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      The Influence of Migraine on Driving: Current Understanding, Future Directions, and Potential Implications of Findings

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          Abstract

          Objective

          To review the published findings relevant to migraine and driving performance, with an intent to encourage discussion on research which may broaden understanding in this area and help educate healthcare providers and their patients.

          Background

          Motor vehicle crashes result in more than 35,000 deaths and more than 2 million injuries annually in the United States. Migraine is one of the most prevalent diseases in the world, and many symptoms associated with migraine attacks have the potential to negatively influence driving ability.

          Methods

          We reviewed the published findings related to migraine and driving performance. Study findings relevant to symptoms of migraine and their potential effect on driving were also reviewed. This required a more expansive exploration of the literature beyond migraine, for example, review of the literature relating to the effect of pain, sleepiness, visual disturbances, or vertigo on driving. Finally, the potential effects of treatment for migraine on driving were reviewed.

          Results

          Literature on the effect of migraine on driving performance is sparse and, in general published studies on the topic have a number of limitations. Based on review of the literature pertaining to other disorders, it seems feasible that some symptoms occurring as part of the migraine attack could impact driving performance, although formal study in this area is lacking. Many of the approved treatments for migraine have the potential to impact driving, yet this has not been specifically studied, and the extent to which these risks are communicated to patients is not clear.

          Conclusion

          The impact of migraine on driving performance has been largely neglected, with few studies specifically designed to address the topic, and relevant studies were generally small with limited control of confounders. This area requires more focus, given a potential for impact on road safety.

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          Most cited references54

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          Is Open Access

          Vestibular migraine: diagnostic criteria.

          This paper presents diagnostic criteria for vestibular migraine, jointly formulated by the Committee for Classification of Vestibular Disorders of the Bárány Society and the Migraine Classification Subcommittee of the International Headache Society (IHS). The classification includes vestibular migraine and probable vestibular migraine. Vestibular migraine will appear in an appendix of the third edition of the International Classification of Headache Disorders (ICHD) as a first step for new entities, in accordance with the usual IHS procedures. Probable vestibular migraine may be included in a later version of the ICHD, when further evidence has been accumulated. The diagnosis of vestibular migraine is based on recurrent vestibular symptoms, a history of migraine, a temporal association between vestibular symptoms and migraine symptoms and exclusion of other causes of vestibular symptoms. Symptoms that qualify for a diagnosis of vestibular migraine include various types of vertigo as well as head motion-induced dizziness with nausea. Symptoms must be of moderate or severe intensity. Duration of acute episodes is limited to a window of between 5 minutes and 72 hours.
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            The triggers or precipitants of the acute migraine attack.

            L. Kelman (2007)
            The aim of this study was to evaluate and define the triggers of the acute migraine attack. Patients rated triggers on a 0-3 scale for the average headache. Demographics, prodrome, aura, headache characteristics, postdrome, medication responsiveness, acute and chronic disability, sleep characteristics and social and personal characteristics were also recorded. One thousand two hundred and seven International Classification of Headache Disorders-2 (1.1-1.2, and 1.5.1) patients were evaluated, of whom 75.9% reported triggers (40.4% infrequently, 26.7% frequently and 8.8% very frequently). The trigger frequencies were stress (79.7%), hormones in women (65.1%), not eating (57.3%), weather (53.2%), sleep disturbance (49.8%), perfume or odour (43.7%), neck pain (38.4%), light(s) (38.1%), alcohol (37.8%), smoke (35.7%), sleeping late (32.0%), heat (30.3%), food (26.9%), exercise (22.1%) and sexual activity (5.2%). Triggers were more likely to be associated with a more florid acute migraine attack. Differences were seen between women and men, aura and no aura, episodic and chronic migraine, and between migraine and probable migraine.
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              Migraine

              Migraine is a chronic paroxysmal neurological disorder characterised by multiphase attacks of head pain and a myriad of neurological symptoms. The underlying genetic and biological underpinnings and neural networks involved are coming sharply into focus. This progress in the fundamental understanding of migraine has led to novel, mechanism-based and disease-specific therapeutics. In this Seminar, the clinical features and neurobiology of migraine are reviewed, evidence to support available treatment options is provided, and emerging drug, device, and biological therapies are discussed.
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                Author and article information

                Contributors
                doty_erin_gautier@lilly.com
                Journal
                Headache
                Headache
                10.1111/(ISSN)1526-4610
                HEAD
                Headache
                John Wiley and Sons Inc. (Hoboken )
                0017-8748
                1526-4610
                02 December 2019
                January 2020
                : 60
                : 1 ( doiID: 10.1111/head.v60.1 )
                : 178-189
                Affiliations
                [ 1 ] Geisel School of Medicine at Dartmouth Hanover NH USA
                [ 2 ] Jefferson Headache Center Thomas Jefferson University Philadelphia PA USA
                [ 3 ] Northwell Health Physician Partners Neuroscience Institute Great Neck NY USA
                [ 4 ] Montefiore Headache Center Albert Einstein School of Medicine The Bronx NY USA
                [ 5 ] Eli Lilly and Company Indianapolis IN USA
                [ 6 ] Department of Psychological Sciences Purdue University West Lafayette IN USA
                Author notes
                [*] [* ] Address all correspondence to E. Doty, Eli Lilly and Company, Indianapolis, IN, USA, email: doty_erin_gautier@ 123456lilly.com

                Article
                HEAD13716
                10.1111/head.13716
                7004171
                31792964
                447c7a54-793b-4db7-924e-a9418aefde03
                © 2019 Eli Lilly and Company. Headache: The Journal of Head and Face Pain published by Wiley Periodicals, Inc. on behalf of American Headache Society

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 06 November 2019
                Page count
                Figures: 0, Tables: 1, Pages: 12, Words: 24364
                Categories
                Views and Perspectives
                Views and Perspectives
                Custom metadata
                2.0
                January 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.7.5 mode:remove_FC converted:06.02.2020

                migraine,driving performance,motor vehicle accident,treatment

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