Evolution Of Headache Research Articles

Intracranial Venous and Mesenteric Vein Thrombosis in a Case of Lung Cancer with Brain, Bone, and Leptomeningeal Metastasis

Cancer patients with venous thromboembolism (VTE) are not rare, and the second death cause in patients with cancer is VTE. Although VTE itself is associated with reduced survival particularly in cancer patients, many oncologists may not place enough importance in positive prevention of VTE. Here, we report the case of a 38-year-old male lung cancer patient with brain, bone and leptomeningeal metastasis who diagnosed as a consequential intracranial venous and mesenteric vein thrombosis. The evolution of headache has not been noted gradually, from which led to the underestimation of headache and without careful consideration on the possibility of suspected intracranial venous thrombosis. The problem of mesenteric vein thrombosis reflects the dilemma resulted from the potential risk of thrombogenesis and the high risk of hemorrhage. Preventive anticoagulation strategies are key means especially in patients with cancer, and the management problems of this condition are discussed.

Diffusion tensor imaging in middle-aged headache sufferers in the general population: a cross-sectional population-based imaging study in the Nord-Tr\xf8ndelag health study (HUNT-MRI)

BackgroundSeveral studies have investigated white matter with diffusion tensor imaging (DTI) in those suffering from headache, but so far only in clinic based samples and with conflicting results.MethodsIn the present study, 1006 individuals (50–66 years) from the general population (Nord-Trøndelag Health Study) participated in an imaging study of the head at 1.5 T (HUNT-MRI). Hundred and ninety-six individuals were excluded because of errors in the data acquisition or brain pathology. Two hundred and forty-six of the remaining participants reported suffering from headache (69 from migraine and 76 from tension-type headache) the year prior to the scanning. DTI data were analysed with Tract-Based Spatial Statistics and automated tractography. Type of headache, frequency of attacks and evolution of headache were investigated for an association with white matter fractional anisotropy (FA), mean diffusivity (MD), axonal diffusivity (AD), radial diffusivity (RD) and tract volume. Correction for various demographical and clinical variables were performed.ResultsHeadache sufferers had widespread higher white matter MD, AD and RD compared to headache free individuals (n = 277). The effect sizes were mostly small with the largest seen in those with middle-age onset headache, who also had lower white matter FA. There were no associations between white matter microstructure and attack frequency or type of headache.ConclusionMiddle-age onset headache may be related to a widespread process in the white matter leading to altered microstructure.

Cerebral cortical dimensions in headache sufferers aged 50 to 66 years: a population-based imaging study in the Nord-Trøndelag Health Study (HUNT-MRI)

Based on previous clinic-based magnetic resonance imaging studies showing regional differences in the cerebral cortex between those with and without headache, we hypothesized that headache sufferers have a decrease in volume, thickness, or surface area in the anterior cingulate cortex, prefrontal cortex, and insula. In addition, exploratory analyses on volume, thickness, and surface area across the cerebral cortical mantle were performed. A total of 1006 participants (aged 50-66 years) from the general population were selected to an imaging study of the head at 1.5 T (HUNT-MRI). Two hundred eighty-three individuals suffered from headache, 80 with migraine, and 87 with tension-type headache, whereas 309 individuals did not suffer from headache and were used as controls. T1-weighted 3D scans of the brain were analysed with voxel-based morphometry and FreeSurfer. The association between cortical volume, thickness, and surface area and questionnaire-based headache diagnoses was evaluated, taking into consideration evolution of headache and frequency of attacks. There were no significant differences in cortical volume, thickness, or surface area between headache sufferers and nonsufferers in the anterior cingulate cortex, prefrontal cortex, or insula. Similarly, the exploratory analyses across the cortical mantle demonstrated no significant differences in volume, thickness, or surface area between any of the headache groups and the nonsufferers. Maps of effect sizes showed small differences in the cortical measures between headache sufferers and nonsufferers. Hence, there are probably no or only very small differences in volume, thickness, or surface area of the cerebral cortex between those with and without headache in the general population.

Headache and psychopathology: DSM-V vs ICHD-3β vs ICD10.

A strict relationship between migraine and psychiatric factors has been suggested, but the exact role and the influence on evolution of headache is unknown. The most frequent diagnosis was a comorbidity of anxiety and mood disorders. The comorbidity of psychiatric disorders and headache has important implications as far as treatment is concerned. In comparing DSM-V, ICHD-3β and ICD10 criteria on headache and psychopathology, diagnostic criteria agree on pre-existing headache with the characteristics of a primary headache disorder becoming chronic, or made significantly worse, in close temporal relation to a psychiatric disorder, both in the initial headache diagnosis and psychiatric diagnosis. Headache attributed to psychiatric disorder should be given, provided that there is good evidence that that disorder can cause headache. When a causal relationship cannot be confirmed, the pre-existing primary headache and the psychiatric disorder are diagnosed separately. Thus, the diagnostic categories are limited to those few cases in which a headache occurs in the context and as a direct consequence of a psychiatric condition known to be symptomatically manifested by headache. Diagnostic criteria must be restrictive enough not to include false positive cases, but must set the threshold low enough to admit the majority of affected patients. Headache disorders occur coincidentally with a number of psychiatric disorders. Although criteria for headaches attributed to psychiatric disorders have suggested that headache occurring exclusively in association with several common psychiatric disorders, such as, depressive, anxiety and trauma/stress-related disorders, might be considered as attributed to these disorders, because of uncertainties concerning the causal relationships and relative lack of evidence in this context. Evidence suggests that the presence of a comorbid psychiatric disorder tends to worsen the course of migraine and/or tension-type headache by increasing the frequency and severity of the headache and/or making it less responsive to treatment. Thus, identification and treatment of any comorbid psychiatric condition is important for the proper management of these headaches. It should be noted that somatization disorder per se is not included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), it has been replaced by the category Somatic Symptom Disorder, characterized by one or more somatic symptoms. Thus, ICHD-3 beta continues to refer to the DSM-IV definition of somatization disorder. Using WHO's criteria and methods for measuring burden of disease in DALYs, headache disorders can be placed correctly in the context of other mental and neurological disorders and other chronic illnesses. In order to know the full burden attributable to headache disorders, however, further epidemiological work must be conducted around the world and this must encompass assessments of clinical, economic and humanistic impacts.

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.

Evolution of headache in a population of young Italian headache sufferers: a brief report

Headache is a common symptom in children and adolescence. In this retrospective analysis, we interviewed a population of young patients who were arrived to our observation 10years before, in order to: (1) determine if the first diagnosis was still adequate and (2) which percentage of these young patients developed chronic forms (more than 15days/month) from episodic forms. One hundred and seventy-seven patients suffering from different forms of headache were contacted and interviewed. The original diagnosis was confirmed in all the population of patients and the percentage of chronic forms developed from episodic forms was not significant. From this retrospective study, it does not seem the evolution of episodic forms in young age is necessarily a chronic form in adult as this depends from other behavioural or biological or environmental factors.

How Children and Parents Evaluate the Headache Centre's Intervention

While adult headache patients' satisfaction with treatments has been widely investigated, less attention has been paid to children and adolescent headache patients' opinions and their parents' views. The aim of our follow-up survey was to analyze the outcomes of the Headache Centre's intervention and the evolution of headache according to patients until the age of 16 and their parents. We studied all outpatients suffering from episodic primary headache according to International Classification of Headache Disorders 2nd edition criteria, seen for the first time in 2005-2006 at the Headache Centre of the University Hospital of Modena (Italy), and at least one of their parents. The duration of the follow-up ranged from 1 to 3 years. For the purpose of the study, a specific questionnaire was created and administered by a telephone interview. We enrolled 84 patients (38 females, 45%; 46 males, 55%; mean age +/- SD: 12.9 +/- 2.9 years) with primary headache: migraine without aura 66%, episodic tension-type headache 23%, migraine with aura 11%. At the follow-up, 70% of the patients reported that headache had improved; frequency had decreased significantly more than severity (P = .000, Fisher's exact test), both in those who had followed a prophylactic treatment and in those who had not. A high percentage of the children and parents could precisely indicate trigger factors for headache: especially excessive worrying and studying. The patients reporting an improvement attributed it to pharmacological prophylactic treatment, but also to other factors: first of all, better school results and more happiness than before. Seventy-seven percent of the parents thought that the Headache Centre's intervention had helped them to better understand and manage their children's headache. Children's and adolescents' headache has in most cases a favorable prognosis; the Headache Centre's intervention is considered effective by most parents. We must increase and focus therapeutic efforts addressed to the few patients with worsening headaches in spite of treatment, since these children's/adolescents' headache also is at risk to progress in the adult age.

Idiopathic Headache in Children Under Six Years of Age: A Follow‐Up Study

To assess the evolution of idiopathic headache with early onset and to investigate the influence of early somatic disorders, "life events," and psychiatric disorders on the onset and the course of headache. We also studied the possible prognostic role of gender, headache diagnosis at onset, and history of headache in family members on the course of headache. We also investigated the applicability of the ICHD-II criteria to idiopathic headache in preschool children. Prospective evaluation of 25 consecutive headache patients referred before the age of 6 years. Headache diagnosis was based on the IHS 1988 criteria, on the ICHD-II criteria, and on "alternative" clinical criteria [eg, duration less than 1 hour in migraine without aura (MWA), less than 30 minutes in tension-type headache (TTH)]. All patients were assessed by a structured interview to detect early developmental disorders (eg, feeding difficulties or sleep disorders) and "life events" (eg, parents' separation and others according to DSM-IV). All patients underwent clinical observations and assessment of psychiatric comorbidity (ICD-10) by means of interviews and the Child Behaviour Check List. All the above-mentioned evaluations were performed at recruitment (T0) and at the end of the follow-up period (T1). A total of 25 children with headache (12 males; 13 females) were monitored through long-term clinical follow-up (mean duration: 4.2 years; range: 2.8 to 6.6 years). The "definite" diagnosis of migraine without aura or TTH at T0 was possible in only 6/25 (24%) and 9/25 patients (36%) applying the IHS 1988 criteria and the ICHD-II criteria respectively, but in 20/25 (80%) applying the "alternative" clinical criteria. Evaluation of headache at T1 revealed: remission in 16/25 (64%) patients and persistence in 9/25 (36%). At T1, the ICHD-II diagnosis was possible in 100% of the children with headache persistence (1/9 migraine without aura and 8/9 TTH) and these diagnoses were found to be perfectly concordant with those obtained applying the "alternative criteria." Early developmental disorders were present in 11/25 children, with a significantly higher prevalence in children with headache persistence compared to children showing headache remission (78% vs. 25%; P < .05). No significant differences were found between patients with headache persistence and patients with headache remission with regard to gender, history of headache in family members, headache diagnosis at onset, psychiatric comorbidity at T0, and with regard to "life events" at both T0 and T1. Conversely, the children presenting psychiatric disorders at T1 were more frequently affected by headache than those without psychiatric disorders (59% vs. 15%; P < .05). Our results suggest that the ICHD-II criteria are too restrictive to allow the classification of migraine without aura and TTH in preschool children. Nevertheless, a diagnosis based on these criteria was possible in all the patients with headache persistence at the end of several years' follow-up. We found a significant association between early somatic disorders and persistence of headache and also between the presence of psychiatric disorders at the end of follow-up and the persistence of headache. "Life events," on the other hand, while not showing a statistically significant association with the evolution of the headache, may nevertheless influence the course of the headache in some patients. Our results suggest that environmental and psychological factors play an important role in idiopathic headache with onset in preschool age, and thus that the diagnostic-therapeutic approach must take these factors into account.

Lack of habituation of nociceptive evoked responses and pain sensitivity during migraine attack

Objective The aim of the present study was to investigate the habituation of subjective pain sensation to CO 2 laser stimulus, in relation to the amplitude modifications of the cortical evoked responses (LEPs), during both the migraine attack and the not symptomatic phase. Methods Fourteen migraine patients were selected and compared with 10 healthy controls. Eight patients were evaluated during both the pain-free and the attack phases. Three following series of 20 averaged LEPs were recorded, stimulating the hands and the supraorbital zones: during the attack, two consecutive series of 20 averaged LEPs were carried out. The subjective sensation was requested for each laser stimulus, using a 0–10 points Verbal Rating Scale (VRS). Results In normal subjects the N2–P2 waves amplitude showed habituation across the three repetitions, which correlated with the habituation of the subjective rating of the stimulus. During the not symptomatic phase, patients showed a lack of habituation of the N2–P2 amplitude when the hand and the face was stimulated, with a pattern of increase of the pain rating across the three repetitions; in addition there was a lack of correlation between the LEPs amplitude and the subjective sensation. During the attack, the LEPs amplitude and the pain rating were increased when the face was stimulated, but they did not habituate across the two repetitions, likely the pain-free condition. The percent LEPs amplitude variation across the three repetitions correlated with the main indices of migraine severity, mainly when the supraorbital zone was stimulated. Conclusions The abnormal cortical excitability in migraine could condition an anomalous behavior of nociceptive cortex during the interictal phase of migraine: it persists during the acute phase, and correlates with the frequency and duration of migraine. Significance The reduced habituation of the nociceptive cortex may concur with the onset and evolution of headache.

Pediatric headaches: what's new?

The evolution of headache from childhood into adulthood is receiving greater attention as questions arise regarding prevalence and long-term remission rates. Presenting symptoms of headache in childhood and adolescence tend to differ from those in adults, making it difficult to obtain high sensitivity ratings using the present standard International Headache Society criteria specifically with regard to migraine. The new treatment options that have been available for adults for several years are now being studied in childhood and adolescent populations. Are they safe and effective, and is there a need to alter dosages in this population? The interest in chronic daily headache in childhood and adolescence is increasing because studies in this population may help us to advance our knowledge with regard to adult chronic daily headache.