Headaches in non insulin-dependent diabetes mellitus.

Split W, Szydlowska M.

Department of Neurology and Oromandibular Dysfunction, Medical University of Lodz, Poland.

The aim of the study was to assess the frequency and nature of headaches in patients with non-insulin dependent diabetes (NIDDM). The investigations included 154 patients with NIDDM, 90 females and 64 males aged between 30 to 65 years. Duration of diabetes varied from 6 months to 37 years. The control group comprised 106 persons. Of the 127 NIDDM patients complaining of headaches, 95 had migraine headaches and 32 tension-type headaches. In 50 patients the onset of migraine headaches occurred when the patients were afflicted with diabetes. In 45 patients migraine was diagnosed before they began to suffer from diabetes. In these patients the onset of diabetes significantly increased the average yearly number of headache days. In 21 patients tension-type headaches occurred in the course of diabetes. 11 patients had tension-type headaches before the onset of the disease. In these cases the onset of diabetes increased significantly the average yearly number of headache days. In the control group, migraine was diagnosed in 17 subjects and tension-type headaches in 28 subjects.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9503195&dopt=Abstract headache medicine




Muscular factors are of importance in tension-type headache.

Jensen R, Bendtsen L, Olesen J.

Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark.

Recent studies have indicated that muscular disorders may be of importance for the development of increased pain sensitivity in patients with chronic tension-type headache. The objective of the present study was to investigate this hypothesis by examining the pain perception in tension-type headache with and without muscular disorders defined as increased tenderness. We examined 28 patients with episodic tension-type headache, 28 patients with chronic tension-type headache, and 30 healthy controls. Pericranial myofascial tenderness was recorded with manual palpation, and pressure pain detection and tolerances in cephalic and extracephalic locations with an electronic pressure algometer. In addition, thermal pain sensitivity and electromyographic activity were recorded. The main result was significantly lower pressure pain detection thresholds and tolerances in all the examined locations in patients with chronic tension-type headache with a muscular disorder compared to those without a muscular disorder. There were no such differences in any of the examined locations when the two subgroups of patients with episodic tension-type headache were compared. Thermal pain sensitivity did not differ between patients with and without a muscular disorder, while electromyographic activity levels were significantly higher in patients with chronic tension-type headache with than in those without a muscular disorder. Our results strongly indicate that prolonged nociceptive stimuli from the pericranial myofascial tissue sensitize the central nervous system and, thereby, lead to an increased general pain sensitivity. Muscular factors may, therefore, be of major importance for the conversion of episodic into chronic tension-type headache. The present study complements the understanding of the important interactions between peripheral and central factors in tension-type headache and may lead to a better prevention and treatment of the most prevalent type of headache.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9504997&dopt=Abstract headache medicine




Factors of early life as predictors of headache in children at school entry.

Aromaa M, Rautava P, Helenius H, Sillanpaa ML.

Department of Child Neurology, University of Turku, Finland.

To study the main predictors of childhood preschool headache, 1443 families expecting their first child were followed from the onset of pregnancy to the child's sixth year of life. Subject selection was based on stratified randomized cluster sampling. Of the children, 14.9% (144) suffered from headache disturbing daily activities at the age of 6 years. The mother's assessment of the infant's poor health (OR 2.5, 95% CI 1.1 to 5.8) and feeding problems (OR 1.9, 95% CI 1.1 to 3.2) at the age of 9 months predicted later occurrence of headache. At 3 years, depression and sleeping difficulties (according to Achenbach's psychological test) and recurrent difficulties in falling asleep (OR 3.2, 95% CI 1.5 to 7.2) were strong predictors. Headache in other family members (OR 3.5, 95% CI 2.0 to 5.9), especially in the mother (OR 1.7, 95% CI 1.2 to 2.4), predicted preschool headache in a child. At the age of 5 years, travel sickness (OR 2.8, 95% CI 1.5 to 5.1), nocturnal enuresis (OR 1.8, 95% CI 1.1 to 3.0), and the presence of long-term disease (OR 1.8, 95% CI 1.1 to 3.0) were strong predictors of later headache. At the same age, concentration difficulties (OR 2.3, 95% CI 1.3 to 4.2), behavioral problems (OR 2.7, 95% CI 1.1 to 6.4), unusual tiredness (OR 3.8, 95% CI 1.0 to 13.5), and, conversely, high sociability (OR 1.5, 95% CI 1.0 to 2.2) predicted headache. The three last-mentioned psychological factors seemed to be associated with concentration difficulties at the age of 5, which was found to be the strongest predictor. The parents of child headache sufferers often became aware of the child's problems long before the emergence of headache.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9504999&dopt=Abstract headache medicine




[Factors contributing to so-called idiopathic headaches]

[Article in Polish]

Niczyporuk-Turek A.

Katedry i Kliniki Neurologii AM w Lodzi.

The interest in factors that may trigger in some cases idiopathic headache has increased in recent years. This problem has not been discussed in Polish literature up to now. An analysis of precipitating factors in a group of 116 patients: 70 with migraine, 30 with tension type of headache and 16 with cluster headache was conducted. In these groups: 60 patients (87%) with migraine, 24 patients (80%) with tension type headache and 15 patients (94%) with cluster headache confirmed activity of precipitating factors was shown. Stress was the most frequently cited precipitant in all types of idiopathic headaches (migraine-58%; tension type headache-53%; cluster headache-50%). Weather changes were in the second place. Excessive environmental factors, oversleep, some foods were also prominent factors.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9513953&dopt=Abstract headache medicine




Inheritance of chronic tension-type headache investigated by complex segregation analysis.

Russell MB, Iselius L, Ostergaard S, Olesen J.

Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark.

We investigated the mode of inheritance of chronic tension-type headache in 122 families. The probands were from the Copenhagen Headache Clinic, Denmark. The criteria of the International Headache Society were used. The patterns of segregation of chronic tension-type headache were assessed by complex segregation analysis performed with the computer program POINTER. Of the 122 probands with chronic tension-type headache, 56 had 71 first-degree relatives with chronic tension-type headache. The complex segregation analysis indicates that chronic tension-type headache has multifactorial inheritance.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9521579&dopt=Abstract headache medicine




Medical consultation for migraine: results from the American Migraine Study.

Lipton RB, Stewart WF, Simon D.

Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.

BACKGROUND: Migraine headaches are often disabling but usually responsive to treatment. Nonetheless, many people with migraine never consult a doctor for headaches. In a sample of the US population, we sought to determine the proportion of active migraineurs who ever consulted a doctor for headache and to identify the headache characteristics and sociodemographic factors associated with consulting. METHOD: A mailed questionnaire survey was sent to 15,000 US households, selected from a panel to be representative of the US population. Of 20,468 eligible respondents ranging in age from 12 to 80 years, 2479 met a case definition for migraine. We mailed a second questionnaire to all migraineurs identified on the first survey and achieved a 69.4% response rate. The second survey assessed headache characteristics, patterns of medical care use, medication use, and method of payment for health care. RESULTS: Sixty-eight percent of female and 57% of male migraineurs reported having ever consulted a doctor for headache. Consultation was more likely with increasing age and in women who ever married. In females, several headache characteristics including pain intensity, number of migraine symptoms, attack duration, and disability were associated with consultation. Of those who never consult, 61% report severe or very severe pain and 67% report severe disability or the need for bed rest with their headaches. CONCLUSION: The results of this survey indicate that a significant proportion of migraine sufferers never consult doctors for their headaches. Given that a large proportion of persons who never consult report high levels of pain and disability, these data suggest that there are opportunities to appropriately increase health care utilization for migraine. Given that 40% of migraineurs who have ever consulted do not report a physician diagnosis of migraine, there is a need to improve headache diagnosis and/or doctor-patient communication about migraine.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9529763&dopt=Abstract headache medicine




Headache and analgesic use in Sweden.

Antonov K, Isacson D.

Department of Pharmacy, Pharmaceutical Services Research, University of Uppsala, Sweden.

In this study, patterns of analgesic use among persons with headache in the general Swedish population were analyzed in association with health factors, health care utilization, sociodemographic factors, and life-style. Data from the Swedish Survey of Living Conditions for the 2-year period 1988 through 1989 were used. In this survey, a probability sample of the Swedish population aged 16 years and older was interviewed. Persons with headache were identified by the question, "Have you (during the last 2 weeks) had recurrent headache or migraine?" Analgesic use was defined by the question, "Have you (during the last 2 weeks) used prescription or nonprescription analgesics?" Persons who answered both these questions were included in the present study, yielding a study population of 11,975 persons. Sixteen percent of all women and 8.2 percent of all men reported headache. Seventy-four percent of all women with headache reported analgesic use as compared to 64% of all men with headache. Analgesic use increased with increasing age among women but not men. While few of the studied factors were associated with analgesic use among persons with headache, the associations found differed by gender. Poor social network and musculoskeletal pain were associated with analgesic use among men with headache; age, being underweight, and visits to a physiotherapist were associated with analgesic use among women with headache. Those studying medication use among persons with headache might consider including these factors in future studies to help better understand the mechanisms behind the decision to use or avoid analgesics.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9529764&dopt=Abstract headache medicine




Stress, headache, and physiological disregulation: a time-series analysis of stress in the laboratory.

Davis PA, Holm JE, Myers TC, Suda KT.

Department of Psychology, University of North Dakota, Grand Forks 58202, USA.

This study examined the stress-headache relationship from a disregulation framework by monitoring both physiological responses (e.g., pulse, blood volume, skin resistance, and EMG) and self-reported responses to a stressful event in tension and migraine headache sufferers, as well as in headache-free controls. Responses were analyzed via time-series analyses to determine whether self-reports of stress were correlated with physiological measures of stress. It was hypothesized that tension and migraine headache sufferers would show fewer significant correlations than control participants between their self-reports of stress and physiological activity. Data analyses supported this hypothesis for tension headache sufferers, but generally not for migraine headache sufferers. The most compelling support for the hypothesis in tension headache sufferers came from the cross-correlations between self-reported stress and pulse rate.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9529767&dopt=Abstract headache medicine