Migraine Disability Assessment Questionnaire Research Articles

Headache in patients with non-functioning pituitary adenoma before and after transsphenoidal surgery - a prospective study.

To study the long-term effect of transsphenoidal surgery (TSS) on headache in patients with non-functioning pituitary adenoma (NFPA) and identify factors predicting headache relief following TSS. We evaluated headache in 101 consecutive patients with NFPA who underwent TSS from September 2015 to December 2021, preoperatively and 12-months post-surgery, by using the Migraine Disability Assessment (MIDAS) questionnaire. Health-related quality of life (QoL) was assessed using the EQ-5D visual analogue scale (EQ-VAS). Of 101 patients, 27 (27%) experienced disabling preoperative headache. Among these, the median total MIDAS score improved from 60 (interquartile range (IQR): 19-140) to 10 (IQR: 0-49) (P = 0.004). Additionally, headache frequency over a 90-day period decreased from 45 (IQR: 25-83) to 6 (IQR: 3-36) days (P = 0.002), and headache intensity decreased from 5 (IQR: 4-7) to 4 (IQR: 2-7) (P = 0.016) at 12-months post-surgery. At 12 months post-surgery, 18 (67%) of 27 patients with preoperatively disabling headache showed clinically relevant improvement of their headache, 4 (15%) showed deterioration, and 5 (19%) remained unchanged. In patients with clinically relevant improvement of their headache, the EQ-VAS score improved from 50 (IQR: 30 - 7) to 80 (IQR: 65-86) (P < 0.001). Of the 74 patients with no preoperative headache, 11 (15%) developed postoperative headache. We identified no clinical factors predicting postoperative headache relief. The study supports that clinically significant and long-lasting improvements of disabling headache and QoL can be achieved with TSS in a substantial number of patients with NFPA.

Headache in systemic lupus erythematosus: The LUNA registry cross-sectional study

Objectives This study investigated the clinically relevant factors for headaches in patients with systemic lupus erythematosus (SLE) using a registry from a Japanese multicenter cohort. Methods This cross-sectional study analysed the clinical information of patients with SLE who experienced headache episodes using the Migraine Disability Assessment (MIDAS) questionnaire. Significant findings in the comparisons between patients with headache (HA patients) and those without headache (non-HA patients) and in the comparisons depending on the grades of headache-induced disability in daily life based on the MIDAS scores were evaluated. Multivariate logistic regression analyses were performed to identify the relevant factors for headache. Results We analyzed 369 patients (median age, 45 years; female, 90.8%), including 113 HA patients who were significantly younger than non-HA patients ( p &lt; .005). HA patients had significantly higher frequencies of photosensitivity, rashes, and mucosal ulcers than non-HA patients ( p &lt; .05). Age and photosensitivity were significantly associated with headache (odds ratio (OR) 0.93, 95% confidence interval (CI) 0.95–0.99; OR 2.11, 95% CI 1.29–3.49, respectively). In the HA patients, hypocomplementemia was significantly associated with a disability of more than mild grade (OR 2.89, 95% CI 1.14–7.74), while rash was significantly observed in those presenting with moderate and severe disability. Conclusion This study suggests that photosensitivity is a relevant manifestation of headache in patients with SLE. Persistent hypocomplementemia can contribute to headache-induced disability in daily life, whereas a rash may be a dominant manifestation in patients presenting with moderate/severe headache-induced disability.

Effects of Gluten on Gut Microbiota in Patients with Gastrointestinal Disorders, Migraine, and Dermatitis.

As gluten may trigger gastrointestinal disorders (GIDs), its presence or absence in the diet can change the diversity and proportion of gut microbiota. The effects of gluten after six weeks of a double-blind, placebo-controlled intervention with a gluten-free diet (GFD) were studied in participants with GIDs suffering from migraines and atopic dermatitis (n = 46). Clinical biomarkers, digestive symptoms, stool, the Migraine Disability Assessment questionnaire, and zonulin levels were analyzed. Next-generation sequencing was used to amplify the 16S rRNA gene of bacteria and the internal transcribed spacer (ITS) regions of fungi. The GFD increased Chao1 fungal diversity after the intervention, while the fungal composition showed no changes. Bacterial diversity and composition remained stable, but a positive association between bacterial and fungal Chao1 diversity and a negative association between Dothideomycetes and Akkermansia were observed. GIDs decreased in both groups and migraines improved in the placebo group. Our findings may aid the development of GID treatment strategies.

Modulation of temporal and occipital cortex by acupuncture in non-menstrual MWoA patients: a rest BOLD fMRI study

ObjectiveTo investigate the changes in amplitude of low-frequency fluctuation (ALFF) and degree centrality (DC) values before and after acupuncture in young women with non-menstrual migraine without aura (MWoA) through rest blood-oxygen-level-dependent functional magnetic resonance imaging (BOLD fMRI).MethodsPatients with non-menstrual MWoA (Group 1, n = 50) and healthy controls (Group 2, n = 50) were recruited. fMRI was performed in Group 1 at 2 time points: before acupuncture (time point 1, TP1); and after the end of all acupuncture sessions (time point 2, TP2), and performed in Group 2 as a one-time scan. Patients in Group 1 were assessed with the Migraine Disability Assessment Questionnaire (MIDAS) and the Short-Form McGill Pain Questionnaire (SF-MPQ) at TP1 and TP2 after fMRI was performed. The ALFF and DC values were compared within Group 1 at two time points and between Group 1 and Group2. The correlation between ALFF and DC values with the statistical differences and the clinical scales scores were analyzed.ResultsBrain activities increased in the left fusiform gyrus and right angular gyrus, left middle occipital gyrus, and bilateral prefrontal cortex and decreased in left inferior parietal lobule in Group 1, which had different ALFF values compared with Group 2 at TP1. The bilateral fusiform gyrus, bilateral inferior temporal gyrus and right middle temporal gyrus increased and right angular gyrus, right superior marginal gyrus, right inferior parietal lobule, right middle occipital gyrus, right superior frontal gyrus, right middle frontal gyrus, right anterior central gyrus, and right supplementary motor area decreased in activity in Group 1 had different DC values compared with Group 2 at TP1. ALFF and DC values of right inferior temporal gyrus, right fusiform gyrus and right middle temporal gyrus were decreased in Group1 at TP1 compared with TP2. ALFF values in the left middle occipital area were positively correlated with the pain degree at TP1 in Group1 (correlation coefficient r, r = 0.827, r = 0.343; P < 0.01, P = 0.015). The DC values of the right inferior temporal area were positively correlated with the pain degree at TP1 in Group 1 (r = 0.371; P = 0.008).ConclusionSpontaneous brain activity and network changes in young women with non-menstrual MwoA were altered by acupuncture. The right temporal area may be an important target for acupuncture modulated brain function in young women with non-menstrual MwoA.

Monitoring of optic sheath diameter during acute migraine attack: an objective criteria for the severity of disease.

The etiology of migraine can be complex and multifactorial but not clear, also, intracranial pressure has been already associated with migraine attacks. This study aimed to monitor intracranial pressure during migraine attack to understand the possible relations with disease and severity. A prospective randomized study was designed. Patients with a definitive diagnosis of migraine underwent ultrasonography for optic nerve sheath diameter (ONSD) measurement before treatment and were re-measured after the attack was resolved. The severity of the migraine was assessed with Headache Impact Test-6 (HIT-6) and Migraine Disability Assessment (MIDAS) questionnaire before the treatment and after the symptoms regressed. ONSD values and scores from the questionnaires were compared before and after the migraine attack. The study included 11 (52.4%) women and 10 (47.6%) men, and 42 eyes were evaluated. ONSD was detected as 4.23 ± 0.26 mm in the right eye and 4.10 ± 0.32 mm in the left eye during the migraine attack and decreased to 3.65 ± 0.41 mm in the right eye and 3.50 ± 0.33 mm in the left eye after the attack was treated (p < 0.001, both). A similar statistical improvement was found in HIT-6 and MIDAS scores with ONSD after treatment (p < 0.001). A significant positive correlation was found between the ONSD value in both eyes and HIT-6/MIDAS scores during the migraine attack, and also, after the migraine attack. A subjective increase of ONSD values during the migraine attack decreased after the disease resolved, also changes in ONSD values were significantly correlated with the severity of symptoms.

SAT615 Long-term Effects Of Transsphenoidal Surgery On Headache In Patients With Pituitary Tumors - A Prospective Study

Abstract Disclosure: V. Hantelius: None. O. Ragnarsson: None. G. Johannsson: None. E. Thurin: None. T. Skoglund: None. T. Hallen: None. Objective: Headache is a common symptom in patients with non-functioning pituitary adenomas (NFPA). The aim of this study was to analyze the long-term effect of transsphenoidal surgery (TSS) on disabling headache in patients with NFPA and to investigate possible predictive factors for headache relief following TSS. Methods: This was a prospective study of 101 patients with NFPA who underwent TSS between September 2015 to December 2021. Headache was assessed preoperatively and 12 months postoperatively with The Migraine Disability Assessment (MIDAS) questionnaire. MIDAS measures the impact of headache on the everyday life during the last 3 months and assess the headache frequency and intensity. Results: Of 101 patients, 27 (27%) experienced disabling headache preoperatively. In these 27 patients, the median (interquartile range) total MIDAS total score improved from 60 (19-140) to 10 (0-49) (p=0.004; max score 270), headache frequency decreased from 45 (25-83) to 6 (3-36) days per 90 days (p=0.002), and headache intensity decreased from 5 (4-7) to 4 (2-7) (p=0.016; on a scale 0-10 at 12 months after surgery. Overall, 18 of 27 patients (67%) had a clinically relevant improvement of their headache, 4 (15%) had a clinically relevant deterioration and 5 (19%) had no clinically relevant change at one year after surgery. No clinical factors that predicted postoperative headache relief were identified. Conclusions: Our study supports that transsphenoidal surgery achieves clinically significant and long-lasting improvement of disabling headache in patients with NFPA. Presentation: Saturday, June 17, 2023

Functional outcomes between headache surgery and targeted botox injections: A prospective multicenter pilot study

IntroductionChronic migraine headaches (MH) are a principal cause of disability worldwide. This study evaluated and compared functional outcomes after peripheral trigger point deactivation surgery or botulinum neurotoxin A (BTA) treatment in patients with MH. MethodsA long-term, multicenter, and prospective study was performed. Patients with chronic migraine were recruited at the Ohio State University and Massachusetts General Hospital and included in each treatment group according to their preference (BTA or surgery). Assessment tools including the Migraine Headache Index (MHI), Migraine Disability Assessment Questionnaire (MIDAS) total, MIDAS A, MIDAS B, Migraine Work and Productivity Loss Questionnaire-question 7 (MWPLQ7), and Migraine-Specific Quality of Life Questionnaire (MSQ) version 2.1 were used to evaluate functional outcomes. Patients were evaluated prior to treatment and at 1, 2, and 2.5 years after treatment. ResultsA total of 44 patients were included in the study (surgery=33, BTA=11). Patients treated surgically showed statistically significant improvement in headache intensity as measured on MIDAS B (p = 0.0464) and reduced disability as measured on MWPLQ7 (p = 0.0120) compared to those treated with BTA injection. No statistical difference between groups was found for the remaining functional outcomes. Mean scores significantly improved over time independently of treatment for MHI, MIDAS total, MIDAS A, MIDAS B, and MWPLQ 7 (p<0.05). However, no difference in mean scores over time was observed for MSQ. ConclusionsHeadache surgery and targeted BTA injections are both effective means of addressing peripheral trigger sites causing headache pain. However, lower pain intensity and work-related disabilities were found in the surgical group.

The Effect of Coenzyme Q10 as a Prophylactic Treatment in Episodic Migraine

Aim: Migraine is a neurological disorder characterized by recurring and often severe headaches. The aim of this study was to evaluate the effectiveness of coenzyme Q10 (CoQ10) in episodic migraine prophylaxis. Material and Methods: In a prospective follow-up study, 80 patients with episodic migraine were enrolled according to the International Classification of Headache Disorders 3rd edition and divided into two groups. One group consisted of 40 patients who received CoQ10 oral 200 mg twice daily as monotherapy for three months, while the other group consisted of 40 patients who received CoQ10 as an adjunct therapy in combination with other prophylactic antimigraine drugs. The Migraine Disability Assessment (MIDAS) questionnaire was administered to both groups before and after three months of therapy. Throughout the three-month therapy period, patients recorded daily symptoms, allowing for observation of changes in symptom severity, number, and duration of attacks from baseline. Results: Both groups that received CoQ10 supplementation exhibited positive responses. The group receiving adjunct therapy showed a statistically more significant reduction in the MIDAS (p&amp;lt;0.001), duration (p&amp;lt;0.001), and frequency (p&amp;lt;0.001) of attacks compared to the monotherapy group. Vomiting (p&amp;lt;0.001) in the adjunct therapy group completely disappeared and sound sensitivity (p=0.002) showed a dramatic response to treatment. Conclusion: CoQ10 appears to have more beneficial effects as an adjunct than monotherapy in reducing the duration, frequency, and presenting symptoms such as nausea, vomiting, and light sensitivity, in addition to sound sensitivity that responded only to adjunct therapy than monotherapy among Iraqi patients with episodic 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.

The value of right heart contrast echocardiography combined with migraine rating scale in evaluating the efficacy of patent foramen ovale closure

ObjectivesTo investigate the clinical values of right heart contrast transthoracic echocardiography (cTTE) combined with migraine rating scale in evaluating the efficacy of patent foramen ovale (PFO) closure.MethodsFrom January 2018 to December 2021, a total of 68 hospitalized patients, 21 males and 47 females, who were treated with transcatheter closure of PFO-induced migraine in the Heart Center of the First Affiliated Hospital of Tsinghua University were selected, with the age of 38.4 ± 11.9 years old. The changes of right heart contrast transthoracic echocardiography (cTTE), visual analogue pain score(VAS), headache impact test-6(HIT-6) and migraine disability assessment questionnaire(MIDAS) before and 6 months after PFO occlusion were compared.ResultsPre-operative cTTE data show that 36 patients (52.9%) had moderate right-to-left shunt (RLS), and 32 patients (47.1%) had massive RLS. cTTE was reexamined 6 months after operation and 1 case in the moderate RLS group had minimal RLS, 2 cases in the large RLS group had minimal RLS, and no shunts were seen for the rest. The VAS, HIT-6 and MIDAS scores before and 6 months after the operation were 7.65 ± 1.39 vs. 1.28 ± 1.53, 70.78 ± 6.82 vs. 41.53 ± 6.07, and 30.60 ± 13.24 vs. 1.93 ± 3.87, respectively. All the indexes 6 months after the operation significantly improved compared with the preoperative baseline (P < 0.05).ConclusionscTTE combined with migraine evaluation scale could be used as an objective index to evaluate the clinical effect of PFO occlusion.

Galcanezumab for the treatment of chronic migraine and medication overuse headache: Real-world clinical evidence in a severely impaired patient population.

Galcanezumab is a monoclonal antibody acting against the calcitonin gene-related peptide approved for the preventive treatment of migraine. The aim of this article is to explore its effectiveness and safety of galcanezumab in chronic migraine (CM) with medication overuse-headache (MOH). Seventy-eight patients were consecutively enrolled at the Modena headache center and followed up for 15 months. Visits were scheduled every 3 months, and the following variables were collected: the number of migraine days per month (MDM); the painkillers taken per month (PM); the number of days per month in which the patient took, at least, one painkiller; the six-item headache impact test; and the migraine disability assessment questionnaire (MIDAS) score. Demographic features of the analyzed sample were collected at the baseline and adverse events (AEs) were collected at every visit. After 12 months, galcanezumab significantly reduced the MDM, the PM, the number of days on medication, the HIT-6 as well as the MIDAS scores (all p < .0001). The greatest amelioration was obtained in the first trimester of treatment. A higher MDM, a higher NRS score at the baseline, and a higher number of failed preventive treatments negatively predict the CM relief at the year of treatment. No serious AEs were registered and only one drop-out was due to AE. Galcanezumab is effective and safe for the treatment of patients affected by CM and MOH. Patients with a higher impairment at the baseline may found less benefits with galcanezumab.

Real-World Effectiveness of Fremanezumab in Patients with Migraine who Switched From Another mAb Targeting the CGRP Pathway (Subgroup Analysis From FINESSE) (P13-12.007)

Real-World Effectiveness of Fremanezumab in Patients with Migraine who Switched From Another mAb Targeting the CGRP Pathway (Subgroup Analysis From FINESSE) (P13-12.007)

Fremanezumab for Migraine Prevention: Interim Analysis of the Non-Interventional FINESSE Study (P13-12.010)

Fremanezumab for Migraine Prevention: Interim Analysis of the Non-Interventional FINESSE Study (P13-12.010)

Epidemiological Study on Clinical and Functional Disability of Migraine Patients Visiting Neurological Centers in Nepal (P11-12.011)

<h3>Objective:</h3> To determine the clinical features and influence of migraine headaches on the everyday functioning of patient. Special objectives are to assess the socio-demographic characteristics of patient with migraine, to investigate the clinical manifestation of migraine and to determine the functional disability caused due to migraine using Migraine Disability Assessment (MIDAS) format. <h3>Background:</h3> Migraine is a neurological disabling condition which is prevalent globally and it is a major reason sought for the medical care. A large number of population evidenced by 1 billion people around the world are affected due to migraine disorder. It is the sixth most disabling illness in the world and fifth leading cause of year of life lived with disability in south Asia. This study is conducted in order to explore the clinical and functional disability of patient with migraine among Nepali residents. <h3>Design/Methods:</h3> Quantitative research methods were used to carry out this study. MIDAS questionnaire was used. Data was collected under Likert scale format. Data were analyzed by using descriptive statistical method by SPSS (version 20). <h3>Results:</h3> About 219 patients were diagnosed with migraine in the period of 3 months. Majority of participants were in the age group of 20–29 years (29.7%) followed by age group of 30–39(27.9%) with the majority of female participants (79%). The various symptoms experienced by participants were throbbing pain (87.2%), photophobia (9.2%), Phonophobia (86.3%), Nausea (54.3%) and vomiting (38.8%). About 36.52% of patients were in the category of episodic migraine and 63.47% were in the category of chronic migraine. Most of the subjects (84.5%) experienced the severe level of functional disability. <h3>Conclusions:</h3> It is concluded that chronic migraine was found to be 3.4 times higher in disability called as level IV in comparison with level I also called as lower disability level and this relationship was statistically significant (OR=3.4, 95%CI=1.01–11.48). <b>Disclosure:</b> Mr. Chandra has nothing to disclose. Dr. Chandra has nothing to disclose.

Annual indirect costs savings in patients with episodic or chronic migraine: a post-hoc analysis of phase 3 galcanezumab clinical trials in the United States

BackgroundGalcanezumab (GMB) improved quality-of-life and reduced disability of patients with episodic (EM) and chronic migraine (CM) in Phase 3 trials.AimTo estimate indirect cost savings associated with GMB treatment in patients with migraine in the United States (US).MethodsWe analyzed data of patients from the US from three randomized, Phase 3, double-blind, placebo (PBO)-controlled GMB studies: EVOLVE-1 and EVOLVE-2 (EM patients), REGAIN (CM patients). Annual indirect costs were calculated using items of the Migraine Disability Assessment (MIDAS) questionnaire: lost time/productivity at work/school, household work, and leisure time. All costs were annualized and expressed in 2019 US dollars. While the main analysis considered lost time/productivity at work/school and household work as a full day, a sensitivity analysis was performed by discounting them by half. For EM, annual indirect costs savings were estimated using mixed model repeated measures analysis. For CM, ANCOVA models were used to estimate annual indirect costs savings as change from baseline.ResultsThe analysis included 805 patients with EM (mean age = 41.4 years; PBO = 534; GMB = 271) and 423 patients with CM (mean age = 38.9 years; PBO = 279; GMB = 144). Compared to PBO, GMB significantly reduced annual indirect costs among patients with EM at 3 months (least square mean [95% confidence interval] work/school = $1,883.6 [603.64–3,163.65], p = .0040, household work = $628.9 [352.95–904.88], p <.0001, and leisure activity = $499.17 [42.36–955.98], p = .0323) and 6 months (work/school = $2,382.29 [1,065.48–3,699.10], p = .0004, household work = $559.45 [268.99–849.90], p = .0002, and leisure activity = $753.81 [334.35–1,173.27], p = .0004), whereas a significant difference was not observed among patients with CM. Sensitivity analysis results were similar to primary analysis results.ConclusionsGMB treatment versus PBO resulted in significantly greater indirect cost savings in patients with EM through improved productivity at work/school, household work, and leisure days. Patients with CM receiving GMB versus PBO attained greater cost savings, although not statistically significant, through reduced lost productivity at work/school.

Headache and sleep quality in mitochondrial diseases

Objective: Describe the characteristics and prevalence of headache in patients with mitochondrial diseases (MDs), as well as sleep quality, trying to observe possible associations. To assess whether these patients are more likely to suffer headaches in relation to poorer quality of sleep. Background: Sleep disorders and headache are considered to be common in MDs. We present the largest sample analyzed to date. Methods: Observational, descriptive, cross-sectional study that analyzed a database of 232 patients with MDs, including age, sex, genotype, phenotype, presence and characteristics of headache. All patients fulfilled the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI) and, in migraine, the Migraine Disability Assessment questionnaire (MIDAS). Headache was divided into two groups: migraine headache, according to criteria of the International Classification of Headache Disorders (ICHD-III beta), and non-migraine headache. Results: A total of 203 cases were analyzed, 124 women (61%) and 79 men (39%). Average age was 46 years. Most frequent DNA mutation was m.3243 A &gt; G in MITL1 gene (33%). Most frequent phenotype was MELAS syndrome: 28 patients (13.8%). Ninety-two patients (45.3%), reported headache, 44 fulfilling migraine criteria (21.7%). Headache was more frequent in MELAS syndrome ( p &lt; 0.01). Statistically significant differences were found in the number of disabling episodes per month in patients with migraine ( p &lt; 0.001). Patients with headache scored higher in Epworth ( p = 0.01) and Pittsburgh scales ( p &lt; 0.001). Conclusions: A higher prevalence of migraine is observed in patients with mitochondrial diseases, independent of genotype and phenotype. MD-associated migraine tends to be chronic and more disabling. A higher frequency of headache, not specifically migraine, has also been observed in patients with MELAS syndrome. Mitochondrial dysfunction could be one of the pathophysiological mechanisms of migraine and a factor of chronification and severity. Poor sleep quality could also be associated with headache in patients with MDs. Assessment of headache and sleep disturbances should be part of the routine workup of patients with mitochondrial disease. Trial registration: N/A.

The relationship of attachment styles, perceived social support, and anxiety and depressive symptoms with migraine-related disability

The objectives of the present study was to examine the attachment styles, perceived social support, and levels of depression and anxiety symptoms in patients with migraine and to determine the relationships of these variables with migraine disability. In total, 80 patients with episodic migraine (EM), 35 patients with chronic migraine (CM), and 50 healthy controls were included. All participants completed the Experiences in Close Relationships Inventory (ECRI), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Hospital Anxiety and Depression Scale (HADS). In addition, patients with migraine completed the Migraine Disability Assessment (MIDAS) Questionnaire. A statistically significant difference was found between the EM and CM groups in terms of MIDAS scores. The Avoidance subscale mean scores in the EM and CM group were statistically significantly higher than the mean scores of the healthy control group. The MSPSS Total, Family and Friends subscale mean scores of the EM group and healthy control group were significantly higher than the mean scores of the CM group. MANOVA showed statistically significant differences between groups in terms of ECRI, MSPSS, and the HADS scores. Chronic migraine patients who have high levels of avoidant attachment, anxious attachment, and depression tend to experience greater migraine-related disability. In contrast, those with higher levels of perceived social support from friends and a larger social support network tend to experience less migraine-related disability. Family support is the key support system for predicting migraine-related disability. Prioritizing and improving perceived social support can minimize negative effects and prevent chronicity, making it a crucial aspect of migraine treatment.

Migraine severity, disability, and duration: Is a good diet quality, high intake of phytochemicals and polyphenols important?

Dietary pattern may be the determinant of migraine prognosis through various mechanisms such as systemic inflammation, vasodilation, cerebral glucose metabolism, and mitochondrial dysfunction.This study was conducted to examine the relationship of the symptoms and signs of migraine with dietary polyphenols and the phytochemical intake and the quality of the diet. Individuals (n = 90), who were admitted to the headache outpatient clinic due to the diagnosis of episodic migraine, underwent physical examination by a neurologist. Migraine characteristics were assessed using the Migraine Disability Assessment Questionnaire and the Visual Analogue Scale. The Healthy Eating Index-2015 (HEI-2015) was used to evaluate the diet quality of individuals, and the Phytochemical Index developed by McCarty was used to determine the dietary intake of phytochemicals. Phenol-Explorer version 3.6 and the USDA Database for the Flavonoid Content of Selected Foods-Release 3.3 were used to calculate the dietary polyphenol intake. Migraine severity was negatively correlated with the intake of phytochemicals and good diet quality (r = -0.37, p = 0.0003; r = -0.37, p = 0.0003, respectively), and with the intake of phenolic components flavanones (r = -0.27, p = 0.01) and lignans (r = -0.27, p = 0.01). With respect to the food groups; migraine severity was found to be inversely correlated with the total phenol intake from olive oil, oil, and fruits (r = -0.26, p = 0.01; r = -0.21, p = 0.04; r = -0.24, p = 0.02, respectively), and the flavonoid intake from olive oil, oil, fruits, and vegetables (r = -0.26, p = 0.01; r = -0.26, p = 0.01; r = -0.35, p = 0.0007; r = -0.22, p = 0.04, respectively). Strikingly, fruit flavanone intake was correlated with low migraine severity (r = -0.39, p = 0.0002), and fruit flavanol intake was correlated with low migraine disability (r = -0.21, p = 0.04). A high-quality diet rich in phytochemicals and polyphenols (especially flavanones and lignans) is associated with low migraine severity. Lower intake of phenols and flavonoids from vegetable oil, olive oil, fruits, and vegetables were associated with more severe migraine attacks. Examination of migraine characteristics and dietary pattern together with phytochemical and polyphenol intake may guide the development of dietary strategies to be used in migraine patients.

B vitamins and their combination could reduce migraine headaches: A randomized double-blind controlled trial.

Background: The B vitamins can potentially help prevent migraine. This study was designed to examine the effects of supplementation with thiamine (B1), pyridoxine (B6), cobalamin (B12), folic acid (B9), and a combination of these vitamins on women with episodic migraine (EM). Methods: This study was a double-blind, placebo-controlled, randomized, clinical trial conducted on 120 women with EM. The participants were divided into the 6 groups of B1 (n = 20), B6 (n = 20), B12 (n = 20), B9 (n = 20), vitamin B complex (n = 20), and placebo (n = 20). Subjects received 1 capsule daily for 12 weeks. As part of the baseline and post-intervention phases, paper-based headache diaries were used to record the number of abortive drugs consumed and the frequency of headache attacks, and the Migraine Disability Assessment Questionnaire (MIDAS) was used to assess migraine disability. Results: A 16-week study on women with EM revealed that the mean changes in the frequency of headache attacks decreased significantly in all vitamin groups in comparison with the placebo group (P < 0.001). In contrast to the placebo, there was also a significant improvement in the migraine disability score in each vitamin group (P < 0.001). The 12-week supplementation with vitamins B9, B1, B6, B12, and B complex also brought on a significant decrease in the use of abortive drugs compared to the placebo group (P = 0.032). Conclusion: The results of this study showed that B1, B6, B12, and B9, and a combination of these vitamins could be effective as an adjuvant in treatment and prophylaxis of EM. Further large trials with long-term follow-ups will be required to confirm our results.

Impact of fremanezumab on disability outcomes in patients with episodic and chronic migraine: a pooled analysis of phase 3 studies

BackgroundMigraine is the second leading cause of disability worldwide. Although many preventive treatments reduce migraine frequency and severity, it is unclear whether these treatments reduce migraine-related disability in a clinically meaningful way. This pooled analysis evaluated the ability of fremanezumab to reduce migraine-related disability, based on responses and shifts in severity in patient-reported disability outcomes.MethodsThis pooled analysis included 3 double-blind phase 3 trials (HALO EM, HALO CM, FOCUS) in which patients with episodic or chronic migraine were randomly assigned 1:1:1 to quarterly or monthly fremanezumab or matched placebo for 12 weeks. Migraine-related disability was assessed using the 6-item Headache Impact Test (HIT-6) and Migraine Disability Assessment (MIDAS) questionnaires. A clinically meaningful improvement in disability was defined per American Headache Society guidelines: for HIT-6, a ≥ 5-point reduction; for MIDAS, a ≥ 5-point reduction when baseline score was 11 to 20 or ≥ 30% reduction when baseline score was > 20. Proportions of patients who demonstrated shifts in severity for each outcome were also evaluated.ResultsFor patients with baseline MIDAS scores of 11 to 20 (n = 234), significantly higher proportions achieved 5-point reductions from baseline in MIDAS scores with fremanezumab (quarterly, 71%; monthly, 70%) compared with placebo (49%; both P ≤ 0.01). For patients with baseline MIDAS scores of > 20 (n = 1266), proportions achieving ≥30% reduction from baseline in MIDAS scores were also significantly higher with fremanezumab (quarterly, 69%; monthly, 79%) compared with placebo (58%; both P < 0.001). For HIT-6 scores, proportions of patients achieving 5-point reductions from baseline were significantly higher with fremanezumab (quarterly, 53%; monthly, 55%) compared with placebo (39%; both P < 0.0001). Proportions of patients with shifts of 1 to 3 grades down in MIDAS or HIT-6 disability severity were significantly greater with quarterly and monthly fremanezumab compared with placebo (all P < 0.0001).ConclusionFremanezumab demonstrated clinically meaningful improvements in disability severity in this pooled analysis.Trial registrationsHALO CM, NCT02621931; HALO EM, NCT02629861; FOCUS, NCT03308968.