The aim was to estimate lifetime sex and age-specific incidence of migraine. Data are from the American Migraine Prevalence and Prevention study, a mailed survey sent to 120 000 US households. ...Age-specific incidence was estimated using self-reported data relevant to identification of migraine cases, age of onset of migraine and age at interview. Migraine incidence peaked between the ages of 20 and 24 years in women (18.2/1000 person-years) and the ages of 15 and 19 years in men (6.2/1000 person-years). Cumulative incidence was 43± in women and 18± in men. Median age of onset was 25 years among women and 24 years among men. Onset in 50± of cases occurred before age 25 and in 75± before age 35 years. Four of every 10 women and two of every 10 men will contract migraine in their lifetime, most before age 35 years. The incidence estimates from this analysis are consistent with those reported in previous longitudinal studies.
Probable migraine (PM) is a prevalent migraine subtype fulfilling all but one criterion for migraine with or without aura. The aims of this study were: (i) to describe the epidemiology, medical ...recognition and patterns of treatment for PM in the USA; (ii) to compare the patterns of preventive PM treatment in the population with expert panel guidelines for preventive treatment. A validated self-administered headache questionnaire was mailed to a random sample of 120 000 US households. Subjects were classified as PM according to the second edition of the International Classification of Headache Disorders (ICHD-2). The questionnaire also assessed patterns of migraine treatment. Guidelines for preventive medication use were developed by a panel of headache experts, who used headache frequency and impairment to assess the need for preventive therapy and the gap between current and ideal use. Our sample consisted of 162 576 individuals aged ≥12 years. The 1-year period prevalence of PM was 4.5% (3.9% in men and 5.1% in women). In women and men, prevalence was higher in middle life, between the ages of 30 and 59 years. The prevalence of PM was significantly higher in African-Americans than in Whites (female 7.4% vs. 4.8%; male 4.8% vs. 3.7%) and inversely related to household income. During their headaches, most (48.2%) had at least some impairment, while 22.1% were severely disabled. The vast majority (97%) of PM sufferers used acute treatments, although 71% usually treated with over-the-counter medication. Most PM sufferers (52.8%) never used a migraine-preventive treatment and only 7.9% were currently using preventive medication. According to the expert panel guidelines, prevention should be offered (16.9%) or considered (11.5%) for 28.4% of the PM sufferers in the survey. We conclude that PM is a frequent, undertreated, sometimes disabling disorder. It has an epidemiological profile similar to migraine. In contrast to migraine, which is less prevalent in African-Americans than in Whites, PM is more prevalent in African-Americans than in Whites. In the USA, many with PM do not receive adequate treatment.
Objective
To develop and validate a questionnaire for assessing cutaneous allodynia (CA), and to estimate the prevalence and severity of CA in the migraine population.
Methods
Migraineurs (n = ...11,388) completed the Allodynia Symptom Checklist, assessing the frequency of allodynia symptoms during headache. Response options were never (0), rarely (0), less than 50% of the time (1), ≥50% of the time (2), and none (0). We used item response theory to explore how well each item discriminated CA. The relations of CA to headache features were examined.
Results
All 12 questions had excellent item properties. The greatest discrimination occurred with CA during “taking a shower” (discrimination = 2.54), wearing a necklace (2.39) or ring (2.31), and exposure to heat (2.1) or cold (2.0). The factor analysis demonstrated three factors: thermal, mechanical static, and mechanical dynamic. Based on the psychometrics, we developed a scale distinguishing no CA (scores 0–2), mild (3–5), moderate (6–8), and severe (≥9). The prevalence of allodynia among migraineurs was 63.2%. Severe CA occurred in 20.4% of migraineurs. CA was associated with migraine defining features (eg, unilateral pain: odds ratio, 2.3; 95% confidence interval, 2.0–2.4; throbbing pain: odds ratio, 2.3; 95% confidence interval, 2.1–2.6; nausea: odds ratio, 2.3; 95% confidence interval, 2.1–2.6), as well as illness duration, attack frequency, and disability.
Interpretation
The Allodynia Symptom Checklist measures overall allodynia and subtypes. CA affects 63% of migraineurs in the population and is associated with frequency, severity, disability, and associated symptoms of migraine. CA maps onto migraine biology. Ann Neurol 2007
The authors estimated the prevalence and severity of cutaneous allodynia (CA) in individuals with primary headaches from the general population.
We mailed questionnaires to a random sample of 24,000 ...headache sufferers previously identified from the population. The questionnaire included the validated Allodynia Symptom Checklist (ASC) as well as measures of headache features, disability, and comorbidities. We modeled allodynia as an outcome using headache diagnosis, frequency and severity of headaches, and disability as predictor variables in logistic regression. Covariates included demographic variables, comorbidities, use of preventive medication, and use of opioids.
Complete surveys were returned by 16,573 individuals. The prevalence of CA of any severity (ASC score >or=3) varied with headache type. Prevalence was significantly higher in transformed migraine (TM, 68.3%) than in episodic migraine (63.2%, p < 0.01) and significantly elevated in both of these groups compared with probable migraine (42.6%), other chronic daily headaches (36.8%), and severe episodic tension-type headache (36.7%). The prevalence of severe CA (ASC score >or=9) was also highest in TM (28.5%) followed by migraine (20.4%), probable migraine (12.3%), other chronic daily headaches (6.2%), and severe episodic tension-type headache (5.1%). In the migraine and TM groups, prevalence of CA was higher in women and increased with disability score. Among migraineurs, CA increased with headache frequency and body mass index. In all groups, ASC scores were higher in individuals with major depression.
Cutaneous allodynia (CA) is more common and more severe in transformed migraine and migraine than in other primary headaches. Among migraineurs, CA is associated with female sex, headache frequency, increased body mass index, disability, and depression.
Objective
In a population sample of persons with migraine treating with a single category of acute migraine medication, to identify rates and factors associated with acute treatment outcomes, ...including 2‐hour pain freedom (2hPF), 24‐hour pain response (24hPR), and 24‐hour sustained pain response (24hSPR). Key predictors include acute treatment type (triptans and other medication categories), the influence of allodynia on response to medication, and the interaction between medication category and presence of allodynia in response to treatment among people with migraine.
Background
Cutaneous allodynia was previously associated with inadequate 2hPF, 24hPR, and 24hSPR (sustained response at 24 hours among those with adequate 2hPF) among people with migraine in the American Migraine Prevalence and Prevention (AMPP) Study.
Methods
The AMPP Study obtained data from a representative US sample of persons with migraine by mailed questionnaire. The 2006 survey included 8233 people with migraine aged 18 or over who completed the Migraine Treatment Optimization Questionnaire (mTOQ). mTOQ was used to assess acute treatment outcomes including 2hPF, 24hPR, and 24hSPR. Eligible individuals used only a single category of acute prescription migraine treatments (n = 5236, 63.6%). This sample was stratified into 5 categories of type of acute prescription headache medication used (triptans, nonsteroidal anti‐inflammatory drugs, barbiturate‐combinations, opioids, and opioid combinations and ergot alkaloids). Separate binary logistic regression models evaluated: (1) triptans vs other medication types; (2) presence of allodynia vs no allodynia; and (3) the interaction of medication category with allodynia. Sociodemographic variables, health insurance status, over‐the‐counter and preventive medication use were included as covariates. Odds ratios (OR) and 95% confidence intervals (CI) were generated for each acute treatment outcome.
Results
Among eligible participants, the mean age was 46 years, and 82.5% were women. The triptan use group had better outcomes than other medication groups for 2hPF (OR range: 2.00‐2.63, all significant except ergot alkaloids) and 24hPR (OR range: 2.10‐6.22, all significant). No significant medication effects were found for the 24hSPR outcome. The presence of allodynia was associated with significantly worse outcomes for both 2hPF (OR range: 1.42‐1.55, all significant) and 24hPR (OR range: 1.30‐1.32, all significant, except for ergot alkaloids, P = .051). Allodynia effects were not significant for the 24hSPR. The interaction between medication and allodynia was also not significant (OR range for 2hPF: .68‐2.02; OR range for 2hPR: .35‐1.34; OR range for 24hSPR: 1.21‐2.72) in any of the models, suggesting allodynia is an important predictor of treatment response regardless of the medication group prescribed.
Conclusions
The use of triptan medication was associated with significantly better 2hPF (except vs ergot alkaloids) and significantly better 24hPR outcomes compared with other acute medication categories. The presence of allodynia significantly increased the likelihood of an inadequate treatment response for both of these outcomes. Triptan use was generally associated with the best outcomes. Because allodynia was associated with inadequate outcomes for all medication groups, we suggest that allodynia is an area of unmet treatment need.
Background
While nausea is a defining feature of migraine, the association of nausea with other headache features and its influence on the burden of migraine have not been quantified. ...Population‐based data were used to elucidate the relative frequency and burden of migraine‐associated nausea in persons with migraine.
Methods
Participants with episodic migraine who completed the 2009 American Migraine Prevalence and Prevention survey rated their headache‐related nausea as occurring none of the time, rarely, <half the time, or ≥half the time with their headaches. They also completed headache symptom severity and occupation/work status questions, the Headache Impact Test‐6, and treatment attitude items that were part of the 2009 survey. Regression models that adjusted for both sociodemographic characteristics and symptom severity were used to assess the influence of nausea frequency on outcome measures. Partial and semipartial correlational analyses were used to estimate the influence of nausea alone and in combination with other headache symptoms on headache‐related impact.
Results
Among the 6488 respondents with episodic migraine, approximately half (49.5%) reported high‐frequency nausea (ie, ≥half the time) with headache. High‐frequency nausea was more common in females than males (adjusted odds ratio 1.35, 95% confidence interval 1.26‐1.44). Persons with high‐frequency nausea, compared with the no/rare or less than half the time nausea groups, reported significantly more headache symptoms and more headache‐related impact as measured by the Headache Impact Test‐6. High‐frequency nausea was also associated with being occupationally disabled or on medical leave, and more self‐reported financial burden of headache medications, worry about running out of headache medication(s), and that headache medications interfered with work or school work, household work, and family/leisure activities. Regression‐based correlational analyses indicated that nausea contributes significantly and independently to headache‐related impact.
Conclusions
High‐frequency migraine‐associated nausea is common and is a marker for severe, debilitating migraine. Nausea makes an independent contribution to migraine‐associated disability and impact. Management strategies that take nausea into account could reduce the burden of migraine. Nausea is an important target for monitoring and treatment.
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.
To estimate the comparative prevalence of bipolar symptoms in respondents with epilepsy vs other chronic medical conditions.
The Mood Disorder Questionnaire (MDQ), a validated screening instrument ...for bipolar I and II symptoms, in conjunction with questions about current health problems, was sent to a sample of 127,800 people selected to represent the US adult population on selected demographic variables. A total of 85,358 subjects (66.8%) aged 18 or older returned the survey and had usable data. Subjects who identified themselves as having epilepsy were compared to those with migraine, asthma, diabetes mellitus, or a healthy comparison group with regard to relative lifetime prevalence rates of bipolar symptoms and past clinical diagnoses of an affective disorder.
Bipolar symptoms, evident in 12.2% of epilepsy patients, were 1.6 to 2.2 times more common in subjects with epilepsy than with migraine, asthma, or diabetes mellitus, and 6.6 times more likely to occur than in the healthy comparison group. A total of 49.7% of patients with epilepsy who screened positive for bipolar symptoms were diagnosed with bipolar disorder by a physician, nearly twice the rate seen in other disorders. However, 26.3% of MDQ positive epilepsy subjects carried a diagnosis of unipolar depression, and 25.8% had neither a uni- nor bipolar depression diagnosis.
Bipolar symptoms occurred in 12% of community-based epilepsy patients, and at a rate higher than in other medical disorders. One quarter were unrecognized.
In the present study, we assessed the functional impact of depressive versus manic symptoms in bipolar disorder.
A survey comprising the Sheehan Disability Scale (SDS), the Social Adjustment Scale ...Self-Report (SAS-SR), the Mood Disorder Questionnaire (MDQ), and other questions was mailed to a representative subset of 4810 individuals (with or without bipolar disorder) from a U.S. population-based epidemiologic study conducted in 2001.
Of the 3191 evaluable surveys returned, 593 respondents screened positive for bipolar disorder on the MDQ and/or reported a physician diagnosis of bipolar disorder. In the 4 weeks prior to the survey, subjects reported a mean of 12.4 days of depressive symptoms and 7.0 days of manic symptoms (p < .0001). The majority of days with depressive (79.8%) and manic (77.1%) symptoms were disruptive. Both total and mean scores on each domain of the SDS (work, social life, family life) reflect significantly greater impairment because of depressive versus manic symptoms during the 4 weeks prior to the survey (p < .0001). Among the 118 employed subjects who missed at least 1 day of work in the past month, more workdays were missed because of depressive versus manic symptoms (0.78 vs. 0.15, p < .004). For each domain of the SAS-SR, functional impairment was attributed significantly more often to depressive symptoms than manic symptoms (p < .0001). Similar results were observed for the 12 months preceding the survey.
Self-reported depressive symptoms are more frequent than manic symptoms and cause greater disruption of occupational, family, and social functioning. These findings underscore the need to improve the recognition and management of bipolar depression.
In blackwater systems of the southeastern US, dissolved organic carbon (DOC) contributes a major portion to the total dissolved organic matter pool. The primary DOC source is terrestrial vegetation, ...with phytoplankton contributing less. Thus, upland development may reduce terrestrial DOC inputs, thereby affecting bacterial abundances. Conversely, development and runoff may increase nitrogen (N) and phosphorus (P) inputs, fueling phytoplankton growth and algal-derived DOC. Yet, the variability of DOC, bacteria, and phytoplankton has not been fully assessed across diverse land uses. We investigated seasonal (July 2012 to May 2013) levels of DOC, bacteria, and phytoplankton biomass (chl a) in response to N and P additions at 4 coastal South Carolina sites: a forested/agricultural creek, an urbanized creek, a forested creek, and a detention pond. DOC concentrations were highest at the least developed site (forested creek), suggesting the influence of surrounding land. DOC was significantly and positively correlated with precipitation but negatively correlated with salinity, suggesting that rainfall affected DOC mobilization. Chl a was highest during summer and positively correlated with temperature, whereas bacterial abundances were generally negatively correlated with salinity. During experiments, chl a was often greater in addition treatments than controls, especially at the urbanized creek and detention pond. In certain N-amended treatments, particularly those containing urea, both DOC and chl a became elevated following incubation. These results indicate that urea stimulated phytoplankton biomass and possibly a greater contribution of phytoplankton-derived DOC to the total DOC pool. Our findings suggest that biogeochemical cycling of DOC may become altered in developing coastal regions.
PDF
