Crying as a precipitating factor for migraine and tension-type headache.

Fragoso YD, Carvalho R, Ferrero F, Lourenco DM, Paulino ER.

Departamento de Neurologia, Universidade Metropolitana de Santos Avenida Epitacio Pessoa, 555-Apto. 91 Santos/SP, Brasil-CEP 11030-601. yara bsnet.com.br

CONTEXT: Scarcely reported in the literature, crying seems to be an important precipitating factor for both migraine and tension-type headache in daily practice. OBJECTIVE: To evaluate the role of crying as a precipitating factor for migraine and tension-type headache. TYPE OF STUDY: Prospective evaluation. PARTICIPANTS: 163 workers or students from the Universidade Metropolitana de Santos, who presented at least one attack a month, for at least one year, of either migraine or tension-type headache. PROCEDURES: Interview by means of questionnaires and personal evaluations. Details of precipitating factors for the attacks were assessed. RESULTS: From the total group of 163 individuals, 90 (55.2%) considered crying to be a potential factor for triggering headache attacks. Of this group of 90 persons, 62 presented migraine (6 males, 56 females) and 28 presented tension-type headache (5 males, 23 females). Only stress, anxiety and menstrual periods rated higher or equal to crying as triggering factors for both types of headache. CONCLUSIONS: The physiology of crying is not well documented or understood. The act of crying seems to be an important precipitating factor for primary headaches and it should be studied further. The authors welcome comments on the matter and would like to work in collaboration with other groups interested in this subject.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12751342&dopt=Abstract headache medicine




Naratriptan in the preventive treatment of refractory chronic migraine: a review of 27 cases.

Rapoport AM, Bigal ME, Volcy M, Sheftell FD, Feleppa M, Tepper SJ.

Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA.

OBJECTIVE: To review the efficacy of naratriptan as preventive treatment in 27 patients with chronic migraine refractory to other commonly used preventive therapies. BACKGROUND: The treatment of chronic migraine often poses a major challenge to the clinician. Even when given expert care, patients with chronic migraine may continue to have daily or near-daily headaches. METHODS: Clinical records and headache calendars were reviewed of 27 patients fulfilling the following inclusion criteria: (1) aged 18 to 65 years; (2) diagnosis of chronic migraine (formerly transformed migraine), according to the criteria proposed by Silberstein et al; (3) previous failure of at least 4 preventive medications prescribed as part of a management program that included nonpharmacological measures, preventive medication, acute care medication, and detoxification from overused medication; and (4) have used daily naratriptan for no less than 2 consecutive months. The dose of naratriptan prescribed was 2.5 mg twice daily. We considered the following outcomes: (1) frequency of headache, (2) intensity of pain, (3) number of days per month with severe headache, (4) headache index (frequency times intensity), and (5) proportion of patients who reverted to an episodic pattern of pain after 6 months of treatment. RESULTS: There was a statistically significant reduction in the frequency of headache days 2 months (15.3 days versus 24.1 days at baseline, P<.001), 6 months (9.1 days, P<.001), and 1 year (7.3 days, P<.001) after daily treatment with naratriptan was initiated. There was also a statistically significant reduction in the number of days per month of severe pain at 1 month (5.6 days versus 12.5 days at baseline, P<.01), 2 months (5.7 days, P<.01), 6 months (2.8 days, P<.01), and 1 year (2.6 days, P<.01). Similarly, there was a statistically significant reduction in the headache index at 2 months (33 versus 56.4 at baseline, P<.001), 6 months (19.5, P<.001), and 1 year (17.2, P<.001). Of the 20 patients who continued to use naratriptan daily for at least 6 months, 13 (65%) reverted to an episodic pattern of pain (migraine). At 1 year, 11 (55%) still continued to experience episodic headache, 1 (5%) relapsed to chronic migraine, and 2 (10%) were lost to follow-up. No patients had intolerability to naratriptan during the treatment period, and no one stopped treatment due to adverse events. CONCLUSIONS: Naratriptan may have a role in the preventive treatment of intractable chronic migraine. Prospective, controlled studies should be considered.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12752754&dopt=Abstract headache medicine




Headache and the lower cervical spine: long-term, postoperative follow-up after decompressive neck surgery.

Torbjorn AF, Stolt-Nielsen A, Skaanes KO, Sjaastad O.

Department of Neurosurgery, University of Trondheim Hospital, Norway. berit.mjoen medisin.ntnu.no

A retrospective search for headache sufferers was conducted among patients operated on for cervicobrachialgia, and the operative results were evaluated. We also tried to classify the preoperative headache according to current headache classification systems. A total of 187 patients were operated on with Smith-Robinson's method, or by "simple" foraminectomy/ facetectomy. Headache was present in 23, and 17 of these could be followed up for an average post-operative observation period of 8.5 years. The operation seemed to result in headache improvement in 15 patients, i.e., excellent in 7; good in 2; moderate in 6; in other words: "excellent"/"good" in 53%. Improvement of neck pain was found in 15 patients (excellent in 5; good in 4; moderate in 6). The headache characteristics were generally compatible with the criteria for cervicogenic headache (CEH) (1990 version). CEH can probably stem from a pathology in the lower cervical spine. This should probably be taken into account when evaluating the individual patient with symptoms reminiscent of CEH. This headache may benefit from operations directed towards the cervical spine.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12760410&dopt=Abstract headache medicine




[Differential diagnosis and therapy of headache in general practice. Anamnesis is the alpha and omega]

[Article in German]

Neu IS.

Neurologische Abteilung des Stadtischen Krankenhauses Sindelfingen, Akademisches Lehrkrankenhaus der Universitat Tubingen.

Headache is one of the most common reasons for a patient to consult the doctor. Of prime importance are the correct differential diagnosis and effective treatment. A differentiation is made between primary and secondary headache. In the international classification, the primary headache syndromes include migraine with and without an aura, tension type headache, headache associated with misuse of analgesics, cluster headache, and a number of rare forms of headache with no structural lesion. The secondary headache syndromes occur symptomatically as sequelae of underlying disease, the spectrum of causes covering more than 300 different disorders. In patients with headache of unclear genesis, careful history-taking and thorough physical examination should be followed by a further diagnostic work-up.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11434255&dopt=Abstract headache medicine




Headache in the emergency department.

Morgenstern LB, Huber JC, Luna-Gonzales H, Saldin KR, Grotta JC, Shaw SG, Knudson L, Frankowski RF.

Department of Neurology, University of Texas Medical School, Houston 77030, USA.

OBJECTIVE: To perform an observational study of the demographics, clinical factors, and therapeutic efficacy in patients presenting to the emergency department with a chief complaint of headache. BACKGROUND: Acute headache presentations to the emergency department are a therapeutic dilemma for physicians. METHODS: Patients presenting with nontraumatic headache to the emergency department of Hermann Hospital in Houston, Texas, during a 16-month period were prospectively ascertained by active and passive surveillance. The medical record was abstracted. Demographic and clinical information are presented with descriptive statistics. Relative benefit of individual therapies are compared with odds ratios (95% confidence intervals). RESULTS: Of the 38 730 patients who were prospectively screened, 455 presented with a chief complaint of headache. Seventy-six percent were women, and the mean age was 37 years. Non-Hispanic whites were more likely diagnosed with migraine compared with Hispanics or African Americans (P<.001). Three percent had subarachnoid hemorrhage. Neurologist follow-up was ordered in 10%. The median time in the emergency department was 265 minutes. With the initial treatment, 44% resolved, 47% improved, and 9% had no change; none worsened. In comparison with all other therapies used, there was a trend suggesting the superiority of antiemetics (odds ratio, 2.66; 95% confidence interval, 0.81 to 8.61). Acetaminophen was less helpful (odds ratio, 0.27; 95% confidence interval, 0.10 to 0.70). When comparing specific agents to therapies which could be used at home, antiemetics led to headache resolution most often (odds ratio, 3.18; 95% confidence interval, 1.40 to 7.22); ketorolac showed a similar trend (odds ratio, 2.05; 95% confidence interval, 0.86 to 4.89). CONCLUSIONS: Headache in the emergency department is a phenomena of young women who spend a long time waiting and receive many tests. A variety of therapies are used. Antiemetics may be especially useful for headache resolution.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11437887&dopt=Abstract headache medicine




Behavioral response to headache: a comparison between migraine and tension-type headache.

Martins IP, Parreira E.

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

OBJECTIVE: To compare patients with migraine and tension-type headache in their behavior during the attacks and the maneuvers used to relieve the pain. BACKGROUND: Patients with headache often perform nonpharmacological measures to relieve the pain, but it is not known if these behaviors vary with the diagnosis, clinical features, and pathogenesis. METHODS: One hundred consecutive patients with either migraine (n = 72 ) or tension-type headache (n = 28) were questioned (including the use of a checklist) concerning their usual behavior during the attacks and nonpharmacological maneuvers performed to relieve the pain. The results of the two types of headache were compared. RESULTS: Patients with migraine tended to perform more maneuvers than individuals with tension-type headache (mean, 6.2 versus 3). These maneuvers included pressing and applying cold stimuli to the painful site, trying to sleep, changing posture, sitting or reclining in bed (using more pillows than usual to lay down), isolating themselves, using symptomatic medication, inducing vomiting, changing diet, and becoming immobile during the attacks. The only measure predominantly reported by patients with tension-type headache was scalp massage. However, the benefit derived from these measures was not significantly different between the two groups (except for a significantly better response to isolation, local pressure, local cold stimulation, and symptomatic medication in migraineurs). CONCLUSIONS: The behavior of patients during headache attacks varies with the diagnosis. Measures that do not always result in pain relief are performed to prevent its worsening or to improve associated symptoms. These behavioral differences may be due to the different pathogenesis of the attacks or to different styles of dealing with the pain. They can also aid the differential diagnosis between headaches in doubtful cases.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11437889&dopt=Abstract headache medicine




Determination of manipulative physiotherapy treatment outcome in headache patients.

Niere K, Robinson P.

School of Physiotherapy, La Trobe University, Carlton, Victoria, Australia

SUMMARY. Although physiotherapists are frequently involved in the treatment of headache when cervical spine dysfunction is thought to be a cause or contributing factor there does not appear to be a consistent definition of treatment success. This study analysed treatment outcome in a population of 112 headache patients presenting for manipulative physiotherapy. Two months after the initial consultation, statistically significant improvements were observed in mean scores for each of headache frequency (P < 0.001), duration (P < 0.05) and intensity (P < 0.001). When a combination of patient estimate of treatment effect and a headache index incorporating scores for frequency, intensity and duration was used to classify treatment outcome, 51 of the 91 subjects analysed at follow-up were deemed to have had a positive response to treatment. This method of classification of treatment outcome appeared to be sensitive to cases where the patient's headaches were improved by factors other than the physiotherapy treatment. However the classification used was less sensitive when the patient's headaches were aggravated by other factors or where there was not consistent improvement or deterioration in the measures of headache frequency, intensity and duration. Copyright 1997 Harcourt Publishers Ltd.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11440533&dopt=Abstract headache medicine




Prevalence and characteristics of headache in Dutch schoolchildren.

Bandell-Hoekstra IE, Abu-Saad HH, Passchier J, Frederiks CM, Feron FJ, Knipschild P.

Department of Health Care Sciences, Maastricht University, Centre for Nursing Research, The Netherlands. i.bandell zw.unimaas.nl

The aim of this study was to determine whether there has been an increase in headache prevalence in Dutch children and to compare headache characteristics of children with low, medium and high headache severity.A sample of 2358 schoolchildren between the ages of 10 and 17 years filled out Waters' Headache Questionnaire and the Paediatric Pain Assessment Tool. Results showed that 21% of the boys and 26% of the girls at elementary school, and 14% of the boys and 28% of the girls at high school reported weekly headaches. When compared to figures from a previous study in the Netherlands published in 1985, the prevalence of weekly headaches in 10-17-year-olds has increased by 6%. In boys at elementary school, the prevalence of headaches with a frequency of a few times a week has doubled.Children with low, medium and high headache severity differed with respect to all headache characteristics, i.e. pain quality, accompanying symptoms, warning signals, location, onset, impact of headache, family occurrence, perceived cause, medical consultation, and school absence. Copyright 2001 European Federation of Chapters of the International Association for the study of pain.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11465980&dopt=Abstract headache medicine