Rumination in migraine: Mediating effects of brooding and reflection between migraine and psychological distress

Objective: The relationship between migraine and psychological distress has been consistently reported in cross-sectional and longitudinal studies. We hypothesised that a stable tendency to perseverative thoughts such as rumination would mediate the relationship between migraine and psychological distress.

Design and Main Outcomes Measures: Self-report questionnaires measuring depressive rumination, current psychological distress and migraine symptoms in two independent European population cohorts, recruited from Budapest (N = 1139) and Manchester (N = 2004), were used. Structural regression analysis within structural equation modelling was applied to test the mediational role of brooding and reflection, the components of rumination, between migraine and psychological distress. Sex, age and lifetime depression were controlled for in the analysis.

Results: Migraine predicted higher brooding and reflection scores, and brooding proved to be a mediator between migraine and psychological distress in both samples, while reflection mediated the relationship significantly only in the Budapest sample.

Conclusions: Elevated psychological distress in migraine is partially attributed to ruminative response style. Further studies are needed to expand our findings to clinical samples and to examine how rumination links to the adjustment to migraine.     

Wiederkehrende,primäre Kopfschmerzen im Jugendalter

Background

Recurrent pain, especially primary headache, is a serious health problem in adolescents. Music therapy in the treatment of children with migraine has already been evaluated. The aim of this pilot study was to adopt this treatment manual for adolescent patients with recurrent primary headache in preparation for the main randomized controlled trial.

Patients and methods

In this pilot study two different modes of treatment (standard and compact treatment) were tested in an outpatient setting with 19 patients. Frequency and intensity of headache symptoms were evaluated using pain diaries for 8 weeks in a pre-post design.

Results

The pilot study showed good feasibility of both treatment conditions in outpatient practice. Patients reported a reduction of pain frequency and intensity in both groups. The evaluation of the clinical relevance of these effects remains the objective for the main trial.

Conclusions

The music therapeutic treatment plan for children with migraine is even feasible in the treatment of adolescents with recurrent, primary headache. Further evidence questioning the effectiveness of the treatment under controlled conditions is needed.

     

Exploration of anomalous perceptual experiences in migraine between attacks using the Cardiff Anomalous Perceptions Scale

Distortions in sensory experiences that precede a migraine attack have been extensively documented, the most well-known being the visual aura. Distortions in the experience of other senses are also reported as part of an aura, albeit less frequently, together with changes in the perception or ownership of the body or body parts. There are many examples of differences in aspects of visual perception between migraine and control groups, between attacks, but not as much on unusual experiences involving other senses, the sense of the body or the experience of the environment. Seventy-seven migraine (33 with aura) and 74 control participants took part. Anomalous perceptions were experienced by both migraine and control groups, but more with migraine experienced them and rated them as more distressing, intrusive and frequent. Associations with reports of visual triggers of migraine and visual discomfort are presented. This study is the first to show relationships between these factors.     

The combined use of rational-emotive therapy and biofeedback in the treatment of childhood migraine

The available literature on the psychological treatment of childhood migraine was reviewed and evaluated. The current treatment modalities have relled essentially upon biofeedback techniques and neglected the potential cognitive factors that might lead to successful results. A case example is provided that demonstrates the combined treatment of childhood migraine using both biofeedback and rational emotive therapy (RET). Continued relief was reported during a follow-up interview conducted a year and a half after the treatment concluded. While both the biofeedback and RET elements for treatment were considered important for alleviation of the migraine condition, the subject reported that it was the RET training that proved most effective in dealing with stressors related to the onset of migraine attacks.     

Topiramate in the preventive treatment of episodic migraine: a combined analysis from pilot,double-blind,placebo-controlled trials

The safety and efficacy of medications for preventive treatment of migraine is the subject of current concern and investigation in health care. Two single-center, double-blind, placebo-controlled studies were conducted to evaluate the efficacy and safety of topiramate for migraine prophylaxis. Seventy patients with a diagnosis of migraine were randomly assigned to topiramate-treated and placebo groups. The studies consisted of a 4-week baseline phase, a 6-8 week titration, and 8-12 weeks of maintenance. Topiramate was titrated from an initial dose of 25 mg/day to a target dose of 100 mg BID. The primary efficacy measure, the mean 28-day migraine frequency, was lower in topiramate-treated patients than in the placebo group (3.2 versus 3.8, P=.001). Similarly, topiramate treatment resulted in a significantly greater mean reduction in migraine frequency than did placebo (1.55 versus 0.47, P=.001) and a significantly higher responder rate (35.3% versus 8.3%, P=.008). Paresthesia was the most common side effect reported with topiramate treatment. Other topiramate-associated adverse events included altered taste, memory impairment, diarrhea, and appetite suppression/weight loss. The rates of discontinuation were similar for the topiramate group (n=10) and the placebo group (n=8). These results suggest that topiramate is effective and well tolerated in the preventive treatment of migraine headaches.     

Persistent visual aura following catheter ablation in a patient with WPW syndrome

We report a patient who has had persistent visual disturbances since she underwent catheter ablation to treat her Wolff-Parkinson-White (WPW) syndrome. We examined her visual symptoms carefully and quantitatively by means of our newly developed method combining image-processing and psychophysics. We first simulated the patient's visual symptoms using image-processing techniques. Since the simulation indicated that she would be very sensitive to the edges of the visual stimuli, we evaluated her sensitivity to the edges using psychophysics. The results indicated that she was hypersensitive to the clear-cut edges of the visual stimuli. Her visual symptoms were very similar to those of visual aura of migraine, rather than those of photosensitive epilepsy. Magnetic resonance imaging (MRI) and single photon emission computed tomography (SPECT), electroenchepalogram (EEG), and visual-evoked potentials (VEP) in the patient were normal. No abnormalities in her fundus, visual field, or electroretinogram were found, either. Transesophageal echocardiography with bubble study indicated that she had a preexisting right-to-left shunt. We hypothesize that visual aura of migraine was triggered and made persistent by the catheter ablation in this patient. Although the relationship between migraine, catheter ablation, and right-to-left shunts is unknown, previous studies on the transcatheter closure of patent foramen ovale suggest a possible link between them. Catheter ablation in patients with migraine and preexisting shunts may lead to exacerbations in migraine symptoms.     

Social problem‐solving,perceived stress,depression and life‐satisfaction in patients suffering from tension type and migraine headaches

This study aimed at investigating social problem solving, perceived stress, depression, and life‐satisfaction in patients with tension type and migraine headaches. Forty‐nine migraine and 42 tension type headache patients (n = 91) consenting to participate were compared to a total of 49 matched healthy control group. Participants filled in a questionnaire consisting self‐report measures of problem solving, perceived stress, depression and life satisfaction. They were also asked about headache duration, frequency, pain severity, psychiatric treatment and sense of control in one's life. T‐tests, chi‐square, analysis of variance, logistic regression analysis and Pearson product moment correlation coefficient procedures were used to analyze the data. Tension type headache patients reported having had more frequent headaches than the migraine patients but migraine patients reported having had more intense pain than the tension type headache patients. Instances of psychiatric treatment were more common among tension type headache patients than the migraine and the control group. Compared to the healthy controls, headache patients displayed a deficiency in problem solving, higher levels of perceived stress and depression. Levels of problem solving skills in headache patients were related inversely to depression, perceived stress and the number of negative life events but problem solving skills of headache patients was related positively to life‐satisfaction. The findings from this study suggested that cognitive behavioral problem solving therapy or training might be a viable option for reducing levels of stress and depression, and to increase life‐satisfaction in patients suffering from primary headache.     

The comorbidity of migraine

This review addresses the methodologic issues relevant to the study of comorbidity and provides a broad overview of the medical and psychiatric conditions associated with migraine. Since the body of literature examining the comorbidity of migraine is enormous, the scope of this review will largely focus on community and case-control studies. Among the selected comorbid medical conditions, including disorders of the cardiovascular, respiratory, neurologic, gastrointestinal and immunologic systems, stroke, asthma, and allergies appear to be most strongly associated with migraine. Among the psychiatric illnesses, mood and anxiety disorders have been shown to be most strongly associated with migraine in the general population. Further research is indicated and necessary to elucidate the precise mechanism of migraine comorbidity.     

Effect of pulsating electromagnetic field therapy on cell volume and phagocytosis activity in multiple sclerosis and migraine

PEMF treatment was studied in 10 patients with multiple sclerosis and 10 patients with migraine. In both patients' groups a single treatment induced a significant rise of yeast particle uptake by blood granulocytes. The percentage of phagocytizing cells was increased in migraine patients only. In both patients' groups 20 PEMF treatments caused a reduction of particle uptake, whereas the percentage of phagocytizing cells remained unchanged. In migraine patients the opsonic capacity of serum and the mean cell volume of erythrocytes, lymphocytes and granulocytes were initially reduced, but increased during the course of 20 PEMF treatments. The biphasic changes of cell volume and phagocytic activity are interpreted as a result of counter-regulation of the organism in response to the primary PEMF effect.     

Punctate transcutaneous electrical nerve stimulation in migraine therapy

Pharmacotherapy of migraine is not satisfying at present, especially in case of frequent attacks of headache. Therefore alternative methods of treatment gain increasing relevance. Based upon many years of experience with specific reflexotherapy and conventional stimulation therapy for treatment of pain we started a clinical study in migraine applying the punctual transcutaneous electrical nerve stimulation (PuTENS) performed with self-made pocket electrostimulators (TRG I-III). The study includes self-treatment of patients at home. After more than 6 months PuTENS was prophylactically effective in 225 out of 282 patients, i.e. in 80% of cases the frequency of attacks and the use of drugs were reduced to at least 50%. In 90 patients treated by the physician the rate of improvement was 86% compared to 76% in 192 patients, which performed self-treatment according to the physician's instruction and under medical supervision. 96 out of 160 patients with migraine could alleviate their acute headache by PuTENS applying the pocket electrostimulator at home. In conclusion, PuTENS is superior to drug therapy and conventioned electrotherapy in the treatment of migraine. Its effectiveness is similar to needle acupuncture. The method can therefore be regarded as a valuable alternative and help for patients with frequent headache.     

The link between glutamate and migraine

Migraine pain-relay centers, including the trigeminal ganglion, trigeminal nucleus caudalis, and thalamus, contain glutamate-positive neurons, and glutamate activates the trigeminal nucleus caudalis. Glutamate is implicated in cortical spreading depression, trigeminovascular activation, and central sensitization. Glutamate receptor-subtype antagonists are effective in preclinical models of migraine, and in the clinic. These preclinical and clinical observations argue for a strong link between migraine and the glutamatergic system, a link that is important to further characterize in an effort to better understand migraine mechanisms and deliver effective therapies.     

Results of neurophysiologic studies in ophthalmic migraine

The influence in 8 of our patients with ophthalmic migraine of photic driving with sine-like flashing lights on EEG background activity was checked and the visually evoked potentials following the application of diffused simple light stimuli were analyzed using the recovery cycle technique. The results indicate a slightly increased tonic activity of the structures of the mesencephalic formatio reticularis, such as may be produced by slight functional disturbances. Some vegetative secondary symptoms of migraine attacks and some of the changes in EEG observed in patients with ophthalmic migraine are explicable by such an abnormality.     

Sequential comparisons of relaxation training and biofeedback in the treatment of three kinds of chronic headache or,the machines may be necessary some time of the time

Two studies are reported in which patients with chronic headache, who did not improve significantly as a result of a 10-session, 8-week relaxation training program, were subsequently treated with biofeedback. For the tension headache sufferers, 36% of the relaxation non-responders showed significant improvement with frontal EMG biofeedback training. For those with vascular headaches, 44% of the relaxation non-responders showed significant improvement with thermal biofeedback. Vascular headache patients with combined migraine and tension symptoms did better than those with only migraine. Psychological test scores significantly differentiated successful vs non-successful biofeedback responders.     

One-day behavioral treatment for patients with comorbid depression and migraine: a pilot study

BackgroundMigraine is a common and disabling disorder that is highly comorbid with depression. The comorbidity of depression and migraine is a major health concern as it results in poorer prognosis and quality of life. Yet, effective treatments have rarely been investigated.Method45 patients with comorbid migraine and depression were assigned to a 1-day Acceptance and Commitment Training plus Migraine Education workshop (ACT-ED; N = 31) or to Wait List/Treatment as Usual (WL/TAU; N = 14). Assessment of depressive symptoms, general functioning, and migraine related disability were completed at baseline and 2-, 6-, and 12 weeks after the workshop.ResultsAt the 3-month follow up, participants in the ACT-ED condition exhibited significantly greater improvements in depressive symptoms, general functioning, and migraine-related disability than patients in the WL/TAU group.ConclusionA 1-day ACT-ED workshop is a promising approach to the treatment for depression and disability in migraineurs that merits further investigation.     

The resurrection of a magical reality: treatment of functional migraine in a child

A magical world view and logic were used in the treatment of a 10-year-old girl who was referred because of suicidal threats due to migrainous pain. The treatment consisted of a one-session intervention with three-week, six-month, and one-year follow-up indicating elimination of migraine. Within a strategic family therapy, a magical ritual was prescribed that derived from the preoperational logic explicated by Piaget and from the healing practices described in anthropological studies. Such a ritual casts the symptom in a different context, alters the meaning of migraine to the family system, and leads to different interactional patterns. Piaget's theory and anthropological data are discussed as sources of a magical world view to help families and children disengage from a symptomatic system of interactions.     

Family therapy approach to incapacitating migraine

A nine-year-old boy who suffered from intractable migraine was referred for psychiatric consultation and treatment after failing to respond to congeries of medications and diets, notwithstanding thorough investigations by neurologists, pediatricians, and other specialists. The decision for a family systems treatment approach resulted in the following defined objectives: (1) to investigate triggers for the headaches and to see if these could be reduced and/or eliminated, (2) to see if therapy would help the boy stay in school, (3) to examine, and if possible, change family rules of interaction and transaction, (4) to allow for more fun within the family (5) to allow for ventilation without retribution, and (6) to clarify the mother's role as a significant contributor to the family's interactions, shifting the focus from the father as the sole generator of family tension. The principal therapeutic tools which proved efficacious involved the following: (1) scrutiny of the maternal and paternal histories, and (2) analysis of triangulations within the family system, leading to (3) the formulation of therapeutic strategies, and (4) specific task assignments. A major intervention by the therapist was the specific strategy to have the family examine the rules of transaction which were in the metapsychological sense unarticulated.     

Temperature self-regulation and relaxation with migraine patients and normals

Ten migraine headache subjects and 10 non-migraine subjects were divided equally into two groups: a progressive relaxation group and a finger temperature biofeedback group. Finger temperature, temporal artery pulse amplitude and forehead blood flow were monitored for all subjects during two baseline and six treatment sessions.

The biofeedback group achieved greater (albeit low magnitude) increases in finger temperature than the relaxation group, but no improvement in headache activity was obtained. However the relaxation group improved significantly in terms of headache intensity.

There was no significant difference in the ability to achieve finger temperature control, nor in stability point temperatures, between the migraine and non-migraine subjects.

No systematic relationship was found between finger temperature, forehead blood volume and temporal artery pulse amplitude. Possible mechanisms of the therapeutic effects of finger temperature training are examined in the light of these results.     

Migräne und Botulinumtoxin Typ A

A chronic migraine occurs significantly less frequently than an episodic migraine, with a prevalence of approximately 0.5 to 2.2?%. Based on the scientific data of an extensive study program, Botox® has been permitted for use as a prophylaxis in Austria since 2012. Most other forms of medicinal prophylaxis are of limited effectiveness and are associated with significant side-effects. Successful prophylaxis and therapy require patient compliance and withdrawal treatment for the frequent accompanying headache caused by the overuse of analgesics.     

Differences on the projective hand test among chronic pain patients reporting three different pain experiences

This study examined personality differences among individuals experiencing 3 different types of pain. The projective Hand Test was administered to 90 individuals who were seeking treatment at a pain clinic in an urban area of the southeast United States. These people were seeking treatment for either arthritis (n = 31), fibromyalgia (n = 29), or migraine headaches (n = 30). A 2 (gender) x 3 (pain group) x Age Group multivariate analysis of variance was conducted using the quantitative Hand Test scoring variables as dependent measures. Results indicated that individuals who were seeking treatment for migraine headaches had a higher production rate of responses involving exhibitionistic displays (EXH) than individuals in the other 2 groups. Individuals who were seeking treatment for fibromyalgia had a higher production rate of responses indicating fear and phobic concerns (FEAR) than individuals in the other 2 groups. Individuals who were seeking treatment for arthritis had a higher production rate of Active (ACT) responses than individuals in the other 2 groups. Possible causes and consequences of these effects are discussed.