[Headache in the elderly]

[Article in German]

Klotz JM.

Neurologische Klinik, Klinikum Fulda. j.klotz.neuro klinikum-fulda.de

Although the elderly generally suffer less often from headache, symptomatic headache and concomitant diseases are more frequent. For the diagnostic work-up of newly occurring headaches in old age, imaging examinations of the head (CT or MRI), together with laboratory investigations are necessary. The treatment of symptomatic headache is oriented to the underlying disease, and should be applied promptly, with the aim of preventing serious complications. When considering the management strategy, account must be taken of possible changes in pharmacokinetics, pharmacodynamics and the therapeutic response in the elderly. Numerous medications often cause headache or other side effects in patients of advanced age. Most antiheadache drugs have not been adequately been investigated in the group of over 65-year-olds. This means that drug treatment for headache is often applied in accordance with the principle: start low, go slow.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15529667&dopt=Abstract headache medicine




The impact of a worksite migraine intervention program on work productivity, productivity costs, and non-workplace impairment among Spanish postal service employees from an employer perspective.

Vicente-Herrero T, Burke TA, Lainez MJ.

Correos y Telegrafos de Espana, Valencia, Spain.

BACKGROUND: Migraine is associated with a significant productivity loss to employers, who may benefit from making a migraine intervention available to their employees. OBJECTIVE: To evaluate changes in migraine-related productivity and non-workplace impairment associated with a migraine intervention program from the employer perspective. METHODS: This was a pre-test post-test study of Spanish Postal Service employees with migraine. The intervention consisted of counseling from occupational health physicians and rizatriptan 10 mg for symptomatic treatment of two subsequent migraine headaches. Physicians also prescribed additional medications for migraine prophylaxis, treatment of tension headaches, and rescue medications. Migraine-related work loss and non-workplace impairment (interference with daily and social activities) were self-reported at baseline (pre-intervention) and separately following each migraine headache (post-intervention) with the aid of a diary. Migraine-related work loss was reported as work loss due to absenteeism, reduced productivity while at work, and the sum of the two (total lost work day equivalents [LWDE]). An employer perspective was taken for the cost analysis, and thus productivity costs were the only costs considered. RESULTS: A total of 436 patients comprised the population for analysis. The number of migraine-related LWDE per migraine attack were 0.48 days per migraine headache in the month before the intervention, decreasing to 0.20 days and 0.07 days per migraine headache during the first and second migraine headaches following the intervention (p < 0.0001 vs. baseline). Total migraine-related productivity costs per migraine headache were 34 euros/patient before the intervention, decreasing to 14 euros/patient and 5 euros/patient during the first and second headaches following the intervention (p < 0.0001). Non-workplace activity impairment was also significantly reduced (p < 0.0001) following the intervention. The main limitations of the study were the lack of a parallel control group and the potential for differential recall bias between the usual care and the intervention periods. In addition, the results may not be generalizable to other employers or other countries. CONCLUSION: This study documents the value of a workplace migraine intervention program, which focused on migraine prevention and rizatriptan-based symptomatic treatment. It also highlights the important role occupational health clinics can play in helping employers and employees reduce the burden of migraine.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15537481&dopt=Abstract headache medicine




Disability and quality of life in different primary headaches: results from Italian studies.

Bussone G, Usai S, Grazzi L, Rigamonti A, Solari A, D'Amico D.

National Neurological Institute C Besta, Via Celoria 11, I-20133 Milan, Italy. bussone istituto-besta.it

Headaches may have a wide range of impact on patients' lives. We report the results of Italian studies in which disability and health-related quality of life (HRQOL) in patients with different primary headaches were evaluated. The Short Form 36 (SF-36) was used to assess HRQOL; the Migraine Disability Assessment Score questionnaire (MIDAS) was used to assess disability in patients with migraine without aura or with chronic migraine. Mean MIDAS total scores were evaluated in migraine without aura and chronic migraine patients. The scores at the eight SF-36 scales were calculated in patients with the three studied headaches, and were compared with Italian normative data (Student's t-test with Bonferroni correction). Primary headaches had a considerable negative impact on patients' lives, with poor quality of life and decreased ability to function in daily duties. The mean MIDAS total score was 23.4 in 264 patients with migraine without aura, and 79.2 in 150 patients with chronic migraine. Mean SF-36 scores in migraine without aura (68 subjects), chronic migraine (84) and cluster headache (56) were lower than those from the Italian general population, with significant differences for 3 scales in migraine without aura, for 6 in chronic migraine, and for all scales in cluster headache. Our results confirmed a marked personal and social burden in patients with migraine without aura, and also in the less well-studied forms of primary headaches, cluster headache and chronic migraine.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15549514&dopt=Abstract headache medicine




Disability in young patients suffering from primary headaches.

Grazzi L, D'Amico D, Usai S, Solari A, Bussone G.

Headache Centre, National Neurological Institute C Besta, Via Celoria 11, I-20123 Milan, Italy. liciagrazzi mac.com

During the last decade researchers have begun to employ standardised methodologies to investigate the global impact of primary headaches. Disease-specific instruments have been developed to measure headache-related disability. The MIDAS Questionnaire, which is the most extensively studied of these instruments, was designed to assess the overall impact of headaches over the 3 months before compilation. The MIDAS Questionnaire is an optimal tool to assess headache-related disability in adults in relation to patients' daily activities. Primary headaches are a recurrent problem for children and adolescents. Forty percent of children have experienced headaches by the age of 7 years increasing to 75% by the age of 15. In a recent report we determined the suitability of the MIDAS Questionnaire in its original form for assessing disability in children and adolescents suffering from different kinds of headache. This was the first step of a line of research aimed to develop a new MIDAS Questionnaire adapted for young patients. In this second study the aims were: (1) to produce a new version of the MIDAS Questionnaire specific for young patients suffering from different forms of headache; (2) to assess the reliability of this new instrument; (3) to assess its sensitivity to treatment intervention.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15549516&dopt=Abstract headache medicine




Headache and hypertension.

Cortelli P, Grimaldi D, Guaraldi P, Pierangeli G.

Dipartimento di Neuroscienze, Universita di Modena, Via Del Pozzo 71, I-41100 Modena, Italy. cortelli.pietro unimo.it

Headache is generally regarded as a symptom of high blood pressure in spite of conflicting opinions on the association of headache and arterial hypertension. Most studies have shown that mild chronic hypertension and headache are not associated and this demonstration needs to be implemented in clinical practice. Whether moderate hypertension predisposes to headache remains controversial, but there is little evidence that it does. Headaches caused by significant disturbances in arterial pressure are included in the section "Headache attributed to a disorders of homeostasis" (code 10.3) of the 2nd edition of the International Classification of Headache disorders.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15549522&dopt=Abstract headache medicine




Workplace disability in migraine: an Italian experience.

D'Amico D, Genco S, Perini F.

National Neurological Institute C. Besta, Via Celoria 11, I-20133 Milan, Italy. damicodo tiscali.it

Workplace disability due to migraine has not been extensively researched in non-English speaking countries. We assessed the repercussions of headache, and particularly of migraine, on work in a sample of employees from an Italian company (Bulgari). Information was obtained through a self-answering questionnaire in "all headaches" sufferers, and through direct interview in migraine sufferers (diagnosis according to IHS criteria). Headache frequency, pain intensity and headache-related disability were higher in migraineurs than in "all headaches" sufferers. About a quarter of migraineurs missed at least one day in the three months prior to the interview due to headache, and around 10% lost two or more days over the same period. Moore than 50% of migraineurs reported 1-7 days per month at work with headache, with reduction in productivity level by 50% or more in 15% of respondents. Our data confirmed that headaches, and particularly migraine, cause a considerable reduction in workplace productivity. Workplace interventions to effectively manage migraine are needed.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15549550&dopt=Abstract headache medicine




MIDAS questionnaire modification for a new MIDAS junior questionnaire: a clinical experience at the Neurological Institute "C. Besta".

Grazzi L.

Headache Centre, National Neurological Institute C. Besta, Via Celoria 11, I-20133 Milan, Italy. liciagrazzi mac.com

During the last decade researchers have begun to employ standardised methodologies to investigate the global impact of primary headaches. Disease-specific instruments have been developed to measure headache-related disability. The MIDAS questionnaire, which is the most extensively studied of these instruments, was designed to assess the overall impact of headaches over the 3 months before compilation. The MIDAS questionnaire is an optimal tool to assess headache-related disability in adults in relation to patients' daily activities. Primary headaches are a recurrent problem for children and adolescents. Forty percent of children have experienced headaches by the age of 7 years increasing to 75% by the age of 15. In a recent report we determined the suitability of the MIDAS questionnaire in its original form for assessing disability in children and adolescents suffering from different kinds of headache. This was the first step of a line of research aimed to develop a new MIDAS questionnaire adapted for young patients. In this second study the aims were: (1) to produce a new version of the MIDAS questionnaire specific for young patients suffering from different forms of headache; (2) to assess the reliability of this new instrument; (3) to assess its sensitivity to treatment intervention.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15549553&dopt=Abstract headache medicine




Headache classification: criticism and suggestions.

Manzoni GC, Torelli P.

Headache Centre, Section of Neurology, Department of Neuroscience, University of Parma, I-43100 Parma, Italy. manzoni ipruniv.cce.unipr.it

The International Classification of Headache Disorders 2nd Edition (ICHD-II), published in 2004, marks an unquestionable progress from the preceding 1988 edition, but the in-depth analysis it offers is not immune from drawbacks and shortcomings. First of all, it is still basically a classification of attacks and not of syndromes. For the migraine group, while the revised classification more accurately characterises migraine with aura, it fails to provide a sufficiently structured description of those forms of migraine without aura that over the years evolve to so-called daily chronic forms. These forms are not adequately recognised as chronic migraine, which ICHD-II includes among the complications of migraine. The inclusion of short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) in the cluster headache group is bound to generate some perplexity, while the recognition of new daily persistent headache (NDPH) included in the group of other primary headaches as a separate clinical entity appears somewhat premature. Doubts are also raised by the actual existence of triptan-overuse headache, which ICHD-II includes in Group 8 among medication-overuse headaches. Finally, the addition of headache attributed to psychiatric disorder, which is certainly a good option in perspective, is not yet supported by an adequate systematisation.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15549572&dopt=Abstract headache medicine