IHS Criteria For Migraine Research Articles

Do you really have sinus headache?

<p class="abstract"><strong>Background:</strong> Headache is a common symptom. Correct diagnosis of the etiology is the key to successful treatment. Chronic headache are misdiagnosed as sinus headache because of presence of overlapping symptoms leading to unnecessary treatment with no relief to the patient. We decided to undertake this study with the objective of evaluating patients with chronic headache for presence of chronic rhinosinusitis and hence assess the contribution of sinus headache to chronic headache.</p><p class="abstract"><strong>Methods:</strong> The present study was conducted at Adichunchanagiri Institute of Medical Sciences, BG Nagara during the period January 2018 to December 2018. Patients presenting to OPD with chronic headache previously diagnosed as sinus headache were included in the study. A total of 174 patients were studied. All patients underwent detailed history taking, detailed ENT examination, and diagnostic nasal endoscopy. AAOHNS criteria for rhinosinusitis and IHS criteria for migraine and tension type headache were used for diagnosis. </p><p class="abstract"><strong>Results:</strong> We found that only 13% (n=23) cases had chronic rhinosinusitis and hence diagnosed as sinus headache. 53% (n=92) had migraine, 31% (n=54) had tension type headache and 3% (n=5) could not be categorized.</p><p class="abstract"><strong>Conclusions:</strong> Prevalence of sinus headache in our study was found to be 13%. There are high chances of misdiagnosing chronic headache as sinus headache because primary forms of headache can present with nasal symptoms. The AAOHNS criteria for rhinosinusitis and IHS criteria for migraine and tension type headaches are very useful and effective in making an accurate diagnosis.</p>

An open-label trial of alsuma auto-injector for migraine

Methods This was an open-label, Phase 3 trial conducted at 10 sites in the US. Male or female adults, ages 18 to 60 years old, were eligible for study entry if they met IHS criteria for migraine with or without aura, with at least 2 attacks per month, and if they reported use of subcutaneous injectable sumatriptan on at least 2 occasions within the previous 2 months. During the onset of a migraine attack of moderate-to-severe intensity, patients were asked to administer a 6 mg subcutaneous dose of sumatriptan using the Auto-Injector. Subjects returned to the study site within 72 hours of the migraine for the post-treatment assessment visit.

The relevance of migraine in patients with Ménière's disease

Conclusion. Coexistent migraine affects relevant clinical features of patients with Ménière's disease (MD). Objective. Epidemiological studies have shown an association between migraine and MD. We sought to determine whether the coexistence of migraine affects any clinical features in patients with MD. Patients and methods. In this retrospective case-control study of University Neurotology Clinic patients, 50 patients meeting 1995 AAO-HNS criteria for definite MD were compared to 18 patients meeting the same criteria in addition to the 2004 IHS criteria for migraine (MMD). All had typical low frequency sensorineural hearing loss and episodes of rotational vertigo. Outcome measures included: sex, age of onset of episodic vertigo or fluctuating hearing loss, laterality of hearing loss, aural symptoms, caloric responses, severity of hearing loss, and family history of migraine, episodic vertigo or hearing loss. Results. Age of onset of episodic vertigo or fluctuating hearing loss was significantly lower in patients with MMD (mean±1.96*SE=37.2±6.3 years) than in those with MD (mean±1.96*SE=49.3±4.4 years). Concurrent bilateral aural symptoms and hearing loss were seen in 56% of MMD and 4% of MD patients. A family history of episodic vertigo was seen in 39% of MMD and 2% of MD patients.

Patient preference for eletriptan 80 mg versus subcutaneous sumatriptan 6 mg: results of a crossover study in patients who have recently used subcutaneous sumatriptan

This current randomized, open-label, crossover study evaluated preference for oral eletriptan 80 mg compared with subcutaneous sumatriptan 6 mg (suma-sc) amongst patients (n = 311) meeting IHS criteria for migraine who had recently used suma-sc, and found it well tolerated. Three attacks were treated on each study medication. Assessment of subjective preference was evaluated, after which patients freely chose which study medication they wished to use to treat each of three additional migraine attacks. A slight majority (50.6%) preferred or greatly preferred eletriptan, whilst 43% preferred suma-sc. When permitted to choose between eletriptan and suma-sc for subsequent treatment, 78% of patients who had preferred eletriptan took eletriptan during the extension phase for all three of their attacks, whilst only 37% of patients who preferred suma-sc took suma-sc for all of their extension-phase attacks (P < 0.05). Secondary efficacy measures showed comparable efficacy for each study medication, except for faster headache response and pain-free rates favor of suma-sc, and a significantly lower recurrence rate on eletriptan (25% vs. 40%; P < 0.05). The results of this study suggest that eletriptan is a strong alternative option for patients who have been prescribed suma-sc.

Is migraine in unipolar depressed patients a bipolar spectrum trait?

Background: It is well known that affective disorders and migraine often coexist in the same patients, and some information is available indicating that migraine is particularly prevalent in bipolar II disorder. The aims of this study were to compare the clinical features in unipolar depressed patients with and without comorbid migraine to bipolar patients. Methods: Semi-structured interview of 201 patients with major affective disorders, using DSM-IV criteria for affective disorders combined with Akiskal's criteria for affective temperaments, and IHS-criteria for migraine. Results: Compared to the group of patients having unipolar depressions without comorbid migraine ( n=51) the group with unipolar depression and migraine ( n=63) had a higher number of depressive episodes (4.5 vs. 2.5, P=0.017), significantly higher prevalences of affective temperaments (46% vs. 16%, P=0.001), irritability (70% vs. 45%, P=0.008), seasonal variation (22% vs. 5%, P=0.017), agoraphobia (44% vs. 26%, P=0.036), asthma (25% vs. 6%, P=0.006) and migraine in family (59% vs. 29%, P=0.002). The clinical features of unipolar depressed patients with comorbid migraine resemble the bipolar II patients ( n=51) in this sample. Limitations: Non-blind, cross-sectional assessment. Conclusions: These results indicate that there may be important clinical differences between unipolar depressed patients with and without comorbid migraine, possibly indicating that migraine in depressed patients is a bipolar spectrum trait.

Validez de los criterios diagnósticos de migraña en la edad pediátrica

The diagnosis of migraine is based entirely on clinical data, and generally accepted and valid criteria should be applied as a common diagnostic reference.The aim of this work was to study the epidemiological and clinical characteristics of migraine in the paediatric age and to analyse the validity of the criteria used in its diagnosis.A total of 290 histories of patients with recurring headaches (150 with migraine and 140 with non-migraine headaches) were reviewed, epidemiological and clinical data were collected, and complementary examinations were performed, when necessary. The sensitivity, specificity and likelihood ratio of the Vahlsquit, Prensky and IHS criteria for migraine were all calculated.32% of cases were migraines with aura. The age of onset of migraine was 8.7 +/- 2.9 years, with no differences between sexes. Nevertheless, in migraine with aura the age of onset (9.8 +/- 3.3 years) and prevalence of females (63.3%) were significantly higher (p < 0.05). Family history was positive in 77.3% of the cases. In migraine, the pain was unilateral (44.4%) or bilateral (55.6%), throbbing (93.7%), interrupted daily activities (63.2%), got worse on doing exercise (68.1%) and was accompanied by nausea (70.1%) and sensitivity to light and sound (66.2%). The throbbing quality, vomiting, one-sidedness and moderate to severe intensity were the items that displayed the greatest discriminating capacity and the IHS criteria were those with the highest diagnostic validity. Diagnosis was not altered by the complementary examinations.Migraine is a common pathology among children in the paediatric age and generally begins in the school age. The IHS criteria allow it to be diagnosed, although monitoring its progress would be the reference test with which to validate the diagnostic criteria.

Pharmacokinetics and Pharmacodynamics of Avitriptan in Patients With Migraine After Oral Dosing

Avitriptan (BMS-180048) is a 5-HT1-like receptor agonist for the treatment of migraine. This double-blind, placebo-controlled, randomized, parallel-group study evaluated the pharmacokinetics, safety, and preliminary efficacy of avitriptan in patients with migraine during migrainous and pain-free states. Patients met the IHS criteria for migraine with or without aura and suffered one to six migraines per month for at least 1 year. Patients in a clinic experiencing a migraine headache received avitriptan 75 mg, 150 mg, or 200 mg or matching placebo capsules. Blood samples were obtained before and 0.25, 0.75, 1, 1.5, 2, 2.5, 3, 4, 5, and 6 hours after dosing. Headache intensity was rated before and up to 6 hours after dosing. Seven to 30 days after the inclinic treatment, patients returned in a pain-free state for the same study medication. All pharmacokinetic and safety measures were repeated. Forty-eight patients (9 men and 39 women) participated. Peak plasma concentrations of avitriptan were achieved 1 to 2 hours following dosing in migraine and pain-free states for all doses. The pharmacokinetics of avitriptan were proportional to dose during a migraine attack over the 75- to 200-mg dose range. The 150- and 200-mg doses of avitriptan demonstrated a greater decrease in headache intensity scores at 2 hours postdose. The most common adverse event was paresthesia. Thus, avitriptan was rapidly absorbed, well tolerated, and demonstrated preliminary efficacy in this population.

Headache intensity and quality of life in adolescents. How are changes in headache intensity in adolescents related to changes in experienced quality of life?

To investigate the relationship between changes in actual presence of headache and the experience of different subdomains of quality of life (QoL) in adolescents. Diary entered measurements of headache intensity and frequency were related to simultaneously recorded data on a QoL questionnaire for adolescents. Subjects completed both the QoL questionnaires and the headache diaries at home. Subjects were selected by screening the total population of two secondary schools (N = 1566) for headache and migraine symptoms. Sixty-four students subject to chronic headache or migraine participated in the study. All subjects were diagnosed by a neurologist, following the IHS criteria for migraine. Changes in headache intensity and frequency were related to changes in self-reported QoL within all QoL subdomains. More headache coincided with a lower self-reported QoL.

Coping Style and Social Support in Women Suffering from Cluster Headache or Migraine

Many clinical neurologists have considered cluster headache patients to differ from migraine patients as to behavioral patterns. There is, however, little empirical validation of such a differentiation. Coping profiles and social networks were studied in patients suffering from two kinds of recurrent headache. Twenty-four female patients with cluster headache, aged 23-72 years, and 24 age-matched migraine patients with and without aura participated in the study. All female cluster patients treated at the neurologic clinic of the hospital were included, and consecutive outpatients, who had been referred to the policlinics for diagnosis and treatment, whose symptoms agreed with the IHS criteria for migraine and who had ages matching the cluster headache patients, participated in the study. In the semiprojective coping tests the cluster headache patients were found to be statistically significant more 'positive' as to their anticipated activities in the future compared to the migraine patients (p < 0.04). No other statistical differences were found between the two groups. Compared to randomly selected and age-matched referents in the population. cluster headache patients reported significantly poorer social support (p < 0.01), while no other difference was found when the migraine patients were compared with controls. The findings indicate that there are differences in perception of anticipated activities and social support between patients with cluster headache and migraine.

IHS criteria and gender: a study on migraine and tension-type headache in children and adolescents.

The aim of this study was to investigate whether the IHS criteria for migraine and tension-type headache depend on gender. Among 409 children and adolescents with recurrent idiopathic headache seen at a university outpatient clinic, girls had significantly more often migraine with aura. Also, there was a trend towards a higher frequency of tension-type headache in girls. In migraine, aggravation of headache by physical activity and occurrence of aura symptoms were more common in females, whereas vomiting and phonophobia occurred more often in males. In tension-type headache, females more often reported mild intensity of headache. All other criteria were similar in both sexes. Age influenced the expression of some of the accompanying symptoms in the various types of migraine, but had only minimal influence on other diagnostic criteria of migraine and tension-type headache in females as well as in males. Our study suggests that the frequency of migraine (except that of migraine with aura) is similar among girls and boys, that tension-type headache may occur more often in girls, and that gender has some influence on the IHS criteria for migraine, but almost no influence on those of tension-type headache.

IHS Criteria for Migraine and Tension‐Type Headache in Children and Adolescents

We investigated the influence of age on the IHS criteria for migraine and tension-type headache in 437 consecutive children and adolescents and found the following age-associated statistically significant differences: migraine duration, occurrence of migraine aura, and bilateral location of tension-type headache were more often fulfilled by adolescents, whereas aggravation of headache by physical activity (in migrainous disorder) and photophobia (in migraine with aura) were more often fulfilled by children. Accordingly, there are only a few differences concerning the fulfillment of the IHS criteria for migraine and tension-type headache in children and adolescents. Independent of age, the intensity of headache and the presence or absence of nausea are most important for differentiating the two major types of idiopathic headache. The sensitivity of the IHS criteria for migraine could be increased by reducing the minimum duration of migraine and by allowing the diagnosis of migraine when severe headache is associated with nausea, even though the criteria of location, quality, and aggravation by physical activity are not fulfilled.

Effect of Age on The Fulfilment of the IHS Criteria for Migraine in Children at a Headache Clinic

In a headache clinic, 247 children suffering from severe recurrent headaches were studied in relation to the IHS criteria for migraine. Of the 247, 163 had migrainous headache, with 100 (67.5%) of these having migraine in accordance with the IHS criteria. The remaining 53 (32.5%) had headache attacks fulfilling all but one of the IHS criteria. Coverage of the IHS criteria for migraine was 93%. Symptoms of unilateral headache, aggravation by physical activity, and nausea showed the greatest differences in frequency between those with migraine and those with probable migraine. All children with aura fulfilled criteria for migraine. Children with migraine with aura (11.8, 95% CI: 11.0-12.6 years) were older than those without aura (10.1, 9.4-10.8 years; p = 0.001). Children with pulsating headache were slightly older than children without pulsating headache. No differences in age were detected with other IHS criteria.

Effect of age on the fulfilment of the IHS criteria for migraine in children at a headache clinic

Effect of age on the fulfilment of the IHS criteria for migraine in children at a headache clinic

Diagnostic screen for assessment of the IHS criteria for migraine by general practitioners

This study examines the sensitivity and specificity of a self-report screen for the diagnosis of migraine according to the IHS criteria in a sample of 1049 employees of the French National Railways. The diagnosis of migraine derived from the self-report instrument was compared to an unstructured diagnostic interview conducted by a neurologist specialized in the diagnosis and treatment of headache. The sensitivity of the diagnostic screen was poor, but the specificity was excellent. Optimal cut-off points for the questionnaire were determined by the Receiver Operator Characteristics (ROC) method. Assessment of the specific IHS criteria for migraine revealed that the following criteria failed to discriminate subjects with migraine from non-cases: "aggravation by physical activity" and "photophobia and phonophobia". Implications of the findings for modification of the IHS criteria were discussed.