A meta-analytic review of acceptance-based interventions for migraine.

OBJECTIVE: To determine the efficacy of acceptance and mindfulness-based interventions on migraine disability, medication use, and attack frequency. BACKGROUND: Acceptance-based approaches to headache management are those in which individuals learn to mitigate the influence of pain-related experiences on their general functioning without controlling pain itself. Treatment approaches include acceptance and commitment therapy (ACT) and mindfulness-based practices. Both have shown promise in improving broad functioning and disability among individuals with headache. Despite a growing body of research examining acceptance-based interventions for headache broadly and migraine specifically, no meta-analytic review of ACT interventions for headache exists, and two meta-analytic reviews of mindfulness-based practices yielded conflicting results. METHODS: The present study aimed to systematically and quantitatively review the literature related to the efficacy of acceptance-based interventions among adults with migraine. A multi-database search (PubMed/MEDLINE, Scopus, PsycINFO, and the Cochrane Central Register of Controlled Trials) identified clinical trials among individuals with migraine that compared structured ACT or mindfulness-based interventions to control treatment. Random-effects meta-analyses were performed using RevMan 5.4 meta-analytic software, and standardized mean differences (SMD) with 95% confidence intervals (CIs) quantified effect sizes on outcomes of disability, medication use, and headache frequency. Heterogeneity was quantified via I2 index and explored via subgroup analyses. RESULTS: Acceptance-based interventions yielded significant improvements in disability (SMD = -0.38, 95% CI = -0.56 to -0.20; I2 = 25%, p = 0.20) but not in medication use (SMD = -0.25, 95% CI: -0.57 to 0.06; I2 = 0%, p = 0.82) or headache frequency (SMD = -0.16, 95% CI = -0.37 to 0.05; I2 = 0%, p = 0.73). CONCLUSION: Results suggest that acceptance-based interventions are effective in improving disability among adults with migraine and are a viable non-pharmacological treatment option, in addition to well-established behavioral migraine management approaches, for patients seeking functional improvement.

Allodynia and Disability in Migraine: The Mediating Role of Stress.

OBJECTIVE: This study sought to investigate the relationship between allodynia, psychological variables, and disability among individuals with migraine. BACKGROUND: A growing body of research views migraine as a condition of stress-related physiological dysregulation. Cutaneous allodynia is one manifestation of this dysregulation and affects a majority of individuals with migraine, though it is typically discussed in the context of headache pathophysiology. Stress, like allodynia, is implicated in the development of central sensitization and migraine progression. However, the contributions of stress and related psychological factors in allodynia and resulting disability remain largely unknown. METHODS: A cross-sectional study at a Southern U.S. university queried young adults with migraine regarding headache symptoms, disability, allodynia symptom frequency, and psychological variables using validated measures. Relations among allodynia and psychological variables of relevance were examined, including the association between allodynia and disability after controlling for pain severity. Subsequently, we assessed whether stress mediated the relationship between allodynia and disability. RESULTS: The final sample consisted of 147 young adults (87.8% [129/147] female, mean age = 19.0 ± 2.4) with an average headache frequency of 9.9 days per month (SD = 5.9). Increases in allodynia showed small associations with increases in stress, (r = 0.26, P = .001), fear of pain (r = 0.22, P = .008), and headache-related disability (r = 0.18, P = .003); and a small association with reduced self-efficacy (r = -0.16, P = .049). Allodynia significantly predicted disability even after controlling for pain severity (∆R2  = 0.02, P = .040), and the allodynia-disability relationship was mediated by stress (point estimate = 0.10, 95% CI [0.02-0.21]), such that as allodynia severity increased, stress increased and subsequent disability worsened. CONCLUSIONS: This study establishes meaningful relationships between allodynia and psychological variables of importance to headache self-management and adaptive coping. Allodynia exerts some effect on disability independent of pain itself, and this relationship is partially driven by stress. This study highlights the potential role of the stress response among those with allodynia, and further research is needed to determine if migraine interventions that target maladaptive stress responses may reduce disability by impeding the feedforward loop of allostatic load.

Alcohol Use as a Comorbidity and Precipitant of Primary Headache: Review and Meta-analysis.

PURPOSE OF REVIEW: In contrast to well-established relationships between headache and affective disorders, the role of alcohol use in primary headache disorders is less clear. This paper provides a narrative overview of research on alcohol use disorders (AUDs) in primary headache and presents a meta-analysis of the role of alcohol as a trigger (precipitant) of headache. RECENT FINDINGS: The majority of studies on AUDs in headache have failed to find evidence that migraine or tension-type headache (TTH) is associated with increased risk for AUDs or problematic alcohol use. The meta-analysis indicated that 22% (95% CI: 17-29%) of individuals with primary headache endorsed alcohol as a trigger. No differences were found between individuals with migraine (with or without aura) or TTH. Odds of endorsing red wine as a trigger were over 3 times greater than odds of endorsing beer. An absence of increased risk for AUDs among those with primary headache may be attributable to alcohol's role in precipitating headache attacks for some susceptible individuals. Roughly one fifth of headache sufferers believe alcohol precipitates at least some of their attacks. Considerable study heterogeneity limits fine-grained comparisons across studies and suggests needs for more standardized methods for studying alcohol-headache relationships and rigorous experimental designs.

Rat Palatability Study for Taste Assessment of Caffeine Citrate Formulation Prepared via Hot-Melt Extrusion Technology.

Developing a pediatric oral formulation with an age-appropriate dosage form and taste masking of naturally bitter active pharmaceutical ingredients (APIs) are key challenges for formulation scientists. Several techniques are used for taste masking of bitter APIs to improve formulation palatability; however, not all the techniques are applicable to pediatric dosage forms because of the limitations on the kind and concentration of the excipients that can be used. Hot-melt extrusion (HME) technology is used successfully for taste masking of bitter APIs and overcomes some of the limitations of the existing taste-masking techniques. Likewise, analytical taste assessment is an important quality control parameter evaluated by several in vivo and in vitro methods, such as the human taste panel, electrophysiological methods, electronic sensor, and animal preference tests to aid in selecting a taste-masked formulation. However, the most appropriate in vivo method to assess the taste-masking efficacy of pediatric formulations remains unknown because it is not known to what extent the human taste panel/electronic tongue can predict the palatability in the pediatric patients. The purpose of this study was to develop taste-masked caffeine citrate extrudates via HME and to demonstrate the wide applicability of a single bottle-test rat model to record and compare the volume consumed of the taste-masked solutions to that of the pure API. Thus, this rat model can be considered as a low-cost alternative taste-assessment method to the most commonly used expensive human taste panel/electronic tongue method for pediatric formulations.