Further clinical clarification of the muscle dysfunction in cervical headache.

Jull G, Barrett C, Magee R, Ho P.

Department of Physiotherapy, University of Queensland, Brisbane, Australia. jull physio.therapies.uq.edu.au

The Headache Classification Committee of the International Headache Society listed impairments in cervical muscle function as criteria for headaches of cervical spine origin. Fifteen subjects with cervical headache and 15 controls were tested for the frequency of abnormal responses to passive stretching and abnormal muscle contraction. A new test of cranio-cervical flexion was used to assess the contraction of the deep neck flexors. Results indicated a trend towards a higher frequency of abnormal response to passive stretching of the muscles examined in the cervical headache group but only the upper trapezius proved significantly different to the control group. Deep neck flexor muscle contraction was significantly inferior in the cervical headache group. From the perspective of physical characterization of cervical headache, it appears that response from passive stretch of muscle may not be a strong criterion for cervical headache but deep neck flexor performance may have potential to identify musculoskeletal involvement in headache. The finding may also provide positive directions for conservative treatment of cervical headache.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10234466&dopt=Abstract headache medicine




Frequency of headaches associated with the cervical spine and relationships with anthropometric, muscle performance, and recreational factors.

Grimmer K, Blizzard L, Dwyer T.

Menzies Centre for Population Health Research, University of Tasmania, Hobart, Australia.

OBJECTIVE: To investigate headache specifically associated with the cervical spine, and factors associated with it. DESIGN: Cross-sectional, population-based observational study. SETTING: Two agriculturally based municipalities in southern Tasmania, Australia. PATIENTS: Four hundred fifty adults were randomly selected from electoral rolls; after refusals and exclusions, 427 subjects participated. OUTCOME MEASURE: For analysis, subjects were divided into three groups: those who did not have a particular type of headache in the previous month, those reporting fewer than two headaches of this type for the month (occasional headache), and those reporting two or more (frequent) headaches of this type in the month. STUDY FACTORS: Information collected by questionnaire and by objective measurement on anthropometric and functional measurements, wearing glasses or dentures, usual occupation, and usual recreational activities. RESULTS: The monthly prevalence of frequent headaches associated with the cervical spine was 28.3% (95% confidence interval [CI], 24.2-32.9), and another 35.4% (30.9-40.1) of subjects had these headaches occasionally. The frequency of headache occurrence was associated with a difference between front and back neck length of 2 cm or more. Occasional participation in recreational sport by men and wearing glasses by women were significant predictors of headache. CONCLUSION: Headaches of this type were more frequent in subjects with a long anterior neck length relative to their posterior neck length, particularly if they occasionally participated in recreational sports (men) or wore glasses (women).

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10326913&dopt=Abstract headache medicine




[Recent-onset headache is a risk factor of intracranial lesion. A prospective study of 299 patients]

[Article in Spanish]

Ortin Castano A, Lopez Alburquerque T, Adeva Bartolome MT, Gonzalez Buitrago JM.

Servicio de Neurologia, Hospital Clinico Universitario, Salamanca.

BACKGROUND: There is some controversy in the medical literature concerning the need to perform neuroimaging studies in neurologically normal patients complaining of headaches. The objective of the study is to determine the detection rate of intracranial abnormalities by computed tomography in patients with different headache durations. METHOD: Consecutive patients with the chief complaint of headache referred for neurological evaluation from January 1996 to April 1997 were studied both clinically and by computed tomography scanning. Brain magnetic resonance imaging was performed in 15 patients. Cerebrospinal fluid and/or blood analyses were performed when clinically indicated to rule out subarachnoid hemorrhage, meningitis or temporal arteritis. RESULTS: 15 (5%) out of the 299 patients available for study had significant intracranial lesion. 3 (1%) out of the 266 patients with headaches lasting for more than 1 month had computed tomography findings considered clinically significant and neurological examination was normal in 2 (0.7%) patients with abnormal scans. Patients with a headache duration of 1 month or less had the following case-finding rate: an overall significant intracranial abnormality of 36% (12/33) and significant intracranial abnormality in neurologically normal patients of 15% (5/33). CONCLUSION: Patients with headache of recent onset (duration of 1 month or less), even with normal neurological examination, are at greater risk of significant intracranial abnormality than patients with long-lasting headaches. These patients at risk should be studied by cranial computed tomography and lumbar puncture if the computed tomography scan is normal and the cause of the headaches cannot be clinically determined.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10339839&dopt=Abstract headache medicine




A psychiatric study of nonorganic chronic headache patients.

Okasha A, Ismail MK, Khalil AH, el Fiki R, Soliman A, Okasha T.

Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt. aokasha internetegypt.com

Nonorganic chronic headache is a common, challenging presentation in clinical practice. The aim of this study was to investigate the frequency of associated psychiatric psychopathology, personality disorders, or traits. In addition, the study attempted to investigate possible relationships of nonorganic chronic headache with alexithymia, locus of control, and pain perception. Psychiatric pathology, personality traits, and pain profiles were examined in 100 randomized patients with chronic headache lacking an obvious organic basis, and they were compared with 100 subjects, 50 with headache of a known organic cause and 50 seemingly healthy persons, by using structured clinical interviews. Somatoform pain disorder was diagnosed in 43% of the nonorganic and 20% of the organic headache group. Nine percent of the former group had major depression, 16% had dysthymia, and 8% had both. In the organic group, 56% had no psychiatric disorder and 20% had somatoform pain disorder. Seventy-seven percent of the patients in the nonorganic pain group had personality disorders, mostly of the mixed and multiple types, compared with 24% of the organic headache patients. The study sample was more alexithymic than the other groups (in 65% of subjects) and had a culturally influenced locus of control and a pain profile characterized by dramatization, vagueness, lower pain threshold, and lower pain tolerance. The nonorganic chronic headache patients showed a high prevalence of somatoform, depressive, and other forms of psychiatric disorders. The high frequency of personality disorders, mostly the mixed and multiple types, the high alexithymic pattern, and low pain threshold and tolerance in the study group should be taken into consideration in the evaluation and management of nonorganic headache patients.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10341536&dopt=Abstract headache medicine




Acupuncture for migraine and headache in primary care: a protocol for a pragmatic, randomized trial.

Vickers A, Rees R, Zollman C, Smith C, Ellis N.

Research Council for Complementary Medicine, London, UK. ajcrccm gn.apc.org

This paper presents the protocol for a randomized trial of acupuncture for migraine and headache. TRIAL OBJECTIVE: To determine the effects of a policy of 'use acupuncture' on headache, health status, days off sick and resource use compared to a policy of 'avoid acupuncture.' SUBJECTS: Four hundred patients with migraine or headache will be recruited from GP practices. INCLUSION CRITERIA: Eighteen to 65 years old, contractable by telephone, onset at least 1 year prior at age less than 50, two headaches per month in the previous 6 months, adequate data completion and headache severity during pre-randomization baseline. EXCLUSION CRITERIA: Pregnancy or malignancy, cluster headache, serious pathological aetiology, cranial neuralgia, acupuncture treatment in the past year. DESIGN: Following a 4-week baseline, patients will be allocated to acupuncture or control by minimized randomization. Up to 12 acupuncture treatments will be provided by advanced members of the Acupuncture Association of Chartered Physiotherapists. The type of acupuncture given will be recorded. STUDY MEASURES: Outcome will be assessed by headache diary, medication diary and SF36 at 3 months and 1 year. Resource use and days off sick will be assessed by quarterly questionnaire. Adverse events will be monitored by self-report. The primary outcome measure will be the change in mean daily headache score between baseline and the 1 year follow-up. An economic evaluation will also be undertaken.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10361566&dopt=Abstract headache medicine




Comorbidity of headache and depressive disorders.

Mitsikostas DD, Thomas AM.

Athens Naval and Veterans Hospital, Department of Neurology, Greece. dmitsikostas hotmail.com

The goal of the present study was to investigate the clinical profile of patients with primary headache syndromes who also suffer from mood disorders. Four-hundred-and-seventy headache outpatients (170M, 300F) and 150 age- and sex-matched healthy subjects were screened using a specific questionnaire that included the Hamilton rating scales for anxiety and depression. The average scores of the Hamilton rating scales for anxiety and depression were significantly higher in headache sufferers (17.4 and 14.2, respectively) than in healthy people (6.8 and 5.7, respectively). The frequency of headache attacks, the history of headaches, and gender (women more than men) were correlated with the score of the Hamilton rating scale for both anxiety and depression. Sixteen headache patients (3.4%) achieved the DSM-IV criteria for major depression or dysthymia versus one among headache-free subjects (0.6%; OR 5.2). Patients suffering from drug-overuse and migraine with aura showed the higher odds ratios (35 and 17, respectively). These results suggest that those headache patients with long history and high frequency of headaches, or patients suffering from migraine with aura and drug-overuse might benefit from psychiatric evaluation.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10376165&dopt=Abstract headache medicine




Correlation between structural and functional changes in brain in an idiopathic headache syndrome.

May A, Ashburner J, Buchel C, McGonigle DJ, Friston KJ, Frackowiak RS, Goadsby PJ.

University Department of Clinical Neurology, Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London, UK.

Fundamental to the concept of idiopathic or primary headache, including migraine, tension-type headache and cluster headache, is the currently accepted view that these conditions are due to abnormal brain function with completely normal brain structure. Cluster headache is one such idiopathic headache with many similarities to migraine, including normal brain structure on magnetic resonance imaging and abnormal function in the hypothalamic grey matter by positron emission tomography. Given the consistency of the positron emission tomography findings with the clinical presentation, we sought to assess whether the brains of such patients were structurally normal. We used voxel-based morphometry, an objective and automated method of analyzing changes in brain structure, to study the structure of the brains of patients with cluster headache. We found a co-localization of structural changes and changes in local brain activity with positron emission tomography in the same area of the brain in the same patients. The results indicate that the current view of the neurobiology of cluster headache requires complete revision and that this periodic headache is associated with a hitherto unrecognized brain abnormality in the hypothalamic region. We believe that voxel-based morphometry has the potential to change in the most fundamental way our concept of primary headache disorders, requiring a radical reappraisal of the tenet of structural normality.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10395332&dopt=Abstract headache medicine




Primary headache care delivery by nonspecialists in Brazil. Brazilian Headache Care Cooperative Group.

Vincent MB, de Carvalho JJ.

Department of Neurology, Hospital Universitario Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Brazil.

Headaches are common disorders usually examined by nonneurologists. In order to assess how primary headache patients (IHS groups 1, 2, and 3) are generally managed by nonspecialists, 414 patients were asked about their previous headache care. Correct diagnosis had previously been made in only 44.9%, 6.7%, and 26.7% of the migraine, tension-type headache, and cluster headache patients, respectively. The patients underwent 501 investigative procedures motivated by the headache, averaging 1.21 examinations per patient, mostly EEGs. Preventive treatment was largely overlooked irrespective of the headache type. It is concluded that scientific improvements in headache care may be ineffective unless educational programs improve headache knowledge in general.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10403068&dopt=Abstract headache medicine