Migraine Briefs

Mind and body cognitive behavioral therapy (CBT‐HA) relaxation skills emerged as popular and effective for pediatric migraine sufferers, based on patient and parent reports in a recent study. Qualitative interviews were conducted with 10 patients and 9 of their parents who had undergone CBT‐HA. Interviews were analyzed using an inductive thematic analysis approach based upon modified grounded theory. Patients were ranged in age from 13 to 17.5 years (median=15.4, standard deviation=1.63) and had undergone CBT‐HA about 1 to 2 years prior to participating in the study. Researchers found:

• Overall, patients and their parents reported that CBT‐HA was helpful in reducing headache frequency and related disability.
• Although patients provided mixed reports on the effectiveness of different CBT‐HA skills, the majority of patients indicated that the mind and body relaxation skills of CBT‐HA (deep breathing, progressive muscle relaxation, and activity pacing in particular) were the most helpful and most frequently used skills.
• Patients and parents also generally reported that treatment was easy to learn, and noted at least some aspect of treatment was enjoyable.

CBT for pediatric migraine: A qualitative study of patient and parent experience. Headache. 2018;58(5):661-675. doi:10.1111/head.13285.

Mind and body cognitive behavioral therapy (CBT‐HA) relaxation skills emerged as popular and effective for pediatric migraine sufferers, based on patient and parent reports in a recent study. Qualitative interviews were conducted with 10 patients and 9 of their parents who had undergone CBT‐HA. Interviews were analyzed using an inductive thematic analysis approach based upon modified grounded theory. Patients were ranged in age from 13 to 17.5 years (median=15.4, standard deviation=1.63) and had undergone CBT‐HA about 1 to 2 years prior to participating in the study. Researchers found:

• Overall, patients and their parents reported that CBT‐HA was helpful in reducing headache frequency and related disability.
• Although patients provided mixed reports on the effectiveness of different CBT‐HA skills, the majority of patients indicated that the mind and body relaxation skills of CBT‐HA (deep breathing, progressive muscle relaxation, and activity pacing in particular) were the most helpful and most frequently used skills.
• Patients and parents also generally reported that treatment was easy to learn, and noted at least some aspect of treatment was enjoyable.

CBT for pediatric migraine: A qualitative study of patient and parent experience. Headache. 2018;58(5):661-675. doi:10.1111/head.13285.

Mind and body cognitive behavioral therapy (CBT‐HA) relaxation skills emerged as popular and effective for pediatric migraine sufferers, based on patient and parent reports in a recent study. Qualitative interviews were conducted with 10 patients and 9 of their parents who had undergone CBT‐HA. Interviews were analyzed using an inductive thematic analysis approach based upon modified grounded theory. Patients were ranged in age from 13 to 17.5 years (median=15.4, standard deviation=1.63) and had undergone CBT‐HA about 1 to 2 years prior to participating in the study. Researchers found:

• Overall, patients and their parents reported that CBT‐HA was helpful in reducing headache frequency and related disability.
• Although patients provided mixed reports on the effectiveness of different CBT‐HA skills, the majority of patients indicated that the mind and body relaxation skills of CBT‐HA (deep breathing, progressive muscle relaxation, and activity pacing in particular) were the most helpful and most frequently used skills.
• Patients and parents also generally reported that treatment was easy to learn, and noted at least some aspect of treatment was enjoyable.

CBT for pediatric migraine: A qualitative study of patient and parent experience. Headache. 2018;58(5):661-675. doi:10.1111/head.13285.

Visual quality of life (QOL) is significantly adversely affected in migraine sufferers, according to a recent study. In fact, patients with chronic migraine may have visual QOL impacts that are as significant as those associated with other common neuro‐ophthalmic disorders. In this cross‐sectional quantitative survey, visual QOL in individuals with chronic and episodic migraine was assessed using the National Eye Institute Visual Function Questionnaire‐25, and the 10‐item National Eye Institute Visual Function Questionnaire‐25 Neuro‐Ophthalmic Supplement. Overall headache severity and impact was assessed using the Migraine‐specific Quality of Life Questionnaire and the Headache Impact Test‐6. Researchers found:

• Among 29 participants with chronic migraine, vision‐specific QOL scores were all statistically significantly decreased compared to disease‐free controls.
• Among 37 participants with episodic migraine, vision‐specific QOL scores were also decreased compared to disease‐free controls.
• Chronic migraineurs had decreased visual QOL scores compared to those with episodic migraines.
• Participants with chronic migraine had visual QOL scores that were as poor as those previously published for patients with other neuro‐ophthalmic disorders, such as multiple sclerosis, myasthenia gravis, and ischemic optic neuropathy.
   

Patients with migraine have substantial reductions in measures of visual quality of life. [Published online ahead of print June 7, 2018]. Headache. doi:10.1111/head.13330.

Visual quality of life (QOL) is significantly adversely affected in migraine sufferers, according to a recent study. In fact, patients with chronic migraine may have visual QOL impacts that are as significant as those associated with other common neuro‐ophthalmic disorders. In this cross‐sectional quantitative survey, visual QOL in individuals with chronic and episodic migraine was assessed using the National Eye Institute Visual Function Questionnaire‐25, and the 10‐item National Eye Institute Visual Function Questionnaire‐25 Neuro‐Ophthalmic Supplement. Overall headache severity and impact was assessed using the Migraine‐specific Quality of Life Questionnaire and the Headache Impact Test‐6. Researchers found:

• Among 29 participants with chronic migraine, vision‐specific QOL scores were all statistically significantly decreased compared to disease‐free controls.
• Among 37 participants with episodic migraine, vision‐specific QOL scores were also decreased compared to disease‐free controls.
• Chronic migraineurs had decreased visual QOL scores compared to those with episodic migraines.
• Participants with chronic migraine had visual QOL scores that were as poor as those previously published for patients with other neuro‐ophthalmic disorders, such as multiple sclerosis, myasthenia gravis, and ischemic optic neuropathy.
   

Patients with migraine have substantial reductions in measures of visual quality of life. [Published online ahead of print June 7, 2018]. Headache. doi:10.1111/head.13330.

Visual quality of life (QOL) is significantly adversely affected in migraine sufferers, according to a recent study. In fact, patients with chronic migraine may have visual QOL impacts that are as significant as those associated with other common neuro‐ophthalmic disorders. In this cross‐sectional quantitative survey, visual QOL in individuals with chronic and episodic migraine was assessed using the National Eye Institute Visual Function Questionnaire‐25, and the 10‐item National Eye Institute Visual Function Questionnaire‐25 Neuro‐Ophthalmic Supplement. Overall headache severity and impact was assessed using the Migraine‐specific Quality of Life Questionnaire and the Headache Impact Test‐6. Researchers found:

• Among 29 participants with chronic migraine, vision‐specific QOL scores were all statistically significantly decreased compared to disease‐free controls.
• Among 37 participants with episodic migraine, vision‐specific QOL scores were also decreased compared to disease‐free controls.
• Chronic migraineurs had decreased visual QOL scores compared to those with episodic migraines.
• Participants with chronic migraine had visual QOL scores that were as poor as those previously published for patients with other neuro‐ophthalmic disorders, such as multiple sclerosis, myasthenia gravis, and ischemic optic neuropathy.
   

Patients with migraine have substantial reductions in measures of visual quality of life. [Published online ahead of print June 7, 2018]. Headache. doi:10.1111/head.13330.

Less than one-third of eligible migraineurs were referred for behavioral treatment and only about half initiated behavioral migraine treatment in a recent prospective cohort study. Researchers compared patients who initiated behavioral migraine treatment following a provider recommendation with those who did not (demographics, migraine characteristics, and locus of control) with analysis of variance and chi-square tests. They found:

• Of the 234 eligible patients, 69 (29.5%) were referred for behavioral treatment.
• 53 (76.8%) patients referred for behavioral treatment were reached by phone.
• The mean duration from time of referral to follow-up was 76 (median 76, SD=45) days.
• 30 (56.6%) patients initiated behavioral migraine treatment.
• There was no difference in initiation of behavioral migraine treatment with regard to sex, age, age of diagnosis, years suffered with headaches, health care utilization visits, Migraine Disability Assessment Screen, and locus of control.
• Patients who had previously seen a psychologist for migraine were more likely to initiate behavioral migraine treatment than patients who had not.
• Time constraints were the most common barrier cited for not initiating behavioral migraine treatment.

Factors related to migraine patients’ decisions to initiate behavioral migraine treatment following a headache specialist’s recommendation: A prospective observational study. [Published online ahead of print June 5, 2018]. Pain Medicine. doi:10.1093/pm/pny028.

Less than one-third of eligible migraineurs were referred for behavioral treatment and only about half initiated behavioral migraine treatment in a recent prospective cohort study. Researchers compared patients who initiated behavioral migraine treatment following a provider recommendation with those who did not (demographics, migraine characteristics, and locus of control) with analysis of variance and chi-square tests. They found:

• Of the 234 eligible patients, 69 (29.5%) were referred for behavioral treatment.
• 53 (76.8%) patients referred for behavioral treatment were reached by phone.
• The mean duration from time of referral to follow-up was 76 (median 76, SD=45) days.
• 30 (56.6%) patients initiated behavioral migraine treatment.
• There was no difference in initiation of behavioral migraine treatment with regard to sex, age, age of diagnosis, years suffered with headaches, health care utilization visits, Migraine Disability Assessment Screen, and locus of control.
• Patients who had previously seen a psychologist for migraine were more likely to initiate behavioral migraine treatment than patients who had not.
• Time constraints were the most common barrier cited for not initiating behavioral migraine treatment.

Factors related to migraine patients’ decisions to initiate behavioral migraine treatment following a headache specialist’s recommendation: A prospective observational study. [Published online ahead of print June 5, 2018]. Pain Medicine. doi:10.1093/pm/pny028.

Less than one-third of eligible migraineurs were referred for behavioral treatment and only about half initiated behavioral migraine treatment in a recent prospective cohort study. Researchers compared patients who initiated behavioral migraine treatment following a provider recommendation with those who did not (demographics, migraine characteristics, and locus of control) with analysis of variance and chi-square tests. They found:

• Of the 234 eligible patients, 69 (29.5%) were referred for behavioral treatment.
• 53 (76.8%) patients referred for behavioral treatment were reached by phone.
• The mean duration from time of referral to follow-up was 76 (median 76, SD=45) days.
• 30 (56.6%) patients initiated behavioral migraine treatment.
• There was no difference in initiation of behavioral migraine treatment with regard to sex, age, age of diagnosis, years suffered with headaches, health care utilization visits, Migraine Disability Assessment Screen, and locus of control.
• Patients who had previously seen a psychologist for migraine were more likely to initiate behavioral migraine treatment than patients who had not.
• Time constraints were the most common barrier cited for not initiating behavioral migraine treatment.

Factors related to migraine patients’ decisions to initiate behavioral migraine treatment following a headache specialist’s recommendation: A prospective observational study. [Published online ahead of print June 5, 2018]. Pain Medicine. doi:10.1093/pm/pny028.

Abdominal migraine is a common cause of chronic and recurrent abdominal pain in children, according to a recent review. It is characterized by paroxysms of moderate to severe abdominal pain that is midline, periumbilical, or diffuse in location and accompanied by other symptoms including headache, anorexia, nausea, vomiting, or pallor. Despite the presence of comprehensive diagnostic criteria, it continues to be an underdiagnosed entity. Key points include:

• The average age of diagnosis is 3 to 10 years with peak incidence at 7 years.
• Most of the patients have a personal or family history of migraine.
• Pathophysiology of the condition is believed to be similar to that of other functional gastrointestinal disorders and cephalic migraine; it is also well recognized as a type of pediatric migraine variant.
• A careful history, thorough physical examination, and use of well-defined, symptom-based guidelines are needed to make a diagnosis.
• Although it resolves completely in most of the patients, these patients have a strong propensity to develop migraine later in life.
• Nonpharmacologic treatment options, including avoidance of triggers, behavior therapy, and dietary modifications should be the initial line of management.

Pediatric abdominal migraine: current perspectives on a lesser known entity. [Published online ahead of print April 24, 2018]. Pediatric Health Med Ther. doi:10.2147%2FPHMT.S127210.

Abdominal migraine is a common cause of chronic and recurrent abdominal pain in children, according to a recent review. It is characterized by paroxysms of moderate to severe abdominal pain that is midline, periumbilical, or diffuse in location and accompanied by other symptoms including headache, anorexia, nausea, vomiting, or pallor. Despite the presence of comprehensive diagnostic criteria, it continues to be an underdiagnosed entity. Key points include:

• The average age of diagnosis is 3 to 10 years with peak incidence at 7 years.
• Most of the patients have a personal or family history of migraine.
• Pathophysiology of the condition is believed to be similar to that of other functional gastrointestinal disorders and cephalic migraine; it is also well recognized as a type of pediatric migraine variant.
• A careful history, thorough physical examination, and use of well-defined, symptom-based guidelines are needed to make a diagnosis.
• Although it resolves completely in most of the patients, these patients have a strong propensity to develop migraine later in life.
• Nonpharmacologic treatment options, including avoidance of triggers, behavior therapy, and dietary modifications should be the initial line of management.

Pediatric abdominal migraine: current perspectives on a lesser known entity. [Published online ahead of print April 24, 2018]. Pediatric Health Med Ther. doi:10.2147%2FPHMT.S127210.

Abdominal migraine is a common cause of chronic and recurrent abdominal pain in children, according to a recent review. It is characterized by paroxysms of moderate to severe abdominal pain that is midline, periumbilical, or diffuse in location and accompanied by other symptoms including headache, anorexia, nausea, vomiting, or pallor. Despite the presence of comprehensive diagnostic criteria, it continues to be an underdiagnosed entity. Key points include:

• The average age of diagnosis is 3 to 10 years with peak incidence at 7 years.
• Most of the patients have a personal or family history of migraine.
• Pathophysiology of the condition is believed to be similar to that of other functional gastrointestinal disorders and cephalic migraine; it is also well recognized as a type of pediatric migraine variant.
• A careful history, thorough physical examination, and use of well-defined, symptom-based guidelines are needed to make a diagnosis.
• Although it resolves completely in most of the patients, these patients have a strong propensity to develop migraine later in life.
• Nonpharmacologic treatment options, including avoidance of triggers, behavior therapy, and dietary modifications should be the initial line of management.

Pediatric abdominal migraine: current perspectives on a lesser known entity. [Published online ahead of print April 24, 2018]. Pediatric Health Med Ther. doi:10.2147%2FPHMT.S127210.

Athletes with a pre-injury migraine history may be at an elevated risk for a protracted return to school after concussion, especially girls and women, according to a recent study. High school and collegiate athletes (n=1265; 42% female) who sustained a sport-related concussion were monitored by athletic trainers using a web-based surveillance system that collects information about concussion recovery. Researchers found:

• There were 117 athletes (9.2%) who reported a pre-injury migraine history.
• Athletes with a history of migraine took a median of 6 days to return to academics and 15.5 days to return to athletics, while those with no migraine history took a median of 5 days to return to academics and 14 days to return to athletics.
• There were no statistically significant differences in days to return to school or athletics between the groups.
• However, a lower percentage of athletes with a history of migraine had returned to school after 7 days, 14 days, and 21 days post-injury.
• Stratifying the analyses by sex showed that this effect was significant in girls and women with pre-existing migraines, but not boys and men with pre-existing migraines.

Pre-injury migraine history as a risk factor for prolonged return to school and sports following concussion. [Published online ahead of print May 5, 2018]. J Neurotrauma. doi:10.1089/neu.2017.5443.

Athletes with a pre-injury migraine history may be at an elevated risk for a protracted return to school after concussion, especially girls and women, according to a recent study. High school and collegiate athletes (n=1265; 42% female) who sustained a sport-related concussion were monitored by athletic trainers using a web-based surveillance system that collects information about concussion recovery. Researchers found:

• There were 117 athletes (9.2%) who reported a pre-injury migraine history.
• Athletes with a history of migraine took a median of 6 days to return to academics and 15.5 days to return to athletics, while those with no migraine history took a median of 5 days to return to academics and 14 days to return to athletics.
• There were no statistically significant differences in days to return to school or athletics between the groups.
• However, a lower percentage of athletes with a history of migraine had returned to school after 7 days, 14 days, and 21 days post-injury.
• Stratifying the analyses by sex showed that this effect was significant in girls and women with pre-existing migraines, but not boys and men with pre-existing migraines.

Pre-injury migraine history as a risk factor for prolonged return to school and sports following concussion. [Published online ahead of print May 5, 2018]. J Neurotrauma. doi:10.1089/neu.2017.5443.

Athletes with a pre-injury migraine history may be at an elevated risk for a protracted return to school after concussion, especially girls and women, according to a recent study. High school and collegiate athletes (n=1265; 42% female) who sustained a sport-related concussion were monitored by athletic trainers using a web-based surveillance system that collects information about concussion recovery. Researchers found:

• There were 117 athletes (9.2%) who reported a pre-injury migraine history.
• Athletes with a history of migraine took a median of 6 days to return to academics and 15.5 days to return to athletics, while those with no migraine history took a median of 5 days to return to academics and 14 days to return to athletics.
• There were no statistically significant differences in days to return to school or athletics between the groups.
• However, a lower percentage of athletes with a history of migraine had returned to school after 7 days, 14 days, and 21 days post-injury.
• Stratifying the analyses by sex showed that this effect was significant in girls and women with pre-existing migraines, but not boys and men with pre-existing migraines.

Pre-injury migraine history as a risk factor for prolonged return to school and sports following concussion. [Published online ahead of print May 5, 2018]. J Neurotrauma. doi:10.1089/neu.2017.5443.

Circadian misalignment and delayed sleep timing are associated with higher migraine frequency and severity that was not better accounted for by the amount of sleep, according to a recent study. Twenty women with chronic migraine (CM) and 20 age‐matched healthy controls (HC) completed a protocol that included a 7-day sleep assessment at home using wrist actigraphy followed by a circadian phase assessment using salivary melatonin. Researchers compared CM vs HC on sleep parameters and circadian factors. Subsequently, they examined associations between dim‐light melatonin onset (DLMO), the midpoint of the sleep episode, and the phase angle (time from DLMO to sleep midpoint) with the number of migraine days per month and the migraine disability assessment scale (MIDAS). They found:

• CM and HC did not differ on measures of sleep or circadian phase.
• Within the CM group, more frequent migraine days per month was significantly correlated with DLMO (r = .49) and later sleep episode (r = .47).
• In addition, a greater phase angle (ie, circadian misalignment) was significantly correlated with more severe migraine‐related disability (r = .48).
• These relationships remained significant after adjusting for total sleep time.

Can Circadian dysregulation exacerbate migraines? [Published online ahead of print May 4, 2018]. Headache. doi:10.1111/head.13310.

Circadian misalignment and delayed sleep timing are associated with higher migraine frequency and severity that was not better accounted for by the amount of sleep, according to a recent study. Twenty women with chronic migraine (CM) and 20 age‐matched healthy controls (HC) completed a protocol that included a 7-day sleep assessment at home using wrist actigraphy followed by a circadian phase assessment using salivary melatonin. Researchers compared CM vs HC on sleep parameters and circadian factors. Subsequently, they examined associations between dim‐light melatonin onset (DLMO), the midpoint of the sleep episode, and the phase angle (time from DLMO to sleep midpoint) with the number of migraine days per month and the migraine disability assessment scale (MIDAS). They found:

• CM and HC did not differ on measures of sleep or circadian phase.
• Within the CM group, more frequent migraine days per month was significantly correlated with DLMO (r = .49) and later sleep episode (r = .47).
• In addition, a greater phase angle (ie, circadian misalignment) was significantly correlated with more severe migraine‐related disability (r = .48).
• These relationships remained significant after adjusting for total sleep time.

Can Circadian dysregulation exacerbate migraines? [Published online ahead of print May 4, 2018]. Headache. doi:10.1111/head.13310.

Circadian misalignment and delayed sleep timing are associated with higher migraine frequency and severity that was not better accounted for by the amount of sleep, according to a recent study. Twenty women with chronic migraine (CM) and 20 age‐matched healthy controls (HC) completed a protocol that included a 7-day sleep assessment at home using wrist actigraphy followed by a circadian phase assessment using salivary melatonin. Researchers compared CM vs HC on sleep parameters and circadian factors. Subsequently, they examined associations between dim‐light melatonin onset (DLMO), the midpoint of the sleep episode, and the phase angle (time from DLMO to sleep midpoint) with the number of migraine days per month and the migraine disability assessment scale (MIDAS). They found:

• CM and HC did not differ on measures of sleep or circadian phase.
• Within the CM group, more frequent migraine days per month was significantly correlated with DLMO (r = .49) and later sleep episode (r = .47).
• In addition, a greater phase angle (ie, circadian misalignment) was significantly correlated with more severe migraine‐related disability (r = .48).
• These relationships remained significant after adjusting for total sleep time.

Can Circadian dysregulation exacerbate migraines? [Published online ahead of print May 4, 2018]. Headache. doi:10.1111/head.13310.

Mobile phone apps have the potential to improve medication adherence and are a promising intervention for adolescent and young adult patients with migraine who have demonstrated low adherence to treatment, according to a recent study. Involving parents in the intervention is also helpful. Thirty-five adolescents and young adults (aged 13 to 21 years) with migraine participated in an AB-design pilot study to assess the use of a mobile phone app and progressive reminder system. Adherence was calculated using electronic monitoring during the baseline period and medication adherence intervention. Researchers found:

• Relative to baseline, adherence significantly improved during the first month of the intervention.
• Specifically, improvements existed for older participants with lower baseline adherence.
• Self-reported app-based adherence rates were significantly lower than electronically monitored adherence rates.
• Participants rated the intervention as acceptable and easy to use.

A pilot investigation of a mobile phone application and progressive reminder system to improve adherence to daily prevention treatment in adolescents and young adults with migraine. [Published online ahead of print April 10, 2018]. Cephalalgia. doi:10.1177/0333102418756864.

Mobile phone apps have the potential to improve medication adherence and are a promising intervention for adolescent and young adult patients with migraine who have demonstrated low adherence to treatment, according to a recent study. Involving parents in the intervention is also helpful. Thirty-five adolescents and young adults (aged 13 to 21 years) with migraine participated in an AB-design pilot study to assess the use of a mobile phone app and progressive reminder system. Adherence was calculated using electronic monitoring during the baseline period and medication adherence intervention. Researchers found:

• Relative to baseline, adherence significantly improved during the first month of the intervention.
• Specifically, improvements existed for older participants with lower baseline adherence.
• Self-reported app-based adherence rates were significantly lower than electronically monitored adherence rates.
• Participants rated the intervention as acceptable and easy to use.

A pilot investigation of a mobile phone application and progressive reminder system to improve adherence to daily prevention treatment in adolescents and young adults with migraine. [Published online ahead of print April 10, 2018]. Cephalalgia. doi:10.1177/0333102418756864.

Mobile phone apps have the potential to improve medication adherence and are a promising intervention for adolescent and young adult patients with migraine who have demonstrated low adherence to treatment, according to a recent study. Involving parents in the intervention is also helpful. Thirty-five adolescents and young adults (aged 13 to 21 years) with migraine participated in an AB-design pilot study to assess the use of a mobile phone app and progressive reminder system. Adherence was calculated using electronic monitoring during the baseline period and medication adherence intervention. Researchers found:

• Relative to baseline, adherence significantly improved during the first month of the intervention.
• Specifically, improvements existed for older participants with lower baseline adherence.
• Self-reported app-based adherence rates were significantly lower than electronically monitored adherence rates.
• Participants rated the intervention as acceptable and easy to use.

A pilot investigation of a mobile phone application and progressive reminder system to improve adherence to daily prevention treatment in adolescents and young adults with migraine. [Published online ahead of print April 10, 2018]. Cephalalgia. doi:10.1177/0333102418756864.

No major racial/ethnic differences in abortive or prophylactic treatment for migraine were identified in a recent study that sought to determine if racial differences in quality of migraine medical prescription care exist. Researchers used data from the National Ambulatory Medical Care Survey to estimate differences in the use of migraine prophylactic and abortive medications by race. Patients were assigned to 1 of 4 categories representing the overall quality of evidence for their abortive and prophylactic medications. They found:

• 2860 visits were included in the study, representing approximately 50 million migraine visits in the US from 2006 to 2013.
• In all, 41.3% of African American (AA), 40.8% of non-Hispanic whites (NHW), and 41.2% of Hispanic (HI) patients received no prophylactic treatments.
• A total of 18.8% of AA patients, 11.9% of NHW patients, and 6.9% of HI patients received exclusively Level A prophylaxis.
• A total of 47.1% of AA patients, 38.2% of NHW patients, and 36.3% of HI patients received no abortive treatments.
• In total, 15.3% of AA patients, 19.4% of NHW patients, and 17.7% of HI patients received any Level A abortives.

Do racial/ethnic disparities exist in recommended migraine treatments in US ambulatory care? Cephalalgia. 2018;38(5):786-882. doi:10.1177/0333102417716933.

No major racial/ethnic differences in abortive or prophylactic treatment for migraine were identified in a recent study that sought to determine if racial differences in quality of migraine medical prescription care exist. Researchers used data from the National Ambulatory Medical Care Survey to estimate differences in the use of migraine prophylactic and abortive medications by race. Patients were assigned to 1 of 4 categories representing the overall quality of evidence for their abortive and prophylactic medications. They found:

• 2860 visits were included in the study, representing approximately 50 million migraine visits in the US from 2006 to 2013.
• In all, 41.3% of African American (AA), 40.8% of non-Hispanic whites (NHW), and 41.2% of Hispanic (HI) patients received no prophylactic treatments.
• A total of 18.8% of AA patients, 11.9% of NHW patients, and 6.9% of HI patients received exclusively Level A prophylaxis.
• A total of 47.1% of AA patients, 38.2% of NHW patients, and 36.3% of HI patients received no abortive treatments.
• In total, 15.3% of AA patients, 19.4% of NHW patients, and 17.7% of HI patients received any Level A abortives.

Do racial/ethnic disparities exist in recommended migraine treatments in US ambulatory care? Cephalalgia. 2018;38(5):786-882. doi:10.1177/0333102417716933.

No major racial/ethnic differences in abortive or prophylactic treatment for migraine were identified in a recent study that sought to determine if racial differences in quality of migraine medical prescription care exist. Researchers used data from the National Ambulatory Medical Care Survey to estimate differences in the use of migraine prophylactic and abortive medications by race. Patients were assigned to 1 of 4 categories representing the overall quality of evidence for their abortive and prophylactic medications. They found:

• 2860 visits were included in the study, representing approximately 50 million migraine visits in the US from 2006 to 2013.
• In all, 41.3% of African American (AA), 40.8% of non-Hispanic whites (NHW), and 41.2% of Hispanic (HI) patients received no prophylactic treatments.
• A total of 18.8% of AA patients, 11.9% of NHW patients, and 6.9% of HI patients received exclusively Level A prophylaxis.
• A total of 47.1% of AA patients, 38.2% of NHW patients, and 36.3% of HI patients received no abortive treatments.
• In total, 15.3% of AA patients, 19.4% of NHW patients, and 17.7% of HI patients received any Level A abortives.

Do racial/ethnic disparities exist in recommended migraine treatments in US ambulatory care? Cephalalgia. 2018;38(5):786-882. doi:10.1177/0333102417716933.

In patients with cryptogenic stroke who have migraine, there is a high prevalence (79%) of patent foramen ovale (PFO) with right-to-left shunt, according to a recent study. Furthermore, the timing of the stroke in migraineurs is usually not related to a migraine attack. Patients between the ages of 18 and 60 who presented with an ischemic stroke were characterized based on ASCOD (atherosclerosis, small vessel disease, cardiac pathology, other causes, dissection) phenotyping. A migraine diagnosis was identified by reviewing physician notes, and frequent aura was defined if present in at least 50% of attacks. A PFO with right-to-left shunt diagnosis was identified by the presence of a positive bubble contrast study. Researchers found:

• Of the 712 patients who presented with ischemic stroke, 127 (18%) were diagnosed as cryptogenic; 68 patients had adequate testing for PFO and a documented migraine history.
• The prevalence of PFO in patients with cryptogenic stroke without migraine was elevated (59%) compared with the general population (18%).
• Patients with both cryptogenic stroke and migraine had a higher prevalence of PFO (79%).

In patients with cryptogenic stroke who had migraine with frequent aura, the prevalence of PFO was 93%.

Frequency of patent foramen ovale and migraine in patients with cryptogenic stroke. [Published online ahead of print April 10, 2018]. Stroke. doi:10.1161/STROKEAHA.117.020160.

In patients with cryptogenic stroke who have migraine, there is a high prevalence (79%) of patent foramen ovale (PFO) with right-to-left shunt, according to a recent study. Furthermore, the timing of the stroke in migraineurs is usually not related to a migraine attack. Patients between the ages of 18 and 60 who presented with an ischemic stroke were characterized based on ASCOD (atherosclerosis, small vessel disease, cardiac pathology, other causes, dissection) phenotyping. A migraine diagnosis was identified by reviewing physician notes, and frequent aura was defined if present in at least 50% of attacks. A PFO with right-to-left shunt diagnosis was identified by the presence of a positive bubble contrast study. Researchers found:

• Of the 712 patients who presented with ischemic stroke, 127 (18%) were diagnosed as cryptogenic; 68 patients had adequate testing for PFO and a documented migraine history.
• The prevalence of PFO in patients with cryptogenic stroke without migraine was elevated (59%) compared with the general population (18%).
• Patients with both cryptogenic stroke and migraine had a higher prevalence of PFO (79%).

In patients with cryptogenic stroke who had migraine with frequent aura, the prevalence of PFO was 93%.

Frequency of patent foramen ovale and migraine in patients with cryptogenic stroke. [Published online ahead of print April 10, 2018]. Stroke. doi:10.1161/STROKEAHA.117.020160.

In patients with cryptogenic stroke who have migraine, there is a high prevalence (79%) of patent foramen ovale (PFO) with right-to-left shunt, according to a recent study. Furthermore, the timing of the stroke in migraineurs is usually not related to a migraine attack. Patients between the ages of 18 and 60 who presented with an ischemic stroke were characterized based on ASCOD (atherosclerosis, small vessel disease, cardiac pathology, other causes, dissection) phenotyping. A migraine diagnosis was identified by reviewing physician notes, and frequent aura was defined if present in at least 50% of attacks. A PFO with right-to-left shunt diagnosis was identified by the presence of a positive bubble contrast study. Researchers found:

• Of the 712 patients who presented with ischemic stroke, 127 (18%) were diagnosed as cryptogenic; 68 patients had adequate testing for PFO and a documented migraine history.
• The prevalence of PFO in patients with cryptogenic stroke without migraine was elevated (59%) compared with the general population (18%).
• Patients with both cryptogenic stroke and migraine had a higher prevalence of PFO (79%).

In patients with cryptogenic stroke who had migraine with frequent aura, the prevalence of PFO was 93%.

Frequency of patent foramen ovale and migraine in patients with cryptogenic stroke. [Published online ahead of print April 10, 2018]. Stroke. doi:10.1161/STROKEAHA.117.020160.