Reliability of an illness severity measure for headache in a population sample of migraine sufferers.

Stewart WF, Lipton RB, Simon D, Von Korff M, Liberman J.

Department of Epidemiology, Johns Hopkins School of Hygiene and Public Health, USA.

OBJECTIVES: To examine the reliability and related measurement properties of an illness severity measure for headache derived from responses to a 16-item self-administered questionnaire, the Headache Impact Questionnaire (HImQ), and to determine if there is support for combining measures of pain and disability into a single scaled measure of severity. METHODS: A population-based sample of migraine headache sufferers completed the HImQ twice, an average of 38 days apart. The HImQ included questions about number of headaches in the last 3 months, headache duration, last headache, pain intensity (two questions), need for bedrest (two questions), disability in specific domains of activity (seven questions about interference with ability to work, do household chores, and engage in non-work activity), and symptoms (two questions). RESULTS: Test-retest correlations of individual questions ranged from 0.65 to 0.93. In principal components analysis, a single factor with significant loading emerged. One measure of pain intensity (average pain score from 0 to 10) and items related to disability (i.e., missed days due to headache, and reduced effectiveness because of headache) in defined activity domains (work for pay, housework, nonwork activities) had the greatest weights on this single factor, supporting prior work on combining measures of pain and disability into a single scale. The HImQ score was derived as the sum of average pain intensity and total lost time in each of the three domains of activity, expressed as lost days. The latter was derived as the sum of actual missed days in each activity domain and reduced effectiveness day equivalents in each activity with a headache. The test-retest correlation was 0.77 for all eligible subjects and 0.85 when one influential outlier was removed. Cronbach's alpha was 0.83. CONCLUSIONS: The HImQ score, based on eight items, is a highly reliable and internally consistent measure of headache severity.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9601624&dopt=Abstract headache medicine




Episodic cluster headache in a community: clinical features and treatment.

Riess CM, Becker WJ, Robertson M.

Department of Clinical Neurosciences, University of Calgary, Canada.

OBJECTIVE: To study the clinical features and treatment given to episodic cluster headache patients in the Calgary region. PATIENTS: Fifty-one (51) patients who responded to a media campaign, had previously been diagnosed by their family physicians, and who met International Headache Society (IHS) criteria for episodic cluster headache, formed the population for this study. METHODS: The media campaign consisted of newspaper advertisements and radio publicity including physician interviews and talk shows. Patients were required to complete by 200-item questionnaire detailing clinical features and treatment of their cluster headache syndrome. Each patient was also interviewed by our research nurse for clarification and proper completion of questionnaire. RESULTS: Fifty-one percent (51%) of our patients had short headache attacks lasting one hour or less. Almost one-half (45%) had three or four attacks per 24 hour period. Eighty-six percent (86%) had been referred to a neurologist. Sixty-nine percent (69%) had never used oxygen, but of those who had, one-half were still using it. Sumatriptan by injection had been tried by 26% of patients and of these, 93% considered it effective. Subcutaneous dihydroergotamine had been tried by 8%. For prophylaxis, 41% had tried methysergide, 31% prednisone, and 4% verapamil. Many patients had been prescribed migraine prophylactic drugs which are ineffective for cluster headache, and some had also undergone dental procedures or nasal and sinus surgeries. CONCLUSIONS: Many cluster headache patients had not, to their knowledge, been prescribed or used the best symptomatic and prophylactic treatments for cluster headache. This should be addressed through educational programs and through making up-to-date information on the treatment of cluster headache readily available to physicians and patients.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9604136&dopt=Abstract headache medicine




Headache and blood pressure among triethylamine-exposed foundry workers.

Jarvinen P.

Porin Laakaritalon Tyoterveys Oy, Aittaluodon terveysasema, Aittaluodokatu, Pori, Finland.

This study attempted to determine whether cold box core makers exposed to triethylamine in foundries experienced headaches or had elevated blood pressure more often than workers without TEA exposure, as proposed by earlier reports. Forty-one core makers in three foundries and 82 referents were interviewed according to a structured questionnaire, and their blood pressure was measured. TEA exposure was determined from breathing-zone measurements. The 8-h time-weighted average TEA exposure varied between 0.3-60 mg/m3. The core makers did not report that they had the general symptoms of headaches more often than the referents. However, they had mild weekly headaches more often (44% vs. 17%). The core makers also reported headaches more often during the workweeks (45% vs. 19%). It seems likely that TEA exposure provokes mild headache among persons prone to suffer from vascular headaches. There was no difference in the occurrence of severe headaches or in the duration of headaches between the groups. The blood pressures were similar in both groups.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9614770&dopt=Abstract headache medicine




Clinical experience on headache in children: analysis of 92 cases.

Aysun S, Yetuk M.

Division of Pediatric Neurology, Hacettepe University, Hacettepe/ANK, Turkey.

We analyzed, retrospectively, 92 patients with headache to determine the changes in the order of frequency of causes with the development of neuroimaging studies and its efficacy in the investigation of patients with headache. The type of headache was redefined according to the International Headache Society (IHS) diagnostic criteria. Migraine was the most frequent cause of headache and the rest in decreasing order were: tension-type headache, sinusitis, and epilepsy. The percentage of the findings relevant to headache in computed tomographic (CT) scans, magnetic resonance images (MRIs), Waters' projection (radiographs), and electroencephalograms (EEGs) were respectively 4.2%, 33.3%, 16%, and 25%. Neuroimaging studies are not necessary in the routine evaluation of patients with headache unless there is an abnormality in the findings. When it is needed, MRI, which has higher yield, can take the place of CT scanning. The most important point is taking a proper history of headache and making a thorough physical and neurologic examination of the patient.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9620010&dopt=Abstract headache medicine




[Association between headache and anxiety disorders indicators in a school sample from Ribeirao Preto, Brazil]

[Article in Portuguese]

Gorayeb MA, Gorayeb R.

Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, Ribeirao Preto, SP, Brasil.

A sample of 374 public elementary and junior high school students aged 8 to 13 years were evaluated to assess the prevalence of frequent headache complaints, associated with indications of anxiety disorder. Parents answered a questionnaire to investigate the presence and frequency of headache and of behaviors/symptoms that might indicate the presence of anxiety disorders. Children were evaluated using the Revised Children's Manifest Anxiety Scale adapted to this population. Among them, 45.4% had never had a headache complaint; 41.2% had occasional headache complaints; and 13.5% had frequent headache complaints. Among children with frequent headache complaints there were more girls than boys, higher anxiety scores, higher occurrence of bruxism, and higher frequency of agitation. The high prevalence of headache and its association with bruxism in this sample is compatible with North American and Brazilian epidemiological data. Results show an association between frequent headache complaints and high anxiety scores.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12364946&dopt=Abstract headache medicine




[Preventive treatment of migraine and chronic tension headache with moclobemide]

[Article in German]

Meienberg O, Amsler F.

Tricyclic antidepressants have been used for a long time in migraine prophylaxis and in the treatment of chronic tension-type headache. Because of their relatively frequent and unpleasant side effects, however, their use cannot be recommended without reservation. The selective and reversible monoamine oxidase inhibitor type A (MAO-A inhibitor), moclobemide (Aurorix), is much better tolerated and safer to use. For this reason, we began to use this substance in the prophylactic treatment of migraine and chronic tension-type headache. The obviously good efficacy in many cases prompted us to conduct a retrospective analysis of 61 headache patients treated with moclobemide. The patients, classified according to the diagnostic criteria of the International Headache Society, were treated for about 8 months on average with moclobemide. While on this therapy, 35 of the 42 migraine patients and 16 of the 17 patients with tension-type headache experienced good or very good improvement in their symptoms. In the migraine patients, the average number of monthly headache days declined from 7.8 before treatment to 1.2 at the end of treatment. In tension-type headaches, the effect occurred at the earliest 3-6 weeks and in the case of migraines at the earliest 6-8 weeks after the start of treatment. The therapeutic result was independent of any concurrent depression. Nine patients ended their treatment prematurely, seven because of side effects and two because of compliance problems. Treatment compliance, essential for the success of any long term treatment of headache, is promoted by open and detailed explanation of the treatment concept, and by medical supervision with individual adjustment of treatment. The patient should be instructed regarding the time required until the onset of action, the intended length of treatment, treatment of further headache attacks, and an appropriate lifestyle. The highly promising results with moclobemide in the prophylactic treatment of migraines and chronic tension-type headaches should be verified in a controlled study.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9324719&dopt=Abstract headache medicine




Alteration of central excitation circuits in chronic headache and analgesic misuse.

Fusco BM, Colantoni O, Giacovazzo M.

Department of Clinical Medicine, University La Sapienza, Rome, Italy.

Central excitatory circuits could be involved in the pathophysiology of pain; particularly, the genesis of chronic pain. The "second pain" is the sensation that follows the initial pain after an appropriate nociceptive stimulus. The second pain is amplified by repeating the stimulus after brief intervals (temporal summation). This phenomenon is the psychophysical correlate of the excitatory pain circuits. The temporal summation of the second pain was evaluated in four groups of subjects; one group affected by migraine without aura, one by episodic tension headache, one by chronic daily headache, and a group of healthy subjects. A percutaneous electrical shock was used as the nociceptive stimulus. The intensity of the second pain was significantly greater in the group of patients with chronic headache in comparison with the other groups. The patients with chronic headache were subdivided into three groups on the basis of their clinical history: a group with transformed migraine; a group with chronic headache ab initio, a form related to the first one; (both groups suffered from chronic daily headache with a frequent superimposition of episodes of migraine attacks) and the third group consisted of patients with chronic tension headache. The temporal summation of the second pain was altered in the first two groups. The patients with chronic migraine abused ergotamine given as a symptomatic drug. Those who were able to discontinue this drug were retested and reported a decrease of the second pain in comparison to the previous measurements. The results of the present study indicate that central excitatory circuits could be involved in the mechanism leading to the development of chronic daily headache.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9329230&dopt=Abstract headache medicine




Features of medication overuse headache following overuse of different acute headache drugs.

Limmroth V, Katsarava Z, Fritsche G, Przywara S, Diener HC.

Department of Neurology, University Hospital Essen, Germany.

OBJECTIVE: To investigate pharmacologic features such as mean critical duration until onset of medication-overuse headache (MOH) (MCDO), mean critical monthly intake frequencies (MCMIF), and mean critical monthly dosages (MCMD) as well as specific clinical features of MOH after overuse of different acute headache drugs, with a focus on newly approved triptans. METHODS: In a prospective study 98 patients with MOH according to International Headache Society (IHS) criteria underwent standardized inpatient withdrawal from their medication. Patient diaries and structured interviews were used to calculate the MCDO, MCMIF, and MCMD for each substance group. RESULTS: The MCDO was shortest for triptans (1.7 years), longer for ergots (2.7 years), and longest for analgesics (4.8 years). The MCMIF was lowest for triptans (18 single doses per month), higher for ergots (37), and highest for analgesics (114). Although patients overusing ergots and analgesics typically had a daily tension-type headache, patients with triptan-induced MOH were more likely to describe a (daily) migraine-like headache or an increase in migraine frequency. CONCLUSION: Overuse of triptans leads to MOH faster and with lower dosages compared with ergots and analgesics. Clinical features of MOH depend on the type of overused headache medication. Pharmacologic and clinical characteristics of triptan-induced MOH call for the renewal of the current IHS classification.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12370454&dopt=Abstract headache medicine