Adverse Childhood Experiences and Primary Headache Disorders: A Systematic Review, Meta-analysis, and Application of a Biological Theory.

BACKGROUND AND OBJECTIVES: Headache disorders are among the leading causes of disability worldwide. While an association between adverse childhood experiences and primary headaches has been reported, the pooled magnitude across studies and pathways of the association are unknown. Our objectives were (1) to estimate the pooled effect of ≥1 adverse childhood experience (ACE) on primary headache disorders in adulthood and (2) to test the hypothesis that ACEs categorized as "threat" traumas or "deprivation" traumas have distinct effects on primary headaches based on a selected theory from our narrative review of how ACEs affect human development along the life course. METHODS: PubMed, EMBASE, MEDLINE, Web of Science, Google Scholar, Biological Psychiatry, and gray literature were searched up to March 16, 2023 (PROSPERO, CRD42020223403). Selected articles included (1) observational studies with a comparator group, (2) ACEs that occurred before 18 years of age, and (3) primary headaches occurring at or after 21 years of age. Pooled odds ratios (ORs) were calculated using multilevel linear random-effects modeling. The narrative review included theories that describe how ACEs affect human development and disease across the life course. We selected a theory from our narrative review and tested ACEs categorized according to this theory for any modification of point estimates. RESULTS: Our search identified 32 studies, of which 28 were eligible for meta-analysis (n = 154,739 participants, 19 countries). The occurrence of ≥1 adverse childhood experience(s) was associated with primary headaches (pooled OR = 1.48 [95% CI 1.36-1.61]; high-quality evidence, 134,696 participants). As the number of ACEs increased, the odds of primary headaches increased (range: 1 ACE OR = 1.24 [95% CI 1.14-1.35] to ≥4 ACEs OR = 2.09 [95% CI 1.83-2.38], p for trend <0.0001). From the narrative review, a neurodevelopmental theory that categorizes ACEs into threat or deprivation was tested, and both were independently associated with primary headaches (threat OR = 1.46 [95% CI 1.32-1.60] and deprivation OR = 1.35 [95% CI 1.23-1.49], respectively), accounting for heterogeneity (p = 0.021). DISCUSSION: This systematic review and meta-analysis confirm that ACEs are important risk factors of primary headache disorders in adulthood. Our findings provide epidemiologic support that ACEs categorized as threat and deprivation may manifest as distinct pathways of early adversity.

Patient Experiences With a Remote Monitoring Pathway for COVID-19.

INTRODUCTION: Due to the coronavirus disease 2019 (COVID-19) pandemic, a remote monitoring pathway was developed at Michael Garron Hospital to allow individuals with confirmed or presumed COVID-19 infection to successfully manage their illness at home. This study aims to understand patients' experiences on this remote monitoring pathway and to investigate the effectiveness of the pathway in preventing unnecessary emergency department (ED) visits and detecting severe infection. METHODS: A total of 35 semi-structured interviews were conducted over the phone. Researchers reviewed transcripts to come up with an index of nodes. Two researchers initially coded the same four transcripts to ensure high inter-rater reliability. The remaining 31 transcripts were coded by one researcher. RESULTS: Of patients, 80% (n = 28) had a positive experience on the pathway. Remote monitoring was effective in reassuring 22.9% of patients (n = 8) with mild-moderate symptoms that their symptoms were not significant enough to go to the ED and they were monitored at home. A total of 8.6% of patients (n = 3) were correctly identified as having severe symptoms while on the pathway and were asked to present to the hospital. For 8.6% of patients (n = 3), remote monitoring did not identify their severe COVID-19 illness. Of patients, 2.9% (n = 1) were incorrectly identified as having severe COVID-19 symptoms when they were clinically well. DISCUSSION: Remote monitoring is an effective tool to optimize healthcare resources during a pandemic. It reduces ER visits and provides a means for routine follow-up while minimizing virus exposure. Patients generally had a positive experience; however, more research needs to be done on optimizing the detection of severe infection.

Can Clinical Empathy Be Communicated by Text Message? A Case Report.

This case report examines a text message communication between a pediatric primary care provider and the mother of a medically complex child for indicators of clinical empathy. First, some clinical background information is provided; second, indicators of clinical empathy are evaluated using a validated instrument; and third, some benefits, limitations, and future directions informed by the case are discussed.