Daily Headache Diary Improves Diagnosis, Study Shows

BACKGROUND Frequently recurring tension headaches, migraines, and orofacial pain affect over 2.4 billion people worldwide, representing the second most prevalent medical condition in the world. In-office behavioral therapy (ie, relaxation and mindfulness exercises) has been shown to be one of the most effective treatment options for these patients. However, it has been underutilized due to stigma, cost, and accessibility. Mobile health apps may be one way to provide accessible, lower cost care in a nonstigmatized environment. As a result, apps are becoming an increasingly popular method for delivering behavioral therapy interventions and may provide an effective means to reach this population. OBJECTIVE The aim of this study was to assess the feasibility and acceptability of delivering a clinically validated behavioral therapy for migraine/headaches through a mobile app. METHODS Twenty-one migraine or headache sufferers met the criteria for severe migraine disability determined by the MIDAS test. Participants completed a two-week baseline period in which they kept a daily headache diary through the Halo app. They then began a four-week intervention period. During this period they were instructed to complete ten minutes of relaxation training exercises provided by the app each day, as well as monitor headaches via the daily headache diary. Relaxation training exercises consisted of various breathing techniques, progressive muscle relaxation, and mindfulness. Headache frequency was tracked throughout the intervention period, and further assessments, such as an in-person interview and posttreatment MIDAS test, were completed at the end of the four-week intervention period. RESULTS Analysis of data showed that there were significant differences between baseline scores (Headache Frequency Average=11.47/mo, MIDAS average=25.4) and postintervention follow-up (Headache Frequency Average=6.63/mo, MIDAS average=11.7, Frequency P<.01, MIDAS P<.01). Postintervention interviews revealed that more than 90% of the participants felt that the Halo beta app was easy to use and provided a benefit to the user. More than 85% of participants enjoyed using a daily headache diary and felt it gave them greater insights into their condition. More than 90% of the patients felt that the relaxation training had helped reduce the frequency of their headaches or headache related disability. CONCLUSIONS We found that mindfulness and relaxation-based interventions administered through the Halo beta app was a feasible and acceptable treatment for people suffering from frequently recurring headaches and migraines or disability associated with headaches and migraines. The pilot demonstrated the potential feasibility and usability of a mobile health app in delivering behavioral therapy for headache and migraine as an adjunct or alternative to in-office behavioral therapy for headache and migraine.

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Devising and validating a headache diary in a series of patients with chronic daily headache from Colombia

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2012000100009 ◽

2012 ◽

Vol 70 (1) ◽

pp. 40-44 ◽

Cited By ~ 1

Author(s):

Gabriel F Torres ◽

Martha I. Otálvaro ◽

Juan C. Vargas ◽

Yulexi Castellanos ◽

Jeimy Xiomara García ◽

...

Keyword(s):

Chronic Daily Headache ◽

Group Identification ◽

Reliability And Validity ◽

Medical Interview ◽

Writing Group ◽

Headache Diary ◽

Valid Instrument ◽

Daily Headache ◽

Pain Analgesics ◽

Selection Of

OBJECTIVE: To devise and test the reliability and validity of a brief headache diary in a series of Colombian patients with chronic daily headache. METHODS: The study was designed in five stages: selection of domains (group of patients and experts); initial devising of the items (writing group); identification of non-understandable items (n=20); assessment of internal consistency (n=100); assessment of validity and assessment of sensitivity to change during seven consecutive days (n=25, 175 observations). RESULTS: Five domains were selected: headache presence, severity and length of pain, analgesics intake, and missing workdays. The headache diary is internally consistent (≈75% of rotated variance), correlates with the medical interview (Spearman's rho and Kendall's tau over 0.8 for each domain) and it has an adequate and stable sensitivity and specificity (82 to 96%). CONCLUSIONS: This headache diary is a reliable and valid instrument and represents the most important features affecting Colombian patients with chronic daily headache.

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Does the Antimigraine Action of Flunarizine Involve the Dopaminergic System? A Clinical-Neuroendocrinological Study

Cephalalgia ◽

10.1111/j.1468-2982.1999.1901027.x ◽

1999 ◽

Vol 19 (1) ◽

pp. 27-31 ◽

Cited By ~ 7

Author(s):

LM Cupini ◽

E Troisi ◽

F Placidi ◽

M Diomedi ◽

M Silvestrini ◽

...

Keyword(s):

Therapeutic Efficacy ◽

Therapeutic Response ◽

Dopaminergic System ◽

Dopamine Receptor Agonist ◽

System A ◽

Before And After ◽

Headache Diary ◽

Daily Headache ◽

Prolactin Response ◽

Late Follicular Phase

We have investigated the prolactin response to bromocriptine (BRC), a D2 dopamine receptor agonist in migrainous women before and after treatment with flunarizine. We evaluated whether this test was predictive of therapeutic efficacy of flunarizine treatment and whether the therapeutic response to flunarizine treatment was related to its effect on dopaminergic system at tuberoinfundibular level. Ten migrainous women underwent a BRC test in the late follicular phase before and after 1 and 3 months of treatment with flunarizine 10 mg at bedtime. Blood samples of prolactin (PRL), growth hormone, follicle-stimulating hormone, luteinizing hormone, estradiol and progesterone were taken at basal condition. PRL was also evaluated 1 and 2 h after BRC (2.5 mg) administration. Each patient kept a daily headache diary for 1 month prior to the test and throughout the study. The level of PRL inhibition after BRC administration, observed before flunarizine treatment, was not predictive of the therapeutic response observed after 1 and 3 months of treatment. The effect of flunarizine on PRL level was not related to the therapeutic efficacy of the drug. These data suggest that flunarizine does not attenuate the activity of dopaminergic neurons in migrainous patients, and that the antimigraine effect of flunarizine does not seem related to its action on dopaminergic system at least at tuberoinfundibular level.

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Effect of antibody switch in non-responders to a CGRP receptor antibody treatment in migraine: A multi-center retrospective cohort study

Cephalalgia ◽

10.1177/03331024211048765 ◽

2021 ◽

pp. 033310242110487

Author(s):

Lucas Hendrik Overeem ◽

Andreas Peikert ◽

Maxi Dana Hofacker ◽

Katharina Kamm ◽

Ruth Ruscheweyh ◽

...

Keyword(s):

Treatment Option ◽

Responder Rate ◽

Cgrp Receptor ◽

Antibody Treatment ◽

Acute Medication ◽

Headache Diary ◽

Secondary Endpoints ◽

Daily Headache ◽

Treatment Switch ◽

Stratified Analysis

Background Switching between antibody classes might be a treatment option in migraine patients who have not responded to one class of a CGRP-(receptor) monoclonal antibody (mAb), but there are no efficacy data so far. In this real-world analysis, we assessed the treatment response to a CGRP-mAb in patients that have previously failed the CGRP-receptor-mAb erenumab. Methods We analyzed retrospective headache diary data of 78 patients with migraine who switched between CGRP-mAbs classes at four German headache centers either due to lack of efficacy or intolerable side effects. Among these, we identified 25 patients who did not respond to erenumab after three treatment cycles (defined as <30% reduction of monthly headache days) and had complete headache documentation at least one month before and during both treatments. We assessed the ≥30% responder rate at month three after switching from erenumab to a CGRP-mAb (galcanezumab or fremanezumab) (primary endpoint). Secondary endpoints included ≥50% responder rate, monthly headache days, and monthly days with acute medication use. In an exploratory subgroup analysis patients were stratified for daily and non-daily headache. Results The switch from erenumab to a CGRP-mAb led to a ≥30% response in one-third (32%) of the patients after three treatment cycles. A ≥50% response was achieved in 12% of the patients. Monthly headache days were reduced in month three compared to baseline (20.8 ± 7.1 to 17.8 ± 9.1; p = 0.009). Stratified analysis revealed that no patient with daily headache (n = 9) responded to the treatment switch, while a 30% response was achieved by 50% of patients with non-daily headache (n = 16). Conclusion Our findings demonstrate that a relevant proportion of erenumab non-responders might benefit from a treatment switch to a CGRP-mAb. Switching seems to be a promising treatment option especially in migraine patients with non-daily headache.

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