Prevalence and clinical characteristics of headache in a rural community in Oman

OBJECTIVES: To perform a prospective epidemiological study of headache in a rural community in Oman, assessing prevalence, symptom profile, and health care utilization pattern. METHODS: Using a door-to-door survey prevalence estimates were based on a detailed structured headache assessment questionnaire performed in 1158 subjects. Migraine and tension-type headache were diagnosed according to the International Headache Society criteria. RESULTS: The crude lifetime and last-year prevalence of headache were 83.6% and 78.8%, respectively, with a female preponderance. The last-year prevalence of migraine and tension headache was 10.1% and 11.2%, respectively. There was no significant gender difference in migraine prevalence (4.5% in male and 5.6% in female), but tension-type headache was 2.6 times more common in females (3.1% in male and 8.1% in female). Last-year prevalence of frequent headaches was 5.4%. Forty eight percent of respondents sought medical assistance for their headaches and 79% were using medication, 40% of them used self-medication. CONCLUSIONS: This prospective study shows that headache is also highly prevalent in this community. Migraine and tension-type headache have the same prevalence, but the sex distribution for migraine is different from that observed in the Western world. Tension-type headache prevalence was substantially lower than that observed in other parts of the world. Frequent headaches were as common as in other population-based studies worldwide. Analgesic use/overuse probably also coexisted with headache, because self-medication was quite common.     

Prevalence and clinical characteristics of migraine in university students in Turkey

Migraine is a significant health problem due to its frequency and accompanying morbidity, which includes disability and loss of performance. We aimed to estimate the prevalence of migraine and assess the disability and preferences of treatment among university students in Afyon, a Turkish city. This is the first cross-sectional prevalence study of migraine conducted on university students in Turkey. The study has been carried out in two stages. The first stage aimed to identify the students with migraine by using a standardized International Headache Society (IHS) questionnaire. In this questionnaire, the students were asked about medical consultations and medicines used during attacks. The standard questionnaire was applied to 1,029 students, and migraine was found in 128 students (12.4%). Of these headache sufferers, 104 students were using non-prescribed drugs during headache attacks, while the remaining 24 students were using the drugs on advice of physicians. At the second stage, we evaluated the impact of disease on daily life in these students by the Migraine Disability Assessment Scale (MIDAS) questionnaire, showing that the degrees of disability are minimal in 11 students (8.6%), mild in 30 students (23.4%), moderate in 34 students (26.6%), and severe in 53 students (41.4%). In conclusion, migraine attacks are associated with a considerable degree of handicap in activities of daily living. However, many university students with migraine do not consult a physician and continue to treat their headaches with simple analgesics. Global educational programs are required for patients to recognize the importance of effective migraine treatment.     

Firearm-related personal and clinical characteristics of US medical students

BACKGROUND: Firearm injuries are the second leading cause of fatal injury in the US, and several medical specialty societies encourage patient counseling about firearm injury prevention. Because personal choices. influence physicians' willingness to counsel, it would be valuable to know how frequently guns are kept in the homes of physicians-in-training, as well as their perceptions and current rates of counseling about firearm injury prevention. METHODS: At a nationally representative sample of 16 medical schools, we surveyed the class of 2003 at freshman orientation, entrance to wards, and during senior year. RESULTS: A total of 2,316 students provided data (response rate = 80.3%). Among freshmen, 16% reported living in a home with a firearm, 13% did so at entry to wards, as did 14% of seniors (14% overall, women = 9%, men = 19%). Only 34% of seniors reported counseling their patients more often than "never/rarely" about firearm possession and storage. CONCLUSIONS: US medical students reported substantially lower rates of household gun ownership than the general population, but their participation in firearm-related counseling is also low.     

Epidemiological and clinical characteristics with psychosocial aspects of tension-type headache in Turkish college students

We investigated the prevalence and clinical characteristics of tension-type headache (TTH), psychosocial factors contributing to the onset and aggravation of headache and coping mechanisms of individuals in a young population in Turkey. The sample consisted of 2226 university students, aged 7 to 21 years old. A self-administered questionnaire inquiring about epidemiological and clinical features of headache was filled out by participants. TTH diagnosis was determined in accordance with the International Headache Society Criteria of 1988. The prevalence of TTH was 20.35% (25.54% for women and 14.25% for men). 43.7% of headache sufferers had one or more stressful life events before the onset of headache and stress was the most frequent aggravating factor of headache (52%). Resting (58.1%) was the most common coping style. In conclusion, TTH is not a rare condition in Turkish young people and psychosocial factors are always taken into consideration for diagnosis and treatment of TTH.     

Prevalence and characteristics of headache in Dutch schoolchildren.

The aim of this study was to determine whether there has been an increase in headache prevalence in Dutch children and to compare headache characteristics of children with low, medium and high headache severity.A sample of 2358 schoolchildren between the ages of 10 and 17 years filled out Waters' Headache Questionnaire and the Paediatric Pain Assessment Tool. Results showed that 21% of the boys and 26% of the girls at elementary school, and 14% of the boys and 28% of the girls at high school reported weekly headaches. When compared to figures from a previous study in the Netherlands published in 1985, the prevalence of weekly headaches in 10-17-year-olds has increased by 6%. In boys at elementary school, the prevalence of headaches with a frequency of a few times a week has doubled.Children with low, medium and high headache severity differed with respect to all headache characteristics, i.e. pain quality, accompanying symptoms, warning signals, location, onset, impact of headache, family occurrence, perceived cause, medical consultation, and school absence.     

Prevalence and clinical characteristics of an experimental model of 'ice-cream headache' in migraine and episodic tension-type headache patients

This study was designed to compare the prevalence and clinical characteristics of 'cold-induced headache' between migraine and episodic tension-type headache patients. Seventy-six migraine and 38 episodic tension-type headache patients were included in the study. An experimental model of an 'ice-cream headache' was developed for the study. The pain occurrence period, its location and quality were recorded for each patient who felt pain in their head during the test procedure. Pain in the head occurred in 74% of migraine and 32% of 'tension-type headache' patients. Although the most frequent pain location was the temple in both groups of patients, this rate was greater than twofold in migraine patients when compared with episodic tension-type headache patients. While headache quality was throbbing in 71% of migraine patients, it was so in only 8% of the episodic tension-type headache patients. Considering all the results, it seems that 'cold-stimulus headache' is not only more frequent in migraine patients, but also its location and quality differ from 'tension-type headache'.     

医学院学生述情障碍及其与人格特征的关系

目的:分析医学生述情障碍特征与人格特征的关系,为进一步认识述情障碍,明确其性质,更好地为临床医生和心理咨询的治疗服务提供依据。方法:于2005-11-20整群随机抽取不同年级大学生322名为调查对象。采用多伦多述情障碍量表评定学生的述情障碍特征,包括4个因子,分别为:①描述情感的能力。②认识、区别情绪和躯体感受的能力。③缺乏幻想。④外向型思维。每个条目按从完全不同意到完全同意分1～5个等级记分,其中11项为反向分,得分越高,述情障碍越明显。采用艾森克个性问卷国内修订本评定大学生的人格特征,计算内外向、情绪稳定性、说谎分及精神质4个人格维度的粗分及量表分。结果:发放问卷322份,排除资料填写不完整的12份,回收有效问卷310份。其中男生144名,女生166。一年级72名,二年级66名,三年级84名,四年级88名。①310名医学生的多伦多述情障碍量表总分为(69.95±11.12)分,与常模比较[(65.70±7.98)分],差异无统计学意义(P>0.05)。②大学一年级学生多伦多述情障碍量表总分平均为(71.56±7.96)分,二年级学生(69.81±9.47)分,三年级学生(67.34±6.57)分,四年级学生(69.97±7.54)分。各年级多伦多述情障碍量表总分均高于常模,4组间差异无显著性(F=2.038,P>0.05)。③女生多伦多述情障碍量表总分、外向型思维因子分高于男生[(71.65±9.47),(68.02±8.44)分;(19.86±3.98),(18.12±4.03)分,P<0.05],其他3个因子分比较差异无统计学意义(P>0.05)。④多伦多述情障碍量表总分,描述情感的能力,认识、区别情绪和躯体感受的能力,外向型思维因子评分均与内外向评分具有相关性(r=-0.287～-0.443,P=0.000);多伦多述情障碍量表总分,描述情感的能力,认识、区别情绪和躯体感受的能力,缺乏幻想评分与情绪稳定性评分具有相关性(r=-0.298～-0.432,P均=0.000);回归分析发现内外向对多伦多述情障碍量表作用较强。结论:在校医学生述情障碍特征不明显。人格特征越外向者,存在述情障碍的可能性越小。     

Frequency of headache in the medical students of Santa Catarina's Federal University

Studies in well-defined populations are useful in identifying factors that influence frequency and severity of headache and in understanding its impact on people. The aims of this study were to determine the frequency of headache in the medical students of Santa Catarina's Federal University, examine associated factors, verify the diagnostic impressions of the different types of headache, and describe the self-medication level. This study included 408 medical students who were interviewed by a questionnaire from October 1997 to August 1998. The frequency of headache in this group was 33%, with women and students in the five last semesters of the medical course experiencing increased headache frequency. The diagnostic impressions of the different types of headache were migraine without aura (31.3%), migraine with aura (8.2%), episodic tension-type headache (32.1%), chronic tension-type headache (7.5%), and tension-type headache combined with migraine without aura (3%). Self-medication was reported by 51.8% of the medical students with headache; 34.4% used prescribed medications. The most common self-help techniques used by students during a headache were to lie down or isolate themselves from their surroundings.     

Prevalence of menstrually related migraine and nonmigraine primary headache in female students of Belgrade University

OBJECTIVES: To determine prevalence and characteristics of menstrually related migraine and nonmigraine headache in female students of Belgrade University. METHODS: A questionnaire was administered to female students during randomly selected classes of the Schools of Medicine and Pharmacy. Diagnoses were assigned according to the criteria of the International Headache Society and MacGregor's stricter definition of "menstrual" migraine. RESULTS: Of 1943 female students (18 to 28 years old), 1298 (66.8%) had primary headaches. Among 1298 students with headache, 245 (12.6%) had migraine and 1053 (54.2%) had nonmigraine headache. The prevalence rates of migraine versus nonmigraine headache in relation to the menstrual cycle were: premenstrual, 0.9% versus 4.4%; menstrual, 1.5% versus 1.5%; menstrually associated, 6.1% versus 10.1%; menstrually unchanged, 2.7% versus 19.2%; and menstrually unrelated, 1.4% versus 18.9%. Female students with migraine had menstrually related attacks more frequently than students with nonmigraine headache (67.7% versus 29.5%). This difference was most prominent among students with menstrual migraine compared with students with menstrual nonmigraine headache (12.2% versus 2.7%). Exacerbation of migraine during menstruation was slightly more severe and more complex than exacerbation of nonmigraine headache. Female students with migraine versus nonmigraine headache did not differ significantly in age, age at onset of menarche, or age at onset of headache. Female students with migraine were significantly more likely to report a positive family history for migraine and menstrual migraine, severe attacks, reduced work activity, and aura. CONCLUSION: The results obtained are in accord with the prevailing opinion that there is a relationship between migraine and female sex hormones, and suggest that women with nonmigraine headache are also susceptible to hormonal fluctuations.     

The clinical characteristics of new daily persistent headache

New daily persistent headache (NDPH) is a subtype of chronic daily headache. The literature on NDPH is scant and its true aetiology is unknown. A retrospective chart review was carried out from a computerized database at the Jefferson Headache Centre from August 1997 to May 2000 to identify patients with NDPH using the Silberstein et al. criteria. Forty women and 16 men were identified. Age of onset ranged from 12 to 78 years. The peak age of onset was the second and third decade in women and the fifth decade in men. Eighty-two per cent of patients were able to pinpoint the exact day their headache started. Onset occurred in relation to an infection or flu-like illness in 30%. A prior headache history was found in 38% of patients. A family history of headache was documented in 29%. The duration of daily headache ranged from 1.5 h to 24 h; 79% were continuous. Nausea occurred in 68% of patients, photophobia in 66%, phonophobia in 61%, and lightheadedness in 55%. Laboratory testing and neuroimaging in all patients was normal except for Epstein-Barr virus antibody titres, which were positive in 71% of seven patients tested, representing past infection. NDPH appears to be a female-predominant disorder, marked by a continuous daily headache with associated migrainous symptoms. Over 80% of patients could state the exact date their headache began. One-third of patients developed NDPH with a flu-like illness.     

Calcineurin inhibitor-induced headache: clinical characteristics and possible mechanisms

OBJECTIVE: To classify the headache syndromes under treatment with calcineurin inhibitors and to investigate whether the latter influence the nitric oxide production of human brain microvascular cells (HBMEC). BACKGROUND: Single cases of cyclosporine-induced headaches have been reported. Since calcineurin inhibitors are known to influence the renal metabolism of NO, a key molecule in tension-type headache and migraine, we were interested whether calcineurin inhibitors might change NO metabolism in HBMEC as well. DESIGN AND METHODS: Headache symptoms of 74 patients receiving cyclosporine and/or tacrolimus for organ transplantation were retrospectively assessed. Furthermore, the effect of cyclosporine and tacrolimus on nitric oxide production in human brain microvascular endothelial cells was investigated after incubation. RESULTS: Only 18 of the 74 patients reported no headache 1-36 months after liver, lung, or bone-marrow transplantation, 28 reported a new headache, and 17 an increase in the frequency or intensity of a pre-existing headache. The headache was generally classified as migraine without aura (IHS 1.1) or migraine-like headache (IHS 1.6). Furthermore, we found significantly increased NO production after co-incubation of calcineurin inhibitors with human brain microvascular endothelial cells. CONCLUSION: The pathophysiological mechanism of these headaches may be connected with an endothelial dysfunction in terms of increased production of NO.     

Headache characteristics in senior medical students in Turkey

Headache is one of the most common neurological complaints of the young population and it affects the quality of life due to limitation of daily activities. In this study, our main goal was to appraise the general headache characteristics in senior medical students just before graduation and to determine the impact of headache on the quality of life, as well as the general attitude of students about their headaches. The study group consisted of 141 senior students. As the first step, the question about "having headache within the past one year period" was asked. Of the 141 students, 127 students answering "yes" were invited to a face-to-face interview. Of these, 67 students (52.8%) participated in the second evaluation. The second evaluation consisted of history taking and neurological and physical examination. All subjects were classified according to the International Classification of Headache Disorders (2nd edition) criteria. Validated Turkish version of Migraine Disability Assessment questionnaire was given to the subjects to evaluate the socio-economical impact of headache. Tension-type headache, which is the most common form of primary headaches, was identified in 34 students (50.7%) out of 67 students. Migraine was detected in 31 students (46.3%). This is the first study performed on a face-to-face interview basis with medical students using the new classification criteria in Turkey. Astonishingly, most of the students (n:65) ignored their headaches and did not seek medication, despite the negative impact of headache on daily functioning and overall quality of life.     

Prevalence of headache in Puerto Rico

BACKGROUND: Headache is one of the most frequently reported disorders in the general adult population. Despite the fact that this disorder is common, no official estimate of the prevalence of headache exists in Puerto Rico. PURPOSE: To examine the prevalence of headache and migraine, specifically, in Puerto Rico. METHODS: A telephone survey of 1610 individuals was conducted. The telephone calls were distributed using the 1990 census adjusted to the population of Puerto Rico in 1998, and according to gender, geographical area, and age. RESULTS: The prevalence of headache in Puerto Rico was 35.9% and migraine, in particular, 13.0%. When prevalence was fractionated by age, gender, and geographical areas, the prevalence of headache was similar for all ages, with females exhibiting a 2:1 preponderance over males. In the younger population (between 20 and 50 years of age), the female-male ratio for migraine was 3:1, and the prevalence for migraine was lower in the Metropolitan area. CONCLUSION: This study, the first of its type in Puerto Rico, demonstrates that headache (and migraine specifically) is a common disorder in this country.     

提高临床实习中带教效果的探讨

临床实习是医学教育的重要环节,是医学生从理论学习迈向实践的第一步,也是他们临床职业生涯的前奏。实习效果的好坏直接影响到所培养学生今后的临床工作能力。临床带教的质量是影响实习效果的一个重要因素,如何做好这项工作是所有带教老师所面临的重要课题。近年来我科接受繁重的教学任务,为了进一步提高临床实习带教效果,现对其中的一些工作方法进行了思考、总结,以冀共同探讨与提高。     

Cluster headache: clinical presentation, lifestyle features, and medical treatment

BACKGROUND: Cluster headache (CH) is a rare but severe headache form with a distinct clinical presentation. Misdiagnoses and mismanagement among these patients are high. OBJECTIVE: To characterize clinical features and medical treatment in patients with CH. METHODS: We established a cohort of 246 clinic-based and non-clinic-based CH patients. The diagnosis of CH was verified according to International Headache Society (IHS) criteria. We used standardized questionnaires to assess associated factors as well as success or failure of treatments. RESULTS: The majority (75.6%) was not treated before at our clinic-77.6% were males; 74.8% had episodic CH, 16.7% had chronic CH, in the remaining patients, the periodicity was undetermined because they were newly diagnosed. Cranial autonomic features were present in 98.8%, nausea and vomiting in 27.8%, and photophobia or phonophobia in 61.2% of CH patients. Most (67.9%) reported restlessness during attacks and 23% a typical migrainous aura preceding the attacks. The rate of current smoking was high (65.9%). Half of the patients reported that alcohol (red wine in 70%) triggered CH attacks. Eighty-seven percent reported the use of drugs of first choice (triptans 77.6%, oxygen 71.1%) with sumatriptan subcutaneous injection being the most effective drug for acute therapy (81.2%). The most frequently used preventive medications were verapamil (70.3%) and glucocorticoids (57.7%) with equally high effectiveness. CONCLUSIONS: Apart from the IHS criteria additional features like nausea/vomiting and migrainous aura may guide the diagnosis of CH. A large number of CH patients do not receive adequate treatments.     

Concomitant medical disease and headache

The treatment of headache disorders in patients with concomitant medical illness constitutes one of the more challenging areas of headache therapy. As new agents are added to our pharmacologic armamentarium, it will become easier to tailor therapy to our patients. The physician who treats the headache patient with concomitant medical illness must be particularly aware of drug side effects and pharmacology in order to prevent a worsening of underlying medical conditions or an exacerbation of headaches.