Prevalence Of Chronic Migraine Research Articles

Experience of Botulinum Toxin A Injections for Chronic Migraine Headaches in a Pediatric Chronic Pain Clinic.

Prevalence of chronic migraine in children can reach 7.7%, causing decreased school performance, difficulty with extracurricular activities (including sports, theater, or music), and changes in sleep and mood. Many studies confirm that botulinum toxin type A injections effectively alleviate chronic migraines in adults; however, the literature regarding children is sparse. This study aims to analyze the safety and effectiveness of botulinum type A injections in a group of pediatric patients diagnosed with chronic migraines in a pediatric pain clinic. In this retrospective (2013-2018) study, the effects of botulinum toxin type A injections were analyzed using data from 65 pediatric patients diagnosed with chronic migraines. The study group ranged from 11 to 18 years of age. A pediatric pain management physician administered the botulinum using the Phase 3 Research Evaluating Migraine Prophylaxis Therapy program protocol and followed the pain pattern. Dosages, tolerance, and side effects were measured. In this study, 74% of the patients tried more than 6 medications before the injections. There was a decrease in the visual analog scale score of 5.2 ± 2.2 points upon 6-week follow-up. The mean amount of medication used was 173.2 ± 35 units, and patients received an average of 2.8 ± 1.1 units/kg. Adverse events include one patient who developed dizziness and another who had low-grade fevers with enlarged cervical lymph nodes; both resolved within few minutes. This study supports the use of botulinum type A for chronic migraines in pediatric patients. Multicentered, randomized studies with larger population are needed to evaluate the long-term safety and efficacy of this therapy.

Characteristics of pain in patients with pituitary adenomas: A cross-sectional study.

This study determines the prevalence and particularities of headache and pain with neuropathic characteristics (NC) in a large French group of patients with pituitary adenoma (PA). Analysis of validated self-administered questionnaires, radiological characteristics and treatment strategies of PA was performed. Of the 221 sent questionnaires, 146 could be used for statistical analysis, 50% of which were completed by women. Among responders, 58.9% had pain: 30.1% migraine, 15.7% pain with NC and 13.1% other types of pain. Migraine was more common in patients with PA than in the general population (30.1% vs. 21.3%, p=.010) and attacks received appropriate treatment for less than 20% of these patients. Furthermore, the prevalence of chronic migraine was much higher than in the general population (6.8% vs. 2.2%, p=.003). Neuropathic pain was also more frequent in PA patients than in the general population (15.8% vs. 6.9%, p<.001). Neuropathic pain was most often located in the extremities and was frequently described as an 'electric shock', 'numbness', or 'pins-and-needles'. Multivariate analyses linked migraine to younger age, anxiety, pain with NC, and a visible tumour on MRI, regardless of its invasiveness or secretory nature. Migraine headaches and neuropathic pain are more frequent and disabling in PA patients than in the general population. Both types of pain are comorbid in PA patients and are poorly treated. Migraine is associated with the presence of a tumour. Thus, biological mechanisms of this relationship need to be characterized to design optimal treatments for these individuals. Migraine headaches and neuropathic pain are more common in PA patients than in the general population and are generally poorly treated. A systematic screening for migraine should be done by physicians in daily practice to provide adequate therapeutics.

Treatment in chronic migraine: choice of reabilitation strategies

Migraine is a disabling neurologic condition with a spontaneous clinical evolution into a chronic form. Migraine progression from an episodic into a chronic form is realized through a period of time involving several months or years, during which an increase attack frequency occurs. .According to the International Classification of Headache Disorders (ICHD-3) chronic migraine is a type of primary headache occurring on 15 or more days per month for more than 3 months, in which more than 8 days per month headache meet criteria for migraine with or without aura or respond to specific migraine treatment. The prevalence of chronic migraine is estimated between 13% of general population. Persons with chronic migraine are more likely to suffer from severe disability; chronic migraine has an important socio-economic impact. Diagnostic approach in chronic migraine includes exclusion of a secondary headache disorder and confirmation of a primary episodic headache. When a patient is found to overuse pain medication, diagnosis of both chronic migraine and MOH should be considered. Treating episodic migraine early and managing attack frequency using preventive medication and behavioural interventions will be benefic in reducing the risk of chronicisation. Lifestyle changes are important for avoiding triggers for migraine attacks; treatment of comorbidities is equally important because these conditions exacerbate patient’s tendency to have headaches. The initial relief step for drug abusers always relies in drug withdrawal. For migraine attacks treatment begins with non-pharmacologic interventions (staying in a quiet, dark room, pressure on painful areas, applying cold compresses ), simple OTC analgetics (NSAIDs, paracetamol, aspirin, acetaminophen). If these are not effective, triptans are the drugs of choice. Preventive treatment is always recommended in patients with chronic migraine because the high frequency of headache attacks. Treatment should be started with topiramate, because the drug has the highest level of evidence in treating CM; Onabotulinumtoxin A reduced the number headache days, headache severity, headache-related disability and improved functioning and quality of life. Additionally, complementary and alternative medicine treatments are available in CM prophylaxis, such as biobehavioral techniques (relaxation training, thermal biofeedback, electromyography feedback and cognitive-behavioral therapy). Invasive and non-invasive neurostimulation techniques have been studied in the treatment and prevention of various types of headaches, including chronic migraine. New treatment options for acute attacks and for prevention include calcitonin generelated peptide (CGRP) antagonists and antibodies.

The Prevalence, Burden, and Treatment of Severe, Frequent, and Migraine Headaches in US Minority Populations: Statistics From National Survey Studies

The prevalence and burden of migraine and other severe headaches in the US population as a whole is well documented. Prevalence and treatment patterns in US racial and ethnic minorities, however, have received less attention. We sought to assemble and compare this information as identified in large, nationally representative studies. We searched for summary statistics from studies performed in the United States between 1989 and 2014. Included studies had to provide population-based, nationally or broadly representative information on the prevalence, burden, or treatment of severe or frequent headache or migraine in adult US Blacks, Hispanics, Native Americans, or Asians. Nine studies were included in the review. Prevalence data from the National Health Interview Survey (NHIS) provide the most comprehensive information for major racial and ethnic groups. The average prevalence of severe headache or migraine from 2005 to 2012 NHIS was 17.7% for Native Americans, 15.5% for Whites, 14.5% for Hispanics, 14.45% for Blacks, and 9.2% for Asians. Severe headache or migraine prevalence was higher in females of all races and ethnic groups compared with males and across all included studies. Female to male prevalence ratios from the 2005-2012 NHIS were 2.1 for Whites, 2.5 for Hispanics, 2.1 for Blacks, and 2.0 for Asians. Among those with chronic migraine (≥15 days of headache per month), prevalence data from the American Migraine Prevalence and Prevention study showed that the prevalence of chronic migraine was highest in Hispanic women (2.26% compared with 1.2% for White females), whereas White males had the lowest prevalence at 0.46%. Data from the National Hospital Ambulatory Care Survey and National Ambulatory Care Survey show that Hispanics make only 89.5 annual ambulatory care visits per 10,000 population at which they receive a diagnosis of migraine, compared with 176.3 for Whites and 133.2 for Blacks. In contrast, visit rates resulting in a diagnosis of nonspecific headache were more comparable across all groups. Only one study obtained information on selected subgroups within Hispanic and Asian populations. This showed that differences among these subgroups, which suggest composite prevalence estimates for broadly defined racial and ethnic groups such as Asians, may conceal meaningful differences in subgroups, such as Vietnamese or Filipinos. In the United States, migraine prevalence is highest among Native Americans, then Whites, followed closely by Hispanics and Blacks. Asians have the lowest prevalence of severe, frequent headache or migraine of the major racial or ethnic groups. Differences in diagnosis and treatment of headache and migraine may indicate racial and ethnic disparities in access and quality of care for minority patients.

EHMTI-0358. Improved chronic migraine after DTMS

Background The prevalence of chronic migraine (CM) in the general population is around 2%. CM occurs with impaired quality-of-life and frequent medication overuse. Deep transcranial magnetic stimulation (dTMS) of the dorsolateral prefrontal cortex (DLPFC) transiently suppresses central pain perception through reduced functional connectivity between mid-brain and medial thalamus. Aim To assess pain reduction in CM using high frequency rTMS over the left DLPFC. Method Fourteen patients with ICHD-32 CM were randomised to 12 dTMS sessions, delivered on alternate days over bilateral DLPFC with left prevalence (N = 7; 6 women, 1 man; mean age 45 years) or to treatment as usual (TAU, with anti-migraine agents). All had severe headaches for ≥ 15 days/month in the last three months, and did not respond to ≥ 3 preventive medications and to drug overuse treatment. Outcome measures were attack frequency, headache index, and number of medications in the month before (baseline), during treatment, and one month later. Results Patients treated with dTMS, compared to TAU and baseline, had reduced pain intensity, frequency of attacks, and analgesic overuse, during treatment and one month later. Conclusion dTMS presumably improved DLPFC function, thus allowing better executive abilities. This may have enhanced salience-related brain activity, redirecting or diverting attention through the hippocampus, the cingulate cortex, or other pain matrix structures. Results are compatible with improved brain control over pain sensations. Highfrequency dTMS over bilateral DLPFC improved CM, supporting a role for DLPFC in pain control. No conflict of interest.

Chronic migraine

The classification of the International Headache Society (IHS) generally differentiates episodic from chronic headache. Chronic migraine is defined as headache on 15 and more days a month over more than 3 months and headache on 8 days or more fulfils the criteria for migraine or were triptan/ergot-responsive when thought to be migrainous in early stages of the attack. The prevalence of chronic migraine is estimated at 2-4 %. The quality of life is highly compromised in this condition and comorbidities are much more frequent compared to episodic migraine. Data from prospective randomized studies are scarce as most patients with chronic migraine were excluded from previous trials and only few studies were conducted for this condition. The efficacy for prophylactic treatment compared with placebo is proven for topiramate and onabotulinum toxin A.

Chronic Migraine Prevalence, Disability, and Sociodemographic Factors: Results From the American Migraine Prevalence and Prevention Study

To estimate the prevalence and distribution of chronic migraine (CM) in the US population and compare the age- and sex-specific profiles of headache-related disability in persons with CM and episodic migraine. Global estimates of CM prevalence using various definitions typically range from 1.4% to 2.2%, but the influence of sociodemographic factors has not been completely characterized. The American Migraine Prevalence and Prevention Study mailed surveys to a sample of 120,000 US households selected to represent the US population. Data on headache frequency, symptoms, sociodemographics, and headache-related disability (using the Migraine Disability Assessment Scale) were obtained. Modified Silberstein-Lipton criteria were used to classify CM (meeting International Classification of Headache Disorders, second edition, criteria for migraine with a headache frequency of ≥15 days over the preceding 3 months). Surveys were returned by 162,756 individuals aged ≥12 years; 19,189 individuals (11.79%) met International Classification of Headache Disorders, second edition, criteria for migraine (17.27% of females; 5.72% of males), and 0.91% met criteria for CM (1.29% of females; 0.48% of males). Relative to 12 to 17 year olds, the age- and sex-specific prevalence for CM peaked in the 40s at 1.89% (prevalence ratio 4.57; 95% confidence interval 3.13-6.67) for females and 0.79% (prevalence ratio 3.35; 95% confidence interval 1.99-5.63) for males. In univariate and adjusted models, CM prevalence was inversely related to annual household income. Lower income groups had higher rates of CM. Individuals with CM had greater headache-related disability than those with episodic migraine and were more likely to be in the highest Migraine Disability Assessment Scale grade (37.96% vs. 9.50%, respectively). Headache-related disability was highest among females with CM compared with males. CM represented 7.68% of migraine cases overall, and the proportion generally increased with age. In the US population, the prevalence of CM was nearly 1%. In adjusted models, CM prevalence was highest among females, in mid-life, and in households with the lowest annual income. Severe headache-related disability was more common among persons with CM and most common among females with CM.

Prevalence of primary headaches: it is not the behavior, but still we have to pay attention to it!

Tension-type headache and migraine rank among the most common and disabling disorders worldwide. Headache burden has both individual—decreasing the quality of life of sufferers—and socio-economic—with absenteeism and higher health care consumption—consequences. This negative impact is especially impressive in the middle-aged women, where the prevalence of chronic migraine is above 5% of the general population [1], which leads to daily or almost daily analgesic overuse in around one-third of the cases [2]. The management of these primary headaches, and especially of those with frequent or chronic migraine attacks, therefore, must be taken seriously. Could we decrease headache prevalence by eliminating some negative or unhealthy lifestyle habits? There is no doubt that, especially for migraine, factors such as sedentarism [3–5], obesity [6, 7], smoking [5, 8] or alcohol [5, 9] consumption are attack precipitants, what can be responsible for an impairment or even chronification. The role of these, and other, lifestyle habits as potential etiological factors leading to or influencing migraine or tension-type headache is not so clear. Reported data in this regard are first contradictory and second difficult to interpret, as these lifestyle factors can be both causes and effects for primary headaches. For instance, both tobacco and alcohol consumption have been associated with an increase or decrease in headache prevalence [5, 8–10]. A plausible explanation for these contradictory results could be that both alcohol and tobacco are in fact precipitants—which justifies those studies showing an increase in prevalence in drinkers or smokers—, but that subjects with headache disorders may be abstaining from alcohol or tobacco—this explaining studies showing an increase in prevalence in abstainers. It is also important to notice that some of the associations observed between lifestyle habits and primary headaches can be mediated by confounding factors. For instance, the statistically significant univariate association between smoking for obesity and headache prevalence disappears when adjusted for socio-economic factors [11]. In this issue of JHP, Winter and colleagues [12] again analyse a potential relationship between the prevalence of primary headaches and four common lifestyle factors: alcohol consumption, smoking, physical activity, and overweight. Their analysis is a step forward as they obtain face-to-face data from more than 7,000 subjects participating in three different epidemiological surveys carried out in Germany. Even taking into account their limitations, such as the cross-sectional (not prospective) nature of the data, the relevant variations in the distribution of lifestyle factors between the three regions, or the rather high age (35–75 years old) of the interviewed subjects, their results are straightforward: there was no consistent association between tension-type headache or migraine prevalence and any of these lifestyle factors. Therefore, the first message to our patients is that they are not experiencing headaches due to an “unhealthy” behavior in their habits, which should not be considered as etiological factors for experiencing headaches. This does not mean that a healthy behavior of lifestyle factors does not contribute to a much better management and quality of life in our migraine or tension-type headache patients. The German paper does not address this crucial point, but in general a critical analysis of current scientific literature convincingly shows an association between both following a negative lifestyle behavior and experiencing a higher number of attacks [3–11] with a consequently higher risk of suffering from ischemic events [13]. Contrary to heredity and genes, lifestyle habits do not seem to play a role in the etiology of primary headaches, but they should not be forgotten within the necessary global management approach of our headache patients.

What we ask is what we get

One of the major achievements in headache management and research over the past decades is the classification of headache disorders by the International Headache Classification Committee (1,2), allowing standardized assessments of specific headache disorders in various clinical and research settings. Many features and clinical presentation of headaches are included in the criteria and specific algorithms can help clinicians and researches alike to derive a diagnosis. These criteria have also improved the quality of large-scale, population-based, headache studies as the criteria can be implemented in standardized questionnaires (3,4) or telephone interviews (5,6). While the criteria of main headache forms remain unchanged, specific aspects of the headache classification criteria are revised over time as our understanding of the pathophysiology, clinical presentation, and treatment of headaches subforms advances. The third version of the International Classification of Headache Disorders is expected to appear soon and will provide the newest classification algorithms. For some specific headache forms, however, there is a more profound discussion about the right approach for classification. For example, several definitions for ‘chronic migraine’ exist and new approaches to cover high-frequency headaches have been proposed (7). But, which one should be used? Which one should be implemented when studying the burden of highly frequent headache on the population level? In this issue of Cephalalgia, Katsarava and colleagues (8) address the important questions: (i) what happens if different classifications of chronic migraine are applied to a population-based setting; (ii) how different are these groups with regard to personal characteristics; and (iii) do these groups differ when compared to patients with episodic migraine of various headache frequencies? They applied a self-administered, standardized questionnaire to a large, populationbased sample from Germany covering three chronic migraine definitions: (i) given by the American Headache Society in 2005 (9); (ii) the revised classification given by the International Headache Classification Committee in 2006; (10) and (iii) the so-called Silberstein and Lipton criteria for transformed migraine from 1994 (11). The prevalence of chronic migraine varied substantially from 0.4% (American Headache Society criteria) to 2.0% (Silberstein and Lipton criteria) among the 9350 responders. However, the three groups did not differ according to age, gender, body mass index, alcohol consumption or education. In contrast, many characteristics differed to highor low-frequency episodic migraine groups. While some limitations of the study, such as limited power to compare personal characteristics in subgroups, should caution the interpretation, the study provides important information for clinicand population-based headache research. It is evident, and certainly not surprising, that by applying different criteria to define chronic migraine, somewhat different groups are identified. As the smaller group was a subset of the larger group and the overall personal characteristics did not differ between the three chronic migraine groups, it may be speculated that the various criteria identify subfeatures of chronic migraine but that all patients also had common features. It is further of note that patients with episodic high-frequency migraine had different personal characteristics, suggesting that specific risk factors are determining common chronic migraine features no matter which criteria are applied. In clinical practice, a few key features will guide a physician to diagnose a migraine or specifics of migraine. As the clinical presentation of migraine is very heterogeneous and changing over time, specific features necessary to fulfil all migraine criteria may be present at one time point but not at another. Introducing the category of probable migraine by the second revision of the International Headache Classification Committee was an improvement for population-based headache research as this category

Prevalence of chronic migraine and medication overuse headache in Germany—the German DMKG headache study

Population-based epidemiological studies about the prevalence of chronic migraine using the 2004 International Headache Society (IHS) classification definition are rare. We analysed the data of the Deutsche Migräne und Kopfschmerz Gesellschaft headache study, which included 7417 adults in three regions of Germany, with respect to their headache. Additionally, body mass index, alcohol consumption and smoking behaviour were recorded. Using the IHS definition from 2004, chronic migraine was diagnosed in 0.2% of the population. Half of these patients also fulfilled the criteria of medication overuse headache (MOH). The distribution of migraine attacks per subject was highly skewed, with only 14% of all migraine patients having more than six migraine attacks per month. Patients with chronic migraine or MOH seem more often to be active smokers than controls without headache. A body mass index of ≥ 30 was present significantly more often in patients with MOH than in controls or in patients with episodic migraine. The skewed distribution of the numbers of attacks per patient supports the recommendation to differentiate between episodic migraine with low and high attack frequency, as is done in the classification of tension-type headache. It further suggests that migraine with high attack frequency might be biologically different. The higher prevalence of smokers and of patients with a body mass index ≥ 30 in chronic migraine or MOH supports the idea of a frontal dysfunction in these patients.

Epidemiology, Risk Factors, and Treatment of Chronic Migraine: A Focus on Topiramate

The term chronic daily headache refers to a heterogeneous group of headache disorders characterized by a frequency of headaches on > or = 15 days per month. Chronic migraine is a subtype of chronic daily headache. The prevalence of chronic migraine is approximately 1%. Baseline attack frequency and acute medication overuse have been identified as potential risk factors for the progression of migraine from an episodic disorder to a chronic condition. There is an unmet patient need for effective and safe treatments for patients with chronic migraine, but data from rigorous controlled trials are limited. Previous studies have demonstrated that topiramate is an effective and safe preventive treatment for episodic migraine. In addition, pilot studies have suggested the utility of topiramate for the prevention of chronic migraine. Two randomized, double-blind, placebo-controlled, multicenter trials investigating the efficacy and safety of topiramate in the treatment of patients with chronic migraine have recently been completed. This review presents comparative data from these 2 clinical trials, which suggest that topiramate at a dose of 100 mg daily is effective and generally well tolerated in chronic migraine.

Outcome of Chronic Daily Headache in Adolescents

Neurology| June 01 2007 Outcome of Chronic Daily Headache in Adolescents AAP Grand Rounds (2007) 17 (6): 68. https://doi.org/10.1542/gr.17-6-68 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Outcome of Chronic Daily Headache in Adolescents. AAP Grand Rounds June 2007; 17 (6): 68. https://doi.org/10.1542/gr.17-6-68 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: chronic daily headache, headache Source: Wang S-J, Fuh J-L, Lu S-R, et al. Outcomes and predictors of chronic daily headache in adolescents: a 2-year longitudinal study. Neurology. 2007;68:591–596; doi:10.1212/01. wnl.0000252800.82704.62 Outcomes and predictors of chronic daily headache (CDH) were determined in a two-year longitudinal study of a sample of 122 adolescents (32 male/90 female; ages 12–14) based on annual telephone follow-up by neurologists at Taipei Veterans General Hospital, Taiwan. CDH was defined as ≥15 headache days/month, average of two hours/day or more, for more than three months. All study patients met criteria for CDH at enrollment in 2000. Follow-up response rates were 92% in 2001 and 84% in 2002. Average monthly headache frequency for study patients was 11.0 ± 9.7 days during the first year of follow-up and 7.7 ± 6.5 days in the subsequent year. At the one-year follow-up, symptoms in 40% of study patients met criteria for CDH; by the year two follow-up the persistence rate was 25%. A gender difference was observed: only 4% of boys vs 32% of girls had persistent CDH at two-year follow-up. At baseline, 20% of patients met criteria for medication overuse; this decreased to 6% at two years. Based on the International Classification of Headache Disorders (ICHD-2)1 the prevalence of chronic migraine was not significantly changed during follow-up (67% at baseline and 60% at two years), whereas chronic tension-type headache (CTTH) decreased from 86% to 46% in the same time interval (P<.001). However, because the ICHD-2 criteria for diagnosing chronic migraine were felt to be too restrictive, they were revised in 2006.2 Based on the revised criteria, migraine prevalence increased three to four times when compared with the original ICDH-2 criteria, and chronic migraine became more common than CTTH in patients with persistent CDH in 2001 and 2002. Headaches were found to adversely affect learning at school in 56% of patients at the one-year follow-up and in 57% at the second follow-up; seven (6%) dropped out of school during the two-year study period. Poor outcome predictors included female gender, chronic migraine, medication overuse, major depression, anxiety disorders, school phobia, and obsessive compulsive disorder. Independent predictors for CDH persistence were medication overuse (P<.05) and major depression (P<.01). In contrast, migraine, age at CDH onset, and CDH duration were not significant predictors of the persistence of CDH. Dr. Millichap has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of a commercial product/device. This commentary does not contain a discussion of an unapproved/ investigative use of a commercial product/device. This report is an extension of a Taiwan study of the prevalence of headache and medication overuse in adolescents with chronic daily headache (CDH).3 The prevalence was 2.4% in girls and 0.8% in boys. CDH was subtyped as CTTH in 65.6% and chronic migraine in 6.6%; medication overuse CDH occurred in 20% of cases. Whereas the incidence of CDH in adolescents declined over a two-year follow-up, the relative prevalence... You do not currently have access to this content.