Headaches during intracranial endovascular procedures: a possible model of vascular headache.

Martins IP, Baeta E, Paiva T, Campos J, Gomes L.

Department of Neurology, Hospital de Santa Maria, Lisboa, Portugal.

We report a series of 11 patients who developed headaches during intracranial endovascular procedures performed for the treatment of arteriovenous malformations (10 cases) or aneurysms (1 case). Headache was precipitated either by balloon inflation (3 cases) or by embolization (8 cases), and had a very constant pattern. In all cases the pain started suddenly, reaching maximum intensity at once. Headache was focal, unilateral, ipsilateral to the occluded artery, nonthrobbing and short-lasting (usually less than 10 minutes). It was not associated with gastrointestinal, autonomic, or aura-like symptoms. Headache localization depended upon the catheterized artery, being constant for each of the major vascular territories. Yet, in all patients pain was felt in the cutaneous territory of the ophthalmic division of the trigeminal nerve. The occurrence of headache was not associated with cortical deficit nor cortical irritation (assessed both clinically and by the EEG) and therefore seems to be directly related to the stimulation of the arterial wall. This type of pain can be used as a model of pure vascular headache. Its study can contribute not only to understand the pattern of intracranial vascular innervation but also to understand or to refute the vascular components of migraine.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8320095&dopt=Abstract headache medicine




The Headache Self-Efficacy Scale: adaptation to recurrent headaches.

Martin NJ, Holroyd KA, Rokicki LA.

Duke University Medical Center.

This paper describes the development, construct and discriminant validity, and incremental utility of a headache self-efficacy scale. The Headache Self-Efficacy Scale is a 51 item scale designed specifically for recurrent headache sufferers. It assesses individuals' belief that they are able to do the things necessary to prevent a moderately painful headache when confronted with personally relevant headache precipitants. High self-efficacy was associated with less depression, anxiety, and physical symptoms, and less use of passive coping strategies (P < .01), even when headache frequency, intensity and chronicity were controlled statistically. Self-efficacy also explained unique variance in psychological and somatic symptoms beyond that explained by locus of control and general self-efficacy. These findings suggest that adaptation to headaches is influenced by self-efficacy beliefs, and that the assessment of self-efficacy may provide useful information in the evaluation of recurrent headache sufferers.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8320099&dopt=Abstract headache medicine




Impact of migraine and tension-type headache on life-style, consulting behaviour, and medication use: a Canadian population survey.

Edmeads J, Findlay H, Tugwell P, Pryse-Phillips W, Nelson RF, Murray TJ.

Department of Neurology, University of Toronto, Ontario, Canada.

A large sample of Canadian adults was surveyed by telephone to determine the prevalence and characterization of headache, and the effects of headache on life-style, consulting behaviours and medication use. We reported prevalence and characterization in a previous issue; here, we detail the effects of headaches on sufferers. Sixteen and one-half percent of adult Canadians experience migraine and 29% tension-type headaches. In over 70% of headache sufferers interpersonal relationships are impaired. Regular activities are limited in 78% of migraine attacks and 38% of tension-type headaches. Despite this, only 64% of migraine and 45% of tension-type headache sufferers had ever sought medical attention, and of these only 32% returned for ongoing care. Fourteen percent of migraine and 8% of tension-type headache sufferers had used emergency departments. Most headache sufferers take medication, primarily over-the-counter varieties. Measures to reach the headache population are needed, as are safe effective treatment options that will encourage them to participate in their medical care.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8334575&dopt=Abstract headache medicine




Pain state as artifact in the psychological assessment of recurrent headache sufferers.

Holroyd KA, France JL, Nash JM, Hursey KG.

Department of Psychology, Ohio University, Athens 45701.

The finding that recurrent headache sufferers, particularly tension headache sufferers, obtain higher scores on psychological symptoms measures than controls was replicated in 262 recurrent (tension, mixed, and migraine) headache sufferers and 26 controls. However, closer examination of the data revealed that psychological symptoms were elevated only in patients who experienced head pain at the time of assessment. This finding raises the possibility that previously reported elevations in psychological symptoms have resulted from uncontrolled differences in the pain state of respondents. Retrospective reports of headache activity also were related to pain state. In contrast, a measure of perceived control of factors affecting headaches was unrelated to pain state. As a result, locus of control (but not psychological symptoms) successfully differentiated recurrent headache sufferers from controls even when headache sufferers were tested when pain free. These results suggest that psychological symptom measures may yield misleading results when used with individuals with pain disorders.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8336993&dopt=Abstract headache medicine




The role of life event stress, coping and social support in chronic headaches.

Martin PR, Theunissen C.

Department of Psychology, University of Western Australia, Nedlands.

A group of chronic headache sufferers (migraine and tension-type headache) was compared with two individually matched control groups of nonheadache subjects in terms of life event stress, and the stress moderating factors of coping skills and social support. The headache group did not differ from the control groups on the measures of life event stress or coping but significant differences arose on the measure of social support with the headache group achieving lower scores than the control groups. The findings were interpreted as suggesting that clinicians and researchers should pay more attention to social aspects of headaches, and that interventions aimed at teaching headache sufferers to mobilize social support should be considered as components of treatment packages.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8349472&dopt=Abstract headache medicine




The relationship between perceived stress, social support and chronic headaches.

Martin PR, Soon K.

Department of Psychology, University of Western Australia, Nedlands.

A group of chronic headache sufferers (migraine and tension-type headache) was compared with a group of nonheadache control subjects in terms of two domains of social support (social integration and functional support), perceived social support, sources of social support, and perceived stress. Headache sufferers and controls were not differentiated with respect to number of social relationships, sources of support and availability of support. In contrast, headache sufferers were significantly less satisfied with the support available to them and scored lower on all four types of functional support measured (appraisal, esteem, belonging and tangible). Support measures did not show a linear relationship with headache chronicity, and were at their lowest at an intermediate point in the headache history rather than at an early or late point. Headache sufferers scored higher on perceived stress than control subjects and differences between the groups increased as a function of headache chronicity. The findings were interpreted as suggesting that clinicians and researchers should focus greater attention on the social dimension of headaches.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8349473&dopt=Abstract headache medicine




Lack of asymmetry of middle cerebral artery blood velocity in unilateral migraine.

Zwetsloot CP, Caekebeke JF, Ferrari MD.

Department of Neurology, University Hospital, Leiden, The Netherlands.

BACKGROUND AND PURPOSE: A recent transcranial Doppler study found reduced blood velocity in seven patients during migraine attacks in the middle cerebral artery at the headache side. This would implicate vasodilation of the middle cerebral artery in the pathogenesis of headache in migraine. We attempted to confirm this finding. METHODS: We determined blood velocity with transcranial Doppler ultrasonography in the middle cerebral arteries of 51 migraine patients with unilateral headache (5 with aura, 46 without aura) and of 14 patients with bilateral headache, during and outside attacks. During attacks, median time from onset of attack to transcranial Doppler examination was 6 hours (range, 1 to 35 hours). RESULTS: We found no difference between blood velocity at the headache and nonheadache sides nor between blood velocity during and outside attacks. Similar results were obtained in a subgroup of 11 patients who were investigated in the first 4 hours of an attack. There were also no differences between attacks with unilateral or bilateral headache. CONCLUSIONS: We cannot support the hypothesis that migraine is associated with vasodilation of the middle cerebral artery ipsilateral to the headache.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8362427&dopt=Abstract headache medicine




Perioperative ingestion of caffeine and postoperative headache.

Weber JG, Ereth MH, Danielson DR.

Department of Anesthesiology, Mayo Clinic Rochester, Minnesota 55905.

The interruption of daily consumption of caffeine-containing beverages can cause headache and other symptoms within 8 hours. Resumption of caffeine alleviates these symptoms. Surgical patients routinely fast preoperatively and may have postoperative symptoms from caffeine withdrawal. In the current study, we determined whether perioperative caffeine consumption altered the incidence of postoperative headache. After institutional approval of the study design, 233 surgical outpatients were surveyed about history of headaches, caffeine consumption, and the presence and severity of headaches postoperatively. Of the 233 patients, 190 (82%) drank caffeinated beverages daily (mean daily consumption, 290 mg of caffeine). Postoperative headaches occurred in 22% of patients who routinely drank caffeinated beverages but in only 7% of those who did not (P < 0.03). Other factors associated with postoperative headaches included a history of frequent headaches (P < 0.0001), age of 50 years or younger (P < 0.002), and amount of daily caffeine ingested (P < 0.01). Among daily caffeine drinkers, those who drank caffeinated beverages on the day of the surgical procedure had a lower incidence of postoperative headaches than did those who abstained (17% versus 28%; P < 0.04). Postoperative headaches may be related to several factors. Perioperative intake of caffeine altered postoperative well-being. Caffeine given preoperatively may limit postoperative withdrawal headaches among the millions of daily drinkers of caffeinated beverages. A randomized, prospective, and blinded trial to test this hypothesis is warranted.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8371601&dopt=Abstract headache medicine