Prednisone as initial treatment of analgesic-induced daily headache.

Krymchantowski AV, Barbosa JS.

Headache Center of Rio/Institute of Neurology Deolindo Couto, Rio de Janeiro, Brazil. abouchkrym openlink.com.br

The majority of the patients who seek medical care in tertiary headache centres present with transformed migraine, and convert to daily headache, as a result of excessive intake of symptomatic medications (SM). This study aimed to analyse the possibility of using a short course of oral prednisone for detoxifying patients with chronic daily headache due to medication overuse in an out-patient setting. Four hundred patients with headache occurring more than 28 days per month for longer than 6 months were studied (mean baseline frequency of 0.96). Symptomatic medications were stopped suddenly and prednisone was initiated in tapering doses during 6 days, followed by the introduction of preventive treatment. Withdrawal symptoms and the frequency, intensity and duration of the headache, as well as the consumption of rescue medications, were analysed during the first 16 and 30 days of withdrawal. Eighty-five percent of the patients experienced a reduction in headache frequency and no patients presented severe attacks during the first 6 days. With regard to the following 10 days, 46% of the patients experienced at least 2 days without headache and 58% less intense attacks. Most of the patients noticed attacks with longer duration. After the 30-day period there was a significant decrease in headache frequency (mean 0.83, P<0.001), and no patients returned to overuse of SM. This study demonstrates that it is possible to detoxify patients suffering from rebound headaches, using oral prednisone during the first days of withdrawal, in an out-patient setting.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10961766&dopt=Abstract headache medicine




Reversible cognitive decline accompanies migraine and cluster headaches.

Meyer JS, Thornby J, Crawford K, Rauch GM.

Cerebrovascular Research, Baylor College of Medicine, Houston, TX, USA.

Vascular headaches, including migraine, cluster, and migrainous transformation to chronic daily headaches, are disabling. During and shortly after headache intervals, difficulties are reported in concentration, comprehension, and communication, not accounted for by nausea, photophobia, or sonophobia. These interfere with interpersonal relations and performance at work with economic loss. The hypothesis tested and reported here is that cognitive impairments comprise an important part of vascular headache diatheses. One hundred ninety-six otherwise normative subjects suffering from migraine or cluster, but not tension-type, headaches (136 women, 63 men; mean age, 46 years) participated in an outpatient prospective trial. One hundred thirty-three patients had migraine without aura, 39 migraine with aura, 11 periodic cluster (by IHS criteria), and 13 had migrainous transformation into chronic daily headaches. Neuropsychological testing was compared with and without headaches, by combined Mini-Mental Status Examination (MMSE), Cognitive Capacity Screening Examination (CCSE), and Hamilton Depression Rating Scale (HDRS). During headache intervals, significant decline was measured in both CCSE and MMSE scores (P <. 001) without HDRS change in all types of vascular headache and independent of headache severity, which often improved, or associated physical symptoms. Cognitive decline was promptly relieved by serotonin agonists and sleep. Disorders of cerebral serotoninergic projection systems appear to cause these reversible cognitive impairments.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10971660&dopt=Abstract headache medicine




Chronic Daily Headache: Theory to Therapy.

Wheeler AH.

Pain and Orthopedic Neurology, P.A., Charlotte Spine Center, 2001 Randolph Road, Charlotte, NC 28207, USA.

Headaches are among the most frequent symptoms for which Americans seek physician advice and treatment. Although headache may herald a serious underlying organic or psychological illness, it more commonly represents a primary disorder of brain stem nociceptive processing and modulation. Chronic daily headache characteristically develops gradually from episodic tension or migraine-type headaches into a refractory syndrome often associated with medication overuse and disability. Better understanding of the pathophysiology and evolutionary mechanisms involved in the development of chronic headache has led to recommended changes in nosology originally proposed by the International Headache Society (IHS). Recent scientific and clinical observations prompting revised classification have also led to the integration of pathoanatomic models, which explain persistent headache. Strategies for the management of chronic craniofacial pain should emphasize key behavioral and attitudinal changes and avoidance of medication overusage.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10998707&dopt=Abstract headache medicine




Head-HUNT: validity and reliability of a headache questionnaire in a large population-based study in Norway.

Hagen K, Zwart JA, Vatten L, Stovner LJ, Bovim G.

Department of Clinical Neuroscience, Norwegian University of Science and Technology, Trondheim. knut.hagen medisin.ntnu.no

We have assessed the validity and reliability of a self-administered headache questionnaire used in the 'Nord-Trondelag Health Survey 1995-97 (HUNT)' in Norway, by blindly comparing questionnaire-based headache diagnoses with those made in a clinical interview of a sample of the participants. Restrictive questionnaire-based diagnostic criteria for migraine, assessed according to modified criteria of the International Headache Society, performed excellently in selecting 'definite' migraine patients (100% positive predictive value). The best agreement concerning migraine diagnoses was achieved by using a liberal set of criteria (kappa 0.59). Similar agreement was found evaluating patient status as headache sufferers, and as sufferers from frequent headaches (>6 days per month) (kappa 0.57 and 0.50, respectively). The kappa values of non-migrainous headache and chronic headache (> 14 days per month) were 0.43 and 0.44, respectively. The results suggest that our self-administered questionnaire may be suitable in identifying a population with 'definite' migraine, and the questionnaire is an acceptable instrument in determining the prevalence in Nord-Trondelag of headache sufferers, migraine, non-migrainous headache, and frequent or chronic headache sufferers.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10999674&dopt=Abstract headache medicine




Depression and anxiety disorders associated with headache frequency. The Nord-Trondelag Health Study.

Zwart JA, Dyb G, Hagen K, Odegard KJ, Dahl AA, Bovim G, Stovner LJ.

Department of Clinical Neuroscience, Section of Neurology, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. john-anker.zwart medisin.ntnu.no

The aim of this large cross-sectional population-based study was to examine the association between migraine, non-migrainous headache and headache frequency with depression, and anxiety disorders. From 1995 to 1997, all 92 566 inhabitants aged 20 years and above in Nord-Trondelag County in Norway were invited to participate in the Nord-Trondelag Health Study ('Helseundersokelsen i Nord-Trondelag' = HUNT-2). A total of 64 560 participated, whereof 51 383 subjects (80%) completed a headache questionnaire that was included. Of these 51 383 individuals, 47 257 (92%) completed the depression subscale items and 43 478 (85%), the anxiety subscale items of the Hospital Anxiety and Depression Scale (HADS). Associations were assessed in multivariate analyses, estimating prevalence odds ratios (OR) with 95% confidence intervals (CI). Depression and anxiety disorders as measured by HADS, were significantly associated with migraine (OR = 2.7, 95% CI 2.3-3.2; OR = 3.2, 95% CI 2.8-3.6) and non-migrainous headache (OR = 2.2, 95% CI 2.0-2.5; OR = 2.7, 95% CI 2.4-3.0) when compared with headache-free individuals. The association was stronger for anxiety disorders than for depression. The ORs for depression and anxiety disorders amongst both migraine and non-migrainous sufferers increased with increasing headache frequency. Depression and anxiety disorders are associated with both migraine and non-migrainous headache, and this association seems more dependent on headache frequency than diagnostic category.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12603289&dopt=Abstract headache medicine




Efficacy and effect of SI17 therapy on pancreatic polypeptide in vascular and tension-type headache.

Zhang X, Li Y, Ren S, Kuang P, Wu W, Zhang F, Liu J.

Department of Neurology, 261 Hospital, Beijing, China.

BACKGROUND AND PURPOSE: Vascular and tension-type headache is most commonly encountered, and SI17 therapy has been tested to treat headache with good results. The efficacy of SI17 therapy for vascular and tension-type headache was compared and the effect of SI17 therapy on pancreatic polypeptide (PP) was studied. MATERIALS AND METHODS: 29 cases of vascular headache (20 cases in acute attack during the trial) and 27 cases of tension-type headache (19 cases in acute attack) were enrolled in the study. Plasma PP level before and 4th day after treatment was measured by radioimmunoassay. RESULTS: SI17 therapy is better for the treatment of vascular headache. Vascular headache with higher PP level and tension-type headache with normal PP level had good therapeutic results. CONCLUSION: The clinical efficacy is better for vascular headache with the increase of vagus tension and for tension-type headache with normal vagus tension.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11038985&dopt=Abstract headache medicine




Anger, depression, and coping interactions in headache activity and adjustment: a controlled study.

Materazzo F, Cathcart S, Pritchard D.

Pain Management Unit, Flinders Medical Center, Bedford Park, South Australia 5042, Australia. felicity.materazzo fmc.sa.gov.au

OBJECTIVE: To determine if individuals in the general community with chronic headache or migraine differ in terms of anger, depression, and coping strategies and from headache-free individuals in terms of anger and depression. METHOD: A community sample comprising 16 chronic tension-type headache (CTH), 28 migraine headache (MH), and 38 headache-free control subjects (CNT) were compared on measures of anger, depression, and use of various coping strategies. Affective and coping measures, recorded during a headache-free period, were regressed on headache activity measured in a daily diary over the following 2 weeks. Relationships between anger, depression, and coping were also examined in each of the headache groups. RESULTS: The MH subjects were found to use less effective coping strategies than controls and CTH, while the CTH group had higher levels on depression and various anger scales compared to controls and MH. Direct positive relationships were observed between suppressed anger and depression in the MH group, and between trait anger and depression in the CTH group. Anger and coping were predictive of headache activity in the following 2 weeks for both MH and CTH groups, while depression and coping, compared to coping only, were predictive of lifestyle interference from head pain in MH and CTH, respectively. CONCLUSION: The results support a relationship between affective and coping factors in headache activity and adjustment.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11053606&dopt=Abstract headache medicine




Attitudes and judgment of emergency physicians in the management of patients with acute headache.

Perry JJ, Stiell IG, Wells GA, Mortensen M, Lesiuk H, Sivilotti M, Kapur A.

Department of Emergency Medicine, University of Ottawa, Ontario, Canada. jperry ohri.ca

OBJECTIVES: There is little evidence guiding physicians in the evaluation of acute headache to rule out nontraumatic subarachnoid hemorrhage (SAH). The authors assessed emergency physicians in: 1) their pretest accuracy for predicting SAH, 2) their comfort with not ordering either head computed tomography (CT) or lumbar puncture (LP) in patients with acute headache, and 3) their comfort with not ordering head CT before performing LP in patients with acute headache. METHODS: This two-and-a-half-year prospective cohort study was conducted in three tertiary care university emergency departments with 51 emergency physicians. Consecutive patients more than 15 years of age with a nontraumatic, acute headache (onset to peak headache less than one hour) and normal results on neurologic examination were enrolled. Patients known to have cerebrospinal fluid shunt, aneurysm, or brain neoplasm, and patients with recurrent headaches of the same intensity/character as their current headache were excluded. Physicians recorded their pretest probability for SAH and their comfort with performing either no tests or an LP without first obtaining head CT. RESULTS: The authors enrolled 747 patients (mean age 42.8 years; 60.1% female; 77.0% their worst headache; 83.4% had CT and/or LP), including 50 (6.7%) with SAHs. Physicians reported being "uncomfortable" or "very uncomfortable" with performing no test in 75.4% of cases and being "uncomfortable" or "very uncomfortable" with performing LP without CT in 49.6% of cases. The area under the receiver operating characteristic (ROC) curve for SAH was 0.85 (95% CI = 0.80 to 0.91). CONCLUSIONS: Physicians were able to moderately discriminate SAH from other causes of headache before diagnostic testing.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15635135&dopt=Abstract headache medicine