BackgroundStudies of the difference between menstrually associated and non-menstrually associated migraine are somewhat controversial. The majority of studies have focused on comparing menstrual to non-menstrual attacks rather than comparing study groups with different migraine diagnoses with respect to menstruation. As there is limited knowledge available on the overall impact and burden of migraine among groups of women with and without menstrually associated migraine our goal was to examine differences between these groups. We hypothesized that there would be greater burden of migraine related to menstruation and headache frequency in a population study across groups of women.MethodsWe analyzed data from the American Migraine Prevalence and Prevention (AMPP) Study, a longitudinal, US, population-based study. We included female respondents to the 2009 survey, aged 18 to 60, who met modified ICHD-2 criteria for migraine, were actively menstruating and fit one of three definitions based on the self-reported association of menses and migraine attacks: self-reported predominantly menstrual migraine (MM, attacks that only or predominantly occur at the time of menses), self-reported menstrually-associated migraine (MAM, attacks commonly associated with menses, but that also occur at other times of the month), and self-reported menstrually-unrelated migraine (MUM). These three groups were compared on characteristics and measures of headache impact and burden (Headache Impact Test– 6 item (HIT-6) and Migraine Disability Assessment Scale (MIDAS).ResultsThere were 1,697 eligible subjects for this study in the following categories: MM (5.5%), MAM (53.8%), or MUM (40.7%). Women with MM had an older age of migraine onset. Those with predominantly menstrually-related attacks (MM) had fewer headache-days but appeared to be more impaired by attacks. HIT-6 and MIDAS scores were significantly higher for both the MM and MAM groups compared with the MUM groups; however, effects were more robust for MM than MAM.ConclusionsNearly 60% of women with migraine reported an association between migraine and menses. These women reported greater headache impact and migraine-related burden on functioning than those in whom migraines were not related to menstruation. Women with MM were more impaired by attacks while women with MAM had overall highest burden, likely due to experiencing migraines on additional days.
Lost productive time impact of migraine and other health problems depends on workforce demographics and the cost of labor. Employers can often estimate LPT costs to reveal priorities for optimizing use of health care.
Objectives:Advances in medical discoveries have bolstered expectations of precise and complete care, but delivering on such a promise for complex, chronic neurological care delivery requires solving last-mile challenges. We describe the iterative human-centered design and pilot process for MS neuroSHARE, a digital health solution that brings practical information to the point-of-care so clinicians and patients with multiple sclerosis (MS) can view, discuss and make informed decisions together.Methods:We initiated a comprehensive human-centered process to iteratively design, develop and implement a digital health solution for managing MS in the routine outpatient setting of the nonprofit Sutter Health system in Northern California. The human-centered co-design process included three phases: Discovery and Design, Development, and Implementation and Pilot. Stakeholders included Sutter Health’s Research Development and Dissemination team, academic domain experts, neurologists, patients with MS, and an Advisory Group.Results:MS neuroSHARE went live in November 2018. It included a patient- and clinician-facing web application that launches from the electronic health record, visually displays a patient’s data relevant to MS, and prompts the clinician to comprehensively evaluate and treat the patient. Both patients and clinicians valued the ability to jointly view patient-generated and other data. Preliminary results suggest that MS neuroSHARE promotes patient-clinician communication and more active patient participation in decision-making.Conclusions:Lessons learned in the design and implementation of MS NeuroSHARE are broadly applicable to the design and implementation of digital tools aiming to improve the experience of delivering and receiving high-quality care for complex, neurological conditions across large health systems.
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