The Association of Changes in Pain Acceptance and Headache-Related Disability.

BACKGROUND: Migraine accounts for substantial suffering and disability. Previous studies show cross-sectional associations between higher pain acceptance and lower headache-related disability in individuals with migraine, but none has evaluated this association longitudinally during migraine treatment. PURPOSE: This study evaluated whether changes in pain acceptance were associated with changes in headache-related disability and migraine characteristics in a randomized controlled trial (Women's Health and Migraine) that compared effects of behavioral weight loss (BWL) treatment and migraine education (ME) on headache frequency in women with migraine and overweight/obesity. METHODS: This was a post hoc analysis of 110 adult women with comorbid migraine and overweight/obesity who received 16 weeks of either BWL or ME. Linear and nonlinear mixed effects modeling methods were used to test for between-group differences in change in pain acceptance, and also to examine the association between change in pain acceptance and change in headache disability. RESULTS: BWL and ME did not differ on improvement in pain acceptance from baseline across post-treatment and follow-up. Improvement in pain acceptance was associated with reduced headache disability, even when controlling for intervention-related improvements in migraine frequency, headache duration, and pain intensity. CONCLUSIONS: This study is the first to show that improvements in pain acceptance following two different treatments are associated with greater reductions in headache-related disability, suggesting a potential new target for intervention development. CLINICAL TRIALS INFORMATION: NCT01197196.

Pain worsening with physical activity during migraine attacks in women with overweight/obesity: A prospective evaluation of frequency, consistency, and correlates.

Background Migraine is a neurological disease involving recurrent attacks of moderate-to-severe and disabling head pain. Worsening of pain with routine physical activity during attacks is a principal migraine symptom; however, the frequency, individual consistency, and correlates of this symptom are unknown. Given the potential of this symptom to undermine participation in daily physical activity, an effective migraine prevention strategy, further research is warranted. This study is the first to prospectively evaluate (a) frequency and individual consistency of physical activity-related pain worsening during migraine attacks, and (b) potential correlates, including other migraine symptoms, anthropometric characteristics, psychological symptoms, and daily physical activity. Methods Participants were women (n = 132) aged 18-50 years with neurologist-confirmed migraine and overweight/obesity seeking weight loss treatment in the Women's Health and Migraine trial. At baseline, participants used a smartphone diary to record migraine attack occurrence, severity, and symptoms for 28 days. Participants also completed questionnaires and 7 days of objective physical activity monitoring before and after diary completion, respectively. Patterning of the effect of physical activity on pain was summarized within-subject by calculating the proportion (%) of attacks in which physical activity worsened, improved, or had no effect on pain. Results Participants reported 5.5 ± 2.8 (mean ± standard deviation) migraine attacks over 28 days. The intraclass correlation (coefficient = 0.71) indicated high consistency in participants' reports of activity-related pain worsening or not. On average, activity worsened pain in 34.8 ± 35.6% of attacks, had no effect on pain in 61.8 ± 34.6% of attacks and improved pain in 3.4 ± 12.7% of attacks. Few participants (9.8%) reported activity-related pain worsening in all attacks. A higher percentage of attacks where physical activity worsened pain demonstrated small-sized correlations with more severe nausea, photophobia, phonophobia, and allodynia (r = 0.18 - 0.22, p < 0.05). Pain worsening due to physical activity was not related to psychological symptoms or total daily physical activity. Conclusions There is large variability in the effect of physical activity on pain during migraine attacks that can be accounted for by individual differences. For a minority of participants, physical activity consistently contributed to pain worsening. More frequent physical activity-related pain worsening was related to greater severity of other migraine symptoms and pain sensitivity, which supports the validity of this diagnostic feature. Study protocol ClinicalTrials.govIdentifier: NCT01197196.

The role of migraine headache severity, associated features and interactions with overweight/obesity in inhibitory control.

AIM OF THE STUDY: While migraine and obesity are related and both conditions are associated with reduced executive functioning, no study has examined whether obesity exacerbates executive dysfunction in migraine. This cross-sectional study examined whether overweight/obesity moderated associations of migraine severity and associated features with inhibitory control, one aspect of executive function. MATERIALS AND METHODS: Women (n = 124) aged 18-50 years old with overweight/obesity body mass index (BMI) = 35.1 ± 6.4 kg/m2 and migraine completed a 28-day smartphone-based headache diary assessing migraine headache severity (attack frequency, pain intensity) and frequency of associated features (aura, photophobia, phonophobia, nausea). They then completed computerized measures of inhibitory control during an interictal (headache-free) period. RESULTS: Participants with higher migraine attack frequency performed worse on the Flanker test (accuracy and reaction time; p < .05). Migraine attack frequency and pain intensity interacted with BMI to predict slower Stroop and/or Flanker Reaction Time (RT; p < .05). More frequent photophobia, phonophobia and aura were independently related to slower RT on the Stroop and/or Flanker tests (p < .05), and BMI moderated the relationship between the occurrence of aura and Stroop RT (p = .03). CONCLUSIONS: Associations of migraine severity and presence of associated features with inhibitory control varied by BMI in overweight/obese women with migraine. These findings warrant consideration of weight status in clarifying the role of migraine in executive functioning.

Importance of Pain Acceptance in Relation to Headache Disability and Pain Interference in Women With Migraine and Overweight/Obesity.

BACKGROUND: Pain acceptance involves willingness to experience pain and engaging in valued activities while pain is present. Though pain acceptance could limit both headache-related disability and pain interference in individuals with migraine, few studies have addressed this issue. This study evaluated whether higher levels of total pain acceptance and its two subcomponents, pain willingness and activity engagement, were associated with lower levels of headache-related impairment in women who had both migraine and overweight/obesity. METHODS: In this cross-sectional study, participants seeking weight loss and headache relief in the Women's Health and Migraine trial completed baseline measures of pain acceptance (Chronic Pain Acceptance Questionnaire [CPAQ]), headache-related disability (Headache Impact Test-6), and pain interference (Brief Pain Inventory). Migraine headache frequency and pain intensity were assessed daily via smartphone diary. Using CPAQ total and subcomponent (pain willingness and activity engagement) scores, headache frequency, pain intensity, and body mass index (BMI) as predictors in linear regression, headache-related disability, and pain interference were modeled as outcomes. RESULTS: On average, participants (n = 126; age = 38.5 ± 8.2 years; BMI = 35.3 ± 6.6 kg/m2 ) reported 8.4 ± 4.7 migraine days/month and pain intensity of 6.0 ± 1.5 on a 0-10 scale on headache days. After correcting for multiple comparisons (adjusted α = .008), pain willingness was independently associated with both lower headache-related disability (P < .001; ß = -0.233) and pain interference (P < .001; ß = -0.261). Activity engagement was not associated with headache-related disability (P = .128; ß = -0.138) and pain interference (P = .042; ß = -0.154). CPAQ total score was not associated with headache-related disability (P = .439; ß = 0.066) and pain interference (P = .305; ß = 0.074). Pain intensity was significantly associated with outcomes in all analyses (Ps < .001; ßs 0.343-0.615). CONCLUSIONS: Higher pain willingness, independent of degree of both migraine severity and overweight, is associated with lower headache-related disability and general pain interference in treatment-seeking women with migraine and overweight/obesity. Future studies are needed to clarify direction of causality and test whether strategies designed to help women increase pain willingness, or relinquish ineffective efforts to control pain, can improve functional outcomes in women who have migraine and overweight/obesity.

Sexual Dysfunction in Women With Migraine and Overweight/Obesity: Relative Frequency and Association With Migraine Severity.

BACKGROUND/OBJECTIVE: Previous studies suggest that migraine might be associated with female sexual dysfunction (FSD), although this association may be complicated by overweight/obesity. To disentangle relationships of migraine and obesity with FSD, we examined: (1) FSD rates in women who had migraine and obesity with a matched sample of women with obesity who were free of migraine and (2) associations between indices of migraine severity and FSD in a larger sample of participants with migraine and overweight/obesity, controlling for important confounders. METHODS: Women with migraine and obesity seeking behavioral weight loss treatment to decrease headaches (n = 37) and nonmigraine controls (n = 37) with obesity seeking weight loss via bariatric surgery were matched on age (±5 years), body mass index (BMI; ±3 kg/m2 ), and reported sexual activity during the past month. Both groups completed the Female Sexual Function Index (FSFI), with a validated FSFI-total cutoff score used to define FSD. In participants with migraine and overweight/obesity (n = 105), separate logistic regression models evaluated associations of migraine attack frequency, intensity, and duration with odds of having FSD, controlling for age, BMI, depression, and anxiety. RESULTS: On average, participants and matched controls had severe obesity (BMI = 42.4 ± 3.8 kg/m2 ; range = 35-49.9) and were 37.3 ± 7.2 years of age (range = 22-50). FSD rate did not differ between migraine participants and controls (56.8% vs. 54.1%, P = .82). In the larger sample of participants with migraine and overweight/obesity (38.2 ± 7.8 years of age; BMI = 34.8 ± 6.4 [range = 25-50 kg/m2 ]; 8.0 ± 4.3 migraine days/month, maximum pain intensity = 5.9 ± 1.4 on 0-10 scale; average attack duration = 18.3 ± 9.7 hours), FSD was not associated with attack frequency (P = .31), pain intensity (P = .92), or attack duration (P = .35) but was associated with more severe anxiety symptoms (Ps < .017). CONCLUSIONS: Rates of sexual dysfunction did not differ in severely obese women with and without migraine. Moreover, indices of migraine severity were not associated with increased risk of FSD in women with overweight/obesity. Replication of present findings in wider populations of women with migraine and of both normal-weight and overweight/obese status are warranted.

Lower inhibitory control interacts with greater pain catastrophizing to predict greater pain intensity in women with migraine and overweight/obesity.

BACKGROUND: Pain catastrophizing (PC) is associated with more severe and disabling migraine attacks. However, factors that moderate this relationship are unknown. Failure of inhibitory control (IC), or the ability to suppress automatic or inappropriate responses, may be one such factor given previous research showing a relationship between higher PC and lower IC in non-migraine samples, and research showing reduced IC in migraine. Therefore, we examined whether lower IC interacts with increased PC to predict greater migraine severity as measured by pain intensity, attack frequency, and duration. METHODS: Women (n = 105) aged 18-50 years old (M = 38.0 ± 1.2) with overweight/obesity and migraine who were seeking behavioral treatment for weight loss and migraine reduction completed a 28-day smartphone-based headache diary assessing migraine headache severity. Participants then completed a modified computerized Stroop task as a measure of IC and self-report measures of PC (Pain Catastrophizing Scale [PCS]), anxiety, and depression. Linear regression was used to examine independent and joint associations of PC and IC with indices of migraine severity after controlling for age, body mass index (BMI) depression, and anxiety. RESULTS: Participants on average had BMI of 35.1 ± 6.5 kg/m2and reported 5.3 ± 2.6 migraine attacks (8.3 ± 4.4 migraine days) over 28 days that produced moderate pain intensity (5.9 ± 1.4 out of 10) with duration of 20.0 ± 14.2 h. After adjusting for covariates, higher PCS total (ß = .241, SE = .14, p = .03) and magnification subscale (ß = .311, SE = .51, p < .01) scores were significant independent correlates of longer attack duration. IC interacted with total PCS (ß = 1.106, SE = .001, p = .03) rumination (ß = 1.098, SE = .001, p = .04), and helplessness (ß = 1.026, SE = .001, p = .04) subscale scores to predict headache pain intensity, such that the association between PC and pain intensity became more positive at lower levels of IC. CONCLUSIONS: Results showed that lower IC interacted with higher PC, both overall and specific subcomponents, to predict higher pain intensity during migraine attacks. Future studies are needed to determine whether interventions to improve IC could lead to less painful migraine attacks via improvements in PC.

Ecological momentary assessment of the relationship between headache pain intensity and pain interference in women with migraine and obesity.

Background While pain intensity during migraine headache attacks is known to be a determinant of interference with daily activities, no study has evaluated: (a) the pain intensity-interference association in real-time on a per-headache basis, (b) multiple interference domains, and (c) factors that modify the association. Methods Participants were 116 women with overweight/obesity and migraine seeking behavioral treatment to lose weight and decrease headaches in the Women's Health and Migraine trial. Ecological momentary assessment, via smartphone-based 28-day headache diary, and linear mixed-effects models were used to study associations between pain intensity and total- and domain-specific interference scores using the Brief Pain Inventory. Multiple factors (e.g. pain catastrophizing (PC) and headache management self-efficacy (HMSE)) were evaluated either as independent predictors or moderators of the pain intensity-interference relationship. Results Pain intensity predicted degree of pain interference across all domains either as a main effect (coeff = 0.61-0.78, p < 0.001) or interaction with PC, allodynia, and HMSE ( p < 0.05). Older age and greater allodynia consistently predicted higher interference, regardless of pain intensity (coeff = 0.04-0.19, p < 0.05). Conclusions Pain intensity is a consistent predictor of pain interference on migraine headache days. Allodynia, PC, and HMSE moderated the pain intensity-interference relationship, and may be promising targets for interventions to reduce pain interference.

Objectively measured physical activity in obese women with and without migraine.

AIM: The aim of this article is to cross-sectionally compare objectively measured physical activity (PA) levels and their association with migraine characteristics in obese women with and without migraine. METHODS: Obese women seeking weight loss treatment were divided into migraine (n = 25) and control (n = 25) groups matched by age and body mass index (BMI). Participants wore the SenseWear Armband monitor for seven days to objectively evaluate daily light-(LPA) and moderate-to-vigorous intensity PA (MVPA). Migraine diagnosis was confirmed by a neurologist using ICHD-3-beta criteria. Migraine characteristics were tracked daily using a smartphone-based diary over a four-week period immediately preceding the objective PA assessment. RESULTS: Migraine participants spent 57.9 fewer minutes/day in LPA (141.1 ± 56.4 vs. 199.1 ± 87.7, p = 0.019) and 24.5 fewer minutes/day in MVPA (27.8 ± 17.0 vs. 52.3 ± 26.0, p < 0.001), compared to controls. Migraine participants reported 4.8 ± 3.1 migraine days/month (mean duration = 17.1 ± 8.9 hours; mean maximum pain severity = 6.4 ± 1.7 on a 0-10 scale). Higher BMI (p < 0.05), but not migraine characteristics, were related to lower total PA. Additionally, total objectively measured PA was not associated with how often PA was reported to exacerbate migraine attacks during the four-week diary assessment. CONCLUSIONS: Obese women with migraine spent nearly 1.5 hours/day less in PA compared to controls; however, lower PA was not related to migraine characteristics. Further research is needed to identify PA barriers and effective interventions in obese women with migraine.

Consistency in compensatory eating responses following acute exercise in inactive, overweight and obese women.

It is often assumed that some individuals reliably increase energy intake (EI) post-exercise ('compensators') and some do not ('non-compensators'), leading researchers to examine the characteristics that distinguish these two groups. However, it is unclear whether EI post-exercise is stable over time. The present study examined whether compensatory eating responses to a single exercise bout are consistent within individuals across three pairs of trials. Physically inactive, overweight/obese women (n 28, BMI 30·3 (SD 2·9) kg/m²) participated in three pairs of testing sessions, with each pair consisting of an exercise (30 min of moderate-intensity walking) and resting testing day. EI was measured using a buffet meal 1 h post-exercise/rest. For each pair, the difference in EI (EIdiff = EIex - EIrest) was calculated, where EIex is the EI of the exercise session and EIrest is the EI of the resting session, and women were classified as a 'compensator' (EIex > EIrest) or 'non-compensator' (EIex ≤ EIrest). The average EI on exercise days (3328·0 (SD 1686·2) kJ) was similar to those on resting days (3269·4 (SD 1582·4) kJ) (P= 0·67). Although EI was reliable within individuals across the three resting days (intraclass correlation coefficient (ICC) 0·75, 95 % CI 0·60, 0·87; P< 0·001) and three exercise days (ICC 0·83, 95 % CI 0·70, 0·91; P< 0·001), the ICC for EIdiff across the three pairs of trials was low (ICC 0·20, 95 % CI -0·02, 0·45; P= 0·04), suggesting that compensatory eating post-exercise is not a stable construct. Moreover, the classification of 'compensators'/'non-compensators' was not reliable (κ = -0·048; P= 0·66). The results were unaltered when 'relative' EI was used, which considers the energy expenditure of the exercise/resting sessions. Acute compensatory EI following an exercise bout is not reliable in overweight women. Seeking to understand what distinguishes 'compensators' from 'non-compensators' based on a single eating episode post-exercise is not justified.

Dietary intake patterns and diet quality in a nationally representative sample of women with and without severe headache or migraine.

OBJECTIVE/BACKGROUND: The role of diet in migraine is not well understood. We sought to characterize usual dietary intake patterns and diet quality in a nationally representative sample of women with and without severe headache or migraine. We also examined whether the relationship between migraine and diet differs by weight status. METHODS: In this analysis, women with migraine or severe headache status was determined by questionnaire for 3069 women, ages 20-50 years, who participated in the National Health and Nutrition Examination Study, 1999-2004. Women who experienced severe headaches or migraines were classified as migraine for the purposes of this analysis. Dietary intake patterns (micro- and macronutrient intake and eating frequency) and diet quality, measured by the Healthy Eating Index, 2005, were determined using one 24-hour dietary recall. RESULTS: Dietary intake patterns did not significantly differ between women with and without migraine. Normal weight women with migraine had significantly lower diet quality (Healthy Eating Index, 2005 total scores) than women without migraine (52.5 ± 0.9 vs. 45.9 ± 1.0; P < .0001). CONCLUSIONS: Whereas findings suggest no differences in dietary intake patterns among women with and without migraine, dietary quality differs by migraine status in normal weight women. Prospective analyses are needed to establish how diet relates to migraine onset, characteristics, and clinical features in individuals of varying weight status.

Examination of the Consistency in Affective Response to Acute Exercise in Overweight and Obese Women.

This study examined whether inactive, overweight/obese women experience consistent affective responses to moderate-intensity exercise. Twenty-eight women participated in 3 identical (same treadmill grade and speed within a subject) 30-min exercise sessions. The Feeling Scale (FS), Positive and Negative Affect Schedule and Subjective Exercise Experience Scale were administered pre- and postexercise and FS was also administered every 5 min during exercise. All measures exhibited less than optimal agreement in pre-to-postexercise change within an individual across the 3 sessions (ICCs = 0.02-0.60), even after controlling for within-subject variations in heart rate. Only FS exhibited "good" consistency when controlling for preexercise values (ICC = 0.72). However, the mean FS score during exercise was highly consistent within an individual (ICC = 0.83). Thus, an individual's affective response to an exercise session does not provide reliable information about how they will respond to subsequent exercise sessions. Taking the average of FS measurements during exercise may yield more consistent findings.

Aerobic fitness and intra-individual variability of neurocognition in preadolescent children.

This study examined behavioral and neuroelectric intra-individual variability (IIV) in preadolescent children during a task requiring variable amounts of cognitive control. The current study further examined whether IIV was moderated by aerobic fitness level. Participants performed a modified flanker task, comprised of congruent and incongruent arrays, within compatible and incompatible stimulus-response conditions. Results revealed that congruent, relative to incongruent, conditions were associated with less IIV of RT. Further, less IIV of RT, P3 amplitude, and P3 latency was observed for the compatible relative to the incompatible condition. Higher fitness was associated with shorter and less variable RT only for the incompatible condition, with no fitness-related differences observed for P3 variability. The findings suggest that conditions requiring greater cognitive control are associated with increased IIV, and that higher fitness may be associated with greater integrity of cognitive control systems during development.

Physical activity and quality of life in severely obese individuals seeking bariatric surgery or lifestyle intervention.

BACKGROUND: Given that bariatric surgery (BS) and lifestyle intervention (LI) represent two vastly different approaches to treating severe obesity, there is growing interest in whether individuals who seek BS versus LI also differ on weight-related behaviors. In the present study, we compared BS- and LI-seekers on physical activity (PA) and sedentary behaviors (SB), and examined between-group differences in health-related quality of life (HRQoL), while controlling for PA. FINDINGS: A sample of 34 LI-seekers were matched with 34 BS-seekers on gender, age, BMI, and PA monitor-daily wear time (age: 42.1±10.0 years; BMI: 45.6±6.5 kg/m2). PA and SB were assessed over a 7-day period via the SenseWear Armband (SWA). HRQoL was measured using the SF-36, with scores standardized to a population normal distribution (M=50, SD=10). Participants wore the SWA for 13.7±1.6 h/day. BS-seekers did not differ from LI-seekers on average min/d over the wear period spent in SB (641±117.1 vs. 638.4±133.4, p=0.62) or light (136.4±76.1 vs. 145.5±72.5, p=0.59) and moderate-to-vigorous (>1-min bouts=36.4±26.2 vs. 40.2±31.3, p=0.59; ≥10-min bouts=5.7±8.3 vs. 10.2±17.0, p=0.17) PA. BS-seekers reported significantly lower SF-36 physical functioning (42.4±10.9 vs. 49.0±6.8, p=0.004) and physical component summary (43.9±10.1 vs. 48.9±7.0) scores versus LI-seekers. BS-seeker group status was related to lower physical functioning (ß=0.30, p=0.009), independent of gender, age, BMI, and daily PA. CONCLUSIONS: Findings suggest that seeking BS versus LI is not related to patterns of PA or SB, and that lower subjective physical functioning is not associated with lower overall PA levels in BS-seekers.

The effects of an afterschool physical activity program on working memory in preadolescent children.

The present study examined the effects of a 9-month randomized control physical activity intervention aimed at improving cardiorespiratory fitness on changes in working memory performance in preadolescent children relative to a waitlist control group. Participants performed a modified Sternberg task, which manipulated working memory demands based on encoding set sizes, while task performance and the contingent negative variation (CNV) event-related brain potential were measured. Analyses revealed that the physical activity intervention led to increases in cardiorespiratory fitness and improved Sternberg task performance. Further, the beneficial effects of the physical activity intervention were greater for a task condition requiring greater working memory demands. In addition, the intervention group exhibited larger initial CNV at the frontal electrode site, relative to the waitlist group at post-test; an effect not observed during the pre-test. These results indicate that increases in cardiorespiratory fitness are associated with improvements in the cognitive control of working memory in preadolescent children.

Conscientiousness in weight loss maintainers and regainers.

OBJECTIVE: The role of personality in weight loss maintenance (WLM) is poorly understood. Although the personality trait of conscientiousness has been associated with health-promoting behaviors in general, no study has specifically evaluated the importance of conscientiousness for WLM. This study compared conscientiousness (both in aggregate and on the facet level) and control over healthy lifestyle behaviors (e.g., food quantity and temptations, consistent meal and sleep timing, exercise adherence, and psychosocial health and stress coping) in successful weight loss maintainers and regainers. METHOD: The sample included 869 National Weight Control Registry participants who reported maintaining ≥ 30-lb weight loss for ≥ 1 year (maintainers) and 484 participants from Amazon's MTurk crowdsourcing marketplace who reported trying but failing to maintain weight loss for 1 year (regainers). Both groups self-reported the Cherynshenko Conscientiousness Scale, the Healthy Lifestyle & Personal Control Questionnaire, body mass index, and demographics in an online survey. RESULTS: Maintainers reported higher levels of total conscientiousness (p = .005), order, virtue, responsibility, and industriousness (ps ≤ .05), but not self-control, compared with regainers after controlling for basic demographic differences. Unexpectedly, regainers scored significantly higher on the facet of traditionalism (p < .001). Maintainers also reported greater degree of control over food quantity and temptations, consistent meal and sleep timing, and exercise adherence (ps < .001), but not psychosocial health and stress coping, compared to with regainers. CONCLUSIONS: Successful weight loss maintainers reported small-to-moderately higher levels of conscientiousness compared with regainers. Evaluating whether conscientiousness can be incorporated into WLM treatment is warranted. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Relationship of Consistency in Timing of Exercise Performance and Exercise Levels Among Successful Weight Loss Maintainers.

OBJECTIVE: This study aimed to evaluate whether consistency in time of day that moderate- to vigorous-intensity physical activity (MVPA) is performed relates to MVPA levels among successful weight loss maintainers in the National Weight Control Registry. METHODS: Participants (n = 375) reporting MVPA on ≥ 2 d/wk completed measures of temporal consistency in physical activity (PA) (> 50% of MVPA sessions per week occurring during the same time window: early/late morning, afternoon, or evening), PA levels, PA automaticity, and consistency in cues underlying PA habit formation (e.g., location). RESULTS: Most (68.0%) participants reported temporally consistent MVPA. These individuals reported higher MVPA frequency (4.8 ± 1.6 vs. 4.4 ± 1.5 d/wk; P = 0.007) and duration (median [IQR]: 350.0 [200.0-510.0] vs. 285.0 [140.0-460.0] min/wk; P = 0.03), and they were more likely to achieve the national MVPA guideline (≥ 150 min/wk) than temporally inconsistent exercisers (86.3% vs. 74.2%, P = 0.004). Among temporally consistent exercisers, 47.8% were early-morning exercisers; MVPA levels did not differ by time of day of routine MVPA performance (P > 0.05). Greater automaticity and consistency in several cues were related to greater MVPA among all participants. CONCLUSIONS: Most participants reported consistent timing of MVPA. Temporal consistency was associated with greater MVPA, regardless of the specific time of day of routine MVPA performance. Consistency in exercise timing and other cues might help explain characteristic high PA levels among successful maintainers.

Behavioral Weight Loss Intervention for Migraine: A Randomized Controlled Trial.

OBJECTIVE: The objective of this study was to test whether behavioral weight loss (BWL) intervention decreases headaches in women with comorbid migraine and overweight or obesity. METHODS: This randomized, single-blind trial allocated women 18 to 50 years old with 4 to 20 migraine days per month and a BMI = 25.0-49.9 kg/m2 to 16 weeks of BWL (n = 54), which targeted exercise and eating behaviors for weight loss, or to migraine education control (ME, n = 56), which delivered didactic instruction on migraine and treatments. Participants completed a 4-week smartphone headache diary at baseline, posttreatment (16-20 wk), and follow-up (32-36 wk). The primary outcome was posttreatment change in migraine days per month, analyzed via linear mixed effects models. RESULTS: Of 110 participants randomly assigned, 85 (78%) and 80 (73%) completed posttreatment and follow-up. Although the BWL group achieved greater weight loss (mean [95% CI] in kilograms) than the ME group at posttreatment (-3.8 [-2.5 to -5.0] vs. + 0.9 [-0.4 to 2.2], P < 0.001) and follow-up (-3.2 [-2.0 to -4.5] vs. + 1.1 [-0.2 to 2.4], P < 0.001), there were no significant group (BWL vs. ME) differences (mean [95% CI]) in migraine days per month at posttreatment (-3.0 [-2.0 to -4.0] vs. -4.0 [-2.9 to -5.0], P = 0.185) or follow-up (-3.8 [-2.7 to -4.8] vs. -4.4 [-3.4 to -5.5], P = 0.378). CONCLUSIONS: Contrary to hypotheses, BWL and ME yielded similar, sustained reductions in migraine headaches. Future research should evaluate whether adding BWL to standard pharmacological and/or nonpharmacological migraine treatment approaches yields greater benefits.

Can weight loss improve migraine headaches in obese women? Rationale and design of the Women's Health and Migraine (WHAM) randomized controlled trial.

BACKGROUND: Research demonstrates a link between migraine and obesity. Obesity increases the risk of frequent migraines and is associated with migraine prevalence among reproductive-aged women. These findings are substantiated by several plausible mechanisms and emerging evidence of migraine improvements after surgical and non-surgical weight loss. However, no previous study has examined the effect of weight loss on migraine within a treatment-controlled framework. The WHAM trial is an RCT to test the efficacy of behavioral weight loss as a treatment for migraine. STUDY DESIGN: Overweight/obese women (n=140; BMI=25.0-49.9 kg/m(2)) who meet international diagnostic criteria for migraine and record ≥3 migraines and 4-20 migraine days using a smartphone-based headache diary during a 4-week baseline period, will be randomly assigned to 4 months of either group-based behavioral weight loss (intervention) or migraine education (control). Intervention participants will be taught strategies to increase physical activity and consume fewer calories in order to lose weight. Control participants will receive general education on migraine symptoms/triggers and various treatment approaches. Both groups will use smartphones to record their headaches for 4 weeks at baseline, after the 16-week treatment period, and at the end of a 16-week follow-up period. Changes in weight and other potential physiological (inflammation), psychological (depression), and behavioral (diet and physical activity) mediators of the intervention effect will also be assessed. CONCLUSION: The WHAM trial will evaluate the efficacy of a standardized behavioral weight loss intervention for reducing migraine frequency, and the extent to which weight loss and other potential mediators account for intervention effects.

Physical activity enhancement to a behavioral weight loss program for severely obese individuals: A preliminary investigation.

Severe obesity is characterized by low physical activity (PA) and interventions to enhance PA are needed. Participants (45.0 ± 3.9 kg/m2) were randomized to a 6-month standard behavioral weight loss program (SBWL; n = 14) or SBWL+technology (SBWL+TECH; n = 15). Both groups received identical SBWL treatment and SBWL+TECH also received a wearable PA monitor, providing "real-time" feedback, and website access to monitor energy balance. 6-month retention was similar between groups (SBWL: 12/13 versus SBWL+TECH: 11/14 completers; P = 0.19) and adherence to wearing the armband was excellent (91.3% of days). Although differences in PA between groups did not meet conventional thresholds of significance, SBWL+TECH increased their moderate-to-vigorous intensity PA by 132.9±216.8 min/week, which was 3 times greater than SBWL (44.8±124.3 min/week; P = 0.27; Cohen's d = 0.50). There was a trend for SBWL+TECH to self-monitor for a greater proportion of days compared to SBWL (86.2±21.4% versus 71.5±19.4%; P = 0.098; Cohen's d = 0.72). The difference in weight loss between groups was modest (SBWL+TECH: -10.0 ± 7.1% versus SBWL: -7.8 ± 6.7%; P = 0.46). These preliminary findings suggest that PA monitors may be one strategy for increasing PA among the severely obese. Larger, long-term trials are needed.

From ERPs to academics.

Standardized tests have been used to forecast scholastic success of school-age children, and have been related to intelligence, working memory, and inhibition using neuropsychological tests. However, ERP correlates of standardized achievement have not been reported. Thus, the relationship between academic achievement and the P3 component was assessed in a sample of 105 children during performance on a Go/NoGo task. The Wide Range Achievement Test - 3rd edition was administered to assess aptitude in reading, spelling, and arithmetic. Regression analyses indicated an independent contribution of P3 amplitude to reading and arithmetic achievement beyond the variance accounted for by IQ and school grade. No such relationship was observed for spelling. These data suggest that the P3, which reflects attentional processes involved in stimulus evaluation and inhibitory control may be a biomarker for academic achievement during childhood.