Prevalence of headaches in children in schools: the case of primary schools in Libreville

Objective: To study the prevalence of headaches in schools. Patients and methods: This was a cross-sectional descriptive and analytical study conducted in the ten schools of Libreville, from November 2013 to May 2014. We proceeded by exhaustive recruitment of all the students of the framework, fulfilling the inclusion criteria. We interviewed 5837 school children from 4 to 19 years interviewed and examined children from these schools about Results: The sample consisted of 2076 girls (51.0%) and 2861 boys (49.0%); the sex ratio was 0.96 for girls. Grade 5 students were the most represented. The prevalence of headache was 23.5%; 758 (25.6%) girls were prone to headache compared to 615 (21.5%) boys. The prevalence of headache increased with age, 10.6% at 5 years; 22.5% to 6-10 years; 25.9% to 11-15 years and 30.5% to over 15 years. The cephalalgic students were significantly older, ie 10 ± 2.4 years compared to 9 ± 2.5 years for the healthy students. Absenteeism was the most observed pass-through (68.7%), followed by lack of concentration (34.9%) and repetition (3.1%). Isolated headache accounted for 20.0%, compared to 80.0% of symptomatic headaches with the most commonly found oral lesions. Self-medication was the most common means of management (72.0%), with paracetamol as the molecule of choice (65.4%). Conclusion: Headache is a current symptom that is common and disabling. It constitutes a public health problem and must be investigated and adequately addressed to reduce their negative impact on the student's schooling and social life.

Multidisciplinary Care of Unruptured Brain Arteriovenous Malformations to Improve Symptomatic Headache and the Onset, Progression, and Outcomes of Unruptured Brain Arteriovenous Malformations

Background: Symptomatic headaches attributed to unruptured brain arteriovenous malformations (ubAVMs) are very common and affect patients’ quality life, but multidisciplinary care of ubAVMs to improve symptomatic headache remains unclear. Objective: The objective is to identify the features of symptomatic headaches, and to obtain headache outcomes following multidisciplinary care of ubAVMs, as well as provide background on the natural history of ubAVMs. Study Design: The features of symptomatic headaches and headache outcomes were analyzed in a large cohort of cases after multidisciplinary care of ubAVMs. We have also provided information on the natural history of ubAVMs Setting: This study was conducted at the Department of Neurosurgery of Zhujiang Hospital where 336 patients from 1998 to 2014 were reviewed by a multidiscipline team. Only 124 patients were eligible. Methods: The demographics, clinical features, imaging features, and headache details of eligible patients were reviewed. An 11-point pain scale score was used to assess symptomatic headaches before, during, and after treatment. The headache outcomes, death or stroke, and adverse functional outcomes (modified Rankin Scale score ≥ 2, mRS ≥ 2) were assessed following multidisciplinary care of ubAVMs. Results: Twenty-three (56.1%) of 41 patients had migraine-like headaches located in occipital lobe (P < 0.001), while forty (63.5%) of 63 patients had tension-type-like headaches located in frontotemporal lobe (P < 0.001). For patients with tension-type-like or all types of headache, headache improvement differed between the multidisciplinary group and medical group (87.8% vs. 31.8%, P < 0.001; 85.7% vs. 40.7%, P < 0.001). The risk of death or stroke did not differ between multidisciplinary group and medical group (P = 0.393), whereas the risk of adverse functional outcome (mRS ≥ 2) differed significantly by long-time follow-up (23.0% vs.10.0%, P = 0.022). Limitations: This study provides the initial experience to support multidisciplinary care for ubAVMs to improve symptomatic headaches and patients’ quality life, but based on the retrospective study with inherent limitations, larger samples and multi-center trials are needed on this interesting issue. Conclusions: Occipital ubAVM is more likely to present with migraine-like headache, while frontotemporal ubAVM tends to present with tension-type-like headache. The effectiveness of multidisciplinary care for ubAVM to improve headache has been shown, but the natural history of ubAVM patients with headache remains unclear. Key Words: Unruptured brain arteriovenous malformations, headache, headache improvement, natural history

Hemicrania continua in carotid artery dissection – symptomatic cases or linked pathophysiology?

Background Hemicrania continua (HC) -like headaches have been rarely reported as symptomatic headaches, including cases secondary to cervical artery dissection. Case series We present five cases of HC-like headaches following cervical artery dissection, in three cases with specific indomethacin response. In two cases, comorbidity of fibromuscular dysplasia (FMD) was noted. Conclusion Carotid artery dissection may result in an HC-like headache syndrome. A specific response to indomethacin does not rule out dissection as underlying pathology. Screening for extracranial manifestations of FMD should be considered, especially in middle-aged females.

Prevalence of Headache in Tulp's Observationes Medicae (1641) with a Description of Cluster Headache

In 1641, Nicolaas Tulp, a well-known physician from Amsterdam, published his Observationes Medicae, in which medical knowledge and practice in that period is described in more than 200 systematically organized case histories. Next to symptomatic headaches he mentioned two different types of “recurring headache” based on the characteristics of the pain and reaction to contemporary treatment: migraine and, probably, cluster headache.