Headache Disability Index Research Articles

Questionnaires used to assess the quality of life of patients with migraine and other headache disorders: an integrative review

IntroductionAccording to the World Health Organization (WHO), quality of life is an individual's perception of their position in life in the context of the culture and value system in which they live and in relation to their goals, expectations, standards and concerns. Despite the subjectivity, quality of life may be measured through some assessment instruments in various diseases, including migraine and other headache disorders. Objective: This study aimed to review the main instruments used to assess the quality of life of patients with migraine and/or other headache disorders. MethodThis was an integrative literature review using articles with historical data on the main instruments used to assess the quality of life of patients with migraine or other headache disorders. ResultsSeven instruments for assessing the quality of life in patients with headache and other disorders were described. They were: Migraine Disability Assessment Scale (MIDAS), Headache Impact Test (HIT-6), Headache Disability Index (HDI), Short Form Health Survey (SF 36), Migraine Specific Quality of Life Questionnaire (MSQ), Migraine Severity (MIGSEV), and Migraine Functional Impact Questionnaire (MFIQ). ConclusionThe quality of life of patients with headache may be compromised, but despite its subjectivity, it can be measured through assessment instruments.

Investigation of the Prevalence of Primary Headaches and the Factors Affecting the Acceptance of Perceived Pain in Elderly Individuals with Headaches

Background: Pain can have irreversible consequences for patients, and one common type of perceived pain is headaches. Objectives: This study aimed to investigate the prevalence of primary headaches and the factors affecting the acceptance of perceived pain in elderly individuals with headaches. Methods: A total of 238 patients were enrolled in this study. The tools used included the Chronic Pain Acceptance Questionnaire, the Headache Disability Index (HIT-6), and the Brief Pain Inventory (BPI). The study was conducted in accordance with ethical guidelines and ethical codes. The study data were analyzed using SPSS version 16 software. Results: Out of 1260 patients included in the study, 238 elderly individuals experienced one of the types of headaches. The mean ± SD score of Pain Interference was 6.37 ± 2.34, the Headache Disability score was 14.75 ± 8.52, and the Chronic Pain Acceptance score was 75.05 ± 32.02. Additionally, pain intensity and disability scores were lower in patients who demonstrated higher levels of pain acceptance. Conclusions: Considering that pain and disability were reported to be less in patients with higher pain acceptance scores, therapeutic and psychological interventions to increase pain acceptance are suggested.

Effectiveness and Safety of Pharmacopuncture on Inpatients with Tension Headache Caused by Traffic Accidents: A Pragmatic Randomized Controlled Trial.

Background: This study investigated the effectiveness and safety of pharmacopuncture for pain relief and functional improvement in patients with traffic accident (TA)-induced acute tension headaches. Methods: The study employed a parallel, single-centered, pragmatic, randomized controlled trial design. Eighty patients complaining of acute tension headaches were randomized into the integrative Korean medicine treatment (IKM treatment) group and the pharmacopuncture group on suboccipital muscles (suboccipital muscles pharmacopuncture + IKM treatment), with 40 participants assigned to each group. The patients in the pharmacopuncture group underwent pharmacopuncture as an add-on therapy, consisting of three sessions. Both groups were reassessed 2 months post-intervention. To assess the outcomes, the Numeric Rating Scale (NRS) for Headache, NRS for Neck Pain, Headache Disability Index, Headache Impact Test-6, EuroQol 5-Dimension, and Patient Global Impression of Change were used. Results: The improvement in the outcomes of the pharmacopuncture group was significantly greater than that of the comparison group on day 4 of hospitalization in terms of pain (difference in NRS of headache -2.59, 95% CI -3.06 to -2.12; NRS of Neck pain -1.05, 95% CI -1.50 to -0.59) and function (difference in HDI -24.78, 95% CI, -31.79 to -17.76; HIT-6 -6.13, 95% CI, -9.47 to -2.78). Additionally, in 2 months of follow-up, the recovery rate of headache was significantly higher in the pharmacopuncture group than in the comparison group. Conclusions: The pharmacopuncture group demonstrated superior outcomes in symptom improvement than the comparison group did, providing insights into novel and useful applications of pharmacopuncture in the clinical practice of Korean medicine.

Effects of suboccipital inhibition versus soft tissue manipulation on pain intensity and disability in tension-type headache among undergraduate physiotherapy students

BackgroundTension-type headache (TTH) is prevalent among collegiate students due to academic stress. Manual therapies like suboccipital inhibition and soft tissue manipulation have shown efficacy in TTH management. However, comparative studies between these interventions in collegiate populations are scarce. Understanding their relative effectiveness can enhance treatment strategies and improve outcomes, shedding light on optimal manual therapy approaches for TTH among collegiate students. This study aimed to investigate the effects of suboccipital inhibition and soft tissue manipulation on pain intensity and disability in tension-type headache (TTH) among undergraduate physiotherapy students.MethodsForty undergraduate physiotherapy students diagnosed with TTH were randomly assigned to the suboccipital inhibition group (group A, n = 20) and the soft tissue manipulation group (group B, n = 20). The suboccipital inhibition group received manual therapy targeting the suboccipital muscles, while the soft tissue manipulation group received manipulation techniques focusing on the cervical and shoulder girdle muscles. Pain intensity and disability were assessed using Visual Analogue Scale (VAS) and Headache Disability Index (HDI) Questionnaire at baseline and after 6 weeks of intervention. The data were collected and analysed using independent t test.ResultsBoth interventions demonstrated significant reductions in pain intensity and disability after 6 weeks, with the t value − 4.3150 and − 3.3106 at p < 0.05 for VAS and HDI respectively.ConclusionSuboccipital inhibition and soft tissue manipulation are effective interventions for reducing pain intensity and disability among undergraduate physiotherapy students with TTH. However, the suboccipital inhibition group showed improvement in pain intensity and disability and it has been statistically significant when compared to the soft tissue manipulation group.

Effect of Extracorporeal Shock Wave on Upper Trapezius Trigger Points in Patients With Cervicogenic Headache: A Randomized Clinical Trial.

A recent study was designed to ascertain the impact of extracorporeal shock wave therapy on upper trapezius trigger points in cervicogenic headaches patients. A double-blinded randomized controlled trial study, in which 50 participants (11 male and 39 female) aged between 20-40 with cervicogenic headache were subdivided with randomization to group (A), which received traditional physical therapy and sham shock wave therapy, and group (B), which received traditional physical therapy and actual shock wave therapy. All assessments were performed by a therapist before and after the treatment program (4 wks). There was a significant difference of headache disability index, visual analog scale scores, and upper trapezius electromyographic characteristics with P value <0.05 in both groups, in favor of the shock wave group. Extracorporeal shock wave therapy could be used for clinical and research concerns because its positive effects on pain suppression, reduction of headache intensity, and restoration of muscle regular activity in cervicogenic headache patients.

The Association between Smartphone Addiction and Headache among Adults

Background: Limited studies that adequately explain the cause-and-effect relationships have linked mobile phone use to various health consequences. Several studies have examined how exposure to mobile phones may affect various symptoms. To find out an association between smartphone addiction and headaches among adults. Methods: In this cross-sectional survey, data was collected through a non-probability sampling technique from 400 adults of either gender aged between 18 to 35 years from Rawalpindi, Islamabad and Taxila. Data was collected via the Smartphone Addiction Scale Short Version (SAS-SV), Headache Disability Index (HDI) and Visual Analogue Scale (VAS). The data were analyzed using the SPSS version 23. Results: There were 400 participants, n=187(46.8%) male and n= 213(53.3%) female, with mean age (23.20±4.41) years. The descriptive statistics of the study population were Functional HDI (21.10±11.62), Emotional HDI (19.99±12.47), HDI-Sum (41.09±22.90) and SAS-Sum (33.48±11.35). The correlation of smartphone addiction with pain (r=0.258, p=0.000), Functional HDI (r=0.349, p=0.000), Emotional HDI (r=0.364, p=0.000), and HDI-Sum (r=0.375,p=0.000) respectively. Conclusion: Headache due to smartphone addiction affects adults because of unrestricted usage of smartphones. Keywords: Headache, Pain, Smart Phones, Young Adults.

Relationship of Serum Vitamin D Levels to the Severity of Migraine

Abstract Background: Most studies done on Vitamin D deficiency in migraine focused more on headache frequency than intensity and severity of the condition. This study is aimed at determining the relationship between serum Vitamin D levels and severity of migraine in a Nigerian setting. Materials and Methods: Using a cross-sectional analytical study design, adult patients with migraine consecutively attending the neurology clinic at the Lagos University Teaching Hospital, were recruited on fulfilling the study criteria. Their age- and sex-matched healthy headache-free controls were also recruited. Demographic information and clinical parameters were obtained with an interviewer-administered questionnaire. Headache severity and pain intensity were documented using incorporated headache disability index (HDI) and numerical rating scale (NRS) tools, respectively. Serum levels of Vitamin D, calcium and albumin were assayed for all study participants. Results: The participants comprised 35 migraine and 50 control subjects. The migraine subjects comprised 10 males and 25 females, with mean ages of 29.4 ± 9.3 and 40.0 ± 11.1 years respectively (P = 0.01). The mean serum Vitamin D levels among migraine and control participants were 43.45 ng/ml ± 16.84 and 48.78 ng/ml ± 23.33, respectively (P = 0.31). The mean NRS was 7.3 ± 1.2 while the mean HDI was 44.7 ± 19.1 among migraine patients. There was no significant correlation between serum Vitamin D levels and pain intensity (r = 0.29, P = 0.9), and no correlation with HDI (r = 0.004, P = 0.96). Conclusion: The serum Vitamin D levels among migraine and control participants were not significantly different. No significant relationship was found between serum Vitamin D level and headache severity index or pain intensity in migraine patients.

Comparative Analysis of the Impact of Positional Release Technique (PRT) and Ischemic Compression (IC) on Headache Disability and Pain in Cervicogenic Headache (CGH) Patients

Headache originating from the bony structures or soft tissues of the neck is commonly known as cervicogenic headache. This study was conducted to determine the effects of the positional release technique (PRT) and ischemic compression (IC) on pain and headache disability among patients with cervicogenic headache (CGH). For this purpose, a randomized clinical trial was conducted. Data was collected from the Physiotherapy Department of Sharif Medical Complex, Lahore. A total of 36 CGH patients were assigned into two groups, randomly. The first group was treated with PRT and the other with IC. Both groups were given 12 sessions of therapy over a span of 4-weeks. HDI (Headache Disability Index) and NPRS (Numeric Pain Rating Scale) were used to measure the treatment effect on pain and headache disability before and after treatment. Among the participants (N = 36), the mean age of Group A and Group B was 26.22 ± 2.90 and 24.55 ± 2.55, respectively. A significant difference was found between the mean values of pre- and post-HDI and NPRS, with p-values 0.025 and 0.031, respectively and after treatment p value was 0.001 &amp; 0.00 respectively. The results favoured the use of PRT because there was more variation in the mean values of PRT as compared to IC. Also, the mean values of pre- and post-HDI and NPRS scores varied significantly. Notably, a significant difference was not found between the mean values of both techniques at the beginning of treatment (pre-treatment). However, a significant difference was observed between the mean values of both techniques following treatment (post-treatment) in favour of PRT, since the mean values of PRT varied more than those of IC.

Investigating the Effect of Pain Neurophysiology Education in the Treatment of Cervicogenic Headache: A Randomized Clinical Trial

Background: Cervicogenic headaches that stem from musculoskeletal disorders of the upper cervical spine are among the most common types of chronic headaches. In recent years, physiotherapy has emerged as a potential treatment for this type of headache. Objectives: Given the emphasis on educational methods such as pain neurophysiology education (PNE) for musculoskeletal pain, the aim of this study is to investigate the effect of PNE in treating cervicogenic headaches. Methods: This study was a single-blind clinical trial. A sample of 30 participants with cervicogenic headache was divided into two groups using the block method: An experimental group of 15 participants and a control group of 15 participants. Experienced physiotherapists provided conventional physiotherapy for 10 sessions, and the experimental group also received pain neurophysiology education for four additional sessions. Pain severity, disability, and pain catastrophizing information were collected using the visual analog scale, headache disability index, and pain catastrophizing scale, respectively, at the beginning of the study, after the study, and at the one-month follow-up. Statistical analysis was conducted using SPSS software version 22, and the significance level was set at 0.05. Results: A significant difference was observed in pain intensity assessment at different times (P &lt; 0.001), headache disability index (P = 0.003), and pain catastrophizing (P &lt; 0.001). The time-by-group interaction was significant for pain intensity (F = 49.051; P &lt; 0.001; ηp2=0.637) and pain catastrophizing (F = 25.528; P &lt; 0.001; ηp2=0.477); however, there was no significant difference in disability (F = 1.781; P = 0.178; ηp2=0.060). Conclusions: Pain neurophysiology education can have a positive effect on pain reduction, as well as the attitude and knowledge of individuals who experience pain in the short term.

Migraine patients with and without neck pain: Differences in clinical characteristics, sensitization, musculoskeletal impairments, and psychological burden.

AimsThis study aims to assess differences in clinical characteristics across healthy controls and migraine patients with (MNP) and without (MwoNP) neck pain. MethodThis study assessed: headache frequency; headache disability index (HDI); central sensitization inventory (CSI); Hospital Anxiety (HADS-A) and Depression (HADS-D) scale; active range of motion (AROM); flexion rotation test (FRT); activation pressure score (APS); number of active/latent myofascial trigger points (MTrPs) in head/neck muscles; number of positive cervical vertebral segments (C1/C2) who reproduce migraine pain; wind-up ratio (WUR); mechanical pain threshold (MPT) and static pressure pain threshold (sPPT) over the trigeminal area; sPPT and dynamic PPT (dPPT) over the cervical area; sPPTs and MPT over the hand. ResultsCompared to controls, MNP had: worse CSI, HADS-A, and HADS-D (all, p < 0.002); reduced AROM (flexion, extension, left lateral-flexion, and right-rotation), FRT, APS, and a higher number of MTrPs and positive cervical vertebral segments (all, p < 0.020); reduced trigeminal MPT and sPPT, cervical sPPT and dPPT, hand MPT and sPPT (all, p < 0.006).Compared to controls, MwoNP had: worse CSI, and HADS-A (all, p < 0.002); reduced AROM (flexion, and left lateral-flexion), FRT, APS, and a higher number of MTrPs and positive cervical vertebral segments (all, p < 0.017); reduced trigeminal MPT and cervical dPPT (all, p < 0.007).Compared to MwoNP, MNP had higher headache frequency, worse HDI and CSI (all, p < 0.006); reduced AROM (flexion, and right rotation) (all, p < 0.037); reduced cervical dPPT (all, p < 0.002). ConclusionMNP had worse headache characteristics, more pronounced cervical musculoskeletal impairments, enhanced signs and symptoms related to sensitization, and worse psychological burden compared to MwoNP.

Outcomes of Calvarial and Soft-Tissue Reconstruction with Latissimus Dorsi-Rib Osteomyocutaneous Free Flap.

The latissimus dorsi-rib osteomyocutaneous free flap (LDRF) has been used for autologous reconstruction of large composite calvarial and scalp defects. In this study, the authors aim to present clinical and patient-reported outcomes after LDRF reconstruction. An anatomical study was conducted to evaluate the distribution of the connecting perforators between the thoracodorsal and intercostal systems. An institutional review board-approved retrospective review of 10 patients who underwent LDRF with one or two ribs for treatment of cranial defects was conducted. Patient-reported outcomes regarding quality of life, neurologic status, and functional status were evaluated using validated surveys. One-way analysis of variance and post hoc Tukey tests were used for anatomical outcomes. Preoperative and postoperative scores were compared using paired t tests. The tenth rib (4.65 ± 2.01) followed by the ninth rib (3.7 ± 1.63) had the highest number of perforators. A combination of the ninth and eleventh ribs exhibited maximal perforator number and pedicle length. All patients had stable LDRF reconstructions. Eight patients completed both preoperative and postoperative questionnaires; Median clinical follow-up was 48 months (range, 34 to 70 months). Scores trended toward improvement but did not reach statistical significance on the Karnofsky Performance Scale ( P = 0.22), the Functional Independence Measure (Motor, P = 0.52; Cognitive, P = 0.55), or the Headache Disability Index ( P = 0.38). The minimum clinically important difference was surpassed, demonstrating improvement of function for 71% of patients on the Barthel Index and 63% on the Selective Functional Movement Assessment test. The LDRF can improve cognitive and physical functional status in complex patients with prior failed reconstructions for composite scalp and skull defects. Therapeutic, IV.

D106. Outcomes of Calvarial and Soft Tissue Reconstruction with Latissimus Dorsi Rib Osteomyocutaneous Free Flap

PURPOSE: The latissimus dorsi-rib osteomyocutaneous free flap (LDRF) has been used for autologous reconstruction of large composite calvarial and scalp defects. In this study, we aim to present patient-reported and clinical outcomes for patients treated with LDRF. METHODS: An anatomical study was conducted to evaluate the distribution of the connecting perforators between the thoraco-dorsal and intercostal system. An IRB-approved retrospective review of ten patients who underwent LDRF and one or two ribs for treatment of cranial defects was conducted. Patient-reported outcomes regarding quality of life, neurological and functional status were evaluated. One-way analysis of variance (ANOVA) and post hoc Tukey’s tests were used for anatomical outcomes. Preoperative and postoperative scores were compared using paired t-tests. RESULTS: The 10th rib (4.65± 2.01) followed by 9th rib (3.7±1.63) had the highest number of perforators. A combination of the 9th and 11th ribs exhibited maximal perforator number and pedicle length. All patients had stable LDRF reconstructions. Eight patients completed both pre and postoperative questionnaires; Median clinical follow-up was 48 [34-70] months. Scores trended toward improvement but did not reach statistical significance on the Karnofsky Performance Scale (p=0.22), Functional Independence Measure (FIM; Motor p=0.52, Cognitive p=0.55), and Headache Disability Index (p=0.38). The minimum clinically important difference (MCID) was surpassed, demonstrating improvement of function for 71% of patients on the Barthel Index and 63% on the Selective Functional Movement Assessment test (SFMA). CONCLUSION: The LDRF can improve cognitive and physical functional status in complex patients with prior failed reconstructions for composite scalp and skull defects.

An observational study of headache disability index with reference to different Mizaj to evaluate life quality of headache patients

Headache is an almost universal experience and one of the most common symptom in medical practice. Headache disorders are among the most common of the nervous system disorders with the prevalence of 48.9 percent in the general population. Some headaches are extremely debilitating and have a significant impact on an individual’s quality of life imposing huge costs to healthcare and their consequences leads to disability. Concept of Mizaj in the Unani system of medicine is a wide area of research. Mizaj is one of the basic and fundamental concept of the Unani system of medicine, diagnosis and line of management of any disease is based upon it. In this cross sectional descriptive study to assess the Mizaj and headache disability, we used Mizaj assessment proforma based on classical literature and Headache Disability Index proforma (developed by Doctor Yusuf Jamal) in headache patients of different age and both gender & this study was carried out in Out Patient Department and In Patient Department of Ayurvedic and Unani Tibbia college and hospital, Karol Bagh, New Delhi. Analysis of data in the current study was done by calculating the Mean, Standard Deviation and one way Analysis of Variance in SPSS 22.0 software for all the factors of Mizaj and Headache Disability Index. The findings suggested that Headache Disability Index had significant association with the variability of Mizaj of the headache patients.

Frequency and risk factors for headache disability: A population-based cross-sectional study in Egypt.

A headache is a very common condition that can have a significant impact on one's quality of life. It is one of the leading causes of years lived with disability worldwide. The objective of the study was to determine the prevalence of primary headache disability, its characteristics, risk factors and its impact on daily life. A cross-sectional study was conducted in Fayoum governorate. The sample size was 1909 participants. A multistage random sample technique was used to select adults aged above 18 years. A self-structured questionnaire solicited information on sociodemographic characteristics, headache characteristics, and the headache disability index. SPSS v 22.0 was used for data analysis. Headaches caused complete disability in 19.5% of the study group, and 76.8% developed severe disability. Participants who reported that they had a headache more than once a week were; 44.5% had moderate pain and 40.2% had more intense pain. About 55% complained of attacks rather than continuous headache and were more likely to have a degree of complete disability, (P = 0.001). A statistically significant association was found between living in urban areas, working in professional occupations, complaining of severe headache in the form of an attack and seeking medical advice, with high scores of headache disability. Headache is a condition that affects the entire population in a way that causes high levels of disability. Good management is necessary for the reduction of the adverse effects of headaches on the health of the population. This should focus on raising public awareness by means of education and on the provision of basic healthcare.

Comparison Of Positional Release Technique and Ischemic Pressure on Pain and Headache Disability in Cervicogenic Headache

Cervicogenic headache may imitate those usually connected through essential headache problems. Objective: To determine the effects of ischemic compression and positional release procedure on pain and Headache Disability Index in Cervicogenic headache. Methods: Data were collected from Physiogic Physiotherapy Clinic Lahore, for 6 months. Quasi Experimental study was conducted on 18 patients of Cervicogenic headache. All were randomly allocated to ICT group and PRT group, both groups were treated for 12 sessions in 4 weeks. NPRS, HDI were used to measure the treatment effect before and after treatment of 12 sessions in 4 weeks. Data was analyzed by SPSS 21. Results: There were 9 (50.0%) participation with mean of 26.22 and SD 2.90 in group A and 9 (50.0%) participants with mean of 24.55 and SD 2.55 in group B. Across the gathering correlation of VAS, KOOS AND AKPS with mean difference and standard p value of pre and post treatment values and within group comparison of VAS, KOOS AND AKPS showed significant difference in Group A as compared to group B. Conclusions: Result showed that significant difference found between the mean values of both technique after treatment (Post-Treatment) in HDI &amp; NPRS in the favor of PRT because there is more variation in mean of PRT as compared to IC technique.

A Preliminary Study of the Efficacy of Transcranial Direct Current Stimulation in Trigeminal Neuralgia.

The purpose of this study is to assess the efficacy of transcranial direct current stimulation (tDCS) in patients with treatment-refractory trigeminal neuralgia (TN) and examine the utility of neuroimaging methods in identifying markers of such efficacy. Six patients with classical TN refractory to maximal medical treatment, underwent tDCS (three cases inhibitory/cathodic and three cases excitatory/anodic stimulation). All patients underwent pre- and posttreatment functional magnetic resonance imaging (fMRI) during block-design tasks (i.e., Pain, Pain + tDCS, tDCS) as well as single-shell diffusion MRI (dMRI) acquisition. The precise locations of tDCS electrodes were identified by neuronavigation. Five therapeutic tDCS sessions were carried out for each patient with either anodic or cathodic applications. The Numeric Rating Scale of pain (NRS) and the Headache Disability Index (HDI) were used to score the subjective efficacy of treatment. Altered activity of regional sites was identified by fMRI and associated changes in the spinothalamocortical sensory tract (STCT) were measured by the dMRI indices of fractional anisotropy (FA) and mean diffusivity (MD). Fiber counts of the bilateral trigeminal root entry zone (REZ) were performed as an added measure of fiber loss or recovery. All patients experienced a significant reduction in pain scores with a substantial decline in HDI (P value < 0.01). Following a course of anodic tDCS, the ipsilateral caudate, globus pallidus, somatosensory cortex, and the contralateral globus pallidus showed a significantly attenuated activation whereas cathodic tDCS treatment resulted in attenuation of the thalamus and globus pallidus bilaterally, and the somatosensory cortex and anterior cingulate gyrus contralaterally. dMRI analysis identified a substantial increase (>50%) in the number of contralateral sensory fibers in the STCT with either anodic or cathodic tDCS treatment in four of the six patients. A significant reduction in FA (>40%) was observed in the ipsilateral REZ in the posttreatment phase in five of the six patients. Preliminary evidence suggests that navigated tDCS presents a promising method for alleviating the pain of TN. Different patterns of activation manifested by anodic and cathodic stimulation require further elaboration to understand their implication. Activation and attenuation of responses at various sites may provide further avenues for condition treatment.

Effects of Online Facial Exercise and Self-Massage Program on Neck and Head Pain and Quality of Life

Background. Due to the COVID-19 pandemic and the lockdown, most people with headache and neck pain were unable to access health care services, so it is unclear which remote physiotherapy methods would be effective in treating neck and head pain.&#x0D; Aim. To investigate the effects of virtual facial exercise and self-massage on women’s neck and head pain and functional condition.&#x0D; Methods. The study included 33 women 45–59 years old, who had experienced neck and head pain in the past month and were not taking pain medications. All subjects were in the experimental group. Facial exercise and self-massage for 20 minutes daily for 20 days were performed by the subjects following virtual instructions. Before and after the intervention, the intensity of neck and head pain was assessed using numeric pain intensity scale, the quality of life was assessed using neck disability index and headache disability index.&#x0D; Results. Neck pain decreased by 3.82 ± 2.63 points (p &lt; 0.05), headache decreased by 2.82 ± 1.93 points (p &lt; 0.05), neck functional disability decreased by 7.33 ± 4.57 points (p &lt; 0.05), headache disability index values decreased by 15.57 ± 8.47 points (p &lt; 0.05).&#x0D; Conclusion. After the application of virtual facial exercise and self-massage, women’s neck and head pain was reduced and the quality of life improved.&#x0D; Keywords: neck pain, headache, physiotherapy, massage, quality of life.

Effects of aerobic exercise and progressive muscle relaxation on migraine.

To determine the effect of aerobic exercises and progressive muscle relaxation in migraine patients. The quasi-experimental study was conducted at the Sheikh Khalifa Bin Zayed Al Nayhan Hospital / Combined Military Hospital, Muzaffarabad, Azad Jammu and Kashmir, from February to July 2017, and comprised migraine patients of either gender aged 20-50 years. They were divided into experimental and control group. Experimental group A received supervised exercises protocol, including aerobic exercise (stationary bicycle) 30min with 10min warm-up and 5min cool-down followed by progressive muscle relaxation for 15min 3 times a week for 6 weeks along with prophylactic medicine. The control group received prophylactic medicines flunarazine 5mg twice daily, inderal 10mg thrice daily and nortriptyline 25mg at night. Patients were assessed using Numeric Pain Rating Scale, Migraine Disability Assessment Scale, Headache Disability Index, Headache Impact test-6 and the Central Sensitisation Inventory at baseline, midline and at the completion of intervention. Data was analysed using SPSS 21. Of the 28 patients, there were 14(50%) in each of the two groups. Overall, there were 24(85.7%) females and 4(14.3%) males with a mean age of 29.7±10 years. There were significant improvements in all parameters in both the groups, but group A had significantly better outcome post-intervention (p<0.05). Prophylactic medicine, aerobic exercises and progressive muscle relaxation, when used together, were found to be effective means of intervention for migraine.

Effect of adjunctive transcranial direct current stimulation and cognitive behavior therapy on headache disability in episodic frequent or chronic tension-type headache: A pilot, exploratory study

Background: Literature suggests that non-pharmacological treatments like non-invasive brain stimulation and cognitive behavioural therapy (CBT) may be used as augments in the management of Tension-Type Headache (TTH). Aims and Objectives: To assess the efficacy of Transcranial Direct Current Stimulation (tDCS) and Cognitive Behavioral Therapy (CBT) compared to treatment as usual (TAU) on headache-related disability and the psychological impact of headache on life of patients suffering from TTH. Materials and Methods: Thirty right-handed TTH patients HDI (headache disability index) > 30 were randomly allocated to group A (tDCS + TAU), group B (CBT + TAU), and group C (TAU). While the primary outcome measure was headache related disability (Headache Disability Index(HDI)), somatic symptoms (Somatic Symptom Severity (SSS-8)), anxiety & depression (Hospital Anxiety and Depression Scale (HADS)) and sleep quality (Pittsburgh Sleep Quality Index (PSQI). Assessments were done at baseline, end of the third and sixth month. Results: We found a statistically significant reduction in HDI (F=12.419, p <0.001), SSS-8 (F=4.587, p=0.010), and HADS-anxiety (F=4.810, p=0.002). tDCS showed better efficacy than CBT, while these two were significantly better than TAU on HDI and SSS-8. On HADS-A also both tDCS and CBT were better than TAU, but showed no significant difference between them. Conclusion: Supplementing non-pharmacological techniques like tDCS and CBT will be effective in reducing headache-related disability and associated psychological symptoms.

A Prospective, Multicenter Study to Assess the Safety and Efficacy of Translingual Neurostimulation Plus Physical Therapy for the Treatment of a Chronic Balance Deficit Due to Mild-to-Moderate Traumatic Brain Injury

ObjectivesTranslingual neurostimulation (TLNS) studies indicate improved outcomes in neurodegenerative disease or spinal cord injury patients. This study was designed to assess the safety and efficacy of TLNS plus targeted physical therapy (PT) in people with a chronic balance deficit after mild‐to‐moderate traumatic brain injury (mmTBI).Materials and MethodsThis international, multicenter, randomized study enrolled 122 participants with a chronic balance deficit who had undergone PT following an mmTBI and had plateaued in recovery. Randomized participants received PT plus either high‐frequency pulse (HFP; n = 59) or low‐frequency pulse (LFP; n = 63) TLNS. The primary efficacy and safety endpoints were the proportion of sensory organization test (SOT) responders (SOT composite score improvement of ≥15 points) and fall frequency after five weeks of treatment, respectively.ResultsThe proportion of SOT responders was significant in the HFP + PT (71.2%) and LFP + PT (63.5%) groups compared with baseline (p < 0.0005). For the pooled population, the SOT responder rate was 67.2% (p < 0.00005), and there were clinically and statistically significant improvements in SOT composite scores after two and five weeks (p < 0.0005). Both groups had reductions in falls and headache disability index scores. Mean dynamic gait index scores in both groups also significantly increased from baseline at weeks 2 and 5.ConclusionsSignificant improvements in balance and gait, in addition to headaches, sleep quality, and fall frequency, were observed with TLNS plus targeted PT; in participants who had a chronic balance deficit following an mmTBI and had plateaued on prior conventional physiotherapy.