Headache Attacks In Patients Research Articles

Determination of sex hormones levels in patients with migraine

Relevance. Primary headaches are currently one of the most common neurological diseases, and the role of sex hormones in their occurrence has been proven.The purpose of the study is to analyze the levels of sex hormones (estradiol and testosterone) in the blood of patients with various clinical forms of migraine during an attack and outside of an attack.Materials and methods. The study included 60 patients aged 18–45 years with migraine, who formed the main group. Each patient in the main group was diagnosed according to the International Classification of Headache Disorders, Third Revision (ICHD3). The control group consisted of 15 practically healthy individuals, comparable in age with the main group, who did not suffer from migraine. The study was conducted inpatient and outpatient in a multidisciplinary clinic of the Center for Advanced Professional Development of Medical Workers, the clinical base of the Department of Neurology and Medical Psychology of the Tashkent Medical Academy.Results. The study examined the concentration of sex hormones – testosterone and estradiol – in the blood serum of female and male patients with migraine with and without aura during an attack and outside of an attack, and compared the obtained values with the results of studies in the control group. The level of estradiol is higher in women and men with migraine with aura, which affects the duration and intensity of attacks. In women with migraine without aura, the level of estradiol in the blood decreases in the 1st phase of the menstrual cycle, and its normal value in the 2nd phase is associated with the duration of the headache attack. No statistically significant change in testosterone levels was noted.Conclusions. Our data can be used for considering the possibility of hormonal therapy as a preventive measure against headache attacks in patients with various clinical forms of migraine.

Transcutaneous electrical nerve stimulation of the occipital nerves as treatment for chronic cluster headache.

Chronic cluster headache (CCH) is an excruciatingly painful condition that can be difficult to treat sufficiently with the available medical treatment options. The greater occipital nerves (GON) are of major interest in treating CCH, and various invasive treatment modalities, such as stimulating or blocking the nerves, have been applied. Because the terminal segment of the GON has a superficial course, the nerve is also accessible for non-invasive transcutaneous stimulation. Transcutaneous electrical nerve stimulation (TENS) has been suggested as a treatment for different chronic headaches, but evidence of the efficacy in patients with CCH is scarce. Additionally, no consensus exists on the optimal placement of the transcutaneous stimulation electrodes or the treatment usage pattern. In this explorative open-label clinical study, 36 patients with CCH were treated with TENS of the GON for 8-12 consecutive weeks between August 2021 and October 2023 as a separate part of the study protocol for a trial on stimulation of the GON (Clinicaltrials.gov identifier: NCT05023460). After a baseline period, TENS was used primarily as a preventive treatment, stimulating for 30 min twice daily at a minimum. The primary outcome was a change in attack frequency and safety with TENS treatment. Secondary outcomes were change in attack duration and pain intensity on the numeric rating scale, abortive treatments, and the Patient Global Impression of Change (PGIC) with TENS treatment. The change in attack frequency, duration, pain intensity, and use of abortive treatment was analyzed by comparing the baseline data with 4-weekly data from TENS treatment. The study aimed to systematically investigate the effect of TENS of the GON as a preventive treatment for CCH. Weekly attack frequency decreased from a median of 15.7 (95% confidence interval [CI] 11.2-22.1) at baseline to 11.0 (95% CI 7.4-16.4) with TENS. In all, 13 of the 36 (36%) patients had a minimum 30% reduction in attack frequency. In the group of 30% responders, the number of weekly attacks decreased from 15.8 (95% CI 9.8-24.5) at baseline to 5.8 (95% CI 3.3-10.5) attacks with TENS. Five patients became entirely or nearly attack-free. For the entire cohort, attack duration and pain intensity were also significantly reduced with TENS. The use of oxygen was reduced by 42%, and triptan injections decreased by 55%. Overall, 15 (42%) patients reported a clinically important improvement with TENS treatment, rated on the PGIC scale. The 100 Hz stimulation programs were preferred over 10 Hz. No serious adverse events were registered. Transcutaneous electrical nerve stimulation of the GON significantly reduced the frequency, intensity, and duration of weekly headache attacks in patients with severe CCH. Not all patients benefitted from TENS, but the treatment responders had a substantial improvement in their cluster headache. TENS treatment was well-tolerated with little or no side effects and could be a relevant supplement to conventional preventive treatment. A standard TENS apparatus is low cost, making the treatment accessible to most patients. This paper includes a detailed, comprehensive description of our clinical application of the therapy.

Why does ingestion of watermelon trigger headache attacks in patients with migraine?

Several triggers can trigger a migraine attack, including food. By the way, food only triggers headache in migraine sufferers. The foods that most trigger headache attacks are these: cheese, chocolate, citrus fruits and some sweet fruits, such as watermelon.

Validation of a Digital Headache Calendar at a Tertiary Referral Center.

Headache calendars are essential tools in monitoring changes in headache frequency and type. They are used in clinical practice for long-term monitoring, but their validation remains limited. The aim of this study was to validate the use of a digital calendar in monitoring single migraine and tension-type headache attacks. From July 2022 to February 2023, patients diagnosed with migraine and tension-type headache were enrolled. The validation of the digital calendar involved the comparison of self-reported single headache attacks in the digital calendar with the diagnostic headache diary based on the ICHD-3 criteria for migraine and tension-type headache. Sensitivity and specificity were calculated to assess reliability, and the level of agreement was calculated using kappa statistics. This study included 30 patients (87% women) diagnosed with migraine and tension-type headache. The level of agreement in the classification of a single migraine attack revealed a sensitivity of 82% and a specificity of 78%, representing a substantial level of agreement (κ = 0.60). The classification of a single tension-type headache attack revealed a sensitivity of 84% and a specificity of 72%, with a moderate level of agreement (κ = 0.54). The digital calendar proves effective in monitoring single headache attacks in patients with migraine and tension-type headache. In clinical practice, we recommend using the digital calendar as a monitoring tool for headache patients, as they can accurately identify true migraine and tension-type headache days.

Headache and Osmophobia in Gas Station Workers Exposed to Gasoline Odor

Introduction: Headache attacks may be triggered by several factors, among them odors, especially in migraine patients. Objectives: The aim of this study wasto determine the association between gasoline odor and headache attacks in patients with migraine or tension-type headache (TTH). Subjects and Methods: The study was prospective, cross-sectional, with comparison of groups, using nonrandom sample and convenience. Fifty-two gas station workers diagnosed with migraine or TTH according to ICHD-3 criteria were interviewed on the relationship between gasoline odor and headache. Results: Of the 52 gas station workers with headaches, there were 39 (75%) with migraine without aura and 13 (25%) with TTH. The age ranged from 19 to 50 years, with a mean of 29.5 ± 7.2 years. Osmophobia during headache attacks predominated in workers with migraine (29/39; 74.4%). The onset of headache due to odor exposure occurred in 23/39 (60%) of the workers with migraine and in 2/13 (15.4%) in TTH. These differences were statistically significant (χ² = 7.4; p = 0.016). Osmophobia in the absence of pain (period between attacks) predominated in workers with migraine (17/39, 43.6%), but with no statistical value. Conclusions: Gas station workers diagnosed with migraine or TTH may experience osmophobia and headache triggered by the odor of gasoline.

Effects of Non-invasive Brain Stimulation on Headache Intensity and Frequency of Headache Attacks in Patients With Migraine: A Systematic Review and Meta-Analysis.

Non-invasive brain stimulation (NIBS) techniques such as repetitive transcranial magnetic stimulation (rTMS), as well as transcranial direct current stimulation (tDCS) electrically stimulate the brain and modify brain activity to suppress pain. This method is emerging as a potential clinical intervention against migraine. To quantitatively review the efficacy of rTMS and tDCS in randomized controlled trials (RCTs) in modifying headache intensity and frequency of headache attacks in patients suffering from migraine. We searched 5 databases: PubMed, EMBASE, Web of Science, Cochrane Library, and Scopus for articles from January 2000 to September 2018. Any RCT regarding the efficacy on rTMS and tDCS on patients with migraine, was considered to be included. A random effects meta-analysis was performed to pool effect sizes of outcomes related to headache intensity or frequency of headache attacks. The methodological quality of the included RCTs was assessed using the Physiotherapy Evidence Database scale. Nine RCTs with 276 participants in total (experimental group [EG]=149; control group [CG]=127) were included in this review. Five included articles used rTMS (EG=81; CG=80), and 4 used tDCS (EG=68; CG=47). Meta-analysis of excitatory primary motor cortex (M1) stimulation showed significant effects on reducing headache intensity in patients with migraine (Hedges' g=-0.94; 95% CI, -1.28 to -0.59; P<.001, I2 =18.39%) with a large effect size. Meta-analysis of excitatory M1 stimulation showed significant effects on reducing frequency of headache attacks in patients with migraine, with a large effect size (Hedges' g=-0.88; 95% CI, -1.38 to -0.38; P=.001, I2 =57.15%). Excitatory dorsolateral prefrontal cortex stimulation showed a significant effect on the headache intensity in patients with migraine (Hedges' g=-1.14; 95% CI, -2.21 to -0.07; P=.04, I2 =61.86%) with a large effect size. However, reductions of frequency of headache attacks was not significant. Potential differential effects of rTMS and tDCS, various sham methods, and potential overlapping headache disorders among included subjects may affect the estimation of effect sizes. Excitatory NIBS of the M1 is likely to reduce headache intensity and the frequency of headache attacks in patients with migraine.

Non-invasive Vagal Nerve Stimulation for the Treatment of Headache Attacks in Patients with Chronic Migraine and Medication-Overuse Headache (P1.262)

Non-invasive Vagal Nerve Stimulation for the Treatment of Headache Attacks in Patients with Chronic Migraine and Medication-Overuse Headache (P1.262)

The Effects of Oral Contraceptives on Detection and Pain Thresholds As Well As Headache Intensity During Menstrual Cycle in Migraine

Clinically, oral contraceptives (OC) can influence pain in both migraine headache and temporomandibular pain disorders. Estrogen as an ingredient of OC might be a responsible factor for these observations. We conducted the present study to test whether OC are able to alter the severity of headache attacks as well as the detection or pain thresholds over the course of the menstrual cycle in patients with migraine. Thirteen healthy and regularly menstruating women and 26 migraineurs (13 using OC and 13 not using OC) were studied on the days 1, 4, 14, and 22 of their menstrual cycle. In all participants, saliva was collected first for determination of estrogen on each study day. Then, detection thresholds (warmth, cold, electrical current) and pain thresholds (cold, heat, pressure, electrical current) were assessed. Migraineurs were asked for headache attacks occurring in a period of 24 hours before testing and to estimate pain intensity on a verbal rating scale. On day 4 of the menstrual cycle, migraineurs using OC suffered significantly more from severe migraine attacks than migraineurs not taking OC. With respect to detection and pain thresholds, no effects of OC could be observed as concerning the differences between migraineurs with or without OC medication. On day 22, the severity of migraine headache was significantly related with the pain thresholds for pressure and electrical current, suggesting paradoxically more severe headache attacks in patients presenting with higher pain thresholds. Healthy volunteers disclosed higher salivary estrogen levels than migraineurs and migraineurs not using OC higher concentrations than migraineurs using OC throughout the menstrual cycle. In this study, the use of OC intensified migraine (however only at the end of menstruation) however had no influence on detection and pain thresholds in migraineurs. Possible reasons for this dissociation will be discussed.

Hypnic headache

Hypnic headache is a rare primary headache disorder that is characterized by exclusively sleep-related headache attacks in patients usually beyond 50 years of age. Only 174 cases have been reported in the literature so far. Owing to its low prevalence, clinical features and therapeutic options, as well as underlying pathophysiologic mechanisms, are widely unknown or being controversially discussed. The association of hypnic headache with rapid-eye movement sleep was strongly contradicted in recent articles, while an association with hypothalamic dysfunction is thought to be one important pathophysiological mechanism. Common acute, as well as prophylactic, treatment is caffeine intake, either in the form of a cup of coffee or a caffeine tablet. Lithium, indomethacin and melatonin were promoted as potent medical treatments, while almost every other drug commonly used to treat headache or other pain syndromes was reported to be effective in single case reports on hypnic headache.

Clinical Assessment of Topiramate Therapy in Patients With Migrainous Vertigo

To assess the efficacy of topiramate in reducing both the frequency and the severity of vertigo and headache attacks in patients with migrainous vertigo and to compare 50 and 100 mg/day doses of the drug. Thirty patients diagnosed as definite migrainous vertigo were recruited in the study. Vertigo and headache frequency was determined as the monthly number of attacks whereas severity was determined by visual analog scales measured in millimeters from 0 to 100. Patients were randomized to either 50 or 100 mg/day topiramate for 6 months. Vertigo and headache frequency and severity were evaluated at the end of the study period. Number of mothly vertigo attacks decreased significantly in the overall group after treatment (median from 5.5 to 1; P < .01). The same was true for monthly headache attacks (median from 4 to 1; P < .01). A statically significant improvement in vertigo severity was noted (median from 80 to 20 mm; P < .01). Headache severity showed significant improvement as well (median from 60 to 30 mm; P < .01). No statistically significant difference between high- and low-dose groups was present regarding efficacy (P > .05). Four patients in the high-dose group discontinued treatment at the end of the first month because of adverse effects. In the overall group, topiramate was found to be effective in reducing the frequency and the severity of vertigo and headache attacks. Both doses of the drug were equally efficacious. The 50 mg/day dose seems to be appropriate as higher adverse effects were noted when 100 mg/day was used.

One or Several Types of Triptan Overuse Headaches?

Whereas the clinical features of pure triptan overuse headache (TOH) are well known, there are insufficient data regarding the semiological pattern of headaches when triptan overuse is associated with other types of medication overuse. To investigate and compare the clinical characteristics of patients with pure TOH and those with medication overuse headaches associating triptan and other medication overuses (combined TOH). This cross-sectional, observational study was conducted in 7 tertiary-care headache centers participating in the French Observatory of Migraine and Headaches. From 2004 to 2006, data from 163 patients with TOH were collected in face-to-face structured interviews (according to the International Classification of Headache Disorders, 2nd edition criteria). Eighty-two patients fulfilled criteria for pure TOH (pTOH patients) and 81 for combined TOH (cTOH) patients. Continuous headaches were reported in 76% of cTOH patients compared with 32% of pTOH patients. Significantly more frequent and severe headaches and more intense phono-/photophobia between attacks were noted in cTOH patients. More cTOH than pTOH patients reported a history of tension-type headaches and a long-standing history of chronic headaches. Finally, compared with pTOH patients, cTOH patients were characterized by stronger dependence on acute treatments of headaches according to the DSM-IV criteria. Combined therapy with analgesics and/or the total number of drug units taken per day may cause a shift from a pattern of clear-cut headache attacks in patients with pTOH toward more severe clinical presentation in patients with cTOH. These patients should receive more intensive prophylactic therapy and specific behavioral management.

Two Cases of Symptomatic Cluster-Like Headache Suggest the Importance of Sympathetic/Parasympathetic Balance

Despite several reports on symptomatic cluster-like headache, there is no clear explanation of how different lesions thought to be causative are related to cluster-like headache. On the basis of two additional cases of symptomatic cluster headache, we discuss the possibility that an acute imbalance of the autonomic nervous system, namely a net overactivity of the parasympathetic system, may be able to trigger these headache attacks in patients who probably have an additional individual predisposition to react with a cluster-like headache. Such an imbalance can be due to an increase in parasympathetic tone (e.g. stimulation of parasympathetic fibres) or to a reduction of the sympathetic tone (e.g. a lesion of the sympathetic fibres).

Occipital nerve stimulation for drug-resistant chronic cluster headache: a prospective pilot study

Drug-resistant chronic cluster headache (drCCH) is a devastating disorder for which various destructive procedures have been tried unsuccessfully. Occipital nerve stimulation (ONS) is a new, safe strategy for intractable headaches. We undertook a prospective pilot trial of ONS in drCCH to assess clinical efficacy and pain perception. Eight patients with drCCH had a suboccipital neurostimulator implanted on the side of the headache and were asked to record details of frequency, intensity, and symptomatic treatment for their attacks in a diary before and after continuous ONS. To detect changes in cephalic and extracephalic pain processing we measured electrical and pressure pain thresholds and the nociceptive blink reflex. Two patients were pain free after a follow-up of 16 and 22 months; one of them still had occasional autonomic attacks. Three patients had around a 90% reduction in attack frequency. Two patients, one of whom had had the implant for only 3 months, had improvement of around 40%. Mean follow-up was 15.1 months (SD 9.5, range 3-22). Intensity of attacks tends to decrease earlier than frequency during ONS and, on average, is improved by 50% in remaining attacks. All but one patient were able to substantially reduce their preventive drug treatment. Interruption of ONS by switching off the stimulator or because of an empty battery was followed within days by recurrence and increase of attacks in all improved patients. ONS did not significantly modify pain thresholds. The amplitude of the nociceptive blink reflex increased with longer durations of ONS. There were no serious adverse events. ONS could be an efficient treatment for drCCH and could be safer than deep hypothalamic stimulation. The delay of 2 months or more between implantation and significant clinical improvement suggests that the procedure acts via slow neuromodulatory processes at the level of upper brain stem or diencephalic centres.

Dihydroergokryptine Versus Dihydroergotamine in Migraine Prophylaxis: A Double-Blind Clinical Trial

Dihydroergokryptine has been evaluated in the prophylaxis of headache attacks in patients with migraine without aura. The study was controlled vs dihydroergotamine with a double-blind crossover design. After a 1-month run-in period, 30 patients were randomized into two groups and submitted to 4 months treatment with dihydroergokryptine 10 mg b.i.d. or dihydroergotamine (controlled release) 5 mg b.i.d. The treatment was repeated in crossover after 2 months washout. The clinical patients' evaluation was determined by monthly Pain Total Index recording, headache days/month and analgesic consumption. The patients were considered responsible when Pain Total Index decreased by 50% or more in 1 or more months of each treatment period; otherwise the patients were considered unresponsive. The response rate to dihydroergokryptine was 66% while 48% of cases were responsive to dihydroergotamine. The response rate to both treatments was 41%, while 26% did not respond to either treatment. Seven cases unresponsive to dihydroergotamine responded positively to dihydroergokryptine while two cases only, resistant to dihydroergokryptine, responded positively to dihydroergotamine. Three cases dropped out during treatment with dihydroergotamine due to gastric pain and nausea, while they did not show any side effects during dihydroergokryptine therapy. During treatment with dihydroergokryptine there was one case of skin rash which disappeared after drug withdrawal. In conclusion, dihydroergokryptine appears to be an effective drug for the prophylaxis of migraine attacks.