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Results of a web-based questionnaire: A gender-based study of migraine with and without aura and possible differences in pain perception and drug effectiveness

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  • Headache Center Frankfurt

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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.
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Original Article
Results of a web-based questionnaire: A
gender-based study of migraine with
and without aura and possible differences in
pain perception and drug effectiveness
Johannes Drescher
1,2
, Tina Katharina Amann
1
, Charly Gaul
3
,
Peter Kropp
2
, Yannic Siebenhaar
1
, and Jo
¨rg Scheidt
1
Abstract
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.
Keywords
citizen science, ibuprofen, pain intensity, pain onset, pain origin, triptan
Date received: 23 June 2021; Received revised October 22, 2021; accepted: 1 November 2021
Introduction
Collecting health data as part of citizen science projects
using modern technologies such as smartphone or web apps
makes it possible to conduct studies with a larger number of
participants over a longer period of time and on a more
transregional basis than is possible in the context of con-
ventional medical studies. In research of headache disor-
ders, for example, it is thus possible to record and evaluate
1
Institute of Information Systems, University of Applied Sciences Hof, Hof,
Germany
2
Institute of Medical Psychology and Medical Sociology, University of
Rostock, Rostock, Germany
3
Headache Center Frankfurt, Frankfurt, Germany
Corresponding author:
Jo
¨rg Scheidt, Institute of Information Systems, University of Applied
Sciences Hof, Alfons-Goppel-Platz 1, 95028 Hof, Germany.
Email: jscheidt@acm.org
Cephalalgia Re ports
Volume 4: 1–10
ªThe Author(s) 2021
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a large number of headache attacks in a large number of
participants. Data collection in a real-world scenario offers
a number of advantages over data collection via question-
naires, as data can be collected immediately during or after
the attacks. In addition, many clinical studies are limited to
patients of headache clinics, which may lead to a bias
toward severely affected headache patients.
Results from the citizen science project CLUE (CLUs-
terkopfschmerz Erforschen) are presented in this article.
Migraine attacks are investigated with regard to differ-
ences in the assessment of drug effectiveness as well as
differences in reported pain parameters in different parti-
cipant groups. Distinction is made with regard to the
migraine disease—migraine with aura (MA) and migraine
without aura (MO)—and with regard to the gender of the
participants.
Some studies report data on clinical characteristics of
migraine attacks
1,2,3
in terms of pain intensity, accompany-
ing symptoms, and duration of attacks between MA and MO,
others on the effects of placebos in both groups,
4
and two
focused on the effect of sumatriptan for attack treatment
5,6
and obtained conflicting results. Another study investigated
the effect of different triptans in women and men.
7
However, there are only few studies that consider not
only the intensity but also the origin, type and location of
pain for both groups. With the help of the CLUE research
project and the associated “Migraine Radar” app, numerous
migraine attacks have been recorded, thus creating a suit-
able database for those evaluations. However, it must be
considered that the recording of migraine attacks with the
help of the citizen science approach has some limitations
that will be discussed in detail in the context of this work.
Methods
The CLUE project
The CLUE project is a citizen science project to study
cluster headaches and migraines. Smartphone and web apps
have been used to collect data on headache attacks. Differ-
ent apps were developed for the diseases and adapted to the
signs and symptoms of the specific condition. The migraine
attacks relevant for the study have been collected since
2015.
8
Participants could register and take part in the proj-
ect 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. All data are anonymized for analysis.
The study was approved by the Ethics Committee of the
Medical Faculty of the University of Rostock (reference
number A 2017-0091).
Study design
The aim of the prospective study was to investigate differ-
ent pain parameters such as intensity, type, origin and
location as well as the effect of the medication taken
during the migraine attack. Analyses focused on identify-
ing differences in and between two main groups of partici-
pants: the gender (male/female) and the migraine type
(MA/MO) group.
Participants
Between January 1, 2015 and December 31, 2020, 84,501
migraine attacks were reported by 4,681 participants from
Germany, Austria and Switzerland. A standard headache
questionnaire using the diagnostic criteria of the Interna-
tional Classification of Headache Disorders (ICHD-3 beta)
was used to diagnose migraine.
9,10
Additionally, partici-
pants were asked if they experienced typical aura symp-
toms related to their headache attacks. The translation of
the wording in the query is: “At the onset of migraine
attacks, often before the headache, an aura may occur. Aura
symptoms are characterized by increasing and spreading
over minutes and then typically lasting 20–60 minutes.
Typical aura symptoms include an increasing flicker before
the eyes or an increasing restriction of the visual field, a
rising tingling sensation or numbness, for example, in the
arm. Do you suffer from such symptoms occasionally or
regularly in connection with your headaches?” The answer
to this question was used to classify the participant’s diag-
nosis as a migraine with aura or a migraine without aura.
The duration of a migraineur’s participation in the project
was calculated by the difference between the first and last
reported attack. Participants were included in our study if
they met the criteria to participate for at least 30 days and to
report not less than five migraine attacks. In addition, we
also ensured that the attacks considered were actually
migraine attacks. For this purpose, only those attacks that
met at least one of the typical accompanying symptoms
were considered. According to ICHD-3 beta, these are nau-
sea, vomiting, sensitivity to light and noise.
10
For compar-
ison of the effectiveness of individual drugs, only attacks in
which exactly one single drug was taken were observed.
Participants with chronic migraine were excluded. Partici-
pants who did not want to reveal the year of birth and
therefore chose the current year were also excluded from
the study.
Data collection
During the registration process, basic characteristics such
as gender, year of birth, place of residence, occupational
group (employed (full-time, part-time), not employed
(pupil or student, retired, unemployed)) and information
on shift work (shift work: yes or no) were collected. During
the study, the participants entered information for each
migraine attack on the onset and end of the attack, pain
characteristics (pulsing/throbbing, dull, sharp and others),
pain location and intensity (on a numerical pain scale
between 0 and 10 according to Hawker et al.
11
). The
2Cephalalgia Reports
participants also provided information on accompanying
symptoms (nausea, vomiting, sensitivity to light/sound/
odor, need for rest or movement, dizziness, etc.), medica-
tions taken and an assessment of their effectiveness, other
measures (resting and lying down, cooling down, caffeine
intake, etc.) and absence from work and cancellation of
planned activities.
The drugs taken were divided into eight classes (trip-
tans, ibuprofen, acetylsalicylic acid (ASA), paracetamol,
combination preparation, metamizole, tramadol or tilidine
and peppermint oil). Also “others” could be selected. A
differentiation of the individual drugs in the classes, for
example in the case of triptans, did not take place. The
effectiveness of acute medication was asked with the ques-
tion “improvement due to medication” and participants
could choose between “yes,” “no” and “little.”
Statistics
The data were analyzed using the R language and the R-
studio environment.
12
Chi-square tests were used to com-
pare the distribution of the participants to different groups
like gender or the different migraine headaches (MA, MO).
Welch’s t-test was used to compare the age distributions of
the several groups. Chi-square tests were used to compare
the effectiveness of drugs in different groups. The groups
could represent different drugs (e.g. triptans, ibuprofen) or
the gender of the participants (female or male). The effec-
tiveness of the drugs was divided into two classes (“yes”
and “little/no”) in accordance with Pearson et al.
13
The
duration of participation and the number of reported attacks
varied greatly among the participants. To ensure that indi-
vidual participants with a large number of reported attacks
do not dominate any result, the density distribution for each
participant was included in the calculation of the Chi-
square. The different number of attacks was then taken into
account when calculating the statistical error of the
components.
Results
Considering only those participants who met the require-
ments of at least 5 attacks within at least 30 participant
days, 47,274 migraine attacks of 1,394 participants remain.
These data include 36,366 attacks in females (18,264
migraine attacks with aura (MA)/18,102 attacks without
aura (MO)) and 10,908 attacks in males (5,697 MA/
5,211 MO).
For the study of pain parameters, we excluded the typ-
ical aura without headache by considering only attacks with
pain intensity greater than zero; 47,233 attacks fulfilled this
requirement. All these attack reports include—beside the
pain intensity—information about the pain type, origin
and location.
At least one drug was reported in 41,173 attacks.
Table 1 summarizes the key figures of the participants.
Table 2 divides the participants into migraine with aura and
migraine without aura.
Effectiveness of acute medication
In the examinations of the medications taken, only those
attacks are taken into account in which the participants
reported taking exactly one acute medication for pain con-
trol. This means that the stated effect could only be attrib-
uted to the one medication. After this restriction, 27,171
attacks remained. The drugs the participants could choose
from are shown in Figure 1. In addition, the figure contains
information on the number of participants who used the
respective drug. Since each participant can report attacks
with different drugs, the total number of participants in
Figure 1 is higher than the total number of participants
shown above. Attacks are only included in the further anal-
ysis if a participant reported at least five attacks with the
corresponding drug.
In the following, the analysis was limited to attacks with
triptans and ibuprofen because these two drugs are the most
commonly used and because only for these two there is a
sufficient number of reported attacks to analyze the data in
the groups considered.
First, the assessment of the effectiveness of the two drug
groups was examined. Figure 2 shows the assessment of the
Table 1. Participant characteristics.
Characteristic Participants* (N ¼1,394)
Gender
Female 1,153 (82.7%)
Male 241 (17.3%)
Age [years]
Mean +SD 41.1 +12.7
Range 10–78
Migraine headache
with aura 748 (53.7%)
without aura 646 (46.3%)
SD: standard deviation.
*Except for age.
Table 2. Division of participants into with aura and without aura.
Participants* (N ¼1,394)
Frequency
with aura
(MA)
without aura
(MO) Statistic
Gender
Female 612 (81.8%) 541 (83.7%) w
2
¼0.90
Male 136 (18.2%) 105 (16.6%) p¼0.34
Age [y], mean +SD 40.8 +12.2 41.6 +13.3 p¼0.27
SD: standard deviation.
*Except for age.
Drescher et al. 3
effectiveness of the drug triptan with its classification into
“yes,” “little” and “no” in the different groups.
Table 3 shows the results of the analysis. As mentioned
above, the effectiveness classes “little” and “no” were
merged into one class for the evaluation of the effects.
Looking at the effect of triptans and differentiating by
migraine type, statistically significant differences can be
found. In particular, it can be seen that MO migraineurs
perceive a better effect than MA patients. However, when
looking at the effect of triptans in relation to gender, there is
no difference.
These studies were carried out in the same way for the
drug ibuprofen. In this case, Figure 3 shows the effectiveness
of the drug ibuprofen and Table 4 shows the results of the
corresponding chi-square test.
Figure 1. Distribution of the medications for attacks with only one medication reported.
Figure 2. Assessment of the effectiveness of the drug triptan.
Table 3. Results of the assessment of the drug triptan in terms of
effectiveness as an acute medication.
Group Subgroup pValue OR
MO vs. MA <0.001*** 1.28
m: MO vs. MA 0.034* 1.35
w: MO vs. MA 0.001** 1.26
m vs. f 0.976
MA: m vs. f 0.750
MO: m vs. f 0.808
*p< 0.05, ** p< 0.01, *** p< 0.001
4Cephalalgia Reports
If a distinction is made between the groups of MA and
MO migraineurs, no statistically significant differences in
the effect of ibuprofen are found. However, there are
gender-specific differences in the drug ibuprofen, espe-
cially in the group of MA migraineurs. Among this group,
the effect is significantly better in men than in women.
Subsequently, the two drugs were compared to each
other. As can already be seen from Figure 2 compared to
Figure 3, participants rated the effect of triptan much better
than the effect of ibuprofen, regardless of which group was
considered. The corresponding pvalues and odds ratios are
summarized in Table 5.
Pain perception
First, the intensity of pain was examined. Attacks with an
intensity of 0 were excluded because they can only occur in
the MA group (attacks with an aura but without pain
phase). The different values cover the different levels
between freedom from pain and maximum pain. Figure 4
shows the distribution of the pain intensities in the groups
of participants. Different levels of pain are illustrated in the
same color to classify the intensities as mild (intensities 1
to 3), moderate (4 to 6), severe (7 and 8) and very severe
(9 and 10).
Slight differences can be observed between the groups.
For example, migraine attacks with aura seem to lead to a
trend to higher pain intensities. On average, migraine
attacks are perceived as slightly more severe by women
than by men. However, while most of the differences are
statistically not significant, trends can be seen. The results
are summarized in Table 6.
In addition, the indicated pain side was examined. The
participants had three different possibilities—only left-
sided, only right-sided and bilateral pain—to specify the
pain location. Figure 5 shows the distribution of the spec-
ified pain locations in the selected groups.
Again, there were statistically significant differences in
the groups considered. Table 7 shows the corresponding
results. With regard to the migraine types, there is a differ-
ence in the distributions, which is due to a significant dif-
ference in women, whereas no significant difference is
Table 5. Comparison of the assessment of the effectiveness
of triptans and ibuprofen using the latter as a reference when
calculating the odds ratio.
Group pValue OR
MA <0.001*** 3.59
MO <0.001*** 4.41
Male <0.001*** 2.75
Female <0.001*** 4.41
*p< 0.05, ** p< 0.01, *** p< 0.001.
Figure 3. Assessment of the effectiveness of the drug ibuprofen.
Table 4. Results of the assessment of the drug ibuprofen in terms
of effectiveness as an acute medication.
Group Subgroup pValue OR
MO vs. MA 0.652
m: MO vs. MA 0.539
w: MO vs. MA 0.484
m vs. f <0.001*** 1.60
MA: m vs. f <0.001*** 1.74
MO: m vs. f 0.029* 1.44
*p< 0.05, ** p< 0.01, *** p< 0.001.
Drescher et al. 5
Figure 4. Pain intensity of the attacks in the subgroups under investigation.
Figure 5. Pain location in the subgroups under investigation.
Table 6. Results from the analysis of pain intensities.
Group Subgroup pValue Mean Pain Intensity SD of Pain Intensity
MO vs. MA 0.076 5.71/5.80 1.11/1.27
m: MO vs. MA 0.056 5.45/5.74 1.23/1.52
w: MO vs. MA 0.255 5.75/5.82 1.08/1.21
m vs. f 0.095 5.61/5.79 1.41/1.15
MA: m vs. f 0.723 5.74/5.82 1.52/1.21
MO: m vs. f 0.024* 5.45/5.75 1.23/1.08
SD: standard deviation.
*p< 0.05, ** p< 0.01, *** p< 0.001.
6Cephalalgia Reports
found in men related to pain side. Additionally, men suffer
from bilateral pain more often than women.
We additionally examined the origin of the migraine
pain. The origin of the pain may be in the area of the head,
eyes or neck. Figure 6 shows the distributions, Table 8 the
results of the analysis.
The figure shows that the onset of pain around the eye is
less frequent in male MO migraineurs than in the other
groups. This results in statistically significant differences
in the comparison of the groups.
In addition, the type of pain was considered. Figure 7
shows the distributions in the investigated groups, Table 9
the results of the quantitative distinctions.
There is a significant difference in the proportions of
pain types in the group of male MO migraineurs—espe-
cially between the pain types dull and pulsating.
Discussion
We analyzed 47,274 migraine attacks in 1,394 participants
in terms of acute medication use and effectiveness. The
focus of all the analyses was to detect differences between
the genders and between the groups migraine with aura
(MA) and migraine without aura (MO).
In terms of medications, we found that triptans and ibu-
profen were by far the most commonly used acute medica-
tions among the participants in our sample.
Looking at the drugs individually and comparing the
participants’ assessment of their effectiveness in the sub-
groups considered, there are no differences in the effective-
ness of triptans between genders, which is in agreement
with the study of Franconi et al.
7
where 1,978 attacks in
346 participants were analyzed. The effect of triptans in
migraine without aura is estimated to be significantly better
than the effect in migraine with aura. This is in accordance
with the study of Hansen et al.
6
Figure 6. Pain origin in the subgroups under investigation.
Table 8. Results of the analysis of the reported pain origins (neck,
head, eye).
a
Group Subgroup pValue
MO vs. MA 0.001***
m: MO vs. MA <0.001***
w: MO vs. MA 0.033
m vs. f <0.001***
MA: m vs. f 0.037
MO: m vs. f <0.001***
a
The pvalues indicate the results for the comparison (chi-square tests) of
the distribution in the groups considered (see also Figure 6).
*p< 0.05, ** p< 0.01, *** p< 0.001.
Table 7. Results of the analysis of the pain location (only right,
only left, bilateral) reported by the participants.
a
Group Subgroup pValue
MO vs. MA <0.001***
m: MO vs. MA 0.860
w: MO vs. MA <0.001***
m vs. f <0.001***
MA: m vs. f <0.001***
MO: m vs. f <0.001***
a
The pvalues indicate the results for the comparison (chi-square tests) of
the distribution in the groups considered (see also Figure 5).
*p< 0.05, ** p< 0.01, *** p< 0.001.
Drescher et al. 7
Ibuprofen is considered to be equally effective in
migraine regardless of the presence of an aura, but there
is a difference between the genders: the attacks reported by
men suggest a better effect of ibuprofen compared to that
reported by women. This is in agreement with the study of
Walker and Carmody,
14
but there, the effect of ibuprofen
was measured in electrically induced pain.
Comparing the effects of the drugs with each other, the
effectiveness of triptans proved to be significantly better
than that of ibuprofen in all groups considered.
It is noteworthy that although triptans are recommended
for therapy of migraine attacks if they are severe and do not
adequately respond to analgesics or NSAIDS,
15
a large pro-
portion of attacks are treated with less effective drugs. This
could be because as a study has shown, about half of those
affected by headaches do not consult a doctor.
16
However,
three non-prescription triptans are now on the market, which
decouples the use of triptans from a doctor’s visit.
The following results were obtained for the pain para-
meters considered: Although the distribution of pain inten-
sity of the reported attacks showed minor differences in the
groups considered, the mean pain intensities were not sta-
tistically significantly different. This is consistent with
Davies et al.,
1
a questionnaire-based study in which 354
patients with MA and 397 patients with MO were included.
As far as the location of pain is concerned, significant
differences were found between the groups. It is noticeable
that women report bilateral pain much less frequently than
men. In addition, MO seems to lead to bilateral pain less
frequently than MA. The study by Rasmussen and Olesen
2
found evidence of this, but the difference was not statisti-
cally significant in their study, which was based on 38 MA
and 58 MO patients.
Examination of the origin of pain shows differences
between the genders, especially in the MO group. The
groups also differ significantly in the type of pain. It is
noticeable that quite a large proportion of participants
report dull pain.
Some limitations of this work have to be discussed. The
main weakness of this study is the way in which the data
were collected. Participants could join or leave the study at
any time. Even though a minimum participation period of
30 days was required, it cannotbe guaranteed that participants
actually reported all their attacks during this period. Selective
reporting by the participants could also not be ruled out.
In addition, the diagnosis of migraine was not confirmed
by a physician, but was merely based on a standard ques-
tionnaire. Although, as a precaution, only attacks with at
least one of the typical accompanying symptoms were
included, it cannot be ruled out that migraineurs who do
not suffer from migraine at all also participated.
Figure 7. Pain type in the subgroups under investigation.
Table 9. Results of the analysis of the reported pain types
(pulsating, dull, stabbing).
a
Group Subgroup pValue
MO vs. MA <0.001***
m: MO vs. MA <0.001***
w: MO vs. MA 0.045*
m vs. f <0.001***
MA: m vs. f 0.113
MO: m vs. f <0.001***
a
The pvalues indicate the results for the comparison (chi-square tests) of
the distribution in the groups considered (see also Figure 7).
*p< 0.05, ** p< 0.01, *** p< 0.001.
8Cephalalgia Reports
Another critical point is the fact that the presence of aura
was only self-reported by the participants and not con-
firmed by a medical diagnosis. This can lead to individual
participants mistaking perceptions for an aura that are not.
Of course, the results on the effectiveness of acute treat-
ments are not absolute because participants take the med-
ications they expect will help them. We do not have
information on which acute treatments a participant had
previously tried and may have found less helpful.
In addition, we examined the medications taken only in
groups; for example, we did not distinguish between dif-
ferent types of triptans or between different dosage forms.
Studies have shown that the dosage form can have a great
impact on the effectiveness of triptans, see e.g. Eiland and
Hunt
17
and Hou et al.
18
This publication addressed two questions: (1) Are there
gender-specific differences in the use and effect of acute
medication and pain parameters in migraine with and with-
out aura? (2) Can valid results be achieved with web-based
data collection, in which a large number of volunteers
report their migraine attacks nationwide and over a long
period of time?
The first question can be answered with yes. Various
differences were found in the groups considered.
Regarding the second question, it can be said that the
web-based collection of health data can be at least a good
complement to classical health studies. Due to the large
number of participants and attacks, many explorative stud-
ies are possible, but the weaknesses of the data collection
must always be taken into account. Results that seem inter-
esting should always be verified in conventional studies
that do not have the weakness of web-based data collection.
Key findings
The effect of triptans in migraine without aura is
estimated to be significantly better than the effect
in migraine with aura.
The effectiveness of triptans proved to be significantly
better than that of ibuprofen in all groups considered.
Web-based collection of health data can be at least a
good complement to classical health studies.
Declaration of conflicting interests
The author(s) declared the following potential conflicts of interest
with respect to the research, authorship, and/or publication of this
article: Dr Gaul has received honoraria for consulting and lectures
within the past 3 years from Allergan Pharma, Lilly Germany,
Novartis Pharma, Hormosan Pharma, Gru
¨nenthal, Sanofi-
Aventis, Weber & Weber, Lundbeck, Perfood and TEVA. He
does not hold any stocks of pharmaceutical companies. He is
honorary secretary of the German Migraine and Headache Soci-
ety. Dr Kropp has received honoraria for consulting and lectures
within the past 3 years from Allergan Pharma, Lilly Germany,
Novartis Pharma, and TEVA. All other authors declare that there
is no conflict of interest.
Ethics approval and consent to participate
The study was approved by the Ethics Committee of the Medical
Faculty of the University of Rostock (reference number A 2017-
0091). We confirm that all methods were performed in accor-
dance with the relevant guidelines and regulations.
Funding
The author(s) disclosed receipt of the following financial support
for the research, authorship, and/or publication of this article: This
work was supported by the German Federal Ministry of Education
and Research (BMBF—Project 01BF1701).
ORCID iD
Jo¨rg Scheidt https://orcid.org/0000-0001-9742-6080
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10 Cephalalgia Reports
... The results of all previous studies were obtained using self-reported questionnaires, and the studies did not directly determine attack frequencies during school and vacation periods. The CLUE research project directly determined migraine attacks, thereby creating a database for future studies [8,9]. ...
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This citizen science project CLUE compared the attack frequency between school and vacation periods among adolescents. The data collection process adopted in citizen science projects opens up the possibility of conducting analyses by including a large number of participants over a long period and across different regions. The data on 684 migraine attacks reported by 68 adolescents aged 16 to 19 years were collected using an online platform and smartphone apps. A Fisher’s exact test was used to compare the distributions of the migraine attack frequency during vacation and school periods in two different scenarios. In both scenarios, the attack frequency during school periods was significantly higher than that during vacation periods. The use of web-based data collection has some methodological limitations; however, it enabled the measurement of relative migraine attack frequency in students during vacation and school periods. The higher prevalence of migraine during school periods indicates the requirement of increasing headache awareness among children.
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Background: Headache sufferers in need of professional health care often do not utilize the care available, and factors influencing headache-specific physician consultation are not yet understood. Objectives of this study are (1) to assess self-reported headache-specific physician consultations and (2) to identify headache-related and sociodemographic predictors. Methods: Data of a random sample of the general population in Germany aged ≥14 years were analyzed (N = 2461). A multivariate binary logistic regression was conducted to identify a parsimonious model to predict physician consultation. Results: 50.7% of the participants with headache reported at least one headache-specific physician consultation during lifetime. Of these, 53.6% had seen one, 26.1% two, and 20.3% more than two physicians because of their headaches. The odds of physician consultation increased with the number of headache days per month (HDM) [(reference HDM < 1) HDM 1-3 (OR = 2.29), HDM 4-14 (OR = 2.41), and HDM ≥15 (OR = 4.83)] and increasing Headache Impact Test score (HIT-6) [(reference "no or little impact") moderate impact (OR = 1.74), substantial impact (OR = 3.01), and severe impact (OR = 5.08)]. Middle-aged participants were more likely to have consulted than younger and older ones [(reference 14-34 years) 35-54 years (OR = 1.90), 55-74 years (OR = 1.96), ≥75 years (OR = 1.02)]. The odds of physician consultation among self-employed subjects were lower than among employed manual workers (OR = 0.48). The living environment (rural versus urban) did not have an influence on the consultation frequency. Conclusion: The results indicate that apart from burden-related factors (headache frequency; headache impact), health care utilization patterns are also influenced by patients' occupational status and age. Further research is needed to analyze whether the lower consultation rate means that the self-employed have a higher risk of chronification or that they have more effective self-management strategies regarding headache.
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Objectives This study aimed to establish a pharmacodynamic model to quantitatively compare the efficacy characteristics of seven kinds of triptans and their different dosage forms in the treatment of acute migraines. Methods Clinical studies of triptans in the treatment of acute migraines were comprehensively searched in the public databases. Pharmacodynamic models were established to describe the dose-effect and time-course of each kind of triptan for the proportion of patients who became pain free or had pain relief. Results A total of 92 articles involving 47,376 subjects were included in the analysis. After eliminating the placebo effect, oral eletriptan (40 mg) had the highest efficacy among all oral drugs at the maximum approved dose, and the proportion of patients who became pain free and had pain relief were 30.9% and 37.9% at 2 h, respectively. However, oral naratriptan (2.5 mg) had the lowest efficacy, and the proportion of patients who became pain free and had pain relief was 10.3% and 21.6% at 2 h, respectively. The efficacy of subcutaneous administration was significantly higher than that of oral administration, and the efficacy of nasal spray administration was comparable to that of oral administration. Regarding the dose-effect, the efficacy of the sumatriptan nasal spray significantly increased within the FDA (Food and Drug Administration)-approved dose range. When the dose was increased from 5 to 20 mg of sumatriptan nasal spray, the proportion of patients who became pain free and had pain relief increased by 16.8% and 18.3% at 2 h, respectively. Regarding the time-course, the time of onset of subcutaneous sumatriptan (6 mg) was the fastest, and the fraction of patients who were pain free at 2 h accounted for 90.6% of that at 4 h. Conclusions This study evaluated the efficacy characteristics of seven kinds of triptans and their different dosage forms. The present findings provide necessary quantitative information for migraine medication guidelines.
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In collaboration with some of the leading headache centres in Germany, Switzerland and Austria, we have established new guidelines for the treatment of migraine attacks and the prevention of migraine. A thorough literature research of the last 10 years has been the basis of the current recommendations. At the beginning, we present therapeutic novelties, followed by a summary of all recommendations. After an introduction, we cover topics like drug therapy and practical experience, non-effective medication, migraine prevention, interventional methods, non-medicational and psychological methods for prevention and therapies without proof of efficacy.
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Objective To assess the effectiveness and adverse effects of acute cluster headache medications in a large international sample, including recommended treatments such as oxygen, commonly used medications such as opioids, and emerging medications such as intranasal ketamine. Particular focus is paid to a large subset of respondents 65 years of age or older. Background Large international surveys of cluster headache are rare, as are examinations of treatments and side effects in older cluster headache patients. This article presents data from the Cluster Headache Questionnaire, with respondents from over 50 countries and with the vast majority from the United States, the United Kingdom, and Canada. Methods This internet‐based survey included questions on cluster headache diagnostic criteria, which were used as part of the inclusion/exclusion criteria for the study, as well as effectiveness of medications, physical and medical complications, psychological and emotional complications, mood scores, and difficulty obtaining medications. The diagnostic questions were also used to create a separate group of respondents with probable cluster headache. Limitations to the methods include the use of nonvalidated questions, the lack of a formal clinical diagnosis of cluster headache, and the grouping of some medications (eg, all triptans as opposed to sumatriptan subcutaneous alone). Results A total of 3251 subjects participated in the questionnaire, and 2193 respondents met criteria for this study (1604 cluster headache and 589 probable cluster headache). Of the respondents with cluster headache, 68.8% (1104/1604) were male and 78.0% (1245/1596) had episodic cluster headache. Over half of respondents reported complete or very effective treatment for triptans (54%, 639/1139) and oxygen (54%, 582/1082). Between 14 and 25% of respondents reported complete or very effective treatment for ergot derivatives (dihydroergotamine 25%, 42/170; cafergot/ergotamine 17%, 50/303), caffeine and energy drinks (17%, 7/41), and intranasal ketamine (14%, 5/37). Less than 10% reported complete or very effective treatment for opioids (6%, 30/541), intranasal capsaicin (5%, 7/151), and intranasal lidocaine (2%, 5/241). Adverse events were especially low for oxygen (no or minimal physical and medical complications 99%, 1077/1093; no or minimal psychological and emotional complications 97%, 1065/1093), intranasal lidocaine (no or minimal physical and medical complications 97%, 248/257; no or minimal psychological and emotional complications 98%, 251/257), intranasal ketamine (no or minimal physical and medical complications 95%, 38/40; no or minimal psychological and emotional complications 98%, 39/40), intranasal capsaicin (no or minimal physical and medical complications 91%, 145/159; no or minimal psychological and emotional complications 94%, 150/159), and caffeine and energy drinks (no or minimal physical and medical complications 89%, 39/44; no or minimal psychological and emotional complications 91%, 40/44). This is in comparison to ergotamine/cafergot (no or minimal physical and medical complications 83%, 273/327; no or minimal psychological and emotional complications 89%, 290/327), dihydroergotamine (no or minimal physical and medical complications 81%, 143/176; no or minimal psychological and emotional complications 91%, 160/176), opioids (no or minimal physical and medical complications 76%, 416/549; no or minimal psychological and emotional complications 77%, 423/549), or triptans (no or minimal physical and medical complications 73%, 883/1218; no or minimal psychological and emotional complications 85%, 1032/1218). A total of 139 of 1604 cluster headache respondents (8.7%) were age 65 and older and reported similar effectiveness and adverse events to the general population. The 589 respondents with probable cluster headache reported similar medication effectiveness to respondents with a full diagnosis of cluster headache. Conclusions Oxygen is reported by survey respondents to be a highly effective treatment with few complications in cluster headache in a large international sample, including those 65 years or over. Triptans are also very effective with some side effects, and newer medications deserve additional study. Patients with probable cluster headache may respond similarly to acute medications as patients with a full diagnosis of cluster headache.
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Migraine headache is one of the most common primary headache disorders and is three times more prevalent in women than in men, especially during the reproductive ages. The neurobiological basis of the female dominance has been partly established. The present study aimed to investigate the effect of gender on the headache manifestations in migraine patients. The study group consisted of 2082 adult patients from five different hospitals' tertiary care-based headache clinics. The relationship between headache characteristics and gender was evaluated in migraine with aura (MwA) and migraine without aura (MwoA). The duration, severity, frequency of headache and associated symptoms were evaluated in both genders and age-dependent variations and analyzed in two subgroups. Women with migraine were prone to significantly longer duration and intensity of headache attacks. Nausea, phonophobia and photophobia were more prevalent in women. Median headache duration was also longer in women than in men in MwA (p = 0.013) and MwoA (p < 0.001). Median headache intensity was higher in women than in men in MwA (p = 0.010) and MwoA (p = 0.009). The frequency of nausea was significantly higher in women than in men in MwA (p = 0.049). Throbbing headache quality and associated features (nausea, photophobia, and phonophobia) were significantly more frequent in women than in men in MwoA. The gender impact varied across age groups and significant changes were seen in female migraineurs after age 30. No age-dependent variation was observed in male migraineurs. Gender has an influence on the characteristics of the headache as well as on the associated symptoms in migraine patients, and this impact varies across the age groups, particularly in women. © International Headache Society 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
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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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Background: The headache in migraine attacks may be caused by dilatation of certain cranial arteries or arteriovenous anastomoses, by neurogenic dural plasma extravasation, or by both of these mechanisms. Sumatriptan, a novel selective agonist of 5-hydroxytryptamine-like receptors, blocks these phenomena. We investigated its efficacy in migraine. Methods: We studied 639 patients with migraine attacks in a randomized, double-blind, placebo-controlled, parallel-group clinical trial. We assessed the effect of subcutaneous injections of 6 or 8 mg of sumatriptan or placebo on the severity of headache and associated migrane symptoms 30, 60, and 120 minutes after treatment. Patients who were not free of pain after 60 minutes subsequently received placebo if they had initially received placebo or 8 mg of sumatriptan, and 6 mg of sumatriptan or placebo if they had initially received 6 mg of sumatriptan. Results: After 60 minutes, the severity of headache was decreased in 72 percent (95 percent confidence interval, 68 to 76 percent) of the 422 patients given 6 mg of sumatriptan, 79 percent (95 percent confidence interval, 71 to 87 percent) of the 109 patients given 8 mg of sumatriptan, and 25 percent (95 percent confidence interval, 17 to 33 percent) of the 105 patients given placebo (data on 3 patients could not be evaluated). As compared with the placebo group, 47 percent (95 percent confidence interval, 38 to 57 percent) more patients who had received 6 mg of sumatriptan and 54 percent (95 percent confidence interval, 43 to 65 percent) more patients who had received 8 mg of sumatriptan had a decrease in the severity of headache (P less than 0.001 for both comparisons). After 120 minutes, 86 to 92 percent of the 511 patients treated with sumatriptan (202 assigned to 6 mg plus placebo, 203 to 6 mg plus 6 mg, and 106 to 8 mg plus placebo) had improvement in the severity of headache, as compared with only 37 percent of the 104 patients who received placebo once or twice (P less than 0.001 for all comparisons). Twenty-one patients were excluded from the analysis because of missing data (19) or protocol violations (2). The response rates did not differ significantly among the sumatriptan regimens. Adverse events were minor and transient in all groups. Conclusions: We conclude that a single 6-mg dose of sumatriptan given subcutaneously is a highly effective, rapid-acting, and well-tolerated treatment for migrane attacks. The administration of a second dose 60 minutes later to patients not responding well to an initial dose affords little additional benefit.
Article
To determine whether acute migraine treatment outcome is different in migraine with aura compared with migraine without aura. We examined pooled outcome data for sumatriptan treatment of migraine with and without aura from the sumatriptan/naratriptan aggregate patient database. We also examined similar outcome data for inhaled dihydroergotamine (DHE) from a single, large randomized controlled study. The pooled pain-free rates 2 hours postdose for sumatriptan 100 mg were significantly higher in patients treating attacks without aura (32%) compared with the group who treated attacks with aura (24%) (p < 0.001). The relative risk for pain freedom 2 hours postdose for attacks without aura was 1.33 (95% confidence interval: 1.16-1.54). The number needed to treat for 2 hours of pain freedom was 4.4 for attacks without aura and 6.2 for attacks with aura. For the clinical trial of DHE, the 2-hour pain-free rates did not differ between patients treating attacks without aura (29.4%) compared with those who treated attacks with aura (27.2%; p = 0.65). The relative risk for pain freedom 2 hours postdose for attacks without aura vs with aura was 1.08 (95% confidence interval: 0.77-1.53). The number needed to treat for 2 hours pain free was 5.8 for attacks without aura and 5.0 for attacks with aura. This post hoc analysis of pooled data from multiple randomized trials indicates that sumatriptan is less effective as acute therapy for migraine attacks with aura compared with attacks without aura. In the single study of inhaled DHE, the treatment had similar efficacy for migraine attacks with and without aura. Different responses of migraine with vs without aura to acute therapies may provide insight into underlying migraine mechanisms and influence the choice of acute therapies for different types of migraine attacks. © 2015 American Academy of Neurology.