[Prevalence and indirect costs of headache in a Brazilian Company]

[Article in Portuguese]

Vincent M, Rodrigues Ade J, De Oliveira GV, De Souza KF, Doi LM, Rocha MB, Saporta MA, Orleans RB, Kotecki R, Estrela VV, De Medeiros VA, Borges WI.

Servico de Neurologia, Hospital Universitario Clementino Fraga Filho, Brazil. vincent unisys.com.br

Employees from a Brazilian oil company research centre (n = 993) were interviewed on the occurrence of headache during a 30 days period. Headache prevalence was 49.8%, with a mean frequency of 4.3 +/- 7.0 attacks per month, lasting 12.2 +/- 21.4 hours each. According to the International Headache Society diagnostic criteria, migraine (5.5%), episodic tension-type headache (26.4%), chronic tension-type headache (1.7%) and headaches not fulfilling the criteria for such disorders (16.2%) were observed. Women suffered comparatively more headache and specifically migraine than men. The pain interfered with work productivity in 10% of the subjects, corresponding to 538.75 hours off. According to an indirect costs estimation for each headache, the company may loose up to US$125.98 per employee annually. Since among headaches migraine has the highest indirect cost, migraine prevention and treatment is particularly important at the working environment. Migraine frequency may be prevented to a large extent, resulting on positive effects in both the quality of life and productivity. The cost-benefit ratio clearly favours therapeutic and preventive programs against chronic headaches.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10029875&dopt=Abstract headache medicine




Effects of blood pressure on orbital and middle cerebral artery resistances in healthy pregnant women and women with preeclampsia.

Belfort MA, Saade GR, Grunewald C, Dildy GA, Varner MA, Nisell H.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah, USA.

OBJECTIVE: The object of the study was to test the hypothesis that preeclampsia leads to an abnormal vascular response to increasing blood pressure in cerebral vessels by analyzing the relationship between mean arterial pressure and resistance index in the central retinal, ophthalmic, and middle cerebral arteries in women with normal pregnancies and women with preeclampsia.Study Design: Transcranial and color flow Doppler ultrasonographic studies were used to determine systolic, diastolic, and mean velocities and the resistance indexes in the central retinal, ophthalmic, and middle cerebral arteries in 24 women with normal pregnancies and 18 women with preeclampsia. In each group the relationship between the mean arterial pressure and the resistance index was determined for each artery by means of linear regression analysis. The Pearson correlation coefficients for each mean arterial pressure versus resistance index relationship were compared between the groups. In a separate analysis middle cerebral artery data obtained from 79 women with preeclampsia (with and without headache) were compared with data from the normal pregnancy group and analyzed in terms of the relationship between mean arterial pressure and resistance index. RESULTS: The resistance index in women with normal pregnancies decreased with increasing mean arterial pressure in all 3 vessels studied (ophthalmic artery r = -0.33, central retinal artery r = -0. 43, middle cerebral artery r = -0.30). In the women with preeclampsia, however, as mean arterial pressure increased the resistance index increased in the orbital vessels and decreased in the middle cerebral artery (ophthalmic artery r = 0.54, central retinal artery r = 0.65, middle cerebral artery r = -0.25). The correlation coefficients in the women with preeclampsia were significantly different from those in the women with normal pregnancies for the ophthalmic and central retinal arteries (P =. 001) but not for the middle cerebral artery (P =.8). Within-group analysis in the patients with normal pregnancies showed no differences between the correlation coefficients of the studied vessels. In the women with preeclampsia the ophthalmic artery (P =. 02) and the central retinal artery (P =.005) were significantly different from the middle cerebral artery but not from each other. Women with preeclampsia who had headache had a different correlation coefficient for the middle cerebral artery than did those without headache (r = -0.34 versus r = 0.23; P <.001). The correlation coefficient for the middle cerebral artery for women with preeclampsia without headache was not significantly different from the central retinal artery and ophthalmic artery correlation coefficients in the general preeclampsia group. CONCLUSIONS: Women with preeclampsia demonstrate a different relationship between blood pressure and resistance index in the ophthalmic and central retinal arteries than do women with normal pregnancies. In the middle cerebral artery, however, preeclampsia does not appear to affect the resistance index response to increasing mean arterial pressure in women with headache. In women with preeclampsia without headache the relationship seen in the ophthalmic artery and central retinal artery is preserved in the middle cerebral artery. This may indicate a failure in the autoregulatory capacity of the middle cerebral artery in the presence of headache. Alternatively, the resistance index response in the ophthalmic artery and central retinal artery may represent small-caliber vessel vasospasm that is not present in the middle cerebral artery in women with preeclampsia who have headache.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10076135&dopt=Abstract headache medicine




Primary Headache and Helicobacter Pylori.

Gasbarrini A, De Luca A, Fiore G, Franceschi F, Ojetti V V, Torre ES, Di Campli C, Candelli M, Pola R, Serricchio M, Tondi P, Gasbarrini G, Pola P, Giacovazzo M.

Internal Medicine and Angiology Departments, Catholic University, Rome, Italy

H. pylori infection has recently been associated with various vascular disorders. The aim of this study was to investigate its role in primary headache, a pathology strictly associated with vascular alterations. A total of 200 subjects affected by primary headache were evaluated. H. pylori infection was diagnosed by the 13C urea breath test. Headache was classified in tension-type headache, cluster headache, and migraine with or without aura. Prevalence of H. pylori infection and gastrointestinal (GI) symptoms were evaluated. H. pylori infection was found in 40% of the patients; prevalence of migraine without aura was found to be significantly greater in infected patients. The positive group showed no significant differences in the prevalence of the GI symptoms evaluated. In 30 infected patients, it was assessed whether the eradication of the bacterium was able to reduce frequency, intensity, and duration of clinical attacks of headache. After eradication, clinical attacks of headache completely disappeared in 17% of patients. Moreover, intensity, duration, and frequency of headache attacks were reduced in 69% of the remaining subjects. In conclusion, H. pylori infection is common in primary headache; bacterium eradication appears to be related to a significant reduction in clinical attacks of the disease.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9716793&dopt=Abstract headache medicine




Emergency medical services transport of patients with headache: mode of arrival may indicate serious etiology.

Nemer JA, Tallick SA, O'Connor RE, Reese CL.

Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pennsylvania, USA.

OBJECTIVE: To determine whether mode of arrival is associated with seriousness of etiology and use of diagnostic testing in patients treated in the emergency department for headache. METHODS: This observational, retrospective study was conducted by consecutive review of the records of patients presenting to the emergency department with a chief complaint of headache from December 1994 through May 1995. Patients with altered mental status or seizures were excluded. Mode of arrival was classified as either by EMS or other (e.g., private vehicle). Patients with a final diagnosis of meningitis, intracranial hemorrhage, or central nervous system tumor were classified as having serious causes, whereas those with headache due to migraine, tension headache, or headache that was otherwise unspecified were classified as nonserious. The use of diagnostic studies, such as lumbar puncture or CT scan, and their results, was recorded. Patients were included in the category of patients having serious intracranial pathology even if the diagnosis was delayed. Statistical analysis was performed using the Yates-corrected chi-square test, and by determining odds ratios (ORs) with 95% confidence intervals. RESULTS: For 967 patients presenting with a chief complaint of headache, 837 charts were included in the analysis. A total of 102 patients arrived by EMS, and 735 arrived by other means. Patients arriving by EMS had a higher rate of serious cause of headache than did those arriving by other means (OR = 18.5, p < 0.0001). EMS patients tended to undergo additional diagnostic testing (OR = 4.4, p < 0.0001), and those tests were more likely to be abnormal than for those arriving by other means (OR = 9.4, p < 0.0001). Males had a somewhat higher rate of serious diagnosis (OR = 2.6, p < 0.05). CONCLUSIONS: In this EMS system, patients with headache who arrive by EMS are more likely to have serious causes. Mode of arrival may be of use to the clinician in assessing risk of serious illness among patients with headache. Whether this observation represents an element of self-triage or a combination of other factors remains to be determined.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9799019&dopt=Abstract headache medicine




[Psychological aspects of tension type headache]

[Article in Polish]

Dubojska AM, Split W, Rostowski J.

Zakladu Neurologii i Zaburzen Czynnosciowych Narzadu Zucia, Akademii Medycznej w Lodzi.

In understanding and treatment of tension type headache the psychological stress is considered as one of the most important factors causing and strengthening headache. The aim of this work was the assessment of personality traits in patients suffering from tension-type headache. Methods of this study were based on investigation of the dimensions of personality using the Eysenck Personality Inventory EPQ-R and the assessment of psychological stress using a Questionnaire of Demographic Variables. The group of 120 patients suffering from tension-type headache was assessed and 30 control subjects without headaches were investigated. Special personality traits conditioning/characterising tension-type headache were not confirmed. Patients with tension-type headache comparing to subjects from the control group showed neurotism and introversion.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9921102&dopt=Abstract headache medicine




[Headaches during oral contraception. A selective study concerning 159 observations]

[Article in English, French, Spanish]

Bourdais J-p, Delavierre P, Bourdais-varenne O, Hureau J.

PIP: Headaches experienced by 159 women during use of oral contraceptives for at least 1 year are characterized as migraine or tension headaches, and whether the headaches were related to dose or type of pill is examined. The 159 women accounted for 15% of a total of 1061 pill users: well-defined syndromes such as pituitary adenoma were eliminated. 47 of these women had headaches before, 31 of them worsened, and in 6 improved. Of 115 women with migraine, diagnosed by having at least 2 of 5 criteria for the disorder, 82 developed them during oral contraception. 12 of the 20 women with tension headaches had never had them before. 8 (5%) of the headaches were of indeterminate origin. In 50% headaches occurred during menses, or in 13% they were aggravated then. In 11 women the condition was improved by lowering progestagen dose. Generally migraines appeared or worsened within the 1st year of pill use, while tension headaches usually developed later. Younger women tolerated the pill better. 42 women stopped the pill because of headaches.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12334989&dopt=Abstract headache medicine




Headache level during neuropsychological testing and test performance in patients with chronic posttraumatic headache.

Lake AE 3rd, Branca B, Lutz TE, Saper JR.

Michigan Head-Pain and Neurological Institute, Ann Arbor 48104, USA.

This study addresses (1) the relationship between headache presence/intensity at time of testing and neurocognitive performance, and (2) the probability that testing triggers or intensifies pain. Subjects were 125 patients with chronic posttraumatic headache (mean = 2.67 years post injury) who completed a 4-hour test battery emphasizing memory. Comparisons of 34 individual tests/subtests and the five Wechsler Memory Scale-Revised (WMS-R) indices of relative memory impairment for 73 patients with no headache or mild headache versus 52 patients with moderate to severe pain revealed no significant differences. Testing intensified existing headaches for 55% but triggered headache for only 1 of 20 (5%; P =.00003). Results support the validity of neuropsychological test performance regardless of pain level, although testing can be painful.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9949247&dopt=Abstract headache medicine




[Effectiveness of brain imaging in children with headache]

[Article in Spanish]

Romero Sanchez J, Picazo Angelin B, Tapia Ceballos L, Romero Gonzalez J, Diaz Cabrera R, Romero Sanchez I.

Hospital Costa del Sol, Marbella, Malaga.

OBJECTIVE: Headache is a common complaint in children and brain imaging has become widely used to evaluate this clinical condition. We studied the value of neuroimaging in children with chronic headaches. PATIENTS AND METHODS: A retrospective chart review was conducted of all children referred to the pediatric outpatient clinic for evaluation of headache over a 3-year period. The charts were reviewed for headache characteristics, clinical indications for performing neuroimaging, and imaging results. Special attention was paid to evidence of space-occupying lesions. RESULTS: A total of 160 records were studied, with subjects ranging in age from 4 to 14 years. Most patients were diagnosed as having migraine headaches (60%) or chronic tension headaches (29.5%). Other diagnoses were post-traumatic (6%) and unclassified (4%). Sixty-six patients (41%) had computed tomography imaging performed. In most cases, brain imaging studies were performed because of clinical data (41%) like atypical pattern, sleep-related headache or increase of headache, because of the parents' concerns about brain lesions (38%) and because of an age less than 5 years (14%). Structural changes were found on brain imaging in 4 patients, but none indicated the presence of a treatable space-occupying lesion and all were deemed unrelated to the headache. Our findings of no relevant abnormalities in a series of 66 neuroimaging studies indicate that the maximal rate at which such abnormalities might appear in this population is 4.4%. CONCLUSIONS: These results indicate that neuroimaging studies have very limited value in the clinical evaluation of pediatric patients with chronic headache and should be reserved for those patients with clinical evidence suggestive of underlying structural lesion.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9949590&dopt=Abstract headache medicine