{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T23:42:04Z","timestamp":1793317324164,"version":"4.5.0"},"reference-count":48,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,9,12]],"date-time":"2020-09-12T00:00:00Z","timestamp":1599868800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["headachejournal.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Headache"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To describe patterns of perceived stress across stages of the migraine cycle, within and between individuals and migraine episodes as defined for this study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Individuals with migraine aged \u226518\u00a0years, who were registered to use the digital health platform N1\u2010Headache\n                      <jats:sup>TM<\/jats:sup>\n                      , and completed 90\u00a0days of daily data entry regarding migraine, headache symptoms, and lifestyle factors were eligible for inclusion. Perceived stress was rated once a day at the participant\u2019s chosen time with a single question, \u201cHow stressed have you felt today?\u201d with response options graded on a 0\u201010 scale. Days were categorized into phases of the migraine cycle:\n                      <jats:italic>P<\/jats:italic>\n                      <jats:sub>pre<\/jats:sub>\n                      \u00a0=\u00a0pre\u2010migraine headache (the 2\u00a0days prior to the first day with migraine headache),\n                      <jats:italic>P<\/jats:italic>\n                      <jats:sub>0<\/jats:sub>\n                      \u00a0=\u00a0migraine headache days,\n                      <jats:italic>P<\/jats:italic>\n                      <jats:sub>post<\/jats:sub>\n                      \u00a0=\u00a0post\u2010migraine headache (the 2\u00a0days following the last migraine day with migraine headache), and\n                      <jats:italic>\n                        P\n                        <jats:sub>i<\/jats:sub>\n                      <\/jats:italic>\n                      \u00a0=\u00a0interictal days (all other days). Episodes, defined as discrete occurrences of migraine with days in all 4 phases, were eligible if there was at least 1 reported daily perceived stress value in each phase. Individuals with \u22655 valid episodes, and \u226575% compliance (tracking 90\u00a0days in 120 calendar days or less) were eligible for inclusion in the analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Data from 351 participants and 2115 episodes were included in this analysis. Eighty\u2010six percent of the sample (302\/351) were female. The mean number of migraine days per month was 6.1 (range 2\u201013, standard deviation\u00a0=\u00a02.3) and the mean number of episodes was 6.0 (range 5\u201010, standard deviation\u00a0=\u00a01.0) over the 90\u2010day period. Only 8 (8\/351, 2.3%) participants had chronic migraine (defined as 15 or more headache days per month with at least 8 days meeting criteria for migraine). Cluster analysis revealed 3 common patterns of perceived stress variation across the migraine cycle. For cluster 1, the \u201clet down\u201d pattern, perceived stress in the interictal phase (\n                      <jats:italic>\n                        P\n                        <jats:sub>i<\/jats:sub>\n                      <\/jats:italic>\n                      ) falls in the pre\u2010headache phase (\n                      <jats:italic>P<\/jats:italic>\n                      <jats:sub>pre<\/jats:sub>\n                      ) and then decreases more in the migraine phase (\n                      <jats:italic>P<\/jats:italic>\n                      <jats:sub>0<\/jats:sub>\n                      ) relative to\n                      <jats:italic>\n                        P\n                        <jats:sub>i<\/jats:sub>\n                      <\/jats:italic>\n                      . For cluster 2, the \u201cflat\u201d pattern, perceived stress is relatively unchanging throughout the migraine cycle. For cluster 3, the \u201cstress as a trigger\/symptom\u201d pattern, perceived stress in\n                      <jats:italic>P<\/jats:italic>\n                      <jats:sub>pre<\/jats:sub>\n                      increases relative to\n                      <jats:italic>\n                        P\n                        <jats:sub>i<\/jats:sub>\n                      <\/jats:italic>\n                      , and increases further in\n                      <jats:italic>P<\/jats:italic>\n                      <jats:sub>0<\/jats:sub>\n                      relative to\n                      <jats:italic>\n                        P\n                        <jats:sub>i<\/jats:sub>\n                      <\/jats:italic>\n                      . Episodes were distributed across clusters as follows: cluster 1: 354\/2115, 16.7%; cluster 2: 1253\/2115, 59.2%, and cluster 3: 508\/2115, 24.0%. Twelve participants (12\/351, 3.4%) had more than 50% of their episodes fall into cluster 1, 216 participants (216\/351, 61.5%) had more than 50% of their episodes fall into cluster 2, and 25 participants (25\/351, 7.1%) had more than 50% of their episodes fall into cluster 3.\u00a0There were 40 participants with \u226590% of their episodes in cluster 2, with no participants having \u226590% of their episodes in cluster 1 or 3.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>On an aggregate level, perceived stress peaks during the pain phase of the migraine cycle. However, on an individual and episode basis, there are 3 dominant patterns of perceived stress variation across the migraine cycle. Elucidating how patterns of perceived stress vary across the migraine cycle may contribute insights into disease biology, triggers and protective factors, and provide a framework for targeting individualized treatment plans.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/head.13943","type":"journal-article","created":{"date-parts":[[2020,9,27]],"date-time":"2020-09-27T06:20:51Z","timestamp":1601187651000},"page":"90-102","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Patterns of Perceived Stress Throughout the Migraine Cycle: A Longitudinal Cohort Study Using Daily Prospective Diary Data"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8304-257X","authenticated-orcid":false,"given":"Marina","family":"Vives\u2010Mestres","sequence":"first","affiliation":[{"name":"Curelator Inc. 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