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Menés Fernández L, Salvat I, Adillón C. Expressed Beliefs about the Cause of Pain in a Pediatric Population: A Qualitative Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1007. [PMID: 37371238 DOI: 10.3390/children10061007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/28/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023]
Abstract
(1) Background: The aims of this study are to explore what beliefs children and adolescents manifest about the cause of the pain they describe, to compare whether there are differences between beliefs by age and the persistence of pain, and to relate the explanations of the cause of pain with current scientific evidence. (2) Methods: a cross-sectional qualitative study was used. The primary endpoint of the study was obtaining explanations of the cause of pain recorded by means of an open-ended question. The participants were school-age children attending a charted school in the province of Barcelona. (3) Results: The children and adolescents proposed a diverse range of explanations for the cause of pain that they reported in their responses. The most frequent explanation for the cause of pain were pathologies and injuries (45.95%), ergonomic issues (22.60%) and psychological issues (15.95%). (4) Conclusions: There is a lot of variety in the explanations that young people give about the cause of their pain in schoolchildren aged between 10 and 16 years old. There exists a high prevalence of explanations non-associated with tissue damage (ENAD) concerning the causes of pain described. It is necessary that future health prevention programs dedicated to early ages consider which beliefs about the cause of pain are the most frequent in the pediatric population.
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Affiliation(s)
- Laura Menés Fernández
- Department of Medicine and Surgery, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Isabel Salvat
- Department of Medicine and Surgery, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Cristina Adillón
- Department of Medicine and Surgery, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
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2
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Turner DP, Houle TT. Learning headache triggers through experience: A laboratory study. Headache 2023; 63:721-729. [PMID: 37114676 PMCID: PMC10411509 DOI: 10.1111/head.14496] [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: 12/10/2022] [Revised: 02/20/2023] [Accepted: 02/27/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To examine how individuals may learn headache trigger beliefs through sequential symbolic pairings of trigger candidates and headache attacks. BACKGROUND Learning from experience may be a major source of information about headache triggers. Little is known about learning-based influences on the establishment of trigger beliefs. METHODS This cross-sectional, observational study included N = 300 adults with headache who participated in a laboratory computer task. First, participants rated the chances (0%-100%) that encountering specific triggers would lead to experiencing a headache. Then, 30 sequential images with the presence or absence of a common headache trigger were presented alongside images representing the presence or absence of a headache attack. The primary outcome measure was the cumulative association strength rating (0 = no relationship to 10 = perfect relationship) between the trigger and headache using all previous trials. RESULTS A total of N = 296 individuals completed 30 trials for each of three triggers, yielding 26,640 total trials for analysis. The median [25th, 75th] association strength ratings for each of the randomly presented headache triggers were 2.2 [0, 3] for the Color Green, 2.7 [0, 5] for Nuts, and 3.9 [0, 8] for Weather Changes. There was a strong association between the "true" cumulative association strength and corresponding ratings. A 1-point increase on the phi scale (i.e., no relationship to perfect relationship) was associated with a 1.20 (95% CI: 0.81 to 1.49, p < 0.0001) point increase in association strength rating. A participant's prior belief about the potency of a trigger affected their perceived rating of the accumulating evidence, accounting for 17% of the total variation. CONCLUSION In this laboratory task, individuals appeared to learn trigger-headache associations through repeated exposures to accumulating symbolic evidence. Prior beliefs about the triggers appeared to influence ratings of the strength of relationships between triggers and headache attacks.
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Affiliation(s)
- Dana P Turner
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy T Houle
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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3
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Lakshmanan S, Singh U, Zaffrullah NS, Manimaran V. Clinical Outcome Following Endoscopic Septoturbinal Surgeries for Rhinogenic Contact Point Headache: A Retrospective Analysis. Indian J Otolaryngol Head Neck Surg 2022; 74:780-784. [PMID: 36452515 PMCID: PMC9702146 DOI: 10.1007/s12070-020-01825-w] [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: 12/12/2019] [Accepted: 02/26/2020] [Indexed: 10/24/2022] Open
Abstract
To assess the clinical outcome of endoscopic septoturbinal surgeries in patients with rhinogenic contact point headache. Retrospective audit of medical records. Retrospective audit of medical records of patients having undergone endoscopic surgical management for contact point headache between a period of May 2017 to May 2018 were included in the study. Patients who underwent functional endoscopic sinus surgery were excluded from the study. Pre operative pain score were compared with post operative pain score at interval of 1 month for 3 months consequently and at 1 year interval using Visual Analog scale (VAS). The difference between preoperative (mean 6.82) and post operative VAS pain scores after 1 month (mean 3.36), 2 months (mean 4.50), 3 months (mean 5.48), 1 year (mean 5.01) was statistically significant (p < 0.001). Contact point headache is an important clinical entity that might be missed during evaluation and management of refractory headache. Surgical management under endoscopic guidance can help to ensure removal of mucosal contact point and aid in the treatment of refractory headache as noted in our study.
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Affiliation(s)
- Somu Lakshmanan
- Department of ENT, Head and Neck Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Urvashi Singh
- Department of ENT, Head and Neck Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Nufra Senopher Zaffrullah
- Department of ENT, Head and Neck Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Vinoth Manimaran
- Department of ENT, Head and Neck Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
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Matt E, Aslan T, Amini A, Sariçiçek K, Seidel S, Martin P, Wöber C, Beisteiner R. Avoid or seek light - a randomized crossover fMRI study investigating opposing treatment strategies for photophobia in migraine. J Headache Pain 2022; 23:99. [PMID: 35948966 PMCID: PMC9367056 DOI: 10.1186/s10194-022-01466-0] [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: 06/09/2022] [Accepted: 07/18/2022] [Indexed: 11/23/2022] Open
Abstract
Background Photophobia, the aberrantly increased sensitivity to light, is a common symptom in migraine patients and light discomfort is frequently found as a trigger for migraine attacks. In behavioral studies, planned exposure to light was found to reduce headache in migraine patients with photophobia, potentially by increasing habituation to this migraine trigger. Here, we aimed to elucidate neurophysiological mechanisms of light exposure versus light deprivation in migraine patients using functional magnetic resonance imaging (fMRI). Methods Ten migraine patients (9 female, age = 28.70 ± 8.18 years) and 11 healthy controls (9 female, age = 23.73 ± 2.24 years) spent one hour on 7 consecutive days exposed to flashing light (Flash) or darkness (Dark) using a crossover design with a wash-out period of 3 months. Study participants kept a diary including items on interictal and ictal photophobia, presence and severity of headache 7 days before, during and 7 days after the interventions. One week before and one day after both interventions, fMRI using flickering light in a block design was applied. Functional activation was analyzed at whole-brain level and habituation of the visual cortex (V1) was modeled with the initial amplitude estimate and the corrected habituation slope. Results Mean interictal photophobia decreased after both interventions, but differences relative to the baseline did not survive correction for multiple comparisons. At baseline, flickering light induced activation in V1 was higher in the patients compared to the controls, but activation normalized after the Flash and the Dark interventions. V1 habituation indices correlated with headache frequency, headache severity and ictal photophobia. In the Flash condition, the individual change of headache frequency relative to the baseline corresponded almost perfectly to the change of the habituation slope compared to the baseline. Conclusions On average, light exposure did not lead to symptom relief, potentially due to the short duration of the intervention and the high variability of the patients’ responses to the intervention. However, the strong relationship between visual cortex habituation and headache symptoms and its modulation by light exposure might shed light on the neurophysiological basis of exposure treatment effects. Trial registration NCT05369910 (05/06/2022, retrospectively registered).
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Affiliation(s)
- Eva Matt
- Imaging-Based Functional Brain Diagnostics and Therapy, Department of Neurology, High Field Magnetic Resonance Centre, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Tuna Aslan
- Imaging-Based Functional Brain Diagnostics and Therapy, Department of Neurology, High Field Magnetic Resonance Centre, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Ahmad Amini
- Imaging-Based Functional Brain Diagnostics and Therapy, Department of Neurology, High Field Magnetic Resonance Centre, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Kardelen Sariçiçek
- Imaging-Based Functional Brain Diagnostics and Therapy, Department of Neurology, High Field Magnetic Resonance Centre, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Stefan Seidel
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Paul Martin
- School of Applied Psychology, Griffith University, Southport, QLD, Australia.,Department of Psychiatry, Monash University, Victoria, Australia
| | - Christian Wöber
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Roland Beisteiner
- Imaging-Based Functional Brain Diagnostics and Therapy, Department of Neurology, High Field Magnetic Resonance Centre, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
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Mao Y, Pan L, Li W, Xiao S, Qi R, Zhao L, Wang J, Cai Y. Stroboscopic lighting with intensity synchronized to rotation velocity alleviates motion sickness gastrointestinal symptoms and motor disorders in rats. Front Integr Neurosci 2022; 16:941947. [PMID: 35965602 PMCID: PMC9366139 DOI: 10.3389/fnint.2022.941947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/06/2022] [Indexed: 11/18/2022] Open
Abstract
Motion sickness (MS) is caused by mismatch between conflicted motion perception produced by motion challenges and expected “internal model” of integrated motion sensory pattern formed under normal condition in the brain. Stroboscopic light could reduce MS nausea symptom via increasing fixation ability for gaze stabilization to reduce visuo-vestibular confliction triggered by distorted vision during locomotion. This study tried to clarify whether MS induced by passive motion could be alleviated by stroboscopic light with emitting rate and intensity synchronized to acceleration–deceleration phase of motion. We observed synchronized and unsynchronized stroboscopic light (SSL: 6 cycle/min; uSSL: 2, 4, and 8 cycle/min) on MS-related gastrointestinal symptoms (conditioned gaping and defecation responses), motor disorders (hypoactivity and balance disturbance), and central Fos protein expression in rats receiving Ferris wheel-like rotation (6 cycle/min). The effects of color temperature and peak light intensity were also examined. We found that SSL (6 cycle/min) significantly reduced rotation-induced conditioned gaping and defecation responses and alleviated rotation-induced decline in spontaneous locomotion activity and disruption in balance beam performance. The efficacy of SSL against MS behavioral responses was affected by peak light intensity but not color temperature. The uSSL (4 and 8 cycle/min) only released defecation but less efficiently than SSL, while uSSL (2 cycle/min) showed no beneficial effect in MS animals. SSL but not uSSL inhibited Fos protein expression in the caudal vestibular nucleus, the nucleus of solitary tract, the parabrachial nucleus, the central nucleus of amygdala, and the paraventricular nucleus of hypothalamus, while uSSL (4 and 8 cycle/min) only decreased Fos expression in the paraventricular nucleus of hypothalamus. These results suggested that stroboscopic light synchronized to motion pattern might alleviate MS gastrointestinal symptoms and motor disorders and inhibit vestibular-autonomic pathways. Our study supports the utilization of motion-synchronous stroboscopic light as a potential countermeasure against MS under abnormal motion condition in future.
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Sullivan DP, Martin PR, Boschen MJ, Bandarian-Balooch S. Dysfunctional sleep beliefs and behaviours: Psychological factors in sleep-related headaches. Behav Res Ther 2022; 153:104094. [DOI: 10.1016/j.brat.2022.104094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/01/2022] [Accepted: 04/08/2022] [Indexed: 11/29/2022]
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O’Hare L, Asher JM, Hibbard PB. Migraine Visual Aura and Cortical Spreading Depression-Linking Mathematical Models to Empirical Evidence. Vision (Basel) 2021; 5:30. [PMID: 34200625 PMCID: PMC8293461 DOI: 10.3390/vision5020030] [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: 03/25/2021] [Revised: 05/15/2021] [Accepted: 05/24/2021] [Indexed: 01/10/2023] Open
Abstract
This review describes the subjective experience of visual aura in migraine, outlines theoretical models of this phenomenon, and explores how these may be linked to neurochemical, electrophysiological, and psychophysical differences in sensory processing that have been reported in migraine with aura. Reaction-diffusion models have been used to model the hallucinations thought to arise from cortical spreading depolarisation and depression in migraine aura. One aim of this review is to make the underlying principles of these models accessible to a general readership. Cortical spreading depolarisation and depression in these models depends on the balance of the diffusion rate between excitation and inhibition and the occurrence of a large spike in activity to initiate spontaneous pattern formation. We review experimental evidence, including recordings of brain activity made during the aura and attack phase, self-reported triggers of migraine, and psychophysical studies of visual processing in migraine with aura, and how these might relate to mechanisms of excitability that make some people susceptible to aura. Increased cortical excitability, increased neural noise, and fluctuations in oscillatory activity across the migraine cycle are all factors that are likely to contribute to the occurrence of migraine aura. There remain many outstanding questions relating to the current limitations of both models and experimental evidence. Nevertheless, reaction-diffusion models, by providing an integrative theoretical framework, support the generation of testable experimental hypotheses to guide future research.
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Affiliation(s)
- Louise O’Hare
- Division of Psychology, Nottingham Trent University, Nottingham NG1 4FQ, UK
| | - Jordi M. Asher
- Department of Psychology, University of Essex, Colchester CO4 3SQ, UK; (J.M.A.); (P.B.H.)
| | - Paul B. Hibbard
- Department of Psychology, University of Essex, Colchester CO4 3SQ, UK; (J.M.A.); (P.B.H.)
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8
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Karvounides D, Marzouk M, Ross AC, VanderPluym JH, Pettet C, Ladak A, Ziplow J, Patterson Gentile C, Turner S, Anto M, Barmherzig R, Chadehumbe M, Kalkbrenner J, Malavolta CP, Clementi MA, Gerson T, Szperka CL. The intersection of COVID-19, school, and headaches: Problems and solutions. Headache 2021; 61:190-201. [PMID: 33382459 PMCID: PMC8086994 DOI: 10.1111/head.14038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/12/2020] [Accepted: 11/12/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To equip clinicians with recommendations specific to concerns related to the novel coronavirus disease 2019 (COVID-19), which impact the physical, emotional, and social health of youth with headache disorders. BACKGROUND COVID-19 has affected societies on a global scale including children and youth with chronic headache disorders. Many concerns are predicted to arise in the 2020-2021 school year, whether classes are conducted in-person or virtually. METHODS Clinical impressions were combined with a review of the literature, although limited due to the recent nature of this issue. RESULTS We describe recommendations to support caregivers and youth as they face changes expected with the return to school in the fall of 2020. CONCLUSION Although there are significant concerns for caregivers and youth with migraine given the context of changes related to the pandemic, there are many recommendations that can help minimize exacerbations of the physical, emotional, and social health of youth with chronic migraine.
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Affiliation(s)
- Dina Karvounides
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Maya Marzouk
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA
| | - Alexandra C Ross
- UCSF Benioff Children's Hospital, University of California, San Francisco, CA, USA
| | | | | | - Ali Ladak
- Penn Therapy & Fitness, University City, Philadelphia, PA, USA
| | - Jason Ziplow
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Carlyn Patterson Gentile
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Scott Turner
- Department of Neurology, University of Alabama at Birmingham, School of Medicine, Birmingham, AL, USA
| | - Marissa Anto
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rebecca Barmherzig
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Madeline Chadehumbe
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jocelyn Kalkbrenner
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Carrie P Malavolta
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michelle A Clementi
- Department of Psychiatry, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA
| | - Trevor Gerson
- Division of Child Neurology, Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Christina L Szperka
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Martin PR, Timmings H. Effect of Headache Websites on Locus of Control and Self‐efficacy of Readers. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12177] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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Caroli A, Klan T, Gaul C, Kubik SU, Martin PR, Witthöft M. Types of Triggers in Migraine – Factor Structure of the Headache Triggers Sensitivity and Avoidance Questionnaire and Development of a New Short Form (
HTSAQ‐SF
). Headache 2020; 60:1920-1929. [DOI: 10.1111/head.13896] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/06/2020] [Accepted: 06/06/2020] [Indexed: 01/07/2023]
Affiliation(s)
- Anna Caroli
- Department of Psychology Johannes Gutenberg‐University of Mainz Mainz Germany
| | - Timo Klan
- Department of Psychology Johannes Gutenberg‐University of Mainz Mainz Germany
| | - Charly Gaul
- Migraine and Headache Clinic Königstein Königstein Germany
| | - Sonja U. Kubik
- School of Applied Psychology Griffith University Brisbane QLD Australia
| | - Paul R. Martin
- Department of Psychiatry Monash University Melbourne VIC Australia
- Department of Applied Psychology Griffith University Brisbane QLD Australia
| | - Michael Witthöft
- Department of Psychology Johannes Gutenberg‐University of Mainz Mainz Germany
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Martin PR. Triggers of Primary Headaches: Issues and Pathways Forward. Headache 2020; 60:2495-2507. [PMID: 32648597 DOI: 10.1111/head.13901] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 12/11/2022]
Abstract
The triggers of primary headaches have considerable significance for our understanding and management of headache and migraine. Triggers explain the variance in headaches - why they occur when they do. Trigger management is generally viewed as an important component of a comprehensive treatment approach for headaches. Historically, however, triggers have not had a prominent place in the headache literature. This situation began to change 20 to 30 years ago, and the pace of change has increased exponentially in recent times. Nevertheless, the field is beset with issues that have held it back from achieving more. This review will focus on elaborating those issues with the goal of suggesting ways forward. The first issue considered will be the definition of a trigger, and how specific triggers are labeled. Consideration will then be given to a classification system for triggers. The review will discuss next the evidence relating to whether self-reported triggers can, indeed, precipitate headaches, and how the capacity to elicit headaches may be acquired or extinguished. Attention will be given to the very important clinical issue of trigger management. Finally, the pathways forward will be proposed. Perhaps the most useful thing to accomplish at this point in time would be agreement on a definition of headache triggers, a list of triggers, and a classification system for triggers. This would greatly assist in comparing research on triggers from different research groups as well as eliminating some of the issues identified in this review. An authoritative body such as the American Headache Society or the International Headache Society, could establish a multidisciplinary committee that would complete these tasks. Consideration should also be given to incorporating triggers into the International Classification of Headache Disorders as an axis or via the use of codes, as this would raise the profile of triggers in assessment and management.
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Affiliation(s)
- Paul R Martin
- Department of Psychiatry, Monash University, Melbourne, VIC, Australia.,Department of Applied Psychology, Griffith University, Brisbane, QLD, Australia
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Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the role of avoidance behavior in headache-related disability and overview relevant clinical implications. RECENT FINDINGS Avoidance occupies a central role in contemporary psychological perspectives on headache disorders and other chronic pain conditions. Several cognitive constructs of relevance to headache are influenced and maintained by avoidance behavior. A growing body of literature attests to the notion that avoidance of headache triggers, of stimuli that exacerbate headache, and of broader life domains can negatively affect headache progression, disability/quality of life, and comorbid psychiatric symptoms. Interventions targeting avoidance behavior, such as therapeutic exposure to headache triggers, mindfulness, and acceptance and commitment therapy (ACT), hold promise for headache disorders but need to be tested in larger trials. Researchers and clinicians are encouraged to attend to functional impairment as a critically important treatment outcome. Comprehensive understanding of headache disorders necessitates attention not merely to diagnostic symptoms and their reduction, but to patterns of avoidance behavior that inadvertently exacerbate headache and contribute to functional impairment.
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Mindfulness and Chronic Headache/Migraine: Mechanisms Explored Through the Fear-Avoidance Model of Chronic Pain. Clin J Pain 2019; 34:638-649. [PMID: 29271796 DOI: 10.1097/ajp.0000000000000580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To replicate a study by Schutze and colleagues on a headache sample, rather than a heterogenous chronic pain sample, investigating whether level of mindfulness predicts key components in the Fear-Avoidance Model of chronic pain (pain intensity, negative affect, pain catastrophizing, pain-related fear, pain hypervigilance, and functional disability); to investigate the relationships between level of mindfulness and headache/migraine pain intensity, frequency, and duration. MATERIALS AND METHODS Participants were 217 individuals who self-reported chronic headache/migraine (51 male, 166 female), aged between 18 and 65 years. Participants completed an online survey measuring demographics, mindfulness, the key components of the Fear-Avoidance Model, and headache pain intensity, duration, and frequency. RESULTS Mindfulness had significant negative correlations (P<0.05) with all variables except headache pain intensity and headache frequency. Mindfulness significantly predicted negative affect, pain catastrophizing, fear of pain, pain hypervigilance, and headache duration (P<0.05). Mindfulness remained a significant predictor of negative affect and pain hypervigilance after controlling for other key components and background characteristics (P<0.05). Mindfulness did not moderate the relationship between pain intensity and pain catastrophizing (P=0.204). DISCUSSION Findings suggest that mindfulness may be integrated into the Fear-Avoidance Model of chronic pain for individuals with chronic headache/migraine. Directions for future research are discussed.
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Caroli A, Klan T, Gaul C, Liesering-Latta E, Martin P, Witthöft M. Die Erfassung von Triggerempfindlichkeit und -vermeidung bei primären Kopfschmerzen: Entwicklung und psychometrische Erprobung einer deutschen Version des Headache Triggers Sensitivity and Avoidance Questionnaire (HTSAQ-G). VERHALTENSTHERAPIE 2019. [DOI: 10.1159/000501218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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15
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Silverberg ND, Martin P, Panenka WJ. Headache Trigger Sensitivity and Avoidance after Mild Traumatic Brain Injury. J Neurotrauma 2019; 36:1544-1550. [DOI: 10.1089/neu.2018.6025] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Noah D. Silverberg
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver, British Columbia, Canada
| | - Paul Martin
- Research School of Psychology, Australian National University, Canberra, Australia
| | - William J. Panenka
- British Columbia Neuropsychiatry Program, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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Klan T, Liesering‐Latta E, Gaul C, Martin PR, Witthöft M. An Integrative Cognitive Behavioral Therapy Program for Adults With Migraine: A Feasibility Study. Headache 2019; 59:741-755. [DOI: 10.1111/head.13532] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Timo Klan
- Department of Psychology University of Mainz Mainz Germany
| | | | - Charly Gaul
- Migraine and Headache Clinic Königstein Königstein Germany
| | - Paul R. Martin
- Research School of Psychology The Australian National University Canberra Australia
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17
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Turner DP, Lebowitz AD, Chtay I, Houle TT. Headache Triggers as Surprise. Headache 2019; 59:495-508. [PMID: 30919414 DOI: 10.1111/head.13507] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To examine the hypothesis that surprising experiences of headache triggers are associated with daily headache activity. BACKGROUND Little is known about the specific environmental or behavioral interactions that might trigger a headache attack in a prone individual. We propose that headache trigger exposures can be usefully characterized, not only by their mechanisms of action, but also on the degree of "surprise" they present to the individual. This hypothesis is based on elements of information theory: that unusual events and experiences carry more information than common events and experiences and that headache attacks are associated with reactions to uncommon or unexpected biopsychosocial exposures. METHODS A secondary analysis of the Headache Prediction Study, this prospective cohort study followed N = 95 individuals with episodic migraine who contributed 4195 days of diary data. Information was collected on daily levels of several common headache triggers: number of caffeinated beverages, number of alcoholic beverages, stress (Daily Stress Inventory), and mood disturbance (Profile of Mood States). The probability of observing variations in each trigger was used to estimate the "surprisal" of experiencing each trigger, and this information, measured in bits, was used to predict headache attacks. RESULTS Participants experienced a headache attack on 1613 of 4195 days (38.5%). Each of the triggers was modestly related to the probability of experiencing a future headache in a complex manner that involved interactions between current headache status, current levels of the trigger, and lagged (previous) levels of the trigger. However, when expressed as a surprisal, the associations were simplified and strengthened. For example, each of the individual trigger surprisals exhibited a meaningful association with the development of a future headache attack (expressed as a 1 SD change in surprisal), with odds ratios ranging from a low of 1.11 (95%CI: 1.00 to 1.24) for alcohol to a high of 1.30 (95%CI: 1.14 to 1.46) for stress. The individual surprisals could be summed for total trigger surprise and exhibited a reliable association with new onset headache, OR 1.35 (95%CI: 1.17 to 1.49). This score exhibited superior discrimination between headache and non-headache days from all of the individual triggers (ignoring base rate, AUC: 0.61; AUC: 0.71 with base rate). CONCLUSIONS Diverse headache triggers can be uniformly described using their probability distributions. Rare values of headache triggers, or surprising values, were found to have consistent associations with headache activity across a variety of triggers. This finding, if validated in external data using other triggers, has potential to be used to conceptualize the influence of a wide range of headache triggers.
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Affiliation(s)
- Dana P Turner
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Adriana D Lebowitz
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ivana Chtay
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Timothy T Houle
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Hayne DP, Martin PR. Relating Photophobia, Visual Aura, and Visual Triggers of Headache and Migraine. Headache 2019; 59:430-442. [PMID: 30737782 DOI: 10.1111/head.13486] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study investigated a potential association between visual factors and symptoms related to migraine. It was predicted that photophobia and visual aura would be positively associated with interictal light sensitivity and visual headache triggers (flicker, glare, and eyestrain), and that these 2 visual symptoms would also be associated. BACKGROUND Previous studies have found independent neurophysiological associations between several visual factors and symptoms related to headache disorders. Many of these connections appear to be associated with increased cortical hypersensitivity, a phenomenon that might be in part due to repeated avoidance and reduced tolerance to triggers. If true, and if associations between visual factors and symptoms can be established, this may have implications for an exposure-based treatment for migraine symptoms. METHODS Four hundred and ninety-one participants (411 female, 80 male) were recruited through Griffith University (AUS), Headache Australia, Pain Australia, and through social media. Participants were grouped based on the presence of headache disorder symptoms and the presence or absence of photophobia and/or visual aura. A cross-sectional online survey design was utilized to gather information pertaining to interictal light sensitivity, visual triggers, and visual symptoms. RESULTS With respect to interictal light sensitivity and photophobia, a significant difference (P < .001, eta squared [η2 ] = 0.084) was found between the 3 groups, where headache disorder participants with photophobia (group A1; mean [M] = 2.5, standard deviation [SD] = 0.97) reported significantly greater light sensitivity than participants with headache disorder and no photophobia (A2; M = 1.68, SD = 0.62) and control group participants (A3; M = 1.82, SD = 0.85). This pattern was repeated for participants reporting flicker as a headache trigger (P < .001, η2 = 0.061), with group A1 (M = 2.45, SD = 1.24) significantly higher than groups A2 (M = 1.68, SD = 0.83) and A3 (M = 1.68, SD = 0.89), and was also seen for glare as a headache trigger (P < .001, η2 = 0.092), with group A1 (M = 2.92, SD = 0.96) significantly higher than A2 (M = 2.31, SD = 0.89) and A3 (M = 2.09, SD = 0.93). This pattern of results was not replicated for headache disorder participants with and without visual aura. A significant association (P < .001) was found between photophobia and visual aura in headache disorder participants based on a chi-square test of independence, with 86/136 participants reporting either both or neither visual symptom. CONCLUSIONS This study supports a link between certain visual phenomena in headache disorder populations, and supports future research into exposure-based treatments for migraine symptoms.
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Affiliation(s)
- Daniel P Hayne
- School of Psychology, University of New England, Armidale, Australia.,School of Applied Psychology, Griffith University, Mt Gravatt, Australia
| | - Paul R Martin
- Research School of Psychology, The Australian National University, Canberra, Australia
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19
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Kubik SU, Martin PR. The Headache Triggers Sensitivity and Avoidance Questionnaire: Establishing the Psychometric Properties of the Questionnaire. Headache 2016; 57:236-254. [PMID: 27753075 DOI: 10.1111/head.12940] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2016] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the psychometric properties of the newly developed Headache Triggers Sensitivity and Avoidance Questionnaire (HTSAQ) designed to measure variables relating to the Trigger Avoidance Model of Headaches. BACKGROUND The Trigger Avoidance Model of Headaches proposes that one pathway to developing a primary headache disorder is through the avoidance of headache triggers, resulting in an increase in trigger potency through sensitization. Conversely, prolonged exposure to certain triggers may reduce a potential trigger's ability to precipitate a headache. This model has led to an alternative approach to trigger management being proposed called Learning to Cope with Triggers, which advocates the desensitization of certain headache triggers through controlled exposure, while supporting avoidance of those triggers that are detrimental to health and wellbeing. To be able to evaluate predictions based on the Trigger Avoidance Model of Headaches and to investigate the effectiveness of Learning to Cope with Triggers, psychometrically sound measures of trigger sensitivity and trigger avoidance are needed. METHOD A convenience sample of 376 participants (87.5% female; 64.1% European descent) was recruited for the online study which consisted of a battery of measures including the HTSAQ, Brief Headache Screen, Pain Anxiety Symptoms Scale, Pain Sensitivity Questionnaire, Chronic Pain Acceptance Questionnaire, and demographic items. With an interval of 2-6 weeks, a subsample of participants (n = 201) completed the HTSAQ for a second time. The mean age of the sample was 31.4 years (SD = 12.8). The most common headache diagnoses (based on the Brief Headache Screen) were migraine (chronic = 62; episodic = 160), followed by medication-overuse headache (n = 87). The remaining participants (n = 67) were diagnosed as having episodic less severe headache (most likely tension-type headache). RESULTS Reliability was assessed through internal consistency and test-retest reliability over a period of 2-6 weeks, and both were excellent (alpha > .80). Strong construct validity was demonstrated by the measure's scale scores being significantly correlated in theoretically consistent ways with the Pain Sensitivity Questionnaire, Pain Anxiety Symptoms Scale, and Chronic Pain Acceptance Questionnaire. As the Trigger Avoidance Model of Headaches would predict, correlations between the HTSAQ Sensitivity scales and the Avoidance scale were strong (P < .001), and participants with chronic migraine had significantly higher HTSAQ scores than those with episodic headaches. CONCLUSION The findings support the use of the HTSAQ as a valid and reliable tool for assessing sensitivity to headache triggers and avoidance of headache triggers. Further research examining the factor structure of the HTSAQ is warranted.
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Affiliation(s)
- Sonja U Kubik
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Paul R Martin
- School of Applied Psychology and Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
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20
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Tomé-Pires C, Solé E, Racine M, Galán S, Castarlenas E, Jensen MP, Miró J. The relative importance of anxiety and depression in pain impact in individuals with migraine headaches. Scand J Pain 2016; 13:109-113. [PMID: 28850506 DOI: 10.1016/j.sjpain.2016.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 08/01/2016] [Accepted: 08/03/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Psychological factors are thought to impact headache as triggering, maintaining, and exacerbating factors. A better understanding of the role that modifiable factors, such as anxiety or depression, play in the impact of migraine could help identify potential treatment targets in this population. OBJECTIVES The objective of this study was to evaluate the relative importance of anxiety and depression as predictors of the impact of migraine on function. Thus, we aim to understand the relative importance that anxiety and depression have on the impact of migraines by assessing both and some life domains. METHODS Cross-sectional study involving forty-three individuals, mostly females (93%), with migraine headaches aged between 20 and 60 years old. Participants answered questions about headache pain intensity at the time of data collection and the usual in the past 30 days (0-10 Numerical Rating Scales) as well as other pain characteristics (i.e., duration, frequency, and duration), headache impact (vitality and social, role, and cognitive functioning), anxiety and depression by using the Hospital Anxiety and Depression Scale. RESULTS Anxiety (r=0.56, p<.001), but not depression (r=0.09, p=.59), was significantly associated with headache impact. Thus showing the relative importance that anxiety has on headache impact. CONCLUSIONS The findings support a larger role for anxiety than depression in the impact of migraine headaches on patient function. There are a number of mechanisms by which anxiety could potentially influence the impact of headache on patient function, and this study highlights that anxiety could potentially be a trigger of headache activity. IMPLICATIONS The findings thus suggest the possibility that treatments that focus on anxiety might be potentially more important for individuals with migraine than treatments that focus on depression, at least with respect to having a beneficial impact on the interference of headache with activity. Research is needed to evaluate the beneficial impact of anxiety treatment in individuals with migraine headaches. Clinicians should evaluate and consider treating, as appropriate and necessary, anxiety in patients with migraine.
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Affiliation(s)
- Catarina Tomé-Pires
- Chair in Pediatric Pain URV-FundaciónGrünenthal and Unit for the Study and Treatment of Pain - ALGOS, Catalonia, Spain.,Research Center for Behavior Assessment (CRAMC), Department of Psychology, Catalonia, Spain.,Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili, Catalonia, Spain
| | - Ester Solé
- Chair in Pediatric Pain URV-FundaciónGrünenthal and Unit for the Study and Treatment of Pain - ALGOS, Catalonia, Spain.,Research Center for Behavior Assessment (CRAMC), Department of Psychology, Catalonia, Spain.,Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili, Catalonia, Spain
| | - Mélanie Racine
- Lawson Health Research Institute, Ontario, Canada.,Beryl & Richard Ivey Rheumatology Day Programs, St. Joseph's Health Care, Ontario, Canada.,Clinical and Neurological Sciences Department, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Santiago Galán
- Chair in Pediatric Pain URV-FundaciónGrünenthal and Unit for the Study and Treatment of Pain - ALGOS, Catalonia, Spain.,Research Center for Behavior Assessment (CRAMC), Department of Psychology, Catalonia, Spain.,Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili, Catalonia, Spain
| | - Elena Castarlenas
- Chair in Pediatric Pain URV-FundaciónGrünenthal and Unit for the Study and Treatment of Pain - ALGOS, Catalonia, Spain.,Research Center for Behavior Assessment (CRAMC), Department of Psychology, Catalonia, Spain.,Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili, Catalonia, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Jordi Miró
- Chair in Pediatric Pain URV-FundaciónGrünenthal and Unit for the Study and Treatment of Pain - ALGOS, Catalonia, Spain.,Research Center for Behavior Assessment (CRAMC), Department of Psychology, Catalonia, Spain.,Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili, Catalonia, Spain
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Demarquay G, Royet JP, Giraud P, Chazot G, Valade D, Ryvlin P. Rating of Olfactory Judgements in Migraine Patients. Cephalalgia 2016; 26:1123-30. [PMID: 16919063 DOI: 10.1111/j.1468-2982.2006.01174.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The aim of this study was to evaluate olfactory hypersensitivity (OHS) between attacks in migraine patients. Seventy-four migraine patients and 30 controls were enrolled. The presence of OHS was evaluated using an oral questionnaire and a chemical odour intolerance index. Subjects had to rate the intensity and hedonicity of 12 odourants using a linear rating scale. Twenty-six patients (35.2±) but no control subjects reported an interictal OHS ( P < 0.001). Logistic regression analysis showed that patients with OHS presented a greater attack frequency, a higher number of odour-induced migraines and visual hypersensitivity when compared with other patients. Disease duration, age, gender and auditory hypersensitivity were not associated with OHS. OHS patients judged odours less pleasant than did other patients and controls, whereas the intensity scores were identical in both groups. OHS between attacks was significantly associated with odour-triggered migraine and an alteration of hedonic judgement.
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Affiliation(s)
- G Demarquay
- Unité de Neurologie Fonctionnelle et d'Epileptologie, Hôpital Neurologique Pierre Wertheimer, and Neuroscience and Sensory Systems, Claude-Bernard University, Lyon, France.
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22
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Abstract
Three studies are reported that explore colour perception in migraine. In each, sensitivity for colours detected selectively by the S-cones and the L- and M-cones was assessed separately. The first study assessed the discrimination of small colour differences using the Farnsworth-Munsell 100-hue test. The second assessed threshold detection for purple, yellow, red and green targets on five equiluminant background colours. The third examined supra-threshold colour scaling using two colour series, purple-yellow and red-green. Each study indicated that differences in colour perception between migraine and control groups were restricted to colours detected by the S-cones, there were no differences in performance for colours detected by the L- and M-cones. The results are discussed in terms of possible pathologies in the early visual pathways.
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Affiliation(s)
- A J Shepherd
- School of Psychology, Birkbeck College, London WC1E 7HX, UK.
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23
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Stonnington CM, Kothari DJ, Davis MC. Understanding and Promoting Resiliency in Patients with Chronic Headache. Curr Neurol Neurosci Rep 2015; 16:6. [DOI: 10.1007/s11910-015-0609-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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24
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Behavioural Management of Headache Triggers: Three Case Examples Illustrating a New Effective Approach (Learning to Cope with Triggers). BEHAVIOUR CHANGE 2015. [DOI: 10.1017/bec.2015.8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The traditional approach to headache trigger management is to advise avoidance of all triggers, but we have advocated an alternative approach called ‘Learning to Cope with Triggers’ (LCT), in which the objective is to desensitise headache sufferers to some triggers or to build up tolerance for the triggers, using exposure techniques. A recent publication established the efficacy of this approach to trigger management. Reported here are three cases to illustrate how LCT is used in practice. Two cases were male and one was female, with ages ranging from 32 to 67 years. The headache diagnoses were frequent episodic tension-type headache, migraine without aura, and chronic tension-type headache; all had had headaches since childhood/adolescence. The headache triggers that were the focus of the intervention were heat, tiredness, and stress/anger. Post-treatment, changes in the capacity of the triggers to elicit headaches were reported in all three cases. Reductions in headaches from pre- to post-treatment, and from pre- to 4-month follow-up, were: case 1, 69% and 60% respectively; case 2, 76% and 80% respectively; and case 3, 73% and 61% respectively. Decreases in medication consumption, and enhanced self-efficacy were also recorded.
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25
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Martin PR, Mackenzie S, Bandarian-Balooch S, Brunelli A, Broadley S, Reece J, Goadsby PJ. Enhancing cognitive-behavioural therapy for recurrent headache: design of a randomised controlled trial. BMC Neurol 2014; 14:233. [PMID: 25496514 PMCID: PMC4285632 DOI: 10.1186/s12883-014-0233-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 11/27/2014] [Indexed: 01/03/2023] Open
Abstract
Background We have argued against the traditional approach of counselling avoidance of all triggers of headaches and migraine. Problems with this approach include the impossibility of avoiding all triggers and the high costs associated with trying to do so, and that avoidance could lead to reduced tolerance for the triggers. We have developed an alternative approach called Learning to Cope with Triggers (LCT) that encourages avoidance of triggers that are detrimental to health and wellbeing, but uses exposure to other triggers to desensitise headache sufferers to the triggers. This approach has been shown to be more effective than advising avoidance of all triggers. Trigger management is only one component of a comprehensive treatment program and the current study is designed to evaluate a new approach to treating headaches in which LCT has been integrated into an established cognitive-behavioural therapy (CBT) package (LCT/CBT). Methods/Design A target sample of 120 adult participants who suffer from migraine or tension-type headache, at least six days per month, and have done so for at least 12 months will be recruited. Participants will be randomly assigned to one of three groups: LCT/CBT; Avoid/CBT (CBT combined with instructions to avoid all triggers); and waiting-list control. Measures will include: daily diaries for recording headaches, triggers and medication consumption; headache disability and quality of life; trigger avoidance; locus of control and self-efficacy; and coping strategies. Treatment will involve 12 60-minute sessions scheduled weekly. Assessment will be completed before and after treatment, and at 4 and 12 month follow-up. The data will be analysed to determine which approach is most effective, and predictors of response to treatment. Discussion Migraine and tension-type headache are common and can be disabling. CBT has been demonstrated to be an efficacious treatment for both disorders. However, there is room for improvement. This study aims to increase the efficacy of behavioural approaches and identify factors predictive of a positive response. Trial registration Australian and New Zealand Clinical Trials Registry ACTRN12614000435684.
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Affiliation(s)
- Paul R Martin
- School of Applied Psychology and Behavioural Basis of Health, Griffith University, Gold Coast Campus, Parklands Drive, Southport, Queensland, 4222, Australia.
| | - Sharon Mackenzie
- School of Applied Psychology and Behavioural Basis of Health, Griffith University, Gold Coast Campus, Parklands Drive, Southport, Queensland, 4222, Australia.
| | - Siavash Bandarian-Balooch
- School of Applied Psychology and Behavioural Basis of Health, Griffith University, Gold Coast Campus, Parklands Drive, Southport, Queensland, 4222, Australia.
| | - Arissa Brunelli
- School of Applied Psychology and Behavioural Basis of Health, Griffith University, Gold Coast Campus, Parklands Drive, Southport, Queensland, 4222, Australia.
| | - Simon Broadley
- School of Medicine, Griffith University, Gold Coast Campus, Parklands Drive, Southport, Queensland, 4222, Australia.
| | - John Reece
- School of Health Sciences, RMIT University, PO Box 71, Bundoora, Victoria, 3083, Australia. .,Australian College of Applied Psychology, Melbourne, Australia.
| | - Peter J Goadsby
- Headache Group, NIHR-Welcome Trust Clinical Research Facility, King's College London, London, UK.
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Pavlovic JM, Buse DC, Sollars CM, Haut S, Lipton RB. Trigger Factors and Premonitory Features of Migraine Attacks: Summary of Studies. Headache 2014; 54:1670-9. [DOI: 10.1111/head.12468] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Jelena M. Pavlovic
- Department of Neurology; Albert Einstein College of Medicine; Bronx NY USA
- Montefiore Headache Center; Bronx NY USA
| | - Dawn C. Buse
- Department of Neurology; Albert Einstein College of Medicine; Bronx NY USA
- Montefiore Headache Center; Bronx NY USA
| | - C. Mark Sollars
- Department of Neurology; Albert Einstein College of Medicine; Bronx NY USA
- Montefiore Headache Center; Bronx NY USA
| | - Sheryl Haut
- Department of Neurology; Albert Einstein College of Medicine; Bronx NY USA
- Montefiore Headache Center; Bronx NY USA
| | - Richard B. Lipton
- Department of Neurology; Albert Einstein College of Medicine; Bronx NY USA
- Department of Epidemiology and Population Health; Albert Einstein College of Medicine; Bronx NY USA
- Montefiore Headache Center; Bronx NY USA
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27
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Behavioral management of the triggers of recurrent headache: A randomized controlled trial. Behav Res Ther 2014; 61:1-11. [DOI: 10.1016/j.brat.2014.07.002] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 06/23/2014] [Accepted: 07/08/2014] [Indexed: 01/04/2023]
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28
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Leone M, Vila C, McGown C. Influence of trigger factors on the efficacy of almotriptan as early intervention for the treatment of acute migraine in a primary care setting: the START study. Expert Rev Neurother 2014; 10:1399-408. [DOI: 10.1586/ern.10.119] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Behavioral evidence for photophobia and stress-related ipsilateral head pain in transgenic Cacna1a mutant mice. Pain 2013; 154:1254-62. [PMID: 23673147 DOI: 10.1016/j.pain.2013.03.038] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 03/07/2013] [Accepted: 03/28/2013] [Indexed: 11/21/2022]
Abstract
Migraine is a highly prevalent, disabling and complex episodic brain disorder whose pathogenesis is poorly understood, due in part to the lack of valid animal models. Here we report behavioral evidence of hallmark migraine features, photophobia and unilateral head pain, in transgenic knock-in mice bearing human familial hemiplegic migraine, type 1 (FHM-1) gain-of-function missense mutations (R192Q or S218L) in the Cacna1a gene encoding the CaV2.1 calcium channel α1 subunit. Photophobia was demonstrated using a modified elevated plus maze in which the safe closed arms were brightly illuminated; mutant mice avoided the light despite showing no differences in the standard (anxiety) version of the test. Multiple behavioral measures suggestive of spontaneous head pain were found in 192Q mutants subjected to novelty and/or restraint stress. These behaviors were: (1) more frequent in mutant versus wildtype mice; (2) lateralized in mutant but not in wildtype mice; (3) more frequent in females versus males; and (4) dose-dependently normalized by systemic administration of 2 different acute analgesics, rizatriptan and morphine. Furthermore, some of these behaviors were found to be more frequent and severe in 218L compared to 192Q mutants, consistent with the clinical presentation in humans. We suggest that Cacna1a transgenic mice can experience migraine-related head pain and can thus serve as unique tools to study the pathogenesis of migraine and test novel antimigraine agents.
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Turner DP, Smitherman TA, Martin VT, Penzien DB, Houle TT. Causality and headache triggers. Headache 2013; 53:628-35. [PMID: 23534872 PMCID: PMC3628761 DOI: 10.1111/head.12076] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2013] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The objective of this study was to explore the conditions necessary to assign causal status to headache triggers. BACKGROUND The term "headache trigger" is commonly used to label any stimulus that is assumed to cause headaches. However, the assumptions required for determining if a given stimulus in fact has a causal-type relationship in eliciting headaches have not been explicated. METHODS A synthesis and application of Rubin's Causal Model is applied to the context of headache causes. From this application, the conditions necessary to infer that 1 event (trigger) causes another (headache) are outlined using basic assumptions and examples from relevant literature. RESULTS Although many conditions must be satisfied for a causal attribution, 3 basic assumptions are identified for determining causality in headache triggers: (1) constancy of the sufferer, (2) constancy of the trigger effect, and (3) constancy of the trigger presentation. A valid evaluation of a potential trigger's effect can only be undertaken once these 3 basic assumptions are satisfied during formal or informal studies of headache triggers. CONCLUSIONS Evaluating these assumptions is extremely difficult or infeasible in clinical practice, and satisfying them during natural experimentation is unlikely. Researchers, practitioners, and headache sufferers are encouraged to avoid natural experimentation to determine the causal effects of headache triggers. Instead, formal experimental designs or retrospective diary studies using advanced statistical modeling techniques provide the best approaches to satisfy the required assumptions and inform causal statements about headache triggers.
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Affiliation(s)
- Dana P Turner
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
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31
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Houle TT, Turner DP. Natural experimentation is a challenging method for identifying headache triggers. Headache 2013; 53:636-43. [PMID: 23534852 DOI: 10.1111/head.12075] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2013] [Indexed: 01/07/2023]
Abstract
OBJECTIVE In this study, we set out to determine whether individual headache sufferers can learn about the potency of their headache triggers (causes) using only natural experimentation. BACKGROUND Headache patients naturally use the covariation of the presence-absence of triggers with headache attacks to assess the potency of triggers. The validity of this natural experimentation has never been investigated. A companion study has proposed 3 assumptions that are important for assigning causal status to triggers. This manuscript examines one of these assumptions, constancy in trigger presentation, using real-world conditions. METHODS The similarity of day-to-day weather conditions over 4 years, as well as the similarity of ovarian hormones and perceived stress over a median of 89 days in 9 regularly cycling headache sufferers, was examined using several available time series. An arbitrary threshold of 90% similarity using Gower's index identified similar days for comparison. RESULTS The day-to-day variability in just these 3 headache triggers is substantial enough that finding 2 naturally similar days for which to contrast the effect of a fourth trigger (eg, drinking wine vs not drinking wine) will only infrequently occur. Fluctuations in weather patterns resulted in a median of 2.3 days each year that were similar (range 0-27.4). Considering fluctuations in stress patterns and ovarian hormones, only 1.5 days/month (95% confidence interval 1.2-2.9) and 2.0 days/month (95% confidence interval 1.9-2.2), respectively, met our threshold for similarity. CONCLUSION Although assessing the personal causes of headache is an age-old endeavor, the great many candidate triggers exhibit variability that may prevent sound conclusions without assistance from formal experimentation or statistical balancing.
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Affiliation(s)
- Timothy T Houle
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
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Shepherd AJ, Hine TJ, Beaumont HM. Color and Spatial Frequency Are Related to Visual Pattern Sensitivity in Migraine. Headache 2013; 53:1087-103. [DOI: 10.1111/head.12062] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2012] [Indexed: 01/07/2023]
Affiliation(s)
- Alex J. Shepherd
- Department of Psychological Sciences; Birkbeck; University of London; London; UK
| | | | - Heidi M. Beaumont
- Department of Applied Psychology; Griffith University; Brisbane; Qld; Australia
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Wang J, Huang Q, Li N, Tan G, Chen L, Zhou J. Triggers of migraine and tension-type headache in China: a clinic-based survey. Eur J Neurol 2013; 20:689-96. [PMID: 23356519 DOI: 10.1111/ene.12039] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 10/11/2012] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE Identification of the trigger factors of headache could be an important aspect of preventive management, but the characteristics of primary headache triggers in China are unknown. This study was performed to estimate the frequencies of the putative headache triggers, which are endorsed by patients with migraine and tension-type headache (TTH). METHODS From July 2011 to December 2011, a cross-sectional survey was conducted in the neurological clinic of a tertiary care hospital in Chongqing. All consecutive patients with the chief complaint of headache were interviewed by a board-certified headache specialist. The diagnoses were made according to International Classification of Headache Disorders - 2nd edition. Patients with migraine and TTH were recruited. RESULTS The number of investigated patients was 1219, of whom 394 were migraine and 344 were TTH; and 80.2% migraineurs and 67.4% TTH patients reported trigger factors. The most common triggers for both migraine and TTH were sleep disturbance, negative affect and sunlight. Menstrual cycle (OR 3.6, 95%CI 1.2, 11.2), change of the weather (OR 3.1, 95%CI 1.9, 4.8), noise (OR 2.2, 95%CI 1.1, 4.4) and alcohol (OR 1.8, 95%CI 0.7, 1.8) were more associated with migraineurs. Negative affect was more associated with TTH (OR 2.0, 95%CI 1.3, 2.9). CONCLUSIONS Trigger factors were frequent among both migraine and TTH patients. Avoidance of all headache triggers is impractical. Learning to cope with triggers is important to headache prevention.
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Affiliation(s)
- J Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Varkey E, Linde M, Henoch I. "It's a balance between letting it influence life completely and not letting it influence life at all"--a qualitative study of migraine prevention from patients' perspective. Disabil Rehabil 2012; 35:835-44. [PMID: 22992052 DOI: 10.3109/09638288.2012.709304] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE The aim of this study was to elucidate migraine prevention from a patient perspective. METHOD Twenty-one participants who suffered from migraine were interviewed and the data analysed by means of qualitative content analysis. RESULTS The analysis revealed two categories; Avoiding migraine triggers and introducing migraine inhibiting strategies. In both categories, decisions were influenced by an appraisal of the advantages versus disadvantages, attitudes, support and knowledge. An overarching theme: "migraine prevention from the patients' perspective is a balance between letting it influence life completely and not letting it influence life at all" was identified from the interviews. CONCLUSIONS As migraine is a chronic disorder that cannot be cured, merely relieved, prevention is of great importance. The present study highlights migraine prevention from the patients' perspective and the important issue of how much prevention is allowed to influence life. Either of the directions involves a risk that life can be controlled by migraine. Acceptance of the disease and allowing migraine prevention to influence life to some degree can be a way of regaining control. IMPLICATIONS FOR REHABILITATION • Migraine prevention from the patients' perspective is described as a balance between letting it influence life completely and not letting it influence life at all, which in either direction can lead to a life controlled by migraine. • To take the patients' perspectives of the illness in consideration as well as finding the most suitable treatment, based on an appraisal of individual advantages versus disadvantages is important to meet the need of the patient and to improve migraine prevention. Increased knowledge about migraine prevention is imperative both in health care and for the individual patient. Support during prevention is requested by patients.
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Affiliation(s)
- E Varkey
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Hypervigilance or avoidance of trigger related cues in migraineurs? - a case-control study using the emotional stroop task. BMC Neurol 2011; 11:141. [PMID: 22054256 PMCID: PMC3235964 DOI: 10.1186/1471-2377-11-141] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 11/05/2011] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND "Negative affect" is one of the major migraine triggers. The aim of the study was to assess attentional biases for negative affective stimuli that might be related to migraine triggers in migraine patients with either few or frequent migraine and healthy controls. METHODS Thirty-three subjects with frequent migraine (FM) or with less frequent episodic migraine, and 20 healthy controls conducted two emotional Stroop tasks in the interictal period. In task 1, general affective words and in task 2, pictures of affective faces (angry, neutral, happy) were used. For each task we calculated two emotional Stroop indices. Groups were compared using one-way ANOVAs. RESULTS The expected attentional bias in migraine patients was not found. However, in task 2 the controls showed a significant attentional bias to negative faces, whereas the FM group showed indices near zero. Thus, the FM group responded faster to negative than to positive stimuli. The difference between the groups was statistically significant. CONCLUSIONS The findings in the FM group may reflect a learned avoidance mechanism away from affective migraine triggers.
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Abu-Samra M, Gawad OA, Agha M. The outcomes for nasal contact point surgeries in patients with unsatisfactory response to chronic daily headache medications. Eur Arch Otorhinolaryngol 2011; 268:1299-304. [PMID: 21461896 DOI: 10.1007/s00405-011-1590-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Accepted: 03/15/2011] [Indexed: 11/29/2022]
Abstract
The nasal contact point may act as a trigger point or peripheral enhancer in patients with chronic daily headaches. A total of 42 patients had unsatisfactory response to medical treatment for chronic daily headache with radiologic evidence of nasal contact point. Of them, 12 (28.5%) patients were positive for the local anesthetic test. Those patients were operated upon to separate this contact by either septoplasties or submucous resections with or without partial turbinectomies. The mean headache frequency was reduced from 22 to 7 days/month. The mean headache severity was reduced from 5.6 to 2.4. Eight (19%) patients became completely free from headache and its medications, six (75%) of them were positive for local anesthetic test. The patients were satisfied with postoperative monotherapy, or headache severity and frequency could be tolerated without medications in 26 (62%) patients. There was no improvement in seven (16.6%) patients and only one patient (2%) became worse. The overall satisfaction was 83 and 81% for positive and negative anesthetic tests, respectively. The average monthly medication cost was reduced from $85 to 32. Nasal contact point surgery for chronic daily headache patients can satisfy them compared to previously unsatisfactory medications. Nasal contact point may contribute to potentiating or triggering chronic daily headache.
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Affiliation(s)
- Mohamed Abu-Samra
- Otorhinolaryngology Department, Mansoura University, Mansoura, Egypt.
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Martin PR. Behavioral management of migraine headache triggers: learning to cope with triggers. Curr Pain Headache Rep 2010; 14:221-7. [PMID: 20425190 DOI: 10.1007/s11916-010-0112-z] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The literature on migraine triggers is reviewed, including the most common triggers, interactions between triggers, the research evidence related to the capacity of self-reported triggers to precipitate headaches, and the neurobiologic pathways by which triggers induce migraine attacks. An argument is developed against the standard advice to avoid migraine triggers as the best way of preventing attacks, based on conceptual and practical criticisms, and consideration of cognate literatures on chronic pain, stress, and anxiety. A small number of studies suggest that exposure to headache triggers has the same effect as exposure to anxiety-eliciting stimuli, with short exposure associated with increased pain response and prolonged exposure associated with decreased pain response. On the basis of this literature, "learning to cope with triggers" is advocated, where controlled exposure and approach/confront strategies are used to manage migraine triggers, except in cases where such an approach would probably be inappropriate.
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Mérelle SY, Sorbi MJ, Duivenvoorden HJ, Passchier J. Qualities and Health of Lay Trainers With Migraine for Behavioral Attack Prevention. Headache 2010; 50:613-25. [DOI: 10.1111/j.1526-4610.2008.01241.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Connelly M, Miller T, Gerry G, Bickel J. Electronic momentary assessment of weather changes as a trigger of headaches in children. Headache 2009; 50:779-89. [PMID: 20039960 DOI: 10.1111/j.1526-4610.2009.01586.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Variables that are thought to precipitate migraine or tension-type headache episodes in children hitherto have only been studied using retrospective reports. As such, there is little empirical evidence to support the actual predictive association between presumed headache triggers and actual headache occurrence in children. OBJECTIVE The present study sought to determine if fluctuations in weather, a commonly reported headache trigger in children, predict increased likelihood of headache occurrence when evaluated using rigorous prospective methodology ("electronic momentary assessment"). METHODS Twenty-five children (21 girls, 4 boys) between the ages of 8-17 years attending a new patient neurology clinic appointment and having a diagnosis of chronic migraine, chronic tension-type, or episodic migraine headache (with or without aura) participated in the study. Children completed baseline measures on headache characteristics, presumed headache triggers, and mood and subsequently were trained in the use of electronic diaries to record information on headaches. Children then completed thrice daily diaries on handheld computers for a 2-week time period (42 assessments per child) while data on weather variables (temperature, dew point temperature, barometric pressure, humidity, precipitation, and sunlight) in the child's geographic location were recorded each time a diary was completed. Data were analyzed using multilevel models. RESULTS Of the weather variables, relative humidity and presence of precipitation were significantly predictive of new headache onset, with nearly a 3-fold increase in probability of headache occurrence during times of precipitation or elevated humidity in the child's area, b = 0.38, t(821) = 2.10, P = .04, and b = 0.02, t(821) = 2.81, P = .01, respectively. These associations remained after accounting for fluctuations in mood, and associations were not significantly stronger in children who at baseline thought that weather was a headache trigger for them. Changes in temperature, dew point temperature, barometric pressure, and sunlight were not significantly predictive of new headache episode occurrence in this sample. CONCLUSIONS Results of the present study lend some support to the belief commonly held by children with recurrent headaches that weather changes may contribute to headache onset. Although electronic momentary assessment methodology was found to be feasible in this population and to have the potential to identify specific headache triggers for children, it remains to be determined how best (or even whether) to incorporate this information into treatment recommendations.
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Affiliation(s)
- Mark Connelly
- Children's Mercy Hospitals and Clinics, Kansas City, MO 64108, USA
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Abstract
The standard clinical advice for individuals who suffer from recurrent headaches is that the best way to prevent headaches is to avoid the triggers. This editorial challenges that advice from a number of perspectives. First, there is little empirical support for such advice. Second, cognate literatures in the fields of chronic pain, stress and anxiety raise concerns about avoidance as a strategy. Third, studies have demonstrated that short exposure to a headache trigger results in increased sensitivity and prolonged exposure results in decreased sensitivity. Conclusions include that one aetiological pathway to developing a primary headache disorder may be via attempts to avoid triggers resulting in increased sensitivity to triggers. Also, clinicians need to become more flexible in the advice they give pertaining to triggers, namely they should think ‘coping with triggers’ rather than avoiding all triggers, as avoidance will sometimes be the preferred strategy, but often it will not be.
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Affiliation(s)
- PR Martin
- Monash University, Division of Psychological Medicine, Melbourne, Vic., Australia
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Behavioral management of headache triggers: Avoidance of triggers is an inadequate strategy. Clin Psychol Rev 2009; 29:483-95. [DOI: 10.1016/j.cpr.2009.05.002] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 05/29/2009] [Accepted: 05/30/2009] [Indexed: 01/07/2023]
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Namaka M, Leong C, Grossberndt A, Klowak M, Louizos C, Drummond J, Leligdowicz E, Lichkowski M, Melanson M. Managing Migraines: Options for Acute Abortive Treatment. Can Pharm J (Ott) 2009. [DOI: 10.3821/1913-701x-142.4.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction Triptans, ergotamine derivatives and nonsteroidal anti-inflammatory drugs are front-line agents used in the acute abortive therapy of migraines. In this article, these medications are reviewed and a treatment algorithm suggested. Methods A comprehensive review of the literature from 1990 to 2008 was conducted using PubMed, MEDLINE and The Cochrane Library to explore the underlying pathophysiology of migraines and comparatively assess the acute and chronic treatment options available in their management. The information obtained from all literature searches was further categorized as level 1, 2 or 3 based on pre-defined peer-reviewed criteria. Conclusion: This review is able to present a relatively preliminary but practical migraine treatment algorithm. Although there is no standard universal treatment strategy to manage migraine headaches in all patients, this review has been put forth to serve as a clinical guideline to assist health professionals in deciding the most appropriate treatment for migraine headaches.
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Affiliation(s)
- Mike Namaka
- From the Faculty of Pharmacy, University of Manitoba (Namaka, Leong, Grossberndt, Klowak, Louizos, Drummond, Leligdowicz and Lichkowski); and the Department of Neurology, Health Sciences Centre, Winnipeg, Manitoba (Namaka and Melanson). Contact
| | - Christine Leong
- From the Faculty of Pharmacy, University of Manitoba (Namaka, Leong, Grossberndt, Klowak, Louizos, Drummond, Leligdowicz and Lichkowski); and the Department of Neurology, Health Sciences Centre, Winnipeg, Manitoba (Namaka and Melanson). Contact
| | - Amy Grossberndt
- From the Faculty of Pharmacy, University of Manitoba (Namaka, Leong, Grossberndt, Klowak, Louizos, Drummond, Leligdowicz and Lichkowski); and the Department of Neurology, Health Sciences Centre, Winnipeg, Manitoba (Namaka and Melanson). Contact
| | - Meghann Klowak
- From the Faculty of Pharmacy, University of Manitoba (Namaka, Leong, Grossberndt, Klowak, Louizos, Drummond, Leligdowicz and Lichkowski); and the Department of Neurology, Health Sciences Centre, Winnipeg, Manitoba (Namaka and Melanson). Contact
| | - Chris Louizos
- From the Faculty of Pharmacy, University of Manitoba (Namaka, Leong, Grossberndt, Klowak, Louizos, Drummond, Leligdowicz and Lichkowski); and the Department of Neurology, Health Sciences Centre, Winnipeg, Manitoba (Namaka and Melanson). Contact
| | - Jenny Drummond
- From the Faculty of Pharmacy, University of Manitoba (Namaka, Leong, Grossberndt, Klowak, Louizos, Drummond, Leligdowicz and Lichkowski); and the Department of Neurology, Health Sciences Centre, Winnipeg, Manitoba (Namaka and Melanson). Contact
| | - Ewa Leligdowicz
- From the Faculty of Pharmacy, University of Manitoba (Namaka, Leong, Grossberndt, Klowak, Louizos, Drummond, Leligdowicz and Lichkowski); and the Department of Neurology, Health Sciences Centre, Winnipeg, Manitoba (Namaka and Melanson). Contact
| | - Melanie Lichkowski
- From the Faculty of Pharmacy, University of Manitoba (Namaka, Leong, Grossberndt, Klowak, Louizos, Drummond, Leligdowicz and Lichkowski); and the Department of Neurology, Health Sciences Centre, Winnipeg, Manitoba (Namaka and Melanson). Contact
| | - Maria Melanson
- From the Faculty of Pharmacy, University of Manitoba (Namaka, Leong, Grossberndt, Klowak, Louizos, Drummond, Leligdowicz and Lichkowski); and the Department of Neurology, Health Sciences Centre, Winnipeg, Manitoba (Namaka and Melanson). Contact
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Ferrari A, Pileri F, Spaccapelo L, Zappaterra M, Ruggerini C, Tacchi R, Bertolini A. How children and parents evaluate the Headache Centre's intervention. Headache 2009; 49:194-201. [PMID: 19222593 DOI: 10.1111/j.1526-4610.2008.01325.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND While adult headache patients' satisfaction with treatments has been widely investigated, less attention has been paid to children and adolescent headache patients' opinions and their parents' views. OBJECTIVE The aim of our follow-up survey was to analyze the outcomes of the Headache Centre's intervention and the evolution of headache according to patients until the age of 16 and their parents. METHODS We studied all outpatients suffering from episodic primary headache according to International Classification of Headache Disorders 2nd edition criteria, seen for the first time in 2005-2006 at the Headache Centre of the University Hospital of Modena (Italy), and at least one of their parents. The duration of the follow-up ranged from 1 to 3 years. For the purpose of the study, a specific questionnaire was created and administered by a telephone interview. RESULTS We enrolled 84 patients (38 females, 45%; 46 males, 55%; mean age +/- SD: 12.9 +/- 2.9 years) with primary headache: migraine without aura 66%, episodic tension-type headache 23%, migraine with aura 11%. At the follow-up, 70% of the patients reported that headache had improved; frequency had decreased significantly more than severity (P = .000, Fisher's exact test), both in those who had followed a prophylactic treatment and in those who had not. A high percentage of the children and parents could precisely indicate trigger factors for headache: especially excessive worrying and studying. The patients reporting an improvement attributed it to pharmacological prophylactic treatment, but also to other factors: first of all, better school results and more happiness than before. Seventy-seven percent of the parents thought that the Headache Centre's intervention had helped them to better understand and manage their children's headache. CONCLUSIONS Children's and adolescents' headache has in most cases a favorable prognosis; the Headache Centre's intervention is considered effective by most parents. We must increase and focus therapeutic efforts addressed to the few patients with worsening headaches in spite of treatment, since these children's/adolescents' headache also is at risk to progress in the adult age.
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Affiliation(s)
- Anna Ferrari
- Headache Centre, Division of Toxicology and Clinical Pharmacology, University of Modena and Reggio Emilia, Modena, Italy
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Mérelle SY, Sorbi MJ, van Doornen LJ, Passchier J. Lay Trainers With Migraine for a Home-Based Behavioral Training: A 6-Month Follow-Up Study. Headache 2008; 48:1311-25. [DOI: 10.1111/j.1526-4610.2007.01043.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cathcart S, Petkov J, Pritchard D. Effects of induced stress on experimental pain sensitivity in chronic tension-type headache sufferers. Eur J Neurol 2008; 15:552-8. [PMID: 18397305 DOI: 10.1111/j.1468-1331.2008.02124.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE It has been proposed that stress may contribute to chronic tension-type headache (CTH) through hyperalgesic effects on already sensitized pain pathways in CTH sufferers. This hypothesis could be partially tested by examining effects of stress on mechanical and thermal pain sensitivity in CTH sufferers. Such examinations have not been reported to date. MATERIALS AND METHODS In the present study, we measured cephalic and extra-cephalic pressure [pressure-pain threshold (PPT)] and cold-pain thresholds (CPT) in CTH sufferers (n = 8 females, n = 8 males) and healthy control subjects (n = 8 males, n = 7 females) recruited from the general population before and after exposure to a 15-min stressful mental task. RESULTS Results indicated that PPT's at head and hand were lower in the CTH compared with control group both before and after task exposure. PPT's and CPT's decreased from pre- to post-task in both groups, with a significantly greater pre- to post-task reduction in cephalic PPT in the CTH compared with control group. Subjective stress increased from pre- to post-task in both groups and did not differ between groups. In the CTH group, stress reactivity was negatively correlated with PPT's, whilst absolute stress levels were positively correlated with pre- to post-task decrease in PPT's. CONCLUSIONS The main finding is an enhanced hyperalgesic effect of stress on cephalic pressure-pain sensitivity in the CTH sufferers compared with the healthy controls. The results support the hypothesis that stress may contribute to CTH through hyperalgesic effects on already sensitized pain pathways in CTH sufferers.
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Affiliation(s)
- S Cathcart
- Centre for Applied Psychological Research, University of South Australia, Adelaide, Australia.
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Mérelle SYM, Sorbi MJ, van Doornen LJP, Passchier J. Migraine patients as trainers of their fellow patients in non-pharmacological preventive attack management: short-term effects of a randomized controlled trial. Cephalalgia 2008; 28:127-38. [PMID: 18197883 DOI: 10.1111/j.1468-2982.2007.01472.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In conformity with current views on patient empowerment, we designed and evaluated the effects of home-based behavioural training (BT) provided by lay trainers with migraine to small groups of fellow patients. The primary aims of BT were to reduce attack frequency and increase perceived control over and self-confidence in attack prevention. In a randomized controlled trial the BT group (n = 51) was compared with a waitlist-control group (WLC), receiving usual care (n = 57). BT produced a minor (-21%) short-term effect on attack frequency and clinically significant improvement in 35% of the participants. Covariance analysis showed a non-significant trend (P = 0.07) compared with WLC. However, patients' perceived control over migraine attacks and self-confidence in attack prevention increased significantly with large effect sizes. Patients with high baseline attack frequency might benefit more from BT than those with low attack frequency. In conclusion, lay trainers with migraine strengthened fellow patients' perceived control, but did not induce a significant immediate improvement in attack frequency.
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Affiliation(s)
- S Y M Mérelle
- Department of Medical Psychology and Psychotherapy, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Martin PR, Lae L, Reece J. Stress as a trigger for headaches: Relationship between exposure and sensitivity. ANXIETY STRESS AND COPING 2007; 20:393-407. [DOI: 10.1080/10615800701628843] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
The aim of this study was to evaluate and define the triggers of the acute migraine attack. Patients rated triggers on a 0-3 scale for the average headache. Demographics, prodrome, aura, headache characteristics, postdrome, medication responsiveness, acute and chronic disability, sleep characteristics and social and personal characteristics were also recorded. One thousand two hundred and seven International Classification of Headache Disorders-2 (1.1-1.2, and 1.5.1) patients were evaluated, of whom 75.9% reported triggers (40.4% infrequently, 26.7% frequently and 8.8% very frequently). The trigger frequencies were stress (79.7%), hormones in women (65.1%), not eating (57.3%), weather (53.2%), sleep disturbance (49.8%), perfume or odour (43.7%), neck pain (38.4%), light(s) (38.1%), alcohol (37.8%), smoke (35.7%), sleeping late (32.0%), heat (30.3%), food (26.9%), exercise (22.1%) and sexual activity (5.2%). Triggers were more likely to be associated with a more florid acute migraine attack. Differences were seen between women and men, aura and no aura, episodic and chronic migraine, and between migraine and probable migraine.
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Affiliation(s)
- L Kelman
- Headache Center of Atlanta, Atlanta, GA 30342, USA.
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Martin PR. Noise as a Trigger for Headaches? A Response. Headache 2006. [DOI: 10.1111/j.1526-4610.2006.00618_3.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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