Migraine Disability Score Research Articles

Evaluating the Prevalence of Migraine Headache among Patients with Female-Pattern Baldness

Background: According to WHO, migraine is a neurological disorder that has ranked third among the most prevalent medical conditions. Androgenetic alopecia (AGA), on the other hand, is a patterned hair loss disorder due to excessive response to androgens, affecting about half of the world's population. This disorder is presented by progressive hair loss in males and females after puberty, and sex hormones influence both diseases. Methods: A total of 50 women with clinically diagnosed AGA and a mean age of 37.5 referring to dermatology outpatient clinics of Shiraz University of Medical Sciences during 2020 were included in this study. The control group consisted of 50 women of similar age without alopecia. Hair loss was evaluated using the Ludwig classification, and the Persian versions of migraine screen questionnaire (MS_Q) and migraine disability assessment tests (MIDAS) were used to assess migraine among participants. Pain intensity was also measured using the Visual Analog scale (VAS). Results: According to the MS_Q Questionnaire, seven females (14%) in the case group and six females (12%) in the control group had migraines, and no significant correlation was observed between migraine and AGA (P = 0.766). There was no significant correlation between Ludwig score and migraine disability score in the case group with migraine (Spearman correlation coefficient = 0.367, P = 0.419). The only significant positive correlation was between Ludwig score and visual analog scale (VAS) in the case group with migraine (Spearman correlation coefficient = 0.844, P = 0.017) Conclusions: Based on the results, no significant correlation was found between migraine and androgenetic alopecia.

Efficacy and safety of levetiracetam for migraine prophylaxis in children: a systematic review and meta-analysis.

Levetiracetam (LEV), an antiepileptic drug, has been effective in adult migraine prevention but lacks extensive research in children. This study evaluates LEV's efficacy and safety for pediatric migraine prophylaxis. We reviewed randomized controlled trials (RCTs) and non-RCTs in major databases through 8 January 2024, focusing on four efficacy endpoints and adverse drug reactions (ADRs). Data synthesis involved pooled relative risks or odds ratios for dichotomous outcomes and mean differences for continuous outcomes, using fixed- or random-effects models as appropriate. Eight studies with 190 participants showed that after taking LEV, the mean headache frequency decreased 5.19 per month (MD: -5.19, 95% CI: -7.11 to -3.27, p < 0.00001) and improved headache-free rates to 28% (95% CI: 0.17-0.41). More than 83% experienced a >50% reduction in monthly headache frequency. The migraine disability score decreased by 33.51 points (MD: -33.51, 95% CI: -38.46 to -28.55, p < 0.00001). ADR incidence did not significantly differ between LEV and control groups (RR: 1.06, 95% CI: 0.39 to 2.85, p = 0.91), with an overall ADR rate of 18% (95% CI: 0.13-0.24). The most common ADR was irritability (12%), leading to treatment discontinuation in 13% of cases (95% CI: 0.05-0.30). LEV has shown good efficacy in preventing pediatric migraines. However, its safety requires further confirmation through more extensive and well-designed RCTs. Identifier PROSPERO CRD42024497643.

Effect of aerobic exercises and therapeutic pain neuroscience education on disability, pain, head posture and QOL in migraine patients

Migraine is a type of primary headache with a high degree of associated disability that can present with a variety of indications and co-morbidities. The role of physical therapy treatment in migraine management is largely obscure. To investigate the combine effect of aerobic exercises and therapeutic pain neuroscience education on disability, pain pressure threshold, head posture and quality of life (QoL) in patients having migraine. Subjects were screened by using Migraine Disability Assessment (MIDAS) and after screening total sample of 50 subjects were randomly assigned into two groups: Group A (Experimental, n=25) and Group B (Control, n=25). Migraine disability assessment, pressure algometer, craniovertebral angle (CVA) and migraine specific quality of life were examined before and after 6 weeks of the intervention. Group A were given aerobic exercises and therapeutic pain neuroscience education along with conventional treatment for 45 min 3 days/week for 6 weeks, whereas participants in the Group B performed conventional exercises alone for 20 min 3 days/week for 6 weeks. Significant differences were observed in migraine disability score (P=0.003) and pain pressure threshold (P=0.039, P=0.030 and P=0.025) and improvement in forward head posture (P=0.001) between the groups after the intervention period, signifying greater improvement in the group A. QoL also improved in both the groups after intervention. Main findings of the present study suggest that the therapeutic pain neuroscience education and aerobic exercises combined with conventional treatment together maybe helpful to give better quality of life, reduced disability, increased pain pressure threshold and increased CVA to patients with migraine.

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.

Efficacy of ultrasound-guided greater occipital nerve pulsed radiofrequency therapy in chronic refractory migraine.

Ultrasound (US) guided pulsed radiofrequency (PRF) therapy can be used on the greater occipital nerve (GON) in patients with chronic migraine (CM) who are unresponsive to conservative treatments. We aimed to demonstrate the change in pain intensity, duration of migraine episodes, frequency of attacks, migraine disability, depression, and sleep disturbance scores before and after treatment in patients with CM who underwent US-guided GON PRF and the effectiveness of treatment. According to the International Classification of Headache Disorders III beta version diagnostic criteria, 25 of 43 patients with CM whom treated with GON PRF were included in the study. The Migraine Disability Assessment Scale (MIDAS), Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), and a visual analog scale (VAS) were used on patients before GON PRF treatment and at post treatment months 1 and 3. The median duration and number of migraine episodes in the post-interventional 1st month and 3rd month were significantly shorter and fewer compared with the pre-intervention period (p < 0.001). In the comparison with the pre-intervention values, all of the scoring concepts, namely the MIDAS, VAS, BDI, and PSQI, revealed a significant drop in the postintervention 1st and 3rd month (p < 0.001). In this study, we observed that US-guided GON PRF therapy applied at the proximal (C2) level was a safe and effective treatment option. With GON PRF, we observed a decrease in pain intensity, pain frequency, and duration of episodes, and an improvement in depression symptoms, migraine disability, and sleep disorder scores accompanying chronic migraine.

Brain Processing of Visual Self-Motion Stimuli in Patients With Migraine: An fMRI Study.

To investigate the behavioral and neuronal responses of patients with migraine to a visual simulation of self-motion through a virtual roller coaster ride in comparison to controls. Twenty consecutive patients with migraine from a university-based hospital headache clinic and 20 controls were included. Participants underwent an experiment where a visually displayed self-motion paradigm was presented based on customized roller coaster videos during fMRI. Within each video, blocks of motion stimulation were interleaved with low-speed upward motion in a random order. In the scanning intervals and after the experiment, participants rated their perceived level of vestibular symptoms and motion sickness during the videos. We hypothesized that patients with migraine will perceive more motion sickness and that it correlates with different central processing and brain responses. Compared to controls, patients with migraine reported more dizziness (65% vs 30%; p = 0.03) and motion sickness (Simulator Sickness Questionnaire score 47.3 [95% confidence interval (CI), 37.1, 57.5] vs 24.3 [95% CI, 18.2, 30.4]) as well as longer symptom duration (01:19 minutes [95% CI, 00:51, 01:48] vs 00:27 minutes [95% CI, 00:03, 00:51]) and intensity (visual analogue scale score 0-100, 22.0 [95% CI, 14.8, 29.2] vs 9.9 [95% CI, 4.9, 14.7]) during the virtual roller coaster ride. Neuronal activity in patients with migraine was more pronounced in clusters within the superior (contrast estimate 3.005 [90% CI, 1.817, 4.194]) and inferior occipital gyrus (contrast estimate 1.759 [90% CI, 1.062, 2.456]), pontine nuclei (contrast estimate 0.665 [90% CI, 0.383, 0.946]), and within the cerebellar lobules V/VI (contrast estimate 0.672 [90% CI, 0.380, 0.964]), while decreased activity was seen in the cerebellar lobule VIIb (contrast estimate 0.787 [90% CI, 0.444, 1.130]) and in the middle frontal gyrus (contrast estimate 0.962 [90% CI, 0.557, 1.367]). These activations correlated with migraine disability (r = -0.46, p = 0.04) and motion sickness scores (r = 0.32, p = 0.04). We found enhanced connectivity between the pontine nuclei, cerebellar areas V/VI, and interior and superior occipital gyrus with numerous cortical areas in patients with migraine but not in controls. Migraine is related to abnormal modulation of visual motion stimuli within superior and inferior occipital gyrus, middle frontal gyrus, pontine nuclei, and cerebellar lobules V, VI, and VIIb. These abnormalities relate to migraine disability and motion sickness susceptibility.

PEARL study protocol: a real-world study of fremanezumab effectiveness in patients with chronic or episodic migraine.

Fremanezumab is a humanized monoclonal antibody (IgG2Δa) that selectively targets calcitoningene-related peptide and isapproved in Europe for migraine prevention in adults with ≥4 migraine days/month. The Pan-European Real Life (PEARL) study is a 24-month, prospective, observational study of fremanezumab in chronicor episodic migraine. End points include proportion of patients with ≥50% reduction in monthly migraine daysduring 6months of treatment (primary); changes in monthly migraine days, disability scores and acute headache medication use; adherence and persistence; and effectiveness in patients switching from another calcitonin gene-related peptide pathway-targeting monoclonal antibody. PEARL is being conducted in approximately 100 centers in 11 European countries (estimated n =1100). PEARL will generate important real-world data on effectiveness of fremanezumab and treatment patterns in patients with chronic migraine or episodic migraine.

Repetitive transcranial magnetic stimulation as a prophylactic treatment in migraine

BackgroundClinical applications of transcranial magnetic stimulation (TMS) have shown promising results in the treatment of headache disorders, with migraine being one of the most encountered.ObjectiveTo assess the role of low-frequency repetitive transcranial magnetic stimulation as a preventive treatment of migraine (with and without aura) and correlate the results with the serum level of the inflammatory biomarker (neurokinin A).MethodsForty patients, with age ranging from 15 to 55 years, diagnosed with migraine (30 migraine without aura and 10 with aura) and 20 apparently healthy individuals, who were age and sex matched with the patient group, were included in this study.A low-frequency (1 Hz) rTMS protocol was applied for all patients for five consecutive days interictally. Assessment of pain intensity using visual analogue scale and frequency and duration of attacks as well as number of pills taken by patients as an abortive treatment according to the Basic Diagnostic Headache Diary for 4 weeks before and 4 weeks after TMS sessions was done. In addition, the Migraine Disability Assessment scale (MIDAS) was applied to assess the severity and degree of disability caused by migraine.Measurement of neurokinin A serum level was done by using ELISA for all patients before and after TMS and for control group once.ResultsThere was a significant reduction in pain intensity, frequency and duration of migraine attacks, migraine disability scores, and number of pills taken as abortive treatment for attacks after rTMS (P < 0.001). Also, serum level of neurokinin A in the patients was significantly reduced after rTMS (P < 0.001).ConclusionLow-frequency rTMS is an effective prophylactic treatment for migraine with and without aura.

Effectiveness of onabotulinumtoxinA (BOTOX) in pediatric patients experiencing migraines: a randomized, double-blinded, placebo-controlled crossover study in the pediatric pain population

IntroductionOnabotulinumtoxinA (OBTA) is approved for treating chronic headaches and migraines in adults, but there is limited scientific literature on the outcomes in pediatric patients. The aim of this study was...

Smartphone based behavioral therapy for pain in multiple sclerosis (MS) patients: A feasibility acceptability randomized controlled study for the treatment of comorbid migraine and ms pain

BackgroundMultiple Sclerosis (MS) and Migraine are comorbid neurologic conditions. Migraine prevalence is three times higher in the MS clinic population compared to the general population, and patients with MS and migraine are more symptomatic than patients with MS without migraine. ObjectiveWe sought to conduct a pilot feasibility and acceptability study of the RELAXaHEAD app in MS-Migraine patients and to assess whether there was any change in migraine disability and MS pain-related disability. MethodsRandomized controlled study of patients with MS-migraine ages 18–80 years with 4+ headache days/ month who were willing to engage in smartphone based behavioral therapy. Half received the RELAXaHEAD app with progressive muscle relaxation (PMR) and the other half received the app without the PMR. Data was collected for 90 days on measures of recruitment, retention, engagement, and adherence to RELAXaHEAD. Preliminary data was also collected on migraine disability (MIDAS) and MS pain (PES). ResultsSixty-two subjects with MS-migraine were enrolled in the study (34 in PMR arm, 28 in monitored usual care arm). On average, during the 90 days, participants played the PMR on average 1.8 times per week, and for 12.9 min on days it was played. Forty-one percent (14/34) of the participants played the PMR two or more times weekly on average. Data was entered into the daily diaries, on average, 49% (44/90) of the days. There were major challenges in reaching subjects in follow-up for the efficacy data, and there was no significant change in migraine disability (MIDAS) scores or MS Pain (PES) scores from baseline to the endpoints. During the six-month follow-up, most patients felt either positively or neutral about the relaxation therapy. ConclusionThere was interest in scalable accessible forms of behavioral therapy to treat migraine and MS-related pain in patients with MS and comorbid migraine. Similar to prior studies, a significant minority were willing to practice the PMR at least twice weekly. In the societal shift from telephone to more text and internet-based interactions, follow up was challenging, but those reached indicated that they appreciated the PMR and would recommend it to others. Future work should focus on engagement and efficacy.

A global real-world assessment of the impact on health-related quality of life and work productivity of migraine in patients with insufficient versus good response to triptan medication

BackgroundMigraine is a chronic, disabling neurological disease characterized by moderate-to-severe headache pain with other symptoms, including nausea, vomiting, and photophobia. Triptans, while generally effective, are insufficiently efficacious in 30–40% of patients and poorly tolerated by or contraindicated in others. We assessed the impact of insufficient response to triptans on health-related quality of life (HRQoL) and work productivity in patients currently receiving any prescribed triptan formulation as their only acute migraine medication.MethodsData were from the 2017 Adelphi Migraine Disease Specific Programme, a cross-sectional survey of primary care physicians, neurologists, and headache specialists and their consulting patients with migraine in the USA, France, Germany, Italy, Spain, and UK. Triptan insufficient responders (TIRs) achieved freedom from headache pain within 2 h of acute treatment in ≤3/5 migraine attacks; triptan responders (TRs) achieved pain freedom within 2 h in ≥4/5 attacks. Multivariable general linear model examined differences between TIRs and TRs in HRQoL and work productivity. Logistic regression identified factors associated with insufficient response to triptans.ResultsThe study included 1413 triptan-treated patients (TIRs: n = 483, 34.2%; TRs: n = 930, 65.8%). TIRs were more likely to be female (76% vs. 70% for TIRs vs TRs, respectively; p = 0.011), older (mean age 42.6 vs. 40.5 years; p = 0.003), and had more headache days/month (7.0 vs. 4.4; p < 0.001). TIRs had significantly more disability, with higher Migraine Disability Scores (MIDAS; 13.2 vs. 7.7; p < 0.001), lower Migraine-specific Quality of Life scores, indicating greater impact (Role Function Restrictive: 62.4 vs. 74.5; Role Function Preventive: 70.0 vs. 82.2; Emotional Function: 67.7 vs. 82.1; all p < 0.001), and lower EQ5D utility scores (0.84 vs. 0.91; p = 0.001). Work productivity and activity were impaired (absenteeism, 8.6% vs. 5.1% for TIRs vs. TRs; presenteeism, 34.3% vs. 21.0%; work impairment, 37.1% vs. 23.3%; overall activity impairment, 39.8% vs. 25.3%; all p < 0.05).ConclusionHRQoL and work productivity were significantly impacted in TIRs versus TRs in this real-world analysis of patients with migraine acutely treated with triptans, highlighting the need for more effective treatments for patients with an insufficient triptan response. Further research is needed to establish causal relationships between insufficient response and these outcomes.

Neck pain in episodic migraine: a cross-sectional study.

Purpose: It has been reported that neck pain is more prevalent in episodic migraineurs (EM) than in the general population. Subjects with episodic migraine exhibited widespread hypersensitivity in cranio-cervical region. Our objectives were to explore the potential factors associated with the presence of neck pain for EM, and whether there were differences in pericranial muscle tenderness between EM with and without neck pain.Patients and methods: Fifty EM with neck pain (34.76±8.04) and 50 age- and sex-matched EM without neck pain (34.26±9.39) were enrolled. The characteristics of headaches and some lifestyle factors were assessed in two groups. The migraine disability score and neck disability index were also recorded. During migraine-free period, cranio-cervical muscle tenderness scores and mechanical pain threshold were assessed for all patients.Results: There were no significant differences in pain intensity (p=0.44), migraine disability (p=0.71), duration (p=0.44) or frequency (p=0.85) of headache between EM with and without neck pain. The lifestyle factors including smoking, alcohol, coffee, body mass index≧23kg/m2, poor sleeping (<8 h/day) and time spent on TV and computers (>2 h/day) were not associated with the presence of neck pain in this study. Compared with EM without neck pain, those with neck pain had higher neck tenderness (p<0.01) and higher cephalic tenderness scores (p<0.01). Neck Disability Index scores were positively correlated with neck and total muscle tenderness scores.Conclusion: There was a significant difference in cranio-cervical muscle tenderness scores between EM with and without neck pain. For EM, the factors studied in the current research seemed not associated with the onset of neck pain, and further studies including other factors are needed.

The role of personality, disability and physical activity in the development of medication-overuse headache: a prospective observational study

BackgroundFactors associated with development of medication-overuse headache (MOH) in migraine patients are not fully understood, but with respect to prevention, the ability to predict the onset of MOH is clinically important. The aims were to examine if personality characteristics, disability and physical activity level are associated with the onset of MOH in a group of migraine patients and explore to which extend these factors combined can predict the onset of MOH.MethodsThe study was a single-center prospective observational study of migraine patients. At inclusion, all patients completed questionnaires evaluating 1) personality (NEO Five-Factor Inventory), 2) disability (Migraine Disability Assessment), and 3) physical activity level (Physical Activity Scale 2.1). Diagnostic codes from patients’ electronic health records confirmed if they had developed MOH during the study period of 20 months. Analyses of associations were performed and to identify which of the variables predict onset MOH, a multivariable least absolute shrinkage and selection operator (LASSO) logistic regression model was fitted to predict presence or absence of MOH.ResultsOut of 131 participants, 12 % (n=16) developed MOH. Migraine disability score (OR=1.02, 95 % CI: 1.00 to 1.04), intensity of headache (OR=1.49, 95 % CI: 1.03 to 2.15) and headache frequency (OR=1.02, 95 % CI: 1.00 to 1.04) were associated with the onset of MOH adjusting for age and gender. To identify which of the variables predict onset MOH, we used a LASSO regression model, and evaluating the predictive performance of the LASSO-mode (containing the predictors MIDAS score, MIDAS-intensity and –frequency, neuroticism score, time with moderate physical activity, educational level, hours of sleep daily and number of contacts to the headache clinic) in terms of area under the curve (AUC) was weak (apparent AUC=0.62, 95% CI: 0.41-0.82).ConclusionDisability, headache intensity and frequency were associated with the onset of MOH whereas personality and the level of physical activity were not. The multivariable LASSO model based on personality, disability and physical activity is applicable despite moderate study size, however it can be considered as a weak classifier for discriminating between absence and presence of MOH.

Rhinogenic Contact Point Headache: Surgical Treatment Versus Medical Treatment

Rhinogenic contact point headache (RCPH) is a headache syndrome secondary to mucosal contact points in the sinonasal cavities, in the absence of inflammatory signs, hyperplastic mucosa, purulent discharge, sinonasal polyps, or masses. It may result from pressure on the nasal mucosa due to anatomic variations among which the septal deviation, septal spur, and concha bullosa, are the most commonly observed. In recent years, RCPH has remained a subject of controversy regarding both its pathogenesis and treatment. This study aimed to investigate the effect of surgical and medical treatment of pain relief in patients with RCPH, evaluating the intensity, duration, and frequency of headaches, and the impact of different treatments on quality of life. Ninety-four patients with headache, no symptoms or signs of acute and chronic sinonasal inflammation and who present with intranasal mucosal contact points positive to the lidocaine test were randomized into 2 equal groups and given medical or surgical treatment. The authors used visual analog scale, number of hours, and days with pain to characterize the headache and Migraine Disability Assessment score (MIDAS) to assess the migraine disability score before and 3 to 6 months after treatment. After treatment the severity, duration, and frequency of the headache decreased significantly (P < 0.001, P < 0.001, and P = 0.031, respectively) as well as the MIDAS in the surgical group compared with medical group. Our results suggest that surgical removal of mucosal contact points is more effective than local medical treatment improving the therapeutic outcomes in patients with contact point headache.

Health and quality of life in patients with medication overuse headache syndrome after standardized inpatient rehabilitation: A cross-sectional pilot study.

The aim of this pilot study was to determine health-related quality of life (HRQoL) in patients with history of medication overuse headache (MOH) after detoxification and a headache-specific inpatient rehabilitation program and to receive necessary information for future prospective studies.HRQoL and headache-related disability were cross-sectionally measured by Short Form 36 (SF-36), Hospital Anxiety and Depression Scale (HADS), Migraine Disability Score (MIDAS), Coping Strategies Questionnaire (CSQ), and Symptom Checklist 90 revised (SCL-90-R). SF-36, HADS, and SCL-90-R data were compared to German population norms, stratified by age, sex, and comorbidities.Fifty-one patients (72.5% females, mean age 47.3 years) were included with an average headache duration of 25.3 years. Moderate to high levels of headache were reported on the MIDAS VAS at 6.51 (range 0–10); SF-36 bodily pain was 40.3 (norm = 59.0, P < .001, 100 = best). Impaired functioning averaged at 78.4 (100 = no impairment) on the MIDAS. In contrast, SF-36 physical functioning was comparable to the norm (mean: 78.4, norm = 81.8, P = .63). All other SF-36 scales were significantly lower than expected from the norm (all P < .001). The scales depression, anxiety, obsessive-compulsive, and interpersonal sensitivity were significantly affected, whereas the levels of SCL-90-R schizophrenia nuclear and schizotypia were not lower than the norm. Coping with pain was moderate.This pilot study is the first that presents a comprehensive and simultaneously specific assessment of health and quality of life of MOH patients after detoxification and inpatient rehabilitation. Moderate to high levels of pain and self-reported disability owing to headache were observed, whereas physical function on the SF-36 was not different from the expected level of the norm. Mental health was substantially affected in several dimensions, which had been described to reduce the ability to cope with pain. MOH patients seem to have high expectations of functionality, low symptomatology, and intact well-being.

Treatment Adherence in Child and Adolescent Chronic Migraine Patients: Results From the Cognitive-Behavioral Therapy and Amitriptyline Trial.

To examine treatment adherence among children and adolescents with chronic migraine who volunteered to be in a clinical trial using 3 measures: treatment session attendance, therapy homework completion, and preventive medication use by daily diary. Analyses are secondary from a trial of 135 youth aged 10 to 17 years diagnosed with chronic migraine and with a Pediatric Migraine Disability Score over 20. Participants were randomly assigned to cognitive-behavioral therapy plus amitriptyline (CBT+A, N=64) or headache education plus amitriptyline (HE+A, N=71). Therapists recorded session attendance. Completion of homework/practice between sessions was reported to therapists by patients. Patients reported preventive medication adherence using a daily headache diary. Mean session attendance adherence out of 10 treatment sessions was 95% for CBT+A and 99% for HE+A. CBT+A participants reported completing a mean of 90% of home practice of CBT skills between the 10 sessions. Participants reported taking amitriptyline daily at a mean level of 90% when missing diaries were excluded and 79% when missing diaries were considered as missed doses of medication. Our findings demonstrate that youth with chronic migraine who agree to be a part of a clinical trial do quite well at attending therapy sessions, and report that they are adherent to completing home/practice between sessions and taking medication. These results lend further support to consideration of CBT+A as a first-line treatment for youth with chronic migraine and suggest that measurement of adherence when this treatment is provided in practice will be important.

Extended Long-Term Effects of Cervical Vagal Nerve Stimulation on Headache Intensity/Frequency and Affective/Cognitive Headache Perception in Drug Resistant Complex-Partial Seizure Patients

Invasive vagal nerve stimulation (iVNS) is an established treatment option for drug-resistant focal seizures and has been assumed to diminish frequent co-incidental daily headache/migraine. However, long-term effects on cognitive/affective head pain perception, headache intensity/frequency are lacking. We therefore investigated potential iVNS-induced effects in patients with drug-resistant focal seizure and daily headache/migraine. A clinical database was used to select 325 patients with drug-resistant epilepsy treated by either iVNS plus best medical treatment (BMT) or BMT alone, compared to a healthy control group (HC). We assessed headache intensity (VAS), headache frequency, affective/cognitive pain perception (PASS; FSVA), migraine disability scores (MIDAS), sleep architecture (PSQI), depressive symptoms (BDI), and body weight (BMI). Nineteen patients with daily headache/migraine composed the clinical groups (10 iVNS and 9 BMT; iVNS mean age 49 years, range 36-61 years; BMT mean age 45 years, range 23-63 years; equally distributed gender). Cervical iVNS was applied from 5-13 years (mean 8 years) with following stimulation patterns: 1.3 mA (0.5-2 mA), 20 Hz, 250 μsec, 30 sec on/1.9 min off (0.5-5 min). The iVNS group had significantly lower VAS scores (iVNS 5.4; BMT 7.8; p = 0.03) and PASS cognitive/anxiety subscores (iVNS 21; BMT 16; p = 0.02) compared to BMT and HC. Global PASS (p = 0.07), FSVA, PSQI, BDI, and BMI scores did not differ significantly between groups. iVNS appears to have positive modulatory long-term effects on headache and affective/cognitive head pain perception in patients with drug-resistant focal epilepsy, thus deserving further attention.

Association Between Migraine and Diabetes in Pregnancy

Background: Migraine ranks as the eighth most disabling condition and one of the most common causes of headache in Pakistan. Objectives: In this study, we aimed to determine the association between migraine and diabetes in pregnant women. Patients and Methods: This cross-sectional study recruited 498 pregnant women, grouped into pregnant without diabetes (n = 300) and pregnant with diabetes (n = 198) according to the International Association of the Diabetes and Pregnancy Study criteria. Seventy-five women with known migraine were also recruited as positive controls. After confirming that the study subjects had headache at least once a month, the researcher filled out a comprehensive form based on the International Classification of Headache Disorders version II. Migraine disability score was used to assess severity. Fasting blood glucose levels were measured by using the enzymatic method. Data were presented as meanSD and frequencies, where applicable. Chi-square test and Spearman correlation test were performed. A P value of <0.05 was considered significant. Results: The headache prevalence during pregnancy was 69% in the women with diabetes and 64% in the women without diabetes. A positive unilateral distribution was observed in 51% of the cases and 36.3% of the controls (P< 0.01). However, 94.7% of the pregnant cohort reported not having experienced aura. Of the pregnant women with diabetes, 19% fell within the mild to moderate disability score as compared with the 10.3% of the pregnant women without diabetes (P < 0.01). High fasting blood glucose levels showed a significant association with headache scores (r = 0.144; P < 0.01). Conclusions: Headaches, particularly migraine without aura, are a common occurrence in pregnancy in our population. Migraine severity is positively associated with high blood glucose levels.

Population-based study of vestibular symptoms in migraineurs

Conclusion: The differences between migraineurs with vertigo or motion sickness or both, and migraineurs with neither might reflect differences in migraine pathophysiology. Objective: To assess vestibular symptoms in 871 definite migraineurs. Methods: Data were gathered using a structured questionnaire. We considered responses to only 2/150 questions: (1) ‘have you had vertigo with or apart from your headaches?’ and (2) ‘have you experienced motion sickness most of your life?’. The target groups were: (a) migraineurs with either vertigo or motion sickness, ‘migraine with vestibular symptoms’ (MwVS), their control group being migraineurs with neither vertigo nor motion sickness, ‘migraine without vestibular symptoms’ (MwoVS); (b) migraineurs who reported vertigo, ‘migraine with vertigo’ (MwV); their control group being migraineurs without vertigo (MwoV). Results: Among the 871 definite migraineurs, 534 had MwV, 337 had MwoV, 663 had MwVS, and 208 had MwoVS. The MwVS group had more headache, aura, nausea, vomiting, osmophobia, allergy, allodynia, headache increasing with head motion, noise as trigger for headache, days needing analgesics, and higher migraine disability scores than the MwoVS group. The pattern was the same in the MwV vertigo group as in the MwVS group, apart from migraine disability scores, which were no different.

48.: The effect of brief biofeedback intervention on headache disability and analgesic use in episodic or chronic migraine and chronic tension type headache

Chronic headache and migraine are highly prevalent in Australia. Pharmacological treatment has low efficacy, often compounded by overuse of medication, and psychological distress in this population is common. Thus, easily accessible, non-pharmacological interventions that address psychological components of headache and migraine are needed. This study explored the effectiveness of biofeedback as a mechanism for change in analgesic use. Forty people diagnosed by a neurologist as experiencing either chronic or episodic migraine or tension type headache were given psycho-education and relaxation during two sessions of biofeedback. The present study utilized two sessions of biofeedback (which has shown promise in meta-analysis) as a mechanism for change. Biofeedback sessions were of 1 hour duration and repeated at 1 month. Using a pre-post experimental design, the Migraine Disability Score (MIDAS), affective distress (DASS5) and analgesic use were recorded before commencing biofeedback and by mail survey at 3 month follow up. Paired sample t-test was used to explore differences in MIDAS score and analgesic use from baseline to 3 month follow-up using 95% confidence intervals. Mean difference from baseline to follow-up in MIDAS scores was 23.43 (8.53, 38.3), t(1, 36) = 3.19, p = .003. Mean analgesic use difference was 9.47 (4.02, 14.92), t(1, 34) = 3.53, p = .001. These changes indicate a 56% improvement in headache disability scores and 58% reduction in analgesic use. Psychological interventions such as biofeedback may reduce both the burden of headache and reliance on medication for patients, simultaneously impacting on the cost of health care provision and lost work days due to headache disability. The 56% reduction in MIDAS scores could not be attributed to medication prophylaxis, which remained unchanged, or analgesic usage, which was reduced by 58% at 3 months. Further studies with a control group, larger cohort of patients and longer follow-up may determine a clinical benefit of biofeedback in the treatment of episodic and chronic migraine and chronic tension type headache.