Evaluation and treatment of headache associated with moyamoya disease – a narrative review

Background Headache in patients with moyamoya disease is an under-addressed topic in the medical literature. Delay in the diagnosis of moyamoya disease or inappropriate treatment of headache could lead to devastating cerebrovascular outcome. With the evolving understanding of moyamoya disease, migraine pathophysiology, and various migraine-specific medications that have become available, it is crucial to provide an updated overview on this topic. Methods We searched PubMed for keywords including moyamoya disease, moyamoya syndrome, headache in moyamoya, surgical revascularization, surgical bypass, migraine and moyamoya, and calcitonin gene-related peptide (CGRP). We summarized the literature and provide a comprehensive review of the headache presentation, possible mechanisms, the impact of various surgical revascularizations on headache in patients with moyamoya disease, and the medical management of headache incorporating novel migraine-specific treatments. Results and conclusion: The most common headache phenotype is migraine; tension-type headache, hemiplegic migraine, and cluster headache have also been reported. Most patients experience improvement of headache after surgical revascularization, though some patients report worsening, or new-onset headache after surgery. Given the complexity of moyamoya disease, careful consideration of different types of medical therapy for headache is necessary to improve the quality of life while not increasing the risk of adverse cerebrovascular events. More prospective studies are warranted to better understand and manage headache in patients with moyamoya disease.

Download Full-text

Abstract WP171: Surgical Strategy And Results Of Additional Bypass For Patients With Moyamoya Disease Refractory To Previous Surgery

Stroke ◽

10.1161/str.44.suppl_1.awp171 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Satoshi Kuroda ◽

Naoki Akioka ◽

Daina Kashiwazaki ◽

Hideo Hamada ◽

Naoya Kuwayama ◽

...

Keyword(s):

Disease Progression ◽

Moyamoya Disease ◽

Bypass Surgery ◽

Posterior Cerebral Artery ◽

Cerebral Hemodynamics ◽

Surgical Revascularization ◽

Surgical Strategies ◽

Cerebrovascular Events ◽

Before And After

Introduction —It is well known that surgical revascularization can improve cerebral hemodynamics and prevent further ischemic cerebrovascular events in moyamoya disease. However, a certain subgroup of patients repeats ischemic attacks even after surgery because of insufficient surgery or disease progression during follow-up periods. Hypothesis —Relevant designs and techniques in additional bypass surgery can resolve ischemic cerebrovascular events in patients with moyamoya disease refractory to previous bypass surgery. Methods —This study included totally 7 patients (9 hemispheres) with moyamoya disease refractory to previous bypass surgery. There were 5 children and 2 adults. They underwent previous bypass surgery in Japan and Europe 6 to 240 months before admission. Based on precise clinical and radiological analysis, cerebrovascular events were considered to occur because of insufficient bypass surgery in 5 patients and disease progression in the ipsilateral posterior cerebral artery in 2. Surgical strategies included wide craniotomy to cover the area where cerebral hemodynamics is still impaired and appropriate bypass procedures such as STA-MCA anastomosis, OA-PCA anastomosis, and indirect bypass. Using [123]I-IMP SPECT or [15]O-gas PET, cerebral hemodynamics was precisely examined before and after surgery Results —Postoperative course was uneventful and cerebral hemodynamics significantly improved in all 7 patients. Postoperative cerebral angiography revealed that additional bypass provided collateral blood flow to ischemic area before surgery. Ischemic cerebrovascular events rapidly resolved in 5 patients and gradually decreased in 2. Conclusion —This study strongly suggests adequate surgical design and procedures can resolve ischemic cerebrovascular events in patients with moyamoya disease refractory to previous bypass surgery.

Download Full-text

A cross-sectional study of pain severity in patients suffering from different types of primary headache in the hospital setting

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20201920 ◽

2020 ◽

Vol 8 (5) ◽

pp. 1740

Author(s):

Sanjay Prasad ◽

Abhay Paliwal ◽

Ram Ghulam Razdan

Keyword(s):

Primary Headache ◽

Cross Sectional Study ◽

Tension Type Headache ◽

Pain Severity ◽

Sectional Study ◽

Headache Disorders ◽

Cross Sectional ◽

Different Types ◽

Type Headache ◽

The Impact

Background: Primary headache disorders including migraine and tension-type headache (TTH) are of great importance to global public health due to its high prevalence, but very few studies have been conducted to know its prevalence and pain severity of different types of primary headache. Aim of this study was to investigate the subtypes and pain severity of different types of primary headache in hospital setting.Methods: This study is a cross-sectional study with 200 sample size. Includes patients with Primary headache in department of Psychiatry, MGMMC, Indore. Patient aged between 18-65 years, both gender. Diagnosis of headache was done clinically in accordance with International Classification of Headache disorders (ICHD- 3). Semi-structured headache questionnaire, Comparative pain scale were used for assessment of samples.Results: Among 200 patients, Tension type headache was 73.5%, Migraine was 22%, Mixed headache was in 4.5% patients. Majority of migraine and mixed headache cases had severe pain at 93.2% & 55.6% respectively. Majority of TTH cases had moderate pain in 42.2% patients.Conclusions: Study has shown assessments of severity of pain, can be used to assess the impact of Primary headache on patient’s quality of life.

Download Full-text

A Single Institution’s Experience of Primary Headache in Children With Celiac Disease

Journal of Child Neurology ◽

10.1177/0883073819873751 ◽

2019 ◽

Vol 35 (1) ◽

pp. 37-41 ◽

Cited By ~ 1

Author(s):

Grant L. Hom ◽

Brian L. Hom ◽

Barbara Kaplan ◽

A. David Rothner

Keyword(s):

Celiac Disease ◽

Tissue Transglutaminase ◽

Primary Headache ◽

Tension Type Headache ◽

Gluten Free Diet ◽

Gluten Free ◽

Phone Survey ◽

Type Headache ◽

The Impact ◽

Histologic Changes

Background: Few studies exist examining the frequency of primary headache in children with celiac disease and the impact of a gluten-free diet on primary headache symptomology. This study explores characteristics and frequency of headaches in children with celiac disease and response to gluten-free diet at a single institution. Methods: Medical records were reviewed for children with celiac disease confirmed by the presence of elevated tissue transglutaminase IgA levels and histologic changes consistent with the diagnosis of celiac disease on small bowel biopsy. Eligible participants were contacted via letter for participation in a phone survey regarding headaches. Phone interviews were conducted 2 weeks after notification and lasted approximately 10 minutes. Headaches were classified according to ICHD-3 criteria. Results: 247 eligible patients or their families were contacted. A total of 132 (53.44%) agreed to participate. One participant was excluded due to insufficient information provided. Overall, 51 of 131 participants had recurrent headache defined as at least 1 episode per month (39%, 95% confidence interval [CI]: 31%-47%) and 33 had migraine with or without aura (25%, 95% CI: 18%-33%). Twenty-eight had frequent tension-type headache (22%, 95% CI: 15%-29%). Thirty-two participants noted headaches before a confirmed diagnosis of celiac disease. Twenty-two of 32 participants (68.75%) noticed decreased headache frequency or intensity, or both, after starting the gluten-free diet. Conclusion: This study suggests that at least one-third of children and adolescents with celiac disease have recurrent headaches at the time of diagnosis. A gluten-free diet led to improved headache symptomology in a significant number of these patients.

Download Full-text

Effect of episodic tension-type headache on the health-related quality of life in employees of a Brazilian public hospital

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2004000500005 ◽

2004 ◽

Vol 62 (3b) ◽

pp. 769-773 ◽

Cited By ~ 6

Author(s):

Hilton Mariano Silva Jr ◽

Roberta P. Garbelini ◽

Simone O. Teixeira ◽

Carlos A. Bordini ◽

José G. Speciali

Keyword(s):

Public Hospital ◽

Bodily Pain ◽

Tension Type Headache ◽

Control Group ◽

Sf 36 ◽

Related Quality ◽

Health Related ◽

The Difference ◽

Type Headache ◽

The Impact

OBJECTIVE: To evaluate the impact of ETTH on HRQoL in a sample of employees of a Brazilian public hospital. METHOD: Three hundred and sixty Mário Gatti Hospital employees were asked about headache occurrence in the previous 6 months and completed a SF-36 and a pain questionnaires concerning impact of pain (0 to 10 scale) on daily activities, work efficiency, leisure and social activities in previous six months. Two groups were studied: 1. Episodic Tension-type headache group: 127 employees - 81 (63.8%) female and 46 (36.2%), male. 2. Control group: 124, 71 (57.3%) female and 53 (42.7%) male. RESULTS: ETTH had lowers scores than control in all domains of SF-36; in vitality and bodily pain the difference was statistically significant. CONCLUSION: Our results indicate that ETTH suffers have impact on HRQoL predominantly in vitality. Psychological factors associated to pain may explain this finding.

Download Full-text

Excitatory and Inhibitory Purinergic Control of Neck Muscle Nociception in Anaesthetized Mice

Cephalalgia ◽

10.1111/j.1468-2982.2008.01700.x ◽

2009 ◽

Vol 29 (1) ◽

pp. 58-67 ◽

Cited By ~ 15

Author(s):

M Reitz ◽

A Makowska ◽

J Ellrich

Keyword(s):

Experimental Studies ◽

Tension Type Headache ◽

Neck Muscles ◽

Neck Muscle ◽

Dependent Manner ◽

Jaw Opening ◽

Jaw Opening Reflex ◽

Subsequent Activation ◽

Type Headache ◽

The Impact

Tension-type headache is associated with noxious input from neck muscles. Due to the importance of purinergic mechanisms in muscle nociception, experimental studies typically inject α,β-methyleneadenosine 5′-triphosphate (α,β-meATP). In contrast to native adenosine 5′-triphosphate (ATP), α,β-meATP has a narrow receptor profile and remains stable in tissue. The present study administered α,β-meATP or ATP in semi-spinal neck muscles in anaesthetized mice (n = 65) in order to address different effects in neck muscle nociception. The jaw-opening reflex monitored the impact of neck muscle noxious input on brainstem processing. Injection of α,β-meATP induced reflex facilitation in a dose-dependent manner. In contrast, only the lowest ATP dosage evoked facilitation. Preceding P2Y1 receptor blockade revealed facilitation even under high-dosage ATP. Ongoing facilitation after α,β-meATP injection neutralized under subsequent activation of P2Y1 receptors. Results demonstrate opposing excitatory P2X and inhibitory P2Y effects of ATP in neck muscle nociception. These mechanisms may be involved in the pathophysiology of neck muscle pain in man.

Download Full-text

Migraine co-existing tension-type headache and neck pain: Validation of questionnaires

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2015.03.001 ◽

2015 ◽

Vol 8 (1) ◽

pp. 10-16 ◽

Cited By ~ 2

Author(s):

Lotte Skytte Krøll ◽

Catharina Sjödahl Hammarlund ◽

Rigmor Højland Jensen ◽

Gunvor Gard

Keyword(s):

Neck Pain ◽

Content Validity ◽

Tension Type Headache ◽

Face Validity ◽

Life Questionnaire ◽

End Points ◽

Group Interviews ◽

Type Headache ◽

The Impact ◽

Headache And Neck Pain

AabstractBackground and aimMigraine often includes co-existing tension-type headache (TTH) and neck pain (NP). Multiple headache questionnaires assessing headache impact have beendescribed previously; however, none of the existing questionnaires have been designed to cover migraine with co-existing TTH and NP. Therefore a new questionnaire was developed to measure these co-morbidities. The aim was to determine face and content validity of the newly developed questionnaire, “Impact of Migraine, Tension-Type Headache and Neck Pain” (impact M-TTH-NP) and to determine face and content validity of the International Physical Activity Questionnaire (IPAQ short form), Migraine-Specific Quality of Life Questionnaire (MSQ v. 2.1), WHO-Five Well-Being Index (WHO-5), Major Depression Inventory (MDI) and Neck Disability Index (NDI) not yet validated in this target population.Material and methodsThe new multi-dimensional questionnaire “Impact M-TTH-NP” cover pain, triggers, psychosocial, socioeconomic and work related aspects, based on a four-week recall period. The items are rated on an 11-point numeric rating scale with the end points 0 = no impact and 10 = most imaginable impact. Face validity was assessed by migraine patients with co-existing TTH and NP. They were recruited between September 2012 and March 2013 from a tertiary referral headache centre. Nine women with a mean age of 38 years participated in group interviews. The questionnaires were reviewed for relevance and meaningfulness. Content validity was assessed by 13 headache experts. They had worked with headache diseases for an average of 9 (range, 2–38) years. Experts were recruited between August 2012 and October 2012. Nine medical doctors, two physical therapists, one headache nurse and one psychologist (eight women and five men, mean age of 42 years) participated. The experts rated each item of the questionnaires using a four-point Likert scale with the end points 1 = not relevant and 4 = highly relevant. The quantitative measurement of content validity was calculated by the item-level content validity index (I-CVI) and the scale-level content validity average method (S-CVI/Ave). The average deviation (AD) index was used as a measure of interrater agreement.ResultsImpact M-TTH-NP showed acceptable face validity. Of 78 items twelve were revised and one was added based on group interviews and expert review. Seventy-two items (92%) obtained I-CVI≥0.78 (range 0.78–1.00) indicating excellent content validity, 71 items (91%) obtained acceptable AD index. Nine items did not meet either the limit for excellent I-CVI and/or acceptable AD index. The overall S-CVI/Ave was 0.92 indicating an excellent content validity. In addition, four of the five additional questionnaires showed acceptable face validity (MSQ, WHO-5, MDI and NDI) and three showed excellent content validity (WHO-5, MDI and NDI) for patients suffering from migraine and co-existing TTH and NP.Conclusions and implicationsThe impact M-TTH-NP questionnaire showed acceptable face validity and excellent content validity and may be useful when evaluating treatment effect in this target group. The new impact M-TTH-NP questionnaire in combination with the additional questionnaires that together assess pain, triggers, psychosocial and socioeconomic aspects may provide a deeper understanding of the complexity of migraine with co-existing TTH and NP

Download Full-text

Comparison of Children with Migraine and Those with Tension-Type Headache for Psychiatric Symptoms and Quality of Life

Journal of Pediatric Neurology ◽

10.1055/s-0039-1692138 ◽

2019 ◽

Author(s):

Burak Sadettin Açıkel ◽

Ayhan Bilgiç ◽

Hatice Derin ◽

Arzu Eroğlu ◽

Ömer Faruk Akça ◽

...

Keyword(s):

Quality Of Life ◽

Sleep Disturbances ◽

Psychiatric Symptoms ◽

Sleep Onset ◽

Tension Type Headache ◽

Control Group ◽

Healthy Children ◽

Type Headache ◽

The Impact

AbstractThis study compared the severity of depression, anxiety, somatization, anxiety sensitivity, sleep disturbances, and quality of life (QoL) among children with migraine, children with tension-type headache (TTH), and healthy children. A total of 37 children with migraine, 22 with TTH, and a healthy control group (n = 35) participated in this study. Children with migraine exhibited higher depression and somatization and lower QoL scores than those in the control group. General sleep disturbances, bedtime resistance, sleep onset delay, sleep duration, sleep anxiety, night wakings, sleep-disordered breathing, and daytime sleepiness scores were also higher in those in the migraine group than in the control group. Regression models indicated that the severity of headache and depression scores significantly affected the QoLs of children with headache disorder as a whole. Migraine is associated with depression, somatization, sleep disturbances, and poor QoL, whereas TTH is associated with only sleep disturbances in childhood. The impact of headache on the QoL occurs mainly through the headache-specific and psychiatric factors.

Download Full-text

Quality of life in adolescents with headache: Results from a population-based survey

Cephalalgia ◽

10.1177/0333102409354389 ◽

2010 ◽

Vol 30 (6) ◽

pp. 713-721 ◽

Cited By ~ 25

Author(s):

Astrid Milde-Busch ◽

Sabine Heinrich ◽

Silke Thomas ◽

Anja Kühnlein ◽

Katja Radon ◽

...

Keyword(s):

Quality Of Life ◽

Chronic Conditions ◽

Population Based ◽

Tension Type Headache ◽

Physical Wellbeing ◽

Type Headache ◽

Stratified Analysis ◽

The Impact ◽

Population Based Survey

The aim of the investigation was to study the impact of headache on quality of life (QOL) in adolescents in a population-based sample ( N = 1047, aged between 13 and 17 years). QOL was assessed using the KINDL-R (Revidierter Kinder Lebensqualitätsfragebogen) questionnaire with its six dimensions. In order to assess potential differences in the impact on QOL according to the type of headache, a stratified analysis was performed. QOL differences compared to the ‘no headache’ group are presented with adjustment for socio-demographic confounders. Headache at least once per month was reported in 48% of the adolescents and accounted for a small but significant reduction of 2.5 points in the total KINDL-R score, which was mainly caused by a reduction in physical wellbeing by 6.8 points. Adolescents with migraine reported higher reductions in physical wellbeing and total QOL than subjects with tension-type headache (TTH). The size of the reduction in QOL scores was small but similar to that observed for other chronic conditions in adolescents. Headache prevention programs might therefore have an impact on QOL in adolescents.

Download Full-text

Headache Associated with Myasthenia Gravis: The Impact of Mild Ocular Symptoms

Autoimmune Diseases ◽

10.4061/2011/840364 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Yoshinori Nishimoto ◽

Shigeaki Suzuki ◽

Kimiaki Utsugisawa ◽

Yuriko Nagane ◽

Mamoru Shibata ◽

...

Keyword(s):

Myasthenia Gravis ◽

Chronic Headache ◽

Female Gender ◽

Tension Type Headache ◽

Outpatient Clinics ◽

Regression Analyses ◽

Ocular Symptoms ◽

Type Headache ◽

The Impact

Myasthenia gravis (MG) patients visiting outpatient clinics frequently complain of headache. However, there have been few reports on the relation between chronic headache and myasthenia gravis (MG). We aimed to investigate whether MG symptoms affect the development or worsening of chronic headache. Among the 184 MG patients who were followed at the MG clinics, tension-type headache was observed in 71 (38.6%) patients and 9 (4.9%) complained of migraine. Twenty-five (13.6%) complained that headache appeared or was exacerbated after the MG onset. The investigation into differences in the clinical characteristics of the MG patients showed that women tended to suffer from MG-associated headache more often than men. Logistic regression analyses revealed that female gender and mild ocular symptoms were independently predictive of headache associated with MG. Our results suggest that treatment of chronic headache should be required to improve the quality of life in MG patients.

Download Full-text