Sex differences in clinical characteristics of migraine and its burden: a population-based study

Background and purpose

Understanding migraine in a sex-specific manner is crucial for improving clinical care, diagnosis and therapy for both females and males. Here, data on sex differences are provided in the presentation of migraine in a large European-based population cohort, which is representative of the general population.

Methods

A population-based study of 62,672 Danish blood donors (both present and previous donors), of whom 12,658 had migraine, was performed. All participants completed a 105-item diagnostic migraine questionnaire sent via an electronic mailing system (e-Boks) between May 2020 and August 2020. The questionnaire allowed for correct diagnosis of migraine according to the International Classification of Headache Disorders, third edition.

Results

The migraine questionnaire was in-cohort validated and had a positive predictive value of 97% for any migraine, a specificity of 93% and a sensitivity of 93%. There were 9184 females (mean age 45.1 years) and 3434 males (mean age 48.0 years). The 3-month prevalence of migraine without aura was 11% in females and 3.59% in males. The 3-month prevalence of migraine with aura was 1.72% in females and 1.58% in males. In females, the age-related 3-month prevalence of migraine without aura increased markedly during childbearing age. In males, migraine both with and without aura showed less age variation. Females had a higher frequency of migraine attacks (odds ratio [OR] 1.22) but a lower frequency of non-migraine headaches (OR = 0.35). Females also had a greater intensity of pain, more unilateral and pulsatile pain, and exacerbation by physical activity (OR = 1.40–1.49) as well as more associated symptoms (OR = 1.26–1.98). Females carried 79% of the total migraine disease burden, which was almost exclusively driven by migraine without aura (77%), whilst there was no sex difference in the disease burden of migraine with aura.

Conclusion

Females have more severe disease, resulting in a much higher migraine disease burden than indicated by prevalence alone.     

Time to REST: epidemiology and burden

Restless legs syndrome (RLS) is a neurological disorder characterized by a compelling urge to move, accompanied by disturbing sensations within the legs. It is now recognized that RLS is a common condition that has a substantial impact on sleep, daily activities and quality of life. Recent data from the REST (RLS Epidemiology, Symptoms, and Treatment) general population study show that symptoms of RLS are present in approximately 7% of the general population, and that 2–3% experience moderate or severe symptoms at least twice a week. Amongst this RLS cohort, approximately 88% reported sensory disturbances and 76% reported sleep-related symptoms. These symptoms had a marked effect on everyday life, with up to 50% of the RLS cohort reporting disruption of everyday activities or personal relationships. Sleep disturbances in turn lead to impaired daytime functioning. RLS is associated with a significant impairment of quality of life, comparable with that seen in chronic medical conditions such as diabetes or depression. Given the significant burden of morbidity associated with RLS, there is a strong case for treatment in patients with troublesome symptoms.     

Severity of depressive symptoms as predictor of impairment of quality of life in chronic migraine: Comparison with episodic migraine

To identify predictors of quality of life (QoL) in episodic migraine (EM) and chronic migraine (CM), 116 migraineurs were evaluated using the Headache Needs Assessment (HANA). QoL was significantly more impaired in patients with CM. Disability was a predictor of QoL in both EM and CM. Severity of depressive symptoms emerged as a predictor of QoL in CM. QoL was also poorer in women and in those with greater headache intensity and nausea associated with headache in the total sample. The present findings suggest a specific role for depressive symptoms in impaired QoL in CM sufferers.     

头痛严重程度对偏头痛患者生活质量的影响

目的 探讨头痛严重程度对偏头痛患者生活质量的影响.方法 根据头痛严重程度将84例偏头痛患者分为轻、中、重度3组,采用生活质量综合评定问卷-74(GQOLI-74)对患者进行测试.结果 轻、中、重度3组偏头痛患者在躯体不适感、进食功能、工作与学习、婚姻与家庭方面评分的平均值差异均有统计学意义(均P＜0.05),其余牛活质...     

北京城区精神分裂症家属经济负担与生存质量

目的：了解精神分裂症家属的经济负担与生存质量的关系。方法：对来自北京市东城区的172位社区精神分裂症家属进行了一般资料,疾病家庭负担量表及世界卫生组织生存质量测定量表简表的调查,对经济负担和生存质量进行相关性分析,并按照不同医疗付费方式进行分组,比较各组间经济负担和生存质量的差异。结果：精神分裂症家属经济负担评分与生存质量总分、生理领域、环境领域评分呈负相关（P〈0.01）;自费医疗比公费医疗经济负担大（P〈0.05）;不同医疗付费方式的精神分裂症家属生存质量总分及其4个领域总体差异无显著性（P〉0.05）。结论：社区精神分裂症家属的经济负担越重,生存质量越低,应采取相应干预措施提高精神分裂症患者家属的生存质量。     

Quality of life and burden in parents of outpatients with schizophrenia

Abstract Background Since the late 1950s, several studies have reported the burden faced by families living with a mentally ill relative. These studies have pointed out the importance of a progressive mental health service, focusing not only on the treatment of the patients, but also on the needs of the relatives. The aims of the present study were to compare the quality of life of parents of outpatients with schizophrenia with a randomly selected reference group and the relation between quality of life and burden on the parents. Subjects The sample comprised all parents (n=38) of outpatients with schizophrenia at an outpatient clinic in 2001, where the patients had contact at least once a week with both parents and staff. The parents were compared with a reference group (n=698). Methods The self-rating scale Quality of Life Index (QLI) was used to assess quality of life in both groups. In the case of the parents, semistructured interviews were supplemented by the data collection to assess the degree of burden with the Burden Assessment Scale (BAS). The outpatients were also interviewed to assess their global function with the Global Assessment of Functioning scale (GAF) and the Clinical Global Impression scale (CGI). Results The parents were significantly less satisfied with their overall quality of life (p<0.05). There was a correlation between lower overall quality of life and higher perceived burden r=0.58 (p<0.01). There was also a correlation between lower values on the family subscale and social subscale within the QLI and higher subjective burden r=0.54 (p<0.01) and r=0.52 (p<0.01), respectively. Conclusion These results indicate that caregiving has an influence on the family situation and on the quality of life of parents. These findings suggest that the professions working with the parents must have an approach focusing not only on the care given to the ill daughter or son, but also on the parents situation.     

Health-related quality of life measures and psychiatric comorbidity in patients with migraine

Background and purpose:  The identification of factors associated to health-related quality of life (HRQoL) measures in patients with migraine has major implications in terms of prognosis and treatment. This study aimed at investigating associations between HRQoL and comorbid mood and anxiety disorders.
Methods:  Consecutive adult outpatients with a diagnosis of migraine with or without aura were assessed using the Mini International Neuropsychiatric Interview (M.I.N.I.) Plus version 5.0.0 and the Migraine-Specific Quality-of-Life Questionnaire (MSQ).
Results:  Data of 112 patients (82 females), 69 without aura, mean age 41.2 ± 13.3 years were analyzed. According to the M.I.N.I., 50% patients had a lifetime or current DSM-IV diagnosis of mood or anxiety disorder. There was no between-groups difference in MSQ total and subscale scores in relation to the presence/absence of psychiatric comorbidity, independently whether that was current or lifetime. In the group of subjects with psychiatric disorders, age at onset of migraine correlated with MSQ-total (rho = −0.407 P  = 0.002), and subscale scores (Role Function-Restrictive, rho = −0.397, P  = 0.002; Emotional Function, rho = −0.487, P  < 0.001).
Conclusions:  Our findings suggest that current and/or lifetime psychiatric comorbidities are not associated with HRQoL measures in patients with migraine. However, patients with migraine and psychiatric comorbidities may represent a specific subgroup deserving particular attention for targeted interventions.     

Assessing migraine disability by diary-based measurement: relationship to the characteristics of individual headache attacks

Background and purpose:  Information on headache-related disability helps clinicians create the optimal treatment plan for migraine sufferers. The estimation of disability must be determined by gathering the individual effects of multiple headache attacks within a given period of time. This study was aimed to examine migraine-related disability from diary-based assessment and to determine which elements of the headache characteristics are associated with disability.
Methods:  Ninety-two migraine patients were enrolled and contributed data on a total of 422 diary days of headache attacks. Each diary booklet was comprised of questions on headache features and disability comprising five items that originated from Migraine Disability Assessment (MIDAS).
Results:  The average days recorded with disability for one or more of the three aspects of activities per headache attack was 0.55. Amongst the headache variables, pain intensity, nausea/vomiting, photophobia, type of abortive treatment and the employment status were significantly correlated with disability. On regression analysis, pain intensity, nausea/vomiting and employed work status were identified as significant predicting factors for migraine-related disability.
Conclusion:  These results demonstrated that a considerable amount of disability could occur during migraine attack and there are specified elements that act on the development of disability.     

Sumatriptan nasal spray: a dose-ranging study in the acute treatment of migraine

This multicentre, randomized, double-blind, placebo-controlled, parallel group dose-ranging study compared the efficacy and tolerability of four doses of sumatriptan nasal spray (2.5, 5, 10 and 20 mg) with a placebo, in the acute treatment of a single migraine attack. In total, 544 patients received the study medication as a single spray in one nostril, to treat a single migraine attack in the clinic. Efficacy assessments included the measurement of headache severity, clinical disability, and the presence/absence of associated symptoms. The incidence of headache recurrence was also assessed. The three highest doses of sumatriptan (5 mg 49%, 10 mg 46%, 20 mg 64%) were significantly better than the placebo (25%) at providing headache relief (moderate or severe headache improving to mild or none) 120 min after treatment (P 相似文献   

Caregiver burden in Parkinson's disease.

Parkinson's disease (PD) is a neurodegenerative disorder that imposes an important burden upon the patient's caregiver. This study aims at assessing caregiver burden (CB) and analyzing its relationship with sociodemographic, emotional, and functional factors, as well as health-related quality of life (HRQoL). The following measures were applied to 80 patients with PD: the Hospital Anxiety and Depression Scale (HADS); the EuroQoL (for HRQoL); and PD-specific measures (Hoehn and Yahr staging and SCOPA-Motor ADL subscale). Patients' main caregivers completed the HADS, SF-36, EuroQoL, and Zarit CB Inventory (ZCBI). The ZCBI was found to be a valid and reliable measure in the context of PD. There was a significant association between CB and caregivers' HRQoL (r = -0.29 to -0.64). Mental aspects of caregivers' HRQoL and burden were affected by disability and disease severity. The presence of caregivers' depression had a significant negative effect on both CB and HRQoL. The main predictors of CB were caregivers' psychological well-being, patients' mood and clinical aspects of PD (disability and severity), and HRQoL of patients and caregivers. This study underscores the need to consider the impact of PD on caregivers' well-being.     

Negative impact of migraine on quality of life after 4 weeks of treatment in patients with major depressive disorder

Aim: The impact of migraine on health‐related quality of life (HRQoL) among patients with major depressive disorder (MDD) after acute antidepressant treatment has not been addressed. The aim of the present study was to investigate whether or not the negative impact of migraine on HRQoL among outpatients with MDD continued to have an effect after 4 weeks of venlafaxine treatment. Methods: A total of 135 outpatients with MDD were enrolled, who were then treated with venlafaxine 75 mg per day for 4 weeks in the present open‐label study. Migraine was diagnosed based on the International Classification of Headache Disorders (2nd edn). Changes in Short‐Form 36 (SF‐36) and Hamilton Depression Rating Scale (HAMD) scores were the outcome measures. Multiple linear regression was used to assess whether migraine was an independent factor predicting SF‐36 score after treatment. Results: Seventy‐two participants (18M/54F) completed the 4‐week treatment. Subjects with migraine had a poorer HRQoL in terms of bodily pain and mental health at baseline. Subjects with and without migraine showed significant improvement in all SF‐36 subscales and depression after treatment, but subjects with migraine still had a poorer HRQoL regarding bodily pain and physical functioning after treatment as compared with those without migraine. Migraine could predict a negative outcome after treatment in the subscales of physical functioning, role limitations–physical, and role limitations–emotional. Conclusions: Migraine may have a negative impact on the improvement of partial SF‐36 subscales, especially on functional recovery, after acute treatment among outpatients with MDD. Whether additional intervention besides antidepressant treatment for migraine is indicated may need further study.     

Perceived burden and quality of life of caregivers in obsessive-compulsive disorder

Aim: The study aimed to examine the family burden and quality of life (QOL) of caregivers of patients with obsessive–compulsive disorder (OCD). Methods: A cross‐sectional assessment of 50 patients with OCD and their caregivers was carried out. The severity of OCD was assessed using the Yale–Brown Obsessive Compulsive Scale. The caregivers were assessed using the Family Burden Interview Schedule and the World Health Organization Quality of Life BREF version (WHOQOL‐BREF). Results: Fifty‐six percent of caregivers reported a high objective burden. Severity of illness correlated with burden and impaired QOL of caregivers. Age of patient, longer duration of illness and longer duration of treatment were predictive of poorer QOL of caregivers in the physical health domain. Greater objective burden, disruption of family leisure and interaction due to OCD led to significantly poorer QOL in all domains in caregivers. Higher financial burden, perception of poorer mental health, and higher subjective burden were predictive of poorer physical, general health and general and psychological QOL, respectively. Conclusions: The study provides important insights into the QOL and perceived burden of caregivers of OCD patients. It highlights the need for improving the quality of care not only for patients but also for primary caregivers.     

Vestibular migraine: a critical review of treatment trials

Vestibular migraine (VM), also known as migraine-associated vertigo, is a common cause of dizziness in adults. We performed a comprehensive literature search regarding treatment for VM or migraine-associated vertigo during the period of 1990–2008 and used, individually or in combination, the search terms VM, migraine-associated vertigo, migraine-associated dizziness, migrainous vertigo, migraine and vertigo, migraine and disequilibrium, and headache and vertigo. We found nine publications that address treatment strategies for VM. One small randomized clinical trial found some benefit from the use of zolmitriptan for abortive treatment of VM. The other eight observational studies showed marginal improvement with migraine prophylactic medications such as nortriptyline, verapamil, or metoprolol. Until more specific treatment options become available, patients with VM need to be managed with similar prophylactic and abortive strategies as those used for migraine in adults.     

An exploration of the burden experienced by spousal caregivers of individuals with Parkinson's disease

Although previous research has attempted to identify the needs of caregivers for individuals with Parkinson's disease (PD), most has focused on the demands associated with the physical needs of the patient, and not on “mental burden.” This study used the repertory grid method to capture the full range of caregivers' subjective experience, quantify their perceptions, and to acquire information that might be useful in directing remediation attempts. Within this sample, caregivers reported far greater burden from “mental stress” (e.g., worrying about individual's safety) than from “physical stress” (e.g., lifting individual into bed). Specifically, caregivers were primarily concerned about spousal safety, as this requires continuous vigilance and constant worry. Caregivers also reported experiencing “little deaths” as the disease progresses, related to a loss of independence for the couple, and the steady diminishment of social networks. Increasing attention on the mental burden experienced by spousal caregivers promises to increase quality of care, and quality of life for individuals with PD, by improving quality of life for the caregiver. © 2010 Movement Disorder Society