How specific are risk factors for headache in adolescents? Results from a cross-sectional study in Germany.

PubMed

Lehmann, Steffi; Milde-Busch, Astrid; Straube, Andreas; von Kries, Ruediger; Heinen, Florian

2013-02-01

The identified preventable risk factors for primary headache in adolescents are smoking; consumption of coffee or alcoholic mixed drinks; physical inactivity; muscle pain in the head, neck, or shoulder region; and chronic stress. To investigate the interrelation of headache with other health complaints and the specificity of the above-mentioned risk factors for headache in adolescents. A total of 1,260 students (grades 10 and 11) filled in questionnaires on headache, dietary, and lifestyle factors. The type of headache and health complaints such as dizziness, abdominal pain, musculoskeletal pains, symptoms of possible fatigue syndrome, and psychic complaints were assessed. Isolated headache was found in 18% of the headache sufferers; most frequently isolated tension-type headache (78.2%). Only among adolescents with a combination of headache (mainly migraine) and other health complaints, significant associations for almost all analyzed risk factors were found. The strength of the associations with the considered risk factors was very similar in all three analyzed strata except for considerably lower odds ratios for isolated headache. All analyzed risk factors are nonspecific for headache in adolescents because they also increase the risk for other health complaints. Interventions, therefore, should consider a holistic approach focusing not only on headache but also on a broader spectrum of health complaints. Georg Thieme Verlag KG Stuttgart · New York.

The prevalence of headache in Greece: correlations to latitude and climatological factors.

PubMed

Mitsikostas, D D; Tsaklakidou, D; Athanasiadis, N; Thomas, A

1996-03-01

A questionnaire study on headaches, using a door-to-door survey, was carried out in a representative sample of the general Greek population, including 1737 men and 1764 women, from 15 to 75 years of age. The parameters evaluated included age, sex, education, socioeconomic status, region of domicile, frequency of headache, use of medication, medical consultation, and family history. Latitude and climatologic factors such as humidity, temperature, and atmospheric pressure were also investigated. Headaches were not classified because the interviewers were not specialists. Nineteen percent of men and 40% of women (mean 29%) suffered from headaches in the prior year. Headaches were more frequent in lower social classes, in people with less education, and in those between 45 and 64 years of age. Nineteen percent of sufferers did not take any medication and 33% used medication every time that they had a headache, while 36% sought medical consultation. Twenty-nine percent of headache sufferers had a family history of headaches. Daily headache was present in 15% of headache sufferers. Humidity and atmospheric pressure were not correlated to headache frequency. However, in the northern areas of Greece, as well as in the regions with low mean temperature, more people suffered from daily headaches. These data may explain the lower 1-year prevalence of headaches in other Greece as compared to the prevalence of headaches in other northern European countries.

Menstruation-related Headache in Adolescents: Point Prevalence and Associated Factors.

PubMed

Carman, K B; Arslantas, D; Unsal, A; Atay, E; Ocal, E E; Demirtas, Z; Saglan, R; Dinleyici, M; Yarar, C

2018-04-02

To study the prevalence of menstruation-related headache and the impact of associated factors in adolescents. This cross-sectional study was conducted in seven randomly selected high schools, and 3,886 girls attending those schools were invited. After the consent of the school principals, a final total of 2,485 girls (63.9%) were involved in the study. A specific questionnaire was distributed to adolescent girls (14-19 years old). The first part of the survey investigated the features of menstruation (age of first menstruation, duration of period, pad fully soaked per day). The last part of the questionnaire surveyed the presence of headache during the menstruation period. The severity of headache was measured by a visual analogue scale. Lastly, participants were requested to complete the Beck Depression Inventory (BDI). The prevalence of menstruation-related headache and associated factors were studied. The mean age of the study group was 15.89 ± 1.07 (14-19) years old. The age of onset of menarche was younger than 12 years old in 32.4% of girls, and mean age of onset of menarche was 12.96 ± 1.09 years old. The prevalence of menstruation-related headache was calculated to be 25.9% (n = 646). The onset of menstruation before the age of 12 years old, longer duration of menstruation period, dysmenorrhea, daily consumption of coffee and cola and smoking significantly affected the frequency of menstruation-related headache. The mean scores of the BDI were calculated as 21.68 ± 13.65 and a significant relationship was found between headache and BDI scores. Our study indicates that menstruation-related headache is a common problem of adolescent girls. It might be associated with different comorbidities such as depression. Accordingly, a multidisciplinary treatment approach must be considered to improve their life quality. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

New daily-persistent headache versus tension-type headache.

PubMed

Robbins, Matthew S; Crystal, Sara C

2010-12-01

New daily-persistent headache (NDPH) and chronic tension-type headache (CTTH) are two forms of primary chronic daily headache of long duration that often are similar in their headache manifestations. NDPH distinguishes itself from CTTH and the other forms of chronic daily headache by its continuous head pain from onset. However, despite formalized criteria that specify NDPH must resemble the acute onset of a headache identical to that of CTTH, NDPH commonly has migraine features. Here, we review the available literature on NDPH and compare its clinical features, epidemiology, prognosis, inciting factors, and treatment to CTTH.

Precipitating and Relieving Factors of Migraine Headache in 200 Iraqi Kurdish Patients

PubMed Central

Al-Shimmery, Ehsan K.

2010-01-01

Objectives To study the precipitating and relieving factors of migraine headache in a group of Iraqi Kurdish patients including the effect of fasting in Ramadan, and to estimate the percentage of family history of migraine. Methods A series of 200 migraine cases from different parts of the Kurdistan region in the North of Iraq attending the out-patient Neurology clinic at Rizgary Teaching Hospital and a private Neurology clinic at Erbil City was carried out between October 2007 and May 2008 were reviewed. The precipitating factors and relieving factors for migraine headache were registered and tabulated to be compared with others. Case definition of migraine was based on the International Headache Society (IHS) criteria. Results 33% of the patients were aged between 30-39 years, while 40.5% of patients experienced their first attack aged between 20-29 years. Stress or psychological upset was the commonest triggering factor (80%), followed by increasing physical activity (68%), change in weather (65.5%), and in relation to fasting (65%). Fasting in Ramadan was a triggering factor for headaches in 65% of patients. However, there was no significant association between the triggering factors with regards to sex difference. Relief of migraine in the studied sample was achieved using NSAIDs in 50% of patients, and sleep (45.5%). Hence, 61% of the study population had positive family history of migraine, 32.5% of them reported maternal history of migraine. Conclusion Psychological upset, stress and excessive physical activity were the commonest triggering factors of migraine headache, while NSAID was the commonest relieving factor of migraine in this population. Family history was present in 61% of migraine patients based mainly from maternal root. PMID:22043340

Precipitating and relieving factors of migraine headache in 200 iraqi kurdish patients.

PubMed

Al-Shimmery, Ehsan K

2010-07-01

To study the precipitating and relieving factors of migraine headache in a group of Iraqi Kurdish patients including the effect of fasting in Ramadan, and to estimate the percentage of family history of migraine. A series of 200 migraine cases from different parts of the Kurdistan region in the North of Iraq attending the out-patient Neurology clinic at Rizgary Teaching Hospital and a private Neurology clinic at Erbil City was carried out between October 2007 and May 2008 were reviewed. The precipitating factors and relieving factors for migraine headache were registered and tabulated to be compared with others. Case definition of migraine was based on the International Headache Society (IHS) criteria. 33% of the patients were aged between 30-39 years, while 40.5% of patients experienced their first attack aged between 20-29 years. Stress or psychological upset was the commonest triggering factor (80%), followed by increasing physical activity (68%), change in weather (65.5%), and in relation to fasting (65%). Fasting in Ramadan was a triggering factor for headaches in 65% of patients. However, there was no significant association between the triggering factors with regards to sex difference. Relief of migraine in the studied sample was achieved using NSAIDs in 50% of patients, and sleep (45.5%). Hence, 61% of the study population had positive family history of migraine, 32.5% of them reported maternal history of migraine. Psychological upset, stress and excessive physical activity were the commonest triggering factors of migraine headache, while NSAID was the commonest relieving factor of migraine in this population. Family history was present in 61% of migraine patients based mainly from maternal root.

Tobacco, Nicotine, and Headache.

PubMed

Taylor, Frederick R

2015-01-01

nonsupportive and even conflicting, headache, pain, and tobacco exposure currently remain associated. Conflicting data support the validity of patient-reported environmental tobacco exposure as a headache trigger. Prospective controlled studies are needed, but unlikely to be performed, to determine the extent that tobacco influences the headache process, in addition to other under-recognized factors. Meanwhile, because of numerous other negative health effects, decreased tobacco exposure should be recommended to headache patients of all ages in hopes of decreasing disability and improving functionality. © 2015 American Headache Society.

Rethinking Headache Chronification

PubMed Central

Turner, Dana P.; Smitherman, Todd A.; Penzien, Donald B.; Lipton, Richard B.; Houle, Timothy T.

2013-01-01

The objective of this series is to examine several threats to the interpretation of headache chronification studies that arise from methodological issues. The study of headache chronification has extensively used longitudinal designs with two or more measurement occasions. Unfortunately, application of these designs when combined with the common practice of extreme score selection as well as the extant challenges in measuring headache frequency rates (eg, unreliability, regression to the mean), induces substantive threats to accurate interpretation of findings. Partitioning the amount of observed variance in rates of chronification and remission attributable to regression artifacts is a critical yet previously overlooked step to learning more about headache as a potentially progressive disease. In this series on rethinking headache chronification, we provide an overview of methodological issues in this area (this paper), highlight the influence of rounding error on estimates of headache frequency (second paper), examine the influence of random error and regression artifacts on estimates of chronification and remission (third paper), and consider future directions for this line of research (fourth paper). PMID:23721237

Psychosocial factors associated with migraine and tension-type headache in medical students.

PubMed

Lebedeva, Elena R; Kobzeva, Natalia R; Gilev, Denis V; Kislyak, Nadezhda V; Olesen, Jes

2017-11-01

Background In our previous study of workers, blood donors and medical students, students stood out with a higher 1-year prevalence of migraine (28%) and tension-type headache (TTH) (74%). General factors associated with headache were common for all groups except low physical activity. The hypothesis of this study was therefore that a number of psychosocial factors relating to the personal sphere would better explain the high prevalence of migraine and TTH in students. Methods The study population consisted of 1042 students (719 females, 323 males, mean age 20.6, range 17-40). Headache diagnoses and associated factors were identified by direct professional semi-structured interview. We also interviewed about the following psychosocial factors: dissatisfaction with study, dissatisfaction with family life, dissatisfaction for personal reasons, bad financial situation, overwork, stress, not enough sleep, insomnia, depressed mood, anxiety, irritability, tendency towards conflicts and not being married. We report psychosocial factors associated with headache according to diagnosis and sex using univariate and multivariate logistic regression analyses. Results Several factors were significantly associated with migraine and TTH in the univariate analysis. In the multivariate analysis, two psychosocial factors were statistically significantly associated with migraine in all students: irritability (OR 2.2, 95% CI 1.4-3.6) and overwork (OR 2.2, 95% CI 1.4-3.5). Insomnia (2.7, 95% CI 1.1-6.9) and depressed mood (OR 2.1, 95% CI 1.1-4.2) were associated with migraine only in females. Two psychosocial factors were associated with TTH: dissatisfaction with study in males (OR 2.0, 95% CI 1.0-3.8) and depressed mood in females (OR 1.8, 95% CI 1.0-3.5). Conclusion Psychosocial factors from the personal sphere showed significant association with migraine and TTH in students. Such factors should therefore be major targets for preventive efforts to reduce the prevalence of primary

Cardiovascular Risk Factors in Cluster Headache.

PubMed

Lasaosa, S Santos; Diago, E Bellosta; Calzada, J Navarro; Benito, A Velázquez

2017-06-01

 Patients with cluster headache tend to have a dysregulation of systemic blood pressure such as increased blood pressure variability and decreased nocturnal dipping. This pattern of nocturnal nondipping is associated with end-organ damage and increased risk of cardiovascular disease.  To determine if cluster headache is associated with a higher risk of cardiovascular disease.  Cross-sectional study of 33 cluster headache patients without evidence of cardiovascular disease and 30 age- and gender-matched healthy controls. Ambulatory blood pressure monitoring was performed in all subjects. We evaluate anthropometric, hematologic, and structural parameters (carotid intima-media thickness and ankle-brachial index).  Of the 33 cluster headache patients, 16 (48.5%) were nondippers, a higher percentage than expected. Most of the cluster headache patients (69.7%) also presented a pathological ankle-brachial index. In terms of the carotid intima-media thickness values, 58.3% of the patients were in the 75th percentile, 25% were in the 90th percentile, and 20% were in the 95th percentile. In the control group, only five of the 30 subjects (16.7%) had a nondipper pattern ( P  =   0.004), with 4.54% in the 90th and 95th percentiles ( P  =   0.012 and 0.015).  Compared with healthy controls, patients with cluster headache presented a high incidence (48.5%) of nondipper pattern, pathological ankle-brachial index (69.7%), and intima-media thickness values above the 75th percentile. These findings support the hypothesis that patients with cluster headache present increased risk of cardiovascular disease. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Ice cream headache in students and family history of headache: a cross-sectional epidemiological study.

PubMed

Zierz, Antonia Maria; Mehl, Theresa; Kraya, Torsten; Wienke, Andreas; Zierz, Stephan

2016-06-01

Headache attributed to ingestion of a cold stimulus (ICHD-3 beta 4.5.1) is also known as ice cream headache (ICH). This cross-sectional epidemiological study included 283 students (10-14-year-olds) attending a grammar school in Germany, their parents (n = 401), and 41 teachers. A self-administered questionnaire was used to analyze the prevalence and characteristics of ICH based on the ICHD classification. Additionally, the association between ICH and other headaches was investigated in students and parents. Prevalence of ICH in students was 62 % without gender difference. In adults, only 36 % of females and 22 % of males reported ICH. There was an increased risk for ICH in students when mother (OR 10.7) or father (OR 8.4) had ICH. Other headaches in parents had no influence on the prevalence of ICH in students. However, in the groups of students and parents itself there was a highly significant association between ICH and other headaches (students: OR 2.4, mothers: OR 2.9, fathers: OR 6.8). There was a decreased risk for ICH when parents and students had no headache at all (OR < 0.4). ICH in students clearly shows a familial disposition by both father and mother. There was also an association between ICH and other headaches within the student and adult groups. The absence of headache history seems to be a protective factor for ICH.

Headache triggers in the US military.

PubMed

Theeler, Brett J; Kenney, Kimbra; Prokhorenko, Olga A; Fideli, Ulgen S; Campbell, William; Erickson, Jay C

2010-05-01

Headaches can be triggered by a variety of factors. Military service members have a high prevalence of headache but the factors triggering headaches in military troops have not been identified. The objective of this study is to determine headache triggers in soldiers and military beneficiaries seeking specialty care for headaches. A total of 172 consecutive US Army soldiers and military dependents (civilians) evaluated at the headache clinics of 2 US Army Medical Centers completed a standardized questionnaire about their headache triggers. A total of 150 (87%) patients were active-duty military members and 22 (13%) patients were civilians. In total, 77% of subjects had migraine; 89% of patients reported at least one headache trigger with a mean of 8.3 triggers per patient. A wide variety of headache triggers was seen with the most common categories being environmental factors (74%), stress (67%), consumption-related factors (60%), and fatigue-related factors (57%). The types of headache triggers identified in active-duty service members were similar to those seen in civilians. Stress-related triggers were significantly more common in soldiers. There were no significant differences in trigger types between soldiers with and without a history of head trauma. Headaches in military service members are triggered mostly by the same factors as in civilians with stress being the most common trigger. Knowledge of headache triggers may be useful for developing strategies that reduce headache occurrence in the military.

Hemodialysis-related headache.

PubMed

Sav, Murat Yusuf; Sav, Tansu; Senocak, Elif; Sav, Nadide Melike

2014-10-01

Headache is one of the most frequently encountered neurological symptoms during hemodialysis. According to International Classification of Headache criteria dialysis-related headache was defined as the headache occurring during hemodialysis with no specific characteristic. It resolves spontaneously within 72 hours after the hemodialysis session ends. There are few studies in the literature investigating the clinical features of dialysis headache. The pathophysiology of hemodialysis-related headache is not known, but various triggering factors have been identified, including changes in blood pressure, serum sodium and magnesium levels during hemodialysis sessions, caffeine deprivation and stress. The aim of this article is to evaluate and analyze features of headache in patients undergoing hemodialysis. © 2014 International Society for Hemodialysis.

Chronic daily headache: identification of factors associated with induction and transformation.

PubMed

Bigal, Marcelo E; Sheftell, Fred D; Rapoport, Alan M; Tepper, Stewart J; Lipton, Richard B

2002-01-01

Chronic daily headache (CDH) is one of the more frequently encountered headache syndromes at major tertiary care centers. The analysis of factors related to the transformation from episodic to chronic migraine (CM) and to the de novo development of new daily persistent headache (NDPH) remain poorly understood. To identify somatic factors and lifestyle factors associated with the development of CM and NDPH. We used a randomized case-control design to study the following groups: 1) CM with analgesic overuse (ARH), n = 399; 2) CM without analgesic overuse, n = 158; and 3) NDPH, n = 69. These groups were compared with two control groups: 1) episodic migraine, n = 100; and 2) chronic posttraumatic headache (CPTH); n = 65. Associated medical conditions were assessed. We investigated the case groups for any association with somatic or behavioral factors. Data were analyzed by the two-sided Fischer's exact test, with the odds ratio being calculated considering a 95% confidence interval using the approximation of Woolf. When the active groups were compared with the episodic migraine group, the following associations were found: 1) ARH: hypertension and daily consumption of caffeine; 2) CM: allergies, asthma, hypothyroidism, hypertension, and daily consumption of caffeine; and 3) NDPH: allergies, asthma, hypothyroidism, and consumption of alcohol more than three times per week. The following associations were found when comparing the active groups with CPTH: 1) ARH: asthma and hypertension; 2) CM: allergies, asthma, hypothyroidism, hypertension, and daily consumption of caffeine; and 3) NDPH: allergies, asthma, hypothyroidism, and consumption of alcohol more than three times per week. Several strong correlations were obtained between patients with specific types of CDH and certain somatic conditions or behaviors; some have not been previously described. Transformation of previously episodic headache or development of a NDPH thus may be related to certain medical conditions

Does menopause influence nocturnal awakening with headache?

PubMed

Lucchesi, L M; Hachul, H; Yagihara, F; Santos-Silva, R; Tufik, S; Bittencourt, L

2013-06-01

The aim of the present study was to assess whether menopausal status influences the occurrence of nocturnal awakening with headache (NAH) in the female population of Sao Paulo, Brazil. We also examined the relationship of this complaint to sociodemographic determinants, hot flushes, sleep quality and parameters, anxiety and depressive symptoms, somnolence and fatigue according to menopausal status. The female population of the Sao Paulo Epidemiologic Sleep Study (EPISONO) (n = 576) was divided according to menopausal status (pre-, peri-, early and late menopause) based on questionnaires and hormonal blood measures. The complaint of waking up because of a headache at least once a week was assessed by the UNIFESP Sleep questionnaire. Additionally, hot flushes, sleep complaints, anxiety and depressive symptoms, somnolence and fatigue were assessed by specific questionnaires. A full-night polysomnography assessed sleep parameters. The prevalence of NAH in women in the Sao Paulo population was 13.3%. Perimenopause was associated with a higher risk of having NAH (odds ratio 13.9; 95% confidence interval 4.3-45.2). More complaints of NAH were observed in obese women. All the groups with NAH showed more hot flushes, worse subjective sleep quality, more complaints of insomnia, anxiety symptoms and fatigue. We observed a constellation of symptoms in women according to menopausal status and NAH that included hot flushes, sleep complaints, more anxiety symptoms and fatigue. Moreover, some of these symptoms were more frequent in perimenopausal women with NAH. Therefore, we concluded that menopausal status influences NAH and the women in perimenopause presented a high risk of having this complaint.

Epigenetic changes in headache.

PubMed

Cámara, M S; Martín Bujanda, M; Mendioroz Iriarte, M

2017-12-23

Multiple factors, including both genetic and environmental mechanisms, appear to play a role in the aetiology of headache. An interesting area of study is the possible involvement of epigenetic mechanisms in headache development and the transformation to chronic headache, and the potential role of these factors as a therapeutic target. We performed a literature review of the involvement of different epigenetic mechanisms in headache, mainly using the Medline/PubMed database. To this end, we used the following English search terms: headache, migraine, epigenetics, DNA methylation, histones, non-coding RNA, and miRNA. A total of 15 English-language publications related to the above terms were obtained. There is limited but consistent evidence of the relationship between epigenetics and headache; it is therefore essential to continue research of epigenetic changes in headache. This may help to understand the pathophysiology of headache and even to identify candidate biomarkers and new, more effective, therapeutic targets. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Whiplash headache is transitory worsening of a pre-existing primary headache.

PubMed

Stovner, L J; Obelieniene, D

2008-07-01

Acute and chronic whiplash headache are new diagnostic entities in the ICHD-2 (5.3, 5.4). In a prospective cohort study, 210 rear-end collision victims were identified consecutively from police records and asked about head and neck pain in questionnaires after 2 weeks, 3 months and 1 year. The results were compared with those of matched controls who were also followed for 1 year. Of 210 accident victims, 75 developed headache within 7 days. Of these, 37 had also neck pain and complied with the criteria for acute whiplash headache. These 37 had the same headache diagnoses, headache features, accompanying symptoms and long-term prognosis as the 38 without initial neck pain who therefore did not comply with the acute whiplash headache diagnosis. Previous headache was a major risk factor for headache both in the acute and chronic stage. Compared with the non-traumatized controls, headache in the whiplash group had the same prevalence, the same diagnoses and characteristic features, and the same prognosis. Both acute and chronic whiplash headache lack specificity compared with the headache in a control group, and have the same long-term prognosis, indicating that such headaches are primary headaches, probably elicited by the stress of the situation.

Headache Disorders May Be a Risk Factor for the Development of New Onset Hypothyroidism.

PubMed

Martin, Andrew T; Pinney, Susan M; Xie, Changchun; Herrick, Robert L; Bai, Yun; Buckholz, Jeanette; Martin, Vincent T

2017-01-01

To determine whether headache disorders are a risk factor for the development of new onset hypothyroidism. Past studies have reported associations between headache disorders and hypothyroidism, but the directionality of the association is unknown. This was a longitudinal retrospective cohort study using data from the Fernald Medical Monitoring Program (FMMP). Residents received physical examinations and thyroid function testing every 3 years during the 20 year program. Residents were excluded from the cohort if there was evidence of past thyroid disease or abnormal thyroid function tests at the first office visit. A diagnosis of a headache disorder was established by self-report of "frequent headaches," use of any headache-specific medication, or a physician diagnosis of a headache disorder. The primary outcome measure was new onset hypothyroidism defined as the initiation of thyroid replacement therapy or TSH ≥ 10 without thyroid medication. A Cox survival analysis with time dependent variables were used for the model. Headache disorders, age, sex, body mass index, income, smoking, narcotic use, and hypothyroidism-producing medications were independent variables in the model. Data from 8412 residents enrolled in the FMMP were used in the current study. Headache disorders were present in about 26% of the residents and new onset hypothyroidism developed in ∼7%. The hazard ratio for the development of new onset hypothyroidism was 1.21 (95% CI = 1.001, 1.462) for those with headache disorders. Headache disorders may be associated with an increased risk for the development of new onset hypothyroidism. © 2016 American Headache Society.

Pediatric Headache and Sleep Disturbance: A Comparison of Diagnostic Groups.

PubMed

Rabner, Jonathan; Kaczynski, Karen J; Simons, Laura E; LeBel, Alyssa

2018-02-01

and headache diagnostic factors influencing the severity of sleep disturbance. © 2017 American Headache Society.

Influence of headache frequency on clinical signs and symptoms of TMD in subjects with temple headache and TMD pain

PubMed Central

Anderson, Gary C.; John, Mike T.; Ohrbach, Richard; Nixdorf, Donald R.; Schiffman, Eric L.; Truelove, Edmond S.; List, Thomas

2011-01-01

The relationship of the frequency of temple headache to signs and symptoms of temporomandibular disorders (TMD) was investigated in a subset of a larger convenience sample of community TMD cases. The study sample included: 86 painful TMD, non-headache subjects; 309 painful TMD subjects with varied frequency of temple headaches; and 149 subjects without painful TMD or headache for descriptive comparison. Painful TMD included Research Diagnostic Criteria (RDC) diagnoses of myofascial pain, TMJ arthralgia and TMJ osteoarthritis. Mild to moderate intensity temple headaches were classified by frequency using criteria based on the ICHD-II classification of TTH. Outcomes included TMD signs and symptoms (pain duration, pain intensity, number of painful masticatory sites on palpation, mandibular range of motion), PPTs and temple headache resulting from masticatory provocation tests. Trend analyses across the painful TMD groups showed a substantial trend for aggravation of all of the TMD signs and symptoms associated with increased frequency of the temple headaches. In addition, increased headache frequency showed significant trends associated with reduced PPTs and reported temple headache with masticatory provocation tests. In conclusion, these findings suggest that these headaches may be TMD-related, as well as a possible role for peripheral and central sensitization in TMD patients. PMID:21196079

Depression, automatic thoughts, alexithymia, and assertiveness in patients with tension-type headache.

PubMed

Yücel, Basak; Kora, Kaan; Ozyalçín, Süleyman; Alçalar, Nilüfer; Ozdemir, Ozay; Yücel, Aysen

2002-03-01

The role of psychological factors related to headache has long been a focus of investigation. The aim of this study was to evaluate depression, automatic thoughts, alexithymia, and assertiveness in persons with tension-type headache and to compare the results with those from healthy controls. One hundred five subjects with tension-type headache (according to the criteria of the International Headache Society classification) and 70 controls were studied. The Beck Depression Inventory, Automatic Thoughts Scale, Toronto Alexithymia Scale, and Rathus Assertiveness Schedule were administered to both groups. Sociodemographic variables and headache features were evaluated via a semistructured scale. Compared with healthy controls, the subjects with headache had significantly higher scores on measures of depression, automatic thoughts, and alexithymia and lower scores on assertiveness. Subjects with chronic tension-type headache had higher depression and automatic thoughts scores than those with episodic tension-type headache. These findings suggested that persons with tension-type headache have high depression scores and also may have difficulty with expression of their emotions. Headache frequency appears to influence the likelihood of coexisting depression.

Factors Associated With the Onset and Persistence of Post–Lumbar Puncture Headache

PubMed Central

Monserrate, Andrés E.; Ryman, Davis C.; Ma, Shengmei; Xiong, Chengjie; Noble, James M.; Ringman, John M.; Morris, John C.; Danek, Adrian; Müller-Sarnowski, Felix; Clifford, David B.; McDade, Eric M.; Brooks, William S.; Darby, David G.; Masters, Colin L.; Weston, Philip S. J.; Farlow, Martin R.; Graff-Radford, Neill R.; Salloway, Stephen P.; Fagan, Anne M.; Oliver, Angela; Bateman, Randall J.

2015-01-01

IMPORTANCE This study assesses factors associated with the most common adverse event following lumbar puncture. OBJECTIVE To identify factors associated with the risk, onset, and persistence of post–dural puncture headache (PDPH). DESIGN, SETTING, AND PARTICIPANTS We performed univariate and multivariable analyses of 338 lumbar punctures in the Dominantly Inherited Alzheimer Network observational study using linear mixed models, adjusting for participant-level and family-level random effects. MAIN OUTCOMES AND MEASURES We directly evaluated associations of 3 post–lumbar puncture outcomes (immediate postprocedural headache, PDPH at 24-hour follow-up, and PDPH receiving a therapeutic blood patch) with participant age and sex, positioning, collection method, needle size, needle insertion site, and cerebrospinal fluid (CSF) volume collected. RESULTS The incidence of adverse events included 73 immediate postprocedural headaches (21.6%), 59 PDPHs at 24-hour follow-up (17.5%), and 15 PDPHs receiving a therapeutic blood patch (4.4%). Greater volume of CSF collected was associated with increased risk of immediate postprocedural headache, largely owing to a nonlinear increase in risk on collection of volumes above 30 mL (odds ratio, 3.73 for >30 mL and 0.98 for <17 mL). In contrast, collection of higher volumes showed a protective effect in decreasing rates of PDPH at 24-hour follow-up and rates of PDPH receiving a therapeutic blood patch (odds ratio, 0.35 per 10 mL). Although differences in needle size did not reach statistical significance, no participant in the 24G needle group received a therapeutic blood patch compared to 8 of 253 for the larger 22G needles. CONCLUSIONS AND RELEVANCE Factors that acutely lower CSF pressure (eg, seated positioning or extracting very high volumes of CSF) may be associated with transient post-lumbar puncture headache, without increasing rates of persistent PDPH or therapeutic blood patch. Collection of up to 30 mL of CSF appears to be

Temporomandibular Disorders and Headache: A Retrospective Analysis of 1198 Patients

PubMed Central

Di Paolo, Carlo; D'Urso, Anna; Di Sabato, Francesco; Pompa, Giorgio

2017-01-01

Aim. Headache is one of the most common diseases associated with Temporomandibular Disorders (TMDs). The aim of this study was to evaluate, retrospectively, if headache influences TMD's symptoms. Material and Methods. A total sample of 1198 consecutive TMD patients was selected. After a neurological examination, a diagnosis of headache, according to the latest edition of the International Classification of Headache Disorders, was performed in 625 subjects. Patients were divided into two groups based on presence/absence of headache: Group with Headache (GwH) and Group without Headache (GwoH). Descriptive statistics and Chi-square index were performed. Results. Sociodemographic (gender, marital status, and occupation) and functional factors, occlusion (occlusal and skeletal classes, dental formula, and occlusal abnormalities), and familiar pain did not show a statistically significant correlation in either group. Intensity and frequency of neck pain, arthralgia of TMJ, and myalgia showed higher correlation values in GwH. Conclusion. This study is consistent with previous literature in showing a close relationship between headache and TMD. All data underlines that headache makes pain parameters more intense and frequent. Therefore, an early and multidisciplinary treatment of TMDs should be performed in order to avoid the overlay of painful events that could result in pain chronicity. PMID:28420942

Weekly headache periodicity and the effect of weather changes on headache

NASA Astrophysics Data System (ADS)

Osterman, P. O.; Lövstrand, K. G.; Lundberg, P. O.; Lundquist, S.; Muhr, C.

1981-03-01

A weekly periodicity in the occurrence of headache was found in 53 patients with migraine and in 20 with tension headache during an observation period of four weeks. In the migraine group the frequency was highest on Thursday and on Saturday and lowest on Sunday Monday, and in patients with tension headache it was lowest on Sunday Tuesday and highest on Friday. During the observation period several climatic factors were recorded. After correction for the weekly periodicity a highly significant correlation was found in the migraine group between headache frequency, on the one hand, and atmospheric pressure and outdoor temperature recorded 1 3 days later, on the other.

Overview of diagnosis and management of paediatric headache. Part I: diagnosis.

PubMed

Ozge, Aynur; Termine, Cristiano; Antonaci, Fabio; Natriashvili, Sophia; Guidetti, Vincenzo; Wöber-Bingöl, Ciçek

2011-02-01

Headache is the most common somatic complaint in children and adolescents. The evaluation should include detailed history of children and adolescents completed by detailed general and neurological examinations. Moreover, the possible role of psychological factors, life events and excessively stressful lifestyle in influencing recurrent headache need to be checked. The choice of laboratory tests rests on the differential diagnosis suggested by the history, the character and temporal pattern of the headache, and the physical and neurological examinations. Subjects who have any signs or symptoms of focal/progressive neurological disturbances should be investigated by neuroimaging techniques. The electroencephalogram and other neurophysiological examinations are of limited value in the routine evaluation of headaches. In a primary headache disorder, headache itself is the illness and headache is not attributed to any other disorder (e.g. migraine, tension-type headache, cluster headache and other trigeminal autonomic cephalgias). In secondary headache disorders, headache is the symptom of identifiable structural, metabolic or other abnormality. Red flags include the first or worst headache ever in the life, recent headache onset, increasing severity or frequency, occipital location, awakening from sleep because of headache, headache occurring exclusively in the morning associated with severe vomiting and headache associated with straining. Thus, the differential diagnosis between primary and secondary headaches rests mainly on clinical criteria. A thorough evaluation of headache in children and adolescents is necessary to make the correct diagnosis and initiate treatment, bearing in mind that children with headache are more likely to experience psychosocial adversity and to grow up with an excess of both headache and other physical and psychiatric symptoms and this creates an important healthcare problem for their future life.

Headache

MedlinePlus

... Accessed March 2, 2016 Secondary headaches. American Headache Society Committee for Headache Education. http://www.achenet.org/ ... 2012;30:43. Headache hygiene tips. American Headache Society Committee for Headache Education. http://www.achenet.org/ ...

Academic aptitude as a predictor of headache proneness during college: could headache be an outcome of low test scores?

PubMed

Hovanitz, Christine A; Thatcher, Dawn Lindsay

2012-03-01

Academic work as well as compensated employment has been found adversely associated with frequent headache; headache remains a costly disorder to the person and to society. However, little is known of factors--other than prior headache complaints--that may predict headache frequency over extended periods of time. Based on previous research, effortful task engagement appears to be a contributing factor to headache onset. This suggests that relatively stable attributes that are likely to affect effort expenditure may predict headache frequency over long intervals. The goal of this study was to evaluate the predictability of headache proneness in college-attending students by college aptitude tests administered in high school. Five hundred undergraduate students enrolled in a large public, urban university completed a number of questionnaires. Official admissions records of the college aptitude tests ACT (an acronym for the original test name, the American College Testing), SAT (the Scholastic Aptitude Test), and GPA (grade point average) were obtained and compared to the report of headache frequency. The ACT test mathematics predicted headache proneness in the hypothesized direction, while the ACT English test provided conflicting data; some evidence of gender differences was suggested. While nearly all research on headache and work effectiveness has considered headache to be a cause of reduced efficiency or productivity, this study suggests that a factor which presumably affects the ease of work completion (e.g., scholastic aptitude) may predict headache, at least in some cases within the "work" environment of academia.

Headaches: a Review of the Role of Dietary Factors.

PubMed

Zaeem, Zoya; Zhou, Lily; Dilli, Esma

2016-11-01

Dietary triggers are commonly reported by patients with a variety of headaches, particularly those with migraines. The presence of any specific dietary trigger in migraine patients varies from 10 to 64 % depending on study population and methodology. Some foods trigger headache within an hour while others develop within 12 h post ingestion. Alcohol (especially red wine and beer), chocolate, caffeine, dairy products such as aged cheese, food preservatives with nitrates and nitrites, monosodium glutamate (MSG), and artificial sweeteners such as aspartame have all been studied as migraine triggers in the past. This review focuses the evidence linking these compounds to headache and examines the prevalence of these triggers from prior population-based studies. Recent literature surrounding headache related to fasting and weight loss as well as elimination diets based on serum food antibody testing will also be summarized to help physicians recommend low-risk, non-pharmacological adjunctive therapies for patients with debilitating headaches.

Post spinal puncture headache, an old problem and new concepts: review of articles about predisposing factors

PubMed Central

Jabbari, Ali; Alijanpour, Ebrahim; Mir, Mehrafza; Bani hashem, Nadia; Rabiea, Seyed Mozaffar; Rupani, Mohammad Ali

2013-01-01

Post spinal puncture headache (PSPH) is a well known complication of spinal anesthesia. It occurs after spinal anesthesia induction due to dural and arachnoid puncture and has a significant effect on the patient’s postoperative well being. This manuscript is based on an observational study that runs on Babol University of Medical Sciences and review of literatures about current concepts about the incidence, risk factors and predisposing factors of post spinal puncture headache. The overall incidence of post-dural puncture headache after intentional dural puncture varies form 0.1-36%, while it is about 3.1% by atraumatic spinal needle 25G Whitacre. 25G Quincke needle with a medium bevel cutting is popular with widespread use and the incidence of PSPH is about 25%, but its incidence obtained 17.3% by spinal needle 25G Quincke in our observation. The association of predisposing factors like female, young age, pregnancy, low body mass index, multiple dural puncture, inexpert operators and past medical history of chronic headache, expose the patient to PSPH. The identification of factors that predict the likelihood of PSPH is important so that measures can be taken to minimize this painful complication resulting from spinal anesthesia. PMID:24009943

Stress and headache chronification.

PubMed

Houle, Timothy; Nash, Justin M

2008-01-01

In this special section, the concept of stress has been linked to the chronification of headache and is considered to be one of several likely mechanisms for the progression of an otherwise episodic disorder to a chronic daily phenomenon. The present review discusses the concept of stress and describes the mechanisms through which stress could influence headache progression. The hypothesized mechanisms include stress serving as a unique trigger for individual attacks, as a nociceptive activator, and as a moderator of other mechanisms. Finally, the techniques used in the screening and management of stress are mentioned in the context of employing strategies for the primary, secondary, or tertiary prevention of headache progression.

Developmental trajectories of paediatric headache - sex-specific analyses and predictors.

PubMed

Isensee, Corinna; Fernandez Castelao, Carolin; Kröner-Herwig, Birgit

2016-01-01

Headache is the most common pain disorder in children and adolescents and is associated with diverse dysfunctions and psychological symptoms. Several studies evidenced sex-specific differences in headache frequency. Until now no study exists that examined sex-specific patterns of change in paediatric headache across time and included pain-related somatic and (socio-)psychological predictors. Latent Class Growth Analysis (LCGA) was used in order to identify different trajectory classes of headache across four annual time points in a population-based sample (n = 3 227; mean age 11.34 years; 51.2 % girls). In multinomial logistic regression analyses the influence of several predictors on the class membership was examined. For girls, a four-class model was identified as the best fitting model. While the majority of girls reported no (30.5 %) or moderate headache frequencies (32.5 %) across time, one class with a high level of headache days (20.8 %) and a class with an increasing headache frequency across time (16.2 %) were identified. For boys a two class model with a 'no headache class' (48.6 %) and 'moderate headache class' (51.4 %) showed the best model fit. Regarding logistic regression analyses, migraine and parental headache proved to be stable predictors across sexes. Depression/anxiety was a significant predictor for all pain classes in girls. Life events, dysfunctional stress coping and school burden were also able to differentiate at least between some classes in both sexes. The identified trajectories reflect sex-specific differences in paediatric headache, as seen in the number and type of classes extracted. The documented risk factors can deliver ideas for preventive actions and considerations for treatment programmes.

Influence of psychological stress on headache in patients with systemic lupus erythematosus.

PubMed

Vargas-Hitos, José Antonio; Sabio, José Mario; Martínez-Egea, Isabel; Jiménez-Jáimez, Enrique; Rodríguez-Guzmán, Manuel; Navarrete-Navarrete, Nuria; López-Lozano, Esther; Romero-Alegría, Ángela; de la Calle, Cristina; Jáimez-Gámiz, Laura; Baños-Piñero, Pilar; Nebrera-Navarro, Fernando; Fidalgo, Alba; Caminal, Luis; de Ramón Garrido, Enrique; Ortego-Centeno, Norberto; Expósito, Manuela; Zamora-Pasadas, Mónica; Jiménez-Alonso, Juan

2014-03-01

To compare the prevalence and disability of headache in patients with systemic lupus erythematosus (SLE) with the general population and to assess the role of chronic psychological stress (CPS) in headache development. One hundred seventy patients with SLE and 102 control subjects matched for age, sex, and level of education were included in this multicenter, cross-sectional study. CPS, headache-related disability, and chronic analgesic intake (CAI) were evaluated in all participants. No statistical differences in the prevalence of headache between both groups were observed but headache disability was significantly higher in patients with SLE. In addition, a higher average score in the Cohen Perceived Stress Scale (CPSS) and a higher prevalence of patients with CAI were observed in patients with SLE. In multivariate analysis, CPSS score was positively (OR 1.09; 95% CI: 1.03-1.14; p = 0.001) and CAI negatively (OR 0.43; 95% CI: 0.19-0.99; p = 0.049) associated with headache in patients with SLE. Despite the prevalence of headache in patients with SLE and the general population being similar, headache-related disability may be higher in patients with SLE. Moreover, CPS might play a role in the pathogenesis of SLE headache, whereas CAI might have a protective effect against it.

New daily persistent headache with a thunderclap headache onset and complete response to nimodipine (a new distinct subtype of NDPH).

PubMed

Rozen, Todd D; Beams, Jennifer L

2013-12-23

At present new daily persistent headache is just a group of conditions that are connected based on the temporal profile of their mode of onset. If new daily persistent headache is a true distinct syndrome like migraine then we need to start to define subtypes that have specific effective treatments such has been noted for migraine sub-forms. We present what we believe is the first recognized subtype of new daily persistent headache that which starts with a thunderclap headache onset. A patient presented with a 13 month history of a daily headache from onset which initiated as a thunderclap headache along with persistent acalculia. All neuroimaging studies for secondary causes were negative. Nimodipine rapidly and completely alleviated her headache and associated neurologic symptoms. We propose that this subtype of new daily persistent headache is caused by a very rapid increase in CSF tumor necrosis factor alpha levels leading to cerebral artery vasospasm with a subsequent thunderclap headache, then continuous or near continuous cerebral artery vasospasm leading to a persistent daily headache. Nimodipine which not only inhibits cerebral artery vasospasm but also tumor necrosis factor alpha production appears to be a specific treatment for this distinct subtype of new daily persistent headache.

New daily persistent headache with a thunderclap headache onset and complete response to Nimodipine (A new distinct subtype of NDPH)

PubMed Central

2013-01-01

At present new daily persistent headache is just a group of conditions that are connected based on the temporal profile of their mode of onset. If new daily persistent headache is a true distinct syndrome like migraine then we need to start to define subtypes that have specific effective treatments such has been noted for migraine sub-forms. We present what we believe is the first recognized subtype of new daily persistent headache that which starts with a thunderclap headache onset. A patient presented with a 13 month history of a daily headache from onset which initiated as a thunderclap headache along with persistent acalculia. All neuroimaging studies for secondary causes were negative. Nimodipine rapidly and completely alleviated her headache and associated neurologic symptoms. We propose that this subtype of new daily persistent headache is caused by a very rapid increase in CSF tumor necrosis factor alpha levels leading to cerebral artery vasospasm with a subsequent thunderclap headache, then continuous or near continuous cerebral artery vasospasm leading to a persistent daily headache. Nimodipine which not only inhibits cerebral artery vasospasm but also tumor necrosis factor alpha production appears to be a specific treatment for this distinct subtype of new daily persistent headache. PMID:24364890

Laughing headache with giant pacchionian granulations.

PubMed

Giraud, Pierric; Segal, Olivier; Chauvet, Sylvie

2013-04-01

Laughing is recognized as a provoking factor for headache, certainly underestimated among the general population and few cases have been published to date. We report a single case of severe headache, provoked almost exclusively by outbursts of laughing, where venous magnetic resonance imaging revealed the presence of giant Pacchioni granulations in both right and transverse sinuses. Reviewing published cases of laughing headache, we discuss possible mechanisms of pain and the role of giant Pacchionian granulations. © 2013 American Headache Society.

Epidemiology and pathogenesis of posttraumatic headache.

PubMed

Packard, R C

1999-02-01

This article presents an overview of the epidemiology and pathophysiology of posttraumatic headache. It reviews definitions of mild head injury (MHI), mild traumatic brain injury (MTBI), and concussion, and discusses the confusion that often occurs with these terms. Headache types and their pathophysiology are examined in detail. Just as the exact pathophysiology is unknown for migraine and other types of headache, the exact pathophysiology of headache after trauma is also still unknown in many cases. Possible connections between head or neck injuries and headache are reviewed, as well as hypothesized neurochemical changes that may occur in both migraine and traumatic brain injury (TBI). Psychological and legal factors are also considered.

Incidence of headache as a presenting complaint in over 1000 patients with sellar lesions and factors predicting postoperative improvement.

PubMed

Jahangiri, Arman; Wagner, Jeffrey R; Chin, Aaron T; Han, Sung Won; Tran, Mai T; Miller, Liane M; Tom, Maxwell W; Chen, Rebecca; Kunwar, Sandeep; Blevins, Lewis; Aghi, Manish K

2015-05-01

Due to the high incidence of headaches and pituitary tumors, neurosurgeons often evaluate patients with benign-appearing sellar lesions and headaches without insight into whether the headache is attributable to the lesion. We sought to evaluate the incidence of headache as a presenting complaint in patients undergoing transsphenoidal surgery for various pathologies and to identify factors predicting postoperative improvement. We conducted a 5-year retrospective review of our first 1015 transsphenoidal surgeries since establishing a dedicated pituitary center. Of 1015 patients, 329 (32%) presented with headache. Of these 329 patients, 241 (73)% had headache as their chief complaint. Headache was most common in patients with apoplexy (84%), followed by Rathke's cleft cysts (RCCs) (60%). Multivariate analyses revealed diagnosis (P = 0.001), younger age (P = 0.001), and female gender (P = 0.006) to be associated with headache. Of patients presenting with headaches, 11% reported improvement at 6-week follow-up and 53% improved at 6-month follow-up. Multivariate analyses revealed gross total resection (GTR; P = 0.04) and decreased duration of headache (P = 0.04) to be associated with improvement, while diagnosis, age, gender, lesion size, whether headache was a chief complaint, and location of headache were not associated with improvement (P > 0.05). In analyzing over 1000 consecutive patients undergoing transsphenoidal surgery, younger patients, females, and patients with RCCs and apoplexy were more likely to present with headache. Patients who underwent GTR and had shorter duration of headache were more likely to experience headache improvement. This information can be used to counsel patients preoperatively. Copyright © 2015 Elsevier B.V. All rights reserved.

Headache during airplane travel ("airplane headache"): first case in Greece.

PubMed

Kararizou, Evangelia; Anagnostou, Evangelos; Paraskevas, George P; Vassilopoulou, Sofia D; Naoumis, Dimitrios; Kararizos, Grigoris; Spengos, Konstantinos

2011-08-01

Headache related to airplane flights is rare. We describe a 37-year-old female patient with multiple intense, jabbing headache episodes over the last 3 years that occur exclusively during airplane flights. The pain manifests during take-off and landing, and is located always in the left retro-orbital and frontotemporal area. It is occasionally accompanied by dizziness, but no additional symptoms occur. Pain intensity diminishes and disappears after 15-20 min. Apart from occasional dizziness, no other symptoms occur. The patient has a history of tension-type headache and polycystic ovaries. Blood tests and imaging revealed no abnormalities. Here, we present the first case in Greece. We review the current literature on this rare syndrome and discuss on possible pathophysiology and the investigation of possible co-factors such as anxiety and depression.

Headache and pregnancy: a systematic review.

PubMed

Negro, A; Delaruelle, Z; Ivanova, T A; Khan, S; Ornello, R; Raffaelli, B; Terrin, A; Reuter, U; Mitsikostas, D D

2017-10-19

This systematic review summarizes the existing data on headache and pregnancy with a scope on clinical headache phenotypes, treatment of headaches in pregnancy and effects of headache medications on the child during pregnancy and breastfeeding, headache related complications, and diagnostics of headache in pregnancy. Headache during pregnancy can be both primary and secondary, and in the last case can be a symptom of a life-threatening condition. The most common secondary headaches are stroke, cerebral venous thrombosis, subarachnoid hemorrhage, pituitary tumor, choriocarcinoma, eclampsia, preeclampsia, idiopathic intracranial hypertension, and reversible cerebral vasoconstriction syndrome. Migraine is a risk factor for pregnancy complications, particularly vascular events. Data regarding other primary headache conditions are still scarce. Early diagnostics of the disease manifested by headache is important for mother and fetus life. It is especially important to identify "red flag symptoms" suggesting that headache is a symptom of a serious disease. In order to exclude a secondary headache additional studies can be necessary: electroencephalography, ultrasound of the vessels of the head and neck, brain MRI and MR angiography with contrast ophthalmoscopy and lumbar puncture. During pregnancy and breastfeeding the preferred therapeutic strategy for the treatment of primary headaches should always be a non-pharmacological one. Treatment should not be postponed as an undermanaged headache can lead to stress, sleep deprivation, depression and poor nutritional intake that in turn can have negative consequences for both mother and baby. Therefore, if non-pharmacological interventions seem inadequate, a well-considered choice should be made concerning the use of medication, taking into account all the benefits and possible risks.

["Thunder clap headache": an independent form of headache?].

PubMed

Strittmatter, M; Zimmermann, C; Schimrigk, K; Hamann, G F

1996-01-01

Acute severe headache indicative of subarachnoid haemorrhage (SAH), but without the requisite proof, is defined as thunderclap. A special pathophysiological mechanism for the development of this headache is not known as yet. This retrospective study comprised 84 patients. All had the typical clinical signs of a SAH, but cranial computer tomography and lumbar puncture excluded this diagnosis. In 82% of these patients the headache was classified according to aetiologically defined symptomatic groups. One patient with headache of vascular aetiology had an angiographically proven, but not ruptured aneurysm. No definite cause for the headache was found in 18% of cases. None of the patients followed up over a period of between 12 months and 6 years developed SAH or any other severe neurological disorder. 9% reported repeat of the headache event. Thunderclap headache seems to be only a descriptive term for patients with symptoms typical of a SAH without signs of bleeding. Thunderclap headache has no diagnostic or prognostic specificity and therefore we recommend use of this term only as a description of the headache characteristic. Thunderclap headache is not a predictor of a future SAH. Cerebral angiography should be restricted to cases with neurological deficits.

Headache at high school: clinical characteristics and impact.

PubMed

Tonini, M C; Frediani, F

2012-05-01

Although migraine (MH) and tension type headache (TTH) are the most common and important causes of recurrent headache in adolescents, they are poorly understood and not recognized by parents and teachers, delaying the first physician evaluation for correct diagnosis and management. The purpose of this study is to assess the knowledge about headache impact among the students of a Communication Private High School in Rimini city, and to evaluate the main different types of headaches interfering with school and social day activities. A self-administered questionnaire interview was given to students of the last 2 years of high school; ten items assessed the headache experience during the prior 12 months, especially during school time: the features and diagnosis of headaches types (based on the 2004 IHS criteria), precipitating factors, disability measured using the migraine disability assessment (MIDAS); therapeutic intervention. Out of the 60 students, 84 % experienced recurrent headache during the last 12 months. 79 % were females, aged 17-20 years; a family history was present in 74 % of headache students, in the maternal line; 45 % of subjects were identified as having MH and 27 % TTH; 25 % had morning headache and 20 % in the afternoon; fatigue, emotional stress and lack of sleep were the main trigger factors for headache, respectively in 86, 50 and 50 % of students; 92 % of headache students could not follow the lessons, could not participate in exercises and physical activity because of the headache; none had consulted a medical doctor and the 90 % of all students had never read, listened or watched television about headache. This study remarks on the need to promote headache educational programs, starting from high school, to increase communication between teachers-family-physician and patient-adolescents, with the goal to have an early appropriate therapeutic intervention, improvement of the quality of life and to prevent long-term headache disease in the

Headaches

MedlinePlus

... and throbbing can be a sign of a migraine headache . Migraine headaches aren't as common as tension headaches. ... treated. Fortunately, doctors know more about what causes migraines and have better ways to treat them than ...

Primary Headache Disorders- Part 2: Tension-type headache and medication overuse headache.

PubMed

Jay, Gary W; Barkin, Robert L

2017-12-01

In Part 2 of Primary Headache disorders, we discuss the fourth Primary Headache Disorder, Tension-Type Headache (TTHA). We are again using the ICHD-III (Beta) definitions of such headaches, taking into consideration episodic and chronic TTHA, as well as the presence or absence of pericranial muscle tenderness. We discuss the pathophysiology and pharmacotherapeutic treatment of TTHA, and the aspects of the Myofascial Pain Syndrome that enhance and help the development of TTHA. We then discuss Medication Overuse Headache (MOH), itself a Secondary headache disorder, but one that is extremely important as it assists with the chronification of both migraine and TTHA. Finally we discuss how to manage and treat those patients with MOH. Chronic migraine, which is TTHA, Migraine as well as, in many patients, MOH, is discussed along with the treatment of this multifaceted disorder. Copyright © 2017 Elsevier Inc. All rights reserved.

Headache

MedlinePlus

... most common type of headache is a tension headache. Tension headaches are due to tight muscles in your shoulders, neck, scalp and jaw. They are often related to stress, depression or anxiety. You are more likely to ...

The Association Between Headaches and Temporomandibular Disorders is Confounded by Bruxism and Somatic Symptoms.

PubMed

van der Meer, Hedwig A; Speksnijder, Caroline M; Engelbert, Raoul H H; Lobbezoo, Frank; Nijhuis-van der Sanden, Maria W G; Visscher, Corine M

2017-09-01

The objective of this observational study was to establish the possible presence of confounders on the association between temporomandibular disorders (TMD) and headaches in a patient population from a TMD and Orofacial Pain Clinic. Several subtypes of headaches have been diagnosed: self-reported headache, (probable) migraine, (probable) tension-type headache, and secondary headache attributed to TMD. The presence of TMD was subdivided into 2 subtypes: painful TMD and function-related TMD. The associations between the subtypes of TMD and headaches were evaluated by single regression models. To study the influence of possible confounding factors on this association, the regression models were extended with age, sex, bruxism, stress, depression, and somatic symptoms. Of the included patients (n=203), 67.5% experienced headaches. In the subsample of patients with a painful TMD (n=58), the prevalence of self-reported headaches increased to 82.8%. The associations found between self-reported headache and (1) painful TMD and (2) function-related TMD were confounded by the presence of somatic symptoms. For probable migraine, both somatic symptoms and bruxism confounded the initial association found with painful TMD. The findings of this study imply that there is a central working mechanism overlapping TMD and headache. Health care providers should not regard these disorders separately, but rather look at the bigger picture to appreciate the complex nature of the diagnostic and therapeutic process.

Cough Headaches

MedlinePlus

... secondary cough headaches may require surgery. Symptoms Primary cough headaches Begin suddenly with and just after coughing ... by a dull, aching pain for hours Secondary cough headaches Secondary cough headaches often have symptoms similar ...

[A rarely known headache: Airplane travel headache].

PubMed

Azman, Filiz; Erkılınç, Büşra; Çabalar, Murat; Çağırıcı, Sultan; Yayla, Vildan

2017-01-01

Recently, headache associated with airplane travel has gained importance with case reports and took its place in the classification of headache in 2013. This rare condition has different spesific characteristic from the primary headaches and its pathophysiology is not clear yet. In this case report, a 27-years-old female patient was diagnosed with the headache associated with airplane travel by history, examination and imaging findings. The possible pathophysiology and treatment were discussed.

Combat-related headache and traumatic brain injury.

PubMed

Waung, Maggie W; Abrams, Gary M

2012-12-01

Post-traumatic headache is a commonly described complication of traumatic brain injury. Recent studies highlight differences between headache features of combat veterans who suffered traumatic brain injury compared to civilians. Not surprisingly, there is a higher rate of associated PTSD and sleep disturbances among veterans. Factors of lower socioeconomic status, rank, and multiple head injuries appear to have a similar effect on post-traumatic headache in combat-related traumatic brain injury. Areas of discordance in the literature include the effect of prolonged loss of consciousness and the prevalence of specific headache phenotypes following head trauma. To date, there have been no randomized trials of treatment for post-traumatic headache. This may be related to the variability of headache features and uncertainty of pathophysiologic mechanisms. Given this lack of data, many practitioners follow treatment guidelines for primary headaches. Additionally, because of mounting data linking PTSD to post-traumatic headache in combat veterans, it may be crucial to choose multimodal agents and take a multidisciplinary approach to combat-related headache.

Headache: an important factor associated with muscle soreness/pain at the two-year follow-up point among patients with major depressive disorder.

PubMed

Hung, Ching-I; Liu, Chia-Yih; Yang, Ching-Hui; Wang, Shuu-Jiun

2016-01-01

No study has compared the associations of headache, anxiety, and depression at baseline with muscle soreness or pain (MS/P) at baseline and at the two-year follow-up point among outpatients with major depressive disorder (MDD). This study aimed to investigate the above issue. This study enrolled 155 outpatients with MDD at baseline, and 131 attended a two-year follow-up appointment. At baseline, migraine was diagnosed based on the International Classification of Headache Disorders, 2(nd) edition. MDD and anxiety disorders were diagnosed using the Structured Clinical Interview for DSM-IV-TR. The visual analog scale was used to evaluate the intensities of headache and MS/P in the neck, shoulder, back, upper limbs, and lower limbs. Depression and anxiety were evaluated using the Hospital Anxiety and Depression Scale. Multiple linear regressions were used to compare the associations of these factors with MS/P. Compared with anxiety disorders, migraine was more strongly associated with MS/P in all areas at baseline and in the upper and lower limbs at follow-up. Headache intensity at baseline was the factor most strongly associated with MS/P in all areas at baseline and follow-up after controlling for depression and anxiety. Headache intensity at baseline predicted MS/P at baseline and follow-up. Migraine and headache intensity are important factors related to MS/P at baseline and follow-up among patients with MDD. Integrating depression and headache treatment might be indicated to improve MS/P.

[Headache Treatment].

PubMed

Diener, Hans Christoph; Holle-Lee, Dagny; Nägel, Steffen; Gaul, Charly

2017-03-01

A precondition for the successful treatment of headaches is the correct headache diagnosis. Triptans are effective for attack treatment of migraine and cluster headache. However, there are not effective for the treatment of tension-type headache. For the prevention of frequent episodic migraine betablockers, flunarizine, topiramate and amitriptyline are recommended. For the prevention of chronic migraine evidence is only available for onabotulinumtoxinA and topiramate. For prophylactic treatment of tension-type headaches tricyclic antidepressants are used. In cluster headache verapamil (in combination with steroids) is the most frequently used prophylactic agent. This article focusses on the current acute and prophylactic treatment of common headache syndromes. © Georg Thieme Verlag KG Stuttgart · New York.

Sex Headaches

MedlinePlus

Sex headaches Overview Sex headaches are brought on by sexual activity — especially an orgasm. You may notice a dull ache in your head ... severe headache just before or during orgasm. Most sex headaches are nothing to worry about. But some ...

Tinnitus and Headache

PubMed Central

Langguth, Berthold; Hund, Verena; Busch, Volker; Jürgens, Tim P.; Lainez, Jose-Miguel; Landgrebe, Michael; Schecklmann, Martin

2015-01-01

Background. Tinnitus and headache are frequent disorders. Here, we aimed to investigate whether the occurrence of headache among tinnitus patients is purely coincidental or whether tinnitus and headache are pathophysiologically linked. We investigated a large sample of patients with tinnitus and headache to estimate prevalence rates of different headache forms, to determine the relationship between tinnitus laterality and headache laterality, and to explore the relationship between tinnitus and headache over time. Method. Patients who presented at a tertiary referral center because of tinnitus and reported comorbid headache were asked to complete validated questionnaires to determine the prevalence of migraine and tension-type headache and to assess tinnitus severity. In addition, several questions about the relationship between headache and tinnitus were asked. Results. Datasets of 193 patients with tinnitus and headache were analysed. 44.6% suffered from migraine, 13% from tension-type headache, and 5.7% from both. Headache laterality was significantly related to tinnitus laterality and in the majority of patients fluctuations in symptom severity of tinnitus and headache were interrelated. Conclusion. These findings suggest a significant relationship between tinnitus and headache laterality and symptom interaction over time and argue against a purely coincidental cooccurrence of tinnitus and headache. Both disorders may be linked by common pathophysiological mechanisms. PMID:26583133

International Headache Society classification: new proposals about chronic headache.

PubMed

Manzoni, G C; Torelli, P

2003-05-01

In the International Headache Society (IHS) classification of 1988, chronic daily headache (CDH) forms are not exhaustively categorized. The forthcoming revision of the classification will include a number of CDH forms that had been reported prior to 1988 or have been identified after that date. In particular, chronic migraine will be added to the classification as a complication of migraine, provided that use of symptomatic drugs does not exceed 10 days per month. In addition to chronic cluster headache and chronic paroxysmal hemicrania, short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) and hemicrania continua will be comprised among CDH forms with short-lived attacks. Hypnic headache will be included in Group 4 ("Other primary headaches"). No additions will be made to the new IHS classification for forms such as new daily persistent headache (NDPH) and cervicogenic headache as proposed by Sjaastad.

Primary headache pathophysiology in children: the contribution of clinical neurophysiology.

PubMed

Pro, S; Tarantino, S; Capuano, A; Vigevano, F; Valeriani, M

2014-01-01

Although primary headaches are very prevalent also in pediatric age, most neurophysiologic studies in these diseases concerned only the adulthood. The neurophysiologic investigation of the pathophysiological mechanisms subtending migraine and tension-type headache in children and adolescents could be particularly interesting, since during the developmental age the migrainous phenotype is scarcely influenced by many environmental factors that can typically act on adult headache patients. The neurophysiologic abnormality most frequently found in adult migraineurs, that is the reduced habituation of evoked potentials, was confirmed also in migraine children, although it was shown to involve also children with tension-type headache. Some studies showed abnormalities in the maturation of brain functions in migraine children and adolescents. While the visual system maturation seems slowed in young migraineurs, the psychophysiological mechanisms subtending somatosensory spatial attention in migraine children are more similar to those of healthy adults than to those of age-matched controls. There are some still unexplored fields that will have to be subjects of future studies. The nociceptive modality, which has been investigated in adult patients with primary headaches, should be studied also in pediatric migraine. Moreover, the technique of transcranial magnetic stimulation, not yet used in young migraineurs, will possibly provide further elements about brain excitability in migraine children. Copyright © 2013 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Headaches and Migraines: Headache Symptoms, Diagnosis, and Treatment

MedlinePlus

... Bar Home Current Issue Past Issues Headaches and Migraines Headache Symptoms, Diagnosis, and Treatment Past Issues / Spring ... of headache. Each has distinct symptoms and treatments. Migraine and Other Vascular Headaches—Symptoms and Diagnosis Migraine: ...

[Preventive treatment of tension headache in children and adolescents].

PubMed

Shypilova, E M; Zavadenko, N N; Nesterovskiy, Yu E

To assess the efficacy of noophen (γ-amino-β-phenylbutyric acid hydrochloride) in the preventive treatment of tension-type headache (TTH) in children and adolescents. The study included 30 patients with TTH, aged from 8 to 16 years, treated with noophen in dose of 15-20 mg/kg per day (2-3 times perorally) during 2 month. Before and during the treatment characteristics of headache, its influence on daily activities were assessed with HIT-6 and PedMIDAS, anxiety disorders were assessed with SCAS, the dynamics of sleep disturbances in children were evaluated. A significant decrease in the frequency, duration and intensity of TTH as well as positive changes in daily life activities and reduction of anxiety and sleep disorders manifestations, which are the risk factors for TTH, were demonstrated during the treatment with noophen. Starting from the first month of treatment, there was a significant decrease in the number of days completely lost because of headache and days with the reduced activity (a decrease in the productivity by >50%).

Rare nocturnal headaches.

PubMed

Cohen, Anna S; Kaube, Holger

2004-06-01

This review describes rare headaches that can occur at night or during sleep, with a focus on cluster headaches, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing, hypnic headache and exploding head syndrome. It is known that cluster headaches and hypnic headache are associated with rapid eye movement sleep, as illustrated by recent polysomnographic studies. Functional imaging studies have documented hypothalamic activation that is likely to be of relevance to circadian rhythms. These headache syndromes have been shown to respond to melatonin and lithium therapy, both of which have an indirect impact on the sleep-wake cycle. There is growing evidence that cluster headache and hypnic headache are chronobiological disorders.

Helmet-induced headache among Danish military personnel.

PubMed

Rahmani, Zakia; Kochanek, Aneta; Astrup, Jesper Johnsen; Poulsen, Jeppe Nørgaard; Gazerani, Parisa

2017-12-01

External compression headache is defined as a headache caused by an external physical compression applied on the head. It affects about 4% of the general population; however, certain populations (e.g. construction workers and military personnel) with particular needs of headwear or helmet are at higher risk of developing this type of headache. External compression headache is poorly studied in relation to specific populations. This study aimed to investigate the prevalence and pattern of helmet-induced external compression headache among Danish military personnel of the Northern Jutland region in Denmark. Data acquisition was based on a custom-made questionnaire delivered to volunteers who used helmets in the Danish military service and who agreed to participate in this study. The military of the Northern Jutland region of Denmark facilitated recruitment of the participants. The questionnaires were delivered on paper and the collected (anonymous) answers (total 279) were used for further analysis. About 30% of the study participants reported headache in relation to wearing a military helmet. Headache was defined as a pressing pain predominantly in the front of the head with an average intensity of 4 on a visual analogue scale of 0 (no pain) to 10 (worst pain imaginable). It was also found that helmets with different designs influenced both the occurrence of headache and its characteristics. This study is the first to demonstrate the prevalence and pattern of compression headache among military personnel in North Jutland, Denmark. The findings of this study call for further attention to helmet-induced external compression headache and strategies to minimize the burden.

Headache with autonomic features in a child: cluster headache or contact-point headache?

PubMed

Mishra, Devendra; Choudhury, Krishna Kant; Gupta, Alok

2008-03-01

Headache and facial pain due to diseases of the nose and sinuses are not uncommon in children. However, nasal contact-point associated with headache is relatively uncommon and has unclear etiological significance. We herein report a child having headache with autonomic features and contact-point in the nose, and discuss the difficulties in diagnostic categorization.

Weather and headache onset: a large-scale study of headache medicine purchases

NASA Astrophysics Data System (ADS)

Ozeki, Kayoko; Noda, Tatsuya; Nakamura, Mieko; Ojima, Toshiyuki

2015-04-01

It is widely recognized that weather changes can trigger headache onset. Most people who develop headaches choose to self-medicate rather than visit a hospital or clinic. We investigated the association between weather and headache onset using large-sample sales of the headache medicine, loxoprofen. We collected daily sales figures of loxoprofen and over-the-counter drugs over a 1-year period from a drugstore chain in western Shizuoka prefecture, Japan. To adjust for changes in daily sales of loxoprofen due to social environmental factors, we calculated a proportion of loxoprofen daily sales to over-the-counter drug daily sales. At the same time, we obtained weather data for the study region from the website of the Japan Meteorological Agency. We performed linear regression analysis to ascertain the association between weather conditions and the loxoprofen daily sales proportion. We also conducted a separate questionnaire survey at the same drugstores to determine the reason why people purchased loxoprofen. Over the study period, we surveyed the sale of hundreds of thousands of loxoprofen tablets. Most people purchased loxoprofen because they had a headache. We found that the sales proportion of loxoprofen increased when average barometric pressure decreased, and that precipitation, average humidity, and minimum humidity increased on loxoprofen purchase days compared to the previous day of purchases. This study, performed using a large dataset that was easy-to-collect and representative of the general population, revealed that sales of loxoprofen, which can represent the onset and aggravation of headache, significantly increased with worsening weather conditions.

[Psychosomatic approach to patients with headache: alternative or integrated diagnoses?].

PubMed

De Giorgio, Giuseppina; Ruberto, Stefania; Firenze, Caterina; Quartesan, Roberto

2010-01-01

Each person has an inseparable body-mind unity, with psychic factors that can also manifest themselves through changes in the functions of the body, and with changing somatic states that contribute to mental experience. This explains why somatic symptoms fall within psychiatry. When a patient complains about physical symptoms, it is essentially an integrated, multidisciplinary diagnosis which is used to identify the various factors (biological and psychological) which worsen the disorder, and a psychiatric dimensional approach is used to integrate the descriptive symptomatic diagnosis with the psychostructural diagnosis. The same symptoms, in fact, may underlie different psychological dynamics that direct the treatment and determine the prognosis, as explained in three clinical cases that we described. The literature on headaches reports a high rate of co-morbidity between migraines and psychiatric disorders, but doesn't take into account the fact that often the symptom of headache is part of the disorder, even when it presents on its own. In conclusion, a holistic approach is needed for the patient to be diagnosed as having a "psychiatric" form of headache. A medical examination of the illness leading to a diagnoses is essential, according to the criteria of the International Classification of Headache Disease (ICHD-II). In clinical practice, we have integrated the descriptive diagnosis (ICHD-II mini-Plus) with the psychological (Diagnostic Criteria of Psychosomatic Research - DCPR) and psycho-structural (Kenberg's interview, Minnesota Multiphasic Personality Inventory - MMPI) diagnoses. The clarification of the dynamics underlying the definition of symptoms and the role played by psychological factors has influenced the identification of therapeutic objectives and in the identification of the most appropriate strategies.

History of Migraine Predicts Headache at High Altitude.

PubMed

Davis, Christopher; Reno, Elaine; Maa, Edward; Roach, Robert

2016-12-01

Davis, Christopher, Elaine Reno, Edward Maa, and Robert Roach. History of Migraine Predicts Headache at High Altitude. High Alt Med Biol. 17:300-304, 2016.-Objective: To characterize the spectrum of headaches and their association with migraine history within a population of recreational hikers above 4300 m. Using a cross-sectional survey design, a convenience sample of 667 hikers participated in a written survey after descent from Mount Gray/Torreys (4349 m). Headaches were characterized as migraine, high altitude headache (HAH), and/or acute mountain sickness (AMS) using International Headache Society Lake Louise AMS scoring criteria. A univariate odds ratio was calculated to determine whether a history of migraine increased the risk of migrainous headache. Multivariate logistic regression was used to assess whether a priori identified risk factors such as age, sex, recent alcohol consumption, home elevation, and self-reported fluid intake and whether summit success increased the risk of any headache at altitude. Sixty percent of hikers were male with an age range of 17-62 years. Eighty percent reached the summit of Mount Grays/Torreys (4349 m). Seventy-nine percent of participants resided in Colorado; the median elevation of residence for subjects was 1697 m (interquartile range 1557-1765 m). HAH occurred in 39% of hikers, while AMS occurred in 26% of hikers. A history of migraine was associated with increased risk of any headache at altitude (OR: 2.49, 95% CI: 1.62-3.65) and was strongly associated with the development of migrainous headache while at altitude (OR: 14.05, 95% CI: 5.49-35.93). A history of migraine is a risk factor for the development of headache at altitude and is strongly associated with the development of migrainous headache.

Self-reported headache in schoolchildren: parents underestimate their children's headaches.

PubMed

Lundqvist, Christofer; Clench-Aas, Jocelyne; Hofoss, Dag; Bartonova, Alena

2006-08-01

Most previous studies of childhood headache have used indirect parental/physician reports to estimate the prevalence of headache in children. To use direct information from children and to compare the results with data collected from parents. A cross-sectional questionnaire was sent to parents of 7-12-y-olds in Oslo, Norway. The questionnaire included retrospective reports by the parents of the presence of headache among their children during the past 6 mo. A panel study was subsequently done with daily diaries completed by the children over 6 wk. This was done at school. For 2126 children, both diary reports and parental reports were available. We found a 1-mo prevalence of self-reported headache of 57.6%. Parents, particularly fathers, reported lower headache prevalence than the children. The difference between parental reports and those of the children was larger when the child was a girl. There was a clear difference for the youngest children and parental underreporting for children with the most frequent headaches. Since indirect parental reports of child headache underestimated headache frequency compared to direct diary-based self-reports, we suggest more widespread use of diary registration of headaches in studies of child headache.

[Botulinum toxin type A in headache treatment : Established and experimental indications].

PubMed

Gaul, C; Holle-Lee, D; Straube, A

2016-08-01

In recent years botulinum toxin type A has been used increasingly more in the treatment of specific headache disorders. Especially regarding chronic migraine with and without combined medication overuse, convincing randomized studies have proven the efficacy of this treatment option and have led to approval for this indication. Regarding other headache entities, such as episodic migraine, tension-type headache, trigeminal autonomic cephalalgia (TAC), neuralgic, neuropathic and myofascial pain, currently available scientific data on the efficacy of botulinum toxin type A are scarce and often ambiguous. The exact underlying mechanisms of the influence of botulinum toxin type A on the pathophysiology of headache are not completely clear but an influence on the release of calcitonin gene-related peptide (CGRP) seems to play a crucial role. This article summarizes the most important studies as well as experiences of treatment with botulinum toxin type A regarding different headache entities.

Extracranial vascular reactivity in migraine and tension headache.

PubMed

Drummond, P D; Lance, J W

1981-09-01

The amplitude of temporal artery pulsation was monitored at rest, after standing from the sitting position and after exercise in 23 normal controls, 10 patients subject to chronic tension headache and 107 migrainous patients. The pulses of migrainous patients did not differ from normal at rest or on standing. On exercise, the temporal artery on the habitually affected side of migrainous patients dilated more than the headache-free-side, while exercise-induced changes in tension headache patients were less than those in normal controls. The responses were not influenced by previous or current medication.

Exercise Headaches

MedlinePlus

... disease. Secondary exercise headaches may require emergency medical attention. Symptoms Primary exercise headaches These headaches: Are usually described as throbbing Occur during or after strenuous exercise Affect both sides of the head in most cases ...

Sinus Headaches

MedlinePlus

... Achy feeling in your upper teeth Sinusitis or migraine? Migraines and headaches from sinusitis are easy to confuse ... types of headaches may overlap. Both sinusitis and migraine headache pain often gets worse when you bend ...

Prescription headache medication in OEF/OIF veterans: results from the Women Veterans Cohort Study.

PubMed

Seng, Elizabeth K; Driscoll, Mary A; Brandt, Cynthia A; Bathulapalli, Harini; Goulet, Joseph; Silliker, Norman; Kerns, Robert D; Haskell, Sally G

2013-09-01

To examine differences in male and female veterans of Operations Enduring Freedom/Iraqi Freedom (OEF/OIF) period of service in taking prescription headache medication, and associations between taking prescription headache medication and mental health status, psychiatric symptoms, and rates of traumatic events. Headaches are common among active service members and are associated with impairment in quality of life. Little is known about headaches in OEF/OIF veterans. Veterans participating in the Women Veterans Cohort Study responded to a cross-sectional survey to assess taking prescription headache medication, mental health status (Post Deployment Health Assessment), psychiatric symptoms (portions of the Brief Patient Health Questionnaire and the Posttraumatic Stress Disorder Checklist), and traumatic events (the Traumatic Life Events Questionnaire and queries regarding military trauma). Gender differences among taking prescription headache medication, health status, psychiatric symptoms, and traumatic events were examined. Regression analyses were used to examine the influence of gender on the associations between taking prescription headache medication and health status, psychiatric symptoms, and traumatic events. 139/551 (25.2%) participants reported taking prescription headache medication in the past year. A higher proportion of women veterans (29.1%) reported taking prescription medication for headache in the last year compared with men (19.7%). Taking prescription headache medication was associated with poorer perceived mental health status, higher anxiety and posttraumatic stress disorder symptoms, and higher rates of traumatic events. The association between prescription headache medication use and perceived mental health status, and with the association between prescription headache medication use and posttraumatic stress disorder symptoms, was stronger for men than for women. Among OEF/OIF veterans, the prevalence of clinically relevant headache is high

Headache in sports.

PubMed

Seifert, Tad

2014-09-01

Sports- and exercise-related headaches are not unusual. Despite their frequent occurrence in this context, there are little epidemiologic data concerning sports-related headache. The recent attention of concussive injuries and associated post-traumatic headache has renewed interest in the study of those headaches occurring after head trauma; however, any primary headache type can also occur in the setting of contact and/or collision sports. The nonspecific nature of headaches provides unique challenges to clinicians encountering this complaint. It is, therefore, imperative that physicians treating athletes are able to distinguish the various headache types and presentations often seen in this population.

Rare primary headaches: clinical insights.

PubMed

Casucci, G; d'Onofrio, F; Torelli, P

2004-10-01

So-called "rare" headaches, whose prevalence rate is lower than 1% or is not known at all and have been reported in only a few dozen cases to date, constitute a very heterogeneous group. Those that are best characterised from the clinical point of view can be classified into forms with prominent autonomic features and forms with sparse or no autonomic features. Among the former are trigeminal autonomic cephalalgias (TACs) and hemicrania continua, while the latter comprise classical trigeminal neuralgia, hypnic headache, primary thunderclap headache, and exploding head syndrome. The major clinical discriminating factor for the differential diagnosis of TACs is the relationship between duration and frequency of attacks: the forms in which pain is shorter lived are those with the higher frequency of daily attacks. Other aspects to be considered are the time pattern of symptoms, intensity and timing of attacks, the patient's behaviour during the attacks, the presence of any triggering factors and of the refractory period after an induced attack, and response to therapy, especially with indomethacin. Often these are little known clinical entities, which are not easily detected in clinical practice. For some of them, e. g., thunderclap headache, it is always necessary to perform instrumental tests to exclude the presence of underlying organic diseases.

Atraumatic headache in US emergency departments: recent trends in CT/MRI utilisation and factors associated with severe intracranial pathology.

PubMed

Gilbert, John W; Johnson, Kevin M; Larkin, Gregory L; Moore, Christopher L

2012-07-01

To estimate recent trends in CT/MRI utilisation among patients seeking emergency care for atraumatic headache in the USA and to identify factors associated with a diagnosis of significant intracranial pathology (ICP) in these patients. Data were obtained from the USA National Hospital Ambulatory Medical Care Survey of emergency department (ED) visits between 1998 and 2008. A cohort of atraumatic headache-related visits were identified using preassigned 'reason-for-visit' codes. Sample visits were weighted to provide national estimates. Between 1998 and 2008 the percentage of patients presenting to the ED with atraumatic headache who underwent imaging increased from 12.5% to 31.0% (p < 0.01) while the prevalence of ICP among those visits decreased from 10.1% to 3.5% (p < 0.05). The length of stay in the ED was 4.6 h (95% CI 4.4 to 4.8) for patients with headache who received imaging compared with 2.7 (95% CI 2.6 to 2.9) for those who did not. Of 18 factors evaluated in patients with headache, 10 were associated with a significantly increased odds of an ICP diagnosis: age ≥ 50 years, arrival by ambulance, triage immediacy <15 min, systolic blood pressure ≥ 160 mm Hg or diastolic blood pressure ≥ 100 mm Hg and disturbance in sensation, vision, speech or motor function including neurological weakness. The use of CT/MRI for evaluation of atraumatic headache increased dramatically in EDs in the USA between 1998 and 2008. The prevalence of ICP among patients who received CT/MRI declined concurrently, suggesting a role for clinical decision support to guide more judicious use of imaging.

The methodology of population surveys of headache prevalence, burden and cost: Principles and recommendations from the Global Campaign against Headache

PubMed Central

2014-01-01

The global burden of headache is very large, but knowledge of it is far from complete and needs still to be gathered. Published population-based studies have used variable methodology, which has influenced findings and made comparisons difficult. Among the initiatives of the Global Campaign against Headache to improve and standardize methods in use for cross-sectional studies, the most important is the production of consensus-based methodological guidelines. This report describes the development of detailed principles and recommendations. For this purpose we brought together an expert consensus group to include experience and competence in headache epidemiology and/or epidemiology in general and drawn from all six WHO world regions. The recommendations presented are for anyone, of whatever background, with interests in designing, performing, understanding or assessing studies that measure or describe the burden of headache in populations. While aimed principally at researchers whose main interests are in the field of headache, they should also be useful, at least in parts, to those who are expert in public health or epidemiology and wish to extend their interest into the field of headache disorders. Most of all, these recommendations seek to encourage collaborations between specialists in headache disorders and epidemiologists. The focus is on migraine, tension-type headache and medication-overuse headache, but they are not intended to be exclusive to these. The burdens arising from secondary headaches are, in the majority of cases, more correctly attributed to the underlying disorders. Nevertheless, the principles outlined here are relevant for epidemiological studies on secondary headaches, provided that adequate definitions can be not only given but also applied in questionnaires or other survey instruments. PMID:24467862

Cluster headache in women: relation with menstruation, use of oral contraceptives, pregnancy, and menopause

PubMed Central

van Vliet, J A; Favier, I; Helmerhorst, F M; Haan, J; Ferrari, M D

2006-01-01

In contrast with migraine, little is known about the relation between cluster headache and menstrual cycle, oral contraceptives, pregnancy, and menopause. A population based questionnaire study was performed among 224 female cluster headache patients, and the possible effect of hormonal influences on cluster headache attacks studied. For control data, a similar but adjusted questionnaire was sent to healthy volunteers and migraine patients. It was found that menstruation, use of oral contraceptives, pregnancy, and menopause had a much smaller influence on cluster headache attacks than in migraine. Cluster headache can, however, have a large impact on individual women, for example to refrain from having children. PMID:16407458

Migraine Headaches

MedlinePlus

... Staying Safe Videos for Educators Search English Español Migraine Headaches KidsHealth / For Teens / Migraine Headaches What's in ... Prevented? Print en español Las migrañas What Are Migraines? Almost everyone gets headaches. You might feel pain ...

Chronic Daily Headache and Medication Overuse Headache in First-Visit Headache Patients in Korea: A Multicenter Clinic-Based Study

PubMed Central

Cha, Myoung-Jin; Moon, Heui-Soo; Sohn, Jong-Hee; Kim, Byung-Su; Song, Tae-Jin; Kim, Jae-Moon; Park, Jeong Wook; Park, Kwang-Yeol; Kim, Soo-Kyoung; Kim, Byung-Kun

2016-01-01

Background and Purpose Chronic daily headache (CDH) is defined as a headache disorder in which headaches occur on a daily or near-daily basis (at least 15 days/month) for more than 3 months. Chronic migraine (CM) and medication overuse headache (MOH) are very disabling headaches that remain underdiagnosed. The aim of this study was to establish the frequency of CDH and its various subtypes, and examine the associations with MOH among first-visit headache patients presenting at neurology outpatient clinics in Korea. Methods Eleven neurologists enrolled first-visit patients with complaints of headaches into outpatient clinics for further assessment. Headache disorders were classified according to the International Classification of Headache Disorder (third edition beta version) by each investigator. Results Primary CDH was present in 248 (15.2%) of the 1,627 included patients, comprising CM (143, 8.8%), chronic tension-type headache (CTTH) (98, 6%), and definite new daily persistent headache (NDPH) (7, 0.4%). MOH was associated with headache in 81 patients (5%). The association with MOH was stronger among CM patients (34.5%) than patients with CTTH (13.3%) or NDPH (14.3%) (p=0.001). The frequency of CDH did not differ between secondary and tertiary referral hospitals. Conclusions The frequencies of CDH and MOH diagnoses were 15.2% and 5%, respectively in first-visit headache patients presented at secondary or tertiary referral hospitals in Korea. CM was the most common subtype of CDH and was most frequently associated with MOH. PMID:27449912

Chronic Daily Headache and Medication Overuse Headache in First-Visit Headache Patients in Korea: A Multicenter Clinic-Based Study.

PubMed

Cha, Myoung Jin; Moon, Heui Soo; Sohn, Jong Hee; Kim, Byung Su; Song, Tae Jin; Kim, Jae Moon; Park, Jeong Wook; Park, Kwang Yeol; Kim, Soo Kyoung; Kim, Byung Kun; Cho, Soo Jin

2016-07-01

Chronic daily headache (CDH) is defined as a headache disorder in which headaches occur on a daily or near-daily basis (at least 15 days/month) for more than 3 months. Chronic migraine (CM) and medication overuse headache (MOH) are very disabling headaches that remain underdiagnosed. The aim of this study was to establish the frequency of CDH and its various subtypes, and examine the associations with MOH among first-visit headache patients presenting at neurology outpatient clinics in Korea. Eleven neurologists enrolled first-visit patients with complaints of headaches into outpatient clinics for further assessment. Headache disorders were classified according to the International Classification of Headache Disorder (third edition beta version) by each investigator. Primary CDH was present in 248 (15.2%) of the 1,627 included patients, comprising CM (143, 8.8%), chronic tension-type headache (CTTH) (98, 6%), and definite new daily persistent headache (NDPH) (7, 0.4%). MOH was associated with headache in 81 patients (5%). The association with MOH was stronger among CM patients (34.5%) than patients with CTTH (13.3%) or NDPH (14.3%) (p=0.001). The frequency of CDH did not differ between secondary and tertiary referral hospitals. The frequencies of CDH and MOH diagnoses were 15.2% and 5%, respectively in first-visit headache patients presented at secondary or tertiary referral hospitals in Korea. CM was the most common subtype of CDH and was most frequently associated with MOH.

Hijab (headscarf) headache.

PubMed

Ansari, Huma N; Solomon, Glen D

2015-03-01

Hijab (headscarf) headache is well known among wearers and is a common topic of discussion. It has never previously been reported in the medical literature. Five women described bilateral headache either prompted by or worsened by donning the hijab, or headscarf. The headache always resolved soon after removal of the headscarf. Hijab headache may also be alleviated by minimal modifications in style while allowing women to maintain their moral conviction. It likely represents an extracranial etiology of headache, and recognition may prevent unnecessary evaluation and suffering in hijab wearers. © 2015 American Headache Society.

[Primary headache and work: concepts of pathophysiology, occupational risk factors, health monitoring and criteria for judging causation].

PubMed

Taino, Giuseppe; Pucci, Ennio; Imbriani, Paola; Delogu, Alberto; Brevi, Marco; Bruscella, Sara; Imbriani, Marcello

2014-01-01

Primary headaches account for 90% of all the forms of headache. The disease is characterized by high occurrence in the working-age population and by significant impact in countries with high economic and social development. These two epidemiological aspects carry significant economic costs that can be estimated calculating loss of working days due to illness and appreciable loss of labour productivity. In an occupational setting several circumstances are known to cause the onset of attacks in workers who already suffer from primary headache. In this sense, the following factors have an important role: interruption of the circadian sleep-wake rhythm, sleep deprivation, physical/mental distress, not ergonomic postures (mainly those involving the cervical-brachial district), prolonged use of display screen, acoustic discomfort. Among chemicals, in the current conditions of exposure, the olfactory characteristics seem of primary importance rather than the more "conventional" mechanism of toxicity. The main aim of this study is to provide useful information to occupational physicians on the management of workers suffering from primary headache, with regard either to the formulation of the judgement of suitability, or to their auxiliary role in the planning and organization of work. A second aim involves the identification of specific preventive measures in order to reduce the probability of occurrence of a headache attack. This also minimizes the risk of accidents and injuries and ensures workers' efficiency. After these considerations, we suggest guidelines for a flow chart (aimed to understand worker's suitability for his/her specific task). This guarantees not only safety and health of workers who suffer from the illness, but also safeguards any third worker from a possible consequence due to less working capacity and reduction of attention of employees working with a headache attack. In conclusion we also identify three critical factors: the diagnosis of the form of

The Role of Negative Affect on Headache-Related Disability Following Traumatic Physical Injury.

PubMed

Pacella, Maria L; Hruska, Bryce; George, Richard L; Delahanty, Douglas L

2018-03-01

Acute postinjury negative affect (NA) may contribute to headache pain following physical injury. Early psychiatric-headache comorbidity conveys increased vulnerability to chronic headache-related disability and impairment. Yet, it is unknown whether NA is involved in the transition to chronic headache related-disability after injury. This prospective observational study examined the role of acute postinjury NA on subacute and chronic headache-related disability above and beyond nonpsychiatric factors. Eighty adult survivors of single-incident traumatic physical injury were assessed for negative affect (NA): a composite of depression and anxiety symptoms, and symptoms of posttraumatic stress disorder (PTSS) during the acute 2-week postinjury phase. NA was examined as the primary predictor of subacute (6-week) and chronic (3-month) headache-related disability; secondary analyses examined whether the individual NA components differentially impacted the outcomes. Hierarchical linear regression confirmed NA as a unique predictor of subacute (Cohen's f  2  = 0.130; P = .005) and chronic headache related-disability (Cohen's f  2  = 0.160; P = .004) beyond demographic and injury-related factors (sex, prior headaches, and closed head injury). Upon further analysis, PTSS uniquely predicted greater subacute (Cohen's f  2  = 0.105; P = .012) and chronic headache-related disability (Cohen's f  2  = 0.103; P = .022) above and beyond demographic and injury-related factors, depression, and anxiety. Avoidance was a robust predictor of subacute headache impairment (explaining 15% of the variance) and hyperarousal was a robust predictor of chronic headache impairment (10% of the variance). Although NA consistently predicted headache-related disability, PTSS alone was a unique predictor above and beyond nonpsychiatric factors, depression, and anxiety. These results are suggestive that early treatment of acute postinjury PTSS may correlate with

Rounding Behavior in the Reporting of Headache Frequency Complicates Headache Chronification Research

PubMed Central

Houle, Timothy T.; Turner, Dana P.; Houle, Thomas A.; Smitherman, Todd A.; Martin, Vincent; Penzien, Donald B.; Lipton, Richard B.

2013-01-01

Objectives To characterize the extent of measurement error arising from rounding in headache frequency reporting (days per month) in a population sample of headache sufferers. Background When reporting numerical health information, individuals tend to round their estimates. The tendency to round to the nearest 5 days when reporting headache frequency can distort distributions and engender unreliability in frequency estimates in both clinical and research contexts. Methods This secondary analysis of the 2005 American Migraine Prevalence and Prevention study (AMPP) survey characterized the population distribution of 30-day headache frequency among community headache sufferers and determined the extent of numerical rounding (“heaping”) in self-reported data. Headache frequency distributions (days per month) were examined using a simplified version of Wang and Heitjan’s (2008) approach to heaping to estimate the probability that headache sufferers round to a multiple of 5 when providing frequency reports. Multiple imputation was used to estimate a theoretical “true” headache frequency. Results Of the 24,000 surveys, headache frequency data were available for 15,976 respondents diagnosed with migraine (68.6%), probable migraine (8.3%), or episodic tension-type headache (10.0%); the remainder had other headache types. The mean number of headaches days/month was 3.7 (SD = 5.6). Examination of the distribution of headache frequency reports revealed a disproportionate number of responses centered on multiples of 5 days. The odds that headache frequency was rounded to 5 increased by 24% with each one-day increase in headache frequency (OR: 1.24, 95% CI: 1.23 to 1.25), indicating that heaping occurs most commonly at higher headache frequencies. Women were more likely to round than men, and rounding decreased with increasing age and increased with symptoms of depression. Conclusions Because of the coarsening induced by rounding, caution should be used when

Influence of Temple Headache Frequency on Physical Functioning and Emotional Functioning in Subjects with Temporomandibular Disorder Pain

PubMed Central

List, Thomas; John, Mike T.; Ohrbach, Richard; Schiffman, Eric L.; Truelove, Edmond L.; Anderson, Gary C.

2015-01-01

Aims To investigate the relationship of headache frequency with patient-reported physical functioning and emotional functioning in temporomandibular disorder (TMD) subjects with concurrent temple headache. Methods The Research Diagnostic Criteria for TMD (RDC/TMD) Validation Project identified, as a subset of 614 TMD cases and 91 controls (n = 705), 309 subjects with concurrent TMD pain diagnoses (RDC/TMD) and temple headache. The temple headaches were subdivided into infrequent, frequent, and chronic headache according to the International Classification of Headache Disorders, second edition (ICHD–II). Study variables included self-report measures of physical functioning (Jaw Function Limitation Scale [JFLS], Graded Chronic Pain Scale [GCPS], Short Form–12 [SF–12]) and emotional functioning (depression and anxiety as measured by the Symptom Checklist–90R/SCL–90R). Differences among the three headache subgroups were characterized by increasing headache frequency. The relationship between ordered headache frequency and physical as well as emotional functioning was analyzed using linear regression and trend tests for proportions. Results Physical functioning, as assessed with the JFLS (P < .001), SF-12 (P < .001), and GCPS (P < .001), was significantly associated with increased headache frequency. Emotional functioning, reflected in depression and anxiety, was also associated with increased frequency of headache (both P < .001). Conclusion Headache frequency was substantially correlated with reduced physical functioning and emotional functioning in subjects with TMD and concurrent temple headaches. A secondary finding was that headache was precipitated by jaw activities more often in subjects with more frequent temple headaches. PMID:22558607

Epidemiology of headache in the Republic of San Marino.

PubMed Central

D'Alessandro, R; Benassi, G; Lenzi, P L; Gamberini, G; Sacquegna, T; De Carolis, P; Lugaresi, E

1988-01-01

An epidemiological survey on headache was performed in the Republic of San Marino, which is the smallest independent State in the world, located near the Adriatic Coast, within Italy. Among a random sample of 1500 inhabitants over 7 years of age the frequency of headache, severe headache and migraine in the previous year was 35.3%, 12.2%, 9.3% respectively for men, and 46.2%, 20.6%, 18% for women. The most common factors reported to provoke headache were emotional stress, physical strain, lack of sleep, particular foods or drinks and for women menstruation. Migraine patients differed from people without headache in that they had a higher consumption of coffee, more frequently reported bad sleep, allergic disease and previous appendectomy. Furthermore, migraine patients and severe headache sufferers had a higher diastolic blood pressure than non headache subjects. PMID:3258357

New daily persistent headache.

PubMed

Tyagi, Alok

2012-08-01

New daily persistent headache (NDPH) is a chronic headache developing in a person who does not have a past history of headaches. The headache begins acutely and reaches its peak within 3 days. It is important to exclude secondary causes, particularly headaches due to alterations in cerebrospinal fluid (CSF) pressure and volume. A significant proportion of NDPH sufferers may have intractable headaches that are refractory to treatment. The condition is best viewed as a syndrome rather than a diagnosis. The headache can mimic chronic migraine and chronic tension-type headache, and it is also important to exclude secondary causes, particularly headaches due to alterations in CSF pressure and volume. A large proportion of NDPH sufferers have migrainous features to their headache and should be managed with treatments used for treating migraine. A small group of NDPH sufferers may have intractable headaches that are refractory to treatment.

New daily persistent headache

PubMed Central

Tyagi, Alok

2012-01-01

New daily persistent headache (NDPH) is a chronic headache developing in a person who does not have a past history of headaches. The headache begins acutely and reaches its peak within 3 days. It is important to exclude secondary causes, particularly headaches due to alterations in cerebrospinal fluid (CSF) pressure and volume. A significant proportion of NDPH sufferers may have intractable headaches that are refractory to treatment. The condition is best viewed as a syndrome rather than a diagnosis. The headache can mimic chronic migraine and chronic tension-type headache, and it is also important to exclude secondary causes, particularly headaches due to alterations in CSF pressure and volume. A large proportion of NDPH sufferers have migrainous features to their headache and should be managed with treatments used for treating migraine. A small group of NDPH sufferers may have intractable headaches that are refractory to treatment. PMID:23024565

Understanding psychological stress, its biological processes, and impact on primary headache.

PubMed

Nash, Justin M; Thebarge, Ronald W

2006-10-01

Psychological stress is generally acknowledged to be a central contributor to primary headache. Stress results from any challenge or threat, either real or perceived, to normal functioning. The stress response is the body's activation of physiological systems, namely the hypothalamic-pituitary-adrenal axis, to protect and restore functioning. Chronic activation of the stress response can lead to wear and tear that eventually can predispose an individual to disease. There are multiple ways that stress and headache are closely related. Stress can (a) be a predisposing factor that contributes to headache disorder onset, (b) accelerate the progression of the headache disorder into a chronic condition, and (c) precipitate and exacerbate individual headache episodes. How stress impacts headache is not often understood. However, stress is assumed to affect primary headache by directly impacting pain production and modulation processes at both the peripheral and central levels. Stress can also independently worsen headache-related disability and quality of life. Finally, the headache experience itself can serve as a stressor that compromises an individual's health and well-being. With the prominent role that stress plays in headache, there are implications for the evaluation of stress and the use of stress reduction strategies at the various stages of headache disorder onset and progression. Future directions can help to develop a better empirical understanding of the pattern of the stress and headache connections and the mechanisms that explain the connections. Further research can also examine the interactive effects of stress and other factors that impact headache disorder onset, course, and adjustment.

Migraine headache in patients with idiopathic intracranial hypertension.

PubMed

Sina, Farzad; Razmeh, Saeed; Habibzadeh, Neda; Zavari, Arefeh; Nabovvati, Mona

2017-08-29

Migraine is a neurological disorder that afflicts many people in the world and can cause severe disability during the attacks. The pathophysiology of migraine is complex and not fully understood. It seems that migraine is common in idiopathic intracranial hypertension (IIH). However, the association between migraine headache and IIH is still unclear. The present study was conducted to assess the prevalence of migraine headache and associated factors in IIH patients. In this cross-sectional study, a total of 68 patients diagnosed with IIH underwent a medical history interview and a neurological examination. The diagnosis of migraine was based on the four diagnostic criteria of the International Classification of Headache Disorders 3rd edition. Forty-five patients (63.2%) met the diagnostic criteria of migraine headache. There was no significant difference between patients with and without migraine headache in respect of their age, gender, body mass. This study revealed high prevalence of migraine headache in IIH patients; appropriate treatment can reduce their headache and prevent unnecessary treatments for IIH.

Migraine headache in patients with idiopathic intracranial hypertension

PubMed Central

Sina, Farzad; Razmeh, Saeed; Habibzadeh, Neda; Zavari, Arefeh; Nabovvati, Mona

2017-01-01

Migraine is a neurological disorder that afflicts many people in the world and can cause severe disability during the attacks. The pathophysiology of migraine is complex and not fully understood. It seems that migraine is common in idiopathic intracranial hypertension (IIH). However, the association between migraine headache and IIH is still unclear. The present study was conducted to assess the prevalence of migraine headache and associated factors in IIH patients. In this cross-sectional study, a total of 68 patients diagnosed with IIH underwent a medical history interview and a neurological examination. The diagnosis of migraine was based on the four diagnostic criteria of the International Classification of Headache Disorders 3rd edition. Forty-five patients (63.2%) met the diagnostic criteria of migraine headache. There was no significant difference between patients with and without migraine headache in respect of their age, gender, body mass. This study revealed high prevalence of migraine headache in IIH patients; appropriate treatment can reduce their headache and prevent unnecessary treatments for IIH. PMID:29071043

Headache cessation by an educational intervention in grammar schools: a cluster randomized trial.

PubMed

Albers, L; Heinen, F; Landgraf, M; Straube, A; Blum, B; Filippopulos, F; Lehmann, S; Mansmann, U; Berger, U; Akboga, Y; von Kries, R

2015-02-01

Headache is a common health problem in adolescents. There are a number of risk factors for headache in adolescents that are amenable to intervention. The aim of the study was to assess the effectiveness of a low-level headache prevention programme in the classroom setting to prevent these risk factors. In all, 1674 students in 8th-10th grade at 12 grammar schools in greater Munich, Germany, were cluster randomized into intervention and control groups. A standardized 60-min prevention lesson focusing on preventable risk factors for headache (physical inactivity, coffee consumption, alcohol consumption and smoking) and providing instructions on stress management and neck and shoulder muscle relaxation exercises was given in a classroom setting. Seven months later, students were reassessed. The main outcome parameter was headache cessation. Logistic regression models with random effects for cluster and adjustment for baseline risk factors were calculated. Nine hundred students (intervention group N = 450, control group N = 450) with headache at baseline and complete data for headache and confounders were included in the analysis. Headache cessation was observed in 9.78% of the control group compared with 16.22% in the intervention group (number needed to treat = 16). Accounting for cluster effects and confounders, the probability of headache cessation in the intervention group was 1.77 (95% confidence interval = [1.08; 2.90]) higher than in the control group. The effect was most pronounced in adolescents with tension-type headache: odds ratio = 2.11 (95% confidence interval = [1.15; 3.80]). Our study demonstrates the effectiveness of a one-time, classroom-based headache prevention programme. © 2014 EAN.

Serial headache drawings by children with migraine: correlation with clinical headache status.

PubMed

Stafstrom, Carl E; Goldenholz, Shira R; Dulli, Douglas A

2005-10-01

Children's artistic self-depictions of headache provide valuable insights into their experience of pain and aid in the diagnostic differentiation of headache types. In a previous study, we compared the clinical diagnosis (gold standard) and artistic diagnosis of headaches in 226 children. In approximately 90% of cases, the drawing predicted the clinical diagnosis of migraine versus nonmigraine headache correctly. In the present study, we explored whether headache drawings correlate with clinical improvement after treatment in children with migraine headaches followed longitudinally. Children seen in the Pediatric Neurology Clinic with the chief complaint of headache were asked to draw a picture of what their headache feels like. On subsequent clinic visits, children with the clinical diagnosis of migraine were asked to draw another picture depicting their current headache. The two drawings were compared to assess whether there was improvement; this "artistic response" was then correlated with the child's clinical status (ie, whether the headaches were improved clinically). One hundred eleven children (66 girls, 45 boys) participated in the study, with a mean interval of 5.3 +/- 2.3 (standard error of the mean) months between the first and second visits. The mean age at the first visit was 11.6 +/- 3.1 years. The raters agreed that serial drawings were both improved or both not improved in 99 of the 111 cases (89%; interrater reliability kappa score of 0.767). Fifty-three children had improvements in their headaches and drawings, 3 children had an improved drawing but no clinical headache improvement, 32 children had no improvement in either their drawing or clinical headaches, and 11 children had improved headaches but no improvement in their drawing. The sensitivity of the drawings for clinical improvement was 0.83, and the specificity was 0.91. The predictive value of an improved headache drawing for an improved clinical response was 0.946. There was no

Managing tension headaches at home

MedlinePlus

Tension-type headache - self-care; Muscle contraction headache - self-care; Headache - benign - self-care; Headache - tension- self-care; Chronic headaches - tension - self-care; Rebound headaches - ...

Prevalence of headache in adolescents and association with use of computer and videogames.

PubMed

Xavier, Michelle Katherine Andrade; Pitangui, Ana Carolina Rodarti; Silva, Georgia Rodrigues Reis; Oliveira, Valéria Mayaly Alves de; Beltrão, Natália Barros; Araújo, Rodrigo Cappato de

2015-11-01

The aim of this study was to determine the prevalence of headache in adolescents and its association with excessive use of electronic devices and games. The sample comprised 954 adolescents of both sexes (14 to 19 years) who answered a questionnaire about use of computers and electronic games, presence of headache and physical activity. The binary and multinomial logistic regression, with significance level of 5% was used for inferential analysis. The prevalence of headache was 80.6%. The excessive use of electronics devices proved to be a risk factor (OR = 1.21) for headache. Subjects aged between 14 and 16 years were less likely to report headache (OR = 0.64). Regarding classification, 17.9% of adolescents had tension-type headache, 19.3% had migraine and 43.4% other types of headache. The adolescents aged form 14 to 16 years had lower chance (OR ≤ 0.68) to report the tension-type headache and other types of headache. The excessive use of digital equipment, electronic games and attending the third year of high school proved to be risk factors for migraine-type development (OR ≥ 1.84). There was a high prevalence of headache in adolescents and high-time use of electronic devices. We observed an association between excessive use of electronic devices and the presence of headache, and this habit is considered a risk factor, especially for the development of migraine-type.

Unusual headache syndromes.

PubMed

Queiroz, Luiz P

2013-01-01

Some headache syndromes have few cases reported in the literature. Their clinical characteristics, pathogenesis, and treatment may have not been completely defined. They may not actually be uncommon but rather under-recognized and/or underreported. A literature review of unusual headache syndromes, searching PubMed and ISI Web of Knowledge, was performed. After deciding which disorders to study, relevant publications in scientific journals, including original articles, reviews, meeting abstracts, and letters or correspondences to the editors were searched. This paper reviewed the clinical characteristics, the pathogenesis, the diagnosis, and the treatment of five interesting and unusual headache syndromes: exploding head syndrome, red ear syndrome, neck-tongue syndrome, nummular headache, and cardiac cephalgia. Recognizing some unusual headaches, either primary or secondary, may be a challenge for many non-headache specialist physicians. It is important to study them because the correct diagnosis may result in specific treatments that may improve the quality of life of these patients, and this can even be life saving. © 2013 American Headache Society.

Psychiatric comorbidity in childhood and adolescence headache.

PubMed

Dyb, Grete; Stensland, Synne; Zwart, John-Anker

2015-03-01

Primary headaches among children and adolescents have a substantial impact on quality of life, daily activities, social interaction, and school performance in combination with psychopathological symptoms. The main purpose of the present paper is to summarize clinical and epidemiological evidence for psychiatric comorbidity among children and adolescents with headaches, to describe how evidence in headache research suggest different pathways involved in the development and maintenance of these comorbid conditions, and finally suggest some elements professionals may find helpful to assess the scope of complaints, related functional impairment, and potential precipitating factors in planning of more targeted treatments.

Headache, anxiety and depressive disorders: the HADAS study.

PubMed

Beghi, Ettore; Bussone, Gennaro; D'Amico, Domenico; Cortelli, Pietro; Cevoli, Sabina; Manzoni, Gian Camillo; Torelli, Paola; Tonini, Maria Clara; Allais, Giovanni; De Simone, Roberto; D'Onofrio, Florindo; Genco, Sergio; Moschiano, Franca; Beghi, Massimiliano; Salvi, Sara

2010-04-01

The objective of this paper was to assess prevalence and characteristics of anxiety and depression in migraine without aura and tension-type headache, either isolated or in combination. Although the association between headache and psychiatric disorders is undisputed, patients with migraine and/or tension-type headache have been frequently investigated in different settings and using different tests, which prevents meaningful comparisons. Psychiatric comorbidity was tested through structured interview and the MINI inventory in 158 adults with migraine without aura and in 216 persons with tension-type headache or migraine plus tension-type headache. 49 patients reported psychiatric disorders: migraine 10.9%, tension-type headache 12.8%, and migraine plus tension-type headache 21.4%. The MINI detected a depressive episode in 59.9, 67.0, and 69.6% of cases. Values were 18.4, 19.3, and 18.4% for anxiety, 12.7, 5.5, and 14.2%, for panic disorder and 2.3, 1.1 and 9.4% (p = 0.009) for obsessive-compulsive disorder. Multivariate analysis showed panic disorder prevailing in migraine compared with the other groups (OR 2.9; 95% CI 1.2-7.0). The association was higher (OR 6.3; 95% CI 1.4-28.5) when migraine (with or without tension-type headache) was compared to pure tension-type headache. This also applied to obsessive-compulsive disorder (OR 4.8; 95% CI 1.1-20.9) in migraine plus tension-type headache. Psychopathology of primary headache can reflect shared risk factors, pathophysiologic mechanisms, and disease burden.

Aspirin is first-line treatment for migraine and episodic tension-type headache regardless of headache intensity.

PubMed

Lampl, Christian; Voelker, Michael; Steiner, Timothy J

2012-01-01

(1) To establish whether pre-treatment headache intensity in migraine or episodic tension-type headache (ETTH) predicts success or failure of treatment with aspirin; and (2) to reflect, accordingly, on the place of aspirin in the management of these disorders. Stepped care in migraine management uses symptomatic treatments as first-line, reserving triptans for those in whom this proves ineffective. Stratified care chooses between symptomatic therapy and triptans as first-line on an individual basis according to perceived illness severity. We questioned the 2 assumptions underpinning stratified care in migraine that greater illness severity: (1) reflects greater need; and (2) is a risk factor for failure of symptomatic treatment but not of triptans. With regard to the first assumption, we developed a rhetorical argument that need for treatment is underpinned by expectation of benefit, not by illness severity. To address the second, we reviewed individual patient data from 6 clinical trials of aspirin 1000 mg in migraine (N = 2079; 1165 moderate headache, 914 severe) and one of aspirin 500 and 1000 mg in ETTH (N = 325; 180 moderate, 145 severe), relating outcome to pre-treatment headache intensity. In migraine, for headache relief at 2 hours, a small (4.7%) and non-significant risk difference (RD) in therapeutic gain favored moderate pain; for pain freedom at 2 hours, therapeutic gains were almost identical (RD: -0.2%). In ETTH, for headache relief at 2 hours, RDs for both aspirin 500 mg (-4.2%) and aspirin 1000 mg (-9.7%) favored severe pain, although neither significantly; for pain freedom at 2 hours, RDs (-14.2 and -3.6) again favored severe pain. In neither migraine nor ETTH does pre-treatment headache intensity predict success or failure of aspirin. This is not an arguable basis for stratified care in migraine. In both disorders, aspirin is first-line treatment regardless of headache intensity. © 2011 American Headache Society.

Unusual headaches in the elderly.

PubMed

Bamford, Cynthia C; Mays, MaryAnn; Tepper, Stewart J

2011-08-01

Prevalence of headache lowers with age, and headaches of elderly adults tend to be different than those of the younger population. Secondary headaches, such as headaches associated with vascular disease, head trauma, and neoplasm, are more common. Also, certain headache types tend to be geriatric disorders, such as primary cough headache, hypnic headache, typical aura without headache, exploding head syndrome, and giant cell arteritis. This review provides an overview of some of the major and unusual geriatric headaches, both primary and secondary.

Headache care in China.

PubMed

Yu, Shengyuan; Zhang, Mingjie; Zhou, Jiying; Liu, Ruozhuo; Wan, Qi; Li, Yansheng

2014-04-01

Headache disorders are problematic worldwide. China is no different. A population-based door-to-door survey revealed that the 1-year prevalence of primary headache disorders in China was 23.8%, constituting a major societal burden. Many headache centers and clinics have been established in China, and headache disorders (and associated stress) are receiving an increased level of expert attention. This review summarizes the outcomes of the epidemiological survey and the progress of clinical and basic research in China, describes the present situation in terms of headache diagnosis and treatment, and discusses the future of headache care in China. © 2014 American Headache Society.

Headaches: In Depth

MedlinePlus

... complementary health approaches for both. Tension Headaches and Migraines: What’s the Difference? Tension headaches —the most common ... too little, miss meals, or drink alcoholic beverages. Migraine headaches —which affect about 12 percent of Americans— ...

Neuropsychiatric Predictors of Post-Injury Headache After Mild-Moderate Traumatic Brain Injury in Veterans.

PubMed

Bomyea, Jessica; Lang, Ariel J; Delano-Wood, Lisa; Jak, Amy; Hanson, Karen L; Sorg, Scott; Clark, Alexandra L; Schiehser, Dawn M

2016-04-01

To determine differences in neuropsychiatric complaints between Veterans with mild to moderate traumatic brain injury (TBI), with and without headache, compared with Veteran controls, and to identify neuropsychiatric predictors of headache severity. Mild to moderate TBI is a common occurrence in Veterans, and is frequently associated with complaints of headache. Neuropsychiatric complaints are also common among individuals who have sustained head injury, although the relationship between these factors and headache after injury is unclear. Research is needed to comprehensively determine differences between individuals with mild to moderate traumatic brain injury who differ with respect to headache, and which injury, psychological, or sleep and fatigue factors predict headache severity. A cross-sectional study compared 85 Veterans in three groups (positive for TBI and headache, positive for TBI without significant headache, and a control group) on a set of injury characteristics and neuropsychiatric variables. Correlates of headache severity were examined, and a regression model was used to identify significant independent predictors of headache severity. Individuals with mild to moderate TBI and headache endorsed significantly greater neuropsychiatric symptoms than participants in the other groups (η(p)2  = .23-.36) Neuropsychiatric complaints, as well as presence of posttraumatic amnesia, were correlated with headache in the subsample with TBI (rs = .44-.57). When entering all predictors into a regression model, only fatigue represented a significant independent predictor of headache severity (β = .59, R2 = .35). Rather than being a global risk factor, mild to moderate TBI was associated with poorer mental health outcomes, particularly for those who endorse headache. Findings underscore the possibility that Veterans with history of TBI who present with complaints of headache may represent a particularly vulnerable subgroup. Additionally, our findings

[Headache in children and adolescents. Epidemiology, biopsychosocial correlates, and psychological treatment approaches].

PubMed

Kröner-Herwig, B

2014-08-01

An abundance of studies have consistently shown that headache is the most prevalent pain in children and adolescents. Weekly headache is experienced by more than 10 % and is distinctly more frequent in girls. The number of headache-affected youths with high disability is lower than expected (~ 4 %). Headache is associated with pain in other body sites, thus multiple pain is experienced more often than isolated headache. Various somatic symptoms and even chronic diseases are also correlated with headache. Headache in parents carries a high risk of also occurring in their children. Various other psychosocial factors such as dysfunctional psychological traits are closely linked with headache, the most prominent being internalizing symptoms. However, externalizing symptoms also correlate with headache. Pain catastrophizing, as well as somatosensory amplification and anxiety sensitivity, have been shown to characterize individuals with headache. Features of the social environment, such as life events, school, as well as family stressors and socioeconomic parameters, are among the risk factors. Psychological interventions such as biofeedback, relaxation, and cognitive-behavioral training have proved their efficacy in headache treatment according to several meta-analyses. The latter has also been conducted in group settings and more recently in self-management focused trainings using electronic media. They mainly aim at the prevention of further headache episodes. The goal of this training is the strengthening of self-efficacy beliefs and active coping strategies. It is proposed that these competencies could contribute to the successful long-term prevention of an adverse course of headache into adulthood.

[Primary headache and depression].

PubMed

Gesztelyi, Gyöngyi

2004-11-28

Primary headaches--mainly tension-type headache and migraine--affect a significant portion of the population. Depression is also highly prevalent. The co-existence of a primary headache and depression in the same patient therefore might be a coincidence due to the high prevalence of these conditions, but there might be a causal relationship between them, or headaches and depression might have a common background. This review of the literature summarizes the features of the relationship between primary headaches and depression. Depression is more prevalent in headache patients than in the headache-free population. Prospective epidemiological studies suggest a common genetic, biochemical or environmental background behind primary headaches and depression. This theory is supported by the role of the same neurotransmitter systems (mostly serotonin and dopamine) in headaches as well as in depression. Comorbid depression is associated with female gender, higher age, and higher frequency of headaches. Most depression inventories--questionnaires used to screen for the severity of depressive symptoms--contain transdiagnostic items, therefore their use in their original form is limited in organic diseases: due to the somatic items they might overestimate the severity of depression. When examining a headache patient special attention should be paid to the recognition of comorbid depression. The diagnosis of suspected mood disorder could be supported by using simple screening methods, such as the original or the abbreviated versions of standard depression inventories, but the final diagnosis of major depression needs psychiatric evaluation. Quality of life of the headache patient is affected not only by the characteristics of pain (frequency, duration, severity) but also by the disability caused by headache and the associating mood disorder. Recognizing coexisting mood disorder and disability helps to make the best treatment choice for the acute and preventive treatment of

Prevalence and Impact of Migraine and Tension-Type Headache in Korea

PubMed Central

Kim, Byung-Kun; Chu, Min Kyung; Lee, Te Gyu; Kim, Jae-Moon; Chung, Chin-Sang

2012-01-01

Background and Purpose The epidemiology and impact of headache disorders are only partially documented for Asian countries. We investigated the prevalence and impact of migraine and tension-type headache - which are the two most common primary headache disorders - in a Korean population. Methods A stratified random population sample of Koreans older than 19 years was selected and evaluated using a 29-item, semistructured interview. The questionnaire was designed to classify headache types according to the criteria of the International Classification of Headache Disorders, second edition, including migraine and tension-type headache. The questionnaire also included items on basic demographics such as age, gender, geographical region, education level, and income, and the impact of headache on the participant. Results Among the 1507 participants, the 1-year prevalence of all types of headaches was 61.4% (69.9% in women and 52.8% in men). The overall prevalence rates of migraine and tension-type headaches were 6.1% (9.2% in women and 2.9% in men) and 30.8% (29.3% in women and 32.2% in men), respectively. The prevalence of migraine peaked at the age of 40-49 years in women and 19-29 years in men. In contrast to migraine, the prevalence of tension-type headache was not influenced by either age or gender. Among individuals with migraine and tension-type headache, 31.5% and 7% reported being substantially or severely impacted by headache, respectively (Headache Impact Test score ≥56). Overall, 13.4% of all headache sufferers reported being either substantially or severely impacted by headache. Conclusions The 1-year prevalence rates of migraine and tension-type headache in the studied Korean population were 6.1% and 30.8%, respectively. One-third of migraineurs and some individuals with tension-type headache reported being either substantially or severely impacted by headache. PMID:23091530

Postdural puncture headache

PubMed Central

2017-01-01

Postdural puncture headache (PDPH) is a common complication after inadvertent dural puncture. Risks factors include female sex, young age, pregnancy, vaginal delivery, low body mass index, and being a non-smoker. Needle size, design, and the technique used also affect the risk. Because PDPH can be incapacitating, prompt diagnosis and treatment are mandatory. A diagnostic hallmark of PDPH is a postural headache that worsens with sitting or standing, and improves with lying down. Conservative therapies such as bed rest, hydration, and caffeine are commonly used as prophylaxis and treatment for this condition; however, no substantial evidence supports routine bed rest and aggressive hydration. An epidural blood patch is the most effective treatment option for patients with unsuccessful conservative management. Various other prophylactic and treatment interventions have been suggested. However, due to a lack of conclusive evidence supporting their use, the potential benefits of such interventions should be weighed carefully against the risks. This article reviews the current literature on the diagnosis, risk factors, pathophysiology, prevention, and treatment of PDPH. PMID:28367283

[Headache in the elderly].

PubMed

Reinisch, V M; Schankin, C J; Felbinger, J; Sostak, P; Straube, A

2008-02-01

Chronic headache is still a frequent problem in old age, affecting about 10% of all women and 5% of all men older than 70 years. The incidence of primary headache decreases with advancing age, while that of secondary headache increases. The clinical characteristics of migraine can also change with age; for example, vegetative symptoms are less prominent, and less intense migrainous pain localized predominantly in the neck is frequently reported. Migraine aura can also be experienced more frequently in isolation, without a headache. Hypnic headache is a rare primary headache syndrome that occurs almost exclusively in the elderly. Most of the secondary headache syndromes that occur more frequently in old age present clinically as tension-type headache. Examples of rather common reasons for secondary headache syndromes in the elderly are intracranial space-occupying lesions, ophthalmological problems and autoimmune diseases such as giant cell arteritis. Elderly patients are especially likely to have a number of illnesses at any one time for which they take various medications each day, so that headaches can also quite often be caused by their medication or by withdrawal of these. As a result of such multimorbidity the homeostasis is disturbed in such patients, leading to various conditions that can entail concomitant headaches (sleep apnoea syndrome, dialysis headache, headache attributed to arterial hypertension or hypothyroidism). Familiar facial neuralgias, such as trigeminal neuralgia or postherpetic neuralgia following manifest herpes zoster affecting the face, become markedly more frequent with age. In general, in the treatment of headaches in the elderly it is essential to pay careful attention to potential interactions with the multiple drugs needed because of other diseases; in addition, the comorbidities themselves have to be taken into account, especially depression, anxiety and cognitive impairment, necessitating multimodal, interdisciplinary therapy plans.

Tension-Type Headache - The Normal and Most Prevalent Headache.

PubMed

Jensen, Rigmor Højland

2018-02-01

Tension-type headache (TTH) is the most prevalent form of primary headache in the general population but paradoxically the least studied headache. In this article, the epidemiology and diagnostic challenges of TTH are presented and discussed. The typical features and differential diagnosis of TTH are highlighted and the situations more likely to raise doubts are discussed. A structured approach to the patient and a better comprehension of the very frequent coexistence of migraine and medication overuse headache in the clinical population are emphasized. According to the IHS classification, several diagnoses should be applied but still some clinicians prefer to apply a single combined diagnosis in the severely affected patients, namely chronic migraine. Such uneven practice may complicate the diagnostic comparability and the entire management of TTH. The present treatment strategies for TTH are summarized and hopefully an increased awareness of TTH can translate into better quality of care and a more specific diagnosis and treatment for the numerous TTH sufferers. © 2017 American Headache Society.

Medication-overuse headache: epidemiology, diagnosis and treatment

PubMed Central

Lundqvist, Christofer

2014-01-01

Medication-overuse headache (MOH) is one of the most common chronic headache disorders and a public health problem with a worldwide prevalence of 1–2%. It is a condition characterized by chronic headache and overuse of different headache medications, and withdrawal of the overused medication is recognised as the treatment of choice. However, the strategy for achieving withdrawal is, at present, based on expert opinion rather than scientific evidence, partly due to the lack of randomised controlled studies. This narrative review investigates different aspects of epidemiology, diagnosis, risk factors and pathogenesis as well as management for MOH. We suggest that the first step in the treatment of MOH should be carried out in general practice and should focus primarily on detoxification. For most patients, both prevention and follow up after detoxification can also be performed in general practice, thus freeing resources for referral of more complicated cases to headache clinics and neurologists. These suffering patients have much to gain by an earlier treatment-focused approach lower down on the treatment ladder. PMID:25083264

[Electrotherapy for headaches].

PubMed

Lutters, B; Koehler, P J

2016-01-01

Neuromodulation is being applied increasingly for the treatment of drug resistant headache. Although these techniques are often considered high-tech, electrotherapy for headache has a long history; electric fish have been used for headache treatment since the first century CE. During the eighteenth and nineteenth century, static electricity was a treatment for a wide variety of neuropsychiatric disorders including headache. The efficacy of electrotherapy, however, has been disputed continuously, since opponents were of the opinion that the positive results could be attributed to suggestion. At the beginning of the twentieth century, the electric treatment of headache gradually disappeared. In recent years, there has been a resurgence in the use of electrotherapy, along with the efficacy debate. With this historical review we wish to emphasize the importance of placebo-controlled studies, not only in terms of electrotherapy of headache, but also for the evaluation of neuromodulation for other disorders.

Prevalence of neck pain and headaches: impact of computer use and other associative factors.

PubMed

Smith, L; Louw, Q; Crous, L; Grimmer-Somers, K

2009-02-01

Headaches and neck pain are reported to be among the most prevalent musculoskeletal complaints in the general population. A significant body of research has reported a high prevalence of headaches and neck pain among adolescents. Sitting for lengthy periods in fixed postures such as at computer terminals may result in adolescent neck pain and headaches. The aim of this paper was to report the association between computer use (exposure) and headaches and neck pain (outcome) among adolescent school students in a developing country. A cross-sectional study was conducted and comprehensive description of the data collection instrument was used to collect the data from 1073 high-school students. Headaches were associated with high psychosocial scores and were more common among girls. We found a concerning association between neck pain and high hours of computing for school students, and have confirmed the need to educate new computer users (school students) about appropriate ergonomics and postural health.

New daily persistent headache.

PubMed

Evans, Randolph W

2003-08-01

New daily persistent headache (NDPH), which is the acute onset of headache within 3 days and is persistent for 15 days or more each month for at least 3 months, is a predominantly female heterogeneous subtype of chronic daily headache, typically with migraine features of unknown etiology. NDPH may be a presentation of other primary headaches such as new onset migraine, tension, or benign thunderclap headache. The headaches can be difficult to treat. The diagnosis is one of excluding the many secondary types or NDPH mimics, which is especially critical early in the course of the disease when a secondary etiology is more likely. NDPH mimics include postmeningitis headache, NDPH with medication rebound, neoplasms, temporal arteritis, chronic meningitis, chronic subdural hematoma, post-traumatic headaches, sphenoid sinusitis, hypertension, subarachnoid hemorrhage, low cerebrospinal fluid pressure syndrome, cervical artery dissections, pseudotumor cerebri without papilledema, and cerebral venous thrombosis.

Drug therapy in headache.

PubMed

Weatherall, Mark W

2015-06-01

All physicians will encounter patients with headaches. Primary headache disorders are common, and often disabling. This paper reviews the principles of drug therapy in headache in adults, focusing on the three commonest disorders presenting in both primary and secondary care: tension-type headache, migraine and cluster headache. The clinical evidence on the basis of which choices can be made between the currently available drug therapies for acute and preventive treatment of these disorders is presented, and information given on the options available for the emergency parenteral treatment of refractory migraine attacks and cluster headache. © Royal College of Physicians 2015. All rights reserved.

An expert system for headache diagnosis: the Computerized Headache Assessment tool (CHAT).

PubMed

Maizels, Morris; Wolfe, William J

2008-01-01

Migraine is a highly prevalent chronic disorder associated with significant morbidity. Chronic daily headache syndromes, while less common, are less likely to be recognized, and impair quality of life to an even greater extent than episodic migraine. A variety of screening and diagnostic tools for migraine have been proposed and studied. Few investigators have developed and evaluated computerized programs to diagnose headache. To develop and determine the accuracy and utility of a computerized headache assessment tool (CHAT). CHAT was designed to identify all of the major primary headache disorders, distinguish daily from episodic types, and recognize medication overuse. CHAT was developed using an expert systems approach to headache diagnosis, with initial branch points determined by headache frequency and duration. Appropriate clinical criteria are presented relevant to brief and longer-lasting headaches. CHAT was posted on a web site using Microsoft active server pages and a SQL-server database server. A convenience sample of patients who presented to the adult urgent care department with headache, and patients in a family practice waiting room, were solicited to participate. Those who completed the on-line questionnaire were contacted for a diagnostic interview. One hundred thirty-five patients completed CHAT and 117 completed a diagnostic interview. CHAT correctly identified 35/35 (100%) patients with episodic migraine and 42/49 (85.7%) of patients with transformed migraine. CHAT also correctly identified 11/11 patients with chronic tension-type headache, 2/2 with episodic tension-type headache, and 1/1 with episodic cluster headache. Medication overuse was correctly recognized in 43/52 (82.7%). The most common misdiagnoses by CHAT were seen in patients with transformed migraine or new daily persistent headache. Fifty patients were referred to their primary care physician and 62 to the headache clinic. Of 29 patients referred to the PCP with a confirmed

[The influence of cognitive-behavioral therapy on the P300 potential in children with psychogenic nonepileptic seizures and tension headache].

PubMed

Stolarska-Weryńska, Urszula; Steczkowska, Małgorzata; Kaciński, Marek

2016-01-01

Explaining associations between neurophysiological and neuropsychological parameteres in children and improving the measurement methods would lead to a better understanding of the pathogenesis and course of psychosomatic disease. Goal: clinical assessment of the efficacy of cognitive-behavioral therapy in the treatment of psychogenic no- nepileptic seizures and tension type headaches in children. Determining the influence of cognitive behavioral therapy on the cognitive P300 potential and whether P300 parameters in children correlate with neuropsychological parameters. 20 children with nonepileptic psychogenic seizures and 30 children with tension type headaches, aged 11.3 - 17.11 years. The final diagnosis was made in the Paediatric Neurology Clinic. The P300 examination was performed before/after therapy, with/without hyperventilation. A fixed structure therapy was implemented (10 sessions, 90 minutes each), during two weeks of hospitalization or in an outpatient clinic (9 children with tension type headache). The psychological assessment comprised of temperament questionnaires, auditory and visual memory trials, executive function and attention trials, and in some cases also intelligence testing. More significant correlations were found in children with psychogenic seizures: attention parameters correlated negatively with reaction time, and this correlation tended to fade in the second examination, after psychotherapy. In children with tension type headache a statistically insignificant tendency was found of a positive correlation between those parameters. Medium P300 parameteres in this group were better. In 17/20 of children with psychogenic seizures a clinical improvement was observed, in 3 children the symptoms persisted in a 6 month follow up, but of a lower frequency. In 11/27 of chil- dren with tension headache the symptoms persisted, also with a lower frequency. cognitive-behavioral therapy is effective in the reduction of symptoms in many cases of

Headache - Multiple Languages

MedlinePlus

... Section Headaches - العربية (Arabic) Bilingual PDF Health Information Translations Chinese, Simplified (Mandarin dialect) (简体中文) Expand Section Headaches - ... Chinese, Simplified (Mandarin dialect)) Bilingual PDF ... Health Information Translations Chinese, Traditional (Cantonese dialect) (繁體中文) Expand Section Headaches - ...

White matter hyperintensities and headache: A population-based imaging study (HUNT MRI).

PubMed

Honningsvåg, Lasse-Marius; Håberg, Asta Kristine; Hagen, Knut; Kvistad, Kjell Arne; Stovner, Lars Jacob; Linde, Mattias

2018-01-01

Objective To examine the relationship between white matter hyperintensities and headache. Methods White matter hyperintensities burden was assessed semi-quantitatively using Fazekas and Scheltens scales, and by manual and automated volumetry of MRI in a sub-study of the general population-based Nord-Trøndelag Health Study (HUNT MRI). Using validated questionnaires, participants were categorized into four cross-sectional headache groups: Headache-free (n = 551), tension-type headache (n = 94), migraine (n = 91), and unclassified headache (n = 126). Prospective questionnaire data was used to further categorize participants into groups according to the evolution of headache during the last 12 years: Stable headache-free, past headache, new onset headache, and persistent headache. White matter hyperintensities burden was compared across headache groups using adjusted multivariate regression models. Results Individuals with tension-type headache were more likely to have extensive white matter hyperintensities than headache-free subjects, with this being the case across all methods of white matter hyperintensities assessment (Scheltens scale: Odds ratio, 2.46; 95% CI, 1.44-4.20). Migraine or unclassified headache did not influence the odds of having extensive white matter hyperintensities. Those with new onset headache were more likely to have extensive white matter hyperintensities than those who were stable headache-free (Scheltens scale: Odds ratio, 2.24; 95% CI, 1.13-4.44). Conclusions Having tension-type headache or developing headache in middle age was linked to extensive white matter hyperintensities. These results were similar across all methods of assessing white matter hyperintensities. If white matter hyperintensities treatment strategies emerge in the future, this association should be taken into consideration.

Headache in essential thrombocythaemia

PubMed Central

Frewin, R; Dowson, A

2012-01-01

Headache is frequently reported as one of the neurological manifestations of essential thrombocythaemia (ET) and other myeloproliferative neoplasms. It is associated with considerable morbidity; yet, it is a frequently under-recognised symptom. In patients with ET, headaches may be attributable to the disease, to the prescribed ET treatment, or unrelated to ET. The majority of headaches in ET are self-limiting and can be managed with standard headache therapies such as paracetamol, but it is vital that the clinician managing these conditions is able to recognise the headaches with a more sinister pathology. In this article, we will review the incidence and management of headaches in ET, whether they are primarily related to the disease or a result of its treatment. Identification of specific headache types in patients with ET may enable physicians to employ the most effective headache medication. This would enhance the patient-physician relationship, increasing patient compliance and thus reducing the risk of adverse outcomes. PMID:22889110

Causality and headache triggers

PubMed Central

Turner, Dana P.; Smitherman, Todd A.; Martin, Vincent T.; Penzien, Donald B.; Houle, Timothy T.

2013-01-01

Objective The objective of this study was to explore the conditions necessary to assign causal status to headache triggers. Background The term “headache trigger” is commonly used to label any stimulus that is assumed to cause headaches. However, the assumptions required for determining if a given stimulus in fact has a causal-type relationship in eliciting headaches have not been explicated. Methods A synthesis and application of Rubin’s Causal Model is applied to the context of headache causes. From this application the conditions necessary to infer that one event (trigger) causes another (headache) are outlined using basic assumptions and examples from relevant literature. Results Although many conditions must be satisfied for a causal attribution, three basic assumptions are identified for determining causality in headache triggers: 1) constancy of the sufferer; 2) constancy of the trigger effect; and 3) constancy of the trigger presentation. A valid evaluation of a potential trigger’s effect can only be undertaken once these three basic assumptions are satisfied during formal or informal studies of headache triggers. Conclusions Evaluating these assumptions is extremely difficult or infeasible in clinical practice, and satisfying them during natural experimentation is unlikely. Researchers, practitioners, and headache sufferers are encouraged to avoid natural experimentation to determine the causal effects of headache triggers. Instead, formal experimental designs or retrospective diary studies using advanced statistical modeling techniques provide the best approaches to satisfy the required assumptions and inform causal statements about headache triggers. PMID:23534872

Presence of Headache and Migraine in Asthma Patients.

PubMed

Turan, Muzaffer Onur; Susuz, Çiğdem Çelik; Turan, Pakize Ayşe

2017-04-01

Migraine is a diseases characterized with severe headaches, with neurological and systemic findings. The purpose of this study is to investigate the prevalence of migraine and to examine whether there is a relationship between atopic disorders, parental history and migraine in asthma patients. A total of 288 asthma outpatients, who had the diagnosis by an early or late test of reversibility showing a reversible airway obstruction according to hospital database were included. The presence of headache, atopic symptoms and parental history about asthma, atopic disorders and migraine were asked. The patients with headache were consultated by neurology department and investigated about the presence of migraine. The diagnosis of migraine headache was made if patients fulfilled the International Headache Society (IHS) criteria. 60.4% of patients described a headache. There were 94 patients (32.6%) with headaches meeting the IHS criteria for migraine. Only 12 patients had migraine with aura. There were atopic symptoms in 86.8% of patients. According to parental history, there were asthma in 47.9%, atopic symptoms in 39.6% and migraine in 22.2% of parents. Patients with atopic symptoms were found to have significantly high rate of headaches (65.3%) "p=0.007". The prevalence of migraine was significantly high in patients with parental atopic symptoms (54%) "p=0.002". Multiple logistic regression analysis identified that gender, parental history of asthma, allergia and migraine, and smoking were independent risk factors for presence of migraine in asthmatics. There is a high prevalence of migraine headaches in patients with asthma. The coexistence of asthma and headaches may be related with a similar pathophysiological mechanism; parental history, common genetic compounds and smoking may play role in this mechanism. The headaches in asthma patients, atopic symptoms and family history should be questioned, and clinicians should be careful about the presence of migraine.

Self-reported neck pain is associated with migraine but not with tension-type headache in adolescents.

PubMed

Blaschek, Astrid; Decke, Siona; Albers, Lucia; Schroeder, Andreas Sebastian; Lehmann, Steffi; Straube, Andreas; Landgraf, Mirjam N; Heinen, Florian; von Kries, Rüdiger

2014-10-01

The aim of the present analysis is to confirm or refute the association of neck pain to migraine or tension-type headache and to assess whether this association is independent of other risk factors for headache. Secondary school students were invited to complete a questionnaire on headache and lifestyle factors in a cross-sectional study. Neck pain was assessed via (a) a screening question concerning neck pain and (b) denoting affected areas in schematic drawings of the human body. Absolute increment in prevalence of headache with pain in the shoulder-neck region was between 7.5% and 9.6%. Gender, grade, stress and lifestyle factors were assessed as potential confounding factors. Nearly all factors were associated with shoulder-neck pain and most with headache. After adjustment for confounders, the association of neck pain with headache was almost completely confined to migraine (OR 2.39; 95% CI 1.48-3.85) and migraine + tension-type headache (OR 2.12; 95% CI 1.50-2.99), whereas the association with isolated tension-type headache was negligible (OR 1.22, 95% CI 0.87-1.69). Neck pain is associated with migraine but not with tension-type headache. A possible link between migraine and neck pain may be the cervico-trigeminal convergence of neck and meningeal sensory afferents or a disturbed descending inhibition in migraine. © International Headache Society 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

The evolution of headache from childhood to adulthood: a review of the literature

PubMed Central

2014-01-01

Headache is one of the most common disorders in childhood, with an estimated 75% of children reporting significant headache by the age of 15 years. Pediatric migraine is the most frequent recurrent headache disorder, occurring in up to 28% of older teenagers. Headaches rank third among the illness-related causes of school absenteeism and result in substantial psychosocial impairment among pediatric patients. The aim of this study was to clarify the evolution of the clinical features of primary headache in the transition from childhood to adulthood through a review of relevant data available in the PubMed and Google Scholar databases for the period 1988 to July 2013. The search strategy identified 15 published articles which were considered eligible for inclusion in the analysis (i.e. relevant to the investigation of pediatric headache outcome). All were carried out after the publication of the first version of the International Classification of Headache Disorders (ICHD-I). The availability of data on the evolution of primary headaches over a period of time is important from both a clinical and a public health perspective. The identification of prognostic factors of the evolution of headache (remission or evolution into another headache form) over time should be an objective of future headache research for the development of prevention strategies. Given that headache is a major factor contributing to school absenteeism and poorer quality of life not only in childhood but also in adolescence, understanding the natural history and the management of the different headache forms is vital for our future. PMID:24641507

The evolution of headache from childhood to adulthood: a review of the literature.

PubMed

Antonaci, Fabio; Voiticovschi-Iosob, Cristina; Di Stefano, Anna Luisia; Galli, Federica; Ozge, Aynur; Balottin, Umberto

2014-03-18

Headache is one of the most common disorders in childhood, with an estimated 75% of children reporting significant headache by the age of 15 years. Pediatric migraine is the most frequent recurrent headache disorder, occurring in up to 28% of older teenagers. Headaches rank third among the illness-related causes of school absenteeism and result in substantial psychosocial impairment among pediatric patients. The aim of this study was to clarify the evolution of the clinical features of primary headache in the transition from childhood to adulthood through a review of relevant data available in the PubMed and Google Scholar databases for the period 1988 to July 2013.The search strategy identified 15 published articles which were considered eligible for inclusion in the analysis (i.e., relevant to the investigation of pediatric headache outcome). All were carried out after the publication of the first version of the International Classification of Headache Disorders (ICHD-I). The availability of data on the evolution of primary headaches over a period of time is important from both a clinical and a public health perspective. The identification of prognostic factors of the evolution of headache (remission or evolution into another headache form) over time should be an objective of future headache research for the development of prevention strategies. Given that headache is a major factor contributing to school absenteeism and poorer quality of life not only in childhood but also in adolescence, understanding the natural history and the management of the different headache forms is vital for our future.

Headache attributed to airplane travel ('airplane headache'): clinical profile based on a large case series.

PubMed

Mainardi, F; Lisotto, C; Maggioni, F; Zanchin, G

2012-06-01

The 'headache attributed to airplane travel', also named 'airplane headache' (AH), is a recently described headache disorder that appears exclusively in relation to airplane flights, in particular during the landing phase. Based on the stereotypical nature of the attacks in all reported cases, we proposed provisional diagnostic criteria for AH in a previously published paper. Up to now 37 cases have been described in the literature. After our paper was disseminated via the Internet, we received several email messages from subjects around the world who had experienced such a peculiar headache. Their cooperation, by completing a structured questionnaire and allowing the direct observation of three subjects, enabled us to carry out a study on a total of 75 patients suffering from AH. Our survey confirmed the stereotypical nature of the attacks, in particular with regard to the short duration of the pain (lasting less than 30 minutes in up to 95% of the cases), the clear relationship with the landing phase, the unilateral pain, the male preponderance, and the absence of accompanying signs and/or symptoms. It is conceivable to consider barotrauma as one of the main mechanisms involved in the pathophysiology of AH. The observation that the pain appears inconstantly in the majority of cases, without any evident disorder affecting the paranasal sinuses, could be consistent with a multimodal pathogenesis underlying this condition, possibly resulting in the interaction between anatomic, environmental and temporary concurrent factors. This is by far the largest AH case series ever reported in the literature. The diagnostic criteria that we previously proposed proved to be valid when applied to a large number of patients suffering from this condition. We support its recognition as a new form of headache, to be included in the forthcoming update of the International Headache Society Classification, within '10. Headache attributed to disorder of homoeostasis'. Its formal

Neuromodulation of chronic headaches: position statement from the European Headache Federation

PubMed Central

2013-01-01

The medical treatment of patients with chronic primary headache syndromes (chronic migraine, chronic tension-type headache, chronic cluster headache, hemicrania continua) is challenging as serious side effects frequently complicate the course of medical treatment and some patients may be even medically intractable. When a definitive lack of responsiveness to conservative treatments is ascertained and medication overuse headache is excluded, neuromodulation options can be considered in selected cases. Here, the various invasive and non-invasive approaches, such as hypothalamic deep brain stimulation, occipital nerve stimulation, stimulation of sphenopalatine ganglion, cervical spinal cord stimulation, vagus nerve stimulation, transcranial direct current stimulation, repetitive transcranial magnetic stimulation, and transcutaneous electrical nerve stimulation are extensively published although proper RCT-based evidence is limited. The European Headache Federation herewith provides a consensus statement on the clinical use of neuromodulation in headache, based on theoretical background, clinical data, and side effect of each method. This international consensus further gives recommendations for future studies on these new approaches. In spite of a growing field of stimulation devices in headaches treatment, further controlled studies to validate, strengthen and disseminate the use of neurostimulation are clearly warranted. Consequently, until these data are available any neurostimulation device should only be used in patients with medically intractable syndromes from tertiary headache centers either as part of a valid study or have shown to be effective in such controlled studies with an acceptable side effect profile. PMID:24144382

Headache in children's drawings.

PubMed

Wojaczyńska-Stanek, Katarzyna; Koprowski, Robert; Wróbel, Zygmunt; Gola, Małgorzata

2008-02-01

Headache is a common health problem in childhood. Children's drawings are helpful in the diagnosis of headache type. Children, especially younger ones, communicate better through pictures than verbally. The aim of the present study is to evaluate the usefulness of drawings of the child's headache in the diagnostic process carried out by a pediatrician and a pediatric neurologist. At the beginning of a visit in a neurological clinic, or on the first day of hospitalization, the child was asked, "Please draw your headache," or "How do you feel your headache?" without any additional explanations or suggestions. Clinical diagnosis of headache type was made on the basis of the standard diagnostic evaluation. For the purpose of this study, children's headaches were categorized as migraine, tension-type headache, or "the others." One hundred twenty-four drawings of children with headaches were analyzed by 8 pediatricians and 8 pediatric neurologists. The analysts were unaware of the clinical history, age, sex, and diagnosis of the patients. The clinical diagnosis was considered the "gold standard" to which the headache drawing diagnosis was compared. There were 68 girls 5-18 years of age and 56 boys 7-18 years of age. Of the 124 children, 40 were clinically diagnosed with migraine (32.2%), 47 with tension-type headache (37.9%), and 37 (29.8%) as the others. Children with migraine most frequently draw sharp elements. Children with tension-type headache mainly drew compression elements and pressing elements. In the group of "the other" headaches, 21 children were diagnosed with somatoform disorders. The most frequent element in this group's drawings was a whirl in the head. Colors used most frequently were black and red, which signify severe pain. There was no difference in sensitivity of diagnoses between neurologists and pediatricians. Because the evaluation of drawings by children with headaches done both by pediatricians and pediatric neurologists was correct for

Cluster Headache

MedlinePlus

... after a head injury, even if it's a minor fall or bump, especially if it worsens A sudden, severe headache unlike any you've had A headache that worsens over days and changes in pattern Causes The exact cause of cluster ...

Pediatric Headache: An Overview.

PubMed

Langdon, Raquel; DiSabella, Marc T

2017-03-01

Headache represents the most common neurologic disorder in the general population including children and is increasingly being recognized as a major source of morbidity in youth related to missed school days and activities. In this article, we take a holistic approach to the child presenting with headache with a focus on the detailed headache history, physical and neurologic examinations, and diagnostic evaluation of these patients. Clinical presentations and classification schema of multiple primary and secondary headache types in children are discussed using the International Headache Criteria (IHCD-3) as a guide, and a summary provided of the various treatment modalities employed for pediatric headache including lifestyle modifications, behavioral techniques, and abortive and preventive medications. Copyright © 2017 Mosby, Inc. All rights reserved.

Headache - what to ask your doctor

MedlinePlus

... Tension-type headache - what to ask your doctor; Cluster headache - what to ask your doctor ... a tension-type headache ? A migraine headache ? A cluster headache ? What medical problems can cause headaches? What ...

Stress and Primary Headache: Review of the Research and Clinical Management.

PubMed

Martin, Paul R

2016-07-01

This review begins with a discussion of the nature of stress and then presents the functional model of primary headache as a framework for conceptualizing the complex relationship between stress and headaches. Research is reviewed on stress as a trigger of headaches and how stress can play a role in the developmental and psychosocial context of headaches. Clinical management of headaches from a stress perspective is considered both at the level of trials of behavioral interventions that broadly fit into the stress management category and the additional strategies that might be useful for individual cases based on the research demonstrating associations between stress and headaches. The review concludes by suggesting that although some researchers have questioned whether stress can trigger headaches, overall, the literature is still supportive of such a link. Advances in methodology are discussed, the recent emphasis on protective factors is welcomed, and directions for future research suggested.

Association between lifetime headache and history of suicide attempts in the elderly.

PubMed

Calati, R; Courtet, P; Norton, J; Ritchie, K; Artero, S

2017-03-01

Pain-related conditions have been reported to play a key role among risk factors for suicide. Headache in particular has been repeatedly associated with suicidal thoughts and behaviors. The aims of this study were: 1) to assess the association between lifetime headache (both non-migrainous headache and migraine) and lifetime suicide attempts (SA); 2) to differentiate, within subjects with lifetime SA, patients with and without lifetime headache in terms of socio-demographic and clinical features. We studied 1965 subjects from a cohort of community-dwelling persons aged 65 years and over without dementia (the ESPRIT study), divided in two groups: those with (n=75), and those without a lifetime SA (n=1890). Logistic regression analyses were used to compare these groups according to lifetime headache status. After adjusting for gender, living alone, tobacco and alcohol consumption, and depressive, manic/hypomanic and anxiety disorders, lifetime headache frequency was significantly higher in subjects with a lifetime SA compared with controls (OR=1.92 [1.17-3.15]). Additionally, different factors were identified as being associated with lifetime SA in participants with lifetime headache (female gender, a lower level of high-density lipoprotein cholesterol, insomnia, lifetime major depression) versus participants without headache (glycemia and lifetime major depression). Lifetime headache was associated with lifetime SA. Subjects who are women and report the co-occurrence of headache and insomnia as well as lifetime major depression require higher attention and a careful screening for suicidal thoughts and behaviors. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Children's Headache: Drawings in the Diagnostic Work Up.

PubMed

Mazzotta, Silvia; Pavlidis, Elena; Cordori, Cecilia; Spagnoli, Carlotta; Pini, Luigi Alberto; Pisani, Francesco

2015-08-01

This study aims to evaluate the drawings effectiveness in childhood headache assessment. Headache is a common cause of pain in children. Although drawings have been used in childhood to recognize psychological insights and pain perception, they were rarely used for headache characterization. We collected drawings from 67 subjects with cephalalgia during a 22-month timeframe. The clinical diagnosis was made according to the 2nd edition of The International Headache Classification. Drawings were independently categorized as migraine or tension-type headache (TTH) by two child neuropsychiatrists blinded to the clinical data. Cohen kappa for interrater agreement, sensitivity, specificity, and positive predictive value (PPV) were calculated. Subjects were also divided into three age groups to assess the influence of age. Finally, a control group of 90 subjects was collected and K-means cluster analysis was performed. The drawings had a sensitivity of 85.71 and 81.48%, a specificity of 81.48 and 85.71%, and a PPV of 85.71 and 81.48%, for migraine and TTH diagnosis, respectively. Drawings by the older age group showed the highest predictability degree. Finally, by mean of cluster analysis, 59 of the 67 patients were correctly classified, whereas control subjects were similarly distributed between the two clusters. Drawings are a useful instrument for migraine and TTH differential diagnosis. Thus, we suggest their inclusion in childhood headache diagnostic assessment. Georg Thieme Verlag KG Stuttgart · New York.

Presence of Headache and Migraine in Asthma Patients

PubMed Central

Turan, Muzaffer Onur; Susuz, Çiğdem Çelik; Turan, Pakize Ayşe

2017-01-01

OBJECTIVES Migraine is a diseases characterized with severe headaches, with neurological and systemic findings. The purpose of this study is to investigate the prevalence of migraine and to examine whether there is a relationship between atopic disorders, parental history and migraine in asthma patients. MATERIAL AND METHODS A total of 288 asthma outpatients, who had the diagnosis by an early or late test of reversibility showing a reversible airway obstruction according to hospital database were included. The presence of headache, atopic symptoms and parental history about asthma, atopic disorders and migraine were asked. The patients with headache were consultated by neurology department and investigated about the presence of migraine. The diagnosis of migraine headache was made if patients fulfilled the International Headache Society (IHS) criteria. RESULTS 60.4% of patients described a headache. There were 94 patients (32.6%) with headaches meeting the IHS criteria for migraine. Only 12 patients had migraine with aura. There were atopic symptoms in 86.8% of patients. According to parental history, there were asthma in 47.9%, atopic symptoms in 39.6% and migraine in 22.2% of parents. Patients with atopic symptoms were found to have significantly high rate of headaches (65.3%) “p=0.007”. The prevalence of migraine was significantly high in patients with parental atopic symptoms (54%) “p=0.002”. Multiple logistic regression analysis identified that gender, parental history of asthma, allergia and migraine, and smoking were independent risk factors for presence of migraine in asthmatics. CONCLUSION There is a high prevalence of migraine headaches in patients with asthma. The coexistence of asthma and headaches may be related with a similar pathophysiological mechanism; parental history, common genetic compounds and smoking may play role in this mechanism. The headaches in asthma patients, atopic symptoms and family history should be questioned, and

Are migraine and non-migrainous headache risk factors for stroke in the elderly? Findings from a 12-year cohort follow-up.

PubMed

Norton, J; Portet, F; Gabelle, A; Debette, S; Ritchie, K; Touchon, J; Berr, C

2016-09-01

There is evidence that migraine is a risk factor for stroke but little is known about this association in elderly people. Furthermore, non-migrainous headache (NMH) has received little attention despite being the most frequently reported type of headache. Late-life migraine and NMH were examined as candidate risk factors for stroke in a community-dwelling elderly sample over a 12-year follow-up. One thousand nine hundred and nineteen non-institutionalized subjects aged 65+, without dementia (Diagnostic and Statistical Manual of Mental Disorders, 4th edition, DSM-IV criteria) and with no stroke history at baseline, were drawn from the Three-City Montpellier cohort (recruitment 1999-2001) for longitudinal analysis. Ischaemic and haemorrhagic stroke was reported at baseline and at each of the five follow-ups, with cases validated by a panel of experts, according to ICD-10 criteria (International Classification of Diseases, 10th revision). Migraine and NMH were determined at baseline during a neurological interview and examination using 1988 International Headache Society criteria. A total of 110 (5.4%) cases of migraine and 179 (8.9%) cases of NMH were identified at baseline. During the median 8.8-year follow-up, incident stroke was observed in 1.9% of baseline migrainers, 6.2% of NMH and 3.6% of those with no lifetime history of headache. Cox proportional hazard models indicated that migraine was not a risk factor for stroke; however, NMH sufferers were twice as likely to have a stroke (hazard ratio 2.00, 95% confidence interval 1.00-3.93, P = 0.049). This study is one of the first to suggest that late-life NMH rather than migraine could be an independent risk factor for stroke and a warning sign. The incidence of stroke in elderly migrainers, seldom reported, is particularly low. © 2016 EAN.

Circadian variations in the clinical presentation of headaches among migraineurs: A study using a smartphone headache diary.

PubMed

Park, Jeong-Wook; Cho, Soo-Jin; Park, Sang-Gue; Chu, Min Kyung

2018-04-01

Migraines occur within certain time frames. Nevertheless, information regarding circadian variation in the clinical presentation of migraine is limited. We investigated circadian variations in the clinical presentation of migraine using a smartphone headache diary (SHD). We enrolled adult participants with the diagnosis of migraine according to the third beta edition of the International Classification of Headache Disorders. Participants were asked to log in to the SHD every day for 90 days to record the occurrence of headaches. We compared the occurrence and clinical presentation of headaches during four 6-hour quadrants per day (00:00-05:59, 06:00-11:59, 12:00-17:59, and 18:00-23:59). Migraine-type headache was defined as a headache attack that fulfilled all criteria of migraine, except for the criterion regarding typical headache duration. Eighty-two participants kept a dairy for at least 50% of the study period and recorded 1491 headache attacks. Among the 1491 headache attacks, 474 (31.8%) were classified as migraine-type headaches and 1017 (68.2%) were classified as non-migraine-type headaches. All headaches, migraine-type headaches and non-migraine-type headaches occurred most frequently between 06:00 and 11:59, and least frequently between 18:00 and 23:59, and between 00:00 and 05:59. Migrainous headache characteristics, such as unilateral pain, pulsating quality, severe headache intensity, aggravation by movement, nausea, photophobia, and phonophobia presented most frequently between 06:00 and 11:59, and least frequently between 18:00 and 23:59, and 00:00 and 05:59 among 1491 all headache attacks. Headache clinical presentation as well as headache occurrence exhibited circadian periodicity among migraineurs. SHD: smartphone headache diary; ICHD-3 beta: the third edition beta version of the International Classification of Headache Disorders.

[Management of chronic daily headache in children and adolescents].

PubMed

Cuvellier, J-C

2009-01-01

Chronic daily headache (CDH) affects 2 to 4% of adolescent females and 0,8 to 2% of adolescent males. CDH is diagnosed when headaches occur more than 4 hours a day, for greater than or equal to 15 headache days per month, over a period of 3 consecutive months, without an underlying pathology. It is manifested by severe intermittent headaches, that are migraine-like, as well as a chronic baseline headache. Silberstein and Lipton divided patients into four diagnostic categories: transformed migraine, chronic tension-type headache, new daily-persistent headache, and hemicrania continua. The second edition of the International Classification of Headache Disorders did not comprise any CDH category as such, but provided criteria for all four types of CDH: chronic migraine, chronic tension-type headache, new daily-persistent headache, and hemicrania continua. Evaluation of CDH needs to include a complete history and physical examination to identify any possibility of the headache representing secondary headaches. Children and adolescents with CDH frequently have sleep disturbance, pain at other sites, dizziness, medication-overuse headache and a psychiatric comorbidity (anxiety and mood disorders). CDH frequently results in school absence. CDH management plan is dictated by CDH subtype, the presence or absence of medication overuse, functional disability and presence of attacks of full-migraine superimposed. Reassuring, explaining, and educating the patient and family, starting prophylactic therapy and limiting aborting medications are the mainstay of treatment. It includes pharmacologic (acute and prophylactic therapy) and nonpharmacologic measures (biobehavioral management, biofeedback-assisted relaxation therapy, and psychologic or psychiatric intervention). Part of the teaching process must incorporate life-style changes, such as regulation of sleep and eating habits, regular exercise, avoidance of identified triggering factors and stress management. Emphasis must be

Female cluster headache in the United States of America: what are the gender differences? Results from the United States Cluster Headache Survey.

PubMed

Rozen, Todd D; Fishman, Royce S

2012-06-15

location: cluster headache pain is typically retro-orbital in location in both sexes but women are significantly more likely to experience cluster headache pain in the jaw, cheek and ear than men. f. Associated symptoms: women with cluster headache develop more “migrainous” associated symptoms than men, especially nausea and they are also more likely to have self-injurious behavior than men. g. Triggers: women with cluster headache are much less likely to have alcohol trigger a headache, but are significantly more likely to have “migrainous” triggers for their cluster headaches than men. h. Smoking issues: women are much less likely to have a smoking history than male cluster headache sufferers, more likely to have never smoked prior to cluster headache onset. i. Cycle issues: spring and fall are the most common time to start a cluster headache cycle in both sexes. Women are statistically significantly less likely to start a cluster headache cycle in the months of October–December than men. Women have more attacks per day and higher pain intensity nighttime attacks than men. j. in regard to acute treatment women statistically were less response to sumatriptan injectable and nasal spray than men, but statistically more likely to respond to inhaled lidocaine. There was equal efficacy in the sexes to inhaled oxygen but slower response in women. For preventive treatment no significant gender differences were noted, but overall women were less responsive to almost all preventives than men. k. Diagnostic delay: there remains a significant diagnostic delay for cluster headache patients in both sexes but women were more likely to be diagnosed after 10 years of symptom onset than males and significantly fewer women were diagnosed correctly at an initial physician visit than men. l. Female specific issues: cluster headache does not appear to be influenced by menses or menopause but 50% of the survey responders stated their headaches improved with pregnancy. Cluster

[Tricyclic antidepressant therapy in headache].

PubMed

Magyar, Máté; Csépány, Éva; Gyüre, Tamás; Bozsik, György; Bereczki, Dániel; Ertsey, Csaba

2015-12-01

The two most important representatives of the primary headaches are migraine and tension-type headache. More than 10% of the population suffer from migraine and even a greater part, approximately 30-40% from tension-type headache. These two headache types have a great effect both on the individual and on the society. There are two types of therapeutic approaches to headaches: the abortive and the prophylactic therapy. Prophylactic treatment is used for frequent and/or difficult-to-treat headache attacks. Although both migraine and tension-type headache are often associated with depression, for their treatment - in contrast to the widespread medical opinion - not all antidepressants were found to be effective. Amitriptyline, which is a tricyclic antidepressant, is used as a prophylactic therapy for headache since 1968. Its efficacy has been demonstrated in several double-blind, placebo-controlled studies. Although the newer types of antidepressant, such as selective serotonin reuptake inhibitors and selective serotonin-norepinephrine reuptake inhibitor, have a more favorable side-effect profile than tricyclic antidepressants, their headache prophylactic effect has not been proven yet.

Lifestyle, quality of life, nutritional status and headache in school-age children.

PubMed

Castro, Kamila; Rockett, Fernanda C; Billo, Maira; Oliveira, Gabriela T; Klein, Luciana S; Parizotti, Cristiane S; Perla, Alexandre S; Perry, Ingrid D S

2013-01-01

Headache has been described as a factor with significant negative impact on the quality of life of school-aged children with a high risk of developing in chronic and persistent form in adulthood. Among other headache associated triggers or aggravating factors, lifestyle and obesity has been investigated, but results are still conflicting. To evaluate the prevalence of headache in school-aged children and its relationship to anthropometric characteristics, lifestyle, and quality of life. A cross-sectional study was conducted in six schools located in two cities in southern Brazil, involving 750 students aged 7 to 14 years. Information was collected on sociodemographic characteristics, clinical variables (presence of headache and menarche), anthropometric data, lifestyle, and quality of life. A total of 185 (24.7%) students reported having headache crises in the last 3 months. Among students aged 10 to 14 years, presence of headache was associated with female sex, affecting 32.2% of girls vs. 23.3% of boys (p = 0.042, chi-square test). Anthropometric parameters (data on overweight/obesity) were consistent with national prevalence rates, and there was no association between Body Mass Index (BMI) and headache. Regarding lifestyle, 2.0% of students reported smoking and 1.6% consuming alcohol occasionally, and neither was associated with headache. Quality of life, especially aspects of social life, appeared to be affected by the presence of headache. This study found a high prevalence of headache in school-aged children, which was associated with female students aged 10-14 years and quality of life. Copyright © AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.

Faked headaches becoming real.

PubMed

Haan, Joost

2013-06-01

In the gangster movie White Heat, the main character, Cody (played by James Cagney), suffers from 2 headache attacks. Here, I analyze these attacks by using the International Headache Society criteria, but an unequivocal diagnosis is not possible. Nevertheless, the attacks play an important role in the narrative and--as representation of something between "real" (mimesis) and not real--provide a ground for reflection on how to think of headache in general. © 2013 American Headache Society.

Headache management: pharmacological approaches

PubMed Central

Sinclair, Alex J; Sturrock, Aaron; Davies, Brendan; Matharu, Manjit

2015-01-01

Headache is one of the most common conditions presenting to the neurology clinic, yet a significant proportion of these patients are unsatisfied by their clinic experience. Headache can be extremely disabling; effective treatment is not only essential for patients but is rewarding for the physician. In this first of two parts review of headache, we provide an overview of headache management, emerging therapeutic strategies and an accessible interpretation of clinical guidelines to assist the busy neurologist. PMID:26141299

Epidemiology of concurrent headache and sleep problems in Denmark.

PubMed

Lund, Nunu; Westergaard, Maria Lurenda; Barloese, Mads; Glümer, Charlotte; Jensen, Rigmor Højland

2014-09-01

There are no previous epidemiologic studies on concurrent headache and sleep problems (HSP). This cross-sectional study aimed to determine the prevalence of HSP in Denmark, broadly characterize those with HSP, and examine associations between HSP and socioeconomic/lifestyle factors. A total of 129,150 randomly selected individuals were invited to participate in the Danish National Health Survey 2010. Respondents were asked about headache, sleep problems, depression and anxiety in the last two weeks, health-related lifestyle and quality of life (SF-12). Socioeconomic data were retrieved from national registers. Prevalence proportions were adjusted for stratified sampling and non-response. Regression analyses examined associations between HSP and socioeconomic/lifestyle factors. Of 68,518 respondents, 16.3% reported only headache, 21.1% only sleep problems, and 18.1% HSP with 2.6% being severely affected. Prevalence was higher among women and the middle-aged. Severe HSP was associated with low socioeconomic position, non-Western ethnicity, unhealthy lifestyle, high stress and anxiety/depression. Those with HSP had substantially reduced quality of life; more so than those having only headache or only sleep problems. HSP is a highly prevalent condition. Lifestyle modification, stress reduction, and screening for concurrent depression and anxiety may play important roles in management. The high prevalence of HSP suggests a common pathophysiological mechanism. © International Headache Society 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

A Survey of Headache Medicine Physicians on the Likeability of Headaches and Their Personal Headache History.

PubMed

Evans, Randolph W; Ghosh, Kamalika

2016-03-01

Two prior studies have shown an increased prevalence of migraine among physicians who are headache medicine specialists (HMS). There have been no studies of the prevalence of other headache disorders among HMS. A prior survey showed that neurologists like to treat some headaches more than others but there has not been a similar survey of HMS. The aim of the survey was to learn more about the prevalence of headaches among HMS and which headache disorders they like to treat. An email survey was sent to 749 physician members of the American Headache Society who were asked to respond to the following statement using a 5-point Likert scale (from 1, strongly disagree to 5, strongly agree): "I like to treat patients with the following types of headaches or syndromes." They were asked, "Have you personally suffered from any of the following at any time during your life: episodic migraine (EM), chronic migraine (CM), refractory migraine (RM), episodic cluster (EC), chronic cluster (CC), new daily persistent headache (NDPH), and postconcussion syndrome (PCS)." The response rate was 15.8% (n = 118) with a mean age of 51.4 years, 64.4% males, and 85.6% neurologists. HMS reported likeability for treating disorders in rank order as follows: EM (mean = 4.69, SD = 0.61); CM (mean = 4.20, SD = 0.94); RM (mean = 3.62, SD = 1.17); EC (mean = 4.37, SD = 0.80); CC (mean = 3.68, SD = 1.10); NDPH (mean = 3.52, SD = 1.21); and PCS (mean = 3.66, SD = 1.18). The lifetime prevalence of disorders was as follows: EM, 69.5% (85.7% in females and 60.5% in males); CM, 13.6% (19% in females and 10.5% in males); RM, .9% (2.4% females and 0% males); EC, 1.7% (0% females and 2.6% males); CC, 0%; NDPH, 0%, and PCS, 4.2% (7.1% females and 2.6% males). HMS with a personal history of EM (mean = 4.73, SD = 0.51) showed a significant preference (t130  = 7.30, P < .001) to treat episodic migraine more than other headaches (mean�

Migraine disability assessment (MIDAS) score: relation to headache frequency, pain intensity, and headache symptoms.

PubMed

Stewart, Walter F; Lipton, Richard B; Kolodner, Ken

2003-03-01

To determine the extent to which variation in the Migraine Disability Assessment (MIDAS) score is associated with headache frequency, pain intensity, headache symptoms, gender, and employment status. The MIDAS questionnaire is a 7-item questionnaire (with 5 scored items) designed to measure headache-related disability, to improve physician-patient communication, and to identify patients with high treatment needs. Data from 3 population-based studies (total sample, n = 397) conducted in the United States and the United Kingdom were used to evaluate the relationship between headache features (attack frequency, pain intensity, pain quality, and associated symptoms) and MIDAS score. Data on headache features were collected by telephone using a standardized interview. The MIDAS questionnaire was completed shortly after the telephone interview. General linear models were used to determine the extent to which population variation in the MIDAS score was explained by headache features. Using linear regression, variables for all headache features (ie, headache frequency, pain intensity, pain quality, and associated symptoms) and demographic characteristics explained only 22% of the variation in MIDAS scores. Almost all (19.9%) the explained variance was accounted for by average pain intensity (12.0%), number of headache days (6.1%), and exacerbation of pain with movement (1.8%). When pain intensity and headache frequency were included in the model, no statistically significant differences in MIDAS scores were observed by gender or employment status. Although explaining only 2.1% of the variance, age was significantly associated with MIDAS scores, with those under 25 years demonstrating higher MIDAS scores than other age groups. No other variables (ie, frequency of occurrence of associated symptoms and other measures of quality of pain) were associated with MIDAS scores. Challenges to the utility of the MIDAS as a measure include whether headache-related disability is largely

Chronic Daily Headaches

MedlinePlus

... headache New daily persistent headache Hemicrania continua Chronic migraine This type typically occurs in people with a history of episodic migraines. Chronic migraines tend to: Affect one side or ...

Pain sensitivity mediates the relationship between stress and headache intensity in chronic tension-type headache.

PubMed

Cathcart, Stuart; Bhullar, Navjot; Immink, Maarten; Della Vedova, Chris; Hayball, John

2012-01-01

A central model for chronic tension-type headache (CTH) posits that stress contributes to headache, in part, by aggravating existing hyperalgesia in CTH sufferers. The prediction from this model that pain sensitivity mediates the relationship between stress and headache activity has not yet been examined. To determine whether pain sensitivity mediates the relationship between stress and prospective headache activity in CTH sufferers. Self-reported stress, pain sensitivity and prospective headache activity were measured in 53 CTH sufferers recruited from the general population. Pain sensitivity was modelled as a mediator between stress and headache activity, and tested using a nonparametric bootstrap analysis. Pain sensitivity significantly mediated the relationship between stress and headache intensity. The results of the present study support the central model for CTH, which posits that stress contributes to headache, in part, by aggravating existing hyperalgesia in CTH sufferers. Implications for the mechanisms and treatment of CTH are discussed.

Psychological Factors Associated with Chronic Migraine and Severe Migraine-Related Disability: an Observational Study in a Tertiary Headache Center

PubMed Central

Seng, Elizabeth K.; Buse, Dawn C.; Klepper, Jaclyn E.; Mayson, Sarah Jo; Grinberg, Amy S.; Grosberg, Brian M.; Pavlovic, Jelena M.; Robbins, Matthew S.; Vollbracht, Sarah E.; Lipton, Richard B.

2016-01-01

Objective To evaluate relationships among modifiable psychological factors and chronic migraine and severe migraine-related disability in a clinic-based sample of persons with migraine. Background Evidence evaluating relationships between modifiable psychological factors and chronic migraine and severe migraine-related disability is lacking in people with migraine presenting for routine clinical care. Methods Adults with migraine completed surveys during routinely scheduled visits to a tertiary headache center. Participants completed surveys assessing chronic migraine (meeting criteria for migraine with ≥15 headache days in the past month), severe migraine disability (Migraine Disability Assessment Scale score ≥ 21), and modifiable psychological factors [depressive symptoms (Patient Health Questionnaire-9), anxious symptoms (Generalized Anxiety Disorder-7), Pain Catastrophizing Scale and Headache Specific Locus of Control]. Logistic regression evaluated relationships between modifiable psychological factors and chronic migraine and severe migraine disability. Results Among 90 eligible participants the mean age was 45.0 (SD = 12.4); 84.8% were women. One-third (36.0%) met study criteria for chronic migraine; half of participants (51.5%) reported severe migraine-related disability. Higher depressive symptoms (OR = 1.99, 95% CI = 1,11, 3.55) and chance HSLC (OR = 1.85, 95% CI = 1.13, 1.43) were associated with chronic migraine. Higher depressive symptoms (OR = 3.54, 95%CI = 1.49, 8.41), anxiety symptoms (OR = 3.65, 95% CI = 1.65, 8.06), and pain catastrophizing (OR = 1.95, 95% CI = 1.14, 3.35), were associated with severe migraine-related disability. Conclusions Psychiatric symptoms and pain catastrophizing were strongly associated with severe migraine-related disability. Depression and chance locus of control were associated with chronic migraine. This study supports the need for longitudinal observational studies to evaluate relationships among naturalistic

Headache in epilepsy patients: the (un)awareness of this phenomenon among Dutch neurologists.

PubMed

Hofstra, W A; Hageman, G; de Weerd, A W

2015-02-01

Headache is a frequently heard complaint that can strongly influence quality of life. This is probably even more so in people with a chronic illness. Knowing that headache, and especially migraine, is more frequent among epilepsy patients, the knowledge concerning this problem has been studied among Dutch neurologists. Seven hundred and seventy two neurologists, working in 89 hospitals and two tertiary epilepsy clinics were asked to participate. Using a questionnaire, neurologists were surveyed on different subjects, e.g. whether they thought current headaches are more frequent in people with epilepsy than in the general population, their interest for epilepsy and how many patients with epilepsy visited their polyclinic per month. In total, 334 questionnaires were returned (response rate of 43%) of which 18 were excluded. One third of neurologists responded affirmatively that current headaches are more prevalent among people with epilepsy and eight percent knows that this is, more specified, migraine. The number of years of experience does not influence knowledge on headaches in epilepsy patients. The interest in epilepsy and the number of epilepsy patients per month on the polyclinic does. These results show that the occurrence of headache in people with epilepsy is underestimated by Dutch neurologists. This leaves an often bothersome and potentially treatable condition underexposed. Copyright © 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

The linear trend of headache prevalence and some headache features in school children.

PubMed

Ozge, Aynur; Buğdayci, Resul; Saşmaz, Tayyar; Kaleağasi, Hakan; Kurt, Oner; Karakelle, Ali; Siva, Aksel

2007-04-01

The objectives of this study were to determine the age and sex dependent linear trend of recurrent headache prevalence in schoolchildren in Mersin. A stratified sample composed of 5562 children; detailed characteristics were previously published. In this study the prevalence distribution of headache by age and sex showed a peak in the female population at the age of 11 (27.2%) with a plateau in the following years. The great stratified random sample results suggested that, in addition to socio-demographic features, detailed linear trend analysis showed headache features of children with headache have some specific characteristics dependent on age, gender and headache type. This study results can constitute a basis for the future epidemiological based studies.

Pain sensitivity mediates the relationship between stress and headache intensity in chronic tension-type headache

PubMed Central

Cathcart, Stuart; Bhullar, Navjot; Immink, Maarten; Della Vedova, Chris; Hayball, John

2012-01-01

BACKGROUND: A central model for chronic tension-type headache (CTH) posits that stress contributes to headache, in part, by aggravating existing hyperalgesia in CTH sufferers. The prediction from this model that pain sensitivity mediates the relationship between stress and headache activity has not yet been examined. OBJECTIVE: To determine whether pain sensitivity mediates the relationship between stress and prospective headache activity in CTH sufferers. METHOD: Self-reported stress, pain sensitivity and prospective headache activity were measured in 53 CTH sufferers recruited from the general population. Pain sensitivity was modelled as a mediator between stress and headache activity, and tested using a nonparametric bootstrap analysis. RESULTS: Pain sensitivity significantly mediated the relationship between stress and headache intensity. CONCLUSIONS: The results of the present study support the central model for CTH, which posits that stress contributes to headache, in part, by aggravating existing hyperalgesia in CTH sufferers. Implications for the mechanisms and treatment of CTH are discussed. PMID:23248808

The Global Burden of Headache.

PubMed

Saylor, Deanna; Steiner, Timothy J

2018-04-01

At the turn of the century, most of the world's population lived in regions where the prevalence of headache was unknown and its impact poorly understood. Lifting The Burden (LTB), a nonprofit organization in official relations with the World Health Organization, established the Global Campaign against Headache, with the ultimate purpose of reducing the burden of headache worldwide. First, the scope and scale of this burden had to be known. LTB embarked upon a program of population-based studies in countries in all world regions in order to achieve its aim. Its studies have demonstrated a high prevalence of headache disorders, including migraine, tension-type headache, and medication-overuse headache, and their associations with impaired quality of life, substantial lost productivity, and high economic costs in every country surveyed. Informed by these, the Global Burden of Disease study ranks headache disorders as the second leading cause of years lived with disability worldwide; migraine alone is third among people aged 15 to 49 years. With interventions urgently needed to reduce these burdens throughout the world, we review the epidemiological studies conducted by LTB, examine proposed interventions to improve provision of headache care including a three-tier system of structured headache services, and consider the challenges still remaining in providing effective, efficient, and equitable headache care especially in low-income countries. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

[Chronic daily headache: clinical presentation].

PubMed

Krymchantowski, A V; Moreira Filho, P F

2000-06-01

Chronic daily headache (CDH) represents a group of any headache disorder that occurs on a daily or near daily basis, for longer than 6 months. Even though it is a common problem, it is not a well defined disorder, resulting in controversies regarding its identification, description and approach. Three hundred patients, 232 women and 68 men, ages 16 to 86 (mean 38 years old for the women and 42 for the men), attending a headache center and fulfilling the proposed criteria for CDH (Silberstein et al.) and presenting headache 28 days per month were retrospectively studied. The clinical features allowed the primary headache diagnosis, before the transformation into daily presentation as: transformed migraine (TM ) in 271 patients (90,3%), chronic tension-type headache (CTTH) in 26 patients (8,7%) and new daily persistent headache (NDPH) in 3 patients (1%). Among the TM patients, the most observed presentation was pressure or tightening, bilateral fronto-temporal, moderate non-continuous headache, with a progressive onset. The association with nausea and phonophobia was demonstrated in 60% and 32% of the patients respectively. The association with photophobia and sleep disturbances, as well as the occurrence of intermittent headache attacks, was different among male and female patients. With regard to the CTTH patients, pressure or tightening, bilateral fronto-temporal, moderate non-continuous headache, with sleep disturbances and no associated symptoms, was the predominant presentation.

Chronic daily headache in U.S. soldiers after concussion.

PubMed

Theeler, Brett J; Flynn, Frederick G; Erickson, Jay C

2012-05-01

To determine the prevalence and characteristics of, and factors associated with, chronic daily headache (CDH) in U.S. soldiers after a deployment-related concussion. A cross-sectional, questionnaire-based study was conducted with a cohort of 978 U.S. soldiers who screened positive for a deployment-related concussion upon returning from Iraq or Afghanistan. All soldiers underwent a clinical evaluation at the Madigan Traumatic Brain Injury Program that included a history, physical examination, 13-item self-administered headache questionnaire, and a battery of cognitive and psychological assessments. Soldiers with CDH, defined as headaches occurring on 15 or more days per month for the previous 3 months, were compared to soldiers with episodic headaches occurring less than 15 days per month. One hundred ninety-six of 978 soldiers (20%) with a history of deployment-related concussion met criteria for CDH and 761 (78%) had episodic headache. Soldiers with CDH had a median of 27 headache days per month, and 46/196 (23%) reported headaches occurring every day. One hundred seven out of 196 (55%) soldiers with CDH had onset of headaches within 1 week of head trauma and thereby met the time criterion for posttraumatic headache (PTHA) compared to 253/761 (33%) soldiers with episodic headache. Ninety-seven out of 196 (49%) soldiers with CDH used abortive medications to treat headache on 15 or more days per month for the previous 3 months. One hundred thirty out of 196 (66%) soldiers with CDH had headaches meeting criteria for migraine compared to 49% of soldiers with episodic headache. The number of concussions, blast exposures, and concussions with loss of consciousness was not significantly different between soldiers with and without CDH. Cognitive performance was also similar for soldiers with and without CDH. Soldiers with CDH had significantly higher average scores on the posttraumatic stress disorder (PTSD) checklist compared to soldiers with episodic headaches. Forty

Headache associated with cough: a review

PubMed Central

2013-01-01

Headache only triggered by coughing is a rather uncommon condition. The aim of the present review is to present an overview of the diagnosis, clinical characteristics, pathophysiology and treatment of both primary and symptomatic cough headache and discuss other relevant headache disorders affected by coughing. The diagnosis of primary cough headache is made when headache is brought on and occurs only in association with coughing, straining or a Valsalva manoeuvre and in the absence of any abnormalities on neuro-imaging. In case an underlying pathology is identified as a cause of the headache, the diagnosis of symptomatic cough headache is made. The vast majority of these patients present with a Chiari malformation type I. Other frequently reported causes include miscellaneous posterior fossa pathology, carotid or vertebrobasilar disease and cerebral aneurysms. Consequently, diagnostic neuroimaging is key in the diagnosis of cough-related headache and guides treatment. Besides primary and symptomatic cough headache, several other both primary and secondary headache disorders exist where coughing acts as a trigger or aggravator of headache symptomatology. PMID:23687906

The influence of ictal cutaneous allodynia on the response to occipital transcutaneous electrical stimulation in chronic migraine and chronic tension-type headache: a randomized, sham-controlled study.

PubMed

Bono, F; Salvino, D; Mazza, M R; Curcio, M; Trimboli, M; Vescio, B; Quattrone, A

2015-04-01

The objective of this article is to determine whether cutaneous allodynia (CA) influences the response to treatment with occipital transcutaneous electrical stimulation (OTES) in chronic migraine (CM) and chronic tension-type headache (CTTH). One hundred and sixty consecutive patients with CM or CTTH were randomized to be treated with real or sham OTES stimulation three times a day for two consecutive weeks. All patients completed the validated 12-item allodynia symptom checklist for assessing the presence and the severity of CA during headache attack. Primary end-point was change (≥50%) in number of monthly headache-free days. There was a significant difference in the percentage of responders in the real OTES compared with sham OTES group (p <0.001). Importantly, there was not a significant change of monthly headache-free days in the allodynic patients with CM and CTTH treated both with real and sham OTES, while the number of headache-free days per month was significantly reduced in the real (86%) but not in the sham group (7%) of non-allodynic patients with CTTH and CM. Severe CA is associated with decreased response to treatment with OTES in patients with CM and CTTH. © International Headache Society 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Headache Sufferers' Diet

MedlinePlus

... of sensitivities (for example, people who find red wine to be a headache trigger often find chocolate ... headaches from alcohol . Others react mostly to red wine (especially Chianti), which is a sensitivity to chemicals, ...

Allergies and Headache

MedlinePlus

... headache continues to be controversial. Many patients with migraine headache attribute their reactions to certain foods as ... majority of foods that play a role in migraine contain vasoactive or neuroactive amino acids such as ...

Comprehensive Headache Experience in Collegiate Student-Athletes: An Initial Report From the NCAA Headache Task Force.

PubMed

Seifert, Tad; Sufrinko, Alicia; Cowan, Robert; Scott Black, W; Watson, Dave; Edwards, Bill; Livingston, Scott; Webster, Keith; Akers, David; Lively, Mathew; Kontos, Anthony P

2017-06-01

The prevalence of primary headache disorders in the general population provides a unique challenge in the evaluation of headache occurring in the context of sport. Despite a wealth of studies exploring the epidemiology of headache in the layperson, little is known about the prevalence and nature of headaches in collegiate student-athletes. These scenarios are challenging in the return to play context, as it is often unclear whether an athlete has an exacerbation of a primary headache disorder, new onset headache unrelated to trauma, or has suffered a concussive injury. To establish the prevalence and nature of headaches in collegiate student-athletes. Retrospective cross-sectional survey. This cross-sectional survey evaluated the characteristics and prevalence of headache in 834 student-athletes from four NCAA Division-I institutions. Because headache occurrence may vary by sport (collision, contact, non-contact), by sex, and medical history, our sample included male and female athletes in a variety of sports, with differing degrees of contact exposure. The 20 question survey collected data on personal and family history of headache, as well as concussion history. A total of 23.7% (n = 198) of participants reported having a personal history of migraine, 25.2% (n = 210) history of sinus headache, and 12.3% (n = 103) history of tension type headache. Among athletes with a prior history of concussion, 46.3% (n = 25) of females reported a history of migraine, while only 32.2% of males reported history of migraine (χ 2  = 3.421, P = .064). The etiology of increased prevalence of migraine in our study is unclear. Whether this is due to increased awareness of headache disorders, a consequence of contact exposure, or a predisposition for migraine development in this age group remains unclear. Further studies are indicated. © 2017 American Headache Society.

Osmophobia in juvenile primary headaches.

PubMed

Corletto, E; Dal Zotto, L; Resos, A; Tripoli, E; Zanchin, G; Bulfoni, C; Battistella, P A

2008-08-01

This study was planned to investigate the prevalence of osmophobia in juvenile headache sufferers and to analyse the diagnostic utility of osmophobia in order to distinguish migraine without aura from episodic tension-type headache. We examined 305 consecutive patients presenting at our Paediatric Headache Centre. A semistructured questionnaire was given to 275 selected patients affected by migraine or tension-type headache. The prevalence of osmophobia during attacks was 18.5%, mainly in migraine patients (25.1%) vs. those with tension-type headache (8.3%). Osmophobia showed more specificity than phonophobia or photophobia in the differential diagnosis between migraine and tension-type headache. In conclusion, this study demonstrates that osmophobia resulted in a symptom with poor sensitivity (27.1%) but high specificity (92%) that could become a supportive diagnostic criterion even in children for the differential diagnosis between migraine without aura and tension-type headache.

Botulinum toxin A is effective to treat tension-type headache caused by hemifacial spasm.

PubMed

Mizuma, Atsushi; Nagata, Eiichiro; Yasuda, Takashi; Kouchi, Maiko; Nakayama, Taira; Honma, Kazunari; Tokuoka, Kentaro; Kitagawa, Yasuhisa; Nogawa, Shigeru; Takizawa, Shunya

2017-10-01

We examined the relationship between hemifacial spasm (HFS; a form of cranio-cervical dystonia) and chronic primary headache, including tension-type headache (TTH). We also examined whether botulinum toxin A (BoNT/A) therapy for HFS ameliorates concomitant TTH. Fifty-one HFS patients receiving BoNT/A therapy were recruited. Patients' characteristics (including age, gender, chronic headache history, exercise habits, stiff neck, cervical spondylolysis history), stress factors, worsening/new onset of headache associated with HFS, and dose of BoNT/A were examined. We diagnosed headache types according to The International Classification of Headache Disorders, 3rd edition, beta. Numerical Rating Scale (NRS) and Headache Impact Test-6 (HIT-6) scores for headache severity were compared between the 6-week baseline before BoNT/A therapy and 6-week follow-up after BoNT/A therapy. Of 51 patients with HFS, 17 (33.3%) reported worsening or new onset of headache (especially TTH) associated with HFS (Group-S), and 34 were not aware of headache (Group-N). Twelve patients (70.6%) in group-S reported improvement of headache after BoNT/A therapy. NRS (from 7 [5-9] to 0 [0-5], p<0.01) and HIT-6 (from 55 [54-64] to 44 [36-52], p<0.001) scores were significantly improved after BoNT/A therapy. Logistic regression analysis revealed significant interaction between TTH associated with HFS and the presence of stress factors (odds ratio 43.11: 2.95-629.39, p<0.001) and history of chronic headache (odds ratio 28.53: 2.96-275.10, p<0.001). Primary headache, especially TTH, is associated with HFS. BoNT/A therapy for HFS may also be indirectly effective for treatment of TTH. Copyright © 2017 Elsevier Ltd. All rights reserved.

Nummular headache: diagnosis and treatment.

PubMed

Pareja, Juan A; Pareja, Julia

2003-05-01

Nummular headache (coin-shaped cephalgia) has an unusual distinct feature: it is characterized by mild-to-moderate pressure-like pain exclusively felt in a rounded or elliptical area typically 2-6 cm in diameter. Although any region of the head may be affected, the parietal area is the common localization of nummular headache. The pain remains confined to the same symptomatic area which does not change in shape or size with time. The pain is continuous but lancinating exacerbations lasting for several seconds or gradually increasing from 10 mins to 2 h may superimpose the baseline pain. The temporal pattern is either chronic or remitting. Pseudoremissions may be observed when the pain reaches a very low grade or only discomfort (not pain) in the affected area is reported. At times, discomfort may prevail. Either during symptomatic periods or interictally, the affected area may show a variable combination of hypoethesia, dysesthesia, paresthesia or tenderness. Physical and supplementary examinations are normal. Nummular headache emerges as a primary clear-cut clinical picture. The particular topography and signs of sensory dysfunction make it reasonable to vent the idea that nummular headache is an extracranial headache, probably stemming from epicranial tissues such as terminal branches of sensitive nerves. Nummular headache may seem to be the paradigm of epicranias (group of headaches and pericranial neuralgias stemming from epicranial tissues). Nummular headache must be distinguished from head pain secondary to local processes and from tender points of more extensive headaches. Although nummular headache may frequently coexist with other primary headaches, it has an independent course. Treatment is seldom necessary and in most cases simple reassurance is sufficient.

Anxiety, depression and school absenteeism in youth with chronic or episodic headache

PubMed Central

Rousseau-Salvador, Céline; Amouroux, Rémy; Annequin, Daniel; Salvador, Alexandre; Tourniaire, Barbara; Rusinek, Stéphane

2014-01-01

BACKGROUND: Chronic daily headache (CDH) in children has been documented in general and clinical populations. Comorbid psychological conditions, risk factors and functional outcomes of CDH in children are not well understood. OBJECTIVES: To examine anxiety and depression, associated risk factors and school outcomes in a clinical population of youth with CDH compared with youth with episodic headache (EH). METHODS: Data regarding headache characteristics, anxiety, depression and missed school days were collected from 368 consecutive patients eight to 17 years of age, who presented with primary headache at a specialized pediatric headache centre. RESULTS: A total of 297 patients (81%) were diagnosed with EH and 71 were diagnosed with CDH. Among those with CDH, 78.9% presented with chronic tension-type headache and 21.1% with chronic migraine (CM). Children with CDH had a higher depression score than the standardized reference population. No difference was observed for anxiety or depression scores between children with CDH and those with EH. However, children with CM were more anxious and more depressed than those with chronic tension-type headache. Youth experiencing migraine with aura were three times as likely to have clinically significant anxiety scores. Headache frequency and history were not associated with psychopathological symptoms. Children with CDH missed school more often and for longer periods of time. CONCLUSIONS: These findings document the prevalence of anxiety, depression and school absenteeism in youth with CDH or EH. The present research also extends recent studies examining the impact of aura on psychiatric comorbidity and the debate on CM criteria. PMID:24911174

New daily persistent headache: A lack of an association with white matter abnormalities on neuroimaging.

PubMed

Rozen, Todd D

2016-09-01

To provide results from the largest study of new daily persistent headache patients to date and specifically evaluate if patients with primary new daily persistent headache develop white matter abnormalities or infarct-like lesions on neuroimaging. Retrospective analysis of patient medical records utilizing an electronic medical record system. All patients were seen at a headache specialty clinic by a single headache neurologist and diagnosed with primary new daily persistent headache during the time period of January 2009 to January 2013. Altogether, 97 patients were diagnosed with primary new daily persistent headache (65 women and 32 men). The mean average age of onset was slightly younger in women than men: 32.4 years vs. 35.8 years. In total, 84 of the 97 new daily persistent headache patients had no white matter abnormalities or infarct-like lesions on magnetic resonance imaging with a gender distribution of 56 women and 28 men. The mean age of onset of this white matter negative subgroup was 31.1 years. Of these individuals, 36% had cardiovascular/cerebrovascular risk factors and 44% had a history of migraine. Only 13 new daily persistent headache patients (nine women, four men) demonstrated white matter abnormalities on magnetic resonance imaging. None had infarct-like lesions. The mean age of onset of this white matter positive subgroup was 54.2 years, significantly older than the white matter negative population (p < .05). All new daily persistent headache patients in the white matter positive subgroup had cardiovascular/cerebrovascular risk factors and dual risk factors were noted in seven of 13 patients. Only 23% had a migraine history. Almost 40% of the patients in the white matter negative group were imaged 3 years after headache onset and at least six patients were imaged at least 9 years or more after onset of new daily persistent headache. Triggering events in both white matter lesion positive and negative populations were typical of the new

Obesity and Headache: Part I – A Systematic Review of the Epidemiology of Obesity and Headache

PubMed Central

Chai, Nu Cindy; Scher, Ann I.; Moghekar, Abhay; Bond, Dale S.; Peterlin, B. Lee

2014-01-01

Individually, both obesity and headache are conditions associated with a substantial personal and societal impact. Recent data support that obesity is comorbid with headache in general and migraine specifically, as well as with certain secondary headache conditions such as idiopathic intracranial hypertension. In the current manuscript, we first briefly review the epidemiology of obesity and common primary and secondary headache disorders individually. This is followed by a systematic review of the general population data evaluating the association between obesity and headache in general, and then obesity and migraine and tension-type headache disorders. Finally, we briefly discuss the data on the association between obesity and a common secondary headache disorder that is associated with obesity, idiopathic intracranial hypertension. Taken together, these data suggest that it is important for clinicians and patients to be aware of the headache/migraine-obesity association, given that it is potentially modifiable. Hypotheses for mechanisms of the obesity-migraine association and treatment considerations for overweight and obese headache sufferers are discussed in the companion manuscript, as part II of this topic. PMID:24512574

Advice and care for headaches: who seeks it, who gives it?

PubMed

Thomas, E; Boardman, H F; Ogden, H; Millson, D S; Croft, P R

2004-09-01

Using data from a cross-sectional survey and a prospective record linkage study the aims of this study were to: (i) determine sources of advice and care for headaches in a population survey of adults, and (ii) investigate prospectively the influences of headaches on general practice consultation in a 12-month follow-up of the responders to the population survey. A population based cross-sectional survey was mailed to 4885 adults (aged > or = 18 years) with an adjusted response rate of 56% (n = 2662). The main outcome measures of interest were (i) self-report advice and care-seeking in the survey (ii) consultation with general practitioner for headache and for other conditions in 12-month period subsequent to the survey. Reporting a recent GP consultation for headache was associated with younger age (mean: 46 vs 48 years), female gender (68% vs 60%), and greater headache severity as measured by frequency, pain, and associated disability. The commonest sources of advice and care in the past were GPs (27%), opticians (21%), and pharmacists (8%). Consultations for headache were not common in the 12-months following the survey (n = 144); however, those reporting a recent headache were almost 4 times more likely to consult subsequently with a headache than those not (relative risk; 95% CI: 3.7; 1.9, 7.0). Recent reporting of headache was also associated with an increased risk of consulting for mental disorders (1.7; 1.2, 2.6), diseases of the digestive (1.6; 1.1, 2.3) and respiratory system (1.4; 1.1, 1.8), and a decreased risk of consulting for circulatory diseases (0.8; 0.7, 1.0). Only a minority of headache sufferers consult their GP, regardless of severity, with opticians and pharmacists being other important sources of information. Headache appears to have an additional impact upon GP workload through increased rates of consultations for nonheadache conditions amongst headache sufferers. The interesting findings regarding rates of consultation for digestive and

Chronic daily headache in the elderly.

PubMed

Özge, Aynur

2013-12-01

Disabling headache disorders are ubiquitous in all age groups, including the elderly, yet they are under-recognized, underdiagnosed and undertreated worldwide. Surveys and clinic-based research reports on headache disorders in elderly populations are extremely limited in number. Chronic daily headache (CDH) is an important and growing subtype of primary headache disorders, associated with increased burden and disruption to quality of life. CDH can be divided into two forms, based on headache duration. Common forms of primary headache disorders of long duration (>4 hours) were comprehensively defined in the third edition of the International Classification of Headache Disorders (ICHD-3 beta). These include chronic migraine, chronic tension-type headache, new daily persistent headache, and hemicrania continua. Rarer short-duration (<4 hours) forms of CDH are chronic cluster headache, chronic paroxysmal hemicrania, SUNCT, and hypnic headache. Accurate diagnosis, management, and relief of the burden of CDH in the elderly population present numerous unique challenges as the "aging world" continues to grow. In order to implement appropriate coping strategies for the elderly, it is essential to establish the correct diagnosis at each step and to exercise caution in differentiating from secondary causes, while always taking into consideration the unique needs and limitations of the aged body.

Patients with sudden onset headache not meeting the criteria of the International Headache Society for new daily persistent headache. How to classify them?

PubMed

Monzillo, Paulo Hélio; Nemoto, Patrícia Homsi

2011-12-01

We conducted a retrospective analysis of the records of 1348 patients regularly treated at the headache clinic of Department of Neurology of Santa Casa de São Paulo, Brazil. Sixty-two patients reported history of daily and persistent headache. From the 62 patients selected, only 21 (group 1) could be diagnosed with new daily-persistent headache (NDPH) according to the International Headache Society (HIS) 2004 criteria. The 41 remaining patients (group 2) could not be diagnosed with NDPH according to IHS-2004 once they presented two or more migraine attack-related symptoms, such as: nausea, photophobia, phonophobia and vomiting, in different combinations. It was not possible to classify them in groups 1 to 4 of primary headaches either. How to classify them? We suggest that the criteria are revised. And one way we can classify them, would be the subdivision: NDPH with migraine features and without migraine features that would allow the inclusion of all individuals present who has a daily and persistent headache from the beginning.

INFLUENCE OF RETIREMENT AND WORK STRESS ON HEADACHE PREVALENCE: A LONGITUDINAL MODELLING STUDY FROM THE GAZEL COHORT

PubMed Central

Sjösten, Noora; Nabi, Hermann; Westerlund, Hugo; Singh-Manoux, Archana; Dartigues, Jean-François; Goldberg, Marcel; Zins, Marie; Oksanen, Tuula; Salo, Paula; Pentti, Jaana; Kivimäki, Mika; Vahtera, Jussi

2012-01-01

Aims To examine trajectories of headache in relation to retirement and to clarify the role of work stress and stress-prone personality. Methods Headache prevalence during seven years before and after retirement was measured by annual questionnaires from GAZEL cohort comprising French national gas and electricity company employees (N=12,913). Odds ratios and 95% confidence intervals for headache during pre- peri- and post-retirement were calculated. The role of effect modifiers (work stress, type A or hostile personality) was tested by multiplicative interactions and synergy indices. Results 11%-13% reduction in headache prevalence was found during pre- and post-retirement, whereas decline was much steeper (46%) during the retirement transition. In absolute terms, the decline was greater among persons with high work stress or stress-prone personality than among other participants. Conclusions Retirement is associated with a decrease in headache prevalence, particularly among persons with high amount of work stress or proneness to overreact to stress. PMID:21220374

Spinal Cord Injury and Migraine Headache: A Population-Based Study

PubMed Central

Warner, Freda M.; Cragg, Jacquelyn J.; Weisskopf, Marc G.; Kramer, John K.

2015-01-01

Migraine headaches are a common neurological condition, negatively impacting health and quality of life. Among potential risk factors for migraine headache, risk of migraine headaches was elevated in individuals with spinal cord injury (SCI). The association between migraines and SCI is intriguing to consider from the perspective that migraine headaches may be acquired in response to damage in the spinal cord. The primary objective of this study was to further examine the association between SCI and migraine headache, controlling for potential confounding variables. A secondary objective was to determine the impact of migraine headaches on self-perceived health. Data from a sample of 61,047 participants were obtained from the cross-sectional Canadian Community Health Survey. Multivariable logistic regression was used to explore the association between SCI and migraine headache using probability weights and adjusting for confounders. The multivariable age- and sex-adjusted model revealed a strong association between SCI and migraine headache, with an adjusted odds ratio for migraine of 4.82 (95% confidence interval [3.02, 7.67]) among those with SCI compared to those without SCI. Further, individuals who experienced both SCI and migraine tended to report poorer perceived general health compared with the other groups (i.e., SCI and no migraine). In conclusion, this study established a strong association between SCI and migraine headache. Further research is needed to explore the possible mechanisms underlying this relationship. Improvements in clinical practice to minimize this issue could result in significant improvements in quality of life. PMID:26308549

Pediatric Headache Clinic Model: Implementation of Integrative Therapies in Practice.

PubMed

Esparham, Anna; Herbert, Anne; Pierzchalski, Emily; Tran, Catherine; Dilts, Jennifer; Boorigie, Madeline; Wingert, Tammie; Connelly, Mark; Bickel, Jennifer

2018-06-12

The demand for integrative medicine has risen in recent years as research has demonstrated the efficacy of such treatments. The public has also become more conscientious of the potential limitations of conventional treatment alone. Because primary headache syndromes are often the culmination of genetics, lifestyle, stress, trauma, and environmental factors, they are best treated with therapies that are equally multifaceted. The Children’s Mercy Hospital, Kansas City, Missouri Headache Clinic has successfully incorporated integrative therapies including nutraceuticals, acupuncture, aromatherapy, biofeedback, relaxation training, hypnosis, psychology services, and lifestyle recommendations for headache management. This paper provides a detailed review of the implementation of integrative therapies for headache treatment and discusses examples through case studies. It can serve as a model for other specialty settings intending to incorporate all evidenced-based practices, whether complementary or conventional.

Carbon monoxide inhalation induces headache in a human headache model.

PubMed

Arngrim, Nanna; Schytz, Henrik Winther; Britze, Josefine; Vestergaard, Mark Bitsch; Sander, Mikael; Olsen, Karsten Skovgaard; Olesen, Jes; Ashina, Messoud

2018-04-01

Introduction Carbon monoxide (CO) is an endogenously produced signalling molecule that has a role in nociceptive processing and cerebral vasodilatation. We hypothesized that inhalation of CO would induce headache and vasodilation of cephalic and extracephalic arteries. Methods In a randomized, double-blind, placebo-controlled crossover design, 12 healthy volunteers were allocated to inhalation of CO (carboxyhemoglobin 22%) or placebo on two separate days. Headache was scored on a verbal rating scale from 0-10. We recorded mean blood velocity in the middle cerebral artery (VMCA) by transcranial Doppler, diameter of the superficial temporal artery (STA) and radial artery (RA) by high-resolution ultrasonography and facial skin blood flow by laser speckle contrast imaging. Results Ten volunteers developed headache after CO compared to six after placebo. The area under the curve for headache (0-12 hours) was increased after CO compared with placebo ( p = 0.021). CO increased VMCA ( p = 0.002) and facial skin blood flow ( p = 0.012), but did not change the diameter of the STA ( p = 0.060) and RA ( p = 0.433). Conclusion In conclusion, the study demonstrated that CO caused mild prolonged headache but no arterial dilatation in healthy volunteers. We suggest this may be caused by a combination of hypoxic and direct cellular effects of CO.

New Daily Persistent Headache Caused by a Multinodular Goiter and Headaches Associated With Thyroid Disease.

PubMed

Evans, Randolph W; Timm, Josefine S

2017-02-01

A 33-year-old female is presented with the first case to our knowledge of new daily persistent headache (NDPH) with a large right benign non-toxic multinodular goiter causing carotid and vertebral compression with complete resolution of the headache immediately after thyroidectomy. Although this may be quite rare, hypothyroidism or hyperthyroidism causing NDPH, migraine, or an exacerbation of pre-existing migraine is not. Clinicians should consider routinely obtaining serum thyroid-stimulating hormone (TSH) and free T4 in patients with new onset frequent headaches or an exacerbation of prior primary headaches. © 2016 American Headache Society.

Are migraine and non-migrainous headache risk factors for stroke in the elderly? Findings from a 12-year cohort follow-up

PubMed Central

Norton, Joanna; Portet, Florence; Gabelle, Audrey; Debette, Stephanie; Ritchie, Karen; Touchon, Jacques; Berr, Claudine

2016-01-01

Background There is evidence that migraine is a risk factor for stroke but little is known about this association in elderly people. Furthermore, non-migrainous headache (NMH) has received little attention as a potential risk factor, despite being the most frequently reported type of headache. Late-life migraine and NMH were examined as candidate risk factors for stroke in a community-dwelling elderly sample over a 12-year follow-up. Methods 1919 non-institutionalized subjects 65+, without dementia (DSM-IV criteria) and no stroke history at baseline were drawn from the 3C-Montpellier cohort (recruitment 1999–2001) for the longitudinal analysis. Ischemic and haemorrhagic stroke was reported at baseline, and at each of the 5 follow-ups, with ICD-10 cases validated by a panel of experts. Migraine and NMH were determined at baseline during a neurological interview and examination using 1988 IHS criteria. Results 110 (5.4%) cases of migraine and 179 (8.9%) cases of NMH were identified at baseline. During the median 8.8 year follow-up, incident stroke was observed in 1.9% of baseline migrainers, 6.2% of NMH and 3.6% of those with no lifetime history of headache. Cox proportional hazard models indicated that migraine was not a risk factor for stroke, however NMH sufferers were twice as likely to have a stroke (Hazard Ratio=2.00, 95% CI: 1.00–3.93, p=0.049). Conclusions This study is one of the first to suggest that late-life NMH rather than migraine could be an independent risk factor for stroke and warning sign. The incidence of stroke in elderly migrainers, seldom reported, is particularly low. PMID:27399611

Headache classification: criticism and suggestions.

PubMed

Manzoni, G C; Torelli, P

2004-10-01

The International Classification of Headache Disorders 2nd Edition (ICHD-II), published in 2004, marks an unquestionable progress from the preceding 1988 edition, but the in-depth analysis it offers is not immune from drawbacks and shortcomings. First of all, it is still basically a classification of attacks and not of syndromes. For the migraine group, while the revised classification more accurately characterises migraine with aura, it fails to provide a sufficiently structured description of those forms of migraine without aura that over the years evolve to so-called daily chronic forms. These forms are not adequately recognised as chronic migraine, which ICHD-II includes among the complications of migraine. The inclusion of short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) in the cluster headache group is bound to generate some perplexity, while the recognition of new daily persistent headache (NDPH) included in the group of other primary headaches as a separate clinical entity appears somewhat premature. Doubts are also raised by the actual existence of triptan-overuse headache, which ICHD-II includes in Group 8 among medication-overuse headaches. Finally, the addition of headache attributed to psychiatric disorder, which is certainly a good option in perspective, is not yet supported by an adequate systematisation.

Headaches related to sexual activity.

PubMed Central

Lance, J W

1976-01-01

Twenty-one patients experienced headache related to sexual activity. Two varieties of headache could be distinguished from the clinical histories. The first, developing as sexual excitement mount, had the characteristics of muscle contraction headache. The second, severe, throbbing or 'explosive' in character, occurring at the time of orgasm, was presumably of vascular origin associated with a hyperdynamic circulatory state. Two of the patients with the latter type of headache had each experienced episodes of cerebral vascular insufficiency on one occasion which subsequently resolved. A third patient in this category had a past history of drop attacks. No evidence of any structural lesion was obtained on clinical examination or investigation, including cerebral angiography in seven patients. Eighteen patients have been followed up for periods of two to seven years without any serious intracranial disorder becoming apparent. While the possibility of intracranial vascular or other lesions must always be borne in mind, there appears to be a syndrome of headache associated with sexual excitement where no organic change can be demonstrated, analogous to benign cough headache and benign exertional headache. PMID:1011034

Sleep apnoea and chronic headache.

PubMed

Sand, T; Hagen, K; Schrader, H

2003-03-01

The objective of this study was to estimate prevalence of headache and body pain among patients referred for suspected sleep apnoea syndrome compared with the occurrence in a large population-based study (the Nord-Trøndelag Health Study). Between 1995 and 1998, ambulatory polysomnography was successfully performed in 421 consecutive patients, 324 of whom completed a questionnaire about sleep-related habits, headache and body pain. Headache and neck pain were more likely among patients admitted for polysomnography compared with the general population (n = 41 340). In the multivariate analyses, this association was mainly restricted to those with frequent complaints (> or =7 days per month). Chronic headache (headache > or = 15 days per month) was seven times more common among individuals with and without confirmed obstructive sleep apnoea syndrome than in the general population. There was no linear dose-response relationship between headache and neck pain and severity of apnoea or oxygen desaturation. Thus, hypoxia per se is less likely to explain the high headache prevalence among patients admitted for polysomnography.

[Headache and immigration. A study in the outpatient department of the Hospital de la Santa Creu i Sant Pau in Barcelona].

PubMed

Vidal-Jordana, A; Barroeta-Espar, I; Sainz-Pelayo, M P; Sala, I; Roig, C

2011-09-01

The immigrant population (IP) is visiting neurology departments on an increasingly more frequent basis. Research has still not made it clear whether there are geographical differences in the prevalence of primary headaches and the possible influence of emigration. We conducted a retrospective (12 months) and prospective study (18 months) of the first visits to the Headache Unit at the Hospital de la Santa Creu i Sant Pau. Data collected included the country of birth, time parameters of the headache and of the immigration, diagnoses according to the criteria of the IHS and treatments that had been used. Related headaches were considered to be those that began within one year of having immigrated. The IP represents 13.6% (n = 142) of the total number of first visits because of headaches (n = 1044). Immigrants came mostly from Latin America (83.9%). Headaches began after immigration in 40.1% of cases without the existence of any temporal relation with immigration. The distribution of the diagnoses of headache is similar to those of the local population, the most frequent being migraine (57.7%) and tension-type headache (15.5%). On comparing treatments prior to and following immigration, we find differences in the use of triptans (2.1% versus 46.2%), ergotamine (9.8% versus 2.1%) and in the use of preventive treatments (2% versus 45%). The IP accounts for 13% of all first visits due to headaches and their diagnoses are similar to those of the local population. Emigration is neither a precipitating nor an aggravating factor for headaches in our series. There is a significant difference in symptomatic and preventive treatment between the period prior to immigration and afterwards.

Case studies of uncommon headaches.

PubMed

Evans, Randolph W

2006-05-01

The following interesting and uncommon headache disorders are presented through case studies: exploding head syndrome, hypnic headache, neck-tongue syndrome, "Alice in Wonderland" syndrome, nummular headache, red ear syndrome, burning mouth syndrome, spontaneous intracranial hypotension syndrome, and cardiac cephalalgia.

Cervical spine joint hypermobility: a possible predisposing factor for new daily persistent headache.

PubMed

Rozen, T D; Roth, J M; Denenberg, N

2006-10-01

The objective of this study was to suggest that joint hypermobility (specifically of the cervical spine) is a predisposing factor for the development of new daily persistent headache (NDPH). Twelve individuals (10 female, 2 male) with primary NDPH were evaluated by one of two physical therapists. Each patient was tested for active cervical range of motion and for the presence of excessive intersegmental vertebral motion in the cervical spine. All patients were screened utilizing the Beighton score, which determines degree of systemic hypermobility. Eleven of the 12 NDPH patients were found to have cervical spine joint hypermobility. Ten of the 12 NDPH patients had evidence of widespread joint hypermobility with the Beighton score. Based on our findings we suggest that joint hypermobility, specifically of the cervical spine, may be a predisposing factor for the development of NDPH.

Posttraumatic stress disorder and intimate partner violence in a women's headache center.

PubMed

Gerber, Megan R; Fried, Lise E; Pineles, Suzanne L; Shipherd, Jillian C; Bernstein, Carolyn A

2012-01-01

Posttraumatic stress disorder has been linked to women's ill health, including headaches. Intimate partner violence, which may result in posttraumatic stress disorder, is often reported by women with headaches. Prior studies of intimate partner violence and headache have estimated lifetime but not 12-month prevalence. The researchers in this study examined the relationship between headache and posttraumatic stress disorder in a novel population, and estimated 12-month and lifetime prevalence rates of intimate partner violence. Patients were recruited from a women's headache center (n = 92) during 2006-07 and completed the Migraine Disability Assessment measure of headache severity. Posttraumatic stress disorder was measured using a modified Breslau scale. Twelve-month and lifetime physical intimate partner violence were measured with the Partner Violence Screen and the STaT ("slapped, threatened and throw") measure. Multivariable regression determined factors independently associated with headache severity. Among all participants, 28.3% screened positive for posttraumatic stress disorder; 9.8% and 36.9% of women endorsed recent and lifetime intimate partner violence. Posttraumatic stress disorder was strongly associated with headache severity (β = 34.12, p = 0.01). Patients reporting lifetime intimate partner violence exhibited a trend of nine additional days of disability due to headache over 90 days. Posttraumatic stress disorder and intimate partner violence occur among a sizable proportion of women referred for headache. The authors' findings reaffirm that clinicians treating women with headaches must be aware of the possibility of posttraumatic stress disorder and intimate partner violence in such patients.

What clues are available for differential diagnosis of headaches in emergency settings?

PubMed

Mert, Ertan; Ozge, Aynur; Taşdelen, Bahar; Yilmaz, Arda; Bilgin, Nursel G

2008-04-01

The correct diagnosis of headache disorders in an emergency room is important for developing early management strategies and determining optimal emergency room activities. This prospective clinical based study was performed in order to determine demographic and clinical clues for differential diagnosis of primary and secondary headache disorders and also to obtain a classification plot for the emergency room practitioners. This study included 174 patients older than 15 years of age presenting in the emergency room with a chief complaint of headache. Definite headache diagnoses were made according to ICHD-II criteria. Classification and regression tree was used as new method for the statistical analysis of the differential diagnostic process. Our 174 patients with headache were diagnosed as basically primary (72.9%) and secondary (27.1%) headaches. Univariate analysis with cross tabs showed three important results. First, unilateral pain location caused 1.431-fold increase in the primary headache risk (p = 0.006). Second, having any triggers caused 1.440-fold increase in the primary headache risk (p = 0.001). Third, having associated co-morbid medical disorders caused 4.643-fold increase in the secondary headache risk (p < 0.001). It was concluded that the presence of comorbidity, the patient's age, the existence of trigger and relaxing factors, the pain in other body parts that accompanies headache and the quality of pain in terms of location and duration were all important clues for physicians in making an accurate differentiation between primary and secondary headaches.

Side-locked headaches: an algorithm-based approach.

PubMed

Prakash, Sanjay; Rathore, Chaturbhuj

2016-12-01

The differential diagnosis of strictly unilateral hemicranial pain includes a large number of primary and secondary headaches and cranial neuropathies. It may arise from both intracranial and extracranial structures such as cranium, neck, vessels, eyes, ears, nose, sinuses, teeth, mouth, and the other facial or cervical structure. Available data suggest that about two-third patients with side-locked headache visiting neurology or headache clinics have primary headaches. Other one-third will have either secondary headaches or neuralgias. Many of these hemicranial pain syndromes have overlapping presentations. Primary headache disorders may spread to involve the face and / or neck. Even various intracranial and extracranial pathologies may have similar overlapping presentations. Patients may present to a variety of clinicians, including headache experts, dentists, otolaryngologists, ophthalmologist, psychiatrists, and physiotherapists. Unfortunately, there is not uniform approach for such patients and diagnostic ambiguity is frequently encountered in clinical practice.Herein, we review the differential diagnoses of side-locked headaches and provide an algorithm based approach for patients presenting with side-locked headaches. Side-locked headache is itself a red flag. So, the first priority should be to rule out secondary headaches. A comprehensive history and thorough examinations will help one to formulate an algorithm to rule out or confirm secondary side-locked headaches. The diagnoses of most secondary side-locked headaches are largely investigations dependent. Therefore, each suspected secondary headache should be subjected for appropriate investigations or referral. The diagnostic approach of primary side-locked headache starts once one rule out all the possible secondary headaches. We have discussed an algorithmic approach for both secondary and primary side-locked headaches.

Heat stress disorders and headache: a case of new daily persistent headache secondary to heat stroke.

PubMed

Di Lorenzo, C; Ambrosini, A; Coppola, G; Pierelli, F

2009-01-01

Headache is considered as a common symptom of heat stress disorders (HSD), but no forms of secondary headache from heat exposure are reported in the International Classification of Headache Disorders-2 Edition (ICHD-II). Heat-stroke (HS) is the HSD most severe condition, it may be divided into two forms: classic (due to a long period environmental heat exposure) and exertional (a severe condition caused by strenuous physical exercises in heat environmental conditions). Here we report the case of a patient who developed a headache clinical picture fulfilling the diagnostic criteria for new daily persistent headache (NDPH), after an exertional HS, and discuss about possible pathophysiological mechanisms and classification aspects of headache induced by heat conditions.

Heat stress disorders and headache: a case of new daily persistent headache secondary to heat stroke

PubMed Central

Di Lorenzo, C; Ambrosini, A; Coppola, G; Pierelli, F

2009-01-01

Headache is considered as a common symptom of heat stress disorders (HSD), but no forms of secondary headache from heat exposure are reported in the International Classification of Headache Disorders-2 Edition (ICHD-II). Heat-stroke (HS) is the HSD most severe condition, it may be divided into two forms: classic (due to a long period environmental heat exposure) and exertional (a severe condition caused by strenuous physical exercises in heat environmental conditions). Here we report the case of a patient who developed a headache clinical picture fulfilling the diagnostic criteria for new daily persistent headache (NDPH), after an exertional HS, and discuss about possible pathophysiological mechanisms and classification aspects of headache induced by heat conditions. PMID:21686677

Headache in Behçet's disease.

PubMed

Aykutlu, E; Baykan, B; Akman-Demir, G; Topcular, B; Ertas, M

2006-02-01

The aim of this study was to investigate the characteristics of headache in patients with Behçet's disease (BD) seeking neurological consultation. Consecutive patients with BD seen within 1 year at the neuro-Behçet's out-patient clinic were studied using an electronic database according to the classification criteria of the International Headache Society. During a 12-month period 118 BD patients were admitted, and 98 had headaches. Migraine was the most common type of primary headache diagnosed in 45 patients (46.4%) in the whole headache group, followed by tension-type headache (TTH) in 26 cases (26.8%). Thirty-seven patients had secondary headaches mainly due to cerebral venous thrombosis or parenchymal neurological involvement of BD. Of these patients, 15 had both primary and secondary headaches. The primary headaches of 13 patients were exacerbated with systemic BD flare-ups, and four patients had migraine attacks triggered only by systemic BD activation which showed a good response to the treatment of systemic inflammation. The majority of the headaches of patients with BD do not indicate any neurological involvement; they are usually due to migraine or TTH. In a minority of patients, migraine associated with systemic inflammation of BD is notable.

Postdural Puncture Headache

PubMed Central

Ghaleb, Ahmed

2010-01-01

Postdural puncture headache (PDPH) has been a problem for patients, following dural puncture, since August Bier reported the first case in 1898. His paper discussed the pathophysiology of low-pressure headache resulting from leakage of cerebrospinal fluid (CSF) from the subarachnoid to the epidural space. Clinical and laboratory research over the last 30 years has shown that use of small-gauge needles, particularly of the pencil-point design, is associated with a lower risk of PDPH than traditional cutting point needle tips (Quincke-point needle). A careful history can rule out other causes of headache. A postural component of headache is the sine qua non of PDPH. In high-risk patients , for example, age < 50 years, postpartum, large-gauge needle puncture, epidural blood patch should be performed within 24–48 h of dural puncture. The optimum volume of blood has been shown to be 12–20 mL for adult patients. Complications of AEBP are rare. PMID:20814596

Acute headache diagnosis in pregnant women

PubMed Central

Farmakidis, Constantine; Dayal, Ashlesha K.; Lipton, Richard B.

2015-01-01

Objective: To characterize demographic and clinical features in pregnant women presenting with acute headache, and to identify clinical features associated with secondary headache. Methods: We conducted a 5-year, single-center, retrospective study of consecutive pregnant women presenting to acute care with headache receiving neurologic consultation. Results: The 140 women had a mean age of 29 ± 6.4 years and often presented in the third trimester (56.4%). Diagnoses were divided into primary (65.0%) and secondary (35.0%) disorders. The most common primary headache disorder was migraine (91.2%) and secondary headache disorders were hypertensive disorders (51.0%). The groups were similar in demographics, gestational ages, and most headache features. In univariate analysis, secondary headaches were associated with a lack of headache history (36.7% vs 13.2%, p = 0.0012), seizures (12.2% vs 0.0%, p = 0.0015), elevated blood pressure (55.1% vs 8.8%, p < 0.0001), fever (8.2% vs 0.0%, p = 0.014), and an abnormal neurologic examination (34.7% vs 16.5%, p = 0.014). In multivariate logistic regression, elevated blood pressure (odds ratio [OR] 17.0, 95% confidence interval [CI] 4.2–56.0) and a lack of headache history (OR 4.9, 95% CI 1.7–14.5) had an increased association with secondary headache, while psychiatric comorbidity (OR 0.13, 95% CI 0.021–0.78) and phonophobia (OR 0.29, 95% CI 0.09–0.91) had a reduced association with secondary headache. Conclusions: Among pregnant women receiving inpatient neurologic consultation, more than one-third have secondary headache. Diagnostic vigilance should be heightened in the absence of a headache history and if seizures, hypertension, or fever are present. Attack features may not adequately distinguish primary vs secondary disorders, and low thresholds for neuroimaging and monitoring for preeclampsia are justified. PMID:26291282

Sleep quality and arousal in migraine and tension-type headache: the headache-sleep study.

PubMed

Engstrøm, M; Hagen, K; Bjørk, M H; Stovner, L J; Sand, T

2014-01-01

The present paper summarizes and compares data from our studies on subjective and objective sleep quality and pain thresholds in tension-type headache (TTH), migraine, and controls. In a blinded controlled explorative study, we recorded polysomnography (PSG) and pressure, heat, and cold pain thresholds in 34 controls, 20 TTH, and 53 migraine patients. Sleep quality was assessed by questionnaires, sleep diaries, and PSG. Migraineurs who had their recordings more than 2 days from an attack were classified as interictal while the rest were classified as either preictal or postictal. Interictal migraineurs (n=33) were also divided into two groups if their headache onsets mainly were during sleep and awakening (sleep migraine, SM), or during daytime and no regular onset pattern (non-sleep migraine, NSM). TTH patients were divided into a chronic or episodic group according to headache days per month. Compared to controls, all headache groups reported more anxiety and sleep-related symptoms. TTH and NSM patients reported more daytime tiredness and tended to have lower pain thresholds. Despite normal sleep times in diary, TTH and NSM had increased slow-wave sleep as seen after sleep deprivation. Migraineurs in the preictal phase had shorter latency to sleep onset than controls. Except for a slight but significantly increased awakening index SM, patients differed little from controls in objective measurements. We hypothesize that TTH and NSM patients on the average need more sleep than healthy controls. SM patients seem more susceptible to sleep disturbances. Inadequate rest might be an attack-precipitating- and hyperalgesia-inducing factor. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Orgasmic headache treated with nimodipine.

PubMed

Lee, Jea Whan; Ha, Yeon Soo; Park, Seung Chol; Seo, Ill Young; Lee, Hak Seung

2013-07-01

Orgasmic headache (OH) is a sudden and severe headache that occurs at the time of or shortly after an orgasm. AIM.: We present the case of typical primary headache associated with sexual activity, especially during an orgasmic period. A 34-year-old man complained of sudden and severe headache during sexual activity, or orgasmic period, for 2 months. The headache developed abruptly with an orgasm and then decreased shortly over a period of 4 ≈ 8 hours. Magnetic resonance angiography revealed severe spasm of the M1 segment of both the middle cerebral arteries. He was treated with oral nimodipine (30 mg every 8 hours), which alleviated the headache and prevented its recurrence. We postulated a pathophysiological relationship between OH and migraine, especially with respect to vasoconstriction, and believe that in such cases, nimodipine may be an effective therapy. © 2013 International Society for Sexual Medicine.

Adolescent disc degeneration--no headache association.

PubMed

Laimi, K; Erkintalo, M; Metsähonkala, L; Vahlberg, T; Mikkelsson, M; Sonninen, P; Parkkola, R; Aromaa, M; Sillanpäa, M; Rautava, P; Anttila, P; Salminen, J

2007-01-01

The objective of the study was to determine whether adolescents with headache have more disc degeneration in the cervical spine than headache-free controls. This study is part of a population-based follow-up study of adolescents with and without headache. At the age of 17 years, adolescents with headache at least three times a month (N = 47) and adolescents with no headache (N = 22) participated in a magnetic resonance imaging (MRI) study of the cervical spine. Of the 47 headache sufferers, 17 also had weekly neck pain and 30 had neck pain less than once a month. MRI scans were interpreted independently by three neuroradiologists. Disc degeneration was found in 67% of participants, with no difference between adolescents with and without headache. Most of the degenerative changes were located in the lower cervical spine. In adolescence, mild degenerative changes of the cervical spine are surprisingly common but do not contribute to headache.

Restricted neck mobility in children with chronic tension type headache: a blinded, controlled study.

PubMed

Fernández-Mayoralas, Daniel M; Fernández-de-las-Peñas, César; Palacios-Ceña, Domingo; Cantarero-Villanueva, Irene; Fernández-Lao, Carolina; Pareja, Juan A

2010-10-01

The main purpose of this study was to analyze the differences in neck mobility between children with chronic tension type headache (CTTH) and healthy children, and to determine the influence of cervical mobility on headache intensity, frequency and duration. Fifty children, 13 boys and 37 girls (mean age 8.5 ± 1.6 years) with CTTH associated to peri-cranial tenderness (IHS 2.3.1) and 50 age- and sex matched children without headache (13 boys, 37 girls, mean age 8.5 ± 1.8 years, P = 0.955) participated. Cervical range of motion (CROM) was objectively assessed with a cervical goniometer by an assessor blinded to the children's condition. Children completed a headache diary for 4 weeks to confirm the diagnosis. Children with CTTH showed decreased CROM as compared to children without headache for flexion (z = -6.170; P < 0.001), extension (z = -4.230; P < 0.001), right (z = -4.505; P < 0.001) and left (z = -4.768; P < 0.001) lateral-flexions, but not for rotation (right z = -0.802; P = 0.425; left z = -1.254; P = 0.213) and also for total range of motion for flexion-extension (z = -4.267; P < 0.001) and lateral-flexion (z = -4.801; P < 0.001), but not for rotation (z = -1.058; P = 0.293). Within CTTH children, CROM was not correlated with headache intensity, frequency or duration. Additionally, age (P > 0.125) or gender (P > 0.250) did not influence CROM in either children with CTTH or without headache. Current results support the hypothesis that the cervical spine should be explored in children with headache. Further research is also needed to clearly define the potential role of the cervical spine in the genesis or maintenance of CTTH.

Recent developments in pediatric headache.

PubMed

Hershey, Andrew D

2010-06-01

This review will focus on some of the recent findings in pediatric headache including headache characteristics, epidemiology, comorbid associations and treatment updates. Pediatric headache remains a frequent health problem for children and their families, yet there remain many gaps in our knowledge. This review will broadly address some of the recent findings and highlight the gaps in our understanding and treatment of pediatric headache. There will be a focus on pediatric migraine as this has been the best characterized and studied. Our understanding of pediatric headache is improving with increased recognition of the characteristics and associated symptomology. This should further guide the individualized treatment approaches for improved outcome and reduction of progression into adulthood.

A new type of headache, headache associated with airplane travel: preliminary diagnostic criteria and possible mechanisms of aetiopathogenesis.

PubMed

Berilgen, M Said; Müngen, Bulent

2011-09-01

In recent years, there has been an increase in the reports indicating a form of headache that occurs during commercial aircraft travel. This headache, called airplane headache by some authors, is believed to be a new type of headache. The headache has very specific characteristics and all of the cases exhibited very stereotypical symptoms. The headache starts suddenly during the ascent and/or descent of the commercial aircraft. It has a mean duration of 20 minutes, which is usually unilateral and commonly localized to periorbital region. The headache is described to be severe, and has a stabbing or jabbing nature, and generally subsides in a short time. In some cases, an organic cause can be identified whereas in others no organic pathology could be found. We described the clinical features of 22 cases who suffered from a headache that occurred during airplane travel. We examined other cases with similar features reported in the literature and proposed preliminary diagnostic criteria for this new form of headache. We also discussed the possible patholophysiological mechanisms that may cause this headache.

Headaches associated with refractive errors: myth or reality?

PubMed

Gil-Gouveia, R; Martins, I P

2002-04-01

Headache and refractive errors are very common conditions in the general population, and those with headache often attribute their pain to a visual problem. The International Headache Society (IHS) criteria for the classification of headache includes an entity of headache associated with refractive errors (HARE), but indicates that its importance is widely overestimated. To compare overall headache frequency and HARE frequency in healthy subjects with uncorrected or miscorrected refractive errors and a control group. We interviewed 105 individuals with uncorrected refractive errors and a control group of 71 subjects (with properly corrected or without refractive errors) regarding their headache history. We compared the occurrence of headache and its diagnosis in both groups and assessed its relation to their habits of visual effort and type of refractive errors. Headache frequency was similar in both subjects and controls. Headache associated with refractive errors was the only headache type significantly more common in subjects with refractive errors than in controls (6.7% versus 0%). It was associated with hyperopia and was unrelated to visual effort or to the severity of visual error. With adequate correction, 72.5% of the subjects with headache and refractive error reported improvement in their headaches, and 38% had complete remission of headache. Regardless of the type of headache present, headache frequency was significantly reduced in these subjects (t = 2.34, P =.02). Headache associated with refractive errors was rarely identified in individuals with refractive errors. In those with chronic headache, proper correction of refractive errors significantly improved headache complaints and did so primarily by decreasing the frequency of headache episodes.

The use of oxygen in cluster headache treatment worldwide - a survey of the International Headache Society (IHS).

PubMed

Evers, Stefan; Rapoport, Alan

2017-04-01

Background Oxygen is recommended for the treatment of acute cluster headache attacks. However, it is not available worldwide. Methods The International Headache Society performed a survey among its national member societies on the availability and the restrictions for oxygen in the treatment of cluster headache. Results Oxygen is reimbursed in 50% of all countries responding ( n = 22). There are additional restrictions in the reimbursement of the facial mask and with respect to age. Conclusion Oxygen for the treatment of cluster headache attack is not reimbursed worldwide. Headache societies should pressure national/public health authorities to reimburse oxygen for cluster headache in all countries.

Use of the Emergency Department for Severe Headache. A population-based study

PubMed Central

Friedman, Benjamin W.; Serrano, Daniel; Reed, Michael; Diamond, Merle; Lipton, Richard B.

2008-01-01

Background Although headache is a common emergency department (ED) chief complaint, the role of the ED in the management of primary headache disorders has rarely been assessed from a population perspective. We determined frequency of ED use and risk factors for use among patients suffering severe headache. Methods As part of the American Migraine Prevalence and Prevention study, a validated self-administered questionnaire was mailed to 24,000 severe headache sufferers, who were randomly drawn from a larger sample constructed to be socio-demographically representative of the US population. Participants were asked a series of questions on headache management, healthcare system use, socio-demographic features, and number of ED visits for management of headache in the previous 12 months. In keeping with the work of others, “frequent” ED use was defined as a particpants report of four or more visits to the ED for treatment of a headache in the previous 12 months. Headaches were categorized into specific diagnoses using a validated methodology. Results Of 24,000 surveys, 18,514 were returned, and 13,451 (56%) provided complete data on ED use. Socio-demographic characteristics did not differ substantially between responders and non-responders. Among the 13,451 responders, over the course of the previous year, 12,592 (94%) did not visit the ED at all, 415 (3%) visited the ED once, and 444 (3%) visited the ED more than once. Patients with severe episodic tension-type headache were less likely to use the ED than patients with severe episodic migraine (OR 0.4 [95%CI 0.3, 0.6]). Frequent ED use was reported by 1% of the total sample or 19% (95%CI: 17, 22%) of subjects who used the ED in the previous year, though frequent users accounted for 51% (95%CI: 49, 53) of all ED visits. Predictors of ED use included markers of disease severity, elevated depression scores, low socio-economic status, and a predilection for ED use for conditions other than headache. Conclusions Most

Lightning and its association with the frequency of headache in migraineurs: an observational cohort study.

PubMed

Martin, Geoffrey V; Houle, Timothy; Nicholson, Robert; Peterlin, Albert; Martin, Vincent T

2013-04-01

The aim of this article is to determine if lightning is associated with the frequency of headache in migraineurs. Participants fulfilling diagnostic criteria for International Headache Society-defined migraine were recruited from sites located in Ohio ( N  = 23) and Missouri ( N  = 67). They recorded headache activity in a daily diary for three to six months. A generalized estimating equations (GEE) logistic regression determined the odds ratio (OR) of headache on lightning days compared to non-lightning days. Other weather factors associated with thunderstorms were also added as covariates to the GEE model to see how they would attenuate the effect of lightning on headache. The mean age of the study population was 44 and 91% were female. The OR for headache was 1.31 (95% confidence limits (CL); 1.07, 1.66) during lighting days as compared to non-lightning days. The addition of thunderstorm-associated weather variables as covariates were only able to reduce the OR for headache on lightning days to 1.18 (95% CL; 1.02, 1.37). The probability of having a headache on lightning days was also further increased when the average current of lightning strikes for the day was more negative. This study suggests that lightning represents a trigger for headache in migraineurs that cannot be completely explained by other meteorological factors. It is unknown if lightning directly triggers headaches through electromagnetic waves or indirectly through production of bioaerosols (e.g. ozone), induction of fungal spores or other mechanisms. These results should be interpreted cautiously until replicated in a second dataset.

Nonrhinologic headache in a tertiary rhinology practice.

PubMed

Perry, Brian F; Login, Ivan S; Kountakis, Stilianos E

2004-04-01

Our goal was to determine the etiology of headache in patients who were referred for sinus evaluation but were found to have no evidence of rhinosinusitis on computed tomography (CT) of the sinuses and on endoscopic examination. Data were collected prospectively from 100 patients with headache but with normal sinus CT and endoscopic examination. Headache and 20-Item Sino-Nasal Outcomes Test (SNOT-20) scores of patients with the chief complaint of headache and who requested further neurologic evaluation (group I) were compared with the scores of patients who did not list headache as a significant symptom (group II) and with the scores of patients without headache (group III). The most common neurologic diagnosis for group I patients (n = 36) was migraine headaches (58%). These patients also had higher mean SNOT-20 scores (24 +/- 3.3) compared to group II patients with mild headache (14.6 +/- 2.3) or group III patients without headache (12.4 +/- 2.1). Migraine was the most common type of headache in patients with normal sinus CT treated for presumed rhinosinusitis as the cause of the headache. Patients with headache as their chief complaint that required further neurologic evaluation had overall higher SNOT-20 scores than nonheadache patients, indicating greater disability of their overall quality of life index.

Headache among medical and psychology students.

PubMed

Ferri-de-Barros, João Eliezer; Alencar, Mauricio José de; Berchielli, Luis Felipe; Castelhano Junior, Luis Carlos

2011-06-01

Headaches occur frequently and thus are a key component of sociocentric medical education. To study headaches among students of medicine and psychology in a single university. This was a questionnaire-based survey of a cohort of students of medicine and psychology. The overall lifetime prevalence of headache was 98% and over the last year, 91%. Tensional headache accounted for 59% and migraine 22% in medicine; and 48.5% and 32% respectively in psychology. Forty-five percent reported that headaches had a variable sporadic impact on their productivity. The self-medication rate was 77%. Thirty-six percent reported worsening since admission to the university. The prevalence of headaches was very high. Tension-type headaches predominated in males and migraine in females. Tension-type was more frequent among medical students than among psychology students; migraine was more frequent in psychology (more females) than in medicine. Both kinds of students reported that headaches caused low interference with daily activities. The students reported that their symptoms had worsened since admission to the university.

New daily persistent headache.

PubMed

Rozen, Todd D

2010-01-01

New daily persistent headache (NDPH) is a unique form of chronic daily headache (CDH) which is marked by a daily headache from onset, typically occurring in individuals without a significant prior history of headaches. There are two subforms of NDPH: one which is self-limited and normally goes away without therapy, and a more chronic refractory form which is unresponsive to typical headache treatment strategies. The pathogenesis of NDPH is unknown but recent observations suggest a connection with cervical spine hypermobility and elevation of proinflammatory cytokines in the cerebrospinal fluid (CSF). Recognized triggers for NDPH include infection, stressful life events, and surgical procedures. Clinically, NDPH is characterized by continuous head pain of mild to severe intensity. Migrainous symptoms are common. The syndrome appears to affect women in their teens and 20s, while males develop NDPH later in life in their 50s or 60s. There are no recognized treatments for this condition, although treatment options will be discussed. Secondary mimics of NDPH will also be touched upon in this chapter. Copyright © 2011 Elsevier B.V. All rights reserved.

Influence of retirement and work stress on headache prevalence: a longitudinal modelling study from the GAZEL Cohort Study.

PubMed

Sjösten, Noora; Nabi, Hermann; Westerlund, Hugo; Singh-Manoux, Archana; Dartigues, Jean-François; Goldberg, Marcel; Zins, Marie; Oksanen, Tuula; Salo, Paula; Pentti, Jaana; Kivimäki, Mika; Vahtera, Jussi

2011-04-01

The aims of this study were to examine trajectories of headache in relation to retirement and to clarify the role of work stress and stress-prone personality. Headache prevalence during the 7 years before and after retirement was measured by annual questionnaires from GAZEL cohort comprising French national gas and electricity company employees (n = 12,913). Odds ratios and 95% confidence intervals for headache during pre- peri- and post-retirement were calculated. The role of effect modifiers (work stress, type A or hostile personality) was tested by multiplicative interactions and synergy indices. An 11-13% reduction in headache prevalence was found during pre- and post-retirement, whereas decline was much steeper (46%) during the retirement transition. In absolute terms, the decline was greater among persons with high work stress or stress-prone personality than among other participants. Retirement is associated with a decrease in headache prevalence, particularly among persons with a high amount of work stress or proneness to over-react to stress.

Stress and tension-type headache mechanisms.

PubMed

Cathcart, Stuart; Winefield, Anthony H; Lushington, Kurt; Rolan, Paul

2010-10-01

Stress is widely demonstrated as a contributing factor in tension-type headache (TTH). The mechanisms underlying this remain unclear at present. Recent research indicates the importance of central pain processes in tension-type headache (TTH) pathophysiology. Concurrently, research with animals and healthy humans has begun to elucidate the relationship between stress and pain processing in the central nervous system, including central pain processes putatively dysfunctional in TTH. Combined, these two fields of research present new insights and hypotheses into possible mechanisms by which stress may contribute to TTH. To date, however, there has been no comprehensive review of this literature. The present paper provides such a review, which may be valuable in facilitating a broader understanding of the central mechanisms by which stress may contribute to TTH.

Impact of psychosocial factors on the prevalence of headaches in the industrial setting. A case-control approach.

PubMed

Tobiasz-Adamczyk, B; Flak, E; Jedrychowski, W A

1985-01-01

A sociomedical survey of 975 workers employed in an electronic instrument factory was carried out by standardized interview and aimed at defining the relationship between some psychosocial working conditions and the occurrence of headaches. The findings showed different patterns of headaches in specific occupational categories with workers exposed to different psychosocial stresses. Headaches were more frequent in those who became nervous during their work, those who were often in conflict with their co-workers, and those holding managerial posts.

Headache in chagasic women.

PubMed

dos Santos, V M; da Cunha, S F; Teixeira, V de P; Monteiro, J P; dos Santos, J A; dos Santos, T A; dos Santos, L A; da Cunha, D F

1999-01-01

The aim of this study was to compare the frequency of headache between Chagasic and Non-chagasic women. The cross-sectional study comprised 647 female > or = 40 years old, Chagasic (n = 362) and Controls (n = 285) at a Brazilian University Hospital. Chagasic were classified as Cardiac (n = 179), Megas (n = 58) or Indeterminate (n = 125) clinical forms. Headache was ascertained according to Headache International Society diagnostic criteria. The age (57.0 +/- 11.3 versus 57.3 +/- 10.4 years), and the percentage of white women (75.8% versus 77.1%) were similar between Chagasic and Controls, respectively. Headache was more prevalent among Chagasic (32.9%) than Controls (16.1%), mainly in Cardiac form (odds ratio, 2.41; 95% confidence interval, 1.38-4.23), phenomenon possibly related to parasympathetic denervation and cerebral vessels changes.

The history of craniotomy for headache treatment.

PubMed

Assina, Rachid; Sarris, Christina E; Mammis, Antonios

2014-04-01

Both the history of headache and the practice of craniotomy can be traced to antiquity. From ancient times through the present day, numerous civilizations and scholars have performed craniotomy in attempts to treat headache. Today, surgical intervention for headache management is becoming increasingly more common due to improved technology and greater understanding of headache. By tracing the evolution of the understanding of headache alongside the practice of craniotomy, investigators can better evaluate the mechanisms of headache and the therapeutic treatments used today.

Relations between epileptic seizures and headaches.

PubMed

Gameleira, Fernando Tenório; Ataíde, Luiz; Raposo, Maria Cristina Falcão

2013-10-01

To describe headaches in patients with epilepsy and try to identify relations between epileptic seizures and headaches. Cross-sectional study, with 304 patients from the epilepsy out-patient section of University Hospital of Federal University of Alagoas (Brazil) between February 2007 and February 2008. The presence of headaches and their relationships with the epileptic seizures were analyzed. Frequent seizures were associated with a greater tendency of occurrence of headaches (odds ratio=1.6 times, p=0.077). Headaches occurred in 66.1% of the cases. The highest occurrence was of migraine (32.9% of the patients), followed by tension-type headaches (9.2%). Two syndromes with a continuum epilepsy-migraine in the same seizure are worth mentioning: migralepsy in 6.6% and epilepgraine in 10.2% of the patients with epilepsy. A high prevalence of headaches in patients with epilepsy was observed, with emphasis on hybrid crises of epilepsy and migraine. Copyright © 2013 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

The Prevalence of Magnetic Resonance Imaging Hyperintensity in Migraine Patients and Its Association with Migraine Headache Characteristics and Cardiovascular Risk Factors

PubMed Central

Toghae, Mansoureh; Rahimian, Elham; Abdollahi, Mohammad; Shoar, Saeed; Naderan, Mohammad

2015-01-01

Objectives To determine the frequency of hyperintense foci in migraine patients and the relationship with migraine headache characteristics and cardiovascular risk factors. Methods Ninety patients with migraine headache (70 without aura and 20 with aura) were enrolled and interviewed. Information on their headache (severity, frequency, and mean disease duration) and other related data was obtained by completing a clinical checklist. Subsequently, brain magnetic resonance imaging (MRI) was performed and each patient was then evaluated for hyperintense lesions. Results Of the 90 patients, 29 (32%) had silent hyperintense lesions on their MRI. The mean age of the patients with hyperintense foci was 41 years while those with no lesions was 33 years (p<0.010). Supratentorial hyperintense lesions represented the majority of lesions in the patients (n=46, 63%). Moreover, 56.3% of the lesions (n=41) were located within the right hemisphere. Cardiovascular risk factors such as smoking, serum cholesterol, oral contraceptive pills use, and body mass index (BMI) were not significantly different in these two groups (p>0.050). The lesions were found significantly more frequently in the patients who experienced chronic migraine (p=0.032). Conclusion Our study adds weight to the theory that disease duration has a key role in the formation of hyperintense brain lesions. Certain cardiovascular risk factors such as sex, smoking, serum cholesterol, and BMI, do not affect the presence or absence of such lesions, suggesting that the relationship between migraine and these lesions may be directly due to the effects of migraine itself. PMID:26171127

Short-lasting headache syndromes and treatment options.

PubMed

Rozen, Todd D

2004-08-01

A number of primary headache syndromes are marked by their short duration of pain. Many of these syndromes have their own unique treatment, so they must be recognized by practicing physicians. In this article, a number of the short-lasting headache disorders are reviewed, including chronic paroxysmal hemicrania, SUNCT syndrome, hypnic headache, exploding head syndrome, primary stabbing headache, and cough headache.

Factors influencing neck pain intensity in whiplash-associated disorders.

PubMed

Holm, Lena W; Carroll, Linda J; Cassidy, J David; Ahlbom, Anders

2006-02-15

Cohort study of subjects with whiplash-associated disorders (WAD). To assess the association between preinjury factors and neck pain intensity within 30 days after a motor vehicle collision. Neck pain is the main symptom in WAD. There are studies of nonspecific musculoskeletal pain suggesting that pain intensity can be modified by psychologic, personal, or social factors, but, to our knowledge, no studies have investigated the association between such factors and neck pain intensity in WAD. The subjects (n = 5970) either filed a claim or were treated for neck pain within 30 days after a collision. Neck pain intensity was measured on the visual analog scale. Fair or poor health before the collision was associated with severe neck pain in females (odds ratio 4.0, 95% confidence interval 1.8-8.9). Other associated factors in females included low education and prior neck pain. Low family income was associated with severe neck pain in males (odds ratio 2.3, 95% confidence interval 1.5-3.4), as was prior headache and being unaware of the head position at the time of collision. The results suggest that neck pain intensity in WAD seems to be influenced by several factors other than characteristics related to the injury event itself.

Elevation of CSF tumor necrosis factor alpha levels in new daily persistent headache and treatment refractory chronic migraine.

PubMed

Rozen, Todd; Swidan, Sahar Z

2007-01-01

To determine if patients with new daily persistent headache (NDPH) have elevated levels of tumor necrosis factor alpha (TNF alpha) in the CSF. NDPH is considered one of the most treatment resistant of all headache syndromes. This reflects a lack of understanding of its pathogenesis. As a certain percentage of NDPH patients have their headaches start after an infection, the possibility of a persistent state of systemic or CNS inflammation comes into question. TNF alpha is a proinflammatory cytokine involved in brain immune and inflammatory activities, as well as in pain initiation. The goal of this study was to look at TNF alpha levels in the CSF of NDPH patients, to determine if CNS inflammation may play some role in the pathogenesis of this condition. CSF TNF alpha levels were studied in 38 patients: 20 with NDPH and a control population of 16 patients with chronic migraine (CM), and 2 with post-traumatic headache (PT). CSF TNF alpha levels were elevated in 19 of 20 NDPH patients, 16 of 16 CM patients, and both PT patients. Serum TNF alpha levels were normal in most of the study subjects. An elevation of CSF TNF alpha levels was found in almost all NDPH patients and suggest a role for TNF alpha in the pathogenesis of this condition. Surprisingly, all CM and PT patients tested had elevated CSF TNF alpha levels. In most patients with elevated CSF levels, serum TNF alpha levels were normal. All of these syndromes may be manifestations of CNS inflammation. As most of the positive-tested patients showed minimal to no improvement during aggressive inpatient treatment, persistent elevation of CSF TNF alpha levels may be one of the causes of treatment refractory CDH.

N-acetylcysteine-induced headache in hospitalized patients with acute acetaminophen overdose.

PubMed

Zyoud, Sa'ed H; Awang, Rahmat; Sulaiman, Syed Azhar Syed; Al-Jabi, Samah W

2011-06-01

Intravenous N-acetylcysteine (IV-NAC) is usually regarded as a safe antidote to acetaminophen overdose. However, during infusion of the loading dose, adverse drug reactions such as a headache may occur. The objectives of this study were to investigate the prevalence of headache in patients presenting to hospital after acetaminophen overdose and to determine which clinical findings are most predictive of headache among these patients. This is a retrospective cohort study of hospital admissions for acute acetaminophen overdose that was conducted over a period of 4 years from January 1, 2005 to December 31, 2008. Demographic data, clinical characteristics, and predictors of headache were analyzed. spss 15 was used for data analysis. Two-hundred and fifty-five patients were studied; their mean age was 23.1 ± 1.6; 83.9% of them were women and 14.9% had a headache during hospitalization. Headache among patients was significantly associated with IV-NAC administration (P = 0.001), intentional ingestion of drug (P = 0.04), acetaminophen concentration above 'possible toxicity' treatment line (P = 0.04), a high acetaminophen concentration (P = 0.04), and a long hospital stay (P = 0.03). Multiple logistic regression showed a significant risk factor for headache in patients administered IV-NAC (P = 0.04). We recorded a high frequency of headache in patients with acute acetaminophen overdose in our geographical area. This study suggests that among those patients, the use of IV-NAC is associated with an increased risk of headache. © 2010 The Authors Fundamental and Clinical Pharmacology © 2010 Société Française de Pharmacologie et de Thérapeutique.

Implementation of effective, self-sustaining headache services in the Republic of Georgia: Evaluation of their impact on headache-related disability and quality of life of people with headache.

PubMed

Giorgadze, Gvantsa; Mania, Maka; Kukava, Maka; Dzagnidze, Ana; Mirvelashvili, Ekaterine; Steiner, Timothy J; Katsarava, Zaza

2018-04-01

Background Headache disorders are widespread and disabling. They are common in Georgia, especially headache on ≥15 days/month (HA ≥ 15), but there are no headache services. Objective We established headache services meeting local needs, investigating feasibility, consumer uptake and satisfaction, and cost, with an exit strategy bequeathing effective, self-sustaining services that could be rolled out nationwide. Methods We created headache centres in Tbilisi and Gori offering free expert care for three visits over three months, and affordable medication thereafter. The primary outcome measure was the percentage of patients using the service beyond the free period - a measure of both satisfaction and sustainability. Results Of 1,445 patients (age 43.7 ± 12.4 years; 10.5% male), 49.8% had episodic migraine, 22.5% episodic tension-type headache, 25.7% HA ≥ 15 (24.5% overusing medication) and 2.0% trigeminal autonomic cephalalgias. Only 454 (31.4%) and 51 (3.5%) returned for second and third visits; in these, headache improved and treatment costs decreased. As information about the service spread, five other headache clinics opened in Tbilisi and Kutaisi (western Georgia). Pharmaceutical companies reduced prices (sumatriptan 100 mg from US$7 to US$1). Conclusion The study failed to achieve its primary outcome, but sustainable headache services operating to international standards were successfully implemented nonetheless, with demand increasing.

Headache in Idiopathic Intracranial Hypertension: Findings From the Idiopathic Intracranial Hypertension Treatment Trial.

PubMed

Friedman, Deborah I; Quiros, Peter A; Subramanian, Prem S; Mejico, Luis J; Gao, Shan; McDermott, Michael; Wall, Michael

2017-09-01

character, disabling, and associated with poorer quality of life in our cohort of patients with mild visual impairment. The lack of correlation between headache disability and cerebrospinal fluid (CSF) pressure at baseline and at the end of the randomized phase of the study implies that headache in IIH may be related to factors other than intracranial hypertension, and that specific headache treatment is needed in addition to therapies directed at lowering CSF pressure. © 2017 American Headache Society.

Diagnosis and Management of Childhood Headache.

PubMed

Gofshteyn, Jacqueline S; Stephenson, Donna J

2016-02-01

Headache is one of the most common chief complaints seen in the pediatrician's office. Oftentimes, identifying the etiology of headache and differentiating primary and secondary causes can present a diagnostic conundrum. Understanding the most common causes of primary and secondary headache is vital to making a correct diagnosis. Here we review the typical presentations of the most common primary headache disorders and the approach to evaluation of the pediatric patient presenting with headache. Diagnostic workup, including the key features to elicit on physical examination, when to order head imaging, and the use of other ancillary tests, is discussed. Current treatment modalities and their indications are reviewed. We will also describe some of the new, emerging therapies that may alter the way we manage headache in the pediatric population. Headache can, at times, be a frustrating symptom seen in the pediatrician's office, but here we hope to better elucidate the approach to evaluation, management, and treatment as well as provide some hope in regards to more effective upcoming therapies. Copyright © 2016 Mosby, Inc. All rights reserved.

Headache and refractive errors in children.

PubMed

Roth, Zachary; Pandolfo, Katie R; Simon, John; Zobal-Ratner, Jitka

2014-01-01

To investigate the association between uncorrected or miscorrected refractive errors in children and headache, and to determine whether correction of refractive errors contributes to headache resolution. Results of ophthalmic examination, including refractive error, were recorded at initial visit for headache. If resolution of headache on subsequent visits was not documented, a telephone call was placed to their caregivers to inquire whether headache had resolved. Of the 158 patients, 75.3% had normal or unchanged eye examinations, including refractions.Follow-up data were available for 110 patients. Among those, 32 received new or changed spectacle correction and 78 did not require a change in refraction.Headaches improved in 76.4% of all patients, whether with (71.9%) or without (78.2%) a change in refractive correction. The difference between these two groups was not statistically significant (P = .38). Headaches in children usually do not appear to be caused by ophthalmic disease, including refractive error. The prognosis for improvement is favorable, regardless of whether refractive correction is required. Copyright 2014, SLACK Incorporated.

Secondary headaches attributed to arterial hypertension

PubMed Central

Assarzadegan, Farhad; Hesami, Omid; Aryani, Omid; Mansouri, Behnam; Beladi moghadam, Nahid

2013-01-01

Mild (140 to 159/90 to 99 mmHg) or moderate (160 to 179/100 to 109 mmHg) chronic arterial hypertension does not appear to cause headache. Whether moderate hypertension predisposes patients to headache at all remains controversial, but there is little evidence that it does. Ambulatory blood pressure monitoring in patients with mild and moderate hypertension has shown no convincing relationship between blood pressure fluctuations over a 24-hour period and presence or absence of headache. However, headaches are associated to various disorders that lead to abrupt, severe, and paroxysmal elevations in blood pressure. In this paper, the secondary headaches attributed to acute crises of hypertension and the criteria for diagnosing each of them have been reviewed. These are headaches attributed to pheochromocytoma, hypertensive crisis without encephalopathy, hypertensive encephalopathy, pre-eclampsia, eclampsia, and acute pressure response to exogenous agents. PMID:24250915

Caffeine and headache: specific remarks.

PubMed

Espinosa Jovel, C A; Sobrino Mejía, F E

Caffeine is the most widely used psychostimulant worldwide. Excessive caffeine consumption induces a series of both acute and chronic biological and physiological changes that may give rise to cognitive decline, depression, fatigue, insomnia, cardiovascular changes, and headache. Chronic consumption of caffeine promotes a pro-nociceptive state of cortical hyperexcitability that can intensify a primary headache or trigger a headache due to excessive analgesic use. This review offers an in-depth analysis of the physiological mechanisms of caffeine and its relationship with headache. Copyright © 2014 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Headache in children with Chiari I malformation.

PubMed

Toldo, Irene; Tangari, Marta; Mardari, Rodica; Perissinotto, Egle; Sartori, Stefano; Gatta, Michela; Calderone, Milena; Battistella, Pier Antonio

2014-05-01

Headache is the most common symptom of Chiari 1 malformation, a condition characterized by the herniation of cerebellar tonsils through the foramen magnum. However, the headache pattern of cases with Chiari 1 malformations is not well defined in the literature, especially in children. The aim of this retrospective chart review was to evaluate the frequency and the characteristics of headache in children with Chiari 1 malformation at initial evaluation and during follow up. Forty-five cases with tonsillar ectopia were selected among 9947 cases under 18 years of age who underwent neuroimaging between 2002 and 2010. A semistructured clinical interview (mean follow-up: 5.2 years) was conducted. Headache was classified according to the second edition of the International Classification of Headache Disorders. Possible associations between clinical picture, in particular headache pattern, but also other signs and symptoms attributable to Chiari 1 malformation, and the extent of tonsillar ectopia were found for 3 different groups: those with borderline (<5 mm, N = 12), mild (5-9 mm, N = 27), and severe tonsillar ectopia (≥10 mm, N = 6), respectively. Twenty-four out of 33 (73%) cases with Chiari 1 malformation complained of headache, and 9/33 (27%) of those patients (5 with mild and 4 with severe tonsillar ectopia) reported headache attributed to Chiari 1 malformation. In our studied pediatric population, the most common symptom for cases diagnosed with Chiari 1 malformation was headache, and headache attributed to Chiari 1 malformation was the most common headache pattern in patients with Chiari 1 malformation. The presence of headache attributed to Chiari 1 malformation along with 3 other signs or symptoms of Chiari 1 malformation were highly predictive of severe tonsillar ectopia. © 2014 American Headache Society.

Benign Headache Management in the Emergency Department.

PubMed

Long, Brit J; Koyfman, Alex

2018-04-01

Headache is a common complaint managed in the emergency department (ED), with emergency physicians focusing on evaluation for life-threatening conditions while treating pain and nausea. This review evaluates the treatment of benign, primary headaches in the ED, with recommendations provided based on the literature. Headaches are a major cause of disability in the United States and a common condition managed in the ED. The primary objectives of emergency evaluation of these patients include evaluation for a life-threatening, secondary cause of headache, with treatment of primary headaches. Close evaluation for a secondary cause of headache include consideration of red flags and focused neurologic examination. The diagnosis of primary headaches is clinical. Literature has evaluated medication efficacy in headache treatment, with antidopaminergic medications demonstrating high rates of efficacy when used in combination with nonsteroidal inflammatory drugs or acetaminophen. Dexamethasone can be used for the reduction of headache recurrence. If dehydration is present, intravenous fluids should be provided. Diphenhydramine is not recommended for analgesia but may reduce akathisia associated with prochlorperazine. Ketamine, propofol, and nerve blocks demonstrate promise. Triptan agents are also efficacious, provided absence of contraindications. Most patients are appropriate for discharge with pain improvement. A variety of medications is available for the treatment of primary headaches in the ED. Antidopaminergic agents demonstrate the highest efficacy and should be provided with acetaminophen and nonsteroidal inflammatory drugs. Dexamethasone may reduce headache recurrence. Other treatments include ketamine, propofol, and nerve blocks. Published by Elsevier Inc.

The anterior hypothalamus in cluster headache.

PubMed

Arkink, Enrico B; Schmitz, Nicole; Schoonman, Guus G; van Vliet, Jorine A; Haan, Joost; van Buchem, Mark A; Ferrari, Michel D; Kruit, Mark C

2017-10-01

Objective To evaluate the presence, localization, and specificity of structural hypothalamic and whole brain changes in cluster headache and chronic paroxysmal hemicrania (CPH). Methods We compared T1-weighted magnetic resonance images of subjects with cluster headache (episodic n = 24; chronic n = 23; probable n = 14), CPH ( n = 9), migraine (with aura n = 14; without aura n = 19), and no headache ( n = 48). We applied whole brain voxel-based morphometry (VBM) using two complementary methods to analyze structural changes in the hypothalamus: region-of-interest analyses in whole brain VBM, and manual segmentation of the hypothalamus to calculate volumes. We used both conservative VBM thresholds, correcting for multiple comparisons, and less conservative thresholds for exploratory purposes. Results Using region-of-interest VBM analyses mirrored to the headache side, we found enlargement ( p < 0.05, small volume correction) in the anterior hypothalamic gray matter in subjects with chronic cluster headache compared to controls, and in all participants with episodic or chronic cluster headache taken together compared to migraineurs. After manual segmentation, hypothalamic volume (mean±SD) was larger ( p < 0.05) both in subjects with episodic (1.89 ± 0.18 ml) and chronic (1.87 ± 0.21 ml) cluster headache compared to controls (1.72 ± 0.15 ml) and migraineurs (1.68 ± 0.19 ml). Similar but non-significant trends were observed for participants with probable cluster headache (1.82 ± 0.19 ml; p = 0.07) and CPH (1.79 ± 0.20 ml; p = 0.15). Increased hypothalamic volume was primarily explained by bilateral enlargement of the anterior hypothalamus. Exploratory whole brain VBM analyses showed widespread changes in pain-modulating areas in all subjects with headache. Interpretation The anterior hypothalamus is enlarged in episodic and chronic cluster headache and possibly also in probable cluster

The association of pituitary tumors and headache.

PubMed

Levy, Miles J

2011-04-01

Pituitary tumors may give rise to headache via numerous mechanisms. The traditional explanation for headache is dural stretch and cavernous sinus invasion, although this is not borne out by clinical studies. Certain functional pituitary tumors are associated with headache, notably growth hormone and prolactin-secreting tumors. The observation that somatostatin analogues can have a dramatic analgesic effect in acromegaly suggests that biochemical properties of the tumor may be important. The genetic predisposition of the patient to primary headache also determines whether headache occurs with pituitary tumors. This article attempts to outline the clinical features, management strategies, and key academic questions regarding the subject of pituitary tumors and headache.

Experts' opinion about the pediatric secondary headaches diagnostic criteria of the ICHD-3 beta.

PubMed

Özge, Aynur; Abu-Arafeh, Ishaq; Gelfand, Amy A; Goadsby, Peter James; Cuvellier, Jean Christophe; Valeriani, Massimiliano; Sergeev, Alexey; Barlow, Karen; Uludüz, Derya; Yalın, Osman Özgür; Faedda, Noemi; Lipton, Richard B; Rapoport, Alan; Guidetti, Vincenzo

2017-11-29

The 2013 International Classification of Headache Disorders-3 was published in a beta version to allow clinicians to confirm the validity of the criteria or suggest improvements based on field studies. The aim of this work was to review the Secondary Headache Disorders and Cranial Neuralgias and Other Headache Disorders sections of ICHD-3 beta data on children and adolescents (age 0-18 years) and to suggest changes, additions, and amendments. Several experts in childhood headache across the world applied different aspects of ICHD-3 beta in their normal clinical practice. Based on their personal experience and the available literature on pediatric headache, they made observations and proposed suggestions for the mentioned headache disorders on children and adolescents. Some headache disorders in children have specific features, which are different from adults that should be acknowledged and considered. Some features in children were found to be age-dependent: clinical characteristics, risks factors and etiologies have a strong bio psychosocial basis in children and adolescents making primary headache disorders in children distinct from those in adults. Several recommendations are presented in order to make ICHD-3 more appropriate for use in children.

Survey on treatments for primary headaches in 13 specialized juvenile Headache Centers: The first multicenter Italian study.

PubMed

Toldo, Irene; Rattin, Martina; Perissinotto, Egle; De Carlo, Debora; Bolzonella, Barbara; Nosadini, Margherita; Rossi, Livia Nicoletta; Vecchio, Angelo; Simonati, Alessandro; Carotenuto, Marco; Scalas, Cinzia; Sciruicchio, Vittorio; Raieli, Vincenzo; Mazzotta, Giovanni; Tozzi, Elisabetta; Valeriani, Massimiliano; Cianchetti, Carlo; Balottin, Umberto; Guidetti, Vincenzo; Sartori, Stefano; Battistella, Pier Antonio

2017-05-01

The purpose of this retrospective multicenter study was to evaluate the use and the self-perceived efficacy and tolerability of pharmacological and non-pharmacological treatments in children and adolescents with primary headaches. Study of a cohort of children and adolescents diagnosed with primary headache, consecutively referred to 13 juvenile Italian Headache Centers. An ad hoc questionnaire was used for clinical data collection. Among 706 patients with primary headaches included in the study, 637 cases with a single type of headache (migraine 76% - with and without aura in 10% and 67% respectively; tension-type headache 24%) were selected (mean age at clinical interview: 12 years). Acetaminophen and non-steroidal anti-inflammatory drugs (in particular ibuprofen) were commonly used to treat attacks, by 76% and 46% of cases respectively. Triptans were used overall by 6% of migraineurs and by 13% of adolescents with migraine, with better efficacy than acetaminophen and non-steroidal anti-inflammatory drugs. Preventive drugs were used by 19% of migraineurs and by 3% of subjects with tension-type headache. In migraineurs, flunarizine was the most frequently used drug (18%), followed by antiepileptic drugs (7%) and pizotifen (6%), while cyproheptadine, propanolol and amitriptyline were rarely used. Pizotifen showed the best perceived efficacy and tolerability. Melatonin and nutraceuticals were used by 10% and 32% of subjects, respectively, both for migraine and tension-type headache, with good results in terms of perceived efficacy and tolerability. Non-pharmacological preventive treatments (i.e. relaxation techniques, biofeedback, cognitive-behavioral therapy, acupuncture) were used only by 10% of cases (migraine 9%, tension-type headache 15%). Non-steroidal anti-inflammatory drugs, especially ibuprofen, should be preferred to acetaminophen for acute attacks of migraine or tension-type headache, because they were usually more effective and well tolerated. Triptans

Biofeedback therapy for migraine headaches.

PubMed

Turin, A; Johnson, W G

1976-04-01

We studied the biofeedback treatment of migraine headaches, attempting to control for some of the methodological limitations of previous work. Seven individuals suffering from migraine headache were trained in the usual finger warming procedure with the omission of autogenic phrases. Additionally, to control for placebo-expectance effects, three of these subjects received training in finger cooling prior to warming. With training in finger warming, headache activity was substantially reduced. In contrast, headache activity either remained at base line levels or increased during training in cooling despite positive therapeutic expectations. The results of this study indicate that finger temperature warming, without autogenic training, is effective in reducing migraine activity, independent of suggestion effects.

A systematic review of causes of sudden and severe headache (Thunderclap Headache): should lists be evidence based?

PubMed Central

2014-01-01

Background There are many potential causes of sudden and severe headache (thunderclap headache), the most important of which is aneurysmal subarachnoid haemorrhage. Published academic reviews report a wide range of causes. We sought to create a definitive list of causes, other than aneurysmal subarachnoid haemorrhage, using a systematic review. Methods Systematic Review of EMBASE and MEDLINE databases using pre-defined search criteria up to September 2009. We extracted data from any original research paper or case report describing a case of someone presenting with a sudden and severe headache, and summarized the published causes. Results Our search identified over 21,000 titles, of which 1224 articles were scrutinized in full. 213 articles described 2345 people with sudden and severe headache, and we identified 6 English language academic review articles. A total of 119 causes were identified, of which 46 (38%) were not mentioned in published academic review articles. Using capture-recapture analysis, we estimate that our search was 98% complete. There is only one population-based estimate of the incidence of sudden and severe headache at 43 cases per 100,000. In cohort studies, the most common causes identified were primary headaches or headaches of uncertain cause. Vasoconstriction syndromes are commonly mentioned in case reports or case series. The most common cause not mentioned in academic reviews was pneumocephalus. 70 non-English language articles were identified but these did not contain additional causes. Conclusions There are over 100 different published causes of sudden and severe headache, other than aneurysmal subarachnoid haemorrhage. We have now made a definitive list of causes for future reference which we intend to maintain. There is a need for an up to date population based description of cause of sudden and severe headache as the modern epidemiology of thunderclap headache may require updating in the light of research on cerebral

Another cause of headache after epidural injection.

PubMed

Anwari, Jamil S; Hazazi, Abdulaziz A

2015-04-01

Headache is a potential complication of epidural injection. We report a patient who developed headache 5 days after a lumbar epidural steroid injection, which was not related to the epidural procedure, but caused by Duloxetine induced hyponatremia. Antidepressant drug induced headache should be considered in the differential diagnosis of post dural puncture headache.

Prevalence and impact of headache and migraine among secondary school students in Nigeria.

PubMed

Ofovwe, Gabriel E; Ofili, Antoinette N

2010-11-01

A cross-sectional descriptive study to determine the overall, age and gender specific prevalence, trigger factors and impact of headache and migraine on quality of life of students attending secondary schools in Benin City, Nigeria. Six secondary schools were randomly selected from which students were randomly selected. A self-administered questionnaire was used to screen those with frequent headache, defined as at least 2 episodes of headache unrelated to fever or any underlying disease within the last 12 months or at least 1 episode in the last 6 months preceding the date questionnaire was administered. Another questionnaire based on the ICHD-2 criteria for diagnosis of migraine was then administered to those with frequent headaches. Data analysis was with SPSS 13.0 for Windows. One thousand six hundred and seventy-nine students aged 11-18 years were recruited. The overall prevalence of headache was 19.5%. The prevalence of migraine was 13.5%. Migraine was more common in girls than in boys at all ages. The most common trigger factors included emotional stress, sunlight or bright light, sleep deprivation, and hunger. Inability to participate in outdoor activities, household chores, and school absenteeism were the common impacts on the quality of life of among 76.8% of the migraineurs. Migraine is common and underdiagnosed among secondary school students in Benin City, Nigeria, and negatively impacts on the quality of life including school absenteeism. © 2010 American Headache Society.

Epidemiology of chronic daily headache.

PubMed

Pascual, J; Colás, R; Castillo, J

2001-12-01

Daily or near-daily headache is a widespread problem in clinical practice. The general term of chronic daily headache (CDH) encompasses those primary headaches presenting more than 15 days per month and lasting more than 4 hours per day. CDH includes transformed migraine (TM), chronic tension-type headache (CTTH), new daily persistent headache (NDPH), and hemicrania continua (HC). Around 40% of patients attending a specialized headache clinic meet CDH diagnostic criteria, of which 80% are women. In these clinics about 60% of patients suffer from TM, 20% from CTTH, and 20% meet NDPH criteria. Most, some 80%, overuse symptomatic medications. One should be very cautious on extrapolating these numbers to the general population. CDH prevalence in the general population seems to be around 4% to 5% (up to 8% to 9% for women). Regarding the prevalence of CDH subtypes, NDPH is rare (0.1%), whereas the prevalence of TM (1.5% to 2%) and CTTH (2.5% to 3%) is clearly higher. In contrast to data from specialized clinics, only around a quarter of CDH subjects in the general population overuse analgesics; the prevalence of CDH subjects with analgesic overuse being 1.1% to 1.9% of the general population. Most of these patients with analgesic overuse are TM patients.

[Diagnostic and therapy of tension-type headache].

PubMed

Straube, A

2014-08-01

Episodic headache of the tension type is the most prevalent primary headache with a lifetime prevalence of about 78 %. Clinical characteristics are a dull, moderate, holocephalic headache without accompanying autonomic or vegetative symptoms. The episodic tension-type headache often lasts only 30 min up to a maximum of a few days. In contrast to this clinically often undemanding headache, chronic tension-type headache can cause considerable disability in patients. The 1-year prevalence is 1-3 % of the population. All therapy strategies combine nonpharmaceutical therapy such as education of the patient, regular aerobic exercise, and psychological treatment (e.g., Jacobson's progressive muscle relaxation etc.) with pharmaceutical treatment such as tricyclic antidepressants or combined serotonergic and noradrenergic antidepressants. Combination therapy has been proven to be more effective than singular strategies; however, the chronic tension-type headache still poses a therapeutic problem.

Headache, snoring and sleep apnoea.

PubMed

Ulfberg, J; Carter, N; Talbäck, M; Edling, C

1996-09-01

To evaluate reported headache prevalence among the general population and patients suffering from snoring and obstructive sleep apnoea syndrome (OSAS), a cross-sectional study was performed among those aged 30-64 years residing in Kopparberg county in central Sweden. Consecutive patients referred to the sleep laboratory in the catchment area who fulfilled objective diagnostic criteria (snorers = 448, OSAS = 324) and a random sample of the general population (n = 583) responded to the same questionnaire. Patients were selected following sleep apnoea screening with 100% specificity for both OSAS and snoring. Responders from the general population were divided into snorers or non-snorers on the basis of self-report. To validate the self-report question on snoring in the questionnaire, 50 males and 49 females, randomly selected from the sample of the general population, underwent sleep apnoea screening in their homes. Headache among both men and women was found to be more prevalent among heavy snorers and OSAS patients compared with the control group. Morning headache, in particular, was at least three times more common among male and female heavy snorers and OSAS patients then among the general population. Headache in the control group was more common among snorers than non-snorers. Among responders, 5% of the general population reported experiencing headache often or very often upon awakening. For the heavy snoring and OSAS groups, 18% reported experiencing headache often or very often upon awakening. The results indicate that headache is common among heavy snorers and OSAS patients regardless of gender.

Massage Therapy and Frequency of Chronic Tension Headaches

PubMed Central

Quinn, Christopher; Chandler, Clint; Moraska, Albert

2002-01-01

Objectives. The effect of massage therapy on chronic nonmigraine headache was investigated. Methods. Chronic tension headache sufferers received structured massage therapy treatment directed toward neck and shoulder muscles. Headache frequency, duration, and intensity were recorded and compared with baseline measures. Results. Compared with baseline values, headache frequency was significantly reduced within the first week of the massage protocol. The reduction of headache frequency continued for the remainder of the study (P = .009). The duration of headaches tended to decrease during the massage treatment period (P = .058). Headache intensity was unaffected by massage (P = .19). Conclusions. The muscle-specific massage therapy technique used in this study has the potential to be a functional, nonpharmacological intervention for reducing the incidence of chronic tension headache. PMID:12356617

Headaches after traumatic spinal cord injury in Estonia.

PubMed

Sabre, Liis; Rugo, Mariann; Asser, Toomas; Kõrv, Janika; Braschinsky, Mark

2016-04-01

Patients with traumatic spinal cord injury (TSCI) often suffer from different types of pain. However, headaches after TSCI have not been studied. The aim of this article is to examine the occurrence of headache among patients with TSCI. This cross-sectional study included individuals with TSCI from 1997 to 2012 in Estonia. Patients with TSCI were interviewed via telephone. The interview was based on a questionnaire specifically designed to identify headache type using the International Classification of Headache Disorders, third edition (beta version). There were 73 patients with a mean age 37.1 ± 10.6 years. The mean time since TSCI was 7.5 ± 4.0 years. The most frequently mentioned pain was headache (71%), followed by back pain (60%) and pain in neck (44%).Headaches were more frequent after the trauma compared with the headaches before TSCI (71% vs 51%, ITALIC! p = 0.02). Headaches that arose after TSCI were not related to the concomitant brain injury ( ITALIC! p = 0.15). The occurrence of headache did not depend on the severity or the level of the TSCI.Eighty-five percent of patients had not contacted any physician and headache was not diagnosed. This is the first study that evidentially shows that headache is the most prevalent pain condition after TSCI. Despite this, the majority of patients never consult a physician, nor is their headache diagnosed or appropriately managed. This indicates that further studies are needed to provide evidence regarding the prevalence and causes of headache and its impact on quality of life. © International Headache Society 2015.

The clinician's approach to the management of headache.

PubMed Central

Maizels, M

1998-01-01

Headache is a ubiquitous complaint, yet it is one that often elicits anxiety in both patients and physicians. When a patient presents with headache, the clinician must answer the following questions: (1) Is the headache "worrisome" (secondary to underlying disease)? (2) If the headache is benign, what type is it? (3) How is the acute headache best treated? and (4) How may future headaches be prevented? The following review is intended to aid primary care physicians in answering these questions. PMID:9549429

Headaches caused by decreased intracranial pressure: diagnosis and management.

PubMed

Mokri, Bahram

2003-06-01

More patients with spontaneous intracranial hypotension are now being diagnosed, and it is realized that most cases result from spontaneous cerebrospinal fluid leaks. A broader clinical and imaging spectrum of the disorder is recognized. This paper reviews new insights into the variability of clinical manifestations, imaging features, etiological factors, anatomy of leaks, and implications of these in patient management. Spontaneous intracranial hypotension should not be equated with post-lumbar puncture headaches. In a substantial minority of patients, headaches are not orthostatic and may mimic other types of headache. Additional diverse neurological manifestations may dominate the clinical picture and patients may occasionally have no headache at all. Reports on unusual presentations of the disorder continue to appear in the literature. Furthermore, additional imaging features of cerebrospinal fluid leaks are recognized. High-flow and slow-flow leaks may present diagnostic challenges, and require modification of diagnostic studies aimed at locating the site of the leak. Stigmata of connective tissue abnormality, especially abnormalities of fibrillin and elastin, are seen in a notable minority of patients, pointing to weakness of the dural sac as one of the etiological factors. After treatment of spontaneous intracranial hypotension, surgically or by epidural blood patch, a rebound and self-limiting intracranial hypertension may sometimes develop. In the past decade, interest in spontaneous intracranial hypotension has been rekindled, with a substantial growth of knowledge on various aspects of the disorder. We are in the learning phase, and new information will probably appear in the future, with notable diagnostic and therapeutic implications.

Epilepsy and headaches: Further evidence of a link.

PubMed

Çilliler, Asli Ece; Güven, Hayat; Çomoğlu, Selim Selçuk

2017-05-01

Epilepsy and primary headaches are two of the most common neurologic conditions that share some common clinical characteristics, and can affect individuals of all age groups around the world. In recent years, the underlying pathophysiologic mechanisms potentially common to both headaches and epileptic seizures have been the subject of scrutiny. The objective of this study was to determine the frequencies and types of headaches in patients with epilepsy, and evaluate any temporal relationship with epileptic seizures. Demographic data, epilepsy durations, seizure frequencies, seizure types and antiepileptic medications used were captured of 349 patients who were followed up at our epilepsy outpatient clinic. Patients who experienced headaches were grouped based on the type of headaches and on whether their headaches occurred in the preictal, postictal or interictal period. Three hundred forty-nine patients (190 females, 159 males) were enrolled in the study. The patients' average age was 30.9±13.1 years, and average epilepsy duration was 13.5±10.9 years. The types of epileptic seizures were partial in 19.8% of patients, generalized in 57.9%, and secondary generalized in 20.3% of patients. Some 43.6% of the patients did not experience headaches, and 26.9% had migraine and 17.2% tension-type headaches. Headaches could not be classified in 12.3% of patients. The headaches occurred preictally in 9.6%, postictally in 41.6% and interictally in 8.6% of patients. The ratio of headaches was lower in male patients compared with females, and females experienced migraine-type headaches more frequently compared with males (p=0.006). Migraine-type headaches were less frequent a mong patients who experienced less than one seizure per year, but more frequent (p=0.017) among those who experienced more than one seizure per month, but less than one seizure per week. Migraine-type headaches were significantly more frequent (p=0.015) among patients receiving polytherapy compared with

Nummular headache update.

PubMed

Pareja, Juan A; Montojo, Teresa; Alvarez, Mónica

2012-04-01

Nummular headache is characterized by head pain exclusively felt in a rounded or elliptical area, typically 1 to 6 cm in diameter. The pain remains confined to the same symptomatic area, which does not change in shape or size with time. The symptomatic area may be localized in any part of the head but mostly in the parietal region. Rarely, the disorder may be multifocal, each symptomatic area keeping all the characteristics of nummular headache. The pain is generally mild or moderate, commonly described as oppressive or stabbing, and lasting minutes, hours, or days, with a remitting or unremitting pattern. Superimposed on the baseline pain, there may be spontaneous or triggered exacerbations. During and between symptomatic periods, the affected area may show variable combinations of hypoesthesia, dysesthesia, paresthesia, tenderness, and trophic changes. Nummular headache emerges as a primary disorder with a clear-cut clinical picture developed in a unique topography.

[A role of treatment of autonomic syndrome in patients with tension-type headache].

PubMed

Duma, S N

2015-01-01

The study aims to evaluate the effect of correction of psycho-vegetative violations anxiolitikami on the frequency and intensity of headache. the study included 50 women (average age - 37,4 years) with confirmed diagnosis: frequent episodic headache and chronic headache no factor abuses. Patients of the main group received ibuprofen to 200-400 mg/day for headaches in combination with tizanidine (2-4 mg/day) and anvifen 750 mg a day for 8 weeks. Patients in the comparison group received ibuprofen and tizanidine in the same mode, but did not take anvifen. Evaluated the severity of headaches by visual analogue scale, the level of anxiety on the Hamilton depression rating scale, vegetative disorders on questionnaire ( Wayne), the quality of sleep before treatment and 60 days. In addition, 60 day therapy was conducted subjective assessment of the General state on a scale GGI. The conclusion about expediency of inclusion of, anvifen in the complex treatment of the condition.

[Trigemino-autonomic headache syndromes].

PubMed

Busch, V; May, A

2003-01-01

This review describes the characteristics of some rare severe primary headache syndromes without any structural lesions, which are summarized as the trigemino-autonomic headaches. Pain in these syndromes is associated with autonomic symptoms such as conjunctival injection, lacrimation, rhinorrhoe, ptosis or eyelid edema. This article summarizes the diagnostics, epidemiology and therapy of these conditions.

The diet factor in pediatric and adolescent migraine.

PubMed

Millichap, J Gordon; Yee, Michelle M

2003-01-01

Diet can play an important role in the precipitation of headaches in children and adolescents with migraine. The diet factor in pediatric migraine is frequently neglected in favor of preventive drug therapy. The list of foods, beverages, and additives that trigger migraine includes cheese, chocolate, citrus fruits, hot dogs, monosodium glutamate, aspartame, fatty foods, ice cream, caffeine withdrawal, and alcoholic drinks, especially red wine and beer. Underage drinking is a significant potential cause of recurrent headache in today's adolescent patients. Tyramine, phenylethylamine, histamine, nitrites, and sulfites are involved in the mechanism of food intolerance headache. Immunoglobulin E-mediated food allergy is an infrequent cause. Dietary triggers affect phases of the migraine process by influencing release of serotonin and norepinephrine, causing vasoconstriction or vasodilatation, or by direct stimulation of trigeminal ganglia, brainstem, and cortical neuronal pathways. Treatment begins with a headache and diet diary and the selective avoidance of foods presumed to trigger attacks. A universal migraine diet with simultaneous elimination of all potential food triggers is generally not advised in practice. A well-balanced diet is encouraged, with avoidance of fasting or skipped meals. Long-term prophylactic drug therapy is appropriate only after exclusion of headache-precipitating trigger factors, including dietary factors.

Hallucinogens and cannabinoids for headache.

PubMed

McGeeney, Brian E

2012-10-01

Most hallucinogens and cannabinoids fall into Federal Controlled Substances schedule 1, meaning they cannot be prescribed by practitioners, allegedly have no accepted medical use, and have a high abuse potential. The legal and regulatory status has inhibited clinical research on these substances such that there are no blinded studies from which to assess true efficacy. Despite such classification, hallucinogens and cannabinoids are used by patients with headache on occasion. Cannabinoids in particular have a long history of use for headache and migraine before prohibition and are still used by patients as a migraine abortive. Hallucinogens are being increasing used by cluster headache patients outside of physician recommendation mainly to abort a cluster period and to maintain quiescence for which there is considerable anecdotal success. © 2012 American Headache Society.

Two reports of flight-related headache.

PubMed

Nagatani, Kazuhiko

2013-07-01

Airplane headache is flight-related and appears during airplane landing and/or takeoff without accompanying symptoms. Intracranial and paranasal imaging studies reveal no abnormalities. The etiology is still uncertain, although sinus barotrauma has been proposed as a possible mechanism. 1) A 26-yr-old woman presented with recurring headache during each air travel since she was 22 yr old. Severe bursting pain suddenly manifested in the bilateral orbits and temples during airplane descent, with no accompanying additional symptoms. She had no unusual medical history. X-ray computed tomography (CT) scans showed no abnormalities except thickening of the nasal mucosa. Effective pain relief was obtained with over-the-counter nasal decongestant spray. 2) A 49-yr-old man presented with a 3-yr history of flight-related headache that appeared at airplane touchdown, when he had mental stress, or when he was suffering from a lack of sleep. Pain was of a severe jabbing quality, localized over the forehead with no additional accompanying symptoms. He had a past history of episodic tension-type headache. Intracranial and paranasal CT scan revealed no abnormalities. Headache ceased spontaneously within 40 min of the end of the flight and nonsteroidal anti-inflammatory drug premedication did not prevent the headache. Sinus barotrauma was thought to be a plausible explanation for the headache in Case 1. In Case 2, an anxiety disorder could be considered as an underlying etiology. The etiology of so-called airplane headache is probably protean and this should be taken into account when assessing cases of in-flight cephalalgia.

New daily persistent headache: An evolving entity.

PubMed

Uniyal, Ravi; Paliwal, Vimal Kumar; Anand, Sucharita; Ambesh, Paurush

2018-01-01

New daily persistent headache (NDPH) is characterized by an abrupt onset of headache that becomes a daily entity, is unremitting and continuous from the onset, and lasts for more than 3 months. Dr Walter Vanast first described NDPH in the year 1986. Originally, it was proposed as a chronic daily headache but it was placed under "other primary headaches" in the International Classification of Headache Disorder Second Edition (ICHD 2nd edition). However, with evolving literature and better understanding of its clinical characteristics, it was classified as a "chronic daily headache" in the ICHD 3 rd edition beta. There are still many knowledge-gaps regarding the underlying cause, pathophysiology, natural history and treatment of NDPH. This review tries to revisit the entity and discusses the current status of understanding regarding NDPH.

Dietary patterns according to headache and migraine status: a cross-sectional study.

PubMed

Rist, Pamela M; Buring, Julie E; Kurth, Tobias

2015-08-01

Several potential dietary trigger factors for migraine have been proposed. However, few studies have examined the intake pattern of these dietary items compared to adequate control populations and whether intake levels may vary by migraine aura status or attack frequency. We conducted a cross-sectional study among participants in the Women's Health Study. We used logistic regression to evaluate the association between migraine and headache status and low intake of foods commonly reported to affect migraine. A total of 25,755 women reported no history of migraine or headache, 5573 reported non-migraine headache and 7042 reported any migraine. Those with non-migraine headache or any migraine were more likely to have low intake of total alcohol (OR = 1.22, 95% CI:1.14-1.29 and OR = 1.17, 95% CI:1.11-1.24, respectively). Migraineurs with aura were more likely to have low intake of chocolate, ice cream, hot dogs, and processed meats. Those who experience migraine at least once per week were more likely to have low intake of skim/low-fat milk and white and red wine. Intake of most suggested migraine dietary triggers differs by migraine aura status and attack frequency, a pattern not found for non-migraine headache. © International Headache Society 2014.

Primary headaches in pediatric patients with chronic rheumatic disease.

PubMed

Uluduz, Derya; Tavsanli, Mustafa Emir; Uygunoğlu, Uğur; Saip, Sabahattin; Kasapcopur, Ozgur; Ozge, Aynur; Temel, Gulhan Orekici

2014-11-01

To assess the presence, prevalence and clinical characteristics of primary headaches in pediatric patients with chronic rheumatic diseases such as juvenile idiopathic arthritis (JIA) and familial Mediterranean fever (FMF), and to analyze the common pathophysiological mechanisms. In this noncontrolled, cross-sectional study, a semi-structured 53 item headache questionnaire was administered to subjects with FMF and JIA, and interviewed a total sample size of 601 patients younger than16years of age. The questionnaires were then analyzed according to the International Headache Society's diagnostic criteria. Children with FMF (n=378) and JIA (n=223) were studied. Each group was then divided into two subgroups according to whether the subjects reported headache or not. 29.5% of subjects with FMF reported having migraine, 37.6% probable migraine and 32.9% tension type headache (TTH). In JIA group 28.2% were diagnosed with migraine; 41.2% with probable migraine and 30.6% with TTH. No significant difference was found between all subjects with (n=258) and without (n=343) headache for variables such as living in a crowded family (p=0.95), being the first child in the family (p=0.63), academic achievement of the child (p=0.63), high education level (higher than high school) of the mother (p=0.52) and father (p=0.46). The presence of systemic disease was reported not to be effecting the daily life at the time of evaluation by 90.2% of the children with headache and 91.0% of the children without headache (p=0.94). 81.4% of the children reported their headaches were not aggravating with the exacerbation periods of their systemic disease. Family history of hypertension was reported higher by the subjects with headache (13.5% with headache and 4.0% without headache p=0.001). Diabetes mellitus was also reported higher (5.8% with headache; 0.5% without headache; p=0.006). Family history of headache was reported in 28.2% of the patients with headache whereas it was 17.4% of the

Cluster headache: present and future therapy.

PubMed

Leone, Massimo; Giustiniani, Alessandro; Cecchini, Alberto Proietti

2017-05-01

Cluster headache is characterized by severe, unilateral headache attacks of orbital, supraorbital or temporal pain lasting 15-180 min accompanied by ipsilateral lacrimation, rhinorrhea and other cranial autonomic manifestations. Cluster headache attacks need fast-acting abortive agents because the pain peaks very quickly; sumatriptan injection is the gold standard acute treatment. First-line preventative drugs include verapamil and carbolithium. Other drugs demonstrated effective in open trials include topiramate, valproic acid, gabapentin and others. Steroids are very effective; local injection in the occipital area is also effective but its prolonged use needs caution. Monoclonal antibodies against calcitonin gene-related peptide are under investigation as prophylactic agents in both episodic and chronic cluster headache. A number of neurostimulation procedures including occipital nerve stimulation, vagus nerve stimulation, sphenopalatine ganglion stimulation and the more invasive hypothalamic stimulation are employed in chronic intractable cluster headache.

Examination of the diagnostic validity of 'headache attributed to whiplash injury': a controlled, prospective study.

PubMed

Schrader, H; Stovner, L J; Obelieniene, D; Surkiene, D; Mickeviciene, D; Bovim, G; Sand, T

2006-11-01

Acute and chronic headache attributed to whiplash injury are new diagnostic entities in the International Classification of Headache Disorders, second edition. A main objective of the present study was to assess the validity of these nosologic entities by studying the headache pattern in an inception cohort of 210 rear-end car collision victims and in 210 matched controls. Consecutive drivers involved in rear-end collisions were identified from the daily records of the Traffic Police Department of Kaunas, Lithuania. A standard self-report questionnaire was sent to the drivers between 2 and 7 days after the collision, and their passengers were recruited as well. Headache and neck pain were evaluated within 7 days of the collision, at 2 months and 1 year after the collision. A control group of non-traumatized subjects received questionnaires at the time of the selection and 1 year later. Of the 75 collision victims who developed headache within the first 7 days of the collision, 37 had a clinical picture in accordance with the criteria for acute whiplash headache (i.e., concomitant neck pain) and 38 did not. For acute headache after collision, concomitant neck pain was of no relevance to the headache type or its course. In both these subgroups, migraine and tension-type headache could be diagnosed in similar proportions and the prognosis after 2 months and 1 year was also similar. Preexisting headache was a strong prognostic factor in both groups for both acute and chronic pain. Compared with the non-traumatized control group, the 1-year incidence of new or worsened headache, or of headache improvement, was the same. A likely interpretation of the data is that acute headaches after rear-end car collisions mainly represent episodes of a primary headache precipitated by the stress of the situation. We conclude that the nosologic validity of both acute and chronic whiplash headache is poor as the headaches, in accordance with the criteria lack distinguishing clinical

Understanding of headache patterns modification in an emergency department during the economic crisis of Greece.

PubMed

Bougea, Anastasia; Spantideas, Nicolaos; Anagnostou, Evangelos; Massou, Efthalia; Xirou, Sophia; Thomaidis, Thomas; Evdokimidis, Ioannis; Kararizou, Evangelia

2016-08-01

Very few neurological research is published regarding health effects of global economic crisis. Our aim was to assess the impact of economic recession on frequency and severity of headaches. We also tested if depression, anxiety and experiences associated with crisis, such as unemployment, were reflected in headaches. This is a retrospective observational study in the Emergency setting of tertiary Clinic from 1 January 2008 until 31 December 2009 and from 1 January 2010 until 31 December 2011. Demographic data were collected of 1094 consecutive adult patients with headache. Multinomial logistic regression performed to examine if hospital anxiety depression (HAD), HAD anxiety, experience of serious life events, year of survey had influence on type of headache. The total number of headache cases increased significantly from 2008 to 2011 (p < 0.001). Tension type and medication overuse headaches remained unchanged over time (p > 0.05), while migraines decreased. Secondary and not otherwise specified (NOS) increased significantly (p < 0.05). The most common, overtime, was Tension type headache, followed by migraines (in 2008, 2011) and NOS (2010). Chi square test showed significant correlation between type of headache and year, as well medication type and year (p < 0.05). Common analgesics, the most common medication, increased five times during survey period (77 % 2008 to 87.6 % 2011). Multivariate analysis revealed stronger association for experience serious events with NOS vs. tension type headache [odds ratio (OR) 0.13; 95 % confidence interval (CI) 0.03, 0.7]. This is the first study showing that the prolonged economic crisis affected headache frequency accompanied by a higher use of analgesics.

Headache (chronic tension-type)

PubMed Central

2009-01-01

Introduction Chronic tension-type headache (CTTH) is a disorder that evolves from episodic tension-type headache, with daily or very frequent episodes of headache lasting minutes to days. It affects 4.1% of the general population in the USA, and is more prevalent in women (up to 65% of cases). Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of drug treatments for chronic tension-type headache? What are the effects of non-drug treatments for chronic tension-type headache? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2007 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 50 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review, we present information relating to the effectiveness and safety of the following interventions: acupuncture; amitriptyline; analgesics; anticonvulsant drugs; benzodiazepines; botulinum toxin; chiropractic and osteopathic manipulations; cognitive behavioural therapy (CBT); Indian head massage; mirtazapine; relaxation and electromyographic biofeedback; selective serotonin reuptake inhibitor antidepressants (SSRIs); and tricyclic antidepressants (other than amitriptyline). PMID:21696647

Associations between headache and stress, alcohol drinking, exercise, sleep, and comorbid health conditions in a Japanese population.

PubMed

Yokoyama, Masako; Yokoyama, Tetsuji; Funazu, Kazuo; Yamashita, Takeshi; Kondo, Shuji; Hosoai, Hiroshi; Yokoyama, Akira; Nakamura, Haruo

2009-06-01

We conducted a cross-sectional survey of 12,988 subjects aged 20-79 years (5,908 men and 7,090 women) receiving health checkups at a Tokyo clinic. They filled out a self-administered structured questionnaire, and 5.4% of the men and 15.4% of the women reported having headaches. Younger subjects were more prone to having headaches. The likelihood of having headaches increased with stress level and decreased ability to relieve stress in both genders. There was an inverse dose-response relationship between having headaches and alcohol consumption, and less walking/exercise and sleep problems increased the likelihood of headaches in both genders. Headache sufferers of both genders were more likely to report multiple additional poor health conditions. A multivariate stepwise logistic analysis showed that age, self-estimated degree of stress, reported number of additional poor health conditions, and less alcohol consumption were independently correlated with having headaches. In conclusion, although women were more susceptible to headache, Japanese men and women in Tokyo shared factors associated with headache, including age, stress, having other poor health conditions, alcohol consumption, sleep, and exercise.

Posttraumatic Headache: Basic Mechanisms and Therapeutic Targets.

PubMed

Kamins, Joshua; Charles, Andrew

2018-06-01

Frequent or continuous headache, often refractory to medical therapy, is a common occurrence after head trauma. In addition to being the most common acute symptom after traumatic brain injury (TBI), headache is also one of the most persistent and disabling symptoms. Different studies indicate that 18-58% of those suffering a TBI will have significant headache at 1 year following the trauma. In addition to being disabling on its own, posttraumatic headache (PTH) is a predictor of overall outcome after concussion. Despite its remarkable prevalence and associated social and economic costs, many fundamental and important questions about PTH remain unanswered. The purpose of this review is to identify key questions regarding the clinical characteristics of posttraumatic headache, its basic mechanisms, and its optimal management. We discuss phenotypic features of PTH, pathophysiological mechanisms of TBI including potential overlaps with those of migraine and other primary headache disorders, and potential novel targets for treatment. We suggest different strategies to finding answers to the questions regarding PTH in order to advance the understanding of the disorder and develop more effective therapies. © 2018 American Headache Society.

[Childhood headaches: new concepts and recent advances].

PubMed

Rufo-Campos, M; Rufo-Munoz, M

2018-06-05

This study reports on the latest advances in childhood headaches that have been made in the last few years, with special emphasis on the important new modifications that have been produced with respect to the previous ones, published in the beta version of the third edition of the International Classification of Headache Disorders. These include headaches that have undergone important qualifications, the appearance of new entities and a section which reports the existence of new headaches, but which have still not been considered as new entities. Additionally, other points that are highlighted include the strong relation between childhood headaches and attention deficit hyperactivity disorder, the weak relation between glutamate intake and the appearance of headaches, and the scant usefulness of magnetic resonance imaging of the brain in the diagnosis of these processes. Moreover, the new modification produced in childhood episodic syndromes is highlighted.

The Use of Cannabis for Headache Disorders

PubMed Central

Lochte, Bryson C.; Beletsky, Alexander; Samuel, Nebiyou K.; Grant, Igor

2017-01-01

Abstract Headache disorders are common, debilitating, and, in many cases, inadequately managed by existing treatments. Although clinical trials of cannabis for neuropathic pain have shown promising results, there has been limited research on its use, specifically for headache disorders. This review considers historical prescription practices, summarizes the existing reports on the use of cannabis for headache, and examines the preclinical literature exploring the role of exogenous and endogenous cannabinoids to alter headache pathophysiology. Currently, there is not enough evidence from well-designed clinical trials to support the use of cannabis for headache, but there are sufficient anecdotal and preliminary results, as well as plausible neurobiological mechanisms, to warrant properly designed clinical trials. Such trials are needed to determine short- and long-term efficacy for specific headache types, compatibility with existing treatments, optimal administration practices, as well as potential risks. PMID:28861505

Autonomic headache with autonomic seizures: a case report.

PubMed

Ozge, Aynur; Kaleagasi, Hakan; Yalçin Tasmertek, Fazilet

2006-10-01

The aim of the report is to present a case of an autonomic headache associated with autonomic seizures. A 19-year-old male who had had complex partial seizures for 15 years was admitted with autonomic complaints and left hemicranial headache, independent from seizures, that he had had for 2 years and were provoked by watching television. Brain magnetic resonance imaging showed right hippocampal sclerosis and electroencephalography revealed epileptic activity in right hemispheric areas. Treatment with valproic acid decreased the complaints. The headache did not fulfil the criteria for the diagnosis of trigeminal autonomic cephalalgias, and was different from epileptic headache, which was defined as a pressing type pain felt over the forehead for several minutes to a few hours. Although epileptic headache responds to anti-epileptics and the complaints of the present case decreased with antiepileptics, it has been suggested that the headache could be a non-trigeminal autonomic headache instead of an epileptic headache.

Natural very-low-frequency sferics and headache

NASA Astrophysics Data System (ADS)

Vaitl, D.; Propson, N.; Stark, R.; Schienle, A.

  Very-low-frequency (VLF) atmospherics or sferics are pulse-shaped alternating electric and magnetic fields which originate from atmospheric discharges (lightning). The objective of the study was threefold: (i) to analyse numerous parameters characterizing the sferics activity with regard to their suitability for field studies, (ii) to identify meteorological processes related to the sferics activity and (iii) to investigate the possible association of sferics with pain processes in patients suffering from migraine- and tension-type headaches. Over a period of 6 months (July through December) the sferics activity in the area of Giessen (Germany) was recorded. Three sferics parameters were chosen. The number of sferics impulses per day, the variability of the impulse rate during a day and the variability in comparison to the preceding day were correlated with weather processes (thunderstorm, temperature, vapour pressure, barometric pressure, humidity, wind velocity, warm sector). Significant correlations were obtained during the summer months (July, August) but not during the autumn months (October, November, December). During autumn, however, the sferics activity was correlated with the occurrence of migraine-type headaches (r=0.33, P<0.01) recorded by 37 women who had filled out a headache diary over a period of 6 months (July-December). While the thunderstorm activity was very intense during July and August, no relationship between sferics and migraine was found. In summer, tension-type headaches were associated with meteorological parameters such as temperature (r=0.42, P<0.01) and vapour pressure (r=0.28, P<0.05). Although the sferics activity can explain a small percentage of the variation in migraine occurrence, a direct influence was more likely exerted by visible or otherwise perceptible weather conditions (thunderstorms, humidity, vapour pressure, warm sector, etc.) than by the sferics activity itself.

Masticatory sensory-motor changes after an experimental chewing test influenced by pain catastrophizing and neck-pain-related disability in patients with headache attributed to temporomandibular disorders.

PubMed

La Touche, Roy; Paris-Alemany, Alba; Gil-Martínez, Alfonso; Pardo-Montero, Joaquín; Angulo-Díaz-Parreño, Santiago; Fernández-Carnero, Josué

2015-03-05

Recent research has shown a relationship of craniomandibular disability with neck-pain-related disability has been shown. However, there is still insufficient information demonstrating the influence of neck pain and disability in the sensory-motor activity in patients with headache attributed to temporomandibular disorders (TMD). The purpose of this study was to investigate the influence of neck-pain-related disability on masticatory sensory-motor variables. An experimental case-control study investigated 83 patients with headache attributed to TMD and 39 healthy controls. Patients were grouped according to their scores on the neck disability index (NDI) (mild and moderate neck disability). Initial assessment included the pain catastrophizing scale and the Headache Impact Test-6. The protocol consisted of baseline measurements of pressure pain thresholds (PPT) and pain-free maximum mouth opening (MMO). Individuals were asked to perform the provocation chewing test, and measurements were taken immediately after and 24 hours later. During the test, patients were assessed for subjective feelings of fatigue (VAFS) and pain intensity. VAFS was higher at 6 minutes (mean 51.7; 95% CI: 50.15-53.26) and 24 hours after (21.08; 95% CI: 18.6-23.5) for the group showing moderate neck disability compared with the mild neck disability group (6 minutes, 44.16; 95% CI 42.65-45.67/ 24 hours after, 14.3; 95% CI: 11.9-16.7) and the control group. The analysis shows a decrease in the pain-free MMO only in the group of moderate disability 24 hours after the test. PPTs of the trigeminal region decreased immediately in all groups, whereas at 24 hours, a decrease was observed in only the groups of patients. PPTs of the cervical region decreased in only the group with moderate neck disability 24 hours after the test. The strongest negative correlation was found between pain-free MMO immediately after the test and NDI in both the mild (r = -0.49) and moderate (r = -0.54) neck disability

Incidence of migraine and tension-type headache in three different populations at risk within the German DMKG headache study.

PubMed

Khil, Laura; Pfaffenrath, Volker; Straube, Andreas; Evers, Stefan; Berger, Klaus

2012-03-01

Unlike the prevalence, the incidence of headache disorders has attracted only little attention in epidemiological research. Different definitions of the 'population at risk' among the few published migraine and tension-type headache incidence studies limit their comparability and warrant further research. Therefore, we analysed data from the German Migraine and Headache Society (DMKG). Incidences were assessed in the general population in Germany via standardized headache questions using the International Classification of Headache Disorders, 2nd Edition (ICHD-2). The population was drawn from a 5-year age-group- stratified and gender-stratified random sample from the population register. Of the 1312 baseline participants examined between 2003 and 2004, 1122 (85.5%) participated in the follow-up in 2006 and were the basis for three different populations at risk. We found that the three populations differed in size, age, gender and incidence estimate. The total sample incidence of migraine ranged between 0% and 3.3% and of tension-type headache between 5.3% and 9.2% depending on the definition of 'at risk'. We concluded that one significant problem in headache incidence estimation is the definition of 'at risk', limiting comparability. Thus, this study supports the need for a common definition for prospective headache incidence estimations.

[Headache News].

PubMed

Diener, Hans-Christoph; Gaul, Charly; Holle-Lee, Dagny; Lazaridis, Lazaros; Nägel, Steffen; Obermann, Mark

2017-06-01

A review of the latest and most relevant information on different disorders of head and facial pain is presented. News from epidemiologic studies regarding the relationship between migraine and patent foramen ovale, the cardiovascular risk in migraine, and migraine behavior during menopause, and the development of white matter lesions or migraine genetics are presented. Regarding pathophysiology there are very recent insights regarding the role of the hypothalamus during prodromal phase and the interplay of brain-stem and hypothalamus during the attack. In the last year studies and metaanalysis generated new knowledge for the use of triptans in general as in menstrual related migraine and hemiplegic variants. Furthermore, new hope rises for the CGRP (calcitonin-gene related peptide)-antagonists, as the data for ubrogepant do not suggest hepatotoxicity but efficacy. In prophylactic migraine treatment the news are manly on how the new therapeutic approach with monoclonal antibodies against CGRP or its receptor is moving on. Additional newly generated data for already known prophylactic agents as for new approaches are compactly discussed. Although main developments in headache focus on migraine new data on trigemino-autonomic headache trigeminal neuralgia and new daily persistant headache became available. Georg Thieme Verlag KG Stuttgart · New York.

Αn uncommon coexistence of primary sexual, cough and exercise headaches: the first three cases from Greece.

PubMed

Bougea, A; Constantinides, V; Anagnostou, E; Kararizou, E

2015-01-01

The "other primary headaches" encompasses a group of uncommon but distinct headache disorders. The coexistence of their subforms such as primary sexual and exercise headache is not a new phenomenon, but in association with cough headache is rather uncommon. Report of cases: We report three cases with a rare coexistence of primary cough, exercise and associated with sexual activity headache. Indomethacin was effective in all patients. The leading pathophysiological explanation involves a rapid rise in intra-abdominal pressure exertional factors or an inappropriate reaction in the cerebral vasculature. Further studies are needed to confirm a common pathogenic mechanism in these patients. Τhe coexistence of these headaches needs to be taken into account in the final classification that is expected to be available in 2016. Hippokratia 2015; 19 (4): 369-371.

Post procedure headache in patients treated for neurovascular arteriovenous malformations and aneurysms using endovascular therapy.

PubMed

Khan, Sabrina; Amin, Faisal Mohammad; Hauerberg, John; Holtmannspötter, Markus; Petersen, Julie Falkenberg; Fakhril-Din, Zainab; Gaist, David; Ashina, Messoud

2016-12-01

Though endovascular therapy (EVT) is increasingly applied in the treatment of intracranial vascular lesions, little is known about the effect of EVT on post-procedure headache. We aimed to investigate the prevalence of headache in patients who have undergone EVT for cerebral arteriovenous malformations (AVMs) and aneurysms. A total of 324 patients underwent EVT treatment for aneurysms and AVMs at the Danish National Hospital from January 2012 to December 2014. We applied strict exclusion criteria in order to minimize the effect of other factors on headache occurrence, e.g., craniotomy. Eligible subjects were phone-interviewed using a purpose-developed semi-structured questionnaire. Headaches were classified according to ICHD-III beta criteria. The 59 patients underwent treatment of aneurysms (n = 43), cranial dural fistulas (n = 11), and AVMs (n = 5). There was a significant increase in overall headache (p = 0.017) and tension-type headache (TTH) (p = 0.012) within the first 3 months after EVT compared to 1 month before EVT. However, at interview time (median 2.5 years post-EVT), the increase in overall headache, migraine, and tension-type headache was not statistically significant. A minority of patients experienced headaches for the first time within 3 months of their EVT (migraine 4, TTH 10). At interview time, 50 % of these new headaches still persisted. Our results suggest a temporary increase in headache in the first 3 months after EVT, which normalizes over time. Clinicians may use this knowledge to better inform their patients of functional outcomes after their EVT procedure.

Primary stabbing headache.

PubMed

Pareja, Juan A; Sjaastad, Ottar

2010-01-01

Primary stabbing headache is characterized by transient, cephalic ultrashort stabs of pain. It is a frequent complaint with a prevalence of 35.2%, a female preponderance, and a mean age of onset of 28 years (Vågå study). Attacks are generally characterized by moderate to severe, jabbing or stabbing pain, lasting from a fraction of a second to 3s. Attack frequency is generally low, with one or a few attacks per day. The paroxysms generally occur spontaneously, during daytime. Most patients exhibit a sporadic pattern, with an erratic, unpredictable alternation between symptomatic and non-symptomatic periods. Paroxysms are almost invariably unilateral. Temporal and fronto-ocular areas are most frequently affected. Attacks tend to move from one area to another, in either the same or the opposite hemicranium. Jabs may be accompanied by a shock-like feeling and even by head movement - "jolts" -or vocalization. On rare occasions, conjunctival hemorrhage and monocular vision loss have been described as associated features. Primary stabbing headache may concur, synchronously or independently, with other primary headaches. In contrast to what is the case in adults, in childhood it is not usually associated with other headaches. Treatment is rarely necessary. Indomethacin, 75-150 mg daily, may seem to be of some avail. Celecoxib, nifedipine, melatonin, and gabapentin have been reported to be effective in isolated cases and small series of patients. The drug studies need corroboration. Copyright © 2011 Elsevier B.V. All rights reserved.

Prevalence of primary headache disorders in Fayoum Governorate, Egypt.

PubMed

El-Sherbiny, Naglaa A; Masoud, Mohamed; Shalaby, Nevin M; Shehata, Hatem S

2015-01-01

There is abundance of epidemiological studies of headache in developed and western countries; however, data in developing countries and in Egypt are still lacking. This study aims to detect the prevalence of primary headache disorders in both urban and rural sectors in Fayoum governorate, Egypt. A total of 2600 subjects were included using multi-stage stratified systematic random sampling, with respondent rate of 91.3 %. A pre-designed Arabic version, interviewer-administered, pilot tested structured questionnaire was developed according to The International Classification of Headache Disorders, 3rd edition (beta version), and this questionnaire was validated and the strength of agreement in headache diagnosis was good. The 1-year headache prevalence was 51.4 %, which was more prevalent in urban dwellers. The most common primary headache type was episodic tension type headache (prevalence; 24.5 %), followed by episodic migraine (prevalence; 17.3 %), both types peaked in midlife. Headache disorders were more common in females with exception of cluster headache that showed the expected male dominance. The risk of chronic headache increased more than one fold and half when the participants were females, married, and in those with high education. More than 60 % of our participants did not seek medical advice for their headaches problem; this percentage was higher in rural areas. Primary headache disorders are common in Egypt; prevalence rate was comparable with western countries with exception of episodic tension headache. Still headache is under-estimated and under-recognized in Egypt and this problem should be targeted by health care providers.

Defining refractory migraine: results of the RHSIS Survey of American Headache Society members.

PubMed

Schulman, Elliott A; Peterlin, B Lee; Lake, Alvin E; Lipton, Richard B; Hanlon, Alexandra; Siegel, Sherry; Levin, Morris; Goadsby, Peter J; Markley, Herbert G

2009-04-01

To gauge consensus regarding a proposed definition for refractory migraine proposed by Refractory Headache Special Interest Section, and where its use would be most appropriate. Headache experts have long recognized that a subgroup of headache sufferers remains refractory to treatment. Although different groups have proposed criteria to define refractory migraine, the definition remains controversial. The Refractory Headache Special Interest Section of the American Headache Society developed a definition through a consensus process, assisted by a literature review and initial membership survey. A 12-item questionnaire was distributed at the American Headache Society meeting in 2007 during a platform session and at the Refractory Headache Special Interest Section symposium. The same questionnaire was subsequently sent to all American Headache Society members via e-mail. A total of 151 responses from AHS members form the basis of this report. The survey instrument was designed using Survey Monkey. Frequencies and percentages of the survey were used to describe survey responses. American Headache Society members agreed that a definition for refractory migraine is needed (91%) that it should be added to the International Classification of Headache Disorders-2 (86%), and that refractory forms of non-migraine headache disorders should be defined (87%). Responders believed a refractory migraine definition would be of greatest value in selecting patients for clinical drug trials. The current refractory migraine definition requires a diagnosis of migraine, interference with function or quality of life despite modification of lifestyle factors, and adequate trials of acute and preventive medicines with established efficacy. The proposed criteria for the refractory migraine definition require failing 2 preventive medications to meet the threshold for failure. Although 42% of respondents agreed with the working definition of refractory migraine, 43% favored increasing the

Autonomic dysfunction in pediatric patients with headache: migraine versus tension-type headache.

PubMed

Rabner, Jonathan; Caruso, Alessandra; Zurakowski, David; Lazdowsky, Lori; LeBel, Alyssa

2016-12-01

To examine symptoms indicating central nervous system (CNS) autonomic dysfunction in pediatric patients with migraine and tension-type headache. A retrospective chart review assessed six symptoms (i.e. constipation, insomnia, dizziness, blurry vision, abnormal blood pressure, and cold and clammy palms and soles) indicating central nervous system (CNS) autonomic dysfunction in 231 patients, ages 5-18 years, diagnosed with migraine, tension-type headache (TTH), or Idiopathic Scoliosis (IS). Higher frequencies of "insomnia," "dizziness," and "cold and clammy palms and soles" were found for both migraine and TTH patients compared to the IS control group (P < 0.001). Frequencies of all six symptoms were greater in TTH than migraine patients with "cold and clammy palms and soles" reaching significance (P < 0.001). The need for prospective research investigating autonomic dysfunction in pediatric headache patients is discussed.

Chronic post-traumatic headache: clinical findings and possible mechanisms

PubMed Central

Defrin, Ruth

2014-01-01

Chronic post-traumatic headache (CPTHA), the most frequent complaint after traumatic brain injury (TBI), dramatically affects quality of life and function. Despite its high prevalence and persistence, the mechanism of CPTHA is poorly understood. This literature review aimed to analyze the results of studies assessing the characteristics and sensory profile of CPTHA in order to shed light on its possible underlying mechanisms. The search for English language articles published between 1960 and 2013 was conducted in MEDLINE, CINAHL, and PubMed. Studies assessing clinical features of headache after TBI as well as studies conducting quantitative somatosensory testing (QST) in individuals with CPTHA and in individuals suffering from other types of pain were included. Studies on animal models of pain following damage to peripheral tissues and to the peripheral and central nervous system were also included. The clinical features of CPTHA resembled those of primary headache, especially tension-type and migraine headache. Positive and negative signs were prevalent among individuals with CPTHA, in both the head and in other body regions, suggesting the presence of local (cranial) mechanical hypersensitivity, together with generalized thermal hypoesthesia and hypoalgesia. Evidence of dysfunctional pain modulation was also observed. Chronic post-traumatic headache can result from damage to intra- and pericranial tissues that caused chronic sensitization of these tissues. Alternatively, although not mutually exclusive, CPTHA might possibly be a form of central pain due to damage to brain structures involved in pain processing. These, other possibilities, as well as risk factors for CPTHA are discussed at length. PMID:24976746

Posttraumatic headache: biopsychosocial comparisons with multiple control groups.

PubMed

Tatrow, Kristin; Blanchard, Edward B; Hickling, Edward J; Silverman, Daniel J

2003-01-01

This study examined somatic, psychological, and cognitive functioning of subjects with posttraumatic headache in comparison with multiple control groups. Posttraumatic headache is not as widely studied as other forms of headache (eg, tension-type, migraine). Previous research has suggested poor psychological functioning in patients with posttraumatic headache in comparison with other groups of patients with pain; however, this group has yet to be compared with a group of persons who have experienced trauma but are headache-free. Nineteen subjects with posttraumatic headache were studied, with full assessments available for 14 participants. Comparison groups, containing 16 participants each, included another headache group, a nonheadache group, and a trauma (motor vehicle accident) survivor nonheadache group. Participants completed several measures assessing somatic, psychological, and cognitive functioning. Findings revealed that the posttraumatic headache group exhibited significantly poorer functioning than the comparison groups on several measures including the Psychosomatic Symptom Checklist, Postconcussion Syndrome Checklist, axis II psychiatric diagnoses, Minnesota Multiphasic Personality Inventory, and the Daily Hassles Scale (frequency and total). Additionally, they scored higher on the following: number of axis I psychiatric diagnoses, the Daily Hassles Scale (intensity), Beck Depression Inventory, State-Trait Anxiety Inventory, and State-Trait Anger Expression Inventory. The posttraumatic headache group was similar to the other trauma group on the Posttraumatic Stress Disorder Symptom Checklist and the Life-Trauma Checklist. This study confirmed the distress seen in this understudied population of persons with headache and highlights areas of focus for proper assessment and treatment of those with headache and who have had an accident.

Central sensitization in tension-type headache--possible pathophysiological mechanisms.

PubMed

Bendtsen, L

2000-06-01

headache significantly more than placebo, while citalopram had only a slight and insignificant effect. It was concluded that the blockade of 5-HT reuptake could only partly explain the efficacy of amitriptyline in tension-type headache, and that also other actions of amitriptyline, e.g. reduction of central sensitization, were involved. Finally, the plasma 5-HT level, the platelet 5-HT level and the number of platelet 5-HT transporters were found to be normal in chronic tension-type headache. On the basis of the present and previous studies, a pathophysiological model for tension-type headache is presented. According to the model, the main problem in chronic tension-type headache is central sensitization at the level of the spinal dorsal horn/trigeminal nucleus due to prolonged nociceptive inputs from pericranial myofascial tissues. The increased nociceptive input to supraspinal structures may in turn result in supraspinal sensitization. The central neuroplastic changes may affect the regulation of peripheral mechanisms and thereby lead to, for example, increased pericranial muscle activity or release of neurotransmitters in the myofascial tissues. By such mechanisms the central sensitization may be maintained even after the initial eliciting factors have been normalized, resulting in the conversion of episodic into chronic tension-type headache. Future basic and clinical research should aim at identifying the source of peripheral nociception in order to prevent the development of central sensitization and at ways of reducing established sensitization. This may lead to a much needed improvement in the treatment of chronic tension-type headache and other chronic myofascial pain conditions.

Hair Transplantation in Migraine Headache Patients.

PubMed

Ors, Safvet

2017-09-01

Migraine headache is a primary neurologic disease affecting millions of people worldwide. As a consequence, quality of life is diminished, productivity suffers (through loss of work force), and treatment costs are substantial. The occurrence rate in the general population is quite high, with women accounting for 3 of every 4 cases. Between January 2011 and May 2012, a total of 221 patients received hair transplants. Another 590 patients underwent hair transplantation between June 2012 and December 2016. Initially (first interval), patients were not questioned on migraine headaches in preoperative visits, but questioning was regularly done thereafter. Overall, 150 patients given transplants in the first period were surveyed by phone regarding preoperative migraine headaches. Aside from the 1 incidental discovery, no other instances of migraine emerged. Headache origins were occipital-frontal in 2 patients, occipital-temporal in 2 patients, and occipital-temporal-frontal in the 2 others. Donor/receiver areas in hair transplantation and migraine trigger zones shared locations. Headache frequencies ranged from 4 to 8 days per month (average, 6 days), and pain scores were 5-8 (10 being highest). Duration of pain was 3-5 hours (average, 4 hours). All six patients had used various medications, such as triptans, ergot, and nonsteroidal anti-inflammatory drugs, before hair transplantation. The 1 female patient was a 32-year-old seeking treatment for alopecia, with a 6-year history of migraine headaches. The male patients presenting with androgenetic alopecia (grade 4-5 by Norwood classification) had 6- to 20-year migrainous histories. After hair transplantation, each migraine sufferer was checked once in the first month and then once every 3 months. Those who could not appear in person after the first year were evaluated by phone every 3 months. Migraine headaches had ceased in all 6 patients, none of whom used medical treatments for migraines thereafter. The postoperative

[PRIMARY HEADACHE IN CHILDREN AND ADOLESCENTS--DIAGNOSIS AND TREATMENT].

PubMed

Matar, Amal Khourieh; Kerem, Nogah C; Srugo, Isaac; Genizi, Jacob

2015-12-01

Primary headaches are one of the most common disorders of childhood, with migraine and tension type headaches (TTHs) being the most frequent ones. In spite of their prevalence, there is paucity of knowledge regarding the underlying pathophysiological mechanisms that cause headaches and regarding the unique aspects of headaches in children and adolescents. To review the literature and summarize the knowledge regarding clinical features, diagnosis and management of primary headache in children and adolescents, mainly migraine and TTH. Most of our current knowledge regarding primary headaches in children and adolescents is driven from extrapolations from studies that were conducted with adult patients. Therefore, it needs to be validated for the different age groups. Migraines may be diagnosed effectively based on the 2nd edition of the International Classification of Headache Disorders (ICHD-II), however, TTH is diagnosed mainly by the absence of features found in other headache types. Treatment strategies for primary headaches vary according to patient's age, family structure, culture and beliefs, headache diagnosis, and based on the disability the headache imposes on the patient's daily living. It was shown that a multidisciplinary approach, that includes continuing counseling, education, and reassurance, in combination with pharmacological and non-pharmacological treatment, is an effective strategy for children and adolescents suffering from primary headaches. Further studies are needed to enrich our knowledge about the pathophysiological mechanisms that cause headaches in children and adolescents and to develop efficient strategies to alleviate their burden.

Headache associated with airplane travel: a rare entity.

PubMed

Cherian, Ajith; Mathew, Mini; Iype, Thomas; Sandeep, P; Jabeen, Afshan; Ayyappan, K

2013-01-01

Airplane travel headache is rare and has recently been described as a new form of headache associated with a specific situation. Of the 1,208 patients with primary headaches attending a tertiary care neurology hospital, two (0.16%) patients satisfied the criteria for headache related to airplane travel. Both the patients fulfilled the proposed diagnostic criteria for airplane travel headache. This unique headache had a mean duration of 24 minutes, localized to the medial supraorbital region described as having an intense jabbing or stabbing character that occurred exclusively and maximally during aircraft landing or take-off, following which pain intensity subsided . This rare headache felt on aircraft descent is probably due to the squeeze effect on the frontal sinus wall, when air trapped inside it contracts producing a negative pressure leading to mucosal edema, transudation and intense pain. Use of nasal decongestants either alone or in combination with naproxen sodium prior to ascent and descent abated the headache episodes. Awareness about this unique entity is essential to provide proper treatment and avoid patient suffering.

The efficacy of oral habit modification on headache.

PubMed

Agha-Hosseini, Farzaneh; Sheykhbahaei, Nafiseh; Mirzaii-Dizgah, Iraj; Fatehi, Farzad

2017-12-01

Headache is the most common complaint of patients suffering from temporomandibular joint disorders (TMDs). Thus, temporomandibular joint (TMJ) examinations maybe necessary in patients with headache. Considering the high prevalence of bruxism and TMDs in patients with headache the effects of conservative TMD treatment on headache should be assessed. Patients were questioned about headaches in the past three months. Those responding affirmatively to this question were examined for TMD and bruxism. After the examinations, 219 patients remained in the study and received self-management instructions. Patients were requested to modify oral habits except when eating or sleeping. The degree of pain (visual analogue scale), headache disability index (HDI), frequency of headaches (FH) per month and TMD intensity were evaluated. The median levels of pain, HDI, FH, and TMD intensity were 8, 44, 8, and 7, respectively, before modifying oral habits and decreased to 4, 24, 2, and 3, respectively, after intervention. These decreases were statistically significant. Having patients maintain free space between the teeth and relax muscles can be an efficient method to treat headache and TMD, especially when repeated frequently.

Headache and soccer: a survey in professional soccer players of the Italian "Serie A".

PubMed

Mainardi, Federico; Alicicco, Ernesto; Maggioni, Ferdinando; Devetag, Flavio; Lisotto, Carlo; Zanchin, Giorgio

2009-02-01

The aim of the study was to assess the occurrence and the clinical features of primary headaches in a sample of players of the Italian Soccer League first division. The design of the study allowed a retrospective and prospective diagnosis of primary headaches according to the International Classification of Headache Disorders-II edition (ICHD-II), using anonymous questionnaires, which had to be filled out at regular times during the playing season. A total of 83 athletes playing in four different clubs were involved; four of them changed football team during the season and so did not complete the study. During the championship three soccer players reported headache (3.6%) with features fulfilling ICHD-II criteria for episodic tension-type headache. Important and prolonged physical effort was reported as aggravating factor in one case, but no attacks occurred during competitive matches. The same athletes had reported a personal history of episodic tension-type headache. In conclusion, the occurrence of primary headaches among professional soccer players of Italian first division championship appear to be strikingly lower, as compared to that found in the general population. A possible explanation could be given by the selection operated by a career which is not compatible with unpredictable, disabling attacks.

Personality traits in childhood and adolescent headache.

PubMed

Lanzi, G; Zambrino, C A; Ferrari-Ginevra, O; Termine, C; D'Arrigo, S; Vercelli, P; De Silvestri, A; Guglielmino, C R

2001-02-01

We evaluate personality traits, anxiety and depression in a population of paediatric and adolescent patients, correlating personality characteristics with headache and sociodemographic variables. The clinical features of headache include specific personality traits. We report a clinical study of 57 patients (age 8-18 years), divided up as follows: 12 migraine with aura, 29 migraine without aura and 16 tension-type headache. One of Cattel's tests was administered to every patient; the Children's Depression Inventory test was administered to 53 patients and the Test Anxiety Inventory test to 43 subjects. The scores obtained by every patient in each test were correlated with the characteristics of headache and with sociodemographic data. We found that patients affected by idiopathic headache share some personality traits, mainly emotional rigidity and tendency to repress anger and aggression. These traits do not seem to be correlated with sociodemographic data and the duration of headache: we considered these as characteristic of migrainous patients.

Psychological functioning in headache sufferers.

PubMed

Andrasik, F; Blanchard, E B; Arena, J G; Teders, S J; Teevan, R C; Rodichok, L D

1982-05-01

The present study examined the psychological test responses of 99 headache sufferers and 30 matched nonheadache controls. Headache subjects were of four types: migraine (n = 26), muscle contraction (n = 39), combined migraine-muscle contract ion (n = 22), and cluster (n = 12). Measures consisted of the Minnesota Multiphasic Personality Inventory, a modified hostility scale derived from the MMPI, Back Depression Inventory, State-Trait Anxiety Inventory, Autonomic Perception Questionnaire, Rathus Assertiveness Schedule, Social Readjustment Rating Scale, Psychosomatic Symptom Checklist, Schalling-Sifneos Scale, Need for Achievement, and Hostile Press. Significant differences were found on five clinical scales of the MMPI--1, 2, 3, 6, and 7. Of the non-MMPI scales, only the Psychosomatic Symptom Checklist and Trait Anxiety Inventory were significant. Control subjects revealed no significant findings on any tests. The headache groups fell along a continuum, beginning with cluster subjects, who showed only minimal distress, continuing through migraine and combined migraine-muscle contraction, and ending with muscle contraction subjects, who revealed the greatest degree of psychological disturbance. However, none of the headache groups could be characterized by marked elevations on any of the psychological tests, which contrasts with past research findings. It is suggested that the present results may be more representative of the "typical" headache sufferer.

Naratriptan in the Prophylactic Treatment of Cluster Headache.

PubMed

Ito, Yasuo; Mitsufuji, Takashi; Asano, Yoshio; Shimazu, Tomokazu; Kato, Yuji; Tanahashi, Norio; Maruki, Yuichi; Sakai, Fumihiko; Yamamoto, Toshimasa; Araki, Nobuo

2017-10-01

Objective Naratriptan has been reported to reduce the frequency of cluster headache. The purpose of this study was to determine whether naratriptan is effective as a prophylactic treatment for cluster headache in Japan. Methods We retrospectively reviewed all 43 patients with cluster headache who received preventive treatment with naratriptan from April 2009 to April 2015. The International Classification of Headache Disorders, 3rd Edition (beta version) (ICHD-3 beta) was used to diagnose cluster headache. This study was conducted at 3 centers (Department of Neurology, Saitama Medical University; Saitama Neuropsychiatric Institute; Saitama Medical University International Medical Center). Patients were recruited from these specialized headache outpatient centers. Naratriptan was taken before the patient went to bed. Results The study population included 30 men (69.8%) and 13 women (30.2%). Twenty-two cases received other preventive treatments (51.2%), while 21 cases only received naratriptan (48.8%). Among the 43 cases, 37 patients (86.0%) achieved an improvement of cluster headache on naratriptan. Conclusion Naratriptan has been suggested as a preventive medicine for cluster headache because of the longer the biological half-life in comparison to other triptans. The internal use of naratriptan 2 hours before attacks appears to achieve a good response in patients with cluster headache.

Cluster Headache: Epidemiology, Pathophysiology, Clinical Features, and Diagnosis

PubMed Central

Wei, Diana Yi-Ting; Yuan Ong, Jonathan Jia; Goadsby, Peter James

2018-01-01

Cluster headache is a primary headache disorder affecting up to 0.1% of the population. Patients suffer from cluster headache attacks lasting from 15 to 180 min up to 8 times a day. The attacks are characterized by the severe unilateral pain mainly in the first division of the trigeminal nerve, with associated prominent unilateral cranial autonomic symptoms and a sense of agitation and restlessness during the attacks. The male-to-female ratio is approximately 2.5:1. Experimental, clinical, and neuroimaging studies have advanced our understanding of the pathogenesis of cluster headache. The pathophysiology involves activation of the trigeminovascular complex and the trigeminal-autonomic reflex and accounts for the unilateral severe headache, the prominent ipsilateral cranial autonomic symptoms. In addition, the circadian and circannual rhythmicity unique to this condition is postulated to involve the hypothalamus and suprachiasmatic nucleus. Although the clinical features are distinct, it may be misdiagnosed, with patients often presenting to the otolaryngologist or dentist with symptoms. The prognosis of cluster headache remains difficult to predict. Patients with episodic cluster headache can shift to chronic cluster headache and vice versa. Longitudinally, cluster headache tends to remit with age with less frequent bouts and more prolonged periods of remission in between bouts. PMID:29720812

Cluster Headache: Epidemiology, Pathophysiology, Clinical Features, and Diagnosis.

PubMed

Wei, Diana Yi-Ting; Yuan Ong, Jonathan Jia; Goadsby, Peter James

2018-04-01

Cluster headache is a primary headache disorder affecting up to 0.1% of the population. Patients suffer from cluster headache attacks lasting from 15 to 180 min up to 8 times a day. The attacks are characterized by the severe unilateral pain mainly in the first division of the trigeminal nerve, with associated prominent unilateral cranial autonomic symptoms and a sense of agitation and restlessness during the attacks. The male-to-female ratio is approximately 2.5:1. Experimental, clinical, and neuroimaging studies have advanced our understanding of the pathogenesis of cluster headache. The pathophysiology involves activation of the trigeminovascular complex and the trigeminal-autonomic reflex and accounts for the unilateral severe headache, the prominent ipsilateral cranial autonomic symptoms. In addition, the circadian and circannual rhythmicity unique to this condition is postulated to involve the hypothalamus and suprachiasmatic nucleus. Although the clinical features are distinct, it may be misdiagnosed, with patients often presenting to the otolaryngologist or dentist with symptoms. The prognosis of cluster headache remains difficult to predict. Patients with episodic cluster headache can shift to chronic cluster headache and vice versa. Longitudinally, cluster headache tends to remit with age with less frequent bouts and more prolonged periods of remission in between bouts.

New daily persistent headache in the paediatric population.

PubMed

Kung, E; Tepper, S J; Rapoport, A M; Sheftell, F D; Bigal, M E

2009-01-01

We conducted a clinic-based study focusing on the clinical features of new-onset chronic daily headaches (CDH) in children and adolescents. The clinical records and headache diaries of 306 children and adolescents were reviewed, to identify 187 with CDH. Relevant information was transferred to a standardized form that included operational criteria for the diagnoses of the headaches. Since we were interested in describing the clinical features of these headaches, we followed the criteria A and B of the 2nd edn of the International Classification of Headache Disorders (ICHD-2) and refer to them as new daily persistent headaches (NDPH) regardless of the presence of migraine features (therefore, this is a modified version of the ICHD-2 criteria). From the 56 adolescents with NDPH, most (91.8%) did not overuse medications. Nearly half (48.1%) reported they could recall the month when their headaches started. NDPH was more common than chronic tension-type headache in both adolescents overusing and not overusing medication. Individuals with NDPH had headaches fulfilling criteria for migraine on an average of 18.5 days per month. On most days, they had migraine-associated symptoms (one of nausea, photophobia or phonophobia)). NDPH is common in children and adolescents with CDH. Most subjects do not overuse medication. Migraine features are common.

Headache-attributed burden and its impact on productivity and quality of life in Russia: structured healthcare for headache is urgently needed.

PubMed

Ayzenberg, I; Katsarava, Z; Sborowski, A; Chernysh, M; Osipova, V; Tabeeva, G; Steiner, T J

2014-05-01

The study evaluated headache-attributed burden and its impact on productivity and quality of life (QoL) in Russia. Its purpose was to support recommendations for change. A countrywide population-based random sample of 2725 biologically unrelated adults (aged 18-65 years) in 35 cities and nine rural areas of Russia were interviewed in a door-to-door survey. The structured questionnaire enquired into symptom burden, functional disability, lost productive time and QoL (applying the WHOQoL-8 question set), as well as willingness to pay (WTP) for adequate headache treatment, if it were available. Mean lost paid-work days due to headache in the previous 3 months were 1.9 ± 4.2, and mean lost household work days were 3.4 ± 5.7. The estimated annual indirect cost of primary headache disorders was USD 22.8 billion, accounting for 1.75% of gross domestic product. QoL was reduced by all types of primary headaches. According to WHOQoL-8, it was significantly lower in those with headache on ≥15 days/month than in those with episodic headache (24.7 ± 4.6 vs. 28.1 ± 5.0; P < 0.05) and lower in those with migraine than in those with tension-type headache (TTH) (27.1 ± 4.9 vs. 28.8 ± 5.0; P < 0.05). Average WTP for adequate headache treatment was RUB 455 ± 494 per month (median RUB 300), a sum sufficient in most cases, and correlated with illness severity (higher for headache on ≥15 days/month than for migraine, and for migraine than for TTH). Headache is common, burdensome and costly in Russia and, manifestly, poorly mitigated by existing healthcare. Structured healthcare services for headache need to be urgently put in place. © 2014 The Author(s) European Journal of Neurology © 2014 EFNS.

Recurrent headache and interpersonal violence in adolescence: the roles of psychological distress, loneliness and family cohesion: the HUNT study.

PubMed

Stensland, Synne Oien; Thoresen, Siri; Wentzel-Larsen, Tore; Zwart, John-Anker; Dyb, Grete

2014-06-10

Recurrent headache is the most common and disabling pain condition in adolescence. Co-occurrence of psychosocial adversity is associated with increased risk of chronification and functional impairment. Exposure to interpersonal violence seems to constitute an important etiological factor. Thus, knowledge of the multiple pathways linking interpersonal violence to recurrent headache could help guide preventive and clinical interventions. In the present study we explored a hypothetical causal model where the link between exposure to interpersonal violence and recurrent headache is mediated in parallel through loneliness and psychological distress. Higher level of family cohesion and male sex is hypothesized to buffer the adverse effect of exposure to interpersonal violence on headache. The model was assessed using data from the cross-sectional, population-based Young-HUNT 3 study of Norwegian adolescents, conducted from 2006-2008. A cohort of 10 464 adolescents were invited. The response rate was 73% (7620), age ranged from 12 and 20 years, and 50% (3832) were girls. The study comprised self-report measures of exposure to interpersonal violence, loneliness, psychological distress and family cohesion, in addition to a validated interview on headache, meeting the International Classification of Headache Disorders criteria. Recurrent headache was defined as headache recurring at least monthly during the past year, and sub-classified into monthly and weekly headache, which served as separate outcomes. In Conditional Process Analysis, loneliness and psychological distress consistently posed as parallel mediating mechanisms, indirectly linking exposure to interpersonal violence to recurrent headache. We found no substantial moderating effect of family cohesion or sex. Loneliness and psychological distress seem to play crucial roles in the relationship between exposure to interpersonal violence and recurrent headache. To facilitate coping and recovery, it may be helpful to

Reversible Cerebral Vasoconstriction Syndrome Without Typical Thunderclap Headache.

PubMed

Wolff, Valérie; Ducros, Anne

2016-04-01

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by severe headache and diffuse segmental intracranial arterial constriction that resolve within three months. Stroke, which is the major complication of RCVS, can result in persistent neurological disability, and rarely causes death. Diagnosis of RCVS early in the clinical course might improve outcomes. Although recurrent thunderclap headache is the clinical hallmark of RCVS, the absence of such a pattern should not lead to discard the diagnosis. Our literature review shows that RCVS can also manifest as an unspecific headache, such as a single severe headache episode, a mild or a progressive headache. Moreover, a subset of patients with severe RCVS presents without any headache, but frequently with seizures, focal neurological deficits, confusion or coma, in the setting of stroke or posterior reversible encephalopathy syndrome. These patients may be aphasic or in comatose state, explaining their inability to give their own medical history. They may have forgotten the headache they had a few days before more dramatic symptoms, or may have a variant of the classical RCVS. By consequence, an RCVS should be suspected in patients with any unusual headache, whether thunderclap or not, and in patients with cryptogenic stroke or convexity subarachnoid hemorrhage, whether the patient also has headache or not. Diagnosis in such cases relies on the demonstration of reversible multifocal intracranial arterial stenosis and the exclusion of other causes. © 2016 American Headache Society.

Headache and temporo mandibular disorders: epidemiological assessment.

PubMed

D'Urso, Anna; Serritella, Emanuela; Tolevski Meshkova, Doria; Falisi, Giovanni; Di Paolo, Carlo

2016-04-01

Temporo mandibular disorders (TMDs) and headache are closely related pathologies. The aim of this study was to determine the prevalence, incidence, and the intensity of headache in 3304 dysfunctional patients (G1) at the Service of Clinical Gnathology of the Head-Neck Assistance Department of Umberto I Polyclinic at Sapienza University of Rome. G1 is composed by two subgroups of patient S1 (N.=2375) and S2 (N.=929) analyzed in different periods, respectively 1996-2006 and 2011-2013. The findings were compared with those of a control group of subjects from the general Italian population recently reported elsewhere. The prevalence of headache in the dysfunctional population was analyzed by calculating the proportion of that population who tested positive to cephalic pain for the entire study period. The incidence of headache has been calculated by determining the proportion cases of headache in TMD population, during the period analyzed among those considered at risk at the beginning of the examination period. The intensity of cephalic pain was evaluated using the Verbal Numeric Scale. Confidence Intervals (CI) at the 95% confidence level were calculated to get a precise estimate of research data. Comparison of G1 and control sample did not reveal many important differences, respectively with a headache prevalence of 49.5% (95%CI 47.8%-51.2%) and 42.8%(95%CI 46.8-38.8%). However, comparison of S1, which constituted a sample similar in numbers to the control sample and was observed during a similar time period, revealed a clearly greater prevalence of headache in the dysfunctional population 67.3% (95%CI 64.3-70.3%) than in the general representative population of Italian people 42.8% (95%CI 46.8-38.8%). The incidence of headache in the dysfunctional population was 39.49% (95%CI 37.79-41.19%). Headache incidence in the first subgroup (S1) was 32.7%(95%CI 34.6-30.8%), while in S2 was 59.24%(95%CI 56.24-62.24%), demonstrating an increase of incidence in the second

Update on New Daily Persistent Headache.

PubMed

Nierenburg, Hida; Newman, Lawrence C

2016-06-01

New daily persistent headache (NDPH) is an uncommon and under-recognized primary headache disorder. Clinically, NDPH may resemble migraine or tension-type headache. Unlike migraine or tension-type headaches, however, a distinguishing feature of NDPH is that the majority of patients with NDPH can pinpoint the exact date of onset of symptoms. While cases can arise de novo, in multiple reports, a viral illness precedes the onset of headache. NDPH has two temporal profiles: a self-limited form that resolves spontaneously without treatment and a refractory, persistent form in which headaches continue unabated for years. Diagnosis is predicated on first eliminating secondary mimics via diagnostic imaging and hematological studies. Lumbar puncture should be considered in patients who are refractory to treatment to search for alterations in CSF pressure or for an infectious process. There have been no randomized clinical trials utilizing acute or preventive therapies for NDPH. In clinical practice, treatment is aimed at matching the predominant headache phenotype; nonetheless, most therapies are generally ineffective or only partially effective. Not surprisingly, medication overuse is very common among patients with this disorder and should be identified, although in most patients, eliminating medication overuse does not alter the course of the illness. There have been reports of successful treatment combining doxycycline 100 mg and montelukast 10 mg, dosed BID for 3 months. Anecdotally, in our practice, this combination has occasionally provided good results. Onabotulinum toxin injections are currently under investigation and may provide a potential new effective treatment regimen.

Critical Evaluation of Headache Classifications

PubMed Central

ÖZGE, Aynur

2013-01-01

Transforming a subjective sense like headache into an objective state and establishing a common language for this complaint which can be both a symptom and a disease all by itself have kept the investigators busy for years. Each recommendation proposed has brought along a set of patients who do not meet the criteria. While almost the most ideal and most comprehensive classification studies continued at this point, this time criticisims about withdrawing from daily practice came to the fore. In this article, the classification adventure of scientists who work in the area of headache will be summarized. More specifically, 2 classifications made by the International Headache Society (IHS) and the point reached in relation with the 3rd classification which is still being worked on will be discussed together with headache subtypes. It has been presented with the wish and belief that it will contribute to the readers and young investigators who are interested in this subject. PMID:28360577

Critical Evaluation of Headache Classifications.

PubMed

Özge, Aynur

2013-08-01

Transforming a subjective sense like headache into an objective state and establishing a common language for this complaint which can be both a symptom and a disease all by itself have kept the investigators busy for years. Each recommendation proposed has brought along a set of patients who do not meet the criteria. While almost the most ideal and most comprehensive classification studies continued at this point, this time criticisims about withdrawing from daily practice came to the fore. In this article, the classification adventure of scientists who work in the area of headache will be summarized. More specifically, 2 classifications made by the International Headache Society (IHS) and the point reached in relation with the 3rd classification which is still being worked on will be discussed together with headache subtypes. It has been presented with the wish and belief that it will contribute to the readers and young investigators who are interested in this subject.

Psychiatric Symptoms in Children with Primary Headache

ERIC Educational Resources Information Center

Anttila, Pirjo; Sourander, Andre; Metsahonkala, Liisa; Aromaa, Minna; Helenius, Hans; Sillanpaa, Matti

2004-01-01

Objective: To examine the association of psychiatric symptoms with migraine and tension-type headache in children. Method: A questionnaire completed by 1,135 Finnish children in the sixth grade identified 154 children with migraine, 138 with tension-type headache, and 407 children who were headache-free. Seventy children were randomly selected…

Headache and Decompression Sickness: Type I or Type II?

DTIC Science & Technology

2001-06-01

criteria for Type I instead of Type II DCS. This includes no clear alternative diagnosis, a localized headache along the suture, and no nerologic findings...page survey. Here, demographic information, exposure data, predisposing factors, symptom onset, symptoms and signs, diagnosis, disease progression

Muscle pain in the head: overlap between temporomandibular disorders and tension-type headaches.

PubMed

Svensson, Peter

2007-06-01

A variety of painful problems can affect the muscles in the head and face. Both temporomandibular disorders and tension-type headaches are believed to have a significant contribution from the skeletal muscles and have several clinical features in common. It still unclear, however, to what extent these two prevalent disorders are separate entities or have similar pathophysiological background. There is now reasonably good evidence that myofascial temporomandibular disorder patients are more likely to have a tension-type headache problem and vice versa, but the overlap is not complete. Studies have documented similarities regarding sensitization of the nociceptive pathways, dysfunction of the endogenous pain modulatory systems as well as contributing genetic factors, but there are also a number of distinct differences between temporomandibular disorders and tension-type headaches that need to be considered. Using the current classification systems, myofascial temporomandibular disorder pain and tension-type headache disorders do overlap and appear to share many of the same pathophysiological mechanisms, but it would be premature to consider them as identical entities since the importance of, for example, the affected muscles and associated function and genetic background needs to be established. Orofacial pain and headache specialists should collaborate to further develop diagnostic procedures and management strategies of temporomandibular disorders and tension-type headaches.

New daily persistent headache in children and adolescents.

PubMed

Baron, Eric P; Rothner, A David

2010-03-01

New daily persistent headache (NDPH) is a form of chronic daily headache (CDH) that may have features of both migraine and tension-type headache. In contrast with other types of CDH, NDPH is characterized by patients recalling the specific date their unremitting daily headache began. In comparison, chronic tension-type headache and chronic migraine are preceded by a gradually increasing frequency of headache. After several months, all three of these CDH forms often have a similar phenotype, making early history a key to diagnosing NDPH. Evaluations to exclude secondary causes are necessary but usually negative. NDPH is difficult to treat and requires a multimodal approach. Questions regarding NDPH remain unanswered. Additional prospective studies are necessary to further understand, characterize, diagnose, and treat NDPH.

Anxiety, depression and behavioral problems among adolescents with recurrent headache: the Young-HUNT study

PubMed Central

2014-01-01

not with anxiety and depressive symptoms. Headache frequency was significantly associated with increasing symptoms scores for anxiety and depressive symptoms as well as attention difficulties, evident for both age groups. Conclusions The results from the present study indicate that both anxiety and depressive symptoms and behavioral problems are associated with recurrent headache, and should accordingly be considered a part of the clinical assessment of children and adolescents with headache. Identification of these associated factors and addressing them in interventions may improve headache management. PMID:24925252

Advances in the understanding of cluster headache.

PubMed

Leone, Massimo; Proietti Cecchini, Alberto

2017-02-01

Cluster headache is the worst primary headache form; it occurs in paroxysmal excruciatingly severe unilateral head pain attacks usually grouped in cluster periods. The familial occurrence of the disease indicates a genetic component but a gene abnormality is yet to be disclosed. Activation of trigeminal afferents and cranial parasympathetic efferents, the so-called trigemino-parasympathetic reflex, can explain pain and accompanying oculo-facial autonomic phenomena. In particular, pain in cluster headache is attributed, at least in part, to the increased CGRP plasma levels released by activated trigeminal system. Posterior hypothalamus was hypothesized to be the cluster generator activating the trigemino-parasympathetic reflex. Efficacy of monoclonal antibodies against CRGP is under investigation in randomized clinical trials. Areas covered: This paper will focus on main findings contributing to consider cluster headache as a neurovascular disorder with an origin from within the brain. Expert commentary: Accumulated evidence with hypothalamic stimulation in cluster headache patients indicate that posterior hypothalamus terminates rather than triggers the attacks. More extensive studies on the genetics of cluster headache are necessary to disclose anomalies behind the increased familial risk of the disease. Results from ongoing clinical trials in cluster headache sufferers using monoclonal antibodies against CGRP will open soon a new era.

[Effect of autogenic training with cognitive and symbol therapy on the treatment of patients with primary headache].

PubMed

Zsombók, Terézia; Juhász, Gabriella; Gonda, Xénia; Vitrai, József; Bagdy, György

2005-01-01

Only a minor part of headaches are associated with an organic abnormality in the nervous system. In case of migraine and tension headache, the main provoking factor is psychological stress. Furthermore, these syndromes often occur together with depression and anxiety disorders, and when these comorbid conditions are present headache attacks tend to be more frequent, longer and stronger, causing an increase in the consumption of antimigraine agents, and at the same time increase the consumption of antidepressant and anxiolytic agents. Further to drugs, modified versions of Schultz-type autogenic training is also frequently used for anxiolysis. The aim of our research was to study the effect of the cognitive and symbol therapy enhanced autogenic training on headache and related drug consumption in three different types of primary headaches. Twenty five female patients with migraine, tension-type headache or mixed headache participated in an eight-month follow-up study. Headache frequency, analgesic, antimigraine and anxiolytic consumption were measured by means of a headache diary. During the first four months (observation phase) patients became familiar with using the diary, and in the second four months they participated in autogenic training. The data of the second, third and fourth months were considered as baseline data. Our method decreased headache frequency and drug consumption in all three headache groups. This means that the cognitive and symbol therapy enhanced autogenic training is an effective alternative for medications in the treatment of primary headaches.

Effect of rajyoga meditation on chronic tension headache.

PubMed

Kiran; Girgla, Kawalinder K; Chalana, Harsh; Singh, Harjot

2014-01-01

Chronic tension-type headache (CTTH) is the most common type of headache with no truly effective treatment. This study was designed to correlate the additive effect of meditation on CTTH patients receiving medical treatment. 50 patients (aged 18-58 years) presenting with a clinical diagnosis of CCTH, were divided in 2 groups. Group 1 (n=30) received 8 lessons and practical demonstration of Brahmakumaris spiritual based meditation known as Rajyoga meditation for relaxation therapy, in addition to routine medical treatment (analgesics and muscle relaxants). Group 2 (n=20) patients received analgesics and muscle relaxants twice a day but no relaxation therapy in the form of meditation. Both groups were followed up for 8 weeks period. The parameters studied were severity, frequency and duration of CCTH, and their headache index calculated. Patients in both groups showed a highly significant reduction in headache variables (P<0.001) after 8 weeks. But the percentage of patients showing highly significant relief in severity of headache, duration & frequency in Group 1 was 94%, 91% and 97% respectively whereas in Group 2 it was 36%, 36% and 49% respectively. Headache relief as calculated by headache index was 99% in Group 1 as compared to 51% in Group 2. Even Short term spiritual based relaxation therapy (Rajyoga meditation) was highly effective in causing earlier relief in chronic tension headache as measured by headache parameter.

Prevalence of new daily persistent headache in the general population. The Akershus study of chronic headache.

PubMed

Grande, R B; Aaseth, K; Lundqvist, C; Russell, M B

2009-11-01

The aim of the present study was to investigate the prevalence of new daily persistent headache (NDPH) in the general population, and compare the clinical characteristics of NDPH and chronic tension-type headache (CTTH). This is a population-based cross-sectional study. A random sample of 30 000 persons aged 30-44 years was drawn from the population of Akershus County, Norway. A postal questionnaire was screened for chronic headache. Those (n = 633) with self-reported chronic headache within the last month and/or year were invited to an interview and examination by a neurological resident. A follow-up interview was conducted after 1.5-3 years. The headaches were diagnosed according to the International Classification of Headache Disorders, 2nd edn and relevant revisions. The response rate of the questionnaire was 71% and the participation rate of the interview was 74%. Four persons, three men and one woman, had NDPH. The overall 1-year prevalence of NDPH was 0.03%. The clinical characteristics of NDPH and CTTH were similar, except for the sudden onset in DPH.Three of the four persons with NDPH had medication overuse. Follow-up disclosed that the symptomatology of NDPH is not unchangeable, since two persons had improvement of their NDPH. NDPH is rare and occurs in one of 3500 persons from the general population of 30-44-year-olds. It is often associated with medication overuse.

Headache and Facial Pain in Sickle Cell Disease.

PubMed

Vgontzas, Angeliki; Charleston, Larry; Robbins, Matthew S

2016-03-01

Children and adolescents with sickle cell disease (SCD) have a high prevalence of recurrent headaches (24.0-43.9 %). Acute presentation with headache can be diagnostically challenging, as the clinician must consider evaluation of several potentially devastating conditions including vascular diseases (stroke, hemorrhage, venous sinus thrombosis, moyamoya, posterior reversible encephalopathy syndrome), facial and orbital bone infarcts, dental pain, and osteomyelitis. Patients with SCD and primary headache disorders may benefit from comprehensive headache treatment plans that include abortive therapy, prophylactic therapy, and non-pharmacological modalities. Although there is limited data in adults, those with SCD are at risk for medication overuse headache secondary to frequent opioid use. Addressing headache in patients with SCD may help to reduce their use of opioids and disability and improve pain and quality of life.

Commercially available mobile phone headache diary apps: a systematic review.

PubMed

Hundert, Amos S; Huguet, Anna; McGrath, Patrick J; Stinson, Jennifer N; Wheaton, Mike

2014-08-19

Headache diaries are often used by headache sufferers to self-monitor headaches. With advances in mobile technology, mobile electronic diary apps are becoming increasingly common. This review aims to identify and evaluate all commercially available mobile headache diary apps for the two most popular mobile phone platforms, iOS and Android. The authors developed a priori a set of 7 criteria that define an ideal headache diary app intended to help headache sufferers better understand and manage their headaches, while providing relevant data to health professionals. The app criteria were intended as minimum requirements for an acceptable headache diary app that could be prescribed by health care professionals. Each app was evaluated and scored against each criterion. Of the 38 apps identified, none of the apps met all 7 app criteria. The 3 highest scoring apps, meeting 5 of the app criteria, were iHeadache (developed by Better QOL), ecoHeadache (developed by ecoTouchMedia), and Headache Diary Pro (developed by Froggyware). Only 18% of the apps were created with scientific or clinical headache expertise and none of the apps reported on psychometric properties. Despite the growing market and demand, there is a concerning lack of scientific expertise and evidence base associated with headache diary apps.

Commercially Available Mobile Phone Headache Diary Apps: A Systematic Review

PubMed Central

Huguet, Anna; McGrath, Patrick J; Stinson, Jennifer N; Wheaton, Mike

2014-01-01

Background Headache diaries are often used by headache sufferers to self-monitor headaches. With advances in mobile technology, mobile electronic diary apps are becoming increasingly common. Objective This review aims to identify and evaluate all commercially available mobile headache diary apps for the two most popular mobile phone platforms, iOS and Android. Methods The authors developed a priori a set of 7 criteria that define an ideal headache diary app intended to help headache sufferers better understand and manage their headaches, while providing relevant data to health professionals. The app criteria were intended as minimum requirements for an acceptable headache diary app that could be prescribed by health care professionals. Each app was evaluated and scored against each criterion. Results Of the 38 apps identified, none of the apps met all 7 app criteria. The 3 highest scoring apps, meeting 5 of the app criteria, were iHeadache (developed by Better QOL), ecoHeadache (developed by ecoTouchMedia), and Headache Diary Pro (developed by Froggyware). Only 18% of the apps were created with scientific or clinical headache expertise and none of the apps reported on psychometric properties. Conclusions Despite the growing market and demand, there is a concerning lack of scientific expertise and evidence base associated with headache diary apps. PMID:25138438

The momentary relationship between stress and headaches in adolescent girls.

PubMed

Björling, Elin A

2009-09-01

The objective of this study was to compare the relationship between repeated momentary reports of stress and headaches in female adolescents with varying degrees of headache frequency. Headaches are the most common form of pain reported by adolescents affecting more than a third of all adolescents. High levels of stress during adolescence may predispose an adolescent to experience headaches in adulthood. Randomized, momentary data collection of stress and headaches provides the most accurate data regarding the adolescent experience of these variables. The research methodology, ecological momentary assessment, is a valid approach to better understand the relationship between stress and headaches in adolescence. Data were obtained by each participant's use of an electronic diary (ED), which captured repeated momentary reports of perceived stress, head pain, and stress-related symptoms in female adolescents with varying degrees of recurrent headache. Seven times per day for the 21-day study period, teen girls responded to ED questions about their current stress levels, head pain, and stress-related symptoms. Based on participants' momentary reports of headaches, Low Headache, Moderate Headache, and Chronic Headache groups were created. General estimating equation models were used to analyze the relationship between momentary variables as well as the lag effect between stress and head pain. Thirty-one participants, aged 14-18 years, completed 2841 randomized ED reports and reported 674 occurrences of headache. The Chronic Headache and Moderate Headache groups reported significantly increased levels of stress, head pain, and headaches. The relationship between momentary stress and head pain was significantly strong both within and across participants. The strength of this relationship increased with increased headache activity. A significant lag effect was found between stress and headaches; however, the effect of depression as a moderator of the stress and headache

Regional cerebral blood flow in childhood headache

DOE Office of Scientific and Technical Information (OSTI.GOV)

Roach, E.S.; Stump, D.A.

1989-06-01

Regional cerebral blood flow (rCBF) was measured in 16 cranial regions in 23 children and adolescents with frequent headaches using the non-invasive Xenon-133 inhalation technique. Blood flow response to 5% carbon dioxide (CO2) was also determined in 21 patients, while response to 50% oxygen was measured in the two patients with hemoglobinopathy. Included were 10 patients with a clinical diagnosis of migraine, 4 with musculoskeletal headaches, and 3 with features of both types. Also studied were 2 patients with primary thrombocythemia, 2 patients with hemoglobinopathy and headaches, 1 patient with polycythemia, and 1 with headaches following trauma. With two exceptions,more » rCBF determinations were done during an asymptomatic period. Baseline rCBF values tended to be higher in these young patients than in young adults done in our laboratory. Localized reduction in the expected blood flow surge after CO2 inhalation, most often noted posteriorly, was seen in 8 of the 13 vascular headaches, but in none of the musculoskeletal headache group. Both patients with primary thrombocythemia had normal baseline flow values and altered responsiveness to CO2 similar to that seen in migraineurs; thus, the frequently reported headache and transient neurologic signs with primary thrombocythemia are probably not due to microvascular obstruction as previously suggested. These data support the concept of pediatric migraine as a disorder of vasomotor function and also add to our knowledge of normal rCBF values in younger patients. Demonstration of altered vasomotor reactivity to CO2 could prove helpful in children whose headache is atypical.« less

Recurrent and chronic headaches in children below 6 years of age.

PubMed

Raieli, Vincenzo; Eliseo, Mario; Pandolfi, Eleonora; La Vecchia, Michela; La Franca, Girolama; Puma, Domenico; Ragusa, Donatella

2005-06-01

The objective was to determine the frequency of headache subtypes, according to International Headache Society (IHS) criteria, in a population of children below 6 years visiting a Center for Diagnosis and Treatment of Headache in Youth. Medical records of the children below 6 years at their first visit, admitted for headache between 1997 and 2003, were studied. Headache was classified according to the IHS criteria 2004. Children with less than three headache attacks or less than 15 days of daily headache were excluded. We found 1598 medical records of children who visited our Headache Center in the study period. One hundred and five (6.5%) were children younger than 6 years. The mean age at the first medical control was 4.8+/-1.3 years (range 17-71 months). There were 59 males (56.1%) and 46 females (43.9%). The mean age at onset of headaches was 4.3 years (range 14-69 months). According to the IHS criteria we found 37 cases (35.2%) with migraine, 19 cases (18%) with episodic tension headache, 5 cases (4.8%) with chronic daily headache, 13 cases (12.4%) with primary stabbing headache, 18 cases (17.1%) with post-traumatic headache, 7 cases (6.6%) with other non-dangerous secondary headaches (otorhinolaryngological diseases, post-infectious headaches), 3 cases (2.85%) with dangerous headaches (Arnold-Chiari type 1 malformation, brain tumour) and 9 cases (8.6%) with unclassifiable headaches. Six children (5.7%) reported more than one headache subtype. The prevalence of dangerous headaches was higher than those in school age (chi(2)=4.70, p<0.05). Our study shows some differences in headaches in this population vs. school children. In fact at this age migraine is the most common headache, but we also found an increase of secondary causes among the chronic/recurrent and daily headaches, especially posttraumatic disorders and potentially dangerous headaches. Finally our study shows the highest prevalence of the idiopathic stabbing headache in pre-school children in

Prediction of vascular abnormalities on CT angiography in patients with acute headache.

PubMed

Alons, Imanda M E; Goudsmit, Ben F J; Jellema, Korné; van Walderveen, Marianne A A; Wermer, Marieke J H; Algra, Ale

2018-05-09

Patients with acute headache increasingly undergo CT-angiography (CTA) to evaluate underlying vascular causes. The aim of this study is to determine clinical and non-contrast CT (NCCT) criteria to select patients who might benefit from CTA. We retrospectively included patients with acute headache who presented to the emergency department of an academic medical center and large regional teaching hospital and underwent NCCT and CTA. We identified factors that increased the probability of finding a vascular abnormality on CTA, performed multivariable regression analyses and determined discrimination with the c-statistic. A total of 384 patients underwent NCCT and CTA due to acute headache. NCCT was abnormal in 194 patients. Among these, we found abnormalities in 116 cases of which 99 aneurysms. In the remaining 190 with normal NCCT we found abnormalities in 12 cases; four unruptured aneurysms, three cerebral venous thrombosis', two reversible cerebral vasoconstriction syndromes, two cervical arterial dissections and one cerebellar infarction. In multivariable analysis abnormal NCCT, lowered consciousness and presentation within 6 hr of headache onset were independently associated with abnormal CTA. The c-statistic of abnormal NCCT alone was 0.80 (95% CI: 0.75-0.80), that also including the other two variables was 0.84 (95% CI: 0.80-0.88). If NCCT was normal no other factors could help identify patients at risk for abnormalities. In patients with acute headache abnormal NCCT is the strongest predictor of a vascular abnormality on CTA. If NCCT is normal no other predictors increase the probability of finding an abnormality on CTA and diagnostic yield is low. © 2018 The Authors. Brain and Behavior published by Wiley Periodicals, Inc.

Economic recession and headache-related hospital admissions.

PubMed

Chinta, Ravi; Rao, M B; Narendran, Vivek; Malla, Ganesh; Joshi, Hem

2013-01-01

Incidence of headaches across different regions and its relationship to unemployment rates in the United States before and during an economic recession was evaluated. Years 2008 and 2009 were determined as recessionary period. Headache-related admissions, particularly the uncomplicated headaches, increased significantly during recession. Proportion of women with headaches has increased and the age group of 25-54 years was the most affected during the recession. The hospital charges have increased even though the average length and charge of stay decreased. These findings are consistent with our understanding of effects of stress and unemployment on psychological and physical health.

Rebound Headaches

MedlinePlus

... relievers. Common pain relievers such as aspirin and acetaminophen (Tylenol, others) may contribute to rebound headaches — especially ... OTC) pain relievers that combine caffeine, aspirin and acetaminophen (Excedrin, others) are common culprits. This group also ...

Harry Potter and the curse of headache.

PubMed

Sheftell, Fred; Steiner, Timothy J; Thomas, Hallie

2007-06-01

Headache disorders are common in children and adolescents. Even young male Wizards are disabled by them. In this article we review Harry Potter's headaches as described in the biographical series by JK Rowling. Moreover, we attempt to classify them. Regrettably we are not privy to the Wizard system of classifying headache disorders and are therefore limited to the Muggle method, the International Classification of Headache Disorders, 2nd edition (ICHD-II). Harry's headaches are recurrent. Although conforming to a basic stereotype, and constant in location, throughout the 6 years of his adolescence so far described they have shown a tendency to progression. Later descriptions include a range of accompanying symptoms. Despite some quite unusual features, they meet all but one of the ICHD-II criteria for migraine, so allowing the diagnosis of 1.6 Probable migraine.

Headaches and Migraines: Migraine 101 Quiz

MedlinePlus

... Bar Home Current Issue Past Issues Headaches and Migraines Migraine 101 Quiz Past Issues / Spring 2009 Table of ... the facts when it comes to headaches and migraines? Test your knowledge with this quick quiz. True/ ...

The clinical characteristics of new daily persistent headache.

PubMed

Li, D; Rozen, T D

2002-02-01

New daily persistent headache (NDPH) is a subtype of chronic daily headache. The literature on NDPH is scant and its true aetiology is unknown. A retrospective chart review was carried out from a computerized database at the Jefferson Headache Centre from August 1997 to May 2000 to identify patients with NDPH using the Silberstein et al. criteria. Forty women and 16 men were identified. Age of onset ranged from 12 to 78 years. The peak age of onset was the second and third decade in women and the fifth decade in men. Eighty-two per cent of patients were able to pinpoint the exact day their headache started. Onset occurred in relation to an infection or flu-like illness in 30%. A prior headache history was found in 38% of patients. A family history of headache was documented in 29%. The duration of daily headache ranged from 1.5 h to 24 h; 79% were continuous. Nausea occurred in 68% of patients, photophobia in 66%, phonophobia in 61%, and lightheadedness in 55%. Laboratory testing and neuroimaging in all patients was normal except for Epstein-Barr virus antibody titres, which were positive in 71% of seven patients tested, representing past infection. NDPH appears to be a female-predominant disorder, marked by a continuous daily headache with associated migrainous symptoms. Over 80% of patients could state the exact date their headache began. One-third of patients developed NDPH with a flu-like illness.

Muscle trigger point therapy in tension-type headache.

PubMed

Alonso-Blanco, Cristina; de-la-Llave-Rincón, Ana Isabel; Fernández-de-las-Peñas, César

2012-03-01

Recent evidence suggests that active trigger points (TrPs) in neck and shoulder muscles contribute to tension-type headache. Active TrPs within the suboccipital, upper trapezius, sternocleidomastoid, temporalis, superior oblique and lateral rectus muscles have been associated with chronic and episodic tension-type headache forms. It seems that the pain profile of this headache may be provoked by referred pain from active TrPs in the posterior cervical, head and shoulder muscles. In fact, the presence of active TrPs has been related to a higher degree of sensitization in tension-type headache. Different therapeutic approaches are proposed for proper TrP management. Preliminary evidence indicates that inactivation of TrPs may be effective for the management of tension-type headache, particularly in a subgroup of patients who may respond positively to this approach. Different treatment approaches targeted to TrP inactivation are discussed in the current paper, focusing on tension-type headache. New studies are needed to further delineate the relationship between muscle TrP inactivation and tension-type headache.

Chronic Daily Headache: Mechanisms and Principles of Management.

PubMed

Voigt, Amy W; Gould, Harry J

2016-02-01

Primary headache is a common malady that is often under-recognized and frequently inadequately managed in spite of the fact that it affects up to 95 % of the population in a lifetime. Many forms of headache, including episodic tension and migraine headaches, if properly diagnosed, are reasonably amenable to treatment, but a smaller, though not insignificant, percent of the population suffer daily from a chronic, intractable form of headache that destroys one's productivity and quality of life. These patients are frequently seen in neurological practices at a point when treatment options are limited and largely ineffective. In the following review, we will discuss mechanisms drawn from recent studies that address the transition from acute to chronic pain that may apply to the transformation from episodic to chronic daily headaches which may offer opportunities for preempting headache transformation.

Symptomatic Overlap and Therapeutic Opportunities in Primary Headache.

PubMed

Cady, Roger; Garas, Sandy Yacoub; Patel, Ketu; Peterson, Andrew; Wenzel, Richard

2015-08-01

Headache, a nearly universal experience, remains costly, disabling, and often suboptimally managed. The most common presentations in the United States are migraine, tension-type headache (TTH) and "sinus" headache, but their extensive symptomatic overlap suggests that these conditions can be approached as variations in the same underlying pathology and managed accordingly. We use case studies of patients with varying prior diagnoses (none, migraine, TTH, and sinus headache), as well as a 4-question diagnostic screening tool, to illustrate how pharmacists can use this conceptual framework to simplify identification, management, and referral of patients with primary headache conditions of uncertain etiology. © The Author(s) 2014.

Interaction between anxiety, depression, quality of life and clinical parameters in chronic tension-type headache.

PubMed

Peñacoba-Puente, Cecilia; Fernández-de-Las-Peñas, César; González-Gutierrez, Jose L; Miangolarra-Page, Juan C; Pareja, Juan A

2008-10-01

Our aim was to investigate the mediating or moderating role of anxiety and depression in the relationship between headache clinical parameters and quality of life in Chronic Tension-Type Headache (CTTH). Twenty-five patients diagnosed with CTTH according to the criteria of the International Headache Society were studied. A headache diary was kept for 4 weeks in order to substantiate the diagnosis and record the pain history. Quality of life was assessed by means of the Medical Outcome Study (MOS) 36-Item Short-Form (SF-36) questionnaire. The Beck Depression Inventory (BDI-II) was used to assess depression, and the Trait Anxiety Scale (TA) from the State-Trait Anxiety Inventory was administered in order to assess anxiety. Moderating and mediating analyses were conducted with ordinary least squares multiple regression analysis using the SPSS General Linear Model procedure. Anxiety mediated the effect between headache frequency and quality of life, but not the effect of either headache intensity or duration. Anxiety totally mediated the effects of headache frequency on vitality, social functioning and mental health. On the other hand, depression modulated the effect in the mental health domain. The effect in the mental health domain was a function of the interaction between headache duration and depression (beta=-0.34, p<0.05), after controlling for age, gender, the main effects of headache duration, and depression. We did not find anxiety to be a moderating factor between intensity, frequency or duration of headache and perceived quality of life. Anxiety exerts a mediating effect, conditioning the relationship between headache frequency and some quality of life domains; depression seems to play an inherent role in the reduced quality of life of these patients, that is, it has a moderating effect.

Cannabinoids and hallucinogens for headache.

PubMed

McGeeney, Brian E

2013-03-01

Hallucinogens and most cannabinoids are classified under schedule 1 of the Federal Controlled Substances Act 1970, along with heroin and ecstacy. Hence they cannot be prescribed by physicians, and by implication, have no accepted medical use with a high abuse potential. Despite their legal status, hallucinogens and cannabinoids are used by patients for relief of headache, helped by the growing number of American states that have legalized medical marijuana. Cannabinoids in particular have a long history of use in the abortive and prophylactic treatment of migraine before prohibition and are still used by patients as a migraine abortive in particular. Most practitioners are unaware of the prominence cannabis or "marijuana" once held in medical practice. Hallucinogens are being increasingly used by cluster headache patients outside of physician recommendation mainly to abort a cluster period and maintain quiescence for which there is considerable anecdotal success. The legal status of cannabinoids and hallucinogens has for a long time severely inhibited medical research, and there are still no blinded studies on headache subjects, from which we could assess true efficacy. © 2012 American Headache Society.

Post-dural puncture headache

PubMed Central

Ghaleb, Ahmed; Khorasani, Arjang; Mangar, Devanand

2012-01-01

Since August Bier reported the first case in 1898, post-dural puncture headache (PDPH) has been a problem for patients following dural puncture. Clinical and laboratory research over the last 30 years has shown that use of smaller-gauge needles, particularly of the pencil-point design, are associated with a lower risk of PDPH than traditional cutting point needle tips (Quincke-point needle). A careful history can rule out other causes of headache. A postural component of headache is the sine qua non of PDPH. In high-risk patients < 50 years, post-partum, in the event a large-gauge needle puncture is initiated, an epidural blood patch should be performed within 24–48 hours of dural puncture. The optimum volume of blood has been shown to be 12–20 mL for adult patients. Complications caused by autologous epidural blood patching (AEBP) are rare. PMID:22287846

Use of the International Classification of Headache Disorders, Second Edition, criteria in the diagnosis of primary headache in schoolchildren: epidemiology study from eastern Turkey.

PubMed

Alp, Recep; Alp, Selen Ilhan; Palanci, Yilmaz; Sur, Haydar; Boru, Ulku Turk; Ozge, Aynur; Yapici, Zuhal

2010-07-01

We aimed to determine the prevalence of primary headache among schoolchildren in the city of Agri, located in eastern Turkey, where geographical, climatic and socio-economic conditions differ greatly from those of other regions of Turkey. A cross-sectional school-based (ages ranging from 11 to 18) study was conducted from January to April 2006. Diagnosis was based on the second edition of the International Classification of Headache Disorders. This population was evaluated by a two-stage clustered sampling procedure. In the first phase, 1385 children were asked whether they had had a headache within the past year. For the second-step interview, 540 children (38.9%) with a complaint of headache were selected. Five children who had complained of headaches in the first interview did not agree to participate in the second stage. Of the remaining 535, 473 were identified as having primary headache and 62 as having secondary headache. Overall, one-year prevalence of headache subtypes was 14.3% for migraine, 3.5% for probable migraine, 8.6% for pure tension-type headache, 4.6% for migraine plus tension-type headache, and 3.0% for probable migraine plus tension-type headache. The prevalence of migraine was higher in our study than in previous studies.

Effectiveness of an intensive multidisciplinary headache treatment program.

PubMed

Gunreben-Stempfle, Birgit; Griessinger, Norbert; Lang, Eberhard; Muehlhans, Barbara; Sittl, Reinhard; Ulrich, Kathrin

2009-07-01

To investigate if the effectiveness of a 96-hour multidisciplinary headache treatment program exceeds the effectiveness of a 20-hour program and primary care. When dealing with chronic back pain, low-intensity multidisciplinary treatment yields no significantly better results than standard care and monodisciplinary therapy; however, high-intensity treatment does. For multidisciplinary headache treatment, such comparisons are not yet available. In a previous study undertaken by our Pain Center, the outcome of a minimal multidisciplinary intervention model (20-hour) did not exceed primary care. Forty-two patients suffering from frequent headaches (20 +/- 9 headache days/month; range: 8-30) were treated and evaluated in a 96-hour group program. The results were compared with the outcomes of the previous study. Subjects who had undergone either the 20-hour multidisciplinary program or the primary care were used as historical control groups. A significant reduction in migraine days (P < .001), tension-type headache days (P < .001), frequency of migraine attacks (P = .004), and depression score (P < .001) was seen at the follow-up after 22 (+/-2) weeks. Comparing the intensive multidisciplinary program with primary care, repeated measures ANOVAs revealed significant time x group interactions for migraine days (P = .020), tension-type headache days (P = .016), and frequency of migraine attacks (P = .016). In comparison with the 20-hour multidisciplinary program, the 96-hour program showed significantly better effects only in the reduction of migraine days (P = .037) and depression score (P = .003). The responder-rates (> or =50% improvement) in the 96-hour program were significantly higher than in the 20-hour program (migraine days, P = .008; tension-type headache days, P = .044) and primary care (migraine days, P = .007; tension-type headache days, P = .003; tension-type headache intensity, P = .037). The effect sizes were small to medium in the 96-hour program

Triptans for acute cluster headache

PubMed Central

Law, Simon; Derry, Sheena; Moore, R Andrew

2014-01-01

Background Cluster headache is an uncommon, but severely painful and disabling condition, with rapid onset. Validated treatment options are limited, and first-line therapy includes inhaled oxygen. Alternative therapies such as intranasal lignocaine and ergotamine are not as commonly used and are less well studied. Triptans are successfully used to treat migraine attacks and, because of this, they may also be useful for cluster headache. Objectives To determine the efficacy and tolerability of triptans for the acute treatment of cluster headaches. Search methods We searched Cochrane CENTRAL, MEDLINE and EMBASE for studies through 22 January 2010. Selection criteria Randomised, double-blind, placebo-controlled studies of triptans for acute treatment of cluster headache episodes. Data collection and analysis Two review authors independently assessed study quality and extracted data. Numbers of participants with different levels of pain relief, requiring rescue medication and experiencing adverse events and headache-associated symptoms in treatment and control groups were used to calculate relative risk and numbers needed to treat (NNT) and harm (NNH). Main results All six included studies used a single dose of triptan to treat an attack of moderate to severe pain intensity. In total 231 participants received zolmitriptan 5 mg, 223 received zolmitriptan 10 mg, 131 received sumatriptan 6 mg, 88 received sumatriptan 12 mg, and 326 received placebo. Zolmitriptan was administered either orally or intranasally, and sumatriptan either subcutaneously or intranasally. Overall, the triptans studied were better than placebo for headache relief and pain-free responses, with an NNT of 2.4 for 15 minute pain relief with subcutaneous sumatriptan 6 mg (75% with sumatriptan and 32% with placebo), and 2.8 for 30 minute pain relief with intranasal zolmitriptan 10 mg (62% with zolmitriptan and 26% with placebo). Fewer participants need rescue medication with triptan than with placebo

Adherence to headache treatment and profile of previous health professional seeking among patients with chronic headache: a retrospective analysis.

PubMed

Krymchantowski, Abouch Valenty; Adriano, Marcus Vinicius; de Góes, Renemilda; Moreira, Pedro Ferreira; da Cunha Jevoux, Carla

2007-04-26

Chronic headache is common among patients in neurology clinics. Patients may suffer important economic and social losses because of headaches, which may result in high expectations for treatment outcomes. When their treatment goals are not reached quickly, treatment may be difficult to maintain and patients may consult with numerous health professionals. This retrospective study evaluated the relationship between treatment and the profiles of previous health professionals consulted by patients in a tertiary headache center. The records were reviewed of all patients from a headache center who were seen in initial consultation between January 2000 and June 2003. Data related to patient demographic characteristics (sex and age), headache diagnosis, and the profile (quality and quantity) of previous healthcare consultations exclusively related to headache, were collected. The headache diagnoses were confirmed according to the IHS criteria (1988) and to the Silberstein criteria (1994,1996). Although adherence includes taking the prescribed medicines, discontinuing overused symptomatic medications, and changing behavior, among other things, for this study, adherence was defined as when the patient returned at least 2 times within a 3- to 3.5-month period. Patients were separated into groups depending on the number of different healthcare professionals they had consulted, from none to more than 7. Data from 495 patients were analyzed; 357 were women and 138 were men (ages 6 to 90 years; mean, 41.1 +/- 15.05 years). The headache diagnoses included migraine without aura (43.2%), chronic (transformed) migraine (40%), cluster headache (6.5%), episodic tension-type headache (0.8%), and hemicrania continua (0.4%). The 24.2% of patients who sought care from no more than 1 health professional showed a 59.8% adherence rate; 29% of the total had consulted 7 or more health professionals and showed an adherence rate of 74.3% (P = .0004). In Brazil, the belief is widespread that

Gender, Headaches, and Sleep Health in High School Students.

PubMed

Ming, Xue; Radhakrishnan, Varsha; Kang, Lilia; Pecor, Keith

2016-09-01

The effects of gender, headaches, and their interaction on sleep health (sleep duration, sleep onset and continuity, and indications of hypersomnolence) have not been well studied. For American adolescents, we contrasted sleep health variables between males (n = 378) and females (n = 372) and between individuals with chronic headaches (n = 102 females and 60 males) and without chronic headaches (n = 270 females and 318 males) using data from surveys. Not all measures of sleep health differed between groups, but the following patterns were observed for the measures that did differ. Females reported shorter sleep durations on school nights (p = 0.001), increased likelihood of sleepiness on school days (p < 0.05), and higher hypersomnolence scores compared with males (p = 0.005). Individuals with headaches reported shorter sleep durations on weekends (p = 0.009) and higher hypersomnolence scores (p = 0.009) than individuals without headaches. Interestingly, females with headaches reported worse sleep health than females without headaches for multiple measures. Males with headaches did not differ from males without headaches, except for greater waking at night (p = 0.04). These results are consistent with other studies of gender-based differences in sleep health and emphasize the importance of recognizing the risk of headache in female adolescents and treating that condition to prevent additional sleep health issues.

Plasma serotonin in patients with chronic tension headaches.

PubMed

Anthony, M; Lance, J W

1989-02-01

Previous reports have suggested that platelet level of serotonin in chronic tension headache (CTH) is lower than in normal control subjects, and that there is continuous activation of platelets both in migraine and in CTH. In this study we compared platelet serotonin concentration in 95 patients with CTH, 166 patients with migraine and 35 normal control subjects. Mean platelet serotonin (ng/10(9) platelets) was 310 for the CTH group, 384 during migraine headache, 474 for normal control subjects and 514 in headache-free migrainous patients. There was significant statistical difference of values between CTH patients and those of normal control subjects as well as headache-free migrainous patients, but not of those of migrainous patients during headache. It is suggested that CTH is a low serotonin syndrome, representing one end of the spectrum of idiopathic headache, the other end being represented by migraine.

Recurrent headache and interpersonal violence in adolescence: the roles of psychological distress, loneliness and family cohesion: the HUNT study

PubMed Central

2014-01-01

Background Recurrent headache is the most common and disabling pain condition in adolescence. Co-occurrence of psychosocial adversity is associated with increased risk of chronification and functional impairment. Exposure to interpersonal violence seems to constitute an important etiological factor. Thus, knowledge of the multiple pathways linking interpersonal violence to recurrent headache could help guide preventive and clinical interventions. In the present study we explored a hypothetical causal model where the link between exposure to interpersonal violence and recurrent headache is mediated in parallel through loneliness and psychological distress. Higher level of family cohesion and male sex is hypothesized to buffer the adverse effect of exposure to interpersonal violence on headache. Methods The model was assessed using data from the cross-sectional, population-based Young-HUNT 3 study of Norwegian adolescents, conducted from 2006–2008. A cohort of 10 464 adolescents were invited. The response rate was 73% (7620), age ranged from 12 and 20 years, and 50% (3832) were girls. The study comprised self-report measures of exposure to interpersonal violence, loneliness, psychological distress and family cohesion, in addition to a validated interview on headache, meeting the International Classification of Headache Disorders criteria. Recurrent headache was defined as headache recurring at least monthly during the past year, and sub-classified into monthly and weekly headache, which served as separate outcomes. Results In Conditional Process Analysis, loneliness and psychological distress consistently posed as parallel mediating mechanisms, indirectly linking exposure to interpersonal violence to recurrent headache. We found no substantial moderating effect of family cohesion or sex. Conclusions Loneliness and psychological distress seem to play crucial roles in the relationship between exposure to interpersonal violence and recurrent headache. To facilitate

Common Primary and Secondary Causes of Headache in the Elderly.

PubMed

Sharma, Tara L

2018-03-01

Headache in the elderly, defined as individuals aged 65 and older, although less prevalent than younger individuals, can present as a diagnostic challenge, given the increase in potentially fatal diseases within this population. These individuals require a complete history, neurological examination, and assessment of potential secondary causes of headaches. Secondary causes include temporal or giant cell arteritis, subdural hematomas, central nervous system (CNS) tumors, strokes, and CNS infections. Once secondary conditions are ruled out, then primary causes of headache are considered such as tension-type headache, migraine, cluster headache, or hypnic headache. This article reviews the distinguishing characteristics of the most common types of headache in patients over the age of 65 years old, along with potential diagnostic tests and treatment. © 2018 American Headache Society.

Telemedicine in the management of non-acute headaches: A prospective, open-labelled non-inferiority, randomised clinical trial.

PubMed

Müller, Kai I; Alstadhaug, Karl B; Bekkelund, Svein I

2017-08-01

Objectives We determined headache patients' satisfaction with telemedicine and assessed how telemedicine influenced headache burden, compliance with diagnosis and treatment, and need for follow-up consultations. Methods During 2.5 years, patients from Northern Norway referred with non-acute headaches for a specialist consultation at Tromsø University Hospital were consecutively randomised to either telemedicine or traditional visits. Baseline data were recorded and compared to data from a three-month follow-up questionnaire (see Supplementary material). The following were evaluated: (1) satisfaction with the consultation; (2) headache status; subjective improvement, average pain intensity, treatment, headache days per month, and Headache Impact Test (HIT-6); and (3) treatment compliance and follow-up visits. Results Out of 402 consultations, 348 (86.6%) answered the questionnaire. Satisfaction was similar in the telemedicine and the traditional group (88.8% vs. 92.3%; p = 0.35). Subgroup analyses were not prespecified, but there were no differences in satisfaction among females, migraineurs, rural patients and urban patients. Improvement from baseline after three months was reported equally in the telemedicine and the traditional groups. There were also no differences in treatment compliance, but rural telemedicine patients had less-frequent headache visits at three months' follow-up (28.9% vs. 48.7%, p = 0.002). Conclusion Telemedicine is non-inferior to traditional consultations in patient satisfaction, specialist evaluation, and treatment of non-acute headaches. ClinicalTrials.gov ID: NCT02270177.

Prevalence and predictors of headache in patients referred to polysomnography.

PubMed

Beiske, Kornelia Katalin; Russell, Michael Bjørn; Stavem, Knut

2013-11-18

The objectives of this study were; (1) to assess the prevalence and frequency of headache in patients referred to polysomnography (PSG) due to a clinical suspicion of obstructive sleep apnea (OSA) or another sleep disturbance and compare with a reference population, and (2) to assess the association of OSA severity with headache and headache frequency. A total of 784 participants filled in a headache questionnaire between 2003 and 2009 at the Department of Clinical Neurophysiology, Akershus University Hospital. Of these patients 477 were suspected to have OSA, and 307 had other sleep complaints. We assessed the prevalence of headache and monthly headache frequencies, as well as sleep apnea severity using an apnea-hypopnea index (AHI). The association of headache and monthly headache frequencies with PSG subgroups was assessed using multivariate logistic and ordered logistic regression analysis. The frequency of headache was not associated with the severity of OSA. Patients referred to a sleep study for any reason had higher odds ratio (OR) for having experienced headache during the past year than population controls after adjustment for age, gender and education, i.e. patients with normal AHI had OR of 3.56, patients with OSA had OR of 3.51, and patients with other sleep disturbances had OR of 3.33. Similarly, the adjusted OR of being in a higher category of monthly headache frequency compared to controls was higher in those with normal AHI (OR 3.42), OSA (OR 3.29), and other sleep disturbances (OR 3.00). The odds of headache and headache frequency were higher in subjects referred to a PSG for any sleep disturbance independently of OSA, compared to general population controls. However, there was no association between experiencing headache during the past year or headache frequency with OSA severity.

Effect of Flunarizine on Serum Glutamate Levels and its Correlation with Headache Intensity in Chronic Tension-Type Headache Patients.

PubMed

Surbakti, Khairul Putra; Sjahrir, Hasan; Juwita-Sembiring, Rosita; Mutiara, Erna

2017-10-15

Some of the excitatory neurotransmitters including glutamate have been suggested to be involved in headache pathophysiology. To our knowledge, there is a lack of publication about flunarizine efficacy in chronic tension-type headache (CTTH) treatments and the roles of glutamate in CTTH pathophysiology. This study aimed to investigate the flunarizine effect on serum levels of glutamate and its correlation with headache intensity based on the Numeric Rating Scale for pain (NRS) scores in CTTH patients. In a prospective randomised, double-blind study with pre and post-test design, seventy-three CTTH patients were randomly allocated with flunarizine 5 mg, flunarizine 10 mg and amitriptyline 12.5 mg groups. The serum levels of glutamate and NRS scores were measured before and after 15-day treatment. Flunarizine 5 mg was more effective than flunarizine 10 mg and amitriptyline 12.5 mg in reducing serum glutamate levels, whereas amitriptyline 12.5 mg was the most effective in reducing headache intensity. There was found nonsignificant, but very weak negative correlation between headache intensity and serum glutamate levels after flunarizine 5 mg administration (r = -0.062; P = 0.385), nonsignificant very weak negative correlation after flunarizine 10 mg administration (r = -0.007; P = 0.488) and there was found a significant moderate positive correlation (r = 0.508; P = 0.007) between headache intensity and serum glutamate levels after amitriptyline 12.5 mg administration. Since there was no significant correlation found between serum glutamate and headache intensity after treatment with flunarizine, it is suggested that decreasing of headache intensity after flunarizine treatment occurred not through glutamate pathways in CTTH patients.

Athletes' Headaches: Not Necessarily 'Little' Problems.

ERIC Educational Resources Information Center

McCarthy, Paul

1988-01-01

Headaches experienced by athletes are categorized (exertional, effort, and trauma-triggered migraines), and treatment methods related. Consequences of misdiagnosis, lack of reporting, and poor monitoring are discussed as well as categories of athletes most likely to suffer sports-related headaches. (IAH)

Tension headache

MedlinePlus

... often associated with muscle tightness in these areas. Causes Tension headaches occur when neck and scalp muscles become tense, or contract. The muscle contractions can be a response to stress, depression, head injury, or anxiety. They may occur at ...

The art of history-taking in a headache patient

PubMed Central

Ravishankar, K.

2012-01-01

Headache is a common complaint that makes up for approximately 25% of any neurologists outpatient practice. Yet, it is often underdiagnosed and undertreated. Ninety percent of headaches seen in practice are due to a primary headache disorder where there are no confirmatory tests, and neuroimaging studies, if done, are normal. In this situation, a good headache history allows the physician to recognize a pattern that in turn leads to the correct diagnosis. A comprehensive history needs time, interest, focus and establishment of rapport with the patient. When to ask what question to elicit which information, is an art that is acquired by practice and improves with experience. This review discusses the art of history-taking in headache patients across different settings. The nuances of headache history-taking are discussed in detail, particularly the questions related to the time, severity, location and frequency of the headache syndrome in general and the episode in particular. An emphasis is made on the recognition of red flags that help in the identification of secondary headaches. PMID:23024567

National awareness campaign to prevent medication-overuse headache in Denmark.

PubMed

Carlsen, Louise Ninett; Westergaard, Maria Lurenda; Bisgaard, Mette; Schytz, Julie Brogaard; Jensen, Rigmor Højland

2017-01-01

Background Medication-overuse headache is prevalent, but in principle preventable. Objective To describe the Danish national awareness campaign for medication-overuse headache. Methods The Danish Headache Center, the Association of Danish Pharmacies, and headache patient organizations implemented a four-month medication-overuse headache awareness campaign in 2016. Target groups were the general public, general practitioners, and pharmacists. Key messages were: Overuse of pain-medication can worsen headaches; pain-medication should be used rationally; and medication-overuse headache is treatable. A range of communication technologies was used. A survey on the public's awareness of medication-overuse headache was conducted. Results The Danish adult population is 4.2 million. Online videos were viewed 297,000 times in three weeks. All 400 pharmacies received campaign materials. Over 28,000 leaflets were distributed. Two radio interviews were conducted. A television broadcast about headache reached an audience of 520,000. Forty articles were published in print media. Information was accessible at 32 reputable websites and five online news agencies. Three scientific papers were published. Information was available at an annual conference of general practitioners, including a headache lecture. The survey showed an increase in percentage of the public who knew about medication-overuse headache (from 31% to 38%). Conclusion A concerted campaign to prevent medication-overuse headache can be implemented through involvement of key stakeholders.

Management of chronic daily headache: challenges in clinical practice.

PubMed

Saper, Joel R; Dodick, David; Gladstone, Jonathan P

2005-04-01

Chronic daily headache (CHD) refers to a category of headache disorders that are characterized by headaches occurring on more than 15 days per month. This category is subdivided into long- and short-duration (>4 or <4 hours) CDH disorders based on the duration of individual headache attacks. Examples of long-duration CDH include transformed migraine (TM), chronic migraine (CM), new daily persistent headache (NDPH), acute medication overuse headache, and hemicrania continua (HC). The goal of this review is to enable clinicians to accurately diagnose and effectively manage patients with long-duration CDH. Patients with CDH often require an aggressive and comprehensive treatment approach that includes a combination of acute and preventive medications, as well as nondrug therapies.

[P300 potential in chldren with psychogenic nonepileptic events and tension headache].

PubMed

Steczkowska, Małgorzata; Stolarska-Weryńska, Urszula; Fiederer, Krystyna; Kaciński, Marek

2016-01-01

Psychotherapy is being used as the primary treatment in nonepileptic psychogenic seizures and tension headaches in children. Children's intelectual functioning is related to certain endogenous neurophysiological parameters. The goal of this study was to establish whether the endogenous potential P300 is different in children with nonepileptic psychogenic events and with tension headaches, and whether it changes under the influence of the cognitive-behavioral psychotherapy. The study included a group of 47 children: 20 with nonepileptic psychogenic seizures (18 girls and 2 boys), aged 11.09-17.11 years, and 27 children with tension headache (25 girls and 2 boys), aged 10.11-17.11 years. The P300 potential was induced using an auditory stimulus. The reaction time, the amount of mistakes and the percentage of attention focus was measured in all children. All children attended 8-10 psychotherapy sessions. The P300 potential was registered before and after the course of therapy, and additionally in both cycles also after a 3 minutes hyperventilation. Medium P300 parameters were closer to normal in the group of children with tension headaches rather than in the group with nonepileptic seizures. The shorter was the reaction time in the first measurement, the higher the attention score and the shorter the reaction time in the second measurement - this was visible in the results of children with nonepileptic seizures, in contrast to children with tension headaches. The use of hyperventilation caused a noticeable extension of the reaction time in the P300 measurement, with other components unchanged (mistake count and percentage of attention focus). The endogenous potential P300 does vary, although on a statistically insignificant level, in groups of children with tension headaches and nonepileptic seizures.

Heuristic Evaluation and Usability Testing of a Computerized Patient-Reported Outcomes Survey for Headache Sufferers

PubMed Central

Saris-Baglama, Renee N.; Smith, Kevin J.; DeRosa, Michael A.; Paulsen, Christine A.; Hogue, Sarah J.

2011-01-01

Abstract Objective The aim of this study was to evaluate usability of a prototype tablet PC-administered computerized adaptive test (CAT) of headache impact and patient feedback report, referred to as HEADACHE-CAT. Materials and Methods Heuristic evaluation specialists (n = 2) formed a consensus opinion on the application's strengths and areas for improvement based on general usability principles and human factors research. Usability testing involved structured interviews with headache sufferers (n = 9) to assess how they interacted with and navigated through the application, and to gather input on the survey and report interface, content, visual design, navigation, instructions, and user preferences. Results Specialists identified the need for improved instructions and text formatting, increased font size, page setup that avoids scrolling, and simplified presentation of feedback reports. Participants found the tool useful, and indicated a willingness to complete it again and recommend it to their healthcare provider. However, some had difficulty using the onscreen keyboard and autoadvance option; understanding the difference between generic and headache-specific questions; and interpreting score reports. Conclusions Heuristic evaluation and user testing can help identify usability problems in the early stages of application development, and improve the construct validity of electronic assessments such as the HEADACHE-CAT. An improved computerized HEADACHE-CAT measure can offer headache sufferers an efficient tool to increase patient self-awareness, monitor headaches over time, aid patient–provider communications, and improve quality of life. PMID:21214341

Update of Inpatient Treatment for Refractory Chronic Daily Headache.

PubMed

Lai, Tzu-Hsien; Wang, Shuu-Jiun

2016-01-01

Chronic daily headache (CDH) is a group of headache disorders, in which headaches occur daily or near-daily (>15 days per month) and last for more than 3 months. Important CDH subtypes include chronic migraine, chronic tension-type headache, hemicrania continua, and new daily persistent headache. Other headaches with shorter durations (<4 h/day) are usually not included in CDH. Common comorbidities of CDH are medication overuse headache and various psychiatric disorders, such as depression and anxiety. Indications of inpatient treatment for CDH patients include poor responses to outpatient management, need for detoxification for overuse of specific medications (particularly opioids and barbiturates), and severe psychiatric comorbidities. Inpatient treatment usually involves stopping acute pain, preventing future attacks, and detoxifying medication overuse if present. Multidisciplinary integrated care that includes medical staff from different disciplines (e.g., psychiatry, clinical psychology, and physical therapy) has been recommended. The outcomes of inpatient treatment are satisfactory in terms of decreasing headache intensity or frequency, withdrawal from medication overuse, reducing disability, and improving life quality, although long-term relapse is not uncommon. In conclusion, inpatient treatment may be useful for select patients with refractory CDH and should be incorporated in a holistic headache care program.

Evaluation and management of "sinus headache" in the otolaryngology practice.

PubMed

Patel, Zara M; Setzen, Michael; Poetker, David M; DelGaudio, John M

2014-04-01

Patients, primary care doctors, neurologists and otolaryngologists often have differing views on what is truly causing headache in the sinonasal region. This review discusses common primary headache diagnoses that can masquerade as "sinus headache" or "rhinogenic headache," such as migraine, trigeminal neuralgia, tension-type headache, temporomandibular joint dysfunction, giant cell arteritis (also known as temporal arteritis) and medication overuse headache, as well as the trigeminal autonomic cephalalgias, including cluster headache, paroxysmal hemicrania, and hemicrania continua. Diagnostic criteria are discussed and evidence outlined that allows physicians to make better clinical diagnoses and point patients toward better treatment options. Copyright © 2014 Elsevier Inc. All rights reserved.

[Clinical analysis of nasal mucosa contact headache].

PubMed

Gu, Qingjia; Wen, Bei; Li, Jingxian; Fan, Jiangang; He, Gang

2013-07-01

To investigate the efficacy of nasal mucosa contact point headache with the treatment of endoscopic sinus surgery. Clinical data of 75 cases with nasal mucosa contact point headache treated in our department from Jan 2008 to Nov 2011 were retrospectively analyzed. These patients were performed with endoscopic sinus surgery. All patients were followed up for more than six months. They all achieved significant efficacy and no complications occurred. Nasal mucosa contact point headache and primary headache had different clinical features and different treatment. Misdiagnosis were easily made if not being carefully analyzed. Three lines tension relaxing septorhinoplasty combined with nasal bone fracture correction can achieve satisfactory curative effect and can effectively prevent the occurrence of complications. Therefore, it is necessary to strengthen the awareness of this disease. Nasal structure abnormality is the main reason of nasal mucosa contact point headache. The implementation of individualized nasal endoscopic sinus surgery can achieve satisfactory curative effect.

The use of abdominal binders to treat over-shunting headaches.

PubMed

Sklar, Frederick H; Nagy, Laszlo; Robertson, Brian D

2012-06-01

Headaches are common in children with shunts. Headaches associated with over-shunting are typically intermittent and tend to occur later in the day. Lying down frequently makes the headaches better. This paper examines the efficacy of using abdominal binders to treat over-shunting headaches. Over an 18-year period, the senior author monitored 1027 children with shunts. Office charts of 483 active patients were retrospectively reviewed to identify those children with headaches and, in particular, those children who were thought to have headaches as a result of over-shunting. Abdominal binders were frequently used to treat children with presumed over-shunting headaches, and these data were analyzed. Of the 483 patients undergoing chart review, 258 (53.4%) had headache. A clinical diagnosis of over-shunting was made in 103 patients (21.3% overall; 39.9% of patients with headache). In 14 patients, the headaches were very mild (1-2 on a 5-point scale) and infrequent (1 or 2 per month), and treatment with an abdominal binder was not thought indicated. Eighty-nine patients were treated with a binder, but 19 were excluded from this retrospective study for noncompliance, interruption of the binder trial, or lack of follow-up. The remaining 70 pediatric patients, who were diagnosed with over-shunting headaches and were treated with abdominal binders, were the subjects of a more detailed retrospective study. Significant headache improvement was observed in 85.8% of patients. On average, the patients wore the binders for approximately 1 month, and headache relief usually persisted even after the binders were discontinued. However, the headaches eventually did recur in many of the patients more than a year later. In these patients, reuse of the abdominal binder was successful in relieving headaches in 78.9%. The abdominal binder is an effective, noninvasive therapy to control over-shunting headaches in most children. This treatment should be tried before any surgery is

Headache Disability, Suicidality and Pain Catastrophization - Are They Related.

PubMed

Rathod, Harshal; Ram, Dushad; Sundarmurthy, Harsha; Rathod, Snehal; John, Deepa

2016-11-01

Studies have found that headache is associated with suicidality. Some demographic and clinical features have been reported to be associated with suicidality. Pain catastrophizing and disability may also have bearing on suicidality in patients with headache. To evaluate the relationship between pain disability and catastrophizing in headache and suicidal behaviour. Patients diagnosed with headache were recruited from neurology Out-Patient Department (OPD). With ethical approval and informed consent, patients were subjected to a structured interview. Headache disability and pain catastrophizing was assessed with the Henry Ford Hospital Headache Disability Inventory (HDI) and Pain Catastrophy Scale (PCS) respectively. For evaluation of suicidal ideation and behaviour, MINI International Neuropsychiatric Interview (MINI Plus) scale and The Columbia-Suicide Severity Rating Scale (C-SSRS) were applied. Data was analysed with Mann-Whitney U test and Kruskal-Wallis test using appropriate statistical programs. In 200 patients of headache, male: female ratio was 0.48: 1. Headache disability was significantly higher in females (p=0.060) and unemployed (p=0.019) patients whereas, pain catastrophizing was significant in patients belonging to low socioeconomic class (p=0.045). Headache disability and pain catastrophizing had significant association with suicidal ideation. Disability score was significantly associated with the score of deterrents (p=0.067) and controllability (p=0.039) subscale of intensity of suicidal ideation. There were four patients who actually attempted suicide. Pain catastrophizing was significantly associated with non-suicidal self injurious behaviour (p=0.041). Disability due to headache and pain catastrophizing is associated with increased suicidal tendencies, behaviour and suicidal attempts. Headache in females and patients in rural habitat, unemployed individuals belonging to low socioeconomic class need special attention to reduce high risk suicidal

Drug and Nondrug Treatment in Tension-type Headache

PubMed Central

2009-01-01

Tension-type headache (TTH) is a common primary headache with tremendous socioeconomic impact. Establishment of an accurate diagnosis is important before initiation of any treatment. Nondrug management is crucial. Information, reassurance and identification of trigger factors may be rewarding. Psychological treatments with scientific evidence for efficacy include relaxation training, EMG biofeedback and cognitive-behavioural therapy. Physical therapy and acupuncture are widely used, but the scientific evidence for efficacy is sparse. Simple analgesics are the mainstays for treatment of episodic TTH. Combination analgesics, triptans, muscle relaxants and opioids should not be used, and it is crucial to avoid frequent and excessive use of simple analgesics to prevent the development of medication-overuse headache. The tricyclic antidepressant amitriptyline is drug of first choice for the prophylactic treatment of chronic TTH. The efficacy is modest and treatment is often hampered by side effects. Thus, treatment of frequent TTH is often difficult and multidisciplinary treatment strategies can be useful. The development of specific nonpharmacological and pharmacological managements for TTH with higher efficacy and fewer side effects is urgently needed. Future studies should also examine the relative efficacy of the various treatment modalities; for example, psychological, physical and pharmacological treatments, and clarify how treatment programs should be optimized to best suit the individual patient. PMID:21179525

Central mechanisms of stress-induced headache.

PubMed

Cathcart, S; Petkov, J; Winefield, A H; Lushington, K; Rolan, P

2010-03-01

Stress is the most commonly reported trigger of an episode of chronic tension-type headache (CTTH); however, the causal significance has not been experimentally demonstrated to date. Stress may trigger CTTH through hyperalgesic effects on already sensitized pain pathways in CTTH sufferers. This hypothesis could be partially tested by examining pain sensitivity in an experimental model of stress-induced headache in CTTH sufferers. Such examinations have not been reported to date. We measured pericranial muscle tenderness and pain thresholds at the finger, head and shoulder in 23 CTTH sufferers (CTH-S) and 25 healthy control subjects (CNT) exposed to an hour-long stressful mental task, and in 23 CTTH sufferers exposed to an hour-long neutral condition (CTH-N). Headache developed in 91% of CTH-S, 4% of CNT, and 17% of CTH-N subjects. Headache sufferers had increased muscle tenderness and reduced pain thresholds compared with healthy controls. During the task, muscle tenderness increased and pain thresholds decreased in the CTH-S group compared with CTH-N and CNT groups. Pre-task muscle tenderness and reduction in pain threshold during task were predictive of the development and intensity of headache following task. The main findings are that stress induced a headache in CTTH sufferers, and this was associated with pre-task muscle tenderness and stress-induced reduction in pain thresholds. The results support the hypothesis that stress triggers CTTH through hyperalgesic effects on already increased pain sensitivity in CTTH sufferers, reducing the threshold to noxious input from pericranial structures.

Acute treatment of migraine headaches.

PubMed

Taylor, Frederick R

2010-04-01

Optimum acute treatment of migraine requires prevention of headache as a top priority. Recognition of the multitude of migraine presentations, the frequency of total headache attacks, and number of days of headache disability are critical. Successful treatment requires excellent patient-clinician communication enhancing confidence and mutual trust based on patient needs and preferences. Optimum management of acute migraine nearly always requires pharmacologic treatment for rapid resolution. Migraine-specific triptans, dihydroergotamine, and several antiinflammatories have substantial empirical clinical efficacy. Older nonspecific drugs, particularly butalbital and opioids, contribute to medication overuse headache and are to be avoided. Clinicians should utilize evidence-based acute migraine-specific therapy stressing the imperative acute treatment goal of early intervention, but not too often with the correct drug, formulation, and dose. This therapy needs to provide cost-effective fast results, meaningful to the patient while minimizing the need for additional drugs. Migraine-ACT evaluates 2-hour pain freedom with return to normal function, comfort with treatment, and consistency of response. Employ a thoroughly educated patient, formulary, testimonials, stratification, and rational cotherapy against the race to central sensitization for optimum outcomes. Thieme Medical Publishers.

Childhood headache attributed to airplane travel: a case report.

PubMed

Rogers, Kirsty; Rafiq, Nadia; Prabhakar, Prab; Ahmed, Mas

2015-05-01

Headache attributed to airplane flights is a rare form of headache disorder. This case study describes an 11-year-old girl with recurrent, severe, frontal headaches occurring during airplane travel. The episodes were associated with dizziness and facial pallor but no additional symptoms and showed spontaneous resolution on landing. Blood tests and imaging revealed no abnormalities. The present case fulfils the criteria for airplane headache recently included in the revised edition of the International Classification of Headache Disorders (ICHD-III Beta). Only a few cases of airplane headache have been reported in children. To our knowledge, this is the fourth case. We review the current literature on this rare syndrome and discuss various proposed pathophysiological mechanisms. © The Author(s) 2014.

The relationship between headache and religious attendance (the Nord-Trøndelag health study- HUNT)

PubMed Central

2014-01-01

Background Religious belief can be used as a pain coping strategy. Our purpose was to evaluate the relationship between headache and religious activity using prospective data from a large population-based study. Methods This longitudinal cohort study used data from two consecutive surveys in the Nord-Trøndelag Health Survey (HUNT 2 and 3) performed in 1995–1997; and 2006–2008. Among the 51,383 participants aged ≥ 20 years who answered headache questions at baseline, 41,766 were eligible approximately 11 years later. Of these, 25,177 (60%) completed the question in HUNT 3 regarding religious activity. Frequent religious attendees (fRA) (used as a marker of stronger religious belief than average) were defined as those who had been to church/prayer house at least once monthly during the last six months. Results In the multivariate analyses, adjusting for known potential confounders, individuals with headache 1–14 days/month in HUNT 2 were more likely to be fRA 11 years later than headache-free individuals. Migraine at baseline predisposed more strongly to fRA at follow-up (OR = 1.25; 95% CI 1.19-1.40) than did non-migrainous headache (OR = 1.13; 95% 1.04-1.23). The odds of being fRA was 48% increased (OR 1.48; 95% 1.19-1.83) among those with migraine 7–14 days/month at baseline compared to subjects without headache. In contrast, headache status at baseline did not influence the odds of being frequent visitors of concerts, cinema and/or theatre at follow-up 11 years later. Conclusions In this prospective study, headache, in particular migraine, at baseline slightly increased the odds of being fRA 11 years later. PMID:24386923

Effect of manual therapy techniques on headache disability in patients with tension-type headache. Randomized controlled trial.

PubMed

Espí-López, G V; Rodríguez-Blanco, C; Oliva-Pascual-Vaca, A; Benítez-Martínez, J C; Lluch, E; Falla, D

2014-12-01

Tension-type headache (TTH) is the most common type of primary headache however there is no clear evidence as to which specific treatment is most effective or whether combined treatment is more effective than individual treatments. To assess the effectiveness of manual therapy techniques, applied to the suboccipital region, on aspects of disability in a sample of patients with tension-type headache. Randomized Controlled Trial. Specialized centre for headache treatment. Seventy-six (62 women) patients (age: 39.9 ± 10.9 years) with episodic chronic TTH. Patients were randomly divided into four treatment groups: 1) suboccipital soft tissue inhibition; 2) occiput-atlas-axis manipulation; 3) combined treatment of both techniques; 4) control. Four sessions were applied over 4 weeks and disability was assessed before and after treatment using the Headache Disability Inventory (HDI). Headache frequency, severity and the functional and emotional subscales of the questionnaire were assessed. Photophobia, phonophobia and pericranial tenderness were also monitored. Headache frequency was significantly reduced with the manipulative and combined treatment (P<0.05), and the severity and functional subscale of the HDI changed in all three treatment groups (P<0.05). Manipulation treatment also reduced the score on the emotional subscale of the HDI (P<0.05). The combined intervention showed a greater effect at reducing the overall HDI score compared to the group that received suboccipital soft tissue inhibition and to the control group (both P<0.05). In addition, photophobia, phonophobia and pericranial tenderness only improved in the group receiving combined therapy (P<0.05). When given individually, suboccipital soft tissue inhibition and occiput-atlas-axis manipulation resulted in changes in different parameters related to the disability caused by TTH. However, when the two treatments were combined, effectiveness was noted for all aspects of disability and other symptoms

The causal role of smoking on the risk of headache. A Mendelian randomization analysis in the HUNT Study.

PubMed

Johnsen, Marianne Bakke; Winsvold, Bendik Slagsvold; Børte, Sigrid; Vie, Gunnhild Åberge; Pedersen, Linda Margareth; Storheim, Kjersti; Skorpen, Frank; Hagen, Knut; Bjørngaard, Johan Håkon; Åsvold, Bjørn Olav; Zwart, John Anker

2018-05-10

Headache has been associated with various lifestyle- and psychosocial factors, one of which is smoking. The aim of the present study was to investigate whether the association between smoking intensity and headache is likely to be causal. 58 316 participants from the Nord-Trøndelag Health Study (HUNT) with information on headache status were genotyped for the rs1051730 C>T single-nucleotide polymorphism (SNP). The SNP was used as an instrument for smoking intensity in a Mendelian randomization (MR) analysis. Association between rs1051730 T alleles and headache was estimated by odds ratios (OR) with 95% confidence intervals (CI). Additionally, we investigated the association between the SNP and migraine or non-migrainous headache vs. no headache. All analyses were adjusted for age and sex. There was no strong evidence that the rs1051730 T allele was associated with headache in ever smokers (OR 0.99, 95% CI 0.95-1.02). Similarly, there was no association between the rs1051730 T allele and migraine or non-migrainous headache vs. no headache. Findings from this study do not support that there is a strong causal relationship between smoking intensity and any type of headache. Larger MR studies are required to examine whether higher smoking quantity can lead to a moderate increase in the risk of headache subtypes. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Cervicogenic headache: a critical review of the current diagnostic criteria.

PubMed

Leone, M; D'Amico, D; Grazzi, L; Attanasio, A; Bussone, G

1998-10-01

Opinions are divided on the use of the term cervicogenic headache (CGH) in cases with no evidence of cervical damage. According to Sjaastad et al. (1990), CGH is diagnosed from three features: (1) unilateral headache triggered by head/neck movements or posture; (2) unilateral headache triggered by pressure on the neck; (3) unilateral headache spreading to the neck and the homolateral shoulder/arm. Other characteristics are not essential for CGH diagnosis, including pain improvement after greater occipital nerve (GON)/C2 block. However, other authors give different definitions of CGH, and this may explain why reported frequencies for this headache vary so widely. In this paper we critically review the major diagnostic criteria of Sjaastad et al. for CGH in the light of clinical studies conducted at our institute and other literature findings. In a study of 500 headaches we found only two patients with unilateral headache triggered by head/ neck movements or posture, and no cases of neck pressure-induced headache. No clear-cut criteria are given in the literature for differentiating CGH trigger points from myofascial trigger points. In another study of 440 primary headache patients we found that in the unilateral long-lasting headache group (64 migraines and 10 tension-type headaches), a pain involving the occiput/neck was present in 30 migraine and seven tension headache patients; thus, according to the CGH major criteria, 10% (30/307) of 'migraines' and 7% (7/96) of 'tension headaches' could be diagnosed as CGH. However, one cannot exclude that the association of unilateral pain with posterior irradiation is due to the high prevalence of migraine, tension-type headache and chronic neck pain. The relation between CGH and whip-lash injury has been put in doubt by a recent study which found no difference in headache frequency between trauma and control groups and reported no specific headache pattern in the trauma group. Other reports suggest that, when it occurs, CGH

Management of chronic daily headache in children and adolescents.

PubMed

Mack, Kenneth J; Gladstein, Jack

2008-01-01

Chronic daily headache (CDH) occurs in 1-2% of children and adolescents. It can evolve from either episodic tension-type headache or episodic migraine, or can appear with no previous headache history. As with other primary headache disorders, treatment is based on the level of disability. There are children and adolescents who cope well, but there are others who are markedly disabled by their chronic headaches. As in adults, children and adolescents with CDH are at risk for medication overuse. CDH is a diagnosis of exclusion, based on a thorough history, normal physical examination, and negative neuroimaging findings. Along with the chronic headaches, children with this condition may have co-morbid sleep problems, autonomic dysfunction, anxiety, and/or depression. Principles of treatment include identifying migrainous components, stopping medication overuse, stressing normalcy, using rational pharmacotherapy, and addressing co-morbid conditions. Successful outcomes often involve identifying an appropriate headache preventative, reintegration into school, and family participation in resetting realistic expectations.

Dietary patterns according to headache and migraine status: A cross-sectional study

PubMed Central

Rist, Pamela M.; Buring, Julie E.; Kurth, Tobias

2014-01-01

Background Several potential dietary trigger factors for migraine have been proposed. However, few studies have examined the intake pattern of these dietary items compared to adequate control populations and if intake levels may vary by migraine aura status or attack frequency. Methods Cross-sectional study among participants in the Women's Health Study. We used logistic regression to evaluate the association between migraine and headache status and low intake for foods commonly reported to affect migraine. Results 25,755 women reported no history of migraine or headache; 5573 reported non-migraine headache and 7042 reported any migraine of which 2972 reported migraine without aura and 1974 reported migraine with aura within the past year. Those with non-migraine headache or any migraine were more likely to have low intake of total alcohol (OR=1.22, 95% CI:1.14–1.29 and OR=1.17, 95% CI:1.11–1.24, respectively). Migraineurs with aura were more likely to have low intake of chocolate, ice cream, hot dogs, and processed meats. Those who experience migraine at least once per week were more likely to have low intake of skim/low-fat milk and white and red wine. Conclusion Intake of most suggested migraine dietary triggers differs by migraine aura status and attack frequency, a pattern not found for non-migraine headache. PMID:25424709

Post-traumatic stress disorder in U.S. soldiers with post-traumatic headache.

PubMed

Rosenthal, Jacqueline F; Erickson, Jay C

2013-01-01

To determine the impact of post-traumatic stress disorder (PTSD) on headache characteristics and headache prognosis in U.S. soldiers with post-traumatic headache. PTSD and post-concussive headache are common conditions among U.S. Army personnel returning from deployment. The impact of comorbid PTSD on the characteristics and outcomes of post-traumatic headache has not been determined in U.S. Army soldiers. A retrospective cohort study was conducted among 270 consecutive U.S. Army soldiers diagnosed with post-traumatic headache at a single Army neurology clinic. All subjects were screened for PTSD at baseline using the PTSD symptom checklist. Headache frequency and characteristics were determined for post-traumatic headache subjects with and without PTSD at baseline. Headache measures were reassessed 3 months after the baseline visit, and were compared between groups with and without PTSD. Of 270 soldiers with post-traumatic headache, 105 (39%) met screening criteria for PTSD. There was no significant difference between subjects with PTSD and those without PTSD with regard to headache frequency (17.2 vs 15.7 headache days per month; P = .15) or chronic daily headache (58.1% vs 52.1%; P = .34). Comorbid PTSD was associated with higher headache-related disability as measured by the Migraine Disability Assessment Score. Three months after the baseline neurology clinic visit, the number of subjects with at least 50% reduction in headache frequency was similar among post-traumatic headache cases with and without PTSD (25.9% vs 26.8%). PTSD is prevalent among U.S. Army soldiers with post-traumatic headache. Comorbid PTSD is not associated with more frequent headaches or chronic daily headache in soldiers evaluated at a military neurology clinic for chronic post-traumatic headache. Comorbid PTSD does not adversely affect short-term headache outcomes, although prospective controlled trials are needed to better assess this relationship. © 2013 American Headache

Epidemiology of headache disorders in the Asia-pacific region.

PubMed

Peng, Kuan-Po; Wang, Shuu-Jiun

2014-04-01

Headache disorder is a major public health issue and is a great burden for the person, the health care system, and society. This article reviews epidemiological surveys of primary headache disorders including migraine and tension-type headache (TTH) among adults in the Asia-Pacific region using the International Classification of Headache Disorders (ICHD), first or second edition. Chronic daily headache (CDH), which is not an official diagnosis in the ICHD, was also reviewed. In the Asia-Pacific region, the median (range) 1-year prevalence of primary headache disorders was 9.1% (1.5-22.8%) for migraine, 16.2% (10.8-33.8%) for TTH, and 2.9% (1.0-3.9%) for CDH. The 1-year prevalence of migraine and TTH were rather consistent; however, the extremes in the 1-year prevalence of migraine in earlier studies from Hong Kong (1.5%) and South Korea (22.3%) were not repeated in later surveys (Hong Kong: 12.5%; South Korea: 6%). According to the United Nations, the estimated population of the Asia-Pacific region was 3.85 billion in 2010, equaling to headache suffers of 350 million patients with migraine, 624 million with TTH, and 112 million with CDH; many remain to be treated. The prevalence of headache disorders has remained stable over the last 2 decades in this region, where the diversity of geography, race, and development is wide. Thus, the pursuit of better headache care in this region might be our next challenge. © 2014 American Headache Society.

Headache Disability, Suicidality and Pain Catastrophization - Are They Related

PubMed Central

Ram, Dushad; Sundarmurthy, Harsha; Rathod, Snehal; John, Deepa

2016-01-01

Introduction Studies have found that headache is associated with suicidality. Some demographic and clinical features have been reported to be associated with suicidality. Pain catastrophizing and disability may also have bearing on suicidality in patients with headache. Aim To evaluate the relationship between pain disability and catastrophizing in headache and suicidal behaviour. Materials and Methods Patients diagnosed with headache were recruited from neurology Out-Patient Department (OPD). With ethical approval and informed consent, patients were subjected to a structured interview. Headache disability and pain catastrophizing was assessed with the Henry Ford Hospital Headache Disability Inventory (HDI) and Pain Catastrophy Scale (PCS) respectively. For evaluation of suicidal ideation and behaviour, MINI International Neuropsychiatric Interview (MINI Plus) scale and The Columbia-Suicide Severity Rating Scale (C-SSRS) were applied. Data was analysed with Mann-Whitney U test and Kruskal-Wallis test using appropriate statistical programs. Results In 200 patients of headache, male: female ratio was 0.48: 1. Headache disability was significantly higher in females (p=0.060) and unemployed (p=0.019) patients whereas, pain catastrophizing was significant in patients belonging to low socioeconomic class (p=0.045). Headache disability and pain catastrophizing had significant association with suicidal ideation. Disability score was significantly associated with the score of deterrents (p=0.067) and controllability (p=0.039) subscale of intensity of suicidal ideation. There were four patients who actually attempted suicide. Pain catastrophizing was significantly associated with non-suicidal self injurious behaviour (p=0.041). Conclusion Disability due to headache and pain catastrophizing is associated with increased suicidal tendencies, behaviour and suicidal attempts. Headache in females and patients in rural habitat, unemployed individuals belonging to low socioeconomic

Seasonal Variation in Emergency Department Visits Among Pediatric Headache Patients.

PubMed

Pakalnis, A; Heyer, G L

2016-09-01

To ascertain whether seasonal variation occurs in emergency department (ED) visits for headache among children and adolescents. A retrospective review was conducted using the electronic medical records of ED visits for headache at a tertiary children's hospital through calendar years 2010-2014. Using ICD-9 diagnostic codes for headache and migraine, the numbers of headache visits were determined and compared by season and during school months vs summer months. A total of 6572 headache visits occurred. Headache visits increased during the fall season (133 ± 27 visits per month) compared with other seasons (101 ± 19 visits per month), P ≤ .002, but did not differ when comparing school months (113 ± 25 visits per month) and summer months (100 ± 24 visits per month), P = .1. The corresponding increase in ED visits during the fall season coincides with the start of the school year. Academic stressors and the change in daily schedule may lead to more headaches and more ED headache visits among school-aged youth. © 2016 American Headache Society.

Descriptive features and causal attributions of headache in an Australian community.

PubMed

Fernandez, E; Sheffield, J

1996-04-01

The reported characteristics and causes of headache differ across individuals and between groups. Such differences are of interest from an epidemiological point of view. This study set out to identify the main descriptive features and causal attributions of headache within an Australian urban community. A sample of 261 subjects reporting headache volunteered to participate in the survey. Subjects completed a self-report questionnaire for assessing demographic variables, headache parameters (intensity, duration, etc), headache medication habits, and perceived causes of one's headache (as in the UK headache survey by Blau, 1990). Results revealed that the typical headache sufferer was a middle-aged employed individual. Migraine versus tension headache were equivalent in number, and on the average, subjects experienced moderate intensity, day-long headaches that recurred about nine times per month. With regard to causal attributions, the prevalence of headaches due to mental stress was higher than that due to any other single stimulus (eg, noise, exercise), and alcohol was the most frequent dietary cause of headache. These findings are generally consistent with those from previous surveys, although some interesting departures emerge which may be accounted for by demographic differences in the populations studied.

Acromegaly diagnosed in a young woman presenting with headache and arthritis.

PubMed

Nachtigall, Lisa B

2006-10-01

A 38-year-old woman presented with severe headaches to her primary-care physician. The patient had been diagnosed with rheumatoid arthritis and had begun having headache 4 years previously. An MRI scan revealed an 11-12 mm pituitary tumor. Her physical examination was unremarkable for the classic acral or facial changes characteristic of acromegaly, and she was referred for neuroendocrine consultation for a presumed nonfunctioning adenoma. MRI of the pituitary, and laboratory investigations that included measurement of serum insulin-like growth factor 1 (IGF1) and prolactin levels. In view of the elevated level of IGF1 and presence of a pituitary adenoma, the patient was diagnosed with acromegaly caused by a pituitary adenoma that secretes growth hormone. The patient underwent trans-sphenoidal surgery, which resulted in resolution of joint pain and headache, eradication of the tumor mass, normal IGF1 levels, and appropriate suppression of growth hormone (confirmed by oral glucose tolerance test postoperatively).

Role of Acupuncture in the Treatment or Prevention of Migraine, Tension-Type Headache, or Chronic Headache Disorders.

PubMed

Coeytaux, Remy R; Befus, Deanna

2016-07-01

To summarize the current evidence that evaluates the effectiveness of acupuncture for the treatment or prevention of migraine, tension-type headache, and chronic headache disorders. Findings from selected systematic reviews and meta-analyses are summarized. Recently published systematic reviews and meta-analyses demonstrate that acupuncture is associated with improved clinical outcomes compared to routine care only, medical management, and sham acupuncture 2 months after randomization. The evidence in support of acupuncture's comparative effectiveness at longer follow-up periods is mixed. Cost effectiveness analyses conducted in the United Kingdom and Germany suggest that acupuncture is a cost-effective treatment option in those countries. There are few or no cost-effectiveness studies of acupuncture in the United States. This brief review of the current, published evidence does not include a discussion of potential risks or adverse events associated with acupuncture. There is also the question of the extent to which placebo effects might contribute to acupuncture's clinical effectiveness. From a purely comparative effectiveness perspective, however, the evidence from clinical trials and meta-analyses makes a compelling case in support of a potentially important role for acupuncture as part of a treatment plan for patients with migraine, tension-type headache, and several different types of chronic headache disorders. © 2016 American Headache Society.

New daily persistent headache in children and adults.

PubMed

Mack, Kenneth J

2009-02-01

New daily persistent headache (NDPH) is frequently seen in young patients with chronic daily headache. NDPH begins with a sudden onset, often associated with an infection or other physical stress. This headache syndrome is difficult to treat and may persist for years. This review discusses the epidemiology, comorbid symptoms, evaluation, and treatment of this disorder.

[Impact of headache among studied military population in Afghanistan deployed in the Kabul military field hospital].

PubMed

Guilloton, L; Bruneau, O; Trousselard, M; Zagnoli, F; Blanc, P A; De Greslan, T; Drouet, A

2015-11-01

Headaches are a common reason for consultation with a prevalence of 30%. Few data exist for military personnel, including in situations of war operations. The main objective of this work was to measure the evolution of the impact of headache in such a context. Two hundred and one personnel deployed in the Kaïa military field hospital in Afghanistan were recruited. A questionnaire designed to recognize headaches, supported by two quality of life scales (MIDAS and HIT-6) and a stress questionnaire were filled out before departure and upon return from missions. Sixty-three patients with headache were initially identified, of whom 52 remained symptomatic during the mission. The average total score of MIDAS before departure was 4 days and fell to 1.4 days upon return, with a mean measured change of 3.3 days. For HIT-6, the mean total score was 51.2 points initially and 51.9 points at the end of the mission with a mean change of-0.3 points. Nine patients without headache initially became symptomatic: MIDAS and HIT-6 were not affected. Thus, the impact of headache in the particular context of presence in a theater of operations was low: improved MIDAS score and the lack of influence on the HIT-6 score are underlined. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Medication overuse, healthy lifestyle behaviour and stress in chronic headache: Results from a population-based representative survey.

PubMed

Westergaard, Maria Lurenda; Glümer, Charlotte; Hansen, Ebba Holme; Jensen, Rigmor Højland

2016-01-01

This cross-sectional study investigated associations between chronic headache (CH) with and without medication overuse, healthy lifestyle behaviour, and stress. Questionnaires were sent to 129,150 adults. Those with headache ≥15 days per month for three months were classified as having CH then further described as having medication-overuse headache (MOH) or CH without medication overuse. Associations between headache and daily smoking, physical inactivity, obesity, excessive drinking, illicit drug use, and high stress were analysed by logistic regression. CH with and without medication overuse (prevalence 1.8% and 1.6%, respectively) had strong, graded associations with stress. Associations with daily smoking, physical inactivity, and obesity were significant only for MOH. Odds for MOH were highest among people who had all three factors compared to those who had none (OR 2.8 in women and 5.1 in men). High stress plus any of these three factors had synergistic effects in MOH but not clearly in those who had CH without overuse. Associations between CH subtypes and excessive drinking or illicit drug use were not statistically significant. Results suggest strong links between healthy lifestyle behaviour and stress in MOH. Stress reduction and promoting healthy behaviour are highly relevant in MOH management. © International Headache Society 2015.

Medication overuse headache: An entrenched idea in need of scrutiny.

PubMed

Scher, Ann I; Rizzoli, Paul B; Loder, Elizabeth W

2017-09-19

It is a widely accepted idea that medications taken to relieve acute headache pain can paradoxically worsen headache if used too often. This type of secondary headache is referred to as medication overuse headache (MOH); previously used terms include rebound headache and drug-induced headache. In the absence of consensus about the duration of use, amount, and type of medication needed to cause MOH, the default position is conservative. A common recommendation is to limit treatment to no more than 10 or 15 days per month (depending on medication type) to prevent headache frequency progression. Medication withdrawal is often recommended as a first step in treatment of patients with very frequent headaches. Existing evidence, however, does not provide a strong basis for such causal claims about the relationship between medication use and frequent headache. Observational studies linking treatment patterns with headache frequency are by their nature confounded by indication. Medication withdrawal studies have mostly been uncontrolled and often have high dropout rates. Evaluation of this evidence suggests that only a minority of patients required to limit the use of symptomatic medication may benefit from treatment limitation. Similarly, only a minority of patients deemed to be overusing medications may benefit from withdrawal. These findings raise serious questions about the value of withholding or withdrawing symptom-relieving medications from people with frequent headaches solely to prevent or treat MOH. The benefits of doing so are smaller, and the harms larger, than currently recognized. The concept of MOH should be viewed with more skepticism. Until the evidence is better, we should avoid dogmatism about the use of symptomatic medication. Frequent use of symptom-relieving headache medications should be viewed more neutrally, as an indicator of poorly controlled headaches, and not invariably a cause. © 2017 American Academy of Neurology.

Diagnosis, pathophysiology, and management of cluster headache.

PubMed

Hoffmann, Jan; May, Arne

2018-01-01

Cluster headache is a trigeminal autonomic cephalalgia characterised by extremely painful, strictly unilateral, short-lasting headache attacks accompanied by ipsilateral autonomic symptoms or the sense of restlessness and agitation, or both. The severity of the disorder has major effects on the patient's quality of life and, in some cases, might lead to suicidal ideation. Cluster headache is now thought to involve a synchronised abnormal activity in the hypothalamus, the trigeminovascular system, and the autonomic nervous system. The hypothalamus appears to play a fundamental role in the generation of a permissive state that allows the initiation of an episode, whereas the attacks are likely to require the involvement of the peripheral nervous system. Triptans are the most effective drugs to treat an acute cluster headache attack. Monoclonal antibodies against calcitonin gene-related peptide, a crucial neurotransmitter of the trigeminal system, are under investigation for the preventive treatment of cluster headache. These studies will increase our understanding of the disorder and perhaps reveal other therapeutic targets. Copyright © 2018 Elsevier Ltd. All rights reserved.

Chronic daily headache: correlation between the 2004 and the 1988 International Headache Society diagnostic criteria.

PubMed

Bigal, Marcelo E; Tepper, Stewart J; Sheftell, Fred D; Rapoport, Alan M; Lipton, Richard B

2004-01-01

In a previous study, we compared the 1988 International Headache Society (IHS) criteria and the Silberstein-Lipton criteria (S-L) in a subspeciality clinic sample of 638 patients with chronic daily headache (CDH) assessed both clinically and with headache diaries. Both systems allowed for the classification of most patients with CDH. The 1988 IHS classification required multiple diagnoses and was more complex to apply. The aim of this study was to revisit the same database, now comparing the prior classification systems with the new 2004 IHS classification. In contrast with the 1st edition, the 2nd edition includes criteria for chronic migraine (CM), new daily persistent headache (NDPH), and hemicrania continua (HC). We reviewed the clinical records and the headache diaries of 638 patients seen between 1980 and 2001 at a headache center. All patients had primary CDH according to the S-L criteria. Using the S-L criteria as a reference, of the 158 patients with transformed migraine (TM) without medication overuse, just 9 (5.6%) met 2004 IHS criteria for CM. Most of the subjects were classified using combinations of migraine and CTTH diagnoses, much like the 1988 IHS classification. Similarly, using the new IHS system, just 41/399 (10.2%) subjects with TM with medication overuse were classified as probable CM with probable medication overuse. Most patients with NDPH without overuse were easily classified using the 2004 criteria (95.8%). Regarding NDPH with medication overuse, the diagnostic groups were much like results for the 1st edition. All patients with chronic tension-type headache (CTTH) and hemicrania continua (HC) according to the S-L system were easily classified using the 2004 IHS criteria. We conclude that the 2004 IHS criteria facilitate the classification of NDPH without medication overuse and HC. For subjects with TM according to the S-L system, the new IHS criteria are complex to use and require multiple diagnoses. Very few patients with TM in the S

Headaches (For Parents)

MedlinePlus

... activity — symptoms that do often occur with migraines. Migraines Often triggered by things like stress, sleep deprivation, and menstruation, migraine headaches can cause the following symptoms: pounding, throbbing ...

Migraine headache is present in the aura phase

PubMed Central

Hansen, Jakob M.; Lipton, Richard B.; Dodick, David W.; Silberstein, Stephen D.; Saper, Joel R.; Aurora, Sheena K.; Goadsby, Peter J.

2012-01-01

ABSTRACT Objectives: Migraine aura is commonly considered to be a distinct phase of a migraine attack that precedes headache. The objective of the study was to examine a large number of prospectively recorded attacks of migraine with aura and determine the timing of headache and other migraine symptoms relative to aura. Methods: As part of a clinical trial we collected prospective data on the time course of headache and other symptoms relative to the aura. Patients (n = 267) were enrolled from 16 centers, and asked to keep a headache diary for 1 month (phase I). They were asked to record headache symptoms as soon as possible after aura began and always within 1 hour of aura onset. A total of 456 attacks were reported during phase I by 201 patients. These patients were then randomized and included in phase II, during which a total of 405 attacks were reported in 164 patients. In total, we present data from 861 attacks of migraine with aura from 201 patients. Results: During the aura phase, the majority of attacks (73%) were associated with headache. Other migraine symptoms were also frequently reported during the aura: nausea (51%), photophobia (88%), and photophobia (73%). During the first 15 minutes within the onset of aura, 54% of patients reported headache fulfilling the criteria for migraine. Conclusion: Our results indicate that headaches as well as associated migraine symptoms are present early, during the aura phase of the migraine attack in the majority of patients. PMID:23115208

Muscles and their role in episodic tension-type headache: implications for treatment.

PubMed

Bendtsen, L; Ashina, S; Moore, A; Steiner, T J

2016-02-01

Tension-type headache (TTH) imposes a heavy burden on the global population but remains incompletely understood and poorly managed. Here, we review current knowledge of peripheral factors involved in the mechanism of TTH and make recommendations for the treatment of episodic TTH based on these. Peripheral activation or sensitization of myofascial nociceptors is most probably involved in the development of muscle pain and the acute episode of TTH. Repetitive episodes of muscle pain may sensitize the central nervous system resulting in progression of TTH to the chronic form. Thus, muscular factors may be responsible not only for the acute headache episode but also for chronification of the disorder. Simple analgesics and non-steroidal anti-inflammatory drugs are the mainstays of management of individual headache episodes. Ibuprofen 400 mg and aspirin 1000 mg are recommended as drugs of first choice based on treatment effect, safety profile and costs. Non-pharmacological therapies include electromyographic biofeedback, physiotherapy and muscle relaxation therapy. Future studies should aim to identify the triggers of peripheral nociception and how to avoid peripheral and central sensitization. There is a need for more effective, faster acting drugs for acute TTH. Muscular factors play an important role in episodic TTH. Ibuprofen 400 mg and aspirin 1000 mg are recommended as drugs of first choice. © 2015 European Pain Federation - EFIC®

Modified Valsalva test differentiates primary from secondary cough headache.

PubMed

Lane, Russell J M; Davies, Paul T G

2013-03-28

The current definition of cough headache includes provocation of the symptom by Valsalva manoeuvre, and it is generally believed that all cough headache results from a sudden increase in intracranial pressure. We sought to question that presumption and to determine whether the Valsalva test might distinguish primary from secondary cough headache. We examined 16 consecutive cough headache patients using a modified Valsalva test (exhalation into the connecting tube of a standard anaeroid sphygmomanometer to 60 mm Hg for 10 seconds). A positive response was recorded if the manoeuvre provoked headache. All patients subsequently underwent brain MRI. None of the patients had neurological signs. Eleven had positive modified Valsalva tests. Ten were found subsequently to have posterior fossa pathologies (secondary cough headache: 8 Chiari Type 1 malformations, 2 posterior fossa meningiomas). The cough headache was relieved following surgery in all cases. One patient with a positive Valsalva test had an apparently normal brain MRI but measurements of hindbrain and posterior fossa dimensions were consistent with 'posterior fossa crowdedness'. The remaining 5 patients had negative (4 patients) or equivocal (1 patient) Valsalva tests and normal MRI scans (primary cough headache). These findings suggest that secondary cough headache results from a transient increase in intracranial CSF pressure during exertion in the presence of obstruction to normal cerebrospinal fluid dynamics. The modified Valsalva test can also determine whether tonsillar herniation found on brain MRI is symptomatic. Primary cough headache appears to be caused by a different mechanism, possibly through congestion of the orbital venous plexus in the presence of jugular venous incompetence and a reduced threshold for trigeminal sensory activation.

Radiosurgery for Arteriovenous Malformations and the Impact on Headaches.

PubMed

Bowden, Greg; Cavaleri, Jonathon; Kano, Hideyuki; Monaco, Edward; Niranjan, Ajay; Flickinger, John; Dade Lunsford, L

2017-05-01

Arteriovenous malformations (AVMs) can underlie many diverse neurological signs and symptoms. Headaches are a common presentation that can have a significant impact on quality of life. The authors investigated Gamma Knife ® stereotactic radiosurgery (SRS) outcomes in patients with AVMs and associated headaches. This retrospective study analyzed 102 patients with AVMs who underwent SRS between 1995 and 2013. The patient's headache symptoms led to their AVM diagnosis or developed post hemorrhage of their AVM. Information regarding headache characteristics was obtained from the patient's medical records and at follow-up using a scripted clinical interview. The median imaging follow-up was 61.7 months and clinical follow-up was 89.7 months. The median treatment volume at SRS was 4.1 cm 3 and the median marginal dose was 20 Gy. The actuarial AVM obliteration rate was 60% at 5 years and 78% at 10 years. Patients reported that their overall headache severity decreased by -43.6% and their headache frequency was reduced by -53.4%. Headache reduction was reported in 49.1% of patients at 1 year and 69.5% at 5 years. The median time until improvement was 6.5 months. After SRS, headache medication usage decreased in 29% of patients. Permanent adverse radiation effects after SRS occurred in 3% of patients. Until obliteration was complete, the annual risk of a hemorrhage after SRS was 0.4% per year. Although recall bias related to a retrospective analysis can impact outcomes, headache symptoms associated with AVMs may potentially be decreased or eliminated in a subset of patients treated with Gamma Knife radiosurgery. © 2017 American Headache Society.

Migraine headache and labor market outcomes.

PubMed

Rees, Daniel I; Sabia, Joseph J

2015-06-01