Headache Diary Research Articles

Addition of lesser occipital nerve blockade to greater occipital nerve blockade in patients with chronic migraine

Objectives: The aim of this study was to compare greater occipital nerve blockade (GONB) alone and GONB combined with lesser occipital nerve blockade (LONB) in chronic migraine patients. Methods: Patients were randomly divided into two groups: Group A consisted of 22 patients who received only GONB; while Group B consisted of 20 patients who underwent GONB and LONB. The demographics and clinical characteristics of the patients were evaluated. The injections were given unilaterally and to the side where the subjects experienced greater pain. GONB with or without LONB was performed on each patient once a week for 4 weeks and then two more times a month apart; 6 times in total. The number of headache days, severity of attacks and duration of headache episodes was recorded from headache diaries before treatment and the on the first, second and third month following the start of treatment. Treatment efficiencies were evaluated within and between the groups. Results: The duration of pretreatment headaches was significantly longer in Group B (p=0.032). There were no differences between the groups in terms of other demographic and clinical characteristics. When the treatments applied in group A and group B were evaluated separately compared to the control group, there was a statistically significant decrease in the number of headache days, VAS scores and headache duration (p <0.05). When the results of treatment between groups were compared, there was no difference in terms of the number of headache days and VAS scores. Although the duration of headache was longer in the pretreatment period in group B, this difference disappeared on posttreatment follow-up (p>0.05). Conclusions: This study suggests that there is no difference in the number of headache days or headache intensity between GONB alone or in combination with LONB in chronic migraine patients. GONB combined with LONB in patients may be more effective than GONB alone when headaches of longer duration are present.

Napping behavior in adults with episodic migraine: a six-week prospective cohort study.

Patients with migraine commonly endorse napping as a strategy for headache pain relief, but also experience high rates of sleep disturbance. To elucidate the relationship between napping behavior and migraine, we evaluated the association between napping and headache frequency, severity, and intensity among adults with episodic migraine. We also examined the association between daily napping and that night's sleep. In this six-week prospective cohort study, 97 adults with episodic migraine completed twice-daily headache and sleep electronic diaries and wore a wrist actigraph. We modeled the associations between napping (yes/no) and headaches with conditional logistic regression and daily napping and nighttime sleep with linear regression. Over 4,353 study days, participants reported 1,059 headache days and 389 days with naps. More than 80% of participants napped during the study, with mean nap duration of 76.7 ± 62.4 min. Naps were more likely to occur on day 2 of headache 35/242 (14.5%) than on nonheadache days 279/3294 (8.5%, OR 2.2 [95% CI 1.4, 3.4]). Mean nap onset time (14:40 ± 3.3 h) was later than headache onset (12:48 ± 5.3 h). In adjusted models, napping was associated with an additional 1.1 (95% CI -1.4, 3.6) headache days/month. Naps were not associated with worse self-reported or objective sleep that night. Our findings suggest that naps may be an uncommonly used behavioral strategy for prolonged migraine attacks and do not contribute to nightly sleep disturbance. Future studies are needed to examine the acute analgesic effects of daytime napping in patients with migraine.

Changes in migraine characteristics over 30days of Ramadan fasting: A prospective study.

To study Ramadan's effect on migraine from the start to the end of the month and the tolerability of patients with migraine to fasting. Fasting is a well-known trigger for migraine. Whether this effect on migraine is the same throughout the whole month, or whether it varies from the first to the last days of the month, has not been studied yet. A prospective cohort observational study was carried out on persons with migraine who fasted from 24 April to 23May during Ramadan 2020. Each patient was asked to fill out their headache diary starting from Shaaban (the month before Ramadan) to the end of Ramadan. The Ramadan diary was divided by 10days each, by which the patient was asked to accurately describe their migraine attacks in terms of frequency, duration, and intensity by using the Visual Analog Scale. Migraine attacks during the first day of fasting were assessed separately. A total of 292known persons with migraine from Egypt completed the study. Their median age was 33years; 72/292 (24.7%) were male, and 220/292 (75.3%) were female. About 126/236 (53.4%) of the patients had migraine attacks on Ramadan's first day, most of them during fasting. The frequency of migraine attacks was significantly increased in Ramadan (median 4, interquartile range [IQR] 2-7) compared with Shaaban (median 3, IQR 1-6), p=0.009. The number of attacks was significantly reduced in both the second (median 1, IQR 0-2.25) and the third 10days of Ramadan (median 1, IQR 1-3) compared with the first 10days (median 3, IQR 1-5) (p<0.001 for each). Ramadan's potential exacerbating effect on the frequency of migraine attacks should be discussed with patients with migraine. This effect appears to be limited to the first 10days of Ramadan and then subsides with successive days of fasting.

The effects of synbiotic supplementation on oxidative stress and clinical symptoms in women with migraine: A double‐blind, placebo‐controlled, randomized trial

Oxidative stress may play an important role in migraine pathogenesis. This randomized controlled trial aimed to investigate the effect of 12 weeks synbiotic supplementation on the oxidative stress and clinical symptoms of migraine in eighty women. The effect of the intervention on the total antioxidant capacity (TAC), nitric oxide (NO), oxidative stress index (OSI), total oxidant status (TOS), migraine index (MI), headache diary result (HDR) and migraine headache index score (MHIS) were investigated using bivariate comparison. Synbiotic supplementation improved TAC (381.77 vs 43.17 nmol/ml, P = 0.034), and reduced NO (-4.62 vs 0.55 nmol/ml, P = 0.021), OSI levels (-0.33 vs 0.0009, P = 0.027), and MI (-8.27 vs −3.20, P = 0.013) compared to placebo. A positive correlation between the severity of migraine headache and NO level was observed following synbiotic supplementation (r = 0.44, P = 0.002). Synbiotics may reduce oxidative stress and improve migraine symptoms in women and help as a supplemental therapy in managing migraine headaches.

The Relationship Between Daily Carbonhydrate and Fat Intake A long with Migraine

The pathophysiology of migraine is not fully understood. The trigeminovascular pathway activation, cortical spreading depression, vascular dysfunction, pro-inflammatory and oxidative states, and gut microbiota are investigated. In this study, we aimed to evaluate the relationship between diet and migraine disease characteristics of our patients. This study was conducted with episodic migraine without aura (n:30) and chronic migraine patients (n:30). Demographic data, body mass indexes (BMI), migraine characteristics were recorded from headache diaries. Food consumption were noted Daily from diet diaries. Total calorie intake and carbohydrate and fat amounts were calculated with an internet-based calorie calculator program.The mean age was 40.1±7.83 years in chronic migraine group ( group 1), and 39.1±6.09 years in group 2. The mean BMI of group 1 was significantly higher (respectively; 28.3±3.14, and 24.9±3.29). The mean duration of migraine was found longer in group 1. The mean headache attack duration was 29.9±21.85 hours in group 1, and 29.6±22.4 was in episodic migraine without aura group (group 2). There was no significant difference between both groups in terms of headache attack duration. Average Daily carbohydrate intake is 178.53±44.86 grams in group 1, and 171.42±50.67 grams in group 2. The mean Daily fat intake was 58.01±13.65 grams in group 1 and 56.62±7.51 grams in group 2. No significant difference was found between the groups in terms of Daily calorie, mean Daily fat and, average carbohydrate intake. In our study, we did not find difference in food intake between groups, but BMI of the chronic migraine group were higher. The role of diet on the migraine pathophysiology is still under investigation. An integrative approach to migraine patients by reviewing their diet will help to understand the pathophysiology of migraine, increase the quality of life of patients and prevent unnecessary drug usage.

Effect of antibody switch in non-responders to a CGRP receptor antibody treatment in migraine: A multi-center retrospective cohort study.

BackgroundSwitching between antibody classes might be a treatment option in migraine patients who have not responded to one class of a CGRP-(receptor) monoclonal antibody (mAb), but there are no efficacy data so far. In this real-world analysis, we assessed the treatment response to a CGRP-mAb in patients that have previously failed the CGRP-receptor-mAb erenumab.MethodsWe analyzed retrospective headache diary data of 78 patients with migraine who switched between CGRP-mAbs classes at four German headache centers either due to lack of efficacy or intolerable side effects. Among these, we identified 25 patients who did not respond to erenumab after three treatment cycles (defined as <30% reduction of monthly headache days) and had complete headache documentation at least one month before and during both treatments. We assessed the ≥30% responder rate at month three after switching from erenumab to a CGRP-mAb (galcanezumab or fremanezumab) (primary endpoint). Secondary endpoints included ≥50% responder rate, monthly headache days, and monthly days with acute medication use. In an exploratory subgroup analysis patients were stratified for daily and non-daily headache.ResultsThe switch from erenumab to a CGRP-mAb led to a ≥30% response in one-third (32%) of the patients after three treatment cycles. A ≥50% response was achieved in 12% of the patients. Monthly headache days were reduced in month three compared to baseline (20.8 ± 7.1 to 17.8 ± 9.1; p = 0.009). Stratified analysis revealed that no patient with daily headache (n = 9) responded to the treatment switch, while a 30% response was achieved by 50% of patients with non-daily headache (n = 16).ConclusionOur findings demonstrate that a relevant proportion of erenumab non-responders might benefit from a treatment switch to a CGRP-mAb. Switching seems to be a promising treatment option especially in migraine patients with non-daily headache.

Effects of Inhaling Essential Oil on Headache-Related Quality of Life Among Nurses Working in Emergency and Critical Care Units

Headache attacks are prevalent symptoms in emergency and critical care nurses. Prior evidence supports the analgesic effects of essential oils on headache symptoms. However, few empirical studies have examined how essential oil may further improve the relief of related symptoms. If essential oils are effective in headache relief, nurses' quality of life and care quality may also be improved. This study was designed to examine the effects of inhaling essential oil on (1) headache-related disability, (2) headache-related quality of life, and (3) perceived care quality in emergency and critical care nurses. A cluster randomized control trial and crossover experimental design were adopted. The participants, all nurses with headaches working in emergency and critical care units (N = 49) in a medical center in northern Taiwan, were cluster randomized to Group A and B. Group A wore a necklace with essential oil (100% Lavandula angustifolia 0.1 ml + 100% citrus bergamia 0.1 ml) for 28 days (intervention period), stopped wearing the necklace for 7 days (wash-out), and then wore the necklace without essential oil for 28 days (control period). Group B underwent the control period (28 days) first, followed by the wash-out (7 days) and then the intervention period (28 days). Data were collected using a self-administered questionnaires that was administered three times (at day 0, day 28, day 63). The questionnaire included a demographic and headache-related datasheet, headache diary, Headache Disability Index, Migraine-Specific Questionnaire version 2.1 (role restrictive, role preventive, and emotion function), SERVQUAL (Service Quality), DASS-21, and Copenhagen Burnout Inventory. Repeated measures ANOVA (RM-ANOVA) and generalized estimating equations (GEEs) were used to analyze data. Headache-related quality of life showed significant improvement in the role restrictive (β = 9.77, p = .008) and role preventive (β = 10.03, p = .018) domains. However, headache-related disability and care quality showed no significant differences (p > .05), indicating that inhaling essential oil had a positive effect on quality of life. The findings of this study support that using a necklace with essential oil (Lavandula angustifolia and citrus bergamia 1:1) for 28 days effectively improves quality of life, especially in the domain of role function, in nurses working in emergency and critical care units. Additional empirical studies may be developed in the future to promote the benefits of using essential oils to ease pain.

Trajectory of treatment response in the child and adolescent migraine prevention (CHAMP) study: A randomized clinical trial.

Identify preventive medication treatment response trajectories among youth participating in the Childhood and Adolescent Migraine Prevention study. Data were evaluated from 328 youth (ages 8-17). Childhood and Adolescent Migraine Prevention study participants completed headache diaries during a 28-day baseline period and a 168-day active treatment period during which youth took amitriptyline, topiramate, or placebo. Daily headache occurrence trajectories were established across baseline and active treatment periods using longitudinal hierarchical linear modeling. We tested potential treatment group differences. We also compared final models to trajectory findings from a clinical trial of cognitive behavioral therapy plus amitriptyline for youth with chronic migraine to test for reproducibility. Daily headache occurrence showed stability across baseline. Active treatment models revealed decreases in headache frequency that were most notable early in the trial period. Baseline and active treatment models did not differ by treatment group and replicated trajectory cognitive behavioral therapy plus amitriptyline trial findings. Replicating headache frequency trajectories across clinical trials provides strong evidence that youth can improve quickly. Given no effect for medication, we need to better understand what drives this clinically meaningful improvement. Results also suggest an expected trajectory of treatment response for use in designing and determining endpoints for future clinical trials.Trial Registration. ClinicalTrials.gov Identifier: NCT01581281.

Menstrual cycle and gynecologic pathology in menstrual-related migraine

Migraine is the first most frequent cause of disability among women of reproductive age globally, and up to 60% of patients note the association of headache attacks with menstruation.Objective: to determine the features of menstrual cycle and gynecologic pathology in women with menstrual-related migraine (MRM).Patients and methods. A prospective comparative study included 69 women of reproductive age with a migraine diagnosis who did not receive hormonal contraception. Depending on the association of migraine attacks with menstruation (according to headache diaries), the patients were divided into two groups: the 1st group consisted of 44 patients with MRM; group 2 — 25 patients with non-menstrual migraine (without the association of attacks with menstruation).Results and discussion. Patients with MRM had heavier menstrual bleeding, longer menstruations (more than six days), abnormal menstrual cycle length and regularity, dysmenorrhea. In addition, the obtained data indicate a comorbid estrogen-associated gynecological pathology (endometriosis, adenomyosis, endometrial polyps, myoma) in MRM.Conclusion. Presumably, the hypothalamic-pituitary-ovarian axis dysfunction plays the leading role in the MRM. It presents with menstrual cycle abnormalities and increased presence of estrogen-associated gynecological pathology, which should be considered during patient evaluation and suggesting recommendations.

Effectiveness of different physiotherapy interventions in the management of cervicogenic headache: a pilot randomized controlled trial

ABSTRACT Background Cervicogenic headache is a secondary headache which leads to decreased functional activity, quality of life and functional disability. Objective To determine the feasibility and acceptability of different physiotherapy interventions in the management of cervicogenic headache and to determine sample size for a full trial. Trial design A pilot randomized controlled trial. Settings Various physiotherapy outpatient department. Methods Participants suffering from cervicogenic headache with age 20- 60 years were randomly allocated into four groups. Sessions were given over 4 weeks 4 times a week (16 sessions). The primary outcomes were feasibility of participant recruitment, assessment procedure, retention, adherence, and acceptability. The secondary outcomes were headache impact test-6 for a headache disability, headache diary for headache intensity, frequency, duration, and neck disability index for neck pain, disability measured at baseline, 4th week, and follow up after 1 month. Result 178 subjects were screened based on selection criteria. Out of them, 93 (52%) were eligible and 80 (86%) participated in the study. 96.25% of participants completed the final 8-week assessment. Overall 93.75% of participants completed the entire assessment item across all time points. 95% completed all treatment sessions. 97.5–100% of participants were satisfied with the treatment protocol. No adverse effects were reported by participants. Based on the data obtained from the pilot trial, sample size was determined as 35 participants in each group. Conclusion The results indicate that the trial methodology and intervention are feasible for implementing a full-powered randomized controlled trial to determine the effectiveness of physiotherapy intervention in the management of cervicogenic headache.

P–647 How do migraine attacks change during puberty?

Abstract Study question How do the stage of puberty and the menstrual cycle influence characteristics of migraine? Summary answer During puberty, the frequency of migraine attacks increases, especially during the follicular phase. The pattern of migraine changes to a typical adult pattern of migraine. What is known already Up to puberty, headaches are as common in girls as in boys. After the onset of puberty migraine is more prevalent in adolescent girls suggesting an association with sex hormones. Attacks of menstrual migraine are characterized by a longer duration, tend to be more severe, and are less responsive to acute medication compared to migraine attacks which are independent from the menstrual cycle phase. Study design, size, duration For this prospective cohort study 47 girls were recruited from two Departments of Pediatrics and Adolescent Medicine between 01/2016 and 12/2018. Participants/materials, setting, methods Girls between 7 and 18 years old, diagnosed with migraine without aura according to the “International Classification of Headache Disorders II” diagnostic criteria, took part. Three groups (pre-, peri-, and postpubertal) were formed according to the Tanner stage and the onset of a regular menstruation. Girls kept a daily headache and menstrual cycle diary over 8 weeks. Ovulatory cycles were analyzed by weekly progesterone saliva tests. Main results and the role of chance Three groups according to Tanner stage and onset of regular menstruation were compared: pre- (n = 16), peri- (n = 19) and post-pubertal (n = 12) girls. A significant difference in migraine frequency was found between pre- and post- pubertal girls (p = 0.005). Headache characteristics did not differ significantly between the three groups. Interestingly, a higher frequency of attacks in follicular phase occurred compared to luteal phase (p = 0.030). Limitations, reasons for caution Repeated blood sampling would have been a more reliable technique compared to saliva assays. The sample size is small. Wider implications of the findings: During puberty, the number of migraine attacks but not the specific headache characteristics changes in adolescent girls which should be taken into consideration regarding the management of these patients. Trial registration number AN2013–0027

A Biofeedback App for Migraine: Development and Usability Study.

BackgroundBiofeedback is effective in treating migraines. It is believed to have a beneficial effect on autonomous nervous system activity and render individuals resilient to stressors that may trigger a migraine. However, widespread use of biofeedback is hampered by the need for a trained therapist and specialized equipment. Emerging digital health technology, including smartphones and wearables (mHealth), enables new ways of administering biofeedback. Currently, mHealth interventions for migraine appear feasible, but development processes and usability testing remain insufficient.ObjectiveThe objective of this study was to evaluate and improve the feasibility and usability of an mHealth biofeedback treatment app for adults with migraine.MethodsIn a prospective development and usability study, 18 adults with migraine completed a 4-week testing period of self-administered therapist-independent biofeedback treatment consisting of a smartphone app connected to wearable sensors (Cerebri, Nordic Brain Tech AS). The app included biofeedback training, instructions for self-delivery, and a headache diary. Two wearable sensors were used to measure surface electromyographic voltage at the trapezius muscle and peripheral skin temperature and heart rate at the right second fingertip. Participants were instructed to complete a daily headache diary entry and biofeedback session of 10 minutes duration. The testing period was preceded by a preusability expectation interview and succeeded by a postusability experience interview. In addition, an evaluation questionnaire was completed at weeks 2 and 4. Adherence was calculated as the proportion of 10-minute sessions completed within the first 28 days of treatment. Usability and feasibility were analyzed and summarized quantitatively and qualitatively.ResultsA total of 391 biofeedback sessions were completed with a median of 25 (IQR 17-28) per participant. The mean adherence rate was 0.76 (SD 0.26). The evaluation questionnaire revealed that functionality and design had the highest scores, whereas engagement and biofeedback were lower. Qualitative preexpectation analysis revealed that participants expected to become better familiar with physical signals and gain more understanding of their migraine attacks and noted that the app should be simple and understandable. Postusability analysis indicated that participants had an overall positive user experience with some suggestions for improvement regarding the design of the wearables and app content. The intervention was safe and tolerable. One case of prespecified adverse events was recorded in which a patient developed a skin rash from the sticky surface electromyography electrodes.ConclusionsThe app underwent a rigorous development process that indicated an overall positive user experience, good usability, and high adherence rate. This study highlights the value of usability testing in the development of mHealth apps.

FRAMES protocol versus simple advice for medication-overuse headache: a prospective, randomized, controlled clinical trial.

It is central to the management of patients with Medication-overuse headache that they reverse their behavior regarding the frequent use of pain medication. The objective of this study wasto compare two counseling techniques for treating patients with Medication-overuse headache (MOH). This was a randomized, blind, controlled clinical trial that compared a structured (FRAMES) and unstructured counseling, for the treatment of MOH. Patients were assessed before the counseling and then again four and eight weeks after it. Semi-structured interview, headache diary, the Headache Impact Test (HIT-6) and the Hospital Anxiety and Depression Scale were used. Primary endpoints were the following: number of patients who stopped medication overuse; days with acute medication use; HIT-6; the number of patients who returned for consultations. Secondary endpoints were as follows: days per month of headache; 50% reduction in monthly days with acute medication use; the number of patients with less than 15days of headache. Thirty-seven patients were allocated to the "FRAMES Group" and 33 to the "Control Group". There was no difference regarding primary or secondary outcomes between the two groups. There was a significant reduction in the frequency of headache and the number of days using pain medication in the first and second months of follow-up compared to baseline in both groups. There was a significant reduction in the HIT-6 in the first and second months of follow-up compared to baseline in the FRAMES Group, but not in the control group. Patients in both counseling groups significantly decreased the use of pain medications and the frequency of their headaches.

A headache diary might be a useful tool in the management of chronic migraine patients.

A headache diary might be a useful tool in the management of chronic migraine patients.

Determining the Evolution of Headache Among Regular Users of a Daily Electronic Diary via a Smartphone App: Observational Study.

BackgroundSmartphone-based apps represent a major development in health care management. Specifically in headache care, the use of electronic headache diaries via apps has become increasingly popular. In contrast to the soaring volume of available data, scientific use of these data resources is sparse.ObjectiveIn this analysis, we aimed to assess changes in headache and migraine frequency, headache and migraine intensity, and use of acute medication among people who showed daily use of the headache diary as implemented in the freely available basic version of the German commercial app, M-sense.MethodsThe basic version of M-sense comprises an electronic headache diary, documentation of lifestyle factors with a possible impact on headaches, and evaluation of headache patterns. This analysis included all M-sense users who had entered data into the app on a daily basis for at least 7 months.ResultsWe analyzed data from 1545 users. Mean MHD decreased from 9.42 (SD 5.81) at baseline to 6.39 (SD 5.09) after 6 months (P<.001; 95% CI 2.80-3.25). MMD, AMD, and migraine intensity were also significantly reduced. Similar results were found in 985 users with episodic migraine and in 126 users with chronic migraine.ConclusionsAmong regular users of an electronic headache diary, headache and migraine frequency, in addition to other headache characteristics, improved over time. The use of an electronic headache diary may support standard headache care.

Long-Term Effects of Self-Administered Transcranial Direct Current Stimulation in Episodic Migraine Prevention: Results of a Randomized Controlled Trial

Migraine is a multifactorial neurovascular disorder, which affects about 12% of the general population. In episodic migraine, the visual cortex revealed abnormal processing, most likely due to decreased preactivation level. Transcranial direct current stimulation (tDCS) is able to modify cortical excitability and might result in an alleviation of migraine occurrence if used repetitively. To test the hypothesis that self-administered anodal tDCS over the visual cortex significantly decreases the number of monthly migraine days in episodic migraine. The study was single-blind, randomized, and sham-controlled. Inclusion criteria were age 18-80 years and an ICHD-3 diagnosis of episodic migraine. Exclusion criteria were pregnancy, presence of a neurodegenerative disorder, a contraindication against MRI examinations, and less than two migraine days during the 28-day baseline period. Patients in whom the baseline period suggested chronic migraine were excluded. After baseline, participants applied daily either verum (anodal-1mA to 20 min) or sham tDCS (anodal-1mA to 30 sec) at Oz (reference Cz electrode) for 28 days. Headache diaries were used to record the number of migraine days at baseline, during the stimulation period, and during four subsequent 28-day periods. Twenty-eight patients were included; two were excluded after the baseline period because less than two migraine days occurred; three were excluded because their headache diaries suggested the diagnosis of chronic migraine. Twenty-three datasets were taken for further analysis. Compared to sham tDCS (n=12), verum tDCS (n=11) resulted in a lower number of migraine days (p=0.010) across all follow-up periods. We found no significant change in total headache days (p=0.165), anxiety (p=0.884), or depression scores (p=0.535). No serious adverse events occurred; minor side effects were similar in both groups. This study provides Class II evidence that self-administered anodal tDCS over the visual cortex in episodic migraine results in a significantly lower number of monthly migraine days. However, it has neither an immediate nor a long-term effect.

Is Allodynia a Determinant Factor in the Effectiveness of Transcranial Direct Current Stimulation in the Prophylaxis of Migraine?

Allodynia, the clinical marker of central sensitization, affects even simple daily living activities and increases the tendency for migraine to be more resistant to treatment and have a chronic course. Migraine that impairs quality of life can often be treated with variable pharmaceutical agents, but with various side effects. Transcranial direct current stimulation (tDCS) is a potential alternative treatment for migraine prophylaxis. Seventy-seven patients diagnosed with migraine (48 with allodynia and 29 without allodynia) were included in the study. Randomly, 41 of the 77 patients received sham stimulation and 36 patients underwent three sessions of anodal left primary motor cortex stimulation for 2mA, 20 min. Migraine attack characteristics (frequency, severity, and duration) and analgesic drug use were followed with headache diaries for one month after the stimulation. After tDCS, migraine attack frequency (p=0.021), the number of headache days (p=0.005), duration of attacks (p=0.008), and symptomatic analgesic drug use (p=0.007) decreased in patients receiving active tDCS, compared to the sham group. The therapeutic gain of tDCS was calculated as 44% (95% confidence interval [CI]: 22-60%) for headache days and 76% (95% CI: 55-86) for headache duration. Response to tDCS treatment was higher in patients without allodynia (60% vs. 24%; p=0.028) and allodynia came out as an independent predictor of response to tDCS with logistic regression analysis. Side effects were rare and similar to the sham group. tDCS is a safe, efficacious, and fast method for migraine prophylaxis. However, the administration of tDCS before allodynia occurs, that is, before central sensitization develops, will provide increased responsiveness to the treatment. tDCS is more effective before the development of allodynia, but it also improves the quality of life even after the development of allodynia.

The effect of weather variables on the severity, duration, and frequency of headache attacks in the cases of episodic migraine and episodic tension-type headache

Background/aimAlthough many headache patients report that the frequency and severity of attacks vary according to the season or weather in clinical practice, the relationship between the characteristics of the attacks and the weather is not very clear in episodic headaches. We aimed to compare the effects of weather variables (temperature, wind speed, wind direction, humidity, pressure, ultraviolet index, and sunshine duration) on episodic migraine (EM) and episodic tension-type headache (ETTH) attacks (incidence, duration, and severity).Materials and methodsFifty patients with EM and fifty patients with ETTH diagnosed according to International Classification of Headache Disorders-II are included in the study. Patients were given one diary for headache follow-up. The evaluation form on the relationship between the duration, frequency, and severity of the pain and the findings obtained from the headache diaries were compared with the daily weather data, and the two headache groups were compared with each other in terms of the effect of meteorological data on the pain characteristics.ResultsIt is determined that mean wind velocity in EM attacks is significantly higher when compared to the tension-type headache (TTH) attacks and mean UV index is significantly higher in TTH attacks (p = 0.018 and 0.039). Mean UV index in TTH attack days was reported higher in women than men (p = 0.044). Mean sunshine duration in TTH attack days was reported longer in women than men (p = 0.050). When mean age gets higher in patients with migraine, mean temperature in the days of attack gets lower (r = –0.146 and p = 0.046).Conclusion During the treatment of migraine and TTH patients, recommendations and warnings about weather conditions can be made. This information can guide patients to regulate their daily living activities. The importance of considering the weather-headache relationship during the review of the current treatment in cases of unresponsiveness to treatment should be kept in mind.

Role of educational programs in management of patients with medication-overuse headache

Patients with primary headaches are prone to frequent uncontrolled use of analgesics, leading to medication-overuse headache (MOH). One of the most accessible and effective strategies for its prevention is informing patients about the potential danger of its development. For this, training programs («schools») are conducted.Objective: to evaluate the effectiveness of educational programs in management of patients with MOH and its prevention.Patients and methods. We included 120 patients (12 men and 108 women, mean age: men – 46.3±3.54 years, women – 41.3±9.5 years) with primary headache and MOH. The follow-up period was 12 months. First, patients were divided into two groups depending on the clinical diagnosis: group I (n=44) – patients with chronic primary headaches without MOH, group II (n=76) – patients with chronic primary headaches and MOH. Then, patients in each group were randomized into subgroups depending on the prescribed therapy. All participants underwent repeated clinical examinations and questionnaires assessment at 1-, 3- and 12-months follow-ups. In addition, all patients kept a headache diary. An educational «school» developed for this study was held in those subgroups where educational programs were specified.Results and discussion. We observed a significant decrease in mean Headache-Attributed Lost Time (HALT) and Headache Impact Test (HIT-6) scores (р&lt;0,05) at 12-months follow-up in subgroups where headache educational programs were combined with drug therapy, compared to the subgroups without educational programs. At the end of follow-up, we found a mean 1.75-fold increase in patients' treatment satisfaction (compared to baseline) in the subgroups where the «school» was held. Financial costs during the 12-month follow-up period for patients decreased by seven times because most patients stopped taking medications to relieve headaches.Conclusion. Information and educational programs are an integral part of the management of patients with MOH.

Enhanced mindfulness-based stress reduction in episodic migraine-effects on sleep quality, anxiety, stress, and depression: a secondary analysis of a randomized clinical trial.

Patients with migraine suffer from high morbidity related to the repeated headache attacks, characteristic of the disorder, poor sleep, and a high prevalence of comorbid psychosocial disorders. Current pharmacological therapies do not address these aspects of migraine, but nonpharmacological treatments such as mindfulness-based stress reduction (MBSR) have been shown to improve both pain and psychological well-being. In this secondary analysis, we examined the change over time in sleep quality and psychosocial outcomes from the magnetic resonance imaging outcomes for mindfulness meditation clinical trial and assessed how these mediated treatment response (50% reduction in headache frequency postintervention). We also examined the relationship between baseline values and treatment response. The trial (primary outcomes previously reported) included 98 patients with episodic migraine randomized to either enhanced MBSR (MBSR+) or stress management for headache. They completed psychosocial questionnaires and headache diaries at baseline (preintervention), midintervention (10 weeks after baseline), and postintervention (20 weeks after baseline). There was a significant improvement in sleep quality from baseline to postintervention (P = 0.0025) in both groups. There were no significant changes from baseline or between groups in anxiety, depression, and stress. There was also no significant association between baseline scores and treatment response. Mediation analysis showed a significant indirect effect of 6% for sleep: In other words, small improvements in sleep may have contributed to the efficacy of MBSR+.Trial registration: NCT02133209.