ArticleLiterature Review

The Prevalence, Impact, and Treatment of Migraine and Severe Headaches in the United States: A Review of Statistics From National Surveillance Studies

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Abstract

Background: Four ongoing U.S. public health surveillance studies gather information relevant to the prevalence, impact, and treatment of headache and migraine: the National Health Interview Survey, the National Health and Nutrition Examination Survey, the National Ambulatory Care Survey, and the National Hospital Ambulatory Medical Care Survey. The American Migraine Prevalence and Prevention (AMPP) study is a privately funded study that provides comparative U.S. population-based estimates of the prevalence and burden of migraine and chronic migraine. Objective: To gather in one place and compare the most current available estimates of the U.S. adult prevalence of headache and migraine, and the number of affected people overall and in various subgroups, and to provide estimates of headache burden and treatment patterns by examining migraine and headache as a reason for ambulatory care and emergency department (ED) visits in the United States. Methods: We reviewed published analyses from available epidemiological studies identified through searches of PubMed and the National Center for Health Statistics. We aimed to identify information about migraine and headache burden, and treatment in national surveys conducted over the last decade. For each source, we selected the best available and most current estimate of migraine or headache prevalence, and selected associated measures of disability, health care use, and treatment patterns. Results: Compared with a slightly higher proportion of 22.7% in the National Health and Nutrition Examination Survey, 16.6% of adults 18 or older reported having migraine or other severe headaches in the last 3 months in the 2011 National Health Interview Survey. In contrast, the AMPP study found an overall prevalence of migraine of 11.7% and probable migraine of 4.5%, for a total of 16.2%. Data from National Ambulatory Medical Care Survey/National Hospital Ambulatory Medical Care Survey showed that head pain was the fifth leading cause of ED visits overall in the U.S. and accounted for 1.2% of outpatient visits. The burden of headache was highest in females 18-44, where the 3-month prevalence of migraine or severe headache was 26.1% and head pain was the third leading cause of ED visits. The prevalence and burden of headache was substantial even in the least affected subgroup of males 75 or older, where 4.6% reported experiencing severe headache or migraine in the previous 3 months. Triptans accounted for almost 80% of antimigraine analgesics prescribed at office visits in 2009, nearly half of which were for sumatriptan. Migraine is associated with increased risk for other physical and psychiatric comorbidities, and this risk increases with headache frequency. Conclusion: This report provides the most current available estimates of the prevalence, impact, and treatment patterns of migraine or severe headache in the United States. Migraine and other severe headaches are a common and major public health problem, particularly among reproductive-aged women. Data about prevalence and disability from the major government-funded surveillance studies are generally consistent with results of studies such as the American Migraine Studies 1 and 2, and the AMPP study.

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... Migraine Speci c Quality of Life questionnaire MSQ is the speci c evaluation method more widely used for quality of life in migraine patients. As pain in uences the life quality of the patients, we designed MSQ for evaluation of quality of life [6,11,12]. ...
... Migraine became the third cause of disability in people under 50 years of age according to the Global Burden of Disease Study 2015 (GBD 2015) [10]. Migraine not only impaired human health, but also aggravated health-related economic burden which further imposed negative impact on quality of life [6,9,11,12]. Thus, how to effectively prevent and control migraine attacks has been a hot area of research, which attract increasing attention of clinical researchers all over the word. ...
... Drugs such as betaadrenoceptor blockers and antidepressants usually prescribed to alleviate headache attack. However, medication-induced side effects limited clinical effectiveness and reduced patient-based compliance [11,13]. ...
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Background: Headache attacks severely impaired life quality and increase economic burden of migraineurs. Electroacupuncture (EA) has been used world-widely to treat several pain-related diseases including migraine. However, whether EA with low- or high-frequency exerts distinct analgesic effect remains unknown and need to further study. Methods/Design: This study is a randomised, single-blinded, placebo-controlled trial with three parallel arms. A total of 144 migraine outpatients will be randomly allocated to 2Hz EA group, 100Hz EA group and placebo control group. The duration of the trial is 20 weeks, including a 4-week long baseline assessment period (week-4-0), 4-week long treatment period (week 1-4), and 12-week long follow-up period (week 5-16). Twelve treatment sessions will be performed over a four-week period (week 1-4). The primary outcome will be measured by frequency of migraine attacks in the past 4 week at the end of week 4 post-randomisation. Secondary outcome will be measured by frequency of migraine attacks in the past 4 week at the end of week 8,12,16 post-randomisation, number of days with migraine, dosage of ibuprofen, the scores of Visual Analogue Scale (VAS), Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS) and Migraine Specific Quality of Life questionnaire (MSQ) in the past 4 week at the end of week 4, 8, 12, 16 post-randomisation. Safety assessment, compliance and blinding evaluation will be carried out at the end of week 16 post-randomisation. Discussion: The recruitment will be started at 1 June, 2021 and expected to finish at 31 May, 2023. We aimed to clarify the dominant frequency of EA on headache attacks in migraineur. Trial registration: Chinese Clinical Trial Registry, ChiCTR-1800017259. Registered on 20 July 2018.
... ranged from 5.986 to22.0083 and the burst durations ranged from 4 to 6 years. Eleven publications(6,(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) had citation bursts ending in 2016 or later, six references(6,(31)(32)(33)(34)36) had citation bursts ending in 2016; two references(35,37) had bursts that ended in 2017, namely "Freilinger T, 2012, Nature Genetics, V44, P777", and "Natoli JL, 2010, Cephalalgia, V30, P599"; and three references(38)(39)(40) had bursts that ended in 2019, namely "Smitherman TA, 2013, Headache, V53, P427", "Noseda R, 2013, Pain, V154, P0", and "Maniyar FH, 2014, Brain, V137, P232". These publications with citation bursts may reflect the development frontiers of migraine research in recent years.DiscussionGeneral informationAccording to 2010-2019 data from SCIE in WoS, migraine research comprised a total of 6,357 items (5,203 articles and 1,154 reviews) published in 986 peer-reviewed journals with 94,610 co-cited references in 14 languages by5,197 institutions from 92 countries/regions. ...
... ranged from 5.986 to22.0083 and the burst durations ranged from 4 to 6 years. Eleven publications(6,(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) had citation bursts ending in 2016 or later, six references(6,(31)(32)(33)(34)36) had citation bursts ending in 2016; two references(35,37) had bursts that ended in 2017, namely "Freilinger T, 2012, Nature Genetics, V44, P777", and "Natoli JL, 2010, Cephalalgia, V30, P599"; and three references(38)(39)(40) had bursts that ended in 2019, namely "Smitherman TA, 2013, Headache, V53, P427", "Noseda R, 2013, Pain, V154, P0", and "Maniyar FH, 2014, Brain, V137, P232". These publications with citation bursts may reflect the development frontiers of migraine research in recent years.DiscussionGeneral informationAccording to 2010-2019 data from SCIE in WoS, migraine research comprised a total of 6,357 items (5,203 articles and 1,154 reviews) published in 986 peer-reviewed journals with 94,610 co-cited references in 14 languages by5,197 institutions from 92 countries/regions. ...
... Smitherman et al. published "The prevalence, impact, and treatment of migraine and severe headaches in the USA: a review of statistics from national surveillance studies" in 2013, which had the third strongest citation burst (n=21.5006) from 2014 to 2019 in Headache.This review reported that migraine and other severe headaches are common public health problems, especially among women of childbearing age, whereas triptans are the most conventional analgesics for migraine(38). In 2013, Noseda et al. published the paper with fourth strongest citation burst (n=20.4609) ...
Article
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In the recent years, migraine has been widely studied by scholars from all over the world. This study aimed to use scientometric methods to identify research frontiers and development trends in the field of migraine research. We used the Web of Science (WoS) core collection database to collect articles and reviews related to migraine published from 2010 to 2019 on March 25, 2020. VOSviewer, CiteSpace, and Excel were used for the scientometric analysis. A total of 6,357 publications (including 5,203 articles and 1,154 reviews) were identified. The United States published the most publications (n=2,151, 33.84%). Albert Einstein College of Medicine contributed the most publications (n=220, 3.46%). Cephalalgia was found to be the core journal with the most publications (n=766, impact factor 2019 =4.868) as well as the most co-citations (n=35,535). Lipton RB authored the most publications (n=159, 2.50%), while Silberstein SD received the most co-citations (n=4,215). The critical topics were causes and pathophysiological mechanisms, epidemiological characteristics, diagnostic criteria, treatment and prevention drugs, and migraine-related genes. Through the use of scientometric methods, this article has mapped the knowledge landscape of migraine research over the past decade. By showing the overall status of the field, it provides a useful reference for future research.
... Several studies have reported an association between severe and/or frequent headaches (HAs) and eating disorders (EDs), all of which are highly disabling conditions that occur more commonly in females [1][2][3][4][5][6][7][8][9][10][11][12][13]. Common migraine and tension-type HAs have been reported in association with traumatic events, posttraumatic stress disorder (PTSD), and related psychiatric comorbidities, including mood and anxiety disorders, all of which are linked to EDs [14][15][16][17]. ...
... Common migraine and tension-type HAs have been reported in association with traumatic events, posttraumatic stress disorder (PTSD), and related psychiatric comorbidities, including mood and anxiety disorders, all of which are linked to EDs [14][15][16][17]. Migraine, tension-type HAs and these co-occurring psychiatric manifestations have been associated with disturbances or dysregulation of the serotonin system and related psychoneurobiological systems [18][19][20][21], and pharmacological agents that target various components of the serotonergic system are widely used for all of these conditions [10,11,[22][23][24][25][26]. Furthermore, eating disordered behaviors, including food restriction, binge eating, purging and compulsive exercising, as well as consumption of substances of abuse, e.g., alcohol, and other forms of stress are known to be major triggers of migraine and other types of HAs, including tension-type HAs [27][28][29][30][31][32][33][34]. ...
... These results confirm that frequent HAs are common in patients receiving higher levels of care for eating and related disorders, occurring in 39% of patients across all ED diagnoses and in association with PTSD and related psychiatric comorbidity, particularly major depression. This 39% prevalence is substantially higher than the prevalence rates of migraine and other severe HAs (5-22%) reported in community and national samples of women [10,11,49,50]. ...
Article
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Purpose Severe headaches (HAs) have been associated with eating disorders (ED) as well as with trauma, posttraumatic stress disorder (PTSD), major depression and anxiety. However, data addressing all of these factors in the same subjects are limited. Methods In a large sample of patients (n = 1461, 93% female) admitted to residential treatment (RT) for an ED, we assessed within 48–72 h of admission subjective reports of frequent HAs and their associations with severity of ED, PTSD, major depressive and state–trait anxiety symptoms, as well as quality of life measures. HA ratings were significantly correlated to the number of lifetime trauma types as well as to symptoms of PTSD, major depression, and state–trait anxiety. Results Results indicated that 39% of patients endorsed that frequent HAs occurred “often” or “always” (HA+) in association with their eating or weight issues. This HA-positive (HA+) group had statistically significant higher numbers of lifetime trauma types, higher scores on measures of ED, PTSD, major depressive, and state–trait anxiety symptoms, and worse quality of life measures (p ≤ 0.001) in comparison to the HA-negative (HA−) group, who endorsed that frequent HAs occurred “never,” “rarely,” or “sometimes” in association with their eating or weight issues. The HA + group also had a significantly higher rate of a provisional PTSD diagnosis (64%) than the HA− group (35%) (p ≤ .001). Following comprehensive RT, HA frequency significantly improved (p ≤ .001). Conclusion These findings have important implications for the assessment and treatment of HAs in the context of ED, PTSD and related psychiatric comorbidities, especially at higher levels of care. In addition, the importance of identifying traumatic histories and treating comorbid PTSD and related psychopathology in individuals presenting with severe HAs is emphasized. Level of evidence III Evidence obtained from well-designed cohort or case–control analytic studies.
... 14-16 Migraine affects up to 18% of people each year. 4,17,18 The peak prevalence of migraine has been identified in middle life, typically in the thirties and forties, with a midlife prevalence of 25% and 8% in females and males, respectively. A nonlinear decrease in prevalence is appreciated in adults greater than 60 years of age with approximately 5% of females and 1.6% of males affected. ...
... 17,21,22 In midlife, when migraine prevalence is greatest, there is a roughly 3:1 female-to-male ratio. 18 This difference is made evident through a study by Stewart et al. demonstrating a lifetime incidence of 43% in females compared to an 18% lifetime incidence in males. 23 However, prior to the onset of puberty, the occurrence of migraine is found to be higher in males than females. ...
... 24 Headache, commonly migraine, is a leading cause of emergency department (ED) visits and among the front 20 causes of outpatient appointments. 14, 18 In the United States alone, there is an estimated $36 billion spent from direct costs of healthcare resources and indirect costs of loss of productivity. 15 A study published by the American Headache Society showed that those who experience migraines had an annual cost of $8924 greater from both direct healthcare costs and indirect costs compared to a matched group of patients without migraine. ...
Article
Migraine headache is a widespread and complex neurobiological disorder that is characterized by unilateral headaches that are often accompanied by photophobia and phonophobia. Migraine is one of the leading chief complaints in the emergency department with negative impacts on quality of life and activities of daily living. The high number of emergency presentations also results in a significant economic burden. Its risk factors include family history, genetics, sex, race, socioeconomics, the existence of comorbid conditions, and level of education. Triggers include stress, light, noise, menstruation, weather, changes in sleep pattern, hunger, dehydration, dietary factors, odors, and alcohol. The International Headache Society has defined criteria for the diagnosis of migraine with and without aura. The pathophysiology of migraine headaches is multifactorial so there are a variety of treatment approaches. The current treatment approach includes abortive medications and prophylactic medications. Abortive medications include the first-line treatment of triptans, followed by ergot alkaloids, and calcitonin gene-related peptide (CGRP) receptor antagonists along with supplemental caffeine and antiemetics. Trigeminal afferents from the trigeminal ganglion innervate most cranial tissues and many areas of the head and face. These trigeminal afferents express certain biomarkers such as calcitonin gene-related peptide (CGRP), substance P, neurokinin A, and pituitary adenylate cyclase-activating polypeptide that are important to the pain and sensory aspect of migraines. In this comprehensive review, we discuss Zavegepant, a calcitonin gene-related peptide receptor antagonist, as a new abortive medication for migraine headaches.
... Migraine became the third cause of disability in people under 50 years of age according to the Global Burden of Disease Study 2015 (GBD 2015) [10]. Migraine not only impaired human health, but also aggravated health-related economic burden which further imposed a negative impact on quality of life [6,9,11,12]. Thus, how to effectively prevent and control migraine attacks has been a hot area of research, which attract an increasing attention of clinical researchers all over the world. ...
... Drugs such as beta-adrenoceptor blockers and antidepressants are usually prescribed to alleviate headache attacks. However, medication-induced side effects limited clinical effectiveness and reduced patientbased compliance [11,13]. ...
... Migraine Specific Quality of Life questionnaire (MSQ) is the specific evaluation method more widely used for quality of life in migraine patients. As pain influences the life quality of the patients, we designed MSQ for the evaluation of quality of life [6,11,12]. ...
Article
Full-text available
Background Headache attacks severely impaired life quality and increase the economic burden of migraineurs. Electroacupuncture (EA) has been used worldwidely to treat several pain-related diseases including migraines. However, whether EA with low or high frequency exerts a distinct analgesic effect remains unknown and needs further study. Methods/Design This study is a randomised, single-blinded, placebo-controlled trial with three parallel arms. A total of 144 migraine outpatients will be randomly allocated to the 2 Hz EA group, 100 Hz EA group and placebo control group. The duration of the trial is 20 weeks, including a 4-week-long baseline assessment period (weeks − 4–0), a 4-week-long treatment period (weeks 1–4) and a 12-week-long follow-up period (weeks 5–16). Twelve treatment sessions will be performed over a 4-week period (weeks 1–4). The primary outcome will be measured by the frequency of migraine attacks in the past 4 weeks at the end of week 4 post-randomisation. The secondary outcome will be measured by the frequency of migraine attacks in the past 4 weeks at the end of weeks 8, 12 and16 post-randomisation; number of days with migraine; dosage of ibuprofen; the scores of visual analogue scale (VAS); Self-Rating Anxiety Scale (SAS); Self-Rating Depression Scale (SDS); and Migraine Specific Quality of Life questionnaire (MSQ) in the past 4 weeks at the end of weeks 4, 8, 12 and 16 post-randomisation. Safety assessment, compliance and blinding evaluation will be carried out at the end of week 16 post-randomisation. Discussion The recruitment will be started on 1 June 2021 and expected to finish on 31 May 2023. We aimed to clarify the dominant frequency of EA on headache attacks in a migraineur. Trial registration Chinese Clinical Trial Registry ChiCTR-1800017259 . Registered on 20 July 2018.
... Migraine is a primary headache disorder affecting ~ 10-15% of the population [1,2] and associated with a high burden of disease [3] and relevant socioeconomic costs [4]. ...
... Considering the results of previous studies investigating single relationships, we hypothesized that (1) psychological factors were rather associated with the subjective measure of headacherelated disability than with the more objective measure of headache frequency. We also hypothesized that (2) psychological factors from all three domains (affective, cognitive, and behavioral) would show independent relationships to headache parameters. ...
... The present data show that headache outcome variables as well as headache-related disability have several dimensions, which can be roughly divided into two groups: (1) The first dimension consists of headache frequency, acute medication frequency and days with disability (MIDAS), with limited relation to psychological factors. (2) The second dimension includes the degree of disability (PDI) and headache intensity, with extensive relation to psychological factors. The psychological factors independently related to headache outcome variables were depression, catastrophizing and social avoidance. ...
Article
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Background Several psychological cofactors of migraine have been identified, but relationships to different headache parameters (e.g., headache frequency vs. headache-related disability) are only incompletely understood. Methods We cross-sectionally assessed 279 migraine patients at their first presentation at our tertiary headache center. We obtained headache and acute medication frequency, pain intensity, the Migraine Disability Assessment Scale (MIDAS), and the Pain Disability Index (PDI) as headache-related outcomes as well as scores of the Hospital Anxiety and Depression Scale (HADS), the Pain Catastrophizing Scale (PCS), Pain-Related Control Scale (PRCS), and Avoidance Endurance Questionnaire (AEQ) as psychological factors. Results Linear regression models revealed the highest associations of the psychological factors with the PDI (adjusted R ² = 0.296, p < 0.001, independent predictors: PCS, AEQ social avoidance, depression) followed by the MIDAS (adjusted R ² = 0.137, p < 0.001, predictors: depression, AEQ social avoidance) and headache frequency (adjusted R ² = 0.083, p < 0.001, predictors: depression, AEQ humor/distraction). Principal component analysis corroborated that psychological factors were preferentially associated with the PDI, while the MIDAS loaded together with headache frequency. Conclusion Our results suggest that psychological factors are more strongly associated with the subjective degree of headache-related disability measured by the PDI than with the days with disability (MIDAS) or the more objective parameter of headache frequency. This once again highlights the need for comprehensive assessment of migraine patients with different headache parameters and the need for considering psychological treatment, especially in patients with high disability.
... Migraines are often caused by stress or dehydration and are often treatable with over-the-counter painkillers [35]. Cluster headaches are more painful even though they are less common. ...
... These disturbances can include flashing lights, blind spots, or tingling in the hands or feet. A combination of over-the-counter and prescription drugs isused to treat migraines with aura [35]. Migraines without aura are the most severe type of migraine. ...
... They are characterized by intense, throbbing pain, and can last for days or even weeks. Migraines without aura are treated with a combination of over-the-counter and prescription medications as well as lifestyle changes [35]. ...
Article
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Advancements in knowledge are needed to identify the link between childhood trauma and migraines in men. Though migraines are more prevalent in women, research about migraines in men with past traumatic exposure has received little attention. There are 9% of men of all ages with migraines in the United States, 12% of adult males in Europe between the ages of 18 and 65 with migraines, and 5 to 29% of males who experienced childhood sexual abuse, in other words, 1 in 6 males; whereby 50% of children who are sex trafficked in the United States are males, while 4% of male victims of significant trauma develop post-traumatic stress disorder. There may be a strong correlation that suggests that male migraine sufferers are more likely to have experienced some form of childhood trauma, in particular sexual abuse. Men’s migraines underrepresentation in research limits understanding of the adverse effects of childhood sexual abuse that often results in post-traumatic stress disorder and other psychiatric and medical conditions. As migraines become more understood, advances in our understanding of the neurobiological effects of trauma on brain structure and function may suggest a possible impact of early-life stress on the onset of migraines. Early-life stress-induced conditions in males may manifest because of sexual abuse often being undetected, fear of speaking out, or fear of being embarrassed. Unlike physical abuse where bruises are visible or neglect where malnourishment is noticeable, sexual abuse may inflict hidden bruises that may contribute to males suffering in silence. An increase in our knowledge may identify sexual abuse as the link between childhood trauma and migraines in men to suggest new treatment strategies.
... Keloids have a high recurrence rate, and growth usually continues even after therapeutic interventions. 2 A migraine is a highly prevalent distressing primary headache disorder which usually occurs in younger subjects and is more common in females than in males at a ratio of 3:1. 3 Migraines are characterised by frequent attacks of unilateral, pulsating headaches aggravated by physical activity. The two main subtypes are migraines with aura and migraines without aura. ...
... These results are consistent with several reports that the prevalence of migraine is generally higher in women than in men and widely varies by age. 3 Migraine risk in both genders reportedly increases with age from adolescence to approximately 40-45 years and then declines thereafter. 3 Regardless of comorbidity, the overall data showed a significantly higher migraine risk in the keloids group compared with the non-keloids group. ...
... These results are consistent with several reports that the prevalence of migraine is generally higher in women than in men and widely varies by age. 3 Migraine risk in both genders reportedly increases with age from adolescence to approximately 40-45 years and then declines thereafter. 3 Regardless of comorbidity, the overall data showed a significantly higher migraine risk in the keloids group compared with the non-keloids group. In the keloids group, comorbidities specifically associated with increased migraine risk were stroke, fibromyalgia, insomnia, anxiety and asthma. ...
Article
Full-text available
Background Fibroproliferative lesions with intractable pruritus, pain and hyperesthesia that cause uncontrolled scar growth are known as keloids. Migraines are common upsetting headache disorders characterised by frequent recurrence and attacks aggravated by physical activity. Both keloids and migraines can cause physical exhaustion and discomfort in patients; they have similar pathophysiological pathways, that is, the transforming growth factor-β1 gene and neurogenic inflammation. Objective To investigate subsequent development of migraines in patients with keloids. Methods Data were retrieved from the Taiwan National Health Insurance Research Database. The keloids group included patients aged 20 years and older with a recent diagnosis of keloids(n=9864). The non-keloids group included patients without keloids matched for gender and age at 1–4 ratio (n=39 456). Migraine risk between groups was measured by Cox proportional hazards regression models. Incidence rates and hazard ratios were calculated. Results During the study period, 103 keloids patients and 323 non-keloids patients developed migraines. The keloids patients had a 2.29-fold greater risk of developing migraines compared with the non-keloids group after adjustment for covariates (1.81 vs 0.55 per 1000 person-years, respectively). In the keloids group, female or patients younger than 50 years were prone to developing migraines. Conclusion The higher tendency to develop migraines in the keloids group in comparison with the non-keloids group suggests that keloids could be a predisposing risk factor for migraine development in adults. Keloids patients who complain of headaches should be examined for migraines.
... Almost 90% of migrainous patients experience moderate or severe pain, three quarter have reduced functional capacity during attacks of headache, and one-third require bed rest during the attacks with performing daily chores, and maintain active family, the inability to work, social, and community relationships [2,3]. Moreover, migraine headache is associated with an increased risk of physical and psychiatric comorbidities [4]. Headache is among the top 20 causes of outpatient healthcare visits and the top 5 causes of emergency department visits [4]. ...
... Moreover, migraine headache is associated with an increased risk of physical and psychiatric comorbidities [4]. Headache is among the top 20 causes of outpatient healthcare visits and the top 5 causes of emergency department visits [4]. Regarding the chronic migraine incidence in the general population, it has not been thoroughly studied yet [2]. ...
... Almost more than one-third of migrainous patients have equal to or more than four monthly attacks, for which onefourth of them are labeled as chronic migrainous (Kernick, 2020). Chronic migraine greatly influences psychosocial functioning and is associated with an increased risk of medical and psychiatric illness (Smitherman et al., 2013;Kernick, 2020). Migrainous headache is commonly affecting females with a female to male ratio of almost 3: 1. ...
... It has been suggested that nearly one in every four women will suffer from migraine, and the prevalence heights in early to middle adulthood and decreased considerably consequently. Moreover, headache is among the top 20 reasons for clinic consultation and the top 5 reasons for emergency department consultation (Smitherman et al., 2013). Episodic migraine is defined by the occurrence of migrainous attacks less than 15 days monthly. ...
... Migraine, a chronic disabling condition characterized by acute attacks of head pain and associated symptoms, accounts for a substantial portion of the 4-5 million emergency department (ED) visits per year for headache [1,2]. Long wait times, loud noises and bright lights, overuse of neuro-imaging, and suboptimal treatment of acute migraine attacks with medications such as opioids, make the ED less than ideal for patients with migraine [3]. ...
... Urgent Care Services are defined by the Centers for Medicare and Medicaid Services (CMS) as services furnished within 12 h in order to avoid the likely Open Access *Correspondence: minenmd@gmail.com 1 Departments of Neurology and Population Health, NYU Langone Health, 222 East 41st Street, 9th floor, New York, NY 10017, USA Full list of author information is available at the end of the article onset of an emergency medical condition. UC facilities location is distinct from a hospital emergency room, an office, or a clinic, and purpose is to diagnose and treat illness or injury for unscheduled, ambulatory patients seeking immediate medical attention [5,6]. ...
Article
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Background Patients with headache often seek urgent medical care to treat pain and associated symptoms that do not respond to therapeutic options at home. Urgent Cares (UCs) may be suitable for the evaluation and treatment of such patients but there is little data on how headache is evaluated in UC settings and what types of treatments are available. We conducted a study to evaluate the types of care available for patients with headache presenting to UCs. Design Cross-Sectional. Methods Headache specialists across the United States contacted UCs to collect data on a questionnaire. Questions asked about UC staffing (e.g. number and backgrounds of staff, hours of operation), average length of UC visits for headache, treatments and tests available for patients presenting with headache, and disposition including to the ED. Results Data from 10 UC programs comprised of 61 individual UC sites revealed: The vast majority (8/10; 80%) had diagnostic testing onsite for headache evaluation. A small majority (6/10; 60%) had the American Headache Society recommended intravenous medications for acute migraine available. Half (5/10) had a headache protocol in place. The majority (6/10; 60%) had no follow up policy after UC discharge. Conclusions UCs have the potential to provide expedited care for patients presenting for evaluation and treatment of headache. However, considerable variability exists amongst UCs in their abilities to manage headaches. This study reveals many opportunities for future research including the development of protocols and professional partnerships to help guide the evaluation, triage, and treatment of patients with headache in UC settings.
... Migraine was associated to epilepsy in our study as in other studies [19,25,27] and migraine with aura was more frequent in PWE as seen in general population [26]. There are probably common multifactorial mechanisms underlying this association [2] such as increasing in cortical excitability and genetic factors [14,18] as epilepsy is part of the phenotype of some mutations involved in familial hemiplegic migraines, FHM1 and FHM2. ...
Article
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To study relationship between migraine and epilepsy in adolescents and adults in northern Benin in 2018, a cross-sectional study with control group was conducted at Parakou in Benin. Cases were people with epilepsy (PWE) according to ILAE (International League Against Epilepsy) definition and followed at the Neurology Department of the Teaching Hospital of Borgou. Each case was matched to three controls (population-based controls) on age, sex and living area. Migraine was defined according to the ICHD-3 beta criteria of 2013. Conditional logistic regression models were used for associations. Thirty cases and ninety controls were included. The mean age was 32 ± 15 years for the cases and 32 ± 15 years for the controls with a sex-ratio (M/W) of 1.45. Migraine frequency in PWE was 63.33% and 17.78% in controls. After adjustment there were 8 times more migraine headaches in PWE than in controls (OR = 8.53; CI 95%: 2.6-28.0; P < 0.001).Epilepsy is associated with an increased frequency of migraine headaches.
... M igraine is a common and highly debilitating condition that has substantial social and economic burdens (1). This condition affects approximately 10-15% of the general population in Iran and worldwide (2,3). Migraine also is more frequent among women and those aged 30-40 years (4). ...
Article
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Background: Sumatriptan is a routine medication in the treatment of migraine and cluster headache that is generally given by oral or parental routes. However, a substantial proportion of patients suffer severe side effects. The aim of this study was to investigate the physicochemical characterization and pharmacokinetic parameters of a novel delivery system for sumatriptan succinate (SS) using nanoliposomes (NLs) coated by chitosan (CCLs) to optimize the formulations to enhance its bioavailability. Methods: The new formulation was used to minimize drug particle size and extend its release and bioavailability. The mean particle size and entrapment efficiency for NLs and CCls were optimized and the formulations with better characteristics were chosen for in vivo studies. The concentration-time profile of intravenous SS, intranasal SS, SS-NLs, and CCLs were examined in a rabbit model. Results: The results demonstrated that CCLs were absorbed more rapidly from nasal drops containing chitosan compared to those of SS and SS-NLs as indicated by a shorter tmax, and a higher Cmax in both states. A comparison of the AUC (0-240 min) values revealed that chitosan improved the extent of SS absorption for CCLs formulation. The results of the present study indicated that loading SS into the liposome and coating with chitosan improves drug absorption and a large amount of the drug can be efficiently delivered into the systemic circulation. Conclusion: The liposomal and chitosan formulations of SS had better kinetic behavior than the soluble form in the animal model.
... Based on this fact, several studies have been performed, which investigate the sex differences in many aspects of migraine such as symptoms (frequency, severity, and duration), migraineassociated features, and relapse of headache after treatment (Buse et al., 2013;MacGregor et al., 2011). Sumatriptan belongs to the triptans recommended as first-line therapies for migraineurs with moderate-to-severe pain (Fullerton & Gengo, 1992;Gilmore & Michael, 2011;Smitherman et al., 2013). Some patients prefer the oral form of sumatriptan because it is easy to use and effective at relieving migraine pain (Dahlöf, 2001;Dahlöf et al., 2004). ...
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Sumatriptan was introduced in 1983, as the first of the triptans, selective 5-hydroxytryptamine (5-HT1B/1D) receptor agonists, to treat moderate to severe migraine. Migraine predominates in females. Although there have been reports of sex differences in migraine-associated features and pharmacokinetics (PKs) of some triptans, sex differences in the PKs of oral sumatriptan have never been evaluated in Korean. We conducted this study of oral sumatriptan to assess the sex differences in Korean population. Thirty-eight healthy Korean subjects who participated in two separate clinical studies receiving a single oral dose of 50 mg sumatriptan with the same protocols were included in this analysis. A total of 532 sumatriptan concentration observations were used for a population PK modeling. Validation of final population PK model of sumatriptan was performed using bootstrap and visual predictive check. The PK profile of oral sumatriptan was adequately described by a one-compartmental model with combined transit compartment model and a first-order absorption. The covariate analysis showed that the clearance of oral sumatriptan was significantly higher in males than in females (male: 444 L/h, female: 281 L/h). Our results showed that there were sex differences in the clearance of oral sumatriptan. These results encourage further studies to establish the sumatriptan pharmacokinetic-pharmacodynamic (PK-PD) model considering sex-related PK differences, which may help to determine optimal dosing regimens for effective treatment of migraine in males and females. This article is protected by copyright. All rights reserved.
... As functional pain states, including migraine, show an increased prevalence in the female population [1,24,25], physiologic differences in expression and localization of ECS components between males and females may underscore the female prevalence of these disorders. Thus, these studies tested whether ECS expression differed between male and female rats in a regionally selective manner in the descending pain pathways that are implicated in chronic pain disorders. ...
Article
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Background Several chronic pain disorders, such as migraine and fibromyalgia, have an increased prevalence in the female population. The underlying mechanisms of this sex-biased prevalence have yet to be thoroughly documented, but could be related to endogenous differences in neuromodulators in pain networks, including the endocannabinoid system. The cellular endocannabinoid system comprises the endogenous lipid signals 2-AG (2-arachidonoylglycerol) and AEA (anandamide); the enzymes that synthesize and degrade them; and the cannabinoid receptors. The relative prevalence of different components of the endocannabinoid system in specific brain regions may alter responses to endogenous and exogenous ligands. Methods Brain tissue from naïve male and estrous staged female Sprague Dawley rats was harvested from V1M cortex, periaqueductal gray, trigeminal nerve, and trigeminal nucleus caudalis. Tissue was analyzed for relative levels of endocannabinoid enzymes, ligands, and receptors via mass spectrometry, unlabeled quantitative proteomic analysis, and immunohistochemistry. Results Mass spectrometry revealed significant differences in 2-AG and AEA concentrations between males and females, as well as between female estrous cycle stages. Specifically, 2-AG concentration was lower within female PAG as compared to male PAG (* p = 0.0077); female 2-AG concentration within the PAG did not demonstrate estrous stage dependence. Immunohistochemistry followed by proteomics confirmed the prevalence of 2-AG-endocannabinoid system enzymes in the female PAG. Conclusions Our results suggest that sex differences exist in the endocannabinoid system in two CNS regions relevant to cortical spreading depression (V1M cortex) and descending modulatory networks in pain/anxiety (PAG). These basal differences in endogenous endocannabinoid mechanisms may facilitate the development of chronic pain conditions and may also underlie sex differences in response to therapeutic intervention.
... Herein, we present migraine as a use-case to demonstrate that the combined use of EHR data and survey data facilitates a better understanding of population health needs and overcomes the response bias common to traditional population-based surveys. Migraine is a prevalent, often disabling chronic disease which exemplifies other symptomatic and burdensome diseases where people may not seek care and those that do seek care may not be diagnosed or receive an appropriate treatment [3][4][5][6][7][8][9][10][11][12][13]. Survey data indicate that variation in use of acute and preventive medications is directly linked to migraine-related disability and to associated comorbidities [5-7, 12, 14]. ...
Article
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Background Electronic health records (EHR) data can be used to understand population level quality of care especially when supplemented with patient reported data. However, survey non-response can result in biased population estimates. As a case study, we demonstrate that EHR and survey data can be combined to estimate primary care population prescription treatment status for migraine stratified by migraine disability, without and with adjustment for survey non-response bias. We selected disability as it is associated with survey participation and patterns of prescribing for migraine. Methods A stratified random sample of Sutter Health adult primary care (PC) patients completed a digital survey about headache, migraine, and migraine related disability. The survey data from respondents with migraine were combined with their EHR data to estimate the proportion who had prescription orders for acute or preventive migraine treatments. Separate proportions were also estimated for those with mild disability (denoted “mild migraine”) versus moderate to severe disability (denoted mod-severe migraine) without and with correction, using the inverse propensity weighting method, for non-response bias. We hypothesized that correction for non-response bias would result in smaller differences in proportions who had a treatment order by migraine disability status. Results The response rate among 28,268 patients was 8.2%. Among survey respondents, 37.2% had an acute treatment order and 16.8% had a preventive treatment order. The response bias corrected proportions were 26.2% and 11.6%, respectively, and these estimates did not differ from the total source population estimates (i.e., 26.4% for acute treatments, 12.0% for preventive treatments), validating the correction method. Acute treatment orders proportions were 32.3% for mild migraine versus 37.3% for mod-severe migraine and preventive treatment order proportions were 12.0% for mild migraine and 17.7% for mod-severe migraine. The response bias corrected proportions for acute treatments were 24.8% for mild migraine and 26.6% for mod-severe migraine and the proportions for preventive treatment were 8.1% for mild migraine and 12.0% for mod-severe migraine. Conclusions In this study, we combined survey data with EHR data to better understand treatment needs among patients diagnosed with migraine. Migraine-related disability is directly related to preventive treatment orders but less so for acute treatments. Estimates of treatment status by self-reported disability status were substantially over-estimated among those with moderate to severe migraine-related disability without correction for non-response bias.
... [3] Chronic headaches are a Erenumab-monoclonal antibody blocking the CGRP receptor has been approved for migraine prophylaxis Eptinezumab, fremanezumab, galcanezumab-monoclonal antibodies against CGRP molecule have been approved for migraine prophylaxis CGRP: Calcitonin gene-related peptide, HT: Hydroxytryptamine severely disabling long-term condition with higher symptom frequency and severity than episodic headaches. [46] Chronic headache includes both primary and secondary headache disorder. [47] The primary headache could be chronic migraine, chronic TTH, hemicrania continua, or new daily persistent headache (NDPH). ...
Article
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Headache is a common presenting complaint encountered in the outpatient as well as inpatient settings. Appropriate diagnosis and treatment of the commonly encountered primary headaches, timely evaluation for secondary causes, and patient education are the management's cornerstones. Our review aims to summarize the key diagnostic features and treatment of primary headaches and discuss the red flags that aid in the diagnosis of secondary headaches. For this, we searched the PubMed database using the keywords “Primary headache,” “Primary headache AND Diagnosis,” “Primary headache AND Treatment,” “Red flags AND Headache,” “Secondary Headaches.” Those articles written in English and were available in full text were reviewed. In this review, in addition to the clinical and management aspects, we have also elucidated the diagnosis and management of headache in special situations such as pregnancy and menstruation, headache in the emergency room, status migrainosus, and newer developments in the therapeutic armamentarium of headache. We have also tried to simplify the approach to headaches seen in routine outpatient clinics and emergency settings and develop a structured approach for diagnosis and management.
... Migraine is a condition characterized by recurrent, moderate to severe headache mostly in the autonomous nervous system. It affects about 10 to 15% of the general population and is more prevalent in women than in men (1,2,3). It is considered to be a neurovascular disorder although its exact mechanism is not known. ...
Article
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Aim: Migraine is a chronic condition characterized by recurrent moderate or severe headache, mostly in the autonomous nerve system. Virchow-Robin spaces (VRS) are perivascular areas in laid with pia matter surrounding small arteries and arterioles perforating the brain surface and invading the tissue. This study looks into the VRS of migraine patients through magnetic resonance imaging (MRI) to investigate the neurovascular basis of migraine. Material and Method: Patient group consist of 83 female who were diagnosed with migraine and had been taken MRI; and control group consist of 87 female subjects were formed. Whether there were correlations between migraine and number of VRS at the hippocampus, white matter and basal ganglia was investigated. Results: In all three levels, there were statistically significant differences between the patient and control groups, favoring the patient group. The correlation of the white matter to the basal ganglia and hippocampus was very weak, and the correlation of the basal ganglia to hippocampus was weak. Conclusion: Statistically significantly higher results in the patients group with migraine compared the controls in all three levels may provide guidance in diagnosing the disease and/or confirming the diagnosis. Özet Amaç: Migren çoğunlukla otonom sinir sisteminde görülen tekrarlayıcı, orta şiddette veya şiddetli baş ağrısıyla karakterize kronik bir hastalıktır. Virchow-Robin boşlukları (VRB) beynin yüzeyini delerek dokunun içine doğru ilerleyen küçük arter ve arteriyollerin etrafını saran pia ile döşeli perivasküler alanlardır. Bu çalışmada migren hastalığının nörovasküler temelini araştırmak amacıyla migren hastalarındaki VRB, manyetik rezonans görüntüleme (MRG) üzerinden incelenmektedir. Gereç ve Yöntem: MRG'si çekilen ve migren tanısı almış 83 kadından hasta grubu ve 87 kadın ile kontrol grubu oluşturuldu. Beyaz cevher, bazal ganglionlar ve hippocampus düzeyindeki VRB sayısı ile migren hastalığı arasında ilişki olup olmadığı araştırıldı. Bulgular: Her üç seviyede de hasta ve kontrol grubu arasında hasta grubunu destekleyen istatistiksel olarak anlamlı farklılıklar vardı. Beyaz cevherin bazal ganglionlar ve hippocampus ile korelasyonu çok zayıftı ve bazal ganglionların, hipokampus ile korelasyonu zayıftı. Sonuç: Migren tanılı hastaların kontrol grubuna göre her üç seviyede istatistiksel olarak anlamlı şekilde yüksek çıkması, hastalığın tanısını koymak ve/veya doğrulamak için bir yol gösterici olabilir.
... Migraine is a neurovascular disorder acknowledged since olden times which is greatly prevalent in society, affecting 1 in 10 people worldwide [428][429][430]. Migraine pathophysiology theories are very vast. ...
Article
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Endothelin-1 (ET-1) is involved in the regulation of a myriad of processes highly relevant for physical and mental well-being; female and male health; in the modulation of senses, pain, stress reactions and drug sensitivity as well as healing processes, amongst others. Shifted ET-1 homeostasis may influence and predict the development and progression of suboptimal health conditions, metabolic impairments with cascading complications, ageing and related pathologies, cardiovascular diseases, neurodegenerative pathologies, aggressive malignancies, modulating, therefore, individual outcomes of both non-communicable and infectious diseases such as COVID-19. This article provides an in-depth analysis of the involvement of ET-1 and related regulatory pathways in physiological and pathophysiological processes and estimates its capacity as a predictor of ageing and related pathologies, a sensor of lifestyle quality and progression of suboptimal health conditions to diseases for their targeted prevention and as a potent target for cost-effective treatments tailored to the person.
... Nonetheless, migraine patients typically migrate to analgesics, typically nonsteroidal antiinflammatory drugs (NSAIDs) available without prescription, despite mixed reports over their efficacy. Unfortunately, triptans, selective 5-HT1B/1D receptor agonists, which make up 80% of prescribed medications, proved to be effective in only 60% of migraine patients not responding to NSAIDs [123][124][125]. ...
Article
Full-text available
Migraine is a common neurological disease that affects about 11% of the adult population. The disease is divided into two main clinical subtypes: migraine with aura and migraine without aura. According to the neurovascular theory of migraine, the activation of the trigeminovascular system (TGVS) and the release of numerous neuropeptides, including calcitonin gene-related peptide (CGRP) are involved in headache pathogenesis. TGVS can be activated by cortical spreading depression (CSD), a phenomenon responsible for the aura. The mechanism of CSD, stemming in part from aberrant interactions between neurons and glia have been studied in models of familial hemiplegic migraine (FHM), a rare monogenic form of migraine with aura. The present review focuses on those interactions, especially as seen in FHM type 1, a variant of the disease caused by a mutation in CACNA1A, which encodes the α1A subunit of the P/Q-type voltage-gated calcium channel.
... As functional pain states, including migraine, show an increased prevalence in the female population [1,24,25], physiologic differences in expression and localization of ECS components between male and females may underscore the female prevalence of these disorders. Thus, these studies tested whether ECS expression differed between male and female rats in a regionally selective manner in the descending pain pathways that are implicated in chronic pain disorders. ...
Preprint
Full-text available
Background: Several chronic pain disorders, such as migraine and fibromyalgia, have an increased prevalence in the female population. The underlying mechanisms of this sex-biased prevalence have yet to be thoroughly documented but could be related to endogenous differences in neuromodulators in pain networks, including the endocannabinoid system. The cellular endocannabinoid system is comprised of the endogenous lipid signals 2-AG (2-arachidonoylglycerol) and AEA (anandamide); the enzymes that synthesize and degrade them; and the cannabinoid receptors. The relative prevalence of different components of the endocannabinoid system in specific brain regions may alter responses to endogenous and exogenous ligands. Methods: Brain tissue from naïve male and female Sprague Dawley rats was harvested from V1M cortex, periaqueductal gray, trigeminal nerve, and trigeminal nucleus caudalis. Tissue was analyzed for relative levels of endocannabinoid enzymes, ligands, and receptors via mass spectrometry, unbiased proteomic analysis, and immunohistochemistry. Results: Mass spectrometry revealed cortical AEA levels were significantly higher in males compared to females (p<0.001), whereas 2-AG levels in periaqueductal grey were significantly higher in females compared to males (p<0.0001). Immunohistochemistry followed by unbiased proteomics confirmed the prevalence of 2-AG-endocannabinoid system enzymes in the female PAG. Conclusions: Our results suggest that sex differences exist in the endocannabinoid system in two CNS regions relevant to cortical spreading depression (V1M cortex) and descending modulatory networks in pain/anxiety (PAG). These basal differences in endogenous endocannabinoid mechanisms may facilitate the development of chronic pain conditions and may also underlie sex differences in response to therapeutic intervention.
... Meningeal vasodilation together with inflammation is caused by activation of vascular networks, resulting in headache [12,13,16]. The pathophysiology of migraine involves modulating pain originating in disrupted neural networks in the head [17]. ...
Article
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Migraine is a neurological ailment that is characterized by severe throbbing unilateral headache and associated with nausea, photophobia, phonophobia and vomiting. A full and clear mechanism of the pathogenesis of migraine, though studied extensively, has not been established yet. The current available information indicates an intracranial network activation that culminates in the sensitization of the trigemino-vascular system, release of inflammatory markers, and initiation of meningeal-like inflammatory reaction that is sensed as headache. Genetic factors might play a significant role in deciding an individual's susceptibility to migraine. Twin studies have revealed that a single gene polymorphism can lead to migraine in individuals with a monogenic migraine disorder. In this review, we describe recent advancements in the genetics, pathophysiology, diagnosis, treatment, management, and prevention of migraine. We also discuss the potential roles of genetic and abnormal factors, including some of the metabolic triggering factors that result in migraine attacks. This review will help to accumulate current knowledge about migraine and understanding of its pathophysiology, and provides up-to-date prevention strategies.
... and a virtually balanced male-to-female ratio in the MD-dg group (1:1.2). Although frequencies in headache differed between the two groups, it's believed that gender distribution was a confounding factor, since generally prevalence of migraine is higher in women than in men [117] The radiological signs of superior semicircular canal (SCC) dehiscence were more common in the MD-hp group (29.4%) than in the MD-dg group (3.6%), as a result, MDhp patients may be on an increased risk of concomitant audiovestibular symptoms caused by SCC dehiscence syndrome. This may be compounded by the abnormal development at the fetal stage. ...
Article
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Introduction: Meniere's disease (MD) is a chronic disorder of inner ear, characterized by audial and vestibular symptoms. It presents a great variability among patients in terms of clinical features, etiology, pathology, and response to the same therapy. It's challenging to diagnose and manage for its heterogeneity. Indeed, the consensus is reached that MD has subtypes. Identifying subtypes of MD is important for individualized therapy and further research. Areas covered: In this review, we examined the heterogeneity of MD. We also included the valid subtyping solutions and updated data regarding the association among subtypes, disease progression, and management. Expert opinion: MD is an etiologically multifactorial condition, and it might be a constellation of symptoms associated with endolymph hydrops, not a disease entity. So far, MD can be classified as distinct phenotypes and endotype, respectively based on symptoms, pathology, possible etiology, and co-existing condition. Patients in different subtypes present different clinical features and are suitable for different treatment. The identification of these subtypes will benefit both basic and clinical studies of MD, by helping achieve personalized therapy, accurate prognosis prediction and even disease screening in near future. Therefore, MD subtyping is the emerging direction of diagnosis and treatment in the future.
... The prevalence of migraine is believed to be between 10 and 15 % of the population worldwide [1]. Recurrent headache pain is its defining feature, and it may also be accompanied by other autonomic symptoms including nausea, vomiting, and sensitivity to light and sound (photophobia) [2]. ...
Article
Full-text available
The complex, neurological, and incapacitating condition known as migraine is also marked by a number of autonomic symptoms. The first line of defence against moderate-to-severe headache episodes is the use of triptans, which are selective 5-HT1B/1D serotonin agonists. In this article, we examine the most recent information on the clinical effectiveness, safety, and tolerability of eletriptan as well as any potential clinically significant medication interactions. Eletriptan, a triptan, has a high tolerability profile and consistently considerable clinical effectiveness in the treatment of migraine, particularly in individuals with cardiovascular risk factors but without coronary artery disease. Along with rizatriptan, zolmitriptan, and injections of sumatriptan, it exhibits the best clinical response. In addition, when compared to the other triptans, eletriptan has the most complicated pharmacokinetic/dynamic profile. Since the hepatic enzyme CYP3A4 is principally responsible for its metabolism, the concurrent administration of CYP3A4-potent inhibitors needs to be carefully considered. The co-administration of serotoninergic medications results in a comparatively low incidence of serotonin syndrome. With the exception of ergot derivatives, which shouldn't be provided with eletriptan, no clinically significant interactions have been discovered between eletriptan and medications used for migraine preventative therapy or other acute medications. ___________________________________________________________________________________
... ГБ -одна их самых частых жалоб среди пациентов в общемедицинской практике [11]. На ГБ приходится 3-4,4% всех консультаций в системе первичной медико-санитарной помощи [6], около 20% всех пациентов с ГБ наблюдаются в неврологической практике [12], и ГБ является 5-й по частоте причиной и составляет 1,2-4% всех обращений в неотложную помощь [13]. ГБ занимает 14-е место среди самых частых причин обращений к ВОП [14], на долю которых приходится около 1,5% всех посещений практикующих врачей первичного звена [15]. ...
Article
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The bulk of patients with primary headaches HA (cephalalgias) are observed in primary care. The optimal diagnostic algorithm implies the exclusion of potentially dangerous causes of HA and secondary cephalalgias requiring specific treatment. Verification of the form of primary HA is carried out clinically, does not require additional diagnostic methods and is based on the use of the criteria of the International Classification of Headache Disorders. Among all cephalalgias in general clinical practice, the vast majority of cases are represented by four forms: migraine, tension type headache, cluster headache, and medication overuse headache. The complex application of modern methods of pharmacological and non-pharmacological treatment with the use of preventive strategies ensures high efficiency in the management of patients with HA.
... Triptan use was associated with lower scores on all CHQQ subscales, while headache pain severity was associated with lower scores on physical and total CHQQ subscales. Triptans, i.e. serotonin (5-hydroxytryptamine ) agonists with high affinity for 5-HT 1B and 5-HT 1D receptors, are commonly prescribed agents for the acute treatment of migraine 19 . Our know -ledge about the link between triptan use and HRQoL is quite scarce. ...
Article
Background and purpose: Previous studies using generic and disease specific instruments showed that both migraine and medication overuse headache are associated with lower health-related quality of life (HRQoL). The aim of our study was to assess HRQoL differences in migraineurs and in patients with MOH and to examine how headache characteristics such as years with headache, aura symptoms, triptan use, headache pain severity and headache frequency are related to HRQoL. Methods: In this cross-sectional study 334 participants were examined (248 were recruited from a tertiary headache centre and 86 via advertisements). The Comp-rehensive Headache-related Quality of life Questionnaire (CHQQ) was used to measure the participants' HRQoL. Data showed normal distribution, therefore beside Chi-squared test parametric tests (e.g. independent samples t-test) were used with a two-tailed p<0.05 threshold. Linear regression models were used to determine the independent effects of sex, age, recruitment method, headache type (migraine vs. MOH) and headache characteristics (presence of aura symptoms, years with headache, headache pain severity, headache frequency and triptan use) separately for each domain and for the total score of CHQQ. Significance threshold was adopted to p0.0125 (0.05/4) to correct for multiple testing and avoid Type I error. Results: Independent samples t-tests showed that patients with MOH had significantly lower scores on all CHQQ domains than migraineurs, except on the social subscale. Results of a series of regression analyses showed that triptan use was inversely related to all the domains of HRQoL after correction for multiple testing (p<0.0125). In addition, headache pain severity was associated with lower physical (p=0.001) and total scores (p=0.002) on CHQQ subscales. Conclusion: Based on the results, different headache characteristics (but not the headache type, namely migraine or MOH) were associated with lower levels of HRQoL in patients with headache. Determining which factors play significant role in the deterioration of HRQoL is important to adequately manage different patient populations and to guide public health policies regarding health service utilization and health-care costs.
... The overall prevalence of migraine was comparable to other international studies, which found a prevalence ranging from 10% to 16.6%, [1,23] considering that the reported prevalence on migraine can vary according to the method used to collect data; telephone interviews or filling surveys have had somewhat higher prevalence than when a patient answers based on a previous diagnosis made by their physician. [4,13,24] Migraine was much lower in the SR subgroup compared to the other subgroups in this study. ...
Article
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Background: The prevalence of migraine and psychiatric comorbidities has been found to differ on a global scale according to country development. We aimed to determine this prevalence in three samples of Arabs living in different countries at different levels of development and political stability. Methods: The study included Saudi and Syrian participants ≥16 years of age. The cohort was subdivided into three groups: Saudi Arabian residents (SARs), Syrian residents (SRs), and Syrian expatriates (SEs). Information regarding age, sex, education, and marital status was also collected. Migraine was determined by the International Classification of Headache Disorders-3 criteria; depression and bipolar disorder were determined by the Patient Health Questionnaire-9 and the Mini-International Neuropsychiatric Interview, respectively. Odds ratios were estimated for associations. Results: Of 620 participants, 102 (16.5%) met migraine criteria, and 81 (79.4%) were female. Migraine was found in 66 (20.6%) SARs, 25 (19%) SEs, and 11 (6.5%) SRs. Being married was significantly associated with migraine (P = 0.01). Depression had a significant association with migraine within the entire cohort (odds ratio [OR] =2, confidence interval [CI] =1.2–3.1, P = 0.004) and the subgroups of SEs (OR =3, CI =1.14–7.8, P = 0.02) and SARs (OR =2.1, CI =1.14–7.8, P = 0.02); depression was significantly associated in the SE and SAR migraine groups (both P = 0.02). Conclusion: Migraine and comorbid depression occur at a rate similar to international reports in Middle Eastern Arabs and more prominently in SEs and SARs. The migraine frequency was lower in SRs in comparison to SEs and SARs residing in more developed countries. Future research that explores these conditions under different environmental and sociopolitical circumstances will improve the understanding of causal relationships.
... Mast cell degranulation, autonomic dysfunction, and a combination of genetic and environmental factors may favor this process. [55][56][57][58][59][60] A cohort study in South Korea analyzed an adult population (> 20 years) of 113,059 patients with a diagnosis of asthma and 36,044 with CM and their respective controls. Migraineurs had a risk ratio (RR) 1.47 times greater of suffering with asthma compared to controls. ...
Article
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Introduction Migraine is a polygenic multifactorial disorder with a neuronal initiation of a cascade of neurochemical processes leading to incapacitating headaches. Headaches are generally unilateral, throbbing, 4–72 h in duration, and associated with nausea, vomiting, photophobia, and sonophobia. Chronic migraine (CM) is the presence of a headache at least 15 days per month for ≥3 months and has a high global impact on health and economy, and therapeutic guidelines are lacking. Methods Using the Grading of Recommendations, Assessment, Development, and Evaluations system, we conducted a search in MEDLINE and Cochrane to investigate the current evidence and generate recommendations of clinical practice on the identification of risk factors and treatment of CM in adults. Results We recommend avoiding overmedication of non-steroidal anti-inflammatory drugs (NSAIDs); ergotamine; caffeine; opioids; barbiturates; and initiating individualized prophylactic treatment with topiramate eptinezumab, galcanezumab, erenumab, fremanezumab, or botulinum toxin. We highlight the necessity of managing comorbidities initially. In the acute management, we recommend NSAIDs, triptans, lasmiditan, and gepants alone or with metoclopramide if nausea or vomiting. Non-pharmacological measures include neurostimulation. Conclusions We have identified the risk factors and treatments available for the management of CM based on a grading system, which facilitates selection for individualized management.
... Migraine is a neurovascular ailment, which affects 10-15% subjects of the general population (Smitherman et al. 2013). It is characterized by the throbbing, intense, recurrent and unilateral head pain that is often related to vomiting, nausea, phonophobia and photophobia. ...
... Porém, as crises geralmente estão associadas a fatores relacionados ao sono, estresse, atividade física, período menstrual, condutas alimentares e predisposição genética. Fatores ambientais como exposição a odores fortes, umidade, calor e frio, além de idade, cor da pele, nível socioeconômico, uso de anticoncepcionais e outros hormônios, também podem estar associados, entretanto não há consenso quanto a essas associações(SMITHERMAN, 2013; MOLLAOĞLU, 2013).Estuda-se a relação entre estado nutricional e prevalência de enxaquecas, observando-se a frequência entre pessoas obesas(YOUNG, 2011); entretanto, a relação entre excesso de tecido adiposo e migrânea ainda não está totalmente elucidada(WANG, FUH e CHEN, 2010;CASTRO et al, 2013).Por conta dessas associações ainda pouco esclarecidas, as intervenções clínicas para o cuidado da migrânea estão em constantes inovações envolvendo tratamento farmacológico, dietoterápico e mudança de hábitos laborais, com o intuito de melhorar tanto a frequência como a gravidade das crises (SLAVIN, AILANI, 2017). Sendo assim, esta pesquisa tem por objetivo investigar se existe correlação entre o perfil nutricional e gravidade da migrânea em pacientes atendidos em ambulatório de dor de uma universidade pública no município de Salvador -BA.Trata-se de um estudo do tipo transversal retrospectivo, com abordagem quantitativa. ...
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RESUMO: O número de casos novos de câncer se tornou a segunda causa de morte no país. Esse fato se explica devido à maior exposição dos indivíduos a fatores de risco, tais como ambientais comportamentais ou hereditários, sendo a alimentação inadequada um dos fatores de maior impacto. Baseado nestes dados, este estudo teve como objetivo avaliar o consumo alimentar, hábitos de vida e composição corporal de pacientes com diagnóstico de neoplasia no trato gastrointestinal e relacionar essas variáveis com o risco de desenvolver a doença. Trata-se de um estudo transversal, tendo como amostra 42 pacientes em tratamento quimioterápico no Hospital do Câncer de Francisco Beltrão – PR. Foram coletados dados referentes à idade, renda, hábitos de vida, história familiar, história atual, composição corporal e consumo alimentar. Os resultados demonstraram uma maioria de indivíduos em eutrofia (54,76%) segundo o IMC, porém com alto risco para desenvolvimento de complicações metabólicas (46,61%). A análise de a frequência alimentar demonstrou um baixo consumo de alimentos com fatores protetores a doença, como frutas (52,5%), verduras e legumes (59,6%) e cereais integrais (86,7%), e uma elevada ingesta alimentos com compostos cancerígenos, como carnes (N=29), embutidos (N=23), conservas (N=22), chimarrão (N=34), e alto teor em gordura (N=25). Os hábitos alimentares irregulares, associada a um estilo de vida sedentário, hábito tabagista e uso de bebida alcoólica são fatores de risco para o desenvolvimento de neoplasia. Diante disso, cabe ao nutricionista orientar quanto a um estilo de vida e hábitos alimentares saudáveis, promovendo a prevenção ao câncer. RESUMO: A desnutrição é um dos maiores problemas em pacientes hospitalizados, principalmente, em Unidade de Terapia Intensiva (UTI). A prevalência de desnutrição em indivíduos hospitalizados não é um dado recente, podendo acometer entre 19 a 80% dos indivíduos hospitalizados e sua incidência aumenta conforme o tempo de hospitalização. O objetivo deste trabalho é determinar o estado nutricional (EN), bem como a prevalência de desnutrição em pacientes críticos, associar a taxa de prevalência com o tempo de hospitalização e o óbito. Trata-se de um estudo do tipo transversal retrospectivo, com análise de dados em prontuários de um hospital público. A amostra foi composta por indivíduos dos sexos masculino e feminino com idade entre 18 e 60 anos, que tiveram passagem pela UTI durante os anos de 2015 e 2016. Para classificação do EN, foi utilizado o Índice de Massa Corporal (IMC) e a classificação da circunferência do braço (CB). Segundo a classificação pelo IMC, obtevese uma prevalência de 10,9% de magreza, já a prevalência de desnutrição, segundo a CB, foi de 33,3%. O perfil do EN da amostra foi de 46,2 % de eutrofia, 10,9% de magreza e 42,9% de sobrepeso segundo o IMC. Por sua vez, na classificação pela CB, os resultados foram de 59,0%, 33,3% e 7,7% respectivamente. O EN do paciente hospitalizado tem grande influência na sua evolução clínica, sendo de extrema importância que seja avaliado de maneira eficaz, a fim de diagnosticar precocemente algum nível de desnutrição ou risco nutricional.
... Patterns of specific antimigraine drug use in Netherlands above 95% of patients were prescribed with a drug in triptans group and 4.6% were received ergotamine (15) . Triptans account for almost 80% of antimigraine analgesic prescribed in the US (16) . Findings from South Africa showed that migraine patients were prescribed with rizatriptan (28.0%) and ergotamine (26.0%) (17) . ...
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Severe migraine attacks often required treatment with specific drugs. The study of pharmaceutical services on the patients with migraine headache has still been limited in Thailand. This study aimed to investigate the pharmaceutical services offered for a severe migraine patient in the community pharmacies. The study was descriptive research and collected data by using a simulated patient with a severe migraine headache. The fifty-seven community pharmacies, in Phayao province, Thailand, were assessed for the pharmaceutical services. The results demonstrated that the simulated patients received the services from 33 pharmacist-pharmacies (57.89%) and 24 non-pharmacist pharmacies (42.11%). The most frequent dispensed medication was the single drug of pain relievers (n = 30, 52.63%). Non-steroidal anti-inflammatory drug (n = 14, 24.56%), ergotamine (n = 8, 14.04%), and paracetamol (n = 8, 14.04%) were top three most dispensed pain relievers, respectively. Combination therapy between analgesics and other medications was found in 13 pharmacies (22.81%). Domperidone was used as an antinausea drug (n = 8, 14.04%). Prophylactic drugs (n = 6, 10.53%) were flunarizine (n = 35.26%), cinnarizine (n = 2, 3.51%), and amitriptyline (n=1, 1.75%). In conclusion, most pharmacy personnel performed inappropriate practice on taking the necessary information from the patient and drug dispensing for severe migraine. Educational interventions should be developed and trained to improve knowledge and practice in the migraine management.
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Pain assessment is essential for preclinical and clinical studies on pain. The mouse grimace scale (MGS), consisting of five grimace action units, is a reliable measurement of spontaneous pain in mice. However, MGS scoring is labor-intensive and time-consuming. Deep learning can be applied for the automatic assessment of spontaneous pain. We developed a deep learning model, the DeepMGS, that automatically crops mouse face images, predicts action unit scores and total scores on the MGS, and finally infers whether pain exists. We then compared the performance of DeepMGS with that of experienced and apprentice human scorers. The DeepMGS achieved an accuracy of 70-90% in identifying the five action units of the MGS, and its performance (correlation coefficient = 0.83) highly correlated with that of an experienced human scorer in total MGS scores. In classifying pain and no pain conditions, the DeepMGS is comparable to the experienced human scorer and superior to the apprentice human scorers. Heatmaps generated by gradient-weighted class activation mapping indicate that the DeepMGS accurately focuses on MGS-relevant areas in mouse face images. These findings support that the DeepMGS can be applied for quantifying spontaneous pain in mice, implying its potential application for predicting other painful conditions from facial images.
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Introduction: Chronic headache is one of the most disabling conditions afflicting humankind. The management of chronic headaches has, to date, been only partially successful. The goal of this paper is to highlight the importance of collaboration between surgeons and headache physicians in treating this condition. Methods: We present a narrative review of migraine pathophysiology, its medical and surgical treatment options, and the important role of collaboration between headache physicians and surgeons. Results: Migraine headaches can be treated with both medication-based regimens and surgery. Novel medications such monoclonal antibodies directed at the CGRP molecule or its receptor have recently been FDA approved as an effective treatment modality in chronic migraines. However, these medications are associated with a high cost, and there is a paucity in data regarding effectiveness compared to other treatment modalities. The pathophysiology of headache likely exists along a spectrum with peripheral - extracranial and meningeal - factors at one end and central - brain - factors at the other, with anatomic and physiologic connections between both ends. Recent evidence has clearly shown that surgical decompression of extracranial nerves improves headache outcomes. However, appropriate patient selection and preoperative diagnosis are of paramount importance to achieve excellent outcomes. Conclusions: Surgeons and headache physicians who are interested in providing treatment for patients with chronic headache should strive to form a close collaboration with each other in order to provide the optimal plan for migraine/headache patients.
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Background: Clinical trials have demonstrated magnesium supplements to be effective for prophylactic treatment of migraine. Dietary magnesium intake of many Americans is known to be below nutritional recommendations, but typical magnesium intake from dietary sources in adults with migraine has not previously been evaluated. Objective: This study aimed to quantify dietary and total (diet + supplement) magnesium consumption of adults with migraine or severe headache in the United States, and to investigate the relationship between magnesium consumption levels and prevalence of migraine or severe headache. Methods: This analysis included cross-sectional data from 3626 participants, 20- to 50-years old in the National Health and Nutrition Examination Survey between 2001 and 2004. Presence of migraine or severe headache in the past 3 months was determined by questionnaire. Individuals responding affirmatively were classified as having migraine, and individuals reporting not experiencing migraine or severe headache were classified as controls. Dietary magnesium intake was determined from a 24-hour recall interview, supplemental magnesium intake was determined from the dietary supplements interview, and total magnesium intake was the sum of dietary and supplement intake. Results: Mean dietary consumption of magnesium was below the recommended dietary allowance (RDA) for both migraine (n = 905) and control groups (n = 2721). Attainment of the RDA through a combination of diet and supplements was associated with lower adjusted odds of migraine (odds ratio [OR] = 0.83, 95% confidence intervals [CIs] = 0.70, 0.99, p = 0.035). Magnesium consumption in the highest quartile (Q) was associated with lower odds of migraine than in the lowest Q for both dietary (OR = 0.76, 95% CI = 0.63, 0.92, p = 0.006) and total (OR = 0.78, 95% CI = 0.62, 0.99, p = 0.042) magnesium intake in adjusted models. Conclusion: These results suggest inadequate consumption of magnesium intake is associated with migraine in U.S. adults ages 20-50. Further prospective investigations are warranted to evaluate the role of dietary magnesium intake on migraine.
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Introduction Bipolar disorder (BD) and migraine headaches are frequently comorbid. The common etiological features are unknown, however cortical hyperexcitability (EEG) of migraines, and the report of hyperexcitability in pluripotent stem cell‐derived neurons from lithium responsive BD subjects offers a physiological hypothesis of excitable neurons linking these disorders. However, clinical studies suggest that a history of migraine is associated with higher rates of relapse in those with BD taking lithium. Lithium use and history of migraine in this prospective longitudinal study of BD find that lithium use is associated with a greater symptom severity in BD. Methods Data on longitudinal outcome from 538 patients with BD I were categorized according to treatment with lithium and comorbidity with migraine. Clinical outcome measures on depression, mania, and quality of life over the most recent 2‐year period compared the BD and BD/migraine cohort according to lithium treatment status. Results A history of migraines was associated with worse clinical outcomes of depression (p = .002), mania (p = .005), and mental and physical quality of life (p = .004 and p = .005, respectively), independent of lithium use. The BD/migraine cohort treated with lithium was associated with worse symptoms of mania, whereas those without migraine and lithium use were associated with milder manic symptoms (p = .026). Conclusions Herein, we replicate the relatively worse outcome in BD with comorbid migraine. We find evidence to suggest that lithium use is associated with more severe symptoms of mania among those with BD and a history of migraine and conclude that lithium is contraindicated in BD comorbid with migraine.
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Objectives Clinical studies demonstrate that supplemental riboflavin is an efficacious and low risk prophylactic treatment for migraine. However, background riboflavin intake of adults with migraine from nutritional sources has not been evaluated. This study aimed to evaluate riboflavin consumption of adults with migraine in the United States, and further investigate the relationship between nutritional riboflavin consumption and the prevalence of migraine among adults. Methods This cross-sectional secondary analysis included 3439 participants ages 20–50 years old in the National Health and Nutrition Examination Survey from 2001 to 2004. Presence of migraine in the past three months was self-reported. Riboflavin intake was determined from one 24-hour recall interview. Odds ratios and 95% confidence intervals were calculated for riboflavin intake quartiles using an adjusted logistic regression model. Statistical significance was determined using an adjusted Wald test. Results Results showed that mean dietary consumption of riboflavin fulfilled the Recommended Dietary Allowance for migraine and control groups. Dietary riboflavin intake was associated with the odds of migraine (pWald = 0.002), but no association was found for supplemental or total riboflavin consumption (pWald = 0.479 and 0.136). When stratified by gender, there was no association of dietary riboflavin with migraine in males (pWald = 0.423), but an association was observed in females (pWald = 0.014). Discussion The RDA value for riboflavin was not relevant for assessing odds of migraine; however, differing odds of migraine were detected across dietary riboflavin consumption groups at levels above the RDA. Future riboflavin supplementation trials for migraine prophylaxis should consider measuring background dietary intake.
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Pancreatic cancer presents a unique challenge for the development of effective oncotherapies. The tumor microenvironment (TME) of this type of tumor typically contains a dense desmoplastic barrier composed of aberrant extracellular matrix proteins, as well as an acidic hypoxic and necrotic core. Additionally, the immune system surrounding this type of tumor has often been suppressed by the TME. Hence, choosing the correct model of the tumor microenvironment within which to test a potential anti-cancer therapy is a critical experimental design decision. While the typical solid tumor contains a complex microenvironment including both phenotypic and genotypic heterogeneity, the methods used to model this disease state often do not reflect this complexity. This simplistic approach may have contributed to stagnant five-year survival rates experienced over the past four decades. Oncolytic bacteria, a class of bacteria with the innate ability to seek and destroy solid tumors has been revived from historical anecdotes in an attempt to overcome these challenges. Regardless of the promise of oncolytic bacteria, accurate assessment of their potential requires choosing the proper tumor model. This study explores the impact of cancer cell lines co-cultures with Wild-Type C. novyi to establish the efficacy of this oncolytic bacteria in a monolayer culture.
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Background and Objectives – To determine gender differences in headache types diagnosed, sociodemographic characteristics, military campaign and exposures, and healthcare utilization among United States (U.S.) Veterans in the Veterans Health Administration (VHA). Methods – This study employed a retrospective cohort design to examine VHA Electronic Health Record (EHR) data. This cohort includes Veterans who had at least one visit for any headache between fiscal years 2008 and 2019. Headache diagnoses were classified into eight categories using International Classification of Disease, Clinical Modification codes. Demographics, military-related exposures, comorbidities, and type of provider(s) consulted were extracted from the EHR, and compared by gender. Age-adjusted incidence and prevalence rates of medically diagnosed headache disorders were calculated separately for each type of headache. Results – Of the 1,524,960 Veterans with headache diagnoses included in the cohort, 82.8% were men. Compared with women, men were more often white (70.4% vs 56.7%), older (52.0±16.8 vs 41.9±13.0 years), with higher rates of traumatic brain injury (2.9% vs 1.1%) and post-traumatic stress disorder (23.7% vs 21.7%), and lower rates of military sexual trauma (3.2% vs 33.7%; p <0.001 for all). Age adjusted incidence rate of headache of any type was higher among women. Migraine and trigeminal autonomic cephalalgias rates were most stable over time. Men were more likely than women to be diagnosed with headache not-otherwise-specified (77.4% vs 67.7%) and have higher incidence rates of headaches related to trauma (3.4% vs 1.9% [post-traumatic]; 5.5% vs 5.1% [post-whiplash]; p <0.001 for all). Men also had fewer headache types diagnosed (mean ± standard deviation; 1.3 ± 0.6 vs 1.5 ± 0.7), had fewer encounters for headache/year (0.8 ± 1.2 vs 1.2 ± 1.6) and fewer visits to headache specialists (20.8% vs 27.4% p <0.001 for all), compared to women. Emergency Department utilization for headache care was high for both genders and higher for women compared to men (20.3% vs 22.9%; p <0.001). Discussion – Among Veterans with headache diagnoses, important gender differences exist for men and women Veterans receiving headache care within VHA regarding sociodemographic characteristics, headache diagnoses, military exposure, and headache healthcare utilization. The findings have potential implications for providers and the healthcare system caring for Veterans living with headache.
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Migraine is one of the most common pain disorders in the United States, affecting over 15% of the general population. Treatment guidelines exist regarding the use of both prophylactic and abortive therapies. However, there is still controversy over the utility and practice of polytherapy in those who do not respond to a first-line preventative agent. There is a small body of evidence to support the use of polytherapy for the management of refractory migraine, and a much larger pool of anecdotal clinical experience. In addition to the confusion between mono- and polytherapy, many new treatment modalities including injectable medications and nerve stimulators for episodic migraine have become available. The incorporation of these interventions into the migraine treatment plan will be discussed.
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Brain disorders can be defined as injury or inflammation in neuronal circuits. Under the umbrella of brain disorders, Alzheimer's disease (AD), Parkinson's disease (PD), Multiple Sclerosis (MS), migraine, epilepsy, depression, motor nerve cell disorders, stroke, or Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig's disease, brain infection, and brain cancer are mostly covered. In brain disorders, the blood-brain barrier (BBB) defensive mechanism is harshly damaged. The scientific fraternity has discovered drugs of several categories for the management of brain disorders, however; owing to poor physicochemical attributes, drugs usually do not cross BBB to attain targeted drug delivery in the brain. Moreover, impaired transportation pathway of drugs during disease condition may change the both nonspecific and specific transport mechanisms. Recently, nanotechnology has provided many technical advances including invasive and noninvasive techniques directly targeting the brain with high efficiency and accuracy. Therefore, here, we have reviewed brain anatomy and physiology, routes of drug administration to brain, drug transport mechanisms, pathophysiology of brain disorders and their molecular targets, brain targeting drug delivery systems as well as management of brain disorders using nanotechnological approaches. Moreover, special attention has been emphasized on preclinical and clinical status of brain targeting drug delivery strategies.
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Background: Migraine-attributed burden, impact, disability and migraine-impacted quality of life are important concepts in clinical management, clinical and epidemiological research, and health policy, requiring clear and agreed definitions. We aimed to formulate concise and precise definitions of these concepts by expert consensus. Methods: We searched the terms migraine-attributed burden, impact, disability and migraine-impacted quality of life in Embase and Medline from 1974 and 1946 respectively. We followed a Delphi process to reach consensus on definitions. Results: We found widespread conflation of concepts and inconsistent terminology within publications. Following three Delphi rounds, we defined migraine-attributed burden as "the summation of all negative consequences of the disease or its diagnosis"; migraine-attributed impact as "the effect of the disease, or its diagnosis, on a specified aspect of life, health or wellbeing"; migraine-attributed disability as "physical, cognitive and mental incapacities imposed by the disease"; and migraine-impacted quality of life as "the subjective assessment by a person with the disease of their general wellbeing, position and prospects in life". We complemented each definition with a detailed description. Conclusion: These definitions and descriptions should foster consistency and encourage more appropriate use of currently available quantifying instruments and aid the future development of others.
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Aim To evaluate the diagnostic accuracy of the SNNOOP10 list in the detection of high-risk headaches. Methods Patients that visited the Hospital Clínico San Carlos (Madrid) emergency department due to headache that were allocated to a Manchester Triage System level between critical and urgent were prospectively included but retrospectively analysed. A researcher blind to the patients’ diagnosis administered a standardised questionnaire and afterwards a neurologist blind to the questionnaire results diagnosed the patient according to the International Classification of Headache Disorders. The primary endpoint was to assess the sensitivity of the SNNOOP10 list in the detection of high-risk headaches. Secondary endpoints included the evaluation of the sensitivity, specificity, positive predictive value, negative predictive value and area under the curve of each SNNOOP10 item. Results Between April 2015 and October 2021, 100 patients were included. Patients were 44 years old (inter-quartile range: 33.6–64.7) and 57% were female. We identified 37 different diagnoses. Final diagnosis was a primary headache in 33%, secondary headache in 65% and cranial neuralgia in 2%. There were 46 patients that were considered as having high-risk headache. Patients from the primary headache group were younger and more frequently female. Sensitivity of SNNOOP10 list was 100% (95% confidence interval: 90.2%–100%). The items with higher sensitivity were neurologic deficit or disfunction (75.5%), pattern change or recent onset of the headache (64.4%), onset after 50 years (64.4%). The most specific items were posttraumatic onset of headache (94.5%), neoplasm in history (89.1%) and systemic symptoms (89%). The area under the curve of the SNNOOP10 list was 0.66 (95% CI: 0.55–0.76). Conclusion The red flags from the SNNOOP10 list showed a 100% sensitivity in the detection of high-risk headache disorders.
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Fasting has been widely studied in both prevention and treatment of many neurologic disorders. Some conditions may be prevented with any type of fasting, while some may require a stricter regimen. Fasting reduces weight, fasting blood glucose, and insulin resistance, and favorably alters the gut biome and the immune system. This article discusses various versions of fasting that have been studied as well as the known and theoretical mechanisms of how fasting effects the body and the brain. This article will then review evidence supporting the potential preventive and treatment effects of fasting in specific neurologic disorders including ameliorating the symptoms of Parkinson's disease, improving cognition in Alzheimer's disease, reducing migraine frequency and intensity, and reducing seizure frequency in epilepsy.
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Chronic overlapping pain conditions (COPCs) are a collection of chronic pain syndromes that often co-occur and are thought to share underlying nociplastic pathophysiology. Since they can manifest as seemingly unrelated syndromes they have historically been studied in isolation. Use of International Classification of Diseases (ICD) codes in medical records has been proposed as a means to identify and study trends in COPCs at the population level, however validated code sets are needed. Recently, a code set comprising ICD-10 codes as proxies for 11 COPCs was validated. The goal of this project was to validate a code set composed of ICD-9 codes for the identification of COPCs in administrative datasets. Data was extracted using the Electronic Medical Record Search Engine at the University of Michigan Health System from January 1st, 2011 to January 1st, 2015. The source population were patients with one of the candidate ICD-9 codes corresponding to various COPCs. Natural language searches were used as a reference standard. If code sets met a pre-specified threshold of agreement between ICD-9 codes and natural language searches (≥ 70%), they were retained and diagnostic accuracy statistics were calculated for each code set. Validated ICD-9 code sets were generated for 10 of the 11 COPCs evaluated. The majority had high levels of diagnostic accuracy, with all but one code set achieving ≥ 80% specificity, sensitivity, and predictive values. This code set may be used by pain researchers to identify COPCs using ICD-9 codes in administrative datasets.
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Migraine prophylaxis is an important part of the treatment algorithm for migraine disease therapy. Prophylaxis of episodic migraine may lead to decreased frequency, severity, and distress which will prevent interruptions to daily living and reduce visits to outpatient clinics, emergency settings, and in turn increases utilization of health care dollars. Prevention of acute migraine may also lead to the prevention of chronic migraine as well as increasing quality of life. Indications for prophylaxis, in general, include multiple headaches a month, debilitating headaches, medication-overuse headaches, and interruptions to daily living. Identifying environmental, dietary, and behavioral triggers are a useful first-line approach to prophylaxis, followed by utilizing over-the-counter medications, prescription medications, novel pharmacologic treatments, nonpharmacologic therapies, alternative therapies (acupuncture, massage, nutrition), and neuromodulation which may all help with migraine prophylaxis. Even with multiple therapies, treatment options are often complex.
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Introduction: : Migraine occupies the first position regarding to the disability caused in female working population (15-49 years). Research in the field of prophylaxis of this pathology has made enormous strides in recent years. Areas covered: In this narrative review we retrace the most important scientific evidence regarding recently approved and emerging drug for prophylactic treatment of migraine. The purpose of this article is in fact to evaluate currently approved or emerging pharmacological agents for migraine prophylaxis. This review is based on literature published in peer review journal obtained through PubMed, Cochrane library, Clinicaltrials.gov and US FDA. Expert opinion: : Monoclonal antibodies (mAbs) that target the calcitonin gene-related peptide signalling pathway (CGRP) have marked an innovation in prophylactic migraine therapy. The combination of Onabotulinumtoxin-A (OBTA) and mAbs appears to be an effective, but costly, therapeutic option for resistant cases. New classes of molecules like gepants and ditans seem to give exceptional results. In addition, new prophylactic drugs are emerging with several targets: the pituitary adenylate cyclase-activating polypeptide (PACAP), ion channels, several receptors coupled to G proteins, orexin, and glutamate. All these therapies will implement and improve migraine management, as well as personalized medicine for each patient.
Article
Background Acupuncture has shown benefit in preventing migraine attacks, but there has been no clear recommendation about the number of treatment sessions that should be provided. Objectives The aim of this study was to examine whether 5 sessions of acupuncture treatment is non-inferior to 10 sessions for migraine. Methods We performed a multicenter, open-label, randomized, controlled clinical trial across five hospitals in Thailand. Migraine patients were randomly assigned into two groups: treatment with 5 sessions of acupuncture (group A) or 10 sessions of acupuncture (group B). Acupuncture was performed twice a week. We measured the number of migraine days, average pain severity according to a 0–10 numeric pain rating scale (NPRS) and quality of life using the EQ-5D-5L questionnaire, comparing 4 weeks after treatment versus baseline. Results Of 156 patients, 83 and 73 patients were assigned to groups A and B, respectively. Comparing 4 weeks after treatment with baseline, the mean reduction in the number of headache days in groups A and B was 6.4 (95% confidence interval [CI] 4.8 to 7.9) days and 6.4 (95% CI 4.5 to 8.4) days, respectively (p = 0.97). The mean difference between the reduction in headache days of the two groups was −0.1 (95% CI −2.5 to 2.4) days, which included the pre-specified non-inferiority limit of −1. The mean reduction of NPRS scores in groups A and B was 4.5 (95% CI 3.8 to 5.1) and 3.8 (95% CI 3.1 to 4.5), respectively (p = 0.17). Both groups showed an improvement in quality of life. Conclusion Both 5 and 10 sessions of acupuncture were associated with apparent benefits in terms of preventing migraine attacks, reducing the severity of the headache and improving quality of life, based on comparisons between baseline and follow-up in both study groups. Although we were unable to demonstrate non-inferiority of 5 sessions versus 10 sessions of acupuncture, the effects in the two groups were not significantly different and the temporal effects appeared to last for at least 1 month. Trial registration number TCTR20170612002 (Thai Clinical Trials Registry).
Chapter
The enormous boost of evidence that underlies the knowledge of the migraine mechanisms opens today completely innovative scenarios and lays the foundations for robust applied pharmacology projects. The data network based on genetics and molecular biology allows a more complete understanding of causal or casual interrelationships with other wide-ranging pathologies in clinical medicine. How behaviour, the environment, exogenous or endogenous factors can epigenetically affect the phenotype are now crucial information for having a complete picture of the origin and occurrence of migraine.
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To describe the prevalence, sociodemographic profile, and the burden of migraine in the United States in 1999 and to compare results with the original American Migraine Study, a 1989 population-based study employing identical methods. A validated, self-administered questionnaire was mailed to a sample of 20 000 households in the United States. Each household member with severe headache was asked to respond to questions about symptoms, frequency, and severity of headaches and about headache-related disability. Diagnostic criteria for migraine were based on those of the International Headache Society. This report is restricted to individuals 12 years and older. Of the 43 527 age-eligible individuals, 29 727 responded to the questionnaire for a 68.3% response rate. The prevalence of migraine was 18.2% among females and 6.5% among males. Approximately 23% of households contained at least one member suffering from migraine. Migraine prevalence was higher in whites than in blacks and was inversely related to household income. Prevalence increased from aged 12 years to about aged 40 years and declined thereafter in both sexes. Fifty-three percent of respondents reported that their severe headaches caused substantial impairment in activities or required bed rest. Approximately 31% missed at least 1 day of work or school in the previous 3 months because of migraine; 51% reported that work or school productivity was reduced by at least 50%. Two methodologically identical national surveys in the United States conducted 10 years apart show that the prevalence and distribution of migraine have remained stable over the last decade. Migraine-associated disability remains substantial and pervasive. The number of migraineurs has increased from 23.6 million in 1989 to 27.9 million in 1999 commensurate with the growth of the population. Migraine is an important target for public health interventions because it is highly prevalent and disabling.
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The Headache Impact Test-6 (HIT-6) has been demonstrated to be a reliable and valid measure that assesses the impact of headaches on the lives of persons with migraine. Originally used in studies of episodic migraine (EM), HIT-6 is finding increasing applications in chronic migraine (CM) research. (1) To examine the headache-impact on persons with migraine (EM and CM) using HIT-6 in a large population sample; (2) to identify predictors of headache-impact in this sample; (3) to assess the magnitude of effect for significant predictors of headache-impact in this sample. The American Migraine Prevalence and Prevention study is a longitudinal, population-based study that collected data from persons with severe headache from 2004 to 2009 through annual, mailed surveys. Respondents to the 2009 survey who met International Classification of Headache Disorders 2 criteria for migraine reported at least 1 headache in the preceding year, and completed the HIT-6 questionnaire were included in the present analysis. Persons with migraine were categorized as EM (average <15 headache days per month) or CM (average ≥15 headache days per month). Predictors of headache-impact examined include: sociodemographics; headache days per month; a composite migraine symptom severity score (MSS); an average pain severity rating during the most recent long-duration headache; depression; and anxiety. HIT-6 scores were analyzed both as continuous sum scores and using the standard, validated categories: no impact; some impact; substantial impact; and severe impact. Group contrasts were based on descriptive statistics along with linear regression models. Multiple imputation techniques were used to manage missing data. There were 7169 eligible respondents (CM = 373, EM = 6554). HIT-6 scores were normally distributed. After converting sum HIT-6 scores to the standard categories, those with CM were significantly more likely to experience "severe" headache impact (72.9% vs 42.3%) and had higher odds of greater adverse headache impact compared with persons with EM (OR = 3.5, 95% CI = 2.77-4.41, P < .0001). Significant predictors of adverse headache impact in both groups included younger age, higher MSS score, higher average long-duration headache pain severity rating, and depression. Lower annual household income, anxiety, and higher standardized headache day frequency predicted adverse headache impact in EM but not CM. With few exceptions, gender, race, and body mass index did not significantly predict adverse headache impact. Finally, rates of depression were more than double among persons with CM (CM = 25.2%, EM = 10.0%), and rates of anxiety were nearly triple (CM = 23.6%, EM = 8.5%). This work further establishes HIT-6 as a useful instrument for characterizing CM and understanding the increased disease related burden. Persons with CM had significantly higher odds of greater adverse headache impact, when compared with EM. Predictors of greater headache impact for both groups included higher MSS scores, higher average headache pain severity, and depression. Additional predictors unique to EM included higher average household income, younger age, higher standardized headache day frequency, and anxiety. This finding may be related to differences in sample size and power. Further exploration is warranted.
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This overview of the published epidemiological evidence of migraine helps to identify the size of the public-health problem that migraine represents. It also highlights the need for further epidemiological studies in many parts of the world to gain full understanding of the scale of clinical, economic and humanistic burdens attributable to it. This paper presents some of the work on migraine undertaken by the World Health Organization (WHO) in the Global Burden of Disease study conducted in 2000 and reported in the World Health Report 2001. Migraine was not included in the first Global Burden of Disease 1990. The paper also discussed the measurement of disability attributable to headache disorders using WHO ICF Classification. Using disability-adjusted life years (DALYs) as a summary measure of population health (which adds disability to mortality), WHO have shown that mental and neurological disorders collectively account for 30.8% of all years of healthy life lost to disability (YLDs) whilst migraine, one amongst these, alone accounts for 1.4% and is in the top 20 causes of disability worldwide. This information is combined with the increasingly widely accepted belief that disability and functioning are relevant parameters for monitoring the health of nations and that there is an increasing need to measure them. WHO's Classification of Functioning, Disability and Health (ICF) provides a model of human functioning and disability, as well as a classification system, that allows us to highlight and measure all dimensions of disability. ICF applied to headache disorders allows comparability with other health conditions as well as evaluation of the role of the environment as a cause of disability amongst people with headache. Migraine causes a large proportion of the non-fatal disease-related burden worldwide. Our knowledge of headache related burden is incomplete and it is necessary to add to it epidemiological studies in many parts of the world and to combine this with measurements of disability using both DALYs and WHO's ICF Classification. The work described here has been the base for the Global Campaign against Headache disorders: "Lifting the Burden", launched in 2004 jointly by WHO, IHS (International Headache Society), WHA (World Headache Alliance) and EHF (European Headache Federation).
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To describe the patterns of medical treatment for migraineurs in the United States. Over the past decade, many new treatments for migraine have become available and awareness of migraine has improved. However, there is little information about the patterns of medical treatment in the US society. A validated self-administered headache questionnaire was mailed to a random sample of 120,000 US households. Each household member with severe headaches was asked to complete the survey. The questionnaire assessed headache features, disability, and patterns of medical treatment. Subjects were classified according to their use of headache preventive medication, as current users, coincident users (using effective medications for other medical reasons), lapsed users (had used in the past but not at the time of the survey), or never users. In 162,576 participants, the prevalence of migraine was 17.1% in women and 5.6% in men. Only 56.2% of those with migraine had ever received a medical diagnosis. Ninety-eight percent of the migraineurs used acute treatment for their migraine attacks. Forty-nine percent (49%) usually used over-the-counters, 20% usually used prescription medications, and 29% used both. Only 12.4% of migraineurs indicated that they were taking a migraine preventive medication, but 17.2% were using medications with potential antimigraine effects for other medical reasons. Current or past use of preventive medication was more likely in women than men (odds ratio [OR] = 1.37, 95% confidence interval [CI] 1.27-1.48), increased with age and individuals with high MIDAS grade (Grade IV vs I, OR 2.35, 95% CI 2.09-2.64). Preventive medication use increased with awareness of migraine and with illness severity. Migraine remains undertreated in the US population. Barriers to preventive treatment are greater in younger age groups, men, and people unaware that they have migraine.
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Objectives.— To estimate the prevalence and distribution of chronic migraine (CM) in the US population and compare the age- and sex-specific profiles of headache-related disability in persons with CM and episodic migraine. Background.— Global estimates of CM prevalence using various definitions typically range from 1.4% to 2.2%, but the influence of sociodemographic factors has not been completely characterized. Methods.— The American Migraine Prevalence and Prevention Study mailed surveys to a sample of 120,000 US households selected to represent the US population. Data on headache frequency, symptoms, sociodemographics, and headache-related disability (using the Migraine Disability Assessment Scale) were obtained. Modified Silberstein–Lipton criteria were used to classify CM (meeting International Classification of Headache Disorders, second edition, criteria for migraine with a headache frequency of ≥15 days over the preceding 3 months). Results.— Surveys were returned by 162,756 individuals aged ≥12 years; 19,189 individuals (11.79%) met International Classification of Headache Disorders, second edition, criteria for migraine (17.27% of females; 5.72% of males), and 0.91% met criteria for CM (1.29% of females; 0.48% of males). Relative to 12 to 17 year olds, the age- and sex-specific prevalence for CM peaked in the 40s at 1.89% (prevalence ratio 4.57; 95% confidence interval 3.13-6.67) for females and 0.79% (prevalence ratio 3.35; 95% confidence interval 1.99-5.63) for males. In univariate and adjusted models, CM prevalence was inversely related to annual household income. Lower income groups had higher rates of CM. Individuals with CM had greater headache-related disability than those with episodic migraine and were more likely to be in the highest Migraine Disability Assessment Scale grade (37.96% vs 9.50%, respectively). Headache-related disability was highest among females with CM compared with males. CM represented 7.68% of migraine cases overall, and the proportion generally increased with age. Conclusions.— In the US population, the prevalence of CM was nearly 1%. In adjusted models, CM prevalence was highest among females, in mid-life, and in households with the lowest annual income. Severe headache-related disability was more common among persons with CM and most common among females with CM.
Article
Objective.—A population-based survey was conducted in 1999 to describe the patterns of migraine diagnosis and medication use in a representative sample of the US population and to compare results with a methodologically identical study conducted 10 years earlier. Methods.—A survey mailed to a panel of 20 000 US households identified 3577 individuals with severe headache meeting a case definition for migraine based on the International Headache Society (IHS) criteria. Those with severe headache answered questions regarding physician diagnosis and use of medications for headache as well as headache-related disability. Results.—A physician diagnosis of migraine was reported by 48% of survey participants who met IHS criteria for migraine in 1999, compared with 38% in 1989. A total of 41% of IHS-defined migraineurs used prescription drugs for headaches in 1999, compared with 37% in 1989. The proportion of IHS-defined migraineurs using only over-the-counter medications to treat their headaches was 57% in 1999, compared with 59% in 1989. In 1999, 37% of diagnosed and 21% of undiagnosed migraineurs reported 1 to 2 days of activity restriction per episode (P<.001); 38% of diagnosed and 24% of undiagnosed migraineurs missed at least 1 day of work or school in the previous 3 months (P<.001); 57% of diagnosed and 45% of undiagnosed migraineurs experienced at least a 50% reduction in work/school productivity (P<.001). Conclusions.— Diagnosis of migraine has increased over the past decade. Nonetheless, approximately half of migraineurs remain undiagnosed, and the increased rates of diagnosis of migraine have been accompanied by only a modest increase in the proportion using prescription medicines. Migraine continues to cause significant disability whether or not there has been a physician diagnosis. Given the availability of effective treatments, public health initiatives to improve patterns of care are warranted.
Article
Migraine headaches are often disabling but usually responsive to treatment. Nonetheless, many people with migraine never consult a doctor for headaches. In a sample of the US population, we sought to determine the proportion of active migraineurs who ever consulted a doctor for headache and to identify the headache characteristics and sociodemographic factors associated with consulting. A mailed questionnaire survey was sent to 15,000 US households, selected from a panel to be representative of the US population. Of 20,468 eligible respondents ranging in age from 12 to 80 years, 2479 met a case definition for migraine. We mailed a second questionnaire to all migraineurs identified on the first survey and achieved a 69.4% response rate. The second survey assessed headache characteristics, patterns of medical care use, medication use, and method of payment for health care. Sixty-eight percent of female and 57% of male migraineurs reported having ever consulted a doctor for headache. Consultation was more likely with increasing age and in women who ever married. In females, several headache characteristics including pain intensity, number of migraine symptoms, attack duration, and disability were associated with consultation. Of those who never consult, 61% report severe or very severe pain and 67% report severe disability or the need for bed rest with their headaches. The results of this survey indicate that a significant proportion of migraine sufferers never consult doctors for their headaches. Given that a large proportion of persons who never consult report high levels of pain and disability, these data suggest that there are opportunities to appropriately increase health care utilization for migraine. Given that 40% of migraineurs who have ever consulted do not report a physician diagnosis of migraine, there is a need to improve headache diagnosis and/or doctor-patient communication about migraine.
Article
Although headache is a common emergency department (ED) chief complaint, the role of the ED in the management of primary headache disorders has rarely been assessed from a population perspective. We determined frequency of ED use and risk factors for use among patients suffering severe headache. As part of the American Migraine Prevalence and Prevention study, a validated self-administered questionnaire was mailed to 24,000 severe headache sufferers, who were randomly drawn from a larger sample constructed to be sociodemographically representative of the US population. Participants were asked a series of questions on headache management, healthcare system use, sociodemographic features, and number of ED visits for management of headache in the previous 12 months. In keeping with the work of others, "frequent" ED use was defined as a participant's report of 4 or more visits to the ED for treatment of a headache in the previous 12 months. Headaches were categorized into specific diagnoses using a validated methodology. Of 24,000 surveys, 18,514 were returned, and 13,451 (56%) provided complete data on ED use. Sociodemographic characteristics did not differ substantially between responders and nonresponders. Among the 13,451 responders, over the course of the previous year, 12,592 (94%) did not visit the ED at all, 415 (3%) visited the ED once, and 444 (3%) visited the ED more than once. Patients with severe episodic tension-type headache were less likely to use the ED than patients with severe episodic migraine (OR 0.4 [95% CI: 0.3, 0.6]). Frequent ED use was reported by 1% of the total sample or 19% (95% CI: 17%, 22%) of subjects who used the ED in the previous year, although frequent users accounted for 51% (95% CI: 49%, 53%) of all ED visits. Predictors of ED use included markers of disease severity, elevated depression scores, low socioeconomic status, and a predilection for ED use for conditions other than headache. Most individuals suffering severe headaches do not use the ED over the course of a single year. The majority of ED visits for severe headache are accounted for by a small subset of all ED users. Increasing disease severity and depression are the most readily addressable factors associated with ED use.
Article
To investigate the contribution of comorbidity to health utilization and negative health perception in a large-scale population-based study. Comorbidity of headache with physical and mental disorders has been reported frequently in clinical samples. This concern was addressed using combined 6-year data from the 1999 to 2004 National Health Examination and Nutrition Survey (n = 31,126 adults), nationally representative datasets of the US population. Measures of physical disorders were based on standardized interviews of chronic conditions, and mental disorders were assessed by the Composite International Diagnostic Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. The 3-month prevalence of severe headaches or migraine in the US general population was 22.73%, with females and young adults having greater rates than males and older adults. Adults with headache had increased odds for a variety of physical disorders (including asthma, rheumatoid arthritis, and stroke) and mental disorders (including depression, generalized anxiety disorder, and panic disorder). Adults with headache were more likely to rate their health as "fair or poor" (17.9% versus 6.1%), to seek health care four or more times in a year (43.3% versus 22.7%), and to endorse physical and mental limitations. Health utilization and negative health perception were more strongly influenced by comorbid mental disorders than physical disorders. The results from this nationally representative sample provide new information on the interrelationships of headache with mental and physical disorders. The greater impact of comorbid mental compared with physical disorders on healthcare utilization and health perception has important implications for the clinical evaluation and treatment of headache in the population.
Article
1) To reassess the prevalence of migraine in the United States; 2) to assess patterns of migraine treatment in the population; and 3) to contrast current patterns of preventive treatment use with recommendations for use from an expert headache panel. A validated self-administered headache questionnaire was mailed to 120,000 US households, representative of the US population. Migraineurs were identified according to the criteria of the second edition of the International Classification of Headache Disorders. Guidelines for preventive medication use were developed by a panel of headache experts. Criteria for consider or offer prevention were based on headache frequency and impairment. We assessed 162,576 individuals aged 12 years or older. The 1-year period prevalence for migraine was 11.7% (17.1% in women and 5.6% in men). Prevalence peaked in middle life and was lower in adolescents and those older than age 60 years. Of all migraineurs, 31.3% had an attack frequency of three or more per month, and 53.7% reported severe impairment or the need for bed rest. In total, 25.7% met criteria for "offer prevention," and in an additional 13.1%, prevention should be considered. Just 13.0% reported current use of daily preventive migraine medication. Compared with previous studies, the epidemiologic profile of migraine has remained stable in the United States during the past 15 years. More than one in four migraineurs are candidates for preventive therapy, and a substantial proportion of those who might benefit from prevention do not receive it.
Article
Probable migraine (PM) is a prevalent migraine subtype fulfilling all but one criterion for migraine with or without aura. The aims of this study were: (i) to describe the epidemiology, medical recognition and patterns of treatment for PM in the USA; (ii) to compare the patterns of preventive PM treatment in the population with expert panel guidelines for preventive treatment. A validated self-administered headache questionnaire was mailed to a random sample of 120,000 US households. Subjects were classified as PM according to the second edition of the International Classification of Headache Disorders (ICHD-2). The questionnaire also assessed patterns of migraine treatment. Guidelines for preventive medication use were developed by a panel of headache experts, who used headache frequency and impairment to assess the need for preventive therapy and the gap between current and ideal use. Our sample consisted of 162 576 individuals aged > or = 12 years. The 1-year period prevalence of PM was 4.5% (3.9% in men and 5.1% in women). In women and men, prevalence was higher in middle life, between the ages of 30 and 59 years. The prevalence of PM was significantly higher in African-Americans than in Whites (female 7.4% vs. 4.8%; male 4.8% vs. 3.7%) and inversely related to household income. During their headaches, most (48.2%) had at least some impairment, while 22.1% were severely disabled. The vast majority (97%) of PM sufferers used acute treatments, although 71% usually treated with over-the-counter medication. Most PM sufferers (52.8%) never used a migraine-preventive treatment and only 7.9% were currently using preventive medication. According to the expert panel guidelines, prevention should be offered (16.9%) or considered (11.5%) for 28.4% of the PM sufferers in the survey. We conclude that PM is a frequent, undertreated, sometimes disabling disorder. It has an epidemiological profile similar to migraine. In contrast to migraine, which is less prevalent in African-Americans than in Whites, PM is more prevalent in African-Americans than in Whites. In the USA, many with PM do not receive adequate treatment.
Patterns of diagnosis and acute and preventive treatment for migraine in the
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With Special Feature on Socioeconomic Status and Health
National Center for Health Statistics. National Health Interview Survey, 2011: With Special Feature on Socioeconomic Status and Health. Hyattsville, MD: Public Health Service; 2012.
National Ambulatory Medical Care Survey and National Hospital Ambulatory Care Survey
National Center for Health Statistics. National Ambulatory Medical Care Survey and National Hospital Ambulatory Care Survey, 2009. Hyattsville, MD: Public Health Service; 2010.
Patterns of diagnosis and acute and preventive treatment for migraine in the US-AMPP
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