Objective behavior associated with an "ordinary" mild headache: a surprising failure of pain onset to signal self-protective or self-regulatory behavior.

Hovanitz CA, Reynolds DJ, Cote MP, Christianson A, Stokes-Crowe LA, Altum S, Chase-Carmichael CA.

Department of Psychology, M. L. #376, University of Cincinnati, Cincinnati, OH 45221, USA.

OBJECTIVE: The goal of this study was to determine whether onset of an "ordinary" headache initiated self-protective behavior or self-regulation, as indexed by a reduction in effort expenditure. METHODS: A nonclinical sample was employed. The ambition and performance accuracy of a headache-developing group (n = 23) and a sex-matched, headache-free group (n = 23) was compared during a series of mental arithmetic problems. Embedded within the series of math problems was a task involving recall of a stressor previously found to induce headache in many subjects. RESULTS: Onset of mild head pain did not lead to effort conservation; instead, heightened ambition appeared to characterize the headache-developing participants before as well as after headache onset. Headache-developing subjects also displayed a performance accuracy deficit. CONCLUSIONS: The data suggest unusually ambitious, effortful task engagement may contribute to the onset of mild "ordinary" headache. This possibility requires further examination under other controlled conditions as well as in the natural environment.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11279961&dopt=Abstract headache medicine




Calcitonin gene-related peptide levels during nitric oxide-induced headache in patients with chronic tension-type headache.

Ashina M, Bendtsen L, Jensen R, Schifter S, Olesen J.

Department of Neurology, Glostrup Hospital, University of Copenhagen, DK-2600 Glostrup, Copenhagen, Denmark. ashina dadnet.dk

It has been proposed that nitric oxide (NO) induced headache in primary headaches may be associated with release of calcitonin gene-related peptide (CGRP). In the present study we aimed to investigate plasma levels of CGRP during headache induced by the NO donor glyceryl trinitrate (GTN) in 16 patients with chronic tension-type headache and 16 healthy controls. The subjects were randomly allocated to receive 0.5 microg/kg/min GTN or placebo over 20 min on two headache-free days. Blood samples were collected at baseline, 10, 20 and 60 min after start of infusion. Both patients and controls developed significantly stronger immediate headache on the GTN day than on the placebo day and the headache was significantly more pronounced in patients than in controls. There was no difference between the area under the CGRP curve (AUCCGRP) on GTN vs. placebo day in either patients (P=0.65) or controls (P=0.48). The AUCCGRP recorded on the GTN day did not differ between patients and controls (P=0.36). Both in patients and controls, CGRP levels changed significantly over time, on both the GTN and placebo days (P < 0.05). The present study indicates that NO-induced immediate headache is not associated with release of CGRP.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11284996&dopt=Abstract headache medicine




Frequency and predictors of physician consultations for headache.

Wang SJ, Fuh JL, Young YH, Lu SR, Shia BC.

The Neurological Institute, Taipei Veterans General Hospital, Taiwan. sjwang vghtpe.gov.tw

We conducted a population-based headache questionnaire survey including questions on physician consultation for headache in Taipei, Taiwan from August 1997 to June 1998. The participants comprised 3377 subjects aged > or = 15 years, of whom 328 (9.7%) had a diagnosis of migraine and 1754 (52%) had a diagnosis of non-migraine headache. Migraineurs had a higher physician consultation rate (once or more in the past year) than the subjects with non-migraine headache (54% vs. 31%, P < 0.0001). When frequency > or = 10 times was taken as 10 times, the analysis showed that migraineurs consulted physicians more often than non-migraine headache subjects (2.36 vs. 0.96, P = 0.04). A small proportion of the subjects with either migraine (12%) or non-migraine headache (6%) accounted for 50% of total consultations within their groups. In addition to old age, low education levels, living in a rural area, migrainous features (nausea and photophobia), and work day loss, predictors of physician consultations also included 'having been troubled with headache' (odds ratio (OR) = 1.7) and co-morbidity with hypertension (OR = 1.8) or heart disease (OR = 2.2). Low copayment and unrestricted access to medical care, as well as cultural factors played an important role in the high consultation rates in our headache subjects. Moreover, this study found self-perception of headache impact and co-morbid illnesses were important factors affecting the decision to consult physicians about headache.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11298660&dopt=Abstract headache medicine




The prevalence and treatment of headache sufficient to impact on the quality of life of undergraduate students entering university.

Kernick DP, Reinhold D.

St Thomas Health Centre, Cowick Street, Exeter EX4 4RS, UK. su1838 eclipse.co.uk

AIM OF STUDY: Headache has a significant impact on public health in terms of quality of life and economic consequences, but in primary care, needs often remain unmet in terms of recognition, diagnosis and treatment. Our aim was to measure the prevalence of headache sufficient to affect the quality of life of undergraduate students who were entering the University of Exeter. METHOD: 1124 consecutive undergraduate entrants aged 21 and under who registered at the Student Health Centre at the beginning of the academic year were invited to complete a questionnaire during their registration procedure. We used the Headache Impact Score to measure effect of headache on quality of life. RESULTS: A completed questionnaire was received from 1057 (94%) students registering at the Health Centre. 212 (21%) of these students had headaches that affected the quality of their life. Of these, 95 (45%) had seen a doctor previously about their headaches and 28 (13%) had headaches on more than 15 days a month. Less than 5% were taking prescription medication. The headache impact score was 56 indicating a substantial impact on quality of life of students. CONCLUSION: Headache has a considerable impact on the quality of life of students entering University which we speculate may have a deleterious effect on educational attainment. This study has confirmed the findings of other population groups that morbidity from headache is often unrecognised and under treated.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12564656&dopt=Abstract headache medicine




Management by nurses of primary headache: a pilot study.

Main A, Abu-Saad H, Salt R, Vlachonikolis I, Dowson A.

European Institute of Health and Medical Sciences, Surrey University, Guildford, UK. a.main surrey.ac.uk

Primary headache is a very common condition and one that nurses encounter in many different care settings. Yet there is a lack of evidence as to whether advice given to sufferers is effective and what improvements may be expected in the condition. The aim of this study was to evaluate the advice given by a nurse to primary headache sufferers. The design was quasi-experimental. An experimental group (n = 19) and a control group (n = 25) of primary headache sufferers had their headache parameters of frequency, severity duration and disability (Migraine Disability Assessment) over the previous six months assessed. The experimental group then received advice in the form of health education from a nurse. Both groups kept a headache diary for six months. After six months both groups had their headache parameters assessed again. Compared to the control group, there was a significant reduction in the severity of headaches experienced by the experimental group (p = 0.006). Although there were reductions in frequency and duration of headaches experienced by the experimental group compared to the control group, these were not significant (p = 0.664 and p = 0.235, respectively). The Migraine Disability Assessment showed a trend towards reduced scores in the experimental group compared to controls which were not significant (p = 0.535). This pilot study suggests that health education can be effective in reducing the severity of headaches. However, a larger study over a longer period is needed to evaluate improvements in headache parameters.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12564658&dopt=Abstract headache medicine




Headache in pediatric and neuropsychiatric primary care. A pilot study.

[Article in English, Italian]

Donfrancesco R, La Rosa S, Romagnoli C, Lo Parrino R.

UO di Neuropsichiatria Infantile Azienda Sanitaria, Firenze.

BACKGROUND: To evaluate the prevalence of headache in primary health care for children (child neuropsychiatry and pediatric primary care), detecting possible differences among areas, showing the number of patients with headache with a clinical significance that had not been communicated to a physician and studying the clinical features of cases. METHODS: A questionnaire is administered to all consecutive patients of 3 child neuropsychiatrists of a primary health care unit during a period of 20 days and of 2 family pediatricians during a period of 10 days. Data are collected on 259 children, between 5 and 14 years. RESULTS: 17.76% of examined children have recurrent headache. The percentage is significantly different (p < 0.05) in neuropsychiatry (22.78%) and pediatrics (9.90%). 63.04% of parents with children affected by headache have never reported the disease to a physician and 28.26% of affected children should follow a preventive therapy, but do not. Among all children, 6.56% have migraine and 8.49% have a tension-type headache, according to ICD-10 criteria. CONCLUSIONS: The higher frequency of headache in child neuropsychiatric primary care is probably due to a comorbidity with psychiatric diseases. The high number of non-reported cases of headache is in agreement with data reported in the literature about adults and suggests that it is important to ask standard questions about headache in the course of the anamnesis in all primary health care for children.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11085054&dopt=Abstract headache medicine




Treatment of chronic daily posttraumatic headache with divalproex sodium.

Packard RC.

Department of Neuropsychiatry, Texas Tech University, Lubbock 79430, USA.

OBJECTIVE: To determine the effectiveness of divalproex sodium in the treatment of chronic daily posttraumatic headaches. BACKGROUND: Divalproex sodium has been found to be useful for the treatment of migraine and chronic daily headache. No studies have been done to evaluate effectiveness in posttraumatic headache. METHODS: A retrospective review was done of 100 patients treated with divalproex for chronic daily posttraumatic headache of 2 months or longer. RESULTS: Sixty percent of patients with chronic posttraumatic headache had mild to moderate improvement in their headaches after at least 1 month of divalproex sodium. Forty percent either showed no response (26%) or discontinued treatment because of side effects (14%). Fifty-eight percent of patients showing improvement had a change in headache pattern from daily to episodic. CONCLUSIONS: Divalproex sodium appears to be safe and effective for treatment of patients with persistent, chronic daily posttraumatic headaches.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11091292&dopt=Abstract headache medicine




[Headache in systemic lupus erythematosus]

[Article in Polish]

Banecka-Majkutewicz Z.

Poradni Konsultacyjnej Chorob Wewnetrznych Katedry Medycyny Rodzinnej Akademii Medycznej w Gdansku.

This study was conducted to analyse the prevalence and features of headache in patients with SLE. 44 patients with SLE were reviewed retrospectively. The mean age of the patients was 43.8 +/- 11.5 years (r: 22-68), mean time of evolution of SLE was 11.8 +/- 9.0 years (r: 1-30). 28 patients (27 woman and 1 man) had clinical evidence of central nervous system involvement, 18 patients (40.9%) had headache; 6 (33.4%) being vascular, 3 (16.7%) migraine, 9 (50%) muscle contraction headache. In 4 patients headache started before the other signs or symptoms of SLE, in 8 patients headache appeared in the first year of the disease. In the patients with headache other manifestations of nervous system involvement were present very often. Most patients had more than one symptom or sign during the course of the illness. The results of our examination showed that headache is frequent in the course of SLE and probably it is connected with vascular lesion of the nervous system. We failed to find a relationship between headache and other manifestations of SLE and the treatment of SLE.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11107580&dopt=Abstract headache medicine