Headache provocation by nitric oxide in men who have never experienced a headache

Introduction In the general population 4% have never experienced a headache. Freedom from headache could be due to distinctive protective mechanisms or a lack of environmental risk factors for headache. Isosorbide-5-mononitrate is an organic nitrate which in the body is metabolised to nitric oxide. The nitric oxide pathway plays a crucial role in the primary headaches. We hypothesized that people who are free from headache are protected by distinctive mechanisms in the nitric oxide pathway. Methods We performed an observer blinded case-control study using nitric oxide to provoke a headache. 32 headache free male participants and 26 randomly selected male controls received 60 mg Isosorbide-5-mononitrate orally on the study day. Participants fill out a headache diary with headache intensity and characteristics until 12 hours after administration of Isosorbide-5-mononitrate. Primary endpoint were areas under the curve of headache intensity score. Results All 58 participants completed the study. There was no significant difference in headache incidence, headache intensity score or migraine-like attack between headache free participants and controls. Conclusion We show that men who have never experienced a headache develop a headache when provoked with Isosorbide-5-mononitrate. This indicates that freedom from headache in men is not related to the nitric oxide pathway which is involved in the primary headache disorders.

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Headache

10.2310/em.4174 ◽

2018 ◽

Author(s):

Benjamin W Friedman

Keyword(s):

Differential Diagnosis ◽

Clinical Characteristics ◽

Sinus Thrombosis ◽

International Headache Society ◽

Primary Headache ◽

Primary Headaches ◽

Key Words Migraine ◽

Secondary Headaches ◽

Primary Headache Disorders ◽

Greater Occipital Nerve

Headaches are one of the most common complaints of patients seen by emergency physicians. They can be classified as primary headaches, which have no identifiable underlying cause, and secondary headaches, which are classified according to their cause. The majority of headaches are benign in origin, and most patients with headache can be treated successfully in the emergency department and discharged home; however, some have potentially life-threatening causes, and consideration of a broad differential diagnosis for all patients is essential. This review covers the primary headache disorders, pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes. The figure shows areas of the brain sensitive to pain. Tables review differential diagnosis of headache, International Headache Society primary headache criteria, clinical characteristics of secondary headaches, high-risk clinical characteristics among patients with a headache peaking in intensity within 1 hour, drugs associated with headache, and parenteral treatment of acute migraine. This review contains 1 figure, 9 tables, and 58 references. Key words: migraine, calcitonin gene related peptide, greater occipital nerve block, venous sinus thrombosis, reversible cerebral vasoconstriction syndrome, Ottawa, subarachnoid, cluster headache, trigeminal autonomic cephalalgias, post-traumatic headache

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Headaches

Oxford Textbook of Pediatric Pain ◽

10.1093/med/9780198818762.003.0032 ◽

2021 ◽

pp. 329-342

Author(s):

Andrew D. Hershey

Keyword(s):

Early Recognition ◽

Primary Headache ◽

Primary Care Providers ◽

School Nurses ◽

Primary Headaches ◽

Care Providers ◽

Primary Headache Disorders ◽

Tension Type Headaches ◽

The Impact

This chapter discusses recurrent headaches, especially when episodic, which are much more likely to represent primary headache disorders. Primary headaches are intrinsic to the nervous system and are the disease itself. Early recognition of the primary headaches in patients should result in improved response and outcome, minimizing the impact of the primary headaches and disability. Primary headaches can be grouped into migraine, tension-type headaches, and trigeminal autonomic cephalalgia, and an additional grouping of rarer headaches without a secondary cause. The primary headache that has the greatest impact on a child’s quality of life and disability is migraine, and subsequently is the most frequent primary headache brought to the attention of parents, primary care providers, and school nurses.

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Brain structure and function related to headache: Brainstem structure and function in headache

Cephalalgia ◽

10.1177/0333102418784698 ◽

2018 ◽

Vol 39 (13) ◽

pp. 1635-1660 ◽

Cited By ~ 6

Author(s):

Marta Vila-Pueyo ◽

Jan Hoffmann ◽

Marcela Romero-Reyes ◽

Simon Akerman

Keyword(s):

Primary Headache ◽

Structure And Function ◽

Affective Processing ◽

Primary Headaches ◽

Headache Disorders ◽

Primary Headache Disorders ◽

Brain Structure And Function ◽

And Function ◽

The Brain

Objective To review and discuss the literature relevant to the role of brainstem structure and function in headache. Background Primary headache disorders, such as migraine and cluster headache, are considered disorders of the brain. As well as head-related pain, these headache disorders are also associated with other neurological symptoms, such as those related to sensory, homeostatic, autonomic, cognitive and affective processing that can all occur before, during or even after headache has ceased. Many imaging studies demonstrate activation in brainstem areas that appear specifically associated with headache disorders, especially migraine, which may be related to the mechanisms of many of these symptoms. This is further supported by preclinical studies, which demonstrate that modulation of specific brainstem nuclei alters sensory processing relevant to these symptoms, including headache, cranial autonomic responses and homeostatic mechanisms. Review focus This review will specifically focus on the role of brainstem structures relevant to primary headaches, including medullary, pontine, and midbrain, and describe their functional role and how they relate to mechanisms of primary headaches, especially migraine.

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Perivascular neurotransmitters: Regulation of cerebral blood flow and role in primary headaches

Journal of Cerebral Blood Flow & Metabolism ◽

10.1177/0271678x17747188 ◽

2017 ◽

Vol 39 (4) ◽

pp. 610-632 ◽

Cited By ~ 6

Author(s):

Simona D Frederiksen ◽

Kristian A Haanes ◽

Karin Warfvinge ◽

Lars Edvinsson

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Environmental Influence ◽

Primary Headache ◽

Brain Regions ◽

Sensory Nerves ◽

Primary Headaches ◽

Headache Disorders ◽

Primary Headache Disorders ◽

The Individual

In order to understand the nature of the relationship between cerebral blood flow (CBF) and primary headaches, we have conducted a literature review with particular emphasis on the role of perivascular neurotransmitters. Primary headaches are in general considered complex polygenic disorders (genetic and environmental influence) with pathophysiological neurovascular alterations. Identified candidate headache genes are associated with neuro- and gliogenesis, vascular development and diseases, and regulation of vascular tone. These findings support a role for the vasculature in primary headache disorders. Moreover, neuronal hyperexcitability and other abnormalities have been observed in primary headaches and related to changes in hemodynamic factors. In particular, this relates to migraine aura and spreading depression. During headache attacks, ganglia such as trigeminal and sphenopalatine (located outside the blood-brain barrier) are variably activated and sensitized which gives rise to vasoactive neurotransmitter release. Sympathetic, parasympathetic and sensory nerves to the cerebral vasculature are activated. During migraine attacks, altered CBF has been observed in brain regions such as the somatosensory cortex, brainstem and thalamus. In regulation of CBF, the individual roles of neurotransmitters are partly known, but much needs to be unraveled with respect to headache disorders.

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Diagnosis and Clinical Management of Headaches

CNS Spectrums ◽

10.1017/s1092852900012153 ◽

1999 ◽

Vol 4 (9) ◽

pp. 32-37

Author(s):

Daniel P. Greenfield ◽

Subramanian Hariharan

Keyword(s):

Clinical Management ◽

International Headache Society ◽

Brain Lesion ◽

Pain Syndrome ◽

Primary Headache ◽

Tension Type Headache ◽

Primary Headaches ◽

Primary Headache Disorders ◽

Primary Disorder ◽

Type Headache

AbstractIn this article, we will first present an overview of the epidemiology and classification of headaches, distinguishing between primary headaches (in which the headache itself is the primary disorder) and secondary headaches (ie, headaches due to an underlying condition, such as a neoplastic and/or space-occupying lesion, a cerebrovascular accident, or other type of structural brain lesion). We will use the current classification system of the International Headache Society, focusing on primary headache disorders (migraine, tension-type headache, cluster headache), which we will discuss from the practical clinical perspectives of diagnosis and clinical management. Throughout this article, we will emphasize the chronicity and periodicity of headaches as a type of chronic pain syndrome.

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Prevalence of Primary Headache Disorders in Kuwait

Neuroepidemiology ◽

10.1159/000478892 ◽

2017 ◽

Vol 48 (3-4) ◽

pp. 138-146 ◽

Cited By ~ 4

Author(s):

Jasem Yousef Al-Hashel ◽

Samar Farouk Ahmed ◽

Raed Alroughani

Keyword(s):

Medication Overuse Headache ◽

Primary Headache ◽

Headache Disorder ◽

Episodic Migraine ◽

Tension Type Headache ◽

Primary Headaches ◽

Primary Headache Disorder ◽

Work Related ◽

Primary Headache Disorders ◽

Kuwaiti Population

Background: Only an insignificant quantum of data exists on the prevalence of primary headaches among those living in Kuwait. We aimed to determine the prevalence of primary headaches among the Kuwaiti population. Methods: This community-based study included Kuwaiti population aged 18-65 years. Using systematic random sampling, data was collected by the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation questionnaire. Responses to the diagnostic questions were transformed into diagnoses algorithmically to confirm the diagnosis of primary headache. Results: A total of 15,523 patients were identified of whom 9,527 (61%) were diagnosed with primary headache disorder; a female predominance of 62.2% was observed. The mean age was 34.84 ± 10.19. Tension-type headache (TTH) was the most prevalent at 29% followed by episodic migraine (23.11%), chronic migraine (5.4%), and medication overuse headache (2.4%). Primary headache prevalence declined steadily from 71% in those aged 18-30 years to 23% in those over 50 (p < 0. 037). The female:male ratio was 1.7:1. Frequency and severity of primary headache were correlated significantly with lost work days (r = 0.611, p < 0.001 and r = 0.102, p = 0.001, respectively). Conclusions. In Kuwait, primary headache disorder is more frequent in young adults and females. TTH followed by episodic migraine were the more prevalent types of headache. Higher frequency and severe headaches were associated with increasing social and work-related burden.

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Primary Headache Disorders at a Tertiary Health Facility in Lagos, Nigeria: Prevalence and Consultation Patterns

BioMed Research International ◽

10.1155/2014/782915 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 13

Author(s):

Olajumoke Oshinaike ◽

Oluwadamilola Ojo ◽

Njideka Okubadejo ◽

Olaitan Ojelabi ◽

Akinola Dada

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Health Facility ◽

Primary Headache ◽

Tension Type Headache ◽

University Teaching ◽

Care Utilization ◽

Primary Headaches ◽

Primary Headache Disorders ◽

Type Headache

Background. Primary headaches are underdiagnosed and undertreated, with a significant impact on social activities and work.Aim.To determine the last-year prevalence and health care utilization pattern of primary headaches at a tertiary centre.Methods.A cross-sectional study was carried out amongst staff of the Lagos State University Teaching Hospital in Lagos, Nigeria. 402 staff members were selected by simple random sampling and administered a detailed structured headache assessment questionnaire. Migraine and tension-type headache were diagnosed according to the criteria of the International Headache Society (2004).Results.The participants comprised 168 males and 234 females. The mean age was36.9±7.9years. The overall headache prevalence was 39.3% with female predominance (P<0.0001). Tension-type headache was the most prevalent at 72.8% and migraine at 18.9%. Unclassifiable headache constituted 8.2%. Migraine headache showed female preponderance (P=0.000). 80.4% of participants did not seek medical consultation compared with 19.6% who did (P=0.000). Of the latter, 83.9% consulted the general practitioner (GP), whilst 16.1% consulted the neurologist.Conclusions.Primary headache prevalence is high in our population. It is not recognised as that requiring care by most of the staff of this tertiary health facility; thus education is required to increase health care utilization.

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Markers of endothelial function in migraine patients: Results from a bi-center prospective study

Cephalalgia ◽

10.1177/0333102414564890 ◽

2014 ◽

Vol 35 (10) ◽

pp. 877-885 ◽

Cited By ~ 4

Author(s):

Marlene Fischer ◽

Charly Gaul ◽

Hind Shanib ◽

Dagny Holle ◽

Lorin Loacker ◽

...

Keyword(s):

Endothelial Function ◽

Cluster Headache ◽

Primary Headache ◽

Tension Type Headache ◽

Healthy Controls ◽

Headache Disorders ◽

Endothelial Markers ◽

Primary Headache Disorders ◽

Significant Difference ◽

Type Headache

Background Numerous studies suggest an increased vascular risk in patients with migraine, in particular in those with aura. A possible link between both conditions might be a dysfunction of the vascular endothelium. This observational study analyzed the endothelial markers angiopoietin-1, angiopoietin-2, Tie-2, sFlt-1 and NT-proBNP for the first time in migraineurs, patients with other primary headache disorders and healthy controls. Methods Patients with episodic migraine with and without aura, episodic cluster headache, tension-type headache and healthy controls were included. Blood samples were obtained during migraine attacks and headache-free periods in migraineurs, in and out of bout in cluster headache and during headache-free periods in tension-type headache and healthy individuals to analyze markers of endothelial function. Results No significant difference in endothelial markers between migraine, other headache disorders and healthy controls was detected. There was no significant difference between migraine attacks and headache-free intervals. Additionally, no distinction could be found between migraine with and without aura. Discussion The endothelial markers analyzed do not display a characteristic pattern in different headache disorders especially migraine compared to healthy controls. The novel findings of our study indicate that factors other than endothelial dysfunction seem to be responsible for the at least statistical association of migraine with vascular disease.

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An Application of a Hybrid Intelligent System for Diagnosing Primary Headaches

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18041890 ◽

2021 ◽

Vol 18 (4) ◽

pp. 1890

Author(s):

Svetlana Simić ◽

José R. Villar ◽

José Luis Calvo-Rolle ◽

Slobodan R. Sekulić ◽

Svetislav D. Simić ◽

...

Keyword(s):

Intelligent System ◽

Primary Headache ◽

Primary Headaches ◽

Headache Disorders ◽

Data Set ◽

Primary Headache Disorders ◽

Hybrid Intelligent System ◽

Ihs Criteria ◽

Tension Type Headaches ◽

Quality Diagnosis

(1) Background: Modern medicine generates a great deal of information that stored in medical databases. Simultaneously, extracting useful knowledge and making scientific decisions for diagnosis and treatment of diseases becomes increasingly necessary. Headache disorders are the most prevalent of all the neurological conditions. Headaches have not only medical but also great socioeconomic significance. The aim of this research is to develop an intelligent system for diagnosing primary headache disorders. (2) Methods: This research applied various mathematical, statistical and artificial intelligence techniques, among which the most important are: Calinski-Harabasz index, Analytical Hierarchy Process, and Weighted Fuzzy C-means Clustering Algorithm. These methods, techniques and methodologies are used to create a hybrid intelligent system for diagnosing primary headache disorders. The proposed intelligent diagnostic system is tested with original real-world data set with different metrics. (3) Results: First at all, nine of 20 attributes – features from International Headache Society (IHS) criteria are selected, and then only five most important attributes from IHS criteria are selected. The calculation result based on the Calinski–Harabasz index value (178) for the optimal number of clusters is three, and they present three classes of headaches: (i) migraine, (ii) tension-type headaches (TTHs), and (iii) other primary headaches (OPHs). The proposed hybrid intelligent system shows the following quality metrics: Accuracy 75%; Precision 67% for migraine, 74% for TTHs, 86% for OPHs, and Average Precision 77%; Recall 86% for migraine, 73% for TTHs, 67% for OPHs, Average Recall 75%; F1 score 75% for migraine, 74% for TTHs, 75% for OPHs, and Average F1 score 75%. (4) Conclusions: The hybrid intelligent system presents qualitative and respectable experimental results. The implementation of existing diagnostics systems and the development of new diagnostics systems in medicine is necessary in order to help physicians make quality diagnosis and decide the best treatments for the patients.

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Preliminary development of a deep learning-based automated primary headache diagnosis model using Japanese natural language processing of medical questionnaire

Surgical Neurology International ◽

10.25259/sni_827_2020 ◽

2020 ◽

Vol 11 ◽

pp. 475

Author(s):

Masahito Katsuki ◽

Norio Narita ◽

Yasuhiko Matsumori ◽

Naoya Ishida ◽

Ohmi Watanabe ◽

...

Keyword(s):

Deep Learning ◽

Natural Language Processing ◽

Natural Language ◽

Language Processing ◽

Primary Headache ◽

Tension Type Headache ◽

Primary Headaches ◽

Primary Headache Disorders ◽

Diagnosis Model ◽

Medical Questionnaire

Background: Primary headaches are widespread and costly public health problems. However, there are insufficient medical resources for their treatment in Japan due to two reasons. First, the numbers of headache specialists and clinics remain insufficient. Second, neurologists and neurosurgeons mainly treat headaches in Japan. However, they mainly work as general stroke neurologists, so they cannot focus on primary headache treatment. To solve these problems, we preliminarily developed a deep learning (DL)-based automated diagnosis model from patients’ Japanese unstructured sentences in the medical questionnaire using a DL framework. We hypothesized that the model would reduce the time and burden on both doctors and patients and improve their quality of life. Methods: We retrospectively investigated our primary headache database and developed a diagnosis model using the DL framework (Prediction One, Sony Network Communications Inc., Japan). We used age, sex, date, and embedding layer made by the medical questionnaire’s natural language processing (NLP). Results: Eight hundred and forty-eight primary headache patients (495 women and 353 men) are included. The median (interquartile range) age was 59 (40–74). Migraine accounted for 46%, tension-type headache for 47%, trigeminal autonomic cephalalgias for 5%, and other primary headache disorders for 2%. The accuracy, mean precision, mean recall, and mean F value of the developed diagnosis model were 0.7759, 0.8537, 0.6086, and 0.6353, which were satisfactory. Conclusion: The DL-based diagnosis model for primary headaches using the raw medical questionnaire’s Japanese NLP would be useful in performing efficient medical practice after ruling out the secondary headaches.

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