Forecasting Individual Headache Attacks Using Perceived Stress: Development of a Multivariable Prediction Model for Persons With Episodic Migraine

Abstract

Objective To develop and validate a prediction model that forecasts future migraine attacks for an individual headache sufferer. Background Many headache patients and physicians believe that precipitants of headache can be identified and avoided or managed to reduce the frequency of headache attacks. Of the numerous candidate triggers, perceived stress has received considerable attention for its association with the onset of headache in episodic and chronic headache sufferers. However, no evidence is available to support forecasting headache attacks within individuals using any of the candidate headache triggers. Methods This longitudinal cohort with forecasting model development study enrolled 100 participants with episodic migraine with or without aura, and N = 95 contributed 4626 days of electronic diary data and were included in the analysis. Individual headache forecasts were derived from current headache state and current levels of stress using several aspects of the Daily Stress Inventory, a measure of daily hassles that is completed at the end of each day. The primary outcome measure was the presence/absence of any headache attack (head pain > 0 on a numerical rating scale of 0 to 10) over the next 24 hour period. Results After removing missing data (n = 431 days), participants in the study experienced a headache attack on 1613/4195 (38.5%) days. A generalized linear mixed-effects forecast model using either the frequency of stressful events or the perceived intensity of these events fit the data well. This simple forecasting model possessed promising predictive utility with an AUC of 0.73 (95%CI: 0.71 to 0.75) in the training sample and an AUC of 0.65 (95%CI: 0.6 to 0.67) in a leave-one-out validation sample. This forecasting model had a Brier Score of 0.202 and possessed good calibration between forecasted probabilities and observed frequencies but had only low levels of resolution (i.e., sharpness). Conclusions This study demonstrates that future headache attacks can be forecasted for a diverse group of individuals over time. Future work will enhance prediction through improvements in the assessment of stress as well as the development of other candidate domains to use in the models.

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

“…52 Multiple high-quality diary studies have demonstrated relationships between changes in stress and migraine attack onset [53][54][55][56] though the effect varies both inter-and intra-individually, and may interact with other trigger factors. 52 Multiple high-quality diary studies have demonstrated relationships between changes in stress and migraine attack onset [53][54][55][56] though the effect varies both inter-and intra-individually, and may interact with other trigger factors.…”

Headache Triggers as Surprise

“…The examination of the influence of trigger surprise on initiating new headache attacks is a secondary analysis of twice‐daily headache diaries collected as part of the Headache Prediction Study (HAPRED). The primary analysis of the study was fully reported previously . HAPRED was a prospective cohort study conducted between 2009 and 2014 in Winston‐Salem, NC.…”

Synergism between Female Gender and High Levels of Daily Stress Associated with Migraine Headaches in Ontario, Canada

“…In a recent study, Lipton et al [28] found no direct association between self-reported daily stress and migraine occurrence but instead found a significant association between stress recovery ("let down") and migraine onset over the following 6-24 h. Similarly, Houle et al [29] developed a predictive model for migraine in which average daily stress was used to forecast migraine attacks over the course of several days. In the short-term, migraine onset appears several hours to days after episodes of stress, which often leads migraineurs to identify stress as the main trigger for their headache symptoms [30].…”