ENBIS Spring Meeting 2019 in Barcelona

13 – 14 June 2019 Abstract submission: 15 January – 20 May 2019

Individual-level patterns of perceived stress throughout the migraine cycle: A longitudinal cohort study using daily prospective data

13 June 2019, 17:20 – 17:45


Submitted by
Marina Vives-Mestres
Marina Vives-Mestres (Universitat de Girona), Serena L. Orr (Pediatrics, University of Calgary), Stephen Donoghue (Curelator, Inc.), Kenneth Shulman (Curelator, Inc.), Alec Mian (Curelator, Inc.)
Objective: To determine individual patterns of perceived stress across stages of the migraine cycle.
Methods: Individuals with migraine registered to use the mobile headache diary N1-Headache® and completed 90 days of daily data
entry, including perceived stress, rated on a 0-10 scale. Days were categorized into phases: P1 = prodromal (2 days prior to the first
day with migraine), P2 = migraine (migraine days per International Classification of Headache Disorders-3 definition), P3 =
postdromal (2 days following the last migraine day with migraine), P0 = interictal days (other days). Individuals with at least 5 days
in each phase were eligible and data from their first 90 days were used. The odds of stress were modeled with a multinomial
regression model using sex, age and phase as covariates. A two-step cluster analysis (hierarchical and a k-means) was used to
determine the number of patterns of stress variation.
Results: In 730 participants (n= 730), the mean perceived stress rating was 3.4 (standard deviation = + 2.4) and the median was 3.0
(interquartile range = 3.0). The odds of high perceived stress scores increased in P2 and to a lesser extent in P1 relative to P0
(p<0.0001), in females relative to males, and decreased with age (p<0.05). Cluster analysis uncovered 6 dominant patterns of stress
variation. Although P2 had the highest odds of elevated perceived stress scores in the regression model, results of the cluster analysis
indicate that this is only true for 3 clusters of participants (cluster 1: n=205, cluster 3: n=78 and cluster 6: n=156). Other interesting
and distinct patterns were seen in clusters 2 (n=79), 4 (n=136) and 5 (n=75).
Conclusion: Although on an aggregate level perceived stress peaks during the pain phase, in individuals there appear to be 6 distinct
dominant patterns of stress variation across the migraine cycle. A better understanding of how stress and other related factors vary
across the migraine cycle in individuals may allow for insights into disease biology and facilitate targeted individualized treatment
plans in the future.

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