Clinical features and therapy of medication overuse headache.

Kavuk I, Katsarava Z, Selekler M, Sayar K, Agelink MW, Limmroth V, Diener HC.

Department of Neurology, University of Diusburg-Essen, Essen, Germany. ilker.kavuk uni-essen.de

Inappropriate use of headache medication (>15 times/month) for the treatment of headache episodes may contribute to the development of chronic headache which is refractory to most treatments. Physicians experienced in the treatment of migraine and other headaches are well aware that the daily intake of antipyretic or antiinflammatory analgesics, opioids, ergot alkaloids and "triptans" may result in chronic daily headache. Conversely, if a patient complains of chronic headache and takes pain medication every day, this headache is most likely to be caused and sustained by the medication and will vanish or improve with abstinence. Treatment includes drug withdrawal followed by structured acute therapy and initiation of migraine prophylactic treatment.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15689304&dopt=Abstract headache medicine




Use of the headache impact test (HIT-6) in general practice: relationship with quality of life and severity.

Nachit-Ouinekh F, Dartigues JF, Henry P, Becg JP, Chastan G, Lemaire N, El Hasnaoui A.

Public Health Department, University Victor Segalen, INSERM U593, Bordeaux, France. fatima.nachit noos.fr

To assess the global impact of episodic headaches in patients consulting general practitioners (GPs) using the Headache Impact Test (HIT-6) questionnaire, and to compare this with measures of headache severity and quality of life. A total of 2802 patients consulting 349 GPs participated to this cross-sectional study. Data were collected on headache severity using the Migraine Severity (MIGSEV) scale, headache impact with the HIT-6 and quality of life with the Qualite de Vie et Migraine (QVM) questionnaire. Diagnosis was assigned retrospectively according to the International Headache Society criteria. The association between the HIT-6 scale and the other scales was determined from a Pearson's chi-square test, an analysis of variance and Spearman correlation coefficients. Patients (2537) provided exploitable data. Six percent of the sample had little impact, 14% moderate, 14% substantial and 66% severe impact. The HIT-6 scores were significantly different between diagnostic groups, being highest in the migraine group. The HIT-6 score were well correlated with headache severity and QVM score. The HIT-6 scale correlates, across different diagnostic groups of headache, with both headache severity and with quality of life.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15693807&dopt=Abstract headache medicine




Speed of onset, efficacy and tolerability of zolmitriptan nasal spray in the acute treatment of migraine: a randomised, double-blind, placebo-controlled study.

Dodick D, Brandes J, Elkind A, Mathew N, Rodichok L.

Department of Neurology, Mayo Clinic College of Medicine, Scottsdale, Arizona 85259, USA. Dodick.David mayo.edu

INTRODUCTION: Migraine is a common, disabling condition that has a significant impact on patients and relatives, and is a considerable economic burden on society. Migraine patients want fast-acting treatments with high efficacy. Previous studies have demonstrated that orally administered formulations of zolmitriptan are rapidly and highly effective in the acute treatment of migraine. The objective of this study was to assess the efficacy, speed of onset and tolerability of the nasal spray formulation of zolmitriptan in migraine treatment. METHODS: This multicentre, randomised, double-blind study recruited 2122 patients (aged 18-65 years) who had an established diagnosis of migraine (according to International Headache Society criteria), with or without aura. Patients were randomised to receive zolmitriptan 5mg nasal spray or placebo to treat up to two migraine attacks within 15 minutes of headache pain becoming moderate or severe. The primary endpoint was headache response (reduction in migraine pain from severe/moderate to mild/none) at 2 hours, 1 hour, 30 minutes and 15 minutes post-dose (analysed using a step-down approach). Secondary endpoints included headache response at 4 hours, pain-free rates at 30 minutes and 1, 2 and 4 hours, and sustained headache response and pain-free status at 24 hours post-dose. RESULTS: The headache response rate at 2 hours post-dose was 66.2% for the zolmitriptan group, compared with 35.0% for the placebo group (p < 0.001). Zolmitriptan nasal spray also produced significantly higher headache response rates than placebo at all earlier timepoints assessed, starting as early as 15 minutes post-dose (p < 0.001). Similar results were obtained for the analysis of the first attack. Significantly higher pain-free rates were obtained with zolmitriptan nasal spray, compared with placebo, from 15 minutes post-dose onward (p < 0.005). Zolmitriptan nasal spray was also significantly superior to placebo for headache response at 4 hours, sustained headache response at 24 hours and sustained pain-free rate at 24 hours.Zolmitriptan nasal spray was well tolerated, with most adverse events being of short duration and mild or moderate intensity. CONCLUSIONS: Zolmitriptan nasal spray is highly effective in the acute treatment of migraine and has a very fast onset of action, producing significant headache response and pain-free rates as early as 15 minutes post-dose (the earliest assessment in this study). In addition to the very fast onset of action, zolmitriptan nasal spray produced significantly higher sustained headache response and pain-free rates at 24 hours post-dose compared with placebo. These desirable efficacy outcomes were combined with good tolerability.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15697326&dopt=Abstract headache medicine




Greater occipital nerve blockade for cluster headache.

Peres MF, Stiles MA, Siow HC, Rozen TD, Young WB, Silberstein SD.

Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, USA.

Cluster headache is perhaps the most painful of the primary headache disorders. Its treatment includes acute, transitional, and preventive therapy. Despite the availability of many treatments, cluster headache patients can still be difficult to treat. We treated 14 cluster headache patients with greater occipital nerve block as transitional therapy (treatment initiated at the same time as preventive therapy). The mean number of headache-free days was 13.1 + 23.6. Four patients (28.5%) had a good response, five (35.7%) a moderate, and five (35.7%) no response. The greater occipital nerve block was well tolerated with no adverse events. Headache intensity, frequency and duration were significantly decreased comparing the week before with the week after the nerve block (P < 0.003, P = 0.003, P < 0.005, respectively). Greater occipital nerve blockade is a therapeutic option for the transitional treatment of cluster headache.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12230593&dopt=Abstract headache medicine




Self-reported headache frequency in canadian adolescents: validation and follow-up.

Dooley JM, Gordon KE, Wood EP.

Objective.-To validate our previous estimates of the prevalence of frequent headache and associated factors in a new sample of 12- to 13-year-old adolescent Canadians, and to explore if estimates of the prevalence of frequent headache and associated factors remain stable within the original cohort after a two-year interval. Methods.-We analyzed the self-administered questionnaire microdata files of the National Longitudinal Survey of Children and Youth (NLSCY: 1998-1999). 1694 respondents representing 724 400 youth aged 12 to 13 years were used to validate the prevalence in our initial estimates. From the initial cohort, 1764 respondents representing 819 600 youth, now aged 14 to 15 years, were used to examine whether frequent headache prevalence or associated factors had changed in the intervening two years. Results.-Among the analyzed individuals, 26.3% of 12- to 13-year olds and 31.2% of 14- to 15-year olds reported frequent headaches of "about once a week" or more often (P= .001). Our previous study of the NLSCY: 1996-1997 found a prevalence of 26.6% in 12- to 13-year olds. We previously identified 22 risk factors, of which 15 were replicated and one proxy was available within this iteration of the survey. For the 12- to 13-year olds, 14/16 were associated (P < .01, chi-square) with frequent headaches. For the initial cohort, now 14- to 15-year olds, 15/16 risk factors remained associated (P < .01, chi-square) with an increased risk of headaches. Conclusions.-Our estimates of frequent headache prevalence are reliable and consistent in two large nationally representative cohorts of 12- to 13-year olds. In the first of these groups there was an increase in prevalence over 2 years as adolescence progresses. Our identified risk factors for frequent headaches have been validated within another cohort and are maintained as the cohort ages. (Headache 2005;45:127-131).

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15705117&dopt=Abstract headache medicine




Risk factors for headache, including TMD signs and symptoms, and their impact on quality of life. Results of the Study of Health in Pomerania (SHIP).

Bernhardt O, Gesch D, Schwahn C, Mack F, Meyer G, John U, Kocher T.

Department of Restorative Dentistry, Periodontology and Pediatric Dentistry, School of Dentistry, University of Greifswald, 17487 Greifswald, Germany. obernhar uni-greifswald.de

OBJECTIVE: The aim of this investigation was to evaluate the role of various signs and symptoms of temporomandibular disorders (TMD), among other potential risk factors, in developing frequent headache in a population-based sample of the cross-sectional epidemiologic Study of Health in Pomerania (SHIP). The impact of headache and of myogenous and arthrogenous signs of TMD on the quality of life of this sample was evaluated. METHOD AND MATERIALS: Medical history and dental and sociodemographic parameters of 4,255 subjects were checked for correlations with frequent headache using a multivariate logistic regression model. The quality of life of the headache sufferers was evaluated with a questionnaire on mental and physical health. RESULTS: Of the sample, 9% reported suffering from frequent headache. Significant values for the odds ratios for the whole sample were found for pain on palpation of the masticatory muscles; the anamnestic question on masticatory muscle pain; ear noises; lateral palpation pain of the temporomandibular joints (TMJ); several sleep disorders; psychosomatic complaints; and risk for women. Palpation pain of the muscles showed a dose/response effect. Subjects with a higher education level had a significantly reduced risk for developing frequent headache. Anamnestic questions for pain in the TMJ area, TMJ clicking, smoking, alcohol abuse, contraceptives, income, and chronic diseases did not correlate significantly with frequent headache. Subjects who reported frequent headache exhibited a significant reduction of physical and mental health scores. Pain upon muscle palpation showed significantly reduced scores on both scales for both genders. CONCLUSION: Within the limitations of this study, in addition to sensitive TMJs, mainly palpation-sensitive masticatory muscles showed a significant relation to the occurrence of frequent headache. Because of the number of tested covariates originally included in the model, this relation seems essential.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15709498&dopt=Abstract headache medicine




[Chronic daily headache: I. Diagnosis and pathophysiology.]

[Article in Spanish]

Volcy-Gomez M.

Hospital Universitario San Vicente de Paul., Medellin, Colombia.

INTRODUCTION. Chronic daily headache (CDH), or headache more than 15 days/month or over 180 days/year, is one of the main reasons for visits to specialised headache centres and accounts for up to 5% of primary headaches. AIMS. Our objective was to determine the classification, epidemiology, risk factors and pathophysiology of CDH by reviewing the literature. DEVELOPMENT. CDH has a prevalence of 2 to 3% in the general population and is subdivided into two groups according to the headache duration. The first group (more than four hours) represents over 90% patients; includes chronic migraine (60 to 87.4%), chronic tension-type headache (0.9 to 28.8%), new daily persistent headache (0.8 to 20%) and hemicrania continua (2.2%), which represents over 90% of patients. The second group (less than four hours) is made up of cluster, chronic paroxysmal hemicranial, idiopathic stabbing-type headache and cranial neuralgias. The pathophysiology of CDH is multifactorial; it has been suggested that genetic factors, peripheral and central neuronal dysfunction derived from the alteration of protein and receptor synthesis, inadequate release of inhibitory and excitatory neuropeptides, imbalance, excitatory and inhibitory neuropeptides concentration imbalance, in association with abuse of analgesics, high comorbidity with psychiatric disorders (anxiety, depression and panic) and sleep disorders may all be involved. CONCLUSIONS. CDH is a frequent cause of headache and chronic migraine is the main presenting symptom. Pathophysiology is multifactorial; there is a strong association with analgesic abuse, high comorbidity with psychiatric disorders and sleep disorders.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15712167&dopt=Abstract headache medicine




[Verbal and drawing expression of primary headaches in developmental age]

[Article in Polish]

Kacinski M, Prajsner B, Gergont A, Wesolowska E.

Klinika Neurologii Dzieciecej, Collegium Medicum, Uniwersytetu Jagiellonskiego, Krakow. neupedkr cm-uj.krakow.pl

THE AIM OF THE STUDY: Children and adolescents are the subject, which suffers from primary headaches.Type and character of the pain is known only by them and their relations are necessary to know it. This study was performed to establish how children and adolescents express verbally and by paintings their headaches. MATERIAL AND METHODS: The group of 52 patients with primary headaches and normal IQ was analysed. It was 35 girls and 17 boys, aged 6-17 years. Due to IHS International Classification, 20 of them suffered from migraine, and 32 from tension headaches. All patients were asked by physician to illustrate their headache verbally and by painting. Description should involve details about pain character, its localisation, severity, time of duration, frequency and time of appearance, and also accompaning symptoms. Instruction was to use 1/2 -1 page and to colour paintings. RESULTS: Only 11/52 children illustrated headaches by painting. Red colour dominated on these illustrations. 20% of children only described pain using verbal expression as normal for their age level. Other children used very short elaboration, from laconic to full pain characteristic. CONCLUSION: Patients in developmental age more often used verbal than drawing expression of their headaches. Migraine and tension headaches drawing was significantly different. Also verbal expression of migraine was different in localisation and symptoms during pain and accompanied pain. It is necessary to investigate headaches in a subjective and quantitative way.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15727023&dopt=Abstract headache medicine