University of Amsterdam, Amsterdam, The Netherlands
| | - Emile G M Couturier
- Department of Neurology, Boerhaave Medisch Centrum, Amsterdam, The Netherlands
| | - Abdelhak El Bouziani
- Department of Clinical and Experimental Cardiology, Heart Center; Amsterdam Cardiovascular Sciences, Amsterdam UMC-University of Amsterdam, Amsterdam, The Netherlands
| | - Jorge Dahdal
- Department of Cardiology, Heart Center, Amsterdam UMC-Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Jolien Neefs
- Department of Clinical and Experimental Cardiology, Heart Center; Amsterdam Cardiovascular Sciences, Amsterdam UMC-University of Amsterdam, Amsterdam, The Netherlands
| | - Janneke Woudstra
- Department of Cardiology, Heart Center, Amsterdam UMC-Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Birgit Vogel
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Antoinette MaassenVanDenBrink
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robbert J de Winter
- Department of Clinical and Experimental Cardiology, Heart Center; Amsterdam Cardiovascular Sciences, Amsterdam UMC-University of Amsterdam, Amsterdam, The Netherlands
| | - Yolande Appelman
- Department of Cardiology, Heart Center, Amsterdam UMC-Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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Yue JH, Li A, Cui X, Sun XC, Li XL, Yang X, Liu X, Cao DN, Zhao WW, Yang GH, Golianu B, Wang Y, Han SW, Zhang QH. Bibliometric analysis of acupuncture for headache from 1974 to 2022: A scoping literature review based on international database. Medicine (Baltimore) 2023; 102:e34590. [PMID: 37543789 PMCID: PMC10402990 DOI: 10.1097/md.0000000000034590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/06/2023] [Accepted: 07/13/2023] [Indexed: 08/07/2023] Open
Abstract
This study aimed to investigate the research hotspots and global trends of acupuncture in the treatment of headaches from 1974 to 2022. The Web of Science core collection database and literature related to acupuncture for headache treatment were retrieved. The CiteSpace (version 5.1.R8) and VOSviewer (version 1.6.19) software perform collaborative network analysis on the information of countries, academic institutions, authors, and co-occurrence network analysis on keywords, co-cited journals, and references. A total of 841 studies were included. Overall, the number of publications has increased over the past 5 decades. We identified and analyzed the countries, institutions, authors, and journals that were most active in the domain of acupuncture treatment for headaches. The most productive countries were the United States and China. Chengdu University of Traditional Chinese Medicine was the most productive institution and Linde Klaus was the most productive author. Cephalalgia was the most productive and co-cited journal, whereas Lancet had the highest impact factor. The research hotspots mainly focus on headache, migraine, tension headache, electroacupuncture, and acupuncture. Research trends have mainly focused on acupuncture therapy and its curative effects, migraine without aura, paroxysmal migraine, and the mechanism of acupuncture treatment. The main research hotspots and frontier trends were the therapeutic effect and mechanism of acupuncture for headaches. The mechanism of acupuncture in the treatment of headache mainly focused on the neural mechanism by multimodal MRI.
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Affiliation(s)
- Jin-Huan Yue
- Shenzhen Frontier in Chinese Medicine Research Co., Ltd., Shenzhen, China
- Department of Acupuncture and Moxibustion, Shenzhen Jiuwei Chinese Medicine Clinic, Shenzhen, China
| | - Ang Li
- Pharmaceutical Research and Development Co. Ltd., Beijing, China
| | - Xuan Cui
- Graduate School of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Xu-Chen Sun
- Graduate School of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Xiao-Ling Li
- Division of CT and MRI, First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Xu Yang
- Graduate School of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Xiao Liu
- Department of Pediatrics, First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Dan-Na Cao
- Division of CT and MRI, First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | | | - Guan-Hu Yang
- Department of Specialty Medicine, Ohio University, Athens, OH
| | | | - Yang Wang
- Division of CT and MRI, First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Sheng-Wang Han
- Third Ward of Rehabilitation Department, Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Qin-Hong Zhang
- Shenzhen Frontier in Chinese Medicine Research Co., Ltd., Shenzhen, China
- Department of Acupuncture and Moxibustion, Shenzhen Jiuwei Chinese Medicine Clinic, Shenzhen, China
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Gerstein MT, Wirth RJ, Uzumcu AA, Houts CR, McGinley JS, Buse DC, McCarrier KP, Cooke A, Touba NM, Nishida TK, Goadsby PJ, Dodick DW, Lipton RB. Patient-reported experiences with migraine-related cognitive symptoms: Results of the MiCOAS qualitative study. Headache 2023; 63:441-454. [PMID: 36905166 DOI: 10.1111/head.14484] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/12/2022] [Accepted: 01/14/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVES To capture patients' perspectives on migraine-related cognitive symptoms during pre-headache, headache, post-headache, and interictal periods. BACKGROUND Migraine-related cognitive symptoms are reported by people with migraine both during and between attacks. Associated with disability, they are increasingly viewed as a priority target for treatment. The Migraine Clinical Outcome Assessment System (MiCOAS) project is focused on developing a patient-centered core set of outcome measures for the evaluation of migraine treatments. The project focuses on incorporating the experience of people living with migraine and the outcomes most meaningful to them. This includes an examination of the presence and functional impact of migraine-related cognitive symptoms and their perceived impact on quality of life and disability. METHODS Forty individuals with self-reported medically diagnosed migraine were recruited via iterative purposeful sampling for semi-structured qualitative interviews conducted using audio-only web conferencing. Thematic content analysis was performed to identify key concepts around migraine-related cognitive symptoms. Recruitment continued until concept saturation was achieved. RESULTS Participants described symptoms consistent with migraine-related deficits in language/speech, sustained attention, executive function, and memory that manifest during pre-headache (36/40 [90%] reported ≥1 cognitive feature), headache (35/40 [88%] reported ≥1 cognitive feature), post-headache (27/40 [68%] reported ≥1 cognitive feature), and interictal periods (13/40 [33%] reported ≥1 cognitive feature). Among participants reporting cognitive symptoms during pre-headache, 32/40 (81%) endorsed 2-5 cognitive symptoms. Findings were similar during the headache phase. Participants reported language/speech problems consistent with, for example, impairments in receptive language, expressive language, and articulation. Issues with sustained attention included fogginess, confusion/disorientation, and trouble with concentration/focus. Deficits in executive function included difficulty processing information and reduced capacity for planning and decision-making. Memory issues were reported across all phases of the migraine attack. CONCLUSIONS This patient-level qualitative study suggests that cognitive symptoms are common for persons with migraine, particularly in the pre-headache and headache phases. These findings highlight the importance of assessing and ameliorating these cognitive problems.
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Affiliation(s)
- Maya T Gerstein
- Patient Centered Outcomes, OPEN Health Group, Bethesda, Maryland, USA
| | - R J Wirth
- Vector Psychometric Group, LLC, Chapel Hill, North Carolina, USA
| | - Alyssa A Uzumcu
- Patient Centered Outcomes, OPEN Health Group, Bethesda, Maryland, USA
| | - Carrie R Houts
- Vector Psychometric Group, LLC, Chapel Hill, North Carolina, USA
| | - James S McGinley
- Vector Psychometric Group, LLC, Chapel Hill, North Carolina, USA
| | - Dawn C Buse
- Vector Psychometric Group, LLC, Chapel Hill, North Carolina, USA
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kelly P McCarrier
- Patient Centered Outcomes, OPEN Health Group, Bethesda, Maryland, USA
| | - Alexis Cooke
- Patient Centered Outcomes, OPEN Health Group, Bethesda, Maryland, USA
| | - Nancy M Touba
- Patient Centered Outcomes, OPEN Health Group, Bethesda, Maryland, USA
| | - Tracy K Nishida
- Vector Psychometric Group, LLC, Chapel Hill, North Carolina, USA
| | - Peter J Goadsby
- NIHR SLaM King's Clinical Research Facility, King's College London, London, UK
- Department of Neurology, University of California, Los Angeles, California, USA
| | - David W Dodick
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona, USA
- Atria Institute, New York, New York, USA
| | - Richard B Lipton
- Albert Einstein College of Medicine, Bronx, New York, USA
- Montefiore Medical Center, Bronx, New York, USA
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Husøy A, Katsarava Z, Steiner TJ. The relationship between headache-attributed disability and lost productivity: 3 Attack frequency is the dominating variable. J Headache Pain 2023; 24:7. [PMID: 36782131 PMCID: PMC9926851 DOI: 10.1186/s10194-023-01546-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/30/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND In an earlier paper, we examined the relationship between headache-attributed disability, measured as proportion of time in ictal state, and lost productivity. In a linear model, we found positive and significant associations with lost paid worktime, lost household worktime and total lost productivity (paid + household), but with high variance, which was increased when headache intensity was introduced as a factor. We speculated that analyses based on headache frequency alone as the independent variable, eliminating both the subjectivity of intensity estimates and the uncertainties of duration, might show stronger associations. METHODS Focusing on migraine, we used individual participant data from 16 countries surveyed either in population-based studies or in the Eurolight project. These data included frequency (headache days/month), usual attack duration (hours), usual headache intensity ("not bad", "quite bad", "very bad") and lost productivity from paid and household work according to enquiries using the Headache-Attributed Lost Time (HALT) questionnaire. We used multiple linear regressions, calculating regression equations along with unstandardized and standardized regression coefficients. We made line and bar charts to visualize relationships. RESULTS Both frequency and intensity were significant predictors of lost productivity in all multiple linear regressions, but duration was a non-significant predictor in several of the regressions. Predicted productivity in paid work decreased among males by 0.75-0.85 days/3 months for each increase of 1 headache day/month, and among females by 0.34-0.53 days/3 months. In household chores, decreases in productivity for each added day/month of headache were more similar (0.67-0.87 days/3 months among males, 0.83-0.89 days/3 months among females). Visualizations showed that the impact of duration varied little across the range of 2-24 h. The standardized regression coefficients demonstrated that frequency was a much better predictor of lost productivity than intensity or duration. CONCLUSION In the relationship between migraine-attributed impairment (symptom burden) and lost productivity, frequency (migraine days/month) is the dominating variable - more important than headache intensity and far more important than episode duration. This has major implications for current practice in headache care and for health policy and health-resource investment. Preventative drugs, grossly underutilized in current practice, offer a high prospect of economic benefit (cost-saving), but new preventative drugs are needed with better efficacy and/or tolerability.
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Affiliation(s)
- Andreas Husøy
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Edvard Griegs Gate 8, 7030, Trondheim, Norway.
| | - Zaza Katsarava
- Evangelical Hospital Unna, Unna, Germany ,grid.5718.b0000 0001 2187 5445Department of Neurology, University of Duisburg-Essen, Essen, Germany ,EVEX Medical Corporation, Tbilisi, Georgia
| | - Timothy J. Steiner
- grid.5947.f0000 0001 1516 2393Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Edvard Griegs Gate 8, 7030 Trondheim, Norway ,grid.5254.60000 0001 0674 042XDepartment of Neurology, University of Copenhagen, Copenhagen, Denmark ,grid.7445.20000 0001 2113 8111Division of Brain Sciences, Imperial College London, London, UK
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Shapiro RE, Martin AA, Bhardwaj S, Thomson H, Maculaitis MC, Anderson C, Kymes SM. Relationships between headache frequency, disability, and disability-related unemployment among adults with migraine. J Manag Care Spec Pharm 2023; 29:197-209. [PMID: 36705286 PMCID: PMC10387962 DOI: 10.18553/jmcp.2023.29.2.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND: Migraine is the second most common cause of disability worldwide. Understanding the relationship between migraine and employment status is critical for policymakers, as disability-related unemployment is associated with eligibility for private or governmental disability insurance payments and other associated support for those unable to work because of disability. OBJECTIVE: To assess the association between migraine frequency and selfreported employment status and overall disability in a US representative survey. METHODS: Using data from the 2019 National Health and Wellness Survey (NHWS) (Kantar Health), adults in the United States (aged 18-65 years) reporting at least 1 migraine day in the past 30 days were categorized by headache frequency: low-frequency episodic migraine (LFEM) (≤4 days/month), moderate-frequency EM (MFEM) (5-9 days/month), high-frequency EM (HFEM) (10-14 days/month), or chronic migraine (CM) (≥15 days/month). A control group of adults without migraine with similar baseline characteristics was identified by propensity score matching. Disability-related unemployment was defined as participants responding "short-term disability" or "long-term disability" to occupational status on the NHWS. The frequency of short- or long-term disability was then evaluated across headache frequency groups. In addition, participants were asked to assess migraine-related disability via the Migraine Disability questionnaire (MIDAS). RESULTS: A total of 1,962 respondents with LFEM, 987 with MFEM, 554 with HFEM, and 926 with CM were included in this analysis, along with 4,429 matched controls. Headache frequency was associated both with increased MIDAS score and with employment disability (P < 0.001); 12.3% (n = 114 of 926) of participants with CM reported employment disability, as did 4.4% (n = 86 of 1,962) of the LFEM group and 6.9% (n = 306 of 4,429) of matched controls. There was considerable discordance between the proportion of participants classified as disabled via MIDAS vs those reporting employment-related disability. CONCLUSIONS: More frequent migraine headaches are associated with a higher likelihood of self-reported short- and long-term employment disability and overall migraine-related disability, suggesting that health and economic policymakers must seek ways to maximize the employment opportunities for people living with migraine that may benefit from novel preventive treatments. DISCLOSURES: Robert E Shapiro is a research consultant for Eli Lilly and Lundbeck. Ashley A Martin and Martine C Maculaitis are employees of Cerner Enviza (formerly Kantar Health), which received payment from Lundbeck to conduct the research. Shiven Bhardwaj was an employee of Lundbeck at the time of study and manuscript development. Heather Thomson and Carlton Anderson are employees of Lundbeck. Steven M Kymes is an employee and stockholder of Lundbeck. Financial support for research conducted and manuscript preparation was provided by Lundbeck.
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Affiliation(s)
- Robert E Shapiro
- Department of Neurological Sciences, University of Vermont, Burlington
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Migraine Surgery and Determination of Success over Time by Trigger Site: A Systematic Review of the Literature. Plast Reconstr Surg 2023; 151:120e-135e. [PMID: 36251961 DOI: 10.1097/prs.0000000000009775] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Migraine headache is a debilitating disorder that produces high costs and compromises patient quality of life. This study aimed to evaluate surgery success and the longevity of the surgical benefit by trigger site. METHODS A systematic literature review was performed by querying the PubMed, Embase, Scopus, and Web of Science databases. The keywords "surgery," "migraine," "outcomes," "headache index," and synonyms in titles and abstracts were used to perform the search. RESULTS A total of 17 articles published between 2009 and 2019 met the inclusion criteria. Six studies were prospective and 11 were retrospective. Most of the studies (77.8%, 77.8%, and 80%, respectively) reported success of migraine surgery at 12-month follow-up for trigger sites I, II, and III, respectively. For trigger site IV, the greatest Migraine Headache Index reduction (93.4%) was observed at 12-month follow-up, and the earliest Migraine Headache Index reductions (80.3% and 74.6%) were observed at 6-month follow-up. All studies that evaluated trigger sites V and VI identified surgery success at 12-month follow-up. Migraine surgery was found to remain beneficial at 22 months for trigger sites I, II, III, and IV. CONCLUSIONS The symptomatic improvement may initially be evident at 6 months for trigger site IV and at 12 months for trigger sites I, II, III, V, and VI. Surgical benefit in trigger sites I, II, III, and IV can persist after 22 months. Further studies are required to evaluate results at longer follow-up.
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Varnado OJ, Ye W, Mi X, Burge R, Hall J. Annual indirect costs savings in patients with episodic or chronic migraine: a post-hoc analysis of phase 3 galcanezumab clinical trials in the United States. J Med Econ 2023; 26:149-157. [PMID: 36601798 DOI: 10.1080/13696998.2023.2165365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Galcanezumab (GMB) improved quality-of-life and reduced disability of patients with episodic (EM) and chronic migraine (CM) in Phase 3 trials. AIM To estimate indirect cost savings associated with GMB treatment in patients with migraine in the United States (US). METHODS We analyzed data of patients from the US from three randomized, Phase 3, double-blind, placebo (PBO)-controlled GMB studies: EVOLVE-1 and EVOLVE-2 (EM patients), REGAIN (CM patients). Annual indirect costs were calculated using items of the Migraine Disability Assessment (MIDAS) questionnaire: lost time/productivity at work/school, household work, and leisure time. All costs were annualized and expressed in 2019 US dollars. While the main analysis considered lost time/productivity at work/school and household work as a full day, a sensitivity analysis was performed by discounting them by half. For EM, annual indirect costs savings were estimated using mixed model repeated measures analysis. For CM, ANCOVA models were used to estimate annual indirect costs savings as change from baseline. RESULTS The analysis included 805 patients with EM (mean age = 41.4 years; PBO = 534; GMB = 271) and 423 patients with CM (mean age = 38.9 years; PBO = 279; GMB = 144). Compared to PBO, GMB significantly reduced annual indirect costs among patients with EM at 3 months (least square mean [95% confidence interval] work/school = $1,883.6 [603.64-3,163.65], p = .0040, household work = $628.9 [352.95-904.88], p <.0001, and leisure activity = $499.17 [42.36-955.98], p = .0323) and 6 months (work/school = $2,382.29 [1,065.48-3,699.10], p = .0004, household work = $559.45 [268.99-849.90], p = .0002, and leisure activity = $753.81 [334.35-1,173.27], p = .0004), whereas a significant difference was not observed among patients with CM. Sensitivity analysis results were similar to primary analysis results. CONCLUSIONS GMB treatment versus PBO resulted in significantly greater indirect cost savings in patients with EM through improved productivity at work/school, household work, and leisure days. Patients with CM receiving GMB versus PBO attained greater cost savings, although not statistically significant, through reduced lost productivity at work/school.
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Affiliation(s)
| | - Wenyu Ye
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Xiaojuan Mi
- TechData Services Company, King of Prussia, PA, USA
| | | | - Jerry Hall
- Eli Lilly and Company, Indianapolis, IN, USA
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Preysner TA, Gardi AZ, Ahmad S, Sharon JD. Vestibular Migraine: Cognitive Dysfunction, Mobility, Falls. Otol Neurotol 2022; 43:1216-1221. [PMID: 36136612 DOI: 10.1097/mao.0000000000003700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Recent evidence has shown that vestibular migraine is strongly associated with cognitive difficulties. However, limited data exist on real-world effects of that dysfunction. The objective of this study is to understand the epidemiology of cognitive dysfunction with vestibular migraine and associated sequelae using National Health Interview Survey data. STUDY DESIGN Randomized, population-based survey study of US adults. SETTING We generated a case definition approximating probable vestibular migraine based on Bárány Society criteria and validated that definition in a tertiary care vestibular clinic. PATIENTS Adult respondents to the 2016 NHIS, which queries a representative sample of the civilian, noninstitutionalized US population. INTERVENTION Diagnostic. MAIN OUTCOME MEASURES We evaluated incidence of self-reported cognitive dysfunction with vestibular migraine and whether individuals were more likely to have impaired mobility, falls, and work absenteeism than those without either condition. RESULTS Among individuals with vestibular migraine, 40% reported "some" and 12% reported "a lot" of difficulty thinking versus 13% and 2% of those without vestibular migraine, respectively. Vestibular migraine sufferers were more likely to have difficulty thinking or remembering compared with respondents without dizziness (odds ratio, 7.43; 95% confidence interval, 6.06-9.10; p < 0.001) when controlled for age, sex, education, stroke, smoking, heart disease, and diabetes. Individuals with both vestibular migraine and cognitive dysfunction had fivefold increased odds of falls and 10-fold increased odds of mobility issues compared with those without either condition. Furthermore, individuals with both vestibular migraine and cognitive dysfunction missed 12.8 more days of work compared to those without either condition. CONCLUSION Our findings indicate vestibular migraine is not only associated with cognitive dysfunction, but they are together associated with mobility issues, fall risk, and work absenteeism.
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Affiliation(s)
- Thi A Preysner
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco School of Medicine
| | - Adam Z Gardi
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco School of Medicine
| | - Sarah Ahmad
- Division of Headache Medicine, Department of Neurology, University of California-San Francisco School of Medicine, San Francisco, California
| | - Jeffrey D Sharon
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco School of Medicine
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Abstract
It is well established that migraine is a multifactorial disorder. A deep understanding of migraine should be based upon both the underlying traits and the current states affected by different physiological, psychological, and environmental factors. At this point, there is no framework fully meeting these criteria. Here, we describe a broader view of the migraine disorder defined as a dysfunctional brain state and trait interaction. In this model, we consider events that may enhance or diminish migraine responsivity based on an individual's trait and state. This could provide an expanded view for considering how migraine attacks are sometimes precipitated by "triggers" and sometimes not, how these factors only lead to migraine attacks in migraine patients, or how individuals with an increased risk for migraine do not show any symptoms at all. Summarizing recent studies and evidence that support the concept of migraine as a brain state-trait interaction can also contribute to improving patient care by highlighting the importance of precision medicine and applying measures that are able to capture how different traits and states work together to determine migraine.
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Migraine Headache in an Employed Population. J Occup Environ Med 2022; 64:679-685. [DOI: 10.1097/jom.0000000000002564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Legarda SB, Michas-Martin PA, McDermott D. Remediating Intractable Headache: An Effective Nonpharmacological Approach Employing Infralow Frequency Neuromodulation. Front Hum Neurosci 2022; 16:894856. [PMID: 35874149 PMCID: PMC9304546 DOI: 10.3389/fnhum.2022.894856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
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Zandieh A, Cutrer FM. OnabotulinumtoxinA in chronic migraine: is the response dose dependent? BMC Neurol 2022; 22:218. [PMID: 35698027 PMCID: PMC9190093 DOI: 10.1186/s12883-022-02742-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/01/2022] [Indexed: 11/18/2022] Open
Abstract
Background OnabotulinumtoxinA has been widely used for control of chronic migraine. The aim of the current study was to evaluate the efficacy of different doses of the onabotulinumtoxinA therapy in patients with chronic migraine. Methods This is a retrospective paired comparison study on patients with chronic migraine who received at least 3 rounds of 150 units of onabotulinumtoxinA followed by at least 3 rounds of 200 units of onabotulinumtoxinA. The data from the patient-reported questionnaires about headache days, severe headache days and wearing off periods were reviewed. Results A total of 175 patients were included in this study. The headache days and severe headache days decreased from 13.62 ± 10.79 and 5.88 ± 6.73 to 11.02 ± 10.61and 4.01 ± 4.89 days, after increase in the onabotulinumtoxinA dose, respectively (P < 0.001 for both comparisons). The favorable effect of the 200 units compared to the 150 units of the onabotulinumtoxinA, was independent from the headache location and the duration of the onabotulinumtoxinA 150 units therapy; and persisted as patients continued to receive the higher dose of onabotulinumtoxinA. Increase in the onabotulinumtoxinA dose was also associated with a decreased wearing off period (P < 0.05). Conclusion We found that increase in the onabotulinumtoxinA is associated with fewer headache and severe headache days. Future randomized clinical trials are needed to confirm the dose-dependent response to onabotulinumtoxinA.
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Affiliation(s)
- Ali Zandieh
- Department of Neurology, University of Wisconsin, 1685 Highland Avenue, Madison, WI, 53705, USA
| | - Fred Michael Cutrer
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Riccò M, Ferraro P, Camisa V, Di Palma P, Minutolo G, Ranzieri S, Zaffina S, Baldassarre A, Restivo V. Managing of Migraine in the Workplaces: Knowledge, Attitudes and Practices of Italian Occupational Physicians. Medicina (B Aires) 2022; 58:medicina58050686. [PMID: 35630103 PMCID: PMC9144137 DOI: 10.3390/medicina58050686] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 12/29/2022] Open
Abstract
Background and Objectives: Migraine is a debilitating disorder, whose incidence peak in the age group of 30–39 years overlaps with the peak of employment years, potentially representing a significant issue for occupational physicians (OP). The present study was performed in order to characterize their knowledge, attitudes and practices on migraine in the workplaces. Materials and Methods: A convenience sample of 242 Italian OP (mean age 47.8 ± 8.8 years, males 67.4%) participated in an internet-based survey by completing a structured questionnaire. Results: Adequate general knowledge of migraine was found in the majority of participants. Migraine was identified as a common and severe disorder by the majority of respondents (54.0% and 60.0%). Overall, 61.2% of participants acknowledged migraine as difficult to manage in the workplace, a status that made it more likely for OP understanding its potential frequency (Odds Ratio [OR] 3.672, 95% confidence interval [95%CI] 1.526–8.831), or reported previous managing of complicated cases requiring conditional fitness to work judgement (OR 4.761, 95%CI 1.781–2.726). Moreover, professionals with a qualification in occupational medicine (OR 20.326, 95%CI 2.642–156.358), acknowledging the difficult managing of migraine in the workplaces (OR 2.715, 95%CI 1.034–7.128) and having received any request of medical surveillance for migraine (OR 22.878, 95%CI 4.816–108.683), were more likely to recommend specific requirements for migraineur workers. Conclusions: Migraine was recognized as a common disorder, but also as a challenging clinical problem for OP. Participating OP exhibited a substantial understanding of migraine and its triggers, but residual false beliefs and common misunderstanding may impair the proper management of this disorder, requiring improved and specifically targeted interventions.
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Affiliation(s)
- Matteo Riccò
- Servizio di Prevenzione e Sicurezza Negli Ambienti di Lavoro (SPSAL), AUSL-IRCCS di Reggio Emilia, Via Amendola n.2, I-42122 Reggio Emilia, Italy
- Correspondence: ; Tel.: +39-339-2994-343
| | - Pietro Ferraro
- Occupational Medicine Unit, Direzione Sanità, Italian Railways’ Infrastructure Division, RFI SpA, I-00161 Rome, Italy;
| | - Vincenzo Camisa
- Health Directorate, Occupational Medicine Unit, Bambino Gesù Children’s Hospital IRCCS, I-00146 Rome, Italy; (V.C.); (S.Z.)
| | - Pasquale Di Palma
- Istituto nazionale Assicurazione Infortuni sul Lavoro, INAIL—DM2, Roma Tuscolano, Via Michele de Marco, 20, I-00169 Rome, Italy;
| | - Giuseppa Minutolo
- Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialties “G. D’Alessandro”—Hygiene Section, University of Palermo, I-90127 Palermo, Italy; (G.M.); (V.R.)
| | - Silvia Ranzieri
- Department of Medicine and Surgery, University of Parma, Via Gramsci, 14, I-43126 Parma, Italy;
| | - Salvatore Zaffina
- Health Directorate, Occupational Medicine Unit, Bambino Gesù Children’s Hospital IRCCS, I-00146 Rome, Italy; (V.C.); (S.Z.)
| | - Antonio Baldassarre
- Occupational Medicine Unit, Careggi University Hospital, I-50134 Florence, Italy;
| | - Vincenzo Restivo
- Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialties “G. D’Alessandro”—Hygiene Section, University of Palermo, I-90127 Palermo, Italy; (G.M.); (V.R.)
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Tsai CK, Tsai CL, Lin GY, Yang FC, Wang SJ. Sex Differences in Chronic Migraine: Focusing on Clinical Features, Pathophysiology, and Treatments. Curr Pain Headache Rep 2022; 26:347-355. [PMID: 35218478 DOI: 10.1007/s11916-022-01034-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW This review provides an update on sex differences in chronic migraine (CM), with a focus on clinical characteristics, pathophysiology, and treatments. RECENT FINDINGS Approximately 6.8-7.8% of all migraineurs have CM, with an estimated prevalence of 1.4-2.2% in the general population. The economic burden caused by CM, including medical costs and lost working ability, is threefold higher than that caused by episodic migraine (EM). Notably, the prevalence of migraine is affected by age and sex. Female migraineurs with CM experience higher levels of headache-related disability, including longer headache duration, higher frequency of attacks, and more severely impacted efficiency at work. Sex hormones, including estrogen, testosterone, and progesterone, contribute to the sexually dimorphic characteristics and prevalence of migraine in men and women. Recent neuroimaging studies have indicated that migraine may have a greater impact and cause greater dysfunction in the organization of resting-state functional networks in women. Accumulating evidence suggests that topiramate, Onabotulinumtoxin A and calcitonin gene-related peptide (CGRP) monoclonal antibodies are effective as the preventative treatments for CM. Recent evidence highlights a divergence in the characteristics of CM between male and female populations. The data comparing the treatment response for CM regarding sex are lacking.
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Affiliation(s)
- Chia-Kuang Tsai
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Chia-Lin Tsai
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Guan-Yu Lin
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Fu-Chi Yang
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan.
| | - Shuu-Jiun Wang
- Neurological Institute, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou 112, Taipei, Taiwan.
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Outcomes of Endolymphatic Sac Surgery for Meniere's Disease with and without Comorbid Migraine. Int J Otolaryngol 2022; 2021:7987851. [PMID: 34976068 PMCID: PMC8719987 DOI: 10.1155/2021/7987851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/24/2021] [Accepted: 12/10/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To explore outcomes of endolymphatic sac surgery for patients with Meniere's disease with and without the comorbid condition of migraine. Materials and Methods A retrospective chart review of adult patients undergoing endolymphatic sac surgery at a single tertiary care center from 1987 to 2019 was performed. All adult patients who failed medical therapy and underwent primary endolymphatic sac surgery were included. The main outcome measures were vertigo control and functional level scale (FLS) score. Patient characteristics, comorbidities, and audiometric outcomes were tracked as well. Results Patients with Meniere's disease and migraine had a stronger association with psychiatric comorbidities (64.29% vs. 25.80%, p=0.01), shorter duration of vertigo episodes (143 vs. 393 min, p=0.02), and younger age (36.6 vs. 50.8 yr, p=0.005) at the time of endolymphatic sac surgery. Postoperative pure tone averages and word recognition scores were nearly identical to preoperative baselines. Class A vertigo control (47.92%) was most common, followed by class B vertigo control (31.25%). The FLS score improved from 4.2 to 2.8 (p < 0.001). Both patients with and without migraine had classes A-B vertigo control (66.67% vs. 80.95%) without any statistically significant difference (p=0.59). Of the patients who required secondary treatment (10.42%), none had migraine. Conclusions Endolymphatic sac surgery is an effective surgical intervention for Meniere's disease with and without migraine. Patients with comorbid migraine tend to be younger and present with psychiatric comorbidities.
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Lipton RB, Gandhi P, Stokes J, Cala ML, Evans CJ, Knoble N, Gelhorn HL, Revicki D, Viswanathan HN, Dodick DW. Development and validation of a novel patient-reported outcome measure in people with episodic migraine and chronic migraine: The Activity Impairment in Migraine Diary. Headache 2021; 62:89-105. [PMID: 34962305 PMCID: PMC9306594 DOI: 10.1111/head.14229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 09/04/2021] [Accepted: 09/13/2021] [Indexed: 12/14/2022]
Abstract
Objective To evaluate the content validity and psychometric properties of the Activity Impairment in Migraine Diary (AIM‐D). Background Measuring treatment effects on migraine impairment requires a psychometrically sound patient‐reported outcome (PRO) measure developed consistent with U.S. Food and Drug Administration guidance. Methods The AIM‐D was created from concepts that emerged during qualitative interviews with five clinicians experienced in treating migraine and concept elicitation (CE) interviews with 40 adults with episodic migraine (EM) or chronic migraine (CM). The initial version was refined based on three waves of cognitive interviews with 38 adults with EM or CM and input from a panel of clinical and measurement experts. The AIM‐D was psychometrically evaluated using data from 316 adults with EM or CM who participated in a 13‐week prospective observational study. Study participants completed PRO assessments including the AIM‐D and a daily headache diary. Exploratory and confirmatory factor analysis were used to determine the factor structure. The reliability, validity, and responsiveness of the AIM‐D were assessed. Additional PRO measures including the Patient Global Impression – Severity (PGI‐S), Migraine Specific Quality of Life Questionnaire, Version 2.1 Role Function‐Restrictive domain, and Headache Impact Test were used for psychometric evaluation of the AIM‐D. Results Based on CE interviews with adults with migraine and input from an expert panel, activity impairment was identified as the target in the preliminary conceptual framework, which had two domains: performance of daily activities (PDAs) and physical impairment (PI). Revision of the draft AIM‐D through multiple rounds of cognitive interviews and expert panel meetings resulted in a content valid 11‐item version. Exploratory factor analysis supported both one‐ and two‐domain structures for the AIM‐D, which were further supported by confirmatory factor analysis (factor loadings all >0.90). The AIM‐D domains (PDA and PI) and total score showed high internal consistency reliability (Cronbach's alpha 0.95–0.97), acceptable test–retest reliability for weekly average scores (intraclass correlation coefficient >0.60 for participants with no change in PGI‐S between baseline and week 2), and good convergent and known‐groups validity. There was evidence of responsiveness based on changes in PGI‐S score and monthly migraine days. Conclusion The AIM‐D is a content valid and psychometrically sound measure designed to evaluate activity impairment and is suitable for use in clinical trials of preventive treatments for EM or CM.
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Affiliation(s)
- Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | | | | | | | | | | | - Dennis Revicki
- Evidera, Bethesda, Maryland, USA.,Outcomes Research Consulting, Sarasota, Florida, USA
| | | | - David W Dodick
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona, USA
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Thomas H, Kothari SF, Husøy A, Jensen RH, Katsarava Z, Tinelli M, Steiner TJ. The relationship between headache-attributed disability and lost productivity: 2. Empirical evidence from population-based studies in nine disparate countries. J Headache Pain 2021; 22:153. [PMID: 34922442 PMCID: PMC8903529 DOI: 10.1186/s10194-021-01362-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 11/17/2021] [Indexed: 01/11/2023] Open
Abstract
Background Headache disorders are disabling, with major consequences for productivity, yet the literature is silent on the relationship between headache-attributed disability and lost productivity, often erroneously regarding the two as synonymous. We evaluated the relationship empirically, having earlier found that investment in structured headache services would be cost saving, not merely cost-effective, if reductions in headache-attributed disability led to > 20% pro rata recovery of lost productivity. Methods We used individual participant data from Global Campaign population-based studies conducted in China, Ethiopia, India, Nepal, Pakistan and Russia, and from Eurolight in Lithuania, Luxembourg and Spain. We assessed relationships in migraine and probable medication-overuse headache (pMOH), the most disabling common headache disorders. Available symptom data included headache frequency, usual duration and usual intensity. We used frequency and duration to estimate proportion of time in ictal state (pTIS). Disability, in the sense used by the Global Burden of Disease study, was measured as the product of pTIS and disability weight for the ictal state. Impairment was measured as pTIS * intensity. Lost productivity was measured as lost days (absence or < 50% productivity) from paid work and corresponding losses from household work over the preceding 3 months. We used Spearman correlation and linear regression analyses. Results For migraine, in a linear model, we found positive associations with lost paid worktime, significant (p < 0.05) in many countries and highly significant (p < 0.001) in some despite low values of R2 (0–0.16) due to high variance. With lost household worktime and total lost productivity (paid + household), associations were highly significant in almost all countries, although still with low R2 (0.04–0.22). Applying the regression equations for each country to the population mean migraine-attributed disability, we found pro rata recoveries of lost productivity in the range 16–56% (> 20% in all countries but Pakistan). Analysing impairment rather than disability increased variability. For pMOH, with smaller numbers, associations were generally weaker, occasionally negative and mostly not significant. Conclusion Relief of disability through effective treatment of migraine is expected, in most countries, to recover > 20% pro rata of lost productivity, above the threshold for investment in structured headache services to be cost saving.
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Affiliation(s)
- Hallie Thomas
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Edvard Griegs gate, Trondheim, Norway
| | - Simple Futarmal Kothari
- Department of Dentistry and Oral Health, Section of Orofacial Pain and Jaw Function, Aarhus University, Aarhus, Denmark.,Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark
| | - Andreas Husøy
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Edvard Griegs gate, Trondheim, Norway
| | - Rigmor Højland Jensen
- Danish Headache Centre, Department of Neurology, University of Copenhagen, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Zaza Katsarava
- Evangelical Hospital Unna, Unna, Germany.,Department of Neurology, University of Duisburg-Essen, Essen, Germany.,EVEX Medical Corporation, Tbilisi, Georgia.,IM Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Michela Tinelli
- Care Policy Evaluation Centre, The London School of Economics and Political Science, London, UK
| | - Timothy J Steiner
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Edvard Griegs gate, Trondheim, Norway. .,Division of Brain Sciences, Imperial College London, London, UK.
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29
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Stewart WF, Yan X, Pressman A, Jacobson A, Vaidya S, Chia V, Buse DC, Lipton RB. Combining patient reported outcomes and EHR data to understand population level treatment needs: correcting for selection bias in the migraine signature study. J Patient Rep Outcomes 2021; 5:132. [PMID: 34921650 PMCID: PMC8684566 DOI: 10.1186/s41687-021-00401-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 11/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Electronic health records (EHR) data can be used to understand population level quality of care especially when supplemented with patient reported data. However, survey non-response can result in biased population estimates. As a case study, we demonstrate that EHR and survey data can be combined to estimate primary care population prescription treatment status for migraine stratified by migraine disability, without and with adjustment for survey non-response bias. We selected disability as it is associated with survey participation and patterns of prescribing for migraine. METHODS A stratified random sample of Sutter Health adult primary care (PC) patients completed a digital survey about headache, migraine, and migraine related disability. The survey data from respondents with migraine were combined with their EHR data to estimate the proportion who had prescription orders for acute or preventive migraine treatments. Separate proportions were also estimated for those with mild disability (denoted "mild migraine") versus moderate to severe disability (denoted mod-severe migraine) without and with correction, using the inverse propensity weighting method, for non-response bias. We hypothesized that correction for non-response bias would result in smaller differences in proportions who had a treatment order by migraine disability status. RESULTS The response rate among 28,268 patients was 8.2%. Among survey respondents, 37.2% had an acute treatment order and 16.8% had a preventive treatment order. The response bias corrected proportions were 26.2% and 11.6%, respectively, and these estimates did not differ from the total source population estimates (i.e., 26.4% for acute treatments, 12.0% for preventive treatments), validating the correction method. Acute treatment orders proportions were 32.3% for mild migraine versus 37.3% for mod-severe migraine and preventive treatment order proportions were 12.0% for mild migraine and 17.7% for mod-severe migraine. The response bias corrected proportions for acute treatments were 24.8% for mild migraine and 26.6% for mod-severe migraine and the proportions for preventive treatment were 8.1% for mild migraine and 12.0% for mod-severe migraine. CONCLUSIONS In this study, we combined survey data with EHR data to better understand treatment needs among patients diagnosed with migraine. Migraine-related disability is directly related to preventive treatment orders but less so for acute treatments. Estimates of treatment status by self-reported disability status were substantially over-estimated among those with moderate to severe migraine-related disability without correction for non-response bias.
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Affiliation(s)
| | - Xiaowei Yan
- Sutter Health Center for Health Systems Research, 2121 N. California Blvd., Ste. 310, Walnut Creek, CA, 94596, USA
| | - Alice Pressman
- Sutter Health Center for Health Systems Research, 2121 N. California Blvd., Ste. 310, Walnut Creek, CA, 94596, USA.
| | - Alice Jacobson
- Sutter Health Center for Health Systems Research, 2121 N. California Blvd., Ste. 310, Walnut Creek, CA, 94596, USA
| | - Shruti Vaidya
- Sutter Health Center for Health Systems Research, 2121 N. California Blvd., Ste. 310, Walnut Creek, CA, 94596, USA
| | | | - Dawn C Buse
- Montefiore Medical Center, Bronx, NY, 10467, USA
| | - Richard B Lipton
- Montefiore Medical Center, Bronx, NY, 10467, USA.,Albert Einstein College of Medicine, Bronx, NY, 10461, USA
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Janson CM, Millenson ME, Okunowo O, Dai D, Christmyer Z, Tan RB, Ramesh Iyer V, Shah MJ, O'Byrne ML. Incidence of life-threatening events in children with Wolff-Parkinson-White syndrome: Analysis of a large claims database. Heart Rhythm 2021; 19:642-647. [PMID: 34902591 DOI: 10.1016/j.hrthm.2021.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/06/2021] [Accepted: 12/06/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Previous estimates of life-threatening event (LTE) risk in Wolff-Parkinson-White (WPW) syndrome are limited by selection bias inherent to tertiary referral-based cohorts. OBJECTIVE This analysis sought to measure LTE incidence in children with WPW syndrome in a large contemporary representative population. METHODS A retrospective cohort study was conducted using claims data from the IBM MarketScan Research Databases, evaluating patients with WPW syndrome (age 1-18 years) from any encounter between January 1, 2013, and December 31, 2018. Subjects with congenital heart disease and cardiomyopathy were excluded. The primary outcome was diagnosis of ventricular fibrillation (VF); a composite outcome, LTE, was defined as occurrence of VF and/or cardiac arrest. VF and LTE rates were compared to matched representative controls without WPW syndrome (3:1 ratio). RESULTS The prevalence of WPW syndrome was 0.03% (8733/26,684,581) over a median follow-up of 1.6 years (interquartile range 0.7-2.9 years). Excluding congenital heart disease/cardiomyopathy, 6946 subjects were analyzed. LTE occurred in 49 subjects, including VF in 20. The incidence of VF was 0.8 events per 1000 person-years, and the incidence of LTE was 1.9 events per 1000 person-years. There were no occurrences of VF in controls; the rate of LTE was 70 times higher in patients with WPW syndrome (0.7%; 95% confidence interval 0.5%-0.9%) than in controls (0.01%; 95% confidence interval 0%-0.02%). CONCLUSION The use of a large claims data set allowed for an evaluation of VF and LTE risk in an unselected pediatric population with WPW syndrome. The observed range of 0.8-1.9 events per 1000 person-years is consistent with prior reports from selected populations. A comparison of event rates to matched controls confirms and quantifies the significant elevation in VF and LTE risk in pediatric WPW syndrome.
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Affiliation(s)
- Christopher M Janson
- Division of Cardiology, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Marisa E Millenson
- Division of Cardiology, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania
| | - Oluwatimilehin Okunowo
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Dingwei Dai
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania
| | - Zane Christmyer
- Division of Cardiology, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Reina Bianca Tan
- Division of Cardiology, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - V Ramesh Iyer
- Division of Cardiology, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Maully J Shah
- Division of Cardiology, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael L O'Byrne
- Division of Cardiology, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania; Leonard Davis Institute and Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia, Pennsylvania
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Jin C, Yi C, Zhong W, Xue Y, Chen K, Deng K, Wang Z, Wang T. Design, synthesis and biological evaluation of pyridinylmethylenepiperidine derivatives as potent 5-HT 1F receptor agonists for migraine therapy. Eur J Med Chem 2021; 225:113782. [PMID: 34419891 DOI: 10.1016/j.ejmech.2021.113782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/08/2021] [Accepted: 08/13/2021] [Indexed: 11/16/2022]
Abstract
Migraine is a common neurovascular disease which has been classified as the sixth most disabling disorder. Current migraine therapy was triptans, however, riptans can cause contraction of blood vessels. Therefore, novel drugs without cardiovascular effects emerged, such as CGRP and selective 5-HT1F receptor agonists. In this work, a series of pyridinylmethylenepiperidine derivatives were designed, synthesized and evaluated for their 5-HT1F receptor agonist activity. The results in vitro showed that compound C1-C6 displayed potent agonist activities compared with positive drug lasmiditan. Pharmacokinetic properties in rat indicated that 2,4,6-trifluoro-N-(6-(fluoro(1-methylpiperidin-4-ylidene)methyl)pyridin-2-yl)benzamide (C5) possessed high AUC and good bioavailability. In two rodent models of migraine, C5 significantly inhibited dural plasma protein extravasation and c-fos expression in the trigeminal nucleus caudalis. Moreover, C5 showed no effect on vasoconstriction. Through these studies, we identified C5 as a potent 5-HT1F receptor agonist for migraine therapy.
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Affiliation(s)
- Chuanfei Jin
- Sunshine Lake Pharma Co. Ltd., Shenzhen 518000; HEC Pharm Group, HEC Research and Development Center, Dongguan 523871, PR China.
| | - Chao Yi
- Sunshine Lake Pharma Co. Ltd., Shenzhen 518000; HEC Pharm Group, HEC Research and Development Center, Dongguan 523871, PR China
| | - Wenhe Zhong
- Sunshine Lake Pharma Co. Ltd., Shenzhen 518000; HEC Pharm Group, HEC Research and Development Center, Dongguan 523871, PR China
| | - Yaping Xue
- Sunshine Lake Pharma Co. Ltd., Shenzhen 518000; HEC Pharm Group, HEC Research and Development Center, Dongguan 523871, PR China
| | - Kangzhi Chen
- Sunshine Lake Pharma Co. Ltd., Shenzhen 518000; HEC Pharm Group, HEC Research and Development Center, Dongguan 523871, PR China
| | - Kang Deng
- Sunshine Lake Pharma Co. Ltd., Shenzhen 518000; HEC Pharm Group, HEC Research and Development Center, Dongguan 523871, PR China
| | - Zusheng Wang
- Sunshine Lake Pharma Co. Ltd., Shenzhen 518000; HEC Pharm Group, HEC Research and Development Center, Dongguan 523871, PR China
| | - Tao Wang
- Sunshine Lake Pharma Co. Ltd., Shenzhen 518000; HEC Pharm Group, HEC Research and Development Center, Dongguan 523871, PR China
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32
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Oraby MI, Soliman RH, Mahmoud MA, Elfar E, Abd ElMonem NA. Migraine prevalence, clinical characteristics, and health care-seeking practice in a sample of medical students in Egypt. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00282-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Abstract
Introduction
Migraine is a common disabling primary headache disorder with significant personal and socio-economic impacts. Medical students usually have multiple triggers for migraine, particularly stress and irregular sleep.
Objective
To assess the prevalence, characteristics, and degree of disability of migraine in a sample of Egyptian medical students and to study their health care-seeking practice when having migraine
Patients and methods
A descriptive cross-sectional, questionnaire-based study included 631 undergraduate medical students enrolled in the Faculty of Medicine. Participants’ sociodemographic data, migraine prevalence, characteristic, migraine disability, and health care-seeking practice were evaluated. By using the MIDAS test in the questionnaire, we assessed the impact of migraine headache on the daily activities of the students. The severity of headache was assessed using the visual analog scale (VAS) scores.
Results
Prevalence of migraine in medical students was found to be 17.9% causing moderate disability. Migraine was significantly more prevalent and caused more disability among female students compared to males (p value 0.001 and 0.001). Only 35.4% of the migraineurs had already seen doctors for their migraine, and self-prescription of medications for migraine was practiced by 58.4%. Statistically significant positive correlation was found between migraine frequency, migraine severity, and low academic performance (p value 0.001 and 0.003 respectively).
Conclusion
Migraine is highly prevalent among medical students with predominant female prevalence and has a negative impact on their academic performance and other activities.
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Halpern LR, Gammal P, Adams DR. An Update on Diagnosis and Pharmacologic Therapy for Headache in the Oral and Maxillofacial Surgery Practice. Oral Maxillofac Surg Clin North Am 2021; 34:83-97. [PMID: 34802617 DOI: 10.1016/j.coms.2021.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Headaches are synonymous with neurovascular pain (cephalalgias), which comprise a heterogeneous group of pain disorders that share a common anatomic region (head and neck). Headaches are often a "universal" disease presentation that is evaluated by the oral and maxillofacial surgeon. Pharmacologic therapy of headaches is most often based on the severity of symptoms and the degree of disability experienced by the patient. This article describes the epidemiology of neurovascular headaches, their pathophysiologic mechanisms/presentation, the workup of patients, and an up-to-date overview of pharmacologic approaches that can be applied in the oral and maxillofacial surgical practice to treat this patient population.
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Affiliation(s)
- Leslie R Halpern
- Oral and Maxillofacial Surgery, University of Utah, School of Dentistry, 530 South Wakara Way, Salt Lake City, UT 84108, USA.
| | - Paul Gammal
- Department of Dentistry/Oral Surgery, Woodhull Hospital and Mental Health Center, 760 Broadway, Brooklyn, NY 11206, USA
| | - David R Adams
- Oral and Maxillofacial Surgery, University of Utah, School of Dentistry, 530 South Wakara Way, Salt Lake City, UT 84108, USA
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Deighton AM, Harris LA, Johnston K, Hogan S, Quaranta LA, L'Italien G, Coric V. The burden of medication overuse headache and patterns of switching and discontinuation among triptan users: a systematic literature review. BMC Neurol 2021; 21:425. [PMID: 34727873 PMCID: PMC8561931 DOI: 10.1186/s12883-021-02451-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A synthesis of real-world discontinuation and switching patterns among triptan users and rates of acute medication use among patients with medication overuse headache (MOH) is needed to better understand the burden among patients with migraine. The study objectives were to: (1) synthesize rates of switching and discontinuation from triptans; (2) characterize acute medication use among patients with MOH; and (3) describe the associated burden. METHODS A systematic literature review was conducted, under the Preferred Reporting Items for Systematic Review guidelines, using MEDLINE/EMBASE from database inception to July 2019. The search strategy targeted studies of adults with migraine, and included terms related to migraine and its treatment. Continuous variables were summarized using means, standard deviations, and ranges. Dichotomous and categorical variables were summarized using the number and proportion of individuals. RESULTS Twenty studies were included; seven describing patterns of switching and discontinuation among triptan users, and 13 characterizing triptan overuse among patients with MOH. High rates of switching to non-specific acute medications and low two-year retention rates were reported; among US samples switching to opioids at the first refill (18.2%) or after 1-year (15.5%) was frequent. Compared to persistent use of triptans, switchers experienced greater headache related impact and either no improvement or increased headache-related disability. Rates of medication overuse by agent among patients with MOH varied greatly across the included studies, and only one study described factors associated with the risk of MOH (e.g. duration of medication overuse). Medication agent, increased headache frequency (p = .008), and increased disability (p = .045) were associated with unsuccessful withdrawal; patients overusing triptans were more successful at withdrawal than those overusing opioids or combination analgesics (P < .0001). CONCLUSIONS The evidence summarized here highlights that rates of WCS are low and many patients turn to other acute medication at their first refill. Patients may experience no improvement in disability when switching from one triptan agent to another, or experience increasing disability and/or increasing migraine frequency when turning to traditional acute treatment for migraine. Variability in health care settings, patient severity, and study design contributed to heterogeneity across the synthesis.
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Affiliation(s)
- Alison M Deighton
- Broadstreet HEOR, 201-343 Railway St, Vancouver, BC, V6A 1A4, Canada.
| | - Linda A Harris
- Biohaven Pharmaceuticals, 215 Church Street, New Haven, CT, USA
| | - Karissa Johnston
- Broadstreet HEOR, 201-343 Railway St, Vancouver, BC, V6A 1A4, Canada
| | - Shomari Hogan
- Biohaven Pharmaceuticals, 215 Church Street, New Haven, CT, USA
| | - Lynn A Quaranta
- Biohaven Pharmaceuticals, 215 Church Street, New Haven, CT, USA
| | | | - Vlad Coric
- Biohaven Pharmaceuticals, 215 Church Street, New Haven, CT, USA
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Liu A, Han J, Nakano A, Konno H, Moriwaki H, Abe H, Izawa K, Soloshonok VA. New pharmaceuticals approved by FDA in 2020: Small-molecule drugs derived from amino acids and related compounds. Chirality 2021; 34:86-103. [PMID: 34713503 DOI: 10.1002/chir.23376] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/09/2021] [Accepted: 09/26/2021] [Indexed: 12/24/2022]
Abstract
Amino acids (AAs) play an important role in the modern health industry as key synthetic precursors for pharmaceuticals, biomaterials, biosensors, and drug delivery systems. Currently, over 30% of small-molecule drugs contain residues of tailor-made AAs or derived from them amino-alcohols and di-amines. In this review article, we profile 12 AA-derived new pharmaceuticals approved by the FDA in 2020. These newly introduced drugs include Tazverik (epithelioid sarcoma), Gemtesa (overactive bladder), Zeposia (multiple sclerosis), Byfavo (induction and maintenance of procedural sedation), Cu 64 dotatate, and Gallium 68 PSMA-11 (both PET imaging), Rimegepant (acute migraine), Zepzelca (lung cancer), Remdesivir (COVID-19), Amisulpride (nausea and vomiting), Setmelanotide (obesity), and Lonafarnib (progeria syndrome). For each compound, we describe the spectrum of biological activity, medicinal chemistry discovery, and synthetic preparation.
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Affiliation(s)
- Aiyao Liu
- Jiangsu Co-Innovation Center of Efficient Processing and Utilization of Forest Resources, College of Chemical Engineering, Nanjing Forestry University, Nanjing, China
| | - Jianlin Han
- Jiangsu Co-Innovation Center of Efficient Processing and Utilization of Forest Resources, College of Chemical Engineering, Nanjing Forestry University, Nanjing, China
| | - Arina Nakano
- Department of Biological Engineering, Graduate School of Science and Engineering, Yamagata University, Yonezawa, Japan
| | - Hiroyuki Konno
- Department of Biological Engineering, Graduate School of Science and Engineering, Yamagata University, Yonezawa, Japan
| | | | | | | | - Vadim A Soloshonok
- Department of Organic Chemistry I, Faculty of Chemistry, University of the Basque Country UPV/EHU, San Sebastián, Spain.,IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
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36
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Newman LC, Lalvani N. What's in a name: What a difference a day (or two) makes. Headache 2021; 61:1460-1461. [PMID: 34601727 DOI: 10.1111/head.14215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Lawrence C Newman
- Headache Medicine-NYU Langone, New York, New York, USA.,American Migraine Foundation, Mount Royal, New Jersey, USA
| | - Nim Lalvani
- American Migraine Foundation, Mount Royal, New Jersey, USA
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Kim BK, Cho SJ, Kim CS, Sakai F, Dodick DW, Chu MK. Disability and Economic Loss Caused by Headache among Information Technology Workers in Korea. J Clin Neurol 2021; 17:546-557. [PMID: 34595863 PMCID: PMC8490897 DOI: 10.3988/jcn.2021.17.4.546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/03/2021] [Accepted: 05/03/2021] [Indexed: 01/03/2023] Open
Abstract
Background and Purpose Headache disorders are a leading cause of disability globally. However, there is inadequate information available about these disorders and the related economic loss in the workplace in Asian countries. Information technology (IT) jobs are intellectually and cognitively challenging, and hence IT workers are a suitable population for assessing headache disorders and related economic loss. Methods We sent invitation emails to all employees of selected IT companies. A comprehensive Web-based questionnaire regarding headache characteristics, disability, quality of life, and economic loss was completed by 522 participants from 8 companies. Results The participants included 450 (86.2%) who had experienced headache more than once during the previous year. The frequencies of migraine, probable migraine (PM), and tension-type headache (TTH) were 18.2%, 21.1%, and 37.0%, respectively. The Migraine Disability Assessment score was higher for participants with migraine [median and interquartile range, 3.0 (0.0–6.0)] than for those with PM [0.0 (0.0–2.0), p<0.001] and TTH [0.0 (0.0–1.0), p<0.001]. The estimated annual economic losses caused by migraine per person associated with absenteeism and presenteeism were USD 197.5±686.1 and USD 837.7±22.04 (mean±standard deviation), respectively. The total annual economic loss per person caused by migraine (USD 1,023.3±1,972.7) was higher than those caused by PM (USD 424.8±1,209.1, p<0.001) and TTH (USD 197.6±636.4, p<0.001). Conclusions Migraine, PM, and TTH were found to be prevalent among IT workers in Korea. Disability and economic loss were significantly greater in participants with migraine than in those with PM or TTH.
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Affiliation(s)
- Byung Kun Kim
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Soo Jin Cho
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Chang Soo Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Fumihiko Sakai
- The Saitama International Headache Center, Saitama, Japan
| | | | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Steiner TJ, Jensen R, Katsarava Z, Stovner LJ, Uluduz D, Adarmouch L, Al Jumah M, Al Khathaami AM, Ashina M, Braschinsky M, Broner S, Eliasson JH, Gil-Gouveia R, Gómez-Galván JB, Gudmundsson LS, Herekar AA, Kawatu N, Kissani N, Kulkarni GB, Lebedeva ER, Leonardi M, Linde M, Luvsannorov O, Maiga Y, Milanov I, Mitsikostas DD, Musayev T, Olesen J, Osipova V, Paemeleire K, Peres MFP, Quispe G, Rao GN, Risal A, de la Torre ER, Saylor D, Togha M, Yu SY, Zebenigus M, Zewde YZ, Zidverc-Trajković J, Tinelli M. Structured headache services as the solution to the ill-health burden of headache: 1. Rationale and description. J Headache Pain 2021; 22:78. [PMID: 34289806 PMCID: PMC8293530 DOI: 10.1186/s10194-021-01265-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/25/2021] [Indexed: 12/14/2022] Open
Abstract
In countries where headache services exist at all, their focus is usually on specialist (tertiary) care. This is clinically and economically inappropriate: most headache disorders can effectively and more efficiently (and at lower cost) be treated in educationally supported primary care. At the same time, compartmentalizing divisions between primary, secondary and tertiary care in many health-care systems create multiple inefficiencies, confronting patients attempting to navigate these levels (the "patient journey") with perplexing obstacles.High demand for headache care, estimated here in a needs-assessment exercise, is the biggest of the challenges to reform. It is also the principal reason why reform is necessary.The structured headache services model presented here by experts from all world regions on behalf of the Global Campaign against Headache is the suggested health-care solution to headache. It develops and refines previous proposals, responding to the challenge of high demand by basing headache services in primary care, with two supporting arguments. First, only primary care can deliver headache services equitably to the large numbers of people needing it. Second, with educational supports, they can do so effectively to most of these people. The model calls for vertical integration between care levels (primary, secondary and tertiary), and protection of the more advanced levels for the minority of patients who need them. At the same time, it is amenable to horizontal integration with other care services. It is adaptable according to the broader national or regional health services in which headache services should be embedded.It is, according to evidence and argument presented, an efficient and cost-effective model, but these are claims to be tested in formal economic analyses.
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Affiliation(s)
- Timothy J Steiner
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Edvard Griegs gate, Trondheim, Norway.
- Division of Brain Sciences, Imperial College London, London, UK.
| | - Rigmor Jensen
- Danish Headache Centre, Department of Neurology, University of Copenhagen, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Zaza Katsarava
- Evangelical Hospital Unna, Unna, Germany
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
- EVEX Medical Corporation, Tbilisi, Georgia
- IM Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Lars Jacob Stovner
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Edvard Griegs gate, Trondheim, Norway
- Norwegian Advisory Unit on Headache, Department of Neurology and Clinical Neurophysiology, St Olavs University Hospital, Trondheim, Norway
| | - Derya Uluduz
- Neurology Department, Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Latifa Adarmouch
- Community Medicine and Public Health Department, Cadi Ayyad University School of Medicine, Marrakech, Morocco
| | - Mohammed Al Jumah
- Department of Neurosciences, King Fahad Medical City, MOH, Riyadh, Saudi Arabia
| | - Ali M Al Khathaami
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Messoud Ashina
- Danish Headache Centre, Department of Neurology, University of Copenhagen, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Mark Braschinsky
- Headache Clinic, Neurology Clinic, Tartu University Hospital, Tartu, Estonia
| | - Susan Broner
- Weill Cornell Medicine Headache Program, Department of Neurology, Weill Cornell Medical College, New York, NY, USA
| | - Jon H Eliasson
- Department of Neurology, Centralsjukhuset, Kristianstad, Sweden
| | - Raquel Gil-Gouveia
- Headache Centre, Neurology Department, Hospital da Luz, Lisbon, Portugal
| | | | - Larus S Gudmundsson
- Faculty of Pharmaceutical Sciences, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Akbar A Herekar
- Department of Anesthesiology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Nfwama Kawatu
- Department of Paediatrics, University Teaching Hospital, Lusaka, Zambia
| | - Najib Kissani
- Laboratory of Clinical and Experimental Neuroscience, Faculty of Medicine, Université Cadi Ayyad Marrakech, Marrakech, Morocco
- Department of Neurology, University Teaching Hospital Mohammed VI, Marrakech, Morocco
| | - Girish Baburao Kulkarni
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Elena R Lebedeva
- Department of Neurology and Neurosurgery, The Ural State Medical University, Yekaterinburg, Russia
- International Headache Centre "Europe-Asia", Yekaterinburg, Russia
| | - Matilde Leonardi
- Neurology, Public Health, Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Mattias Linde
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Edvard Griegs gate, Trondheim, Norway
- Norwegian Advisory Unit on Headache, Department of Neurology and Clinical Neurophysiology, St Olavs University Hospital, Trondheim, Norway
- Tjörn Headache Clinic, Rönnäng, Sweden
| | - Otgonbayar Luvsannorov
- Department of Neurology, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Youssoufa Maiga
- Faculty of Medicine, University of Technical Sciences and Technologies, Bamako, Mali
| | - Ivan Milanov
- Department of Neurology, University Hospital of Neurology and Psychiatry "St Naum", Medical University Sofia, Sofia, Bulgaria
| | - Dimos D Mitsikostas
- 1st Neurology Department, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Teymur Musayev
- Chief of Department of Health Organization, Ministry of Health, Baku, Azerbaijan
| | - Jes Olesen
- Danish Headache Centre, Department of Neurology, University of Copenhagen, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Vera Osipova
- Moscow Research Clinical Centre for Neuropsychiatry, Moscow, Russian Federation
- University Headache Clinic, Moscow, Russian Federation
| | - Koen Paemeleire
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Mario F P Peres
- Institute of Psychiatry, University of São Paulo, Hospital Albert Einstein, São Paulo, Brazil
| | - Guiovanna Quispe
- Department of Neurology, Hospital Luis Negreiros Vega, Callao, Lima, Peru
| | - Girish N Rao
- Department of Epidemiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Ajay Risal
- Department of Psychiatry, Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Kavre, Nepal
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | | | - Deanna Saylor
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Mansoureh Togha
- Neurology Ward, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Headache Department, Iranian Center of Neurological Researches, Institute of Neuroscience, Tehran University of Medical Sciences, Tehran, Iran
| | - Sheng-Yuan Yu
- International Headache Centre, Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Mehila Zebenigus
- Department of Neurology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yared Zenebe Zewde
- Department of Neurology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Michela Tinelli
- Care Policy and Evaluation Centre, The London School of Economics and Political Science, London, UK
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Kothari SF, Jensen RH, Steiner TJ. The relationship between headache-attributed disability and lost productivity: 1. A review of the literature. J Headache Pain 2021; 22:73. [PMID: 34273952 PMCID: PMC8285879 DOI: 10.1186/s10194-021-01264-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/25/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Headache disorders are disabling and have a significant impact on productivity. The relationship between these two consequences is of considerable economic and political interest. We enquired into it through a systematic search of the English-language literature. METHODS We followed PRISMA guidelines in specifying search terms and syntax and in article selection. We used the term "disability" in the search, accepting any meaning that authors attached to it, but this proved problematic. Accordingly, we adopted the definition used in the Global Burden of Disease study. In article selection, we included only those that purported to measure disability as so defined and lost productivity. We reviewed the full texts of those selected. We included further articles identified from review of the bibliographies of selected articles. RESULTS The literature search found 598 studies, of which 21 warranted further review. Their bibliographies identified another four of possible relevance. On full-text reading of these 25, all were rejected. Ten applied incompatible definitions of disability and/or lost productivity. Two did not measure both. Four reported lost productivity but not disability. Eight studies reported and measured both but did not assess the association between them or provide the means of doing so. One was purely methodological. CONCLUSIONS The literature is silent on the relationship between headache-attributed disability and lost productivity. In view of its health economic and political importance, empirical studies are required to remedy this. A prerequisite is to clarify what is meant by "disability" in this context.
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Affiliation(s)
- Simple Futarmal Kothari
- Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark
| | - Rigmor Hølland Jensen
- Danish Headache Centre, Department of Neurology, University of Copenhagen, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Timothy J Steiner
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Edvard Griefs gate, Trondheim, Norway
- Division of Brain Sciences, Imperial College London, London, UK
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Pantoja-Ruiz C, Restrepo-Jimenez P, Castañeda-Cardona C, Ferreirós A, Rosselli D. Cannabis and pain: a scoping review. Braz J Anesthesiol 2021; 72:142-151. [PMID: 34280454 PMCID: PMC9373074 DOI: 10.1016/j.bjane.2021.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/16/2021] [Accepted: 06/26/2021] [Indexed: 11/05/2022] Open
Abstract
For centuries, cannabis has been used with many different purposes, including medicinal use, usually bypassing any formal approval process. However, during the last decade, interest in cannabis in medicine has been increasing, and several countries, including the United States and Canada, have produced their own legislation about marihuana and cannabis-based medicines. Because of this, interest in research has been increasing and evidence about its medical effects is becoming necessary. We conducted a review examining the evidence of cannabis in pain. Cannabis had been shown to be useful in acute and chronic pain, however recently, these results have been controverted. Within the different types of chronic pain, it has a weak evidence for neuropathic, rheumatic pain, and headache, modest evidence for multiple sclerosis related pain, and as adjuvant therapy in cancer pain. There is no strong evidence to recommend cannabis in order to decrease opioids in patients with chronic use. Even though cannabis-based medications appear to be mostly safe, mild adverse effects are common; somnolence, sedation, amnesia, euphoric mood, hyperhidrosis, paranoia, and confusion may limit the use of cannabis in clinical practice. Risks have not been systematically analyzed. Special concern arises on how adverse effect might affect vulnerable population such as elderly patients. More research is needed in order to evaluate benefits and risks, as well as the ideal administration route and dosages. As cannabis use increases in several countries, answers to these questions might be coming soon.
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Affiliation(s)
- Camila Pantoja-Ruiz
- Pontificia Universidad Javeriana, Medical School, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Paula Restrepo-Jimenez
- Pontificia Universidad Javeriana, Medical School, Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | | | - Diego Rosselli
- Pontificia Universidad Javeriana, Medical School, Bogotá, Colombia.
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Qualitative Analysis of Single-Site Headache Surgery: Is It Different From Multiple-Site Surgery? Ann Plast Surg 2021; 87:73-79. [PMID: 34133367 DOI: 10.1097/sap.0000000000002828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Migraine surgery has been shown to be efficacious, but nuanced effects of surgery on pain and individuals' lives remain incompletely understood. Surgery may be performed at a single or multiple "primary" sites. The aims of this study were to investigate patient perceptions following single-site surgery and compare themes in patients undergoing single-site surgery with those from a previously published conceptual framework generated with patients undergoing multisite surgery. METHODS Patients who underwent single-site headache surgery participated in open-ended interviews at least 1 year after surgery. Participants (n = 14) had undergone either occipital, temporal, or nasoseptal site surgery. A multidisciplinary team analyzed transcripts. Recurring themes were identified and compared and contrasted to those observed in patients who underwent multiple-site surgery (n = 15) in a previous study (Plast Reconstr Surg 2019;144(4):956-964). RESULTS Similar recurring themes emerged from the single-site cohort, and the conceptual framework was applicable to all participants. Two new themes emerged from the single-site analysis. First, 5 of 14 participants described being "migraine-free" postoperatively, a finding not observed in the multisite group. Second, several individuals described financial benefits after surgery, via decreased prescription medication requirements, raises at work, and improved productivity. CONCLUSIONS Single-site headache surgery appears to positively impact patients' lives in ways that support and expand upon previously published outcomes. Patients undergoing surgery at a single site may be more likely to experience a "pain-free" state, which may relate to the underlying pathophysiology of chronic headache. The effect of surgery on finances appears to be an outcome of interest to patients, which should be explored further.
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Doll E, Gong P, Sowell M, Evanczyk L. Post-traumatic Headache in Children and Adolescents. Curr Pain Headache Rep 2021; 25:51. [PMID: 34086145 DOI: 10.1007/s11916-021-00967-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Post-traumatic headache is a common disorder in the pediatric age group, seen both by child neurologists and by non-neurologists. The current review of post-traumatic headache in children and adolescents aims to review the pathophysiology, risk factors, clinical features, neuroimaging, and both acute and preventive treatment options. RECENT FINDINGS Recent literature provides insight into specific risk factors in the pediatric age group for developing post-traumatic headache as well as unique pathophysiologic changes seen in neuroimaging and neurometabolic pathways. It also elucidates common treatment options and novel treatments being currently explored, such as with monoclonal antibodies to CGRP. Finally, current evidence and guidelines recommend the benefit of a gradual return to normal activity based on symptom stability rather than a specific time period. Review of literature on pediatric post-traumatic headache reveals a growing understanding of the factors involved in developing headache after head trauma and the diagnosis/treatment of headache though future research will help further elucidate these areas.
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Affiliation(s)
- Elizabeth Doll
- Department of Neurology, University of Louisville School of Medicine, 500 S Preston St, 113-a HSC, Louisville, KY, 40202, USA
| | - Paul Gong
- Department of Neurology, University of Louisville School of Medicine, 500 S Preston St, 113-a HSC, Louisville, KY, 40202, USA.
| | - Michael Sowell
- Department of Neurology, University of Louisville School of Medicine, 500 S Preston St, 113-a HSC, Louisville, KY, 40202, USA
| | - Lauren Evanczyk
- Norton Children's Neuroscience Institute, Norton Healthcare, Louisville, KY, USA
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Abstract
Migraine is considered mostly a woman’s complaint, even if it affects also men. Epidemiological data show a higher incidence of the disease in women, starting from puberty throughout life. The sex-related differences of migraine hold clinical relevance too. The frequency, duration, and disability of attacks tend to be higher in women. Because of this, probably, they also consult specialists more frequently and take more prescription drugs than men. Different mechanisms have been evaluated to explain these differences. Hormonal milieu and its modulation of neuronal and vascular reactivity is probably one of the most important aspects. Estrogens and progesterone regulate a host of biological functions through two mechanisms: nongenomic and genomic. They influence several neuromediators and neurotransmitters, and they may cause functional and structural differences in several brain regions, involved in migraine pathogenesis. In addition to their central action, sex hormones exert rapid modulation of vascular tone. The resulting specific sex phenotype should be considered during clinical management and experimental studies.
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Brain Energy Deficit as a Source of Oxidative Stress in Migraine: A Molecular Basis for Migraine Susceptibility. Neurochem Res 2021; 46:1913-1932. [PMID: 33939061 DOI: 10.1007/s11064-021-03335-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/06/2021] [Accepted: 04/22/2021] [Indexed: 02/06/2023]
Abstract
People with migraine are prone to a brain energy deficit between attacks, through increased energy demand (hyperexcitable brain) or decreased supply (mitochondrial impairment). However, it is uncertain how this precipitates an acute attack. Here, the central role of oxidative stress is adduced. Specifically, neurons' antioxidant defenses rest ultimately on internally generated NADPH (reduced nicotinamide adenine dinucleotide phosphate), whose levels are tightly coupled to energy production. Mitochondrial NADPH is produced primarily by enzymes involved in energy generation, including isocitrate dehydrogenase of the Krebs (tricarboxylic acid) cycle; and an enzyme, nicotinamide nucleotide transhydrogenase (NNT), that depends on the Krebs cycle and oxidative phosphorylation to function, and that works in reverse, consuming antioxidants, when energy generation fails. In migraine aura, cortical spreading depression (CSD) causes an initial severe drop in level of NADH (reduced nicotinamide adenine dinucleotide), causing NNT to impair antioxidant defense. This is followed by functional hypoxia and a rebound in NADH, in which the electron transport chain overproduces oxidants. In migraine without aura, a similar biphasic fluctuation in NADH very likely generates oxidants in cortical regions farthest from capillaries and penetrating arterioles. Thus, the perturbations in brain energy demand and/or production seen in migraine are likely sufficient to cause oxidative stress, triggering an attack through oxidant-sensing nociceptive ion channels. Implications are discussed for the development of new classes of migraine preventives, for the current use of C57BL/6J mice (which lack NNT) in preclinical studies of migraine, for how a microembolism initiates CSD, and for how CSD can trigger a migraine.
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Elser H, Morello-Frosch R, Jacobson A, Pressman A, Kioumourtzoglou MA, Reimer R, Casey JA. Air pollution, methane super-emitters, and oil and gas wells in Northern California: the relationship with migraine headache prevalence and exacerbation. Environ Health 2021; 20:45. [PMID: 33865403 PMCID: PMC8053292 DOI: 10.1186/s12940-021-00727-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 04/12/2021] [Indexed: 05/25/2023]
Abstract
BACKGROUND Migraine-an episodic disorder characterized by severe headache that can lead to disability-affects over 1 billion people worldwide. Prior studies have found that short-term exposure to fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone increases risk of migraine-related emergency department (ED) visits. Our objective was to characterize the association between long-term exposure to sources of harmful emissions and common air pollutants with both migraine headache and, among patients with migraine, headache severity. METHODS From the Sutter Health electronic health record database, we identified 89,575 prevalent migraine cases between 2014 and 2018 using a migraine probability algorithm (MPA) score and 270,564 frequency-matched controls. Sutter Health delivers care to 3.5 million patients annually in Northern California. Exposures included 2015 annual average block group-level PM2.5 and NO2 concentrations, inverse-distance weighted (IDW) methane emissions from 60 super-emitters located within 10 km of participant residence between 2016 and 2018, and IDW active oil and gas wells in 2015 within 10 km of each participant. We used logistic and negative binomial mixed models to evaluate the association between environmental exposures and (1) migraine case status; and (2) migraine severity (i.e., MPA score > 100, triptan prescriptions, neurology visits, urgent care migraine visits, and ED migraine visits per person-year). Models controlled for age, sex, race/ethnicity, Medicaid use, primary care visits, and block group-level population density and poverty. RESULTS In adjusted analyses, for each 5 ppb increase in NO2, we observed 2% increased odds of migraine case status (95% CI: 1.00, 1.05) and for each 100,000 kg/hour increase in IDW methane emissions, the odds of case status also increased (OR = 1.04, 95% CI: 1.00, 1.08). We found no association between PM2.5 or oil and gas wells and migraine case status. PM2.5 was linearly associated with neurology visits, migraine-specific urgent care visits, and MPA score > 100, but not triptans or ED visits. NO2 was associated with migraine-specific urgent care and ED visits, but not other severity measures. We observed limited or null associations between continuous measures of methane emissions and proximity to oil and gas wells and migraine severity. CONCLUSIONS Our findings illustrate the potential role of long-term exposure to multiple ambient air pollutants for prevalent migraine and migraine severity.
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Affiliation(s)
- Holly Elser
- Stanford University School of Medicine, Stanford Center for Population Health Sciences, Stanford, USA
| | - Rachel Morello-Frosch
- Department of Environmental Science, Policy, and Management and School of Public Health, University of California Berkeley, Berkeley, CA USA
| | - Alice Jacobson
- Research, Development and Dissemination, Sutter Health, Sacramento, USA
| | - Alice Pressman
- Research, Development and Dissemination, Sutter Health, Sacramento, USA
| | - Marianthi-Anna Kioumourtzoglou
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W 168th St, Rm 1206, New York, NY 10032-3727 USA
| | - Richard Reimer
- Department of Neurology and Neurological Science, Stanford University School of Medicine, Stanford, USA
| | - Joan A. Casey
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W 168th St, Rm 1206, New York, NY 10032-3727 USA
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Ashina M, Katsarava Z, Do TP, Buse DC, Pozo-Rosich P, Özge A, Krymchantowski AV, Lebedeva ER, Ravishankar K, Yu S, Sacco S, Ashina S, Younis S, Steiner TJ, Lipton RB. Migraine: epidemiology and systems of care. Lancet 2021; 397:1485-1495. [PMID: 33773613 DOI: 10.1016/s0140-6736(20)32160-7] [Citation(s) in RCA: 275] [Impact Index Per Article: 91.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/11/2020] [Accepted: 10/14/2020] [Indexed: 02/06/2023]
Abstract
Migraine is a neurovascular disorder that affects over 1 billion people worldwide. Its widespread prevalence, and associated disability, have a range of negative and substantial effects not only on those immediately affected but also on their families, colleagues, employers, and society. To reduce this global burden, concerted efforts are needed to implement and improve migraine care that is supported by informed health-care policies. In this Series paper, we summarise the data on migraine epidemiology, including estimates of its very considerable burden on the global economy. First, we present the challenges that continue to obstruct provision of adequate care worldwide. Second, we outline the advantages of integrated and coordinated systems of care, in which primary and specialist care complement and support each other; the use of comprehensive referral and linkage protocols should enable continuity of care between these systems levels. Finally, we describe challenges in low and middle-income countries, including countries with poor public health education, inadequate access to medication, and insufficient formal education and training of health-care professionals resulting in misdiagnosis, mismanagement, and wastage of resources.
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Affiliation(s)
- Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Danish Knowledge Center on Headache Disorders, Glostrup, Denmark; Department of Neurology, Azerbaijan Medical University, Baku, Azerbaijan; Department of Neurology, IM Sechenov First Moscow State Medical University, Moscow, Russia.
| | - Zaza Katsarava
- Department of Neurology, Evangelical Hospital Unna, Unna, Germany; Department of Neurology, University of Duisburg-Essen, Essen, Germany; EVEX Medical Corporation, Tbilisi, Georgia; Department of Neurology, IM Sechenov First Moscow State Medical University, Moscow, Russia
| | - Thien Phu Do
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Aynur Özge
- Department of Neurology, Mersin University, School of Medicine, Mersin, Turkey
| | | | - Elena R Lebedeva
- Department of Neurology, International Headache Centre Europe-Asia, the Ural State Medical University, Yekaterinburg, Russia
| | - Krishnamurthy Ravishankar
- The Headache and Migraine Clinic, Jaslok Hospital and Research Centre, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Shengyuan Yu
- Department of Neurology, People's Liberation Army General Hospital, Beijing, China
| | - Simona Sacco
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Sait Ashina
- Comprehensive Headache Center, Department of Neurology and Anesthesia, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Samaira Younis
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Timothy J Steiner
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway; Division of Brain Sciences, Imperial College London, London, UK
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA; Montefiore Medical Center, Bronx, NY, USA
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Real-World Treatment Profiles, Clinical Outcomes, and Healthcare Resource Utilization of Patients with Migraine Prescribed Erenumab: A Multicenter Chart-Review Study of US Headache Centers. Neurol Ther 2021; 10:293-306. [PMID: 33856626 PMCID: PMC8140045 DOI: 10.1007/s40120-021-00245-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/17/2021] [Indexed: 01/03/2023] Open
Abstract
Introduction Erenumab, a first-in-class monoclonal antibody targeting the calcitonin gene-related peptide pathway, was approved by the US Food and Drug Administration in 2018 for the prevention of migraine in adults. There is limited data available on its impact in real-world settings. The study aim was to characterize the real-world treatment profiles, clinical outcomes, and healthcare resource utilization of patients prescribed erenumab from select major US headache centers. Methods A retrospective chart review of patients with migraine treated with erenumab for at least 3 months across five major headache centers was conducted. Data was collected from patient charts between April 2019 and April 2020 and included patient and clinical characteristics, migraine medication use, and outpatient visits. The date of the first prescription fill of erenumab was defined as the index date. The baseline period comprised the 3 months prior to the index date and the study period comprised the at least 3 months on erenumab treatment. Results Data from a total of 1034 patients with chronic migraine with a mean of 9.3 months of erenumab treatment were analyzed. Patients were on average 48 years old, 86% were female, and 79% were white. Patients had a mean of 5 preventive treatment failures prior to erenumab initiation. Patients used a mean of 2 preventive treatments (excluding erenumab) and 2 acute treatments during baseline and study periods. Among patients with effectiveness data, 45% of patients had improvement in physician-reported migraine severity and 35% experienced at least 50% reduction in mean headache/migraine days per month. The average number of monthly outpatient visits was 0.43 and 0.30 before and after erenumab initiation, respectively. Conclusion In this predominantly refractory chronic migraine population treated in select headache centers, patients had fewer headache/migraine days per month and outpatient visits after initiating erenumab. However, patients largely continued to be managed via a polypharmacy approach after erenumab initiation.
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CHANG HY, YANG CC, JENSEN MP, LAI YH. The Frequency and Perceived Effectiveness of Pain Self-Management Strategies Used by Individuals With Migraine. J Nurs Res 2021; 29:e154. [PMID: 33840771 PMCID: PMC8126499 DOI: 10.1097/jnr.0000000000000429] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Migraine is ranked among the most important causes of disability worldwide. Some effective migraine treatments have been identified. However, little is known regarding the treatment strategies used by patients with migraine to manage pain or their efficacy. PURPOSE This study was designed to (a) investigate the pain management strategies used by migraineurs and their perceived effectiveness and (b) evaluate the association between the number of strategies used and their overall perceived effectiveness. METHODS A cross-sectional design with consecutive sampling was used in a medical center in Taiwan. Individuals with migraine (N = 174) completed self-administered questionnaires and in-depth interviews to assess the frequency and perceived effectiveness of a variety of pain management strategies. RESULTS Most participants reported using prescription medications (56%) and over-the-counter medications (51%), which were rated as having good efficacy rates of 78% and 81%, respectively. Traditional Chinese medicine (17%) and folk remedies (13%) were used less frequently and rated as relatively less effective at 65% and 48%, respectively. About half (47%) reported using more than one pain management strategy. Significantly more of those who reported using multiple pain management strategies reported at least "some effect" than those who reported using one strategy only (73% vs. 27%, p = .001). CONCLUSIONS Prescription medications showed good usage rate and good perceived efficacy. However, about half of the participants used multiple pain management strategies, supporting the need for further research to evaluate the efficacy of combination treatments and to identify those combinations that may have the most additive and/or synergistic effects. Furthermore, the findings indicate that continued use of medications for migraine management is appropriate for many individuals because of the relatively high rates of perceived efficacy for this strategy found in this study.
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Affiliation(s)
- Hao-Yuan CHANG
- PhD, RN, Assistant Professor, School of Nursing, College of Medicine, National Taiwan University, and Adjunct Supervisor, Department of Nursing, National Taiwan University Hospital, Taiwan, ROC
| | - Chih-Chao YANG
- MD, Attending Physician, Department of Neurology, National Taiwan University Hospital, Taiwan, ROC
| | - Mark P. JENSEN
- PhD, Professor, Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Yeur-Hur LAI
- PhD, RN, FAAN, Professor, School of Nursing, College of Medicine, National Taiwan University, and Director, Department of Nursing, National Taiwan University Cancer Center, Taipei, Taiwan, ROC
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Khan K, Arain MI, Asghar MA, Rehman AA, Ghoto MA, Dayo A, Imtiaz MS, Rana MH, Asghar MA. Analysis of treatment cost and persistence among migraineurs: A two-year retrospective cohort study in Pakistan. PLoS One 2021; 16:e0248761. [PMID: 33770109 PMCID: PMC7996986 DOI: 10.1371/journal.pone.0248761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/04/2021] [Indexed: 01/03/2023] Open
Abstract
Objectives The persistence pattern of anti-migraine drugs’ use among migraineurs is very low in the United States and different European countries. However, the cost and persistence of antimigraine drugs in Asian countries have not been well-studied. Hence, the present study aimed to evaluate the treatment cost and persistence among migraineurs in Pakistan. Methods Data from prescriptions collected from migraineurs who visited the Outpatient Department (OPD) of different public and private sector tertiary-care hospitals of Karachi, Pakistan were used to conduct this retrospective cohort study from 2017 to 2019. The minimum follow up period for each migraineur was about 12 months for persistence analysis while dropped-out patients data were also included in survival analysis as right censored data. Pairwise comparisons from Cox regression/hazards ratio were used to assess the predictors of persistence with the reference category of non-binary variables i.e. hazard ratio = 1 for low frequency migraineurs and NSAIDs users. Persistence with anti-migraine drugs was estimated using the Kaplan-Meier curve along with the Log Rank test. Results A total of 1597 patients were included in this study, 729 (45.6%) were male and 868 (54.3%) were female. Non-steroidal anti-inflammatory drugs (NSAIDs) were the most prescribed class of drug initially for all classes of migraineurs (26.1%). Of them, 57.3% of migraineurs discontinued their treatment, 28.5% continued while 14.8% were switched to other treatment approaches. Persistence with initial treatment was more profound in female (58.8%) patients compared to males while the median age of continuers was 31 years. The total cost of migraine treatment in the entire study cohort was 297532.5 Pakistani Rupees ($1901.1). By estimating the hazard ratios (HR) using the Cox regression analysis, it can be observed that patients with high frequency (HR, 1.628; 95%CI, 1.221–2.179; p<0.0001) migraine, depression (HR, 1.268; 95%CI, 1.084–1.458; p<0.0001), increasing age (HR, 1.293; 95%CI, 1.092–1.458; p<0.0001), combination analgesics (HR, 1.817; 95%CI, 0.841–2.725; p = 0.0004) and prophylaxis drugs (HR, 1.314; 95%CI, 0.958–1.424; p<0.0001) users were at a higher risk of treatment discontinuation. However, patients with chronic migraine (HR, 0.881; 95%CI, 0.762–0.912; p = 0.0002), epileptic seizure (HR, 0.922; 95%CI, 0.654–1.206; p = 0.0002), other comorbidities (HR, 0.671; 95%CI, 0.352–1.011; p = 0.0003) and users of triptan(s) (HR, 0.701; 95%CI, 0.182–1.414; p = 0.0005) and triptan(s) with NSAIDs (HR, 0.758; 95%CI, 0.501–1.289; p<0.0001) had more chances to continue their initial therapy. Conclusion Similar to western countries, the majority of migraineurs exhibited poor persistence to migraine treatments. Various factors of improved persistence were identified in this study.
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Affiliation(s)
- Kamran Khan
- Department of Pharmaceutics, Institute of Pharmaceutical Sciences, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Mudassar Iqbal Arain
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Sindh, Jamshoro, Pakistan
| | - Muhammad Arif Asghar
- Department of Pharmaceutics, Institute of Pharmaceutical Sciences, Jinnah Sindh Medical University, Karachi, Pakistan
- * E-mail:
| | - Ahad Abdul Rehman
- Department of Pharmacology, Institute of Pharmaceutical Sciences, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Muhammad Ali Ghoto
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Sindh, Jamshoro, Pakistan
| | - Abdullah Dayo
- Department of Pharmaceutics, Faculty of Pharmacy, University of Sindh, Jamshoro, Pakistan
| | - Muhammad Suleman Imtiaz
- Department of Pharmaceutics, Institute of Pharmaceutical Sciences, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Mohsin Hamied Rana
- Department of Research and Development, Reckitt Benckiser, Karachi, Pakistan
| | - Muhammad Asif Asghar
- Food and Feed Safety Laboratory, Food and Marine Resources Research Centre, PCSIR Laboratories Complex, Shahrah-e-Salimuzzaman Siddiqui, Karachi, Sindh, Pakistan
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Simić S, Villar JR, Calvo-Rolle JL, Sekulić SR, Simić SD, Simić D. An Application of a Hybrid Intelligent System for Diagnosing Primary Headaches. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041890. [PMID: 33669247 PMCID: PMC7919804 DOI: 10.3390/ijerph18041890] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 01/03/2023]
Abstract
(1) Background: Modern medicine generates a great deal of information that stored in medical databases. Simultaneously, extracting useful knowledge and making scientific decisions for diagnosis and treatment of diseases becomes increasingly necessary. Headache disorders are the most prevalent of all the neurological conditions. Headaches have not only medical but also great socioeconomic significance. The aim of this research is to develop an intelligent system for diagnosing primary headache disorders. (2) Methods: This research applied various mathematical, statistical and artificial intelligence techniques, among which the most important are: Calinski-Harabasz index, Analytical Hierarchy Process, and Weighted Fuzzy C-means Clustering Algorithm. These methods, techniques and methodologies are used to create a hybrid intelligent system for diagnosing primary headache disorders. The proposed intelligent diagnostic system is tested with original real-world data set with different metrics. (3) Results: First at all, nine of 20 attributes – features from International Headache Society (IHS) criteria are selected, and then only five most important attributes from IHS criteria are selected. The calculation result based on the Calinski–Harabasz index value (178) for the optimal number of clusters is three, and they present three classes of headaches: (i) migraine, (ii) tension-type headaches (TTHs), and (iii) other primary headaches (OPHs). The proposed hybrid intelligent system shows the following quality metrics: Accuracy 75%; Precision 67% for migraine, 74% for TTHs, 86% for OPHs, and Average Precision 77%; Recall 86% for migraine, 73% for TTHs, 67% for OPHs, Average Recall 75%; F1 score 75% for migraine, 74% for TTHs, 75% for OPHs, and Average F1 score 75%. (4) Conclusions: The hybrid intelligent system presents qualitative and respectable experimental results. The implementation of existing diagnostics systems and the development of new diagnostics systems in medicine is necessary in order to help physicians make quality diagnosis and decide the best treatments for the patients.
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Affiliation(s)
- Svetlana Simić
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (S.S.); (S.R.S.)
| | - José R. Villar
- Faculty of Geology, Campus de Llamaquique, University of Oviedo, 33005 Oviedo, Spain;
| | - José Luis Calvo-Rolle
- Department of Industrial Engineering, University of A Coruña, 15405 Ferrol-A Coruña, Spain;
| | - Slobodan R. Sekulić
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (S.S.); (S.R.S.)
| | - Svetislav D. Simić
- Faculty of Technical Sciences, University of Novi Sad, 21000 Novi Sad, Serbia;
| | - Dragan Simić
- Faculty of Technical Sciences, University of Novi Sad, 21000 Novi Sad, Serbia;
- Correspondence: ; Tel.: +381-63-519-342
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