Affiliation:
1. Department of Clinical Statistics Curelator Inc. Cambridge Massachusetts USA
2. Department of Computer Science, Applied Mathematics and Statistics Universitat de Girona Girona Spain
3. Jefferson Headache Center Thomas Jefferson University Philadelphia Pennsylvania USA
4. Division of Neurology Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA
5. Department of Pediatrics University of Cincinnati College of Medicine Cincinnati Ohio USA
6. Section of Neurology Alberta Children's Hospital Calgary Alberta Canada
7. Department of Pediatrics, Cumming School of Medicine University of Calgary Calgary Alberta Canada
8. Department of Community Health Sciences, Cumming School of Medicine University of Calgary Calgary Alberta Canada
9. Department of Clinical Neurosciences, Cumming School of Medicine University of Calgary Calgary Alberta Canada
Abstract
AbstractObjectiveTo describe the association between day‐to‐day peak pain severity and clinical factors in individuals with chronic migraine (CM).BackgroundLittle is known about how clinical factors relate to day‐to‐day pain severity in individuals with CM.MethodsAdults with CM were enrolled into this observational prospective cohort study that collected daily data about headache, associated symptoms, and lifestyle factors using a digital health platform (N1‐Headache™) for 90 days. “Migraine days” were defined as days in which a headache occurred that had features described by the International Classification of Headache Disorders criteria. On these days, peak pain severity was recorded on a 4‐point scale; on non‐headache days peak pain severity was imputed as “0/none”. The associations between peak pain severity and 12 clinical factors were modeled and adjusted for sex, age, daily headache, presence of menstrual bleeding, day of the week, and disability. All numerical and Likert scale variables were standardized prior to analysis.ResultsData were available for 392 participants (35,280 tracked days). The sample was predominantly female (90.6%), with a mean (standard deviation) age of 39.9 (12.8) years. In the final multivariable model with random intercept and slopes, higher than typical self‐reported levels of standardized stress (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.04–1.11), standardized irritability (OR 1.05, 95% CI 1.02–1.08), standardized sadness (OR 1.05, 95% CI 1.02–1.07), fatigue (OR 1.25, 95% CI 1.15–1.36), eyestrain (OR 1.38, 95% CI 1.26–1.52), neck pain (OR 1.94, 95% CI 1.76–2.13), skin sensitivity (OR 1.61, 95% CI 1.44–1.80), and dehydration (OR 1.29, 95% CI 1.18–1.42) were associated with higher reported peak pain severity levels, while standardized sleep quality (OR 0.96, 95% CI 0.93–0.99) and standardized waking feeling refreshed (OR 0.84, 95% CI 0.81–0.88) were associated with lower reported peak pain severity levels. The inclusion of a random intercept and random slopes improved upon more parsimonious models and illustrated large differences in individuals’ reporting of peak severity according to the levels of the associated clinical factors.ConclusionOur data showed that the experience of CM, from a pain severity perspective, is complex, related to multiple clinical variables, and highly individualized. These results suggest that future work should aim to study a personalized approach to both medical and behavioral interventions for CM based on which clinical factors relate to the individual's experience of pain severity.