Exploring the Neuropsychiatric Sequalae of Perceived COVID-19 Exposure in College Students: A Pilot Digital Phenotyping Study

The urgency to understand the long-term neuropsychiatric sequala of COVID-19, a part of the Post-Acute COVID-19 Syndrome (PACS), is expanding as millions of infected individuals experience new unexplained symptoms related to mood, anxiety, insomnia, headache, pain, and more. Much research on PACS involves cross sectional surveys which limits ability to understand the dynamic trajectory of this emerging phenomenon. In this secondary analysis, we analyzed data from a 4-week observational digital phenotyping study using the mindLAMP app for 695 college students with elevated stress who specified if they were exposed to COVID-19. Students also completed a biweekly survey of clinical assessments to obtain active data. Additionally, passive data streams like GPS, accelerometer, and screen state were extracted from phone sensors and through features the group built. Three hundred and eighty-second number participants successfully specified their COVID-19 exposure and completed the biweekly survey. From active smartphone data, we found significantly higher scores for the Prodromal Questionnaire (PQ) and the Pittsburgh Sleep Quality Index (PSQI) for students reporting exposure to COVID-19 compared to those who were not (ps < 0.05). Additionally, we found significantly decreased sleep duration as captured from the smartphone via passive data for the COVID-19 exposed group (p < 0.05). No significant differences were detected for other surveys or passive sensors. Smartphones can capture both self-reported symptoms and behavioral changes related to PACS. Our results around changes in sleep highlight how digital phenotyping methods can be used in a scalable and accessible manner toward better capturing the evolving phenomena of PACS. The present study further provides a foundation for future research to implement improving digital phenotyping methods.

Pain Following Endoscopic Foreheadplasty Surgery in Women

Background Endoscopic foreheadplasty surgery (EFS) is a common procedure, however little evidence exists describing the nature or treatment of postoperative headache pain and associated symptoms. Objectives Our objective was to describe the intensity, quality, location, and duration of headache pain in women following EFS. We also compared post EFS symptoms with migraine, described medication use and efficacy, and measured emotional and functional outcomes. Methods This descriptive study used an observational repeated measures design. Forty-two women (age mean±std=59.0±7.9 years) undergoing EFS were prospectively recruited from twelve private cosmetic practices in three California counties. Phone interviews with the Acute Short-Form 12v2, and Headache Questionnaires were conducted on postoperative days (POD) 1, 3, 7, and 30. Results At POD#1, 93% reported at least moderate pain and 64% severe pain. Severe pain was characterized as throbbing (71%), sharp (53%), dull (76%), exploding (41%), imploding (53%), continuous (53%) or intermittent (41%) on POD#1. Moderate pain was most frequent on POD#3 (21%) compared to POD#1 (19%), POD#7 and #30 (12%). Mild pain predominated on POD#3 (40%) and POD#7 (40%), with (20%) remaining on POD#30. The majority (79%) of post EFS symptoms commonly included light sensitivity and nausea, and therefore met most International Classification of Headache Disorders criteria for migraine. Analgesic use provided inconsistent relief. Functional and emotional status did not return to baseline throughout the 30-day postoperative period. Conclusions Immediately following EFS, most women experience moderate to severe headache pain, despite use of medications. Pain persists in many patients for up to a month. Headache is associated with migraine symptoms, including light sensitivity and nausea.

Associations of Physical Function and Physical Activity With COVID-19-Like Symptoms

Physical function and physical activity have been associated with health outcomes related to the cardiopulmonary and immune systems, but the extent to which they are related to the risk of developing COVID-19-like symptoms remains unclear. We aimed to explore these associations among Swedish older adults. We analyzed data from 904 individuals aged ≥68 years from the population-based Swedish National study on Aging and Care in Kungsholmen. COVID-19-like symptoms were assessed by phone interview (March-June 2020) and included fever, cough, sore throat and/or a cold, headache, pain in muscles, legs and joints, loss of taste and/or odour, breathing difficulties, chest pain, gastrointestinal symptoms and eye inflammation. Muscle strength, mobility, and physical activity were objectively examined in 2016-2018. Data were analyzed using logistic regression models and stratifying by age. During the first outbreak of the pandemic, 325 (36%) individuals from our sample developed COVID-19-like symptoms. Those with longer time to perform the chair stand test had an odds ratio (OR) of 1.5 (95% confidence interval [CI] 1.1-2.1) for presenting with COVID-19-like symptoms compared to those with a faster time to perform the test, after adjusting for potential confounders. The risk was even higher among people aged ≥80 years (OR: 2.6; 95% CI 1.5-4.7). No significant associations were found for walking speed or moderate-to-vigorous physical activity. A weaker muscle strength, especially among the oldest-old adults, may contribute to higher odds of developing COVID-19-like symptoms, emphasizing the need to maintain sufficient levels of muscle strength in old age.

Decreasing Headache Pain Secondary to a Subarachnoid Hemorrhage with the use of Osteopathic Manipulative Medicine

Background: Controlling a headache (HA) secondary to a subarachnoid hemorrhage (SAH) can be challenging for most physicians. At Maine Medical Center in Portland, Maine, the neurointensivist and staff noticed a trend in decreasing HA pain caused by a SAH in patients treated with osteopathic cranial manipulative medicine and osteopathic manipulative medicine (OMM), more so than those treated solely with the traditional opioid approach. It was requested that a chart review of these patients be evaluated for an objective analysis of this observation. Hypothesis: A decrease in HA caused by SAH will be observed in the group treated with OMM in comparison to those treated with opioids alone. Methods and Materials: A retrospective, IRB approved, and exempted study reviewed 21 subjects with a SAH that were treated with OMM. This population was analyzed for a decrease in pain score following osteopathic treatment as well as for adverse events 6-month post treatment. Results: Pain scores were consistently reduced when comparing pre-and-post OMM treatment. After the first treatment, pain scores decreased by an average of 4 points, after the second treatment scores decreased by an average of 3 points and after the third treatment pain scores decreased by an average of 2.5 points. The number of adverse events recorded were found to be less than the national averages. Conclusion: The use of OMM as an adjunct with traditional treatments for a SAH can lead to a decrease in HA pain caused by a SAH. Minimal adverse events were observed.

Effects of Acute and Chronic Stretching on Pain Control

ABSTRACT While muscle stretching has been commonly used to alleviate pain, reports of its effectiveness are conflicting. The objective of this review is to investigate the acute and chronic effects of stretching on pain, including delayed onset muscle soreness. The few studies implementing acute stretching protocols have reported small to large magnitude decreases in quadriceps and anterior knee pain as well as reductions in headache pain. Chronic stretching programs have demonstrated more consistent reductions in pain from a wide variety of joints and muscles, which has been ascribed to an increased sensory (pain) tolerance. Other mechanisms underlying acute and chronic pain reduction have been proposed to be related to gate control theory, diffuse noxious inhibitory control, myofascial meridians, and reflex-induced increases in parasympathetic nervous activity. By contrast, the acute effects of stretching on delayed onset muscle soreness are conflicting. Reports of stretch-induced reductions in delayed onset muscle soreness may be attributed to increased pain tolerance or alterations in the muscle's parallel elastic component or extracellular matrix properties providing protection against tissue damage. Further research evaluating the effect of various stretching protocols on different pain modalities is needed to clarify conflicts within the literature.

Napping behavior in adults with episodic migraine: a six-week prospective cohort study

Study objectives Patients with migraine commonly endorse napping as a strategy for headache pain relief, but also experience high rates of sleep disturbance. To elucidate the relationship between napping behavior and migraine, we evaluated the association between napping and headache frequency, severity, and intensity among adults with episodic migraine. We also examined the association between daily napping and that night’s sleep. Methods In this six-week prospective cohort study, 97 adults with episodic migraine completed twice-daily headache and sleep electronic diaries and wore a wrist actigraph. We modeled the associations between napping (yes/no) and headaches with conditional logistic regression and daily napping and nighttime sleep with linear regression. Results Over 4,353 study days, participants reported 1,059 headache days and 389 days with naps. More than 80% of participants napped during the study, with mean nap duration of 76.7±62.4 minutes. Naps were more likely to occur on day 2 of headache 35/242 (14.5%) than on non-headache days 279/3294 (8.5%, OR 2.2 [95%CI 1.4,3.4]). Mean nap onset time (14:40h ± 3.3h) was later than headache onset (12:48h ± 5.3h). In adjusted models, napping was associated with an additional 1.1 (95%CI -1.4, 3.6) headache days/month. Naps were not associated with worse self-reported or objective sleep that night. Conclusions Our findings suggest that naps may be an uncommonly used behavioral strategy for prolonged migraine attacks and do not contribute to nightly sleep disturbance. Future studies are needed to examine the acute analgesic effects of daytime napping in patients with migraine.

P.027 Efficacy and Safety of Eptinezumab Initiated During a Migraine Attack: Results from the RELIEF Study

Background: Eptinezumab is approved for migraine prevention, with demonstrated rapid onset of preventive benefit. RELIEF evaluated the efficacy and safety of eptinezumab initiated during a migraine attack. Methods: RELIEF (NCT04152083; parallel-group, double-blind, placebo-controlled) randomized adults with migraine (4-15d/mo in 3mo prior to screening) to eptinezumab 100mg or placebo, administered IV within 1-6h of qualifying migraine onset. Co-primary efficacy endpoints were time to headache pain freedom and time to absence of most bothersome symptom (MBS). Results: Eptinezumab (n=238) compared with placebo (n=242) achieved significantly faster headache pain freedom (median 4h vs 9h; hazard ratio=1.54, P=0.0006) and absence of MBS (2h vs 3h; 1.75, P<0.0001). At 2h, 23.5% and 12.0% (P=0.0009) of eptinezumab-treated and placebo patients, respectively, reported headache pain freedom, and 55.5% and 35.8% (P<0.0001) reported absence of MBS. Significantly fewer eptinezumab-treated patients used rescue medication within 24h (31.5% vs 59.9%; P<0.0001). Treatment-emergent adverse events occurred in 10.9% eptinezumab-treated and 10.3% placebo patients; no serious adverse events occurred. Conclusions: Infusion of the preventive migraine treatment, eptinezumab, during a migraine resulted in rapid and sustained freedom from headache pain and MBS vs placebo, starting 2h post-infusion, decreasing need for acute medication within 24h post-infusion. No notable safety findings were identified.

Sodium Chloride, Migraine and Salt Withdrawal: Controversy and Insights

This paper examines evidence implicating migraine headache as a withdrawal symptom of excessive sodium chloride intake. Emerging research in food addiction posits that food and drug addictions share common features, such as withdrawal symptoms. Salt (sodium chloride) meets the criteria for the diagnosis of substance dependence, including withdrawal in which the substance is used to relieve withdrawal symptoms. The premonitory symptoms of migraine include food cravings for salty foods, which can alleviate migraine pain. Edema, possibly related to large amounts of salt consumed in binge eating, can cause approximately four pounds of retained fluid. This amount of fluid is similar to the fluid retained before the onset of migraine headache, which may be accompanied by polyuria. This paper proposes that inhibited withdrawal from highly processed food intake, rich in salt, mediates an association between increased sodium chloride intake and relief from migraine headache pain. The relief from withdrawal symptoms could also be a mediating factor that explains the controversial findings inversely associating dietary sodium intake with migraine history. Moreover, the withdrawal of retained sodium and edema related to the use of nonsteroidal anti-inflammatory drugs may elucidate a potential mechanism in medication overuse headache. Further research is needed to investigate the pain experienced from sodium chloride withdrawal in migraine headache.