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A Comparison of Patients' and Neurologists' Assessments of their Teleneurology Encounter: A Cross-Sectional Analysis

Thawani, Sujata P; Minen, Mia T; Grossman, Scott N; Friedman, Steven; Bhatt, Jaydeep M; Foo, Farng-Yang A; Torres, Daniel M; Weinberg, Harold J; Kim, Nina H; Levitan, Valeriya; Cardiel, Myrna I; Zakin, Elina; Conway, Jenna M; Kurzweil, Arielle M; Hasanaj, Lisena; Stainman, Rebecca S; Seixas, Azizi; Galetta, Steven L; Balcer, Laura J; Busis, Neil A
PMID: 37624656
ISSN: 1556-3669
CID: 5599032

Factors Associated with Patient Adherence to Biofeedback Therapy Referral for Migraine: An Observational Study

Minen, Mia T; George, Alexis; Cuneo, Ami Z
Biofeedback has Grade A evidence for the treatment of migraine, yet few studies have examined the factors associated with patients' decisions to pursue biofeedback treatment recommendations. We sought to examine reasons for adherence or non-adherence to referral to biofeedback therapy as treatment for migraine. Patients with migraine who had been referred for biofeedback by a headache specialist/behavioral neurologist were interviewed in person or via Webex. Patients completed an enrollment questionnaire addressing demographics and questions related to their headache histories. At one month, patients were sent a follow-up questionnaire via REDCap and asked if they had pursued the recommendation for biofeedback therapy, their reasons for their decision, and their impressions about biofeedback for those who pursued it. Nearly two-thirds (65%; 33/51) of patients responded at one month. Of these, fewer than half (45%, 15/33) had contacted biofeedback providers, and only 18% (6/33) completed a biofeedback session. Common themes emerged for patients who did not pursue biofeedback, including feeling that they did not have time, concern for financial obstacles (e.g., treatment cost and/or insurance coverage), and having difficulty scheduling an appointment due to limited provider availability. When asked about their preference between type of biofeedback provider (e.g., a physical therapist or psychologist), qualitative responses were mixed; many patients indicated no preference as long as they took insurance and/or were experienced, while others indicated a specific preference for a physical therapist or psychologist due to familiarity, or prior experiences with that kind of provider. Patients with migraine referred for biofeedback therapy face numerous obstacles to pursuing treatment.
PMID: 38386246
ISSN: 1573-3270
CID: 5634452

Resistant and refractory migraine: clinical presentation, pathophysiology, and management

Ornello, Raffaele; Andreou, Anna P; De Matteis, Eleonora; Jürgens, Tim P; Minen, Mia T; Sacco, Simona
Migraine is a leading cause of disability worldwide. A minority of individuals with migraine develop resistant or refractory conditions characterised by ≥ 8 monthly days of debilitating headaches and inadequate response, intolerance, or contraindication to ≥3 or all preventive drug classes, respectively. Resistant and refractory migraine are emerging clinical definitions stemming from better knowledge of the pathophysiology of migraine and from the advent of migraine-specific preventive treatments. Resistant migraine mostly results from drug failures, while refractory migraine has complex and still unknown mechanisms that impair the efficacy of preventive treatments. Individuals with resistant migraine can be treated with migraine-specific preventive drugs. The management of refractory migraine is challenging and often unsuccessful, being based on combinations of different drugs and non-pharmacological treatment. Future research should aim to identify individuals at risk of developing treatment failures, prevent the condition, investigate the mechanisms of refractoriness to treatments, and find effective treatment strategies.
PMID: 38142636
ISSN: 2352-3964
CID: 5623422

Treatment Options for Posttraumatic Headache: A Current Review of the Literature

Minen, Mia T; Mahmood, Naoroz; Khan, Fardin; Waire, Erin K; George, Alexis; Datta, Shae
PURPOSE OF REVIEW/OBJECTIVE:We evaluate evidence-based treatments for posttraumatic headache (PTH), a secondary headache disorder resulting from traumatic brain injury (TBI), comprising nearly 4% of all symptomatic headache disorders. Utilizing recent publications, we aim to inform clinicians of current treatment methods. RECENT FINDINGS/RESULTS:There is limited research on PTH treatment. A randomized controlled trial (RCT) of metoclopramide with diphenhydramine for acute PTH found that the treatment group (N = 81) experienced more significant pain improvement than placebo by 1.4 points. For persistent PTH, an open-label study of erenumab (N = 89) found that 28% of participants reported ≥ 50% reduction in moderate-to-severe headache days, but an RCT of fremanezumab showed a non-significant reduction in moderate-to-severe headache days. A randomized crossover study of 40 patients with persistent PTH found that onabotulinum toxin-A decreased cumulative number of headaches/week by 43.3% in the treatment group and increased by 35.1% among placebos. In a study of military veterans with severe posttraumatic stress disorder and persistent/delayed onset PTH (N = 193), patients who received Cognitive Behavioral Therapy reported significant improvements in headache-related disability compared to usual care (aggregate mean HIT-6, -3.4). A transcranial magnetic stimulation (N = 24) study found that 58% of participants with mild TBI-related headache experienced a 50% reduction in headache frequency. New studies indicate promise in improving clinically important outcomes of PTH. However, more research is necessary to determine the optimal treatment and whether combining pharmacologic and nonpharmacologic treatment versus a single modality is more effective.
PMID: 38133705
ISSN: 1534-3081
CID: 5612262

Rethinking headache as a global public health case model for reaching the SDG 3 HEALTH by 2030

Martelletti, Paolo; Leonardi, Matilde; Ashina, Messoud; Burstein, Rami; Cho, Soo-Jin; Charway-Felli, Augustina; Dodick, David W; Gil-Gouveia, Raquel; Grazzi, Licia; Lampl, Christian; MaassenVanDenBrink, Antoinette; Minen, Mia T; Mitsikostas, Dimos Dimitrios; Olesen, Jes; Owolabi, Mayowa Ojo; Reuter, Uwe; Ruiz de la Torre, Elena; Sacco, Simona; Schwedt, Todd J; Serafini, Gianluca; Surya, Nirmal; Tassorelli, Cristina; Wang, Shuu-Jiun; Wang, Yonggang; Wijeratne, Tissa; Raggi, Alberto
The 2030 Agenda for Sustainable Development sets out, through 17 Sustainable Development Goals (SDGs), a path for the prosperity of people and the planet. SDG 3 in particular aims to ensure healthy lives and promote well-being for all at all ages and includes several targets to enhance health. This review presents a "headache-tailored" perspective on how to achieve SDG 3 by focusing on six specific actions: targeting chronic headaches; reducing the overuse of acute pain-relieving medications; promoting the education of healthcare professionals; granting access to medication in low- and middle-income countries (LMIC); implementing training and educational opportunities for healthcare professionals in low and middle income countries; building a global alliance against headache disorders. Addressing the burden of headache disorders directly impacts on populations' health, as well as on the possibility to improve the productivity of people aged below 50, women in particular. Our analysis pointed out several elements, and included: moving forward from frequency-based parameters to define headache severity; recognizing and managing comorbid diseases and risk factors; implementing a disease management multi-modal management model that incorporates pharmacological and non-pharmacological treatments; early recognizing and managing the overuse of acute pain-relieving medications; promoting undergraduate, postgraduate, and continuing medical education of healthcare professionals with specific training on headache; and promoting a culture that favors the recognition of headaches as diseases with a neurobiological basis, where this is not yet recognized. Making headache care more sustainable is an achievable objective, which will require multi-stakeholder collaborations across all sectors of society, both health-related and not health-related. Robust investments will be needed; however, considering the high prevalence of headache disorders and the associated disability, these investments will surely improve multiple health outcomes and lift development and well-being globally.
PMCID:10604921
PMID: 37884869
ISSN: 1129-2377
CID: 5610462

Episodic Migraine and Psychiatric Comorbidity: A Narrative Review of the Literature

George, Alexis; Minen, Mia T
PURPOSE OF REVIEW/OBJECTIVE:We evaluate the evolving evidence of psychiatric comorbidities associated with episodic migraine. Utilizing recent research publications, we aim to assess traditional treatment option considerations and discuss recent and evolving non-pharmacologic treatment progress for episodic migraine and related psychiatric conditions. RECENT FINDINGS/RESULTS:Recent findings indicate that episodic migraine is strongly linked to comorbid depression, anxiety, posttraumatic stress disorder, and sleep disorders. Not only do patients with episodic migraine have higher rates of psychiatric comorbidity, but a higher number of headache days reported is also strongly linked to an increased risk of developing a psychiatric disorder, indicating there may be a link between frequency and psychiatric comorbidity and that patients with high-frequency episodic migraine should be assessed for psychiatric comorbidity. Few migraine preventive medications have examined the effect of the medication on both migraine and psychiatric comorbidity though we discuss what has been reported in the literature. Non-pharmacologic-based treatments including behavioral therapies and mind-body interventions previously developed for psychiatric conditions, e.g., mindfulness-based CBT (MBCT), acceptance and commitment therapy (ACT), and mindfulness-based stress reduction (MBSR) therapy, have promising results for patients diagnosed with episodic migraine and may therefore be useful in treating migraine and comorbid psychiatric conditions. Psychiatric comorbidity may affect the efficacy of the treatment of episodic migraine. Thus, we must assess for psychiatric comorbidities to inform better treatment plans for patients. Providing patients with episodic migraine with alternate modalities of treatment may help to improve patient-centered care and increase patients' sense of self-efficacy.
PMID: 37382869
ISSN: 1534-3081
CID: 5540402

Neurologists' Evaluations of Experience and Effectiveness of Teleneurology Encounters

Thawani, Sujata P; Minen, Mia T; Stainman, Rebecca S; Friedman, Steven; Bhatt, Jaydeep M; Foo, Farng-Yang A; Torres, Daniel M; Weinberg, Harold J; Kim, Nina H; Levitan, Valeriya; Cardiel, Myrna I; Zakin, Elina; Conway, Jenna M; Kurzweil, Arielle M; Hasanaj, Lisena; Galetta, Steven L; Balcer, Laura J; Busis, Neil A
PMID: 35834603
ISSN: 1556-3669
CID: 5266202

A critical systematic review of K-12 neurology/neuroscience pipeline programs

Minen, Mia T.; Lebowitz, Naomi; Ekhtman, Jane; Oza, Khushalee; Yusaf, Ishah; Katara, Aarti; Aymon, Ramisha; Plovnick, Caitlin
Background: Early exposure to neuroscience is imperative to strengthening the neuroscience and neurology pipeline and may present an avenue for increasing the number of practicing neurologists and diversifying the neuroscience workforce. Our objective was to systematically review existing K-12 neuroscience education and outreach programs to understand what educational programs have been developed and implemented. Methods: We conducted an electronic database search of PubMed, EMBASE, PsycINFO, Education Source, and ERIC. All eligible articles were systematically reviewed to examine the type of program developed, target age group, implementation, and efficacy. Results: Our search produced 2,574 results, from which 23 articles were deemed eligible. The breakdown by age group was as follows: 5 elementary school, 8 middle school, 8 high school, and 2 general K-12 range of students. Six articles described programs intended for URM students. All programs were found to be successful in exposing students to neuroscience and inspiring interest in pursuing a career in the field of neurology. Discussion: Further efforts are necessary to analyze the long-term effectiveness of K-12 neuroscience education and outreach programs in overcoming the shortage of neurologists and explore the impact of mentorship for various age groups among K-12. Systematic review registrationhttps://doi.org/10.17605/OSF.IO/2G8CN.
SCOPUS:85180699058
ISSN: 2296-858x
CID: 5631222

Headache clinicians' perspectives on the remote monitoring of patients' electronic diary data: A qualitative study

Minen, Mia T; George, Alexis; Katara, Aarti; Lebowitz, Naomi; Snyder, Ivy Charlotte; Busis, Neil A; Lipchitz, Jessica M
OBJECTIVE:We assessed headache clinicians' viewpoints on potential remote access to patients' digital headache diary data and the practicalities of data utilization. BACKGROUND:With the ubiquitous nature of electronic medical records and the existence of remote monitoring (RM) for many medical conditions, there is now the potential for remote symptom monitoring for patients with headache disorders. While patients are asked to utilize headache diaries, clinicians may or may not have access to the data before patient visits, and their perspectives regarding this emerging technology are currently unknown. METHODS:After recruiting participants from the National Institutes of Health Pain Consortium Network, the American Headache Society Special Interest Section listservs, and Twitter and Facebook social media platforms, we conducted 20 semi-structured qualitative interviews of headache providers across the United States from various types of institutions and asked them their perspectives on remote access to patient headache diary data. We transcribed the interviews, which were then coded by two independent coders. Themes and sub-themes were developed using inductive content analysis. RESULTS:All clinicians felt the RM data needed to be integrated into the electronic medical record. Six themes emerged from the interviews: (i) Clinician perspectives on how RM could be beneficial but at other times could create obstacles/challenges, (ii) operationally, data integration could benefit headache care, (iii) there should be initial logistical considerations for bringing RM into clinical care, (iv) education may need to be provided to both patients and clinicians, (v) there are likely research benefits associated with RM, and (vi) additional suggestions for considering potential integration of RM into practice. CONCLUSIONS:While headache clinicians had mixed opinions on the benefits/challenges that RM presents to patient care, patient satisfaction, and visit time, new ideas emerged that may help advance the field.
PMID: 37313636
ISSN: 1526-4610
CID: 5506912

Educational initiatives in headache medicine: A 20-year scoping review

Dominguez, Moises; Minen, Mia; Robbins, Matthew S
BACKGROUND:Headache disorders are among the most common and disabling medical conditions worldwide, have a great societal impact and are a common reason to seek medical care. Headache disorders are often misdiagnosed and undertreated, and the number of headache fellowship-trained physicians cannot meet patient demand. Educational initiatives for non-headache-specialist clinicians may be an avenue to increase clinician competency and patient access to appropriate management. OBJECTIVE:To undertake a scoping review of the educational initiatives in headache medicine for medical students, trainees, general practitioners/primary care physicians, and neurologists. METHODS:Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for scoping reviews, an author (M.D.), with the help of a medical librarian, conducted a search of the Embase, Ovid Medline, and PsychInfo databases for articles related to medical educational initiatives on headache medicine in medical students, residents, and physicians over the last 20 years. RESULTS:A total of 17 articles met the inclusion criteria for this scoping review. Six articles were identified for medical students, seven for general practitioners/primary care physicians, one for emergency medicine residents, two for neurology residents, and one for neurologists. Certain educational initiatives were headache-focused while others had headaches as one of the educational topics. Educational content was delivered and assessed via diverse and innovative means, such as flipped classroom, simulation, theatrical performance, repeated quizzing and study, and a formalized headache elective. CONCLUSION/CONCLUSIONS:Education initiatives in headache medicine are important to improve competency and patient access to appropriate management of various headache disorders. Future research should focus on using innovative and evidence-based methods of content delivery, knowledge, and procedural assessment, and evaluating changes in practice behaviors.
PMID: 37382041
ISSN: 1526-4610
CID: 5535192