Experience Of Headache Research Articles

Neural correlates of pain acceptance and the role of the cerebellum: Functional connectivity and anatomical differences in individuals with headaches versus matched controls.

Despite functional connectivity network dysfunction among individuals with headaches, no studies have examined functional connectivity neural correlates and anatomical differences in coping with headaches. This study investigated inter-individual variability in whole-brain functional connectivity and anatomical differences among 37 individuals with primary headaches and 24 age- and gender-matched controls, and neural correlates of psychological flexibility (PF) that was previously found to contribute to headache adjustment. Participants (84% women; M headache severity = 4/10; M age = 43 years) underwent functional magnetic resonance imaging scans and completed questionnaires to examine global and subnetwork brain areas, and their relations with PF components, controlling for age, gender, education, and head-motion. Seed and voxel-based contrast analyses between groups showed atypical functional connectivity of regions involved in pain matrix and core resting-state networks. Pain acceptance was the sole PF component that correlated with the cerebellum (x, y, z: 28, -72, -34, p-false discovery rate <0.001), where individuals with headaches showed higher grey matter density compared to controls. The cerebellum, recently implicated in modulating emotional and cognitive processes, was indicated to process information resembling what individuals do when practicing pain acceptance. Our findings establish for the first time this connection of the cerebellum and its role in pain acceptance. We propose that pain acceptance might be a behavioural biomarker target that could modulate problematic headache perceptions and brain networks abnormalities. This study highlights the potential use of emerging behavioural biomarkers in headache management, such as pain acceptance, and their role in modifying the headache experience. Notably, grey matter reorganization in the cerebellum and other known brain pain networks, could indicate brain networks that can be modified from targeted behavioural interventions to help decode the nociplastic mechanisms that predominates in headaches.

Stress and headaches in university students during the COVID-19 pandemic.

With regards to the relationship between mental and physical health conditions, some studies predict increased headache frequency as a result of exposure to stressful situations. Thus, the purpose of our study was to investigate whether headache characteristics among a sample of university students (N = 234) correlated with fear of COVID-19, stress and quality of life vis-à-vis the pandemic. We found statistically significant positive correlations between headache frequency and both general stress and quality of life. Further, results from a multiple regression analysis suggested that fear of COVID-19 did not account for incremental variance in headache intensity. Explanations for our key findings, limitations of our study, and future directions for post pandemic studies on headache experience are outlined.

Randomized Trial Examining Efficacy of Mentha piperita in Reducing Chronic Headache Discomfort in Youth

BackgroundYouth with chronic headache experience disruption to routine activities and require significant health care utilization. While interventions targeting a relaxation response have shown clinically significant benefit in headache outcomes, peppermint oil has not been evaluated for efficacy in a pediatric headache population. AimsTo explore the extent to which a brief aromatherapy intervention improves subjective and objective indicators of discomfort beyond passive relaxation in youth with chronic headaches. DesignSingle-center, randomized, experimental study. MethodsPatients were randomly assigned to a brief foot bath or foot bath plus peppermint oil group. Measurements were collected at baseline, mid-intervention, and post-intervention. Data included heart rate and subjective pain, anxiety, and satisfaction scores. ResultsForty-six adolescents (89% female, mean age 15.2 years) diagnosed with a primary headache disorder were enrolled. Both groups reported a significant decrease in pain, though the intervention group plateaued (p < .01) and the control group progressively decreased intensity at each time-point (p < .01). Whereas both groups reported a decrease in anxiety over time (p < .01), the control group reported less of a decrease in anxiety than the intervention group (p = .03). The control group had a significant decrease in mean heart rate (p < .01). There were no adverse events. The intervention was well tolerated, liked, and recommended by 95.5% of study participants. ConclusionsA brief intervention intended to activate the relaxation response produced a subjective reduction in pain and anxiety. However, the addition of peppermint oil to a foot bath did not significantly improve pain or anxiety beyond the control condition.

Anguish in Language: Pain as a Biocultural Experience in Claudia Rankine's Citizen: An American Lyric.

Claudia Rankine's Citizen: An American Lyric (2014) represents physical pain as a multidimensional experience entwined with history, language, and culture. By linking descriptions of anti-Black racist encounters with the imagery of somatic aches, Rankine blurs the boundaries between psychological suffering and physical distress to offer readers a nuanced depiction of the way racist discourse can both cause and, most crucially, shape one's private perception of corporeal agony. She zeros in on the experience of headaches to represent the interwoven relationship between the psycholinguistic contours of thought and bodily hurt, insisting that physical pain is more than a physiological alarm whose essence lies outside of language and culture.

The relationship between nitrate induced headache and whole blood viscosity: an observational prospective study.

Nitrates are one of the most prescribed medications in the treatment of angina pectoris today. Headache is the most common side effect of nitrates, and there is limited prospective data on the determinants of this effect. Our aim in this study is to open a foresight window for clinicians in clinical practice by explaining the possible relationship between nitrate induced headache (NIH) and whole blood viscosity (WBV). After coronary revascularization treatment, 869 patients with angina who were prescribed nitrate preparations were divided into groups according to the development of headache or not, and categorized according to the four-grade scale (4GS) level. Those who had no headache during nitrate use were graded as Grade 0, those who felt mild headache were Grade 1, those who felt moderate headache were Grade 2, and those who described severe headache were graded as Grade 3. The groups were compared according to WBV values. A total of 869 participants were included in the study. Most patients (82.1%) experienced any level of headache. Headache severity was correlated with both WBV at HSR (r=0.657, p<0.001) and WBV at LSR (r=0.687, p<0.001). In multivariate analysis, WBV was determined as an independent predictor of headache experience. WBV predicted NIH with 75% sensitivity and 75% specificity at HSR and 77% sensitivity and 77% specificity at LSR. WBV seems to be one of the major determinants for NIH. WBV may be a guide for initiating alternative antianginal drugs without prescribing nitrates to the patient in order to increase patient compliance.

Immune Fitness, Migraine, and Headache Complaints in Individuals with Self-Reported Impaired Wound Healing.

Having chronic wounds and impaired wound healing are associated with psychological distress. The current study aims to evaluate migraine and headache complaints in young adults with self-reported impaired wound healing. A survey was conducted among N=1935 young adults (83.6% women), 18-30 years old, living in the Netherlands. Wound healing status was verified, immune fitness was assessed using a single-item rating scale, and ID Migraine was completed. In addition, several questions were answered on past year's headache experiences (including frequency, quantity, type, location, and severity). In both the control group (p < 0.001) and the IWH group (p = 0.002) immune fitness was significantly lower among those that reported headaches compared to those that reported no headaches. Individuals with self-reported impaired wound healing (IWH) scored significantly higher on the ID Migraine scale, and individuals of the IWH group scored significantly more often positive for migraine (ie, an ID Migraine score ≥2). They reported a younger age of onset of experiencing headaches, and significantly more often reported having a beating or pounding headache than the control group. Compared to the control group, the IWH group reported being significantly more limited in their daily activities compared to the control group. Headaches and migraines are more frequently reported by individuals with self-reported impaired wound healing, and their reported immune fitness is significantly poorer compared to healthy controls. These headache and migraine complaints significantly limit them in their daily activities.

Relationship Between Changes in Cranio-Cervical Extensor Muscles and Quality of Life: A Single-Center Study of 15 Patients with Chronic Tension-Type Headache.

BACKGROUND This single-center study of 15 patients with chronic tension-type headache aimed to compare the cranio-cervical extensor muscles between patients with chronic tension-type headache and healthy individuals and to explore the relationship between changes in cranio-cervical extensor muscles and quality of life (QoL). MATERIAL AND METHODS We recruited 15 patients with chronic tension-type headache and 15 healthy individuals. Patients with chronic tension-type headache were diagnosed by 2 neurologists according to the diagnostic criteria in the International Classification of Headache Disorders, 3rd edition (ICHD-3). Morphological changes in the cranio-cervical extensor muscle were detected using magnetic resonance imaging (MRI). QoL and the degree of neck dysfunction were assessed using the Headache Impact Test-6 (HIT-6) and Neck Disability Index (NDI), respectively. RESULTS The relative cross-sectional areas (rCSAs) of the rectus capitis posterior minor (RCPmin) were lower in patients with chronic tension-type headache than in healthy individuals. The HIT-6 scores (r=-0.93, P<0.001 and r=-0.85, P<0.001 for RCPmin right side and left side, respectively) and NDI scores (r=-0.75, P<0.001 and r=-0.70, P<0.001 for RCPmin right side and left side, respectively) were negatively associated with the rCSA of RCPmin in the chronic tension-type headache group. CONCLUSIONS Most patients with chronic tension-type headache experience RCPmin atrophy. The more evident the RCPmin atrophy, the worse the QoL of the patients with chronic tension-type headache.

Pediatric Headache Experience During the COVID-19 Pandemic.

ObjectiveHeadache disorders are exceedingly common in children and adolescents. The association between headaches, emotional stress, and disruptions in daily routines are well established. The goal of this study is to compare the experiences of patients with a preexisting diagnosis of a primary headache disorder in terms of headache frequency and severity, lifestyle techniques for headache prevention, screen use, and mood from before and after the onset of the COVID-19 pandemic.MethodsPatients evaluated by the Headache Clinic at Children’s National Hospital between Summer 2020 and Winter 2021 were enrolled in a patient registry. Patients completed a questionnaire examining changes in headache characteristics and lifestyle factors since the onset of the COVID-19 pandemic.ResultsA total of 107 patients completed the survey. Since the pandemic’s onset, patients reported decreased physical activity (n = 59, 55%), increased frequency of chronic headaches from 40% (N = 42) to 50% (N = 54), and increased constant daily headaches from 22% (n = 24) to 36% (n = 38). Patients reported worsened anxiety (n = 58, 54%), mood (n = 50, 47%), and workload (n = 49, 46%). Sixty-one percent (n = 65) of patients reported using screens for school for more than 6 hours per day. The majority (n = 67, 63%) of patients indicated that they would prefer attending in-person school, with 14% (n = 15) responding that they preferred online school.ConclusionSince the COVID-19 pandemic’s onset, pediatric headache patients have experienced increasing headache frequency, worsening anxiety and mood, decreased physical activity, and increased screen usage. Although this study is limited by sample size and observational design, future population-based studies will further elucidate the impact of this pandemic on pediatric headache.

Migraine

Abstract: Migraine is the most common disabling brain disorder. Chronic migraine, a condition characterized by the experience of migrainous headache on at least 15 days per month, is highly disabling. Patients with chronic migraine present to primary care, are often referred for management to secondary care, and make up a large proportion of patients in specialist headache clinics. Many patients with chronic migraine also have medication overuse, defined as using a compound analgesic, opioid, triptan or ergot derivative on at least 10 days per month. All doctors will encounter patients with chronic headaches. A basic working knowledge of the common primary headaches, and a rational manner of approaching the patient with these conditions, allows a specific diagnosis of chronic migraine to be made quickly and safely, and by making this diagnosis one opens up a substantial number of acute and preventive treatment options. This article discusses the current state of management of chronic migraine.

Health Mindsets in Pediatric Chronic Headache.

Given how frequently youth with chronic headache and migraine experience setbacks in treatment, identifying factors that promote coping and resilience is critical. Mindsets have gained attention as predictors of behavior and targets of intervention across contexts, including health. Health mindsets may help to explain how children with chronic pain interpret and respond to treatment. This study evaluated whether growth health mindsets might relate to adaptive outcomes in patients with chronic pediatric headache. Participants were 88 children and adolescents (ages 10-17 years) with headache or migraine contacted following an appointment at a pediatric headache clinic, and their parent. Patients rated their beliefs about health as more fixed versus growth-oriented. They were presented with vignettes depicting hypothetical treatment setbacks and instructed to reflect upon real-life setbacks. Patients completed questionnaires about their cognitive appraisals of setbacks, coping, quality of life, life satisfaction, and functional impairment. The higher children rated their growth health mindsets, the less likely they were to appraise setbacks as threatening and endorse quality-of-life problems. Children with higher growth mindsets reported higher life satisfaction and lower functional disability. There was also an indirect relation between children's mindsets and coping through cognitive appraisals of setbacks as a threat, but not challenge. This research extends the health mindsets literature by contributing preliminary evidence of health mindsets as tied to adaptive outcomes in youth with chronic headache. These findings may be of interest to clinicians and parents, as health mindsets may offer an avenue by which resilience is promoted and maladaptive appraisals are minimized.

Mechanisms of change in acceptance and commitment therapy for primary headaches

AbstractBackgroundDespite the demonstrated effectiveness of behavioural headache interventions, it is not yet known which intervention processes account for treatment responses. Acceptance and commitment therapy (ACT), an emerging behavioural intervention for headaches, proposes psychological flexibility (PF) processes as the mechanisms via which intervention change occurs. This is the first study examining these processes of change variables on headache‐related disability and quality of life (treatment outcome).MethodsData originated from a Randomized Clinical Trial evaluating the efficacy of ACT for primary headaches. Ninety‐four individuals with primary headaches (M = 43 y; 84% females; M headache frequency/month = 9.30) were randomized to either an ACT‐based or a Wait‐list control group (N = 47 in each). Participants completed questionnaires related to their headache experiences and PF processes at pre‐ (T1), post‐treatment (T2), and 3‐month follow‐up (T3).ResultsFollowing a bootstrapped cross product of coefficients approach, results demonstrated mediating effects of headache acceptance, cognitive defusion, avoidance of headache, and mindfulness in the ACT group compared to control on parameters of headache‐related disability and quality of life at post and 3‐month follow‐ups.ConclusionsThese findings demonstrate that changes in certain PF processes lower disability and improve quality of life in headache sufferers, supporting that ACT works via its proposed mechanisms of change. Interventions for headache management may be optimized if they target increases in headache acceptance, defusion from thoughts, and mindfulness.SignificancePsychological flexibility (PF) guides the ACT approach, an emerging behavioral headache intervention that focuses on optimizing head pain adjustment via flexible responses to pain. It targets at increasing daily functioning rather than preventing or controlling headache episodes. Pain acceptance, cognitive defusion, and mindfulness act as processes of functional change in ACT, lowering disability and increasing daily functioning and quality of life. These components can upgrade the established effectiveness of behavioral headache interventions with personalized, modularized therapeutic targets that can help headache sufferers re‐establish optimal daily functioning even in fluctuating and persistent headache episodes.Trial registrationclinical trials.gov registry (NCT02734992).

Measuring health-related quality of life in chronic headache: A comparative evaluation of the Chronic Headache Quality of Life Questionnaire and Headache Impact Test (HIT-6).

ObjectiveTo compare the quality and acceptability of a new headache-specific patient-reported measure, the Chronic Headache Quality of Life Questionnaire (CHQLQ) with the six-item Headache Impact Test (HIT-6), in people meeting an epidemiological definition of chronic headaches.MethodsParticipants in the feasibility stage of the Chronic Headache Education and Self-management Study (CHESS) (n = 130) completed measures three times during a 12-week prospective cohort study. Data quality, measurement acceptability, reliability, validity, responsiveness to change, and score interpretation were determined. Semi-structured cognitive interviews explored measurement relevance, acceptability, clarity, and comprehensiveness.ResultsBoth measures were well completed with few missing items. The CHQLQ’s inclusion of emotional wellbeing items increased its relevance to participant’s experience of chronic headache. End effects were present at item level only for both measures. Structural assessment supported the three and one-factor solutions of the CHQLQ and HIT-6, respectively. Both the CHQLQ (range 0.87 to 0.94) and HIT-6 (0.90) were internally consistent, with acceptable temporal stability over 2 weeks (CHQLQ range 0.74 to 0.80; HIT-6 0.86). Both measures responded to change in headache-specific health at 12 weeks (CHQLQ smallest detectable change (improvement) range 3 to 5; HIT-6 2.1).ConclusionsWhile both measures are structurally valid, internally consistent, temporally stable, and responsive to change, the CHQLQ has greater relevance to the patient experience of chronic headache.Trial registration number: ISRCTN79708100. Registered 16th December 2015, http://www.isrctn.com/ISRCTN79708100

Advocacy in Headache Medicine: Tips at the Bedside, the Institutional Level, and Beyond.

We describe the pervasiveness of headache diseases across the globe and the need for healthcare advocacy, define healthcare advocacy, and identify how providers can incorporate healthcare advocacy into clinical practice and beyond. Nearly 3 billion people across the globe experience migraine or tension-type headache, yet headache diseases receive a fraction of the funding that is allocated to other diseases. Despite its prevalence, those with headache diseases, especially migraine, experience external and internal stigma. As physicians, our job extends past the direct needs of the patient and must also focus on the systemic problems affecting our patients such as accessibility to healthcare providers and treatment options, as well as addressing stigma. We can empower our patients with education, community, and supportive, non-stigmatizing language used to describe headache diseases. Headache diseases are prevalent throughout the world and contribute to a substantial amount of disability. Disability is further compounded by stigma. Advocacy starts with empowering patients and peers with knowledge. It extends into the workplace to create accommodations and in the community to raise awareness and lobby for access to specialists, treatment options, and research funding.

Elective Hospitalizations for Intractable Headache: Outcomes and Response Predictors.

To review our inpatient experience treating a variety of headache disorders with heterogeneous therapies and to determine outcomes and predictors of response. We conducted an institutional review board-approved retrospective chart review of elective inpatient headache admissions from the Montefiore Headache Center from 2014 to 2018. We examined factors associated with response and outcomes at discharge and posthospitalization follow-up in an intractable population. Patients received different classes of IV medications including antiemetics, neuroleptics, dihydroergotamine, lidocaine, steroids, valproic acid, and nerve blocks, and home preventive medications were either continued or changed before discharge. Improvements were defined at discharge by headache intensity compared with before hospitalization. Among the 83 admissions, pain improvement at discharge occurred in 90.4% (n = 75) of the overall sample, 89.5% (n = 60) of those with chronic migraine, 75.0% (n = 9) of patients with new daily persistent headache, and 89.5% (n = 34) of all those with acute medication overuse. Fifty-six patients (67.5%) reported improvement of a 3-or-more-point reduction in headache intensity at discharge, with a mean reduction of 4.84 ± SD 2.51 (range 1-10). Of the 66 patients who received IV dihydroergotamine, 59 (89.4%) of them improved at discharge. Of the 11 (13.2%) patients who received IV lidocaine, 7 (63.6%) improved. Of the 14 (16.9%) patients who received nerve blocks, all 14 (100%) improved at discharge. Of the 75 patients who had improved at discharge, 63 (84%) followed up and 50 (79.4%) of those patients remained improved. At the second follow-up, 68 (81.9%) patients returned for follow-up on average of 71 days (range 10-283) after discharge. Our inpatient headache experience featured numerous treatments with high rates of improvement in the short and intermediate term for all headache disorders. These results may suggest that stratified hospitalized care including polytherapy may be useful for many patients.

L-Cysteine Containing Vitamin Supplement Which Prevents or Alleviates Alcohol-related Hangover Symptoms: Nausea, Headache, Stress and Anxiety.

Alcohol-related hangover symptoms: nausea, headache, stress and anxiety cause globally considerable amount of health problems and economic losses. Many of these harmful effects are produced by alcohol and its metabolite, acetaldehyde, which also is a common ingredient in alcohol beverages. The aim of the present study is to investigate the effect of the amino acid L-cysteine on the alcohol/acetaldehyde related aftereffects. Voluntary healthy participants were recruited through advertisements. Volunteers had to have experience of hangover and/or headache. The hangover study was randomized, double-blind and placebo-controlled. Nineteen males randomly swallowed placebo and L-cysteine tablets. The alcohol dose was 1.5g/kg, which was consumed during 3h. The primary results based on correlational analysis showed that L-cysteine prevents or alleviates hangover, nausea, headache, stress and anxiety. For hangover, nausea and headache the results were apparent with the L-cysteine dose of 1200mg and for stress and anxiety already with the dose of 600mg. L-cysteine would reduce the need of drinking the next day with no or less hangover symptoms: nausea, headache, stress and anxiety. Altogether, these effects of L-cysteine are unique and seem to have a future in preventing or alleviating these harmful symptoms as well as reducing the risk of alcohol addiction.

Patterns of Simultaneous Polysubstance Use among Partygoers: Correlates and Differences in Adverse Acute Effects Experienced

ABSTRACT This study identifies patterns of simultaneous polysubstance use (SPU) in partygoers, their associated characteristics, and their differences in terms of acute effects experienced. We used a web-based survey with 1345 partygoers who reported using at least one substance during the past year, collecting information on drug use and drug-related acute effects experienced at the last party attended. Latent class analysis identified three SPU profiles according to the use of nine substances: low polysubstance use (67.7%), moderate polysubstance use/hallucinogens (11.6%), and extensive polysubstance use/stimulants (20.7%). These profiles differed in their sociodemographic characteristics and were associated with different odds of experiencing adverse drug-related effects. Compared with participants with a profile of low polysubstance use or moderate polysubstance use/hallucinogens, those in the extensive polysubstance use/stimulants group were at higher odds of experiencing memory impairment, tachycardia, and bad mood after drug use. The only differences between the low polysubstance use and moderate polysubstance use/hallucinogens groups were in terms of hangover and headache experiences, which were less likely in the latter group (who consume less alcohol). Knowledge regarding the acute adverse drug-related effects experienced by partygoers who use multiple drugs can help to develop interventions for reducing drug-related risks in this population.

Factors Influencing Pain Dimensions in Patients with Chronic Tension-Type Headache: An Exploratory Survey

BackgroundChronic tension type headache (CTTH) is one of the common cause of hospital visits among adolescents and adults. Chronic tension type headache produces pain, sleep disturbances, and disability among patients leading to a poor quality of life. Knowledge pattern of headache and various associated factors will aid appropriate management. AimsTo identify the headache dimensions and their various influencing factors among patients of chronic tension-type headache. MethodsUsing consecutive sampling techniques, 169 patients with chronic tension-type headache were recruited in this cross-sectional survey. Approval was obtained from the Institute's Ethics Committee. The Wong-Baker Foundation Pain intensity scale was used to assess the pain severity. ResultsA pain severity score of 6 out of 10 was reported by 56% of the patients, and the mean pain score reported by the patients was 6.62 ± 1.16. The mean weekly headache frequency was 4.95 ± 0.38, and the mean daily headache duration was 8.68 ± 1.68 hours. Significantly more patients who are married, patients who had a duration of illness less than two years, and patients who were treated with only analgesics reported higher headache severity. Higher headache frequency was reported by significantly more patients who were male, married, from a nuclear family, educated, unskilled laborers or employed, urban inhabitants, or only on analgesics, or had illness duration less than two years. Headache duration was significantly higher in patients who were unskilled laborers or only on analgesics, or had illness duration less than two years. ConclusionsPatients with chronic tension-type headache experience moderate to high severity of headache, along with substantial duration and frequency, an outcome that was associated with various lifestyle-related factors that can result in stress. Lifestyle modification and nonpharmacological management are thus essential to reduce the severity, frequency, and duration of headache in patients with a chronic tension-type headache and medication overuse.

Subjectively Reported Effects Experienced in an Actively Shielded 7T MRI: A Large-Scale Study.

Ultrahigh-field (UHF) MRI advances towards clinical use. Patient compliance is generally high, but few large-scale studies have investigated the effects experienced in 7T MRI systems, especially considering peripheral nerve stimulation (PNS) and caregiving. To evaluate the quantity, the intensity, and subjective experiences from short-term effects, focusing on the levels of comfort and compliance of subjects. Prospective. In all, 954 consecutive MRIs in 801 subjects for 3 years. 7T. After the 7T examination, a questionnaire was used to collect data. Descriptive statistics, Spearman's rank correlation, Mann-Whitney U-test, and t-test. The majority (63%) of subjects agreed that the MRI experience was comfortable and 93% would be willing to undergo future 7T MRI as a patient (5% undecided) and 82% for research purposes (12% undecided). The most common short-term effects experienced were dizziness (81%), inconsistent movement (68%), PNS (63%), headache (40%), nausea (32%), metallic taste (12%), and light flashes (8%). Of the subjects who reported having PNS (n = 603), 44% experienced PNS as "not uncomfortable at all," 45% as "little or very little uncomfortable," and 11% as "moderate to very much uncomfortable." Scanner room temperature was experienced more comfortable before (78%) than during (58%) examinations, and the noise level was acceptable by 90% of subjects. Anxiety before the examination was reported by 43%. Patients differed from healthy volunteers regarding an experience of headache, metallic taste, dizziness, or anxiety. Room for improvement was pointed out after 117 examinations concerning given information (n = 73), communication and sound system (n = 35), or nursing care (n = 15). Subjectively reported effects occur in actively shielded 7T MRI and include physiological responses and individual psychological issues. Although leaving room for improvement, few subjects experienced these effects being so uncomfortable that they would lead to aversion to future UHF examinations. 1 TECHNICAL EFFICACY: Stage 5 J. Magn. Reson. Imaging 2020;52:1265-1276.

Deeper inside the Experience of Pediatric Headache: A Narrative Study

Objective: To explore meanings, perspectives and points of view of the subjective experience of paediatric patients with headache (PPwH) and create a first-person narrative for clinical practice. Methods: We conducted a qualitative, narrative research study with PPwH, 11 - 17 years old. Data were collected through narratives interviews and a twofold narrative analysis was performed: a narrative and a thematic analysis. Results: Twenty-three patients (14 girls; mean age 14.5; median duration of illness of 5.8 years) were recruited. Through narrative analysis and close reading, narratives revealed different ways to organize illness experience: PPwH can use 1) narrative sequences of recurrent events in order a) to describe the continuing living-through of the experience of headache, b) to define operative script or c) to characterize the illness experience generally as a “controlled” routine; or 2) a storied account of events, with well-defined characters, plot and evaluation of contingency and correlation between events to express a personal point of view and a moral standpoint about the illness experience. Through thematic analysis 5 main themes and 22 subthemes about the significance of being a PPwH emerged: a) disease dimension (description of pain), b) illness dimension, c) sickness, d) causality, e) coping and f) future perception. Then, a first-person narrative story was created as a tool enabling reflection and conversation during clinical consultation. Conclusions: Results suggest that promoting narrative dialogue can be an opportunity for the neurologist: the prototypical narrative developed from story analysis might be a tool to apply for the narrative-based medicine in the clinical setting.

A Single Institution's Experience of Primary Headache in Children With Celiac Disease.

Few studies exist examining the frequency of primary headache in children with celiac disease and the impact of a gluten-free diet on primary headache symptomology. This study explores characteristics and frequency of headaches in children with celiac disease and response to gluten-free diet at a single institution. Medical records were reviewed for children with celiac disease confirmed by the presence of elevated tissue transglutaminase IgA levels and histologic changes consistent with the diagnosis of celiac disease on small bowel biopsy. Eligible participants were contacted via letter for participation in a phone survey regarding headaches. Phone interviews were conducted 2 weeks after notification and lasted approximately 10 minutes. Headaches were classified according to ICHD-3 criteria. 247 eligible patients or their families were contacted. A total of 132 (53.44%) agreed to participate. One participant was excluded due to insufficient information provided. Overall, 51 of 131 participants had recurrent headache defined as at least 1 episode per month (39%, 95% confidence interval [CI]: 31%-47%) and 33 had migraine with or without aura (25%, 95% CI: 18%-33%). Twenty-eight had frequent tension-type headache (22%, 95% CI: 15%-29%). Thirty-two participants noted headaches before a confirmed diagnosis of celiac disease. Twenty-two of 32 participants (68.75%) noticed decreased headache frequency or intensity, or both, after starting the gluten-free diet. This study suggests that at least one-third of children and adolescents with celiac disease have recurrent headaches at the time of diagnosis. A gluten-free diet led to improved headache symptomology in a significant number of these patients.