***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Migraine frequently co-occurs with and is triggered by sleep disturbance , particularly insomnia , and the large majority of patients with chronic migraine ( CM ) have comorbid insomnia . Limited evidence suggests that behavioral regulation of sleep may reduce migraine frequency , but studies to date have not assessed the viability of stimulus control and sleep restriction interventions or included objective measurement of sleep parameters . The aim of this study , thus , was to pilot-test the efficacy of a brief behavioral insomnia intervention for adults with CM and comorbid insomnia ; headache diaries and actigraphy were included to assess outcomes throughout the trial . METHODS This r and omized parallel-arm pilot trial recruited adults with both CM and comorbid insomnia . Participants were r and omly assigned to three 30-minute biweekly sessions of cognitive-behavioral therapy for insomnia ( CBTi ) or control treatment . Participants were blinded to treatment and control conditions to control for outcome expectations . Each treatment condition involved training in and daily practice in 5 instructions/skills . The CBTi group learned and practice d skills pertaining to stimulus control and sleep restriction . The control intervention was the same as used by Calhoun and Ford ( 2007 ) and involved training in and daily practice of skills pertaining to keeping a consistent food/liquid intake , range of motion exercises , and acupressure . Participants provided outcome data via daily headache diaries , actigraphy , and self-report measures . The primary outcome was reduction in headache frequency at 2 weeks post-treatment and 6-week follow-up ; secondary outcomes included other headache parameters , objective actigraphic and subjective changes in sleep , and treatment effect sizes and perceived credibility . Generalized estimating equations with a binomial logit link and inverse probability weights were used to assess the primary outcome among the intent-to-treat sample , and repeated measures generalized linear models were used to assess changes in secondary outcomes after controlling for baseline values . RESULTS The intent-to-treat analyses included 31 adults ( M age = 30.8 [ 12.9 ] years ; 90.3 % female ; 80.6 % white ) with CM and comorbid insomnia . Both interventions yielded reductions in headache frequency at post-treatment ( 26.9 % reduction for CBTi vs. 36.2 % for control ) and follow-up ( 48.9 % for CBTi vs. 25.0 % for control ) . At follow-up the odds of experiencing headache were 60 % lower for CBTi than for control treatment , indicative of a large effect size that did not reach statistical significance after Bonferroni correction for assessing two primary endpoints ( odds ratio : 0.40 ; 95 % CI : 0.17 , 0.91 ; P = .028 ) . CBTi produced significantly larger increases than control treatment in total sleep time and sleep efficiency as quantified by actigraphy , as well as in self-reported insomnia severity . Adherence was high and treatments were perceived as credible without differences between groups , but the control group experienced a higher rate of dropouts . No adverse events were reported . CONCLUSIONS Behavioral treatment of comorbid insomnia in individuals with CM produced large reductions in headache frequency , though some improvement in headache occurred with a behavioral intervention not focused on modifying sleep . Among the CBTi group only , both headache frequency and sleep parameters continued to improve after treatment , suggesting the presence of enduring effects over time . Directly treating insomnia using components of stimulus control and sleep restriction holds promise for reducing comorbid migraine . Development of and comparison to a truly inert pseudotherapy control presents unique challenges that future studies should address CONTEXT A previous cross-sectional study showed an association of migraine with a higher prevalence of magnetic resonance imaging (MRI)-measured ischemic lesions in the brain . OBJECTIVE To determine whether women or men with migraine ( with and without aura ) have a higher incidence of brain lesions 9 years after initial MRI , whether migraine frequency was associated with progression of brain lesions , and whether progression of brain lesions was associated with cognitive decline . DESIGN , SETTING , AND PARTICIPANTS In a follow-up of the 2000 Cerebral Abnormalities in Migraine , an Epidemiological Risk Analysis cohort , a prospect i ve population -based observational study of Dutch participants with migraine and an age- and sex-matched control group , 203 of the 295 baseline participants in the migraine group and 83 of 140 in the control group underwent MRI scan in 2009  to identify progression of MRI-measured brain lesions . Comparisons were adjusted for age , sex , hypertension , diabetes , and educational level . The participants in the migraine group were a mean 57 years ( range , 43 - 72 years ) , and 71 % were women . Those in the control group were a mean 55 years ( range , 44 - 71 years ) , and 69 % were women . MAIN OUTCOME MEASURES Progression of MRI-measured cerebral deep white matter hyperintensities , infratentorial hyperintensities , and posterior circulation territory infa rct like lesions . Change in cognition was also measured . RESULTS Of the 145 women in the migraine group , 112 ( 77 % ) vs 33 of 55 women ( 60 % ) in the control group had progression of deep white matter hyperintensities ( adjusted odds ratio [ OR ] , 2.1 ; 95%CI , 1.0 - 4.1 ; P = .04 ) . There were no significant associations of migraine with progression of infratentorial hyperintensities : 21 participants ( 15 % ) in the migraine group and 1 of 57 participants ( 2 % ) in the control group showed progression ( adjusted OR , 7.7 ; 95 % CI , 1.0 - 59.5 ; P = .05 ) or new posterior circulation territory infa rct like lesions : 10 of 203 participants ( 5 % ) in the migraine group but none of 83 in the control group ( P = .07 ) . There was no association of number or frequency of migraine headaches with progression of lesions . There was no significant association of high vs nonhigh deep white matter hyperintensity load with change in cognitive scores ( -3.7 in the migraine group vs 1.4 in the control group ; 95 % CI , -4.4 to 0.2 ; adjusted P = .07 ) . CONCLUSIONS In a community-based cohort followed up after 9 years , women with migraine had a higher incidence of deep white matter hyperintensities but did not have significantly higher progression of other MRI-measured brain changes . There was no association of migraine with progression of any MRI-measured brain lesions in men Objective To test whether behavioral weight loss ( BWL ) intervention decreases  headaches in women with comorbid migraine and overweight/obesity . Methods This r and omized , single-blind trial allocated women [ 18–50 years old , 4–20 migraine days/month , Body Mass Index ( BMI ) = 25.0–49.9 kg/m2 ] to 16 weeks of BWL  , ( n=54 ) that targeted exercise and eating behaviors for weight loss , or Migraine Education control ( ME , n=56 ) that delivered didactic instruction on migraine and treatments . Participants completed a 4-week smartphone headache diary  at baseline , post-treatment ( 16–20 weeks ) and follow-up ( 32–36 weeks ) . The primary outcome was post-treatment change in migraine days/month , analyzed via linear mixed effects models . Results Of 110 participants r and omized , 85 ( 78 % ) and 80 ( 73 % ) completed post-treatment and follow-up . Although BWL achieved greater weight loss [ mean ( 95 % CI ) kg ] vs. ME at post-treatment [ −3.8 ( −2.5 , −5.0 ) vs. + 0.9 ( −0.4,2.2 ) p<.001 ] and follow-up [ −3.2 ( −2.0 , −4.5 ) vs. + 1.1 ( −0.2,2.4 ) , p<.001 ] , there were no significant group ( BWL vs. ME ) differences [ mean ( 95%CI ) ] migraine days/month at post-treatment [ −3.0 ( −2.0 , −4.0 ) vs. −4.0 ( −2.9 , −5.0 ) , p=.185 ] or follow-up [ −3.8 ( −2.7 , −4.8 ) vs. −4.4 ( −3.4 , −5.5 ) , p=.378 ] . Conclusion Contrary to hypotheses , BWL and ME yielded similar , sustained reductions in migraine headaches . Future research should evaluate whether adding BWL to st and ard pharmacologic and /or non-pharmacologic migraine treatment approaches yields greater benefits Chronic daily headache ( CDH ) , when defined as ≥ 15 headache days per month , affects 3 - 5 % of the adult population . Major life changes are putative precipitating events for onset of chronic pain , including chronic headache . This study compared the occurrence of specific life events between CDH cases and episodic headache controls in a community sample . CDH cases ( 180 + headache days per year : n = 206 ) and episodic headache controls ( 2 - 104 headache days per year : n = 507 ) were identified from a r and omly selected adult US population . Subjects were interviewed about the occurrence of certain major life changes or events ( change of residence , employment status , marital status , related to their children , deaths of relatives or close friends , and ‘ extremely stressful ’ ongoing situations )  occurring in a defined time period . Events that occurred during the same year or year before frequent headache onset in cases or in an equivalent time period in controls were considered to be antecedent events . Those that occurred after this time were considered subsequent events . Compared with episodic headache controls , CDH cases had more major life changes in the year before or same year as CDH onset . After adjusting for age , gender , headache type and year of event , the odds of CDH increased additionally with each antecedent event [ odds ratio ( OR ) 1.20 ( 1.1 , 1.3 ) , P < 0.001 ] , but not with subsequent events [ OR 0.94 ( 0.8 , 1.1 ) , P < 0.4 ] . In secondary analyses , the association between antecedent events and CDH was significant only for the approximately half of CDH cases who were aged ≥ 40 years [ OR 1.33 ( 1.2 , 1.50 ) vs. OR 1.04 ( 0.9 , 1.2 ) , P < 0.05 for interaction by age ] . These results suggest that major life changes are associated with the onset of chronic daily headache , particularly in middle age Objectives : Research increasingly suggests that obesity is an exacerbating factor for migraine . However , it is less clear whether weight loss may help to alleviate  migraine in obese individuals . We examined whether weight loss after bariatric surgery is associated with improvements in migraine headaches . Methods : In this prospect i ve observational study , 24 patients who had migraine according to the ID-Migraine screener were assessed before and 6 months after bariatric surgery .  At both time points , patients had their weight measured and reported on frequency of headache days , average headache pain severity , and headache-related disability over the past 90 days via the Migraine Disability Assessment question naire . Changes in headache measures and the relation of weight loss to these changes were assessed using paired- sample t tests and logistic regression , respectively . Results : Patients were mostly female ( 88 % ) , middle-aged ( mean age 39.3 ) , and severely obese ( mean body mass index 46.6 ) at baseline  . Mean ( ±SD ) number of headache days was reduced from 11.1 ± 10.3 preoperatively to 6.7 ± 8.2 postoperatively ( p < 0.05 ) , after a mean percent excess weight loss ( % EWL ) of 49.4 % . The odds of experiencing a ≥50 % reduction in headache days was related to greater % EWL , independent of surgery type ( p < 0.05 ) . Reductions in severity were also observed ( p < 0.05 ) and the number of patients reporting moderate to severe disability decreased from 12 ( 50.0 % ) before surgery to 3 ( 12.5 % ) after surgery ( p < 0.01 ) . Conclusions : Severely obese migraineurs experience marked alleviation of headaches after significant weight reduction via bariatric surgery . Future studies are needed to determine whether more modest , behaviorally produced weight losses can effect similar migraine improvements . Classification of evidence : This study provides Class III evidence that bariatric surgery is associated with reduction of migraine headaches in severely obese individuals BACKGROUND Sleep problems have been linked with headaches for more than a century , but whether the headaches are the cause or the result of the disrupted sleep is unknown . OBJECTIVES We previously reported that nonrestorative sleep and poor sleep habits are almost universal in a referral population of women with transformed migraine ( TM ) . Since cognitive behavioral therapy is effective in improving sleep quality in individuals with poor sleep hygiene , we design ed a r and omized , placebo-controlled study to assess the impact of such treatment on TM . We hypothesized that behavioral sleep modification ( BSM ) would be associated with improvement in headache frequency and intensity and with reversion to episodic migraine . METHODS Subjects were 43 women with TM referred to an academic headache center . After obtaining informed consent , patients were r and omized to receive either behavioral sleep instructions or placebo behavioral instructions in addition to 
    Output:
    
A range of risk factors for the new onset of CM/TM , CDH , or related chronic headache diseases were identified with the strongest data supporting increased headache day frequency , acute medication overuse/high-frequency use and depression , which are potentially modifiable risk factors .
Development of central sensitization and increased activation of the trigeminal nociceptive pathways may be drivers of the new onset of CM or CDH .