Diagnostic Criteria For Migraine Research Articles

Supplementary file; ICHD 3 diagnostic criteria for Migraine

No abstract available

Validity and reliability of Arabic version of pediatric migraine disability assessment scale (Child Self-Report versus Parent Proxy-Report): a multi-center study

BackgroundPediatric Migraine Disability Assessment (PedMIDAS) is one of the most frequently used questionnaires to assess disability from migraine in pediatric patients. This work aimed to evaluate the validity and test–retest reliability of the Arabic version of the child self-report versus the parent proxy report PedMIDAS. We also aimed to test the agreement between children's and parents' reports of the scale.MethodsPedMIDAS was subjected to translation and back-translation, then applied to 112 pediatric patients fulfilling the migraine diagnostic criteria. This cross-sectional study was conducted on two visits, one week apart. At visit 1, the following data were obtained from the included pediatric patients: disease duration, migraine type, current treatment regimen, monthly migraine days (MMD) during the last month preceding the enrollment, and migraine intensity using the visual analogue scale. Then, each child and his parent were independently asked to fill out PedMIDAS and Child Self-Report of the Pediatric Quality of Life Inventory™ 4.0 (PedsQL™) to test the convergent validity of PedMIDAS. At visit 2, each child was requested to complete PedMIDAS again, and so was the parent to evaluate test–retest reliability.ResultsCronbach’s alpha was estimated to be 0.94 for each instrument. For the child-self report PedMIDAS, the average measure intraclass correlation coefficient (ICC) value was 0.992 (95%CI = 0.989–0.995), while it was estimated to be 0.990 for the parent-proxy report with 95%CI = 0.985–0.993, indicating excellent test–retest reliability for both instruments. The child-self report and the parent-proxy report PedMIDAS scores were significantly correlated with MMD, VAS, and all domains of the corresponding PedsQL, supporting convergent validity for both instruments. Agreement between parent and child on disability grading categories of PedMIDAS was substantial (κ = 0.644).ConclusionThe Arabic version of PedMIDAS was a valid and reliable instrument to assess disability from migraine in Arabic-speaking pediatric patients with migraine. Parent reports can be valuable as a complement to child reports for a comprehensive assessment of migraine.

Epidemiology of Migraines in Iraqi Females: Emphasis on Dietary Influence.

Introduction Migraine is a neurological condition that frequently results in a severe headache. The headache comes in episodes and is occasionally accompanied by nausea, vomiting, and sensitivity to light. Migraines can be caused by a variety of conditions and can last anywhere from three to four hours to several days, with females experiencing them three times more frequently than men. Studies have found some evidence that lifestyle variables, such as nutrition, may play an important role in the emergence of migraines. The purpose of this research is to determine the epidemiology of migraine among females with an emphasis on the relationship between headaches and the dietary habits of females who are enduring migraine attacks in Iraq. Methods This study is descriptive research employing a quantitative method, specifically a survey. The data collection process involved a three-section online survey disseminated to females through internet platforms, including WhatsApp, Viber, Facebook, and Instagram. In this research, 360 females from Sulaymaniyah, Iraq, aged 18 to 35, participated. The survey's primary questions centered on the characteristics of the female respondents, drawing from the International Headache Society (IHS) criteria for migraine diagnosis. Participants meeting the migraine diagnostic criteria were also asked a few questions about aura symptoms. The Migraine Disability Assessment (MIDAS) questionnaire was incorporated, accompanied by inquiries about headache treatment, headache-related signs and symptoms, headache triggers, factors that relieve headaches, sleep routines, dietary consumption, and the impact of each factor on migraines. Results Of the 360 females who participated in the study, 159 (44.2%) experienced migraines, while 201 (55.8%) did not. The dietary habits of females who experienced migraines showed a statistically significant relationship to the duration of their headaches, specifically those lasting from 4 to 72 hours. This relationship was particularly evident in relation to nuts (p-value= 0.000), hot/spicy foods (p-value= 0.000), tomatoes (p-value= 0.005), bananas (p-value=0.01), aspartame (p-value=0.012), beverages containing caffeine (p-value=0.000), and citrusy fruits (p-value=0.008). These findings are based on p-values less than the commonly accepted alpha of 0.05. To maintain good health, it's essential to adhere to healthy eating habits and proper nutritional guidelines. Further research is necessary to identify additional dietary triggers for migraines. Enhancing data collection methods, such as using face-to-face interviews, could improve the quality of future research. Conclusion This study determined the prevalence of migraines among a sample of females in Sulaymaniyah, Iraq, and identified various foods consumed in excess by females without considering their potential impact on migraines.

Migraine treatment with external concurrent occipital and trigeminal neurostimulation-A randomized controlled trial.

To evaluate the efficacy and safety of concurrent non-invasive stimulation of occipital and trigeminal nerves in acute treatment of migraine with or without aura. Non-invasive neuromodulation devices stimulating a single peripheral nerve or anatomic distribution are routinely used by patients with migraine refractory to the first-line drugs or those who opt out of pharmaceutical treatment. Concurrent occipital and trigeminal stimulation was described in an invasive setting, and its safety cost outweighed its efficacy gain. This study evaluated the efficacy and safety of an external concurrent occipital and trigeminal device in acute treatment of migraine. This was a randomized, sham-controlled, double-blind, multi-center trial. Patients 18 years of age or older who met the International Classification of Headache Disorders (2018) diagnostic criteria for migraine with or without aura, reported 1-6 migraine attacks per month, and other headaches no more than 6 days per month were enrolled. Of 131 intention-to-treat participants (67 and 64 in the active and sham groups, respectively), 109 (50 and 59 in the active and sham groups, respectively) treated at least one migraine episode. Reduction of migraine headache (pain relief) 2 h after treatment initiation was the primary efficacy endpoint. Pain relief at 1 h, and pain freedom and relief in most bothersome symptom at 2 h after treatment initiation were the secondary endpoints. Freedom from most bothersome symptom at 2 h and sustained pain freedom 24 h after treatment initiation were among the exploratory endpoints. Sixty percent of participants (30/50) in the active arm reported pain relief at 2 h after initiation of the first eligible treatment (primary outcome) compared to 37% (22/59) in the control arm (difference, 23%; 95% confidence interval [CI], 2%-41%; p=0.018). Pain freedom at 2 h without rescue medication was reported by 46% (23/50) of participants in the active arm and by 12% (7/59) of participants in the sham arm (p < 0.001). Pain freedom 2 h after the treatment and, subsequently, at 24 h, was reported by 4.25 times more participants in the active arm (36%; 18/50) than in the sham arm (8%; 5/59). The 28% difference was statistically significant (95% CI, 1%-43%; p < 0.001). A 4.25-fold difference was also observed comparing the proportion of participants free from pain and most bothersome symptom 2 h after the stimulation (47% [17/36] and 11% [5/45] in the active and sham arms, respectively; 95% CI, 14%-54%; p < 0.001). Adverse events were not serious or severe. All study-related events resolved without treatment. External concurrent occipital and trigeminal neurostimulation is a well-tolerated, safe, and effective migraine treatment that provided a fast and durable relief and freedom from migraine pain and associated symptoms in a randomized setting. The observed safety and performance suggest external concurrent occipital and trigeminal neurostimulation is a viable alternative to the currently available acute migraine treatments. clinicaltrials.gov identifier NCT03631550.

Update on migraine management.

Migraine is a highly prevalent disorder in women associated with significant disability. Yet it remains underdiagnosed and undertreated. Recent advances in our understanding of the pathophysiology of migraine, including the role of calcitonin gene-related peptide, has led to the development of new targeted migraine therapies. It is important for all healthcare professionals caring for women to be familiar with the diagnostic criteria for migraine and for them to follow a stepwise approach to management of acute and chronic migraine that comprises biobehavioral and pharmacologic management, particularly the more recently approved therapies.

Atypical Migraine in Clinical Practice: Are We Missing It?

In countries like India, many migraine patients presenting to primary care clinics fail to fulfill standard (ICHD 3) migraine diagnostic criteria. Since they do not present with typical ICHD 3 migraine diagnostic symptoms, it is necessary to define the criteria for atypical migraine. This would ensure that the patients receive the right treatment approach, both non-pharmacological and pharmacological. Looking for triggers, family history, activity affected and absolute normality in between attacks, past episodes of episodic syndromes, prodromal and oculonasal autonomic symptoms will help in identifying the migraine origin of these headaches.

Migraine in children and adolescents: modern principles of diagnostics and treatment

Migraine is a nervous system disorder that affects 7.7% of children and can debut before the age of 3 years. As they get older, the incidence of migraine increases, and among adolescents, its prevalence reaches 15%. The disease can significantly reduce the child's daily activity, school performance. Migraine is the most common cause of headache in children and adolescents, but it is not always diagnosed; it is not uncommon for patients with migraine to be misdiagnosed and given ineffective treatment. An effective approach to the diagnosis of migraine in children is presented, diagnostic criteria for migraine according to the 3rd edition of International Classification of Headache Disorders are described. Special disorders in childhood are described – episodic syndromes in children associated with migraine. Migraine treatment in children includes four main approaches: 1) lifestyle recommendations; 2) migraine attack treatment; 3) nonpharmacological treatment; 4) migraine preventive pharmacotherapy. All of the listed approaches for the treatment of migraine in childhood are discussed in detail.

Effect of Cervical Mobilization and Transcutaneous Supraorbital Nerve Stimulation in Migraine Without Aura

Migraine is one of the most common disabling headache disorders which is categorized into two broad types based on the number of headache days. It is called episodic or general migraine if the attacks occur less than 15 days per month, and it is categorized as chronic or transformed migraine if headache occur on 15 or more days per month. This study was conducted to find out the effect of strategy for pain using a modality and strategy using mobilization in reducing disability, frequency and pain in migraine without aura. Thirty-Two subjects were selected based on diagnostic criteria for migraine and divided into two groups. Group A received Cervical Mobilization and Myofascial Release with home exercise program and Group B received Transcutaneous Supraorbital Nerve Stimulation with home exercise program. Visual Analogue Scale, Questionnaire (HIT-6) were recorded as outcome on baseline and after 3 weeks. Results showed significant improvements in both the groups with, p&lt;0.01. Between group comparisons elicited non-significant differences with p˃ 0.05. Following the results, it can be concluded that cervical mobilization and Transcutaneous Supraorbital nerve stimulation can be added as a valuable adjunct to medical management in the treatment of migraine without aura.

Diagnostics and modern treatment of migraine: what can a general practitioner do?

The article focuses on the basic principles of diagnosis and treatment of migraine at the stage of primary health care. The diagnostic criteria of migraine, common diagnostic errors and alarming symptoms that are indications for instrumental investigations are given. The main treatment strategies of migraine are described: behavioral therapy, attack relief, and preventive therapy. Special attention is being paid to the treatment of a migraine attack, depending on its severity, including the features of the use of simple analgesics and triptans – specific drugs that have a pathogenetic antimigrenous effect. The principles of the use of tryptans that provide a high effect of relieving a migraine attack are being listed. The advantages of eletriptan as a last‑generation triptan, which is highly effective in relieving migraine attacks and is safer than other drugs in this class, are highlighted. Among the modern classes of drugs that have an evidence base in migraine prevention, those that can be successfully used by general practitioners are indicated.

Prevalence and socio-demographic and clinical correlation of migraine in depressive disorder – A cross sectional study

Introduction: Studies have shown an association between migraine and psychiatric disorders like depression where a bidirectional etiology exists. Aim: To study the prevalence of migraine among depressed patients and to correlate the severity of migraine and depression. Methodology: The included 152 outpatients who were diagnosed with depressive disorder and recurrent depressive disorder using the ICD 10 diagnostic criteria. They were then given the Hamilton Depression Rating Scale (HAM-D). Migraine was diagnosed using the International Headache Society (IHS) diagnostic criteria of migraine and rated using the Migraine Disability Assessment Score (MIDAS). Data were analyzed using chi-square test, independent sample t test and Pearson’s correlation. Results: The study included 152 patients with depression. There is a 35.5% prevalence of migraine was seen in depressed patients. In 75.9% of cases, migraine was previously un-diagnosed. There was a significant association between presence of migraine and female sex (?2= 5.32, p=0.02), student status (?2 =; 1.5 p

Migraine and tension-type headache in Germany. Prevalence and disease severity from the BURDEN 2020 Burden of Disease Study.

Headache disorders are widespread among women and men in Germany and are primarily associated with restrictions on quality of life. The two most common types of headache disorders are migraine and tension-type headache. In order to gain valid estimates of the prevalence of these conditions, a cross-sectional telephone-based survey was conducted among adults in Germany (N=5,009) between October 2019 and March 2020. The frequency, duration, the characteristics and comorbidities associated with headache were measured using the diagnostic criteria defined in the International Classification of Headache Disorders. 57.5% of women and 44.4% of men in Germany stated that they had had a headache in the last twelve months. 14.8% of women and 6.0% of men meet all of the diagnostic criteria for migraine. Tension-type headache affects 10.3% of women and 6.5% of men. Migraine and tension-type headache are predominantly found among people of working age and steadily decrease with age. Migraine is often accompanied by comorbidities such as depressive symptoms and anxiety disorders. People affected by headache disorders tend to receive very little professional medical care, with only a minority seeking treatment within a year. These results provide a comprehensive picture of the population-related impact of headache disorders and are used in the BURDEN 2020 study to quantify key indicators for burden of disease assessment.

Treatment and management of migraine in neurological ambulatory practice in Poland by indicating therapy with monoclonal anti-CGRP antibodies.

To analyse Polish neurologists' familiarity with the diagnostic criteria for migraine, and how their methods of management of migraine work in daily practice. Migraine is a common primary headache disease that causes substantial disability and reduces quality of life. Many migraine patients remain undiagnosed and deprived of treatment. Migraine treatment is problematic, and many patients discontinue preventive treatment, mainly because of a lack of efficacy or adverse effects. Antibodies targeting calcitonin gene-related peptide and its receptor seem to be effective and well-tolerated agents in migraine prevention. This study was conducted using a computer-assisted web interview conducted with 51 neurologists in Poland, who agreed to participate in the study during a phone call. The questionnaire mainly assessed methods of treatment of migraine patients and diagnostic criteria used in neurological practice. Only one neurologist listed all of the diagnostic criteria for migraine, and 80% of physicians in their practice used only a part of the migraine diagnostic criteria, usually the migraine without aura criteria. On average, each neurologist had 55 patients under continuous care, seeing roughly 18 patients per month. On average, neurologists estimated that 77% of all patients with migraine had episodic migraine, whereas the rest had the chronic form. Importantly, 40% of patients with chronic migraine received all available preventive treatments without a satisfactory effect. Neurologists could offer monoclonal antibodies that target the CGRP-pathway (i.e. anti-CGRP and anti-CGRP receptor monoclonal antibodies) for the prevention of chronic migraine to about one in three patients with a chronic form of the disease. Migraine is underdiagnosed and undertreated in Poland. Understanding of the diagnostic criteria for migraine among neurologists is insufficient. Most neurologists in Poland see patients in whom anti-CGRP/R-targeting treatment is indicated.

Prevalence of Migraine and Neuropathic Pain in Rheumatic Diseases.

To investigate the physiopathology of pain in chronic inflammatory rheumatic diseases (CIRDs), we assessed the prevalence of migraine and neuropathic pain in 499 patients with CIRDs. We studied 238 patients with rheumatoid arthritis, 188 with spondyloarthritis (SpA), 72 with psoriatic arthritis (PsA), and 1 unclassified. Migraine was diagnosed according to IHS migraine diagnostic criteria. Neuropathic pain was diagnosed when patients scored at least 3 on the DN4 questionnaire. Participants completed a validated self-assessment questionnaire. Migraine prevalence was 34% (165/484), and it was highest in PsA. Risk factors for migraine were a high level of anxiety, female sex, young age, and TNF-alpha inhibitor treatment (OR = 1.90 (1.13–3.25)). Besides, high disease activity was a risk factor in SpA. Blood CRP level was not significantly associated with migraine. Of 493 patients with CIRDs, 21.5% had chronic pain with neuropathic characteristics. Compared to the French general population, these patients had significantly higher prevalences of migraine (two-fold) and neuropathic pain (three-fold). This study showed that migraine and neuropathic pain frequently occurred in patients with rheumatic diseases. Therefore, upon reporting residual pain, these patients should be checked for the presence of migraine or neuropathic pain, despite adequate clinical control of rheumatic disease.

SOCIODEMOGRAPHIC AND COMORBIDITY PROFILES OF MIGRAINE PATIENTS: AN OUTPATIENT-BASED STUDY IN A TERTIARY CARE HOSPITAL

Objective: Migraine is a primary headache disorder. The study was undertaken to assess correlation between sociodemographic characteristics of migraineurs with their various comorbidities so as to determine most important factors influencing their comorbidity profile.&#x0D; Methods: A prospective study was conducted between June 2018 –April 2020 in 323 patients suffering from migraine in out-patient department of Neurology. Patients were labeled as migraine on the basis of Simplified Diagnostic Criteria for Migraine. A structured questionnaire was used for evaluation of sociodemographic variables and evidence based approach was adapted to fill psychiatric and comorbidity profiles of patients.&#x0D; Results: In 323 patients of migraine males were 30 (9.3%) and females 293 (90.7%). Mean age of males is 38.80±17.53 years and of females 35.38±13.29 years, (p=0.307). Most of them were in 21-30 years age group followed by 31-40 years Majority of patients were from district Srinagar followed by Ganderbal. Housewives formed major group of patients followed by students It was seen more in the illiterate class than in literates. 57% patients belonged to lower middle class. Psychiatric comorbidities including anxiety,depression and physical comorbidities like hypertension, hypothyroidism and comorbid pains were common associations. Comorbidities have been compared with mean age of the patients and it was found that psychiatric comorbidities, neuropathic pain, hypothyroidism, hypertension, Type 2 DM, comorbid pains and PCOD were statistically significant, (p=≤0.05).&#x0D; Conclusion: Most common comorbidities associated with migraine are anxiety, depression, neuropathic pain, hypothyroidism, hypertension, Type 2 DM and comorbid pain. Comorbidities have direct impact on nature of treatment protocol and need to be addressed to achieve outcome based treatment.

Manifestation of migraine in adolescents: Does it change in puberty?

To analyze the association between pubertal stage, menstrual cycle and migraine attacks in girls with migraine. In addition, headache frequency, accompanying symptoms, duration and onset in relation to the specific phase of the cycle were investigated. Girls between 7 and 18 years old, diagnosed with headaches that met "International Classification of Headache Disorders II" diagnostic criteria for migraine without aura, kept a daily headache and menstrual cycle diary over 8 weeks. Ovulatory cycles were identified by weekly progesterone saliva tests. 47 girls participated in the study and were divided into three groups according to Tanner stage and onset of regular menstruation: pre- (n=16), peri- (n=19) and post-pubertal (n=12). A significant difference in migraine frequency was found between pre- and post-pubertal girls (p=0.005). No significant differences with regard to headache characteristics were detected. Interestingly, a higher frequency of attacks in follicular phase occurred compared to luteal phase in peri- and post-pubertal girls (p=0.030). During puberty, migraine patterns in girls change to a typical adult pattern of migraine in a stepwise manner not clearly related to menarche. The first sign of this transition phase could be the higher frequency of migraine attacks in post-pubertal girls.

A prospective study on osmophobia in migraine versus tension-type headache in a large series of attacks

In literature, osmophobia is reported as a specific migrainous symptom with a prevalence of up to 95%. Despite the International Classification of Headache Disorders 2nd edition proposal of including osmophobia among accompanying symptoms, it was no longer mentioned in the ICHD 3rd edition. We conducted a prospective study on 193 patients suffering from migraine without aura, migraine with aura, episodic tension-type headache or a combination of these. After a retrospective interview, each patient was asked to describe in detail osmophobia, when present, in the following four headache attacks. In all, 45.7% of migraine without aura attacks were associated with osmophobia, 67.2% of migraineurs reported osmophobia in at least a quarter of the attacks. No episodic tension-type headache attack was associated with osmophobia. It was associated with photophobia or phonophobia in 4.3% of migraine without aura attacks, and it was the only accompanying symptom in 4.7% of migraine without aura attacks. The inclusion of osmophobia in the ICHD-3 diagnostic criteria would enable a 9.0% increased diagnostic sensitivity. Osmophobia is a specific clinical marker of migraine, easy to ascertain and able to disentangle the sometimes challenging differential diagnosis between migraine without aura and episodic tension-type headache. We recommend its inclusion among the diagnostic criteria for migraine as it increases sensitivity, showing absolute specificity.

Prevalencia de migraña y caracterización de una población estudiantil universitaria, Medellín, 2014

Objective: To determine the prevalence of migraine and the clinical and epidemiological characteristics of a representative subset of university students from Medellin in 2014. Methods: Descriptive, cross-sectional study. Data was collected from a private university student subset. All participants were over 18 (legal age in Colombia) and were enrolled in different university programs. They all verbally agreed to participate before submitting their personal data to the study. Data was collected using a survey developed by researchers and was based on the 2013 International Headache Society (IHS) diagnostic criteria (beta version) and other variables of interest to the study, such as sociodemographic data, comorbidities, family disease history, and treatment methods. Results: A total of 650 students completed and submitted the survey. The median age was 21 years (interquartile range: 19-23 years), and 427 students (65.7%) were female participants. Migraine prevalence was determined to be 27.7%. Among students who met migraine diagnostic criteria (n=180), irritable bowel syndrome (24.4%) and depressive disorders (8.9%) were the two most common conditions in their medical records. A total of 103 (57.2%) students had a family history of migraine, and only 51% of those who met migraine diagnostic criteria had already been diagnosed by a qualified physician. The most common migraine episode triggers identified included long periods of fasting (71.3%), sleep deprivation (69.1%), and university testing (63.8%). Of the participants, 168 (93.3%) expressed that they use analgesics to treat their migraine episodes, but only 44.6% were using analgesic therapy prescribed by a qualified physician. The most common medications used as a prophylactic approach were naproxen (19.6%) and propranolol (12,3%). The most common medications used as a therapeutic approach were acetaminophen (70.8%) and ibuprofen (44.4%). Conclusions: A greater migraine prevalence was observed than that which was reported in the general population and the presence of factors traditionally described with this pathology.

Psoriasis and migraine.

Psoriasis and migraine share several pathogenetic mechanisms due to systemic inflammation, which increase the risk of developing cardiovascular disease. Our aim was to investigate the prevalence of migraine with (MA) and without aura (MO) in the psoriatic population, investigating a possible new comorbidity of the psoriatic disease. We referred 68 psoriatic patients to a nine questions survey formulated on the basis of the International Headache Society (IHS) diagnostic criteria for migraine. Then, in the case of MA, the mean monthly number of migraine crises was assessed. Data of psoriatic patients were then compared with those of a psoriasis-free control group composed of 235 migraine patients (with and without aura). A clinical diagnosis of migraine was performed in 32 psoriasis patients with a great prevalence in women (F: 87.50% - M: 12.5%). Moreover, we found a much higher prevalence (62.5%) of MA, with the remaining 37.5% diagnosed with MO. Comparing the prevalence of MA between psoriasis + migraine patients and the control group we observed a statistical significative difference (P < 0.0001); furthermore, the number of MA crises was significantly higher (P < 0.0001) in patients with psoriasis with respect to the MA control group. We showed a significant association between psoriasis and migraine, especially MA, probably due to common pathogenetic mechanisms, but further studies are needed to assess their interplay in developing cardiovascular diseases.

Recognition of Chronic Migraine by Medicine Trainees: A Cross‐Sectional Survey

Chronic migraine is a diagnosis that can be abstracted through the clinical history, although some providers may struggle in properly applying diagnostic criteria. We aimed to learn how well medicine trainees would be able to recognize the diagnostic criteria for chronic migraine and apply that medical knowledge to case vignettes illustrating different symptom interpretation strategies of the identical information. An electronic, anonymous and multiple-choice response questionairre assessing selected trainee characteristics, headache case vignettes, and chronic migraine diagnostic criteria was distributed to all regional medicine program directors and coordinators in Kentucky and surrounding states. Program directors and coordinators could then individually decide whether or not they would forward to their trainees. The primary outcome measure was the frequency of chronic migraine recognition as a function of history style (ie, lumping versus splitting). Secondary outcome measures included recognition of chronic migraine diagnosis as a function of program affiliation (academic versus community), training year, gender, and recognition of ICHD-3 beta chronic migraine diagnostic criteria. Nominal variables were described as counts and percentages, and compared using chi-square tests. Statistical tests were considered to be two-sided and P ≤ .05 was considered to be statistically significant. Statistical analyses were performed using the JMP 11.0.0 (SAS Institute Inc., Cary, NC, USA). Fifty-six medicine trainees completed the survey. Episodic migraine and chronic tension-type headache were correctly recognized by 85.7% and 96.4%, respectively. Chronic migraine was recognized by a greater proportion of trainees when the identical information was presented using a lumped versus split symptom interpretation strategy (24.1% vs 3.6%, chi-square = 6.5, df =1, P = .01). Accurate recognition of chronic migraine was more likely among trainees in community versus academic/university program (40% vs 14.7%, chi-square = 4.4, df = 1, P = .03) and among male versus female trainees (33.3% vs 9.5%, chi-square = 3.9, df = 1, P = .04). Interestingly, accurate recognition of chronic migraine diagnosis was neither related to training year nor correct recognition of the ICHD-3 beta diagnostic criteria for chronic migraine. Despite accurate individual recognition of episodic migraine and chronic tension-type headache, participants were poor at recognizing that features of these primary headache disorders can co-exist to comprise a uniform diagnosis of chronic migraine. Accurate diagnosis of chronic migraine was improved with use of a lumping strategy to the headache history.

Migraine Subclassification via a Data-Driven Automated Approach Using Multimodality Factor Mixture Modeling of Brain Structure Measurements.

The current subclassification of migraine is according to headache frequency and aura status. The variability in migraine symptoms, disease course, and response to treatment suggest the presence of additional heterogeneity or subclasses within migraine. The study objective was to subclassify migraine via a data-driven approach, identifying latent factors by jointly exploiting multiple sets of brain structural features obtained via magnetic resonance imaging (MRI). Migraineurs (n=66) and healthy controls (n=54) had brain MRI measurements of cortical thickness, cortical surface area, and volumes for 68 regions. A multimodality factor mixture model was used to subclassify MRIs and to determine the brain structural factors that most contributed to the subclassification. Clinical characteristics of subjects in each subgroup were compared. Automated MRI classification divided the subjects into two subgroups. Migraineurs in subgroup #1 had more severe allodynia symptoms during migraines (6.1±5.3 vs. 3.6±3.2, P=.03), moreyears with migraine (19.2±11.3years vs 13±8.3years, P=.01), and higher Migraine Disability Assessment (MIDAS) scores (25±22.9 vs 15.7±12.2, P=.04). There were not differences in headache frequency or migraine aura status between the two subgroups. Data-driven subclassification of brain MRIs based upon structural measurements identified two subgroups. Amongst migraineurs, the subgroups differed in allodynia symptom severity,years with migraine, and migraine-related disability. Since allodynia is associated with this imaging-based subclassification of migraine and prior publications suggest that allodynia impacts migraine treatment response and disease prognosis, future migraine diagnostic criteria could consider allodynia when defining migraine subgroups.