Minimal important change and responsiveness of the Migraine Disability Assessment Score (MIDAS) questionnaire

Background The MIDAS is the most used questionnaire to evaluate migraine-related disability, but its utility to assess treatment response remains unclear. Our aim was to estimate the MIDAS’ minimal important change (MIC) value and its responsiveness. Methods A total of 103 patients were enrolled in a non-pharmacological, preference-based clinical trial. MIDAS and global rating of self-perceived change (GRoC) scores were collected at baseline, after 5 weeks of treatment, 4-weeks and 3-months follow-up after treatment. Anchor-based approaches were used to establish MIC values and responsiveness. Findings In all 3 timepoint comparisons, MIDAS presented a MIC of 4.5 points. A moderate positive correlation was identified between the MIDAS change and GRoC scores. The area under the curve ranged from 0.63 to 0.68. Conclusions This study showed that MIDAS has a limited responsiveness to change. A change of 4.5 points or more represents a clinically important change for patients with high frequent migraine and chronic migraine receiving non-pharmacological treatment.

Real-Life Analysis with Erenumab: First Target Therapy in the Episodic and Chronic Migraine’s Prophylaxis

Background: to research retrospectively the efficacy of Erenumab’s treatment, thus allowing to describe a summary more in line with the reality observed every day in clinical practice, relative to a sample of patients widely heterogeneous. The study aims to confirm the efficacy of Erenumab, in terms of reduction of migraine days per month, from baseline to month 12 of treatment. Additional objectives included a reduction in the number of days of symptomatic drug use and change from baseline in the Migraine Disability Assessment Score Questionnaire (MIDAS); Methods: the analysis included all patients treated for 12 months with Erenumab during the year 2019–2020. The population analyzed consists of twenty-six patients from the Neurology outpatient clinic in Fossombrone. Several quantitative and qualitative variables were recorded by reading the medical records of the patients. The MIDAS was administered to patients to assess the disability related to migraine; Results: at the end of treatment, a statistically significant reduction in the mean number of monthly migraine days, acute medication use per month, and MIDAS questionnaire score was observed; Conclusions: as a preventive treatment of episodic and chronic migraine, our analysis data confirm the efficacy of Erenumab for the prevention of the migraine. The success is achieved in 96% of cases.

Microsurgical decompression of the supraorbital nerve in the treatment of chronic neuropathic pain in the frontal-temporal area

Chronic headache is common. One of the causes of frontal-temporal pain may be compression of sensory nerves from the trigeminal nerve system, for example, the supraorbital nerve. Our study involved 12 women with symptoms of supraorbital nerve neuralgia resistant to drug correction. He underwent microsurgical decompression of the supraorbital nerve. The results of the operation were assessed by the change in the level of neuropathic pain using the PainDetect questionnaire and the degree of psychosocial maladjustment of the patient according to the MIDAS questionnaire, before and after the operation. The data obtained indicate a significant decrease in the level of neuropathic pain in patients 1 month after surgery and a significant minimization of the effect of headache on the quality of life in patients 3 months after surgery. Two out of 12 women did not notice any improvement, which required repeated delayed revision and extended proximal decompression of the supraorbital nerve with dissection of m. corrugator supercilii fibers. After the myotomy, pain regression was achieved and the patients noted that they were satisfied with the result.

Transcranial DC Stimulation in Patients with Migraine: a study protocol for a randomized clinical trial

BackgroundChronic migraine is a disease with a difficult diagnosis and an as yet undefined pathophysiology. Its symptoms affect the quality of life and the daily activities of the individual, leading to momentary disability. This study is a controlled clinical trial of a randomized parallel group that will select patients aged between 18–65 years who are diagnosed with chronic migraine.Methods / DesignThis study will be held at the Aging Studies Laboratory and Neuroscience of the Federal University of Paraíba, where twelve sessions of transcranial direct current stimulation (tDCS) and associated with mindfulness practices will be applied over four weeks (one per week). Muse, a portable electroencephalogram (EEG), will be used to measure brain wave biomarkers before and after the intervention. We will use, at the beginning and end of treatment and one month after the completion of any intervention, the score on the Migraine Disability Assessment (MIDAS) questionnaire as the primary outcome and the scores on the HIT-6 (Headache Impact Test) questionnaire and on the Five Facet Mindfulness Questionnaire (FFMQ-BR) as the secondary outcomes.DiscussionBased on the use of tDCS in patients with chronic pain, and in benefits of Mindfulness practice in these patients, the objective is to evaluate if the mindfulness-associated tD provides satisfactory results in the painful prophylaxis of patients with chronic migraine.Trial registrationClinicaltrials.gov, NCT04219345. Registered 16 September 2019. Retrospectively registered.

Headache Before and After Endoscopic Transsphenoidal Pituitary Tumor Surgery: A Prospective Study

Objective Headache is a common symptom among patients with pituitary tumors, as it is in the general population. The aim of the study was to investigate headache as a symptom in patients with pituitary tumors before and 6 months after endoscopic transsphenoidal surgery (TSS). Design This is a prospective observational cohort study. Setting This study was conducted at university tertiary referral hospital. Participants A total of 110 adult patients underwent endoscopic TSS for pituitary tumors. Main Outcome Measures The Migraine Disability Assessment (MIDAS) questionnaire was used before and 6 months after surgery for the assessment of headache. Clinical variables with potential influence on headache were analyzed. Results Sixty-eight (62%) patients experienced headaches at least once during the 3 months before surgery. Thirty (27%) patients reported disabling headache before surgery, with younger age being an independent associated factor (p < 0.001). In patients with disabling headache before surgery, the median (interquartile range) MIDAS score improved from 78 (27–168) to 16 (2–145; p = 0.049), headache frequency decreased from 45 (20–81) to 14 (4–35) days (p = 0.009), and headache intensity decreased from 6 (5–8) to 5 (4–7) (p = 0.011) after surgery. In total, 16 of the 30 (53%) patients reported a clinically relevant improvement and five (17%) a clinically relevant worsening. Four (5%) patients developed new disabling headache. No predictor for postoperative improvement of headache was identified. Conclusion In this prospective study, the results show that disabling headache improves following endoscopic TSS in a subset of patients with pituitary tumors. However, no predictive factors for improvement could be identified.

The Effectiveness of Compassion-focused Therapy for Improving Emotional Control and Reducing the Severity of Pain in Migraine Patients

Objective: Because of the unwanted effects of the patient’s migraine headaches and the role of excitement and stress in the development and exacerbation of headaches, migraine headaches are psychosomatic disorders that affect the patients’ psychological lives. The present study aimed to investigate the effectiveness of Compassion-Focused Therapy (CFT) for improving emotional control and reducing the severity of pain in patients with migraines. Methods: A total of 30 patients with migraines referred to Isfahan Al-Zahra Hospital, Isfahan City, Iran, were selected and randomly divided into experimental and control groups. The research instruments included the Emotion Control Questionnaire (ECQ), von Korff’s questionnaire for grading the severity of chronic pain, and the Migraine Disability Assessment (MIDAS) questionnaire. The experimental group received eight 90-min sessions of CFT, and both groups took the post-test after finishing the training sessions. Analysis of the data involved both descriptive and inferential statistics, including mean, standard deviation, Multivariate Analysis of Covariance (MANCOVA), and Analysis of Covariance (ANCOVA). Results: The results showed that the training based on CFT had a significant effect on improving emotional control and its subscales (F=21.81; P<0.01), as well as reducing pain severity in the patients (F=17.21; P<0.01). Conclusion: Therefore, in treating migraine patients, CFT can be a useful supplementary approach along with medications.

Association between diet and migraine characteristics: The role of Dietary Inflammatory Index

Background: Migraine is a neurologic disorder. Although, based on previous evidence, migraine is related with inflammation and oxidative stress, its relationship with the inflammatory potential of the diet is still unknown. Thus, the aim of this study was to show the correlation between Dietary Inflammatory Index (DII) and severity and duration of migraine headache. Methods: In this cross-sectional study, 266 women who suffered from migraine, were included. Demographic and anthropometric data were collected form all participants. 147-item semiquantitative food frequency questionnaire (FFQ) was collected to assess dietary intake and consequently, DII scores were calculated. Migraine Disability Assessment (MIDAS) questionnaire, Visual Analog Scale (VAS), and a 30-day headache diary were also completed by each participant. Results: The DII score ranged between -4.22 and 5.19 and its median [interquartile range (IQR)] was 0.003 (-1.48-1.55). There was no meaningful association between age, occupation, physical activity (PA), weight, height, Body Mass Index (BMI), waist circumference (WC), hip circumference, waist-to-hip ratio (WHR) and DII score classifications (P > 0.050). Subjects with more than 20 days of headache had higher DII score compared to those with less than 10 days per month [odds ratio (OR) = 1.60, 95% confidence interval (CI) = 1.12-2.08, P = 0.001]. There was no association between DII and migraine severity (VAS and MIDAS) in the crude and adjusted model of logistic regression. Although there was a significant association between headache duration and DII (P = 0.020), this relationship was not meaningful after adjusting for age, PA, BMI, and job status (OR = 0.53, 95% CI = 0.28-1.00, P = 0.052). Conclusion: The present study showed a direct association between headache frequency and DII. Nevertheless, any relationship was not found between headache duration or migraine severity and DII score. Future large and prospective studies are needed to explore the effect of inflammatory potential of diet in migraine characteristics.

Thai-version Migraine Disability Assessment (MIDAS) questionnaire: concurrent validity, test–retest reliability, internal consistency, and factors predictive for migraine-related disability

BackgroundA Thai-version of the Migraine Specific Quality of Life Questionnaire (MSQ 2.1) is available, but a qualified questionnaire used specifically for disability assessment was not available. The most relevant practical disability assessment tested during this study was the Migraine Disability Assessment (MIDAS) Questionnaire.ObjectivesTo test the concurrent validity, test–retest reliability, and internal consistency of a Thai-version MIDAS questionnaire, and factors to predict disability in people with migraine.MethodsWe conducted the present prospective study at a tertiary care teaching hospital in Bangkok. The original English MIDAS Questionnaire was translated into Thai with back-translation into English and the language equivalence was assessed. The Thai-version MIDAS Questionnaire was tested for concurrent validity, test–retest reliability, and internal consistency, and factors including duration of migraine history, migraine characteristics, and comorbidity were assessed for the ability to predict migraine-related disability of migraineurs.ResultsOf the 58 participants, 31 were eligible to be included. The validity of the Thai-version questionnaire between the MIDAS total score and the mean headache severity (question B), the mean pain duration per attack, and the mean pain numerical rating scale (NRS) score were moderately correlated with a Spearman correlation coefficient range 0.42–0.58. The test–retest reliability of MIDAS grade had a weighted κ of 0.66, and for individual questions of the MIDAS total score, questions A and B assessed by intraclass correlation coefficients ranged 0.89–0.98. The internal consistency had a Cronbach α of 0.98. The mean pain NRS score in the past 3 months was an independent predictive factor for migraine-related disability.ConclusionThe Thai-version MIDAS Questionnaire has moderate concurrent validity, acceptable internal consistency, and excellent test–retest reliability. It would be helpful to assess clinical outcomes. Future study with a standardized translation process for the Thai-version questionnaire and a larger sample size is warranted to confirm internal consistency and determine all probable predictive factors for migraine-related disability.

Effects of upper cervical joints manipulation on the signs and symptoms of subjects with headache: a blind clinical trial.

There is a relationship between headaches and dysfunctions in the upper cervical spine, so joint manipulation in this region can be a useful tool for recovering tissue mobility and improving the related symptoms. Objectives: to evaluate the effect of 3 sessions of manipulation of the upper cervical spine on pain, cervical mobility, neck disability index (NDI) and the MIDAS questionnaire of subjects with headache. Methods: 13 subjects (28.1 ± 6.7 years) with headache participated. Initially, they filled in a pain diary for 4 weeks. After this period, NDI and MIDAS questionnaire were applied. Then, the cervical spine movements were measured with a tape measure, with the subject in the seated position. Subsequently, the intervention was performed (3 sessions with an interval of 7 days between them), with the subject positioned in the supine position and the global manipulation for the upper cervical spine was applied bilaterally. At the end of the intervention, subjects were re-evaluated for cervical mobility and for the NDI and MIDAS questionnaire. After that period, subjects answered the pain diary for another 4 weeks (follow up). The statistical analysis consisted of the KS normality test, followed by ANOVA test (and Tukey post hoc test) or paired Student's t test, with the level of significance set at 5%. Results: MIDAS questionnaire and NDI showed a significant improvement after the cervical mobility intervention. The pain parameters, assessed by the pain diary, were significantly reduced during the intervention and remained so in the follow up evaluation. Conclusion: the intervention was effective in reducing the signs and symptoms of subjects with headache.

Educational and cultural diversity and the case of multiple intelligences theory within a Romanian secondary school

This paper approaches the problem of diversity in an educational context. The balance between diversity and unity is an old philosophical question. Education has not been spared the struggle for the answer to this dichotomy. The application of multiple intelligences theory, based on the administration of a MIDAS questionnaire, has revealed a detailed panorama of the potential of a group within the context of the education system. The problem of diversity is not bound to the direct teaching or immediate address of this potential. It is not only a question of the immediate but also a question of what the future holds and how this potential unfolds and is folded by the context of the global village and its speeded time spiral. Keywords: Educational diversity, cultural diversity, multiple intelligences theory, interpersonal intelligences, intrapersonal intelligence.