Fatigue and sleep in chronic headache sufferers: an age- and sex-controlled questionnaire study.

Spierings EL, van Hoof MJ.

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

We studied fatigue and sleep in chronic headache sufferers in comparison to age- and sex-matched controls. We determined the prevalence and intensity of fatigue as well as several sleep features. The study was conducted in a headache center through the use of a questionnaire. One hundred thirteen headache sufferers (59 men and 54 women) and 110 controls (56 men and 54 women) were included in the analysis. Fatigue was found to be equally common in the headache sufferers (70.3%) and in the controls (60.0%). However, the headache sufferers rated the intensity of their fatigue significantly higher (4.1 versus 2.8 cm on a 10-cm visual analog scale). When the sexes were considered separately, the difference in intensity of the fatigue between the two groups was significant only for the women (5.1 versus 3.0 cm). With regard to sleep, the headache sufferers slept significantly shorter (6.7 hours) than the controls (7.0 hours). It also took them longer to fall asleep (31.4 versus 21.1 minutes) and longer to fall back asleep after waking up at night (28.5 versus 14.6 minutes). When the sexes were considered separately, the differences in sleep features between the two groups were significant only for the men. On the basis of these results, we conclude that chronic headache sufferers feel more tired, especially the women, and do not sleep as well at night, especially the men. Further study is necessary to determine the significance of these findings in relation to chronic headache suffering.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9385751&dopt=Abstract headache medicine




Alcohol, smoking, and caffeine use among headache patients.

Mannix LK, Frame JR, Solomon GD.

Headache Center, Cleveland Clinic Foundation, OH 44195, USA.

We reviewed the charts of 151 headache patients, seen initially in a specialty headache center between 1988 and 1994, to collect information regarding reported alcohol consumption, smoking, daily number of caffeinated beverages, and medications. Charts of 50 patients in a general medicine clinic were reviewed for the same information. No significant differences between headache patients and general medicine patients were found in consumption of alcohol, smoking, or caffeinated beverages. Thirty headache patients (20%) used caffeine-containing medications more frequently than recommended; 24 of these patients used the products daily; 18 of those had a greater caffeine intake from medications than from beverages. Over-the-counter caffeine-containing analgesics were overused by 12 of the patients compared to 21 patients who overused prescription caffeine-containing preparations. Headache patients consume minimal amounts of alcohol, tobacco, and caffeinated beverages. However, headache patients often use caffeine-containing analgesics more frequently than recommended, which may lead to rebound and withdrawal headache.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9385756&dopt=Abstract headache medicine




The reproducibility of cephalic pain pressure thresholds in control subjects and headache patients.

Sand T, Zwart JA, Helde G, Bovim G.

Department of Neurology, Trondheim University Hospital, Norway. trond.sand medisin.ntnu.no

Pain pressure thresholds (PPT) were measured at 13 cephalic points bilaterally in 30 headache patients (10 with tension-type headache, 10 with migraine and 10 with cervicogenic headache) and 10 control subjects on three different days. During the sessions, the subjects reported their pain intensity on the right and left sides of the head on a visual analogue scale (VAS). The variability between days was estimated as a coefficient of repeatability (CR = 2 standard deviations of intraindividual differences). The mean CR across all 13 locations was larger in headache patients (2.0 kg/cm2) than in controls (1.68 kg/cm2). Variability (CR) was larger in headache patients as compared to control subjects for 11 of the 13 points (p = 0.02). Reliability was better in controls (intraclass correlation coefficients (ICC) ranging from 0.55 to 0.85) than in headache patients (ICC ranging from 0.43 to 0.78). A moderate negative association between PPT and pain intensity was demonstrated. The intraindividual PPT difference (PPT on the most painful occasions-PPT on the least painful occasions) was negative at 12 of 13 cephalic points (p = 0.003, across-location mean difference: -0.20 kg/cm2). The PPT differed significantly from one day to the next. A part of this variation was presumably related to the circumstances around the procedure; thresholds were lower when the subjects came directly to algometry without any preceding medical examination at all 13 points (p = 0.0002). These results have implications for the planning of future algometer studies. The sample size that is required in studies of headache patients is greater than that in studies of healthy subjects, especially when patients suffer from pain during the PPT session. Particular attention should be paid to circumstances (e.g. preceding medical investigations) around the algometry procedure in order to reduce variability.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9399004&dopt=Abstract headache medicine




Post-lumbar puncture headache: clinical features and suggestions for diagnostic criteria.

Vilming ST, Kloster R.

Department of Neurology, Ullevaal Hospital, University of Oslo, Norway.

The aim of the present prospective study was to describe clinical features of post-lumbar puncture headache (PPH), and to test the validity of the diagnostic criteria of the International Headache Society (IHS). Eighty-eight of the 239 included patients (36.8%) experienced PPH. Females were affected more frequently than males (45.2% vs 21.4%; p < 0.001). First onset of PPH occurred within the first day in 40 patients (53%), within 2 days in 89%, and never after the fourth day. When PPH occurred for the first time on the day the lumbar puncture was performed, it was usually experienced much later in the day (median 14.00 h) than it first occurred on the second day (median 09.30 h) or later. The median duration of PPH was 6 days (range 1-29 days). Patients with headache performed a "Rising Manoeuvre" twice daily as long as the headache period lasted, and recorded pain and time variables. The severity of PPH was negatively correlated to the time till the headache started or worsened upon rising (T1) and the time from the headache started to increase till it reached its maximum (T2), but was not significantly correlated to the time to restitution upon lying down (T3). The results are in good accordance with the leakage theory. T1 varied from immediate onset to 265 min (median 20 sec). T2 (median 30 sec, range 0-60 min) and T3 (median 20 sec, range 0-15 min) varied considerably as well. During the course of PPH, 45% of the patients occasionally reported non-postural headache or no headache when the Rising Manoeuvre was performed. It is suggested that PPH should be diagnosed in any patient who experiences postural headache at least once within 4 days of lumbar puncture.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9399009&dopt=Abstract headache medicine




[Odontogenic (concomitant) etiology of headache]

[Article in German]

Lunardon M, Barolin GS.

Aus dem Ludwig-Boltzmann-Institut fur Neuro-Rehabilitation und -Prophylaxe.

A systematic follow-up showed that out of 785 headache patients 1/4 had odontogenic pathogenic factors with possible connections to the headache syndrome and were indicated to be operated. 158 could be systematically examined and (surprisingly enough) improvement of headache syndromes ranking at 2/3 was about equally frequent within the group of those who had undergone dental operation and those that had not wanted to do so. In sub-groups different responses to operation were observed: cephalaea (permanent headache), better than migraine (attack figured headache); etiology of wisdom-tooth better than other tooth-pathology; upper jaw better than lower jaw. Our results once more underlined the multifactorial etiology of headache, that is opposed to a monocausal oriented headache diagnosis (as the IHS-nomenclature tries to impose). Still it has considered to be relevant that a good diagnostic examination in the field of tooth-, jaw- and mouth medicine should be conducted in every headache patient, even in "typical" migraine patients. When indicated, operations should be done; however the patient properly informed that improvement is not obligatory. Same time all the other possible etiologies for headaches shall be regarded and if positive treated.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9432810&dopt=Abstract headache medicine




Quantitative assessment of the tension-type headache and migraine severity continuum.

Schade AJ.

Department of Psychology, University of Auckland, New Zealand.

Two quantitative measures for Waters' tension-type headache and migraine severity continuum are proposed. To ensure face validity, symptoms and precipitants of this disorder were complied from the literature as a basis for the Auckland Migraine and Headache Inventory. This inventory was completed by 84 participants (mean age +/- SD, 26.0 +/- 9.7 years; range, 18 to 59 years) who complied with the criteria of the International Headache Society for migraine or tension-type headache. The migraine headache index and the number of precipitants were derived from the Auckland Migraine and Headache Inventory. These scores yielded significant internal reliability (r = .77 and .84), test-retest reliability (r = .86 and .74), and concurrent validity (r = .57) coefficients. The data, therefore, support the notion that the migraine headache index and the number of precipitants are reliable and valid indices of tension-type headache and migraine severity, suitable for participant selection and assessment of treatment. This study offers support for Waters' suggestion that tension-type headache and migraine are extremes of a severity continuum.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9439086&dopt=Abstract headache medicine




Epidemiology of tension-type headache.

Schwartz BS, Stewart WF, Simon D, Lipton RB.

Department of Epidemiology, Johns Hopkins University, School of Hygiene and Public Health, Baltimore, Md 21205, USA.

CONTEXT: Tension-type headache is a highly prevalent condition. Because few population-based studies have been performed, little is known about its epidemiology. OBJECTIVES: To estimate the 1-year period prevalence of episodic tension-type headache (ETTH) and chronic tension-type headache (CTTH) in a population-based study; to describe differences in 1-year period prevalence by sex, age, education, and race; and to describe attack frequency and headache pain intensity. DESIGN: Telephone survey conducted 1993 to 1994. SETTING: Baltimore County, Maryland. PARTICIPANTS: A total of 13 345 subjects from the community. MAIN OUTCOME MEASURES: Percentage of respondentswith diagnoses of headache using International Headache Society criteria. Workdays lost and reduced effectiveness at work, home, and school because of headache, based on self-report. RESULTS: The overall prevalence of ETTH in the past year was 38.3%. Women had a higher 1-year ETTH prevalence than men in all age, race, and education groups, with an overall prevalence ratio of 1.16. Prevalence peaked in the 30- to 39-year-old age group in both men (42.3%) and women (46.9%). Whites had a higher 1-year prevalence than African Americans in men (40.1% vs. 22.8%) and women (46.8% vs 30.9%). Prevalence increased with increasing educational levels in both sexes, reaching a peak in subjects with graduate school educations of 48.5% for men and 48.9% for women. The 1-year period prevalence of CTTH was 2.2%; prevalence was higher in women and declined with increasing education. Of subjects with ETTH, 8.3% reported lost workdays because of their headaches, while 43.6% reported decreased effectiveness at work, home, or school. Subjects with CTTH reported more lost workdays (mean of 27.4 days vs 8.9 days for those reporting lost workdays) and reduced-effectiveness days (mean of 20.4 vs 5.0 days for those reporting reduced effectiveness) compared with subjects with ETTH. CONCLUSIONS: Episodic tension-type headache is a highly prevalent condition with a significant functional impact at work, home, and school. Chronic tension-type headache is much less prevalent than ETTH; despite its greater individual impact, CTTH has a smaller societal impact than ETTH.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9459472&dopt=Abstract headache medicine




[A new type of headache of ocular origin: ophthalmotonic headache. Diagnosis and treatment]

[Article in Spanish]

Morell M, Clement E, Bernad MJ, Berbegal P, Soler S.

Servicio de Oftalmologia y de Neurologia, Hospital Militar de Zaragoza,Espana.

INTRODUCTION: In some patients it was seen that chronic headaches disappeared after laser iridectomies had been done to prevent glaucoma, in persons with normal intra-ocular pressure (IOP). OBJECTIVE: To make a study of patients with headache, some of whom were treated with topical beta-blockers (carteolol) and others by Yag-laser iridectomies. The effect on headache and IOP was analyzed. MATERIAL AND METHODS: A survey, ophthalmological examination and headache provocation test were carried out in patients with headaches, and the changes in IOP determined by pharmacologically inducing miosis and mydriasis were recorded. Three treatment groups were formed and the results analyzed statistically. RESULTS: In the 12 patients treated pharmacologically, 62% improved and in 14% the headaches disappeared. In the 16 treated using laser 94% were cured and 6% improved. When both types of treatment were used on 9 patients, 22% improved and 78% were cured. The validity of the ocular pressure curve was checked in the diagnosis of blockage of the pupil. CONCLUSIONS: Some headaches of ocular origin (ophthalmotonic), not previously described, occur due to abrupt changes in intraocular pressure, and improve significantly when the IOP is reduced by beta-blockers or Yag-laser iridectomies are done. A valid provocation tests for diagnosis of this type of headache is described. We consider that blockage of the pupil and/or of the angle of the anterior chamber are possible etiopathogenic mechanisms.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9462979&dopt=Abstract headache medicine