Quality Improvement in Neurology: Headache Quality Measurement Set

Robbins, Matthew S.; Victorio, M. Cristina; Bailey, Matthew; Cook, Calli; Garza, Ivan; Huff, J. Stephen; Ready, Duren Michael; Schuster, Nathaniel M.; Seidenwurm, David; Seng, Elizabeth K.; Szperka, Christina L.; Lee, Erin; Villanueva, Raissa

doi:10.1111/head.13988

Cited by 9 publications

(5 citation statements)

References 45 publications

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“…First, the term migraine attacks was preferred over “migraines” to describe the patient experience of their migraine. This is consistent with a September 2020 American Academy of Neurology (AAN) updated quality measurement set for headache, which uses the term “migraine attack” rather than “migraine” when measuring outcomes [ 20 ].…”

Section: Discussionsupporting

confidence: 76%

Establishing content validity for the migraine Global Impression Item (mGI-I) assessment: a modified single-item migraine symptom severity questionnaire

et al. 2022

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Objective To establish content validity of a single-item, migraine-specific symptom severity questionnaire for completion by migraine patients, key family members (KFMs) of migraine patients, and Healthcare Professionals (HCPs) who treat migraine patients. Background Migraine is a common disabling primary headache disorder with high prevalence and significant socioeconomic burden and personal impacts. There is a need for a global assessment of migraine symptom severity to evaluate potential new therapies from multiple perspectives. Methods The migraine Global Impression Item (mGI-I) was drafted and tested in a non-interventional, qualitative study comprising telephone interviews with 15 migraine patients, 15 KFMs of migraine patients, and 15 migraine treating HCPs. The mGI-I was drafted with two different item stem options and two different response scale options to ask about the patient’s migraine from the perspective of each respondent. Cognitive interviews were conducted to test comprehensiveness, clarity and ease of completion of the different versions of the mGI-I iteratively in three sequential waves of respondents. Results Revisions were made to the draft mGI-I after Wave 1 and Wave 2 of the interviews. Changes were made to simplify the item stem (removing unnecessary text), make language more patient-friendly (e.g. use of “migraine attack”), and add clarity to the item stem for consistent interpretation (include descriptive language of migraine attacks). Across both waves there was a preference for a 5-point response scale compared to a 7-point scale. In Wave 3, all respondents found the revised instructions, item stem, and 5-point response scale comprehensive, easy to understand and to answer. No further changes to the mGI-I were made after Wave 3. Conclusions This qualitative study of 45 total respondents across 3 subpopulations, established the content validity and appropriateness of the mGI-I in migraine patients, KFMs, and migraine-treating HCPs. The study specifically confirmed that the mGI-I is comprehensive, easily understood and answered for each respondent population.

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Section: Discussionsupporting

confidence: 76%

Establishing content validity for the migraine Global Impression Item (mGI-I) assessment: a modified single-item migraine symptom severity questionnaire

et al. 2022

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“…Patient education and lifestyle modification are important tools in the management of patients with migraine, and acute treatment plans should incorporate personalized guidance about the benefits of proper nutrition, regular exercise, adequate hydration, proper sleep, stress management, and maintaining a migraine diary. 32,33 In addition to education and lifestyle recommendations tailored to the individual, the following principles should be used as a guide in developing personalized plans for the acute treatment of patients with migraine. 23…”

Section: Developing Treatment Plansmentioning

confidence: 99%

The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice

2021

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Objective To incorporate recent research findings, expert consensus, and patient perspectives into updated guidance on the use of new acute and preventive treatments for migraine in adults. Background The American Headache Society previously published a Consensus Statement on the use of newly introduced treatments for adults with migraine. This update, which is based on the expanded evidence base and emerging expert consensus concerning postapproval usage, provides practical recommendations in the absence of a formal guideline. Methods This update involved four steps: (1) review of data about the efficacy, safety, and clinical use of migraine treatments introduced since the previous Statement was published; (2) incorporation of these data into a proposed update; (3) review and commentary by the Board of Directors of the American Headache Society and patients and advocates associated with the American Migraine Foundation; (4) consideration of these collective insights and integration into an updated Consensus Statement. Results Since the last Consensus Statement, no evidence has emerged to alter the established principles of either acute or preventive treatment. Newly introduced acute treatments include two small‐molecule calcitonin gene‐related peptide (CGRP) receptor antagonists (ubrogepant, rimegepant); a serotonin (5‐HT1F) agonist (lasmiditan); a nonsteroidal anti‐inflammatory drug (celecoxib oral solution); and a neuromodulatory device (remote electrical neuromodulation). New preventive treatments include an intravenous anti‐CGRP ligand monoclonal antibody (eptinezumab). Several modalities, including neuromodulation (electrical trigeminal nerve stimulation, noninvasive vagus nerve stimulation, single‐pulse transcranial magnetic stimulation) and biobehavioral therapy (cognitive behavioral therapy, biofeedback, relaxation therapies, mindfulness‐based therapies, acceptance and commitment therapy) may be appropriate for either acute and/or preventive treatment; a neuromodulation device may be appropriate for acute migraine treatment only (remote electrical neuromodulation). Conclusions The integration of new treatments into clinical practice should be informed by the potential for benefit relative to established therapies, as well as by the characteristics and preferences of individual patients.

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“…We observed a decreased risk of gastrointestinal cancer, particularly among patients diagnosed with migraine in the emergency departments. This finding could be explained by an increased consumption of aspirin and non-steroidal anti-inflammatory drugs (NSAIDs), which are commonly used for pain relief by individuals with migraine, 45,49,50 and are also protective against stomach and colorectal cancers. 38,[51][52][53][54][55] Additionally, because the use of NSAIDs and aspirin increases bleeding risk, increased use among individuals with migraine may lead to earlier detection of premalignant changes associated with colorectal cancer.…”

Section: Discussionmentioning

confidence: 99%

Cancer risk in patients with migraine: A population‐based cohort study in Denmark

et al. 2022

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Objective:The purpose of this study was to examine overall and site-specific cancer risk among individuals diagnosed with migraine compared with the general population.Background: Current evidence regarding migraine and risk of cancer is sparse and inconclusive.Methods: We conducted a nationwide population-based cohort study with data collected routinely and prospectively from Danish population-based registries from 1995 to 2017.We computed the age-and sex-standardized incidence ratio (SIR) as the ratio of observed to expected cancers among patients diagnosed with migraine in the study population overall, and by encounter type of first diagnosis (inpatient, outpatient specialty clinic, and emergency department). Site-specific cancers were grouped according to etiology. Results:We identified 72,826 patients with a first-time hospital migraine diagnosis. There were 3090 observed overall cancer cases among individuals diagnosed with migraine as compared with 3108 expected cases (SIR 0.99, 95% confidence interval[CI]: 0.96-1.03). The cumulative incidence of all cancers combined from 1995 to 2017 among those with a first-time migraine diagnosis was 9.47% (95% CI: 9.08-9.87). The SIRs for most cancers were consistent with absence of an association: 1.00 (95% CI: 0.94-1.06) for hormone-related cancers, 0.96 (95% CI: 0.88-1.03) for smoking-related cancers, 1.10 (95% CI: 0.98-1.24) for hematologic cancers, and 0.95 (95% CI: 0.85-1.06) for immune-related cancers. Exceptions were SIRs for gastrointestinal cancers (0.78, 95% CI: 0.70-0.87) and for cancers of neurological origin (1.57, 95% CI: 1.40-1.76). Conclusions:For most cancer groups, our results did not support an association with migraine. The exceptions were an increased risk for cancers of neurological origin and a decreased risk for gastrointestinal cancers. These findings may reflect a true difference in risk among individuals with migraine, or more plausibly they reflect other forces, such as differences in medication use, detection bias and reverse causation, or shared risk factors.

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Quality Improvement in Neurology: Headache Quality Measurement Set

Cited by 9 publications

References 45 publications

Establishing content validity for the migraine Global Impression Item (mGI-I) assessment: a modified single-item migraine symptom severity questionnaire

Establishing content validity for the migraine Global Impression Item (mGI-I) assessment: a modified single-item migraine symptom severity questionnaire

The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice

Cancer risk in patients with migraine: A population‐based cohort study in Denmark

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