Faculty Bibliography

Objective: Effective treatments for insomnia exist, but few physicians treating headaches have routine methods for screening for insomnia. We sought to 1) describe the migraine characteristics and comorbid conditions that can affect sleep and 2) assess their relationships with positive screens on the Insomnia Severity Index (ISI). Methods: This is a retrospective cross-sectional study of the migraine and sleep characteristics of new patients in our headache center (August 15, 2015-October 28, 2015) who were suspected of having migraines based on the new patient intake questionnaire. The questionnaire included the ISI, questions about headache characteristics, and screens for psychiatric comorbidities. Two tailed t tests and analysis of variance evaluated relationships between headache characteristics, comorbidities, and ISI score. Results: A total of 61 new patients were suspected to have migraines. The mean number of headache days per month was 11.6. Only 41% of patients reported sleeping seven or more hours; 49.2% had an ISI of 15 or higher (positive screen). Regarding the insomnia scores, there were no differences between moderate and severe headache pain, between episodic and chronic headaches, and between the associated symptoms (nausea/vomiting, photophobia, phonophobia; P > 0.05). Musculoskeletal pain (18.7 vs 13.8, P = 0.027), depression (rho = 0.610), and general anxiety (rho = 0.436) were associated with higher ISI scores. Conclusions: Nearly half of the patients with suspected migraines in a headache center screened positive for insomnia, independent of whether they had episodic or chronic headaches. This would generate a substantial number of cognitive behavioral therapy for insomnia (CBT-I) referrals. Given the strong association between comorbid musculoskeletal pain, depression, anxiety, and insomnia, we suggest prioritizing CBT-I referral for those patients regardless of their headache frequency.

This article consists of a Letter to the Editor regarding Post-traumatic headache: the use of the sport concussion assessment tool (SCAT-3) as a predictor of post-concussion recovery, recently published in The Journal of Headache and Pain, along with a response from the original authors.

PurposeThe inhomogeneity of flip angle distribution is a major challenge impeding the application of high-field MRI. We report a method combining spatially selective excitation using generalized spatial encoding magnetic fields (SAGS) with radiofrequency (RF) shimming to achieve homogeneous excitation. This method can be an alternative approach to address the challenge of B1+ inhomogeneity using nonlinear gradients. MethodsWe proposed a two-step algorithm that jointly optimizes the combination of nonlinear spatial encoding magnetic fields and the combination of multiple RF transmitter coils and then optimizes the locations, RF amplitudes, and phases of the spokes. ResultsOur results show that jointly designed SAGS and RF shimming can provide a more homogeneous flip angle distribution than using SAGS or RF shimming alone. Compared with RF shimming alone, our approach can reduce the relative standard deviation of flip angle by 56% and 52% using phantom and human head data, respectively. ConclusionThe jointly designed SAGS and RF shimming method can be used to achieve homogeneous flip angle distributions when fully parallel RF transmission is not available. Magn Reson Med 78:577-587, 2017. (c) 2016 International Society for Magnetic Resonance in Medicine