Date post: | 13-Apr-2017 |
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#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
Berengueres & Cadiou | 2
Outline
1. Migraine: Review of what we know2. Why collecting data with a Smartphone?3. Triggers4. Symptoms5. Pain locations6. Outcomes7. Discussion
Berengueres & Cadiou | 3
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
Berengueres & Cadiou | 4
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
Berengueres & Cadiou | 7
Advice
DataReal Time
New Questions
Drug Co. Dashboard
Migraineuser
The Virtuous Circle of iHealth
A.I+Cloud
Berengueres & Cadiou | 8
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
Berengueres & Cadiou | 9
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
Berengueres & Cadiou | 10
3. Triggers: by country
Berengueres & Cadiou | 11
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
Berengueres & Cadiou | 12
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
Berengueres & Cadiou | 13
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
Berengueres & Cadiou | 14
4. Symptoms: by country
en_CAen_GBen_USes_ESes_USfr_FRja_JP
% M
igra
ines
Berengueres & Cadiou | 15
4. Symptoms: by country
0
50
100
150
ja_JPfr_FRes_USes_ESen_USen_GBen_CA
% o
f mig
rain
es
Berengueres & Cadiou | 16
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
Berengueres & Cadiou | 17
5. Pain locations: touch based data collection
Berengueres & Cadiou | 18
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
Berengueres & Cadiou | 19
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
Berengueres & Cadiou | 20
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
Berengueres & Cadiou | 21
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)
Berengueres & Cadiou | 24
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
Berengueres & Cadiou | 25
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
Berengueres & Cadiou | 26
8. Acknowledgement