ieee / embc global migraine factors as reported by smartphone users

#embc16

Migraine factors as reported by smartphone users

Jose Berengueres& Francois Cadiou

The 38th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC’16), Walt Disney World® Resort, Lake Buena Vista (Orlando), Florida USA.

Oral session: Biomarkers and Global HealthcareTrack 14: Sorcerers Apprentice 2

Wednesday, August 17, 2016, 08:00-09:30

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Outline

1. Migraine: Review of what we know2. Why collecting data with a Smartphone?3. Triggers4. Symptoms5. Pain locations6. Outcomes7. Discussion

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1. Migraine: Review of what we know

1. It is a Neurological disorder• 4.7% affected• Medical Cost $200/year • Pathogenesis: not well understood

2. Typical clinical study sample size• N ~ 50 (1980)• N ~ 500 (1990)• N ~ 65,000 (2000)• N ~ 1,000,000 (this study, not clinical)

3. Q: What are the most common triggers of migraine according to you?• Chocolate, Cheese, Wine, Temperature,

Menstruation or Pollution

4. Selection Bias• Emergency room visit only• Geographic• Cautionary tale (Beijing pollution in winter)

Evolution

Screenshots

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2. Why collecting data with Smartphone?

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2. Why collecting data with Smartphone?

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Advice

Data

New Questions

Drug Co. Dashboard

Migraineuser

The Virtuous Circle of iHealth: Drivers & levers

A.I+Cloud

X

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Advice

DataReal Time

New Questions

Drug Co. Dashboard

Migraineuser

The Virtuous Circle of iHealth

A.I+Cloud

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2. Why collecting data with Smartphone?

1. Clinical vs. Observational• Clinical +Control• Smartphone +Convenience• Smartphone less transformation steps

2. App stats• 65k active users• 800k migraines logged• 87% female

3. Face to face vs. screen mediated• Honesty• Convenience

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3. Triggers: Global

Stress

Lack

of sl

eep

Anxiet

y

Skippe

d a m

eal

Wea

ther

Physic

al ex

ercise

Neck p

ain

Caffein

e

Irreg

ular s

leep

Dehyd

ration

Alcoho

l

Proces

sed f

oodSinu

s

Rebou

nd

Bright

light

Fatigu

e

Menstr

uatio

n

Salty f

ood

Low pr

essu

reHea

t0

5

10

15

20

25

Per

cent

Stress

Lack

of sl

eep

Anxiet

y

Skippe

d a m

eal

Wea

ther

Physic

al ex

ercise

Neck p

ain

Caffein

e

Irreg

ular s

leep

Dehyd

ration

Alcoho

l0

5

10

15

20

25

30en_CAen_GBen_USes_ESes_USfr_FRjp_JP

Per

cent

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3. Triggers: by country

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3. Triggers: by country stack bar

Stress

Lack

of sl

eep

Anxiet

y

Neck p

ain

Skippe

d a m

eal

Irreg

ular s

leep

Physic

al Exe

rcise

Wea

ther

Alcoho

l

Caffein

e

Dehyd

ration

Proces

sed f

ood

Rebou

nd

Fatigu

e

Bright

Light/

Sun0

20

40

60

80

100

120

140

160

180

en_CAen_GBen_USes_ESes_USfr_FRja_JP

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3. Triggers: outliers, by conditional probability of locale given the trigger

Stress

Lack

of sl

eep

Anxiet

y

Neck p

ain

Skippe

d a m

eal

Irreg

ular s

leep

Physic

al Exe

rcise

Wea

ther

Alcoho

l

Caffein

e

Dehyd

ration

Proces

sed f

ood

Rebou

nd

Fatigu

e

Bright

Light/

Sun0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

en_CA en_GB en_US es_ES es_US fr_FR ja_JP

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4. Symptoms: Global

Sensit

ivity

to lig

ht

Neck p

ain

Sensit

ivity

to no

ise

Nause

a

Nasal

cong

estio

n

Depres

sed m

ood

Anxiet

y

Sensit

ivity

to sm

ell

Dizzine

ss

Insom

nia

Fatigu

eNon

e

Vomitin

g

Moody

Blurred

visio

n

Light

head

ed

Tinnitu

sHea

t

Diarrhe

a

Eye pa

in0

5

10

15

20

25

Per

cent

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4. Symptoms: by country

en_CAen_GBen_USes_ESes_USfr_FRja_JP

% M

igra

ines

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4. Symptoms: by country

0

50

100

150

ja_JPfr_FRes_USes_ESen_USen_GBen_CA

% o

f mig

rain

es

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4. Symptoms: outliers by conditional probability

Sensiti

vity t

o light

Neck pain

Sensiti

vity t

o noise

Nausea

Nasal co

ngesti

on

Depres

sed m

ood

Anxiety

Sensiti

vity t

o smell

Dizziness

Insomnia

Fatigu

eNone

Vomiting

Moody

Blurred vis

ion

Light h

eaded

Tinnitu

sHea

t0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

en_CA en_GB en_US es_ES es_US fr_FR ja_JP

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5. Pain locations: touch based data collection

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5. Pain locations: global

Front head

Eye

Back head

Top back head

Neck

Temple

Between eyes

Cheek

Jaw

0 5 10 15 20 25 30

% onset pain locations

Front head

Eye

Back head

Top back head

Neck

Temple

Between eyes

Cheek

Jaw

47% 50% 53%

L R

% onset pain locations

RightLeft

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5. Pain locations: by country

Back head

Eye

Frontal

Neck

Temple

Top back head

-3.0 0.0 3.0 6.0

ja_JP

fr_FR

es_US

es_ES

en_US

en_GB

en_CA

Spread = % (R-L)/(R+L) migraines logged

L

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5. Pain locations: JP vs non-JP asymmetry. Genetic, cultural, or language induced?

Back Head

Cheek

Eye

Head

Neck

Temple

Top Back Head

Grand Total

-12 -10 -8 -6 -4 -2 0 2 4 6

jp non_jp

L

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6. Outcomes: How drugs are priced in the US

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6. Outcomes: How drugs are priced in the US

R2= 0.53

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7. Discussion: web survey vs. Migraine Buddy App

Other PC-based surveys… (PC-bias)

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7. Discussion: Migraine Buddy App vs. migraine.com web survey (triggers)

Stress

Lack

of sl

eep

Anxiet

y

Skippe

d a m

eal

Wea

ther

Physic

al ex

ercise

Neck p

ain

Caffein

e

Irreg

ular s

leep

Dehyd

ration

Alcoho

l

Proces

sed f

oodSinu

s

Rebou

nd

Bright

light

Fatigu

e

Menstr

uatio

n

Salty f

ood

Low pr

essu

reHea

t0

5

10

15

20

25

Per

cent

Sleep

Stress

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7. Discussion

1. Discrepancies by locale:• Lost in translation sinus• Geographic/culture factor skipped a meal• Unknown factor

• (UX/UI/Lang/DNA/?) pain asymmetry JPN vs non JPN

2. Popular triggers vs what research actually focuses on• We found top triggers anxiety & stress• Not top menstruation, weather, food• However, most studies focus on weather, food)

3. We show an alternative to case crossover studies• more global, convenient and wider in scope • All approaches suffer bias (ER bias, smartphone

bias, geographic bias…)

4. Further works: 1. Migraine waves / AI2. Could not replicate correlation with temperature

from other studies (Boston ref. Mittelmann)

1. Review2. Why Smartphone3. Triggers4. Symptoms5. Pain locations6. Outcomes7. Discussion

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8. Acknowledgement