Headache Outpatient Clinic Research Articles

Prevalence of Epilepsy in an Outpatient Headache Clinic

Prevalence of Epilepsy in an Outpatient Headache Clinic

Diagnosis of Headache in Childhood and Adolescence: A Study in 437 Patients

We investigated whether the criteria for idiopathic headache published by the International Headache Society (IHS) are useful in childhood and adolescence and compared the diagnoses according to this classification with those of Vahlquist. We used a semi-structured questionnaire to examine a total of 437 children and adolescents referred consecutively to a headache outpatient clinic. Twenty-eight of 437 patients were excluded because of symptomatic or unclassifiable headache. Of 409 patients with idiopathic headache, 70.4% had definite migraine or tension-type headache (IHS 1.1, 1.2, 2.1, 2.2), 20.5% had a migrainous disorder (IHS 1.7) and 9.1% had headache of the tension-type not fulfilling the criteria (IHS 2.3). In the differential diagnosis of migraine and tension-type headache the intensity of pain, aggravation of headache by physical activity, nausea and vomiting were the most important features. The quality of pain, photo- and phonophobia were less helpful and location least important. The duration of migraine attacks was less than 2 h in 19.0% of the migraine patients. In general, the diagnostic criteria of migraine were highly specific but less sensitive, and those of tension-type headache highly sensitive but less specific. The agreement between IHS criteria and those of Vahlquist was marked (kappa = 0.57). We conclude that the IHS criteria are useful for classifying headache in children and adolescents referred to a headache outpatient clinic. A forthcoming modification of the IHS criteria should consider a reduction of the minimum duration of migraine attacks from 2 h to 1 h and should try to increase the sensitivity of the criteria for migraine and the specificity of the criteria for tension-type headache.

Clinical experience with patient administered subcutaneous dihydroergotamine mesylate in refractory headaches.

This study examines the practicality and efficacy of dihydroergotamine mesylate (DHE) when self-administered subcutaneously in a population of refractory headache patients. Forty-three patients with chronic daily headache or migraine headache without aura, who had been taught self-injection of DHE either through the Raskin Protocol or in an outpatient headache clinic, were contacted by telephone and administered a questionnaire regarding usage and results from DHE injection. Ninety-two percent of patients could successfully administer DHE. Forty-six percent of patients experienced 90% or greater relief of pain and the majority of patients (77%) had greater than 50% relief. Emergency room use was decreased in 83% and 80% preferred DHE to their previous therapy. While side effects were common (79%), only four patients (9%) stopped DHE for this reason. No convincing evidence for the development of rebound headaches due to DHE was found in this sample.

Dihydroergotamine Suppositories in a Headache Clinic

Dihydroergotamine (DHE) is available in the United States for parenteral use. We report a preliminary trial of DHE suppositories in an outpatient headache clinic setting. Dihydroergotamine suppositories may be appropriate for patients with catamenial migraine and classic migraine in particular.

Differential Emotional Precipitation of Migraine and Tension-Type Headache Attacks

The frequency of precipitation of headache attacks by individual emotional states as well as the awareness of vulnerability to particular emotional precipitants were investigated in 90 consecutive patients with tension-type headache and 50 consecutive migraine subjects at an Outpatient Headache Clinic. There was differential emotional precipitation in tension-type headache and migraine, with patients with tension-type headache reacting more selectively to negative emotional arousal (anger, anxiety) and reporting a graded frequency of attack precipitation by individual emotional states. Migraine subjects reported a more uniform distribution of attacks among different emotional precipitants. The two groups also showed a differential awareness of vulnerability to individual emotional precipitants. A cognitive process screening the emotional precipitants of tension-type headache and migraine attacks is proposed, based on different cognitive schemata functioning either over-effectively or defectively. The significance of cognitive mediation of the precipitation of attacks is further emphasized for a comprehensive management of both tension-type headache and migraine.

BRIEF REPORT: HEADACHE AND DEPRESSION

SYNOPSISHeadache is the formost somatic symptom among depressed patients. Patients from an outpatient headache clinic, and from a field study were examined to determine the incidence of depression among headache sufferers. A preponderance of depressive criteria in the headache population was found. Depression was more common in non‐paroxysmal headache sufferers than in migraine patients. Subjects with headache and depression required twice as many leave days per year as those suffering from headache alone. Vertebral‐basilar insufficiency is a frequent cause of “depressive headache”. Anti‐depressant drugs should be used along with headache medication when depression is found. The relationship of depression and headache in the same patient is also discussed.