Biomedical subjects

Dawn A Marcus

Publications and source records attributed to Dawn A Marcus.

At least 19 recordsLinked to original sources

PubMed2006

A review of perinatal acute pain: treating perinatal pain to reduce adult chronic pain.

Changes in neural connections and activity after an acute insult are hypothesised to contribute to chronic pain syndromes in mature experimental animals and humans. Over the last decade, studies have suggested that exposure to repeated painful procedures during the early perinatal period results in profound changes in sensitivity of nociceptive pathways. Both animal and human studies show that early pain experiences increase pain responses beyond the period of infancy. These data suggest a need to increase implementation of guidelines for minimising pain exposures during infancy. In addition, an experimental perinatal pain model may provide a unique opportunity to study the effects on the nervous system of both painful insults and pre-emptive analgesia.

Animals↗

PubMed2006

The neuropsychology of recurrent headache.

Headache is recognized as one of the most prevalent neurological disorders, and is the most frequently reported symptom following injury to the head, brain, or neck. Although studies of central nervous system abnormalities in headache sufferers have emerged in recent years, less is known about the associated functional impairments. The research literature addressing neuropsychological consequences of headache has been far from conclusive. Migraine has been most extensively studied, with some consistent evidence of subtle but potentially significant changes in cognition occurring during and between migraine episodes. It also appears likely that migraine patients with aura experience more neuropsychological deficits than those without aura. While the literature devoted to understanding the neurocognitive profile of migraine sufferers is growing, much less research has addressed the neuropsychology of tension-type headache and posttraumatic headache (PTHA). There is some suggestion of poorer neuropsychological function in tension-type headache than controls, but the evidence is inconclusive. The PTHA population is highly varied in degree and location of trauma, preexisting headache condition, and other injury-related variables, allowing little generalization across studies. This paper summarizes research regarding the cognitive symptoms associated with migraine, tension-type headache, and PTHA, provides an overview of the cognitive side effects of headache medications, and addresses clinical implications and priorities for future research.

Comorbidity↗

PubMed2005

Prevention of motion sickness with rizatriptan: a double-blind, placebo-controlled pilot study.

BACKGROUND: Serotonergic triptan medications effectively reverse pain and associated symptoms of migraine. Vestibular symptoms, including dizziness and vertigo, occur in about one-third of migraineurs. The most frequent and consistent balance symptom in migraineurs is motion sickness, which is experienced by about half of migraineurs and may be related to serotonergic influences. This double-blind, placebo-controlled, crossover pilot study was designed to test the hypothesis that pre-treatment with the serotonin agonist rizatriptan would prevent motion sickness provocation in headache-free migraineurs. MATERIAL/METHODS: Ten healthy adult migraineurs (5 migrainous vertigo and 5 migraine without associated vestibular symptoms) with a history of motion sickness were tested in three sessions: a baseline vestibular battery and two motion sickness provocation sessions two hours following randomly ordered blinded pre-treatment with either oral rizatriptan 10 mg or placebo. Motion sickness was assessed using two standardized questionnaires. RESULTS: Motion sickness scores were lower following pre-treatment with rizatriptan compared with placebo in subjects with migrainous vertigo. Rizatriptan did not affect motion sickness in migraineurs without vertigo. Otolith-ocular reflex sensitivity was reduced following pretreatment with rizatriptan in both groups. CONCLUSIONS: This is the first study in humans testing a triptan serotonin agonist as a preventive tool for motion sickness. Rizatriptan prevented the development of motion sickness and severe motion sickness symptoms in patients with migrainous vertigo. These pilot data suggest a possible role for serotonin in the development of motion sickness symptoms in migraineurs with migrainous vertigo.

Adult↗

PubMed2005

Fibromyalgia and headache: an epidemiological study supporting migraine as part of the fibromyalgia syndrome.

Fibromyalgia is defined by widespread body pain, tenderness to palpation of tender point areas, and constitutional symptoms. The literature reports headache in about half of fibromyalgia patients. The current epidemiological study was designed to determine the prevalence and characteristics of headache in fibromyalgia patients. Treatment-seeking fibromyalgia patients were evaluated with measures for fibromyalgia, chronic headache, quality of life, and psychological distress. Multivariate analysis of variance (MANOVA) and t-tests were used to identify significant differences, as appropriate. A total of 100 fibromyalgia patients were screened (24 fibromyalgia without headache and 76 fibromyalgia with headache). International Headache Society diagnoses included: migraine alone (n = 15 with aura, n = 17 without aura), tension-type alone (n = 18), combined migraine and tension-type (n = 16), post-traumatic (n = 4), and probable analgesic overuse headache (n = 6). Fibromyalgia tender point scores and counts and most measures of pain severity, sleep disruption, or psychological distress were not significantly different between fibromyalgia patients with and without headache. As expected, the fibromyalgia patients with headache scored higher on the Headache Impact Test (HIT-6) (62.1 +/- 0.9 vs 48.3 +/- 1.6, p < 0.001). HIT-6 scores were >60 in 80% of fibromyalgia plus headache patients, representing severe impact from headache, and 56-58 in 4%, representing substantial impact. In summary, chronic headache was endorsed by 76% of treatment-seeking fibromyalgia patients, with 84% reporting substantial or severe impact from their headaches. Migraine was diagnosed in 63% of fibromyalgia plus headache patients, with probable analgesic overuse headache in only 8%. General measures of pain, pain-related disability, sleep quality, and psychological distress were similar in fibromyalgia patients with and without headache. Therefore, fibromyalgia patients with headache do not appear to represent a significantly different subgroup compared to fibromyalgia patients without headache. The high prevalence and significant impact associated with chronic headache in fibromyalgia patients, however, warrants inclusion of a headache assessment as part of the routine evaluation of fibromyalgia patients.

Comorbidity↗

PubMed2005

Practical approach to the management of chronic pain.

Chronic pain is a common and disabling complaint in most primary care practices. This article offers an explanation for the physiological basis of persistent chronic pain, provides practical guidelines to help distinguish among common pain syndromes, and recommends treatment strategies.

Age Factors↗

PubMed2005

Motion sickness in migraine sufferers.

Motion sickness commonly occurs after exposure to actual motion, such as car or amusement park rides, or virtual motion, such as panoramic movies. Motion sickness symptoms may be disabling, significantly limiting business, travel and leisure activities. Motion sickness occurs in approximately 50% of migraine sufferers. Understanding motion sickness in migraine patients may improve understanding of the physiology of both conditions. Recent literature suggests important relationships between the trigeminal system and vestibular nuclei that may have implications for both motion sickness and migraine. Studies demonstrating an important relationship between serotonin receptors and motion sickness susceptibility in both rodents and humans suggest possible new motion sickness prevention therapies.

Humans↗

PubMed2005

Neuropsychology of migraine: present status and future directions.

Migraine is recognized as a primarily neural condition. Changes in neural physiology have been consistently identified in migraineurs. Numerous studies are available that evaluate physical and functional differences between migraineurs and headache-free controls. The most prominent neuroimaging findings reported in migraine sufferers have been white matter changes. However, physical changes on neuroimaging have not been clearly correlated with functional impairment in migraineurs. The current literature addressing the neuropsychologic consequences of migraine has been far from conclusive, and reports of cognitive testing in adult migraineurs and controls has yielded inconsistent results. Neuropsychologic testing suggests that there may be some subtle but possibly significant changes in cognition that occur both during and between migraine episodes. A finding emerging with some consistency is that migraine patients with aura experience more neuropsychologic deficits than migraine patients without aura. The few studies that assess nonmigraine headache suggest that physical changes may not be unique to migraine, although neuropsychologic changes do appear to be limited to migraineurs. An examination of the unmet needs and priorities for future research addressing this important topic is provided.

Cognition Disorders↗

PubMed2004

Diagnosis of migrainous vertigo: validity of a structured interview.

BACKGROUND: Migraine and vestibular symptoms are co-morbid. Migraine is increasingly recognized as a cause of benign, recurrent vertigo. Although the International Headache Society does not currently include the diagnosis of migrainous vertigo, specific criteria have been proposed and utilized in clinical trials. MATERIAL/METHODS: Seventeen adult migraineurs were separately screened for the diagnosis of migrainous vertigo using a standardized structured interview for migrainous vertigo (SIM-V) and a clinical evaluation by an experienced neurotologist. The SIM-V was administered by a nurse who read and recorded subject responses, obtaining no additional information for the diagnosis of migrainous vertigo. Comparison of diagnoses between clinician and SIM-V was made using Cohen's kappa reliability testing. Subjects were asked to return for a second interview by the same nurse using the SIM-V, at least 2 weeks after the initial assessment. Testing stability was evaluated by comparing diagnoses obtained with each SIM-V administration. RESULTS: Cohen's kappa demonstrated excellent test validity (kappa=0.75). Fourteen subjects returned for repeat testing, with excellent retest stability (kappa=0.85). The additional three subjects could not be relocated or were not interested in attending a retest appointment. CONCLUSIONS: The SIM-V is an easy-to-administer screening tool for the diagnosis of migrainous vertigo. Diagnostic comparison to a standard clinical assessment shows good test validity. Retest stability was also demonstrated. The SIM-V may be a useful screening tool for migraineurs with an additional complaint of dizziness.

Adult↗

PubMed2004

Estrogen and chronic daily headache.

Estrogen exerts a strong influence on episodic headaches, such as migraine and tension-type headache. A relationship between sex hormones and chronic daily headache (CDH) is less well established. However, similarities between episodic and CDH suggest that estrogen also may significantly influence CDH. Pathophysiologic studies of CDH identify neurochemical abnormalities similar to those influenced by estrogen in episodic headache, such as aberrant 5-hydroxytryptamine activity. In addition, gender differences in CDH prevalence in pediatric and adult populations support a hormonal influence. Few studies have evaluated the ability of gynecologic events, such as menses, to influence CDH.

Adolescent↗

PubMed2004

Validation of a brief nurse-administered migraine assessment tool.

OBJECTIVE: To validate a brief tool for screening migraine. BACKGROUND: Migraine is a common, but underdiagnosed condition. Effective utilization of nonphysician personnel to reliably screen patients for migraine may improve identification of migraineurs for clinical treatment and research. METHODS: An 8-question Migraine Assessment Tool (based on International Headache Society criteria) was designed for administration by a nurse with no specialized headache training as a pre-assessment for the diagnosis of migraine for use in either a research or clinical environment. A community sample of 80 adults (71 women, 9 men; mean age, 33.7 years; 80% white, 14% African American, 2.5% Asian American) with self-reported headache was recruited through advertisements. A headache specialist independently diagnosed subjects using clinical assessment, and a nurse who works in a balance disorder clinic used the Migraine Assessment Tool. Agreement between physician and nurse-administered Migraine Assessment Tool diagnoses was determined. Each subject returned in 2 to 4 weeks for a second assessment, administered by the same nurse. Agreement between the 2 diagnoses from the Migraine Assessment Tool was calculated. RESULTS: Comparison between diagnosis by the physician versus the Migraine Assessment Tool revealed a positive predictive value of 0.85; negative predictive value, 0.84; sensitivity, 0.89; specificity, 0.79; and observed agreement, 0.85. Cohen's kappa reliability measure was 0.69, indicating good test reliability. Interestingly, in 8 of the 12 cases of disagreement, the examiner diagnosing nonmigraine diagnosed analgesic overuse headache. Comparing diagnoses assigned by the 2 separate administrations of the Migraine Assessment Tool revealed a Cohen's kappa of 0.69. Notably, 9 of the 12 cases of nonagreement on the 2 assessments were due to subjects endorsing analgesic overuse in only 1 of the 2 testing sessions. CONCLUSIONS: This study showed good reliability and stability of a new, brief, nurse-administered migraine questionnaire. In addition, the study also showed that consistency in self-reporting analgesic overuse within individuals with headache is poor. This suggests the need for repeat questioning about analgesic overuse on subsequent appointments to ensure absence of analgesic overuse headache.

Adult↗

PubMed2003

Headache in pregnancy.

Headache is a frequent symptom in women of childbearing age and during pregnancy. Benign and pathologic headaches may change in response to changes in estrogen after conception. Expected patterns of change are described for headaches that occur commonly during pregnancy. In addition, although treatment options are limited during pregnancy, a variety of effective medication and nonmedication treatments are available and should be offered to women with benign headaches that persist into the second trimester of pregnancy.

Estrogens↗

PubMed2003

Headache and other types of chronic pain.

OBJECTIVE: To compare pain severity, disability, psychological distress, and quality of life between patients with headache and nonheadache treatment-seeking chronic pain patients. METHODS: Six hundred forty-three patients seeking treatment at a university pain clinic were divided into 3 categories based on primary pain complaint and the presence of focal or diffuse pain complaints: headache, nonheadache focal (pain involving <50% of the body), and nonheadache diffuse (pain involving >/=50% of the body). Patients completed questionnaires to identify pain severity, disability, depression, anxiety, and quality of life. RESULTS: Patients with headache differed from nonheadache patients for all evaluated parameters. Average pain severity on a 0 to 10 point severity scale was 5.55 for headache, 6.93 for nonheadache focal, and 8.05 for nonheadache diffuse. Pain occurred an additional 1.51 to 1.71 days per week for patients without headache. Compared to patients with headache, patients without headache reported greater frequency of reduced daily activities and complete disability related to pain. In addition, patients without headache and with diffuse pain reported more depression (78.2% vs. 45.8%) and anxiety (70.0% vs. 39.1%) than patients with headache. Quality of life measures were significantly reduced in patients with either nonheadache focal or diffuse conditions compared to patients with headache. CONCLUSIONS: Even when considering patients with focal rather than diffuse chronic pain complaints, patients with headache are dissimilar from other patients with chronic pain. Pain severity, frequency, disability, psychological distress, and quality of life are significantly more prominent or impaired in patients with chronic pain without headache compared to patients with headache.

Adult↗

PubMed2003

Disability and chronic posttraumatic headache.

OBJECTIVE: To test the hypothesis that chronic posttraumatic headache is associated with greater severity and psychological distress than headache of nontraumatic origin. METHODS: Two hundred eighty-nine consecutive patients with chronic headache attending a university headache clinic were evaluated. Questionnaires about headache symptoms, quality of life (Medical Outcome Survey SF-36 Health Survey), and psychological distress were completed. RESULTS: Frequent headache (>4 days per week) occurred more often with traumatic (84%) than nontraumatic headache (60%). Traumatic headache resulted in greater reduced activity (3.31 +/- 1.06 days per week versus 2.62 +/- 1.11 days per week with nontraumatic headache; P<.001) and complete disability (2.89 +/- 1.17 days per week versus 2.25 +/- 1.17 days per week with nontraumatic headache; P<.001). Physical function was also rated significantly lower in patients with traumatic headache (SF-36 score: 59.8 +/- 27.7 versus 71.6 +/- 26.4 with nontraumatic headache; P<.01). These differences were not attributable to differences in headache frequency or gender between patients with traumatic and nontraumatic headache. Psychological symptoms were similar between patients with traumatic and nontraumatic chronic headache. CONCLUSIONS: Chronic traumatic headache is associated with increased headache frequency and disability compared with nontraumatic headache. Headache evaluation should include an investigation for origin of headache and consideration for more aggressive treatment in patients with traumatic headache.

Adult↗

PubMed2003

Migrainous vertigo: development of a pathogenetic model and structured diagnostic interview.

PURPOSE OF REVIEW: Vestibular symptoms occur frequently in patients with migraine. This review refines recently proposed diagnostic criteria for migraine-related vestibular symptoms, and develops a pathophysiological model for the interface between migraine and the vestibular system. RECENT FINDINGS: The epidemiological link between migraine and vestibular symptoms and signs suggests shared pathogenetic mechanisms. Links between the vestibular nuclei, the trigeminal system, and thalamocortical processing centers provide the basis for the development of a pathophysiological model of migraine-related vertigo. During the last year, several studies have increased understanding of the relationship between migraine and vestibular symptoms. A study of motion sickness and allodynia in migraine patients supports the importance of central mechanisms of sensitization for migraine-related vestibular symptoms. A study has demonstrated effective treatment of vertigo with migraine therapy. The identification of migrainous vertigo, however, is hampered by a lack of standardized assessment criteria for both clinical and research practices. The application of published criteria for the diagnosis of migrainous vertigo allows the development of a standardized, structured assessment interview. SUMMARY: An understanding of the relationship between migraine and the vestibular system increases knowledge of the pathogenesis of both migraine and vertigo. In addition, studies have identified successful treatment, with standard migraine therapies, of vestibular symptoms in patients with both migraine and vertigo. The use of a standardized assessment tool to identify this unique population of patients will help future studies to test both the pathological model and effective treatment options.

Cerebral Cortex↗

PubMed2003

Current trends in fibromyalgia research.

The development of standardised criteria for the diagnosis of fibromyalgia in 1990 has allowed careful study of this chronically painful syndrome. Epidemiological studies show increased symptoms and disability in patients with fibromyalgia, compared with other conditions associated with chronic, widespread pain. In addition, prevalence and severity of fibromyalgia symptoms are increased in women. Current studies have identified strong evidence for central sensitisation in fibromyalgia. Data from these studies may expand effective treatment options for fibromyalgia.

Antidepressive Agents↗

PubMed2003

Central nervous system abnormalities in migraine.

Migraine is associated with structural and functional CNS changes, for example, ictal hyperalgesia and allodynia and interictal neural excitation. Structural abnormalities, most notably white matter changes, occur in greater prevalence in migraineurs (16 - 40%). Several studies have examined the neuropsychological correlates of migraine and/or white matter abnormalities. These studies suggest mild, interictal dysfunction in migraineurs. More research is needed to correlate migraine severity, frequency and/or treatment with neuropsychological testing. Additional studies should: identify interictal cognitive changes; clarify the contribution to long-term cognitive changes from migraine genotype, sequelae of repeated pain episodes or their treatment and the consequences of co-morbid vascular disease; and include cognitive measures as secondary end points in clinical trials.

Alzheimer Disease↗

PubMed2003

45(th) Annual Scientific Meeting of the American Headache Society June 19 -22, 2003, Chicago, IL, USA.

The 45(th) Annual Scientific Meeting of the American Headache Society focused on new areas of headache research: revised diagnostic criteria, increased the understanding of the pathogenesis of migraine and expansion of identified physiological changes in migraine beyond head pain to include cognitive, sleep and vestibular disturbances. A preview of the new International Headache Society criteria described changes in diagnostic categories, including special criteria for research. New definitions to categorise chronic daily headache, menstrual migraine and secondary headaches were the main highlights of the modified criteria. In addition, novel data on activation within trigeminovascular pathways expand the understanding of the pathogenesis of migraine. Identification of the ability of treatment to impact activation and sensitisation of peripheral and central neurons results in: an explanation for initial headache worsening and neck/chest tightness that commonly occur with triptans, a better understanding of the mechanisms of triptans, and a strong recommendation for early triptan intervention (within 20 min of headache onset). Application of matrix metalloproteinase models to migraine helps explain the ability of medications to cross the blood-brain barrier during a migraine episode, as well as describe possible ischaemia with repeated migraine (e.g., white matter abnormalities seen on magnetic resonance scanning). Improved classification of headache disorders, along with increased understanding of the physiology of migraine and mechanism of action of common treatments, should enhance future development and evaluation of effective headache therapy.

Humans↗

PubMed2003

Tips for managing chronic pain. Implementing the latest guidelines.

Recently revised guidelines from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) call for an increased awareness of the impact of chronic pain and recommend that physicians assess and treat pain complaints seriously. Although significant and persistent chronic pain is a common reason for primary care visits, the incidence of psychologic distress and personality disorder in patients with chronic pain often makes this population a difficult one for physicians and staff to treat. This discussion offers practical tips for managing patients with chronic pain and reducing staff burnout. The author also dispels various myths about chronic pain and focuses on the effective management of its comorbidities.

Clinical Competence↗