[Headache in children: also a problem for child and adolescent psychiatry? Pathogenesis, comorbidity, therapy]

[Article in German]

Oelkers-Ax R, Resch F.

Abteilung fur Kinder- und Jugendpsychiatrie der Psychiatrischen Klinik Ruprecht-Karls-Universitat Heidelberg. rieke_oelkers med.uni-heidelberg.de

Headache is a recurrent somatic complaint in childhood and adolescence. In recent decades headache prevalence has increased while the age of onset has decreased. In most cases headache can be categorized as migraine or tension-type headache without significant organic pathology, i.e. head trauma, structural lesion, etc. Diagnosis according to the criteria of the International Headache Society is based on subjective reports by patients and their parents. The basic tools of clinical assessment are history, physical examination and a headache diary. Laboratory tests, including electroencephalography and imaging studies should not, as a rule, be undertaken routinely. Pathophysiological models with an impact on therapeutic interventions will be discussed. Childhood headache is often treated inappropriately in daily practice despite the availability of various options (including environmental, drug, and psychological therapy). Psychological therapy (relaxation training, biofeedback, stress management, etc.) as well as medication can be applied for prophylaxis. Minimal therapeutic interventions have been shown to be equally effective in a remarkable number of patients. Chronic Headache shows relevant comorbidity with anxiety and depression and is associated with somatization and school disorders. A careful investigation and an adequate therapy of eventual psychiatric comorbidity is therefore strongly recommended.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12474319&dopt=Abstract headache medicine




Chronic cluster headache: provocation with carbon dioxide breathing and nitroglycerin.

Hannerz J, Jogestrand T.

Department of Neurology, Karolinska Hospital, Stockholm, Sweden.

Nine patients with chronic cluster headache were studied as to end-tidal PCO2, heart rate, blood pressure, common carotid artery blood flow, vascular resistance, and intensity and duration of pain before, during, and after breathing 6% CO2 in air for 6 minutes and before and after administration of 1 mg nitroglycerin sublingually. End-tidal PCO2 was low at rest without provocation indicating that chronic cluster headache patients hyperventilate. Carbon dioxide provocation induced an increase in common carotid artery blood flow. This provocation, previously shown to induce pain in episodic cluster headache patients, did not result in unilateral pain in chronic cluster headache patients. Nitroglycerin did not provoke any pain in 4 of 5 chronic cluster headache patients in contrast to the effects in episodic cluster headache patients in a cluster period. In one chronic cluster headache patient, a short-lasting attack of moderate pain intensity was provoked. The results agree with the hypothesis that chronic cluster headache patients have changed vascular reactivity due to permanent sympathicoplegia unilaterally in the middle fossa in contrast to episodic cluster headache patients who it has been suggested have a nonpermanent sympathicoplegia unilaterally in the same region.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8984091&dopt=Abstract headache medicine




[Evaluation of usefulness of the IHS criteria in the diagnosis of functional headaches in pediatric age]

[Article in Spanish]

Navarro-Quesada FJ, Lluch MD, Roldan S, Ramos I.

Hospital Universitario Virgen Macarena, Departamento de Pediatria, Unidad de Neurologia Infantil.

Following the criteria of the IHS, we studied 117 children (63 female and 54 male, mean age 9.35 +/- 1.65 years), selecting those classified as migraine (77) or tension-type headaches (30), total 107. We analysed the frequency of clinical manifestations with each type of headache (type and localization of pain, severity of the headache--intensity, duration and degree of disability--and associated symptoms) and their contribution to the differential diagnosis of each entity (evaluated as the presence--sensitivity--or absence--specificity--of each clinical manifestation in each group). Our study shows that throbbing headache (49%) and a unilateral location (31%) as well as nausea and vomiting (33.6%), although constituting diagnostic criteria of migraine, according to the IHS, have acceptable sensibility (91-95%), but only slight specificity (34-40%) for infantile migraine. On the other hand, we found that a greater intensity of headache (22%), and the presence of abdominal pain (15%) as associated symptom, although not considered diagnostic criteria, are also parameters of high sensitivity (100-92%) respectively, and also of greater specificity (30-70%) than the anterior criteria. We conclude that the criteria of IHS for the diagnosis of headache in infancy may be valid although some considerations are necessary. The new IHS criteria for the headache diagnosis in adults [1] may be useful in pediatric age, but the experience on this use is spare, consequently the increment on the use of this classification and the future changes, could produce a best operativity in the diagnosis of headache in childrens.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7497235&dopt=Abstract headache medicine




[Prevalence of migraine in a population of university students]

[Article in Spanish]

Muniz R, Montiel I, Asensio M, Martin R, Matias-Guiu J.

Servicio de Neurologia, Hospital General Universitario de Alicante.

A group of universities not related with health sciences were interviewed using the questionnaire 'Alcoi 1992', based on the operational diagnostic criteria of the International Headache Society (IHS), to evaluate the prevalence of migraine. This questionnaire for the diagnosis of migraine was validated in 1993, showing a high sensibility and specificity for the diagnosis of migraine. Sensitivity, specificity, predictive value and chance-corrected agreement rate for the diagnosis of migraine was 100%, 94%, 90% (PVpos), 1008 (PVneg) and 0.71 respectively. The study group was composed by 96 students, men and women; the mean age of the group was 21 years old. The prevalence of headache, migraine, tensional headache and cluster headache was 95.4%; 7.58%; 12.2% and 1.52% cases respectively. The prevalence for male of headache, migraine, tensional headache and cluster headache was 92.5%, 12.5%, 15.9% and 2.5% cases respectively. The prevalence for female of headache, migraine, tensional headache and cluster headache was 100%; 0%; 5.5% and 0% cases respectively. The questionnaire appears like an useful, fast and easy method for the evaluation of diagnosis of migraine in populations groups.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7497253&dopt=Abstract headache medicine




Subjective stress and coping in recurrent tension-type headache.

Ficek SK, Wittrock DA.

Department of Psychology, North Dakota State University, Fargo 58105, USA.

Subjects with tension-type headache and headache-free control subjects completed two mental stressor tasks, solving anagrams and mental arithmetic. During the experimental session, measures of heart rate, muscle tension, and subjective stress ratings were recorded. In addition, all subjects completed a week-long series of questionnaires which monitored headache activity in addition to frequency and intensity of stressful life events. Recurrent tension headache sufferers were found to have higher levels of depression and trait anxiety. Headache and control subjects were not found to respond differently to stressors presented in the laboratory based on measures of EMG, heart rate, or subjective stress ratings, nor were there differences in reports of coping. However, diary questionnaires revealed that headache subjects experienced stressful events more frequently than headache-free controls. Headache subjects also rated these events as causing more stress.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7591737&dopt=Abstract headache medicine




Possible identification of cervicogenic headache among patients with migraine: an analysis of 374 headaches.

Leone M, D'Amico D, Moschiano F, Farinotti M, Filippini G, Bussone G.

Centro Cefalee, Istituto Neurologico Carlo Besta, Milano, Italy.

According to Sjaastad, the pain in cervicogenic headache, a form not recognized by the IHS, is long lasting and always side-locked unilateral. The frequency of side-locked unilateral pain (defined here as no change in side from onset) and other characteristics of cervicogenic headache were investigated in 300 outpatients using information collected on standard forms in structured interviews. Three hundred seventy-four headaches diagnosed according to IHS criteria were identified. Three hundred forty-eight of these headaches were long-lasting (duration of more than 4 hours); migraine (65%) followed by tension-type headache (25%) were the commonest forms. Side-locked unilaterality was present in 29% (101 of 348), and occurred most frequently in migrainous disorders not fulfilling the criteria (25 of 56, 44.6%). This group differed significantly from the other migraine conditions for longer pain duration (P < 0.02) and less frequent nausea, vomiting, photophobia, phonophobia (P < 0.0001), and aggravation by physical activity (P < 0.02). With these characteristics, this group resembled cervicogenic headache. However, in none of these patients was pain triggered by head or neck movements, and the frequency of head or neck trauma did not differ from other headaches. A more precise definition of clinical criteria for cervicogenic headache vs migraine is, therefore, required.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7591738&dopt=Abstract headache medicine




Headache and neck pain in spontaneous internal carotid and vertebral artery dissections.

Silbert PL, Mokri B, Schievink WI.

Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.

We studied the characteristics of headaches in 161 consecutive symptomatic patients with spontaneous dissections of the internal carotid artery (n = 135) or the vertebral artery (n = 26). For patients with internal carotid artery dissection (ICAD), the mean age was 47 years and for those with vertebral artery dissection (VAD), 40.7 years. A history of migraine was present in 18% of the ICAD group and in 23% of the VAD group. Headache was reported by 68% of the patients with ICAD and by 69% of those with VAD, and, when present, it was the initial manifestation in 47% of those with ICAD and in 33% of those with VAD. Ten percent of patients with ICAD had eye, facial, or ear pain without headache. The median interval from onset of headache to development of other neurologic manifestations was 4 days for the ICAD group and 14.5 hours for the VAD group. For all dissections, headaches typically were ipsilateral to the side of dissection. In the ICAD group, headaches were limited to the anterior head in 60% of patients and were steady in 73% and pulsating in 25%. In the VAD group, headaches were distributed posteriorly in 83% of patients and were steady in 56% and pulsating in 44%. Neck pain was present in 26% of patients with ICAD (anterolateral) and in 46% of those with VAD (posterior). The median duration of the headache in patients with VAD and ICAD was 72 hours, but headaches became prolonged, persisting for months to years, in four patients with ICAD.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7644051&dopt=Abstract headache medicine




Headaches associated with nasal obstruction due to deviated nasal septum.

Low WK, Willatt DJ.

ENT Department, Hope Hospital, University of Manchester, School of Medicine, UK.

A deviated nasal septum not only can cause a blocked nose, but may also be associated with headaches. This study evaluates the nature of these headaches, the effect of submucous resection of the nasal septum, and the factors associated with postoperative headache relief. Deviated nasal septa were corrected by submucous resection in 99 men and 17 women. Patients were studied at 4 to 48 months (mean 18 months) postoperatively. Fifty-five of the 116 patients studied (47.4%) had preoperative recurring headaches. Thirty-five of the 55 patients with headaches (63.6%) experienced relief (complete or partial) of their headaches at a mean follow-up period of 18 months. Patients were more likely to be relieved of their headaches following submucous resection if the headaches were most intense over the frontal region, pressurelike in nature, and if the submucous resection resulted in relief of nasal obstruction. It is possible that headaches recur in the long term, and it is postulated that central mechanisms play a role.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7672957&dopt=Abstract headache medicine