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

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.

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

Scandinavian Journal of Pain ◽

10.1515/sjpain-2021-0050 ◽

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.

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Chronic migraine: Classification and comparisons

Cephalalgia ◽

10.1177/0333102410383590 ◽

2011 ◽

Vol 31 (5) ◽

pp. 520-529 ◽

Cited By ~ 54

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.

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Production of the English past tense by children with language comprehension impairments

Journal of Child Language ◽

10.1017/s0305000904006555 ◽

2005 ◽

Vol 32 (1) ◽

pp. 117-137 ◽

Cited By ~ 16

Author(s):

KATE NATION ◽

MARGARET J. SNOWLING ◽

PAULA CLARKE

Keyword(s):

Language Comprehension ◽

High Frequency ◽

Matched Control ◽

Low Frequency ◽

Past Tense ◽

Phonological Skills ◽

The Poor ◽

Poor Comprehenders ◽

Irregular Form ◽

Irregular Verbs

Three experiments investigated the ability of eight-year old children with poor language comprehension to produce past tense forms of verbs. Twenty children selected as poor comprehenders were compared to 20 age-matched control children. Although the poor comprehenders performed less well than controls on a range of tasks considered to tap verbal-semantic abilities, the two groups showed equivalent phonological skills. Poor comprehenders performed as well as control children when asked to inflect novel verbs and regular verbs. In contrast, poor comprehenders were less skilled than controls at inflecting both high frequency and low frequency irregular verbs. Although the predominant error pattern for all children was to over-regularize, this was most marked in the poor comprehenders; control children were more likely to produce errors that contained knowledge of the irregular form than poor comprehenders. In addition, the ability to inflect irregular verbs was related to individual differences in verbal-semantic skills. These findings are discussed within a framework in which verb inflection is related to underlying language skills in both the phonological and semantic domains.

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

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20190159 ◽

2020 ◽

Vol 78 (3) ◽

pp. 133-138 ◽

Cited By ~ 3

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.

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Factors Associated with the Poor Outcomes in Diabetic Patients with COVID-19

10.21203/rs.3.rs-34111/v1 ◽

2020 ◽

Author(s):

Hadith Rastad ◽

Hanieh-Sadat Ejtahed ◽

Armita Mahdavi Ghorabi ◽

Anis Safari ◽

Ehsan Shahrestanaki ◽

...

Keyword(s):

Mechanical Ventilation ◽

Hospital Mortality ◽

Creatinine Level ◽

Neutrophil Count ◽

Invasive Mechanical Ventilation ◽

Low Frequency ◽

Diabetic Patients ◽

Logistic Regression Models ◽

The Poor ◽

Poor Outcomes

Abstract Background: Diabetic’s patients are supposed to experience higher rates of COVID-19 related poor outcomes. We aimed to determined factors predicting poor outcomes in hospitalized diabetic patients with COVID-19. Methods: This retrospective cohort study included all adult diabetic patients with radiological or laboratory confirmed COVID-19 who hospitalized between 20 February 2020 and 27 April 2020 in Alborz province, Iran. Data on demographic, medical history, and laboratory test at presentation were obtained from electronic medical records. Diagnosis of diabetes mellitus was self-reported. Comorbidities including cancer, rheumatism, immunodeficiency, or chronic diseases of respiratory, liver, and blood were classified as “other comorbidities” due to low frequency. The assessed poor outcomes were in-hospital mortality, need to ICU care, and receiving invasive mechanical ventilation. Self-reported. Multivariate logistic regression models were fitted to quantify the predictors of in-hospital mortality from COVID-19 in patients with DM. Results: Of 455 included patients, 98(21.5%) received ICU care, 65(14.3%) required invasive mechanical ventilation, and 79 (17.4%) dead. In the multivariate model, significant predictors of “death of COVID-19” were age 65 years or older (OR (95% CI): 2.0 (1.16-3.44), chronic kidney disease (CKD) (2.05 (1.16 -3.62), presence of “other comorbidities” (2.20 (1.04-4.63)), neutrophil count ≥ 8.0 × 10⁹/L )6.62 (3.73-11.7 ((, Hb level <12.5 g/dl (2.05 (1.13-3.72)(, and creatinine level ≥1.36 mg/dl (3.10 (1.38-6.98)). (All p –values < 0.05). Some of these factors were also associated with other assessed poor outcomes, e.g., need to ICU care or invasive mechanical ventilation.Conclusions: Diabetic patients with age 65 years or older, comorbidity CKD, “other comorbidities”, as well as neutrophil count ≥ 8.0 × 10⁹/L, Hb level <12.5 g/dl, and creatinine level ≥1.36 mg/dl, were more likely to dead after COVID-19. Presence of hypertension and cardiovascular disease were associated with none of the poor outcomes.

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Factors associated with the poor outcomes in diabetic patients with COVID-19

10.21203/rs.3.rs-56358/v1 ◽

2020 ◽

Author(s):

Hadith Rastad ◽

Hanieh-Sadat Ejtahed ◽

Armita Mahdavi-Ghorabi ◽

Anis Safari ◽

Ehsan Shahrestanaki ◽

...

Keyword(s):

Mechanical Ventilation ◽

Hospital Mortality ◽

Creatinine Level ◽

Neutrophil Count ◽

Invasive Mechanical Ventilation ◽

Low Frequency ◽

Diabetic Patients ◽

Logistic Regression Models ◽

The Poor ◽

Poor Outcomes

Abstract Background Diabetic’s patients are supposed to experience higher rates of COVID-19 related poor outcomes. We aimed to determined factors predicting poor outcomes in hospitalized diabetic patients with COVID-19. Methods This retrospective cohort study included all adult diabetic patients with radiological or laboratory confirmed COVID-19 who hospitalized between 20 February 2020 and 27 April 2020 in Alborz province, Iran. Data on demographic, medical history, and laboratory test at presentation were obtained from electronic medical records. Diagnosis of diabetes mellitus was self-reported. Comorbidities including cancer, rheumatism, immunodeficiency, or chronic diseases of respiratory, liver, and blood were classified as “other comorbidities” due to low frequency. The assessed poor outcomes were in-hospital mortality, need to ICU care, and receiving invasive mechanical ventilation. Self-reported. Multivariate logistic regression models were fitted to quantify the predictors of in-hospital mortality from COVID-19 in patients with DM. Results Of 455 included patients, 98(21.5%) received ICU care, 65(14.3%) required invasive mechanical ventilation, and 79 (17.4%) dead. In the multivariate model, significant predictors of “death of COVID-19” were age 65 years or older (OR (95% CI): 2.0 (1.16–3.44), chronic kidney disease (CKD) (2.05 (1.16–3.62), presence of “other comorbidities” (2.20 (1.04–4.63)), neutrophil count ≥ 8.0 × 10⁹/L )6.62 (3.73–11.7 ((, Hb level < 12.5 g/dl (2.05 (1.13–3.72) (, and creatinine level ≥ 1.36 mg/dl (3.10 (1.38–6.98)). (All p –values < 0.05). Some of these factors were also associated with other assessed poor outcomes, e.g., need to ICU care or invasive mechanical ventilation. Conclusions Diabetic patients with age 65 years or older, comorbidity CKD, “other comorbidities”, as well as neutrophil count ≥ 8.0 × 10⁹/L, Hb level < 12.5 g/dl, and creatinine level ≥ 1.36 mg/dl, were more likely to dead after COVID-19. Presence of hypertension and cardiovascular disease were associated with none of the poor outcomes.

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

Cephalalgia ◽

10.1177/0333102419895777 ◽

2019 ◽

Vol 40 (4) ◽

pp. 407-410 ◽

Cited By ~ 4

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.

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

Neuromuscular Diseases ◽

10.17650/2222-8721-2018-8-4-35-42 ◽

2019 ◽

Vol 8 (4) ◽

pp. 35-42 ◽

Cited By ~ 1

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.

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Interictal Photophobia and Phonophobia Are Related to the Presence of Aura and High Frequency of Attacks in Patients with Migraine

Applied Sciences ◽

10.3390/app11062474 ◽

2021 ◽

Vol 11 (6) ◽

pp. 2474

Author(s):

Carina F. Pinheiro ◽

Jessica R. Moreira ◽

Gabriela F. Carvalho ◽

Leticia Zorzin ◽

Fabiola Dach ◽

...

Keyword(s):

Chronic Migraine ◽

Migraine With Aura ◽

High Frequency ◽

Migraine Without Aura ◽

Daily Life ◽

Likert Scale ◽

Daily Activities ◽

Social Situations ◽

Daily Life Activities ◽

Positive Correlations

Background: Despite that photophobia and phonophobia are well-known symptoms related to migraine, it is unclear whether they affect daily life activities during the headache-free period. Objective: To evaluate the interictal photophobia/phonophobia intensity during daily activities in migraineurs and non-headache individuals. Methods: Women with migraine without aura (MoA, n = 30), migraine with aura (MA, n = 30), chronic migraine (CM, n = 30) and without headache (CG, n = 30) reported the photophobia and phonophobia intensity during daily activities using a Likert scale ranging from 0 (no discomfort) to 10 (maximum discomfort). Results: The migraine groups reported higher intensity of interictal photophobia and phonophobia than CG during “driving” and “social situations”, respectively (p < 0.05). MA and CM groups presented higher intensity of phonophobia than CG, hearing sounds in everyday situations and listening to conversations in noisy places (p < 0.05). Also, the MA group presented higher interictal phonophobia than the CG to keep concentration in noisy places (p < 0.05). Weak positive correlations were observed between the intensity of both photophobia and phonophobia with migraine intensity, frequency of migraine and frequency of aura (p < 0.05). Conclusion: Interictally, the intensity of photophobia and phonophobia reported during daily activities is higher in patients with migraine, especially those with aura and chronic migraine, than in non-headache subjects.

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

10.21203/rs.3.rs-1175049/v1 ◽

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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