BACKGROUND:Most adults with migraine never consult their family doctor or receive a formal diagnosis. It is often these people that turn to the internet for healthcare information. Here we describe the development and testing of an on-line version of a previously validated telephone migraine classification interview. METHODS:We co-produced and tested the tool with people with migraine, clinicians, a web-design company and the National Migraine Centre, a UK based charity. We started with an online stakeholder meeting to understand what resources people wanted and any potential obstacles and facilitators to successful implementation. At a consensus meeting we used nominal group technique to gain consensus on the key questions to include. We used a 'Think Aloud technique' with people with migraine to explore the performance and acceptability of the questions in the new tool. To validate it, we asked people with headache disorders, including migraine, to complete the online tool before a doctor specialising in headache diagnosed their headache type. Level of agreement was measured between the outcome of the new migraine tool and the diagnosis by the doctor for 100 participants. RESULTS:At the consensus meeting it was agreed that the questions for the new tool should be clear and easy to understand and distinguish between migraine, tension type headache, other primary headache disorders and medication overuse headache. For our initial validation exercise the level of agreement between the migraine quiz and the doctor diagnosis for 100 participants was 78% agreement. We made some adjustments to the wording and logic of the tool and repeated the validation exercise with 130 participants; the level of agreement was 80%. CONCLUSIONS:Despite a careful development process our on-line tool did not perform to an adequate standard. There is a risk that misclassification could lead to people receiving inappropriate treatment. Any on-line classification tool for multiple headache disorders should be adequately validated before widespread use to avoid risk of iatrogenic harm. CLINICAL TRIAL NUMBER:Not applicable.
We report the initial results from an ongoing study of Daith ear piercing undertaken in collaboration with experienced piercers at a long-established national chain of piercing studios. Daith piercing passes through the cartilage of the crus helix, an area innervated by the auricular branch of the vagus nerve. Historically, Daith piercing was cosmetic, but has become increasingly popular after unexpected improvement in migraine was first noticed in 1992. Since then, many migraine sufferers have sought a Daith piercing from cosmetic piercing studios and their reports of improvements continue. Apart from isolated case histories there has been no medical investigation. Electrical stimulation of the vagus nerve is an established treatment for migraine and epilepsy that is recognised by NICE in the UK. We hypothesize that the piercing stimulates the vagus nerve by mechanical or inflammatory irritation.
European Journal of NeurologyVolume 30, Issue S1 p. 36-42 Special SessionsFree Access Special Sessions First published: 28 June 2023 https://doi.org/10.1111/ene.15947AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Volume30, IssueS1Special Issue: Abstracts of the 9th Congress of the European Academy of Neurology, Budapest, Hungary, 1‐4 July 2023June 2023Pages 36-42 RelatedInformation
Background: Aortic stenosis (AS) is associated with pathophysiological changes in both left ventricular and coronary microvascular structure and function. The treatment of AS with transcatheter aortic valve replacement (TAVR) has been associated with improvements in invasive indices of coronary microvascular function. This study sought to address whether systemic microvascular dysfunction was present in patients with AS and if microvascular function was altered by treatment of aortic stenosis with TAVR. The conjunctival microcirculation was used as the site for the non-invasive assessment of systemic microvascular function. Methods: Patients undergoing TAVR for the treatment of severe AS were compared to a cohort of age- and sex-matched controls without valvular heart disease. Conjunctival vascular imaging was performed in all subjects using a previously validated combination of a smartphone and slit-lamp biomicroscope. This technique allowed measurement of vessel diameter and other indices of microvascular function by tracking erythrocyte motion. Conjunctival hemodynamics were compared pre- and post-TAVR, in addition to between the severe AS and control cohorts. Results: A total of 165 patients were included (90 severe AS and 75 controls). Baseline characteristics were well matched between groups. In comparison to the control cohort, arteriole axial (Va) and cross-sectional velocity (Vcs) were significantly lower in females with AS (Va severe AS 0.53 ± 0.11mm/s vs control 0.59 ± 0.12mm/s, p=0.047; Vcs severe AS 0.38 ± 0.07mm/s vs control 0.41 ± 0.08mm/s, p=0.043), but not in males (Va severe AS 0.61 ± 0.11mm/s vs control 0.58 ± 0.10mm/s, p=0.19; Vcs severe AS 0.43 ± 0.08mm/s vs control 0.41 ± 0.07mm/s, p=0.20). Arteriole Va and Vcs significantly increased following TAVR in females (Va Pre-TAVR 0.52 ± 0.16mm/s vs post-TAVR 0.59 ± 0.15mm/s, p<0.001; Vcs Pre-TAVR 0.37 ± 0.11mm/s vs post-TAVR 0.42 ± 0.11mm/s, p<0.001). Conclusion: This study highlights sex-specific differences in conjunctival microvascular function in patients with severe AS. In this study TAVR resulted in significant improvements in conjunctival arteriolar V a and V cs . These findings are consistent with severe AS being a reversible cause of systemic microvascular dysfunction.
This article gives an overview of migraine in children. It outlines the epidemiology of the condition and describes presentation with headache and other symptoms and linked conditions. It aims to raise awareness of the diagnosis of migraine and its impact on children and young people, their families and school life. The author also describes methods of diagnosis and management, and the importance of recognising and of avoiding medication overuse.
