Chronic migraine is associated with significant headache-related disability and psychiatric comorbidity. OnabotulinumtoxinA (BOTOX(®)) is effective and well tolerated in the prophylactic treatment of ...chronic migraine. This study aimed to provide preliminary data on the efficacy and safety of prophylactic onabotulinumtoxinA in patients with chronic migraine and comorbid depressive symptoms.
This was a prospective, open-label, multicenter pilot study. Eligible patients met International Classification of Headache Disorders 2nd edition Revision criteria for chronic migraine and had associated depressive symptoms, including Patient Health Questionnaire depression module scores of 5-19. Eligible participants received 155 units of onabotulinumtoxinA, according to the PREEMPT protocol, at baseline and week 12. Assessments included headache frequency, the Headache Impact Test™, the Migraine Disability Assessment, the Beck Depression Inventory(®)-II, the nine-item Patient Health Questionnaire depression module, and the seven-item Generalized Anxiety Disorder questionnaire. Adverse events were also monitored.
Overall, 32 participants received treatment. At week 24, there were statistically significant mean (standard deviation SD) improvements relative to baseline in the number of headache/migraine-free days (+8.2 5.8) (P<0.0001) and in the number of headache/migraine days (-8.2 5.8) (P<0.0001) per 30-day period. In addition, there were significant improvements in Headache Impact Test scores (-6.3 6.9) (P=0.0001) and Migraine Disability Assessment scores (-44.2 67.5) (P=0.0058). From baseline to week 24, statistically significant improvements were also seen in Beck Depression Inventory-II (-7.9 6.0) (P<0.0001), Patient Health Questionnaire depression module (-4.3 4.7) (P<0.0001), and Generalized Anxiety Disorder questionnaire (-3.5 5.0) (P=0.0002) scores. No serious adverse events were reported. Adverse events considered related to treatment occurred in 30% of patients and were mild or moderate.
Prophylactic onabotulinumtoxinA was well tolerated in patients with chronic migraine and comorbid depression, and was effective in reducing headache frequency, impact, and related disability, which led to statistically significant improvements in depression and anxiety symptoms.
Background
The migraine Treatment Optimization Questionnaire (mTOQ) was developed to assess response to acute treatment in persons with migraine. The original validated form used yes or no response ...options.
Objectives
This study aims to (1) assess the psychometric properties of a 6‐item version of the mTOQ (mTOQ‐6) using ordinal response options; (2) compare treatment optimization using the revised mTOQ‐6 for both episodic and chronic migraine (EM and CM, respectively); (3) identify demographic, headache, and treatment features associated with treatment optimization.
Methods
The American Migraine Prevalence and Prevention (AMPP) Study is a longitudinal, US population‐based study. Annual questionnaires were mailed to a sample of 24,000 severe headache sufferers identified by screening a panel constructed to be representative of the US population. The current study included respondents to the 2006 AMPP Study survey who met modified International Classification of Headache Disorders‐3 beta criteria for migraine; persons with CM (≥15 HA days/month) or EM (<15 HA days/month) were included. Acute treatment optimization was measured with the mTOQ‐6. A single factor latent variable model was used to assess item characteristics. This model was expanded through structural equation models (SEM) to incorporate a contrast between persons with CM and EM on the scaled treatment optimization scores. We estimated both an unadjusted SEM and a SEM adjusted for demographic features, headache characteristics, and acute treatment.
Results
Migraine criteria were met by 8612 persons (539 for CM and 8073 for EM) who completed the mTOQ‐6 as part of the 2006 AMPP Study survey. When compared, those with CM exhibited worse treatment optimization across all domains of the mTOQ‐6. For example, 35.1% of CM and 44.6% of EM respondents reported being pain free at 2 hours “half the time or more” with their usual migraine medication. Latent variable model parameters indicated excellent psychometric properties of the mTOQ‐6. Scaled treatment optimization scores obtained from the unadjusted SEM were significantly lower (indicating worse treatment optimization) for persons with CM (3.25) compared to persons with EM (4.01), b = −0.76, P < .0001; scores remained significantly lower for CM after adjustment with a wide array of demographic and disease severity covariates. Poor treatment optimization was associated with cutaneous allodynia, major depression, and the use of nonsteroidal anti‐inflammatory drugs. Better treatment optimization was associated with the use of triptans and preventive medications.
Conclusion
Estimates of the latent variable scores for the mTOQ‐6 revealed persistent low levels of treatment optimization for both EM and CM, though treatment optimization is worse for CM.
Due to the complexity of modern industrial systems, a conventional automation system is not capable of providing sufficient information management and high-level intelligent approaches, as achieving ...these functionalities requires the support of comprehensive data management and coordination between system devices and heterogenous information. This paper proposes the concept of e-Automation, in which computer networking and distributed intelligence agent technologies are applied to industrial automation systems, and presents a hardware and software architecture that implements this concept. An open infrastructure based on multi-agent systems is employed in the proposed architecture of e-Automation, which aims to allow the implementation of diverse tasks and to permit greater configurability than can be obtained from a traditional system. To evaluate our proposed e-Automation concept, this paper presents a case study of substation information management which adopts the proposed e-Automation architecture in power system domain.
Objectives: To determine whether change in headache-days over 1-year is associated with change in lost productive time (LPT) among a population sample of migraineurs. Methods: Data are from migraine ...sufferers who participated in at least two consecutive annual American Migraine Prevalence and Prevention surveys between 2005 and 2008. LPT was estimated using two questions from the validated Migraine Disability Assessment survey about missed workdays and number of days at work. Results: The reduction in LPT (ie, missed workdays + reduced productive time) from 1 year to the next had a nonlinear relationship with reduction in headache-days. The relationship was directly linear, however, when change in employment status was considered in the regression model. Conclusion: A reduction in headache days over time translates into a linear reduction in LPT, including an increased likelihood of employment.
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