Clinical papers and abstracts

Citations and brief descriptions for N1-Headache's clinical abstracts and publications.
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 Oct; 18(10): 455
An explanation of a novel approach following the ubiquitous adoption of smartphones as a personal data entry interface, combined with sophisticated statistical algorithms. Migraineurs and eventually users with other chronic conditions are presented with an important, new set of tools to understand and manage their individual risk factors.
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: 141-142
Visual Migraine Language was developed and tested with patients, leading migraine neurologists and patient organizations to expedite daily data collection for clinical trials and improve physician/patient interactions by tracking the efficacy of medications and identifying possible risk factors: triggers, protectors and factors not associated with migraine attacks.
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
A novel digital health platform was tested in over 500 individuals with migraine. Users were required to enter daily data including their exposure (or lack of) to a variety of potential risk factors: emotional, dietary, physical and weather as well as headache attacks, symptoms and medications used. Compliance and adherence were assessed, as was the ability to generate personal risk factor maps, e.g. Individual Trigger Maps.
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: 36-37
To validate a novel statistical approach, Curelator Headache applied a N=1 statistical algorithm to a 326 migraine patient database from the benchmark PAMINA study. Patients used paper-based diaries for 90 days to track 33 potential risk factors: potential triggers or premonitory symptoms- associated with their migraine attacks. The results show an unexpectedly high degree of variability in individual risk profiles: 85% of the patients had unique trigger profiles and no one had the aggregate average profile.
Donoghue S, Boucher G, Peris F, Mian A.
Migraineurs’ suspected triggers compared with scientifically determined associations using a daily diary and statistical analysis platform, Curelator Headache.
Headache: The Journal of Head and Face Pain 2016; 56: 35-36
A digital platform, Curelator Headache, enables daily collection of migraineurs' individual data concerning symptoms and potential risk factors. The approach then statistically identifies factors associated with attacks and dismisses those that are not. Users inaccurately suspect many risk factors that are in fact not associated with their attacks.
Donoghue S, Martin PR, Boucher G, Peris F, Mian A.
Migraineurs suspected triggers vs associations statistically determined using a digital platform.
Cephalalgia 2016; Vol. 36(1S) 19-20
This study shows that retrospective, recall-based identification of personal triggers (i.e., suspected triggers) is unreliable compared to daily, prospective data collection coupled with statistical analysis of potential trigger-attack associations, as is done with the Curelator Headache digital platform.
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; Vol. 36(1S) 19.
Potential ‘protectors’ were identified in about one-third of individual patients with migraine using the paper-based diary data from the benchmark PAMINA study, coupled with novel n=1 statistical algorithms from Curelator Headache. Identifying such factors may be a useful addition to the management of migraine, potentially of equal importance to identifying triggers.
Donoghue S, Mian A, Albert M, Boucher G, Peris F.
Identification of ‘protectors’ – factors associated with reduced risk of migraine attacks: some surprising observations and interpretations.
Headache: The Journal of Head and Face Pain 2016; 56: 36
In this study Curelator Headache reports that in a group of 254 users a number of factors, generally thought of as triggers, were surprisingly identified as ‘protectors’ in some individuals, notably: alcohol (15); travel (14); stress (12); bright lights (8); odors (6); and neck pain (5).
Donoghue S, Mian A, Albert M, Boucher G, Peris F, Wöber C.
Identification of ‘protectors’ against migraine attacks using Curelator Headache.
Cephalalgia 2016; Vol. 36(1S) 18–19
This study shows for the first time, potential ‘protectors,’ the spectrum of factors associated with reduced incidence of migraine attacks. Identifying ‘protectors’ may be a useful addition to the management of migraine, potentially of equal importance to identifying triggers.
Peris F, Donoghue S, Torres F, Mian A, Wöber C.
Towards improved migraine management: Determining potential trigger factors in individual patients.
Cephalagia 2017 Apr; 37(5):452-463
Accurate identification of individual risk factor-symptomology profiles is a prerequisite for testing which are true migraine triggers and for development of trigger avoidance or desensitization strategies. Curelator Headache's methodology represents a necessary development toward this goal.
Vieira J R, 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; Vol. 37(1S) 209–303
With the advent of electronic diaries, understanding user profiles that correlate with tracking compliance is critical. How many are able to track for 90 consecutive days? In this study, the 18% of individuals who successfully did so were older, less likely to be employed, had slightly less severe pain, visited the ER less frequently, took less caffeine and smoked less (compared to those that dropped tracking earlier).
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; Vol. 37(1S) 209–303
How good can patients be at predicting their migraines? We asked Curelator Headache users to predict next day migraine (or migraine-free day) and classified good predictors as those who predicted both migraine days and migraine-free days with >75% accuracy. Only 5% of migraineurs were able to do this. Next step: how did ‘good predictors’ do it? Understanding how good predictors predict is tantamount to crowd-sourcing and understanding best-of-practice among individuals with migraine.
Prieto P, Boucher G, Donoghue S, Mian A, Rosen N.
* Alcohol as a risk factor for migraine attacks: an exploration.
Donoghue S, Boucher G, Peris F, Mian A, MacGregor A.
Tyramine as a risk factor for migraine attacks: an exploration.
Cephalalgia 2017; Vol. 37(1S) 172–208 (* Poster selected as the top submission for a special presentation)
Alcohol and tyramine are widely suspected as migraine triggers - but are they really? In these prospective studies neither factor was found to be commonly associated with migraine attacks. Furthermore, they were as equally (<10%) identified as potential protectors and potential triggers. Since these studies only reveal simple associations, and causal associations are likely to be a small subset of these, we conclude that alcohol and tyramine rarely, if ever, act as univariate triggers (or protectors).
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.
McGinley JS, Wirth RJ, Boucher G, Buse DC, Donoghue S, Pavlovic J, MacGregor A, Lipton RB.
Redefining the Time Window of Perimenstrual Migraine Days Reveals Additional Inter- and Intra-Individual Differences.
Cephalalgia 2017; Vol. 37(1S) 172–208 (* Poster selected as the top submission for a special presentation)
Longitudinal analyses of the association between migraine and menstruation using the standard ICHD-3 beta window (day -2 to +3) over an average of 6 cycles showed increased odds of migraine in 66% of women studied, but with substantial variation both within and between individuals. Thus, a ‘one size fits all’ window for analysis of the impact of menstruation on migraine is likely not valid for many individuals.
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; Vol. 37(1S) 172–208 (* Poster selected as the top submission for a special presentation)
Here we demonstrate that some lifestyle, dietary, physical and emotional factors can modify the severity of migraine attacks. Using a novel visualization tool (Pez Plots) we can compare these so called “migraine severity modifiers” to factors that, in contrast, are associated with provoking or protecting from attacks (i.e. potential triggers/protectors), in both an aggregated population as well as within individuals. Surprisingly, we find limited overlap. This may provide patients with a new and potentially important clinical management tool.
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 headaches versus migraines within individuals.
Cephalalgia 2017; Vol. 37(1S) 209–303
This study describes lifestyle, dietary, physical and emotional factors that act as “severity modifiers” and/or potential “triggers and protectors” and compares them for ICHD-3 beta classified migraines and ’other’ headaches within individuals. We show that ‘other’ headaches have distinct sets of factors associated with severity modification versus attack occurrence and, furthermore, both these sets of factors are distinct from those associated with migraines. This study suggests that non-migrainous headaches and migraine attacks are distinct pathophysiological entities and as such may need to be distinctly managed.
Donoghue S, Boucher G, Peris F, Mian A and Martin PR.
Comparison of self-reported triggers in individuals with episodic or chronic migraine.
Headache: The Journal of Head and Face Pain 2017; 57: 113–226. Cephalalgia 2017; Vol. 37(1S) 209–303
Even though the two conditions differ markedly, surprisingly, there is no clear difference in the range or type of suspected (but scientifically unconfirmed) triggers in those with EM (episodic migraine) and CM (chronic migraine). This is likely because an individual's suspicion of triggers is often based on information in popular press and internet, which is often anecdotal. Therefore an objective way of finding ‘true’ triggers in individuals could be beneficial by facilitating an achievable strategy of trigger management.
Donoghue S, Boucher G, Peris F, Mian A and Martin PR.
Self-reported triggers vs. those prospectively statistically determined in individuals with episodic and chronic migraine.
Headache: The Journal of Head and Face Pain 2017; 57: 113–226. Cephalalgia 2017; Vol. 37(1S) 209–303
People are suspicious of many triggers. How often can these suspected associations be confirmed scientifically based on a statistical analysis of 90 days of daily data tracking those suspected factors? Curelator Headache digital platform was able to generate statistical associations between suspected trigger factors and migraine attacks in less than 15% of cases in both the EM (episodic migraine) and CM (chronic migraine) groups. Even though both groups suspected essentially the same set of risk factors, a scientific analysis revealed significant differences in actual trigger profiles between the two groups.
Donoghue S, Boucher G, Peris F, Mian A, MacGregor A.
Tyramine as a risk factor for migraine attacks: an exploration.
Headache: The Journal of Head and Face Pain 2017; 57: 113–226. Cephalalgia 2017; Vol. 37(1S) 209–303
Tyramine was suspected as a trigger by nearly half of individuals at baseline, but in only a small proportion of individuals was an association between daily self-reported intake and increased risk of migraine attacks (potential trigger) identified statistically. It is likely a great many people are avoiding tyramine unnecessarily.
Prieto P, Boucher G and Donoghue S, Goadsby PJ and Silberstein SD.
Medication use and overuse patterns in Curelator Headache US and UK users.
Headache: The Journal of Head and Face Pain 2017; 57: 113–226. Cephalalgia 2017; Vol. 37(1S) 209–303
Curelator Headache identified MO (medication overuse) in 29% of individuals in a predominantly physician referred group (US) and in 19% in a predominantly population recruited group (UK). Differences in use, overuse and type of medication were seen between chronic and episodic migraine users. Type of medications used was also different between US and UK users.
Loading...