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O'Brien HL, Halker Singh RB. Breaking down barriers to care: Understanding migraine knowledge gaps among women's healthcare providers. Headache 2021; 61:7-8. [PMID: 33616914 DOI: 10.1111/head.14034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/04/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Hope L O'Brien
- Headache Center of Hope, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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2
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Orr SL, Gelfand AA, Hranilovich J, Irwin SL, Kabbouche M, Lagman-Bartolome AM, Lavell C, O'Brien HL, Rajapakse T, Rao R, Szperka C, Werner K, VanderPluym J, Yonker M, Hershey A. The Development of the Medical Transfer Packet for Transition of Care of the Pediatric Patient with Headache. Headache 2020; 60:2589-2591. [PMID: 32969505 DOI: 10.1111/head.13948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 07/27/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Serena L Orr
- Department of Pediatrics, Alberta Children's Hospital, Calgary, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Amy A Gelfand
- UCSF Child & Adolescent Headache Program, San Francisco, CA, USA
| | | | - Samantha L Irwin
- UCSF Child & Adolescent Headache Program, San Francisco, CA, USA
| | - Marielle Kabbouche
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Cheryl Lavell
- Mountain Consulting Pediatrics, Hamilton, ON, Canada
| | - Hope L O'Brien
- Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Thilinie Rajapakse
- Department of Pediatrics, Faculty of Medicine and Dentistry, Edmonton, AB, Canada.,Stollery Children's Hospital, Edmonton, AB, Canada.,Women and Children's Research Institute, Edmonton, AB, Canada
| | - Rashmi Rao
- Louisiana State University Health Sciences Center and Children's Hospital New Orleans, New Orleans, LA, USA
| | - Christina Szperka
- Pediatric Headache Program, Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Klaus Werner
- Division of Pediatric Neurology, Duke University Medical Center, Durham, NC, USA
| | | | - Marcy Yonker
- Department of Pediatrics, Division of Child Neurology, Children's Hospital Colorado, University of Colorado, CO, USA
| | - Andrew Hershey
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Borrero‐Mejias C, Starling AJ, Burch R, Loder E, Armand C, Begasse de Dhaem O, Broner S, Buse DC, Candee MS, Chehrenama M, Dougherty C, Duvall JR, Gautreaux J, Gokani T, Singh RH, Issa S, Jion YI, Krel R, Kriegler J, Kuruvilla D, Leroux E, Metzler A, Minen M, Monteith TS, Nahas S, Nye B, O'Brien HL, Orlova Y, Pace A, Padilla JM, Pham A, Rastogi RG, Rayhill M, Robblee J, Schusse C, Simms G, Vgontzas A, Vollbracht SE, Werely JC, Wrobel Goldberg S. Ten Eleven Things Not to Say to Your Female Colleagues. Headache 2019; 59:1846-1854. [DOI: 10.1111/head.13647] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Clarimar Borrero‐Mejias
- Department of Neurology Barrow Neurological Institute at Phoenix Children's Hospital Phoenix AZ USA
| | | | - Rebecca Burch
- Department of Neurology Brigham and Women's Hospital Harvard Medical School Boston MA USA
| | - Elizabeth Loder
- Division of Headache Department of Neurology Brigham and Women's Hospital Harvard Medical School Boston MA USA
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Charleston L, Royce J, Monteith TS, Broner SW, O'Brien HL, Manrriquez SL, Robbins MS. Migraine Care Challenges and Strategies in US Uninsured and Underinsured Adults: A Narrative Review, Part 2. Headache 2019; 58:633-647. [PMID: 29878343 DOI: 10.1111/head.13321] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/21/2018] [Accepted: 02/22/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To review the challenges and potential solutions in treatment options for quality migraine care in adult patients who are under or uninsured. BACKGROUND The Affordable Care Act has improved access to health care for many; however, those who are underserved continue to face treatment disparities and have inadequate access to appropriate migraine management. METHODS This manuscript is the second of a 2-part narrative review which was performed after a series of discussions within the Underserved Populations in Headache Medicine Special Interest Section meetings of the American Headache Society. Literature was reviewed for key concepts underpinning conceptual boundaries and a broad overview of the subject matter. Published guidelines, state-specific Medicaid websites, headache quality measurement sets, literature review, and expert opinion were used to tailor suggested treatment options and therapeutic strategies. In this second part of our narrative review, we explored migraine care strategies and considerations for underserved and vulnerable adult populations with migraine. RESULTS Although common, migraine remains untreated, particularly among those of low socioeconomic status. Low socioeconomic status may play an important role in the disease progression, prescription of hazardous medications such as opioids, outcomes, and quality of life of patients with migraine and other headache disorders. There are some evidence-based and guideline supported treatment options available at low cost that include prescription medications and supplements, though approved devices are costly. Resources available online and simple nonpharmacological strategies may be particularly useful in the underserved migraine population. CONCLUSIONS We identified and discussed migraine treatment barriers that affect underserved populations in the US and summarized practical, cost-effective strategies to surmount them. However, more research is needed to identify the best cost-effective measures for migraine management in underserved and vulnerable patients who are uninsured or underinsured.
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Affiliation(s)
- Larry Charleston
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Jeffrey Royce
- Neuro and Headache Center, SwedishAmerican Hospital, Rockford, IL, USA
| | - Teshamae S Monteith
- Department of Neurology-Headache Division, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Susan W Broner
- Weill Cornell Medicine Headache Program, Department of Neurology, Weill Cornell Medical College, New York, NY, USA
| | - Hope L O'Brien
- Division of Neurology, Cincinnati Children's Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Salvador L Manrriquez
- Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Matthew S Robbins
- Department of Neurology, Albert Einstein College of Medicine, Montefiore Headache Center, Bronx, NY, USA
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5
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Orr SL, Turner A, Kabbouche MA, Horn PS, O'Brien HL, Kacperski J, LeCates S, White S, Weberding J, Miller MN, Powers SW, Hershey AD. Predictors of Short-Term Prognosis While in Pediatric Headache Care: An Observational Study. Headache 2019; 59:543-555. [PMID: 30671933 DOI: 10.1111/head.13477] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To characterize the short-term prognosis of a clinical population of pediatric and young adult patients with migraine and explore predictors of clinical worsening while in care. METHODS This was a retrospective study of all migraine patients seen at the Cincinnati Children's Hospital Headache Center from 09/01/2006 to 12/31/2017, who had at least 1 follow-up visit within 1-3 months of the index visit analyzed. Included data were: age, sex, race, primary ICHD diagnosis, chronic migraine, medication overuse, history of status migrainosus, BMI percentile, headache frequency, headache severity, PedMIDAS score, allodynia, preventive treatment type, lifestyle habits, disease duration, depressive and anxiety symptoms. Clinical worsening was defined as an increase in 4 or more headache days per month between the index visit and the follow-up visit. RESULTS Data for 13,160 visit pairs (index and follow-up), from 5316 patients, were analyzed. Clinical worsening occurred in only 14.5% (1908/13,160), whereas a reduction in headache frequency was observed in 56.8% of visit intervals (7475/13,160), with 34.8% of the intervals (4580/13,160) showing a reduction of 50% or greater. The change in headache frequency was minimal (increase in 0-3 headaches/month) in 28.7% of intervals (3737/13,160). In the multivariable model, the odds of worsening were significantly higher with increasing age, female sex, chronic migraine, status migrainosus, depressive symptoms, higher PedMIDAS scores, and use of nutraceuticals, whereas the odds of worsening were lower for summer visits, caffeine drinkers, higher headache frequencies, and use of pharmaceuticals. CONCLUSIONS The majority of pediatric patients who receive multimodal interdisciplinary care for migraine improve over time. Our findings highlight a set of clinical features that may help in identifying specific factors that may contribute to an unfavorable short-term prognosis.
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Affiliation(s)
- Serena L Orr
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Abigail Turner
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Marielle A Kabbouche
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Paul S Horn
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Hope L O'Brien
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Joanne Kacperski
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Susan LeCates
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shannon White
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jessica Weberding
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Mimi N Miller
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Scott W Powers
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Andrew D Hershey
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Orr SL, Kabbouche MA, Horn PS, O'Brien HL, Kacperski J, LeCates S, White S, Weberding J, Miller MN, Powers SW, Hershey AD. Predictors of First-Line Treatment Success in Children and Adolescents Visiting an Infusion Center for Acute Migraine. Headache 2018; 58:1194-1202. [DOI: 10.1111/head.13340] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Serena L. Orr
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Marielle A. Kabbouche
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Paul S. Horn
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Hope L. O'Brien
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Joanne Kacperski
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Susan LeCates
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Shannon White
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Jessica Weberding
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Mimi N. Miller
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Scott W. Powers
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Andrew D. Hershey
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
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Ramsey RR, Holbein CE, Powers SW, Hershey AD, Kabbouche MA, O'Brien HL, Kacperski J, Shepard J, Hommel KA. A pilot investigation of a mobile phone application and progressive reminder system to improve adherence to daily prevention treatment in adolescents and young adults with migraine. Cephalalgia 2018; 38:2035-2044. [PMID: 29635937 DOI: 10.1177/0333102418756864] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Effective management of migraine requires adherence to treatment recommendations; however, adolescents with migraine take their daily medications only 75% of the time. Low-cost adherence-focused interventions using technology may improve adherence, but have not been investigated. METHODS Thirty-five adolescents and young adults (13-21 years) with migraine participated in an AB-design pilot study to assess the use of a mobile phone adherence-promotion application ("app") and progressive reminder system. Adherence was calculated using electronic monitoring during the baseline period and medication adherence intervention. RESULTS Relative to baseline, adherence significantly improved during the first month of the intervention. Specifically, improvements existed for older participants with lower baseline adherence. Self-reported app-based adherence rates were significantly lower than electronically monitored adherence rates. Participants rated the intervention as acceptable and easy to use. CONCLUSIONS "Apps" have the potential to improve medication adherence and are a promising intervention for adolescents and young adults with low adherence. Involving parents in the intervention is also helpful. Providers should assess barriers to adherence and use of technology-based interventions, encourage parents to incorporate behavioral incentives, and provide referrals for more intensive interventions to improve long-term outcomes. Further, tracking adherence in an app may result in an underestimation of adherence. Future full-scale studies should be conducted to examine adherence promotion app interventions.
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Affiliation(s)
- Rachelle R Ramsey
- 1 Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,2 Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Christina E Holbein
- 1 Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Scott W Powers
- 1 Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,2 Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,3 Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Andrew D Hershey
- 2 Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,3 Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,4 Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Marielle A Kabbouche
- 2 Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,3 Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,4 Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Hope L O'Brien
- 2 Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,3 Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,4 Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Joanne Kacperski
- 2 Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,3 Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,4 Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Kevin A Hommel
- 1 Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,2 Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Charleston L, Royce J, Monteith TS, Broner SW, O'Brien HL, Manrriquez SL, Robbins MS. Migraine Care Challenges and Strategies in US Uninsured and Underinsured Adults: A Narrative Review, Part 1. Headache 2018. [DOI: 10.1111/head.13286] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Larry Charleston
- Department of Neurology; University of Michigan; Ann Arbor MI USA
| | - Jeffrey Royce
- Neuro and Headache Center, SwedishAmerican Hospital; Rockford IL USA
| | - Teshamae S. Monteith
- Headache Division, Department of Neurology; University of Miami, Miller School of Medicine; Miami FL USA
| | - Susan W. Broner
- Weill Cornell Medicine Headache Program, Department of Neurology, Weill Cornell Medical College; New York NY USA
| | - Hope L. O'Brien
- Division of Neurology; Cincinnati Children's Medical Center, University of Cincinnati College of Medicine; Cincinnati OH USA
| | - Salvador L. Manrriquez
- Herman Ostrow School of Dentistry; University of Southern California; Los Angeles CA USA
| | - Matthew S. Robbins
- Department of Neurology, Albert Einstein College of Medicine; Montefiore Headache Center; Bronx NY USA
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Kroon Van Diest AM, Ramsey RR, Kashikar-Zuck S, Slater S, Hommel K, Kroner JW, LeCates S, Kabbouche MA, O'Brien HL, Kacperski J, Allen JR, Peugh J, Hershey AD, Powers SW. Treatment Adherence in Child and Adolescent Chronic Migraine Patients: Results From the Cognitive-Behavioral Therapy and Amitriptyline Trial. Clin J Pain 2017; 33:892-898. [PMID: 28118256 PMCID: PMC5522369 DOI: 10.1097/ajp.0000000000000481] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To examine treatment adherence among children and adolescents with chronic migraine who volunteered to be in a clinical trial using 3 measures: treatment session attendance, therapy homework completion, and preventive medication use by daily diary. MATERIALS AND METHODS Analyses are secondary from a trial of 135 youth aged 10 to 17 years diagnosed with chronic migraine and with a Pediatric Migraine Disability Score over 20. Participants were randomly assigned to cognitive-behavioral therapy plus amitriptyline (CBT+A, N=64) or headache education plus amitriptyline (HE+A, N=71). Therapists recorded session attendance. Completion of homework/practice between sessions was reported to therapists by patients. Patients reported preventive medication adherence using a daily headache diary. RESULTS Mean session attendance adherence out of 10 treatment sessions was 95% for CBT+A and 99% for HE+A. CBT+A participants reported completing a mean of 90% of home practice of CBT skills between the 10 sessions. Participants reported taking amitriptyline daily at a mean level of 90% when missing diaries were excluded and 79% when missing diaries were considered as missed doses of medication. DISCUSSION Our findings demonstrate that youth with chronic migraine who agree to be a part of a clinical trial do quite well at attending therapy sessions, and report that they are adherent to completing home/practice between sessions and taking medication. These results lend further support to consideration of CBT+A as a first-line treatment for youth with chronic migraine and suggest that measurement of adherence when this treatment is provided in practice will be important.
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Affiliation(s)
- Ashley M Kroon Van Diest
- Divisions of *Behavioral Medicine and Clinical Psychology §Neurology ‡Headache Center, Cincinnati Children's Hospital Medical Center †Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
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10
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Kroner JW, Peugh J, Kashikar-Zuck SM, LeCates SL, Allen JR, Slater SK, Zafar M, Kabbouche MA, O'Brien HL, Shenk CE, Kroon Van Diest AM, Hershey AD, Powers SW. Trajectory of Improvement in Children and Adolescents With Chronic Migraine: Results From the Cognitive-Behavioral Therapy and Amitriptyline Trial. J Pain 2017; 18:637-644. [PMID: 28108386 DOI: 10.1016/j.jpain.2017.01.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 11/07/2016] [Accepted: 01/04/2017] [Indexed: 02/06/2023]
Abstract
We compared headache frequency trajectories between clinical trial participants who received cognitive-behavioral therapy (CBT) and amitriptyline (CBT+A) or headache education (HE) and amitriptyline (HE+A) to determine if there was a differential time course of treatment response between the groups. One hundred thirty-five patients (age 10-17 years) diagnosed with chronic migraine participated, attending 8 one-hour one-on-one CBT or HE sessions with a trained psychologist for 8 weekly sessions, 2 sessions at weeks 12 and 16, and a post-treatment visit at week 20. Participants kept daily headache diaries and completed take-home assignments between visits. Data from daily headache diaries are presented for each day and according to 28-day periods. Trajectories of improvement indicate initial decrease in headache days began during the first month of treatment, for both groups, and continued to decrease throughout treatment. The CBT+A group had greater daily improvement than the HE+A group. A significantly greater proportion of the CBT+A group had a ≥50% reduction in headache days each month, and a significantly greater proportion of the CBT+A group had ≤4 headache days per month in months 3 through 5. Results indicate the trajectory of decrease in headache days is significantly better for patients receiving CBT+A versus HE+A. PERSPECTIVE This article presents daily information about headache frequency over a 20-week clinical trial. Youth with chronic migraine who received CBT+A improved faster than those in the control group. Findings provide clinicians with evidence-based expectations for treatment response over time and ways of monitoring treatment success. TRIAL REGISTRATION clinicaltrials.gov identifier NCT00389038.
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Affiliation(s)
- John W Kroner
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - James Peugh
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Susmita M Kashikar-Zuck
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Susan L LeCates
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Janelle R Allen
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Shalonda K Slater
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Marium Zafar
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Marielle A Kabbouche
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Hope L O'Brien
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Chad E Shenk
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ashley M Kroon Van Diest
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Andrew D Hershey
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Scott W Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
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11
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Leiken KA, Xiang J, Curry E, Fujiwara H, Rose DF, Allen JR, Kacperski JE, O'Brien HL, Kabbouche MA, Powers SW, Hershey AD. Quantitative neuromagnetic signatures of aberrant cortical excitability in pediatric chronic migraine. J Headache Pain 2016; 17:46. [PMID: 27113076 PMCID: PMC4844586 DOI: 10.1186/s10194-016-0641-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 04/15/2016] [Indexed: 11/24/2022] Open
Abstract
Background Reports have suggested that abnormal cortical excitability may be associated with acute migraines. The present study quantitatively assesses the degree of cortical excitability in chronic migraine as compared to acute migraine and healthy controls within the pediatric population. Methods We investigated 27 children suffering from chronic migraine, 27 children suffering from acute migraine, and 27 healthy controls using a magnetoencephalography (MEG) system, recording at a sampling rate of 6000 Hz. All groups were age-matched and gender-matched. Neuromagnetic brain activation was elicited by a finger-tapping motor task. The spatiotemporal and spectral signatures of MEG data within a 5–2884 Hz range were analyzed using Morlet wavelet transform and beamformer analyses. Results Compared with controls, the chronic migraine group showed (1) significantly prolonged latencies of movement-elicited magnetic fields (MEFs) between 5 and 100 Hz; (2) increased spectral power between 100 and 200 Hz, and between 2200 and 2800 Hz; and (3) a higher likelihood of neuromagnetic activation in the ipsilateral sensorimotor cortices, supplementary motor area, and occipital regions. Compared with acute migraine group, chronic migraine patients showed (1) significantly higher odds of having strong MEFs after 150 ms; and (2) significantly higher odds of having neuromagnetic activation from the deep brain areas. Conclusions Results demonstrated that chronic migraine subjects were not only different from the healthy controls, but also different from acute migraine subjects. The chronification of migraines may be associated with elevated cortical excitability, delayed and spread neural response, as well as aberrant activation from deep brain areas.
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Affiliation(s)
- Kimberly A Leiken
- Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2015, Cincinnati, OH, 45220, USA.
| | - Jing Xiang
- Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2015, Cincinnati, OH, 45220, USA.,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - Emily Curry
- Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2015, Cincinnati, OH, 45220, USA
| | - Hisako Fujiwara
- Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2015, Cincinnati, OH, 45220, USA
| | - Douglas F Rose
- Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2015, Cincinnati, OH, 45220, USA.,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - Janelle R Allen
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Joanne E Kacperski
- Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2015, Cincinnati, OH, 45220, USA.,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - Hope L O'Brien
- Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2015, Cincinnati, OH, 45220, USA.,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - Marielle A Kabbouche
- Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2015, Cincinnati, OH, 45220, USA.,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - Scott W Powers
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Andrew D Hershey
- Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2015, Cincinnati, OH, 45220, USA.,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
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Kroner JW, Hershey AD, Kashikar-Zuck SM, LeCates SL, Allen JR, Slater SK, Zafar M, Kabbouche MA, O'Brien HL, Shenk CE, Rausch JR, Kroon Van Diest AM, Powers SW. Cognitive Behavioral Therapy plus Amitriptyline for Children and Adolescents with Chronic Migraine Reduces Headache Days to ≤4 Per Month. Headache 2016; 56:711-6. [PMID: 26992129 DOI: 10.1111/head.12795] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this secondary analysis of results from a previously published trial (Clinical Trials Registration Number: NCT00389038) in chronic migraine in children and adolescents was to examine if participants who received cognitive behavioral therapy and amitriptyline reached a greater level of reduction in headache frequency that no longer indicated a recommendation for preventive treatment as compared to those who received headache education and amitriptyline. BACKGROUND Chronic migraine negatively affects children's home, school, and social activities. Preventive medication therapy is suggested for 5 or more headaches per month. Reduction to one headache day per week or less may suggest that preventive treatment is no longer indicated and provide a clinically relevant outcome for treatment efficacy and patient care. METHODS Randomized study participants (N = 135) kept a daily record of their headache frequency during 20 weeks of treatment and during a 1 year follow-up period. Baseline headache frequency was determined at the end of a 28 day screening period. Post treatment frequency was determined at 20 weeks (N = 128 completed) and post treatment follow-up was measured 12 months later (N = 124 completed). A chi-square test of independence was conducted by treatment group and by time point to determine group differences in the proportion of headache days experienced. RESULTS At 20 weeks (post treatment), 47% of the cognitive behavioral therapy plus amitriptyline group had ≤4 headache days per month compared to 20% of the headache education plus amitriptyline group, (P = .0011), and 32% of the cognitive behavioral therapy plus amitriptyline group had ≤3 headache days per month at 20 weeks compared to 16% of the headache education plus amitriptyline group, (P = .0304). At the month 12 follow-up, 72% of the cognitive behavioral therapy plus amitriptyline group had ≤4 headache days per month compared to 52% of the headache education plus amitriptyline group, (P = .0249), and 61% of the cognitive behavioral therapy plus amitriptyline group had ≤3 headache days per month at their month 12 follow-up compared to 40% of the headache education plus amitriptyline group, (P = .0192). CONCLUSIONS Participants who received cognitive behavioral therapy and amitriptyline were more likely than participants who received headache education plus amitriptyline to reach the clinically meaningful outcome of less than or equal to 4 headache days per month at both time points. These results may help inform what treatment outcomes are possible for children and adolescents suffering from chronic migraine and provides further evidence for behavioral treatment to be considered as a key part of a first line treatment regimen.
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Affiliation(s)
- John W Kroner
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Andrew D Hershey
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Headache Center, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Susmita M Kashikar-Zuck
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Susan L LeCates
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Headache Center, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Janelle R Allen
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Headache Center, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shalonda K Slater
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Marium Zafar
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Marielle A Kabbouche
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Headache Center, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Hope L O'Brien
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Chad E Shenk
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Joseph R Rausch
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ashley M Kroon Van Diest
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Scott W Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Headache Center, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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13
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Xiang J, Leiken K, Degrauw X, Kay B, Fujiwara H, Rose DF, Allen JR, Kacperski JE, O'Brien HL, Kabbouche MA, Powers SW, Hershey AD. Spatial Heterogeneity of Cortical Excitability in Migraine Revealed by Multifrequency Neuromagnetic Signals. J Pain 2016; 17:694-706. [PMID: 26970516 DOI: 10.1016/j.jpain.2016.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 12/23/2015] [Accepted: 02/11/2016] [Indexed: 01/03/2023]
Abstract
UNLABELLED To investigate the spatial heterogeneity of cortical excitability in adolescents with migraine, magnetoencephalography (MEG) recordings at a sampling rate of 6,000 Hz were obtained from 35 adolescents with an acute migraine and 35 age- and sex-matched healthy control participants during an auditory-motor task. Neuromagnetic activation from low- to high-frequency ranges (5-1,000 Hz) was measured at sensor and source levels. The heterogeneity of cortical excitability was quantified within each functional modality (auditory vs motor) and hemispherical lateralization. MEG data showed that high-frequency, not low-frequency neuromagnetic signals, showed heterogeneous cortical activation in migraine subjects compared with control participants (P < .001). The alteration of the heterogeneity of cortical excitability in migraine subjects was independent of age and sex. The degree of the neuromagnetic heterogeneity of cortical activation was significantly correlated with headache frequency (r = .71, P < .005). The alteration of cortical excitability in migraine subjects was spatially heterogeneous and frequency dependent, which previously has not been reported. The finding may be critical for developing spatially targeted therapeutic strategies for normalizing cortical excitability with the purpose of reducing headache attacks. PERSPECTIVE This article presents a new approach to quantitatively measure the spatial heterogeneity of cortical excitability in adolescents with migraine using MEG signals in a frequency range of 5 to 1,000 Hz. The characteristics of the location and degree of cortical excitability may be critical for spatially targeted treatment for migraine.
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Affiliation(s)
- Jing Xiang
- MEG Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio.
| | - Kimberly Leiken
- MEG Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Xinyao Degrauw
- MEG Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Benjamin Kay
- MEG Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Hisako Fujiwara
- MEG Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Douglas F Rose
- MEG Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Janelle R Allen
- MEG Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Joanne E Kacperski
- MEG Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Hope L O'Brien
- MEG Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Marielle A Kabbouche
- MEG Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Scott W Powers
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio; MEG Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Andrew D Hershey
- MEG Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
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14
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Ernst MM, O'Brien HL, Powers SW. Cognitive-Behavioral Therapy: How Medical Providers Can Increase Patient and Family Openness and Access to Evidence-Based Multimodal Therapy for Pediatric Migraine. Headache 2015; 55:1382-96. [PMID: 26198185 PMCID: PMC4715506 DOI: 10.1111/head.12605] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2015] [Indexed: 01/09/2023]
Abstract
Although evidence supports the recommendation for cognitive-behavioral therapy (CBT) for pediatric migraine, few children actually receive this evidence-based intervention. In this article, we briefly review the most recent empirical evidence supporting CBT. We then identify both provider- and system-related barriers as well as patient-related barriers. Finally, we provide practical solutions to addressing these barriers in the service of facilitating children receiving optimal comprehensive management of their headaches.
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Affiliation(s)
- Michelle M Ernst
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Hope L O'Brien
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Scott W Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Headache Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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15
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Affiliation(s)
- Hope L. O'Brien
- Department of Pediatrics, Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
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16
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Cobb-Pitstick KM, Hershey AD, O'Brien HL, Kabbouche MA, LeCates S, White S, Vaughn P, Manning P, Segers A, Bush J, Horn PS, Kacperski J. Factors Influencing Migraine Recurrence After Infusion and Inpatient Migraine Treatment in Children and Adolescents. Headache 2015; 55:1397-403. [DOI: 10.1111/head.12654] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2015] [Indexed: 11/29/2022]
Affiliation(s)
| | - Andrew D. Hershey
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Hope L. O'Brien
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Marielle A. Kabbouche
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Susan LeCates
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Shannon White
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Polly Vaughn
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Paula Manning
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Ann Segers
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Judith Bush
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Paul S. Horn
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
- Division of Biostatistics and Epidemiology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Joanne Kacperski
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
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Abstract
OPINION STATEMENT The diagnosis of migraine in the pediatric population is increasing as providers are becoming more familiar with recognizing the condition. Over-the-counter and migraine-specific treatment, once considered off-label, have proven to be effective, especially if given at the early onset of head pain. Mild to severe cases of migraine should be treated with nonsteroidal anti-inflammatory drugs (NSAIDs), with triptans used alone or in combination in moderate to severe headaches unresponsive to over-the-counter therapy. Rescue medication including dihydroergotamine (DHE), a potent vasoconstrictor should be used for intractable migraines and is preferred in the hospital setting. Anti-emetics that have anti-dopaminergic properties can be helpful in patients with associated symptoms of nausea and vomiting along with headache, especially when used in combination therapy. Preventative treatment should be initiated early in patients with frequent headaches to improve headache outcomes and quality of life. Patients and families should be educated on non-pharmacologic management, such as lifestyle modification and avoidance of triggers, that can prevent progression and worsening of migraine.
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Affiliation(s)
- Hope L O'Brien
- Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, OH, 45229, USA,
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18
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Xiang J, deGrauw X, Korman AM, Allen JR, O'Brien HL, Kabbouche MA, Powers SW, Hershey AD. Neuromagnetic abnormality of motor cortical activation and phases of headache attacks in childhood migraine. PLoS One 2013; 8:e83669. [PMID: 24386250 PMCID: PMC3873943 DOI: 10.1371/journal.pone.0083669] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 11/06/2013] [Indexed: 11/18/2022] Open
Abstract
The cerebral cortex serves a primary role in the pathogenesis of migraine. This aberrant brain activation in migraine can be noninvasively detected with magnetoencephalography (MEG). The objective of this study was to investigate the differences in motor cortical activation between attacks (ictal) and pain free intervals (interictal) in children and adolescents with migraine using both low- and high-frequency neuromagnetic signals. Thirty subjects with an acute migraine and 30 subjects with a history of migraine, while pain free, were compared to age- and gender-matched controls using MEG. Motor cortical activation was elicited by a standardized, validated finger-tapping task. Low-frequency brain activation (1∼50 Hz) was analyzed with waveform measurements and high-frequency oscillations (65–150 Hz) were analyzed with wavelet-based beamforming. MEG waveforms showed that the ictal latency of low-frequency brain activation was significantly delayed as compared with controls, while the interictal latency of brain activation was similar to that of controls. The ictal amplitude of low-frequency brain activation was significantly increased as compared with controls, while the interictal amplitude of brain activation was similar to that of controls. The ictal source power of high-frequency oscillations was significantly stronger than that of the controls, while the interictal source power of high-frequency oscillations was significantly weaker than that of controls. The results suggest that aberrant low-frequency brain activation in migraine during a headache attack returned to normal interictally. However, high-frequency oscillations changed from ictal hyper-activation to interictal hypo-activation. Noninvasive assessment of cortical abnormality in migraine with MEG opens a new window for developing novel therapeutic strategies for childhood migraine by maintaining a balanced cortical excitability.
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Affiliation(s)
- Jing Xiang
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, United States of America
- * E-mail:
| | - Xinyao deGrauw
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Abraham M. Korman
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Janelle R. Allen
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Hope L. O'Brien
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, United States of America
| | - Marielle A. Kabbouche
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, United States of America
| | - Scott W. Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Andrew D. Hershey
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, United States of America
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Powers SW, Kashikar-Zuck SM, Allen JR, LeCates SL, Slater SK, Zafar M, Kabbouche MA, O'Brien HL, Shenk CE, Rausch JR, Hershey AD. Cognitive behavioral therapy plus amitriptyline for chronic migraine in children and adolescents: a randomized clinical trial. JAMA 2013; 310:2622-30. [PMID: 24368463 PMCID: PMC4865682 DOI: 10.1001/jama.2013.282533] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
IMPORTANCE Early, safe, effective, and durable evidence-based interventions for children and adolescents with chronic migraine do not exist. OBJECTIVE To determine the benefits of cognitive behavioral therapy (CBT) when combined with amitriptyline vs headache education plus amitriptyline. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial of 135 youth (79% female) aged 10 to 17 years diagnosed with chronic migraine (≥15 days with headache/month) and a Pediatric Migraine Disability Assessment Score (PedMIDAS) greater than 20 points were assigned to the CBT plus amitriptyline group (n = 64) or the headache education plus amitriptyline group (n = 71). The study was conducted in the Headache Center at Cincinnati Children's Hospital between October 2006 and September 2012; 129 completed 20-week follow-up and 124 completed 12-month follow-up. INTERVENTIONS Ten CBT vs 10 headache education sessions involving equivalent time and therapist attention. Each group received 1 mg/kg/d of amitriptyline and a 20-week end point visit. In addition, follow-up visits were conducted at 3, 6, 9, and 12 months. MAIN OUTCOMES AND MEASURES The primary end point was days with headache and the secondary end point was PedMIDAS (disability score range: 0-240 points; 0-10 for little to none, 11-30 for mild, 31-50 for moderate, >50 for severe); both end points were determined at 20 weeks. Durability was examined over the 12-month follow-up period. Clinical significance was measured by a 50% or greater reduction in days with headache and a disability score in the mild to none range (<20 points). RESULTS At baseline, there were a mean (SD) of 21 (5) days with headache per 28 days and the mean (SD) PedMIDAS was 68 (32) points. At the 20-week end point, days with headache were reduced by 11.5 for the CBT plus amitriptyline group vs 6.8 for the headache education plus amitriptyline group (difference, 4.7 [95% CI, 1.7-7.7] days; P = .002). The PedMIDAS decreased by 52.7 points for the CBT group vs 38.6 points for the headache education group (difference, 14.1 [95% CI, 3.3-24.9] points; P = .01). In the CBT group, 66% had a 50% or greater reduction in headache days vs 36% in the headache education group (odds ratio, 3.5 [95% CI, 1.7-7.2]; P < .001). At 12-month follow-up, 86% of the CBT group had a 50% or greater reduction in headache days vs 69% of the headache education group; 88% of the CBT group had a PedMIDAS of less than 20 points vs 76% of the headache education group. Measured treatment credibility and integrity was high for both groups. CONCLUSIONS AND RELEVANCE Among young persons with chronic migraine, the use of CBT plus amitriptyline resulted in greater reductions in days with headache and migraine-related disability compared with use of headache education plus amitriptyline. These findings support the efficacy of CBT in the treatment of chronic migraine in children and adolescents. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00389038.
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Affiliation(s)
- Scott W Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio3Headache Center, Cincinnati Children's Hospital Medical Center4Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Susmita M Kashikar-Zuck
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio4Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Janelle R Allen
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio3Headache Center, Cincinnati Children's Hospital Medical Center
| | - Susan L LeCates
- Division of Neurology, Cincinnati Children's Hospital Medical Center3Headache Center, Cincinnati Children's Hospital Medical Center
| | - Shalonda K Slater
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio3Headache Center, Cincinnati Children's Hospital Medical Center4Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Marium Zafar
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Marielle A Kabbouche
- Division of Neurology, Cincinnati Children's Hospital Medical Center3Headache Center, Cincinnati Children's Hospital Medical Center4Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Hope L O'Brien
- Division of Neurology, Cincinnati Children's Hospital Medical Center3Headache Center, Cincinnati Children's Hospital Medical Center4Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Chad E Shenk
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio4Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Joseph R Rausch
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio4Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Andrew D Hershey
- Division of Neurology, Cincinnati Children's Hospital Medical Center3Headache Center, Cincinnati Children's Hospital Medical Center4Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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20
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Xiang J, deGrauw X, Korostenskaja M, Korman AM, O'Brien HL, Kabbouche MA, Powers SW, Hershey AD. Altered cortical activation in adolescents with acute migraine: a magnetoencephalography study. J Pain 2013; 14:1553-63. [PMID: 23792072 DOI: 10.1016/j.jpain.2013.04.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 04/08/2013] [Accepted: 04/16/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED To quantitatively assess cortical dysfunction in pediatric migraine, 31 adolescents with acute migraine and age- and gender-matched controls were studied using a magnetoencephalography (MEG) system at a sampling rate of 6,000 Hz. Neuromagnetic brain activation was elicited by a finger-tapping task. The spectral and spatial signatures of magnetoencephalography data in 5 to 2,884 Hz were analyzed using Morlet wavelet and beamformers. Compared with controls, 31 migraine subjects during their headache attack phases (ictal) showed significantly prolonged latencies of neuromagnetic activation in 5 to 30 Hz, increased spectral power in 100 to 200 Hz, and a higher likelihood of neuromagnetic activation in the supplementary motor area, the occipital and ipsilateral sensorimotor cortices, in 2,200 to 2,800 Hz. Of the 31 migraine subjects, 16 migraine subjects during their headache-free phases (interictal) showed that there were no significant differences between interictal and control MEG data except that interictal spectral power in 100 to 200 Hz was significantly decreased. The results demonstrated that migraine subjects had significantly aberrant ictal brain activation, which can normalize interictally. The spread of abnormal ictal brain activation in both low- and high-frequency ranges triggered by movements may play a key role in the cascade of migraine attacks. PERSPECTIVE This is the first study focusing on the spectral and spatial signatures of cortical dysfunction in adolescents with migraine using MEG signals in a frequency range of 5 to 2,884 Hz. This methodology analyzing aberrant brain activation may be important for developing new therapeutic interventions for migraine in the future.
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Affiliation(s)
- Jing Xiang
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Neurology, University of Cincinnati, College of Medicine, Cincinnati, Ohio.
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21
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Slater SK, Kashikar-Zuck SM, Allen JR, LeCates SL, Kabbouche MA, O'Brien HL, Hershey AD, Powers SW. Psychiatric comorbidity in pediatric chronic daily headache. Cephalalgia 2012; 32:1116-22. [PMID: 22990686 DOI: 10.1177/0333102412460776] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The objectives of this study were to assess comorbid psychiatric diagnoses in youth with chronic daily headache (CDH) and to examine relationships between psychiatric status and CDH symptom severity, as well as headache-related disability. METHODS Standardized psychiatric interviews (Kiddie Schedule for Affective Disorders and Schizophrenia, KSADS) were conducted with 169 youth ages 10-17 diagnosed with CDH. Participants provided prospective reports of headache frequency with a daily headache diary and completed measures of symptom severity, headache-related disability (PedMIDAS) and quality of life (PedsQL). RESULTS Results showed that 29.6% of CDH patients met criteria for at least one current psychiatric diagnosis, and 34.9% met criteria for at least one lifetime psychiatric diagnosis. No significant relationship between psychiatric status and headache frequency, duration, or severity was found. However, children with at least one lifetime psychiatric diagnosis had greater functional disability and poorer quality of life than those without a psychiatric diagnosis. DISCUSSION Contrary to research in adults with chronic headaches, most youth with CDH did not appear to be at an elevated risk for comorbid psychiatric diagnosis. However, patients with a comorbid psychiatric diagnosis were found to have higher levels of headache-related disability and poorer quality of life. Implications for treatment are discussed.
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Affiliation(s)
- Shalonda K Slater
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, USA.
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22
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Abstract
INTRODUCTION Headaches are common in children and adolescents and migraine affects almost 8% of this population. As revisions are made to the ICHD-II criteria to include additional characteristics of pediatric migraine, the diagnosis of migraine is expected to increase. Therefore, it is important to understand and apply successful treatment in acute migraine. Patients and families should be educated about the options for migraine treatment that includes both pharmacologic and conservative behavioral techniques in managing headaches. AREAS COVERED This review examines the studies that have been performed in pediatric patients, in addition to exploring the treatment options commonly used in pediatrics and adolescents for migraine and their rationale for use. EXPERT OPINION For the acute treatment of migraine, we recommend the use of ibuprofen or acetaminophen for mild, moderate or severe headache. For moderate to severe headache, or for headaches that fail to respond to over-the-counter medications, we recommend the use of a triptan or combination NSAID/triptan therapy. For preventative treament of migraine, cyproheptadine should be reserved for younger children unable to swallow tablets while amitriptyline is preferred due to its once daily dosing and minimal side effects. Topiramate and divalproate are considerable options depending on patient co-morbid profile and preference.
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Affiliation(s)
- Hope L O'Brien
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
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24
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Abstract
Impaired optic flow perception may contribute to the visuospatial disorientation of Alzheimer's disease (AD). We find that 36% of AD patients have elevated perceptual thresholds for left/right outward radial optic flow discrimination. This impairment is related to independent visual motion processing deficits affecting the perception of left/right motion-defined boundaries and in/out radial motion. Elevated optic flow thresholds in AD are correlated with greater difficulty in the Road Map test of visuospatial function (r = -0.5) and in on-the-road driving tests (r = -0.83). When local motion cues are removed from optic flow, subjects must rely on the global pattern of motion. This reveals global pattern perceptual deficits that affect most AD patients (85%) and some normal elderly subjects (21%). This deficit might combine with impaired local motion processing to undermine the alternative perceptual strategies for visuospatial orientation. The greater prevalence of global pattern deficits suggests that it might precede local motion processing impairments, possibly relating to the sequence of early hippocampal and later posterior cortical damage that is typical of AD.
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Affiliation(s)
- H L O'Brien
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, USA
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Chess-Williams R, Austin CE, O'Brien HL. Alpha-adrenoceptors do not contribute to the chronotropic or inotropic responses of the avian heart to noradrenaline. J Auton Pharmacol 1991; 11:27-35. [PMID: 1851498 DOI: 10.1111/j.1474-8673.1991.tb00241.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
1. The chronotropic and inotropic responses of the young chick heart to noradrenaline have been investigated in isolated right atria, left atria and ventricular strips from 14-day-old chicks. 2. In the presence of desipramine and metanephrine to inhibit amine uptake, concentration-response curves to noradrenaline in all three tissues were shifted to the right by propranolol (1 microM) but were not altered by the presence of either phentolamine (5 microM) or prazosin (10 microM). 3. Similar results were obtained in the presence of cocaine (10 microM) and corticosterone (10 microM) to inhibit amine uptake. Propranolol (0.3-3.0 microM) produced rightward shifts of noradrenaline concentration-response curves which gave pA2 values of 8.1-8.4. Phentolamine (5 microM), in contrast, did not affect responses to noradrenaline in any tissue, either in the absence or presence of propranolol (1 microM). 4. Isoprenaline produced positive chronotropic responses in right atria and positive inotropic responses in left atria and ventricular strips. Methoxamine elicited positive inotropic responses in left atria but only negative chronotropic responses in right atria and negative inotropic responses in ventricular strips. 5. These results demonstrate that cardiac responses to noradrenaline in the chick heart are mediated via beta-adrenoceptors only, and that cardiac alpha-adrenoceptors are not involved in these responses.
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Affiliation(s)
- R Chess-Williams
- Department of Pharmacology and Therapeutics, University of Liverpool, UK
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