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Irfan S, Mohammed F, Hameed S, Ravi V, V K, S S, Arumugam S, Subramanian B, Ravichandran S, Ravichandran U. The Assessment of Clinical Characteristics, Treatment Patterns, and Burden of Illness in Patients With Episodic and Chronic Migraine: A Cross-Sectional Study. Cureus 2024; 16:e59073. [PMID: 38800196 PMCID: PMC11128265 DOI: 10.7759/cureus.59073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
INTRODUCTION Migraine is a prevalent and disabling primary headache disorder worldwide, causing significant years lost due to disability (YLD) and impacting various aspects of everyday life. Despite its high prevalence and substantial burden, there is a lack of comprehensive data on clinical patterns and management trends, in places like Tamil Nadu, India. This study aims and also fill gaps by investigating and analyzing the clinical characteristics, treatment patterns, and illness burden among patients with episodic migraine (EM) and chronic migraine (CM) in the state of Tamil Nadu. STUDY This cross-sectional retrospective study was conducted at the Department of Neurology, Madras Medical College, Chennai, over a three-month period starting from January 2024 to March 2024. The study included migraine patients aged 18 years and above who met the International Classification of Headache Disorders (ICHD)-3 criteria and took treatment at the department. Data were collected using patient interviews, medical records, and counseling sessions and using a pre-designed questionnaire. Patient demographics, clinical characteristics, symptom prevalence, prescription patterns, and illness burden were analyzed accordingly. The Migraine Disability Assessment (MIDAS) questionnaire was used to measure the burden of illness. RESULTS The analysis involved 400 migraine patients, 92.5% of them having EM and 7.5% of them having CM. The mean age of patients was 37.5 years, with a predominance of females (73.5%). Patients with CM had having significantly higher average number of headache days per month when compared to those with EM. Tension-type headache (TTH) and medication-overuse headache (MOH) were more prevalent in those CM patients. Trigger factors include lack of sleep, bright light exposure, and stress. Comorbidities such as diabetes mellitus, obesity, and depression were significantly higher in CM patients. Acute treatment included NSAIDs and Triptans, while preventive therapy was more commonly used in CM patients. The mean MIDAS score was significantly higher in CM patients, which indicates greater disability. CONCLUSION The study provides valuable insights into the clinical characteristics, treatment patterns, and burden of illness among migraine patients in Tamil Nadu, India. Significant differences were observed between EM and CM patients, which highlights the need for comprehensive management strategies. Preventive therapy, lifestyle modifications, and comprehensive assessment of disability are all important in addressing the variable needs of migraine patients and also reducing the burden of illness. Further research is necessary to explore additional factors influencing migraine outcomes in this population.
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Affiliation(s)
- Shahul Irfan
- Internal Medicine, Government Medical College and Hospital Cuddalore, Chidambaram, IND
| | - Fadhil Mohammed
- Radiology, Stanley Medical College and Hospital, Chennai, IND
| | - Shahul Hameed
- Medicine and Surgery, Stanley Medical College and Hospital, Chennai, IND
| | - Vasupriya Ravi
- Medicine and Surgery, Stanley Medical College and Hospital, Chennai, IND
| | - Kashish V
- Internal Medicine, Government Medical College and Hospital Cuddalore, Chidambaram, IND
| | - Srimati S
- Medicine, Government Medical College and Hospital Cuddalore, Chidambaram, IND
| | - Sashanga Arumugam
- Internal Medicine, Government Medical College and Hospital Cuddalore, Chidambaram, IND
| | - Bala Subramanian
- Internal Medicine, Government Medical College and Hospital Cuddalore, Chidambaram, IND
| | | | - Umarani Ravichandran
- Internal Medicine, Government Medical College and Hospital Cuddalore, Chidambaram, IND
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Liaw V, McCreary M, Friedman DI. Quality of Life in Patients With Confirmed and Suspected Spinal CSF Leaks. Neurology 2023; 101:e2411-e2422. [PMID: 37816637 PMCID: PMC10752647 DOI: 10.1212/wnl.0000000000207763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/11/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Spontaneous intracranial hypotension (SIH) is a debilitating condition typically producing orthostatic headache limiting upright time. SIH is often difficult to diagnose and treat, negatively affecting quality of life (QoL) in patients with the disorder. We studied QoL in patients with confirmed and suspected SIH using standardized instruments, including suicidality. METHODS We performed a cross-sectional survey of adult patients with confirmed and clinically suspected SIH evaluated in our Headache and Facial Pain Program from 2016 to 2022. Using an online data collection tool (REDCap V 11.2.2), participants completed validated questionnaires assessing general well-being (SF-36), depression (PHQ-9), generalized anxiety disorder-7 (GAD-7), spiritual well-being during chronic illness therapy (FACIT-Sp-12), and headache impact (HIT-6). Subsequently, we interviewed willing participants to administer the Columbia-Suicide Severity Rating Scale (C-SSRS) assessing suicidal behavior and ideation. RESULTS A total of 234 patients met inclusion criteria and were invited to participate in the study, and 95 patients (59 confirmed and 36 clinically suspected) completed the questionnaires. The average age of the cohort was 51.1 years (SD: 15.5), predominantly female (69.5%), White (91.6%), and married (69.5%). Three-quarters (74.5%) scored within the most severe headache category (HIT-6). SF-36 scores were significantly inferior (p < 0.0001) to the general population and lower than reported values for patients with multiple sclerosis and idiopathic intracranial hypertension. Almost half (49.1%) of respondents scored in the moderate depression range or worse (>10), and 25.4% scored with moderate anxiety or worse (>10). FACIT-Sp-12 scores were significantly worse (p < 0.0001) in symptomatic participants than in the validation cohorts of patients with AIDS and cancer. Of the 67 respondents who completed the C-SSRS, more than half (64.2%) endorsed a wish to be dead, and 22.4% had demonstrated suicidal behavior. Patients with symptom-free SIH (n = 22) scored significantly better than symptomatic patients, comparable with the general population. DISCUSSION Based on our single-center cohort, SIH is associated with severe headache pain and high rates of depression, anxiety, and disability, affecting basic activities of daily living. Individuals with confirmed and suspected spinal CSF leaks scored similarly on these measures including suicidality. Outcomes were comparable with the general population after successful treatment or spontaneous remission. Improved identification and treatment of SIH are imperative to improve patients' QoL.
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Affiliation(s)
- Victor Liaw
- From the Department of Neurology (M.M., D.I.F.), University of Texas Southwestern Medical Center (V.L.), Dallas; and Department of Ophthalmology (D.I.F.), University of Texas Southwestern, Dallas
| | - Morgan McCreary
- From the Department of Neurology (M.M., D.I.F.), University of Texas Southwestern Medical Center (V.L.), Dallas; and Department of Ophthalmology (D.I.F.), University of Texas Southwestern, Dallas
| | - Deborah I Friedman
- From the Department of Neurology (M.M., D.I.F.), University of Texas Southwestern Medical Center (V.L.), Dallas; and Department of Ophthalmology (D.I.F.), University of Texas Southwestern, Dallas.
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Vikelis M, Dermitzakis EV, Xiromerisiou G, Rallis D, Soldatos P, Litsardopoulos P, Rikos D, Argyriou AA. Effects of Fremanezumab on Psychiatric Comorbidities in Difficult-to-Treat Patients with Chronic Migraine: Post Hoc Analysis of a Prospective, Multicenter, Real-World Greek Registry. J Clin Med 2023; 12:4526. [PMID: 37445560 DOI: 10.3390/jcm12134526] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
OBJECTIVE this post hoc analysis aimed to evaluate the efficacy of fremanezumab in difficult-to-treat chronic migraine (CM) patients with and without psychiatric comorbidities (PCs), mainly anxiety and/or depression. METHODS We assessed data from CM patients with and without PCs who failed at least 3 preventives and eventually received at least 3 consecutive monthly doses of fremanezumab 225 mg. Outcomes included the crude response (≥50% reduction in monthly headache days (MHDs)) rates to fremanezumab from the baseline to the last clinical follow-up. The changes in MHDs; MHDs of moderate/greater severity; monthly days with intake of abortive medication; and the proportion of patients' changing status from with PCs to decreased/without PCs were also compared. Disability and quality of life (QOL) outcomes were also assessed. RESULTS Of 107 patients enrolled, 65 (60.7%) had baseline PCs. The percentage of patients with (n = 38/65; 58.5%) and without (n = 28/42; 66.6%) PCs that achieved a ≥50% reduction in MHDs with fremanezumab was comparable (p = 0.41), whereas MHDs were significantly reduced (difference vs. baseline) in both patients with PCs (mean -8.9 (standard error: 6.8); p < 0.001) and without PCs (-9.8 (7.5); p < 0.001). Both groups experienced significant improvements in all other efficacy, disability, and QOL outcomes at comparable rates, including in MHD reduction. A significant proportion of fremanezumab-treated patients with baseline PCs de-escalated in corresponding severities or even reverted to no PCs (28/65; 43.1%) post-fremanezumab. CONCLUSIONS fremanezumab appears to be effective as a preventive treatment in difficult-to-treat CM patients with and without PCs while also being beneficial in reducing the severity of comorbid anxiety and/or depression.
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Affiliation(s)
- Michail Vikelis
- Headache Clinic, Mediterraneo Hospital, 16675 Athens, Greece
| | | | - Georgia Xiromerisiou
- Department of Neurology, University Hospital of Larissa, University of Thessaly, 41110 Larissa, Greece
| | - Dimitrios Rallis
- Department of Neurology, Tzaneio General Hospital of Piraeus, 18536 Athens, Greece
| | | | - Pantelis Litsardopoulos
- Headache Outpatient Clinic, Department of Neurology, Agios Andreas State General Hospital of Patras, 26335 Patras, Greece
| | | | - Andreas A Argyriou
- Headache Outpatient Clinic, Department of Neurology, Agios Andreas State General Hospital of Patras, 26335 Patras, Greece
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Goldstein ED, Gopal N, Badi MK, Hodge DO, de Havenon A, Glover P, Durham PL, Huang JF, Lin MP, Baradaran H, Majersik JJ, Meschia JF. CGRP, Migraine, and Brain MRI in CADASIL: A Pilot Study. Neurologist 2023; 28:231-236. [PMID: 36729391 PMCID: PMC10277309 DOI: 10.1097/nrl.0000000000000478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Migraine is associated with neuroimaging differences in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). However, it is unknown if migraine-related disability (MRD) or if calcitonin gene-related peptide (CGRP), a vasoactive peptide important in migraine pathology, have radiographic implications. The aims of this study were to identify whether MRD or interictal serum CGRP levels impacted neuroimaging findings for those with CADASIL. MATERIALS AND METHODS A cross-sectional analysis was performed. The primary outcomes were neuroimaging differences associated with MRD among those with migraine or interictal serum CGRP levels of those with and without migraine. MRD was defined by 2 migraine disability scales (Migraine Disability Assessment, Headache Impact Test-6). Retrospective brain magnetic resonance imaging was reviewed (average 1.7 ± 2.0 y before enrollment). Rank-sum and χ 2 tests were used. RESULTS Those with migraine (n=25, vs. n=14 without) were younger [median 49 (25 to 82) y vs. 60 (31 to 82) y, P <0.007], had fewer cerebral microbleeds (0 to 31 vs. 0 to 50, P =0.02) and less frequently had anterior temporal lobe T2 hyperintensities [68% (17/25) vs 100% (14/14), P =0.02]. MRD scale outcomes had no significant radiographic associations. Interictal serum CGRP did not differ (migraine: n=18, 27.0±9.6 pg/mL vs. no migraine: n=10, 26.8±15.7 pg/mL, P =0.965). CONCLUSIONS Migraine may forestall microangiopathy in CADASIL, though possibly independent of severity as measured by MRD. Interictal serum CGRP did not differ in our cohort suggesting CGRP may not be vital to migraine pathophysiology in CADASIL. Larger studies are needed to account for age differences.
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Affiliation(s)
- Eric D. Goldstein
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Neethu Gopal
- Department of Neurology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Mohammed K. Badi
- Department of Neurology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - David O. Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Adam de Havenon
- Department of Neurology, Yale University, New Haven, CT, USA
| | - Patrick Glover
- Department of Neurology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Paul L. Durham
- Department of Biology, Missouri State University, Springfield, MO, USA
| | | | - Michelle P Lin
- Department of Neurology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Hediyeh Baradaran
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | | | - James F. Meschia
- Department of Neurology, Mayo Clinic Florida, Jacksonville, FL, USA
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Bhatia S, Bahl VJ, Sharma M, Sharma D, Gupta V, Nanda MS, Thakur P. Recurrent Epistaxis: An Unusual Manifestation of Clinical Spectrum of Migraine -Case Series with Scoping Review of Literature. Indian J Otolaryngol Head Neck Surg 2023; 75:984-993. [PMID: 37206793 PMCID: PMC10188710 DOI: 10.1007/s12070-023-03542-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/27/2023] [Indexed: 02/19/2023] Open
Abstract
OBJECTIVE We report four cases of migraine induced epistaxis and reviewed the published literature of migraine with epistaxis to establish demographic profiles, types of migraine, severity, family history of headache and other associated disorders in adults. METHODS A panoramic search of the Medline database through Pubmed was done in May 2022 using search terms: {Migraine with Epistaxis}, case reports. All articles/case reports in English from January 2001 to April 2022 where age of patients was > 18 years were included in our review. RESULTS Our search recognized total of three cases and with inclusion of the four cases who reported to us, we reviewed these seven cases and studied demographic profile, clinical features, association of epistaxis with types and severity of migraine and relationship with other medical disorders. Mean age of presentation was 28.7 years (range 18-49), with five female and two male patients. The intensity of headache was severe in three of seven cases and there was one case each of moderate and mild category. Five of seven (71%) patients had reduction in intensity of headache with onset of bleeding and various types of migraine (Migraine with and without Aura, vestibular migraine, sporadic familial hemiplegic migraine) according to ICHD classification were associated with epistaxis. Four of seven had positive family history of migraine. There was no diagnostic finding in any patient and all patients responded to migraine preventive medication. CONCLUSION Recurrent epistaxis is not so uncommon manifestation of various types of migraine and specialist should keep this clinical diagnosis in mind to avoid misdiagnosis.
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Affiliation(s)
- Shenny Bhatia
- Department of Otorhinolaryngology, MM Medical College & Hospital, Solan, Himachal Pradesh India
| | - Vishwa Jyoti Bahl
- Department of Ophthalmology, MM Medical College & Hospital, Solan, Himachal Pradesh India
| | - Monika Sharma
- Department of Radiodiagnosis, MM Medical College & Hospital, Solan, Himachal Pradesh India
| | - Deepika Sharma
- Department of Otorhinolaryngology, MM Medical College & Hospital, Solan, Himachal Pradesh India
| | - Vipan Gupta
- Department of Otorhinolaryngology, MM Medical College & Hospital, Solan, Himachal Pradesh India
| | - Manpreet Singh Nanda
- Department of Otorhinolaryngology, MM Medical College & Hospital, Solan, Himachal Pradesh India
| | - Pooja Thakur
- Department of Otorhinolaryngology, MM Medical College & Hospital, Solan, Himachal Pradesh India
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Graves EB, Gerber BR, Berrigan PS, Shaw E, Cowling TM, Ladouceur MP, Bougie JK. Epidemiology and treatment utilization for Canadian patients with migraine: a literature review. J Int Med Res 2022; 50:3000605221126380. [PMID: 36173008 PMCID: PMC9528037 DOI: 10.1177/03000605221126380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The objective of this narrative review was to identify real-world evidence regarding the burden of migraine in Canada. We conducted a literature search in MEDLINE, Embase, and the Cochrane Database of Systematic Reviews for studies published between August 2010 and August 2020. Of the 3269 publications identified, 29 studies were included. Prevalence estimates varied widely across Canada, and mental health comorbidities were common. Individuals with migraine have a lower quality of life, detrimental impact on workforce productivity, and higher rates of health care resource utilization (HCRU), with HCRU and costs highest among those with chronic migraine. We found inconsistencies in care, including underutilization of medications such as triptans, and varied utilization of over-the-counter and prescription medications. Increased medication use was identified among those with chronic migraine, and only a small number of patients used migraine preventive medications. The burden of migraine in Canada is substantial. Reduced quality of life and workforce productivity, increased HCRU and costs, and underutilization of triptans and migraine preventive medications highlight an important need for more effective management of individuals with migraine.
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Affiliation(s)
- Erin B Graves
- Medlior Health Outcomes Research Ltd., Calgary, AB, Canada
| | | | | | - Eileen Shaw
- Medlior Health Outcomes Research Ltd., Calgary, AB, Canada
| | - Tara M Cowling
- Medlior Health Outcomes Research Ltd., Calgary, AB, Canada
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Monterrey P, González M, Ramírez D, Gracia F, Henríquez F, Pérez‐Franco E, Díaz A, Vásquez JF, Benzadón A, Obage J, Luna D, Pertuz W. Characteristics of migraine in patients with headache disorders: A clinic‐based study from Central American and Caribbean countries. Headache 2022; 62:1029-1038. [PMID: 36017947 PMCID: PMC9545062 DOI: 10.1111/head.14375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 06/23/2022] [Indexed: 12/03/2022]
Abstract
Objective The objective of the study was to measure the proportion of patients who consulted for headache and of those who had a final diagnosis of migraine. We also assessed the proportion and characteristics of patients with migraine and the impact of migraine on the daily activities and the professional and social lives of patients visiting private/public medical centers in Guatemala, Costa Rica, Panama, and the Dominican Republic. Background Underdiagnosis of migraine is high in Central America and Caribbean urban communities. However, there is limited knowledge on characteristics of headache disorders for the appropriate classification of migraine, which is a prerequisite for targeted treatment. Hence, there is a need to improve migraine awareness among patients and medical professionals in this region. Methods Central America and Caribbean countries epidemioLogy study of Migraine (CALM) was a non‐interventional, cross‐sectional, multinational study in adults aged 18–65 years with a history of or current headache. The primary outcome was the proportion of patients with migraine visiting medical centers due to headache disorders. Using a specially designed migraine survey questionnaire, patients self‐reported migraine characteristics, duration, and severity of attacks and impact on work and social life. Results Of the 313 enrolled patients, 308 (98.4%) completed the study. Approximately 75.3% (232/308) of patients with headache visiting medical centers had migraine, with episodic migraine being the most common (193 [83.2%]). Overall, 34/308 (11.0%) patients had a new diagnosis of migraine. Among patients with migraine, 66 (28.4%) had a history of migraine for ≥20 years and 59 (25.4%) experienced severe pain. Overall, 52.2% (121/232) of patients reported that migraine affected their professional life and 78.4% (182/232) reported an impact on social life. Conclusion The CALM study establishes that a high proportion of patients with migraine had a long duration and high severity of migraine attacks, leading to a direct impact on work/social life as well as on costs incurred by patients in these countries.
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Affiliation(s)
| | | | | | | | | | | | - Alejandro Díaz
- Guatemalan Institute of Social Security Cdad. de Guatemala Guatemala
| | | | - Aarón Benzadón
- Complejo Hospitalario Dr. Arnulfo Arias Madrid, CSS Panama City Panama
| | - Jeanine Obage
- Novartis Caribe S.A. Santo Domingo Dominican Republic
| | - Diego Luna
- Novartis Pharma Logistics, Inc. Panama City Panama
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Chandler D, Navetta M, Shah S, Cline J, Phinney M. Establishing content validity for the migraine Global Impression Item (mGI-I) assessment: a modified single-item migraine symptom severity questionnaire. BMC Neurol 2022; 22:103. [PMID: 35303826 PMCID: PMC8932152 DOI: 10.1186/s12883-022-02626-0] [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: 08/24/2021] [Accepted: 03/08/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To establish content validity of a single-item, migraine-specific symptom severity questionnaire for completion by migraine patients, key family members (KFMs) of migraine patients, and Healthcare Professionals (HCPs) who treat migraine patients. Background Migraine is a common disabling primary headache disorder with high prevalence and significant socioeconomic burden and personal impacts. There is a need for a global assessment of migraine symptom severity to evaluate potential new therapies from multiple perspectives. Methods The migraine Global Impression Item (mGI-I) was drafted and tested in a non-interventional, qualitative study comprising telephone interviews with 15 migraine patients, 15 KFMs of migraine patients, and 15 migraine treating HCPs. The mGI-I was drafted with two different item stem options and two different response scale options to ask about the patient’s migraine from the perspective of each respondent. Cognitive interviews were conducted to test comprehensiveness, clarity and ease of completion of the different versions of the mGI-I iteratively in three sequential waves of respondents. Results Revisions were made to the draft mGI-I after Wave 1 and Wave 2 of the interviews. Changes were made to simplify the item stem (removing unnecessary text), make language more patient-friendly (e.g. use of “migraine attack”), and add clarity to the item stem for consistent interpretation (include descriptive language of migraine attacks). Across both waves there was a preference for a 5-point response scale compared to a 7-point scale. In Wave 3, all respondents found the revised instructions, item stem, and 5-point response scale comprehensive, easy to understand and to answer. No further changes to the mGI-I were made after Wave 3. Conclusions This qualitative study of 45 total respondents across 3 subpopulations, established the content validity and appropriateness of the mGI-I in migraine patients, KFMs, and migraine-treating HCPs. The study specifically confirmed that the mGI-I is comprehensive, easily understood and answered for each respondent population. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02626-0.
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Affiliation(s)
| | - Marco Navetta
- Amgen, 1 Amgen Center Dr, Thousand Oaks, CA, 91320, USA
| | - Shweta Shah
- Amgen, 1 Amgen Center Dr, Thousand Oaks, CA, 91320, USA
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Wang D, Casares S, Eilers K, Hitchcock S, Iverson R, Lahn E, Loux M, Schnetzer C, Frey-Law LA. Assessing Multisensory Sensitivity Across Scales: Using the Resulting Core Factors to Create the Multisensory Amplification Scale. THE JOURNAL OF PAIN 2022; 23:276-288. [PMID: 34461307 PMCID: PMC11065416 DOI: 10.1016/j.jpain.2021.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/15/2021] [Accepted: 07/22/2021] [Indexed: 11/17/2022]
Abstract
Multisensory sensitivity (MSS), observed in some chronic pain patients, may reflect a generalized central nervous system sensitivity. While several surveys measure aspects of MSS, there remains no gold standard. We explored the underlying constructs of 4 MSS-related surveys (80 items in total) using factor analyses using REDCap surveys (N = 614, 58.7% with pain). Four core- and 6 associated-MSS factors were identified from the items assessed. None of these surveys addressed all major sensory systems and most included additional related constructs. A revised version of the Somatosensory Amplification Scale was developed, encompassing 5 core MSS systems: vision, hearing, smell, tactile, and internal bodily sensations: the 12-item Multisensory Amplification Scale (MSAS). The MSAS demonstrated good internal consistency (alpha = 0.82), test-retest reliability (ICC3,1 = 0.90), and construct validity in the original and in a new, separate cohort (R = 0.54-0.79, P < .0001). Further, the odds of having pain were 2-3.5 times higher in the highest sex-specific MSAS quartile relative to the lowest MSAS quartile, after adjusting for age, sex, BMI, and pain schema (P < .03). The MSAS provides a psychometrically comprehensive, brief, and promising tool for measuring the core-dimensions of MSS. PERSPECTIVE: Multiple multisensory sensitivity (MSS) tools are used, but without exploration of their underlying domains. We found several measures lacking core MSS domains, thus we modified an existing scale to encompass 5 core MSS domains: light, smell, sound, tactile, and internal bodily sensations using only 12 items, with good psychometric properties.
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Affiliation(s)
- Dan Wang
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Sabrina Casares
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Karen Eilers
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Shannon Hitchcock
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Ryan Iverson
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Ethan Lahn
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Megan Loux
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Colton Schnetzer
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Laura A Frey-Law
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, Iowa.
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Leahu P, Bange M, Ciolac D, Scheiter S, Matei A, Gonzalez-Escamilla G, Chirumamilla VC, Groppa SA, Muthuraman M, Groppa S. Increased migraine-free intervals with multifocal repetitive transcranial magnetic stimulation. Brain Stimul 2021; 14:1544-1552. [PMID: 34673259 DOI: 10.1016/j.brs.2021.10.383] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/13/2021] [Accepted: 10/16/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Episodic migraine is a debilitating condition associated with vast impairments of health, daily living, and life quality. Several prophylactic treatments exist, having a moderate ratio of action related to side effects and therapy costs. Repetitive transcranial magnetic stimulation (rTMS) is an evidence based therapy in several neuropsychiatric conditions, showing robust efficacy in alleviating specific symptoms. However, its efficacy in migraine disorders is unequivocal and might be tightly linked to the applied rTMS protocol. We hypothesized that multifocal rTMS paradigm could improve clinical outcomes in patients with episodic migraine by reducing the number of migraine days, frequency and intensity of migraine attacks, and improve the quality of life. METHODS We conducted an experimental, double-blind, randomized controlled study by applying a multifocal rTMS paradigm. Patients with episodic migraine with or without aura were enrolled in two centers from August 2018, to December 2019, and randomized to receive either real (n = 37) or sham (sham coil stimulation, n = 28) multifocal rTMS for six sessions over two weeks. Patients, physicians, and raters were blinded to the applied protocol. The experimental multifocal rTMS protocol included two components; first, swipe stimulation of 13 trains of 140 pulses/train, 67 Hz, 60% of RMT, and 2s intertrain interval and second, spot burst stimulation of 33 trains of 15 pulses/train, 67 Hz, 85% of RMT, and 8s intertrain interval. Reduction >50% from the baseline in migraine days (as primary outcome) and frequency and intensity of migraine attacks (as key secondary outcomes) over a 12-week period were assessed. To balance the baseline variables between the treatment arms, we applied the propensity score matching through the logistic regression. RESULTS Among 65 randomized patients, sixty (age 39.7 ± 11.6; 52 females; real rTMS n = 33 and sham rTMS n = 27) completed the trial and five patients dropped out. Over 12 weeks, the responder's rate in the number of migraine days was significantly higher in the real rTMS compared to the sham group (42% vs. 26%, p < 0.05). The mean migraine days per month decreased from 7.6 to 4.3 days in the real rTMS group and from 6.2 to 4.3 days in the sham rTMS group, resulting in a difference with real vs. sham rTMS of -3.2 days (p < 0.05). Similarly, over the 12-week period, the responder's rate in the reduction of migraine attacks frequency was higher in the real rTMS compared to the sham group (42% vs 33%, p < 0.05). No serious adverse events were observed. CONCLUSION Our pilot study shows compelling evidence in a double placebo-controlled trial that multifocal rTMS is an effective and well-tolerated preventive treatment in patients with episodic migraine.
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Affiliation(s)
- Pavel Leahu
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova; Laboratory of Neurobiology and Medical Genetics, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - Manuel Bange
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Dumitru Ciolac
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova; Laboratory of Neurobiology and Medical Genetics, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - Stefanie Scheiter
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Alexandru Matei
- Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova
| | - Gabriel Gonzalez-Escamilla
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Venkata C Chirumamilla
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stanislav A Groppa
- Department of Neurology, Institute of Emergency Medicine, Chisinau, Republic of Moldova; Laboratory of Neurobiology and Medical Genetics, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - Muthuraman Muthuraman
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sergiu Groppa
- Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn(2)), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
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11
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Pozo-Rosich P, Gil-Gouveia R, Donnet A, Poole AC, Gendolla A, Afridi S, Sanchez-De la Rosa R, Terwindt GM, Tassorelli C. Relevant factors for neurologists to define effectiveness of migraine preventive drugs and take decisions on treatment. My-LIFE European Delphi survey. Eur J Pain 2021; 25:2177-2189. [PMID: 34173301 PMCID: PMC8596543 DOI: 10.1002/ejp.1831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/24/2021] [Indexed: 11/30/2022]
Abstract
Background Clinical guidelines agree that preventive treatment should be considered in patients with uncontrolled migraine despite acute medications or patients with ≥4 migraine days per month. However, the criteria to define the effectiveness of treatment and the factors that inform the decision to (dis)continue it are not clearly defined in clinical practice. Methods Overall, 148 healthcare practitioners from five European countries completed a two‐wave questionnaire. The Steering Committee defined a simulated set of 108 migraine patient profiles based on the combination of five factors (frequency of the attacks, intensity of the attacks, use of acute migraine medications, patient perception and presence/absence of tolerable side effects). These profiles were used in a Delphi survey among European neurologists to identify the criteria that should be used to decide treatment response and continuation using a conjoint analysis approach. Results Consensus was reached for 82/108 (76%) of profiles regarding treatment response, and for 86/108 (80%) regarding treatment continuation. Multivariable logistic regression analysis showed that a ≥50% reduction in the use of acute migraine medications and positive patient's perception of treatment were the most important factors that lead to the decision of continuing (combined factors, OR = 18.3, 95% CI 13.4–25.05). Conclusions This survey identifies two relevant outcome measures: one objective (use of acute migraine treatment medications) and one subjective (positive patient perception) that guide the clinician decision to continue preventive treatment in migraine patients. Significance In clinical practice, criteria to define the effectiveness of migraine preventive treatment and factors that guide treatment stop or continuation are not clearly defined. In this simulated clinical setting study, a reduction in the use of acute migraine medications was the factor associated with preventive treatment effectiveness definition. This study also revealed that factors strongly associated with the decision of treatment continuation in real life are the acute migraine medications use and a positive patient's perception of treatment effectiveness.
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Affiliation(s)
- Patricia Pozo-Rosich
- Headache Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Headache Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Raquel Gil-Gouveia
- Headache Center, Neurology Department, Hospital da Luz, Lisboa, Portugal
| | - Anne Donnet
- Pain Department, Timone Hospital, Marseille, France
| | | | | | - Shazia Afridi
- Headache Service, Department of Neurology, Guy's and St Thomas' NHS Trust, London, UK
| | | | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Cristina Tassorelli
- Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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12
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Donnet A, Ducros A, Radat F, Allaf B, Chouette I, Lanteri-Minet M. Severe migraine and its control: A proposal for definitions and consequences for care. Rev Neurol (Paris) 2021; 177:924-934. [PMID: 33810839 DOI: 10.1016/j.neurol.2020.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/19/2020] [Accepted: 11/26/2020] [Indexed: 12/13/2022]
Abstract
Currently many patients with severe migraine do not receive appropriate treatment and are never referred to specialist headache centres. On the other hand, specialist headache centres are frequently attended by patients whose migraines could be managed adequately in the community. One reason for this may be the absence of standardised definitions of migraine severity and control and of a treatment algorithm for orientating difficult-to-treat patients to specialist headache centres. Based on a review of the relevant literature and consensus meetings, proposals have been made for these items. We propose that migraine should be considered severe if headache frequency is at least eight migraine days per month or, if headaches are less frequent, the HIT-6 score is ≥60 or ≥50% of headaches require complete interruption of activity. The proposed definition of migraine control is defined on the basis of appropriate response to acute headache therapy and to preventative therapy. A treatment algorithm is proposed to assess migraine control regularly and to adapt therapy accordingly. These proposals may contribute to developing and testing strategies for management of severe disease with appropriate and effective preventive treatment strategies. With the anticipated introduction of new possibilities for migraine prevention in the near future, the time is ripe for a holistic approach to migraine management.
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Affiliation(s)
- Anne Donnet
- Centre d'évaluation et de traitement de la douleur, CHU de la Timone, Marseille, France; Neuro-Dol Inserm U1107, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Anne Ducros
- Service de Neurologie, CHU Gui de Chauliac, Montpellier, France
| | - Françoise Radat
- Unité de traitement de la douleur chronique, CHU de Bordeaux, Bordeaux, France
| | | | | | - Michel Lanteri-Minet
- Neuro-Dol Inserm U1107, Université Clermont Auvergne, Clermont-Ferrand, France; Département d'évaluation et de traitement de la douleur CHU de Nice, FHU InovPain Université Côte Azur, Nice, France.
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13
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Sollmann N, Schandelmaier P, Weidlich D, Börner C, Urban G, Lang M, Zimmer C, Karampinos DC, Landgraf MN, Heinen F, Baum T, Bonfert MV. Patients with episodic migraine show increased T2 values of the trapezius muscles - an investigation by quantitative high-resolution magnetic resonance imaging. Cephalalgia 2021; 41:934-942. [PMID: 33615841 PMCID: PMC8217886 DOI: 10.1177/0333102421996374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Neck pain is frequent in patients with migraine. Likewise, evidence for inflammatory processes in the trapezius muscles is accumulating. However, non-invasive and objectively assessable correlates are missing in vivo. Methods Twenty-one subjects with episodic migraine (mean age: 24.6 ± 3.1 years, 18 females) and 22 controls (mean age: 23.0 ± 2.2 years, 17 females) without any history of headache prospectively underwent physical examination and quantitative magnetic resonance imaging of the trapezius muscles. A T2‐prepared turbo spin-echo sequence was acquired for manual segmentation of the trapezius muscles and extraction of mean T2 values. Results There were no statistically significant differences regarding age, sex, body mass index, or number of myofascial trigger points (mTrPs) between groups. All patients with migraine presented with mTrPs in the trapezius muscles. T2 of the entire trapezius muscles was significantly higher in the migraine group when compared to controls (31.1 ± 0.8 ms vs. 30.1 ± 1.1 ms; p = 0.002). Conclusions Elevated T2 values of the trapezius muscles may indicate subtle inflammatory processes within musculature among patients with migraine because T2 increase is likely to stem from edematous changes. Future work may validate this finding in larger cohorts, but muscle T2 might have potential to develop into a viable in vivo biomarker for muscular affection in migraine.
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Affiliation(s)
- Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Paul Schandelmaier
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU - University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Dominik Weidlich
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Corinna Börner
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU - University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Giada Urban
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU - University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Magdalena Lang
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU - University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Mirjam N Landgraf
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU - University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Florian Heinen
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU - University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michaela V Bonfert
- Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU - University Hospital, Ludwig Maximilian University, Munich, Germany
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14
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Migraine-Related Disabilities Among Saudi Migraine Patients and Its Association with Social Factors. ARCHIVES OF NEUROSCIENCE 2021. [DOI: 10.5812/ans.108778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Migraine is a complex disorder triggered by an interaction of multiple abnormalities involving genes, blood vessels, and brain structures. It is characterized by throbbing headaches, mostly on one side of the head. It is one of the most common causes of disability, as announced by the Global Burden of the Diseases (GBD). Objectives: We aimed at assessing disabilities in Saudi migraine patients and addressing the relation between migraine-associated disabilities and social factors in Saudi Arabia. Methods: We conducted a web-based survey randomly through social media channels to the general population around Saudi Arabia. Basic personal information, along with a confirmation of the migraine diagnosis, were included in the first part of the questionnaire, and the respondent’s eligibility was determined to complete the survey. Specified questions about the sociodemographic characteristics, migraine attacks and medications, and the items of Migraine Disability Assessment score (MIDAS), were included in the next parts of the survey. Results: Of the 480 total responses, 250 (52.1%) eligible participants were included (mean age of 34.84 ± 10.14 years; 83.2% females). Most of the participants were married (59.6%), had three or more kids (50.7%), had a bachelor’s degree (60.8%), and 52.8% were employed. Only 16.4% of the subjects did regular exercise, and 16.8% were current smokers. No significant association was detected between the MIDAS score and most of the social characteristics, including marital status, number of kids, education level, occupation, and smocking. Conclusions: Most of the migraineurs in Saudi Arabia had a severe disability according to the MIDAS score. Gender, regular exercise, the severity of the disease, and frequency of attack had a statistically significant relationship with migraine-related disabilities. Migraine treatment and prophylaxis were incompetent in decreasing migraine severity and related disabilities in our selected participants.
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Mapping Assessments Instruments for Headache Disorders against the ICF Biopsychosocial Model of Health and Disability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010246. [PMID: 33396262 PMCID: PMC7795912 DOI: 10.3390/ijerph18010246] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/23/2020] [Accepted: 12/24/2020] [Indexed: 12/12/2022]
Abstract
Headache disorders have a strong impact on sufferers’ lives. However, the “content” of assessment instruments addressing concepts, such as disability and quality of life (QoL), has not comprehensively been addressed. We searched SCOPUS for research papers in which outcome measures were used in adult populations of patients with migraine, tension-type headache (TTH), and cluster headache (CH). The content of single instruments was then mapped against the International Classification of Functioning, Disability, and Health. A total of 150 papers and 26 instruments were included: 15 addressed disability or impact, two addressed work-related difficulties, and nine addressed QoL. Few instruments were commonly used across the conditions and covered domains of functioning were impact on daily life activities, homework, school, and work-related tasks, leisure time, informal and family relations, pain, emotional difficulties, energy level, and impulse control. Most of the research is based on instruments that were developed for migraine, which is critical for CH, and the impact of headache disorders on work-related activities is poorly acknowledged. Further research is needed to expand the scope of headaches impact on daily life activities, and on environmental factors relevant to headache disorders to raise knowledge on the less represented areas, e.g., TTH impact.
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16
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Parodi IC, Poeta MG, Assini A, Schirinzi E, Del Sette P. Impact of quarantine due to COVID infection on migraine: a survey in Genova, Italy. Neurol Sci 2020; 41:2025-2027. [PMID: 32613542 PMCID: PMC7329264 DOI: 10.1007/s10072-020-04543-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/21/2020] [Indexed: 12/19/2022]
Abstract
Quarantine is a well-known risk factor for psychological and psychiatric disturbances. We evaluated burden of migraine during lockdown due to COVID 19 pandemia. Forty-nine subjects followed in our headache clinic for migraine were evaluated for migraine burden by means of global assessment of migraine severity (GAMS) and visual analogue scale (VAS) by phone interview. Moreover, depression and anxiety were quantified by Beck depression inventory (BDI) and Zung Self-Rating Anxiety Scale (SAS). We evaluated changes in the value of migraine score from the 2 months immediately before lockdown (from January 1 to March 9) to the 2 months of quarantine (from March 10 to May 3). Value of GAMS was 5.61 ± 0.76 before and 4.16 ± 1.46 during quarantine (p < .001). VAS was 7.49 ± 1.10 before and 5.47 ± 1.88 during quarantine (p < .001). We also found a time by depression level interaction, F(1,47) = 6.21, p = .016, F(1,47) = 14.52, p < .006, respectively, showing that subjects with lower level of depression had better course of migraine. In conclusion, we showed that, during quarantine due to COVID pandemia, subjects with migraine had fewer migraine attacks and lesser pain and show moderate level of depression, correlated to migraine burden.
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Affiliation(s)
| | | | - Andrea Assini
- Neurology Unit, Galliera Hospital Genova, Genoa, Italy
| | - Erika Schirinzi
- Neurology Unit, Galliera Hospital Genova, Genoa, Italy.
- Neurological Clinic, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy.
| | - Paola Del Sette
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
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