Chronic migraine: Classification and comparisons

Cephalalgia ◽  
2011 ◽  
Vol 31 (5) ◽  
pp. 520-529 ◽  
Author(s):  
Z Katsarava ◽  
A Manack ◽  
M-S Yoon ◽  
M Obermann ◽  
H Becker ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Chronic Migraine ◽  
High Frequency ◽  
Low Frequency ◽  
Epidemiological Data ◽  
Field Testing ◽  
Episodic Migraine ◽  
Case Definition ◽  
Descriptive Statistics ◽  
Chi Square

Objective: The objective of our study was to field test different chronic migraine (CM) criteria and compare CM epidemiological profiles, which include demographic, personal, and lifestyle characteristics, with high-frequency episodic migraine (HFEM) and low-frequency episodic migraine (LFEM). Methods: Questionnaires were mailed to a random sample of 18,000 18–65-year-olds in demographically diverse regions of Germany. The epidemiological data for the three classifications of CM, LFEM and HFEM were assessed using descriptive statistics, Pearson Chi-square, and analysis of variance tests. Results: Among 9350 respondents, CM_I was the most restrictive ( N = 37, 0.4%), followed by CM_II ( N = 45, 0.5%) and CM_III ( N = 185, 2.0%). CM groups did not differ in distribution by age, gender, body mass index, education or smoking and alcohol consumption. Compared to those with LFEM and HFEM, those with CM (CM_III) had significantly different epidemiological profiles. Conclusions: CM prevalence varies by case definition. The epidemiological profiles of the three CM groups are similar but differ significantly from those of HFEM and LFEM. Optimal definitions for clinical practice and epidemiological research require additional field testing.

When does chronic migraine strike? A clinical comparison of migraine according to the headache days suffered per month

Cephalalgia ◽  
2016 ◽  
Vol 37 (2) ◽  
pp. 104-113 ◽  
Author(s):  
M Torres-Ferrús ◽  
M Quintana ◽  
J Fernandez-Morales ◽  
J Alvarez-Sabin ◽  
P Pozo-Rosich
Keyword(s):  
Chronic Migraine ◽  
High Frequency ◽  
Daily Life ◽  
Low Frequency ◽  
Episodic Migraine ◽  
Predictive Capacity ◽  
The Poor ◽  
Clinical Comparison ◽  
Current Classification ◽  
Poor Outcomes

Introduction According to the IHCD-3β classification, chronic migraine (CM) is headache occurring on 15 or more days/month. Episodic migraine (EM) can be divided into low frequency (LFEM) and high frequency (HFEM) depending on the headache days suffered per month. Methods We performed a clinical comparison of migraine characteristics according to monthly headache days suffered. Patients were divided into three groups: LFEM (1–9 headache days/month), HFEM (10–14 headache days/month) and CM (≥15 headache days/month). Results The analysis included 1109 patients. Previously reported differences between EM and CM were replicated. However, there were three times more clinical differences between LFEM and HFEM than between HFEM and CM (15 vs. 6). A new model that takes 10 headache days as a cut-off value for CM would have a minimally higher predictive capacity (72.8%) and no statistical differences (71.8%) when comparing it to the current classification. Conclusions HFEM patients have few clinical differences compared with CM patients. This includes the poor outcomes regarding headache-related disability and impact on daily life. According to these findings, neurologists and headache specialists should consider that the emotional and functional impact in HFEM patients could be as disabling as in those with CM.

Disability, burden, and symptoms related to sensitization in migraine patients associate with headache frequency

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Stefano Di Antonio ◽  
Matteo Castaldo ◽  
Marta Ponzano ◽  
Francesca Bovis ◽  
Paola Torelli ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Migraine ◽  
High Frequency ◽  
Low Frequency ◽  
Episodic Migraine ◽  
Headache Frequency ◽  
Headache Attack ◽  
Burden Of Headache ◽  
The Difference

Abstract Objectives This observational study aimed to assess the difference in disability, burden, and sensitization between migraine patients with low-frequency headache attack (1–8 headache days/month), high-frequency headache attack (9–14 headache days/months), and patients with chronic migraine (>14 headache days/months). Methods Migraine patients with or without aura were divided into three groups according to headache frequency (low-frequency episodic migraine; high-frequency episodic migraine; chronic migraine). Questionnaires were used to assess the burden of headache, quality of life, phycological burden, and symptoms related to sensitization (estimated by the Central Sensitization Inventory). Differences among migraine groups were assessed using Chi-Quadro test, ANOVA, or Kruskal–Wallis as appropriate. Results 136 patients were included (68 low-frequency episodic migraine, 45 high-frequency episodic migraine, 23 chronic migraine). Patients with high frequency episodic migraine and chronic migraine differed from patients with low frequency episodic migraine showing a worse burden of headache (p=0.002; p=0.002), worse level of physical (p=0.001; p<0.001) and mental (p=0.002; p=0.001) quality of life, worse level of depression (p=0.008; p=0.003), and increase presence of symptoms related to sensitization (p<0.001; p=0.003). No differences were found in any variables between patients with high-frequency episodic migraine and patients with chronic migraine (p>0.05). Conclusions Patients with high-frequency episodic migraine and chronic migraine could be considered in the same segment of the migraine population, with similar degrees of disability and sensitization related symptoms.

scholarly journals 82 Struggle behavior and vocalizations of male piglets during castration

2020 ◽  
Vol 98 (Supplement_3) ◽  
pp. 3-4
Author(s):  
Maria E Lou ◽  
Yuzhi Li ◽  
Beth Ventura
Keyword(s):  
Birth Weight ◽  
Acute Pain ◽  
High Frequency ◽  
Video Recording ◽  
Low Frequency ◽  
Peak Frequency ◽  
Analysis Software ◽  
Chi Square ◽  
Behavioral Indicators ◽  
Treatment Groups

Abstract Castration without the use of analgesia is routinely performed on male piglets. The objective of this study was to assess acute pain during castration through behavioral indicators. Piglets (n=88) were randomly allocated to one of two treatments: castration without the use of analgesia (C) and sham-castration (S). Within 24 hours after birth (birth weight = 1.78kg ±0.71), identical procedures were followed for both treatment groups, except sham piglets were not castrated. Struggle behavior (curl ups, leg kicks, and body flailing) and vocalizations were collected via continuous video recording as piglets received treatment from start (first application of scalpel) to end (application of iodine). Vocalization parameters (duration and peak frequency) were analyzed using the Raven Pro: Interactive Sound Analysis Software (Version 1.5). Peak frequency was defined as low (&lt; 1000 Hz) and high (≥ 1000 Hz). Data were analyzed using the Glimmix Procedure of SAS. For struggle behavior, treatment did not affect curl up frequency. However, castrated piglets kicked more frequently than did sham piglets (C=28.8±0.9 vs. S=21.3±0.9 kicks/min; P=0.02). Additionally, 52% of castrated piglets displayed body flailing, whereas only 4.4% of sham piglets displayed the same behavior (Chi-Square = 24.2; P &lt; 0.0001). For vocalizations, no difference was found for duration and peak frequency of low frequency calls. However, castrated piglets responded with more high frequency calls than sham piglets (C=23.6±0.3 vs. S=18.6±0.3 calls/min; P=0.04). High frequency calls tended to be of longer duration for castrated piglets (C=0.45±0.04 vs. S=0.27±0.04 sec/call; P=0.08). Results indicate that castration without the use of analgesia increased the frequency of leg kicks, body failing, and high frequency calls. This suggests that leg kicks, body flailing, and high frequency calls maybe useful behavioral indicators of acute pain in piglets.

scholarly journals Cognitive impairment in chronic migraine: a cross-sectional study in a clinic-based sample

2020 ◽  
Vol 78 (3) ◽  
pp. 133-138 ◽  
Author(s):  
Nina LATYSHEVA ◽  
Elena FILATOVA ◽  
Diana OSIPOVA ◽  
Alexey B. DANILOV
Keyword(s):  
Cognitive Impairment ◽  
Chronic Migraine ◽  
Verbal Learning ◽  
Depression Scale ◽  
Low Frequency ◽  
Preventive Treatment ◽  
Episodic Migraine ◽  
Cross Sectional Study ◽  
Digit Symbol Substitution Test ◽  
Cross Sectional

Abstract Cognitive impairment has been described in all phases of a migraine attack and interictally. However, the prevalence and phenotype of such impairment in chronic migraine (CM) have not yet been studied. Objectives: The aim of this study was to evaluate both the prevalence of the objective cognitive deficit in patients with CM and the factors underlying its etiology. Methods: 144 patients with CM and 44 age-matched patients with low-frequency episodic migraine (EM) (a maximum of 4 headache days per month) participated in this study. Neuropsychiatric characteristics were measured with the HADS Hospital Anxiety and Depression Scale. Cognitive function was assessed with the Montreal Cognitive Assessment (MoCA), Digit Symbol Substitution Test (DSST), Rey Auditory Verbal Learning Test (RAVLT), and the Perceived Deficits Questionnaire (PDQ-20). Results: Compared to EM, CM subjects demonstrated higher subjective and objective cognitive impairment across all tests. CM patients had 4 times higher odds of achieving a RAVLT score in the lower quartile range compared to EM (Odds Ratio [OR] 3.8; 95% confidence interval [95%CI] 1.5‒9.6; р=0.005). In the MoCA, CM patients demonstrated the most striking impairment in memory/delayed recall (65.3%), attention (46.5%), abstraction (30.6%), and language (27.1%). Chronic headache and level of education, but not gender, depression or anxiety, were independent predictors of cognitive impairment. Conclusions: Cognitive impairment is prevalent in the CM population during their mildest possible pain and may be caused by a central sensitization. Timely preventive treatment of EM is warranted.

The clinical and public health implications and risks of widening the definition of chronic migraine

Cephalalgia ◽  
2019 ◽  
Vol 40 (4) ◽  
pp. 407-410 ◽  
Author(s):  
Martina Guglielmetti ◽  
Alberto Raggi ◽  
Raffaele Ornello ◽  
Simona Sacco ◽  
Domenico D’Amico ◽  
...  
Keyword(s):  
Public Health ◽  
Chronic Migraine ◽  
High Frequency ◽  
Episodic Migraine ◽  
Headache Frequency ◽  
Allocation Of Resources ◽  
Independent Entity ◽  
Definition Of ◽  
The Impact

Background The definition of chronic migraine has long been debated. Recently, it was suggested to define subjects with at least 8/migraine days as chronic migraine; that is, incorporating so-called high frequency episodic migraine (eight or more migraine days but less than 15 headache days per month). Methods We addressed the possible problems that might arise based on this proposal accounting for clinical, pathophysiological, impact and public health aspects. Results and conclusions Defining chronic migraine on the basis of headache frequency alone does not account for clinical and pathophysiological aspects, as well as for the impact of chronic migraine in terms of disability and quality of life. Moreover, it is potentially harmful for patients in terms of allocation of resources. These issues are discussed in the present manuscript, and we support the idea of defining high frequency episodic migraine as an independent entity as a viable path to follow.

scholarly journals Depression is not the only cause of cognitive impairment in chronic migraine

2019 ◽  
Vol 8 (4) ◽  
pp. 35-42 ◽  
Author(s):  
N. V. Latysheva ◽  
E. G. Filatova ◽  
D. V. Osipova
Keyword(s):  
Cognitive Impairment ◽  
Chronic Migraine ◽  
Verbal Learning ◽  
Memory Loss ◽  
Depression Scale ◽  
Low Frequency ◽  
Episodic Migraine ◽  
Memory And Attention ◽  
Symbol Substitution ◽  
Learning Test

Background. Patients with the chronic migraine frequently present with memory and attention complaints. However, the prevalence and phenotype of such impairment in chronic migraine have not been studied.Objective – to evaluate the prevalence of the objective cognitive deficit in patients with chronic migraine and factors underlying its etiology. Materials and methods. We recruited 62 subjects with chronic migraine and 36 genderand age-matched controls with low-frequency episodic migraine (not more, then 4 headache days per month) aged 18–59. All patients filled in the Hospital Anxiety and Depression Scale (HADS) and Sheehan Disability Scale. Cognitive function was assessed with the Montreal Cognitive Assessment (MoCA), Digital Symbol Substitution Test (DSST), Rey Auditory Verbal Learning Test (RAVLT), and the Perceived Deficits Questionnaire (PDQ-20).Results. In this study 58 % of patients with chronic migraine complained of memory loss. Cognitive impairment was also found with PDQ-20. Objectively, we found a significant decrease in 90-second DSST results and RAVLT total recall and learning rate. In 40 % of subjects with chronic migraine scored lower than 26 points on MoCA. Patients with chronic migraine more frequently had lower DSST rates as compared to episodic migraine (odds ratio 5.07 (95 % confidence interval – 1.59–16.17); p = 0.003). Depression and anxiety did not correlate with performance on cognitive tests. Chronic migraine (frequent headache) and longer headache history, but not depression, anxiety or medication overuse were independent predictors of cognitive impairment.Conclusion. Subjective and objective cognitive deficits are prevalent in the chronic migraine population. Most often memory and attention are impaired. Longer headache history and presence of chronic migraine are independent risk factors for cognitive impairment in patients with chronic migraine.

Field Testing Alternative Criteria for Chronic Migraine

Cephalalgia ◽  
2006 ◽  
Vol 26 (4) ◽  
pp. 477-482 ◽  
Author(s):  
ME Bigal ◽  
SJ Tepper ◽  
FD Sheftell ◽  
AM Rapoport ◽  
RB Lipton
Keyword(s):  
Chronic Migraine ◽  
Chronic Daily Headache ◽  
Medication Overuse ◽  
Field Testing ◽  
Episodic Migraine ◽  
Headache Disorders ◽  
Transformed Migraine ◽  
Daily Headache ◽  
Probable Migraine

The criteria for chronic migraine (CM), as proposed by the Second Edition of the International Classification of Headache Disorders (ICHD-2) is very restrictive, excluding most patients that evolve from episodic migraine. In this study we empirically tested three recent proposals for revised criteria for CM. We included individuals with transformed migraine (TM) with or without medication overuse, according to the criteria proposed by Silberstein and Lipton. All individuals had headache calendars for at least three consecutive months. We assessed the proportion of subjects that fulfilled ICHD-2 criteria for CM or probable chronic migraine with probable medication overuse (CM+). We also tested three proposals for making the CM criteria more inclusive. In proposal 1, CM/CM+ would require at least 15 days of migraine or probable migraine per month. Proposal 2 suggests that CM/CM+ would be classified in those with ≥15 days of headache per month, where at least 50% of these days are migraine or probable migraine. Proposal 3 suggests that CM/CM+ would be classified in those with chronic daily headache and at least 8 days of migraine or probable migraine per month. Among TM sufferers, 399 (62.5%) had TM with medication overuse, and just 10.2% were classified as CM+ 158 (37.5%) had TM without medication overuse; just nine (5.6%) met current ICHD-2 criteria for CM. Using the alternative criteria, proposal 1 included 48.7% of patients with TM without medication overuse; proposal 2 captured 88%, and proposal 3 classified 94.9% of these patients. For TM with medication overuse, the proportions for proposals 1-3 were, respectively, 37%, 81% and 91%. The differences were statistically significant, favouring proposal 3. Consistently, criteria for CM and CM+ should be revised to require at least 8 days of migraine or probable migraine per month, in individuals with 15 or more days of headache per month.

scholarly journals Investigating interpersonal metadiscourse markers in English M.A. theses: The case of transition markers

2019 ◽  
Vol 9 (4) ◽  
pp. 184-192
Author(s):  
Hosna Rasooyar ◽  
Esmail Hosseini
Keyword(s):  
High Frequency ◽  
Low Frequency ◽  
English Teachers ◽  
Cutting Edge ◽  
Corpus Analysis ◽  
Chi Square ◽  
Chi Square Test ◽  
Iranian Students ◽  
Interpersonal Model ◽  
Type Of Transition

This study aimed to know which types of transition markers (i.e., and, since, hence, in addition and then) were more frequently used in English M.A theses. To do this study, the researcher collected 30 English M.A theses which were written by Iranian students from Azad University of Kermanshah. Hyland’s (2005) interpersonal model of metadiscourse was used in this study. Identifying each type of transition markers was used more, the teacher analysed the so-called texts by utilising one of the Cutting-Edge softwares. Next, the frequency of transition markers was calculated by AntConc, one of the simplest and easiest corpus analysis toolkits. The outcome of the study was revealed that 6924 transition markers were found. The transition marker of ‘and’ was the most frequent and the transition marker of ‘hence’ was the least frequent. Furthermore, the results of Chi-square test indicated that transition markers were not equally used in English M.A theses. The implication of the study suggests that using concordance software can make English teachers aware of high-frequency and low-frequency vocabularies. Keywords: AntConc software, metadiscourse, transition markers

scholarly journals Fremanezumab in the Prevention of High-Frequency Episodic and Chronic Migraine: A 12-Week, Multicenter, Real-Life, Cohort Study (The FRIEND Study).

2021 ◽  
Author(s):  
Piero Barbanti ◽  
Gabriella Egeo ◽  
Cinzia Aurilia ◽  
Florindo d'Onofrio ◽  
Maria Albanese ◽  
...  
Keyword(s):  
Chronic Migraine ◽  
High Frequency ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Real Life ◽  
Drug Effects ◽  
Episodic Migraine ◽  
Primary Study ◽  
Life Study ◽  
Younger Age

Abstract Background Fremanezumab has demonstrated to be effective, safe, and tolerated in the prevention of episodic or chronic migraine (CM) in randomized, placebo-controlled trials (RCTs). Real-life studies are needed to explore drug effects in unselected patients in routine circumstances and to provide higher generalizability results. This study explores the effectiveness, safety, and tolerability of fremanezumab in a real-life population of individuals affected by high-frequency episodic (HFEM: 8-14 days/month) or CM. Methods This is a 12-week multicenter, prospective, cohort, real-life study. We considered all consecutive patients affected by HFEM or CM visited at 9 Italian headache centers from 28/07/2020 to 11/11/2020. Eligible patients were given subcutaneous fremanezumab at the doses of 225 mg monthly or 675 mg quarterly, according to their preference. Primary study endpoints were the change in monthly migraine days (MMDs) in HFEM and monthly headache days (MHDs) in CM patients at weeks 9-12 compared to baseline. Secondary endpoints encompassed variation in monthly analgesic intake (MAI), Numerical Rating Scale (NRS), HIT-6 and MIDAS scores, and ≥50%, ≥75% and 100% responder rates at the same time intervals. Results 67 migraine patients had received ≥1 subcutaneous fremanezumab dose and were considered for safety analysis, while 53 patients completed 12 weeks of treatment and were included also in the effectiveness analysis. Fremanezumab was effective in both HFEM and CM, inducing at week 12 a significant reduction in MMDs (-4.6, p<0.05), MHDs (-9.4, p<0.001), MAI (-5.7, p<0.05; -11.1, p<0.001), NRS (-3.1, p<0.001; -2.5, p<0.001), and MIDAS scores (-58.3, p<0.05; -43.7; p<0.001). HIT-6 was significantly reduced only in HFEM patients (-18.1, p<0.001). Remission from CM to episodic migraine and from MO to no-MO occurred in 75% and 67.7% of the patients. The ≥50%, ≥75% and 100% responder rates at week 12 were 76.5%, 29.4% and 9.9% in HFEM and 58.3%, 25% and 0% in CM. Younger age emerged as a positive response predictor (OR=0.91; 95% CI 0.85-0.98, p=0.013). Treatment-emergent adverse events were uncommon (5.7%) and mild. No patient discontinued fremanezumab for any reason. Conclusions Fremanezumab seems more effective in real-life than in RCTs. Younger age emerges as a potential response predictor.

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