Nearly half (48%) of the world suffers from a headache disorder, with 11% suffering from migraine headache. Because we do not know what causes headaches, treatment either consists of treating attacks once they occur, or attempting to reduce the frequency of attacks using daily prophylactic medications or behavioral therapies. For the vast majority of individuals, management typically involves waiting for an attack to begin and then treating the attack with medication. We have begun to show that individual headache attacks are predictable using a stress-arousal model, and that this information could be used to forecast headache risk to an individual sufferer over time. Building forecasting capabilities will require both an enhanced understanding of the causes of headache, and substantial experience in applying a forecasting algorithm across a diverse range of headache sufferers. These capabilities could be used to reduce headache burden, enhance treatment, and create more research opportunities for the study of headache. This application has the following aims:
Aim 1 : To formally examine the stress-arousal model in eliciting headaches using the Trier Social Stress Test (TSST) and a Fasting Test (FT).
Aim 2 : To examine the utility of a headache forecasting algorithm in a diverse group of headache sufferers.

Public Health Relevance

Although headache disorders are extremely common, we still do not know what causes an individual headache attack. Because we do not know what causes attacks, we are unable to predict them, and as a result many patients live in fear of their next headache. Treatment strategies primarily involve treating attacks after they occur, or attempting to reduce the frequency of attacks by taking daily medicines. This application will enhance knowledge about what causes headache attacks and begin to shift the focus to predicting headaches before they occur.

National Institute of Health (NIH)
National Institute of Neurological Disorders and Stroke (NINDS)
Research Project (R01)
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Special Emphasis Panel (ZRG1)
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Oshinsky, Michael L
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Massachusetts General Hospital
United States
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Turner, Dana P; Houle, Timothy T (2018) Influences on headache trigger beliefs and perceptions. Cephalalgia 38:1545-1553
Pellegrino, A Brooke Walters; Davis-Martin, Rachel E; Houle, Timothy T et al. (2018) Perceived triggers of primary headache disorders: A meta-analysis. Cephalalgia 38:1188-1198
Burns, Sara M; Turner, Dana P; Sexton, Katherine E et al. (2017) Using Search Engines to Investigate Shared Migraine Experiences. Headache 57:1217-1227
Houle, Timothy T; Turner, Dana P; Golding, Adrienne N et al. (2017) Forecasting Individual Headache Attacks Using Perceived Stress: Development of a Multivariable Prediction Model for Persons With Episodic Migraine. Headache 57:1041-1050
Turner, Dana P; Golding, Adrienne N; Houle, Timothy T (2016) Using a graphical risk tool to examine willingness to take migraine prophylactic medications. Pain 157:2226-2234
Smitherman, Todd A; Davis, Rachel E; Walters, A Brooke et al. (2015) Anxiety sensitivity and headache: diagnostic differences, impact, and relations with perceived headache triggers. Cephalalgia 35:710-21
Turner, Dana P; Smitherman, Todd A; Black, Anna Katherine et al. (2015) Are migraine and tension-type headache diagnostic types or points on a severity continuum? An exploration of the latent taxometric structure of headache. Pain 156:1200-7
Turner, Dana P; Smitherman, Todd A; Penzien, Donald B et al. (2014) Nighttime snacking, stress, and migraine activity. J Clin Neurosci 21:638-43
Houle, Timothy T; Turner, Dana P (2013) Natural experimentation is a challenging method for identifying headache triggers. Headache 53:636-43
Turner, Dana P; Smitherman, Todd A; Martin, Vincent T et al. (2013) Causality and headache triggers. Headache 53:628-35

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