Headache fear.

Saadah HA.

Mercy Health Center, Oklahoma City, Oklahoma 73120, USA.

A prospective study of migraine patients seen at the office, over six months, was conducted to ascertain the prevalence and intensity of headache fear. With patients' help a questionnaire, with 14 questions and a maximum score of 50, was developed and refined. A total of 100 patients with episodic migraines (< 15 headache days/month) and another 100 patients with intractable migraines (> or = 15 headache days/month) were inducted. Fifty controls were selected from office patients who, on routine system review, were found to have migraine headaches but had never consulted a physician about them. The average fear score of the control group was 3/50 (range: 0 to 9), and only 2% felt a strong compulsion to take analgesics when headaches began. Based on that, headache fear was defined as a score of 10 or more. The average fear score of the episodic group was 12/50 (range: 0 to 43), 49% had a fear score of > or = 10, and 38% felt a strong compulsion to take analgesics. The average fear score of the intractable group was 19/50 (range: 0 to 46), 73% had a fear score of > or = 10, and 60% felt a strong compulsion to take analgesics. The average number of analgesic tablets taken per month in the control group was 7 (range: 0-150), in the episodic group 22 (range: 0-120), and in the intractable group 139 (range: 0-400). The three groups were comparable as far as age, gender, and migraine years. The frequency of migraines per month was 3 (range: 0-30) in the control group, 6 (range: 0-14) in the episodic group, and 29 (range: 15-30) in the intractable group. As empirically defined, headache fear is common and increases in a statistically significant manner across the three migraine groups (control-episodic-intractable). I theorize that this fear may reinforce analgesic overuse and interfere with withdrawal efforts. Alloying this fear from the outset might provide patients with the support and reassurance needed for analgesic withdrawal, which is often necessary for recovery.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9203766&dopt=Abstract headache medicine




Prevalence of sleep disorders in childhood and adolescence with headache: a case-control study.

Bruni O, Fabrizi P, Ottaviano S, Cortesi F, Giannotti F, Guidetti V.

Department of Developmental Neurology and Psychiatry, University of Rome La Sapienza, Italy.

Although a relationship between headache and sleep disturbances has been reported in adults, only few data have been available in children. Accordingly, we performed a survey to determine the prevalence of sleep disturbances in children with migraine and tension-type headache. A questionnaire of history and clinical data and of sleep disturbances was given to parents of 283 headache subjects (164 with migraine and 119 with tension-type headache). Results were compared to a normative group comparable for age and sex of 893 normal healthy subjects. Migraine subjects showed a higher prevalence of sleep disturbances during infancy as well as 3-month colic. In both headache groups, more parents had sleep disturbances and there was a higher occurrence of co-sleeping and napping. A high frequency of sleep disturbances involving sleep quality, night awakenings, nocturnal symptoms and daytime sleepiness was reported in headache children. No statistical differences were found in the prevalence of sleep disturbances between migraine and tension-type headache. However, the migraine group tended to have "disturbed sleep" more often with increased prevalence of nocturnal symptoms such as sleep breathing disorders and parasomnias. Our results give further support to an association between sleep and migraine that may have a common intrinsic origin.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9209768&dopt=Abstract headache medicine




Droperidol treatment of status migrainosus and refractory migraine.

Wang SJ, Silberstein SD, Young WB.

Department of Neurology, National Yang-Ming University School of Medicine, Taipei, Taiwan.

We conducted a pilot study of intravenous droperidol in 35 patients (32 women and 3 men; mean age 43 years) with status migrainosus (n = 25) or refractory migraine (n = 10) in an ambulatory infusion center. Headache was graded as severe in 21 patients and moderate in 14. An intravenous line was started and kept open. Droperidol (2.5 mg) was given intravenously every 30 minutes until either three doses were given or the patient was completely or almost headache-free prior to the next dose. Seven patients received one dose, 12 received two doses, and 16, three doses (mean 5.6 mg). Our success rate (headache-free or mild headache) was 88% (22 of 25) in patients with status migrainosus and 100% (10 of 10) in patients with refractory migraine. The average time to headache improvement was 40 minutes (n = 35), to mild headache--60 minutes (n = 32), and to headache-free--105 minutes (n = 28). Nausea, vomiting, and light and sound sensitivity resolved in all but 5 patients. Four patients had an asymptomatic systolic blood pressure drop > or = 20 mm Hg. Most patients were sedated (34 of 35). Five patients developed akathisia and 1 dystonia. At follow-up 24 hours after discharge, the recurrence rate (headache intensity from none or mild to moderate or severe) was 23% in status migrainosus and 10% in refractory migraine. Twenty-one patients were sedated, while 19 had extrapyramidal symptoms, mainly restlessness. Droperidol is effective and safe in treating status migrainosus or refractory migraine. Hypotension was uncommon. Patients should be warned of sedation and akathisia.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9237411&dopt=Abstract headache medicine




[Clinical features of daily chronic headache]

[Article in Spanish]

Iniguez C, Larrode P, Mauri JA, Morales F.

Servicio de Neurologia, Hospital Clinico Universitario, Zaragoza, Espana.

INTRODUCTION: Although the International Headache Society considers chronic tension headache to be a chronic headache, patients with daily chronic headache may have pain which is not only due to tension but also has migrainous features. OBJECTIVE: To evaluate the clinical differences and abuse of drugs in a group of patients with chronic daily headache who were consecutively evaluated in the Neurology Clinic. MATERIAL AND METHODS: We consider the patients to have daily chronic headache when they have had pain at least 6 days a week for the past 6 months. Using this criterion, we studied 112 patients, of whom 90 (80.4%) were women and 22 (19.6%) men. Results. Sixty nine (61.6%) had transformed migraine and 43 (38.4%) tension headache. There were no differences in their current ages but the age of onset of the headaches varied (p = 0.000,t). Unilateral pain, trigger factors and a family history were more frequent in the cases of transformed migraine. Eighty four patients (75%) abused analgesics. Although we found different pain intensities (p = 0.000, chi 2) there was no difference in the weekly consumption of analgesics (p = 0.64, t) in the mg/week of ergotamine (p = 0.96, t) nor in absence from work between the two types of headache. CONCLUSIONS: In spite of clinical differences between transformed migraine and tension headache, which may help diagnosis, in our series abuse of analgesics (including ergotamine) was a common characteristic.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9280629&dopt=Abstract headache medicine




Health-related quality of life of chronic headache patients is predicted by the emotional component of their pain.

Passchier J, de Boo M, Quaak HZ, Brienen JA.

Department of Medical Psychology, Erasmus University, Rotterdam, The Netherlands.

Questions to be answered by this study were: (1) what is the health-related quality of life (HRQL) of migraine and tension headache patients who consult their general practitioner, and (2) what are the unique contributions of the perceptual and emotional components of headaches to the HRQL. The Nottingham Health Profile (NHP) was used to measure the HRQL of patients with migraine (n = 27), tension headache (n = 25), both migraine and tension headache (n = 17), and two reference groups. Perceptual components of the pain (intensity, frequency, and duration) were measured with a headache diary, while emotional components were measured with five visual analogue scales (for tension, depression, frustration, anger and fear). The NHP dimensions of pain, sleep, energy, and social isolation revealed that each headache patient group had a lower HRQL than the healthy reference group. There were no differences in HRQL between the headache groups. Regarding the second question: it was found that the greater the patient's emotional pain, the more problems he or she had with physical mobility and social isolation. Neither the type of headache nor the headache index were related to the HRQL of the patient. We recommend to increase the research efforts concerning tension headache and to measure the emotional component of pain in clinical trials.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8916564&dopt=Abstract headache medicine




Ciliospinal reflex response in cluster headache.

Havelius U, Heuck M, Milos P, Hindfelt B.

Department of Neurology, University Hospital MAS, Lund University, Malmo, Sweden.

The ciliospinal reflex response is mainly mediated by second- and third-order sympathetic nerves to the dilatator muscle of the iris. As the pupillary response to various pharmacological agents indicates a sympathetic dysfunction in patients with cluster headache, the ciliospinal reflex was studied in 25 patients. Five of these patients with cluster headache exhibited a Horner-like syndrome (miosis, ptosis) on the symptomatic side. The pupillary responses to phenylephrine and tyramine showed that the Horner-like syndrome was due to postganglionic sympathetic nerve dysfunction. Their ciliospinal reflex response on the symptomatic side was significantly less than in controls and in other patients with cluster headache, lacking a Horner-like syndrome. This also applied to the nonsymptomatic side compared to the majority of cluster headache patients without any clinical evidence of sympathetic nerve dysfunction. These findings seem to delineate those patients with a Horner-like syndrome as a subgroup, distinctly separated from the majority of cluster headache patients. Furthermore, the findings indicate that the Horner-like syndrome is not a consequence of repeated attacks of headache over many years, but is a manifestation of bilateral cephalic sympathetic dysfunction being more marked on the symptomatic side. In 18 (72%) of our 25 patients, an asymmetric and lower ciliospinal reflex response on the symptomatic side was seen. In 3 (12%) patients, there was no difference in the response. In 4 patients (16%), the incorrect side was indicated by an asymmetric reflex response. Two of these patients (8%) had suffered from cluster headache on alternating sides. In summary, the findings support the concept that dysfunction of the sympathetic nervous system, whether peripheral or central is involved in the pathophysiology of cluster headache.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8916567&dopt=Abstract headache medicine




Health resource utilization of the emergency department headache "repeater".

Maizels M.

Department of Family Practice, Kaiser Permanente, Woodland Hills, Calif 91367, USA.

OBJECTIVE: To document the health resource utilization of patients who repeatedly use emergency department services for headache care. BACKGROUND: Patients with headache who frequently use emergency department services may differ from patients with more typical, episodic migraine. Previous studies of health resource utilization have often failed to distinguish the high utilizer as a specific subset of the migraine population. DESIGN: Retrospective review of urgent care/emergency department charts, clinic charts, and pharmacy rosters. PATIENTS AND METHODS: Patients who made three or more visits for headache to an urgent care/emergency department (UC/ED) facility for headache over a 6-month study period were identified and designated as "repeaters" for this study. Pharmacy profiles and appointment histories of 52 of the 54 repeaters whose records were available were reviewed for the 12 months prior to the study period. RESULTS: Over the 6-month study period, 518 patients visited the UC/ED 1004 times for primary headache complaints. Fifty-four (10%) repeaters made 502 visits (50% of total visits; mean 9.3, range 3-50). In the 12 months prior to the study period, 52 of these repeaters made 1832 visits to the UC/ED or clinic (mean 35.2, range 0-178): 1458 (79.6%) were headache related, and 1271 (69.4%) of all visits were to the UC/ED. An estimated 12-month cost for all visits was $183,760. Pharmacy rosters showed use of narcotics in 41 of the 52 patients (annual mean +/- SD, 613 +/- 670 tablets), benzodiazepines in 30 patients (500 +/- 486 tablets), and butalbital products in 27 patients (395 +/- 590 tablets). Mean daily use of all symptomatic medications combined was 3.9 +/- 3.2 doses/day. CONCLUSION: Health resource utilization of emergency department headache repeaters is predominantly headache-related acute care. Associated medication overuse is frequently present. Efforts to improve care for patients with headache will benefit from distinguishing the high utilizer as a subset of the migraine population.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12390637&dopt=Abstract headache medicine




Long-term outcome of patients with headache and drug abuse after inpatient withdrawal: five-year follow-up.

Schnider P, Aull S, Baumgartner C, Marterer A, Wober C, Zeiler K, Wessely P.

University Clinic for Neurology, Vienna, Austria.

Thirty-eight patients with "chronic daily" headache and ergotamine and/or analgesics abuse according to the criteria proposed by the International Headache Society were re-investigated 5 years after inpatient drug withdrawal. At the end of the observation period, 19 patients (50.0%) had their headaches on only 8 days per month or less, 18 patients (47.4%) were free of symptoms or had only mild headaches. A close correlation was found between the frequency of headache and the duration of drug abuse, as well as between the intensity of headache and the number of tablets taken per month. Frequency and intensity of headache had changed within the first 2 years after withdrawal, but remained stable afterwards. Fifteen patients (39.5%) reported on recurrent drug abuse. Patients with migraine showed a tendency towards a better prognosis compared to patients with tension-type headache or with combined migraine and tension-type headache. The results of this study highlight the long-term efficacy of inpatient drug withdrawal in patients with headache and ergotamine and/or analgesics abuse.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8933992&dopt=Abstract headache medicine