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Reina-Varona Á, Madroñero-Miguel B, Fierro-Marrero J, Paris-Alemany A, La Touche R. Efficacy of various exercise interventions for migraine treatment: A systematic review and network meta-analysis. Headache 2024. [PMID: 38597252 DOI: 10.1111/head.14696] [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: 08/29/2023] [Revised: 12/29/2023] [Accepted: 01/02/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE To compare various exercise modalities' efficacy on migraine frequency, intensity, duration, and disability. BACKGROUND Exercise has been shown to be an effective intervention to reduce migraine symptoms and disability; however, no clear evidence exists regarding the most effective exercise modalities for migraine treatment. METHODS A systematic review was performed in PubMed, PEDro, Web of Science, and Google Scholar. Clinical trials that analyzed the efficacy of various exercise modalities in addressing the frequency, intensity, duration, and disability of patients with migraine were included. Eight network meta-analyses based on frequentist (F) and Bayesian (B) models were developed to estimate the direct and indirect evidence of various exercise modalities. Standardized mean difference (SMD) and 95% confidence (CI) and credible intervals (CrI) were calculated for each treatment effect based on Hedge's g and p scores to rank the modalities. RESULTS We included 28 studies with 1501 migraine participants. Yoga (F: SMD -1.30; 95% CI -2.09, -0.51; B: SMD -1.33; 95% CrI -2.21, -0.45), high-intensity aerobic exercise (F: SMD -1.30; 95% CI -2.21, -0.39; B: SMD -1.17; 95% CrI -2.20, -0.20) and moderate-intensity continuous aerobic exercise (F: SMD -1.01; 95% CI -1.63, -0.39; B: SMD -1.06; 95% CrI -1.74, -0.38) were significantly superior to pharmacological treatment alone for decreasing migraine frequency based on both models. Only yoga (F: SMD -1.40; 95% CI -2.41, -0.39; B: SMD -1.41; 95% CrI -2.54, -0.27) was significantly superior to pharmacological treatment alone for reducing migraine intensity. For diminishing migraine duration, high-intensity aerobic exercise (F: SMD -1.64; 95% CI -2.43, -0.85; B: SMD -1.56; 95% CrI -2.59, -0.63) and moderate-intensity continuous aerobic exercise (SMD -0.96; 95% CI -1.50, -0.41; B: SMD -1.00; 95% CrI -1.71, -0.31) were superior to pharmacological treatment alone. CONCLUSION Very low-quality evidence showed that yoga, high- and moderate-intensity aerobic exercises were the best interventions for reducing migraine frequency and intensity; high- and moderate-intensity aerobic exercises were best for decreasing migraine duration; and moderate-intensity aerobic exercise was best for diminishing disability.
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Affiliation(s)
- Álvaro Reina-Varona
- Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- PhD Program in Medicine and Surgery, Doctoral School, Universidad Autónoma de Madrid, Madrid, Spain
| | - Beatriz Madroñero-Miguel
- Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - José Fierro-Marrero
- Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- PhD Program in Medicine and Surgery, Doctoral School, Universidad Autónoma de Madrid, Madrid, Spain
| | - Alba Paris-Alemany
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), Madrid, Spain
- Departamento de Radiología, Rehabilitación y Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
| | - Roy La Touche
- Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), Madrid, Spain
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Ulrich S, Gantenbein AR, Zuber V, Von Wyl A, Kowatsch T, Künzli H. Development and Evaluation of a Smartphone-Based Chatbot Coach to Facilitate a Balanced Lifestyle in Individuals With Headaches (BalanceUP App): Randomized Controlled Trial. J Med Internet Res 2024; 26:e50132. [PMID: 38265863 PMCID: PMC10851123 DOI: 10.2196/50132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/20/2023] [Accepted: 12/12/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Primary headaches, including migraine and tension-type headaches, are widespread and have a social, physical, mental, and economic impact. Among the key components of treatment are behavior interventions such as lifestyle modification. Scalable conversational agents (CAs) have the potential to deliver behavior interventions at a low threshold. To our knowledge, there is no evidence of behavioral interventions delivered by CAs for the treatment of headaches. OBJECTIVE This study has 2 aims. The first aim was to develop and test a smartphone-based coaching intervention (BalanceUP) for people experiencing frequent headaches, delivered by a CA and designed to improve mental well-being using various behavior change techniques. The second aim was to evaluate the effectiveness of BalanceUP by comparing the intervention and waitlist control groups and assess the engagement and acceptance of participants using BalanceUP. METHODS In an unblinded randomized controlled trial, adults with frequent headaches were recruited on the web and in collaboration with experts and allocated to either a CA intervention (BalanceUP) or a control condition. The effects of the treatment on changes in the primary outcome of the study, that is, mental well-being (as measured by the Patient Health Questionnaire Anxiety and Depression Scale), and secondary outcomes (eg, psychosomatic symptoms, stress, headache-related self-efficacy, intention to change behavior, presenteeism and absenteeism, and pain coping) were analyzed using linear mixed models and Cohen d. Primary and secondary outcomes were self-assessed before and after the intervention, and acceptance was assessed after the intervention. Engagement was measured during the intervention using self-reports and usage data. RESULTS A total of 198 participants (mean age 38.7, SD 12.14 y; n=172, 86.9% women) participated in the study (intervention group: n=110; waitlist control group: n=88). After the intervention, the intention-to-treat analysis revealed evidence for improved well-being (treatment: β estimate=-3.28, 95% CI -5.07 to -1.48) with moderate between-group effects (Cohen d=-0.66, 95% CI -0.99 to -0.33) in favor of the intervention group. We also found evidence of reduced somatic symptoms, perceived stress, and absenteeism and presenteeism, as well as improved headache management self-efficacy, application of behavior change techniques, and pain coping skills, with effects ranging from medium to large (Cohen d=0.43-1.05). Overall, 64.8% (118/182) of the participants used coaching as intended by engaging throughout the coaching and completing the outro. CONCLUSIONS BalanceUP was well accepted, and the results suggest that coaching delivered by a CA can be effective in reducing the burden of people who experience headaches by improving their well-being. TRIAL REGISTRATION German Clinical Trials Register DRKS00017422; https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00017422.
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Affiliation(s)
- Sandra Ulrich
- School of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Andreas R Gantenbein
- Pain and Research Unit, ZURZACH Care, Bad Zurzach, Switzerland
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Viktor Zuber
- School of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Agnes Von Wyl
- School of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Tobias Kowatsch
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- School of Medicine, University of St.Gallen, St. Gallen, Switzerland
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Hansjörg Künzli
- School of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
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Meşe Pekdemir E, Tanik N. Clinical significance of osmophobia and its effect on quality of life in people with migraine. Acta Neurol Belg 2023; 123:1747-1755. [PMID: 35864435 DOI: 10.1007/s13760-022-02030-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/10/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES In this study, we aimed to evaluate the clinical significance of osmophobia and its effect on quality of life in people with migraine. METHODS A total of 145 people with migraine were included in this cross-sectional study. Patients were evaluated with the migraine data form, the Migraine 24-Hour Quality of Life Questionnaire (24-HrMQoLQ), the Migraine Disability Assessment Scale (MIDAS), the Patient Health Questionnaire-9 (PHQ-9), the Insomnia Severity Index (ISI), the Generalized Anxiety Disorder-7 (GAD-7), the Allodynia Symptom Checklist (ASC), and the Fatigue Severity Scale (FSS). To evaluate the presence of osmophobia retrospectively, a semi-structured interview was conducted with the patients by the neurologist. RESULTS The mean 24-Hr-MQoLQ of patients with osmophobia was significantly lower than those without osmophobia. The decrease in the 24-Hr-MQoLQ was statistically significant in the areas of feeling and concerns and social functionality. The mean of the MIDAS scale was higher significantly in patients with osmophobia than those without osmophobia. In addition, the mean ISI, PHQ-9, FSS and ASC scores of patients with osmophobia were statistically significantly higher than those without osmophobia. CONCLUSIONS Both 24-h and 3-month quality of life of people with migraine with osmophobia were more affected than those without osmophobia. At the same manner, insomnia, depression, fatigue and allodynia were observed at higher rates in people with migraine with osmophobia than in migraine without osmophobia. Osmophobia, which is one of the specific symptoms that distinguishes migraine from other headache disorders, deserves further and multifaceted investigation.
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Affiliation(s)
| | - Nermin Tanik
- Yozgat Bozok University Medical School, Yozgat, Turkey
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La Touche R, Fierro-Marrero J, Sánchez-Ruíz I, Rodríguez de Rivera-Romero B, Cabrera-López CD, Lerma-Lara S, Requejo-Salinas N, de Asís-Fernández F, Elizagaray-García I, Fernández-Carnero J, Matesanz-García L, Pardo-Montero J, Paris-Alemany A, Reina-Varona Á. Prescription of therapeutic exercise in migraine, an evidence-based clinical practice guideline. J Headache Pain 2023; 24:68. [PMID: 37286937 DOI: 10.1186/s10194-023-01571-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/24/2023] [Indexed: 06/09/2023] Open
Abstract
The main objective of this clinical practice guideline is to provide a series of recommendations for healthcare and exercise professionals, such as neurologists, physical therapists, and exercise physiologists, regarding exercise prescription for patients with migraine.This guideline was developed following the methodology and procedures recommended in the Appraisal of Guidelines for Research and Evaluation (AGREE). The quality of evidence and strength of recommendations were evaluated with the Scottish Intercollegiate Guidelines Network (SIGN). A systematic literature review was performed and an established appraisal process was employed to rate the quality of relevant scientific research (Grading of Recommendations Assessment, Development, and Evaluation methodology).The evaluation of the current evidence, the elaboration of the grades of recommendation, and their validation show a B grade of recommendation for aerobic exercise, moderate-continuous aerobic exercise, yoga, and exercise and lifestyle recommendations for the improvement of symptoms, disability, and quality of life in patients with migraine. Relaxation techniques, high-intensity interval training, low-intensity continuous aerobic exercise, exercise and relaxation techniques, Tai Chi, and resistance exercise obtained a C grade of recommendation for the improvement of migraine symptoms and disability.
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Affiliation(s)
- Roy La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- PhD Program in Medicine and Surgery. Doctoral School, Universidad Autónoma de Madrid, Madrid, Spain
- Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), Madrid, Spain
| | - José Fierro-Marrero
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
| | - Irene Sánchez-Ruíz
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
| | - Borja Rodríguez de Rivera-Romero
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
| | - Carlos Donato Cabrera-López
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
| | - Sergio Lerma-Lara
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
| | - Néstor Requejo-Salinas
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
| | - Francisco de Asís-Fernández
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Research Group Breatherapy, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
| | - Ignacio Elizagaray-García
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, 28023, Madrid, Spain
| | - Josué Fernández-Carnero
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, 28922, Alcorcón, Spain
| | - Luís Matesanz-García
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, 28023, Madrid, Spain
| | - Joaquín Pardo-Montero
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
| | - Alba Paris-Alemany
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain.
- Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), Madrid, Spain.
- Department of Radiology, Rehabilitation and Physiotherapy. Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain.
| | - Álvaro Reina-Varona
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- PhD Program in Medicine and Surgery. Doctoral School, Universidad Autónoma de Madrid, Madrid, Spain
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Reina-Varona Á, Rodríguez de Rivera-Romero B, Cabrera-López CD, Fierro-Marrero J, Sánchez-Ruiz I, La Touche R. Exercise interventions in migraine patients: a YouTube content analysis study based on grades of recommendation. PeerJ 2022; 10:e14150. [PMID: 36199286 PMCID: PMC9528906 DOI: 10.7717/peerj.14150] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/07/2022] [Indexed: 01/21/2023] Open
Abstract
Background Migraine is the second leading cause of disability worldwide, engendering a high economic cost in developed countries. The adverse events related to pharmacological treatment use have increased interest in non-pharmacological interventions such as exercise. YouTube offers a public source of information for migraine patients regarding exercise interventions for migraine improvement. However, this information has not been validated to ensure the quality and validity of its content. Objective This qualitative content analysis study aims to review and evaluate YouTube videos regarding exercise for migraine. Methods A systematic review of the current evidence regarding exercise for migraine was performed to establish evidence classification and grades of recommendation with the Scottish Intercollegiate Guidelines Network tool. The data sources were PubMed, PEDro, Cochrane, EBSCO, Google Scholar and Web of Science. The quality of YouTube videos on exercise in migraine was reviewed using the Global Quality Scale and DISCERN scale. Finally, the classification in grades of recommendation was used to evaluate the included videos in terms of the various exercise modalities. Results The classification into recommendation grades showed a grade B for aerobic exercise, yoga and changes in lifestyle behavior regarding exercise. A total of 129 videos were included. The healthcare and exercise professional authors produced higher quality videos with a significant statistical difference, although the alternative therapists and patients' videos had a greater impact and a higher viewership based on correlation analysis. The evaluation of the videos based on the recommendation grades could only include 90 videos. 71% of these videos showed a B grade of recommendation, which corresponded to fewer than half of the total included videos. Conclusions YouTube needs higher quality videos on exercise for migraine, and healthcare and exercise professional authors need to improve their scoping strategies to acquire more views. The authors of YouTube videos should have better access to the best current evidence regarding exercise interventions in migraine.
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Affiliation(s)
- Álvaro Reina-Varona
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Aravaca, Madrid, Spain,Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
| | - Borja Rodríguez de Rivera-Romero
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
| | - Carlos Donato Cabrera-López
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
| | - José Fierro-Marrero
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
| | - Irene Sánchez-Ruiz
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
| | - Roy La Touche
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Aravaca, Madrid, Spain,Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain,Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), Madrid, Madrid, Spain
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Dixon P, Harrison S, Hollingworth W, Davies NM, Davey Smith G. Estimating the causal effect of liability to disease on healthcare costs using Mendelian Randomization. ECONOMICS AND HUMAN BIOLOGY 2022; 46:101154. [PMID: 35803012 DOI: 10.1016/j.ehb.2022.101154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 06/15/2022] [Accepted: 06/28/2022] [Indexed: 05/27/2023]
Abstract
Accurate measurement of the effects of disease status on healthcare costs is important in the pragmatic evaluation of interventions but is complicated by endogeneity bias. Mendelian Randomization, the use of random perturbations in germline genetic variation as instrumental variables, can avoid these limitations. We used a novel Mendelian Randomization analysis to model the causal impact on inpatient hospital costs of liability to six prevalent diseases and health conditions: asthma, eczema, migraine, coronary heart disease, Type 2 diabetes, and depression. We identified genetic variants from replicated genome-wide associations studies and estimated their association with inpatient hospital costs on over 300,000 individuals. There was concordance of findings across varieties of sensitivity analyses, including stratification by sex and methods robust to violations of the exclusion restriction. Results overall were imprecise and we could not rule out large effects of liability to disease on healthcare costs. In particular, genetic liability to coronary heart disease had substantial impacts on costs.
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Affiliation(s)
- Padraig Dixon
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom.
| | - Sean Harrison
- MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom; Population Health Sciences, University of Bristol, United Kingdom
| | | | - Neil M Davies
- MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom; Population Health Sciences, University of Bristol, United Kingdom; K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Norway
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom; Population Health Sciences, University of Bristol, United Kingdom; NIHR Biomedical Research Centre, University of Bristol, United Kingdom
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Knoedler L, Chartier C, ElHawary H, Kehrer A, Muehlberger T. Letter to the Editor: The Case for Publicly Funded Headache Surgery in Germany. JPRAS Open 2021; 30:157-159. [PMID: 34703872 PMCID: PMC8526409 DOI: 10.1016/j.jpra.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/06/2021] [Indexed: 11/26/2022] Open
Abstract
Headache surgery has become a considerable therapeutic option in headache treatment and is of rising interest in the German medical sector. This viewpoint outlines the need for reimbursement of headache surgery in the German healthcare system and demonstrates its cost-effectiveness. Using state-of-the-art patient selection algorithms, the authors found headache surgery to be cost-effective within 7.2 to 6.3 years. Of note, the approach presented is not limited to the German healthcare system.
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Affiliation(s)
- Leonard Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | | | - Hassan ElHawary
- Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Canada
| | - Andreas Kehrer
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Thomas Muehlberger
- Department of Plastic Surgery and Hand Surgery, DRK-Kliniken Berlin Westend, Humboldt University Berlin, Berlin, Germany
- Migraine Surgery Centre, Harley Street, London, W1G 9PF, United Kingdom
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Luedtke K, Starke W, Korn KV, Szikszay TM, Schwarz A, May A. Neck treatment compared to aerobic exercise in migraine: A preference-based clinical trial. CEPHALALGIA REPORTS 2020. [DOI: 10.1177/2515816320930681] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: The main objective of this study was to compare the effectiveness of aerobic exercise with physiotherapy. A second objective was to evaluate whether patients with pain referred to the head during manual palpation will benefit more from physiotherapy than patients with local or no pain. Methods: A total of 103 patients with migraine received physiotherapy ( n = 79) or supervised aerobic exercise ( n = 24) according to their preference as an add-on treatment. Both groups had the same contact time with a specialized physiotherapist. The primary outcome measure was headache frequency during the 4 weeks after the intervention. Eighty-seven patients were analyzed at the primary end point ( n = 69 in the physiotherapy group; n = 18 in the aerobic exercise group). A follow-up assessment was conducted 3 months after the final intervention. Results: During the initial assessment of the upper cervical spine, 17 patients reported no pain, 45 local pain, and 25 referred pain to the head. Patients in the physiotherapy group had a mean reduction of 1.8 days (standard deviation (SD) 6.07), while patients in the aerobic exercise group had a mean reduction of 1.2 days (SD 4.27) at the primary end point. This difference was not statistically significant ( p = 0.8). The largest improvement was noted in the group that showed referred pain to the head and received physiotherapy (2.13 days (SD 7.82)). Only patients in the physiotherapy group reported a subjectively perceived general improvement. Conclusions: Patients had a strong preference for physiotherapy. Both groups showed small reductions in headache frequency. Effects were superior after physiotherapy but not statistically significant. Patients with pain referred to the head responded best to a physiotherapy intervention.
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Affiliation(s)
- Kerstin Luedtke
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Health Sciences, Academic Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L), University of Luebeck, Luebeck, Germany
| | - Wiebke Starke
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Tibor Maximillian Szikszay
- Department of Health Sciences, Academic Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L), University of Luebeck, Luebeck, Germany
| | - Annika Schwarz
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Arne May
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Luedtke K, Basener A, Bedei S, Castien R, Chaibi A, Falla D, Fernández-de-Las-Peñas C, Gustafsson M, Hall T, Jull G, Kropp P, Madsen BK, Schaefer B, Seng E, Steen C, Tuchin P, von Piekartz H, Wollesen B. Outcome measures for assessing the effectiveness of non-pharmacological interventions in frequent episodic or chronic migraine: a Delphi study. BMJ Open 2020; 10:e029855. [PMID: 32051295 PMCID: PMC7044826 DOI: 10.1136/bmjopen-2019-029855] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The aim of this Delphi survey was to establish an international consensus on the most useful outcome measures for research on the effectiveness of non-pharmacological interventions for migraine. This is important, since guidelines for pharmacological trials recommend measuring the frequency of headaches with 50% reduction considered a clinically meaningful effect. It is unclear whether the same recommendations apply to complementary (or adjunct) non-pharmacological approaches, whether the same cut-off levels need to be considered for effectiveness when used as an adjunct or stand-alone intervention, and what is meaningful to patients. SETTING University-initiated international survey. PARTICIPANTS The expert panel was chosen based on publications on non-pharmacological interventions in migraine populations and from personal contacts. 35 eligible researchers were contacted, 12 agreed to participate and 10 completed all 3 rounds of the survey. To further explore how migraine patients viewed potential outcome measures, four migraine patients were interviewed and presented with the same measurement tools as the researchers. PROCEDURES The initial Delphi round was based on a systematic search of the literature for outcome measures used in non-pharmacological interventions for headache. Suggested outcome measures were rated by each expert, blinded towards the other members of the panel, for its usefulness on a 5-point Likert scale ranging from definitely not useful to extremely useful. Results were combined using median values and IQRs. Tools rated overall as definitely or probably not useful were excluded from subsequent rounds. Experts further suggested additional outcome measures that were presented to the panel in subsequent rounds. Additionally, experts were asked to rank the most useful tools and provide information on feasible cut-off levels for effectiveness for the three highest ranked tools. RESULTS Results suggest the use of the Migraine Disability Assessment (MIDAS), Headache Impact Test (HIT-6) and headache frequency as primary outcome measures. Patient experts suggested the inclusion of a measure of quality of life and evaluation of associated symptoms and fear of attacks. CONCLUSIONS Recommendations are for the use of the MIDAS, the HIT-6 and headache frequency, in combination with an outcome measure for quality of life. Associated symptoms and fear of attacks should also be considered as secondary outcomes, if relevant for the individual target population. The cut-off level for effectiveness should be lower for non-pharmacological interventions, especially when used as an adjunct to medication. TRIAL REGISTRATION NUMBER German Register of Clinical Trials (DRKS00011777).
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Affiliation(s)
- Kerstin Luedtke
- Pain and Exercise Research, Universitat zu Lubeck Sektion Medizin, Lubeck, Germany
- Department of Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Annika Basener
- Department of Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Stephanie Bedei
- Department of Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Rene Castien
- Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, Netherlands
| | - Aleksander Chaibi
- Head and Neck Research Group, Research Centre Akershus University Hospital, Lørenskog, Oslo, Norway
| | - Deborah Falla
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Cesar Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Mirja Gustafsson
- Department of Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Toby Hall
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Gwen Jull
- Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Peter Kropp
- Institut für Medizinische Psychologie und Medizinische Soziologie, University of Rostock, Rostock, Germany
| | - Bjarne K Madsen
- Danish Headache Center, Department of Neurology, University of Copenhagen, Kopenhagen, UK
| | | | - Elizabeth Seng
- Albert Einstein College of Medicine, Montefiore Medical Center, Yeshiva University, New York, New York, USA
| | - Claudia Steen
- Department of Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Peter Tuchin
- Department of Chiropractic, Macquarie University, Sydney, New South Wales, Australia
| | | | - Bettina Wollesen
- Department of Human Movement Science, University of Hamburg, Hamburg, Hamburg, Germany
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10
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Vosoughi K, Stovner LJ, Steiner TJ, Moradi-Lakeh M, Fereshtehnejad SM, Farzadfar F, Heydarpour P, Malekzadeh R, Naghavi M, Sahraian MA, Sepanlou SG, Tehrani-Banihashemi A, Majdzadeh R, Feigin VL, Vos T, Mokdad AH, Murray CJL. The burden of headache disorders in the Eastern Mediterranean Region, 1990-2016: findings from the Global Burden of Disease study 2016. J Headache Pain 2019; 20:40. [PMID: 31023215 PMCID: PMC6734477 DOI: 10.1186/s10194-019-0990-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/29/2019] [Indexed: 01/11/2023] Open
Abstract
Objectives Using the findings of the Global Burden of Disease Study (GBD), we report the burden of primary headache disorders in the Eastern Mediterranean Region (EMR) from 1990 to 2016. Methods We modelled headache disorders using DisMod-MR 2.1 Bayesian meta-regression tool to ensure consistency between prevalence, incidence, and remission. Years lived with disability (YLDs) were calculated by multiplying prevalence and disability weight (DW) of migraine and tension-type headache (TTH). We assumed primary headache disorders as non-fatal, so their YLD is equal to disability-adjusted life years (DALYs). Results Migraine and TTH were the second and twentieth leading causes of YLDs in EMR. Between 1990 and 2016, the absolute YLD numbers of migraine and TTH increased from 2.3 million (95% uncertainty interval (UI): 1.5–3.2) to 4.7 million (95%UI: 3–6.5) and from 383 thousand (95%UI: 240–562) to 816 thousand (95%UI: 516–1221), respectively. During the same period, age-standardised YLD rates of migraine and TTH in EMR increased by 0.7% and 2.5%, respectively, in comparison to a small decrease in the global rates (0.2% decrease in migraine and TTH). The bulk of burden due to headache occurred in the 30–49 year age group, with a peak at ages 35–44 years. The age-standardised YLD rates of both headache disorders were higher in women with female to male ratio of 1.69 for migraine and 1.38 for TTH. All countries of the EMR except for Somalia and Djibouti had higher age-standardised YLD rates for migraine and TTH in compare to the global rates. Libya and Saudi Arabia had the highest increase in age-standardised YLD rates of migraine and TTH, respectively. Conclusion The findings of this study show that primary headache disorders are a major and a growing cause of disability in EMR. Since 1990, burden of primary headache disorders has constantly been higher in EMR compared to rest of the world, which indicates that health systems in EMR must focus further on developing and implementing preventive and management strategies to control headache. Electronic supplementary material The online version of this article (10.1186/s10194-019-0990-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kia Vosoughi
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran.,Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Lars Jacob Stovner
- Department of Neuromedicine and Movement Science (INB), Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, Norwegian Advisory Unit on Headache, St Olavs University Hospital, Trondheim, Norway
| | - Timothy J Steiner
- Department of Neuromedicine and Movement Science (INB), Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Division of Brain Sciences, Imperial College London, London, UK.,Lifting The Burden, London, UK
| | - Maziar Moradi-Lakeh
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Seyed-Mohammad Fereshtehnejad
- Division of Neurology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Pouria Heydarpour
- Multiple Sclerosis Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Malekzadeh
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Naghavi
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sadaf G Sepanlou
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Tehrani-Banihashemi
- Preventive Medicine and Public Health Research Center, Social Health Institute, Iran University of Medical Sciences, Tehran, Iran.,Department of Community Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Majdzadeh
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Valery L Feigin
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA.,National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Theo Vos
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Ali H Mokdad
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
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Przeklasa-Muszyńska A, Skrzypiec K, Kocot-Kępska M, Dobrogowski J, Wiatr M, Mika J. Non-invasive transcutaneous Supraorbital Neurostimulation (tSNS) using Cefaly ® device in prevention of primary headaches. Neurol Neurochir Pol 2017; 51:127-134. [PMID: 28159327 DOI: 10.1016/j.pjnns.2017.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 01/08/2017] [Accepted: 01/09/2017] [Indexed: 11/26/2022]
Abstract
Headaches are one of the most common pain syndromes experienced by adult patients. International Classification of Headache Disorders identifies about 300 different entities. Primary headaches (migraine, tension-type headache, trigeminal autonomic cephalalgias, other primary headaches) has the common occurrence. Although effective treatment of these disorders is possible, it is inefficient or poorly tolerated in some patients. Neuromodulation methods, being element of multimodal treatment, provide an additional treatment option in pharmacotherapy-refractory patients. Both invasive and non-invasive stimulation methods are used. The non-invasive techniques is transcutaneous nerve stimulation using Cefaly® device. In this study, Cefaly® was used as prevention treatment in patients with pharmacotherapy-refractory headaches. This device is indicated for the prophylactic treatment of episodic primary headaches. A total of 91-patients (30 without and 61 with tSNS) were enrolled in the study, including 60-patients with migraine and 31-patients with other primary headaches. Ten courses of non-invasive peripheral (supraorbitral/supratrochlear) nerves stimulation were delivered to 57-patients; in the remaining 4 patients, the treatment was abandoned due to poor tolerance. Patients were observed for 30 days after stimulation treatment. Compared to the pre-treatment period, the reduction in the intensity of pain was observed in both the migraine group and patients with other types of headaches; this included the number of pain episodes being reduced by half, with simultaneous reduction in average pain intensity and duration of individual pain episodes. The subjective assessment of pain reduction was in the range of 40-47%. Based on our data we recommend tSNS as useful tool in the prophylaxis of primary headaches, including migraine.
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Affiliation(s)
- Anna Przeklasa-Muszyńska
- Department of Pain Research and Treatment, Chair of Anesthesiology and Intensive Therapy, Medical College of Jagiellonian University, Krakow, Poland.
| | - Kinga Skrzypiec
- Department of Pain Research and Treatment, University Hospital, Krakow, Poland
| | - Magdalena Kocot-Kępska
- Department of Pain Research and Treatment, Chair of Anesthesiology and Intensive Therapy, Medical College of Jagiellonian University, Krakow, Poland
| | - Jan Dobrogowski
- Department of Pain Research and Treatment, Chair of Anesthesiology and Intensive Therapy, Medical College of Jagiellonian University, Krakow, Poland
| | - Maciej Wiatr
- Chair and Department of Otolaryngology, Medical College of Jagiellonian University, Krakow, Poland
| | - Joanna Mika
- Institute of Pharmacology, Polish Academy of Sciences, Krakow, Department of Pain Pharmacology, Poland
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12
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13
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Brown JS, Papadopoulos G, Neumann PJ, Price M, Friedman M, Menzin J. Cost-Effectiveness of Migraine Prevention: The Case of Topiramate in the UK. Cephalalgia 2016; 26:1473-82. [PMID: 17116098 DOI: 10.1111/j.1468-2982.2006.01240.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this study was to assess the cost-effectiveness of topiramate vs. no preventive treatment in the UK. Model inputs included baseline migraine frequency, treatment discontinuation and response, preventive and acute medical cost per attack [2005 GBP (£)] and gain in health utility. Outcomes included monthly migraines averted, acute and preventive treatment costs and cost per quality-adjusted life year (QALY). Topiramate was associated with 1.8 fewer monthly migraines and a QALY gain of 0.0384. The incremental cost of topiramate vs. no preventive treatment was about £10 per migraine averted and £5700 per QALY. Results are sensitive to baseline monthly migraine frequency, triptan use rate and the gain in utility. Incorporating savings from reduced work loss (about £36 per month) suggests that topiramate would be cost saving compared with no preventive treatment. This analysis suggests that topiramate is a cost-effective treatment for migraine prevention compared with no preventive treatment.
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Affiliation(s)
- J S Brown
- Harvard Medical School/Harvard Pilgrim Health Care, Department of Ambulatory Care & Prevention, Boston, MA, USA
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14
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Fiane I, Haugland ME, Stovner LJ, Zwart JA, Bovim G, Hagen K. Sick Leave is Related to Frequencies of Migraine and Non-Migrainous Headache—The HUNT Study. Cephalalgia 2016; 26:960-7. [PMID: 16886932 DOI: 10.1111/j.1468-2982.2006.01151.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this large, cross-sectional, population-based study was to examine the association between sick leave and headache. Between 1995 and 1997, all 92 566 adults in Nord-Tr⊘ndelag County in Norway were invited to participate in a health survey. Out of 73 327 invited individuals <67 years old, a total of 38 192 (52±) responded to questions about headache, work situation and sick leave during the past year. Associations between sick leave, headache and migraine included were assessed in multivariate analyses, estimating prevalence odds ratios (ORs) with 95± confidence intervals (CIs). There was an increasing prevalence of sick leave with increasing frequency of migraine and non-migrainous headache. The prevalence of sick leave >8 weeks during the past year was more than three times higher among individuals with headache >14 days per month (20±) compared with those without headache (6±). The results may indicate that better treatment of individuals with chronic headache may have beneficial economic implications.
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Affiliation(s)
- I Fiane
- Department of Clinical Neuroscience, Section of Neurology, Norwegian University of Science and Technology, Trondheim, Norway
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15
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International consensus on the most useful physical examination tests used by physiotherapists for patients with headache: A Delphi study. ACTA ACUST UNITED AC 2016; 23:17-24. [PMID: 27183831 DOI: 10.1016/j.math.2016.02.010] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 02/17/2016] [Accepted: 02/18/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND A wide range of physical tests have been published for use in the assessment of musculoskeletal dysfunction in patients with headache. Which tests are used depends on a physiotherapist's clinical and scientific background as there is little guidance on the most clinically useful tests. OBJECTIVES To identify which physical examination tests international experts in physiotherapy consider the most clinically useful for the assessment of patients with headache. DESIGN/METHODS Delphi survey with pre-specified procedures based on a systematic search of the literature for physical examination tests proposed for the assessment of musculoskeletal dysfunction in patients with headache. RESULTS Seventeen experts completed all three rounds of the survey. Fifteen tests were included in round one with eleven additional tests suggested by the experts. Finally eleven physical examination tests were considered clinically useful: manual joint palpation, the cranio-cervical flexion test, the cervical flexion-rotation test, active range of cervical movement, head forward position, trigger point palpation, muscle tests of the shoulder girdle, passive physiological intervertebral movements, reproduction and resolution of headache symptoms, screening of the thoracic spine, and combined movement tests. CONCLUSIONS Eleven tests are suggested as a minimum standard for the physical examination of musculoskeletal dysfunctions in patients with headache.
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16
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Morgan M, Cousins S, Middleton L, Warriner-Gallyer G, Ridsdale L. Patients' experiences of a behavioural intervention for migraine headache: a qualitative study. J Headache Pain 2016; 17:16. [PMID: 26922332 PMCID: PMC4769711 DOI: 10.1186/s10194-016-0601-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Migraine headache has a high prevalence and a severe impact on personal, social and work life, forming a significant burden on patients, service providers and society. There is some evidence of the effectiveness of behavioural interventions to supplement drug therapy but a recognised need to identify an effective minimal contact approach to enhance access and provide a model for use in publicly funded health systems. This study uses in-depth interviews to examine patients' experience and responses to a behavioural intervention with relaxation and CBT components delivered in three individual therapist sessions with follow-up. METHODS Qualitative study of 20 adults aged 18-75 years in London, UK, with clinically diagnosed migraine and at least four headache days per month. Semi-structured and tape recorded interviews were held post intervention based on a topic guide. Transcripts were coded and charted for all participants and analysed thematically. RESULTS The majority of participants cited the impacts of migraine and a desire for additional non-drug treatment as their main reasons for taking part and almost all completed the course. They valued contact with the therapist and almost all reported benefiting from the therapy. Post intervention they used those techniques they found most beneficial and implemented them flexibly in their daily life to reduce stress and risks of migraine or to respond to migraine. Relaxation training (deep breathing) was easily adopted and often used post intervention. The CBT components were mainly viewed positively but regarded as more challenging to learn and implement. CONCLUSIONS Patients' selectively identified and employed the techniques learned as 'tools' to assist in preventing and managing their migraines, with reported benefits supporting the development of minimal contact behavioural therapy to increase accessibility for adults with migraine headache and the conduct of a definitive trial.
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Affiliation(s)
- Myfanwy Morgan
- King's College London, Department of Primary Care and Public Health Sciences, Guy's campus, London, SE1 1UL, UK.
| | - Sian Cousins
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Laura Middleton
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | | | - Leone Ridsdale
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
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Chaibi A, Šaltytė Benth J, Tuchin PJ, Russell MB. Chiropractic spinal manipulative therapy for migraine: a study protocol of a single-blinded placebo-controlled randomised clinical trial. BMJ Open 2015; 5:e008095. [PMID: 26586317 PMCID: PMC4654276 DOI: 10.1136/bmjopen-2015-008095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Migraine affects 15% of the population, and has substantial health and socioeconomic costs. Pharmacological management is first-line treatment. However, acute and/or prophylactic medicine might not be tolerated due to side effects or contraindications. Thus, we aim to assess the efficacy of chiropractic spinal manipulative therapy (CSMT) for migraineurs in a single-blinded placebo-controlled randomised clinical trial (RCT). METHOD AND ANALYSIS According to the power calculations, 90 participants are needed in the RCT. Participants will be randomised into one of three groups: CSMT, placebo (sham manipulation) and control (usual non-manual management). The RCT consists of three stages: 1 month run-in, 3 months intervention and follow-up analyses at the end of the intervention and 3, 6 and 12 months. The primary end point is migraine frequency, while migraine duration, migraine intensity, headache index (frequency x duration x intensity) and medicine consumption are secondary end points. Primary analysis will assess a change in migraine frequency from baseline to the end of the intervention and follow-up, where the groups CSMT and placebo and CSMT and control will be compared. Owing to two group comparisons, p values below 0.025 will be considered statistically significant. For all secondary end points and analyses, a p value below 0.05 will be used. The results will be presented with the corresponding p values and 95% CIs. ETHICS AND DISSEMINATION The RCT will follow the clinical trial guidelines from the International Headache Society. The Norwegian Regional Committee for Medical Research Ethics and the Norwegian Social Science Data Services have approved the project. Procedure will be conducted according to the declaration of Helsinki. The results will be published at scientific meetings and in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT01741714.
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Affiliation(s)
- Aleksander Chaibi
- Head and Neck Research Group, Research Centre, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Akershus University Hospital, University of Oslo, Nordbyhagen, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Akershus University Hospital, University of Oslo, Nordbyhagen, Norway
- HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway
| | - Peter J Tuchin
- Department of Chiropractic, Macquarie University, Sydney, New South Wales, Australia
| | - Michael Bjørn Russell
- Head and Neck Research Group, Research Centre, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Akershus University Hospital, University of Oslo, Nordbyhagen, Norway
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18
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Berra E, Sances G, De Icco R, Avenali M, Berlangieri M, De Paoli I, Bolla M, Allena M, Ghiotto N, Guaschino E, Cristina S, Tassorelli C, Sandrini G, Nappi G. Cost of Chronic and Episodic Migraine. A pilot study from a tertiary headache centre in northern Italy. J Headache Pain 2015; 16:532. [PMID: 26018292 PMCID: PMC4460116 DOI: 10.1186/s10194-015-0532-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/12/2015] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Chronic migraine (CM) has a high impact on functional performance and quality of life (QoL). CM also has a relevant burden on the National Health Service (NHS), however precise figures are lacking. In this pilot study we compared the impact in terms of costs of CM and episodic migraine (EM) on the individual and on the National Health System (NHS). Furthermore, we comparatively evaluated the impact of CM and EM on functional capability and on QoL of sufferers. METHODS We enrolled 92 consecutive patients attending the Pavia headache centre: 51 subjects with CM and 41 with episodic migraine (EM). Patients were tested with disability scales (MIDAS, HIT-6, SF-36) and with an ad hoc semi-structured questionnaire. RESULTS The direct mean annual cost (in euro) per patient suffering from CM was €2250.0 ± 1796.1, against €523.6 ± 825.8 per patient with EM. The cost loaded on NHS was €2110.4 ± 1756.9 for CM, €468.3 ± 801.8 for EM. The total economic load and the different sub-items were significantly different between groups (CM vs. EM p = 0.001 for each value). CM subjects had higher scores than EM for MIDAS (98.4 ± 72,3 vs 15.5 ± 17.7, p = 0.001) and for HIT-6 (66.1 ± 8.4 vs 58.7 ± 10.1, p = 0.001). The SF-36 score was 39.9 ± 14,74 for CM and 66.2 ± 18.2 for EM (p = 0.001). CONCLUSIONS CM is a disabling condition with a huge impact on the QoL of sufferers and a significant economic impact on the NHS. The adequate management of CM, reverting it back to EM, will provide a dual benefit: on the individual and on the society.
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Affiliation(s)
- E Berra
- Headache Science Centre, "C. Mondino" National Neurological Institute, Pavia, Italy,
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Graef JE, Rief W, French DJ, Nilges P, Nestoriuc Y. German Language Adaptation of the Headache Management Self-Efficacy Scale (HMSE-G) and Development of a New Short Form (HMSE-G-SF). Headache 2015; 55:958-72. [PMID: 25904007 DOI: 10.1111/head.12564] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aims to develop and validate a German version of French and colleagues' Headache Management Self-efficacy Scale and to construct an abbreviated form for use in behavioral headache research. Furthermore, the contribution of headache-specific self-efficacy to pain-related disability in German chronic headache sufferers was examined. BACKGROUND Headache-specific self-efficacy refers to an individuals' confidence that they can engage in behaviors to either prevent headache episodes or to manage headache-related pain and disability. Self-efficacy beliefs have been shown repeatedly to be positively associated with psychological well-being, effective coping, and enhanced treatment outcomes. METHODS A cross-sectional sample of 304 individuals diagnosed with either migraine, chronic tension-type headache, or a combination of 2 or more headache disorders completed the German Headache Management Self-efficacy Scale and questionnaires assessing headache activity, pain-related coping, general self-efficacy, depression, and anxiety. Responsiveness of the scale was analyzed in a longitudinal subsample of 32 inpatients undergoing headache treatment. Finally, a short form was constructed and evaluated regarding psychometric properties. RESULTS The German Headache Management Self-efficacy Scale showed good reliability (Cronbach's α = 0.87) as did the 6-item short form (Cronbach's α = 0.72). In the longitudinal sample, both versions showed a good ability to change over time (SRM= 0.52-1.16). Chronic headache patients with higher levels of self-efficacy reported lower levels of disability (r = -0.26 to -0.31). Multiple regression analyses revealed headache intensity and headache-specific self-efficacy as strongest predictors of headache-related disability (βself-efficacy = -0.21, βintensity = 0.26). CONCLUSIONS Both the 25-item version and the 6-item version appear to be valid, reliable measures of self-efficacy beliefs. These scales will allow clinicians to identify headache sufferers with low levels of headache-specific self-efficacy with the goal of enhancing this expectancy for improvement. The new short form can help accomplish this goal without adding significantly to the burden of the self-report assessment batteries used in clinical settings.
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Affiliation(s)
- Julia E Graef
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | | | - Paul Nilges
- Department of Clinical Psychology, German Red Cross Pain Centre Mainz, Mainz, Germany
| | - Yvonne Nestoriuc
- Clinical Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany
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Kanji G, Weatherall M, Peter R, Purdie G, Page R. Efficacy of regular sauna bathing for chronic tension-type headache: a randomized controlled study. J Altern Complement Med 2015; 21:103-9. [PMID: 25636135 DOI: 10.1089/acm.2013.0466] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Chronic tension-type headache (CTTH) is a chronic syndrome characterized by frequent headache occurring more than 15 days per month. The intensity and duration of headache pain can be very distressing and disabling on an individuals' well-being. The purpose of this study was to examine the applicability of sauna bathing as a new method of treatment for reducing pain in patients with CTTH. METHODS Thirty-seven people who fulfilled the International Headache Society criteria for CTTH were randomly assigned into two groups. The control group (n=20) received advice and education while the intervention group (n=17) received the same advice and attended a sauna regularly for 8 weeks. Reductions in subjective pain were determined using the numerical pain rating scale (NPRS). Disturbance in sleep, depression as assessed by Beckman Disability Index (BDI), and Headache Disability Index (HDI) were measured. RESULTS Mean change in headache intensity significantly differed between the sauna and control group by 1.27 (95% confidence interval, 0.48-2.07; F=10.17; df=1, 117; p=0.002). There was no statistically significant change in duration of headache or improvement in sleep, depression, or HDI between the sauna and control groups. CONCLUSION Regular sauna bathing is a simple, self-directed treatment that is effective for reducing headache pain intensity in CTTH.
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Affiliation(s)
- Giresh Kanji
- 1 Musculoskeletal Pain Specialist, Wellington Pain and Headache Clinic, Southern Cross Hospital , Wellington, New Zealand
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21
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Ruggeri M. The cost effectiveness of Botox in Italian patients with chronic migraine. Neurol Sci 2015; 35 Suppl 1:45-7. [PMID: 24867835 DOI: 10.1007/s10072-014-1741-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Migraine is a primary headache which World Health Organization ranks in 19th place in the list of disabling diseases. In Europe, in 2004, the total costs for migraine were quantified by Stovner and Berg, Eur J Neurol, 12(s1) (2005) at <euro>27 billion. The objective of this study is to provide an estimate of the incremental cost-effectiveness ratio (ICER) of the treatment of chronic migraine with Botox compared to treatment with placebo in the perspective of the Italian National Health Service and society. To do this we studied the disease progression in a cohort of 688 individuals (patients enrolled in the study PREEMPT) via the application of a Markov model. Over a period of 2 years, the total costs of the experimental arm of the model amounted to <euro>3,274 compared with a gain of 1.34 QALYs. In contrast, the costs of the control arm amounted to <euro>2,395 with a gain of 1.24 QALYs. It follows that the incremental costs amounted to <euro>889 compared to an incremental gain of 0.09 QALYs in favor of the experimental arm. The relationship between costs and incremental QALYs generated an ICER of <euro>9,407/QALY. The incremental cost-effectiveness ratio, therefore, is favorable compared to the value usually considered by NICE as a threshold limit for reimbursement which ranges between <euro>20,000 and <euro>40,000/QALY.
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Affiliation(s)
- M Ruggeri
- Istituto di Politica Economica e Alta scuola di Economia e Management dei Sistemi Sanitari (ALTEMS), Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy,
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22
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Leonardi M. Higher burden of migraine compared to other neurological conditions: results from a cross-sectional study. Neurol Sci 2015; 35 Suppl 1:149-52. [PMID: 24867853 DOI: 10.1007/s10072-014-1780-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Headache disorders are prevalent, burdensome and costly. However, it is difficult to get an idea of how much of a burden do they cause if they are not compared with other conditions. Using data from PARADISE project, we compared 80 migraineurs and 80 patients similar for age, gender and work condition. Our results showed that the amount of psycho-social difficulties was higher among patients with migraine than among patients with epilepsy, stroke, multiple sclerosis or Parkinson's disease.
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Affiliation(s)
- Matilde Leonardi
- Neurology, Public Health and Disability Unit, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133, Milan, Italy,
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23
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Amer M, Woodward M, Appel LJ. Effects of dietary sodium and the DASH diet on the occurrence of headaches: results from randomised multicentre DASH-Sodium clinical trial. BMJ Open 2014; 4:e006671. [PMID: 25500372 PMCID: PMC4265150 DOI: 10.1136/bmjopen-2014-006671] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Headaches are a common medical problem, yet few studies, particularly trials, have evaluated therapies that might prevent or control headaches. We, thus, investigated the effects on the occurrence of headaches of three levels of dietary sodium intake and two diet patterns (the Dietary Approaches to Stop Hypertension (DASH) diet (rich in fruits, vegetables and low-fat dairy products with reduced saturated and total fat) and a control diet (typical of Western consumption patterns)). DESIGN Randomised multicentre clinical trial. SETTING Post hoc analyses of the DASH-Sodium trial in the USA. PARTICIPANTS In a multicentre feeding study with three 30 day periods, 390 participants were randomised to the DASH or control diet. On their assigned diet, participants ate food with high sodium during one period, intermediate sodium during another period and low sodium during another period, in random order. OUTCOME MEASURES Occurrence and severity of headache were ascertained from self-administered questionnaires, completed at the end of each feeding period. RESULTS The occurrence of headaches was similar in DASH versus control, at high (OR (95% CI)=0.65 (0.37 to 1.12); p=0.12), intermediate (0.57 (0.29 to 1.12); p=0.10) and low (0.64 (0.36 to 1.13); p=0.12) sodium levels. By contrast, there was a lower risk of headache on the low, compared with high, sodium level, both on the control (0.69 (0.49 to 0.99); p=0.05) and DASH (0.69 (0.49 to 0.98); p=0.04) diets. CONCLUSIONS A reduced sodium intake was associated with a significantly lower risk of headache, while dietary patterns had no effect on the risk of headaches in adults. Reduced dietary sodium intake offers a novel approach to prevent headaches. TRIAL REGISTRATION NUMBER NCT00000608.
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Affiliation(s)
- Muhammad Amer
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Howard University Hospital, Washington DC, USA
| | - Mark Woodward
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia
| | - Lawrence J Appel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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van Hemert S, Breedveld AC, Rovers JMP, Vermeiden JPW, Witteman BJM, Smits MG, de Roos NM. Migraine associated with gastrointestinal disorders: review of the literature and clinical implications. Front Neurol 2014; 5:241. [PMID: 25484876 PMCID: PMC4240046 DOI: 10.3389/fneur.2014.00241] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 11/06/2014] [Indexed: 12/12/2022] Open
Abstract
Recent studies suggest that migraine may be associated with gastrointestinal (GI) disorders, including irritable bowel syndrome (IBS), inflammatory bowel syndrome, and celiac disease. Here, an overview of the associations between migraine and GI disorders is presented, as well as possible mechanistic links and clinical implications. People who regularly experience GI symptoms have a higher prevalence of headaches, with a stronger association with increasing headache frequency. Children with a mother with a history of migraine are more likely to have infantile colic. Children with migraine are more likely to have experienced infantile colic compared to controls. Several studies demonstrated significant associations between migraine and celiac disease, inflammatory bowel disease, and IBS. Possible underlying mechanisms of migraine and GI diseases could be increased gut permeability and inflammation. Therefore, it would be worthwhile to investigate these mechanisms further in migraine patients. These mechanisms also give a rationale to investigate the effects of the use of pre- and probiotics in migraine patients.
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Affiliation(s)
| | - Anne C Breedveld
- Division of Human Nutrition, Wageningen University , Wageningen , Netherlands
| | - Jörgen M P Rovers
- Department of Neurology, Gelderse Vallei Hospital , Ede , Netherlands
| | | | - Ben J M Witteman
- Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital , Ede , Netherlands
| | - Marcel G Smits
- Department of Neurology, Gelderse Vallei Hospital , Ede , Netherlands
| | - Nicole M de Roos
- Division of Human Nutrition, Wageningen University , Wageningen , Netherlands
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Konsensuspapier der Deutschen Migräne- und Kopfschmerzgesellschaft zur Struktur von Kopfschmerzzentren und Kopfschmerzschwerpunktpraxen in Deutschland. Schmerz 2014; 28:128-34. [DOI: 10.1007/s00482-014-1417-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Steiner TJ, Stovner LJ, Al Jumah M, Birbeck GL, Gururaj G, Jensen R, Katsarava Z, Queiroz LP, Scher AI, Tekle-Haimanot R, Wang SJ, Martelletti P, Dua T, Chatterji S. Improving quality in population surveys of headache prevalence, burden and cost: key methodological considerations. J Headache Pain 2013; 14:87. [PMID: 24160915 PMCID: PMC4231353 DOI: 10.1186/1129-2377-14-87] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 10/14/2013] [Indexed: 11/29/2022] Open
Abstract
Population-based studies of headache disorders are important. They inform needs assessment and underpin service policy for a set of disorders that are a public-health priority. On the one hand, our knowledge of the global burden of headache is incomplete, with major geographical gaps; on the other, methodological differences and variable quality are notable among published studies of headache prevalence, burden and cost. The purpose here was to start the process of developing standardized and better methodology in these studies. An expert consensus group was assembled to identify the key methodological issues, and areas where studies might fail. Members had competence and practical experience in headache epidemiology or epidemiology in general, and were drawn from all WHO world regions. We reviewed the relevant literature, and supplemented the knowledge gathered from this exercise with experience gained from recent Global Campaign population-based studies, not all yet published. We extracted methodological themes and identified issues within them that were of key importance. We found wide variations in methodology. The themes within which methodological shortcomings had adverse impact on quality were the following: study design; selection and/or definition of population of interest; sampling and bias avoidance; sample size estimation; access to selected subjects (managing and reporting non-participation); case definition (including diagnosis and timeframe); case ascertainment (including diagnostic validation of questionnaires); burden estimation; reporting (methods and results). These are discussed.
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Affiliation(s)
- Timothy J Steiner
- Norwegian National Headache Centre, Norwegian University of Science and Technology, and St Olavs University Hospital, Trondheim, Norway
- Department of Neuroscience, Imperial College London, London, UK
| | - Lars Jacob Stovner
- Norwegian National Headache Centre, Norwegian University of Science and Technology, and St Olavs University Hospital, Trondheim, Norway
| | - Mohammed Al Jumah
- King Saud Bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Gretchen L Birbeck
- Department of Neurology, University of Rochester, Rochester, NY, USA
- Chikankata Hospital, Mazabuka, Zambia
| | - Gopalakrishna Gururaj
- Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Rigmor Jensen
- Danish Headache Centre, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Zaza Katsarava
- Evangelical Hospital, Unna, Germany
- Department of Neurology, University of Duisburg-Essen, Essen, Germany
| | - Luiz Paulo Queiroz
- Department of Neurology, University Hospital, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Ann I Scher
- Uniformed Services University, Bethesda, MD, USA
| | - Redda Tekle-Haimanot
- School of Medicine, Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Shuu-Jiun Wang
- The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Neurology, Brain Research Center and Institute of Brain Science, National Yang-Ming University of School of Medicine, Taipei, Taiwan
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Tarun Dua
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Somnath Chatterji
- Department of Health Statistics and Informatics, World Health Organization, Geneva, Switzerland
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Bernstein JA, Fox RW, Martin VT, Lockey RF. Headache and facial pain: differential diagnosis and treatment. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2013; 1:242-51. [PMID: 24565480 DOI: 10.1016/j.jaip.2013.03.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 03/07/2013] [Accepted: 03/08/2013] [Indexed: 11/16/2022]
Abstract
Headaches affect 90% of the population sometime during their life. Most are benign and fleeting, some are serious and life-threatening, and others require ongoing medical consultation and treatment. A careful history and physical is necessary to establish a differential diagnosis and to guide the choice of testing to make an accurate diagnosis. The most common types of headaches are discussed in this review. They are divided into primary and secondary headache disorders as classified by the International Headache Society. Primary headache disorders include migraine without and with aura, cluster and tension-type headaches. Secondary headaches are those that occur as a result of some other disorder and include brain tumors, rhinosinusitis, diseases of intracranial and extracranial vasculature, and temporomandibular joint disease.
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Affiliation(s)
- Jonathan A Bernstein
- Professor of Medicine, Director of Clinical Research, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Roger W Fox
- Professor of Medicine, Pediatrics and Public Health, Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Vincent T Martin
- Professor of Medicine, Department of Internal Medicine, Division of General Internal Medicine, University of Cincinnati, Cincinnati, Ohio; Associate Editor for Headache, American Headache Society, Mount Royal, NJ
| | - Richard F Lockey
- Distinguished University Health Professor, Professor of Medicine, Pediatrics and Public Health, Director, Division of Allergy and Immunology, Joy McCann Culverhouse Chair in Allergy and Immunology, Morsani University of South Florida College of Medicine, Tampa, Fla.
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Sokolovic E, Riederer F, Szucs T, Agosti R, Sándor PS. Self-reported headache among the employees of a Swiss university hospital: prevalence, disability, current treatment, and economic impact. J Headache Pain 2013; 14:29. [PMID: 23565579 PMCID: PMC3639129 DOI: 10.1186/1129-2377-14-29] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 12/17/2012] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The objectives of this cross-sectional, observational study were to determine the prevalence of self-reported headache among the employees of the large Swiss university hospital, to measure the impact of headache using the MIDAS questionnaire, to assess current treatment and to estimate economic burden of headache considering indirect costs. METHODS A self-administered questionnaire was distributed internally to 2000 randomly selected employees of the University Hospital Zurich. RESULTS 1210 employees (60.5%) responded. Of the 1192 (98.5%) employees who provided sufficiently complete information, 723 (61%) reported at least one headache type in the last three months. The prevalence of migraine, and tension-type headache was 20% and 50%, respectively. Regarding the occupational groups, there was a trend that healthcare staff, administration employees, and medical technicians suffered more from headaches than physicians, correcting for age and sex. The economic consequences of lost productivity were calculated to amount to approximately 14 million Swiss Francs (9.5 million EUR), representing 3.2% of the overall annual expenditure of the hospital for personnel. CONCLUSION Headache is highly prevalent among university hospital employees, with significant economic impact.
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Affiliation(s)
- Emina Sokolovic
- Gilead Sciences Switzerland Sarl, Turmstrasse 28, CH-6300, Zug, Switzerland.
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29
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Chowdhury D. Tension type headache. Ann Indian Acad Neurol 2012; 15:S83-8. [PMID: 23024570 PMCID: PMC3444224 DOI: 10.4103/0972-2327.100023] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Revised: 06/03/2012] [Accepted: 06/03/2012] [Indexed: 12/16/2022] Open
Abstract
Tension type headaches are common in clinical practice. Earlier known by various names, the diagnosis has had psychological connotations. Recent evidence has helped clarify the neurobiological basis and the disorder is increasingly considered more in the preview of neurologists. The classification, clinical features, differential diagnosis and treatment of tension type headache are discussed in this paper.
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Affiliation(s)
- Debashish Chowdhury
- Department of Neurology, Academic Block, G. B. Pant Hospital, New Delhi, India
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30
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Yu S, Liu R, Zhao G, Yang X, Qiao X, Feng J, Fang Y, Cao X, He M, Steiner T. The prevalence and burden of primary headaches in China: a population-based door-to-door survey. Headache 2012; 52:582-91. [PMID: 22590713 DOI: 10.1111/j.1526-4610.2011.02061.x] [Citation(s) in RCA: 230] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES In the absence of reliable data on the prevalence and burden of primary headache disorders in the mainland of China, a population-based survey was initiated by Lifting The Burden: the Global Campaign against Headache. METHODS Throughout all regions of China, 5041 non-related adult respondents aged 18-65 years were randomly sampled from the general population according to the expanded programme on immunization method established by World Health Organization. They were visited by door-to-door calling and surveyed using the structured questionnaire developed by Lifting The Burden, translated into Chinese and adapted to Chinese culture after a pilot study. RESULTS The responder rate was 94.1%.The estimated 1-year prevalence of primary headache disorders was 23.8% (95%confidence interval 22.6-25.0%), of migraine 9.3% (95% confidence interval 8.5-10.1%), of tension-type headache (TTH) 10.8%(9.9-11.6%), and of chronic daily headache (CDH) 1.0% (0.7-1.2%). Of respondents with migraine, TTH, and CDH, moderate or severe impact and therefore high need for effective medical care were reported by 38.0%, 23.1%, and 47.9%, respectively.The World Health Organization quality of life-8 questionnaire showed that all 3 types of headache reduced life quality. The total estimated annual cost of primary headache disorders, including migraine,TTH, and CDH was CNY 672.7 billion, accounting for 2.24% of gross domestic product (GDP) (direct cost: CNY 108.8 billion, 0.36% of GDP; indirect cost: CNY 563.9 billion, 1.88%of GDP). CONCLUSION The prevalence of primary headaches is high in China and not dissimilar from the world average. These headaches cause disability, impair work, study and daily activities, decrease life quality, and bring about a heavy and hitherto unrecognized socioeconomic burden.
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Affiliation(s)
- Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China.
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Abstract
PURPOSE OF REVIEW This review provides an update on our knowledge regarding prevention and management of medication overuse headache (MOH). RECENT FINDINGS The prevalence of MOH is 1-2% in the general population worldwide, and because of the tremendous socio-economic cost, it is likely to be the most costly neurological disorder known. MOH has similarities with traditional drug addiction. Use of a brochure on medication overuse can prevent MOH. The Severity of Dependence Scale (SDS) score is a significant predictor of medication overuse among headache patients. Withdrawal of medication is essential in the management of MOH, and simultaneous initiation of prophylactic medication may alleviate this process. Short advice on medication overuse by a physician reduced mean medication days from 22 to 6 days; 76% no longer had medication overuse and 42% no longer had chronic headache. SUMMARY A brochure and/or the SDS should be used to prevent MOH. Withdrawal is the cornerstone of MOH management. Short advice on MOH is the current most cost effective management method, a method that can be applied anywhere including third world countries.
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Ng-Mak DS, Chen YT, Ho TW, Stanford B, Roset M. Results of a 2-year retrospective cohort study of newly prescribed triptan users in European nationwide practice databases. Cephalalgia 2012; 32:875-87. [DOI: 10.1177/0333102412449929] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective: This study was conducted to characterize prescription refill patterns for triptans among European patients with new prescriptions of triptans. Background: Persistency with prescriptions of triptan monotherapy for migraine headache among newly prescribed users in European primary-care practices has not been well described. Methods: Using electronic medical databases in the UK ( N = 3618), France ( N = 2051) and Germany ( N = 954), we conducted a retrospective cohort analysis to identify refill patterns over 2 years among migraineurs receiving new prescriptions of triptan monotherapy in 2006. Results: Of all patients, >33% of migraineurs with new triptan prescriptions received ≥1 refill of their index triptan prescriptions (UK, 44.3%; France, 34.2%; Germany, 37.7%). More than 50% never received index-triptan refill prescriptions (UK, 55.7%; France, 65.8%; Germany, 63.3%). Small proportions of patients (<7.0%) switched to alternative triptans, and even fewer switched to different prescription-medication classes (UK and Germany, 2.3%; France, 4.0%). More than 48% of patients received no further prescriptions for migraine after index prescriptions (UK, 48.5%; France, 54.9%; Germany, 54.7%). After the second year, >83.0% of patients in each country had no further prescriptions for migraine medications, <14.0% remained persistent with index prescriptions, <4.0% switched to other triptans, and <3.0% switched to alternative medication classes. Conclusions: In migraine patients who received new prescriptions of triptan monotherapy from their primary-care physicians, poor triptan prescription refill frequency was observed in Europe. Although consistent with potential clinical challenges in migraine management, our findings should be interpreted with caution given certain inherent limitations associated with the database study design. Further research is warranted to confirm our findings and to identify reasons for, or predictors of, triptan discontinuation.
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Affiliation(s)
- Daisy S Ng-Mak
- Global Health Outcomes, Merck Sharp & Dohme Corp., West Point, PA, USA
| | - Ya-Ting Chen
- Global Access Strategy Team, Merck & Co., Inc., Whitehouse Station, NJ, USA
| | - Tony W Ho
- Innovative Medicine, AstraZeneca, Wilmington, DE, USA
| | | | - Montse Roset
- Health Economics & Outcomes Research, IMS Health, Barcelona, Spain
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Reza A, Sievert LL, Rahberg N, Morrison LA, Brown DE. Prevalence and determinants of headaches in Hawaii: the Hilo Women's Health Study. Ann Hum Biol 2012; 39:305-14. [PMID: 22747070 DOI: 10.3109/03014460.2012.700069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Headache frequency has been associated with ethnicity, menopause, abdominal obesity and stress. AIM To examine the prevalence and determinants of headaches in the multi-ethnic community of Hilo, Hawaii. SUBJECTS AND METHODS A random sample of 1824 women aged 16-100 was recruited by postal survey; 206 women aged 45-55 were recruited for clinical measures. Both studies queried the presence/absence of headaches during the past 2 weeks. The clinical study also examined migraines and tension headaches. Headaches were examined in relation to demographic, reproductive and lifestyle variables, stress, symptoms and anthropometric measures. RESULTS Headache prevalence was 47%. Japanese women were less likely to report headaches compared to women of European descent, but, after controlling for measures of stress, Japanese women were at a higher risk for headaches. Post-menopausal women were half as likely to report headaches compared with pre-menopausal women. Women with children younger than 18 were 4-times as likely to report migraines compared with women who did not have children younger than 18. CONCLUSION Standardized measures of daily hassles, life and job satisfaction were not associated with headaches. The relationship between headaches and having young children suggests that the everyday stress of family life is a headache risk. This may be particularly true in Hilo, Hawaii, where the value of family is culturally prioritized.
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Affiliation(s)
- Angela Reza
- Department of Anthropology, UMass Amherst, Amherst, MA, USA
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Bloudek LM, Stokes M, Buse DC, Wilcox TK, Lipton RB, Goadsby PJ, Varon SF, Blumenfeld AM, Katsarava Z, Pascual J, Lanteri-Minet M, Cortelli P, Martelletti P. Cost of healthcare for patients with migraine in five European countries: results from the International Burden of Migraine Study (IBMS). J Headache Pain 2012; 13:361-78. [PMID: 22644214 PMCID: PMC3381065 DOI: 10.1007/s10194-012-0460-7] [Citation(s) in RCA: 214] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 05/07/2012] [Indexed: 11/26/2022] Open
Abstract
Migraine is a disabling neurological disease that affects 14.7 % of Europeans. Studies evaluating the economic impact of migraine are complex to conduct adequately and with time become outdated as healthcare systems evolve. This study sought to quantify and compare direct medical costs of chronic migraine (CM) and episodic migraine (EM) in five European countries. Cross-sectional data collected via a web-based survey were screened for migraine and classified as CM (≥15 headache days/month) or EM (<15 headache days/month), and included sociodemographics, resource use data and medication use. Unit cost data, gathered using publicly available sources, were analyzed for each type of service, stratified by migraine status. Univariate and multivariate log-normal regression models were used to examine the relationship between various factors and their impact on total healthcare costs. This economic analysis included data from respondents with migraine in the UK, France, Germany, Italy, and Spain. CM participants had higher level of disability and more prevalent psychiatric disorders compared to EM. CM participants had more provider visits, emergency department/hospital visits, and diagnostic tests; the medical costs were three times higher for CM than EM. Per patient annual costs were highest in the UK and Spain and lower in France and Germany. CM was associated with higher medical resource use and total costs compared to EM in all study countries, suggesting that treatments that reduce headache frequency could decrease the clinical and economic burden of migraine in Europe. Comparing patterns of care and outcomes among countries may facilitate the development of more cost-effective care, and bring greater recognition to patients affected by migraine.
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Affiliation(s)
- L M Bloudek
- Allergan Inc., 2525 Dupont Drive, Irvine, CA, 92612, USA.
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Stafford MR, Hareendran A, Ng-Mak DS, Insinga RP, Xu R, Stull DE. EQ-5D™-derived utility values for different levels of migraine severity from a UK sample of migraineurs. Health Qual Life Outcomes 2012; 10:65. [PMID: 22691697 PMCID: PMC3407525 DOI: 10.1186/1477-7525-10-65] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 06/12/2012] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND To estimate utility values for different levels of migraine pain severity from a United Kingdom (UK) sample of migraineurs. METHODS One hundred and six migraineurs completed the EQ-5D to evaluate their health status for mild, moderate and severe levels of migraine pain severity for a recent migraine attack, and for current health defined as health status within seven days post-migraine attack. Statistical tests were used to evaluate differences in mean utility scores by migraine severity. RESULTS Utility scores for each health state were significantly different from 1.0 (no problems on any EQ-5D dimension) (p < 0.0001) and one another (p < 0.0001). The lowest mean utility, - 0.20 (95% confidence interval [CI]: -0.27 - -0.13), was for severe migraine pain. The smallest difference in mean utility was between mild and moderate migraine pain (0.13) and the largest difference in mean utility was between current health (without migraine) and severe migraine pain (1.07). CONCLUSIONS Results indicate that all levels of migraine pain are associated with significantly reduced utility values. As severity worsened, utility decreased and severe migraine pain was considered a health state worse than death. Results can be used in cost-utility models examining the relative economic value of therapeutic strategies for migraine in the UK.
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Affiliation(s)
- Megan R Stafford
- Outcomes Research, United BioSource Corporation, 26-28 Hammersmith Grove, Floor 5E, London, W6 7HA, United Kingdom
- NCCMH, Royal College of Psychiatrists, (during the work conducted and preparation of this manuscript, MRS was employed by United BioSource Corporation), 4th Floor Mansell Street, 21 Standon House, London, E1 8AA, United Kingdom
| | - Asha Hareendran
- Outcomes Research, United BioSource Corporation, 26-28 Hammersmith Grove, Floor 5E, London, W6 7HA, United Kingdom
| | - Daisy S Ng-Mak
- Director, Global Health Outcomes Strategy & Research, Allergan, (during the work conducted and preparation of this manuscript, DSN was employed by Merck Research Laboratories), 2525 Dupont Drive (MI3-110A), Irvine, CA, 92612-1599, USA
| | - Ralph P Insinga
- Department of Health Economic Statistics, Merck Research Laboratories, Merck Sharp & Dohme Corp, Whitehouse Station, NJ, 08889, USA
| | - Ruifeng Xu
- Department of Health Economic Statistics, Merck Research Laboratories, Merck Sharp & Dohme Corp, Whitehouse Station, NJ, 08889, USA
| | - Donald E Stull
- Outcomes Research, United BioSource Corporation, 26-28 Hammersmith Grove, Floor 5E, London, W6 7HA, United Kingdom
- RTI-Health Solutions, (during the work conducted and preparation of this manuscript, DES was employed by United BioSource Corporation), 2nd floor, the Pavilion; Towers Business Park, Wilmslow Road, Didsbury, Manchester, M20 2LS, United Kingdom
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Linde M, Gustavsson A, Stovner LJ, Steiner TJ, Barré J, Katsarava Z, Lainez JM, Lampl C, Lantéri-Minet M, Rastenyte D, Ruiz de la Torre E, Tassorelli C, Andrée C. The cost of headache disorders in Europe: the Eurolight project. Eur J Neurol 2011; 19:703-11. [PMID: 22136117 DOI: 10.1111/j.1468-1331.2011.03612.x] [Citation(s) in RCA: 452] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M Linde
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
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Gustavsson A, Svensson M, Jacobi F, Allgulander C, Alonso J, Beghi E, Dodel R, Ekman M, Faravelli C, Fratiglioni L, Gannon B, Jones DH, Jennum P, Jordanova A, Jönsson L, Karampampa K, Knapp M, Kobelt G, Kurth T, Lieb R, Linde M, Ljungcrantz C, Maercker A, Melin B, Moscarelli M, Musayev A, Norwood F, Preisig M, Pugliatti M, Rehm J, Salvador-Carulla L, Schlehofer B, Simon R, Steinhausen HC, Stovner LJ, Vallat JM, Van den Bergh P, van Os J, Vos P, Xu W, Wittchen HU, Jönsson B, Olesen J. Cost of disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 2011; 21:718-79. [PMID: 21924589 DOI: 10.1016/j.euroneuro.2011.08.008] [Citation(s) in RCA: 985] [Impact Index Per Article: 75.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The spectrum of disorders of the brain is large, covering hundreds of disorders that are listed in either the mental or neurological disorder chapters of the established international diagnostic classification systems. These disorders have a high prevalence as well as short- and long-term impairments and disabilities. Therefore they are an emotional, financial and social burden to the patients, their families and their social network. In a 2005 landmark study, we estimated for the first time the annual cost of 12 major groups of disorders of the brain in Europe and gave a conservative estimate of €386 billion for the year 2004. This estimate was limited in scope and conservative due to the lack of sufficiently comprehensive epidemiological and/or economic data on several important diagnostic groups. We are now in a position to substantially improve and revise the 2004 estimates. In the present report we cover 19 major groups of disorders, 7 more than previously, of an increased range of age groups and more cost items. We therefore present much improved cost estimates. Our revised estimates also now include the new EU member states, and hence a population of 514 million people. AIMS To estimate the number of persons with defined disorders of the brain in Europe in 2010, the total cost per person related to each disease in terms of direct and indirect costs, and an estimate of the total cost per disorder and country. METHODS The best available estimates of the prevalence and cost per person for 19 groups of disorders of the brain (covering well over 100 specific disorders) were identified via a systematic review of the published literature. Together with the twelve disorders included in 2004, the following range of mental and neurologic groups of disorders is covered: addictive disorders, affective disorders, anxiety disorders, brain tumor, childhood and adolescent disorders (developmental disorders), dementia, eating disorders, epilepsy, mental retardation, migraine, multiple sclerosis, neuromuscular disorders, Parkinson's disease, personality disorders, psychotic disorders, sleep disorders, somatoform disorders, stroke, and traumatic brain injury. Epidemiologic panels were charged to complete the literature review for each disorder in order to estimate the 12-month prevalence, and health economic panels were charged to estimate best cost-estimates. A cost model was developed to combine the epidemiologic and economic data and estimate the total cost of each disorder in each of 30 European countries (EU27+Iceland, Norway and Switzerland). The cost model was populated with national statistics from Eurostat to adjust all costs to 2010 values, converting all local currencies to Euro, imputing costs for countries where no data were available, and aggregating country estimates to purchasing power parity adjusted estimates for the total cost of disorders of the brain in Europe 2010. RESULTS The total cost of disorders of the brain was estimated at €798 billion in 2010. Direct costs constitute the majority of costs (37% direct healthcare costs and 23% direct non-medical costs) whereas the remaining 40% were indirect costs associated with patients' production losses. On average, the estimated cost per person with a disorder of the brain in Europe ranged between €285 for headache and €30,000 for neuromuscular disorders. The European per capita cost of disorders of the brain was €1550 on average but varied by country. The cost (in billion €PPP 2010) of the disorders of the brain included in this study was as follows: addiction: €65.7; anxiety disorders: €74.4; brain tumor: €5.2; child/adolescent disorders: €21.3; dementia: €105.2; eating disorders: €0.8; epilepsy: €13.8; headache: €43.5; mental retardation: €43.3; mood disorders: €113.4; multiple sclerosis: €14.6; neuromuscular disorders: €7.7; Parkinson's disease: €13.9; personality disorders: €27.3; psychotic disorders: €93.9; sleep disorders: €35.4; somatoform disorder: €21.2; stroke: €64.1; traumatic brain injury: €33.0. It should be noted that the revised estimate of those disorders included in the previous 2004 report constituted €477 billion, by and large confirming our previous study results after considering the inflation and population increase since 2004. Further, our results were consistent with administrative data on the health care expenditure in Europe, and comparable to previous studies on the cost of specific disorders in Europe. Our estimates were lower than comparable estimates from the US. DISCUSSION This study was based on the best currently available data in Europe and our model enabled extrapolation to countries where no data could be found. Still, the scarcity of data is an important source of uncertainty in our estimates and may imply over- or underestimations in some disorders and countries. Even though this review included many disorders, diagnoses, age groups and cost items that were omitted in 2004, there are still remaining disorders that could not be included due to limitations in the available data. We therefore consider our estimate of the total cost of the disorders of the brain in Europe to be conservative. In terms of the health economic burden outlined in this report, disorders of the brain likely constitute the number one economic challenge for European health care, now and in the future. Data presented in this report should be considered by all stakeholder groups, including policy makers, industry and patient advocacy groups, to reconsider the current science, research and public health agenda and define a coordinated plan of action of various levels to address the associated challenges. RECOMMENDATIONS Political action is required in light of the present high cost of disorders of the brain. Funding of brain research must be increased; care for patients with brain disorders as well as teaching at medical schools and other health related educations must be quantitatively and qualitatively improved, including psychological treatments. The current move of the pharmaceutical industry away from brain related indications must be halted and reversed. Continued research into the cost of the many disorders not included in the present study is warranted. It is essential that not only the EU but also the national governments forcefully support these initiatives.
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Galletti F, Sarchielli P, Hamam M, Costa C, Cupini LM, Cardaioli G, Belcastro V, Eusebi P, Lunardi P, Calabresi P. Occipital arteriovenous malformations and migraine. Cephalalgia 2011; 31:1320-4. [DOI: 10.1177/0333102411417465] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Headache has been reported to be the first clinical presentation in several patients with cerebral arteriovenous malformations (AVMs). Headache associated with AVMs often shows characteristics of migraine with and without aura. Angiographic characteristics of AVMs, such as their location, could determine the ‘migraine-like’ features of attacks. Methods: We performed an observational study of the clinical and angiographic characteristics of a cohort of 40 consecutive patients with AVMs who had been admitted to our institute for endovascular embolization over a 4-year period. Headache was characterized according to ICHD-II criteria. The relationship between headaches and the angioarchitectural features of AVMs was also analysed. Results: Migraine-like headache was the first clinical manifestation in 22.5% of patients. The location of the malformation was significantly associated with migraine-like presentation (p = 0.03) and the occipital lobe was the predominant site. Conclusions: An occipital location may be linked with spreading depression, a pathogenic mechanism of migraine. Headache associated with arteriovenous malformations in the occipital lobe, although secondary in nature, could have clinical features similar to migraine.
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Affiliation(s)
- Francesca Galletti
- Clinica Neurologica, Università degli Studi di Perugia, Italy
- Fondazione Santa Lucia, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | | | - Mohamed Hamam
- Neuroradiologia, Ospedale Santa Maria della Misericordia, Italy
| | - Cinzia Costa
- Clinica Neurologica, Università degli Studi di Perugia, Italy
- Fondazione Santa Lucia, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | | | | | - Vincenzo Belcastro
- Clinica Neurologica, Università degli Studi di Perugia, Italy
- Fondazione Santa Lucia, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Paolo Eusebi
- Fondazione Santa Lucia, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
- Regional Health Authority of Umbria, Italy
| | | | - Paolo Calabresi
- Clinica Neurologica, Università degli Studi di Perugia, Italy
- Fondazione Santa Lucia, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
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McCrone P, Seed PT, Dowson AJ, Clark LV, Goldstein LH, Morgan M, Ridsdale L. Service use and costs for people with headache: a UK primary care study. J Headache Pain 2011; 12:617-23. [PMID: 21744225 PMCID: PMC3208040 DOI: 10.1007/s10194-011-0362-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 06/20/2011] [Indexed: 11/27/2022] Open
Abstract
This paper aims to estimate the service and social costs of headache presenting in primary care and to identify predictors of headache costs. Patients were recruited from GP practices in England and service use and lost employment recorded. Predictors of cost were identified using regression models. Service and social costs were available on 288 and 282 patients, respectively. Average service costs over 3 months were £117 whilst total costs (including lost production) were £582. Patients referred to neurologists had service costs that were £82 higher than those not referred (90% CI £36–£128). Costs including lost employment were higher by £150, but this was not significant (90% CI -£139–£439). The annual mean service and social costs, weighted to represent population rates of referral, were £468 and £2328, respectively. Higher costs were significantly related to pain. Age was linked to higher service costs and lower social costs. The figures extrapolated to the whole of the UK suggest £956 million due to service use and £4.8 billion including lost employment. These are likely to be underestimates because many people experiencing headaches do not consult their GP.
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Affiliation(s)
- Paul McCrone
- P024, Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London, SE5 8AF, UK.
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Raggi A, Leonardi M, Giovannetti A, Curone M, Bussone G, D’Amico D. A longitudinal evaluation of changes in disability and quality of life in a sample of women with migraine. Neurol Sci 2011; 32 Suppl 1:S189-91. [DOI: 10.1007/s10072-011-0535-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Beckstrand RL, Pickens JS. Beneficial Effects of Magnesium Supplementation. J Evid Based Complementary Altern Med 2011. [DOI: 10.1177/2156587211401746] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Magnesium is an essential mineral necessary for optimal cellular health and well-being. Many adults in the United States fail to get recommended amounts of magnesium from their diets. Even so, symptoms of magnesium deficiency are rarely seen; however, maintaining normal body stores could be preventative against common diseases.
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Raggi A, Leonardi M, Bussone G, D’Amico D. Value and utility of disease-specific and generic instruments for assessing disability in patients with migraine, and their relationships with health-related quality of life. Neurol Sci 2010; 32:387-92. [DOI: 10.1007/s10072-010-0466-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 11/25/2010] [Indexed: 01/11/2023]
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Leonardi M, Raggi A, Bussone G, D'Amico D. Health-related quality of life, disability and severity of disease in patients with migraine attending to a specialty headache center. Headache 2010; 50:1576-86. [PMID: 21029083 DOI: 10.1111/j.1526-4610.2010.01770.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The impact of migraine on patients' daily life has been evaluated in several studies. The relationship between disability and health-related quality of life (HRQoL) in patients with migraine, however, has not been systematically evaluated. OBJECTIVE To assess the impact of migraine on patients' HRQoL and disability patterns and to describe the relationship between disability and HRQoL in patients with migraine attending a specialty Italian headache center according to the biopsychosocial model of disability endorsed by the International Classification of Functioning, Disability and Health. METHODS In this observational study, adult patients with migraine were consecutively recruited. Disability was measured with the MIDAS (Migraine Disability Assessment) and the WHO-DAS II (World Health Organization Disability Assessment Schedule), HRQoL with the SF-36 (Medical Outcome Survey 36-item Short-Form Health Survey). Spearman's rank correlation between MIDAS score, SF-36 and WHO-DAS II scales was performed to evaluate the relationships between quality of life and disability. The impact of migraine on disability and HRQoL was assessed by comparing WHO-DAS II and SF-36 scores against Italian normative values, and by evaluating the different disability and HRQoL profiles in patients with different severity of migraine, defined according to migraine frequency and pain intensity. RESULTS A total of 102 patients with migraine (87 females) were enrolled. Mild to moderate correlations were reported between WHO-DAS II and SF-36's PCS (r = -0.67, P < .01) and MCS (r = -0.36, P < .05) scales; MIDAS score correlations to SF-36's PCS (r = -0.44, P < .01) and MCS (not significant) were lower than WHO-DAS II summary score. The correlation between MIDAS score and the WHO-DAS II summary score was mild (r = -0.36, P < .05). The majority of HRQoL and disability scales (with the exception of SF-36's Physical Functioning, and WHO-DAS II Getting along with people scales) scored significantly lower than normative values. A trend towards worsening of both HRQoL and disability, consistent with increasing migraine severity, was reported (Mann-Whitney's U = 119.5 for MIDAS; U= 113.0 for WHO-DAS II summary score, both with P < .01; U = 152.9 for PCS; U = 171.0 for MCS, both with P< .05) CONCLUSIONS In migraineurs attending an Italian specialty headache clinic, disability scores were worse and HRQoL scores lower than those of the general population, and worsened consistently with increased migraine severity. Measures of HRQoL and disability evaluate different psychosocial aspects of migraine and researchers should continue to employ them in public health and clinical research on migraine. They provide information on a poorly recognized part of migraine's burden, where economic impact is minimal but there are important effects on patients' daily lives in terms of interpersonal relationships, perceived quality of life and emotional status.
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Affiliation(s)
- Matilde Leonardi
- Neurology, Public Health and Disability Unit, Scientific Directorate, Neurological Institute C. Besta, IRCCS Foundation, Via Celoria 11, Milan, Italy
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Leonardi M, Raggi A, Ajovalasit D, Bussone G, D'amico D. Functioning and disability in migraine. Disabil Rehabil 2010; 32 Suppl 1:S23-32. [DOI: 10.3109/09638288.2010.511687] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Bhola R, Goadsby PJ. A trans-cultural comparison of the organisation of care at headache centres world-wide. Cephalalgia 2010; 31:316-30. [DOI: 10.1177/0333102410380756] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: The need to provide better outcomes for patients with headache, and to minimise the costs involved in doing so, has prompted the search for new modes of service delivery by exploring the service organisation and nursing role from various cultural, economic and global perspectives. Materials and Methods: This study was based on comparisons with the UK headache service up to 2007, the point at which this study was set up. This UK service was based at the National Hospital for Neurology and Neurosurgery (NHNN, UCLH Trust). Data were obtained from US headache centres in 2008 and from centres in Copenhagen, Bangkok, Sydney and Porto Alegre in 2009. Results: A comparison shows the key components of services at all centres showing the team structure and size of service. Prominent features at the centres included: team-working, regular meetings, educational input, good access and communication among team members, headache-trained neurologists, specialist nursing at most centres, and the input of psychological and physical therapists at some centres. Conclusions: The problems of tertiary headache care are very similar throughout the world and seem to transcend ethnic, cultural and economic considerations.
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Affiliation(s)
- Ria Bhola
- The National Hospital for Neurology and Neurosurgery, UK
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Disability and functional profiles of patients with migraine measured with ICF classification. Int J Rehabil Res 2010; 33:225-31. [DOI: 10.1097/mrr.0b013e3283375e53] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Le H, Tfelt-Hansen P, Russell MB, Skytthe A, Kyvik KO, Olesen J. Co-morbidity of migraine with somatic disease in a large population-based study. Cephalalgia 2010; 31:43-64. [PMID: 20974590 DOI: 10.1177/0333102410373159] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The aim of this study was to determine sex specific co-morbidity of migraine and its subtypes migraine without aura (MO) and migraine with aura (MA) with a number of common somatic diseases. SUBJECTS AND METHODS In 2002, a questionnaire containing previously validated questions to diagnose migraine and its subtypes as well as questions regarding some somatic diseases was sent to 46,418 twins residing in Denmark and born between 1931 and 1982. The twins are representative of the whole Danish population and were used as such in the present study. RESULTS We found that 21, 23 and 12 conditions were co-morbid with migraine, MA and MO, respectively. Co-morbid diseases included previously documented diseases: asthma, epilepsy and stroke as well as new conditions: kidney stone, psoriasis, rheumatoid arthritis and fibromyalgia. MA had more co-morbidities than MO and females more than males. CONCLUSIONS Migraine occurs in 20-30% of several medical conditions. It should be diagnosed and treated along with the primary disease.
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Affiliation(s)
- Han Le
- University of Copenhagen, Denmark
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Porta-Etessam J, López-Gil A, Matías-Guiu J, Fernández C. Validación de un cuestionario diagnóstico para migraña adaptado para encuesta telefónica asistida por ordenador. Neurologia 2010. [DOI: 10.1016/s0213-4853(10)70004-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Porta-Etessam J, López-Gil A, Matías-Guiu J, Fernández C. Validation of a diagnostic questionnaire for migraine adapted for a computer assisted telephone interviewing. NEUROLOGÍA (ENGLISH EDITION) 2010. [DOI: 10.1016/s2173-5808(10)70032-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
The substantial societal and individual burdens associated with tension-type headache (TTH) constitute a previously overlooked major public health issue. TTH is prevalent, affecting up to 78% of the general population, and 3% suffer from chronic TTH. Pericranial myofascial nociception probably is important for the pathophysiology of episodic TTH, whereas sensitization of central nociceptive pathways seems responsible for the conversion of episodic to chronic TTH. Headache-related disability usually can be reduced by identification of trigger factors combined with nonpharmacologic and pharmacologic treatments, but effective treatment modalities are lacking. Benefits can be gained by development of specific and effective treatment strategies.
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