Evaluating migraine disability: the headache impact test instrument in context

Migraine impairs physical, social and emotional functioning but the diagnosis is not always made despite the availability of helpful tools. Poor patient-physician communication is one reason cited for this. It is arguable that if the impact that headaches are having on a person's life can be communicated adequately to the physician, the likelihood of appropriate management will increase. The tools currently employed for assessing headache impact are reviewed briefly and the Headache Impact Test (HIT) and HIT-6 described as validated and reliable measures of the effect that headaches are having on patients. The availability of the standard test on the internet, with feedback provided, indicates that this is a potentially useful tool enabling headache sufferers to realize the extent of the burden of migraine and empowering them to seek appropriate management strategies.     

Periictal and interictal headache including migraine in Dutch patients with epilepsy: A cross-sectional study

As early as in 1898, it was noted that there was a need to find “a plausible explanation of the long recognized affinities of migraine and epilepsy”. However, results of recent studies are clearly conflicting on this matter. In this cross-sectional study, we aimed to define the prevalence and characteristics of both seizure-related and interictal headaches in patients with epilepsy (5–75 years) seeking help in the tertiary epilepsy clinic SEIN in Zwolle. Using a questionnaire, subjects were surveyed on the existence of headaches including characteristics, duration, severity, and accompanying symptoms. Furthermore, details on epilepsy were retrieved from medical records (e.g., syndrome, seizure frequency, and use of drugs). Diagnoses of migraine, tension-type headache, or unclassifiable headache were made based on criteria of the International Classification of Headache Disorders. Between March and December 2013, 29 children and 226 adults were evaluated, 73% of whom indicated having current headaches, which is significantly more often when compared with the general population (p < 0.001). Forty-nine percent indicated having solely interictal headache, while 29% had solely seizure-related headaches and 22% had both. Migraine occurs significantly more often in people with epilepsy in comparison with the general population (p < 0.001), and the occurrence of tension-type headaches conforms to results in the general population. These results show that current headaches are a significantly more frequent problem amongst people with epilepsy than in people without epilepsy. When comparing migraine prevalence, this is significantly higher in the population of patients with epilepsy.     

Antiepileptic drugs in the prophylaxis of migraine,chronic headache forms and cluster headache: a review of their efficacy and tolerability

Neurological Sciences - The studies of different antiepileptic drugs (AEDs) in the prophylaxis of episodic migraine, cluster headache (CH) and chronic headache forms (chronic daily headache,...     

Assessing migraine disability by diary-based measurement: relationship to the characteristics of individual headache attacks

Background and purpose:  Information on headache-related disability helps clinicians create the optimal treatment plan for migraine sufferers. The estimation of disability must be determined by gathering the individual effects of multiple headache attacks within a given period of time. This study was aimed to examine migraine-related disability from diary-based assessment and to determine which elements of the headache characteristics are associated with disability.
Methods:  Ninety-two migraine patients were enrolled and contributed data on a total of 422 diary days of headache attacks. Each diary booklet was comprised of questions on headache features and disability comprising five items that originated from Migraine Disability Assessment (MIDAS).
Results:  The average days recorded with disability for one or more of the three aspects of activities per headache attack was 0.55. Amongst the headache variables, pain intensity, nausea/vomiting, photophobia, type of abortive treatment and the employment status were significantly correlated with disability. On regression analysis, pain intensity, nausea/vomiting and employed work status were identified as significant predicting factors for migraine-related disability.
Conclusion:  These results demonstrated that a considerable amount of disability could occur during migraine attack and there are specified elements that act on the development of disability.     

Applied behaviour analysis and standard treatment in intellectual disability: 2-year outcomes

Applied behaviour analysis by a specialist team plus standard treatment for adults with intellectual disability displaying challenging behaviour was reported to be clinically and cost-effective after 6 months. In a 2-year follow-up of the same trial cohort, participants receiving the specialist intervention had significantly lower total and subdomain Aberrant Behavior Checklist scores than those receiving usual care alone. After adjustment for baseline covariates there was no significant difference in costs between the trial arms.     

Botulinum toxin therapy of migraine and tension‐type headache: comparing different botulinum toxin preparations

Most of the initial reports on botulinum toxin in tension‐type headache (TTH) and in migraine were positive. Unfortunately, these results were not reproduced in well‐designed, randomized controlled trials. So far, doses from 20 U (Botox®) to 500 U (Dysport®) have been studied in patients with chronic TTH, and doses from 16 to 200 U (Botox®) in patients with migraine. Overall, there is no evidence for a beneficial effect of botulinum toxin, although trends favoring botulinum toxin were reported. Experience with botulinum toxin type B (Myobloc®/NeuroBloc®) is limited and similar to the experience with the type A. Thus, a widespread use of botulinum toxin therapy in headache can currently not be recommended.     

Comorbidities in cluster headache and migraine

The aim of this study was to investigate the most frequent comorbid diseases occurring in patients with cluster headache (CH) and, for comparison, in migraine patients. Over a period of eight years 130 patients with CH and 982 patients with migraine were diagnosed according to ICHD-II criteria. In all patients the presence and type of different diseases were assessed from medical records and coded by the ICD, X revision. Odds ratios (OR) with corresponding 95% confidence intervals (95% CI) were calculated by logistic regression analyses. Comorbid disorders were present in 56.9% patients with CH and in 56.7% migraine patients. Chronic sinusitis (p = 0.001), malignancy (p = 0.012), diabetes mellitus (p = 0.021), glaucoma (p = 0.038), as well as another primary headache disorders were more frequently present in patients with cluster headache (p = 0.001), than in migraine patients. In the multivariate analysis, chronic sinusitis (OR = 7.6, p = 0.001) and diabetes mellitus (OR = 4.2, p = 0.035), adjusted by gender, age and duration of headache, are more frequently associated with CH than with migraine. Comorbid disorders in CH patients were frequent and similar to those noticed in migraine patients, except chronic sinusitis and diabetes mellitus.     

Autonomic dysfunction in pediatric patients with headache: migraine versus tension-type headache

Purpose

To examine symptoms indicating central nervous system (CNS) autonomic dysfunction in pediatric patients with migraine and tension-type headache.

Methods

A retrospective chart review assessed six symptoms (i.e. constipation, insomnia, dizziness, blurry vision, abnormal blood pressure, and cold and clammy palms and soles) indicating central nervous system (CNS) autonomic dysfunction in 231 patients, ages 5–18 years, diagnosed with migraine, tension-type headache (TTH), or Idiopathic Scoliosis (IS).

Results

Higher frequencies of “insomnia,” “dizziness,” and “cold and clammy palms and soles” were found for both migraine and TTH patients compared to the IS control group (P < 0.001). Frequencies of all six symptoms were greater in TTH than migraine patients with “cold and clammy palms and soles” reaching significance (P < 0.001).

Conclusions

The need for prospective research investigating autonomic dysfunction in pediatric headache patients is discussed.

     

Epidemiology of headache and migraine in women

During a survey of a defined community, 2,933 women aged 20 to 64 years were asked standard questions about headaches. Overall, 78·7% had headaches during the year immediately preceding the survey and this proportion decreased significantly with age. Random samples of subgroups with unilateral headaches, headaches preceded by a warning, and headaches accompanied by nausea were examined clinically. From these clinical diagnoses the prevalence of women with migraine during the previous year was estimated as 19%. Nearly half of those diagnosed as having migraine had never consulted a doctor because of headaches. Women with migraine and non-migrainous headaches kept diaries of all headaches and data are presented for the time and day of onset, severity, duration and relation of menstruation for both types of headache.     

Histamine metabolism in cluster headache and migraine

Summary Various parameters of histamine metabolism were studied in patients with migraine, cluster headache and chronic paroxysmal hemicrania. These included urinary excretion of radioactivity and of ¹⁴C histamine and its metabolites, exhaled ¹⁴CO₂ and fecal radioactivity after oral as well as subcutaneous administration of radioactive histamine.No marked deviation from the normal was found except in one patient with the cluster headache variant, chronic paroxysmal hemicrania, in whom an aberration in ¹⁴C histamine degradation seemed to be present. Only minute quantities of the ¹⁴C histamine metabolite C¹⁴ imidazoleacetic acid riboside seemed to be formed during a period with severe paroxysms. During a symptom-free period no deviation from normal was observed.The most likely explanation for this finding seems to be a defect in the conversion of imidazoleacetic acid to its riboside. This defect may possibly explain the increased urinary excretion of histamine in this particular patient. The relationship of this metabolic aberration to the production of headache still remains dubious for various reasons.

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Zusammenfassung Bei Patienten mit Migräne, Bing-Horton Kopfschmerz (cluster headache) und chronisch paroxysmaler Hemikranie wurden folgende Parameter des Histaminstoffswechsels untersucht:Die Urinausscheidung der Gesamtradioaktivität, C¹⁴-Histamin und seiner Abbauprodukte sowie die Menge von abgeatmetem C¹⁴-CO₂ und die Gesamtradioaktivität im Stuhl nach oraler und subcutaner Verabfolgung radioaktiv markiertem Histamins. Mit Ausnahme einer Patientin mit einer Variante des cluster headache — der chronisch paroxysmalen Hemikranie — wurden keinerlei Abweichungen von der Norm festgestellt. Bei der Patientin mit chronisch paroxysmaler Hemikranie schien eine Störung des Histaminabbaues vorzuliegen, indem zu Zeiten schwerer paroxysmaler Kopfschmerzen nur sehr geringe Mengen des C¹⁴-Histamin Abbauproduktes C¹⁴-Imidazolessigsäure-Ribosid gebildet wurden. Im symptomarmen Intervall wurden keine sicheren Abweichungen von der Norm festgestellt.Die naheliegendste Erklärung für diesen Befund scheint die Annahme eines Defektes in der Umwandlung von Imidazolessigsäure zu seinem Ribosid zu bieten. Dieser Defekt könnte möglicherweise die erhöhte Ausscheidung von Histamin im Urin dieser Patientin erklären.Die Bedeutung dieser Stoffwechselstörung für die Entstehung von Kopfschmerzen ist aus verschiedenen Gründen noch ungeklärt.

     

Endothelin 1 in migraine and tension-type headache

We determined the plasma levels of ET1, both interictally and ictally, in 50 migraine patients, 20 with aura (MPA) and 30 without aura (MPWA), comparing them with the levels of 40 age-matched tension-type headache patients (20 episodic and 20 chronic) (ETTHP and CTTHP) and the levels of a group of 20 healthy control subjects (CS). No statistically significant difference was evident between the mean ET1 plasma levels of MPA and those of MPWA, assessed in headache-free periods. The mean ET1 plasma levels of MPA and MPWA, assessed interictally, were significantly higher than those of CS. However, the values of plasma ET1 in ETTP and in CTTHP did not differ statistically from those of CS. MPA and MPWA ET1 plasma levels increased significantly within 2 h from the onset of attacks (p<0.0001) and remained significantly higher between 4 and 6 h from the onset. The ET1 plasma levels of ETTHP and CTTHP assessed during attacks did not differ statistically from those of the same patients assessed in the headache-free periods. The increase in ET1 levels in MPA and MPWA patients when assessed ictally, suggests that this peptide is involved in the haemodynamic changes and vascular tone modifications observed during migraine attacks, particularly in the first phase of the ictal period.     

Frequency of headache and migraine in Qatar

BACKGROUND: Headache is a worldwide problem that affects all ages. To date there are no epidemiological data regarding headaches in Qatar. AIM: The aim of this study was to use the International Headache Society (IHS) diagnostic criteria to estimate the prevalence of migraine and headache in an adult population. DESIGN: This is a cross-sectional population-based study. SETTING: The study was carried out at 12 Primary Health Care Centers during the period from October to December 2004 in Qatar. SUBJECTS: Of the 1,200 subjects who were approached to participate in this study, 913 gave their consent, representing a response rate of 76.1%. METHODS: Subjects were selected by a multistage stratified sampling procedure. We used the IHS criteria for migraine. Face-to-face interviews were based on a questionnaire that included variables such as age, sex, socioeconomic status, lifestyle habits, exacerbating factors, warning symptoms, associated features, family history and associated factors. RESULTS: Of the studied subjects, 54.9% were males and 45.1% females. The prevalence of headache and migraine among men was 67.9%, 7.8%, and among women 78.2%, 8.0%, respectively. Subjects aged 25-34 years had higher prevalence of headache comparing to other age groups (27.3%). Prevalence of headache was higher in women. Subjects with less than a high school education had higher frequency of headache (49.1%). The most common warning symptoms prior to headache were abnormal vision (53.0%) and weakness (30.4%). Stress (71.8%) and weather (49.5%) made headache worse in subjects. The majority of the headache sufferers looked for a dark (33.7%) and quiet place (74.5%) to rest. CONCLUSION: Headachedisorders constitute a public health problem in a newly developed Qatari society, due to fast urbanization. More women suffered from headache and migraine than men. The study revealed that there was a strong association between hemoglobin level and headache and its severity. Furthermore, the prevalence of headache and migraine in Qatar is higher than in Western and African countries.     

Valproate: a new drug in migraine prophylaxis

22 patients with severe migraine resistant to previous prophylactic treatments participated in a prospective open trial of valproate in migraine prophylaxis; 17 had common and 5 classic migraine. The attack frequency was from 4 to 16(30)/month (1 patient suffered from attacks every day). The dose of valproate was 600 mg twice a day from start of treatment, successively adjusted to a serum level about 700 mumol/l. Follow-up was from 3 to 12 months; 11 patients were free from migraine attacks, 6 had a significant reduction of the frequency; in one patient there was no effect; 4 dropped out because of lack of cooperation; 3 who had been free from migraine for 3 months, participated in a withdrawal experiment during which they all experienced relapse. After reinstitution of valproate the attacks disappeared again. How valproate acts in migraine prophylaxis is not known, but this prospective open trial demonstrates that valproate has an appreciable prophylactic effect in patients suffering from severe migraine, and calls for controlled clinical trials.     

Non-pharmacological approaches in migraine prophylaxis: behavioral medicine

The high prevalence of headache in young age has a significant impact on patients and their families. Migraine and tension-type headache are the most common forms of headache for which young patients see a physician. Recent studies confirm the increasing incidence of migraine and also chronic migraine in the pediatric population. The article reviews the most important diagnostic categories of headache in young age and the limitations of the classification criteria for this group of patients.     

Key points in migraine prophylaxis: patient perspective

Migraine is a chronic neurological condition with heterogeneous presentation. It is associated with significant pain, disability, and diminished quality of life in a large proportion of patients. Patients with severe and/or frequent migraines require prophylaxis, which implies daily administration of anti-migraine compounds for several months, with potential adverse events or contraindications. This paper reviews the main factors influencing patient acceptance of anti-migraine prophylaxis, providing practical suggestions to maximize patient agreement with, and adherence to, preventive treatment.