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Migraine Disorders: HELP
Articles from Bethesda
Based on 51 articles published since 2009
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These are the 51 published articles about Migraine Disorders that originated from Bethesda during 2009-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Editorial Migraine and the social selection vs causation hypotheses: a question larger than either/or? 2013

Peterlin, B Lee / Scher, Ann I. ·From the Department of Neurology (B.L.P.), Johns Hopkins University School of Medicine, Baltimore · and Department of Preventive Medicine Biometrics (A.I.S.), Uniformed Services University, Bethesda, MD. ·Neurology · Pubmed #23990406.

ABSTRACT: For decades, the question of social selection vs social causation has been raised by public health researchers and social scientists to explain the association between socioeconomic factors and mood disorders.(1,2) The social selection or "downward drift" theory postulates that the disease itself limits an individual's educational and occupational achievements, leading to a lower socioeconomic status (SES). In contrast, the social causation hypothesis suggests that factors associated with low SES (e.g., stressful life events, poor health care access) increase the likelihood of disease onset or prolonged disease duration.(3,4) Simply stated, the end result of each hypothesis is as follows:

2 Review Concussion in the Military: an Evidence-Base Review of mTBI in US Military Personnel Focused on Posttraumatic Headache. 2016

Holtkamp, Matthew D / Grimes, Jamie / Ling, Geoffrey. ·Department of Neurology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bldg 19, 6th Floor, Neurology, Bethesda, MD, 20889, USA. Matthew.D.Holtkamp.mil@mail.mil. · Department of Neurology, Uniformed Services University of Health Sciences, Bethesda, MD, USA. Matthew.D.Holtkamp.mil@mail.mil. · Department of Neurology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bldg 19, 6th Floor, Neurology, Bethesda, MD, 20889, USA. · Department of Neurology, Uniformed Services University of Health Sciences, Bethesda, MD, USA. · Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. ·Curr Pain Headache Rep · Pubmed #27084376.

ABSTRACT: Traumatic brain injury (TBI) is defined as an alteration in brain function caused by an external force. Mild TBI or concussion is now well recognized to be a risk of military service as well as participation in athletic sports such as football. Posttraumatic headache (PTH) is the most common symptom after mTBI in US service members. PTH most commonly presents with migraine-like headache features. The following is an overview of the epidemiology, pathophysiology, clinical course, prognosis, complications, and treatment of mTBI and associated comorbidities with a focus on PTH. There is a particular emphasis on emerging evidence-based clinical practice. One important medical consequence of the recognition that mTBI is a highly prevalent among military service members is that the Department of Defense (DoD) is dedicating significant financial and intellectual resources to better understanding and developing treatments for TBI. The identification of the importance of TBI among the US military population has had the added benefit of increasing awareness of this condition among civilian populations, particularly those engaged in both professional and youth sports. The NIH and NSF are also supporting important TBI research. President Obama's Brain Initiative is also providing additional impetus for these efforts. Unfortunately, the understanding of the acute and chronic effects of mTBI on the brain remains limited. Gratefully, there is hope that through innovative research, there will be advances in elucidating the underlying pathophysiology, which will lead to clinical and prognostic indicators, ultimately resulting in new treatment options for this very complicated set of disorders.

3 Review Adipokines and Migraine: A Systematic Review. 2016

Peterlin, B Lee / Sacco, Simona / Bernecker, Claudia / Scher, Ann I. ·Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, MD, USA. · University of L'Aquila, Department of Applied Clinical Sciences and Biotechnology, Institute of Neurology, L'Aquila, Italy. · Medical University of Graz, Clinical Institute of Medical and Chemical Laboratory Diagnostics, Graz, Austria. · Medical University of Graz, Department of Blood Group Serology and Transfusion Medicine, Graz, Austria. · Uniformed Services University, Bethesda, MD, USA. ·Headache · Pubmed #27012149.

ABSTRACT: BACKGROUND: Migraine is comorbid with obesity. Recent research suggests an association between migraine and adipocytokines, proteins that are predominantly secreted from adipose tissue and which participate in energy homeostasis and inflammatory processes. OBJECTIVES: In this review, we first briefly discuss the association between migraine and obesity and the importance of adipose tissue as a neuroendocrine organ. We then present a systematic review of the extant literature evaluating circulating levels of adiponectin and leptin in those with migraine. METHODS: A search of the PubMed database was conducted using the keywords "migraine," "adiponectin," and "leptin." In addition reference lists of relevant articles were reviewed for possible inclusion. English language studies published between 2005 and 2015 evaluating circulating blood concentration of adiponectin or leptin in those with migraine were included. CONCLUSIONS: While the existing data are suggestive that adipokines may be associated with migraine, substantial study design differences and conflicting results limit definitive conclusions. Future research utilizing carefully considered designs and methodology is warranted. In particular careful and systematic characterization of pain states at the time of samples, as well as systematic consideration of demographic (e.g., age, sex) and other vital covariates (e.g., obesity status, lipids) are needed to determine if adipokines play a role in migraine pathophysiology and if any adipokine represents a viable, novel migraine biomarker, or drug target.

4 Review Acute migraine treatment in emergency settings. 2014

Saguil, Aaron / Lax, John W. ·Uniformed Services University of the Health Sciences, Bethesda, MD, USA. · Fort Belvoir Community Hospital Family Medicine Residency, Fort Belvoir, VA, USA. ·Am Fam Physician · Pubmed #24784338.

ABSTRACT: -- No abstract --

5 Review Contributions of epidemiology to our understanding of migraine. 2013

Merikangas, Kathleen R. ·Genetic Epidemiology Research Branch, National Institute of Mental Health, Bethesda, MD 20892, USA. ·Headache · Pubmed #23432441.

ABSTRACT: BACKGROUND: During the past decade, the introduction of the second edition of the International Classification of Headache Disorders (ICHD-II) and the initiation of active campaigns to increase awareness of the high magnitude, burden, and impact of migraine have stimulated numerous studies of population-based data on the prevalence, correlates, and impact of migraine. OBJECTIVE: This paper provides an update of the literature on the worldwide epidemiology of migraine from studies that included the ICHD-II criteria. The aims of this paper are: (1) to review evidence regarding the magnitude of migraine; (2) to summarize information on the correlates and impact of migraine; and (3) to discuss the contributions, challenges, and future directions in the epidemiology of migraine. Evidence on the magnitude of migraine is divided into the following types of data: (1) prevalence rates of ICHD-II-defined migraine and tension-type headache from international population-based studies of adults; (2) the magnitude of migraine in U.S. studies; (3) ICHD-II-based international prevalence rates of ICHD-II-defined migraine in children; and (4) incidence rates of migraine from prospective longitudinal studies. METHODS: A comprehensive review of the literature on the prevalence of migraine subtypes and tension-type headache defined by ICHD-II criteria during the past decade was conducted and aggregate weighted rates across studies were derived. RESULTS: Across the 19 studies of adults that employed the ICHD-II criteria, the aggregate weighted estimates of the 12-month prevalence of definite migraine are 11.5%, and probable migraine of 7%, yielding a total of 18.5%. The cross-study weighted aggregate rate of migraine with aura is 4.4%, chronic migraine is 0.5%, and of tension-type headache is 13%. There has been even greater growth in international prevalence data on migraine in children, with a total of 21 studies of children that have employed the ICDH-II criteria. The aggregate weighted rate of definite migraine in children is 10.1% and migraine with aura is 1.6%. The well-established demographic correlates of migraine including the equal sex ratio in childhood, with increasing prevalence of migraine in females across adolescence to mid-adulthood were confirmed in these studies. Despite increasing effort to increase awareness of migraine, approximately 50% of those with frequent and/or severe migraine do not receive professional treatment. CONCLUSIONS: This review demonstrates that the descriptive epidemiology of migraine has reached its maturity. The prevalence rates and sociodemographic correlates have been stable across 50 years. These developments justify a shift in efforts to the application of the designs and methods of analytic epidemiology. Retrospective case-control studies followed by prospective cohort studies that test specific associations are likely to enhance our understanding of the predictors of incidence and progression of migraine, subtypes of migraine with differential patterns of onset and course, and specific environmental exposures that may have either causal or provocative influences on migraine etiology.

6 Review Treatment of chronic migraine headache with onabotulinumtoxinA. 2011

Gerwin, Robert. ·Johns Hopkins University, 7830 Old Georgetown Road, Suite C15, Bethesda, MD 20814, USA. gerwin@painpoints.com ·Curr Pain Headache Rep · Pubmed #21547527.

ABSTRACT: Chronic migraine headache remains an exceedingly difficult entity to manage. Treatment of chronic migraine headache with onabotulinumtoxinA has recently been shown to be effective in reducing the severity and frequency of chronic migraine headache, in the PREEMPT trials, a landmark achievement. However, the studies use a primarily fixed dose and site approach to treatment, allowing some individualized injections. However, the authors do not address the issue of myofascial trigger points as potential triggers of migraine that could be inactivated using onabotulinumtoxinA, despite several studies that support the role of myofascial trigger points in initiating some migraine headaches.

7 Review Comorbidity in anxiety disorders. 2010

Merikangas, Kathleen Ries / Swanson, Sonja Alsemgeest. ·Genetic Epidemiology Research Branch, Mood and Anxiety Disorders Program, Department of Health and Human Services, National Institute of Mental Health, National Institutes of Health, 35 Convent Drive, MSC#3720, Bethesda, MD 20892, USA. Kathleen.Merikangas@nih.gov ·Curr Top Behav Neurosci · Pubmed #21309105.

ABSTRACT: Ever since Feinstein coined the term "comorbidity", referring to the presence of any additional coexisting ailment in a patient with a particular index disease (J Chronic Dis 23:455-468, 1970), aspects of the phenomenon have been extensively studied. The aims of this chapter are: (1) to summarize the evidence of psychiatric comorbidity in anxiety disorders from adult population-based studies; (2) to present findings from the National Comorbidity Survey Replication (NCS-R); (3) to summarize evidence of psychiatric comorbidity in anxiety disorders from child and adolescent population-based samples; (4) to provide a summary of evidence on comorbidity from family and genetic studies; and (5) to examine patterns of comorbidity between anxiety disorders and medical conditions. Throughout each of these aims, implications of the comorbidity are explored, including whether these patterns reflect a need for redefining the disorders or rather an etiologic or even causal path.

8 Clinical Trial Trial of Amitriptyline, Topiramate, and Placebo for Pediatric Migraine. 2017

Powers, Scott W / Coffey, Christopher S / Chamberlin, Leigh A / Ecklund, Dixie J / Klingner, Elizabeth A / Yankey, Jon W / Korbee, Leslie L / Porter, Linda L / Hershey, Andrew D / Anonymous5211224. ·From the Department of Pediatrics, University of Cincinnati College of Medicine (S.W.P., A.D.H.), and the Division of Behavioral Medicine and Clinical Psychology (S.W.P., L.A.C.), the Office for Clinical and Translational Research (L.L.K.), and the Division of Neurology (A.D.H.), Cincinnati Children's Hospital Medical Center - all in Cincinnati · the Department of Biostatistics, Clinical Trials Statistical and Data Management Center, University of Iowa, Iowa City (C.S.C., D.J.E., E.A.K., J.W.Y.) · and the National Institute of Neurological Disorders and Stroke, Bethesda, MD (L.L.P.). ·N Engl J Med · Pubmed #27788026.

ABSTRACT: BACKGROUND: Which medication, if any, to use to prevent the headache of pediatric migraine has not been established. METHODS: We conducted a randomized, double-blind, placebo-controlled trial of amitriptyline (1 mg per kilogram of body weight per day), topiramate (2 mg per kilogram per day), and placebo in children and adolescents 8 to 17 years of age with migraine. Patients were randomly assigned in a 2:2:1 ratio to receive one of the medications or placebo. The primary outcome was a relative reduction of 50% or more in the number of headache days in the comparison of the 28-day baseline period with the last 28 days of a 24-week trial. Secondary outcomes were headache-related disability, headache days, number of trial completers, and serious adverse events that emerged during treatment. RESULTS: A total of 361 patients underwent randomization, and 328 were included in the primary efficacy analysis (132 in the amitriptyline group, 130 in the topiramate group, and 66 in the placebo group). The trial was concluded early for futility after a planned interim analysis. There were no significant between-group differences in the primary outcome, which occurred in 52% of the patients in the amitriptyline group, 55% of those in the topiramate group, and 61% of those in the placebo group (amitriptyline vs. placebo, P=0.26; topiramate vs. placebo, P=0.48; amitriptyline vs. topiramate, P=0.49). There were also no significant between-group differences in headache-related disability, headache days, or the percentage of patients who completed the 24-week treatment period. Patients who received amitriptyline or topiramate had higher rates of several adverse events than those receiving placebo, including fatigue (30% vs. 14%) and dry mouth (25% vs. 12%) in the amitriptyline group and paresthesia (31% vs. 8%) and weight loss (8% vs. 0%) in the topiramate group. Three patients in the amitriptyline group had serious adverse events of altered mood, and one patient in the topiramate group had a suicide attempt. CONCLUSIONS: There were no significant differences in reduction in headache frequency or headache-related disability in childhood and adolescent migraine with amitriptyline, topiramate, or placebo over a period of 24 weeks. The active drugs were associated with higher rates of adverse events. (Funded by the National Institutes of Health; CHAMP ClinicalTrials.gov number, NCT01581281 ).

9 Article A sixteen-week three-armed, randomized, controlled trial investigating clinical and biochemical effects of targeted alterations in dietary linoleic acid and n-3 EPA+DHA in adults with episodic migraine: Study protocol. 2018

Mann, John Douglas / Faurot, Keturah R / MacIntosh, Beth / Palsson, Olafur S / Suchindran, Chirayath M / Gaylord, Susan Ann / Lynch, Chanee / Johnston, Angela / Maiden, Kristen / Barrow, David A / Hibbeln, Joseph R / Ramsden, Christopher E. ·Department of Neurology, UNC, 2133 Physicians Office Bld, 170 Manning Drive, Chapel Hill, NC 27599-7025, United States. Electronic address: mannj@neurology.unc.edu. · Department of Physical Medicine and Rehabilitation, UNC School of Medicine, 171 Wing D, C.B.#7200, 170 Manning Drive, Chapel Hill, NC 27599-7200, United States. Electronic address: faurot@med.unc.edu. · UNC Healthcare Department of Nutrition & Food Services - Metabolic & Nutrition Research Core, 102 Mason Farm Rd., CB#7777, Chapel Hill, NC 27599, United States. Electronic address: beth.macintosh@unchealth.unc.edu. · Department of Medicine, 4111 Bioinformatics Building, Campus Box 7080, 130 Mason Farm Rd., Chapel Hill, NC 27599-7080, United States. Electronic address: opalsson@med.unc.edu. · Department of Biostatistics, Gillings School of Global Public Health, CB # 7420, 3103-A, McGavran-Greenberg Hall, Chapel Hill, NC 27599-7420, United States. Electronic address: suchi@bios.unc.edu. · Department of Physical Medicine and Rehabilitation, UNC School of Medicine, 183 Wing D, C.B.#7200, 170 Manning Drive, Chapel Hill, NC 27599-7025, United States. Electronic address: gaylords@med.unc.edu. · Department of Physical Medicine and Rehabilitation, UNC School of Medicine, 183 Wing D, C.B.#7200, 170 Manning Drive, Chapel Hill, NC 27599-7025, United States. Electronic address: chanee_lynch@med.unc.edu. · North Carolina Department of Agriculture and Consumer Services, 2 West Edenton St., Raleigh, NC 27601, United States. Electronic address: angela.johnston@ncagr.gov. · Lipid Mediators, Inflammation, and Pain Unit, Laboratory of Clinical Investigation, National Institute on Aging, NIH, 251 Bayview Blvd., Baltimore, MD 21224, United States. Electronic address: kristen.maiden@nih.gov. · UNC Cytokine Analysis Facility, North Carolina Oral Health Institute, 3412 Koury Oral Health Sciences Bldg., CB #7455, Chapel Hill, NC 27599-7455, United States. Electronic address: David_Barrow@unc.edu. · Laboratory of Membrane Biochemistry and Biophysics, National Institute on Alcohol Abuse and Alcoholism, NIH, 5625 Fishers Lane, Room 3N-07, Rockville, MD 20892, United States. Electronic address: jhibbeln@mail.nih.gov. · Lipid Mediators, Inflammation, and Pain Unit, Laboratory of Clinical Investigation, National Institute on Aging, NIH, 251 Bayview Blvd., Baltimore, MD 21224, United States; Intramural Program of the National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, MD 20892, United States; Department of Physical Medicine and Rehabilitation, UNC School of Medicine, 171 Wing D, C.B.#7200, 170 Manning Drive, Chapel Hill, NC 27599, United States. Electronic address: chris.ramsden@nih.gov. ·Prostaglandins Leukot Essent Fatty Acids · Pubmed #29413360.

ABSTRACT: Migraine is a prevalent neurological disorder, affecting over 16% of adult women and 7% of adult men in the U.S., causing significant pain, disability, and medical expense, with incomplete benefits from conventional medical management. Migraine, as a chronic pain syndrome, provides a practical model for investigating the impact of dietary modifications in omega-3 (n-3) and omega-6 (n-6) fatty acids. This paper reports the protocol of a trial to assess whether targeted dietary modifications designed to increase n-3 eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), with or without concurrent reduction in n-6 linoleic acid (LA), will alter nociceptive lipid mediators and mediate decreases in frequency and severity of migraine. This prospective, randomized, controlled trial in 153 male and female adult subjects, ages 18-99, with diagnosed and actively managed episodic migraine tests the efficacy, safety, and biochemical effects of targeted, controlled alterations in dietary omega-3 and omega-6 fatty acids. Participants are masked to diet hypotheses and all assessors are masked to treatment assignment. Following a four-week baseline period, participants with migraine headache frequency of 5-20 per month are randomized to one of three intensive dietary regimens for 16 additional weeks followed by a less intensive observation period. Dietary intervention arms include: 1) increased n-3 EPA+DHA with low n-6 linoleic acid (H3 L6); 2) increased n-3 EPA+DHA with usual US dietary intake of n-6 linoleic acid (H3 H6); and 3) usual US dietary content of n-3 and n-6 fatty acids (L3 H6). During the actual intervention, subjects receive content-specific study oils and foods sufficient for two meals and two snacks per day, as well as dietary counseling. Biochemical and clinical outcome measures are performed at intervals throughout this period. This randomized controlled trial is designed to determine whether targeted alterations in dietary n-3 and n-6 fatty acids can alter nociceptive lipid mediators in a manner that decreases headache pain and enhances quality of life and function in adults with frequent migraines. TRIAL REGISTRATION: NCT02012790.

10 Article Migraine and vascular disease biomarkers: A population-based case-control study. 2018

Tietjen, Gretchen E / Khubchandani, Jagdish / Herial, Nabeel / Palm-Meinders, Inge H / Koppen, Hille / Terwindt, Gisela M / van Buchem, Mark A / Launer, Lenore J / Ferrari, Michel D / Kruit, Mark C. ·1 University of Toledo Medical Center, Toledo, OH, USA. · 2 Ball State University, Muncie, IN, USA. · 3 Thomas Jefferson University, Philadelphia, PA, USA. · 4 Leiden University Medical Center, Leiden, Netherlands. · 5 National Institutes of Health, Bethesda, MD, USA. ·Cephalalgia · Pubmed #28885052.

ABSTRACT: Background The underpinnings of the migraine-stroke association remain uncertain, but endothelial activation is a potential mechanism. We evaluated the association of migraine and vascular disease biomarkers in a community-based population. Methods Participants (300 women, 117 men) were recruited as a part of the Dutch CAMERA 1 (Cerebral Abnormalities in Migraine, an Epidemiologic Risk Analysis) study. Participants were aged 30-60 (mean 48) years, 155 migraine had with aura (MA), 128 migraine without aura (MO), and 134 were controls with no severe headaches. Plasma concentrations of fibrinogen, Factor II, D-dimer, high sensitivity C-reactive protein (hs-CRP), and von Willebrand factor antigen were compared between groups, also stratifying by sex. Results Fibrinogen and hs-CRP were elevated in migraineurs compared to controls. In logistic regression analyses, MO and MA had increased likelihood of elevated fibrinogen, and MA had increased likelihood of elevated Factor II and hs-CRP. Fibrinogen and Factor II were associated with MA in women but not men. In the migraine subgroup, the total number of years of aura, but not headache, predicted elevated hs-CRP, and the average number of aura, but not headache, attacks predicted all biomarkers but Factor II. Conclusions Elevated vascular biomarkers were associated with migraine, particularly MA, as well as with years of aura and number of aura attacks.

11 Article Region-specific disruption of the blood-brain barrier following repeated inflammatory dural stimulation in a rat model of chronic trigeminal allodynia. 2018

Fried, Nathan T / Maxwell, Christina R / Elliott, Melanie B / Oshinsky, Michael L. ·1 Thomas Jefferson University, Department of Neurology, Philadelphia, PA, USA. · 2 Thomas Jefferson University, Department of Neurosurgery, Philadelphia, PA, USA. · 3 National Institutes of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA. ·Cephalalgia · Pubmed #28457145.

ABSTRACT: Background The blood-brain barrier (BBB) has been hypothesized to play a role in migraine since the late 1970s. Despite this, limited investigation of the BBB in migraine has been conducted. We used the inflammatory soup rat model of trigeminal allodynia, which closely mimics chronic migraine, to determine the impact of repeated dural inflammatory stimulation on BBB permeability. Methods The sodium fluorescein BBB permeability assay was used in multiple brain regions (trigeminal nucleus caudalis (TNC), periaqueductal grey, frontal cortex, sub-cortex, and cortex directly below the area of dural activation) during the episodic and chronic stages of repeated inflammatory dural stimulation. Glial activation was assessed in the TNC via GFAP and OX42 immunoreactivity. Minocycline was tested for its ability to prevent BBB disruption and trigeminal sensitivity. Results No astrocyte or microglial activation was found during the episodic stage, but BBB permeability and trigeminal sensitivity were increased. Astrocyte and microglial activation, BBB permeability, and trigeminal sensitivity were increased during the chronic stage. These changes were only found in the TNC. Minocycline treatment prevented BBB permeability modulation and trigeminal sensitivity during the episodic and chronic stages. Discussion Modulation of BBB permeability occurs centrally within the TNC following repeated dural inflammatory stimulation and may play a role in migraine.

12 Article Development and exploration of the content validity of a patient-reported outcome measure to evaluate the impact of migraine- the migraine physical function impact diary (MPFID). 2017

Hareendran, Asha / Mannix, Sally / Skalicky, Anne / Bayliss, Martha / Blumenfeld, Andrew / Buse, Dawn C / Desai, Pooja R / Ortmeier, Brian G / Sapra, Sandhya. ·Evidera, Metro Building, 6th Floor, 1 Butterwick, London, W6 8DL, UK. asha.hareendran@evidera.com. · Evidera, Bethesda, MD, USA. · Optum, Lincoln, RI, USA. · Headache Center of Southern California, Encinitas, CA, USA. · Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA. · Amgen Inc., Thousand Oaks, CA, USA. ·Health Qual Life Outcomes · Pubmed #29149901.

ABSTRACT: BACKGROUND: Adults with migraine experience substantial reductions in quality of life during and in-between migraine attacks. Clinical and regulatory guidelines encourage the inclusion of patient reported outcomes for the evaluation of benefits of interventions for migraine. METHODS: The conceptual framework and items for a new patient-reported outcome (PRO) instrument, the Migraine Physical Function Impact Diary (MPFID), were developed using scientific methods recommended to ensure content validity of PRO instruments. The MPFID was developed to measure the impact of migraine on physical functioning based on themes raised in concept elicitation (CE) interviews (conducted previously) with adults with migraine. Cognitive interviews were conducted with adults with migraine to further explore content validity. The instrument was modified following an interim analysis of a first round of cognitive interviews, to assess comprehensiveness and clarity of items, instructions, and response options. Refinements were subsequently tested in additional cognitive interviews. RESULTS: The conceptual framework included impacts on physical functioning experienced by most adults with migraine and deemed clinically relevant for measuring the outcome of an intervention for migraine. Concepts in the framework included the impact of migraine on physical impairments (acts) and ability to complete day-to-day activities and perform everyday activities (tasks). MPFID items were generated to evaluate functioning over the past 24 h and to collect data daily, to capture experiences on days with migraine as well as the days in-between migraines. Items asked about needing to rest or lie down; ability to get out of bed, stand up, bend over, walk, perform household chores, do tasks outside the home, keep routines or schedules, get ready for the day, do activities that require concentration or clear thinking; difficulty moving head and body, doing activities requiring physical effort; avoiding interacting with others. Initial modifications based on the first round of cognitive interviews (n = 8) included clarifying instructions, updating three items to enhance specificity and clarity, and revising one item to include gender-neutral language. The second round of interviews (n = 9) confirmed acceptability of revisions and supported content validity. CONCLUSIONS: The results provide qualitative evidence supporting the content validity of the MPFID for evaluating outcomes of interventions for migraine.

13 Article Volumetric brain changes in migraineurs from the general population. 2017

Palm-Meinders, Inge H / Arkink, Enrico B / Koppen, Hille / Amlal, Souad / Terwindt, Gisela M / Launer, Lenore J / van Buchem, Mark A / Ferrari, Michel D / Kruit, Mark C. ·From the Department of Radiology (I.H.P.-M., E.B.A., S.A, M.A.v.B., M.C.K.) and Department of Neurology (H.K., G.M.T., M.D.F.), Leiden University Medical Center · Department of Neurology (H.K.), Haga Hospital, The Hague, the Netherlands · and Laboratory of Epidemiology, Demography and Biometry (L.J.L.), NIH, Bethesda, MD. ·Neurology · Pubmed #29021356.

ABSTRACT: OBJECTIVE: To assess volumetric brain changes in migraineurs from the general population compared with controls. METHODS: Structural brain changes in migraineurs from the general population-based MRI Cerebral Abnormalities in Migraine, an Epidemiologic Risk Analysis (CAMERA)-2 observational cohort study were assessed by state-of-the-art voxel-based morphometry. T1-weighted MRIs of 84 migraineurs (52 with aura, 32 without aura) and 35 headache-free controls were evaluated. Regional volumes were compared voxelwise, corrected for age, sex, and total intracranial volume, with region-of-interest and whole-brain analyses. RESULTS: In region-of-interest analyses, migraineurs showed decreased gray matter volume in the visual areas V3 and V5 of the right occipital cortex compared to controls ( CONCLUSIONS: Migraineurs from the general population showed small volumetric brain changes, mainly in cortical areas involved in visual motion processing, compared to controls. The presence of morphologic changes regardless of the presence of migraine aura or disease activity suggests that migraines with and without aura share common pathophysiologic pathways and suggests that these changes are (partially) irreversible or might have been present throughout life.

14 Article Fluctuations in episodic and chronic migraine status over the course of 1 year: implications for diagnosis, treatment and clinical trial design. 2017

Serrano, Daniel / Lipton, Richard B / Scher, Ann I / Reed, Michael L / Stewart, Walter Buzz F / Adams, Aubrey Manack / Buse, Dawn C. ·Endpoint Outcomes, Boston, MA, USA. daniel.serrano@endpointoutcomes.com. · The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA. Richard.Lipton@einstein.yu.edu. · Montefiore Headache Center; Department of Neurology and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. Richard.Lipton@einstein.yu.edu. · Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. · Vedanta Research, Chapel Hill, NC, USA. · Sutter Health, Walnut Creek, CA, USA. · Allergan plc, Irvine, CA, USA. · Montefiore Medical Center, Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA. ·J Headache Pain · Pubmed #28980171.

ABSTRACT: BACKGROUND: Relatively little is known about the stability of a diagnosis of episodic migraine (EM) or chronic migraine (CM) over time. This study examines natural fluctuations in self-reported headache frequency as well as the stability and variation in migraine type among individuals meeting criteria for EM and CM at baseline. METHODS: The Chronic Migraine Epidemiology and Outcomes (CaMEO) Study was a longitudinal survey of US adults with EM and CM identified by a web-questionnaire. A validated questionnaire was used to classify respondents with EM (<15 headache days/month) or CM (≥15 headache days/month) every three months for a total of five assessments. We described longitudinal persistence of baseline EM and CM classifications. In addition, we modelled longitudinal variation in headache day frequency per month using negative binomial repeated measures regression models (NBRMR). RESULTS: Among the 5464 respondents with EM at baseline providing four or five waves of data, 5048 (92.4%) had EM in all waves and 416 (7.6%) had CM in at least one wave. Among 526 respondents with CM at baseline providing four or five waves of data, 140 (26.6%) had CM in every wave and 386 (73.4%) had EM for at least one wave. Individual plots revealed striking within-person variations in headache days per month. The NBRMR model revealed that the rate of headache days increased across waves of observation 19% more per wave for CM compared to EM (rate ratio [RR], 1.19; 95% CI, 1.13-1.26). After adjustment for covariates, the relative difference changed to a 26% increase per wave (RR, 1.26; 95% CI, 1.2-1.33). CONCLUSIONS: Follow-up at three-month intervals reveals a high level of short-term variability in headache days per month. As a consequence, many individuals cross the CM diagnostic boundary of ≥15 headache days per month.Nearly three quarters of persons with CM at baseline drop below this diagnostic boundary at least once over the course of a year. These findings are of interest in the consideration of headache classification and diagnosis, the design and interpretation of epidemiologic and clinical studies, and clinical management.

15 Article Psychometric Evaluation of a Novel Instrument Assessing the Impact of Migraine on Physical Functioning: The Migraine Physical Function Impact Diary. 2017

Kawata, Ariane K / Hsieh, Ray / Bender, Randall / Shaffer, Shannon / Revicki, Dennis A / Bayliss, Martha / Buse, Dawn C / Desai, Pooja / Sapra, Sandhya / Ortmeier, Brian / Hareendran, Asha. ·Evidera, Bethesda, MD, USA. · Optum, Lincoln, RI, USA. · Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA. · Amgen Inc, Thousand Oaks, CA, USA. · Evidera, London, United Kingdom. ·Headache · Pubmed #28857154.

ABSTRACT: OBJECTIVE: The objective of this study was to evaluate the measurement properties of the Migraine Physical Function Impact Diary (MPFID), a novel patient-reported outcome (PRO) measure for assessing the impact of migraine on physical functioning. METHODS: In a prospective, observational study, adults with episodic migraine (EM) or chronic migraine (CM) used an eDiary to complete the MPFID (assessing daily impacts of migraine on physical function) and a headache diary (capturing migraine days, migraine pain intensity, and migraine interference) each day, and other PRO instruments related to migraine. Item-level evaluation, item response theory (IRT), and exploratory factor analysis (EFA) methods were applied to identify domains, select final MPFID items, and develop scoring procedures. Psychometric properties of the final 13-item MPFID were evaluated using confirmatory factor analysis and tests of reliability (Cronbach's α for internal consistency and intra-class correlation [ICC] for test-retest) and validity (convergent and known-groups). RESULTS: The study enrolled 569 adults with chronic or episodic migraine, mean (SD) age 39.9 (12.0) years and 87.2% female. Item-level analyses based on interim data informed selection of a set of 13 items for the MPFID, through evaluation of floor/ceiling effects, item-to-item correlations, factor loadings, and IRT-based fit/misfit statistics. Two domain scores (EA: Impact on Everyday Activities; PI: Physical Impairment) and a global item score for impact on everyday activities were identified. EA and PI domains exhibited high internal consistency (α = 0.97; α = 0.93) and good test-retest reliability among stable subjects (ICCs = 0.74 and 0.77). Convergent validity was demonstrated by moderate correlations (r = ±0.50-0.68; P < .0001) between MPFID domain scores and number of migraine days, headache days, bed days, and other migraine-related PRO instruments. EA and PI scores differentiated between groups who varied by number of migraine days, migraine interference levels, migraine pain intensity, and median split groups of scores based on other PROs instruments (P < .05). CONCLUSIONS: The MPFID has robust psychometric properties (ie, reliability and validity). Findings supported two distinct domains about the impact of migraine on physical functioning: Impact on Everyday Activities and Physical Impairment. Both domain scores showed evidence of excellent reliability and construct validity in assessing the impacts of migraine on physical functioning.

16 Article Comorbid pain and migraine chronicity: The Chronic Migraine Epidemiology and Outcomes Study. 2017

Scher, Ann I / Buse, Dawn C / Fanning, Kristina M / Kelly, Amanda M / Franznick, Dana A / Adams, Aubrey M / Lipton, Richard B. ·From the Department of Neurology (D.C.B., R.B.L.), Albert Einstein College of Medicine, Bronx, NY · Montefiore Medical Center (D.C.B., R.B.L.), Bronx, NY · Vedanta Research (K.M.F.), Chapel Hill, NC · Complete Healthcare Communications (A.M.K., D.A.F.), Chadds Ford, PA · Allergan plc (A.M.A.), Irvine, CA. affiliated with the Department of Preventive Medicine and Biometrics (A.I.S.), Uniformed Services University of the Health Sciences, Bethesda, MD. ·Neurology · Pubmed #28679597.

ABSTRACT: OBJECTIVE: To identify patterns of noncephalic pain comorbidity in people with episodic migraine (EM; <15 headache-days per month) and chronic migraine (CM; ≥15 headache-days per month) and to examine whether the presence of noncephalic pain is an indicator for the 3-month onset or persistence of CM. METHODS: Data from the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study, a prospective, web-based study with cross-sectional modules embedded in a longitudinal design, were analyzed at baseline and the 3-month follow-up. Relationships between the number of noncephalic pain sites and 3-month onset of CM or persistent CM were assessed. RESULTS: Of 8,908 eligible respondents, 8,139 (91.4%) had EM and 769 (8.6%) had CM at baseline. At 3 months, the incidence of CM among those with baseline EM was 3.4%. When adjusted for demographics and headache-day frequency, the odds of CM onset among those with baseline EM increased by 30% (95% confidence interval [CI] 1.21-1.40, CONCLUSIONS: These results suggest that noncephalic pain may be a marker for headache chronicity that could be used to identify people with EM at risk of the onset of CM and people with CM at risk of persistent CM.

17 Article A genetic risk score is differentially associated with migraine with and without aura. 2017

Pisanu, Claudia / Preisig, Martin / Castelao, Enrique / Glaus, Jennifer / Pistis, Giorgio / Squassina, Alessio / Del Zompo, Maria / Merikangas, Kathleen R / Waeber, Gérard / Vollenweider, Peter / Mwinyi, Jessica / Schiöth, Helgi B. ·Division of Functional Pharmacology, Department of Neuroscience, BMC, University of Uppsala, Husargatan 3, 75124, Uppsala, Sweden. · Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy. · Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland. · Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA. · Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland. · Division of Functional Pharmacology, Department of Neuroscience, BMC, University of Uppsala, Husargatan 3, 75124, Uppsala, Sweden. jessica.mwinyi@neuro.uu.se. ·Hum Genet · Pubmed #28656458.

ABSTRACT: Although a number of migraine-associated single-nucleotide polymorphisms (SNP) with small effect size have been identified, little is known about the additive impact of these variants on migraine risk, frequency and severity. We investigated to what extent a genetic risk score (GRS) based on recently published, novel migraine-associated SNPs is associated with migraine prevalence, subtypes and severity in a large population-based sample. The sample comprised 446 subjects with migraine and 2511 controls from the CoLaus/PsyCoLaus study. Fifty-four SNPs earlier associated with migraine were selected. SNPs with a low impact on migraine prevalence in our sample were excluded using random forest. We combined the remaining 21 SNPs into a GRS and analyzed the association with migraine using logistic regression models. The GRS was significantly associated with migraine (OR = 1.56, p = 0.02) and migraine without aura (MWOA) (OR = 2.01, p = 0.003), but not with migraine with aura (MWA). The GRS was not associated with migraine frequency, intensity or interference with daily activities. We show that a GRS combining multiple genetic risk variants is associated with MWOA but not MWA, suggesting a different genetic susceptibility background underlying the two forms of migraine.

18 Article Iron in deep brain nuclei in migraine? CAMERA follow-up MRI findings. 2017

Palm-Meinders, Inge H / Koppen, Hille / Terwindt, Gisela M / Launer, Lenore J / van Buchem, Mark A / Ferrari, Michel D / Kruit, Mark C. ·1 Department of Radiology, Leiden University Medical Center, The Netherlands. · 2 Department of Neurology, Leiden University Medical Center, The Netherlands. · 3 Department of Neurology, Haga Hospital, The Hague, The Netherlands. · 4 Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging (NIA), National Institutes of Health (NIH), Bethesda, MD, USA. ·Cephalalgia · Pubmed #28385084.

ABSTRACT: Introduction In the CAMERA population-based MRI study, migraineurs below the age of 50 had decreased T2-values indicative of increased iron deposition in several deep brain nuclei. Longer migraine history was associated with lower T2-values, suggesting an association between migraine attacks and iron accumulation. In the present nine-year follow-up study of the CAMERA cohort we re-measured the T2-values in deep brain nuclei to assess the evolution over time. Methods Baseline and follow-up T2-values measured in several basal ganglia of 128 participants (38 control, 90 migraine) were analyzed using quantitative T2 measurements and multivariate regression analysis. Results T2-values of most deep brain nuclei were increased - instead of an expected further decrease when only age-related iron accumulation would have played a role - compared to baseline (both among controls and migraineurs) and were not different in either group. In migraineurs, no differences were found by gender, migraine severity or subtype. Conclusion This study did not provide supportive data for migraine related increased iron accumulation in deep brain nuclei, but neither is it able to reject such hypotheses. Increased T2-values probably point at microstructural tissue changes that counteracted earlier accumulated iron effects. We hypothesize that, with aging, migraine-induced iron-related brain changes are obscured by other age-related tissue changes.

19 Article Supradural inflammatory soup in awake and freely moving rats induces facial allodynia that is blocked by putative immune modulators. 2017

Wieseler, Julie / Ellis, Amanda / McFadden, Andrew / Stone, Kendra / Brown, Kimberley / Cady, Sara / Bastos, Leandro F / Sprunger, David / Rezvani, Niloofar / Johnson, Kirk / Rice, Kenner C / Maier, Steven F / Watkins, Linda R. ·Department of Psychology and Neuroscience, Center for Neuroscience, University of Colorado at Boulder, Boulder, CO, USA. · Departamento de Fisiologia e Biofisica, Instituto de Ciencias Biologicas, Universidade Federal de Minas Gerais, Avenida Antonio Carlos, 6627, CEP 31270-901 Minas Gerais, Brazil. · MediciNova Inc, 4350 La Jolla Village Dr., #950, San Diego, CA, USA. · Drug Design and Synthesis Section, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA. · Department of Psychology and Neuroscience, Center for Neuroscience, University of Colorado at Boulder, Boulder, CO, USA. Electronic address: linda.watkins@colorado.edu. ·Brain Res · Pubmed #28322750.

ABSTRACT: Facial allodynia is a migraine symptom that is generally considered to represent a pivotal point in migraine progression. Treatment before development of facial allodynia tends to be more successful than treatment afterwards. As such, understanding the underlying mechanisms of facial allodynia may lead to a better understanding of the mechanisms underlying migraine. Migraine facial allodynia is modeled by applying inflammatory soup (histamine, bradykinin, serotonin, prostaglandin E2) over the dura. Whether glial and/or immune activation contributes to such pain is unknown. Here we tested if trigeminal nucleus caudalis (Sp5C) glial and/or immune cells are activated following supradural inflammatory soup, and if putative glial/immune inhibitors suppress the consequent facial allodynia. Inflammatory soup was administered via bilateral indwelling supradural catheters in freely moving rats, inducing robust and reliable facial allodynia. Gene expression for microglial/macrophage activation markers, interleukin-1β, and tumor necrosis factor-α increased following inflammatory soup along with robust expression of facial allodynia. This provided the basis for pursuing studies of the behavioral effects of 3 diverse immunomodulatory drugs on facial allodynia. Pretreatment with either of two compounds broadly used as putative glial/immune inhibitors (minocycline, ibudilast) prevented the development of facial allodynia, as did treatment after supradural inflammatory soup but prior to the expression of facial allodynia. Lastly, the toll-like receptor 4 (TLR4) antagonist (+)-naltrexone likewise blocked development of facial allodynia after supradural inflammatory soup. Taken together, these exploratory data support that activated glia and/or immune cells may drive the development of facial allodynia in response to supradural inflammatory soup in unanesthetized male rats.

20 Article Worsening migraine due to neurocysticercosis. 2017

Elliott, Emily Jernigan / Landaker, Edwin J. ·Department of Internal Medicine, Naval Medical Center, Portsmouth, VA, USA. emily.e.jernigan.mil@mail.mil. · Department of Neurology, Walter Reed National Military Medical Center, Bethesda, MD, USA. · Department Head, Department of Neurology, Naval Medical Center, Portsmouth, VA, USA. ·Cleve Clin J Med · Pubmed #28322682.

ABSTRACT: -- No abstract --

21 Article Which Matters More? A Retrospective Cohort Study of Headache Characteristics and Diagnosis Type in Soldiers with mTBI/Concussion. 2017

Finkel, Alan G / Ivins, Brian J / Yerry, Juanita A / Klaric, John S / Scher, Ann / Sammy Choi, Y. ·Womack Army Medical Center (WAMC), Ft. Bragg, NC, USA. · Defense and Veterans Brain Injury Center, Silver Spring, MD, USA. · Carolina Headache Institute, Durham, NC, USA. · University of North Carolina School of Medicine, Chapel Hill, NC, USA. · Veterans Administration Hospital, Fayetteville, NC, USA. · Uniform Services University, Bethesda, MD, USA. ·Headache · Pubmed #28239838.

ABSTRACT: OBJECTIVE: To describe the diagnostic types and characteristics of headaches in soldiers with mild traumatic brain injury during the wars in Afghanistan and Iraq. BACKGROUND: Persistent post-traumatic headache interferes with returns to activity or duty. The most commonly cited headache diagnosis after concussion is migraine. We hypothesize that headache diagnosis type, eg, migraine, is not sufficient to predict relationships with occupational outcomes after concussion. METHODS: The study sample consisted of all new patients referred for headache evaluation at the Brain Injury Center at Womack Army Medical Center over a 1-year time period. The design was retrospective and observational. Clinical data reported included demographics, causes of injury, headache characteristics, and headache diagnosis type. After reviewing records for retention or severance from military service, the primary occupational outcome measure was departure from service due to medical cause as determined by a Medical Evaluation Board (MEB). The primary outcome measure was to test the strength of association between leaving service for MEB and headache characteristics or diagnosis. RESULTS: A total of 95 patients (94% male) with concussion described 166 distinct headache types, the most common being migraine (60%) and trigeminal autonomic cephalalgia (24%). A total of 25% of all patients remained on active duty. A continuous headache of any type was present in 75% of patients and of these, 23% remained on active duty. Of the 51% of patients who had both a continuous and non-continuous headache, 17% remained on active duty (P < .001). Therefore, we report that a continuous headache, regardless of diagnosis type was associated with negative occupational outcomes. Regardless of headache duration, headache diagnosis type alone was not associated with soldiers' separations from service. CONCLUSIONS: Persistent post-traumatic headache is most likely to present with continuous pain. Migraine is the most common primary diagnosis type. The presence of a continuous headache was strongly associated with negative occupational outcomes. Primary headache diagnosis type was not. Headache characteristics, therefore, may be more important than diagnosis type when determining active duty status. Further prospective research is indicated.

22 Article Migraine Headache and Long-Term Cardiovascular Outcomes: An Extended Follow-Up of the Women's Ischemia Syndrome Evaluation. 2017

Rambarat, Cecil A / Elgendy, Islam Y / Johnson, B Delia / Reis, Steven E / Thompson, Diane V / Sharaf, Barry L / Bittner, Vera / Sopko, George / Bairey Merz, C Noel / Pepine, Carl J / Ahmed, Bina. ·Department of Medicine, University of Florida, Gainesville. Electronic address: cecil.rambarat@medicine.ufl.edu. · Division of Cardiovascular Disease, Department of Medicine, University of Florida, Gainesville. · Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. · Department of Medicine, University of Pittsburgh, Pa. · Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, Pa. · Rhode Island Hospital, Providence. · Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham. · Division of Heart and Vascular Diseases, National Heart, Lung and Blood Institute, National Institute of Health, Bethesda, Md. · Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, Calif. · Division of Cardiovascular Disease, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH. ·Am J Med · Pubmed #28109970.

ABSTRACT: BACKGROUND: The association between migraine headache and cardiovascular events has been inconsistent. This study determines the long-term risk of cardiovascular events among women with and without a history of migraine headache who were under evaluation for suspected myocardial ischemia in the Women's Ischemia Syndrome Evaluation (WISE). METHODS: The WISE is a National Heart, Lung and Blood Institute-sponsored prospective, multicenter study that aims to improve myocardial ischemia evaluation in women. A total of 936 women presenting with symptoms of myocardial ischemia underwent structured data collection and coronary angiography. Information pertaining to migraine headache was available in 917 women. All-cause mortality data were available on all women for a median of 9.5 years, and nonfatal cardiovascular event data were available on 888 women for a median of 6.5 years. RESULTS: A total of 224 (24.4%) women reported a history of migraine headache. Compared with women who did not report a history of migraine headache, women with a history of migraine headache had an increased adjusted risk of cardiovascular event (cardiovascular death, nonfatal myocardial infarction, heart failure, or stroke) (hazard ratio 1.83; 95% confidence interval, 1.22-2.75) at a median follow-up of 6.5 years. This result was driven mainly by a twofold increase in the risk of stroke (hazard ratio 2.33; 95% confidence interval, 1.16-4.68). CONCLUSION: Among women being evaluated for ischemic heart disease, those reporting a history of migraine headache had increased risk of future cardiovascular events on long-term follow-up. This risk was primarily driven by a more-than twofold increase in the risk of stroke.

23 Article High leptin levels are associated with migraine with aura. 2017

Pisanu, Claudia / Preisig, Martin / Castelao, Enrique / Glaus, Jennifer / Cunningham, Janet L / Del Zompo, Maria / Merikangas, Kathleen R / Schiöth, Helgi B / Mwinyi, Jessica. ·1 Department of Neuroscience, University of Uppsala, Uppsala, Sweden. · 2 Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy. · 3 Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland. · 4 Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA. · 5 Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden. ·Cephalalgia · Pubmed #27165492.

ABSTRACT: Background Migraine is a prevalent disorder characterised by recurrent headache attacks preceded or accompanied by aura in a subgroup of patients. Migraine often occurs together with major depressive disorder (MDD). Alterations of adipokine levels have been reported both in migraine and in MDD. In this cross-sectional study, we aimed to assess the associations between serum leptin and adiponectin levels and migraine or migraine subtypes. Analyses were adjusted for a lifetime history of MDD in order to investigate the association between adipokines and migraine under consideration of depression status. Methods We included 3025 participants from the CoLaus/PsyCoLaus study. The impact of leptin and adiponectin levels on a diagnosis of migraine was analysed by binary regression analyses, adjusting for variables known to influence adipokine levels. Subgroup analyses were conducted based on the presence of aura. Results Crude leptin levels were significantly higher in subjects with migraine than controls (Mann-Whitney U = 515,102, p = 6 × 10

24 Article Measuring the impact of migraine for evaluating outcomes of preventive treatments for migraine headaches. 2016

Mannix, Sally / Skalicky, Anne / Buse, Dawn C / Desai, Pooja / Sapra, Sandhya / Ortmeier, Brian / Widnell, Katherine / Hareendran, Asha. ·Evidera, Bethesda, MD, USA. · Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA. · Amgen Inc, Thousand Oaks, CA, USA. · Evidera, Bethesda, MD, USA. asha.hareendran@evidera.com. · Evidera, London, UK. asha.hareendran@evidera.com. ·Health Qual Life Outcomes · Pubmed #27716228.

ABSTRACT: BACKGROUND: Migraine is characterized by headache with symptoms such as intense pain, nausea, vomiting, photophobia, and phonophobia that significantly impact individuals' lives. The objective of this study was to develop a strategy to measure outcomes from the patients' perspectives for use in evaluating preventive treatments for migraine. METHODS: This study used a multi-stage process. The first stage included concept identification research through literature review, patient-reported outcome (PRO) instrument content review, and clinician interviews, and resulted in a list of concepts relevant to understand the migraine experience. These results informed the design of the subsequent concept elicitation stage that involved qualitative interviews of adults with migraine to understand their experiences. Information from these two stages was used to develop a conceptual disease model (CDM) of the migraine experience. This CDM was used to identify concepts of interest (COI) to evaluate patient-relevant outcomes for assessing treatment benefit of migraine prophylactics. In the final stage, existing PRO instruments were reviewed to assess coverage of concepts related to the selected COI. RESULTS: Nine articles from 563 screened abstracts underwent full review to identify migraine-relevant concepts. This concept identification and subsequent concept elicitation interviews (N = 32; 21 episodic migraine; 11 chronic migraine) indicated that people with migraine experience difficulties during and between migraine attacks with considerable day-to-day variability in the impact on movement, ability to perform every day and social activities, and emotion. The CDM organized concepts as proximal to and more distal from disease-defining migraine symptoms, and was used to identify impact on physical function as the key COI. The item level review of PRO instruments revealed that none of the existing PRO instruments were suitable to collect data on impact of migraine on physical functioning, to evaluate treatment benefit. CONCLUSIONS: The impact of migraine includes impairments in functioning during and between migraine attacks that vary considerably on a daily basis. There is a need for novel PRO instruments that reflect patients' migraine experience to assess treatment benefit of migraine prophylactics. These instruments must evaluate the concepts identified and be able to capture the variability of patients' experience.

25 Article Sumatriptan iontophoretic transdermal system for acute treatment of episodic migraine. 2016

Cohen, Steven P / Chaudhry, Hira. ·a Departments of Anesthesiology & Critical Care Medicine and Physical Medicine & Rehabilitation , Johns Hopkins School of Medicine , Baltimore , MD , USA. · b Anesthesiology and Physical Medicine and Rehabilitation , Uniformed Services University of the Health Sciences , Bethesda , MD , USA. · c Blaustein Pain Treatment Center , Johns Hopkins University , Baltimore , MD , USA. ·Expert Rev Neurother · Pubmed #27063965.

ABSTRACT: Migraine is a common and debilitating condition affecting approximately nearly one in four women in the USA and Europe. Episodic attacks can be associated with a number of symptoms, with nausea and/or vomiting being among the most frequent and distressing. Sumatriptan is widely used for acute treatment of migraine and is available in several formulations. The efficacy of oral sumatriptan is well-established. However, patients who experience migraine-associated nausea and/or vomiting can have difficulty swallowing tablets and may delay taking anti-migraine medication. In addition, absorption of oral sumatriptan can be reduced by migraine-associated gastroparesis. Non-oral formulations of sumatriptan are recommended for patients with nausea and/or vomiting, but their use may be limited by adverse effects and patient acceptance. A new transdermal formulation of sumatriptan has recently become available in the USA for acute treatment of migraine in adults. In this article, we review the properties of the sumatriptan iontophoretic transdermal patch and discuss the evidence to support its use in clinical practice.

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