An Internet-Based Migraine Headache Diary: Issues in Internet-Based Research

Objective.— The primary purpose of this study was to explore the feasibility and acceptability of using an Internet-based headache diary to obtain acceptable completion rates of daily diaries. Background.— Migraine sufferers often perceive that headaches are unpredictable, but 70% have prodromal warning symptoms that may be identified via daily headache diaries. Although diaries are widely used for tracking headaches, Internet-based diaries have not been used previously. Methods.— A conventional headache diary was formatted for the Internet to collect daily headache data over 4 months using a time-series design. Women between 18 and 55 years who were not pregnant or postmenopausal, and whose headaches met migraine criteria, were recruited primarily via the Internet, completed online consent forms, and were screened via telephone. They completed health history questionnaires and daily diary pages containing scales and open-ended questions, which were saved to a database. Diaries were reviewed and participants were contacted weekly. Completion dates were tracked electronically. Follow-up interviews addressed perceptions about study experiences, and participants received feedback about headache patterns. Results.— The majority of participants were recruited from discussion boards and free classified web sites. Of the 101 participants enrolled, 24 withdrew prior to completing 4 months of diary entries. Participants (n = 77) had a mean age of 37.5 (±7.5) years and were primarily white (82%) and well-educated (93%). They lived in 21 US states, and one in the UK. The majority (68%) completed at least 50% of their diary pages within 24 hours; 75% of all pages were completed within 2 days. At least 64 (83%) kept notes or printed pages when they lacked Internet access. In a follow-up survey (n = 67), 87% would have been willing to continue the diary for another 2 months; 69% had not previously participated in any research. Participants also reported that the study helped them better understand their headache patterns, that the study was a major commitment but worthwhile, and that they felt they had helped others by participating. Conclusion.— The Internet-based headache diary is a feasible, acceptable data collection tool that can access geographically diverse populations who have not previously participated in research studies. Use of an Internet-based approach was found to be feasible for recruitment and retention of such diverse populations.     

Privacy concerns of patients and nurse practitioners in primary care--an APRNet study

PURPOSE: This study explores and compares the privacy concerns of primary care nurse practitioners (NPs) and their patients. DATA SOURCES: Privacy concerns were identified in separate focus groups of NPs and patients, and then parallel survey instruments were designed and administered to 27 NPs and 185 of their patients. All subjects were recruited through APRNet, a regional practice-based research network of NPs in southern New England encompassing 58 practices. CONCLUSIONS: Both groups demonstrated high levels of concern regarding privacy. While NPs and patients had similar levels of concern about most issues, there were some notable differences regarding breeches because of carelessness, disclosures for research, and which disorders require the most care in maintaining privacy. IMPLICATIONS FOR PRACTICE: These results allow NPs to anticipate patient privacy concerns and to enhance trust in the clinical relationship. These results also indicate the need to educate patients regarding privacy rights and expectations.     

Privacy versus Convenience: A Historical Perspective,Analysis of Risks,and an Informatics Call to Action

Background  The pace of technological change dwarfs the pace of social and policy change. This mismatch allows for individual harm from lack of recognition of changes in societal context. The value of privacy has not kept pace with changes in technology over time; individuals seem to discount how loss of privacy can lead to directed personal harm. Objective  The authors examined individuals sharing personal data with mobile health applications (mHealth apps) and compared the current digital context to the historical context of harm. The authors make recommendations to informatics professionals to support consumers who wish to use mHealth apps in a manner that balances convenience with personal privacy to reduce the risk of harm. Methods  A literature search focused by a historical perspective of risk of harm was performed throughout the development of this paper. Two case studies highlight questions a consumer might ask to assess the risk of harm posed by mobile health applications. Results  A historical review provides the context for the collective human experience of harm. We then encapsulate current perceptions and views of privacy and list potential risks created by insufficient attention to privacy management. Discussion  The results provide a historical context for individuals to view the risk of harm and shed light on potential emotional, reputational, economic, and physical harms that can result from naïve use of mHealth apps. We formulate implications for clinical informaticists. Conclusion  Concepts of both harm and privacy have changed substantially over the past 20 years. Technology provides methods to invade privacy and cause harm unimaginable a few decades ago. Only recently have the consequences become clearer. The current regulatory framework is extremely limited. Given the risks of harm and limited awareness, we call upon informatics professionals to support more privacy education and protections and increase mHealth transparency about data usage.     

Possible Identification of Cervicogenic Headache Among Patients With Migraine: An Analysis of 374 Headaches

According to Sjaastad, the pain in cervicogenic headache, a form not recognized by the IHS, is long lasting and always side-locked unilateral. The frequency of side-locked unilateral pain (defined here as no change in side from onset) and other characteristics of cervicogenic headache were investigated in 300 outpatients using information collected on standard forms in structured interviews. Three hundred seventy-four headaches diagnosed according to IHS criteria were identified. Three hundred forty-eight of these headaches were long-lasting (duration of more than 4 hours); migraine (65%) followed by tension-type headache (25%) were the commonest forms. Side-locked unilaterality was present in 29% (101 of 348), and occurred most frequently in migrainous disorders not fulfilling the criteria (25 of 56, 44.6%). This group differed significantly from the other migraine conditions for longer pain duration ( P <0.02) and less frequent nausea, vomiting, photophobia, phonophobia ( P <0.0001), and aggravation by physical activity ( P <0.02). With these characteristics, this group resembled cervicogenic headache. However, in none of these patients was pain triggered by head or neck movements, and the frequency of head or neck trauma did not differ from other headaches. A more precise definition of clinical criteria for cervicogenic headache vs migraine is, therefore, required.     

The Prevalence of Headache and Migraine in Atopic Children: An Epidemiological Study in General Practice

SYNOPSIS
The lifetime prevalence of headache and migraine was assessed in an unselected sample of atopic (asthma, eczema or rhinitis) children in a general practice population of known socio-economic and age/sex composition. Maternal migraine was also recorded. The prevalence of both headache and migraine was significantly and proportionally higher in children with atopic disorders compared to those without. Childhood migraine was associated with atopy and the association was strongest with rhinitis. Rhinitis in children was associated with maternal migraine. A history of atopy (especially rhinitis) supports the diagnosis of migraine in young children with paroxysmal headaches.     

Migraine,Tension-Type Headache,and Attention-Deficit/Hyperactivity Disorder in Childhood: A Population-Based Study

Abstract

Objectives: Primary headache syndromes (eg, migraine and tension-type headache [TTH]) and attention-deficit/hyperactivity disorder (ADHD) are prevalent in childhood and may cause impairment in social and academic functioning. We tested if ADHD or its symptoms are associated with specific headache syndromes or with headache frequency. Study design: Cross-sectional epidemiological study with direct interviews to parents and teachers using validated and standardized questionnaires. Setting: Populational study. Participants: Children aged 5 to 11 years (n = 1856). Outcome measures: Prevalence of ADHD as a function of headache status in crude and adjusted analyses. Results: The prevalence of migraine was 3.76%. Infrequent episodic TTH occurred in 2.3% of the sample, and frequent episodic TTH occurred in 1.6%. The prevalence of ADHD was 6.1%. The prevalence of ADHD was not significantly different by headache category. For hyperactivity-impulsivity symptoms, the prevalence was 8.1% in children without headache, 23.7% in children with migraine (relative risk [RR], 2.6; 95% confidence interval [CI], 1.6–4.2), and 18.4% in children with probable migraine (RR, 2.1; 95% CI, 1.4–3.2). For inattention, no significant differences were seen. In multivariate analyses, ADHD or inattention symptoms were not predicted by headache subtypes or headache frequency. Hyperactivity-impulsivity symptoms were significantly associated with any headache (P < 0.01), TTH (P < 0.01), or migraine (P < 0.001). Conclusion: Migraine and TTH are not comorbid to ADHD overall, but are comorbid to hyperactive-impulsive behavior. Providers and educators should be aware of the association.     

Mast Cell Involvement in the Pathophysiology of Migraine Headache: A Hypothesis

Migraine attacks are triggered by a variety of conditions including endogenous and exogenous factors. Evidence suggests that activation and sensitization of primary afferent meningeal nociceptive neurons, the peripheral arm of the trigeminovascular system, constitutes one of the earliest events promoting the intracranial pain of migraine. However, the link between the varied triggering factors and activation of meningeal nociceptive neurons is not completely understood. Local inflammation with release of mediators from local immune/inflammatory cells is thought to play a critical role in such neuronal response. Meningeal mast cells may play such a role by virtue of their proximity both to meningeal blood vessels and nociceptive axons and their ability to release a host of proinflammatory/algesic mediators. This paper reviews data relevant to the hypothesis that mast cells, upon activation by migraine triggers, contribute to the genesis of migraine headache. Epidemiologic findings, clinical data, and observations on anatomical and physiological characteristics of mast cells converge to suggest an important role of these immune cells in the pathogenesis of migraine. Migraine triggers might directly or indirectly promote mediator secretion from meningeal mast cells, and thereby cause inflammation and activation of the trigeminovascular system. While consistent, the evidence supporting mast cell involvement in the genesis of migraine is largely circumstantial to date. Further studies are needed to test directly the nature of mast cell involvement in the pathogenesis of migraine headache.     

Psychophysical Precedents of Migraine in Relation to the Time of Onset of the Headache: The Migraine Time Line

We conducted a prospective study of 19 female migraine patients who kept a diary four times per day at 8 AM, I PM, 6 PM, and 11 PM for 10 consecutive weeks. In the diary, the patients recorded the occurrence as well as the features and associated symptoms of their headaches. They also rated five mood states: alertness, tension, irritability, depression, and fatigue, as well as the quality of sleep and the incidence and stressfulness of daily hassles as measurements of stress. They quantified the variables through the use of 100-mm visual analog scales.
In the diaries, we identified 68 migraine headaches of which 23 developed during the night, 19 during the morning, 16 during the afternoon, and 10 during the evening. The headaches which developed during the evening or night were preceded by an increased incidence of daily hassles during the afternoon. The headaches which developed during the morning or afternoon were preceded by increased tension the previous days.
The day before the headaches which developed during the morning, the incidence of daily hassles was increased during the morning, afternoon, and evening. The increased tension at I PM was followed by increased fatigue at 6 PM, which was still present at 8 AM of the morning during which the headaches developed. The day before the headaches which developed during the afternoon, the increased tension at 6 PM was followed by increased alertness at 11 PM. The next morning, the stressfulness of daily hassles was increased at 8 AM, followed by increased tension and irritability at 1 PM.
We conclude that there are three different sequences of events with regard to the psychophysical precedents of migraine, depending on the time of onset of the headache: the migraine time line.