Sutapa Ford

Behavioral Sleep Modification May Revert Transformed Migraine to Episodic Migraine

Background.—Sleep problems have been linked with headaches for more than a century, but whether the headaches are the cause or the result of the disrupted sleep is unknown.

The Prevalence of Neck Pain in Migraine

(Headache 2010;50:1273‐1277)

Elimination of Menstrual-Related Migraine Beneficially Impacts Chronification and Medication Overuse

Objectives.— This study seeks to determine whether menstrual‐related migraine (MRM) has a discrete, attributable impact on migraine chronicity and medication overuse.

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.

The Impact of Extended‐Cycle Vaginal Ring Contraception on Migraine Aura: A Retrospective Case Series

Objective.— To determine whether extended‐cycle dosing of an ultralow dose vaginal ring contraceptive decreases frequency of migraine aura and prevents menstrual related migraine (MRM).

The Point Prevalence of Dizziness or Vertigo in Migraine - and Factors That Influence Presentation

Objective.— To ascertain and characterize the point prevalence of dizziness or vertigo in migraineurs presenting for routine appointments at a specialty headache clinic.

Emerging Behavioral Treatments for Migraine

Although the efficacy of behavioral interventions for migraine (e.g., relaxation training, stress management, cognitive-behavioral therapy, biofeedback) is well established, other behavioral interventions that have shown efficacy for other conditions are being adapted to treat migraine. This paper reviews the literature to date on acceptance and commitment therapy (ACT), mindfulness-based interventions, and behavioral interventions for common migraine comorbidities. ACT and mindfulness interventions prioritize the outcome of improved functioning above headache reduction and have demonstrated efficacy for chronic pain broadly. These emerging behavioral therapies show considerable promise for improving outcomes of migraine patients, particularly in reducing headache-related disability and affective distress, but efficacy to date is limited by small trials, short follow-up periods, and a need for comparison or integration with established pharmacologic and behavioral migraine treatments.

Presence of neck pain may delay migraine treatment.

Abstract Objective: To determine whether the presence of neck pain (NP) is associated with a delay in migraine treatment. Background: We have previously shown that 1) NP is exceedingly common in migraine; 2) its presence on the day preceding migraine is associated with impaired treatment response; and 3) NP is predictive of migraine-related disability independent of headache frequency and severity. Materials and Methods: This was a prospective, observational, cross-sectional study of 113 patients with migraine, ranging in attack frequency from episodic to chronic migraine. Subjects were examined by headache specialists to confirm the diagnosis of migraine and exclude both cervicogenic headache and fibromyalgia. Details of all headaches were recorded over the course of at least 1 month and until 6 qualifying migraines had been treated. Subjects were permitted to treat at the stage they customarily treated. A chi-square test of independence was performed to examine the relationship between the presence of NP and treatment within 30 minutes of headache onset. Analysis of variance was used to test the relationship of NP intensity with headache intensity at the time of migraine treatment. Results: Subjects recorded 2411 headache days, 786 of which were migraines, the majority of which were treated in the moderate pain stage. Presence of NP in the hour preceding initial migraine treatment was associated with delay in treatment beyond 30 minutes of headache onset (P < 0.01) and initiation of treatment at a greater headache pain intensity (P < 0.001). When NP accompanied migraine, those with moderate or severe NP were more likely to treat within 30 minutes of headache onset than those with mild NP (P < 0.05). Conclusion: Presence of NP was associated with delayed treatment of migraine, as indicated not only by higher pain burden at time of treatment but also by delay beyond 30 minutes.

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).