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.     

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.     

Fatigue and Sleep in Chronic Headache Sufferers: An Age- and Sex-Controlled Questionnaire Study

We studied fatigue and sleep in chronic headache sufferers in comparison to age- and sex-matched controls. We determined the prevalence and intensity of fatigue as well as several sleep features. The study was conducted in a headache center through the use of a questionnaire. One hundred thirteen headache sufferers (59 men and 54 women) and 110 controls (56 men and 54 women) were included in the analysis. Fatigue was found to be equally common in the headache sufferers (70.3%) and in the controls (60.0%). However, the headache sufferers rated the intensity of their fatigue significantly higher (4.1 versus 2.8 cm on a 10-cm visual analog scale). When the sexes were considered separately, the difference in intensity of the fatigue between the two groups was significant only for the women (5.1 versus 3.0 cm). With regard to sleep, the headache sufferers slept significantly shorter (6.7 hours) than the controls (7.0 hours). It also took them longer to fall asleep (31.4 versus 21.1 minutes) and longer to fall back asleep after waking up at night (28.5 versus 14.6 minutes). When the sexes were considered separately, the differences in sleep features between the two groups were significant only for the men.
On the basis of these results, we conclude that chronic headache sufferers feel more tired, especially the women, and do not sleep as well at night, especially the men. Further study is necessary to determine the significance of these findings in relation to chronic headache suffering.     

SECONDARY HEADACHES

Murata Y, Yamagata M, Ogata S, Shimizu K, Ikeda Y, Hirayama J, Yamada H. The influence of early ambulation and other factors on headache after lumbar myelography. J Bone Joint Surg Br. 2003;85:531-534.
In order to determine the influence of early ambulation and other factors on headaches occurring after lumbar myelography we randomised 207 patients (127 men and 80 women) into two groups. Following the investigation, we allowed the 101 patients (65 men and 36 women) in group A to sit or stand freely, while we confined the 106 patients (62 men and 44 women) in group B to bed for 20 hours. The nine patients in group B who could not maintain bed rest were excluded. There was no significant difference between the two groups as regards the prevalence of spinal headache (8.9% in group A v 14.4% in group B). Patients who reported headaches, however, were significantly more likely to be women (18.7%) than men (73%), be younger (mean age 45 years v 56 years), have a higher cerebrospinal pressure before removal of fluid (mean values 172 v 137 mm H2O) and a lower systolic (mean values 120 v 134 mmHg) and diastolic blood pressure. We conclude that, although other factors may be associated with headaches, late ambulation is not effective in preventing spinal headaches after lumbar myelography.
Comment: The only proven way to prevent spinal headache after lumbar puncture that I have ever read is to use special blunt-end needles such as Sprotte needles, which need to be special ordered, but which markedly reduce this complication. SJT     

Prevalence and Burden of Headache and Migraine in Germany

Objective.— To determine prevalence and burden of headache and migraine in the general population in Germany including patterns of healthcare and medication use.
Methods.— Telephone interviews were conducted on a representative sample of the general population in Germany aged ≥18 years (n = 7341). Migraine was diagnosed according to the International Headache Society criteria.
Results.— One-year prevalence was: headache 60.2%, migraine 10.6%, nonmigrainous severe headache 24.7% (women 66.6%, 15.6%, and 27.1%; men 53.0%, 5.3%, and 22.2%). Approximately 60% of headache sufferers reported severe headaches, 30% of which were migrainous. Migraineurs reported more often frequent headaches, disability, use of analgesics, and medical consultation than individuals with nonmigrainous severe headaches. Only 42% of migraineurs had consulted a physician and the majority relied exclusively on over-the-counter medication.
Conclusion.— Migraine accounts for a great part of the healthcare impact of headaches in Germany. However, the majority of migraineurs do not seek medical care and may not be optimally treated.     

Psychometric Characteristics of the Bakal Headache Assessment Questionnaire

SYNOPSIS
To assist the therapist in understanding the psychological components of headache pain, Bakal¹ developed the Headache Assessment Questionnaire (HAQ). The HAQ consists of statements describing nonproductive or distressing thoughts or negative affect experienced at headache onset. In the present study, the discriminant and construct validity of the HAQ was assessed by exploring its relationship with various other indices and examining the HAQ's ability to differentiate chronic headache sufferers from people who occasionally experience headaches.
The HAQ successfully differentiated the high frequency and moderate frequency headache groups and a discriminant function accurately classified 82% of the subjects. For frequent headache sufferers, the HAQ was significantly correlated with headache activity indices suggesting that people who experience more frequent and severe headaches also tend to experience more dysfunctional thoughts and feelings. In addition, principal components analyses suggest that the HAQ has several dimensions (e.g., nonproductive rumination, self-denigration, and tension and worry}. The development of HAQ sub-scales on these dimensions might provide both useful research tools for classifying samples of headache sufferers and useful clinical tools for identifying the types of dysfunctional thoughts and affect a patient experiences.     

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.     

A double-blind provocative study chocolate as a trigger of headache

A provocative double blind study of headache was performed using chocolate as the active agent and carob as the placebo. The chocolate and carob samples were formulated to duplicate products used in an earlier study (1) in which strong differential effects between the ability of chocolate and carob to trigger headache in migraine were shown. Sixty-three women with chronic headache (50% migraine, 37.5% tension-type, 12.5% combined migraine and tension-type) participated in the study. After 2 weeks of following a diet that restricted vasoactive amine-rich foods, each subject underwent double-blinded provocative trials with two samples of chocolate and two of carob presented in random order. Diaries were maintained by the subjects throughout the study, monitoring diet and headache. The results demonstrated that chocolate was not more likely to provoke headache than was carol in any of the headache diagnostic groups (²(2) 0.36, p =0.83). Interestingly, these results were independent of subjects' beliefs regarding the role of chocolate in the instigation of headache (²(1)=0.73, p =0.39). Headache diagnosis and the concomitant use of additional vasoactive amine-containing foods were also not associated with chocolate acting as a headache trigger. Thus, contrary to the commonly held belief of patients and physicians, chocolate does not appear to play a significant role in triggering headaches in typical migraine, tension-type, or combined headache sufferers.     

Prevalence of primary headaches and cranial neuralgias in men and women aged 55-94 years (Bruneck Study)

The aim of the current study was to estimate the prevalence of all primary headaches and cranial neuralgias in the general community. As part of the population-based Bruneck Study, 574 men and women aged 55–94 years underwent extensive neurological and laboratory examinations involving a standardized headache interview. In the Bruneck Study population the lifetime prevalence of all primary headaches combined and of cranial neuralgias was 51.7 and 1.6%, respectively. Tension-type headache (40.9%) and migraine (19.3%) emerged as the most common types of headache. In men and women aged 55–94 years the 1-year prevalence of primary headaches was high at 40.5%. In this age range headaches caused significant impairment of health-related quality of life. The Bruneck Study has confirmed the high lifetime prevalence of primary headaches and cranial neuralgias in the general population and provided first valid prevalence data for all primary headaches based on International Classification of Headache Disorders, 2nd edition criteria.     

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.     

Comorbidity of headache and depressive disorders

The goal of the present study was to investigate the clinical profile of patients with primary headache syndromes who also suffer from mood disorders. Four-hundred-and-seventy headache outpatients (170M, 300F) and 150 age- and sex-matched healthy subjects were screened using a specific questionnaire that included the Hamilton rating scales for anxiety and depression. The average scores of the Hamilton rating scales for anxiety and depression were significantly higher in headache sufferers (17.4 and 14.2, respectively) than in healthy people (6.8 and 5.7, respectively). The frequency of headache attacks, the history of headaches, and gender (women more than men) were correlated with the score of the Hamilton rating scale for both anxiety and depression. Sixteen headache patients (3.4%) achieved the DSM-IV criteria for major depression or dysthymia versus one among headache-free subjects (0.6%; OR 5.2). Patients suffering from drug-overuse and migraine with aura showed the higher odds ratios (35 and 17, respectively). These results suggest that those headache patients with long history and high frequency of headaches, or patients suffering from migraine with aura and drug-overuse might benefit from psychiatric evaluation.     

Psychosocial Functioning in Schoolchildren With Recurrent Headaches

The psychosocial functioning of 113 schoolchildren (8 to 15 years old) reporting headaches at least once a month was compared to a group of headache-free control subjects matched for sex and age. Thirteen percent of the headache sufferers had migraine headaches, 28% had episodic tension-type headaches, 30% had chronic tension-type headaches, and 29% had migraine coexisting with tension-type headaches.
Overall, the headache sufferers experienced more somatic complaints, stress, and psychological symptoms, in addition to being absent from school (due to illness), more often and reported fewer caring persons as compared to headache-free controls. Although few differences between the four headache groups emerged in the children's psychosocial functioning levels, children with migraine coexisting with tension-type headaches had significantly more frequent somatic complaints than those having episodic tension-type headaches. In addition, children with migraine or migraine coexisting with tension-type headaches were more often absent from school than those having tension-type headaches only. A significant but weak relationship between children's headache severity and their somatic complaints was noted.     

Sumatriptan Prophylaxis for Postelectroconvulsive Therapy Headaches

Very little has been written about headaches following electroconvulsive therapy (ECT) but the incidence has been estimated at 26%. ¹ Patients with a history of migraine occasionally have similar headaches precipitated by ECT.² In addition, some patients may have headaches that persist for months after a series of ECT treatments, while some patients who have a preexisting headache problem report improvement with ECT.³
Serotonergic mechanisms have been proposed both for the efficacy of ECT and its tendency to produce headaches in susceptible patients.^3,4 There have been no studies on the prophylaxis or treatment of post-ECT headache. While various strategies have been suggested for these headaches, even case reports documenting the efficacy of these strategies are lacking. We, therefore, report a case of severe, refractory, post-ECT headaches which responded to prophylactic treatment with sumatriptan.     

Personality Factors in Classical Migraine and Tension Headache

SYNOPSIS
The hypothesis that classical migraine and tension headache sufferers show a "specific headache personality" characterized by traits of obsessionality, neuroticism and repressed hostility was tested. A sample of fifteen classical migraine and fifteen tension headache sufferers selected without reference to treatment, was compared with fifteen non-headache normal subjects and fifteen subjects suffering physical pain but of a non-headache nature.
Personality tests of obsessionality, neuroticism, anxiety and hostility were administered. Analyses of variance revealed that sufferers from headache and non-headache physical pain had higher levels of neuroticism and repressed hostility than the non-headache controls. No evidence for increased incidence of obsessionality was found in any group.
It was concluded that the similarities between headache and non-headache physical pain sufferers found on several of the personality indices suggested that traits frequently reported as characteristic of headache sufferers may be the result of a coping strategy for recurrent pain and not specific to headaches.     

One-year prevalence of migraine in Sweden: a population-based study in adults

A randomly selected sample of 1668 individuals (782 women and 886 men) aged 18-74 years was interviewed by telephone using a standardized questionnaire including the International Headache Society (IHS) criteria for migraine. The survey was performed by SIFO, the national public opinion poll agency. The results obtained demonstrate that 21% of the Swedish population had suffered from severe headaches during the past year. A majority of these headache sufferers (61%) fulfilled the IHS-criteria for migraine. The 1-year prevalence of migraine in Sweden was found to be 13.2 +/- 1.9% (16.7% among women and 9.5% among men). The prevalence of migraine in this Swedish population did not differ between the northern, middle and southern part of Sweden, or between urban and rural areas or different income groups. Only about half (49%) of the migraineurs had been diagnosed by a physician. Among the individuals who fulfilled the IHS criteria for migraine the mean attack-frequency was 1.3 per month and the mean attack-duration was 19 h. If the duration of the attack was disregarded as a strict criterion for migraine (attacks < 4 h and > 72 h were included), the prevalence increased to 17.0 +/- 1.9% without affecting the sex distribution. With this amendment, 92% of those who considered their headaches to be migraine or migraine-like in fact fulfilled the alternative criteria for migraine. However, only 76% of those who believed that they had migraine or migraine-like headaches fulfilled the strict IHS criteria for migraine. An extension of the time window from 4 to 72 h may be reasonable both from a pragmatic and from a rational clinical point of view.     

The Effect of Muscle Contraction Headache Chronicity on Frontal EMG

SYNOPSIS
The purpose of this study was to test the effect of muscle contraction headache chronicity on electromyographic (EMG) response.
Frontal EMG was measured under two stress conditions and three baselines for subjects complaining of muscle contraction headaches for (1) ³ 19 years, (2) £ 10 years, and (3) subjects not complaining of headaches of any kind. There were ten subjects in each group. The three groups were equivalent in age and sex distribution. They did not differ in their ratings of the stressfulness of the experimental conditions. Neither ANOVA nor ANCOVA with frequency of headache as the covariate supported Group differences or Group X Trials interactions. The results do not support the hypothesis that changes in frontal musculature occur as a function of the number of years that an individual has had a problem with muscle contraction headaches. The results are consistent with those of other EMG investigations employing an adaptation period of ³ 5 minutes. They are also supportive of the recent skepticism about frontal EMG biofeedback as a critical component in the treatment of muscle contraction headaches.     

The Prevalence of Headache in a Small New Zealand Town

SYNOPSIS
Information on the prevalence, characteristic features and possible causative factors of headache was collected from 1138 adults who participated in a multiphasic health survey in Milton in May 1981.
Thirty-nine percent of men and 60% of women experienced headaches in the year preceding the survey. Total prevalence of headache peaked in men 30–39 years and in women aged 20–29 years and thereafter decreased with increasing age.
The most commonly reported positions for headache were at the forehead unilaterally and bilaterally. The most common precipitating factors were 'too much' alcohol (men only), tiredness, mental stress and eye strain. Chocolate was the food most commonly blamed for the headache.
No association was found between headache frequency and blood pressure or smoking habit. However the psychometric scores for anger, anxiety and depression were positively related to frequency of headache.     

Deficiency In Serum Ionized Magnesium But Not Total Magnesium In Patients With Migraines. Possible Role Of Ica2+/IMg2+ Ratio

SYNOPSIS
It has been suggested that magnesium (Mg) may play a role in the pathogenesis of headaches. Serum and intracellular measurements of Mg in headache patients have produced inconsistent results. The recent development of an ion-selective electrode for Mg²⁺ allowed precise measurement of serum ionized magnesium (IMg²⁺) in patients with various headache syndromes. Low serum Img²⁺ and a high ICa²⁺/IMg²⁺ ratio were found in 42% of patients having an attack of migraine, but only in 23% of patients with e severe continuous headache. Total serum Mg was normal in both groups of patients. However, in patients with low serum IMg²⁺ total serum Mg was lower than in patients with normal serum IMg²⁺. These results are compatible with the serotonin and vascular concepts of migraine pathogenesis. Low IMg²⁺ and a high ICa²⁺/Img²⁺ would result in cerebral vasospasm and reduced blood flow in the brain. The activity of serotonin receptors can also be affected by changes in IMg²⁺ levels. The finding of a difference in IMg²⁺ levels in two different headache types suggests a possible novel classification of headaches and that migraine patients with a low serum IMg²⁺ or a high ICa²⁺/IMg²⁺ ratio may benefit from Mg supplementation.     

Consulting behaviour in migraine and tension-type headache sufferers: a population survey in Santiago, Chile

Migraine and tension-type headaches are the most frequent types of headaches in Santiago. The purpose of this paper is to describe the patterns of health care utilization in migraine and compare them with tension-type headache sufferers in a community-based study of the prevalence of headache in Santiago, Chile. A two-step questionnaire was administered to an age- and gender-representative sample of 1540 eligible subjects who were aged 15 years or older. Of these, 1385 (89.9%) responded. Cases were defined according to the most frequent type of headache experienced in the last year. Migraine and tension-type headaches were diagnosed according to a questionnaire-based algorithm constructed using the IHS criteria. Consultation rates in migraneurs were significantly (P < 0.01) higher (63%) than in tension-type headache suffers (39%). Migraneurs were more likely to be female, younger and less educated, and had more severe attacks than those with tension-type headache. Female sex, younger age, fewer years of education in migraneurs and younger age and moderate or severe headache in tension-type headache sufferers were found to be independently associated with the likelihood of ever consulting, respectively. Migraneurs are more likely to consult than tension-type headache suffers in this population.