Epidemiological and clinical characteristics of migraine and tension type headache in 1146 females in Kayseri, Turkey.

Koseoglu E, Nacar M, Talaslioglu A, Cetinkaya F.

Headache Centre, Department of Neurology, University of Erciyes, Kayseri, Turkey. emelk erciyes.edu.tr

In a female population of Turkey (1146 adult females), some epidemiological and clinical characteristics of migraine and tension type headache and their subtypes were investigated. The relation of the headache severity to clinical characteristics were inquired. Migraine prevalence was found to be statistically higher in the 35-44 years age group (P < 0.01) and those who were university graduates (P < 0.001), married (P < 0.01) and living in urban areas (P < 0.01). Tension type headache was found to be higher in the 45-64 years age group (P < 0.05). Chronic tension type headache patients were found to be older than episodic type (P < 0.01) and frequently were in the lowest education level (P < 0.05). Presence of impact on daily activities because of the severity of headache was found to be related to aggravation by physical activities (P = 0.001) in tension type headache, with no clinical characteristics in migraine headache and on consideration of all headache patients with throbbing nature (P < 0.05), aggravation on physical activities (P = 0.001), nausea (P < 0.01), vomiting (P < 0.05) and phonophobia (P < 0.05).

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12780769&dopt=Abstract headache medicine




Abnormal neuromuscular transmission in cluster headache.

Ertas M, Baslo MB.

Department of Neurology and Electrodiagnostic Neurology, Istanbul Faculty of Medicine, Barbaros mah. Baskan sok. No. 17, Uskudar, Istanbul 81150, Turkey.

OBJECTIVE: To identify and investigate any dysfunction of neuromuscular transmission in episodic cluster headache. BACKGROUND: Abnormal neuromuscular transmission has been shown in migraine with aura and in migraine without aura by using single fiber electromyography. Especially for migraine with aura, a genetic cause has been postulated. Episodic cluster headache is a primary headache disorder in which genetic factors may, at times, play a strong role. METHODS: Single fiber electromyography during voluntary contraction of the extensor digitorum communis muscle, nerve conduction studies of upper and lower extremities, and concentric needle electromyography of the extensor digitorum communis were performed on 6 patients with episodic cluster headache and 6 age-matched normal controls. Twenty potential pairs were recorded from each subject. Twenty individual jitter values and a mean jitter value were calculated for each subject. Both mean individual jitter values and numbers of abnormal individual jitter values were compared in patients with cluster headache versus normal controls. RESULTS: Three of 6 patients with episodic cluster headache showed pronounced neuromuscular transmission abnormalities by single fiber electromyography. None of the controls had any neuromuscular transmission abnormality. Another patient with episodic cluster headache had borderline dysfunction of neuromuscular transmission. Transmission was clearly normal in only 2 of 6 patients with cluster headache. CONCLUSION: These results suggest that episodic cluster headache may share the same abnormality of neuromuscular transmission observed in migraine.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12786920&dopt=Abstract headache medicine




Evaluating HIV-infected patients with headache: who needs computed tomography?

Gifford AL, Hecht FM.

Health Services Research and Development Program, VA San Diego (Calif) Healthcare System and the Department of Medicine, University of California San Diego School of Medicine, La Jolla, USA.

OBJECTIVE: To empirically test a clinical prediction rule for evaluating HIV-infected patients complaining of headache and to identify those at low risk for intracranial mass lesion who do not need immediate computed tomography of the head. DESIGN: Two retrospective clinical cohorts of HIV-infected patients clinically evaluated for headache. METHODS: To describe the headache clinical outcomes, medical records were abstracted from all HIV-infected patients evaluated for headache with computed tomography of the head at two urban hospitals. Patients were categorized as low, intermediate, or high risk based on clinical criteria (focal neurological signs, altered mental status, history of seizure) and immune status (CD4 lymphocytes < or =200 microL). Records were abstracted from a second unselected cohort of HIV-infected outpatients with headache who were all treated and followed in primary care (N=101). RESULTS: Of 101 unselected HIV-infected outpatients followed in primary care after headache, 1% (95% confidence interval [CI], 0% to 6%) had a treatable intracranial lesion. Of 364 HIV-infected patients with headache sent for evaluation with computed tomography of the head, the rate of any abnormality was zero in the low-risk group (95% CI, 0% to 10%; n=35); 9% in the intermediate-risk group (95% CI, 2% to 16%; n=242); and 21% in the high-risk group (95% CI, 12% to 29%; n=87). CONCLUSION: Most HIV-infected patients with headache may be treated with analgesics and followed up clinically. Those without focal neurological signs, altered mental status, seizure, or decreased CD4 lymphocytes are unlikely to have intracranial mass lesions.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11380641&dopt=Abstract headache medicine




Perioperative headache and day case surgery.

Gill PS, Guest C, Rabey PG, Buggy DJ.

Leicester General Hospital, University Department of Anaesthesia, Leicester, UK. gasdoc99 hotmail.com

BACKGROUND AND OBJECTIVE: Headache is a common and distressing morbidity associated with day case surgery. We undertook a prospective, observational study to identify risk factors associated with perioperative headache in a modern, day case surgery setting. METHODS: Two hundred-and-thirty consecutive patients presenting for day case surgery were invited to complete a questionnaire about their previous experience of headache and various associated risk factors. Questionnaires were completed by 90% of patients. The presence of headache in the pre- or postoperative period was also documented. We used multivariate logistic regression to model perioperative headache. RESULTS: Increased frequency of previous headache, odds ratio (95% confidence interval) 1.9 (1.2-2.8) (P = 0.004) and low alcohol consumption 0.90 (0.87-0.98) (P = 0.019) were significant predictors. A history of migraine showed a trend towards being predictive 1.9 (0.9-4.0) (P = 0.055). Some risk factors thought to be important such as caffeine withdrawal and duration of starvation and fluid deprivation were not associated with perioperative headache in this setting. CONCLUSIONS: In this study of risk factors associated with perioperative headache in day case surgery, increased frequency of headache and low alcohol consumption were independent risk factors.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12790213&dopt=Abstract headache medicine




[Acute treatment of episodic childhood tension-type headache with flupirtine and paracetamol - a double-blind crossover-study]

[Article in German]

Pothmann R, Lobisch M.

Neuropadiatrisches Zentrum und Kinderschmerzambulanz, Ev. Krankenhaus Oberhausen.

BACKGROUND: About 10% of all schoolchil- dren are suffering from migraine and 50% from tension-type headache. Headache of acute onset usually will be treated with analgesic substances like paracetamol, acetylsalicylic acid or ibuprofen, the first one being the reference drug for tension-type headache in childhood. In case of lacking improvement or side-effects there is demand for an alternative safe substance for the acute analgesic therapy. METHODS: In a double-blind randomised investigation flupirtine and paracetamol were given in two consecutive attacks of episodic tension-type headache. 30 children, 6-12 years old, were included. Dosage was determined according to age and weight. The children documented the acute headache intensity and duration in a special diary. RESULTS: Headache intensity was reduced during 2 h after intake in 89% of the 19 children treated. The reduction was 6,5 to 3,1 for flupirtine and 6,9 to 3,3/10 for paracetamol. There was no statistically significant difference between the two substances. Relevant side-effects could not be observed. CONCLUSION: Flupirtine has shown a convincing clinical effect treating acute episodic tension-type headache for children. The substance was well tolerated by the patients. In addition, flupirtine provides a high degree of safety.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12799904&dopt=Abstract headache medicine




[The cervicogenic headache from the spiral surgery point of view--a pilot study]

[Article in German]

Greiner-Perth R, Neubauer U, Bohm H.

Klinik fur Neurochirurgie, Zentralklinik Bad Berka GmbH.

In a retrospective analysis of 299 consecutive patients with degenerative cervical spine disease the incidence of cervicogenic headache and the results of conservative and operative therapy have been investigated. Cervicogenic headache was noted in 117 of 299 patients (40%). 73 of those patients were treated conservatively. The cervicogenic headache resolved in 10% or improved in 27% and remained unchanged in 63% of the patients. 44 of these patients were operated by ventral discectomy, which was indicated in case of neurological deficit and painful shoulder-arm syndrome refractory to conservative treatment. In none of these patients the operation was indicated by the cervicogenic headache. In the postoperative follow-up with a mean of 6 months the headache resolved in 20%, improved in 60% and remained unchanged in 20% of the patients. These results suggest the existence of a cervicogenic headache, i.e. a headache due to disorders of the cervical spine, and the chance of successful operative treatment.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12799916&dopt=Abstract headache medicine




[Drug-induced headache--pathomechanisms of addiction]

[Article in German]

Heinz A, Denke C, Ernst G.

Klinik fur Abhangiges Verhalten und Suchmedizin, Zentralinstitut fur Seelische Gesundheit Mannheim.

The pathogenesis of drug abuse in patients suffering from drug-induced headache is not known in detail. It is unclear whether drug abuse in chronic daily headache should be classified as a form of drug dependence. Current findings concerning the neurobiological correlates of addictive behavior and affective disorders point to the importance of monoaminergic dysregulation, especially a dysfunction of central serotonergic neurotransmission. We reviewed the literature on drug-induced headache and examined hypothetical pathomechanisms of addiction. Drugs causing drug-induced headache such as paracetamol, coffein and ergotamine interfere with behavior patterns or neurotransmitter systems that are also affected by drugs of abuse. Several drugs that ameliorate acute headache interact with central serotonergic neurotransmission and may affect anxiety and depression in patients with chronic daily headache. Non human primate and human studies revealed mechanisms of serotonergic dysfunction in drug dependence, which may also be relevant for drug-abuse in medication-induced headache. Medication-induced dysfunction of monoaminergic, especially serotonergic neurotransmission, may affect drug dependence by exacerbating mood disorders. Further studies are necessary to assess serotonergic neurotransmission in patients with drug-induced headache and abuse of medication.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12799918&dopt=Abstract headache medicine




[Headache caused by polycythemia vera. Classification of a headache under the heading of metabolic disturbances]

[Article in German]

Ickenstein GW, Klotz JM, Langohr HD.

Klinik fur Neurologie und Neurophysiologie, Klinikum Fulda, Akademisches Lehrkrankenhaus der Philipps-Universitat Marburg.

As polycythemia vera is a myeloproliferative syndrome, it is based on an autonomic increase in the proliferation of all hematopoetic cells--mostly of erythropoesis. An increase in blood viscosity induces disturbed microcirculation, resulting in headaches with clinical symptoms. So far, the headache in polycythemia vera has not been classified. METHODS: We would like to demonstrate a case of a female patient aged 58 years who had been complaining of persistent hemicranial right-sided headaches for the last 16 days, alternating between throbbing and stabbing pain as well as a retrobulbar feeling of pressure. Blood chemistry demonstrated pronounced changes: hemoglobin, 20,1 g/dl; hematocrit, 58%; erythrocytes, 6,8 T/l (6,800,000/microl) leucocytes, 14,400/microl; thrombocytes, 543,000/microl A punch biopsy from the pelvic rim showed cell-rich bone marrow, demonstrating a myeloproliferative syndrome suggestive of polycytemia vera. RESULTS: Following hemodilution, the headache disappeared within 3 days following normalization of blood chemistry: hemoglobin, 14.9 g/dl; hematocrit, 44%; erythrocytes, 5.2 T/l (5,200,000/microl; leucocytes, 13,100/microl. Further diagnosis of the headache by means of MRI of the head, extra and transcranial doppler sonography as well as MRI of the cervical spine did not produce findings with the exception of retrospondylophyth at C5-6. The patient was therefore managed on aspirin 300 mg daily and was given weekly isovolemic bleeding. The headaches did not recur. CONCLUSION: We diagnosed a headache caused by polycythemia vera and recommend classification of this headache under the heading of metabolic disturbances, because this classification meets the diagnostic criteria of the international headache classification.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12799929&dopt=Abstract headache medicine