Background
Migraine is a chronic disabling disorder, with paroxysmal attacks of unilateral, pulsating headache associated with symptoms such as nausea and vomiting. Dependent upon the intensity of the pain and the duration of the migraine episode, migraine significantly reduces quality of life and leads to impaired functioning (emotional, social, behavioral) both at home and at work. The impact of migraine on daily functioning has presently only been quantified by means of repeated subjective assessments before, during and after migraine attacks, using daily logs and/or questionnaires.

Aim
We explored whether ambulatory accelerometry (e.g.[1,2]) by means of a portable digital recorder (Vitaport2; Temec Instruments b.v., Kerkrade, The Netherlands) can be used as an objective method to quantify the behavioral aspects of migraine-related disability.

Methods
Four body mounted uni-axial piezo-resistive accelerometers were used to quantify the time spent in different body postures (lying, sitting, standing), physical activities (walking, cycling) and a general index of body motility during 8 migraine attacks and subsequent recovery periods of 6 female migraine patients (mean age: 39.8 years, range: 29-49) in their habitual environment. The length of each recording period was approximately 3 days. Two patients used no drugs for the acute treatment of their migraine attack; the other patients used their habitual medication. In order to quantify the influence of a migraine episode on daily activities, we alsperformed measurements during a headache-free baseline period (2 days) of the same patients.

Results
Within the context of the time required to travel to the patient and attach the sensors (approximately 60-75 min in this study), the migraine attacks and recovery periods were monitored. Overall, the procedures functioned well, indicating that ambulatory accelerometry measurements before, during and after a migraine attack are feasible to perform. All recorded migraine attacks influenced daily physical activities as quantified by means of ambulatory accelerometry. A bed rest-requiring moderate or severe migraine attack showed the following behavioral changes: the number of postural transitions and the time spent in the standing position and as movement were reduced, whereas the time spent in the lying position was increased, versus a corresponding headache-free baseline period. Total body motility was always reduced during migraine, also in those patients who were able to continue their daily activities.

Conclusions
Our data suggest that migraine always influences behavior by reducing motility and that, dependent upon the severity of the attack, effectiveness of acute treatment, and the time of day, the time spent in various body positions, dynamic activities, and number of postural transitions are affected. Therefore, ambulatory accelerometry may provide the objective behavioral effect parameters for the evaluation of migraine and its treatment on daily functioning in the habitual environment.

References

1. Bussmann, J.B.J. (1998). Ambulatory Monitoring of Mobility-Related Activities in Rehabilitation Medicine. Doctoral Thesis, Erasmus University Rotterdam.
2. Tulen, J.H.M.; Stronks, D.L.; Bussmann, J.B.J.; Pepplinkhuizen, L.; Passchier, J. (2000). Towards an objective quantitative assessment of daily functioning in migraine: a feasibility study. Pain, 86, 139-149

© 2000 Noldus Information Technology b.v.