Relation between headache in childhood and physical and psychiatric symptoms in adulthood: national birth cohort study.

Fearon P, Hotopf M.

Institute of Psychiatry and Guy's, King's and St Thomas's School of Medicine, De Crespigny Park, London SE5 8AF. p.fearon iop.kcl.ac.uk

OBJECTIVE: To elucidate the associations between frequent headache and psychosocial factors in childhood and to determine whether such children are at an increased risk of headache, multiple physical symptoms, and psychiatric symptoms in adulthood. DESIGN: Population based birth cohort study. SETTING: General population. PARTICIPANTS: People participating in the national child development study, a population based birth cohort study established in 1958. Main outcome measures: Headache, multiple physical symptoms, and psychiatric morbidity at age 33. RESULTS: Headache in childhood was associated with several psychosocial factors. Prospectively, children with frequent headache had an increased risk in adulthood of headache (odds ratio 2.22, 95% confidence interval 1.62 to 3.06), multiple physical symptoms (1.75, 1.46 to 2.10), and psychiatric morbidity (1.41, 1.20 to 1.66). The outcomes of headache and multiple physical symptoms were not accounted for by psychiatric morbidity. CONCLUSION: Children with headache are at an increased risk of recurring headache in adulthood and may complain of other physical and psychiatric symptoms. Strategies for coping with psychosocial adversity in childhood may improve the prognosis in adulthood.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11348907&dopt=Abstract headache medicine




Headache complaints associated with psychiatric comorbidity in a population-based sample.

Bensenor IM, Tofoli LF, Andrade L.

Departamento de Clinica Medica, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brasil. isabensenor hcnet.usp.br

The objective of the present study was to determine the frequency at which people complain of any type of headache, and its relationship with sociodemographic characteristics and psychiatric comorbidity in S o Paulo, Brazil. A three-step cluster sampling method was used to select 1,464 subjects aged 18 years or older. They were mainly from families of middle and upper socioeconomic levels living in the catchment area of Instituto de Psiquiatria. However, this area also contains some slums and shantytowns. The subjects were interviewed using the Brazilian version of the Composite International Diagnostic Interview version 1.1. (CIDI 1.1) by a lay trained interviewer. Answers to CIDI 1.1 questions allowed us to classify people according to their psychiatric condition and their headaches based on their own ideas about the nature of their illness. The lifetime prevalence of "a lot of problems with" headache was 37.4% (76.2% of which were attributed to use of medicines, drugs/alcohol, physical illness or trauma, and 23.8% attributed to nervousness, tension or mental illness). The odds ratio (OR) for headache among participants with "nervousness, tension or mental illness" was elevated for depressive episodes (OR, 2.1; 95%CI, 1.4-3.4), dysthymia (OR, 3.4; 95%CI, 1.6-7.4) and generalized anxiety disorder (OR, 4.3; 95%CI, 2.1-8.6), when compared with patients without headache. For "a lot of problems with" headaches attributed to medicines, drugs/alcohol, physical illness or trauma, the risk was also increased for dysthymia but not for generalized anxiety disorder. These data show a high association between headache and chronic psychiatric disorders in this Brazilian population sample.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14502377&dopt=Abstract headache medicine




Patients' decision-making for migraine and chronic daily headache management. A qualitative study.

Peters M, Abu-Saad HH, Vydelingum V, Dowson A, Murphy M.

European Institute of Health and Medical Sciences, University of Surrey, UK. M.Peters surrey.ac.uk

The objective of this study was to gain insight into the patients' decision-making for migraine and chronic daily headache management. Patients were recruited by theoretical sampling in Surrey (UK). Semi-structured and tape-recorded interviews (n = 13) were conducted, transcribed verbatim, coded and analysed according to the grounded theory methodology. Thirteen patients (8 migraine and 5 chronic daily headache) described their management. All patients employed multiple behaviours to manage their headaches. From the patients' descriptions emerged their decision-making. Based on experience, perceptions and new information, the decision-making process involved four stages: headache severity, evaluation, decision making and behaviours. Although the participants were passive with regards to certain management strategies, overall they were actively involved in treating and preventing their headaches. Furthermore, they were active decision-makers in choosing appropriate management. Migraine and chronic daily headache patients are actively involved in managing their headaches. They are key decision-makers and should not be overlooked as a resource for effective management.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14510931&dopt=Abstract headache medicine




Headache is not more frequent among patients with moderate to severe hypertension.

Fuchs FD, Gus M, Moreira LB, Moreira WD, Goncalves SC, Nunes G.

Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil. ffuchs hcpa.ufrgs.br

The association between hypertension and headache has been a contentious issue. Most studies have showed that mild hypertension and headache are not associated, but this may not be the case in patients with hypertension classified at more severe stages. We investigated the association between hypertension classified at moderate to severe stages and headache in a cross-sectional study conducted in the hypertension clinic of a tertiary care University hospital. In total, 1763 referred patients with a medical diagnosis of hypertension in most cases (95.7%) were evaluated by an extensive protocol questionnaire, detailed physical examination, laboratory examination, and had their blood pressure classified according to the VI Joint National Committee (JNC-VI) recommendation. Logistic regression models were used to explore the association between severity of hypertension and pulse pressure with the presence of headache, controlling for several potential confounders. The complaint of headache was referred by 903 (51.3% of whole sample), and a total of 378 patients (21.4%) were classified at the moderate to severe stage (stage III of the JNC-VI report). The diagnosis of moderate to severe hypertension was not associated with the complaint of headache (OR 1.02, 95% CI from 0.79 to 1.30). Pulse pressure and headache were inversely associated (OR 0.91, 95% CI from 0.86 to 0.97, for 10 mmHg). We concluded that headache and hypertension classified at moderate to severe stages were not associated in patients attending to a hypertension clinic. The novel finding of an inverse association between pulse pressure and headache should be addressed in further investigations.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14578919&dopt=Abstract headache medicine




Factors associated with the onset and remission of chronic daily headache in a population-based study.

Scher AI, Stewart WF, Ricci JA, Lipton RB.

Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, National Institutes of Health, Gateway Building, Suite 3C-309, 7201 Wisconsin Avenue, MSC 9205, Bethesda, MD 20892-9205, USA. schera mail.nih.gov

The etiology and prognosis of chronic daily headache (CDH) are not well understood. The aim of this study is to describe factors that predict CDH onset or remission in an adult population. Potential cases (180+ headaches per year, n=1134) and controls (two to 104 headaches per year, n=798) were interviewed two times over an average 11 months of follow-up. Factors associated with CDH prevalence at baseline were evaluated. The incidence of CDH and risk factors for onset were assessed in controls whose headache frequency increased to 180+ per year at follow-up. Prognostic factors were assessed in CDH cases whose headache frequency fell at follow-up. CDH was more common in women, in whites, and those of less education. CDH cases were more likely to be previously married (divorced, widowed, separated), obese, and report a physician diagnosis of diabetes or arthritis. At follow-up, 3% of the controls reported 180 or more headaches per year. Obesity and baseline headache frequency were significantly associated with new onset CDH. In CDH cases, the projected 1-year remission rate to less than one headache per week was 14% and to less than 180 headaches per year was 57%. A better prognosis was associated with higher education, non-white race, being married, and with diagnosed diabetes. Individuals with less than a high-school education, whites, and those who were previously married had a higher risk of CDH at baseline and reduced likelihood of remission at follow-up. New onset CDH was associated with baseline headache frequency and obesity.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14581114&dopt=Abstract headache medicine




Morning headaches in patients with sleep disorders: a systematic polysomnographic study.

Goder R, Friege L, Fritzer G, Strenge H, Aldenhoff JB, Hinze-Selch D.

Department of Psychiatry and Psychotherapy, Christian-Albrechts-University of Kiel, Niemannsweg 147, D-24105 Kiel, Germany. rgoeder psychiatry.uni-kiel.de

OBJECTIVES: Patients with sleep disorders suffer more often from headache after awakening than healthy subjects. However, it still is a matter of controversy whether this applies only to patients with sleep apnea syndrome (SAS) or also to patients with other diagnoses of sleep disorders. METHODS: We asked all patients in our sleep laboratory about the frequency of past headaches and also ascertained the occurrence of morning headaches after awakening in the sleep laboratory. Polysomnographic recordings from nights before morning headache were compared with nights without following headache. Four hundred and thirty-two patients with sleep disorders (age range 18-86 years, 37% women) and 30 healthy subjects (age range 24-55 years, 27% women) participated in this prospective study. RESULTS: The reported frequency of past headaches and the frequency of morning headache in the sleep laboratory were significantly increased in patients with SAS and other sleep disorders compared with healthy subjects. The occurrence of morning headache in the sleep laboratory was associated polysomnographically with a decrease in total sleep time, sleep efficiency and amount of rapid eye movement sleep and with an increase in the wake-time during the preceding night. CONCLUSIONS: We conclude that morning headaches in patients with sleep disorders might be associated with particular disturbances of the preceding night's sleep. We speculate that dysregulation in anatomically identical central regions modulating sleep and nociception might be relevant to morning headache, rather than one particular sleep disorder such as SAS.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14592279&dopt=Abstract headache medicine




[Diagnostic value of the criteria of the International Headache Society in the differential diagnosis of primary headaches]

[Article in Spanish]

Colina-Garcia RC, Carrasquero-Arias SL; International Headache Society.

Departamento de Salud Publica, Universidad de Carabobo, Venezuela.

INTRODUCTION: In this research we study primary headaches, which are currently considered to be a public health problem. We also examine the fact that an ever increasing number of people are affected and that in some cases such headaches can eventually be disabling because they bring about different degrees of functional deterioration, which leads to negative repercussions on occupational capacity and on the quality of life of the people who suffer them. AIMS. Our aim is to determine the diagnostic value of the criteria of the International Headache Society (IHS) in the differential diagnosis of tension type headaches (TH) and migraine (M) in patients who attend the Neurology outpatients department at the Dr. Luis Guada Lacau clinic. PATIENTS AND METHODS: 100 consecutive patients, over the period between March and August 2001, were studied and, through an interview, we applied the IHS criteria to determine the type of primary headache they suffered from; blind comparisons of results were conducted against the diagnosis provided by an expert. RESULTS: Findings reveal a high degree of sensitivity (84, 85, 92 and 89%) for migraine with aura (MA), migraine without aura (MWA), TH, M + TH, respectively, and a specificity of 92, 95, 95 and 96% for MA, MWA, TH, M + TH, respectively, which correlates with the values obtained for the positive and negative predictive values, and the positive and negative probability coefficient. CONCLUSIONS: The IHS criteria are of great value in establishing HT, MA or MWA diagnoses and in those in which TH and M are presented together, and can therefore be used without risk in medical practice, if they are applied correctly. We recommend the use of these criteria in the General medicine and the Neurology clinic to detect cases of primary headaches and classify them correctly, thus enabling a correct diagnosis and effective therapy to be established.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12766860&dopt=Abstract headache medicine




Idiopathic stabbing headache: clinical characteristics of children and adolescents.

Fusco C, Pisani F, Faienza C.

Department of Pediatrics, Service of Child Neurology and Psychiatry, University of Parma, Ospedale Maggiore, Via Gramsci 14, 43100 Parma, Italy.

Very few cases of short-lasting headaches have been reported in children and adolescents. The aim of this study is to describe a group of patients in the pediatric age group with short attacks of head pain and to demonstrate that they are not easily classified according to existing criteria for adults. We describe 23 subjects in retrospect, 12 males and 11 females, with brief attacks of headache, stabbing in nature, self-limited, lasting from a few seconds to 15 min. This sample was taken from a total population of 548 children and adolescents referred to our Pediatric Headache Unit during the years 1995-1999. Mean age at onset of symptomatology was 9 years. The localization of the headache was bilateral in 60% of the patients and unilateral in 40%. The pain was either unifocal at the orbit or temple (60%) or multifocal (40%). In 24% of the children, the interictal awake EEG showed infrequent posterior slow-waves. In 12 patients we used paracetamol with a good response. Although these painful episodes shared some aspects with the adult form of idiopathic stabbing headache, they had different durations of attack, and other primary headache syndromes did not accompany them either at the time of presentation or during the following 2 years. Short attacks of headache are present in the pediatric age group and are not easily classified according to the International Headache Society criteria. Their nature and correlation with migraine remains unclear. We propose follow-up of these subjects to obtain a better description of the natural history of these forms of headache in the pediatric age group.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12767453&dopt=Abstract headache medicine