Business management of headache centers.

Nappi G, Micieli G, Cavallini A, Rossi G Sr, Rossi G Jr, Rossi F.

University Centre for Adaptive Disorders and Headache, Section of Pavia, IRCCS C. Mondino Foundation, Italy.

Economic evaluation of the costs and benefits of a headache center or unit has become very important for headache specialists. Many of the problems concerning this "financial" approach to headache derive from the model of organization of the Headache Unit, which is dependent on the various approaches to healthcare practiced in the country considered. So far there are two models of headache center that are generally considered: the hospital-based center and the independent center. An argument favoring hospital-based headache clinics is the lower costs, primarily because of their functional connection with the services of a general hospital, i.e., neuroradiology, neurophysiology, routine laboratory analysis, etc. Another is that the headache specialist has the possibility to visit the patients presenting to the emergency room in the acute phase of headache. Independent clinics have greater costs, but are equally as effective as hospital-based models.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9533678&dopt=Abstract headache medicine




Presentation of chronic daily headache: a clinical study.

Spierings EL, Schroevers M, Honkoop PC, Sorbi M.

Department of Neurology, Brigham & Women's Hospital, Boston, Mass., USA.

We studied the presentation of chronic daily headache in 258 patients from a private headache practice, 50 men and 208 women. Chronic daily headache was defined as headaches, occurring at least 5 days per week for at least 1 year. Seventy-seven percent of the patients experienced the onset of headache before the age of 30. The daily headaches were present on awakening in the morning or came about in the course of the morning in 79% of the patients. In 53%, they were worst in the afternoon or evening. The headaches awoke the patients at night at least once per week in 36%. At least twice per week, they were associated with nausea in 35% of the patients and with vomiting in 9%. Common aggravating factors included light, physical activity, bending over, noise, stress or tension, and menstruation. Ninety-four percent of the patients experienced severe headaches in addition to the daily headaches. In 63%, the severe headaches occurred 10 days per month or less. The daily caffeine intake of the patients averaged 170 mg, and the daily analgesic intake, 1860 mg of aspirin equivalents.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9563209&dopt=Abstract headache medicine




Massage therapy and frequency of chronic tension headaches.

Quinn C, Chandler C, Moraska A.

Boulder College of Massage Therapy, 6255 Longbow Drive, Boulder, CO 80301, USA. cquinn bcmt.org

OBJECTIVES: The effect of massage therapy on chronic nonmigraine headache was investigated. METHODS: Chronic tension headache sufferers received structured massage therapy treatment directed toward neck and shoulder muscles. Headache frequency, duration, and intensity were recorded and compared with baseline measures. RESULTS: Compared with baseline values, headache frequency was significantly reduced within the first week of the massage protocol. The reduction of headache frequency continued for the remainder of the study (P =.009). The duration of headaches tended to decrease during the massage treatment period (P =.058). Headache intensity was unaffected by massage (P =.19). CONCLUSIONS: The muscle-specific massage therapy technique used in this study has the potential to be a functional, nonpharmacological intervention for reducing the incidence of chronic tension headache.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12356617&dopt=Abstract headache medicine




Relationships between arousal-related moods and episodic tension-type headache: a biopsychological study.

Cathcart S, Pritchard D.

Department of Psychology, University of Adelaide, South Australia.

An exploratory study was conducted examining arousal-related moods and episodic tension-type headache. Twelve subjects meeting International Headache Society criteria for episodic tension-type headache and 12 headache-free controls recorded headache activity and mood eight times daily for 14 consecutive days. Moods were measured using the Activation-Deactivation Adjective Check List, a self-report list that subjectively represents general arousal along two dimensions of Tension and Energy. Headache subjects had higher Tension levels than controls even in the absence of pain, and greater variation in this dimension as well. Within the headache group, Tension during pain-free periods was significantly lower than when experiencing headache, and was correlated with headache activity. The results were taken to support Thayer's (1989) biopsychological model of mood and arousal, and are discussed in terms of the model's heuristic value for general arousal and headache research.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9563213&dopt=Abstract headache medicine




Social environment and headache in 8- to 9-year-old children: a follow-up study.

Metsahonkala L, Sillanpaa M, Tuominen J.

Department of Child Neurology, Turku University, Finland.

We studied the occurrence of migraine and nonmigrainous headache and the factors associated with headache in a group of 3580 children. These children belong to a 1-year age cohort which has been followed since birth. When the children were 8 to 9 years old, data on their headaches were gathered through a postal questionnaire. Ninety-five of the children (2.7%) had migraine and 977 (27.3%) reported non-migrainous headache at the age of 8 to 9 years. Thirty-four percent of the children with migraine had already had headache at the age of 5 years. Children with migraine and children with nonmigrainous headache both reported more often being bullied in school, stress in school, and problems in getting along with other children than children without headache. The association of stress in school with headache was strongest in girls with migraine, even though they reported the least difficulties in school subjects. As many as one third of the boys with migraine reported that they had problems with peer relationships.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9563214&dopt=Abstract headache medicine




Preliminary investigation of associations of illness schemata and treatment-induced reduction in headaches.

Narduzzi KJ, Nolan RP, Reesor K, Jackson T, Spanos NP, Hayward AA, Scott HA.

Department of Psychology, University of Windsor, Ontario, Canada.

This study examined how illness schemata-ways people organize information about illness-change over the course of cognitive-behavioral treatment of chronic headache and the extent to which such changes predict reduction of headache. 73 subjects with chronic migraine, mixed migraine and tension, or tension headache were classified on the basis of outcome from imagery-based treatment as Treatment-responders (n = 24). Treatment nonresponders (n = 27), and Monitoring Controls (n = 22). Self-reported illness schemata related to the seriousness and changeability of headache were assessed at pretreatment and 8-wk. follow-up. While groups did not differ on pretreatment measures of illness schemata, at follow-up the Treatment responder group reported higher Changeability scores than Treatment-nonresponders and Control subjects and lower Seriousness scores than Control subjects. Headache reduction at follow-up was related to follow-up Changeability scores, in-session changes in systolic blood pressure and reported posttreatment expectations of headache activity, but not pretreatment measures of illness schemata. Findings indicate that improvements in headache activity are not influenced by the severity of headaches and may change prior to cognitive-behavioral treatment. Rather, among individuals who show decreases in headache activity, changes in beliefs about illness and headache reduction may have reciprocal relations both of which result from cognitive behavioral treatment.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9580319&dopt=Abstract headache medicine




Psychological well-being in older adults suffering from chronic headache.

Jelicic M, Kempen GI, Passchier J.

Department of Health Sciences, School of Medicine, University of Groningen, The Netherlands.

OBJECTIVE: The aim of this study was to examine two components of psychological well-being--life satisfaction and affective well-being--in community-dwelling elderly with (n = 321) and without chronic headache (n = 4955). METHODS: A checklist of chronic medical conditions was used to determine whether respondents were suffering from headache. Cantril's ladder was employed to measure life satisfaction. The subscale, Mental Health, from the MOS SF-20 was used to assess affective well-being. RESULTS: Headache sufferers reported lower life satisfaction as well as lower affective well-being. However, the difference in life satisfaction between the two groups disappeared after controlling for comorbidity. The difference in affective well-being disappeared after controlling for neuroticism. CONCLUSIONS: Lower life satisfaction in patients with chronic headache is caused by more comorbid diseases in the headache group. Lower affective well-being in headache sufferers is due to higher levels of neuroticism in the headache group.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9595869&dopt=Abstract headache medicine




[Is headache a women's disease?]

[Article in Swedish]

Nilsen CV, Lande SA, Malterud K.

Seksjon for allmennmedisin, Universitetet i Bergen.

Headache is experienced by the majority of people in the population. The prevalence of migraine in women is greater than in men, and there are indications that this is also the case for non-migrainous headache. We reviewed available literature on headache epidemiology for documented knowledge on the prevalence of non-migrainous headache in men and women and severity of the disease. In this article we present a summary of 13 studies of the general population where prevalence of the common headache in men and women could be expressed as a gender ratio. The studies covered the period 1977-96, and included a total number of 75,000 people. The review confirms that non-migrainous headache is a women's disease, in that a female dominated gender ratio was found consistently throughout the studies. However, female dominance is not as great as for migraine. Varying definitions of headache resulted in a great variation in prevalence across the studies, but this did not influence the gender ratio. From the literature available no conclusions can be drawn on gender differences related to severity or frequency of the non-migrainous headache. These areas need to be explored further in order to provide adequate health care for men and women suffering from headache.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9599506&dopt=Abstract headache medicine