HeadachePub Date : 2024-10-01Epub Date: 2024-08-28DOI: 10.1111/head.14821
Cecilia H Fuglsang, Lars Pedersen, Morten Schmidt, Jan P Vandenbroucke, Hans Erik Bøtker, Henrik Toft Sørensen
{"title":"The combined impact of migraine and gestational diabetes on long-term risk of premature myocardial infarction and stroke: A population-based cohort study.","authors":"Cecilia H Fuglsang, Lars Pedersen, Morten Schmidt, Jan P Vandenbroucke, Hans Erik Bøtker, Henrik Toft Sørensen","doi":"10.1111/head.14821","DOIUrl":"10.1111/head.14821","url":null,"abstract":"<p><strong>Objective: </strong>To examine the combined impact of migraine and gestational diabetes mellitus (GDM) on the risks of premature (persons aged ≤60 years) major adverse cardiovascular and cerebrovascular events (MACCE) based on a composite endpoint of fatal and non-fatal myocardial infarction (MI) and stroke.</p><p><strong>Background: </strong>Migraine and GDM are risk factors for cardiovascular disease. It is unknown how the combination of migraine and GDM may affect cardiovascular disease risk.</p><p><strong>Methods: </strong>In a Danish population-based cohort longitudinal study, we established four cohorts among women with at least one pregnancy during 1996-2018: women with migraine, women with GDM, women with both migraine and GDM, and women free of migraine and free of GDM. Risks of premature MACCE and component endpoints were assessed for each cohort.</p><p><strong>Results: </strong>We included 1,307,456 women free of migraine and free of GDM, 56,811 women with migraine, 24,700 women with GDM, and 1484 women with migraine and GDM. The 20-year absolute risk of MACCE was 1.3% (MI: 0.4%, ischemic stroke: 0.6%, hemorrhagic stroke: 0.3%) among women free of migraine and free of GDM, 2.3% (MI: 0.8%, ischemic stroke: 1.2%, hemorrhagic stroke: 0.5%) among women with migraine, 2.2% (MI: 1.0%, ischemic stroke: 1.0%, hemorrhagic stroke: 0.4%) among women with GDM, and 3.7% (MI: 1.7%, ischemic stroke: 1.7%, hemorrhagic stroke: 0.3%) among women with both migraine and GDM. The 20-year adjusted hazard ratio of premature MACCE was 1.65 (95% confidence interval [CI] 1.49-1.82) for women with migraine; 1.64 (95% CI 1.37-1.96) for women with GDM; and 2.35 (95% CI 1.03-5.36) for women with both GDM and migraine when compared with women free of migraine and free of GDM.</p><p><strong>Conclusions: </strong>Migraine and GDM were each independently associated with an increased risk of MACCE. Risk of premature MACCE was greatest among women with both migraine and GDM, although this risk estimate was imprecise.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1124-1134"},"PeriodicalIF":5.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
HeadachePub Date : 2024-10-01Epub Date: 2024-08-23DOI: 10.1111/head.14818
Ashley Lebel, Dylan Da Silva Vieira, Yves Boucher
{"title":"Topical amitriptyline in burning mouth syndrome: A retrospective real-world evidence study.","authors":"Ashley Lebel, Dylan Da Silva Vieira, Yves Boucher","doi":"10.1111/head.14818","DOIUrl":"10.1111/head.14818","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effectiveness, tolerability, and safety of topical amitriptyline as a potential route of administration for the management of burning mouth syndrome.</p><p><strong>Background: </strong>Burning mouth syndrome is a complex, idiopathic, and debilitating orofacial pain disorder that impairs quality of life, with a prevalence of up to 18% in menopausal women. Available drugs to alleviate its burning sensation have inconsistent and limited efficacy. Given its physicochemical properties, excellent tolerability, and ability to target peripheral pathways, topical amitriptyline seems a promising mechanistically specific analgesic drug for burning mouth syndrome.</p><p><strong>Methods: </strong>In this retrospective cross-sectional real-world evidence study, patients with burning mouth syndrome who were prescribed topical amitriptyline for 8 weeks were identified. Eligibility criteria stemmed from ICHD-3, ICOP, and consensus definitions. The primary outcome measure was mean daily pain intensity (on a 0-10 scale); secondary outcomes included adverse events and patient global impression of improvement. Data are given as the mean ± SD.</p><p><strong>Results: </strong>A total of 15 patients fulfilling the eligibility criteria were included and analyzed. Mean daily pain was 6.7 ± 2.1 at baseline and 3.7 ± 2.3 after treatment, with a mean reduction of 3.1 ± 2.8 (p = 0.002). Half of the patients experienced a decrease in pain by at least 50% (p = 0.008). Several mild adverse events were reported, such as somnolence or dry mouth.</p><p><strong>Conclusions: </strong>Topical amitriptyline may be a safe and potent route of administration in the treatment of burning mouth syndrome, a hypothesis to be tested in further controlled trials.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1167-1173"},"PeriodicalIF":5.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A history of abuse is associated with more severe migraine- and pain-related disability: Results from the American Registry for Migraine Research.","authors":"Meesha Trivedi, Gina Dumkrieger, Catherine D Chong, Zachary Leibovit-Reiben, Todd J Schwedt","doi":"10.1111/head.14787","DOIUrl":"10.1111/head.14787","url":null,"abstract":"<p><strong>Background: </strong>Prior studies have established an association between a history of abuse and more severe migraine presentation.</p><p><strong>Objectives: </strong>This cross-sectional, observational study of a clinic-based migraine population used validated measures to elucidate migraine-specific and migraine-related burdens among patients with a history of abuse.</p><p><strong>Methods: </strong>Patients with migraine (n = 866) from the American Registry for Migraine Research self-reported if they had a history of emotional, physical, and/or sexual abuse and completed questionnaires assessing migraine-related burden: Migraine Disability Assessment, Subjective Cognitive Impairment Scale for Migraine Attacks, Work Productivity and Activity Impairment, Patient-Reported Outcomes Measurement Information System Pain Interference, Patient Health Questionnaire-2, and Generalized Anxiety Disorder-7. Migraine-related burden in patients with versus without a history of abuse was compared. Subsequently, a mediation analysis evaluated the impact of depression and anxiety symptoms in the relationship between abuse history and migraine burden.</p><p><strong>Results: </strong>A history of abuse was reported by 36.5% (n = 316/866) of participants. After controlling for patient age, sex, years lived with headache, and headache frequency, a history of abuse was significantly associated with more severe migraine-related disability. The combined burden of depression and anxiety symptoms mediated the relationship.</p><p><strong>Conclusion: </strong>A history of abuse is associated with greater migraine-related disability. Future studies should determine if identification and management of the psychological and physical sequelae of abuse reduce migraine burden.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1109-1123"},"PeriodicalIF":5.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
HeadachePub Date : 2024-10-01Epub Date: 2024-07-18DOI: 10.1111/head.14799
Karlee N Burns, Huaqing Zhao, Christina Master, Dianne Langford, Ryan Tierney, Jane McDevitt
{"title":"Migraine epidemiology in collegiate student-athletes: Findings from the Concussion Assessment, Research, and Education (CARE) Consortium.","authors":"Karlee N Burns, Huaqing Zhao, Christina Master, Dianne Langford, Ryan Tierney, Jane McDevitt","doi":"10.1111/head.14799","DOIUrl":"10.1111/head.14799","url":null,"abstract":"<p><strong>Objective: </strong>This cross-sectional study evaluated de-identified data from the National Collegiate Athletic Association-Department of Defense Grand Alliance from 2014 to 2020 to determine the prevalence of migraine and migraine medication and to describe differences in migraine prevalence by sex, race, and sport.</p><p><strong>Background: </strong>Epidemiological studies can help identify underdiagnosed and undertreated populations. Understanding migraine prevalence in collegiate student-athletes is essential for positive healthcare outcomes including development of prevention and treatment plans.</p><p><strong>Methods: </strong>From a concussion baseline assessment, participant's self-reported demographics (e.g., age, sex, sport), migraine diagnosis (i.e., yes/no), and migraine medication usage (e.g., yes/no, type) determined prevalence of migraine and medication use in collegiate student-athletes.</p><p><strong>Results: </strong>Migraine was reported in 5.6% (2617/47,060; 95% confidence interval [CI] 5.4%-5.8%) of the student-athletes, with higher prevalence in females, 7.5% (1319/17,628; 95% CI 7.1%-7.9%), than males, 4.6% (1298/28,116; 95% CI 4.4%-4.9%). Medication usage was reported by 36.2% (947/2617; 95% CI 34.3%-38.0%) of individuals with migraine. Migraine reporting differed by race, with Caucasian reporting highest (5.9%; 1990/33,913; 95% CI 5.6%-6.1%) and Asian the lowest (2.7%; 55/2027; 95% CI 2.1%-3.5%). Women's sports, including golf, gymnastics, and lacrosse, and men's diving and squash had higher migraine reporting than other sports.</p><p><strong>Conclusion: </strong>Caucasian females reported higher rates than other groups and sport influenced rates of migraine diagnosis.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1088-1093"},"PeriodicalIF":5.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141633207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
HeadachePub Date : 2024-10-01Epub Date: 2024-07-29DOI: 10.1111/head.14795
Carlyn Patterson Gentile, Scott Rosenthal, Heidi Blume, Reena Gogia Rastogi, Jennifer McVige, Alma Bicknese, Ali Ladak, Harshul Zaveri, Kaitlin Greene, Karen Barlow
{"title":"American Headache Society white paper on treatment of post-traumatic headache from concussion in youth.","authors":"Carlyn Patterson Gentile, Scott Rosenthal, Heidi Blume, Reena Gogia Rastogi, Jennifer McVige, Alma Bicknese, Ali Ladak, Harshul Zaveri, Kaitlin Greene, Karen Barlow","doi":"10.1111/head.14795","DOIUrl":"10.1111/head.14795","url":null,"abstract":"<p><strong>Objective: </strong>To provide healthcare professionals guidance on youth at risk for prolonged recovery and post-traumatic headache (PTH), and on pharmacologic and non-pharmacologic management of PTH due to concussion and mild traumatic brain injury.</p><p><strong>Background: </strong>Headache is the most common persistent post-concussive symptom affecting 8% of youth for >3 months after concussion. Over the past decade, many studies have explored the treatment of PTH in youth, but there are no established guidelines.</p><p><strong>Methods: </strong>This white paper is based on a synthesis of an updated systematic review of the literature on treatment of PTH and a narrative review of the literature on risk factors for prolonged recovery and health disparities. Results were interpreted by a group of expert providers in PTH in children and adolescents through collaboration of the PTH and pediatric special interest groups of the American Headache Society.</p><p><strong>Results: </strong>Factors that consistently were associated with prolonged recovery from concussion and persistent PTH included female sex, a high number of acute symptoms, and adolescent age. Social determinants of health also likely play an important role in PTH and deserve consideration in the clinical and research settings. A total of 33 studies met the criteria for inclusion in the systematic review of PTH treatment in youth, although most were retrospective and of fair-to-poor quality. Treatment strategies included acute and preventive pharmacologic management, procedures, neuro-modulatory devices, physical therapy, physical activity, and behavioral health support. A collaborative care approach that includes a thoughtful combination of these management strategies is likely most effective.</p><p><strong>Conclusions: </strong>This white paper provides a roadmap for tailoring the treatment of PTH based on factors influencing prolonged headache, the timing of therapies, and therapies with the most evidence for treating PTH in youth. We also highlight research needed for developing more definitive guidelines on PTH management in youth.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":"1148-1162"},"PeriodicalIF":5.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
HeadachePub Date : 2024-09-30DOI: 10.1111/head.14840
Costanza Sottani, Giulia Di Lazzaro, Paolo Calabresi, Maria Grazia Pomponi, Francesco Danilo Tiziano, Anna Rita Bentivoglio, Serenella Servidei, Catello Vollono
{"title":"Efficacy of galcanezumab in proline-rich transmembrane protein 2 (PRRT2)-associated familial hemiplegic migraine: A case series.","authors":"Costanza Sottani, Giulia Di Lazzaro, Paolo Calabresi, Maria Grazia Pomponi, Francesco Danilo Tiziano, Anna Rita Bentivoglio, Serenella Servidei, Catello Vollono","doi":"10.1111/head.14840","DOIUrl":"https://doi.org/10.1111/head.14840","url":null,"abstract":"<p><strong>Background: </strong>Familial hemiplegic migraine (FHM) is a rare subtype of migraine with aura. Variants in calcium voltage-gated channel subunit alpha1 A (CACNA1A), ATPase Na+/K+ transporting subunit alpha 2 (ATP1A2), and sodium voltage-gated channel alpha subunit 1 (SCN1A) genes have a well-established association with the development of FHM. Recent studies suggest that other genes may also have a significant role in the pathogenesis of FHM, including proline-rich transmembrane protein 2 (PRRT2). To our knowledge, there are currently no documented reports of the use of monoclonal antibodies targeting calcitonin gene-related peptide in FHM caused by a specific identified genetic mutation - and in particular not in FHM associated with PRRT2 mutations. The aim of our work is to describe the efficacy of galcanezumab as a prophylaxis treatment on patients from an Italian family consisting of six patient carriers of a PRRT2 pathogenic variant.</p><p><strong>Methods: </strong>Inclusion criteria for treatment eligibility consisted of a confirmed diagnosis of genetically confirmed FHM as defined by the International Classification of Headache Disorders, third edition, number of headache days/month ≥4, and at least two previously failed migraine prophylaxis treatments. We evaluated clinical data of patients treated with galcanezumab regarding number of headache days/month, frequency of aura, disability caused by HM using the Migraine Disability Assessment (MIDAS), attack severity through a numerical rating scale (NRS), acute medications intake, and response to acute medications at baseline (t0) and after 3 (t1) and 6 (t2) months of treatment.</p><p><strong>Results: </strong>Three out of six family members met inclusion criteria for treatment with galcanezumab. The average number of headache days/month, acute medications, and MIDAS significantly decreased in all treated patients, as well as the average NRS score. Aura frequency reduced by ≥50% compared to the baseline in all three patients. No adverse events related to galcanezumab were reported.</p><p><strong>Conclusion: </strong>Galcanezumab is a valid and well-tolerated treatment option in PRRT2-associated FHM.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142345141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
HeadachePub Date : 2024-09-30DOI: 10.1111/head.14843
Samuel K Peasah, Yu Hyeon Soh, Yan Huang, Jennifer Nguyen, Janel Hanmer, Chester Good
{"title":"Patient reported outcomes and the real-world use of calcitonin gene-related peptide medications in migraine.","authors":"Samuel K Peasah, Yu Hyeon Soh, Yan Huang, Jennifer Nguyen, Janel Hanmer, Chester Good","doi":"10.1111/head.14843","DOIUrl":"https://doi.org/10.1111/head.14843","url":null,"abstract":"<p><strong>Objective: </strong>To assess patient reported outcomes of patients with migraine receiving preventative medications, and to compare patient reported outcomes and unplanned care of patients on calcitonin gene-related peptide inhibitors (CGRPi) with those on other preventative medications.</p><p><strong>Background: </strong>Patient reported outcome measures can be useful in conditions such as migraine with frequent disability. CGRPi are newer migraine preventative medications that can improve patients' quality of life.</p><p><strong>Methods: </strong>This was a retrospective cohort analysis of Patient Reported Outcomes Measurement Information System (PROMIS) data combined with administrative claims data from a large regional health plan for adult patients (≥18 years) with migraine who were on preventative medications from January 2019 to March 2022. PROMIS scores of patients on CGRPi were compared to scores of patients who switched from other preventative medications to CGRPi (pre vs. post), between patients adherent to CGRPi versus non-adherent, and changes in all-cause/migraine-related unplanned care (emergency department) use by the CGRPi cohort.</p><p><strong>Results: </strong>There were 1245 patients on other preventative medications (antiseizure [532/1245 (43%)], antidepressants [316/1245 (25%)], and beta-blockers [397/1245 (32%)]), 148 who were on CGRPi, and 112 who had switched from other preventative medications to CGRPi. The mean age was 44 years old, 88% were females, 50% were married, and 75% were on commercial insurance. Patients with migraine had higher T-scores in pain, fatigue, anxiety, and sleep disturbance than the general population. Patients on CGRPi had a statistically significant reduction in pain T-scores (60.4 [standard deviation (SD) 7.4] to 58.4 [SD 8.2], p = 0.003) post initiation of medications, especially those who switched from other preventative medications to CGRPi (61.4 [SD 6.9] to 58.7 [SD 8.3], p < 0.001). The pain T-score reduction occurred only among the adherent group. There was a lower proportion of patients with all-cause unplanned care among patients on CGRPi (43% [64/148] to 32% [47/148], p < 0.001), but the reduction in migraine-related unplanned care was not statistically significant (9% [14/148] to 6% [9/148], p = 0.197).</p><p><strong>Conclusion: </strong>Our findings suggest that patients had an improvement in pain reduction scores after initiating CGRPi. PROMIS scores could provide important information about quality-of-life improvement for prescribers.</p>","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142345143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
HeadachePub Date : 2024-09-27DOI: 10.1111/head.14847
Bahar Atasoy, Asli Yaman Kula, Serdar Balsak, Yagmur Basak Polat, Zeynep Donmez, Ahmet Akcay, Abdusselim Adil Peker, Ozlem Toluk, Alpay Alkan
{"title":"Plain language summary publication: Role of diffusion tensor imaging in the evaluation of white matter integrity in idiopathic intracranial hypertension.","authors":"Bahar Atasoy, Asli Yaman Kula, Serdar Balsak, Yagmur Basak Polat, Zeynep Donmez, Ahmet Akcay, Abdusselim Adil Peker, Ozlem Toluk, Alpay Alkan","doi":"10.1111/head.14847","DOIUrl":"https://doi.org/10.1111/head.14847","url":null,"abstract":"","PeriodicalId":12844,"journal":{"name":"Headache","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142345159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
HeadachePub Date : 2024-09-18DOI: 10.1111/head.14838
Serena Laura Orr, Jonathan Kuziek, Samina Ali, Eva Anderson, Kathryn A. Birnie, Andrew D. Hershey, Prachi Khanna, Adam Kirton, Tolulope Sajobi, Stephen B. Freedman
{"title":"Remote electrical neuromodulation to treat children and adolescents with migraine in the emergency department: A randomized double‐dummy pilot trial","authors":"Serena Laura Orr, Jonathan Kuziek, Samina Ali, Eva Anderson, Kathryn A. Birnie, Andrew D. Hershey, Prachi Khanna, Adam Kirton, Tolulope Sajobi, Stephen B. Freedman","doi":"10.1111/head.14838","DOIUrl":"https://doi.org/10.1111/head.14838","url":null,"abstract":"ObjectiveUsing a double‐dummy pilot randomized controlled trial design, we aimed to determine the feasibility and acceptability of comparing remote electrical neuromodulation (REN) to typical care intravenous pharmacologic interventions for the treatment of children and adolescents visiting the emergency department (ED) with migraine, and to compare parallel‐group versus crossover trial designs.BackgroundThere are limited data to guide the management of migraine in the ED. Children and adolescents are interested in neuromodulation, and specifically REN, for treatment in this setting, but there are no existing data on this approach.MethodsWe employed a double‐dummy, double‐blind, pilot randomized controlled trial that tested two designs in two phases: a parallel‐group design and a crossover design (ClinicalTrials.gov identifier: NCT05102591). The intervention arms consisted of: (i) active REN stimulation with matched normal saline placebo intravenously, and (ii) matched sham REN stimulation, intravenous metoclopramide (0.15 mg/kg, maximum 10 mg), and intravenous ketorolac (0.5 mg/kg, maximum 30 mg). Youth aged 8.0–<18.0 years visiting a Canadian tertiary care pediatric ED with migraine attacks as per criteria B–E of the International Classification of Headache Disorders third edition were eligible. Primary outcomes were focused on trial feasibility and acceptability, and preliminary efficacy and safety data were also collected.ResultsA total of 34% (22/65) of those who screened eligible were enrolled. Three participants (14%) withdrew prior to receiving any study interventions. In all, 10 participants were allocated to typical care, and nine to REN. All treated participants (19/19) completed all assessments. Recruitment was higher during the parallel‐group phase: 1.1 participants/month versus 0.6 participants/month, and 36% (17/47) versus 28% (five of 18) of screened eligible were enrolled in the parallel‐group and crossover phases, respectively. Participants reported positive impressions of REN use in the ED, e.g., higher mean (standard deviation [SD]) levels of interest in using REN only at 3.7 (1.0) versus 2.8 (1.0) in using intravenous interventions only for a future ED visit. Participants and clinical staff reported overall positive impressions regarding the study protocol. Employing an 11‐point pain numerical rating scale, the mean (SD) reduction in pain severity score was 2.1 (1.3) and 2.9 (2.9) from baseline to 1 h, and 2.4 (1.6) and 4.0 (3.5) from baseline to 2 h for REN and intravenous interventions, respectively. One participant in the typical care group and none in the REN group experienced adverse events.ConclusionWe demonstrated the feasibility and acceptability of our trial protocol and of using REN to treat youth presenting to the ED with migraine. The parallel‐group design generated a higher recruitment rate than the crossover design. Our preliminary efficacy and safety data suggest that REN could be non‐inferior to typical car","PeriodicalId":12844,"journal":{"name":"Headache","volume":"42 1","pages":""},"PeriodicalIF":5.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142254373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Predictors of migraine interictal burden: The hidden role of subjective memory complaints","authors":"Filipa Dourado Sotero, João Nobre, Beatriz Nunes Vicente, Isabel Pavão Martins","doi":"10.1111/head.14819","DOIUrl":"https://doi.org/10.1111/head.14819","url":null,"abstract":"BackgroundThe “interictal burden of migraine” (MIB) is a new concept that encompasses the overall impact of the disease between migraine episodes. However, the factors that contribute to this interictal burden are still unclear.ObjectiveThis study aimed to identify explanatory factors of interictal burden in patients with migraine.MethodsThis prospective cross‐sectional observational including 200 patients with migraine (92% [<jats:italic>n</jats:italic> = 184] female, with a mean [standard deviation] age of 44.8 [12] years, 53% [<jats:italic>n</jats:italic> = 106] with chronic migraine) completed a clinical and questionnaire assessment targeting MIB, migraine impact, and depressive and cognitive complaints.ResultsMore than three‐fourths (76% [<jats:italic>n</jats:italic> = 152]) of patients had moderate‐to‐severe interictal burden. Higher interictal burden (MIB Scale ≥2) was associated with higher headache frequency (eight vs. 14, <jats:italic>p</jats:italic> = 0.001) and intensity (headache index score 17.0 vs. 30.0, <jats:italic>p</jats:italic> = 0.002), higher headache impact (six‐item Headache Impact Test score 59.2 vs. 63.9, <jats:italic>p</jats:italic> = 0.001), and more subjective memory complaints (Subjective Memory Complaints Questionnaire [SMC] score 9.0 vs. 4.5, <jats:italic>p</jats:italic> = 0.001), as well as anxiety (Hospital Anxiety and Depression Scale (HADS)‐Anxiety score 5 vs. 10, <jats:italic>p</jats:italic> < 0.001) and depression symptoms (HADS‐Depression score 5 vs. 8, <jats:italic>p</jats:italic> < 0.001). Once accounted for these potential explanatory variables, subjective memory complaints and impact of headache during ictal phase remained as individual determinants of the interictal burden, with SMC explaining 15% (odds ratio 1.15, 95% confidence interval 1.03–1.28; <jats:italic>p</jats:italic> = 0.010) of the interictal burden.ConclusionThis finding highlights the need to consider cognitive complaints as part of the construct of interictal burden of these patients to refine the focus of their management.","PeriodicalId":12844,"journal":{"name":"Headache","volume":"17 1","pages":""},"PeriodicalIF":5.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142254377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}