紧张型头痛患者的生活质量与应对方式以及社会支持的相关性研究

目的 探讨紧张型头痛患者的生活质量、应对方式及其社会支持状况.方法 采用生活质量综合评定问卷(GQOLI)、医学应对问卷(MCMQ)及社会支持评定量表(SSAS)对56例紧张型头痛(观察组)和56例健康自愿者(对照组)进行调查,并对生活质量与应对方式及社会支持作相关分析.结果 ①观察组生活质量总分及躯体功能、心理功能2个维度评分均显著低于对照组(P＜0.01);②观察组面对分量表评分显著低于对照组,而屈服分量表评分则显著高于对照组(P＜0.05);③观察组社会支持总分及主观支持、支持利用度评分均显著低于对照组(P＜0.05或P＜0.01);④紧张型头痛患者的生活质量总分及躯体功能、心理功能2个维度评分与面对分量表评分及社会支持总分、主观支持、支持利用度2个维度评分均呈显著性正相关,而与屈服分量表评分则呈显著性负相关(P＜0.05或P＜0.01).结论 紧张型头痛患者的生活质量较低,与应对方式及社会支持有关.因此,指导紧张型头痛患者采取积极的应对方式,增强其社会支持,可以提高紧张型头痛患者的生活质量.     

Treatment of headache with botulinum toxin administration

Botulinum toxin has been increasingly applied to the treatment of a wide variety of neurological disorders. Its application to headache disorders, and specifically those classified as migraine or tension-type, followed the observation of its effectiveness in decreasing pain. Studies that have primarily used botulinum toxin type A, but with varying dose regimens and sites of administration, have since observed its beneficial effects and in those subjects, headaches have lessened in their frequency or severity. However, questions that have primarily concerned dose and sites of administration have since arisen and clear guidelines for botulinum toxin use in headache disorders have yet to be developed.     

Experimental induction of muscle tenderness and headache in tension-type headache patients

The aim of the present study was to investigate the impact of static contraction of the shoulder and neck muscles on muscle tenderness and headache in patients with tension-type headache. Twenty patients with frequent episodic tension-type headache and 20 healthy age- and sex-matched controls were examined using a placebo-controlled cross-over design. The subjects performed static contraction of the trapezius muscles (active procedure) or the anterior tibial muscles (placebo procedure) with 10% of maximal force for 30 min. Total tenderness score, local tenderness score and headache intensity were evaluated before and after the static work. Changes in headache intensity were followed for 24 h. Pericranial tenderness increased significantly more in patients than in controls after the active procedure (P = 0.04). The increase in pericranial tenderness tended to be higher after the active procedure than after the placebo procedure in patients (P = 0.08) and in controls (P = 0.07). Sixty per cent of the patients and 20% of the healthy controls developed headache after the active procedure. Fifty per cent of the patients and none of the controls developed headache after the placebo procedure. There was no significant difference in headache development between the active and the placebo procedure in patients or controls. These findings demonstrate that tension-type headache patients are more liable to develop shoulder and neck pain in response to static exercise than healthy controls.     

Behavioral management of headache triggers: Avoidance of triggers is an inadequate strategy

The standard clinical advice for individuals who suffer from recurrent headaches is that the best way to prevent headaches is to avoid the triggers. This review challenges that advice from a number of perspectives, including: that the advice is given in a theoretical vacuum; it is associated with practical problems; and it is not evidence-based. The review considers cognate literatures on stress, negative affect, and chronic pain that advocate approach/confront strategies over avoidance strategies. It is suggested that advice to avoid triggers could result in maintenance of the capacity of the trigger to precipitate headaches or even a sensitization process whereby tolerance diminishes. As anxiety researchers have investigated extensively the issue of how stimuli acquire and lose their capacity to elicit fear, this literature is explored to draw inferences for headache triggers. The review concludes with suggestions concerning etiology of chronic headache and associated management implications, and directions for future research. It argues that the philosophy of ‘avoidance of triggers’ should be replaced with ‘coping with triggers,’ as the latter includes both avoidance and approach/confront strategies involving exposure to triggers.     

Similarities in stress physiology among patients with chronic pain and headache disorders: evidence for a common pathophysiological mechanism?

One common feature of chronic musculoskeletal pain and headaches are that they are both influenced by stress. Among these, tension-type headache (TTH), fibromyalgia (FMS) and chronic shoulder/neck pain (SNP) appear to have several similarities, both with regard to pathophysiology, clinical features and demographics. The main hypothesis of the present study was that patients with chronic pain (TTH, FMS and SNP) had stress-induced features distinguishing them from migraine patients and healthy controls. We measured pain, blood pressure, heart rate (HR) and skin blood flow (BF) during (1 h) and after (30 min) controlled low-grade cognitive stressor in 22 migraine patients, 18 TTH patients, 23 FMS patients, 29 SNP patients and 44 healthy controls. FMS patients had a lower early HR response to stress than migraine patients, but no differences were found among FMS, TTH and SNP patients. Finger skin BF decreased more in FMS patients compared to migraine patients, both during and after the test. When comparing chronic pain patients (chronic TTH, FMS and SNP) with those with episodic pain (episodic TTH and migraine patients) or little or no pain (healthy controls), different adaptation profiles were found during the test for systolic and diastolic blood pressure, HR and skin BF in the chronic group. In conclusion, these results suggest that TTH, FMS and SNP patients may share common pathophysiological mechanisms regarding the physiological responses to and recovery from low-grade cognitive stress, differentiating them from episodic pain conditions such as migraine.     

Relationship between high prolactine levels and migraine attacks in patients with microprolactinoma

The pathophysiology of pituitary-associated headache is unknown, although structural and functional features of the tumour are proposed mechanisms. The objective of this study was to evaluate whether headache in a population with pituitary micro-adenomas was related to hyperprolactinemia. We recruited 29 patients with microprolactinoma and headache: 16 with migraine (group A) and 13 with tension-type-headache (group B). The prolactin (PRL) levels measured during attacks of headache were significantly higher in nine patients (56%) of group A and in one patient (8%) of group B. In four of the nine patients of group A, PRL increased after thyrotropin-releasing-hormone (TRH) test and induced severe attacks. After dopamine-agonist (DA) treatment, the headache improved in seven (44%) patients of the group A and in two (15%) patients of the group B. Three of the four patients in whom the TRH-test induced headache attacks, improved after DA treatment. We suggest that hyperprolactinemia may contribute to development of pain in migraine subgroups and further TRH-test could be used to predict which patients could benefit by DA therapy.     

Electromyographical ischemic test, clinical symptoms related to neuromuscular hyperexcitability, and intra- and extracellular Mg++ levels in headache patients

We observed the occurrence of neuromuscular hyperexcitability, assessed with electromyographic ischemic tests, in headache patients in relation to Mg⁺⁺ levels in serum, red blood cells and mononuclear cells. Clinical symptoms most significantly associated with neuromuscolar hyperexcitability and magnesium derangements were also investigated. A total of 36 patients with migraine without aura (MwoA),18 patients with episodic tension-type headache (ETTH) and 22 patients with chronic tension-type headache (CTTH) were examined during interictal periods. The electromyographic (EMG) ischemic test was positive in 91.7% of MwoA patients, in 27.7% of ETTH and in 13.6% of CTTH patients. In patients with MwoA, the Mg⁺⁺ levels in red blood cells were significantly less than those in the other two groups of patients with tension-type headache (ANOVA, p<0.00l). Positive EMG ischemic tests were significantly associated with decreased erythrocyte Mg⁺⁺ levels in MwoA patients (χ², p<0.01). The clinical symptoms in patients with MwoA most frequently suggest the presence of neuromuscular hyperexcitability and are more strictly associated with reduced red blood cell Mg⁺⁺ levels. They include fasciculations (91.7%), asthenia (91.7%), blepharospasm (75.8%) and paresthesiae (47.2%). Anxiety and depression most often occurred in tension-type headache patients, but were not related to modifications in intra- and extracellular Mg⁺⁺ levels. Received: 14 January 2002, Accepted in revised form: 22 July 2002 Correspondence to G. Mazzotta     

Aspirin and tension-type headache

Acetylsalicylic acid (ASA, Aspirin) is among the most used drugs worldwide. At present, Aspirin represents a quite versatile drug employed in the control of pain symptomatologies and in situations such as prevention of both ischaemic stroke and cardiovascular events. Aspirin causes inhibition of prostaglandin (PG) synthesis by inactivation of the cyclooxygenase (COX) enzyme. ASA constitutes the focus of new researches explaining more widely Aspirin’s control of inflammation. The induction of the endogenous epimers lipoxins (Aspirin-triggered 15-epi-lipoxins, ATLs) represents one of the most recent achievements. This particular feature of Aspirin is not shared by other NSAIDs. ASA is well known as a headache medication, figuring as a possible treatment choice in tension-type headache but also in acute migraine attacks. Furthermore, a new Aspirin formulation with a greater rapidity of action has been introduced. In conclusion, little information exists on the subject and more studies are required.     

The global burden of headache in children and adolescents – developing a questionnaire and methodology for a global study

Background

Burden of headache has been assessed in adults in countries worldwide, and is high, but data for children and adolescents are sparse. The objectives of this study were o develop a questionnaire and methodology for the global estimation of burden of headache in children and adolescents, to test these in use and to present preliminary data.

Methods

We designed structured questionnaires for mediated-group self-administration in schools by children aged 6-11 years and adolescents aged 12-17 years. In two pilot studies, we offered the questionnaires to pupils in Vienna and Istanbul. We performed face-to-face interviews in a randomly selected subsample of 199 pupils to validate the headache diagnostic questions.

Results

Data were collected from 1,202 pupils (mean 13.9 ± 2.4 years; 621 female, 581 male). The participation rate was 81.1% in Istanbul, 67.2% in Vienna. The questionnaire proved acceptable: ≤5% of participants disagreed partially or totally with its length, comprehensibility or simplicity. The sensitivity, specificity, positive and negative predictive values ranged between 0.71 and 0.76 for migraine and between 0.61 and 0.85 for tension-type headache (TTH). Cronbach’s alpha was 0.83. The 1-year prevalence of headache was 89.3%, of migraine 39.3% and of TTH 37.9%. The prevalence of headache on ≥15 days/month was 4.5%. One fifth (20.7%) of pupils with headache lost ≥1 day of school during the preceding 4 weeks and nearly half (48.8%) reported ≥1 day when they could not do activities they had wanted to. The vast majority of pupils with headache experienced difficulties in coping with headache and in concentrating during headache. Quality of life was poorer in pupils with headache than in those without.

Conclusion

These pilot studies demonstrate the usefulness of the questionnaires and feasibility of the methodology for assessing the global burden of headache in children and adolescents, and predict substantial impact of headache in these age groups.