Changes In Headache Intensity Research Articles

Validation of a modified-composite autonomic symptom score (COMPASS-31) as an outcome measure for persistent autonomic symptoms post-concussion: an observational pilot study

ABSTRACT Objective Persistent symptoms post-mild traumatic brain injury (mTBI) includes autonomic dysregulation (AD). The composite autonomic symptoms score, (COMPASS-31), was developed to quantify AD symptom severity in the last year, which limits clinical utility. The primary aim was to determine validity of a modified-COMPASS-31 measuring symptoms in the last month compared to the original, secondarily to compare both original and modified versions to the Neurobehavioral Symptom Inventory (NSI), and tertiarily to detect change post-treatment of the modified-COMPASS-31 compared to NSI and headache intensity (HI). Participants Thirty-three military personnel with persistent headache post-mTBI. Main outcome measures Total and domain scores for COMPASS-31 (original vs. modified) NSI and HI at baseline. Change in modified-COMPASS-31. NSI, and HI. Results Baseline COMPASS-31 versions were comparable and highly correlated (r = 0.72, p < 0.001), they were moderately correlated at best to the NSI (r < 0.6), which may suggest differences in measurement metrics. The mean change in modified-COMPASS-31 scores (15.4/100, effect size 0.8) was mild to moderately correlated to the change in HI (r = 0.39) score, but not to NSI (r = 0.28). Conclusion The modified-COMPASS-31 appears to be valid, can measure change of AD symptom severity, and is recommended as an outcome measure.

Pulsed Radiofrequency Neuromodulation of the Greater Occipital Nerve for the Treatment of Headache Disorders in Adults: A Systematic Review

ABSTRACT Background Pulsed radiofrequency neuromodulation (PRFN) of greater occipital nerve (GON) is considered in patients with headaches failing to achieve sustained analgesic benefit from nerve blocks with local anesthetic and steroids. However, the evidence supporting this practice is unclear. Aims This narrative systematic review aims to explore the effectiveness and safety of GON PRFN on headaches. Methods Databases were searched for studies, published up to February 1, 2024, investigating PRFN of GON for adults with headaches. s and posters were excluded. Primary outcome was change in headache intensity. Secondary outcomes included effect on monthly headache frequency (MHF), mental and physical health, mood, sleep, analgesic consumption, and side-effects. Two reviewers screened and extracted data. Results Twenty-two papers (2 randomized controlled trials (RCT), 11 cohort, and 9 case reports/series) including 608 patients were identified. Considerable heterogeneity in terms of study design, headache diagnosis, PRF target and settings, and image-guidance was noted. PRFN settings varied (38–42°C, 40–60 V, and 150–400 Ohms). Studies demonstrated PRFN to provide significant analgesia and reduction of MHF in chronic migraine (CM) from 3 to 6 months; and significant pain relief for ON from six to ten months. Mild adverse effects were reported in 3.1% of cohort. A minority of studies reported on secondary outcomes. The quality of the evidence was low. Conclusions Low-quality evidence indicates an analgesic benefit from PRFN of GON for ON and CM, but its role for other headache types needs more investigation. Optimal PRFN target and settings remain unclear. High-quality RCTs are required to further explore the role of this intervention. PROSPERO ID CRD42022363234.

Altered functional brain network patterns in patients with migraine without aura after transcutaneous auricular vagus nerve stimulation

Transcutaneous auricular vagus nerve stimulation (taVNS) shows excellent effects on relieving clinical symptoms in migraine patients. Nevertheless, the neurological mechanisms of taVNS for migraineurs remain unclear. In recent years, voxel-wise degree centrality (DC) and functional connectivity (FC) methods were extensively utilized for exploring alterations in patterns of FC in the resting-state brain. In the present study, thirty-five migraine patients without aura and thirty-eight healthy controls (HCs) were recruited for magnetic resonance imaging scans. Firstly, this study used voxel-wise DC analysis to explore brain regions where abnormalities were present in migraine patients. Secondly, for elucidating neurological mechanisms underlying taVNS in migraine, seed-based resting-state functional connectivity analysis was employed to the taVNS treatment group. Finally, correlation analysis was performed to explore the relationship between alterations in neurological mechanisms and clinical symptoms. Our findings indicated that migraineurs have lower DC values in the inferior temporal gyrus (ITG) and paracentral lobule than in healthy controls (HCs). In addition, migraineurs have higher DC values in the cerebellar lobule VIII and the fusiform gyrus than HCs. Moreover, after taVNS treatment (post-taVNS), patients displayed increased FC between the ITG with the inferior parietal lobule (IPL), orbitofrontal gyrus, angular gyrus, and posterior cingulate gyrus than before taVNS treatment (pre-taVNS). Besides, the post-taVNS patients showed decreased FC between the cerebellar lobule VIII with the supplementary motor area and postcentral gyrus compared with the pre-taVNS patients. The changed FC of ITG-IPL was significantly related to changes in headache intensity. Our study suggested that migraine patients without aura have altered brain connectivity patterns in several hub regions involving multisensory integration, pain perception, and cognitive function. More importantly, taVNS modulated the default mode network and the vestibular cortical network related to the dysfunctions in migraineurs. This paper provides a new perspective on the potential neurological mechanisms and therapeutic targets of taVNS for treating migraine.

The role of ONSD in the assessment of headache associated with Chiari malformation type 1.

Cough associated headache is the most common symptom in Chiari malformation type 1 (CM1). However, its pathophysiology and treatment are not clear. The aim of this study was to investigate the relationship between optic nerve sheath diameter (ONSD), an indicator of intracranial pressure, and headache and to investigate its predictive value on postoperative outcome. In symptomatic CM1 patients, craniovertebral junction morphometric measurements and ONSD measurements were made from preoperative MR images, and headache intensities and characteristics were evaluated. After different surgical procedures, the clinical characteristics of the patients were evaluated according to the Chicago Chiari Outcome Scale, the change in headache intensity was assessed and the relationship with ONSD was evaluated. Preoperative headache intensity was significantly correlated with ONSD measurement (p < 0.01). Modified clivoaxial angle and ONSD were independent predictors of postoperative clinical outcome (p < 0.01). The procedure that achieved the greatest surgical enlargement of the foramen Magnum stenosis provided the best clinical outcome. Postoperative reduction in headache intensity and ONS diameter were correlated (p < 0.01). The fact that ONSD is found to be wide in the preoperative period in CM1 patients indicates that the intracranial pressure is permanently high. This diameter increase is correlated with headache and is a valuable guide in the selection of the appropriate treatment method.

Case Studies on Acupuncture Principles in Headaches

Objective: This observational cohort pilot study aimed to evaluate the effects of the acupuncture methods, Jiu Cang Zhen (JCZ) and Huang Guan (HG), on changes in headache intensity in an inpatient, multimodal Zurzach Headache Programme (ZHP). Methods: Study participants consisted of patients diagnosed with chronic headache disorder (headache ds, 30 days per month) or daily persistent headache. All patients received conventional therapies with active and passive approaches. The patient group was treated with JCZ and HG acupuncture methods, receiving a total of six to eight acupuncture sessions of 50 to 60 minutes each, during a 3–4-week multimodal ZHP at the RehaClinic Bad Zurzach. Pain intensity was quantified using a Numerical Rating Scale (NRS) before and after each acupuncture therapy session. Results: Ten patients were recruited, six women and four men, with a mean age of 41.7 (standard deviation, [SD] =13.9). A reduction in headache intensity was reported by all patients in each of the sessions. The average NRS for pain was 4.21 (SD = 1.44) before acupuncture and 1.24 (SD = 0.93) after acupuncture (means first by number of sessions, then per n = 10 patients). This resulted in a mean difference of 2.97 (SD = 1.04), corresponding to a standardized response mean of 2.85 (95% confidence interval: 2.11–3.60, one-tailed P < 0.001), meaning there was a large effect. Conclusions: This pilot study shows that JCZ and HG are suitable acupuncture methods for reducing headache intensity in the treatment of headaches. A comparison with the conventional classical acupuncture methods from the acupuncture textbook for traditional Chinese medicine students in China, exploration with a larger patient group, and prolonged monitoring of pain behavior could be foci of follow-up investigations.

Factors Related to Prodromal Symptoms in Patients With Acute Myocardial Infarction

Prior to acute myocardial infarction (AMI), patients may experience different prodromal symptoms (PSs) that may delay their seeking medical treatment prior to hospitalization. This study was designed to identify the relationship between PSs and demographics, including gender and age, acute symptoms, and pre-hospital delay time, in patients with AMI. A cross-sectional study design was applied, and a convenience sampling approach was used to recruit 121 patients in the emergency room of a medical center located in southern Taiwan. Instruments, including a demographic and disease variables datasheet, acute symptoms of AMI, McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (MAPMISS), and pre-hospital delay time, were used. Chi-square, Fisher exact, and Spearman correlation coefficients tests were used to examine the respective relationships between the targeted variables and PSs. Binary logistic regression analysis was used to determine the important determinants of PSs. Most (83.5%) of the participants had experienced PSs. The MAPMISS score was significantly associated with age (ρ= -.20, p < .05) and marital status (Z = 2.23, p < .05). Three prodromal symptoms, including pain or discomfort in left breast, pain or discomfort in the legs, and change in headache intensity, were significantly different between male and female participants. Only one symptom, pain or discomfort in the central high chest area, differed significantly among age groups. Binary logistic regression analysis found that participants in the 40-60 years old age group were 3.19 times more likely to develop PSs than their peers in the 65 years old and older group. The results of this study suggest that PSs should be incorporated into medical education to increase the cognition and awareness of healthcare professionals toward PSs and to improve patient education overall in order to strengthen public awareness regarding the relationship between PSs and AMI and subsequently increase the timeliness of their seeking appropriate medical help.

Unrecognized challenges of treating status migrainosus: An observational study.

Status migrainosus is a condition with limited epidemiological knowledge, and no evidence-based treatment guideline or rational-driven assessment of successful treatment outcome. To fill this gap, we performed a prospective observational study in which we documented effectiveness of treatment approaches commonly used in a tertiary headache clinic. Patients with episodic and chronic migraine who experienced continuous and prolonged attacks for more than 72 hours were treated with dexamethasone (4 mg orally twice daily for 3 days), ketorolac (60 mg intramuscularly), bilateral nerve blocks (1-2% lidocaine, 0.1-0.2 ml for both supraorbital and supratrochlear nerves, 1 ml for both auriculotemporal nerves, and 1 ml for both greater occipital nerves), or naratriptan (2.5 mg twice daily for 5 days). Hourly (for the first 24 hours) and daily (for first 30 days) change in headache intensity was documented using appropriate headache diaries. Fifty-four patients provided eligible data for 60 treatment attempts. The success rate of rendering patients pain free within 24 hours and maintaining the pain-free status for 48 hours was 4/13 (31%) for dexamethasone, 7/29 (24%) for nerve blocks, 1/9 (11%) for ketorolac and 1/9 (11%) for naratriptan. These success rates depended on time to remission, as the longer we allowed the treatments to begin to work and patients to become pain free (i.e. 2, 12, 24, 48, 72, or 96 hours), the more likely patients were to achieve and maintain a pain-free status for at least 48 hours. These findings suggest that current treatment approaches to terminating status migrainosus are not satisfactory and call attention to the need to develop a more scientific approach to define a treatment response for status migrainosus.

The prevalence, course and clinical correlates of migraine in Parkinson's disease: A multicentre case-controlled study.

Background Previous studies have reported a lower migraine prevalence in Parkinson's disease (PD) patients and improvements in migraine headaches after PD onset, but the clinical association of migraines with PD is unclear. Methods We analysed headache and migraine prevalence and clinical correlates in 436 PD patients (mean age, 69.3 ± 7.8 years) and 401 age- and sex-matched controls (mean age, 69.2 ± 8.6 years) in a case-controlled, multicentre study. Migraines were diagnosed by a questionnaire developed according to the International Classification of Headache Disorders, second edition. We evaluated changes in headache intensity, frequency and severity over several years around the onset of PD among PD patients with headaches or migraines, and over the past several years among control subjects with headaches or migraines. Results PD patients had lower lifetime (9.6% vs. 18.0%) and 1-year (6.7% vs. 11.0%) migraine prevalences than controls. However, lifetime (38.5% vs. 38.9%) and 1-year (26.1% vs. 26.2%) headache prevalence did not differ between PD patients and controls. After adjusting for gender, timing of the evaluation of headache changes, and recall period, PD patients with headaches or migraines exhibited a pronounced reduction in the intensity, frequency and overall severity of their headaches and migraines after the onset of PD compared with controls with headaches or migraines. PD patients with migraines exhibited a higher rate of depression and higher Pittsburgh Sleep Quality Index and PD sleep scale-2 scores than those without headaches. Conclusion While overall headache and migraine severity reduced after PD onset, the presence of migraines was associated with sleep disturbances and depression in PD patients.

Additional effects of kinesiotaping to mobilization techniques in chronic mechanical neck pain

Objectives: The aim of this study was to investigate the additional e ects of kinesio taping to mobilization techniques on muscle activation of deep cervical exors and neck pain in chronic mechanical neck pain. Methods: Twenty-eight participants with mechanical neck pain were included in this study. The participants were randomized into two groups: mobilization group (Group 1) and kinesio taping group (Group 2). Treatment for Group 1 (Mean age: 25.71±8.39 yrs) included scapular mobilization, ischemic compression for trigger points and Cyriax mobilization techniques for cervical region. Treatment for Group 2 (Mean age: 30.29±12.92 yrs) included kinesio taping, additionally. Head and neck pain were assessed by Visual Analog Scale, while the muscle activation of deep neck cervical exors was assessed by Craniocervical Flexion Test, using “Stabilizer Pressure Biofeedback” device before treatment and four days a er treatment. Inter-group di erences were analyzed by Mann Whitney U Test, and intra-group changes were analyzed by Wilcoxon Test. Also the e ect sizes of intra-group changes were analyzed. Results: There was no significant di erence between the groups for any outcome (p>0.05). Endurance of deep cervical exors improved (Group 1, p=0.018; Group 2, p=0.004), and inten - sity of headache reduced significantly, in both groups (Group 1, p=0.038; Group 2, p<0.001). E ect sizes of changes in activation of deep cervical exor muscles were d: 0.68 and d: 0.863 in Group 1 and 2, respectively. E ect sizes of changes in headache intensity were d: 0.86 and 0.83 in Group 1 and 2, respectively. Conclusions: When e ect size di erences were analyzed, it was considered that kinesio taping could be used in addition to mobilization techniques in the treatment of mechanical neck pain.

Efficacy of regular sauna bathing for chronic tension-type headache: a randomized controlled study.

Chronic tension-type headache (CTTH) is a chronic syndrome characterized by frequent headache occurring more than 15 days per month. The intensity and duration of headache pain can be very distressing and disabling on an individuals' well-being. The purpose of this study was to examine the applicability of sauna bathing as a new method of treatment for reducing pain in patients with CTTH. Thirty-seven people who fulfilled the International Headache Society criteria for CTTH were randomly assigned into two groups. The control group (n=20) received advice and education while the intervention group (n=17) received the same advice and attended a sauna regularly for 8 weeks. Reductions in subjective pain were determined using the numerical pain rating scale (NPRS). Disturbance in sleep, depression as assessed by Beckman Disability Index (BDI), and Headache Disability Index (HDI) were measured. Mean change in headache intensity significantly differed between the sauna and control group by 1.27 (95% confidence interval, 0.48-2.07; F=10.17; df=1, 117; p=0.002). There was no statistically significant change in duration of headache or improvement in sleep, depression, or HDI between the sauna and control groups. Regular sauna bathing is a simple, self-directed treatment that is effective for reducing headache pain intensity in CTTH.

Queckenstedt’s Test Headache Response is Associated with Increased Jugular Venous Flow Volume During Migraine Attack

Cephalic venous congestion induced by Queckenstedt’s (Q)-test, i.e., transient compression of bilateral internal jugular veins (IJV), can aggravate headache intensity during migraine attacks, especially in patients with throbbing pain. We hypothesized that the IJV flow volume was related to the Q-test response. Ultrasonography was used to measure the flow volume of bilateral IJV in migraine patients during acute attacks and interictal periods and in normal controls. All acute migraine patients underwent Q-test in a supine position. “Q-test headache response” was designated by the changes in headache intensity (0–10 scale) before and 30 s after the Q-test. Thirty-nine acute migraine patients, 20 interictal migraine patients and 23 noxrmal controls completed the study. Acute migraine patients had higher bilateral IJV flow volume than both interictal patients and normal controls (973.4 ± 348.2 vs. 733.8 ± 210.1 vs. 720.3 ± 244.9 mL/min, p = 0.001). In acute migraine patients, bilateral IJV flow volume was the only independent variable related to the Q-test headache response (adjusted R 2= 0.422). Thus, the IJV flow volume was increased during migraine attacks and was directly related to the Q-test response. It may be used as a research tool for peripheral sensitization during acute migraine attacks. (E-mail: sjwang@vghtpe.gov.tw)

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.

Cognitive–behavioral therapy of pediatric headache: Are there differences in efficacy between a therapist-administered group training and a self-help format?

Objective: The efficacy of cognitive–behavioral training in a therapist-administered group format (TG) and a self-help format (SH) for children with recurrent headache was compared. Methods: A total of 77 children (10–14 years) were randomly assigned to TG ( n=29), SH ( n=27) and a waiting-list control group (WC; n=19). TG consisted of eight 90-min sessions with groups of five children. SH was conducted via a written manual in which instructions were given and homework tasks were assigned. In both training formats, the topics covered were identical (e.g., self-monitoring of headache, trigger analysis, relaxation, etc.). Main outcome variables related to changes in headache intensity, duration and frequency as assessed with a diary prior to and following training, as well as at 6-month follow-up. Results: Children reported a high degree of satisfaction with the training. No significant differences between the two conditions were found. Differences between treatment groups and WC were statistically corroborated for two headache variables. In both treatments, headache decreased markedly from posttraining to follow-up, with 68–76% of children reporting clinically significant improvement. No differential effects of age, gender or headache diagnosis were found. Changes in self-concept and ability to cope with stress after training point to further positive effects of the intervention. Conclusion: The efficiency of the two training formats is nearly identical. The group format, because of its better acceptance, is recommended for practical use.

Headache intensity and quality of life in adolescents. How are changes in headache intensity in adolescents related to changes in experienced quality of life?

To investigate the relationship between changes in actual presence of headache and the experience of different subdomains of quality of life (QoL) in adolescents. Diary entered measurements of headache intensity and frequency were related to simultaneously recorded data on a QoL questionnaire for adolescents. Subjects completed both the QoL questionnaires and the headache diaries at home. Subjects were selected by screening the total population of two secondary schools (N = 1566) for headache and migraine symptoms. Sixty-four students subject to chronic headache or migraine participated in the study. All subjects were diagnosed by a neurologist, following the IHS criteria for migraine. Changes in headache intensity and frequency were related to changes in self-reported QoL within all QoL subdomains. More headache coincided with a lower self-reported QoL.

Facial temperature in migraine, tension-vascular and tension headache.

The relationship between clinical features and changes in the extracranial circulation was studied during 209 separate attacks of headache affecting the anterior part of the head. Extracranial vascular changes were assessed thermographically and by the change in headache intensity when pressure was applied over the superficial temporal and common carotid arteries. In unilateral headaches, increased heat loss from the affected frontotemporal region was observed most frequently in attacks which were temporarily relieved by compression of the superficial temporal artery; thermographic asymmetry disappeared as the headache abated. Although such headaches were associated more frequently with migrainous features than attacks which did not respond to arterial compression, many headaches with clinical features of migraine had no vascular component detectable by thermography or vascular compression. Furthermore, the response to arterial compression was not consistent from one headache to another in the same patient. It was concluded that extracranial vascular changes recur intermittently in headache-prone patients, depending on the severity of pain and association with other features commonly regarded as migrainous. However, there was no clear demarcation point between entities diagnosed clinically as "migraine" and "tension headache".

A probability model of headache recurrence

A highly selected group of 234 adult volunteers with recurrent headaches completed a daily headache chronicle for 28 consecutive days. The persistence and recurrence of headaches in this sample is compatible with a stochastic model characterized as a stationary first-order Markov chain. The two main features of this model are: (a) the level of headache on any day is a function of the headache level on the previous day, and (b) the probabilities of moving from one headache level on one day to another headache level on the next day do not vary with time. Men and women tend to have similar transition probabilities. In both sexes, highest transition probabilities were for no change in headache intensity. Changes in headache level were not random. Movement from one headache level to another tended to be in the direction of lower intensity. Fitting data of headache recurrence to a model may be helpful in understanding both the biology of disorders manifested as recurrent headache and the factors that modify clinical expression of these disorders.