Migrainous disorder and headache of the tension-type not fulfilling the criteria: a follow-up study in children and adolescents.

Zebenholzer K, Wober C, Kienbacher C, Wober-Bingol C.

Department of Neuropsychiatry of Childhood and Adolescence, University of Vienna, Austria. Karin.Zebenholzer univie.ac.at

In this follow-up study in children and adolescents with recurrent headaches classified as migrainous disorder (IHS 1.7) and headache of the tension-type not fulfilling the criteria (IHS 2.3), 28.6% were headache-free and 71.4% still had headaches 2-5 years after the first examination. The majority remained in the same one-digit IHS diagnosis, whereas 20% changed from migraine to tension-type headache or vice versa. The number of IHS criteria fulfilled increased significantly from the first to the second examination. The reason for diagnosing IHS 1.7 and IHS 2.3 most often was a short headache duration or headache characteristics not meeting the criteria. By reducing the minimum headache duration to 1 h, 11 of 58 patients could be diagnosed as migraine without aura. There was a remarkable overlap in the diagnostic criteria for migraine without aura and tension-type headache. In IHS 1.7 and IHS 2.3 this overlap exceeded 80%, with a trend to decrease at the second examination.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11128817&dopt=Abstract headache medicine




Migraine without aura and migrainous disorder in children; International Headache Society (IHS) and revised IHS criteria.

Cano A, Palomeras E, Alfonso S, Ortega D, Sanz P, Fossas P.

Department of Neurology, Hospital de Mataro, Barcelona, Spain. 26821acg comb.es

The widely used criteria of the IHS to define migraine without aura in children are highly specific but show poor sensitivity, with a large percentage of headaches being classified as migrainous disorder (MD). The objective of this study was to assess how many headache patients in a series of children met the diagnostic criteria of the IHS for migraine without aura or MD and to determine the changes required to convert the greatest number of MD into migraine without aura, without affecting classification of the remaining headache types. A prospective study was undertaken of 131 patients under 15 years old referred to our centre for headache. Patients were classified according to the IHS criteria and according to a modification of these criteria consisting of: (1) reduction of minimum time required for classification into migraine without aura from 2 h to 1 h; (2) acceptance of bifrontal location in addition to hemicranial; (3) acceptance of either phonophobia or photophobia as valid criteria instead of requiring presence of both. Using the IHS criteria, 51 (39%) children were diagnosed as having migraine without aura and 26 (20%) as having MD. According to our revised IHS criteria, 68 (52%) were diagnosed as migraine without aura and nine (7%) as MD. When the three modified criteria were applied, three tension headaches and one unclassifiable headache changed category. When only reduced duration and bifrontal location were applied, none of the headaches other than MD changed category. Application of two modifications to the IHS criteria--reduction in duration of headache to 1 h and acceptance of bifrontal location--increased sensitivity without reducing specificity in classifying migraine without aura in children.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11128818&dopt=Abstract headache medicine




Withdrawal therapy improves chronic daily headache associated with long-term misuse of headache medication: a retrospective study.

Linton-Dahlof P, Linde M, Dahlof C.

Gothenburg Migraine Clinic, Goteborg, Sweden. carl.dahlof migraineclinic.se

Chronic daily headache (CDH) associated with long-term misuse of headache medication is a common clinical problem which is refractory to most treatments. The present study is a retrospective analysis of the effect of drug withdrawal therapy in patients with CDH and frequent long-term use of headache symptomatic medication. One hundred and one adult patients (74 women and 27 men, aged between 16 and 72 years, mean age 43 years) were evaluated 1-3 months after drug withdrawal therapy had been initiated. The mean headache frequency at baseline was 26.9+/-4.0 days per month. Fifty-seven (56%) patients were significantly improved (defined as at least 50% reduction in number of headache days) after a period of drug withdrawal therapy. Based on the outcome of the drug withdrawal therapy, the patients were divided into three categories: group I, those who had between 0 and 10 headache days per month (n = 41), group II, those who had 11-20 days (n = 37), and group III, those who had 21-30 days (n = 23). The mean headache frequencies in groups I, II and III were 5.6+/-2.8 days, 15.7+/-2.5 days and 28.7+/-2.4 days, respectively. Treatment with amitriptyline was offered to patients in whom no improvement had been achieved. Ten of those 22 patients (36%) experienced a significant (> or = 50%) reduction of headache days. It is concluded that out-patient drug withdrawal therapy is the treatment of choice in patients with CDH and frequent long-term use of headache symptomatic medication, and that about one quarter of these CDH patients do not respond to drug withdrawal therapy only.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11128824&dopt=Abstract headache medicine




Comorbidity of depressive and anxiety disorders in chronic daily headache and its subtypes.

Juang KD, Wang SJ, Fuh JL, Lu SR, Su TP.

Department of Psychiatry, Taipei Veterans General Hospital, Taiwan.

OBJECTIVE: To investigate the frequency of depressive and anxiety disorders in patients with chronic daily headache. BACKGROUND: There is a lack of data in the literature on the extent of psychiatric comorbidity in patients with different subtypes of chronic daily headache. METHODS: We recruited consecutive patients with chronic daily headache seen in a headache clinic from November 1998 to December 1999. The subtypes of chronic daily headache were classified according to the criteria proposed by Silberstein et al. A psychiatrist evaluated the patients according to the structured Mini-International Neuropsychiatric Interview to assess the comorbidity of depressive and anxiety disorders. RESULTS: Two hundred sixty-one patients with chronic daily headache were recruited. The mean age was 46 years, and 80% were women. Transformed migraine was diagnosed in 152 patients (58%) and chronic tension-type headache in 92 patients (35%). Seventy-eight percent of patients with transformed migraine had psychiatric comorbidity, including major depression (57%), dysthymia (11%), panic disorder (30%), and generalized anxiety disorder (8%). Sixty-four percent of patients with chronic tension-type headache had psychiatric diagnoses, including major depression (51%), dysthymia (8%), panic disorder (22%), and generalized anxiety disorder (1%). The frequency of anxiety disorders was significantly higher in patients with transformed migraine after controlling for age and sex (P =.02). Both depressive and anxiety disorders were significantly more frequent in women. CONCLUSION: Psychiatric comorbidity, especially major depression and panic disorders, was highly prevalent in patients with chronic daily headache seen in a headache clinic. These results demonstrate that women and patients with transformed migraine are at higher risk of psychiatric comorbidity.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11135026&dopt=Abstract headache medicine




Quality of life differs among headache diagnoses: analysis of SF-36 survey in 901 headache patients.

Wang SJ, Fuh JL, Lu SR, Juang KD.

The Neurological Institute, Taipei Veterans General Hospital, 201 Shi-Pai Road, Section 2, Taipei 11217, Taiwan. sjwang vghtpe.goc.tw

This paper presents the results of health-related quality of life (HRQoL) in 901 patients consecutively visiting a headache clinic of a national medical center in Taipei, Taiwan. HRQoL was evaluated with the Medical Outcome Study-Short Form (SF-36) and the Hospital Anxiety and Depression Scale (HADS). According to the classification criteria for chronic daily headache (CDH) proposed by Silberstein et al. (Neurology 47 (1996) 871) five hundred and ninety-three (66%) patients had CDH, of whom transformed migraine (TM) was diagnosed in 310, and chronic tension-type headache (CTTH) in 231. One hundred and ninety-three patients had episodic migraine. All SF-36 scale scores significantly correlated with the HADS scores and the intensity and frequency of pain. Compared with the normative data, a pervasive multi-dimensional decline of the SF-36 scores was noted among the headache patients except for the physical functioning scale. The decline was most remarkable in the role limitations of physical and emotional dimensions and in the bodily pain. An increasing impairment of the SF-36 scores was noted from migraine to CTTH to TM. After controlling for the HADS, age, gender, education, and chronic illness by multiple linear regression analyses, the patients with TM had the worst SF-36 profile; whereas, the patients with CTTH and migraine had compatible results. This study is the first to demonstrate that the SF-36 scores differ among headache diagnoses. Psychological distress, as well as the percentages of the types of patients, greatly influenced the SF-36 scores in hospital-based headache samples. Our findings also suggest that improvement in the pain profile as well as psychological well-being can predict a generalized improvement in the SF-36 scales in headache patients.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11166485&dopt=Abstract headache medicine




Aminergic tone correlates of migraine and tension-type headache: a study using the tridimensional personality questionnaire.

Di Piero V, Bruti G, Venturi P, Talamonti F, Biondi M, Di Legge S, Lenzi GL.

Centro Interuniversitario per lo Studio delle Cefalee e dei Disordini Neurotrasmettitoriali del Sistema Nervoso, Rome, Italy.

BACKGROUND: Aminergic neurotransmitter activity has been studied in many neuropsychiatric diseases by means of a self-administered questionnaire proposed by Cloninger. Given that central aminergic modulation plays a major role in the pathophysiology of primary headaches, we investigated the personality dimensions related to aminergic neurotransmitter activity in patients with migraine and tension-type headache. METHODS: From a consecutive series of 230 patients, we selected those presenting with migraine and tension-type headache according to the International Headache Society criteria. All patients were assessed by means of the Cloninger 100-item self-report Tridimensional Personality Questionnaire and a depression scale. The four dimensions of personality are novelty seeking (dopaminergic), harm avoidance (serotonergic), reward dependence (noradrenergic), and persistence (glutaminergic). RESULTS: One hundred twenty-one patients presenting with migraine and 42 with tension-type headache were recruited. The results indicate significantly higher harm avoidance scores (P<.001) in both patients with migraine and those with tension-type headache than in controls. Furthermore, patients with migraine had a significantly low score in the novelty seeking dimension (P<.001). When we compared only the two groups of patients with headache, we found that the persistence dimension alone was significantly higher in patients with migraine than in those with tension-type headache (P<.05). No differences were observed either in the overall scores of the other personality dimensions or in the depression scale scores. CONCLUSIONS: The Tridimensional Personality Questionnaire results support a role of the serotonergic system in both migraine and tension-type headache pathophysiology. A dysfunction of dopaminergic and glutaminergic tone seems to be a specific feature of migraine.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11168605&dopt=Abstract headache medicine




Headache types and panic disorder: directionality and specificity.

Breslau N, Schultz LR, Stewart WF, Lipton R, Welch KM.

Department of Psychiatry, Henry Ford Health System, Detroit, MI, USA. nbresla1 hfhs.org

OBJECTIVE: To examine the relationship of migraine and other severe headaches with panic disorder. METHODS: Representative samples of persons with migraine, non-migrainous severe headaches, and controls with no history of severe headaches, identified by a telephone survey, were interviewed in person, using a standardized psychiatric interview. Cox proportional hazards models with time-dependent covariates were used to examine the relationship of headaches with first-onset panic disorder and vice versa. RESULTS: Lifetime prevalence of panic disorder was significantly higher in persons with migraine and in persons with other severe headaches, compared with controls. Migraine and other severe headaches were associated with an increased risk for first onset of panic disorder (hazards ratios = 3.55 and 5.75). Panic disorder was associated with an increased risk for first onset of migraine and for first onset of other severe headaches, although the influences in this direction were lower (hazards ratios = 2.10 and 1.85). CONCLUSIONS: Comorbidity of panic disorder is not specific to migraine and applies also to other severe headaches. The influence is primarily from headaches to panic disorders, with a weaker influence in the reverse direction. The bidirectional associations, despite the difference in the strength of the associations, suggest that shared environmental or genetic factors might be involved in the comorbidity of panic disorder with migraine and other severe headaches.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11171900&dopt=Abstract headache medicine




[Prospective epidemiologic study of headache in ambulatory neurology service in the province of Palencia]

[Article in Spanish]

Bueno V, Hernandez M, Guerrero AL, Ponce MA, Ovejero A.

Unidad de Neurologia del Hospital Rio Carrion, Palencia.

OBJECTIVES: To study demographic data about the first time consultations for headache in our neurologic clinic, its diagnostic distribution, its diagnostic and therapeutic management by the neurologist, its source, and the influence of the primary care doctors formation in their search of neurological consultation and therapeutic management in patients with headache. PATIENTS AND METHODS: A protocol with several demographic clinical and medical care data of the all first time visits for headache in our province was picked up, during 3 consecutive months. RESULTS: Headaches represent 21.5% of the first time consultations. The majority of the patients were women. The primary care doctors sent 93.6% of patients. The two more common diagnoses were tension-type headache (60%) and migraine (25.4%), reflecting their prevalences in the population. The more common treatments were the associations of two drugs. The general doctors sent more patients with headache (3.36 per thousand and year) than family doctors (1.84 per thousand and year). The approximation between initial diagnosis (primary care doctor) and final diagnosis (neurologist) was 26.4%, greater for family doctors (38.1%) than for general doctors (23.9%). CONCLUSIONS: Headaches represent the first cause of neurological consultation. The diagnostic distribution of the patients sent to our province shows the prevalences in the population. The family medicine formation is useful for a better selection of the patients sent to neurologists and a better diagnostic approach.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11195145&dopt=Abstract headache medicine