Headache characteristics and chronification of migraine and tension-type headache: A population-based study

Cephalalgia ◽  
2010 ◽  
Vol 30 (8) ◽  
pp. 943-954 ◽  
Author(s):  
Sait Ashina ◽  
Ann Lyngberg ◽  
Rigmor Jensen
Keyword(s):  
Chronic Headache ◽  
Clinical Characteristics ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Tension Type Headache ◽  
Primary Headaches ◽  
Headache Attack ◽  
Poor Outcome ◽  
Type Headache

Migraine and tension-type headache (TTH) can increase in frequency and transform from episodic to chronic forms. The process of transformation of these primary headaches is complex and involves multiple risk factors. In this cross-sectional and longitudinal population study, we aimed to investigate the relation of clinical characteristics of primary headaches to poor outcome: new-onset or persistent chronic headache (≥180 days/year). Individuals who had migraine + / − TTH and those who had pure TTH were studied separately. Of 740 individuals who entered this study in 1989, 673 were eligible for follow-up in 2001, and a total of 549 individuals participated in the follow-up study. At baseline in 1989, no difference was found between episodic and chronic migraine headache ( + / − TTH). Duration of headache episodes >72 hours ( p = .002) was associated with pure chronic TTH at baseline in 1989 whereas aggravation of headache by physical activity ( p = .045) was associated with pure frequent episodic TTH. Of 64 subjects with migraine + / − TTH, 12 had a poor outcome in 2001. For pure TTH, of 116 subjects at baseline, 11 had a poor outcome in 2001. Using multivariate logistic regression analysis with adjustment for medication overuse and use of preventive medications, poor outcome of migraine + / − TTH tended to be associated with a baseline pulsating quality and severe intensity of migraine, photophobia and phonophobia, as well as longer duration of an individual headache attack. For pure TTH, unilateral headache, nausea and individual headache attack duration greater than 72 hours was associated with poor outcome. Pooled data univariate analysis revealed that nausea, daily use of acute headache medications, use of headache preventive medications and coexistent headaches were significant predictors of chronic headache in 2001( p<.05). In conclusion, our study demonstrates that certain clinical characteristics of headaches are associated with poor outcome but alone may not predict the chronification of migraine or TTH.

scholarly journals Diagnostic and classification tools for chronic headache disorders: A systematic review

Cephalalgia ◽  
2018 ◽  
Vol 39 (6) ◽  
pp. 761-784 ◽  
Author(s):  
Rachel Potter ◽  
Katrin Probyn ◽  
Celia Bernstein ◽  
Tamar Pincus ◽  
Martin Underwood ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Headache ◽  
Tension Type Headache ◽  
Primary Headaches ◽  
Headache Disorders ◽  
Headache Classification ◽  
Headache Type ◽  
Expert Clinician ◽  
Primary Care Clinicians ◽  
Type Headache

Background or aim Despite guidelines and the International Classification of Headache Disorders (ICHD-III beta) criteria, the diagnosis of common chronic headache disorders can be challenging for non-expert clinicians. The aim of the review was to identify headache classification tools that could be used by a non-expert clinician to classify common chronic disorders in primary care. Methods We conducted a systematic literature review of studies validating diagnostic and classification headache tools published between Jan 1988 and June 2016 from key databases: MEDLINE, ASSIA, Embase, Web of Knowledge and PsycINFO. Quality assessment was assessed using items of the Quality of Diagnostic Accuracy Studies (QUADAS-2). Results The search identified 38 papers reporting the validation of 30 tools designed to diagnose, classify or screen for headache disorders; nine for multiple headache types, and 21 for one headache type only. We did not identify a tool validated in a primary care that can be used by a non-expert clinician to classify common chronic headache disorders and screen for primary headaches other than migraine and tension-type headache in primary care. Conclusions Despite the availability of many headache classification tools we propose the need for a tool that could support primary care clinicians in diagnosing and managing chronic headache disorders within primary care, and allow more targeted referral to headache specialists.

scholarly journals Psychological, clinical, and therapeutic predictors of the outcome of detoxification in a large clinical population of medication-overuse headache: A six-month follow-up of the COMOESTAS Project

Cephalalgia ◽  
2018 ◽  
Vol 39 (1) ◽  
pp. 135-147 ◽  
Author(s):  
Sara Bottiroli ◽  
Marta Allena ◽  
Grazia Sances ◽  
Roberto De Icco ◽  
Micol Avenali ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Odds Ratio ◽  
Chronic Headache ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Tension Type Headache ◽  
Outcome Evaluation ◽  
Type Headache

Aim To identify factors that may be predictors of the outcome of a detoxification treatment in medication-overuse headache. Methods Consecutive patients entering a detoxification program in six centres in Europe and Latin America were evaluated and followed up for 6 months. We evaluated anxious and depressive symptomatology (though patients with severe psychiatric comorbidity were excluded), quality of life, headache-related disability, headache characteristics, and prophylaxis upon discharge. Results Of the 492 patients who completed the six-month follow up, 407 ceased overuse following the detoxification (non overusers), another 23 ceased overuse following detoxification but relapsed during the follow-up. In the 407 non-overusers, headache acquired an episodic pattern in 287 subjects (responders). At the multivariate analyses, lower depression scores (odds ratio = 0.891; p = 0.001) predicted ceasing overuse. The primary headache diagnosis – migraine with respect to tension-type headache (odds ratio = 0.224; p = 0.001) or migraine plus tension-type headache (odds ratio = 0.467; p = 0.002) – and the preventive treatment with flunarizine (compared to no such treatment) (odds ratio = 0.891; p = 0.001) predicted being a responder. A longer duration of chronic headache (odds ratio = 1.053; p = 0.032) predicted relapse into overuse. Quality of life and disability were not associated with any of the outcomes. Conclusions Though exploratory in nature, these findings point to specific factors that are associated with a positive outcome of medication-overuse headache management, while identifying others that may be associated with a negative outcome. Evaluation of the presence/absence of these factors may help to optimize the management of this challenging groups of chronic headache sufferers.

Prevalence and Clinical Characteristics of Headache in Medical Students of the University of Lagos, Nigeria

Cephalalgia ◽  
2009 ◽  
Vol 29 (4) ◽  
pp. 472-477 ◽  
Author(s):  
FI Ojini ◽  
Nu Okubadejo ◽  
MA Danesi
Keyword(s):  
Medical Students ◽  
Prescription Drugs ◽  
Clinical Characteristics ◽  
Tension Type Headache ◽  
Primary Headaches ◽  
Medical Assistance ◽  
Consultation Rate ◽  
History Of ◽  
Type Headache ◽  
The University

We investigated the 1-year prevalence, clinical features and mode of treatment of headache in medical students of the University of Lagos, Nigeria, using a self-administered headache questionnaire. Headache prevalence was 46.0% and was significantly higher in women than in men (62.8% vs. 34.1%). Prevalence of tension-type headache was higher than that of migraine (18.1% vs. 6.4%). Although tension-type headache had a similar prevalence in both sexes (male 17.3%, female 19.2%), migraine was three times more common in women (10.9% vs. 3.2%). A family history of headache was present in 22.0%. Only 4.6% sought medical assistance, whereas 68.2% took non-prescription drugs, mainly simple analgesics. Specific drugs for migraine and tension-type headache were rarely used. In conclusion, 1-year headache prevalence is high among medical students at this university. The low consultation rate and the rarity of usage of specific anti-headache drugs probably reflect inadequacies in the management of primary headaches in this population.

scholarly journals Behavioural Management of Headache Triggers: Three Case Examples Illustrating a New Effective Approach (Learning to Cope with Triggers)

2015 ◽  
Vol 32 (3) ◽  
pp. 202-208 ◽  
Author(s):  
Paul R. Martin ◽  
Moira Callan ◽  
Archana Kaur ◽  
Karen Gregg
Keyword(s):  
Traditional Approach ◽  
Tension Type Headache ◽  
Post Treatment ◽  
Case Examples ◽  
Medication Consumption ◽  
Alternative Approach ◽  
Treatment Changes ◽  
Type Headache ◽  
Behavioural Management

The traditional approach to headache trigger management is to advise avoidance of all triggers, but we have advocated an alternative approach called ‘Learning to Cope with Triggers’ (LCT), in which the objective is to desensitise headache sufferers to some triggers or to build up tolerance for the triggers, using exposure techniques. A recent publication established the efficacy of this approach to trigger management. Reported here are three cases to illustrate how LCT is used in practice. Two cases were male and one was female, with ages ranging from 32 to 67 years. The headache diagnoses were frequent episodic tension-type headache, migraine without aura, and chronic tension-type headache; all had had headaches since childhood/adolescence. The headache triggers that were the focus of the intervention were heat, tiredness, and stress/anger. Post-treatment, changes in the capacity of the triggers to elicit headaches were reported in all three cases. Reductions in headaches from pre- to post-treatment, and from pre- to 4-month follow-up, were: case 1, 69% and 60% respectively; case 2, 76% and 80% respectively; and case 3, 73% and 61% respectively. Decreases in medication consumption, and enhanced self-efficacy were also recorded.

Psychopathology in children and adolescents with primary headaches: Categorical and dimensional approaches

Cephalalgia ◽  
2013 ◽  
Vol 33 (16) ◽  
pp. 1311-1318 ◽  
Author(s):  
Francesco Margari ◽  
Elisabetta Lucarelli ◽  
Francesco Craig ◽  
Maria G Petruzzelli ◽  
Paola A Lecce ◽  
...  
Keyword(s):  
Behavioral Problems ◽  
Child Psychopathology ◽  
Psychiatric Comorbidity ◽  
Primary Headache ◽  
Tension Type Headache ◽  
Emotional And Behavioral Problems ◽  
Control Group ◽  
Primary Headaches ◽  
Healthy Children ◽  
Type Headache

Background Recurrent headache is common in childhood, but there is not a great amount of data on the associations between headaches and psychopathology in children. Objective The aim of this study is to examine the relationships between primary headaches and psychopathology in children, using both the categorical and dimensional assessment. Methods The sample consisted of 70 patients with primary headache compared to a matched sample of 50 healthy children. Psychiatric comorbidity was defined according to the diagnostic criteria of the Diagnostic and Statistical Manual of Disorders. Child psychopathology outcomes were assessed using child- and parent-reported standardized instruments. Results Internalizing and externalizing problems were significantly represented among children with headaches compared to the control group, respectively 63% and 27%, without significant differences between migraine and tension-type headache children. Moreover, a total of 26% of the children with a headache reported psychiatric comorbidity such as anxiety and mood disorders. Conclusion The dimensional approach improves accuracy in the recognition of emotional and behavioral problems compared to the categorical approach; however, the use of both of these approaches could be useful for clinical practice, treatment and research.

scholarly journals Prevalence of Tension Type Headache among Young Adults and Their Gender Difference on Percieved Stress Scale: A Comparative Study

2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Priyanka Yadav
Keyword(s):  
Perceived Stress ◽  
Tension Type Headache ◽  
Primary Headaches ◽  
Second Phase ◽  
Perceived Stress Scale ◽  
Chi Square ◽  
Stress Scale ◽  
Males And Females ◽  
Type Headache ◽  
Tension Type Headaches

Background: Tension-type headaches (TTH), together with migraines, are the most common primary headaches, affecting 80% of the general population. Stress is known to be a contributing factor to chronic tension-type headache (CTH), with research indicating that mental stress is the most commonly reported trigger and aggravating factor of a CTH episode. The study was conducted to find out the prevalence of TTH among youths of 18-25 age reporting frequent headache and to compare the perceived stress level among the diagnosed male and females of TTH. Methods: Perceived Stress Scale (PSS) rating and an IHS (International Headache Society) TTH Diagnostic questionnaire were used in this study. A sample of 150 students including 75 males and 75 females in the age group of 18-25 years complaining of frequent headache were taken from different colleges and universities located in Rewari district of Haryana. In the second phase, only the diagnosed cases of tension type headache participated in the study and fill the perceived stress scale questionnaire. After data collection, analysis of data using SPSS software was done which then further help in testing the hypothesis and extracting the result and inferences. Descriptive analysis of quantitative data expressed as mean and standard deviation. Mean and Chi square test were used for comparison of individual on quantitative parameters between groups. P value < 0.05 was considered statistically significant. Results: The mean age of subjects with TTH was 22.79 ±2.14. Prevalence of TTH among frequent headache sufferers is 68%. Out of 68% TTH cases 66.7% subjects have episodic TTH and 33.3% have chronic TTH. Value of PSS * Gender Pearson chi square is 5.151 at a significance value of .076 and it shows that there would be no significant differences exist between males and females on perceived stress score. Conclusion: TTH is more prevalent among females as compared to males. No significant differences exist between males and females on perceived stress scores.

scholarly journals СОЦІАЛЬНО-ДЕМОГРАФІЧНІ ТА КЛІНІЧНІ ХАРАКТЕРИСТИКИ ПАЦІЄНТІВ З АБУЗУСНИМ ГОЛОВНИМ БОЛЕМ В ПОЄДНАНІ З ХРОНІЧНИМ ГОЛОВНИМ БОЛЕМ НАПРУГИ

2021 ◽  
Vol 25 (3-4) ◽  
pp. 3-7
Author(s):  
М.Ю. Дельва ◽  
І.І. Дельва ◽  
В.А. Пінчук ◽  
Г.Я. Силенко ◽  
А.М. Кривчун
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Abdominal Obesity ◽  
Medication Overuse Headache ◽  
Depression Scale ◽  
Female Gender ◽  
Tension Type Headache ◽  
Primary Headaches ◽  
Exact Test ◽  
Type Headache

Introduction. A study of medication overuse headache (MOH) can define the risk group for MOH in patients with primary headaches. The aim of the research is to study the socio-demographic, clinical and pharmacotherapeutic characteristics of patients with MOH and chronic tension-type headache (CTTH). Material and methods. We examined 28 patients with MOH in combination with CTTH and 34 patients with CTTH. MOH and CTTH were diagnosed according to the International Classification of Headache Disorders 3rd revision. Anxiety and depressive signs were assessed by the Hospital Anxiety and Depression Scale; abdominal obesity was determined using waist circumference. Quantitative values were presented as the median and the interquartile range. Quantitative samples were analyzed according to Mann-Whitney U-test, qualitative samples - according to Fisher's exact test. Differences at p <0.05 were considered significant. Results. Patients with MOH and CTTH had the following characteristics: female gender - 79%, age - 41.0 (33.0-49.5) years, familyless state - 54%, higher education - 25%, employment - 46%, smoking - 43%, anxiety signs - 71%, depressive signs - 75%, cervicalgia - 36%, lower back pain - 61%, arterial hypertension - 21%, diabetes mellitus - 7%, abdominal obesity - 46%, mild traumatic brain injury - 43%, headache intensity - 5.0 (4.0-6.3) points on a visual analog scale, duration of headache attacks - 7.0 (5.0-8.3) hours, age of CTTH onset - 31,5 (23,0-41,0) years, duration of CTTH - 9.0 (6,8-10,3) years, duration of MOH – 15.5 (8.3-20.8) months. Patients with MOH and CTTH compared to patients with CTTH were significantly younger, had a history of traumatic brain injury, had significantly more headache days per month. Patients with MOH and CTTH overused combined analgesics (47%), nonsteroidal anti-inflammatory drugs (32%), triptans with analgesics (21%). Abortive medications had been used on 23.0 (18.0-28.5) days a month, in form of 32.0 (27.3 -41.8) doses a month.

Characteristics of Brain Tumour-Associated Headache

Cephalalgia ◽  
2007 ◽  
Vol 27 (8) ◽  
pp. 904-911 ◽  
Author(s):  
CJ Schankin ◽  
U Ferrari ◽  
VM Reinisch ◽  
T Birnbaum ◽  
R Goldbrunner ◽  
...  
Keyword(s):  
Brain Tumour ◽  
Univariate Analysis ◽  
Positive Family History ◽  
Primary Headache ◽  
Tension Type Headache ◽  
Moderate Intensity ◽  
Secondary Headache ◽  
History Of ◽  
Type Headache

Eighty-five brain tumour patients were examined for further characteristics of brain tumour-associated headache. The overall prevalence of headache in this population was 60%, but headache was the sole symptom in only 2%. Pain was generally dull, of moderate intensity, and not specifically localized. Nearly 40% met the criteria of tension-type headache. An alteration of the pain with the occurrence of the tumour was experienced by 82.5%, implying that the preexisting and the brain tumour headaches were different. The classic characteristics mentioned in the International Classification of Headache Disorders (worsening in the morning or during coughing) were not found; this might be explained by the patients not having elevated intracranial pressure. Univariate analysis revealed that a positive family history of headache and the presence of meningiomas are risk factors for tumour-associated headache, and the use of β-blockers is prophylactic. Pre-existing headache was the only risk factor according to logistic regression, suggesting that patients with pre-existing (primary) headache have a greater predisposition to develop secondary headache. Dull headache occurs significantly more often in patients with glioblastoma multiforme, and pulsating headache in patients with meningioma. In our study, only infratentorial tumours were associated with headache location, and predominantly with occipital but rarely frontal pain.

MO558ROLE OF ANEMIA ON PROGRESSION AND CLINICAL OUTCOMES OF CKD: A PATIENT-LEVEL, RETROSPECTIVE, COHORT ANALYSIS OF A CKD OUTPATIENTS POPULATION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Sara Fernandes ◽  
Beatriz Donato ◽  
Adriana Paixão Fernandes ◽  
Luís Falcão ◽  
Mário Raimundo ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Cohort Analysis ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Multivariate Logistic Regression ◽  
Ckd Progression ◽  
Patient Level

Abstract Background and Aims Anemia is a well-know complication of Chronic Kidney Disease (CKD) and it seems to contribute for deterioration of kidney function. Experimental data suggest that anemia produces hypoxia of tubular cells which leads to tubulointerstitial damage resulting on CKD progression. Other mechanism described is that red blood cells have antioxidant properties that prevent the damage of tubulointerstitial cells and glomerulosclerosis from oxidative stress. There aren’t many observational studies that evaluated the association between anemia and progression of CKD. Therefore, our aim was to evaluate the association of anemia and CKD progression and its association outcomes in an outpatient ND-CKD population. Method We conduct a retrospective, patient-level, cohort analysis of all adult ND-CKD patients evaluated in an outpatient nephrology clinic over a 6 years period. The follow up time was at least 12 months. Anemia was defined according to the WHO definition (hemoglobin [hb] &lt; 13.0 g/dL in men and 12.0 g/dL in women). Progression of CKD was defined by one of the following criteria: decline in eGFR (CKD-EPI) superior to 5 ml/min/1.73 m2/year; duplication of serum creatinine or the need renal replacement therapy. Demographics and clinical data were also accessed. Results Out of 3008 patients referred to the nephrology clinic, 49.9% had anemia (mean age 71.9±15.9 years; 50.4% male; 92% white; mean follow-up time of 2.3±1.2 years). The mean Hb was 11.8 ±1.9 g/dL. Important cardiovascular comorbidities in patients with anemia were arterial hypertension (86.7%), obesity (65.5%), Diabetes Mellitus (DM) (52%) and dyslipidemia (46%). In univariate analysis, mortality was associated with anemia (36.9 vs 13.0%, p&lt;0.001), obesity (30.1 vs 21.8%, p&lt;0.001) and DM (30.1 vs 21.1%, p&lt;0.001). Of the patients with anemia, 738 met the criteria for CKD progression. In univariate analysis, CKD progression was associated with anemia (49.6 vs 43.9%, p=0.002), male gender (49.5 vs 43.6% p= 0.001); DM (49.6 vs 44.8 % p=0.009) and hypertension (47.9 vs 42.3% p=0.0018). In multivariate logistic regression analysis, anemia emerged was an independent predictor of CKD progression (OR 1.435, CI 95% 1.21-1.71, p&lt;0,001). Comparing hb values intervals (hb ≤10g/dl; hb10-12 g/dL; hb ≥12 g/dL), in the multivariate logistic regression analysis, hb ≤10g/dl was not associated with CKD progression and hb value between 10-12 g/dL was associated (OR 1,486, CI 95% 1.23-1.80, p&lt;0,001), when compared with the group with hb ≥12g/dL. In multivariate logistic regression analysis, the independent predictors of mortality were: older age (OR per 1 year increase: 1.048, 95% CI 95% 1.04-1.06, p&lt;0.001); arterial hypertension (OR 0.699 CI 95% 0.51-0.96, p=0.0029); obesity (OR 0.741, CI 95% 0.60-0.91, p=0.004) and hb value (OR per 1 g/dL decrease: 1.301, CI 95% 1.23-1.38, p&lt;0.001). Cardiovascular events were correlated with Hb levels between 10-12 g/dL (univariate analysis: OR 2.021, CI 95% 1.27-3.22, P=0.003), but not with the group with hb≤10 g/dL (univariate analysis: OR 1.837, CI 95% 0.96-3.51, P=0.066), having the group with hb ≥12g/dL was reference. Anemia was strongly associated with hospitalizations (multivariate logistic regression analysis: OR per 1 g/dL of Hb decrease: 1.256 CI 95% 1.12-1.32 p&lt;0.001), and this strong association was also observed on the groups with hb hb≤10 g/dL (multivariate logistic regression analysis: OR 3.591 CI 95% 32.67-4.84 p&lt;0.001) and between 10-12 g/dL (multivariate logistic regression analysis: OR 1.678 CI 95% 1.40-2.02, p&lt;0.001) Conclusion Our study suggests that anemia, at first consultation, increases the risk for rapid CKD progression and global mortality. This study could guide us on the development of futures studies in order to prove if anemia correction can slow the progression of CKD.

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