The three dimensions of headache impact: pain, disability and affective distress.

Holroyd KA, Malinoski P, Davis MK, Lipchik GL.

Psychology Department, 032 Porter Hall, Ohio University, Athens 45701, USA. holroyd oak.cats.ohiou.edu

It is increasingly recognized that pain measures alone provide incomplete information about the impact of pain on functioning or quality-of-life. A wide range of measures that promise to provide additional information about the impact of pain on people's lives are thus coming into use. In order to clarify the construct of headache impact, we attempted to identify the dimensions assessed by a set of 22 headache-impact measures and to identify the specific measures that best assessed each of these headache-impact dimensions. Adults (n=329) with frequent benign headache disorders completed a comprehensive assessment battery that included 22 headache-impact measures. Factor analysis was then used to identify dimensions underlying the headache-impact measures. Three factors labeled Affective Distress, Pain Density and Disability best accounted for correlations among headache-impact measures. Interfactor correlations ranged between 0.37 and 0.20, suggesting three correlated but separable impact dimensions. These results suggest the construct of headache impact needs to be broadened beyond pain and disability to include affective distress. An adequate assessment of the impact of recurrent headache disorders in clinical trials and other research may require measures from all three of the headache-impact dimensions identified here.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10568866&dopt=Abstract headache medicine




Use of the hospital anxiety and depression scale as a screening tool for patients with headache.

Juang KD, Wang SJ, Lin CH, Fuh JL.

Department of Psychiatry, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.

BACKGROUND: The Hospital Anxiety and Depression Scale (HADS) is becoming widely used in medical settings to screen for anxiety or depressive disorders. It has been shown to be a good screening instrument in different ethnic and disease populations. The objective of this study was to evaluate the validity and reliability of HADS in patients with headache at a headache clinic. METHODS: Consecutive new patients to a headache clinic at the Taipei Veterans General Hospital from September to December, 1998, were recruited in the study. The participants completed the HADS questionnaire and underwent a psychiatric semistructured interview according to the Diagnostic and Statistical Manual (4th revision). The reliability and validity of the HADS were evaluated with respect to headache. RESULTS: A total of 62 patients (21 men, 41 women) completed the study. The HADS had a good internal consistency when applied to patients suffering from headache, with a Cronbach's alpha coefficient of 0.84 and a split-half reliability of 0.84. Factor analysis in this sample revealed four factors: anxiety, depression, panic and somatic factors. A total of 48 patients (77%) had a psychiatric diagnosis. The frequency of depressive disorders was 57% and anxiety disorders 31%. A total HADS score of 10 or more was the optimal cut-off point for depressive disorders. The sensitivity was 85.7%, and the specificity 33.3%. A total score of at least 13 was the optimal cut-off point for anxiety disorder. The sensitivity was 84.2%, while the specificity was 41.9%. CONCLUSIONS: Depression and anxiety were quite common among patients with headache in a headache clinic. The HADS can be used as a screening instrument for depressive and anxiety disorders. Because of the low specificity, the HADS should not be used solely as an indicator of psychiatric comorbidity among patients with headache in a headache clinic. This is the first study that verifies the use of the HADS as a psychiatric screening tool in patients with headache by comparing the scores of the HADS with psychiatric diagnoses.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10575802&dopt=Abstract headache medicine




[Transformed migraine--chronic daily headache]

[Article in Norwegian]

Boe MG, Monstad P.

Nevrologisk avdeling Vest-Agder Sentralsykehus, Kristiansand. magne.boe c2i.net

Transformed migraine is probably a common cause of chronic daily headache. The International Headache Society system of diagnostic classification of headache classifies headaches, not patients, and pays no attention to the long-term evolution of the patient's headache. We support the suggestion made by Silberstein et al. that transformed migraine should be used as a diagnostic label in patients suffering from chronic daily headache with "migrainous features" and a history of migraine. Since 1994, intravenous treatment with dihydroergotamine (DHE) has been used for these patients. Among 16 patients suffering from chronic daily headache which were treated with this drug in 1996, 10 patients reported complete relief of headache at discharge from the hospital, but only four patients experienced complete relief from headache for more than two weeks. We think that the most important treatment for these patients are medicament withdrawal, information, help and support so that patients may cope with their headache. Dihydroergotamine can help patients going through a withdrawal regime.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10667127&dopt=Abstract headache medicine




Familial occurrence of headache.

Aromaa M, Rautava P, Sillanpaa M, Helenius H, Ojanlatva A.

Department of Child Neurology, University of Turku, Finland.

Associations between the occurrences of headache among parents and their offspring during a 7-year follow-up were studied. Data were collected using a prestructured questionnaire from a representative population-based sample of 1443 families expecting their first child. Seven years later, another questionnaire was sent to 1132 families still included in the study. Questionnaires were returned by 968 families. One or either of the parents had experienced frequent headache in 47% of families (34% of the mothers and 19% of the fathers) before pregnancy. Of the 6-year-old children, 15% had headache disturbing daily activities. Mother's prepregnancy headache was a clear predictor of her child's preschool headache (p = 0.006, OR = 1.7, 95% CI 1.2-2.4). In the clinical interview, the children with headache more often had first-degree and second-degree relatives with headache than the control children.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10668122&dopt=Abstract headache medicine




Headache and major depression: is the association specific to migraine?

Breslau N, Schultz LR, Stewart WF, Lipton RB, Lucia VC, Welch KM.

Department of Psychiatry, Henry Ford Health System, Detroit, MI 48202-3450, USA. nbresla1 hfhs.org

OBJECTIVE: To examine the relationship between migraine and major depression, by estimating the risk for first-onset major depression associated with prior migraine and the risk for first migraine associated with prior major depression. We also examined the extent to which comorbidity with major depression is specific to migraine or is observed in other severe headaches. METHODS: Representative samples of persons 25 to 55 years of age with migraine or other severe headaches (i.e., disabling headaches without migraine features) and controls with no history of severe headaches were identified by a telephone survey and later interviewed in person to ascertain history of common psychiatric disorders. RESULTS: Lifetime prevalence of major depression was approximately three times higher in persons with migraine and in persons with severe headaches compared with controls. Significant bidirectional relationships were observed between major depression and migraine, with migraine predicting first-onset depression and depression predicting first-onset migraine. In contrast, persons with severe headaches had a higher incidence of first-onset major depression (hazard ratio = 3.6), but major depression did not predict a significantly increased incidence of other severe headaches (hazard ratio = 1.6). CONCLUSIONS: The contrasting results regarding the relationship of major depression with migraine versus other severe headaches suggest that different causes may underlie the co-occurrence of major depression in persons with migraine compared with persons with other severe headaches.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10668688&dopt=Abstract headache medicine




The notion of "warning leaks" in subarachnoid haemorrhage: are such patients in fact admitted with a rebleed?

Linn FH, Rinkel GJ, Algra A, van Gijn J.

University Department of Neurology, Utrecht, The Netherlands. F.H.H.Linn neuro.azu.nl

OBJECTIVE: Often patients with subarachnoid haemorrhage (SAH) recall a recent episode of acute severe headache, usually interpreted as a "warning headache" or first SAH. An alternative explanation is recall bias. The clinical and radiological features of patients with SAH were studied in relation to previous headaches or later rebleeding. METHODS: Patients with either a previous headache episode or a subsequent rebleed were selected from the SAH database in Utrecht within 1 month of the index SAH. The clinical condition was graded on the World Federation of Neurological Surgeons (WFNS) scale. The CT was reviewed and the amounts of subarachnoid blood, hydrocephalus, and intraventricular, intracerebral, and subdural blood were rated. Proportions were compared by unpaired or paired t test. RESULTS: Forty four of 390 patients (11%) had had a severe headache before their index SAH (11 of these had a subsequent rebleed); 31 other patients had a rebleed in hospital but no preceding headache. Patients with and without preceding headache did not differ in level of consciousness (14 of 44 v 11 of 31 were comatose), nor in any of the radiological features. After rebleeding (42 patients), 37 of 42 patients were comatose (v 11 of 42 before), and CT showed higher proportions of intracerebral haemorrhage (17%), intraventricular haemorrhage, (27%), and hydrocephalus (12%) than baseline scans. Intraventricular haemorrhage was twice as frequent after rebleeding than at baseline. CONCLUSIONS: The clinical and radiological features of patients admitted with SAH after a preceding bout of headache did not differ from those without such an episode, and are clearly dissimilar from those after documented rebleeds. The findings challenge the existence of minor "warning headaches".

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10675215&dopt=Abstract headache medicine




[Headaches in the population of school children in Poznan]

[Article in Polish]

Krasnik A.

Katedra i Klinika Neurologii, Wieku Rozwojowego Akademii Medycznej im. Karola Marcinkowskiego w Poznaniu.

A total of 2353 children and youths, 6-19 years old attending three primary and one secondary school situated in Poznan were examined. It was found that the overall prevalence of all types of headache (primary and secondary) in the general childhood population was 75%--1759 cases during the last 12 months. The medical examination of these school-children comprised full systematic physical and detailed neurological examination with visual acuity. Some laryngological examinations and laboratory tests also were made. The diagnosis of primary headaches was made according to the operational diagnostic criteria of the IHS classification. We was found 675 (28.69%) cases of tension type headache, 198 (8.42%) migraine, and only one case of cluster headache (0.04%). The prevalence of headache increased progressively with increasing age. Obtained data confirm an important part of positive family history and small influence of birth weight and living conditions. The other findings indicate that sleeping problems, dizziness, motion sickness, abdominalgia, belong to important risk factors for headache in children. At the end, it was made a comparison between "migrenous" and tension headache group. The conclusion is that headache in children and youth is serious social and medical problem.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10719693&dopt=Abstract headache medicine




[Headache in a short-stay unit. A retrospective study of 140 cases]

[Article in Spanish]

Lobera Gutierrez de Pando E, Lopez Navarro JA, Youssef Fasheh W, Vernet Bori A, Luaces Cubells C.

Servicio de pediatria, Hospital Clinic-Sant Joan de Deu, Universidad de Barcelona.

OBJECTIVE: Our objective was to study those patients that warranted admission to our Short-Stay Unit (Observation Unit) with an incoming diagnosis of headache so as to determine the characteristics of the headache, analyze complementary explorations and their use and to establish the causes of the problem. PATIENTS AND METHODS: A retrospective review of the clinical history of patients admitted for headache between 1992 and 1997 was done, recording specific data according to pre-set objectives. RESULTS: One hundred forty patients were admitted with headache (2% of total admittance to the Unit. Sixty-one percent were males. Seventy cases were between 11 and 15 years old. The most frequent accompanying symptoms were vomiting (61%), fever (31%) and various concurrent infections (21%). Seventy-two cases (51%) presented an evolution of less than 24 hours before admittance. Frontal headache was the most common localization, 30.6% of the patients were awaken by the pain and 32% calmed with analgesics. CAT scan/70%) and skull X-ray (59%) were the most used complementary explorations. Ten CAT scans and 3 X-rays showed anomalies. Evolution was favorable in most cases. The most frequent diagnoses were headache associated with infections (31%), tension headaches (29%) and migraine (21%). Fourteen percent were non-specific headaches. A central nervous system tumor was diagnosed in 6 patients, where 5 showed papilledema on initial exploration. CONCLUSIONS: Headache, especially in adolescents, is a common cause of consultations to the emergency room. When not accompanied by other symptoms it is not usually precluding a severe disease. In an emergency room exploration, a complete neurological exam must be undergone, including retinal exam, leaving further complementary exams for those cases where the patient history suggests an organic alteration.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10410417&dopt=Abstract headache medicine