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Migraine Disability Rising in the United States

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Migraine Disability Rising in the United States

Although migraine prevalence rates in the United States have remained stable for almost 30 years, the proportion of chronic migraine is rising, new research suggests.

Fred Cohen, MD

“Migraine prevalence has been relatively unchanged over the past several decades, but our measurements of burden, or the impact of migraine, has been going up,” study investigator Fred Cohen, MD, headache medicine fellow at Jefferson Headache Center, Thomas Jefferson University, Philadelphia, Pennsylvania, told Medscape Medical News.

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The findings were presented at the American Headache Society (AHS) Annual Meeting 2022.

‘Ebb and Flow’

Ways of measuring migraine burden have changed over time. In the 1990s, experts only used the number of missed workdays. But today, they use the migraine disability assessment (MIDAS) and the six-item headache impact test (HIT-6) to assess lost productivity and the impact on school, home, and social life.

For the study, the investigators analyzed 11 US epidemiologic studies conducted from 1989 to 2018 that defined migraine using International Classification of Headache Disorders (ICHD) criteria. Government surveys were not included because of their reliance on self-report of a medical diagnosis and/or having experienced a recent severe headache or migraine.

The analysis showed an “ebb and flow” of migraine prevalence over time, but the rate remained stable, said Cohen. The prevalence rate ranged from a low of about 11.7% to a high of about 14.7% over time.

However, Cohen noted that the moderate to severe degree of disability, signified by a grade of 3-4 on the MIDAS, appears to be going up.

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Among studies included in the current analysis, this rate was 22% in the 2004 AMPP study and 42.4% in the 2018 OVERCOME study.

In addition, the researchers found a decrease in the number of individuals reporting low-frequency episodic migraine, defined as zero to three headache days a month, but found a steady increase in the percentage of patients reporting chronic headache, defined as 15 or more headache days a month. This number almost doubled from 6.8% in the AMPP study to 11.7% in the OVERCOME study.

Possible Contributors

These findings could merely be an artifact of using different tools to assess burden, Cohen noted. Early studies were all mail-in or phone surveys or both. However, starting in 2012, surveys were conducted using online panels, he added.

“It could very well be that this change in methodology, this change in participant interaction, is leading to some kind of bias,” said Cohen, who in the fall will be clinical assistant professor of medicine and neurology at Mount Sinai in New York City.

In addition, responder rates in these studies have declined over time, which could bias outcomes, he noted.

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Still, the increased burden could be real and could be caused by a host of possible factors including, for example, a change in use of opioids, which previous studies have shown makes headaches worse.

Of interest, Cohen noted that opioid use “did not go up for the most part” over the course of the analysis.

Investigators also investigated employment, but again, this did not seem to be a factor in the findings. “The employment rate has not recovered from the 2008 recession,” said Cohen.

Climate change could also contribute to the rise in migraine burden, as environmental factors such as change in barometric pressure are a common migraine trigger. Cohen said that new research points to natural disasters as an important contributor to migraine.

There are also changes in cultural views of migraine and stigma that might affect burden, he added. Whereas stigma “wasn’t even talked about in the 1990s,” it’s now being acknowledged and discussed, even though the issue is still “not solved,” said Cohen.

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Increased Disclosure?

Commenting for Medscape Medical News, Matthew S. Robbins, MD, associate professor of neurology, Weill Cornell Medicine, New York City, called the systematic review “intriguing.”

“It’s possible that migraine simply has evolved to become a more severe disorder over time,” said Robbins, who was not involved with the research.

He noted that reasons this trend disproportionately affects women needs to be explored.

However, it’s also possible that a reporting bias in individuals with migraine that has developed over the years, he said.

“It could be migraine is more well accepted as a major cause of disability and people feel more comfortable disclosing symptoms and their impact,” Robbins concluded.

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The investigators and Robbins reported no relevant financial relationships.

American Headache Society (AHS) Annual Meeting 2022. Scientific Session 1. Presented June 10, 2022.

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A Relationship Therapist Ranked the Most Problematic Disney Romances

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A Relationship Therapist Ranked the Most Problematic Disney Romances

Disney romances have long been critiqued for being, well, entirely unrealistic. Not only have animated cartoons set some seriously unobtainable romantic standards for us all, but there are some pretty concerning themes presented in classic children’s movies. Falling in love with a literal vendetta-driven Beast aside—ehm, Belle—consent and logic are often missing from the fictional relationships, not to mention a fairly standard period of getting to know each other before going all in.

So what does a relationship therapist have to say about all this?

In a recent YouTube video, relationship therapist Jonathan Decker analyzed a random assortment of Disney romantic relationships to see which are most problematic and which actually have a solid basis. Testing their partnerships in the battle-royal are animated couples Alladin and Jasmine, Cinderella and Prince Charming, Fix-It Felix and Calhoun from Wreck-It Ralph, Rapunzel and Eugene from Tangled, Simba and Nala from The Lion King, and Snow White and Prince Florian.

Out of the selected couples, Decker ranks Snow White and Prince Florian (yes, the prince as a name — and it apparently is that) as the most problematic pairing. After all, the two meet only once (without talking!) before betrothing themselves to one another with Snow White becoming so scared during that meeting that she literally runs away.

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So this is love? Well, maybe not.

“Snow White, you are experiencing a chemical rush that is probably a combination of responding to his pheromones and being physically attracted to him, and the adrenaline of absolute terror,” Decker says. “So those things combined can be kind of potent. Doesn’t mean it’s love.”

That’s all not to mention the little (or, rather, absolutely blatantly massive) issue of consent in their relationship — or lack thereof.

Decker says, “[Snow White] eats the poison apple, she gets knocked out, and then he sees her and is like, ‘I should totally kiss that.’”

Now, remember, Prince Florian has absolutely no idea a kiss will save Snow White from the poison. As Decker says, he just stumbles upon her unconscious and thinks “now’s my window.”

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Obviously, the vintage Disney couple is outdated and problematic by any standards — but what about the least problematic couple of the bunch? Decker says Fix-It Felix and Calhoun from Wreck-It Ralph actually have a relationship to envy, creating a dynamite team and embracing each other’s personalities.

“They accept influence from each other,” Decker says. “On the surface, [Calhoun] is tough, no-nonsense, leads troops into battle — and Felix seems like this really sweet, kind of derpy, doesn’t-really know what he’s doing guy. But she accepts influence from him, he definitely accepts it from her all throughout, and they complement each other. It’s like salty and sweet.”

Though the two may win all-or-nothing video games with their complemenary personalities and differing approaches, they also make each other grow and flourish in their relationship.

“She softens because of his influence, and he toughens up because of her influence,” Decker says. “And there’s kind of a meeting in the middle.”

Curious to find out where the other couples land? Watch the full video above to see get the entire definitive ranking.

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Former MLB Pitcher Kyle Farnsworth Is an Absolutely Shredded Bodybuilder Now

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Former MLB Pitcher Kyle Farnsworth Is an Absolutely Shredded Bodybuilder Now

houston astros v minnesota twins

Brace HemmelgarnGetty Images

You may know Kyle Farnsworth for his 17-year Major League Baseball career spanning from 1999 to 2014. Though the 46-year-old former pitcher left the major leagues in 2014, he hasn’t let his love of fitness falter. In fact, Farnsworth is now an absolutely jacked bodybuilder in his “retirement.”

Once sporting a relatively-slim baseball player physique, Farnsworth recently captured headlines for his status as a bludging competitive bodybuilder. In a recent YouTube video, Athlean-X trainer Jeff Cavaliere broke down Farnsworth’s incredible physical transformation—and why it may not be as surprising as it seems.

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“No doubt, he looks like an absolute beast,” Cavaliere says of Farnsworth’s current physique. “The vascularity is sort of crazy, the size is ridiculous, the legs are absolutely shredded and humongous…Basically, Kyle Farnsworth is a big, jacked dude.”

At 6’4″ and currently 240 pounds, Cavaliere says Farnsworth has always had bodybuilding potential from a genetic standpoint, adding that he was also “one of the hardest workers in the room,” giving him the ability to capitalize on the hereditary leg-up.

“He was an anomaly when it came to baseball players, especially as a pitcher,” Cavaliere says in the video. “His size and his overall appearance were not what you would typically see. So he was always big.”

Cavaliere, who worked for the Mets from 2006 to 2008, was with the New York-based team at the same time that Farnsworth played for the Yankees. The trainer said he personally would see the pitcher “cranking out” countless leg extensions before any other players showed up on game day, showing his bodybuilding potential several years ago.

“I didn’t really see that as being the best, most functional way to train for his sport. Step-ups, lunges — there are better things that he could do,” Cavaliere said. “But he did a lot of leg extensions, so the fact that he’s now become a bodybuilder certainly doesn’t surprise me at all because I always wondered if he was more interested in bodybuilding versus pitching.”

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Cavaliere also mentions the possibility of performance-enhancing drugs playing a role in the transformation, though the speculation is just that — entirely speculation. Yet, the trainer says performance-enhancers were a reality of the baseball era Farnsworth played in, citing that the former pitcher was on the receiving end of some PED rumors during his major league tenure.

During his time in the major leagues, the pitcher played for several teams from 1999 to 2014. He signed with the Chicago Cubs in 1999, playing with the team until 2004. He was then traded to the Detroit Tigers in 2005, then traded again to the Atlanta Braves later that same year. Farnsworth signed with the New York Yankees in 2006, playing with the team until 2008. In 2008, he was traded back to the Tigers, but swiftly signed to the Kansas City Royals from 2009-2010. In 2010, Farnsworth was traded back to the Braves, then signed with the Tampa Bay Rays from 2011 to 2013. In 2013, he traded to the Pittsburgh Pirates, then to the New York Mets in 2014. He wrapped up his MLB career with the Houston Astros in 2014.

You can watch the entire video below:

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‘Pam and Tommy’ Originally Wanted Chris Evans to Voice Tommy Lee’s Penis

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‘Pam and Tommy’ Originally Wanted Chris Evans to Voice Tommy Lee’s Penis

If a penis could talk, what would it sound like? That’s the burning question creators of Hulu’s Pam & Tommy had to grapple with when creating the now-infamous talking penis scene in the biopic series.

Well, according to Sebastian Stan, who stars as Tommy Lee in the series, the show’s creative team originally thought Lee’s penis would sound something like Chris Evans.

In a recent interview with Awards Daily, Stan revealed that he shot the comedic yet vulnerable scene not knowing who would voice the prosthetic appendage.

“He actually wasn’t there on the day,” Stan told the outlet. “We didn’t know who we were going to get at that point. The guys, I think, called me at one point and were like, ‘What do you think? Do you think Chris Evans would do this with you?’ And I was like, ‘I’m not calling him, OK?’”

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Just consider it: Captain America voicing Bucky Barnes’ penis? What in the MCU multiverse…

Eventually, the role ended up going to Big Mouth and Brooklyn Nine-Nine actor Jason Mantzoukas, whose delightfully brash voice is inarguably perfect for Tommy Lee’s sentient penis.

In a February interview with Entertainment Weekly, showrunner Rob Siegel revealed some of the inner workings of creating the oddly captivating scene with a puppet-like animatronic penis, which was created from a lifecast of Stan’s actual appendage.

“I can’t think of a more fun and cuddly way to get away with extended full-frontal male nudity,” Siegel said. “It’s a puppet, it’s like Yoda.”

To get a seamless look that makes it appear like Stan is standing nude and not with a puppet hanging from his member, the SFX team used a lot of glue (ouch) and paint to secure and blend the appendage.

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“There were wires running between his legs from behind, and a guy crouched on the floor with joysticks, mechanically controlling what’s going on,” showrunner D.V. DeVincentis told Entertainment Weekly. “That animatronic guy had to look in a mirror and sort of really act with Sebastian physically, like all the gestures and the nods and looks up, and we had to actually direct that. I’ve never done anything quite like that.”

Truly, that’s not surprising.

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