Headache Characteristics Research Articles

A cross-sectional study on the quality of life in migraine and medication overuse headache in a Hungarian sample: understanding the effect of headache characteristics.

Previous studies using generic and disease specific instruments showed that both migraine and medication overuse headache are associated with lower health-related quality of life (HRQoL). The aim of our study was to assess HRQoL differences in migraineurs and in patients with MOH and to examine how headache characteristics such as years with headache, aura symptoms, triptan use, headache pain severity and headache frequency are related to HRQoL. In this cross-sectional study 334 participants were examined (248 were recruited from a tertiary headache centre and 86 via advertisements). The Comp-rehensive Headache-related Quality of life Questionnaire (CHQQ) was used to measure the participants' HRQoL. Data showed normal distribution, therefore beside Chi-squared test parametric tests (e.g. independent samples t-test) were used with a two-tailed p<0.05 threshold. Linear regression models were used to determine the independent effects of sex, age, recruitment method, headache type (migraine vs. MOH) and headache characteristics (presence of aura symptoms, years with headache, headache pain severity, headache frequency and triptan use) separately for each domain and for the total score of CHQQ. Significance threshold was adopted to p0.0125 (0.05/4) to correct for multiple testing and avoid Type I error. Independent samples t-tests showed that patients with MOH had significantly lower scores on all CHQQ domains than migraineurs, except on the social subscale. Results of a series of regression analyses showed that triptan use was inversely related to all the domains of HRQoL after correction for multiple testing (p<0.0125). In addition, headache pain severity was associated with lower physical (p=0.001) and total scores (p=0.002) on CHQQ subscales. Based on the results, different headache characteristics (but not the headache type, namely migraine or MOH) were associated with lower levels of HRQoL in patients with headache. Determining which factors play significant role in the deterioration of HRQoL is important to adequately manage different patient populations and to guide public health policies regarding health service utilization and health-care costs.

Закономерности формирования и оценка эффективности терапии лекарственно-индуцированной головной боли

Study Objective: The aim of the study was to evaluate the patterns of medical overuse headache (MOH), the effectiveness of therapy, and to compare 2 subgroups of patients with chronic migraine, medical overuse of symptomatic analgesics: with MOH and without MOH. Study Design: prospective cohort study. Materials and Methods. The study included 20 patients aged 18 to 75 years with an established diagnosis of chronic migraine medical overuse of symptomatic analgesics. We’re planning to apply a headache diary, several scales about various characteristics of headaches, the psychological state of patients, scales on lifestyle and quality of life, somatic pathology. Study Results. All patients were recommended to cancel the “guilty” analgesic and limit the use of the drug with analgesic action from another group. For prophylaxis, metoprolol was used in 6 (30%) cases, topiramate — in 2 (10%) cases, amitriptyline — in 30%, venlafaxine in 30%. After 3 months from the start of therapy, patients noted the greatest reduction in the frequency and intensity of headache when taking amitriptyline at a dose of up to 50 mg, venlafaxine at a dose of up to 150 mg. At the time of withdrawal, “rebound” symptoms and withdrawal syndrome developed in 14 (70%) people. Detoxification therapy (dexamethasone 4–8 mg per 200 ml of saline and magnesia 10% 25 ml N10) was carried out in 12 (60%) patients. Over 3 months of follow-up, the occurrence of a headache attack decreased by 2 points on the intensity scale, duration — by an average of 6 hours, the number of days with a headache increased by an average of 3.4 days, the number of days with the use of pathogens per month — by 12.6 days. Conclusion. It is necessary to raise the awareness of therapists, neurologists about the causes, patterns, methods of treatment of МОН, as well as about the risk factors for its recurrence. Patient compliance can be improved by telephone interviews, face-to-face consultations 1–3 months after the start of preventive therapy. With the correct use of the prophylactic drug and following the recommendations to limit the overuse of symptomatic analgesics, after 3 months the patient's quality of life improves, the headache decreases in frequency and intensity, and cognitive functions improve. Keywords: chronic migraine, medical overuse headache, chronic headache, overuse, treatment.

Features of headache in young persons with different phenotypes of masked arterial hypertension

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Изучить клинические особенности головной боли (ГБ) и роль уровня нейротрофического фактора головного мозга у пациентов молодого возраста с артериальной нормотензией и маскированной артериальной гипертензией. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> В исследование включены 128 пациентов в возрасте от 18 до 44 лет с жалобами на ГБ, у которых регистрировались артериальная нормотензия и маскированная артериальная гипертензия (МАГ). Использовалась цифровая рейтинговая шкала, шкалы Спилбергера—Ханина, шкала депрессии Бека. Проводилось суточное мониторирование артериального давления. Оценивался уровень сывороточного нейротрофического фактора головного мозга (BDNF). <h3>РЕЗУЛЬТАТЫ</h3> Пациенты молодого возраста с артериальной нормотензией предъявляли жалобы, которые соответствовали критериям эпизодической частой ГБ напряжения (ГБН). Диагностировались легкая депрессия и высокая личностная тревожность. У пациентов с коморбидной патологией МАГ и ГБН жалобы носили разноплановый характер, что зависело от гемодинамического фенотипа МАГ. При изолированной диастолической МАГ (ИДМАГ) и ГБН диагностированы высокая личностная и ситуативная тревожность, умеренная депрессия, при этом достоверно снижался уровень BDNF. <h3>ЗАКЛЮЧЕНИЕ</h3> У пациентов с коморбидной патологией ГБН и ИДМАГ уровень BDNF был достоверно снижен по сравнению с контрольной группой, что свидетельствует о несомненной вовлеченности данного нейротрофина в патогенетические механизмы формирования и поддержания болевого синдрома. ГБН и ИДМАГ достоверно чаще приводят к психоэмоциональным расстройствам и достоверному снижению уровня BDNF.

Cranial Autonomic Symptoms in Migraine: An Observational Study.

Objective:Our aim was to observe frequency of cranial autonomic symptoms (CAS) in migraineurs (primary) and its relation with laterality of headache or other factors, if any.Background:Migraine episodes have headaches with or without aura, and sometimes associated with systemic autonomic nervous system symptoms. Primarily presence of cranial autonomic symptoms suggests diagnosis of TACs. But many studies reported cranial autonomic symptoms (CAS) ranging from 26% to 80% in migraine patients.Material and Methods:Consecutive patients of migraine attending our headache clinic were included in our study. Presence of CAS was recorded with respect to ocular, nasal, facial and aural symptoms along with headache characteristics and laterality information. Detailed clinical examination was performed. We used ICHD 3 (beta version) criteria.Results:Our study cohort comprised of 200 patients having mean (± SD) age 31.12 (± 10.67) years. There were 157 (78.5%), females. Out of 200 patients, 148 (74%) were having at least one CAS, of which 70% were having 2 or more CAS. Frequency of CAS was lacrimation (45.5%), conjunctival injection (34.5%), eyelid edema (34%), aural fullness (27.5%), facial sweating (25%), facial flushing (17.5%), nasal congestion (9%), rhinorrhea (5%) and ptosis (4%). Bilateral CAS was present in 129 (87%) and unilateral CAS in 19 (13%) (OR 35.31; 95% CI 9.19 to 135.7), (P < 0.0001). Sunlight as a trigger was present in all 148 (100%) patients.Conclusion:Our study showed that CASs in migraine is common and bilateral. Sunlight triggers headache in almost all CAS positive patients.

Headache Characteristics Among Patients with Epilepsy and the Association with Temporal Encephaloceles

Headache Characteristics Among Patients with Epilepsy and the Association with Temporal Encephaloceles

Primary Headache in Behçet's and Neuro-Behçet's Disease.

Behçet's disease (BD) is a multisystem vasculitis, which can involve the central nervous system, the gastrointestinal tract, the blood vessels, the joints, and the lungs. Neurological involvement is about 5%, but the headache is common in these patients. This study aimed to investigate whether differences exist in the onset and types of primary headaches between patients with BD without neurological involvement (BWoNI) and patients with neurological involvement, that is, neuro-Behçet's disease (NBD). A total of 136 consecutive BD patients (98 BWoNI and 38 NBD) were evaluated and compared. Primary headaches beginning before and after the onset of BD were found in 27.6 and 48.1% of BWoNI patients, respectively, and in 10.5 and 34.2% of NBD patients, respectively. The start of primary headaches was more frequent after then before the onset of BD in each group and overall. The primary headache types were similar in both BWoNI and NBD patients. The primary headache starts more frequently after then before the onset of BD, and characteristics of primary headaches were similar in both BWoNI and NBD patients.

Headache Characteristics of Patients with COVID-19 in Turkey: Is COVID-19 Infection a Trigger for Migraine Headache?

Headache is a common symptom in patients with Coronavirus-19 infection (COVID-19). In this research, we aim to assess the frequency, characteristics, and response to treatment of headache in patients with COVID-19 and its correlation with psychosocial features in Turkey. To describe the clinical features of headache in COVID-19 positive individuals. Patients were evaluated and followed up with face-to-face visits in a tertiary hospital during the pandemic period. One hundred and seventeen of 150 patients (78%) had a headache diagnosed before and during the pandemic, 62 of 150 (41.3%) had a new type of headache. No significant differences were observed in terms of demographics, Beck Depression Score, Beck Anxiety Score, and quality of life scales (QOLS) between patients with and without headache (p>0.05). The most common triggering factor for headache was stress and fatigue in 59% (n=69), while the second most common (32.4%, n=38) was COVID-19 infection. 46.5% of the patients reported that the severity and frequency of their current headaches increased after the COVID-19 infection. Among new-onset headaches, the social functionality and pain score subgroups of the QOLS form were significantly lower in housewives and unemployed patients compared to the working group (p=0.018; p=0.039 respectively). Twelve of 117 patients had a mild to moderate, throbbing headache in the temporoparietal region, which did not fulfill the International Classification of Headache Disorders diagnosis criteria, but showed as a common feature among COVID-19 patients. Nineteen of 62 patients (30.9%) had a newly diagnosed migraine syndrome. The diagnosis incidence of migraine in patients with COVID-19 disease being more than other headaches types may suggest the existence of a common pathway in possible immune mechanisms.

Relation of post-stroke headachto cerebrovascular pathology and hemodynamics.

Despite high prevalence of cerebrovascular stroke, headache attributed to ischemic strokes is often undertreated and overlooked. The aim is to detect the relation of a post-stroke headache to cerebrovascular pathology and changes in hemodynamics through a high-resolution duplex ultrasound examination. The present study was a case-control study conducted among 239 patients, who presented with an acute ischemic stroke. Patients were sub-divided into two groups: group I included patients with headache attributed to ischemic stroke (cases) and group II included headache-free stroke patients (controls). History consisted of headache characteristics and risk factors. Clinical and radiological examination were preformed to detect the type of stroke. Ultrasound duplex examination of extra-cranial and intra-cranial cerebrovascular system was carried for both groups. Group I included 112 patients (mean age, 57.66 ±6.59 years), and group II included 127 patients (mean age 57.73 ±7.89 years). Post-stroke headache was more frequent in patients with posterior circulation infarction (58%). Post-stroke headache was reported within 7 days post-stroke in 61.6% of patients. Pre-stroke headache was an independent predictor for post-stroke headache occurrence (OR = 28.187, 95% CI: 6.612-120.158%, p < 0.001). Collateral opening and various degrees of intra-cranial vascular stenosis were strong predictors of headache occurrence (OR = 25.071, 95% CI: 6.498-96.722%, p < 0.001). In conclusion, post-stroke headache is a common phenomenon, especially in patients with pre-stroke headache, history of old stroke, posterior circulation infarction, and large artery disease. This headache was of moderate-intensity with clinical characteristics of tension-type. Intra-cranial cerebrovascular pathological changes including opening of collateral channels and variable degrees of stenosis of cerebrovascular systems were implicated in the production of that headache.

Clinical Features and Pain Characteristics of Cluster Headache

Clinical Features and Pain Characteristics of Cluster Headache

A History of Mild Traumatic Brain Injury Is Associated With a a More Severe Long-term Migraine Phenotype

This study aimed to investigate the effect of prior mTBI on the clinical features and disability in patients presenting with migraine. Head injury is a risk factor for chronic migraine (CM) and migraine is a risk factor for persistent headache after mild traumatic brain injury (mTBI). Of 2,161 migraine patients without a diagnosis of post-traumatic headache (PTH) who participated in the American Registry for Migraine Research (ARMR) between February 2016 and March 2020, 1,120 answered questions about a history of mTBI. After controlling for age, gender, and having CM, demographics, headache characteristics, Patient Health Questionnaire-2 (PHQ-2) score, General Anxiety Disorder-7 (GAD-7) grade, and Migraine Disability Assessment Scale (MIDAS) scores were compared between those with a history of mTBI to those without. Among 1,098 migraine patients, 37.6% (n = 413) had a history of mTBI. The patients with mTBI were more likely to have CM (p = 0.004), dizziness (p = 0.003), vertigo (p = 0.009), and difficulty finding words (p < 0.001). Patients with mTBI had significantly greater scores on the MIDAS (58.6 ± 52.6 vs 50.0 ± 47.8, p = 0.034) and PHQ-2 (1.6 ± 1.8 vs 1.3 ± 1.6, p = 0.012), and had significantly higher proportion of moderate to severe GAD-7 grade (21.7% vs 17.1%, p = 0.017) compared to those without mTBI. In patients presenting with migraine, a prior history of mTBI was associated with a diagnosis of chronic migraine, disability, anxiety and depression severity, as well as dizziness, vertigo, and word finding difficulty. A history of mTBI should be assessed in patients presenting with migraine, and people with migraine who have a high exposure risk to mTBI, should be aware of the potential for migraine progression and psychiatric symptoms after mTBI.

Differentiating Between Migraine and Post-traumatic Headache Using a Machine Learning Classifier

The objective was to develop classification models differentiating persistent PTH (PPTH) and migraine using clinical data and MRI-based measures of brain structure and functional connectivity. PTH and migraine commonly have similar phenotypes. Furthermore, migraine is a risk factor for developing PTH, sometimes making it difficult to differentiate PTH from exacerbation of migraine symptoms. Thirty-four individuals with migraine without history of TBI and 48 individuals with mild TBI attributed to PPTH but without history of migraine or prior frequent tension type headache were included. Subjects completed questionnaires assessing headache characteristics, mood, sensory hypersensitivities and cognitive function and underwent MRI imaging during the same day. Clinical features and structural brain measures from T1-weighted imaging, diffusion tensor imaging and functional resting-state measures were included as potential variables. A classifier using ridge logistic regression of principal components (PC) was fit. Since PCs can hinder identification of significant variables in a model, a second regression model was fit directly to the data. In the non-PC based model, input variables were selected based on lowest t-test or chi-square p-value by modality. Average accuracy was calculated using leave-one-out cross validation. The importance of variables to the classifier were examined. The PC-based classifier achieved an average classification accuracy of 85%. The non-PC based classifier achieved an average classification accuracy of 74.4%. Both classifiers were more accurate at classifying migraine subjects than PPTH. The PC-based model incorrectly classified 9/48 (18.8%) PPTH subjects compared to 3/34 (8.8%) migraine patients, whereas the non-PC classifier incorrectly classed 16/48 (33.3%) vs 5/34 (14.7%) of migraine subjects. Important variables in the non-PC model included static and dynamic functional connectivity values, several questions from the Beck Depression Inventory, and worsening symptoms and headaches with mental activity. Multivariate models including clinical characteristics, functional connectivity, and brain structural data accurately classify and differentiate PPTH vs migraine.

Headache Worsening after COVID-19 Vaccination: An Online Questionnaire-Based Study on 841 Patients with Migraine.

Vaccines have represented the breakthrough in the fight against COVID-19. Based on reported headache attacks after vaccination in randomized controlled trials, we focused on the effects of COVID-19 vaccine administration on the migraine population, using an online questionnaire published on Italian Facebook groups oriented to headache patients. We collected data about the demographics and clinical parameters of migraine severity, COVID-19 infection, vaccination, and characteristics of headaches following vaccination. Out of 841 migraine patients filling in the questionnaire, 66.47% and 60.15% patients experienced a headache attack (from 1 hour to 7 days) after the first and the second vaccine dose, respectively. The main finding concerns headaches perceived by 57.60% of patients: attacks following vaccination were referred to as more severe (50.62% of patients), long-lasting (52.80% of patients) and hardwearing (49.69% of patients) compared to the usually experienced migraine attacks. This could be related to the production of inflammatory mediators such as type Iβ interferon. Considering the high prevalence of migraine in the general population, awareness of the possibility of headaches worsening following COVID-19 vaccination in these patients may allow both patients and clinicians to face this clinical entity with conscious serenity, and to reduce the waste of resources towards inappropriate health-care.

Mask and Personal Protective Equipment (PPE) Associated Headache: A Cross-Sectional Study among the COVID-Time Physicians in Bangladesh

We investigated the prevalence of mask/PPE associated headache among Bangladeshi physicians during COVID 19 pandemic along with the risk factors and headache characteristics. Headache severity was assessed by the Headache Impact Test (HIT-6). This is a cross-sectional, online Google form based study among 200 physicians from different hospitals in Dhaka conducted from December 2020 to April 2021. We compared characteristics of ‘mask associated headache’ and ‘no headache’ groups as well as of groups with and without previous headache. Independent factors associated with headache occurrence and severity were identified. Majority participants were male (129, 64.5%) with mean (SD) age of 35.4(7.5) years. Filter masks (146, 73%) were mostly used along with other PPE (139, 69.5%). Headache prevalence was 71% and 59.9% developed new onset headache. Doctors with a pre-existing primary headache disorder [OR: 5.40, 95% CI: 2.03-14.41; P=0.001] had the highest risk of developing headache. Headache occurrence was independently associated with working in the COVID unit [OR: 2.47, 95% CI: 1.18-5.18; P=0.017] and combined mask & other PPE usage [OR: 2.35, 95% CI: 1.13-4.84;P=0.021] for ≥ 6months [OR:2.06, 95%CI:1.05-3.99; P=0.036]. Most headaches were dull aching (33.8%), lasted for 1-4 hours (58.5%) & relieved within 1 hour of mask removal (43.6%). Headache Impact Test (HIT-6) score was substantial too severe among the doctors with previous headaches [OR: 2.91, 95%CI: 1.43-5.92; P=0.003] and those having moderate to severe stress levels [OR: 2.56, 95%CI: 1.19-5.55; P=0.017]. Most physicians with previous primary headache develop mask/PPE associated headache with considerable impacts on daily life. Keywords: Headache, Mask, COVID­19, Doctors

Headache provocation by nitric oxide in men who have never experienced a headache.

IntroductionIn the general population 4% have never experienced a headache. Freedom from headache could be due to distinctive protective mechanisms or a lack of environmental risk factors for headache. Isosorbide-5-mononitrate is an organic nitrate which in the body is metabolised to nitric oxide. The nitric oxide pathway plays a crucial role in the primary headaches. We hypothesized that people who are free from headache are protected by distinctive mechanisms in the nitric oxide pathway.MethodsWe performed an observer blinded case-control study using nitric oxide to provoke a headache. 32 headache free male participants and 26 randomly selected male controls received 60 mg Isosorbide-5-mononitrate orally on the study day. Participants fill out a headache diary with headache intensity and characteristics until 12 hours after administration of Isosorbide-5-mononitrate. Primary endpoint were areas under the curve of headache intensity score.ResultsAll 58 participants completed the study. There was no significant difference in headache incidence, headache intensity score or migraine-like attack between headache free participants and controls.ConclusionWe show that men who have never experienced a headache develop a headache when provoked with Isosorbide-5-mononitrate. This indicates that freedom from headache in men is not related to the nitric oxide pathway which is involved in the primary headache disorders.

Associations between adherence to Mediterranean dietary pattern and frequency, duration, and severity of migraine headache: A cross-sectional study

ABSTRACT Background The present study was conducted to explore the association between adherence to Mediterranean dietary pattern and migraine headache features including frequency, duration, and severity, as well as patients’ migraine-related disabilities among the Iranian population diagnosed with migraine. Methods In the present cross-sectional study on 262 migraine patients aged 20-50 years old, a validated 168-item, food frequency questionnaire was used to assess the dietary intakes of participants. The Mediterranean diet score was calculated for each subject using nine pre-defined dietary components and ranged from 0-9. The headache severity, duration, frequency, migraine headache index score (MHIS), and headache impact test-6 (HIT-6) were measured using related questionnaires. Results After controlling for potential confounders, Mediterranean diet tended to be associated with lower headache frequency (β = −1.74, 95% CI: −3.53,0.03) and duration (β = −0.28, 95% CI: −0.59, −0.02) and was significantly associated with lower MHIS (β = −29.32, 95% CI: −51.22, −7.42), and HIT-6 score (β = −2.86, 95% CI: −5.40, −0.32) for those in the highest category of Mediterranean diet scores compared to the lowest category. A subgroup analysis of women also revealed a negative association between Mediterranean diet and headaches frequency (β = −2.30, 95% CI: −4.27, −0.32), duration (β = −0.42, 95% CI: −0.78, −0.07), scores of MHIS (β = −47.44, 95% CI: −71.90, −22.99), and HIT-6 (β = −3.45, 95% CI: −6.29, −0.61), after controlling for potential confounders. Conclusions The present study suggests that adherence to the Mediterranean dietary pattern is associated with lower headache frequency, duration, MHIS, and HIT-6 score.

Cranial autonomic symptoms in episodic and chronic migraine: a cross sectional study in Iran

BackgroundCranial autonomic symptoms are common in migraine, with eye redness and tearing being the most common ones. Their identification can help to avoid misdiagnosis, predict the disease course, and select the appropriate treatment.MethodsThis was a cross-sectional study of 904 patients who presented with migraine to a headache referral clinic. The participants filled out a questionnaire about their headache characteristics, as well as the presence of cranial autonomic symptoms. A total of 904 patients, 698 women (77.2%) and 206 men (22.8%), were included in the study, with a mean (SD) age of 38.05 (11.76) years.ResultsAbout 70% of subjects with chronic migraine and 56.2% of those with episodic migraine reported one or more cranial autonomic symptoms. The two most commonly reported autonomic symptoms were eye redness (36.06%) and tearing (21.02%). Chronic migraine (43.4% vs. 29.5%), unilateral headache (56.8% vs. 48.7%), and blurred vision (20% vs. 14.7%) were significantly more frequent in migraineurs with cranial autonomic symptoms. Headache intensity and frequency in subjects with cranial autonomic symptoms were significantly higher than in those without cranial autonomic symptoms.ConclusionWe found higher percentages of cranial autonomic symptoms in patients with unilateral headaches, frequent and severe attacks and blurred vision. A diagnosis of cranial autonomic symptoms accompanying migraine may predict more severe disease and the possibility of evolution into chronic migraine.

New Daily Persistent Headache in Children

Source: Strong E, Pierce EL, Langdon R, et al. New daily persistent headache in a pediatric population. J Child Neurol. 2021; 36(10):888–893; doi:10.1177/08830738211004514Investigators from Children’s National Hospital, Washington, DC, conducted a retrospective study to describe the characteristics of new daily persistent headache (NDPH) in pediatric patients. Study participants were patients seen at the Children’s National Hospital Headache Clinic between 2016 and 2018 who were included in a clinic patient registry and were identified as having NDPH using ICD-10 codes. All enrolled youths were evaluated by headache specialists; a standardized history intake form was used to record clinical characteristics. Data abstracted from the medical record of study participants included demographics, site of headache and quality of pain, presence of migrainous features (photophobia, phonophobia, reduced activity), medications and non-pharmacologic treatments, head imaging results, comorbidities, and family history of headaches. Patients additionally were diagnosed with medication overuse headaches based on International Classification of Headache Disorders, 3rd Edition criteria.Among a total of 3,620 visits to the headache clinic during the 2-year study period, 245 patients were diagnosed with NDPH. The average age of the NDPH patients was 14.7 years, with a range of 12.7 to 16.8 years. Among these youths with NDPH, 79% were female, and 73% were white. The most common site of headache was frontal in 66% of patients, followed by occipital (26%), and temporal (22%). The quality of the pain was described as pulsatile and throbbing in 38% of study participants, and the median pain level on the Wong-Baker FACES scale was 6 out of 10. Migrainous features were common, with 85% of patients reporting photophobia, 85% phonophobia, and 88% reduced activity level. Comorbidities in the NDPH patients included anxiety (reported in 19%) and depression (10%); there was a history of head trauma in 23%. Overall, 54% of participants had undergone neuroimaging, including MRI in 43% and CT in 11%. No findings to explain headaches were seen. There was a family history of headache in 70% of patients. Abortive medications had been tried in nearly 80% of study participants, with ibuprofen (51%) and acetaminophen (29%) most commonly used. A diagnosis of medication overuse headache was made in 36% of patients. Preventive medications were used by 35%. Non-pharmacologic treatment had been tried in 16%, including pain-focused cognitive behavioral therapy, acupuncture, and physical therapy desensitization.The authors conclude that NDPH is a common cause of chronic headache in pediatric patients.Dr Alissa has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.Headache in children is a concerning complaint for both parents and physicians. Although generally benign, the fear of a tumor or a serious underlying condition is real.1 In 2019, the American Academy of Pediatrics’ Healthy Children publication released instructions to parents about when to call their pediatrician if their child suffers a headache. The instructions stated that although most headaches are harmless, recurrent headaches can cause school problems, behavioral problems, and/or depression.2 The same instructions warned parents to be careful using over-the-counter medication because more than 3 doses per week can cause medication overuse headache.2 In a recent study, Neiswand et al were not able to find any reliable effects of preventive medications to treat children with headache when compared to adults.3NDPH may have features of both migraine and tension-type headache. The same preventive medications indicated for chronic migraine or chronic tension-type headache, including tricyclic antidepressants amitriptyline and topiramate, commonly are used in NDPH despite the lack of standardized guidelines.4 Integrating conventional medicine with mind-body-spirit methods such as acupuncture, stimulation, and physical therapy has been useful in managing headache in adolescents.5The current investigators diagnosed 14% of their total headache population with NDPH. Migrainous features were noted in nearly 90% of their adolescent patients compared to 50% of adults,6 which suggests that pediatric NDPH is more likely to present with characteristics consistent with migraine than adults. Abortive medications had been used in 79% of participants, most commonly ibuprofen and acetaminophen, and more than half had failed at least 1 medication. On the other hand, 35% of participants were treated with preventive medication, most commonly amitriptyline and topiramate, with the same failure proportion.This study’s limitations included lack of reporting the morbidity of headaches, such as missing school for the patients and/or work for their parents. The authors failed to provide guidance regarding appropriate interventions or preventive measures to consider when facing patients with NDPH.NDPH is a relatively common diagnosis in children with chronic headache. It is debilitating and highly refractory to treatment.For the uninitiated, NDPH is a relatively newly described subtype of chronic headache.7 It is severe, unremitting, and persists for at least 3 months. Perhaps the authors failed to report effective preventive and abortive pharmacotherapies as they have yet to be identified.

Headache Incidence and Characteristics in COVID-19 Patients: A Hospital-Based Study.

Background:Headache is one of the commonly reported symptoms of coronavirus disease-2019 (COVID-19) illness. A number of studies have been done so far focusing on headache associated with COVID-19 with variable incidence and characteristics.Material and Methods:This study is a prospective study conducted on 120 patients with confirmed COVID-19 illness. Critically ill and ventilated patients were excluded. Demographic data, COVID illness symptom profile, headache characteristics were documented. Patients were followed up at 2 weeks and 4 weeks. For the statistical analysis, Statistical Package for the Social Sciences (SPSS), version 24.0 was used.Results:120 COVID-19 positive cases were included in the study with a mean age of 54.59 ± 14.89 years (range 21-84 years) with male-to-female ratio of 3:2. 78.33% (94) of patients had various comorbidities. 43.33% (52) cases were diabetic. The presenting symptoms were fever (65%), cough (53.33%), shortness of breath (35%) and myalgia (31.66%). 26 (21.66%) patients reported headache during the COVID illness. 18 (15%) cases had headache attributed as secondary to COVID-19 illness. Out of them, 12 cases were new onset with no past history of headache and 6 cases had a significant change in previous headache episodes. COVID-19 illness precipitated headache episodes similar to past headache type in 8 cases. Headache was the presenting symptom in 8 (6.66%) patients with COVID-19 being detected in the regular hospital screening protocol.Conclusion:Headache was a common symptom in COVID-19 patients. New onset headaches or change in past headache type in patients in the setting of ongoing pandemic should be screened for COVID-19.

Pattern and localization of headache in cerebral venous sinus thrombosis (CVST).

Introduction: Cerebral Venous Sinus Thrombosis (CVST) is an underdiagnosed but not rare type of neurovascular disease. There is involvement of cerebral veins or dural sinuses instead of arteries. The vein or dural sinuses are blocked by thrombus resulting in increased pressure and leading to rupture of vessels and leakage of blood into the brain. Headache is the most frequent presenting symptom of CVST.Methodology: This descriptive study was conducted at Sheikh Zayed Medical Col-lege and Hospital Rahim Yar Khan. All consecutive patients with confirmed diagno-ses of CVST were included in the study. Diagnosis of CVST confirmed by MRI/MR Venogram. An informed consent was taken and the data was collected on a ques-tionnaire. Ethical permission was taken from Institutional ethical review com-mittee.Results: Headache was present in 51 (81%) of 63 confirmed CVST patients. Data regarding characteristics of headache from 51 patients was analyzed. The headache was associated with photophobia (4%), phonophobia (6%), loss of vision(6%), nau-sea (9%) and vomiting (42%) .The headache was not related with infarct and hem-orrhage on Computed Tomography scan and Magnetic Resonance Imaging. The site of headache was not linked with site of sinus thrombosis.Conclusion: Headache is the common symptom in patients with CVST. Usually the headache in CVST is subacute, throbbing, unilateral or localized to some specific region i.e frontal, temporal and occipital. There is no relation between headache and site of sinus thrombosis. Also there is no link between headache and hemor-rhage or infarct on Computed Tomography scan (CT) and Magnetic Resonance Im-aging (MRI).Key words: Cerebral Venous Sinus Thrombosis , Headache, MRI/MR Venogram.

Characteristics of headache in vertebral artery dissections

Purpose: A vertebral artery dissection (VAD) is a rare disorder that can masquerade as musculoskeletal head and/or neck pain and requires an urgent medical referral. If the diagnosis is missed or mismanaged it can progress to stroke and death. Headaches are one of the main symptoms of a VAD that precedes ischaemic signs. The aim of this systematic review is to identify the common features of VAD headaches to ascertain if key characteristics can aid differentiation from other less sinister causes of headache with musculoskeletal origin.