Profile Of Headache Research Articles

Migraine Headache: A Bangladesh Perspective

Background: Migraine headache is one of the commonest cause of primary headache. This study aims to reveal the clinical profile of migraine headache in Bangladeshi people presented in Headache clinic, Dhaka Medical College Hospital. It will give an overview on presentation of migraine and its functional consequences among the people of Bangladesh.
 Methods: The study was a hospital based cross sectional observational study. It was conducted in the Headache clinic Dhaka Medical college Hospital from January 2018 to December 2018. About 854 patients with headache was attended in the headache clinic during the study period. Of that 234 patients were diagnosed as migraine according to ICHD-3 classification and 75 patents were enrolled in this study by systematic sampling. Details were collected using a preformed questioner.
 Results: In this study migraine burden among the headache patients found to be about 25%.The mean age of the onset of the migraine headache in this study was found to be 25.2±11.86 years, in most of the cases (4 68%) in 15-34 years age group. In this study 36% of the patient with migraine had positive family history which is significantly higher in patients with migraine with aura (52% vs. 30% p value <0.5). In this study about 81% of the patient has single or multiple trigger factors. Along with other known factor sun exposure and journey was found to be the important trigger factors for Bangladeshi population. In this study 22% of the female migraineurs and 33% of male migraineurs had aura. About 53% of the patient with aura had combinations of aura and 47% patient had exclusive visual aura. In the present study 100% of the patient had visual aura, 42% had brainstem aura and 10% had sensory aura. The study revealed that 25% patient had chronic daily headache due to migraine, 26% patient had >5 attack/ month and 15% patient had < 4 attack per month. In this study 44% had moderate headache and 56% had severe headache according to VAS score. Chronic migraine with anxiety, chronic migraine with medication overuse Migralepsy, Status migrainosus were found as a complications of migraine in this study. According to MIDAS score Patient largely had Mild (32%) to Moderate (34.67%) disability.
 Conclusions: Clinical profile of migraine in Bangladesh differs in some trigger points and migraine subtypes than the western world. Sun exposure and journey found to be most important triggers. Migraine with brainstem aura occurs in a significant number of the patient.
 Bangladesh Journal of Neuroscience 2019; Vol. 35 (1): 1-9

Altered near-infrared spectroscopy response to breath-holding in patients with fibromyalgia.

Fibromyalgia (FM) is a complex syndrome characterized by chronic widespread pain and a heightened response to pressure. Most medical researches pointed out that FM patients with endothelial dysfunction and arterial stiffness. A continuous-wave near-infrared spectroscopy (NIRS) system is used in present study to measure the hemodynamic changes elicited by breath-holding task in patients with FM. Each patient completed a questionnaire survey including demographics, characteristics of body pain, associated symptoms, headache profiles and Hospital Anxiety and Depression Scale. A total of 27 FM patients and 26 health controls were enrolled. In comparison with healthy controls, patients with FM showed lower maximal and averaged change of oxyhemoglobin concentration in both the left (1.634 ±0.890 and 0.810 ±0.525 μM) and the right (1.576 ±0.897 and 0.811 ±0.601 μM) prefrontal cortex than healthy controls (P < .05 for both sides) during the breath-holding task. In conclusion, FM is associated with altered cerebrovascular reactivity measured by NIRS and breath-holding task, which may reflect endothelial dysfunction or arterial stiffness. Oxygenated hemoglobin concentration changes of healthy controls and FM patients.

CLINICAL PROFILE OF RECURRENT HEADACHE IN RURAL CHILDREN OF RAJASTHAN: A CROSS-SECTIONAL STUDY

Context: Recurrent headache is a commonly encountered clinical entity in rural children. Aims: This study aims to record the clinical profile of recurrent headache in rural children of Rajasthan. Settings and Design: A cross-sectional, observational study in a pediatric outpatient department of a tertiary care teaching hospital. Methods and Materials: A total of 164 children of either sex, between 5 and 17 years of age, presenting with complaints of a recurrent headache were included in the study. All relevant clinical details collected from patients and their relatives were recorded in a structured pro forma. A detailed examination was performed to rule out underlying problems associated with a headache. Headache subtypes were classified according to the International Classification of Headache Disorders, 3rd edition beta, 2013. Pediatric migraine disability assessment test score and Faces pain rating scale were utilized to assess the disability and severity, respectively. Statistical analysis involved summarizing the continuous variables as mean and standard deviation while nominal/categorical variables were expressed as percentages. Results: The mean age was 11.5 years and the M:F ratio was 1:1.1. Adolescents in 13–17 years age group constituted 61.5% (n=101) of the study sample with 58.4% (n=59) female subjects. Primary headaches - tension-type headache (n=77, 46.9%), migraine (n=43, 26.2%), and new daily persistent headache (n=5, 3%) were observed in 125 (76.1%) cases. Common causes of secondary headache were somatization disorder (n=27, 16.5%), ophthalmic problems (n=7, 4.3%), medication overuse (n=3, 1.9%), intracranial tumor (n=1, 0.6), and postictal (n=1, 0.6). Conclusions: Recurrent headache in rural children has distinct etiological profile which mandates a meticulous evaluation for initiating appropriate management.

Comparison of gray matter volume between migraine and \u201cstrict-criteria\u201d tension-type headache

BackgroundDespite evidently distinct symptoms, tension-type headache (TTH) and migraine are highly comorbid and exhibit many similarities in clinical practice. The purpose of this study was to investigate whether both types of headaches are similar in brain morphology.MethodsConsecutive patients with TTH and age- and sex-matched patients with migraine and healthy controls were enrolled for brain magnetic resonance imaging examination. Patients with TTH were excluded if they reported any headache features or associated symptoms of migraine. Changes in gray matter (GM) volume associated with headache diagnosis (TTH vs. migraine) and frequency (episodic vs. chronic) were examined using voxel-based morphometry. The correlation with headache profile and the discriminative ability between TTH and migraine were also investigated for these GM changes.ResultsIn comparison with controls (n = 43), the patients with TTH (25 episodic and 24 chronic) exhibited a GM volume increase in the anterior cingulate cortex, supramarginal gyrus, temporal pole, lateral occipital cortex, and caudate. The patients with migraine (31 episodic and 25 chronic) conversely exhibited a GM volume decrease in the orbitofrontal cortex. These GM changes did not correlate with any headache profile. A voxel-wise 2 × 2 factorial analysis further revealed the substantial effects of headache types and frequency in the comparison of GM volume between TTH and migraine. Specifically, the migraine group (vs. TTH) had a GM decrease in the superior and middle frontal gyri, cerebellum, dorsal striatum, and precuneus. The chronic group (vs. episodic group) otherwise demonstrated a GM decrease in the bilateral insula and anterior cingulate cortex. In receiver operating characteristic analysis, the GM volumes of the left superior frontal gyrus and right cerebellum V combined had good discriminative ability for distinguishing TTH and migraine (area under the curve = 0.806).ConclusionsTTH and migraine are separate headache disorders with different characteristics in relation to GM changes. The major morphological difference between the two types of headaches is the relative GM decrease of the prefrontal and cerebellar regions in migraine, which may reflect a higher allostatic load associated with this disabling headache.

Prevalence and Pattern of Migraine, Tension Type Headache and Chronic Daily Headache among Medical and Nursing Students in Enugu, South East Nigeria

Aim: To assess the lifetime prevalence of tension-type headache, migraine and chronic daily headache, including the primary headaches in a student population. Methods: This is a cross-sectional descriptive study. Data were collected from consecutive consenting students by means of a semi-structured questionnaire. The questionnaire was designed to assess demographic data, headache profiles and medical consultation. Results: Four hundred and forty-nine (89.8%) out of 500 students who were interviewed were analyzed. The lifetime prevalence of primary headache was 89.8%; it 90.5% and 88.6% in females and males respectively. The overall prevalence of migraine was 8.9%, with a prevalence of 10.6% in females and 6.5% in males. Migraine without aura was most commonly seen at 73%. The prevalence of migraine without aura was 7.6% in females and 4.9% in males. Tension type headache (TTH) had an overall prevalence of 22.9%, with a prevalence of 28.4% in females and 15.1% in males. Migraine and tension type headache co-existed in 5.8% of the students. About 8.5% suffered from chronic daily headache: chronic migraine 2.9%, chronic tension headache 3.1%. The rate of medical consultation was 54.8% (males 49.7%, females 58.3%). Conclusions: Headache is a common health problem among medical and nursing students in Enugu South East Nigeria where 89.8% of respondents have had primary headaches. The prevalence of migraine, TTH and chronic daily headache was 8.9%, 22.9% and 8.5% respectively. Headaches therefore, represent one of the most challenging neurological disorders in Sub-Saharan Africa where most sufferers do not have access to specialist care.

Assessment of Migraine Disability Using the Migraine Disability Assessment Questionnaire in Young Nigerians

Background and purpose: Migraine is a common debilitating condition with variable prevalence in young Nigerians with significant deterioration in normal daily functioning and in the quality of life. Few data exist on the disability of migraine in Nigeria. The aim of this study was to measure the headache related disability of patients with migraine using the MIDAS among young Nigerians. Methods: This was a cross sectional study conducted in Enugu South East Nigeria. The questionnaire was designed to assess headache profiles according to ICHD-III beta and disability using the Migraine Disability Assessment Questionnaire. Results: About 40.6% of migraineurs were concerned about headache attacks and 39.1% consulted a doctor because of migraine. Most students were affected due to reduced effectiveness at school and number of days missed from housework—18.8% and 20.3% respectively. Overall, 47.8% had at least one day affected by headache in the last three months. The mean number of days disabled by headache was 14.3 days. The mean headache frequency was 5.7 days and the mean pain intensity was 4.2. About 27.5% of the migraineurs had moderate to severe disability due to migraine. There were no significant differences between males and females. Conclusion: Most with migraine experienced reduction in effectiveness at school and number of days missed from housework. Overall, 47.8% had at least one day affected by headache with an average of 14.3 days disabled by headache and 27.5% of the migraineurs had moderate to severe disability due to migraine.

Clinical Profile of Migraine Headache with Special Reference to Trigger Factors in Medical College Set Up

Clinical Profile of Migraine Headache with Special Reference to Trigger Factors in Medical College Set Up

The Role of the Trigemino Cervical Complex in Chronic Whiplash Associated Headache: A Cross Sectional Study.

To investigate signs of central sensitization in a cohort of patients with chronic whiplash associated headache (CWAH). Central sensitization is one of the mechanisms leading to chronicity of primary headache, and thus might contribute to CWAH. However, the pathophysiological mechanism of CWAH is poorly understood and whether it is simply an expression of the primary headache or has a distinct pathogenesis remains unclear. Thus, the factors involved in the genesis of CWAH require further investigation. Twenty-two patients with CWAH (20 females, 2 males; age 25-50 years, mean age 36.3 years) and 25 asymptomatic participants (13 females, 12 males; age 18-50 years, mean age 35.6 years) rated glare and light-induced discomfort in response to light from an ophthalmoscope. Hyperalgesia evoked by a pressure algometer was assessed bilaterally on the forehead, temples, occipital base, and the middle phalanx of the third finger. The number, latency, area under the curve, and recovery cycle of nociceptive blink reflexes elicited by a supraorbital electrical stimulus were also recorded. Eight and 6 CWAH patients had migrainous and tension-type headache (TTH) profiles, respectively; the remainder had features attributable to both migraine and TTH. Patients in the whiplash group reported significantly greater light-induced pain than controls (8.48 ± .35 vs 6.66 ± .43 on a 0-10 scale; P = .001). The CWAH patients reported significantly lower pressure pain thresholds at all sites. For stimuli delivered at 20 second intervals, whiplash patients were more responsive than controls (4.8 ± .6 blinks vs 3.0 ± .6 blinks in a block of 10 stimuli; P = .036). While R2 latencies and the area under the curve for the 20 second interval trials were comparable in both groups, there was a significant reduction of the area under the curve from the first to the second of the 2-second interval trials only in controls (99 ± 8% of baseline in whiplash patients vs 68 ± 7% in controls; P = .009). The recovery cycle was comparable for both groups. Our results corroborate previous findings of mechanical hypersensitivity and photophobia in CWAH patients. The neurophysiological data provide further evidence for hyperexcitability in central nociceptive pathways, and endorse the hypothesis that CWAH may be driven by central sensitization.

Headache Profile Change in an Emergency Department during the Economic Crisis of Greece

Headache Profile Change in an Emergency Department during the Economic Crisis of Greece

Suicide risk in patients with migraine and comorbid fibromyalgia.

To identify the frequency, clinical effects, and suicide risk in comorbid fibromyalgia(FM) among patients with migraine. We surveyed patients with migraine who attended a headache clinic. All patients completed questionnaires containing demographics, headache profiles based on the International Classification of Headache Disorders, 2nd edition, FM questionnaires based on the modified 2010 American College of Rheumatology preliminary diagnostic criteria, Migraine Disability Assessment, Hospital Anxiety and Depression Scale, and Pittsburgh Sleep Quality Index. Suicide risk was evaluated by self-report of lifetime suicidal ideation and attempts. Of the 1,318 recruited patients with migraine (aged 42.6 ± 12.7 years; female/male = 4.5), 10.1% (aged 44.3 ± 12.6 years; female/male = 7.9) had comorbidity of FM. Patients with migraine and comorbid FM had higher headache frequency and headache-related disability, poor sleep quality, and were more depressed/anxious than those with migraine only (p < 0.001). Suicidal ideation and attempts were reported in 27.3% and 6.9% of patients with migraine, respectively, and were higher in patients with comorbid FM than in those without (ideation: 58.3% vs 24%; attempt: 17.6% vs 5.7%; p < 0.001). In addition, comorbidity of FM was associated with a higher suicide risk in 3 different migraine subgroups, i.e., migraine without aura, migraine with aura, and chronic migraine. After controlling for covariates, comorbidity of FM remained as a predictor of suicidal ideation and attempts (odds ratio 2.61 and 1.99, respectively, p < 0.05)in patients with migraine. Comorbidity with FM is associated with a high suicide risk in patients with migraine.

An update on the pathophysiology of idiopathic intracranial hypertension alias pseudotumor cerebri.

Idiopathic intracranial hypertension (IIH) is a syndrome characterized by increased intracranial pressure of unknown cause, leading to severe headache, papilledema and visual disturbances. Its former name, pseudotumor cerebri, has gained popularity recently. The strongest and most consistent risk factors of IIH are obesity and female gender. Infrequently, IIH may present in the absence of papilledema showing a headache profile similar to chronic daily headache with migrainous features. There have been several proposed mechanisms to explain the etiology of this disorder associated with various clinical conditions. In recent years, some inflammatory factors, natriuretic peptides and aquaporins have been proposed as possible contributors of the pathogenesis. On the other hand, some investigators have reported that bilateral transverse sinus stenosis is seen in the majority of IIH patients; therefore, dural sinus stent placement is used in some patients. No single theory has been able to provide a comprehensive answer, and there is no consensus about the exact cause of IIH. The aim of this review was to discuss the new insights on the mysterious pathogenesis of IIH.

Abstract T P168: Headache and Cerebral Venous Thrombosis

Background and purpose: Headache is the most frequent presenting symptom of cerebral venous thrombosis (CVT), but many aspects of its profile are unknown because large scale studies are scarce. We aimed to analyze the headache characteristics in the largest cohort of Hispanic Mestizo patients with CVT. Methods: Since 1986 a systematic CVT registry has been carried out in 2 tertiary referral Neurological centers in Mexico City. Herein we examine the headache profile and the association of demographic, clinical and neuroimaging factors with the occurrence of headache in 408 consecutive patients. Results: Among 408 patients (82% women) included in this registry, headache occurred in 346 (85%; 86% in women, 79% in men, p NS), being the first neurological manifestation in 309 (76%). Headache onset was acute in 46%, of gradual onset in 51%, and a sudden explosive onset like thunderclap occurred in 3%. A diffuse headache pattern occurred in 56%, bifrontal in 22%, unilateral in 15%, and suboccipital in 8%. It was of pulsatile quality in 73%, and oppressive in 24.3%, and it was mostly deemed as severe (49%) or moderate (47%) in intensity, described as progressive in 19%, and with nausea or vomiting in 52% patients. Headache was the only neurological symptom in 58 patients (14%): as part of an isolated intracranial syndrome in 52 (13%) and as the sole manifestation of CVT in 6 (1.5%). Headache was followed by other neurological symptoms in 70%, appearing within 48 hours of headache onset in 33%, within 3-6 days in 34%, within 7-10 days in 16%, and after 10 days in 18%. CVT diagnosis was significantly delayed in patients with headache, as compared with other neurological presentations (delay &gt;15 days: 30% vs. 8%, respectively; p&lt;0.05). There were not differences in anatomical topography of CVT in patients presenting with headache, as compared with other neurological features. Conclusions: There is no identifiable, uniform, recognizable pattern of headache in CVT and often precedes the development of other neurological deficits for days or even weeks delaying the diagnosis of CVT. Interestingly, neither the presence nor the quality of headache is associated with the topography or extension of CTV.

Clinical profile of cluster headaches in China – a clinic-based study

BackgroundThe clinical profile of cluster headache in Chinese patients have not been fully studied.MethodsThe classification and clinical features of 120 consecutive patients with cluster headache (105 males, 15 females; mean age, 34.9 ± 10.5 years) visiting at International Headache Center from May 2010 to August 2012 were analyzed.ResultsPatients came from 16 different regions of China. Mean age at onset of cluster headache was 26.7 ± 10.9 years. Only 13 patients (10.8%) had previously been diagnosed with cluster headache. Mean time to diagnosis from first symptoms was 8.2 ± 7.1 years (range, 0–35 years). Chronic cluster headache was observed in only 9 patients (7.5%). The most commonly reported location of cluster headache was temporal region (75.0%), followed by retro-orbital region (68.3%), forehead (32.5%), vertex (32.5%) and occipital (22.5%). Lacrimation was the most consistently reported autonomic feature (72.5%). During acute attacks, 60.0% of patients experienced nausea, and 41.7% experienced photophobia and 40.8% experienced phonophobia. In addition, 38.3% reported restless behavior and 45.8% reported that physical activity exacerbated the pain. None of patients experienced visual or other kinds of aura symptoms before cluster attacks. We found that 38.3% of patients had <1 cluster period and 35.8% for 1–2 cluster periods per year with these periods occurring less frequently during the summer than during other seasons. Cluster duration was 1–2 months in 32.5% of patients. During cluster periods, 73.3% of patients had 1–2 attacks per day, and 39.2% experienced cluster attacks ranging in duration from 1 h to less than 2 h. The duration of attacks were 1.5 (1–2.25) hours for males and 1.5 (1-3) for females respectively. The World Health Organization quality of life-8 questionnaire showed that cluster headache reduced life quality.ConclusionsCompared to Western patients, Chinese patients showed a relatively low prevalence of chronic cluster headaches, pain sites mainly focused on areas distributed by the first division of the trigeminal nerve, a low frequency of restlessness and absent aura. These clinical features may be more common in Eastern populations, including mainland Chinese, Japanese and Taiwanese patients, than in Western patients.

The analysis of allodynia in patients with idiopathic intracranial hypertension

Allodynia is frequently associated with migraine and other primary headaches. Our aim was to investigate the presence of allodynia and related features in idiopathic intracranial hypertension (IIH), which is a disabling secondary headache disorder. We included 46 IIH patients and analyzed their clinical and laboratory findings retrospectively. Allodynia was assessed using the validated 12-item allodynia symptom checklist (ASC-12), in addition to examining pressure (with von Frey filaments) and brush allodynia. Allodynia was detected in 23 (50%) of IIH patients with ASC-12 and/or instrumental testing. The most commonly reported location was unilateral V1 distribution. The allodynic symptom profile was similar but milder when compared to 143 migraineurs with ASC-12. Only the aggravation of headache with physical activity emerged as a significant variable associated with allodynia in IIH. Among allodynic patients, only eight had previous migraine diagnosis. After onset of IIH, 20 patients reported migraine-like headache, while only three reported non-migrainous headache. In contrast, 13 of 23 non-allodynic IIH patients had non-migrainous headache features (p = 0.0045). Half of the IIH patients reported allodynia, and these allodynic patients had mostly migraine-like headache profiles. Our study suggested that IIH may trigger some common mechanisms with migraine in pain pathways causing allodynia.

New daily persistent headache: Should migrainous features be incorporated?

International Classification of Headache Disorders (ICHD-2) criteria for new daily persistent headache (NDPH) require tension-type headache features. Many patients with 'new-onset persistent' headache fail to fulfil such criteria due to prominent migrainous features. We reviewed all NDPH patients in our headache clinic, using the definition of persistent headache < 3 days after onset for > 3 months. The patients were dichotomised: patients meeting ICHD-2 criteria (NDPH-S) and patients failing to meet ICHD-2 criteria due to prominent migrainous features (NDPH-M). All patients had completed a structured intake form including demographics, headache profiles, Beck Depression Inventory (BDI), Short Form 36 (SF-36) Health Survey, and Migraine Disability Assessment (MIDAS). A telephone interview was conducted for follow-up. A total of 92 NDPH patients were enrolled (59 (64.1%) NDPH-M, 33 (35.9%) NDPH-S). Between the two subgroups, the sociodemographics were indistinguishable, but the patients with NDPH-M had higher headache intensity, BDI scores, MIDAS scores, and lower scores of most SF-36 subscales. After an average of 2 years of follow-up, 57 (66%) had a good outcome (≥ 50% reduction in headache frequency). Cox proportional analysis showed that disease duration ≤ 6 months and NDPH-S diagnosis predicted good outcomes. Migrainous features were common in patients with NDPH. Unlike prior studies, our study showed NDPH-M represented a more severe subgroup with a poorer outcome compared with NDPH-S.

Levetiracetam in chronic daily headache: A double-blind, randomised placebo-controlled study

Chronic daily headache (CDH) represents a temporal profile of headache (15+ days/month; 4+ hours/day; >6 months). We report the first comprehensive and largest levetiracetam (LEV) trial in CDH. A 27-week, multi-centre, randomised, placebo-controlled, cross-over, phase III B study assessed efficacy of a target of 3 g/day LEV of 6 placebo tablets/day in CDH. Primary efficacy was headache-free rate (HFR) while secondary parameters were loss of diagnostic criteria; severity; duration; disability; associated features; pain; and quality of life. Ninety-six patients were recruited (baseline HFR 10.4 ± 14.6%; median 0%). At onset of history 73 (74.1%) had migraine +/- aura and 35 (36.5%) had tension-type headache (TTH). Over the six months preceding recruitment 54 (56.3%) had migraine and 42 (43.8%) had TTH. Headache history was 22.6 ± 15.0 years (median 20.0). Eighty-eight received placebo and 89 received LEV with >80 receiving stable dose in either arm. LEV achieved 3.9% increased HFR over placebo, showing a trend but not significance. There was 9.9% increase in loss of CDH diagnostic criteria re: headache days/month for LEV over placebo (p = .0325), reduced disability (p = .0487) and reduced pain severity for LEV (p = .0162). The Short-Form Quality of Life assessment instrument (SF-36) showed impaired mental health on LEV (p = .001). These findings conflict with reports of LEV efficacy, mandating placebo control in headache trials. Primary efficacy equated to one extra headache-free day/month with reduced disability and pain intensity. Mental health was reduced on LEV. The 10% loss of diagnostic criteria, decreased intensity and disability suggest a subpopulation with CDH where LEV remains a therapeutic option.

Clinical features, imaging findings and outcomes of headache associated with sexual activity

To study the clinical profiles, imaging findings and outcomes and field test the diagnostic criteria proposed by the International Classification of Headache Disorders, 2nd edition (ICHD-II) in patients with headache associated with sexual activity (HSA). We recruited 30 patients (16 men, 14 women, mean age at onset 40.2±10.0 years) with headache associated with sexual activity at a headache clinic from 2004 to 2009. None of the patients had neurological deficits at onset. Twenty patients (67%) had secondary causes, including one subarachnoid hemorrhage, one basilar artery dissection, and 18 cases reversible cerebral vasoconstriction syndrome (RCVS). Ten patients (33%) had primary HSA. The demographics, headache profiles, drug response and clinical course were similar between primary and secondary HSA. Compared to prior studies done in Western societies, our patients had similar clinical features but with a higher ratio of females (50%) and a higher frequency of chronic course (39%). Sixty-seven percent of patients with RCVS could not fulfill the criteria of reversible angiopathy of the central nervous system (Code 6.7.3) proposed by the ICHD-II. The most common reason was headache resolution in more than two months. In addition, 40% of patients with primary HSA could not fulfill the ICHD-II criteria for primary HSA (Code 4.4). Our study found that intracranial vascular disorders were very common in patients with HSA. Thorough neurovascular imaging is required for all patients with HSA.

CHRONIC DAILY HEADACHE IN ADOLESCENTS: AN 8-YEAR FOLLOW-UP STUDY

Objective: To assess the long-term outcome of a community-based adolescent cohort with chronic daily headache (CDH). Methods: A field sample of 122 adolescents aged 12–14 years with CDH was established in 2000 (baseline) with short-term follow-up studies in 2001 and 2002. In 2008, the cohort was re-interviewed by physicians via telephone to determine the headache profile for the past year, including Migraine Disability Assessment (MIDAS), a headache disability questionnaire. Presence of CDH was defined as ≥15 headache days/month, average ≥4 hours/day for >3 months. Outcome measures included headache frequency, MIDAS score, and presence of CDH in 2008. Results: A total of 103 subjects (26 male/77 female, mean age 21.6 ± 0.9 years) completed the study (response rate 84.4%). The average monthly headache frequency was 4.7 ± 6.0 (0–30) days. Twenty-eight (27.2%) subjects had moderate or severe headache disability (MIDAS ≥11). Twelve (12%) subjects met CDH criteria, with chronic migraine (n = 10, 83%) as the most common subtype. Two (2%) subjects overused medications. From 2000 to 2008, the frequencies of migraine diagnoses were fairly consistent in this cohort. Presence of migraine at baseline predicted poorer outcome of all 3 measures. Additionally, CDH onset Conclusions: This long-term follow-up study revealed a marked decline in the frequency of chronic daily headache (CDH). However, one fourth of patients still had significant headache disability. Migraine history was a major factor in evolution of CDH into young adulthood. Early onset and longer duration of CDH implied a protracted disease course.

Headache and cognitive profile in children: a cross-sectional controlled study

We investigated whether children affected by tension-type headache and migraine without aura, compared with a healthy control group that was matched by age, culturally and socioeconomically display a diverse intellectual functioning and have a separate “cognitive profile”. A cross-sectional study was conducted from January 2006 to November 2008 at “Sapienza University” in Rome. A total of 134 children were diagnosed as being affected by either migraine without aura (93) or tension-type headache (41). On the basis of our exclusion/inclusion criteria, we enrolled 82 of these 134 children, 63 of whom were affected by migraine without aura and 19 by tension-type headache. On entry, cognitive functions were assessed in both the affected subjects and the control group by the Wechsler Intelligence Scale for Children-revised. Significant differences were found between the headache and control groups in the mean total intelligence quotient and verbal intelligence quotient scores (p < 0.001). Significant negative correlations were found between the total intelligence quotient, verbal intelligence quotient, performance intelligence quotient and the frequency of attacks (r = −0.55 and p < 0.001, r = −0.61 and p < 0.001, r = −0.29 and p < 0.01, respectively), as well as between the total intelligence quotient score and the age at headache onset (r = 0.234, p < 0.05). Our results suggest that the cognitive profile of children affected by headache should be assessed at the first child neurology outpatient observation. From a therapeutic point of view, although within a normal range, the abilities most likely to be less brilliant in such children are verbal skills.

Chronic daily headache in adolescents

To assess the long-term outcome of a community-based adolescent cohort with chronic daily headache (CDH). A field sample of 122 adolescents aged 12-14 years with CDH was established in 2000 (baseline) with short-term follow-up studies in 2001 and 2002. In 2008, the cohort was re-interviewed by physicians via telephone to determine the headache profile for the past year, including Migraine Disability Assessment (MIDAS), a headache disability questionnaire. Presence of CDH was defined as >or=15 headache days/month, average >or=4 hours/day for >3 months. Outcome measures included headache frequency, MIDAS score, and presence of CDH in 2008. A total of 103 subjects (26 male/77 female, mean age 21.6 +/- 0.9 years) completed the study (response rate 84.4%). The average monthly headache frequency was 4.7 +/- 6.0 (0-30) days. Twenty-eight (27.2%) subjects had moderate or severe headache disability (MIDAS >or=11). Twelve (12%) subjects met CDH criteria, with chronic migraine (n = 10, 83%) as the most common subtype. Two (2%) subjects overused medications. From 2000 to 2008, the frequencies of migraine diagnoses were fairly consistent in this cohort. Presence of migraine at baseline predicted poorer outcome of all 3 measures. Additionally, CDH onset <13 years old, duration >or=2 years, and medication overuse predicted either higher headache frequencies or presence of CDH in 2008. This long-term follow-up study revealed a marked decline in the frequency of chronic daily headache (CDH). However, one fourth of patients still had significant headache disability. Migraine history was a major factor in evolution of CDH into young adulthood. Early onset and longer duration of CDH implied a protracted disease course.