Migraine Disability Assessment Scale Research Articles

Assessing the impact of migraine on benign paroxysmal positional vertigo symptoms and recovery

BackgroundDuring episodes of benign paroxysmal positional vertigo (BPPV), individuals with migraine, compared with individuals without migraine, may experience more severe vestibular symptoms because of their hyperexcitable brain structures, more adverse effects on quality of life, and worse recovery processes from BPPV.MethodsAll patients with BPPV were assigned to the migraine group (MG, n = 64) and without migraine group (BPPV w/o MG, n = 64) and completed the Vertigo Symptom Scale (VSS), Vertigo Dizziness Imbalance Symptom Scale (VDI-SS), VDI Health-Related Quality of Life Scale (VDI-HRQoLS), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI) at the time of BPPV diagnosis (baseline) and on the one-month follow-up. Headache Impact Test-6 and Migraine Disability Assessment Scale were used for an assessment of headache. Motion sickness was evaluated based on the statement of each patient as present or absent.ResultsCompared with the BPPV w/o MG, the MG had higher VSS scores at baseline [19.5 (10.7) vs. 11.3 (8.5); p < 0.001] and on one-month follow-up [10.9 (9.3) vs. 2.2 (2.7), p < 0.001]; experienced more severe dizziness and imbalance symptoms based on the VDI-SS at baseline (61.9% vs. 77.3%; p < 0.001) and after one month (78.9% vs. 93.7%, p < 0.001); and more significantly impaired quality of life according to the VDI-HRQoLS at baseline (77.4% vs. 91.8%, p < 0.001) and after one month (86.3% vs. 97.6%, p < 0.001).On the one-month follow-up, the subgroups of patients with moderate and severe scores of the BAI were higher in the MG (39.2%, n = 24) than in the BPPV w/o MG (21.8%, n = 14) and the number of patients who had normal scores of the BDI was lower in the MG than in the BPPV w/o MG (67.1% vs. 87.5%, p = 0.038).ConclusionClinicians are advised to inquire about migraine when evaluating patients with BPPV because it may lead to more intricate and severe clinical presentation. Further studies will be elaborated the genuine nature of the causal relationship between migraine and BPPV.

Reliability, validity, and responsiveness of the Arabic version of HIT-6 questionnaire in patients with migraine indicated for preventive therapy: A multi-center study.

The Headache Impact Test (HIT-6) is an important patient-reported outcome measure (PROM) in migraine prevention trials. This study aimed to (i) assess the reliability and validity of the Arabic version of HIT-6 in Arabic-speaking patients experiencing migraine, and (ii) evaluate the responsiveness of HIT-6 following migraine preventive therapy. In this prospective study, patients with migraine (n = 145) were requested to fill out a headache diary, the Arabic version of HIT-6, and Migraine Disability Assessment Scale (MIDAS) at two time points (baseline and 3 months after initiation of prophylactic treatment). Some respondents (n = 73) were requested to fill out HIT-6 again 1 week from the baseline for test-retest reliability. The intensity of migraine headache attacks was evaluated using the Visual Analogue Scale (VAS). An anchor-based method was used to establish the minimal important change (MIC) value and responsiveness of HIT-6. The total scores of HIT-6 were significantly correlated to a fair degree with MIDAS (r = 0.41), as well as VAS (r = 0.53), and monthly migraine days (r = 0.38) at the baseline while at the follow-up (after 3 months), the correlations were of moderate degree with MIDAS scores (r = 0.62) and monthly migraine days (r = 0.60; convergent validity). Reliability estimates of the Arabic HIT-6 were excellent (Cronbach's α = 0.91 at baseline and 0.89 at follow-up). The average measure interclass correlation coefficient (ICC) value for the test-retest reliability was 0.96 (95% confidence interval = 0.94-0.98, p < 0.001). The HIT-6 total score is sensitive to change, being significantly reduced after prophylactic treatment compared to before (effect size = 1.5, standardized response mean = 1.3). A reduction from baseline of 4.5 on HIT-6 showed the highest responsiveness to predict improvement with an area under the curve equal to 0.66, sensitivity of 80%, specificity of 45%, and significance at 0.021. Changes in the HIT-6 total score were positively correlated with changes in monthly migraine days (r = 0.40) and VAS scores (r = 0.69) but not with changes in the score of MIDAS (r = 0.07). The Arabic version of HIT-6 is valid, reliable, and sensitive to detect clinical changes following migraine prophylactic treatment with a MIC of 4.5 points.

Impact of headache frequency and preventive treatment failure on quality of life, disability, and direct and indirect costs among individuals with episodic migraine in the United States.

To evaluate unmet needs among individuals with episodic migraine (EM) in the United States (US). Data are limited on the impact of headache frequency (HF) and preventive treatment failure (TF) on the burden of migraine in the US. A retrospective, cross-sectional analysis of 2019 National Health and Wellness Survey (NHWS) data was conducted from an opt-in online survey that identified respondents (aged ≥18 years) in the US with self-reported physician-diagnosed migraine. Participants were stratified by HF (low: 0-3 days/month; moderate-to-high: 4-14 days/month) and prior preventive TF (preventive naive; 0-1 TF; ≥2 TFs). Comparisons were conducted between preventive TF groups using multivariable regression models controlling for patient demographic and health characteristics. Among individuals with moderate-to-high frequency EM, the NHWS identified 397 with ≥2 TFs, 334 with 0-1 TF, and 356 as preventive naive. The 36-item Short-Form Health Survey (version 2) Physical Component Summary scores were significantly lower among those with ≥2 TFs, at a mean (standard error [SE]) of 41.4 [0.8] versus the preventive-naive 46.8 [0.9] and 0-1 TF 44.5 [0.9] groups; p < 0.001 for both). Migraine Disability Assessment Scale scores were significantly higher in the ≥2 TFs, at a mean (SE) of 37.7 (3.9) versus preventive-naive 26.8 (2.9) (p < 0.001) and 0-1 TF 30.1 (3.3) (p = 0.011) groups. The percentages of time that respondents experienced absenteeism (mean [SE] 21.6% [5.5%] vs. 13.4% [3.6%]; p = 0.022), presenteeism (mean [SE] 55.0% [8.3%] vs. 40.8% [6.5%]; p = 0.015), overall work impairment (mean [SE] 59.4% [5.6%] vs. 45.0% [4.4%]; p < 0.001), and activity impairment (mean [SE] 56.8% [1.0%] vs. 44.4% [0.9%]; p < 0.001) were significantly higher in the ≥2 TFs versus preventive-naive group. Emergency department visits (preventive-naive, p = 0.006; 0-1 TF, p = 0.008) and hospitalizations (p < 0.001 both) in the past 6 months were significantly higher in the ≥2 TFs group. Direct and indirect costs were significantly higher in the ≥2 TFs (mean [SE] $24,026 [3460]; $22,074 [20]) versus 0-1 TF ($10,897 [1636]; $17,965 [17]) and preventive-naive ($11,497 [1715]; $17,167 [17]) groups (p < 0.001 for all). Results were similar in the low-frequency EM group. In this NHWS analysis, individuals with more prior preventive TFs experienced significantly higher humanistic and economic burden regardless of HF.

The impact of living with migraine disease in Aotearoa New Zealand.

aim: To describe the impact of living with migraine disease in Aotearoa New Zealand. method: Online survey: Migraine in Aotearoa New Zealand Survey (MiANZ) delivered via SurveyMonkey from 22 August 2022 to 7 October 2022. Questions included: socio-demographics, the Migraine Disability Assessment Scale (MIDAS), the impact on work and open-ended questions with free text. Analysis used a mixed method approach. results: Five hundred and thirty people from Aotearoa New Zealand (82% female; 77% NZ European/Other). Almost half of respondents had severe disability, measured by the MIDAS. Based on reported headaches days per month, 23% had chronic migraine. Significant impacts were noted on all areas of life. Themes from rich free-text data included “physical impacts”, “mental health impacts”, “impacts on work (paid/unpaid)”, “impacts on social connection” and “impacts of trying to find a cause or cure”. conclusion: This is the first reported survey of people with migraine in Aotearoa New Zealand and shows high levels of migraine disability. Greater awareness of the impact of migraine is needed, among the public and in workplaces, where more support and accommodation for workers with migraine could have a positive effect on productivity.

A 12-week randomized double-blind clinical trial of eicosapentaenoic acid intervention in episodic migraine

Omega-3 polyunsaturated fatty acids (PUFAs) may benefit migraine improvement, though prior studies are inconclusive. This study evaluated the effect of eicosapentaenoic acid (EPA) on episodic migraine (EM) prevention. Seventy individuals with EM participated in a 12-week randomized, double-blind, placebo-controlled trial from March 2020 and May 2022. They were randomly assigned to either the EPA (N = 35, 2 g fish oil with 1.8 g of EPA as a stand-alone treatment daily), or the placebo group (N = 35, 2 g soybean oil daily). Migraine frequency and headache severity were assessed using the monthly migraine days, visual analog scale (VAS), Migraine Disability Assessment (MIDAS), Hospital Anxiety and Depression Scale (HADS), Migraine-Specific Quality-of-Life Questionnaire (MSQ), and Pittsburgh Sleep Quality Index (PSQI) in comparison to baseline measurements. The EPA group significantly outperformed the placebo in reducing monthly migraine days (−4.4 ± 5.1 days vs. − 0.6 ± 3.5 days, p = 0.001), days using acute headache medication (−1.3 ± 3.0 days vs. 0.1 ± 2.3 days, p = 0.035), improving scores for headache severity (ΔVAS score: −1.3 ± 2.4 vs. 0.0 ± 2.2, p = 0.030), disability (ΔMIDAS score: −13.1 ± 16.2 vs. 2.6 ± 20.2, p = 0.001), anxiety and depression (ΔHADS score: −3.9 ± 9.4 vs. 1.1 ± 9.1, p = 0.025), and quality of life (ΔMSQ score: −11.4 ± 19.0 vs. 3.1 ± 24.6, p = 0.007). Notably, female particularly benefited from EPA, underscoring its potential in migraine management. In conclusion, high-dose EPA has significantly reduced migraine frequency and severity, improved psychological symptoms and quality of life in EM patients, and shown no major adverse events, suggesting its potential as a prophylactic for EM.

Assessing the Long-Term (48-Week) Effectiveness, Safety, and Tolerability of Fremanezumab in Migraine in Real Life: Insights from the Multicenter, Prospective, FRIEND3 Study.

Long-term (1-year) fremanezumab treatment proved to be effective, safe, and well tolerated in individuals with migraine and < 2 medication clusters in a randomized controlled trial (RCT). We aimed to assess real-world evidence (RWE), long-term effectiveness, tolerability, and safety of fremanezumab in people with high-frequency episodic migraine (HFEM) or chronic migraine (CM) with > 3 treatment failures and various comorbidities. A 48-week, prospective, multicenter (n = 26), cohort study assessed fremanezumab's effectiveness, safety, and tolerability in consecutive adults with HFEM or CM with > 3 treatment failures. Primary endpoint was variation from baseline in monthly migraine days (MMD) in HFEM and monthly headache days (MHD) in CM at weeks45-48. Secondary endpoints were changes in monthly analgesic medications, Numerical Rating Scale (NRS), Headache Impact Test (HIT-6), and the Migraine Disability Assessment Scale (MIDAS) scores and ≥ 50%, ≥ 75%, and 100% responder rates. Of 533 participants who had received ≥ 1 fremanezumab dose, 130 were treated for ≥ 48weeks and considered for effectiveness analysis. No participant missed any treatment dosage every other consecutive month during the 12-month period. fremanezumab significantly (p < 0.001) reduced both MMD (- 6.4) in HFEM and MHD (- 14.5) in CM. Secondary endpoints: a significant reduction (p < 0.001) was observed in monthly analgesic medications (HFEM -6.0; CM -16.5), NRS (HFEM -3.4; CM -3.4), HIT-6 (HFEM -16.9; CM -17.9) and MIDAS score (HFEM -50.4; CM -76.6). The ≥ 50%, ≥ 75%, and 100% response rates to fremanezumab were 75.5%, 36.7%, and 2% in HFEM and 71.6%, 44.4%, and 3.7% in CM. Corresponding response rates were 60.5%, 37.2%, and 2.3% in individuals with psychiatric comorbidities, 74.2%, 50%, and 4.8% in CM with medication overuse, and 60.9%, 39.1%, and 4.3% in CM with medication overuse and psychiatric comorbidities. Mild and transient treatment-emergent adverse events occurred in 7.8% of the participants. No subject discontinued the treatment for any reason. This RWE study documents that long-term fremanezumab treatment is highly effective and remarkably well tolerated in subjects with HFEM or CM with multiple (> 3) therapeutic failures, even in the presence of concomitant medication overuse, psychiatric comorbidities, or both. The effectiveness-to-tolerability ratio appears to be better in RWE than in RCTs.

The first interim analysis of Italian patients enrolled in the real-world, Pan-European, prospective, observational, phase 4 PEARL study of fremanezumab effectiveness

IntroductionIn 2020, the Italian Medicines Agency (AIFA) approved the reimbursement of calcitonin gene-related peptide (CGRP) pathway monoclonal antibodies (mAbs), including fremanezumab, in patients with a Migraine Disability Assessment Scale (MIDAS) score ≥ 11, with prescription renewals for up to 12 months in patients with ≥ 50% reduction in MIDAS score at Months 3 and 6. In this sub-analysis of the Pan-European Real Life (PEARL) study, we provide real-world data on fremanezumab use in Italian routine clinical practice (EUPAS35111).MethodsThis first interim analysis for Italy was conducted when 300 enrolled adult patients with episodic or chronic migraine (EM, CM) completed 6 months of treatment with fremanezumab. The primary endpoint is the proportion of patients achieving ≥ 50% reduction in monthly migraine days (MMD) across the 6 months post-fremanezumab initiation. Secondary endpoints include: proportion of patients achieving ≥ 50% reduction in MIDAS score at Months 3 and 6, and mean change from baseline across Months 1–6 in MMD and headache-related disability. Safety was assessed through adverse events (AEs) reported.ResultsOf 354 patients enrolled at Italian centers, 318 (EM, 35.5%, CM, 64.5%) were included in the effectiveness analysis. Of patients with available data, 109 (61.2%) achieved the primary endpoint. 61.0% and 65.1% achieved ≥ 50% reduction in MMDs at Months 3 and 6, respectively; 79.9% and 81.0% experienced ≥ 50% reduction in MIDAS at the same timepoints.ConclusionFremanezumab was effective and well-tolerated over the first 6 months of treatment, with approximately 80% of patients meeting Italian criteria for treatment continuation at Months 3 and 6.

Efficacy of greater occipital nerve block treatment for migraine and potential impact of patient positioning during procedure: Results of randomised controlled trial.

PurposeAssess the efficacy, and potential impact of patient positioning for 10 minutes immediately post-procedure, of greater occipital nerve (GON) block for treatment of migraine. MethodsProspective multicentre non-blinded randomised controlled trial, randomisation and treatment of 60 neurology clinic patients with poorly controlled migraine. Outcomes measured with Headache Impact Test-6 (HIT-6), modified MIgraine Disability Assessment Scale (M-MIDAS), and RELIEF scores. ResultsPatient positioning did not lead to significant difference in RELIEF score (34% vs 11%, p-value 0.10, Chi-squared test) at day 90. When considered in a multiple regression analysis, the sitting position outperformed supine position significantly (p-value 0.04). However, no significant difference in HIT-6 score between the supine (n = 27) and sitting position groups (n = 33) was detected at baseline (p-value 0.76), day 30 (p-value 0.69) or day 90 (p-value 0.54, Mann-Whitney U-test). The HIT-6 score significantly improved post-GON block, from median 67 (baseline pre-GON) to 59 (day 30) and 62 (day 90) for the supine group and a score of 66, 61–62 for the sitting group (all p-value ≤ 0.001, intra-group comparison using Wilcoxon test); M-MIDAS achieved similar outcomes. Overall, a significant minimal clinically important improvement was obtained with GON block, and the GON injections were deemed very tolerable by patients (median score of 2 on 10 cm pain scale). ConclusionRegardless of patient positioning, GON block is an effective and near-painless procedure for migraine symptom control. Unlike earlier published observational study data, this trial concludes that a sitting patient position immediately post-GON is preferred.

Monoclonal antibodies targeting the calcitonin gene-related peptide pathway improve the effectiveness of acute medication—a real-world study

Abstract Background One of the aims of migraine prevention is to improve response to acute migraine treatments. The aim of the present study was to assess whether monoclonal antibodies targeting the CGRP pathway (CGRP-mAbs) can improve the perceived efficacy of acute treatments. Methods We included and followed up patients with chronic or episodic migraine from the Headache Centers of Avezzano-L’Aquila and Naples treated with CGRP-mAbs from March 2021 to December 2022. All patients filled out the Migraine Treatment Optimization Questionnaire (MTOQ), the Headache Impact Test (HIT-6), and the Migraine Impact and Disability Assessment Scale (MIDAS) at baseline and 3–6 months after the start of treatment with CGRP-mAbs. Results Sixty-five patients (81.3%) completed the 6-month follow-up. Most patients were female (55, 84.6%), with a median age of 46 years (IQR 39–56). Median MTOQ score increased from 8 (interquartile range [IQR] 4–13) at baseline to 15 (IQR 11–17) at 3 months (p &lt; 0.001) and 16 (IQR 13–17) at the 6-month follow-up (p &lt; 0.001). Median migraine days over 90-day periods decreased from 40 (IQR 24–60) to 24 (IQR 15–30) at 3 months (p &lt; 0.001) and to 20 (IQR 12–24) at 6 months (p &lt; 0.001). Median monthly intake of acute medication decreased from 55 doses (IQR 29–80.5) to 24 doses (IQR 15–40) at 3 months and 18 doses (IQR 11–30) at 6 months (p &lt; 0.001). Conclusions We showed that 6 months of preventive treatment with CGRP-mAbs led to a significantly better effectiveness of acute treatments, paralleled by decreased monthly migraine days and acute treatment intake.

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.

A new neuromodulation method in chronic migraine; non-ınvasive pulsed radiofrequency, a single-blinded, randomised, controlled trial.

Non-invasive pulsed radiofrequency (NipRF) therapy, a neuromodulation method for peripheral nerves, is a new treatment modality for pain. We aimed to show the changes in pain severity and frequency per month in chronic migraine with NipRF treatment. We treated patients diagnosed with chronic migraine according to the International Classification of Headache Disorders III beta diagnostic criteria. In half of the patients, we applied pulsed radiofrequency (pRF) treatment with transcutaneous electrodes to the greater occipital nerve (GON) trace. In the other half, we applied the GON block under ultrasound guidance. The Migraine Disability Assessment Scale (MIDAS) was administered to the participants, and those with scores > 2 were included in the study. Pain intensity and frequency were evaluated using the visual analog scale (VAS) and a headache diary completed before and 4weeks after treatment. When both groups were compared, the pre- and post-treatment VAS scores and headache frequencies were similar. Comparing the pre-treatment and post-treatment values within the groups, VAS scores and headache frequency decreased significantly after treatment in both groups (p < 0.001). In this study, we observed that NipRF treatment is safe and effective for treating chronic migraine. Pain intensity and frequency decreased with NipRF treatment, similar to that in the GON block group. NCT05499689, Date: 08/11/2022.

A study of drug prescription patterns, disease-therapy awareness and of quality of life among patients with migraine visiting a tertiary care hospital in Mumbai, India

Background: Migraine is one of the leading causes of disability globally. There is scarcity of data on disease -therapy awareness and its correlation with demographic factors. Hence its was of interest to assess those along with quality of life in these patients. Methods: A Cross-sectional observational study was conducted in108 patients attending the Neurology and headache OPD at a tertiary care hospital between March 2017 and August 2018. Disease and therapy awareness among patients were evaluated using validated questionnaires and correlation was done with demographic factors. The severity of the disease and its impact on the patients' quality of life were assessed using the migraine disability assessment scale. Results: The mean disease and therapy awareness scores were 9 and 7 respectively. Both had a positive correlation with education and socioeconomic factors. The quality of life was affected moderately in 48.1% of the patients followed by severely 32.4% of the patients. The average number of drugs prescribed per encounter was 3.05. NSAIDS were used more commonly as compared to Triptans for acute attacks. Conclusions: The disease and therapy awareness were fair and positively correlated with education/ socioeconomic status. However, a significant disability was found among patients even with treatment. This highlights the need for educating these patients for effectively controlling the disability.

Sexual dysfunction in Egyptian patients with migraine

BackgroundMigraine is believed to affect over 20% of people at some point in their lives. The presence of sexual dysfunction in migraine sufferers can cause lack of self-confidence and divorces. The aim of this work is to study sexual dysfunction in migraine headache patients.MethodsThe study was carried out at Tanta University Hospital. The study included married patients who visited our hospital clinic and have had episodic or chronic migraine headaches and another group of age and sex matched healthy subjects will be recurited as a control group. Our interview includes questions for disease duration, severity and frequency of headache attacks and attack duration. questionnaire. the Arabic Version of the Migraine Disability Assessment Scale and Beck depression inventory. Sexual function will be evaluated by an Arabic version of Arizona sexual experience scale.ResultsThe ASEX score showed high significant changes between migraine patients and healthy subjects. These changes were reconfirmed when comparing male patients to healthy subjects or female patients to healthy subjects.Despite there was no significant difference regarding total ASEX score between bot male and female patients with migraine there was significant differences in the items of derive, erection/lubrication and satisfaction between them. In patients with migraine the total ASEX score was correlated with the MIDAS, Beck depression inventory, Beck anxiety inventory; but not with the age of patients or headache duration.ConclusionsSexual dysfunction is a common finding in migrine patients which is poorly evaluted in the clinical sitting.

Development and initial validation of the Kiswahili version of the Migraine Disability Assessment (MIDAS-K) questionnaire.

The Migraine Disability Assessment Scale (MIDAS) is one of the tools for measuring and understanding disability caused by migraine. The purpose of this study was to validate a Kiswahili translation of the MIDAS (MIDAS-K) among patients suffering from migraines in Dar es Salaam, Tanzania. A psychometric validation study of MIDAS was conducted after translation to Kiswahili. A total of 70 people with migraine were recruited by systematic random sampling and they completed the MIDAS-K questionnaire twice, 10-14 days apart. Internal consistency, split-half reliability, and test-retest reliability, convergent and divergent validity were examined. 70 patients (F:M; 59:11) with median (25th, 75th) headache days of 4.0 (2.0, 7.0) were recruited. Twenty-eight out of 70 (40%) of the population had severe disability on MIDAS-K. The overall test-retest reliability of MIDAS-K was high (ICC = 0.86; 95% CI = 0.78-0.92 p < 0.001). Factor analysis showed a two-factor structure; the number of days missed and reduced efficiency. MIDAS-K had a good internal consistency of 0.78, good split-half reliability of 0.80 and acceptable test-retest reliability for all items as well as total MIDAS-K scores. The Kiswahili version of the MIDAS questionnaire (MIDAS-K) is a valid, responsive, and reliable tool to measure migraine-related disability among Tanzanians and other Swahili-speaking populations. Quantification of migraine disability in the region will guide policies directed at care allotment, improvement in the provision of interventions for migraine, as well as enhancement of health-related quality of life for patients with migraine in our region.

Depression, Anxiety, and Pain Catastrophizing in Migraine Patients

Aim: In this study, we aimed to evaluate the relationship between anxiety, depression, and pain catastrophizing in individuals with and without migraine. Method: Data of the study was collected using the socio-demographic data form, Beck Depression Scale (BDI), Beck Anxiety Scale (BAI), Pain Catastrophizing Scale (PCS), Migraine Disability Assessment Scale (MIDAS), and Visual Analogue Scale (VAS). Results: Of the 183 patients, 80 were migraine patients and 103 were the control group. The BDI, BAI, and PCS scores were found to be higher in the migraine patients compared to the control group. The migraine patients were found to have "moderate" depression, "mild" anxiety, and "moderate" disability. There was a positive correlation between BDI, BAI, PCS, MIDAS, and VAS scores in the migraine patients. According to the total BDI and BAI scores of the migraine patients, the PCS total score and the PCS subscales "helplessness", " magnification", and "rumination" scores were higher in the patients with depression or anxiety. Conclusions: It was found that the migraine patients had "moderate" depression and "mild" anxiety, and their pain catastrophizing level increased with increasing depression and anxiety severity.

Migraine in bipolar disorder and schizophrenia; The hidden pain.

This study examined the prevalence of comorbid migraine in patients with bipolar disorder and those with schizophrenia and also examined the association between migraine comorbidity and disease characteristics of both psychiatric disorders. In this cross-sectional study, 150 patients with bipolar disorder and 150 with schizophrenia were evaluated for migraine diagnosis using the International Classification of Headache Disorders (3rd ed). Patients were selected from psychiatry outpatient clinics at Kasr Al Ainy hospitals, Cairo University. The Young Mania Rating Scale (YMRS) and the Hamilton Depression Rating Scale (HDRS) were administered to the bipolar group, whereas the Positive and Negative Syndrome Scale (PANSS) was administered to the schizophrenia group. Both groups were evaluated by the Clinical Global Impression (CGI) scale. The diagnosis of migraine was made in 34 (22.7%) of the bipolar group and 24 (16.0%) of the schizophrenia group. Patients with schizophrenia showed a significantly higher frequency and intensity of migraine attacks on the Migraine Disability Assessment scale than did the bipolar group (p < 0.001). In the bipolar group, there was no significant difference between patients with and without migraine on the YMRS, HDRS, and CGI. Among patients with schizophrenia, the duration of the migraine attacks was positively correlated with CGI scores (r = 0.40, p = 0.02). Migraine is a significant comorbidity in patients with bipolar disorder and schizophrenia.However, the intensity and frequency of migraine attacks were higher in the schizophrenia than in the bipolar group.

Assessment of serum level of melatonin in migraine: a case control study

BackgroundMigraine attacks are reported to be severe enough to affect daily living events and can affect different age groups including early childhood. Chronic migraine is usually associated with several comorbidities such as anxiety, depression, sleep disorders, fibromyalgia, and fatigue. The existence of a bidirectional relationship between sleep and migraine is documented. This study aims at assessing the relationship between serum melatonin, sleep quality, and both migraine and migraine severity. This case–control study was executed on 70 patients and 70 healthy controls. Serum melatonin was assessed in morning and evening blood samples. Patients underwent a thorough clinical examination, assessing migraine severity using the Migraine Disability Assessment Scale and the sleep quality of both groups was evaluated using the sleep quality scale.ResultsSerum melatonin levels were significantly reduced among migraine patients in both morning and evening samples. Sleep quality was significantly impaired in migraine patients. There is a statistically significant negative correlation between melatonin in both samples and both of frequency of attack and migraine disability. Positive family history, presence of aura and chronic migraine had significantly lower melatonin in both samples compared to those without aura was associated with significantly lower melatonin. Sleep quality was negatively correlated with serum melatonin, and positively correlated with migraine severity and frequency.ConclusionSerum melatonin is significantly reduced among migraineurs, and linked to migraine severity; they also had impaired sleep quality so melatonin administration may represent a chance for improving headache characteristics.

Burden of Migraine and Migraine-Associated Symptoms in People with Differing Ethnic and Racial Backgrounds: Results of the OVERCOME (US) Study (S41.003)

Burden of Migraine and Migraine-Associated Symptoms in People with Differing Ethnic and Racial Backgrounds: Results of the OVERCOME (US) Study (S41.003)

Positive Establishment of a Digital Working Alliance with a Prescription Digital Therapeutic in Patients with Migraine (P11-12.004)

<h3>Objective:</h3> Obtain evidence for a digital working alliance (DWA) between participants with migraine and an investigational precursor of a prescription digital therapeutic (PDT). <h3>Background:</h3> Recommended migraine treatments including cognitive behavioral therapy, biofeedback, and muscle relaxation are underutilized. PDTs can standardize such approaches to migraine treatment and overcome utilization barriers including provider availability and cost. A therapeutic alliance, which identifies patient goals, builds rapport, and establishes patient commitment to treatment, is a critical factor in successful face-to-face treatments. A digital working alliance (DWA), akin to the therapeutic alliance, is likely to be necessary in an effective PDT. Development of an effective DWA has not been assessed in participants with migraine. <h3>Design/Methods:</h3> Single-center, exploratory, single-arm, 2-week study of a precursor version of a PDT in individuals (18–64yrs) with physician-diagnosed migraine (N=60). Participants were asked to complete a lesson each day. DWA was interpreted on a 7-item Likert scale (Mobile Agnew Relationship Measure [mARM]) at end of treatment. <h3>Results:</h3> Correlating with real-world prevalence, Participants were majority female (90%) with a median age (IQR) of 38 years (34, 49). Most (73.3%) had episodic migraine and reported a median (IQR) Migraine Disability Assessment Scale score of 32.5 (18, 45.3). Participants completed a median (IQR) of 14 (13, 14) lessons and a total of 204 therapeutic skill modules. The median (IQR) overall mARM score was 5.9 (5.4, 6.2). <h3>Conclusions:</h3> This is the first study to report that participants with severe migraine related disability form a positive DWA with a PDT. Consistent with this, most participants completed a majority of daily lessons and therapeutic skill modules available to them. This evidence supports further development of PDTs for migraine and is a first step towards refinement and assessment in randomized controlled trials to evaluate clinical efficacy and safety in migraine. <b>Disclosure:</b> Dr. Snipes has received personal compensation for serving as an employee of Click Therapeutics. Dr. Snipes has received publishing royalties from a publication relating to health care. Dr. Kuka has received personal compensation for serving as an employee of Click Therapeutics. Miss Besedina has received personal compensation for serving as an employee of Click Therapeutics Inc.. Laura Taraboanta has received personal compensation for serving as an employee of Click Therapeutics. Laura Taraboanta has stock in Click Therapeutics. Mr. Hare has received personal compensation for serving as an employee of Click Therapeutics, Inc.. Dr. Gupta has received personal compensation for serving as an employee of Click Therapeutics. Dr. Lakhan has received personal compensation for serving as an employee of Zogenix, Fern Health, Thriveworks, The Learning Corp, Click Therapeutics. Dr. Lakhan has received personal compensation in the range of $500,000-$999,999 for serving as a Consultant for Shaheen Lakhan, MD. Dr. Lakhan has received personal compensation in the range of $100,000-$499,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Neurocrine, Fern Health, Lin Health. Dr. Lakhan has received personal compensation in the range of $500,000-$999,999 for serving as an officer or member of the Board of Directors for Click Therapeutics, SpineThera. Dr. Lakhan has stock in Zogenix, NeuroSport, Click Therapeutics, SpineThera.

Surgical therapy of migraine: a 12-year single-center experience

BackgroundIn recent years, surgical therapy has taken on an increasingly decisive role in the therapeutic armamentarium of migraine. All surgical techniques are aimed at the complete neurolysis of some extra-cranial nerves, of which the most involved (in our experience) are the greater and lesser occipital, auriculotemporal, supraorbital, and supratrochlear nerves. This paper describes our surgical approaches for the treatment of occipital, temporal, and frontal trigger sites. MethodsA single-center, retrospective study was conducted on all patients who underwent surgical treatment of migraine between 2011 and 2022. Patients were asked to fill out a headache diary and complete a migraine questionnaire assessing parameters before surgery, after 3 months, and 1 year after surgery. Data regarding age, sex, age at onset, migraines per month (in days), associated symptoms, severity (on a scale from 1 to 10), inability to work per month (in days), health status, history of neck trauma, and family history were collected. The Migraine Disability Assessment Scale (MIDAS) score was also used to evaluate the degree of disability for each patient.ResultsWe have operated on 612 patients: n.266 occipital, n.248 temporal, n.98 frontal. The surgical procedure elicited a positive response in 90% of the patients (69% complete recovery). Complications were mild and temporary: mainly, hypoesthesia and numbness of the undermined areas, lasting from 3 weeks to 6 months. We observed the onset of secondary trigger sites in 257 (42%) patients.DiscussionThe described procedure is minimally invasive and highly reproducible and allows to obtain a high degree of success with a negligible rate of complications. Nevertheless, given the high percentage of occurrence of secondary trigger points, it is particularly important to warn the patient of this possibility in pre-operative visits.Level of evidence:Level III, Therapeutic