The prevalence and impact of migraine on US Military officer trainees

Objective.— To determine the prevalence and impact of migraine in US Army officer trainees. Background.— The prevalence of migraine in military officer trainees, frequency of diagnosis, pharmacologic management, and the impact of migraine on military training has not been previously determined. We sought to elucidate the above and also to identify trainee characteristics associated with impaired training performance because of the disabling effects of migraine. Methods.— An anonymous voluntary migraine questionnaire was administered to 1389 consecutive US Army Reserve Officer Training Corps cadets upon completion of 5 weeks of military training. Headaches were classified as definite migraine or possible migraine. Migraine frequency, prior diagnosis, number of missed or suboptimal training days attributable to migraine, patterns of analgesic use, and trainee characteristics associated with impaired training performance were identified. Results.— In total, 741 of 1389 (54%) officer trainees completed the migraine questionnaire, including 582 males and 159 females. The prevalence of definite migraine was 18% in all cadets including 14% in males and 31% in females. Migraines had been previously diagnosed in only 10% of trainees meeting criteria for definite or possible migraine. During training, male trainees experienced a mean of 0.70 migraines/month compared with female trainees at 1.4 migraines/month. Only 3% of trainees meeting criteria for definite or possible migriane had ever been prescribed triptans. Eight percent of cadets experienced impaired training performance because of migraine resulting in 63 days of suboptimal or missed training. Characteristics associated with impaired training performance included a prior diagnosis of migraine, screening positive for definite migraine vs possible migraine, and a higher baseline frequency of migraine. Conclusions.— Migraine is common yet underdiagnosed and undertreated in US Army officer trainees and adversely impacts military training. We identified characteristics which place military trainees at risk for impaired training performance. We predict that improved diagnosis and treatment of migraine would result in improved training performance.     

Overview of migraine.

Migraine, one of the most common incapacitating headaches, afflicts 23 million adults in the United States. There is a controversy in the literature on the theoretical perspective of migraine, the efficacy of treatment strategies, measurement, and correlates. Thus, more research is needed on these issues. A wide range of treatments is available for migraine. In addition to terminating migraine headache, appropriate migraine care includes preventing its attacks and improving patients' quality of life by administrating pharmacologic preparations in conjunction with a variety of alternative methods.     

The prevalence of diet-induced migraine

Nineteen percent of about 490 patients with classical or common migraine reported that headaches can be precipitated by chocolate, 18% by cheese and 11% by citrus fruit, and a highly significant majority of these patients were sensitive to all three foods. Twenty-nine percent of the patients reported sensitivity to alcohol; again this was significantly associated with sensitivity to the three food stuffs, though a substantial number of patients were sensitive to alcohol but not foods. Thirty-one percent of 331 female patients believed that oral contraceptives precipitated headaches, but this could not be related to any dietary response. Patients with affected relatives were significantly more likely to report sensitivity to alcohol and chocolate; sensitivity to cheese and citrus fruit was less strongly related, and there was no relationship at all for oral contraceptives. These correlations suggest that food induced headaches are mediated by chemical constituents common to these foods.     

The prevalence and impact of migraine headache in bipolar disorder: results from the Canadian Community Health Survey

OBJECTIVE: To report on the prevalence of comorbid migraine in bipolar disorder and the implications for bipolar age of onset, psychiatric comorbidity, illness course, functional outcome, and medical service utilization. BACKGROUND: Migraine comorbidity is differentially reported in bipolar versus unipolar depressed clinical samples. The bipolar disorder-migraine association and its consequences have been infrequently reported in epidemiological studies. METHODS: Data for this analysis were derived from respondents (n = 36 984) to the Canadian Community Health Survey - Mental Health and Well-Being (CCHS). Respondents reporting a lifetime WHO-CIDI-defined manic episode and physician-diagnosed migraine (lifetime) were compared to respondents without migraine on sociodemography, course of illness, and medical service utilization indices. RESULTS: An estimated 2.4% of the sample met criteria for bipolar disorder. Persons with bipolar disorder had a relatively higher prevalence of migraine versus the general population (24.8% vs. 10.3%; P < .05). The sex-specific prevalence of comorbid migraine in bipolar disorder was 14.9% for males and 34.7% for females. Bipolar males with comorbid migraine were more likely to live in a low income household (P < .05); receive welfare and social assistance (P < .05); report an earlier age of onset of bipolar disorder (P < .05); and have a higher lifetime prevalence of comorbid anxiety disorders (P < .05). Bipolar males with comorbid migraine were also more likely to utilize primary (P < .05) and mental health care services (P < .05) . Bipolar females with comorbid migraine had more comorbid medical disorders (P < .05) and were more likely to require help with personal or instrumental activities of daily living when compared to bipolar females without migraine. CONCLUSION: Bipolar disorder with comorbid migraine is prevalent and associated with greater dysfunction and medical service utilization, notable in males. Opportunistic screening and surveillance for bipolar and comorbid migraine is warranted.     

One-year prevalence and the impact of migraine and tension-type headache in Turkey: a nationwide home-based study in adults

Several studies have shown that the prevalence of migraine and tension-type headache (TTH) varied between different geographical regions. Therefore, there is a need of a nationwide prevalence study for headache in our country, located between Asia and Europe. This nationwide study was designed to estimate the 1-year prevalence of migraine and TTH and analyse the clinical features, the impact as well as the demographic and socio-economic characteristics of the participant households in Turkey. We planned to investigate 6,000 representative households in 21 cities of Turkey; and a total of 5,323 households (response rate of 89%) aged between 18 and 65 years were examined for headache by 33 trained physicians at home on the basis of the diagnostic criteria of the second edition of the International Classification of Headache Disorders (ICHD-II). The electronically registered questionnaire was based on the headache features, the associated symptoms, demographic and socio-economic situation and history. Of 5,323 participants (48.8% women; mean age 35.9 ± 12 years) 44.6% reported recurrent headaches during the last 1 year and 871 were diagnosed with migraine at a prevalence rate of 16.4% (8.5% in men and 24.6% in women), whereas only 270 were diagnosed with TTH at a prevalence rate of 5.1% (5.7% in men and 4.5% in women). The 1-year prevalence of probable migraine was 12.4% and probable TTH was 9.5% additionally. The rate of migraine with aura among migraineurs was 21.5%. The prevalence of migraine was highest among 35–40-year-old women while there were no differences in age groups among men and in TTH overall. More than 2/3 of migraineurs had ever consulted a physician whereas only 1/3 of patients with TTH had ever consulted a physician. For women, the migraine prevalence was higher among the ones with a lower income, while among men, it did not show any change by income. Migraine prevalence was lower in those with a lower educational status compared to those with a high educational status. Chronic daily headache was present in 3.3% and the prevalence of medication overuse headache was 2.1% in our population. There was an important impact of migraine with a monthly frequency of 5.9 ± 6, and an attack duration of 35.1 ± 72 h, but only 4.9% were on prophylactic treatment. The one-year prevalence of migraine estimated as 16.4% was similar or even higher than world-wide reported migraine prevalence figures and identical to a previous nation-wide study conducted in 1998, whereas the TTH prevalence was much lower using the same methodology with the ICHD-II criteria.     

Economic and social impact of migraine

We sent an anonymous self-administered questionnaire to 4200 employees of a Trust hospital, 1903 of whom returned it. We identified 158 migraine sufferers according to International Headache Society (IHS) criteria. These sufferers estimated 2.0 days/year absence from work, and an equivalent of 5.5 days/year lost by reduced effectiveness at work, caused by their migraine at an estimated financial cost of over 50,000 pounds to the Trust. An additional 220 individuals who had received a diagnosis of migraine from a doctor but fulfilled only 3/4 IHS criteria lost the equivalent of 6.7 days off work at a further cost of 63,000 pounds). Few patients had consulted their general practitioner about their migraines in the last 3 months. Most (78%) were using only over-the-counter medication. Migraine patients should be encouraged to seek medical attention.      

The prevalence of adult migraine in Calabria Region and its relationships with major sociodemographic characteristics and socio-economic impact of headache

Although headache is a common complaint, only few sufferers seek specific medical assistance. Migraine is one of the most frequently encountered varieties of headache. The first presentation of migraine is impaired quality of life and work disorders as a consequence of sickness. Epidemiological quantitative studies in Italy have been performed. The aim of this survey was to estimate the prevalence of migraine in adults living the Region of Calabria who were visited by general practitioners for any reason. We also analyzed the characteristics and associated demographic factors for this disorder, and analyzed costs generated by migraine. We conducted an observational, multicentre, cross-sectional study. Sample size was not predetermined. A total of 1397 patients patients were asked if they suffered headache. If they did not suffer, the doctor completed a questionnaire. Therefore, we have decided to define as possible migraineurs those patients who only met 3 of 4 criteria used to define migraine (pain, 2 or more attacks/month, associated symptoms). The prevalence of migraine was greater in women than in men (66.8% vs. 33.2%). When we considereded the number of patients diagnosed with possible migraine, the prevalence of the disorder was 35.2%. More than half of patients reduced social activities. This is mainly reflected in a loss of productivity and a increasing in indirect costs associated with the disorder. The overall prevalence of migraine in the Region of Calabria was 35.2%, which means that approximately 650 000 people suffer from this disorder. This produces a significant impact on the global social care but at same time a stimulation for the best management and improved quality of life of patients.     

The prevalence and characteristics of migraine in twins from the general population

We examined whether prevalence, age at onset, and cessation of migraine without aura and migraine with aura are different among twins and singletons. The study population was recruited from the population-based New Danish Twin Register and comprised 2026 monozygotic and 3334 same-sex dizygotic twins born during 1953 to 1960. A simple questionnaire was used to screen for migraine. Twin pairs with at least one twin with possible migraine were interviewed by telephone by two physicians. A total of 1136 twin pairs were included in the telephone interviews. The criteria of the International Headache Society were used for diagnosis. The questionnaire response rate was 87%, and the telephone interview participation rate was 90%. Of the 715 migraineurs, 498 had migraine without aura, 264 had migraine with aura, and 47 had both migraine with and without aura. The lifetime prevalence, age at onset, and cessation of migraine with and without aura did not differ in monozygotic and dizygotic twins. Males and females had a lifetime prevalence of migraine without aura of 7% and 19%, respectively. The female preponderance of migraine without aura was first apparent after aged 14 years; this may be related to an influence of female hormones. The lifetime prevalence of migraine with aura was 7% in males and 8% in females. The observed and expected number of those with both migraine with and without aura was not significantly different, suggesting that migraine without aura and migraine with aura are distinct types of migraine. Males with migraine without aura had a significantly lower mean age at onset than females with migraine without aura (16.5 years versus 21.5 years), while males and females with migraine with aura had similar ages at onset (20.8 years versus 21.8 years). About 20% of the twins had ceased having attacks of migraine with or without aura. More males than females with onset of migraine without aura before aged 15 years had ceased having attacks. The prevalence of migraine without aura and migraine with aura in twins was similar to the prevalence in the general population. Being a twin did not affect age at onset or cessation of migraine. Previous observations on differences of migraine without aura and migraine with aura regarding gender was confirmed.     

Pathophysiology,epidemiology, and impact of migraine

Despite a decade of progress, migraine headache remains prevalent, disabling, underdiagnosed, and undertreated in the United States. Migraine affects ∼12% of the population, and the economic burden in terms of annual cost of labor lost to migraine disability is between $5.6 and $17.2 billion. The threshold for migraine may be genetically determined, although recent genetic and neurophysiologic studies point to migraine as possibly a channelopathy. Cerebral cortical and brain stem changes occur in migraine. Head pain and associated symptoms of migraine can be explained by activation of the trigeminal vascular system. Evidence has also been accumulated that suggests the release of nitric oxide is an important trigger mechanism. Introduction of the triptans has dramatically advanced acute migraine pharmacotherapy, and preventive therapy has greatly improved; however, public health initiatives may be needed to further advance diagnosis and treatment of this common and disabling disorder.     

Visualizing the impact of prevalence on a diagnostic test

Abstract

The purpose of a diagnostic test is to confirm or rule out disease or to increase or decrease the probability of disease. Only a few tests can separate all patients into those with and without a disease (true positive and true negative test). Usually there will be some false test results (false positive and false negative). Traditionally, the four test results are given in a 2 by 2 table, and the terms sensitivity, specificity, and predictive values defined. The influence of the prevalence of the disease in question on the relative distribution of the four test results is not obvious. This technical note brings a new illustration of the relative distribution of the four test results at prevalence from 0–1. The figure facilitates the understanding of the impact prevalence has on the predictive values of a clinical test.     

Pathophysiology,epidemiology, and impact of migraine

Despite a decade of progress, migraine headache remains prevalent, disabling, underdiagnosed, and undertreated in the United States. Migraine affects approximately 12% of the population, and the economic burden in terms of annual cost of labor lost to migraine disability is between $5.6 and $17.2 billion. The threshold for migraine may be genetically determined, although recent genetic and neurophysiologic studies point to migraine as possibly a channelopathy. Cerebral cortical and brain stem changes occur in migraine. Head pain and associated symptoms of migraine can be explained by activation of the trigeminal vascular system. Evidence has also been accumulated that suggests the release of nitric oxide is an important trigger mechanism. Introduction of the triptans has dramatically advanced acute migraine pharmacotherapy, and preventive therapy has greatly improved; however, public health initiatives may be needed to further advance diagnosis and treatment of this common and disabling disorder.     

Overview of the psychosocial impact of disasters

The psychosocial sequelae can be intense and of long duration in the aftermath of natural and technological disasters, as well as terrorist attacks. Post-traumatic stress symptoms and full syndrome disorder, depression, anxiety, somatic complaints, and excessive alcohol use have been demonstrated consistently, particularly following large-scale disasters. This paper examines the psychological research conducted at various intervals after extensive natural disasters, the Three Mile Island and Chernobyl technological accidents, and recent terrorist events in the United States. Factors predictive of the emergence of emotional distress and psychological and physical problems following a disaster also are discussed.     

Overview of chronic fatigue syndrome focusing on prevalence and diagnostic criteria

Chronic fatigue syndrome (CFS) is an operational concept proposed by Centers for Disease Control and Prevention to clarify the unknown etiology of the syndrome characterized by the sensation of abnormally prolonged fatigue. Lots of investigators reported various abnormalities such as virus infection, immune abnormalities, HPA axis abnormalities, metabolic abnormalities, etc., but there are a few abnormalities common to vast majority cases of CFS. Therefore, lots of people as well as medical doctors are still skeptical about the presence of CFS. However, recent studies reveal that CFS can be understood to be a special condition based on the abnormality of neuroendocrine-immunologic system caused by the psycho-social stress and some genetic components. Under these conditions, a reactivation of various kinds of herpes virus infections and/or chronic infections might occur as a result of immune dysfunction, causing the abnormal production of several cytokines. A distinctive feature of CFS is thought to be the secondary brain dysfunction caused by the abnormal production of several cytokines. In this paper, I show the overview of CFS focusing around prevalence, economic impact and diagnostic criteria in Japan.     

Overview of target validation and the impact of oligonucleotides

During target validation, researchers attempt to modulate the activity of potential drug targets in relevant cell and/or animal disease models in order to identify those that might be expected to have therapeutic benefit in human patients. This has become increasingly important with the large expansion of potential targets identified by the human genome project and as a result of the spiralling costs of bringing drugs to market. This review will present an overview of the target-validation mechanism and examine the strengths and weaknesses of using oligonucleotide-based technologies such as antisense, short interfering RNA and aptamers.     

The prevalence of migraine and probable migraine in a Brazilian favela: results of a community survey

(Headache 2011;51:971‐979) Objectives.— The objectives of the present study were to estimate the 1‐year prevalence of primary headaches and the role of select socio‐demographic aspects in a representative sample of adults living in a Brazilian shanty town. Background.— Some socio‐demographic factors, such as marital status, income, education, and job status have been described in studies with contentious results. Nevertheless, few studies have assessed the prevalence of headache and the role of socio‐demographic aspects in very low‐income communities. Methods.— A cross‐sectional, population‐based study was undertaken. Door‐to‐door interviews with 383 people were conducted. Individuals were aged greater than 18 years, randomly selected from the “Paraisopolis” shanty town in São Paulo, Brazil. The degree of the association was calculated through prevalence ratios and adjusted with backward logistic regression by gender, age, and some socio‐demographic factors, including living conditions. Results.— The estimated 1‐year prevalence of headache, migraine, chronic migraine, and tension‐type headache were 47% (CI 95%: 39.5‐52.6%), 20.4% (CI 95%: 16.6‐24.9%), 8.4% (CI 95%: 6.1‐12.0%), and 6.2% (CI 95%: 3.3‐9.8%), respectively. Migraine was more prevalent in women and among employed people. No other relationship was found. The overall prevalence of migraine and chronic migraine in this very low‐income community were high and migraine was associated with gender and job status. Conclusion.— The overall prevalence of migraine and chronic migraine in this very low‐income community were high and tension‐type headache was low. A paradox was noted in the employment status and income association, one would expect higher levels of migraine in a low‐income population, but higher numbers were found in those employed vs unemployed. These findings will need to be replicated in other population samples.     

Role of CGRP pathway polymorphisms in migraine: a systematic review and impact on CGRP mAbs migraine therapy

Backgroundthe interest of clinical reaseach in polymorphisms and epigenetics in migraine has been growing over the years. Due to the new era of preventative migraine treatment opened by monoclonal antibodies (mAbs) targeting the signaling of the calcitonin-gene related peptide (CGRP), the present systematic review aims at identifying genetic variants occurring along the CGRP pathway and at verifying whether these can affect the clinical features and the course of disease and the responsiveness of patients to therapy.Methodsthe literature search has been conducted consulting the most relevant scientific databases, i.e. PubMed/MEDLINE, Scopus, Web of Science, the Human Genome Epidemiology (HuGE) Published Literature database (Public Health Genomics Knowledge Base) and Clinicaltrials.gov from database inception until April 1, 2021. The process of identification and selection of the studies included in the analysis has followed the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) criteria for systematic reviews and meta-analyses and the guidance from the Human Genome Epidemiology Network for reporting gene-disease associations.Resultsthe search has retrieved 800 results, among which only 7 studies have met the eligibility criteria for inclusion in the analysis. The latter are case-control studies of genetic association and an exploratory analysis and two polymorphisms have been detected as the most recurring: the rs3781719 (T > C) of the CALC A gene encoding CGRP and the rs7590387 of the gene encoding the receptor activity-modifying protein (RAMP) 1 (C > G). Only one study assessing the methylation pattern with regard to CGRP pathway has been found from the search. No genetic association studies investigating the possible effect of genetic variants affecting CGRP signaling on the responsiveness to the most recent pharmacological approaches, i.e. anti-CGRP(R) mAbs, gepants and ditans, have been published. According to the Human Genome Epidemiology (HuGE) systematic reviews and meta-analyses risk-of-bias score for genetic association studies, the heterogeneity between and across studies and the small sample size do not allow to draw conclusions and prompt future studies.Conclusionsadequately powered, good quality genetic association studies are needed to understand the impact of genetic variants affecting the pathway of CGRP on migraine susceptibility and clinical manifestation and to predict the response to therapy in terms of efficacy and safety.     

The impact of migraine on patients with major depressive disorder

BACKGROUND: The impact of migraine and other headache types among psychiatric outpatients with major depressive disorder (MDD) has not been fully described. OBJECTIVE: To investigate the impact of migraine on the severity, physical, and anxiety symptoms in patients with MDD and to examine the interaction between headache and depression. METHODS: This clinic-based study enrolled consecutive psychiatric outpatients meeting DSM-IV criteria for MDD. Headache types were diagnosed based on the International Classification of Headache Disorders, 2nd edition (2004). Three psychometric instruments were used to evaluate anxiety, depression, and physical components: the Hamilton Depression Rating Scale, the Beck Depression Inventory, and the Hospital Anxiety and Depression Scale. In addition, the interactions between headache and their depressive episode were also evaluated. RESULTS: Compared with patients without migraine, MDD patients with comorbid migraine (n = 73, 48.3%) had higher physical and anxiety scores on the three psychometric instruments. Migraine accounted for 5% to 11% of the variance of the total scores on the three psychometric scales. Approximately half (48.5%) of patients reported headache worsening during or after a depressive episode. CONCLUSIONS: Our study found that comorbidity of migraine in patients with MDD was associated with more anxiety and physical symptoms. Headache should not be considered as only a somatic symptom of depression, but should be treated as an important comorbid disorder because it might exacerbate or interact with depression during a depressive episode.