Pupil diameter in migraine and tension headache.

Drummond PD.

Pupil diameter was measured in darkness and in dull and bright illumination in 39 migrainous patients and in 15 tension headache sufferers during headache. In 21 migrainous patients, measurements were repeated during the headache-free interval. Mean pupil diameter was smaller in patients with common migraine at the time of examination than in 20 nonheadache control subjects, and smaller on the symptomatic side in migrainous patients with unilateral headache. During the headache-free interval mean pupil diameter did not differ from values in non-headache controls. These findings suggest that migraine is associated with a sympathetic pupillary deficit which is greater on the habitually-affected side.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3572438&dopt=Abstract headache medicine




Headache in cerebrovascular disease. A common symptom of stroke.

Edmeads J.

Headache is a common affliction of humanity. The physician evaluating a patient who happens to have a history of headaches may naturally consider them as part of the disease when formulating a diagnosis, thus attributing undue significance to ordinary functional headaches. This may account for the myths that unruptured aneurysms or arteriovenous malformations cause headache and that migraine can eventually lead to stroke. Sometimes, however, headaches do warn of cerebrovascular disease or occur as part of that disease. The presence of headache may aid in or hinder diagnosis. Clues that a headache may indicate cerebrovascular disease are onset after the age of 35; pain described as "the worst headache ever"; persistent localization and progressive worsening of pain; and risk factors for cerebrovascular disease, such as advancing age, hypertension, bruits, and heart disease.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3588461&dopt=Abstract headache medicine




Cervical spondylosis and headaches.

Iansek R, Heywood J, Karnaghan J, Balla JI.

Department of Neurology, Prince Henry's Hospital, Melbourne, Victoria.

The incidence of headaches in well documented cases of cervical spondylosis with neurological disability was reviewed. This was compared to that in a series of cases with a clinical diagnosis of tension headache in order to determine if there were any identifiable differences between the two types of headache. Fifty-nine cases of cervical spondylosis were reviewed. Five of these patients had headaches. Fifty patients with tension headaches were also reviewed. No differences were seen when location or other qualitative features of the headaches were compared between the two groups of patients. We conclude that the incidence of headache is low in cervical spondylosis and that the pattern of headache has no features that distinguish it from that of tension headache, suggesting that the pathogenesis is similar. We therefore suggest that the basis of headache in patients with cervical spondylosis is secondary muscle contraction.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3665165&dopt=Abstract headache medicine




Whiplash headache.

Balla J, Karnaghan J.

Department of Neurology, Prince Henry's Hospital, Melbourne, Victoria.

This study considers the natural history and characteristics of headache occurring after whiplash injuries. Previous descriptions generally failed to distinguish between the headaches seen at various stages after the injury. In a prospective study of 180 cases of acute whiplash injury, it was demonstrated that 82% suffered from headache. One hundred and twenty-two cases were analysed to describe the type of headache seen and it was shown that in the majority rapid improvement occurred over a matter of some weeks. In a retrospective analysis of over 5000 cases of whiplash injury, about 25% developed chronic disability. Practically all of these had headaches. A retrospective analysis of 100 cases describes a spectrum of headaches different from those seen after the acute illness. The pathogenesis of the two types of headache is likely to be different and this needs to be investigated before rational treatment can be instituted.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3665166&dopt=Abstract headache medicine




Headache and dysfunction of the masticatory system in adolescents.

Wanman A, Agerberg G.

An epidemiologic group of 285 17-year-old adolescents was studied with the aid of a questionnaire for frequency and intensity of headache and for symptoms of dysfunction of the masticatory system. They were also subjected to a functional examination of the masticatory system. Recurrent headaches occurred significantly more often among the girls (18%) than the boys (6%). Girls also reported significantly more intense headaches than boys. Fatigue in the jaws and difficulties in chewing were commoner in those with frequent and more intensive headaches. Tenderness to palpation of the masticatory muscles and impaired mandibular mobility were significantly commoner findings among those with recurrent headaches and those with more intense headaches. Tooth-grinding and clenching were related to frequency but not to intensity of headache. The investigation showed a significant relationship between frequency and intensity of headaches and signs and symptoms of dysfunction of the masticatory system.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3802191&dopt=Abstract headache medicine




The headache of temporal arteritis.

Solomon S, Cappa KG.

Patients with temporal arteritis may be misdiagnosed because the headache does not affect the temples. The records of 24 patients with biopsy proven temporal arteritis were reviewed to determine the site and other qualities of headache. Past reports of the sites of headache in this disease were also reviewed. The temporal area was the sole site of headache in only six of 24 patients; the temple was included in pain that affected the frontal, vertex, and occipital areas in another seven patients. Two patients had generalized headaches. The headache did not involve the temple in seven patients and two patients did not experience headaches. Temporal arteritis should be considered in every elderly individual who begins to complain of headache, no matter what the site, quality, severity, or time pattern.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3805561&dopt=Abstract headache medicine




Chronic daily headache with analgesic overuse: epidemiology and impact on quality of life.

Colas R, Munoz P, Temprano R, Gomez C, Pascual J.

Health Center of Santona, University Hospital Marques de Valdecilla (UC), Cantabria, Spain.

OBJECTIVE: To analyze the prevalence and demography of chronic daily headache (CDH) with analgesic overuse. METHODS: A population of 9,984 inhabitants aged 14 or older living in Santona, Spain, was studied. The authors personally interviewed 4,855 subjects, using a quota sampling approach. Those with headache for > or = 10 days/month and some analgesic use were asked to fill in a diary over the course of 1 month. Then, subjects were classified into CDH with or without analgesic overuse subtypes. Quality of life (Short Form-36 Health Survey [SF-36]) was also assessed in this second interview. RESULTS: Headache for > or = 10 days/month with analgesic consumption was reported by 332 subjects. Seven had secondary headache. Seventy-four (standardized prevalence 1.41%, 95% CI 1.1 to 1.8) fulfilled criteria for CDH with analgesic overuse. Prevalence in women (2.6%, 2.0 to 3.3) was much higher than in men (0.19%, 0.006 to 0.52). Mean age was 56 years (range 19 to 82 years). As recalled by the subjects, the mean age at onset of CDH was 38 years (range 9 to 82 years), whereas the mean age at onset of CDH with frequent analgesic consumption was 45 years (range 19 to 80 years) and that of primary headache was 22 years (range 5 to 60 years). CDH subjects showed a significant decrease in each SF-36 health-related score as compared with healthy control subjects. Transformed migraine was diagnosed in 49 (prevalence 0.9%), chronic tension-type headache in 20 (0.4%), and new daily persistent headache in 5 (0.1%). Thirty-five percent of patients overused simple analgesics, 22% ergotics, 12.5% opioids, and 2.7% triptans; the remaining 27.8% were overusing different combinations. CONCLUSION: CDH with analgesic overuse is a common disorder in the general population, mainly in women in their fifties, in whom 5% meet its diagnostic criteria.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15111671&dopt=Abstract headache medicine




Analgesic overuse among subjects with headache, neck, and low-back pain.

Zwart JA, Dyb G, Hagen K, Svebak S, Stovner LJ, Holmen J.

Department of Clinical Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. john-anker.zwart medisin.ntnu.no

OBJECTIVES: To examine the prevalence of chronic headache (> or =15 days/month) associated with analgesic overuse in relation to age and gender and the association between analgesic overuse and chronic pain (i.e., migraine, nonmigrainous headache, neck and low-back pain). METHODS: In the Nord-Trondelag Health Study 1995 to 1997 (HUNT-2), a total of 51,383 subjects responded to headache questions (Head-HUNT), of which 51,050 completed questions related to musculoskeletal symptoms and 49,064 questions regarding the use of analgesics. RESULTS: The prevalence of chronic headache associated with analgesic use daily or almost daily for > or =1 month was 1% (1.3% for women and 0.7% for men) and for analgesic overuse duration of > or =3 months 0.9% (1.2% for women and 0.6% for men). Chronic headache was more than seven times more likely among those with analgesic overuse (> or =1 month) than those without (odds ratio [OR] = 7.5, 95% CI: 6.6 to 8.5). Upon analysis of the different chronic pain subgroups separately, the association with analgesic overuse was strongest for chronic migraine (OR = 10.3, 95% CI: 8.1 to 13.0), intermediate for chronic nonmigrainous headache (OR = 6.2, 95% CI: 5.3 to 7.2), and weakest for chronic neck (OR = 2.6, 95% CI: 2.3 to 2.9) and chronic low-back (OR = 3.0, 95% CI: 2.7 to 3.3) pain. The association became stronger with increasing duration of analgesic use for all groups and was most evident among those with headache, especially those with migraine. CONCLUSIONS: Chronic headache associated with analgesic overuse is prevalent and especially chronic migraine is more strongly associated with frequent intake of analgesics than other common pain conditions like chronic neck and chronic low-back pain.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15136678&dopt=Abstract headache medicine