Headache in a Population-Based Elderly Cohort. An Ancillary Study to the Italian Longitudinal Study of Aging (ILSA)

The aims of this ancillary study to the Italian Longitudinal Study of Aging were: (1) to provide reliable prevalence data on headache in an elderly population, (2) to classify the subtypes of headache according to International Headache Society criteria, and (3) to identify possible risk factors and associated pathologies in the elderly.
A total of 312 subjects were examined, 148 women and 164 men, with a mean age of 73 years (SD 5.5). For 236 subjects (75.7%), 141 men (85.9%) and 95 women (64.2%), headache had never been a problem; 57 subjects (18.3%), 21 men (12.8%) and 36 women (24.3%), reported troublesome headache only in the past. Nineteen subjects (6%), 6 men (3.6%) and 13 women (8.8%), reported current headache: in this group tension-type headache was the most prevalent, accounting for 2.6%; secondary headaches ranked second, accounting for 2.2%; and only 1% had current migraine.
Our data indicate female sex and younger age as risk factors for headache, and associate migraine and secondary headaches with hypertension, tension-type headaches and secondary headaches with diabetes, and tension-type headaches with myocardial ischemia.     

The effect of ambulation on post-myelography headache in patients injected with metrizamide

This study was conducted to determine whether prescribed ambulation in post-myelography patients injected with metrizamide would significantly decrease the incidence of post-myelography headache. Eighty patients undergoing metrizamide lumbar myelography were assigned to two groups of 40 patients each. The control group was restricted to complete bedrest for the immediate 24-hour period following myelography. The experimental group participated in a prescribed regimen of ambulation every four hours following myelography. Data were collected during the immediate 24 hours post-myelography. Subjects were assessed as to the presence or absence of headache at four-hour intervals during data collection. At the end of the 24-hour period post-myelography, the Visual Analogue Pain Intensity Scale was administered to subjects with documented subjective complaints of headache pain. The nonambulatory group had a 62.5% incidence of headache while the ambulatory group revealed only a 42.5% incidence of post-myelography headache. The z test was used to test the first research hypothesis that there would be a higher incidence of post-myelography headache in the nonambulatory group than in the ambulatory group. The calculated z = 1.79, p less than .05; therefore, it was possible to conclude that the number of nonambulatory patients with headache was significantly higher than the number of ambulatory patients with headache. The second research hypothesis, that the severity of post-myelography headache would be greater in the nonambulatory group than in the ambulatory group, was tested using the Student's t test. The calculated t = .6492, p greater than .05. The subjects' self-perception of the severity of headache was not significantly different in the nonambulatory than in the ambulatory subjects.     

Use of atraumatic spinal needles among neurologists in the United States

OBJECTIVE: To evaluate atraumatic spinal needle use among US neurologists. BACKGROUND: Postdural puncture headache following lumbar puncture may be dramatically reduced through the use of atraumatic pencil-point spinal needles. It was hypothesized that atraumatic spinal needles are rarely used by members of specialties outside of anesthesiology. To determine the extent to which atraumatic spinal needles are currently being used for lumbar puncture in the United States, American neurologists (one group of physicians who regularly perform lumbar punctures) were surveyed. METHODS: A questionnaire was mailed to all 7798 members of the American Academy of Neurology listed in the membership directory. The questionnaire included items pertaining to age, practice setting, knowledge of pencil-point (atraumatic) spinal needles, and lumbar puncture practices. RESULTS: Only a fraction (2%) of the neurologists surveyed routinely use atraumatic spinal needles. Almost half of the responding neurologists reported having no knowledge of pencil-point spinal needles. Among those who did have knowledge of these new spinal needles, the most common reasons given for not using them were nonavailability and expense. CONCLUSIONS: Atraumatic spinal needles for lumbar puncture have been shown to dramatically decrease the risk of postdural puncture headache. Although the use of these needles is standard practice among anesthesiologists, they have not been adopted by other medical specialties. This may lead to unnecessary morbidity among patients undergoing lumbar puncture.     

Lower cervical disc prolapse may cause cervicogenic headache: prospective study in patients undergoing surgery

In 1983 Sjaastad published for the first time diagnostic criteria for cervicogenic headache. Until now there have been no prospective studies investigating whether cervical disc prolapse can cause cervicogenic headache. Between July 2002 and July 2003 50 patients with cervical disc prolapse proven by computed tomography, myelography or magnetic resonance imaging were recruited and prospectively followed for 3 months. Patients were asked at different time points about headache and neck pain by questionnaires and structured interviews. These data were collected prior to and 7 and 90 days after surgery for the disc prolapse. Fifty patients with lumbar disc prolapse, matched for age and sex, undergoing surgery were recruited as controls. Headache and neck pain was diagnosed according to International Headache Society (IHS) criteria. Twelve of 50 patients with cervical disc prolapse reported new headache and neck pain. Seven patients (58%) fulfilled the 2004 IHS criteria for cervicogenic headache. Two of 50 patients with lumbar disc prolapse had new headaches. Their headaches did not fulfil the criteria for cervicogenic headache. One week after surgery, 8/12 patients with cervical disc prolapse and headache reported to be pain free. One patient was improved and three were unchanged. Three months after cervical prolapse surgery, seven patients were pain free, three improved and two unchanged. This prospective study shows an association of low cervical prolapse with cervicogenic headache: headache and neck pain improves or disappears in 80% of patients after surgery for the cervical disc prolapse. These results indicate that pain afferents from the lower cervical roots can converge on the cervical trigeminal nucleus and the nucleus caudalis.     

Epidemiology of Headache in Elderly Correlations With Life Conditions and Socio-professional Environment

SYNOPSIS
The decreased frequency of headache in the aged is generally acknowledged. Thus in a general population, Waters (1975) reported 74% men and 92% women suffering from headaches and ranging between 21 and 34 years, while in a group aged 75 years or more, he reported only 21% men and 55% women. Likewise Newland et al (1978) mentioned 88% men and 96.7% women ranging between 21 and 34 years suffering from headaches and only 45.5% men and 52.7% women aged 75 years or more. Our previous study¹⁸ dealed with a group of 1990 headache sufferers (H.S.), who consulted for isolated headache among whom we noticed a low percentage (about 5%) of individuals over 65.This decrease of headaches in aged people is difficult to explain and there are few studies concerning headaches in the elderly. Prospective studies were carried out in poorly homogeneous groups examined by written questionnaires,^3,4,5,6. less accurate than a direct examination. Conversely, this present study deals with a group of hospitalized patients, more homogeneous as regards the age, examined and followed up very closely. There are still no studies tending to compare H.S. and non-headache sufferers (N.H.) and dealing with the difference or relationship between them. The aim of this work is an epidemiological and clinical analysis within a group of old people and then a comparison between this group and another of N.S. to determine if the life conditions and the socio-professional environment have any influence on the occurrence of headaches.     

Persistent Post-DuraI-Puncture Headache Treated With Epidural Infusion of Dextran

SYNOPSIS
A retrospective review was done on medical records of 13 patients with persistent post-dural-puncture headaches after one or more epidural blood patches. Headache occurred in nine patients with post-laminectomy syndrome after "wet taps" while performing epidural blocks. In two patients post-dural-puncture headache appeared after long term implanted intrathecal catheters were removed. In two other cases headache developed after spinal anesthesia. Treatment included bed rest, intravenous hydration and at least one epidural blood patch; three patients were given 60 milliliters of epidural saline, without success. Eight epidural catheters were inserted through the lumbar access and five through the caudal approach. Initially, a bolus of 20 milliliters of dextran-40 was given followed by an infusion of 3 mL/hr, until 12 hours after the head pain and any other related symptoms subsided. In all patients the headache disappeared within 20 hours after initiating therapy (9.55 mean hours, SD ± 0.79). In five patients headache ceased in less than five hours. Nausea and photo-phobia subsided earlier. Patients with post-dural-puncture headache resistant to other treatments, including at least one epidural blood patch, were successfully treated by a bolus followed by continuous epidural infusion of dextran-40.     

The Prevalence of Headache in Greece: Correlations to Latitude and Climatological Factors

A questionnaire study on headaches, using a door-to-door survey, was carried out in a representative sample of the general Greek population, including 1737 men and 1764 women, from 15 to 75 years of age. The parameters evaluated included age, sex, education, socioeconomic status, region of domicile, frequency of headache, use of medication, medical consultation, and family history. Latitude and climatologic factors such as humidity, temperature, and atmospheric pressure were also investigated. Headaches were not classified because the interviewers were not specialists. Nineteen percent of men and 40% of women (mean 29%) suffered from headaches in the prior year. Headaches were more frequent in lower social classes, in people with less education, and in those between 45 and 64 years of age. Nineteen percent of sufferers did not take any medication and 33% used medication every time that they had a headache, while 36% sought medical consultation. Twenty-nine percent of headache sufferers had a family history of headaches. Daily headache was present in 15% of headache sufferers. Humidity and atmospheric pressure were not correlated to headache frequency. However, in the northern areas of Greece, as well as in the regions with low mean temperature, more people suffered from daily headaches. These data may explain the lower 1 -year prevalence of headaches in Greece as compared to the prevalence of headaches in other northern European countries.     

Spinal headache: cause and care

Patients undergoing spinal anesthesia or myelography are at risk for developing a spinal headache that can be incapacitating and anxiety producing. Nursing staff knowledgeable about spinal headaches can contribute to the patient's recovery. This article discusses the etiology, symptoms, treatment, and appropriate nursing care for a patient with a spinal headache.     

Headaches Associated With Nasal Obstruction Due to Deviated Nasal Septum

A deviated nasal septum not only can cause a blocked nose, but may also be associated with headaches. This study evaluates the nature of these headaches, the effect of submucous resection of the nasal septum, and the factors associated with postoperative headache relief. Deviated nasal septa were corrected by submucous resection in 99 men and 17 women. Patients were studied at 4 to 48 months (mean 18 months) postoperatively. Fifty-five of the 116 patients studied (47.4%) had preoperative recurring headaches. Thirty-five of the 55 patients with headaches (63.6%) experienced relief (complete or partial) of their headaches at a mean follow-up period of 18 months. Patients were more likely to be relieved of their headaches following submucous resection if the headaches were most intense over the frontal region, pressure like in nature, and if the submucous resection resulted in relief of nasal obstruction. It is possible that headaches recur in the long term, and it is postulated that central mechanisms play a role.     

Prevention and management of post-lumbar puncture headache in pediatric oncology patients.

Pediatric oncology patients are at risk for developing a headache after they undergo a lumbar puncture for diagnostic or therapeutic purposes. These headaches are likely due to leakage of cerebrospinal fluid at the puncture site. While usually mild and self-limited, some headaches may be persistent and severe, adding to the distress of these young patients. In the past 10 years, refinements in lumbar needle size and shape as well as procedural techniques have reduced the tissue trauma that predisposes patients to headache. A number of interventions, such as bed rest, hydration, caffeine administration, and epidural blood patching, have been suggested to prevent and relieve the headaches that follow lumbar punctures. This article outlines the pathophysiology and incidence of headaches related to lumbar punctures in the pediatric oncology setting and reviews the evidence from research trials to suggest which interventions clinicians should adopt into their practice to minimize this complication of lumbar punctures.     

MMPI Pattern Specificity in Primary Headache Disorders

SYNOPSIS
MMPI' were obtained from 258 untreated headache patients, of whom 113 were males and 145 females. The diagnostic headache categories included: 1. Migraine alone; 2. Chronic scalp muscle contraction headache (SMC); 3. Combination headache (migraine and SMC); 4. Cluster headache; 5. Post-traumatic cephalgia (P-T); 6. conversion cephalgia.
Mean scores of the validity and clinical scales were calculated and compared between diagnostic categories; males considered separately from females. As a result of this comparison, three significantly distinct groups, two categories per group, were obtained; Group A, migraine and cluster; Group B, SMC and combination headaches; Group C, P-T and conversion cephalgia. This grouping applied to women and men similarly.
In a spectrum of from most normal to most neurotic patterns, Group A was followed by Groups B and C respectively. Significant "conversion v" patterns were found in women with SMC, P-T, and conversion cephalgia, and in men with combination headache.
In an effort to determine the predictability of correct diagnoses from MMPI patterns, selective criteria were generated and tested in a blind fashion using an additional 83 coded MMPI'. The accuracy of predictability exceeded the .001 level.     

An Epidemiological Study of Headaches Among Medical Students in Athens

In order to study the prevalence of frequent headaches among the medical students of Athens University, an epidemiological survey was carried out among 588 medical students (318 men and 270 women), with mean age 23.5 years. Two questionnaires were designed for the study: one general, consisting of 10 questions and a second one, specific for headache sufferers, consisting of 117 questions. All those with headache who voluntarily completed the two questionnaires also underwent a neurological examination. Thirty point eight percent of men and 50.3% of women reported various headache attacks during the previous 6 months (39.6% in both sexes). However, only the 11.9% of students (from both sexes) reported that they suffered from disturbing headaches. The 6-month prevalence of migraine was 2.4% and 9.5% for tension-type headache (in both sexes). Cluster headache was not traced. The prevalence of nonclassifiable headaches (according to the criteria of the International Headache Society) was 0.85%. Headache was correlated to sex (more frequent among women) and anxiety level (Hamilton scale for anxiety). Headache prevalence was not correlated to smoking and social class.     

Postdural puncture headache: diagnosis,prevention and therapy

Lumbar puncture (LP) is a routine technique performed for a variety of procedures, e.g. diagnosis, administration of drugs, myelography and spinal anaesthesia. Postdural puncture headache is a common complication (30-40% in diagnostic LP). Prevention can be accomplished by using small-gauge needles (< or = 25 G) or pencil-point needles (22 G). Therapy should be carried out in a stepwise approach. The first step is bedrest, use of analgetics, i.v. fluids and an adequate guidance of the patient. The second step comprises special drug therapy. Several methods of pharmacologic management have been presented in the literature, but most of these are case reports. There is a lack of large double-blind placebo-controlled studies. Theophylline, caffeine, ACTH and sumatriptan are potentially promising agents for the treatment of postdural puncture headache. The efficacy of theophylline has been proven in a double-blind and placebo-controlled study. There are a few studies and case reports reporting that caffeine p.o. and i.v. is effective in the treatment of postdural puncture headache, but recurrence of headache after caffeine therapy is frequent. ACTH acts on a complex hormonal system. The treatment with sumatriptan has been reported in only a few case reports. The third step, and one of the most effective treatments of postdural puncture headache, is the epidural blood patch. The success rate ranges between 80 and 97%.     

Effect of 24-Hour Bed Rest versus Early Ambulation on Headache after Spinal Anesthesia: Systematic Review and Meta-analysis

Objectives: We performed a systematic review of the evidence for the effectiveness of bed rest after dural puncture to update current evidence on the topic. Design: The design was a systematic review and meta-analysis. Data Sources: We searched 10 electronic databases in English (Medline, CINAHL, EMBASE, and the Cochrane Controlled Trial Register) and Korean (KISS, KMBASE, NDSL, and RISS) using the terms “post–dural puncture headache,” “spinal anesthesia,” “epidural anesthesia,” and “bed rest” to identify reports discussing the effectiveness of bed rest in preventing post–dural puncture headache (PDPH) after spinal anesthesia from 1980 to 2014. Review/Analysis Methods: Original studies such as randomized and nonrandomized controlled trials, where participants were allocated to an intervention or control group, were included. A total of eight studies that met the inclusion criteria were independently reviewed and encoded by two review authors. To ensure the quality of the eight studies, levels of risk of bias were assessed by two different researchers. The main outcome was the prevalence of PDPH. Results: The included studies indicated that PDPH prevalence did not differ between the group assigned to 24 hours of bed rest and the group assigned to early ambulation. In subgroup analysis, the effect size of clinical factors (severity of headache, day of onset, and needle gauge) and the study characteristics (language and sample size) did not differ between groups. Conclusion: This meta-analysis of studies suggested that long-term bed rest after spinal anesthesia may not be effective in preventing PDPH.     

The prevalence of headache among elderly in a low-income area of São Paulo, Brazil

There are scarce data about headache prevalence and its characteristics among elderly people. The aim was to carry out a cross-sectional study to determine the 1-year prevalence of tension-type and migraine headaches in people >65 years old in the city of São Paulo, Brazil. All 1615 people living in the study catchment area who agreed to participate in the study answered a questionnaire based in the International Headache Society criteria. Prevalence (mean and 95% confidence interval) of any type of headache in the last year was 45.6% (43.2, 48.0). Prevalence of tension-type headache in the last year was 33.1% (30.8, 35.4): 28.1% (24.6, 31.6) for men and 36.4% (33.4, 39.4) for women; for migraine headaches, prevalence in the last year was 10.6% (9.1, 12.1): 5.1% (3.4, 6.8) for men and 14.1% (11.9, 16.3) for women. One-year prevalence rates of headaches, and especially of migraine headaches, are very high among the elderly in Brazil.     

Prevention of post-puncture complications by rotation of the puncture needle by 90 degrees

We investigated whether the incidence of post-lumbar puncture headache could be reduced by using a new technique. By rotating the puncture needle the spinal meninges become penetrated with the bevel adjusted parallel to the main fibre direction. Therefore the fibres are only dissociated and not cut. We used this method in 20 patients and only 2 of them complained of headache. By contrast 14 out of another group of 20 patients suffered from headache after conventional lumbar puncture. These results demonstrate that post-lumbar puncture headache can be prevented in a high percentage of patients without using special puncture needles or sophisticated techniques.     

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.     

Chronic daily headache: a time perspective

OBJECTIVE: To determine the development and outcome of chronic daily headache in 258 headache practice patients, consisting of 50 men and 208 women. Chronic daily headache was defined as headaches occurring on at least 5 days per week for at least 1 year. METHODS: Two hundred fifty-eight patients with headache were interviewed and evaluated. Ninety-one patients were contacted by telephone for follow-up. RESULTS: Twenty-two percent of the patients had daily headaches from the onset, and 78% initially experienced intermittent headaches. Of the patients with initially intermittent headaches, 19% experienced an abrupt transition into daily headaches and 81%, a gradual one. In the patients with gradual transition, the transition of the initial, intermittent headaches into daily headaches took an average of 10.7 years. The initial headaches were mild in 33% of the patients and severe in 67%. The severe headaches were associated with nausea and vomiting significantly more often than the mild ones. However, the daily headaches that these patients ultimately developed were the same, regardless of whether the initial headaches were mild or severe. The patients who gradually developed daily headaches from initially intermittent headaches were contacted to determine the outcome of their headaches. Of these patients, 33% continued to have daily headaches and 67% again experienced intermittent headaches. Of the latter group, 88% of the patients who now had migraine also had migraine initially.     

Associations between headache and stress, alcohol drinking, exercise, sleep, and comorbid health conditions in a Japanese population

We conducted a cross-sectional survey of 12,988 subjects aged 20–79 years (5,908 men and 7,090 women) receiving health checkups at a Tokyo clinic. They filled out a self-administered structured questionnaire, and 5.4% of the men and 15.4% of the women reported having headaches. Younger subjects were more prone to having headaches. The likelihood of having headaches increased with stress level and decreased ability to relieve stress in both genders. There was an inverse dose–response relationship between having headaches and alcohol consumption, and less walking/exercise and sleep problems increased the likelihood of headaches in both genders. Headache sufferers of both genders were more likely to report multiple additional poor health conditions. A multivariate stepwise logistic analysis showed that age, self-estimated degree of stress, reported number of additional poor health conditions, and less alcohol consumption were independently correlated with having headaches. In conclusion, although women were more susceptible to headache, Japanese men and women in Tokyo shared factors associated with headache, including age, stress, having other poor health conditions, alcohol consumption, sleep, and exercise.     

模拟腰椎间盘髓核摘除后疲劳载荷对腰椎稳定性的影响

背景:腰椎间盘髓核摘除术后何时下床活动目前尚无统一标准,实验拟通过腰椎间盘髓核摘除术后早期的生物力学变化来指导患者进行功能锻炼。目的:观察腰椎间盘髓核摘除后疲劳载荷对腰椎稳定性的影响。方法:取3具新鲜猪脊柱标本,制成12个脊柱功能单位,随机分为A,B,C组,行单侧椎板开窗髓核摘除后,在不同循环载荷压力(500～1000N,500～2000N,500～3000N)下行疲劳载荷实验。结果与结论:A,B组椎间盘高度、刚度差异无显著性意义(P>0.05),应变增大差异有显著性意义(P<0.05);B,C组椎间盘高度和刚度的降低、应变的增大差异均有显著性意义(P<0.01)。循环载荷后3组间比较,椎间盘高度、应变、刚度的变化幅度均随载荷压力的增大而变大(P<0.05)。结果说明髓核摘除后较大的载荷会破坏腰椎的稳定性。