Neck mobility in different headache disorders.

Zwart JA.

Department of Neurology, Regionsykehuset i Trondheim, Norway.

The main purpose of this study was to assess neck mobility (by Cybex equipment) in different headache disorders and, in particular, cervicogenic headache, and to compare these findings with those in controls. A total of 51 control subjects and 90 headache patients were investigated, where of 28 patients suffered from common migraine (migraine without aura), 34 from tension-type headache (9 episodic and 25 chronic), and 28 patients from cervicogenic headache. One-way ANOVA and post hoc Bonferroni analysis showed significant differences between those with cervicogenic headache and the other groups for rotation (P < 0.001) and flexion/extension (P < 0.001), but not for lateral neck movement (P = NS). There were no significant differences between migraine patients, tension-type headache patients, and controls. In all four groups, there was a significant positive correlation between active and passive neck movement for rotation (P < 0.001), flexion/extension (P < 0.001), and lateral neck movement (P < 0.001). Repeated measures analysis of variance (ANOVA) showed no significant day-to-day differences in 10 control subjects. In the control group (n = 51), there was a significant negative correlation between age and neck movement. For rotation, Pearson's correlation coefficient was; r = -0.71 (P < 0.001), for flexion/extension r = -0.71 (P < 0.001), and for lateral neck movement r = -0.67 (P < 0.001). No significant sex difference was found as for any of the neck movements. Pain at the time of investigation did not seem to influence neck mobility. Cervicogenic headache has been recognized as a pain syndrome by the International Association for the Study of Pain (IASP). Since reduced neck mobility is one of the major criteria for this diagnosis, it emphasizes the need for systematic, objective neck mobility measurements in the individual patient to substantiate the diagnosis. The technique is simple and proved reliable.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9046716&dopt=Abstract headache medicine




Headache and self-assessed depression scores in Singapore University undergraduates.

Ho KH, Ong BK, Lee SC.

Department of Medicine, National University of Singapore, Singapore.

A self-administered questionnaire covering the diagnostic criteria of the International Headache Society was completed by 1208 undergraduates of the National University of Singapore to determine the prevalence and characteristics of headaches in this population. The relationship between headaches and depressive illness was investigated with the Zung Self-assessed Depression Scale. The mean age of respondents was 20.9 +/- 1.6 years; 50.3% were men and 46.4%, women. Ten point nine percent had migraine without aura, 29.8% had tension-type headaches, 1.1% had headaches consistent with migraines with aura, and in 56.3% the headaches could not be classified. The lifetime prevalence of headache in this population was 98.1%. Significantly higher mean Zung scores were found in subjects who had more intense and frequent headaches than in those without headaches and less severe symptoms, although the clinical relevance of this finding is uncertain. Zung scores did not differ significantly with diagnostic group, sex, or race.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9046720&dopt=Abstract headache medicine




Headache intensity and quality of life in adolescents. How are changes in headache intensity in adolescents related to changes in experienced quality of life?

Langeveld JH, Koot HM, Passchier J.

Institute of Medical Psychology and Psychotherapy, Erasmus University Rotterdam, The Netherlands.

OBJECTIVE: To investigate the relationship between changes in actual presence of headache and the experience of different subdomains of quality of life (QoL) in adolescents. DESIGN: Diary entered measurements of headache intensity and frequency were related to simultaneously recorded data on a QoL questionnaire for adolescents. SETTING: Subjects completed both the QoL questionnaires and the headache diaries at home. SUBJECTS: Subjects were selected by screening the total population of two secondary schools (N = 1566) for headache and migraine symptoms. Sixty-four students subject to chronic headache or migraine participated in the study. All subjects were diagnosed by a neurologist, following the IHS criteria for migraine. CONCLUSION: Changes in headache intensity and frequency were related to changes in self-reported QoL within all QoL subdomains. More headache coincided with a lower self-reported QoL.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9046722&dopt=Abstract headache medicine




Headache etiology in a pediatric emergency department.

Burton LJ, Quinn B, Pratt-Cheney JL, Pourani M.

Division of Emergency Medicine, Miami Children's Hospital, FL, USA.

BACKGROUND: Headache may be the presenting complaint of serious diagnoses such as meningitis, brain tumor, or shunt malfunction, yet no previous studies have examined the spectrum of diagnoses for the pediatric emergency department (ED) population with a chief complaint of headache. METHODS: In 1993, 53,988 visits were made to the ED of an urban children's hospital. Six hundred ninety-six patients (1.3%) had a chief complaint of headache. Half of these visits, distributed randomly throughout the year, were chosen for review; total sample size was 288. RESULTS: Patient age ranged from two to 18 years (2-5 years, 24.3%; 6-12 years, 57.6%; 13-18 years, 18.1%). The spectrum of ED diagnoses included viral illness (39.2%), sinusitis (16.0%), migraine (15.6%), post-traumatic headache (6.6%), streptococcal pharyngitis (4.9%), and tension headache (4.5%). No cases of brain tumor or bacterial meningitis were identified at the time of ED visit. The only serious neurologic conditions diagnosed were 15 cases of viral meningitis (5.2%), one shunt malfunction, one newly diagnosed hydrocephalus, one Burkitt's lymphoma patient with newly diagnosed CNS infiltration, and one punctate hemorrhage post head trauma. Two thirds of patients had radiologic and/or laboratory tests. Positive findings were as follows: 45.6% of sinus radiographs, 16.3% of rapid streptococcal antigen tests, 60.9% of lumbar punctures, and 19.0% of brain imaging studies. The frequency of serious and nonserious conditions as a cause of headache was compared to data from general EDs. CONCLUSION: Serious conditions presenting with the chief complaint of headache in the pediatric ED were not common in our population. The most frequent diagnoses in our review were viral illness, sinusitis, and migraine, in contrast to adult studies in which tension headache and migraine were most common. Only 6.6% of patients had serious neurologic diagnoses, which is in the range reported for general EDs. Of the serious conditions in our study, 80% were viral meningitis.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9061724&dopt=Abstract headache medicine




Responsiveness of the trigeminovascular system to nitroglycerine in cluster headache patients.

Fanciullacci M, Alessandri M, Sicuteri R, Marabini S.

Institute of Internal Medicine and Therapeutics IV, Headache Centre, University of Florence, Italy.

Nitroglycerine is known to induce a headache attack in cluster headache patients, which is indistinguishable from a spontaneous attack. It has recently been suggested that a release of calcitonin gene-related peptide (CGRP) from peripheral terminals of trigeminal nociceptive neurons, which supply cephalic blood vessels, underlies symptoms of cluster headache. The aim of this study was to investigate whether the provocative action of nitroglycerine in cluster headache is due, at least in part, to activation of the trigeminovascular system. Nineteen subjects suffering from episodic cluster headache participated in the study. Eleven of them were in an active period, whilst the others were in remission at the time of the study. CGRP-like immunoreactivity (CGRP-LI) was measured in blood samples from the extracerebral circulation before and after the sublingual administration of nitroglycerine. Baseline CGRP-LI plasma levels were higher (P < 0.05) in the patients who were in an active period. Only in these patients did nitroglycerine induce an attack, which was preceded by a latent period with a mean duration of 27 +/- 3 min. When compared with the baseline, a significant (P < 0.01) increase in plasma CGRP-LI was detected at the peak of the provoked attack; no such increase was detected during the latent period, or at the onset of the attack. The results of this study suggests that the provocative action of nitroglycerine in cluster headache is due, at least in part, to activation of the trigeminovascular system. This mechanism seems to be slow and unrelated to the well-known rapidly occurring vasodilator effects of the drug. Finally, activation of the trigeminovascular system only occurs in those patients already in an active cluster headache period who also have high basal CGRP-LI plasma levels. This suggests that a hyperactivity of trigeminal nociceptive fibres could make the trigeminovascular system of these patients sensitive to the triggering action of nitroglycerine.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9117375&dopt=Abstract headache medicine




[Headache in cervical syndrome]

[Article in German]

Dvorak J, Walchli B.

Neurologische Abteilung, Schulthess-Klinik, Zurich.

Headache is a common symptom in patients suffering from cervical spine disorders. The percentage of headaches in association with degenerative changes of the cervical spine ranges from 13 to 79% and that in association with indirect trauma of the cervical spine from 48 to 82%. Based on neuroanatomical and neurophysiological studies, the relationship of the upper cervical spine and the trigeminal nuclei has been demonstrated and serves as an explanation for perceived head pain in cervical spine disorders. As a source of pain, tension in the suboccipital muscles, irritation of the third occipital nerve, and degenerative changes of the C2/C3 joints have been discussed. Bogduk, in his studies, asserts a direct causative role of mechanical derangement of the cervical spine in the pathogenesis of cervicogenic headaches. In 1983, Sjaastad et al. postulated the concept of 'cervicogenic headaches': a migraine-like headache due to certain disorders of the cervical spine, strictly located unilaterally, its manifestations being in the temporal, frontal, and ocular areas, with associated symptoms such as slight lacrimation, conjunctival injections, tinnitus, runny nose, and erythema in the forehead ipsilaterally. As arguments in favour of a cervical origin, Sjaastad mentioned the following features: precipitation of the headaches either by neck movements or by pressure against certain tender spots on the neck, the possibility of homolateral shoulder or arm pain, stiffness and pain of the neck, and reduced mobility of the cervical spine. In 1988, the Headache Classification Committee of the International Headache Society set strict criteria for 'headaches' to be classified as to be of cervical origin.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9139412&dopt=Abstract headache medicine




Coping style and social support in women suffering from cluster headache or migraine.

Blomkvist V, Hannerz J, Orth-Gomer K, Theorell T.

National Institute for Psychosocial Factors and Health, Stockholm, Sweden.

BACKGROUND: Many clinical neurologists have considered cluster headache patients to differ from migraine patients as to behavioral patterns. There is, however, little empirical validation of such a differentiation. METHODS: Coping profiles and social networks were studied in patients suffering from two kinds of recurrent headache. Twenty-four female patients with cluster headache, aged 23-72 years, and 24 age-matched migraine patients with and without aura participated in the study. All female cluster patients treated at the neurologic clinic of the hospital were included, and consecutive outpatients, who had been referred to the policlinics for diagnosis and treatment, whose symptoms agreed with the IHS criteria for migraine and who had ages matching the cluster headache patients, participated in the study. RESULTS: In the semiprojective coping tests the cluster headache patients were found to be statistically significant more 'positive' as to their anticipated activities in the future compared to the migraine patients (p < 0.04). No other statistical differences were found between the two groups. Compared to randomly selected and age-matched referents in the population. cluster headache patients reported significantly poorer social support (p < 0.01), while no other difference was found when the migraine patients were compared with controls. CONCLUSIONS: The findings indicate that there are differences in perception of anticipated activities and social support between patients with cluster headache and migraine.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9176909&dopt=Abstract headache medicine




Long-term effects of octreotide on pituitary gigantism: its analgesic action on cluster headache.

Otsuka F, Mizobuchi S, Ogura T, Sato K, Yokoyama M, Makino H.

Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine and Dentistry, Japan.

We report the case of 19-year-old man with pituitary gigantism due to growth hormone-producing pituitary macroadenoma. The patient complained of recurrent headache and excessive growth spurt since age 15. Octreotide administration was initiated following transsphenoidal pituitary adenomectomy. Octreotide injection for 4 years efficaciously reduced the size of remnant adenoma as well as serum growth hormone levels. Notably, octreotide exhibited a potent analgesic effect on his intractable cluster headache that has continued even after reduction of the adenoma volume. The analgesic effect lasted 2 to 6 hours after each injection and no tachyphylaxis to octreotide appeared during 4-year treatment. To characterize the headache and the pain intensity, analgesic drugs including octreotide, lidocaine, morphine and thiopental were tested using a visual analogue scale (VAS) evaluation, with the result that octreotide exhibited a prompt and complete disappearance of the headache. Headache relief was in part reproduced by morphine injection (56% reduction) but not by lidocaine or thiopental. The present case suggests that the intractable headache associated with pituitary gigantism is possibly related to the endogenous opioid system. Thus, the headache control by octreotide is clinically helpful for continuation of the self-injection regimen.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15516776&dopt=Abstract headache medicine