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Sociodemographic, disability, and employment differences between persons with chronic and episodic migraine: CaMEO (chronic migraine epidemiology & outcomes) study results
Abstracts / Journal of the Neurological Sciences 333 (2013) e481–e518
Vedanta Research, Chapel Hill, NC, USA; cMontefiore Medical Center, Bronx, NY, USA
doi:10.1016/j.jns.2013.07.1795
Abstract — WCN 2013 No: 1138 Topic: 8 — Headache The temporal relationship between daily stress and delayed modulation of chronic headache pain C.B. Clarka, R.J. Allenb. aNeuroscience, University of Puget Sound, Tacoma, WA, USA; bPhysical Therapy/Neuroscience, University of Puget Sound, Tacoma, WA, USA Background: Although triggers are known for headache pain, many chronic headache patients do not know what causes episodic pain fluctuations. Previous fibromyalgia and complex regional pain syndrome studies report ten-day delays in pain flare onset following stressful events. Delayed neuropathic pain flares are associated with stress-released thyroxine modulation, which has latent effects due to attachments with serum thyroxine-binding globulins. Objective: The temporal relationship between reported stress levels and episodic headache pain intensity was investigated to determine if chronic headache shows latent stress-related pain modulation. Patients and methods: Two female subjects diagnosed with chronic migraine completed pain and stress inventories daily across ten weeks. Pain was assessed using the Visual Analog Pain Scale, McGill Pain Questionnaire Short Form, and modified pain-body diagram. The Visual Analog Stress Scale quantified daily stress. Results: Serial lag correlations revealed the highest correlation between stress and pain to occur after a ten-day lag in subject 1 (r = +0.63, p b 0.005). Subject 2 showed a high negative correlation between stress and pain ten and eleven days later (r = −0.37 and r = − 0.46, respectively, p b 0.05). Conclusions: Patients manifested delayed pain changes following stress in diametrically opposed ways, where headache pain ten days later seemed to increase as a function of stress in one yet decreased in the other. This finding is consistent with existing literature on pain modulating effects from stress-related release of thyroxine, whereby some individuals increase thyroxine output as a result of psychogenic stress and others notably decrease thyroxine output.
TE
DP
Background: CaMEO, a prospective cohort study, collects longitudinal and cross-sectional data in migraineurs to characterize migraine clinical course, family burden, barriers to care, endophenotypes, and comorbidities. Objective: To describe the methodology and characterize the population in CaMEO. Methods: Migraineurs were recruited from a 2.4 million member webbased panel and demographically matched with the general population. Using ICHD-2 criteria, participants were divided into episodic (EM) or chronic migraine (CM) based on headache days/month. Participants complete surveys every 3 months for 1 year (starting fall 2012) and also recruit spouses/children in the household to assess familial migrainerelated burden. Baseline data includes headache features/frequency, comorbid depression/anxiety, medication use, healthcare consultation, disability, and quality of life. Results: Of 489,537 invitees, 80,783 (16.5%) responded to the screening survey. Eligible respondents (16,789; 3.4%) were invited into the 12month assessment and were ≥18 years old, spent an appropriate amount of time completing the survey (≥10 min), and had EM (n = 15,313; 91.2%) or CM (n = 1,476; 8.8%). Compared with nonrespondents, respondents were older (P b 0.0001), more likely to be women (P b 0.0001), white (P b 0.0001), or married (P b 0.0001), and less likely to be employed full/part time (P b 0.0001) or have incomes N$50,000 (P b 0.0001). Conclusion: CaMEO characterizes the course of EM and CM over 1 year in a community-based web panel of migraineurs. With repeated assessments, CaMEO data will quantify variations in headache frequency, disability, comorbidities, medication use, and familial impact, and can also be used to define migraine endophenotypes for future genetic studies. Disclosure: Funded by Allergan, Inc.
and whites (87.5% vs 83.3%, P b 0.001), experienced higher headacherelated disability (mean MIDAS, 60.5 vs 13.1; RR = 4.6, P b 0.001), completed fewer years of education (34.9% vs 45.9% had bachelor's degrees or higher; P b 0.001), were more likely to have individual and household incomes below the median (69.1% vs 59.1%; P b 0.001, and 59.8% vs 49.5%; P b 0.001, respectively), and less likely to be employed full- or part-time (56.4% vs 66.0%; P b 0.001). Conclusion: CM confers a greater financial and occupational burden than EM. Ongoing data collection will allow us to characterize the longitudinal course and consequences of CM and EM. Disclosure: Funded by Allergan, Inc.
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e508
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doi:10.1016/j.jns.2013.07.1794
RR
Abstract — WCN 2013 No: 898 Topic: 8 — Headache Sociodemographic, disability, and employment differences between persons with chronic and episodic migraine: CaMEO (chronic migraine epidemiology & outcomes) study results
CO
R.B. Liptona, D. Serranob, D.C. Busea, K. Fanningb, A.N. Manackc, M. Reedb. aMontefiore Medical Center, Bronx, NY, USA; b Vedanta Research, Chapel Hill, NC, USA; cAllergan, Inc., Irvine, CA, USA
UN
Background: Previous research suggests sociodemographic, headacherelated disability, and employment status differences between individuals with chronic migraine (CM) and episodic migraine (EM). Objective: To characterize sociodemographics, headache-related disability, and employment status among individuals with CM and EM in a large population-based sample. Methods: CaMEO prospectively recruited migraineurs from a 2.4 million member web-based panel, demographically matched with the general population. 16,789 of 80,783 (20.8%) respondents met ICHD-2-based definitions for CM (migraine diagnosis, ≥15 headache days/month) or EM and were eligible for inclusion. We used descriptive and inferential statistics to contrast those with CM and EM based on baseline survey responses. Results: Of the 16,789 eligible respondents, 1476 (8.8%) had CM and 15,313 (91.2%) had EM; these groups had comparable mean ages (40.6 y vs 41.0 y; P = 0.32). Compared with the EM group, the CM group had a greater proportion of women (81.1% vs 73.8%; P b 0.001)
doi:10.1016/j.jns.2013.07.1796
Abstract — WCN 2013 No: 1226 Topic: 8 — Headache Hemicrania epileptica IHS code 7.61 S. Dasyam. Neurology, SKS Neuro Hospital, Hyderabad, India Chronic headache of over a 3 month duration is a common disorder for which advice from a neurologist is invariably sought. Over 2500 cases of chronic headache seen between March 1998 and 2013 by
Vedanta Research, Chapel Hill, NC, USA; cMontefiore Medical Center, Bronx, NY, USA
doi:10.1016/j.jns.2013.07.1795
Abstract — WCN 2013 No: 1138 Topic: 8 — Headache The temporal relationship between daily stress and delayed modulation of chronic headache pain C.B. Clarka, R.J. Allenb. aNeuroscience, University of Puget Sound, Tacoma, WA, USA; bPhysical Therapy/Neuroscience, University of Puget Sound, Tacoma, WA, USA Background: Although triggers are known for headache pain, many chronic headache patients do not know what causes episodic pain fluctuations. Previous fibromyalgia and complex regional pain syndrome studies report ten-day delays in pain flare onset following stressful events. Delayed neuropathic pain flares are associated with stress-released thyroxine modulation, which has latent effects due to attachments with serum thyroxine-binding globulins. Objective: The temporal relationship between reported stress levels and episodic headache pain intensity was investigated to determine if chronic headache shows latent stress-related pain modulation. Patients and methods: Two female subjects diagnosed with chronic migraine completed pain and stress inventories daily across ten weeks. Pain was assessed using the Visual Analog Pain Scale, McGill Pain Questionnaire Short Form, and modified pain-body diagram. The Visual Analog Stress Scale quantified daily stress. Results: Serial lag correlations revealed the highest correlation between stress and pain to occur after a ten-day lag in subject 1 (r = +0.63, p b 0.005). Subject 2 showed a high negative correlation between stress and pain ten and eleven days later (r = −0.37 and r = − 0.46, respectively, p b 0.05). Conclusions: Patients manifested delayed pain changes following stress in diametrically opposed ways, where headache pain ten days later seemed to increase as a function of stress in one yet decreased in the other. This finding is consistent with existing literature on pain modulating effects from stress-related release of thyroxine, whereby some individuals increase thyroxine output as a result of psychogenic stress and others notably decrease thyroxine output.
TE
DP
Background: CaMEO, a prospective cohort study, collects longitudinal and cross-sectional data in migraineurs to characterize migraine clinical course, family burden, barriers to care, endophenotypes, and comorbidities. Objective: To describe the methodology and characterize the population in CaMEO. Methods: Migraineurs were recruited from a 2.4 million member webbased panel and demographically matched with the general population. Using ICHD-2 criteria, participants were divided into episodic (EM) or chronic migraine (CM) based on headache days/month. Participants complete surveys every 3 months for 1 year (starting fall 2012) and also recruit spouses/children in the household to assess familial migrainerelated burden. Baseline data includes headache features/frequency, comorbid depression/anxiety, medication use, healthcare consultation, disability, and quality of life. Results: Of 489,537 invitees, 80,783 (16.5%) responded to the screening survey. Eligible respondents (16,789; 3.4%) were invited into the 12month assessment and were ≥18 years old, spent an appropriate amount of time completing the survey (≥10 min), and had EM (n = 15,313; 91.2%) or CM (n = 1,476; 8.8%). Compared with nonrespondents, respondents were older (P b 0.0001), more likely to be women (P b 0.0001), white (P b 0.0001), or married (P b 0.0001), and less likely to be employed full/part time (P b 0.0001) or have incomes N$50,000 (P b 0.0001). Conclusion: CaMEO characterizes the course of EM and CM over 1 year in a community-based web panel of migraineurs. With repeated assessments, CaMEO data will quantify variations in headache frequency, disability, comorbidities, medication use, and familial impact, and can also be used to define migraine endophenotypes for future genetic studies. Disclosure: Funded by Allergan, Inc.
and whites (87.5% vs 83.3%, P b 0.001), experienced higher headacherelated disability (mean MIDAS, 60.5 vs 13.1; RR = 4.6, P b 0.001), completed fewer years of education (34.9% vs 45.9% had bachelor's degrees or higher; P b 0.001), were more likely to have individual and household incomes below the median (69.1% vs 59.1%; P b 0.001, and 59.8% vs 49.5%; P b 0.001, respectively), and less likely to be employed full- or part-time (56.4% vs 66.0%; P b 0.001). Conclusion: CM confers a greater financial and occupational burden than EM. Ongoing data collection will allow us to characterize the longitudinal course and consequences of CM and EM. Disclosure: Funded by Allergan, Inc.
OF
b
RO
e508
EC
doi:10.1016/j.jns.2013.07.1794
RR
Abstract — WCN 2013 No: 898 Topic: 8 — Headache Sociodemographic, disability, and employment differences between persons with chronic and episodic migraine: CaMEO (chronic migraine epidemiology & outcomes) study results
CO
R.B. Liptona, D. Serranob, D.C. Busea, K. Fanningb, A.N. Manackc, M. Reedb. aMontefiore Medical Center, Bronx, NY, USA; b Vedanta Research, Chapel Hill, NC, USA; cAllergan, Inc., Irvine, CA, USA
UN
Background: Previous research suggests sociodemographic, headacherelated disability, and employment status differences between individuals with chronic migraine (CM) and episodic migraine (EM). Objective: To characterize sociodemographics, headache-related disability, and employment status among individuals with CM and EM in a large population-based sample. Methods: CaMEO prospectively recruited migraineurs from a 2.4 million member web-based panel, demographically matched with the general population. 16,789 of 80,783 (20.8%) respondents met ICHD-2-based definitions for CM (migraine diagnosis, ≥15 headache days/month) or EM and were eligible for inclusion. We used descriptive and inferential statistics to contrast those with CM and EM based on baseline survey responses. Results: Of the 16,789 eligible respondents, 1476 (8.8%) had CM and 15,313 (91.2%) had EM; these groups had comparable mean ages (40.6 y vs 41.0 y; P = 0.32). Compared with the EM group, the CM group had a greater proportion of women (81.1% vs 73.8%; P b 0.001)
doi:10.1016/j.jns.2013.07.1796
Abstract — WCN 2013 No: 1226 Topic: 8 — Headache Hemicrania epileptica IHS code 7.61 S. Dasyam. Neurology, SKS Neuro Hospital, Hyderabad, India Chronic headache of over a 3 month duration is a common disorder for which advice from a neurologist is invariably sought. Over 2500 cases of chronic headache seen between March 1998 and 2013 by