Migraines and Family Life: Adaptation and Validation of the Portuguese Version of the IMPAC Scale / Las migrañas y la vida familiar: adaptación y validación de la versión portuguesa de la escala IMPAC

Migraine is a prevalent disorder imposing a great, pervasive burden on the bearer’s life. However, research is lacking on the individual and family impact of migraines. This study aims to adapt and validate a Portuguese version of the Impact of Migraine on Partners and Adolescent Children (IMPAC) scale, analyzing its psychometric properties. Four hundred eighty six individuals with migraines answered an online questionnaire, also containing a health-related quality of life measure – SF-12. The IMPAC-P presented good psychometric properties and fit of the theoretical model with three underlying factors – Activity Limitations, Partner Interaction, and Children Interaction. The impact of migraines was higher in women, single or widowed individuals, and those aged 21 to 40, exhibiting a significant and negative correlation with SF-12. The IMPAC-P is a brief, valid, reliable, and sensitive tool for assessing the impact of migraines on the bearer’s life and family in both clinical and research contexts. (AU)

La migraña es un trastorno prevalente que impone una carga grande y generalizada en la vida del que la sufre. No obstante, falta investigación acerca de la repercusión individual y familiar de la misma. El estudio adapta y valida la versión portuguesa de la escala sobre Repercusión de la Migraña en la Pareja e Hijos Adolescentes (IMPAC según sus siglas en inglés), analizando sus propiedades psicométricas. Una muestra de 456 sujetos que padecían migrañas contestó al cuestionario online, que incluía igualmente una medida de calidad de vida relativa a la salud (la SF-12). La escala presenta buenas propiedades psicométricas y un buen ajuste al modelo teórico, con tres factores subyacentes (limitaciones de la actividad, interacción de pareja e interacción entre los hijos). El impacto de las migrañas era superior en las mujeres y personas solteras o viudas así como en las personas de entre 21 y 40 años de edad, habiendo una correlación negativa significativa con la SF-12. Se trata de una herramienta breve, válida, fiable y sensible para evaluar el efecto de las migrañas en la vida de quien las sufre y de la familia, tanto en contextos clínicos como de investigación. (AU)

Cognitive Behavioral Therapy for the Management of Episodic Migraine.

PURPOSE OF REVIEW: This article provides an overview of the application of CBT in the management of episodic migraine while also providing context and insight into the underlying neurophysiological mechanisms of therapeutic change. It discusses the theoretical foundations of CBT and highlights key components including education, cognitive restructuring, behavioral interventions, relaxation techniques, and lifestyle changes. RECENT FINDINGS: Cognitive behavioral therapy (CBT) is an empirically based treatment that is well suited for the management of episodic migraine. Although first-line treatments of migraine are typically pharmacological, a review of empirical literature suggests growing evidence for the use of CBT as a standard non-pharmacological treatment of headache conditions. In summary, this article explores evidence supporting the efficacy of CBT in reducing the frequency, intensity, and duration of migraine attacks as well as improving the quality of life and psychological well-being of those with episodic migraine.

Conceptualising migraine attacks from a biopsychosocial model using qualitative and functional behavioural analysis.

OBJECTIVE: The aim of this study was to explore patients' experiences and management of pain in connection with a migraine attack in episodic migraine. DESIGN, SETTING AND SUBJECTS: This qualitative study used a semi-structured interview format based on functional behavioural analysis as commonly used in cognitive behavioural therapy. We interviewed eight participants and analysed their responses using systematic text condensation. RESULTS: Participants' descriptions of their experiences and management of pain from episodic migraine were sorted into three description First physical sensations, Automatic reactions and Acts according to the interpretation. CONCLUSION: From a biopsychosocial perspective, a migraine attack is much more complex than just an experience of pain. The purely biological pain prompts a number of automatic reactions leading to strategies for pain management.

Functional behavioural analysis can increase our understanding of experiences during a migraine attack from a biopsychosocial pain perspective.Several pain mechanisms appear to be relevant during the experience of a migraine attack than are described in the diagnostic criteria for migraine.Pain management consists of a chain of behaviours, approaches to the migraine attack and medication and the consequences of pain management.Knowledge and understanding of patients' experiences of pain and pain management during a migraine attack is an important tool in the biopsychosocial model.

Psychological Approaches for Migraine Management.

Migraine headaches are among the most prevalent and disabling pain conditions worldwide. Best-practice migraine management is multidisciplinary and includes the psychological approaches to address cognitive, behavioral, and affective factors that worsen pain, distress, and disability. The psychological interventions with the strongest research support are relaxation strategies, cognitive-behavioral therapy, and biofeedback, though the quality of clinical trials for all psychological interventions needs continued improvement. The efficacy of psychological interventions may be improved by validating technology-based delivery systems, developing interventions for trauma and life stress, and precision medicine approaches matching treatments to patients based on specific clinical characteristics.

The Objective Assessment of Event-Related Potentials: An Influence of Chronic Pain on ERP Parameters.

The article presents an original method for the automatic assessment of the quality of event-related potentials (ERPs), based on the calculation of the coefficient ε, which describes the compliance of recorded ERPs with some statistically significant parameters. This method was used to analyze the neuropsychological EEG monitoring of patients suffering from migraines. The frequency of migraine attacks was correlated with the spatial distribution of the coefficients ε, calculated for EEG channels. More than 15 migraine attacks per month was accompanied by an increase in calculated values in the occipital region. Patients with infrequent migraines exhibited maximum quality in the frontal areas. The automatic analysis of spatial maps of the coefficient ε demonstrated a statistically significant difference between the two analyzed groups with different means of migraine attack numbers per month.

The relationship between meaning of life, perceived social support, spiritual well-being and pain catastrophizing with quality of life in migraine patients: the mediating role of pain self-efficacy.

BACKGROUND: Migraine is a neurological disease that has several physical and psychological complications, which is characterized by disability and impaired quality of life. AIMS: The aim of this study was to explore the mediating role of pain self-efficacy in the relationship between meaning of life, perceived social support, spiritual well-being and pain catastrophizing with quality of life in migraine sufferers. The relationship between these factors with quality of life (QOL) was not fully explored in migraine patients. METHOD: This study was a correlational study of structural equations. Therefore, 300 patients with migraine who referred to one of the specialized neurological treatment centers in Zanjan in 2021 were recruited based on the inclusion criteria. Patients also completed the World Health Organization Quality of Life Scale (WHOQOL-BREF), Meaning in Life Questionnaire, Multidimensional Scale of Perceived Social Support, Spiritual Well-Being Scale, Pain Catastrophizing Scale, Pain Self-Efficacy Questionnaire. Finally, the hypotheses were then analyzed with correlation coefficient and path analysis method by using SPSS-26 and LISREL-10.2 programs. RESULTS: The results of the present study showed that pain self-efficacy has a mediating role in the relationship between meaning of life and quality of life (B = 0.015), perceived social support with quality of life (B = 0.022), spiritual well-being with quality of life (B = 0.021), as well as pain catastrophizing with quality of life (B = - 0.015). CONCLUSION: According to the results of this study, by considering the role of self-efficacy of pain, it is possible to develop the programs to strengthen and improve the meaning of life, perceived social support, spiritual well-being and also reduce pain catastrophizing, in order to improve the quality of life of patients with migraine.

Cognitive impairment in chronic migraine compared to pseudotumor cerebri.

INTRODUCTION: We aimed to define the prevalence of objective cognitive impairment in a group of chronic migraineurs, and to define how migraineurs with cognitive impairment differed from those without impairment, and in doing so to compare cognitive impairment in chronic migraine to another chronic headache-related disorder already associated with cognitive impairment (i.e. pseudotumor cerebri syndrome). OBJECTIVES: Cognitive impairment in migraine, especially chronic migraine, has been too little studied. Only a few studies have been done, demonstrating that cognitive impairment exists in chronic migraineurs. It is not known how this compares to other headache-related conditions. MATERIAL AND METHODS: We administered a cognitive battery consisting of the National Adult Reading Test, Mini-Mental Status Examination, Digit Span, Boston Naming Test, Rey Auditory Verbal Learning Test, Trail Making Test, Controlled Oral Word Association, and Category Fluency. Cognitive impairment was defined as mild single-domain with one test score, and mild multi- -domain with two scores more than two standard deviations below the mean for age-, gender-, and education-adjusted norms. The data from this study was compared to our previously published population of patients with pseudotumor cerebri syndrome. RESULTS: One hundred prospectively recruited patients with chronic migraine were enrolled. Fifty-seven patients had normal cognitive profiles. Forty-three patients demonstrated mild cognitive impairment, and more than half (n = 24) showed impairment in multiple cognitive domains. Migraineurs with multi-domain impairment had higher pain intensity, shorter duration of disease, were taking narcotics, had more impaired vision-related mental health scores, and worse social health scores. We found an association between objective cognitive impairment and subjective perception of impairment only when controlling for pain. We found no associations with depression and topiramate use. The mean composite cognitive Z score was no different in chronic migraineurs and patients with pseudotumor cerebri. CONCLUSIONS AND CLINICAL IMPLICATIONS: Most chronic migraineurs have normal cognitive profiles, but a large proportion of them do experience mild cognitive impairment, especially in multiple domains. The impairment seen in migraine is similar to that in pseudotumor cerebri syndrome, which has already been associated with mild cognitive impairment. Cognitively impaired migraineurs are different from non-impaired/less impaired migraineurs in several ways, which may be an important factor in influencing their migraine treatment.

Depression, anxiety and stress in Saudi migraine patients using DASS-21: local population-based cross-sectional survey.

Background: Psychiatric comorbidity is common among migraineurs, such as anxiety and depression. This type of comorbidity contributed to migraine chronicity, management efficacy, and increasing the risk for other comorbidities. This study designed to estimate the prevalence of depression, anxiety, and stress (DAS) symptoms among Saudi migraine patients using the validated instrument (DASS-21) and considering socio-demographic factors and individual differences that affect migraine progression and prognosis.Design/methods: Cross-sectional, self-administered, web-based-questionnaire distributed among Saudi Arabia general population. Only migraine patients with clinical diagnosis allowed to complete the survey.Results: A total of 247 migraine patients participated and they are predominantly females, with ages between 16 and 45 years, Saudi nationals, married, non-smokers but do not exercise regularly. About 73.3% met the abnormal score in anxiety on DASS-21, as well as 70.9% in depression and 72.3% in stress. Four statistically significant correlations with DAS were identified. Migraine patients who are smoking have a higher prevalence of depression and stress (p < 0.05). Those who do not exercise regularly have a higher prevalence only for depression (p = 0.03). A higher prevalence of all emotional states was found in patients with more than one co-morbidity and patients with a clinical diagnosis of depression and anxiety disorders (p < 0.02). The sensitivity of DASS-21 for depression and anxiety are 96.9% and 93.3%, respectively.Conclusions: Both smoking cessation and exercise to prevent migraine attacks deserve a clinical trial. A holistic approach is needed to decrease psychiatry-related disability and promote management outcomes in migraineurs. Using DASS-21 for migraine patients as a routine screening instrument is valuable to prevent psychiatric comorbidity.

Examining the correlation between salivary cytokine concentrations and CRP in people experiencing social-cognitive stress.

OBJECTIVES: The study aims to determine the relationship of migraine and chronic tension-type headache (TTHs) with alterations in the salivary markers of inflammation . METHODS: The prospective study involved 75 patients . The concentrations of inflammatory markers (CRP, IL-1 ß, and IL-6) in migraine and chronic TTH patients were determined in distinct time points: headache-free period (interictal period), during headache (ictal period), day after headache attack. The STAI-Y (State Trait Anxiety Inventory - Y) and BDI (Beck Depression Inventory) questionnaires were used to measure the level of anxiety and depression in the interictal and ictal periods. RESULTS: The interictal levels of CRP, IL1-ß, and IL-6 were significantly higher in headache groups compared to healthy controls (p < 0.001). Differences in the ictal concentrations were even stronger. Twenty-four hours after headache attack, patients with migraine and chronic TTH experienced a decrease in CRP, IL1-ß, and IL-6 levels; yet, those levels were still higher compared with the interictal ones. The repeated analysis of variance revealed no significant statistical differences in CRP, IL-ß, and IL-6 levels between the migraine and TTH groups over time (p > 0.05). Statistically higher levels of anxiety and depression were seen in unhealthy groups (p < 0.01). CONCLUSIONS: The relationship of CRP, IL1-ß, and IL-6 concentrations with migraine and chronic TTH has been established. No statistically significant differences were found in the dynamics between migraine and chronic TTH groups. There was a direct correlation of migraine and chronic TTH with anxiety and depression.

The Objective Assessment of Event-Related Potentials: An Influence of Chronic Pain on ERP Parameters / 神经科学通报·英文版

The article presents an original method for the automatic assessment of the quality of event-related potentials (ERPs), based on the calculation of the coefficient ε, which describes the compliance of recorded ERPs with some statistically significant parameters. This method was used to analyze the neuropsychological EEG monitoring of patients suffering from migraines. The frequency of migraine attacks was correlated with the spatial distribution of the coefficients ε, calculated for EEG channels. More than 15 migraine attacks per month was accompanied by an increase in calculated values in the occipital region. Patients with infrequent migraines exhibited maximum quality in the frontal areas. The automatic analysis of spatial maps of the coefficient ε demonstrated a statistically significant difference between the two analyzed groups with different means of migraine attack numbers per month.

Preventive treatment can reverse cognitive impairment in chronic migraine.

OBJECTIVE: To study the impact of chronic migraine (CM) on the cognition and quality of life (QoL) of patients in the interictal period, and to analyse the degree of reversibility of any observed alterations following the use of preventive treatment. BACKGROUND: CM is a highly disabling disease, and migraineurs often have associated comorbidities, such as subjective memory problems, that are involved in the development of cognitive impairment. Our hypotheses are that patients suffering from chronic migraine experience objective cognitive alterations that are not only due to the pain that they suffer or their current emotional state. Furthermore, preventive treatment should be capable of reversing, or at least reducing, the impact of CM on the cognition and QoL of migraineurs. METHODS: The cognition and QoL of 50 control subjects and 46 patients with CM were assessed using a battery of tests, prior to the use of preventive treatment based on botulinum toxin or oral drugs and after 3 months of this treatment. RESULTS: Compared with controls, patients with CM had lower scores on the assessment of cognitive performance (Rey-Osterrieth Complex Figure test [ROCF] (p<0.05), Trail Making Test [TMT] B) (p < 0.05) and QoL (p < 0.05). Three months after the use of preventive treatment, improvement was observed in all cognitive parameters (p < 0.05) and QoL (p < 0.05), except the ROCF copy task (p = 0.79). No statistically significant differences were observed when these outcomes were compared based on treatment. CONCLUSIONS: This study confirms poor cognitive performance that is not explained by migraine pain itself, as it occurs in the interictal period, irrespective of the patient's emotional status. Our findings show that these effects are reversible in some cases with preventive treatment of CM, reaffirming the important impact of this condition on the QoL of these patients, and the need to establish preventive treatment guidelines.

A stated preference survey to explore patient preferences for novel preventive migraine treatments.

OBJECTIVE: The objective of this study was to explore patient preference for attributes of calcitonin gene-related peptide (CGRP) inhibitors for the preventive treatment of migraine and to describe differences in treatment preferences between patients. BACKGROUND: CGRP inhibitors are a novel class of migraine drugs specifically developed for the preventive treatment of migraine. Clinicians should understand patient preferences for CGRP inhibitors to inform and support prescribing choices. METHODS: Patients with migraine in the US and Germany were recruited to participate in an online discrete choice experiment (DCE) survey, which presented hypothetical treatment choices using five attributes: mode of administration, side effects, migraine frequency, migraine severity, and consistency of treatment effectiveness. Attribute selection was informed by a literature review and semi-structured patient interviews (n = 35), and evaluated using patient cognitive debriefing interviews (n = 5). RESULTS: Of 680 who consented to participate, 506 participants completed the survey and were included in the study (US = 257; Germany = 249). Overall, participants placed highest importance (preference weight, beta = 1.65, p < 0.001) on the treatment's ability to reduce the severity of migraine (mild vs. unchanged severity), followed by consistent treatment effectiveness (beta = 1.13, p < 0.001), and higher chance of reduced migraine frequency (beta = 1.00, p < 0.001). Participants preferred an oral tablet every other day (beta = 1.00, p < 0.001) over quarterly infusion, quarterly injections (p = 0.019), or monthly injection (p < 0.001). Preference for all treatment attributes were heterogeneous, and the subgroup analyses found that participants naïve to CGRP monoclonal antibody treatments had a stronger preference for oral therapy compared to those with such experience (p = 0.006). CONCLUSION: In this DCE assessing CGRP inhibitors attributes, the main driver of patient choice was treatment effectiveness, specifically reduced migraine severity, and consistent treatment effectiveness. Further, patients exhibited an overall preference for an oral tablet every other day over injectables. Patients' experience with previous treatments informs the value they place on treatment characteristics.

FEATURE OF GUT MICROBIOTA IN PATIENTS WITH MIGRAINE AND HEALTHY INDIVIDUALS.

The gut - brain axis plays a significant role in the pathophysiology of migraine. This interaction can be influenced by multiple factors, such as gut microbiota profiles. The aim of the study was to analyze the gut microbiome state in patients with migraine and healthy individuals, to assess possible correlations between the detected changes in patients with migraine and the frequency, intensity of headaches, their psycho-emotional state, and quality of life. In total, 112 patients-16.3% of men and 83.7% of women. Subjects were divided into 2 groups depending on the presence of migraine: the main - patients with chronic and episodic forms of migraine, the control - healthy individuals. The study of the intestinal microbiome was performed by chromato-mass spectrometry. The following scales were used: Visual Analogue Scale/VAS, Migraine Disability Assessment/MIDAS, Back Depression Inventory/BDI. In patients with migraine compared with healthy individuals, significant changes were noted in the quantitative composition of certain resident microorganisms including Alcaligenes spp (p=0.0061), Clostridium coccoides (p=0.0021), Clostridium propionicum (p=0.0287), Eggerthella lenta (p=0.0138), Pseudonocardia spp (p=0.0210), and Rhodococcus spp (p=0.0164). The number of microscopic fungi such as Candida spp (p=0.0079), Micromycetes spp (p=0.0011) and Micromycetes spp (p=0.0010) were increased in patients with migraine compared to the control group. In the main group, a negative correlation was found between the level of 16 Alcaligenes spp and the score on the BDI score, HARS score (respectively: r= -0.6226, p= 0.007; r= -0.509, p=0.03), the frequency of attacks (r=-0.4879, p=0.046) and the VAS score (r=-0.487, p=0.046). Significant negative correlation was found between elevated level of Clostridium coccoides and MIDAS score (r=-0.5123, p=0.03), BDI score (r=-0.54, p=0.025) in the patients with migraine. At the same time, in the main group a positive correlation was detected between Eggerthella lenta level of and VAS score (r=0.4830, p=0.049). In the main group negative correlations were found between slightly increased content of endotoxin in the main group, the BDI score, HARS score (respectively: r=-0.697, p=0.001; r=-0.557, p=0.02) the frequency of attacks (r=-0.547, p=0.023), on the VAS score (r= -0.531, p=0.028), as well as MIDAS score (r =-0.556, p=0.02). The revealed peculiarities of gut microbiome changes in patients with migraines need further clarification in order to identify the possible role of the gut microbiome in the pathogenesis, clinical picture, and therapy of migraine, and is a promising area of further scientific research.

Gender differences in obsessive-compulsive disorder traits among chronic migraine patients.

BACKGROUND: Psychiatric illnesses are often associated with severe forms of headache as chronic migraine (CM) with medication overuse headaches (MOH). Few data are available about obsessive-compulsive disorders (OCD) in migraineurs. This study aimed to investigate OCD traits in CM with MOH patients of both sexes and the impact on migraine treatment. METHODS: We enrolled all consecutive patients with CM and MOH treated with onabotulinumtoxin-A (OBT-A) in our Headache Center. Each subject was submitted to the Obsessive-Compulsive Inventory-Revised (OCI-R) test at the start (T0) and after four OBT-A sessions (T1). Statistical analysis compared OCI-R results at T0 and T1 according to sex with the chi-square test. RESULTS: We analyzed a sample of 60 subjects (40 females, 66.7%). At T0, 25% of males and 37.5% of females had a normal profile while 60% of males and 22.5% of females presented pathologic OCD traits. At T1, 30% of males and 60% of females were normal, while 40% of males and 15% of females resulted frankly pathologic. The difference in the OCI-R distribution was significant at T0 (p = 0.024) and at T1 (p = 0.047). Both males and females underwent a significant increase in normalization rates at T1 (p < 0.05). CONCLUSION: We observed a significant OCD traits rate at baseline, moreover among men. Females showed a more significant improvement in OCD traits at T1. OBT-A confirmed its high efficacy on CM, with a migraine severity improvement in both genders and all the OCI-R classes. Psychological attitude in the management of migraine should be better investigated in future studies.

Dysfunctional sleep beliefs and behaviours: Psychological factors in sleep-related headaches.

Sleep problems are amongst the most common triggers of migraine and non-migraine primary headache. Despite a majority of sleep problems being psychological in nature, there is a paucity of quantitative research on the psychological factors involved in sleep-related headaches. This is the first study to examine the link between maladaptive sleep beliefs and headaches. 542 participants completed an online battery measuring headache, sleep, and psychological distress. Avoidance of sleep-related headache triggers was associated with more headaches, as mediated by increased sensitivity to the triggers. Sleep quality, sleep beliefs, and sleep behaviours all significantly (p < .001) correlated with headache frequency and disability, with effect sizes ranging from small (rs = 0.16) to medium (rs = 0.37). Mediation models testing the effect of sleep beliefs on headaches via sleep quality (covaried by sleep behaviours) accounted for 13% and 14% of variance in migraine and non-migraine headaches, respectively (p < .001). Avoidance of sleep-related headache triggers was shown to be associated with greater headache frequency (via increased trigger sensitivity). It is posited that maladaptive sleep beliefs and behaviours may increase headache activity by causing poor sleep quality, leading to dysregulation in brain regions shared between sleep and headaches.

Receiving Medical Care for Chronic Migraines: A Phenomenological Study.

OBJECTIVES: Treating chronic migraine (CM) effectively is one of the greatest challenges a primary care provider (PCP) may encounter. Many patients with CM report dissatisfaction and minimal gains from treatment, despite using the best medical interventions available. For this study, patients with CM and their partners provided insight into how PCPs could improve CM treatment. METHODS: Using the immersion/crystallization phenomenological method, we collected data from 11 patients with CM and 8 of their partners (N = 19). We analyzed open-ended survey responses about migraine treatment from patients with CM, as well as transcripts from interviews with patients with CM and their partners (14 interviews total) about their medical experiences. RESULTS: Participants used a variety of pharmacological and alternative treatments in search of a cure; wanted to be treated more collaboratively; and repeatedly gave up on medical care, but then sought treatment again. CONCLUSIONS: PCPs could be trained to encourage patients with CM to shift toward accepting and managing migraines rather than endlessly hoping for a cure. Patients could be taught to manage CM using a holistic, biopsychosocial approach.

Cogniphobia and neuropsychological functioning in migraine.

OBJECTIVE: Cogniphobia refers to the fear and avoidance of cognitive exertion, believed to cause or exacerbate headache. The objective of the present study was to demonstrate associations between cogniphobia and key fear-avoidance constructs. METHOD: In this cross-sectional study, 72 adults with migraine were recruited from a tertiary headache center. Patients completed the Cogniphobia Scale for Headache Disorders (CS-HD) and a series of self-reported surveys and neuropsychological measures that assessed patient demographics, migraine diagnosis and headache characteristics, current pain severity, emotional state (i.e., anxiety, pain-related fear, and depression), cognitive exertion, and functioning (self-reported disability, self-reported cognitive symptoms, and neuropsychological measures). RESULTS: The CS-HD was associated with greater anxiety (Patient-Reported Outcomes Measurement Information System; PROMIS Anxiety; r = 0.39, p = .001), pain-related fear (PASS-20; ρ = 0.37, p = .002), self-reported cognitive symptoms (ABS; ρ = 0.38, p = .001), self-reported headache disability (HDI; r = 0.28, p = .022), and depression (PROMIS Depression; r = 0.25, p = .039). The CS-HD was also associated with lower scores on neuropsychological measures of semantic fluency (Animal Naming; r = -0.29, p = .015), visual immediate recall memory (RCFT Immediate Recall; r = -0.27, p = .027), visual delayed recall memory (RCFT Delayed Recall; r = -0.36, p = .002), and visual recognition memory (RCFT Recognition; r = -0.42, p < .001), with comparable findings when adjusting for depression and anxiety. CONCLUSION: This study demonstrated associations between cogniphobia and key fear-avoidance constructs. Fear-avoidance constructs, such as cogniphobia, are important constructs to consider when evaluating migraine and neuropsychological functioning. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

An Explorative Study of Common Themes of Patient Experiences With Migraine.

Objective: To explore important themes in patient experiences with migraine and to understand the relationship of these themes with external factors such as the health care system and societal influences.Methods: This qualitative study was part of a larger online survey (conducted for a period of 2 months from March 1, 2013, to April 30, 2013) that recruited participants with migraine through nonprobability-based sampling techniques. Respondents were asked an open-ended question to describe their experience with migraine. A codebook was developed based on existing literature and new categories that emerged from the responses. Deductive and inductive content analysis was conducted followed by axial coding of the themes based on the codebook.Results: The open-ended question resulted in 154 eligible responses. The final codebook contained 28 categories. The categories were combined into 6 distinct themes. The 6 themes included quality of life and health status, disease condition, societal response to disease, health care and medications, support, and patient response to disease. The most frequently occurring categories were pain and quality of life (QoL) (work functioning). The least frequent themes were cognitive symptoms, QoL economic functioning, and caregiver burden. Axial coding of the themes showed that QoL was the central theme. Aspects of the disease condition and negative societal responses were found to substantially affect QoL, leading to caregiver burden and absence/presence of social support.Conclusions: The findings demonstrate that pain and QoL are central to patient experience with migraine. Attention should be paid to improve the treatment and social support provided to patients and reduce stigma and invalidation.