Pathophysiology of headache associated with cough in patients with Chiari I malformation.

Sansur CA, Heiss JD, DeVroom HL, Eskioglu E, Ennis R, Oldfield EH.

Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892-1414, USA.

OBJECT: The aim of this study was to evaluate the pathophysiology underlying headache associated with cough in patients with Chiari I tonsillar abnormality. The authors hypothesized that peak intrathecal pressure during coughing is higher in patients with headache aggravated by cough than in patients without or in healthy volunteers. In addition, the authors evaluated the use of intrathecal pressure during cough as a means of assessing obstruction to the free flow of cerebrospinal fluid (CSF) at the craniocervical junction. METHODS: Twenty-six adult patients with Chiari I malformation and syringomyelia, four adult patients with Chiari I malformation without syringomyelia, and 15 healthy volunteers were prospectively studied. Testing before surgery included the following: 1) clinical evaluation for the presence of headache associated with cough; and 2) evaluation of lumbar subarachnoid pressure at rest, during three to five coughs, while performing the Valsalva maneuver, during jugular compression, and after removal of CSF. Patients underwent suboccipital craniectomy, C-1 laminectomy, and duraplasty. Testing was repeated 6 months after surgery. CONCLUSIONS: Peak intrathecal pressures during cough and at baseline were elevated in patients with headache associated with cough compared with either patients without headache or healthy volunteers. After surgery, intrathecal pressures during cough were significantly lower than preoperative values and headache aggravated by cough was resolved partially or completely. Headache linked to coughing in patients with Chiari I malformation is associated with sudden increased intrathecal pressure caused by obstruction to the free flow of CSF in the subarachnoid space.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12650413&dopt=Abstract headache medicine




Assessment of migraine disability using the migraine disability assessment (MIDAS) questionnaire: a comparison of chronic migraine with episodic migraine.

Bigal ME, Rapoport AM, Lipton RB, Tepper SJ, Sheftell FD.

Department of Neurology, Albert Einstein College of Medicine, Office 334-A, Rousso Building, 1165 Morris Park Avenue, Bronx, NY 10461, USA.

BACKGROUND: Chronic migraine is the most common type of chronic daily headache seen in headache tertiary care centers. Most patients with chronic migraine report their ability to function and feeling of well-being as severely impaired. OBJECTIVE: To measure the headache-related disability of patients with chronic migraine using the Migraine Disability Assessment (MIDAS) Questionnaire, comparing it with that obtained in a control group of patients with episodic migraine. METHODS: The clinical records of 703 patients with chronic daily headache treated in a headache specialty clinic were reviewed to identify 182 with chronic migraine who were evaluated using the MIDAS at their initial visit. Our control group consisted of 86 patients with episodic migraine. RESULTS: Of the 182 patients with chronic migraine, 127 (69.8%) were overusing acute-care medication. Patients were predominantly women (72.5%), with a mean age of 38.3 years. The group with episodic migraine consisted of 59 women (68.6%), with a mean age of 36.1 years. No statistically significant demographic differences were observed between the two groups. The group with chronic migraine had more total headache days over 3 months (66.7 versus 15.5, P<.001), missed more days of work or school (5.3 versus 2.3, P =.0007), had more reduced effectiveness days at work or school (11.9 versus 4.6, P =.0001), missed more days of housework (16.5 versus 3.3, P<.0001), and missed more days of family, social, or leisure activities (7.0 versus 5.5, P =.03). The group with chronic migraine was more likely to be in MIDAS grade IV (64.3% versus 43.2%, P =.001), reflecting the great likelihood of severe disability in this group. The average total MIDAS score was 34.9 in the group with chronic migraine versus 19.3 in the group with episodic migraine (P<.001). CONCLUSION: In subspecialty centers, patients with chronic migraine demonstrate remarkable impairment of their daily activities and are severely burdened by their headache syndrome, reflected by their high MIDAS scores. The chronicity and pervasiveness of migraine thus is associated with increased functional impairment as well as increase in headache frequency.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12656704&dopt=Abstract headache medicine




[Headaches in ophthamology]

[Article in French]

Kaimbo DK, Missotten L.

Service d'Ophtalmologie, Universite de Kinshasa, Republique Democratique du Congo. kaimbo raga.net

PURPOSE: To determine the frequency of ocular abnormalities in patients with headache seen for an ocular examination. METHODS: All 944 consecutive new patients with headache examined during a 3-year period (1984-1986) at the Department of Ophthalmology, University of Kinshasa, Democratic Republic of the Congo, were enrolled in this retrospective study. All patients received an ocular examination which included measurement of visual acuity, refraction, slit lamp examination, and fundoscopy. Other examinations such as measurement of intraocular pressure, neuro-ophthalmological examination, visual field and fluoangiography were performed when needed. RESULTS: The frequency of patients with headache examined during this period was 15.6% (944 out of 6,066 patients) or one patient out of 16 new patients. Their average age was 30+/-13.5 years. Females (60%) complained more frequently of headache than males (40%) (p<0.05). Migraine was found in 3.9% of patients. Ocular abnormalities were found in 505 (64%) patients and included refractive disorders (44%), lesions of the posterior segment (17%), abnormalities of the conjunctiva (12%), abnormalities of the anterior segment (12%), presbyopia (11%), and ocular motor palsies, heterophoria, convergence insufficiency and other ocular abnormalities (4%). Of 224 patients with ametropia, 154 (69%) were myopic with or without astigmatism. When specified, headache was most often fronto-occipital. Headache was most frequently associated with decreased vision, eye pain, epiphora, foreign body sensation, itching, and photophobia. CONCLUSION: Ocular examination could be necessary in cases of patients who complain of headache.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12660587&dopt=Abstract headache medicine




[Prevalence and semiologic aspects of the idiopathic stabbing headache in a migraine population]

[Article in Portuguese]

Piovesan EJ, Kowacs PA, Lange MC, Pacheco C, Piovesan LR, Werneck LC.

Unidade de Cefaleias, Servico de Neurologia, Departamento de Clinica Medica, Hospital de Clinicas, Universidade Federal do Parana. piovesan avalon.sul.com.br

Idiopathic stabbing headache is a quite unknown disorder. Its main features consist of brief stabbing pains, lasting few seconds. In most cases, idiopathic stabbing headache is underdiagnosed. We have followed up migraine patients during a period of 12 months, aiming to determine the prevalence and main features of idiopathic stabbing headache while occurring apart from migraine attacks. Two hundred and thirty-three of the 280 patients initially surveyed were included in the analysis of the results. Ninety-four patients presented idiopathic stabbing headaches (40.4%), being 72 of them females (76.5%). For migraine with idiopathic stabbing headaches, mean age, age of beginning of migraine and years with migraine were 33, 22.5 and 10.6 years, respectively. Mean duration of the idiopathic stabbing headaches was reported to be 1.42 seconds [ 1 second by 68 patients (72.4%), 2 seconds by 17 (18.1%), 3 seconds by 6 (6.3%), 4 seconds by 1 (1.05%) and 5 seconds by 2 (2.15%)]. Pain paroxysms were reported to be unilateral by 86 (91.4%) and bilateral by 8 (8.6%) of the cases. They were reported to be temporal by 56 patients (60%), occipital by 15 (15.6%), frontal by 8 (8.5%), temporo-occipital by 7 (7.4%), parietal by 5 (5.3%), fronto-temporal by 1 (1.06%), cervical by 1 (1.06%) and ocular by 1 patient (1.06%). The study confirms a high prevalence of idiopathic stabbing headaches in migraineurs. Its main clinical features could be well determined during the interval between migraine attacks.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11400025&dopt=Abstract headache medicine




Emotional and behavioural problems in children and adolescents with primary headache.

Just U, Oelkers R, Bender S, Parzer P, Ebinger F, Weisbrod M, Resch F.

Department of Child and Adolescent Psychiatry, University of Heidelberg, Heidelberg, Germany. Ulrike_Just med.uni-heidelberg.de

Psychiatric co-morbidity is an important risk factor for chronification of primary headache into adulthood. The aim of this study was to investigate the extent and clinical relevance of emotional and behavioural problems in children and adolescents with primary headache. Children and adolescents (n = 128) with primary headache (International Headache Society, codes 1.1, 1.2, 2.1) and 83 matched controls aged 6-18 years were examined by standardized dimensional psychometric tests (Child Behaviour Checklist, Depression Inventory for Children and Adolescents, Anxiety Questionnaire for Pupils). Children and adolescents with primary headache suffer more often from internalizing problems (depression, anxiety, somatization) than healthy controls. The detected emotional and behavioural problems are clinically relevant and require particular therapy in every third child suffering from headache. Two out of three children and adolescents with primary headache do not show clinically relevant psychopathology and may benefit from minimal therapeutic intervention. One of three examined headache patients needs additional psychiatric therapy.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12662188&dopt=Abstract headache medicine




[Characteristics of headache associated with cerebral arteriovenous malformations]

[Article in French]

Ghossoub M, Nataf F, Merienne L, Devaux B, Turak B, Roux FX.

Service de Neurochirurgie, Centre Hospitalier Sainte-Anne, 1, rue Cabanis, 75674 Paris Cedex 14.

BACKGROUND: and purposes. The purpose of this study was to identify the specific characteristics of headaches associated with cerebral arteriovenous malformations in order to differentiate them from other known entities of headaches such as migraine, cluster headache, and trigeminal neuralgia. This differentiation allows an early diagnosis of cAVM and a treatment to be administrated before any cerebral hemorrhage. PATIENTS AND METHODS: The study included 700 patients with cAVM and treated by radiosurgery. Out of this series, only 109 (48 males, 61 females, mean age of 33) presented with headaches. Headaches were studied as a possible revelation mode of a cAVM, either as an isolated sign, preceding an epileptic seizure, a cerebral hemorrhage, or associated with a neurological deficit. Analysis concerned 13 clinical parameters and 30 anatomic parameters based on angiography. RESULTS: Headaches were found in 15.6%; they were isolated in 6%. They preceded a cerebral hemorrhage in 12.6%, constituting an early alarm signal when increasing in intensity, frequency and duration. They were associated with seizures or a neurological deficit in 9.6%. We found a predominant female sex-ratio (0.78) and occurrence at a young age (72.3% between 10 and 40 years). Headaches were non-pulsating in 95.3%; nausea, vomiting, light or sound phobia were only found in 4.7%. Headaches were unilateral and homolateral to the malformation in 80%, corresponding to the malformation topography in 97.4% in posterior location and 80% in anterior location. Associated neurological symptoms existed in 20.2%; related to the malformation and lasting 5 to 30 minutes. Duration of pain episodes was less than 3 hours in 77% with a frequency of 1 to 2 per month in 82.5%. Pain was mild and responded to simple analgesics. A family migraine was found in only 3 patients. The angiographic characteristics of the malformations were meningeal afferences, superficial venous drainage and posterior location. CONCLUSIONS: Headaches associated with cerebral arterio-venous malformations form a distinct category that can be determined from specific characteristics; this should help an early diagnosis of cerebral arterio-venous malformations in order to start a treatment before the occurrence of cerebral hemorrhage.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11404693&dopt=Abstract headache medicine




Epidemiology of headache in Hong Kong primary-level schoolchildren: questionnaire study.

Kong CK, Cheng WW, Wong LY.

Department of Paediatrics, Caritas Medical Centre, 111 Wing Hong Street, Shamshuipo, Hong Kong.

OBJECTIVE: To collect and analyse epidemiological data on childhood headache in the Hong Kong community. DESIGN: Questionnaire study. SETTING: Three primary schools, Hong Kong. PARTICIPANTS: Two thousand, one hundred and twenty pupils from 2156 replied to the questionnaire survey. One hundred and twenty-four pupils who were identified to have suspected recurrent headache were invited to a follow-up medical consultation. MAIN OUTCOME MEASURES: Age-groups and prevalence of tension-type and migraine headache, using the diagnostic criteria of the International Headache Society. RESULTS: The overall prevalence of headache in the 2120 respondents was 2.8%. The prevalence of tension-type headache, migraine, probable migraine, and unclassified headache were 1.2%, 0.5%, 0.7%, and 0.5%, respectively. The age-specific prevalence of headache from the age of 6 to 13 years showed a steadily increasing trend from childhood to the early teens. CONCLUSION: Headache is a common complaint for children, although it may be underrecognised. Further study will be beneficial for providing better management of headache in this population.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11406673&dopt=Abstract headache medicine




Headache and the risk of stroke: a prospective observational cohort study among 35,056 Finnish men and women.

Jousilahti P, Tuomilehto J, Rastenyte D, Vartiainen E.

Department of Public Health, University of Helsinki, and the National Public Health Institute, Mannerheimintie 166, FIN-00300 Helsinki, Finland. pekka.jousilahti ktl.fi

BACKGROUND: Previous studies have shown an increased risk of stroke among patients with migraine. However, very few data are available on the possible association between chronic unspecified headache and the risk of stroke. METHODS: A prospective cohort study including 35,056 randomly selected Finnish men and women aged 25 to 64 years at baseline who participated in a cardiovascular risk factor survey in 1972, 1977, 1982, or 1987. Self-reported headache, smoking, diabetes, blood pressure, weight, height, serum cholesterol level, and oral contraceptive use were recorded at baseline. During the follow-up, 2167 incident stroke events were ascertained with computer-based record linkage. RESULTS: Women reported headache twice as often as men (16.7% vs 8.9%). Among men, the headache-associated hazard ratios (95% confidence intervals) for stroke were 4.08 (2.10-7.93), 1.86 (1.33-2.59), and 1.24 (1.05-1.47) during 1, 5, and a maximum of 23 years of follow-up, respectively. Adjustment for the other risk factors decreased the hazard ratios only slightly. Among women, there was also a direct but statistically nonsignificant association between headache and the risk of stroke. CONCLUSIONS: Chronic headache is an independent predictor of stroke among men. Since the association between headache and the risk of stroke was particularly strong during a short follow-up, chronic headache may be a marker of the underlying disease process leading to acute stroke. The sex difference observed in this association may be due to a higher prevalence and a more heterogeneous etiology of headache in women compared with men.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12742803&dopt=Abstract headache medicine