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.     

The Epidemiology of Migraine in Medical Students

The purpose of this study was to investigate the prevalence of migraine in medical students, as well as its clinical aspects and impact. All 595 medical students of Santa Casa School of Medicine of São Paulo, Brazil were asked if they had experienced any kind of headache in the past year. Those who responded positively were further investigated by an appropriate questionnaire. Diagnosis of migraine was based on the International Headache Society criteria of 1988. Forty percent of students suffered from some kind of headache; 40.2% of these headaches were migraine. The prevalence of migraine was 54.4% in women and 28.3% in men. Migraine headaches were unilateral in 24.2%, had a gradual onset in 69%, and were of a throbbing type in 88.3%. Migraine was considered incapacitating by 53.9% of students. Migraine with aura caused more disability than migraine without aura. Women experienced more intense migraine than men, and migraine with aura was especially more severe than migraine without aura. Photophobia, phonophobia, and nausea were more commonly encountered in migraine with aura. Despite the high prevalence, the high rate of disability, and the need for analgesic medication, only 7.1% of students with migraine had sought medical treatment.     

A Population-Based Survey of Headache and Migraine in 22,809 Adults

SYNOPSIS
A population-based epidemiological study of the prevalence of headache in a sample of 24,682 adults was carried out in Finland. Enquiries were made concerning the frequency of headache, migraine and characteristics of headache attacks in a questionnaire survey in 1981. Headache was classified as migraine, and headache without migrainous features. Possible somatic causes of headache were excluded by record-linkage with three nation-wide medical registries.
The prevalence of both headache types depended on age and gender. Among women the overall prevalence of migraine was 10.1% with a maximum of 11.5% in the 40-49 age group. The prevalence rate among men was 2.5% and the female/male gender ratio was 4.0. Women with migraine had an average of 52.5 headache occasions during a year and men with migraine 61 headache occasions per year. At the individual level, headache without migrainous features was least invalidating. There were only 16.5 headache occasions a year among women and 11.5 among men. However, from a population perspective headache without migrainous features accounted for 46.5% of all headache occasions among women and for 60.8% among men. Thus, from the public health viewpoint, studies of "non-clinical" headache, e.g. headache without migrainous features should be emphasized.     

Migraine prevalence: a literature review

Worldwide epidemiological studies provide estimates of migraine prevalence. The International Headache Society (IHS) diagnostic criteria have permitted more reliable and generalizable study estimates. In this review, recent population-based reports of IHS-defined migraine are discussed to update the current epidemiological literature, to highlight methodological challenges, and to encourage greater public awareness of this frequently undiagnosed disabling disorder.     

An Epidemiological Study of Headache Among the Monks of Athos (Greece)

SYNOPSIS
The Monks of Athos in Greece constitute a particular group with unusual sleep schedule and specific diet. In order to study the frequency of headache among them, a special questionnaire was designed. Four hundred forty-nine monks below the age of 50 were approached, 39 of whom suffered from frequent (more than one episode per month, in the last 6 months) headaches (8.68%). The prevalence of migraine was 1.78% (0.66% with aura and 1.11% without) and of tension-type headache 3.34% (1.33% chronic and 2% episodic). Furthermore, 1.87% of monks suffered from mixed headaches (tension-type and migraine attacks as well). Cluster headache was not traced.     

Epidemiologic and Clinical Characteristics of Migraine and Tension-Type Headache in Korea

This is the first population-based epidemiologic study of chronic headache in South Korea. The diagnosis and classification of headache was according to the criteria of the International Headache Society. Sixty-eight percent of the studied population experienced headache during the preceding year. The estimated prevalences were 22.3% for migraine (male 20.2%, female 24.3%) and 16.2% for tension-type headache (male 17.8%, female 14.7%). In migraine, the 15-to 19-year age group showed maximal prevalence in both sexes (male 28.5%, female 34.7%). The prevalence of tension-type headache was highest in the 50- to 59-year age group in men(24.2%) and in the 20- to 29-year age group in women(20.2%). In migraine, headache intensity was more severe in women than in men, but in tension-type headache there was no difference in the severity of headache between the sexes. Phonophobia was the most common associated symptom of migraine (65.1%). In the migraine with aura group, the most common aura was visual disturbance, including scintillation and image distortion (82.3%). Only 24.4% of migraineurs and 12.3% of patients with tension-type headache had ever consulted a doctor for headache. The prevalence of migraine was not lower than in western countries and much higher than in previous studies conducted in other Asian countries.     

Flunarizine in Migraine: A Double-blind Placebo-controlled Study (in a Saudi Population)

We evaluated the effect of flunarizine (Fz) (10 mg/d) on migraine in a double-blind placebo-controlled design. The attacks' frequency, duration, severity and associated symptoms were compared before and after treatment. Forty-two patients completed a three-month trial period; 21 patients received Fz and 21 placebo. Statistical analysis showed no significant difference between Fz and placebo (p > 0.05). In this study Fz was not more efficient than placebo in migraine.     

Menstrual Migraine in Adolescents

Objective.— To characterize menstrually associated headaches and migraine in adolescent girls and identify any developmental and pubertal changes. Background.— Headache and migraine is a common problem in adolescents with a transition to adult patterns. One pattern of adult migraine is the menstrual association in a significant number of women. Methods.— A retrospective analysis was performed of characteristics of adolescent's headaches including association with menstrual pattern. A detailed analysis of the patient‐ and parent‐reported headache characteristics and patterns of longitudinal change with development and puberty was reviewed, including timing of headache with age and menstrual period and progression of these events over the adolescence. Results.— Of the 896 girls between 9 and 18 years old reviewed at initial evaluation, 331 (50.3% of menarchal girls and 36.9% of all girls) report experiencing headaches with their menstrual period. Of those reporting a menstrual pattern, 63.6% reported migraines starting between day ?2 and +3 of their menstrual period start. Girls with menstrual migraine reported increased associated symptoms compared with girls without menstrual migraine. There was no difference in disability between girls with a menstrual pattern and those without a menstrual pattern (t = 1.64; P = .10). Additionally, 160 girls reported a monthly pattern to their headaches prior to beginning menstruation, suggestive of a menstrually related migraine pattern prior to menstruation. Conclusions.— The pattern of menstrual association begins to become apparent during adolescence. Once the menstrual pattern has developed, this association is stable. Early identification of this pattern has potential long‐term benefit for improved lifelong outcome.     

Rizatriptan (MAXALT) for the Acute Treatment of Migraine and Migraine Recurrence. A Placebo-Controlled, Outpatient Study

Rizatriptan is a novel 5-HT_1B/1D agonist which is rapidly absorbed after oral administration. The efficacy and tolerability of oral rizatriptan (5 mg and 10 mg) were examined in this multicenter, double-blind, outpatient study of 1473 migraineurs which featured randomized, placebo-controlled treatment of migraine recurrences. On experiencing moderate or severe migraine headaches, patients rated headache severity prior to dosing and at 30-minute intervals for 2 hours after dosing. Onset of effect was seen as early as 30 minutes after dosing with rizatriptan 10 mg. At 2 hours postdose, the percentage of patients with pain relief was significantly higher after rizatriptan 5 mg (62%) or 10 mg (71%) compared with placebo (35%). Complete relief was also significantly higher after rizatriptan 5 mg (33%) and 10 mg (42%) compared with placebo (10%). In patients experiencing headache recurrence after initial benefit, further relief was obtained in 71% with rizatriptan 5 mg (placebo 54%) and in 82% with rizatriptan 10 mg (placebo 44%). Complete relief of recurrent headache was obtained in 36% with rizatriptan 5 mg, 49% with rizatriptan 10 mg, and 15% with placebo ( P <0.05). The most common drug-related adverse experiences were dizziness, somnolence, asthenia/fatigue, and nausea (the incidences of which were low and dose related). There was no increase in the incidence of adverse experiences after use of up to three doses of rizatriptan within 24 hours. We conclude that both doses of rizatriptan are effective and well tolerated in the acute treatment of migraine and migraine recurrence, with the l0-mg dose preferred as it is more effective with a faster onset of action.     

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.     

Prevalence of Migraine and Headache in a High-Altitude Town of Peru: A Population-Based Study

A door-to-door population-based epidemiological study of the prevalence of migraine and headache in a sample of 3246 people older than 15 years of age was carried out in Cuzco, a high-altitude town in the Peruvian Andes, located at 3380 meters.
Among the 3246 screened people, there were 172 cases of migraine and 930 cases of headache, yielding a crude 1-year prevalence of 5.3% for migraine (2.3% among men and 7.8% among women) and 28.7% for headache (17.5% among men and 38.2% among women). Our results suggest that migraine prevalence in Cuzco is close to that of other developing countries, whereas headache prevalence may be higher than in other developing countries. Multivariate logistic regression suggested that both migraine and headache were related to the female sex, age, and anxiety and/or depression.
This study suggests that migraine is a relatively common disorder in Cuzco, but does not show any difference which could be significantly related to altitude. In contrast, our results suggest that headache may be more frequent at high altitude than at sea level.     

Migraine and Concomitant Symptoms Among 8167 Adult Twin Pairs

We studied the inheritance of migraine and concomitant symptoms among 2690 monozygotic (1524 female and 1166 male) pairs and 5497 dizygotic (2951 female and 2546 male) twin pairs. Our material consists of a population-based questionnaire study among Finnish twins in 1981. The definition of migraine is based on a questionnaire method.
Concordance was assessed using probandwise concordance rates and tetrachoric correlations for monozygotic (MZ) and dizygotic (DZ) twin pairs. For estimating the contribution of genetic factors to the susceptibility of migraine, a polygenic multifactorial model was used. Structural equation models were applied for estimating variance components and to compare different genetic models.
Nearly one-half (40% to 50%) of the liability to migraine is attributable to genetic factors. In all structural analyses, the model with both additive genetic and unshared environmental component had the best goodness-of-fit value. The genetic component varied between 34% to 51% in different migraine types. There were no remarkable differences between sexes except in the effects due to dominance, where the proportion was 26% for men and 14% for women. Concomitant symptoms among subjects within pairs concordant for headache had genetic effects varying from 56% (subjects with unilaterality) and 56% (subjects with visual symptoms) to 45% (persons with nausea and vomiting). The two threshold model of headache points to the continuum model of headache, and the thresholds represent different levels of severity of the pain.
Our results emphasize a multifactorial and higher than previously reported genetic pattern in the etiology of migraine. Also unshared environmental factors play an important role.     

偏头痛外科治疗进展

偏头痛不但给患者个人造成痛苦,也给社会都带来巨大的负担。偏头痛的发病机制目前尚未完全阐明,临床上的治疗方法主要包括内科治疗、外科治疗、行为疗法以及针灸等。由于药物治疗只能暂时性缓解症状,并且长期服用会带来恶心、呕吐及其他副作用,因此,外科治疗也许将成为一种有效的根治手段。作者对偏头痛的发病机制、外科治疗的解剖基础及临床应用进行综述。