Inter-ictal assay of peripheral circulating inflammatory mediators in migraine patients under adjunctive cervical non-invasive vagus nerve stimulation (nVNS): A proof-of-concept study

Objective

To assay peripheral inter-ictal cytokine serum levels and possible relations with non-invasive vagus nerve stimulation (nVNS) responsiveness in migraineurs.

Reliability and validity of the Japanese Migraine Disability Assessment (MIDAS) Questionnaire

OBJECTIVE: This study was designed to assess the test-retest reliability, internal consistency, and validity of a Japanese translation of the Migraine Disability Assessment (MIDAS) Questionnaire in a sample of Japanese patients with headache. BACKGROUND: Previous studies have demonstrated that the English-language version of the MIDAS Questionnaire is a reliable and valid instrument for the assessment of migraine-related disability. Any translations of the MIDAS Questionnaire must also be assessed for reliability and validity. METHODS: Study participants were recruited from the patient population attending either the Neurology Department of Kitasato University or an affiliated clinic. Participants were eligible for study entry if they had 6 or more primary headaches per year. For reliability testing, participants completed the MIDAS Questionnaire on 2 occasions, exactly 2 weeks apart. To assess validity, patients were also invited to participate in a 90-day daily diary study. Composite measures from the 90-day diaries were compared to equivalent MIDAS measures (ie, 5 questions on headache-related disability and 1 question each on average pain intensity and headache frequency in the last 3 months) and to the total MIDAS score obtained from a third MIDAS Questionnaire completed at the end of this 90-day period. RESULTS: One hundred one patients between the ages of 21 and 77 years were recruited (81 women and 20 men). Ninety-nine patients (80 women and 19 men) participated in the diary study. At baseline, 46.5% of patients were MIDAS grade I or II (minimal, mild, or infrequent disability), 22.2% were MIDAS grade III (moderate disability), and 31.3% were MIDAS grade IV (severe disability). Test-retest Spearman correlations for the 5 disability questions and the questions on average pain intensity and headache frequency ranged from 0.59 to 0.80 (P<.0001). The test-retest Spearman correlation coefficient for the total MIDAS score was 0.83 (P<.0001). The degree to which individual MIDAS questions correlated with the diary-based measures ranged from 0.36 to 0.88. The correlation between the total MIDAS score and the equivalent diary-based measure was 0.66. In general, the mean and median values for the MIDAS items and total MIDAS score were similar to the means and medians for the diary-based measures. However, the mean MIDAS scores for the number of days on which headache was experienced and the number of missed workdays were significantly different compared to the diary-based estimates for these items (P<.05). In addition, the mean MIDAS score for the number of days of missed housework was significantly higher than the corresponding diary-based estimate (P<.01). CONCLUSIONS: The results from this study show that the Japanese translation of the MIDAS Questionnaire is comparable with the English-language version in terms of reliability and validity.     

Anthrax toxin receptor proteins

Anthrax toxin is a key virulence factor for Bacillus anthracis, the causative agent of anthrax. Here we discuss what is known about the anthrax toxin receptor (ATR), the cellular receptor for anthrax toxin, and how this information is being used to develop treatments for anthrax as well as to understand aspects of cancer. ATR was identified recently as a type I transmembrane protein with unknown function that contains an extracellular integrin-like inserted (I) domain. The ATR I domain contains the toxin binding site, and a soluble form of this domain was shown to serve as an effective antitoxin to protect cultured cells from toxin action. ATR is encoded by the tumor endothelial marker 8 (TEM8) gene, which is selectively up-regulated during blood vessel formation and in tumor vasculature, raising the possibility that this protein normally functions in angiogenesis. Therefore, identification of the cellular receptor for anthrax toxin has made possible new avenues of research in the areas of anthrax pathogenesis, antitoxin development, and cancer biology.     

The Migraine Disability Assessment (MIDAS) questionnaire: translation and reliability of the Italian version

We have developed and tested an Italian version of the Migraine Disability Assessment (MIDAS) questionnaire, an established instrument for assessing headache-related disability. A multistep process was used to translate and adapt the questionnaire into Italian, which was then tested on 109 Italian migraine without aura patients, 86 (78.9%) of whom completed the form a second time 21 days later. Overall MIDAS score had good test-retest reliability (Spearman's correlation 0.77), closely similar to that found in English-speaking migraineurs, and individual responses were also satisfactorily reliable. Internal consistency was good (Cronbach's alpha 0.7). These findings support the use of the MIDAS questionnaire as a clinical and research tool with Italian patients.     

Outcome measurement in behavioral headache research: headache parameters and psychosocial outcomes

The experience of pain is complex and includes multiple dimensions or aspects, such as sensory and affective (among others). Headache includes not only pain, but also associated symptoms that can further diversify the relevant dimensions. Subjective ratings of head pain, sampled daily, have come to be regarded as the "gold standard" in behavioral headache research. Primary measures of headache include the attack frequency or headache days per month. Secondary measures of headache may include headache activity/index, headache duration, peak headache severity, and/or frequency of severe headaches per month. Secondary measures of disability and quality of life include Migraine Disability Assessment (MIDAS), Headache Impact Test (HIT), Headache Disability Inventory (HDI). Secondary nonheadache measures include medication consumption, psychiatric symptoms, stress and coping, treatment satisfaction and preference, side effects, and others. Researchers should include not only primary measures of headache, but also secondary measures, disability and quality of life, and nonheadache measures. All measures should be clearly defined and reported. A baseline period that is adequate for each measure needs inclusion and a minimum of 4 weeks is recommended for primary headache measures. Specific suggestions for future research directions are provided.     

MIDAS and HIT-6 French translation: reliability and correlation between tests

The aim was to evaluate the test-retest reliability of the French translation of the Migraine Disability Assessment (MIDAS) and Headache Impact Test (HIT)-6 questionnaires as applied to episodic and chronic headaches and to assess the correlation between these two questionnaires. The MIDAS and HIT-6 questionnaires, which assess the degree of migraine-related functional disability, are widely used in headache treatment clinics. The French translation has not been checked for test-retest reliability. MIDAS involves recall, over the previous 3 months, of the number of days with functional disability with regard to work and to home and social life. HIT-6 involves a more subjective and general assessment of headache-related disability over the previous 4 weeks. We expect that there may be greater impact recall bias for chronic headaches than for episodic headaches and considered it important to be able to determine if the reliability of these questionnaires is equally good for these two patient populations. Given that both questionnaires have the same objective, that of assessing headache impact, it was thought useful to determine if their results might show a correlation and if they could thus be used interchangeably. The study was approved by an external ethics committee. The subjects were patients who regularly visit the Clinique de la Migraine de Montréal, which specializes in the treatment of headaches. The MIDAS and HIT-6 questionnaires were completed by the patients during their regular visit. Twelve days later, the same questionnaires were mailed with a prepaid return envelope. Sixty-five patients were required in both the episodic and chronic headache groups, assuming an 80% questionnaire return rate. One hundred and eighty-five patients were enrolled, and 143 completed the study, 75 with episodic headaches and 68 with chronic headaches. The questionnaire return rate was 78.9%. On average, questionnaires were completed a second time 21 days after the first, with a median of 19 days. The Shrout-Fleiss intraclass correlation coefficients for MIDAS and HIT-6 were, respectively, 0.76 and 0.77 for episodic headaches and 0.83 and 0.80 for chronic headaches. The Pearson correlation coefficient between the MIDAS and HIT-6 questionnaires was 0.48 for episodic headaches and 0.58 for chronic headaches at the first compilation and 0.42 and 0.59 at the second compilation. The test-retest intraclass correlation of the French versions for both MIDAS and HIT-6 questionnaires indicates moderate reliability for episodic headache and substantial reliability for chronic headache. The correlation between the MIDAS and HIT-6 questionnaires is weak for episodic headaches, but approaches a level of 'good' for chronic headaches.     

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.     

Prevention of episodic migraine with topiramate: a prospective 24-week,open-label,flexible-dose clinical trial with optional 24 weeks follow-up in a community setting

Abstract

Objective:

To explore efficacy and safety outcomes of topiramate for episodic migraine prevention in community practice.     

The effect of individual training and counselling programme for patients with myocardial infarction over patients’ quality of life

The aim of the present study was to identify the effect of individual training and counselling programme for patients having experienced myocardial infarction over patients’ quality of life. The sample was composed of 90 patients, 45 in the intervention and 45 in the control group, selected by sequential sampling from patients who had myocardial infarction for the first time. Data were collected between April and November 2008 by means of patient information form, Myocardial Infarction Dimensional Assessment Scale MIDAS, and Short Form SF‐36. In the intervention group, more improvement was observed in comparison with the control group in terms of quitting smoking, physical activity, body mass index, waist circumference (mean differences P = 0.000). A significant difference was observed in the third month of evaluation of both MIDAS and SF‐36 quality of life scales in comparison with the baseline values (P ≤ 0.000). The results indicated that individual training and counselling provided to patients having experienced acute myocardial infarction lead to improvement in quality of life and decrease risk factors by increasing behaviours that protect cardiac health. Such educational programmes should be applied to patients with acute myocardial infarction prior to discharge.     

Scanning laser polarimetry with variable corneal compensation in migraine patients

Purpose: This study aimed to compare scanning laser polarimetry measurements of retinal nerve fibre layer (RNFL) thickness in eyes of migraine patients with those in eyes of age‐matched, healthy subjects. Methods: The study was designed as an observational, prospective, cross‐sectional study. It included 57 eyes of 57 patients with migraine with or without aura according to the criteria of the International Headache Society and 44 eyes of 44 age‐matched healthy controls. Scanning laser polarimetry images were obtained using a commercial GDx VCC system (Version 5.3.1; Laser Diagnostic Technologies, Inc.). At each sitting, three sets of GDx VCC measurements were acquired for each patient and used in the analysis. Image acquisition was performed in undilated eyes in all subjects. Results: The mean ± standard deviation RNFL average thickness parameter in the migraine subjects was significantly lower than in the control group, at 50.4 ± 4.8 μm versus 54.7 ± 3.4 μm, respectively (p < 0.0001). However, there were no differences between migraine subjects and controls in mean RNFL thickness in superior and inferior areas. In the migraine group the mean migraine disability assessment (MIDAS) score was 34.3 ± 15.3 and the mean number of attacks per year was 17.1 ± 6.9 (range 6?28). The mean RNFL average thickness parameter was significantly correlated with MIDAS score (r = ? 0.86, p < 0.0001) and frequency of attacks (r = ? 0.86, p < 0.0001). Conclusions: The mean RNFL average thickness parameter was found to be thinner in migraine patients. In addition, we found a strong correlation between migraine severity and RNFL average thickness parameters.