Clinic-Based Characterization of Adolescents and Young Adults With Migraine: Psychological Functioning, Headache Days, and Disability.

Background and Objectives: This cross-sectional observational study retrospectively examined clinical data collected from adolescents and young adults (AYAs) seeking care in a specialty headache clinic. We characterized participants' headache characteristics and psychological functioning and examined the association between self-reported anxiety and depressive symptoms and headache frequency, severity, and disability. Methods: During their clinic visit, AYAs (M age = 18.36; range = 14-32, 79.5% female) completed an intake questionnaire and reported about their headache characteristics (i.e., frequency, severity, and duration of symptoms in months), mental health history (i.e., previous diagnosis of an anxiety or depressive disorder), and utilization of emergency department (ED) services for migraine. AYAs also completed psychometrically validated screening tools for anxiety and depressive symptoms (i.e., the GAD-7 and PHQ-9). We computed descriptive statistics and examined associations among scores on psychological measures and headache characteristics, including migraine-related disability. We also tested whether individuals with clinically elevated GAD-7 and PHQ-9 scores had higher levels of disability relative to those with fewer/subclinical levels of anxiety and depressive symptoms. Results: Participants (N = 283) reported more than 19 headache days per month on average, with more than 90% describing their average headache intensity as moderate or severe. Nearly half of AYAs reported severe headache-related disability. Approximately one-quarter of AYAs reported a previous diagnosis anxiety or depressive disorder diagnosis, and more than one-third scored above clinical cutoffs on the PHQ-9 and GAD-7. Higher scores on both psychological screening instruments were associated with greater headache frequency. More than 10% of patients endorsed current suicidal ideation; this was not related to headache-related disability. Participants reported a high degree of ED utilization for headache; these rates were unrelated to endorsement of psychological comorbidities. Discussion: In this sample of AYAs, headache characteristics were generally unrelated to scores on measures on psychological functioning. However, the observed rates of clinically elevated anxiety/depressive symptoms and suicidality in this sample of AYAs underscore the importance of screening for psychological comorbidities in neurology clinics that serve this age group, irrespective of self-reported disability. Results also emphasize the need to expand access to behavioral health services for AYAs with headache disorders and the importance of incorporating a biopsychosocial perspective to the transition of health care from pediatrics to adult neurology practice.

Response to Mindfulness-Based Cognitive Therapy Differs Between Chronic and Episodic Migraine.

OBJECTIVE: Evaluate whether the benefits of Mindfulness-Based Cognitive Therapy for Migraine (MBCT-M) on headache disability differs among people with episodic and chronic migraine (CM). METHODS: This is a planned secondary analysis of a randomized clinical trial. After a 30-day baseline, participants were stratified by episodic (6-14 d/mo) and CM (15-30 d/mo) and randomized to 8 weekly individual sessions of MBCT-M or wait list/treatment as usual (WL/TAU). Primary outcomes (Headache Disability Inventory; Severe Migraine Disability Assessment Scale [scores ≥ 21]) were assessed at months 0, 1, 2, and 4. Mixed models for repeated measures tested moderation with fixed effects of treatment, time, CM, and all interactions. Planned subgroup analyses evaluated treatment*time in episodic and CM. RESULTS: Of 60 participants (MBCT-M N = 31, WL/TAU N = 29), 52% had CM. CM moderated the effect of MBCT-M on Severe Migraine Disability Assessment Scale, F(3, 205) = 3.68, p = 0.013; MBCT-M vs WL/TAU reduced the proportion of people reporting severe disability to a greater extent among people with episodic migraine (-40.0% vs -14.3%) than CM (-16.4% vs +8.7%). Subgroup analysis revealed MBCT-M (vs WL/TAU) significantly reduced Headache Disability Inventory for episodic (p = 0.011) but not CM (p = 0.268). CONCLUSIONS: MBCT-M is a promising treatment for reducing headache-related disability, with greater benefits in episodic than CM. TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov Identifier: NCT02443519. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that MBCT-M reduces headache disability to a greater extent in people with episodic than CM.

Factors Associated With, and Mitigation Strategies for, Health Care Disparities Faced by Patients With Headache Disorders.

OBJECTIVE: To review contemporary issues of health care disparities in headache medicine with regard to race/ethnicity, socioeconomic status (SES), and geography and propose solutions for addressing these disparities. METHODS: An Internet and PubMed search was performed and literature was reviewed for key concepts underpinning disparities in headache medicine. Content was refined to areas most salient to our goal of informing the provision of equitable care in headache treatment through discussions with a group of 16 experts from a range of headache subspecialties. RESULTS: Taken together, a multitude of factors, including racism, SES, insurance status, and geographical disparities, contribute to the inequities that exist within the health care system when treating headache disorders. Interventions such as improving public education, advocacy, optimizing telemedicine, engaging in community outreach to educate primary care providers, training providers in cultural sensitivity and competence and implicit bias, addressing health literacy, and developing recruitment strategies to increase representation of underserved groups within headache research are proposed as solutions to ameliorate disparities. CONCLUSION: Neurologists have a responsibility to provide and deliver equitable care to all. It is important that disparities in the management of headache disorders are identified and addressed.

The Impact of Parental Migraine on Children.

PURPOSE OF REVIEW: This review surveys our current understanding of the impact of parental migraine on children. Understanding the impact of migraine on others in a family unit is critical to describing the full burden of migraine and to developing psychosocial supportive interventions for patients and their families. RECENT FINDINGS: Having a parent with migraine is associated with several early developmental features including infant colic. Adolescent children of parents with migraine self-report their parent's migraine interferes with school and activities and events. Further, migraine is perceived to impact the relationship between the parent and child. Having a parent with migraine increases a child's risk of having migraine, and having more severe migraine disease. However, children with migraine whose parent also has migraine appear to receive more early and aggressive treatment. The impact of migraine extends beyond the parent with migraine and influences children across biological, psychological, and social domains.

The intersection of COVID-19, school, and headaches: Problems and solutions.

OBJECTIVE: To equip clinicians with recommendations specific to concerns related to the novel coronavirus disease 2019 (COVID-19), which impact the physical, emotional, and social health of youth with headache disorders. BACKGROUND: COVID-19 has affected societies on a global scale including children and youth with chronic headache disorders. Many concerns are predicted to arise in the 2020-2021 school year, whether classes are conducted in-person or virtually. METHODS: Clinical impressions were combined with a review of the literature, although limited due to the recent nature of this issue. RESULTS: We describe recommendations to support caregivers and youth as they face changes expected with the return to school in the fall of 2020. CONCLUSION: Although there are significant concerns for caregivers and youth with migraine given the context of changes related to the pandemic, there are many recommendations that can help minimize exacerbations of the physical, emotional, and social health of youth with chronic migraine.

Three-year-olds' spatial language comprehension and links with mathematics and spatial performance.

Early spatial skills predict the development of later spatial and mathematical skills. Yet, it is unclear how comprehension of the words that capture spatial relations, words like behind and under, might be associated with children's early spatial and mathematics skills. The current study addressed this question by conducting a moderated mediation model to test the potential moderating effects of group factors, such as socioeconomic status (SES) and gender, on the possible mediation of spatial language comprehension on the association between spatial skill and mathematics performance. In total, 192 3-year-olds were tested on a battery of assessments, including a novel Spatial Language Comprehension Task, a test of spatial skills (2- and 3-dimensional trials of the Test of Spatial Assembly [2D and 3D TOSA, respectively]), and a composite of 2 mathematical assessments. The results indicate that this novel Spatial Language Comprehension Task is a reliable measure useful for examining group differences and the early space-math link. Specifically, higher-SES preschoolers and females had higher spatial language comprehension compared with their lower-SES peers and males, respectively. These SES and gender disparities in spatial language comprehension are concerning, given the strong association between spatial language comprehension and mathematics skills. Additionally, spatial language comprehension mediated the association between spatial skill and mathematics performance for females only. Future work should examine the potential causal role that spatial language comprehension may have in concurrent and later spatial and mathematics skills. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Associations of 3-year-olds' block-building complexity with later spatial and mathematical skills.

Block-building skills at age 3 are related to spatial skills at age 5 and spatial skills in grade school are linked to later success in science, technology, engineering, and mathematics (STEM) fields (Wai, Lubinski, & Benbow, 2009; Wai, Lubinski, Benbow, & Steiger, 2010). Though studies have focused on block-building behaviors and design complexity, few have examined these variables in relation to future spatial and mathematical skills or have considered how children go about copying the model in detail. This study coded 3-year-olds' (N = 102) block-building behaviors and structural complexity on 3-D trials of the Test of Spatial Assembly (TOSA; Verdine, Golinkoff, Hirsh-Pasek, & Newcombe, 2017). It explored whether individual differences in children's building behaviors and the complexity of their designs related to accuracy in copying the model block structures or their spatial and mathematical skills at ages 4 and 5. Our findings reveal that block-building behaviors were associated with concurrent and later spatial skills while structural complexity was associated with concurrent and later spatial skills as well as concurrent mathematics skills. Future work might teach children to engage in the apparently successful block-building strategies examined in this research to evaluate a potential causal mechanism.

Does Mindfulness-Based Cognitive Therapy for Migraine Reduce Migraine-Related Disability in People with Episodic and Chronic Migraine? A Phase 2b Pilot Randomized Clinical Trial.

OBJECTIVE: The current Phase 2b study aimed to evaluate the efficacy of mindfulness-based cognitive therapy for migraine (MBCT-M) to reduce migraine-related disability in people with migraine. BACKGROUND: Mindfulness-based interventions represent a promising avenue to investigate effects in people with migraine. MBCT teaches mindfulness meditation and cognitive-behavioral skills and directly applies these skills to address disease-related cognitions. METHODS: Participants with migraine (6-30 headache days/month) were recruited from neurology office referrals and local and online advertisements in the broader New York City area. During the 30-day baseline period, all participants completed a daily headache diary. Participants who met inclusion and exclusion criteria were randomized in a parallel design, stratified by chronic migraine status, to receive either 8 weekly individual MBCT-M sessions or 8 weeks of waitlist/treatment as usual (WL/TAU). All participants completed surveys including primary outcome evaluations at Months 0, 1, 2, and 4. All participants completed a headache diary during the 30-day posttreatment evaluation period. Primary outcomes were the change from Month 0 to Month 4 in the headache disability inventory (HDI) and the Migraine Disability Assessment (MIDAS) (total score ≥ 21 indicating severe disability); secondary outcomes (headache days/30 days, average headache attack pain intensity, and attack-level migraine-related disability [Migraine Disability Index (MIDI)]) were derived from the daily headache diary. RESULTS: Sixty participants were randomized to receive MBCT-M (n = 31) or WL/TAU (n = 29). Participants (M age = 40.1, SD = 11.7) were predominantly White (n = 49/60; 81.7%) and Non-Hispanic (N = 50/60; 83.3%) women (n = 55/60; 91.7%) with a graduate degree (n = 35/60; 55.0%) who were working full-time (n = 38/60; 63.3%). At baseline, the average HDI score (51.4, SD = 19.0) indicated a moderate level of disability and the majority of participants (50/60, 83.3%) fell in the "Severe Disability" range in the MIDAS. Participants recorded an average of 16.0 (SD = 5.9) headache days/30 days, with an average headache attack pain intensity of 1.7 on a 4-point scale (SD = 0.3), indicating moderate intensity. Average levels of daily disability reported on the MIDI were 3.1/10 (SD = 1.8). For the HDI, mean scores decreased more from Month 0 to Month 4 in the MBCT-M group (-14.3) than the waitlist/treatment as an usual group (-0.2; P < .001). For the MIDAS, the group*month interaction was not significant when accounting for the divided alpha, P = .027; across all participants in both groups, the estimated proportion of participants falling in the "Severe Disability" category fell significantly from 88.3% at Month 0 to 66.7% at Month 4, P < .001. For diary-reported headache days/30 days an average headache attack pain intensity, neither the group*month interaction (Ps = .773 and .888, respectively) nor the time effect (Ps = .059 and .428, respectively) was significant. Mean MIDI scores decreased in the MBCT-M group (-0.6/10), whereas they increased in the waitlist/treatment as an usual group (+0.3/10), P = .007. CONCLUSIONS: MBCT-M demonstrated efficacy to reduce headache-related disability and attack-level migraine-related disability. MBCT-M is a promising emerging treatment for addressing migraine-related disability.

When Mom Has Migraine: An Observational Study of the Impact of Parental Migraine on Adolescent Children.

OBJECTIVE: The current study aimed to describe the impact of parental migraine on adolescent children (aged 11-17) living at home with a parent with migraine. BACKGROUND: Emerging evidence suggests that migraine impacts the family members of people with migraine. However, there has been little research to evaluate the perspective of the child of a parent with migraine. METHODS: This cross-sectional observational study included parents who met International Classification of Headache Disorders criteria for migraine and their 11-17-year-old children currently living with the parent with migraine recruited from neurologist offices and online. Parents completed measures of demographics, a diagnostic migraine criteria screener, parental illness impact (Parental Illness Impact Survey - Revised; subscales = Burden of Daily Help, Emotional Impact, Social Impact, Communication and Understanding, Impact on Personal Future, Friends Reactions, Parent/Child Relationship, and Global Well-Being), migraine-related disability (MIDAS), headache attack frequency, and headache attack pain intensity. Children completed measures of demographics, parental illness impact, and a migraine diagnostic screener if applicable. RESULTS: Children (n = 40) reported the greatest impact of their parent's migraine on the Global Well-Being (M = 3.3, SD = 0.9) and Parent/Child Relationship (M = 3.5, SD = 0.6) subscales. There were no significant differences between the average child and parent rating of parental migraine impact on children. Correlations between parent and child ratings of parental migraine impact were strongest for the Social Impact subscale (ρ = 0.55, P < .001), and non-significant for the Parent/Child Relationship (ρ = 0.13, P = .416) and Friends Reactions (ρ = 0.18, P = .257) subscales. Higher attack frequency and endorsing severe disability on the MIDAS were associated with higher child-rated impact (eg, lower scores) on Global Well-Being (frequency ρ = -0.35, P = .028; MIDAS t(38) = 2.74, P = .009) and Impact on Personal Future (frequency ρ = -0.41, P = .009; MIDAS t(35.7) = 2.49, P = .017) subscales. Higher attack pain intensity was associated with higher child-rated impact (eg, lower scores) on Burden of Daily Help (r = -0.34, P = .031) and Emotional Impact (r = -0.40, P = .010). Over half of children (23/40, 57.5%) reported some kind of service or intervention to help them manage the impact of their parent's migraine on their lives would be helpful. CONCLUSIONS: Parental migraine impacts children aged 11-17 living in the home, particularly in the domains of global well-being and the parent/child relationship. Parent and child reports are not strongly correlated across all domains of parental impact.

Effects of Geometric Toy Design on Parent-Child Interactions and Spatial Language.

Geometric forms have formal definitions. While knowing shape names is considered important for school-readiness, many children do not understand the defining features of shapes until well into elementary school (Satlow & Newcombe, 1998). One reason is likely that they do not encounter enough variety in the shapes they see (citation removed). The present study observed 60 parents and their 3-year-old children during play with geometric toys, exploring how spatial language varied with the nature of the shape-toy set (canonical shapes versus a mix of canonical and unusual or less-canonical variants) and whether geometric shapes were presented as tangible, traditional toys or shown on a touchscreen tablet app. Although children in the app condition heard more shape names than the other conditions due to the language produced by the app itself, children used more overall words and more spatial language with tangible toys that included varied shapes. In addition, parents used more shape names with sons than with daughters and tended to adjust their use of spatial language more in response to varied shape sets with boys, although these findings need replication to evaluate generality. These data suggest that including non-canonical shapes in tangible shape toys may provide a low-cost, high-impact way of refining adult-child interactions that might facilitate children's early geometric knowledge.