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Abstract

In this paper we introduce the design and technical implementation of the citizen science project Migraine Radar. The goal of the project is to establish a large collection of migraine attack data in order to explore the trigger factors of migraine attacks. A main focus is the investigation of the influence of environmental factors like weather or changes in the geomagnetic activity on the frequency of migraine attacks. After registering with the project, participants report their migraine attack data using a web app or one of the smartphone apps implemented for Android and iOS. As a benefit, the system serves as a personal headache calendar and participants have access to statistics and individualized reports about their attacks. For scientific analysis the data are pre-processed and provided to the researchers in an anonymized way.

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... As mentioned above we use a web app and a smartphone app to record the attacks. The overall system is described in [13]. The recording mask is presented in the supplementary material to this publication. ...
... We thus received the informed consent of all participants in the study. As described in [13], no data analysis starts directly from the migraine attack database. Instead, all necessary attack data are extracted from the database while skipping the link to the email address. ...
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Background The aim of this work is to analyze the reports on cluster headache attacks collected online in the citizen science project CLUE with respect to the effectiveness of drugs taken during the attacks. The collection of data within the framework of citizen science projects opens up the possibility of investigating the effectiveness of acute medication on the basis of a large number of individual attacks instead of a simple survey of patients. Methods Data from 8369 cluster headache attacks, containing information about acute medication taken and the assessment of its effect, were collected from 133 participants using an online platform and a smartphone app. Chi-square tests were used to investigate whether the effect of the three recommended acute drugs differs when distinguishing between participants with chronic or episodic cluster headache. Furthermore, it was investigated whether there are differences between smokers and non-smokers in the assessment of the effect of the acute medication. Results Our participants rated the effectiveness of sumatriptan 6 mg s.c. as significantly better than oxygen and zolmitriptan nasal spray. Oxygen is considered to be significantly better in episodic versus chronic cluster headache, and sumatriptan is considered to be significantly better in chronic versus episodic cluster headache. Smokers rate the effect of oxygen as significantly better than non-smokers. Conclusions Despite some methodological limitations, web-based data collection is able to support findings from clinical trials in a real world setting about effectiveness of acute cluster headache treatment in several situations.
... The migraine attacks relevant for the study have been collected since 2015. 8 Participants could register and take part in the project at any time and then start reporting their migraine attacks. During the registration process, participants were informed about privacy issues and gave their consent to participate. ...
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Background The aim of this work is to analyze reports of migraine attacks collected online in the citizen science project CLUE with respect to gender- and migraine type-specific differences in drug effectiveness and pain perception. Citizen science project data collection opens the possibility to examine these differences based on a large number of individual attacks instead of a simple survey of patients. Methods One thousand three hundred and ninety four participants reported 47,274 migraine attacks via an online platform and smartphone apps. The reports contained information on the acute medications taken, the evaluation of their effect, and information on pain parameters such as pain intensity, origin, and localization. Chi-square tests were used to investigate whether the effect of acute medications and pain parameters differed when collated by gender and migraine type (migraine with and without aura). Results Our participants rated the effectiveness of triptans as significantly better than that of ibuprofen. For triptans, significant differences in effectiveness were found when migraine types were distinguished, but no difference was found between genders. For ibuprofen, there were no differences between migraine types but significant differences between gender groups. Examination of pain parameters reveals differences between groups in pain intensity, pain origin, and pain location. The differences are statistically significant, but the effects are small. Conclusions Despite some methodological limitations, web-based data collection is able to support findings from clinical trials in a real-world setting. Due to the high numbers of participants included and attacks reported, even small differences in medication efficacy and pain parameters between the groups considered can be demonstrated to be statistically significant.
... The purpose of this work is the analysis of migraine attack reports collected online within the project Migraine Radar (https:// www.migraene-radar.de) 9 in respect to the distribution of the migraine attacks over the week on a single-participant level. ...
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Long-term community resilience, which privileges a long view look at chronic issues influencing communities, has begun to draw more attention from city planners, researchers and policymakers. In Phoenix, resilience to heat is both a necessity and a way of life. In this paper, we attempt to understand how residents living in Phoenix experience and behave in an extreme heat environment. To achieve this goal, we introduced a smartphone application (ActivityLog) to study spatio-temporal dynamics of human interaction with urban environments. Compared with traditional paper activity log results we have in this study, the smartphone-based activity log has higher data quality in terms of total number of logs, response rates, accuracy, and connection with GPS and temperature sensors. The research results show that low-income residents in Phoenix mostly stay home during the summer but experience a relatively high indoor temperature due to the lack/low efficiency of air-conditioning (AC) equipment or lack of funds to run AC frequently. Middle-class residents have a better living experience in Phoenix with better mobility with automobiles and good quality of AC. The research results help us better understand user behaviors for daily log activities and how human activities interact with the urban thermal environment, informing further planning policy development. The ActivityLog smartphone application is also presented as an open-source prototype to design a similar urban climate citizen science program in the future.
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In 1991 the Clinical Trials Subcommittee of the International Headache Society (IHS) published its first edition of the Guidelines on controlled trials of drugs in migraine (1). The Guidelines’ overarching goal was to improve ‘the quality of controlled clinical trials in migraine’, which could be achieved by using scientifically robust methods of clinical research. The report highlighted the complex nature of migraine clinical trial methodologies and offered a road map to clinical investigators who were interested in the field. The Migraine Guidelines were adopted widely (2–7), although – for a variety of reasons, including regulatory restrictions – not universally (8–11), and this was the impetus for the development of similar guidelines for tension-type headache (12,13) and for cluster headache (14). The second edition of the guidelines was published in 2000 (15) and, based on the second edition, the European Medicines Agency published in 2007 ‘Guidelines on Clinical Investigation of Medicinal Products for the Treatment of Migraine’ (16). Have investigators then followed the recommendations in these guidelines for randomized controlled trials (RCTs)? Unlike the case of RCTs for migraine prevention where the recommended primary efficacy measure of migraine attack frequency was used in 72% of 52 RCTs (17), adherence to the recommendations in the guidelines for acute migraine treatment has not been overwhelming. Indeed, the recommended measure of freedom from pain after 2 h was the primary efficacy measure in 31% of 145 acute RCTs between 2002 and 2008 (17). Instead, headache relief after 2 h (a decrease from moderate or severe to none or mild) was used in 39% of such trials. Notwithstanding, the proportion of RCTs using pain freedom as the primary efficacy measure has continued to increase over time (17), and is even used in recent large clinical trials (18–21). Following the publication of the IHS Clinical Trials Guidelines, several clinical drug development programmes emerged, notably for acute migraine (e.g. 5- HT1B/D agonists, triptans) and for prevention (e.g. topiramate). The majority of these RCTs were performed mainly for registration purposes (16). This exponential increase in migraine clinical research, the accumulating experience of clinical researchers and the pharmaceutical industry alike, and the trend towards large multi-centre and multi-national studies, call for a timely revisit and a refresh of the original guidelines and their second edition. The third edition of Migraine Clinical Trials Guidelines is a consensus summary that was developed by experts in the field, and its purpose is to recommend a contemporary, standardized, and evidence-based approach to the conduct and reporting of migraine RCTs. Broader discussions of clinical trials methodologies can be found elsewhere (22–30). Also, ethical considerations in migraine clinical research have been published separately (31). Finally, it should be noted that the revised Guidelines represent Research Practice Parameters and are the highest level in the hierarchy of Evidence-Based Recommendations in the absence of published Standards of Research Practice. Therefore, the IHS endorses the adherence to the Guidelines unless there is scientific justification for deviations from the recommendations. The Third Edition of The Migraine Clinical Trials Guidelines is organized similarly to the previous two editions. Notably, RCTs for acute attacks of migraine are addressed in the first section of these guidelines and are followed by discussions and recommendations relating to RCTs for migraine prevention, including short-term prophylaxis or ‘mini-prophylaxis’ for predictable migraine attacks, such as those associated with menses (32). Sub-sections include: patient selection, trial design, evaluation of results and statistics. A toolbox for each type of trial (acute and prevention) is provided at the end. R 1. IHS. Guidelines for controlled trials of drugs in migraine. First edition. International Headache Society Committee on Clinical Trials in Migraine. Cephalalgia 1991; 11: 1–12. 2. Schoenen J and Sawyer J. Zolmitriptan (Zomig, 311C90), a novel dual central and peripheral 5HT1B/1D agonist: an overview of efficacy. Cephalalgia 1997; 17(Suppl 18): 28–40. 3. Rolan PE and Martin GR. Zolmitriptan: a new acute treatment for migraine. Expert Opin Investig Drugs 1998; 7: 633–652. 4. Dahlof C and Lines C. Rizatriptan: a new 5-HT1B/1D receptor agonist for the treatment of migraine. Expert Opin Investig Drugs 1999; 8: 671–685. 5. Dooley M and Faulds D. Rizatriptan: a review of its efficacy in the management of migraine. Drugs 1999; 58: 699–723. 6. Spencer CM, Gunasekara NS and Hills C. Zolmitriptan: a review of its use in migraine. Drugs 1999; 58: 347–374. 7. Saxena P and Tfelt-Hansen P. Triptans, 5HT1B/1D agonists in the acute treatment of migraine. In: Olesen J, Goadsby PJ, Ramadan NM, Tfelt-Hansen P, Welch KMA (eds) The headaches. Vol. 3, Philadelphia: Lippincott Williams & Wilkins, 2006, pp.469–503. 8. Pilgrim AJ. Methodology of clinical trials of sumatriptan in migraine and cluster headache. Eur Neurol 1991; 31: 295–299. 9. Dechant KL and Clissold SP. Sumatriptan. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in the acute treatment of migraine and cluster headache. Drugs 1992; 43: 776–798. 10. Plosker GL and McTavish D. Sumatriptan. A reappraisal of its pharmacology and therapeutic efficacy in the acute treatment of migraine and cluster headache. Drugs 1994; 47: 622–651. 11. Perry CM and Markham A. Sumatriptan. An updated review of its use in migraine. Drugs 1998; 55: 889–922. 12. IHS. Guidelines for trials of drug treatments in tensiontype headache. First edition: International Headache Society Committee on Clinical Trials. Cephalalgia 1995; 15: 165–179. 13. Bendtsen L, Bigal ME, Cerbo R, et al. Guidelines for controlled trials of drugs in tension-type headache: second edition. Cephalalgia 2010; 30: 1–16. 14. Lipton RB, Micieli G, Russell D, et al. Guidelines for controlled trials of drugs in cluster headache. Cephalalgia 1995; 15: 452–462. 15. Tfelt-Hansen P, Block G, Dahlof C, et al. Guidelines for controlled trials of drugs in migraine: second edition. Cephalalgia 2000; 20: 765–786. 16. EMEA CFMPFHU. Guideline on clinical investigation of medicinal products for the treatment of migraine. Vol 2011. London, 2007. 17. Hougaard A and Tfelt-Hansen P. Are the current IHS guidelines for migraine drug trials being followed? J Headache Pain 2010; 11: 457–468. 18. Ho TW, Mannix LK, Fan X, et al. Randomized controlled trial of an oral CGRP receptor antagonist, MK- 0974, in acute treatment of migraine. Neurology 2008; 70: 1304–1312. 19. Ho TW, Ferrari MD, Dodick DW, et al. Efficacy and tolerability of MK-0974 (telcagepant), a new oral antagonist of calcitonin gene-related peptide receptor, compared with zolmitriptan for acute migraine: a randomised, placebo-controlled, parallel-treatment trial. Lancet 2008; 372: 2115–2123. 20. Connor KM, Shapiro RE, Diener HC, et al. Randomized, controlled trial of telcagepant for the acute treatment of migraine. Neurology 2009; 73: 970–977. 21. Tfelt-Hansen P. Pain freedom at 2 hours in migraine after telcagepant 300 mg. CNS Drugs 2011; 25: 269–270. 22. Good C. The principles and practice of clinical trials. Edinburgh: Churchill Livingstone, 1976. 23. Pocock S. Clinical trials. A practical approach. Chichester: John Wiley & Sons, 1984. 24. Meinert C. Clinical trials: design, conduct, and analysis. Oxford: Oxford University Press, 1986. 25. Spilker B. Guide to clinical trials. New York: Raven Press, 1991. 26. Olesen J, Krabbe AA and Tfelt-Hansen P. Methodological aspects of prophylactic drug trials in migraine. Cephalalgia 1981; 1: 127–141. 27. Gerber WD, Soyka D, Niederberger U and Haag G. [Problems in and approaches to the design and evaluation of therapeutic studies in patients with headache.]. Schmerz 1987; 1: 81–91. 28. Tfelt-Hansen P and Olesen J. Methodological aspects of drug trials in migraine. Neuroepidemiology 1985; 4: 204–226. 29. Olesen J and Tfelt-Hansen P. Methodology of migraine trials. In: Orgogozo J-M, Capildeo R (eds) Methods in clinical trials in neurology. Vascular and degenerative brain disease. London: Macmillan, 1988, pp.85–109. 30. Lipton RB. Methodologic issues in acute migraine clinical trials. Neurology 2000; 55: S3–S7. 31. IHS. Ethical issues in headache research and management: report and recommendations of the ethics subcommittee of the International Headache Society. Cephalalgia 1998; 18: 505–529. 32. MacGregor EA. "Menstrual" migraine: towards a definition. Cephalalgia 1996; 16: 11–21.
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This study, which is a part of the initiative 'Lifting The Burden: The Global Campaign to Reduce the Burden of Headache Worldwide', assesses and presents all existing evidence of the world prevalence and burden of headache disorders. Population-based studies applying International Headache Society criteria for migraine and tension-type headache, and also studies on headache in general and 'chronic daily headache', have been included. Globally, the percentages of the adult population with an active headache disorder are 46% for headache in general, 11% for migraine, 42% for tension-type headache and 3% for chronic daily headache. Our calculations indicate that the disability attributable to tension-type headache is larger worldwide than that due to migraine. On the World Health Organization's ranking of causes of disability, this would bring headache disorders into the 10 most disabling conditions for the two genders, and into the five most disabling for women.
Article
Cluster headache causes severe unilateral temporal or periorbital pain, lasting 15 to 180 minutes and accompanied by autonomic symptoms in the nose, eyes, and face. Headaches often recur at the same time each day during the cluster period, which can last for weeks to months. Some patients have chronic cluster headache without remission periods. The pathophysiology of cluster headache is not fully understood, but may include a genetic component. Cluster headache is more prevalent in men and typically begins between 20 and 40 years of age. Treatment focuses on avoiding triggers and includes abortive therapies, prophylaxis during the cluster period, and long-term treatment in patients with chronic cluster headache. Evidence supports the use of supplemental oxygen, sumatriptan, and zolmitriptan for acute treatment of episodic cluster headache. Verapamil is first-line prophylactic therapy and can also be used to treat chronic cluster headache. More invasive treatments, including nerve stimulation and surgery, may be helpful in refractory cases.
Article
sGeomagnetic activity, the frequency and intensity of magnetic disturbance, is supposed to indicate the influence of solar corpuscularadiation on the Earth. Various schemes for measuring the fluctuations of this phenomenon are in operation, but in connection with direct ionospheric studies by radio methods it was found necessary to provide a new scheme using smaller time-units than a day or half a day. A threehour-range index/ ( based on the "Potsdarner erdmagnetische Kennziffer " was therefore provisionally adopted by the International Association of Terrestrial Magnetism and Electricity, at Washington, D.C., U.S. A., in September 1939. Each collaborating observatory is to assign, to each three-hour interval beginning at 0 h, 3 •,... etc. GMT, one of the integers 0 to 9 as range-index/(; their averages/in, carried to half-units, express the new measure. Scales for K are determined by assimilation of frequencycurves so that each observatory, within a year, for instance, has approximately the same number of intervals with K=O, or with K = 1, etc. The principles and the practice of scaling / ( are described. The magnetic variations are regarded as superpositions of K-variations (to be measured), and of non-K-variations (such as regular daily variations
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Many factors trigger migraine attacks. Weather is often reported to be one of the most common migraine triggers. However, there is little scientific evidence about the underlying mechanisms and causes. In our pilot study, we used smartphone apps and a web form to collect around 4,700 migraine messages in Germany between June 2011 and February 2012. Taking interdiurnal temperature changes as an indicator for changes in the prevailing meteorological conditions, our analyses were focused on the relationship between temperature changes and the frequency of occurrence of migraine attacks. Linear trends were fitted to the total number of migraine messages with respect to temperature changes. Statistical and systematic errors were estimated. Both increases and decreases in temperature lead to a significant increase in the number of migraine messages. A temperature increase (decrease) of 5 °C resulted in an increase of 19 ± 7 % (24 ± 8 %) in the number of migraine messages.
Article
Cluster headache is a trigemino-autonomic cephalgia with a low prevalence. Several population-based studies on its prevalence and incidence have been performed, but with different methodology resulting in different figures. We analysed all available population-based epidemiological studies on cluster headache and compared the data in a meta-analysis. The pooled data showed a lifetime prevalence of 124 per 100,000 [confidence interval (CI) 101, 151] and a 1-year prevalence of 53 per 100,000 (CI 26, 95). The overall sex ratio was 4.3 (male to female), it was higher in chronic cluster headache (15.0) compared with episodic cluster headache (3.8). The ratio of episodic vs. chronic cluster headache was 6.0. Our analysis revealed a relatively stable lifetime prevalence, which suggests that about one in 1000 people suffers from cluster headache, the prevalence being independent of the region of the population study. The sex ratio (male to female) is higher than published in several patient-based epidemiological studies.
London, UK, P. Peregrinus Ltd/The Institution of Electrical Engineers
  • K Davies
K. Davies. Ionospheric Radio, IEE Electromagnetic Waves Series, Volume 31. London, UK, P. Peregrinus Ltd/The Institution of Electrical Engineers, pp. 50, online: books.google.de/books?id=qdWUKSj5PCcC, 1990.