Alan G. Finkel

The Prevalence of Neck Pain in Migraine

(Headache 2010;50:1273‐1277)

Psychometric Properties of the HIT‐6 Among Patients in a Headache‐Specialty Practice

Objective.—To evaluate the performance and score interpretability of the Headache Impact Test (HIT‐6) questionnaire in a headache patient population.

The Prevalence and Spectrum of Sleep Problems in Women With Transformed Migraine

Objectives.—It is our clinical observation that patients with transformed migraine (TM) almost invariably report nonrestorative sleep. In this study we sought first to validate that clinical observation, then to describe the prevalence and spectrum of factors that might contribute to nonrestorative sleep in a TM population.

Predictors of disability in migraineurs referred to a tertiary clinic: neck pain, headache characteristics, and coping behaviors.

Objective.— The aim of this retrospective study was to determine if neck pain, select headache characteristics, and migraine‐related coping response predicted disability in migraineurs referred to a tertiary headache clinic.

Headaches in Soldiers With Mild Traumatic Brain Injury: Findings and Phenomenologic Descriptions

Objective.— The primary goal of this study was to use headache criteria‐based classification for headache types described by service members.

Dietary Considerations in Migraine Management: Does a Consistent Diet Improve Migraine?

The clinical expression of migraine is significantly impacted by dietary and gastrointestinal issues. This includes gut dysfunction during and between attacks, food triggers, increase in migraine with obesity, comorbid GI and systemic inflammation influenced by diet, and specific food allergies such as dairy and gluten. Practitioners often encourage migraineurs to seek consistency in their lifestyle behaviors, and environmental exposures, as a way of avoiding sudden changes that may precipitate attacks. However, rigorous evidence linking consistency of diet with improvement in migraine is very limited and is, at best, indirect, being based mainly on the consistency of avoiding suspected food triggers. A review of current data surrounding the issue of dietary consistency is presented from the perspective of migraine as an illness (vulnerable state), as a disease (symptom expression traits), and with a view toward the role of local and systemic inflammation in its genesis. Firm recommendations await further investigation.

Successful Treatment of Headache Related to Intravenous Immunoglobulin With Antimigraine Medications

In order to investigate headache related to intravenous immunoglobulin, we studied a 36‐year‐old woman with a history of migraine receiving weekly intravenous immunoglobulin for refractory myasthenia gravis who experienced severe headaches with each treatment. Neurological examination, CT scan of the head, and a lumbar puncture after the first headache were normal. Significant therapeutic response was based upon 50% reduction in pain and associated features. Headache features included throbbing pain which worsened with head movement and was associated with severe photophobia and nausea. Sumatriptan, 6 mg subcutaneous, reduced headache significantly with resolution of associated complaints. Treatment prior to intravenous immunoglobulin with dihydroergotamine mesylate resulted in development of only a mild dull ache without further development of severe head pain. Dihydroergotamine mesylate was also abortive in the few instances when the headache worsened. Headaches associated with intravenous immunoglobulin may have features of migraine and may be successfully prevented and/or treated with 5‐HT1D receptor agonists.

Botulinum Toxin and the Treatment of Headache: A Clinical Review

Parsing head pain is about classifying the common complaints people bring to us. Classification of primary headaches implies a discoverable pathology. It is assumed that by creating procedures or drugs which correct that pathology, we can provide new ways of treating the common headache disorders. The recent approval of onabotulinum toxin A (OBA) for the treatment of chronic migraine (CM) may offer just such an opportunity. Yet by attempting to answer old questions, new ones have been raised amongst by this new treatment, some of which include:

Migraine in patients with inflammatory bowel disorders.

To the Editor: Migraines are a common episodic neuroinflammatory disease with varying expression of associated gastrointestinal, neurologic, and autonomic phenomena. The high comorbidity between migraine and other chronic autoimmune and inflammatory conditions is well documented with the presence of migraine being linked to disease exacerbation, increased disease burden, and reduced health-related quality of life. For example, in patients with multiple sclerosis (MS), a familial history or comorbid migraine are putative risk factors for disease development; and migraine prophylaxis in MS patients, particularly those undergoing interferon treatments, are suggested to optimize clinical outcomes. The prevalence of migraine in patients with inflammatory bowel disease (IBD) remains unknown. Migraine is associated with systemic endothelial dysfunction also postulated in the etiopathogenesis of IBD. Migraine has also been anecdotally reported as an adverse response to immunosuppressant therapies, and in 1 clinical trial of IBD patients, migraine onset necessitated drug withdrawal. Thus, investigation of the possible comorbidity between migraine and IBD is warranted as it may have implications for further understanding of IBD as a systemic disorder and for IBD disease management. We conducted a small pilot study to investigate the prevalence of migraine in patients diagnosed with inflammatory bowel disorders. We prospectively recruited 100 patients presenting for a regular clinic appointment at the Gastroenterology Clinic at the University of North Carolina, Chapel Hill between February 2006 and August 2006. All patients carried a diagnosis of Crohn’s disease (CD) or ulcerative colitis (UC). Upon provision of informed consent, subjects completed a demographic sheet and the ID-migraine, a validated migraine screening questionnaire with high sensitivity [0.81, 95% confidence interval (CI), 0.77-0.85], specificity (0.75, CI, 0.64-0.84), and positive predictive value (0.93, 95% CI, 89-95). The demographic sheet elicited information about age, sex, educational status, ethnic background, IBD diagnosis, and years since IBD diagnosis. We analyzed the data using descriptive analyses, Fisher exact test, w, and Mann-Whitney U test using SPSS for Windows (version 14.0). A P value of <0.05 was considered statistically significant. The mean age of the IBD patients was 40.3 years (SD±14.9, range: 18 to 74y). A total of 77% of the IBD subjects were female and 23% were male. Of the 2 forms of IBD, 66% reported a diagnosis of CD, 27% reported UC. The mean length of IBD diagnosis was 145.4 months (SD± 122.3, range: 2 to 468mo). The ethnicity of respondents was as follows: white (94%), African (5%), Asian (1%), and Hispanic (1%). The prevalence of migraine in the IBD sample was 30%. Migraine was more prevalent in the CD subjects (36%) than UC subjects (14.8%), P=0.035. Of the CD respondents, migraine was more prevalent in females (20/43 or 46%) than males (4/23 or 17%), P=0.01 with both prevalence rates exceeding that of the general population. Of the CD patients who endorsed headaches, a high percentage of both male (75%) and female (90%) respondents reported that headaches limited their ability to perform work, study, or daily activities for at least 1 day over the prior 3 months. In the UC patients, prevalence of migraine in females did not approach that of the general population (2/16 or 12.5%), whereas prevalence in males exceeded the general population (2/11 or 18%). Every UC patient who screened positive for migraine endorsed that headaches limited functional status for at least 1 day over the prior 3-month period. This study suggests a high prevalence of migraine headaches in patients with IBD. This rate is higher than the US population base rate of 18.2% (females) and 6.5% (males) and is consistent with lifetime headache prevalence in other inflammatory diseases, including MS (26% to 58%). These findings suggest that migraine is underrecognized in IBD patients and indicates the need for further research establishing the prevalence of migraine using International Headache Society criteria. It is noteworthy that a high percentage of IBD patients with migraine indicated that headache-related symptoms limited their ability to work, study, or perform routine activities. These functional impairments may account for the finding that CD patients screening positive for migraine had lower education attainment than those screening negative (13.8 vs. 15.2 y, P<0.05).

Academic Headache medicine in america: Report of Academic Membership Survey of the American Headache Society special interest section on academic affairs

Background.—What constitutes the typical clinical experience of an academic headache specialist in America is unknown.