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Detecting elusive warning signs of the migraine attack -an Ecological Momentary Assessment study-

dit project werd mogelijk gemaakt met steun van dossier nr. 11000.0009 dossier nr. 1871. Detecting elusive warning signs of the migraine attack -an Ecological Momentary Assessment study-. Jan Houtveen / Marjolijn Sorbi 2 nd symposium NSRII eHBM oct 11 2012. Utrecht University

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Detecting elusive warning signs of the migraine attack -an Ecological Momentary Assessment study-

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  1. dit project werd mogelijk gemaakt met steun van dossier nr. 11000.0009 dossier nr. 1871 Detecting elusive warning signs of the migraine attack -an Ecological Momentary Assessment study- Jan Houtveen / Marjolijn Sorbi 2nd symposium NSRII eHBM oct 11 2012 Utrecht University Faculty of Social and Behavioural Sciences Clinical and Health Psychology The Netherlands E-mail: j.h.houtveen@uu.nl

  2. Migraine is a chronic brain disorder with attacks of invalidating headache

  3. 3 days 1 day prodromal recovery (aura) attack Prodromal symptoms may precede attacks up to three days in advance Detection of elusive prodromal symptoms (warning signs) is highly relevant for attack prevention through behavioural self-management. However: -retrospection bias (real time assessment needed) -Individual variability is high (subject-specific baselines needed) -multilevel statistical analysis needed Ecological Momentary Assessment (EMA)

  4. These data permit an analysis of prodromal symptoms (warning signs) relative to the ‘normal’ functioning per patient Data set available: In a large project migraine patients filled in EMA diaries and received feedback on the spot to support their self-management in daily life Sorbi et al., 2007; Kleiboer et al., 2009

  5. Aim To apply EMA techniquesto detect prodromal symptoms relative to ‘normal’ functioning To identify elusive warning signs of the migraine attack … in real time

  6. Subjects 93 migraine patients participated of which 87 patients experienced attacks (during 3-6 weeks)

  7. Methods Online Ecological Momentary Assessment (EMA) using smartphones EMA diaries 4 times daily during 3-6 weeks: Random beep in morning and afternoon: migraine items prodromal features Getting up x - Morning x x Afternoon x x Going to sleep x -

  8. Based on factor analysis 8 oblique momentary state factors were created: Positive affect I feel contented, I feel cheerful, I feel strong, I feel relaxed, I feel well, I feel inspired, I am doing pleasant work Negative affect I feel Tense, I am depressed, I am angry, I am sad, I am lonely, I feel irritable, I am worried Sensoric sensitivity I experience blurred vision, I experience difficulty reading, I experience noise sensitivity, I experience smell sensitivity, I experience dizziness, I experience sensitive skin Cognitive functioning I feel concentrated, I am alert, I am clear-headed, I have everything in order, I feel competent, I worked efficiently Pain in neck/shoulder/head I have a stiff neck, I feel neck pain, I have sore shoulders, I feel pain in forehead/back of head Stressors something unpleasant happened, I had a conflict, things went not my way, I had a problem I couldn’t solve Fatigue I have strained eyes, I feel listless, I feel tired, I feel weary, I feel rickety, I feel exhausted, I feel sleepy Effort spent I was busy, I worked not at easy, I thought hard, I worked hard, I exerted myself, much was expected

  9. Data analysis Multi-level dataset : Subject and time (residual) level Unbalanced data and many missings/unusable data Linear mixed model analysis (SPSS v 20): Fixed factors (across subjects) Random residuals (time) To estimate overall fixed effects and individual slopes

  10. Number of valid EMA-diaries Database: compliance 89.4% 7941 valid EMA diaries (mean = 91 per subject) Equally distributed over the days of the week migraine prodromal features 2102 getting up x - 1893 morning x x 2065 afternoon x x 2065 going to sleep x - N=87 (74 female, 13 male)

  11. Number of valid migraine attacks 252 valid migraine attacks were observed, mean = 2.9 [1-9] per subject 68 while getting up 65 morning 41 afternoon 78 while going to sleep Attacks were not equally distributed over time of day p<.01 N=87 (74 female, 13 male)

  12. Attacks not equally distributedover the weekp<.001

  13. Number of prodromal and control diaries Prodromal warning signs : 72 hours before an attack 2002 valid prodromal diaries were available, mean = 23 per subject (time-stamped) 4484 valid control diaries were available, mean = 52 per subject Control diaries are labeled: -morning / afternoon, -weekend (sa su) / week (mo – fri)

  14. Individual-specific delta scores delta=0 migraine -72 hour control diaries were matched for period (mean morning or afternoon diary) and mean weekend-week. Delta = prodromal diary – matched control

  15. 12 hour pre-attack time windows Data were aggregated to obtain 12-hour mean-aggregated delta values: Independent variable: pre-attack time (6 intervals of 12 hours) -72 hour migraine 383 matched 12-hour mean-aggregated pre-attack diaries; 87 subjects: mean = 4.4 per subject [2-6] Time of the day and day of the week (linear and squared) and mean baseline levels (between attacks) are covariates

  16. And now… fixed factor RESULTS (based on SPSS linear mixed model analysis )

  17. Sensoric sensitivity Fixed difference 6 windows: F(5,333.9)=4.01, p<.01

  18. Neck/shoulder/headache Fixed difference 6 windows: F(5,314.8)=6.88, p<.001

  19. Fatigue Fixed difference 6 windows: F(5,316.7)=3.37, p<.01

  20. Cognitive functioning Fixed difference 6 windows: F(5,319.6)=2.60, p<.05

  21. Positive affect Fixed difference 6 windows: F(5,324.5)=3.65, p<.01

  22. Negative affect Fixed difference 6 windows: F(5,336.0)=1.49, p=.19

  23. Effort Fixed difference 6 windows: F(5,321.1)=1.35, p=.24

  24. Stressors Fixed difference 6 windows: F(5,336.5)=1.57, p=.17

  25. Menses N=43 intercept: F(1,87.5)=5.48, p<.05

  26. What about individual differences: random slopes

  27. N.B.: Four different time contrasts were explored: linear, 000001, 000011, and 000111. Results of the contrast with the best significant fit (largest explained % variance on the time level) were reported. ICC=intra class correlation; ns=not significant; * p<.05; ** p<.01; *** p<.001; # p=.06.

  28. Conclusions 1) Elusive warning signs of the migraine attack can be detected using online EMA Fixed: sensoric sensitivity fatigue neck/head/shoulder pain affect cognitive functioning Towards customer-tailored identification of warning signs for behavioral attack prevention 2) Fixed factors (across subjects) explain little variance (< 10%) 3) Random factors indicate that we have to look at the individual case (random slopes) Random: sensoric sensitivity fatigue neck/head/shoulder pain negative affect effort?

  29. Thank you for your attention Utrecht University Faculty of Social and Behavioural Sciences Clinical and Health Psychology The Netherlands E-mail: j.h.houtveen@uu.nl

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