Migraine Disorders Research Articles

Does Gender Moderate the Relationship Between Chronic Pain and Substance Use Disorder? Insights From a National Canadian Population Survey.

BackgroundThough it has been shown that men have a higher lifetime prevalence of substance use disorder and a lower prevalence of chronic pain than women, there is little research to date focusing on gender differences in the relationship between chronic pain and substance use disorder. This study examined whether gender moderates the relationship of chronic pain and substance use disorder. We also sought to examine the gender differences in the associations between specific pain types—arthritis, migraine, and back pain, and substance use disorder.MethodsThe data were drawn from the 2012 Canadian Community Health Survey-Mental Health (CCHS-MH 2012) with individuals aged 20 years and older living in the 10 Canadian provinces (N = 23,089). A two-level logistic mixed effects model was used to account for provincial differences.ResultsOur findings indicated gender moderated the association between arthritis as well as migraine, and substance use disorder. However, no moderation effect of gender on the relationship between back pain and substance use disorder was found. Specifically, the strength of the association between arthritis and substance use disorder was stronger among men (ORinteraction = 0.62, 95% CI: 0.53 to 0.73), whereas the strength of the association between migraine and substance use disorder was stronger among women (ORinteraction = 1.45, 95% CI: 1.18 to 1.79). In addition, geographical location was found to explain a small proportion (2.3%-2.4%) of the overall variance in SUD.ConclusionsThe results suggest that gender moderated the relations between arthritis as well as migraine, and substance use disorder, respectively. Treatment programs for pain and substance misuse might benefit from an approach tailored to gender differences.

A framework for employing longitudinally collected multicenter electronic health records to stratify heterogeneous patient populations on disease history.

ObjectiveTo facilitate patient disease subset and risk factor identification by constructing a pipeline which is generalizable, provides easily interpretable results, and allows replication by overcoming electronic health records (EHRs) batch effects.Material and MethodsWe used 1872 billing codes in EHRs of 102 880 patients from 12 healthcare systems. Using tools borrowed from single-cell omics, we mitigated center-specific batch effects and performed clustering to identify patients with highly similar medical history patterns across the various centers. Our visualization method (PheSpec) depicts the phenotypic profile of clusters, applies a novel filtering of noninformative codes (Ranked Scope Pervasion), and indicates the most distinguishing features.ResultsWe observed 114 clinically meaningful profiles, for example, linking prostate hyperplasia with cancer and diabetes with cardiovascular problems and grouping pediatric developmental disorders. Our framework identified disease subsets, exemplified by 6 “other headache” clusters, where phenotypic profiles suggested different underlying mechanisms: migraine, convulsion, injury, eye problems, joint pain, and pituitary gland disorders. Phenotypic patterns replicated well, with high correlations of ≥0.75 to an average of 6 (2–8) of the 12 different cohorts, demonstrating the consistency with which our method discovers disease history profiles.DiscussionCostly clinical research ventures should be based on solid hypotheses. We repurpose methods from single-cell omics to build these hypotheses from observational EHR data, distilling useful information from complex data.ConclusionWe establish a generalizable pipeline for the identification and replication of clinically meaningful (sub)phenotypes from widely available high-dimensional billing codes. This approach overcomes datatype problems and produces comprehensive visualizations of validation-ready phenotypes.

Research progress on the mechanism of comorbidities of vestibular migraine and sleep disorders

Vestibular migraine （VM） is one of the common vestibular diseases characterized by recurrent vertigo and migraine. Studies have shown that the sleep structure of VM patients is similar to that of migraine patients, and they have a common pathophysiological pathogenesis. There is a strong correlation between VM and the clinical symptoms of sleep disorders. Sleep disorders can trigger VM. On the contrary, VM can affect sleep regulatory centers and lead to structural sleep disorders. In addition, there is a common relationship between VM and sleep disorders in neuroanatomy, neurotransmitters and neural pathways. A correct understanding of the relationship between vestibular migraine and sleep disorders can provide some help for clinical diagnosis and treatment. This article reviews the relationship between vestibular migraine and the pathogenesis of sleep disorders.

Migraine and sleep disorders

Migraine and sleep disorders

Maternal Stroke Associated With Pregnancy.

This article summarizes current knowledge of the epidemiology, pathophysiology, prevention, and treatment of cerebrovascular disease in pregnant and postpartum women. Stroke is a leading cause of maternal morbidity and mortality, and most fatal strokes are preventable. Adaptive physiologic changes of pregnancy, including hemodynamic changes, venous stasis, hypercoagulability, and immunomodulation, contribute to increased maternal stroke risk. The highest-risk time period for maternal stroke is the immediate postpartum period. Migraine and hypertensive disorders of pregnancy, including gestational hypertension and preeclampsia, are major risk factors for maternal stroke. Adverse pregnancy outcomes, including gestational hypertension, preeclampsia, preterm delivery, and fetal growth restriction, are important risk factors for cerebrovascular disease later in life. Many catastrophic maternal strokes could be avoided with targeted prevention efforts, early recognition of warning signs, and rapid evaluation of neurologic symptoms. Neurologists play a central role in the care of pregnant patients with cerebrovascular disease, whether acute or chronic, and should be familiar with the unique and complex physiology of pregnancy and its complications, particularly hypertensive disorders of pregnancy.

Pre-hospital transdermal glyceryl trinitrate in patients with stroke mimics: data from the RIGHT-2 randomised-controlled ambulance trial

BackgroundPrehospital stroke trials will inevitably recruit patients with non-stroke conditions, so called stroke mimics. We undertook a pre-specified analysis to determine outcomes in patients with mimics in the second Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial (RIGHT-2).MethodsRIGHT-2 was a prospective, multicentre, paramedic-delivered, ambulance-based, sham-controlled, participant-and outcome-blinded, randomised-controlled trial of transdermal glyceryl trinitrate (GTN) in adults with ultra-acute presumed stroke in the UK. Final diagnosis (intracerebral haemorrhage, ischaemic stroke, transient ischaemic attack, mimic) was determined by the hospital investigator. This pre-specified subgroup analysis assessed the safety and efficacy of transdermal GTN (5 mg daily for 4 days) versus sham patch among stroke mimic patients. The primary outcome was the 7-level modified Rankin Scale (mRS) at 90 days.ResultsAmong 1149 participants in RIGHT-2, 297 (26%) had a final diagnosis of mimic (GTN 134, sham 163). The mimic group were younger, mean age 67 (SD: 18) vs 75 (SD: 13) years, had a longer interval from symptom onset to randomisation, median 75 [95% CI: 47,126] vs 70 [95% CI:45,108] minutes, less atrial fibrillation and a lower systolic blood pressure and Face-Arm-Speech-Time tool score than the stroke group. The three most common mimic diagnoses were seizure (17%), migraine or primary headache disorder (17%) and functional disorders (14%). At 90 days, the GTN group had a better mRS score as compared to the sham group (adjusted common odds ratio 0.54; 95% confidence intervals 0.34, 0.85; p = 0.008), a difference that persisted at 365 days. There was no difference in the proportion of patients who died in hospital, were discharged to a residential care facility, or suffered a serious adverse event.ConclusionsOne-quarter of patients suspected by paramedics to have an ultra-acute stroke were subsequently diagnosed with a non-stroke condition. GTN was associated with unexplained improved functional outcome observed at 90 days and one year, a finding that may represent an undetected baseline imbalance, chance, or real efficacy. GTN was not associated with harm.Trial registrationThis trial is registered with International Standard Randomised Controlled Trials Number ISRCTN 26986053.

Care Gaps and Recommendations in Vestibular Migraine: An Expert Panel Summit.

Vestibular migraine (VM) is an increasingly recognized pathology yet remains as an underdiagnosed cause of vestibular disorders. While current diagnostic criteria are codified in the 2012 Barany Society document and included in the third edition of the international classification of headache disorders, the pathophysiology of this disorder is still elusive. The Association for Migraine Disorders hosted a multidisciplinary, international expert workshop in October 2020 and identified seven current care gaps that the scientific community needs to resolve, including a better understanding of the range of symptoms and phenotypes of VM, the lack of a diagnostic marker, a better understanding of pathophysiologic mechanisms, as well as the lack of clear recommendations for interventions (nonpharmacologic and pharmacologic) and finally, the need for specific outcome measures that will guide clinicians as well as research into the efficacy of interventions. The expert group issued several recommendations to address those areas including establishing a global VM registry, creating an improved diagnostic algorithm using available vestibular tests as well as others that are in development, conducting appropriate trials of high quality to validate current clinically available treatment and fostering collaborative efforts to elucidate the pathophysiologic mechanisms underlying VM, specifically the role of the trigemino-vascular pathways.

Neuromodulation for Prevention and Treatment of Headache Disorders

Neuromodulation is a treatment modality that can be used in the abortive and preventive treatment of migraine and other primary headache disorders. The basic concept of neurostimulation is to manipulate peripheral or central pain pathways with either magnetic or electrical impulses. Common neuromodulation techniques include occipital nerve stimulation, which is the oldest technique, and trigeminal nerve stimulation, combined occipital and trigeminal nerve stimulation, sphenopalatine ganglion stimulation, vagus nerve stimulation and transcranial magnetic stimulation, which were introduced soon after. The two newest modalities are remote electrical neuromodulation and caloric vestibular stimulation, the last of which is still in the experimental phases.

The effects of sleep disturbance and chronotype on baseline vestibular/ocular motor screening in collegiate athletes

The vestibular/ocular motor screening (VOMS) is a clinically validated screening tool for concussion management. Multiple factors have been known to influence VOMS performance such as preexisting migraine and mood disorders. Poor sleep is an another important variable that warrants investigation as a modifier on the VOMS that may need to be considered during administration. This study aims to examine whether self-reported sleep difficulties significantly modify baseline VOMS symptom provocation in collegiate athletes. A total of 191 collegiate student-athletes completed a pre-season baseline VOMS and the 16-item Athlete Sleep Screening Questionnaire (ASSQ) before the start of their respective sport season. The ASSQ was used to establish sleep health variables consisting of hours of sleep per night, sleep difficulties when traveling for sport, chronotype (e.g., morning or evening person), and a sleep disturbance score (SDS) category of none, mild, and moderate + severe. Those who reported sleep disturbances when traveling for sport on that respective ASSQ item had higher pre-test VOMS symptoms (P < 0.001) and symptom provocation on convergence (P = 0.015), horizontal vestibular ocular reflex (VOR) (P = 0.008), and vertical VOR (P = 0.039). There were worse pre-test symptoms (P = 0.015) and provocation on horizontal VOR (P = 0.046) in the moderate + severe SDS group than no SDS. The moderate + severe SDS group reported worse symptom provocation on the horizontal (P = 0.018) and vertical VOR (P = 0.010), and VMS (P = 0.017). No differences were found on VOMS symptom provocation for hours of sleep or chronotype. These results show agreement with previous symptom and neurocognitive data in that sleep difficulties among collegiate athletes may have an important role in the interpretation of baseline concussion testing. It may be beneficial to utilize sleep assessments with baseline concussion testing when using the VOMS as the clinical concussion measurement modality. The addition of sleep assessment may aid sports medicine practitioners in properly interpreting baseline VOMS scores. Pre-season baseline testing may need to be delayed if athletes report with poor sleep in the acute period prior.

Association of Circadian Locomotor Output Cycles Kaput Rs1801260 and Hypocretin Receptor 1 Rs2271933 Polymorphisms in Patients with Chronic Migraine and Sleep Disorder

Background: Insomnia and excessive daytime sleepiness (EDS) are frequently reported as sleep disorders, especially in patients with chronic migraine (CM). The main drive of conducting a study on the relationship of genes that regulate circadian rhythm is that migraine contains a robust genetic background, and it is known that migraine attacks have circadian characteristics. This study aims to evaluate the relationship of circadian locomotor output cycles kaput (CLOCK) rs1801260 and hypocretin receptor 1 (HCRTR1) rs2271933 gene-related circadian rhythm of patients with CM and sleep disorders. Methods: The present study was designed prospectively in the Mersin University Neurology Clinic. Volunteer individuals aged 18–75 were included in the study in three groups. Each group was made up of 100 individuals. The first group was created among the patients diagnosed with CM. The sleep disorders of patients were evaluated by Epworth Sleep Scale and Pittsburgh Sleep Quality Scale. The second group healthy first-degree relatives of patients. Finally, the third group was formed by the other healthy volunteers who did not have blood relations with the patients. Genotyping was performed for the CLOCK rs1801260 and HCRTR1 rs2271933 genes. Results: Eighty-seven (87%) of the patients, 56 (56%) of the control group 1, and 50 (50%) of the control group 2 consisted of female patients. Their mean ages were 41.1 ± 11.5, 45.7 ± 15.2, and 35.9 ± 10. EDS was detected in 27% of the patients, and poor sleep quality was detected in 67%. About 21% of the patients were found to be suffering from both EDS and poor sleep quality. The CLOCK rs1801260 AG genotype was 6.71 times higher than the AA genotype in the migraine patient group with EDS compared to the second control group (odds ratio [OR]: 6.71, 95% confidence interval [CI]: 0.819–54.992, P = 0.076). The GG genotype, according to the AA genotype, also was found 2.87 times higher in this group (OR = 2.87, 95% CI: 0.336–24.566, P = 0.335). In the group of patients with CM and insomnia, the CLOCK rs1801260 AG genotype was 17.763 times higher than the AA genotype compared to the second control (OR = 17.763, 95% CI: 2.242–140.740, P = 0.006). Conclusion: When CM patients were compared with control groups, CLOCK rs1801260 gene AG genotype was associated with both insomnia and EDS. However, there was no significant relationship between patients and control groups regarding the HCRTR1 rs2271933 gene.

Autistic Traits and Obsessive-Compulsive Disorder in Patients with Migraine With or Without Aura

Background: Migraine is one of the most common neurological disorders and often shows comorbidity with psychiatric disorders. Data regarding comorbidity between migraine and autism spectrum disorder (ASD) are limited. In addition, although anxiety disorders such as obsessive compulsive disorder (OCD) are commonly encountered with migraine, and the fact that the OCD and ASD relationship is well established, there are conflicting results concerning the possible relationships between migraine and OCD. The purpose of this study is to understand is there any relationship between ASD, OCD and migraine. Methods: The study included only females, 40 with migraine and 26 without migraine or any other type of headache syndrome or neurological disorders. The study included people aged between 20 and 61 years of age. Migraineurs were divided into two groups according to the presence/absence of aura. Demographic and clinical variables were recorded. Diagnosis of OCD was made by using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Obsessive-compulsive symptoms (OCS) and OCD severity and content was assessed by the Yale Brown Obsession and Compulsion Scale (YBOCS). Autistic traits were rated by use of the Autism Spectrum Quotient (AQ). Results: The YBOCS and AQ total scores were higher in patients with migraine (vs. controls) and those with aura (vs. non-aura); however, in both of these comparisons, the ‘attention switching’ and ‘imagination’ subscales (of the AQ) were found to be similar among the compared groups. Subclinical OCD was significantly more frequent in migraineurs (vs. controls) and those with aura (vs. non-aura). OCD diagnosis was similar among migraineurs and controls, but the aura group had significantly higher frequency of OCD compared to the non-aura group. Conclusion: According to our results, migraine and the presence of aura in migraineurs appear to be associated with OCD and autistic traits (as measured by the YBOCS and the AQ).

Free Papers Compiled

BACKGROUNDBipolar disorder is an episodic psychiatric illness characterized by episodes of mania and hypomania. Presentation of bipolar disorder differs in women as compared to men, due to frequent occurrence of comorbidities like migraine, thyroid disorders, polycystic ovarian syndrome, etc. Migraine is one of the most disabling primary headaches and is more commonly seen in women with bipolar disorder. Women with migraine also tend to have more frequent mood episodes and greater psychosocial impairment. There are limited studies conducted on migraine and bipolar disorder in women in India.AIMS AND OBJECTIVESTo determine the co-occurrence of Migraine in women with Bipolar Affective DisorderMETHODOLOGYWomen with Bipolar Affective Disorder, who visited the Psychiatry Out Patient Department of a Tertiary Care Hospital in South India, were evaluated for the presence of migraine headache using the International Headache Society criteria for diagnosis.RESULTSOut of 80 subjects, 40% (N = 32) women with Bipolar Affective Disorder (BPAD) were also suffering from Migraine. 38.2% (N = 13) women with Type 1 BPAD had migraine; while 61.7% (N = 21) women with Type 2 BPAD had migraine.CONCLUSIONMigraine is a frequent complaint in women with bipolar disorder. It was more commonly seen in women with BPAD type 2. As the presence of migraine affects course and treatment response in women with bipolar disorder, it emphasizes on the importance of detailed evaluation and further research in the area.

Prevalence Rates of Primary Headache Disorders and Evaluation and Treatment Patterns Among Korean Neurologists.

Background and PurposeSeveral studies have found that the prevalence of migraine is higher among healthcare professionals than in the general population. Furthermore, several investigations have suggested that the personal experiences of neurologists with migraine can influence their perception and treatment of the disease. This study assessed these relationships in Korea.MethodsA survey was used to investigate the following characteristics among neurologists: 1) the prevalence rates of migraine, primary stabbing headache, and cluster headache, and 2) their perceptions of migraine and the pain severity experienced by patients, diagnosing migraine, evaluation and treatment patterns, and satisfaction and difficulties with treatment.ResultsThe survey was completed by 442 actively practicing board-certified Korean neurologists. The self-reported lifetime prevalence rates of migraine, migraine with aura, primary stabbing headache, and cluster headache were 49.8%, 12.7%, 26.7%, and 1.4%, respectively. Few of the neurologists used a headache diary or validated scales with their patients, and approximately half were satisfied with the effectiveness of preventive medications. Significant differences were observed between neurologists who had and had not experienced migraine, regarding certain perceptions of migraine, but no differences were found between these groups in the evaluation and preventive treatment of migraine.ConclusionsThe high self-reported lifetime prevalence rates of migraine and other primary headache disorders among Korean neurologists may indicate that these rates are underreported in the general population, although potential population biases must be considered. From the perspective of neurologists, there is an unmet need for the proper application of headache diaries, validated scales, and effective preventive treatments for patients. While the past experiences of neurologists with migraine might not influence how they evaluate or apply preventive treatments to migraine, they may influence certain perceptions of the disease.

Prevalence of Migraine in Young Male Patients Presented with Severe Headache

Background and Aim: Migraine is a spiking prime headache disorder that has a significant impact on both patients and society. Migraine and other headache disorders are major causes of misery and frailty on a global scale. The aim of the present study was to determine the prevalence of migraine in young male patients presented with severe headache. Methodology: This cross-sectional study was carried out on 276 young male patients who presented with severe headache Medicine outpatient department (OPD) at Ayub Teaching Hospital, Abbottabad from August 2019 to July 2020. Criteria of International Classification of Headache Disorders were followed for headache diagnosis. All the patients of age range 15-40 years with severe headaches were enrolled whereas patients of previous chronic medical conditions were excluded. Ethical approval was taken from the institutional ethical committee. All the demographic details were gathered in a pre-designed proforma. SPSS version 24 was used for data analysis. Results: A total of 276 young adult patients who presented with severe headaches were investigated during the study period. The mean age was 29.38±8.65 years with an age varies from 15 years to 40 years. Most of the patients were in the age range of 31-40 years 132 (47.8%) followed by 21 to 30 years 97 (35.1%). Patients of age 15-20 years were less frequent with a prevalence of 47 (17.1%). The overall prevalence of migraine headache was in 137 (49.6%) patients out of which migraine with and without aura was 5.7% and 43.9% respectively. Tension-type headache being the second common headache was found in 23.7% followed by Cluster headache at 2.8%. Conclusion: Migraine without aura was the most prominent headache among young male outpatients with severe headache. The findings highlight the socioeconomic factors impact on headache epidemiology and show that excessive use of NSAIDs may have an effect the primary headaches distribution. More multicenter studies are needed to assess headache epidemiology across the country. Keywords: Severe Headache, Migraine, Prevalence, Tension Type Headache (TTH)

Mistaken Identity: Many Diagnoses are Frequently Misattributed to Lyme Disease

BackgroundPrior studies have demonstrated that Lyme disease is frequently over-diagnosed. However, few studies describe which conditions are misdiagnosed as Lyme disease. MethodsThis retrospective observational cohort study evaluated patients who lacked evidence for Borrelia burgdorferi infection referred for Lyme disease to a Mid-Atlantic academic center from 2000-2013. The primary outcome is clinically described diagnoses contributing to symptoms. Secondary outcomes included symptom duration and determination whether diagnoses were new or attributed to existing medical conditions. ResultsOf 1261 referred patients, 1061 (84%) had no findings of active Lyme disease, with 690 (65%) receiving other diagnoses; resulting in 405 (59%) having newly diagnosed medical conditions, 134 (19%) attributed to pre-existing medical issues, and 151 (22%) with both new and pre-existing conditions. Among the 690 patients, the median symptom duration was 796 days, and a total of 139 discrete diagnoses were made. Infectious disease diagnoses comprised only 3.2%. Leading diagnoses were anxiety/depression 222 (21%), fibromyalgia 120 (11%), chronic fatigue syndrome 77 (7%), migraine disorder 74 (7%), osteoarthritis 62 (6%), and sleep disorder/apnea 48 (5%). Examples of less frequent but non-syndromic diseases newly diagnosed included multiple sclerosis (n = 11), malignancy (n = 8), Parkinson's disease (n = 8), sarcoidosis (n = 4), or amyotrophic lateral sclerosis (n = 4). ConclusionsMost patients with long-term symptoms have either new or pre-existing disorders accounting for their symptoms other than Lyme disease, suggesting overdiagnosis in this population. Patients referred for consideration of Lyme disease for chronic symptoms deserve careful assessment for diagnoses other than Borrelia burgdorferi infection.

Hormonal therapies in migraine management: current perspectives on patient selection and risk management

ABSTRACT Introduction The link between sex hormones and migraines has long been investigated but the mechanisms underlying this altered interaction are not yet fully understood. Herein, we retrace the knowledge on this association in relationship with risk of stroke. Areas covered Estrogens fluctuations could trigger migraine attacks and exogenous estrogens intake could be a risk factor for venous thromboembolism (VTE) and stroke. At the same time, ischemic heart diseases and stroke share a common substrate with migraine and other mood disorders, depression, and anxiety. Expert opinion The use of hormonal therapies in the context of contraception or replacement therapy must be closely evaluated in a careful risk assessment. We highlight the complex interaction of hormone/neuroinflammation pathways underlying the pathophysiology of migraine glimpsing in mood disorders a possible common denominator of link between hormonal and neuronal systems.

Особливості коморбідних патологій при мігрені без аури у дітей і вплив її лікування на перебіг хвороби

Актуальність. Мігрень — первинна форма головного болю з високою варіабельністю і непередбачуваною частотою нападів, що часто супроводжується різноманітними коморбідними станами, які впливають на клінічний перебіг захворювання і ускладнюють його лікування. Мета: оцінити частоту і структуру провідних неврологічних коморбідних порушень при мігрені без аури у дітей і оцінити динаміку частоти атак після їх лікування. Матеріали та методи. Сформовано дві групи залежно від форми захворювання: 1-ша група (основ­на) — мігрень без аури (МБА), 2-га група (порівняння) — мігрень з аурою (МЗА). Групу МБА становили 142 пацієнта. Групу МЗА становили 96 пацієнтів. Результати. При МБА неврологічні коморбідні порушення зустрічаються в 77,5 % (110 випадків), що в 2,5 раза частіше, ніж при МЗА — 31,2 % (30 випадків) (pФішера &lt; 0,001). У всіх випадках коморбідних порушень виявлено астенічний синдром (ізольовано або в поєднанні з іншими порушеннями), їх лікування (нефармакологічне і фармакологічне) істотно вплинуло на перебіг МБА зі зменшенням частоти атак. Висновки. Корекція коморбідних неврологічних порушень при МБА у дітей зменшує кількість нападів (за три контрольних місяці), що обґрунтовує доцільність даного підходу при лікуванні МБА в педіатричній популяції.

Differences of Sleep Disorders Between Vestibular Migraine and Benign Paroxysmal Positional Vertigo.

Introduction: Sleep disorders can affect the overall health and quality of life of patients. This study was conducted to compare the differences of sleep disorders in vestibular migraine (VM) patients and benign paroxysmal positional vertigo (BPPV) patients.Methods: VM patients, BPPV patients, and healthy controls (HCs) were recruited. Pittsburgh sleep quality index and polysomnography monitoring were used as subjective and objective, respectively, evaluation methods to evaluate the sleep quality of participants in the latest month.Results: Fifty-seven BPPV patients, 48 VM patients, and 42 HCs were included in this study. There were 79.16% VM patients, 54.39% BPPV patients, and 14.28% HCs with sleep disorders. The difference in the incidence rate of sleep disorders was significant between VM patients and BPPV patients (p = 0.008) and significantly higher in both the VM group (p < 0.00001) and BPPV group (p = 0.00004) than in the HC groups (14.28%). Compared with BPPV patients, the VM patients had the significantly lower sleep efficiency (p < 0.001) and N3 (p < 0.001) and the significantly higher time of wake-up after sleep onset (p < 0.001), N1 (p < 0.001), and N2 (p < 0.001). Meanwhile, the VM patients had significantly higher incidence rates of severe obstructive sleep apnea hypoventilation syndrome (p = 0.001) and periodic leg movement in sleep (p = 0.016).Conclusion: The incidence rate of sleep disorders was significantly higher in both VM and BPPV patients than in the HC groups. To improve the curative effects, clinicians should pay more attention to the comorbidity of sleep disorders in treating VM and BPPV.

Stigma and Migraine: Developing Effective Interventions.

Purpose of ReviewMigraine and other primary headache disorders do not receive adequate research funding, medical resources, or other forms of structural support relative to their prevalence and the disability they cause. In recent research, scholars have argued that stigma associated with headache disorders explains some of this discrepancy.This review will discuss (1) the factors contributing to stigma toward migraine and other primary headache disorders, (2) how structural and enacted stigma may perpetuate individual disability, (3) the impact of internalized stigma, and (4) interventions to mitigate stigma toward headache disorders with an emphasis on outcome monitoring. The review will also propose new areas of stigma research in need of further investigation.Recent FindingsRecent research shows that discrimination can exacerbate chronic pain.SummaryStigma profoundly affects everything from the allocation of federal research funds and healthcare resources to individual patients’ self-efficacy and ability to care for themselves. Understanding the stigma of migraine and learning how to develop effective interventions to mitigate this stigma will increase access to appropriate migraine care, improve healthcare providers’ ability to care for their migraine patients, and help advocates reverse policies that discriminate against those with migraine. It is important to closely monitor outcomes of anti-stigma efforts for both positive and negative consequences and take note of outcomes and “lessons learned” from anti-stigma campaigns for other diseases.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11916-021-00982-z.

Migraine and Obesity: Is There a Relationship? A Systematic Review and Meta-Analysis of Observational Studies.

Many studies have evaluated the risk of migraine headache in obese persons, suggesting controversial conclusions. The aim of this systematic review and meta- analysis of the observational studies was to clarify the association between migraine and obesity. Scopus and PubMed electronic databases were systematically searched up to February 2019 for observational studies providing data dealing with migraine disorder in obese subjects, as well as normal-weight controls. The random effects model was applied for assessing pool effect size, and inter-study heterogeneity was evaluated by conducting subgroup analyses. Among 1122 publications, 16 studies (10 cross-sectional, 5 cohort studies and 1 case-control study) were detected and were included in the meta-analysis. The pooled data analysis illustrated an elevated risk of migraine headache (Prevalence ratio estimate = 1.29, 95% CI, 1.15 - 1.44, p = 0.000) in obese individuals compared to normal-weight persons. Subgroup analyses revealed that geographical distribution was an important source of heterogeneity (p = 0.04). Significantly greater migraine prevalence was found in European and Asian patients, but no statistically significant relationship with obesity was observed in American patients. Based on a cumulative meta-analysis of available studies indicating an association between migraine and obesity, obesity can be appropriately considered as an overall risk factor for migraine headaches. Additional high-quality original studies considering frequency, severity, and duration of headaches are required to clarify confident evidence.