Clinical Features Of Headache Research Articles

Clinical Characteristics of Headache among a Sample of Iraqi Medical and Dental Students

Background: Headache is a painful condition related to a major lack of productivity, limitation of social activities and impairment of quality of life.Method: in this study a structured questionnaire was formulated in a form of multiple choices questions to gather information on the clinical characteristics, associated factors and the triggering factors along with the mode of treatment adopted by dental and medical undergraduate students of the University of Baghdad in the period from January to March 2019. Language of questionnaire was made simple and easily understandable to students. Students were assured of confidentiality and the participation was entirely voluntary.Results: in this study a total number of 340 students participated, 170 of them were medical students 76(44.7%) males and 94(55.3%) females, and the other 170 were dental students 45(26%) males and 125(74%) females .It was found that 170 medical students had 161 associated symptoms with headache , the most common associated symptoms was scalp tenderness 44(25.9%), while the least common associated symptom was diarrhea 4(2.4%).While 170 dental students had 162 associated symptoms, the most common associated symptoms was scalp tenderness 46 (27.2%), while the least common associated symptom was seizures 2 (1.2%). 170 medical students expressed 385 triggering factors for causation of headache. It was found that the most common triggering factors was irregular sleep 118(69.4%). And 170 dental students expressed 437 triggering factors for causation of headache. It was found that the most common triggering factors was stress 136 (80.5%). In this study the percentage of medical students who taking self medications was 88.82% and 92.35% for dental students also it was found that both medical & dental students had the highest percentage for using Paracetamol as analgesic, 119(70%) for medical students, and 126(74.6%) for dental students.Conclusions: the results of this study show that the majority of both medical and dental students suffer from headache with self medications used by the majority.

Headache in patients with Tourette syndrome: A systematic literature review

Aim: To systematically review the available literature on the prevalence and clinical characteristics of headache in patients with Tourette syndrome (TS), a neurodevelopmental condition characterized by the chronic presence of motor and vocal tics. Design: We conducted a systematic literature review of original studies using three clinical databases (Medline, EMBASE and PsycInfo), according to the standards outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Outcome measures included both tic severity and tic frequency. Results: Our systematic literature review identified six studies on the prevalence and characteristics of headache in patients with TS (data on paediatric patients were available from five studies and data on adult patients from four studies). The proportion of patients with TS who had a diagnosis of headache ranged from 29% to 62%. Migraine was the most commonly investigated headache disorder in this patient population. The findings of the reviewed studies showed that the prevalence of migraine in patients with TS ranges between 13% and 43% and is significantly higher compared to the two control groups ( p < 0.05). Discussion: The prevalence of headache in patients with TS could be higher than in the general population, with the most reliable data being available for migraine. Overall, the literature on the prevalence and characteristics of headache in TS is sparse and highly heterogeneous. Further research on the prevalence and clinical correlates of migraine, tension-type headache and other types of headache in patients with TS across the lifespan is needed to inform clinical practice aimed at improving health-related quality of life in patients with tics.

Clinical characteristics of headaches attributed to diagnostic and therapeutic procedures

Headaches may appear after performing diagnostic and / or therapeutic procedures with close temporal relationship to these events. The objective of this research was to know the clinical characteristics of headache secondary to diagnostic and / or therapeutic procedures. We reviewed secondary headaches according to ICHD-3, and searched for those that arose after performing a diagnostic and / or therapeutic procedure. A total of 11 different diagnoses of headache attributed to diagnostic and / or therapeutic procedures were found. Some secondary headaches are due to diagnostic and / or therapeutic procedures.

Epidemiological and clinical characteristics of primary headaches in adolescent population: is there a relationship with the way of life?

The headache in the adolescent population is one of the most common conditions that doctors deal with. It is an important source of disability with several health-related considerations. The aim of the study was to investigate the frequency, as well as different epidemiological and clinical characteristics, of primary headaches in adolescents. An epidemiological study was conducted on 1800 adolescents of both sexes based on a questionnaire consisting of 65 questions referring to sociodemographic and clinical characteristics of headaches. Based on the questionnaire information, the examinees were divided into four groups: adolescents with migraine, tension-type and mixed headache and the fourth group were examinees without headaches. The information was statistically processed and the level of significance < 0.05 is considered statistically significant. Out of 1800 respondents, 1160 subjects were those with headache (64.4%) and 640 subjects were without headache (35.6%). The most common primary headache is tension-type headache. The majority of subjects with tension-type headaches attend elementary school and with migraine and mixed headaches high school. There were significantly more headaches among adolescents who had their own computer and who spent more than 2h using it. More frequent headaches were found in those who travel by public transport and spend more time on Facebook. Primary headaches in adolescent population occur frequently and despite numerous studies, they are still not taken seriously enough. It is necessary to educate parents, teachers and adolescents to avoid risk factors or at least reduce their impact.

Relationship of Migraine and Tension-Type Headache With Hypothyroidism: A Literature Review.

Migraine, tension-type headache, and hypothyroidism constitute very common medical conditions. Headache is one of the most common symptoms of hypothyroidism, occurring in approximately one-third of the patients. To date, data about the relationship between migraine and tension-type headache and thyroid dysfunction, and in particular hypothyroidism have been contradictory, while the underlying pathophysiological basis explaining this association is still unclear. In this review, we investigated the association between primary headaches and hypothyroidism, with the aim of shedding light on its pathophysiological basis. We conducted a systematic search in the MEDLINE database using both subject headings and keywords for headache, migraine, tension-type headache, thyroid hormones, and hypothyroidism, and we also examined manually the reference lists of all articles that met the inclusion criteria. Included studies were related to headache and thyroid disease comorbidity, with emphasis on hypothyroidism (ideally demonstrated by hormonal measurements), and with the term headache including migraine, tension-type headache, and headache attributed to hypothyroidism (HAH) based on the International Classification of Headache Disorders IIIb. Quality of studies was assessed by the Newcastle-Ottawa scale. Of a total of 640 identified articles, 9 studies were included. Overall, there was vast heterogeneity across the included studies concerning population, study design and outcomes. Two studies investigated the HAH, with emphasis on the clinical characteristics of headache (time of onset, localization, quality, intensity, and response to hormonal replacement treatment). Five studies investigated comorbidity between migraine and thyroid disorders, especially hypothyroidism, and in the majority of them a positive association was demonstrated. One study found that headache, and particularly migraine, may increase the risk of developing hypothyroidism. Finally, only 1 study on chronic tension-type headache found coexistence of migraine and hypoactivity of the hypothalamus-pituitary-thyroid axis. The strengths and limitations of these studies are analyzed and possible pathophysiological mechanisms are suggested. The existing data are considered inadequate to answer with certainty the relationship between headaches and thyroid disorders. According to our analysis, it seems that suggestions for a possible bidirectional association between headaches and especially migraine and hypothyroidism could exist. It hence lays the foundation for further research into the aforementioned association and its pathogenesis via large prospective multicenter studies.

Clinical Characteristics of Headache in Egyptian Patients with Idiopathic Epilepsy

Purpose: Headache and epilepsy are common neurological disorders and their relationship is still incompletely known. The purpose of our work was to estimate the most common types of primary headache syndromes and its relation to seizure timing in epileptic patients in Upper Egypt. Patients & Methods: In a cross-sectional study, we evaluated headaches in 100 consecutive patients with idiopathic epilepsy attending the neurology outpatient clinic and the epilepsy clinic at Sohag university hospital by complete medical history, physical and neurologic examination EEG and CT brain. Results: Of our study population, 78% of patients with epilepsy reported headaches. Migraine occurred in 70.6% of patients with headache followed by tension-type headache in 25.58% of patients and other types of headaches occurred in 2.56% of patients. There were 8 patients (10.1%) had a pre-ictal headache, 52 patients (66.5%) had a postictal headache and 39 patients (50%) had an interictal headache. In our study, we found that the occurrence of headache being linked to the female sex, lower mean age, lower mean age at the onset of epilepsy, focal epilepsy, longer duration of epilepsy, high frequency of seizures and the use of polytherapy of antiepileptics. Conclusion: Headache especially migraine is an important comorbidity of epilepsy and should receive more attention especially in female patients, patients with younger age, lower mean age at epilepsy onset, longer duration of the disease, patients on polytherapy, patients with higher frequency of seizures and patients with focal epilepsy.

Clinical Features of Headache in Patients With Diagnosis of Definite Vestibular Migraine: The VM-Phenotypes Projects.

Migraine is a common neurological disorder characterized by episodic headaches with specific features, presenting familial aggregation. Migraine is associated with episodic vertigo, named Vestibular Migraine (VM) whose diagnosis mainly rely on clinical history showing a temporary association of symptoms. Some patient refers symptoms occurring in pediatric age, defined “episodic symptoms which may be associated with migraine.” The aim of this cross sectional observational study was to assess migraine-related clinical features in VM subjects. For the purpose, 279 patients were recruited in different centers in Europe; data were collected by a senior neurologist or ENT specialist through a structured questionnaire. The age of onset of migraine was 21.8 ± 9. The duration of headaches was lower than 24 h in 79.1% of cases. Symptoms accompanying migrainous headaches were, in order of frequency, nausea (79.9%), phonophobia (54.5%), photophobia (53.8%), vomiting (29%), lightheadedness (21.1%). Visual or other auras were reported by 25.4% of subjects. A familial aggregation was referred by 67.4%, while migraine precursors were reported by 52.3% of subjects. Patients reporting nausea and vomiting during headaches more frequently experienced the same symptoms during vertigo. Comparing our results in VM subjects with previously published papers in migraine sufferers, our patients presented a lower duration of headaches and a higher rate of familial aggregation; moreover some common characters were observed in headache and vertigo attacks for accompanying symptoms like nausea and vomiting and clustering of attacks.

Clinical characteristics of headache in Italian adolescents aged 11\u201316\xa0years: a cross-sectional questionnaire school-based study

BackgroundThe purpose of this study was to determine headache characteristics, impact on daily activities and medication attitudes among a large sample of adolescents in Italy.MethodsSecondary school classes were randomly selected from a national stratified multistage sampling. Data regarding socio-familial factors, headache characteristics, impact on daily activities and medication use were recorded with an anonymous multiple-choice questionnaire.ResultsThe survey involved 2064 adolescents. 1950 questionnaires were considered for analysis. Study population included 944 males (48.4%) and 1006 females (51.6%), aged between 11 and 16 years (mean 13.5 ± 1.87). Headache prevalence was 65.9%. Mean age at headache onset was 8.33 years. 9.8% suffered from headache > 1/week, 14.3% > 1/month, 24.2% monthly and 17.7% less than monthly. The mean duration of a headache episode was less than 30 min in 32.9%, 1 hour in 28.1%, 2 hours in 19.3% and several hours in 19.5%. Pain intensity was moderate in 52.2% and severe in 9.5%. School represented the main trigger factor (67%). Impact on daily activities was noted in 57.5%. 69.2% of adolescents reported the use of pain relievers. Up to 5.7% declared self-medication, while only 20.6% followed a physician’s prescription. Female adolescents experienced headache more frequently (70.2% vs 60%) and more intensely than male peers. Girls had a higher family history of headache, could more frequently identify a trigger factor, and were more affected into their daily activities than boys.ConclusionsPopulation-based studies of headache disorders are important, as they inform needs assessment and underpin service policy for a disease that is a public-health priority. Headache has a high prevalence among adolescents and carries a significant burden in terms of impact on daily activities and use of medication. Furthermore, underdiagnose is common, while trigger factors are often detectable. Special consideration should be given to female adolescents and self-medication attitudes.

Abstract TP396: Distinguishing Characteristics of Headache in Non-Traumatic Subarachnoid Hemorrhage

Subarachnoid hemorrhage (SAH) is a life-threatening emergency that is frequently missed due to its varied and often subtle presentation. The most common presentation of SAH is with a severe headache. The classical adjective used in subarachnoid hemorrhage is “thunderclap;” however, this has not been well defined in the literature rendering it challenge to triage patients in clinical practice presenting with severe headache. We undertook a prospective, observational study at a tertiary academic medical center examining the clinical characteristics of the presenting headache in subarachnoid hemorrhage. We enrolled patients through the emergency department and from the neurosciences intensive care unit and documented clinical features of the headache including the time to peak intensity, location, associated symptoms and activities that caused worsening. One hundred and fifty-eight subjects were enrolled, of whom 20 patients had SAH and 138 did not. Notable distinguishing features on history included occipital location (55% in the SAH group vs. 22% in the non-SAH group, P&lt;0.001), “stabbing” quality (35% in the SAH group vs. 5% in the non-SAH group, P&lt;0.001), presence of prior headache (50% in the SAH group vs. 83% in the non-SAH group, p=0.002) and associated meningismus (80% in the SAH group and 42% in the non-SAH group, P=0.002). Sixty-five percent of patients with SAH reported that their headache peaked within 1 second of onset, compared with only 10% of those without SAH (p&lt;0.001). This is the first study that has sought to examine in detail the clinical characteristics of the presenting headache in SAH. Our study suggests that the clinical features of headache with SAH are distinct from those associated with other headache syndromes,

Prevalence and clinical characteristics of headache in juvenile myoclonic epilepsy: experience from a tertiary epilepsy center.

The comorbidity of headache and epilepsy is often seen in neurological practice. The objective of this study was to assess the prevalence, types of, and risk factors for headache in juvenile myoclonic epilepsy (JME). We assessed a total of 200 patients and 100 healthy controls in our study. Headache was classified in participants using a self-administered questionnaire. Demographical, clinical features and headache characteristics were recorded. Seizure and headache temporal profiles were noted. Headache was present in 111 (56%) patients and 50 (50%) healthy participants. From these patients, 47 (42.3%) JME patients had migraine [30 (27%) migraine without aura (MO), 17 (15.3%) migraine with aura (MA)], 52 (46.8%) had tension type headache (TTH), 4 (3.6%) had both migraine and TTH, and 8 (7.2%) had other non-primary headaches. In the healthy control group, migraine was detected in 16 (32%) subjects, TTH in 33 (66%), both migraine and TTH in 1 (2%) subject. A positive migraine family history and symptom relief with sleep were more frequent in JME patients (p = 0.01). Headache was classified as inter-ictal in 82 (79.6%) patients and peri-ictal in 21 (20.4%) patients. In conclusion, the present study revealed that headache frequency was not significantly different between JME patients and healthy controls (p > 0.05). However, migraine frequency was higher in JME patients than healthy controls. Some migraine and TTH characteristics were different in between groups. We suggest that our results support both genetic relationship and shared underlying hypothetical pathopysiological mechanisms between JME and headache, especially migraine.

Pain Extent Is Associated with the Emotional and Physical Burdens of Chronic Tension-Type Headache, but Not with Depression or Anxiety.

Earlier studies suggest that pain extent, extracted from the patients' pain drawings, can help clinicians to identify people with central sensitization or worse clinical features. Our aim was to investigate possible associations between perceived pain extent and clinical pain features, burden of headache, psychological outcomes, and pressure sensitivity in people with chronic tension-type headache (CTTH). Ninety-nine people (27% men) with CTTH reported their pain on four different body charts representing the head and neck. Pain extent and frequency maps were obtained using customized software. Clinical features of headache, burden related to headache (Headache Disability Inventory [HDI]), anxiety and depression (Hospital Anxiety-Depression Scale [HADS]), and anxiety state/trait (State-Trait Anxiety Inventory [STAI]) levels were assessed. Pressure pain thresholds (PPT) were assessed over the temporalis muscle (trigeminal area), the cervical spine (extratrigeminal area), and the tibialis anterior muscle (distant pain-free area) to determine widespread pressure sensitivity. Associations between pain extent and all outcomes were analyzed. Pain extent showed significant positive associations with age (r = 0.221, P = 0.029) and burden of the headache (emotional: r = 0.213, P = 0.030; physical: r = 0.208, P = 0.039), but no other significant association was found. Pain extent weakly correlated with older age as well as with higher emotional and physical burden of the headache in CTTH. In this population, there was no relationship between pain extent and PPT, indicating that larger pain areas were not associated with signs of central sensitization. Pain drawings can complement other clinical pain features for better characterization of CTTH, but further studies are needed.

Topographical Pressure Pain Sensitivity Maps of the Temporalis Muscle in People with Frequent Episodic and Chronic Tension‐Type Headache

Previous pilot studies suggest the presence of heterogeneous sensitivity to pressure in primary headaches without considering the frequency of headache episodes. To investigate the differences in topographical pressure pain sensitivity maps in the temporalis muscle between individuals with frequent episodic (FETTH) and chronic (CTTH) tension-type headache by controlling the presence of anxiety and depression. oPressure pain thresholds (PPTs) were assessed bilaterally from 9 points distributed over the temporalis muscle (3 points in the anterior portion, 3 in the middle portion, and the remaining 3 in the posterior portion of the muscle belly) in 113 patients with FETTH and 91 with CTTH in a blinded design. Topographical pressure pain sensitivity maps based on interpolation of the PPTs were constructed. Clinical features of headache were collected in a 4-week headache diary. Anxiety and depression (Hospital Anxiety and Depression Scale) were also assessed. The multilevel analysis of covariance found significant difference in PPT levels between points (F = 47.649; P < 0.001), but not between groups (F = 0.801; P = 0.602) or sides (F = 0.331; P = 0.565). No significant effect of gender (F = 0.785; P = 0.667), depression (F = 0.515; P = 0.846), or anxiety (F = 0.639; P = 0.745) was observed. Post hoc comparisons revealed: (1) no differences between FETTH and CTTH; (2) no side-to-side differences; and (3) anterior-to-posterior gradient with the most sensitive points located in the anterior column, followed by those located in the central column and the posterior column of the muscle (all, P < 0.001). This study confirmed an anterior-to-posterior gradient of sensitivity to pressure in both groups, with the highest sensitivity at the anterior part of the muscle. Further, we found similar pressure pain sensitivity in the trigeminal area in people with FETTH or CTTH with no association with depressive or anxiety levels.

Relationship of active trigger points with related disability and anxiety in people with tension-type headache.

To investigate the differences in the presence of trigger points (TrPs) and their association with headache-related disability and mood disorders in people with frequent episodic tension-type headache (TTH) (FETTH) and chronic TTH (CTTH). One hundred twenty-two individuals with TTH participated. Clinical features of headache (i.e., intensity, duration, and frequency) were recorded on a headache diary. Headache-related disability was assessed with the Headache Disability Inventory, trait and state anxiety levels with State-Trait Anxiety Inventory, and depression with the Hospital Anxiety and Depression Scale. TrPs were bilaterally explored in the temporalis, masseter, suboccipital, upper trapezius, splenius capitis, and sternocleidomastoid muscles. Sixty-two (51%) patients were classified as FETTH, whereas 60 (49%) were classified as CTTH. Individuals with CTTH showed higher burden of headache and depression than FETTH (P < 0.001). Subjects with FETTH showed similar number of TrPs (total number: 5.9 ± 3.1, active TrPs: 4.7 ± 2.5, and latent TrPs: 1.2 ± 1.9) than those with CTTH (total number: 5.7 ± 3.2, active TrPs: 4.2 ± 3.0, and latent TrPs: 1.5 ± 1.8). The number of active TrPs was significantly associated with the burden of headache (r = 0.189; P = 0.037) and trait anxiety (r = 0.273; P = 0.005): the higher the number of active TrPs, the greater the physical burden of headache or the more the trait anxiety level. No association with the depression was observed. The presence of active TrPs in head and neck/shoulder muscles was similar between individuals with FETTH and CTTH and associated with the physical burden of headache and trait anxiety levels independently of the subgroup of TTH.

Prevalence and clinical characteristics of headaches among undergraduate students in three tertiary institutions in Ilorin, Nigeria

Headache is a common chronic neurologic disorder with huge economic and psychosocial impact. In comparison with other neurological disorders, there is limited data on primary headache, especially from sub-Saharan Africa. This study was done to fill in the gap and provide recent information on headache among Nigerian undergraduate students. Quota sampling was used to select students from three tertiary educational institutions within Ilorin, the capital of Kwara state. Two-stage self-administered questionnaires developed from the guideline of the International Society of Headache were used to harvest information. A total of 1500 students participated in the study. The mean age of the students was 20.9 ± 3.1 years, with male:female ratio of 1.6:1. A total of 356 students have frequent headache within previous 1 year, given the headache frequency of 23.7%. Fifty-three students (3.5%) had headaches on almost daily basis, 84 (5.6%) had ≥4 attacks/week, 145 (9.7%) had ≤2-3 attacks/month, and 123 (8.2%) had 1-3 attacks every 3 months. Close to 75% indicated that it limits their daily activity frequently. One hundred and eighty-seven (12.5%) students fulfilled the criteria for tension-type headache, 36 (2.4%) for migraine headache, and 133 (8.9%) had nonclassified headaches. The most frequent headache-associated symptoms are photophia - 100 students (6.7%), phonophobia - 159 students (10.6%), while 62 students (4.1%) had nausea and vomiting. None of the students had seen a physician for proper headache diagnosis. Majority (90.2%) used none prescription over-the-counter analgesia (acetaminophen) for symptomatic treatment of their aches. Headache is a common complaint among Nigerian undergraduate students and it limits the daily activity of majority of the sufferers. Students need proper education regarding treatment to alleviate their suffering and forestall complication, especially those associated with analgesic overuse.

Trigger points are associated with widespread pressure pain sensitivity in people with tension-type headache.

Objective To investigate the association between trigger points (TrPs) and widespread pressure pain sensitivity in people with tension-type headache (TTH) and to determine if this association is different between frequent episodic (FETTH) or chronic (CTTH) headache. Design A cross-sectional study. Methods One hundred and fifty-seven individuals (29% male) with TTH participated. Clinical features of headache, i.e., intensity, duration, and frequency, were recorded in a headache diary. Active and latent TrPs were bilaterally explored in the temporalis, masseter, suboccipital, upper trapezius, sternocleidomastoid, and splenius capitis muscles. Pressure pain thresholds (PPT) were assessed over the trigeminal area (i.e., temporalis muscle), extra-trigeminal (i.e., C5/C6 zygapophyseal joint), and two distant pain-free points (i.e., second metacarpal and tibialis anterior muscle). Results Eighty (51%) patients were classified as FETTH, whereas 77 (49%) were classified as CTTH. No differences in the number of either active or latent TrPs (all p > 0.171) or widespread pressure pain sensitivity (all p > 0.351) were observed between FETTH and CTTH groups. The number of active and latent TrPs was significantly and negatively associated with PPTs: The higher the number of active or latent TrPs, the lower the widespread PPT, and the more generalized sensitization. This association was stronger within the FETTH group than the CTTH group. Conclusions This study found that the number of TrPs in head and neck/shoulder muscles was associated with widespread pressure hypersensitivity independently of the frequency of headache.

The psychometric properties of the Comprehensive Headache-related Quality of life Questionnaire (CHQQ) translated to Serbian.

BackgroundThe Comprehensive Headache-related Quality of life Questionnaire (CHQQ), is a recently developed and validated instrument, intended for measuring quality of life of patients with all headache types. Currently no validated headache-specific quality of life questionnaires are available in Serbian. The aim of this study was to translate the CHQQ from Hungarian to Serbian, to make necessary cultural adaptations and to test its psychometric properties in a sample of outpatients with headache.MethodsThe CHQQ was translated and adapted according to internationally accepted guidelines, and then tested on a sample of 216 Serbian headache patients (171 females and 45 males, mean age 42.3 years/SD 13.35; range 18–75). The majority of patients suffered from episodic tension-type headache (TTH); 27 (12.5 %) had episodic migraine. We calculated the internal consistency (Cronbach’s alpha), criterion validity (correlations of individual items, dimensions and whole questionnaire with the clinical characteristics of headache), convergent validity (correlations of the abovementioned scores with results of other instruments measuring headache severity and impact), and discriminative validity (comparison of the scores in the two diagnostic groups) of the CHQQ. We used factor analysis to explore the underlying construct.ResultsThe Serbian translation of CHQQ showed excellent internal consistency, both for the whole instrument (Cronbach’s alpha 0.937) and its dimensions. The validity of the instrument in all aspects (criterion, convergent and discriminative validity) was also excellent when the whole sample and the subgroup of patients with TTH were analyzed, while the results for patients with migraine were less favorable. Factor analysis suggested the existence of a single dimension in this sample.ConclusionsThe Serbian translation of CHQQ is as reliable and valid specific instrument for measuring headache-related quality of life in patients with TTH and probably in patients with migraine.

A proposal for a national registry on chronic migraines.

According to the existing classification chronic migraine (CM) is a primary headache that occurs on 15 or more days per month for more than 3 months and has the features of migraine on at least 8 days per month. In Europe, CM prevalence ranges from 2.7% to 4.7%. CM is an extremely disabling disorder associated with significant functional impairment. The 2010 Global Burden of Disease Survey conducted by the WHO listed migraine as the 7th cause of disability in the world, responsible for 2.9% of all years of life lost to disability. Unfortunately, however, in its current definition CM includes subgroups of patients with very different levels of severity and outcome. Failing to recognize them entails highly negative repercussions on research and clinical practice, with inadequate patient management and lack of cost-effectiveness. Therefore, it is essential that these subgroups of subjects be clearly identified to optimize clinical management, rationalize the allocation of economic resources, provide specific clinical and health care procedures, and clarify pathogenetic mechanisms. The clinical registry will include the data of all patients with CM, aged 18 or over, seen at the Headache Centres of Parma, Bologna, Rome, and Milan. The diagnosis of CM will be made by a headache specialist based on the diagnostic criteria of the ICHD-III beta (2013) and on the CM classification proposed by Manzoni et al[1]. The principal aim of the clinical registry will be to identify still undefined subgroups of subjects with CM through a specially designed clinical registry to be applied in a large number of outpatients. The registry will make it possible to collect: personal and social patient data, as well as data about their physiological conditions and non-essential habits; clinical features of headache (before and after its evolution to chronicity); any factors concomitant with the headache's evolution to chronicity (i.e., medication overuse, life events, hypertension); comorbidity and injuries; headache-related disability (MIDAS, WHO-DAS-II, MSQ); quality of life (SF36); symptomatic and preventive treatments; medication overuse; visits and hospitalizations for CM; and recognized sickness and invalidity allowances. The creation of a large-scale registry will make it possible to identify specific CM (i.e., refractory CM) subgroups, based on clinical and biological features. It will also make it possible to identify areas with lack of or inadequate health care provision and waste of resources (i.e., useless examinations or treatments), eventually helping to improve CM management and ensure health care procedures that are more appropriate.

O036. Cocaine and headache: a 2-year follow-up study in chronic cocaine users and literature review.

As many as 14-21 million people worldwide (0.3-0.5% of the population, aged 15-65 years) use cocaine [1]. In Europe, cocaine consumption has shown a 2- to 3-fold increase during the last 2 decades [2,3]; in Italy, lifetime cocaine experience among adults corresponds to 6.6% [4]. Cocaine use and headache share some common characteristics: present heavy global burden, prevail among young individuals, cause more severe consequences in females, may lead to emergency department access and progress to chronification. The study of headache in chronic cocaine users (CCU) is of interest also from a pathophysiological point of view, given that chronic cocaine use causes decreased dopamine and serotonin synaptic levels, a typical migraine biochemical feature (“empty neuron” condition) [5,6]. In a previous study we encouraged clinicians to carry out a more in-depth investigation on cocaine use in all headache suffers, especially those with migraine, as headache occurs in a very high proportion of CCU (90%), mostly showing migraine or migraine-like characteristics, while cocaine-induced headache, as classified by the ICHD criteria [7], seems exceedingly rare (2.2%). Moreover, we pointed out that CCU sometimes use cocaine as an acute remedy for the headache attack, even though improvement occurs very rarely (17.2% of cases) [8]. Recently, it has been described that patients with intractable cluster headache who tried cocaine, being dissatisfied with conventional treatments in terms of efficacy and/or tolerability, referred a full or partial improvement in 30.8% of cases [9]. The present study was aimed to evaluate the modification of the clinical characteristics of headache in CCU after a 2-year follow-up period. We contacted by phone the 80 patients previously enrolled [8] attending the Cocaine Addiction Service of the Drug Addiction Service, 20th District, Rome. Of these 80 patients, 60 (still followed by the Drug Addiction Service) were enrolled and interviewed by the same physicians of the previous study. We studied the modifications of headache pattern and characteristics relative to their actual cocaine consumption in CCU patients previously subdivided into 3 groups: neither lifetime nor current headache (group 0); lifetime and current headache (group 1); and de novo headache, i.e. individuals in whom headache developed only after cocaine use began (group 2). The correlation between headache and cocaine is controversial and still understimated. Written informed consent to publish was obtained from the patient(s).

Prevalence and Clinical Characteristics of Headaches in PHACE Syndrome.

PHACE (posterior fossa brain malformation, hemangiomas, arterial anomalies, coarctation of the aorta and cardiac defects, and eye abnormalities) syndrome is a neurocutaneous disorder often involving the cerebral vasculature. PHACE patients appear to have early-onset and severe headaches more commonly than children without PHACE. The objective of this study was to characterize the clinical features and prevalence of headache by conducting a cross-sectional survey of families in 2 large PHACE registries. Sixty-six percent of eligible families completed the survey in which 62.7% of respondents reported headaches. Average age of headache onset was 48.8 months. Females were more likely to have headaches (68.6% vs 30.8%, P = .014). Families reported associated migrainous features including nausea (62.5%), vomiting (37.5%), photophobia (75%), and phonophobia (75%). Headaches occurred at least weekly in 29.4%, lasted ≥1 hour in 85.4%, and led to ≥1 hospital admission in 15.7%. Three respondents with headaches had at least 1 ischemic stroke. We demonstrated that headaches are common among PHACE patients, develop at an early age, and have migrainous features.

Posterior fossa decompression with duraplasty in Chiari-1 malformations.

To evaluate the symptomatic outcome after PFD (Posterior Fossa Decompression) with duraplasty in Chiari-1 malformations. Case series. Department of Neurosurgery, JPMC, Karachi, from July 2008 to September 2012. This included 21 patients of Chiari 1 malformations admitted in department through OPD with clinical features of headache, neck pain, numbness, neurological deficit, and syringomyelia. Diagnosis was confirmed by MRI. PFD followed by C1 laminectomy with duraplasty was done in all cases and symptomatic outcome was assessed in follow-up clinic. Among 21 patients, 13 were females and 8 were males. Age ranged from 18 to 40 years. All the patients had neck pain and numbness in hands. Only 3 patients had weakness of all four limbs and 12 with weakness of hands. Symptoms evolved over a mean of 12 months. Syringomyelia was present in all cases. All patients underwent posterior fossa decompression with duraplasty with an additional C1 laminectomy and in 2 cases C2 laminectomy was done. Syringo-subarachnoid shunt was placed in one patient and ventriculo-peritoneal shunt was placed in 2 patients. Pain was relieved in all cases. Weakness was improved in all cases and numbness was improved in 19 cases. Syringomyelia was improved in all cases. Postoperative complications included CSF leak in 2 patients and wound infection in one patient. However, there was no mortality. Posterior fossa decompression with duraplasty is the best treatment option for Chiari-1 malformations because of symptomatic improvement and less chances of complications.