Loss of Productivity and Quality of Life in Migraine Sufferers Among French Workers: Results From the GAZEL Cohort

To assess the burden of migraine, we compared the productivity and the perceived health of 991 migraine sufferers (IHS criteria), 1004 other-headache sufferers, and 1757 nonheadache sufferers randomly chosen among volunteers from employees of the French national gas and electricity company. The extent of absenteeism was collected independently from the study subjects during a 4-year period. Performance at work was self-assessed at the end of the followup. The study subjects also completed the Short-Form 36 Health Survey Questionnaire (SF36) and the Spielberger anxiety scale. The number of workdays lost due to migraine was not statistically different between the migraine and control groups, after adjustment for age, sex, and number of health impairments other than headaches. Performance was found to be greatly reduced in migraineurs. The quality of life was poorer and the anxiety level was higher in the migraine group than in the nonheadache group. There was no difference between migraineurs and other-headache sufferers for any variable. The lack of difference in absenteeism between migraineurs and nonheadache subjects calls into question prior research based on self-report. Moreover, it also calls into question the economic impact of migraine due to its indirect costs found in previous studies without e control group. We found that the burden of migraine may be considered mainly in terms of reduced quality of life.     

The Burden of Headache in Neurology Outpatient Clinics in Turkey

Background and Aim: The aim of the study was to investigate the burden of headache in neurology outpatient clinics (NOCs) regardless of their primary complaint. Methods: Patients presenting for their routine appointments in 41 NOCs were screened during the course of 1 week. All eligible subjects (n = 3682; 61.9% female, mean age 45.2 ± 16.5 years) were evaluated by a neurologist for the headache diagnosis and some demographic characteristics. Results: Of all patients, 66.4% reported headache, and in 35.1% headache was the primary cause for admitting to the NOC. Of 3682 patients, 917 (24.9%) were diagnosed as migraine according to International Headache Society (IHS) criteria. Thirty‐three and nine‐tenths percent of all patients admitted and 56% of the migraineurs according to IHS had severe headaches. As the headache severity increases, the ratio of the patients admitted with headache as the primary complaint increases significantly. The distribution of burden and other characteristics of headache did not differ in seven geographic regions and 41 different centers. Conclusion: Headache complaint caused at least 1/3 of all neurological outpatient visits in Turkey and 2/3 of all patients admitted to NOC had headache. Of these patients, 1/4 had migraine according to IHS with substantial disability and severity level. ?     

Quality of Life and Productivity in Nurses Reporting Migraine

A random sample survey was conducted to determine the prevalence of migraine in nurses and to study its effect on quality of life and productivity. Of the 10 000 nurses sampled, 2949 returned the questionnaire for a response rate of 29.5%. The majority (99%) of respondents were employed and worked in hospitals (60%). According to the International Headache Society (IHS) criteria, 17% of the sample (n=495) were classified as having migraine. An additional 25% (n=750) suffered severe headaches but did not meet IHS criteria for migraine, and the remaining 58% (n=1704) were classified as not having either migraine or severe headaches. The migraineurs had significantly reduced work productivity and quality of life compared to both the severe headache and the nonmigraine nonsevere headache groups. This study will increase awareness and sensitivity of the profession to its colleagues who are migraine sufferers.     

Symptom Burden Clusters: A Challenge for Targeted Symptom Management. A Longitudinal Study Examining Symptom Burden Clusters in Breast Cancer

ContextAlthough there has been a growing interest in cancer symptom clusters, less is known about symptom burden clusters.ObjectivesTo explore clusters of burdensome symptoms over time, the impact on health status and quality of life, and coping capacity in patients with breast cancer.MethodsIn this longitudinal study, a sample of 206 patients completed the Memorial Symptom Assessment Scale, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, and the Sense of Coherence scale, at diagnosis of primary or recurrent breast cancer, and at one-, three-, and six-month follow-ups.ResultsThree clusters of burdensome symptoms were identified: emotional symptom burden, gastrointestinal symptom burden, and unwellness symptom burden. Most burdensome were emotional symptoms, with worrying, feeling sad, and feeling nervous as the core or defining symptoms. Over time, additional symptoms escalated the emotional symptom burden. The gastrointestinal symptom burden, with “change in the way food tastes” as a core symptom, was more often associated with chemotherapy. Less stable over time, the unwellness symptom burden could be interpreted as short- and long-term side effects of hormonal therapy. Of these clusters, only the emotional symptom burden cluster significantly diminished health status and quality of life. Patients reporting lower coping capacity experienced higher levels of symptom burden.ConclusionThis study provides insights into symptom burden clusters over time. A challenging approach toward symptom management in clinical oncology is to target the burden of a symptom cluster and to recognize the need for individually designed interventions to ameliorate symptom burden in cancer patients.     

慢性心力衰竭患者自我感受负担与生活质量的相关性

目的探讨慢性心力衰竭患者自我感受负担与其生活质量的相关性,为临床护理干预提供依据。方法便利抽样法选择2014年9月至2015年3月在某院心血管内科病房住院治疗的CHF患者292例,采用一般资料调查表、自我感受负担量表及健康状况调查量表对其进行问卷调查。结果慢性心力衰竭患者自我感受负担得分和生活质量总分分别为(25.41±7.60)分、(45.35±20.85)分,77.74%患者存在轻度至重度的自我感受负担,自我感受负担与生活质量呈负相关(均P0.01)。结论自我感受负担是影响慢性心力衰竭患者生活质量的重要因素,降低自我感受负担水平能改善慢性心力衰竭患者的生活质量。     

Effects on productivity and quality of life of rizatriptan for acute migraine: a workplace study

OBJECTIVE: To evaluate the impact of treatment with rizatriptan 10 mg on jobs and quality of life of patients with migraine. METHODS: Prospective, open-label study at 27 work sites of 20 companies representing diverse labor sectors in Spain. Eligible patients according International Headache Society (IHS) criteria were recruited for the study by on-site physicians and instructed to treat moderate or severe migraine attacks with one tablet of rizatriptan 10 mg. They were asked to complete the study questionnaires (ML-96, SF-36) at baseline, and then 3 months later. RESULTS: A total of 259 patients (83 men and 176 women) of a mean age of 39 (range 18 to 61 years) completed the study. Only 7% had taken triptans before for treatment of their migraine attacks. After 3 months of rizatriptan therapy, the use of medical services was significantly lower and all tested domains of quality of life had improved (P<.001). Absenteeism and days worked during migraine attacks also fell significantly during 3 months of rizatriptan therapy as compared with the 3 months before the study (P<.001). The improvement in productivity was reflected in the significant decreases in lost workday equivalents (decrease from 3.32 to 1.21 days; P<.001) and also in the total number of workdays lost (decrease from 5.16 to 1.82 days; P<.001). Two-thirds of patients described the efficacy of oral rizatriptan as excellent or very good (62%), and 89% preferred it over their usual medications for acute treatment of migraine attacks. CONCLUSION: For this employed population of patients with migraine, treatment with rizatriptan significantly improved parameters measuring direct medical costs, work and productivity, and health-related quality of life. In accordance with these findings, direct and indirect costs related to migraine could be substantially reduced by gathering detailed information about the nature of headache, eliminating triggering factors, and instituting effective treatment of migraine attacks.     

Clinical characteristics and patient-reported outcomes of chronic and episodic migraine patients at a US tertiary headache center: A retrospective observational study

Objective

To describe differences in clinical and demographic characteristics between patients with episodic migraine (EM) or chronic migraine (CM) and determine the effect of migraine subtype on patient-reported outcome measures (PROM).

Background

Prior studies have characterized migraine in the general population. While this provides a basis for our understanding of migraine, we have less insight into the characteristics, comorbidities, and outcomes of migraine patients who present to subspecialty headache clinics. These patients represent a subset of the population that bears the greatest burden of migraine disability and are more representative of migraine patients who seek medical care. Valuable insights can be gained from a better understanding of CM and EM in this population.

Methods

We conducted a retrospective observational cohort study of patients with CM or EM seen in the Cleveland Clinic Headache Center between January 2012 and June 2017. Demographics, clinical characteristics, and patient-reported outcome measures (3-Level European Quality of Life 5-Dimension [EQ-5D-3L], Headache Impact Test-6 [HIT-6], Patient Health Questionnaire-9 [PHQ-9]) were compared between groups.

Results

Eleven thousand thirty-seven patients who had 29,032 visits were included. More CM patients reported being on disability 517/3652 (14.2%) than EM patients 249/4881 (5.1%) and had significantly worse mean HIT-6 (67.3 ± 7.4 vs. 63.1 ± 7.4, p < 0.001) and median [interquartile range] EQ-5D-3L (0.77 [0.44–0.82] vs. 0.83 [0.77–1.00], p < 0.001), and PHQ-9 (10 [6–16] vs. 5 [2–10], p < 0.001).

Conclusions

There are multiple differences in demographic characteristics and comorbid conditions between patients with CM and EM. After adjustment for these factors, CM patients had higher PHQ-9 scores, lower quality of life scores, greater disability, and greater work restrictions/unemployment.     

Economic Burden of Transformed Migraine: Results From the American Migraine Prevalence and Prevention (AMPP) Study

Objective.— To evaluate the impact of incident transformed migraine on health care resource utilization, medication use, and productivity loss. In addition, the study estimates the total direct and indirect costs associated with transformed migraine. Background.— Emerging evidence indicates that migraine may be a chronic progressive disorder characterized by escalating frequency of headache attacks, often termed transformed migraine. Little is known about the economic impact of transformed migraine. Methods.— AMPP is a 5‐year, national, longitudinal survey study of headache in the US. The study utilized data from the 2006 follow‐up survey based on an initial sample of 14,544 adults identified as having migraine in either the 2004 screening or 2005 baseline survey. A diagnosis of migraine was assigned based on criteria proposed by the International Classification of Headache Disorders, 2nd Edition. Participants completed self‐administered, validated questionnaires on headache features, frequency, impairment, resource use, medication use, and productivity loss. Direct and indirect headache‐related costs were estimated using unit cost assumptions from the PharMetrics Patient‐Centric database, wholesale acquisition costs (Red Book), and wage data from the US Bureau of Labor Statistics. Those who developed transformed migraine were compared with those who did not develop transformed migraine in the 1‐2 year interval between screening/baseline and follow‐up. Results.— A total of 7796 (54%) identified migraine cases completed the 2006 follow‐up survey. Of those cases, 359 (4.6%) developed transformed migraine. Participants who developed transformed migraine reported significantly more primary care visits, neurologist or headache specialist visits, pain clinic visits, and emergency room visits compared with participants whose migraine remained episodic. Hospital nights and urgent care visits did not reach statistical significance. Transformed migraine participants reported significantly more time missed at work or school because of headaches and more time where work or school productivity was reduced by >50% in the previous 3 months because of headaches. Average per‐person annual total costs, including direct and indirect costs, were 4.4‐fold greater for those who developed transformed migraine ($7750) compared with those who remained episodic ($1757). Conclusion.— Transformed migraine exacts a significantly higher economic toll on patients and health care systems compared with other forms of migraine. Our findings support the need to prevent migraine progression and to provide appropriate management and treatment of transformed migraine.     

Migraine and Migraines of Specialists: Perceptions and Management

(Headache 2010;50:1115‐1125) Objectives.— To describe the perception of migraine by neurologists in France, to compare perceptions between neurologists who did and did not suffer from migraines and to describe treatments used for their own migraines. Background.— Patients with migraine are usually undertreated, as treatment guidelines are frequently not followed and, therefore, resulting treatment satisfaction is low. One reason for this may be inappropriate perceptions of physicians concerning the seriousness of the pathology and the need to treat. However, available information on physician perceptions of migraine is limited. Methods.— This was an observational, epidemiological survey conducted both in hospital‐ and community‐based neurologists in France. Participating neurologists completed an anonymous questionnaire which collected data on demographics, migraine status, and perceptions of migraine. Neurologists who considered themselves migraineurs also provided data on migraine impact, treatment and on treatment satisfaction. Distributions of responses to questions on migraine perceptions were compared between migraineur and nonmigraineur neurologists. Results.— The study included 368 neurologists, of whom 179 (48.6%) were migraineurs themselves. Some 92.3% of participants claimed to be very or quite interested in migraine. Migraine was considered a real illness by 96.5% of neurologists and to be very or quite disabling by 96.6%. Around half perceived migraine as a challenging condition to manage with respect to unrealistic patient expectations (46.2%), time‐consuming treatment (48.9%), and complications because of anxious or depressive comorbidity (59.9%) or medical nomadism (consulting multiple physicians for the same condition; 47.0%). No significant differences in any perception items were observed between migraineur and nonmigraineur neurologists. In total, 83.1% of neurologists were satisfied with acute headache treatments and 60.4% with prophylactic headache treatments. The most frequently reported treatments for neurologist's own migraines were nonsteroidal anti‐inflammatory drugs (used by 57.0%) and triptans (50.3%). Conclusions.— French neurologists are interested and concerned about migraine but find it challenging to treat. Migraine perceptions do not differ between neurologists who do and do not suffer from migraines themselves. Neurology training needs to prepare medical students adequately for the challenges of migraine treatment in terms of patient communication and psychiatric issues.     

Alleviation of Migraines with Therapeutic Vitamin D and Calcium

SYNOPSIS
Two postmenopausal migraineurs who developed frequent and excruciating migraine headaches (one following estrogen replacement therapy and the other following a stroke) were treated with combination vitamin D and calcium. Therapeutic replacement with vitamin D and calcium resulted in a dramatic reduction in the frequency and duration of their migraine headaches.     

Reduced impact of migraine in everyday life: an observational study in the Dutch Society of Headache Patients

OBJECTIVE: To explore the percentage of patients who report a reduced impact of migraine on their life, and to which factors this improvement can be attributed. METHODS: Four hundred forty-eight members of the Dutch Society of Headache Patients answered a set of structured questionnaires, including the Migraine-Specific Quality of Life instrument (MSQOL). RESULTS: Of this group, 70% reported a reduced impact of migraine. The most frequently reported reason for this reduction was a change in medication (77%); in particular, change to a triptan. Other favorable factors included a change in life-style (56%): 42% of patients reported more relaxed coping with migraine, a reduction of stress in general (28%) and of stress related to work (24%), and leading a more regular life-style (21%). In addition, social support was frequently mentioned, particularly that offered by the Dutch Society of Headache Patients (58%), family (46%), and their general practitioner (28%). The patients who reported a reduced impact of migraine had less migraine attacks and a higher quality of life than those who did not report such a reduction. CONCLUSION: The results confirm that factors that are proven effective in clinical trials on migraine also have these effects outside a formal experimental environment.     

社会支持在肝癌患者主要照顾者生活质量与照顾负担间的作用

目的在了解肝癌患者主要照顾者负担和生活质量现状的基础上,探讨社会支持在两者关系中的作用.方法便利抽样选取某三级甲等肝胆外科医院2018年10月至2019年4月住院治疗的肝癌患者主要照顾者为研究对象,采用照顾负担问卷、社会支持量表及癌症照顾者生活质量量表对其进行调查,采用Pearson相关分析、中介效应检验分析其中的关系.结果照顾负担与生活质量、社会支持均呈负相关(均P<0.05),生活质量与社会支持呈正相关(P<0.01),社会支持在生活质量与照顾负担中起部分中介作用,Bootstrap检验中介效应显著,中介效应量的95%置信区间为(-0.733,-0.237).结论肝癌患者主要照顾者生活质量有待提高,可通过减轻照顾者负担来直接提高,也可通过提高社会支持水平来间接提高.     

Retracted: Prevalence and Burden of Headache Disorders: A Comparative Regional Study in China

Background.— Since the early 1990s, no study has been undertaken examining the prevalence and burden of headache disorders in China. Objective.— We conducted a one‐year survey on the prevalence and burden of primary headache in the Chinese provinces of Guangdong and Guangxi. Our study also evaluated the factors behind similarities and differences affecting prevalence in the 2 regions of study. Methods.— Random samples of 372 local residents in Guangdong and 182 local residents in Guangxi aged 18‐65 years were invited to a face‐to‐face interview. Results.— The one‐year prevalence of primary headache was 22.6% (84/372) in Guangdong and 41.2% (75/182) in Guangxi. The prevalence of migraine (14.3%, n = 26) in Guangxi was higher than prevalence of migraine (8.3%, n = 31) in Guangdong (P = .03). The ratio of headache cost and household income was 2.1% in Guangdong and 3.7% in Guangxi, the ratio in Guangdong was less than that in Guangxi (P = .001). The diagnostic confirmation rate of migraine was low. No migraineur used triptans drugs to treat migraine in either region. Conclusion.— Migraine prevalence was higher in the lower‐income region that also contains a higher proportion of ethnic minorities. Although there was no difference of headache cost between the 2 regions, the headache populations in the lower‐income region would relatively suffer a greater financial burden if taking the economic differences between the 2 regions into account. The improvement of diagnostic and therapeutic levels for the treatment of headache, especially migraine, in the 2 regions may be a matter of urgency.     

The Relationship of Household Routines to Morbidity Outcomes in Childhood Asthma

PURPOSE.   The major purpose of this study was to explore the effect of routines on asthma management and morbidity outcomes for children with asthma and their parents.
DESIGN AND METHODS.   This study is a secondary data analysis in a sample of 150 children, which was originally used for an intervention study.
RESULTS.   Parents who had fewer routines in their homes had lower quality-of-life scores and higher burden of asthma scores when compared to parents in households with more routines. More routines were associated with improved asthma morbidity outcomes as measured by nurse rankings of routines.
PRACTICE IMPLICATIONS.   Assisting families to establish routines may result in improved asthma morbidity outcomes.