Factors Influencing Treatment-Seeking Behavior In Problem Headache Sufferers

SYNOPSIS
Subject samples used in research on recurrent headache disorders typically are composed of individuals who are seeking or receiving treatment. To the extent such subjects are unrepresentative of the larger population of recurrent headache sufferers, the external validity of findings may be jeopardized. We examined young recurrent (tension-type or migraine) headache sufferers and compared individuals who had sought treatment (N=81) and individuals who had not sought treatment (N=109) for their headache problem. Subjects who did not experience headaches (N=129) served as a comparison group. Recurrent headache sufferers who had sought treatment reported more frequent headaches and experienced problem headaches for a longer period of time than recurrent headache sufferers who had not sought treatment for their headaches. However, the two treatment-seeking groups did not differ on measures of psychological symptoms, coping strategies, or beliefs about their headache disorder. Irrespective of whether they had sought treatment or not sought treatment for their headache problems, recurrent headache sufferers reported higher levels of depression and physical symptoms than comparison subjects. These results provide no support for the hypothesis that psychological symptoms or neuroticism are associated with treatment-seeking behavior in recurrent headache sufferers.     

Patient-centered outcomes for frequent headaches

OBJECTIVE: To identify clinical outcomes that headache sufferers consider meaningful. BACKGROUND: Several standardized instruments have been developed to assess the severity of headaches and the impact of headaches on an individual's quality of life. To our knowledge, however, little research has been conducted to determine which of these many clinical endpoints are considered by headache sufferers themselves to be most important. METHODS: We conducted 4 focus groups with patients with frequent headaches who had recently participated in a randomized clinical trial. Subjects were informed that the purpose of the focus groups was to help healthcare providers learn how to better recognize if their patients' headache conditions improved or worsened over time. RESULTS: Five salient topics emerged from the discussions: (1) severity of pain associated with headaches; (2) definition of meaningful symptom relief; (3) uncertainty regarding timing and severity of headaches; (4) devaluation of the impact of headaches on sufferers; and (5) assessments of pain. Participants stated unambiguously that headache pain is one of the most important aspects of their headache experience. Each of the 4 groups agreed that an increase in the number of pain-free days would be meaningful. Participants also reported that daily headache diaries are not overly burdensome to complete and that the diaries helped them identify useful trends over time. CONCLUSIONS: Our findings suggest that severity and frequency of headache pain are important clinical outcomes from patients' perspective, and that headache diaries are a feasible and useful method of assessing meaningful clinical change over time. Although standardized questionnaires that assess functional status, disability, or health-related quality of life may help quantify patients' response to treatment for frequent headaches, participants in this study did not consider such questionnaires particularly informative. Further research is needed to validate headache diaries among patients with headache in the primary care setting.     

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.     

The Headache Self-Efficacy Scale: Adaptation to Recurrent Headaches

SYNOPSISThis paper describes the development, construct and discriminant validity, and incremental utility of a headache self-efficacy scale. The Headache Self-Efficacy Scale is a 51 item scale designed specifically for recurrent headache sufferers. It assesses individuals' belief that they are able to do the things necessary to prevent a moderately painful headache when confronted with personally relevant headache precipitants. High self-efficacy was associated with less depression, anxiety, and physical symptoms, and less use of passive coping strategies (P<.01), even when headache frequency, intensity and chronicity were controlled statistically. Self-efficacy also explained unique variance in psychological and somatic symptoms beyond that explained by locus of control and general self-efficacy. These findings suggest that adaptation to headaches is influenced by self-efficacy beliefs, and that the assessment of self-efficacy may provide useful information in the evaluation of recurrent headache sufferers.     

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.     

The Relationship of Cocaine to Headache in Polysubstance Abusers

SYNOPSIS
In a questionnaire survey of inpatient polysubstance abusers it was found that cocaine relieved migraine-type headaches much more often in chronic headache sufferers than in those with only occasional headaches (p < .05). However, cocaine could also bring on headaches after several hours, both in chronic headache sufferers and in those not subject to headaches. The fasts that cocaine may relieve headache immediately, and also may precipitate headaches several hours after use, suggests that the well-known vasoconstrictive actions of cocaine may be responsible. Migraineurs seem more susceptible to some of these effects of cocaine than are people without chronic headaches.     

Effects of Headache on Working Ability: A Survey of an Urban and a Rural Population in Northern Finland

SYNOPSISIn a headache survey in which a self-administered questionnaire was used, the respondents were asked to estimate work absence frequency, effect on daily activities and disability due to headache. Work absence was not a common occurrence. Only 2632018 respondents (13%) who suffered from headaches were absent from work one or more days during the previous year. Of these, absence was estimated at 1–3 daysyear in 41%, and 7 days or less, in 55%. 28% stated that they had been absent but were unable to estimate the number of days. Self-employed persons had a higher percentage of absence than other employed categories, and the rural self-employed and rural housewives had the highest percentage of absence. 22% stated that headache did not affect their work, 26% were able to carry on by easing their pace of work, and 47% were forced to rest or lie down during an attack. In a random sample of 154 personally examined headache sufferers, vascular headaches were more incapacitating, but did not cause more frequent absence from work.     

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.     

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.     

Cognitive Correlates of Headache Intensity and Duration

Cognitive processes and cognitive styles of persistent headache sufferers were examined in relation to indices of intensity and duration of head pain. One hundred and eight persistent headache patients, referred for cognitive-behavioral management of their disorder, completed questionnaires designed to assess: distressing thoughts and feelings experienced during headache attacks, evaluation of the experienced pain, perceived influence of stress and worry on headaches, and capacity to verbally express emotions. The results showed that the intensity of head pain correlated with measures of headache-related distress and with the proportion of headache-related distress to situation-related distress. Duration of head pain was also associated with the proportion of headache-related distress to situation-related distress, and additionally with a tendency to deny the influence of stress and worry on headaches and with difficulty in expressing emotions. These findings were taken as support of our previously stated hypothesis that head pain of increased severity is associated with a cognitive shift whereby the patient's primary concern moves from situational and interpersonal distress to distress associated with the disorder itself. In addition, these findings point to affective distress and lack of emotional expressiveness as correlating differentially with the headache dimensions of intensity and duration.     

Prevalence of frequent headache in a population sample

PURPOSE: Patients with daily or near-daily headaches are commonly seen in neurology practices and in headache subspecialty centers, but there is little information on the prevalence of this condition in the general population. We present the first US-based study describing the prevalence and characteristics of frequent headache in the general population. METHODS: In Baltimore County, Maryland, 13 343 individuals 18 to 65 years of age were selected by random-digit dialing and interviewed by telephone about their headaches. Subjects reporting 180 or more headaches per year were classified as having frequent headache. Three mutually exclusive subtypes of frequent headache were identified: frequent headache with migrainous features, chronic tension-type headache, and unclassified frequent headache. RESULTS: The overall prevalence of frequent headache was 4.1% (5.0% female, 2.8% male; 1.8:1 female to male ratio). Frequent headache was 33% more common in Caucasians (4.4%) than in African Americans (3.3%). In both males and females, prevalence was highest in the lowest educational category. Among frequent headache sufferers, more than half (52% female, 56% male) met criteria for chronic tension-type headache, almost one third (33% female, 25% male) met criteria for frequent headache with migrainous features, and the remainder (15% female, 19% male) were unclassified. Overall, 30% of female and 25% of male frequent headache sufferers met International Headache Society (IHS) criteria for migraine (with or without aura). CONCLUSIONS: Frequent headache is common in the general population and is more prevalent in Caucasians and in those with less than a high school education. Chronic tension-type headache is more common than frequent headache with migrainous features, though the latter is more disabling. Although more common in females than males, the female preponderance of frequent headache is less marked than in migraine. The sex ratio varies by frequent headache subtype.     

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.     

Dynamic assessment of abnormalities in central pain transmission and modulation in tension-type headache sufferers

OBJECTIVE: To examine and compare central pain processing and modulation in young tension-type headache sufferers with that of matched healthy controls using an induced headache "challenge" paradigm. BACKGROUND: Recent research has suggested that abnormalities in central pain processing and descending pain modulation may contribute to chronic tension-type headache. These abnormalities, if they contribute to headache pathogenesis, should be present in young adult tension-type headache sufferers. Recent research using static measures of physiological variables, such as muscle tenderness and exteroceptive suppression, has identified chronic muscle tenderness as a characteristic of young tension-type headache sufferers, but other central nervous system functional abnormalities may require a dynamic "challenge" to be observed. METHODS: Twenty-four young women meeting the International Headache Society diagnostic criteria for tension-type headache (headache-prone) and a matched group of 24 healthy women who reported fewer than 10 problem headaches per year (control) participated in a double-blind, placebo-controlled, crossover study. Subjects completed jaw clenching and a placebo condition on different days in counterbalanced order. Pericranial muscle tenderness, pressure-pain thresholds on the temporalis, and exteroceptive suppression periods were assessed before and after each procedure. Head pain was recorded for 12 to16 hours following each condition. RESULTS: Headache-prone subjects were more likely than controls to experience headaches after both the jaw clenching and placebo procedures, but neither group was significantly more likely to experience headaches following jaw clenching than placebo. In pretreatment measurements, headache-prone subjects exhibited greater muscle tenderness than controls, but pressure-pain detection thresholds and exteroceptive suppression periods did not differ in the two groups. Control subjects showed increases in muscle tenderness and exteroceptive suppression periods following both the clenching and placebo procedures, whereas headache-prone subjects exhibited no significant changes in any of the physiological measures following either experimental manipulation. CONCLUSIONS: These results confirm previous findings indicating abnormally high pericranial muscle tenderness in young tension headache sufferers even in the headache-free state. In addition, the results suggest that the development of headaches following noxious stimulation is more strongly related to headache proneness and associated abnormalities in central pain transmission or modulation (indexed by pericranial muscle tenderness and exteroceptive suppression responses) than muscle strain induced by jaw clenching.     

Psychosocial impact of headache and comorbidity with other pains among Swedish school adolescents

BACKGROUND: The psychosocial impact of headache combined with other pains has previously been insufficiently investigated. OBJECTIVE: The present study examined the prevalence of headache, its comorbidity with other pains and psychosocial impact among adolescents. METHODS: 793 adolescents in a sample recruited from 8 schools in the middle of Sweden were assessed. RESULTS: Forty-five percent of the adolescents reported ongoing pain during assessment and more than half of the adolescents reported at least one frequent pain during the previous 6 months. The most common pain among girls was headache (42%), but for boys muscle pain (32%) was most prevalent. Number of pains and perceived pain disability were also higher among girls than boys. One-third of the headache sufferers had headache only, while one-third reported one other frequent pain and the others had at least two other frequent pains. Overall, adolescents with frequent headaches had higher levels of anxiety or depressive symptoms, in addition to functional disability and usage of analgesic medication. Frequent headache sufferers reported more problems in everyday life areas than those with infrequent headaches. CONCLUSIONS: It is recommended that adolescents suffering from recurrent headaches routinely should be asked about the presence of other pains, anxiety and depressive symptoms, medication usage, in addition to psychosocial consequences in their everyday life activities. Longitudinal research is also needed to delineate causal relationships between psychosocial factors and recurrent pains, in particular regarding possible sex differences.     

Headache secondary to deep brain implantation

This article examines the headaches that can develop with deep brain stimulation. We identified 15 (23.4%) of 64 patients who developed chronic headaches following implantation of deep brain stimulation electrodes for relief of chronic pain syndromes. Electrodes were implanted in the periaqueductal gray, sensory thalamus, and internal capsule. None of these 15 patients reported similar headaches prior to the implantation. Although 5 patients were intermittent headache sufferers prior to implantation, they reported post-implantation headaches to be completely different in nature. Our experience suggests that headache syndromes may arise due to disturbance of serotonergic neurotransmission within deep brain structures.     

Associations between frequent headaches, persistent smoking, and attempts to quit

BACKGROUND: Recent studies have found a strong relationship between tobacco smoking and headache pain. It remains unclear whether smoking behavior leads to headache or visa versa, mainly due to the cross-sectional nature of the majority of this research. OBJECTIVE: To help clarify the direction of the relation between smoking and frequent headaches in a representative cohort study. DESIGN AND METHODS: Members of the Dunedin Multidisciplinary Health and Development Study (N=980) were asked about their cigarette smoking and headache history at ages 11 and 13 (childhood), age 15 (mid-adolescence), and age 26 (adulthood). Both cross-sectional and longitudinal associations between smoking and headache status were examined using logistic regression. RESULTS: During mid-adolescence, the likelihood of frequent headaches doubled for smokers relative to nonsmokers (OR: 2.16, 95% CI: 1.39-3.35). Smoking did not increase the risk of developing headaches in adulthood, however. In contrast, individuals who suffered from frequent headaches during mid-adolescence were 2 times more likely to smoke in adulthood than those without headache (OR: 2.20, 95% CI: 1.3-3.7), after controlling for sex and family socioeconomic status. Attempts to quit smoking were significantly more difficult for migraine sufferers with a history of headache than for those with tension-type headache. CONCLUSIONS: Frequent headaches during mid-adolescence appear to increase the risk of daily smoking in adolescence and adulthood. These individuals also have a more difficult time quitting than their headache-free peers.     

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.     

Perfectionists' appraisal of daily hassles and chronic headache

OBJECTIVE: To investigate the relationships between daily hassles, perfectionism, and the experience of chronic headache among university students. BACKGROUND: Headaches are very common among university students. It has been found that a higher number of hassles reported by students is associated with an increase in headache activity. It has also been suggested that individuals higher in perfectionism appraise more situations as hassles, and that this dispositional characteristic may constitute a risk factor for the experience of chronic headaches. METHODS: A total of 291 university students completed three questionnaires: (1) the Headache Assessment Questionnaire that was utilized to obtain information on headache occurrence and its features, (2) the Brief College Student Hassles Scale, and (3) the Multidimensional Perfectionism Scale. RESULTS: A total of 18 students (6.2%) met the 2004 IHS criteria for chronic headaches, 179 (61.5%) met the criteria for frequent headaches, and 69 (23.7%) met the criteria for infrequent headaches. Students with chronic headaches reported significantly more stress, as measured by daily hassles. They also exhibited higher levels of perfectionism. The number of hassles reported was a significant predictor of headache frequency, intensity, and duration. Analyses also revealed that perfectionism was a significant predictor of headache frequency and intensity. CONCLUSIONS: The present study indicates that there is a relationship between perfectionism and chronic headache in university students, with those higher in perfectionism experiencing more frequent headaches. This investigation confirmed the relationship between daily hassles and chronic headache in this population. The results also suggest that perfectionists may generate their own stress through their tendency to appraise more situations as hassles. This, in turn, may explain their tendency to experience chronic headaches.