Chronic Daily Headache in Children and Adolescents: A 2-Year Prospective Study

Chronic daily headache in children and adolescents has not been well described. We analyzed data for 37 children and adolescents who presented with chronic daily headache to our Pediatric Headache Clinic over a 2-year period. These youngsters had five distinct headache patterns; 40% of them had the "comorbid" pattern, 35% were classified with new daily persistent headache, 15% with transformed migraine, 5% with chronic tension-type headache, and 5% could not be classified.
There were no significant differences by diagnosis in externalizing and internalizing behaviors, type A behaviors, disability, pain severity, days missed from school, and number of coping skills employed.
Children and adolescents with chronic daily headache have distinct clinical patterns, but for the most part, have similar disability. Differences between adult and childhood chronic daily headache are emphasized.     

The Assessment of Dispositional Vigilance and Cognitive Avoidance: Factorial Structure, Psychometric Properties, and Validity of the Mainz Coping Inventory

This article reports the construction and empirical evaluation of the English adaptation of the Mainz Coping Inventory (MCI). The MCI, which is based on the model of coping modes (Krohne, 1993), is organized as a stimulus–response inventory and contains two subtests. Eight fictitious situations are presented to the participants. Four of these situations represent physical threat (subtest MCI-P) and four ego threat (subtest MCI-E). Each situation is conjoined with five vigilant and five cognitive avoidant coping strategies, thus allowing the separate assessment of the coping dispositions of vigilance and cognitive avoidance. Analyses concerning appraisals of the threat situations, factorial structure, and psychometric properties of the MCI as well as convergent and discriminant associations with coping and affect variables are presented. Results of the analyses indicate that the MCI is a reliable and valid measure of two central coping dimensions.     

Subjective Stress and Coping in Recurrent Tension-Type Headache

Subjects with tension-type headache and headache-free control subjects completed two mental stressor tasks, solving anagrams and mental arithmetic. During the experimental session, measures of heart rate, muscle tension, and subjective stress ratings were recorded. In addition, all subjects completed a week-long series of questionnaires which monitored headache activity in addition to frequency and intensity of stressful life events. Recurrent tension headache sufferers were found to have higher levels of depression and trait anxiety. Headache and control subjects were not found to respond differently to stressors presented in the laboratory based on measures of EMG, heart rate, or subjective stress ratings, nor were there differences in reports of coping. However, diary questionnaires revealed that headache subjects experienced stressful events more frequently than headache-free controls. Headache subjects also rated these events as causing more stress.     

Chronic Daily Headache in Children and Adolescents

SYNOPSIS
Recurrent headache is a relatively frequent problem in children and adolescents, with the majority of the research attention focused on pediatric migraine. This study assessed differences in consequences to headaches, coping with headaches, and associated disability in children and adolescents attending a headache clinic who were diagnosed with migraine, chronic daily headache, or carried both diagnoses. Results, generally indicated higher levels of impairment for patient's with chronic daily headaches. These patients were also more likely to use blaming others and wishful thinking as coping mechanisms. Gender and racial status interacted with headache diagnosis to predict parent response patterns and disability outcomes. The results provide initial support for the applicability of Martin's functional model of chronic headaches to a pediatric population.     

Migraine and Stress: A Daily Examination of Temporal Relationships in Women Migraineurs

This study examined daily temporal relationships between stress, cognitive appraisal, coping, and migraine in a group of young women migraineurs sampled from a general population. Participants (N=20) meeting International Headache Society 1 criteria for migraine with or migraine without aura provided headache activity, perceived stress, cognitive appraisal, and coping strategy data across 2 months of data collection. A time-series analytic approach was used to cross-correlate daily stress, appraisal, and coping data with daily headache data controlling for factors that can inflate correlations in data collected across time. Analyses revealed that between 50% and 70% of subjects showed significant, substantial, and meaningful temporal correlations between their daily stress and their daily migraine activity. Furthermore, these data support the hypothesis that stress and migraine are reciprocally related (ie, cyclically influencing each other across time). In addition, despite some measurement concerns, our data suggest that cognitive appraisal and coping are also related to migraine activity in a reciprocal fashion.     

Cognitive factors and persistent pain: A glimpse into pandora's box

Conventional models of persistent pain have tended to be dichotomous in nature, with pain viewed as either physically or psychologically based. Inadequacies inherent in both of these views have resulted in alterative conceptualizations that focus on the integration of biomedical with cognitive, affective, and behavioral factors. During the past decade there has been a proliferation of research designed to examine the relative contributions of individuals' attitudes, beliefs, appraisals, self-perceptions, and coping strategies to the perception, experience, and response to noxious sensations as well as treatment, and how these are modified as a result of treatment. In this paper a cognitive—behavioral conceptualization of persistent pain is described and contrasted with sensory, psychogenic, motivational, and operant conditioning models. A number of cognitive assessment procedures and recent research on the role of cognitive schemata, cognitive processes, and ongoing cognition in chronic pain are briefly summarized. The central importance of negative cognition — catastrophizing — is emphasized. Once pandora's cognitive box has been opened, a range of important issues must be addressed or one may be consumed by unbridled enthusiasm for the development of instruments and correlational research. Several caveats regarding current research on cognitive mediators are raised, namely, confounds among the cognitive measures that have proliferated and between cognitive measures and measures of mood states, generalizability of results based on pain clinic samples, and adherence to patient uniformity myths.Preparation of this paper was supported in part by grant 2R01AR38698 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, and grant 2R01DE07514 from the National Institute of Dental Research.     

Efficacy and tolerability of almotriptan in adolescents: a randomized, double-blind, placebo-controlled trial

Objectives.— To assess the efficacy and safety of almotriptan 6.25 mg, 12.5 mg, and 25 mg vs placebo for acute migraine treatment in adolescents. Patients and Methods.— In this double‐blind, placebo‐controlled, parallel‐group, multicenter trial, 866 patients aged 12 to 17 years with a >1 year history of migraine (per International Headache Society criteria) were randomized to treat one migraine headache with almotriptan 6.25 mg, 12.5 mg, 25 mg, or placebo. The primary efficacy endpoint was headache pain relief 2 hours after dosing, adjusted for baseline severity, with absence of nausea, photophobia, and phonophobia 2 hours after dosing as coprimary endpoints. Results.— The 2‐hour pain‐relief rate was significantly higher with almotriptan 25 mg compared with placebo (66.7% vs 55.3%; P = .022). The incidence of nausea, photophobia, and phonophobia at 2 hours (adjusted for baseline pain intensity) for the almotriptan 25 mg and placebo groups was not significantly different. The 2‐hour pain‐relief rates (unadjusted) were significantly higher with almotriptan 6.25 mg (71.8%), 12.5 mg (72.9%), and 25 mg (66.7%) than with placebo (55.3%; P = .001, P < .001, and P = .028, respectively). Rates for sustained pain relief also were significantly greater with almotriptan 6.25 mg (67.2%), 12.5 mg (66.9%), and 25 mg (64.5%) than with placebo group (52.4%), P < .01 for the 6.25‐ and 12.5‐mg doses and P < .05 for the 25‐mg dose. Age group subanalysis demonstrated significantly greater 2‐hour pain‐relief rates with all 3 doses of almotriptan compared with placebo for patients aged 15 to 17 years, a significantly lower incidence of photophobia and phonophobia at 2 hours with almotriptan 12.5 mg compared with placebo for patients aged 15 to 17 years, and a significantly lower incidence of photophobia with almotriptan 12.5 mg compared with placebo for those aged 12 to 14 years. Almotriptan treatment was well tolerated, with the most common adverse events (>2%) of nausea, dizziness, and somnolence. Conclusions.— Oral almotriptan was efficacious for relieving migraine headache pain in adolescents, with the 12.5‐mg dose associated with the most favorable efficacy profile with respect to relieving headache pain and associated symptoms of migraine (photophobia and phonophobia). Almotriptan treatment was well tolerated in this adolescent population.     

Chronic Daily Headache in Children and Adolescents:Current Status and Recommendations for the Future

The Pediatric Committee of the American Association for the Study of Headache was created in 1994 to develop a plan for comprehensively addressing global issues of headache in childhood. It was the impression of clinicians and researchers with an interest in childhood headaches that a clearer focus was needed to facilitate progress in the study and management of pediatric headache. It was further felt that approaches to treatment and outcomes, as well as assessment and classification schema for pediatric patients needed to be examined separately. The goal of the committee is to integrate anecdotal, clinical, and research expertise into a plan for addressing headaches in the pediatric population in the future. During the last 5 years, substantial attention has been devoted to chronic daily headache, primarily in adult populations. It is the purpose of this paper to review the literature of chronic daily headache in children, and propose areas for further exploration, given the recent emergence of interest in this diagnostic entity.     

Presentation of Chronic Daily Headache: A Clinical Study

We studied the presentation of chronic daily headache in 258 patients from a private headache practice, 50 men and 208 women. Chronic daily headache was defined as headaches, occurring at least 5 days per week for at least 1 year.
Seventy-seven percent of the patients experienced the onset of headache before the age of 30. The daily headaches were present on awakening in the morning or came about in the course of the morning in 79% of the patients. In 53%, they were worst in the afternoon or evening. The headaches awoke the patients at night at least once per week in 36%. At least twice per week, they were associated with nausea in 35% of the patients and with vomiting in 9%. Common aggravating factors included light, physical activity, bending over, noise, stress or tension, and menstruation. Ninety-four percent of the patients experienced severe headaches in addition to the daily headaches. In 63%, the severe headaches occurred 10 days per month or less. The daily caffeine intake of the patients averaged 170 mg, and the daily analgesic intake, 1860 mg of aspirin equivalents.     

Living with chronic headache: a qualitative study exploring goal management in chronic headache

Abstract

Objectives: Effective goal management may potentially prevent or reduce disability in chronic pain. The aim of this study was to gain insight into the nature of goal management in the context of chronic headache (CH).

Methods: Interviews with 20 patients were conducted, coded, and analyzed using a combined data-driven and theory-driven approach. The dual process model (DPM) was used as a theoretical framework for this study.

Results: Participants used a combination of strategies to regain and maintain a balance between personal goals and resources available for goal pursuit. Furthermore, their retrospective reports indicated a development in strategy use of time. Three goal management phases were identified: (1) a “persistence phase,” characterized by the use of “resource-depleting” assimilative strategies to remain engaged in goals, (2) a “reorientation phase” in accommodative strategies were used to regain balance, and (3) a “balancing phase” in which a combination of “resource-depleting” and “resource-replenishing” assimilative strategies was used to maintain balance.

Conclusions: Goal management is a dynamic process that may contribute to the development of, and recovery from, headache-related disability. Rehabilitation services offered to individuals with CH should target this process to promote optimal functioning.

• Implications for Rehabilitation

• Individuals with chronic headache use assimilative and accommodative goal management strategies to be able to pursue personal goals despite the limitations of chronic headache.

• Before accommodating goals to the limitations of chronic headache, many patients go through a phase of persistence, characterized by the use of resource-depleting assimilative strategies.

• A reorientation phase, characterized by accommodation of goals to the limitations of chronic headache, allows patients to adopt a more balanced way of pursuing personal goals.

     

老年人日常生活活动能力与认知功能的相关性

目的了解老年人日常生活活动能力和认知功能的现状及其两者间的关系。方法采用目的抽样法对湖南省长沙市1 836名城乡老年人进行简明精神状态量表(mini mental status examination,MMSE)和日常生活活动(activities of daily living,ADL)量表的测试。结果 1836名老年人的MMSE平均得分为(22.49±6.33)分,其中异常者占30.5%;ADL得分为(16.75±4.87)分,其中功能下降者占43.2%;老年人认知功能与日常生活活动能力呈负相关,相关系数为-0.292(P<0.01)。结论尽管认知功能是否减退及减退的速度受个体年龄、性别、受教育程度等多方面的影响,但老年人的ADL能力与认知功能存在明显的负相关关系,有必要通过宣传、教育等途径鼓励老年人多从事有益的活动,增加与外界的接触和联系,尽可能维持良好的认知功能,从而保持良好的ADL能力。     

Interaction of Cognitive Avoidance Coping and Stress in Predicting Depression/Anxiety

This study investigated (1) the moderating effects of gender and cognitive avoidance coping on the negative life events–depressive/anxious symptoms relationship, and (2) the validity of the cognitive avoidance coping construct. One hundred seventy-nine men and women completed the Coping Responses Inventory (CRI), Negative Life Events Questionnaire, and Beck Depression and Anxiety Inventories at Time 1 and, 3 weeks later, at Time 2. A confirmatory factor analysis of the four CRI Avoidant Coping subscales revealed that a two-factor model, comprising Cognitive and Behavioral Avoidance Coping, was superior to the one-factor model composed of Avoidant Coping. Multiple regression analyses revealed that high negative life event scores were predictive of significant increases in symptoms among females who endorsed greater use of cognitive avoidance coping, but not among males. Behavioral avoidance coping was unrelated to changes in depressive and anxious symptoms.     

Cognitive Therapy and Relaxation Training in Muscle Contraction Headache: Efficacy and Cost-Effectiveness

SYNOPSIS
The purpose of this study was first, to examine the efficacy of adding a cognitive therapy component to traditional relaxation training; and second, to examine the feasibility and cost-effectiveness of administering these treatments in a largely self-ad-ministered format for headache patients. Twenty-five muscle contraction headache sufferers were assigned to one of three treatment conditions, which provided either relaxation training alone or relaxation training in combination with cognitive therapy. Procedures were delivered utilizing either a therapist-ad-ministered office-based format, or a largely self-administered format designed to provide significantly less therapist contact than the office-based procedure. At one-month post-treatment, patients in all 3 conditions exhibited significant decreases in headache activity, with no significant differences between the groups, although then appeared to be a slight advantage for the cognitive groups and for groups with increased therapist contact. Patients in all 3 groups evidenced significantly greater use of relaxation and cognitive strategies at post-treatment, with the combined treatment groups showing slightly greater use of the latter. Additionally, all 3 groups decreased their use of traditional medical strategies. There were no significant differences in cost-effectiveness among the 3 groups. However, overall this study suggests that largely self-administered treatments can result in significant improvements in headache, while substantially reducing the total amount of therapist contact.