Development of a Migraine Trigger Measurement System Using Surprisal

Insomnia has been identified as a risk factor for tension-type headache, although the pathogenesis of sleep disturbance in this population is unclear. The present study examined pain-related self-management strategies in a nonclinical, young-adult sample for preliminary evidence to support a novel hypothesis for the development of insomnia in this population. Self-report data on triggers of headache, pain interference with sleep, and pain-related self-management strategies were analyzed for 32 women with tension-type headache and 33 women with minimal pain who served as controls. The results revealed that a significantly greater proportion of the headache group relative to the control group reported sleep problems as a trigger of headaches, stress as a trigger of headache, and going to sleep as a coping strategy for pain. The headache group also reported significantly higher ratings of pain interference with sleep. Going to sleep was the most commonly used self-management strategy (81%) by headache sufferers and also rated as the most effective strategy (5.5 out of 7.0). These findings suggest that a bidirectional relationship between sleep disturbance and headache is present in this young-adult sample. Furthermore, the frequent use of sleep as a self-management strategy for pain is consistent with the hypothesis that sleep-seeking behavior might be a mediating factor in the development of insomnia among people with tension-type headache. This hypothesis fits within the most widely accepted conceptual model of chronic insomnia and should be further investigated in individuals with both tension-type headache and insomnia.

A migraine trigger is a factor which temporarily increases the probability that a migraine headache will occur, and many individuals with migraine blame certain weather conditions for initiating at least some of their migraine attacks (1,2). Some consider weather changes to be their most important headache trigger and even go so far as to refer to themselves as ‘human barometers’. A large, recent, clinic-based study of patient perceptions has indicated that 53% of migraine patients perceive that weather triggers their headaches at least occasionally, and 11% felt that weather triggered at least two-thirds of their headache attacks (2). The perception that weather can trigger headaches is not limited to patients with migraine; a substantial proportion of patients with tension-type headache also report weather as a headache trigger (3,4). While it might be argued that patient self-report of headache triggers from surveys based on memory of past events might be unreliable, data based on patient diaries where patients recorded the factor they felt was responsible for their headaches on a daily basis have given similar results (5). A population-based diary study in France performed in this manner indicated that 35% of migraine sufferers felt that weather had triggered at least some of their attacks. Of interest, similar to a clinic-based study (3), it was found that weather was reported as a headache trigger by a higher proportion of migraine patients as compared to patients with other headache types (35% vs 18%; P< 0.05) (5). On the other hand, in another clinic-based survey study of relatively severely affected headache patients, 45.5% of migraine patients listed weather changes as a headache trigger, and this was not different from patients with tension-type headache (48%) (6). In patients drawn from the general population, Rasmussen (4) found, perhaps surprisingly, that a higher proportion of people with tension-type headache reported weather as a headache trigger than did individuals with migraine. Clearly, when it comes to weather, many patients including both those with migraine and those with tension-type headache consider it to be a factor in triggering their attacks. Yet a very sophisticated recent study by Zebenholzer et al. (7) was unable to show any major connection between weather conditions and migraine occurrence. Although some association was shown between wind speed and day-to-day change of daily sunshine duration and migraine occurrence, none of these associations remained statistically significant after correcting for multiple testing by means of a Bonferroni correction (only P-values of <0.0018 were considered significant). The conclusion of the authors was that: ‘The influence of weather factors on migraine and headache is small and questionable’. Some previous studies which tried to identify weather factors as migraine triggers have also been negative (8,9). Others have shown at least some associations between certain weather conditions and migraine occurrence (10–15), but no consistent picture of which weather-related factors are important migraine triggers has emerged. Can so many migraine patients be wrong? Or is there another reason why research to date has been unable to measure the apparently robust association between weather and migraine attacks that so many of our patients tell us exists? Is the problem with the patients or with the research? Pertinent to this discussion is that a number of studies have found little correlation between whether patients think they are weather sensitive, and whether they actually are based on research results. Although Prince et al. (10) found that 50.6% of patients in their study were weather sensitive, there was no significant difference in the degree of weather sensitivity found

BackgroundThe diagnosis of headache disorders relies on the correct classification of individual headache attacks. Currently, this is mainly done by clinicians in a clinical setting, which is dependent on subjective self-reported input from patients. Existing classification apps also rely on self-reported information and lack validation. Therefore, the exploratory mBrain study investigates moving to continuous, semi-autonomous and objective follow-up and classification based on both self-reported and objective physiological and contextual data.MethodsThe data collection set-up of the observational, longitudinal mBrain study involved physiological data from the Empatica E4 wearable, data-driven machine learning (ML) algorithms detecting activity, stress and sleep events from the wearables’ data modalities, and a custom-made application to interact with these events and keep a diary of contextual and headache-specific data. A knowledge-based classification system for individual headache attacks was designed, focusing on migraine, cluster headache (CH) and tension-type headache (TTH) attacks, by using the classification criteria of ICHD-3. To show how headache and physiological data can be linked, a basic knowledge-based system for headache trigger detection is presented.ResultsIn two waves, 14 migraine and 4 CH patients participated (mean duration 22.3 days). 133 headache attacks were registered (98 by migraine, 35 by CH patients). Strictly applying ICHD-3 criteria leads to 8/98 migraine without aura and 0/35 CH classifications. Adapted versions yield 28/98 migraine without aura and 17/35 CH classifications, with 12/18 participants having mostly diagnosis classifications when episodic TTH classifications (57/98 and 32/35) are ignored.ConclusionsStrictly applying the ICHD-3 criteria on individual attacks does not yield good classification results. Adapted versions yield better results, with the mostly classified phenotype (migraine without aura vs. CH) matching the diagnosis for 12/18 patients. The absolute number of migraine without aura and CH classifications is, however, rather low. Example cases can be identified where activity and stress events explain patient-reported headache triggers. Continuous improvement of the data collection protocol, ML algorithms, and headache classification criteria (including the investigation of integrating physiological data), will further improve future headache follow-up, classification and trigger detection.Trial registration This trial was retrospectively registered with number NCT04949204 on 24 June 2021 at www.clinicaltrials.gov.

The objective of this study was to explore the conditions necessary to assign causal status to headache triggers. The term "headache trigger" is commonly used to label any stimulus that is assumed to cause headaches. However, the assumptions required for determining if a given stimulus in fact has a causal-type relationship in eliciting headaches have not been explicated. A synthesis and application of Rubin's Causal Model is applied to the context of headache causes. From this application, the conditions necessary to infer that 1 event (trigger) causes another (headache) are outlined using basic assumptions and examples from relevant literature. Although many conditions must be satisfied for a causal attribution, 3 basic assumptions are identified for determining causality in headache triggers: (1) constancy of the sufferer, (2) constancy of the trigger effect, and (3) constancy of the trigger presentation. A valid evaluation of a potential trigger's effect can only be undertaken once these 3 basic assumptions are satisfied during formal or informal studies of headache triggers. Evaluating these assumptions is extremely difficult or infeasible in clinical practice, and satisfying them during natural experimentation is unlikely. Researchers, practitioners, and headache sufferers are encouraged to avoid natural experimentation to determine the causal effects of headache triggers. Instead, formal experimental designs or retrospective diary studies using advanced statistical modeling techniques provide the best approaches to satisfy the required assumptions and inform causal statements about headache triggers.

Background: Headache is a very common neurological condition in clinical practice. Identifying triggering factors is part of the treatment strategy for patients with migraine and tension-type headache (TTH). Objective: To evaluate the frequency and association of triggering factors for migraine and tension-type headache in a population from Southern Brazil. Methods: We selected 309 patients seen at the Neurology Department of Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul between January 2010 and December 2013. Patients were diagnosed with either migraine or tension-type headache according to the criteria of the International Classification of Headache Disorders-2 (ICHD-2). The presence of the following triggering factors was assessed: 1) chocolate; 2) cheese; 3) caffeine; 4) wine; 5) other alcoholic beverages; 6) aspartame; 7) processed foods; 8) unpleasant odors; 9) sleep deprivation; 10) menstrual period; and 11) stress. Statistical analysis was conducted using SPSS software, and the chi-square test was used for variable analysis. Results: Most patients (218 [70.6%]) were female, and 215 (69.6%) had a diagnosis of migraine. Among headache-triggering foods, there was a statistically significant difference in the presence of chocolate, 21.9% in migraine patients vs. 10.6% in TTH group (p=0.019), and in relation to cheese, 12.6% vs. 4.3%, respectively (p=0.025). Stress was also more common in migraine (54.9% vs. 41.5%; p=0.036). The only trigger more associated with TTH was sleep deprivation, although without statistical significance (29.8% vs. 20.5%; p=0.075). Conclusion: Our cohort in southern Brazil showed similar headache triggers compared to other countries. Headache triggers may be identified in 50-75% of migraine patients. These precipitants are diverse, and different studies have found varying results when comparing migraine and TTH patients. Geographical distribution, genetic, and cultural factors may contribute to these differences. In our population, stress was the most common trigger for both headaches, followed by the menstrual period, sleep deprivation, alcoholic beverages, chocolate, and caffeine. Stress, a major factor in chronic pain, was more commonly associated with migraines than TTH. Other studies have found conflicting results. Both migraine and TTH may share a dysfunction of pain modulation, more likely to appear in stressful situations and making this trigger difficult to evaluate in individual patients. Female gender, chocolate, and cheese were more significantly associated with migraines. In summary, we found that migraine and TTH share many headache triggers, potentially facilitating internal pain modulation. Stress, chocolate, and cheese were significantly more common in migraineurs. Whether these differences are clinically significant is still debated, but awareness of potential triggers and avoidance strategies remain important for educating and supporting patients in their headache management.

AimsThis study used entropy- and cross entropy-based methods to explore the cardiorespiratory coupling of depressive patients, and thus to assess the values of those entropy methods for identifying depression patients with different disease severities.MethodsElectrocardiogram (ECG) and respiration signals from 69 depression patients were recorded simultaneously for 5 min. Patients were classified into three groups according to the Hamilton Depression Rating Scale (HDRS) scores: group Non-De (HDRS 0–7), Mid-De (HDRS 8–17), and Con-De (HDRS >17). Sample entropy (SEn), fuzzy measure entropy (FMEn) and high-frequency power (HF) were computed on the original RR interval time series and breath-to-breath interval time series. Cross sample entropy (CSEn) and cross fuzzy measure entropy (CFMEn) were computed on interval time series resampled at 2 Hz and 4 Hz, respectively. The difference among three patient groups and correlation between entropy values and HDRS scores were analyzed by statistical analysis. Surrogate data were also employed to confirm the validation of entropy measures in this study.ResultsA consistent increasing trend has been found among most entropy measures from Non-De, to Mid-De, and to Con-De groups, and a significant (p < 0.05) difference in FMEn of RR intervals exists between Non-De and Mid-De or Con-De groups. Significant differences have been also found in all cross entropies, between Non-De and Con-De groups and between Mid-De and Con-De groups. Furthermore, significant correlations also exist between HDRS scores and FMEn of RR intervals (R = 0.24, p < 0.05), CSEn at 4 Hz (R = 0.26, p < 0.05) or 2 Hz (R = 0.28, p < 0.05) resampling, and CFMEn at 4 Hz (R = 0.31, p < 0.01) or 2 Hz (R = 0.30, p < 0.05) resampling. A significant difference of cardiorespiratory coupling parameters between different depression stages and significant correlations between entropy measures and depression severity both indicate central autonomic dysregulation in depression patients and reflect varying degrees of vagal modulation reduction among different depression levels. Analysis based on surrogate data confirms that the non-linear properties of the physiological signals played a major role in depression recognition.ConclusionThe current study demonstrates the potential of cardiorespiratory coupling in the auxiliary diagnosis of depression based on the entropy method.

The purpose of this study was to evaluate the psychometric properties of the newly developed Headache Triggers Sensitivity and Avoidance Questionnaire (HTSAQ) designed to measure variables relating to the Trigger Avoidance Model of Headaches. The Trigger Avoidance Model of Headaches proposes that one pathway to developing a primary headache disorder is through the avoidance of headache triggers, resulting in an increase in trigger potency through sensitization. Conversely, prolonged exposure to certain triggers may reduce a potential trigger's ability to precipitate a headache. This model has led to an alternative approach to trigger management being proposed called Learning to Cope with Triggers, which advocates the desensitization of certain headache triggers through controlled exposure, while supporting avoidance of those triggers that are detrimental to health and wellbeing. To be able to evaluate predictions based on the Trigger Avoidance Model of Headaches and to investigate the effectiveness of Learning to Cope with Triggers, psychometrically sound measures of trigger sensitivity and trigger avoidance are needed. A convenience sample of 376 participants (87.5% female; 64.1% European descent) was recruited for the online study which consisted of a battery of measures including the HTSAQ, Brief Headache Screen, Pain Anxiety Symptoms Scale, Pain Sensitivity Questionnaire, Chronic Pain Acceptance Questionnaire, and demographic items. With an interval of 2-6 weeks, a subsample of participants (n = 201) completed the HTSAQ for a second time. The mean age of the sample was 31.4 years (SD = 12.8). The most common headache diagnoses (based on the Brief Headache Screen) were migraine (chronic = 62; episodic = 160), followed by medication-overuse headache (n = 87). The remaining participants (n = 67) were diagnosed as having episodic less severe headache (most likely tension-type headache). Reliability was assessed through internal consistency and test-retest reliability over a period of 2-6 weeks, and both were excellent (alpha > .80). Strong construct validity was demonstrated by the measure's scale scores being significantly correlated in theoretically consistent ways with the Pain Sensitivity Questionnaire, Pain Anxiety Symptoms Scale, and Chronic Pain Acceptance Questionnaire. As the Trigger Avoidance Model of Headaches would predict, correlations between the HTSAQ Sensitivity scales and the Avoidance scale were strong (P < .001), and participants with chronic migraine had significantly higher HTSAQ scores than those with episodic headaches. The findings support the use of the HTSAQ as a valid and reliable tool for assessing sensitivity to headache triggers and avoidance of headache triggers. Further research examining the factor structure of the HTSAQ is warranted.

Prospective Cohort Study of Caffeinated Beverage Intake as a Potential Trigger of Headaches among Migraineurs

This study investigated the associations between various factors anecdotally reported to trigger headache and migraine. Headache symptoms and headache triggers were assessed using a questionnaire given to 180 volunteers. Two groups were identified, those who fulfilled the International Headache Society's criteria for migraine, and those who did not. Associations between reported headache triggers were explored using a principal components analysis, which grouped common headache triggers into four components: visual stimuli, food, alcohol, and stress/tiredness. The visual stimuli cited as triggers included flickering light, repetitive patterns (stripes), sunshine, patterns of light and shade, glare, bright reflections, computers, TV and the cinema. A separate analysis on the data from the migraine group produced the same four components together with a fifth, interpreted as a non-visual sensory trigger (noise and smell). The results demonstrate that visual stimuli are commonly reported as headache triggers. Those involved in the design of the visual environment could improve the quality of life of many by avoiding environmental factors, particularly visual factors, which can trigger headache and migraine.

Identification of the trigger factors of headache could be an important aspect of preventive management, but the characteristics of primary headache triggers in China are unknown. This study was performed to estimate the frequencies of the putative headache triggers, which are endorsed by patients with migraine and tension-type headache (TTH). From July 2011 to December 2011, a cross-sectional survey was conducted in the neurological clinic of a tertiary care hospital in Chongqing. All consecutive patients with the chief complaint of headache were interviewed by a board-certified headache specialist. The diagnoses were made according to International Classification of Headache Disorders - 2nd edition. Patients with migraine and TTH were recruited. The number of investigated patients was 1219, of whom 394 were migraine and 344 were TTH; and 80.2% migraineurs and 67.4% TTH patients reported trigger factors. The most common triggers for both migraine and TTH were sleep disturbance, negative affect and sunlight. Menstrual cycle (OR 3.6, 95%CI 1.2, 11.2), change of the weather (OR 3.1, 95%CI 1.9, 4.8), noise (OR 2.2, 95%CI 1.1, 4.4) and alcohol (OR 1.8, 95%CI 0.7, 1.8) were more associated with migraineurs. Negative affect was more associated with TTH (OR 2.0, 95%CI 1.3, 2.9). Trigger factors were frequent among both migraine and TTH patients. Avoidance of all headache triggers is impractical. Learning to cope with triggers is important to headache prevention.

This study investigated a potential association between visual factors and symptoms related to migraine. It was predicted that photophobia and visual aura would be positively associated with interictal light sensitivity and visual headache triggers (flicker, glare, and eyestrain), and that these 2 visual symptoms would also be associated. Previous studies have found independent neurophysiological associations between several visual factors and symptoms related to headache disorders. Many of these connections appear to be associated with increased cortical hypersensitivity, a phenomenon that might be in part due to repeated avoidance and reduced tolerance to triggers. If true, and if associations between visual factors and symptoms can be established, this may have implications for an exposure-based treatment for migraine symptoms. Four hundred and ninety-one participants (411 female, 80 male) were recruited through Griffith University (AUS), Headache Australia, Pain Australia, and through social media. Participants were grouped based on the presence of headache disorder symptoms and the presence or absence of photophobia and/or visual aura. A cross-sectional online survey design was utilized to gather information pertaining to interictal light sensitivity, visual triggers, and visual symptoms. With respect to interictal light sensitivity and photophobia, a significant difference (P < .001, eta squared [η2 ] = 0.084) was found between the 3 groups, where headache disorder participants with photophobia (group A1; mean [M] = 2.5, standard deviation [SD] = 0.97) reported significantly greater light sensitivity than participants with headache disorder and no photophobia (A2; M=1.68, SD = 0.62) and control group participants (A3; M=1.82, SD = 0.85). This pattern was repeated for participants reporting flicker as a headache trigger (P < .001, η2 = 0.061), with group A1 (M=2.45, SD = 1.24) significantly higher than groups A2 (M=1.68, SD = 0.83) and A3 (M=1.68, SD = 0.89), and was also seen for glare as a headache trigger (P < .001, η2 = 0.092), with group A1 (M=2.92, SD = 0.96) significantly higher than A2 (M=2.31, SD = 0.89) and A3 (M=2.09, SD = 0.93). This pattern of results was not replicated for headache disorder participants with and without visual aura. A significant association (P < .001) was found between photophobia and visual aura in headache disorder participants based on a chi-square test of independence, with 86/136 participants reporting either both or neither visual symptom. This study supports a link between certain visual phenomena in headache disorder populations, and supports future research into exposure-based treatments for migraine symptoms.

Long-range correlation of renal sympathetic nerve activity in both conscious and anesthetized rats

Weakened long-range correlation of renal sympathetic nerve activity in Wistar rats after anaesthesia

Previous systematic review has shown that individuals with more comprehensive dietary knowledge tend to engage in healthier eating patterns among American or European population. However, research on the association between dietary knowledge based on the Chinese Dietary Guidelines and healthy dietary behaviors, particularly among adolescents and college students in China, is lacking. This study aimed to examine the association between dietary knowledge based on the Chinese Dietary Guidelines and adherence to healthy dietary behaviors among adolescents and college students in China. A cross-sectional study was conducted in China in August and October 2023. The study involved 527 adolescents and 11,856 college students. A convenience and cluster sampling methodology was employed to select one or two grades from 33 different university majors. The dietary behaviors of college students were evaluated by assessing their consumption of nine food groups: water, eggs, milk and milk products, vegetables, fruit, red meat, soy and soy products, seafood, and sugar-sweetened beverages. The dietary behaviors of adolescents were evaluated by assessing their consumption of five food groups: fast food, salty snack foods, fruits, vegetables, and soft drinks and sugared fruit beverages. The participants' dietary knowledge was assessed using the Chinese Dietary Guidelines. The relationship between dietary knowledge and behaviors was examined using a multivariate logistic regression analysis. The questionnaire response rate was 100.0%. Multivariate logistic regression analysis revealed a significant positive association between dietary knowledge and the likelihood of exhibiting diverse dietary behaviors among college students. After adjusting for gender, age, family income, place of residence, and parents' education levels, the results demonstrated a positive association between dietary knowledge and adherence to 4-8 eating habits among college students. In contrast, similar association was not observed among adolescent. This study revealed a significant association between dietary knowledge based on the Guidelines and adherence to healthy dietary behaviors among college students in China. That is to say, the higher the level of dietary knowledge based on the Guidelines among college students, the healthier the dietary behaviors they tend to adopt in their daily lives. These findings indicate the necessity of developing educational interventions based on the Guidelines to enhance dietary knowledge among individuals with limited dietary knowledge. Such interventions could facilitate the acquisition of essential health-related knowledge and strengthen motivation to engage in healthy dietary behaviors. Future studies should employ longitudinal prospective designs or randomized controlled trials in order to establish a causal association between dietary knowledge based on the Guidelines and healthy dietary behaviors.

To review the evidence and role of monosodium glutamate (MSG) as a headache and migraine trigger. MSG is a common food additive, has widely been linked as a trigger of headache, as well as other symptoms. However, the evidence for MSG as a causative agent for headache is debated. Various clinical trials over the past several decades have reported conflicting results, with studies suggesting that MSG does and does not increase the incidence of headache. However, the dosages of MSG exposure are often inconsistent across studies, with many studies administering a dose significantly higher than the average consumption.. Additionally, there are misconceptions about which foods and cuisines have MSG in them. MSG could be a potential trigger for migraine and headaches. It is unclear exactly how MSG plays into the migraine pathophysiology. It's crucial to accurately determine if MSG is present in one's diet to evaluate its potential impact on headaches.