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dc.contributor.authorPatel, Salma
dc.date.accessioned2013-04-17T17:28:24Z
dc.date.available2013-04-17T17:28:24Z
dc.date.issued2013-03
dc.identifier.urihttp://hdl.handle.net/10150/281778
dc.descriptionA Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.en
dc.description.abstractObjectives: (i) Determine the prevalence of imploding, exploding and/or ocular headaches in women with migraine in a primary care practice of women (ii) Investigate the concordance of physician diagnosis with patient self-diagnosis of pain directionality (iii) Assess correlation between the type of headache and severity of migraines, reproductive stage, and response to acute and prophylactic treatments Background: botulinum toxin A is a drug made from the toxin produced by Clostridium botulinum that works by weakening or paralyzing certain muscles or by blocking certain nerves.17 Recent migraine trials evaluating the efficacy of botulinum toxin A therapy noted differences in the efficacy of botulinum toxin A therapy based on directionality of pain ((imploding exploding and ocular). 5,6,7 However, the prevalence of these migraine types and their responses to conventional migraine prevention therapies has not yet been assessed. Methods: 201 patients participated in structured clinician-administered interviews and completed written questionnaires. Directionality of migraines were determined by both patients and physicians. Descriptive statistics, kappa coefficients and Kruskal-Wallis tests were used to assess migraine prevalence, physician-patient diagnosis concordance and association of migraine to severity, treatment and reproductive stage respectively. Results: 201 patients were enrolled with average age of 46. All patients reported directionality of their migraine and prevalence varied depending upon the method used to assign directionality and were: 33%-42% imploding headaches with or without ocular pain, 18%-44% exploding headaches with or without ocular pain, 7%-39% had ocular pain only, and 8%-13% had imploding and exploding headaches with or without ocular pain. The concordance between physician diagnosis of headache directionality with patient written response, between physician diagnosis and patient diagnosis via selection of representative picture, and between patient diagnosis via written question and via selection of representative pictures were week to moderate using Kappa coefficient. No correlation between the type of headache and severity of migraines, reproductive stage, and response to acute and prophylactic treatments was found (p>0.05). Conclusion: Improved methods of determining pain directionality and target therapy are needed.
dc.language.isoen_USen
dc.publisherThe University of Arizona.en_US
dc.rightsCopyright © is held by the author. Digital access to this material is made possible by the College of Medicine - Phoenix, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.en_US
dc.subject.meshMigraine Disordersen
dc.subject.meshPrimary Health Careen
dc.subject.meshWomen's Health Servicesen
dc.titlePrevalence of Imploding, Exploding and Ocular Headache Types in a Women’s Health Outpatient Practiceen_US
dc.typetext; Electronic Thesisen
dc.contributor.departmentThe University of Arizona College of Medicine - Phoenixen
dc.description.collectioninformationThis item is part of the College of Medicine - Phoenix Scholarly Projects 2013 collection. For more information, contact the Phoenix Biomedical Campus Library at pbc-library@email.arizona.edu.en_US
dc.contributor.mentorFiles, Juliaen
refterms.dateFOA2018-09-12T12:10:17Z
html.description.abstractObjectives: (i) Determine the prevalence of imploding, exploding and/or ocular headaches in women with migraine in a primary care practice of women (ii) Investigate the concordance of physician diagnosis with patient self-diagnosis of pain directionality (iii) Assess correlation between the type of headache and severity of migraines, reproductive stage, and response to acute and prophylactic treatments Background: botulinum toxin A is a drug made from the toxin produced by Clostridium botulinum that works by weakening or paralyzing certain muscles or by blocking certain nerves.17 Recent migraine trials evaluating the efficacy of botulinum toxin A therapy noted differences in the efficacy of botulinum toxin A therapy based on directionality of pain ((imploding exploding and ocular). 5,6,7 However, the prevalence of these migraine types and their responses to conventional migraine prevention therapies has not yet been assessed. Methods: 201 patients participated in structured clinician-administered interviews and completed written questionnaires. Directionality of migraines were determined by both patients and physicians. Descriptive statistics, kappa coefficients and Kruskal-Wallis tests were used to assess migraine prevalence, physician-patient diagnosis concordance and association of migraine to severity, treatment and reproductive stage respectively. Results: 201 patients were enrolled with average age of 46. All patients reported directionality of their migraine and prevalence varied depending upon the method used to assign directionality and were: 33%-42% imploding headaches with or without ocular pain, 18%-44% exploding headaches with or without ocular pain, 7%-39% had ocular pain only, and 8%-13% had imploding and exploding headaches with or without ocular pain. The concordance between physician diagnosis of headache directionality with patient written response, between physician diagnosis and patient diagnosis via selection of representative picture, and between patient diagnosis via written question and via selection of representative pictures were week to moderate using Kappa coefficient. No correlation between the type of headache and severity of migraines, reproductive stage, and response to acute and prophylactic treatments was found (p>0.05). Conclusion: Improved methods of determining pain directionality and target therapy are needed.


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