Type Of Primary Headache Research Articles

O059. Predictors of response to botulinum toxin for the treatment of chronic migraine: data from a Headache Center.

Background Chronic migraine (CM) is a disabling type of primary headache for which treatment with botulinum toxin type A (BoNT-A) has proved to be effective and safe in reducing headache days and headache-related disability. However, little is known about factors influencing the response to BoNT-A. We aimed to assess which baseline factors predicted a favorable response to BoNT-A in a sample of patients with CM.

Features of chronic daily headache: a clinical analysis of 128 cases

Objective To review the clinical features of chronic daily headache (CDH). Methods The clinical data of 128 patients with chronic daily headache, including general condition, characteristics of headache, concomitant symptom and disability were analyzed retrospectively. The features of primary chronic daily headache (PCDH) and medication over-dose headache (MOH) were compared. Results Among 128 cases females accounted for 79.7% with an average age of 45.2 years and 88 patients were associated with drug overdose. The symptoms included nausea(68/128), photophobia(75/128), phonophobia(102/128), depression(77/128)and irritability(93/128), sleep disorders(94/128), dizziness(75/128), emotional irritability(58/128) and depression(21/128). The migraine disability assessment questionnaire and headache impact test-6 scores showed that disability was resulted from the severe degree of headache in 62.2%(51/82) and 73.2%(82/112) of CDH patients respectively. Compared with PCDH patients, the MOH patients had older age(t=2.59, P=0.011), longer duration(t=2.48, P=0.015) and severer degree of headache(t=5.58, P=0.018), and chronic migraine (t=11.95.P=0.001) was the most common primary headache type. Conclusions Most CDH patients are middle-aged women, with moderate to severe pain, usually complicated with depression, dysphoria and asomnia. Chronic daily headache patients are commonly associated with drug overdose. Key words: Headache disorders; Signs and symptoms; Retrospective studies

The Prevalence of Migraine in Different Parts of Iran: Review of the Current Evidence

Context: Migraine is a type of primary headache that affects 10% to 20% of people worldwide. Recent studies have reported different prevalences of migraine in Iran. Hence, this study aimed to review current evidences related to the prevalence of migraine in different parts of Iran. Evidence Acquisition: A literature search was done for related articles published between 1998 and 2014 on PubMed, Science Direct, Embase, Web of Science, Medline, Scopus for English language articles, and on Iran Medex, Magiran and SID (Scientific Information Database) for Persian (Farsi) language articles by the following keywords: “migraine”, “headache”, “prevalence” and “Iran”. Results: In most evaluated studies, migraine had a higher prevalence in middle-age individuals and females. The prevalence of migraine in adults varies from 7.14% to 18.11%, and the maximum and minimum prevalence was reported from Tehran and Zahedan, respectively. In children and adolescences, the prevalence varies from 1.7% to 12.3%, and the lowest and highest prevalence were found in Shiraz and Yazd, respectively. Conclusions: Based on the current findings, the prevalence of migraine in evaluated studies was high. Therefore, it is recommended for public health authorities to detect the reasons for the high prevalence of this disease and set appropriate strategies to prevent this disorder.

Association of RAMP1 rs7590387 with the risk of migraine transformation into medication overuse headache.

We herein investigated the role of polymorphisms in calcitonin gene-related peptide (CGRP)-related genes looking at the association of rs3781719 (T > C) in the calcitonin gene-related polypeptide-alpha (CALCA) gene and of rs3754701 (T > A) and rs7590387 (C > G) at the receptor activity modifying 1 (RAMP1) locus with triptan response in patients with migraine without aura (MwoA). In addition, their role was evaluated as risk factors for transformation of episodic migraine into medication overuse headache (MOH). The CGRP has a central role in the pathogenesis of migraine; however, little information is currently available concerning the role of polymorphisms in CGRP-related genes as determinants of clinical response to anti-migraine drugs or as risk factors for migraine chronification. Genotyping was conducted retrospectively by real-time polymerase chain reaction allelic discrimination assay in 219 patients with MwoA and 130 with MOH in whom migraine was the primary headache type. Gene variants association was evaluated by logistic regression analysis adjusted by confounding factors. The threshold of statistical significance was set according to the total number of polymorphisms analyzed in the current study and in previous publications arising from overlapping datasets. No evidence of association was found between the three polymorphisms tested and triptan response in MwoA patients. Conversely, carriers of RAMP1 rs7590387GG displayed a lower risk of episodic migraine transformation into MOH (vs C allele carriers, odds ratio [OR]: 0.27, 95% confidence interval [CI]: 0.13-0.57, P = 0.0002; threshold of significance set at P < 0.0029). When genotype distribution for RAMP1 rs7590387 was compared between healthy controls (n = 209) and MOH patients, carriers of rs7590387GG were found at lower risk of developing MOH (OR: 0.43, 95%CI: 0.22-0.85, P = 0.011). These results suggest that RAMP1 rs7590387 may have a role in the transformation of episodic migraine into MOH.

The effect of prophylactic migraine treatment on arterial stiffness

Background. Migraine is a common type of primary headache predominantly seen in women. This study aimed to evaluate endothelial function in patients with migraine using pulse wave velocity (PWV). Methods. The study included 73 patients with newly diagnosed migraine and 80 healthy subjects. All patients and controls underwent baseline transthoracic echocardiography and PWV measurements. Patients were randomized to three groups to receive propranolol, flunarizine or topiramate, and the measurements were repeated at the end of 1 month. Results. The newly diagnosed migraine patients and the control group exhibited no differences in baseline clinical characteristics, and the measurements showed that PWV was 7.4 ± 1.0 m/s in the patient group and 6.0 ± 1.0 m/s in the control group (p < 0.001). The same measurements were repeated during a control visit at the end of 1 month. Following treatment, a significant decrease was observed in PWV in all patient groups compared to baseline (p < 0.001). Subgroup analysis showed significantly decreased PWV in all drug groups, with the most prominent decrease in the topiramate group. Conclusions. The increased PWV demonstrated in migraine patients in this study stands out as an additional parameter elucidating endothelial dysfunction in these patients. Decreasing the number of migraine attacks with prophylactic treatment may reduce PWV and decrease cardiovascular risk in long-term follow-up.

Analysis of the quality of diagnosis and treatment of primary headache in different social groups of the Ural Region

Objective : to analyze the quality of diagnosis and treatment of primary headache (HA) in different social groups of the Ural Region. Patients and methods . The study enrolled 3124 persons who were divided into three groups: 1) 1042 students; of them there were 719 women; mean age 20.6 years; range 17–40 years; 2) 1075 workers; of them there were 146 women; mean age 40.4 years; range 21–67 years; 3) 1007 blood donors; of them there were 484 women; mean age, 34.1 years; range 18–64 years. Semi-structured interviews involving the characteristics of HA and its prior diagnosis and treatment were conducted face-to-face in all those included in the study. HA was diagnosed using the International Classification of Headache Disorders, 3rd edition, beta version. Results and discussion . The following factors decreasing the quality of diagnosis and treatment of HA were identified in all the study groups: 1) low physician visit rates. Despite the high prevalence of all types of primary HA in 3 groups (67%), only 496 (23%) out of 2110 participants with HA visited their physician with this problem. Among the patients with HA, physicians were visited most often by 342 (35%) out of 968 students, least often by 60 (13%) out of 457 workers and by 94 (14%) out of 685 donors; 2) inadequate diagnosis of HA. Only 12 and 11.7% of the patients were correctly diagnosed with migraine and tension HA (THA), respectively; 3) the practically complete absence of preventive treatment for HA. The majority of patients used drugs to arrest HA attacks; preventive treatment for migraine was performed in 2 (0.4%) and not performed in any of the patients with THA. It is necessary to improve the diagnosis and treatment of primary HA and to elaborate new Russian clinical guidelines for patient management on the basis of international standards.

Tension-Type Headache: A Life-Course Review

Background: Tension-type headache is the most prevalent primary headache type worldwide and is associated with a wide spectrum of disability. Although progress has been made in understanding the complex mechanisms that lead to the pathogenesis of tension-type headache, to date there are no clear-cut markers of what makes tension-type headache unique. Due to a relative lack of research (compared to migraine), the pathophysiology of tension-type headache is not well understood and there are gaps in the epidemiological data, particularly from Australasia. Objective: To provide a structured narrative review of the prevalence and correlates of tension-type headache, with focus on a birth cohort of young adults from the Dunedin Multidisciplinary Health and Development Study (DMHDS) in New Zealand. Method: A review of the literature was conducted to identify the epidemiological, diagnostic, methodological and pathophysiological factors that contribute to tension-type headache being a specific entity. Results: Findings suggest that prevalence rates of TTH vary across global region, age, gender and method of assessment. A wide range of risk factors for TTH was identified, and recent advances in genetic and neurobiological research have increased understanding of the etiology of TTH. Few longitudinal studies have been conducted on TTH. Conclusion: Further longitudinal epidemiological research is needed to help distinguish tension-type headache from migraine, particularly in young people. Identifying the specific markers of tension-type headache is a first step towards developing effective prevention and treatment strategies.

AN APPROACH FOR MEDICAL DIAGNOSIS BASED ON THE HAMMING DISTANCES

In medical diagnosis based on intuitionistic fuzzy sets (IFS), it is a general method to use max–min composition based on relations between the symptoms and diseases. The method, however, has been known to lead to quite conservative results and to a loss of information because the composition neglects most values except for extreme ones. To complement the shortcomings of the max–min composition, other measurements such as similarity and distance between IFS have gained attention as an important content in fuzzy mathematics from researchers. However, the methods based on the similarity and distance also have some drawbacks in that they provide an unclear diagnosis. For example, the distances for each disease do not have generally the same distribution. Therefore, there is a difference between the distance 0.25 for disease A and that for disease B. In addition, the difference in the distances for each disease would be very small. It can therefore be inferred that there would be no definite diagnostic criteria. To solve the problems, we propose a new approach for medical diagnosis based on Hamming distances in this study. In the approach, we do not use directly the Hamming distances but the distributional characteristics of the distances such as quantiles and p-values as a measure for diagnosis. To explore the potential for utilization of the approach, we present the simulation results. The simulation was applied to differentiate patients according to the three main types of primary headaches: migraine, tension and cluster headache. The result of the simulation indicates that it is possible to classify headache using the proposed method.

EHMTI-0152. Epidemiology of primary headaches among adolescents in republic of Croatia

The aim of our research was to perform an epidemiological study of migraine and tension headache among adolescents in Republic of Croatia and to determine whether there are differences in prevalence, socioeconomic status, headache onset, gender distribution, health care utilization and self-medication between these two types of primary headaches. We have surveyed 1876 students attending 18 secondary schools in 10 cities of Croatia using self-administered questionnaire that was designed to classify respondents into a group of migraine or tension headache according to Lipton criteria for migraine and ICHD-2 criteria for both migraine and tension headache. Prevalence of migraine was 12,8% (17% in women and 8,1% in men) and prevalence of tension headache was 38,3% (40,6% in women and 35,7% in men). Prevalence of migraine with TTH was 2,9% (3,1% in women and 2,7% in men). There was significant difference in prevalence of migraine (OR=2,3) and tension headache (OR=1,23) between female and male students. We have found that migraineurs were more prone to self-medication (OR=3,29), as to health care utilization (OR=8,12). Also we have identified smoking as a precipitating factor for migraine. The prevalence of primary headaches in Croatia is similar to that in other countries of the world, tension headache is the most common primary headache, occurring later than migraine, and both types are more common in females. Smoking is a risk factor for developing migraine. Although migraineurs visit the doctor and take medications more frequently, both headaches are underdiagnosed and undertreated. No conflict of interest.

EHMTI-0245. Some clinical characteristics and prophylactic treatment in patients with moh in an out-patient clinical sample

Medication Overuse Headache (MOH) is a well-known condition and diagnostic entity, recognized as a relevant medical and socio-economic problem everywhere. Whether initial primary headache type, its frequency, co-morbid conditions or else, it is not truly clear. The therapeutic management of MOH is often difficult and still not properly and step-by-step guided.

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.

Headache in sports.

Sports- and exercise-related headaches are not unusual. Despite their frequent occurrence in this context, there are little epidemiologic data concerning sports-related headache. The recent attention of concussive injuries and associated post-traumatic headache has renewed interest in the study of those headaches occurring after head trauma; however, any primary headache type can also occur in the setting of contact and/or collision sports. The nonspecific nature of headaches provides unique challenges to clinicians encountering this complaint. It is, therefore, imperative that physicians treating athletes are able to distinguish the various headache types and presentations often seen in this population.

Cervicalgia, cervicocranialgia, and cervicogenic headache

Pain syndromes in the neck and head regions are one of the most difficult conditions to be interpreted in clinical practice. Craniocervical anatomical and physiological features are a basis for development of mixed pain syndromes showing as a polymorphic clinical picture in the presence of not only painful, but also tonic muscle, autonomic, postural, vestibular, and other disorders. The current concept of cervicocranialgia is based on the views and convergence between cranial (trigeminal) and upper cervical afferents, as supported by clinical and experimental data. These mechanisms are responsible for referred pain phenomena that are so characteristic of myofascial pain syndromes in the neck, head, and face. Myofascial pain may both be independent and occur in other types of primary headaches, specifically in migraine and tension headache. In these cases, the clinical symptomatology takes the features that are highly characteristic of myofascial pain: referred pain with a typical pattern of its spread, as well as trigger points and pain associated with postural loads and other physical factors. These peculiarities should be kept in mind when diagnosing pain syndromes in the craniocervical region. Current approaches to managing patients with cervicocranialgias encompass relief of pain and tonic muscle disorders and compensation for postural disturbances. For this, it is customary to use pharmacotherapy with antidepressants, nonsteroidal anti-inflammatory drugs, and myorelaxants. Effective analgesia in these patients still remains an unsolved problem. Analysis of clinical trials can identify the most effective analgesic and safe agents for pharmacotherapy. The phenomena of myofascial pain determine the expediency of using myorelaxants that exert an intrinsic analgesic effect and reduce tonic muscle phenomena.

Headaches in children

Headaches are common in children; however, assessment can be a challenge in this age group. The description of an attack may not be clear, attacks may be infrequent and so a pattern of attacks may be difficult to ascertain, examination can be difficult, especially in a very young or uncooperative child, and presentation is often accompanied by significant parental anxiety. This article aims to provide a strategy for GPs to differentiate primary from secondary headaches and common primary headache types such as migraine and tension-type headache. It also outlines the primary care management of these conditions.

Clinical Speciality of 500 Headache Patients: Documentations of Headache Center

Objective: Headache is a health problem which is a prevalent, disabling condition affecting people in all age groups. In this study, we evaluated headache characteristics and associated factors of patients in our headache center. Method: In this study,we retrospectively investigated the file records of 500 patients followed up between 1994-1997 in our headache center. Demographical data and other information about headache of all patients were evaluated in the file records. Results: .Mean age was 33,5±10,1 years in patients.47,4% of patients had migraine type headache. Other primary headache types were tension type headache, drug overuse headache and trigeminal autonomic cephalalgias, retrospectively. We investigated characteristics of pain, treatment schedules and their responses in all headache types. Conclusion: Headache is one of the most frequent health problem in the general population and it may cause disability. Among patients submitted to the our headache center, half of them had migraine type headache. However, we found that some patients had a wrong diagnosis in their initial assessments. This results, suggest that special headache centers are required for headache patients.

Differential diagnosis of headaches

Headache is a frequent symptom in otorhinolaryngology. Such a secondary headache is typically caused by an organic disease in the head and neck area. Much more frequent is primary headache i.e. that an organic cause cannot be found. The most frequent primary headache types are migraine, tension-type headache, and cluster headache. What has to be done when the otorhinolaryngologist cannot find a cause for a headache in the head and neck area? This continuing education article should enable the otorhinolaryngologist to perform a first differential diagnostic exploration. Often a detailed inquiry of the patient's history and a clinical examination are sufficient to decide to which other medical discipline the patient should be referred. Furthermore, the article should enable the reader to capture red flag symptoms, i.e. to catch symptoms accompanying the headache that might be related to underlying and life-threatening disease.

Does primary headache type influence secondary headache symptoms?

Does primary headache type influence secondary headache symptoms?

Headache‐attributed burden and its impact on productivity and quality of life in Russia: structured healthcare for headache is urgently needed

The study evaluated headache-attributed burden and its impact on productivity and quality of life (QoL) in Russia. Its purpose was to support recommendations for change. A countrywide population-based random sample of 2725 biologically unrelated adults (aged 18-65 years) in 35 cities and nine rural areas of Russia were interviewed in a door-to-door survey. The structured questionnaire enquired into symptom burden, functional disability, lost productive time and QoL (applying the WHOQoL-8 question set), as well as willingness to pay (WTP) for adequate headache treatment, if it were available. Mean lost paid-work days due to headache in the previous 3 months were 1.9 ± 4.2, and mean lost household work days were 3.4 ± 5.7. The estimated annual indirect cost of primary headache disorders was USD 22.8 billion, accounting for 1.75% of gross domestic product. QoL was reduced by all types of primary headaches. According to WHOQoL-8, it was significantly lower in those with headache on ≥15 days/month than in those with episodic headache (24.7 ± 4.6 vs. 28.1 ± 5.0; P < 0.05) and lower in those with migraine than in those with tension-type headache (TTH) (27.1 ± 4.9 vs. 28.8 ± 5.0; P < 0.05). Average WTP for adequate headache treatment was RUB 455 ± 494 per month (median RUB 300), a sum sufficient in most cases, and correlated with illness severity (higher for headache on ≥15 days/month than for migraine, and for migraine than for TTH). Headache is common, burdensome and costly in Russia and, manifestly, poorly mitigated by existing healthcare. Structured healthcare services for headache need to be urgently put in place.

Primary Headaches in Children Under the Age of 7 Years

Recurrent headache is increasingly recognised in young children. Migraine and tension-type headache feature commonly amongst the primary headache disorders seen at this age. Headaches at this age are more likely than in older patients to be 'unclassifiable', possibly a reflection of the difficulties in obtaining a detailed headache history from a young child. Together with recent epidemiological data this review highlights the more prevalent primary headache types with advice on making a focussed headache assessment and guidance on management in this age group.

EPA-0350 – The influence of psychiatric rehabilitation multidimensional model of care depression and anxiety in tension headache patients

Influence lifestyle and aspects of patients and lead to depression and anxiety. A tension headache is the most common type of primary headache. One half of patients with tension-type headaches identify stress or hunger as a precipitating factor. This study aimed to determine the influence of multi-dimensional model of psychosocial rehabilitation on depression and anxiety in Tension Headache patients was performed. A quasi-experimental study, two groups before and after the sampling available method on 40 Tension Headache patients in Ebenesina hospital (intervention) and 40 Tension Headache patients in Mollasadra hospital (control) was conducted in 2011. Collection scales included the questionnaires demographic, depression «Beck»’BDI-II’ and self anxious,’zong»’SAS’, which was measured before and Two months after intervention. Intervention based on a multidimensional model of psychosocial rehabilitation consists of the patient and family, physician, nurse, psychologist, and nutritionist was done in Two months. First, each client separately in aspects physical, mental, social and spiritual was assessed by team members. Then in team meetings needs of each client, progress and lack of progress in treatment, diagnosis. Data analysis between the mean scores of depression and anxiety samples before and after the intervention group showed significant difference (p<0/001). The multi-dimensional model of psychiatric rehabilitation care, significant differences in depression and anxiety scores in Tension Headache patients is caused.