Effectiveness of a multidisciplinary treatment program for chronic daily headache.

Magnusson JE, Riess CM, Becker WJ.

Department of Clinical Neurosciences, University of Calgary and the Calgary Health Region, Calgary, Alberta, Canada.

BACKGROUND: Chronic daily headache (CDH: headache on fifteen days a month or more) is one of the most common forms of chronic pain. The relative efficacy of different treatment methods for these patients needs to be determined. OBJECTIVE: To compare treatment outcomes for patients with CDH treated in a traditional office-based pharmacological treatment program with a second group treated in a multidisciplinary management program. METHODS: Patient outcomes were measured using changes in the Headache Disability Inventory (HDI) and the Short-Form-36 (SF-36) over the treatment period. Outcomes from seventy patients treated in an office setting were compared to thirty-seven patients treated in a multidisciplinary headache treatment program. Both groups received similar pharmacological treatment. All patients treated in the office setting and the majority of patients in the multidisciplinary program had transformed migraine. RESULTS: Even though a reduction in headache days per month occurred, mean headache related disability (measured by HDI) and mean Health Related Quality of Life (HRQoL measured by SF-36) did not improve for the patient group treated in the office setting but did improve significantly for the patient group treated in the multidisciplinary headache program. CONCLUSION: For patients with CDH, headache-related disability and HRQoL is more likely to improve with management in a multidisciplinary headache treatment program as compared to the traditional specialist consultation-family physician office-based setting.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15038474&dopt=Abstract headache medicine




Background morbidity of headache in an adult general population. Results of the Austrian SERMO (Self-Reported Morbidity) study.

Rieder A, Lobentanz I, Zeitlhofer J, Mitsche N, Lawrence K, Schwarz B, Kunze M.

Institute of Social Medicine, Medical University of Vienna, Vienna, Austria. anita.rieder meduniwien.ac.at

STUDY OBJECTIVE: To assess period and point prevalence of headache in Austria and the influence of sociodemographic factors and seasonal variations. DESIGN: Data for the prevalence of headache were drawn from the database of seven representative surveys in the SERMO study (Self-Reported Morbidity Study). The aims of the SERMO study are to describe and monitor the characteristics of background morbidity in the Austrian population. The study is based on face-to-face interviews. Headache/migraine was one of 36 disorders the interviewed persons were asked about. SETTING: The representative samples of the Austrian general population were selected by the "quota-procedure". Thus each cross sectional sample is representative for the entire Austrian population. PARTICIPANTS: The study population consisted of 7,162 Austrian people over 15 years of age. RESULTS: About one fifth (20.1%) of the Austrian adult population reported having headaches during the year (prevalence 26.4% in women vs. 13.0% in men, p<0.001). Period prevalences varied from 19.6% in August to 23.1% in October 1995. Mean point prevalence in the general population was 5.7% (3.6% in men vs. 7.7% in women, p<0.001). The highest point prevalence (8.0%) was observed among people over 60. Whereas period prevalence showed no trend with age or education, we found increasing point prevalence with age and lower levels of education. In general, significantly more people with self-reported headache suffered from stress (39.1% vs. 33.7%, p<0.001) and chronic diseases (33.6% vs. 23.2%, p<0.001) and took drugs regularly (all kinds of medication: 44.3% vs. 26.8%, p<0.001). CONCLUSIONS: Headache is one of the most commonly experienced symptoms in Austria. The most common concomitant disease in the study population as a whole was hypertension. People with headache had a higher prevalence of hypertension, rheumatic diseases, venous diseases, diabetes and a higher consumption of drugs. Therefore, headache, as one aspect of multimorbidity or a symptom of other diseases, could be an indicator of impaired well-being and poor health.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15088992&dopt=Abstract headache medicine




Prevalence of headache in Swedish schoolchildren, with a focus on tension-type headache.

Laurell K, Larsson B, Eeg-Olofsson O.

Department of Neuroscience, Uppsala University, Sweden. Katarina.Laurell nc.uas.lul.se

To estimate the prevalence of tension-type headache, migraine and other headaches, 1850 schoolchildren, age 7-15 years, from the city of Uppsala, were invited to complete a questionnaire. The response rate was 74.1%. To validate the information from the questionnaires, 131 children and their parents were interviewed. Using the criteria of the International Headache Society, the 1-year prevalence of tension-type headache and migraine was 9.8 and 11.0%, respectively. However, these prevalence rates increased considerably, to 23.0 and 17.0%, respectively, when excluding the criteria defining the number of earlier episodes and duration of headache. The prevalence of headache increased with age, similarly in girls and boys up to 11 years, and thereafter only in girls. The preponderance in teenage girls was even more pronounced for tension-type headache than for migraine. Our results indicate an increase over time in headache prevalence when compared with findings in a study conducted in the same city in 1955.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15096227&dopt=Abstract headache medicine




Headache management--are we doing enough? An observational study of patients presenting with headache to the emergency department.

Locker T, Mason S, Rigby A.

Accident and Emergency Department, Northern General Hospital, Sheffield, UK. t.locker sheffield.ac.uk <t.locker sheffield.ac.uk>

OBJECTIVES: To identify the causes of acute headache presenting to the emergency department (ED), assess the adequacy of history, examination, and investigation, and determine which clinical features are predictive of secondary headache. METHOD: A retrospective study of alert (GCS>or=14) patients presenting with headache, to an ED over a one year period. Patients were followed up for three months. The adequacy of history, examination, and investigation were compared with published standards. Analysis using Bayes's theorem determined which clinical features were predictive of secondary headache. RESULTS: Headache in alert patients accounted for 0.5% (n = 353) of new patient episodes, 81.2% (n = 280) of patients had a primary headache disorder. One patient (0.3%) had an adequate history recorded. No patient had a complete examination recorded. Seventy seven (21.8%) patients underwent computed tomography of the head; 80.5% (n = 62) were normal. Lumbar puncture was performed in 23 (6.5%) cases; 18 (78.3%) were normal. A number of clinical features were found to be predictive of secondary headache. CONCLUSION: Headache is an uncommon symptom in alert patients presenting to the ED. The recorded history, examination, and subsequent investigation do not comply with published standards. A number of predictive features have been identified that may permit the development of a clinical prediction rule to improve the management of this patient group.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15107372&dopt=Abstract headache medicine




Sympathetic skin response in migraineurs and patients with medication overuse headache.

Atasoy HT, Atasoy N, Unal AE, Sumer M.

Zonguldak Karaelmas University, Faculty of Medicine, Department of Neurology, Turkey.

BACKGROUND: Autonomic dysfunction has been reported in patients with migraine, and it may play a role in promoting attacks. OBJECTIVE: To investigate changes in the autonomic function of migraineurs and patients with medication overuse headache via sympathetic skin response, and to determine whether psychiatric comorbidity is related to any changes recorded. METHODS: A consecutive series of patients with migraine (n = 45) and medication overuse headache (n = 53) were studied. Patients with other chronic diseases requiring medication were excluded. Sympathetic skin response latencies and amplitudes from the patients with headache (N = 98) and 40 healthy controls were compared statistically. RESULTS: Sympathetic skin response latencies in patients with medication overuse headache and in migraineurs were significantly longer than in controls. To analyze the effect of psychiatric comorbidity, patients with medication overuse headache and migraineurs were each divided into 2 groups: those with psychiatric comorbidity and those without comorbidity. When the sympathetic skin response results of these 4 groups were compared with controls, the only statistically significant difference was between the sympathetic skin response latencies of controls and the latencies of patients with psychiatric comorbidity. We could not find any difference between the results from patients without psychiatric comorbidity and those of controls. CONCLUSION: Psychiatric disease may affect the results of autonomic function testing in migraineurs and patients with medication overuse headache. Consideration should be given to excluding patients with psychiatric comorbidity from studies investigating autonomic dysfunction in patients with headache.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15109353&dopt=Abstract headache medicine




Migraine headache in patients with Tourette syndrome.

Kwak C, Vuong KD, Jankovic J.

Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, TX 77030, USA.

BACKGROUND: Tourette syndrome (TS) is recognized as one of the most common childhood movement disorders, characterized by motor and phonic tics often associated with neurobehavioral comorbidities, such as obsessive-compulsive disorder. Neurotransmitter dysregulation, particularly involving the serotonin system, has been implicated in the pathogenesis of TS, obsessive-compulsive disorder, and migraine headache. OBJECTIVES: To investigate the possible association between migraine headache and TS and to report preliminary findings of family history of migraine headache in patients with TS. METHODS: Subjects diagnosed as having TS at the Baylor College of Medicine Parkinson's Disease Center and Movement Disorders Clinic were administered a migraine headache questionnaire based on the migraine criteria established by the Headache Classification Committee of the International Headache Society. RESULTS: Of 100 patients with TS, 25 (25.0%) satisfied the diagnostic criteria for migraine headache, significantly greater than the estimated 10% to 13% in the general adult population (P<.001) and the estimated 2% to 10% in the general pediatric population (P<.04). There was no significant (P =.44) difference in the presence of comorbid obsessive-compulsive traits in the TS migraine and TS nonmigraine sample groups. Furthermore, our TS group with migraines was not more likely to have features of obsessive-compulsive disorder compared with attention-deficit/hyperactivity disorder. Of patients with TS, 56.0% reported a family history of migraines, 44.0% of whom were first-degree relatives. CONCLUSIONS: The frequency of migraine headache in a clinic sample of TS subjects was nearly 4-fold more than the frequency of migraines reported in the general population. Contrary to previous reports, the co-occurrence of migraines and TS in our sample group may possibly be attributed to another TS comorbidity, other than obsessive-compulsive traits.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14623732&dopt=Abstract headache medicine




Headaches and their relationship to sleep.

Biondi DM.

Headache Management and Pain Rehabilitation Programs, Spaulding Rehabilitation Hospital, Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA.

Despite the complex influences of normal sleep physiology and sleep disorders on the development or presentation of headache, it is important to recognize and understand these relationships. Successful outcomes depend on the provision of treatment interventions specifically directed toward each condition. Nocturnal or early morning headaches that are associated with OSA are often eradicated after the sleep disorder is successfully managed with CPAP, oral appliances, or surgery. Substantial improvement in headache can also result from the successful management of other sleep disorders that may incite headaches such as heavy snoring, PLMS, or the various forms of insomnia. To improve headache patterns associated with bruxism and TMD, it is often necessary to formulate a multidisciplinary treatment approach that combines oral appliance therapy, stress management, biofeedback, oromandibular physical therapy, and, at times, pharmacologic treatment (i.e., tricyclic antidepressant, intramuscular botulinum toxin injections). There are still many gaps in the understanding of the interrelationships of sleep physiology and headache pathophysiology. More well-designed clinical trials are needed so that enough data can be amassed for the formulation of evidence-based guidelines or consensus statements that can better delineate the identification, diagnostic evaluation, and treatment of sleep-related headache disorders and headaches that develop as a consequence of disordered sleep.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11699236&dopt=Abstract headache medicine




Calibration of an item pool for assessing the burden of headaches: an application of item response theory to the headache impact test (HIT).

Bjorner JB, Kosinski M, Ware JE Jr.

QualityMetric Incorporated, Lincoln, RI 02895, USA. jbjorner qualitymetric.com

BACKGROUND: Measurement of headache impact is important in clinical trials, case detection, and the clinical monitoring of patients. Computerized adaptive testing (CAT) of headache impact has potential advantages over traditional fixed-length tests in terms of precision, relevance, real-time quality control and flexibility. OBJECTIVE: To develop an item pool that can be used for a computerized adaptive test of headache impact. METHODS: We analyzed responses to four well-known tests of headache impact from a population-based sample of recent headache sufferers (n = 1016). We used confirmatory factor analysis for categorical data and analyses based on item response theory (IRT). RESULTS: In factor analyses, we found very high correlations between the factors hypothesized by the original test constructers, both within and between the original questionnaires. These results suggest that a single score of headache impact is sufficient. We established a pool of 47 items which fitted the generalized partial credit IRT model. By simulating a computerized adaptive health test we showed that an adaptive test of only five items had a very high concordance with the score based on all items and that different worst-case item selection scenarios did not lead to bias. CONCLUSION: We have established a headache impact item pool that can be used in CAT of headache impact.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14651412&dopt=Abstract headache medicine