Syftet med denna studie var att undersöka hur stor effekt kombinationsbehandling med naproxen och sumatriptan har vid migrän hos vuxna människor jämfört med monoterapi med naproxen eller sumatriptan samt placebo. Studien utformades som en litteraturstudie och sökningar skedde i PubMed via Linnéuniversitetets bibliotek med sökorden ”migraine AND triptan* AND NSAID AND efficacy”, ”migraine AND sumatriptan AND naproxen AND combination AND efficacy” samt ”naproxen AND sumatriptan”. Sökningarna ledde till granskning av 6 studier.     Sammanfattningsvis hade kombinationsbehandlingen statistiskt signifikanta fördelar gällande flera effektmått vid behandling av migrän, bland annat smärtfrihet 2 timmar efter behandling och ihållande smärtfrihet upp till 24 timmar efter behandling, jämfört med såväl monoterapierna som placebo, medan biverkningsrisken inte ökade statistiskt signifikant med kombinationsterapin. Tidigt insättande av behandling, när migränen fortfarande är mild, gav bäst resultat, och effekten kvarstod under flera behandlingstillfällen. Patienter, som behandlades med kombinationsterapin, kunde statistiskt signifikant snabbare återgå till normal funktion i vardagsliv och på arbete, med minskat produktionsbortfall som följd, och de var också nöjdare med kombinationsbehandlingen än med monoterapierna och placebo. Trots dessa resultat blir långt ifrån alla bra. Knappt varannan patient, som behandlas med sumatriptan och naproxen vid mild migrän, är smärtfria efter 2 timmar. Vid måttlig till svår migrän är det ungefär 1 av 3 som är smärtfria 2 timmar efter kombinationsbehandling. Effektivare läkemedel mot migrän är önskvärt. / The purpose of this study was to analyse the efficacy of the combination of naproxen and sumatriptan when used for migraine in adults, and compare with monotherapy with naproxen or sumatriptan and placebo. The study was a literature study and searches were carried out in PubMed via the Linnaeus University library with the keywords ”migraine AND triptan* AND NSAID AND efficacy”, ”migraine AND sumatriptan AND naproxen AND combination AND efficacy” and also ”naproxen AND sumatriptan”. The searches resulted in 6 studies that were reviewed.     In summary, the combination therapy resulted in statistically significant improvements for multiple endpoints in the treatment of migraine, including patients being free of pain 2 hours after treatment and sustained pain-free response up to 24 hours after treatment, compared with both monotherapies and placebo, while the potential for adverse events did not increase statistically significantly with the combination therapy. Early intervention, when migraine was still mild, gave best results, and the effect persisted for several treatment sessions. Patients treated with combination therapy returned statistically significantly faster to normal function in everyday life and at work, with reduced downtime, and they were also more satisfied with the combination therapy than with mono therapy or placebo. Despite this, far from everybody gets well with treatment. Hardly every second patient treated for mild migraine with sumatriptan and naproxen is free from pain after 2 hours and when treating more severe forms of migraine only about 1 in 3 is free from pain after 2 hours. More effective treatments of migraine are needed.

M.A. / In all communities studied, most people suffer from headaches sometime in their life (Blau, 1991; Selby, 1983). A small portion of this group suffer from both migraine and tension-type headache on a regular basis. Currently the main treatment modality for headache is pharmacological in nature. This type of treatment is limited in as far as it does not address the concomitant psychological variables that often accompany chronic headaches. Furthermore, it seems that most psychophysiological therapies were developed in the USA and Canada over the last 30 years, but thus far research has not been done within the South African context. The aim of this study was to determine the effectiveness of an individualized psychophysiological treatment program for individuals suffering from migraine and tension-type headache. A change in headache activity and mood states such as anxiety and depression was envisaged. Seven subjects suffering from both migraine and tension-type headache were selected to participate in the study. The A-B-A single-subject design was employed allowing three weeks before and after the intervention for baseline recordings. The intervention consisted of seven sessions of cognitive coping training and electromyographic biofeedback. All subjects kept daily records of their headache activity over the eleven week period. They completed the Psychological Assessment of Headache Questionnaire, levels of depression and anxiety were assessed by the Beck Depression Inventory and the State-Trait Anxiety Inventory which were administered three weeks prior to and after the intervention. Results indicated that subjects who exhibited a decrease in headache frequency and intensity and an increase in the number of headache-free days per week, were those who were not habituated to analgesic medication. Subjects who reported no differences at all with regard to headache activity were those who suffered from chronic daily headache. Those subjects were older and consumed analgesic and other medications daily. These findings support those found in literature (Blanchard & Andrasik, 1988). All but one subject reported lower scores at post-assessment on indicators of depression and state-anxiety. Even though there were no significant improvements regarding headache activity, for certain subjects. The overall aim of the study, namely to evaluate the effectiveness of individualized treatment strategies, were addressed and contribute to future intervention studies.

Migraine is a debilitating neurological disorder, which affects over 10% of the general population. In addition to headache, migraine includes a host of associated symptoms, such as nausea and hypersensitivity to light, noise, and touch. While great strides have been made in migraine treatment in recent decades, the basic biological and pathophysiological mechanisms underlying migraine are still not well understood. Pain signals travel via a polysynaptic pathway from the periphery to the cortex, where conscious perception of pain occurs. This multi-neuron pathway produces a message that can be modified at any step of its transit. One peptide that may modify this pathway is calcitonin gene-related peptide (CGRP). CGRP is a potent vasodilator and neuromodulator, and mounting evidence suggests CGRP may play a causative role in migraine. CGRP levels are increased during migraine, but can be reduced upon successful treatment with drugs in the triptan class. Importantly, injection of CGRP into migraine patients can elicit a delayed, migraine-like headache. Finally, CGRP receptor antagonists are clinically effective in providing relief to migraine patients. In addition to CGRP, the CGRP gene (CALCA) expresses another peptide that may also be relevant to migraine. Procalcitonin (proCT) is a recognized biomarker for sepsis, but emerging evidence suggests it may have actions similar to CGRP in migraine. First, proCT has biological activity at the CGRP receptor. Second, proCT is reported to be increased during migraine. We hypothesized that regulation of CGRP and proCT may be altered in migraineurs, and that migraineurs may also be sensitized to the effects of these peptides. To study the role of these peptides in migraine pathways, a number of methods have been employed. Studies exploring regulation of gene expression were performed in cultured trigeminal ganglia, as well as primary cultures of trigeminal and cortical glia. These studies show that the Calca gene can be regulated by a number of stimuli, including hypoxia and reactive oxygen species. These insults have the ability to induce CALCA gene and peptide expression to varying degrees on different cell types. In addition to in vitro experiments on Calca gene regulation, the in vivo effects of CGRP on mouse behavior were also investigated. Animals were genetically sensitized to CGRP via overexpression of the rate-limiting CGRP receptor subunit. In these animals, injection of CGRP is sufficient to induce light aversion, which is used to model photophobia. Physiological and biochemical triggers of migraine were tested using this behavioral paradigm. While stress and mast cell degranulation are sufficient to induce light aversion, the role of CGRP in these events remains unclear, as both CGRP sensitized and control animals displayed a light aversion phenotype. Together, these studies show the dynamic regulation of the Calca gene in migraine pathways as well as highlight some of the challenges of modeling a complex disease in an animal model.

Bakgrund: Migrän är en vanlig sjukdom som innebär mer än klassisk huvudvärk då den är både kronisk och ärftlig. Hur migrän upplevs varierar från individ till individ. Sjukdomen har funnits i alla tider och enligt den forskning som finns så förekommer den oftare hos kvinnor än hos män. Processen för att diagnostiseras för migrän är ofta lång, detta på grund av att kunskap saknas och att sjukdomen inte är prioriterad inom hälso- och sjukvården.  Syfte: Att beskriva personers erfarenheter av att leva med migrän. Metod: Artiklarna analyserades och granskades enligt Fribergs metod för litteraturöversikt och resulterade i två teman. Resultat: I analysen identifierade författarna av litteraturöversikten att individerna som deltagit i studierna genomgående upplever och sätter ord på att migrän inte tas på allvar av vårdgivare, arbetsgivare och ibland även av övrig omgivning. Sjukdomen, processen att erhålla en diagnos, att behöva ändra livsstil och att begränsas är något som väcker känslor. Diskussion: Författarna valde att diskutera resultatet utifrån Katie Erikssons Caritativa vårdteori. Grunden i den caritativa vårdteorin är kärleken till individen, vilket innebär att sjuksköterskan skall vandra med den lidande och lindra dess lidande för att nå en så optimal hälsa som möjligt. Kopplat till Katie Erikssons teori råder brist på förståelse, kunskap och bemötande hos vårdgivare samt övrig omgivning till ett obefogat vårdlidande. / Background: Migraines are a common disease which means more than classical headache, since it is both chronic and hereditary. How migraines are experienced varies from individual to individual. The disease has been known since ages, and according to the research, it occurs more often in women than in men. The process of diagnosing migraine is often long because of lack of knowledge and the disease is not a priority in health care.  Aim: To describe people's experiences of living with migraine. Method: The articles were analyzed and reviewed according to Friberg's method for literature review and resulted in two themes. Results: In the analysis, the authors of the literature review identified the individuals who participated in the studies constantly experiencing and saying that migraines are not taken seriously by caregivers, employers and sometimes even from other environments. The disease, the process of obtaining a diagnosis, having to change lifestyle and being limited is something that awakens emotions. Discussion: The authors chose to discuss the result based on Katie Eriksson's Caritative Care Theory. The basis of the caritative care theory is the love of the individual, which means that the nurse should walk with that suffering and relieve her suffering to achieve as optimal health as possible. Linked to Katie Eriksson's theory led to lack of understanding, knowledge and treatment of caregiver and other surroundings for an unjustified care-ward.

With dramatic lifestyle changes, chronic disease has become a significant problem for the health of modern people. The norm for many people is to live with chronic diseases, and migraine is one of the most common chronic diseases.  This thesis aims to investigate whether design can be used as an intervention to empower the experience of living with chronic disease. In this thesis, migraine was taken as an example of chronic disease.  The knowledge for this study was obtained from the field of cognitive behavioral therapy for migraine and gamification design as an intervention for cognitive behavioral therapy. A service design and a qualitative study were used as an approach to the study during the design process.  During the qualitative research, user survey and user interviews were conducted to collect data. Tools such as thematic analysis, affinity analysis, empathy map and persona were used to analyze the data and describe the findings.  The result is a mini-game service for the target group, presented by a concept plan, a system map, a service blueprint and a UI prototype. In this mini-game, the patients and the patients’ families and friends can participate together. Patients can learn more about their illness and adjust their mindset to cope with it, while their family and friends can learn about migraine and provide better support to the patient.  The service concept will be later evaluated by the target group using the Technology Acceptance Model.

Somehow Holier ruminates playfully on the problem of suffering and our responses to it. These poems take as their subjects theology, history, art, my wife's struggle with chronic migraines, and gardening. "Res Gestae Variorum," a crown of sonnets at the center of the book, recounts the lives of would-be Christian saints, like the third-century theologian Origen, whose penchant for suffering obstructed them on the path to holiness. In "Mater Misericordiae" I flip through a calendar filled with famous depictions of Mary while my wife consults with a doctor. These poems blend humor and pathos, striving at once to laugh in the face of pain and account for its awful cost. Throughout, I'm in conversation with the poets who've influenced my voice as a writer: Charles Wright, Phillip Larkin, and Seamus Heaney.

PURPOSE: Sport-related concussions and migraine are both national healthcare concerns that cost billions of dollars in economic burden annually in the United States as well as cause hardship on the individual. More than 539,600 student-athletes in the United States will be directly affected by both comorbidities each year, and the health care providers that care for them will have to make decisions based on both conditions. How healthcare providers are educated on these two conditions, their attitudes in diagnosing and managing these conditions, and beliefs about their role has not been established (aim 1). Due to a common pathophysiology, pre-morbid migraine has been identified as a risk factor for worse outcomes after an individual sustains concussion. However, the impact of these conditions and prescribed medications on commonly used baseline assessments has not been identified (aims 2 and 3). This may have implications in student-athlete referral to other healthcare professionals, in interpretation of test results, and in management of post-injury cases. Many individuals diagnosed with migraine take daily preventative medication (e.g., topiramate); however, these medications have been identified to cause cognitive impairment but the deficit in the collegiate student athlete and on the baseline concussion assessment is unknown (aim 3). Since cognitive exams make up a large portion of the concussion baseline assessment, identifying any real or perceived deficits in these tests may also allow healthcare providers to make decisions for test interpretation for these individuals. PARTICIPANTS: For aim 1, certified athletic trainers from the National Athletic Trainers’ Association and targeted social media groups were recruited to take a novel electronic survey. A total of 576 individuals that completed more than 90% of the survey were included in the final analysis. Student-athletes participating in club and varsity sports at Temple University undergoing routine baseline concussion assessments were recruited to have their data included for aims 2 and 3 (non-migraine = 387, migraine = 33, missing migraine status = 137). METHODS: The survey for aim 1 consisted of 7 subgroups of questions: demographics, concussion, migraine, and comorbid knowledge and atttitudes and beliefs. Questions mainly consisted of true/false and likert-style questions. For aims 2 and 3, student-atheltes completed their routine annual concussion baseline assessment. This consisted of a health history questionnaire, symptom checklist, Hospital Anxiety and Depression Scale, cognitive assessments, postural control test, and vestibular/oculomotor exams. Indiviudals that self-reported a history of migraine were included in aim 3 for analysis of medication use. RESULTS: For aim 1, 61% of respondents had a masters degree and 40% worked in middle or high school athletics. Over 94% of respondents previously reported receiving concussion education, compared to only 40.5% for migraine education. Respondents were able to correctly identify an average of 74% of concussion signs and symptoms and 66% of migraine signs and symptoms. Collegiate and split positions were associated with more negative concussion attitudes and beliefs. A lack of previous concussion or migraine education was associated with more negative attitudes and beliefs. For each year clinically practicing, attitude and belief scores were slightly more positive (β = 0.03 – 0.70, p < 0.001). Females also generally had more positive attitudes and beliefs across outcomes (β = 1.09 – 2.61, p < 0.001). A total of 577 student-athletes were included in aims 2 and 3. Having migraine was associated with 2.36 more symptoms (p = 0.008) and a 5.20 higher severity score (p = 0.005). Migraine was also associated with a 5.58 higher odds of a slower reading time on the King-Devick (p < 0.01). From ImPACT, having migraine decreased visual memory composite by 9.97-points (p = 0.02) and visual motor composite score by 3.89-points (p = 0.07). Of the 33 student-athletes with migraine, 15 were taking a prescription medication, 3 were taking an over-the-counter medication or supplement, and 7 were taking both. None of the athletes were taking a daily preventative medicaton for migraine. The median Migraine Disability Assessment score was 4.5, indicating only little or no disability. The Brief Disability Questionniare showed no significant difference between those with and without migraine (Kruskall-Wallis (1) = 0.4, p = 0.50). Finally, there was high provider trust as measured with the modified Patient-Doctor Relationship Questionniare, and no significant difference between those with and without migraine (Kruskall-Wallis (1) = 1.59, p = 0.21). CONCLUSION: This was one of the first studies to identify athletic trainer knowledge, attitudes and beliefs surrounding concussion and migraine. Idenitfying groups with decreased atttitudes and beliefs can be used for targeted programming and ensuring these athletic trainers have support to increase knowledge and attitudes and beliefs for more positive patient outcomes. This study also determined that migraine affects some aspects of baseline concussion assesments. This can be used by clinicians during test interpretation for patient care. These student-athletes had low measures of disability and high levels of provider trust, key components for individuals with migraine to receive appropriate care. Concussion and migraine are significant healthcare concerns present in populations seen by athletic trainers. Future studies exploring post-concussion migraine effects and medication over the course of collegiate career should be considered. Adequate knowledge and positive attitudes and beliefs would be beneficial in ensuring appropriate medical care given to individuals experiencing these conditions. / Kinesiology

Migraine is a complex neurovascular disorder of the brain characterized by episodes of severe head pain and dysfunction of the autonomic nervous system with or without aura. Migraine affects nearly 324 million people worldwide and causes severe disability in women during the most productive years of life. The World Health Organization considers severe migraine to be as disabling as quadriplegia and terminal stage cancer. Healthcare professionals often perceive migraine headaches as minor complaints, resulting in poorly acknowledged physical, emotional, and economic burdens contributing to diminished quality of life in women with migraine disorder. Approximately 10 million people suffer from migraines in the United States, yet evidence suggests that management of migraine is suboptimal. The purpose of the thesis is to educate healthcare professionals on the screening, diagnosis, and treatment of migraine disorders to enhance care of patients and improve quality of life. An interdisciplinary review of research was completed using the online databases Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE- EBSCOhost, Academic Search Premier, and PubMed. Findings concluded that migraines impact quality of life in the physical, psychological, social, and spiritual dimensions of well-being. Nursing implications for improving migraine management and quality of life include advocating for clients with migraines, seeking continuous education in regards to migraine management, educating clients and their families about managing migraines, and competently caring for clients with migraines.

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Migraine is the third most common medical condition in the world. Xiaogai Li have a hypothesis that implies that a hit to the head when first sensing the aura symptoms will stop the migraine attack. An investigation was made to ensure that the blow does not cause a head injury. The prescale pressure film from Fujifilm is a sensor that measures pressure and the pressure distribution. It is supplied with charts to determine the pressure when purchased. The pressure film was used to measure the reached loading impact from the blow. The new chart for the pressure film would in that case be used to create simulations to study the potential brain damage a hit to the head can result in. This paper examines whether loading rates has an influence on a prescale pressure film from Fujifilm, in order to create new pressure charts if such dependency is found. The testing was made with the help of a loading machine where the desired force could be set. The results showed a lower color density in the test results when comparing with the provided charts. The reason for this is unknown, although it could be a consequence of the environmental conditions that the pressure film was held in. The conclusion made by studying the results was that no loading rate dependency exists.