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Objective: This study is a secondary analysis evaluating changes in cognitive fusion and pain catastrophizing over 8 weeks of mindfulness‐based cognitive therapy for migraine (MBCT‐M) intervention versus waitlist/treatment as usual. Background: Migraine is a common disabling neurological condition. MBCT‐M combines elements of cognitive behavioral therapy with mindfulness‐based approaches and has demonstrated efficacy in reducing migraine‐related disability. Methods: A total of 60 adults with migraine completed a 30‐day run‐in before randomization into a parallel design of either eight weekly individual MBCT‐M sessions (n = 31) or waitlist/treatment as usual (n = 29): participants were followed for 1 month after. Participants completed the Pain Catastrophizing Scale (PCS) and the Cognitive Fusion Questionnaire (CFQ) at Months 0, 1, 2, and 4. Results: The PCS scores decreased more in the MBCT‐M group (mean [SD] at baseline = 22.5 [9.6]; at Month 4 = 15.1 [8.8]) than in the waitlist/treatment as usual group (mean [SD] at baseline = 24.9 [9.0]; at Month 4 = 22.5 [10.4]) from Month 0 to 4 (β = −7.24, p = 0.001, 95% confidence interval [CI] −11.39 to −3.09). The CFQ (mean [SD] baseline = 27.6 [8.0]; at Month 4 = 25.0 [8.0]) did not change significantly from Month 0 to 4 (β = −1.2, p = 0.482, 95% CI −4.5 to 2.1). Parallel mediation analyses indicated that decreases in the PCS and CFQ together (β = −6.1, SE = 2.5, 95% CI −11.6 to −1.8), and the PCS alone (β = −4.8, SE = 2.04, 95% CI −9.1 to −1.1), mediated changes in headache disability in the MBCT‐M treatment completer group (n = 19). Conclusion: In this study, pain catastrophizing showed strong promise as a potential mechanism of MBCT‐M. Future research should continue to explore cognitive appraisal changes in mindfulness‐based interventions. [ABSTRACT FROM AUTHOR]

Background: Stigma is increasingly recognized as an important social feature of living with migraine. Methods: Adults with migraine recruited from neurology offices completed the validated Stigma Scale for Chronic Illnesses 8‐item version (SSCI‐8); two outcome measures (the Migraine Disability Assessment [MIDAS] and the Migraine‐Specific Quality of Life Questionnaire v 2.1 [MSQ]); and measures of allodynia (Allodynia Symptom Checklist [ASC‐12]), pain cognition (Pain Catastrophizing Scale [PCS]), and psychiatric symptoms (Patient Reported Measurement Information System Anxiety [PROMIS‐A] and Depression [PROMIS‐D]). Pearson and Spearman correlations evaluated bivariate relationships, and linear (MSQ) and logistic (MIDAS Severe Disability, scores ≥21) regressions evaluated the unique variance associated with SSCI‐8 beyond other study variables. Conditional process analysis evaluated mediation hypotheses between study variables. Results: Participants (n = 121) reported levels of stigma on par with other chronic illnesses (SSCI‐8 M = 53.0, standard deviation [SD] = 7.8), with 25/127 (19.6%) reporting clinically significant levels of stigma (SSCI‐8 T‐score ≥ 60). Higher SSCI‐8 scores were associated with higher monthly headache day frequency (r = 0.35), MIDAS (ρ = 0.41), ASC‐12 (r = 0.24, p < 0.01), PCS (r = 0.46), both PROMIS‐A (r = 0.43) and D (r = 0.42), and lower MSQ subscale scores (Role Restriction r = −0.50; Role Prevention r = −0.48; Emotion Function r = −0.50), all ps <0.001 unless otherwise noted. The SSCI‐8 contributed significantly beyond migraine symptoms and other psychological factors for MSQ Emotion Function (5% unique variance) and MIDAS Severe Disability (6% of unique variance). The SSCI‐8 mediated relationships between headache frequency and the MSQ subscales and MIDAS Severe Disability. The PCS mediated relationships between the SSCI‐8 and MSQ subscales. The PROMIS‐D mediated relationships between the SSCI‐8 and MSQ Role Restriction and MSQ Role Prevention. Conclusions: Migraine stigma has medium to large associations with migraine outcomes and psychiatric symptoms and is independently associated with migraine disability and emotion‐related quality of life. Migraine stigma is an important contributor to the relationship between headache frequency and migraine outcomes. [ABSTRACT FROM AUTHOR]

The article offers insights into the social impact of migraine and discusses the choices society has in responding to this problem. It highlights the interconnectedness of individuals with migraine and the potential benefits of accommodating their needs, such as increased productivity and improved well-being for everyone.

Migraine, a common and disabling neurological disorder, is among the top reasons for outpatient visits to general neurologists. In addition to pharmacotherapy, lifestyle interventions are a mainstay of treatment. High-quality daily diary studies and intervention studies indicate intraindividual variations in the associations between lifestyle factors (such as stress, sleep, diet, and physical activity) and migraine attack occurrence. Behaviour change interventions can directly address overlapping lifestyle factors; combination approaches could capitalise on multiple mechanisms. These findings provide useful directions for integration of lifestyle management into routine clinical care and for future research. [ABSTRACT FROM AUTHOR]

The article reports on a study exploring the links between airborne hazards and headache disorders. It focuses on the impact of heavy exposure to secondhand cigarette smoke, demonstrates a doubled odds of severe headaches or migraines in individuals who have never smoked cigarettes, highlighting the need for further research to understand the clinical implications and potential distinct clinical entities associated with long-term exposure to airborne environmental toxins like cigarette smoke.

Objective: This study is part of the ODIN‐migraine (Optimization of Diagnostic Instruments in migraine) project. It is a secondary, a priori analysis of previously collected data, and aimed to assess the psychometric properties and factor structure of the Cogniphobia Scale for Headache Disorders (CS‐HD). We aimed to construct a German‐language version and a short version. Background: Cogniphobia is the fear and avoidance of cognitive exertion, which the patient believes triggers or exacerbates headache. High cogniphobia may worsen the course of a headache disorder. Methods: The 15‐item CS‐HD was translated into German and back translated in a masked form by a professional translator. Modifications were discussed and carried out in an expert panel. A cross‐sectional online survey including the CS‐HD and further self‐report questionnaires was conducted in a sample of N = 387 persons with migraine (364/387 [94.1%] female, M = 41.0 [SD = 13.0] years, migraine without aura: 152/387 [39.3%], migraine with aura: 85/387 [22.0%], and chronic migraine: 150/387 [38.8%]). Results: Exploratory factor analysis resulted in two clearly interpretable factors (interictal and ictal cogniphobia). Confirmatory factor analysis yielded an acceptable to good model fit (χ2(89) = 117.87, p = 0.022, χ2/df = 1.32, RMSEA = 0.029, SRMR = 0.055, CFI = 0.996, TLI = 0.995). Item response theory‐based analysis resulted in the selection of six items for the short form (CS‐HD‐6). Reliability was acceptable to excellent (interictal cogniphobia subscale: ω = 0.92 [CS‐HD] or ω = 0.77 [CS‐HD‐6]; ictal cogniphobia subscale: ω = 0.77 [CS‐HD] or ω = 0.73 [CS‐HD‐6]). The pattern of correlations with established questionnaires confirmed convergent validity of both the CS‐HD and the CS‐HD‐6. Conclusion: Both the CS‐HD and the CS‐HD‐6 have good psychometric properties and are suitable for the assessment of cogniphobia in migraine. Plain Language Summary: Cogniphobia is the fear of cognitive exertion, in which the patient believes effortful thinking triggers or exacerbates headache. The Cogniphobia Scale for Headache Disorders (CS‐HD) provides an assessment of this headache specific‐fear. A German version and a six‐item short form of the CS‐HD were developed from an online sample of 387 persons with migraine, and our results showed that this version was suitable. [ABSTRACT FROM AUTHOR]

Persons living with HIV/AIDS (PLWH) report very high prevalences of cigarette smoking, and there are racial/ethnic disparities in smoking consequences and quit outcomes. In this exploratory pilot study, we examined racial/ethnic differences in perceived risks and benefits of quitting cigarette smoking among 97 adult PLWH in the Bronx, New York (Hispanic, 53.6%; African American, 46.4%). Compared to African American PLWH, Hispanic PLWH reported greater endorsement of overall risks and benefits and risks of negative affect, difficulty concentrating, social ostracism, loss of enjoyment, and cravings. It may be useful to incorporate risks and benefits of quitting into smoking treatment for African American and Hispanic PLWH. [ABSTRACT FROM AUTHOR]

The article presents the discussion on behavioral treatments working for migraine prevention. Topics include providing separate estimates for each dose and route of administration of each triptan; resulting from progressive muscle relaxation, autogenic training, behavioral management, cognitive behavioral therapy (CBT), biofeedback, mindfulness-based interventions, and hypnosis; and cognitive behavioral therapies leading to reductions in attacking frequency and disability.

Objective: To examine the influences of depression and anxiety on headache‐related disability in people with episodic migraine or chronic migraine. Background: Depression and anxiety are common comorbidities in people with migraine, especially among those with chronic migraine. Methods: This cross‐sectional analysis of data from the longitudinal, internet‐based Chronic Migraine Epidemiology and Outcomes Study assessed sociodemographic and headache features, and headache‐related disability (Migraine Disability Assessment Scale). Four groups were defined based on scores from validated screeners for depression (9‐item Patient Health Questionnaire) and anxiety (7‐item Generalized Anxiety Disorder Scale): depression alone, anxiety alone, both, or neither. Results: Respondents (N = 16,788) were predominantly women (74.4% [12,494/16,788]) and white (84.0% [14,044/16,788]); mean age was 41 years. Depression was more likely in persons with chronic migraine vs episodic migraine (56.6% [836/1476] vs 30.0% [4589/15,312]; P <.001), as were anxiety (48.4% [715/1476] vs 28.1% 4307/15,312]; P <.001) and coexisting depression and anxiety (42.0% [620/1476] vs 20.8% [3192/15,312]; P <.001). After controlling for headache frequency and other covariates, depression alone, and anxiety alone were associated with 56.0% (rate ratio [RR], 1.56; 95% confidence interval [CI], 1.46‐1.66) and 39.0% (RR, 1.39; 95% CI, 1.30‐1.50) increased risks of moderate/severe migraine‐related disability (both P <.001), respectively; the combination had an even greater effect on risk of moderate/severe disability (79.0% increase; RR, 1.79; 95% CI, 1.71‐1.87; P <.001). Conclusions: Depression alone and anxiety alone are associated with greater headache‐related disability after controlling for sociodemographic and headache features. Coexisting depression and anxiety are more strongly associated with disability than either comorbidity in isolation. Interventions targeting depression and anxiety as well as migraine itself may improve headache‐related disability in people with migraine. [ABSTRACT FROM AUTHOR]

Objective: The current Phase 2b study aimed to evaluate the efficacy of mindfulness‐based cognitive therapy for migraine (MBCT‐M) to reduce migraine‐related disability in people with migraine. Background: Mindfulness‐based interventions represent a promising avenue to investigate effects in people with migraine. MBCT teaches mindfulness meditation and cognitive‐behavioral skills and directly applies these skills to address disease‐related cognitions. Methods: Participants with migraine (6‐30 headache days/month) were recruited from neurology office referrals and local and online advertisements in the broader New York City area. During the 30‐day baseline period, all participants completed a daily headache diary. Participants who met inclusion and exclusion criteria were randomized in a parallel design, stratified by chronic migraine status, to receive either 8 weekly individual MBCT‐M sessions or 8 weeks of waitlist/treatment as usual (WL/TAU). All participants completed surveys including primary outcome evaluations at Months 0, 1, 2, and 4. All participants completed a headache diary during the 30‐day posttreatment evaluation period. Primary outcomes were the change from Month 0 to Month 4 in the headache disability inventory (HDI) and the Migraine Disability Assessment (MIDAS) (total score ≥ 21 indicating severe disability); secondary outcomes (headache days/30 days, average headache attack pain intensity, and attack‐level migraine‐related disability [Migraine Disability Index (MIDI)]) were derived from the daily headache diary. Results: Sixty participants were randomized to receive MBCT‐M (n = 31) or WL/TAU (n = 29). Participants (M age = 40.1, SD = 11.7) were predominantly White (n = 49/60; 81.7%) and Non‐Hispanic (N = 50/60; 83.3%) women (n = 55/60; 91.7%) with a graduate degree (n = 35/60; 55.0%) who were working full‐time (n = 38/60; 63.3%). At baseline, the average HDI score (51.4, SD = 19.0) indicated a moderate level of disability and the majority of participants (50/60, 83.3%) fell in the "Severe Disability" range in the MIDAS. Participants recorded an average of 16.0 (SD = 5.9) headache days/30 days, with an average headache attack pain intensity of 1.7 on a 4‐point scale (SD = 0.3), indicating moderate intensity. Average levels of daily disability reported on the MIDI were 3.1/10 (SD = 1.8). For the HDI, mean scores decreased more from Month 0 to Month 4 in the MBCT‐M group (−14.3) than the waitlist/treatment as an usual group (−0.2; P < .001). For the MIDAS, the group*month interaction was not significant when accounting for the divided alpha, P = .027; across all participants in both groups, the estimated proportion of participants falling in the "Severe Disability" category fell significantly from 88.3% at Month 0 to 66.7% at Month 4, P < .001. For diary‐reported headache days/30 days an average headache attack pain intensity, neither the group*month interaction (Ps = .773 and.888, respectively) nor the time effect (Ps = .059 and.428, respectively) was significant. Mean MIDI scores decreased in the MBCT‐M group (−0.6/10), whereas they increased in the waitlist/treatment as an usual group (+0.3/10), P = .007. Conclusions: MBCT‐M demonstrated efficacy to reduce headache‐related disability and attack‐level migraine‐related disability. MBCT‐M is a promising emerging treatment for addressing migraine‐related disability. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate providers' use and predictors of evidence-based medicine or opioid/barbiturate as first-line acute treatment for children's initial presentation of acute migraine or primary headache.Methods: This retrospective, observational study utilized patient (children ages 6-17) and provider/encounter characteristics extracted from the patient's Electronic Health Record from 2008-2014 during an initial encounter for migraine or primary headache. The primary outcome was provider evidence-based medicine utilization; overall prescriptions and opioid/barbiturate prescriptions were also evaluated. Hierarchical linear modeling examined whether Level 1 (patient: Demographic, insurance type) and Level 2 (provider/encounter: Treatment setting/location, encounter diagnoses) characteristics influenced outcomes.Results: In all, 38,926 patients (56.7% female, mean age = 12.1) and 1617 providers were evaluated. Only 17.7% of patients were diagnosed with migraine; 16.1% received evidence-based medicine. Older children (OR = 1.07, p < 0.001), females (OR = 1.14, p < 0.001), and those diagnosed with migraine (OR = 4.71, p < 0.001) were more likely to receive evidence-based medicine. Among prescriptions, 15.8% were for opioids/barbiturates. Older children (OR = 1.14, p < 0.001) and those cared for in the emergency department/urgent care (OR = 2.02, p < 0.001) were at increased risk.Conclusions: Demographics and migraine diagnosis are associated with evidence-based medicine and opioid/barbiturates. Primary care provides an opportunity to target provider interventions to enhance effective pediatric headache treatment. [ABSTRACT FROM AUTHOR]

Objective: This study aims to investigate the psychometric properties (component structure, reliability, and construct validity) of the Headache‐Specific Locus of Control scale in several clinical migraine populations. Background: Headache‐specific locus of control beliefs may impact a person's behavioral decisions that affect the likelihood of migraine attack onset, emotional responses to migraine attacks, coping strategies used, and treatment adherence. The 33‐item Headache‐Specific Locus of Control scale is the most widely used measure of locus of control specific to headache yet psychometric evaluations remain limited. Methods: Six hundred and ninety‐five adults with a diagnosis of migraine from 5 different research studies completed cross‐sectional self‐report measures including the Headache‐Specific Locus of Control scale and measures of quality of life and disability (Migraine‐Specific Quality of Life Questionnaire and Migraine Disability Assessment). Results: Five Headache‐Specific Locus of Control components emerged from Horn's Parallel Analysis, Minimum Average Partial test, and Principal Component Analysis (eigenvalues: Presence of Internal = 5.7, Lack of Internal = 4.0, Luck = 2.9, Doctor = 2.0, and Treatment = 1.5). The 33 Headache‐Specific Locus of Control items demonstrated adequate internal consistency for total (α = 0.79) and subscale scores (α's = 0.69 to 0.88). This study found preliminary evidence of convergent validity. For example, Lack of Internal (r = −0.12, P = 0.004), Doctor (r = −0.20, P <.001), and Treatment (r = −0.12, P = .004) beliefs were associated with higher overall migraine‐specific quality of life impairments. Conclusions: The Headache‐Specific Locus of Control scale is a reliable and valid measure of headache‐specific locus of control. Findings suggest that headache‐specific locus of control is more multidimensional than previous conceptualizations and contribute to our understanding of control beliefs as a potential mechanism for migraine treatment. [ABSTRACT FROM AUTHOR]

Introduction: Persons living with HIV/AIDS (PLWH) have very high prevalences of both cigarette smoking and pain, yet little is known about the relationship between smoking and pain for PLWH. This study examined the factor structure, reliability, and validity of a measure of perceived interrelations of pain and smoking in a sample of PLWH.Methods: Participants in this study were 108 current cigarette smoking PLWH (64.8% reporting current pain) in the Bronx, NY. Participants completed assessments of demographics, smoking behaviors, and pain. Interrelations of pain and smoking were measured using the 9-item Pain and Smoking Inventory (PSI). The dimensionality of the PSI was evaluated using Horn's Parallel Analysis and exploratory factor analysis. Internal consistency was evaluated using Cronbach's alpha, and validity analyses evaluated the relationship between the PSI and demographics, HIV clinical characteristics, smoking, and pain in the total sample.Results: A single-factor structure was the best fit for the PSI. The internal consistency of the PSI total score was excellent in the total sample (α = 0.94) and among participants with pain (α = 0.93). The PSI total score was significantly higher for PLWH who smoke and had current pain versus no current pain. Among smokers with HIV and pain, higher PSI scores were associated with higher pain interference, pain severity, and certain neuropathic pain symptoms (ie, numbness and pain to touch).Conclusions: Among a sample of PLWH, the PSI appeared to be a reliable and valid instrument as a one-factor measure to assess perceived interrelations among pain and cigarette smoking.Implications: Even though PLWH have very high prevalences of both pain and cigarette smoking, little is known about the relationship between pain and smoking for PLWH. This study is the first to examine a measure of the perceived interrelations of pain and smoking in a sample of PLWH. The measure was reliable and valid, and higher scores, reflecting that higher perceived interrelations of pain and smoking, were associated with more intense pain and pain interference. Learning more about pain and smoking among PLWH will help to better target smoking interventions to this key subgroup of smokers. [ABSTRACT FROM AUTHOR]

Objective: The current study aimed to describe the impact of parental migraine on adolescent children (aged 11–17) living at home with a parent with migraine. Background: Emerging evidence suggests that migraine impacts the family members of people with migraine. However, there has been little research to evaluate the perspective of the child of a parent with migraine. Methods: This cross‐sectional observational study included parents who met International Classification of Headache Disorders criteria for migraine and their 11–17‐year‐old children currently living with the parent with migraine recruited from neurologist offices and online. Parents completed measures of demographics, a diagnostic migraine criteria screener, parental illness impact (Parental Illness Impact Survey – Revised; subscales = Burden of Daily Help, Emotional Impact, Social Impact, Communication and Understanding, Impact on Personal Future, Friends Reactions, Parent/Child Relationship, and Global Well‐Being), migraine‐related disability (MIDAS), headache attack frequency, and headache attack pain intensity. Children completed measures of demographics, parental illness impact, and a migraine diagnostic screener if applicable. Results: Children (n = 40) reported the greatest impact of their parent's migraine on the Global Well‐Being (M = 3.3, SD = 0.9) and Parent/Child Relationship (M = 3.5, SD = 0.6) subscales. There were no significant differences between the average child and parent rating of parental migraine impact on children. Correlations between parent and child ratings of parental migraine impact were strongest for the Social Impact subscale (ρ = 0.55, P <.001), and non‐significant for the Parent/Child Relationship (ρ = 0.13, P =.416) and Friends Reactions (ρ = 0.18, P =.257) subscales. Higher attack frequency and endorsing severe disability on the MIDAS were associated with higher child‐rated impact (eg, lower scores) on Global Well‐Being (frequency ρ = −0.35, P =.028; MIDAS t(38) = 2.74, P =.009) and Impact on Personal Future (frequency ρ = −0.41, P =.009; MIDAS t(35.7) = 2.49, P =.017) subscales. Higher attack pain intensity was associated with higher child‐rated impact (eg, lower scores) on Burden of Daily Help (r = −0.34, P =.031) and Emotional Impact (r = −0.40, P =.010). Over half of children (23/40, 57.5%) reported some kind of service or intervention to help them manage the impact of their parent's migraine on their lives would be helpful. Conclusions: Parental migraine impacts children aged 11–17 living in the home, particularly in the domains of global well‐being and the parent/child relationship. Parent and child reports are not strongly correlated across all domains of parental impact. [ABSTRACT FROM AUTHOR]

Objective: To evaluate factors associated naturalistically with adherence to a mobile headache diary. Background: Self‐monitoring (keeping a headache diary) is commonly used in headache to enhance diagnostic accuracy and evaluate the effectiveness of headache therapies. Mobile applications are increasingly used to facilitate keeping a headache diary. Little is known about the factors associated with adherence to mobile headache diaries. Methods: In this naturalistic longitudinal cohort study, people with headache (n = 1561) registered to use Curelator Headache® (now called N1‐Headache®), an application that includes a mobile headache diary, through their physician (coupon), or directly through the website or app store using either a paid or free version of the application. Participants completed baseline questionnaires and were asked to complete daily recordings of headache symptoms and other factors for at least 90 days. Baseline questionnaires included headache characteristics and migraine disability. Daily recordings included headache symptoms and anxiety ratings. Adherence to keeping the headache diary was conceptualized as completion (kept the headache diary for 90 days), adherence rate (proportion of diary days completed 90 days after registration), and completion delay (the number of days past 90 days after registration required to complete 90 days of headache diary). Results: The majority of participants reported migraine as the most common headache type (90.0%), and reported an average of 30.8 headache days/90 days (SD = 24.2). One‐third of participants completed 90 days of headache diary (32.4%). Endorsing higher daily anxiety scores (8/10 OR = 0.97 [95% CI = 0.96, 0.99]; 10/10 OR = 0.96 [95% CI = 0.91, 0.99]) was associated with lower odds of completion, whereas higher age (OR = 1.04 [95% CI = 1.03, 1.05]), and downloading the app paid vs free (OR = 4.27 [95% CI = 2.62, 7.06]), paid vs coupon (OR = 2.43, 95% CI = 1.41, 4.26]), or through a physician coupon vs free (OR = 1.75 [95% CI = 1.27, 2.42]) were associated with higher odds of completion. The median adherence rate at 90 days was 0.34 (IQR = 0.10–0.88), indicating that half of participants kept 34 or fewer days 90 diary days after registration. Endorsing high daily anxiety scores (5/10 OR = 0.98 [95% CI = 0.97, 1.00]; 8/10 OR = 0.96 [95% CI = 0.94, 0.98]; 10/10 OR = 0.96 [9% CI = 0.92, 0.98]) and higher age (OR = 1.05 [95% CI = 1.04, 1.07]) were associated with lower odds of adhering at 90 days, whereas downloading the app paid vs free (OR = 9.63 [95% CI = 4.61, 25.51]), paid vs coupon (OR = 2.39, 95% CI = 1.27, 5.10]), or through a physician coupon vs free (OR = 4.01 [95% CI = 2.54, 7.26]) were associated with higher odds of adhering at 90 days. Among completers, the median completion delay was 6.0 days (IQR = 2.0–15.0). Among completers, endorsing high daily anxiety scores (9/10 OR = 1/06 [95% CI = 1.01, 1.12]) and younger age (OR = 0.98 [95% CI = 0.97, 1.00]) was associated with completion delay; downloading the app through physician coupon vs free (OR = 0.40 [95% CI = 0.22, 0.71]) or paid vs free (OR = 0.38 [95% CI = 0.20, 0.72]) was associated with lower odds of completing 90 diary days in 90 calendar days. Conclusion: This naturalistic observational study confirmed evidence from clinical observation and research: adherence to mobile headache diaries is a challenge for a significant proportion of people with headache. Endorsing higher levels of daily anxiety, younger age, and downloading the app for free (vs either paying for the self‐monitoring app or receiving a physician referral coupon) were associated with poorer adherence to keeping a mobile headache diary. [ABSTRACT FROM AUTHOR]

Objective: To evaluate relationships between psychiatric symptoms, acceptance, and migraine‐related disability in a sample of people with migraine presenting at a tertiary care headache center. Background: Migraine is a chronic disease that can be severely disabling. Despite a strong theoretical basis and evidence in other pain conditions, little is known about relationships between acceptance, psychiatric symptoms, and migraine‐related disability. Methods: Ninety patients with physician‐diagnosed migraine completed surveys assessing demographics, headache symptoms, severe migraine‐related disability (Migraine Disability Assessment Scale total score dichotomized at ≥ 21), depression (Patient Health Questionnaire‐9) and anxiety symptoms (Generalized Anxiety Disorder‐7), and acceptance (Chronic Pain Acceptance Questionnaire; subscales: Pain Willingness and Activity Engagement). Results: Participants (77.8% white, non‐Hispanic; 85.6% women; and 50.0% with a graduate level education) reported an average headache pain intensity of 6.7/10 (SD = 2.0). One‐third (36.0%) reported chronic migraine, and half (51.5%) reported severe migraine‐related disability. Lower acceptance was associated with severe migraine‐related disability, t(54) = 4.13, P < .001. Higher activity engagement was associated with lower average headache pain intensity (r = −.30, P = .011). Higher acceptance was associated with lower levels of depression (r = −.48, P < .001) and anxiety symptoms (r = −.37, P = .003). Pain willingness and activity engagement serially mediated relationships between depression symptoms and severe migraine‐related disability (indirect effect = 0.05, 95% CI = 0.01, 0.15), and between anxiety symptoms and severe migraine‐related disability (indirect effect = 0.12, 95% CI = 0.02, 0.31). Conclusion: Results provided preliminary support for a theoretical pathway by which psychiatric symptoms may influence migraine‐related disability, in part, through their relationships with pain willingness and activity engagement. [ABSTRACT FROM AUTHOR]

Persons living with HIV/AIDS (PLWH) smoke at high prevalences and experience significant smoking-related consequences. In community samples, perceived risks and benefits of quitting smoking are related to quit motivation and outcomes and are more strongly endorsed by women. This study examined perceived risks and benefits of quitting smoking and the relationship between risks and benefits and quit motivation and confidence in male and female PLWH. One hundred seven PLWH who reported current cigarette smoking completed measures of demographics, smoking, perceived risks and benefits of quitting smoking, motivation to quit smoking, and confidence in ability to quit smoking. The highest endorsed risks of quitting smoking were cravings and weight gain and higher endorsement of craving risks was associated with lower confidence in the ability to quit smoking. Women endorsed overall risks and risks related to negative affect more highly than men. Women and men did not differ in their endorsement of the other risks, the benefits of quitting, or the relationship between risks and benefits and quit motivation or confidence. It may be useful for health care professionals to incorporate information about perceived risks and benefits of quitting smoking into treatment when working with PLWH who want to stop smoking. [ABSTRACT FROM AUTHOR]

Cogniphobia refers to the specific fear and avoidance of cognitive exertion, which is believed to precipitate or exacerbate headache. This parallels a well-documented phenomenon, kinesiophobia (fear of movement), in chronic pain. The existing measure of cogniphobia (C-Scale) was developed in persons with posttraumatic headache, and item content may not generalize to the broader headache population. This study aimed to develop and begin the initial examination of the psychometrics of a novel measure of cogniphobia for headache disorders: The Cogniphobia Scale for Headache Disorders (CS-HD). Candidate CS-HD items were developed through content analysis, patient evaluation, and peer debriefing. Eighty adults with migraine recruited from a headache center completed 23 candidate items for the CS-HD and surveys of demographics, anxiety, and headache locus of control. A series of dimensionality analyses identified a single component, composed of 15 items, which accounted for 54.05% of the variance in the CS-HD items. The CS-HD demonstrated high internal consistency in this sample (α = 0.94). Preliminary convergent validity analyses found CS-HD total scores were positively associated with anxiety (ρ = .37, p = .001) and locus of control (internal, r = .45, p < .001; chance, r = .30, p = .009). This study provides initial evidence supporting the use of the CS-HD to evaluate cogniphobia in people with headache. (PsycINFO Database Record [ABSTRACT FROM AUTHOR]

Objective To examine the influence of acute migraine medication adherence on migraine disability and acute medication satisfaction. Methods Adults with migraine completed three months of daily electronic diaries assessing headache symptoms, acute medication taken, acute medication satisfaction, and daily migraine disability. Repeated measures mixed-effects models examined the effect of initial medication type [migraine-specific medication (MSM) vs. over-the-counter analgesic (OTC) vs. an opiate/barbiturate], the severity of pain at dosing, and their interaction with daily migraine disability and satisfaction with acute medication. Results Participants (N = 337; 92.5% female; 91.1% Caucasian, non-Hispanic; 84.0% with episodic migraine) recorded 29,722 diary days. Participants took acute medication on 96.5% of 8090 migraine days. MSM was most frequently taken first (58%), followed by OTC (29.9%) and an opiate/barbiturate (12.1%). Acute medication was most frequently taken when pain was mild (41.2%), followed by moderate (37.7%) and severe pain (11.4%). Initially dosing with MSM while pain was mild was associated with the lowest daily disability [medication × pain at dosing F (4, 6336.12) = 58.73, p < .001] and highest acute medication satisfaction [medication × pain at dosing F (4, 3867.36) = 24.00, p < .001]. Conclusion Using an MSM (triptan or ergot) first was associated with the lowest migraine disability and highest acute medication satisfaction. [ABSTRACT FROM AUTHOR]

Background: The Perceived Stress Scale (PSS) is made up of two subscales but is typically used as a single summary measure. However, research has shown that the two subscales may have differential properties in older adults.Objective: To evaluate the internal consistency, test-retest reliability, and the concurrent and predictive validity for development of amnestic mild cognitive impairment (aMCI) of the positively-worded (PSS-PW) and negatively-worded (PSS-NW) subscale scores of the PSS in older adults.Methods: We recruited community residing older adults free of dementia from the Einstein Aging Study. Reliability of the PSS-PW and PSS-NW was assessed using Cronbach's alpha for internal consistency and intraclass correlation for one year test-retest reliability. Concurrent validity was evaluated by examining the relationship between the PSS subscales and depression, anxiety, neuroticism, and positive and negative affect. Predictive validity was assessed using multivariate Cox regression analyses to examine the relationship between baseline PSS-PW and PSS-NW score and subsequent onset of aMCI.Results: Both PSS-PW and PSS-NW showed adequate internal consistency and retest reliabilities. Both the PSS-PW and PSS-NW were associated with depression, neuroticism, and negative affect. The PSS-NW was uniquely associated with anxiety while the PSS-PW was uniquely associated with positive affect. Only the PSS-PW was associated with a statistically significant increased risk of incident aMCI (HR = 1.27; 95% CI: 1.06-1.51 for every 5-point increase in PSS-PW).Conclusions: Evaluating the separate effects of the two PSS subscales may reveal more information than simply using a single summation score. Future research should investigate the PSS-PW and PSS-NW as separate subscales. [ABSTRACT FROM AUTHOR]

Objective To evaluate the relationships among modifiable psychological factors and chronic migraine and severe migraine-related disability in a clinic-based sample of persons with migraine. Background Evidence evaluating relationships between modifiable psychological factors and chronic migraine and severe migraine-related disability is lacking in people with migraine presenting for routine clinical care. Methods Adults with migraine completed surveys during routinely scheduled visits to a tertiary headache center. Participants completed surveys assessing chronic migraine (meeting criteria for migraine with ≥15 headache days in the past month), severe migraine disability (Migraine Disability Assessment Scale score ≥ 21), and modifiable psychological factors (depressive symptoms [Patient Health Questionnaire-9], anxious symptoms [Generalized Anxiety Disorder-7], Pain Catastrophizing Scale and Headache Specific Locus of Control). Logistic regression evaluated relationships between modifiable psychological factors and chronic migraine and severe migraine disability. Results Among 90 eligible participants the mean age was 45.0 (SD = 12.4); 84.8% were women. One-third (36.0%) met study criteria for chronic migraine; half of participants (51.5%) reported severe migraine-related disability. Higher depressive symptoms (OR = 1.99, 95% CI = 1.11, 3.55) and chance HSLC (OR = 1.85, 95% CI = 1.13, 1.43) were associated with chronic migraine. Higher depressive symptoms (OR = 3.54, 95%CI = 1.49, 8.41), anxiety symptoms (OR = 3.65, 95% CI = 1.65, 8.06), and pain catastrophizing (OR = 1.95, 95% CI = 1.14, 3.35), were associated with severe migraine-related disability. Conclusions Psychiatric symptoms and pain catastrophizing were strongly associated with severe migraine-related disability. Depression and chance locus of control were associated with chronic migraine. This study supports the need for longitudinal observational studies to evaluate the relationships among naturalistic variation in psychological factors, migraine-related disability, and migraine chronification. [ABSTRACT FROM AUTHOR]

Objective: Job loss is common in multiple sclerosis (MS) and frequently associated with depression, fatigue, and cognitive dysfunction. Identifying these modifiable risk factors and providing "at-risk" women with a neuropsychologically-based intervention may improve employment outcomes. Our study seeks to investigate the utility of a neuropsychologically-based intervention with varying levels of treatment and follow-up, and evaluate treatment and employment outcomes among groups. Method: In this longitudinal, quasi-randomized controlled trial, employed women with MS meeting criteria on screening measures were considered "at-risk" for job instability and randomized to one of two neuropsychological testing interventions (standard-care group received testing and phone feedback of results and recommendations; experimental group received testing and in-person feedback with subsequent care-coordinator calls from a nurse to help coordinate recommendation completion). Participants who did not meet criteria were considered "low-risk" and only followed over time. Results: 56 women in the treatment groups (standard-care = 23; experimental = 33) and 63 women in the follow-only group were analyzed at 1 year. Rates of decreased employment were similar between standard-care (17.4%) and experimental (21.2%) groups (OR =.782, 95% CI.200–3.057). However, the experimental group completed significantly more treatment recommendations, t (53) = −3.237, p =.002. Rates of decreased employment were also similar between the "low-risk" (17.5%) and "at-risk" groups (19.6%), (OR =.721, 95% CI.285–1.826). Conclusion: Employment outcomes were similar at 1 year between treatment groups receiving differing levels of a neuropsychologically-based intervention, however treatment adherence significantly improved in the experimental group. Treatment groups also had similar employment outcomes as compared to a "low-risk," no intervention group, suggesting that engaging in either neuropsychological intervention may have impacted job stability. [ABSTRACT FROM AUTHOR]

Objective. We performed a qualitative study to better understand how patients with RA approach risk–benefit trade-offs inherent in the choice of remaining with their current treatment vs escalating care.Methods. We used a think-aloud protocol to examine how patients with RA approach risk–benefit trade-offs inherent in the choice of remaining with their current treatment vs adding a biologic. The data emerging from the protocols were used to develop a conceptual model describing how patients approach the decision to escalate care.Results. Participants who were strongly impacted by their disease were not open to considering alternative options. For some patients, being highly impacted by their disease results in a strong preference to escalate care. For others, the same level of distress is reason to unconditionally refuse additional medications. In contrast, those who were moderately impacted were more open to consider treatment options. Among these participants, however, subjects’ risk–benefit trade-offs were consistently modified by factors unrelated to medication, including sociodemographic characteristics, role responsibilities and the quality of the patient–physician relationship.Conclusion. The conceptual model indicates that patients approach the decision to escalate care differently from physicians. In order to improve care in RA, it is important to recognize that many patients with moderate to high disease activity are not open to alternative treatments, which is a prerequisite to engaging in decision making. Routine clinical encounters should enable health care providers to identify these patients in order to tailor education prior to recommending treatment escalation. [ABSTRACT FROM PUBLISHER]

Objective This is a secondary analysis of a randomized clinical trial which aims to examine changes in cognitive and behavioral responses to migraine with cognitive behavioral treatment for migraine, preventive medication for migraine, and their combination, and the relationship between these changes and reductions in migraine-related disability. Background Cognitive behavioral treatment is thought to reduce migraine-related disability through modifying maladaptive cognitive and behavioral responses to migraine. Methods Two hundred thirty-two people with migraine who did not respond to 5 weeks of optimized acute therapy were randomized into a 2 (beta-blocker vs placebo) X 2 (behavioral migraine management [ BMM] vs no BMM) treatment design. Participants received BMM and/or beta-blocker dose adjustment for 4 months, and were followed for an additional 12 months. Participants completed measures of catastrophizing, behavioral coping, and migraine-related disability throughout the study. Results Compared to drug therapy only, BMM demonstrated larger decreases in catastrophizing scores (19.16 to 9.89 vs 16.78 to 11.84, P < .001) and increases in number of positive coping strategies (proactive: 1.09 to 1.90 vs 1.16 to 1.09, P < .001; anticipatory: 0.19 to 0.69 vs 0.10 to 0.08, P < .001; migraine management: 0.14 to 0.36 vs 0.04 to 0.04, P < .001) at the end of the follow-up period. Decreases in catastrophizing were associated with a larger BMM effect on migraine-related disability ( P = .036). Conclusions This study demonstrated that BMM modified important cognitive and behavioral factors postulated to be mechanisms of cognitive behavioral treatments for migraine. [ABSTRACT FROM AUTHOR]

Purpose: The current study attempted to expand the literature on cognition and mood in MS by determining if illness intrusiveness may potentially serve as an intermediary factor in the well-established cognition-mood relationship in people with MS. Method: This study employed a retrospective cross-sectional design to answer this question. Baseline neuropsychological test data and mood questionnaires from 199 participants with clinically definite MS were used in this study. The sample was middle-aged (M = 48.4, SD = 11.8), highly educated (M = 14.6, SD = 2.2), majority female (76.9%) and majority White (74.5%). Assumptions for parametric statistics and ordinary least squares regression were met. Conditional process models evaluated whether illness intrusiveness mediated the relationship between cognitive functioning and psychiatric symptoms. Results: In total, 33.2% of the sample met criteria for clinically significant anxiety, 41.7% met criteria for depression, and 27.8% of the sample met criteria for processing speed impairment, consistent with other MS samples. Illness intrusiveness was found to mediate the relationship between processing speed and depression, ab = −.07, 95% CI [−.15, −.002], processing speed and anxiety, ab = −.06, 95% CI [−.12, −.02], and processing speed and more general mood disturbance, ab = −.08, 95% CI [−.13, −.0005]. Conclusions: Illness intrusiveness was found to be a potential important intermediary mechanism by which the primary cognitive impairment in MS, processing speed, impacts mood in this disease population. Conclusions, treatment implications, and directions for future research in light of these findings were discussed. Impact and Implications: Processing speed is related to mood symptoms in people with MS, and illness intrusiveness is a possible pathway by which slowed processing speed influences mood. A potential explanation for these findings is that processing speed is the most common cognitive impairment in MS, and often affects people earlier in life when people's careers and relationships are less well-established. It will be important for clinicians to assess how cognitive impairment is influencing the lives of people with MS including their relationships, goals, and engagement in recreational activities. Cognitive rehabilitation may be an important treatment recommendation, as improving cognition may be able to reduce the perceived burden of the disease and enhance mood. Cognitive behavioral psychotherapy may be another important recommendation for helping MS patients to view their illness from a new perspective. [ABSTRACT FROM AUTHOR]

Objective We sought to examine the relationship of family history of headache and family history of psychiatric disorders on self-reported health care utilization tendencies for migraine treatment. Background Familial aggregation of both migraine and depression has been well established in the literature. Family history of headache and psychiatric disorders could influence health care utilization tendencies for migraine. Methods This is a secondary analysis of patients with severe migraine (n = 225) who answered questions about their family history, previous headache treatment history, disability (Headache Disability Inventory), and psychiatric symptoms (Beck Depression Inventory and Beck Anxiety Inventory). Using regression, we examined the relationship between family history of headache, depression, and anxiety and reported headache-related health care utilization. Results Participants reported family histories of headache (67.6%), anxiety (15.6%), and depression (29.3%). Participants reported seeing a physician for headache an average of 3.1 (standard deviation = 3.8) times in the past 2 years. In a 2-year period, 27.6% of participants reported seeing a general practitioner and 18.5% of participants reported seeing a neurologist. Twenty-eight percent of participants went to urgent care for headaches at least once in the last 2 years. Thirty-nine percent of participants reported using non-pharmacologic treatment for headache in the prior 2 years, with the highest rates of chiropractic manipulation (27.1%) and massage (18.2%), and fewest rates of biofeedback (0.4%), relaxation training (4.4%), psychotherapy (1.8%), physical therapy (4.9%), or acupuncture (1.8%). Family history of anxiety was associated with trying non-pharmacologic treatments for headache, but no other self-reported health care utilization variable. However, neither family history of headache nor family history of depression was associated with self-reported health care utilization tendencies. Headache Disability Inventory was associated with self-reported non-pharmacologic treatments for headache. Conclusions Family history of anxiety, but not depression, was associated with utilizing non-pharmacologic treatments for headache. Also, disability was associated with utilizing non-pharmacologic treatments for headache. However, participants reported low rates of utilization for non-pharmacologic treatments with grade-A evidence. [ABSTRACT FROM AUTHOR]

This study psychometrically evaluates the Motivational Interviewing Treatment Integrity Code (MITI) to assess fidelity to motivational interviewing to reduce sexual risk behaviors in people living with HIV/AIDS. 74 sessions from a pilot randomized controlled trial of motivational interviewing to reduce sexual risk behaviors in people living with HIV were coded with the MITI. Participants reported sexual behavior at baseline, 3-month, and 6-months. Regarding reliability, excellent inter-rater reliability was achieved for measures of behavior frequency across the 12 sessions coded by both coders; global scales demonstrated poor intraclass correlations, but adequate percent agreement. Regarding validity, principle components analyses indicated that a two-factor model accounted for an adequate amount of variance in the data. These factors were associated with decreases in sexual risk behaviors after treatment. The MITI is a reliable and valid measurement of treatment fidelity for motivational interviewing targeting sexual risk behaviors in people living with HIV/AIDS. [ABSTRACT FROM AUTHOR]

Objective This study aims to qualitatively examine the behaviors required to optimally use acute headache medication and the barriers to successful performance of these behaviors. Background The efficacy of drug treatment is partly determined by medication adherence. The adherence literature has focused almost exclusively on the behaviors required to optimally use medications that are taken on a fixed schedule, as opposed to medications taken on an as needed basis to treat acute episodes of symptoms, such as headaches. Methods Twenty-one people with headache and 15 health care providers participated in qualitative phenomenological interviews that were transcribed and coded by a multidisciplinary research team using phenomenological analysis. Results Interviews revealed 8 behaviors required to optimally use acute headache medication, including cross-episode behaviors that people with headache regularly perform to ensure optimal acute headache medication use, and episode-specific behaviors used to treat an individual headache episode. Interviews further revealed 9 barriers that hinder successful performance of these behaviors. Conclusions Behaviors required to optimally use acute headache medication were numerous, often embedded in a larger chain of behaviors, and were susceptible to disruption by numerous barriers. [ABSTRACT FROM AUTHOR]

Objective To examine differences in male and female veterans of Operations Enduring Freedom/ Iraqi Freedom ( OEF/ OIF) period of service in taking prescription headache medication, and associations between taking prescription headache medication and mental health status, psychiatric symptoms, and rates of traumatic events. Background Headaches are common among active service members and are associated with impairment in quality of life. Little is known about headaches in OEF/ OIF veterans. Methods Veterans participating in the Women Veterans Cohort Study responded to a cross-sectional survey to assess taking prescription headache medication, mental health status ( Post Deployment Health Assessment), psychiatric symptoms (portions of the Brief Patient Health Questionnaire and the Posttraumatic Stress Disorder Checklist), and traumatic events (the Traumatic Life Events Questionnaire and queries regarding military trauma). Gender differences among taking prescription headache medication, health status, psychiatric symptoms, and traumatic events were examined. Regression analyses were used to examine the influence of gender on the associations between taking prescription headache medication and health status, psychiatric symptoms, and traumatic events. Results 139/551 (25.2%) participants reported taking prescription headache medication in the past year. A higher proportion of women veterans (29.1%) reported taking prescription medication for headache in the last year compared with men (19.7%). Taking prescription headache medication was associated with poorer perceived mental health status, higher anxiety and posttraumatic stress disorder symptoms, and higher rates of traumatic events. The association between prescription headache medication use and perceived mental health status, and with the association between prescription headache medication use and posttraumatic stress disorder symptoms, was stronger for men than for women. Conclusions Among OEF/ OIF veterans, the prevalence of clinically relevant headache is high, particularly among women veterans. Taking prescription headache medication is associated with poor mental health status, higher rates of psychiatric symptoms, and higher rates of traumatic events; however, these variables did not appear to meaningfully account for gender differences in prevalence of taking prescription headache medication. Future research should endeavor to identify factors that might account for the observed differences. [ABSTRACT FROM AUTHOR]

Introduction: Mood and anxiety disorders are comorbid with migraine and commonly assumed to portend a poor response to preventive migraine therapies. However, there is little evidence to support this assumption.Method: We examined impact of a mood and/or anxiety disorder diagnosis using American Psychiatric Association Diagnostic and Statistical Manual criteria on response to the three preventative migraine therapies evaluated in the Treatment of Severe Migraine trial (n = 177): β-blocker, behavioral migraine management, or behavioral migraine management +β-blocker. Daily diaries assessed migraine activity for the 16 months of the trial. The Migraine Specific Quality of Life Questionnaire and Headache Disability Inventory assessed headache-related disability at regular intervals. Mixed models for repeated measures examined changes in these three outcomes with preventative migraine therapy in participants with and without a mood or anxiety disorder diagnosis.Results: Participants with a comorbid mood or anxiety disorder diagnosis recorded larger reductions in migraine days (p < .05) and larger reductions in the Migraine Specific Quality of Life Questionnaire (p < .001) and Headache Disability Inventory (p < .01) than did participants with neither diagnosis.Discussion: Significantly larger reductions in migraine activity and migraine-related disability were observed in participants with a mood and/or anxiety disorder diagnosis than in participants who did not receive either diagnosis. [ABSTRACT FROM PUBLISHER]

Aim: We review the research literature examining neuropsychological performance in migraine. Findings were organized by neuropsychological construct assessed and results were reported using effect size conventions. Factors considered in explaining results included sample characteristics, migraine factors, and control for non-migraine variables.Findings: There is weak evidence for deficits in processing speed, attention, verbal memory, verbal skills, working memory, sustained attention, and inhibition in migraine relative to healthy controls. There are mixed results regarding deficits in visual memory, motor dexterity, visuospatial/constructional skills, visual reasoning, and mental flexibility in migraine relative to healthy controls. Mixed findings do not seem to be consistently related to study characteristics or presence of aura; other important migraine factors (such as migraine severity or presence of neuroradiological findings) remain understudied. Relative to non-healthy control groups, however, there is weak evidence for an effect of migraine in any cognitive domain. Longitudinal studies provide little evidence that neuropsychological functioning worsens over time in migraine or that migraine is a risk factor for Alzheimer’s disease.Research implications: It remains possible that cognitive dysfunction is seen in only a subset of migraine sufferers, perhaps those with more severe illness or neurological involvement; however, more research is needed to examine this issue. Non-migraine differences among migraine sufferers, including medical and psychiatric comorbidities and variables associated with treatment seeking, may partially account for inconsistent findings and should be evaluated for in future research.Clinical implications: Clinicians should refer migraine patients for comprehensive neuropsychological evaluation only when there is sufficient evidence for concern. Such evaluations should include consideration of other psychological, neurological, and medical contributors to both migraine and cognitive status. [ABSTRACT FROM PUBLISHER]

Background: Modification of expectancies (headache self-efficacy and headache locus of control) is thought to be central to the success of psychological treatments for migraine. Purpose: The purpose of this study is to examine expectancy changes with various combinations of Behavioral Migraine Management and migraine drug therapies. Methods: Frequent migraine sufferers who failed to respond to 5 weeks of optimized acute migraine drug therapy were randomized to a 2 (Behavioral Migraine Management+, Behavioral Migraine Management−) × 2 (β-blocker, placebo) treatment design. Results: Mixed models for repeated measures analyses ( N = 176) revealed large increases in headache self-efficacy and internal headache locus of control and large decreases in chance headache locus of control with Behavioral Migraine Management+ that were maintained over a 12-month evaluation period. Chance headache locus of control and socioeconomic status moderated changes in headache self-efficacy with Behavioral Migraine Management+. Conclusions: The 'deficiency' hypothesis best explained how patient characteristics influenced changes in of headache self-efficacy with Behavioral Migraine Management. [ABSTRACT FROM AUTHOR]

The article discusses the validation of a migraine diagnostic screening tool, ID-migraine-Mx, in Latin-American Spanish. The study compares its operating characteristics in English and Spanish and explores the potential for a policy recommendation for migraine screening. Accurate screening is crucial to improve outcomes for people with migraine.

People with HIV smoke cigarettes at a high prevalence, and it is important to identify modifiable variables related to smoking in this population. Race/ethnicity-based discrimination is common among people with HIV from minoritized racial and ethnic groups and results in significant adverse effects. The goal of this study was to examine the relationship between race/ethnicity-based discrimination, depression, and smoking-related variables among people with HIV who smoke. This was a secondary analysis of data from a prospective, randomized controlled smoking cessation trial for people with HIV. Participants were recruited from three HIV clinical care sites and randomly assigned to an HIV-tailored group therapy intervention or a control condition. Participants completed measures of demographics, smoking-related variables, race/ethnicity-based discrimination, and depressive symptoms at baseline and were followed up 3- and 6-months after study completion. Depressive symptoms had an indirect effect on the relationship between race/ethnicity-based discrimination and self-efficacy to quit smoking at 3-month follow-up. Depressive symptoms mediated the relationship between race/ethnicity-based discrimination and both nicotine dependence and self-efficacy to quit smoking at 6-month follow-up. Findings highlight the importance of considering race/ethnicity-based discrimination and depressive symptoms in the development and implementation of smoking cessation treatment interventions for people with HIV. [ABSTRACT FROM AUTHOR]

Migraine is one of the leading causes of disability worldwide. Third wave therapies, such as Mindfulness Based Cognitive Therapy for Migraine (MBCT-M), have proven efficacious in reducing headache-related disability. However, research is needed to better understand the change mechanisms involved in these third-wave therapies. Acceptance is a fundamental component of third wave therapies, and more research is warranted on the role of pain acceptance in MBCT-M. It is also valuable to understand the independent roles of the two components of pain acceptance—pain willingness (PW) and activity engagement (AE). The current study is a secondary analysis of a randomized control trial of MBCT-M. Sixty participants were included in the study (MBCT = 31; WL/TAU = 29). Baseline correlations between overall pain acceptance, PW, AE, and headache-related disability were run. Mixed models assessed change from baseline to one-month post-treatment and treatment-by-time interaction for overall pain acceptance, PW, and AE. Mixed models also assessed maintenance of changes at 6-month follow-up in the MBCT-M group. Longitudinal mediation models assessed whether change in pain acceptance, PW, and AE mediated the relationship between treatment and change in headache-related disability. Pain acceptance, PW, and AE were all negatively correlated with headache-related disability at baseline. Pain acceptance, PW, and AE all significantly increased over time in both the waitlist/ treatment-as-usual group (WL/TAU) and the MBCT-M group. Only AE increased more in the MBCT group than the WL/TAU group. Change in pain acceptance, PW, and AE all significantly mediated the relationship between MBCT and change in headache-related disability. The study supports the importance of pain acceptance, specifically the activity engagement component, in MBCT-M. [ABSTRACT FROM AUTHOR]

Objective: We examined the perspectives of expert headache psychologists to inform best practices for integrating headache psychologists into the care of children and adults with headache disorders within medical settings. Background: Headache disorders are prevalent, chronic, and disabling neurological conditions. As clinical providers trained in evidence-based behavior change interventions with expertise in headache disorders, headache psychologists are uniquely positioned to provide behavioral headache treatment. Methods: In 2020, we conducted semi-structured interviews with a purposive sample of expert headache psychologists working across the United States. Open–ended questions focused on their roles, clinical flow, and treatment content. Interviews were audio-recorded, transcribed, de-identified, and analyzed using a rapid qualitative analysis method. Results: We interviewed seven expert headache psychologists who have worked for an average of 18 years in outpatient settings with pediatric (n = 4) and adult (n = 3) patients with headache. The themes that emerged across the clinical workflow related to key components of behavioral headache treatment, effective behavioral treatment referral practices, and barriers to patient engagement. The expert headache psychologists offered evidence-based behavioral headache interventions such as biofeedback, relaxation training, and cognitive behavioral therapy emphasizing lifestyle modification as standalone options or concurrently with pharmacological treatment and were of brief duration. Participants reported many of their patients appeared reluctant to seek behavioral treatment for headache. Participants believed referrals were most effective when the referring provider explained to the patient the rationale for behavioral treatment, treatment content, and positive impact on headache activity, functioning, and quality of life. Barriers cited by participants to integrating headache psychology into headache care included the paucity of psychologists with specialized headache training, lack of insurance reimbursement, limited patient time to seek behavioral treatment, and inadequate patient knowledge of what behavioral treatment entails. Conclusion: Headache psychologists are often core members of multidisciplinary headache teams offering short-term, evidence-based behavioral interventions, both as a standalone treatment or in conjunction with pharmacotherapy. However, barriers to care persist. Enhancing referring providers' familiarity with psychologists' role in headache care may aid successful referrals for behavioral interventions for headache. [ABSTRACT FROM AUTHOR]

The author reflects on the headache triggers. She states that clinical practitioners use prospective assessment of covariation with potential triggers and headaches tracked in a diary which may be insufficient to identify reliable and valid headache triggers. There is a necessity to involve methodology and statistics experts in the early phases of research. Author suggests that headache researchers and clinicians should use caution when assigning the label of "trigger".

Persons living with HIV/AIDS (PLWH) have very high prevalences of both cigaret smoking and pain, yet little is known about the relationship between smoking and pain for PLWH. The current study examines the perceived interrelations between pain and smoking and participant characteristics (i.e., demographics, heavier versus lighter smoking, current pain severity, depression, anxiety symptoms) in a sample of 101 current cigaret smoking adult PLWH in the Bronx, New York. Participants completed assessments of demographics, smoking behaviors, psychiatric symptoms, and pain severity. Interrelations of pain and smoking were measured using the 9-item Pain and Smoking Inventory (PSI) total score and three domain scores (pain as a motivator for smoking, smoking to cope with pain, and pain as a barrier for smoking cessation). Significant associations were found between greater current pain severity and greater endorsement of overall perceived interrelations between pain and smoking, pain as a motivator for smoking, and smoking to cope with pain. Greater anxiety symptoms were significantly associated with greater endorsement of overall perceived interrelations between pain and smoking, pain as a motivator for smoking, and smoking to cope with pain. Understanding the perceived relations between smoking and pain, as well as associated factors such as anxiety and pain severity, may help to guide interventions for PLWH who smoke in order to reduce the high prevalence of smoking and significant smoking-related health consequences. [ABSTRACT FROM AUTHOR]

Objective: To determine changes in opioid prescribing among veterans with headaches during the coronavirus disease of 2019 (COVID‐19) pandemic by comparing the stay‐at‐home phase (March 15 to May 30, 2020) and the reopening phase (May 31 to December 31, 2020). Background: Opioid prescribing for chronic pain has declined substantially since 2016; however, changes in opioid prescribing during the COVID‐19 pandemic among veterans with headaches remain unknown. Methods: This retrospective cohort study utilized regression discontinuity in time and difference‐in‐differences design to analyze veterans aged ≥18 years with a previous diagnosis of headache disorders and an outpatient visit to the Veterans Health Administration (VHA) during the study period. We measured the weekly number of opioid prescriptions, the number of days supplied, the daily dose in morphine milligram equivalents (MMEs), and the number of prescriptions with ≥50 morphine equivalent daily doses (MEDD). Results: A total of 81,376 veterans were analyzed with 589,950 opioid prescriptions. The mean (SD) age was 51.6 (13.5) years, 57,242 (70.3%) were male, and 53,464 (65.7%) were White. During the pre‐pandemic period, 323.6 opioid prescriptions (interquartile range 292.1–325.8) were dispensed weekly, with an median (IQR) of 24.1 (24.0–24.4) days supplied and 31.8 (31.2–32.5) MMEs. Transition to stay‐at‐home was associated with a 7.7% decrease in the number of prescriptions (incidence rate ratio [IRR] 1.077, 95% confidence interval [CI] 0.866–0.984) and a 9.8% increase in days supplied (IRR 1.098, 95% CI 1.078–1.119). Similar trends were observed during the reopening period. Subgroup analysis among veterans on long‐term opioid therapy also revealed 1.7% and 1.4% increases in days supplied during the stay‐at‐home (IRR 1.017, 95% CI 1.009–1.025) and reopening phase (IRR 1.014, 95% CI 1.007–1.021); however, changes in the total number of prescriptions, MME/day, or the number of prescriptions >50 MEDD were insignificant. Conclusion: Prescription opioid access was maintained for veterans within VHA during the pandemic. The de‐escalation of opioid prescribing observed prior to the pandemic was not seen in our study. [ABSTRACT FROM AUTHOR]

Objective: In this secondary analysis of mobile health headache diary data, we evaluated the relationship between adherence to medication used for the acute treatment of migraine and lifetime history of an anxiety or depression disorder. Background: Medication non‐adherence can produce poor clinical efficacy and may be associated with medication overuse. Medication overuse was defined by taking a migraine‐specific medication (MSM) for ≥10 days/month, an opioid or barbiturate for ≥10 days/month, or a nonsteroidal anti‐inflammatory drug for ≥15 days/month and having ≥15 headache days/month. Extant literature predominantly evaluates fixed‐schedule medication adherence. Little is known about predictors of adherence to as‐needed medication such as those used for the acute treatment of migraine. Methods: Adults with prior migraine diagnosis and at least 4 headache days/month completed baseline questionnaires assessing lifetime history of depression or anxiety disorder diagnoses and were asked to record 90 days of once‐daily electronic headache diaries soliciting: Headache occurrence; symptoms; medication taken, if any, for the acute treatment of migraine; and their pain level (mild, moderate, severe) when the medication was taken. The 193 participants who completed ≥30 days of headache diary were included in this secondary analysis. Results: A MSM was used as the first medication taken on 45.7% (2825/6176) of headache days. Nearly a quarter of the sample (45/193, 23.3%) overused medications for acute treatment of migraine. Medication overuse was more common in patients with a history of an anxiety disorder, odds ratio (OR) 2.01 (95% confidence interval [CI] 1.01–3.69), but this relationship was not significant when headache days were accounted for, OR 2.02 (95% CI 0.83–4.91). Neither a history of a depression disorder, OR 1.40 (95% CI 0.90–2.16), nor an anxiety disorder, OR 1.11 (95% CI 0.71–1.72), was associated with taking medications early; however, duration of self‐monitoring was associated with taking MSM early, OR 1.006 (95% CI 1.004–1.009). Conclusion: Lifetime history of depression and anxiety were not associated with taking a MSM early. Medication overuse may be more common in patients who have both migraine and anxiety. Taking a MSM early improved over time for all participants, even when adjusting for a history of an anxiety and or a depression disorder. [ABSTRACT FROM AUTHOR]

Objective: To describe and examine the relationships between perceived injustice, quality of life (QoL), and psychiatric symptoms through a mixed-methods, cross-sectional observational study design in people with migraine. Method: Participants completed a series of online quantitative questionnaires, including the Injustice Experience Questionnaire (IEQ). Then, 10 participants took part in qualitative phenomenological interviews. Results: One hundred twenty-seven participants were included in the sample. Correlations revealed higher IEQ scores were strongly associated with lower QoL (r = −.676, p <.001). Higher scores on the IEQ were related to higher migraine attack frequency (r =.403, p <.001), migraine pain intensity (r =.352, p <.001), no association with reports of nausea/vomiting (r =.110, p =.220), and higher report of allodynia symptoms (r =.281, p <.001). Participants who reported a migraine with aura in the past year reported higher IEQ scores than people with no aura in the past year (t[125] = −2.34, p =.02). Higher IEQ scores were associated with higher anxiety (r =.447, p <.001) and depression symptom scores (r =.495, p <.001). The phenomenological interviews revealed 4 core themes describing perceived injustice and QoL with migraine: coping, loss, illness burden, and misunderstanding. Conclusion: Higher levels of perceived injustice showed lower levels of QoL, was associated with higher headache frequency attack severity, and rates of depressive and anxiety symptoms. Participants described their QoL similarly, regardless of reported high or low levels of perceived injustice. Impact and Implications: Perceptions of injustice are important patient experiences in pain populations, with risk factors for poor pain outcomes, higher pain severity, and poor quality of life. This study provides novel information in meaningful areas lacking research. (a) Despite the high rates of prevalence, disease burden, and cause of disability status of migraine, there have been no studies to date that have assessed the impact of perceived injustice on patients specifically with migraine. Further, there have not been any studies inspecting chronic diseases that are characterized by episodic symptom attacks conducted with the construct of injustice and/or evaluating the perceptions of injustice. (b) Consequently, no study has evaluated the relationship between perceptions of injustice and migraine-related quality of life. (c) Given that perceived injustice is a belief system that can influence health behaviors, it might influence QoL, migraine symptoms, and psychiatric symptoms. When comprehensively examining these factors, this was the first study examining these factors through gathering both quantitatively and qualitative data. Having this knowledge could provide beneficial information in order to know how to specifically target psychological treatment and prepare a multidisciplinary team for the consequences of how patients are affected with migraine. [ABSTRACT FROM AUTHOR]

Background Pain acceptance involves willingness to experience pain and engaging in valued activities while pain is present. Though pain acceptance could limit both headache-related disability and pain interference in individuals with migraine, few studies have addressed this issue. This study evaluated whether higher levels of total pain acceptance and its two subcomponents, pain willingness and activity engagement, were associated with lower levels of headache-related impairment in women who had both migraine and overweight/obesity. Methods In this cross-sectional study, participants seeking weight loss and headache relief in the Women's Health and Migraine trial completed baseline measures of pain acceptance (Chronic Pain Acceptance Questionnaire [CPAQ]), headache-related disability (Headache Impact Test-6), and pain interference (Brief Pain Inventory). Migraine headache frequency and pain intensity were assessed daily via smartphone diary. Using CPAQ total and subcomponent (pain willingness and activity engagement) scores, headache frequency, pain intensity, and body mass index (BMI) as predictors in linear regression, headache-related disability, and pain interference were modeled as outcomes. Results On average, participants (n = 126; age = 38.5 ± 8.2 years; BMI = 35.3 ± 6.6 kg/m2) reported 8.4 ± 4.7 migraine days/month and pain intensity of 6.0 ± 1.5 on a 0-10 scale on headache days. After correcting for multiple comparisons (adjusted α = .008), pain willingness was independently associated with both lower headache-related disability ( P < .001; β = −0.233) and pain interference ( P < .001; β = −0.261). Activity engagement was not associated with headache-related disability ( P = .128; β = −0.138) and pain interference ( P = .042; β = −0.154). CPAQ total score was not associated with headache-related disability ( P = .439; β = 0.066) and pain interference ( P = .305; β = 0.074). Pain intensity was significantly associated with outcomes in all analyses ( Ps < .001; βs 0.343-0.615). Conclusions Higher pain willingness, independent of degree of both migraine severity and overweight, is associated with lower headache-related disability and general pain interference in treatment-seeking women with migraine and overweight/obesity. Future studies are needed to clarify direction of causality and test whether strategies designed to help women increase pain willingness, or relinquish ineffective efforts to control pain, can improve functional outcomes in women who have migraine and overweight/obesity. [ABSTRACT FROM AUTHOR]

Background: Post-traumatic headache (PTH) is persistent and highly disabling. Cognitive-behavioral therapy for headache (CBT-HA) reduces headache frequency and severity and improves people's quality of life, yet it is underutilized and inaccessible to many. Leveraging technology to deliver evidence-based psychological treatments for headache may address barriers to treatment engagement. Methods/design: This single-arm, single-site pilot trial aims to test the feasibility, acceptability, clinical signal, and cost of a five-session CBT-HA intervention delivered via interactive voice response technology (IVR). Participants will include 35 Veterans with PTH receiving care within VA Connecticut Healthcare System. Participants will complete an intake interview and a 9-item, 30-day electronic headache diary during a baseline run-in period. The same diary will be done again by participants immediately after treatment completion. Following the baseline assessment period, eligible participants will receive CBT-HA via IVR for 10 weeks, including an automated daily assessment of patient-reported outcomes and retrieval of biweekly tailored feedback from a study therapist. In addition, participants will access an electronic patient workbook, and study therapists will visualize patient-reported data through a secure provider dashboard. Participants will complete validated and reliable assessment measures at baseline, immediately post-treatment completion (week 10), and 1-month post-treatment completion (week 14). The primary clinical signal outcome is the change in self-reported headache days from the 30-day baseline run-in period before treatment (weeks −4 to 0) to the 30-day post-treatment completion (weeks 10–14). Paired-samples t -tests will explore changes in outcomes from baseline. All cost analyses will be exploratory and will use micro-costing techniques. Trial Registration: Clinical Trials.gov: NCT05093556. Registered October 26, 2021. [ABSTRACT FROM AUTHOR]

Objective: This article systematically reviews the empirical literature examining the efficacy of digital headache management interventions for patients with a primary headache disorder. Background: Digital headache management interventions provide opportunities to improve access to behavioral headache interventions to underserved groups. Methods: A systematic search of PubMed, Scopus, and EBSCO (PsycInfo, Education Research Complete, ERIC, Health Source: Nursing/Academic Edition, Psychology and Behavioral Sciences Collection) and reference review was conducted. Included studies had to recruit a sample with a primary headache diagnosis, be a randomized controlled trial including a digital component, assess a headache outcome (i.e., frequency, duration, severity, intensity, disability) or quality of life, and be published in English. Two authors independently extracted data for included studies. The methodological quality of studies was assessed using the revised Cochrane risk‐of‐bias tool. Results: Thirteen studies with unique interventions met inclusion criteria. More than half of the studies were pilots; however, nearly 70% (9/13) demonstrated significant between‐group or within‐group improvements on one or more headache‐related outcomes. All interventions included some form of relaxation training and the majority were delivered via interactive website. While fewer than half the studies report participant race and/or ethnicity, of those that do, 83% (5/6) reported a predominately White/Caucasian sample. Conclusions: Efficacy testing of digital headache interventions is in its infancy with the majority of these studies relying on pilot studies with small samples comprised of homogenous patient populations. Interactive websites were the most common digital medium to deliver digital headache management interventions and have demonstrated promising results. Further testing using large‐scale randomized controlled trials and exploration of other digital tools is warranted. Future studies with more diverse samples are needed to inform health equity of digital headache interventions. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to evaluate the utilization of telehealth for headache services within the Veterans Health Administration's facilities housing a Headache Centers of Excellence and multiple stakeholder's perspectives to inform future telehealth delivery. Background: Telehealth delivery of headache treatment may enhance patient access to headache care, yet little is known about the utilization or patient and provider perceptions of telehealth for veterans with headache. Methods: This mixed‐methods study analyzed multiple data sources: (1) administrative data, which included 58,798 patients with medically diagnosed headache disorders, documented in at least one outpatient visit, from August 2019 through September 2020 from the 12 Veterans Health Administration's facilities with a Headache Center of Excellence and (2) qualitative semistructured interviews with 20 patients and 43 providers 6 months before the coronavirus disease 2019 (COVID‐19) pandemic, and 10 patients and 20 providers 6 months during the beginning of the pandemic. Results: During the pandemic, in‐person visits declined from 12,794 to 6099 (52.0%), whereas video (incidence rate ratio [IRR] = 2.05, 95% confidence interval [CI] = 1.66, 2.52), and telephone visits (IRR = 15.2, 95% CI = 10.7, 21.6) significantly increased. Utilization differed based on patient age, race/ethnicity, and rurality. Patients and providers perceived value in using telehealth, yet had limited experience with this modality pre‐pandemic. Providers preferred in‐person appointments for initial encounters and telehealth for follow‐up visits. Providers and patients identified benefits and challenges of telehealth delivery, often relying on multiple delivery methods for telehealth to enhance patient engagement. Conclusions: The uptake of telehealth delivery of headache‐related care rapidly expanded in response to the pandemic. Patients and providers were amenable to utilizing telehealth, yet also experienced technological barriers. To encourage equitable access to telehealth and direct resources to those in need, it is crucial to understand patient preferences regarding in‐person versus telehealth visits and identify patient groups who face barriers to access. [ABSTRACT FROM AUTHOR]

Objective Women veterans have a higher prevalence of chronic pain relative to men. One hypothesis is that differential combat and traumatic sexual experiences and attenuated levels of social support between men and women may differentially contribute to the development and perpetuation of pain. This investigation examined [1] gender differences in trauma, social support, and family conflict among veterans with chronic pain, and [2] whether trauma, social support, and family conflict were differentially associated with pain severity, pain interference, and depressive symptom severity as a function of gender. Methods Participants included 460 veterans (56% female) who served in support of recent conflicts, and who endorsed pain lasting 3 months or longer. Participants completed a baseline survey during participation in a longitudinal investigation. Self-report measures included pain severity, pain interference, depressive symptom severity, exposure to traumatic life events, emotional and tangible support, and family conflict. Results Relative to men, women veterans reporting chronic pain evidenced higher rates of childhood interpersonal trauma (51% vs 34%; P < 0.001) and military sexual trauma (54% vs 3%; P < 0.001), along with lower levels of combat exposure (10.00 vs 16.85, P < 0.001). Gender was found to be a moderator of the association of marital status, combat exposure, childhood interpersonal trauma, and family conflict with pain interference. It also moderated family conflict in the prediction of depressive symptoms. Conclusions Results underscore the potential importance of developing and testing gender specific models of chronic pain that consider the relative roles of trauma, social support, and family conflict. [ABSTRACT FROM AUTHOR]

Background and Objective: Comprehensive headache care involves numerous specialties and components that have not been well documented or standardized. This study aimed to elicit best practices and characterize important elements of care to be provided in multidisciplinary headache centers. Methods: Qualitative, semi‐structured telephone interviews with a purposive sample of headache neurology specialists from across the US, using open‐ended questions. Interviews were recorded, transcribed, and coded. Coded data were further analyzed using immersion/crystallization techniques for final interpretation. Results: Mean years providing headache care was 17.7 (SD = 10.6). Twelve of the 13 participants held United Council for Neurologic Subspecialties headache certification. Six described their practice site as providing multidisciplinary headache care. Participants explained most of their patients had seen multiple doctors over many years, and had tried numerous unsuccessful treatments. They noted patients with chronic headache frequently present with comorbidities and become stigmatized. All participants asserted successful care depends on taking time to talk with and listen to patients, gain understanding, and earn trust. All participants believed multidisciplinary care is essential within a comprehensive headache center, along with staffing enough headache specialists, implementing detailed headache intake and follow‐up protocols, and providing the newest medications, neuromodulation devices, botulinum toxin injections, monoclonal antibodies, nerve blocks and infusions, and treatment from a health psychologist. Other essential services for a headache center are other behavioral health practitioners providing cognitive behavioral therapy, mindfulness, biofeedback and pain management; and autonomic neurology, neuropsychology, vestibular audiology, sleep medicine, physical therapy, occupational therapy, exercise physiology, speech therapy, nutrition, complementary integrative health modalities, and highly trained support staff. Conclusion: While headache neurology specialists form the backbone of headache care, experts interviewed for this study maintained their specialty is just one of many types of care needed to adequately treat patients with chronic headache, and this is best provided in a comprehensive, multidisciplinary center. [ABSTRACT FROM AUTHOR]

Background Many unanswered questions remain regarding behavioral and mind/body interventions in the treatment of primary headache disorders in adults. Methods We reviewed the literature to ascertain the most pressing unanswered research questions regarding behavioral and mind/body interventions for headache. Results We identify the most pressing unanswered research questions in this field, describe ideal and practical ways to address these questions, and outline steps needed to facilitate these research efforts. We discuss proposed mechanisms of action of behavioral and mind/body interventions and outline goals for future research in this field. Conclusions Although challenges arise from the complex nature of the interventions under study, research that adheres to published study design and reporting standards and focuses closely on answering key questions is most likely to lead to progress in achieving these goals. [ABSTRACT FROM AUTHOR]