Primary headaches among gender dysphoric female-to-male individuals: A cross-sectional survey on gender transition experience.

OBJECTIVE: To investigate the frequency, attack characteristics, and treatment experiences of migraine and tension-type headache (TTH) among gender dysphoric female-to-male (FtM) participants as well as in relation to psychiatric comorbidities and real-life experience that relates to being transgender in Turkey. BACKGROUND: There are only a few publications to date on transgender individuals with headache. Further studies to understand the distinctive needs might provide better management. METHODS: A total of 88 gender dysphoric FtM individuals (mean (SD) age: 24.8 (5.7) years) were included on a voluntary basis in this cross-sectional survey. Each participant filled out the questionnaire form that elicited items on sociodemographic characteristics, Gender Identity Transition Inventory, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Headache Questionnaire. RESULTS: Overall, 32/88 (36.4%; 95% confidence interval [CI]: 27.0%-47.0%) participants were diagnosed with migraine, and 36/88 (40.9%; 95% CI: 31.5%-52.3%) participants were diagnosed with TTH. High rates of unemployment, smoking, and social drinking were observed in our sample compared with the general population in Turkey. The three-item ID migraine screener was positive in 20.5% (18/88 patients) of our population. Patients with migraine in comparison with patients with TTH had statistically significantly higher BDI [12.0 (1-50) vs. 7.0 (0-33); p = 0.013] and BAI [13 (1-48) vs. 5 (0-22); p = 0.016] scores, longer headaches in the past month [median 3 vs. 1 day; p < 0.001], higher Numerical Rating Scale scores for headache severity [7 (2-10) vs. 5 (1-9), p < 0.001], and higher likelihood of menstruation acting as a triggering factor [8/32 patients (25.0%) vs. 0/36 patients (0.0%); p = 0.001] as well as increased rates of previously given diagnosis by a physician [15/32 patients (46.9%) vs. 4/36 patients (11.1%); p < 0.001], a greater number of neuroimaging tests being performed [12/32 patients (37.5%) vs. 3/36 patients (9.1%); p = 0.012], and a higher rate of emergency room utilization [7/32 patients (21.9%) vs. 1/36 patients (2.8%); p = 0.039] for headache. CONCLUSIONS: In the FtM transgender population we investigated, migraine and TTH were quite common. The screening and early recognition of comorbid migraine, as well as the comorbid depression and anxiety, seem to be important in gender dysphoric FtM individuals. Further studies are needed to better understand the potential interaction of migraine with comorbid psychiatric disorders and the prevalence of headache types and gender-affirmative hormone treatment outcomes in the transgender population.

OnabotulinumtoxinA effectiveness on chronic migraine, negative emotional states and sleep quality: a single-center prospective cohort study.

BACKGROUND: OnabotulinumtoxinA (OnabotA) is considered effective in in patients with chronic migraine (CM) who failed on traditional therapies. This study was designed to evaluate the effect of OnabotA injection series on migraine outcome, negative emotional states and sleep quality in patients with CM. METHODS: A total of 190 patients with CM (mean (SD) age: 39.3 (10.2) years; 87.9% were female) were included. Data on Pittsburgh sleep quality index (PSQI), headache frequency and severity, number of analgesics used, Migraine Disability Assessment Scale. (MIDAS) scores and Depression, Anxiety and Stress Scale (DASS-21) were evaluated at baseline (visit 1) and 4 consecutive follow up visits, each conducted after OnabotA injection series; at week 12 (visit 2), week 24 (visit 3), week 36 (visit 4) and week 48 (visit 5) to evaluate change from baseline to follow up. RESULTS: From baseline to visit 5, significant decrease was noted in least square (LS) mean headache frequency (from 19.5 to 8.4, p = 0.002), headache severity (from 8.1 to 6.1, p = 0.017), number of analgesics (from 26.9 to 10.4, p = 0.023) and MIDAS scores (from 67.3 to 18.5, p < 0.001). No significant change from baseline was noted in global PSOI and DASS-21 scores throughout the study. CONCLUSIONS: Our findings revealed that OnabotA therapy was associated with significant improvement in migraine outcome leading to decrease in headache frequency and severity, number of analgesics used and MIDAS scores. While no significant change was noted in overall sleep quality and prevalence of negative emotional states, patients without negative emotional states at baseline showed improved sleep quality throughout the study.

Reliability and Validity of Turkish Version of Headache Impact Test (HIT-6) in Patients with Migraine.

INTRODUCTION: The Headache Impact Test (HIT-6) is a self-report questionnaire designed to evaluate the impact of headache on quality of life. The aim of this study is to assess reliability and validity of Turkish version of HIT-6 questionnaire in patients with migraine. METHODS: A total of 114 patients with migraine were included in this multicenter, prospective, descriptive study conducted at two consecutive visits 4 weeks apart. Comprehensibility, patient-physician reliability, internal consistency, test-retest reliability and validity of the translated HIT-6 were analyzed. RESULTS: Patients identified that HIT-6 items were "well-understood" in both visit 1 (ranged from 88.6% to 95.7%) and visit 2 (ranged from 93.0% to 98.2%). A highly positive correlation (R=0.876, p<0.001) was noted between visit 1 scores related to self-administered and physician-administered HIT-6 scores. Internal consistency analyzed via Cronbach's α values for visit 1 and visit 2 HIT-6 scores in all patients were 0.753 (acceptable) and 0.864 (excellent), respectively. HIT-6 scores of patients (64.13 (6.20) and 62.70 (7.04), at visits 1 and 2, respectively, p=0.07) showed a moderate test-re-test reliability (R=0.437, p=0.0004). The HIT-6 score positively correlated with visit 1 and visit 2 headache severity-Likert scale (R=0.451 and 0.478, respectively, p<0.001) and VAS (R=0.365 and 0.531, respectively p<0.001) scores, and with visit 2 headache days for a month (R=0.215, p=0.022). CONCLUSION: These results demonstrated that the Turkish translation is equivalent to English version of HIT-6 in terms of internal consistency and it has moderate test-retest reliability and validity as correlated with headache severity, VAS and headache days for a month.

Relationship between MIDAS, depression, anxiety and alexithymia in migraine patients.

The co-existence of psychiatric comorbidities with migraine is well known; however, the relationship between alexithymia and migraine has not been persuasively shown yet. The aim of the study was to assess the relationships between migraine-related disability, depression, anxiety and alexithymia. One hundred and forty-five migraine patients (33.18 ± 8.6; 111 females, 34 males), and 50 control subjects (29.06 ± 7.6; 34 females, 16 males) were prospectively enrolled for the study. The participants completed a demographic data form and Migraine Disability Assessment Scale, Beck Depression Inventory, Beck Anxiety Inventory and Toronto Alexithymia Score-20 (TAS-20). All migraine patients were more depressive (p = 0.01) and anxious (p = 0.001) than the healthy subjects. TAS-20 scores of the migraine sufferers and the control group did not indicate alexithymia. The migraine-related disability of all migraine patients was severe (27.84 ± 29.22). Depression and anxiety scores in the migraine patients were highly correlated with each other and TAS-20 (r = 0.485, p = 0.001) and all its subscales in turn: difficulty in identifying (r = 0.435, p < 0.001) and describing feelings (r = 0.451, p = 0.001) and externally oriented thinking (r = 0.302, p = 0.001). Moreover, logistic regression analysis revealed that depression and anxiety predicted alexithymia. Our findings showed a complex relationship between migraine, depression, anxiety and alexithymia. On the other hand, alexithymia apparently was not directly connected to migraine, but its presence could be predicted in migraine patients because of co-morbid depression and anxiety.

A single-center retrospective study of onabotulinumtoxinA for treatment of 245 chronic migraine patients: survey results of a real-world experience.

Preventive treatment in migraine is associated with poor adherence and persistence. In this observational study, our first aim was to evaluate the perceived effectiveness of onabotulinumtoxinA based on our chronic migraine (CM) patients' treatment experience. The second purpose of this study was to determine the compliance with onabotulinumtoxinA treatment in our cohort. Third, we assessed the reasons for withdrawal from treatment in our CM patients. A total of 245 consecutive patients with CM (40.43 ± 10.15 years; 214 females, 31 males) were treated with at least one onabotulinumtoxinA. Data were collected by a standardized interview over the telephone. One-hundred and eighty patients were willing to answer questions about: (1) perceived effectiveness of onabotulinumtoxinA based on their treatment experience; (2) the current continuity of the treatment; (3) their current migraine-related disability; and (4) their current medication usage. The mean number of onabotulinumtoxinA cycles of all patients and the participants were 2.58 and 2.90, respectively. Of the 180 participants, 149 patients (82.8%) thought that onabotulinumtoxinA was effective in controlling their headaches. The mean score for perceived effectiveness of onabotulinumtoxinA treatment given by the participants was as 6.94 ± 2.4 (on a scale from 0 to 10). Of the 245 treated subjects, 31 (12.6%) were treated for 12 months. Compliance rates with onabotulinumtoxinA were very low in our population. However, even CM patients who did not complete five cycles of the treatment showed marked improvement of their current migraine-related disability and reduction of their medication intake as compared to baseline.