Migraine and stress-an exploratory cross-country study of external stress factors

Psychological Resilience and Stress Coping Styles in Migraine Patients

PURPOSE

It was aimed to determine the level of psychological resilience and to investigate the psychological and clinical parameters that affect the resilience level in migraine patients.

PATIENTS AND METHODS

A total of 100 migraine patients and 100 healthy controls who agreed to participate in the study filled in the sociodemographic data form and also Beck Anxiety Scale, Beck Depression Scale, Psychological Resilience Scale for Adults, Perceived Stress Scale, Stress Coping Styles Scale, and Psychological Well-Being Scale. Also, the results of Migraine Disability Assessment Scale (MIDAS) were recorded in order to determine the clinical parameters of migraine patients.

RESULTS

When the migraine patients were examined in terms of the number of painful days in the last 3 months, duration of illness, and correlations between clinical scales, there were statistically significant correlations between the psychological resilience scale and well-being (r=0.691 p<0.001), positive coping styles (r=0.676 p<0.001), Beck depression scale (r=-0.670 p<0.001).

CONCLUSION

Self-confident approach, social support-seeking approach, and level of psychological well-being predict psychological resilience in migraine patients. Interventions aiming to increase the level of psychological resilience, which is negatively correlated with depression, are expected to increase the quality of life of patients with migraine.

Impact of comorbid psychogenic non-epileptic seizures on migraine: An observational study

Objectives

There is a bidirectional and complex interplay between psychiatric comorbidities and migraine. Migraine has been observed in 50-60% of patients with psychogenic non-epileptic seizures (PNES). Studies describe migraine as a medical comorbidity in PNES. However, there are limited studies on impact of PNES on migraine. We aim to see the impact of PNES on migraine.

Materials and Methods

This cross-sectional and observational study was conducted at a tertiary-care center from June 2017 to May 2019. Fifty-two patients with migraine with PNES and 48 patients with migraine without PNES were included on the study. Migraine and PNES were diagnosed based on International Classification of Headache Disorders-3 (ICHD-3) and International League Against Epilepsy (ILAE) criteria, respectively. Headache intensity was assessed using visual analog scale. Comorbid depression, anxiety, and somatoform-symptom-disease were assessed using the Generalized Anxiety Disorder-7 Scale, Patient Health Questionnaire-9, and DSM-5 criteria, respectively.

Results

Females were common in both groups and the difference was statistically insignificant. Headache frequency was significantly more in patients with migraine with PNES (P < 0.05). However, headache intensity was similar in both groups. Patients with headaches and PNES identified triggers less commonly except for stress. Depression and somatoform symptom disorder were significantly more common in patients with migraine with PNES. Abnormal neurocircuitry involving frontal, limbic, and thalamic regions due to comorbid PNES may cause central sensitization, resulting in frequent migraine headaches which is further augmented by coexisting depression and somatoform-symptom-disease.

Conclusion

Migraine with PNES patients suffers more frequent headaches than patients with migraine without PNES. They differ in various headache triggers, with mental stress being the predominant trigger.

The not so hidden impact of interictal burden in migraine: A narrative review

Migraine is a highly prevalent neurological disease of varying attack frequency. Headache attacks that are accompanied by a combination of impact on daily activities, photophobia and/or nausea are most commonly migraine. The headache phase of a migraine attack has attracted more research, assessment tools and treatment goals than any other feature, characteristic, or phase of migraine. However, the migraine attack may encompass up to 4 phases: the prodrome, aura, headache phase and postdrome. There is growing recognition that the burden of migraine, including symptoms associated with the headache phase of the attack, may persist between migraine attacks, sometimes referred to as the "interictal phase." These include allodynia, hypersensitivity, photophobia, phonophobia, osmophobia, visual/vestibular disturbances and motion sickness. Subtle interictal clinical manifestations and a patient's trepidation to make plans or commitments due to the unpredictability of migraine attacks may contribute to poorer quality of life. However, there are only a few tools available to assess the interictal burden. Herein, we examine the recent advances in the recognition, description, and assessment of the interictal burden of migraine. We also highlight the value in patients feeling comfortable discussing the symptoms and overall burden of migraine when discussing migraine treatment needs with their provider.