International Headache Society Classification Research Articles

Personality traits in headache patients with and without dyspepsia

Background & Objectives: Personality trait plays an important role in determining the various presentations of tension-type headache (TTH) and migraine. The primary objective of this study was to evaluate the types of personality traits present among patients with migraine and TTH. The secondary objective was to determine whether the patients with headache and coexisting dyspepsia had different personality traits from the patients with headache alone without dyspepsia. Methods: This was a cross-sectional study conducted in the University Malaya Medical Centre from February 2017 until March 2020. Patients who fulfilled the diagnostic criteria for migraine and TTH according to the International Headache Society (IHS) classification were recruited. The patients’ personality traits were evaluated using the Minnesota Multiphasic Personality Inventory-2-restructured Form (MMPI- 2-RF). The MMPI Personality Psychopathology-Five (PSY-5) Scales, comprising aggressiveness, psychoticism, disconstraint, neuroticism, and introversion were used. The presence of dyspepsia was diagnosed using the Leeds Dyspepsia Questionnaire. Results: There were no statistically significant differences when comparing types of personality traits between migraine and TTH patients. On univariate analysis, headache with dyspepsia was significantly associated with more neuroticism as compared to headache alone (p=0.027). On logistic regression, TTH with dyspepsia was significantly associated with neuroticism (p=0.024, OR=6.921). Psychoticism was significantly associated with chronic daily headache (p=0.001, OR=7.476). Aggression was significantly associated with male gender (p=0.018, OR= 7.580). Conclusion: Headache with coexistent dyspepsia was associated with more neuroticism as compared to headache alone. In particular, TTH with coexistent dyspepsia was significantly associated with neuroticism compared to TTH without dyspepsia.

Only cervical vertebrae C0-C2, not C3 are relevant for subgrouping migraine patients according to manual palpation and pain provocation: secondary analysis of a cohort study

BackgroundSubgrouping of migraine patients according to the pain response to manual palpation of the upper cervical spine has been recently described. Based on the neuroanatomy and the convergence of spinal and trigeminal nerves in the trigeminocervical complex, the cervical segments C1 to C3 are potentially relevant. To date it has not been investigated whether palpation results of all upper cervical segments are based on one underlying construct which allows combining the results of several tests. Therefore, the aim of this secondary analysis of a cohort study was to determine whether results from all three segments form one construct.MethodsSeventy-one migraine patients with chronic or frequent episodic migraine diagnosed according to the international headache society classification version 3 were examined by one physiotherapist. Manual palpation using a posterior to anterior pressure was performed on the upper three cervical vertebrae unilaterally left and right. The results of the palpation according to the patients’ responses were combined using factor analysis. In addition, item response theory (IRT) was used to investigate the structure of the response pattern as well as item difficulty and discrimination.FindingsFactor analysis (principal component) showed that the palpation of C3 loads less onto the underlying construct than the palpation of C1 and C2. Considering a cut-off value > 1.0, the eigenvalues of all three segments do not represent one underlying construct. When excluding the results from C3, remaining items form one construct. The internal consistency of the pain response to palpation of C1 and C2 is acceptable with a Cronbach’s alpha of 0.69. IRT analysis showed that the rating scale model fits best to the pain response pattern. The discrimination value (1.24) was equal for all items. Item difficulty showed a clear hierarchical structure between the palpation of C1 and C2, indicating that people with a higher impairment are more likely to respond with referred pain during palpation of C2.ConclusionStatistical analysis confirms that results from the palpation of the cervical segments C1 and C2 in migraine patients can be combined. IRT analysis confirmed the ordinal pattern of the pain response and showed the higher probability of a pain response during palpation of C2. The pain response to C3 palpation is not relevant for unidimensional IRT analysis.Trial RegistrationGerman registry of clinical trials (DRKS00015995), Registered 20. December 2018, https://www.drks.de/drks_web/setLocale_EN.do

Clínica y fisiopatología de la cefalea en racimos. Acercamiento a la indicación de neuroestimulación combinada occipital y supraorbitaria

Cluster headache (CH) is included under section 3 - Trigeminal autonomic cephalalgias (TAC) of the International Headache Society (IHS) classification. It is one of the most frequent, painful and disabling primary headaches. Acute and preventive pharmacological treatments are often poorly tolerated and of limited effectiveness. Due to improved understanding of the pathophysiology of CH, neuromodulation devices are now considered safe and effective options for preventive and acute treatment of CH. In this paper, we review the information available to date, and present the case of a patient with disabling cluster headache highly resistant to medical treatment who underwent implantation of a peripheral nerve neurostimulation system to stimulate the supraorbital nerves (SON) and greater occipital nerve (GON) in our Pain Unit. We also review the diagnostic criteria for CH, the state of the knowledge on the pathophysiology of CH, and the role played by neuromodulation in treating this condition

Migraine Is More Prevalent in Advanced-Stage Endometriosis, Especially When Co-Occuring with Adenomoysis.

BackgroundEmerging data suggest a significant association between migraine and endometriosis, however the relationship between migraine and endometriosis severity or adenomyosis is unclear. Our objectives were to explore the relationship between migraine and endometriosis, according to the endometriosis severity and co-exist with adenomyosis or not.MethodsThis case-control study of 167 endometriosis patients verified by surgery and 190 patients for other benign gynecological conditions (control subjects) was performed from September 2017 and January 2021. There is 49 adenomyosis detected by transvaginal ultrasound or histologic diagnosis among the endometriosis patients. Besides, we also included 41 adenomyosis but without endometriosis patients as a subgroup. All women completed a self-administered headache questionnaire and diagnosed as migraine according to the International Headache Society classification. The severity and stage of endometriosis was evaluated with revised American Society of Reproductive Medicine (rASRM) score. We used logistic regression to estimate the association between the presence of migraine and endometriosis severity while accounting for important confounders, including age, body mass index (BMI) and family history of migraine. We also estimate the risk of adenomyosis alone and adenomyosis with co-occurring endometriosis in migrainous women.ResultsMigraine was significantly more prevalent in endometriosis patients compared with controls (29.9% vs. 12.1%, p<0.05), but the prevalence was similar between isolated adenomyosis patients and controls (9.8% vs.12.1%, p>0.05). For all endometriosis and control participants, migraineurs were 4.6-times (OR=4.6; 95% CI 2.7-8.1) more likely to have severe endometriosis. However, the strength of the association decreased when the analysis examined in moderate stage (OR=3.6, 95% CI 2.1-6.2). The risk of mild and minimal endometriosis was not significant (OR=1.9, 95%CI 0.9-4.0; OR=1.6, 95% CI 0.8-3.4; respectively). When we divided the endometriosis patients according to whether co-occurring with adenomyosis. We found in migrainous women, the risk of endometriosis co-exist with adenomyosis increased, with nearly fivefold greater odds compared with control (OR=5.4;95% CI 3.0-9.5), and nearly two times higher than the risk of endometriosis without co-exist adenomyosis patients (OR=2.2; 95% CI 1.2-3.8).ConclusionOur study supports the strong association between migraine and endometriosis. We found migrainous women suffer more frequently from sever endometriosis, especially endometriosis with co-occurring adenomyosis. It is advisable to heighten suspicion for patients who presenting with either these conditions in order to optimize therapy.

An unusual Cause of Persistent Frontal Headache in a 9-Year-Old Boy

Headache is a common clinical experience of the patients and is found in all age groups. Intranasal mucosal contact with the absence of inflammation in the nasal cavity and paranasal sinuses may cause a secondary headache which is called a rhinogenic contact point headache (RCPH). RCPH is currently a topic of interest among clinicians and is accepted as a cause of headaches by the International Headache Society Classification. The diagnostic nasal endoscopy showed an S-shaped deviated nasal septum with intranasal mucosal contact in both nostrils. The headache of the child was disappeared after performing septoplasty and excision of the bilateral mucosal contact points. These anatomical variations in the nasal cavity in the pediatric age with bifrontal headache is a very rare clinical entity. Hence, clinicians and pediatricians should keep in mind RCPH during the evaluation of headaches in a pediatric patient. In this case report, a 9-year-old boy presented with a persistent bifrontal headache due to mucosal contact points in the nasal cavity.

Rhinogenic contact point headache in pediatric age group: a review

Headache is a common clinical entity of pediatric patients in routine clinical practice. Anatomical variation in the nasal cavity may result in headaches due to contact of the opposing mucosal surfaces, called rhinogenic contact point headache (RCPH). RCPH has recently begun to be of interest among clinicians and is accepted as a cause of headache by international headache society classification. The pressure of the two opposing mucosal surfaces in the nasal cavity without any evidence of inflammation can be an etiology for headache or facial pain. Anatomical variations in the nasal cavity like deviated nasal septum (DNS), spur, concha bullosa, hypertrophied inferior turbinate, medialized middle turbinate, and septal bullosa are important causes for contact point headache. RCPH is often misdiagnosed by clinicians during the assessment of headaches in pediatric patients and is sometimes considered a headache of unknown etiology. Endoscopic examination of the nasal cavity and computed tomography (CT) scans are important tools for the diagnosis of anatomical variations in the nasal cavity causing RCPH. Endoscopic resection of the contact point in the nasal cavity is the treatment of choice. There is not much literature for RCPH in pediatric patients, indicating that these clinical entities are neglected. This review article discusses the details of the epidemiology, etiopathology, clinical manifestations, diagnosis, treatment of the RCPH in pediatric patients.

One-Year Remission Rate of Chronic Headache Comparing Video and Face-to-Face Consultations by Neurologist: Randomized Controlled Trial.

BackgroundChronic headache causing severe headache-related disability for those affected by the disease is under- or misdiagnosed in many cases and therefore requires easy access to a specialist for optimal health care management.ObjectiveThe goal of the research is to determine whether video consultations are noninferior to face-to-face consultations in treating chronic headache patients referred to a specialist in Northern Norway.MethodsPatients included in the study were recruited from general practice referrals to a specialist at a neurological department in Northern Norway (Tromsø) and diagnosed according to the International Headache Society classification system. In a randomized controlled design, the 1-year remission rate of chronic headache (change from ≥15 to <15 headache days per month during the last 3 months), patient satisfaction with a specialist consultation, and need for follow-up consultations by general practitioners were compared between groups consulted by video and face-to-face in a post hoc analysis. Data were collected by interview (baseline) and questionnaire (follow-up).ResultsFrom a baseline cohort of 402 headache patients consecutively referred from general practice to a specialist over 2.5 years, 58.0% (233/402) were classified as chronic headache and included in this study. Response rates were 71.7% (86/120) in the video group and 67.3% (76/113) in the face-to-face group. One-year remission from chronic headache was achieved in 43.0% (37/86) in the video group and 39.5% (30/76) in the face-to-face group (P=.38). Patient satisfaction with consultations were 86.5% (32/37; video) and 93.3% (28/30; face-to-face; P=.25). A total of 30% (11/37) in the video group and 53% (16/30) in the face-to-face group consulted general practitioners during the follow-up period (P=.03), and median number of consultations was 1 (IQR 0-13) and 1.5 (IQR 0-15), respectively (P=.19).ConclusionsOne-year remission rate from chronic headache was about 40% regardless of consultation form. Likewise, patient satisfaction with consultation and need for follow-up visits in general practice post consultation was similar. Treating chronic headache patients by using video consultations is not inferior to face-to-face consultations and may be used in clinical neurological practice.Trial RegistrationClinicalTrials.gov NCT02270177; https://clinicaltrials.gov/ct2/show/NCT02270177

Long-COVID Headache

The so-called long COVID-19 is a set of symptoms that accompanies the patient even for months after discharge from the hospital. These symptoms include easy muscle fatigue, moderate breathlessness, persistent headache, the feeling of a foggy head, and the development of psychiatric disorders. In general, the quality of life of at least half of the patients who come out of the COVID-19 syndrome, both mild and severe, shows a markedly worsening despite having passed a difficult physical and psychological test. Among all the neurological disorders that can most frequently be found in the long COVID-19, it is important to consider the persistent headache symptomatology as a possible chronic sequela of the infection. Since there is not a definition in the International Headache Society classification of this type of headache, we must focus our attention on this long-COVID-19 headache especially because clinical studies are being planned to collect big data for the International Headache Society Classification Committee.

Can Headache Profile Predict Future Disability: A Cohort Study.

The aim of this study was to determine if headache profile can predict future disability in patients with tension-type headache (TTH). Eighty-three individuals with TTH were recruited. To be included in the study participants needed to fulfill the International Headache Society classification's criteria for episodic or chronic TTH form and to be at least 18 years old. Baseline clinical outcomes (headache and neck-related disability, kinesiophobia, self-efficacy, and anxiety) and physical outcomes (neck extensors muscles maximum voluntary contraction) were collected for all participants. A prospective data collection of headache characteristics (intensity and frequency) was conducted using daily SMS or e-mail over a 1-month period. Headache-related disability was assessed at the 3-month follow-up and was used as the disability criterion for TTH. Correlations showed that the number of years with headache (r=0.53, P<0.001), self-reported neck pain intensity (r=0.29, P=0.025), headache frequency (r=0.60, P<0.001) and intensity (r=0.54, P<0.001), anxiety (r=0.28; P=0.031), as well as neck-related disability (r=0.64, P<0.001) were correlated to headache-related disability assessed at 3 months. Multiple regression showed that these determinants can be used to predict headache disability (R =0.583). Headache frequency (β=0.284) was the best individual predictor. Results showed that TTH frequency and intensity and the presence of concomitant infrequent migraine are predictors of future disability over a 3-month period. Further studies are needed to evaluate the contribution of other potential physical outcomes on headache-related disability.

Psychiatric co morbidities in Patients with Tension Type Headache

Background: Contemporary literature focuses on Tension type headache as highly prevalent and debilitating which can lead to various psychiatric co morbidities. Aim: 1)To assess the prevalence of tension type headache(both chronic and episodic). 2)To assess the psychiatric comorbidites. 3)Association between types of headache and severity of depression, severity of anxiety and severity of somatic complaints. Materials and Method: Two hundred eighteen patients were assessed and classified according to international headache society classification (IHS). Depression, anxiety and physical somatic complaints were assessed by using Hamilton rating scales for depression anxiety and Patient Health Questionnaire Physical Symptoms (PHQ-15). The data was analyzed using the statistical software SPSS version 20. Result: Our study showed mean age of participants with headache to be 33 years, 76% are females and 3/4th of the samples are married hailing from lower socioeconomic status. Around half of the participants are housewives and 21% are employed and 12% are students. Mild levels of anxiety and physical somatic symptoms were exhibited by patients with both episodic and chronic tension type headache. Conclusion: In this study we found that anxiety and physical somatic symptoms are co-morbid with tension type headache as compared to depression and slightly higher prevalence in female participants who suffered from episodic headaches and male participants were diagnosed with chronic tension type headache. How to cite this article:Bansal P, Jiloha RC. Psychiatric Comorbidities in Patients with Tension Type Headache. J Adv Res Psychol Psychother 2020; 3(1): 19-23. DOI: https://doi.org/10.24321/2581.5822.202004

About the understanding of classifications using SUNCT and SUNA as an example

In this issue of Neurology ®, Lambru et al.1 suggest changing the International Headache Society (IHS) classification (International Classification of Headache Disorders [ICHD]) for 2 rare headache syndromes and collapsing them into 1 entity. This seems to be a rather subtle change and may pose the question of whether this might be better suited for subspecialist discussion. Nevertheless, this question strikes at the definition of classifications and thus at the heart of philosophical science and is therefore rather likely to be discussed a lot. So what is it all about?

Comparing neck extensor muscle function in asymptomatic Canadian adults and adults with tension-type headache: a cross-sectional study

AimTo further the understanding of the pathophysiological mechanisms underlying tension-type headache (TTH) by comparing the endurance and strength of neck extensor muscles under acute muscle fatigue in participants with TTH...

P007: Safety and effectiveness of a care protocol to treat migraine with Propofol in the emergency department

Introduction: An evidence-based care protocol to treat migraine with low-dose Propofol was implemented in May 2014 at the emergency department (ED) of the CHUL (Québec city). Given potential side effects of Propofol, we aimed to evaluate the safety and effectiveness of this protocol. Methods: We reviewed charts of all patients aged 16 years and older who received Propofol between May 2014 and August 2017 for a migraine headache with or without aura, as defined in the International Headache Society Classification. The care protocol consisted of: 1) administration of intra-venous Propofol 20 mg each 5 to 10 minutes as needed (maximum of 6 doses); 2) sets of vital signs before and after each dose; and 3) continuous cardiac and saturation monitoring. Our primary outcome measures were the incidence (95%CI) of the following side effects: low arterial pressure (&lt; 90 systolic or &lt; 65 mean), desaturation (SaO2&lt;92%), excessive sedation (scores 3 or 4 on the Pasero scale), and any arrhythmia. We also compared the mean reduction (95%CI) of pain pre- and post-treatment (visual analogous scale VAS 0-10) and the proportion (95%CI) of rescue medication among patients who received Propofol as first-line medication to a matched cohort of patients who had Metoclopramide first. The two cohorts were paired for gender, age, triage priority, and month/year of ED visit. Results: Over the 3-year study period, 45 patients with migraine received Propofol through the care protocol, either as a first-line or a rescue therapy. In this cohort, hypotension, bradycardia (&lt;60/min) and desaturation occurred in 17.8% (8.0-32.1), 13.3% (5.1-26.8) and 6.7% (1.4-18.3) of cases respectively; no excessive sedation was reported. An intervention was undertaken in 4 cases [8.9% (2.5-21.2) 3 iv fluid bolus, 1 supplemental oxygen] to palliate the side effects of Propofol. A statistically significant mean reduction of 3.6 points (2.8-4.4) on the VAS scale was observed in patients treated with Propofol as first-line therapy (n=35). However, patients managed with first-line Metoclopramide (n=100) experienced a significantly higher mean reduction of their VAS score [5.3 (4.6-6.0)] than the Propofol group (p=0.003). The proportion of patients requiring the use of rescue medication was higher among patients first treated with Propofol [77.1% (63.2-91.1) vs. 29.0% (20.1-37.9); p&lt;0.001]. Conclusion: Our care protocol to treat migraine with low doses of Propofol appears to be safe and to cause very few side effects prompting corrective interventions. Continuous (as opposed to intermittent) heart and saturation monitoring is probably not indicated. Given the effectiveness of Propofol compared to Metoclopramide, our care protocol will be used as a second-line therapy.

Migraine and cognitive function: Baseline findings from the Brazilian Longitudinal Study of Adult Health: ELSA-Brasil.

Background The association between migraine and cognitive performance is unclear. We analyzed whether migraine is associated with cognitive performance among participants of the Brazilian Longitudinal Study of Adult Health, ELSA-Brasil. Methods Cross-sectional analysis, including participants with complete information about migraine and aura at baseline. Headache status (no headaches, non-migraine headaches, migraine without aura and migraine with aura), based on the International Headache Society classification, was used as the dependent variable in the multilinear regression models, using the category "no headache" as reference. Cognitive performance was measured with the Consortium to Establish a Registry for Alzheimer's Disease word list memory test (CERAD-WLMT), the semantic fluency test (SFT), and the Trail Making Test version B (TMTB). Z-scores for each cognitive test and a composite global score were created and analyzed as dependent variables. Multivariate models were adjusted for age, gender, education, race, coronary heart disease, heart failure, hypertension, diabetes, dyslipidemia, body mass index, smoking, alcohol use, physical activity, depression, and anxiety. In women, the models were further adjusted for hormone replacement therapy. Results We analyzed 4208 participants. Of these, 19% presented migraine without aura and 10.3% presented migraine with aura. All migraine headaches were associated with poor cognitive performance (linear coefficient β; 95% CI) at TMTB -0.083 (-0.160; -0.008) and poorer global z-score -0.077 (-0.152; -0.002). Also, migraine without aura was associated with poor cognitive performance at TMTB -0.084 (-0.160, -0.008 and global z-score -0.077 (-0.152; -0.002). Conclusion In participants of the ELSA-study, all migraine headaches and migraine without aura were significantly and independently associated with poorer cognitive performance.

Vestibular migraine- a dilemma no more

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Vestibular migraine (VM) is an increasingly recognized cause of episodic vertigo. However, the pathophysiology of VM is still a matter of speculation and it is not known to what extent the dysfunction is located in the central or peripheral vestibular system. Though in its earlier version International Headache Society recognized only adult onset VM in the setting of basilar migraine, but in its latest 3rd edition beta version in consensus with Barany Society (2013), VM is included in the International Headache Society classification of migraine in appendix 1. It does not figure in the main list because it is yet to be validated by scientific research. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;The purpose of this study is to record and describe the spectrum of clinical findings of VM patients, to study the vestibular system and find out the site of vestibular dysfunction. In this study we studied 20 patients with acute VM in the symptomatic and asymptomatic phase. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Abnormal findings in the vestibular work up were present in all 20 VM patients (100%). Central pathology in the vestibular system was seen in 10 patients (50%), 6 patients had peripheral vestibular pathology (30%), and in 4 patients (20%) the site of vestibular dysfunction was indeterminate as they had features of both central and peripheral dysfunction and the exact site of dysfunction could not be determined with certainty. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Acute VM should be considered in the differential diagnosis of vertigo. It can present both as a central and a peripheral vestibular disorder. However there are no definitive signs to pin-point the diagnosis. A careful clinical history combined with clinical findings and exclusion of other causes of vertigo, is fundamental for assessing the profile of patients with vestibular migraine.&lt;/span&gt;&lt;/p&gt;

Abstract P017: Migraine and Cognitive Function: baseline Findings From the Brazilian Longitudinal Study of Adult Health: ELSA-Brasil

Background: Migraine and dementia are associated with higher vascular risk and both conditions have been linked with structural brain lesions. However, evidence on the possible association between migraine and cognitive performance is unclear. We aimed to analyze whether migraine is associated with cognitive performance within participants of the Brazilian Longitudinal Study of Adult Health, ELSA-Brasil. Methods: Inthis a cross-sectional analysis, we evaluated all participants without previous stroke, who were not taking medications that could impair cognitive performance and with complete data on cognitive tests or migraine at baseline assessment. Migraine based on International Headache Society classification was used as dependent variable in binary logistic models. The Consortium to Establish a Registry for Alzheimer’s disease scores for word list memory test (CERAD-WLMT), the semantic fluency test (SFT), and the Trail Making Test version B (TMTB) were categorized into poor cognitive performance as defined by a score below mean minus one standard deviation for a participant’s sex, age and educational-level group for memory and fluency tests and as a score above mean plus one standard deviation for the time to perform the Trail Making Test Version B.. Multivariate analyses were adjusted for marital status, alcohol consumption, smoking, physical activity, body-mass index, hypertension, diabetes mellitus and depression. In women we further adjusted for hormone replacement therapy. Results: We analyzed 4993 men(51.6 ±9.2 y) and 5028 women (51.9±8.9y ). Among those, there were 131 men( 2.6 %) and 926 women migraneurs (18.4%). The proportion of participants in the poor cognitive category did not differ significantly between migraneurs and non-migraneurs for men or women in any of the cognitive tests (p&gt;0.072 for all). Fully adjusted OR (95%) for poor performance in men on immediate recall, late recall, recognition, verbal fluency, and TMTB were 1.02(0.60;1.72),1.15(0.69;1.91), 0.86(0.51;1.43), 1.08(0.51;1.43) and 1.75(0.64;1.82) respectively and in women 1.06(0.69; 1.62); 0.89 (0.61;1.29);1.25(0.81;1.95) and 1.72(1.07;2.77) respectively. Conclusion: Migraine was associated with poorer executive function in middle-aged women after multivariate adjustment including HRT. No association was found for middle-aged men, but this may be a consequence of the lower number of men with migraine compared to women.

Headache in Behcet's disease: types and characteristics.

BackgroundBehcet’s disease involves several systems in the body. Neurological involvement is identified by different symptoms. Headache is one of the common complaints of patients with Behcet’s disease. It might be a part of neurological involvement or may arise independently in the course of disease. Studies with small sample size have resulted in various findings in this field. Since the prevalence of Behcet’s disease is relatively high in Iran, this study was carried out to compare the features of headache between an acceptable number of patients with this rare disease and a control group.MethodsThe current case–control study was performed to compare the features of headache between 312 patients with definite Behcet’s disease who referred to a Behcet’s clinic and healthy individuals. Patients with Behcet’s disease were randomly selected. Controls were matched for age and sex. They were personally examined and interviewed meticulously using a questionnaire that met the standards of the International Headache Society classification for different types of headache.ResultsThe incidence of headache in the case and control groups was 28.3 % (n = 120) and 18.6 % (n = 59), respectively (p < 0.05; OR 2.73). Tension-type headache was observed in 12.2 % (n = 38) of cases which was significantly higher than control group (n = 6.3 %) (p = 0.011; OR 2.05). The most frequent type of headache in the case group was tension-type headache (12.2 %). In the control group, however, migraine without aura was the most common type (9.1 %). A correlation between ophthalmological involvement and headache was observed in 11 patients in the case group. In addition, a significantly higher systolic blood pressure was found in the case group compared to the controls (125.1 vs. 121.7 mmHg; p = 0.007). There was no major correlation between prednisolone consumption in patients with Behcet’s disease and the type and frequency of headache.ConclusionsHeadache, especially tension-type headache, is more common in patients with Behcet’s disease. This might be the result of specific types of uveitis-related and non-structural headaches seen in Behcet’s disease.

Chronic migraine: risk factors, mechanisms and treatment.

Chronic migraine has a great detrimental influence on a patient's life, with a severe impact on socioeconomic functioning and quality of life. Chronic migraine affects 1-2% of the general population, and about 8% of patients with migraine; it usually develops from episodic migraine at an annual conversion rate of about 3%. The chronification is reversible: about 26% of patients with chronic migraine go into remission within 2 years of chronification. The most important modifiable risk factors for chronic migraine include overuse of acute migraine medication, ineffective acute treatment, obesity, depression and stressful life events. Moreover, age, female sex and low educational status increase the risk of chronic migraine. The pathophysiology of migraine chronification can be understood as a threshold problem: certain predisposing factors, combined with frequent headache pain, lower the threshold of migraine attacks, thereby increasing the risk of chronic migraine. Treatment options include oral medications, nerve blockade with local anaesthetics or corticoids, and neuromodulation. Well-defined diagnostic criteria are crucial for the identification of chronic migraine. The International Headache Society classification of chronic migraine was recently updated, and now allows co-diagnosis of chronic migraine and medication overuse headache. This Review provides an up-to-date overview of the classification of chronic migraine, basic mechanisms and risk factors of migraine chronification, and the currently established treatment options.

Subcutaneous trigeminal nerve field stimulation for refractory trigeminal pain: a cohort analysis.

Neurosurgical pain management of drug-resistant trigeminal neuralgia (TN) is highly challenging. Microvascular decompression is a first-line neurosurgical approach for classical TN with neurovascular conflict, but can show clinical relapse despite proper decompression. Second-line destructive techniques like radiofrequency thermocoagulation have become reluctantly used due to their potential for irreversible side effects. Subcutaneous peripheral nerve field stimulation (sPNFS) is a minimally invasive neuromodulatory technique which has been shown to be effective for chronic localised pain conditions. Reports on sPNFS for the treatment of trigeminal pain (sTNFS) are still sparse and primarily focused on pain intensity as outcome measure. Detailed data on the impact of sTNFS on attack frequency are currently not available. Patients were classified according to the International Headache Society classification (ICHD-3-beta). Three patients had classical TN without (n = 3) and another three TN with concomitant persistent facial pain (n = 3). Two patients suffered from post-herpetic trigeminal neuropathy (n = 2). All eight patients underwent a trial stimulation of at least 7days with subcutaneous leads in the affected trigeminal area connected to an external neurostimulator. Of those, six patients received permanent implantation of a neurostimulator. During the follow-up (6-29 months, mean 15.2), VAS-scores, attack frequencies, oral drug intake, complications and side effects were documented. Seven out of eight patients responded to sTNFS (i.e. ≥50% pain reduction) during the test trial. The pain intensity (according to VAS) was reduced by 83 ± 16% (mean ± SD) and the number of attacks decreased by 73 ± 26% (mean ± SD). Five out of six patients were able to reduce or stop pain medication. One patient developed device infection. Two patients developed stimulation-related side effects which could be resolved by reprogramming. Treatment by sTNFS is a beneficial option for patients with refractory trigeminal pain. Prospective randomised trials are required to systematically evaluate efficacy rates and safety of this low-invasive neurosurgical technique.

Increased prevalence of depression and anxiety in patients with migraine and interictal photophobia.

BackgroundMost patients with migraine report photophobia associated with headache; a subset report interictal photophobia. These patients are light sensitive even during headache-free periods. The objective of this case–control study was to assess the prevalence of symptoms of anxiety and depression in migraine patients with and without interictal photophobia.MethodsWe recruited 16 subjects with migraine and interictal photophobia, 16 age- and gender-matched migraine subjects without interictal photophobia, and 16 age- and gender- matched controls. Migraine subjects met International Headache Society classification criteria. Participants completed a photophobia questionnaire, Beck Depression Inventory (BDI-II), and Beck Anxiety Inventory (BAI). Chi-square analyses and two-tailed Wilcoxon rank sum tests were used for the analyses.ResultsSubjects with interictal photophobia had significantly higher scores on the photophobia questionnaire compared to subjects without interictal photophobia. Subjects with interictal photophobia had significantly higher scores on the BDI-II and BAI compared to subjects without interictal photophobia.ConclusionsMigraine patients with interictal photophobia are more likely to manifest symptoms of depression and anxiety compared to migraine patients without interictal photophobia. Care providers should be aware of increased prevalence of these symptoms in this population and consider appropriate referrals. Future research could assess whether treatment of photophobia leads to improvements in symptoms of depression and anxiety in migraine patients.