Prevalence of parafunctional habits and temporomandibular dysfunction symptoms in patients attending a tertiary headache clinic

OBJETIVE: To investigate the most prevalent forms of headache in a tertiary outpatient service, and to assess the frequency of associated parafunctional habits and temporomandibular dysfunction symptoms (TMD). METHOD: All new patients referred to the Headache Outpatient Service in UNIMES during 2008 were prospectively assessed by the neurologist and the dental surgeon. RESULTS: Eighty new patients were assessed; chronic migraine and episodic migraine without aura were the most prevalent conditions, accounting for 66.3% of all cases. There was significantly higher use of analgesics/days for the chronic migraine patients. The prevalence of parafunctional habits was 47.5% and the prevalence of TMD symptoms was 35%. CONCLUSION: The high prevalence of primary headaches, parafunctional habits and TMD symptoms and the inadequate use of analgesic drugs suggest that primary healthcare units need further training in the field of headache and orofacial pain.

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Right-to-left shunt is common in chronic migraine

Cephalalgia ◽

10.1111/j.1468-2982.2009.02002.x ◽

2009 ◽

Vol 30 (5) ◽

pp. 535-542 ◽

Cited By ~ 11

Author(s):

SJ Nahas ◽

WB Young ◽

R Terry ◽

A Kim ◽

T Van Dell ◽

...

Keyword(s):

General Population ◽

Chronic Migraine ◽

Tertiary Care ◽

Episodic Migraine ◽

Diagnostic Interview ◽

Neurological Symptoms ◽

Valsalva Manoeuvre ◽

Clinical Implications ◽

Severity Of Disease ◽

Headache Clinic

Our aim was to determine the prevalence of right-to-left shunt (RtLS) in patients with chronic migraine (CM), and to correlate the presence and grade of RtLS with aura and neurological symptoms, and duration and severity of disease. The prevalence of RtLS in migraine without aura is similar to that of the general population (between 20 and 35%). In migraine with aura, the prevalence is much higher (approximately 50%). The prevalence in CM, with or without aura, is unknown. Consecutive patients between the ages of 18 and 60 years with CM attending a tertiary care specialty headache clinic over an 8-week period were eligible. There were 131 patients in the study. A structured diagnostic interview was performed. Bubble transcranial Doppler with Valsalva manoeuvre determined RtLS presence and grade. Sixty-six percent (86/131) of patients had RtLS, a statistically significantly greater rate than those reported in the general population and in migraine with or without aura ( P < 0.001). There was no difference in RtLS rate or grade between those with and those without aura. Specific headache features and the presence of neurological symptoms were similar between those with and those without RtLS. Compared with both the general population and the episodic migraine population (with and without aura), patients with CM, with or without aura, are more likely to have RtLS. The clinical implications of our findings need to be determined.

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The impact of parental attitudes toward children with primary headaches

Clinical Child Psychology and Psychiatry ◽

10.1177/1359104519838571 ◽

2019 ◽

Vol 24 (4) ◽

pp. 767-775

Author(s):

Devrimsel Harika Ertem ◽

Ayhan Bingol ◽

Busra Ugurcan ◽

Özlem Mercan ◽

Ismail Simsek ◽

...

Keyword(s):

Chronic Migraine ◽

Parental Attitudes ◽

Episodic Migraine ◽

Attitude Scale ◽

Tension Type Headache ◽

Primary Headaches ◽

Scale Scores ◽

Vas Scores ◽

Attitudes Toward Children ◽

Type Headache

There is a lack of data on parental attitudes toward children with primary headaches. The aim of this study is to determine whether there is a relationship between primary headaches and parental attitudes in the pre-adolescent pediatric population. In this cross-sectional study, 195 children with primary headache and 43 healthy children aged 9–16 years were included. A questionnaire for sociodemographic variables, visual analog scale (VAS), Social Anxiety Scale and Depression Inventory for Adolescents and Children, and Parental Attitudes Determining Scale (PATS), which is an attitude measure specifically designed to evaluate psychological adjustment, were administered. Of 195 children (female/male ratio: 89/106, mean age: 12.59 ± 1.09 years), episodic migraine ( n = 90), chronic migraine ( n = 25), and tension-type headache ( n = 80) were evaluated. There was no significant difference among headache groups and healthy subjects in terms of depression, anxiety, and fathers’ attitude scale scores. However, there were significant differences in mean mothers’ attitude scale scores and VAS scores ( p = .002, p = .000). Mean oppressive-authoritarian attitude subscale scores of mothers’ was significantly higher in children with chronic migraine ( p = .000). A relationship between depression and VAS scores among all patient groups was detected ( p = .000). Parental age was negatively related to PATS scores of children with episodic migraine and tension-type headache ( p = .037 and p = .036). Parental attitudes may elevate psychiatric symptoms and influence children’s perception of pain intensity and result in chronification of headache. Our findings support that mothers’ attitude toward children with chronic migraine has strong impacts on the child’s pain experience.

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Prevalence of cranial autonomic parasympathetic symptoms in chronic migraine: Usefulness of a new scale

Cephalalgia ◽

10.1177/0333102415593087 ◽

2015 ◽

Vol 36 (4) ◽

pp. 346-350 ◽

Cited By ~ 29

Author(s):

Nuria Riesco ◽

Angel I Pérez-Alvarez ◽

Laura Verano ◽

Carmen García-Cabo ◽

Juana Martínez-Ramos ◽

...

Keyword(s):

Chronic Migraine ◽

Nasal Congestion ◽

Primary Headaches ◽

Conjunctival Injection ◽

Autonomic Symptoms ◽

Cranial Autonomic Symptoms ◽

Eyelid Oedema ◽

Headache Clinic ◽

First Time ◽

New Criteria

Background Cranial autonomic symptoms (CAS) seem to appear in around half of migraine patients. Objective Our aim was to analyse the prevalence and profile of CAS, mainly of cranial autonomic parasympathetic symptoms (CAPS), in a series of patients with chronic migraine (CM) according the new criteria for autonomic symptoms in the current IHS classification. Patients and methods We recruited consecutive CM patients attending our headache clinic. Five CPAS were surveyed: lacrimation, conjunctival injection, eyelid oedema, ear fullness and nasal congestion. They were graded as 0 (absent), 1 (present and mild) and 2 (present and conspicuous); therefore the score in this CAPS scale ranges from 0 to 10 points. As a cranial autonomic sympathetic symptom (CSAS), we also asked about the presence of ptosis. Results We interviewed 100 CM patients. Their mean age was 45 years (18–63 years); 93 were females. Eighteen had no CAPS, while 82 reported at least one CAPS. There were only six patients with scores higher than 5, the mean and median CAPS being 2.1 and 2, respectively. Prevalence of CAPS was lacrimation (49%), conjunctival injection (44%), eyelid oedema (39%), ear fullness (30%) and nasal congestion (20%). Ptosis was reported by 42. Conclusion These results, by using for the first time an easy quantitative scale, confirm that (mild) CAPS are not the exception but the rule in CM patients. The score in this CAPS scale could be of help as a further endpoint in clinical trials or to be correlated with potential biomarkers of parasympathetic activation in primary headaches.

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Prevalence of right-to-left shunts on transcranial Doppler in chronic migraine and medication-overuse headache

Cephalalgia ◽

10.1177/0333102413497600 ◽

2013 ◽

Vol 34 (1) ◽

pp. 37-41 ◽

Cited By ~ 5

Author(s):

Song Guo ◽

Sarvnaz Shalchian ◽

Pascale Gérard ◽

Michael Küper ◽

Zaza Katsarava ◽

...

Keyword(s):

Chronic Migraine ◽

Transcranial Doppler ◽

Medication Overuse ◽

Medication Overuse Headache ◽

Episodic Migraine ◽

Severe Form ◽

Cross Sectional ◽

Headache Clinic ◽

Chronic Headaches ◽

Chronic Migraineurs

Background It was suggested that right-to-left shunt (RLS) may be highly prevalent in chronic migraine (CM) patients, indicating that patent foramen ovale (PFO) might be an aggravating and chronifying factor of migraine. Since a high proportion of chronic migraineurs also have medication-overuse headache (MOH), one may wonder if they have a more severe form of the disorder and more frequently a PFO. Objective The objective of this study is to determine the prevalence and grade of RLS in patients suffering from CM and MOH. Methods A cross-sectional multicenter study of air-contrast transcranial Doppler was conducted in 159 patients with CM ( n = 57) or MOH ( n = 102) attending a tertiary headache clinic. Results The prevalence of RLS in CM was 37% (11% large shunts) and in MOH patients 31% (13% large shunts). There was no difference between the two groups ( p = 0.49). Conclusion RLS prevalence in CM is within the upper range of those reported in episodic migraine without aura or in the general population, and not higher in MOH. PFO is thus unlikely to have a significant causal role in these chronic headaches.

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Cutaneous allodynia is more frequent in chronic migraine, and its presence and severity seems to be more associated with the duration of the disease

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20170015 ◽

2017 ◽

Vol 75 (3) ◽

pp. 153-159 ◽

Cited By ~ 21

Author(s):

Mariana Tedeschi Benatto ◽

Lidiane Lima Florencio ◽

Gabriela Ferreira Carvalho ◽

Fabíola Dach ◽

Marcelo Eduardo Bigal ◽

...

Keyword(s):

Chronic Migraine ◽

Tertiary Hospital ◽

Episodic Migraine ◽

Symptom Checklist ◽

Cutaneous Allodynia ◽

Migraine Group ◽

Headache Clinic

ABSTRACT Objective To evaluate cutaneous allodynia among patients with chronic and episodic migraine in a tertiary headache clinic. Methods 80 subjects with episodic migraine and 80 with chronic migraine were assessed in a tertiary hospital. The 12-item Allodynia Symptom Checklist/Brazil questionnaire was applied to classify subjects according to the presence and severity of cutaneous allodynia. Results Cutaneous allodynia was identified in 81.3% of the episodic migraine group and 92.5% of the chronic migraine group (p = 0.03). No increased association could be attributed to chronic migraine when adjusted by years with disease (PR = 1.12; 95%CI = 0.99 to 1.27; p = 0.06). The groups also did not differ in the severity of allodynia, and severe presentation was the most frequent. Discussion Both groups seemed to be similarly affected in the cephalic and extracephalic regions, with the same severity. Conclusion Cutaneous allodynia is more frequent in chronic migraine, and its presence and severity seems to be more associated with the duration of the disease.

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Differences in Frontal Lobe Dysfunction in Patients with Episodic and Chronic Migraine

Journal of Clinical Medicine ◽

10.3390/jcm10132779 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2779

Author(s):

Sang-Hwa Lee ◽

Yeonkyeong Lee ◽

Minji Song ◽

Jae Jun Lee ◽

Jong-Hee Sohn

Keyword(s):

Chronic Migraine ◽

Frontal Lobe ◽

Iowa Gambling Task ◽

Medication Overuse Headache ◽

Wisconsin Card Sorting Test ◽

Episodic Migraine ◽

Frontal Lobe Dysfunction ◽

Card Sorting ◽

Cross Sectional ◽

Frontal Lobe Function

Neuroimaging and neuropsychological investigations have indicated that migraineurs exhibit frontal lobe-related cognitive impairment. We investigated whether orbitofrontal and dorsolateral functioning differed between individuals with episodic migraine (EM) and chronic migraine (CM), focusing on orbitofrontal dysfunction because it is implicated in migraine chronification and medication overuse headache (MOH) in migraineurs. This cross-sectional study recruited women with CM with/without MOH (CM + MOH, CM − MOH), EM, and control participants who were matched in terms of age and education. We conducted neuropsychological assessments of frontal lobe function via the Trail Making Test (TMT) A and B, the Wisconsin Card Sorting Test (WCST), and the Iowa Gambling Task (IGT). We enrolled 36 CM (19 CM + MOH, 17 CM–MOH), 30 EM, and 30 control participants. The CM patients performed significantly (p < 0.01) worse on the TMT A and B than the EM patients and the control participants. The WCST also revealed significant differences, with poorer performance in the CM patients versus the EM patients and the control participants. However, the net scores on the IGT did not significantly differ among the three groups. Our findings suggest that the CM patients exhibited frontal lobe dysfunction, and, particularly, dorsolateral dysfunction. However, we found no differences in frontal lobe function according to the presence or absence of MOH.

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Effect of galcanezumab on severity and symptoms of migraine in phase 3 trials in patients with episodic or chronic migraine

The Journal of Headache and Pain ◽

10.1186/s10194-021-01215-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Michael Ament ◽

Kathleen Day ◽

Virginia L Stauffer ◽

Vladimir Skljarevski ◽

Mallikarjuna Rettiganti ◽

...

Keyword(s):

Chronic Migraine ◽

Migraine Headache ◽

Randomized Clinical Trials ◽

Episodic Migraine ◽

Double Blind Study ◽

Double Blind ◽

Prodromal Symptoms ◽

Link Type ◽

Associated Symptoms ◽

Severe Migraine

Abstract Background Galcanezumab, a humanized monoclonal antibody that binds calcitonin gene-related peptide, has demonstrated a significant reduction in monthly migraine headache days compared with placebo. Here, we analyze data from 3 randomized clinical trials (2 episodic trials [EVOLVE-1, EVOLVE-2] and 1 chronic trial [REGAIN]), to examine if galcanezumab also alleviates the severity and symptoms of migraine. Methods The episodic migraine trials were 6-month, double-blind studies in patients with episodic migraine (4–14 monthly migraine headache days). The chronic migraine trial was a 3-month, double-blind study in patients with chronic migraine (≥ 15 headache days per month, where ≥ 8 met criteria for migraine). Patients (18–65 years) were randomized to placebo or galcanezumab 120 mg with a 240-mg loading dose or 240 mg. Patients recorded headache characteristics, duration, severity, and presence of associated symptoms with each headache. The outcomes analyzed were changes from baseline in number of monthly migraine headache days with nausea and/or vomiting, photophobia and phonophobia, aura, and prodromal symptoms other than aura. Additional outcomes analyzed included the number of moderate-to-severe monthly migraine headache days, number of severe migraine headache days, and mean severity of remaining migraine headache days. Change from baseline in the proportion of days with nausea and/or vomiting and the proportion of days with photophobia and phonophobia among the remaining monthly migraine headache days were also analyzed. Results Galcanezumab was superior to placebo in reducing the frequency of migraine headache days with associated symptoms of migraine such as nausea and/or vomiting, photophobia and phonophobia, and prodromal symptoms. Galcanezumab reduced the frequency of migraine headache days with aura in the episodic migraine studies. There was a significant reduction in the proportion of remaining migraine headache days with nausea and/or vomiting for the episodic and chronic migraine studies, and with photophobia and phonophobia for the episodic migraine studies. Galcanezumab was superior to placebo in reducing the number of monthly moderate-to-severe migraine headache days and the overall and monthly severe migraine headache days. Conclusions Galcanezumab reduces the frequency of migraine headache days and can alleviate potentially disabling non-pain symptoms on days when migraine is present in patients with episodic or chronic migraine. Trial registration NCT, NCT02614183 (EVOLVE-1), registered 25 November 2015; NCT, NCT02614196, (EVOLVE-2), registered 25 November 2015; NCT, NCT02614261 (REGAIN), registered 25 November 2015.

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Efficacy and safety of fremanezumab in patients with episodic and chronic migraine with documented inadequate response to 2 to 4 classes of migraine preventive medications over 6 months of treatment in the phase 3b FOCUS study

The Journal of Headache and Pain ◽

10.1186/s10194-021-01279-7 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Messoud Ashina ◽

Joshua M. Cohen ◽

Maja Galic ◽

Verena Ramirez Campos ◽

Steve Barash ◽

...

Keyword(s):

Chronic Migraine ◽

Medication Use ◽

Episodic Migraine ◽

Inadequate Response ◽

Open Label ◽

Double Blind ◽

Moderate Severity ◽

Preventive Medication ◽

Open Label Extension ◽

Acute Headache

Abstract Background Fremanezumab, a fully humanized monoclonal antibody (IgG2Δa) selectively targets the calcitonin gene-related peptide and has proven efficacy for the preventive treatment of migraine. In this study, we evaluated the long-term efficacy, safety, and tolerability of monthly and quarterly fremanezumab. Methods Episodic migraine and chronic migraine patients completing the 12-week double-blind period of the FOCUS trial entered the 12-week open-label extension and received 3 monthly doses of fremanezumab (225 mg). Changes from baseline in monthly migraine days, monthly headache days of at least moderate severity, days of acute headache medication use, days with photophobia/phonophobia, days with nausea or vomiting, disability scores, and proportion of patients achieving a ≥50% or ≥75% reduction in monthly migraine days were evaluated. Results Of the 807 patients who completed the 12-week double-blind treatment period and entered the open-label extension, 772 patients completed the study. In the placebo, quarterly fremanezumab, and monthly fremanezumab dosing regimens, respectively, patients had fewer average monthly migraine days (mean [standard deviation] change from baseline: − 4.7 [5.4]; − 5.1 [4.7]; − 5.5 [5.0]), monthly headache days of at least moderate severity (− 4.5 [5.0]; − 4.8 [4.5]; − 5.2 [4.9]), days per month of acute headache medication use (− 4.3 [5.2]; − 4.9 [4.6]; − 4.8 [4.9]), days with photophobia/phonophobia (− 3.1 [5.3]; − 3.4 [5.3]; − 4.0 [5.2]), and days with nausea or vomiting (− 2.3 [4.6]; − 3.1 [4.5]; − 3.0 [4.4]). During the 12-week open-label extension, 38%, 45%, and 46% of patients, respectively, achieved a ≥50% reduction and 16%, 15%, and 20%, respectively, achieved a ≥75% reduction in monthly migraine days. Disability scores were substantially improved in all 3 treatment groups. There were low rates of adverse events leading to discontinuation (<1%). Conclusion Fremanezumab demonstrated sustained efficacy up to 6 months and was well tolerated in patients with episodic migraine or chronic migraine and documented inadequate response to multiple migraine preventive medication classes. Trial registration ClinicalTrials.gov NCT03308968 (FOCUS).

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