This site uses cookies. By continuing to browse the site you agree to our policy on the use of cookies. Learn more here.
Decline
Accept
Healtcare Providers - Clinician program enrollment header

N1-Headache conducts ongoing research and regularly presents new findings about migraine and headache at scientific conferences and in medical journals.

Publications

Seng EK, Prieto P, Boucher G, Vives-Mestres M.

Self-Monitoring on a Mobile Health Platform: A Naturalistic Longitudinal Cohort Study in People with Headache.

Headache: The Journal of Head and Face Pain 2018; 58 (10): 1541-1555.

Self-monitoring is commonly used to monitor health behaviors and disease activity. Curelator Headache (now called N1-Headache) used a smart-phone application to evaluate the factors associated with adherence to mobile headache diaries. Participants were asked to complete baseline questionnaires and daily recordings of headache symptoms and other factors for at least 90 days. Response options were coded on an 11-point Likert scale ranging from not at all) to 10 (a lot). Out of 4207 who registered, 40.3% (1561) met the criteria for analysis and were included in the final sample. 90% reported migraine as their most common headache type and the majority (79.8%) reported a physician diagnosis of migraine. Of the 1561 participants 505 (32.4%) completed 90 days of self-monitoring. A higher level of anxiety was significantly associated with lower odds of completion of 90 days of data entry. It was also found that age, account type, and gender were associated with adherence rate. Methods designed specifically to improve adherence, such as increasing incentives or reducing the burden of diary entries, could target individuals with high anxiety. Description
Description

Peris F, Donoghue S, Torres F, Mian A, Wöber C.

Towards improved migraine management: Determining potential trigger factors in individual patients.

Cephalalgia 2017; 37 (5): 452-463.

Certain chronic diseases such as migraine result in episodic, debilitating attacks for which neither cause nor timing is well understood. Curelator Headache (now called N1-Headache) applied n=1 statistical analysis to a 326-migraine-patient database from a study in which patients used paper-based diaries for 90 days to track 33 potential factors associated with their migraine attacks. The average number of factors associated with attacks was four per patient. Factor profiles were highly individual and were unique in 85% of patients with at least one identified association. Correct identification of migraine triggers in individuals may allow more effective self-management of the condition. Description
Description

Spierings EL, Donoghue S, Mian A, Wöber C.

Sufficiency and necessity in migraine: how do we figure out if triggers are absolute or partial and, if partial, additive or potentiating?

Curr Pain Headache Rep 2014; 18 (10): 455.

Migraine headaches can seemingly occur spontaneously but are often reportedly precipitated by events or factors, known as migraine triggers. Singularly, the triggers are generally necessary but not sufficient enough to bring on headache by themselves and, compounding of those triggers is usually required. How triggers affect a given individual can vary based on intensity and exposure of the trigger, the susceptibility of the individual to the trigger, and the time interval between exposure and the ensuing migraine attack. Causative trigger identification and subsequent behavioral changes have the potential to benefit people with migraine. However, it is only achievable if reliable daily information is collected, if the analysis is performed using appropriate statistical modelling, and if trigger-modification testing is executed to prove causality. Description
Description

MacGregor A, Mian A.

Challenging the “one size fits all” approach in modern medicine.

Head Wise, volume 7, issue 1, 2018

The paradigm of Mr. Average has had enormous clinical (as well as social and behavioral) consequences for humans who are outliers. Migraine, one of the leading causes of disability worldwide, is a model condition if we want to study variation between individuals and the therapeutic implications of these differences. Patient susceptibility and response to a wide range of potential factors represent an important spectrum of real-world markers for studying individual variation in genetic, physiological, psychological, and ultimately biochemical domains. In addition, many migraine population studies have already been done, generating aggregate data about the average migraine patient, which we can use to benchmark against variation in the individual patient. Therefore it seems that an important next step would be to acknowledge the need to understand both the degree of, and the basis for, individual variation in chronic disease. And if the average approach is limiting, or possibly even causing harm in some individuals, then optimizing individual therapeutic pathways and outcomes may be the most effective way forward for patients with chronic diseases. Description
Description

Shulman KJ, Donoghue S, Vives-Mestres M.

Is chocolate associated with more severe days in chronic migraine?

Headache: The Journal of Head and Face Pain. 2019; 59 (S1): 198
Cephalalgia 2019; 39 (1S): 330.

Chocolate is rarely statistically associated with migraine attack occurrence, and surprisingly just as likely to act as a migraine protector as a migraine trigger. N1-Headache analyzed headache intensity in people with chronic migraine to assess chocolate as a potential trigger associated with more severe pain days and a potential protector associated with less severe pain days. Of 109 individuals, chocolate association with migraine attack intensity was identified statistically in very few individuals, with no difference in associations with “high” or “low“ pain days. Description
Description

Orr SL, Vives-Mestres M, Donoghue S, Shulman KJ, Mian A.

Individual-level patterns of perceived stress throughout the migraine cycle: A longitudinal cohort study using dailyprospective data.

Headache: The Journal of Head and Face Pain. 2019; 59 (S1): 170
Cephalalgia 2019; 39 (1S): 324.

Stress is one of the most common self-reported triggers of migraine. N1-Headache analyzed stress throughout the phases of the migraine cycle on an individual level in 730 people with migraine. Aggregate-level analysis of how stress varied across the migraine cycle suggests there is a homogeneous pattern whereby stress peaks during the pain phase compared to the premonitory, prodromal and interictal phases. However, there was a wide variation among these individual patterns, with distinct dominant patterns of stress variation in the migraine cycle that differ significantly from individual to individual. Description
Description

Donoghue S, Shulman KJ, Vives-Mestres M.

Is stress associated with pain severity in chronic migraine?

Headache: The Journal of Head and Face Pain. 2019; 59 (S1): 165-166
Cephalalgia 2019; 39 (1S): 324-325.

The relationship between stress and migraine attack occurrence is complex, with evidence that changes in stress level, either an increase or a decrease (‘let down’) can be a trigger. N1-Headache analyzed the relationship between daily, self-reported stress level and the intensity of headache pain. Of 120 individuals with chronic migraine, stress was associated with increased risk of a “high” pain day in 34; there was no association found between stress and headache severity in the other 86. Nearly all individuals who responded to the question suspected stress as a migraine trigger, yet there was no clear association between degree of suspicion and the proportions of individuals in whom an association was statistically identified. Description
Description

Donoghue S, Vives-Mestres M, Shulman KJ.

Detecting factors associated with “low” and “high” headache pain days in individuals with chronic migraine.

Headache: The Journal of Head and Face Pain. 2019; 59 (S1): 41
Cephalalgia 2019; 39 (1S): 320.

Curelator studied headache intensity from individual attacks to assess potential triggers associated with more severe “high” pain days and potential protectors associated with less severe “low” pain days. Of 141 individuals with chronic migraine, the most common risk factors associated with “high” pain days were symptoms typically associated with migraine attacks which could be either potential triggers or prodromal symptoms. This compares to those potential protectors associated with “low” pain days, where the top factors were related to good sleep and positive mood. The aggregated data of the most common individual risk factors was consistent with current beliefs about the pathophysiology of migraine. However, there was considerable variability observed between individuals, underscoring the need for analysis at the individual level. Description
Description

Shulman KJ, Prieto P, Vives-Mestres M, de la Torre ER, Lipton RB.

Individual risk factor variability and overlap in factors associated with migraine occurrence vs severity.

Cephalalgia 2018; 38 (1S): 11-12

N1-Headache studied the association of factors that modify risk of occurrence and influence severity of migraine attacks in the same person. Individual n-of-1 analyses in people with migraine demonstrated limited within patient overlap of occurrence factors and severity modifiers, suggesting that factors associated with migraine frequency and severity may act differently in the same patient. Description
Description

Shulman KJ, Vives-Mestres M, Lipton RB, Goadsby PJ.

Correlation of migraine attacks with increased allodynia.

Cephalalgia 2018; 38 (1S): 14.
Headache: The Journal of Head and Face Pain. 2018; 58 (S2): 175-176.

Cutaneous allodynia is a common feature of migraine attacks. In those with migraine, allodynia is associated with inadequate response to acute migraine treatments and is a risk factor for migraine chronification. N1-Headache explored the correlation within individuals between allodynia and migraine attacks. For 774 individuals, cutaneous allodynia was reported by two-thirds. Self-reported allodynia was associated with greater migraine attack frequency and greater migraine days/month compared to those who never reported allodynia. Description
Description

Prieto P, de la Torre ER, Shulman KJ, Vives-Mestres M, Lipton RB.

Real world longitudinal analysis of response with an electronic platform.

Cephalalgia 2018; 38 (1S): 14-15.

Three cases of individuals with migraine who were receiving Botox while using the N1-Headache digital platform were selected to illustrate how the platform can monitor individual tracked days, total headache days, migraine days and disablity due to migraine over time. After 90 days of data collection, a disability score was calculated using the same method as the MIDAS score, but from data captured prospectively on headache days. It was determined that using a digital platform and n=1 statistical algorithms is an effective way to monitor migraine outcomes remotely. Description
Description

Donoghue S, Vives-Mestres M, Silberstein SD.

Chocolate as a risk factor for migraine attacks.

Cephalalgia 2018; 38 (1S): 19.
Headache: The Journal of Head and Face Pain. 2018; 58 (S2): 109-110.

N1-Headache compared chocolate intake and migraine attack occurrence in individuals to see how many suspected chocolate as a trigger and for how many an association between chocolate ingestion and migraine attack occurrence can be identified statistically. Of 774 individuals, chocolate was suspected as a trigger by half at baseline. However, an association between self-reported intake and risk of migraine attacks was identified statistically in only a few individuals, where chocolate could act as either a trigger or protector of migraine attacks. Description
Description

Donoghue S, Vives-Mestres M, MacGregor A.

Correlation of migraine attacks with neck pain and tension.

Cephalalgia 2018; 38 (1S): 20-21.
The Journal of Headache and Pain 2018, 19 (S1): 9
Headache: The Journal of Head and Face Pain. 2018; 58 (S2): 104-105.

N1-Headache explored the belief in neck pain/tension as a migraine trigger and the statistical correlation between neck pain/tension and occurrence of migraine attacks. Each day the question was asked: ‘Did you notice neck pain or tension today?’ In 774 individuals, a high proportion suspected that neck pain is a trigger of their migraine attacks. However a statistical association between neck pain/tension and increased risk of attacks was identified statistically in 32% of individuals. There was an association between the strength of neck pain/tension being suspected as a trigger and the frequency of statistical confirmation of an association with their attacks. The temporal association between neck pain/tension and migraine attacks suggests that neck pain is part of migraine symptomology, rather than a migraine trigger. Description
Description

Donoghue S, Vives-Mestres M, Viirre E.

Nitrates in food as a risk factor for migraine attacks.

Cephalalgia 2018; 38 (1S): 123.
Headache: The Journal of Head and Face Pain. 2018; 58 (S2): 110-111

N1-Headache explored whether daily variation in nitrate intake in food is associated with risk of having migraine attacks. For 774 individuals, nitrates in food was suspected as a trigger by nearly half at baseline but in only a small proportion of these individuals was an association identified statistically between daily self-reported intake and increased risk of migraine attacks. Description
Description

MacGregor A, Donoghue S, Vives-Mestres M.

Correlation of migraine attacks with excessive yawning.

Cephalalgia 2018; 38 (1S): 130.

Repetitive yawning is a common premonitory migraine symptom, and has a high predictive value for a migraine attack. N1-Headache explored how many individuals recorded excessive yawning and for how many an association between excessive yawning and migraine attacks could be identified statistically. Out of 483 individuals, excessive yawning was a discernible symptom and sensitive predictor of migraine in 27%. Description
Description

Donoghue S, Vives-Mestres M, Ailani J.

Monosodium glutamate (MSG) in food as a risk factor for migraine attacks.

Headache: The Journal of Head and Face Pain. 2018; 58 (S2): 114-115.

It has been reported that the food additive, monosodium glutamate (MSG) causes headaches in susceptible individuals and may trigger migraine attacks. N1-Headache was used to determine how many individuals suspected MSG as a migraine trigger and how many had a statistical association between MSG intake and migraine attacks. Of 774 individuals, half suspected MSG as a trigger at baseline, but in only a very small proportion of individuals was an association between self-reported intake of MSG and increased risk of migraine attacks identified statistically. Description
Description

Shulman, KJ, Vives-Mestres, M, Boucher, G, Silberstein, SD, Young WB.

Type of day as a risk factor for migraine attacks: an exploration of “Weekend Headache”.

Headache: The Journal of Head and Face Pain. 2018; 58 (S2): 175.

People with migraine often report an increase in the frequency and/or severity of attacks on non-working days, often referred to as “weekend headache.” Curelator explored the association between type of day and risk of migraine attack. Through individual analysis of self-reported patient data in 707 individuals with migraine, N1-Headache was able to show that there is minimal association between the type of day and risk of migraine attack. Description
Description

Ridenour TA, Vives-Mestres M, Boucher G, Mian A, Hershey AH.

N=1 statistical approaches to examine factors that modify headache severity in chronic versus episodic patients.

Neurology 2018; 90, (S15): P3.099.

In this study, we hypothesize that modifying potential migraine risk factors may also impact the severity of an attack (severity modifiers). N1-Headache identified factors associated with headache pain severity during migraine attacks in individuals, and compared the prevalence and the effect size of these severity modifers in chronic vs. episodic migraineurs. Pain severity was collected on days with headache through the question “How bad was your headache pain at its worst today?” with three possible answers Mild/Moderate/Severe. After studying the data of 775 participants, it was concluded that severity modifier profles were highly individualized. For some factors, the prevalence of severity modifers was higher in chronic compared to episodic migraine and varied with migraine frequency. Description
Description

Donoghue S, Boucher G, Peris F, Mian A, Martin , PR.

Self-reported triggers vs prospectively statistically determined factors associated with attacks in individuals with episodic and chronic migraine.

Cephalalgia 2017; 37:(1S): 155-156.
Headache: The Journal of Head and Face Pain 2017; 57 (S3): 194.
Journal of Headache and Pain 2017; 18 (S1): 54.

N1-Headache compared suspected triggers with those identified statistically from prospective data in 488 individuals with episodic or chronic migraine. An average of 23 migraine triggers were suspected per individual, but a mean of less than 3 factors were associated with increased risk of migraine attack. Statistical associations between suspected triggers and occurrence of migraine attacks were confirmed in less than 15% of individuals for most factors, in both the episodic migraine and chronic migraine groups. Description
Description

Ridenour T, Peris F, Boucher G, Mian A, Donoghue S, Hershey AD.

N=1 statistical approaches to examine risk factor profiles of ICHD-3 beta classified migraines within individuals.

Cephalalgia 2017; 37 (1S): 187.
Journal of Headache and Pain 2017; 18 (S1): 29.

N1-Headache analyzed which risk factors were identified as possible “triggers” of migraine initiation as opposed to being associated with severity of a migraine. For 479 participants, the profiles of risk factors that were associated with incidence and severity of migraines varied considerably between individuals. Overall, more risk factors were associated with migraine attack occurrence compared to migraine attack severity, both in terms of prevalence and types. Description
Description

McGinley JS, Wirth RJ, Boucher G, Buse DC, Donoghue S, Pavlovic J, Lipton RB, MacGregor A.

Individual Differences in the Relation of Migraine and Menstruation: Examining the ICHD-3 Time Window.

Cephalalgia 2017; 37 (1S): 187-188.

This study applied an n=1 analytic framework to individual daily diary data to explore both intra and inter individual differences in the perimenstrual occurence of migraine. Results showed that menstruation was associated with increased odds of migraine in 66% women studied, with substantial variation in the association between migraine and menstruation based on the ICHD-3 beta time window (days -2 to +3). In the future, it may be possible to incorporate specific logorithms into the pathophysiology and management of menstrual migraine. Description
Description

Prieto P, Boucher G, Donoghue S, Mian A, Rosen N.

Alcohol as a risk factor for migraine attacks: an exploration.

Cephalalgia 2017; 37 (1S): 198.
Journal of Headache and Pain 2017; 18 (S1): 49-50.

Alcohol has long been suspected as a migraine trigger, but numerous studies have produced inconclusive results. N1-Headache explored this question by statistically comparing the intake of alcohol and occurrence of migraine. Two different time relations, lagged (previous day) and co-occurring (same day) effect were analyzed. Overall, alcohol was suspected as a trigger at baseline by more than half of 272 individuals, but an association between daily self-reported intake and increased risk of migraine attacks was identified statistically in only a small proportion of individuals. There was no clear association between the strength of alcohol being suspected as a trigger and frequency of statistical confirmation of alcohol being associated with their migraines. An important limitation of this study is that the current study determines simple associations and not causality. Description
Description

Ridenour T, Peris F, Boucher G, Mian A, Donoghue S, Hershey AD.

N=1 statistical approaches to examine risk factor profiles of ICHD-3beta classified headaches versus migraines within individuals.

Cephalalgia 2017; 37 (1S): 209-210.
Journal of Headache and Pain 2017; 18 (S1): 28-29.

To clarify whether migraines are distinct compared to other headaches, N1-Headache investigated associated risk factors at the N=1 level in patients who experience both migraine and non-migraine headaches based on ICHD-3beta criteria. A sample of 479 participants reported daily on headache occurrence, symptoms of migraine attack, degree of pain associated with the headache, and exposure to 70 potential migraine risk factors. Individual-level analyses revealed that nearly all risk factors (triggers and protectors) were usually associated with occurrence and severity of either migraine or non-migraine headaches, but not both. Description
Description

Barra M, Boucher G, MacGregor EA, Vetvik KG

Towards an improved diagnostic criterion for menstrually related migraine (MRM).

Cephalalgia (2017) 37 (1S): 247-248.

Daily diary studies of women with migraine reveal that at the population level, the probability of migraine is increased shortly before and shortly after the onset of menstrual bleeding. The ICHD-3 beta criteria for migraine defines the time of increased risk due to menstruation as the time from 2 days before until 3 days after bleeding begins.This population average data does not consider that migraine risk may vary from woman to woman in relation to bleeding. Here, we consider that headache risk may vary from woman to woman on particular days or particular segments of the menstrual cycle. The analysis sample consisted of data collected from 50 menstruating females reporting on a median of 200 days using the N1-Headache app. Using a categorical approach, analysis of pooled data from all women indicated that migraine risk was highest during actively bleeding days, elevated to a lesser degree on pre-bleeding days and more comparable on post bleeding days. A continuous time method of analysis showed that each woman’s migraine risk often varied not only across menstrual stages but also within specific stages. Understanding these individual patterns may prove useful in clarifying the mechanisms of menstrual migraine and in developing individualized approaches to short-term preventive treatment. Description
Description

Barra M, Boucher G, MacGregor EA, Vetvik KG

Towards an improved diagnostic criterion for menstrually related migraine (MRM).

Cephalalgia (2017) 37 (1S): 247-248.

The ICHD-III classifies Menstrually Related Migraine (MRM) as a subtype of migraine without aura if attacks occur on 2 out of 3 menstrual windows (defined as the five days centered on the first day of bleeding) in women who also have non menstrual attacks. Because of concerns that MRM diagnoses set by this criterion may lead to unacceptable diagnostic error rates, a novel statistical method to diagnose MRM was compared against the ICHD-III 2/3 criterion. Analysis of pooled data from 106 women using the N1-Headache digital platform was compared to 123 women attending the City of London Migraine Clinic whose data have previously been published. All women had logged migraine attacks during at least 3 consecutive natural menstrual cycles and MRM was diagnosed by the standard ICHD-III criterion. Based on the results of the statistical analysis, the ICHD-III criteria did not select women with prolonged menstrual attacks. It was concluded that the proposed standard of 3-cycle observations prior to setting an MRM diagnosis should be extended with at least one perimenstrual window to obtain sufficient information for statistical processing. Description
Description

Prieto P, Boucher G, Mian A, Rosen N.

Individual self-prediction of migraine attacks: longitudinal analysis of cohort of migraine patients using a digital platform.

Cephalalgia 2017; 37 (1S): 275.
Journal of Headache and Pain 2017; 18 (S1): 50-51.

As a critical component of self-management of their condition, this study examines the ability of episodic migraineurs to self-predict attacks on an individual level. Individual participants used N1-Headache daily for at least 90 days, entering details about headaches and also migraine expectation for the next 24 hours. In this study of 146 individuals with episodic migraine, 9% were good migraine predictors (defined as having an accuracy of ≥75%) and 27% were bad predictors (defined as those with ≤25% accuracy). The difference between each of these groups and the rest of the study population was statisticaly significant (p<0.001). Individuals were much better at predicting migraine-free days, with 71% good predictors and <1%% bad predictors. In the 5% of people that can accurately predict migraine and migraine-free days within 24 hours with high accuracy (and the 9% of good migraine predictors), their associated disability and headache frequency remains higher than in the total sample. Description
Description

Prieto P, Boucher G, Donoghue S, Goadsby PJ, Silberstein SD.

Medication use and overuse patterns in a cohort of US and UK migraine patients using a digital platform.

Cephalalgia 2017; 37 (1S): 280-281.
Headache: The Journal of Head and Face Pain 2017; 57 (S3): 204-205.
Journal of Headache and Pain 2017; 18 (S1): 50.

An electronic diary, N1-Headache was used to compare medication use and possible overuse patterns in individuals with migraine in the United States (US) and the United Kingdom (UK). Of 467 individuals, medication overuse was identified in 29% of individuals in a predominantly physician referred group in the US and in 19% in a predominantly population recruited group in the UK. The number of medications or medication classes per user was significantly higher for chronic migraine (CM) than episodic migraine (EM) in both countries. Patients with CM in the US took more medication per headache than UK CM patients, but UK EM patients used more medication per headache than US EM patients. Surprisingly, the average number of medications and classes of medications used on a per headache basis was significantly higher in EM than in CM group in both countries. In both the US and UK, triptans are most frequently used by EM patients and NSAIDs are most frequently used by CM patients. Opioids were used more frequently by CM patients in the US than the UK. Both CM and EM patients showed different rates of medication use per individual, as well as different medication overuse and medication use frequencies. Description
Description

Vieira JR, Boucher G, Prieto P.

Epidemiology differences between migraineurs followed by the (Curelator Headache™) who completed 3 months daily electronic follow up vs. drop-outs.

Cephalalgia 2017; 37 (1S): 281–282.

N1-Headache, a platform that demands daily tracking of both risk factors and headache symptoms, was used to record profile demographic data, as well as real time daily collection of headache data including frequency, possible triggers, treatment and disability score (MIDAS) among other variables. An analysis was performed to compare characteristics of those who completed 90 days of data collection compared to non-completers. Of 2678 individuals with migraine registered with the platform, at 90 days only 493 individuals (18.4%) reliably completed data entry. Completers were older, less likely to be employed, had slightly less severe pain although they visited the ER less frequently, utilized less caffeine and smoked less cigarettes when compared to all non-completers (drop-outs). Description
Description

Donoghue S, Boucher G, Peris F, Mian A, MacGregor A.

Tyramine as a risk factor for migraine attacks: an exploration.

Cephalalgia 2017; 37 (1S): 282.
Headache: The Journal of Head and Face Pain 2017; 57 (S3): 194–195.

Since Dr. Edda Hanington's study in 1967, which suggested a connection between tyramine-containing foods and migraine attacks, doubts have been raised about the prevalence of this sensitivity in the migraine population. To explore this question, N1-Headache, a digital platform that enables daily data capture and novel n-of-1 analytics, was used to statistically compare self-reported intake of tyramine-containing foods and occurrence of migraine attacks. Of 488 individuals using the platform in this study, almost half suspected tyramine was a migraine trigger at baseline. However, data from 49% was not analyzable due to low or unchanged intake of tyramine. In those with analyzable data, an association between self-reported intake of tyramine and risk of migraine attacks was identified statistically in a small portion of individuals. Tyramine was associated with decreased attack risk (potential protector) in a similar proportion of individuals. Description
Description

Donoghue S, Boucher G, Peris F, Mian A, Martin PR.

Comparison of self-reported triggers in individuals with episodic or chronic migraine.

Headache: The Journal of Head and Face Pain 2017; 57 (S3): 193-194.

Migraine attacks may be triggered by combinations of internal and external risk factors which differ markedly between individuals. In the migraine literature many factors have been proposed as triggers, however these are usually based on retrospective recall which is subject to misinterpretation and recall bias. This study describes beliefs about personal triggers and compares these beliefs in those with episodic migraine (EM) and chronic migraine (CM). Using the N1-Headache digital platform, an initial questionnaire presented a list of potential migraine risk factors and asked individuals to rate their importance as personal migraine triggers on a 0 to 10 scale (0=none; 10=maximal). An average of 23 triggers were suspected by 488 individuals at baseline. When comparing those with EM (n=391) and CM (n=97), there are no clear differences in terms of the range and type of suspected triggers other than the CM group suspecting slightly more triggers on average than the EM group. Description
Description

Donoghue S, Peris F, Boucher G, Mian A, Wöber C.

Individual identification of factors associated with reduced risk of migraine attacks: potential ‘protectors’.

Journal of Headache and Pain 2017; 18 (S1): 53.
Headache: The Journal of Head and Face Pain 2016; 56 (S1): 36.

N1-Headache is a digital platform that collects daily data about an individual’s migraine attack risk factors (i.e., up to 80 factors including mood, stress, diet, activity, weather etc.) and then statistically identifies associations between these factors and the occurrence of migraine attacks. The resulting associations include potential triggers (both 'true' triggers associated with increased risk of attack and premonitory symptoms) as well as potential protectors (factors associated with reduced risk of migraine attack occurence). After 557 Individuals used the N1-Headache app daily for 90 days entering details about headaches and tracking daily factors that may affect migraine attack occurrence, potential protectors were found in 471 (84.4%) individuals. On average individuals had 3 such associations (range 0 - 16). Identifying ‘protectors’ may be as clinically useful as identifying potential triggers in people with migraine. Description
Description

Donoghue S, Peris F, Torres F, Mian A, Wöber C.

Statistical methodology for determining potential migraine trigger factors in individuals.

Headache: The Journal of Head and Face Pain 2016; 56 (S1): 36-37.

Historically, factors believed to trigger migraine attacks were identified through analysis of aggregated data from populations of patients, but may not apply to a given individual. This study applied n=1 statistical methods to analyze a 326-migraine patient database from the PAMINA study to determine for each individual which triggers are associated with their attacks. In 87% (285) of migraine patients analyzed, “potential trigger” profiles were generated, with an average of four factors significantly associated with occurrence of migraine attacks per patient. These “potential trigger” profiles were highly individual and unique in 85% of the patients who had at least one identified significant factor. Identification of associations between factors and attacks is not proof of causality as these factors may be triggers and/or may be warning signs of their attacks. Description
Description

Wöber C, Donoghue S, Mian A, Albert M, Boucher G, Peris F.

Identification of individual ‘protectors’ (factors associated with reduced risk of migraine attacks) in the PAMINA study database.

Cephalalgia 2016; 36 (1S): 19.

The PAMINA study analyzed collectively factors increasing and decreasing the risk of attacks in patients with migraine and showed that a reduction in the risk of attacks was associated with a number of factors: including days of holiday or days off, Tuesdays, consumption of beer and (less robustly in the analyses) progresterone-only contraception and being divorced. Here, we report a new analysis of pseudonymized data from 326 participants in the PAMINA study to identify potential 'protectors' in individual patients. This study used n=1 analytical methods to determine statistically significant associations between a variety of potential migraine risk factors and occurrence of migraine attacks. In the PAMINA study patients, we found 0-6 'protectors' per patient: 35% of patients had at least one. Identifying protective factors may be a useful addition to the management of migraine, potentially of equal importance to identifying triggers. However, association is not evidence of causality: it is important to guide each individual to think about their behaviors and self-analyse why and in what context such factors - whether potential protectors or triggers - may affect their condition. Description
Description

Donoghue S, Martin PR, Boucher G, Peris F, Mian A.

Migraineurs suspected triggers vs associations statistically determined using a digital platform.

Cephalalgia 2016; 36 (1S): 19-20.
Headache: The Journal of Head and Face Pain 2016; 56 (S1): 35-36.

Migraine attacks may be triggered by combinations of internal (e.g. hormonal) and external (diet, environment, lifestyle) factors which differ markedly between individuals. Most migraineurs suspect certain factors as triggers: this is usually based on retrospective recall and is subject to recall bias and misinterpreted associations. This study compared suspected triggers from 390 individuals with migraine against statistically identified triggers after 90 days use of Curelator Headache (now called N1-Headache). Overall, of 7317 suspected triggers, only 1186 (16%) were shown to be statistically associated with migraine attack occurrence. An average of 4.6 factors were statistically associated with increased risk of attacks for each individual. Of these, an average of 3 triggers were previously suspected by an individual and 1.6 were not previously suspected. Increasing an individual’s knowledge about their potential migraine triggers may enable them to improve their condition by avoiding or coping with their triggers differently. Description
Description

Donoghue S, Mian A, Albert M, Boucher G, Peris F, Wöber C.

Identification of ‘protectors’ against migraine attacks using Curelator Headache™.

Cephalalgia 2016; 36 (1S): 18–19.
Headache: The Journal of Head and Face Pain 2016; 56 (S1): 36.

Curelator Headache (now called N1-Headache) is a digital platform which collects daily data about potential migraine attack risk factors and then statistically identifies individual associations between factors and migraine attack occurrence. This analysis also identifies factors statistically associated with reduced risk of attack occurrence called potential ‘protectors.’ In 284 individuals, 87% had at least one ‘potential protector." Most common were waking refreshed (46%), sleep quality (23 %), sleep duration (11%), feeling happy (33%), feeling relaxed (23%), physical activity (20%) and caffeine (14%). Surprisingly, a number of factors generally thought of as triggers were identified as ‘protectors’ in some individuals, such as travel and alcohol. Therefore, identifying factors that are associated with reduced incidence of migraine attacks may be a useful addition to the management of migraine, potentially of equal importance to identifying triggers. Description
Description

Albert M, Costas R, Donoghue S, Boucher G, Mian A.

Use of Visual Migraine Language as part of a new data entry interface that identifies possible migraine triggers and premonitory symptoms.

Headache: The Journal of Head and Face Pain 2015; 55 (S3): 141-142.

Curelator Headache (now called N1-Headache) is a novel digital platform that allows individuals with migraine to discover their personal triggers and protective factors and eliminate factors that are not associated with their attacks. To maximize both patient compliance and accuracy of data entry, a freely licensable semiotic system called Visual Migraine Language (VML) was developed and tested on people with migraine. VML codifies migraineurs’ environments, possible interventions and clinically relevant aspects of their condition into a series of intuitive symbols. Use of the VML simplifies the user interface, enhances user experience, and encourages daily data entry compliance and adherence compared to text-based interfaces. Description
Description

Donoghue S, Mian A, Peris F, Boucher G, Albert M.

A new digital platform (Curelator Headache™) to identify possible migraine triggers and warning signs in individuals and test triggers for causality.

Cephalalgia 2015; 35 (6S): 40.

The episodic, largely unpredictable, nature of migraine attacks implies they occur as a result of a complex interaction between an individual’s genetics and their personal environment. Individuals appear to be sensitive to different sets of triggers. In addition, ‘protective factors’ may at least partially counteract the effect of triggers. An approach is needed that objectively identifies important triggers and protectors for individuals with migraine. Curelator Headache (now called N1-Headache) is a novel digital platform that allows individuals with migraine to discover their personal triggers and protective factors and eliminate factors that are not associated with their migraine attacks. To test the data entry interface, 511 people with migraine were recruited on-line and registered to use the pilot versions of Curelator Headache for 90 days. Of those who registered, 375 used the platform for >2 days and 218 (58%) entered adequate data to allow generation of personal ‘trigger maps’. It is expected that improved knowledge of potential migraine triggers and protective factors will help individuals, and their clinicians, manage their migraine more effectively. Description
Description
Loading...