ABSTRACT
BACKGROUND AND PURPOSE: We investigated non-acute headache patients' long-term satisfaction with a telemedicine consultation and consultation preferences in northern Norway. We hypothesized that patients were not less satisfied with telemedicine than traditional consultations. We also examined the influence of gender, age and education on satisfaction. METHODS: For 2.5 years, patients were consecutively screened, recruited and randomly assigned to telemedicine or traditional visits with a consultation at a neurological outpatient department. The primary endpoint was frequency of satisfied patients at 3 and 12 months. Secondary endpoints were satisfaction with consultation, communication, information, diagnosis, advice and prescriptions, and preferred visit form at 12 months. RESULTS: Of 402 participants, 279 (69.4%) answered questionnaires at both 3 and 12 month, and 291 (72.4%) responded at 12 months. The long-term satisfaction of telemedicine patients was 124/145 (85.5%) compared with 118/134 (88.1%) in the traditional group (P = 0.653). The groups did not differ with respect to secondary endpoints, but females were more satisfied with telemedicine communication (P = 0.027). In the telemedicine group, 99/147 (67.3%) were indifferent to the type of consultation. Age and education did not alter the primary results. CONCLUSIONS: At 1 year after a specialist evaluation for headache, telemedicine patients did not express less satisfaction than those with traditional consultation. Telemedicine specialist consultations may be a good alternative for headache patients in secondary care.
Subject(s)
Headache/therapy , Patient Satisfaction , Telemedicine , Adult , Female , Follow-Up Studies , Humans , Male , Middle Aged , Norway , Specialization , Surveys and Questionnaires , Young AdultABSTRACT
Migraine is a complex brain disorder where several neuronal pathways and neurotransmitters are involved in the pathophysiology. To search for a specific anatomical or physiological defect in migraine may be futile, but the hypothalamus, with its widespread connections with other parts of the central nervous system and its paramount control of the hypophysis and the autonomic nervous system, is a suspected locus in quo. Several lines of evidence support involvement of this small brain structure in migraine. However, whether it plays a major or minor role is unclear. The most convincing support for a pivotal role so far is the activation of the hypothalamus shown by positron emission tomography (PET) scanning during spontaneous migraine attacks. A well-known theory is that the joint effect of several triggers may cause temporary hypothalamic dysfunction, resulting in a migraine attack. If PET scanning had consistently confirmed hypothalamic activation prior to migraine headache, this hypothesis would have been supported. However, such evidence has not been provided, and the role of the hypothalamus in migraine remains puzzling. This review summarizes and discusses some of the clues.
Subject(s)
Hypothalamus/physiopathology , Migraine Disorders/physiopathology , Models, Neurological , Nerve Net/physiopathology , HumansABSTRACT
The aim of the study was to study seasonal variation in migraine headache in a group of women with menstrually-related migraine (MRM) compared with non-menstrual migraine. Via newspaper advertisement, women with migraine living in North Norway were invited. The patients were included by questionnaire and telephone interview. We prospectively recorded migraine attacks from a 12-month headache diary performed by a group of 62 women with a mean age of 36.0 years (range 16-46 years), who fulfilled the criteria of migraine without aura. Of these, 29 had MRM and 33 non-menstrual migraine. Mean ratio between number of attacks in the light arctic season (May-June-July) divided with total number of migraine attacks during 12 months was 0.24 (9.4/38.4) in the group of MRM compared with 0.25 (5.6/22.1) in others (confidence interval -4.2, 6.3, P = 0.84). Nor were there more migraine attacks in the dark season in an arctic area (November-December-January) in any group. We found a higher migraine attack rate in those with MRM, but no indication of more or less frequency of attacks during the bright arctic season. These findings support the assumption that MRM and seasonal variation of migraine are due to different mechanisms.
Subject(s)
Menstruation , Migraine Disorders/epidemiology , Seasons , Adolescent , Adult , Confidence Intervals , Female , Humans , Interviews as Topic , Middle Aged , Migraine Disorders/etiology , Norway/epidemiology , Prevalence , Prospective Studies , Surveys and Questionnaires , Young AdultABSTRACT
Seasonal rhythm of migraine attacks may support a role of the suprachiasmatic nucleus of the hypothalamus in the pathophysiology of migraine. The objective of this study was to provide evidence for seasonal variation in migraine. Eighty-nine female migraineurs volunteered to record every migraine attack in detail for 12 consecutive months. Attacks associated with sleep complaints were defined as insomnia-related. By using Edwards' model for recognition and estimation of cyclic trends, time-series analysis was made. Fifty-eight patients, of which 26 had migraine without aura (MO) and 32 had migraine with aura (MA), completed the study. A total of 1840 attacks were recorded. The mean age +/- SD was 36.9 +/- 6.0. Patients with a lifetime history of MA showed marked seasonal fluctuation with more attacks in the light season compared to the dark. Time of peak was May 21. Peak/low ratio was 1.30 (95% CI: 1.08-1.55). When insomnia-related attacks (n = 312) were removed the seasonal variation became insignificant. There is a seasonal trend with more migraine attacks in the light season compared to the dark season in females with MA, but not MO, living in an arctic area. This is caused by the seasonal variation of insomnia-related attacks in patients with MA.
Subject(s)
Circadian Rhythm , Migraine Disorders/diagnosis , Migraine Disorders/epidemiology , Seasons , Adult , Female , Humans , Male , Middle Aged , Norway/epidemiology , Prospective StudiesSubject(s)
Cerebellar Diseases/etiology , Intracranial Hemorrhages/complications , Movement Disorders/physiopathology , Neural Pathways/physiopathology , Olivary Nucleus/physiopathology , Pons/physiopathology , Arm/physiopathology , Cerebellar Diseases/physiopathology , Functional Laterality/physiology , Humans , Hypertension/complications , Hypertrophy/etiology , Hypertrophy/pathology , Hypertrophy/physiopathology , Male , Middle Aged , Movement Disorders/pathology , Myoclonus/etiology , Myoclonus/physiopathology , Nerve Degeneration/etiology , Nerve Degeneration/pathology , Nerve Degeneration/physiopathology , Neural Pathways/pathology , Ocular Motility Disorders/etiology , Ocular Motility Disorders/physiopathology , Olivary Nucleus/pathology , Pons/pathology , Tremor/etiology , Tremor/physiopathologySubject(s)
Brain Stem Infarctions/physiopathology , Deglutition Disorders/physiopathology , Medulla Oblongata/physiopathology , Nystagmus, Pathologic/physiopathology , Paresthesia/physiopathology , Adult , Basilar Artery/pathology , Basilar Artery/physiopathology , Brain Stem Infarctions/pathology , Deglutition Disorders/etiology , Deglutition Disorders/pathology , Humans , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Male , Medulla Oblongata/blood supply , Medulla Oblongata/pathology , Neural Pathways/blood supply , Neural Pathways/pathology , Neural Pathways/physiopathology , Nystagmus, Pathologic/etiology , Nystagmus, Pathologic/pathology , Oculomotor Muscles/innervation , Oculomotor Muscles/physiopathology , Paresthesia/etiology , Paresthesia/pathology , Reticular Formation/blood supply , Reticular Formation/pathology , Reticular Formation/physiopathology , Vagus Nerve/blood supply , Vagus Nerve/pathology , Vagus Nerve/physiopathology , Vertigo/etiology , Vertigo/pathology , Vertigo/physiopathology , Vestibular Nuclei/blood supply , Vestibular Nuclei/pathology , Vestibular Nuclei/physiopathologyABSTRACT
It is a general belief that migraine attacks are prone to occur on days off. Only a few studies, however, have addressed this issue. The objective of this study was to investigate the periodicity of migraine with respect to weekly (circaseptan) variations. Eighty-nine females of fertile age who had participated in a previous questionnaire-based study volunteered to record in detail every migraine attack for 12 consecutive months. Eighty-four patients completed recordings for a mean of 311 days (s.d. = 95.9, range 30-365). A total of 2314 attacks were recorded. Migraine occurrence was almost equally distributed during the week, except on Sundays, when there were significantly fewer attacks (t = -4.42, d.f. = 83, P < 0.001). A Mantel-Haenszel estimate of the relative risk of having an attack on a holiday vs. another day, not Sundays included, was 0.64 (95% CI 0.49-0.85). Our study suggests that days off protect against migraine.
Subject(s)
Chronobiology Disorders/diagnosis , Chronobiology Disorders/epidemiology , Circadian Rhythm , Leisure Activities , Migraine Disorders/diagnosis , Migraine Disorders/epidemiology , Risk Assessment/methods , Adult , Female , Humans , Incidence , Norway/epidemiology , Risk Factors , Time FactorsABSTRACT
Our group has previously shown that migraineurs, as opposed to individuals with other headaches, are more likely to have headache during the bright arctic summer than during the polar night season. We set out to investigate the impact of seasonal light exposure in migraine with and without aura. We performed a questionnaire-based study of 169 female volunteer migraineurs in an arctic area where light conditions during summer and winter seasons are extreme. We included 98 patients with migraine with aura (MA) and 71 with migraine without aura (MoA). One hundred and seven patients (63%) reported seasonal variation in migraine attack frequency. Close to half (47%) of patients with aura, but only 17% of patients without aura, reported more frequent attacks during the light season (P < 0.001). Patients with MA reported interictal light hypersensitivity and light exposure as an attack precipitating factor significantly more often than individuals with MoA. They also reported significantly more frequent use of sunglasses to prevent attacks. We found no significant differences between MA and MoA as regards sleep disturbances, use of oral contraceptives, impact of headache or circadian variations. Seasonal periodicity of migraine in an arctic population with more frequent attacks during the light season is a convincing phenomenon in MA but not in MoA. The amount of light exposure seems to be pivotal to this variation.