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1.
Siniatchkin M Riabus M Hasenbring M 《Cephalalgia : an international journal of headache》1999,19(3):165-173
Psychological factors are important in the chronification and aggravation of headaches. We studied 90 patients suffering from migraine, chronic daily headache (CDH) evolved from migraine, and episodic or chronic tension-type headache (TTH). Emotional, cognitive, and behavioral pain coping were assessed using the Kiel Pain Inventory (KPI), Beck's Depression Inventory, the State-Trait-Anxiety Inventory, and Quality of Life Questionnaire. In addition, the clinical course of headache was analyzed using a validated headache diary. The results were as follows. Firstly, the KPI is reliable internally for the assessment of pain-coping strategy employment among headache patients. Secondly, migraine sufferers were characterized by pronounced psychological abnormalities during the headache phase, demonstrating a less adaptive coping behavior. This was in contrast to the TTH patients, who showed more general distress manifesting in elevated anxiety and lower quality of life. The only factor which appeared to be essential for differentiating between migraine and TTH was the intensity of headache. Thirdly, chronic TTH and CDH evolved from migraine demonstrated more pronounced psychological disabilities and more severe clinical courses of headaches than episodic TTH or nontransformed migraine. The predictor variable for transformation of migraine was impairment of well-being/quality of life, and for transformation of TTH, the frequency of headaches and depression. Finally, analgesic misuse seems to be less important for chronification and transformation of headaches than the degree of psychological disability. This study draws attention to the role of psychological factors in the chronification of TTH and transformation of migraine and provides some recommendations for the behavioral treatment of chronic headaches. 相似文献
2.
Limited studies have investigated the prevalence of insomnia symptoms among individuals with different headache diagnoses
and the association between insomnia and headache in subjects with comorbid anxiety and depression. A total of 310 community-dwelling
Hong Kong Chinese women aged 40–60 years completed a self-administered questionnaire on headache, sleep difficulties, mood
disturbances, and functional impairment. About 31% of the sample complained of recurrent headache unrelated to influenza and
the common cold in the past 12 months. The percentages of women diagnosed to have migraine, tension-type headache (TTH), and
headache unspecified were 8.4, 15.5 and 7.1%, respectively. The most frequent insomnia complaint was “problem waking up too
early” (29.4%), followed by “difficulty staying asleep” (28.0%) and “difficulty falling asleep” (24.4%). Women with headaches
were significantly more likely to report insomnia symptoms than those without headaches. There were no significant differences
among women with migraine, TTH, and headache unspecified in the prevalence of insomnia symptoms. Logistic regression analysis
showed that women with insomnia disorder as defined by an insomnia severity index total score ≥8 had 2.2-fold increased risk
of reporting recurrent headache, 3.2-fold increased risk of migraine, and 2.3-fold increased risk of TTH, after adjusting
for anxiety and depression. Individual insomnia symptoms were not independent predictors. The association between insomnia
and headache was stronger in subjects with more frequent headaches. Our findings suggest that insomnia and the associated
distress, but not insomnia symptoms alone, is an independent risk factor for recurrent headache in middle-aged women with
mixed anxiety, depression and sleep disturbances. 相似文献
3.
Behavioral and nonpharmacologic treatments of headache 总被引:1,自引:0,他引:1
Lake AE 《The Medical clinics of North America》2001,85(4):1055-1075
Cognitive-behavioral analysis and the multiaxial assessment of relevant behavioral domains (headache frequency and severity, analgesic and abortive use and misuse, behavioral and stress-related risk factors, comorbid psychiatric disorders, and degree of overall functional impairment) help set the stage for CBT of headache disorders. Controlled studies of CBTs for migraine, such as biofeedback and relaxation therapy, have a prophylactic efficacy of about 50%, roughly equivalent to propranolol. Cluster headache responds poorly to behavioral treatment. The persistent overuse of symptomatic medication impedes the effectiveness of behavioral and prophylactic medical therapies. Behavioral treatment can help sustain improvement after analgesic withdrawal, however, and prevent relapse in cases of analgesic overuse. Cognitive factors (e.g., an enhanced sense of self-efficacy and internal locus of control) appear to be important mediators of successful behavioral treatment. Patients with CDH are more likely to overuse symptomatic medication (and in some cases abuse analgesics), have more psychiatric comorbidity; have more functional impairment and disability, and are at least as likely to experience stress-related intensification of headache as patients whose episodic headaches occur less than 15 days per month. Despite the significance of these behavioral factors, patients with CDH (particularly those with migrainous features) are less likely to benefit from behavioral treatment without concomitant prophylactic medication than is the case for episodic TTH and migraine sufferers. Continuous daily pain may be more refractory to behavioral treatment as a solo modality than CDH marked by at least some pain-free days or periods of time. The combination of behavioral therapies with prophylactic medication creates a synergistic effect, increasing efficacy beyond either type of treatment alone. Compliance-enhancement techniques, including behavioral contracts for patients with severe personality disorders, can increase adherence to behavioral recommendations. CBT has earned an important place in the comprehensive treatment of patients with episodic migraine/TTH and severe, treatment-resistant chronic daily headache. 相似文献
4.
Luigi A. Pini 《The journal of headache and pain》2003,4(1):1-6
The role of daily analgesic use (also called abuse) in chronic daily headache (CDH) for the maintenance of chronic headache
is discussed. The comprehension of the underlying mechanisms of actions is lacking mainly because of the absence of animal
models. The abuse should be considered as a compulsive behavior rather than linked to the type of analgesic used and related
both to “how” the drug is taken and to “what” drug is used. Moreover, there is no evidence of addictive personality in these
patients, and also predictive factors for the long-term outcomes are inconsistent. In the literature specific indications
are lacking for the treatment to be performed in these patients. In conclusion, the main problem for these patients is to
manage their headaches, and the aim of the therapy should be to enable patients to feel in control of their migraine rather
than feel that migraine or analgesic drugs control them.
Correspondence to L.A. Pini 相似文献
5.
Schulman EA 《Current pain and headache reports》2001,5(5):454-462
Tension-type headache (TTH) is the most prevalent form of headache. Although it is not the most severe form of headache, it
has a significant impact on society. In spite of this, little is known about its pathophysiology. Current International Headache
Society classification has been called into question, and new classification approaches have been suggested. With reference
to chronic TTH, the issue of analgesic rebound may confound the diagnosis. Transformed migraine and new persistent daily headaches
are clarified and differentiated from chronic TTHs (CTTHs).
The best documented abnormality found in TTHs is the presence of pericranial tenderness. It is generally believed that pain
is initiated by a peripheral mechanism, most likely increased input from the myofascial nociceptors. In CTTH, there may be
an impaired supraspinal modulation of the incoming stimuli. Whether there is an overlap in the continuum between TTH and migraine
is controversial. Abortive and prophylactic treatments are discussed and wellness and adjunct therapy are also emphasized.
Lastly, special attention is paid to the doctor-patient relationship in patients with difficult headaches. 相似文献
6.
Sacco S 《Current pain and headache reports》2008,12(6):437-441
The diagnosis of tension-type headache (TTH) is divided into two categories: episodic TTH and chronic TTH. It is important
to differentiate TTH from other headaches, including primary and secondary headaches. Significant overlap in the diagnostic
criteria makes it difficult to differentiate TTH from other headache disorders and, in particular, migraine. A controversy
exists about whether TTH and migraine represent a continuum of the same pathophysiological process. 相似文献
7.
Migraine and tension-type headache (TTH) are highly prevalent primary headaches that remain underdiagnosed and undertreated
in clinical practice. The similarities and differences between migraine and TTH may impose diagnostic challenges as well as
management difficulties. In addition, the possibility of migraine chronification or transformation in daily or near-daily
headache raises the potential level of interaction between pathophysiologic mechanisms of TTH and migraine. The continuum
concept is a possible key to the understanding of this association. Future studies are necessary to clarify epidemiology,
pathophysiology, and management of these two most prevalent headaches. 相似文献
8.
The aim of this study was to estimate the 1-year prevalence of headache, migraine, tension-type headache (TTH) and chronic daily headache (CDH), and the degree of association of migraine with some sociodemographic characteristics of the population of Florianopolis, Brazil. This is a cross-sectional, door-to-door, population-based study. In 300 randomly selected households, 625 subjects, aged 15-64 years, responded to a structured questionnaire. The 1-year prevalence of headache was 80.8%, of migraine 22.1%, of TTH 22.9%, and of CDH 6.4%. Migraine and CDH were significantly more prevalent in females than in males. Migraine was significantly associated with the following variables: low household income, low electricity consumption, and divorced or widowed marital status. We have shown high prevalences of migraine and CDH in Florianopolis, close to the higher rates of previous studies. There was a preponderance of migraine in females, divorced or widowed, with a low socioeconomic level. 相似文献
9.
Levin M 《Current pain and headache reports》2004,8(1):59-65
Chronic daily headache (CDH) is surprisingly common. It is best defined as a primary headache disorder with head pain on most
days. There are a number of possible secondary causes of persistent headache, including traumatic, vascular, neoplastic, and
infectious processes, all of which must be ruled out when the patient with frequent headache is evaluated. However, most patients
with CDH seem to have a primary neurophysiologic disorder. This category of primary CDH does not seem to be a homogeneous
disorder, but rather one with important subtypes. Several authors have proposed subdivisions of primary CDH such as chronic
migraine, evolved migraine, transformed migraine, chronic tension-type headache, new daily persistent headache, and hemicrania
continua. The International Headache Society (IHS) Classification published in 1988 did not address CDH other than to define
a category “chronic tension-type headache.rd The revised IHS Classification (ICHD II) attempts to characterize CDH more thoroughly
with the addition of chronic migraine and new daily persistent headache diagnoses, but this complex issue continues to defy
easy categorization. This article provides a review of thinking about the nature of primary CDH and how ICHD II attempts to
organize this category for much needed research purposes. 相似文献
10.
The prevalence and the
clinical features of chronic daily
headache (CDH) were studied in
968 children and adolescents
observed during a period of one
year in the Headache Centre of the
Anna Meyer Paediatric Hospital of
Florence. Nine hundred and fortyfour
patients (97.52%) had primary
headache according to ICHD-II, 24
subjects had secondary headache
and 56 patients had CDH (5.93%
of primary headaches). The mean
age of subjects with CDH was
higher than general (13.5 vs. 11.5
years), with a female preponderance
(69.6% vs. 30.4%). According
to the ICHD-II, headaches were
classified as chronic migraine in 10
patients (1.5.2 ICHD-II), chronic
tension-type headache in 36 (2.3
ICHD-II), new daily persistent
headache in 8 (4.8 ICHD-II) and 2
patients reported mixed pattern
(chronic migraine+chronic tension
type headache). Medication
overuse was not implicated in our
patients. 相似文献
11.
J Rothrock M Patel P Lyden C Jackson 《Cephalalgia : an international journal of headache》1996,16(1):44-49
We compared data from 243 patients with episodic migraine (EM) and 132 patients with chronic daily headache (CDH). We divided the matter group into those with tension-type headache only (CDH Type 1) and those with headaches having migrainous features (CDH Types 2+3) and compared each with the EM group and all three groups with one another. CDH Type l patients differed from those in the other groups by virtue of gender (more often male) and mean age at headache onset (older). The CDH Types 2+3 and EM groups differed only in that the former were more likely to have undergone a brain-imaging study. These data suggest that CDH Type 1 may represent a distinct headache syndrome, while CDH Types 2+3 closely resemble episodic migraine. 相似文献
12.
BACKGROUND: Mood disorders of anxiety and depression are well known to be comorbid with primary headache disorders. Less is known of the comorbidity of other somatic symptoms with headache. METHODS: Headache Clinic patients were screened with the Primary Care Evaluation of Mental Disorders (PRIME-MD), a multidimensional psychiatric screening tool. The prevalence of somatic symptoms was compared by headache diagnosis, frequency of severe headache, and psychiatric diagnosis. Follow-up data were obtained 6 months after consultation. RESULTS: Clinical diagnoses and PRIME-MD data were available for 289 patients. Associated somatic symptoms were more frequent in patients with chronic migraine (mean 5.5, P<.001) and chronic daily headache (CDH) (6.3, P=.008) compared to episodic migraine (4.0); in patients with severe headache >2 days per week compared to 2 days per week had significantly higher somatic counts (P=.01). Six-month follow-up data were available for 140 patients. Associated symptoms decreased both for patients with and without decrease in severe headache frequency (mean reduction of 1.0, P=.01 and 0.8, P=.003, respectively). CONCLUSION: Associated somatic symptoms are more common in patients with chronic migraine and CDH, with more frequent severe headaches, and with associated anxiety or depression. Patients with episodic migraine have similar somatic prevalence as a previously studied primary care population. The spectrum of headache disorders may be characterized as showing increasing somatic prevalence as headaches, particularly severe headaches, become more frequent. 相似文献
13.
Kukava M Dzagnidze A Janelidze M Mirvelashvili E Djibuti M Fritsche G Jensen R Stovner LJ Steiner TJ Katsarava Z 《The journal of headache and pain》2007,8(6):321-324
In a pilot phase of a survey of the prevalence of primary headache disorders in the Republic of Georgia, we validated a Georgian
language questionnaire for migraine (MIG), tension-type headache (TTH), MIG+TTH and trigeminal autonomic cephalalgias (TAC).
A population-based sample of 186 people with headache completed the questionnaire and were blindly examined by one of two
headache experts. The questionnaire diagnoses were: MIG 49, TTH 76, MIG+TTH 45 and TAC 16. The physicians’ diagnoses were:
MIG 59, TTH 77, MIG+TTH 34, TAC 2 and “symptomatic headache” in 14 subjects. Sensitivity and specificity for MIG were 0.75
and 0.96, for TTH 0.79 and 0.86, and for MIG+TTH 0.61 and 0.84 respectively. Of 16 TAC diagnoses, the physicians confirmed
cluster headache in two patients only. The questionnaire can be utilised to investigate the prevalence of MIG and of TTH.
It offers preliminary screening only for TAC, which should be confirmed during a face to face examination.
This is a “Springer Open Choice” article. Unrestricted non-commercial use, distribution, and reproduction in any medium is
permitted, provided the original author and source are credited.
An erratum to this article can be found at 相似文献
14.
Patricia A. McGrath PhD 《Current pain and headache reports》2001,5(6):557-566
Chronic daily headache (CDH), an almost continual headache in the absence of organic pathology, is an exceptionally challenging
type of headache to treat in children and adolescents. CDH has different expressions in children and adults; the different
expressions may reflect several different etiologies or a developmental continuum. Although a positive family history predisposes
children to develop headache, many environmental, biological, and psychological processes may share a role in the etiology.
To date, no studies have examined the pathophysiology of CDH in children so that our understanding is presumed, rather than
documented, and based primarily on extrapolation from adult studies. For some cases with migraine features, presumed mechanisms
include a neurogenic inflammatory cascade, vascular reactivity, and serotonin, whereas for other cases, mechanisms may include
pericranial muscle tenderness or musculoskeletal abnormalities, as noted recently for adults.
A skilled and careful history is the first step to ensuring an accurate diagnosis for children with CDH. Pain assessment is
an integral component of diagnosis and treatment. We need an objective measure of headache activity and an understanding of
the factors that cause or exacerbate headaches for an individual child. Although many drug and nondrug therapies are available
for treating children’s headache, we lack data about which therapies are best for children with CDH or its subtypes. The current
principles guiding our management of CDH in children and adolescents are extrapolated from the existing literature on childhood
headache, CDH in adults, and our clinical experience. A child-centered focus is particularly important in the treatment of
CDH because it is not caused by an underlying disease or disorder. 相似文献
15.
Yokoyama M Suzuki N Yokoyama T Yokoyama A Funazu K Shimizu T Shibata M 《The journal of headache and pain》2012,13(2):137-145
The aim of the study was to investigate associations between headache types and alcohol drinking, alcohol flushing, and hangover.
Alcohol consumption is inhibited by the presence of inactive aldehyde dehydrogenase-2 (ALDH2) whose carriers are susceptible
to alcohol flushing and hangovers. We conducted a cross-sectional study of the 2,577 subjects (men/women: 1,018/1,559) who
reported having ever experienced headaches unrelated to common colds and alcohol hangovers among 5,408 (2,778/2,630) Tokyo
health checkup examinees. We used a questionnaire inquiring about current and past facial flushing after drinking a glass
of beer which identifies the presence of inactive ALDH2 with a sensitivity and specificity of approximately 90%. Based on
ICHD-II criteria migraine was diagnosed in 419 (75/344) subjects, and tension-type headache (TTH) in 613 (249/364). We classified
the headaches of the remaining 1,545 (694/851) of headaches sufferers into the category “other headaches (OH)”. The migraineurs
drank alcohol less frequently than the subjects with TTH among current/past alcohol flushers and than the subjects with OH
regardless of flushing category. No such difference in drinking frequency was observed between TTH and OH. Current/past flushers
drank alcohol less frequently than never flushers, and the likelihood that male migraineurs would avoid alcohol drinking than
men with TTH or OH was stronger among current/past flushers than among never flushers. Flushers and women were more susceptible
to hangover than never flushers and men, respectively, regardless of headache type. Among never flushers, women with migraine
were more susceptible to hangover than women with OH. The difference in alcohol sensitivity may partly explain less alcohol
consumption by migraineurs. 相似文献
16.
Wang Y Zhou J Fan X Li X Ran L Tan G Chen L Wang K Liu B 《The journal of headache and pain》2011,12(5):561-567
This study aimed to analyze and classify the clinical features of headache in neurological outpatients. A cross-sectional
study was conducted consecutively from March to May 2010 for headache among general neurological outpatients attending the
First Affiliated Hospital of Chongqing Medical University. Personal interviews were carried out and a questionnaire was used
to collect medical records. Diagnosis of headache was according to the International classification of headache disorders,
2nd edition (ICHD-II). Headache patients accounted for 19.5% of the general neurology clinic outpatients. A total of 843 (50.1%)
patients were defined as having primary headache, 454 (27%) secondary headache, and 386 (23%) headache not otherwise specified
(headache NOS). For primary headache, 401 (23.8%) had migraine, 399 (23.7%) tension-type headache (TTH), 8 (0.5%) cluster
headache and 35 (2.1%) other headache types. Overall, migraine patients suffered (1) more severe headache intensity, (2) longer
than 6 years of headache history and (3) more common analgesic medications use than TTH ones (p < 0.001).TTH patients had more frequent episodes of headaches than migraine patients, and typically headache frequency exceeded
15 days/month (p < 0.001); 22.8% of primary headache patients were defined as chronic daily headache. Almost 20% of outpatient visits to the
general neurology department were of headache patients, predominantly primary headache of migraine and TTH. In outpatient
headaches, more attention should be given to headache intensity and duration of headache history for migraine patients, while
more attention to headache frequency should be given for the TTH ones. 相似文献
17.
E Kung SJ Tepper AM Rapoport FD Sheftell & ME Bigal 《Cephalalgia : an international journal of headache》2009,29(1):17-22
We conducted a clinic-based study focusing on the clinical features of new-onset chronic daily headaches (CDH) in children and adolescents. The clinical records and headache diaries of 306 children and adolescents were reviewed, to identify 187 with CDH. Relevant information was transferred to a standardized form that included operational criteria for the diagnoses of the headaches. Since we were interested in describing the clinical features of these headaches, we followed the criteria A and B of the 2nd edn of the International Classification of Headache Disorders (ICHD-2) and refer to them as new daily persistent headaches (NDPH) regardless of the presence of migraine features (therefore, this is a modified version of the ICHD-2 criteria). From the 56 adolescents with NDPH, most (91.8%) did not overuse medications. Nearly half (48.1%) reported they could recall the month when their headaches started. NDPH was more common than chronic tension-type headache in both adolescents overusing and not overusing medication. Individuals with NDPH had headaches fulfilling criteria for migraine on an average of 18.5 days per month. On most days, they had migraine-associated symptoms (one of nausea, photophobia or phonophobia)). NDPH is common in children and adolescents with CDH. Most subjects do not overuse medication. Migraine features are common. 相似文献
18.
Seshia SS 《Current pain and headache reports》2012,16(1):60-72
Chronic daily headache (CDH) may be primary or secondary. Secondary causes can be suspected through “red flags” in the history
and examination. With a prevalence of at least 1% and several associations, primary CDH is a common, often complex, chronic
pain syndrome in children and adolescents. The intricate associations between stressors, psychiatric disorders (especially
anxiety and depression), and CDH can be explained by “the limbically augmented pain syndrome” proposed by Rome and Rome. Disorders
of sleep and other pain syndromes also may co-occur. For these reasons, a multiaxial classification is ideal. Many with primary
CDH have features of both chronic migraine and chronic tension-type headache, contributing to confusion in subtyping. Primary
CDH is often transformed from a primary episodic headache type, stressors being most responsible. Genetic factors also may
facilitate chronification. Management should be biopsychosocial, family-centered, and often multidisciplinary, drugs being
only one component. Treatment is still based on consensus, not evidence. Girls, migraineurs, and those with psychiatric comorbidity,
medication overuse, and CDH onset before the age of 13 years and lasting for 2 years or longer, are at high risk for persistence;
hence, such patients should be followed up into adult life. A classification for CDH should be included in the third edition
of the International Classification of Headache Disorders. 相似文献
19.
Tension-type headache (TTH) is a relatively featureless headache. Many primary and secondary headache disorders can mimic
TTH, particularly in its chronic form, chronic tension-type headache. This review will address both primary and secondary
disorders that can present with headaches phenotypically similar to TTH, and will focus on clinical pearls that help distinguish
these “mimics” from TTH. 相似文献
20.
Chakravarty A 《Cephalalgia : an international journal of headache》2005,25(10):795-800
Chronic Daily Headache (CDH) is uncommon in Indian children compared to their adult counterpart. This is a retrospective study looking at the headache phenomenology of CDH in Indian children and adolescents. The validity of the case definitions of subtypes of chronic primary headaches mentioned in the IHS 2004 classification have been evaluated. 22 children (age range 8-15 years; M : F-16 : 6) diagnosed as having primary CDH using a modified definition seen between 2002 and 2003 have been studied. CDH has been defined as daily or near daily headaches > 15d/month for > 6 weeks. The rationale for this modified definition has been discussed. Majority of children (15/22) had a more or loss specified time of onset of regular headache spells resembling New Daily Persistent Headache (NDPH) but did not fulfil totally the diagnostic criteria of NDPH as laid down by IHS 2004. In all cases headache phenomenology included a significant vascular component. Headache phenomenology closely resembled Chronic Tension Type Headache (CTTH) in 4 patients and Chronic Migraine in 3 patients. However, in no patient in these groups, a history of evolution from the episodic forms of the diseases could be elicited. Heightened level of anxiety mostly related to academic stress and achievement was noted in the majority (19/22). Only a minority of patients (3/22) had anxiety and depression related to interpersonal relationships in the family. Medication overuse was not implicated in any patient. CDH in children in India is very much different from CDH in adults with the vast majority of patients exhibiting overlapping features of migraine and tension-type headache. There is need for a modified diagnostic criteria and terminology for chronic primary headaches in children. 相似文献