MMPI personality profiles in patients with primary headache syndromes.

Pfaffenrath V, Hummelsberger J, Pollmann W, Kaube H, Rath M.

Neurologische Praxis, Munchen, Germany.

The role of psychological factors in the course of primary headache syndromes is still controversial. Using the Minnesota Multiphasic Personality Inventory (MMPI) we investigated the personality profiles of 434 headache patients (160 migraineurs, 95 with tension type headache, 30 with cluster headache and 149 with combination headache) in accordance with the IHS criteria. In the first three MMPI scales (hypochondria, depression, hysteria) there was a slight increase in T mean values to over 60, but still in the range of two standard deviations of the normal population. There were no statistically significant differences between the four headache groups and between patients with and without analgesic abuse. It was impossible to distinguish headache groups on the basis of their personality profiles by means of reclassification with discriminant analysis. In a cluster analysis, patients with cluster headache showed the highest number (20%) of abnormalities, but also the highest percentage (13%) of completely normal results. Our findings--a cross section analysis of personality profiles--contradict many other MMPI-based studies.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1790571&dopt=Abstract headache medicine




Behavioral assessment of chronic headaches in children.

Engel JM.

Although headache is one of the most common somatic complaints of children and adolescents, little is known about its phenomenology. Pediatric headache diagnosis and implications for treatment are often based on parental reports of consequent pain behaviors. Information on how parents assess and respond to children's headache activity is needed. This study identified how children with chronic, recurrent nonmalignant headaches communicated their headache occurrences to their mothers and how mothers responded to suspected headache occurrences. Specific guidelines are offered to assist nurses in the behavioral assessment and management of chronic pediatric headaches.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1842791&dopt=Abstract headache medicine




A population-based analysis of the diagnostic criteria of the International Headache Society.

Rasmussen BK, Jensen R, Olesen J.

Department of Internal Medicine C, Glostrup Hospital, University of Copenhagen, Denmark.

In 740 representative normal subjects a diagnostic headache interview and a neurological examination provided the necessary information to classify headache disorders according to the operational diagnostic criteria of the International Headache Society (IHS). Sixteen per cent (n = 119) had migraine, 78% (n = 578) tension-type headache. In migraineurs, pain was of a pulsating quality in 78%, severe in 85%, unilateral in 62%, and aggravated by routine physical activity in 96%. Tension-type headache was of a pressing quality in 78%, mild or moderate in 99%, bilateral in 90%, and 72% had no aggravation by physical activity. The accompanying symptoms of nausea, photo- and phonophobia occurred frequently and were usually moderate or severe in migraine subjects, and if present in subjects with tension-type headache, they were usually mild. Only two subjects had unclassifiable headache. The IHS Classification is thus exhaustive. The criteria may be improved by mandatory demands to the criterion of pain intensity leaving other features of pain as supportive for the diagnosis and by including graded severity of accompanying symptoms. A specific proposal is given.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1889068&dopt=Abstract headache medicine




Trigeminal cisternal injection of glycerol for treatment of chronic intractable cluster headaches.

Hassenbusch SJ, Kunkel RS, Kosmorsky GS, Covington EC, Pillay PK.

Department of Neurosurgery, Cleveland Clinic Foundation, Ohio.

Medical treatment of chronic cluster headaches (cluster headaches that occur frequently without remission) can be very difficult. In many patients, the pain remains severe despite all medication trials. For these patients, previous reports recommend radiofrequency trigeminal rhizotomy, which risks corneal anesthesia and subsequent corneal decompensation. As a safer, yet effective, treatment, retro-Gasserian injections of glycerol were given to eight patients having intractable chronic cluster headaches. Needle penetration into the trigeminal cistern, glycerol amount (0.55 ml), and length of patient elevation after the procedure (80-90 degrees upright for 10 h) were modified for maximal exposure of the V1 division. Three patients required one additional injection, and one patient required two additional injections. Verbal pain scales (means +/- 1 standard error of the mean) were: 9.1 +/- 0.30 (preoperative), 2.6 +/- 1.10 (1 mo postoperative), and 2.1 +/- 0.64 (1 yr postoperative). Daily headache frequency decreased from 6.0 +/- 2.0 (preoperative) to 0.2 +/- 0.09 (i.e., one headache every 5 days) (1 yr postoperative). Three of the eight patients had no headaches after 1 year. There were no instances of corneal or facial anesthesia. One year postoperatively, five patients required no medication, and three remained on low doses of medication for headache treatment. In contrast to previous limited reports of glycerol injections for cluster headaches, results with these patients having chronic cluster headaches support the use of glycerol injections as a viable treatment alternative, with significant pain relief and corneal safety.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1944829&dopt=Abstract headache medicine




The treatment of cluster headache with repetitive intravenous dihydroergotamine.

Mather PJ, Silberstein SD, Schulman EA, Hopkins MM.

Department of Medicine, Temple University Hospital, Philadelphia, PA.

We reviewed our experience with 54 cluster headache patients (23 episodic, 31 chronic) admitted to our headache center 64 tines over the past five years and treated with repetitive intravenous dihydroergotamine (IV DHE). DHE therapy was initiated on admission and prophylactic medication regimens were started or adjusted. All 54 patients had complete relief of their cluster headache, usually within two days. Most (82.8%) had no side effects. The average length of hospitalization was 6.7 days. At the three month followup, 92.9% of the episodic cluster patients were headache-free and 7.1% had a 50-74% improvement; at six months, all were headache-free. Of the chronic cluster patients, 44.4% were headache-free at three months and 52.8% had at least 50% improvement. At six months, 75% were headache-free and 22.2% were at least 75% improved, probably as a result of continued prophylactic medication. Repetitive IV DHE safely, rapidly, and effectively controls cluster headache.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1960057&dopt=Abstract headache medicine




The impact of cigarette smoking on headache activity in headache patients.

Payne TJ, Stetson B, Stevens VM, Johnson CA, Penzien DB, Van Dorsten B.

Psychology Service, Department of Veterans Affairs Medical Center, Jackson, MS 39216.

The present study was designed to explore the relationship between cigarette smoking and headache activity in a sample of patients presenting for treatment. Subjects completed various self-report measures and monitored headache activity four times per day over a 4-week period. Analyses revealed that smokers experienced greater weekly peak headache intensity, and reported higher levels of depression and general physical symptoms. Among smokers, nicotine content of the preferred brand was associated with mean headache index and weekly headache-free days, as well as depression and anxiety scores. Daily smoking rate and pack-year history were related to level of general physical symptoms only. Thus, both smoking status and the nicotine content of the preferred cigarette appear to adversely impact headache activity. Further, smokers who are more anxious or depressed may increase their headache activity via their preference for higher nicotine-content cigarettes. These results are discussed in the context of possible mechanisms underlying these effects, and implications for the clinical management of headache suffers who smoke.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1860793&dopt=Abstract headache medicine




Is caffeine withdrawal the mechanism of postoperative headache?

Fennelly M, Galletly DC, Purdie GI.

Department of Anaesthesia, Royal Postgraduate Medical School, Hammersmith Hospital, London, England.

This study examined the hypothesis that headache after general anesthesia is related to a caffeine withdrawal state. Two hundred eighty-seven patients undergoing minor elective procedures under general anesthesia were studied. Four to six hours after anesthesia each patient completed a questionnaire assessing his or her own alcohol, tobacco, and caffeine consumption, and the occurrence of postoperative side effects. A highly significant difference was found between the caffeine consumption of patients with and without preoperative (P = 0.0035) and postoperative (P less than 0.0001) headache. Logistic regression analysis of trend between headache and caffeine consumption suggested that with each 100-mg increase in caffeine consumption, there was a 12% increase in the odds of headache developing in the immediate preoperative period (P less than 0.0066) and a 16% increase in the odds of postoperative headache developing (P less than 0.0001). No relationship was found between headache and the patients' age, sex, usual frequency of headache, consumption of alcohol or nicotine, or the anesthetic agents or adjuvants used. It is concluded that postoperative headache is related to caffeine intake and that this relationship is explained, at least in part, by a perioperative caffeine withdrawal syndrome.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2006735&dopt=Abstract headache medicine




The relationship of cocaine to headache in polysubstance abusers.

Dhopesh V, Maany I, Herring C.

Inpatient Substance Abuse Treatment and Research Unit, Philadelphia Veterans Administration Medical Center, Pennsyvania 19104.

In a questionnaire survey of inpatient polysubstance abusers it was found that cocaine relieved migraine-type headaches much more often in chronic headache sufferers than in those with only occasional headaches (p less than .05). However, cocaine could also bring on headaches after several hours, both in chronic headache sufferers and in those not subject to headaches. The facts that cocaine may relieve headache immediately, and also may precipitate headaches several hours after use, suggests that the well-known vasoconstrictive actions of cocaine may be responsible. Migraineurs seem more susceptible to some of these effects of cocaine than are people without chronic headaches.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2016163&dopt=Abstract headache medicine