Headache in schoolchildren: agreement between different sources of information.

Laurell K, Larsson B, Eeg-Olofsson O.

Department of Neuroscience, Uppsala University, Uppsala, Sweden. katarina.laurell nc.uas.lul.se

The level of agreement between different sources of information, i.e. questionnaires, interviews and diaries, was evaluated in a sample of 129 schoolchildren, 69 girls and 60 boys, ranging in age from 7 to 17 years. Headache diagnoses and headache features showed high agreement between questionnaires and subsequent interviews. The concordance between questionnaires and interviews for headache diagnoses increased, and the number of unclassified headaches decreased, when the International Headache Society (IHS) duration criterion was excluded. When comparing headache frequency reported in questionnaires and interviews with diary recordings, the agreement was low and the frequency higher in the diaries. Overall, the agreement between questionnaires, interviews and diaries was not related to age or gender. The questionnaire may serve as a valid source of information in studies of headache in schoolchildren. Prospective recordings in diaries provide additional information, in particular of low-intensity headache. In children, the IHS duration criterion should be modified or excluded.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12807521&dopt=Abstract headache medicine




Migraine headache disability and health-related quality-of-life: a population-based case-control study from England.

Lipton RB, Liberman JN, Kolodner KB, Bigal ME, Dowson A, Stewart WF.

Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, NY 10461, USA. rlipton aecom.yu.edu

The aims of this study were: (i) to compare health-related quality of life (HRQoL) as measured by the Medical Outcomes Study Short Form 36-Item Health Survey (SF-36) in a population sample of migraine headache sufferers and controls without migraine; (ii) to assess the relationship of HRQoL and work-related disability attributed to headache in a population sample. The study was conducted in two phases. First, a population-based, telephone interview survey of 5769 residents of greater London, England was conducted to identify individuals with migraine headache (cases) and controls without migraine. In the second stage, in-person interviews were conducted in a matched sample of 200 migraine cases and 200 controls selected from survey respondents. At the beginning of the in-person interview, participants were asked to complete the SF-36. In addition, a work-related disability score based on the telephone interview was defined as the number of lost work days or days when usual activity was reduced by 50% or more over the previous year. The disability score was trichotomized as mild (n = 98), moderate (n = 49), and severe disability (n = 49). Compared with controls, individuals with migraine headache scored significantly lower in eight of the nine domains of the SF-36 as well as in the overall Physical Component Summary (PCS) score and Mental Component Summary (MCS) score. Further, among migraine sufferers, each of the disability groups scored significantly lower in seven of the nine domains and in the summary scales. Scores showed greater reductions in HRQoL for the moderate and severe disability groups vs. the mild disability group in five of nine scales and in the Total Physical Summary score. We conclude that, in a population-based sample of migraine headache sufferers, individuals with migraine headache have lower HRQoL scores compared with controls. Moreover, among individuals with migraine headache, work-related disability is associated with lower HRQoL scores. Specifically, individuals classified with moderate to severe work-related disability had lower HRQoL scores than those classified with low disability.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12807523&dopt=Abstract headache medicine




Prevalence of primary headaches in Italian elderly: preliminary data from the Zabut Aging Project.

Camarda R, Monastero R.

Adult Headache Centre, Department of Neurology and Rehabilitation, Institute of Neuropsychiatry, University of Palermo, Via La Loggia 1, I-90129 Palermo, Italy.

We describe preliminary 1-year prevalence data of recurrent migraine headache (MH), tension-type headache (TTH), and other headaches (OH) in a rural elderly population. A door-to-door two-phase survey was conducted on all elderly (>or=65 years) residents of a rural village in southern Italy. Participants underwent a two-phase screening including a validated semi-structured questionnaire for headaches based on the International Headache Society criteria, and a neurological evaluation. Recurrent headache was defined as 3 or more attacks within the past 12 months. Out of 1031 participants evaluated, 225 (21.8%) suffered from recurrent headaches. One-year prevalence rates for headaches were respectively 4.6% for MH, 16% for TTH, and 1.3% for OH. For MH and TTH, but not for OH, prevalence rates were significantly higher for women than for men. Only MH prevalence rates significantly decrease with increasing age. In our population, about one-fifth of elderly subjects suffered from recurrent primary headaches. Prevalence rates were higher in women, and tended to decline with increasing age.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12811609&dopt=Abstract headache medicine




Hypothalamic deep brain stimulation for intractable chronic cluster headache: a 3-year follow-up.

Leone M, Franzini A, Broggi G, Bussone G.

Headache Centre, Cerebrovascular Disease Department, C. Besta National Neurological Institute, Via Celoria 11, I-20133 Milan, Italy.

Cluster headache is the most severe among primary headaches. Positron emission tomography and functional MRI studies have demonstrated that the ipsilateral posterior hypothalamus is activated during cluster headache attacks and is structurally asymmetric in these patients thus indicating that cluster headache may originate at that level. These hypothalamic abnormalities in cluster headache led to the suggestion that deep brain stimulation of ipsilateral posterior inferior hypothalamus might produce clinical improvement in otherwise treatment refractory chronic cluster headache patients. In a patient with severe intractable chronic cluster headache, hypothalamic electrical stimulation produced complete and long-term pain relief with no relevant side effects. So far other operations have been performed and the results are encouraging in terms of both pain relief and safety. The efficacy of hypothalamic electrical stimulation provides some hints into cluster headache pathophysiology.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12811614&dopt=Abstract headache medicine




Color Doppler sonography of orbital and vertebral arteries in migraineurs without aura.

Kara SA, Erdemoglu AK, Karadeniz MY, Altinok D.

Department of Radiology, University of Kirikkale, School of Medicine, Saglik Caddesi, Fabrikalar Mahallesi, 71100 Kirikkale, Turkey.

PURPOSE: The objective of this study was to investigate whether the retrobulbar hemodynamics in the ophthalmic (OA), posterior ciliary (PCA), central retinal (CRA), and vertebral (VA) arteries are affected in migraineurs without aura. METHODS: The eyes of migraineurs without aura and those of healthy control subjects were evaluated during both headache and headache-free periods. Retrobulbar and vertebral blood flow velocities in the OA, PCA, CRA, and the extracranial part of the VA were measured bilaterally using color Doppler sonography. The peak systolic and end-diastolic flow velocities and the pulsatility (PI) and resistance (RI) indices were determined for all arteries. RESULTS: In total, we enrolled 30 migraineurs and 31 healthy control subjects. Statistically significant differences between headache-free migraineurs and control subjects were observed in the PI and RI of both right and left PCAs and in the RI of both right and left CRAs. The PI and RI of the left VA of the migraineurs were significantly lower during both headache and headache-free periods than were those of the control subjects. Among the migraineurs, the peak systolic and end-diastolic velocities of the left VA were increased during headache periods relative to those found during the headache-free periods. CONCLUSIONS: The retrobulbar circulation and flow hemodynamics in the left VA may be altered in both headache and headache-free periods in migraineurs without aura. The differences found between migraineurs and control subjects may implicate autonomic dysfunction in migraineurs. Copyright 2003 Wiley Periodicals, Inc. J Clin Ultrasound 31:308-314, 2003

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12811790&dopt=Abstract headache medicine




Quality of life in childhood migraines: clinical impact and comparison to other chronic illnesses.

Powers SW, Patton SR, Hommel KA, Hershey AD.

Division of Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA. Scott.Powers cchmc.org

OBJECTIVE: Despite the high prevalence of headaches in youths, quality of life (QOL) has not been well examined. We examined QOL in a clinical sample of children with headaches and compared it with children with other chronic diseases. METHODS: A survey study was conducted of 572 consecutive patients (mean age, 11.4 +/- 3.6 years) who presented with headaches to a children's headache center. Children and parents completed the Pediatric Quality of Life Inventory, Version 4.0 and a standardized headache assessment. Results were compared with established norms for healthy and chronically ill children. RESULTS: Most patients (99%) had a clinical diagnosis of migraine: 85% met the International Headache Society migraine criteria, and 40% had chronic daily headaches. Total Pediatric Quality of Life Inventory, Version 4.0 score was lower for the entire group (73.1 +/- 14.4) compared with healthy norms (83.0 +/- 14.8) and lowest for children with chronic daily headaches (70.5 +/- 15.5). The impact on QOL of children with migraine was similar to that of children with arthritis and cancer. CONCLUSIONS: QOL of children with headaches is significantly affected by their health condition. The impact of headaches on QOL is similar to that found for other chronic illness conditions, with impairments in school and emotional functioning being the most prominent.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12837897&dopt=Abstract headache medicine




Restless legs syndrome and drug-induced akathisia in headache patients.

Young WB, Piovesan EJ, Biglan KM.

Department of Neurology, Jefferson Headache Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA. william.b.young mail.tju.edu

The purpose of the research presented in this article was to characterize restless leg syndrome (RLS) in a headache population and correlate treatment induced risks with dopamine blockers. Fifty patients with severe headache who were admitted to an outpatient infusion center were enrolled. The diagnosis of RLS was established using the International Restless Leg Syndrome Study Group criteria. Patients were screened for baseline akathisia using an akathisia scale and reexamined for akathisia after receiving intravenous infusion with one of four dopamine receptor blocking agents as treatment for their headaches. A change from baseline to post-infusion assessment of two points on a global assessment of akathisia was considered positive for drug-induced akathisia. Our results indicated that 41 (82%) of patients had episodic or chronic migraine. The rest had new daily persistent headache, cluster, or posttraumatic headache. Seventeen subjects (34%) met the criteria for RLS. Nineteen (38%) of the subjects developed drug-induced akathisia. Thirteen (76.5%) of the subjects with RLS developed akathisia compared with only 6 of the 33 (18.2%) without RLS (P<.0001). Finally, we concluded that headache patients with RLS are at a greatly increased risk of developing drug-induced akathisia when treated with intravenous dopamine receptor blocking agents.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12858135&dopt=Abstract headache medicine




Analysis of the patients attending a specialist UK headache clinic over a 3-year period.

Dowson AJ.

King's Headache Service, King's College Hospital, London, UK.

OBJECTIVE: This study analyzed the profile of patients who attended a specialist UK headache clinic over a 3-year period. METHODS: An audit was conducted of the clinical records of patients attending the specialist headache clinic at King's College, London, between January 1997 and January 2000. Data were collected for diagnoses given, current medications taken, medications prescribed and recommended, and investigations conducted. Results were calculated as numbers and proportions of patients for the 3-year period and for the 3 separate 12-month periods. RESULTS: A total of 458 patients were included in the audit. Most patients were diagnosed as having chronic daily headache (CDH, 60%) or migraine (33%). Prior to the clinic visit, most patients with CDH and migraine treated their headaches with analgesics, and there was little use of prophylactic medication. In the clinic, 74% of patients with CDH and 85% of migraineurs were prescribed prophylactic medication, and 81% of migraineurs were given triptans for acute treatment. Diagnostic testing was performed in 12% of the patients, and all results were normal or negative. CONCLUSIONS: CDH and migraine were the most common headache types encountered in this UK secondary-care clinic. Review of treatment patterns used prior to the initial clinic evaluation suggests that management of CDH and migraine in UK primary care is suboptimal, and educational initiatives are needed to improve headache management.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12864753&dopt=Abstract headache medicine