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Turner DP. Experimental Study Designs. Headache 2020; 60:1501-1507. [PMID: 33448352 DOI: 10.1111/head.13928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Dana P Turner
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Xu J, Kong F, Buse DC. Predictors of episodic migraine transformation to chronic migraine: A systematic review and meta-analysis of observational cohort studies. Cephalalgia 2019; 40:503-516. [PMID: 31635478 DOI: 10.1177/0333102419883355] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE An estimated 2.5-3.1% of people with episodic migraine develop chronic migraine in a year. Several risk factors are associated with an increased risk for this transformation. We conducted a systematic review and meta-analysis to provide quantitative and qualitative data on predictors of this transformation. METHODS An electronic search was conducted for published, prospective, cohort studies that reported risk factors for chronic migraine among people with episodic migraine. Risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. Quality of evidence was determined according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. Effect estimates were retrieved and summarized using risk ratios. RESULTS Of 5695 identified publications, 11 were eligible for inclusion. The pooled analysis (GRADE system) found "high" evidence for monthly headache day frequency ≥ 10 (risk ratio = 5.95), "moderate" evidence for depression (risk ratio = 1.58), monthly headache day frequency ≥ 5 (risk ratio = 3.18), and annual household income ≥ $50,000 (risk ratio = 0.65) and "very low" evidence for allodynia (risk ratio = 1.40) and medication overuse (risk ratio = 8.82) in predicting progression to chronic migraine. CONCLUSIONS High frequency episodic migraine and depression have high quality evidence as predictors of the transformation from episodic migraine to chronic migraine, while annual household income over $50,000 may be protective.
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Affiliation(s)
- Jingjing Xu
- Department of Neurology, the 920th Hospital of Logistics Support Force, People's Liberation Army, Yunnan Province, P R China.,School of Clinical Medicine, Kunming Medical University, Yunnan Province, P R China
| | - Fanyi Kong
- Department of Neurology, the 920th Hospital of Logistics Support Force, People's Liberation Army, Yunnan Province, P R China.,School of Clinical Medicine, Kunming Medical University, Yunnan Province, P R China
| | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
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Buse DC, Greisman JD, Baigi K, Lipton RB. Migraine Progression: A Systematic Review. Headache 2018; 59:306-338. [PMID: 30589090 DOI: 10.1111/head.13459] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Migraine is a common and often debilitating neurological disease. It can be divided into episodic and chronic subforms based on the number of monthly headache days. Because only a subset of individuals with episodic migraine (EM) progress to chronic migraine (CM) over any given time period, understanding the factors that predict the new onset of CM or "migraine progression" may provide insights into the mechanisms, pathophysiology, prevention, and treatment of CM. In this review, we identify and summarize studies that report risk factors associated with the new onset of CM or related chronic headache diagnoses, group these risk factors and report the strength of evidence for the identified risk factors. OBJECTIVE To conduct a systematic review of studies that identify risk factors for the new onset of CM or related chronic headache diagnoses such as transformed migraine (TM) and chronic daily headache (CDH). METHODS Herein we summarize the findings of studies of risk factors associated with the new onset of CM/TM, CDH, or related diagnoses from the English language literature published before March 2018. The PubMed database was searched for relevant studies. Longitudinal studies with follow-up data and case-control studies were included in this qualitative synthesis. We report methodology, analytic criteria, and results for each manuscript and for the parent study. Next, we review the strength of evidence for each of the identified risk factors using a modified version of AB Hill's criteria for causation and rank evidence as fair, moderate, or strong. We categorized risk factors as nonmodifiable, modifiable and based on putative mechanisms. We further categorized risk factors into sociodemographics, lifestyle factors and habits, headache features, comorbid and concomitant diseases and conditions and pharmacologic treatment-related. Finally, we review theories of the pathophysiology underlying the development of new onset chronic migraine or increasing attack frequency. RESULTS The PubMed search yielded 1870 records after duplicates were removed. Nine additional records were identified through expert consultation and other methods (eg, citations found as references in manuscripts identified in the literature review and through communication with the authors of manuscripts included in the review). The 1879 manuscripts were screened against the inclusion and exclusion criteria and 109 were found to be potentially eligible. Of 109 full-text articles, 17 studies were identified as meeting the prespecified criteria based on the consensus of all authors. Of the 17 full texts, 13 were longitudinal cohort studies and 4 were case-controlled studies. We found strength of evidence ranging from fair to strong for the identified risk factors. The strongest data were found for increased headache day frequency, depression, and medication overuse/high-frequency use. Risk factors for new onset CM and CDH in children and adolescents were similar to those identified in adults. CONCLUSIONS A range of risk factors for the new onset of CM/TM, CDH, or related chronic headache diseases were identified with the strongest data supporting increased headache day frequency, acute medication overuse/high-frequency use and depression, which are potentially modifiable risk factors. Modifiable risk factors may provide targets for intervention. The lack of strong evidence or any evidence does not imply that there is not a relationship between a particular risk factor and new onset CM or related disease; but may indicate little or no research or that research did not have sufficient methodological rigor. In addition, it is likely that additional risk factors exist which have not yet been identified. Putative factors include pro-inflammatory states and pro-thrombotic states. Development of central sensitization and increased activation of the trigeminal nociceptive pathways may be drivers of the new onset of CM or CDH. Future research may include the systematic testing of interventions targeting modifiable risk factors to determine if progression can be prevented as well as continued exploration of the benefits of treating these risk factors among people with CM in an effort to increase rates of remission. Future work should also consider the natural fluctuations in headache day frequency and examine progression in terms of continuous definitions rather than or in addition to a dichotomous boundary.
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Affiliation(s)
- Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jacob D Greisman
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Khosrow Baigi
- Department of Family Medicine, Bronx Care Health System, Bronx, NY, USA
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore Medical Center, Bronx, NY, USA.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
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Hagen K, Kristoffersen ES, Winsvold BS, Stovner LJ, Zwart JA. Remission of chronic headache: An 11-year follow-up study. Data from the Nord-Trøndelag Health Surveys 1995-1997 and 2006-2008. Cephalalgia 2018; 38:2026-2034. [PMID: 29629599 DOI: 10.1177/0333102418769940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To estimate remission rates of chronic headache and predictors of remission. METHODS In this longitudinal population-based cohort study, we used validated headache questionnaire data from the second (1995-1997, baseline; n = 51,856 aged ≥ 20 years, response rate: 55%) and third wave (2006-2008, follow-up, response rate: 42%) of the Nord-Trøndelag Health Study. Chronic headache was defined as ≥15 headache days/month during the last year. Chronic headache remission was defined as headache less than 15 days/month at follow-up. Potential predictors of remission were evaluated using logistic regression. RESULTS At baseline, 1266 (2.4%) participants reported chronic headache. Of these, 605 (48%) answered headache questions at follow-up. Remission was observed in 452 (74.7%), the proportion being almost identical in men and women (74.4% vs. 74.9, p = 0.92). In analyses adjusting for age, gender and education level, remission at follow-up was more than two times more likely among individuals without medication overuse headache (OR = 2.4, 95% CI 1.7-3.6) and without chronic musculoskeletal complaints (OR = 2.9, 95% CI 1.5-5.0) at baseline. CONCLUSIONS In this longitudinal population-based cohort study, three-quarters of chronic headache participants remitted from chronic headache. Remission was associated with no medication overuse headache and no chronic musculoskeletal complaints at baseline.
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Affiliation(s)
- Knut Hagen
- 1 Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.,2 Norwegian Advisory Unit on Headache, St. Olav's Hospital, Trondheim, Norway
| | - Espen Saxhaug Kristoffersen
- 3 Department of General Practice, HELSAM, University of Oslo, Oslo, Norway.,4 Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Bendik Slagvold Winsvold
- 5 Department of Neurology and FORMI; Oslo University Hospital, Oslo, Norway.,6 Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lars Jacob Stovner
- 1 Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.,2 Norwegian Advisory Unit on Headache, St. Olav's Hospital, Trondheim, Norway
| | - John-Anker Zwart
- 5 Department of Neurology and FORMI; Oslo University Hospital, Oslo, Norway.,6 Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Carlsen LN, Munksgaard SB, Jensen RH, Bendtsen L. Complete detoxification is the most effective treatment of medication-overuse headache: A randomized controlled open-label trial. Cephalalgia 2017; 38:225-236. [PMID: 29050498 DOI: 10.1177/0333102417737779] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background There is lack of evidence on how to detoxify medication-overuse headache. Aim To compare the effect of complete stop of acute medication with restricted intake. Methods Medication-overuse headache patients were included in a prospective, outpatient study and randomized to two months' detoxification with either a) no analgesics or acute migraine-medication (program A), or b) acute medication restricted to two days/week (program B). Detoxification was followed by preventives if indicated. Patients were followed up at 2, 6 and 12 months. Percentage reduction in headache days/month after 6 months was the primary outcome. Results We included 72 medication-overuse headache patients with a primary migraine and/or tension-type headache diagnosis. Fifty-nine completed detoxification, 58 (81%) were followed up at month 6 and 53 (74%) at month 12. At month 6, program A reduced headache days/month by 46% (95% CI 34-58) compared with 22% (95% CI 11-34) in program-B ( p = 0.005), and 70% in program A versus 42% in program B were reverted to episodic headache ( p = 0.04). Migraine-days/month were reduced by 7.2 in program A ( p < 0.001) and 3.6 in program B ( p = 0.002) after 6 months. Conclusion Both detoxification programs were very effective. Detoxification without analgesics or acute migraine-medication was the most effective program. Trial registration Clinicaltrials.gov (NCT02903329).
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Affiliation(s)
| | | | | | - Lars Bendtsen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Denmark
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Scher AI, Rizzoli PB, Loder EW. Medication overuse headache: An entrenched idea in need of scrutiny. Neurology 2017; 89:1296-1304. [PMID: 28821684 DOI: 10.1212/wnl.0000000000004371] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/10/2017] [Indexed: 12/31/2022] Open
Abstract
It is a widely accepted idea that medications taken to relieve acute headache pain can paradoxically worsen headache if used too often. This type of secondary headache is referred to as medication overuse headache (MOH); previously used terms include rebound headache and drug-induced headache. In the absence of consensus about the duration of use, amount, and type of medication needed to cause MOH, the default position is conservative. A common recommendation is to limit treatment to no more than 10 or 15 days per month (depending on medication type) to prevent headache frequency progression. Medication withdrawal is often recommended as a first step in treatment of patients with very frequent headaches. Existing evidence, however, does not provide a strong basis for such causal claims about the relationship between medication use and frequent headache. Observational studies linking treatment patterns with headache frequency are by their nature confounded by indication. Medication withdrawal studies have mostly been uncontrolled and often have high dropout rates. Evaluation of this evidence suggests that only a minority of patients required to limit the use of symptomatic medication may benefit from treatment limitation. Similarly, only a minority of patients deemed to be overusing medications may benefit from withdrawal. These findings raise serious questions about the value of withholding or withdrawing symptom-relieving medications from people with frequent headaches solely to prevent or treat MOH. The benefits of doing so are smaller, and the harms larger, than currently recognized. The concept of MOH should be viewed with more skepticism. Until the evidence is better, we should avoid dogmatism about the use of symptomatic medication. Frequent use of symptom-relieving headache medications should be viewed more neutrally, as an indicator of poorly controlled headaches, and not invariably a cause.
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Affiliation(s)
- Ann I Scher
- From the Department of Preventive Medicine and Biostatistics (A.I.S.), Uniformed Services University, Bethesda, MD; and Department of Neurology (P.B.R., E.W.L.), Brigham and Women's Hospital, Boston, MA.
| | - Paul B Rizzoli
- From the Department of Preventive Medicine and Biostatistics (A.I.S.), Uniformed Services University, Bethesda, MD; and Department of Neurology (P.B.R., E.W.L.), Brigham and Women's Hospital, Boston, MA
| | - Elizabeth W Loder
- From the Department of Preventive Medicine and Biostatistics (A.I.S.), Uniformed Services University, Bethesda, MD; and Department of Neurology (P.B.R., E.W.L.), Brigham and Women's Hospital, Boston, MA
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Sil S, Dampier C, Cohen LL. Pediatric Sickle Cell Disease and Parent and Child Catastrophizing. THE JOURNAL OF PAIN 2016; 17:963-71. [DOI: 10.1016/j.jpain.2016.05.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 04/29/2016] [Accepted: 05/24/2016] [Indexed: 12/22/2022]
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Sorbi MJ, Kleiboer AM, van Silfhout HG, Vink G, Passchier J. Medium-term effectiveness of online behavioral training in migraine self-management: A randomized trial controlled over 10 months. Cephalalgia 2014; 35:608-18. [PMID: 25228685 DOI: 10.1177/0333102414547137] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 07/06/2014] [Indexed: 01/27/2023]
Abstract
AIM This randomized, controlled trial examined the medium-term effectiveness of online behavioral training in migraine self-management (oBT; N = 195) versus waitlist control (WLC; N = 173) on attack frequency, indicators of self-management (primary outcomes), headache top intensity, use of rescue medications, quality of life and disability (secondary outcomes). METHODS An online headache diary following the ICHD-II and questionnaires were completed at baseline (T0), post-training (T1) and six months later (T2). Missing data (T1: 24%; T2: 37%) were handled by multiple imputation. We established effect sizes (ES) and tested between-group differences over time with linear mixed modelling techniques based on the intention-to-treat principle. RESULTS At T2, attack frequency had improved significantly in oBT (-23%, ES = 0.66) but also in WLC (-19%; ES = 0.52). Self-efficacy, internal and external control in migraine management--and triptan use--improved only in oBT, however. This indicates different processes in both groups and could signify (the start of) active self-management in oBT. Also, only oBT improved migraine-specific quality of life to a sizable extent. CONCLUSIONS oBT produced self-management gains but could not account for improved attack frequency, because WLC improved as well. The perspective that BT effects develop gradually, and that online delivery will boost BT outreach, justifies further research.
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Affiliation(s)
- M J Sorbi
- Department of Clinical and Health Psychology, Utrecht University, the Netherlands
| | - A M Kleiboer
- Department of Clinical and Health Psychology, Utrecht University, the Netherlands Department of Clinical Psychology, VU University, the Netherlands
| | - H G van Silfhout
- Department of Clinical and Health Psychology, Utrecht University, the Netherlands
| | - G Vink
- Department of Methodology and Statistics, Utrecht University, the Netherlands Department of Quality and Methodology, Statistics Netherlands, the Netherlands
| | - J Passchier
- Department of Clinical Psychology, VU University, the Netherlands
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Turner DP, Smitherman TA, Penzien DB, Lipton RB, Houle TT. Rethinking headache chronification. Headache 2014; 53:901-7. [PMID: 23721237 DOI: 10.1111/head.12127] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2013] [Indexed: 11/30/2022]
Abstract
The objective of this series is to examine several threats to the interpretation of headache chronification studies that arise from methodological issues. The study of headache chronification has extensively used longitudinal designs with 2 or more measurement occasions. Unfortunately, application of these designs, when combined with the common practice of extreme score selection as well as the extant challenges in measuring headache frequency rates (eg, unreliability, regression to the mean), induces substantive threats to accurate interpretation of findings. Partitioning the amount of observed variance in rates of chronification and remission attributable to regression artifacts is a critical yet previously overlooked step to learning more about headache as a potentially progressive disease. In this series on rethinking headache chronification, we provide an overview of methodological issues in this area (this paper), highlight the influence of rounding error on estimates of headache frequency (second paper), examine the influence of random error and regression artifacts on estimates of chronification and remission (third paper), and consider future directions for this line of research (fourth paper).
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Affiliation(s)
- Dana P Turner
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
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Lipton RB, Penzien DB, Turner DP, Smitherman TA, Houle TT. Methodological Issues in Studying Rates and Predictors of Migraine Progression and Remission. Headache 2013; 53:930-4. [DOI: 10.1111/head.12128] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2013] [Indexed: 12/20/2022]
Affiliation(s)
- Richard B. Lipton
- Departments of Neurology; Epidemiology and Population Health and the Montefiore Headache Center; Albert Einstein College of Medicine; Bronx; NY; USA
| | - Donald B. Penzien
- Department of Psychiatry; Head Pain Center; University of Mississippi Medical Center; Jackson; MS; USA
| | - Dana P. Turner
- Department of Anesthesiology; Wake Forest University Medical School; Winston-Salem; NC; USA
| | - Todd A Smitherman
- Department of Anesthesiology; Wake Forest University Medical School; Winston-Salem; NC; USA
| | - Timothy T. Houle
- Department of Psychology; University of Mississippi; Oxford; MS; USA
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