Headache and associations with lifestyle among pupils in senior level elementary school.

Leonardsson-Hellgren M, Gustavsson UM, Lindblad U.

Hentorp Health Care Centre, Skovde, Sweden. margareta.leonardsson-hellgren vgregion.se

OBJECTIVE: To investigate the prevalence of headache and its association with lifestyle among schoolchildren and to test an intervention programme. DESIGN: A cross-sectional survey of all pupils in the school who were asked to complete a questionnaire about headache and lifestyle factors. SETTING: School health care at an elementary school in Sweden. SUBJECTS: All 344 pupils aged 13-16 years, 170 girls and 174 boys, at senior level answered the questionnaire and were included in the study. MAIN OUTCOME MEASURES: Headache occurring at least once a week. RESULTS: Twenty-two percent had headache at least once a week. The problem was more common among girls than among boys; OR 1.6 (95%CI 1.3-2.1). In girls, headache was associated with smoking; OR 6.6 (CI 1.2-35.5), going to bed later than 11 p.m.; OR 4.4 (CI 1.1-18.0), headache in parents; OR 2.0 (CI 1.0-4.2), and few sports activities; OR 3.0 (CI 1.2-7.5). The only corresponding association in boys was with smoking; OR 12.0 (CI 1.5-101). Headache improved in pupils participating in the programme. CONCLUSIONS: Headache is a common health problem in schoolchildren of both sexes at senior level and shows strong associations with lifestyle factors in girls. Intervention seems to be efficient.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11482410&dopt=Abstract headache medicine




Personality characteristics and accompanying symptoms in temporomandibular joint dysfunction, headache, and facial pain.

Mongini F, Ciccone G, Ibertis F, Negro C.

Unit for Headache and Facial Pain, Department of Clinical Pathophysiology, University of Turin, Corso Dogliotti 14, I. 10126 Turin, Italy. Spertino golgi.molinette.unito.it

AIMS: Patients with different facial pain/headache pathologies usually complain of numerous accompanying symptoms relative to systemic dysfunctions or to the patient's personality characteristics. The purpose of this work was: (1) to determine the prevalence of accompanying symptoms in groups of patients with temporomandibular joint (TMJ) dysfunction and other types of facial pain or headache disorders, (2) to assess the patients' personality characteristics and anxiety levels, and (3) to see whether significant differences were found between the groups. METHODS: Two hundred forty-three patients were considered. They had TMJ intracapsular disorder (TMJ, n = 71), tension-type headache (TH, n = 52), migraine (M, n = 68), chronic daily headache (CDH, n = 26), or facial pain disorder as somatoform disorder (FP, n = 26). The presence of 23 symptoms was assessed; the Minnesota Multiphasic Personality Inventory (MMPI) and the Spielberger State and Trait Anxiety Inventory (STAI) were administered and the relative scores were calculated. Four different MMPI clusters (depressive, conversive, emotional, coper) were also considered. Intergroup differences were assessed by Chi-square analysis, 1-way analysis of variance, Bonferroni t test, and a logistic regression model and then standardized for gender and age, taking the tension-type headache group as a common reference group. RESULTS: The TMJ group had: (1) a lower prevalence of almost all symptoms; (2) significantly lower scores of several MMPI and of state anxiety; and (3) odds ratio values < 1 for all symptoms except phobias and for emotional, conversive, and depressive MMPI profiles. The FP and CDH groups had the highest prevalence of the majority of symptoms and higher MMPI and STAI scale elevations. CONCLUSION: It is concluded that some types of headache and facial pain seem to correlate with the presence of a number of accompanying symptoms and with some changes in personality. These changes are particularly relevant in patients with chronic daily headache and facial pain disorder. In contrast, patients with TMJ intracapsular disorders tended to show a low prevalence of accompanying symptoms and a normal personality profile.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11203739&dopt=Abstract headache medicine




The relationship between headache and symptoms of temporomandibular disorder in the general population.

Ciancaglini R, Radaelli G.

Department of Biomedical Sciences and Technologies, University of Milan, Via Olgettina 60, I-20132, Milan, Italy.

OBJECTIVES: To describe the relationship between headache and symptoms of temporomandibular disorder (TMD) in a general population, and to assess whether there are specific symptoms associated with headache. METHODS: A personal interview survey conducted in 1995 on 483 adult subjects from the metropolitan community of Segrate, northern Italy. RESULTS: The overall prevalence of headache in the past year was 21.2%. The prevalence of temporomandibular symptoms was 54.3%. Headache occurred significantly more in females than males (26.5 vs 15.4%), and in subjects with, rather than without, symptoms of TMD (27.4 vs 15.2%). Among symptoms, temporomandibular pain, temporomandibular joint sounds, and pain on movements of the jaw were associated with headache using a univariate analysis. After adjustment for confounding variables, a multiple logistic regression confirmed a significant relationship of headache with temporomandibular pain (OR 1.83, 95% CI, 1.07-3.15). CONCLUSIONS: In the general adult population there is an association between headache and symptoms of TMD. A functional evaluation of the stomatognathic system should be therefore considered in subjects with unexplained headache, even if chronic conditions and mechanical symptoms of temporomandibular disorder are absent.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11239582&dopt=Abstract headache medicine




[Chronic tension headache in the neurological outpatient clinics]

[Article in Spanish]

Gracia-Naya M; Grupo de Estudio de Neurologos Aragoneses.

Servicio de Neurologia, Hospital Miguel Servet, Avda. Isabel la Catolica, 1 y 3. E-50009 Zaragoza. gracia.naya meditex.es

INTRODUCTION: Headache is the commonest cause of neurological consultation in Spain. Chronic tension headache is a common reason for consultation, although diagnosis is difficult. OBJECTIVES: To emphasize the profile of a patient with chronic tension headache and analyze the differences from other groups of neurology patients. PATIENTS AND METHODS: We selected chronic tension headaches on the criteria of the International Headache Society, in patients who were seen for the first time in one of 18 Neurology Clinics of the Communidad Autonoma de Aragon during a three month period in 1995. We analysed age, sex, place of origin, provisional diagnosis made by the referring doctor, whether the referral was correct or had to be reviewed. These variables were compared with groups made up of all the patients, the other patients and headaches in general. RESULTS: A total of 3,489 patients were seen: 889 had headache (25.5% of the total number of patients) and 268 had chronic tension headache (7.6% of all the patients). The average age was 47.4 years (SD: +/- 18.7) and 72% were women. Family doctors referred 89.5%. The provisional diagnosis was correct in 52.6% and 17% required further visits. CONCLUSIONS: Chronic tension headache leads to frequent neurological consultation. This was only exceeded by cerebral vascular pathology (12%) and migraine (10.5%), making up 29.4% of all headaches. There was a marked predominance of women, who were younger than patients with other neurological disorders. In spite of the frequency, the family doctors were correct in their provisional diagnosis less often than in other neurological conditions. Although the condition is chronic, the neurologist acted mainly as a consultant and saw few follow-up cases.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11244685&dopt=Abstract headache medicine




Spontaneous oscillations in cerebral blood flow velocity give evidence of different autonomic dysfunctions in various types of headache.

Sliwka U, Harscher S, Diehl RR, van Schayck R, Niesen WD, Weiller C.

Department of Neurology, Friedrich-Schiller University, Philosophenweg 3, D-07740 Jena, Germany.

OBJECTIVES: Our objectives were to determine if: (1) patients with migraine have B wave abnormalities in comparison to normal controls and patients with chronic tension headache and (2) patients with chronic tension headache have an imbalance in autonomic activity that is reflected in differences in Mayer wave activity in comparison to normal controls. BACKGROUND: B waves and Mayer waves are spontaneous oscillations in cerebral blood flow velocity with a frequency of 0.5 to 3 or 4 to 7 cycles per minute, respectively, and can be measured by transcranial Doppler sonography. There is experimental evidence that B waves are generated by certain brain stem nuclei which modulate the lumen of the small intracerebral vessels via monoaminergic nerve endings. In contrast, Mayer waves in cerebral blood flow velocity have no central generator but mirror the Mayer waves in arterial blood pressure which represent peripheral autonomic activity. Migraine may be attributed to a neurotransmitter imbalance in brain stem nuclei. Dysfunctions of the peripheral autonomic nervous system are known in patients with chronic tension headache. METHODS: Using bilateral transcranial Doppler monitoring of the middle cerebral artery B waves and Mayer waves were studied in 30 patients with migraine without aura, 28 subjects with tension-type headache, and 30 normal controls. Coefficient of variation as a quantitative parameter for amplitude of waves and the mean frequency were calculated from the envelope curves of the Doppler spectra. RESULTS: The coefficient of variation of B waves was higher in migrainous patients compared with patients with tension-type headache and normal controls (P<.05), indicating an increase in activity of brain stem nuclei in migraine only. Patients with chronic tension headaches had lower values for Mayer wave activity in comparison with normal controls (P<.05), a sign of an impairment of sympathetic activity. CONCLUSIONS: Our data support the dysfunction of the brain stem monoaminergic/serotonergic system in migraine. In contrast, patients with chronic tension headache have an autonomic dysfunction of peripheral origin presenting as a decrease of sympathetic activity.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11251700&dopt=Abstract headache medicine




Perceived headache associations in Singapore: results of a randomized national survey.

Ho KH, Benjamin KC.

Department of Medicine, National University of Singapore, 5 Lower Kent Ridge Road, Singapore 119074.

We attempted to discern commonly perceived associations between headache symptomatology and various clinical and social parameters based on the results of a nationwide randomized survey involving 2096 respondents. A questionnaire incorporating demographic data, headache characteristics, and management as well as basic health screening was administered by trained interviewers to those aged 12 years and older. A digital semiautomated blood pressure monitor, a Snellen chart, and urinalysis sticks were used to gather clinical information. Elevated blood pressure, poor visual acuity, and fewer hours of nightly sleep did not positively correlate with headaches of increased frequency, intensity, or duration. On the contrary, an age-dependent negative trend was observed with regard to blood pressure and visual acuity. Individuals who performed shift work had more frequent, although not more intense or long-lasting, headaches. Income had no effect on headache prevalence or severity. Our findings are at variance with common perceptions of headache in the region. They highlight the need for informed counseling of patients presenting to medical attention with headaches and suggest that serious intracranial disease should be excluded in atypical headaches even if perceived associations are present.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11251701&dopt=Abstract headache medicine




Extending the efficacy of a thermal biofeedback treatment package to the management of tension-type headaches in children.

Arndorfer RE, Allen KD.

West Central Human Service Center, Bismarck, ND, USA.

This study explored the efficacy of a thermal biofeedback treatment package as an intervention with children with tension-type headaches. In a within-subject, time-lagged, multiple baseline design, five children, aged 8 to 14 years, were assigned to baselines of varying lengths prior to receiving treatment. Treatment was introduced sequentially across subjects and involved six thermal biofeedback treatment visits. Parents were also given guidelines for how best to encourage children to independently use the biofeedback skills. Data confirm that the participants learned the handwarming skill, practiced the skill on a regular basis during treatment, and independently used the skills to manage their pain. All participants demonstrated clinically significant reductions in one or more headache parameters (frequency, duration, intensity) following treatment. At 6-month follow-up, four of the five participants were headache-free. Although the thermal biofeedback treatment package was generally effective for these children with tension-type headaches, the specific type of headache experienced by each child appeared to influence the specific response to treatment. In addition, no single measure of headache activity was the best indicator of response to treatment. The efficacy of the thermal biofeedback treatment package is supported as an alternative treatment for children suffering from tension-type headaches.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11251704&dopt=Abstract headache medicine




Prevalence of migraine in patients with systemic lupus erythematosus.

Glanz BI, Venkatesan A, Schur PH, Lew RA, Khoshbin S.

Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.

OBJECTIVE: To determine the prevalence of migraine in patients with systemic lupus erythematosus (SLE), and to examine the relationships between headache type and other clinical, serologic, and treatment features of the disease. BACKGROUND: Headaches are common in SLE and are a significant source of patient disability. The exact prevalence of headaches in patients with SLE is unknown. The classification of headache syndromes in SLE is also unclear. Previous studies were based on small numbers of patients and the headache types and criteria to define headache types varied widely. METHODS: Four hundred fourteen patients meeting American College of Rheumatology criteria for the diagnosis of SLE were sent the University of California, San Diego Migraine Questionnaire. Patients who completed the questionnaire had their medical records reviewed for constitutional, respiratory, cardiac, vascular, skin, musculoskeletal, other neuropsychiatric, hematologic, renal, and immunologic manifestations of the disease. Recent corticosteroid, nonsteroidal anti-inflammatory drug, antimalarial, and immunosuppressive medications were also recorded. RESULTS: One hundred eighty-six patients completed the questionnaire. Sixty-two percent of patients reported headaches: 39% met diagnostic criteria for migraine and 23% met criteria for nonmigrainous headache. Of the patients with migraine, 56% met criteria for migraine without aura and 44% met criteria for migraine with aura. There were no significant associations between headache type and other clinical, serologic, or treatment features of the disease. CONCLUSIONS: There is a high prevalence of migraine in patients with SLE, and patients should be routinely evaluated for migraine symptoms.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11264689&dopt=Abstract headache medicine