A comparison of headache symptoms between two groups: a TMD group and a general dental practice group.

Pettengill C.

Center for Orofacial Pain, University of California, San Francisco, USA.

Several studies have shown that headaches are associated with patients who have temporomandibular disorders (TMD) compared with non-TMD patients. None of these studies separated the patients by gender or controlled for TMD in the two groups of patients. This study compared a TMD group of patients and a non-TMD group for recent headache symptoms, TMD symptoms and for gender differences. Each patient was asked to rate headache, temporomandibular joint and facial pain symptoms over the past week. The data was collected, tabulated and controlled for TMD symptoms. The data was scored using the Fischer's p-test and a multivariate logistic regression analysis was performed. The headaches were significantly greater in the TMD group (p < 001) than in the private practice group with the genders combined. Dividing the two groups into genders, both males and females in the TMD group were shown to have a greater number of headache symptoms, and the number of headaches was statistically different than the non-TMD group (males p = .037, females p < .001). The TMD group had greater severity of headaches than the non-TMD group. Dividing the two groups into genders, females also had a greater severity of headaches than male counterparts in the TMD and non-TMD groups. From the multivariate logistic regression analysis, these results indicate that headache symptoms are common in patients with TMD symptoms and that the headaches were more severe in the TMD patients than in the non-TMD patients.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10425932&dopt=Abstract headache medicine




[Tinnitus during headache: clinical-instrumental evaluation]

[Article in Italian]

Farri A, Enrico A, Lacilla M, Sartoris A.

Dipartimento di Fisiopatologia Clinica, Universita di Torino.

During the five years running from December 1993 to January 1998, 112 patients who had come to our University Clinic suffering from headache were examined. From this group 71 complaining of tinnitus during headache were recruited for the study: 19 patients suffered from migraine without aura, 8 migraine with aura, 15 tension headache, 21 mixed headache, 3 basic migraine and 5 cluster headache. The purpose of this work was to determine the incidence and to identify the frequency of the various types of tinnitus in the study sample. Once cardiovascular and metabolic pathologies, previous cranial or cervical traumas, barotrauma, chronic on-the-job noise exposure, cervical arthritis, ATM malocclusion, use of drugs that damage the hearing apparatus, morbose processes of the external and middle ear, otosclerosis, jugular tympanum paraganglioma, Meniere's disease, acoustic neurinoma were all ruled out, the patients underwent the following battery of instrumental tests: tonal audiometry, impedance measurement, vestibular examination, electronystagmography, ABR, simplified tinnitometry. Only those patients with normal hearing underwent the tinnitometry and, therefore, the type of tinnitus was established only for this group of 53 patients. Tinnitometry showed that 37% of these subjects had tinnitus at the higher frequency tones, 11% at the middle frequencies, 29% complained of tinnitus at the lower frequencies while 23% complained that the bothersome buzzing was a compound noise. In addition, the subjective intensity of the tinnitus was analyzed. The authors devised a tinnitus irritation scale covering a range from 0 (not irritating) to 10 (intolerable). The tinnitus was bilateral in 66% of the cases while it was limited to only one ear in the remaining 34%. In 15% of the cases tinnitus was present even when there was no headache. In the literature, the etiopathogenesis of tinnitus associated with migraine headache has been attributed to vascular and neuropeptide mechanisms. Even the psychological component appears to play a role in triggering the event. These hypotheses deserve more in depth study.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10434437&dopt=Abstract headache medicine




Personality traits and psychological reactions to mental stress of female migraine patients.

Stronks DL, Tulen JH, Pepplinkhuizen L, Verheij R, Mantel GW, Spinhoven P, Passchier J.

Department of Medical Psychology and Psychotherapy, Erasmus University Rotterdam, The Netherlands.

The purpose of this study was (i) to compare a range of stress-related personality traits, including defense and coping mechanisms, of migraine patients (n = 23) with those of tension headache patients (n = 18) and dermatologically afflicted, but otherwise healthy, controls (n = 22), and (ii) to compare their state anxiety and other moods before, during, and after the presentation of a psychological stressor (mental arithmetic). For all three groups, mental arithmetic induced a significant increase in state anxiety and mood disturbance, followed by a subsequent decrease during recovery. Migraine patients were not found to have a higher disposition for anxiety, depression, or rigidity than tension headache patients or controls. Between the headache groups no differences in the use of defense and coping mechanisms were found. Compared to the control group, however, both migraine patients and tension headache patients were more inclined to use internally focused defense mechanisms and less inclined to seek social support when confronted with a problem. The psychological reaction of migraine patients to mental stress hardly differed from tension headache and control subjects. Compared to the control subjects, however, both groups of headache patients exhibited a diminished recovery from feelings of vigour, depression, and fatigue due to the stress induced. It is suggested that this distinct psychological reaction to stress of headache patients versus healthy control subjects is related to the more internally focused defense style of the headache sufferers. Thus, in contrast to previous results, this study does not present evidence of a migraine personality. It suggests the development of specific personality characteristics as a consequence of suffering from episodic headache.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10448543&dopt=Abstract headache medicine




Association of cerebral perfusion pressure with headache in women with pre-eclampsia.

Belfort MA, Saade GR, Grunewald C, Dildy GA, Abedejos P, Herd JA, Nisell H.

Department of Obstetrics and Gynaecology, University of Utah, Salt Lake City 84132, USA.

OBJECTIVE: To study estimated cerebral perfusion pressure and its relation to headache and scotomata in women with pre-eclampsia. DESIGN: Prospective, observational study. SETTING: University teaching hospitals. POPULATION: Seventy-nine pre-eclamptic women with (n = 42) and without (n = 37) headache. Patients with scotomata were also studied separately. METHODS: Transcranial Doppler ultrasound was used to estimate the resistance index, pulsatility index, and estimated cerebral perfusion pressure in the middle cerebral artery. eCPP data were plotted on the same axes as the mean (and 5th and 95th% prediction limits) eCPP data from 63 normal pregnant women followed longitudinally through pregnancy. Data outside of the 95% prediction limits were regarded as abnormal. Data from the pre-eclamptic women were also expressed in terms of the number of standard deviations from the mean value established for normal pregnancy (multiples of the standard deviation: MOS). All studies were prior to labour, under similar conditions, and before volume expansion or treatment. Analysis of data was performed using Student's t test, Mann-Whitney U test, ANOVA, and Fisher's exact test with two-tailed P < 0.05, and receiver operating characteristic curve analysis with a one-tailed P < 0.05. MAIN OUTCOME MEASURES: Resistance index, pulsatility index, and eCPP. RESULTS: Pre-eclamptic women with headache were much more likely to have abnormal eCPP (34/42; 88%) than those without headache (18/37; 49%), P = 0.004, OR 4.5 (95% CI 1.5 to 13.9). There were no differences in terms of MOS in the resistance index or pulsatility index between the two groups, but estimated perfusion pressure, expressed as multiples of the standard deviation in the group with headache, was significantly higher than in the women without. Headache was noted in both over-perfusion and under-perfusion states. Only women with headache had scotomata, and their presence was not related to the severity of the headache or any difference in resistance indices or eCPP. CONCLUSIONS: Headache in women with pre-eclampsia is strongly associated with the presence of abnormal cerebral perfusion pressure. This information may be of use in clinical management.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10453832&dopt=Abstract headache medicine




Headache in Meniere's disease.

Eklund S.

Department of Otolaryngology, University Hospital of Helsinki, Finland. susanna.kaasinen helsinki.fi

OBJECTIVE: We examined headache in 86 patients with severe or moderately severe Meniere's disease (MD) or with Meniere's syndrome (MS) chosen for intratympanic gentamicin treatment. Forty-five patients with vestibular neuronitis (VN) served as a control group. METHODS: In addition to a clinical examination, the patients filled out a questionnaire concerning their headache. RESULTS: Altogether 60 MD patients (70%) and 26 VN patients (58%) reported headache. Headache was severe in 35 MD patients (58%), moderate in 16 patients (27%) and slight in nine MD patients (15%), and as a whole more severe than that of the VN patients (P < 0.01). The MD patients exhibited significantly more occipital (P < 0.005) and neck headache (P < 0.005) than the VN patients. Analgesics had been used by 82%, antidepressants by 35%, sumatriptan by 13% and carbamazepine and/or amitriptyline by 12% of the MD patients suffering from headache. Pain relief was reported as good by 27%, satisfactory by 60%, poor by 5% of the MD patients and 8% could not rate the pain relief. In this study migraine was diagnosed in 5 MD patients. CONCLUSION: It is concluded that MD is associated with headache that can be handicapping, and tricyclic antidepressants with pain alleviating medication is often needed to treat the headache in MD whereas sumatriptan did not alleviate the headache of the non-migraine patients.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10530738&dopt=Abstract headache medicine




Psychosocial factors in children and adolescents with migraine and tension-type headache: a controlled study and review of the literature.

Karwautz A, Wober C, Lang T, Bock A, Wagner-Ennsgraber C, Vesely C, Kienbacher C, Wober-Bingol C.

Department of Neuropsychiatry of Childhood and Adolescence, University of Vienna, Austria.

We investigated 341 children and adolescents to evaluate the relevance of psychosocial factors in idiopathic headache. According to the criteria of the International Headache Society, 151 subjects had migraine and 94 had tension-type headache (TTH). Ninety-six subjects were headache-free controls. Psychosocial factors covered family and housing conditions, school problems, relations in the peer group, and several other items. We found that migraine patients did not differ from headache-free controls. Patients with TTH more often had divorced parents than the headache-free controls, and they had fewer peer relations than migraineurs and controls. In addition, migraine patients were significantly more often absent from school due to headache. All other psychosocial factors failed to discriminate between the three study groups. In conclusion, this controlled study in children and adolescents suggests that migraine is not related to family and housing conditions, school situation, or peer relations, whereas TTH is associated with a higher rate of divorced parents and fewer peer relations.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10099858&dopt=Abstract headache medicine




Reliability of the migraine disability assessment score in a population-based sample of headache sufferers.

Stewart WF, Lipton RB, Kolodner K, Liberman J, Sawyer J.

Johns Hopkins School of Public Health, Baltimore, MD, USA.

BACKGROUND: The Migraine Disability Assessment (MIDAS) score is used to quantify headache-related disability. In a previous study, we showed that the MIDAS score was highly reliable in population-based samples of migraine headache sufferers in two countries. OBJECTIVES: To examine the test-retest reliability and internal consistency of the five items comprising the MIDAS score and the overall MIDAS score in a population-based sample of both migraine and nonmigraine headache sufferers. METHODS: Using a clinically validated telephone interview, a population-based sample of migraine and nonmigraine headache sufferers was identified in Baltimore, Maryland, USA. A total of 97 migraine cases and 80 nonmigraine subjects completed the MIDAS questionnaire on two occasions an average of 3 weeks apart. The MIDAS score is derived from five questions about missed time from work (or school) and household work (one question each about missed days and days with at least 50% reduced productivity) and missed days of nonwork activities. RESULTS: Among all headache sufferers the test-retest Spearman's correlations of individual MIDAS questions ranged from 0.67 to 0.73. The Spearman's correlation for the MIDAS score (i.e., sum of lost days and reduced effectiveness days in each domain) was 0.84. Cronbach's alpha, a measure of internal consistency, was 0.83. Mean and median item values and the overall MIDAS scores differed between migraine and nonmigraine cases. Even after adjusting for differences in headache frequency, the mean MIDAS scores differed substantially (i.e., 10.3 points) between migraine cases and nonmigraine cases. CONCLUSIONS: The reliability and internal consistency of the MIDAS score are high, as tested in a population-based sample of headache sufferers. MIDAS scores are substantially higher in migraine cases than in non-migraine cases, supporting the validity of the measure.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10214536&dopt=Abstract headache medicine




Headache in children in Dutch general practice.

van der Wouden JC, van der Pas P, Bruijnzeels MA, Brienen JA, van Suijlekom-Smit LW.

Department of General Practice, Erasmus University Rotterdam, The Netherlands. vanderwouden hag.fgg.eur.nl

AIM: To describe the occurrence of headache in general practice, the diagnoses made in general practice, and the management. METHOD: Data from the Dutch national survey of morbidity and interventions in general practice were used. The practice population (103 practices) comprised 63,753 children aged 0-14 years. RESULTS: In 634 episodes, headache was a reason for encounter. The incidence of headache presented to the general practitioner was 40.2 per 1000 person years. More than half of the episodes were related to an infectious disease, among which upper respiratory tract infections predominated. The incidence rate of the diagnosis idiopathic headache was 7.3 episodes per 1000 person years. The incidence increased with age and was higher in girls than in boys. In only 12% of cases of idiopathic headache were special investigations carried out, mostly blood examinations. Medication was prescribed in 27% of all episodes of idiopathic headache. In the absence of an infectious disease, many headache episodes were associated with psychosocial problems. Family problems and school problems were mentioned most often. CONCLUSION: Headache in children as reason for encounter is a common problem in general practice, often associated with an infectious disease. When confronted with a child with idiopathic headache, the general practitioner should be aware of a possible psychosocial component.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10234461&dopt=Abstract headache medicine