Triggers, Protectors, and Predictors in Episodic Migraine

Marmura, Michael J.

doi:10.1007/s11916-018-0734-0

Cited by 119 publications

(96 citation statements)

References 122 publications

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“…Our findings are in keeping with multiple studies demonstrating that the triggers in migraine or TTH were often related to a change in internal and external homeostasis, underscoring the importance of addressing these factors in optimizing headache control. 26,[29][30][31] We recognize that conventional N95 face mask and protective eyewear fit tests consider only the overall fit factor and do not take into account the level of comfort or tolerability especially when used for prolonged periods of time. 32,33 Pain or discomfort is often experienced from tight-fitting PPE, especially after prolonged use.…”

Section: Discussionmentioning

confidence: 99%

Headaches Associated With Personal Protective Equipment – A Cross‐Sectional Study Among Frontline Healthcare Workers During COVID‐19

et al. 2020

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Background.-Coronavirus disease 2019 (COVID-19) is an emerging infectious disease of pandemic proportions. Healthcare workers in Singapore working in high-risk areas were mandated to wear personal protective equipment (PPE) such as N95 face mask and protective eyewear while attending to patients.Objectives.-We sought to determine the risk factors associated with the development of de novo PPE-associated headaches as well as the perceived impact of these headaches on their personal health and work performance. The impact of COVID-19 on pre-existing headache disorders was also investigated.Methods.-This is a cross-sectional study among healthcare workers at our tertiary institution who were working in highrisk hospital areas during COVID-19. All respondents completed a self-administered questionnaire.Results.-A total of 158 healthcare workers participated in the study. Majority [126/158 (77.8%)] were aged 21-35 years. Participants included nurses [102/158 (64.6%)], doctors [51/158 (32.3%)], and paramedical staff [5/158 (3.2%)]. Pre-existing primary headache diagnosis was present in about a third [46/158 (29.1%)] of respondents. Those based at the emergency department had higher average daily duration of combined PPE exposure compared to those working in isolation wards [7.0 (SD 2.2) vs 5.2 (SD 2.4) hours, P < .0001] or medical ICU [7.0 (SD 2.2) vs 2.2 (SD 0.41) hours, P < .0001]. Out of 158 respondents, 128 (81.0%) respondents developed de novo PPE-associated headaches. A pre-existing primary headache diagnosis (OR = 4.20, 95% CI 1.48-15.40; P = .030) and combined PPE usage for >4 hours per day (OR 3.91, 95% CI 1.35-11.31; P = .012) were independently associated with de novo PPE-associated headaches. Since COVID-19 outbreak, 42/46 (91.3%) of respondents with pre-existing headache diagnosis either "agreed" or "strongly agreed" that the increased PPE usage had affected the control of their background headaches, which affected their level of work performance. Conclusion.-Most healthcare workers develop de novo PPE-associated headaches or exacerbation of their pre-existing headache disorders.

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Section: Discussionmentioning

confidence: 99%

Headaches Associated With Personal Protective Equipment – A Cross‐Sectional Study Among Frontline Healthcare Workers During COVID‐19

et al. 2020

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“…Dietary factors are less common, but their role in precipitating migraine episodes is of increasing interest. The classical and most frequently cited migraine dietary triggers are chocolate, cheese, citrus fruits, nuts, processed meats, monosodium glutamate, aspartame, red wine, and coffee [7,[58][59][60]. It is believed that when these foods are avoided headaches improve [61].…”

Section: Migraine Triggersmentioning

confidence: 99%

To Eat or Not to eat: A Review of the Relationship between Chocolate and Migraines

et al. 2020

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Migraine is a chronic disorder with episodic attacks, and patients with a migraine often report that certain factors can trigger their headache, with chocolate being the most popular type of food-based trigger. Many studies have suggested a link between chocolate and headaches; however, the underlying physiological mechanisms are unclear. As premonitory symptoms may herald migraine attacks, a question arises regarding whether eating chocolate before a headache is a consequence of a food craving or indeed a real trigger. Here, we aim to summarize the available evidence on the relationship between chocolate and migraines. All articles concerning this topic published up to January 2020 were retrieved by searching clinical databases, including EMBASE, MEDLINE, PubMed, and Google Scholar. All types of studies have been included. Here, we identify 25 studies investigating the prevalence of chocolate as a trigger factor in migraineurs. Three provocative studies have also evaluated if chocolate can trigger migraine attacks, comparing it to a placebo. Among them, in 23 studies, chocolate was found to be a migraine trigger in a small percentage of participants (ranging from 1.3 to 33), while all provocative studies have failed to find significant differences between migraine attacks induced by eating chocolate and a placebo. Overall, based on our review of the current literature, there is insufficient evidence that chocolate is a migraine trigger; thus, doctors should not make implicit recommendations to migraine patients to avoid it.

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“…Similarly, the pediatric overweight and obesity are more prevalent over the last decades (Verrotti et al, 2012;Farello et al, 2017). Both conditions are multifactorial diseases, influenced by genetic, environmental, and psychological factors (Strauss, 2000;Lipton and Bigal, 2005;Friedman and De ver Dye, 2009;Albuquerque et al, 2017;Marmura, 2018), are associated with a poor quality of life, high healthcare costs, and increased risk of psychological disorders (Abu Bakar et al, 2016;Apovian, 2016;Öztop et al, 2016). In particular, patients suffering from high frequency of migraine attacks are more likely to report a more negative life impact due to pain (Malone et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Anxiety, Depression, and Body Weight in Children and Adolescents With Migraine

et al. 2020

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Background: There is a lack of studies that explore the possible association between body weight, psychological symptoms, and migraine severity in pediatric populations. The purpose of the study was to explore: (1) the association between body weight and the frequency of migraine attacks, (2) the possible differences in anxiety and depression symptoms according to the frequency of attacks and body weight, and (3) the possible mediating role of anxiety and/or depression in the association between body weight and frequency of migraine attacks in children. Methods: One hundred and eleven children/adolescents with migraine were included (47 boys and 64 girls; mean age 11.7; ±2.4 years). The patients were classified as: (1) high frequency patients, reporting from weekly to daily episodes and (2) low frequency patients, with ≤3 episodes per month. According to their body mass index percentiles, the patients were divided in "Normal weight" (from ≥5 to <85 percentile), "Overweight" (from ≥85 to <95 percentile), and "Obese" (≥95 percentile). Given the low number of obese patients, the overweight and obese groups were considered together in the "Overweight" group. Anxiety and depression symptoms were assessed by the Self-Administered Psychiatric Scales for Children and Adolescents (SAFA). Results: Fifty-four patients were normal in weight (49.6%), while 56 patients (50.4%) were overweight. The overweight patients showed a higher frequency of migraine attacks (64.7%; p < 0.05). Patients with a high frequency of attacks reported higher scores in all SAFA-Anxiety subscales (SAFA-A Tot: F = 15.107; p = 0.000). Overweight patients showed a significantly higher score in the "Separation anxiety" subscale (F = 7.855; p = 0.006). We found a mediating role between the overweight and high frequency for total anxiety (z = 2.11 ± 0.03; p < 0.05) and social anxiety (z = 2.04 ± 0.03; p < 0.05). Conclusions: Our results suggest that, among the children suffering from migraine, the overweight status is associated with a higher frequency of attacks and separation anxiety symptoms. In particular, our study provides the first evidence of the role of anxiety in linking overweight and the frequency of migraine attacks in children and adolescents.

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Triggers, Protectors, and Predictors in Episodic Migraine

Cited by 119 publications

References 122 publications

Headaches Associated With Personal Protective Equipment – A Cross‐Sectional Study Among Frontline Healthcare Workers During COVID‐19

Headaches Associated With Personal Protective Equipment – A Cross‐Sectional Study Among Frontline Healthcare Workers During COVID‐19

To Eat or Not to eat: A Review of the Relationship between Chocolate and Migraines

Anxiety, Depression, and Body Weight in Children and Adolescents With Migraine

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