Patient Self Rated Pain: Headache Versus Migraine a Retrospective Chart Review

Patient Self Rated Pain: Headache Versus Migraine a Retrospective Chart Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Patient Self Rated Pain: Headache Versus Migraine a Retrospective Chart Review Elizabeth Toigo, Erin Pellot, Hannah Lyons, Peter McAllister, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4959001/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 26 Oct, 2024 Read the published version in Head & Face Medicine → Version 1 posted 14 You are reading this latest preprint version Abstract Background: The International Classification of Headache Disorders (ICHD-3) uses moderate or severe pain intensity in the diagnostic criterion for migraine. However, few studies have analyzed pain rating on a visual analog scale to identify the numerical intensity that correlates with migraine. Objective To evaluate the impact of daily self-rated headache pain among patients with either episodic or chronic migraine. This study specifically aims to evaluate the probability of patients labeling their head pain as a headache vs migraine based on the pain level reported. Methods: A retrospective chart review was conducted on patients with a clinical diagnosis of migraine from July 1, 2014, to July 1, 2019. Results: Data of 114 subjects (57 episodic migraine and 57 chronic migraine) were used for analysis. Patients with episodic migraine on average rated a migraine more severe than a headache (4.1 VS 6.4; p<0.001). Patients with chronic migraine on average also rated migraine more severe than a headache (4.3 vs 6.8; p=0.0054). Chronic migraine patients transitioned from calling head pain a headache to a migraine significantly later than episodic migraine patients (4.5 vs 6.8; p<0.05). Conclusion: Migraine is perceived as having higher pain intensity than a headache in patients with both episodic and chronic migraine. Patients with chronic migraine have a higher pain threshold when reported a migraine. chronic migraine episodic migraine headache visual analog scale pain relief Background Migraine is a common neurological complaint associated with severe disability. 1 When classifying head pain as migraine, neurologists and headache specialists have largely focused on objective measurements from the International Classification of Headache Disorders (ICHD-3). 2 The ICHD-3 classifies head pain as migraine when it is recurrent, lasting 4 hours to 72 hours, unilaterally located, having a pulsating quality, moderate to severe intensity, aggravated by routine physical activity, and associated with nausea and/or photophobia and phonophobia. Although the ICHD-3 uses moderate or severe intensity as an indicator for migraine diagnosis, few studies have analyzed this on a subjective pain scale. Eleven-point pain scales, such as the Visual Analogue Scale (VAS), have been found to positively impact patient care by focusing on patient pain perception and eliminating physician bias, allowing for better treatment regimens. 3 This has been recognized by the neurological community which uses the headache diary as the gold standard for assessing chronic migraine burden. 4 The headache diary is a prospective, and patient subjective, measurement of pain using an eleven-point pain scale to assess daily head pain. By having patients identify their pain daily the headache diary eliminates patient recall bias allowing for an accurate assessment of head pain burden. 4 This study uses a daily headache diary, which in addition to rating head pain, asks patients to categorize their head pain as either a headache or migraine. According to the ICHD-3, all head pain experienced by migraine sufferers is classified as migraine following a migraine diagnosis. However, the authors wanted to determine the pain intensity that patients considered their head pain to be a migraine rather than a headache subjectively. By having patients categorize their head pain as either headache or migraine, it was hypothesized that a patient’ s perception of a migraine could be predicted by the reported pain level alone. Additionally, the use of abortive therapy for head pain was analyzed. Previous literature recommends using abortive therapy as early as possible during a migraine. 5 Patients commonly use over the counter medications such as aspirin, NSAIDs, and acetaminophen for mild to moderate headaches despite neurologists counseling against stepwise treatment. However, severe migraines are more likely to be treated with triptans, antiemetics, dexamethasone, ergotamines, isometheptene compounds or lidocaine if no improvement. 5 We compared pain ratings and head pain categorization with the use of head pain abortive therapy to find whether severity and patient head pain categorization influenced the use of abortive therapy during a migraine attack. Demographic, comorbidity, and current treatment information was also collected and analyzed to find correlations between pain severity and previously determined migraine risk factors or treatments. Methods Study Participants A total of 114 female and male participants (mean age 42.12 episodic and 48.09 chronic) were enrolled in this retrospective chart review. Data was collected from patient charts located in the SRS electronic medical record (EMR) system. All participants were under the care of the same board-certified headache specialist from July 2014 to July 2019. Patients between 18 to 85 years of age were included. All participants were diagnosed with either Migraine, Unspecified, not Intractable, without Status Migrainosus (International Classification of Disease, Tenth Revison (ICD-10) code G43.909) or Chronic migraine without aura, intractable, without status migrainosus (ICD-10 code G43.719). No patients diagnosed with aura were included in the data set to eliminate any biased aura symptoms, as many patients and providers perceive aura as a telling sign of migraine irrespective of severity 2 . Data collection All participants in the study were categorized as either chronic or episodic migraine sufferers based on the number of migraines per month at time of headache diary data collection, irrespective of initial diagnosis. According to the current ICHD-3 guidelines, chronic migraine sufferers have over 15 days of head pain a month, whereas episodic migraine sufferers have less than 15 days of head pain a month. Categorization of participants may differ from initial diagnosis due to current treatment regimen with prophylactic treatment at time of data collection. Patients included in the sample completed at least one month of head pain ratings in a prospective, non-electronic, daily headache diary. Each headache diary spanned the course of one calendar month (between 28 and 31 days). Headache diary data was excluded from the trial if it spanned less than one calendar month. For the daily headache diary, patients were instructed to rate their maximum head pain on an eleven-point pain scale VAS (0–10) over the previous 24 hours. Patients were then instructed to categorize their head pain as either a headache or migraine based on their own perception of head pain intensity and symptoms. Patients were also instructed to indicate whether abortive therapy was used, if any, in the treatment of the pain. Demographic, comorbidity, and current treatment data were collected as dichotomous data. This data was collected from the EMR progress note that most recently listed each demographic prior to the first headache calendar month being completed. Demographic data included height, weight, age, and BMI. Comorbidity data included hypertension, hyperlipidemia, cerebrovascular disease, anxiety, and depression. Current treatment data included abortive and prophylactic therapy. Forty-one patients were excluded from the study. Patients who listed all head pain as exclusively headache or migraine without distinction were excluded with the assumption that there was a lack of understanding of headache calendar instruction. Daily headache diaries completed outside of the July 2014 to July 2019 time frame were excluded. All data completed in less than one full month was excluded to allow for better identification of episodic vs chronic migraine sufferers at time of the daily headache diary. Statistical Analysis For the average headache or migraine rating for chronic/episodic conditions a MEANS Procedure was used via the SAS System. This was then followed by a t-TEST Procedure via the SAS System where average headache was directly evaluated against average migraine for episodic/chronic conditions. For the comparison of headache ratings between episodic and chronic conditions and for the comparison of migraine ratings between episodic and chronic conditions, a t-TEST Procedure via the SAS System was used. For the comparison of migraine ratings between episodic and chronic conditions a t-TEST Procedure via the SAS System was used For when episodic/chronic transition from calling head pain a headache to a migraine, a MEANS Procedure was used via the SAS System. This was then followed by a t-TEST Procedure via the SAS System to compare the transition between both groups. For the demographics in the chronic/episodic conditions, a FREQ Procedure including a chi-square test via the SAS System was used each time. For the medication therapy results a FREQ procedure including a chi-square test via the SAS System was used to compare the groups. Additionally, a t-TEST Procedure via the SAS System was used to compare the means of each group. Results Data of 114 subjects (57 episodic migraine patients and 57 chronic migraine patients) were used for analysis. Demographics and Comorbidities Demographics and comorbidities (Table 1 and Table 2 ) are listed below for each group. Among those with episodic migraines, the mean migraine rating among females was 6.4 while males were 6.5, This was not statistically significant (p = 0.915). Furthermore, the mean headache rating among females was 4.1 while males was 3.8 and this was also not statistically significant (p = 0.681). Among those with chronic migraines, the mean migraine rating among females was 6.9 and 4.8 for males. This association was statistically significant (p = 0.004). However, the mean headache rating among females was 4.4 while males were 2.6 and this association was not statistically significant (p = 0.083). Table 1 Demographics and comorbidities for patients diagnosed with episodic migraines. Demographic Number of patients female 53 Male 4 Age 47.32 Hypertension 12 Hyperlipidemia 9 Cerebrovascular disease 6 Anxiety 25 Depression 20 Table 2 Demographics and comorbidities for patients diagnosed with chronic migraines. Demographic Number of patients female 54 Male 3 Age 49.05 Hypertension 6 Hyperlipidemia 7 Cerebrovascular disease 2 Anxiety 22 Depression 20 Pain Severity Rating Among study participants with episodic migraine, the average headache rating was 4.1 and the average migraine rating was 6.4. This association was statistically significant (p < 0.001). Among study participants with chronic migraines, the average headache rating was 4.3 and the average migraine rating was 6.8. This association was statistically significant (p = 0.0054). On a VAS pain scale from 0–10, episodic patients change from calling a headache to a migraine at 4.5. while chronic patients change from calling a headache to a migraine at 6.8 This was statistically significant (p < 0.05). (See Graph 1 and 2) Graph 1. Percent of head pain episodes rated as headache vs migraine on VAS pain scale from 0–10. Episodic migraine patients change from calling a headache to a migraine at 4.5. Graph 2. Percent of head pain episodes rated as headache vs migraine on VAS pain scale from 0–10. Chronic migraine patients change from calling a headache to a migraine at 6.8. Abortive Therapy The mean number of times using abortive medication per migraine among those with chronic migraines was 6.15 and among those with episodic migraines was 0.80 (p < 0.001). The mean of number of times using abortive medication per headache among those with chronic migraines was 5.44 and among those with episodic migraines was 0.54 (p < 0.001). Discussion The complexity of pain beliefs arises from the subjectivity of pain where the belief of what the pain means for the patient may differ with scientific understanding. Thus, self-recorded ratings of headache category and severity in a headache calendar or diary are widely recommended for patients with a clinical diagnosis of migraine headaches. These calendars can help patients identify patterns and triggers of their headaches, as well as assist clinicians in proper diagnosis of headache category, such as episodic or chronic type. The subjective information that patients provide clinicians as well as having a proper diagnosis for headache type is important for creating the proper treatment plan for each patient. 4 , 6 Pain burden can be measured using a headache calendar to aid physicians in assessing migraine experience. In the current study, both episodic and chronic migraine patients consider a migraine to be more severe than a headache. Condello et al. 7 used a questionnaire to conclude that both episodic and chronic migraine patients have similar personal beliefs regarding their subjective experience of migraine pain. This emphasizes the similarity of pain perception amongst both groups and is consistent with the current study. Similarly, previous studies support the finding that migraines are rated as more intense than other types of headaches. A review from Stewart et al. 8 found that patients from population-based studies report migraines to be more disabling, painful, and longer in duration than headaches. This is one of the first studies, to our knowledge, that addresses when migraine sufferers transition from calling head pain a headache to a migraine. It was found that on the pain rating scale, chronic migraine patients stop calling head pain a headache and begin calling it a migraine when it is significantly more intense than episodic migraine patients. It is hypothesized that this may be due to a prolonged tolerance effect following long-term chronic pain. Researchers have found that continuous exposure to painful stimuli may lead to an increase pain tolerance through conditioning and adaptation. 9 , 10 Future studies should evaluate this potential prolonged tolerance effect in chronic migraine patients compared to episodic migraine sufferers. Migraine prevention and abortive treatment are critical in the management of patient’s pain experience. Abortive treatment for chronic migraines can help decrease attack intensity to improve quality of life. In the current study, abortive medications are more likely to be used when head pain is considered a migraine by patients with both episodic and chronic migraines. This is consistent with an increase in pain intensity and disability associated with migraines compared to headaches. Sun-Edelstein et. Al. 11 review on the pharmacological treatment of chronic migraine emphasizes the goal of acute abortive treatment resulting in headache freedom within 2 hours. The current study found that abortive medication for headaches and migraines is more likely to be used with chronic migraine patients than episodic migraine patients. It is hypothesized that abortive medication is of utmost importance for chronic migraine sufferers to decrease the higher pain intensity levels and maintain quality of life. Magnusson et al. 12 utilized headache diaries and a pain inventory to conclude that headache intensity is the major correlate to headache-related disability, with increased levels of pain intensity leading to increased levels of disability. Thus, future studies should address the higher utilization of abortive medication for chronic migraine patients, where it is most likely used to decrease these higher levels of disability. Finally, the design of the current study leads to some limitations. As a retrospective chart review, there may be selection bias, information bias, missing data, and patient recall bias. Additionally, most of the subjects included in both groups were female. Females are more likely to suffer from migraine pain due to the role of estrogens in neuroexcitability in the brain, so the distribution in the study is consistent with previous literature. 13 However, this potentially leads to confounding factors within the current study. Future studies should evaluate gender differences in subjectivity amongst migraine pain and how these correlates to abortive therapy use. Conclusion Patients on average rate a migraine to be more severe than a headache, consistent with migraine severity as moderate or severe. A higher VAS pain score is reported as a migraine in chronic migraine patients suggesting prolonged a shift in pain tolerance. Additional prospective clinical trials are recommended moving forward to aid in quantifying the pain burden of migraine on patients. Abbreviations ICHD-3: International Classification of Headache Disorders VAS: Visual Analogue Scale ICD-10 International Classification of Disease, Tenth Revison EMR: Electronic medical record Declarations Ethics approval and consent to participate: Mount Carmel Institutional Review Board Mount Carmel Corporate Services Center 6150 East Broad Street Columbus, Ohio 43213 Email: [email protected] Consent: Approval for a Chart Review with consent waived for the use of protected health information was obtained Dataset: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests: None for this study. Dr. Martin Taylor is a consultant speaker and participates in research support for Abbvie. Additionally, he is a consultant for Revance and participates in research support for Ipsen. Funding: none to disclose Author’s contributions: Elizabeth Toigo participated in data acquisition and in drafting the manuscript, Erin Pellot participated in data acquisition and in drafting the manuscript. Dr. Hannah Lyons, DO, MS, participated in design of the work, Dr. Peter McCalister, MD participated in substantively revising the final manuscript, Dr. Taylor DO, PhD participated as the principal investigator in design of the work, interpretation of data, and in substantively revising the final manuscript. Acknowledgements: We would like to acknowledge Dr. Janet Simon from Ohio University, Athens, Ohio for assistance with data analysis. Author’s Information: For communication regarding this manuscript please contact Erin Pellot OMS-IV [email protected] References Puledda, F., Silva, E.M., Suwanlaong, K. et al. Migraine: from pathophysiology to treatment. J Neurol 270, 3654–3666 (2023). https://doi.org/10.1007/s00415-023-11706-1. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 33(9), 629-808 (2013). https://doi.org/10.1177/0333102413485658. Cakir, U., Cete, Y., Yigit, O., Bozdemir, M.N. Improvement in physician pain perception with using pain scales. Eur J Trauma Emerg Surg 44(6), 909-915 (2018). https://doi.org/10.1007/s00068-017-0882-7. Nappi, G., Jensen, R., Nappi, R., Sances, G., Torelli, P., Olesen, J. Diaries and Calendars for Migraine. A Review. Cephalalgia 26(8), 905-916 (2006). https://doi.org/10.1111/j.1468-2982.2006.01155.x. Jenkins, B. Migraine management. Aust Prescr 43(5), 148-151 (2020). https://doi.org/10.18773/austprescr.2020.047. Torres-Ferrus, M., Gallardo, V.J., Alpuente, A., Pozo-Rosich, P. Influence of headache pain intensity and frequency on migraine-related disability in chronic migraine patients treated with OnabotulinumtoxinA. J Headache Pain 21(1), (2020). https://doi.org/10.1186/s10194-020-01157-8. Condello, C., Piano, V., Dadam, D., Pinessi, L., Lanteri-Minet, M. Pain Beliefs and Perceptions Inventory: A Cross-Sectional Study in Chronic and Episodic Migraine. Headache 55(1), 136-148 (2015). Stewart, W.F., Shechter, A., Lipton, R.B. Migraine heterogeneity. Disability, pain intensity, and attack frequency and duration. Neurology 44(6 Suppl 4), S24-39 (1994). Williams, D.A., Thorn, B.E. An empirical assessment of pain beliefs. Pain 36(3), 351-358 (1989). https://doi.org/10.1016/0304-3959(89)90095-X. Heinricher, M.M. Pain Modulation and the Transition from Acute to Chronic Pain. In: Ma, C., Huang, Y. (eds) Translational Research in Pain and Itch. Advances in Experimental Medicine and Biology, vol 904. Springer, Dordrecht (2016). Sun-Edelstein, C., Rapoport, A.M. Update on the Pharmacological Treatment of Chronic Migraine. Curr Pain Headache Rep 20, 6 (2016). Magnusson, J.E., Becker, W.J. Migraine frequency and intensity: relationship with disability and psychological factors. Headache 43(10), 1049-1059 (2003). https://doi.org/10.1046/j.1526-4610.2003.03206.x. Rossi, M.F., Tumminello, A., Marconi, M., Gualano, M.R., Santoro, P.E., Malorni, W., Moscato, U. Sex and gender differences in migraines: a narrative review. Neurol Sci 43(9), 5729-5734 (2022). https://doi.org/10.1007/s10072-022-06178-6. Graph 1 and 2 Graph 1 and 2 are available in the Supplementary Files section. Additional Declarations Competing interest reported. Martin Taylor, DO, PhD is a consultant speaker and participates in research support for Abbvie. He is a consultant for Revance. He also participates in research support for Ipsen. Supplementary Files Headachevs.Migrainefigures.docx Cite Share Download PDF Status: Published Journal Publication published 26 Oct, 2024 Read the published version in Head & Face Medicine → Version 1 posted Editorial decision: Revision requested 24 Sep, 2024 Reviewers agreed at journal 23 Sep, 2024 Reviews received at journal 21 Sep, 2024 Reviewers agreed at journal 20 Sep, 2024 Reviewers agreed at journal 20 Sep, 2024 Reviews received at journal 19 Sep, 2024 Reviewers agreed at journal 19 Sep, 2024 Reviewers agreed at journal 19 Sep, 2024 Reviews received at journal 16 Sep, 2024 Reviewers agreed at journal 16 Sep, 2024 Reviewers invited by journal 12 Sep, 2024 Editor assigned by journal 28 Aug, 2024 Submission checks completed at journal 28 Aug, 2024 First submitted to journal 22 Aug, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Martin Taylor, DO, PhD is a consultant speaker and participates in research support for Abbvie. He is a consultant for Revance. He also participates in research support for Ipsen.","formattedTitle":"Patient Self Rated Pain: Headache Versus Migraine a Retrospective Chart Review","fulltext":[{"header":"Background","content":"\u003cp\u003eMigraine is a common neurological complaint associated with severe disability.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e When classifying head pain as migraine, neurologists and headache specialists have largely focused on objective measurements from the International Classification of Headache Disorders (ICHD-3).\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e The ICHD-3 classifies head pain as migraine when it is recurrent, lasting 4 hours to 72 hours, unilaterally located, having a pulsating quality, moderate to severe intensity, aggravated by routine physical activity, and associated with nausea and/or photophobia and phonophobia. Although the ICHD-3 uses moderate or severe intensity as an indicator for migraine diagnosis, few studies have analyzed this on a subjective pain scale. Eleven-point pain scales, such as the Visual Analogue Scale (VAS), have been found to positively impact patient care by focusing on patient pain perception and eliminating physician bias, allowing for better treatment regimens.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e This has been recognized by the neurological community which uses the headache diary as the gold standard for assessing chronic migraine burden.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e The headache diary is a prospective, and patient subjective, measurement of pain using an eleven-point pain scale to assess daily head pain. By having patients identify their pain daily the headache diary eliminates patient recall bias allowing for an accurate assessment of head pain burden.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis study uses a daily headache diary, which in addition to rating head pain, asks patients to categorize their head pain as either a headache or migraine. According to the ICHD-3, all head pain experienced by migraine sufferers is classified as migraine following a migraine diagnosis. However, the authors wanted to determine the pain intensity that patients considered their head pain to be a migraine rather than a headache subjectively. By having patients categorize their head pain as either headache or migraine, it was hypothesized that a patient\u0026rsquo; s perception of a migraine could be predicted by the reported pain level alone.\u003c/p\u003e \u003cp\u003eAdditionally, the use of abortive therapy for head pain was analyzed. Previous literature recommends using abortive therapy as early as possible during a migraine.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Patients commonly use over the counter medications such as aspirin, NSAIDs, and acetaminophen for mild to moderate headaches despite neurologists counseling against stepwise treatment. However, severe migraines are more likely to be treated with triptans, antiemetics, dexamethasone, ergotamines, isometheptene compounds or lidocaine if no improvement.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e We compared pain ratings and head pain categorization with the use of head pain abortive therapy to find whether severity and patient head pain categorization influenced the use of abortive therapy during a migraine attack. Demographic, comorbidity, and current treatment information was also collected and analyzed to find correlations between pain severity and previously determined migraine risk factors or treatments.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Participants\u003c/h2\u003e \u003cp\u003eA total of 114 female and male participants (mean age 42.12 episodic and 48.09 chronic) were enrolled in this retrospective chart review. Data was collected from patient charts located in the SRS electronic medical record (EMR) system. All participants were under the care of the same board-certified headache specialist from July 2014 to July 2019. Patients between 18 to 85 years of age were included. All participants were diagnosed with either Migraine, Unspecified, not Intractable, without Status Migrainosus (International Classification of Disease, Tenth Revison (ICD-10) code G43.909) or Chronic migraine without aura, intractable, without status migrainosus (ICD-10 code G43.719). No patients diagnosed with aura were included in the data set to eliminate any biased aura symptoms, as many patients and providers perceive aura as a telling sign of migraine irrespective of severity\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eAll participants in the study were categorized as either chronic or episodic migraine sufferers based on the number of migraines per month at time of headache diary data collection, irrespective of initial diagnosis. According to the current ICHD-3 guidelines, chronic migraine sufferers have over 15 days of head pain a month, whereas episodic migraine sufferers have less than 15 days of head pain a month. Categorization of participants may differ from initial diagnosis due to current treatment regimen with prophylactic treatment at time of data collection.\u003c/p\u003e \u003cp\u003ePatients included in the sample completed at least one month of head pain ratings in a prospective, non-electronic, daily headache diary. Each headache diary spanned the course of one calendar month (between 28 and 31 days). Headache diary data was excluded from the trial if it spanned less than one calendar month. For the daily headache diary, patients were instructed to rate their maximum head pain on an eleven-point pain scale VAS (0\u0026ndash;10) over the previous 24 hours. Patients were then instructed to categorize their head pain as either a headache or migraine based on their own perception of head pain intensity and symptoms. Patients were also instructed to indicate whether abortive therapy was used, if any, in the treatment of the pain.\u003c/p\u003e \u003cp\u003eDemographic, comorbidity, and current treatment data were collected as dichotomous data. This data was collected from the EMR progress note that most recently listed each demographic prior to the first headache calendar month being completed. Demographic data included height, weight, age, and BMI. Comorbidity data included hypertension, hyperlipidemia, cerebrovascular disease, anxiety, and depression. Current treatment data included abortive and prophylactic therapy.\u003c/p\u003e \u003cp\u003eForty-one patients were excluded from the study. Patients who listed all head pain as exclusively headache or migraine without distinction were excluded with the assumption that there was a lack of understanding of headache calendar instruction. Daily headache diaries completed outside of the July 2014 to July 2019 time frame were excluded. All data completed in less than one full month was excluded to allow for better identification of episodic vs chronic migraine sufferers at time of the daily headache diary.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eFor the average headache or migraine rating for chronic/episodic conditions a MEANS Procedure was used via the SAS System. This was then followed by a t-TEST Procedure via the SAS System where average headache was directly evaluated against average migraine for episodic/chronic conditions.\u003c/p\u003e \u003cp\u003eFor the comparison of headache ratings between episodic and chronic conditions and for the comparison of migraine ratings between episodic and chronic conditions, a t-TEST Procedure via the SAS System was used.\u003c/p\u003e \u003cp\u003eFor the comparison of migraine ratings between episodic and chronic conditions a t-TEST Procedure via the SAS System was used\u003c/p\u003e \u003cp\u003eFor when episodic/chronic transition from calling head pain a headache to a migraine, a MEANS Procedure was used via the SAS System. This was then followed by a t-TEST Procedure via the SAS System to compare the transition between both groups.\u003c/p\u003e \u003cp\u003eFor the demographics in the chronic/episodic conditions, a FREQ Procedure including a chi-square test via the SAS System was used each time.\u003c/p\u003e \u003cp\u003eFor the medication therapy results a FREQ procedure including a chi-square test via the SAS System was used to compare the groups. Additionally, a t-TEST Procedure via the SAS System was used to compare the means of each group.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eData of 114 subjects (57 episodic migraine patients and 57 chronic migraine patients) were used for analysis.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eDemographics and Comorbidities\u003c/h2\u003e \u003cp\u003eDemographics and comorbidities (Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cem\u003eand\u003c/em\u003e Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) are listed below for each group. Among those with episodic migraines, the mean migraine rating among females was 6.4 while males were 6.5, This was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.915). Furthermore, the mean headache rating among females was 4.1 while males was 3.8 and this was also not statistically significant (p\u0026thinsp;=\u0026thinsp;0.681). Among those with chronic migraines, the mean migraine rating among females was 6.9 and 4.8 for males. This association was statistically significant (p\u0026thinsp;=\u0026thinsp;0.004). However, the mean headache rating among females was 4.4 while males were 2.6 and this association was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.083).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographics and comorbidities for patients diagnosed with episodic migraines.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDemographic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of patients\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyperlipidemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCerebrovascular disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographics and comorbidities for patients diagnosed with chronic migraines.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDemographic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of patients\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyperlipidemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCerebrovascular disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePain Severity Rating\u003c/h2\u003e \u003cp\u003eAmong study participants with episodic migraine, the average headache rating was 4.1 and the average migraine rating was 6.4. This association was statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Among study participants with chronic migraines, the average headache rating was 4.3 and the average migraine rating was 6.8. This association was statistically significant (p\u0026thinsp;=\u0026thinsp;0.0054).\u003c/p\u003e \u003cp\u003eOn a VAS pain scale from 0\u0026ndash;10, episodic patients change from calling a headache to a migraine at 4.5. while chronic patients change from calling a headache to a migraine at 6.8 This was statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). (See Graph 1 and 2)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eGraph 1.\u003c/em\u003e Percent of head pain episodes rated as headache vs migraine on VAS pain scale from 0\u0026ndash;10. Episodic migraine patients change from calling a headache to a migraine at 4.5.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eGraph 2.\u003c/em\u003e Percent of head pain episodes rated as headache vs migraine on VAS pain scale from 0\u0026ndash;10. Chronic migraine patients change from calling a headache to a migraine at 6.8.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eAbortive Therapy\u003c/h2\u003e \u003cp\u003eThe mean number of times using abortive medication per migraine among those with chronic migraines was 6.15 and among those with episodic migraines was 0.80 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The mean of number of times using abortive medication per headache among those with chronic migraines was 5.44 and among those with episodic migraines was 0.54 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe complexity of pain beliefs arises from the subjectivity of pain where the belief of what the pain means for the patient may differ with scientific understanding. Thus, self-recorded ratings of headache category and severity in a headache calendar or diary are widely recommended for patients with a clinical diagnosis of migraine headaches. These calendars can help patients identify patterns and triggers of their headaches, as well as assist clinicians in proper diagnosis of headache category, such as episodic or chronic type. The subjective information that patients provide clinicians as well as having a proper diagnosis for headache type is important for creating the proper treatment plan for each patient.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003ePain burden can be measured using a headache calendar to aid physicians in assessing migraine experience. In the current study, both episodic and chronic migraine patients consider a migraine to be more severe than a headache. Condello et al.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e used a questionnaire to conclude that both episodic and chronic migraine patients have similar personal beliefs regarding their subjective experience of migraine pain. This emphasizes the similarity of pain perception amongst both groups and is consistent with the current study. Similarly, previous studies support the finding that migraines are rated as more intense than other types of headaches. A review from Stewart et al.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e found that patients from population-based studies report migraines to be more disabling, painful, and longer in duration than headaches.\u003c/p\u003e \u003cp\u003eThis is one of the first studies, to our knowledge, that addresses when migraine sufferers transition from calling head pain a headache to a migraine. It was found that on the pain rating scale, chronic migraine patients stop calling head pain a headache and begin calling it a migraine when it is significantly more intense than episodic migraine patients. It is hypothesized that this may be due to a prolonged tolerance effect following long-term chronic pain. Researchers have found that continuous exposure to painful stimuli may lead to an increase pain tolerance through conditioning and adaptation.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Future studies should evaluate this potential prolonged tolerance effect in chronic migraine patients compared to episodic migraine sufferers.\u003c/p\u003e \u003cp\u003eMigraine prevention and abortive treatment are critical in the management of patient\u0026rsquo;s pain experience. Abortive treatment for chronic migraines can help decrease attack intensity to improve quality of life. In the current study, abortive medications are more likely to be used when head pain is considered a migraine by patients with both episodic and chronic migraines. This is consistent with an increase in pain intensity and disability associated with migraines compared to headaches. Sun-Edelstein et. Al.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e review on the pharmacological treatment of chronic migraine emphasizes the goal of acute abortive treatment resulting in headache freedom within 2 hours. The current study found that abortive medication for headaches and migraines is more likely to be used with chronic migraine patients than episodic migraine patients. It is hypothesized that abortive medication is of utmost importance for chronic migraine sufferers to decrease the higher pain intensity levels and maintain quality of life. Magnusson et al. \u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e utilized headache diaries and a pain inventory to conclude that headache intensity is the major correlate to headache-related disability, with increased levels of pain intensity leading to increased levels of disability. Thus, future studies should address the higher utilization of abortive medication for chronic migraine patients, where it is most likely used to decrease these higher levels of disability.\u003c/p\u003e \u003cp\u003eFinally, the design of the current study leads to some limitations. As a retrospective chart review, there may be selection bias, information bias, missing data, and patient recall bias. Additionally, most of the subjects included in both groups were female. Females are more likely to suffer from migraine pain due to the role of estrogens in neuroexcitability in the brain, so the distribution in the study is consistent with previous literature.\u003csup\u003e\u003cb\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/b\u003e\u003c/sup\u003e However, this potentially leads to confounding factors within the current study. Future studies should evaluate gender differences in subjectivity amongst migraine pain and how these correlates to abortive therapy use.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePatients on average rate a migraine to be more severe than a headache, consistent with migraine severity as moderate or severe. A higher VAS pain score is reported as a migraine in chronic migraine patients suggesting prolonged a shift in pain tolerance. Additional prospective clinical trials are recommended moving forward to aid in quantifying the pain burden of migraine on patients.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eICHD-3: International Classification of Headache Disorders\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVAS:\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Visual Analogue Scale\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eICD-10\u0026nbsp; \u0026nbsp;International Classification of Disease, Tenth Revison\u003c/p\u003e\n\u003cp\u003eEMR: \u0026nbsp; \u0026nbsp; Electronic medical record\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate: Mount Carmel Institutional Review Board\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMount Carmel Corporate Services Center 6150 East Broad Street Columbus, Ohio 43213\u003c/p\u003e\n\u003cp\u003eEmail: [email protected] Consent: Approval for a Chart Review with consent waived for the use of protected health information was obtained\u003c/p\u003e\n\u003cp\u003eDataset: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests: None for this study. Dr. Martin Taylor is a consultant speaker and participates in research support for Abbvie. Additionally, he is a consultant for Revance and participates in research support for Ipsen.\u003c/p\u003e\n\u003cp\u003eFunding: none to disclose\u003c/p\u003e\n\u003cp\u003eAuthor\u0026rsquo;s contributions: Elizabeth Toigo participated in data acquisition and in drafting the manuscript, Erin Pellot participated in data acquisition and in drafting the manuscript. Dr. Hannah Lyons, DO, MS, participated in design of the work, Dr. Peter McCalister, MD participated in substantively revising the final manuscript, Dr. Taylor DO, PhD participated as the principal investigator in design of the work, interpretation of data, and in substantively revising the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements: We would like to acknowledge Dr. Janet Simon from Ohio University, Athens, Ohio for assistance with data analysis.\u003c/p\u003e\n\u003cp\u003eAuthor\u0026rsquo;s Information: For communication regarding this manuscript please contact Erin Pellot OMS-IV [email protected]\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePuledda, F., Silva, E.M., Suwanlaong, K. et al. Migraine: from pathophysiology to treatment. J Neurol 270, 3654\u0026ndash;3666 (2023). https://doi.org/10.1007/s00415-023-11706-1.\u003c/li\u003e\n\u003cli\u003eHeadache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 33(9), 629-808 (2013). https://doi.org/10.1177/0333102413485658.\u003c/li\u003e\n\u003cli\u003eCakir, U., Cete, Y., Yigit, O., Bozdemir, M.N. Improvement in physician pain perception with using pain scales. Eur J Trauma Emerg Surg 44(6), 909-915 (2018). https://doi.org/10.1007/s00068-017-0882-7.\u003c/li\u003e\n\u003cli\u003eNappi, G., Jensen, R., Nappi, R., Sances, G., Torelli, P., Olesen, J. Diaries and Calendars for Migraine. A Review. Cephalalgia 26(8), 905-916 (2006). https://doi.org/10.1111/j.1468-2982.2006.01155.x.\u003c/li\u003e\n\u003cli\u003eJenkins, B. Migraine management. Aust Prescr 43(5), 148-151 (2020). https://doi.org/10.18773/austprescr.2020.047.\u003c/li\u003e\n\u003cli\u003eTorres-Ferrus, M., Gallardo, V.J., Alpuente, A., Pozo-Rosich, P. Influence of headache pain intensity and frequency on migraine-related disability in chronic migraine patients treated with OnabotulinumtoxinA. J Headache Pain 21(1), (2020). https://doi.org/10.1186/s10194-020-01157-8.\u003c/li\u003e\n\u003cli\u003eCondello, C., Piano, V., Dadam, D., Pinessi, L., Lanteri-Minet, M. Pain Beliefs and Perceptions Inventory: A Cross-Sectional Study in Chronic and Episodic Migraine. Headache 55(1), 136-148 (2015).\u003c/li\u003e\n\u003cli\u003eStewart, W.F., Shechter, A., Lipton, R.B. Migraine heterogeneity. Disability, pain intensity, and attack frequency and duration. Neurology 44(6 Suppl 4), S24-39 (1994).\u003c/li\u003e\n\u003cli\u003eWilliams, D.A., Thorn, B.E. An empirical assessment of pain beliefs. Pain 36(3), 351-358 (1989). https://doi.org/10.1016/0304-3959(89)90095-X.\u003c/li\u003e\n\u003cli\u003eHeinricher, M.M. Pain Modulation and the Transition from Acute to Chronic Pain. In: Ma, C., Huang, Y. (eds) Translational Research in Pain and Itch. Advances in Experimental Medicine and Biology, vol 904. Springer, Dordrecht (2016).\u003c/li\u003e\n\u003cli\u003eSun-Edelstein, C., Rapoport, A.M. Update on the Pharmacological Treatment of Chronic Migraine. Curr Pain Headache Rep 20, 6 (2016).\u003c/li\u003e\n\u003cli\u003eMagnusson, J.E., Becker, W.J. Migraine frequency and intensity: relationship with disability and psychological factors. Headache 43(10), 1049-1059 (2003). https://doi.org/10.1046/j.1526-4610.2003.03206.x.\u003c/li\u003e\n\u003cli\u003eRossi, M.F., Tumminello, A., Marconi, M., Gualano, M.R., Santoro, P.E., Malorni, W., Moscato, U. Sex and gender differences in migraines: a narrative review. Neurol Sci 43(9), 5729-5734 (2022). https://doi.org/10.1007/s10072-022-06178-6.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Graph 1 and 2","content":"\u003cp\u003eGraph 1 and 2 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"head-and-face-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"hafm","sideBox":"Learn more about [Head \u0026 Face Medicine](http://head-face-med.biomedcentral.com)","snPcode":"13005","submissionUrl":"https://submission.nature.com/new-submission/13005/3","title":"Head \u0026 Face Medicine","twitterHandle":"@HeadNeckMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"chronic migraine, episodic migraine, headache, visual analog scale, pain relief","lastPublishedDoi":"10.21203/rs.3.rs-4959001/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4959001/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: The International Classification of Headache Disorders (ICHD-3) uses moderate or severe pain intensity in the diagnostic criterion for migraine. However, few studies have analyzed pain rating on a visual analog scale to identify the numerical intensity that correlates with migraine.\u003c/p\u003e\n\u003cp\u003eObjective To evaluate the impact of daily self-rated headache pain among patients with either episodic or chronic migraine. This study specifically aims to evaluate the probability of patients labeling their head pain as a headache vs migraine based on the pain level reported.\u003c/p\u003e\n\u003cp\u003eMethods: A retrospective chart review was conducted on patients with a clinical diagnosis of migraine from July 1, 2014, to July 1, 2019.\u003c/p\u003e\n\u003cp\u003eResults: Data of 114 subjects (57 episodic migraine and 57 chronic migraine) were used for analysis. Patients with episodic migraine on average rated a migraine more severe than a headache (4.1 VS 6.4; p\u0026lt;0.001). Patients with chronic migraine on average also rated migraine more severe than a headache (4.3 vs 6.8; p=0.0054). \u0026nbsp;Chronic migraine patients transitioned from calling head pain a headache to a migraine significantly later than episodic migraine patients (4.5 vs 6.8; p\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003eConclusion: Migraine is perceived as having higher pain intensity than a headache in patients with both episodic and chronic migraine. Patients with chronic migraine have a higher pain threshold when reported a migraine.\u003c/p\u003e","manuscriptTitle":"Patient Self Rated Pain: Headache Versus Migraine a Retrospective Chart Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-26 18:04:41","doi":"10.21203/rs.3.rs-4959001/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-24T05:57:09+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"55095621985272167708060115768652845632","date":"2024-09-23T13:36:46+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-21T10:07:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"294731569364863705663479842567079340631","date":"2024-09-20T13:15:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"223222601495929286730405363827095663362","date":"2024-09-20T10:32:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-20T00:43:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"184787874021995359495680022526827874364","date":"2024-09-19T23:44:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"11519251668745568876367829167874844631","date":"2024-09-19T14:43:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-16T14:59:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"92460245752515466964315151974265290161","date":"2024-09-16T14:57:23+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-09-12T14:33:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-08-28T06:13:56+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-08-28T06:12:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"Head \u0026 Face Medicine","date":"2024-08-22T15:03:07+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"head-and-face-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"hafm","sideBox":"Learn more about [Head \u0026 Face Medicine](http://head-face-med.biomedcentral.com)","snPcode":"13005","submissionUrl":"https://submission.nature.com/new-submission/13005/3","title":"Head \u0026 Face Medicine","twitterHandle":"@HeadNeckMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7c00b879-1db3-483d-a7b9-3a17e9f43a59","owner":[],"postedDate":"September 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-10-28T16:09:35+00:00","versionOfRecord":{"articleIdentity":"rs-4959001","link":"https://doi.org/10.1186/s13005-024-00465-7","journal":{"identity":"head-and-face-medicine","isVorOnly":false,"title":"Head \u0026 Face Medicine"},"publishedOn":"2024-10-26 15:58:18","publishedOnDateReadable":"October 26th, 2024"},"versionCreatedAt":"2024-09-26 18:04:41","video":"","vorDoi":"10.1186/s13005-024-00465-7","vorDoiUrl":"https://doi.org/10.1186/s13005-024-00465-7","workflowStages":[]},"version":"v1","identity":"rs-4959001","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4959001","identity":"rs-4959001","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}