In the study, the team randomized 135 participants ages 10 to 17 diagnosed with chronic migraine with a Pediatric Migraine Disability Assessment Score (PedMIDAS) greater than 20 points to CBT (n = 64) or headache education (n = 71). Interventions consisted of 10 CBT or 10 headache education sessions involving equivalent time and therapist attention; CBT included training in pain coping, including a biofeedback component. Each group received amitriptyline. Follow-up visits were conducted at three, six, nine, and 12 months. At 12-month follow-up, 86% of CBT participants had a 50% or greater reduction in days with headache versus 69% of the headache education group; 88% of CBT participants had a PedMIDAS of less than 20 points (mild to no disability) versus 76% of the headache education group.
“While this is very good news as a study finding, translating this into clinical practice in treating young people with chronic migraine is an enormous challenge,” said Lawrence Newman, MD, President of the American Headache Society. “Treatment specialists will need to find ways to overcome adolescent resistance to behavioral therapy and insurance coverage issues for add-on treatment,” he said.
Women With Migraine Experience More Headaches During the Menopausal Transition
Migraine attack frequency is higher in women during perimenopause and menopause than in premenopause, according to investigators.
“Ours is the first study to demonstrate that the frequency of migraine attacks increases during the menopausal transition,” said first author Vincent T. Martin, MD, Codirector of the University of Cincinnati Headache and Facial Pain Program and Professor of Medicine in the Department of Internal Medicine, University of Cincinnati, and colleagues.
The research was conducted as part of the American Migraine Prevalence and Prevention (AMPP) study, a longitudinal, mailed questionnaire survey of 120,000 US households selected to be representative of the US population. Based on data from the 2006 AMPP study survey, women with migraine between the ages of 35 and 65 were eligible for these analyses. Women with migraine were classified based on headache frequency into a high frequency group if they experienced 10 or more headache days per month and into a low or moderate frequency episodic migraine group if they had fewer than 10 days per month. Women were also classified as premenopausal, perimenopausal, or postmenopausal (absent menstrual periods for at least 12 months) based on responses to the questionnaire.
Of 3,603 eligible women, the mean age was 45, and 34% were premenopausal, 35% were perimenopausal, and 30% were menopausal. Frequent headache (10 or more days per month) was 50% to 60% more common among perimenopausal (12.2%) and menopausal (12.0%) women, compared with the premenopausal group (8.0%).
“Given that migraines tend to worsen during menstruation, it may seem paradoxical that when periods become irregular during perimenopause or absent during menopause that headache became more frequent,” said Richard B. Lipton, MD, Professor of Neurology and Director of the Montefiore Headache Center at the Albert Einstein College of Medicine. “We believe that both declining estrogen levels that occur at the time of menstruation, as well as low estrogen levels that are encountered during the menopause, are triggers of migraine in some women,” he said.
“These results validate the belief by many women that their headaches worsen during the transition into menopause,” Dr. Martin said. “We hope that our work spurs researchers to develop novel treatments for migraine during this time period, given that many of the headaches encountered are thought to be hormonally triggered.”
Retired NFL Players With Headache Lack Access to Adequate Treatment
National Football League (NFL) alumni have a significantly higher incidence and frequency of headache, migraine, and chronic migraine when compared with the general population, but lack access to care, investigators reported.
“The players we examined were not receiving standard headache treatment,” said lead author Frank Conidi, DO, MS, Sports Neurologist and Headache and Concussion Specialist at Florida State University College of Medicine and Florida Center for Headache and Sports Neurology in Palm Beach Gardens, Florida, and colleagues. “In fact, they lacked access to both neurologists and headache specialists, despite an increased incidence of concussion and headache frequency.”
Retired players in the study were between the ages of 30 and 43 (mean age 36.67), had played an average of 4.3 years (range, two to nine years), and had an average of 7.33 concussions (± 5.2, maximum 15). They experienced a mean of 24 headache days per month. Of these, 14.6 headaches were rated as severe and met the International Headache Society (IHS) criteria for migraine; 43% met IHS criteria for chronic migraine. Half of the retired players were currently using narcotic pain medication (not specifically for headache), but only one was taking a migraine-specific abortive medication. Neuropsychologic testing demonstrated significant abnormalities in attention and concentration (66%), executive function (50%), learning and memory (50%), and spatial and perceptual function (33%). Three players had abnormalities on advanced brain imaging that indicated permanent brain injury.