Tension-type Headache Group Research Articles

Headaches and pain referred to the teeth: frequency and potential neurophysiologic mechanisms

To assess frequency of pain referred to the teeth in occipital neuralgia, migraine and tension-type headache. Material and methods:153 patients presenting with bruxing behavior and craniomandibular disorders (CMDs). Clinical examination, questionnaires, palpation, criteria for CMDs, bruxing behavior (BB), occipital neuralgia (ON), migraine (MIG), tension-type headache (TTH) and pain referred to the teeth. Results: Mean ages in the ON, MIG and TTH patients and controls were about 38.0, 37.0, 33.0 and 36.6 years, respectively (p = 0.17). The frequencies of dental pains in the subgroups ON and MIG were 37.1% and 25% (p = 0.52), ON and TTH, 37.1% and 18.6% (p = 0.03), ON and Controls 37.1% and 6.7% (p = 0.006), MIG and TTH 25% and 18.6% (p = 0.51), MIG and Controls 25% and 6.6% (p = 0.16) and TTH and controls 18.6% and 6.7% (p = 0.15). The frequencies of pain referred to the teeth decreased from the ON to the MIG, and then to the TTH and Control groups (x-square for independence p < 0.002, x-square for trends p < 0.001). Conclusion:The ON subgroup demonstrated the highest frequency of dental pain referred to the teeth. This frequency increased with the severity of pain. Neurophysiological mechanisms may explain higher frequency of referred pain associated with the severity of headache.

Iron Deficiency Anemia Is Associated with Menstrual Migraine: A Case-Control Study.

Association between iron deficiency anemia (IDA) and migraine, its subgroups, or tension-type headache (TTH) has not yet been shown. This study aimed to determine whether there was an association between IDA and these disorders. Case-control study. Gebze Fatih General Hospital, Kocaeli, Turkey. Migraine and TTH patients, as well as healthy controls (N = 170/group), were investigated. Descriptive statistics and multivariate logistic regression analyses were performed. Migraine and TTH groups (that included both sexes) and specific migraine subtypes (females only) were selected as dependent variables with sex, age, family history of migraine, alcohol consumption, cigarette smoking, and IDA selected as independent variables. The migraine subgroups selected were as follows: (1) pure menstrual migraine (PMM) or menstrually related migraine (MRM) and (2) migraine not associated with menses (MNAM). IDA was more common in patients with migraine than controls (21.7% vs 12.9%, P = 0.02). There was no association between IDA and TTH (15.9% vs 12.9%, P = 0.43). Family history of migraine (P < 0.001) and IDA (P = 0.03) were significant factors in the model of migraine. Age (P = 0.009), family history of migraine (P < 0.001), and IDA (P = 0.018) were significant factors in the model of PMM/MRM. Only family history of migraine (P < 0.001) was significant in the model of MNAM. Our findings indicate that IDA is significantly associated with PMM/MRM. Further research may determine whether the complex relationships between estrogen, iron metabolism, and dopamine dysfunction, and their effects on migraine, are underlying reasons for this association.

Alexithymic characteristics in pediatric patients with primary headache: a comparison between migraine and tension-type headache.

BackgroundAlexithymia is a personality construct characterized by difficulties in verbal emotional expression and a limited ability to use one’s imagination. Evidence of alexithymic characteristics was found in adults suffering from headache, while little is known about children. The aim of this study was to establish the prevalence of alexithymia in two different subgroups of children and adolescents suffering from primary headache. We also looked for correlation between alexithymia in children and in their mothers.MethodsThis study involved 89 participants: 47 (11 males, 36 females, aged 8 to 17 years) suffering from tension-type headache (TTH), and 42 (18 males, 24 females, aged 8 to 17 years) suffering from migraine (M), based on the International Classification of Headache Disorders (ICHD 2013). A control group of 32 headache-free subjects (26 females and 6 males, aged 8 to17 years) was also considered. Two questionnaires were administered to measure alexithymia: the Alexithymia Questionnaire for Children to young patients and controls, and the Toronto Alexithymia Scale (TAS-20) to the mothers.ResultsHigher rates of alexithymia emerged in the TTH group compared to the M group. In particular, TTH sufferers had difficulty identifying their feelings. The mothers of children with headaches didn’t score higher in alexithymia compared to other mothers. In the M and in the control group, there was a significant correlation between the rates of alexithymia in young people and in their mothers.ConclusionsTo date no other study has investigated alexithymia in subgroups of primary headaches in developmental age. Our results suggest that patients suffering from TTH are more alexithymic than M patients. This pave the way to etiopathogenetic and clinical considerations, calling for a comprehensive and multidisciplinary approach to tackle the problem of headache.

Risk of Restless Legs Syndrome Following Tension-Type Headache: A Nationwide Population-Based Cohort Study.

Migraine and restless legs syndrome (RLS) appear to be associated, but the relationship between tension-type headache (TTH) and RLS is unknown. This nationwide, population-based, retrospective cohort study explored the potential association between TTH and RLS.We identified 15,504 patients with newly diagnosed TTH from 2000 to 2007 and 62,016 individuals without TTH who were selected by frequency matched based on sex, age, and the index year. The study participants were followed until diagnosed with RLS, withdrawal from the NHI program, or the end of 2011. Cox proportional hazard models were used to identify risk factors for RLS in TTH patients.After adjusting for sex, age, comorbidity, and medications, TTH was significantly associated with an increased risk of RLS (hazard ratio [HR] = 1.57, 95% confidence interval [CI] = 1.22–2.02). The risk was most prominent in patients aged 20 to 39 years in the TTH group, which exhibited a 2.60-fold higher risk (95% confidence interval = 1.53–4.42) of RLS compared with the non-TTH group. The TTH group had a higher risk of RLS than that of the non-TTH group regardless of sex.Tension-type headache appears to be associated with an increased risk of developing RLS. This similarity to migraines may indicate that headache and RLS have a coincident pathophysiological mechanism, a possibility requiring further study. Clinicians should be more attentive to RLS as a possible comorbidity in patients with TTH.

A study of cochlear and auditory pathways in patients with tension-type headache.

BackgroundThe purpose of this study was to systematically evaluate the function of cochlear and auditory pathways in patients suffering from tension-type headache (TTH) using various audiological methods.MethodsTwenty-three TTH patients (46 ears) and 26 healthy controls (52 ears) were included, and routine diagnostic audiometry, extended high-frequency audiometry, acoustic reflex (ASR), transient evoked otoacoustic emissions (TEOAEs), distortion product otoacoustic emissions (DPOAEs) and suppression TEOAEs were tested.ResultsThe TTH group showed higher thresholds (P < 0.05) for both pure tone and extended high-frequency audiometry at all frequencies except for 9, 14 and 16 kHz. All ASR thresholds were significantly higher (P < 0.05) in the TTH group compared with the controls, except for the ipsilateral reflex at 1 kHz, but the threshold differences between the ASR and the corresponding pure tone audiometry did not differ (P > 0.05). For the DPOAEs, the detected rates were lower (P < 0.05) in the TTH group compared with the controls at 4 and 6 kHz, and the amplitudes and signal to noise ratio (S/N) were not significantly different between groups. No differences in the TEOAEs (P > 0.05) were observed for the detected rates, amplitudes, S/Ns or contralateral suppression, except for the S/Ns of the 0.5-1 kHz TEOAE responses, which were significantly higher (P < 0.05) in the TTH group.ConclusionsThe results of our study indicate that subclinical changes in cochlear function are associated with TTH.

The second to fourth digit ratio (2D:4D): a risk factor of migraine and tension-type headache.

BackgroundMigraine and Tension-type headache (TTH) are common and disabling primary headache disorders. They are more prevalent in females. The second to fourth digit ratio (2D:4D) is sexually dimorphic in humans and is considered to be a marker for the balance of prenatal testosterone and estrogen exposure. Therefore, we investigated the hypothesis that prenatal sex steroids constitute an independent risk factor for adult headaches later in life.MethodsA total of 891 individuals (303 males, 588 females) of 18–68 years in age (a mean of 37.0 ± 10.1 years), including 279 migraine, 300 TTH, and 312 healthy subjects were enrolled. The 2D:4D ratio was measured by a single investigator using a digital Vernier caliper.ResultsThe females in the migraine group had lower 2D:4D ratios than those in the control group (left hand: 0.947 ± 0.034 vs. 0.955 ± 0.038, p = 0.048; right hand: 0.952 ± 0.035 vs. 0.965 ± 0.037, p = 0.001). There was a similar relationship between the TTH group and the control group (left hand: 0.946 ± 0.034 vs. 0.955 ± 0.038, p = 0.034; right hand: 0.954 ± 0.035 vs. 0.965 ± 0.037, p = 0.005), although this was not observed in males. Males showed lower 2D:4D ratios than females for the right hand in the control group (0.954 ± 0.039 vs. 0.965 ± 0.037, p = 0.015). No significant difference was found in the left hand.ConclusionsThese results suggested that the 2D:4D ratio is a risk factor of migraine and TTH and that the balance of prenatal estrogen and testosterone in utero may impact adult primary headache disorders.

Sleep changes during prophylactic treatment of migraine.

Aims:To assess sleep quality in patients with primary headaches before and after prophylactic treatment using a validated sleep-screening instrument.Materials and Methods:A total of 147 patients, including 63 tension type headache (TTH) and 84 migraine patients were included. Patients were examined in terms of frequency and severity of headaches and sleep quality before and 12 weeks after prophylactic treatment with either propranolol or amitriptyline.Results:Baseline Visual Analogue Score (VAS) in migraine patients was 7.99 ± 1.39 compared with 6.86 ± 1.50 in TTH group (P < 0.001). VAS score after the first month of treatment was 6.08 ± 1.88 in migraine patients and 5.40 ± 1.61 in TTH (P = 0.023). VAS scores decreased after the third month of treatment to 4.32 ± 2.29 in migraine patients and 4.11 ± 1.66 in TTH patients (P = 0.344). The decrease was significant for patients treated with amitriptyline but not for those with propranolol. Baseline Pittsburgh Sleep Quality (PSQI) scores were 5.93 ± 2.43 in migraine patients and 6.71 ± 2.39 in TTH patients. Poor quality of sleep (PSQI ≥ 6) prior to prophylactic treatment was observed in 61.4% of migraine patients and in 77.7% of TTH patients. Comparison of PSQI scores before and 3 months following treatment showed significantly improved quality of sleep in all treatment groups; the greatest significance was detected in migraine patients with initial PSQI scores of ≥6 and treated with amitriptyline (P < 0.001).Conclusions:Increased understanding of routine objective sleep measures in migraine patients is needed to clarify the nature of sleep disturbances associated with primary headaches. This may in turn lead to improvements in headache treatments.

Trigeminal Nerve Reflexes in Chronic Pain Syndromes

Brainstem interneurons are suggested to play a key role in pain modulation and in nociceptive transmission in migraine, in tension type and in cluster headaches and according to the current understanding the primary headache disorders are caused by trigeminocervical pain dysfunction. Brainstem reflexes might be useful in patients with chronic pain syndromes, such as primary headaches and fibromyalgia in order to evaluate the possible pathophysiological mechanism. Patiets with chronic tension-type headache, depression, fibromyalgia and control group were examinated. The blink reflex was induced by surface electrostimulation with stimulus duration of 0,5 ms. The reflex activity was recorded bilaterally at the midline of the lower lid and the back of the nose with surface electrodes. The results of this neurophysiological study of trigeminal reflexes support the concept of primary brainstem dysfunction and central hyperexcitability of the trigeminal sensory pathways in patients with various types of chronic pain syndromes such as fibromyalgia and chronic tension-type headache.

Differentiating occipital neuralgia from migraine and tension-type headache

Objective. To establish differential diagnosis in patients presenting occipital neuralgia, tension-type headache, and migraine with aura. Method. We analyzed 32 patients with Occipital neuralgia (mean age=38.0; females=75%), 102 with tension-type headache (mean age=33.0; females=92.2%), and 16 with migraine without aura (mean age=37.0; females=56.3%). The specific symptoms of headaches were used in according to International Classification of Headache Dis­orders (ICHD) in patients with for craniomandibular disorders and bruxing behavior. Results. Occipital neuralgia group presented more nausea (78.1%; p=0.0001), vomiting (62.5%; p=0.0001), photopho­bia (71.8%; p=0.0001), throbbing (53.1%; p=0.0001), stabbing pain (78.1%; p=0.0001), severe pain (93.7%; p=0.0001), burning (68.8%; p=0.0001), and occipital nerve tenderness (100%; p=0.0001) than tension-type headache group. Occipital neuralgia group showed more stabbing (78.1%; p=0.0001), burning (68.8%; p=0.0005), and oc­cipital nerve tenderness (100%; p=0.0001) than migraine without aura group. Migraine without aura group showed more vomiting (94%; p=0.03) and photophobia (100%; p=0.02) than occipital neu­ralgia group. Conclusions. Nausea, vomiting, photophobia, throb­bing, stabbing, severer pain, a burning description and occipital nerve tenderness, better differentiated occipital neuralgia from tension-type headache. Stabbing pain, burning and occipital nerve tenderness, bet­ter differentiated occipital neuralgia from migraine without aura.

Regional homogeneity abnormalities in patients with tension-type headache: a resting-state fMRI study.

Tension-type headache (TTH) is the most prevalent type of primary headache. Many studies have shown that the pathogenesis of primary headache is associated with fine structural or functional changes. However, these studies were mainly based on migraine. The present study aimed to investigate whether TTH patients show functional disturbances compared with healthy subjects. We used restingstate functional magnetic resonance imaging (fMRI) and regional homogeneity (ReHo) analysis to identify changes in the local synchronization of spontaneous activity in patients with TTH. Ten patients with TTH and 10 age-, gender-, and education-matched healthy controls participated in the study. After demographic and clinical characteristics were acquired, a 3.0-T MRI system was used to obtain resting-state fMRIs. Compared with healthy controls, the TTH group exhibited significantly lower ReHo values in the bilateral caudate nucleus, the precuneus, the putamen, the left middle frontal gyrus, and the superior frontal gyrus. There was no correlation between mean ReHo values in TTH patients and duration of TTH, number of attacks, duration of daily attacks, Visual Analogue Scale score, or Headache Impact Test-6 score. These results suggest that TTH patients exhibit reduced synchronization of neuronal activity in multiple regions involved in the integration and processing of pain signals.

An Observational Study on the Association between Migraines and Tension Type Headaches in Patients Diagnosed with Metabolic Syndrome.

Background. Our aim was to investigate the association between migraine, tension type headache, and metabolic syndrome. Methods. Presence of tension type headache and migraine was investigated in 120 patients diagnosed as metabolic syndrome. The severity of the headache was recorded according to the visual analog scale. Results. Mean age of the patients was 54.41 ± 11.60 years (range, 29–84 yrs). Diagnoses of tension type headache and migraine without aura were made for 39 (32.5%) and 18 (15%) patients, respectively. Mean age of migraine patients was significantly lower relative to the patients with tension type headache and no headache. Incidence of hypertriglyceridemia was significantly higher in migraine patients when compared with cases tension type headache and without headache. In the tension type headache group, requirement for analgesics decreased as HDL cholesterol levels increased, while need for analgesic drugs increased in line with higher diastolic blood pressures. In the migraine group duration of headache was found to be prolonged with decreasing HDL cholesterol levels. Conclusion. In patients presenting with headache, its association with metabolic syndrome should be considered, and the patients should be especially observed with respect to response to analgesic and the presence of hypertension and hyperlipidemia.

Gerilim ve Migren Tipi Baş Ağrılarına Eşlik Eden İslevsel Olmayan Bilişsel İçerikler ve Tutumlar / Maladaptive Cognitive Content and Attitudes Accompanying Tension Type Headache and Migraine

Maladaptive cognitive content and attitudes accompanying tension type headache and migraine Objective: In this study, we examined the presence of some dysfunctional cognitive contents, processes and attitudes which are supposed to accompany the primary headache and described to take part in psychopathologies like anxiety and depression. Method: Thirty three patients diagnosed with migraine, 34 patients diagnosed with chronic tension type headache according to IHS (International Headache Society) criteria who referred to a Turkish training and research hospital neurology outpatient clinic were included. Thirty three healthy volunteers without headache were included as the control group. Automatic Thought Questionnaire (ATQ), White Bear Suppression Inventory (WBSI), Pain Catastrophizing Scale (PCS) and Demographic Information Questionnaire (DIQ) were administered to the participants for the determination of cognitive contents and attitudes. Results: The results showed that in the tension type headache group, ATQ total scores and ‘’Negative Self-Concepts’’, ‘’Personal Maladjustment and Desire for Change’’ and ‘’Giving up/Helplessness’’ subscale scores were significantly higher than the control group. There was no significant difference between the three groups in WBSI. It was shown that in PCS total scores and all scores of ‘’rumination’’, ‘’magnification’’ and ‘’helplessness’’ subscales, tension type headache group and migraine group had significantly higher scores according to the controls. Conclusion: Higher levels of negative cognitive contents in both of the migraine and tension type headache groups according to the healthy controls can explain high depression frequencies in these clinical manifestations. Another result obtained in our study was that as a way of coping with pain, rumination is used more than thought suppression in these individuals.

Comparison of plasma lipid peroxidation between migraine and tension type headache in Iraqi patients.

The oxidant-antioxidant balance disorders underlie a number of acute and chronic diseases of the central nervous system (CNS). It is believed that oxidative stress plays a role in the pathogenesis of migraine. The study objective is to assess the processes of lipid peroxidation with malondialdehyde (MDA) as its major indicator. The study was carried out on Iraqi patients to estimate the level of lipid peroxidation in three groups include control group (41subjects), tension-type headache (TTH) (41patients) and migraine (31patients). The migraine, TTH, and control groups were significantly different on the measures of MDA. The study showed that the migranieurs were significantly different from other two groups with respect to MDA (p&lt;0.001). No significant difference between males and females within each of the three groups (p &gt;0.05). The only significant difference between females’ age-groups was reported between (15-27years) and (28-40years) years old-groups (according to Games-Howell test (P=0.013) while Tukey HSD and Dunnett test contradicted the exits of any differences between them (P&gt;0.05). According to the major similarity between aged-groups for both males and females in the three groups, it can be concluded that MDA level is not affected by age.

Anxiety sensitivity and dissociative experiences in adolescents with migraine and tension type headache

Objective: The aim of this study was to investigate the relationship between headache and anxiety sensitivity (AS), and also headache and dissociative experiences (DE) in adolescents. Methods: Patients were recruited from the adolescents who were admitted to Ankara University Faculty of Medicine Child Neurology Clinic with a complaint of headache and diagnoses of migraine (n=24) or tension type headache (TTH) (n=22). All patients and healthy controls (n=28) were encouraged to complete Childhood Anxiety Sensitivity Index (CASI) and Adolescent Dissociative Experiences Scale (ADES). Results: Patients with headache had higher scores from CASI and ADES instruments in comparison with the healthy adolescents. In case the patient group was divided into two groups regarding to their diagnoses, both migraine and TTH group had higher scores from CASI than control group. However, although TTH group had higher ADES scores than control group, there was no significant difference between migraine and control groups. Likewise, CASI and ADES scores of migraine and TTH groups were not different. Conclusion: Adolescents with headache are having higher AS and DE than normal controls. The diagnosis of migraine or TTH does not change these results in terms of AS. However, adolescents with migraine are not having higher DE than normal controls.

Editorial on “Behavioral and emotional symptoms and primary headaches in children: A population-based study” by Arruda and Bigal

To advance empirically supported care and improve outcomes for children and adolescents with headache, it is important to develop evidence regarding the impact of headaches on everyday life. Helping our patients to achieve good headache control, quality of life and emotional and behavioral health are core objectives of multidisciplinary treatment. From clinical experience, providers of care for youth and adults with headache appreciate the life context of their patients and have an interest in understanding the psychological functioning of those for whom they provide care. Indeed, many studies have assessed psychological functioning using a wide variety of instruments and methodological approaches. Almost all have been cross-sectional, association studies. The majority of investigations have included clinical samples; some have been community or population based. In pediatrics, the general finding is that children and adolescents with headache, including migraine, report (almost always based on caregiver viewpoint) some elevations on measures of internalizing behaviors (for example, anxiety, mood, somatic symptoms); but most youth with headache do not meet the criteria for psychiatric disorder and formal diagnosis (when youth and families participate in validated, structured clinical interviews). Suggestions for how to incorporate what is known today into pediatric headache clinical practice have been made (1,2,3). There is a clear need for data from more methodologically rigorous investigations and development of more evidence-based approaches for meeting the goals of good headache control, quality of life, and emotional and behavioral health for children and adolescents with headache. For our understanding of psychological functioning to better translate into improved care and outcomes, methodologies that incorporate theoretical models of the possible relations between migraine and psychological symptoms, longitudinal designs, multiinformant protocols, clarity on the implications of symptom reports as compared to diagnosis-based assessments, and testing of the impact of interventions directed at headache, psychological functioning, or both will need to be applied. Arruda and Bigal (4) describe a population-based study in Brazil examining the associations between headaches and psychological symptoms reported by caregivers in younger, school-age children (ages 5–11). The investigators obtained data from children registered in a public school system in one city. The second edition of the International Classification of Headache Disorders (ICHD-2) criteria and a reliable, valid caregiver report measure of psychological symptoms were used. A high participation rate (92.5%) was accomplished. The study found that children with migraine and tension-type headache had elevated internalizing scores on the Child Behavior Checklist (CBCL) relative to youth without headache. Differences were not found for externalizing behaviors. While there may be some concerns with multiple statistical comparisons across scales and sub-scales of a psychometric instrument such as the CBCL, domains of somatic, anxiety-depressive, social, attention, internalizing and total score were found to be more impacted for the headache groups than the comparison group. Children diagnosed with migraine had higher scores than those with tension-type headache. For both the migraine and tension-type headache groups, headache frequency was positively associated with psychological symptoms. The clinical meaningfulness of the differences observed is unclear. While this study is cross-sectional and focused on assessment of association of headache and

The validation of a new comprehensive headache-specific quality of life questionnaire

Measuring quality of life (QOL) is an important means of assessing the impact of headache. The currently used QOL questionnaires are usually geared toward migraine and focus on a limited number of factors, thus they are not necessarily informative in other headache types. We report the psychometric properties of a new questionnaire, the Comprehensive Headache-related Quality of life Questionnaire (CHQQ) that may be more sensitive to the burden of headache. A total of 202 patients suffering from migraine (n = 168) or tension-type headache (TTH) (n = 34) completed the CHQQ and SF-36, a generic QOL questionnaire. We assessed the reliability and validity of the CHQQ and its physical, mental and social dimensions. The questionnaire was easy to administer. Reliability was excellent with Cronbach's alpha being 0.913 for the whole instrument (0.814-0.832 for its dimensions). The dimensions and total score showed significant correlations with the patients' headache characteristics (criterion validity), and were also significantly correlated with the SF-36 domains (convergent validity). The total score and dimensions were significantly (p < 0.005) lower in the migraine group than in the TTH group (discriminative validity). In this study the new headache-specific QOL instrument showed adequate psychometric properties.

Electroencephalogram Variations in Pediatric Migraines and Tension-Type Headaches

This study evaluates specific electroencephalogram abnormalities in pediatric migraine and tension-type headaches, and demonstrates the clinical value of these abnormalities. We studied 50 migraine patients and 50 tension-type headache patients. Their mean age ± SD was 10.62 ± 3.21 (range, 5-16) years in the migraine group, and 13.00 ± 2.37 (7-16) years in the tension-type headache group. Diagnoses were rendered according to the International Classification of Headache Disorders, 2nd Edition, First Revision, of the International Headache Society. All patients underwent two waking-state electroencephalograms, one during a headache, and the other when headache-free. Thirty-six percent (18/50) of migraine patients and 12% (6/50) of tension-type headache patients revealed specific electroencephalogram abnormalities in headache attack electroencephalograms (P < 0.05). In headache-free period electroencephalograms, 16% (8/50) of the migraine group and 2% (1/50) of the tension-type headache group revealed abnormalities (P < 0.05). Our results indicate that electroencephalogram abnormalities are particularly prevalent in migraines, especially during headache attacks. This study is the first, to the best of our knowledge, on electroencephalographic evaluation of pediatric migraine and tension-type headache patients during both headache attacks and headache-free periods.

Can headache impair intellectual abilities in children? An observational study

BackgroundThe purpose of this study was to assess the cognitive functioning of children affected by headache, pinpointing the differences in intelligence style between subjects affected by migraine without aura and subjects with tension-type headache.MethodsThe study population consisted of 147 children (mean age 10.82 ± 2.17 years) with headache, recruited from the Headache Center for Developmental Age, Child and Adolescent Neuropsychiatry Clinic, Second University of Naples. Cognitive profiling was performed using Weschler Intelligence Scale for Children Third Edition throughout the sample. According to the International Classification of Headache Disorders II criteria for pediatric age, subjects were divided into a migraine without aura group (n = 75; 43 boys, 32 girls) and a tension-type headache group (n = 72; 49 boys, 23 girls). The results were compared with the findings obtained from a sample of 137 healthy control subjects recruited from schools in the Campania region, matched for age and gender.ResultsNo difference in full intelligence quotient was found between the groups, but the children with tension-type headache had a lower verbal intelligence quotient and a higher performance intelligence quotient than the healthy controls and children with migraine. Factor analysis data showed that the children with migraine seemed to have lower perceptual organization than the children affected by tension-type headache.ConclusionTo our knowledge, studies on cognitive functioning in children affected by headache in the interictal phase are scarce, and our results suggest a new perspective in understanding of the neuropsychological aspects of young patients affected by headaches.

Personality Characteristics of Male Sufferers of Chronic Tension-Type and Cervicogenic Headache

Background and PurposeChronic tension-type headache (a primary headache disorder) and cervicogenic headache (a secondary headache disorder that is attributable to upper cervical spine pathology) share similar clinical manifestations, but their associated personality traits may differ. We evaluated the personality differences between sufferers of chronic tension-type headache and cervicogenic headache.MethodsWe administered the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ) and the Zuckerman Sensation-Seeking Scale (SSS) to 18 patients suffering from chronic tension-type headache, 19 suffering from cervicogenic headache, and 26 healthy volunteers. Depressive trends were measured with the Plutchik-van-Praag Depression Inventory (PVP).ResultsCompared to healthy controls, the chronic tension-type headache group scored significantly higher on ZKPQ Neuroticism-Anxiety and on the PVP, while the cervicogenic headache group scored significantly lower on SSS Thrill and Adventure Seeking. In addition, the total SSS score was significantly lower in the cervicogenic headache group than in both the chronic tension-type headache group and the healthy controls.ConclusionsThe results of this study indicate that higher scores for neuroticism-anxiety and depression were associated with chronic tension-type headache, while lower sensation-seeking scores were associated with cervicogenic headache.

Frequency of headache among the employees of a rubber company in the state of São Paulo, Brazil.

Primary headaches may be responsible for absenteeism and a fall in the yield and productivity of work. The aim of this study was to establish the presence and frequency of primary headache among employees of a rubber shoe sole company, and its link to absenteeism. Cross-sectional study carried out with help from the staff of the medical and social department of a rubber factory located in the municipality of Franca, São Paulo. A questionnaire on headache characteristics was distributed to all employees. The returned and completed questionnaires were divided into two groups: with and without reports of headache. The headaches were classified into four main groups: migraine, tension-type headache (TTH), cluster headache and others. In terms of the reported frequency, headaches were also classified as chronic daily headache (CDH). The number of valid questionnaires was 392 (59%); 80.9% were from male and 19.1% from female employees. Headaches were reported by 120 subjects (30.6%), with 17.4% belonging to the migraine group and 8.9% to the TTH group. Migraine was more frequent (p < 0.001) among all participants and also among the women (p < 0.05). TTH was more frequent among the men (p < 0.05). CDH was identified in 14 individuals (3.6%). Headache was a common problem among the employees of this company and was a cause of absenteeism for 8.7% of the respondents to the questionnaire.