Browsing by Author "Amoozegar, Farnaz"

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    Global assessment of migraine severity measure: preliminary evidence of construct validity
    (2019-04-04) Sajobi, Tolulope T; Amoozegar, Farnaz; Wang, Meng; Wiebe, Natalie; Fiest, Kirsten M; Patten, Scott B; Jette, Nathalie
    Abstract Background In persons with migraine, severity of migraine is an important determinant of several health outcomes (e.g., patient quality of life and health care resource utilization). This study investigated how migraine patients rate the severity of their disease and how these ratings correlate with their socio-demographic, clinical, and psycho-social characteristics. Methods This is a cohort of 263 adult migraine patients consecutively enrolled in the Neurological Disease and Depression Study (NEEDs). We obtained a broad range of clinical and patient-reported measures (e.g., patients’ ratings of migraine severity using the Global Assessment of Migraine Severity (GAMS), and migraine-related disability, as measured by the Migraine Disability Scale (MIDAS)). Depression was measured using the 9-item Patient Health Questionnaire (PHQ-9) and the 14-item Hospital Anxiety and Depression Scale (HADS). Median regression analysis was used to examine the predictors of patient ratings of migraine severity. Results The mean age for the patients was 42.5 years (SD = 13.2). While 209 (79.4%) patients were females, 177 (67.4%) participants reported “moderately severe” to “extremely severe” migraine on the GAMS, and 100 (31.6%) patients had chronic migraine. Patients’ report of severity on the GAMS was strongly correlated with patients’ ratings of MIDAS global severity question, overall MIDAS score, migraine type, PHQ-9 score, and frequency of migraine attacks. Mediation analyses revealed that MIDAS mediated the effect of depression on patient ratings of migraine severity, accounting for about 32% of the total effect of depression. Overall, migraine subtype, frequency of migraine, employment status, depression, and migraine-related disability were statistically significant predictors of patient-ratings of migraine severity. Conclusions This study highlights the impact of clinical and psychosocial determinants of patient-ratings of migraine severity. GAMS is a brief and valid tool that can be used to assess migraine severity in busy clinical settings.
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    Resting-State Functional Connectivity Differences in Pediatric Migraine
    (2019-11-17) Khaira, Akashroop; Bell, Tiffany; Noel, Melanie; Amoozegar, Farnaz; Harris, Ashley D.
    Pediatric migraines are highly prevalent but not well-understood. Neuroimaging can provide great insight to brain physiology, but few studies have applied imaging to study pediatric migraines. Previous adult literature has shown differences in resting-state functional connectivity (rsFC) in migraine patients compared to controls; however, adult migraine findings may not be directly transferable to children. This study’s aim was to investigate rsFC differences between children with migraine and controls to better understand pediatric migraines. Resting-state functional magnetic resonance imaging (rsfMRI) data from 26 participants (10 controls and 16 migraines), between the ages of 7-16 years. Data was preprocessed and analyzed using FSL. An independent component analysis constrained to 30 components was used to identify resting-state networks across all subjects. Group average spatial maps were regressed into each subject’s dataset for a time course, which was then regressed into the subject-specific spatial maps. Permutation testing compared rsFC differences in the groups while controlling for age. Initial analysis indicated significant rsFC differences (p < 0.05) in two networks. In the frontoparietal network, there is decreased rsFC in the right motor cortex in the migraine group compared to controls. In the hippocampal/amygdala network, there is decreased rsFC in migraine patients in the right amygdala and right hippocampus. The frontoparietal and hippocampal/amygdala networks are relevant to migraine with roles in pain perception and processing, learning, emotion, and memory. Detecting differences in these networks in children with migraine compared to controls shows that even between migraines, there is intrinsically altered rsFC in pediatric migraine patients.
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    The Prevalence of Depression and the Accuracy of Depression Screening Tools in Migraine Patients
    (2014-04-23) Amoozegar, Farnaz; Jetté, Nathalie; Patten, Scott
    Migraine and major depressive disorders are common comorbid conditions. The purpose of this cross-sectional study was to assess how well the Patient Health Questionnaire (9 items) and the Hospital Anxiety and Depression Scale perform as depression screening tools in migraine patients attending a headache clinic, determine the prevalence of depression in this patient population using a gold standard semi-structured psychiatric interview, and examine disability and quality of life for these patients. The Patient Health Questionnaire (cut-point 14) and the Hospital Anxiety and Depression Scale (cut-point 11) produced an optimal balance of psychometric properties for the studied migraine population. The point prevalence of depression was 25.0% (95% CI 19.0-31.0), and the prevalence of untreated depression was 17.0% (95% CI 10.8 – 23.2). Patients with both migraine and depression had significantly higher degrees of disability and a poorer quality of life as compared to patients without depression.
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    Treatment of Persistent Headache Attributed to Mild Traumatic Injury to the Head in Patients with Persistent Post Concussion Symptoms using Repetitive Transcranial Magnetic Stimulation
    (2019-05-07) Stilling, Joan M.; Monchi, Oury; Debert, Chantel T.; Amoozegar, Farnaz; Dukelow, Sean P.
    Persistent post-traumatic headache (PTH) following a mild traumatic brain injury (mTBI) is one of the most prominent and highly-reported persistent post-concussion symptoms (PPCS). Non-pharmacologic treatment alternatives, including non-invasive neurostimulation technologies, have been proposed for use. After a systematic review investigating transcranial magnetic and direct current stimulation (TMS/tDCS) for management of headache, we designed a double-blind, sham-controlled, randomized trial investigating repetitive TMS (rTMS) for treatment of persistent PTH in patients with PPCS. Our primary outcome was a change in headache frequency and severity at one-month post-treatment. Twenty participants underwent rTMS therapy to the left dorsolateral prefrontal cortex (DLPFC). Headache diaries and clinical questionnaires assessing function, cognition, and mood were completed. Headache severity demonstrated a significant time effect, while headache frequency demonstrated a reduction across all time points for both the real and sham groups, based on descriptive analysis. Secondary outcomes demonstrated improvements in function, reduced PPCS, and depression in the real-treatment group, with no serious adverse effects. A phase II study is warranted.