Headache Frequency Research Articles

Case Series and Literature Review of Up-to-date Surgical Management of Occipital Neuralgia.

Nerve decompression is an emerging surgical treatment option for patients with occipital neuralgia. However, limited research is available on the efficacy of this treatment in South Korea. This retrospective study evaluates the efficacy of nerve decompression surgery in patients with chronic migraines, specifically focusing on occipital neuralgia, in South Korea. Between January 2019 and December 2022, six patients diagnosed with occipital neuralgia, who had not responded to conservative treatments, underwent nerve decompression surgery. This procedure, performed under local anesthesia, involved decompression of the greater and/or lesser occipital nerves. Patient data were analyzed for headache frequency and intensity (using the Numeric Rating Scale [NRS]) and the decrease in oral medications needed postsurgery. Results showed significant improvement in headache symptoms postsurgery, with the average preoperative NRS score of 7.9 dropping to 3.7 postoperatively. Additionally, the average number of medications used decreased from 3.2 to 1.3. No significant surgical complications were reported. The study highlights the potential of nerve decompression as an effective treatment for occipital neuralgia, particularly in cases resistant to traditional medical management.

The effect of physical therapy integrated with pharmacotherapy on tension-type headache and migraine in children and adolescents

BackgroundTension-type headache (TTH) and migraine are prevalent neurological conditions in children and adolescents that significantly impact activity of daily living (ADL) and quality of life (QOL). Although physical therapy targeting cervical myofascial trigger points (MTrPs) on TTH and migraine has been extensively studied in adults, the efficacy in pediatric patients remains unexplored. The aim of this study is to reveal the effect of physical therapy integrated with pharmacotherapy on TTH and migraine in children and adolescents.MethodsWe conducted a prospective, observational cohort study recruiting consecutive patients aged 6 to 18 years with TTH and migraine with cervical MTrPs. They were classified into 4 types of headaches: frequent episodic TTH (FRTTH), chronic TTH (CTTH), episodic migraine (EM) and chronic migraine (CM). The once-weekly 40-minutes physical therapy session integrated with pharmacotherapy (integrated physical therapy) was continued until the treatment goals (headache days per week less than 2 days, headache impact test-6 (HIT-6) score to below of 50, and the ability to attend school daily) was achieved. Multifaceted assessments including headache frequency (headache days per week), headache intensity using the Visual Analogue Scale (VAS), pain catastrophizing score (PCS), hospital anxiety and depression scale (HADS) score, HIT-6 scores, and EuroQol 5 dimensions 5-level questionnaire (EQ-5D-5 L) scores, were conducted to evaluate the treatment effects.Results161 patients were enrolled in this study. 106 patients (65.8%) were diagnosed with TTH: 70 (66.8%) with FETHH, 36 (34.0%) with CTTH, and 55 patients (34.2%) were diagnosed with migraine: 43 patients (78.2%) with EM, 12 patients (21.8%) with CM. We observed significant improvements in headache frequency, headache intensity, PCS, HADS score, HIT-6 scores, and EQ-5D-5 L scores before and after the treatment in all 4 types of headaches. The average number of sessions required to achieve the treatment goals was 4 times (weeks) for patients with FETTH and EM, 5.5 for those with CTTH, and 7.5 for those with chronic migraine.ConclusionThe integrated physical therapy on pediatric TTH and migraine patients with the cervical MTrPs was significantly effective in reducing headache symptoms and improving ADL and QOL.

Development and Content Validity of Cervicogenic Headache Patient Questionnaire: New Tool for Assessing Severity and Impact.

Cervicogenic headache (CGH) is a complicated and common headache disorder that may present itself with cervical spine dysfunction, irritation of the nerves, central sensitization, and muscular tension. Theoretically, this diagnosis should be an exclusionary diagnosis, considering the fact that it requires extended clinical assessment of the cervical spine and an evaluation for other primary headache types. CGH represents a clinical challenge as they habitually present with an array of nonspecific manifestations highly variable among patients. Management of CGHs is properly based on accurate diagnosis and sound understanding of the complaints of the individual. The development of CGH still carries with it a palpable gap in meaningful literature related to really effective assessment tools for the condition. The aim of the current study was to develop and investigate the validity of the content of the Cervicogenic Headache Patient Questionnaire. This questionnaire is designed especially to measure pain intensity, its impact on daily activities, disturbance in sleep, and the overall quality of life in subjects with CGHs. The content validity ratio (CVR) and Content Validity Index (CVI) have been used to thoroughly examine the content validity. Each item was rated by 10 experts for relevance and clarity. The scale consists of two main parts: demographic information and symptoms. Under the demographic section, the patient is asked for their age, sex, occupation, and any relevant medical history. The Symptom Checklist contains 10 questions concerning headache frequency, intensity, duration, location, and contributing factors, as well as how headaches affect daily activities, sleep, and quality of life. Item-CVI scores ranged from 0.60 to 1.00, and Scale-CVI/Ave was 0.95, which indicates strong overall content validity. The Scale-CVI/Universal Agreement was 0.83, meaning that most items are of high relevance. The clarity assessments resulted in I-CVI ratings of 1.00 for the majority of items. Using CVR analysis, items 1, 2, 5, 6, 7, and 10 all had a CVR of 1.00, whereas all the rest ranged from 0.40 to 0.80, suggesting unanimous agreement among the experts. Theresults underline the strength of the questionnaire in covering all the critical dimensions of cervicogenic headaches, such as pain, daily functioning, sleep, and quality of life. The scores provided by experts for content validity and clarity were high; hence, it is suitable for use as a comprehensive tool both in clinical and research applications.

Ultrasound-guided pulsed radiofrequency of the greater occipital nerve in chronic migraine; proximal approach versus distal approach, a single-blind, randomized controlled trial

Background & Objective: Ultrasound-guided pulsed radiofrequency treatment of the greater occipital nerve can be used at distal and proximal levels of the greater occipital nerve in patients with chronic migraine. We aimed to evaluate the treatment efficacy, procedure duration, and pain experienced during the procedure for both methods. Methods: In the study, 60 chronic migraine patients randomly divided into two groups using a computer programme were evaluated. In the proximal group, the greater occipital nerve was accessed at the level of the 2nd cervical vertebra, while in the distal group it was accessed at the level of the protuberencia occipitalis. Patients completed the Migraine Disability Rating Scale, Visual Analogue Scale and a headache diary before treatment as well as at 1 month and 3 months afterwards. The time from the beginning of the intervention to the spread of the stimulus to the C2 dermatome during the sensory stimulation test was recorded. Patients were asked to rate their pain during the procedure using a Visual Analogue Scale. Results: The Visual Analog Scale scores and headache frequencies were significantly decreased in both the proximal group and distal group (p<0.001). The procedure time was shorter (p<0.001) and was less painful in the distal group (p<0.001). Conclusions: In this study, we observed that pulsed radiofrequency of both distal and proximal levels of the greater occipital nerves effectively treated migraine. A shorter procedure time and superior patient tolerability make the distal stimulation the procedure of choice.

Impact of an Electronic Health Record-Based Interruptive Alert Among Patients With Headaches Seen in Primary Care: Cluster Randomized Controlled Trial.

Headaches, including migraines, are one of the most common causes of disability and account for nearly 20%-30% of referrals from primary care to neurology. In primary care, electronic health record-based alerts offer a mechanism to influence health care provider behaviors, manage neurology referrals, and optimize headache care. This project aimed to evaluate the impact of an electronic alert implemented in primary care on patients' overall headache management. We conducted a stratified cluster-randomized study across 38 primary care clinic sites between December 2021 to December 2022 at a large integrated health care delivery system in the United States. Clinics were stratified into 6 blocks based on region and patient-to-health care provider ratios and then 1:1 randomized within each block into either the control or intervention. Health care providers practicing at intervention clinics received an interruptive alert in the electronic health record. The primary end point was a change in headache burden, measured using the Headache Impact Test 6 scale, from baseline to 6 months. Secondary outcomes included changes in headache frequency and intensity, access to care, and resource use. We analyzed the difference-in-differences between the arms at follow-up at the individual patient level. We enrolled 203 adult patients with a confirmed headache diagnosis. At baseline, the average Headache Impact Test 6 scores in each arm were not significantly different (intervention: mean 63, SD 6.9; control: mean 61.8, SD 6.6; P=.21). We observed a significant reduction in the headache burden only in the intervention arm at follow-up (3.5 points; P=.009). The reduction in the headache burden was not statistically different between groups (difference-in-differences estimate -1.89, 95% CI -5 to 1.31; P=.25). Similarly, secondary outcomes were not significantly different between groups. Only 11.32% (303/2677) of alerts were acted upon. The use of an interruptive electronic alert did not significantly improve headache outcomes. Low use of alerts by health care providers prompts future alterations of the alert and exploration of alternative approaches.

Impact of Face Mask Wearing on Patient-Doctor Communication, and Associated Physical Side Effects

Background: Our study investigated the effect of face masks on communication between doctors and patients and the physical side effects associated with long-term mask use. (of) Methodology: This cross-sectional study was conducted at Jordan University hospital (Hospital) outpatient clinic between October 2021 and February 2022. Some 415 patients completed a self-administered questionnaire developed by the researchers based on their clinical observation and literature review. The questionnaire consisted of three main parts which assessed general sociodemographic information, the effect of mask-wearing on patient-doctor interaction, and common physical side effects of mask-wearing. Results: This study shows that wearing face masks had a significant impact on communication between doctors and patients, making it more difficult for patients to understand what the doctor was explaining to them. This poor communication could lead to non-compliance by patients and negatively affect treatment outcomes. Additionally, the study found other negative physical side effects of wearing face masks, such as the appearance of new or worsened acne, breathing difficulties, new-onset headaches, and an increase in the severity and frequency of pre-existing chronic headaches. Conclusion: Suggestions for future research would be to focus on measuring the extent to which poor communication during a consultation affects compliance and treatment outcomes. We also emphasize the importance of bringing these communication difficulties to the attention of healthcare professionals to avoid poor management and direct efforts towards finding solutions that ensure adequate healthcare for patients.

Evaluating Headache Incidence and Characteristics After Botulinum Toxin Treatment in Blepharospasm and Hemifacial Spasm Patients: A Retrospective Cohort Clinical Study.

The aim of the study is to assess the prevalence and clinical features of headache in patients treated with botulinum toxin for blepharospasm and hemifacial spasm. In addition, our secondary aim was to identify potential factors influencing the development of these headaches. A total of 70 patients who were treated with on a botulinum toxin A for dystonia treatment in our clinic between January 2023 and March 2023 were retrospectively screened, and the clinical and demographic characteristics of the patients who reported headache complaints after the last botulinum toxin treatment were examined. Headache was reported in 8 (%11.4) of the 70 patients included in the study. Of the 8 patients who reported headaches, 6 (%75) had the onset of the complaint within the first 24 hours. There was no significant correlation between headache occurrence and factors like age, gender, diagnosis, botulinum toxin dosage, application site, comorbid diseases, or hypertension. However, a statistically significant link was observed between the intensity of pain experienced during treatment and the frequency of headaches after the treatment. Botulinum toxin treatment can lead to short-term headaches in some patients, starting early after the procedure. The significant link between the frequency of these headaches and the pain experienced during injection highlights the need to examine factors like the volume and dilution rate of the toxin, the solvent used, treatment area, treatment purpose, patient characteristics, and the physician's technique. It is important to study these aspects by comparing them across a large patient group and control subjects.

Fonseca's Questionnaire Is a Useful Tool for Carrying Out the Initial Evaluation of Temporomandibular Disorders in Dental Students.

Background: Temporomandibular disorders (TMDs) represent a prevalent multifactorial condition that impacts a significant portion of the global population. The objective of this study was to employ Fonseca's questionnaire for an initial assessment of TMDs. Methods: A cross-sectional study was conducted on a sample of 250 undergraduates from the Dental School of the University of Perugia, Italy. The chi-square test, with a significance level set at p < 0.05, was used to evaluate a statistically significant relationship between TMDs and several variables such as gender, age, employed/unemployed, and physically active or not. Results: The data obtained through the questionnaire indicated that a considerable percentage of students (78%) exhibited signs consistent with TMDs. The most frequently reported signs and symptoms included psychological stress (49.6%), dental clenching and grinding (34%), joint clicking (33.6%), frequent headaches (15.2%), and neck pain (23.2%). Notably, when considering moderate to severe symptoms of TMDs, females were more significantly affected than males. Furthermore, factors such as age, employment status, and physical activity did not appear to influence the prevalence of TMDs. Conclusions: The high prevalence of TMDs identified within this young population (university students), as measured by this questionnaire (albeit warranting validation through more rigorous methodologies) underscores the necessity for the implementation of new preventive strategies that specifically address this demographic.

Patent foramen ovale and migraine: prevalence, pathogenetic relationship and impact of PFO closure

Background. Migraine is a chronic neurovascular disease with high prevalence (12-15% of the population) and social significance [1]. Pathogenesis of migraine has not been clear. Some studies report an association between migraine and the presence of a patent foramen ovale (PFO) and right-to-left shunt [2, 3, 4]. Introduction. The objectives of this study were to clarify the prevalence and clinical characteristics of migraine, as well as the effect of endovascular PFO closure on the course of migraine in a cohort of patients who suffered ischemic stroke (IS) by paradoxical embolism due to PFO. Material and methods. We examined 97 patients from 18 to 50 y.o. (average age 32.29 ± 2.19 years, women 70.8%) with IS due to PFO in The Research Center of Neurology since January 2018 until October 2023. All patients were assessed for migraine, characteristics of headaches and the impact of migraine on social adaptation. Endovascular surgery was performed in 61 patients. The data from a dynamic examination of 24 patients with migraine were assessed before and after PFO closure. Results. Among a cohort of IS due to PFO patients, the prevalence of migraine was 39.2% (migraine with aura - 55%, migraine without aura - 45%), the ratio of women to men was 1.9:1. The frequency of headaches was 4 [1;7] days per month. Six months after PFO closure, patients with migraine showed a significant decrease in the frequency of headaches from 4 [2; 24] up to 2 [1;5] days per month (p=0.009); reduction in pain intensity from 7 [7; 9] to 3 [3; 7] points according to VAS (p=0.0001); reduction of disability from 20 [6; 89] to 17 [2; 26] points (p=0.019) according to the MIDAS. Conclusion. The present study confirmed the high prevalence of migraine in the PFO cohort. PFO closure led to decrease in frequency and intensity of headaches and decrease of migraine’s impact on social adaptation.

Long-term Health Outcomes After Hospital Discharge Among Children Hospitalized for MIS-C or COVID-19, September 29, 2021, to June 21, 2022.

The long-term effects of children hospitalized with multisystem inflammatory syndrome in children (MIS-C) or acute COVID-19 are not well known. Our objective was to determine long-term outcomes. Children hospitalized with MIS-C or COVID-19 at 3 US hospitals from March 2020, through February 2021 were followed to assess health through 2 years post-hospitalization using medical records and patient surveys. Medical record abstraction was performed for 183 patients hospitalized with MIS-C, 53 of whom participated in surveys, and 97 patients hospitalized with COVID-19, 35 of whom participated in surveys. Patients with MIS-C were younger (median, 9 vs. 14 years of age for COVID-19 patients; P = 0.004), more frequently male (62% vs. 39%; P < 0.001) and had more cardiac (14% vs. 2%; P = 0.001) and neurologic sequelae (8% vs. 1%; P = 0.023). Children with COVID-19 more often had other comorbidities (59% vs. 19%; P < 0.001). Full mental recovery at the time of survey 2 (median, 16 months post-hospitalization for patients with MIS-C and 20 months for patients with COVID-19) was 85% and 88%, respectively; full physical recovery was 87% and 81%, respectively; and nearly all had resumption of normal activities. Patients with MIS-C reported more frequent headache at 1 month (45% vs. 20%; P = 0.037). Patients with COVID-19 were more likely to report cough at 1 month (37% vs. 17%; P = 0.045). Fatigue persisted >1 year in 15%-20% of patients in both groups. Approximately 20% of children with MIS-C and COVID-19 continued to have symptoms including fatigue and headache >1 year after hospital discharge. The duration of these findings emphasizes the importance of providers following patients until sequelae have resolved.

Risk factors associated with headache prevalence among adolescents

Background: Headache prevalence among adolescents has raised growing concerns due to its association with various risk factors in their lifestyle habits. Objective: This literature review aims to identify and analyze the main determinants related to headache prevalence among adolescents. Methods: This study consists of a systematic review of literature published in the last ten years in the Virtual Health Library (BVS) and PubMed, using the descriptors "headache," "adolescent," and "risk factors." The inclusion criteria were articles that address risk factors for headache in adolescents, published in Portuguese or English. Results: A higher prevalence of headache was observed in older adolescents (16-19 years) compared to younger adolescents (12-15 years). This difference may be related to biopsychosocial factors in younger adolescents, such as stress and/or divorce in the family environment. Among headache types, migraine and tension headaches were the most frequent. Tension headaches were more prevalent in females, with women reporting more frequent headache complaints than men. This difference may be associated with hormonal factors. The study also found a significant relationship between excessive technology use and headache occurrence, especially migraine-type headaches. This association can be explained by inadequate posture habits, visual fatigue, and auditory symptoms during the use of electronic devices. Conclusion: This study highlighted a higher prevalence of headache in older adolescents and a lower prevalence among younger ones, possibly due to family stress. Migraine and tension headaches were more common in this group, with tension headaches predominant among girls. Excessive use of digital technologies was associated with headache, especially migraine-type headaches, due to inadequate postures, visual fatigue, and auditory symptoms.

Pain from Internal Organs and Headache: The Challenge of Comorbidity.

Headache and visceral pain are common clinical painful conditions, which often co-exist in the same patients. Numbers relative to their co-occurrence suggest possible common pathophysiological mechanisms. The aim of the present narrative review is to describe the most frequent headache and visceral pain associations and to discuss the possible underlying mechanisms of the associations and their diagnostic and therapeutic implications based on the most recent evidence from the international literature. The conditions addressed are as follows: visceral pain from the cardiovascular, gastrointestinal, and urogenital areas and primary headache conditions such as migraine and tension-type headache. The most frequent comorbidities involve the following: cardiac ischemic pain and migraine (possible shared mechanism of endothelial dysfunction, oxidative stress, and genetic and hormonal factors), functional gastrointestinal disorders, particularly IBS and both migraine and tension-type headache, primary or secondary dysmenorrhea and migraine, and painful bladder syndrome and headache (possible shared mechanisms of peripheral and central sensitization processes). The data also show that the various visceral pain-headache associations are characterized by more than a simple sum of symptoms from each condition but often involve complex interactions with the frequent enhancement of symptoms from both, which is crucial for diagnostic and treatment purposes.

Efficacy and safety of levetiracetam for migraine prophylaxis in children: a systematic review and meta-analysis.

Levetiracetam (LEV), an antiepileptic drug, has been effective in adult migraine prevention but lacks extensive research in children. This study evaluates LEV's efficacy and safety for pediatric migraine prophylaxis. We reviewed randomized controlled trials (RCTs) and non-RCTs in major databases through 8 January 2024, focusing on four efficacy endpoints and adverse drug reactions (ADRs). Data synthesis involved pooled relative risks or odds ratios for dichotomous outcomes and mean differences for continuous outcomes, using fixed- or random-effects models as appropriate. Eight studies with 190 participants showed that after taking LEV, the mean headache frequency decreased 5.19 per month (MD: -5.19, 95% CI: -7.11 to -3.27, p < 0.00001) and improved headache-free rates to 28% (95% CI: 0.17-0.41). More than 83% experienced a >50% reduction in monthly headache frequency. The migraine disability score decreased by 33.51 points (MD: -33.51, 95% CI: -38.46 to -28.55, p < 0.00001). ADR incidence did not significantly differ between LEV and control groups (RR: 1.06, 95% CI: 0.39 to 2.85, p = 0.91), with an overall ADR rate of 18% (95% CI: 0.13-0.24). The most common ADR was irritability (12%), leading to treatment discontinuation in 13% of cases (95% CI: 0.05-0.30). LEV has shown good efficacy in preventing pediatric migraines. However, its safety requires further confirmation through more extensive and well-designed RCTs. Identifier PROSPERO CRD42024497643.

A Review on Osteopathic Manipulation in Patients With Headache.

Headaches are a common neurological disorder, significantly impacting patients' quality of life. Traditional treatments include pharmacological and nonpharmacological approaches. Osteopathic manipulative treatment (OMT) is a holistic, hands-on technique used by osteopathic physicians to alleviate pain and improve function by addressing musculoskeletal dysfunctions. This review aims to evaluate the effectiveness of osteopathic manipulation in managing headaches, focusing on the different types of headaches, the specific techniques used, and the overall outcomes reported in clinical studies. A comprehensive literature search was conducted across multiple databases, including PubMed, Google Scholar, and MEDLINE, to identify relevant studies published in the past two decades. Inclusion criteria were studies involving adult patients diagnosed with headaches and treated with OMT. Both randomized controlled trials (RCTs) and observational studies were included. The review identified 15 studies meeting the inclusion criteria. Evidence suggests that OMT can be beneficial in reducing the frequency, intensity, and duration of headaches, particularly tension-type headaches (TTHs) and migraines. Techniques such as myofascial release, cranial osteopathy, and muscle energy techniques were commonly employed. Many studies reported significant improvements in patients' quality of life and functional status post-treatment. However, the heterogeneity in study designs, sample sizes, and outcome measures warrants cautious interpretation of the results. Osteopathic manipulation shows promise as a complementary approach for managing headaches, with positive effects on pain relief and functional improvement. Further large-scale, high-quality RCTs are needed to confirm these findings and to establish standardized treatment protocols. Integrating OMT into multidisciplinary headache management strategies could potentially enhance patient outcomes and reduce reliance on pharmacological interventions.

Centripetal endoscopic sinus surgery in rhinogenic headache

ObjectivesThe aim of this manuscript is to analyse a diagnostic protocol to select correctly patients with Rhinogenic Headache Contact Point (RH) and to investigate the effect of surgical treatment and medical therapy in pain relief. MethodsA prospective no-randomized study selected adult patients with headache and nasal alteration at CT exam or endoscopic vision with positive response to test with nasal spray with corticosteroids and antihistamine or/and local anesthesia test to the contact points. MIDAS score, intensity score, daily duration of symptoms, frequency of headache in the last month were collected in patients who performed surgery and in patients who performed medical therapy. ResultsFollowing the inclusion, 415 patients were selected for this study. 302 patients performed nasal surgery (septoplasty, turbinoplasty and/or endoscopic surgery with centripetal technique), 113 performed medical therapy. There was a statistically significant improvement in MIDAS score, intensity score, daily duration of symptoms, frequency of headache in the last month in patients who performed surgery and in patients who performed medical therapy. Regarding the comparison between patients who performed surgery (Group A) and patients who performed only medical therapy for RH (Group B), better outcomes were obtained by Group A. Considering the daily life handicap index, the lowest handicap was obtained in Group A. ConclusionThis study demonstrates that surgery, using in some cases centripetal technique, gives an improvement statistically significant than medical therapy in RH. The use of nasal spray with corticosteroids and with anti-histamine is a good method in the diagnosis of RH, especially in patients with anatomical variants such as concha bullosa, agger nasi cells and Haller cells.

Prophylactic Cyproheptadine to Control Paroxysmal Hemicrania Attacks: A Preliminary Investigation.

Paroxysmal hemicrania (PH) is a severe short-lasting headache usually localized around the eye. It might occur in conjunction with ipsilateral autonomic manifestations of trigeminal nerve stimulation. PH responds well to indomethacin treatment; however, considering the adverse effects of indomethacin, its long-term use is a matter of question and investigations about other prophylactic medications are going on, but they are inconclusive. The current study aims to investigate the efficacy of prophylactic use of cyproheptadine to control PH symptoms. The current clinical trial was conducted on 20 children diagnosed with PH undergoing prophylactic treatment with cyproheptadine syrup at a dosage of 0.2-0.4 mg/kg twice daily for a period of 3 months. The duration, frequency, and severity of headaches were assessed at baseline and then monthly for 3 months. Significantly shorter duration, less frequency, and less severity of headaches were observed in the postintervention assessments of the patients (P < 0.001). The effect size analysis showed that the greatest effect of the treatment was on the intensity of the headache (effect size: 0.866) and the least effect was on duration of the headache (effect size: 0.775). Drowsiness (5%) and increased appetite (30%) were the only adverse effects of treatment with cyproheptadine. Findings of this study showed that short-term prophylactic cyproheptadine in divided doses of 0.2-0.4 mg/kg could appropriately improve PH in terms of frequency, duration, and the intensity of the attacks. Nevertheless, further investigations are strongly recommended.

Psychosomatic complaints are indicative of stress in young individuals: findings from a Swedish national cohort study.

Psychosomatic complaints are common in youth and are often assumed to indicate stress. Although several studies have confirmed that a cross-sectional association exists, few have empirically investigated whether or not perceived stress influences psychosomatic complaints. The objective of the present study was to build upon previous research by exploring whether changes in perceived stress over time are associated with corresponding changes in psychosomatic complaints. This analytical approach takes unmeasured time-invariant confounding into account, thereby offering more robust evidence for a causal association between the variables under study. Data was derived from the Swedish national cohort study Futura01, with information from 2,708 participants aged 17-18 in 2019 and 20-21 in 2022. Perceived stress was measured by Cohen's Perceived Stress Scale. Psychosomatic complaints were measured by questions on the frequency of stomach aches, headaches and difficulties falling asleep, which were added to an index. Information on gender, parental education, and parental country of birth was derived from registries. Linear regression analyses were conducted and the first difference (FD) approach was used. Perceived stress and psychosomatic complaints exhibited cross-sectional associations at both time points. The FD analyses showed that increases in perceived stress were associated with increases in psychosomatic complaints, and this was the case irrespective of sociodemographic characteristics. This study provides further empirical support for the assumption that psychosomatic complaints can be partially attributed to stress. Societal efforts aimed at reducing stressors and strengthening coping resources and strategies among young people may help mitigate perceived stress and, consequently, the likelihood of developing psychosomatic complaints.

Flexible modeling of headache frequency fluctuations in migraine with hidden Markov models.

To explore hidden Markov models (HMMs) as an approach for defining clinically meaningful headache-frequency-based groups in migraine. Monthly headache frequency in patients with migraine is known to vary over time. This variation has not been completely characterized and is not well accounted for in the classification of individuals as having chronic or episodic migraine, a diagnosis with potentially significant impacts on the individual. This study investigated variation in reported headache frequency in a migraine population and proposed a model for classifying individuals by frequency while accounting for natural variation. The American Registry for Migraine Research (ARMR) was a longitudinal multisite study of United States adults with migraine. Study participants completed quarterly questionnaires and daily headache diaries. A series of HMMs were fit to monthly headache frequency data calculated from the diary data of ARMR. Changes in monthly headache frequency tended to be small, with 47% of transitions resulting in a change of 0 or 1 day. A substantial portion (24%) of months reflected daily headache with individuals ever reporting daily headache likely to consistently report daily headache. An HMM with four states with mean monthly headache frequency emissions of 3.52 (95% Prediction Interval [PI] 0-8), 10.10 (95% PI 4-17), 20.29 (95% PI 12-28), and constant 28 days/month had the best fit of the models tested. Of sequential month-to-month headache frequency transitions, 12% were across the 15-headache days chronic migraine cutoff. Under the HMM, 38.7% of those transitions involved a change in the HMM state, and the remaining 61.3% of the time, a change in chronic migraine classification was not accompanied by a change in the HMM state. A divide between the second and third states of this model aligns most strongly with the current episodic/chronic distinction, although there is a meaningful overlap between the states that supports the need for flexibility. An HMM has appealing properties for classifying individuals according to their headache frequency while accounting for natural variation in frequency. This empirically derived model may provide an informative classification approach that is more stable than the use of a single cutoff value.

Dairy and Headaches: What is the Connection?

Headaches represent a prevalent and burdensome health condition, affecting individuals of all ages worldwide. While dietary factors have been implicated in headache pathophysiology, the association between dairy consumption and headaches remains controversial and inadequately understood. This comprehensive review systematically examines the existing literature to elucidate the relationship between dairy intake and headaches, addressing methodological challenges, potential biases, and gaps in the current knowledge. A thorough search of electronic databases identified relevant observational studies, clinical trials, and mechanistic investigations exploring the impact of dairy consumption on headache incidence, frequency, severity, and duration. Methodological considerations, including study design, measurement of exposure and outcome variables, confounding factors, and sources of bias, were critically evaluated to assess the strength of evidence and validity of findings. Despite heterogeneity across studies, emerging evidence suggests a complex and multifaceted relationship between dairy intake and headaches, influenced by individual characteristics, dietary patterns, headache subtype, and study context. While some studies report a positive association between dairy consumption and headaches, others indicate no significant effect or potential therapeutic benefits of dairy restriction. Mechanistic insights suggest plausible biological mechanisms, including neuroinflammatory pathways, neurotransmitter modulation, vascular effects, and gut-brain interactions, which may mediate the observed associations. Future research directions encompass longitudinal studies, mechanistic investigations, stratified analyses, randomized controlled trials, and exploration of the gut microbiota to further elucidate the underlying mechanisms and inform evidence-based dietary recommendations for headache management. This integrative review underscores the importance of interdisciplinary collaboration and personalized approaches to address the complex interplay between diet, headaches, and overall health.

A history of abuse is associated with more severe migraine- and pain-related disability: Results from the American Registry for Migraine Research.

Prior studies have established an association between a history of abuse and more severe migraine presentation. This cross-sectional, observational study of a clinic-based migraine population used validated measures to elucidate migraine-specific and migraine-related burdens among patients with a history of abuse. Patients with migraine (n = 866) from the American Registry for Migraine Research self-reported if they had a history of emotional, physical, and/or sexual abuse and completed questionnaires assessing migraine-related burden: Migraine Disability Assessment, Subjective Cognitive Impairment Scale for Migraine Attacks, Work Productivity and Activity Impairment, Patient-Reported Outcomes Measurement Information System Pain Interference, Patient Health Questionnaire-2, and Generalized Anxiety Disorder-7. Migraine-related burden in patients with versus without a history of abuse was compared. Subsequently, a mediation analysis evaluated the impact of depression and anxiety symptoms in the relationship between abuse history and migraine burden. A history of abuse was reported by 36.5% (n = 316/866) of participants. After controlling for patient age, sex, years lived with headache, and headache frequency, a history of abuse was significantly associated with more severe migraine-related disability. The combined burden of depression and anxiety symptoms mediated the relationship. A history of abuse is associated with greater migraine-related disability. Future studies should determine if identification and management of the psychological and physical sequelae of abuse reduce migraine burden.