[Headache and hemodialysis: evaluation of the possible triggering factors and of the treatment]

[Article in Portuguese]

Antoniazzi AL, Bigal ME, Bordini CA, Speciali JG.

Departamento de Neurologia, Hospital das Clinicas, Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, Ribeirao Preto, SP, Brasil. luisantoniazzi hotmail.com

A growing number of patients have been undergoing dialysis procedures all around the world. Around 70% of the patients receiving dialysis treatment complain about headaches. In spite of this, headache is not well studied in this group of patients. The aims of this study are: to evaluate possible triggering factors related to hemodialysis headache and to evaluate the analgesic treatments used under this situation. We prospectively studied 50 patients with chronic renal failure attending to three dialysis services from the town of Ribeirao Preto, State of Sao Paulo, Brazil, from January 1998 to December 1999. All of them presented headaches strictly related to the hemodialysis sessions. Headache occurred mainly in the second half of the hemodialysis (86%). Arterial hypertension (38%), arterial hypotension (12%) and changes in the weight during the hemodialysis sessions (6%) were the most consistently triggering situations. In 28% of the cases no factors were identified. Dipyrone was, by far (56%), the most frequently analgesic used. Despite being so common it noteworthy how scarce are studies in literature concerning headaches in patients with chronic renal failure. These patients, besides having to bear the burden of living with a painful and boring procedure to keep them alive, many of them have the additional burden, to live with a headache in most of the sessions. The identification of possible triggering factors and further evaluations of the treatment might increase our knowledge and contribute to reduce the burden of the headaches in patients with chronic renal failure.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12244401&dopt=Abstract headache medicine




[The relationship of stabbing headaches with migraine attacks.]

[Article in Turkish]

Selekler HM, Komsuoglu SS.

Kocaeli University Faculty of Medicine, Department of Neurology, Kocaeli, Turkey. macitselekler hotmail.com.

Temporal and spatial relationships between idiopathic stabbing headache and migraine headache have so far been reported. We aimed to obtain some clues about the stabbing headache pathophysiology by comparing the two types of headache in regard to temporal and spatial relationships as well as precipitating and relieving factors of stabbing headache during migraine attacks. 43 patients who reported temporal relationship between migraine headache and stabs were studied. Localizations of migraine and stabbing headaches overlapped in 38 (88%) of the patients. 34 (79%) had stabs during migraine attacks, while 9 (21%) had stabs with a very close temporal relationship to migraine attacks. During the attacks, while head movements caused stabs in 10 patients (23%); applying pressure to the temples (n=3) and sleeping (n=2) alleviated or abolished stabs. We thought that stabs probably occur during a period in which central pain control mechanisms are weakened.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15791500&dopt=Abstract headache medicine




Plasma and urinary serotonin and 5-hydroxyindol-3-acetic acid in adults with migraine and tension-type headache.

Milovanovic DD, Majkic-Sing N, Mirkovic D, Pavlovic J.

Health Center, Institute for Medical Biochemistry, Clinical Centre of Serbia, Belgrade, Yugoslavia.

Each headache can be a complex diagnostic, therapeutic, prognostic and social problem. The pain in the head can be connected with many organic and non-organic causes. In this work, the levels of plasma and urinary free 5-HT and 5-HIAA were investigated in eight migraine (aged 23-59 years) and ten tension-type headache suffers (aged 38-61 years). Based on the data obtained and their correlation with clinical features and in comparison with a control group, the following can be stated: (1) there is involvement of serotonin in migraine and tension-type headache during the attacks, although the positive 5-HT values from plasma were small; (2) urinary 5-HT values in migraine and tension-type headache were normal in comparison to the control group; (3) significantly decreased values of 5-HIAA in urine were found both in migraine and tension-type headache groups. These findings show that catabolism of 5-HT is probably decreased during headache periods; (4) visual aura was found in five out of ten subjects with tension-type headache.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10721056&dopt=Abstract headache medicine




Headaches in a pediatric emergency department: etiology, imaging, and treatment.

Kan L, Nagelberg J, Maytal J.

Division of Pediatric Neurology, Schneider Children's Hospital, Long Island Jewish Medical Center, The Long Island Campus for the Albert Einstein College of Medicine, New Hyde Park, NY 11040, USA.

OBJECTIVE: To assess the spectrum of diagnoses, the use of CT scans of the brain, and pharmacological treatments in patients presenting to a pediatric emergency department with headaches as the chief complaint. METHODS: A 1-year retrospective chart review of all children who presented to the emergency department with a headache as the chief complaint. RESULTS: One hundred thirty patients (0.7% of all pediatric emergency department visits, mean age = 9.3 years) were included in the study. Primary headaches included 11 migraine (8.5%) and 2 tension headaches (1.5%). Most of the secondary nonneurological headaches were associated with viral and respiratory illnesses (n=37, 28.5%), while the majority of the secondary neurological headaches included 26 posttraumatic (20%), 15 possible ventriculoperitoneal shunt malfunctions (11.5%), and 3 cases of aseptic meningitis (2.3%). The neurological etiology in 9 of these children (6.9%) was found to be serious (subdural hematoma, epidural hematoma, proven ventriculoperitoneal shunt malfunction, brain abscess, pseudotumor cerebri, and aseptic meningitis). Fifteen patients could not be etiologically classified, either because no specific etiology was found or their discharge diagnoses could not clearly explain the headache. Approximately 10% (5/53) of the CT scans of the head that were performed showed new abnormal findings including hydrocephalus secondary to ventriculoperitoneal shunt malfunction (2), subdural hematoma (1), epidural hematoma (1), and skull fracture (1). Forty-two patients (32%) were treated pharmacologically. Thirty-nine of the 42 treated patients (93%) were given over-the-counter analgesics, and 9 (21%) were given prescribed analgesics. CONCLUSIONS: The majority of the headaches in the pediatric emergency department were secondary to concurrent illness and minor head trauma, and required no pharmacological treatment or only treatment with minor analgesics. In a small minority of patients, headaches were secondary to serious neurological conditions, which required immediate medical attention. Computed tomography scans showed new abnormalities in a minority of patients and should be reserved for those with neurological diagnoses such as head trauma and ventriculoperitoneal shunt, as well as for those patients with recent onset of headaches with no clear etiological explanation, and for those with high-risk medical conditions, such as hypocoagulabilities. Future prospective studies are needed to assess the efficacy of the various pharmacological treatments in this population.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10759899&dopt=Abstract headache medicine




Life event stress and headache frequency revisited.

Reynolds DJ, Hovanitz CA.

Department of Psychology, University of Cincinnati, Cincinnati, OH 45221-0376, USA.

Life stress is found to be related to headache frequency in some studies, but not others. Research designs that find a relationship between the two tend to evaluate young subjects and employ large sample sizes. The purpose of this study was to evaluate the relationship between headache frequency and life stress, while considering gender and age differences that may be present in the relationship. In addition, as depression or presence of headache at the time of assessment may influence the report of headache frequency, an attempt to control for these factors was employed. Several self-report measures of headache symptomatology, headache presence, depression, and life stress were completed by 1289 subjects. Negative life event stress was found to be modestly but significantly related to headache frequency. The relationship between the 2 variables was stronger for women than for men and, after the influence of depression and headache state was removed, the relationship between life stress and headache frequency remained significant only for women. In the oldest 10% of the sample, there was no evidence of a relationship between negative life event stress and headache frequency.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10759910&dopt=Abstract headache medicine




The wavelength of light causing photophobia in migraine and tension-type headache between attacks.

Main A, Vlachonikolis I, Dowson A.

European Institute of Health and Medical Sciences, University of Surrey, Guildford, Surrey; Kings Headache Service, London, England.

OBJECTIVE: To ascertain the wavelength of light that patients with migraine and tension-type headache find uncomfortable between attacks. BACKGROUND: Photophobia is an abnormal perceptual sensitivity to light experienced by most patients with headache during and, also, between attacks. METHODS: We examined the discomfort threshold to light of low, medium, and high wavelengths in a group of patients with migraine (n=21), patients with tension-type headache (n=19), and healthy controls (n=21). RESULTS: The results indicate that the migraine group had significantly lower discomfort thresholds at the low (P=.001) and high (P=.031) wavelengths compared with both the tension-type headache and control groups; the latter two groups had similar average discomfort levels at these two wavelengths. With the medium wavelength, the control group had significantly higher discomfort thresholds than the migraine (P=.002) and tension-type headache (P=.031) groups; the latter two groups had similar discomfort levels at this wavelength. With unfiltered (white) light, the migraine group had the lowest discomfort threshold and the control group the highest (P=.026), whereas the tension-type headache group had an intermediate discomfort threshold. CONCLUSIONS: There were significant differences between migraineurs, patients with tension-type headache, and healthy controls in the wavelengths that are uncomfortable between attacks.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10759921&dopt=Abstract headache medicine




Cluster headache is not associated with signs of a systemic inflammation.

Remahl IN, Waldenlind E, Bratt J, Ekbom K.

Departments of Neurology, Karolinska Institutet, Huddinge University Hospital, Huddinge, Sweden.

OBJECTIVE: To investigate whether there is clinical or biochemical evidence for a transient systemic inflammation during active periods of cluster headache. METHODS: Twenty-seven male and female consecutively selected patients with episodic cluster headache filled in questionnaires aiming at detecting any concurrent systemic vasculitic or rheumatoid disease. They were physically examined by both a neurologist and a rheumatologist independent of each other. Blood and urine samples were taken one to three times during an active cluster period and once in remission. The following analyses were performed: hemoglobin, erythrocyte sedimentation rate, C-reactive protein, complete blood counts including differential counts, creatinine, albumin, creatine kinase, electrophoreses of serum (with haptoglobin, orosomucoid, IgG, IgM), von Willebrand's factor, antinuclear antibodies, rheumatoid factor, cytoplasmic antineutrophil cytoplasmic autoantibodies, perinuclear antineutrophil cytoplasmic autoantibodies, and routine urinary tests. An age- and sex-matched control group of 99 consecutive patients attending the Outpatient Department of Neurology for symptoms/diseases other than severe headache completed the same questionnaire as the patient group. RESULTS: Only one patient with cluster headache showed clinical signs (livedo reticularis) that could have been due to an ongoing systemic vasculitis. Most symptoms were equally or even more prevalent in the control group than among the patients with cluster headache. However, cold feet were about twice as prevalent among female patients with cluster headache than in the control group. This was considered due to their smoking habits. Laboratory tests showed no statistically significant differences between the active cluster periods and remission. There were some slightly abnormal values in single laboratory tests, some of which were probably due to concurrent upper respiratory infections. The findings of laboratory tests for one patient could have been due to nephritis. All patients were negative for cytoplasmic antineutrophil cytoplasmic autoantibodies and perinuclear antineutrophil cytoplasmic autoantibodies. CONCLUSIONS: These results were taken as evidence that no systemic inflammation is present during the active cluster headache period. However, whether a local retro-orbital inflammation underlies the pathophysiology of cluster headache remains obscure.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10759931&dopt=Abstract headache medicine




[Headaches in childhood: association with sleep disorders and psychological implications]

[Article in Spanish]

Smeyers P.

Seccion de Neuropediatria, Hospital Infantil Universitario La Fe, Valencia, Espana. patsmeyers redestb.es

INTRODUCTION: Infantile headache is an increasingly important cause of medical consultation, due both to its increasing prevalence and its subsequent repercussion on the child's life. Also, certain sleep disorders (parasomnias) are commoner in infancy than in later life. The relationship between headache and sleep disorders is not clear, but from the literature it would seem that there is an association, at least in some types of headache, in adults. PATIENTS AND METHODS: In order to determine possible alterations in patterns of sleep in children with chronic headache (a history of headache during the previous six months occurring more than 15/month or 180 days/year) we carried out a comparative study on a total of 224 Valencian children aged between 3 and 15 years. Of these, 97 children had been diagnosed as having primary chronic headache (cases) in a specialized. PAEDIATRIC NEUROLOGY CLINIC: Twenty seven healthy children with no history of headache (controls) were found amongst the pupils of a Valencian state school. Using a purpose-designed sleep questionnaire, data was obtained as to the duration, hygiene, quality and incidence of parasomnia in the two groups. RESULTS: The results showed a decrease in duration of sleep at night, increased frequency of poor sleep hygiene, increased prevalence of certain sleep disorders (insomnia and nocturnal wakening), of certain parasomnias (somnambulism, somniloquy, enuresis) and of nocturnal snoring, all of statistical significance (test chi 2 with p < 0.005). CONCLUSION: In children there is an association between chronic headache and certain sleep disorders.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10778505&dopt=Abstract headache medicine