Transcript Headache - Know Pain Educational Program

TOOLS
Headache Diary
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Patients should record:
Date, time of onset and end
Preceding symptoms
Intensity on scale
Suspected triggers
ANY medication taken, including
over-the-counter medication – note
dosage taken, how many pills the
patient took that day
Relief (complete/partial/none)
Relationship to menstrual cycle
American Headache Society, 2004. Available at: http://www.americanheadachesociety.org/assets/1/7/Book_-_Brainstorm_Syllabus.pdf; National Institute for Health
and Care Excellence, 2012. Available at: http://www.nice.org.uk/CG150.
Tools to Assess Impact of Migraine
Test
MIDAS (Migraine
Disability Assessment)
Comments
• 5-item tool
• Scores number of days of inactivity due to migraine in
the past 3 months
Headache Impact Test™-6 • Covers 6 categories
(HIT-6)
• Useful in clinical practice and research
Headache Needs
Assessment (HANA)
• 7-item self-administered tool
• Can help identify which patients require treatment
Short Form 36® (SF-36®)
• 36 items covering physical and mental components of
health
• Generic measuring tool to identify quality of life issues
Stewart WF et al. Neurology. 2001;56(6 Suppl 1):S20-8; Kosinski M et al. Qual Life Res. 2003;12(8):963-74; Cramer JA et al. Headache. 2001;41(4):402-9; Ware, JE Jr.
Available at: http://www.sf-36.org/tools/SF36.shtml.
Tools to Assess Response
to Migraine Therapy
Test
Comments
Migraine Therapy Assessment
Questionnaire (MTAQ®)
• 9-item questionnaire
• Identifies individuals who may be receiving
suboptimal migraine treatment
Migraine-ACT (Assessment of
Current Therapy)
• 4-item questionnaire
• Identifies patients who require a change in
their current acute migraine therapy
Chatterton ML et al. Headache. 2002;42(10):1006-15; Dowson AJ et al. Curr Med Res Opin. 2004;20(7):1125-35; Kilminster SG et al. Headache. 2006;46(4):553-62.
ID-Chronic Migraine (ID-CM)
• New tool that can accurately identify patients with chronic migraine (CM)
• Can be used by physicians or patients
• Final 12-item tool asks
• How often pain is moderate or severe
• How often patient is unusually sensitive to light or sound
• How often patient feels nauseated
• How often patient worries about missing work, school, or social events
because of headaches
• Compared to gold standard (semi-structured clinical interview), screening tool had
• Sensitivity = 82%
• Specificity = 87%
• Negative predictive value = 77%
• Positive predictive value = 90%
Anderson, 2014. Available at: http://www.medscape.com/viewarticle/831261
ID Migraine™
• 3-item pencil and paper patient questionnaire
• Sensitivity = 0.81 (95% CI, 0.77-0.85)
• Specificity = 0.75 (95% CI, 0.64-0.84)
• Test reliability comparable to that of other disease screening tools
• The following do NOT influence the sensitivity and specificity of ID Migraine:
• Gender
• Age
• Presence of comorbid headaches
• Previous diagnostic status
Lipton RB et al. Neurology. 2003;61:375-82.
ID Migraine™
Lipton RB et al. Neurology. 2003;61:375-82.
PCN (Primary Care Network) Screener
Do you have headaches that
interfere with work, family, or
social function?
Is your pattern of headache
stable for at least 6 months
How frequently do you
experience headaches?
Yes
• Think migraine
• Plan therapy to match
Yes
• Think migraine
No
• Consider detailed workup
Frequent
How effective is your
treatment?
Winner P et al. Available at: http://www.medscape.org/viewarticle/552933
• Consider preventative therapy
• Consider medication overuse
• Consider secondary headache disorder
• Assess acute response, recurrence, coping strategies
• Assess medication overuse (>2 to 3 days/week)
Brief Headache Screen –
Frequency and Disability
How often do you…
1.
Get severe headaches that make it difficult to function?
2.
Get mild or less severe headaches?
3.
Take painkillers or headache relievers?
4.
Miss time from work or leisure activities because of headache?
Frequency Scale
Near daily
3-4 Days/week
2 Days/week to 2 days/month
≤1 Day/month
Almost never
Maizels M, Burchette R. Headache. 2003;43(5):441-50.
Brief Headache Screen – Treatment
• Are you satisfied with your current headache treatment?
• Are you taking daily prescription medications to prevent headaches?
• If not, would you like to?
Maizels M, Burchette R. Headache. 2003;43(5):441-50.
Migraine Impact Assessment Tools
• MIDAS (Migraine Disability Assessment)
• PedMIDAS (Pediatric Migraine Disability Assessment)
• Headache Impact Test™-6 (HIT-6)
• Headache Needs Assessment (HANA)
• Short Form 36 (SF-36®)
1. WHO 2012. Headache disorders. Available at: http://www.who.int/mediacentre/factsheets/fs277/en/
MIDAS (Migraine Disability Assessment)
• Developed to measure headache-related disability in three areas in the past 3
months
• Paid work and education
• Household work
• Family, social, and leisure activities
• Measures number of days missed in these activity due to migraine
• Score provides insight into the medical needs of patients and helps health care
provider determine appropriate treatment at first consultation
Stewart WF et al. Neurology. 2001;56(6 Suppl 1):S20-8.
MIDAS (Migraine Disability Assessment)
Score
Item
1. On how many days in the last 3 months did you miss work or school because of your headaches?
2. How many days in the last 3 months was your productivity at work/school reduced by half or more because
of your headaches? (Do not include days you counted in question 1 where you missed work/school.)
3. On how many days in the last 3 months did you not do household work (such as housework, home
repairs and maintenance, shopping, caring for children and relatives) because of your headaches?
4. How many days in the last 3 months was your productivity in household work reduced by half of more
because of your headaches? (Do not include days you counted in question 3 where you did not do
household work.)
5. On how many days in the last 3 months did you miss family, social or leisure activities because of your
headaches?
_____
Total (questions 1 to 5)
A. On how many days in the last 3 months did you have a headache? (If a headache lasted more than one
day, count each day.)
B. On a scale of 0 to 10, on average how painful were these headaches? 0 = no pain at all; 10 = pain as bad
as it could be)
A MIDAS score ≥6 indicates disability due to migraine
Stewart WF et al. Neurology. 2001;56(6 Suppl 1):S20-8.
MIDAS (Migraine Disability Assessment)
Scoring
MIDAS Grade
Definition
MIDAS Score
I
Little or no disability
0 to 5
II
Mild disability
6 to 10
III
Moderate disability
11 to 20
IV
Severe disability
Stewart WF et al. Neurology. 2001;56(6 Suppl 1):S20-8.
21+
HIT – Headache Impact Test
• Helps patients communicate the severity of their headache pain to their health care
provider
• Helps to
• Determine impact of headaches on patient’s life
• Better communicate the information to the health care provider
• Track the patient’s headache history and response to therapy over time
Headache Impact Test™-6 (HIT-6)
Score >60 indicates patient is severely
impacted or impaired by migraines
Kosinski M et al. Qual Life Res. 2003;12(8):963-74.
Headache Needs Assessment (HANA)
• Designed to assess frequency and impact of migraine headaches
• Brief, self-applied questionnaire
• Probes seven areas related to living with migraine
• Can be used as a screening tool to detect potential problems
• Primary care physicians could use the HANA to screen patients with migraine
for further evaluation
• Can help identify candidates for further evaluation and treatment
• Advantages
• Can select who should be treated
• Can increase productivity by ensuring patients who need treatment receive
treatment
• Can identify the need for aggressive treatment without the usual slow
advanced through stepped-care algorithms
Cramer JA et al. Headache. 2001;41(4):402-9.
Headache Needs Assessment (HANA)
Cramer JA et al. Headache. 2001;41(4):402-9.
Short Form 36 (SF-36®)
SF-36® scales measure physical and mental components of health
Ware, JE Jr. Available at: http://www.sf-36.org/tools/SF36.shtml.
Migraine Treatment Response
Assessment Tools
• Migraine Therapy Assessment Questionnaire (MTAQ®)
• Migraine-ACT (Assessment of Current Therapy) Questionnaire
1. WHO 2012. Headache disorders. Available at: http://www.who.int/mediacentre/factsheets/fs277/en/
Migraine Therapy Assessment
Questionnaire (MTAQ®)
• Identifies migraine sufferers whose migraine management may be suboptimal
• Brief survey to identify possible management issues
• 9 scaled questions focus on:
• Migraine control
• Migraine frequency
• Time missed from work or school
• Satisfaction with treatment
• Emergency department use
• Total score ranges from 0 to 8
Chatterton ML et al. Headache. 2002;42(10):1006-15.
Migraine Therapy Assessment
Questionnaire (MTAQ®)
Yes
No
Item
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Most times, I get relief from my migraine symptoms within 2 afters after I
take my migraine medicine.
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Most times, I can get back to what I was doing within 2 hours after I take
my migraine medication.
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Most months, I get 3 or more migraines.
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I take daily medicine to reduce how often I get migraines.
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I know what may bring on my migraines.
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Most times, I try not to use my migraine medicines right away.
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In the past month, I missed some school, work, or other activity because
of a migraine.
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In the past 6 months, I had to go to an emergency or urgent care centre for
a migraine.
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I am satisfied with my migraine treatment.
Chatterton ML et al. Headache. 2002;42(10):1006-15.
Migraine-ACT (Assessment of Current
Therapy) Questionnaire
• Brief questionnaire to identify patients who require a change in their current acute
migraine therapy
• 4-item questionnaire
• Items pertain to:
• Impact of migraine
• Global assessment of relief
• Consistency of response to medication(s)
• Emotional response
• Total score ranges from 0 to 4
• One or more “NO” responses may indicate that therapy needs to be changed
Dowson AJ et al. Curr Med Res Opin. 2004;20(7):1125-35; Kilminster SG et al. Headache. 2006;46(4):553-62.
Migraine-ACT (Assessment of Current
Therapy) Questionnaire
Yes No
Item
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When you take your treatment:
Does your migraine medication work consistently, in the majority of your attacks?
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When you take your treatment:
Does the headache pain disappear within two hours?
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When you take your treatment:
Are you able to function normally within two hours?
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When you take your treatment:
Are you comfortable enough with your medication to be able to plan your daily
activities?
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Scoring
• One or more “NO” answers may indicate the need to change treatment.
• An increasing number of “NO” answers indicates increasing treatment needs.
Dowson AJ et al. Curr Med Res Opin. 2004;20(7):1125-35; Kilminster SG et al. Headache. 2006;46(4):553-62.
Depression Scales
PHQ-9
Kroenke K et al. J Gen Intern Med. 2001;16(9):606-13.
Hospital Anxiety and Depression Scale
A = anxiety; D = depression
Zigmond AS, Snaith RP. Acta Psychiatr Scand. 1983;67:361-70.
Hamilton Depression Rating Scale (HAM-D)
Montgomery-Åsberg
Depression Rating Scale
Montgomery SA, Asberg M. Br J Psychiatry. 1979;134:382-9.
Beck Depression Inventory
Beck AT et al. Arch Gen Psychiatry. 1961;4:561-71.
Anxiety Scales
Beck Anxiety Inventory
Beck AT et al. J Consult Clin Psychol. 1988;56(6):893-7.
Hamilton Anxiety Rating Scale
(HAM-A)
Hamilton M. Br J Med Psychol. 1959;32:50-5.
Hospital Anxiety and Depression Scale Anxiety
Question
Frequency
Score
I feel tense or “wound up”
Most of the time
A lot of the time
Occasionally
Not at all
3
2
1
0
I get a sort of frightened feeling as if something awful is about to happen
Very definitely and quite badly
Yes, but not too badly
A little, but it doesn’t worry me
Not at all
3
2
1
0
Worrying thoughts go through my mind
A great deal of the time
A lot of the time
From time to time, but not often
Only occasionally
3
2
1
0
I can sit at ease and feel relaxed
Definitely
Usually
Not often
Not at all
0
1
2
3
I get a sort of frightened feeling like “butterflies” in the stomach
Not at all
Occasionally
Quite often
Very often
0
1
2
3
I feel restless as I have to be on the move
Very much indeed
Quite a lot
Not very much
Not at all
3
2
1
0
I get sudden feelings of panic
Very often indeed
Quite often
Not very often
Not often at all
3
2
1
0
Zigmond AS, Snaith RP. Acta Psychiatr Scand. 1983;67:361-70.
Quality of Life Scales
Migraine-Specific Quality of Life
Bagley CL et al. Headache. 2012;52(3):409-21.
Headache Disability Inventory
Holroyd KA. J Consult Clin Psychol. 2002;70:656-77.
Pain Disability Scale
Pain Disability Index
Tait RC, Chibnall JT, Krause S. The Pain Disability Index: psychometric properties. Pain. 1990;40:171-82.
Literature Cited
American Headache Society. (2004). Brainstorm. Retrieved June 18, 2015, from
http://www.americanheadachesociety.org/assets/1/7/Book_-_Brainstorm_Syllabus.pdf
Assessing the Assessment: Clinical Utility of Currently Available Migraine Assessment Tools. (n.d.).
Retrieved June 18, 2015, from http://www.medscape.org/viewarticle/552933
Bagley, C. L., Rendas-Baum, R., Maglinte, G. A., Yang, M., Varon, S. F., Lee, J., & Kosinski, M.
(2012). Validating Migraine-Specific Quality of Life Questionnaire v2.1 in episodic and chronic
migraine. Headache, 52(3), 409–421. http://doi.org/10.1111/j.1526-4610.2011.01997.x
Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical
anxiety: psychometric properties. Journal of Consulting and Clinical Psychology, 56(6), 893–897.
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for
measuring depression. Archives of General Psychiatry, 4, 561–571.
Chatterton, M. L., Lofland, J. H., Shechter, A., Curtice, W. S., Hu, X. H., Lenow, J., … Silberstein, S. D.
(2002). Reliability and validity of the migraine therapy assessment questionnaire. Headache,
42(10), 1006–1015.
Cramer, J. A., Silberstein, S. D., & Winner, P. (2001). Development and validation of the Headache
Needs Assessment (HANA) survey. Headache, 41(4), 402–409.
Literature Cited (Continued)
Dowson, A. J., Tepper, S. J., Baos, V., Baudet, F., D’Amico, D., & Kilminster, S. (2004). Identifying
patients who require a change in their current acute migraine treatment: the Migraine
Assessment of Current Therapy (Migraine-ACT) questionnaire. Current Medical Research and
Opinion, 20(7), 1125–1135. http://doi.org/10.1185/030079904125004079
Hamilton, M. (1959). The assessment of anxiety states by rating. The British Journal of Medical
Psychology, 32(1), 50–55.
Holroyd, K. A. (2002). Assessment and psychological management of recurrent headache
disorders. Journal of Consulting and Clinical Psychology, 70(3), 656–677.
Kilminster, S. G., Dowson, A. J., Tepper, S. J., Baos, V., Baudet, F., & D’Amico, D. (2006). Reliability,
validity, and clinical utility of the Migraine-ACT questionnaire. Headache, 46(4), 553–562.
http://doi.org/10.1111/j.1526-4610.2006.00403.x
Kosinski, M., Bayliss, M. S., Bjorner, J. B., Ware, J. E., Garber, W. H., Batenhorst, A., … Tepper, S.
(2003). A six-item short-form survey for measuring headache impact: the HIT-6. Quality of Life
Research: An International Journal of Quality of Life Aspects of Treatment, Care and
Rehabilitation, 12(8), 963–974.
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9. Journal of General Internal
Medicine, 16(9), 606–613. http://doi.org/10.1046/j.1525-1497.2001.016009606.x
Literature Cited (Continued 1)
Lipton, R. B., Dodick, D., Sadovsky, R., Kolodner, K., Endicott, J., Hettiarachchi, J., … ID Migraine
validation study. (2003). A self-administered screener for migraine in primary care: The ID
Migraine validation study. Neurology, 61(3), 375–382.
Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to
change. The British Journal of Psychiatry: The Journal of Mental Science, 134, 382–389.
New Screening Tool for Chronic Migraine. (n.d.). Retrieved June 18, 2015, from
http://www.medscape.com/viewarticle/831261
Stewart, W. F., Lipton, R. B., Dowson, A. J., & Sawyer, J. (2001). Development and testing of the
Migraine Disability Assessment (MIDAS) Questionnaire to assess headache-related disability.
Neurology, 56(6 Suppl 1), S20–28.
Tait, R. C., Chibnall, J. T., & Krause, S. (1990). The Pain Disability Index: psychometric properties.
Pain, 40(2), 171–182.
The SF Community - SF-36® Health Survey Update. (n.d.). Retrieved June 18, 2015, from
http://www.sf-36.org/tools/SF36.shtml
Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica
Scandinavica, 67(6), 361–370.