Unclassified Headache Research Articles

Migraine and risk of atrial fibrillation: A 9-year follow-up based on the Trøndelag Health Study.

Data from some population-based studies have indicated an increased risk of atrial fibrillation (AF) among patients with migraine, particularly among individuals with migraine with aura. The present study aimed to assess the association between primary headache disorders and AF. In a population-based 9-year follow-up design, we evaluated the questionnaire-based headache diagnosis, migraine and tension-type headache (TTH) included, collected in the Trøndelag Health Study (HUNT3) conducted in 2006-2008, and the subsequent risk of AF in the period until December 2015. The population at risk consisted of 39,340 individuals ≥20 years without AF at HUNT3 baseline who answered headache questionnaire during HUNT3. The prospective association was evaluated by multivariable Cox proportional hazard models with 95% confidence intervals (CIs). Among the 39,340 participants, 1524 (3.8%) developed AF during the 9-year follow up, whereof 91% of these were ≥55 years. In the multivariable analyses, adjusting for known confounders, we did not find any association between migraine or TTH and risk of AF. The adjusted hazard ratios (HRs) were respectively 0.84 (95% CI = 0.64-1.11) for migraine, 1.16 (95% CI = 0.86-1.27) for TTH and 1.04 (95% CI = 0.86-1.27) for unclassified headache. However, in sensitivity analyses of individuals aged ≥55 years, a lower risk of AF was found for migraine (HR = 0.53; 95% CI = 0.39-0.73). In this large population-based study, no increased risk of AF was found among individuals with migraine or TTH at baseline. Indeed, among individuals aged ≥55 years, migraine was associated with a lower risk for AF.

Headache disorders and risk of stroke: A register-linked HUNT study

Background Many studies have found that migraine with aura (MA) is a risk factor of stroke, but the relationship between stroke and migraine without aura and tension-type headache is unclear. The aim of this study was to investigate whether primary headache disorders, including subtypes of migraine, increase the risk of ischemic or hemorrhagic stroke. Methods This large population-based 13-year follow-up study used baseline headache data from the third Trøndelag Health Study (HUNT3) performed between 2006 and 2008. The HUNT3 headache data were linked to the Norwegian National Stroke Register that includes stroke diagnoses recorded from 2013 until December 2021. The association between stroke and headache status was investigated in individuals aged ≥20 years without stroke at baseline. Prospective associations were evaluated using multivariable Cox proportional hazard models with 95% confidence intervals. Separate sub-group analyses by age and sex were performed. Results Among 37,364 included participants, 50% were younger than 55 years. A total of 1095 (2.9%) developed stroke after a median of 9 years. In the multi-adjusted model, reporting MA at baseline was associated with increased risk of stroke at follow-up (HR 1.59, 95% CI 1.14–2.21) compared with those without headache. The increased risk of stroke was most evident among individuals <55 years with MA (HR 2.18, 95% CI 1.24–3.82) and among women (HR 1.70, 95% CI 1.12–2.59). Migraine without aura (MO), tension-type headache (TTH) and unclassified headaches were not associated with increased risk of stroke. Conclusions During 15 years of follow-up, individuals with MA were more likely to suffer from stroke compared to those without headache. The relationship with MA was even stronger in women, and for young individuals aged <55 years. Individuals with MO or TTH were not associated with increased risk of stroke.

The applicability research of the diagnostic criteria for 10.2 Heamodialysis-related headache in the international classification of headache disorders-3rd edition

BackgroundHeadache during hemodialysis (HDH) is prevalent but not negligible. Despite the high prevalence of dialysis headaches, they have rarely been studied. Therefore, this study aimed to evaluate the prevalence, risk factors, and clinical characteristics of HDH and reappraise the HDH diagnostic criteria in the International Classification of Headache Disorders 3 (ICHD-3).MethodsOne hundred and fifty-four patients completed this randomized cross-sectional study. Consecutive patients who underwent haemodialysis were assessed using a semi-structured questionnaire. The patients were administered face-to-face questionnaires while undergoing dialysis.ResultsThis study included 154 patients. Before commencing dialysis, 3.24% (5/154) of the patients had migraine without aura, 1.29% (2/154) had menstrual-related migraine, 0.6% (1/154) had tension-type headaches, and 0.6% (1/154) had an unclassifiable headache. One case (0.6%) of headache resolved after dialysis treatment. HDH was diagnosed in 9.09% (14/154) of the patients. Headache after haemodialysis (HAH) was reported in 6.49% (10/154) of patients. The most prevalent features of HDH were frontal or temporal location, bilateral headaches, dull and throbbing nature, and moderate severity. HDH started at a mean of 2.33 ± 0.79 h after dialysis commenced. The average headache duration was 6.56 ± 1.57 h (median = 3.0 h), with 66.67% of the patients reporting a duration of ≤4 h. HDH was more prevalent in females than males (P = 0.01, P < 0.05). Female sex was a risk factor for HDH (P = 0.01，P < 0.05).ConclusionsThe diagnostic criteria for 10.2 HDH in ICHD-3 may miss several HAH. Therefore, ICHD-3 should be revised according to the literature and further studies.

Primary headache types in adult epilepsy patients

BackgroundHeadache is among the most common comorbidities in epilepsy. This study examined the distribution of different primary headache disorders in a large cohort of patients with diagnosed epilepsy. Headache types were analysed with regard to gender, type of epilepsy and antiepileptic drugs (AEDs).MethodsIn this prospective single-centre study, 500 patients with epilepsy (250 female, mean age: 45.52 ± 17.26 years) were evaluated with regards to primary headache types using a validated German headache questionnaire categorizing for migraine (MIG), tension-type headache (TTH) or trigeminal autonomic cephalalgias (TAC), their combinations and unclassifiable headache. Data regarding type of epilepsy, seizure-associated headache, AED treatment and seizure freedom were collected.ResultsOf 500 patients with epilepsy, 163 (32.6%) patients (108 female and 55 male) reported suffering from headaches at least 1 day per month. MIG (without aura, with aura) and TTH were the most frequent headache type (MIG 33.1%, TTH 33.1%). Female epilepsy patients reported headaches significantly more often than male patients (x2 = 8.20, p = 0.0042). In contrast, the type of epilepsy did not significantly affect headache distribution. Of 163 patients with headache, 66 (40.5%) patients reported seizure-associated headache and AEDs were used by 157 patients. Of importance, patients with AED monotherapy suffered from MIG less often when compared to patients on polytherapy (x2 = 4.79, p = 0.028).ConclusionMIG and TTH are the most common headache types in epilepsy patients and headache is more frequent among female epilepsy patients. Monotherapy in AEDs might have a beneficial effect on the frequency of headache compared to polytherapy.

Development and validation of a web-based headache diagnosis questionnaire

Information technology advances may help in conducting epidemiological studies using web-based surveys. Questionnaire-based headache diagnosis should be validated against the doctor’s diagnosis. This study aimed to develop and validate a web-based diagnostic questionnaire for migraine, probable migraine (PM), and tension-type headache (TTH). We constructed a seven-item questionnaire for diagnosing migraine, PM, and TTH. A web-based survey was conducted among adults aged 20–59 years; migraine, PM, and TTH were diagnosed based on the responses. Validation interview was performed via telephone by a neurologist within 1 month after the web-based interview. Finally, 256 participants completed both web-based survey and validation interview. Of them, 121 (47.3%), 65 (25.4%), 61 (23.8%), and 9 (3.5%) were diagnosed with migraine, PM, TTH, and unclassified headache (UH), respectively in the web-based survey, whereas 119 (46.5%), 60 (23.4%), 74 (28.9%), 2 (0.8%), and 1 (0.4%) were diagnosed with migraine, PM, TTH, UH, and primary stabbing headache, respectively in the validation interview. The best agreement was found in migraine (sensitivity: 92.6%; specificity: 94.8%; kappa coefficient: 0.875), followed by TTH (sensitivity: 78.4%; specificity: 98.4%; kappa coefficient: 0.809). PM showed the least agreement (sensitivity: 85.0%; specificity: 92.9%; kappa coefficient: 0.757). In conclusion, our questionnaire is valid in identifying these headache disorders.

Headache in Children and Adolescents: The Association between Screen Time and Headache within a Clinical Headache Population

More than half of children and adolescents have experienced headache within the last 3 months. Several risk factors for headache have been identified, including obesity and lack of sleep. The association between screen time and headache in children and adolescents is sparsely investigated. The aim of this study was to assess this association and evaluate if it varied according to headache diagnosis. This cross-sectional study was performed at the tertiary pediatric outpatient clinic for headache at Herlev University Hospital. A total of 139 participants who answered a questionnaire on lifestyle factors and their daily living were included. Diagnoses of migraine and tension-type headache (TTH) were made according to the International Classification of Headache Disorders-3. Children with both migraine and TTH were allocated to a mixed headache group. We differentiated between total, leisure, and school-related screen time. The mean age was 13.20 ± 3.38 years and 53.2% were girls. Note that 25.2% were diagnosed with migraine without aura, 23.0% migraine with aura, 28.1% TTH, 15.8% mixed headache, and 7.9% had an unclassified headache diagnosis at the time of inclusion. There was no statistically significant difference in screen time across the five headache groups. An association between screen time and headache frequency was found in children with migraine with aura. In this study, we investigated the association between screen time and headache in children and adolescents. More screen time was associated with more frequent headaches in children with migraine with aura. Future prospective studies are needed to determine the causality of this association.

If headache has any association with hypertension, it is negative. Evidence from a population-based study in Nepal.

Hypertension and headache disorders are major contributors to public ill health, linked by a long-standing but questionable belief that hypertension is a conspicuous cause of headache. In Nepal, where hypertension is common and often untreated, we assessed the substance of this belief, hypothesising that, should hypertension be a significant cause of headache, a clear positive association between these disorders would exist. In a cross-sectional, nationwide study, trained health workers conducted face-to-face structured interviews, during unannounced home visits, with a representative sample of the Nepalese adult population (18-65 years). They applied standard diagnostic criteria for headache disorders and measured blood pressure digitally. Hypertension was defined as systolic pressure ≥140 and/or diastolic ≥90 mm Hg. Of 2,100 participants (59.0% female, mean age 36.4 ± 12.8 years), 317 (15.1%) had hypertension (41.0% female) and 1,794 (85.4%) had headache (61.6% female; 728 migraine, 863 tension-type headache, 161 headache on ≥15 days/month [mutually exclusive diagnoses]; 42 unclassified headaches).All headache collectively was less prevalent among hypertension cases (78.9%) than non-cases (86.6%; p = 0.001). A negative association between hypertension and all headache was demonstrated in bivariate analysis (odds ratio: 0.6 [95% Confidence interval: 0.4-0.8]; p < 0.001), but did not maintain significance in multivariate regression analysis (adjusted odds ratio: 0.8 [95% Confidence interval: 0.5-1.1]; p = 0.09). The findings were reflected, without significance, in each headache type. If any association exists between hypertension and headache disorders, it is negative. From the public-health perspective, headache disorders and hypertension are unrelated entities: they need distinct policies and programs for prevention, control and management.

The Association Between Blood Pressure and Headache in Postmenopausal Women: A Prospective Hospital-Based Study.

BackgroundHeadache is the most frequent condition for outpatient patients because of neurological problems, but little is known about predisposing and enabling factors for headache patients.AimTo investigate the association between blood pressure (BP) and headache in postmenopausal women.MethodsThe postmenopausal women who were admitted to our hospital from January 2015 to December 2019 were screening according to the criteria. Their systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP) were assessed and the information of age, body mass index, smoking status, caffeine consumption, cholesterol levels, and daily alcohol use were collected. Multiple logistic regression model was established to evaluate the association between BP and headache.ResultsA total of 1571 postmenopausal women were included in the analysis, including 953 headache-free population and 618 headache participants during the studied periods. We found that increasing SBP and PP were associated with the lower occurrence of migraine, tension-type headache (TTH), probable migraine, and unclassified headache (P < 0.05). However, there was a negative association between DBP levels and the new occurrence of overall headache, but we did not find any relations of DBP with any subtypes of headache.ConclusionThere were negative associations of SBP and PP with new occurrence of headache, especially migraine and TTH, but there is no relationship between DBP and the subsequent development of headache.

Çocuk ve Ergenlerdeki Baş Ağrılarının Vitamin B12 Düzeyleri ile İlişkisi Var mı?

Objective: Primary headaches are common and benign discomforts both in children and adolescents. However, they have a negative influence on the quality of life. This retrospective study aimed to determine the relationship between vitamin B12 results and primary headaches in Turkish children. Methods: Demographical features, headache types, laboratory results, including vitamin B12, were assessed retrospectively. Headache types were categorized as tension-type headache, migraine, and unclassified headache according to the International Classification of Headache Disorders-beta version (ICD-3 beta). Patients with seconder headaches, anemia, and macrocytosis were excluded. Results: The study group consisted of 133 (86 female, 47 male) patients with headache and a control group of 103 (57 female, 46 male) healthy children. There was no significant difference in terms of age and gender between groups (p&gt;0.05). Vitamin B₁₂ levels in tension-type headache, migraine, and unclassified headache groups were significantly lower (p&lt;0.0001) than in the control group. Logistic regression has identified lower vitamin B12 levels than 400 pg/ml as an independent risk factor for headache (OR: 3.212, 95% CI: 1.850-5.576). Conclusion: We conclude that lower vitamin B12 levels than 400 pg/mL may be associated with tension-type headache, migraine, and unclassified headache.

Migraine, obesity and body fat distribution \u2013 a population-based study

BackgroundObesity has been linked to an increased prevalence of migraine, and to increased migraine attack frequency, but several questions are left unanswered by previous studies. We examined the relationship between obesity and headache in a large, population-based study where we could take into account body fat distribution, migraine subtypes and tension-type headache.MethodsThe third population-based Nord-Trøndelag Health Study (HUNT3) included validated headache questionnaires and objective anthropometric measurements. Using a cross-sectional design, our sample consisted of 18,191 women and 14,985 men, aged 19 to 96 years. Of these 4290 (12.9%) had migraine, 4447 (13.4%) had frequent tension-type headache (TTH), and 24,439 were headache-free controls. A total of 5049 individuals with unclassified headache were excluded from the analyses. Using logistic regression, we modeled the association between obesity and headache prevalence, adjusting for relevant confounders.ResultsBoth total body obesity (TBO) and abdominal obesity (AO) were associated with a higher prevalence of migraine when compared to headache-free controls (OR 1.45 95% CI 1.32–1.59 and OR 1.29 95% CI 1.18–1.41, respectively), in particular for individuals < 50 years of age (OR 1.74 95% CI 1.54–1.98 and OR 1.89 95% CI 1.69–2.11). Similar results were seen for migraine with and without aura. Similar Overall, a weaker associations were as observed between obesity and TTH. There was a dose-response relationship between obesity categories and increased headache frequency in subjects with migraine. TBO was associated with migraine prevalence and attack frequency independent of AO.ConclusionBoth TBO and AO were associated with migraine prevalence and attack frequency. This association was largely limited to individuals < 50 years of age. TBO, rather than AO, may be a better measure of obesity in relation to migraine.

Prevalence of primary headache disorders among information technology staff in China: the negative effects of computer use and other correlative factors

BackgroundTo date, there have been very few studies that have explored the relationship between headaches and computer use. The chief aim of this study is to investigate the prevalence of primary headache disorders among informational technology staff and identify the potential factors contributing to it.MethodsThis is a cross-sectional study based on annual health checks of employees from the information technology industry. We identified 2216 information technology staff members from Beijing by stratified random sampling who met the inclusion criteria. All participants were initially required to have a physical examination, after which they complete a general situation questionnaire that included a headache screening question. Those who had suffered from headache within the previous year also completed the questionnaire developed by Lifting the Burden. The International Classification of Headache Disorders 3(ICHD-3) criteria was used for the diagnosis of headache.ResultsA total of 2012 valid questionnaires (males, 1544 [76.7%]; females, 468 [23.3%]) were obtained from 2216 participants for a response rate of 90.8%. A total of 619 participants were diagnosed with primary headache, the one-year prevalence of which was 30.8%. Regarding the classification of the primary headache, 152 participants suffered from migraine, with a one-year prevalence of 7.6%; 440 and 27 suffered from tension-type headache and unclassified headaches, with one-year prevalences of 21.9 and 1.3%, respectively. Multivariate regression analysis showed that female gender was a risk factor for migraine and tension-type headache (OR 3.21[95% CI 2.28–4.53] and 1.88[95% CI 1.47–2.40], respectively). Age was also related to migraine and tension-type headache. The 41–50 age group had 2.02 times the probability of migraine, and the 31–40 age group had 1.89 times the probability of tension-type headaches compared to the 18–30 age group. Obesity and excessive computer use (more than 12 h per day) were also factors contributing to tension-type headache (OR: 2.61[95% CI 1.91–3.56] and 1.63[95% CI 1.18–2.25], respectively).ConclusionsThe one-year prevalence of primary headache in this population was 30.8%. The prevalence of tension-type headache in this population was higher than that in the general Chinese population. The occurrence of primary headache is correlated with many factors, among which excessive computer use significantly contributed to the risk of tension-type headache.

Headache at the emergency room: Etiologies, diagnostic usefulness of the ICHD 3 criteria, red and green flags.

IntroductionNon-traumatic headaches account for 0.5 to 4.5% at the emergency department (ED). Although primary headaches represent the most common causes, the likelihood of ominous etiology has to be considered by clinicians in order to avoid diagnostic and therapeutic pitfalls. Due to the absence of biological or imaging findings to diagnose primary headaches we hypothesize ICHD 3(International Headache criteria 3) criteria as a useful tool at the moment to identify and to establish a difference between those patients who are undergoing primary headaches and those who will need advanced diagnostic strategies.ObjectivesTo determine the usefulness of ICHD 3 criteria to differentiate primary from non-primary headaches at the emergency department (ED).MethodsDuring five weeks all the patients complaining of headache attended at the triage unit at the ED were interviewed, examined and classified as having primary or non-primary headaches by means of ICHD 3 criteria. Those patients with primary headaches were treated according to standard of care protocols and followed up by means of phone call communication after 48 hours to assure satisfactory outcome. Those patients classified as having non-primary headaches (secondary headaches and neuralgias) were admitted for additional diagnostic and therapeutic interventions. Between both groups we compared the prevalence of fulfilled criteria for primary headaches and the proportion of traditional red flags such as age, sleep headache onset, associated symptoms, abnormal neurological exam, sudden onset, and nonresponse to analgesics in addition to previous consultation before this evaluation.ResultsHeadache was responsible for 244 (2.3%) out of 10450 admissions at the ED, 77.8% were females. Primary, non-primary (secondary plus neuralgias) and unclassified headaches were 59.4%, 32% and 8.6% respectively. Migraine and cervical myofascial pain were the most frequent etiologies for primary and non-primary causes respectively. Factors associated to non-primary etiologies were immunosuppression (OR: 2.7 IC 95% 2.3–3.3) and age older than 50 (OR: 2.7 IC 95% 2.01–3.62). Abnormal neurological exam, sudden and sleep headache onset were not statistically significant.Factors found to be associated with primary headaches were: fulfilling ICHD 3 criteria (OR: 18.7, IC95% 7.1–48.6), history of migraine (OR: 2.9 IC 95% 2.1–3.9), and history of similar episodes (OR: 2.7 IC 95% 2.3–3.3).ConclusionThis data suggests that fulfilling ICHD 3 criteria could be useful to differentiate primary from non-primary headaches. This observation is also valid for immunosuppression, age older than 50, history of migraine and history of similar episodes.

Headache characteristics in multiple sclerosis

ObjectivesThe aims of this study were to study the prevalence and characteristics of headache in patients with multiple sclerosis and to clarify the relationship between headache and multiple sclerosis therapies. Method782 MS patients were consecutively admitted. All patients filled out a detailed headache questionnaire and 754 patients were included. ResultsOf 754 patients, 515 (68%) reported having headache. According to the International Headache Society criteria, we detected 202 (39%) suffering from migraine, 103 (20%) suffering from tension-type headache and 198 (38%) with medication overuse headache. Twelve patients (2%) had unclassified headache. Three hundred and seventy seven patients (73%) were treated with interferon beta, 81 (16%) with fingolimod, 35 (7%) with teriflunamide and 22 (4%) with natalizumab, respectively.One hundred and one (20%) reported that onset of headache occured prior to onset of multiple sclerosis therapies, while 414 (80%) had headaches occured after therapy. A higher incidence of headache was found in patients treated with interferon beta. We found a significant association between migraine and the age of onset of multiple sclerosis therapies. The age of onset of headache was the earliest in the patients with migraine. In migraine patients, the duration of medication use until the headache onset was the shortest when compared to other headache groups. Four hundred and fifty nine patients (89%) have sought help from a physician because of the severity and frequency of headache. ConclusionIn our study, the prevalence of headache among all multiple sclerosis patients was 68%. The results of this study indicate a possible relationship may exist between headache and multiple sclerosis therapies since 80% of patients described headaches after the onset of treatments. The younger start and the shorter duration of interferon beta use caused the higher incidence of headache, but this correlation was not observed in other drugs. Interestingly, medication overuse headache was far more prevalent in multiple sclerosis patients than in previously reported community populations.

P.025 Is this headache normal?: Assessing electronic referrals for headache from primary care physicians

Background: Headache is one of the most frequent complaints in primary care. We reviewed headache questions submitted to an electronic consultation service in Ontario to classify the types of headaches and describe the questions being asked. We also identified reasons why answers were not retrievable within UpToDate, an online clinical resource. Methods: 65 headache eConsults were further divided into 85 questions and categorized by headache type and question theme. Questions were manually searched within UpToDate to determine if they could be answered using this resource. The intent to refer the patient for a face-to-face referral after the eConsult was collected. Results: The top classifications were migraine, unclassified headache, and exertional and/or coital headache. The themes -identified were medication questions (41.7%), investigation questions (33.3%), clinical concerns despite normal neurologic exam and/or imaging (15.5%); and abnormal imaging findings (9.5%). Answers to 40.1% of the questions were not retrievable in UpToDate. The main reason for irretrievability was an unusual presentation. Only 33.8% of eConsults resulted in a face-to-face referral to a specialist. Conclusions: Although electronic resources may be useful in some cases, clinical nuances cannot be accounted for. By providing physicians with rapid access to specialists, eConsult services may obviate the need for formal, face-to-face referrals.

White matter hyperintensities and headache: A population-based imaging study (HUNT MRI).

To examine the relationship between white matter hyperintensities and headache. White matter hyperintensities burden was assessed semi-quantitatively using Fazekas and Scheltens scales, and by manual and automated volumetry of MRI in a sub-study of the general population-based Nord-Trøndelag Health Study (HUNT MRI). Using validated questionnaires, participants were categorized into four cross-sectional headache groups: Headache-free (n = 551), tension-type headache (n = 94), migraine (n = 91), and unclassified headache (n = 126). Prospective questionnaire data was used to further categorize participants into groups according to the evolution of headache during the last 12 years: Stable headache-free, past headache, new onset headache, and persistent headache. White matter hyperintensities burden was compared across headache groups using adjusted multivariate regression models. Individuals with tension-type headache were more likely to have extensive white matter hyperintensities than headache-free subjects, with this being the case across all methods of white matter hyperintensities assessment (Scheltens scale: Odds ratio, 2.46; 95% CI, 1.44-4.20). Migraine or unclassified headache did not influence the odds of having extensive white matter hyperintensities. Those with new onset headache were more likely to have extensive white matter hyperintensities than those who were stable headache-free (Scheltens scale: Odds ratio, 2.24; 95% CI, 1.13-4.44). Having tension-type headache or developing headache in middle age was linked to extensive white matter hyperintensities. These results were similar across all methods of assessing white matter hyperintensities. If white matter hyperintensities treatment strategies emerge in the future, this association should be taken into consideration.

Headache in Multiple Sclerosis From a Different Perspective: A Prospective Study

Objective: It is known that patients with multiple sclerosis have a high incidence of headache. Although there is increasing evidence to suggest that periaqueductal gray matter (PAG) plays a role in the pathophysiology of migraine headache, it is not known whether the type of headache may be a predictor of a MS relapse. Patients and Methods: The study enrolled 100 patients (68 females, 32 males) with clinically confirmed MS diagnosis established by McDonald diagnostic criteria. The type and duration of MS, MRI localization of lesions and cognitive status were recorded for all patients. Patients were questioned whether they experience headache during MS attacks. Results: Sixty-eight percent of the patients had headache and 32% of the patients were free of headache. Of the patients with headache, 16% had tension –type headache (TTH), 14% had migraine, 11% had primary stabbing headache (PSH), 8% had TTH+ migraine, 6% had PSH+ migraine, 6% had medication overuse headache , 2% had medication overuse headache + migraine, 2% had paroxysmal hemicrania, 1% had cervicogenic headache, 1% had chronic TTH, and 1% had unclassified headache. There was a statistically significant relationship between the presence of headache and MS relapse (p<0.001). We found a statistically significant relationship between the type of headache and the localization of plaques in all MS patients in a statistical analysis using chi-square test, (p<0.001). Conclusion: Headache may be the only symptom of a flare-up in MS patients. The relationship between stabbing headache and MS relapses merits further investigation.

Chronic post-traumatic headache in children and adolescents: systematic review of prevalence and headache features.

The aim of this systematic review is to determine the prevalence and clinical features of chronic post-traumatic headache (CPTH) in children and adolescents. Literature search of PubMed, Embase, Cochrane databases and Google Scholar was carried out for all studies reporting on CPTH in children and young people under the age of 18years between January 1980 and November 2016. Search command included post-traumatic headache, postconcussion syndrome, child and adolescent. Demographic data, diagnostic criteria of headache disorders, occurrence of headache after head injury and headache phenotypes were collected. The prevalence of nonspecific 'chronic headache' after head injury in children was 39% and prevalence of CPTH, as defined by the International Classification of Headache Disorders (2004), was 7.6% (95% CI: 5.9-9.7). Migraine-like headache was the most common presentation followed by tension-type headache. Other children had either mixed or unclassified headache disorders.

Prevalence of primary headache disorders in a population aged 60 years and older in a rural area of Northern China.

BackgroundPrimary headache disorders are among the most common neurological complaints worldwide, and are significant causes of disability. Data are limited on the prevalence of primary headaches among individuals aged 60 years and older in China. The purpose of our study was to investigate the prevalence and characteristics of primary headaches among people aged 60 years and older in a rural area of northern China.MethodsA door-to-door survey was conducted in Ji County of Tianjin Province. A total of 5248 residents aged 60 years and older were visited from 2014 to 2015, unannounced, and basic sociodemographic and headache diagnostic information was collected via a questionnaire. Primary headache was classified tension-type headaches, migraines, chronic headache, and unclassified headache.ResultsThe 1-year prevalence for primary headaches in Ji county is 10.30 %. The 1-year prevalence of tension-type headaches, migraines, chronic headache, and unclassified headache is 2.02 %, 0.85 %, 3.79 %, and 3.63 %. The 1-year prevalence of primary headache was higher in women than in men. The 1-year prevalence of primary headache was decreased with increasing age. The 1-year prevalence of tension-type headaches and chronic headache were decreased with higher education. Headache in the elderly was mild to moderate and not serious.ConclusionsIn a population older than 60 years of age in rural, northern China, we found the 1-year prevalence of primary headache was 10.30 %, of tension-type headaches was 2.02 %, of migraines was 0.85 %, of chronic headache was 3.79 %, and of unclassified headache was 3.63 %. The prevalence of all of these was much lower than those observed in previous studies examining prevalence rates in the general population. The results of our study also indicated that women are more likely to have primary headache than men. We also found that chronic headache was frequent among the elderly. Participants with higher education levels were more predisposed than healthy participants to tension-type headaches. We also found that respondents who did not participate in social activities had a decreased predisposition for primary headache in general, as well as for unclassified headache. Lastly, we found that participants who had heart disease were more likely than healthy participants to experience primary headache, tension-type headache, chronic headache, and unclassified headache.

Prevalence of headache among school children in Polonnaruwa educational zone

Objective: To determine the prevalence of primary headache among school children in the age group of 11-16 years in the Polonnaruwa educational zone. Method: This was a school based cross sectional study. Study population was school children aged 11-16 years in Polonnaruwa educational zone. A self-administered questionnaire was used for screening. In those identified, a clinical examination and second questionnaire were used to collect further data. The diagnosis of migraine and tension type headache was based on the second edition of the International Headache Society’s International Classification of Headache Disorders (ICHD II). Results: A total of 683 students aged 11-16 years were invited to participate in this study out of which 606 responded (88.5%).The median age of the study sample was 13 years (Interquartile range 12-15). There was a slight female predominance (50.7%). Except for 32 (5.3%) students, all others experienced headache at least once in their lifetime and 541 (89.3%) had headache during past 12 months. Recurrent headache for at least for 3 months was reported by 39.8%, and 86.4% (208) of them had presented at least once to the General Hospital Polonnaruwa for evaluation previously. After further evaluation, 194 students were found to have primary headaches and secondary causes were found in the balance 14. The prevalence of migraine in this study sample was 7.8%, with 53.2% having migraine with aura. The prevalence of tension type headache was 2.81%. Majority (67%) of the 194 with primary headache had unclassified headache. Migraine was more common among girls (9.1%) compared to boys (6.4%). However, this observed high prevalence was not statistically significant (p=0.204). Tension and unclassified headaches had no variation according to the age and sex. Conclusions: Primary headaches occurred in 94% of children aged 11-16 years in the Polonnaruwa educational zone. The prevalence of migraine was 7.8%.

Paranasal sinus opacification in headache sufferers: A population-based imaging study (the HUNT study-MRI).

Background The association between headache and paranasal sinus disease is still unclear. Because of symptom overlap, the two conditions are not easily studied on the basis of symptoms alone. The aim of the present study was to investigate whether paranasal sinus opacification on magnetic resonance imaging (MRI) was associated with migraine, tension-type headache (TTH) or unclassified headache. Methods This was a cross-sectional study of 844 randomly selected participants (442 women, age range 50-65 years, mean age 57.7 years). Based on 14 headache questions, participants were allocated to four mutually exclusive groups: migraine, TTH, unclassified headache or headache free. On MRI, opacifications as mucosal thickening, polyps/retention cysts and fluid in the five paired sinuses were measured and recorded if ≥1 mm. For each participant, opacification thickness was summed for each sinus and, in addition, a total sum of all sinuses was calculated. Opacification in each sinus was compared between headache-free participants and the headache groups using non-parametric tests, and the total sum was compared by logistical regression. Results No significant association was found between paranasal sinus opacification and headache in general, nor when headache was differentiated into migraine, TTH and unclassified headache. This was also true in separate analyses of mucosal thickening and fluid and of opacification from each paranasal sinus. Conclusion Migraine, TTH and unclassified headache were found not to be associated with an increased degree of paranasal sinus opacification at MRI.